Dialectical behavior therapy (DBT) distress tolerance skills address the tendency of some individuals to experience negative emotions as overwhelming and unbearable. People with a low tolerance for distress can become overwhelmed at relatively mild levels of stress, and may react with negative behaviors. Many traditional treatment approaches focus on avoiding painful situations, but in the distress tolerance module of DBT, clients learn that there will be times when pain is unavoidable and the best course is to learn to accept and tolerate distress.

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A key ingredient of distress tolerance is the concept of radical acceptance. This refers to experiencing the situation and accepting the reality of it when it is something the person cannot change. By practicing radical acceptance without being judgmental or trying to fight reality, the client will be less vulnerable to intense and prolonged negative feelings. Within the distress tolerance module, there are four skill categories:

1. Distracting
2. Self-soothing
3. Improving the moment
4. Focusing on pros and cons

These skills are aimed at helping individuals cope with crisis and experience distress without avoiding it or making it worse.

Skill No. 1: Distracting
The first skill, distracting, helps clients change their focus from upsetting thoughts and emotions to more enjoyable or neutral activities. This skill is taught with the acronym ACCEPTS:

A – is for activities and distracting oneself with healthy, enjoyable pursuits such as hobbies, exercise, and visiting with friends.

C – is for contributing and doing things to help others, through volunteering or just a thoughtful gesture.

C – is for comparing oneself to those less fortunate, finding reasons to be grateful.

E – is for emotion; identifying the current negative emotion and acting in an opposite manner, such as dancing or singing when one is feeling sad.

P – is for pushing away, by mentally leaving the current situation and focusing on something pleasant and unconnected to the present circumstances.

T – is for thoughts; diverting one’s attention from the negative feelings with unrelated and neural thoughts, such as counting items or doing a puzzle.

S – is for sensations, and distracting oneself with physical sensations using multiple senses, like holding an ice cube, drinking a hot beverage, or enjoying a warm foot soak.

Skill No. 2: Self-Soothing
The second skill in distress tolerance is self-soothing; clients can use the five senses to nurture themselves in a variety of ways:

1. Vision: Look at beautiful things such as flowers, art, a landscape, or an artistic performance.
2. Hearing: Listen to music, lively or soft, or enjoy the sounds of nature such as birds chirping and waves crashing. Savor the voice of a relative or friend.
3. Smell: Use a favorite lotion or perfume, light a scented candle, notice the scents of nature, or bake an aromatic recipe.
4. Taste: Enjoy a hearty meal or indulge in decadent dessert. Experiment with a new flavor or texture, and focus on the food’s flavors.
5. Touch: Pet an animal or give someone a hug. Have a massage, rub on lotion, or snuggle up in a soft blanket.

Skill No. 3: Improving the Moment
In the third distress tolerance skill, the goal is to use positive mental imagery to improve one’s current situation. The acronym for this skill is IMPROVE:

I – is for imagery, such as visualizing a relaxing scene or a successful interaction. Imagine negative feelings melting away.

M – is for creating meaning or purpose from a difficult situation or from pain, i.e., finding the silver lining.

P – is for prayer—to God or a higher power—for strength and to be open in the moment.

R – is for relaxation, by breathing deeply and progressively relaxing the large muscle groups. Listen to music, watch a funny television show, drink warm milk, or enjoy a neck or foot massage.

O – is for one thing in the moment, meaning the individual strives to remain mindful and focus on a neutral activity in the present moment.

V – is for vacation, as in taking a mental break from a challenging situation by imagining or doing something pleasant. This could also be taking a day trip, or ignoring calls and emails for a few hours.

E – is for encouragement, by talking to oneself in a positive and supportive manner to help cope with a stressful situation.

Skill No. 4: Focusing on Pros and Cons
In focusing on pros and cons, the individual is asked to list the pros and cons of tolerating the distress and of not tolerating the stress (i.e., coping through self-destructive behaviors). It can be helpful to remember the past consequences of not tolerating distress, and to imagine how it will feel to successfully tolerate the current distress and avoid negative behaviors. Through evaluating the short-term and long-term pros and cons, clients can understand the benefits of tolerating pain and distress, and thereby reduce impulsive reactions.

The distress tolerance skills are valuable tools in helping individuals maintain balance in the face of crises, teaching them to accept the distress and cope with it in healthier ways. By practicing the skills of distracting, self-soothing, improving the moment, and focusing on pros and cons, clients can weather stressful circumstances and decrease painful feelings and destructive impulses.

Kaethe Weingarten of the Department of Psychiatry at Harvard Medical School recently published a paper describing her experience with four clients who experienced chronic sorrow. The clients, who were all successful, vibrant women, had different pasts and different conditions that caused them to lose their sense of self. Despite these differences, the result was the same for each. They struggled with a sense of deep sadness or chronic sorrow. In one’s case, illness had caused her to lose her independence and ability to live the life she once knew. Another woman became addicted to medication that was prescribed to treat a health problem. The addiction led to psychosis that lasted two years. The third woman was born with a heart defect and has lived a life of longing to be the woman she knows she cannot be. The fourth woman was diagnosed with Chronic Fatigue Syndrome. After over a decade of being doubted by family members, medical professionals, and even therapists, this client eventually committed suicide.

