Unhappy Mother Dressed For Work Holding Baby In BedroomMany years ago, before I had children, I worked with a parent who confided that she would sometimes get so frustrated with her baby that she fantasized about throwing him out the window. I was horrified to hear this, and thought there was something really troubled about this parent—that is, until I had my own (colicky) baby and began to have similar fantasies.

Just to be clear, neither this parent nor I was going to hurt anyone. There is a world of difference between fantasizing and acting. But our feelings of frustration and hate were very real and powerful. And we are not alone. Having had the pleasure of both participating in and leading several parenting support groups over the years, I can tell you that many parents have feelings of hate or other strongly negative feelings toward their kids at one time or another.

So, if hating our children is so ubiquitous, why isn’t it more openly acknowledged?

We have all heard (ad nauseam) about the positive feelings we are supposed to cultivate in ourselves and express toward our children, feelings such as patience, acceptance, unconditional love, pride, etc. Rarely, though, do we hear about the validity of feeling hate or other strongly negative feelings toward our children.

Fortunately, this has shifted somewhat in the past decade or so. The proliferation of parent support groups where the expression of negative feelings is accepted and supported, and the publication of books such as the satirical parenting guides Sh*tty Mom: The Parenting Guide for the Rest of Us by Laurie Kilmartin, et al., Toddlers Are A**holes: It’s not Your Fault by Bunmi Laditan, and the faux children’s book Go the F**k to Sleep by Adam Mansbach and Ricardo Cortes, have helped normalize parents’ negative feelings. Despite these advances, however, a culture of secrecy and shame around hating our kids persists.

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In order to understand why this is, it might be helpful to first look at the question of why we hate our kids.

To some extent, it’s just common sense: spending hours upon hours, days upon days, years upon years taking care of someone who is dependent on you, but often demanding and resentful of you, naturally breeds some negative feelings.

For a more in-depth look at parental hate, Donald Winnicott (a psychoanalyst and coiner of the phrase “the good enough mother”) explained it best when he gave the following reasons (among others) as to why a mother might hate her baby (1975; p. 201).

And yet, Winnicott goes on, for all the hate the mother may feel toward her baby, she must learn to tolerate this feeling without acting on it or expressing it in its raw, rageful form (p. 202). In short, mothers—and I would add fathers, too—must contain their feelings of rage. Perhaps it is this need for containment and the challenges this task poses that explains why parental hate is still somewhat taboo.

But what does it even mean to contain one’s negative feelings toward one’s child? And why is it so important?

I would argue that containment is achieved when parents are able to accept and integrate into their emotional landscape, at least to some extent, their negative feelings toward their children. Generally, when we fail to accept our negative feelings toward our children, we act in one of two ways: we become rageful or we withdraw emotionally, either of which can be problematic.

When we rage at our children, we give them the message that we are not in control of our negative feelings, that negative feelings are scary and bad, and that any such feelings they have should be expressed in a similar way, or hidden away because they are too scary.

Alternatively, when we cut ourselves off from our negative feelings or hide them away such that we don’t have access to and don’t express them to our children, our children get the message that negative feelings are unacceptable and wrong and that when they feel and/or express negative feelings, they are bad for doing so. Having negative feelings becomes a scary, lonely, and powerless experience.

So, if we aren’t supposed to act on or hide our hateful feelings toward our kids, what the heck do we do with them?

As I suggested above, the first step is to accept them, to not feel ashamed of them, to understand that they are valid. In this way, we come to integrate these feelings into the rest of who we are and what we feel. In practice, this might mean sharing our feelings with other parents, complaining about or talking trash about our kids to others, or maybe speaking with a counselor or therapist—release! Often, this is enough for us to feel sane and in control and to contain our negative feelings in a way our child needs.

Sometimes, though, it is not enough for us to calmly hold our negative feelings without expressing them. Sometimes our children need to feel our hate or negative feelings toward them—not necessarily in their raw form, but in a controlled way.

Why is this? Why do our children ever need to experience our hate toward them?

How Psychoanalysis Can Inform Parenting

Once again, I believe Winnicott explained it best when he stated (1975): “It seems doubtful whether a human child as he develops is capable of tolerating the full extent of his own hate in a sentimental environment. He needs hate to hate.” (p. 202)

Hyman Spotnitz, founder of modern psychoanalysis, a branch of psychoanalysis, elaborated on Winnicott’s thesis when he wrote about the relationship between the therapist and the person in therapy. In psychoanalysis, it is believed that the relationship between the person in therapy and the therapist inherently evokes feelings from the former’s past (and sometimes the therapist’s, too), particularly with regards to the relationship to his or her parents. When evoked in the context of the psychoanalytic relationship, certain powerful feelings can arise in the person toward the therapist and the therapist towards the person in therapy, including feelings of hate.

Although he cautioned against expressing all of one’s feelings toward the people one works with in therapy, Spotnitz warned against the therapist always hiding his negative feelings (2004). He wrote, “To allot too little hate to a patient who needs to learn to experience and sustain it comfortably is unjust. To give him too little feeling because the analyst has too much of it is a technical error. The patient is entitled to whatever feeling—positive or negative—he needs …” (p. 159)

Spotnitz further writes (2004) that the therapist needs to express his hatred in order to help the person in therapy experience and sustain his or her own negative feelings. In this way, the therapist helps the person feel less alone with his or her hate, feel that the therapist is more like him/her, with a more equitable balance of goodness and badness (that is, the person is not all bad for his or her negative feelings, and the therapist not all good for not expressing his/hers).

Spotnitz also suggests (2004) that the sharing of the therapist’s hate can reassure the person in therapy of his or her impact on the therapist, giving the person a sense of control and power. Furthermore, when the therapist expresses negative feelings to the person, the person can see that the therapist’s verbal expression does not necessarily lead to action, the therapist thereby modeling for the person the importance of putting feelings into words rather than acting out.

While I do not advocate being therapists to our children (in fact, I strongly caution against it), I would argue that many of the beliefs of psychoanalysis more generally, and modern psychoanalysis specifically, very much apply to parenting. We need to try to accept and integrate our feelings of hate and other negative feelings toward our children so that we can contain them and, when appropriate, choose to express them to our children in a controlled fashion. In this way, our children can see that we have powerful, negative feelings, too, and that they are not alone with their scary, hateful feelings and are not bad for having them. We let our children know that despite how powerless they feel at times, they do have some power in being able to affect us and stir up powerful feelings in us. We help our children accept and integrate their own hate, so that it becomes one of many feelings they can experience and express, not one that is split off and acted out because of fear or shame.

In short, sometimes our hate can be helpful to our kids.

So, what does “helpful hate” look like in practice?

How Hate Can Be Helpful

To illustrate, I recount a situation with a parent, whom I shall call Angela, who was a member of one of my parenting groups.

Angela was a parent of two—a 6-year-old girl, whom I will call Josephine, and a 3-year-old boy whom I will call Sam. Josephine had been a very easy baby and toddler; she had a calm temperament and was well-behaved. Angela felt confident and competent in her parenting of Josephine.

