Young woman with hand over heartHow do you react when you’re in pain? Do you resist it, ignore it, or push it away? Do you get consumed by it? Would you like to learn a more healing and compassionate way to respond?

To be alive means we feel happiness, joy, sorrow, and pain. Most of us want to feel happiness and all the other positive feelings, but pain? Not so much. Pain, though, is a natural part of life. It shows up physically, such as when we’re injured, sick, or aging, or as the emotional pain of frustration, sadness, loss, or sorrow. It also arises when we’re consumed by some mind state, such as anxiety or depression.

How Resistance to Pain Creates Suffering

“Resistance creates suffering. Stress happens when your mind resists what is. The only problem in your life is your mind’s resistance to life as it unfolds.” —Dan Millman, author and personal development lecturer

Whether it’s physical, emotional, or mental, staying open and present to pain is challenging. What makes it so isn’t the actual sensation of pain; it’s the way we react to it. We catastrophize, worry, or ruminate about what happened, what it means, and how it will affect our future. Sometimes we go into mental gymnastics, trying to figure out how to make it go away. We use our energy in ways that are exhausting and don’t help. This only fuels the pain, morphing what might have been a temporary period of pain into a longer one.

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These reactions stop us from seeing when we’re caught in some belief or story about how life needs to be in order for us to be happy. If I’m always wanting to please others and neglect myself in the process, I can’t possibly be happy. Fearing rejection or the loss of a loving connection can keep me engaged in behaviors and patterns that are unhealthy and hurtful.

They can also show up as addictions, distractions, or unhealthy mind states, including:

Can you see how these patterned ways of reacting to pain can create deep suffering?

So how do we help ourselves?

How Resistance Manifests

The first step is to become aware of when and how we’re reacting/resisting pain. I like the way Christopher Germer, a clinical psychologist and author, describes the resistance that shows up when emotional pain arises. In his book The Mindful Path to Self-Compassion, he describes the series of internal dialogues that occur when a pain is present as follows:

“I don’t like this feeling!”

“I wish I didn’t have this feeling.”

“I shouldn’t have this feeling.”

“I’m wrong to have this feeling.”

“I’m bad!”

Have you found yourself reacting similarly? Did it intensify the pain?

When we get stuck in these reactive cycles, we cut off from the very source that helps us heal and reconnect with life.

Moving from Reacting to Responding

The practice of mindfulness, and specifically self-compassion, helps us soften the resistance. We stop trying to escape, control, or ignore the pain and instead open to it. Staying present, we begin to investigate, through the practice of nonjudgmental awareness and kindness, how our body reacts to pain (tightening/tension); how our thoughts are affected (fear, anger, aversion); and what emotions are in need of attention and loving acceptance.

This pausing to connect is a pivotal moment, one where we’re shifting from reacting to responding. Deepening our exploration, we can practice the following steps:

This is a powerful, transformative, and healing approach that helps us stay present to the pain and challenges we all face in life. Most of all, it helps us stay open to all of life’s joys and sorrows—and that is what makes life worth living.

May you live with ease and peace.

Mother enjoying nature with her daughter and babyThere are few events in life that are as transformative as becoming a parent. So many aspects of your life—your identity, the dynamics with your partner, your sense of control (or lack thereof)—change in ways you can’t possibly imagine or emotionally prepare for. In these ways, having a second child is far less transformative. Nonetheless, there are aspects of having a second child that are novel and unpredictable, and the transition can be quite disruptive to the family system, particularly in terms of its impact on your firstborn.

Fortunately, despite the many disruptions and unknowns, there are some things you can predict about having a second child. Preparing your first child for the arrival of your baby, and yourself to handle issues as they arise after your baby comes home, can greatly help. If you can find ways to include your child in preparations for the baby, set aside time to spend with your child after the baby arrives, set firm limits with your child (particularly around aggressive behavior), and tolerate your feelings of guilt (and your child’s feelings of anger), you may help ease this transition and create an environment of safety and reassurance for your family.

How Can I Prepare My Child for the Arrival of a Sibling?

Unless you are face to face with one, “baby” is a pretty abstract concept, particularly for a child. Before the baby comes home, one of the few concrete manifestations of this concept is pregnancy (assuming the birth mother is part of the family). Children can have very different reactions to watching their mother’s belly grow. Some worry about the health of their mother; others feel alienated and uncomfortable with their mother’s changing body; others still may feel protective toward their mother.

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As a mother, reassuring your child that you are OK and explaining the growth of the fetus along the way is one way to help make the whole baby thing a bit less mysterious and scary. There are also several age-appropriate books that show the growth of the fetus and the journey to birth that you can read to your child.

If you are adopting or using a surrogate, you may not be able to follow the process of pregnancy in vivo. Nonetheless, there are several other ways for adoptive as well as all parents to make the arrival of a second child more concrete for firstborn children.

The more you can share with your child the concrete steps needed to prepare for the baby’s arrival—picking out a crib, buying diapers, etc.—the more real it may feel to your child, and the greater sense of ownership they may have (“It’s my baby, too!”). It’s also a good idea to discuss with your child what is going to happen when you go to the hospital (or, if adopting, go to pick up the baby), and any changes that may affect your child’s schedule (“Grandma is coming to help take care of the baby”). Children need routine and predictability. The fewer surprises and changes to their schedule during this time, the better.

This might also be a good time look at your child’s baby photos with your child, to remind your child they were a baby once, too, and to plant a seed for identification with the baby (“The baby is going to be like me”). You may also want to read your child some books on babies—what they do (eat, sleep, and cry, mostly) as well as books on being a big sibling. Using photos and books as a springboard, you may ask your child about any feelings your child is having about the arrival of the baby, both negative and positive. Given how abstract the birth is at this stage for your child, do not be surprised or disappointed if your child does not wish to discuss or cannot discuss their feelings yet.

What Can I Expect My Child to Feel After the Arrival of the Baby?

Imagine this: Your partner comes home one evening and announces that, as much as they love you, they have met someone new they also love, and this person will now be moving in with the two of you. For many children, the arrival of a younger sibling feels much the same, at least at the beginning. Children typically feel a bit stunned initially, and then start to feel some anger (along with other, positive feelings) toward the baby and/or you.

What Will I Be Feeling After the Baby Comes Home?

Well, imagine that now you are the one who brings home your new great love to live with your partner. How do you think you’d feel toward your partner? Guilt city! One of the hardest things about becoming a parent a second time around is the guilt. It can feel like you are destroying your child’s life, that you have done this horrible, cruel thing. When you have these feelings, it can be helpful to remember that while this transition may be rough on your child, ultimately it is gift you are giving your child (albeit one that may not pay off for a few years).

While there are things you can do to help your child with the transition and offer reassurance of your love, many children struggle with feelings of anger, hurt, confusion, etc., when a sibling is brought home. You may simply not be able to love away these feelings, which means in addition to having to tolerate a certain amount of guilt, you also have to tolerate a certain amount of hurt and anger on your child’s part. Accepting that your child might have a tough time for a while and reminding yourself (and your child) of your love for them may take the edge off this emotional burden.

How Can I Help My Child Through This Difficult Transition?

Feeling guilty can make it difficult to know what’s best for your child and yourself. Learning to tolerate your guilt and set reasonable expectations for yourself, and spending special time with your older child while continuing to set limits, may provide the foundation for your child feeling safe and secure and for you staying grounded.

Feeling guilty can make it difficult to know what’s best for your child and yourself. Learning to tolerate your guilt and set reasonable expectations for yourself, and spending special time with your older child while continuing to set limits, may provide the foundation for your child feeling safe and secure and for you staying grounded.

Although it may be difficult, especially at the beginning, spending baby-free time with your child can go a long way toward reassuring your child that your feelings have not changed and that you still value the intimacy of your relationship. Even if you can’t spend much time alone, set whatever time you do have aside as “special” time where you do something one-on-one, preferably on a regular, routine basis. This way, you and your child can anticipate your date in advance, which might help your child when they are feeling neglected.