Weingarten, having dealt with her own disability, is all too familiar with the shift from a life of autonomy and ability to one of utter dependence and incapacity. She believes her own experience and those of her clients gives her an insight into chronic sorrow and how to best approach this issue with patients. First, Weingarten believes that chronic sorrow is rooted in a loss of self. The self-narrative of those living with chronic sorrow becomes shattered, dissociative, and disrupted. This can happen as a result of one catastrophic event, such as a debilitating medical diagnosis, or a series or progression of events and symptoms, as was the case for the client with Chronic Fatigue Syndrome. Regardless of how it occurs, this broken narrative is not one that can be fixed. Instead, Weingarten believes that companionship and compassionate witnessing are the keys to living with, and not necessarily overcoming, chronic sorrow.

She believes that witnessing requires developing an empathic understanding of a client’s situation and taking actions to alleviate the psychological pain that ensues. Rather than trying to fully understand, a compassionate witness should accept that they will never fully be able to feel the feelings or loss of their client. Instead of pathologizing and labeling these clients’ reactions to loss of self as bipolar, schizophrenic, or psychotic, a truly compassionate witness will empathize without ever really understanding. “People who live with chronic sorrow need accompaniment,” said Weingarten. By this, she means that clients with chronic sorrow need someone to be with them as they discover how they will interact with the limitations of their minds and bodies. It means showing them the way to peace, teaching them how to tolerate the inconsistency of their lives with support, education, and even humor. It also means requires self-care so that the therapist can be aware of the client’s own boundaries while they take this journey with their client. Weingarten does not believe chronic sorrow can be fixed or healed. But she believes it can be lived with and she suggests compassionate witnessing and companionship as ways to do that.

Reference:
Weingarten, Kaethe. Sorrow: A therapist’s reflection on the inevitable and the unknowable. Family Process 51.4 (2012): 440-55. Print.

To me, “vulnerable” is wonderful word. It means openness, freedom, and the opportunity to love and be loved. But for others, it is what they are trying to get away from: They feel that they are too vulnerable. In actuality, the opposite is true. They feel unsafe because they are too defended, too guarded. True vulnerability comes only with acceptance of self. And with that, fear drops away.

By becoming vulnerable to life, we discover its meaning. Not the meaning of life in an objective sense, but rather its meaning and purpose for each one of us, as individual souls. Whether that is the truth of a given moment, or an expanded sense of purpose and destiny in our professional or personal lives, we can discover it only if we learn to listen to our own hearts in an unguarded and open way.

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Our Own Vulnerability

To be happy and content in life, we must give in and learn to listen to ourselves deeply. We must accept our vulnerabilities, open ourselves to them, and embrace them! Why? Because only then do we feel the safety net that is always there; that mysterious presence that is beauty, love, kindness, and truth. When we don’t move into the mystery of vulnerability, it is like we are clinging to a tightrope after having fallen off, peering into the dark, afraid that there is no net. We find the net by letting go, by falling into the unknown.

This surrender does not have to be, as many think, a large display of emotion, because it is at its heart something internal, something private. Our closest, longest, and most intimate relationship is the one we have with ourselves. So while we might first experience vulnerability with someone else, it is at its heart something we must do with ourselves, by ourselves. It is not enough to be accepted by someone else: We must accept ourselves.

Allowing Others to Be Vulnerable

By becoming vulnerable to yourself, you move toward being vulnerable in your relationships and, just as importantly, being able to accept the vulnerability of those you love. This can be some of the hardest work we do: allowing the people we depend on to have their own vulnerabilities, their own weaknesses, their own struggles.

When vulnerability is not allowed in a relationship, it separates people, no matter how much they love each other. A person may love someone, but he or she may also want that person to be something he or she is not, or to just plain stop having the pain or struggle that he or she does. This dynamic can create a vicious cycle of resentment and frustration in one person, and a sense of confinement, judgment, and claustrophobia in the other.

Practice

Maybe this sounds simple to you, or perhaps complicated and confusing. It all begins with whatever moment you are in. And it takes baby steps. If you are interested in exploring more, note the time and do this five-step practice for the next five minutes:

1. Take three deep breaths. In through the nose, out through the mouth. Soften your shoulders, your forehead, your eyes.
2. Become vulnerable to everything happening in this moment. All the feelings, all the thoughts. Accept and allow everything. Soften toward every part of yourself. Breathe.
3. Soften all resistance to what is here. Feel the energy of your body, emotions, and mind. Feel whatever pain you may be having. Don’t label or think about it, just sense it fully. Don’t push anything away. Breathe.
4. Allow the waterfall that is the experience of each passing moment to wash over you. Just for this moment, accept fully and forgive yourself for all the failings and faults, all the regrets and mistakes that are marching through your mind. Let go of the fight and allow yourself to be just as you are right now. Breathe.
5. Now return to the top and continue the practice. Close your eyes as you are able, repeating the steps and continuing to soften and breathe.

Dialectical behavior therapy (DBT) is a comprehensive, evidence-based treatment approach used to treat individuals with a wide variety of issues, including relationship conflict, anxiety, depression, bipolar, self-injury, eating issues, and substance abuse. Developed in the 1980s by psychologist Marsha M. Linehan for the treatment of borderline personality disorder and chronic suicidality, this method has since been adapted and utilized to help clients with much less severe issues. The therapy can help clients who exhibit extreme emotional reactions, helping them develop self-acceptance while also learning coping skills to better regulate their emotions and handle distress. DBT uses both individual therapy sessions and group skills training, as well as telephone coaching between sessions.

The DBT model combines a behavioral therapy approach with eastern mindfulness practices. In one sense, the term dialectical refers to the goal of synthesizing the extreme opposites inherent in the rigid “black and white” thinking of many clients who have trouble regulating their emotions. “Dialectical” also applies to the core DBT principle of practicing acceptance strategies while implementing change strategies, in the process of reducing and modifying self-destructive behaviors.

