The leadership structure of a group therapy environment has a direct influence on how the participants respond, according to a new study led by Dennis M. Kivlighan, Jr. of the Department of Higher Education and Special Education at the University of Maryland in College Park. “Co-leadership describes a group therapy leadership structure in which two therapists are partnered to facilitate meaningful interactions among group members,” said Kivlighan. “Today, co-leadership is a widely used leadership structure across various mental health, and is often utilized in the training of group psychotherapists.” Leadership structure can have advantages for a group, but can also have disadvantages. Kivlighan said, “For example, large groups often out-perform small group including time, energy, and expertise. Unfortunately, in larger groups, there is also more conflict, absenteeism, and less cooperation than in smaller groups.” He added, “Finally, members of large groups are less satisfied with their group.”

In an effort to identify which structure best supports positive group therapy outcomes, Kivlighan and his colleagues evaluated the interaction between leaders and adolescents in 32 group therapy clusters. The groups had as little as 3 members and as many as 12, and were assessed based on participant satisfaction and overall climate. The team found that members of larger groups participated less than members of smaller groups, except when they were co-led. “In the current study, consistent with our first set of hypotheses regarding group leadership structure, we found some potential advantages of co-leadership over leadership by an individual therapist,” said Kivlighan. “Specifically, group members in co-led groups reported greater benefits of therapy than those in individually led groups, as well as significant interactions of group leadership structure and group size in relationship to avoidance and relationship with the group.” Kivlighan added, “These results suggest that co-led groups have several advantages over individually led groups.”

Reference:
Kivlighan, D. M., Jr., London, K., & Miles, J. R. (2011, November 21). Are Two Heads Better Than One? The Relationship Between Number of Group Leaders and Group Members, and Group Climate and Group Member Benefit From Therapy. Group dynamics: Theory, Research and Practice. Advance online publication. doi: 10.1037/a0026242

Sharing emotional experiences, or engaging in emotional disclosure, can be a cathartic process, resulting in reductions in stress, anxiety and tension. “In an opposite manner, the active concealment of distressing information is associated with psychological distress and physical symptoms such as headaches and backaches,” said Angela M. Garrison of the Department of Counselor Education and Counselor Psychology at Western Michigan University. Similarly, people with depression or anxiety often suppress their emotions to avoid facing negative feelings. Research has shown that individuals who have attachment issues struggle with emotional disclosure as well. Because emotional disclosure is so closely linked to depression and attachment, it is difficult to determine how each condition affects emotional regulation. “Specifically, depression symptoms and attachment are both associated with emotional disclosure, but depression symptoms and attachment are also related to each other,” said Garrison, lead author of a recent study on emotional disclosure. “For theory clarification, it is therefore important to disentangle the effect of depression symptoms on emotional disclosure from the potential effects of attachment on emotional disclosure.”

In order to isolate the effects, Garrison and her colleagues assessed 121 college students for depression and attachment problems, as well as emotional disclosure using a daily diary for seven days. “Results indicated that depression symptoms were negatively related to generalized disclosure tendencies and to intra-individual daily intensity-disclosure slopes,” said Garrison. “Attachment avoidance was negatively related to both generalized disclosure tendencies and to daily disclosure, and attachment anxiety moderated the relation between daily event intensity and disclosure.” She believes clinicians should be aware that a depressed client may need encouragement to disclose particularly difficult emotions. “Knowing this may enable clinicians to encourage these clients to talk about their emotions even when their initial reaction is to not share their feelings.” She added, “It may also be important for clinicians to encourage disclosure differently in clients who are avoidantly or anxiously attached given that recent research has supported the notion that attachment orientation does impact clients’ levels and patterns of disclosure in psychotherapy.”

Reference:
Garrison, A. M., Kahn, J. H., Sauer, E. M., & Florczak, M. A. (2011, November 7). Disentangling the Effects of Depression Symptoms and Adult Attachment on Emotional Disclosure. Journal of Counseling Psychology. Advance online publication. doi: 10.1037/a0026132

Therapeutic immediacy (TI) is a term used to encompass any discussion between a client and therapist during a session. The therapeutic alliance formed between the two parties as a result of the discussion is fundamental to the success of treatment. “Recently, in order to capture the more interactive and dyadic nature of the therapeutic relationship, this definition has been broadened to also include any client-initiated disclosures of feelings about the therapist or their relationship, and the revised term of therapeutic immediacy has been suggested,” said Jason Mayotte-Blum of the Derner Institute of Advanced Psychological Studies at Adelphi University, and lead author of a recent study on the effect of TI. “Typical examples of therapeutic immediacy include exploring parallels between external relationships and the therapy relationship; client or therapist expression of in-session emotional reactions; inquiring about the client’s reactions to therapy; the therapist commenting on his or her experience of the client; supporting, affirming, and validating the client’s feelings in the therapy relationship; and expressing gratitude. Use of therapeutic immediacy in the therapeutic relationship can then act as a template for interpersonal functioning in the client’s outside relationships.”

