The idea of there being stages of grief has been greatly popularized and accepted over the last few decades. It is an idea that gives us perspective on our grief, like the red dotted line going across a map in an old movie to show the itinerary of the protagonists.

However, among professionals, theses stages have been slowly phased out of use over the years for lack of evidence from both research and casual observation.

Now, the old saying that “If you have a hammer, the whole world looks like a nail” comes to mind. Our preconceptions predispose us to experience things a certain way. If we look at our thoughts, feelings, and actions during grief, surely some of it will fit into the five stages Kübler-Ross described: denial, anger, bargaining, depression, and acceptance. This is because these are some of the reactions to loss. Yet these reactions do not tell the whole, or accurate, story of our grief experience.

Most people, according to recent research, do not arrive at acceptance last. Even when people express feeling shock and numbness, they have accepted their loss—they know that someone has died, or that they are divorced, or that they lost their jobs. Wishing something has not happened, or forgetting something that has happened, or feeling the surreal quality of what has occurred, is not the same as denying that it ever happened. To be truly in denial, we cannot consciously acknowledge what it is we deny, for the sake of our psychological well being. It is the very opposite of acceptance.

These days, new knowledge about how we grieve is beginning to filter through and influence how professionals provide grief counseling, and, it is hoped, how we support each other in grief as lay people. There is no longer any point in insisting that someone go through a stage he or she appears to be “skipping” or to feel that one is not “grieving right” if one does not experience certain stages of grief.

According to researchers Stroebe and Schut, we grieve by swinging between two main kinds of activities: loss and restoration.

Loss activities involve missing who or what was lost, crying, feeling sad, etc. This is what we usually associate with grief.

Restorative activities include feeling normal again, socializing with friends and family, enjoying good weather, remembering better times, etc. This is usually the unsung hero in grief, because it looks like what we think of as “normal” behavior, but in the context of grief, it is definitely a part of the experience of mourning and also what helps us to endure, and eventually integrate, our losses into our lives.

The back and forth of our thoughts, feelings, and actions between loss and restoration also give us a different road map for our grief. Rather than conceptualizing ourselves as “backsliding” or “getting worse when I thought I was getting better,” which happens with an idea like stages, using a model of grief that recognizes a natural and wavy progress helps us to know that we are moving forward, even when wistfulness strikes unexpectedly after some time basking in the sun.

It is natural to miss and yearn for someone, just as it is natural to feel better. We may not always want to feel better for fear of forgetting our loved ones or not showing how much we loved by how inconsolable we are, but it is part of our humanity that we can grieve and heal, lose and reconnect. Our pain helps us to remember, but let us not forget that our joy has the same capacity, too.

Reference
Stroebe, M., Henk S. (1999). The dual process model of coping with bereavement: rationale and description. Death Studies 23, 197-224.

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How to Be With Someone Who Is Grieving

Did you know that your brain regularly fills in for missing information, much of the time without your even knowing that this is going on? It’s one of the marvelous little efficiencies of the magnificent organ beneath your skull. I refer to it as the imagination “filling in the blanks.”

Since it happens so very quickly and without conscious knowledge or intent, it can be difficult to identify this quirky capability. But illusions are a fun way to acquaint yourself with this particular hidden talent. The ability is, of course, quite adaptive in some circumstances—like when survival depends on quick decisions about fight or flight. But, like most things in life, this extraordinary tendency to “fill in the blanks” has a down side, too. Think back on the last really bad misunderstanding you experienced in a relationship with someone you care about or whose opinion you value. Dollars to doughnuts, the brain’s sneaky tendency to “fill in the blanks” was somehow involved.

In many parts of Europe, bicycles share the road and are a much greater part of daily traffic congestion than they are in a typical U.S. city. Because cyclists were involved in so many accidents, the British government undertook a public safety campaign. They developed a series of ads designed to make people aware of the information they miss as part of the stimulus overload that is so integrally woven into the fabric of modern urban living. One of the advertisements developed as part of this campaign asks viewers to test their awareness by counting the number of times a basketball is passed from one team member to another. Most viewers get the count right but miss the “moonwalking bear.” The point is, of course, that we all miss a whole lot of information much of the time because our brains are busy “filling in the blanks” with information extrapolated from expectations.

