Man in small space hugging selfMost people have experienced brief periods of anxiety while riding in an elevator, stuck in the midst of a large and tight crowd, or even while playing hide-and-seek. But for people with claustrophobia, the fear of being trapped in a small space can be so debilitating that it interferes with regular life activities.

In fact, the distinction between “normal” anxiety about enclosed spaces and phobic-level fear is the fact claustrophobia tends to interfere with life activities such as climbing a stairwell or riding in an elevator for work, playing with one’s children, or going to certain locations.

What Is It?
Claustrophobia is categorized by a chronic and unreasonable fear of being trapped in a small or enclosed space with no hope of escape, and it is classified as an anxiety disorder. People with claustrophobia also frequently experience a related fear of suffocation. Being in a small space can cause people with the issue to fear that they won’t be able to breathe, and for this reason, people with claustrophobia sometimes experience fear in settings that don’t seem enclosed or frightening. For example, a person with claustrophobia sitting in a dentist’s chair might be so afraid of confinement that the person becomes convinced that he or she will suffocate if he/she remains in the chair. People with the issue may experience extreme anxiety, panic attacks, difficulty breathing, profuse sweating, and difficulty concentrating when they are in a small space.

People with claustrophobia tend to experience anxious reactions in a variety of settings rather than just one particularly frightening setting. For this reason, claustrophobia tends to become generalized and may worsen over time. A person who was once afraid of elevators might generalize his or her fears to closets, apartments, doctor’s offices, and small stores. In extreme cases, people with claustrophobia may be so afraid of confinement that they refuse to leave their homes or travel to unfamiliar locations.

What Causes It?
Claustrophobia is one of the most common phobias, with about 5% of the population experiencing it to one degree or another. Some scientists believe that this indicates an evolved, genetic fear of closed spaces. The reasoning for this explanation is that being trapped in a small space can be dangerous, so the brain has evolved a special fear of these situations to prevent people from taking potentially life-threatening risks. However, there is also evidence that claustrophobia is learned. People who have been trapped in a small space—such as people who were trapped in an elevator or who were locked in their bedrooms as children—are more likely to become claustrophobic, and children of people with claustrophobia are more likely to become claustrophobic. This is probably due to a combination of genetics and parental modeling.

How Is It Treated?
Although phobias can be debilitating, they are generally fairly easy to treat. Counter-conditioning and exposure therapy work by gradually exposing people with claustrophobia to triggering circumstances to help them build a tolerance and learn coping mechanisms for their fears. People with mild claustrophobia sometimes benefit from deep-breathing techniques and distracting thoughts, and people with severe claustrophobia may take anti-anxiety medications to help them function until therapy can help them address the underlying causes of the phobia. Some people with claustrophobia also benefit from cognitive behavioral therapy, which helps them identify the negative thoughts that lead to fear-based reactions and to slowly adjust these thoughts to more positive, less fear-inducing ones.

References:

  1. Claustrophobia. (n.d.). Epigee. Retrieved from http://www.epigee.org/mental_health/claustrophobia.html
  2. Kahn, A. P., & Doctor, R. M. (2000). Facing fears: The sourcebook for phobias, fears, and anxieties. New York, NY: Checkmark Books.

Man praying over his ill friendAs I sat to write my end-of-the-year complementary and alternative medicine blog post, I questioned the wisdom of discussing prayer for healing, as prayer remains one of the most hotly debated CAM therapies. For many people, prayer is a meaningful part of their daily lives; for others, it may be engaged in more out of duty than beliefs. And for some, prayer is simply a practice in which other people engage.

Regardless, according to a large-scale survey by the National Institutes of Health, approximately 43% of Americans say they pray to improve their health, and about 24% indicated asking others to pray on their behalf. In the scientific community, however, the topic of prayer can be as polarizing as many of the other issues and events that marked 2012.

What’s the Evidence?

The research evidence for whether intercessory prayer (prayer on behalf of another for the purpose of healing) can improve mood, heal wounds, or enhance other health-related outcomes has been subject to much scrutiny and harsh debate. The quality of the research has been variable, as have the results. There are also many who believe it is inappropriate to test whether prayer can affect change. Yet prayer for healing, specifically, remains one of the most commonly used CAM “techniques.”

Several prayer studies have found positive effects, whereas others have found prayer to make no difference with regard to health (or even be associated with slightly poorer outcomes). Many have pointed out, not incorrectly, the tendency for the prayer research to create more questions than it answers. Researchers in both the “pro” and “against” camps regarding prayer agree that one challenge in evaluating this type of intervention is that it is not possible to completely rule out whether those in the control or “no prayer” group have in fact also received prayers from loved ones or clergy during the study period. If those in the “no-intervention” group are prayed for, and prayer does have an effect, theoretically this would make it difficult or impossible to tell the difference between one group and another. Thus, even if prayer for others could help them heal, we would be unlikely to detect this effect in a research situation described above.

Of course, no study can answer whether there is, in fact, a God or other divine organizing principle; if He or She answers study-related or other prayers; or whether religious affiliation of the one praying has any impact on the outcome.

Why Pray, Then?