It was therefore a bit of a surprise and disappointment to Angela when Sam was born and turned out to be a very difficult baby and toddler. Much more physically developed than verbal, Sam would get frustrated when he didn’t get his way and couldn’t express himself, and would often hit Angela, quite hard, to express his frustration. Angela would become enraged and scream at Sam when he hit her. Sam, in turn, became very scared and would start sobbing inconsolably, at which point Angela would feel so guilty that she would apologize profusely and try to comfort Sam, to no avail. Unfortunately, this became a cycle, with Angela and Sam clearly both very upset about what was happening between them, but with the hitting and screaming continuing.

As parents, when we learn how to do these things, we become more comfortable with who we are and what we feel, and can therefore be more in control and more deliberate in our parenting choices. And all this helps us be the best parents we can be, no matter what we are feeling toward our children.

When Angela spoke in the parenting group about this dynamic, she expressed deep shame about her rage and her screaming and the cycle in which she and Sam were engaged. She so desperately wanted to be in control and to figure out a way to break the cycle.

After several weeks of discussing her predicament, one of the other members of the group blurted out, “Sam’s a terror! Of course you want to scream at him! It’s a miracle you don’t hit him back!” Angela looked stunned, but then burst out laughing, as did the rest of the group.

It seemed that something had been liberated in Angela. She had finally been given permission to accept her strongly negative feelings toward Sam. Little by little, Angela was able to discuss and accept her more negative feelings—her disappointment that Sam wasn’t easier like his sister, her anger at Sam for leading her to feel like an inadequate parent, and much more.

Over time, these feelings stopped being so scary and shameful to Angela. As Angela became more accepting of her negative feelings, her rage began to dissipate, and when Sam hit her, she often felt “simply” angry rather than enraged. Angela began to feel more in control of her feelings and more able to focus on what to do with Sam in a less reactive, guilty way.

Over time, Angela’s yelling at Sam began to decrease. Rather, when Sam hit her, Angela would firmly and somewhat angrily tell Sam to stop, that she knew he was mad but that hitting was not OK, that if he was mad, he could yell “No!” or “I’m mad!” She would then send Sam to his room for a time-out.

It seemed to have the desired effect. Over time, Sam’s hitting greatly decreased and his use of the words “no!” and “mad!” greatly increased. It would seem that, for both Sam and Angela, negative feelings had become more acceptable, more integrated parts of who they were and how they interacted with each other.

Although it is impossible to know what Sam’s subjective experience of all this was or even to be sure what aspect of Angela’s approach was effective, I would speculate that because of the changes in Angela’s feelings and actions, she was able to accomplish at least some of the following:

Of course, there are times when this type of approach doesn’t work for a variety of reasons. Hey, nothing works all the time in parenting. We are human; we lose control; our kids lose control. And certainly, many parents are perfectly capable of handling their hatred and other negative feelings without the help of psychoanalysis.

Nonetheless, what I think is unique about psychoanalysis and what it can contribute to parenting is its ability to help people learn about and accept all their feelings, both positive and negative, and to show people what to do with their feelings (contain, express, etc.), particularly the more difficult ones such as hate.

As parents, when we learn how to do these things, we become more comfortable with who we are and what we feel, and can therefore be more in control and more deliberate in our parenting choices. And all this helps us be the best parents we can be, no matter what we are feeling toward our children.

References:

  1. Kilmartin, L., Moline, K., Ybarbo, A., & Zoellner, Mary Ann. (2012). Sh*tty Mom: The Parenting Guide for the Rest of Us. Harry Abrams.
  2. Latidan, B. (2015). Toddlers Are A**holes: It’s not Your Fault. Workman Publishing Company.
  3. Mansbach, A., & Cortes, R. (2011). Go the F**k to Sleep. Akashic Books.
  4. Spotnitz, H. (2004). Modern Psychoanalysis of the Schizophrenic Patient. YBK Publishers.
  5. Winnicott, D.W. (1975). Hate in the Countertransference. Through Pediatrics to Psychoanalysis, pp. 194-203. New York: Basic Books.

man training yogaAs Roger—not his real name—sensed his body, he began to notice a deep contraction in his heart that pained him deeply. He had been hearing from his meditation teachers that he had to stay with it and continue sensing his body no matter what, even if he felt emotional pain.

Given how much faith he had in the method, he followed the instructions diligently, even though his emotional response was too overwhelming to put aside. The pain became so intense that it began to feel like sharp shards of glass inside his chest—and he began experiencing deep rage that turned against himself.

“What is wrong with me that I can’t do this?” he thought. Images of self-injury and hitting himself began to flood his mind. He didn’t know what to do with this level of self-hatred. At the same time, he was determined to stay with his body at all costs.

At that point, he had two opposing forces inside him that kept him frozen in great emotional pain and intrusive mental images. Finally, the intensity became so strong that he jumped up and bolted from the meditation hall, running out toward nature, where he found relief at last.

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Roger’s heart was pounding, and his level of arousal was too much for his nervous system to tolerate. He wept deeply. As a result of his intense meditation, Roger experienced a resurfacing of old trauma that he did not even know he had. This incident happened to Roger many years ago, on the sixth day of a silent 10-day Vipassana retreat. The episode had a big impact on his well-being, and he didn’t learn how to deal with it until years later, after much therapy.

Roger’s experience at the retreat can happen for anyone who engages in deep meditation and carries a great deal of unprocessed or unconscious trauma. “I didn’t even know back then that I had such a level of trauma. I thought everybody had so much difficulty being with themselves, and I naively also thought that meditation was the grand cure-all,” Roger told me during a session.

Although meditation can be a great support for many of us and can even be helpful in dealing with psychological difficulties, it can also trigger traumatic responses that may need further processing. Without appropriate guidance, meditation can be more of a stressor than a support for some people.

Unconscious Trauma

Trauma is the result of our nervous systems being overwhelmed by experiences that we are unable to tolerate and process. This can be the result of a single life-threatening event, or of repeated stressors accumulating over time. Trauma is particularly devastating if we’re young and vulnerable, so early traumatic experiences tend to have deep impacts that, as adults, we may be completely unconscious of. Mindfulness meditation can reopen these old wounds, and without appropriate support, anyone can get lost in these deeply painful experiences.

One common meditation technique that is taught at many mindfulness courses and retreats is the body scan. During this practice, participants bring their attention to their body sensations in a methodical way. This is a great tool to develop sensitivity and self-awareness. However, as we sensitize ourselves to our bodies, we may end up encountering previously unconscious trauma.

Titration Is Key

Titration is a concept borrowed from chemistry that Peter Levine, creator of the Somatic Experiencing method, uses to illustrate how to approach traumatic material. Levine (2010) gives the example that if one were to mix two reactive chemical compounds all at once, the result would be an explosion. However, if one uses a glass valve and mixes them one drop at a time, the result would be safe; each drop creates a small, manageable fizzle.

The same principle applies when working with trauma. If we are able to turn our attention back and forth between sources of support (e.g., pleasant bodily sensations, views, or touch) and the safer edges of a difficult inner experience, we have a much better chance of working effectively with the traumatic material than if we try to simply stay present with the material all at once. This takes a great deal of skill and is very difficult to do without support. If we don’t know how to titrate or skillfully work with the challenging sensations that can arise, we can end up retraumatizing ourselves.