If you have to leave your child to attend to the baby and your child seems upset, acknowledge these feelings (“I know it’s hard when I have to leave our game to go take care of the baby”). If your child is interested, you can include your child in helping out with the baby—diapering, bathing, etc. Feeling that they are part of taking care of the baby can be a very bonding experience for your child with the baby and give your child a sense of ownership and responsibility for the baby. There can also be a “well, if you can’t lick ’em, join ’em” quality to these activities.

You may find that there are certain times of the day when your older child becomes more jealous or angry, times such as bath time or bedtime, when your child is used to having all the attention focused on them. Consider alternating care with your partner or caregiver so that you can spend some time with your older child.

Breastfeeding obviously makes this more difficult. Even if you can’t change your behavior at these difficult times, you might give your child a heads-up beforehand (“Hey, I have to feed the baby in a few minutes, and I know that’s a hard time for you”) and, if the child is old enough, ask if they have any ideas about how to make it easier.

How Do I Handle Negative Behavior in My Child?

Children have different ways of handling their negative feelings regarding the arrival of a younger sibling. Some children seem totally happy, but might start regressing in some aspects of their development, such as toilet training, becoming more dependent, showing signs of separation anxiety, etc. Some children may be very sweet with the baby but get very angry with the parents. And, of course, some children may act aggressively toward the baby.

Regression

Regression during this phase is normal. Many children do not feel ready to give up their status as baby or young child. Others see how much attention their baby sibling is getting and want some of that. To a large extent, regression is a call for attention. As such, if you are able to tolerate the regression without focusing too much on it, and give your child positive attention where possible, this behavior generally passes relatively quickly. If your child wants to pretend to be a baby and crawl around and cuddle in your lap from time to time, why not? To some extent, all of our children, no matter how old, are still our babies, and need this reassurance from time to time. Telling our children that they have to be “big kids” now may very well feel like a withdrawal of love or attention.

This is not to say you should allow your 4-year-old to go back to wearing diapers. However, when saying no to your child, you might want to offer an alternative activity, such as being rocked in your lap, etc., that allows your child to regress and feel loved in that special, nurturing way.

Anger at Parents

Some children start to express aggression toward their parents when a sibling arrives, such as hitting, temper tantruming, or acting out in other ways. The tricky part here is that because parents often feel responsible for or guilty about their child’s anger, they find it hard to set limits.

While it is important to be empathic with your child during this time and make some allowances for how difficult this period might be for them, setting firm limits when your child is acting out or being aggressive is still very important, as much for the child as for you. No child wants to feel like a monster or feel out of control.

Anger at the Baby

If there is one activity that sweeps away our guilt over having a second child and gets us in touch with our anger, it is witnessing our child acting aggressively toward our baby. Evolution has hardwired us to protect our baby, and those instincts need to be heeded. We must protect the baby from harm, first and foremost. This means making it clear to our child that aggressive acts—hitting, pushing, shaking, etc.—will not be tolerated.

When children are acting aggressively toward baby siblings, their intention generally is not to harm the baby (though maybe getting the baby to cry would be fun). The issue is that children simply do not always know what is safe. Our job is to teach our children how to be safe around the baby and how to express their anger and resentment in other, more appropriate ways. Limits must be implemented firmly in the area of baby safety.

Feelings-wise, though, when children say they hate their baby siblings, our role is not to tell them they do not hate the baby or that it is not OK to hate the baby, but to acknowledge their feelings and help make the feelings less scary. If “hate” is not a word that you are comfortable with, you can always mirror back to your child, “You are really angry at the baby right now.” If your child says they want the baby dead, you can restate it as, “You really don’t want the baby here right now!” In this way, you are both validating your child’s negative feelings (all feelings are OK) and making those feelings less scary. Your child will learn that although there are moments when they do hate the baby or wish the baby was gone, these are just feelings, not actions, and they will pass and change over time. It is rare for siblings to love each other without hating each other at times, or at least having some negative feelings.

Reading books to your child is another great way to help children express their negative feelings about a younger sibling. When my second child was born, my older child, then 3 years old, could not get enough of Julius, the Baby of the World by Kevin Henkes (1995)—a book about, well, a child who hates her baby sibling … at least at first.

In Julius, the Baby of the World and, for the most part, in life, siblings do come, over time, to love each other (and sometimes even like each other), and your gift of a younger sibling to your older child will become just that, a gift. In the meantime, if you can hold tight and tolerate your and your child’s tough feelings, spend alone time with your child, and maintain firm limits, you will be well on your way!

Vintage journal and fountain penWords have power, so it follows that the process of journaling does, too. It’s a tool I often recommend to the people who see me for therapy.

Some situations in which journaling might be helpful include:

Sometimes people share that they’ve thought about journaling but never moved forward with it. When I explore why that is, it’s often because they saw it as a chore or obligation, something that had to be done the “right” way.

However, there is no right way to journal. The key is to utilize this tool in the way that will work best for you.

You might choose to buy a beautiful book with empty pages, but you could just as easily grab a notecard, a yellow legal pad, or a piece of printer paper and begin.

You need not worry about writing regularly. There’s no rule that says you have to record things daily. Write when you believe it might serve you, not because of an arbitrary “should” that you or someone else has placed on you.

You have the option of sharing what you’ve journaled with others or keeping it private. You decide. You make the rules.

There is no requirement to write full sentences. You can jot down thoughts as they come to you. You can scribble them all over the page if you want and draw lines connecting those that are related to one another, literally connecting the dots of your thoughts in a deliberate way.

Another therapeutic way to journal is to vent on paper all that you are upset about so that you have a sense of expelling that negativity. Give yourself permission to be as “ugly” in these rants as you want so you have the opportunity to empty yourself of toxic thoughts and feelings. Many people resist this at first, fearing others might discover about them what they’ve been trying to hide. In that case, I suggest symbolically ridding yourself of those thoughts and feelings by ripping up the words or shredding them. This act alone can be a powerful one, a moment of triumph over something that was possibly poisoning you from within.

Sometimes people struggle to find the words to express themselves accurately. I encourage such people to draw or sketch what comes to mind. Scribble if need be. Let the pen flow over the paper in a way that mimics how you feel. Even choosing your writing tool might be telling—a pencil’s lead that can be erased as though it never was, a ballpoint that moves smoothly, a colorful marker, a thick, permanent Sharpie. You can grab what’s nearby or you can be more deliberate when selecting.

You have the option of sharing what you’ve journaled with others or keeping it private. You decide. You make the rules.

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I define an emotional affair as a relationship in which one or both parties are involved in another significant relationship where there is emotional intimacy, sexual chemistry, and romantic feelings, without the relationship having been consummated.

Recent research indicates that 76% of Americans consider a secret emotional relationship to constitute a form of infidelity, highlighting just how seriously these connections are viewed. Frequently in emotional affairs, the partner who didn’t have the affair experiences the same degree of betrayal and breach of trust as he or she would if a spouse had a physical affair. Research shows that individuals often view emotional infidelities as more hurtful than sexual infidelities. At times, an emotional affair can feel even more damaging because someone else has met the partner’s emotional needs.

It can also be helpful to understand that an affair is often not only a discrete event, but a signal that something in the relationship system has broken down. While this does not excuse the betrayal or the pain it causes, emotional and physical affairs alike frequently emerge in relationships where partners feel unable, unsafe, or unequipped to address growing disconnection, unmet needs, or conflict directly.

Current studies show that roughly 60% to 75% of couples stay together after discovering an affair, and your relationship can most certainly survive and perhaps even become even closer than it was before the affair.

At the same time, recovery is not only about repairing the rupture caused by the affair itself. It also involves examining the underlying emotional, structural, and communication patterns that may have created the conditions in which the affair developed. In fact, recent research from 2023 found that nearly 46% of unfaithful partners and 36% of betrayed partners believed their relationship ultimately improved after working through the affair.

Here are some tips to get you back on track:

Tip 1: Be willing to look at the affair in the context of your relationship.

Emotional affairs often start because emotional needs are unmet, the person has low self-esteem, and connecting with others online is a very easy process. Many people in unhappy relationships feel unheard, disconnected and unwanted. If one person is looking outside the relationship to get emotional needs met, it may be likely that person’s needs aren’t being met within the primary relationship. Be willing to honestly consider what had been going on in your significant relationship prior to the beginning of the affair.

