Walking on beach at sunrise looking at skyIt isn’t uncommon for us to move away from certain feelings. We have all kinds of methods to help us numb out our emotions. Many times we do this without even being conscious of it. As soon as we begin to feel something a bit uncomfortable inside, we find ourselves turning on the television or eating something as a way to avoid it.

If you were to investigate why you tend to avoid a particular feeling, one thing you may discover is a belief, either conscious or unconscious, that you can’t tolerate the feeling. If instead of moving away from the feeling you turned toward it in the present moment—meaning you allow your experience to be there without trying to change it—you would discover that hidden underneath that feeling lies a precious gem that belongs to you.

Mike had a good day at work, but when he got home he noticed he could not stop thinking about it. His mind was fantasizing about getting a promotion, making a lot of money, or becoming a hot shot at his company. He then felt an urge to have a glass of wine. Typically, Mike wouldn’t have thought twice about this and would have immediately poured himself the glass. However, Mike had recently begun reading a book on emotional intelligence that emphasized the importance of paying attention to inner experience, so he stopped and questioned his experience. He asked himself, “What’s going on? How come I want this glass of wine so bad?” He also paid attention to his body sensations and tried to know what he was feeling.

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As he paid attention to his internal experience, he noticed there were some uncomfortable sensations inside that he didn’t want to feel. He continued allowing his experience to be there without trying to change it. He then began to notice anxiety. He continued to be with it and noticed his whole body felt prickly and uncomfortable. He noticed then that the urge to drink intensified, but he took a deep breath and allowed the intensity to be there with curiosity and interest.

Behind the prickly, uncomfortable sensations, he noticed the sensation of a “hole” in his chest. As he allowed the hole to be there, a wave of sadness came through and tears began to flow down his cheeks. Suddenly he remembered painful memories from childhood that related performance and self-value. His parents used to focus excessively on achievement and accomplishment, and celebrated him only when he achieved things in school. He realized how his sense of worth was tied to how well he did at work. He wept deeply.

Before long, he noticed his experience was much more tolerable. The sadness now had a sweetness in it, and he experienced himself in an open, soft, and receptive way. He was relaxed and at ease, and the desire for wine was gone. He also noticed a deep sense of well-being and, specifically, a sense of value that was not dependent on his work or achievements. He was experiencing value simply by being.

Although Mike’s story is fictional, it illustrates a process that can happen when we are engaged in inner work. As Mike allowed his experience to be what it was without trying to change it, he realized he didn’t need to avoid it. As he continued to stay with it, he was able to see clearly an unconscious connection between performance and value. As he saw through those old templates, he was able to access a true, intrinsic sense of self-worth that wasn’t dependent on externals.

By becoming more open toward our experience instead of avoiding it, you too can access deeper aspects of yourself and encounter deep, intrinsic sources of well-being. Here are some ways to help you stay in the present moment as you encounter difficult feelings.

1. Widen Your Perspective

There are times when we can be with our feelings directly, with our awareness on them like a laser beam. This is particularly true when the feeling is vague, unclear, or not very intense. However, when we are experiencing a difficult emotion, it can be overwhelming and it may be wise to regulate how we are with it. At times like this, we may want to shift our attention from a narrow awareness of the difficult emotion to a wide, inclusive awareness.

Picture a balloon-like sphere (this represents you). Now, inside the balloon, picture a smaller sphere full of spikes (this is the difficult feeling). If you are contracted and tight around the spiky sphere, you will feel the spikes puncturing your inner lining, and you may even burst. However, if you allow spaciousness to come in, your balloon will inflate and expand. The spiky sphere will not touch your inner lining, and you won’t be hurt by the spikes. The spiky sphere will simply be a small particle in a vast container.

There are other methods you can use to expand your awareness. You can do it visually, somatically, or with breath. To do it visually, it can be helpful to be outside. Perhaps you can look at the sky, the ocean, or anything that reflects vastness, and let the emotion be held by it. You then notice how the emotion changes as the vastness is holding it. To do it somatically, instead of just feeling the area where the difficult emotion is located (which will typically be in the chest solar plexus area), you include the rest of your body in your awareness. You feel your feet, arms, head, and so on without denying the area of difficulty, and you notice how it becomes easier to tolerate the intensity. With breath, you simply take deep breaths into the emotion and notice if it becomes more tolerable.

2. Experience the Intrinsic Pleasure of Being Emotionally Intimate with Yourself

If we are able to stay with an emotion from beginning to end, we typically notice a pattern of increasing and decreasing discomfort. As we continue to stay with it, it will eventually cycle through and a discharge will naturally occur. At that point, if we pay close attention, sensations of pleasure will arise as the nervous system comes to a relaxed state.

The key here isn’t to try to get rid of our needs for external gratification, but to bring more consciousness to our inner process. The more aware and conscious we become about our needs, the more freedom we have from our compulsions.

Just as we can stay with the difficulty, we can stay with the pleasure of regulation; we can notice how our nervous system naturally releases tension, and that can feel pleasant. Take in that goodness and soak in the relaxation! As you do this, you may learn that the capacity for soothing lies within. We have the capacity to feel pleasure and well-being without external rewards. However, don’t underestimate our tendency to look for them. This desire is deeply ingrained in the brain. From the moment we’re born, we depend on externals for our survival.

The key here isn’t to try to get rid of our needs for external gratification, but to bring more consciousness to our inner process. The more aware and conscious we become about our needs, the more freedom we have from our compulsions.

3. Notice the Changing Nature of All Experience

Experience is constantly changing, but when we’re caught up in difficulty we tend forget this. In fact, when feeling difficult emotions we tend to believe they are going to stay like this forever. We also tend to concretize them, making them appear solid and unmovable.

The truth is all of our experience is in constant flux. If we’re able to notice the changing nature of experience when we’re experiencing difficulty, it can become easier to ride the feeling. For instance, when bringing your awareness to the changing phenomena in your experience, notice how it all has a beginning, a middle point, and an end. Understanding this constant movement can help you begin to dissolve even the most reified and apparently solid emotional experiences.

4. Share the Burden

Having a language for our emotions and being able to share them with others makes them much more manageable and digestible. In a way, therapy is a training ground for us to become more comfortable with our feelings by talking about them. There are all kinds of support groups out there that operate under this principle. To be able to talk freely about what ails us is an amazing way to make it more tolerable.

There are many ways to allow spaciousness into our difficult emotions. You may want to experiment and find out what works for you, or you might want to contact a therapist who can help guide you. This isn’t about ignoring the difficulty or making it go away. Rather, this is about letting the experience be held in more spaciousness.

Man in business wear sits on bench, holding his headAnxiety can manifest in a variety of ways in the human body. It can make us tense in our large, voluntary muscles, activate the involuntary muscles of our internal organs, and even cause changes in our thinking, sensation, and perception. I want to focus here on one particular pattern of anxiety—anxiety in the smooth muscles—and the style of self-punitive thinking that is associated with it.

Smooth muscle anxiety is linked with a wide range of physical problems that are emotional in origin but can be mistaken as medical, which can lead to misspent health care dollars, lost time, and dashed hopes. It is my hope to help you identify manifestations of smooth muscle anxiety, learn about the thoughts linked with smooth muscle anxiety, and gain exposure to intensive short-term dynamic psychotherapy, a model that has demonstrated effectiveness in treating smooth muscle anxiety.

What Are the Smooth Muscles?

The smooth muscle systems of the body include the gastrointestinal system, the vascular system, the bronchi, and the urogenital system. There are also smooth muscles in our skin and eyes. The muscles are called smooth because they are made up of small, mushy, somewhat elastic cells. They differ from our skeletal muscles, which have long, striated fibers that are less flexible.

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When our smooth muscles are functioning as they should, they regulate our blood pressure, digestion, sexual and excretory functions, and breathing—functions that are essential to human survival. However, the smooth muscles are linked to the emotional center of the brain by the nervous system, and they can be activated in response to anxiety (Janig, 2003). So what happens when anxiety impacts the smooth muscles? What symptoms are linked with dysregulation of the smooth muscle systems?

Conditions Linked with Smooth Muscle Activation

The following conditions are associated with involuntary tensing of the different smooth muscle systems (Abbass, 2015):

Are Types of Thoughts Associated with Smooth Muscle Anxiety?