One of the really interesting aspects of this incredible capacity for making up missing information is that it usually comes with a great subjective sense of certainty, and when we act on that certainty we can get ourselves into trouble—by sideswiping a cyclist we just didn’t see but were quite certain we had checked all the mirrors and blind spots, or by accusing a lover, spouse, friend, or child and reacting without first inquiring and getting all the relevant details.

Another important function of the brain’s awesome capacity to fill in the unknowns with what is expected is the placebo effect. The placebo effect happens when a chemically inert substance has a therapeutic effect because the person expects it to. Most medications, even ones well documented to have powerful chemical effects on the body or in the brain, owe some of their potency to the power of expectancy. Studies using functional magnetic resonance imaging (pictures of the brain at work) demonstrate that the placebo effect is powerful because the brain actually reacts to the expectation with the very same neurochemical changes that would happen if the active drug were given. Some proportion of the effectiveness of the meds we take on a regular basis like over-the-counter pain killers, or even caffeine and alcohol, have the effect they have because we expect them to. Researchers have the brain pictures to prove it. Amazing isn’t it?

Once you decide to tame your brain’s wild tendencies to “fill in the blanks,” you’ll start noticing, without even trying, times when you do it. And every time you do catch yourself “filling in the blanks,” you can silently congratulate yourself on your increasing awareness. Just as it will be impossible for you to look at the video clip again without seeing the moonwalking bear, it will become more and more difficult for you to imagine you really know what you don’t—because you’ll be increasingly aware of your brain’s tricky tendencies. Awareness precedes change, after all.

Related articles:
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Changing Brain Chemistry, Changing Paradigms

There are many different paths one can take to healing through Expressive Arts Therapy. Let’s begin by looking at a major component of this process, which is allowing the creative process to begin.

Releasing the Creative Spirit
Our healing journey is made possible by opening to our creative process. We invite flow again. We say, “Ah there you are, I’ve missed you.” When flow is permitted, we open a channel to buried treasures just beneath the surface of our unconscious yearning. We wonder why we waited so long to let go to our creative spirit. Perhaps we were bound by obligations, commitments, stress, and mundane efforts to keep our status quo. Whatever the reason, we find some comfort in releasing to our creative process again. Not all releasing requires that you pick up a paint brush, write a poem, or perform a yoga pose. And process isn’t just for painters, dancers, or musicians; it is blessed upon everyone in unique and interesting ways. I often find wandering in a gourmet kitchen store or letting my mind relax while sipping tea on a park bench to be useful when in need of some flow. You may prefer a brisk walk, baking a cake, or perusing a secondhand store as adequate letting-go activities. It is the releasing to yourself that is beneficial. It is the simple act of saying, “I matter enough” to allow myself this moment of time to release to what wants to come through me. Find what works for you, and don’t be afraid to try something new. There are jewels awaiting you when releasing to the unknown.

Decentering
We instantly know the feeling of decentering when we’ve hit it. It may come across as a silly fit of giggling or a playful rousing of exuberant combustive energy while forgetting the worries of the day. Decentering lies at the heart of Expressive Arts Therapy. It is letting go to the “imaginal reality through play, art-making or ritual” (Knill, 2005). It’s as if time has passed and we have forgotten, at least for a moment, the demands of the day and have awakened to the essence of ourselves by dropping into our senses. It is here that we notice and say to ourselves, “I’ve forgotten you.” Here, we release our creative spirit, welcome ourselves back home, and find missing parts of ourselves again. We get there not by way of doing, tasking, or driving, but by way of letting go to our deepest self—the playful unconditional child. We step away from ourselves as we know ourselves to be—lawyer, chef, accountant, candlestick maker—and release to the part of ourselves that doesn’t know, doesn’t plan, and doesn’t perceive what is going to happen next. This is the essence of decentering. Here, Expressive Arts Therapy may act as a vessel, assisting in bridging the gap between this tension of restriction and the releasing to flow.