Find a Therapist for Relationships

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“Joanne” and “Jeff,” both teachers at an international school, recently came to see me for therapy because Jeff had an emotional affair with Eileen, another teacher at the school. When Eileen was in the process of separating from her husband, Jeff had become her confidant, and the relationship deepened from there.

When Joanne found out about the affair, she was furious, hurt, and felt out of control. She made going to therapy a condition of continuing the relationship. As we began to work together, it was revealed that Joanne had given birth to the couple’s first child a year ago. Since that time, Jeff reported feeling left out and uncared for as Joanne had been preoccupied with the baby’s needs. He was missing the easy companionship and enjoyable sex they had before. However, he never told this to Joanne, and she had no way of knowing how Jeff was feeling.

Here, the context of the relationship was the birth of the couple’s first child and Jeff’s feelings of isolation and exclusion when Joanne’s attention was diverted to their baby. Because he didn’t share this with Joanne, his emotional needs went unmet within their relationship. Once this came out in therapy, Joanne was able to acknowledge Jeff’s feelings, and together they came up with strategies for Joanne to meet Jeff’s emotional needs and vice versa.

In this way, the affair can be understood as disrupting an existing pattern that had already been fostering disconnection. While the behavior itself is harmful and must be addressed, it can also bring into focus the relationship habits, avoided conversations, and unmet needs that were present beforehand. Exploring these patterns allows couples to move beyond blame and toward a more complete understanding of their shared dynamic.

Tip 2: Talk about your feelings and needs with your partner without judgment or blame.

This is often easier said than done when strong feelings are present. Accusations can be flung, which rarely help couples resolve anything.

For many couples, these moments are especially difficult because they touch on long-standing fears, including fear of conflict, fear of rejection, or fear of destabilizing the relationship. As a result, important issues may have gone unspoken even before the affair. Developing clear boundaries and building the capacity to tolerate the discomfort of honest conversations are essential steps in changing this pattern.

When I work with couples, I teach a communication model called [nonviolent communication NVC, or compassionate communication as I prefer to call it. Recent research from 2024 shows that NVC training has improved interpersonal relationships among healthcare professionals, reduced workplace conflict, and promoted a culture of empathy and cooperation in high-stress environments.

Using this model, couples learn how to identify and express their feelings and needs to each other without blame, then to make a request of their partner, which can be answered yes or no. I find when people take responsibility for their own feelings and needs and communicate them directly to their partners, they can be heard in a non-defensive way because there is no judgment involved.

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It is a very simple model that looks like this:

Observation: I make an observation about what I heard or saw the other person say or do, like a video camera recording the action. A video camera has no judgment or blame; it’s simply recording. The statement starts with, “When you do or say ________ …”

Feelings: I name the feeling I experienced as a result of the observation. An example would be, “When you say I don’t care about you, I feel hurt and misunderstood.”

Needs: This refers to common human needs that we all experience. Examples are needs for acceptance, love, understanding, collaboration, harmony, happiness, peace, etc. Now the model looks like, “When you say I don’t care about you, I feel hurt because I have a need for respect and understanding.”

Request: I then make a request of the other person that can be answered yes or no, using the phrase, “Would you be willing to ________?”

In Jeff and Joanne’s case, after the sentence in the third category of the model (needs), I would ask, “Would you be willing to talk with me more about this without blaming me so I can better understand what you mean?” This puts the whole conversation in a different light and can elicit a very different response than when I’m simply told, “You don’t care about me.”

When an emotional affair has occurred in a relationship, it’s essential that both partners learn to express delicate and vulnerable feelings without judgment so they can get past the accusation phase and arrive at some solutions.

This process is most effective when couples work to move away from rigid roles of villain and victim. While accountability remains crucial, lasting repair often depends on each partner’s willingness to examine both the impact of the affair and the broader relational context in which it occurred.

Tip 3: Be open to coming up with new strategies to solve the underlying problem.

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In Joanne and Jeff’s case, the underlying problem was that, since the birth of their son, Jeff had felt excluded and hurt by what he perceived to be Joanne’s inattentiveness. Because Jeff didn’t want to feel more vulnerable, he didn’t express his feelings to Joanne. They first needed to identify the problem and then communicate their feelings and needs to each other.

The rupture caused by an affair, while painful, can also serve as an opportunity to intentionally rebuild the relationship with a healthier framework. This may include redefining boundaries, clarifying expectations, and asking an important question: “What kind of relationship do we each want to create moving forward?” Answering this together can help shift the focus from simply repairing damage to actively designing a more connected and resilient partnership.

Research on trust rebuilding shows that it is a gradual process requiring patience and consistent effort, with both partners needing to feel internal “pro-relationship” motivation rooted in care for their partner.

This paved the way for them to strategize about effective solutions. Jeff might have said, “When I come home from work and tell you about my day and you don’t listen, I feel hurt and dismissed because I have a need to be heard. Would you be willing to tell me when would be a good time for us to talk if you’re busy with the baby?”

Joanne, for her part, would have heard it was important to Jeff to talk about his day, and she may have been willing to make another time. When Jeff swallowed his feelings instead of expressing them, there was no way for Joanne to know there was a problem, so of course no solution could be reached.

Recent studies on relationship interventions show that most couples who receive evidence-based therapy obtain significant results in improving relationship satisfaction, with these effects often sustained at follow-up. Indeed, a relationship can survive an emotional affair if both partners are committed to finding a way past it.

Ultimately, healing from an emotional affair involves holding two truths at once: acknowledging and working through the real hurt and breach of trust, while also examining the relational patterns that made disconnection possible. When couples are able to do both, they are better positioned not only to recover, but to create a relationship that feels more secure, open, and intentional.

If you find this too difficult to do on your own, often just a few sessions of couples therapy can kick-start the process. Meta-analyses show that couples therapy is effective for improving relationship satisfaction, communication skills, and emotional intimacy.

Note: To protect privacy, names in the preceding article have been changed and the dialogues described are a composite.

References:

  1. Adriani, P. A., Hino, P., Taminato, M., Okuno, M. F. P., Santos, O. V., & Fernandes, H. (2024). Non-violent communication as a technology in interpersonal relationships in health work: A scoping review. BMC Health Services Research, 24, 289. https://doi.org/10.1186/s12913-024-10753-2
  2. Carr, A. (2025). Couple therapy and systemic interventions for adult-focused problems: The evidence base. Journal of Family Therapy, 47(1), 6-42. https://doi.org/10.1111/1467-6427.12481
  3. Fincham, F. D., & May, R. W. (2017). Infidelity in romantic relationships. Current Opinion in Psychology, 13, 70-74.
  4. Institute for Family Studies. (2020). What counts as ‘cheating’ in marriage? Emotional infidelity in a national sample. https://ifstudies.org/blog/what-counts-as-cheating-in-marriage-emotional-infidelity-in-a-national-sample
  5. Kernová, L., Halamová, J., & Deriglazov, D. (2025). Effectiveness of digital interventions on relationship satisfaction among couples: A systematic review and meta-analysis. BMC Psychology, 13, 1069. https://doi.org/10.1186/s40359-025-03444-y
  6. Knox, C., & Rempel, J. K. (2024). Rebuilding trust in romantic relationships [Poster presentation]. Society for Personality and Social Psychology Annual Convention, San Diego, CA, USA. https://doi.org/10.17605/OSF.IO/AP26D
  7. Neilson, E. C., & Maitland, D. W. M. (2025). Acceptance and commitment therapy for couples: A systematic review and meta-analysis. Journal of Contextual Behavioral Science, 36, 100892.
  8. Rosenberg, M. (2003). Nonviolent communication: A language of life. Encinitas, CA: Puddle Dancer.
  9. Weiser, D. A., & Weigel, D. J. (2024). Revisiting the charmed circle: A reflexive examination of unanswered questions in the infidelity literature. Social and Personality Psychology Compass, 18(7), e12983. https://doi.org/10.1111/spc3.12983

Young woman lying on the grass at summer sunsetLet’s stop making mindfulness something other than what it is. Let’s stop making mindfulness the great cure-all. Let’s stop making mindfulness another gimmick to improve ourselves. Because it’s not.

