Starting the day with fibromyalgia pain made Vera angry

Fibromyalgia made it hard for 46 year old Vera to get her legs out of bed in the morning. As she moved toward the bathroom and began her toilette, the pangs of pain moved to her hands, head and neck. It brought tears to her eyes. It made her angry to think that Kurt hadn’t even thought of organizing things around the house to make life a little easier for her. Vera remembered the arguments about accompanying her on doctor appointments and got even angrier. But she never said anything to him. She turned her mind to the support group she would attend later that day, although it wasn’t successful in easing her physical discomfort.

Vera found it easier to focus on the fibromyalgia pain than her scary emotions

As she ate breakfast, flashbacks of her early family file flooded Vera’s vision. She relived the tension she used to feel coming home from school wondering if her parents would fight out loud or give each other the cold shoulder. Her mother would take out her frustration on Vera the oldest and quietest of her kids. Her muscles tightened up as she recalled the fear of uncertainty and not knowing how to speak about her worries. It was the same thing now. She didn’t know how to talk about the anxiety of not being able to take care of herself. Vera had no words for the anger at her father for not making her mother happy, and at Kurt for being equally insensitive and uncaring. What she did have was body pain that ranged from dull aches to excruciating pain for which no specific organic cause had been found. Fibromyalgia was the diagnosis. It came with fatigue, slowing down of actions and restricting her life. It was making Vera dependent on pain medication and on a husband who let her down, repeating the cycle of her childhood. (more…)

“For years it lay in an iron box buried so deep inside me that I was never sure just what it was. I knew it carried slippery, combustible things more secret than sex and more dangerous than any shadow or ghost. … I saw things I knew no little girl should see. Blood and shattered glass. Piles of skeletons and blackened barbed wire with bits of flesh stuck to it…The iron box contained a special room for my mother and father, warm and moist as a greenhouse. They lived there inside me, rare and separate from other beings. … I knew my parents had crossed over a chasm … The box became a vault, collecting in darkness, always collecting; pictures, words, my parent’s glances, becoming loaded with weight. It sank deeper as I grew older, so packed with undigested things that finally it became impossible to ignore.”
-Helen Epstein, Children of the Holocaust

(more…)

Have you ever been in a relationship that challenged your assumptions and beliefs about yourself and the world around you? If so, then you know how powerful and life changing some relationships can be. Imagine then, forming a relationship with a professional who is trained to develop relationships that encourage self-exploration, insight and positive change. Carl Rogers, founder of person centered psychotherapy, outlined three essential ingredients of  a successful therapeutic relationship – unconditional positive regard, genuineness and empathy.

Therapy can be a difficult, and even painful, process, wherein clients explore the good, the bad and the ugly within themselves, perhaps for the very first time in their lives.  As clients explore, the therapist’s attitude towards them will either encourage them to continue the exploration, regardless of what comes up, or the therapist’s attitude will shame them into shutting down. Therapists who have unconditional positive regard for their clients accept them as they are without conditions or judgments. Unconditional positive regard is paramount in the therapeutic relationship; it not only allows, but encourages clients to explore parts of themselves that they have never been permitted to explore. Free from the fear of rejection, clients can fully and honestly explore themselves, past and present, and their desires for their future.

The concept of genuineness in the therapeutic relationship, simply put, calls for therapists to be themselves, and to interact authentically and sincerely with their clients. Genuineness requires therapists to have a high level of self awareness, coupled with a willingness to share the experiences of their clients in a way that is beneficial to the clients. For example, if a therapist is feeling disconnected from a client as he reports the events of his week, the therapist might say something like, “I’m feeling a little disconnected from you right now.  I hear the events you are reporting, but I’m not hearing anything about how you experienced them, how you felt about them, or how they impacted you.” Chances are if this is how the therapist experiences the client, this is also how other people in the client’s life experience him. However, people rarely provide such frank, insightful feedback to one another in everyday life. This genuine statement from his therapist may lead the client to develop some insight into why he feels a distance and lack of connection in his personal relationships.

