A woman doing yoga“It feels heavy right here,” Rebecca* said, crying and touching her chest, “like a huge rock is sitting on me. It’s like that old cartoon, where a boulder would fall off a cliff and pin the roadrunner to the ground—it feels like I can’t move.”  Rebecca, a 32 year-old successful marketing professional whose older sister had recently been diagnosed with a psychotic condition, had come to see me last year. She seemed lost in grief. Fluctuating bewilderment, sadness, fear, anger, tenderness, and love were tying knots in every part of her.

I thought that untying some of the knots in her body, with the help of mindfulness practices, might help her begin to lift the boulder.

Growing up, Rebecca’s sister had provided unconditional loving support which protected Rebecca from demanding, neglectful, and painfully critical parents. She had always relied on her sister to guide and comfort her; they had always been best friends. She said that now it felt like she was standing at the edge of the ocean, watching her sister sit on a raft drifting out to sea. She had been crying uncontrollably off and on for days. What made things even harder was that her sister sometimes acted like her old self, then became delusional again. Rebecca’s emotions were rising and crashing along with her sister’s state of mind.

Mindfulness of the Body: Body Scanning and Stretching

The first foundation of mindfulness is mindfulness of the body. It is cultivated with body scanning and movement practices, like yoga and walking meditation, anchored in feeling the sensations of breathing. A body scan involves directing one’s attention to different areas, one at a time, and focusing on the sensations in each place. A scan can begin with feeling the moisture on one’s skin, sensations of warmth or coolness, pressure or tingling. Then we scan the interior of the body, noting muscle tightness or ease near the surface and going deeper, where emotions express themselves as inner physical sensations.

Building brief body scans into a sustained stretch can begin to soften tight muscles—created from strong emotions—and release the mind from thinking for a while.

Prior to entering therapy, Rebecca had taken an 8-week course in Mindfulness-Based Stress Reduction (MBSR) from me. MBSR is based on the work of Jon Kabat-Zinn at the University of Massachusetts, and is taught in hundreds of hospitals, corporations, and schools in the US and around the world. Rebecca had done many body scans as part of the course. She knew how to locate and identify the physical sensations accompanying her emotional states. The following intervention was natural to offer, and easy to do with her.

Untying Knots in the Body

As Rebecca continued to cry, we talked about the benefits of recognizing and allowing her grief. But after 20 minutes of repeated bouts of intense sobbing, she asked me to help her stop. I asked if she would like me to guide her through some breathing and mindful stretching; she immediately said yes. We did a four- or five-minute sequence of stretches, while she remained seated on the couch. I guided her to stretch gently, to her limit, with each pose, holding it for 20+ seconds, and remembering to breathe. While holding each stretch, she scanned, place by place throughout her entire body, for unnecessary tension—inviting it to soften (without insisting) wherever she found it.

“Psychotherapeutic approaches that utilize mindfulness offer well-developed non-verbal exercises that enable the individual to dip into direct sensation beneath the veil of words that may often conceal the mind’s pain. This sensory immersion enables the individual to disengage from those bottom-up enslavements at the root of suffering….” (Siegel, 2007)

“Our poses can strongly influence our emotional states. For instance, because of the expansive inhalation and opening of the chest, backbending, traditionally a stimulating practice, can elevate a low mood. Exhale-intensive poses such as forward bends tend to calm an agitated mind. In any balance practice, both inhale-oriented and exhale-oriented postures are executed in order to create equilibrium in the body and breath and to gain emotional
harmony.” (Gerstein)

Untying Knots in the Mind and Heart

This practice creates a state of non-thinking in the midst of strong feelings. Non-thinking helps release habitual, reactive thought patterns as attention is redirected to the body—what is called the neutral ground of attention. If, in the heat of raw emotion, we give free rein to thinking or emotions, our familiar and deeply grooved cascades of mental and emotional activity take their usual course, often intensifying the emotions, or cordoning them off from awareness. Instead, if we direct ourselves to notice “what am I feeling in my big toe right now?” the cascade slows, or even stops, for a while. Awareness remains intact, and new, more balanced, and less distorted thoughts have a chance to arise.

