New research suggests that stressful events may cause delayed increase in panic symptoms. Because the effect of stress on panic symptoms has not been studied extensively, researchers wanted to determine if people with panic problems experienced immediate increase or a gradual increase in symptoms following a stressful event. “We definitely expected the symptoms to get worse over time, but we also thought the symptoms would get worse right away,” said Ethan Moitra, a postdoctoral researcher in the Department of Psychiatry and Human Behavior at the Warren Alpert Medical School of Brown University. But the findings revealed that stress does not always cause an immediate panic attack. Dr. Martin Keller, principal investigator of the research and professor of psychiatry and human behavior, warns family members and clients to watch for signs of panic over the several months following the stressful event. (more…)

I recently ordered Deepak and Gotham Chopra’s book, The Seven Spiritual Laws of Superheroes on my iPad. I haven’t been this excited to read something since I read Carl Jung’s book The Archetypes many years ago.

Both books address the archetype of  “shadow.” Both Chopra and Jung describe shadow as a force of the unconscious that can be destructive, divisive, and self-sabotaging when it remains unconscious. Shadow is that part of the human condition, that most mortals attempt to ignore or deny in favor of a self-perception inflated or deflated by ego, neither of which can be sustained without some form of self-destruction. We see this in the lives of adult politicians, entertainers, and sports heroes who have been in the media lately for crimes of passion, adultery, and exploitation. The denial and repression of shadow has allowed ego to “act out” in blatant ways. Because shadow was repressed they thought they would never get caught or that they were somehow above the laws that govern the rest of us. Denial of shadow sets humans up to be destroyed.

In Chopra’s book, “shadow” is explored through the journey of the superhero. The superhero wrestles with the forces of good and evil. In doing so, the superhero recognizes that he or she has a shadow that possesses some of the very qualities that their enemies possess. The superhero embraces their shadow by getting in touch with it, bringing it to consciousness, developing compassion for themselves and thereby others, all in the mission of transforming dark, evil energies into creative, light energies of consciousness.

Jung explored the context of “shadow” through mythology and dreams. Mythological and dream characters, like superheroes are removed from mortal boundaries and expectations. They exist in landscapes where anything is possible. Joseph Campbell identified distinct steps of the Hero’s Journey that can provide a metaphor for our own life’s struggles. Metaphor can penetrate resistance and help us to gain insight into our experiences because the hero’s journey is one we can relate to and learn from.

Like many of us, the superhero often comes from a life of adversity. Chopra wrote that shadow can be found thriving in “abject conditions such as poverty, poor leadership, an ‘us versus them’ mentality, repression, deprivation, social injustice, torture, self-righteous morality, suppression of desire, fear, and conflict.” He goes on to explain, that the “shadow energy within us is destructive, divisive, and self-sabotaging.”

Chopra identified shadow as the “diabolical part of our soul.” How can we recognize our shadow? Shadow usually lurks behind our criticism of others. It is that nasty voice that identifies and picks at other people’s flaws. The funny thing is that the flaws that we see in others are often the same flaws that we ourselves possess. It is much harder to recognize this in ourselves but often easily recognizable in the folly of others. For example, have you ever heard someone who is very annoying because they never give anyone else a chance to talk, complain and go on and on about someone they encountered who does the very same thing? That is shadow, the super-villain, making an appearance.

Chopra says that we can see our shadow when we are in the light of consciousness. But first we have to recognize our shadow behavior before we can bring it into the light of consciousness. Once it is conscious we have power to choose to “act out”–meaning to continue destructive behavior that cuts off a vital source of creative energy–or to consciously stop “acting out” and transform the energy for a healthy, well-balanced existence. If we choose to do nothing, shadow will pounce when we least expect it and throw our lives into chaos and suffering.

On a fairly regular basis I am asked by a divorced parent how old their child must be before they can choose which parent they want to live with. Many parents tell me their child will be 12 years old, 13 years old, 14 years old soon and will be able to make their own decisions. They appear to be uniformly surprised to learn that a minor child does not have the legal right to decide which parent to live with.

