“Why are you out of bed?”
“I’m scared.”
“What are you afraid of?”
“There’s a monster under my bed!”
“There are no monsters. Go back to bed.”
“Nooooooo, I’m scared.”
Sound familiar? Almost every parent has done this. Holding a little hand, down on your hands and knees with a flashlight to prove there is nothing under the bed—unless you count the stray sock, a missing toy, and a few dust bunnies.

Your little one thinks you are a superhero. You faced the monster and saved the day, or in this case, the night. With imagination tamed, feeling safe and secure, your child falls asleep.

Imagination is an amazing thing. Children hone it to a fine art. With a towel on their shoulders and a leap from the couch, they fly!! They feed you imaginary sandwiches and wipe imaginary crumbs from your chin. They introduce you to friends only they can see. They scare themselves at bedtime. Years pass, towels are used for bathing, imaginary sandwiches and friends are forgotten. Monsters no longer hide under the bed. Reality replaces imagination.

Or does it? Many adults continue to exercise their imagination. They don’t have towels on their shoulders or imaginary friends, but they do believe in monsters created entirely with their imagination. Your child, no longer afraid of monsters, is a teenager now. You worry she doesn’t take school seriously, or her current boyfriend is a bad influence, or her college fund isn’t going to be enough. Get the picture?

Adults may not imagine monsters under the bed, but they do imagine a multitude of scenarios that would scare Freddy Krueger, and it’s socially acceptable. A vivid imagination is never questioned if the name is changed from imagination to worry. It is commonly accepted that everyone worries; it’s part of being a responsible adult. How else can you be prepared when the unthinkable happens? If you have played out the worst-case scenarios in your mind, you are ready to deal with them.

Worry is as useful for you as monsters under the bed were for your child. You make things up in your head, believe them, and scare yourself. Who will take you by the hand, shine the flashlight on your imaginary fears, and make them disappear?

Worry is using your thinking to predict the future or to continue to relive the past. Predictions rarely come true, and if they do, worry did not change the outcome. It only made you miserable before the outcome happened. How much have you changed the past by worrying about it? Unless you conquered time travel, it doesn’t work. The past is past. It doesn’t change and it doesn’t cause you pain unless you bring it into your present by thinking about it. So the monsters (worries) of the future and the past are simply you using your imagination to scare yourself. Seems a bit silly, doesn’t it?

Worry (scaring yourself with your imagination) raises your level of tension and lowers your mood. From that low state of mind you expect to find solutions to your problems. It won’t happen. High tension and low mood doesn’t make for good problem solving—ever. Recognizing that you are scaring yourself helps the worries go away. You shine the flashlight on your fears and recognize they are imaginary. From a calmer state of mind, you deal with problems as they occur rather than in the future or the past.

Related articles:
Don’t Worry – Be Happy!
Self-Soothe in Your Own Compassionate Hammock
Mindfulness Practice: Learning to Live in the Moment

I first met Albert Ellis, the founder of Rational Emotive Behavior Therapy (REBT), about 35 years ago. Soon after I became an Associate Fellow and a Supervisor with the Albert Ellis Institute in New York City, and was a died-in-the-wool devotee for decades.

Al was open to all of us adding or subtracting a variety of techniques, whether meditation, homeopathy, yoga philosophy, or anything else, as he had already incorporated disparate ideas from areas as diverse as Buddhism and behaviorism. He wanted each therapist to put his or her own stamp on their ways of working, although I believe he assumed we would all keep the REBT skeleton beneath whatever robes we draped it in.

Rigid, dogmatic thinking was not the coin of his realm. In fact, he loved to engage in lively discussions of all therapeutic techniques and was happy to incorporate anything he believed would help shift a client to becoming more unconditionally self-accepting.

Of course, like any parent, he was proud and delighted when his baby, REBT (the precursor of cognitive behavioral therapy [CBT]), would be “proven” to be effective in alleviating depression, anxiety, anger issues, or anything else, as it was with 40-plus years’ worth of studies.

This plethora of evidence-based practice studies that have lauded the effects of REBT and CBT is what led to the Swedish government’s decision to invest heavily in training clinicians to provide CBT to people with depression and anxiety and spend no money on training or treatment in other modalities. Naturally, the Swedish government was a bit shocked when a recent study showed that training therapists in and treating clients with CBT had little or no effect.

In response to these findings, Scott D. Miller, Ph.D. wrote: “The widespread adoption of the method has had no effect whatsoever on the outcome of people disabled by depression and anxiety.  Moreover, a significant number of people who were not disabled at the time they were treated with CBT became disabled.”

Apparently, this has not deterred the American Psychological Association from resurrecting its plan to draft and promulgate a series of guidelines pushing specific treatments for different mental health issues.

Dr. Miller and his colleagues at the International Center for Clinical Excellence have analyzed many studies showing little difference between treatment approaches in terms of outcome. They argue that all approaches work almost as well, and efforts to target specific treatments for each psychiatric diagnosis are not an effective use of time and money.