Clinical researchers, especially in the literature on intensive short-term dynamic psychotherapy, have noted an association between self-attacking thoughts and smooth muscle symptoms. While it is not clear whether the self-punitive thoughts can cause a stomachache or migraine, harsh thoughts and smooth muscle symptoms do seem to show up together.

In ISTDP, we use collaborative, exploratory questions to support people as they learn to reflect on the emotions that are making them anxious and triggering self-attack.

Here’s a smattering of thoughts I have heard lately that have shown up alongside smooth muscle symptoms in people I work with:

As these examples from my practice demonstrate, negative thoughts going against the self seem to co-occur with nausea and migraines. If you find that these kinds of thoughts co-occur with your IBS, migraine, or other physical symptoms, or seem to trigger them, you may be experiencing smooth muscle anxiety that has been diagnosed as a medical syndrome.

What Triggers Self-Attack and Smooth Muscle Anxiety?

Clinical research in ISTDP has demonstrated a link between complicated, mixed emotions toward loved ones, tendencies toward self-attacking thinking, and smooth muscle anxiety (Abbass, 2015). The theory of smooth muscle anxiety in ISTDP, which has been repeatedly supported by my experiences as a therapist as well as in case series data (Abbass, 2002) and empirical research (Creed, et al., 2003; Guthrie, et al., 1993), is that mixed emotions toward our attachment figures trigger anxiety. These mixed emotions are anxiety- and guilt-laden because it feels dangerous to have rage toward people whom we long to be close with and depend on.

Because of the anxiety and guilt associated with these feelings, the feelings are repressed—not thought about or reflected on. In fact, self-attacking thoughts seem to have the function of turning the anger toward the loved one back against the self with harsh thoughts and against the body with smooth muscle activation. The beloved person is protected from the anger, and the body and the self are punished. It is almost as though an unconscious, automatic part of the mind says, “How dare you have rage toward your beloved! You must redirect the rage toward yourself and your stomach to protect them!”

The Role of ISTDP in Healing

In ISTDP, we use collaborative, exploratory questions to support people as they learn to reflect on the emotions that are making them anxious and triggering self-attack. Increased reflective awareness of emotions seems to reduce the anxiety connected to them—if it can be thought about, talked about, and felt, it is no longer as scary or guilt-ridden. The complicated emotions we have about our loved ones are no longer unconscious (out of awareness) and frightening but can be seen and felt by the light of day and recognized for what they are—just feelings! People learn that they have been getting punished for emotions, which are mental, bodily events that are not inherently dangerous or wrong. Fear and guilt about emotions are replaced with thoughtfulness, openness, and comfort (Abbass, 2015).

If you are experiencing self-attacking thoughts and smooth muscle anxiety and are looking for systematic support in overcoming the automatic emotional factors that trigger your symptoms, ISTDP may be a useful treatment for you.

References:

  1. Abbass, A. (2002). Office based research in ISTDP: Data from the first 6 years of practice. Ad Hoc Bulletin of Short-term Dynamic Psychotherapy, 6, 5-14.
  2. Abbass, A. (2015). Reaching through resistance: Advanced psychotherapy techniques. Kansas City, MO: Seven Leaves Press.
  3. Creed, F., Fernandes, L., Guthrie, E., Palmer, S. Ratecliffed, J., & Read, N. (2003). The cost-effectiveness of psychotherapy and paroxetine for severe irritable bowel syndrome. Gastroenterology, 124, 303-317
  4. Guthrie, E., Creed, F., Dawson, D., & Tomenson, B. (1993). A randomized controlled trial of psychotherapy in patients with refractory Irritable Bowel Syndrome. British Journal of Psychiatry, 163, 315-321.
  5. Janig, W. (2003). The autonomic nervous system and its coordination by the brain. In Davidson, R. J., Scherer, K. R., & Goldsmith, H. H. (Eds.), Handbook of affective sciences (pp. 135-187). Oxford: Oxford University Press.

A small child crouches in waves at the seashoreAs children we have boundless curiosity, energy, and a feeling of connectedness with all that is. Our natural instinct is often to let ourselves be molded by the land and the sky, for we are animals imbued with spirit first and humans with thinking minds second. Spared the influence of our civilization’s dualistic thinking, we likely would have maintained the connection between body, mind, and spirit, as well as our heart-connection with the universe. How can we rediscover this kind of connectivity in this time of high-speed, high-tech upheaval? It’s a journey that each person must take for themselves.

Ever felt energized by an inspiring movie, transformed by a great symphony, or held spellbound by a life-affirming book? Did you walk away with a deep sense of satisfaction, only to say to a friend, “That made everything in life seem to make sense. It’s too bad life isn’t really like that!” But perhaps it’s possible life can be more like that, simply with a greater sense of clarity. If life seems a puzzle, you may simply be missing some of the pieces!

Perhaps you have glimpsed the potential for connectivity that surrounds us all the time. The quest for this holism can take a lifetime, but it is worth the trip. And if you are seeking recovery—whether from trauma, incest, other sexual abuse, cultural oppression, addiction, or something else—you are in fact seeking to rediscover the holistic state. They are one and the same.

My work is based on these principles: we have all suffered emotional or physical trauma to our natural emergent energies at some stage in development; we all have moments of dissociation and separation from ourselves; and we are all consciously or unconsciously seeking a more holistic connection with the universe. I truly believe we can help each other succeed, just by speaking our truth as we discover it. This journey toward complete recovery offers the opportunity to connect with not only other sentient beings, but with the planet as a whole. Thus, those on this path may find themselves in a position to trigger global transformation. [fat_widget_right]

Connecting with Source Energy

In recent years I have gone beyond fostering greater connectivity with the human race and the earth as a whole, as wonderful and as healing as that is. I have found a kind of broadband connectivity of the spirit, which can address any issue, to link up to what I have gradually come to know as “The Source.”

I use “The Source” to refer to a place where all healing and creative ideas and energies ultimately come from. It is not a physical place but a place in consciousness, one where we can tap into the essence of the life force itself. This life force, also called source energy, flows through and connects all things. Everything that exists is a manifestation of this life energy. By becoming more attuned to this gold mine of consciousness and working with it, we can make our lives miraculous beyond anything we can imagine.

There are many valuable pathways for discovering and working with source energy: meditation, trauma resolution, and creative pursuits are a few of these. I do what is called focalizing. Both a healing modality and a creative process, focalizing can foster the continuous flow of energy through us and help this energy express itself with clarity.

We can call this source energy a spirit, God, a higher power, or the universe, but it is definitely an enlivening current we can feel in our bones. Some may experience it as a vibration, some as stillness, others as a presence. Still others may simply feel totally awake and connected. However you describe it, the source energy is the universal force found in all living beings. Filled with universal intelligence, it explains how plants know how to align themselves towards the sun. By the same token, it is there inside us and can help us make our decisions, especially when we listen to what our bodies are telling us.

Three things may block us from experiencing the source energy:

  1. Distracting thoughts (often based on past conditioning)
  2. Unresolved trauma
  3. Sexual barriers and frustrations

Conditioned thinking makes it difficult for us to shift to new ways of perceiving and healing our lives, which can limit us to past experiences and exposures. It regurgitates old data and story lines based on our personal history or what we have been told. Both a healing modality and a creative process, focalizing can foster the continuous flow of energy through us and help this energy express itself with clarity. The conditioned mind does not tolerate intricacy well and may experience difficulty with love, joy, and other textured nuances of life. Without a new set of tools and a fresh way of seeing, the mind can paralyze us and block our best path forward. On the other hand, the heart’s intelligence thrives on intricacy and nuance, on connectivity to deep ancestral roots. It speaks to us through felt sensations of our bodies and sensory perceptions that can guide the next steps in our personal evolution. Focalizing may be so effective because in the process the mind is respectfully set aside while the heart guides us through a natural and fulfilling process of connectivity.

As we host source energy we may become conscious of the role the body plays in shaping the mind and our moment-to-moment experience. It can allow a subtle shift from feeling with the senses to feeling with awareness. When we direct our minds to be aware, we may be able to feel subtle options: a wider range of choices than what we can access via mere thinking alone.

Hosting this energy can be as simple as taking a deep breath. We can also practice what’s called a “body drop.” In a body drop, awareness focuses on deeply relaxing the body while staying connected to it. We might think of this as “striving only to be.” When we give ourselves a quiet pause, we can gain flexibility, in the shift between the outwardly focused mind and the subtler inner mind that uses felt awareness. When this skill is developed, we may be better able to use both levels of awareness fluidly and develop a fresh sense of inner knowing.