The question of whether prayer should be studied, or if it has any efficacy as a tool for healing, will not be answered here. Regardless of the scientific evidence available, people who pray will likely continue to do so for themselves and others. Prayer brings millions of people comfort, and helps them feel connected to others as well as to something greater than themselves. Thus, given the time of year, and especially in light of the events of recent months, it seems relevant and important to mention it here.

As someone who has engaged in research, I know that my questions may never be adequately answered by the data, and yet, as a human being, I admit that when I or someone I care about has been ill or experienced significant difficulty, I have very much appreciated and at times solicited prayers, healing intentions, and “good vibes.” Over the years, I have also worked with many medically ill children and adults, and I can say that prayer is very common in the hospital setting and elsewhere, even when it is not obvious.

Perhaps there is a difference between private prayer for oneself, a loved one, or for one’s community, as compared to prayer for a stranger identified only by a study ID number, at least with regard to the meaning it has for us. Although I am not a religious person, on occasion I have prayed for my clients, although I have never prayed with any of them. At these times, when I have prayed for or hoped on someone’s behalf, or tried to visualize a positive outcome, I have often felt a sense of connection with something greater than myself—whether this is evidence of the divine or simply a sense of knowing I am part of a caring community, or a benefit I receive simply from striving to do good in some way, I cannot say for certain. And at those times, I am not really sure that finding “proof” matters all that much anyway.

Whatever your beliefs, my wish for us all in the coming year is to treat each other with respect, kindness, and compassion. If you do pray, among other things, pray for peace.

Goodwill to all!

References:

  1. Davis, J. L. (2006). Can prayer heal? http://www.webmd.com/balance/features/can-prayer-heal
  2. Mind and body: Do music, imagery, touch, or prayer improve cardiac care? (2006). Harvard Men’s Health Watch; 11, 6-7. http://www.health.harvard.edu/newsletters/Harvard_Mens_Health_Watch/2006/December/Mind_and_body_Do_music_imagery_touch_or_prayer_improve_cardiac_care
  3. More than one-third of U.S. adults use complementary and alternative medicine, according to new government survey(2004). http://nccam.nih.gov/news/2004/052704.htm

Childhood anxiety is a serious but often undiagnosed condition. Separation anxiety, social phobia and generalized anxiety are among the most common mental health issues affecting children and adolescents. Anxiety in childhood often predicts the occurrence of such problems later in life.

Identifying and treating anxiety and other mood disorders at early as possible is therefore an important goal of psychiatric research. Undiagnosed mood issues represent a large public health burden and result in a poor quality of life of those affected. The standard treatments for childhood anxiety are antidepressant medications and cognitive behavioral therapy.

Zoloft (sertraline) belongs to the class of antidepressant medications known as selective serotonin reuptake inhibitors (SSRIs), and researchers have identified it as the medication of choice for treating most instances of childhood anxiety. Compared with similar medications, Zoloft offers the greatest benefit to anxiety sufferers with the lowest incidence of adverse side effects. However, as with many antidepressant medications, there is a small risk of suicide or self-harm in children and young adults at the start of a new drug regimen. Those with anxiety rather than depression are less likely to experience these effects. Children and adolescents should be assessed for suicide risk before beginning any antidepressant medication.

Several clinical trials have offered strong evidence that a combination treatment including Zoloft and cognitive behavioral therapy offers the most substantial improvement for children who have been diagnosed with anxiety issues. In one such study, 80% of participants receiving combination treatment saw significant improvement after 12 weeks. Researchers theorize that therapy and medication have a synergistic effect with one enhancing the effects of the other.

Regular therapy sessions also provide an opportunity for children and parents to report side effects from the children’s medication. In the previously mentioned study, both therapy and Zoloft alone also led to improvements on an anxiety rating scale that far outperformed placebo. Most importantly, participants receiving Zoloft did not report more adverse side effects than participants receiving placebo did, and none considered or attempted suicide.

When considering childhood anxiety, the rewards of effective treatment for outweigh the potential risks of medication. A combination of weekly cognitive behavioral therapy sessions and prescription of the antidepressant medication Zoloft seems to promise the best results for the greatest number of patients. As always, attending physicians must prescribe drugs like Zoloft cautiously, especially to children and adolescents.

References:

  1. Sertraline – PubMed Health. (n.d.). National Center for Biotechnology Information. Retrieved April 6, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001017/
  2. Walkup, J.T., Albano, A.M., Piacentini, J., Birhamer, B., Compton, S.N., Sherrill, J.T., Ginsburg, G.S. et al. (2008). Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. New England Journal of Medicine, 359, (26), 2753-2766.

Family therapy can help families and couples overcome challenges with interpersonal relationships. Many issues that families and couples face become volatile and hostile without the help of learning how to constructively communicate and problem-solve. Relationship issues do not discriminate, and people of all cultures and races are vulnerable to family conflicts. This does not mean that people of every ethnicity embrace family therapy equally. In fact, African-Americans are far less likely than white people to seek out therapy for family problems. The reasons for this are many, and could include limited access to care, financial restrictions, mistrust of mental health professionals, and fear of stigma associated with counseling.