Mayotte-Blum analyzed data from two case studies for his recent study. In both instances, the clients and therapists were not told that TI was the focus of the study. Mayotte-Blum and his colleagues examined data from 16 sessions over a four-year period and found that TI was used quite often by both the therapist and the client. Mayotte-Blum said, “Session excerpts of therapeutic immediacy identified prominent areas of treatment focus such as (a) the building of trust, mutual respect, and recognition of deep feelings with a male figure; (b) the generation of new relational templates and skills related to in-session discussion of the therapeutic relationship; and (c) Ann’s [client] increasing ability to tolerate intense affect such as sadness and anger.” He added, “Although it is unclear to what extent the use of immediacy was responsible for these therapeutic gains, we can surmise from these direct client reports that the use of immediacy was at least experienced as a positive and facilitative intervention during their treatment.”

Reference:
Mayotte-Blum, J., Slavin-Mulford, J., Lehmann, M., Pesale, F., Becker-Matero, N., & Hilsenroth, M. (2011, November 7). Therapeutic Immediacy Across Long-Term Psychodynamic Psychotherapy: An Evidence-Based Case Study. Journal of Counseling Psychology. Advance online publication. doi: 10.1037/a0026087

Man on cliff“Life will give you whatever experience is most helpful for the evolution of your consciousness. How do you know this is the experience you need? Because this is the experience you are having at this moment.” – Eckhart Tolle

If you are reading this, the demons haven’t won. Facing your demons is part of life. From the earliest moments when you might have been hungry and the breast or bottle wasn’t immediately available, to later life crises like divorce, death, job loss, financial hardship, illness, and other challenges, everyone is beset with demons. When things are particularly rough, it may seem as if the demons are winning. But as long as you’re still living and breathing, you are the victor.

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It’s important to remember just how resilient you are, especially in the midst of an invasion. When I say invasion, I mean those times when you feel so overwhelmed by life you think you simply can not stand another minute; when the emotional pain, grief, or hopelessness is all you can see. At those moments, it is crucial to remember how time-limited everything really is, including you.

Demons are excellent shape-shifters and can morph from one torturous form to another in the blink of an eye. A few of the guises they assume include:

Even if you live a long life, it will still be a relatively short span in the body. Being incarnate is fraught with all sorts of experiences. When the less appealing ones visit, it’s best to welcome them with open arms, as counter-intuitive as that may seem. By denying what is really happening for you, or repressing your feelings with addictions or unhealthy habits, you forgo the opportunity to grow. You miss the chance to spar with scary thoughts, ugly impulses, or overwhelming grief, all of which move you into a more evolved and compassionate place.

There are still many people out there, and I don’t mean drug dealers, who will offer you a way around your misery. Advertisers will tell you life can be rosy if only you buy X, Y, or Z. Some New-Agers will claim a quick way to nirvana, and there are myriad options for dulling one’s pain with obsessive-compulsive behaviors of all kinds. Don’t be beguiled by their dog and pony show. Who would turn away an easy way out from pain? Sign me up! I’d love to think there was some quick panacea. Although, after 40 years of studying psychology, religion, and philosophy, I truly believe the only way out is through.

That does not mean you have to weather every storm alone. This is the time to ask for and graciously accept help. Whether it is from a friend, relative, therapist, hotline, clergy-person, or 12-step group, please avail yourself of any support you can. That many of us were brought up with that old Calvinist ethic of independence and self-sufficiency does not mean we are limited in our healing options. If you were traveling west in a covered wagon then you definitely needed to be one tough cookie. But most modern folks are not braving a physical, material wilderness.

In some accounts, when the Buddha was under the Bodhi tree seeking enlightenment, the demons came. He tried to fight them off for days. Finally, realizing that, at best, they would reach an impasse, he invited them to sit with him. I like to think of this as the Buddha inviting his demons to tea. Take a page from the Buddha’s book and befriend your demons. Undoubtedly, you will learn something, and develop more resilience in the process.

Jung, Sigmund Freud‘s disciple, believed each of us has a shadow side and we need to embrace it to be fully human, alive, and whole. By inviting your demons to tea, you establish ownership of your shadow. You bravely go where many fear to tread. You have the guts to face your anger, fear, jealousy, lack of self-acceptance, guilt, and anything else you deem unacceptable.

By dancing with the demons you reclaim your power. If you keep trying to bury them, you unconsciously feed each one and it comes out in projection, attributing all your own issues to others. Everyone does this to some degree, but being unaware of doing it is problematic.