If we look clearly at the definition of mindfulness, we see that it is an inherent capacity in all of us—one that doesn’t need to be made into an object. It is our birthright. Simply put, mindfulness is a way of being aware of our ongoing present-moment experience with an attitude of nonjudgmental acceptance. It is the opposite of being distracted, yet you can be mindful of being distracted. It is the opposite of being on autopilot, yet after enough practice it becomes automatic.

Meditation practice supports mindfulness, but meditation is not mindfulness; meditation merely helps train the mind to be in a mindful state. Mindfulness doesn’t belong to anyone or any one tradition, although many meditative and contemplative traditions (particularly Buddhism) make it explicit in their practices.

Mindfulness is an ever-deepening way of being that can be understood only by living it.

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What Is It, Really, to ‘Live in the Moment’?

As you become increasingly, continuously aware of yourself—with an attitude of wanting to know your experience deeply—your perceptions can change dramatically. What a gift to live life in such a way! If we can begin to rest in the mystery of not knowing what is going to happen next, we open to the possibility of living an exciting life of ongoing discovery and freshness. Even the most mundane activities can become rich, full of texture and volume, and we can experience them anew each time we encounter them.

It’s very easy to fall back into dullness and numbness, though, especially when our environment doesn’t support our aliveness. Also, depending on our current capacity to trust, our ability to open or stay open may be challenged. If we grew up in an abusive environment, we may have much more difficulty resting in the aliveness of not knowing, and we may experience this excitement as dread and anxiety.

The good news is trust can be developed. By repeatedly encountering our open, spacious, and restful nature through mindfulness, our organism begins to trust more and more in the process. Every time we experience true openness and get past the anxiety of not knowing, our nervous systems relax—and that relaxation is deeply nourishing for the parts of us that remain young and afraid.

If we are able to truly take in the relaxation, something deep in us transforms. This is not a one-time thing, but a continually deepening process.

Practicing Without a Goal

Mindfulness is not about becoming a better businessperson, a more focused worker, a more efficient human being, or even an enlightened person. Mindfulness is about becoming more intimate with yourself, more aware of your direct experience in a more alive way.

If you’re practicing mindfulness to increase your capacity to achieve something, it may indeed work. However, the real gift of mindfulness is deep intimacy with ourselves. When we are truly intimate with ourselves, our understanding of who we are can radically transform in ways we couldn’t imagine beforehand, and we can experience a sense of “me” that is not shaped by our history.

Some say it doesn’t matter what our initial motivation for practicing is; what matters is that one begins practicing. In my experience, this seems to be true. I’ll admit when I began practicing, my motivation was narcissistic in nature. I had all these ideas in my head of being some kind of “master of the mind,” becoming a better person, or getting to some marvelous state of mind. I didn’t realize back then that with that attitude, I was rejecting myself. By wanting to become someone other than who I was, I was rejecting who I was at that given moment.

No Two Paths Are the Same

We are each moving along our own path, and all the circumstances that have brought us to this moment are uniquely ours—which means that whatever supports our journey is also uniquely ours. Part of our path requires us to find for ourselves what it is we need to keep opening to it. Mindfulness helps us develop that sensitivity, in learning little by little how to truly live in the moment.

After many years of practice in conjunction with other forms of inner work, I can say that, for me, mindfulness boils down to simple, conscious acceptance of the immediacy of my experience—and that, in and of itself, is the reward of the practice.

When we first start practicing, we have no way of differentiating what is motivating us to do what we do. The more we become in touch with ourselves (in mind, heart, and body), the more we are able to tease apart our various motives and make decisions that are congruent with our deepest longings.

Paradoxically, however, we can’t do this alone; we need others on our journey. We need to feel our connections and rub against others to know ourselves. We also need the guidance of others who are further along the path.

After many years of practice in conjunction with other forms of inner work, I can say that, for me, mindfulness boils down to simple, conscious acceptance of the immediacy of my experience—and that, in and of itself, is the reward of the practice. Other benefits pale in comparison to savoring each changing moment of aliveness with its infinite subtleties and flavors.

Mindfulness doesn’t take away the anguish of being alive. The truth is that life has moments of pain for everyone, and what mindfulness does is give us the capacity, or container, to stay open in the midst of such pain. Even if we need to shut down because the pain is so intolerable, our mindfulness allows the process to go more smoothly.

We cannot expect to want to feel the goodness in our lives without also experiencing the pain. However, we can learn how to breathe through it, and with mindfulness and attunement to our own, unique needs, we can find what will support us in the process.

I hear your love and concern for your sister. There is nothing more painful than watching someone you love make choices you believe are harmful. Unfortunately, they are her choices. You will not get anywhere with your sister if you lecture her about the choices she is making. Letting her know (directly or indirectly) you think her boyfriend is a “loser” will most likely only serve to distance her from you and strengthen her bond to him. It also makes it less likely she would confide in you if she did have misgivings about her relationship or her choices; nobody wants to hear “I told you so” from anyone, particularly family.

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At 19, your sister is technically an adult. You characterize her behavior as stubborn. That feeling may be contributing to a dynamic that makes her believe you and your parents don’t respect her, don’t see her as a capable adult, and don’t understand her needs. Given that dynamic, of course she isn’t going to listen to you. She may insist on sticking to her (destructive) choices just to prove her independence. As long as you continue to approach her with opposition, little is likely to improve. Also, even if you were successful in “getting rid” of the boyfriend, that is no guarantee her life choices would improve.

May I suggest you reach out to her from a different place? Listen to her. Find out from her what works for her in her relationship. What draws her to her boyfriend?

May I suggest you reach out to her from a different place? Listen to her. Find out from her what works for her in her relationship. What draws her to her boyfriend? Let her know you aren’t trying to “meddle”; you are just trying to understand her choices. Lead from a place of love and compassion, not judgment and fear. You can also ask her if she’d be willing to engage in family therapy with you and your parents to see about changing your family dynamic, independent of the boyfriend.

The drug use is absolutely a concern. Not only are there potential physical, financial, and legal ramifications for what she is doing, but emotionally, it is likely distancing her more from you and your parents and connecting her more to her boyfriend as well as impacting her ability to make effective choices. Working with a family therapist and an addiction specialist (with or without your sister) can help you identify some effective intervention strategies. Attending a Nar-Anon meeting could also shed some light (again, with or without your sister).

Best of luck,
Erika

Storm clouds gathering over waterIn the face of our depressed moods, friends, loved ones, and even our therapists may say things like, “Stop doing that to yourself!” or “Get over it!” We may even say to ourselves, “Why can’t I just get over it?” These forms of “psychotherapy” usually come from a loving place but often turn out to be ineffective. But why? Why is it that we can stop ourselves from doing certain things (touching a hot stove, for instance), but when it comes to the low energy, hopelessness, helplessness, and self-attacking thoughts of depression, we can’t “just get over it”?

When ‘Get Over It’ Does Work

Believe it or not, as a therapist I spend a fair chunk of my day using a form of “Stop It!” therapy, often with success. When a person is (1) in conscious control of a behavior, (2) no longer wants to do it, and (3) wants my help to stop, challenge (Abbass, 2015) or response-prevention interventions can be quite effective.

“Get over it!” is a form of challenge or response prevention—it says, “Stop doing the thing that hurts you!” When you look at it that way, you can see the loving core of the comment. When someone asks me for help with a pattern they know is self-defeating, such as stubbornness or detachment, but they intentionally continue to do it, challenging them with a “don’t” intervention is one of the most compassionate, helpful things I can do.

When ‘Get Over It’ Doesn’t Work

When someone has conscious control over a behavior, “get over it”-type interventions can help, but my clinical work looks much different when the self-defeating pattern is unintended or unconscious, habitual, or automatic. Decades of clinical research in intensive short-term dynamic psychotherapy (e.g., Abbass, 2015) have shown that a portion of those experiencing depression have symptoms driven by an unconscious emotional process—a process that, at least at the start of therapy, occurs automatically and is entirely beyond their control.

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In ISTDP, we call this process “repression” or “instant repression”—the process by which mixed emotions toward another person are instantaneously and unintentionally shunted back against the self, either in the form of depression or somatic symptoms (this is a slightly different definition of repression than in psychoanalysis).