Not All Retreats Are Created Equal

A meditation retreat can be a fantastic way to deepen your meditation practice and develop your capacity to be with experience. Meditation retreats are also great for giving us a continuous experience of presence; during sustained meditation practice, after a couple of days you can experience deep levels of absorption and profound wellness. But not all meditation retreats are the same.

If you know you have trauma and are engaged in serious meditation practice, be cautious and seek help to deal with it.

Depending on the tradition and the teachers, retreat leaders may or may not have psychological experience or expertise with trauma. The good news is that, nowadays, many meditation teachers are informed about trauma, and some even get training in working with it. In order to work with your own trauma at a meditation retreat, flexibility is important. Allowing yourself to deviate from the schedule and seek support with teachers or nature can make all the difference.

The retreat mentioned at the beginning of this article was not very flexible. Its guidelines were strict, and it was designed for people to achieve deep levels of concentration—a format that can be fantastic for someone with a relatively intact ego structure, but retraumatizing for someone with deep trauma, as it was for Roger.

It’s about Staying with Our Experience

Staying with our experience without trying to change it is at the core of mindfulness meditation practice. This practice has many benefits, such as developing self-acceptance and self-awareness. However, staying with ourselves does not mean we have to bear inner torture. If an experience feels overwhelming, it is probably not helpful to stay with it in a continuous way. At this point, finding an external resource such as nature or someone to support us becomes more important than staying directly with the experience.

If you know you have trauma and are engaged in serious meditation practice, be cautious and seek help to deal with it. Part of doing inner work consists of discovering the right balance between challenging and supporting ourselves; when trauma is present, this point tends to be skewed toward either too much challenge or complete avoidance of the situation that triggers the trauma. Neither approach will help you metabolize and transform traumatic psychological imprints. This is why having someone to help you traverse this difficult territory is key.

In sum, mindfulness meditation is a fantastic tool for supporting our well-being, and if taken seriously, it can truly transform our lives. However, because it is a serious practice, it can reopen old wounds in unsuspecting participants, so please be careful and seek the guidance of a trained therapist if you know you have trauma in your background.

Reference:

Levine, P. A. In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness. Berkeley: North Atlantic, 2010.

group therapyI was at a party chatting with a stranger when he asked me what sort of work I do. I told him I am a marriage and family therapist who specializes in group therapy. “Group therapy!” he said. “I thought that went away after the ’60s.”

I’m happy to report that group therapy did not, in fact, go away in the 1960s. However, many people, like the guy at the party, don’t realize that group therapy exists as a powerful therapeutic option to consider instead of, or in addition to, individual therapy.

People may dismiss group therapy because it’s a therapeutic approach more often utilized in hospitals and treatment centers than in private practices. It can be difficult to find private practice therapists who run groups. Sometimes, it requires a lot of research and phone calls to find a group. However, plenty of therapists do run groups in their private practices, and this unique experience is worth the effort it might take to find it.

So, what’s so special about group therapy?

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No, group therapy is not dead. All around the country, people are gathering in groups to be more truthful, more engaged in relationships, and more open to insight than they are the rest of the time. Group therapy is very much alive! Are you ready to give it a try?

Couple in Adult Learning ClassCan an old dog learn new tricks? Can we change in adulthood? Many of us struggle with this question as we make New Year’s resolutions that we fail to meet: eating healthier, exercising, overcoming behavioral habits that keep us from living up to our personal and relational goals.

Sometimes we blame our genetics—it’s our DNA that is keeping us stuck! Or we blame our childhoods—if only we had better parenting, we could reach for the stars! There is no question that we are each born with a temperament, and that genes play a role in our abilities and limitations. And early childhood experience does shape our brains. In fact, neuroscientists these days look at the interplay between genes and environment, or G x E. But does that mean once we have survived childhood we are fixed, set in our ways, determined by our nature and early nurture?

Neuroplasticity in Adulthood

Until a decade or so ago, many scientists thought that while children’s brains are malleable or plastic, neuroplasticity stops after age 25, at which point the brain is fully wired and mature; you lose neurons as you age, and basically it’s all downhill after your mid-twenties. Fortunately, this rather grim view of the aging brain has been upended by more recent research. We now know that the human brain is capable of change throughout life. It’s true that a typical child’s brain is more plastic, more capable of change and new learning than a typical adult brain. And we do lose neurons as we age. But it’s not all downhill; the adult brain can create new neuronal connections and even new neurons born from neuronal stem cells. In addition to these gray matter (neuronal) changes, there can be change in our white matter, the pathways between neurons and the myelin that allows neurons to communicate efficiently.

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What Promotes Neuroplasticity?

We are not guaranteed vibrant, flexible brains as we age, however. A lot depends on how we live our lives. The adult brain needs oxygen and stimulation to stay sharp and capable of change.

Researchers have identified the following three habits as facilitating neuroplasticity as we age: physical exercise (which increases blood flow to the brain, delivering much-needed oxygen), paying attention, and learning new things. Once I learned about the impact of physical movement on neuroplasticity, I increased my exercise to daily from twice a week. And I see the difference in both body and mind! While an aerobic workout is great, even walking briskly for half an hour will increase blood flow and feed oxygen to hungry neurons.

The second factor that increases neuroplasticity, paying attention, is the opposite of acting on automatic pilot. Most of the time we do function on automatic, which is easier and less tiring than thinking through and being aware of our every move. This automaticity can be to our advantage, as we easily ride our bike or whip up our favorite recipe. But living on automatic can mean that we miss precious moments, forget to smell the roses, or take for granted a majestic mountain vista. Waking up to our experience allows us to be present. It also allows the brain to be more active and flexible. One of the best ways to pay attention is to engage in mindfulness practices, whether through a formal practice of meditation or in more informal ways.

The third stimulus to brain plasticity in adulthood is learning new things. This comes naturally to a young child, for whom everything is new. By contrast, adults tend to be less open. We get comfortable with the familiar; we like to kick back, relax, and do the same old, same old. This may feel good, but it does not contribute to neural flexibility. And if we combine same old, same old with not exercising—being a couch potato, television, potato chips and all—we are depriving the brain of the nutrients of neuroplasticity.

Mind-Sets about Change

Some of us are more open to change than others. Carol Dweck’s research offers a fascinating glimpse into our mind-sets about change. Some people, she says, have a fixed mind-set; they are not interested in changing, or assume they are incapable of change as adults. This is epitomized in Popeye’s famous statement, “I yam what I yam.” By contrast, people with a growth mind-set assume they are capable of change and growth in their lives.

Change in Couples

Some folks come eagerly to therapy, looking forward to the possibilities of learning and transformation. Others are hesitant, defending their right to be as they are. It’s not uncommon in a couple that one partner takes the “let’s change and grow” position, while the other comes to therapy reluctantly.

Old habits have quite a hold on us and are hard to change. To wire in a new set of behaviors, we have to repeat them over and over again. Eventually, these new behaviors become the new normal.

