What if we were able to identify who is at risk for development of bipolar disorder even before it occurs? What if we were then able to prevent the illness from ever occurring in those lives? What if we could individualize treatment for bipolar disorder according to the precise genes contributing to the person’s disorder? It now appears that with genetic testing, prevention and better treatment may be attainable in the foreseeable future, thanks to a major study funded by the National Institute of Mental Health.

The group of neuroscientists initially gleaned data from genome-wide association research and other results on the activity of genes in humans and animals. Alexander B. Niculescu III, M.D., Ph.D., Indiana University, said, “The process was similar to a Google approach, the more links there are to a page on the Internet, the more likely it is to come up at the top of your search list.” In other words, they looked at genes that had already been identified as contributing to bipolar disorder, in the existing research literature, and prioritized them on the strength of evidence. The investigators were then able to create a genetic map of the disorder, a landmark development.

Further, they investigated how these genes work in tandem. The task of identifying the responsible genes has been an arduous process because hundreds of genes appear to be involved. Dr. Niculescu pointed out that it seems there may be up to ten percent (10%) of the human genome involved in bipolar disorder. Testing is not yet available, but the scientists are planning to develop it.
Researchers involved in the project were from Indiana University’s Medical School - Institute of Psychiatric Research, Scripps Research Institute, the University of California - San Diego, SUNY Upstate Medical University and the National Institute of Mental Health. The study was published this month in the American Journal of Medical Genetics.

©Copyright 2008 by GoodTherapy.org All Rights Reserved. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Jolyn and/or see her GoodTherapy.org Profile.

It has long been known that depression increase the risk of heart disease by as much as 50%. A new study of Veterans in San Francisco indicates that the reason for this may be surprisingly simple: depressed people rarely exercise, and lack of exercise is well-known contributor to heart ailments.

Doctors at the Veterans Affairs Medical Center in San Francisco tracked the behaviors of 1,017 patients with heart disease, and about 10 percent of depressed heart patients had additional heart problems, compared with only 6.7 percent of other patients. That relatively small difference became a 31 percent higher risk of heart problems among the depressed people once confounding variables were removed. However, once the variable of exercise was removed, the difference vanished. Patients who didn’t exercise had a 44 percent higher risk of heart problems, whether or not they were depressed.

Previous studies have pointed to a possible link between antidepressant use and lower heart risk. Dr. Mary A. Whooley, professor of medicine, epidemiology and biostatistics at the University of California, San Francisco, was one of the researchers, and believes the study provides convincing evidence that lifestyle choices are the main factor in depression’s link to heart disease, at least in populations demographically similar to the men in the study - older men with stable coronary disease. But that doesn’t mean these findings easily translate into lowered mortality rates.

“The clinical practice question is a challenging one,” says Dr. Whooley. “It’s easy for us to tell patients to exercise, take their medicines, and refrain from smoking, but actually changing health behaviors is very difficult.”

Click here to contact Daniel and/or see his GoodTherapy.org Profile ©Copyright 2008 by GoodTherapy.org All Rights Reserved. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Daniel and/or see his GoodTherapy.org Profile

A new study at Howard University, Washington, DC, has discovered that having a purpose in life may protect against the potential psychological effects of trauma and be helpful to recovery for those who do develop a trauma-related psychiatric disorder (Alim, Feder & Graves, 2008). Principal investigator, Tanya N. Alim, MD, said the findings show a significant relationship between purpose in life prior to trauma and resilience — lack of development of a psychiatric disorder related to the trauma, and between development of a purpose in life and recovery from psychiatric disorder related to trauma (Cassels, 2008). Study participants were 259 African-Americans who had experienced at least one major traumatic incident in their lives. The study was conducted in order to address the lack of evidence for effective treatment of trauma-related psychiatric disorders.

Published this month in the American Journal of Psychiatry online, study participants were interviewed and categorized into three sub-parts: Forty-seven fell into the resilient sub-group, eighty-five were identified as having recovered from a DSM-IV diagnosis and; one hundred and twenty-seven people were considered currently ill. All study participants were recruited from Howard’s medical services. Investigators looked at mastery and coping strategies, as well as purpose in life.

The resilient sub-group had experienced significantly less trauma in their lifetimes and women pre-dominated the currently ill subgroup, as compared to the other sub-groups. A sense of control, as well as purpose in life, was also found to be significantly related to recovery when the recovered and currently ill sub-groups were compared. More frequent participation in formal religious services was found in the resilient sub-group.

Trauma can result in several different psychiatric disorders, including depression, post-traumatic stress syndrome (PTSD), other anxiety disorders, borderline personality disorder and alcoholism. Study participants who reported a psychiatric disorder had been diagnosed with anxiety, depression and substance-use disorders, with PTSD reported most frequently. PTSD is a type of anxiety disorder. Just nine percent (9%) of the currently ill group had received mental health treatment.

Decisions concerning implications of this study for prevention and treatment of trauma-related psychiatric disorders may be premature at this point. It’s hoped by the investigators that further research will further identify psychosocial factors that are most often linked to resilience and how to effectively integrate these into treatment and prevention efforts.

©Copyright 2008 by GoodTherapy.org All Rights Reserved. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Jolyn and/or see her GoodTherapy.org Profile.

Several studies demonstrate the profound benefit of meditation on emotions, the brain, and mental health. The use of sophisticated technologies has made it possible to prove empirically what many therapists have believed for years – and what Buddhists, Hindus, and other religious and spiritual schools have taught for millennia.

Regular meditation in particular has a measurable effect on a several brain structures related to attention, and can actually change the physical structure of the brain.

In September, a team of Emory University researchers reported that people using Zen Buddhist techniques were much better than control subjects at refocusing their attention on their breath. The study, “‘Thinking about Not-Thinking:’ Neural Correlates of Conceptual Processing During Zen Meditation,” was published in the Internet journal PLoS ONE. Its conclusion that “meditative training may foster the ability to control the automatic cascade of semantic associations triggered by a stimulus and, by extension, to voluntarily regulate the flow of spontaneous mentation,” added force to similar findings at Emory last year.

The same researchers reported in 2007 that frequent meditation over many years actually preserves neurons, often known to laypersons as grey matter. It is normal to lose neurons as we age, and this affects concentration, but Zen practitioners in the Emory study had no detectable loss of grey matter.

“There are a lot of potential applications for this,” said Milos Cekic, one of the researchers. First and foremost, any condition associated with repetitive negative thoughts – such as depression, anxiety, and post-traumatic stress, may be improved through a meditation practice, although it may admittedly be difficult for people suffering from those conditions to muster the strength of discipline to develop such a practice.