Aligning With the Soul
Once we have been able to decenter from the outside work and into ourselves, the opportunity arises to align with the soul—the spiritual or nonmaterial aspect of ourselves. This alignment breathes new life into our expression by recalling a weightless way of being that we may have been missing. When we align with the soul, we say, “I remember you.” The lost part of our true being settles in to the wanting, needing, and arising of forgotten passions that our soul has longed for. Here, utilizing expressive arts, we might play with wild abandon, release to dance, stomp our feet, shake a tambourine, and howl at the moon. We remember our essence and it feels good. Whirling about, we thrust into our forgotten freedom and free our soul to experience again. We drop our roles, egos, and worries and rest into the place that we know satisfies us the most. When we allow this to happen, new information arises that we were not privy to before. Our insatiable longing is satisfied for a moment. At last, we have come home again.

Integration
Integration is a gathering and trying on of the bits and pieces we discover as we align with the soul. We have an opportunity to reflect, bring together, reinvent, and make ourselves new again. We can discard worn out habits, shed old beliefs, and remove residual roles of the past. We embark on meaning-making and try on this new information. Reflecting, we might take moments to journal our thoughts and ask ourselves, “What just happened—what does this mean?” Here, our process becomes one of answers and questions. Like trying on new shoes, we wonder, how does this fit?

Whether it is an instant “aha” or a deep look at a lifestyle change, we ponder the new information and attempt to assimilate it through our senses. Although not an expressive arts requirement, we might create a collage of images to bring together a clearer picture, write a lyric to express our feelings, or choreograph a narrative dance piece. Whatever comes to us, this is where we try on “Is this me; am I you?” The ego and spirit join hands and ultimately decide the usefulness of the new information. This process, throughout our lifetime, returns again and again.

Reference
Knill, P., Levine, E. G., Levine, S. K. (2005). Principles and Practice of Expressive Arts Therapy: Toward a Therapeutic Aesthetics. London, UK: Jessica Kingsley Publishers.

Related articles:
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Active Mood States Encourage Creativity

Traumatic experiences and the trauma healing process can expose the shrapnel from what feels like perpetually open wounds. Time lost to history and recovery, missed opportunities, broken relationships, and a delay in building life’s foundation can be negative side effects of traumatic experiences.

Therapists and people who have experienced trauma are able to identify, with ease, what may seem like irreversible damage or pain. However, it is simple to overlook the pieces of people’s trauma stories that are peppered with traces of hope and with a certain innocence that runs counter to what many of them have survived. This article will reflect on what people in therapy have shared with me. Through their eyes, these are the gifts of trauma:

Gratitude

We can begin with the basics. Survivors regularly express gratitude, disbelief even, for the fact that they are still living. Operating from this premise provides a great deal of delight in each day received. While it may sound cliché, perhaps this is so because of the ordinariness of what is being conveyed; it seems natural that life would be lived with greater enthusiasm in the face of its uncertainty. However, near-death experiences do not appear to be a necessary condition for people to begin to appreciate each new day; rather, being confronted with suffering, fear, or an assault on one’s humanity appear to be more relevant to our ability to appreciate existence.

Enjoying Simple Pleasures

Despite the real struggle associated with trauma recovery, there is often a simultaneous increase in a person’s capacity to enjoy the mundane. A blue sky, a delicate fragrance, a small act of compassion, the subtleties of nature, and the innocence of children and animals are often noted as having significance. Perhaps the sweetness of normalcy is illuminated when confronted with certain kinds of darkness.

Enhanced Awareness and Intuition

Survivors of trauma regularly inform me of what they experience as something akin to having superpowers. The capacity to feel things other people can’t, to identify either the goodness or inherent evil in someone just by looking at them, or to “predict” interpersonal outcomes are some of the new-found abilities people have described. People who have experienced trauma often indicate that they are able to pick up on covert human behaviors, and there is a great deal of trust in their capacity to intuit. Oftentimes, these powers really do exist; survivors have developed a discriminating aptitude for picking up on environmental cues that may have significance to them. A clinical explanation could be hypervigilence; however, people do not necessarily experience this skill negatively and are often quite opposed to this capacity diminishing.