When she sat up again after her last slow, deep forward bend, Rebecca’s face had softened, her breathing was quiet, and she said “it’s gone, the heaviness is gone.” She said she felt sad, but less afraid and overwhelmed. She began to speak with compassion for herself and her sister, while remaining more relaxed for the duration of the session.

Before ending, we rehearsed the practice again: she brought the feelings back into her awareness on purpose, then, increasingly independently, guided herself through stopping, breathing consciously, body scanning, and stretching/releasing tension.

Rehearsal increased the chances that she would remember to use breathing and stretching in the days ahead. Later, she reported with some relief that she had remembered and been able to stop and practice, and that it had helped sometimes. Directing focus away from thinking, and into the body, gave her a sense of independence in calming herself, and also helped her to use her considerable intelligence to understand her sister’s situation, and to face the frightening challenge of becoming independent of her sister for the first time in her life.

Practices like these are not intended to offer an easy fix for difficult emotions or life experiences. Mindfulness, at its core, involves observing things as they are and not fighting them. One formula used is Pain x Resistance = Suffering (PxR=S). Paradoxically, allowing ourselves to be with our pain, sadness, fear, or anger, frees us to go beyond them for a while. And, according to Daniel Siegel, when practiced enough, “… an intentionally and repeatedly created state can become an effortless trait of our being.”

Is prior training required for this intervention to be effective?

A person must be open to locating and feeling different body sensations. Not having this training is a limiting factor. In my experience, however, the breathing, stretching and scanning practice can lead to a similar shift in people who are receptive, regardless of having prior training in mindfulness.

*Names and identifying information have been changed for privacy

Resources:
Center for Mindfulness—Stress Reduction Program
Jon Kabat-Zinn’s Guided Mindfulness Meditations site

http://drdansiegel.com/

References:

  1. Gerstein, Nancy. (n.d.). How Yoga Affects Emotions. OmPlace.com. Retrieved from http://www.omplace.com/articles/Yoga_Emotion.html
  2. Siegel, Daniel J., M.D. (2007). Reflections on the Mindful Brain. New York: W. W. Norton & Company
  3. Siegel, Daniel J., MD. (2010). The Mindful Therapist: A Clinician’s Guide to Mindsight and Neural Integration. New York: W. W. Norton & Company

GoodTherapy | Trauma's Impact on Relationships: Part IICommunication and trust are key ingredients in any relationship, yet are often negatively impacted by the effects of a traumatic experience.

Trust
The very nature of trauma can shatter an individual’s trust in the world and fellow human beings. A survivor’s reduced level of trust can also make communicating difficult and even damage the foundational fabric of a relationship. Many a survivor believes, “I once trusted and I got hurt, therefore I will protect myself by never trusting again.” After trauma, the world and people in general can seem to be completely unpredictable. Danger seems to be everywhere and so a survivor of trauma may feel that they can never put their guard down in order to relax, feel safe, or trust.

These false beliefs about the world—that no one, including oneself, is worthy of trust and that one can never be safe—can be clung to and reinforce each other. Unfortunately, these beliefs are often expressed via impulsive, mean, or aggressive behaviors towards the people closest to the survivor. While the individual may often feel self-hatred or shame for acting in harsh and distrusting manners, to discuss the reality of these behaviors and the impulsiveness and fear behind them would require open communication that may be difficult or impossible at the time.

Listening and Communication
Survivors of traumatic events often struggle with both expressing themselves and listening actively. Active listening requires a certain amount of concentration and can be made more difficult by the presence of  hypervigilance. After experiencing trauma, most people’s concentration levels are lower and their levels of hypervigilance higher than their pre-trauma baseline. It can be difficult, if not impossible, for survivors of trauma to process significant chunks of information, making complex or lengthy conversations a significant challenge.

In addition to a potential decline in listening abilities, people who have experienced a traumatic event often shy away from openly communicating. Open and forthcoming communication may be avoided for two types of reasons:

Emotional Bonding
These deficits in trust also negatively impact the opportunities for appropriate emotional and physical closeness, which, like open communication, are an imperative component of any relationship. A survivor of trauma often feels emotionally dead inside. This internal deadness can prevent the individual from experiencing emotions for friends and loved ones and can make it incredibly difficult to receive care, support, and nurturing from these loved ones. Feeling and being emotionally bonded or close is not really feasible.