Depending on the jurisdiction in which you live, the age of your child may matter only in terms of the weight a judge might give to a child’s preference, should he or she have one. In general, the older they are the more their preference might be considered. Their preferences are not usually considered in a vacuum, however. It could be that Susie might want to live with Dad because he is more lenient in his rules… He doesn’t make her go to church, let’s her stay out an hour later, doesn’t nag her about homework, etc. Or the preference might be because Mom is supportive of Joey’s desire to be on the soccer team or takes him to his horseback riding lessons or is excited about the dance program he is in. When Mom or Dad uniformly does not support a child’s activities when that activity spans the parenting time of both parents, it is not surprising to a judge that a child might have a preference. However, children rarely know all the details of how a parent decides to do something or what both parents talk about regarding their decisions. Sometimes the decisions are financially impacting one parent differently than the other. The child may only know that Mom or Dad is not taking them where they want to go but not that it is not affordable. Whatever the reason, by early to mid teens, a court is likely to take the child’s concerns into consideration in making an order while being very careful not to ask the child to make a decision and learning as much as possible about the context of that preference.

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I was very young when I knew I wanted to be a therapist. I became particularly interested in depression and how people deal with traumatic events. Never in a million years did I think I would be an addiction expert. After my graduate studies I took an internship at a substance abuse outpatient center. This was purely by chance and because they had a good reputation for offering really good supervision. During my internship it quickly became clear to me that my graduate program in mental health had left me ill prepared to work with substance abuse issues. I kept screening for mental health symptoms because that’s what I knew and we tend to go where we feel comfortable.

Substance abuse counselors on the other hand are often undertrained in mental illness and tend to ignore or dismiss signs of it, thinking once the drugs are out of someone’s life they will get back to normal functioning. And when they don’t they blame the clients “for resisting happiness” or being “chronic complainers”.  We fail to recognize that sometimes, even after drugs and alcohol are long gone, people struggle with what could have been there all along: mental illness. (more…)

So often, people talk about the struggles they experience, and how they’ve grown from the pain in their lives. It’s true, but the sentiment is often that it takes pain to grow. What’s not often discussed is how human beings grow from joy, from being in connection; that is, how we heal and grow stronger from the joyous moments in our lives.

These moments might be in the form of comfort: the savoring of a warm cup of hot chocolate on a cool night, or the texture of flannel sheets, sharing a smile with a stranger on the street. Or, it might be in the form of connection: laughing with friends, holding hands with someone you care about, or the feeling of a hug from someone you love. Think now. Feel it. Let the experience of love linger in your mind and heart. How does it feel to be loved? This is how we grow from joy, how healing happens.

Recently, I attended two separate seminars, each on the same subject led by different speakers. The first spoke of trauma and how we are all broken because any disconnection causes brain trauma. She said that our minds can mend, but even with years of “attaching,” as she termed it, we still sift through our hearts and find the broken edges, the places where connections have gone wrong. I looked around the room; people were having difficulty keeping their eyes open. Exhaustion often occurs when we feel overwhelmed. No one made eye contact. Many people looked blank. This is an understandable reaction when we’re told that we are infinitely broken.

The second seminar was led by a researcher and doctor. He talked of the joy of holding his children when they were babies, watching them grow; he spoke of his passion for mental health and educational reform, a society focused on wellness and connection. He smiled as he counted the blessings he’d experienced, he laughed with us, easily making jokes about himself and his own foibles; he told stories of how he’d learned to parent—not being perfect, but always striving to understand, to grow. He thanked all the past researchers who’d led him to create a path of clarity in the field of mental health. He thanked us, all therapists in the room, for creating the experiences he wrote about. He talked about how we all build on each other’s ideas, how we’re all more connected than not, and how everyone matters. He held the potential and the beauty of human nature in his words, and I felt that. I looked around the room. Everyone was beaming.

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When I think of the second seminar, other happy moments come to mind and I feel a flood of warm, happy feelings. Even now, as I type this, I’m smiling, my face is relaxed, no hint of tension in my jaw or shoulders. I’m breathing easily, feeling the warmth in my body of this memory. I remember it as though I’m living it now. Notice what you’re feeling as you read this. How is your breathing? Is it easy and relaxed? How is it different from how you felt when you were reading about the first seminar? Moment-to-moment awareness of positive feelings allows the positive experience to bloom, to be savored.