Cadmona A. Hall of the Marriage and Family Counseling Center at the Adler School of Professional Psychology in Illinois wanted to examine the specific barriers preventing African-Americans from seeking treatment. In a recent study, Hall interviewed nine participants and found that stigma presented the biggest obstacle to treatment. Resilience was the most common personality trait that helped the participants overcome the stigma. Hall believes that African-Americans are more likely to be resilient, having had to surmount the atrocities of slavery and the injustices of discrimination. This ability to overcome could have been an underlying force that led the participants to seek out help despite the barriers.

Hall also noted that eight of the nine individuals in her study were affiliated with the college where the counseling clinic was located. Having knowledge of and access to the services could have increased the willingness in this sample of participants. Another appealing aspect of the university clinic was the sliding fee scale, which was cited as a very beneficial aspect. Mistrust, which was listed as a barrier to treatment seeking, was addressed when the participants realized that their sessions were confidential and they felt comfortable enough to build rapport with their therapists. This was critical in setting them at ease and ensuring they would return to complete therapy. Although the sample size used here was small and lacking diversity, it was able to provide insight into the factors that prevent African-Americans from seeking out therapy. “As clinicians increase sensitivity and understanding of the unique features of African-Americans, they will have an increased ability to engage that population in therapy and increase quality of care,” Hall said.

Reference:
Hall, Cadmona A., and Jonathan G. Sandberg. “We shall overcome”: A qualitative exploratory study of the experiences of African-Americans who overcame barriers to engage in family therapy. American Journal of Family Therapy 40.5 (2012): 445-58. Print.

Corrective learning is a process that occurs when existing conceptions and beliefs are replaced by more adaptive ones. For individuals with anxiety, panic, and phobias, exposure therapy is a common form of treatment that aims to produce corrective learning.

During exposure therapy, individuals are exposed to things they fear or that threaten them. Because these situations or things are usually avoided as a result of anxiety, the theory behind exposure therapy posits that being confronted with the feared item or event in a controlled environment will allow the individual to realize that his or her fears surrounding that item or event will not be realized. It is also believed that the level of fear or anxiety that is experienced during the exposure directly predicts the level of reduction in anxiety at treatment outcome. In other words, the more fearful or anxious someone is during a session, the more he or she will be able to overcome that fear in the long run.

This theory has been tested at length. However, Alicia E. Meuret of the Department of Psychology at Southern Methodist University in Texas wanted to examine this further. In a recent study, Meuret assessed the physiological and emotional responses of 34 participants with agoraphobia and panic as they underwent either a cognitive behavioral or breathing-based exposure therapy. She found that the participants all experienced increases in panic and anxiety during the sessions, as evidenced by physiological markers and emotional responses, but that these increases did not lead to better outcomes. In fact, the more panicked and fearful the individuals were, the worse their treatment outcomes. Additionally, in contrast to existing research, Meuret found that symptom reduction during treatment did not predict treatment outcome. In other words, even if the individuals experienced spikes in treatment severity during exposure and then were able to reduce their anxiety as the session continued, this drop did not lead to better overall outcome.

It has been suggested that allowing a client to experience symptom reduction during exposure provides a sense of self-control and mastery for the client and accomplishment for the therapist. And although this may indeed be true, the reduction of symptoms after exposure does not seem necessary for treatment success. In fact, the treatment outcomes were similar for those who left sessions with symptoms that were elevated as well as with symptoms that were diminished. Meuret believes that these results contradict the theory that fear reactivity is an indicator of treatment outcome, although her study was limited by sample size and the fact most of the participants were well-educated white females. “More research is needed to examine the underlying mechanism of corrective learning during exposure across therapy types,” she said.

Reference:

  1. Meuret, Alicia E., Anke Seidel, Benjamin Rosenfield, Stefan G. Hofmann, and David Rosenfield. Does fear reactivity during exposure predict panic symptom reduction? Journal of Consulting and Clinical Psychology 80.5 (2012): 773-85. Print.

Woman looking out train window

Dialectical behavior therapy (DBT) is a comprehensive, evidence-based treatment approach used to treat individuals with a wide variety of issues, including relationship conflict, anxiety, depression, bipolar, self-injury, eating issues, and substance abuse. Developed in the 1980s by psychologist Marsha M. Linehan for the treatment of borderline personality disorder and chronic suicidality, this method has since been adapted and utilized to help clients with much less severe issues. The therapy can help clients who exhibit extreme emotional reactions, helping them develop self-acceptance while also learning coping skills to better regulate their emotions and handle distress. DBT uses both individual therapy sessions and group skills training, as well as telephone coaching between sessions.

The DBT model combines a behavioral therapy approach with eastern mindfulness practices. In one sense, the term dialectical refers to the goal of synthesizing the extreme opposites inherent in the rigid “black and white” thinking of many clients who have trouble regulating their emotions. “Dialectical” also applies to the core DBT principle of practicing acceptance strategies while implementing change strategies, in the process of reducing and modifying self-destructive behaviors.

This type of therapy is very support-oriented; it helps clients identify their strengths, build new skills, and increase their self-esteem. DBT focuses on cognitive issues by indentifying destructive thought patterns and replacing them with more neutral and accepting internal dialogues. It is designed to be a nonjudgmental collaboration, with the therapist and client working together to increase emotional awareness and understanding, minimize negative thought patterns and behaviors, and develop new coping and problem-solving skills.