Dr. Miller recently talked about what works in behavioral health and recommended shifting the focus to designing client-tailored services rather than spending so much energy on examining specific treatment models and techniques. Meanwhile, Sweden has decided to end the exclusive use of CBT for the treatment of anxiety and depression, realizing that people need to have therapy choices.

As a holistic psychotherapist for almost 40 years, I think it is obvious when treatment is working: people self-report feeling better. They engage in life more fully, sleep better, take better care of themselves, and have more satisfying relationships and more meaningful life experiences.

As much as it can be wonderfully useful to study psychological modalities, theories, and philosophies, at the end of the day it all boils down to whether the person has been helped or not. Using evidence-based practice studies as a Procrustean bed will only cause pain and prolong suffering, just as the original one tried to stretch or shrink people to fit its specifications.

Source:
Miller, S. D. (May 13, 2012). Revolution in Swedish mental health practice: The cognitive behavioral therapy monopoly gives way. Retrieved from http://www.scottdmiller.com/?q=node%2F160&goback=%2Egde_53475_member_125725759

Related articles:
What is CBT?
Deep Breathing and Guided Imagery
When Someone Really Listens, We Heal

According to a recent article, being completely honest with your mate about infidelity might not always be the best strategy. Clinical Psychologist Bruce Stevens explained that understanding the need to be honest about the affair can help guide the decision whether to do so or not. Stevens has worked with couples for more than two decades and said that his experience has shown him that only about half of marriages survive after an affair has been revealed. He says, “After an affair is found out, it’s like a bomb has been dropped on the relationship and you cannot predict how it will go.”

When someone confesses to having an affair, it can create a sense of chaos unlike any other the relationship has ever experienced. Stevens knows that couples who put in the effort to work through the many issues that arise after the affair have a good chance of salvaging their relationship and usually have a stronger, better, healthier relationship because of it. Stevens says that many people admit to their affair in order to assuage their own guilt. He believes that this reason should not be the motivating factor for full disclosure. Stevens says there is no guarantee that both partners will be able to overcome the damage caused by the truth and thinks it’s almost like playing Russian roulette.

The good news is that Stevens also thinks that there is significant hope for couples who can be realistic after they go through the pain of discovering an affair. If both partners are willing to accept responsibility and recognize that they are both human beings, flawed and imperfect, they have a very good chance of moving forward in their life together. Regardless of whether partners choose to come clean about their infidelity or not, Stevens reminds us that affairs are like fairytales. They are illusions that allow us to temporarily escape reality. The difference is, affairs rarely end “happily ever after.”

Related articles:
Reasons for the Affair
When Is the Marriage Really Over?
The 5 Truths Every Married Person Needs to Know About Affairs

One of the primary goals of successful therapy is the formation of a meaningful and strong therapeutic alliance. This bond between the therapist and client is essential for creating an environment of openness, acceptance, and trust. Therapists are largely responsible for developing this foundation, but clients contribute significantly to the bond as well, even if they are unaware they are doing so. Many clients bring past experiences into therapy. Negative and judgmental encounters with previous therapists can cause clients to be distrusting and fearful in treatment, creating barriers to constructive working alliances. Understanding how clients’ past experiences influence the therapeutic bond, and how therapists can overcome these challenges, was the focus of a recent study conducted by Christian Moltu of the Division of Psychiatry at the District General Hospital of Forde in Norway.

Moltu interviewed a dozen therapists and asked them to describe how they overcame hurdles they experienced with hesitant and resistant clients. The therapists were trained in a range of approaches and yet each described similar methods for interacting with difficult clients. Each therapist stated that he or she achieved a productive working alliance, despite their clients’ reservations, by doing one of three things. The therapists said that successful alliances occurred when clients asked the therapists to help them with the relational challenges they faced. Additionally, therapists noted that bonds were built when they acknowledged the clients’ willingness and courage to overcome existing challenges. Lastly, when clients were unable to move past victimization and suffering, therapists found a way to build a bond with them by recognizing this deficit in their clients and explaining that the goal of therapy was to move from challenging situations to positive outcomes. Moltu added, “We found that participants experienced the client as contributing relationally and that this influences how the therapists respond and are present in the interaction.” By being attentive to the past experiences a client brings to therapy, a therapist can work with the client to overcome these limitations and ultimately develop a strong and cooperative therapeutic relationship.

Reference:
Moltu, C., Binder, P.-E., Stige, B. (2012). Collaborating with the client: Skilled psychotherapists’ experiences of the client’s agency as a premise for their own contribution in difficult therapies ending well. Journal of Psychotherapy Integration. Advance online publication. doi: 10.1037/a0028010

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

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

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

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

If you haven’t read the novel yet, you might be 50 shades of curious about why Fifty Shades of Grey is the most-talked-about tale in print currently.