We all share emotions through our mirror neurons, though we might not realize it, and our minds create imprints of these interactions (Damasio). Our inner relationships (memories of relationships) are as vivid as our present interactions, and we connect one memory to others of their kind. In a sense, thoughts of a feather, flock together. So, when we hurt over something, it reminds us of other times we’ve felt pain, (and the brain actually lights up for emotional pain on MRI’s in the area where physical pain is expressed), and when we feel joy, it reminds us of other happy moments, and it strengthens us. It makes it possible for us to imagine other moments of joy, connection, comfort, and clarity.

This is why it’s so important to seek out empowering relationships, such as therapy, where we feel valued and heard. Our relationships—held in mind or in person—inform how we see ourselves, others, and the world. When you feel good in one moment, you’re more likely to seek out other connections similar to the one you’re experiencing in your mind.

Recent neuroscience research supports this. It shows that our brains actually create new neural pathways in response to our experiences. Experiences change the way our neurons fire and rewire in our minds. If these experiences are positive, new neural pathways form that increase our sense of health (viewed as integration), happiness, and connectedness to ourselves and others.

In other words, the more we have positive experiences in our lives, the more the neurons responding to these experiences, wire together. The more they wire together, the easier it is to experience more pleasure because those synaptic connections in the brain are strengthened. It’s circular. Depression works in an opposite way; we focus more on the negative because we feel bad. The keys to feeling better are self-compassion and a pairing together of sad feelings with exercises like the one below (which create new neural wiring patterns). Mindful attention to our emotions—both hard and pleasurable—enables us to move past difficult experiences, and to be open to positive ones. This could be called healing from pain by growing from joy! A true course of resiliency.

In fact, sharing difficult experiences with caring people actually changes the way we perceive those negative experiences; memories become less negative over time because they are paired with neural connections that are infused with being heard and cared about in a responsive connection. Over time, “pruning” of neural connections that are infused with negative experiences wither away. New neural connections are created that diffuse our perceptions of negative experiences. Pretty cool, huh?

This is why it’s so important to feel a sense of connection with the people around you, and why therapy that focuses on mindful awareness, with a person you feel connected to, creates transformation. It literally changes the way we relate to ourselves and those we love (Lewis).

Good therapy, like any positive relationship, creates increased clarity, self-awareness, self-esteem, a desire to create more relationships like the good ones you have, and an increased sense of zest for life. This is based on Relational-Cultural Theory’s perspective of the “Five Good Things” in what Relational-Cultural Theory calls, a growth-fostering relationship (Walker and Rosen). We all need growth-fostering relationships in order to feel emotionally and physically alive and healthy. Babies can die if they aren’t touched. One of the greatest forms of suffering is isolation. Every moment in positive connection is a healing moment. The scholars who created Relational-Cultural Theory knew that, and neuroscience supports this view. Without others, we wither. With others, we are more fully ourselves: vibrant, connected, loved, and joyful.

Suggested exercise: Think of a time when you felt fully connected to another being. It could be to a friend, an acquaintance, a partner, a parent, a teacher, an animal—someone who reminded you of your inherent worth. Feel the connection. If possible, pick someone who is still in your life in a positive way. The following exercise is meant for you to go at your own pace, and the questions are merely guides.

Bring to mind all the qualities of an interaction or experience you had with someone you love:
What was the day like?
Was it sunny, warm, or cool?
Could you feel the air touching your hair or skin?
Can you feel it now?
Where were you?
How did your body feel?
What do you notice right now as you’re sensing this moment?

Sense your connection with the other person.
Bring to mind the feeling of touch (in body or heart).
Notice how you feel, in your body, as you connect your interior experience to the feeling of being with this loved one.
Notice your breathing; is it slow and deep?
How was this other person responding? Feel the sense of that!

Now notice your body.
Has the temperature in your body changed?
Did your body soften?

How does this experience change your mood, your thoughts?
Does focusing on your breath or body-sensations enhance your awareness of the experience?

You can invoke the pleasure of this experience any time you want, simply by visualizing connection. Our minds don’t know the difference between what is visualized and what is actually being experienced (Damasio). When you imagine the joy of connection, your body physically changes. Your feelings about yourself change because the neurotransmitter, oxytocin is being released from the hypothalamus, which reduces anxiety and increases love, relaxation, and connection.

Every time you visualize connection, you strengthen your brain. Neurons in your brain are firing and rewiring, becoming stronger through one simple exercise. The more you do this, the more you strengthen the positive side of who you are. You can use this exercise any time you have a hard moment.

