Religion has been shown to be a stabilizing factor for mental well-being. Research has demonstrated that people who have religious beliefs tend to have better mental health, physical health, and more satisfying relationships than those who do not have any religious beliefs. Religious individuals who seek therapy may look specifically for a therapist who is of their religious affiliation; however, many choose to work with secular therapists in order to receive an unbiased assessment of their psychological state. Because of this, it is important to understand how religious clients view the treatment they receive from secular therapists. Carrie L. Cragun of the Department of Educational and Counseling Psychology at the University of Albany in New York was curious to find out if religious individuals held negative or positive opinions of secular therapists and the treatment they provided.

Cragun recently reviewed assessments from 11 Christian individuals who had received therapy from secular therapists. She evaluated whether the clients reported their experiences as positive or negative and how religion influenced their reports. Cragun found that the majority of the clients reported positive experiences from the secular therapists. This was most often the result of working with a therapist who was open and willing to discuss religious beliefs. The therapists who were judgmental and less inclusive with respect to faith were seen as providing a negative therapeutic experience. However, when therapists explained that they were unqualified to discuss their client’s religion, the clients respected that response and still rated the overall experience as positive.

Religious beliefs play a significant role in the lives of many clients. This study demonstrates that many individuals do not feel comfortable initiating discussions about this important topic to therapists. “Results suggest that creating safety for clients to discuss their religious identity and beliefs could begin on intake,” Cragun said. “Therapists could ask about clients’ coping methods or specifically about religion and spirituality.” Providing an environment in which a client feels fully accepted regardless of religious devotion or ambiguity will set the stage for full disclosure in other areas. Cragun believes that the best place for this to start is when students are studying to become therapists. Learning about the importance of multicultural issues and how to integrate these issues into therapy will allow therapists to be more inclusive of clients from every ethnic and religious background.

Reference:
Cragun, C. L., Friedlander, M. L. (2012). Experiences of Christian clients in secular psychotherapy: A mixed-methods investigation. Journal of Counseling Psychology. Advance online publication. doi: 10.1037/a0028283

We all have dreamwoman gardening self actualization lifes and goals in life starting at a young age. Some of us want to sing for a living, others want to become teachers, and some want to become veterinarians. We have the desire to be liked and known by many, to have families and luxuries. But is there more to life than these hopes?

Understanding the concept of self-actualization could help you come to a better realization of what you’re doing with your life, and where you want to be.

A recent Huffington Post article by Russell Bishop visited the concept of self-actualizing in comparison to self-conceptualizing: “Self-actualization represents the process of becoming more of who you already are, while self-concept is more about your self-talk, about trying to become something or someone you may hope you are but fear you are not,” Bishop said. “While your self-talk represents an amalgam of beliefs, hopes and fears that you have accepted about who you are, your soul-talk emanates from the depth of who [you] truly are, encouraging you to grow, to blossom, and to expand.”

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The Four Aspects of Self-Actualization

From The Inspired Life: Unleashing Your Mind’s Capacity for Joy, by Susyn Reeve:

Six Tips Toward Self-Actualization

From The Inspired Life: Unleashing Your Mind’s Capacity for Joy, by Susyn Reeve:

Obstacles to Self-Actualization

Susyn Reeve, a self-esteem expert and the author of The Inspired Life: Unleashing Your Mind’s Capacity for Joy,  says that unfortunately, many people haven’t even started on the road to self-actualization.

“They don’t understand how the brain works, the creative process, and that everything that exists begins inside and then is brought to form outside,” she says. “Most people suffer from low self-esteem and do not believe in themselves—they feel unworthy, unloved, and are ashamed of these feelings. Their fears, worries, and anxieties stop them in their tracks. They give more credence to the opinions of others and fail to honor their inner knowing.”

Valery Satterwhite, an inner wealth consultant, has additional advice for people who want to become self-actualized. “It is essential to first reconnect with who you really are and what you value most,” Satterwhite said. “Too many people live life through the prism and the prison of a false personality where the real self is buried under layers of expectations—who a person ‘should be’ and what he or she ‘must do.’ As children we tend to condition ourselves—we shape-shift our identities—in order to stay connected, loved, and belong in our environment. The more we strip away these false layers, the more we are able to expand our sense of self and our place in the world.”

She said everyone is capable of self-actualization, and most people want this for themselves, but many people don’t completely become self-actualized. “Whether or not they achieve it depends upon how willing they are to step beyond the comfort zone of conditioning to explore new perspectives, new learning, and new insights,” Satterwhite said.

“Those who live in fear will not travel very far in their journey of self-actualization,” she added. “Fear is restrictive—it cuts off expansion and actualization whether it be within an individual, society, or government. Those who value themselves and the gift that is this life enough reach a point where the pain of staying inauthentic overrides their fear. Those who step into their fears know the joy that comes with the learning and the growth that comes with the courage to step into the unknown. Often what we fear the most is what our heart is calling us to become. It scares us because it matters that much.”