A quick search will reveal that the romance between the main characters, Mr. Grey and Miss Steele, revolves around bondage, discipline, dominance, submission, sadism, and masochism (BDSM). In fact, Christian Grey appears to really only get satisfaction from sex when it involves inflicting pain or dominance over his partner, which, following criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM IV-TR) used by mental health professionals to make diagnoses, could be considered a mental disorder called sexual sadism.

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The DSM IV-TR states that “sexual sadism involves acts (real, not simulated) in which the individual derives sexual excitement from the psychological or physical suffering (including humiliation) of the victim.” In order to officially be diagnosed with sexual sadism, individuals must meet the following criteria:

1)    “Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving acts (real, not simulated) in which the psychological or physical suffering (including humiliation) of the victim is sexually exciting to the person.”
2)    “The person has acted on these sexual urges with a nonconsenting person, or the sexual urges or fantasies cause marked distress or interpersonal difficulty.”

In the first novel of the series, Christian Grey appears to engage in sexual sadism only with consenting participants (like Anastasia Steele, the main female character), but he openly admits to being abused (including sexual abuse) as a child and teenager and appears to be at least somewhat distressed by the fact that it’s difficult for him to have a “normal” relationship. He even explains to the character Anastasia Steele at one point that this is just the way he is, almost with sorrow. And although he does have “normal” or “vanilla” sex with Anastasia, he makes it obvious that he prefers sex that involves pain and pleasure at the same time, always with him dominating.

Anastasia also admits to herself that there is something unusual about Christian and his sexual preferences, but she lets her desire for him take over, and she hopes that she can make him want a “normal” relationship with her. She herself has issues with low self-esteem and confidence, which is perhaps why she is so drawn to the seemingly overly confident Christian. Both characters appear to function as well as the average person in their fictional world, but both have issues that could potentially need to be addressed by a professional if they lived in the real world.

So it appears that one of the main characters of Fifty Shades of Grey may have a diagnosable disorder related to sexuality, or at least has abnormal sexual preferences and a traumatic past that hasn’t been resolved yet. He has major difficulties maintaining any lasting romantic relationship, and yet the relationship between Christian and Anastasia seems to have been received in a somewhat positive light, considering the large following of readers.

The Experts Weigh In
Several mental health experts have offered their insight into the unusual relationship found in Fifty Shades of Grey (and the two other novels in the series). Reef Karim, a board-certified psychiatrist, the founder and medical director of the Control Center for Addictions, and author of Why Does He Do That? Why Does She Do That? and host of the new show Broken Minds on the Discovery channel, said that the novel is definitely making people think about normal and abnormal sexuality and possibly changing some people’s minds.

He said in an e-mail that the main question people are wondering is, “What is normal and abnormal sexual behavior, and when is aberrant sexual experimentation and behavior considered a mental health diagnosis?” “The really interesting part of psychiatric diagnoses is that many are based on a behavioral spectrum where the interruption of an individual’s social, relational, occupational, and functional life is a key factor in making the diagnosis,” Karim said. “This book has become a literary piece of pop culture that is challenging many to review their thoughts on normative and ‘out of the box’ sexual behaviors.”

He said that there could be concerns about a link between sadomasochism (S&M) and childhood abuse as well, since that is mentioned in the novel. “There is definitely a connection, but many people with no psychiatric or psychological history report enjoying BDSM primarily as a novel and alternative way to connect with each other,” Karim said.

Despite (or because of) the unusual relationship involving pain and pleasure (and emotional issues), many women appear to be captivated by the novels. Karim suggests this is because women enjoy having sexual fantasies, but that doesn’t necessarily mean they want the type of relationship found in the novel to become more than a fantasy. If anything, women might be more prone to sexually experiment during or after reading the novels.

However, he doesn’t think the novel is capable of completely changing sexual norms, so sexual sadism and sexual masochism will most likely still be considered mental disorders according to the DSM in the future. “I believe the novel opens up the conversation of BDSM, kink and sexual norms, but it’s much more in the curiosity range than actually changing research-driven professional medicine,” Karim said. “Expecting an increase in sex shop purchases is different than changing a clinical manual.”

Karim explains further why the novel is so appealing to women (and men), even with the dysfunctional (and sometimes even depressing) personalities of the characters. “In regards to sexual research, many women fantasize about submission, and many men fantasize about dominance,” he said. “Even though men and women are more equal than ever in regards to occupation and finances, we are still very different sexes, and definitive gender and role-based fantasies do exist,” he added. “Many people in our society have hidden (or not so hidden) fantasies involving kink, S&M, or altered sexual behavior. 50 Shades of Grey has opened up the conversation of previously hidden sexual desires and fantasies of many women.”

He said the novel could help couples become more creative in their sex lives, but going to any extremes is generally not beneficial. “The introduction of BDSM can add to a couple’s sexual tool box, but occasionally it can get out of control,” Karim said. “When extreme behavior leaves the bedroom or involves extremes in the bedroom, it can negatively impact the relationship. I’ve treated couples who use BDSM as a novel, fun experience in a healthy and intimate way, and I’ve treated other couples or individuals who became obsessed with the act or re-created a previous abuse history with a lot of painful markings.”