Click here to contact Daniel and/or see his GoodTherapy.org Profile ©Copyright 2008 by GoodTherapy.org All Rights Reserved. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Daniel and/or see his GoodTherapy.org Profile

Click here to contact Cedar and/or see her GoodTherapy.org Profile

“The task is to recognize our interdependence, honor boundaries and differences, and remember connectedness.” - Dyrian Benz

“Find the optimum closeness/distance to enable you to experience your OWN unique center of aliveness and awareness, as well as the other’s unique center.” - Mukara Meredith

Good boundaries are a centerpiece for safe and successful relationships. Boundaries are, as well, the space that people consider part of their identity. Skin is the physical boundary. People also have energetic and emotional boundaries. Inadvertent boundary crossings can be very upsetting. Boundaries are very individual, can be negotiated between people, are often communicated non-verbally. They are influenced by cultural values, styles and expectations. Try checking with your clients about precisely what feels to them like the right distance from you. You may be surprised about the amount of variation. Boundaries serve well to provide a consistent container that can define, contain, and limit relationships.

Development of Boundaries

The development of boundaries is a strong aspect of individuation. Boundaries are a fundamental aspect of self-development. Infants are born into a swirling world of new and familiar sensations in which they experience no distinction between self and other—all are merged into one. This is the beginning of the universal and lifelong process of finding a Self. Boundaries define and protect. They allow separation and they can be negotiated to experience the joy of merging. They are both empowering and also provide healthy limits.

Healthy boundary development proceeds through stages briefly described by my Hakomi Method colleague Mukara Meredith as:

1) “Undifferentiated” with the developmental need being to feel welcome and secure in the containment of the caretaker.
2) “Separate But Surrounded” with the developmental need being support and nourishment.
3) “Open Support” with the need for developing autonomy by coming and going from caretaker’s protective presence.
4) “Overlapping” with the need to be able to say no and still belong.
5) “Individuated” with the need to join and separate, and be creative and unique, without fear of loss of love.

Effective boundaries are both secure and flexible. Saying “no” is the simplest form of boundary setting, and may, at times, be necessary to forcefully exert for the protection of clients and others from harm. As a practitioner, you need to be sensitive and responsive to your client’s boundaries, knowing that they may be different from yours.

The 150% equation with boundaries

As the person in the position of greater power and influence, it is your responsibility to set and maintain boundaries. Even though your clients agree to the boundaries you set and often help you in creating the boundaries, you are ultimately responsible for the boundaries. Both you and your clients are responsible for being in right relationship, but you, the practitioner are 150% responsible for both managing the boundaries and repairing them if broken. The 150% equation applies.

Here are some boundary examples in which the power differential can have a significant and harmful impact:

Physical: using touch unconsciously or not attending to spatial boundaries

Emotional: encouraging emotional dependence or being too personally revealing so that your clients feel they must take care of you

Mental: creating a psychologically impactful “smart/dumb” dynamic

Energetic: communicating through one’s energy a more intimate relationship than is real or appropriate

Sexual: becoming intimately involved with your client or encouraging or implying the possibility

Financial: not being clear about your financial contracting or keeping a client longer than they are benefiting from your service

Environmental: not creating a safe, private, and attractive office setting

Social: engaging in or not managing dual relationships

Time: not holding clear time boundaries by being late or going over the time, rushing or being abrupt, or not having or keeping a clear cancellation policy

Role: not owning and skillfully using the power you have

Take a few minutes to reflect on each of these professional boundaries and notice how you are in relation to each one. Pick one of these to work on handling better. Choose a specific and behavioral way you can make some improvement. Arrange to get some feedback from a friend or colleague.

©Copyright 2007 Cedar Barstow, M.Ed., C.H.T. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Cedar and/or see her GoodTherapy.org Profile

A new study from the University of Maryland sociology department provides evidence for what many teachers, parents, and therapists have long suspected: Happy people watch less tv.

John Robinson, UM sociology and the author of the study, and his colleagues relied on 35 years of data collected by the University of Chicago General Social Survey from about 45,000 Americans. The UM study looked at peoples’ level of happiness and then drew correlations with 10 activities, including going to church, visiting friends, reading newspapers and watching television. All of the activities were more likely engaged in by happy people, with the prominent exception of watching tv. In that case, the happiest people watched the least tv, and the least happy people watched the most. The data is correlative, not necessarily causal. Does unhappiness lead to more time in front of the tube, or vice-versa?

“I don’t know that turning off the TV will make you more happy,” Dr. Robinson said. The best predictor of how much time one watches television is whether one is employed. Unemployment can lead to unhappiness, and to more tv time. A controlled study would be very difficult, so causation may never be demonstrated.

Still, the study is certainly an indication that excessive time watching tv will usually be an indicator of dissatisfaction.

Click here to contact Daniel and/or see his GoodTherapy.org Profile ©Copyright 2008 by GoodTherapy.org All Rights Reserved. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Daniel and/or see his GoodTherapy.org Profile

A research report released in late October by the VA (Veteran’s Administration) states that 15% of military personnel who received some medical service from the VA suffered sexual trauma while in Iraq or Afghanistan, according to Reuters. The majority of those who screened positively for sexual trauma were women, one in seven who sought some form of VA service after leaving the military. The VA documented that one percent of men discharged from the military reported sexual trauma. All VA medical service users are screened for sexual trauma, defined as psychological disturbance related to an unwanted sexual advance, including sexual assault and severe sexual harassment.

The study found that this group were one and one-half times more likely to require mental health treatment. Rachel Kimerling of the National Center for Posttraumatic Stress Disorder at the VA Palo Alto Health Care System in California, where the study was conducted, noted that not only can sexual trauma result in post-traumatic stress disorder (PTSD), but also in substance abuse, depression and anxiety.

About 40% of men and women who left the military during the time period following Afghanistan and Iraq war duty sought any type of medical service from the VA. Kimerling is concerned that some discharged veterans may not know they can get effective treatment for sexual trauma through any VA medical center.

This is important information for families of veterans, and psychotherapists, mental health counselors and medical professionals outside of the VA system, too. Families can help their returned veterans get the treatment that might be needed. Mental health and medical practitioners can implement screening for sexual trauma and should know to especially pay attention to the possibility of sexual trauma among women who served in the armed forces in Iraq and Afghanistan.

©Copyright 2008 by GoodTherapy.org All Rights Reserved. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Jolyn and/or see her GoodTherapy.org Profile.

