Teenagers

photo credit: justine reyes

photo credit: justine reyes

This post is more for teenagers, than about them.  

You might be wondering "what is therapy?"  Perhaps someone suggested you seek therapy to work on something specific, or maybe you have sought it out on your own.  Both options beg the question "why would you want to tell a complete stranger your problems?" 

Teenagers exist in this strange space in time, a hundred years ago you would have basically been considered an adult: you're capable of reproduction, you have the intelligence, physicality and attention span to hold a job and help support the family, and child labor laws didn't exist..  In this day and age, we do have child labor laws which, in effect, extended and protected adolescence.  Now, the teenage experience might be that you have a vast store of knowledge that nobody seems to respect or want to listen to; and because of this you might be used to adults not really hearing or valuing what you have to say.  Perhaps they judge you, or don't choose to understand, or in spite of their attempts to understand, seem so far from it that it feels pointless to even try to communicate.  Or maybe you're one of the lucky ones and have amazing, responsive, and patient adults in your life who trust you, and allow you the freedom and agency to choose your own path.  

To be fair, your caretakers have to tread a very difficult line; it's likely that they care for you very much, and at the same time they bear some responsibility for how your lives turn out.  They are personally invested in the outcome, so there is inherently a lot of emotion attached to their interactions with you.  This can translate into bossiness, over-involvement, anger, and frustration, and yet underneath these emotions there are almost always root emotions of love and fear.  

It is developmentally appropriate that teenagers prefer to run things through their peer group rather than their parents, to look for validation from their friends.  This is part of individualization, and growing-up.  That said, it can come with its own set of hazards and problems: your friends have strong opinions, but don't necessarily have the history of life experiences that can add depth to judgment.  What I provide is an opportunity to talk things through with a neutral adult, someone who wants to keep you safe, and has an adult perspective, but whose primary goal is to help you identify and achieve what you truly want.  

The therapeutic relationship is a little different from any other kind of relationship:

  • I tell you the truth.  I won't lie to you.  If I can't tell you something, for whatever reason, I'll be honest about it.
  • I keep your secrets.  Did you know that it would be completely unethical for me to tell anyone (parents, police, teachers...) what is said in therapy?  There are only a very few legal exceptions to this rule.  Any other topic, is going to stay between us, and even in those situations where I have to reveal information, it's my ethical duty to protect your privacy as best I can.  
  • I won't judge, shame, or criticize you.  No matter what your situation is, I trust there's a reason for it, and there is some logic in which it makes sense.  My goal in that situation is to work with you to figure out how it makes sense to you, to help you figure out whether it is healthy for you, whether you want it to be this way, and help you decide how to work the situation so that you get what you truly want or need.
  • I'm very hard to shock.  I've spent my life as a listener, and in so doing I've heard a LOT of things.    In my work with teenagers we've addressed issues of: addiction, bullying, anger management, child abuse, sexual abuse, academic performance, anxiety, family acceptance, deportation, racism, self-harm, suicidal thoughts, homicidal thoughts, sadness, loneliness, rage, poverty, eating disorders, poor self-image, severe mental illness, gang violence, loss...  You can bring anything to me, even things that might feel unsafe to talk about.
  • That said, I won't generally pressure you to talk.  I trust that you will talk when you feel safe, interested, or ready.  The exception to this is if I feel your safety is at immediate risk.
  • On the positive side, my clients and I have worked on future hopes and goals, and taking positive steps towards achieving them; building healthy relationships with family, friends, and romantic attachments; learning positive communication styles to help you get what you want out of life; building self-esteem, and self-awareness...  
  • I really enjoy working with teenagers, and nothing makes me happier than seeing them build the lives they want for themselves.  

A few resources for teens and their adults, interesting information:

This video is a little silly, but does an excellent job explaining the daunting physical changes and challenges teenagers face.  It answers questions about why teens make the decisions they do, need so much sleep, are impulsive, etc.:

Perspectives & Cultural Relativity

photo credit: Mari yamaguchi

photo credit: Mari yamaguchi

 

"Talk to everyone, because everyone has something to teach you." ~ O.E.R. Sr.

"When you talk to strangers, you're making beautiful interruptions into the expected narrative of your daily life — and theirs," ~ Kio Stark.