Five Stages to Self-Actualization

Sarah Lendt, a nationally certified counselor, references the humanist psychologist Abraham Maslow‘s definitions of the stages that people must master before they can reach the final tier of self-actualization. The five stages are:

  1. Physical needs, like food and water
  2. Safety and survival, including physical and emotional safety and shelter
  3. Love and a sense of belonging
  4. Esteem and self-esteem
  5. Self-actualization

It can be challenging, of course, to move past all of these steps to get to self-actualization.

Lendt said, “In our lifetime we strive to meet these various needs,” according to Maslow’s concept of self-actualization and his hierarchy of needs. “Circumstances may cause us to go back to a particular stage and need to fulfill it again; once a need is fulfilled, we can work toward achieving the next need. Sometimes unmet needs can cause a person to become fixated or stuck at a particular level.”

Self-actualization is “looking outside ourselves to do good for others, and receiving satisfaction in life for such behaviors,” Lendt said. “It is a point where we are being the best we can be—self-fulfilled and helping others … I think most people certainly can achieve it, but there is so much pressure, so many expectations in our world that people hold of themselves and others, that it is hard to get beyond the esteem level—feeling good and confident about yourself so much that you can look outside yourself in your actions.”

Nine Characteristics of Self-Actualized People

From Kendra Cherry:

Painting Depression can be challenging. If you have experienced it, then you know that the most basic tasks can become excruciating and leave you feeling apathetic and drained of your willpower. Simple tasks like getting out of bed, doing the laundry, and playing with your children may be daunting. While talk therapy and medications may be helpful, they are not the only solutions to relieving symptoms. This is where art therapy comes in. Art therapy has become an effective treatment in supporting, releasing, and integrating the symptoms of depression by supporting you in exploring depression via the senses. Although art might seem less conventional, it can be just as effective as talk therapy because it utilizes the whole body experience and not just the intellect.

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When Words Do Not Speak

It can be difficult to open up to a complete stranger about your deepest and darkest emotions. Sometimes, we are taught to suppress our emotions and put on a blank face, even when experiencing inner turmoil. In art therapy, words are not always necessary. A mere lump of clay or a blank canvas can be far less threatening than giving voice to painful feelings, words, or images. The simple act of a scribble on paper can likely bring light to darkness, ignite conversation, or be a release for a depressing thought. Because something cannot be heard by the human ear does not mean that nothing is being said or revealed. Art therapy supports our process when words are not enough.

The Capacity to Feel Again

In addition to creating a communication bridge between you and your therapist, art therapy can also help you come to terms with what you are actually feeling. Perhaps you have felt numb or distanced and “incapable” of feeling when depressed. Creating art is at the heart of expression and emotion, supporting your capacity to feel again. Once you have created and externalized a part of yourself as something concrete and tangible, it is easier to acknowledge that such an emotion existed in the first place. By creating, you give yourself permission and voice to that which is difficult to speak. You might feel a sense of relief or a movement of your depression once you have transferred it onto your canvas.

Creating One’s Own Happiness

Research shows that when we observe something that we believe to be beautiful, the neurotransmitter dopamine—located in one of our pleasure centers in the brain—is released. Interestingly, the brain activity observed when we look at art is actually comparable to the brain activity representing love! It’s nice to know that in addition to having created your own art, positive feelings increase.

Research proves art therapy is a beneficial method of treating depression across a wide spectrum of personalities. Many even discover a newfound passion for art and are surprised at the talent that emerges once their emotions are channeled into their artwork. Only in this unique field are therapists performing what is considered by traditional psychoanalysts to be the hardest of tasks: getting those with depression to proactively express, manage, and overcome their symptoms … with the end result being something truly beautiful.

References:

  1. Study shows art may help with depression. (2012, June 6). Retrieved from http://www.arttherapyblog.com/mental-health/study-shows-art-may-help-with-depression/#.T9dlRdUth30
  2. Bar-Sela, G. (2007, Nov. 16). Art therapy improved depression and influenced fatigue levels in cancer patients on chemotherapy. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/17351987
  3. Holm, M. (2011, Aug. 11). Art therapy for depression. Retrieved from http://www.naturaltherapypages.com.au/article/art_therapy_for_depression
  4. Riley, S. (2001, July). Art therapy with adolescents. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071468
  5. Vann, M. (2012, April 4). 8 Unconventional ways to ease depression. Retrieved from http://www.everydayhealth.com/depression-pictures/unconventional-ways-to-ease-depression.aspx#/slide-3

Feet walking a white line on the pavement

While the terms “pedophile” and “child molester” are often used interchangeably, they do not mean the same thing. A pedophile is a person who is attracted to children, but not all people with pedophilia molest children. Many individuals who are attracted to children never act on their attraction, and some seek help in order to keep from harming children.

Pedophilia is considered by some to be one of the most difficult social problems to understand. The 5th edition of the Diagnostic and Statistical Manual classifies pedophilia as a paraphilia, distinguishing it from pedophilic disorder: It is diagnosable as a mental health condition when it causes distress to the affected individual or to someone who is unwilling or unable to consent. Thus, according to this classification, having an attraction to children and not acting on it does not indicate a mental condition.