For hypothetical example, Tina, feeling increasingly disconnected in her marriage and frustrated that Joe doesn’t share her enthusiasm for deep, emotional conversations, drags him to therapy to improve their relationship. Joe comes to couples therapy because he loves his wife and doesn’t want to lose her. But he is resentful. He says, “I’m the same man you married—the strong and silent type. You’re the one who has changed!” For Joe, Tina’s evolving needs and her pushing him to change are the problem. Joe has a fixed mind-set, and he defends his right to stay the same. Tina has a growth mind-set; for her, transformation and growth are vital nutrients. Their “meeting of the mind-sets” is the first challenge we will face as we work together. I will help Joe see the positive payoffs of change, and I will help Tina back off from her campaign to reform Joe.

Most of us don’t want to “be changed” by someone else. We want to author our own change. Tina sees change as a transitive verb with a direct object: “Tina changes Joe.” But Joe doesn’t want to be the direct object of Tina’s change agenda. He wants some autonomy to choose his change. Family therapists have long observed that the only person you can change is yourself. Both Joe and Tina may decide to change in order to revitalize their relationship—but this needs to be a choice for each of them. Authoring your own change can be empowering; having change foisted on you can breed resentment.

Making Change Last

Let’s come back to those New Year’s resolutions. We have great intentions, and do engage in healthier habits for a while—only to find a few weeks in that we are backsliding. It’s too cold to go to the gym. There’s no time. We are great at coming up with excuses. Why is it so hard to live up to our goals and make new changes last?

Once again, neuroscience points to the answer. Habits become wired into the brain; once established through constant repetition, circuits of neurons keep our habits in place. Old habits have quite a hold on us and are hard to change. To wire in a new set of behaviors, we have to repeat them over and over again. Eventually, these new behaviors become the new normal.

When I started swimming as an adult, every trip to the pool was an effort as I worked to coordinate my breathing with my strokes. My brain and body were not accustomed to an aquatic life. Now, after years of regular visits to the pool, I crave my morning swim; I feel so natural in the water, I wonder if I was a fish in a former life.

Embracing a Growth Mind-Set

Whether we like it or not, things change. Our brains and bodies are evolving all the time—getting stronger as we exercise mentally and physically, getting weaker as we age or become couch potatoes. We can’t stop the process of time and aging, but we do have some choices over how we deal with our lives and relationships.

We can opt to live in a way that nurtures neuroplasticity—or we can close our hearts and minds to the new. We can exercise body and mind, or we can let our physical and mental faculties slide. Our mind-sets and our habits affect the brain, for better or worse. Choosing change, a growth mind-set, allows us to nurture neuroplasticity in our brains and promotes flexibility in our personal and relational lives.

Which mind-set will you choose?

References:

  1. Doidge, N. (2007). The brain that changes itself. NY: Viking.
  2. Dweck, C. (2006). Mindset: The new psychology of success. NY: Ballantine.
  3. Fishbane, M.D. (2013). Loving with the brain in mind: Neurobiology & couple therapy. NY: WW Norton.
  4. Ratey, J.J. (2008). Spark: The revolutionary new science of exercise and the brain. NY: Little, Brown & Co.

person crouching, hidingA seizure is a sudden and unexpected loss of control accompanied by abnormal body movements or convulsions, a loss of consciousness, or both. Though epileptic seizures are caused by sudden, rapid, and chaotic electrical discharges in the brain, not all seizures are epileptic.

Psychogenic nonepileptic seizures (PNES) are not caused by abnormal discharge of electrical brain signals, but instead are emotional in nature and usually triggered by stress or anxiety. Although these seizures are rarely discussed, they are not rare. PNES have a prevalence similar to that of multiple sclerosis.

Statistically, one in five people sent to epilepsy centers experience PNES rather than epilepsy. In fact, a team of physicians and psychologists at Johns Hopkins Hospital reported that more than one third of patients admitted to the inpatient epilepsy monitoring unit were experiencing stress-triggered seizures rather than true epileptic seizures.

Diagnosing Psychogenic Nonepileptic Seizures

Because PNES can mimic epileptic attacks, they are often misdiagnosed. At least 80% of patients experiencing PNES are treated with antiepileptic drugs for several years before a correct diagnosis is made.

[fat_widget_right]The source of this dilemma is multifaceted. Most physicians do not have access to electroencephalogram (EEG) video monitoring, and even those who do can easily misread an abnormal EEG without video if they have not been specifically trained in epileptology. A 2005 study of 46 patients published in the Neurology journal revealed that 54% of EEG readouts were misinterpreted as epilepsy.

Epileptic seizures tend to be more serious than PNES. If there is any doubt, a neurologist will usually treat the more serious condition. If medication fails to treat seizures, a patient is then referred to an epileptic center, and it is often there that the diagnosis of PNES is made.

With proper equipment and specialized knowledge, an epileptologist can easily distinguish between epilepsy and PNES. An EEG-video monitoring system monitors a patient for several hours and sometimes days until a seizure occurs, though there are techniques that can be used to trigger a seizure to speed up the monitoring process if necessary or desired. By analyzing the video of the seizure, a diagnosis of PNES can be made with 100% certainty.

Causes and Risk Factors

PNES is a somatoform illness, meaning that emotional stress creates physical illness in the body. These seizures are emotional in nature—induced by stress—and often result from traumatic experiences, some of which may have been repressed or forgotten. Such traumas may include divorce, physical or sexual abuse, death of a loved one, incest, or any other great loss or sudden upheaval in one’s life.

Individuals without developed coping skills may be more susceptible to PNES than those with a high level of resiliency to stress. A team of neuropsychologists and neurologists at Johns Hopkins University School of Medicine found that people with PNES don’t necessarily have a higher frequency of stress and/or trauma than others, but they seem to lack effective coping mechanisms to deal with stress and are thus more affected by it.

Coping with Diagnosis and Stigma

Psychosomatic illnesses like PNES are often misunderstood by family members and even by physicians and other health care professionals. A person may be reluctant to accept the diagnosis and become upset when told the seizures are psychological. Some people completely refuse to accept the diagnosis and continue to take antiepileptic drugs even as symptoms continue. This places responsibility on the physician to stop administering the drugs.

A lack of public knowledge and awareness of PNES only increases the misconceptions, misdiagnoses, and stigmatization of the illness. Somatoform illnesses like PNES are real—resulting from real stressors and traumas—and should be treated as such.

Treatment and Outcomes of PNES

Overall, PNES can be treated if properly diagnosed. The earlier the diagnosis, the better the outcome may be. About 70% of people who receive adequate treatment for PNES eventually experience a complete disappearance in seizures. The recovery time will vary from patient to patient depending on the severity of the traumas and stressors involved, as well as the person’s established coping mechanisms and resiliency to stress.

While a neurologist typically treats epileptic seizures, PNES tends to be treated by a psychologist or other mental health professional. Someone who has been newly diagnosed and has been taking antiepileptic drugs will need to work with a neurologist to gradually come off the drugs rather than stopping use abruptly.