The four modules of dialectical behavior therapy:

In the case of adolescent treatment, Dr. Alec Miller has adapted Dr. Linehan’s model to incorporate parents attending skills training groups with their teens. There is an additional module, “walking the middle path,” which focuses on helping parents and their children understand each other’s viewpoints and reduce conflict and invalidation.

The five functions:

Dialectical behavioral therapy was designed to fulfill five primary functions:

Stages of treatment:

The course of DBT generally flows through three stages:

Who can benefit:

Though DBT originally was developed to treat more severe issues, such as borderline personality disorder, suicidal behaviors, and self-harm, the treatment has become a widely respected method for treating clients who exhibit the following, much milder traits and issues:

Dialectical behavior therapy has proven to be a very effective tool to help people manage intense emotions, change negative thought patterns, and decrease self-destructive behaviors. Individual therapy sessions focus on current detrimental behaviors in the client’s life, while group sessions involve learning skills from the four modules: mindfulness, interpersonal effectiveness, distress tolerance, and emotion regulation.

Leaf making ripples in still pondMy last piece on focusing ended with a definition of felt sensing as a “temporary wave, from the sea of being” (Madison, G.). What is meant by a temporary wave from the sea of being?

It is time to introduce Gendlin’s conception of human being. Note that I said “human being,” not “a human being.” For Gendlin, human being is “interbeing”—what we think of as an individual being is a “livings in the world, and living with” (Gendlin, 1978-79). He calls this principle Interaction First.

Gendlin conceives of human beings experientially not as separate “things” in interaction with each other. More radically, he sees our environments and us as a continuous co-creative process. We are not “inside our skins, but are our living-in the world, and living-with others” (Gendlin, 1978-79). Even our physical being is a continuous process with its inner and outer environments. Hence, in his view, it is impossible to conceive of human being as a separate entity. We are interbeing.

What is a living body such that it has the intricacy of our situations? … With the old concepts, people might say that Focusing is “subjective.” But clearly, if the situation is carried in the body, then a felt sense is not subjective. Objective then? No, also not, since “objective” means the units and patterns to which science limits anything it studies. We could fashion a new sentence that is neither subjective, nor objective, nor both: The body IS an interaction process with the environment, and therefore the body IS its situations. The body isn’t just a sealed thing here, with an external situation over there, which it merely interprets. Rather, even before we think and speak, the living body is already one interaction process with its situation. The situation is not out there, nor inside. The external “things” and the subjective “entities” are derived from one single life-interaction process (which they always bring along with them). (Gendlin 2004)

This is a radical view and paradigm shift that is difficult to absorb. We are used to thinking about ourselves and the environment “around us” through the lens and language of a Cartesian world. We are imbued with philosophical assumptions idealizing objectivity and neutrality and a mechanistic relationship of mind over body. For example, we may have heard of such concepts as the “observer effect,” yet we go about living in a way that leaves context out of the equation.

For Gendlin, the making of meaning is a pluralistic, contextual, constructed process; it is changing and dynamic, not static and eternal (Mitchell, 1993). Our lived bodily sense of things is a function of our interbeing, and our capacity for felt sensing extends us beyond the confines of our delimited physical body.

Recall that I started my first piece by saying that you have within you—“beneath” your everyday practical use of language—another dimension, an inner language that is an imagistic dialogue between you and your immediate experiencing. It is you speaking to yourself (and listening to yourself) in your own code. Gendlin calls it the zigzag between the everyday use of language and the way we may actually hold our experiencing in a bodily felt way.

Gendlin says that this kind of processing exists preconceptually, beneath our everyday use of language and concepts and the assumptions we have about how the world works. In focusing, we find our own language and meaning that is in fact much more specific and precise than our usual use of language. We find language from the sea of our being.

A client with a traumatic history sits quietly, with eyes lowered, pausing to find a way to articulate why his time in boarding school (60 years ago!) is still so meaningful to him. His life before boarding school was consumed by his father’s collapse into psychosis. He is sensing into the situation regarding boarding school—without any explicit reference to his catastrophic childhood history. After a full few minutes of silence, he finds one word that fits: Life at boarding school was “manageable.” At the point that he says “manageable,” tears come to his eyes. He doesn’t know why, but his felt sense tells him, preconceptually, that “manageable” feels right.

The therapist, attuning to her client, takes in “manageable” and acknowledges it. As it resonates within her, she realizes how much is contained in this word “manageable” for her client. Then she drifts into her own felt sense of his childhood and finds ‘unmanageable’ experientially embedded in the world of her client’s meaning making, the therapist quietly offers the newly emerging word “unmanageable” without any reference to his history, and the client considers it.

A few moments later, the client’s full catastrophe of life with his father’s illness impacts him, but in a different way. His therapist has offered a word that touches into his world precisely and with great specificity. What is captured here in two words—manageable and unmanageable—is much more than the common meaning of these words. The client is referring to the experiential world of living-with and living-in his father’s psychosis, as well as to the emergent significance of what boarding school provided for him. The unmanageable and the manageable.