It takes guts to face your demons. Luckily, everyone has the innate capacity to tread this rocky path, and already has. Have you been ill? Divorced? Child of divorced parents? Child of an alcoholic or addict? Moved to a place where you knew no one? Weathered a financial storm? Been estranged from family? Experienced the death of a loved one? If so, you faced your demons.

You courageously soldiered on. It was not easy or fun, but you persevered, even when you thought the pain would never stop. Slowly but surely, it abated. At first, you may not have even noticed the subtle lessening of your anger, anxiety, or grief, but as the weeks and months wore on you started to feel more alive and open. That resiliency supports you through every challenge, allowing you to stretch beyond what you thought your limits were, and finding more capacity to bear what you thought was unbearable.

You are here for the whole enchilada, not just the kittens and rainbows. The sooner you embrace the totality of life with its highs, lows, and everything in between, the sooner you will find some measure of peace. Practicing affirmations, self-soothing thoughts, or a comforting prayer or mantra, will ease you through those trying times everyone has.

No one is exempt, no matter what their life looks like, or what story they tell you. Every life is mix of treasures and traumas. By persevering, speaking lovingly to yourself when the going gets rough, and assuming the best, you will make it to the other side.

Just like all the molecules in you and around you, things are constantly moving and shifting. Whatever you feel at this moment won’t last. It can’t. That’s what makes life so interesting and bittersweet. By embracing the vicissitudes of life with compassion for yourself and others, you allow yourself to fully experience whatever is happening to you right now. Yes, this is also known as mindfulness, acceptance, and liberation.

eiffeltowerPerhaps youʼve come across one of the many articles or videos with titles like, “In Love with the Eiffel Tower”, or a recent National Geographic Taboo program called “Forbidden Love?” The topic is Objectum Sexuality (OS), a rare sexual orientation which includes affectionate, romantic, and sometimes erotic attraction and relationships with objects. The beloved objects can range from transport to landmarks, from sporting equipment to fisheye buttons.

Such stories may make us shake our heads and mutter, “How can this be?” Are these people delusional, or worse – dangerous? How seriously should we take these stories, and the people who are featured in them?

In April 2009, my interest in autism and Aspergerʼs Syndrome (AS) sexuality led me to contact OS-Internationale, an organization of people who have relationships with objects. I had read on their website that a number of the organizationʼs members reported diagnoses of AS, or showed significant autism traits (while other members simply identified as animists). After some correspondence with Erika Eiffel, one of the most influential and well-known OS activists, I volunteered to do a sexological survey of the membership, so that they could have data to offer other interested professionals, as well as journalists.

I didnʼt know it at the time, but the accumulated information kindly provided by the 21 English-speaking members of OS-Internationale granted me a perspective unique among sexologists and mental health professionals. I suddenly became “the” expert in Objectum Sexuality – though obviously OS people are themselves the true experts on what it is like to live and love in this manner.

The most startling finding, from my perspective, is how natural object relationships feel to those who have this orientation. Most of the people I surveyed rejected the idea of human-to-human romance, and many have never had a desire to experience it. Only two people reported having a sexual human relationship in addition to object loves.

Other findings: A history of sexual trauma does not seem to cause OS – only a couple of respondents reported abuse. And aside from Aspergerʼs Syndrome and autism diagnoses, one case of Tourettes, and two cases of PTSD – object lovers are a fairly balanced bunch. Though some respondents mentioned feeling anxiety and depression due to social ostracism, all but one person said they were happy with their orientation toward object relationships.

And itʼs not because object relationships are simple, either. These relationships include jealousy, breakups, and the heartbreak of unrequited love (especially when the object is an inaccessible public landmark or large piece of public transportation) as well as blissful love. Some people who love objects are monogamous, and others are not.

And when two or more people love the same public object, this too requires a complex negotiation within the human community. You can read more about this research in “Love Among the Objectum Sexuals” in the Electronic Journal of Human Sexuality (vol. 13).

At first I saw autism as containing the most likely explanation for Objectum Sexuality – but this didnʼt account for the people who were adamant that they were not autistic! I knew there had to be some other explanation, or collection of explanations, to account for the feelings of “this is whatʼs natural for me!” held by so many OS people.

Then I happened across an article about object personification synesthesia and realized that if a person senses a pleasing personality in, say, a teapot – it is logical that a person may develop warm feelings for that object, and warm feelings may grow even warmer over time. Humans, being what they are, are capable of eroticizing nearly anything.

Interestingly, synesthesia is also known to be more prevalent among people with autism.

Voila! Object personification synesthesia emerged for me as an area of exploration! About a year later I followed up the first OS survey with a second, shorter one. Many respondents did report various synesthesia-like experiences, including sensing personalities in objects. I am convinced that this area merits more research. My modest (self-funded) efforts can only offer an intriguing glimpse into this mystery of love and brain function. A clever group of well-funded researchers could do so much more.