This practice can unify the imaginary separation of body, mind, and nature and enliven source energy to offer guidance. In this embodied state our experience of time collapses, allowing us to connect with imagery and perceptions that are often deeply informative. This focalizing is a way of rediscovering the lost connectivity we can glimpse in the eyes of wild animals and children all over the world.

Contentment and happiness do not come from waving a magic wand or snapping our fingers. They are choices that include a deep level of acceptance for things being exactly as they are and respect for present realities, as reality is always changing. Don’t disconnect with reality. Accept things as they are and then allow source energy to transform them.

It is important to keep sustaining, hosting, and relying on the established connection to source energy in order to keep this loving relationship with spirit vibrant and alive. We can often do this with gratitude. If we ever reach the point where we feel we are lacking gratitude for being alive, we simply need to un-separate ourselves from the source energy. I believe we can’t help but feel happy, playful, and grateful when connected with the wellspring of spiritual creativity. Releasing our preconditioned concepts of who we are can help us become one with the source energy. Through this, we can become the change we wish to see in the world, and more.

Double exposure image combining a person's sleeping face with cloudsHave you ever had a dream so powerful it changed your life? You are not alone. Over the years, I have worked deeply with people and their dreams, and I’ve discovered that, in many instances, these “big dreams” will appear under the heels of life transitions, questioning of identity, and major losses such as the death of a loved one or a breakup. The dream is often of an initiatory nature where the dreamer is highly impacted and the experience life-altering.

What Is an Initiatory Theme?

If we look at the stories we grew up with, we find many motifs that point to initiation. In most myths, the protagonist is faced with a situation that completely transforms them. They may have been swallowed by a sea monster (Jonah and the Whale, Pinocchio) or sent into the underworld or underbelly of Mother Earth (Persephone, Inanna, White Buffalo Calf Woman).

Others may have been dismembered and put together again (Handless Maiden, Skeleton Woman, Osiris), struck by lightning, or visited by a guide in the shape of an animal, spirit, or ancestor (Thor, Gandalf, Thunderbird).

For others still, their rite of passage may have been an illness, animal bite, or near-death experience that evoked superpower abilities (Catwoman, Spiderman, Wolverine).

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Why Do We Have Initiatory Dreams?

These themes are the language of the psyche, and in our modern times we are sadly removed from the initiatory practices and rituals of our ancestors. It is the dream (the final frontier!) that bestows us access to “soul knowledge,” namely in the form of big dreams.

Coined by Carl Jung, these dreams evoke high emotional intensity and extraordinary power that strike a chord in the dreamer that continues to resonate throughout their life. When these dreams occur, the dreamer may transcend into a higher awareness or reality that can be directly reached in the sleeping state.

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In the book Extraordinary Dreams and How to Work with Them, Stanley Krippner, Fariba Bogzaran, and Andre Percia de Carvalho address the many variations of these dreams, including healing, precognitive, lucid, etc., and how these dreams can be spiritual awakenings or initiations that can often lead to a dramatic transformation in the dreamer.

What Are Some Types of Initiation Dreams?

The most the vital aspect of the initiation dream is its emotional impact on the dreamer. The feelings of pure joy and love, even to the point of ecstasy rarely experienced in waking life, are a definite indication.

However, this is not always the case. Initiation dreams more often evoke terror and take nightmarish forms, especially if we are asked to face our biggest fears in order to be transformed by them.

There are certain common elements to these initiation dreams, including but not limited to:

Many of the people I work with have a big dream either right before or at the beginning stages of therapy. This is the time when the initiate is being propelled into the mysteries of profound change, whether externally (loss of a loved one, home, or community) or internally (an inner stirring that “something is not right”).

Many of the people I work with have a big dream either right before or at the beginning stages of therapy. This is the time when the initiate is being propelled into the mysteries of profound change, whether externally (loss of a loved one, home, or community) or internally (an inner stirring that “something is not right”).

Here is one example of an initiation dream:

I am a young girl in an ancient landscape that reminds me of Persia, India, or Babylonia due to the architecture of mosaic columns, pools, and courtyards. There is a particular pool of water where women are lounging about. I dive into this water and retrieve hair adornments from the bottom of the pool for these women, which pleases them immensely. After this ritual, I look down and notice blood on my dress. I realize three of my ribs have been taken or are missing! I am suddenly filled with ecstasy, like I know this is a good omen or sign of initiation. The girl seems to “know” more than I do, but I am her. As I wander this area, there’s a shift as I try to discover the symbol, the meaning of the missing three ribs.

Working with Initiation Dreams in Therapy

One of the most difficult challenges in dreamwork is to make sense of what is being given. This is especially true for the initiation dream.

There are ways to process the material, especially after the fallout of such dreams. It can be an uncomfortable process for people, not only due to the highly charged content but also the fear of making dramatic life changes that may call for a sacrifice in the form of jobs, loved ones, identity, belief systems, and way of life.

If you are experiencing big or initiatory dreams, I highly recommend seeking a trained professional who specializes in dreams and depth work. Having a therapist to hold the container and be a guiding force to bring context as well as support for these powerful experiences in a compassionate and nonjudgmental way is vital. What makes dreamwork so effectual is that the material has an emotional impact and comes directly from the person, not an outside source.

Here are some points of entry and inquiry to consider when working therapeutically with these dreams:

The most important thing to remember is change is a part of life. If we can engage in the dreaming process in a conscious way, we not only live more authentic lives but can make healthier, more mindful choices.

In Part II, I will focus on the dreams of the bereaved and how they can bring healing in the face of grief.

References:

  1. Campbell, J. (1976). The Hero with a Thousand Faces, Bollingen Series 17. Princeton, NJ: Princeton University Press.
  2. Eliade, M. (1958). Rites and Symbols of Initiation (Birth and Rebirth), trans. W. Trask. London, England: Harvill Press.
  3. Jung, C. (1963). Memories, Dreams, Reflections. London, England: Collins and Routledge.
  4. Krippner, S., Bogzaran, F., & Percia de Carvalho, A. (2002). Extraordinary Dreams and How to Work with Them. Albany, NY: State University of New York Press.
  5. Murdock, M. (1990). The Heroine’s Journey. Boston, MA: Shambhala Publications.
  6. Pinkola-Estes, C. (1992). Women Who Run with the Wolves. New York, NY: Ballantine Books.
  7. Sparrow, G. S. (n.d.). The Dream as a Path of Initiation. Edgar Cayce’s ARE, Virginia Beach, VA.

Serious teenage boy stands alone on roofAs a family systems therapist, it’s been my experience that when parents bring a child to my office due to acting-out behaviors or social challenges, it usually comes back to the dynamic in the parental relationship. Typically, what’s going on (or not) between Mom and Dad is at the root of the issue, regardless of whether the parents are married, separated, or divorced.

Marital dissatisfaction and parental conflict, in my experience, are often correlated with how well children adjust to situations. In addition, parental attitudes and approaches can impact children. Children may experience anxiety, depression, shame, or other issues when conflicted parental relationships result in dysfunctional parenting practices. Parental conflict can result in reduced parental involvement, harsh discipline practices, lack of praise and acknowledgement, and increased parent-child conflict.

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A common scenario that often plays out in families with parental conflict is when a child is blamed and scapegoated by the parents, which in turn may cause the child to act out. This nonadaptive parenting style creates a dynamic of discord that is enmeshed, reciprocal, and reinforcing.

When overt or covert (silent or aggressive) parental conflict is present, there may be a tendency to create “alliances” or “collusions” among family members, which typically only alienates healthy family relationships. Additionally, some parents who do not actively engage in conflict in front of their children may allow their negative feelings toward each other to guide their decisions. These decisions, when motivated by resentment and not the best interests of the children, may be equally harmful.

Naturally, parental conflict also can result in reduced emotional availability toward children. Generally speaking, the lower the level of parental conflict, the more positive parent-child relationships tend to be.

Suggestions for Managing Parental Conflict Around Children

Conflict is a natural part of relationships. It is important for children to see that parents can disagree and work through conflicts. The problem solving that follows occasional conflict between parents can be a healthy thing for children to witness. When parents are able to demonstrate effective problem-solving strategies collaboratively, they model supportive parenting and parental involvement at a much higher level.