A new study by the MacArthur Foundation contains good news for stressed parents: the Internet, as used by teenagers, does not appear to be as dangerous a place as conventionally assumed in most cases, and may in fact have benefits.

“It may look as though kids are wasting a lot of time hanging out with new media, whether it’s on MySpace or sending instant messages,” said Mizuko Ito, lead researcher on the study. “But their participation is giving them the technological skills and literacy…They’re learning how to get along with others, how to manage a public identity…”

The study began in 2005 and ended this summer, and describes new-media usage but does not measure its effects. However, based on the patterns discovered by the study, enhancement of teen happiness and productivity appears more likely than, for example, sexual predation or exposure to destructive influences.

Vicki Rideout, vice president of the Kaiser Family Foundation told the NY TIMES, “Ethnographic studies like this are good at describing how young people fit social media into their lives. This highlights the need for larger, nationally representative studies.”

Ito, a researcher at the University of California, Irvine, said that some parental concerns “about predators and stranger danger have been overblown. There’s been some confusion about what kids are actually doing online. Mostly, they’re socializing with their friends…”

The study was part of a $50 million project on digital and media learning. More than 800 young people were observed online for more than 5,000 hours. Many restrictions on computer use were reported, but teens usually found ways to communicate with friends despite the rules, often spending time on sites when they weren’t supposed to. “Teens usually have a ‘full-time intimate community’ with whom they communicate in an always-on mode via mobile phones and instant messaging,” the study said.

What they didn’t generally do is view sites that were entirely prohibited or inappropriate.

Online socializing was the most common activity, but many young people spent time looking for information online, customizing games or experimenting with digital media production.

“New media allow for a degree of freedom and autonomy for youth that is less apparent in a classroom setting,” the study said. “Youth respect one another’s authority online, and they are often more motivated to learn from peers than from adults.”

Click here to contact Daniel and/or see his GoodTherapy.org Profile ©Copyright 2008 by GoodTherapy.org All Rights Reserved. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Daniel and/or see his GoodTherapy.org Profile

Click here to contact Sherry and/or see her GoodTherapy.org Profile

If you are like most people, you are feeling the effects of the economy. The fears of a failing economy, fallen house prices, banks going out of business, and high gas prices cannot be alleviated by an “economic rescue package.” What most people are needing is instead, a “mental health rescue package.” My private practice has never been busier and the issue du jour is anticipatory anxiety over an uncertain financial marketplace. Perhaps our parents and grandparents can remember days gone by of soup kitchens and people throwing themselves out of tall buildings because of the depression. I don’t know if we are not that far off from similar desperate measures due to desperation in these frantic times.. Certainly, my associates are seeing more depression and signs of helplessness and hopelessness with their clients. If managing stress was the buzz before the economic downturn, it is most definitely needed in today’s financially disastrous times.

Some people get confused with the differences between pressure and stress. Pressure is what is happening to you, while stress is how you react to those pressures. Stress is composed of the thoughts that we believe are happening, although there is not always any reality related to those thoughts. For example, you may have a boss that is in a bad mood but you instantly believe he is going to fire you and that may not be necessarily true. Therefore, be careful what you think because that may be what is causing you unnecessary stress in your daily life.

There are various different types of stressors such as financial stress, marital stress, mental, and physical stress. The following are tips to help you cope with the various stress plaguing your serenity and peace of mind.

FINANCIAL STRESS

Try to do an assessment of where you stand financially. Ask yourself where is your money? Do you need assistance from a trusted financial advisor?

Limit your exposure to media coverage about the failing economy.

Make sure that all your bank accounts are covered by the FDIC – Federal Deposit Insurance insures deposits up to $100,000.00.

Be extra wary of financial scams that promise instant high returns.

Talk with your creditors if you are having trouble making your monthly bills and ask if they can be made into smaller payments.

Learn if there are financial assistance programs available to you such as Federal and state programs.

MARITAL STRESS

Before you get married, made sure you share similar values around financial issues such as investments, vacations, keeping a budget, and standard of living goals.

Decide if it is more conducive to have separate or joint accounts. For marriages later in life, separate accounts can protect the assets you have accumulated before you got married.

Figure out who is going to pay the bills and how you want to divide them.

Don’t make impulsive decisions without communicating with your partner. Remind each other you are in this together.

Don’t do the escape and avoidance tactic because most likely you will incur more debt.

Don’t keep secrets about how you both are spending and earning your money because this will erode trust.

Stop bailing out your grown children because this only enables their irresponsible behavior.

MENTAL STRESS

Don’t use buying something new as a way to improve your mood. Ask yourself if you really need the item?

Try to get perspective on your thoughts and beliefs around money so that you have more clarity.

Avoid compulsive and addictive behavior to cope with your financial problems such as substance abuse, compulsive shopping, gambling, or sex addiction. If you find yourself in trouble with any addictions, seek the proper help.

Don’t compare yourself to what others have. You really don’t know what is going on behind closed doors.

Learn to let go of what you cannot control. Freedom begins when we begin to understand what we can and cannot control.

PHYSICAL STRESS

Take brisk walks.

Meditate focusing on breathing in through your nose and out through your mouth.

Laugh. It does wonders.

Tense and relax various muscle groups.

Use guided visualizations to invoke all your senses.

Take a personal day off from work to just get out of the “doing” and get into the “being.”

Although we are powerless over what goes on in certain outside aspects of our financial lives, there are some things we can control when it comes to our financial success. Remember most financial crises are temporary and that when we are in deep fear, it is most likely un-founded, but only feels real in the moment. If we can reframe our negative thoughts to positive ones, our fears lessen allowing us to make better financial decisions today for a more thriving tomorrow.

©Copyright 2008 by Sherry Gaba, LCSW. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Sherry and/or see her GoodTherapy.org Profile

Click here to contact Aylee and/or see her GoodTherapy.org Profile

In the world of western psychotherapy “Body Oriented Psychotherapy” appears to be a new trend. But in reality Body-Psychotherapy dates back to the days of Sigmund Freud. Body-Psychotherapy was pioneered by Wilhelm Reich, who lived from 1897-1957. Reich grew up on a farm in what is now the Ukraine. He was tutored at home and spent most of his time outside. He was a natural scientist, known to experiment with breeding insects and animals as a child. He fled his home in 1914 because of WWI. After the war He went to medical school and by 1920 he was active in Freud’s inner circle and considered one of Freud’s most promising students. By 1922 he had his own “bio-psychiatry” practice and was an astute researcher and lecturer.