Often, people who experience repression-driven problems never recognize they were mad at someone else; instead, they are instantly overcome by a process of self-blame and self-torture that leaves them feeling fatigued and hopeless. At no point did they decide to do this. Before therapy, this is just how their brains are wired; they automatically say, “When I feel anger toward someone I love, I protect them by pointing it back at myself.” Considering the people we love most are the most likely to irritate us, this is a potentially dangerous state of affairs.

Saying ‘Get Over It’ to Someone with Repression

So what happens when we say “get over it” to someone with depression that is driven by unconscious repression? Here, the “get over it” confronts the depressed mind with an impossible task: (1) gain conscious control of an unconscious process that is currently operating out of your awareness, or (2) do a thing you simply can’t do (yet).

When people, especially people we love, challenge us to do something that is impossible, it triggers anger, and in the depressed mind where instant repression is still active, that anger will deflect right back onto the self. Instead of lovingly reducing the person’s symptom burden, then, the “get over it” would actually make symptoms worse by activating anger that will be sucked back in via repression.

When people, especially people we love, challenge us to do something that is impossible, it triggers anger, and in the depressed mind where instant repression is still active, that anger will deflect right back onto the self.

‘Get Over It’ and Psychotherapies for Depression

Some therapies encourage us to challenge, question, or detach from our depressive thoughts and moods. Other therapies encourage us to get up and do something even when we have no energy. Sometimes, for some people, these approaches produce positive benefits.

My concern, however, is that for folks who have depression caused by unconscious repression processes, questioning their thoughts implies, “Don’t think that,” and encouraging different behaviors implies, “Don’t be like that.” These both sound a lot like saying “get over it” to someone who is not in conscious, intentional control of the symptom; asking them to do something different when they literally cannot. This could trigger anger toward the therapist that will get shunted into repression and lead to worsened therapy outcomes. No one wants that.

How ISTDP Can Be Useful

ISTDP is an ideal therapy for building the capacity to become consciously aware and tolerant of the mixed emotions that usually get deflected back on the self in repression-driven depression and somatization. When working with people with depression in ISTDP, the therapist is in a largely supportive mode, helping people self-reflect on and feel the feelings that were previously getting automatically and unintentionally converted into depression or somatic symptoms. This builds affect tolerance—the ability to feel feelings while still being able to think clearly and channel them in a satisfying way.

This process helps people with repression because, rather than telling them what not to do or what they should do, it gives them another option—it helps them become more comfortable with their emotional reactions so they can then decide how to channel their emotions. In ISTDP, what people wind up “getting over” is the destructive way their mind would unconsciously bury mixed emotions. Once they can think clearly while being in touch with their emotions, rather than being unconsciously overwhelmed by those emotions, they can then make wise, authentic decisions about what to do.

Reference:

Abbass, A. (2015). Reaching through resistance: Advanced psychotherapy techniques. Kansas City, MO: Seven Leaves Press.

Two Marines look at a mapResearch on mindfulness shows that it can be beneficial for improving a person’s attention, mood, pain tolerance, and immune function. It can also be used to reduce stress and increase a person’s cognitive functioning. Therapists use it to treat depression, anxiety, drug addiction, and a vast number of other mental health issues. Recently, the practice, rooted in some of the principles of Buddhism, has found an unlikely advocate in the Department of Defense (DoD), which has also started using mindfulness to help soldiers prepare for and return from combat.

Its use in the military is considered somewhat controversial by some, as traditional mindfulness practices are often associated with an opposition to conflict and the promotion of peace.

“Mindfulness can be used as a tool to manage attention, regulate affect, and monitor cognition,” mindfulness practitioner Andrew Archer, LCSW said. “I imagine this form of grounding and centering could prepare people for extremely charged, chaotic environments. However, mindfulness has been best practiced with the act of conscientious objection to war.”

Why Is Mindfulness Taught in the Military?

[fat_widget_right]Proponents of mindfulness training for the military explain that although war is not ideal, it remains a reality for society today. If soldiers must participate in war, they should receive training that will not only help prepare them for combat, but also help them manage the stress and trauma associated with it.

For the military to be successful, soldiers must be able to absorb a large amount of information at once and be able to make quick decisions without succumbing to overwhelm or stress. For this reason, mindfulness-based training programs are being introduced in the military, one of the most visible being Mindfulness-based Mind Fitness Training (MMFT).

MMFT is a 20-hour course designed to increase resilience to stress for those working in high-stress environments. The program is based on the principle of mental fitness. Mentally fit, according to the program, is defined as being efficient in four capacities:

Mindfulness training teaches these important skills that not only help soldiers on the battlefield, but also help ease their return home.

Mindfulness Before Combat

The period before a combat deployment for many in the military is highly demanding both mentally and physically. Not only are service members intensively training for their upcoming mission, but they’re also psychologically preparing to leave their families behind and enter into a dangerous environment.

The University of Miami conducted a mindfulness study of 75 soldiers stationed in Hawaii awaiting deployment to Afghanistan. The results of the study indicated that just 8 hours of mindfulness training during an 8-week period helped improve the soldiers’ attention span and prevented their minds from wandering when subjected to tests that measured those factors. The University of Miami study suggests even brief mindfulness training programs may help improve the cognitive functioning of deploying military personnel.

The University of California, San Diego School of Medicine and Naval Health Research Center published a study in May 2014 in the American Journal of Psychiatry that explored whether integrating mindfulness practices to increase mind and body awareness into pre-deployment training could help reduce the occurrence of posttraumatic stress (PTSD), depression, and anxiety in returning soldiers.

During this study, pre-combat Marine infantrymen learned various mindfulness meditation techniques, including interoception, which is the ability to help the body regulate and sustain its homeostasis by cultivating awareness of bodily sensations such as heart rate, stomach tightening, and skin tingling. The Marines then underwent a mock combat scenario with a highly realistic ambush in a scene designed to resemble one they might encounter in the Middle East. The study examined the Marines’ heart and breathing rates and compared the results of those who received mindfulness training to a group that did not. The group that received mindfulness training returned to baseline sooner than those who hadn’t.

Mindfulness After Combat

The U.S. Department of Veterans Affairs (VA) estimates about 1 in 5 Iraq and Afghanistan veterans return experiencing PTSD. With such a high rate of occurrence, it is important that soldiers have access to effective treatment options. Although medication is still highly prescribed, it may not be effective for treating all the emotional and cognitive aspects of PTSD. Mindfulness training, according to the VA’s National Center for PTSD, The U.S. Department of Veterans Affairs (VA) estimates that about 1 in 5 Iraq and Afghanistan veterans return experiencing PTSD. With such a high rate of occurrence, it is important that soldiers have access to effective treatment options. Although medication is still highly prescribed, it may not be effective for treating all the emotional and cognitive aspects of PTSD.however, has been proven to help those experiencing PTSD cope with anxiety and hyperarousal—two conditions commonly reported by returning veterans. Additionally, the National Center for PTSD says mindfulness can be useful either as a complementary or stand-alone treatment.

Virtual mindfulness training programs have also been used to help teach veterans mindfulness practices as well as connect them to a larger veteran community, all in the comfort of their own homes. Coming Home, a project developed by the University of Southern California’s Institute for Creative Technologies and sponsored by the U.S. Army’s Research, Development, and Engineering Command, is a post-deployment transitional support program offered virtually to veterans who are reintegrating into civilian life. Through this program, veterans learn the principles of mindfulness-based stress reduction using an avatar character in the 3D virtual world of Second Life. The program not only helps veterans learn mindfulness and reduce stress, but it also provides a social component, which may be especially valuable for veterans living in areas where they may not have access to services or a larger veteran community locally.

Research continues to reveal benefits mindfulness training provides for soldiers both before and after combat. These benefits in some cases have the potential to be life-saving, both from improved situational awareness and stress resilience during battle and from decreasing the intensity and occurrence of posttraumatic stress symptoms, which are often linked to a high rate of veteran suicides.