References:

1. Damasio, Antonio. (2000). The Feeling of What Happens: Body and Emotions in the Making of Consciousness.
2. Lewis, Thomas, MD, Fari Amani, MD, Lannon, Richard, MD. (2001). A General Theory of Love.
3. Siegel, Daniel. (2010). Mindsight: The New Science of Personal Transformation.
4. Walker, Maureen, Rosen, Wendy B. (2004). How Connections Heal: Stories from Relational-Cultural Theory

Play is serious business!

–Caitlin ‘Cake’ Gateaux

I was asked by the US Play Coalition research committee to collect personal statements about ideas and beliefs that are connected to the question, what is play?

How we define play and its value is shaped by many personal, historical, and cultural influences. Darell Hammond, in his recently published book, KaBOOM! How One Man Built a Movement to Save Play, writes about the reality of a play deficit in our communities. He calls on those of us who recognize the value of play (and there aren’t enough of us out there, he says) to take action steps that will lead to a greater recognition of play’s value while brightening each child’s life and create playful communities for all ages no matter where we live. (more…)

Many people curb their nervousness with a nice glass of wine or other alcohol beverage. Whether you’re gathering the courage to socialize with people you barely know, fly on an airplane, or even if you’re just feeling worried about the future, alcohol can help loosen inhibitions and dampen self doubt and fears.  While you may feel more relaxed temporarily, using alcohol to tame your anxiety can backfire in the long run.

Immediate Effects

Even though you may be feeling calmer after the first one or two drinks, your body is processing the alcohol and the physiological effects can actually trigger feelings of anxiety. Alcohol can negatively impact blood sugar levels each time that it is consumed. Research has shown that the body responds to alcohol by increasing insulin secretion, causing low blood sugar and also impairs the body’s hormonal response that would normally be able to normalize blood sugar levels. Drinking as little as two ounces of alcohol on an empty stomach can lead to very low blood sugar levels. Low blood sugar levels can cause dizziness, confusion, weakness, nervousness, shaking and numbness, all of which can mimic the symptoms of anxiety, or even trigger an episode of anxiety.

Alcohol consumption can also cause dehydration. Alcohol is a fairly strong diuretic, meaning that the body loses water by producing an increased amount of urine. Symptoms of dehydration include dizziness, muscle weakness, lightheadedness and nausea, again, all of which can mimic symptoms of anxiety, or induce anxious reactions related to the fear of being ill.

Alcohol consumption has a sedative effect on the body. It is a drug that depresses the central nervous system. Immediate effects are a sense of euphoria, decreased inhibitions, and lessened anxiety. However, over time the chronic use of alcohol could result in tolerance, dependency, and damage to many organs of the body including the brain, liver, and heart.

Longer Term Effects

People with anxiety are up to three times more likely to have an alcohol problem or other substance abuse than those without anxiety. It takes increasingly larger amounts of alcohol to achieve the same effects, leading to alcohol dependence. Long-term alcohol use can have multiple negative effects on the body and aggravate existing anxiety.

Recent studies have shown that heavy drinking or long term drinking stresses the body and causes it to have higher levels of the stress hormone, cortisol. Cortisol is necessary in short term stress situations because it helps focus alertness and attention, but cortisol also suppresses bodily functions such as wound repair, bone growth, digestion, and reproduction. Chronically high cortisol levels therefore interfere with these important processes in the body. Alcohol use also depletes the body of vitamin B6 and folic acid, which the body needs to help cope with stress. Long-term exposure to alcohol reduces the levels of the GABA-benzodiazepine receptor in the central nervous system and reduces the brain’s ability to calm the mind and the body and cope with anxiety in the long run.

Serotonin is a chemical in the body which is needed for memory, learning, and especially for feelings of ‘wellbeing”. Drinking alcohol can temporarily boost serotonin levels, therefore making you feel happier, but in the long term, excess alcohol can actually lower serotonin levels, and therefore either causing or exacerbating depression.

In another recent study, researchers found that high anxiety levels in humans are related to a deficiency in an important protein called CREB, which is needed by the amygdala, the area of the brain where emotions are processed. The amygdala is important in calming anxious thoughts. The study results showed that drinking alcohol boosts the CREB levels in the brain and therefore lessens anxiety, which helps to explain why so many anxious people us alcohol to self-medicate. The good news is that there are other, healthier ways to naturally raise CREB levels, such as getting regular exercise and listening to music. Some antidepressants can also help raise CREB levels also.