New research shows that pedophilic disorder may be neurological in nature, lending further support to the position that an attraction to children is not a choice. Some may find this difficult to accept, as those who do act on their desires and molest children have the potential to cause serious and lasting harm to many children. They may repeat their crime over and over until stopped by the criminal justice system. Many people may believe that, once caught, people who molest children deserve to spend the rest of their lives in prison, but the reality is that many of these individuals will eventually be released.

Upon release from prison, offenders are often required to enter rehabilitation programs, which are meant to redirect pedophilic urges and help a person refrain from harming children. These programs are often viewed with skepticism, as many believe that a person who molests children cannot be rehabilitated and that pedophilic urges will always lead to the sexual abuse of a child. However, there are several perspectives on the issue.

The Difference Between Pedophilia and Child Molestation

Psychological perspectives on child molestation vary greatly, but experts agree that most people who molest children fall into one of four categories:

  1. Children or teenagers under the age of 16 who are sexually curious and may experiment with younger children.
  2. Adults who have a brain condition, intellectual disability, or other mental health issue.
  3. Individuals who have an antisocial personality and may use children sexually but have no particular sexual desire for children.
  4. Individuals who are older than 16 and experience ongoing sexual desire for children. Sexual desire for children, or pedophilia, can be identified and treated or controlled with therapy and medication.

Ninety-five percent of all known instances of child molestation are committed by people with pedophilia. Other individuals may molest children for the above reasons, out of sexual frustration, or in order to maintain power or exert control.

Though nearly all those who molest children have pedophilia, many people with pedophilia will never molest a child, and some work to eliminate their attraction to children through various forms of treatment and therapy.

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Non-Offenders

Dan Savage, who frequently writes on the topic of human sexuality, has published several accounts of people who, despite their attraction to young children, avoid being alone around children and are able refrain from committing acts of molestation. It is generally acknowledged that it may take a significant amount of self-control to avoid offending and that pedophiliac inclinations typically mean a person with pedophilia will find it difficult to have a healthy sexual relationship.

In several European countries, Savage points out, people experiencing a sexual attraction to children are often able to seek treatment confidentially. In the United States, however, an individual who discloses pedophilic tendencies may be arrested, as therapists and physicians are required by law to report anyone who poses a threat to children. This law, in addition to the stigma surrounding pedophilia and the limited number of resources available to those seeking help in the U.S., is likely to discourage non-offenders from seeking professional help, help that may enable them to continue to keep from offending.

Free and confidential prevention and treatment programs–such as Germany’s Prevention Project Dunkelfeld–may help those who are attracted to children refrain from acting on their desires. Some European countries do have lower child molestation rates than the United States, and this fact may be connected to the availability of treatment.

Many people who are attracted to children are horrified and frightened by their preferences and attempt to do everything they can to keep from harming a child. They may wish to attend therapy, explore ways to curb their desires, or take medication. Making treatment available and accessible to individuals before they offend may reduce instances of child molestation.

Chemical Castration

Chemical castration is one method that may keep child molesters from reoffending. Many states in the U.S. offer voluntary chemical castration in exchange for earlier release. Some states, such as California, mandate castration for offenders with multiple convictions as a condition of release. The treatment has been shown to greatly reduce sexual desire in men who are attracted to children and to lower rates of recidivism.

Those who have not yet harmed a child and who are committed to avoiding doing so may find relief from their desires through chemical castration. In some cases, an antidepressant, which may have the effect of further limiting one’s sex drive, is also prescribed.

Sexual desire cannot be completely eliminated by castration, a fact that leads many individuals to question the efficacy of the treatment and the risk of releasing offenders who may still experience some sexual desire for children. Another objection stems from the fact that the person undergoing treatment must be relied on to take their medication regularly. However, chemical castration has been shown to be effective for many individuals and thus is likely to protect many children who would potentially be victims of sexual abuse.

Group Therapy

Many therapists use group therapy as a type of treatment for people with pedophilic tendencies. Groups can provide a safe environment to discuss inappropriate and harmful urges, and the support of a group of individuals facing similar challenges may give some people the strength to avoid offending or reoffending.

However, when someone is involuntarily enrolled into group therapy and has no particular desire to stop offending, a support group can become a different environment. Other members may, knowingly or unknowingly, support a high-risk offender’s further attempts at molestation. But because mandated group therapy may be of benefit to some convicted offenders or those who are at risk for offending, group leaders may not wish to withhold a potentially helpful treatment from anyone. They may, however, choose to carefully screen participants prior to program entry and during treatment.

Aversion Therapy

Aversion therapy pairs an unpleasant stimulus such as an electric shock, pinch, or flick along with a pleasant stimulus. Sex offenders may use aversion therapy to attempt to eliminate their attractions to children. While this therapy can be effective, it often poses ethical problems, as therapists cannot shock their patients. It can also be difficult to maintain consistency with this type of treatment. Further, when aversion therapy does work, it is unlikely to do more than eliminate the attraction to children. It likely will not help people develop an attraction to age-appropriate adults if they do not already experience such an attraction.

Fake Porn

Psychologists have still not reached an agreement about whether pedophilia is a sexual orientation or a mental illness. Those who believe it is a sexual orientation may advocate the use of fake porn, depicting animated or CGI children, as a way for those with pedophilic tendencies to achieve sexual release. Some therapists have reported that this method has been successfully used to reduce an individual’s desire to molest a child.