As I've mentioned elsewhere on this website, I come from an incredibly diverse, and culturally rich background.  I was born in the Bay Area, and into a multi-racial and multi-cultural family.  As a toddler I was already trying to suss out the relevance of my racial identity; of course, as a toddler, my limited reason tied racial identity to milkshake preference.  As a biracial child, I learned to navigate that liminal space we all occupy; I lived in both cultures, but didn't wholly embody either; I was discriminated against, but because of my skin color "passed" at the same time; I heard a lot of prejudice from people who were oblivious to my race, and then had to make a decision whether to advocate for myself, or remain silent.  I love being mixed, and always have, and it has its difficulties at the same time.  As a teenager, I was afforded a somewhat unique opportunity to live with people from all over the world for four years, and developed incredible, and lifelong friendships as a result.  I began to explore different languages, developed a rudimentary concept of cultural relativity, and learned the importance of tolerance and curiosity.  In university, my interests led me to pursue a degree in Cultural Anthropology from one of the best programs in the country.  There, I gained a deeper understanding of cultural relativity, and the limits of my own perspective.  I look back at these opportunities I've had and realize what a gift they have been.  I'm now in a position to listen to the experiences of others from a perspective of trust and acceptance; I'm open to further opportunities to learn.  

It strikes me that a lot of the discord we are experiencing in the world right now is precisely because people have had limited exposure to the perspectives of others, and in many cases, people are not aware of their own limited understanding.  On a psychological and societal level there is a tendency to define the Self in opposition to an Other.  I'm using this small platform as a means of furthering understanding and facilitating cultural communication, on a limited scale.  I'm going to share a few resources that I have found interesting and powerful, in the hope that someone will come across some new information, or a new understanding.  I will add to this post as I come across new resources.

If I had limited time to show only one thing it would be this DNA journey.  It speaks to our ethnic interrelatedness, and the futility of us vs. them thinking:

If someone wanted short, evocative, fun stories, I would suggest any of the following:

A Ted Talk in which "Stark explores the overlooked benefits of pushing past our default discomfort when it comes to strangers and embracing those fleeting but profoundly beautiful moments of genuine connection:"

If someone had a few evenings in which to really delve deep into other cultures, I love and highly recommend "Human:"

Cultivating Happiness - Gratitude

photo credit: Louis Vaughan

photo credit: Louis Vaughan

 

"I don't have to chase extraordinary  moments to find happiness - it's right in front of me if I'm paying attention and practicing gratitude." ~Brené Brown

One thing I frequently ask my clients to do is to keep a happiness, or gratitude journal.  Gratitude is an appreciative state of mind that works in much the same way as mantras, and EMDR.  Through neuroplasticity, our brains evolve to meet our usage needs.  Our focus directs what we see, and our experience; if we focus on the negative we begin to see more of it, and the same can be said if we focus on the positive.  Increased levels of gratitude are strongly correlated with greater happiness.  In a sense, when deliberately eliciting gratitude, you are practicing feeling positive emotions, you are building neural networks associated with those emotions, with that comes greater health, better resilience in the face of adversity, and stronger connections to others.

U.C. Davis and the University of Miami conducted a study where one group spent 10 weeks writing daily about things they were grateful for, another spent that time writing about irritations, and a third spent that time writing about anything that affected them, no importance was placed on whether it was positive or negative.  The group who wrote about gratitude were significantly more optimistic about their lives; they also exercised more and experienced better health. ~ paraphrased from Harvard Health Publications

The Gottman Institute has extensively studied couples and found that the regular expression of gratitude builds a reserve of good feeling; one that increases positive feelings, and comfort in the relationship, one that will mediate times of strife.

Exercises in gratitude to try:

  • Writing a heartfelt letter of gratitude to someone who's done something meaningful for you, and whom you haven't yet thanked.
  • Beginning a gratitude / happiness journal.  Buy or create a beautiful journal in which you put positive and life-affirming thoughts and anecdotes.  This can become a book that you can open to any page, and it will brighten your day.
  • Prayer: I'm not any kind of an expert on religion, but it seems to me that prayer in all religions focuses on gratitude.  
  • Making the effort to thank people whenever they do something kind for you.  A smile or a nod is often enough for people to feel appreciated for small things, but try saying it out loud.  In theory, saying it out loud will will reinforce that experience of gratitude in your own mind, and make it easier to access the feeling state later.  (See the blog post on mantras if you want a deeper explanation).
  • Setting aside a regular time to create a comprehensive list of your blessings.
  • Check out: http://www.unstuck.com/gratitude.html

A few videos I find inspiring:

An interesting aside:

"There are some notable exceptions to the generally positive results in research on gratitude.  [A] study found that children and adolescents who wrote and delivered a thank-you letter to someone who made a difference in their lives may have made the other person happier — but did not improve their own well-being. This finding suggests that gratitude is an attainment associated with emotional maturity." ~  Harvard Mental Health Letter

Even with this being true, I would argue that children, and adolescents should still be encouraged to develop the capacity for gratitude.  Circumstances change, children grow up, and a habit of focusing on gratitude, would be a good one to have in place when they do.