Perhaps most central to the development and maintenance of the therapeutic relationship is the concept of empathy.  Empathy goes well beyond the more common notion of sympathy. Sympathy is simply feeling badly that someone is going through a difficult time. Empathy on the other hand is the ability to put yourself in another person’s shoes, and to view, feel and experience the world as that person does. Imagine, for example, how powerful it is to have a therapist take the time to actively listen to a client who has lost her mother.  The empathic therapist, who has worked hard to fully understand her client might say something like, “It sounds like your mom was the only person who ever made you feel taken care of, and now that she is gone you’re feeling very alone and scared.”  Until this point, people have probably told the client that they are “sorry for her loss.”  Through empathy, however, the therapist has offered something much deeper– something that makes the client feel understood and solidly connected to the therapeutic relationship.

Beginning therapy can be a very difficult step to take. You may be concerned that your interaction with the therapist will be cold and clinical, or that the therapist will judge you harshly. These concerns are quite common, but also quite contrary to the Rogerian therapeutic relationship. If you are considering therapy and believe you would thrive in the kind of relationship described in this article, consider seeking out a person centered therapist near you.

The alphabet soup of degrees, licenses, and various organizations related to all things EMDR (Eye Movement Desensitization and Reprocessing) is confusing to be sure, but it is imperative that you review your therapist’s level of training.

As I have addressed before, contrary to popular belief, EMDR is not an intervention, but rather a full and comprehensive modality, one that includes eight phases, each phase with its distinct functionality, process, and methods. An EMDR therapist will approach your case, treatment goals, and your progress through the eyes of that model as it were. EMDR is a way of conceptualizing what you are working on, how your arrived at the symptoms you want to change, and what you want the future to look like.

Knowing your EMDR therapist’s training level will also enable you to determine their experience and knowledge base regarding this modality. While this information may be a little dry, it will give you the tools to ask what you need to of a potential EMDR therapist. You will know what your therapist means when he or she tells you what their level of training is. Remember, most of all, look for someone who has attended an EMDRIA Approved Training.

The Basics

Prior to 2007, the EMDRIA standards for EMDR Basic Training came in the form of an independent two-part training model. EMDR therapists who are trained prior to 2007 would, therefore, identify having been trained at Level One or Level Two. Each workshop took a weekend to complete and in contrast to the current training standard, did not include any consultation hours in between trainings. The EMDR therapist was trained in EMDR and able to identify him or herself as being EMDR trained with just the Level One training, as the Level Two training was not required. Nevertheless, please keep in mind that being Level Two EMDR trained was strongly recommended. From a client’s perspective, Level Two heightened the EMDR therapist’s understanding, provided him or her with additional tools within the EMDR model, and provided skills for processing more complex trauma cases. If your EMDR therapist chose to complete both trainings, he or she would have completed 34 training hours in EMDR.

After 2007, as I previously mentioned in last week’s article, the EMDRIA training standards for EMDR practitioners evolved. What was once Level One and Two EMDR training became a Basic Training model, one that required the completion of both independent trainings in order to identify oneself as having completed the Basic Training that now constitutes 50 total training hours. The lecture and supervised practice portions are conducted over two weekends at 20 hours each weekend. What this also means for you is that your therapist can start using EMDR after Part I, and is encouraged to, while their Basic Training is still in process.

Furthermore, as part of this 50-hour Basic Training, and to receive a formal Certificate of Completion the therapist must also complete a total of 10 documented consultation hours. Five hours must be conducted after the first weekend, and the final five after the second weekend.

Considering Certification

For those seeking to refine their knowledge and utilization of EMDR, there is an option of becoming an EMDRIA Certified In EMDR. Essentially, the goal of the certification process is for the EMDR therapist to demonstrate fidelity to the EMDR protocol and increase his or her knowledge, expertise, and experience with the modality.

To become certified EMDRIA requires that a clinician who is EMDRIA Certified in EMDR has been licensed or certified in their profession for independent practice and has had a minimum of two years experience in their field. They have completed an EMDRIA approved training program in EMDR, have conducted a minimum of fifty clinical sessions in which EMDR was utilized, and have received twenty hours of consultation in EMDR by an Approved Consultant. In addition they must complete twelve hours of continuing education in EMDR every two years.

Working with a Consultant

The EMDR therapist seeking certification completes those 20 consultation hours with someone called an EMDRIA Approved Consultant in EMDR. Or, an EMDRIA Approved Consultant In Training can provide 15 consultation hours, and an EMDRIA Approved Consultant completes the remaining 5.