The absence of a strong emotional bond and the survivor’s heightened state of physiological alertness can negatively impact the physical closeness in a relationship. In a state of hypervigilance and presumption of danger, being touched can set off the person’s safety—fight, flight, or freeze—reactions. The friend or lover who inadvertently triggers the safety response by physically touching the survivor quickly learns to avoid physical contact at all cost. Unfortunately, loved ones often stop trying to connect with the traumatized individual, emotionally or physically, since it can feel like the survivor is actively rejecting the loved one.

Authors Herbert & Wetmore phrase it well when they state that, “It is usually not the case that trauma survivors cease to love the people who were close to them before the trauma, but rather that, for the present, they can’t respond to those people normally, because they have lost access to their capacity to love.” Yet an important distinction to make is that even though a survivor may not be able to feel love, they can still act in a loving manner.

The good news is that these difficulties do not need to be permanent. It is possible, through the slow work of healing,  for the survivor to relearn how to trust and feel safe, and for these disturbances or difficulties in emotional and physical closeness to recede. This slow but entirely do-able process is best engaged in with a trained professional. May those of you who are the friends and family of a trauma survivor find an extra ounce of patience and fortitude, and may those of you who are healing from a traumatic life event find validation and the courage to keep growing.

Sad-woman-looking-downIn my practice, people trace depression back to trauma most of the time. Emotional trauma is an overwhelming shock to a person’s equilibrium. Trauma might be linked to an emotional, physical, or sexual attack or witnessing such an attack. War, rape, murder, accidents, and even well-intentioned medical procedures might all lead to trauma. So can single or repeated incidents of shaming and other emotional and verbal attacks. Trauma can also happen when heartbreaking losses of any kind occur.

When people are traumatized, it often shapes their beliefs about themselves or life. These trauma-induced beliefs—such as “I’m never safe,” “I’m unlovable,” “I’m a monster,” “love is dangerous,” “I’m a failure,” “I’m helpless”—affect how people feel and often contribute to depression. Sometimes an individual’s belief is based on something that was true at the moment of the trauma: “I’m helpless” is true when a person is in surgery under anesthesia (where unconsciously-remembered thoughts can still affect us).

But beliefs that formed during a traumatic event are stored without information about what that means over time. So “I’m helpless at this moment” can become “I’m always helpless.” This underlying belief may contribute to depression and helpless behavior indefinitely. If this person doesn’t get a chance to talk about their helpless feelings and express their emotions, they could carry that belief into the rest of their life. It is trauma that turns time-limited events into a part of people’s belief system and identity. It makes sense that people would be depressed when they believe they have no personal power to create the life they want.

“I’m a Coward”

Trauma-related beliefs can be a formative part of a person’s personality, particularly if trauma occurs in childhood. The trauma-related beliefs can be so painful that the traumatized person has to develop ways to coping with the belief—and then the methods for coping become a new part of who the person is.

For example, say a child watches his mother get mugged and freezes in fear until it’s over. Perhaps in his child mind, he concludes, “I’m a coward.” Living with the belief that he is a coward is so painful that he deals with it by trying to prove he’s brave: picking fights and engaging in high-risk behavior. These behaviors give him a euphoric feeling of self-confidence and he gets some relief from the pain of the “I’m a coward” belief. The combination of euphoria and the desire to avoid the shame of believing he’s a coward keeps him trying risky things.

He is new to taking risks, so he and others begin to think of him with a new identity. Risky behaviors get him in trouble in school, which means other kids in trouble gravitate toward him while cautious kids avoid him. This makes it hard for him to do well in school and he develops an identity as a tough street kid with crime rather than college in his future. This trauma-belief comes to shape every decision he makes and pretty much everything about him: who he dates, what he does for money, where he lives, who his friends are.