The lower the level of parental conflict, the more positive parent-child relationships tend to be.

However, when conflict is chronic and parents aren’t able to come to resolution, it can become problematic from the children’s standpoint.

So what can parents do to demonstrate healthy conflict management in front of their children? Here are some suggestions to consider:

Finally, when trying to resolve conflict, it is important to look at family-of-origin patterns to determine how conflict was resolved in earlier generations, as patterns tend to be passed down in families from generation to generation. Then, it is important for parents to look for patterns in their relationships as well as their own behaviors and motivations.

Ideally, parents should be open to seeking help from a professional, as getting input from an objective third party who is trained to help resolve conflict can be beneficial in identifying ineffective resolution strategies that parents may be engaging in.

Young man wakes up in bed with head painEvery system of the body is vulnerable to physical illness. This is common sense. But did you know every system of the body is vulnerable to emotional discord as well? The nervous system, an elaborate network of cells that facilitates communication between our brains and the rest of our bodies, directly links our physical selves to our emotional life. Voluntary muscles, involuntary muscles, and our five senses can all be influenced by the emotional responses of our bodies, so we can manifest a nearly infinite variety of physical responses to stress. While these reactions can sometimes be adaptive and helpful signals (e.g., preparing for flight when in danger), they can also cause distress, leading to visits to doctors.

When our physical symptoms are caused by an injury, bacteria, or an allergen, for instance, medical treatments can work. A visit to primary care, emergency care, or a specialist will likely yield desired results, at least eventually. However, when our physical ailment is caused or worsened by emotional factors, the potential of traditional medicine is limited. At best, a placebo effect may create some relief; at worst, the frustration caused by failed medical treatments can lead our emotion-driven symptoms to worsen.

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In this article, I will identify and elaborate upon four empirically supported ideas that may be useful to all of us. No one is immune to the physical reactions caused by emotional stress, so we are all equally vulnerable to developing medically unexplained physical symptoms when emotions overwhelm our coping capacities. If we can more readily identify them and seek appropriate treatments, we may be able to significantly reduce the burden on ourselves (and our health care system) that these symptoms can cause.

1. Emotional Factors Can Contribute to or Cause a Range of Physical Conditions

Emotional centers in the brain link with many important structures of the body, including our large voluntary muscles (anything you can flex) and our involuntary muscles, such as the gastrointestinal system (Janig, 2003). As you will read below, anxiety can trigger activation in any of these muscles, triggering a huge variety of physical symptoms that can be misdiagnosed as having a purely medical origin.

Any of the symptoms described here, and many more, can be triggered by anxiety-provoking emotional experiences, and may be most effectively diagnosed and treated by the methods discussed below.

2. Emotional Factors Contribute to a Large Percentage of Costly Emergency Visits

Medically unexplained physical symptoms can have a sudden onset and can be terrifying to the person experiencing them, which can lead to visits to emergency services and referrals to specialists. It is important for all health care consumers and practitioners to be aware of the high rate of patients who present with medically unexplained symptoms—and the significant efficacy of a short course of psychotherapy for treating these symptoms.

One unpublished study cited by Abbass, et al. (2010) found that 16% of emergency department (ED) referrals leave the hospital without a medical explanation for their presenting symptoms. This included 75.8% of people who presented with chest pain. Other common health concerns that left the ED without a medical diagnosis include headaches and abdominal pain. Regarding visits to specialists, Abbass (2004) reported on studies that found:

Eighty-four percent of 567 common internal medicine complaints—such as chest pain, dizziness or weakness—yielded no new diagnosis and cost a great deal to investigate. A recent British study found that one quarter of all new specialty referrals studied resulted in no diagnosis. This included almost one-fifth of surgical referrals and over one-third of some medical specialty referrals (p. 6).

According to this data, between 10% and 20% of ED visits and between 20% and 84% of specialist referrals yield no medical explanation, and it seems the most common medically unexplained symptoms can be linked with the bodily manifestations of anxiety described above. Fortunately, advances in mental health assessment and treatment are helping to change these worrisome statistics.

3. Emotional Contributors to Physical Symptoms Can Be Diagnosed Quickly

In his article about “emotion-focused interviewing” to diagnose somatization (the term for the process by which emotional factors affect physical health), psychiatrist and researcher Allan Abbass (2005) provides examples of brief conversations between doctor and patient that help reveal a clear link between emotional upsets and increases in symptoms. This interviewing technique, which has become an important part of my practice, is based on principles and techniques from a model of brief psychodynamic psychotherapy called intensive short-term dynamic psychotherapy, or ISTDP (Davanloo, 2000).

Clinicians who learn ISTDP are trained to monitor a variety of verbal and bodily signals so they can detect an increase or decrease in the physical symptoms as thoughts and feelings are explored during an interview. According to Abbass (2005):

An increase in symptoms with emotional focus suggests that emotions aggravate or directly cause the problems. A decrease in symptoms during the test also suggests a linkage to emotions. Disappearance of the symptoms by bringing emotional experiences to awareness is the best direct evidence that somatization of these emotions was causing the patients symptoms (p. 235).

Abbass suggests this diagnostic process can be accomplished in as little as 15 minutes of conversation. Considering the financial and time costs of the procedures that are often used to diagnose medically unexplained physical symptoms (e.g., fMRI), Abbass makes a compelling case for the utility and efficacy of an emotion-focused interview based on ISTDP that can help establish whether emotional factors are playing a role in physical symptoms.

4. Psychological Treatments Show Cost-Effectiveness

Seeing a psychotherapist to rule out emotional factors earlier in the diagnostic process can save money and heartache, which is especially important because the emotional upset associated with failed medical procedures and treatments can cause symptoms to worsen.

Seeing a psychotherapist to rule out emotional factors earlier in the diagnostic process can save money and heartache, which is especially important because the emotional upset associated with failed medical procedures and treatments can cause symptoms to worsen.

Abbass (2003) calculated an average health care cost reduction of $1,573 per patient by one year after a course of ISTDP. Only two of the seven studies reviewed for cost-effectiveness by Abbass (2003) were specific to medically unexplained physical symptoms (irritable bowel syndrome and chronic functional dyspepsia); however, even those who were being treated specifically for psychological concerns experienced a large reduction in their overall health care cost burden. This is strong evidence for the cost-effectiveness of ISTDP in reducing health care costs for folks with medically unexplained physical symptoms and general mental health concerns.

Another finding that supports this line of research is that the use of ISTDP therapists in the ED described above led to a 69% reduction in ED visits by those who had a very brief course of psychotherapy (3.2 sessions on average). Those who did not have the therapeutic consultation had anywhere from a 15% reduction to a 43% increase in ED use over the course of the next year (Abbass, et al., 2009). Average health care cost savings among the treated group was $910 in the follow-up year (Abbass, et al., 2010). This is strong evidence for the potential advantages of a medical system that takes emotional factors into account, both for those suffering and for the health care system overall.

Looking at the Data and Looking Forward

Thanks to the work of Davanloo, Abbass, and others, we have helpful tools for understanding the ways emotions impact the body and create medically unexplained symptoms. We know medically unexplained symptoms burden the people who experience them and the medical system with lost time, lost resources, dashed hopes, and continued suffering. Finally, we have tools and methods for diagnosing and treating somatization of emotions that have shown efficacy and cost-effectiveness. To me, as Abbass (2004) has argued, these data make the case for the importance of heightened awareness of this information among health care consumers and practitioners.

It is my hope that with greater awareness of the ways emotions can impact health, doctors and patients alike will be more open to referrals to emotion-focused assessment services like the one described by Abbass (2005) and to therapies, such as ISTDP, that have demonstrated efficacy in treating medically unexplained symptoms. However, until this becomes part of standard medical practice, we can advocate for ourselves by asking questions about whether our symptoms could possibly be linked to stress, anxiety, or other issues, and by seeking out appropriate assessments and treatments.

While we should not flip radically in the opposite direction and assume all our physical woes are psychosomatic, we may save ourselves from needless expenditures of time, money, and hope by having an emotion-focused interview early in the diagnostic process to establish whether emotional factors are contributing to our medically unexplained physical issues.