At this time Freud was hypothesizing that “neurosis” was caused by denial of our natural sexual instincts which leads to frustration. He called this sexual energy “libido”. It is well known that Freud later diluted this idea, in part because of his reaction to patients telling him about sexual abuse, and because of the complicated social implications of the discovery.

Meanwhile, Reich was conducting experiments that led him to conclude that life energy can be qualitatively measured in the body and that the natural build-up and discharge of this energy heightens one’s sense of well-being. Or, if it is frustrated, it can lead to the development of physical armoring and psychological problems. Reich was able to confirm the existence of this biological energy (which is more than sexual excitation) that he called “orgone energy” in the human body. He also verified its presence in the earth’s atmosphere; he developed instrumentation to observe and collect it in plants, and he harnessed it for a variety of purposes. It is because of Reich’s work that science made progress in areas such as cancer treatment, motor power and weather experimentation. But Reich’s passion and his life study was human behavior.

Reich finally split from Freud when Freud, having recanted the libido theory, developed the notion of the “death instinct”, the idea that human suffering is inevitable and therefore there is a natural tendency for self-destruction. Reich felt instead that there is a natural tendency for healing and growth. He believed that the system turns against itself only when it becomes frustrated through inability to express or to get what it needs for survival. People develop patterns of blockages in the body based in part on genetics but also because of the developmental stage he is in when major holding patterns, or frustrations, first occur.

Two psychiatrists, Alexander Lowen and John Pierrakos, continued the development of Reich’s work creating Bio-energetics. Pierrakos eventually added a Spiritual component to the work and called it Core Energetics which, here on the West Coast, is evolving into the more subtle work that I do, called Core Evolution. There are now several body-oriented modalities practiced. Another paper will cover the variety of body oriented and somatic therapies currently available, but his particle article will describe the work that has grown directly out of Reich’s discoveries.

The principle is that our early experiences leave us with images that are generalized into our world view when we are children. These dictate what we believe about the world and how we fit into it. Energy that is held back, not expressed, from these early experiences remains trapped in the biological system so that we are bumping up against it again and again throughout our life. Core Energetic/ Evolution treatment is based on accessing this energy and allowing it to flow again while simultaneously dissolving the old image and freeing the person to live in and react to the present rather than to old expectations and beliefs.

As an example, imagine a baby who is repeatedly left to cry. As long as he can cry for what he needs his energy flows strongly through his body. His growing bones are still soft and when he is left to cry for too long his ribs may spread at the sternum from the exertion. After some time the baby becomes frustrated and the crying takes a different tone, “wah, WAH, WAH”, he demands.

But eventually he becomes exhausted, his voice is hoarse and the crying wanes. Still not getting a response, the infant falls into a state of despair about getting his needs met. He gives up. If this happens regularly the tendency to give up can become hardwired into the body. In some people we can see a caved in place in the middle of the chest. A result for many people is that they are hesitant to ask for what they need. Being quiet can be a compensation to avoid the despair that may be built into the system.

This experience becomes an attitude, part of our character or personality structure. It is maintained as muscle and body structure develops around the physical posture that portrays the attitude. For many reasons these early patterns are perpetuated in a person’s life and this is usually when they seek help from a therapist.

For therapy to work it is important for healing to occur on all levels of the person at once. This means the issue is treated in the body, the mind, the emotions, the behaviors (will) and the spiritual aspect so there is congruence on every level with regards to the issue. It is not enough to just talk and understand your behavior around a certain issues. It may not be enough to understand it and feel your feelings about the patterns; when you really get to the core issue you will also have a physiological change along with an emotional reaction and a new understanding of your choices and reactions. Along with this we do physical exercise to impact the body structure and support the change process.

Many modalities open the energy in the body, or work with the body and the emotions, or work with emotion, thoughts and behavior. They can help for awhile but it is crucial that all 5 levels be addressed for lasting change, otherwise any one of the levels can pull the system back to status quo. In Core Energetic/ Evolution we also use physical exercise to explore the attitudes that we hide from ourselves and from others. When we hide it, it can control us. A part of the therapy is to embrace our deep dark truths and allow them to transform.

Exercises are also used to change the body-structure. The really fun part of this kind of therapy is that there is movement and energy, the client and practitioner don’t just sit and talk and this tends to be energizing and exciting. People often report feeling more alive, more like themselves than they have ever felt before. It inevitably leads to the spiritual aspect, a deepening respect for all of life that impacts how we go about in the world .

While many practitioners are body-oriented because they bring attention to certain aspects of the body along with other traditional elements of therapy, body-psychotherapy in its deepest form can fully restore the organism to its natural state of aliveness. When we bring our awareness to how we block our life energy and release these holding patterns, we are better able to maintain this healthy state for the long term. Allowing our life to open and unfold in new ways every day is a truly joyful practice!

©Copyright 2008 by Aylee Welch, LICSW. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Aylee and/or see her GoodTherapy.org Profile

Click here to contact Sarah and/or see her GoodTherapy.org Profile

“When I became a man I put away childish things, including the fear of childishness and the desire to be very grown up.” - C.S. Lewis

After my childhood, then teenage years, my musings and passion for creative writing “grew up,” succumbing to the norms that college and graduate school required. My journals, having unceremoniously insisted that they be my comfort and companion through every experience, were buried under my “adult” responsibilities.

I meant to write and I was inspired to. Nevertheless, I rarely did. My muses stood by, impatiently, in the unemployment line, eagerly waiting for the next job. Mostly, they waited for me to find the “right” time to pit pen to paper. Granted, words would often materialize, unexpectedly, as if apparitions out of thin air. Joyous and full of energy, they eagerly sprung into step, as if dancing around a maypole, circling me in celebration of me joining them. But, there were many times that I consciously ignored them. At least they trusted that I would return to play with them. I did, albeit twelve years later.

As we “grow up” the playful and creative activities we once loved are often the first to be tossed overboard if the ship goes down. Yet, is in the act of playing that you can find what your spirit hungers for. The most playful, creative, inspiring and “childish” activities can offer a life preserver, to carry us from all of those “have to’s.” They ask that we remember what it feels like to have fun and color outside the lines of expectation and judgment.

Writing is good for me; it feeds me. At the same time, perhaps like you, there are so many other things to juggle. This phone call. That person. That deadline. This meeting. You name it; there is always “something” that has to be done. Nevertheless, we should also allow ourselves to do what is playful and nurturing; we need it to find balance in our lives. At the same time, some activities are just good for us, period. Kind of like broccoli, you know? You don’t ask “why,” you just know it is.