In situations where he might feel vulnerable or scared, he doesn’t dare show it for fear of revealing himself as a “coward.” So when he experiences other trauma, he can’t express his vulnerable feelings, which keeps him from processing the trauma, causing each new trauma to incapacitate him further. When he does start to feel vulnerable, afraid, or sad, he uses drugs or alcohol to suppress the feelings and give him the high of confidence again.

At some point, this man may realize he is depressed, perhaps when a friend dies of an overdose, a woman he loves leaves him, or he ends up in jail or a hospital. At this point, unraveling his story to find what is causing the depression will be complicated. The depression he feels is caused by this most recent loss, but it’s also caused by drugs and alcohol, living a life that keeps him from reaching his potential, and the self-hate that has developed over the years through taking risks despite serious consequences. But ultimately, the depression began when he watched his mother get mugged. When that is resolved, and he realizes he never was a coward, that freezing was normal and even wise at that moment, he will feel much better. He will probably begin to feel free to redefine himself and make different choices for his life. But because his whole life has been based on the way he reacted to trauma and the way he continued to react to his reaction, he will also have to unravel and replace all the aspects of his life and self-image that were created by that initial belief and shame that he was a coward.

“I’m Worthless”

Another example: imagine a child who is sexually assaulted by an adult. That child may respond to the trauma by believing “I’m only worth something if I’m being used for someone’s sexual satisfaction.” It’s not hard to imagine that this child might become an adult who deals with this belief by being sexually available to many people, who she may not even find attractive, as a way of getting some temporary relief from feeling worthless.

Being sexual with many people becomes part of her personality and identity, both of which would have been very different if she hadn’t been assaulted as a child. When this method of coping with trauma stops working—maybe because she can’t find lovers anymore, or she gets caught compulsively having sex outside her marriage and loses her husband—she may become depressed. She will be depressed about the recent changes in her life, but again, ultimately, the depression comes from the original trauma, and from the problems caused by trying to cope with the original trauma.

As complicated as these scenarios may seem, the origins of a given person’s depression can be even more complicated. Sometimes trauma isn’t involved in the origins of depression, but most of the time, with enough exploration, I find the roots of depression in trauma.

Bird nest with two eggsParents often ask me to describe what options they have for their post-divorce living arrangements. In addition to the many ways it is possible for children go back and forth between two residences, there is also the possibility of having children stay in the home they are currently living in while the parents move in and out. This is sometimes described as “the children get the house,” “bird nesting,” or just “nesting.”

The Advantages

How It Works
The parents move in and out of the home according to the parenting plan they have established. This might include a situation where one parent spends the night with the children. The other parent comes to the house when the first parent goes to work and is at the home until the working parent comes home, often after dinner. The daytime parent then goes to their “other” residence. This arrangement could change depending on which parent is spending the night with the children.

Alternately, one parent can live in the home with the children for one week, then the other lives with them the following week. This is what as known as a week on/week off arrangement.

In a 2003 case in Ontario, Canada (Greenough v Greenough), the judge court-ordered parents to implement a bird nesting arrangement—which they had not requested—until the hearings on the case could continue.

In the case record, Justice Quinn wrote:

“The court made a bird’s nest custody arrangement in which the children (aged 3 and 5 years) remained in the home, with the mother staying in the home during the week and the father on the weekend. I think that the benefits of a bird’s nest order are best achieved where the children are able to stay in the matrimonial home, particularly if it has been the only residence that they have known…

“Time and time again I have seen cases (and this is one) where the children are being treated as Frisbees. In general, parents do not seem to appreciate the gross disruption to which children are subjected where one of the parents has frequent access. In this regard, I do not believe there must be evidence that the children are suffering before the court is free to act. To me, it is a matter of common sense. At the risk of falling prey to simplistic generalities, I am of the view that, given a choice, I do not see why anyone would select a living arrangement which involved so much movement from house to house.”

Justice Quinn clearly saw the advantages to the children of living in the home they were most familiar with and of having little change in their day-to-day lives, and saw the role of the court as instrumental in advancing this option on behalf of the children.