References:

  1. Abbass, A. (2003). The cost-effectiveness of short-term dynamic psychotherapy. Expert Review of Pharmacoeconomics Outcomes Research, 3, 535-539.
  2. Abbass, A. (2004). The case for specialty-specific core curriculum on emotions and health. Royal College Outlook, 1, 5-7.
  3. Abbass, A. (2005). Somatization: Diagnosing it sooner through emotion-focused interviewing. The Journal of Family Practice, 54, 215-224.
  4. Abbass, A., Campbell, S., Magee, K., & Tarzwell, R. (2009). Intensive short-term dynamic psychotherapy to reduce rates of emergency department visits for patients with medically unexplained physical symptoms: Preliminary evidence from a pre-post intervention study. Canadian Journal of Emergency Medicine, 11, 1-6.
  5. Abbass, A., Campbell, S., Hann, G., Lenzer, I., Tarzwell, R., & Maxwell, D. (2010). Cost savings of treatment of medically unexplained symptoms using intensive short-term dynamic psychotherapy by a hospital emergency department. Journal of the Academy of Medical Psychology, 1, 34-43.
  6. Davanloo, H. (2000). Intensive short-term dynamic psychotherapy: Selected papers of Habib Davanloo, MD. Chichester: Wiley.
  7. Janig, W. (2003). The autonomic nervous system and its coordination by the brain. In Davidson, R. J., Scherer, K. R., & Goldsmith, H. H. (Eds.), Handbook of affective sciences (pp. 135-187). Oxford: Oxford University Press.

Woman sitting on beach swing facing the seaFourteen years ago, when I was first trained in EMDR therapy, there was less of an understanding of its benefits, as well as a lot of confusion about what eye movement desensitization and reprocessing actually was. One thing it’s never been is a quick fix. And while I make it a point to educate people about this reality, I have found there is another layer to that common misunderstanding: lack of awareness that the existence of complex trauma, as opposed to single-incident trauma, can make EMDR an even longer-term treatment.

When working with those with single-incident trauma—a survivor of a car accident, for example—the standard eight-phased, three-pronged EMDR protocol has the potential to guide the treatment process in a relatively straightforward manner. Treatment can also be more clear-cut and focused when there are multiple traumas that can be grouped into the same category. Someone who reports being raped at various times in their life would be an example of this. Neurologically, the traumas can travel down a similar “track” when processed.

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However, it is usually the cumulative effect of multiple traumas, of multiple kinds and categories, that brings folks to my office. The majority of those who are engaging in ongoing therapy have symptoms driven by foundational experiences—developmental traumas that impact their worldviews. These experiences affect their ability to feel safe, not only physically but also emotionally. These people are seeking to heal from a history of complex trauma.

Complex trauma is identified by Judith Herman and other leaders in the field of traumatology as “the existence of a complex form of posttraumatic disorder in survivors of prolonged, repeated trauma” (Herman, 1992). An example of a history of complex trauma would be a woman who was adopted at birth, experienced sexual abuse by her brother, experienced ongoing physical abuse by her mother, and perhaps had a series of abusive relationships throughout her teenage and early adult years. She has an extensive history of interpersonal traumas at various ages and developmental stages, and spanning multiple categories.

The majority of those who are engaging in ongoing therapy have symptoms driven by foundational experiences, developmental traumas that impact their worldviews. These experiences affect their ability to feel safe, not only physically but also emotionally. These people are seeking to heal from a history of complex trauma.

As part of our healing journeys, we must pay attention to traumas of both omission and commission; both matter and can impact a person’s mental health. Neglect and abandonment, among others, are traumas of omission. Sexual abuse, physical abuse, and violence are clearly acts of commission. Perhaps a person experienced ongoing parental misattunements, significant attachment losses, a parent’s hospitalization or depression, or witnessed a mother grieving the loss of a sibling. These and myriad other experiences are examples of traumas that, at the time, impacted the person’s sense of emotional and physical safety and, more often than not, included caregivers. If they happened in childhood, they may greatly impact the person’s perceptions of the world today. All of this adds up to complex trauma.

Many leaders in the field of trauma treatment believe the newest diagnostic criteria for posttraumatic stress (PTSD), as outlined in the DSM-5, are not comprehensive enough. Although an improvement over the DSM-IV, the latest guide for mental health practitioners does not account for the full clinical picture when it comes to developmental trauma.

The term “complex trauma” didn’t even make it into the DSM-IV; instead, “DES NOS” (disorders of extreme stress not otherwise specified) was often used in clinical application. In the DSM-5, some of the symptoms of DES NOS, such as re-experiencing, avoidance, negative cognitions and mood, and arousal, were included in the PTSD criteria.

Which brings us back around to EMDR therapy. Yes, it is possible to heal from a history of complex trauma. Doing so just takes a conscious, methodical, and phased approach to treatment. If you are considering EMDR and have a history of complex trauma, I highly recommend ensuring that your therapist has experience in working with both. Make sure, also, that your therapist talks to you about extensive preparation and stabilization; these aspects will be a necessary part of your healing journey.

Reference:

Herman, J. (1992). Trauma and Recovery. New York: HarperCollins.

Young woman listens to therapistDo you know what type of therapist you are seeing or are about to see? Not all therapists are the same—they have different perspectives and training. Therapists need to know what motivates their work, what they hope to accomplish professionally, and how they want to serve people in therapy. Many therapists struggle with questions such as, “What’s my niche?” or, “How, exactly, should I help this person?” Most of us come into the field wanting to help and make a difference in people’s lives; orienting ourselves professionally can help us achieve this goal.

As a person in therapy, you may expect your therapist to know exactly what they’re doing, but this is not always the case. Some degree of uncertainty and self-doubt is common and natural among therapists. However, it can become problematic when they fall back on outdated training, integrate interventions that are incompatible, or serve populations with which they have no expertise or knowledge. This can confuse both the person in therapy and the professional.

I have struggled with lack of direction in my own practice, and I have learned to view my work as a therapist from a different, more realistic angle. After working in the field and developing my professional identity, I came to understand there are four important components that describe the style of every therapist. People seeking therapy might benefit from learning about these and being prepared to ask questions when searching for a therapist.

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1. The Therapeutic Philosophy/Approach

It can be helpful for therapists to understand how their worldviews inform their therapy. As a result of their training and experience, they may automatically and unconsciously perceive people in therapy and their work with them in a specific way. As they begin to notice what makes them feel more competent in their work, therapists can become confident about the interventions they use and can identify a clear pattern in their clinical practice.

For instance, therapists who find they are interested in understanding people’s thinking patterns and processes, and adopt a deliberate intervention to redirect these, are usually approaching their work from a cognitive or cognitive behavioral angle. This may not make a lot of sense for people in therapy; however, it is the therapist’s responsibility to be informed and aware of therapeutic philosophy, or at least aspire to this level of professional self-awareness.

You may sometimes hear therapists referring to themselves as “eclectic.” This is common in the field of psychotherapy, and it means they integrate multiple therapeutic approaches, or perhaps use specific techniques borrowed from different models. Although this can be a valid lens from which to conduct therapy, it can also create confusion, diminish the efficacy of evidence-based practices, and distort the objectives of therapy. There are eclectic therapists who truly believe their best work comes from borrowing from different approaches, and then there are “eclectic” therapists who fail to take the time to develop expertise in any one approach.

It is not always easy to distinguish between these two types of eclectic therapists, but it’s important for a person seeking therapy to know the difference. Many therapeutic approaches or models are similar, but they are different enough that therapists may want to be deliberate and specific about their worldview.

2. The Delivery

You may notice therapists often identify with a delivery that matches the model they use. A therapist whose therapeutic philosophy is cognitive behavioral will frequently describe their delivery with people in therapy as “directive.” Specific therapeutic models suggest therapists who use their model should always have a particular way of conducting their sessions.

One of the most common complaints from people in therapy is that therapists act like robots—they aren’t being themselves, or they don’t connect. I believe this is a result of forcing an unnatural delivery in therapy sessions.

I think this is unrealistic. The delivery is about the way therapists communicate with someone in therapy, how they translate the information, and how they choose to convey their messages. A therapist who identifies with a cognitive behavioral philosophy, who tries to exhibit a “directive” delivery as the cognitive behavioral model suggests, but whose personality and natural presentation are more soothing or indirect, is simply not being truthful.

One of the most common complaints from people in therapy is that therapists act like robots—they aren’t being themselves, or they don’t connect. I believe this is a result of forcing an unnatural delivery in therapy sessions. The delivery should match the therapist’s personality, not necessarily the therapeutic approach or philosophy. People pick up on these things.