As an individual seeking EMDR therapy, think of an EMDR Consultant as one who helps EMDR therapists further enhance and assure their understanding of EMDR. To be classified as such, an EMDRIA Approved Consultant must already be EMDRIA Certified, have a minimum of three years experience with EMDR after completion of Basic Training, and have conducted at least 300 EMDR sessions. In addition, the Consultant must continue to obtain at least 12 CEUs, specific to EMDR, every two years.

Whew! Now, keep in mind, you may also run across someone who, on top of being an EMDRIA Approved Consultant in EMDR, is also EMDRIA Institute Facilitator, EMDRIA Approved Training Provider or EMDR HAP Trainer. EMDRIA Facilitators or HAP Trainers conduct and facilitate the actual Basic Training that therapists must complete to begin their EMDR journey. In addition to actually conducting the training, they also provide the consultation hours that are required in between the Part I and Part II of the Basic Training. For those completing the Basic Training through HAP an EMDRIA Approved Consultant or Consultant In Training can conduct those consultation hours in between Part I and Part II.

So, that all being said, I know it can be very confusing. But, I hope that this article has given you an idea of what those EMDR training levels mean! Best of luck to you as you travel your healing journey.

“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

Slow down and listen.

When we communicate, sometimes we ignore what our partner is saying. Instead of focusing on our partner, our thoughts are consumed with what we plan to say next. If you pay attention to your partner’s words, and then you reflect back what you hear them say or feel, then they will feel heard. As a result, you will be on the road to a resolution of the issue. Does someone in your life, maybe yourself, constantly repeat a message over and over? It is probably because said person does not feel heard.

Try reflective listening and see if you can stop that person from repeating. “Reflective listening” means you state back the jest of what you heard or the emotion associated with the communicator’s message. Keep it short. If that is not what the speaker meant for you to hear, then the speaker will say, “No that is not what I wanted you to hear.” The speaker then repeats the statement, trying to change it in a way that the meaning can be more clearly understood. We talk and listen through our life filters. What one person says and intends to be heard may be totally different than what the receiver hears. Reflective listening is an advantageous tool because it confirms if the message was heard in the speaker’s intended manner. (more…)

He called me, as most new clients do, to inquire about me, my practice, and my approach to helping. What made this call unusual was that I had to educate him about Eye Movement Desensitization and Reprocessing (EMDR), not because he was unaware of the treatment, but because what he had heard about it from his current therapist was inaccurate. Unfortunately this happens a lot with all kinds of therapy.

As I tell many folks, finding a therapist is like finding the right pair shoes. Some shoes look good, but they don’t fit. Some don’t appear to be a good fit or style, but they are. Just as many of the choices you make as a consumer are aided by research and experience, becoming an educated therapy consumer is a necessary part of your healing journey. When you contact a new therapist, the therapist, too, will wonder whether he or she is the right therapist for you, whether the type of therapy used will be in your best interest, and whether the therapist can offer the expertise that you seek.

With the potential new client on the phone, I found myself in a bind. On the one hand, I wanted to be respectful of the relationship he had with his therapist, but on the other hand, what he had been told about EMDR was not accurate and could possibly hurt him. I elected to educate him and tell him the truth about it, even though it was different what he had heard from his provider. With this information, he was able to better identify what he needed from a counselor and to determine when or whether to pursue EMDR.

EMDR Is Not a Quick Fix

We often look for a quick fix in this culture. Certainly, EMDR’s way of processing traumatic material can be rapid, intense, and highly effective, but it is no guaranteed quick fix, as the client on the phone had been told. Generally, when I first meet with a client to talk about EMDR, this is one of the first misunderstandings that comes up. EMDR is like a specialized surgery procedure, a laser beam of sorts that hones in on the material that is stuck in the nervous system causing distressing symptoms. I wouldn’t ask my surgeon to rush, nor would you. In fact, rushing may mean missing out on completing the eight phases.

More than Just Eye Movements

The name Eye Movement Desensitization and Reprocessing suggested to the client that the treatment involved little more than eye movements. This is a common misconception. If your EMDR therapist is talking only about eye movements and nothing else, it’s not EMDR. EMDR consists of eight distinct phases, which I will illustrate for you. If you are currently using EMDR therapy, you may already know where you are in the process. If not, I hope to reveal some of the mystery behind the treatment. Though the phases are intended to be completed in a particular order, transitioning between them, in a circular fashion, is not uncommon. We can go back to a phase at any time.