Overall, the BDSM series is encouraging men and women to discuss sexuality more openly with each other. “The book mentions childhood abuse and difficulties with self-esteem that contribute to the psychological make-up of these characters, but it has also found a way to tap into the S&M lifestyle curiosity shared by many men and women,” Karim said. “It may actually normalize the behavior, when done in moderation, as not something strange but perhaps just another form of sexual expression. Life isn’t always black and white; sometimes it’s fun to live with a little grey.”

Kari Tabag, a licensed clinical social worker, works with adolescents and college-age men and women and has read the series. She said the novel has passages that hint at mental health issues like posttraumatic stress, codependency, BDSM, and alcoholism.

Although she agrees that the novel can improve people’s sex lives through fantasy, role play, and experimentation, the sexual expectations people might have after reading the series might be set too high, leading to disappointment. Also, she emphasizes that the actual relationship depicted in the series is very unhealthy in many ways. “Christian and Anastasia’s relationship is not a healthy one. They are codependent and are too enmeshed with each other,” Tabag said. “A lot of women are codependent and are what I call ‘daddy hungry.’ This novel depicts two people who have abandonment along with trust issues.”
There are even more unhealthy aspects of the fictional relationship, according to Tabag:

• When Anastasia finds out that Christian only dates women with brown hair, it is a dead giveaway of his childhood abuse and abandonment. In fact, Anastasia refers to him as her “boy,” which is not healthy.
• Anastasia repeatedly feels that she is not worthy of Christian and vice versa.
• Christian is obsessed with Anastasia and even follows her to another state when she visits with her mother.
• They both are looking for someone to take care of rather than focusing on healing themselves. A healthier relationship involves two people who have their own separate, independent personas, making them well-established, well-rounded, self-reliant individuals.
• Christian wants Anastasia to give in to him and give up all control, and he lavishes her with gifts as a reward.

Although the relationship in the novel is not healthy, BDSM is not necessarily as terrible as it’s made out to be. Tabag suggests our society is not necessarily mature when it comes to accepting and understanding sexual preferences outside of ‘man on top.’”

Viewpoint From a Submissive
Kasi Alexander, the author of several books and short stories about alternative lifestyles, such as Becoming Sage and Saving Sunni, has herself been involved in the lifestyles of polyamory, BDSM, and power exchange. She currently identifies herself as a “slave,” and the partner in her polyamorous relationship is the “master”; she could also be referred to as a submissive. She said in an email that the relationship between Christian and Anastasia is not necessarily a model of the typical BDSM or power exchange relationship. The characters themselves are also not typical. For example, Christian Grey was abused as a child and became involved in BDSM at 15, and he now avoids “vanilla” sex and relationships.

“Very few people in the lifestyle immerse themselves so deeply that they have no desire for a relationship outside the parameters of power exchange,” Alexander said. “The ones who do are using the lifestyle to mask other personality defects, not the other way around. Accepting your dominant or submissive tendencies does not kill the desire for intimacy, closeness, or connection.” Also, the character of Anastasia Steele is low in self-esteem, self-worth, and confidence, which is not usual for submissives, Alexander said.

“Many people assume that submissives give up all responsibility for themselves, are doormats that cannot stand up for themselves, and so are taken advantage of by predatory dominants,” Alexander said. “That couldn’t be further from the truth. Submissives are stereotypically extremely strong, capable people. Many of them crave submission as a way to temporarily escape the huge responsibilities they take on in their “vanilla” lives.”

Alexander adds that the BDSM lifestyle can even be considered therapeutic in different ways. “In my own relationship, we have used our power exchange to work on my self-image and body issues, increase my self-confidence, and achieve many goals, including writing and publishing three books (so far),” she said. “Other kinky people that we know use sensation play as therapy or catharsis to work through feelings of inadequacy, childhood abuse issues, and various kinds of mental health issues.”

The BDSM element of 50 Shades of Grey just takes the typical romance/erotic novel a little further. “Women have a genetic inclination toward alpha males, so we love our fictional heroes to be large, powerful, and a little scary—someone who has the ability to hurt us but doesn’t,” Alexander said. “And almost all BDSM play is based on the intensification of physical experiences. So the fantasy of the physical ‘danger’ (intensity of experience) goes along with the mental domination of having a strong alpha male taking over your life. It’s erotic, even if it’s not what we want in our actual day-to-day lives.”

She said BDSM and power exchange have the potential to make relationships more sexually fulfilling, but just like in any relationships, it’s a matter of communicating wants and desires. And just like in other bad relationships, abuse and manipulation can happen, but that is a matter of individual personalities and relationships, not a characteristic of BDSM as a whole. She said it’s important to make a distinction between mental conditions and different sexual preferences and alternative lifestyles. “The most important aspect of the mental disorder consideration is the difference between true sadism and kinky sadism,” Alexander said. “A vast majority of ‘sadists’ in the BDSM community derive no pleasure from inflicting pain unless the recipient is enjoying the experience, whereas a true sadist is not concerned with the benefit of the other person.”