As most therapists know, one of the most important factors in therapy is the relationship between the therapist and the person in therapy. How can there be a genuine relationship if the therapist is trying to be someone else? I suggest therapists simply be themselves. This is likely to be the easiest part of their clinical work. Therapists can adopt a variety of delivery styles: directive, soothing, indirect, challenging, curious, humorous, reflective, supportive, intellectual, or a combination of these. I don’t think it should be about trying to match the model, but about who the therapist truly is.

3. Skill Level

To have a big influence on another person’s life, therapists should make sure their skills are strong, sharp, and up to the challenge. When I say skills, I am not referring to experience or age of the therapist. Skill level involves the preparation, commitment, and willingness to become a better therapist. A therapist should never assume they know it all, or that they should know it all. This can be a terrible trap and one that can make people in therapy feel like they are wasting their time.

Most licensed therapists are required to participate in continuing education as required by the agency or organization that regulates their credentials. Some therapists may attend any training just to get the hours they need to renew their license, while others may research and attend training that specifically target their personal needs and contributes to their professional development.

For example, if you have a therapist who specializes in treating young girls experiencing an eating disorder who attends a training on substance abuse in middle-aged men, you may want to ask why. Your therapist may have a perfectly sound reason for this, but sometimes the reason is license renewal. An important exception to this is when therapists are curious about new modalities, or when they truly don’t know yet what their niche will be. Most therapists are quite comfortable sharing their recent training and education with people seeking therapy. This is not part of the mandatory disclosure statement, but I think it should be.

4. Awareness of Readiness to Help

Is your therapist ready to help you attain your goals? Sadly, some are not, even if they really want to help. Readiness to help can include preparation, skill level, delivery style, and even therapeutic philosophy—but it’s more than that. Therapists need to be self-aware regarding how helpful they can be within the therapeutic context. Does your therapist have the tools to navigate vicarious trauma? Have they lost their passion for therapy? Are they burned out?

Naturally, this work is difficult. Therapists are exposed to painful stories every day, all day long. This can take a toll on a therapist’s ability to perform on the job in the long run. Burnout can influence a therapist’s self-perceptions about their ability to help. When this happens, your therapist may not be ready to help, or they may be completely unaware of this and continue to do clinical work. (They also have bills to pay.)

The good news is there is hope. Therapists are used to hearing about something called “self-care,” which is necessary to maintain a healthy balance between personal and professional lives. When therapists neglect this area of their work (yes, self-care should be part of the work), they may be unaware or even in denial about the effects of their work on their emotional well-being. This in turn can affect the quality of the service they provide.

Burnout is a real thing in this field. Many therapists who work in community mental health, residential services, in-home therapy, or hospitals run the risk of becoming burned out. It is important to recognize the signs and take immediate action. You want your therapist to love what they do for a job. If they don’t, take your business elsewhere.

I have been (and am) a person in therapy myself, just like many other therapists. I don’t want my therapist, the person who is supposed to help guide me through my journey, to be unaware of where their philosophy and passion lie, to pretend to be someone else, to lack the necessary skills or education to help me overcome my challenges, or to be burned out to the point of not being helpful at all.

I will conclude with sharing the four characteristics that shape my own therapeutic identity. My therapeutic philosophy is narrative therapy, an approach that views the problem external to the person, who is the expert of their own experience, able to retell their stories in their own voice. My delivery includes some traits usually connected to narrative, such as curiosity and respect, but I am also direct, which is often associated with therapeutic models very different from narrative. As for my skill level, well, I’ll let that speak for itself. Lastly, my awareness of my readiness to help is strong because I have made it an important part of my work to practice self-care and to not allow the difficulties of this field diminish the passion that drove me to this work in the first place.

man holding stomach in painSchizophrenia is a chronic, severe mental health condition thought to result from some combination of genetic and environmental factors. Imbalances in brain chemicals, such as dopamine and glutamate, also seem to play a role in schizophrenia.

Schizophrenia is diagnosed both by “positive” symptoms—among them hallucinations, delusions, and other disordered thinking—as well as “negative” symptoms such as reduced expression of emotion and speaking less. People who have this condition also may experience difficulties with cognitive functions such as decision making, planning, paying attention, and working memory.

There has been a great deal of talk about the role of gut flora, also known as the “microbiome,” and mental health. It may sound surprising, but severity of symptoms in depression, anxiety, autism, and now schizophrenia have been linked to imbalances in the gastrointestinal (GI) tract. More recent research has suggested a relationship between activity of the immune system, increased inflammation, the presence of food sensitivities, and imbalances in the GI tract in the presentation of schizophrenia.

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What’s the Gut Got to Do with It?

During the normal birth process, our GI tracts are populated with “good” bacteria (by moving down the mother’s vaginal canal). This, our diets, stress levels, and other factors subsequently affect our gut bacteria and our overall health, as well as our brain development.

Gut bacteria help regulate proteins and other substances that influence the brain’s development. One substance, “brain-derived neurotrophic factor” or BDNF, impacts the brain’s ability to develop new neurons and remain adaptable (referred to as neuroplasticity).

Our gut environment also appears to affect receptors in our brains. Receptors may be thought of as the equivalent of a keyhole on the surface of a neuron. Brain chemicals are like the “keys” that are designed to fit in a specific type of receptor. Once such type of receptor, the NMDA, is a type of glutamate receptor involved in, among other things, plasticity (or adaptability) of neurons related to memory and other functions. An unbalanced microbiome (gut bacteria, or flora) can lead to under-functioning NMDA receptors and variations in BDNF that may contribute to the production of schizophrenia symptoms.

Structural damage to the GI tract in people with schizophrenia has been linked to developing antibodies to brain cells in the hippocampus, amygdala, and frontal cortex. These brain areas are involved in working memory, emotion, motivation, decision making, and logical thinking—all of which may be impaired in people with schizophrenia.

Dr. Kaitlyn Nemani and colleagues reviewed the literature on the role of the gut in schizophrenia. Their review found that imbalances in the microbiome may be linked to structural damage in the gut, inflammation, and the development of autoimmune disorders. People who have schizophrenia, as well as their relatives, have been found to have a greater incidence of autoimmune disorders than people who either do not have or are not related to someone with schizophrenia.

In addition, structural damage to the GI tract in people with schizophrenia has been linked to developing antibodies to brain cells in the hippocampus, amygdala, and prefrontal cortex. These brain areas are involved in working memory, emotion, motivation, decision making, and logical thinking—all of which may be impaired in people with schizophrenia.

Gut flora imbalances may also play a role in increased sensitivity to gluten (a protein found in grains) and casein, which is the main protein found in milk and milk products. A growing body of research has found a relationship between gluten sensitivity that is not due to celiac disease and symptoms of both schizophrenia and autism.

Finally, imbalances in gut flora are linked to obesity and insulin resistance, both of which are linked to diabetes. People who have schizophrenia have an increased risk for these types of metabolic imbalances, and antipsychotic medication can further induce weight gain that can lead to metabolic problems and diabetes.

Novel Therapies to Balance the Gut

Dr. Nemani and colleagues suggest some nontraditional therapies that may complement existing medication and psychotherapy approaches for treating schizophrenia. These include:

  1. Dietary changes. Although the evidence has been mixed, there is some data and also anecdotal reports suggesting that a subset of people who have schizophrenia benefit from avoiding gluten-containing foods (i.e., wheat, rye, barley, and other grains). Data regarding the impact of a casein-free diet on schizophrenia symptoms are lacking, but if your current treatment regimen provides insufficient relief, or you have GI symptoms that appear to worsen after consuming dairy, it may be worth going dairy-free for a few weeks to see if this improves your symptoms.
  2. Antimicrobials. Minocycline (a form of tetracycline) is under investigation as an adjunct treatment in people with schizophrenia. It is thought to reduce inflammation and enhance glutamate neurotransmission.
  3. Probiotics. Probiotics, or supplements containing “good bacteria,” may help balance gut flora and have been shown to positively impact mood, digestion, immunity, and weight. There does not appear to be risk associated with taking probiotics.

The last type of novel therapy discussed by the authors is fecal transplantation, or transplanting the fecal bacteria from someone with a healthy microbiome to a person who has a gut imbalance. Although this is considered a cutting-edge GI treatment for those who have inflammatory bowel disease, the authors conclude that a better understanding of the microbiome in those with schizophrenia is needed to know if this therapy is warranted.