References:

  1. Gregoire, C. (2015, February 18). Mindfulness training improves resilience of active duty soldiers. Huffington Post. Retrieved from: http://www.huffingtonpost.com/2015/02/18/mindfulness-military-_n_6704804.html
  2. Minds at Attention: Military and Mindfulness. (2015, February 12). University of Miami: College of Arts and Sciences. Retrieved from: http://www.as.miami.edu/news/news-archive/minds-at-attention-military-and-mindfulness.html
  3. PTSD: National Center for PTSD. (n.d.). Mental Health Effects of Servicing in Afghanistan and Iraq. Retrieved from http://www.ptsd.va.gov/public/PTSD-overview/reintegration/overview-mental-health-effects.asp
  4. Stanley, E.A. & Schaldach, J.M. (2011 January). Mindfulness-based mind fitness training (MMFT). Mind Fitness Training Institute. Retrieved from: http://www.mind-fitness-training.org/MMFTOverviewNarrative.pdf
  5. Teaching Veterans Virtually. (2011, April 5). Retrieved from: http://www.mindful.org/news/teaching-veterans-virtually
  6. University of California, San Diego. (2014, May 16). War and Peace (of Mind): Mindfulness training for military could help them deal with stress. ScienceDaily. Retrieved from www.sciencedaily.com/releases/2014/05/140516092519.htm
  7. Veterans Relearn Compassion through Meditation. (n.d.) Retrieved from: http://www.mindful.org/the-mindful-society/veterans-relearn-compassion-through-meditation

Man talking to therapist over video chatTwo new studies suggest online therapy may be effective for treating mental health issues. Online therapy is increasingly popular, particularly among people who live in rural areas and cannot easily get to a therapist’s office or who are concerned about the costs of in-person therapy. New technology may pose some concerns, and the security of online therapy continues to be an issue, but research suggests the benefits may be significant.

The Benefits of Online Cognitive Behavioral Therapy

The first study, published in the Canadian Medical Association Journal, reviewed studies of online cognitive behavioral therapy (CBT) conducted between 2000 and 2012. CBT is a widely used and well-researched form of therapy, with most studies saying in-person forms of this treatment are highly effective. CBT focuses on reducing negative thoughts, thereby changing behavior and alleviating symptoms.

Most of the studies tracked participants for a relatively short period of time after undergoing therapy—ranging from eight weeks to about two years. Researchers found online CBT could effectively reduce symptoms of depression and other mental health issues. In some cases, online CBT was even more effective than traditional in-person therapy.

[fat_widget_right]Most online CBT sessions focused on short-term goals and symptom relief. Because the studies did not track participants for an extended period of time, the researchers do not know if the symptoms were permanently alleviated. The team that conducted the analysis cautions that some human connection is lost with online therapy, but they also say the evidence supporting online therapy’s effectiveness is significant.

Reducing Suicidal Feelings in Doctors

Another study, published in JAMA Psychiatry, looked at how online therapy affects the well-being of new doctors. Young doctors often work long hours, including nights and weekends, and the stress of those long shifts can lead to mental health issues such as depression and suicidal thoughts. One previous study found that suicidal thoughts increase four-fold during a medical residency.

Researchers looked at 200 first-year medical residents working 80-hour weeks and overnight shifts. Compared to doctors who received no online therapy, doctors who received four 30-minute online sessions before beginning their residency had fewer suicidal thoughts. Because the sessions were delivered online, researchers say it might be possible to provide such treatment to other doctors while still keeping costs low.

References:

  1. Mozes, A. (2015, November 3). Online therapy may help some with emotional problems. Retrieved from http://health.usnews.com/health-news/articles/2015/11/03/online-psychotherapy-may-help-some-with-emotional-problems
  2. Online cognitive behavioral therapy benefits people with depression, anxiety. (2015, November 2). Retrieved from http://www.sciencedaily.com/releases/2015/11/151102125440.htm
  3. Study: Online therapy eases new doctors’ suicidal thoughts. (2015, November 4). Retrieved from http://news.wabe.org/post/study-online-therapy-eases-new-doctors-suicidal-thoughts

Buddha sculpturesIn the 21st century, as mindfulness-based practices become more mainstream, our society and psychotherapeutic community may be more willing to accept that Buddhism could be a valid psychological approach to reducing human suffering. —Danielle A. Einstein (2007)

In some ways, mindfulness is to Buddhism as worshiping is to religion. Mindfulness is a mental practice that is one core feature within a scaffolding of knowledge, tradition, and awakening. Now removed from its casing, mindfulness practices such as meditation are rigorously operationalized for psychotherapeutic purposes, including research designs. This detached arm of Buddhism has come alive in the West to gain size and strength despite the secular environment. Imagine if the “auditing” process in Scientology was an evidenced-based practice for relieving psychological distress. It is hard to imagine detaching such a practice from its larger cultural understanding and history.

There is an interesting emergence of Buddhist practices in psychotherapy as well as subtle distinction between religion and therapeutic models. The concept of religion relates to a social group’s preferred lifestyle, set of values, and interests, as well as committed practices, principles, and experiences (Mohr, 2011). To act “religiously” is to consciously and methodically conduct oneself in an activity, behavior, or ideology. A modern, magnified version of spirituality now includes positive psychology, whereby one searches for meaning, connection, and other secular hopes of universal inclusion (2011).

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“Mindfulness” has become a stand-alone contemporary practice for focus, affect regulation, and stress management. Mindfulness techniques have been incorporated into psychotherapy practices that, as a result, have taken on religious forms. The fat of the pre-modern (500 B.C.) tradition of Buddhism has been trimmed, and the leaner version (i.e., mindfulness) has migrated from desolate monasteries into empirical research and pop-psychology vernacular. Questions arise: Are the new-age psychotherapy practices religious? When teaching and conducting mindfulness-based practices, is it possible to parcel out the roots, allegiance, and ideology of its origin?

‘Third-Wave’ Therapies and Mindfulness

Mindfulness and other contemplative practices extracted from Buddhism are implanted in several evidence-based, cognitive behavioral practices. Mainstream cognitive behavioral-based therapies have evolved (called the “third wave”) to include mindfulness components. Despite secular efforts aimed to separate mindfulness from Buddhism, when examined closely, religious components are implicit to mindfulness-based stress reduction (MBSR), mindfulness-based cognitive therapy (MCBT), acceptance and commitment therapy (ACT), and dialectical behavior therapy (DBT) (Andersson & Asmundson, 2006). Much like a car’s side mirror, these are closer to religious belief systems and religious practices than they may appear.

The conceptual scaffolding of Kabat-Zinn’s MBSR stems from Theravada Buddhism (Einstein, 2007). The fundamental attitudes are acclimated practices of Buddhist awakening systems and reference the Four Noble Truths. For psychotherapy purposes, MBCT adds the empirical practices of cognitive behavioral therapy (often in group formats) to the MBSR program. Buddhism and MBCT join at the concept of “meta-cognitive insight.” Instead of viewing thoughts as an experiential reality, meta-cognitive insight notices thoughts just as thoughts, with a focus on the individual’s relationship with the thoughts (i.e., not the content).

The structural basis of ACT is relational frame theory (RFT), which is a behavioral explanation of human language and cognition. RFT is applied broadly, so it can be used to understand social processes including religion and spirituality (Andersson & Asmundson, 2006). Interventions derived from RFT and used in ACT approach religious values and practices. In the ACT model, one aim is for the client’s willingness “to clarify life values; and to behave in accord with chosen values through behavioral commitment strategies” (Hayes, 2002).

A significant commonality between ACT and other spiritual traditions (e.g., Buddhism) is the rationale that all humans experience inescapable suffering and the specific role of attachment, mindfulness, valued actions, and issues surrounding self (Andersson & Asmundson, 2006, and Hayes, 2002). Both ACT and Buddhism note the inherent problem of viewing and attaching to this unwavering “self” as something that can be managed with mindfulness practices (2002). For example, a belief that “I am depressed” or “I am a bad person” is a belief one attaches to, which perpetuates further anxiety or suffering. Mindfulness can elicit awareness and acceptance of this process of identification by allowing the person to step back from the internal experience (Sparks, 2015).