 Notice that the felt sensing came first. With “manageable,” he has begun to capture the world of his experiencing—the profound relief of finding himself for the first time in a world that he could handle (boarding school). Then “unmanageable” is intoned, and he resonates with the years of struggling with the catastrophe of his father’s psychosis. “Manageable” arose as a temporary wave from the sea of being. “Unmanageable” emerged from their shared sea of being.

And this shared moment deepens their therapeutic journey.

References

  1. Gendlin. E. T. (1978-79). Befindlichkeit: Heidegger and the philosophy of psychology. Review of Existential Psychology & Psychiatry 16, 43-71.
  2. Gendlin, E.T. (2004). Five philosophical talking points to communicate with colleagues who don’t yet know focusing. Staying in Focus. The Focusing Institute Newsletter, 4 (1), 5-8. From http://www.focusing.org/gendlin/docs/gol_2187.html
  3. Madison, G., www.gregmadison.net.focusing_way_being.
  4. Mitchell, Stephen A. (1993). Hope and dread in psychoanalysis. New York: Basic Books, pp. 285.

A couple in therapy look at one anotherNext Friday, August 31, 2012, GoodTherapy.org is thrilled to welcome Dr. Laurie Moore, who will present Healing Betrayal Caused by Infidelity, a FREE CE teleconference for GoodTherapy.org members available with 1.5 CE Credits. We encourage you to join us for this exciting event, so if you have not already, register today!

Working with clients who are suffering from betrayal caused by infidelity is complex, including grieving stages, posttraumatic stress (PTSD), and additional factors. This article refers to infidelity as a breach in agreed emotional and sexual monogamy. Some couples agree to open relationships or polyamory, which is a different situation. Infidelity as defined in Wikipedia is “a breach of an expectation of sexual and or emotional exclusivity.” This involves a lie and broken promise, causing feelings of intense betrayal for many people.

Infidelity has become a common problem. Some infidelity statistics state that over 50% of both men and women engage in infidelity (Journal of Marital and Family Therapy, 2012) and others say 30% to 60% (Wikipedia, 2012).

Those suffering from infidelity betrayal commonly go through Kubler Ross’s well-known stages of grief:

  1. Denial: This didn’t really happen or it’s not really as upsetting as I feel it is.
  2. Anger: How could you?
  3. Bargaining : If only I had communicated differently, this would not have happened.
  4. Depression : I feel helpless. Nothing I can do changes this discomfort.
  5. Acceptance : I have been hurt and disillusioned but I am at peace with myself.

The experience of grief due to infidelity includes additional factors that are absent from grief occurring from a death. Grief due to death is felt in a finite situation that contains an end. It is understood that the one who is gone is gone from the body permanently. Grief due to a breach in trust has no finite or predictable container. The one suffering finds him- or herself in unpredictable circumstances, which often feel very dismantling and excruciatingly unsettling.

Feelings that challenge self-confidence and worth are more common to infidelity betrayal than loss alone. Death is socially expected. Infidelity is shunned. The one who is betrayed is prone to feel guilt, shame, and embarrassment because the situation remains privately hidden or is condemned by a variety of reactions when exposed.

When death is the cause of grief, a solo journey is required. When betrayal is the cause of grief, two people are involved, so the situation is more complicated. Once one is lied to, the relationship is uncertain. This person can’t tell whether he or she is being lied to or told the truth. The one experiencing this challenge is often upset again in the aftermath of the partner relationship. This is different than the one abandoned by a death whose loss cannot re-emerge in a repeating scenario.

Clients with heartache caused by infidelity and betrayal can also go through fight-or-flight syndrome:

Fight: Arguing with, controlling, or managing the person who betrayed me will solve this.

Flight: Leaving will solve this.

Once fight or flight proves useless, a person will seek comfort in other ways. By assisting this person to fully meet the helplessness, sorrow, anger, anguish, disillusionment, and heartache that has come, peace can be found.

I have found that client-centered talk therapy, hypnotherapy, eye movement desensitization and reprocessing (EMDR), and the 12-step program are all deeply valuable for clients healing from infidelity. I also use my own Success Love Now (SLN) process effectively in these situations. Here is how and why each of these methods is valuable.

Someone who is suffering from loss and feeling isolated due to the taboo nature of this loss needs to be witnessed compassionately and caringly. This in itself helps to relieve the tremendous burden one carries from feeling alone. When being accepted within the context and emotions one is truly feeling, without being corrected or judged, peace can start to return. Acknowledging your understanding and compassion for a clients’ diverse set of feelings can be a profound help to a suffering client.

Because the shock of betrayal can be extreme, disrupting normal life in many ways, EMDR assists the hurting person to digest the deep emotions that are arising. Just getting through the day becomes a challenge for people who are betrayed. EMDR makes the healing time for this upheaval much faster in many cases.

Hypnotherapy allows the person who was hurt to re-find stability, meet parts of him- or herself that were hurting before the situation occurred, heal parts of him- or herself that are hurting now, and find a new basis for equanimity that is deeper than the circumstances. Taking a client into a deep, relaxed state in which the client can bring in peaceful parts of him- or herself to help the hurting parts enables a client to rebuild self-esteem and strength.