The Eight Phases of EMDR 

1. History Taking
   In this stage, your therapist will learn about you and your history and might conduct the standard assessments that he or she uses. This is the time when you share your story, get to know your therapist’s style, and set up initial treatment goals. The therapist should also be creating a target sequence plan, an overview of what affects you from your past and a template for your future. In this phase you are likely to discuss touchstone events, previous experiences that contribute to your current symptoms. You may be surprised to know that how you think and feel in this moment is linked directly to your past. As you review these events with your therapist, you may be asked to rate how disturbing things are to you on a scale of 0-10.
2. Preparation
   The next three phases are like a traffic light, and phase two is like the red light. At this point, you are learning more about EMDR, as well as identifying and ensuring your readiness to move further through the phases. You may be learning additional grounding skills, stress reduction skills, or state change skills, and your therapist will help create a safe-place image for you. You will also be asked to complete a brief assessment to identify if you experience dissociation. You will learn about bilateral stimulation (BLS), the back-and-forth eye movements, sounds, or tactile sensations that help the right and left hemispheres to process the traumatic material and activate the brain’s Adaptive Information Processing (AIP) system. In this phase, you may also hear your therapist talk about resourcing and using the BLS to help you access more positive experiences, thoughts, and images before moving on through the remaining EMDR phases.
3. Assessment
   This phase is like the yellow light on a traffic signal. In the assessment phase, you and your therapist will look at what you want to target when you move into the processing phase. Your therapist will ask you for an image, a negative cognition, and a positive cognition, and to rate how true your positive cognition feels on a scale of 1-7 and how disturbing the target is on a scale of 0-10, and to describe what you experience in your body.
4. Desensitization
   This phase is the green in our traffic light analogy. This is where the BLS really comes into play. Those who have used EMDR know that this is where what you are working on comes up. All of your senses become involved as you process the disturbance you are targeting. You won’t talk to your therapist during this process; you’ll have a brief check in, and then go back to moving your eyes back and forth, hearing the tones, or feeling the taps. This is where AIP comes into play, and your brain will recycle the material for your nervous system to release it as it did not get to at the time. In between sets of BLS, your therapist may also throw some things in for you to think about; these are called cognitive interweaves. The same 0-10 scale from the assessment phase will be used here to assess your level of disturbance. When the level of disturbance is rated at zero and the target truly feels neutral and not distressing, we move on to phase five.
5. Installation
   Next, we will install the positive cognition that you chose with the BLS, but before we do, we recheck to see if the positive cognition has changed at all. It often does because you have moved further on in your healing. We will also check to see how true that positive cognition feels to you, using the same 1-7 scale from phase three. We then keep using the BLS to see if anything is getting in the way. When you get to a 7, completely true, we move to phase six.
6. Body Scan
   Just as the name suggests, you will be asked to mentally scan your body to find any sensations or tensions that signal that something is still stuck regarding the target. If there are any lingering sensations, your therapist will continue with the BLS.
7. Closure
   This will look and sound different depending on if your session was complete or incomplete. You will close down the material and do a final check. You will also use various methods, including imagery, to contain the material that is still not processed. This may include returning to your safe place or creating a container to hold anything that may become to distressing in between sessions.
8. Reevaluation
   Though it looks like the last step, the reevaluation phase spirals back as if it were the beginning. Your EMDR therapist will do a check in at the beginning of your next session that will include reevaluating your disturbance level regarding the target from the last session. This helps to determine if your disturbance is still neutral and if your positive cognition still rings true. If the previous EMDR session was incomplete, the cycle begins again at phase four.

A recent study of people who are trying to quit smoking shows that Cognitive Behavioral Therapy can help reduce cigarette cravings. Overcoming cravings is an essential part of successful addiction therapy, as the craving to pick up another cigarette may, in the short term, overpower the rational reasons for quitting. Helping people overcome cravings by “retraining” the brain has the potential to help people quit smoking more effectively. The study, which was funded by the National Institute of Drug Abuse, took brain scans of people who’d been undergoing cognitive behavioral therapy with the goal of smoking cessation. The scans showed interesting behavior in two areas of the brain.

One area, known as the prefrontal cortex, helps a person control their emotions (among other things). This part was more active in people who’d undergone the smoking therapy. A second area, called the striatum, is related to reward-seeking and craving. This area was less active in people who’d been having therapy. In addition, people who’d been undergoing therapy also reported that their cravings were less intense. (more…)

Sometimes people ask me why they should bother seeing a therapist when they can just talk to their friends. Friends know your history, you’re comfortable together, and you trust and care for each other. Friends don’t expect to get paid either, and you can meet socially instead of making an office appointment. That’s all true and wonderful.