This type of therapy is very support-oriented; it helps clients identify their strengths, build new skills, and increase their self-esteem. DBT focuses on cognitive issues by indentifying destructive thought patterns and replacing them with more neutral and accepting internal dialogues. It is designed to be a nonjudgmental collaboration, with the therapist and client working together to increase emotional awareness and understanding, minimize negative thought patterns and behaviors, and develop new coping and problem-solving skills.

The four modules of dialectical behavior therapy:

• Core mindfulness: The first of the four primary modules of DBT, this concept involves learning to observe one’s emotions, describe those emotions, and fully participate in present experiences. This skill forms the foundation for the other three modules, and is derived largely from eastern practices of living in the moment.
• Interpersonal effectiveness: The second core component of DBT teaches clients assertiveness skills and strategies to ask for what they need, set boundaries and say no when appropriate, and deal more effectively with interpersonal conflict.
• Distress tolerance: The third module entails clients developing nonjudgmental acceptance of themselves as well as their current situation. The focus is on learning to accept the present reality and to tolerate crises, and making use of strategies such as distraction, self-soothing, and improving the moment. Practicing these skills will increase the client’s ability to tolerate challenging events and environments.
• Emotion regulation: The final module of DBT consists of three main goals: to understand one’s emotions, reduce emotional vulnerability, and decrease emotional suffering. With this in mind, some of the specific skills taught in DBT include identifying and labeling emotions as well as evaluating: events that prompt the emotion, interpretations that trigger the emotion, how the emotion is experienced, how the emotion is expressed behaviorally, and the aftereffects of the emotion.

In the case of adolescent treatment, Dr. Alec Miller has adapted Dr. Linehan’s model to incorporate parents attending skills training groups with their teens. There is an additional module, “walking the middle path,” which focuses on helping parents and their children understand each other’s viewpoints and reduce conflict and invalidation.

The five functions:

Dialectical behavioral therapy was designed to fulfill five primary functions:

• Enhance behavioral capabilities: DBT helps clients develop important life skills that help them regulate emotions, experience the present moment, improve interpersonal interactions, and better tolerate distressing situations.
• Improve motivation to changes: DBT supports clients’ motivation to change by tracking and reducing detrimental behaviors, thereby increasing quality of life.
• Generalize capabilities to other environments: In order for the client to make progress, the skills learned in therapy must transfer to a wide variety of situations. This is accomplished through homework assignments and practicing skills. Telephone consultations also can be valuable in helping clients utilize these skills in their daily lives.
• Support client and therapist capabilities: DBT aims to maintain and build the capabilities of therapists through continued training and consultation-team meetings.
• Enhance therapist motivation: The DBT model encourages the use of support, validation, feedback, and encouragement between therapists to avoid burnout and improve their effectiveness.

Stages of treatment:

The course of DBT generally flows through three stages:

• Stage 1: This stage is primarily focused on eliminating or reducing serious behaviors, including self-injury, suicidal thinking, and aggression. Behaviors that interfere with therapy also are addressed, such as missing appointments and not returning phone calls.
• Stage 2: The client strives to increase quality of life and experience emotions in a less intense manner. The client continues to eliminate or decrease destructive behaviors, and address other issues or situations that are interfering with daily life, such as past trauma.
• Stage 3: The client is experiencing increased feelings of completeness, self-respect, and love.

Who can benefit:

Though DBT originally was developed to treat more severe issues, such as borderline personality disorder, suicidal behaviors, and self-harm, the treatment has become a widely respected method for treating clients who exhibit the following, much milder traits and issues:

• Difficulty with emotional regulation
• A high level of reactivity, with a slow return to baseline
• Impulsiveness with a tendency toward self-destructive behaviors
• An inclination toward extreme thinking, unable to perceive a middle ground
• A lack of sense of self, tending to feel incomplete or empty
• A history of instability in relationships, and difficulty with interpersonal interactions
• Extreme sensitivity, accompanied by rapid mood swings, anxiety, and depression
• Fears of abandonment and trouble with intimate relationships

Dialectical behavior therapy has proven to be a very effective tool to help people manage intense emotions, change negative thought patterns, and decrease self-destructive behaviors. Individual therapy sessions focus on current detrimental behaviors in the client’s life, while group sessions involve learning skills from the four modules: mindfulness, interpersonal effectiveness, distress tolerance, and emotion regulation.

The pain of divorce is often unbearable. The experience can be so awful that you wonder whether it would have been easier to stay married or even to be dealing with some other horrific life event like death. The depth of pain is often surprising, particularly when you know you don’t want to be married anymore. What many people forget is that divorce is just a fancy word masking what is truly a broken attachment between two people. Divorce is more than separating assets and belongings.  It’s the severing of a very strong bond founded on deep feelings of dependency and need. Believe it or not, you developed an attachment to your partner over the course of dating and marriage that connected you on an emotional and physiological level beyond what you realized.

When two people get married they are vowing to be committed and to love one another, but they are also pledging to become “attached.” This attachment is unspoken and unknown to both, but it is the most powerful connection anyone can have to another person in a love relationship. According to author Helen Fischer in her book Why We Love, our “cuddle chemicals,” namely oxytocin and vasopressin, contribute to the sense of closeness and attachment couples feel toward each other in a love relationship. These bonding hormones promote a sense of fusion between lovers that deepens attachment and a sense of oneness. This biological phenomenon explains the depth of devastation felt when the attachment is broken and the physiological symptoms that become activated when attachments are severed. The response is often primal, leading to thoughts, feelings, and behaviors that might never surface in any other context of life.