She believes that people will eventually become more accepting of these types of lifestyles and realize that they can be beneficial to people who can learn how to make them work.

“More education is needed to show people that polyamory is not cheating, BDSM is not abuse, and power exchange is not manipulation,” Alexander said. “The important thing to keep in mind is the benefit for the people involved. BDSM and power exchange can be done badly and for the wrong reasons, but they can also be used for personal, professional, and spiritual growth and for the enhancement of relationships.”

Related articles:
What Do Your Sexual Fantasies Mean?
The Good and Bad Sides of Porn
Exploring Alternative Lifestyles in Your Relationship

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

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

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

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

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.

We all experience losses, big and little, throughout our lives. When enduring a big loss, people fall into patterns that may be considered masculine or feminine ways of reacting.

Men and women tend to process their losses differently, but the way they grieve is affected by many other factors besides gender, such as culture, personality, and temperament. Grief and loss are experienced in unique ways by each individual.

A generalization about gender differences in grieving would be that men tend to focus on feelings of guilt and anger. They are likely to spend more time thinking than feeling. They also tend to act independently rather than rely on others.

Women typically need more support and are expressive with their emotions, which is behavior we tend to associate with grief and loss. However, there is no cookie cutter approach to mourning. In recent years, experts like Kenneth Doka, PhD, have recategorized these types as intuitive and instrumental grief.

Intuitive grief can be associated with our generalizations of the way that women grieve, which includes the following:

• Strong, affective reactions (waves of powerful emotions)
• Expressions that mirror feelings (more like an open book)

Moving forward involves exploring and expressing feelings, progressing through the pain in order to heal.

Instrumental grief can be associated with the masculine way of grieving, which includes the following:

• More thinking than feeling (an inward, quiet process, less expression of emotions)
• Being physical, expressing grief through doing something (I could not fix my son, but
  I can fix this broken fence)

So how do you help someone who doesn’t want to talk or ask for help?

• Use logical analysis—figuring out problems by breaking them down into manageable steps (to be less overwhelming)
• Gather information—on new roles (in your household, family, work, etc), supports, faith, to do lists, etc., in order to start implementing
• Use humor—It has much of the same release as crying does, and it’s still okay to laugh
• Provide diversions/distractions—list all supports and assign them to categories
  • Good doers (who could take care of the pet, get the paper, etc.)
  • Good listeners
  • Good respite (who could take a break from the grief and will not ask you about your loss)

Instrumental grievers would benefit more from groups that focus on a how-to (like being a single parent), adventure based, informal or educational, than a traditional support group.

Like any other model for grief, there are several tools you can use with variations for each person. There are always ways to help. You can start by figuring out which support is needed and offer it. And if you need help, ask for what you need. Just know that there is never a wrong way to grieve.

Your social life, the quality of it, was wired into your gray matter by the age of 3, according to current thinking on child development. After a minute of contemplating that statement, the immense impact of early childhood caregivers becomes clear. This subject comes to mind after reading a recent news story about Artyom Saleviev.

Artyom was first in the news in 2010. He is the Russian boy who was adopted by a U.S. couple, the Hansens, 3 years ago. After being part of the Hansen family for 5 months, Artyom was put on a plane bound for Russia by his adoptive mother. Artyom carried a letter which stated the Hansen’s no longer wanted him because of his disruptive behavior related to psychological problems. The recent news article states that Artyom is now living in a foster home (in Russia) and his behavior there is not disruptive.

In the United States, the number of children in the foster care system is close to 500,000. One-quarter of them are infants when they enter the system; 15% are age 3 or younger, some only infants. The most common reasons for removing them from a parent or relative’s home are an absence of supervision (36%) and a failure to provide (31%). What affect does this have on a baby or toddler? Are they so young they will not remember neglect or abuse by early caregivers? If only that were true.

Caregiver Influence

To understand the effect early caregivers have on infants and toddlers, we can look at the implications of attachment theory. This theory, which has been substantiated by research, states that interactions with our initial caretakers determine our future capacity to build emotional bonds with others.

By the age of 3 years, children are either secure in their attachments to their caregivers or insecure. Children who are secure have the benefit of responsive caregivers that consistently meet their needs for food, safety, and affection. In adulthood, they can form lasting emotional connections with others.

There are three types of insecure attachment: avoidant, ambivalent, and disorganized.

When caregivers discourage expressions of a child’s distress or affection, an avoidant style of attachment develops. The child learns to discourage his or her own feelings, which damps down the child’s capacity to feel loved by others. Avoidant children typically withdraw from social interaction and grow into adults who are extremely uncomfortable with feelings and intimacy.