About 70% of people who receive adequate treatment for PNES eventually experience a complete disappearance in seizures.Treatment for PNES typically involves various types of psychotherapy. Cognitive behavioral therapy (CBT) may be used to help people develop adequate coping skills to deal with life stressors. Relaxation techniques and biofeedback are also used to help manage and cope with stress.

For those whose seizures are a manifestation of past trauma, PNES is typically treated as posttraumatic stress. In this case a physical seizure may be the body’s way of expressing what the mind cannot. Some physicians have also found eye movement desensitization and reprocessing (EMDR) to be an effective treatment for PNES.

EMDR is a synthesis of many different therapeutic approaches including CBT, psychodynamic, interpersonal, body-centered, and experiential therapies. This information-processing therapy occurs in eight phases—attending to past traumas that contribute to the pathology being treated; the current situations, beliefs, and sensations that are triggering the dysfunctional emotions; and the positive experiences needed to improve mental health and well-being in the future.

The costs of being treated for misdiagnosed epilepsy are high and should not be ignored. As the incidence of misdiagnosed PNES continues, it is important for neurologists, psychiatrists, and psychologists to work in collaboration to raise public awareness, remove the stigma, and provide proper diagnosis, treatment, and support.

References:

  1. Benbadis, S.R. and Heriaud, L. Psychogenic (Non-Epileptic) Seizures: A Guide for Patients and Families. (n.d.). Comprehensive Epilepsy Program: Tampa General Hospital & University of South Florida College of Medicine. Retrieved from: http://hsc.usf.edu/COM/epilepsy/PNESbrochure.pdf
  2. Desmon, S. (2012, April 10). Symptoms that Mimic Epilepsy Linked to Stress, Poor Coping Skills: Patients with “Pseudo-Seizures” Often Misdiagnosed. Johns Hopkins Medicine. Retrieved from: http://www.hopkinsmedicine.org/news/media/releases/symptoms_that_mimic_epilepsy_linked_to_stress_poor_coping_skills
  3. The Truth about Psychogenic NonEpileptic Seizures. (n.d.). Epilepsy Foundation. Retrieved from: http://www.epilepsy.com/article/2014/3/truth-about-psychogenic-nonepileptic-seizures
  4. What is the actual EMDR session like? – EMDR International Association. (n.d.). Retrieved from http://www.emdria.org/?120

Calm and confidentHis name was Zack. Zack was a 150-pound, 2-year-old Newfoundland dog—my buddy. Wild at heart—at best only ever semi-domesticated—he loved nothing more than to escape from our three-quarters-of-an-acre fenced yard and head toward the hundreds of acres of forest and trails that lay just up the road from our house.

I came home from work late one afternoon and discovered Zack was gone. I parked my car, got out, and then heard the screech of brakes, a loud, dull thud, and one heart-breaking yelp. I ran up the road to the crest of the hill and saw that my worst fears had come true. Lying in the road— illuminated by the car’s headlights—was Zack, tongue hanging out from the side of his open and bleeding mouth, his bear-like chest still. He was dead, killed by a car traveling over the crest of the hill, by a driver who could not see him until it was too late. I felt devastated.

For the next several weeks, as I traveled this same road, each time I came over the crest of the hill where this tragedy had occurred, the image of Zack’s lifeless body, lying in the road, involuntarily came to mind accompanied by all the associated feelings of grief. The sight of the crest of the hill had become a trigger for activating painful memories.

A couple of months later, I attended a weekend workshop focused on something called neuro-linguistic programming, or NLP for short. NLP is the study of how thought and language impact and influence personal experience.

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During the NLP training, the two facilitators—Rick and Ricky—asked that we each find a partner to complete an exercise. In this exercise, one person was to act as the “client” and the other as the “therapist.” The client was directed to pick a memory that was still bothering him or her. The therapist was directed to guide the client through the steps of an NLP procedure called the “swish pattern.”

We were told that when using the swish pattern, it was not necessary for the client to reveal the contents of his or her memory to the therapist. This meant the entire process could be completed without the therapist even knowing the client’s issue.

For this exercise, I opted to play the role of client. As the “client,” here are the instructions I received and followed:

  1. Select a specific “unpleasant memory” you want to change.
  2. Close your eyes and mentally re-create that unpleasant memory to the best of your ability. Imagine it in detail as if it was happening to you now. Be in the experience and see, hear, and feel what you would if it were happening now. (Note: for this exercise I recalled coming to the crest of the hill, finding Zack dead, and feeling devastated.) This original unpleasant memory will soon become the cue for triggering a new “pleasant substitute memory.”
  3. Next, create an alternative mental image of what you would prefer to recall—a pleasant substitute for the original, unpleasant memory. (In my case, I wanted the crest of the hill to automatically trigger a pleasant image of a time spent with Zack instead of triggering the unpleasant memory of his lifeless body lying in the road. The pleasant memory I selected was an image of Zack standing on his hind legs, front paws hanging over the fence, black tail wagging, and happy to see me.) Imagine this new alternative “pleasant memory” as if it was happening to you now. Be in the experience and see, hear, and feel what you would if it were happening now. This is now your new substitute pleasant memory.
  4. Now, once again, imagine a big, bright picture of the unpleasant memory you wish to change (your original cue image). In the bottom right-hand corner of this mental picture, construct a small dark picture of your new “pleasant memory” that you would prefer to experience instead.
  5. Now, quickly and smoothly expand the small, dark image of the pleasant memory so that it grows to become a big, bright image right in front of you—completely replacing the unpleasant memory. This quick exchange of images (from unpleasant to pleasant) takes about a second. Swap the images in the time it takes you to say, “swish.” The key point is to make the exchange sudden and very fast.
  6. Repeat steps four and five 10 to 12 times.

I listened attentively and followed all of the therapist’s instructions. This was my first experience with the “swish pattern.” Was it effective? Last week, I drove to the old house. As I passed over the crest of the hill, sure enough, the first memory that came to my mind was the happy image of Zack standing on his hind legs, front paws hanging over the fence, black tail wagging and happy to see me—just like we programmed my mind to do in this exercise first completed a quarter of a century earlier.

Is the swish pattern magic? No. Does it always produce such impressive results? Probably not. But when you have a troubling memory, is it worth giving it a try? Absolutely!

AdobeStock 571896603Nope, this isn’t a strange riddle where someone is found in the desert in a scuba suit. The answer to the question posed above is actually pretty simple: brain integration.

What is that? Excellent question; I am glad you asked. As you may know, we have two hemispheres of the brain. Neuroscience is a relatively young field, and we are continuing to learn more about the complexity of the brain and its function with time and as research evolves. We do know that there are different roles played by different sides and areas of the brain, and that integrating neural networks appears to be helpful in resolving traumatic memories.

The success of eye movement desensitization and reprocessing (EMDR) in treating trauma and mental health challenges teaches us that alternating right- and left-brain stimulation, via visual, auditory, or tactile experience, helps facilitate emotional processing. Through the simple act of holding something that buzzes between your right and left hand, or listening to something shifting from your right to left ear, a memory that was once charged with emotion can become less distressing. During the process, it is common for relevant associations to arise, for memories of thoughts and body sensations to arise. With support, this process can facilitate lasting and integrated healing.