Phobia Treatment

photo credit: marragem

photo credit: marragem

There's a vast encyclopedia of fears and phobias, and pretty much any object, experience, situation you can think of, there is someone who has a phobia of it. ~ Scott Stossel

If you have ophidiophobia, or a fear of snakes, feel free to contact me; I can send you the text without the image.  

Some practitioners believe that phobias are reflexes that originated as normal fears to dangerous stimuli, but that have generalized to include harmless stimuli.  The goal of phobia treatment is extinction, or the disappearance of the fear response.  There are many ways of treating phobias, all of which involve some sort of exposure to the negative stimulus under safe and controlled conditions, the theory being that repeated exposure without any resultant harm will eventually lead to a fading of the phobia symptoms.

 Some possible treatments:

  • Counter Conditioning involves consciously learning how to relax: how relaxation feels, how to deliberately invoke it.  Exposure is then done slowly, and systematically, in small, pre-established increments so as to not overwhelm the client.  Throughout the process, the client practices relaxation in the face of exposure.  I've mentioned in a previous EMDR post that you can't stimulate the sympathetic nervous system (the stress response) and the parasympathetic nervous system (the calming response) at the same time; in other words, you can't become both more stressed and less stressed simultaneously.  With this method you're gaining mastery at emotional, physical, and cognitive self-regulation all the while disproving the false connection between the stimulus and the fear reaction.  This process can take a long time, and can still be quite distressing, depending on the intensity of the phobia.  
  • There's another form of exposure therapy called Flooding, where the exposure is done all at once ("in vivo" (live), or by using imagination), and maintained until the fear response dissipates.  This dissipation is called habituation; it's what happens when you become used to a noise and stop hearing it, it's why other people might be able to smell your perfume long after you have grown used to it.  There are many obvious concerns about this method, the main one being undue distress for the client.   
  • Some therapists have begun to use Virtual Reality as an alternative way to control exposure to a stimulus.  This would land somewhere between imaginative and in vivo, and can be very cost effective when the phobia is something extravagant like flying.
  •  It will come as no surprise to anyone who has read my previous posts that I prefer to use EMDR.  I'm not going to repeat everything I've said in previous EMDR posts (although I encourage you to read them), but I will say that I've seen phobias resolved remarkably quickly.  EMDR is accelerated processing, so the extent of time in which you're being emotionally exposed the the stimulus is vastly shortened.  It also has its own generalization effect, one that seems to mirror and address phobic generalization; this is something that straight exposure therapy doesn't seem to have.

A few interesting phobias:

  • Hippopotomonstrosesquipedaliophobia- Fear of long words.
  • Allodoxaphobia- Fear of opinions.
  • Coulrophobia- Fear of clowns.  
  • Linonophobia- Fear of string.
  • Gamophobia- Fear of marriage.
  • Melophobia- Fear or hatred of music.
  • Paraskavedekatriaphobia- Fear of Friday the 13th.  

EMDR Hacks

photo credit: MFer Photography

photo credit: MFer Photography

A little knowledge can go a long way  

Sometimes people don't want to work on their past trauma because it feels too painful, the idea of opening it up is frightening, the thought of letting go of control is overwhelming.  EMDR has some safeties built in to the protocols to make the process less difficult.  I also feel that giving my clients a better understanding of the process will help them feel more agency and confidence when going into the work.  I teach my clients all of the following, but I think it will be useful for anyone beginning EMDR work.

The general process of EMDR is that I ask questions to elicit the traumatic memory, thoughts, and feelings we're working on; I do this to bring the scene alive and activate the neural networks associated with the specific trauma or issue.  Depending on our mutually agreed upon focus, I might ask the client to bring all of those sensations and feelings together and see if he or she can trace them back to an earlier memory (which may or may not seem related).  I then add some form of bilateral stimulation, and from that point on most of the processing is done by the client through free association.  The different regions of the brain begin to work together, and create a solution or resolution that is true and relevant for the client.  People process in different ways, some process silently, some process while talking, some express a lot of emotion, some feel the emotion but don't express any.  I will be watching for changes in body language and affect, and looking for a moment of catharsis or release.  When I see something that looks promising, I'll ask if it's a good moment to pause and check-in.  This is one of the moments where I want my clients to be empowered to make a choice.  