Sense of Surprise and Enchantment

Finally, survivors often work from the assumption that, at some point, things will go awry. There is a sense of something lurking, and they conclude that something will happen that will take them out emotionally (or physically). The consequence of being right is the devastation of experiencing their truth (i.e., the world is not safe, I will never be happy) as real. However, when things go well, even smoothly, a genuine sense of surprise and enchantment is rendered.

[fat_widget_left]Feelings of defeat, pain, and innocence lost can be simple to identify following trauma’s destructive trail, while the search for a trailhead to peace can feel insurmountable. Throughout the witnessing of people’s narratives, I have discovered that there are nuggets of their remaining truth that may linger under the surface. During the process of unfolding and unpacking their stories, honoring each component of truth can facilitate a sense of hope for those who have none. In addition, some people are fully aware of what their trauma has provided them and do not want to lose these new strengths; they may have concerns about admitting this to themselves or the therapist.

Identification of trauma gifts throughout one’s story provides a platform for discussing this in a nonpathologizing way. It may also allow therapists to assist people in letting go of vigilance while embracing intuition, releasing pain while maintaining gratitude, and experiencing safety while holding on to joy.

A death, divorce, illness, sudden unemployment, or any major loss can create chaos in your life. This emotional fracturing, as well as the practical aftershocks of dealing with estates, lawyers, housing, finances, and doctors often yields intense feelings that can be overwhelming.

When you can’t assimilate another thing, it is crucial to just stop. Even if you have never meditated, simply sitting or lying down and paying attention to your breath can calm your nervous system and give you the literal breather you need.

If it is too hard to stay still, take a walk. It is imperative you give yourself a break from the internal chatter and incessant activity that may be consuming every waking moment. When you think you do not have a minute to sit, lie down, or walk, that is when you need the break the most. Take it, and watch the world continue to spin on its axis.

Practice Beginner’s Mind, Witness Consciousness, and Self-Compassion

[fat_widget_grief_right]A big part of healing through grief is connecting with yourself while putting all the parts back together in a new way that makes you feel safe and whole. This process of reconnecting all the emotional, physical, and spiritual dots can be an exhausting and chaotic ride. One minute, there is a sense of control and growing mastery; the next, you are surfing a sea of feelings.

Part of the immediate task is showing up with what yogis call beginner’s mind and witness consciousness. Beginner’s mind refers to an attitude of openness when approaching something new—without preconceived notions—just as a beginner would. This particular grief experience is terra incognita; you haven’t had it before. By abandoning all your ideas about how you “should” feel or behave, you allow yourself to safely feel what is true in the moment. That cosmic permission slip, coupled with open awareness, allows you to fully experience the moment and all it entails emotionally. While you may want to run from it, the only way out is through it. Avoidance may provide short-term relief, but it often brings long-term pain.

Achieving witness consciousness means retraining your mind to detach enough for objectivity. It is practicing watching something with a neutral perspective and not identifying with it. Both of these yogic techniques encourage you to leave your ego outside. You might never succeed in completely detaching from your ego, but these practices can allow you to experience the freedom and joy of not taking everything personally, while enhancing your chances for greater inner peace.

Beginner’s mind, witness consciousness, and self-compassion can be the trifecta for healing from almost anything. They shore you up, increase your perspective, and allow for enough detachment to see things more clearly.

Simple Routines Can Help Ease the Chaos

Just as in yoga, where each visit to the mat reveals something new, the process of unraveling the threads of grief is fresh every minute. Whether it’s a crying spell, a fit of anger, guilt, or deep sadness, recognizing how each one is unique can keep you open to change and transformation.

The chaos of grief is sometimes caused, in part, by the old issues it triggers, such as abandonment and posttraumatic stress. During times of acute emotional turmoil, being gentle with yourself can ease the pain. Recognizing unhelpful thought patterns and challenging them as much as possible may help you to feel better and more in control.

The chaotic emotional fallout of grief can also be assuaged by establishing simple routines, such as:

•  Taking a tea break at the same time every day
• Getting some exercise
• Listening to soothing music
• Meditating
• Talking on the phone with someone supportive
• Eating at regular intervals
• Watching the sky
• Spending time with your pet

Simple and readily available tasks can have a greater chance of providing you with an enjoyable way to calm the chaos.