The Disadvantages

These lists are not exhaustive. Clearly, bird nesting is not for everyone. The question remains whether it is for even doable for a small percentage of divorcing families. We do know that when parents live in close proximity to each other, when the children have easy access between homes, and are not subject to ongoing conflict, children of divorced families are quite resilient and do as well as children from families where there is no divorce. This might be a solution that is just shy of bird nesting: good neighbors.

Father and adult son chat by a lakeMost teenagers naturally reach a point where the bounds of sexuality are explored and roles and sexual identity are created. For LGBT teens this natural part of growing up can often be confusing and overwhelming, resulting in a variety of responses. Some individuals experience such intense negative emotions about their sexual feelings that they repress and push those feelings as far away as possible and choose to ignore their sexuality.

By hiding deep in the closet, these teens are setting themselves up for an uphill battle as they get older and inevitably arrive at a point in their adult lives when the reality of their feelings can no longer be ignored. In other cases, this aspect of an individual’s personality does not surface until later in life at which time they may uncover feelings of same sex attraction, for example.

However they arrive there, the challenge of coming out in adulthood is a unique and often mystifying journey for both the person coming out and the people in their lives. As an adult, the fabric of life is often strongly developed with work relationships, long-term friends, and even children and spouses. The complexity of this web of relationships can make the process of coming out quite messy in adulthood, characterized by experiences of deep confusion, guilt, betrayal, rejection, and heartbreak.

When LGBT adults make the difficult but necessary choice to come out, they are often faced with many emotionally fraught questions from people who are shaken by the revelation that their friend or family member is not the person they thought they knew. There can be feelings of shock, anger, and disapproval from those close to the newly identified LGBT person. It is a bewildering experience for everyone involved.

The most basic questions from friends and family address concerns that the newly open LGBT person has been hiding their true nature and their sexuality, and that the trust of the relationship has been broken. Both parties experience feelings of loss and confusion that can severely strain the bonds of the relationship. [fat_widget_left]

For the person coming out, at a time when they most need the support of their friends and family, this layer of confusion can create a perceived lack of safety from the people who would otherwise be that individual’s support network. This lack of support can sometimes lead to an interruption in the coming out process and lead the newly open LGBT individual to regret the decision to come out.

In addressing this issue, it can be important to realize that not only are adults who come out having to redefine themselves and their relationship to their community but also the people they are coming out to have to create a new framework of understanding.

When an adult child comes out to family members, the family story of kids, grandchildren, spouses, and family that has been carried for many years must be re-authored to make the new details meld into the existing family scenario. A time of transition will occur where parents, relatives, and siblings will need to re-establish the family story with fresh details adding a vital new definition to the fabric of the family history. Some family members may become estranged as a result of religious disapproval or an inability to move past feelings of betrayal.

For close friends, there is also a redefinition that must occur in order to assist in building a strong bond between the newly out and open LGBT person and their friends. With both family and friends, questions of lifestyle, safety, and the impact this news will have on future relationships may come to the forefront. Some people who have just come out will feel comfortable answering all of these questions and more, while others may be unsure of their own feelings and may not have all of the answers at that time.

Leaving room to discover this newly developed aspect of the LGBT person’s identity is vital in their ability to define and understand who they are. All of the answers may not be available immediately but the process of coming out is an ongoing experience with new pieces of understanding being continually discovered.

And most important for all people involved in the coming out process—from the LGBT person coming out to family and friends—the qualities of the person coming out are not changing. All of that person’s vital goodness and qualities remain, with the addition of new and exciting aspects being shared openly and honestly for the first time.

GoodTherapy | Partners of Unemployed People: Take Care of YourselfUnemployment is a downright monster. Most often, we see a lot of support for the unemployed person who is building his or her resume, interviewing, networking, staying busy, and being positive. I certainly hope and pray that our economy improves soon and each unemployed person finds work that is fulfilling in both meaning and income.

But how about support for the partners of unemployed people?

Ms. Y (not her real name) came in the other day and said, “My husband has been unemployed for over two years. Over two years. Over—two—years! I say it, dumbfounded, because at some point every day, I realize that I can’t believe how long it’s been. First it was an industry crisis. Then came his depression. Then there was his second wind, his revival. Then the revival turned into stagnation again. There were a number of short-term freelance gigs. There were rejections, interviews, and even jobs-in-hand that folded at the last minute  thanks to the tanking economy.