The end of a marriage is one of the most emotionally painful human experiences. Thinking about the experience of divorce within the context of attachment generates a greater sense of empathy for what you might be feeling. It explains the levels of rage, vindictiveness, grief, and despair that so often accompany this common life transition. We too often think of divorce as a noun or a verb, but it is actually a relational trauma that has a physiological and emotional effect. You may be creating more suffering for yourself by resisting what you are feeling or telling yourself that you are overreacting.

Recognize that the end of your marriage represents much more for you than you may realize. If you were a small child and the person you depended on most was suddenly unavailable to you, there is no doubt you would have a strong reaction. The end of your marriage is no different. Give yourself the time and space to heal and repair. You are not damaged, just temporarily devastated, and the recovery will come with time. Divorce is not just a matter of the heart but an experience that impacts the whole person on a multitude of levels. 

My last piece on focusing ended with a definition of felt sensing as a “temporary wave, from the sea of being” (Madison, G.). What is meant by a temporary wave from the sea of being?

It is time to introduce Gendlin’s conception of human being. Note that I said “human being,” not “a human being.” For Gendlin, human being is “interbeing”—what we think of as an individual being is a “livings in the world, and living with” (Gendlin, 1978-79). He calls this principle Interaction First.

Gendlin conceives of human beings experientially not as separate “things” in interaction with each other. More radically, he sees our environments and us as a continuous co-creative process. We are not “inside our skins, but are our living-in the world, and living-with others” (Gendlin, 1978-79). Even our physical being is a continuous process with its inner and outer environments. Hence, in his view, it is impossible to conceive of human being as a separate entity. We are interbeing.

What is a living body such that it has the intricacy of our situations? … With the old concepts, people might say that Focusing is “subjective.” But clearly, if the situation is carried in the body, then a felt sense is not subjective. Objective then? No, also not, since “objective” means the units and patterns to which science limits anything it studies. We could fashion a new sentence that is neither subjective, nor objective, nor both: The body IS an interaction process with the environment, and therefore the body IS its situations. The body isn’t just a sealed thing here, with an external situation over there, which it merely interprets. Rather, even before we think and speak, the living body is already one interaction process with its situation. The situation is not out there, nor inside. The external “things” and the subjective “entities” are derived from one single life-interaction process (which they always bring along with them). (Gendlin 2004)

This is a radical view and paradigm shift that is difficult to absorb. We are used to thinking about ourselves and the environment “around us” through the lens and language of a Cartesian world. We are imbued with philosophical assumptions idealizing objectivity and neutrality and a mechanistic relationship of mind over body. For example, we may have heard of such concepts as the “observer effect,” yet we go about living in a way that leaves context out of the equation.

For Gendlin, the making of meaning is a pluralistic, contextual, constructed process; it is changing and dynamic, not static and eternal (Mitchell, 1993). Our lived bodily sense of things is a function of our interbeing, and our capacity for felt sensing extends us beyond the confines of our delimited physical body.

Recall that I started my first piece by saying that you have within you—“beneath” your everyday practical use of language—another dimension, an inner language that is an imagistic dialogue between you and your immediate experiencing. It is you speaking to yourself (and listening to yourself) in your own code. Gendlin calls it the zigzag between the everyday use of language and the way we may actually hold our experiencing in a bodily felt way.

Gendlin says that this kind of processing exists preconceptually, beneath our everyday use of language and concepts and the assumptions we have about how the world works. In focusing, we find our own language and meaning that is in fact much more specific and precise than our usual use of language. We find language from the sea of our being.

A client with a traumatic history sits quietly, with eyes lowered, pausing to find a way to articulate why his time in boarding school (60 years ago!) is still so meaningful to him. His life before boarding school was consumed by his father’s collapse into psychosis. He is sensing into the situation regarding boarding school—without any explicit reference to his catastrophic childhood history. After a full few minutes of silence, he finds one word that fits: Life at boarding school was “manageable.” At the point that he says “manageable,” tears come to his eyes. He doesn’t know why, but his felt sense tells him, preconceptually, that “manageable” feels right.

The therapist, attuning to her client, takes in “manageable” and acknowledges it. As it resonates within her, she realizes how much is contained in this word “manageable” for her client. Then she drifts into her own felt sense of his childhood and finds ‘unmanageable’ experientially embedded in the world of her client’s meaning making, the therapist quietly offers the newly emerging word “unmanageable” without any reference to his history, and the client considers it.

A few moments later, the client’s full catastrophe of life with his father’s illness impacts him, but in a different way. His therapist has offered a word that touches into his world precisely and with great specificity. What is captured here in two words—manageable and unmanageable—is much more than the common meaning of these words. The client is referring to the experiential world of living-with and living-in his father’s psychosis, as well as to the emergent significance of what boarding school provided for him. The unmanageable and the manageable.

 Notice that the felt sensing came first. With “manageable,” he has begun to capture the world of his experiencing—the profound relief of finding himself for the first time in a world that he could handle (boarding school). Then “unmanageable” is intoned, and he resonates with the years of struggling with the catastrophe of his father’s psychosis. “Manageable” arose as a temporary wave from the sea of being. “Unmanageable” emerged from their shared sea of being.

And this shared moment deepens their therapeutic journey.