So, even though using alcohol is an easy, short term fix for anxious feelings, you’re not doing your body or your mind any favors by self-medicating with alcohol. Learning to manage anxiety (and naturally boost your CREB levels) in healthy ways such as through exercise, music, and expressing creativity is possible.  Psychotherapy can also be very helpful. In fact, research shows that psychotherapy is usually the most effective long-term treatment for anxiety disorders. Therapy treats more than just the symptoms of anxiety. It helps you discover the underlying causes of your worries and fears.  In therapy, you’ll learn to relax, perceive and interpret situations in new, less frightening ways, and learn better coping and problem-solving skills. Through therapy, you learn the tools to overcome anxiety and how to use them effectively.

Many of the partners or loved ones (POLOs) of those struggling with addiction often seem reluctant to get help for themselves. I’m not sure why that is, but I’m hoping this article provides some answers.

These beleaguered folks are often fixated on the behavior of the loved one who struggles with drugs or alcohol (or other compulsions). Of course, it’s hard not to fixate on rampantly destructive behaviors. It often seems as though families where addiction is present are always struggling to either avoid or deal with addiction’s collateral damage (financial, emotional, professional, etc). I’m coming to the conclusion that because the behaviors surrounding addiction are so darkly magnetic, a constant pull on the family’s attention, it may be hard to understand why focusing on oneself is important. (more…)

When we describe the relationship between mother and infant, we understand that baby and mother are one. In that symbiotic relationship, there is merger. There are not two separate selves with their own subjectivities who are relating to one another. (One’s subjectivity is the unique way in which we perceive our self and the world.) Our selves and subjectivities develop as we grow from infant to child to adolescent to adult.  When two people come together with their subjectivities, they are relating as two different people. When the processes of separation and individuation have been problematic, the development of one’s unique subjectivity is impaired. The ability to consider someone else’s subjectivity is also not developed. This makes relationship difficult. When a self is undeveloped in a relationship, there is no “other” to connect to.

Ken has been married for 15 months to Ellen. They met when he was finishing law school and she was teaching at the local high school. Ken loved her. She was smart and pretty and Ken was excited about making a life with her and starting a family.  Ken was an optimist and nothing seemed more wonderful to him than the thought of their future together. It came as a shock when Ellen told Ken that she didn’t want to be married to him any more. She said it was nothing about him, but that she was just not as happy as she wanted to be and thought they should end the marriage. This was what Ken told me when he came to see me for therapy. (more…)

I decided to dedicate myself to investigating and writing about the experience of body in transgender people. Though I am by no means an “expert” in working with this population, I have learned significantly from people I have worked with who identified themselves as transgender. I set out to organize my observations and insights by grounding them in current research, to offer something of use to the reader that is legitimized by work in the field. It struck me that in looking at body-appearance satisfaction we could learn a lot from people who experience being born with, and living with, a body that they experience as opposite of what they were suppose to have.

What is the nature of the relationship to the body for transgender people? How do they value their body? How do they take care of it, take pleasure in it? How do they deal with other people’s perceptions versus what they see or what they wish they could see? Does that change if they are able to change their body to look like what they believe they were supposed to have? What I was to discover was a dearth of research and a complete lack of theory or even sufficient conversation on the topic. There was certainly almost nothing scientific or academic of any use to working with clients. So here are my truncated thoughts combined with what I learned in my search for information on a very complicated subject.

For those new to this area, know that for transgender people, the desired body isn’t a thought, or a feeling, or even a drive. History has shown that the experience is relatively unchangeable. I would describe it as an experience of persistent identity messages incongruent with the physical body. There is a “hardwired” nature to this lived experience, though science hasn’t found the neural connections yet. Despite abusive efforts to create aversion in people who feel they are in the wrong body, to force them to stop thinking of it and stop expressing it (society can’t handle ambiguity or non-conformity, apparently), transgender people don’t stop being transgender.