However, other therapists point to studies demonstrating the effect pornography can have on sexual desire and express concern that such pornography may actually create or increase a desire to sexually abuse children. Many also question the ethics of making such pornography, even when it does not involve actual children.

References:

  1. Early Diagnosis and Effective Treatment. (n.d.). Retrieved from http://www.childmolestationprevention.org/pages/focus_on_the_cause.html
  2. Goode, S. D. (2010). Understanding and addressing adult sexual attraction to children: A study
    of paedophiles in contemporary society. New York, NY: Routledge.
  3. Jenkins, P. (2004). Moral panic changing concepts of the child molester in modern
    America. New Haven, CT: Yale Univ Press.
  4. Kaplan, M. (2014, October 5). Pedophilia: A Disorder, Not a Crime. Retrieved from http://www.nytimes.com/2014/10/06/opinion/pedophilia-a-disorder-not-a-crime.html?_r=0
  5. Kincaid, J. R. (1998). Erotic innocence: The culture of child molesting. Durham, NC: Duke
    University Press.
  6. Nanos, J. (2014, March 1). Can Chemical Castration Help Pedophiles Tame the Beast Within? Retrieved from http://www.bostonmagazine.com/news/article/2014/02/25/chemical-castration
  7. Schwartz, C. (2011, December 7). What Science Reveals about Pedophilia. Retrieved from http://www.thedailybeast.com/articles/2011/12/06/what-science-reveals-about-pedophilia.html
  8. Seto, M. C. (2008). Pedophilia and sexual offending against children: Theory, assessment, and
    intervention. Washington, DC: American Psychological Association.

When assessing a patient for major depressive disorder (MDD) and choosing the most appropriate course of treatment, personality type is a major consideration. Research has demonstrated that people with high levels of neuroticism and/or low levels of extraversion often respond less well to treatment and have higher relapse rates. Briefly, neuroticism is a personality trait that includes a tendency toward negative emotions and emotional instability. Extraversion, on the other hand, describes a tendency toward positive feelings, including but not limited to higher levels of socialization and self-confidence. A recent study published in the Archives of General Psychiatry examined the links between personality type, cognitive therapy, and the antidepressant medication Paxil (paroxetine).

In multiple studies of the drug Paxil, participants who showed significant improvement in their depression also reported greater feelings of confidence and liveliness. The authors of these studies generally describe these personality changes as effects of the overall improving mood of the patients. A more recent study ponders whether selective serotonin reuptake inhibitors (SSRI) medications, Paxil in this case, do in fact work to change personality states resulting in a lessening of depressive symptoms. The study was broken into three groups: a placebo group, a therapy group, and a group receiving Paxil. Depression and personality ratings were gathered from each participant at regular intervals throughout the 16-week study.

As many previous studies have shown, even people receiving placebo showed noteworthy improvement in their depression. However, the personality trait scores underlined a potentially significant fact. Neuroticism and extraversion were both relatively unchanged in the placebo group, while those receiving Paxil or cognitive therapy showed improvement in both of these key areas. This suggests that Paxil may work to alter personality traits on the molecular level. Cognitive therapy also led to decreased neuroticism and increased extraversion, but the reasons for these changes are not as clear. What is clear is that these personality changes predict a better long-term outcome for patients and a lower chance of relapse.

The lesson from this research is that clinicians should be mindful of specific personality traits when treating an individual with MDD. Paxil, and possibly all of the SSRI medications, may work to improve depression on a more fundamental level than anyone realized. The data has always been there, in a sense, but perhaps the interpretation was lacking. As researchers unlock the mysterious relationship between moods and chemical neurotransmitters, more specifically targeted drugs will be developed. Furthermore, as the early warning signs of depression—neuroticism, low extraversion—are better identified, interventions will be possible to prevent this debilitating mental health condition before it occurs.

References

  1. Depression (major depression) – MayoClinic.com. (n.d.). Mayo Clinic. Retrieved March 8, 2012, from http://www.mayoclinic.com/health/depression/DS00175
  2. Tang, T.Z., DeRubeis, R.J., Hollon, S.D., Amsterdam, J., Shelton, R., & Schalet, B. (2009). A placebo-controlled test of the effects of paroxetine and cognitive therapy on personality risk factors in depression. Archives of General Psychiatry, 66, (12), 1322-1330.

Mother tucking child into bedI am frequently asked what the best complementary or alternative therapies for kids are. This is a broad and potentially complex question, with appropriate courses of treatment depending on both on the child’s struggles and the balance of safety and efficacy of the therapy being considered. Eventually, many parents eventually find a complementary or alternative medicine (CAM) therapy that feels right for their child.