As always, consult with your medical team when considering new therapies, conventional or complementary, such as those described above.

References:

  1. Celiac Disease Foundation. (n.d.). Sources of Gluten. Retrieved from https://celiac.org/live-gluten-free/glutenfreediet/sources-of-gluten/
  2. National Institute of Mental Health. (2016). Schizophrenia. Retrieved from http://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml
  3. Nemani, K., Ghomi, R. H., McCormick, B., & Fan, X. (2015). Schizophrenia and the gut-brain axis. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 56, 155-160.

Milky Way over the desertWhat’s sacred for you? Where is it found? For many of us, the idea of sacred space brings up images of cathedrals or mosques, Stonehenge, Angkor Wat, or the pyramids. These can be places separated from us by great distances and steeped in centuries of tradition, so getting to them is a journey. “Next year in Jerusalem,” we tell one another. Or we dream of making the Hajj to Mecca, or going on pilgrimage to Santiago or Lourdes. Such spaces can also be the houses of worship we go to once a week, for which we dress in special clothes, covering or uncovering our heads, possibly leaving our shoes at the door.

For others of us, the sacred is hard to find, or is something we feel we once had access to but no longer do. We get caught up—sometimes for years at a time—in the business of daily life. Technology provides us with increasingly sophisticated means to keep ourselves distracted. Or the practices that once offered access to the sacred may no longer do so.

In the following discussion, names have been changed and personal material has been screened out.

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Sacred space can mean what we set the space aside for, what we do while within it. Jim creates a memorial altar in his home. On top of a bookcase, he puts photos of people he loves who have died—his grandmother, his partner, his best friend. He keeps a candle burning there, and on their birthdays he sets out flowers or a cup of coffee.

Sacred can refer to what we feel when we enter the space. Benjamin, disillusioned with his church, goes into nature in order to feel he’s contained in something larger than he is, that will accept him no matter what. Janice writes her dreams down in a journal. When she sits down in front of her journal and opens it, she experiences feelings of calm and increased focus. Cathy goes on vacation to Istanbul and enters the Blue Mosque. Although a practicing Lutheran, she finds that looking up into the ornately tiled, domed ceilings produces a sense of weightlessness and freedom from worry.

Bob belongs to a writers’ group. Every two weeks, the group gets together at a different member’s home. They read and critique each other’s work. Although “sacred” isn’t the way he describes this (and, in fact, is a term he objects to), Bob says writing is the most important thing in the world to him—“what he was born to do.”

Kyle meditates before coming to therapy. He sees his therapist’s office as the place where he meets what is most true in his life, sometimes for the first time.

For Alice, it’s her mother’s house. For Karen, it’s wherever her 10-year-old daughter is. Both women struggle with recovery, but don’t use in the spaces where they locate the sacred.

If we give the sacred its own space, do we increase the chances we will recognize it when it greets us?

The sacred is what grounds us in meaning. It can include us, as when we recognize that we are part of or one with the universe. And it can gently put us in our place, as when we slowly realize our ego is not the most important content of that universe. It can be deeply personal, as in meeting rooms where we establish or affirm our relationship to a higher power. And it can be an experience of merger, as when we look up and out into the stars at night. Sharon Olds, in her poem Wilderness, describes sleeping in the desert and looking up at the stars. She feels suddenly “… as if/not only the earth while I am here, but space/and death and existence without me, are my home.”

Sometimes we know it for the first time by responses that surprise us. Fran, hiking, comes into a grove of California oaks in the hills over the ocean. She says, “I suddenly heard the silence for the first time. It seemed to go on forever.” For Steve, the experience came as he was driving through Death Valley. “I was going to meet some friends,” he says. “But I drove more and more slowly, until I just had to pull over and stop. I’d never seen anything like it—white sand dunes, colored cliffs that looked like sculptures, and no one else around anywhere. I felt connected to the earth for the first time since I was a kid.”

Our own bodies can provide such a space. Tom describes an experience late one Christmas Eve that the manger where the Christ child was about to be born was his own body. This original intensity faded, but he was left with a lingering and resonant awareness of what he put into his body in terms of food and recreational substances, and of how he took care of his health.

Sacred space can mean leaving room in our lives for something to be sacred—if not now, then someday. Perhaps as simply as by acknowledging we don’t know all the answers. Or that our answers might not be the ultimate answer, might merely be rest stops along the way.

Sacred space can as well act as a holding place in times of uncertainty or transition. It can be a system of meaning, rather than a literal place.

According to Erik Erikson, in the first stages of life we’re engaged in developmental tasks related to basic psychological functions, such as establishing trust and self-efficacy, and in developing a stable sense of identity. Another way of saying this is that we’re involved in consolidating the ego, the sense of “me” present in experience that makes it “my experience.” This time of life is a little like the Ptolemaic view of the universe, where everything—sun, moon, and stars—seemed to revolve around the earth. That’s us at the center of everything, and whatever happens is about us.

Often around the midpoint of life, we start picking up hints that we’re not going to increase and live forever. In Once Upon a Midlife, Allan Chinen describes how shocking this realization can be, accompanied by anxiety and grief. Especially at such a point, a sense of the sacred can act to ground us. As the fact of “me” begins to lose its apparent guarantee of continuance as well as its centrality (because how central to the universe can I be if I’m not going to be around?), the universe is less and less about me. But perhaps I become more and more about something else, something larger than me.

Carl Jung notes that, in this way, the ego becomes relativized and the process of individualization—becoming wholly who we were meant to be—is accomplished. We begin to live in a system of meaning where the earth revolves around the sun, the sun rotates through the galaxy, and the galaxy itself follows its own great attractor. Our experience then seems to participate in larger movements, whether those are our family or a cause in which we believe or humanity in general, a spiritual pathway or the life of the universe.

Ray tells me that if you go to the mosque to pray 40 mornings in a row, you will be able to meet Khid’r, a mystic figure in Islam, anywhere—in the market, on the street. Barbara tells me she sets a place at the Seder table every year for Elijah, who will someday return from his sojourn in heaven, so why not here, why not now? Beth tells me that when you practice Zen meditation, anything—even a drop of water falling into a bucket—can suddenly herald a glimpse into the nature of reality.

Here, we have the idea of ordinary daily space—and that includes the freeway where we’re caught in traffic, or the area where we keep our trash cans—suddenly converting to sacred.

A related idea is that all space is sacred already. Connie tells me a quotation from the Gospel of Thomas, where the figure of Jesus tells his disciples, “The kingdom of the father is spread out on the earth, and nobody recognizes it.”

If I’m already in a sacred space, what happens to my anxiety that is sometimes so intense? My craving for alcohol? The anger I feel at my partner when we disagree over small matters?

Sacred space can mean leaving room in our lives for something to be sacred—if not now, then someday. Perhaps as simply as by acknowledging we don’t know all the answers. Or that our answers might not be the ultimate answer, might merely be rest stops along the way. The possibility that even though something doesn’t seem to make sense to me, it still might make sense. That I am included in a great web of meaning, at home, wherever I am, with no chance of getting lost.

References:

  1. Chinen, A. (1992). Once Upon a Midlife: Classic Stories and Mythic Tales to Illuminate the Middle Years. New York: Putnam Publishing Group.
  2. Erikson, E. (1980). Identity and the Life Cycle. New York: Norton.
  3. Jung, C. (1969). The Structure and Dynamics of the Psyche, Second Edition. Princeton, NJ: Princeton University Press.
  4. Olds, S. (2002). The Unswept Room. New York: Alfred A. Knopf.
  5. Robinson, J., Editor. (1978). The Nag Hammadi Library. New York: Harper and Row.

Cards, money, and poker chipsThe feeling-state addiction protocol is a modified form of eye movement desensitization and reprocessing, referred to as EMDR in mental health. EMDR is a trauma treatment modality recognized as one of the main treatments for posttraumatic stress (PTSD) and other forms of trauma.

In EMDR therapy, therapists desensitize a traumatic memory by having the person in therapy use eye movements (or other back-and-forth stimulation) while holding the memory in mind along with the feelings, images, and belief about self in that situation. This causes the brain to process the memory in a way that takes the charge off the memory, so it no longer feels disturbing. In feeling-state addiction protocol, we desensitize the pleasant memory causing the addiction by removing the charge from that memory.