Related articles:
Learn to Sit with Discomfort in Your Life
Surviving Suffering
How to Be With Someone Who Is Grieving

Individuals who are “symptomatic” of post-traumatic stress disorder (PTSD) may seem sick, crazy, or irrational. They might appear dissociative, clinically depressed, anxious, highly reactive, or rageful (or all of the above). In addition, it’s common for an individual to cultivate a sense of self-loathing for displaying these characteristics. During treatment, both therapist and survivor may agree that these symptoms are a mark of disease, making it their goal to alleviate the symptoms. Alternatively, both may choose to believe that these symptoms are an expression of health versus illness. This could enable more directed treatment, internal compassion, decreasing fear of symptoms, and a relationship between survivor, therapist, and trauma.

According to the DSM IV (American Psychiatric Association, 1994) criteria for diagnosing PTSD includes intrusive memories, thoughts, or dreams of an event, a sense of reliving the event, and intense distress in response to both internal and external cues that resemble an event(s).  Individuals may thus avoid triggers or cues, increase isolation or have a sense of ‘waiting for the other shoe to drop’ (a foreshortened future), and detachment.  Sleep difficulties are common; mood liabiality, and hyper vigilance are also common (American Psychiatric Association[DSM-IV], 1994). When a survivor feels hopeless, confused, and self-loathing because of the manifestations of their trauma, the initial layer of treatment is frequently the unraveling of self-loathing for the expression of symptoms themselves.

To begin to evaluate trauma and develop a relationship with its influence on survivors, we can draw from the practice of narrative therapy and the concept of externalizing a problem, which recognizes that the person is not the problem; the problem is the problem (Playful approaches to serious problems: Narrative therapy with children and their families. Freeman, Jennifer C.; Epston, David; Lobovits, Dean New York, NY, US: W W Norton & Co. (1997). xvii, 321 pp.). PTSD, as a character in a survivor’s life, uses symptoms as tools to protect us, remind us of our core values, and ensure that what happened before won’t happen again. The trauma response could even correspond to the level of violation on self and values; from this perspective, a profoundly disturbing event calls for a profoundly disturbing response. Flashbacks, dreams, invasive thoughts, and triggers provide specific information about the violation the client’s event(s) infringed upon them. These also exemplify the concept of “stuck points” in Trauma-Focused Cognitive Behavior Therapy (Akin-Little, Angeleque (Ed); Little, Steven G. (Ed); Bray, Melissa A. (Ed); Kehle, Thomas J. (Ed), (2009). Behavioral interventions in schools: Evidence-based positive strategies, School Psychology (pp. 325-333). Washington, DC, US: American Psychological Association, xi, 350 pp.)

The aspect of a survivor’s past that is troublesome can be quite specific and idiosyncratic. Groups of people exposed to the same event often are disturbed by different parts of it. Interpersonal trauma such as child abuse, domestic violence, or sexual assault may render someone feeling responsible for what happened to them, feeling dirty or shameful, betrayed, foolish, unimportant, or completely exposed.  Trauma might be conveying to someone that they are at fault for an assault because it wants the individual to have a sense of mastery or agency.  Helplessness is too passive, so self-blame is an acceptable tone to assume. An individual might also begin to associate a traumatic feeling of betrayal with a feeling of foolishness, ensuring s/he does not trust people too easily and maintaining inner safety.

The way in which a survivor expresses their PTSD can vary widely and presentations can be very complex and oppressive.  It is common for survivors to blame themselves for their past experiences, and they often enter into treatment with a great deal of shame because they feel they should have “gotten over it” without help. A therapist can offer some relief from shame by viewing survivors’ symptoms as useful, even critical to their treatment.

Through the process of healing, a survivor can learn to establish trust in self to clearly identify his/her core values, to reflect his/her significance in the world, and to maintain personal safety. The character of trauma will refrain from presenting images (flashbacks and dreams) when the stuck point has been identified, and will cease making statements that the individual is culpable for what happened once there is a demonstration of mastery over the event. It will hold back on invasive, persistent thoughts once the survivor is able to look at the event rather than avoiding it.  PTSD symptoms reflect individual values and provide explicit guidance for healing; if therapist and client are willing to work with trauma, and absorb the information it has to offer, it will not invade with such rigor.