“We don’t stop playing because we grow old; we grow old because we stop playing.” - George Bernard Shaw

Play doesn’t need you to find a reason for doing it and actually prefers that you don’t. Play doesn’t want you to “schedule” it in your planner. Play just asks that you open yourself to spontaneous experiences, change your patterns, and seek it out. Allow into your life those experiences that dare you to “get out of your head,” to get back in touch with your body, creativity, and spirit. In other words, shift out of your left brain, and allow your right brain to have some good clean fun.

When I talk with my adult clients about allowing play into their lives, they often reply that they can’t do it. This is often the case, because many never learned how, or felt save enough to play. Perhaps you understand their struggle. Maybe you had to become “a little adult” in your childhood years. If that is the case, please know that play is just as important now, as it was back then. Perhaps you can just try one of these suggestions. Hey, go for broke; try them all!

Here are some of the “playful” suggestions that I offer clients.

•Play Twister with a friend, or loved one.
•Create a collage, painting, or drawing. Stop judging it, please.
•On your way to work, look for a park. Go swing. Yes, before you clock in.
•Read your favorite bedtime story before you go to bed.
•Buy a coloring book. Color in the boldest, most daring colors you can find. Dare to draw outside the lines.
•If you have a child, or children in your life, ask them what how you should play.
•Get a deck of cards. Build the tallest card castle. Break it down, then build it again.
•Think of any nurturing activity that you love doing, and haven’t. Do it, just for today. Try it again.

Personally, my lesson about play was that creative writing needs me as much as I need it; it is my nourishing form of play, one that I had cast aside for too long. Maybe your form of play is waiting for you. Granted, my gut quivered in anticipation when I started to write again, as if a spirited racehorse readying for the gun to fire, anxious to defy the gates that contained it. Nevertheless, when I allowed my imagination to run free, I could no longer write just when I “had to.” I remembered that I could write just because I wanted to play, period. That was, and is, reason enough.

©Copyright 2008 by Sarah Jenkins, MC, LPC. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry.
Click here to contact Sarah and/or see her GoodTherapy.org Profile

New York State has just joined the movement for evidenced-based best practices in a big way. The state is currently developing the Evidence-Based Practice Technical Assistance Center (EBP-TAC) to help upgrade New York State’s mental health services. The State Office of Mental Health (OMH) and Columbia Medical Center’s New York State Psychiatric Institute (NYSPI) are collaborating to “improve mental health services, insure accountability, and promote recovery-oriented outcomes for consumers and families,” according to a press release from (State of New York OMH, 2008). It’s hoped that improved physical health outcomes for people with major mental health disorders, a serious issue, will also be a result.

The Center will offer a broad array of services within New York State, such as clinical training support, public education, consensus-building, outcome evaluation and more. “We know that with appropriate treatment and supports, recovery from mental illness is possible. We also know that there are treatments and interventions that have been documented by scientific research to be effective, but oftentimes they are not being provided to individuals with mental illness,” stated OMH Commissioner Michael F. Hogan, PhD (State of New York, 2008).

So far, the Center has been helping agencies implement Wellness Self Management (WSM), a curricula revised from the SAMHSA-sponsored evidence-based Illness Management and Recovery (IMR) Toolkit which focused on “knowledge about mental illness, reducing relapses and rehospitalizations, coping more effectively and reducing distress from symptoms and using medications more effectively” (SAMSHA, 2003).

The WSM includes a consumer workbook and education for supervisors and clinicians, but these are not yet available online. The good news for practitioners who need help now with clients who have serious mental illnesses is that SAMHSA does have “Recovering Your Mental Health: A Self-Help Guide” and other recovery and wellness resources” online, in addition to several best practice toolkits for this population in downloadable formats.

©Copyright 2008 by GoodTherapy.org All Rights Reserved. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Jolyn and/or see her GoodTherapy.org Profile.

A new study suggests yet another use of cognitive-behavioral therapy (CBT) in helping people change their behaviors, this time in the treatment of smokers who suffer depression after a heart attack and are using tobacco to cope. Smoking is a severe risk factor in cardiac arrest, but quitting can of course be very difficult. CBT plus good social support seems to significantly enhance one’s ability to abstain from tobacco.

Dr. Mickey Trockel of Stanford University Medical School report that CBT alone isn’t generally enough to assist smokers in quitting, but that CBT in the context of a good social support system does greatly improve the chances of people trying to quit smoking.

People with heart disease have higher rates of depression than do the general public, which can make kicking the habit more difficult. In the new study, the researchers examined whether CBT had any effect on smoking in 1,233 patients who had a heart attack and were depressed. Overall, patients who had CBT were no less likely to report smoking than those who didn’t receive therapy. However, those who reported good social support and received CBT quit smoking one third more often than those who did not receive CBT.

“Our findings suggest CBT may have little effect in reducing smoking behavior among a larger population of smokers outside a smoking cessation program,” Trockel and colleagues conclude. “More focused smoking cessation intervention is needed.”

Clinicians using CBT should consider whether their clients have good social support, and should not be surprised if CBT is less effective when social support is not present. Groups that offer both social support and CBT are likely to be very helpful in quitting smoking.

Click here to contact Daniel and/or see his GoodTherapy.org Profile ©Copyright 2008 by GoodTherapy.org All Rights Reserved. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Daniel and/or see his GoodTherapy.org Profile
Therapist Seattle

Today the GoodTherapy.org Team and many GT members enjoyed the third event in our Fall Teleconference Series: ‘Addictions, Compulsions, & Self-Sabotage: A Multi-level Approach to Trauma’s Legacy’ presented by Dusty Miller, Ed.D. Big thank yous to Dusty for presenting on her approach to helping people with trauma.

Dusty Miller, Ed.D. is a psychologist, consultant and writer. She is the Director of the ATRIUM institute in Belchertown, Massachusetts. She is the author of the pioneering book for therapists and consumers on self harm and trauma, Women Who Hurt Themselves (1994; Tenth Anniversary Edition, 2005). Dr Miller’s other books include: Addictions and Trauma Recovery: Healing the Body, Mind and Spirit (2001, co-authored with Dr. Laurie Guidry); Your Surviving Spirit: A Workbook of Spiritual Resources for Coping with Trauma, (2003); Stop Running From Love: 3 Steps to Overcoming Emotional Distancing & Fear of Intimacy, (2008); and numerous journal articles on addictions and trauma, including featured articles in Psychiatric Quarterly and Psychotherapy Networker

Dusty Miller’s approach to addictions, compulsions and self-sabotage has been successfully implemented in a variety of settings, including community centers, hospitals, outpatient clinics, correctional systems, and private practice. Dr. Miller provides training in the U.S. and Canada in trauma and addiction programs. Dr.Miller’s presentations have been hosted by The Hazelden Foundation, The Renfrew Center Foundation conferences, The Annual Psychotherapy Networker Symposium,The New England Institute for Learning seminars (Cape Cod & Santa Fe), and Leading Edge Seminars.