S-Anon Twelve Steps allow people to find the value in surrender, the gift in their challenge, and the support of others enduring similar pain. Twelve Steps also help the one who was betrayed to find out if addiction was involved in the betrayal, as commonly is the case. Letting your client know that S-anon is an option can be a valuable part of her or his healing process.

SLN provides a new framework for the person to feel empowered and at ease within the undesired circumstances. Encouraging the client to focus on what his/her purpose and aim are for him- or herself and gratitude for the good that is occurring within the context of the undesired happenings is beneficial. This will bring a client out of a victim mode and into a creative mode.

Of course, if the person who was betrayed plans to stay in the relationship, couples counseling and counseling for the one who was betrayed are necessary.

When working with clients who have been betrayed due to infidelity, it is important to understand the complexity of loss, mixed with PTSD, combined with humiliation–this situation causes a long period of overwhelm and readjustment. When the client is treated with compassion, the healing can go well.

Sources:

  1. Infidelity statistics. (n.d.). Retrieved August 20, 2012, from http://www.statisticbrain.com/infidelity-statistics
  2. Infidelity. (n.d.) Retrieved August 20, 2012, from http://en.wikipedia.org/wiki/Infidelity

Related articles:
Cheating
Can a Couple Recover From Infidelity?
In-Depth Map for Three of the Eight SUCCESS LOVE NOW Steps

Woman meditating in open roomI almost always suggest to clients that they learn focused abdominal breathing and practice a minimum of 5 minutes every day; for the best results, I recommend they practice 20 or more minutes per day. Sometimes they look at me funny and ask “You mean all I have to do is just breathe and everything will be better?” I tell them that no, everything is not going to magically change to exactly what you want in life, but learning and practicing focused abdominal breathing every day WILL do this for you:

1) Special breathing techniques can help reduce physical pain. Often when people are in pain, they breathe in a very shallow, disordered pattern. They also may frequently hold their breath without even realizing it. These are mostly unconscious protective reactions to pain, but they can actually increase the level of pain. Several recent scientific studies have shown that breathing at a slower rate from the diaphragm can significantly reduce sensations of pain.

2) Breathing helps to properly balance oxygen and carbon dioxide levels in the body.  Breathing properly from the diaphragm will:
•    Fuel energy production
•    Improve focus and concentration
•    Increase relaxation and calmness
•    Reduce tension and anxiety
•    Eliminate toxins
•    Strengthen the immune system
•    Improve bowel function
•    Lower blood pressure
•    Increase metabolism, aiding in digestion and weight loss

On the other hand, not breathing correctly can cause problems for a number of systems in the body, including the immune, circulatory, endocrine, and nervous systems. Improper breathing can produce various symptoms including:
•    Difficulty focusing attention
•    Dizziness
•    Numbness
•    Anxiety
•    Chest pain
•    Digestive problems
•    Irritable bowel
•    Neck and shoulder pain

3) Breathing releases emotional energy that is trapped in the body. People with anxiety and/or depression are almost always (and I mean 99.9% of the time) either breathing very shallowly or frequently holding their breath. Holding the breath is one of the most common ways that people stop emotions from coming up (think about the last time you tried not to cry, feel afraid, or get angry). Once you hold in an emotion it stays trapped in your body, until you release it. Breathing allows stifled, buried emotions to finally start to surface and be released.

4) Breathing keeps you in the present moment, instead of the past or the future. People with depression are often stuck in thoughts about the past, and people with anxiety are stuck in thoughts about the future. When you’re concentrating on your breathing, you are paying attention to your body sensations, the sound of your breath, and the process of breathing, all of which are happening RIGHT NOW. When you’re paying full attention to RIGHT NOW, you take AWAY energy and attention from the thoughts about the past or future. When you bring your attention to NOW, you automatically feel calmer.

Using the breath is a way to learn how the body and mind are connected. This is why I teach proper breathing to clients. Thoughts are directly related to feelings in the body and likewise, body sensations give rise to thought patterns in the mind. Mind and body are in a constant dance of influence, and it is important for people to learn that they have more choice and control in the matter than they thought.

Basic Instructions for Focused Abdominal Breathing
More than likely, if you are experiencing depression, anxiety, or pain, you are breathing shallowly from your upper chest. You want to train yourself to breath from your diaphragm/abdomen. Although it’s most effective to have someone teach you the process in person, here are the basic steps:

1) Sit in a comfortable upright position with your back against your chair and your feet on the ground. Keep your back straight, but let your shoulders and the rest or your body be very relaxed.

2) Place your left hand on your abdomen. Imagine that the entire area from your lower abdomen up to your chest is one large, rectangular balloon. Now, start by exhaling as completely as possible. Empty out as much air as possible. Your left hand will move inwards as the “balloon” area deflates. Now, slowly and gently, inhale, imagining that you are filling the balloon starting from the bottom, all the way up to the top. When you are breathing correctly from your abdomen, your lower abdomen will inflate, followed by your chest expanding, and your left hand will be pushed outward. Your shoulders will not go up, they will stay in place. When you inhaled did your hand move? Or did your shoulders go up instead? If your shoulders rise up when you inhale, you are breathing from your upper chest. Exhale and try again. This type of breathing may take a little practice to get the flow going. Work on this step until you can fill and empty the “balloon” completely. Then add the next steps.