Turning points are life experiences that permanently change the course of one’s life. The death of a parent, a divorce, or even a geographical move are all examples of turning points that can have a positive or negative affect on an individual. “The most defining characteristic of a turning point, however, remains that the event is perceived as significant or life-changing to the individual,” said Royette Tavernier of the Department of Psychology at Brock University, St. Catharines in Canada, and author of a recent study. How individuals process those turning points is referred to as meaning-making and is theorized to affect well-being. “The purpose of this study was to examine whether meaning-making within turning point narratives, as well as the timing of these turning points, would be associated with psychological wellbeing among a sample of Grade 12 high school adolescents,” said Tavernier.

For their study, Tavernier and a team of colleagues analyzed the life stories of 418 12th grade students, half of whom had experienced a significant turning point in their lives. All of the students had been previously assessed for well-being while in the 9^th grade, as part of another ongoing study. Tavernier discovered that although the earlier assessment of well-being did not influence meaning-making in 12^th grade, those who described meaning-making as part of their turning point narrative had much higher levels of well-being than the students who did not describe using meaning-making strategies in their life stories.

“This important finding suggests that the significant positive association between meaning-making and psychological well-being was not necessarily a function of preexisting differences on this variable, prior to adolescents’ turning point experiences but instead may be related to the meaning-making process.” Tavernier added, “In conclusion, adolescents, counselors, parents, and other sources of support can benefit from the knowledge that navigating life’s unpredictable paths is not necessarily solely associated with negative affect. Although much more research in this area is needed, these findings provide some support for the possibility that when adolescents engage in a more intimate exploration of their life experiences—particularly those that cause significant change—positive consequences can emerge at the personal and relational level.”

Reference:
Tavernier, R., & Willoughby, T. (2011, November 28). Adolescent Turning Points: The Association Between Meaning-Making and Psychological Well-Being. Developmental Psychology. Advance online publication. doi: 10.1037/a0026326

Feelings of psychological defeat are common symptoms of many mental health problems. In some research, psychological defeat has been linked to the onset of psychosis and other challenges. “Defeat may also contribute to the development and maintenance of schizophrenia,” said Judith Johnson of the School of Psychology at the University of Birmingham in the UK and lead author of a recent study on defeat and emotion. “Perceptions of defeat have been associated with the onset and exacerbation of a range of psychiatric conditions and disorders, including depression, anxiety, and suicide,” said Johnson. “Thus, the aim of the current research was to investigate the extent to which the emotion regulation strategy of reappraisal moderated the impact of failure on perceived defeat among both a nonclinical sample and individuals diagnosed with a schizophrenia-spectrum disorder, for whom perceived defeat may be particularly important.”

For her study, Johnson focused on the effects of trait reappraisal, the frequency with which people use reappraisal. In the first part of the study, over 100 undergraduate students were evaluated for trait reappraisal as they completed tasks designed to elicit feelings of failure or success. “Specifically it was found that higher frequency of reappraisal was associated with greater increases in sadness and negative affect and greater decreases in calmness after an experience of failure,” said Johnson. In the second part, Johnson examined trait reappraisal in people diagnosed with schizophrenia and found similar results. “Supporting the prediction, it was found that reappraisal amplified the difference in defeat between individuals in the failure and success conditions. Specifically, results suggested that the highest increases in self-reported defeat were among frequent reappraisers who experienced failure,” said Johnson, noting that the findings have significant clinical implications. She added, “Frequent use of reappraisal may confer vulnerability to subjective defeat in response to stressful life events among nonclinical and clinical populations and could be an area for relapse prevention interventions to target.”

Reference:
Johnson, Judith, Patricia A. Gooding, Alex M. Wood, Peter J. Taylor, and Nicholas Tarrier. “Trait Reappraisal Amplifies Subjective Defeat, Sadness, and Negative Affect in Response to Failure versus Success in Nonclinical and Psychosis Populations.”Journal of Abnormal Psychology 120.4 (2011): 922-34. Print.

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

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

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

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

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

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

Many couples I work with come in with a large amount of stress and difficulty. The causes vary, but the behaviors people use to respond to the upset are often predictable. People who start out loving each other sometimes find themselves so burdened by stress and difficulty that they end up feeling frustrated in the relationship.