What Can a Therapist Do that a Friend Can’t Do?

First of all, therapy is completely private—you can speak freely, without fear that your story will go where you’d rather it didn’t. Maybe there are things you’re afraid of or that embarrass you or make you feel sad, and you feel a need to talk about them. You can discuss them with friends or family, that’s true, but you might like the confidentiality that a therapist provides.

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Next, a therapist is trained to see your patterns, both good patterns and those that don’t work very well. As a therapist, I can point these patterns out to you, and then together we can employ and enhance the good patterns and identify and avoid the not so good. For example, many people who continue to have the same kinds of relationship problems over and over can learn to make better choices in their behaviors and in finding suitable partners. Other people may have trouble getting along with people at work, difficulty making friends, or feelings of loneliness. Therapy is really good at helping people with all kinds of relationships, because it is a kind of test relationship—you get to receive feedback while trying out new ways of being in a safe environment.

Friends, on the other hand, may not be totally honest with you, because they don’t want to hurt your feelings. I don’t want to hurt your feelings either, but I know how to be straightforward and direct and how to say things in ways that won’t be so painful. And if they are painful, we can slow down, continue at a pace that helps you to feel safe, and use techniques that will help you feel less anxious or depressed.

Can’t a Friend Provide Advice or Help You Figure Things Out?

Certainly, a friend may share ideas of what’s best for you and tell you what to do. I may have ideas about what’s best too, but I will help you figure things out for yourself. A therapist can help you look deep inside to find your own solutions and teach you to remember that pathway so you can find it again when you need it. Therapists encourage self-reflection and empower people to find solutions on their own; these techniques can help people live more rewarding lives.

How Do You Know You’ve Met the Right Therapist?

As with any new person, when you first meet a therapist, you have to get to know and learn to trust the therapist.  Most often, you can feel it in your gut. Do you like each other? Do you think you could get comfortable with this person?

It’s scary to begin treatment, and it’s awkward talking to a stranger about your personal life. All therapists have ways of helping people feel comfortable. As an object relations specialist, I pay close attention to the unspoken feelings revealed in your body language. I’ll let our conversation develop naturally, and I’ll invite you to ask any questions you might have, especially if they seem silly. I’ll probably make a joke, or try to, because therapy can also be playful.

Don’t People Become Too Dependent on Their Therapists?

You might feel dependent for a time, but therapists measure their success by people’s abilities to learn and move on, allowing them to leave therapy with healthier strategies to make better lives for themselves.

When you think it might be time to cease treatment, the best strategy is to talk it over with your therapist and review your original goals. Have you met them? Are there new goals you’d like to work towards?

If you both agree that it’s time to bring your relationship to a close, it can help to set a date for termination, so you can say a full goodbye to each other. Goodbyes are just as important as hellos, you know.

“Generosity brings happiness at every stage of its expression.
We experience joy in forming the intention to be generous.
We experience joy in the actual act of giving something.
And we experience joy in remembering the fact that we have given.”

—The Buddha

The universe works in mysterious ways, often paradoxically. When you give compassion, you open to receive it. When you give love, love comes to you. When you give money or material possessions, your wealth increases. Whatever the focus of your generosity, the underlying assumption is abundance: there is plenty for everyone.

What keeps you from giving freely? Fear. Fear that you won’t have enough, that there is a limited amount of what you want or need in the universe, and you will be short-changed.

I am not suggesting you give everything away, as that shows a lack of basic self-care. But when you let go of possessions and money, when you bravely open your heart to love, when you bestow a kind word or smile on someone, you open unseen portals for goodness, compassion, and prosperity to flow to you.

Of course, when you feel unloved, financially stressed, or beset with personal demons, it is hard to do the opposite of how you might reflexively want to act. It is natural to want to conserve your energy and funds and close your heart when life is particularly stressful. But by taking a leap and having faith that the universe will provide, you change your energy. This allows you to see new opportunities and let life bestow what you need.

It is crucial to remember that you may not get what you asked for in the exact form you desired or envisioned. Perhaps you asked for a loving relationship, and the man or woman of your dreams didn’t come knocking at your door. But maybe while waiting, you developed self-compassion, self-love, and self-acceptance. Weren’t those exactly what you were hoping to find in a relationship: someone who would show you compassion, love, and accept you as you are?