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Right-left brain stimulation may sound like a scary, science fiction-like process, but I assure you there is no electricity involved in this type of therapy. Your body receives input in the form of sound, touch, or sight, without any added energy.

Along with helping us process emotions, EMDR can help build up positive memories, experience, thoughts, and feelings. We call this resourcing, and use imagined or real resources to cultivate feelings of peace, nurturing, protection, and wisdom. In addition to and as part of processing negative experiences, it is crucial to cultivate the positive, sometimes the opposite of what occurred in the experience of trauma.

Think about your life for a moment and ask yourself: when do I engage in an activity that engages my right and left brain in alternating rhythm? How do I feel before, during, and after the fact? How can I incorporate this information into my healing path?

How do walking, running, and drumming factor in? Think about it for a moment. When you walk, run, or drum, you are using your body in a rhythmic way, alternating the stimulation or use of your right and left brain throughout the activity. Have you ever gone on a hike or run and felt that you were sorting through your thoughts, developing new insights, or becoming less distressed about something? We know that exercise has many benefits; EMDR highlights for us some of the mental and emotional benefits.

There are a million ways to alternate right- and left-brain activation, including dance, yoga, and some tai chi moves. People have naturally gravitated toward right-left movements in many healing rituals across the world. Think of how many sacred rituals involve drums, movement, or voyages on foot. Understanding brain integration, plasticity, and resilience gives us some insight into why these rituals have been effective and why they continue to be passed down through generations.

Think about your life for a moment and ask yourself: when do I engage in an activity that engages my right and left brain in alternating rhythm? How do I feel before, during, and after the fact? How can I incorporate this information into my healing path?

If you are looking to heal from specific traumatic memories, I highly recommend working with a skilled EMDR professional who can provide structure and guide you toward health and resolution. Consider how your own choices outside of therapy can support your process as well. Perhaps you will choose to walk or bike to your therapist’s office this week, or do a little dance after your session. Whatever you choose, may it serve your healing and integration.

Family having a meal togetherThe key to tasty pizza is for each part—the crust, the sauce, the cheese, and the toppings—to be unique and distinct, but to blend into a well-balanced and delicious whole. Live life as though you and your family were a delicious pizza. This is the goal of family systems theory, though it’s probably not quite how founder Murray Bowen would phrase it.

Bowen was likely too academic to associate his work with a pizza, but it really helps explain his concept of good relationships. He used the term self-differentiation and taught that families and other groups function best when we are connected and in good relationships with other people. But at the same time, we are able to form our own opinions, feel emotions that are different from those around us, and choose our own responses to situations rather than simply following expectations.

Simply put, this means that if you are the crust on the metaphoric pizza of your family, your role is to be a sturdy foundation for the rest of the pizza. Regardless of the specific ingredients, you hold the rest of the pie together. If you are spread unevenly or have a big hole in the center, this will make it hard for the sauce and cheese to stay on top and not stick to the pan.

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Here’s a real-life example of a family or workplace picnic that gives a variety of possible responses to one tricky situation. Each response results in a different balance between holding onto your own integrity and responding to the needs and expectations of others. Each possible response corresponds to a “relationship pizza quality score” rated from zero to five, with zero showing no self-differentiation and five indicating a high level of self-differentiation.

This scene takes place at either a picnic with extended family, a workplace outing, or a gathering of friends.

You arrive at the gathering and greet everyone. One particular family member or friend leads you toward the food table and piles a rich and savory dish onto a plate. They hand the plate to you and says, “You are going to love this!”

You look at the food and realize that you can’t eat it because you are on a new diet and this is not the kind of food you can eat right now.

Response One

You reluctantly take the plate and eat it without saying anything. You feel guilty and bad about yourself, but you don’t want to offend the other person.

Pizza Quality Score: 0

If you were the crust on this metaphoric pizza, you have holes in your dough. This represents a poorly differentiated response because you are letting go of your values and your needs and focusing only on the other person.

Response Two

You say, “No, thank you. It looks really good, but I’m on a new diet.” The other person responds by saying, “You are always on a diet. One taste won’t hurt you. I worked really hard cooking this.” This time you respond, “Oh, OK. Just one bite.”

Pizza Quality Score: 2

You start out with a response that defines yourself and sets your personal limits, but when the other person rejects that response and pressures you to eat, you let go of your own values and allow the other person to define you. If you were the sauce on this metaphoric pizza, you would be oozing off the edge of the crust.

Response Three

This time, when the other person complains about your diet and pressures you to eat a bite, you respond differently. You say, “No, I’m not going to eat that. That is just the way it is, so get over yourself.”

Pizza Quality Score: 3

Frequently, when one person changes their usual behavior, other people resist. Self-differentiation often takes hard work, but it can have life-changing benefits.You have taken a stand, but you are doing it by pushing the other person away and not showing any respect for their feelings.

Good self-differentiation involves both standing up for yourself and your values while simultaneously remaining connected to others. If you were the sauce on our metaphoric pizza, you have added a large amount of a spice that clashes with the cheese and the crust. The result is unappetizing, but edible. Let’s try again.

Response Four

The other person says the same thing, but you take a different approach. This time, you say, “I really appreciate all the work you put into that dish; it shows how much you care about me. I am sorry, though, I’m really not going to be able to eat any today. I need to stick to my diet.”

Pizza Quality Score: 4

You have held onto your values while also staying positive and appreciative of the other person.

Response Five

You can perfect your differentiated response by adding something to encourage a connection with the person in a way that doesn’t compromise your integrity. For example, after using something similar to response four, you could add: “How about if we take a walk together?” or, “I want to tell you a funny story about this new diet.”

Pizza Quality Score: 5

This response shows excellent self-differentiation because you are holding onto yourself and your values while fostering a relationship with the other person.

Finally, good self-differentiation does NOT depend on the other person’s response. Reaching out to foster connection is a self-differentiated move even if the other person responds by turning away. Frequently, when one person changes their usual behavior, other people resist.

Self-differentiation often takes hard work, but it can have life-changing benefits.

Family in the maternity hospital with newbornA happy event though it is, integrating a new baby into the family is a huge transition. It’s a huge transition for Mom and Dad, of course, but it’s also a huge transition for older children in the family.

The dynamic of the whole family changes when a new baby arrives. The arrival of a new baby can be one of the most traumatic events in a child’s life. It is a significant transition that must be handled with compassion and empathy, lest you risk harming his or her self-worth and sense of security. The integration of a new baby into the family can create an emotional crisis for children. Therefore, children need the assurance of their parents’ love more than ever.

It is completely normal for children to experience jealousy once a new baby arrives, even if the children are excited about having a new baby in the house. The reality is that children will have to adjust to the shift in the amount of attention they receive from their parents. Children may experience this shift as a loss that they grieve. How children adjust to a new baby depends on their temperament and the ease of the transition of integrating the new baby into the family. The goal for parents is to help children manage their jealousy so that, sooner rather than later, love for the new baby can take over.