For more information about Dusty and her work, please visit her website: http://www.dustymiller.org/

Thanks to all of you who attended today’s event,
Noah :)

Noah Rubinstein, LMFT
Executive Director
http://www.GoodTherapy.org

Click here to contact Mary Ellen and/or see her Profile
Click here to contact Ed and/or see his Profile

“Two things will be believed about any man whatsoever, and one is that he has taken to drink.” -Booth Tarkington

It isn’t unusual for people to seek treatment for their alcohol abuse problems when divorce is looming on the horizon. Indeed, probably two thirds of our clients come to us with crumbling marriages. What is surprising is that at a few of these clients don’t really have an alcohol problem and many of the rest are abusing alcohol, but aren’t alcoholics.

How does that happen?

Simply put, the treatment industry has promoted a Catch-22 model: if you’re accused of being an alcoholic and you agree, then obviously you are. But if you don’t agree then you still are – you’re just in denial. As Mr. Tarkington observed long ago, it’s a label that can be hurled at anyone and it will stick. And divorcing spouses like to use it just for that reason, it will stick and they will be able to leverage it to get what they want or at least make your life miserable for a while longer.

What is the reality? At a recent conference in western Canada, one presenter after another pointed out what a few of us have known for a long time, most people seeking help with their alcohol problems aren’t alcohol dependent “alcoholics” - they’re alcohol abusers who can be cured. But you won’t hear that if you go looking for help, or, God help you, an honest evaluation.

Why not? Because over 95% of all alcohol treatment programs are based on the assumption that you’re a powerless and diseased alcoholic, or you’re an alcoholic who’s in denial. Regardless, the outcome of any evaluation will be to put you in one of those two categories and “treat” you accordingly. It’s not an attractive prospect for anyone who actually cares about their future.

Options? Your choices are few and far between, and you’re probably in a vulnerable state, too. Not the best circumstances for making life altering decisions. But before you allow yourself to be labeled through a process that has only one outcome and one prescription, protect yourself by doing at least a bit of research.

First, simply go to a few AA meetings. You will know almost immediately whether or not this model will work for you. If it does, then simply continue. You don’t need to waste tens of thousands of dollars on 12 Step based treatment that’s already available to you for free right in your own neighborhood.

Second, if you don’t find yourself at home at these meetings, then there’s little point in going to traditional treatment. Paying to go to meetings isn’t going to make them any more effective – just the opposite. Most treatment programs will also leave you with a permanent, and public, label. That’s something that can come back to haunt you in the future whether you decide to run for public office or buy life or health insurance.

Third, consider the options. Read through the web sites of organizations like Moderation Management ( www.moderation.com ), the Harm Reduction Network (www.hamsnetwork.org ), and GoodTherapy.org for programs and individuals who do not ascribe to traditional – and ineffectual - treatment.

Finally, resist being labeled, demeaned, and railroaded. Regardless of whether you are being smeared, or are abusing alcohol, or are indeed alcohol dependent, you deserve to be assessed and helped with respect, care, competence, and confidentiality. Do not allow yourself to be diminished and manipulated by others’ agendas.

Remember, there are alternatives, and you aren’t powerless.

For more information about Mary Ellen Barnes, Ph.D. & Ed Wilson, Ph.D., MAC visit http://www.non12step.com

©Copyright 2008 Mary Ellen Barnes, Ph.D. & Ed Wilson, Ph.D., MAC. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry.

A new study published in the New England Journal of Medicine supports the effectiveness of combined medication and cognitive-behavioral therapy for children with anxiety. The study, sponsored by the National Institutes of Health, utilized sertraline, which is sold under Pfizer’s brand name Zoloft, to treat a majority of 488 kids, aged 7-17. Some of the subjects also received CBT, and some got CBT alone. The rest were given a placebo

The results were quite convincing. While just under 60% showed improvement with either medications or CBT alone, over 80% improved with combined therapy. Under one quarter showed improvement with a placebo alone.

Zoloft is approved for treating adults with depression or anxiety, but only for treating obsessive-compulsive disorder in children. However, it is often prescribed “off-label” for use with children experiencing all kinds of anxiety disorders, such as separation anxiety, generalized anxiety, and phobias.

The U.S. Food and Drug Administration has recognized a risk of increased suicidal ideation in children, particularly adolescents, who begin taking certain anti-depressants, and in 2004 ordered strict warning labels on such medications. Since then, teen suicides have risen slightly, rather than decreasing. In the new NIH study none of the children attempted suicide, and researchers said they found no significant increase in suicidal thoughts among those taking sertraline.

The new study will likely provide welcomed information for a currently on-going congressional inquiry into ties between drug manufacturers and medical researchers, particularly those studying medications given to children.

The researchers in this new study, led by John Walkup, deputy director of Johns Hopkins’ Division of Child and Adolescent Psychiatry, said Pfizer did provide free samples of Zoloft to be administered, but wasn’t involved in other aspects of the study. The researchers did receive consulting fees from drug companies, including Pfizer, Eli Lilly, Jazz Pharmaceuticals, and GlaxoSmithKline.

Click here to contact Daniel and/or see his GoodTherapy.org Profile ©Copyright 2008 by GoodTherapy.org All Rights Reserved. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Daniel and/or see his GoodTherapy.org Profile
Therapist Seattle

Click here to contact Judith and/or see her GoodTherapy.org Profile

People don’t generally want to look at how politics and psychology are joined. But if we don’t, we will miss the seam that allows us to utilize what is happening in our world for the deepest healing and transformation possible!

When something brings up intense, deep, raw feelings for you . . .
It means something in your past has been triggered.
It means something within you has been evoked.
It is becoming more commonly known in our world that this is true in our personal lives and our professional lives.

For example . . .

If your spouse has a bad day at the office - whether the office is inside or outside the home - and gets frustrated when you ask for something in the evening, it could evoke for you experiences of abuse from your childhood . . . and the feelings you had at that time.

Or . . .

If you have a frustrating night at home - your partner is too busy to spend time with you - you might be super critical of your employees the next day in an unconscious attempt to get back at your partner for “neglecting” you . . . or your parents before that, who perhaps really did neglect you.