In the meantime, people who identify as OS have the same needs as the rest of us, and share much in common with other sexual and gender minorities. They need acceptance and understanding from informed helping professionals. They need help dealing with social discrimination, grieving, and all the usual developmental challenges we face in life. OS people ask for the same right to live and love as human-loving humans do, and for access to help as they need it.

OS people, and their lovers, may seem improbable to many of us. But it is my belief that they are not part of a circus side-show, far down the midway, but that they too are in the big tent of trying to make sense of it all. Their erotic and emotional preferences may be rare, but they are real.

As a sexologist, I see the need for professional training in understanding OS, and will begin to offer online classes on this topic next week. While you may never have an OS client yourself, I guarantee that making the effort to understand this group will pay off in expanding your concepts of love and  intimacy.

So, is it love? Or is it object personification synesthesia? My answer is: it’s most likely both.

Related Articles:

What Do Your Sexual Fantasies Mean?
An Introduction to Clinical Sexology
Writing Your Personal Manifesto

angry coworkersSometimes co-dependents may be identified by their behavior in the workplace. You may think that is impossible, because co-dependents tend to be good employees. They work harder than anyone else, they anticipate the needs of management and the are very dependable. However, there are two types of behavior that often identify them. The first type of behavior may be identified by management and, in some instances, the referral to the Employee Assistance Program may be on a mandatory basis. The second type of behavior generally comes in as a self referral unless it is extreme.

The first type of behavior involves problems with co-workers. The co-workers may complain that the employee is always angry and very stressed. The employee may be bossy, withdrawn or very short with them.. This comes to the manager’s attention and he or she refers them to the Employee Assistance Program. Why does the co-dependent person behave this way? If you remember the first two articles describing how co-dependents are affected in adulthood, you’ll recall that they feel responsible for everybody and everything. They think that it is their job to make certain that everything gets accomplished even if they are not managers. In order to ensure that everything gets done, they over-function. Of course, they expect everybody else to do the same. When people do not, then the co-dependent becomes very resentful. The co-workers can sense the co-dependent’s annoyance. Sometimes, even though it is not their job, the co-dependent may give other workers suggestions. They may also constantly complain to management, implying that the manager is not doing their job. That may or may not be true, but managers do not want that to be implied, especially by someone who reports to them. Occasionally, with this type of problem, the employee may experience enough anxiety or anger, that they decide to seek help, before they are sent to EAP.

The second type of behavior involves a meltdown. This is when the co-dependent becomes extremely upset at work. They may start crying and not stop. They may get so angry that they shout at other people. It may be a co-worker, or it may even be the boss. The co-dependent may be sent home to recover. Sometimes the manager may say to the employee something like, “If you are having some personal issues, the company provides an Employee Assistance Program to help employees with things like that. Or, if the meltdown is severe enough, the co-dependent may finally realize that they could use a little help.

So, what causes such a meltdown? The answer is similar to the last paragraph. Remember that the co-dependent feels that it is their personal responsibility to ensure that everything gets done. If work is behind, they work faster and faster and try to get the impossible done. They may work through breaks and lunch or dinner and come early and stay late. Of course, they would never ask for help because they do not believe that it is okay to do so. They also constrict their anger, frustration and worry until it is coming out of their ears. Just like a pressure cooker or a volcano, they eventually explode. Out comes all the constricted feelings, and to someone who doesn’t know what is happening, it can look pretty scary. Occasionally, I have had managers bring the employee right to our offices, because they are afraid to send them home.

Generally, when the employee comes to see me, we are quickly able to identify that they comes from a dysfunctional family. We identify how they are affected. and try to work on some of their irrational beliefs. They try to figure out what is and what is not their responsibility. This gives them quite a sense of relief. Then we work on the fact that they are powerless over other people, places, and things. Then, we redirect some of the energy they expend trying futilely to control others into working on taking better care of themselves. In just a short period of time they feel dramatically better.

The next article will begin a workbook on healing the co-dependent within us.

Related Articles:
Part I: How Co-Dependents Come into Therapy
Part II – How Co-Dependents Come to Therapy – Teens

Young man with long hair, beard, and headband running down country road in red and white tee shirt, breathing heavilyAs marathon runners pass mile after mile, many reach a point where they suddenly feel that they cannot go on. They may feel an unimaginable weight come over their body, a depletion of mental and emotional resources so complete that they can’t imagine taking another stride.  They have “hit the wall.”

A similar phenomenon can occur in therapy. You may enter therapy with the commitment and determination of a runner who has just begun to train for a marathon. Then, just as suddenly and inexplicably as a runner hits the wall, you may, at some point, feel unable to move forward in therapy. You may feel like you have painstakingly explored each and every issue that brought you into therapy, but that your life has yet to change and you are no better equipped to make decisions or take actions than when you entered therapy. You have “hit the wall” in your therapy work.