[fat_widget_right]For most documented cases, it has proven to be a life-long struggle between the inner sense of self and the physical, external self. It has also, for most, been a struggle between expressing the true self and repressing it in order to earn or keep acceptance and belonging in relationships and in society in general. The extent that people (often rightfully) fear societal reactions to their true identity is directly related to how much psychological distress they suffer.

Interestingly, to the transgender child, there is no incongruence or distress about the body until they are confronted with the gender that is socially assigned according to the worlds’ image of them. They are often shamed, ridiculed, and otherwise discouraged from expressing what they consider to be their true selves, from an early age. You don’t have to be a therapist to think about the impact of such conditions of worth on the development of self-esteem. Indeed, transgender people have the highest rate of suicide.

There is some published anecdotal evidence that children who are allowed to explore their gender-related interests and self-expressions without external pressure to conform are better adjusted. There is also some research that suggests that trans people who have the resources and support to transition—and who believe they will be able to “pass” as the desired, chosen gender—have better mental and physical health outcomes. Also, while trans people have been shown to be at greater risk for developing eating disorders due to body-image dissatisfaction, depressive symptoms, and low self-esteem—they have also been shown to have reduced risk of these problems after gender-confirmatory surgery.

How do we begin to support these people or even understand their struggle and offer them hope? What is our role as therapists or friends in supporting transgender people? We know that body image issues are a problem for women who feel the pressure to conform to societal ideals and this can result in negative self-perception and negative health outcomes. In clinical studies, trans people have been described as being obsessed with the aesthetics of outward appearance. It makes sense that a trans person, having to live with a body that looks nothing like what they want and one that is often in complete opposition to social ideals for the gender they feel they are, would have even worse self-perception and greater negative health outcomes. So how do we help?

I believe in the fundamental healing value of acceptance and understanding of human experience. In my role as a therapist, I must be a non-judgmental mirror for the people I work with. In asking “what” rather than “why” questions, like at the outset of this article—I can get closer to an understanding that can allow me to mirror a person’s inner view of themselves. In that way I can strengthen the sense of self and self-worth of a person. I work to emphasize the importance of the functions and joys of the body, not just its appearance.

I share the idea that self-esteem comes from dedication to loving self-care and encourage habits that lead to better relationship to the body. This can be life enhancing for a person who has had very little acceptance and hence suffers low self-worth. Indeed most trans people I have met tend to focus on the well-being of everyone other then themselves. However, to truly support trans people in healing their relationship to the body, I must also educate myself on their unique experiences and needs, whether they are in transition or not. I must also be political in joining the struggle for their rights, including educating others. I must be an advocate that supports their rights to dignity and well-being, if that involves gender-confirmatory surgery or other procedures or services. Hopefully this article is a drop in the bucket towards that monumental task.

Vulnerability is an emotion that affects individuals suffering from eating disorders in a multitude of ways. It is the opposite of being in control and a state of mind not particularly comfortable for people suffering from this mental health issue. Feeling vulnerable is an uncomfortable feeling for many of us, but even more so for individuals suffering from an eating disorder. Not feeling in control often acts as a trigger that begins the destructive cycle of disordered eating. A trigger is any input that a person receives; either from their environmental or an internal thought that creates an uncomfortable feeling.

It is important to note, for these individuals their eating disorder is what allows them to cope with emotions. As a whole, individuals suffering from an eating disorder tend to view things in black and white terms; meaning their behaviors and thoughts are either right or wrong/good or bad. This strict thinking pattern leaves little room for ambiguity. Ambiguity is not only part of being vulnerable, but also part of everyday life, so it is important to learn how to navigate through it. (more…)

Lois has five minutes left to her fifth session and is now having a flash of insight. “I’m bored to death with therapy,” she thinks. “This is getting me nowhere.” She feels close to her therapist and decides that he deserves more than a false excuse. “Look,” she says, “I think we can both agree that we’re nearing the end here.” Unsure about how to respond to his neutral facial reactions, Lois plunges forward. “Believe me, I’m as bored of myself as you probably are. There’s no reason to pretend that we’re making progress here when I’m just going over the same issues, again and again. You’ve been trying. I know you have. But I’ve got nothing else to discover about myself. I’m done. That’s all there is. I’m just done.”