When you can really let go and assume the universe provides, you can deeply relax. This doesn’t happen overnight. It requires a big leap of faith and a lot of practice.

One way to enhance your abilities in the leap-of-faith department is to meditate on the concept of plenty. It is not that the universe will change and just send you everything you want: it’s that you change and, as a result, things appear.

Sometimes, when you feel most afraid financially, the best thing you can do is donate some money to charity. It doesn’t have to be your rent check, just something to symbolically teach you that what you need will come back to you. Another technique is to buy yourself a treat when you feel as if you can’t afford it. This shows your faith in yourself and the universe. I am not suggesting going into debt, just a small item to help you escape a poverty mentality.

Similarly, when you feel lonely, go out into the world and smile at someone, call a friend who may also be flying solo, or write a loving note, text, or email. Again, by giving what you seek you change your energy.

Letting your love show when you feel vulnerable takes great courage. Giving money, time, and kindness when you acutely feel their lack is deeply generous and openhearted. By letting go and giving freely, you enhance your connection with others and imbue life with more meaning.

Remember: a radical shift in consciousness and behavior takes time and practice. Be patient with yourself as you gradually change your behaviors. Your worldview will shift accordingly, leaving you more positive, peaceful, and empowered.

Some suggestions:

• A quick and easy way to give is through websites like The Hunger Site, which cost you nothing and benefit those in need.
• Check out books, like Viktor Frankl’s Man’s Search for Meaning.
• Be aware of opportunities to be generous, whether it is leaving a coupon on the grocery store shelf, tipping well at a restaurant, or putting furniture out on the street. Even if you have nothing material to donate and no time to volunteer, you can always give a heartfelt compliment.

“Do everything with a mind that lets go. Do not expect any praise or reward. If you let go a little, you will have a little peace. If you let go a lot, you will have a lot of peace. If you let go completely, you will know complete peace and freedom. Your struggles with the world will have come to an end.”

– Achaan Cha, A Still Forest Pool

When we practice mindfulness, when we learn to notice thoughts without getting carried by their content, and when we learn to sit with pain or discomfort, we practicing letting go. Most clients who come to see me are holding firmly onto something—their story, their fears, losses, expectations, relationships, or possessions—even when these things cause them pain and suffering. We all tend to hold those things and more. Learning to let go can be an act of release and healing.

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The major part of holding takes place in thoughts: obsessive thoughts, worries for the future and regrets of the past, thoughts that form your life philosophy and beliefs about who you are and your journey in the world. There are three ways of mindfulness practice that cultivate letting go of the grip of thoughts.

Awareness and Exploration
By bringing awareness to the content of thoughts through inquiry, one can learn to identify themes and topics that rise repeatedly, note them, and simply observe them without getting involved in their content. This “scientific” observation approach serves as a way to let go. When you are curios about the phenomenon of thoughts, you naturally are less attached to the message that the thought carries. Observing the process of how thoughts emerge, develop, rise and fall, and appear and disappear helps to neutralize identification with the content of the thought.

Focusing on the Breath, the Body, or an Object
The basic method for practicing mindfulness is to focus on the breath. When the meditator notices thoughts coming, he or she just shifts awareness back to the breath. This gentle inner action of shifting awareness serves as a practice of letting go. When one notices thoughts, the tendency is to follow, to get engaged in the content of the thought, even if this engagement brings pain and suffering. Noticing the inner activity of thinking and choosing not to get involved, but rather to reconnect with the breath, is an act of letting go. You allow yourself to let go of the thought.

Openness
Physical openness: Holding means tightness. Holding with your hand means that you tightened and folded your fingers. When we hold sadness, anger, hatred, worries, and more, there is a tightness and closing in the chest, belly, and jaws. Adapting a sense of openness and developing a sense of wide chest, open arms, and open face helps to let go of the inner holding and tightness.

Mental openness: Developing a wider view of a problem, and seeing the relative place it takes in the whole tapestry of one’s life, helps to let go of the sense of emergency and magnitude of whatever one holds. Assuming perspective can apply not just to one’s life, but also to the general scheme of things and the place of the individual within the society, nature, and the universe. These forms of mental openness release constant hovering over the issue and give a sense of release.