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The integration of a new baby tends to be most difficult for children 18 months to three years. Children younger than that aren’t as aware, and children older than that typically have other things distracting them. When the time comes for the baby to arrive, parents need to ensure that children do not feel abandoned. Having Mommy go away to the hospital can be traumatic if the children are on the younger side and don’t understand why she left, which may make it more difficult to accept the new addition to the family once the baby is brought home.

It is best to start preparing children for the new arrival before the baby even arrives. The goal is to help children feel connected to the baby and to become enthusiastic about its arrival.

Strategies for Helping Children Embrace a New Sibling

The following are some strategies parents can use to help children adjust to a new sibling:

Patiently allowing the time needed for children to adjust to the arrival of a new baby, and providing love and emotional support of their feelings, will help children to recognize that their feelings are accepted and understood. As a result, children may be more likely to accept the arrival of a new sibling and view it as a joyful event.

Young woman in forest, sitting on wooden staircase, looking upwardOne aspect of psychotherapy is that the person in therapy and the therapist participate in a process larger than what either or both can directly observe. Something can be happening in plain sight, but we might not see it because it doesn’t fit into our way of looking at things. But sometimes we fit into its.

Tom—not his real name—was in his early thirties. He was dealing with a number of opportunistic infections that had him confined to a hospital bed in a back bedroom of his family’s house and changed his once-handsome appearance. I saw him through an AIDS service organization that put services into people’s homes, and one of those services was therapy. Tom presented with symptoms supporting a major depression diagnosis, which he wore with a decidedly gloomy air—with anger beneath the gloom.

I’ve never felt as flattened as a therapist as when working with Tom. “What the eff good is this supposed to do me? Pardon my French,” he drawled halfway through our second session. He was always polite, and deeply weary.

He had a point. The infections which had affected his appearance and made movement out of bed virtually impossible had interrupted a life that had always been characterized by independence, a successful career, and enjoyment. I tried bereavement work and adjustment interventions, but Tom only withdrew from dialogue, observing me from across an ironic distance. He also made it clear that he didn’t want to address his health (“I live with this all day, every day. You think I want to spend another hour talking about it?”).

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What he was willing to talk about were his teenage years. He’d been born and raised in the Midwest, and his narrative, once he got going, was vibrant with details. Not just of what he’d done and the people he’d known, but about the landscape, the wildlife, and even the weather.

Tom had a highly developed extroverted sensation function. In depth psychology, this is a way of saying that a person is interested in the physical details of the world, and that these details are a source of deep pleasure. Issues of insight and meaning or even feelings weren’t high on Tom’s agenda. But he could describe the particular quality of the snow the night he and his cousin decided to walk to the corner store half a mile from the house for cigarettes (the flakes were slightly wet, so they tended to stick together, coming down in a spin because the wind kept changing direction, which was why he and his cousin lost their way on the street they’d both grown up on).

To me, this level of detail seemed like concrete thinking. I was someone driven by insight and deeply rewarded by it. It’s also how I gauged progress in the work. I couldn’t see anything happening in our sessions, which naturally made me think that nothing was. Early on, I asked him, tentatively, if he would prefer to work with someone else. To my surprise, he told me, “This is working OK. I don’t have any complaints.” I didn’t get it. Gradually, I learned to set aside my own expectations—one of which was that I was supposed to get it, was supposed to get something—and just be available to sit with him.

I was someone driven by insight and deeply rewarded by it. It’s also how I gauged progress in the work. I couldn’t see anything happening in our sessions, which naturally made me think that nothing was.

And so, without leaving the back bedroom of the little house in Los Angeles, I went on walks in the Midwest woods with Tom. I learned that the trees were mostly hickory, with a few spruces here and there. They never grew much over 12 feet and weren’t thick-growing, but they had plenty of walking space between them. It was a wet country, and you could usually hear at least one creek, often more, and the katydids. Birds sang around us, warblers and bluebirds, chickadees whistling like they wanted to get our attention. And of course the mosquitos were murder in spring and summer, and that’s one of the reasons he smoked Kools nonstop as we walked, because skeeters don’t like the smoke.

Sometimes we’d go down to his uncle’s for the Fourth of July barbecue. Everybody was there. His uncle used a cut-open water heater for a grill, and there was never any barbecue sauce, just salt and plenty of smoke. It was the best barbecue we ever tasted, and just one of the things lacking in L.A.

Other times, in the season, we’d go chasing storms up on the flatlands with his cousin—when she could be convinced, anyway, and by ourselves when she couldn’t. Yes, it was a pretty stupid thing to do, but when you saw those big, purple storm heads, bigger than anything you see here, and all that lightning, you forgot about everything else. And the tornadoes, when they came, were the best thing in the world. You never forgot those. And when you were stuck laying in a bed all the time, you dreamed about them and wished one would come out this way and take you back home.

Tom’s health went up and down—down most often. Eventually, he was hospitalized. Part of what I did was to follow people and keep meeting with them when they went into the hospital or nursing facility or hospice. The first week, Tom was in the ICU and not receiving visitors except family. When his mother told me it was OK, I went to sit with him.

“I haven’t slept in days,” he grated miserably. “I can’t sleep here. It’s too noisy, and they’re always coming into the room for something.”

I asked him to close his eyes. We went on a guided imagery walk out in the Midwest countryside. I knew the way. The hum of the air conditioner was the breeze through the tops of the hickory trees. That beep of the IV monitor—was that a grebe calling out on the pond or maybe a thrasher? The air circulating in the special mattress that reduced the chance of bedsores was the sound of the creek that ran along beside us. In this familiar landscape, we walked on and on, in no hurry, until the end of our visit. The last time I saw Tom, he was sleeping peacefully.

When Tom visits me in my thoughts, he reminds me not to judge the work because it’s not mine to judge. Its fruits might not show up anywhere that I ever see or know about. He reminds me to trust in a process that’s larger than I am, that I’m only part of.

Woman with hands on headAnxiety can show itself in many forms. Some can be very painful and impairing, and we may need professional help to deal with them. But anxiety is something that everyone experiences at different times, and there’s something you can do about it.

One powerful tool that can help you navigate anxiety is mindfulness. Being aware of the present moment without judging it, and allowing experience to happen without trying to change it, can free you from the pain of your anxiety as well as help you understand its underlying causes.

But how do you do this? Like anxiety itself, the answer to this question is multifaceted. Anxiety manifests through our moment-to-moment thoughts, emotions, and body sensations. We suffer a great deal when we reject what’s actually happening in our moment-to-moment experience; by recognizing our habits of trying to “get rid of” experience, we can ease unnecessary suffering. What’s more, we can begin to understand the deeper, underlying causes of our anxiety.

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Thinking Plays a Big Role

Our thinking patterns greatly influence how we see ourselves, others, and the world at large. As a consequence of our early interactions with caregivers, peers, and society, we create various thought patterns that continue to evolve throughout our lifetimes. Most of the time, we’re unaware of these patterns, so they can end up dictating a great deal of our lives.