References

1. Gendlin. E. T. (1978-79). Befindlichkeit: Heidegger and the philosophy of psychology. Review of Existential Psychology & Psychiatry 16, 43-71.
2. Gendlin, E.T. (2004). Five philosophical talking points to communicate with colleagues who don’t yet know focusing. Staying in Focus. The Focusing Institute Newsletter, 4 (1), 5-8. From http://www.focusing.org/gendlin/docs/gol_2187.html
3. Madison, G., www.gregmadison.net.focusing_way_being.
4. Mitchell, Stephen A. (1993). Hope and dread in psychoanalysis. New York: Basic Books, pp. 285.

Never underestimate the power of talking with someone who really listens.

Our culture doesn’t encourage people to talk about their emotional pain. Our culture teaches people to suppress their feelings. People tell each other not to “whine” about problems or not to “dwell” on them. People are told to “get over it” and to “be strong,” meaning “don’t feel anything—and if you do, don’t talk about it or show it.”

One example of this is when only certain emotions are deemed “appropriate.” Anger, especially for men, is more acceptable than sadness or anything vulnerable. So, for many men, emotions like sadness, loneliness, disappointment, anxiety, guilt, and shame get funneled into expressions that look like anger. Unhealthy coping mechanisms—such as using alcohol, other substances, or addictive activities—are taken up in order to push the genuine feelings down. These provide some temporary relief but, ultimately, undermine a person’s strength, health, and functionality.

Most people, when they feel upset, benefit by talking to someone who listens patiently, nonjudgmentally, empathically, and who shows that he/she understands at a deep level. There is something basic in the way human beings react when receiving this simple, but skillful, response to talking about their emotional pain.

Depression is no different from any other emotional pain, in this sense. [fat_widget_right]If everyone who felt depressed was comfortable talking about it to a good listener, we would have far fewer depressed people—possibly even fewer people on antidepressants.

Recently, a psychiatrist who was treating a friend of mine said that few people truly have a chemical imbalance causing their depression. Maybe this is why some research shows that antidepressants work about as well as placebos. Maybe the placebo works because the patients get some caring human contact before taking the pill. Human contact goes hand-in-hand with talking. We all need to see people smile at us, be warm toward us, perhaps even touch us in a friendly, appropriate way. Warm, caring human contact is essential for us to live and thrive.

Ideally, we would all have this in our lives without having to pay someone to get it. We would all have friends, relatives, spiritual leaders, mentors, teachers, or healers around to listen and care when we are upset. Yet our culture no longer supports this basic need. We are too busy. Many of us come from families who have abused us, or from whom we are separated. We often live alone, or have only our immediate family around. We are not connected to a church or community where this kind of talking may have been more available in the past. Instead we put value on the rational, over the emotional, to the extreme. As a result, many people end up trying to hide their tears and vulnerability, thus creating more alienation and isolation. Ironically, suppressing our feelings and being deprived of warm contact actually makes us more susceptible to depression, making people think they have even more to hide.

So if you are feeling depressed or in emotional pain, try to find someone you can talk to—someone who will listen deeply and without judgement. Talk to him/her about everything that’s seriously bothering you, and keep talking until you feel relief (even if you have to go through several people to have as much time talking as you need). If there’s no one in your life like this, and you don’t think you can find anyone, find a good therapist. It will help to do your talking with a highly trained, skilled, and naturally intuitive professional. You owe it to yourself to do whatever it takes to prevent depression, or deeper depression. It’s really so simple (though not always easy), yet so important.

Did you know that most individuals who have experienced sex addiction and have taken their recovery process very seriously and remain committed to it for life can be some of the healthiest individuals, despite their past challenges?

Relationships in general take a lot of hard work, but many people are not willing to engage in the hard stuff to make their relationships easier down the road. If people do not feel that they have an addiction or struggle with any kind of sexual integrity issue, it is more challenging for them to understand the need to have boundaries around their relationship to protect it from anything that can cause it to weaken.

Here are THREE REASONS individuals need not be afraid to date someone who has recovered from or is in active recovery from a sex addiction:

STRONG BOUNDARIES: Most individuals recovering from sex addiction who have worked hard in a program, such as outpatient therapy, along with being a part of a support group or in-patient program with a solid outpatient support system know the importance of having strong boundaries to first protect themselves from relapse or slipping back into old habits. For example, a person who has abused alcohol needs to stay away from bars and heavy drinking venues to avoid temptation. The same goes for people with sex addiction; they have certain places they cannot visit, movies they cannot watch, and websites to stay clear of, and even conversations with other individuals that may trigger certain thoughts or feelings.

Therefore, people who have recovered from sex addiction and have moved toward a healthy outlook in life will more than likely be very respectful and aware of situations that may be uncomfortable for their partner, such as noticing attractive people in the partner’s presence or even while alone or putting themselves in a position that could be cause for concern, such as eating lunch alone with a coworker of the opposite sex.

INTEGRITY: Most people recovering from sex addiction have learned the benefits and the importance of having integrity in their life. It is essential that they share their feelings appropriately and be truthful with themselves and that they avoid anything that would cause even a hint of suspicion by others. One way that you will know that your dating partner is someone who values integrity is to watch him or her. Does this person’s behavior coincide with his or her belief system? Is he open about his life’s journey while using discernment? Does she show consistency in making decisions with integrity in all areas of her life (i.e., financial, family, work), not just in relationships?