3) Now that you are breathing abdominally, relax into a natural breathing rate. Your body will take over the breathing and settle into its own rate and depth. Your job is to just observe your breathing. Focus your attention on the tip of your nose and intently notice the pressure, temperature, and sensations of the air passing in and out of your nose. If it helps you to focus, you may also silently say “breathing in” on your inhalation and “breathing out” on your exhalation. Do this focusing for 5 minutes a day to start with, and work up to 20 minutes or more per day.

4) During your focused breathing session, especially when you first start practicing, you will more than likely notice that you are thinking about something else other than breathing. Thoughts have intruded into your mind and distracted your attention. When this happens, try not to react with any emotion (such as frustration). Just gently and silently allow the thoughts to drift upwards far away in to the sky like a soap bubble and then turn your attention back to your breath. At first you will find yourself re-directing your attention many, many times each session. Over time you’ll be able to maintain focus on your breathing for longer and longer periods of time and it will get easier to let go of intruding thoughts. It will even become easier to let go of unhelpful thoughts you have during the rest of the day (such as disturbing thoughts of the past or worrisome thoughts of the future). The most important thing is to keep doing the focused breathing every day, no matter what.

Open, full, unrestricted, unobstructed breathing is very important for your physical, mental and emotional health. It is something simple that can make a very big difference in your life. There are many things in life that we have no control of, so doesn’t it make sense to do the things we can have some control over? You can actively affect your own physiology and mental/emotional state just by mastering the art of breathing, focusing, and being present.

Related articles:
Deep Breathing and Guided Imagery
Alcohol and Anxiety: Not As Helpful As You Think
Managing Your Moods Through Mindfulness

A client that drops out of therapy is one who does not complete the recommended course of treatment. Many therapeutic approaches, such as cognitive behavioral therapy, do not have a specific treatment deadline, and clients are considered dropouts when they have voluntarily stopped therapy prior to resolving the issues and symptoms that brought them there to begin with. Dropout is a serious concern for the medical community and the general population. Individuals who drop out of therapy are more likely to have future psychological complications and seek services multiple times, which places an economic burden on society. Because they do not learn adaptive coping strategies and fail to address the issues that plague them most seriously, they are likely to be less than productive in their careers, families, and communities. Additionally, therapists who experience client dropout may begin to question their ability to help clients and their own adequacy.

Understanding the factors that contribute to dropout can provide clinicians with the information they need to address the problem. Joshua K. Swift of the Department of Psychology at the University of Alaska in Anchorage wanted to explore this problem further and made it the focus of his most recent study. Swift analyzed over 650 studies that included more than 83,000 clients and looked at factors such as client age, therapy setting, therapist experience, type of therapy, issues addressed in therapy, and clinician definition of dropout.

Swift found that nearly 20% of all the clients in the studies ended their treatment early. He found that some variables, such as therapy setting, influenced the rates of dropout. He also discovered that rates of dropout were highest among the youngest participants and those seeking treatment for personality or eating problems. Swift believes that more work is needed to determine specific nuances that effect retention. He hopes efforts will be aimed at isolating psychological issues, such as anxiety or depression, and approaches, such as psychodynamic or behavioral therapy, in order to get a clearer idea of the different dimensions affecting treatment completion. Swift said, “By paying attention to these variables and making adaptations where needed, clinicians may be able to reduce rates of premature discontinuation in their work with clients.”

Reference:
Swift, J. K., Greenberg, R. P. (2012). Premature discontinuation in adult psychotherapy: A meta-analysis. Journal of Consulting and Clinical Psychology80.4: 547-559.

Couple toasting over dinnerHow many relationships do you see around you that you would actually want to be in? For most of us, we can count the number on one hand. An even better question might be, “Am I in the kind of relationship I would want my own child to be in someday?” If you want to top that and move into the area of upping your chances to have an exceptional relationship, you will ask yourself, “Am I being the kind of partner I would want my child to have someday?”

As a therapist who has worked with couples for more than a decade now, I see a disturbing trend on the rise. We are settling for mediocrity in ourselves as partners while expecting our partners to be exceptional, asking more of them than we do from ourselves. If you are thinking to yourself, “Could this be me? Am I being an exceptional or mediocre partner?,” please keep reading. because there are three simple traits that genuinely happy and fulfilled couples seem to have in common. If you are looking to take your relationship to the next level, consider raising your personal standards in any of the following ways, remembering that if you want a better relationship, it begins with looking at one’s own self first and foremost.

1. Exceptional partners have a good idea about what makes it difficult to have themselves for a partner, and they feel a sense of appreciation and respect for the challenges their own personality presents for their partner. They work hard to keep these attributes in check and not let them get out of control. Mediocre partners are rather hazy about their own shortcomings as a partner but can easily enough rattle off a long list of their partner’s flaws.