For example, if as a child you were repeatedly told by your father that you weren’t good at something (or, conversely, that you were amazing at something), you likely internalized that message and it became part of your identity. You act accordingly and believe you aren’t good enough (or amazing) at that particular activity. And if you find yourself faced with the activity you believe you aren’t good at, you may experience anxiety, and doing the activity may be very difficult. In such situations, it’s as if we become that 6-year-old all over again.

Having a mindfulness practice can help us see our actual process of thinking, giving us some space from our thoughts. The next time you tell yourself that you can’t do something or that it’s too difficult, pay close attention to the tone of voice and words you’re using; you may recognize it as the voice of an influential person growing up. At this point, you may begin to appreciate that the thinking is not really “yours,” but an internalized voice.

With mindfulness, you can become aware of the thoughts without identifying with them. Again, this isn’t easy, and you may take a long time to get there—but it is absolutely possible. The more we practice mindfulness, the more this capacity develops.

What about Feelings?

Emotions are inevitable; we experience them all the time. Some are pleasant, and some are unpleasant. As humans, we tend to avoid the unpleasant ones and grasp for the pleasant ones. When we’re experiencing anxiety, our emotions can be especially difficult to tolerate, and we may try to suppress or get rid of them. The problem is, by doing this we perpetuate a rejection of ourselves, creating a negative feedback loop.

By developing a mindfulness practice, little by little you can begin to tolerate the emotional quality of anxiety, to the point that it becomes manageable. When you allow your experience to be what it is, it loses power over your sense of well-being. As with our thoughts, this skill takes time to learn, but it is very real. They key here is to practice.

Besides anxiety management, another important benefit that comes from emotional mindfulness is that we increase our capacity to know and understand our feelings. Many people experience anxiety because they lack a direct awareness of the emotions behind it. The more we became comfortable with our emotions, the deeper we see behind them and the less influence they have over us.

As you might sense, we miss out on a great sense of aliveness and dynamism when we live in our heads.

Everything Happens in the Body

Our bodies are our main vehicles for moving through life. They carry a tremendous amount of information, yet for the most part in modern society, we’ve lost touch with them. Emotions begin in the body, and so anxiety can show itself in the body, too, in ways such as contraction in the chest, heart palpitations, tightness in the stomach, and so on. As we develop the capacity to sense into our bodies, we can pick up on our different emotions earlier. We can also more easily see the impact others and the environment have on us.

At least in the West, most of us ignore our physical sensations and experience the world through thinking. Some of us take emotional life into account, but very few actually incorporate the body’s experience into our worldview. It makes a tremendous difference in our quality of life when we do. As you might sense, we miss out on a great sense of aliveness and dynamism when we live in our heads.

Ultimately, We Must Integrate All Three

Thoughts, emotions, and body sensations are not discrete, separate categories. The truth is, the three are complex and intertwined, affecting each other in many ways. Practicing mindfulness helps us to notice how our thoughts impact how we feel, how our feelings impact how tense our bodies are, and how our physical experience impacts our thoughts and feelings. The great news is that by becoming aware of any one of these processes, all of them begin to shift, harmonize, and flow.

As I’ve mentioned in previous articles, although it’s possible to practice mindfulness alone, it’s beneficial to have a coach, guide, teacher, or therapist who can help you track your progress and notice when you encounter one of the many pitfalls along the way. Sometimes anxiety can increase when we begin paying attention to our long-ignored experiences. Sometimes anxiety is masking psychological trauma, and opening this up without appropriate support can be counterproductive. If you want to reduce your anxiety and reap the full benefits of mindfulness, seeking guidance is crucial to your practice.

hands pulling rope tugWe may have experienced various traumatic experiences in childhood, whether it be abuse, neglect, abandonment, or ongoing misattunements from caregivers that impact our ability to feel safe to attach. Even though the events themselves may be behind us, those internal responses to the traumatic experiences—images, sensations, meanings we create, and emotions—can become “stuck” in the nervous system. They continue to have a “charge.” That charge stays in our system, is stored maladapatively, and is part of our inner world.

At the most unexpected times, this material can push through what we would consider our “normal” day-to-day activities—such as parenting, working, relationship building, and self-care—in the “outside world.” As a result, we may find ourselves in a constant balancing act of pushing back at that charge. Our normal everyday selves, if you will, try to show the world that we are fine on the outside, even though there may be a lot of material that pushes through.

For example, perhaps we are in a discussion with a loved one when, all of the sudden, we interpret that we are being abandoned, even while there is no actual evidence of this. Or perhaps while attempting to set a boundary with a child, we feel feelings of guilt because we don’t feel that we “deserve” to set those boundaries. All of these can be intrusions on day-to-day life, all from past hurts.

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Those feelings and interpretations can actually be the experiences of the past clouding the now, stopping us from truly being in the moment. The nervous system is activated and defending itself from a past injustice. Unfortunately, that charge from the past compels your nervous system to act as if the traumatic experience is still happening.

There can then develop a kind of tug-of-war between who we are on the outside and the charges that remain from the past. If the tug-of-war with the traumatic material becomes too much and we become flooded, we may need to go numb in order to be able to still “do” life on the outside. We may shut down. Even if we do, it doesn’t mean that the material on the inside is gone; it just means that we have had to become more unaware of it in order to function on the outside.

One of the most challenging aspects of complex trauma, whether or not pursuing EMDR therapy, is that we must be able to identify and “own” our feelings and experiences. This allows us to then process traumatic experiences from the perspective of being “here and now” and visiting them versus feeling as if one is flooded and still in those experiences. In EMDR language, we look for one’s ability to maintain dual attention. It expands into making sure we stay within a window of tolerance as we visit those memories.

Often, those starting their healing work find themselves in one of two extremes: flooded by feelings all of the time or feeling completely numb.

For some, this may not seem like such a large step, but for the majority of those who are healing from complex trauma, it is in fact very difficult. Often, those starting their healing work find themselves in one of two extremes: flooded by feelings all of the time or feeling completely numb. The numbness often comes because the material in our inside world becomes unmanageable and we become more fearful of that material. We shut down from the outside world because the inside world is so invasive.

We typically learn to dance this dance of “daily life” vs. “inner stuff” at an early age. In infancy, we learn that our attachment to our caregivers is required; we cannot survive without a caregiver or we will die. Period. We also learn that our attachment relationship is dependent upon us being in tune with our caregiver’s reactions—to know what to do, how to act, and how OK it is (or not OK) to have our emotions be expressed and seen in the outside world.

We also determine whether it is dangerous to really identify, own, and be with the feelings of shame, anger, or sadness, even happiness or calm. We then create certain strategies that seem helpful at the time but show up later as distressing symptoms. As outlined in my previous article on blocking beliefs, it is often those cognitive errors that hold us back from fully realizing and being in tune with our past hurts because it was, at the time, too much to fully realize.

In future articles, I will share more about what it means to fully realize and own what was once unrealized, back when we were experiencing past injustices. Similarly, I will share more regarding what it means to own and process feelings we may have deemed unacceptable in order to survive the past.

If you are a therapist and are interested in expanding your knowledge on this topic, especially as it relates to structural dissociation theory, you are encouraged to read The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization (2006) by Onno van der Hart, Ellert R.S. Nijenhuis, and Kathy Steele.

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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