SELF-CARE: When people who have struggled with sex addiction have worked hard on their personal recovery, one of the tools they learn is the importance of self-care. What that means is their ability to recognize that they first must take care of themselves in a healthy way before they have anything to offer anyone else. They are good at keeping things in their lives that bring value, and they do not expect someone else to fill all their needs. These individuals will have introduced specific behaviors/patterns in their life that support their recovery and reduce the temptations they will face, such as computer filters, accountability partners, continued self-improvement choices, and consistent activities that not only grow who they are but also have a positive impact on others. Most important, where their recovery plan may change along the way, they never let their guard down to say they have arrived, and they stay in the continuous mode of healthy self-care in some fashion. This not only assists them in being the person of integrity they want to be but also prepares them to be real, genuine, honest, and transparent in future relationships.

As you can see, while some may shy away from the idea of dating an individual who has recovered from sexual addiction, there are numerous reasons this can actually be a very positive experience. Keep in mind, it is not your responsibility to keep this person on track in his or her recovery, and if the person is truly taking care of himself, he will not want or expect you to do this. You actually get the benefits of being with an individual who has come face to face with a very challenging addiction and decided that he or she is worth doing the hard work to overcome it and live a life of integrity. The end result is someone who can share compassion, understanding, and love in a deeper, healthier way in relationships because that person made it a point to have tough love for him- or herself first.

Related articles:
Three Ways to Avoid Sex Addiction Relapse
Sex Addiction: Can Trust Be Restored?

If you are reading this article, then you probably have completed Codependency Workbook Exercise Two by creating a list of your troubled relationships. Congratulations for completing this. Generally, in codependent relationships there is some pain and emotional abuse. They tend to be rather lopsided, with you doing most if not all of the giving. When you realize this, you may get angry and feel as though others are using you. You may wonder why this is. It is because when they meet you, they sense that you are a caretaker who will want to help them. When you do this, it is because you care about them and believe that you can love and care some of their problems away. Most of the time this cannot be done. Often, by giving to them, you are actually making it easier for them to continue their maladaptive behavior.

If your loved one gets a DWI, you may rush out and hire a good lawyer who may get him or her off. Had this person suffered the consequences of the DWI, he or she might have been ordered to complete substance abuse treatment, which might have ended or at least interfered with the drinking. So if you are in a relationship with a person with an alcohol or drug problem, can you think of a boundary that you could set that would be good for you and, in the long run, him or her? For example, you might tell this person that if he or she has another legal problem related to substances, that you will no longer help. The person will be on his own. Of course, he or she may not like this and try to push your guilt buttons. Remind yourself that you are not only doing what is best for yourself but also for the other person. You might take your boundary a step further and tell the person that effective immediately, you will no longer undo any of the consequences of his or her using. I suggest you only set the boundary when you are ready. The hard part will come when you have to stick to the boundary. You will need some support from a therapist, your sponsor, or a friend to hold to it. Once you maintain a boundary you will find that it is easier to stick to the next one.

What are some other boundaries that you might set? Maybe you have a friend who borrows money from you and has never paid it back. The next time the friend asks to borrow money, you might tell him or her that you are unwilling to loan any more money until the person repays you the funds already owed. Maybe you have someone who always asks you for rides but never offers to pay for your gasoline. You might decide to tell this person that you cannot afford to continue giving him or her rides. Make a list of all the boundaries that you need to set to take care of yourself. While you are identifying them, do not worry about actually setting them. Try to take one step at a time. I know that the thought of setting them is very scary. You may also be scared about what will happen to your friend if you set them. If your friend is dysfunctional, something will happen to this person no matter what you do. Once you get the hang of doing this, you are going to feel an enormous sense of relief. You will realize you are not responsible for everybody, nor do you have to help someone just because that person needs it.

If you are like some people, you may fear that if you stand up for yourself, you will be abandoned by your friend. I believe that if this happens, then that person was not really a friend to begin with. Can you imagine treating someone that you care about like that? I am sure that you cannot. Now you will have more energy to direct toward taking care of yourself. You will no longer feel so angry at others. The next time you feel like a victim, you may need to check and see if you need to set another boundary.

All too often, compromised energy levels are a lingering impact of traumatic experiences, particularly ongoing or frequent traumatic events in childhood.

Compromised energy means that you simply do not have enough energy to tackle certain tasks. In addition, traumatic experiences often prevent people from learning how to manage their energy levels. This encompasses everything from recognizing when you are running low on energy to knowing how to build an energy reservoir and stamina.

Understanding Energy

Take a quick moment and think about all the energy it took to get through today. Think about the physical energy, as well as emotional and mental energy. Of these three types of energy, physical energy is possibly the most obvious. We have all experienced times when we were simply too tired to engage in a task because our physical energy was just not up to it. Many factors, including sleep, nutrition, exercise, medications, and substance use, can impact your physical energy level.

These factors also impact your emotional and mental energy levels. Emotional energy is used when you interact with emotions, whether in a productive or unhealthy manner. You use emotional energy when you identify an emotion, express it, act on it, calm it, understand it, and so on. Mental energy is the energy you use when thinking, planning, making logical decisions, and following through with your decisions and plans.

When traumatic life events have “stunted” your development of energy management tools, it is important to include learning these skills in your healing work. Broadly speaking, there are three categories of skills you will want to learn for each of the types of energy: the skills necessary for monitoring your energy level, those needed in order to manage your energy, and those that will increase the staying power of your energy.

Monitoring Your Energy Levels

How aware are you of your physical, emotional, and mental energies? Is there one type of energy that you are more aware of? Do you recognize when these energy levels are full and geared up for action, when they are at their midpoint, or when you are close to being empty? Or do you only become aware of your energy level when you are past empty and burnt out? Becoming aware of energy levels before you hit burnout will allow you to refuel before you run out of energy.