Much of psychotherapy is a movement out of a negative state and into a desired, often positive direction. In ACT, the goal is to feel emotions in the context of living a valuable life, while resisting avoidance tactics (Hayes, 2002). There is only a subtle behavioral difference between Buddhist mindfulness practices and ACT, in that the former accepts or actively sits with the thoughts, while the latter focuses on changing the thoughts that get in the way of progress (2002).

Zen Buddhism inspired aspects of DBT, along with behavioral science and dialectical philosophy. The concepts of being whole, interconnected, and amenable to change are central to the dialectical view of the world (Neacsiu & Linehan, 2014). Buddhist dialect uses matching concepts: embodiment, interdependence, or co-arising and impermanence (Einstein, 2007). Zen Buddhism and DBT both focus on the here and now with radical acceptance and letting go of ego. People who use DBT are committed to developing a stable lifestyle (e.g., not engaging in self-harm or suicide) with nonjudgmental awareness and acceptance to reality (Neacsiu & Linehan, 2014).

The fat of the pre-modern (500 B.C.) tradition of Buddhism has been trimmed, and the leaner version (i.e., mindfulness) has migrated from desolate monasteries into empirical research and pop-psychology vernacular. Questions arise: Are the new-age psychotherapy practices religious? When teaching and conducting mindfulness-based practices, is it possible to parcel out the roots, allegiance, and ideology of its origin?

The structure of the DBT model from the perspective of clinicians mirrors the subtle paternalism occupied within DBT practice. Therapists are required to be part of a consultation team and/or a group with an almost dogmatic commitment to a list of rules (Neacsiu & Linehan, 2014). They must use compassion, properly assess problems before giving feedback, exercise assertiveness, emotionally repair with the team, as well as make agreements (e.g., no absolute truth, accept change as natural, empathic interpretations, fallibility). The guidelines are very reasonable and necessary for therapeutic alliance, but the process has an ideological structure one also finds within religious institutions.

In terms of beliefs, a DBT therapist must have a “willingness to believe in the client’s ability to change” (Neacsiu & Linehan, 2014, p. 429) and to use “irreverent communication,” offer “cheerleading,” as well as prescribe “punishments,” such as “vacations from therapy” (p. 437). Is this a conducted activity, behavior, and/or ideology that is conscious and methodic?

Hayes (2002) described Buddhism as the inclusion of “traditions of faith, ritual, practice, and community that are designed to support mindfulness and wholesome actions, and short of becoming a religion, no system of psychotherapy will include all of these elements” (p.65). Perhaps DBT merely falls short in the category of faith.

DBT therapists also use traditional metaphors, parable, and myth with people. They will at times “play devil’s advocate” in a practice called “extending” (Neacsiu & Linehan, 2014). In Zen Buddhism, to reduce dominate meaning of events, “koans” or stories are often “presented as verbal puzzles” as a provocation for questioning principles of reality through meditation (Hayes, 2002, and Fischer, 2013). The dialectic approach activates “What is being left out here?” while Zen koans, similarly, unearth “what is there when the puzzle is no more” (2002, p. 64). Both DBT and Buddhism aim for the individual to let go of their patterns of reactivity to relieve suffering (or in Buddhism, “dukkha”) (Einstein, 2007).

Applicability to Therapy Techniques

When applied to psychotherapy techniques, the separation of mindfulness practices from the origin—Buddhism—initially resulted in a secularization (2007). The cultural taboo of speaking about religion need not apply to “mindfulness” if it is a culturally accepted, therapeutic tool. Neuroscientist and mindfulness proponent Richard Davidson dedicated a chapter in his book, The Emotional Life of the Brain, to this process. He writes about keeping his meditation practice a secret based on perceived stigma or misunderstanding by colleagues. He speaks topically to the idea of spirituality and Buddhism, but there is no explicit mention of an affiliation with Buddhism.

The increasing segregation or nonconformity of “mindfulness” from Buddhism has actually created an independent spiritual practice (i.e., within modernity) that is being measured scientifically. This is akin to the obstinate historical nature of atheism against—largely—monotheistic religions. Although seemingly isolating, the active disbelief in God created a scientific movement (e.g., led by Richard Dawkins, Sam Harris, Daniel Dennett). The degree of this conscious extension of nonconformity essentially created a religion according to this article’s conceptualization (i.e., methodic and behavioral group ideology).

Buddhism is actually counter to our modern, Western culture. “Mindfulness” is a lighter version with more individualistic aspects (e.g., self-improvement, stress reduction). Buddhism is a radical, pre-modern tradition born within a society that emphasizes the collective “we” versus “I”. For individuals to learn mindfulness apart from Buddhist tradition and precepts is as arbitrary as the isolation of genuflecting prayer (e.g., Christianity) or “auditing” (i.e., Scientology) to use as singular tools for eradicating suffering. The dialectical question for contemporary mindfulness practice becomes: what are we leaving out?

References:

  1. Andersson, G., & Asmundson, G. (2006). CBT and Religion. Editorial. Cognitive Behaviour Therapy (35): 1.
  2. Castillo, R. (1997). Culture & Mental Illness: A Client-Centered Approach. Pacific Grove, CA: Brooks/Cole Publishing Company.
  3. Davidson, R. J., & Begley, S. (2012). The Emotional Life of Your Brain: How Its Unique Patterns Affect the Way You Think, Feel, and Live—And How You Can Change Them. Hudson Street Press.
  4. Einstein, D. A. (2007). Innovations and Advances in Cognitive Behaviour Therapy. Huxter, M.J.: Chapter 4 Mindfulness as Therapy from a Buddhist Perspective. Australian Academic Press.
  5. Fischer, N. (2013). Training in Compassion: Zen Teachings on the Practice of Lojong. Shambhala Publications.
  6. Frankl, V. (1959). Man’s Search for Meaning.
  7. Germer, C.K. (2005). Mindfulness: What is it? What does it matter? In C.K. Germer, R.D. Siegel, & P.R. Fulton (Eds.), Mindfulness and Psychotherapy (pp. 3-27). New York: The Guilford Press.
  8. Hayes, S. C. (2002). Buddhism and Acceptance and Commitment Therapy. Cognitive and Behavioral Practice: 9, 58-66.
  9. Mohr, S. (2011). Integration of Spirituality and Religion in the Care of Patients with Severe Mental Disorders. Religions (2): 549-565.
  10. Neacsiu, A. D., & Linehan, M. M. (2014). Dialectical Behavior Therapy for Borderline Personality Disorder. In: D.H. Barlow (ed.) Clinical Handbook of Psychological Disorders. Fifth Edition. New York: The Guildford Press 394-461.
  11. Sparks, F. “Using Mindfulness in Your Practice: Wisdom and Compassion in Counseling and Coaching.” University of Wisconsin Continuing Studies Workshop. March 10-11, 2015. Madison, Wisconsin.

Couple Holding Hands OutdoorsIntensive short-term dynamic psychotherapy (ISTDP), like all psychotherapy models, is a set of ideas and strategies used to form a healing relationship with another human being. Like therapists using other models of therapy, ISTDP therapists strive to create a relationship in which a person in therapy feels safe and secure. Experience shows that people need to feel safe in order to experience the emotions that their symptoms are designed to hide, and that experience of emotions within a secure bond will likely reduce their symptom burden (Davanloo, 1990; Frederickson, 2014; Abbass, 2015).

Sounds simple enough, no?

How ISTDP Therapists Use Attachment to Create Safety

[fat_widget_right]All psychotherapy models are ways of connecting and creating safety, but many assume a willing, motivated person will show up to the first session, which is not always the case. Some people arrive terrified of emotional contact with the therapist. They may come in and, intentionally or unintentionally, do things that interrupt their therapy goals without knowing why. Many therapists get stumped by these situations.

I love learning, teaching, and practicing ISTDP because the model offers an elegant system for reaching out to and supporting people to overcome the automatically deployed avoidance mechanisms that can defeat therapy. In ISTDP, we create safety by inviting a secure attachment, and then help people overcome the automatic thoughts, feelings, and behaviors that would otherwise create an insecure attachment.