It is important to acknowledge that things likely have changed for you—the changes just might not be dramatic or easily noticeable.  Say, for example, you entered therapy because you feel a great deal of loneliness and have trouble maintaining relationships. After a few months in therapy, your loneliness has likely decreased somewhat, simply as the result of having a solid and stable relationship with your therapist: a relationship that you are maintaining.

So while you still may not have an intimate partner to go home to on a daily basis, you may feel a bit less lonely and might have developed some new relationship-building skills. This kind of progress may seem quite small and insignificant, but it represents the necessary foundation for achieving the ultimate goal of developing healthy, fulfilling and lasting relationships. The question then becomes: how can you break through this wall and continue making progress towards your goals?

First, talk to your therapist about your frustration with therapy. You won’t be the first person who has expressed frustration with the process and you won’t be the last. A good therapist is not going to take this personally or be offended; they will view it as a natural part of the therapy process. This conversation creates an opportunity for you and your therapist to explore the smaller changes that have occurred and put them into the context of the bigger picture. This may be enough, in and of itself, to get you moving again and break through the wall.  If it is not, your therapist may be able to suggest some different interventions that can be effective in moving therapy forward.

One such intervention might be bibliotherapy. Your therapist could suggest a book that might be useful to you, then, in subsequent sessions, explore your thoughts and feelings about the book. At first glance this may seem a bit like a really expensive book club, however, the book your therapist recommends will be a book that deals with the primary issues that brought you into therapy. The conversations in your sessions will be very focused on how your thoughts and feelings about book relate to your own issues. Therapy can, at times, be quite painful, and you can grow weary of constantly talking about yourself. Bibliotherapy affords you the luxury of being able to talk about yourself through a book, and can be a strong force in breaking through the wall.

Another possible intervention is dream analysis. Whether you view dreams as being a window into the subconscious, like Freud, or simply as your brain’s way of continuing to work through your thoughts, feelings, and events of the day as you sleep, they can certainly provide grist for the mill. If you and your therapist opt to use this intervention, you will likely be asked to keep a notepad and pen at your bedside. As you awake, you will immediately begin to write down the dream that you just had. Like, bibliotherapy, you will bring this into your next session and work through it with your therapist. Exploring your dreams and discussing possible meanings may be just what is needed to break through the wall and take your therapy to the next level.

Journaling is another potential way to break the wall. Your therapist may ask you to keep a small journal with you at all times. Record any strong thoughts, feelings, or experiences throughout your day. You may also be asked to set aside some time each day to write in your journal. Like both of the previously mentioned interventions, you will bring this into therapy, explore the content of your journal, and discuss how it relates to some of the concerns that led you to therapy in the first place. It can provide new material to draw upon in order to push yourself through the wall and into a more productive place.

There are myriad other interventions that can provide the nudge you need to break through the therapy wall. Like anything else in therapy, there is no “one size fits all” approach, so don’t be shy in telling your therapist what is and is not working. Remain open to the process and give honest feedback to your therapist about the interventions being used. You will almost certainly break through the wall, continue the work of therapy, and experience the joy of living the freer and more fulfilling life you deserve.

Worried woman with arm around sad manA person I’ve been close to for many years is going through the dying process. It has been slow and painful; at times evoking one of the most beautiful and poignant musical pieces I’ve ever encountered. It is “Agnus Dei” by Samuel Barber, a choral version of his beloved and well-known “Adagio for Strings.” The text is from the Latin mass and includes the phrase, “Have mercy on us.”

Now, mercifully, there is an end in sight for my loved one, but for those she leaves behind, the grief is palpable—at times dull and weighty, at others raw and biting, and frequently overwhelming.

Those who have gone or are going through the grieving process know how often all of our psychic resources are consumed with just getting through another day. It can feel like there is no room for creativity—only emptiness. But grieving presents an opportunity for both creativity and renewal; just as we have been changed by the relationship with our loved one, we will also be changed by the process of navigating through grief.

The weight of grief often feels like being imprisoned. One might wonder whether the pain will ever cease, and sometimes the restoration to function fully and enjoy life can seem far away. I imagine that it’s much like the feeling of a condemned prisoner.

I am reminded of the struggle of Viktor Frankl, an Austrian psychiatrist who founded the discipline of logotherapy (a therapy based on existentialism—not the nihilist variety of much existentialist literature, but one founded in hope and understanding of the power of the individual to find meaning in suffering).