Physical energy can be a great one to start practicing these skills with. Take some time throughout the day—maybe every hour or two—and check in with yourself. How awake or tired are you? How full or hungry?

Imagine your energy levels as a gas gauge with marks at full, ¾ full, ½ full, ¼ full, and empty. When you check in with each of these physical experiences, determine where you fit on that scale.  Are you past the point of energy, but not quite tired? Are you not full but not hungry? By figuring out where you’re at, you can determine what you need to do to manage your energy and satiation levels: take a nap, go on a walk, eat a snack, say no to the offer of a snack, or whatever works for you.

Managing Your Energy

Once you can identify your energy levels, you can determine what you need to do to keep your energy at workable and beneficial levels. Let’s look at emotional energy. Say your emotional energy is still at the ¾ full mark, despite it being late in the day. Maybe now would be a good time to call a friend and extend support. Maybe you can take time to reflect on, process, or journal about a recent upsetting experience.

If you notice that your emotional energy is close to empty, but you still have a few emotionally taxing tasks to do,  it would be wise to carve out a bit of time to refuel yourself. Reach out to an emotionally supportive friend, take a break and head to an emotionally restorative place in nature (even if it is just smelling the neighbor’s roses), or take a few moments to breathe deeply, read an encouraging piece of prose or poetry, and so on. If you become aware that you have experienced several days on empty, you may want to consider dedicating your weekend to replenishing, rather than extending, your emotional energy.

Building Energy Reserves and Stamina

If learning how to replenish your energy reserves is one side of a coin, then building stamina is the other. This skill requires a great deal of gentleness and care: many survivors of trauma push themselves to have too much stamina, not allowing themselves to honor their limits.

With this in mind, building your stamina is nonetheless an important pursuit. Just like building physical stamina, developing a deeper mental energy reservoir requires practice in small increments. When you notice that you are approaching empty, but not quite there yet—somewhere just less than ¼ full—gather your mental energy and sustain your focus and effort for another 10 to 15 minutes. Rather than exiting the activity to replenish your energy level, stay engaged and practice hanging in there. If you simply do not have enough mental energy to stay with your current task, try switching to a less demanding activity that still engages your mental energy.

Use Energy to Bring Healing to Your Life

Feel free to play with these ideas and apply the ones that resonate with you. Practice each type of skill (monitoring, replenishing, and building stamina) with each type of energy (physical, emotional, and mental). Be as creative as you can be and brainstorm additional ways to grow these skills. In so doing, you reclaim crucial abilities and further your healing.

Practice these skills in a safe environment and in a manner that can only benefit you. Never do anything in the name of healing that could actually bring damage to you. As always, keep in mind that you do not need to heal on your own. Reach out to support groups, loving friends, supportive family, and trained professionals. We are all here to help you grow.

“Guess what?” your best couple friends ask when you’ve just sat down at an elegant restaurant. “We have an announcement. Guess who’s not having wine?” You and your partner are jolted. You just found out an hour ago that your third in vitro fertility treatment didn’t pan out, and you didn’t even know your friends were trying.

You and your partner have a quick, furtive look. Your throat is dry, and a tear slides out before you can will it to stop. “Great news,” your husband says.

You can’t think of anything you can say aloud. You know you can’t say what you’re feeling: “Why you, not us? This is your third child, and we may never have a first. Why did you have to tell us here and ruin this expensive dinner?”

You could say, “I’m happy for you, but sad for us,” if your friends know that you’ve been trying.

With more public awareness of infertility, people announcing a pregnancy or birth are sometimes more sensitive to your needs. They might tell you in a private moment and add, “It’s hard to tell you, knowing how much you want this. I hope it happens soon for you.” You may appreciate the empathy, and elaborate on your feelings, and feel supported. On the other hand, you might be embarrassed and not want to talk about it, especially if you’re not emotionally close to the woman or you have reasons not to trust her.

First we’ll talk about dealing with your own feelings. Then we’ll talk about taking some control over how you receive news of future pregnancies.

Your feelings: handle with compassion

Mixed in with feelings of disappointment and competition, you may also feel guilty. You may even fantasize about miscarriages or complications. Your partner may add to your guilt by asking “Why can’t you be happy for them?”

Give yourself a break. You’re a good person, not someone who typically goes around with ill wishes. If you’ve been trying for months or even years to get pregnant or to carry to full term, it makes sense that you would be envious. This is especially the case if your friend is complaining of an accidental pregnancy or doesn’t have as much to offer a child as you and your partner do. A compassionate thought to say to yourself is “I’m happy for her but sad for me.” You wouldn’t expect a 24 year-old whose husband died yesterday to dance up and down about a friend’s engagement. It is understandable to have good wishes for the other person while also having feelings about your own loss or disappointment.

Controlling how you receive the information

You can’t control whether your friend gets pregnant before you do, but you can have a say in how you find out. This assumes, of course, that you are aware that someone is planning a family and that they know what you’re going through. Many of my clients have benefitted from what I call “the card trick.”

Ask your friend to send you a card. Yes, an old-fashioned greeting card via snail mail. Real envelope, real stamp. A phone call is hard, because it puts you on the spot. You need to congratulate the person right away, before you’ve had a chance to digest the information. IM is no better than phone, and e-mail is only somewhat better. Even if you don’t open the message, if its subject line reads “BIG NEWS!” you may feel that you are expected to respond quickly.