Why People Create Walls and How We Can Invite Them Out to Play Again

Those of us who set out to create healing relationships, in therapy and elsewhere, quickly become aware of the many barriers people erect to keep love and concern from others out. We learn about the many rationalizations and self-recriminations that buttress people’s interpersonal walls. We understand that for many people the wall was once a survival mechanism, but we also see how it hurts them now. This presents a challenge: How do we create safety and security with someone who won’t let us in? How can we heal a heart if we can’t get close enough to see it?

We understand that for many people the wall was once a survival mechanism, but we also see how it hurts them now. This presents a challenge: How do we create safety and security with someone who won’t let us in? How can we heal a heart if we can’t get close enough to see it?When we reach out to meet a person and instead we meet a wall, therapists and non-therapists alike have a variety of reactions. We might feel angry toward the person we reached out to so lovingly. We might act out that anger and turn it into efforts to control or cajole. We might pretend the walls are not there and carry on a chronically disappointing pseudo-relationship with whatever parts of the person are not walled off. Often, we transiently forget our love, feel only our anger, and become harsh. We might even respond with our own walls.

In psychoanalytic thinking, we call the above reactions “enactments” (Sandler, 1976; Chused, 1991). In other words, we start acting out the relationship that the wall invites us to have, rather than the healing relationship that the person behind the wall needs from us. We end up relating to the character armor (Reich, 1945) or “resistance” rather than the wounded person who is stuck underneath. For therapists, the trick is learning how to step out of or around the enactment and reach out to the person behind the walls.

ISTDP therapists are trained to try to channel our mixed feelings of love and anger into communication. In this case, we talk about the wall with phrases like:

For ISTDP therapists, our first step in connecting with someone who is pushing us away is to describe the behaviors that make up the wall so they can be seen, considered, and discussed. Like any survival mechanism, our walls are built automatically and often unconsciously. To overcome these automatic barriers to connectedness, people often need help slowing down, self-reflecting, and noticing what is happening.

First, help the person see the wall. Let him or her know you see it too. Only then can you start talking about why it’s there and how it’s hurting the person, which may help him or her begin the work of overcoming the wall so you can create a safe, healing space together.

The wall, Davanloo’s (1990) vivid metaphor for the psychoanalyst’s “transference resistance,” will push many friends away, and often deflect any otherwise helpful therapeutic intervention. The wall is often a major driver of symptoms and presenting problems. By talking about the wall in ISTDP, we can sidestep the “enactment” and its destructive potential, and make a safe space where a new kind of relationship—a healing relationship—can take root.

References:

  1. Abbass, A. (2015). Reaching through resistance: Advanced psychotherapy techniques. Kansas City, MO: Seven Leaves Press.
  2. Chused, J. (1991). The evocative power of enactments. Journal of the American Psychoanalytic Association, 39, 615-640.
  3. Davanloo, H. (1990). Unlocking the unconscious: Selected papers of Habib Davanloo, M.D. Hoboken, NJ: Wiley.
  4. Frederickson, J. (2014). Co-creating change: Effective dynamic therapy techniques. Kansas City, MO: Seven Leaves Press.
  5. Reich, W. (1945). Character analysis. New York: Noonday Press.
  6. Sandler, J. (1976). Countertransference and role-responsiveness. International Review of Psycho-analysis, 3, 43-47.

GoodTherapy | 8 Mindful Ways to Deal with Your Unpleasant FeelingsOne of the principal aspects of mindfulness is acceptance of one’s experience in the present moment. This practice has numerous mental health benefits—but as you may have realized, it is easier said than done. When our experience is pleasant, it is easy for us to accept it; if our experience is unpleasant, we naturally want to reject it.

Why would we want to stay with unpleasant feelings? Humans naturally try to repress, distract from, project, or employ other defense mechanisms in order to not feel what is unpleasant. This obviously has degrees, and the more painful an experience is, the harder our systems work to get it out of our consciousness. So here we are, told that we need to “be with our experience,” yet our natural tendency is to run away from it. What to do?

The good news is that as we develop our capacity to be with our experience, it becomes easier. It’s much like going to the gym: initially it is very hard and we resist it, but the more we train, the easier it gets and the more we actually want to do it. When we begin to sense and feel the benefits of being with ourselves, we naturally begin to do it without as much effort.

Here are some ways to make the process easier:

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1. Start Exactly Where You Are

This is probably the most important aspect of being able to be with our experience. As much as we might like to, we simply cannot bypass our experience and be in an idealized place we think we should be. To work with any internal state, we have to be exactly where we are.

For example, we may be feeling a difficult emotion such as disgust, but then may also have a strong reaction to the disgust. We have to work with the reaction before we can really focus on the disgust. If we try to bypass the reaction by saying something like, “I need to accept my disgust,” then we are missing our reactivity. And that is the first layer we need to be with.

2. Allow Rather Than Accept

Similar to the previous point, we cannot force our acceptance of something; we can only have a disposition or attitude toward it. If we are feeling something difficult and telling ourselves, “I need to accept it,” we likely won’t be able to do it.

In a way, acceptance happens on its own and in its own time. The best we can do is try our best to allow: we allow the fact we don’t want to accept whatever feelings we have. We may say something like, “I don’t like this feeling of sadness and I’ll try to be with it, even if I don’t want to feel it.” At the same time, we also allow the fact we don’t like the sadness.

3. Be Curious

Becoming curious about our experience is a key element in navigating our internal world. The more we develop the capacity to observe without judgment, the more we will be able to discover about ourselves.

Becoming curious about our experience is a key element in navigating our internal world. The more we develop the capacity to observe without judgment, the more we will be able to discover about ourselves.

One way to develop curiosity is to adopt the attitude of a biologist doing naturalistic observations. A biologist wanting to understand the behaviors of lions in Africa, for instance, has the goal of simply observing the animals in their natural environment without interfering. They would not say, “Oh, this lion should not be eating that gazelle.” Rather, they would patiently observe and record what they notice. If they intervened and tried to distract the lion in order to save the gazelle, they would not be able to see exactly how the lion behaves naturally.

We can take that same attitude toward our inner landscape. We can notice our emotions, body sensations, and thoughts and not interfere with them. We simply notice what we see and try our best to suspend judgment of what should be happening. With time and patience, we begin to see connections and patterns that reveal a deeper understanding of ourselves.

4. Ask Questions of Your Internal Experience

Sometimes I will feel deep sadness inside and my tendency is to try to make myself feel different. But sometimes, I’ll directly ask my sadness what it needs. “How can I be with you in the most supportive way?” “What do you need?”

As much I don’t want to feel my experience at times, it is there for a reason—and the more open to understanding it that I am, the greater its chances of truly transforming. If I let my inner experience have a life of its own and honor its needs, it will likely reveal its cause and purpose.

5. Find Balance Between Challenge and Support

There may be times when your inner experience feels unbearable, and observing it directly may be very difficult. At such times, it may not be wise to try to stay with it; finding a source of comfort and support may be the better thing to do. This is true particularly if you have trauma in your history. In these cases, staying with difficult material may be counterproductive.

6. Respond with Flexibility

We are complex beings, and there is no one formula to dealing with our inner experience. Each time we meet ourselves, something different may be required.

An important skill we must develop is flexibility of response. At any given moment, any of these tips may be counterproductive, and at another time they may be exactly what we need. With practice, we become more flexible and attuned to what is most supportive at any given moment.

7. Remember That You Are Only Human

As committed as we may be to our inner transformation, we will generally fall short of our expectations. The truth is, the faster we are able to forgive ourselves—to be kind to the parts of us that feel shameful and that we can barely tolerate—the more chances for peace we have.

In addition, being able to let go of the self-improvement project is crucial. The very fact of wanting to improve ourselves implies a rejection of our present-moment experience or circumstances. As much as you are able, try to let go of any ideas of “making yourself better” and focus instead on accepting (or allowing) your experience be exactly what it is.

8. Recognize That Help Is Needed

We can’t do this alone; I don’t know anyone who can or has. In my own work, I have a tremendous capacity to fool myself and stay stuck in repetitive patterns for long periods. If it were not for the help and wisdom of others who have helped me in my process, I probably would not be where I am today.

The sooner we begin to allow others to guide and help us, rather than trying to figure it out on our own, the sooner our inner journey becomes so much easier. If you need help, please seek the support of a qualified therapist.

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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