[fat_widget_grief_right]Frankl was imprisoned in four German concentration camps during World War II. He was initially accorded an elevated status because he was a doctor, but eventually he was consigned to the life of an ordinary inmate, not knowing what the outcome of each day would bring. Frankl refused to accept that he might not survive the camps. Realizing the power of thought and creative visualization, he resolved to envision a positive outcome to his ordeal. It was out of this experience that logotherapy was born.

Later, Frankl wrote a small, but powerful, book, titled Man’s Search for Meaning, in which he outlined his struggle and how—through the power of visualization—he triumphed over despair. Part one is devoted to sharing his personal story with the reader, and the second part discusses the essential questions that form the basis of logotherapy: “What is the meaning of this experience for me?” and “How can I have hope for the future?”

Frankl believed that the process of finding answers to these questions would provide a foundation for coping with adversity and a path toward living a more full and fruitful life. This allows for a person to be changed by the experience of their journey. A person can reinvent an understanding of both the journey’s significance and of personal capacity and strength.

Herein lies the connection between grief and creativity. Working through the meaning of the loss creates not only a new self-concept, but also a new worldview.

I often utilize logotherapy in my sessions with people who are dealing with painful issues related to death and dying, grief and loss, adjustment to illness and disability, and caregiver stress. Utilizing the core questions involved in the re-creation of one’s understanding of suffering and the meaning of life has often been equally helpful to those who believe in an afterlife or a higher purpose and those whose envision our mortal life as finite with no overarching meaning. Although I believe this work is difficult to do without the help of a trained professional, merely asking the questions—such as “What does this mean to me?”, “How am I changed by this experience?”, and “How can I go on?”—sets the framework for conceptualizing a beginning, middle, and ultimate ending to the grief process.

If you are finding it difficult to cope with your own losses, perhaps seeking help from an experienced grief counselor who will be present for you, listen, ask the right questions, and guide you through the grief process would be useful. By all means, reach out to others in your support system. Remember that humans have great capacity for resilience, and the process of developing, recognizing, utilizing, and celebrating that resilience is a highly creative one.

It’s OK to be fully present with our sense of loss, but we should try not to lose sight of the promise of change or the expectation of renewal. You can see your way through this loss, and you may be re-created in a way that is most unexpected.

Reference:

  1. Frankl, V. (2006). Man’s search for meaning. Boston: Beacon Press.

learn to sit with discomfort in your lifeI have a confession to make: I do not believe you can feel happy 24/7, any more than you can feel anything every minute for your entire life. We are designed to feel a broad spectrum of emotions because, so far, they have kept us safe and helped perpetuate the human race.

We all know how something that feels bad can actually redound to your highest good in the future. But, being the hedonists I think we are designed to be, we naturally avoid pain and seek pleasure. What if sitting with discomfort helped us make peace with it—increased our frustration tolerance and our ability to accept life as it is?

As Albert Ellis used to say, it is a choice between short-term hedonism and long-term hedonism. If we forego the pleasure of the moment, we can reap greater benefits in the future. In today’s society, delaying gratification is not popular; however, when we learn to sit with what we don’t like, we can actually build emotional muscle and handle the next challenge with greater ease.

When we feel anxious, for example, our first inclination is often for relief, which usually consists of avoidance. We can distract ourselves with TV, video games, pornography, food, alcohol, drugs (including prescription psychotropics), gambling, and other things that may create new problems; or, we can do the last thing we instinctively gravitate toward: sit with the feeling. Yes, just allow it. Breathe into it. Can you feel the discomfort physically?  If so, notice its characteristics. Is your breathing shallow? Is your back tense? Do you feel a headache coming on? Is your jaw clenched? Are your shoulders hunched up? Is your abdomen tight? Breathe into whatever you notice.

[fat_widget_right]Give yourself permission to feel your feelings. With practice, it may help you accept yourself and your reality. By resting in awareness, you stop fighting what is true for you now and open to the possibility that it is all OK. You can handle what you do not like.

Many intelligent and insightful souls—such as the Buddha, Ram Dass, and Eckhart Tolle—have encouraged us to be here now. That means being with whatever comes up. Your job is not to like everything, but to be aware and open. Luckily, this becomes easier when you remind yourself that everything passes—the pleasant and the unpleasant.

It is crucial to understand that the goal here is not to figure out why you are feeling what you are feeling, but to stay with the discomfort. You may even want to cultivate some curiosity about what you are feeling.

Granted, mindfulness practice is counter-intuitive, but when you are fully in the moment, you can relax into what is. Resisting your feelings often increases them and their power. No harm will come to you if you embrace your feelings, though it may be uncomfortable. In time, you may notice a feeling or sensation and, rather than avoid it, you can label and accept it. Another great benefit of this practice is that by gently and lovingly accepting where you are, you may become more compassionate with yourself and others.

Impermanence is the name of the game. Nothing lasts—good or bad. You may not care to remind yourself of that in the middle of an ice cream sundae (though it might make you more appreciative and increase your enjoyment), but it is helpful to remember when times are tough.