“During every rise and fall of this god-forsaken unemployment phase, I have been there to support my partner every step of the way. I’m exhausted. I’m tired of being the sole breadwinner. I’m especially tired of all those people who tell me what they think about my husband’s lack-of-work situation. During these years, I can’t tell you how many times I’ve been at some function where after a few drinks someone said to me, ‘I feel so bad for your partner. Your partner really needs support. Be patient, be supportive.’

“I think to myself, ‘Me, be patient? Me, be supportive? When haven’t I been?!’ I want to jump out of my skin and slap that person silly. Instead, I stuff my pride, and in my most polite tone, I tell the preacher-man to stick it. I want to hear what they have to say after they’ve supported their unemployed partner for over two years. I doubt it’ll be the same thing, I swear. Jerk.”

My heart goes out to Ms. Y and people like her. It is tough to be unemployed, but it is equally tough to be the partner watching and supporting the unemployed person. It is a terribly helpless position. Some have become involuntary breadwinners, straining to care for everyone and everything with one lone paycheck. All are forced to be passengers on the emotional roller coaster ride of a loved one’s bout with unemployment.

Some are the only people their unemployed partners will talk to about their suffering. Often, their emotional needs involuntarily get thrown aside because of the attitude that “unemployment isn’t happening to you, it’s happening to the unemployed.” Both the unemployed and partners of unemployed vacillate on the spectrum between the hope for the day of the “Great News” (“I start a new, real job on Monday and can help pay the bills now!”) and fear that their savings will be sucked dry and they’ll be forced to live in a shelter—or worse, their parents’ house.

I say unto you, dear partners: It is time.

Partners, it is indeed time to take care of you. You deserve it. You have done an amazing job of standing by your unemployed person’s side despite the mental, physical, and spiritual turmoil that unemployment puts everyone through. So first of all, do yourself a favor and give yourself—your mind, body, and soul—a break.

How can you possibly give yourself a break at a time like this? Well, if you don’t, you’re going to keel over, for one. The truth of the matter is that unemployment is not what defines you or your partner completely. In other words, each of you is a complex, multifaceted human being who remains healthy as long as your mental, physical, spiritual, and relationship states are receiving attention. At this moment, unemployment is taking a toll on these four realms; however, the trick to lessening unemployment’s severe control is self-care.

Self-care means honoring the other facets of your personality and life, thereby diminishing the attention given to the unemployment monster. Take a look at the following short lists of self-care ideas that honor these other parts of who you are. You’ll find that many ideas can cross multiple realms:

Mental: Attend individual and/or group therapy. Meditate, listen to music, take a vacation alone or with a friend or partner, spend time with loved ones, take a class, or escape through watching movies or reading.

Spiritual: Pray alone or with others. Choose to be silent, join a group on a spiritual practice that you enjoy, light a candle and reflect, journal your thoughts and feelings, or attend spiritual events and retreats.

Physical: Get a massage, exercise, go for a walk, take a hot bath, get regular sleep, dance, play sports, do yoga, paint, draw, sing, arrange flowers, color mandalas, play music, use relaxation techniques, or cook.

Relationship: Attend couples counseling. Create creative dates, like cooking from scratch together; do an activity together on a regular basis, like volunteering; take a week-long vacation from talking and thinking about unemployment; have sex.

Try any or all of these ideas, and keep adding to these lists. Find what works for you. You’ll see that given enough respite, you will have more energy to carry on your daily tasks until the “Great News” arrives. No one will be able to do this for you. You have to take care of yourself just as much as you take care of everyone and everything else. So, dear partners, be good to yourself and feed your mind, body, and soul. It is long overdue.

Important Notice

GoodTherapy is not intended to be a substitute for professional advice, diagnosis, medical treatment, or therapy. Always seek the advice of your physician or qualified mental health provider with any questions you may have regarding any mental health symptom or medical condition. Never disregard professional psychological or medical advice nor delay in seeking professional advice or treatment because of something you have read on GoodTherapy.

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