Or . . .

If your child has a temper tantrum when you go to take him to nursery school . . . you may feel so out of control that it evokes your being an innocent 2 year old - out of control of your mom, dad, and your own feelings. And you may try to control your child to hold your own feelings at bay.

These are just some of the many examples of what gets triggered and how . . . in our personal and professional lives.

Awhile back I talked about how current day communal events - national events, world events - can evoke feelings from our individual childhoods - and how what gets triggered in us can affect our lives and the life of our world. Here’s the essence of what I said related to 9/11:

It is the night of 9/11. We are all feeling the terror of the attacks by Al Qaeda. But we aren’t all aware that while some of the terror we’re feeling is the very real here and now terror of what happened this morning, an enormous portion of the terror we’re feeling is from our childhood experiences . . . and 99 out of every 100 people don’t even know this. Most people can’t answer or even ask the question . . . Is this terror from today or from once upon a time?

As a result the ancient and the current terrors are enmeshed with each other, you cannot do the work to heal the ancient terror, and you unconsciously move to bury your terror again . . . creating problems in your current life without even being aware of it. For example, instead of feeling the terror of being attacked as a child by your parent, you might defend against it with your anger and escalate your anger to revenge. This affects your own life and the lives of those you are in contact with on a daily basis. But it also affects the life of our country and our world. Imagine if there are millions like you who try to replace the terror with revenge - consciously or unconsciously! Whether you act on it or not, there is revenge in the air. Your feelings of revenge will bring you to support revenge in many forms . . . in the media, in the government, in the military, and more.

9/11 was 7 years ago. We have major events in our world today that are evoking young feelings and experiences, too. A major one of these is the election!

Most people think of the election only as a current event. It’s happening now. But I can tell you from hours and hours of experience with clients, colleagues, friends, and from watching what is going on in the campaign . . . People’s experiences as children are getting evoked big time! (This doesn’t discount whatever is truly here and now. But it surely clouds the picture and makes it hard to know what feelings, thoughts, and sensations are current and what are ancient, from childhood.)

In my practice and workshops, people explore the roots of their “election feelings.” Colleagues talk with me about their own personal election triggers. I share with you some of these discoveries (transformed into fictionalized stories with fictionalized names) . . . to help you as you start to access your own deep feelings about the election.*

Sally grew up in a home where her mother would be very sweet to her, and then suddenly switch and attack her. She made a decision “something good happens - then - something bad happens.” As she has watched the election process, this has been evoked in her over and over again. She’s been on a roller coaster ride as the candidate she supports has risen in the polls and then fallen, been praised and then criticized. And she doesn’t know how to get off the roller coaster! So she wants to disappear into sleep.

For Robert the election with all its fighting, lying, and mean-spiritedness, triggers helplessness, paralysis, powerlessness, and the experience that “there is no one to step in and make it right”. . . which is what he experienced in his home as a child when his parents fought in a similar way.

Jane is terrified by the election. It stirs up her childhood fear that . . . “the people who are unconscious (Mommy and Daddy) won’t wake up and see the truth of the damage they are causing.” And that “there won’t be change.” As a little girl she realized people weren’t paying attention. She wanted to go up to family members, nudge their arm with her hand, and shout “Wake up! Wake up!” But she was afraid to do that. They never did wake up.

In response to the election campaign and the coming election day . . . Susan and Julie both feel a horror that “there is no safe adult in charge” and that there won’t be. Susan’s mom and dad were both alcoholics. One of them raged and attacked when drunk, the other disappeared for days, either in the bedroom or who knew where? Julie’s father abused her mother, who went through life as though she was walking on egg shells, cowering in response to every move, sound, whisper.

Richard’s mom and dad fought, too, but his dad always won. Although Richard is generally a peace-loving guy, without realizing it, he decided the best parent is the strongest one - like his dad. So he’s happy with the candidate who gets the angriest, the meanest, and thinks of that candidate as the most presidential.

Cindy clings to hope for dear life . . . hope that her candidate will win! When she shared what was evoked in her by the election, she said: “He’ll make everyone behave. He’ll make everyone be more like me. And then I can feel safe to be me!” That’s what she hoped her step-father would do when her mother remarried after four years of being alone post- divorce. He would be the good father at last, come to save the day!

Greg is adamant about honesty, publicly. But right underneath his public persona, he votes for lying. His mother lied all the time to protect herself and her kids from her abusive husband. Anything that feels like a threat to Greg - though unconsciously a threat to the boy still alive inside him - warrants lies and deceit of any kind as protection . . . the consequences be damned!

Linda grew up in a house where her parents and older siblings ganged up on her physically, emotionally, and verbally. They were, naturally, bigger than she. She didn’t have a chance. The conclusions, or early decisions, she came to in her childhood are getting triggered in the election. “The bad guys always win. They overpower you, lie about you, and get you to doubt yourself. They make you believe that because you are good, you lose. You really did have a dream - a dream of happiness in the family, fairness, but they rode roughshod over that and laughed at you for having it.”

Arlene’s parents, by their own actions and by their true paranoia “summoned up the lowest, basest fears, the fears of others, masked it in the guise of devotion to a higher purpose, and got away with it.” When she sees the goings on of the election campaign, she is horrified that this is happening not only in her family but in our country.

Albert grew up with parents who loved him dearly, took good care of him, and never wanted him to experience pain. They used every situation to help him process his thoughts and feelings, understand the bigger picture, trust the process, and make everything okay. Albert’s response to the campaign, whether warranted or not, is that everything’s going to work out all right.

Each of these people needs not only to be aware of what is getting triggered from his/her childhood, but also to work with the feelings and early decisions that are part of those ancient experiences. The healing they do will have a huge impact on how they perceive the election and on how they respond to it. The healing they do will have a huge impact on their individual lives, on the life of our country, and on the life of our world.

Now . . . now it’s your turn. What is getting evoked for you by the campaign and the upcoming election?

Imagine . . .

If we each do our own healing work with the roots of what is evoked in us by the election . . .
Through light and through darkness,
We can help to heal our country and our world in a lasting way.

I have been called a dreamer.
I don’t mind. I know I am.
I also know that dreaming is visioning,
a powerful instrument.
So I play my visioning
with the confidence and skill of a musician
filling the world with the music of possibility.

On Tuesday, if you choose to, you will vote. As you go to the polls, you will carry with you, or be driven by, all the feelings inside you that have been stirred and triggered by this election process. The here and now feelings that are part of the current time. And the feelings from long, long ago that are raw, deep, intense, charged . . . and calling for healing.