Research suggests that up to a third of married individuals report low marital satisfaction, and approximately 20% of all married couples experience marital distress at any given time. These numbers reflect what therapists see daily in their practices.

No one starts out being frustrated. Frustration comes after being unhappy, sometimes for a long time. Often, couples with the best intentions end up not being able to explain themselves to each other, or they won’t say what they really want to say, and as a result they feel tense, stressed and oftentimes frustrated.

The most frequent problem reported by unhappy couples is poor communication. Frustration can appear in many ways. It may come out as a curt answer to a question. Maybe it’s a rolling of the eyes, or a “whatever” response to a partner, or no response at all. Frustration can also be felt when one person ignores the other altogether.

Sometimes frustration is a slammed door, or a sigh. It’s a sign of exasperation from the frustrated person to the other telling them something is very wrong. It also broadcasts unhappiness and discontent. And it’s a problem. It keeps the frustrated person trapped in difficulty and leaves the other partner in the dark regarding the source of the problem.

What would be helpful is to discover how to talk about what doesn’t feel good in the relationship. Unfortunately, this is often difficult for couples who have not communicated with each other for a while. Over time, the breakdown in communication evolves into increased arguing, stonewalling, defensiveness, and contempt. Distressed couples tend to engage in these negative patterns of communication often and are unable to successfully repair the relationship after an argument.

If you find yourself answering your mate with frustrated gestures, you might want to think about what is happening to you. I am pretty sure you used to have very soft, loving responses in the early days. Maybe as time passed you found yourself unable to express your thoughts and feelings to your partner without worrying how he or she might react. It’s possible you may even have started keeping your thoughts and feelings to yourself, not wanting to bother your mate. But the more you kept your thoughts and feelings inside without speaking them, the more you might have felt yourself becoming stressed and uncomfortable.

This is the body’s natural response to too much tension. Marital stress can alter endocrine, cardiovascular, and immune function—key pathways from troubled relationships to poor health. This tension is a clear message about what it feels like when you can’t express yourself and you keep your feelings inside. You might have a sensation of all your feelings being trapped inside your own body and you can’t let them out, like you are frozen. You keep yourself suppressed and you suffer. At first you might be able to manage your increased stress. Maybe you exercise more or take up an activity. Maybe you yell at the kids instead or a co-worker. Perhaps you overindulge; too much alcohol, drugs, or food.

The more you figure out how to manage your challenges, the more you might be looking at your partner with disdain. You may start to believe that he or she just doesn’t care about what you think and feel. Individual and couple responses vary greatly; That’s when people start with the one word answers, or the disinterest, or the shaking of the head. These behaviors tell the other person you are not interested in them. These reactions indicate that you are unhappy.

If you are unhappy in your relationship, take stock of how you are feeling right now. Ask yourself, “Am I stressed and unable to talk to my partner about what is bothering me?” If you answer yes, start looking at the ways you do talk to your mate. Are you short and abrasive? Do you dismiss him or her? Do you just not bother because you don’t think anything will change?

If you answered yes to any of these questions, you

So how do you change your situation? You just took the first step; you recognized it. From here you might want to talk to someone: a friend, family member, religious mentor, or counselor. Get your long held feelings from inside yourself outside of your head by communicating them. Try to understand what is preventing you from talking to your mate about these feelings. Learn why you stay silent.

There are effective treatments for marital distress. No one begins as a perfect partner and a successful marriage depends on a number of skills, such as the ability to understand one’s own behavior and motives, to understand one’s partner, to argue and problem-solve productively, and to effectively negotiate differences—all of which can be enhanced by working with a marriage and family therapist.

You will likely feel better even after just a few sessions. You could also learn different ways to communicate your feelings that may give you confidence. When you leave your old behaviors – the eye rolling, sarcastic responses, non answers – and replace them with true expressions of your feelings, a number of things might also happen. Your stress and tension may decrease, and it’s possible you might even begin to experience some happiness, and that might feel pretty great.