Tom and the Feeling-State Theory of Addictions

The feeling-state theory of addictions assumes that the feeling underlying the behavior, not the apparent object or behavior, is the real goal of unwanted compulsive behavior. In alcohol or drug addiction, the substance creates the [fat_widget_addiction_right]“feeling-state” that causes the compulsive behavior. In behavioral addictions, however, any feeling-state can be linked to any behavior. Feeling-states are state-dependent memories created during an intensely experienced event. With gambling addiction, we look for the positive feeling-state linked to the gambling behavior.

I worked with a person in therapy, who I will call Tom, who came to me because he had “reached bottom with the consequences of his gambling,” as he put it. Tom is a 37-year-old man who started therapy saying that he wanted to overcome two addictions: a very destructive woman and gambling.

The precipitating incident that brought Tom to therapy was having just lost his last $12,000 in a poker game, the final straw that caused him to lose his house. He had recently moved in with his parents, and they insisted he deal with the gambling addiction.

Both of the addictions Tom wished to treat are known as process addictions or behavioral addictions because they are not addictions to a substance. When he first came to see me, Tom was dealing with an intense sadness from losing his relationship and shame from losing his house and moving in with his parents. Tom’s parents agreed to pay for his therapy and insisted he make measured progress, lest they throw him out of the house.

Although addiction to a person and addiction to gambling seem different, like all behavioral addictions, they both involve an addiction to a feeling-state. According to Dr. Robert Miller, who developed the feeling-state addiction protocol in 2011:

“The feeling-state theory of behavioral and substance addictions postulates that addictions are created when positive feelings become rigidly linked with specific objects or behaviors. This linkage between feelings and behaviors is called a feeling-state. When a feeling-state is triggered, the whole psycho-physiological pattern is activated. The activation of the pattern then triggers the out-of-control behavior.”

The first step in eliminating a compulsion, according to Dr. Miller’s feeling-state protocol, is to figure out the feeling-state that drives the compulsion.

Identifying the Real Addictive Behavior

In therapy, we determined that the feeling-state Tom was addicted to with gambling was bonding with his father, which had provided both a sense of belonging and mastery.

Tom had one brother who was five years older. He described his brother as the favorite and the one his dad often Tom was very shy and described himself as someone who had never excelled at anything. He had few friends and participated in few social activities. In fact, the first time he said he felt any positive attention from his father was when he would watch his father’s poker games every week.praised for his intellectual ability and athletic success. Tom was very shy and described himself as someone who had never excelled at anything. He had few friends and participated in few social activities. In fact, the first time he said he felt any positive attention from his father was when he would watch his father’s poker games every week.

By the age of 18, Tom became a good observer and was playing cards with his dad’s poker group. He was skilled and was often the winner. It was this feeling-state of bonding with his father and the feeling of belonging to a group that drove his gambling compulsion.

We processed these strong feeling-states with EMDR, and his craving for gambling started to subside. We then discovered other feeling-states linked to his gambling. They were the feeling-state of freedom and mastery. Once we unlinked or disconnected these feeling-states with gambling, his desire for gambling waned and we could then address the psychological dynamics underlying the “need” for the gambling, such as his relationship with his dad, his feelings of being a “loser,” and the belief he is not smart and can’t succeed at anything.

We also desensitized his attraction to the destructive woman who had recently come back into his life. When he realized how easy it was to remove that attraction for her, it gave his self-esteem a huge boost. This helped him see other dynamics in his life with more clarity and confidence.

I have used this model with many process addictions, including:

I find it to be effective and relatively easy for the person in therapy because the person largely avoids the pain of going through withdrawal.

References:

  1. EMDR International Association. (2014). What is the actual EMDR session like? Retrieved from http://www.emdria.org/?120
  2. Miller. R. (2011). The feeling-state theory of behavioral and substance addictions and the feeling-state addiction protocol. Retrieved from http://www.psychinnovations.com/EMDRSD/Miller_Feeling_State_Addiction.pdf

Lioness displaing dangerous teethHealthy anger requires self-awareness, open communication, and the ability to self-soothe. When you can clearly describe your thoughts and feelings, be open to alternative perspectives, and problem-solve, you keep your anger in check and promote intimacy in relationships. On the other hand, if your anger feels out of your control, makes you “see red,” or even scares the people around you, you must develop a new way of expressing your anger.

Before you can rein in your anger, however, you must stop minimizing or justifying it. Look in the mirror and acknowledge your responsibility for your actions. Refrain from pointing the finger at others for setting you off or provoking you. Physical and verbal aggression never have a place in your relationships. There is always another option.

Once you have fully owned your anger, it is time to understand it. Explore the following aspects of your anger to learn more about its origin, its purpose, and how to address it.

1. How Long Has This Been Going On?

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Ask yourself if the way you manage your anger is new to your life or if it precedes your current situation. When you are honest with yourself, you may recognize a long-term pattern of losing your temper or expressing your anger in unhealthy ways. Perhaps you’ve always had a short fuse and taken your anger out on others. Perhaps you’ve taken your anger out on yourself through self-harm (substance abuse, self-injury, risk-taking, etc.). Allowing yourself to recognize the pattern will help you continue to take responsibility for your actions. You will have further evidence that something inside of you needs to heal.

If your anger does feel new, assess your life for anything unhealthy that impacts your behavior in a negative way. Substance abuse, toxic relationships, and recent trauma can all impact how you manage your anger. Traumatic brain injuries have also been known to alter personalities. Please be sure to address any emotional, situational, or medical factors that could be involved in learning to control your anger.

2. Is There a Cycle?

Use a diary or calendar to chart out when your angry episodes occur, their frequency, and what is going on in your life when they happen. Pay attention to the time between episodes, too. Describe your mood, physical sensations, stress level, and any events or interactions that take place on a daily basis. You might become aware of a gradual increase in tension or irritability that eventually builds up to an explosion. Be sure to note how you feel after an episode, identifying any remorse, shame, or even relief. This can help reinforce consequences of maintaining your angry behaviors and/or offer you valuable information regarding your stress-management needs.

When you tune into your daily experience, you will learn how your anger develops over time. You will gain a clearer picture of what triggers you; even small triggers add up! Even if your anger seems like it erupts quickly and without warning, there is usually something bubbling under the surface. For example, a low tolerance for frustration, a need to control your environment, or anxiety about your life situation can all lead to uncontrollable anger. The more you understand about what fuels your anger and how it progresses, the greater chance you have to address it with therapy, coping skills, or relaxation techniques.

3. Consider Your Family History

Who were your models of emotional expression? The way your parents or caregivers expressed feelings can influence how you recognize emotions and cope with them.

As you begin to uncover the roots of your anger, you can begin to separate your past from your present.

In some families, anger is the only emotion expressed, which can limit your emotional vocabulary. Disappointment, hurt, and embarrassment can become confused with and communicated as anger. Your response to distress also depends highly on what you witnessed as a child. If you watched the important adults in your life act in aggressive or hurtful ways, you might learn to do the same.

Furthermore, families who struggle to experience the vast array of emotions may also struggle to accept and validate you for who you are. Long-lasting anger can develop when we have not been permitted to be ourselves and communicate our thoughts, feelings, and needs openly.

4. Consider Your Personal History

Traumatic experiences of abuse, violence, or other life-threatening circumstances can create an unsafe view of the world and fuel a need to be on guard at all times. This kind of hypervigilance can make you interpret those around you as critical or deceptive, even when they have good or neutral intentions. You may also be justifiably angry at those who hurt you in your past; instead of healing those wounds, though, you take your pain out on those around you. It’s as if your current relationships are being asked to pay the penalty for crimes they did not commit.

As you begin to uncover the roots of your anger, you can begin to separate your past from your present. You can live in the here-and-now with your loved ones, rather than reliving horrific experiences that no longer exist today. If it feels appropriate, you can learn to forgive those who hurt you, thereby letting go of the weight of the pain they caused you. You may also need to forgive yourself for any pain your anger caused the people you love.

Be kind and patient with yourself during this process, as it may reveal aspects of your life that are painful or uncomfortable. Seek support from a professional who is trained to assist you in your self-discovery. A therapist, meditation teacher, spiritual/religious advisor, etc., can help you learn valuable tools to heal past hurts, respond appropriately to a variety of emotions, and cope with the present-day experience of your anger.

Important Notice

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

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