There is nothing wrong with gaining the sense of well-being that comes with having a professional provide reflection and insight on one’s life. Lois is pleased with her therapist’s support and feels the first four sessions were a success. Brief therapy may have provided her the supportive boost she needs as she continues to apply new coping skills on her own. If, on the other hand, there are uncomfortable symptoms plaguing her (sleeplessness, worry, loss of interest in pleasurable activities, intense relational conflicts, etc), it will be worth her while to take a second look at the boredom that is blocking her way.

Lois and her therapist are at a common juncture in treatment. Research into the phases of therapy conducted by Kenneth Howard of Northwestern University outlines a progressive, three-stage sequence of change. In the first phase, the client experiences a restoration of subjectively experienced well-being. The second phase focuses on the resolution of the client’s symptoms. This phase occupies a greater number of sessions—generally, between the 5th and the 15th session of therapy. Curiously, over one-half of his clients had discontinued therapy by session four.

The Problematic Skill of Emotional Insulation

As children, most of us learn to create emotional boundaries around ourselves to keep us safe. Trapped with a negative or mean-spirited crowd, our emotional insulation kicks in and we can feel somewhat removed from harm. Dropping layers of emotional insulation while with a nurturing friend allows us to take in the nutrients of their care. By the time we become adults, this unconscious defense mechanism regulates our relationships automatically.

For those impacted by big or small experiences of neglect or harm from others, it follows that they would be prone toward a self-sufficient stance. This insulation might be felt in the emotional brain as apathy and irritability when the “threat” of an ongoing relationship is apparent. The cognitive messages associated with these feelings may be something like, “I’m fine not caring about this person. I’m waiting for them to leave so I can feel more safe.” Such feelings and thoughts get activated without permission from the conscious mind. Sometimes, as in the case with Lois, the realization of boredom can occur quite suddenly and emphatically.

Repairing Flaws in the Insulation

One does not need to be engaged in long-term psychoanalytic care to see the importance of the therapeutic bond. Even in brief, solution-focused therapy, progress results in large part from the trust established between those two people sitting in that room, taking time together to see what surfaces. Boredom is simply one of the body’s natural resistances to this process. Touching into that boredom gives one the opportunity to test and perhaps readjust one’s automatic reactions. Similar to removing an unnecessary layer on a hot day, the act of staying in a relationship even when bored can yield surprisingly pleasant results.

“So you’re feeling annoyed. I see that. Care to look at that feeling a little bit further?”
Lois laughs. Another minute or two, she thinks, and this will be over. “Oh, great. So now I’m going to pay you for the chance to look at my boredom.” She rolls her eyes and opens her pocketbook.
“Only if you want to,” he answers. She hands her check to him. The two stand as she makes her way to the door. Lois takes one last moment to collect herself before reaching for the doorknob.
“You know,” she says, “I’ve never done this before. I don’t know what comes next.”
She watches her therapist nod and smile. “I can be here if you want to find out.”

Navigating Boredom and Longing

Taking a look at the automatic effort to prevent intimacy is just as important as putting effort into stepping past the resistance. Examining the body’s reactions to closeness and distance can be an unasked for but enlightening part of therapy. As Lois drives home, she is no doubt reexamining that nod and smile from her therapist as she stood at the door. The boredom that prompted their last interaction has now been unmasked to reveal an underlying uncertainty and frustration. Beneath that lies an unanswered longing for connection.

There is no quick answer to Lois’s dilemma of whether to return for another session. There’s neither certainty that therapy is the ideal site for her to place that longing, nor an assurance that it’s better to listen to the call of her boredom and move on. She has her own mind to make up and her own body to tend to as she manages the ebb and flow of her tolerance for relationships. She is not alone in her struggle, though. Boredom and longing carry their unspoken and magnetic influences on our interpersonal behaviors, driving each of us to our own true north. Effective therapy simply offers us a safe place to unmask the process.

While managing the ebb and flow of your capacity for intimacy, remember that every moment offers an opportunity for healing. I find this piece of wisdom encapsulated within the following excerpt:

Empty yourself,
So that you may be filled.
Learn not to love
so that you may learn how to love.
Draw back,
so that you may be approached.

-St. Augustine Narration on Psalm 30:30

References:
Howard, K. I.; Lueger, R. J.; Maling, M. S.; & Martinovich, Z. (1993). A phase model of psychotherapy outcome: Causal mediation of change. Journal of Consulting and Clinical Psychology, 61(4), 678-685.