Once you allow yourself to be with what is true for you now, remember this quote from Haruki Murakami: “Pain is inevitable. Suffering is optional.” By resisting the urge to rate your feelings—or yourself as bad for having them—you will begin to know the peace that comes from acceptance, and your discomfort will not morph into suffering.

Here is an exercise to help you on your path to emotional freedom:

You can immerse yourself in Buddhist thought by reading books by Pema Chodron, and listening to podcasts on iTunes, such as: “A Quiet Mind,” “The I.D. Project,” or interviews on Sounds True.

Reference:

  1. Murakami, H., & Gabriel, P. (2008). What I talk about when I talk about running: A memoir. New York, NY: Alfred A. Knopf.

Close up of kissAs a unique form of short-term, complementary and alternative modality (CAM), clinical sexologists are largely under-recognized and under-used. Though it’s said we specialize in studying “what people do and how they feel about it,” sexology touches on everything from erotology to anthropology, law, medicine, psychology, anatomy and physiology (naturally!), gender studies, public policy, history, and so on. That’s because human sexual behavior is pervasive, it affects everything we collectively do and create. As a sexologist, my interests have included Asperger’s Syndrome and sexuality, Native Hawaiian sexual traditions, objectum sexuality, parenting transgender children, the effect of sensory dysfunction on sexual behavior, and the use of hypnosis to address sexual concerns. Almost anything can provide delightful grist for a perpetual, intellectual mill and this has been my joy. Sometimes useful clinical insights emerge from regarding artifacts or incidents through a sexological lens. However, even when there is no immediate clinical application, the overall effect is a deepened respect for the unstoppable and endlessly creative human engagement with eros.

For some, this process accelerates during a “unique baptism by fire” known as the Sexual Attitude Restructuring (SAR) process. At the Institute for Advanced Study of Human Sexuality in San Francisco (which pioneered SARs during an earlier incarnation as the National Sex Forum), this is no mere weekend of “Sexuality 101 and 201”. At IASHS, you are immersed for eight days in everything you always wanted to know about sex and possibly a whole lot of things you may wish you’d never seen. Explicit media and small group processing are integral aspects. The experience is intense. Even seasoned sexologists have been known to melt down. But a good SAR results in a near-unconditional acceptance of one’s own erotic quirks, and those of fellow human beings. One goal of SAR process is to discover exactly what aspects of human sexuality are personal turn-ons or turn-offs, so that clients are not harmed by the reactions of untrained clinicians. I can say, after having experienced two eight-day SARs, that my ability to hear just about anything is pretty good – and I know when and how to gracefully suggest a referral when out of my depth. For this reason, the American Association of Sex Educators, Counselors and Therapists (AASECT) requires a (briefer) SAR experience of everyone seeking certification through the organization.

AASECT certifies the separate categories of sex educator and sex counselor, but not the hybrid practice of clinical sexology, which does both. Though I have recently completed requirements for sex counselor certification, I am sorry my own professional category is invisible within an organization that has so many of us as members. However, I recognize the reasons for this. For one thing, standards for clinical training in sexology are not as defined or generally agreed upon as they should be. For another, right now in the public mind a “sexologist” may be anything from Masters & Jonson to a woman in lingerie groped in a darkened room during an episode of The Pick Up Artist.

However, clinical sexologists practice with Annon’s PLISSIT model: permission (P), limited information (LI), and specific suggestions (SS). We make referrals for intensive therapy (IT) if necessary. Our understanding of human sexual behavior is fostered by our training, which exceeds the sexuality education requirements of other professions. This depth enables us to attend to clients seeking techniques for sexual enrichment and/or short-term management of non-medical sexual problems. As complementary specialists, we work well in consultation with a range of licensed professionals. Within the ethical scope of our practice, we support sexual health, function, self-esteem, and the intimate capacities of our clients.

GoodTherapy | The Thin Line Between Diet and Eating DisorderLet’s face it, hardly anybody has a completely healthy relationship with food. Unfortunately for our society, disordered eating is the norm, whether it’s crash dieting, stress eating, or whatever else you want to call it. Because of this, it can be really hard for someone in danger of developing an eating disorder to recognize the slippery slope of the diet they’re on until they’re well on their way down. Clearly, not everyone who diets develops an eating disorder, but research does show that 35% of occasional dieters become pathological dieters, and as many as 25% of those diets will progress into full-blown eating disorders. So when does dieting become dangerous? What’s the difference between a diet and an eating disorder? Sometimes the line is an awfully thin one.