The most recent data from the National Center for Complementary and Alternative Medicine (NCCAM) found that 12% of the 9,000 children surveyed in 2007 had used some form of CAM during the previous year. CAM use typically ranges from providing remedies in lieu of medical treatments—such as using a homeopathic flu remedy instead of a prescription—to using CAM in conjunction with conventional remedies. The latter can be as simple as giving a child a zinc lozenge or tea with honey in addition to the antibiotics a doctor prescribes when a child has a sore throat or throat infection. Another example is when a child has been diagnosed with attention deficit hyperactivity disorder (ADHD), and his or her parents employ dietary changes even if the child is also receiving medication or psychotherapy. CAM therapies are often used to help children manage symptoms of chronic pain conditions or notable anxiety, ideally in combination with psychotherapy (and appropriate medical care, if this is indicated).

Remembering Developmental Differences

A point NCCAM emphasizes is that children are not merely smaller versions of adults. Similarly, more studies have been conducted regarding the effects of many CAM therapies on adults, although there is a growing body of research on CAM with children. Thus, what may be considered an appropriate CAM therapy or dose of therapy for an adult is not necessarily what we can recommend for a child.

That being said, there are a number of treatments that are considered generally safe for children, particularly when provided or informed by appropriately trained professionals. My favorites are listed here. I chose to emphasize non-oral intake therapies, although at times these may also be appropriate.

  1. Guided imagery or self-hypnosis can be helpful for managing mood symptoms, pain and itching, sleep difficulties, and nausea.
  2. Mindfulness or other types of meditation can aid in improving mood, pain, itching, sleep, nausea, and concentration.
  3. Aromatherapy can help reduce anxiety and enhance feelings of calm, especially when paired with other therapies, including cognitive behavioral therapy, meditation, imagery/hypnosis, or massage.
  4. Movement therapies, such as yoga, dance therapy, or tai chi can increase a child’s feelings of mastery, discharge excess physical tension, provide focus, and improve mood.
  5. Massage  decreases muscle tension or soreness and increases relaxation.
  6. Energy therapies, such as Reiki or therapeutic touch, may help increase calmness and decrease stress. These may also help with some physical discomforts.
  7. Art therapy can help children cope with change, shed light on emotions and concerns that they may have trouble verbalizing, and reinforce healing images created during guided imagery and hypnosis.
  8. Homeopathy is gently calming and is reported to help with fears, anxiety, and tantrums. There is less data on this therapy, but it is generally considered to be safe.
  9. Diluted ginger tea can help with upset stomach/nausea.
  10. Dietary changes, which may include eliminating processed foods, caffeine, or sugar and emphasizing whole grains, fruits, vegetables, legumes, and healthy sources of protein, are health-supportive overall, and some parents report improved mood, sleep, and concentration when processed foods are limited or eliminated.

One common theme that runs through most of the therapies listed above is that they help children to feel calmer. Some of the approaches provide children with tools to help them directly impact how they feel via what they do (movement therapies, imagery/hypnosis, meditation, art), which enhances children’s feelings of mastery and control. All of these approaches require at least initial participation and monitoring from parents—a key ingredient in helping children to feel safe, loved, and supported.

As always, it is essential to keep healthcare providers in the loop when using CAM therapies with children, particularly with those who have a medical or psychological illness.

Modeling Emotional Intelligence

Finally, if I were to add a number 11 to the list, it would be to emphasize that children pick up on and are undoubtedly affected by their parents’ moods. It is essential for parents dealing with anxiety, depression, or other psychological challenges to obtain appropriate treatment. Doing so helps parents feel better, enhances their ability to cope with the many demands of parenting, and teaches children about the value of self-care. Furthermore, emotionally healthy parents tend to parent more effectively, which also reduces children’s feelings of anxiety and depression.

Resources:

Psychiatric nurses who work at inpatient mental health facilities interact with many different types of clients. Some may be relatively subdued and withdrawn while others may be more outgoing. Facilities designed to address the needs of the severely mentally incapacitated treat individuals with extreme cognitive and behavioral problems, and constant supervision and precaution are necessary to ensure the safety of both the clinicians and the clients. Nursing stations within these facilities are designed to provide maximum accessibility and supervision while also providing safety and security to the staff members. Some stations are designed with glass barriers and locked doors and others are built with no walls or windows, allowing both the staff members and clients open access.

Kelly Southard, the Quality Outcomes Coordinator at the Cone Behavioral Health Hospital in Greensboro, North Carolina, recently conducted a study to determine how each type of nursing station design affected therapeutic outcomes. For her study, Southard assessed 25 nurses and 81 clients in an acute psychiatric unit of a hospital before the nursing station was renovated and after. Prior to renovation, the nursing station was closed and had window and door barriers. The nursing station was only modestly renovated with new paint and countertops and removal of the window and door.

Southard found no significant differences in the perceptions of the ward environment after the renovation compared to before the renovation. The staff members and the clients did not report an increase in therapeutic ambiance as a result of having an open nursing station. However, many clients did comment that they felt that that the nurses were more accessible in the open station. Another interesting finding and one that is of concern to staff members charged with the care of high-risk clients was that the open station did not increase the level of aggression or violence on the ward. In contrast, the staff members discovered that the clients actually exhibited less aggression and anger after the renovations. Southard added, “Although more research is needed, these desired trends could be related to nursing staff being more readily available to better meet patients’ needs.”