Knowing when to keep going

If you are still actively processing when I check-in with you, I would ask that you shake your head, or in some other way indicate that I shouldn't interrupt you, and that you want to keep going.  When positive work is happening it's often better to maintain the momentum of processing.  When you stop and start talking, your attention comes back to the room, and back to me; in order to express your process verbally, you disengage from that live neural network associated with the pain.  Sometimes it might be difficult to access it again to keep processing.

Knowing when to pause

That said, there are times, when it's appropriate to step away from the emotion, and reground in the therapy room.  If the memory becomes too painful that's something that is important to communicate; there are ways to lessen the intensity.  If we liken the process to playing a string instrument; it's necessary that the emotions be gently plucked, but they don't need to be violently twanged.

If you lose touch with the memory, or lose focus in the processing, if you feel a sense of dissociation or drifting, those are all good moments for us to communicate and regroup, as well.

Negative loops

Another thing to bear in mind is that when processing, if you feel like you're stuck in a negative thought loop, or a negative emotion; if you're trying to find your way out, but you're just not feeling any movement or shifts, that is important to communicate.  Part of my training is learning ways to help you out of those situations, and my experience has taught me to use EMDR creatively to match the needs of my clients in those moments.

Having confidence in the process

There are several ways that clients will gain trust in the efficacy of EMDR.  Some trust will come with that first big moment of epiphany or catharsis.  That can feel like an emotional and physical release, a lightening, a loosening, a relaxation, a kind of freedom, or peace, or a sense of becoming unstuck; it might be acceptance or congruence of something you've had difficulty facing; or it might be a release of sadness or anger you've been holding inside and carrying with you.  It will be different for every person, and every memory, but it tends to be a neutral, positive, or at the very least healthful feeling.

Another way clients come to trust EMDR is through repeated successes.  Clients gain confidence that no matter the difficulty of the process, there is an end somewhere, and they will get there eventually.  This deeply felt understanding lends them the courage to take emotional risks, and brave the discomfort, or pain of the process; this willingness to throw themselves into the work often translates into faster processing.

EMDR is a fluid, instinctive, natural, and creative process.  The bilateral stimulation is healing and soothing in and of itself.  Another way to develop confidence in the process is to realize you can't really do it wrong.  It can be made easier or more difficult, and of course easier is preferable, but both will get you there.  The most important thing you can do is to honestly communicate your experience, so that the therapist can help minimize the difficulty of the process.  

Working with resistance

As a therapist, I often hear about resistance in clients as something that's difficult, or negative.  I have a different perspective on it; I actually celebrate it.  Resistance serves a good function, it's the way your subconscious protects you; when a painful memory begins to surface your subconscious starts to throw objections and self-protective logic into the path, you might even feel a physical discomfort or recoil.  The reason I love working with resistance is that it's like a big neon sign saying "this is what we need to work on!  Here's where the pain is!"  Which is another way of saying "once we've worked through this, here's where the relief and change will be!"  Not only that, but if we know we're dealing with resistance we can temporarily shift focus to process the resistance first; this is a tangential way of processing and will likely lead to a decrease in the pain of the original target, therefore making it easier to process when we address it directly.

Resistance might also show up between sessions, and in a very similar way.  If you're about to begin working on something particularly difficult, and suddenly finances and scheduling become the priority, when they weren't before, that's something to think about.  This isn't limited to EMDR processing, but it's useful information all the same!

If you can learn to recognize your resistance, it can become a signal of impending success and give you the confidence to jump into difficult work.

If I think of any other EMDR hacks, I'll add to this post later.

EMDR Part II

photo credit: kevin dooley

photo credit: kevin dooley

The video at the end of this post offers a pretty good introduction to EMDR.  However, it is a bit outdated, and I have a few caveats to add:

EMDR: Visual, Auditory, and Sensory

Since the production of this broadcast, it has been discovered that the bilateral stimulation used in EMDR, the back and forth experience of EMDR, can be both auditory and sensory, as well as visual.  In other words, you don't necessarily have to follow fingers with your eyes; in fact, I rarely use that technique with clients.  For some clients, watching a wand or fingers pass in front of their faces can be too distracting, and can actually prevent them from accessing the feeling state we're trying to process; with them, I would get creative and use one of the many other options for bilateral stimulation; my decision of what method to use is largely based on the client's preference.  