Mindfulness is not Distraction
We all know of another way to let go, usually for a limited amount of time, the way of distraction. Distractions can be helpful sometimes to ease tension, anxiety, and pain, and as long as they are not destructive, they can be used. However, distractions are not part of mindfulness, and their affect is limited, with no cumulative effect of growth.

It is important to note that in the mindfulness methods, the idea is not to ignore a problem or avoid addressing it—it is about a choice between suffering and freedom. One can still choose to deal with issues that need to be addressed, but do it from a place of non-attachment. Letting go releases the energy that was captured by holding to be used for creative and meaningful changes.

Lots of people hope for compromise in their relationship. Compromise is great when it happens; there is an easy flow, and both partners feel happy with the results. Nobody feels like they are losing, like they are being taken advantage of, or that their needs don’t matter. It doesn’t even feel like compromising—it’s just being happy together.

But what gets in the way of this delightful experience? Does it just happen naturally? Do you need to have logical conversations about it? Does it come from being forceful about getting your point across? Do you have to give up your needs?

Compromise Versus Conflict

Do you believe compromise should happen naturally? Do you think it means a relationship can’t work if it isn’t easy? Do you think about leaving relationships when they get difficult?

Let’s take a moment to look at this experience. Perhaps you feel really bad when conflict starts. You want to get away ASAP. You don’t like the feeling of someone being unhappy with you, criticizing you, wanting you to change. You have no experience of conflict being productive. Maybe conflict means someone is going to go crazy on you, demand something from you, or manipulate your feelings.

If that’s the case, it makes a lot of sense that you’d want to avoid conflict. When compromise doesn’t flow, you might conclude that this isn’t the relationship for you, or you become a stonewall and stop talking.

If there’s enough love present for you in the relationship you might want to think about your avoidance of conflict. Maybe it doesn’t have to be as bad as it has been in the past. If you acknowledge how it was and how you have come to protect yourself from these bad experiences—by heading out of town—you’re half way to a more mature, balanced approach to conflict.

Logic Versus Compromise

Does your mate get upset when you bring logic and rationality to the conversation? Do you say to yourself, “I’m just trying to solve the problem—why is he/she getting so upset?” Look at yourself honestly. Does your logical tone have an argumentative, forcing element to it?
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Maybe the conversation gave you an uncomfortable feeling—maybe your gut got tight and you got a brief, but powerful sinking feeling. In Internal Family Systems (IFS) that is called an Exile. It could be that you used logic as a way to try to make that feeling go away (in IFS that’s called a protector). Honesty might work better than logic. Consider saying, “When you said I wasn’t helping enough around the house, I felt bad, and part of me wants to fight you using logical sounding arguments.” Pure logic rarely leads to vital, mutually satisfying compromise.

Forcing Your Point Versus Compromise

We’ve all been there: the conversation is going smoothly, and all of a sudden we find ourselves trying to ram our points home. What happened just before you changed your tone? If you can be honest, you’ll probably find an Exile. Maybe an old feeling of no one listening or caring about your feelings came up. Or you felt an echo of an old feeling of not fitting in with the group, not measuring up.

If you notice a moment when you’ve started to force your point, you might be able to choose what you want to do, rather than charging forward with an attitude which you know will not help you get to compromise. Can you imagine yourself saying, “I don’t want to admit it, but a part of me feels just like I did when the other kids wouldn’t choose me for the team. And another part wants to force you to agree with me so I don’t have to feel that anymore.”

My Needs Versus Compromise

Do you find yourself defaulting to a subservient, submissive, surrendering position, and then getting resentful, depressed, or maybe angry? Do you think someone else’s reality is more valid than yours? Do you have Exiles (walled off parts of  yourself) who had this experience when you were young? Maybe powerful people made you agree with them, and the cost of fighting was too great.

You can acknowledge those young Exiles, find them in the rooms, porches, and yards where they live, re-playing their bad experiences. You can let them know you see them and understand them, and that they aren’t alone anymore. IFS teaches that direct contact between you and your parts opens up surprising, fresh possibilities. They may come to trust you, rely on you for help, and even stop flooding you with their bad feelings. If you can do that, you won’t have to rely on surrendering. You might find it safe and productive to speak up for what you believe, then watch to see how your partner responds.

Compromise Happens

Compromise happens naturally when you recognize the protectors that have come out to help you, and the Exiles behind them. It will be a fluid, fun, mutually supportive, brainstorming experience, and you’ll find solutions you never could have imagined beforehand.