Reference:
Southard, K., Jarrell, A., Shattell, M. M., McCoy, T. P., Bartlett, R. (2012). Enclosed versus open nursing stations in adult acute care psychiatric settings: Does the design affect the therapeutic milieu? Journal of Psychosocial Nursing & Mental Health Services, 50.5, 28-34.

Most classes of antidepressant medications, including the selective serotonin reuptake inhibitors (SSRIs), are thought to require 2 or more weeks of use before therapeutic effects become noticeable. The consumer guidelines for a drug like Celexa (citalopram) clearly advise patients not to expect immediate benefits but to continue taking their medication as prescribed. However, a recent study has cast doubt on the notion that SSRIs really take weeks to build up to therapeutic levels. If the results are confirmed with subsequent experiments, then our understanding of these medications will be greatly enhanced. Observing the neurochemical mechanism behind specific SSRIs will naturally lead to more beneficial prescribing patterns and better patient outcomes.

In a study of the SSRI Celexa, 26 participants were given either a single dose of the drug or a dose of placebo, a harmless sugar pill. None of the participants had depression, a fact which allowed researchers to study specific physiologic responses without interference. Three hours later, participants were shown images of frightened faces while brain activity in their amygdala was measured via magnetic resonance imaging. Psychiatrists have theorized that hyperactivity in the amygdala is a measurable effect of depression that places the individual in a constant state of heightened anxiety. In the single-dose Celexa study, participants given medication showed a muted response in their amygdala when viewing frightened or anxious faces. Researchers observed a spike in amygdala activity in those who received placebo. These findings demonstrate that potentially therapeutic effects begin as quickly as a few hours after the first dose of Celexa, and by extension any SSRI. Interestingly, none of the participants reported either a change in mood or unusual side effects. The study authors theorize that the action on the amygdala has both immediate benefits on an unconscious level and longer term effects on anxiety.

Depression is often described as a constellation of symptoms and effects. Because of its many manifestations, the disease is a long way from being fully understood. There is currently no fool-proof, one-size-fits-all treatment for depression. Research on antidepressant medications like Celexa helps us identify what’s happening in the depressed brain. Armed with that knowledge, we can tailor more effective medications in the future. The study under discussion, for example, highlights the possibility that Celexa’s beneficial effects begin with the amygdala, the brain’s primitive fear center. More importantly, these effects begin almost immediately, contrary to previous assumptions.

References
Murphy, S., Norbury, R., O’Sullivan, U., Cowen, P., Harmer, C. (2009). Effect of a single dose of citalopram on amygdala response to emotional faces. British Journal of Psychiatry, 194(6), 535-540.

Close up of eyeIn my first piece, I said “we want to move into the place where meanings can reconstellate…we sit quietly, eyes lowered, with attention inside.” But what precisely are we paying attention to?

We are paying attention to the forming or coalescing of an internal phenomenon Gendlin calls bodily felt sensing (BFS) or bodily felt experiencing. Since BFS is a central concept in Gendlin’s philosophy (and is best grasped when sensed directly), I want to be clear conceptually about what it is and what it is not.

Gendlin’s construct of BFS is a holistic unity that cannot be divided into the traditional divisions of mind and body. If you are reading Gendlin from a Cartesian separate mind/separate body, it may take you some time to grasp how BFS is different. I think of it as the smallest indivisible microunit of experiential process.

Each of the descriptions below emphasizes different aspects of this central concept (the italics are mine).

“A felt sense typically forms in the trunk area of the body, as an unclear but tangible sensation. If attended to directly where it forms in the body, a felt sense can respond with new meanings, confirmed with shifts in the bodily feeling.” (Barnett, L. & Madison, G.)

Sills describes BFS as a kind of “global perception of the whole of arising process in any one moment of emergent experience – a sense of “all of it.” All those sensations, emotional tones, mental constructs, symbols and images that compose our self-constellations are directly experienced as an embodied and coherent whole.”

“A felt sense is not (only) a mental experience but a physical one. Physical. A bodily awareness of a situation or person or event. An internal aura that encompasses everything you feel and know about the given subject at a given time-encompasses it and communicates it to you all at once rather than detail by detail. A felt sense doesn’t come to you in the form of thoughts or words or other separate units, but as a single (though often puzzling and very complex) feeling.”(Gendlin, G., 1981)

At any moment, one can refer directly to an inwardly felt datum. Experiencing, in the mode of being directly referred to in this way, I term the “direct referent. … At first it may seem that experiencing is simply the inward sense of our body, its tension, or its well being. Yet, upon further reflection, we can notice that only in this direct sensing do we have the meanings of what we say and think. For, without our “feel” of the meaning, verbal symbols are only noises (or sound images of noises)..” (Gendlin, E. T., 1964)

“Focusing is a way of paying attention to one’s being-in-the-world, one’s interaction as it is experienced through the individual (but not separate) body. A felt sense is a temporary wave from the sea of being – it is understood as on-going process, not ‘internal content.’” This initially unclear bodily feeling is referred to as the ‘felt sense.’ It is physically felt, more than clearly defined emotion, and incorporates a whole constellation of this and other situations, now and other times, self and others, elaborated by language. By staying with a felt sense, a shift in meaning may eventually occur that brings a physically felt relief in the way the body holds that issue. (Madison, G.)