Ambivalent attachment occurs when early caregivers give comfort inconsistently. They sometimes respond to the child’s needs and sometimes do not. With this kind of care, children become unsure whether their needs will be met. As adults, they are slow to trust and at risk for mood and eating disorders.

When a child’s needs are not responded to, or the child is abused, a disorganized pattern of attachment can lead to delayed development, social withdrawal, and aggressive or disruptive behavior. Adults with disorganized attachment are susceptible to personality disorders and chronic mental health problems. Their relationships are often chaotic or short-lived.

Our attachment style sticks with us for life, although alternative behaviors and ways of thinking can be learned to improve relationships.

Not All Memory Is Conscious

When Artyom Saleviev arrived in the United States, was he secure, avoidant, ambivalent, or disorganized in relation to others? The Hansens painted a picture of a very disorganized child, although his current foster mother in Russia does not. Regardless, his experience with the Hansens, and the ill-conceived way he was sent back to Russia, are not stand-alone events. They rest on the foundation of interactions he had, or did not have, very early in life.

Even if a school-age child like Artyom is adopted or finds his way to a nurturing foster caregiver, a pattern of connection with others is already established. It begins before the child enters foster care, as a result of the child’s experience with his first caregivers, and the pattern continues after he leaves the system.

Around one-third of those 18 to 24 who age out of foster care are homeless within 18 months (in the U.S.). Up to one-half are unemployed within 4 years of leaving, and approximately 30% to 40% have a mental disorder and likely no health insurance. More than three-fourths will become parents.

Perspective

To keep these sobering numbers in perspective, we can consider that people with less than stellar starts in life can, and do, lead productive lives and find a share of happiness. Humans are highly adaptable and resourceful. It is also a fact that people from “good” homes enter adulthood with mild to severe attachment issues, usually the avoidant or ambivalent type.

Difficulty trusting and connecting with others is not just a single family issue. It is part of the human condition and drives the drama we call history.

The foster care system is imperfect, but it is a nested problem. Looked at as a whole, the problem begins with the child’s experience of insufficient early caregiving and is later aggravated by the lack of support for these children during the transition to adulthood. The system is situated in a disorganized world where, unfortunately, such institutions are necessary. The best we can do is to strive to keep making improvements based on what we continue to learn about the special needs of these children.

References:

1. Child Welfare Information Gateway. Available from: http://www.childwelfare.gov
2. U.S. Department of Health and Human Services, Administration for Children and Families. Abuse, Neglect, Adoption & Foster Care Research: National Survey of Child and Adolescent Well-Being (NSCAW), 1997-2010. Available from: https://acf.gov/opre/project/national-survey-child-and-adolescent-well-being-nscaw-1997-2014-and-2015-2024
3. Radia, K. Adopted Russian boy rejected by U.S. mother adjusts in foster care. Available from: http://gma.yahoo.com/blogs/abc-blogs/adopted-russian-boy-rejected-u-mother-adjusts-foster-110037054–abc-news-topstories.html

Related articles:
Patterns of Attachment in Adults
Understanding Difficult Behavior – For Foster and Adoptive Parents

The following is an open letter to my sister Andrea Haber, who died from complications due to alcoholism on 10/31/11.

Dearest Anj:

Just a note to let you know how much I miss you. It’s still so bitterly ironic to me that what killed you is the very disease I’ve devoted my life to battling. But in a way, your alcoholism never gave you a chance.

I’m sorry we never talked about it, although you can’t say I didn’t try. There was a time, a few years back, when you told me you wanted to talk about it, and my heart leapt. But that talk, like so many hoped-for moments, never materialized.

I believe when I first got sober I wrote you a somewhat long-winded, pompous letter about the perils of drinking. I’m sorry again that I preached at you like that. You handled it with grace but I cringe now at the thought of my presumptuous rambling. Newly sober people often think they can save the world with a few well-chosen phrases. I guess I thought there was really something I could do. Naïve, yes, but even at the end, and maybe even now, I often feel the same way.

I miss your letters. They really made me laugh. You were a fabulous writer and I think that you, as with so much else, underestimated yourself. Their absence has created a very loud silence.

I’m sure you’re thinking, “Gee bro, nice cheery letter!” I only wish I could be more cheery. This is an occasion I never wanted— that even with the grim medical news coming from Pittsburgh, I never really saw coming. There’s just no good way to spin the loss of someone so young, so beautiful, so amazing. Part of the tragedy for me is, I don’t think you ever truly understood just how loved you were. Mom told me you were shocked when she said to you, near the end, how much you’d be missed should the worst happen. This too, is another symptom of addiction: the disbelief that we matter to people, the certainty that we’re really “only hurting ourselves.”