Part of your task will be to make your choice - from which feelings will you vote?
Will you vote from the feelings of Tuesday or will you vote from the feelings of the child you once were who is still alive within you?
Knowing this, will you work toward healing the child’s wounds so you can tease those wounds and feelings away from the current reality?

And on Wednesday, we will either have a new president or be in some process toward that state. Again, as you go through Tuesday, Tuesday night, and into Wednesday, you will carry with you, or be driven by, feelings from Wednesday and feelings from once upon a time.
Will the outcome of the election trigger you into the child’s reaction?
Will you know what is happening and set out to do the healing?
Or will the outcome be a signal for you of what is truly needed from you in the here and now?

Whatever the outcome, part of your task will be to make your choices, moment by moment.From which feelings will you respond? And what will you do with the feelings evoked from long, long ago?

If you - and we all - utilize this occasion for such consciousness and healing . . . we will co-create a better world.

Many blessings,
Judith

*Examples given with fictitious names . . . and with the permission of the participants.

©Copyright 2008 by Judith Barr, MA, LMHC. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Judith and/or see her GoodTherapy.org Profile

Researchers at Brown University in Rhode Island are reporting that children as young as four can meet criteria for obsessive compulsive disorder (OCD). This condition, associated with anxiety, has been studied in older children and adolescents, but this new study was the largest ever study of OCD in preschool age.

“OCD, if left untreated, can significantly disrupt a child’s growth and development and can worsen as the child gets older,” said Abbe Garcia, PhD, director of the Bradley Hasbro Children’s Research Center (BHCRC) Pediatric Anxiety Research Clinic at Brown, and chief author of the new study. “[E]arly diagnosis and intervention are critical to reducing the severity of symptoms and improving quality of life.”

People are said to suffer from obsessive compulsive disorder when they have repeated, intrusive thoughts which bring fear or anxiety, and they feel compelled to carry out repeated actions in order to manage that anxiety or to avoid imagined harm. Children with OCD can have tremendous difficulty socially, in school, and even at home, as their eccentric behaviors may frustrate well-meaning family members.

The Brown study included 58 children, boys and girls, aged four to eight. Ten had been treated with medication and 13 had received psychotherapy. About two in five was also diagnosed with attention deficit hyperactivity disorder (ADHD) or generalized anxiety disorder (GAD).

Fear of contamination and violent themes involving harm to themselves or their families were common obsessive thoughts in the study. Most children had several obsessions and compulsions, including washing, “checking” (doors, people, objects, etc) and repeating (words or actions). OCD is treatable, and non-medical interventions have shown some success. Medications can be helpful in more severe cases. Helping children healthily manage stress is key.

Click here to contact Daniel and/or see his GoodTherapy.org Profile ©Copyright 2008 by GoodTherapy.org All Rights Reserved. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Daniel and/or see his GoodTherapy.org Profile
Therapist Seattle

Click here to contact Jeanine and/or see her GoodTherapy.org Profile

Part of my job as the Department Head of Social Services when I worked for a skilled nursing facility was to have regular client contact. One morning, I stopped by to see how Mr. and Mrs. Carol (not their real names) were doing. As soon as I stepped in the room I felt I was entering into a combat zone. The couple was sparring loudly about which television program they were going to watch: People’s Court or Sally Jesse Raphael. Not five seconds into the debate, in horror I watched a cup of hot tea, launched by Mr. Carol, fly past my head only to narrowly miss Mrs. Carol, his bride of more than 60 years. Not to be outdone, Mrs. Carol chucked her full tray of gooey hospital food towards Mr. Carol. For someone in her final days of a terminal illness, she surprisingly mustered enough strength to create a giant mess with food landing on the ceiling, windows and walls. Indignant and incensed, I looked at my 90-something year old patients and exclaimed with all the authority a 23 year old might command and said, “You two should be ashamed of yourselves!”

Back in my office, I reviewed the couple’s intake and psychosocial assessments. Their marital history was unremarkable and by all accounts it was a happy liaison. What was up with these two crazy characters? Then it hit me. They didn’t know how to say goodbye to each other. Of course, it is much easier to contemplate leaving someone who is on your last nerve than someone whom you feel a warm fuzzy connection with. I was able to bring this up later with Mr. and Mrs. Carol and they both acknowledged that their bickering the last few weeks had to do with their fears of losing each other.

I certainly understood some of what the Carols were resisting. When I was training to be a psychotherapist, the issue of termination of the client therapist relationship was always a challenging one for me. Most schools of social work and psychology suggest that termination isn’t something that you discuss with a client a few weeks before the psychotherapeutic relationship ends, but in fact from the beginning. I often found myself resisting this discussion with clients until midway through the treatment process, which never served myself or the client. Eventually, I learned to bring up termination at the beginning of the process and found that this discussion helped the client to have more clarity regarding the beginning, middle and ending of treatment. The timely discussion gave them time to emotionally prepare and assisted in reducing some of the grief relating to termination.

As a child, I moved around considerably and the same has been true of my adulthood. I remember when I left Southern California about eleven years ago that some of my friends expressed anger at me for leaving for the East Coast. I remember fighting a bit with a best girlfriend about something trivial right before I left. The truth was we had been joined at the hip for 15 years and we weren’t sure what the separation would mean for us. Rather than discuss the issue, we had a couple of cat fights to make the move easier. I also noticed that when she was feeling tearful and expressive, I was feeling cool and distant and when I was feeling scared and sad, she would be apathetic. If we were both feeling emotional at the same time, of course, we would have to confront the grief we were both feeling.

While I don’t have complete mastery in saying goodbye, or in some cases farewell for a time, I do know my intention is to show up for the experience. It may make it seem easier to create a diversion of some kind to make dealing with the goodbye easier, but it is a spurious strategy. A Course in Miracles offers us that no relationship ever ends (this may be disconcerting for some!).

I once work with a darling little boy named Charlie when I was an aide in a kindergarten setting. I was admittedly very attached to Charlie. It was obvious we both took the last day of school very hard but I tried to comfort him by telling him that we would carry each other in our hearts. About five years later, I saw him on a playground. As he ran by me playing ball with his friends he shouted, “Miss Jeanine, you are still in my heart.” This is the paradox of the goodbye, it may be painful but the truth is we take our loved ones with us wherever we go.

©Copyright 2008 by Jeanine Austin, Ph.D.. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Jeanine and/or see her GoodTherapy.org Profile