It is easy enough for most people to list off a handful of traits that make it difficult to have their significant other for a partner, but when the question is turned back on oneself—”What makes it difficult to have MYSELF for a partner?”—the exceptional partner demonstrates a rare willingness to identify his or her own shortcomings and backs this up with a steady commitment to managing and keeping his or her own difficult traits and imperfections in check so that they don’t impact the partner in unfair ways.

Whenever I work with a new couple, I always eventually get to that question because it helps me understand how to best help them. The old saying, “We can see everyone but ourselves when we enter a room,” applies to relationships, too. It’s normal to not know the answer to this question, but the willingness to be open and want to know the answer is everything. As the research from the world-renowned Gottman Institute has found in Seattle, Washington, female partners in particular need to know that their opinions and feedback truly matter to their partners. This is actively demonstrated by listening with the sincere intent to understand the other’s feelings and positions and find common ground and areas for compromise and by validating your partner’s stance without necessarily agreeing with it.

2. Exceptional partners understand that while they are not responsible for their partner’s happiness, contributing to their partner’s happiness is nonetheless a top priority. Mediocre partners, in contrast, are primarily focused on their own gratification first, and while they too can be thoughtful, thoughtfulness is not a daily habit.

Years ago, I placed a beautiful canopy bed up for sale. A couple arrived to purchase it. As they dismantled the bed piece by piece, there was an attitude of playfulness and a sense of mutual joy they took in one another that was striking in its rarity. “What’s your secret?” I asked them. They shared that the secret of their successful marriage was that every morning they ask themselves, “What might I do today to let my partner feel loved?” Exceptional partners make it a habit to be exceptionally thoughtful. They seem to recognize that life is short and seek out ways on a regular basis to express their love. For these couples, love is indeed not just a feeling but an active verb.

3. Exceptional partners ask a lot of themselves and not more nor less of their partners. Mediocre partners, on the other hand, have the balance tipped in the opposite direction. They either are asking more of their partner than they are of themselves or sacrificing their needs regularly in order to serve everyone else, leading to chronic feelings of depletion and often bitterness and not feeling appreciated.

It is often said that we should ask more from ourselves than others because this is the one thing that is in our control. However, this advice has its limits when it comes to the person we spend our lifetime beside day in and day out. Exceptional partners consider themselves a work in progress and make a habit of expressing their needs and desires in a direct yet respectful way. They insist on both treating their partner well while also being treated well in return. In other words, they invest heavily in the success of the relationship and expect their partner to bring this same level of consideration and commitment.

Mediocrity in our relationships may be our conditioned norm, but we can move into the exceptional this very moment by expanding our commitment to ask more of ourselves, appreciating our partner in ever deepening ways, and becoming voluntary stewards of one another’s joy.

Related articles:
Creating the Foundation for a Healthy Relationship
9 Secrets for a Lifetime of Like, Love, and Lust
If Only My Partner Would Change, Then Everything Would Be OK

Clinicians who practice individual therapy have the responsibility of developing a therapeutic bond with their clients, tracking the progress of their clients throughout therapy, and measuring treatment outcome. Along the way, therapists must ensure that the measures they are using are delivering results, and if not, they must change their approach. These steps become even more daunting when they are undertaken in a group setting. Group therapists have the same responsibility to their clients as do therapists conducting individual therapy; however, they must maintain this responsibility with each and every client in their group.

A team of experienced group therapists recently published an article providing guidance for preparation, evaluation, and conclusion of group therapy for clinicians. Dallas R. Jensen, Assistant Clinical Professor in the Counseling and Psychological Services Department at Brigham Young University, spearheaded the effort and outlined several key components for effectively managing group therapy sessions. The first and most important aspect of accurately assessing group therapy progress is gathering practice-based evidence (PBE). Research has shown that clients are more accurate predictors of treatment outcome than clinicians’ assessments. Therefore, Jensen recommends that therapists use a variety of several well-established tools to determine group member eligibility, progress, and outcome.

The Group Therapy Questionnaire (GTC) is an excellent tool to determine group member readiness. This tool allows therapists to examine the level of willingness of the member, previous group experience, and other factors that could influence participation, such as suicidal ideation, substance dependency, therapy fears, and goals. The Group Readiness Questionnaire (GRQ) is a similar tool often used. Jensen suggests other measures, such as the Working Alliance Inventory (WAI), the Cohesion to Therapist Scale (CTS), Therapeutic Factors Inventory (TFI), and the Group Climate Questionnaire (GCQ) to accurately assess the level of cohesion within the group and gauge group fidelity, tone, trust, and acceptance. Although there are several outcome scales to choose from, Jensen notes that the Outcome Questionnaire-45 (OQ-45) is the most commonly used and can be administered via computer or in person. Group therapy assessment is an area of research that is still relatively new, but is critical to group success. “We further encourage clinicians to share results and lessons learned in the literature and in professional settings, so as to continue developing this burgeoning effort,” concluded Jensen.

Reference:
Jensen, D. R., Abbott, M. K., Beecher, M. E., Griner, D., Golightly, T. R., Cannon, J. A. N. (2012). Taking the pulse of the group: The utilization of practice-based evidence in group psychotherapy. Professional Psychology: Research and Practice. Advance online publication. doi: 10.1037/a0029033

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