Hard to be cheery when feeling so cheated…

Of course, denial is the hallmark of this loathsome affliction. We grew up with rationalizations and minimizations aplenty when it came to Dad’s drinking and the family’s Nixonian “cover up”—i.e., “Don’t talk about it, too embarrassing” (Dad’s favorite) and “It’s not that bad” and “Don’t exaggerate,” all repeated like mantras. Even I, near the end, felt that chances were good you’d come around; see the light, get sober. Your disease made a mockery of my optimism.

So hard to sit on the sidelines and simply try to accept. I’ve struggled lately with, “Did I really do enough?” Should I have gone all out and planned an intervention, John Wayne style? Should I have demanded you listen to me until “the truth” sank in? I already felt like a stick in the mud, the voice of gloom, whenever you called or wrote me and wanted to laugh or kid around; I loved the jokes but was so terribly worried about your well-being. We had a trove of inside jokes, a bulwark against the despair of growing up in that chaos and emotional violence. I cherished the humor but wondered what might be going on underneath. There is a pain we can’t hide from, I have found, no matter how clever or humorous we are. When your doctor handed you that grim prognosis last year, that you either stop drinking or die, I thought “well this is it, she can’t ignore it any longer.” Wrong again, bro!

Of course the cliché is that there’s nothing you can do to get a person to stop; no amount of begging or pleading or coercion will ever do the trick. Maybe briefly, superficially, but it’s an “inside job” (as they say) when it comes to lasting change. We can give someone just about anything, except motivation to do the hard but necessary thing. I kept thinking you’d finally “hit bottom” when the doctors told you your liver was shot…until mom told me this wasn’t the case, that she feared nothing was changing. I backed off a bit because I know how she hounded you. Maybe that was a mistake. Maybe hearing it from me would’ve got you moving.

I cringe when I see the pride and ego in that last sentence. Yes, you should have heard it from ME, your big brother, sober white knight on the West Coast, brandishing a master’s degree in psych., saving souls and fighting the good fight. I wonder if you’re chuckling as you read this.

Perhaps it’s pretentious of me to think I had the slightest idea of what might be good for you. I had no idea what was really going on in your life, and I suppose it was none of my business. Maybe the long, hard climb back to sobriety might have been too difficult; perhaps too many skeletons, whatever they were, had accumulated in the closet for any one person to face.

But saying “There’s nothing I could have done” doesn’t seem to help. Maybe that’s why I’m writing you now; perhaps, in my Jewish neurotic guilt, I struggle towards some kind of absolution. Doubt has always dogged me; so hard to not look over my shoulder in almost every instance. This is no exception. Could I have somehow said more, done more, pushed harder to help you “see the light”? (Am I hearing that chuckle again?)

Just this morning I advised the mother of a patient that there was nothing she could do to “get” her daughter to stop using and go to meetings. I thought, “Wow she really thinks there’s something she can do!” So easy to sit in one’s cozy office chair and dispense wisdom to the struggling, misguided souls asking for help…

Here’s the hard part (as if there’s an easy part!): You can detach, stop trying, accept another’s addiction, respect their “life choices” and move on. But how to really “move on” when it’s your own flesh and blood? You can stop obsessing, stop letting the person’s disease hold your serenity hostage, attend Al-Anon meetings, seek counseling…but the kind of Zen-transcendent it’s-all-good acceptance I’ve perhaps subtly advocated to others isn’t possible, at least not for me, at this point in time.

Because I can’t stop loving you. Can’t switch off the caring. How could it be otherwise?

Maybe the idea is to make room for both, the love and the acceptance. It’s not either-or (as I’m fond of telling my patients). You can love the person and hate the disease. It’s just hard to stand by and watch a loved one fall to pieces and to try and pretend it’s not happening. It’s like a fatal car accident happening in slow motion right outside your door. I prayed every night for you to find the desire to stop drinking. I struggle to accept it never happened.

I know you meant no harm, Sis, and I never took it personally. I think if you could have stopped, you would have; as I say, the odds were seriously stacked against us from the get-go. I don’t know why I hit the lucky number; I just know it’s a gift that I protect with my life, and I would have given anything to have shared it with you. I tried.

I hope you know that somehow, wherever you are, I was worried but not condemning you. There is so much shame with this thing but I always longed to say to you, How could you not be an alcoholic, with all the crap we had to deal with? Even so, I underestimated the awesome power of this thing, and can only guess at how you suffered beneath the chuckles, the jokes and that wonderful wit of yours. It’s just hard to accept that, in this case at least, love was not enough…so difficult at those times when I think of our private jokes and laugh and want to email you…hard to really accept that my kid sister—my first friend, my loyal ally—is really, undeniably gone…

 Related articles:
The Pendulum of Grieving
Over-Extended: Thoughts on Boundaries in Addictive Families
In Case of Emergency: Seeking Help When a Loved one Struggles with Addiction

“This is a healing. I haven’t allowed myself to heal. I didn’t understand it. I mean I heard what people said when they said this, but I didn’t understand it – until now.”
– Independent filmmaker

At significant moments in sessions, we pay attention to the nuances of our client’s experiential process as it is conveyed through their verbal and nonverbal communication; and we rely on our own experiential process for our vital clinical intuition. We listen through these levels to grasp what our client is experiencing. It is inconceivable to consider the practice of psychotherapy without paying careful attention to experiential process.