Do Not Try This at Home

Please.  As they say in the video, EMDR is a very strong, and deceptively simple therapeutic tool.  It might be tempting to try it on your own, but I strongly recommend that you don't.  The deeper the trauma the greater the risk in trying to process it alone, and emotional neural networks almost always link up in unexpected ways.  In other words, you don't know how deep the processing will go until you're in it, and if you're in it alone, you may not be able to access the reasoning that will help you resolve it.  The therapist and therapy room are necessary safeties to help you contain the experience, and move through it both quickly, and completely.  I have had many clients work on seemingly easy issues that ended up linking to deep traumas; my presence and expertise helped those clients relieve their suffering much more quickly and easily than they could have done on their own.  There are also ways of distancing yourself from the traumatic memory that are very difficult, if not impossible, to access yourself when processing; EMDR really does take two people.

Beware of youtube charlatans!

I hesitated to post this video because it would be all too easy for people seeing it to follow their curiosity about EMDR down a youtube rabbit hole.  No responsible therapist is going to try to offer EMDR through youtube.  EMDR is an intersubjective process: what I do as the therapist will affect your EMDR journey, and your journey will affect what interventions I choose to do, which will then affect your EMDR journey, etc. until we're done.  You can't have this experience through youtube; there can be no back and forth process.

I also think that most responsible therapists won't even show very much of an EMDR session online.  It's true that seeing someone else's session can be inspiring; it's wonderful to see how quickly and thoroughly painful memories can be resolved.  But EMDR sessions can also look quite dramatic, and be needlessly scary if you're new to EMDR, and looking at the sessions from an outside perspective.  I believe it's far better for someone's first experience of EMDR to be resourcing work: it's a positive way of seeing the power of EMDR, exploring a client's facility with it, providing a lot of information to the therapist, and is done in a safe way and in a safe space.

EMDR is useful for more than just PTSD

EMDR has broader applications than are implied in the video.  Yes, EMDR is great for working with PTSD, war veterans, sexual assault survivors, child abuse survivors, etc.  That said, EMDR has branched well beyond mere PTSD treatment.  It also works incredibly well with addiction recovery, with positive psychology (creating a happier, and more connected outlook on life), with important decision-making, and many other issues.  This is another reason it is important to do EMDR with a professional practitioner; we have a deep understanding of how the process works, and can use EMDR creatively to help you get the results you're looking for.

Having said all of that,

I do believe the video offers a lot of useful information, especially for people just beginning to explore the possibilities EMDR has to offer.

Child Therapy

photo credit: Sanshoot

photo credit: Sanshoot

There is in every child at every stage a new miracle of vigorous unfolding. ~ Erik Erikson 

Psychotherapy with children is unique in that much of the time they don’t have a clear understanding of the roots of their behavior.  Often, behavioral issues like acting out and defiance, can just be symptoms of children trying to get their needs met.  They are still developing emotionally, physically and cognitively and they are testing their environments, trying to figure out where and how they fit in the world.  My job is to observe their behavior, often through play, and try to gain some clarity as to what their motivations and needs might be.  Once I have an understanding, I help them navigate their situation in the hope of improving it.

Child Therapy and the Development of Emotional Language

Often, children are not taught emotional language; unfortunately, this is especially true for boys in our culture.  Without the language, it can be difficult for children to identify their emotional experiences, much less communicate them to others.  This frequently leads to situations of frustration, anger, and tears on the part of both children and their parents.  I help children and parents develop emotional language, and become comfortable using it with each other.  I teach systems of communication that help to break down moments of confusing conflict into smaller, manageable emotional perspectives.  This builds greater understanding, and leads to a happier home life for everyone.

Play Therapy

Much of child therapy is play therapy.  I observe them playing, play with them, focus on themes of play, and emotions.  A lot can be learned about a child’s inner world simply by engaging them in play.  Sometimes, I’ll let children direct the play and help them gain self-efficacy.  Sometimes, I’ll set limits through play and help children practice self-containment.  Play therapy is an organic process that varies depending on the individual child and his or her needs.   

Art Therapy as Child Therapy

Another way that children express themselves is through art.  This can be a way to communicate their emotions when they lack the vocabulary or self-awareness to do so verbally.  Much like it is for adults, art can also be a means of catharsis, healing, and a way of externalizing troubles and thoughts.  