Although the content may be vague at first, with practice, the focuser (and the listener) can  identify the phenomenon of BFS distinctly. It is manifested in the quality and prosody of the focuser’s language. Also, BFS, carries within a potential to transform or to move, to “shift” as you come in contact with it. Further, it is accessed through the body, as an epiphenomenon of our experiencing self, yet cannot be localized in the physical body proper.

What BFS is NOT

It is not sheer emotion, yet includes emotions within it.

This “temporary wave, from the sea of being” is embedded in a worldview that has implications for our notions of relationality and communication, as I will explain in the next article.

References

  1. Barnett, L., Madison, G. (2012). Existential therapy (p.83). New York: Routledge,
    p. 83.
  2. Gendlin, G. (1981). Focusing (p. 33). New York: Bantam New Age Books.
  3. Gendlin, E. T. (1964). A theory of personality change.  In P. Worchel & D. Byrne (eds.), Personality change (pp. 100-148). New York: John Wiley & Sons. Retrieved from http://www.focusing.org/gendlin/docs/gol_2145.html
  4. Madison, G. www.gregmadison.net.focusing_way_being.
  5. Sills, M. (2006). “In this body, a fathom long…” In J. Corrigall, H. Payne, H. Wilkinson (eds.), About a body, working with the embodied mind in psychotherapy (pp. 199-213). New York: Routledge.

Cognitive fusion is a process that involves attaching a thought to an experience. Cognitive fusion is beneficial in many ways. Through the process of cognitive fusion, people can become interested in story lines in movies and books because they attach their emotions to the events. Hobbies that elicit positive feelings can be enhanced as a result of cognitive fusion as well. Even feelings of love can be influenced by cognitive fusion. But this process can also impair behavior in individuals with certain psychological issues. People who struggle with anxiety and depression experience negative thoughts that can prevent them from taking positive actions. For instance, when someone with depression focuses on feelings of worthlessness because they have been unable to overcome their depression, they may continue to avoid seeking help because of the perceived outcome. Individuals who suffer with anxiety also find themselves trapped by cognitive fusion when for instance, they believe they will panic if they are exposed to stressful situations, and therefore avoid all situations that could induce stress, even if they are necessary for recovery.

Understanding how cognitive fusion affects mental health is a relatively new area of research. Acceptance and commitment therapy (ACT) is a mindfulness-based therapeutic approach that teaches clients how to accept negative feelings independently of perceived outcome. Therefore, ACT and other mindfulness techniques aim to teach cognitive de-fusion. Because there is little evidence exploring this, Kristen N. Herzberg of the Department of Psychology at the University at Albany of the State University of New York, recently conducted a study that employed a new tool to measure the effectiveness of ACT on cognitive fusion.

Herzberg and her colleagues developed the Believability of Anxious Feelings and Thoughts Questionnaire (BAFT) and administered it to over 900 individuals, half of whom struggle with extreme anxiety, undergoing 12 weeks of internet ACT treatment. She found that BAFT was quite accurate at identifying levels of cognitive fusion. Specifically, the BAFT was able to measure anxiety sensitivity, avoidance, and cognitive de-fusion in the participants. The results also showed that the anxious participants saw significant reductions in avoidant behaviors after completing the cognitive fusion–targeted ACT program. Herzberg added, “Taken together, these findings suggest the BAFT to be a reliable, valid, and useful measure of cognitive fusion.”

Reference:
Herzberg, K. N., Sheppard, S. C., Forsyth, J. P., Credé, M., Earleywine, M., Eifert, G. H. (2012). The Believability of Anxious Feelings and Thoughts Questionnaire (BAFT): A psychometric evaluation of cognitive fusion in a nonclinical and highly anxious community sample. Psychological Assessment. Advance online publication. doi: 10.1037/a0027782

Open coconut and flowerSaturday April 28th was my 11th Ocha Birthday. That is to say it was the anniversary of my initiation as a Yoruba/Lucumi Priest  of Obatala (April 28, 2001). To me, it’s as important a date as my natal birthday. Traditionally, to mark the anniversary, we purchase food and cook for the Orishas (the divinities we worship), read each Orisha we have with Obi (4 quarters of coconut), and generally strive to have a peaceful and meditative day. Sometimes, if possible, we open our homes to other Orisha Priests to come and salute our Orishas and to offer their blessings. Since I was in a somewhat isolated location, I chose to spend the day with only one other person (my significant other).

My experience on the day of my anniversary was a very positive one. The Orishas were basically happy and were satisfied with my offerings of fruit, candy, and in some instances the food I had prepared for them. One or two wanted a bit more but nothing complicated.

Spending this day basically on my own, taking the risk of reading my Orishas on my own (previously I always had someone else do it) was a real boost to my confidence. I also prayed and sang and felt the presence of spirit. It reaffirmed for me that I was truly blessed. I felt truly grateful that the Orishas had guided me to them and had chosen me as their child.

Now I know this must sound kind of confusing to many of you; maybe even a little bit alarming. My religion is virtually unknown by many if not most Americans, despite the fact that there are millions of observers worldwide.  But my specific belief system is not the point of this article.