Because old-fashioned snail mail is unpredictable, your friend doesn’t know what time or even which day you receive it. This gives you time to tear up the card and stomp on it, have a good cry, or do some deep breathing before you pick up the phone and hit the keyboard. You get to feel like the loving, caring person you actually are and offer sincere congratulations. Even if you don’t have any negative feelings, you still have the luxury of time to respond when you’re ready. Everybody wins. You win because you controlled how you got the news. Your friend wins because you gave her a gentler way of breaking the news. You can both feel good about her new status and sincerely celebrate.

Even though you don’t know when or if your own luck will change, you can avoid unnecessary stress and enjoy your friend’s support and good wishes for your future pregnancy success.

Related articles:
Dealing with Fertility Challenges: Coping Tips and Resources for Parents-in-the-Making
Coping with Holidays While Trying to Have a Baby
Why Should I See a Therapist? I’m Not Crazy – We Just Can’t Have a Baby!

Love and compassion are necessities, not luxuries. Without them humanity cannot survive. -Dalai Lama

In life we encounter many different experiences. Some are joyful and uplifting, and others are painful and challenging. When we encounter joy, there is a yearning to have it last forever, but when there’s pain our first reaction is to avoid, ignore, or push it away. When we react to joy or pain with any form of resistance—clinging to joy, pushing away or ignoring pain—we suffer. What helps us walk through our suffering and the suffering of others is to become aware of when we are reacting to pain and learn to transform this reaction into a compassionate, caring response.

Cultivating a Compassionate Response

My first encounter in learning to confront suffering with compassion was many years ago, when I held a position as an intern at a center for survivors of domestic violence. In this environment, I learned a great deal about extreme suffering, as the women I encountered lived in a hostile, aggressive, and sometimes dangerous environment. In the beginning I felt overwhelmed just trying to learn how to help people deal with life-threatening, painful situations while remaining objective. Working in this setting was stressful, and I recall leaving the center in tears as I watched clients return to hostile and oftentimes dangerous situations. It brought up deep feelings of helplessness, frustration, and judgment.

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In helping these survivors, my initial reaction was to try and fix, change, or in some way rescue them. This was a reactive response as I was trying to get the pain (theirs and mine) to subside, and guess what? It didn’t work! It only increased my own feelings of helplessness and didn’t create the supportive, compassionate environment that promotes healing and empowerment. Luckily, I had a compassionate, patient, and wonderful supervisor who taught me that providing a nonjudgmental presence, connecting with an open heart, and having compassion towards the person, and myself, as I listened to their stories was what healed. This meant I had to let go of trying to control the outcome and allow myself to be present with their pain and my own. It was a growth experience that continues to help me in my professional and personal life.

Opening Heart and Mind Helps Connect and Heal

Running groups for survivors of domestic violence, I hear stories about physical, emotional, and verbal abuse. These stories are traumatic and heart-breaking. They all share a common theme of fear, loss of identity, and confusion. The shared experience of having to set aside their needs in an attempt to meet the needs of a controlling partner, whose wants and expectations are insatiable and unrealistic, left them with a sense of low self-worth, shame, and suffering. What helps them heal and become empowered is their ability to let go of judgment, share their stories in a supportive environment, and learn to develop a practice of self-care and compassion.

What Gets in the Way of Compassion

As we travel through life we will encounter pain. It might be through the loss of a loved one, the end of a relationship, or recovery from a severe illness. Or perhaps it’s the small stuff that brings up feelings of shame, inadequacy, or worthlessness. When this happens, the tendency is to get lost in judgment; we beat ourselves or others up in an attempt to stop the pain. This only intensifies our suffering. Caught in this reactive response we forget that there’s a real need to treat ourselves with kindness, love, and compassion. When we turn towards suffering with compassion it helps us heal and reconnect with life.

The Practice of Compassion

In helping people learn the skill of transforming reactivity into a compassionate and caring response, I use the example of a hurt child or a pet. I ask them how they would help a child who is sad or a pet that is hurt. What would that response look like? They usually state they’d give the child or pet a hug and comfort them with kind words or a gentle touch. Our deepest need, when we are in pain, is compassion; this is what helps us heal. It is not a luxury, it’s a necessity! This turning towards pain, with an open heart and the intention to heal, is what helps us to live life fully.

Developing Self-Compassion

Becoming aware of when we are reacting or in any way judging ourselves is the first step. The second step is to become present with how our bodies, minds, and hearts are responding to the experience of pain. Setting an intention to be kind towards ourselves and let go of reacting is what helps us to connect with compassion.

The following are some steps you can take towards developing a caring and compassionate practice:

1. Awareness is the first step! Notice when you are reactive or triggered. Your body sends signals when reactivity happens. You might feel blood rushing to your face or a tensing up of the hands or body. Your breathing may be shallow and your thoughts may be filled with judgment.
2. Connect with the present moment by letting go of thoughts and focusing on the sensation of the breath as it comes in and out of your body, or focus on feeling the ground beneath your feet. This helps to slow down reactivity and calm the mind.
3. Place your hand on your heart in acknowledgment of the difficulty you are facing in this moment. Imagine the placing of the hand on the heart as symbolic of opening the heart to compassion or sending healing to the hurt place inside.
4. Visualize yourself held or embraced by a spiritual figure or someone who loves you.
5. Allow yourself to take in the healing sensation of compassion until you feel calmer and more connected to the present moment.

When we allow ourselves to care for ourselves and others, it is a profound act of kindness that refills the heart, energizes the body, and nourishes the soul. In that moment of opening our hearts to self and others, we recognize the immense healing power of compassion and reconnect with life and love.

May you be free from suffering.

May your heart be filled with compassion.