But what is meant by experiential process? Are there different levels of experiential process? What does it mean when we say that someone is “too much in their head” or, for that matter, too much in their feelings? What makes one type of psychotherapy really experiential and another less so? Does experiential process have its own natural properties? If such properties exist, how can we know them? These are philosophical and theoretical questions of great value to clinicians.

This article is the first of a series introducing you to Eugene Gendlin’s philosophy of experiencing, its theoretical principles, and its clinical applications. As a philosopher and phenomenologist, Gendlin makes a rare contribution to our work because he addresses ontological questions about the nature of experiencing itself. While a growing number of clinicians, from different schools of psychotherapy, know the clinical value of his experiential focusing method, the philosophy itself is less well known. Ahead of its time, it can now be seen as providing an intellectual holding environment for some of the latest developments in intersubjectivity theory, self-psychology, trauma work, and what is now called the philosophy of the implicit.

My plan in this introduction is to give a brief background to Gendlin’s thought and then to show you how his conceptualization of the natural “laws” of experiential process have direct application to our work with clients.

Gendlin is a philosopher who collaborated with Carl Rogers when they met in 1952 at the University of Chicago. Gendlin’s first major work, Experiencing and the Creation of Meaning (1962), introduced the experiential dimension, and he went on to say that, based on his research (see below, re: The Experiencing Scale), client-centered therapy was not enough. Rogers acknowledged this, citing Gendlin’s contributions to his own article called “On a process conception of psychotherapy” (Rogers, 1958, p. 142). Gendlin went beyond the person-centered approach to describe his view of experiencing in what now is called the implicit dimension of meaning and “implicit knowing.”

Gendlin and his collaborators discovered that clients who showed no progress in therapy didn’t seem to have a capacity to “refer inward” in a particular way. Gendlin designed a way to capture and teach this natural process to anyone interested in working with their inner experiencing.  In order to test the validity of the focusing method, Gendlin and Hendricks developed The Experiencing Scale, a statistically reliable method of measuring levels of experiencing. In the last 20 years, experiential focusing has been cited as an excellent example of a microunit of naturally occurring human change process (Patterns of Change), that can be worked with across most approaches to psychotherapy.

Consider this: 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.

We start the process when some situation in our lives—something we “find ourselves in”—feels stuck or painful. The problem beckons to us in a bodily way. We want to move into the place where meanings can reconstellate. To touch into this realm, we sit quietly, eyes lowered, with attention inside. We let form how exactly the situation touches us, how it is meaningful to us, but in an implicit way, not in words. You might say that It finds a way to let itself develop explicitly.

By staying still yet alert, our inner sensing seems to order itself; bodily felt senses (to be defined in the next article) carry within them a palpable sense of significance. As we let them come to us (we cannot in fact go after them!) they prioritize themselves. In a way, they tell us what we need to be attending to. As we hold them in our awareness, we let our words speak directly from our immediate sense of them. And, as this happens, something starts to happen, however subtle. Something starts to dawn on us. Our usual way of holding a situation starts to open—but it’s not only the situation. It is the way we “hold” the situation. We notice a palpable change. This was a good moment in a good therapy session.

If the above description seems familiar to you, that is probably because you have access to your own creative process; you refer to it without needing to know how it might work. The process has its own palpable efficacy. If you are taken by the process, Gendlin’s philosophy in action, you might over time find yourself “living the practice.”

Gendlin’s worldview has helped me to sit with the pauses, stuck places, and moments of uncertainty that are intrinsic to life, including to my life’s work as a psychotherapist. His view of the human universe lends a beauty to the process of meaning making, helping our clients and ourselves stay alive to the creative process that makes good therapy.

This first attempt to describe the microprocess of experiencing will be refined in further articles. In my next article, I will use clinical examples to demonstrate Gendlin’s principles so that you can see them in action.

References:
1. Depestle, F. (2007). The Primary bibliography of Eugene T. Gendlin.  Retrieved March 3, 2012, from http://www.focusing.org/gendlin/gol_primary_bibliography.htm
2. Gendlin, E. T. (1962).  Experiencing and the creation of meaning:  A philosophical and psychological approach to the subjective. New York: Free Press of Glencoe. Second Edition, Evanston IL: Northwestern University, 1997.
3. Rice, L. N., & Greenberg, L. S. (1984). Patterns of change, intensive analysis of psychotherapy process. New York: Guilford Press, 213-248.
4. Rogers, C. R. (1958). A process conception of psychotherapy. The American Psychologist, 13, 142-149. Also in: Rogers, C. R. (1961). On  Becoming a person: A psychotherapist’s view of psychotherapy. Boston: Houghton-Mifflin, 125-159.