What I have in my life at this time in my life (I’m an Elder) is a solid foundation of faith, which is something I have never had before. I trust in the divinities to guide me, and I do what they say as I learn through divination. I feel protected and held. I have support and love that is unconditional. The Orishas are patient and giving as long as you are respectful and follow their advice (if you don’t, there can be consequences).

What this faith has done for me after decades of psychotherapy is help me heal. In treatment I gained a great deal of understanding, and the relationship with my therapists was healing in itself. There is great value in it. However, it was and is my faith that has taken me to the next level where I was able to finally forgive those who had wronged me; where I was able to either let go of or moderate my fear; and where I was able to accept myself and others as I am/they are.

For most of my life, psychotherapy was my higher power. That is different now. As I observe the patients I treat in my practice, I see that those who have some spiritual connection are those that make the most significant and lasting progress. Those that are what I would call spiritually bankrupt struggle the most for the longest.

People come to me knowing of my dual credentials as Psychotherapist and Ordained Yoruba/Lucumi Priest, and even though we talk about the issues and problems of the day, I believe some at least are seeking help in connecting to their spiritual selves. When they state this outright, I work with them on this. Otherwise, I am very patient.

Related articles:
Part 3: Source Energy Optimizes Life—Escalating Source Energy Through Trauma Resolution
Spirituality and Therapy: Opening the Portal with Prayer
Turning It Over

Japanese bridgeTherapy as a sacred ritual might sound a bit pompous to some. After all, therapy is often considered something of a “have to,” not a “want to.” I would like to consider that therapy is something other than a way out of struggle, depression, and pain. My clients teach me each week that something beautiful is explored, born, or manifested in our weekly get-togethers. As they make their weekly voyage to therapy, they pledge to themselves the opportunity to discover the full range of their experience.

Like a good cup of coffee in the morning, therapy is like a morning jog-so-you-can-get-going kind of ritual. Whether writing morning pages in our journals to scribe our thoughts, or pulling the garden vegetables from the earth for tonight’s dinner, therapy has its place in our lives. It is like sacred nourishment for our soul. It is a commitment to understanding ourselves more intimately, completely, and thoroughly, by doing our weekly sit-in with our therapist.

As my clients cross the threshold of becoming, I see the meaning therapy has become to them and the rituals that they encounter.

Setting the Stage
Upon making the first appointment, it has begun. The ritual begins with a friendly, “Hi, how are you.” The client’s “call” embarks on finding a therapist who will see, feel, and hear them most authentically. They seek to connect their experience with someone who will honor and embrace them. Testing the waters, they may begin with a brief explanation of their story in a “give and take” sort of fashion until a connection is made. Upon feeling a spark, the conversation deepens, which consummates an appointment. This reciprocal dance begins the sacred ritual of setting the stage of meeting, time, and place.

Entering Sacred Space
After arriving, entering the room, closing the door, and with sacred agreements signed, both the client and I begin entering into the depth of what will be shared and discovered. While sitting in front of me and releasing the tension, the client intimately begins the next ritual. The sacred opportunity to be fully seen, heard, and felt has begun. Time and space become a blessed opportunity away from tiring commitments, chores, and obligations. There is sacredness in saying the unsaid and feeling the unfelt before me as their therapist. A trust begins to unfurl as the holy journey to revealing and expanding is explored. Highs and lows, struggles and gains, celebrations and sorrows are all fruit for the harvesting. As my clients explore the depths of their experience, I enter my role of providing safety, empathy, and challenge. Each week, building on the last session, the client and I meet with a greeting and enter into sacred space.

Bridging the Gap
Often clients enter therapy with some blockage to unravel, relationship to untangle, or goal to achieve. As we work through the existing sludge to get to the other side of their desire, I notice that my role vacillates among many. The roles of mentor, educator, and guide work many vantage points to include inner-child work, adult development, and familial understanding. The gap of our work together contracts and expands as we discern emotional terrain, physical symptoms, and insight. Weekly, as we deepen, each of these becomes a sacred practice. Commitment to healing, commitment to knowing, and commitment to discovery become not only tasks, but a revered journey. Our deepening relationship begins to transform, soften, and deepen. There is a sacredness in the reciprocity and trust which now gather their place at the altar of unfolding.

Packing Up
As the merger of relationship between the client and therapist expands and deepens within the context of an hour, there must be time to choose the “take with” nuggets of insight and knowledge gained. Much like camping in the park, we sort through, pack up, and continue our journey back to the familiar. Reflecting, we ponder the sacred meaning of this particular hour. The client and I ask ourselves, “What did we learn?” We take a look back and gather threads of awareness and pieces of clarity as we seek to create meaning of this experience. Moments are given to encapsulate the importance of the discovery by way of closing statements, new visions, and take-home assignments. As the hour quickly ends, the door opens and we say our goodbyes. The sacred journey ends and begins with hope and uncertainty as we look forward to unfolding, yet again, what is to become of our meeting together.

Related articles:
Healing Through Expressive Arts Therapy
Therapy for Self Growth

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