When to Seek Professional Help

Over 98 percent of clients of marriage and family therapists report therapy services as good or excellent. After receiving treatment, almost 90% of clients report an improvement in their emotional health, and nearly two-thirds report an improvement in their overall physical health. A majority of clients report an improvement in their functioning at work, and over three-fourths of those receiving marital/couples or family therapy report an improvement in the couple relationship.

If you’re experiencing persistent relationship frustration, consider reaching out to a qualified couples therapist or marriage and family therapist. They can help you and your partner develop better communication skills and work through underlying issues contributing to your frustration.

For immediate support, you can:

Contact the Find a therapist directory

Call the SAMHSA National Helpline: 1-800-662-4357 for mental health resources

Reach out to your healthcare provider for referrals

References:

1. Regan, P., Walsh, S., Horton, R., Rodriguez, G., & Kaufman, L. (2025). Contextualizing marital dissatisfaction: Examining profiles of discordant spouses across life domains. Frontiers in Psychology, Collection date 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC11961942/
2. Association for Behavioral and Cognitive Therapies. (2021). Marital distress fact sheet. https://www.abct.org/fact-sheets/marital-distress/
3. American Association for Marriage and Family Therapy. (n.d.). Marital distress. https://www.aamft.org/AAMFT/Consumer_Updates/Marital_Distress.aspx
4. Heim, C., & Heim, C. (2025). How long-term couples cope with chronic stressors and adverse life course events in marriage: A qualitative study. The American Journal of Family Therapy, Published online: 18 Feb 2025. https://www.tandfonline.com/doi/full/10.1080/01926187.2025.2459688
5. Shrout, M. R. (2021). The health consequences of stress in couples: A review and new integrated Dyadic Biobehavioral Stress Model. PMC, PMC8474672. https://pmc.ncbi.nlm.nih.gov/articles/PMC8474672/
6. American Association for Marriage and Family Therapy. (n.d.). About marriage and family therapists. https://www.aamft.org/AAMFT/About_AAMFT/About_Marriage_and_Family_Therapists.aspx

According to Randy P. Auerbach of Harvard Medical School, McLean Hospital, positive feelings and feelings of happiness are the result of intrinsic pursuits. “Intrinsically-motivated goals are thought to be inherently interesting, pleasurable, and/or meaningful,” said Auerbach. “In contrast, extrinsically-motivated goals are typically sought in order to attain a reward (i.e., material goods or money) or to avoid punishment.” Research has shown that pursuing both intrinsic and extrinsic goals can be beneficial, but not when one is at the expense of the other. Auerbach said, “Guided by self-determination theory, the research posits that the neglect of intrinsic goals ultimately thwarts the satisfaction of core, inherent psychological needs for relatedness, competence and autonomy, which in turn contributes to negative psychological outcomes including depressive symptoms.” Additionally, people who value extrinsic goals over intrinsic goals may neglect their interpersonal relationships and exert all of their time and energy in the pursuit of material objects and money. Another concern is that children whose parents value extrinsic goals above intrinsic ones may not foster sufficient interpersonal skills in their children, creating maladaptive relationship models for them as adults.

To test how the prioritization of values affected the psychological well-being of adolescents from various cultures, Auerbach and his colleagues studied over 600 teens from Canada and China. They found that the teens with the highest motivation toward extrinsic goals had elevated levels of interpersonal stress. “Further, consistent with past research examining the relationship between stress generation and prospective depressive symptoms, dependent interpersonal stress predicted higher levels of depressive symptoms over time.” The team added, “In conclusion, the present study highlights the relationship between aspirations, stress, and depressive symptoms in culturally distinct samples of adolescents. Traditional prevention and treatment programs primarily target cognitive and interpersonal vulnerability factors. However, the findings in the present study suggest that clinicians must also understand a patient’s core values as they may play an important role in shaping stress generation and subsequent symptoms.”

Reference:
Auerbach, Randy P., Christian A. Webb, Meghan Schreck, Chad M. McWhinnie, Moon-Ho Ringo Ho, Xiongzhao Zhu, and Shuqiao Yao. “ExaMining the PathWay through Which Intrinsic and Extrinsic Aspirations Generate Stress and Subsequent Depressive SyMptoMs.” Journal of Social and Clinical Psychology 30.8 (2011): 856-86. Print.