A typical diet begins with a longing to lose weight. Often, this longing is coupled with a genuine wish to improve overall health and nutrition. A typical diet ends when either the weight goal is achieved or the dieter stops due to some inadequacy of the regime—too many restrictions, too few calories, etc. An eating disorder often begins the same way—with a longing to lose weight. In fact, 80% to 90% of eating disorders begin with a diet … but that diet never ends. The transition from diet to disorder has no one purpose and no one cause.

While diets are about food and weight, eating disorders become much, much more than that. Food and weight become all-powerful, and people with eating disorders use both in an attempt to better their lives (by gaining a sense of control, numbing painful emotions, earning approval or acceptance, etc.). Eating disorders do not end when a weight goal is reached because a new one will always be set. One begins to believe and behave as if “the perfect body” is attainable, and will strive for this allusion no matter what. Over time, a person’s self-esteem and general outlook on life become dependent on weight and appearance. At that point, nothing else matters.

A common danger in assessment by a professional not familiar with eating disorders is that too much emphasis is placed on a person’s weight and other physical symptoms. While these factors are often good indicators of a problem, they are not always “alarming enough,” if present at all. Equally important, if not more important, are the symptoms that cannot be seen—the symptoms in the mind. The psychological disturbances that both cause and perpetuate eating disorders are often the most difficult to treat. It’s important to understand that although someone does not fit all the criteria for a specific eating disorder, such as anorexia, bulimia, or compulsive overeating, they can still be doing a great deal of damage to their body, mind, and soul.

In a world where not being on a diet is abnormal, and restraint is a sought-after skill, being healthy and loving your body can almost feel awkward. I’m reminded of a scene in the movie Mean Girls when new girl Cady enters public school for the first time after growing up in Africa for 16 years. While her new friends nitpick their appearances in the mirror, Cady muses to herself, “I used to think there was just fat and skinny. Apparently, there’s a lot of things that can be wrong with your body.“ It’s an unfortunate message, but a true one. The body-confident girls and guys are few and far between.

What about you? Are you balancing the thin line between diet and disorder? Do you feel preoccupied with food, weight, calories, or a desire to be thinner? Do you feel the need to rigidly control your food intake or exercise schedule?  Don’t let these obsessions rob you of another minute, day, or year of your life. Remember, you’re most beautiful when you are confident and accepting of yourself, just as you are. Then and only then will you be able to make positive, lasting changes in your life.

Upset woman with therapistYou’ve sat comfortably on your therapist’s couch for six months talking about everything under the sun; how you prefer to do your laundry, how nothing is ever good enough for your spouse, how irritating your mother is when she compares you to your older sister, how traffic makes you crazy.  You feel comforted, your feelings validated, your motivation lifted.  You walk out of there, pensive yet energetic, ready to face any challenge.  You feel like you are moving toward your goals with more clarity.

Then one day, it happens.  You’re feeling more depressed than usual, and you go to therapy.  As you talk about how sad you are today, you see a new look on your therapist’s face as she begins to ask you probing questions about your past.  You remember the first time you ever felt this sad, and the floodgates for unhappy memories are opened.  You begin to feel more depressed.  You feel quite horrendous, actually.  You feel like getting out of there, but your therapist encourages you to stay in your horrible feelings and explore them further.  The whole thing begs the question; “Why do I have to talk about this?” This is the first time you looked at your watch in session thinking, “Is this over yet or what?”

That day as you drive home from your session you begin to wonder how much therapy is really helping you, why you even decided to go in the first place, or perhaps that you really don’t need to be spending all this money on it when you could get massages instead and feel great every time.  You don’t feel the usual sense of clarity and optimism that you usually do after session.  Instead, you go home and take a long nap, more depressed than ever.

This is a common experience among therapy seekers.  At the six month mark, things begin to become difficult in therapy.  After six months to a year of consistent therapy, you and your therapist have developed a deep and strong enough relationship where he/she will begin to explore the more painful and therefore, more challenging to access material in your psyche.  Bad memories may start to surface, and emotions that pervaded your past may begin to show themselves again.  Believe it or not, this feeling like crap is a good thing!

Talking about painful material in therapy is beneficial because this brings the material into the present where it can be looked at and understood.  This is the time to feel uncomfortable so that your therapist can perform the psychological surgery that needs to happen for you to feel better later.  Draining an infection is never pleasant, but it is necessary.  Once the painful memories are out in the open, they begin to lose their power.  You feel less burdened by them as your therapist will help you carry their weight.  Verbalizing the emotions and sensations you feel as you remember helps your brain to better process the information, helping you to feel differently or change your perspective.

Much of how we feel, think and behave in the present relates back to the experiences we have already had.  Understanding the pain you carry, and why is an important tool for your therapist to have when working with you.  This enables your therapist to change how you feel, by understanding the root cause and then taking proper treatment channels.  These most unpleasant moments in therapy are the real work, and facing them is your most rewarding challenge.

 

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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.