EMDR as Child Therapy

Children tend to process trauma differently than adults.  Symptoms of trauma and abuse in children can look a lot like ADHD, so part of my job is to differentiate between the two.  In general, children don’t have as many layers of self-protection built-up as adults, so they can access and move through trauma a bit faster.   That said, I take extra care while doing EMDR with children because their lack of understanding could lead to confusion; protecting and promoting their feeling of safety in the therapy room is my number one priority.  In general, I have a lighter touch when doing EMDR with children, and use it in conjunction with play and art therapy.

Child therapy can help with:

  • Abuse: sexual, physical, & emotional
  • PTSD: single incident & complex
  • Complex grief: death & loss
  • Anxiety & Phobias
  • Behavioral issues: aggression, anger management, & defiance
  • Self-esteem & social skills

I’ve been working with children in one capacity or another for most of my life, and tend to build trust with them pretty quickly.  In the therapy room I create a space of safety and acceptance, where kids can relax and begin to face their fears and anxieties. 

The Role of Parents in Child Therapy

Parents are an intrinsic part of child therapy, and I will sometimes call parents in for sessions with or without the child as a means of clarifying therapy goals, planning sessions, reinforcing family structure, and improving communication and understanding.

 

Child Development - Early Stages, Cognitive and Psychosocial Needs

Through each stage of development, children are rapidly learning about, and creating their identities in relation to  their environments; they're making continual judgments about safety, and their own cabilities from the very beginning.  These profound judgments  are largely based on their feelings, and the reactions of others around them; and they're made at a time when perspective, brain function, and cognitive abilities are very limited.  For example, young children are egocentric, if something in their world goes awry, they see it in respect to themselves; their limited cognitive understanding often leads them to believe that they caused the event, and can lead to long-term feelings of guilt, and inadequacy.  These judgments made in early childhood have far-reaching effects as to how people view and approach opportunities, and challenges in their lives, and their ability to imagine potentialities.  

I tend to work from attachment and other psychodynamic theories.  Through my work with EMDR, I've seen how adult dysfunctions are frequently psychologically linked to early childhood attachment breaches, or traumas.  Some people still believe that if children aren't communicating verbally, they aren't learning or otherwise actively engaged in their worlds; that simply isn't the case.  Children learn and retain at a much higher rate precisely during those early periods of development when their ability to communicate is limited. 

While reading this post, one thing to keep in mind is that personalities are not unilaterally formed, and children are very resilient.  Personalities are the result of both deliberate and accidental influence of families, as well as the influence of media and life experiences, etc..  I'm offering up broad guidelines to turn to when questions or troubles arise, but this is not, in any way, meant to be a critique.  Individual family cultures can be so unique that systems might not translate from family to family; what works for mine, might not work for yours.  I see this as an opportunity for critical thinking; take what works, and ignore what doesn't.

Infancy (birth to 1 year of age)

Attachment theory suggests that the development of personality, efficacy, and functionality later in life, is rooted in caregiver attachments beginning in infancy.  Skin to skin contact, eye contact, emotional attunement, and positive regard are the way a baby learns his or her place in the world.  A baby that cries and receives comfort feels safe and connected, a baby that tries something new and receives excited and positive feedback gains confidence and enthusiasm.  This is the age when children learn to trust, and develop a hopeful, and optimistic outlook, knowing that their needs will be met, and that the world is a safe place.

Infants need:

  • Attuned, nurturing, and consistent adults with whom to form attachment
  • Nutrition & health care
  • Stimulation in the form of things to look at, touch, hear, smell, taste...
  • Opportunities to explore their environments
  • Protection from physical danger
  • Exposure to language stimulation

Toddlerhood (1-3 years of age)

Toddlers are developing independence, and a sense of self distinct from their caregivers; the automatic "no" response is an example of toddlers defining themselves in opposition to the wishes of others.  In exploring independence, they're trying to find the balance between autonomy versus doubt or shame; this balance is closely related to the reactions their behavior elicits in others.  Some doubt is obviously a good thing: it can keep them safe, and considerate of their impact on others, but too much doubt leads to inhibition, and limiting themselves for fear of consequences.  During toddlerhood, encouraging interactions with nurturing figures create a positive sense of self that carries over into adulthood.

"The way we talk to our children becomes their inner voice." ~ Peggy O'Mara

Toddlers need:

  • Everything an infant does
  • An opportunity to experiment with independence
  • Help to learn emotional containment, and behavioral self-control
  • Support in gaining new motor, language, and thinking skills
  • Opportunities to play with various objects
  • Support in learning to care for themselves

Early Childhood (3-6+ years of age)

Early childhood is a time to develop purpose.  Children are taking initiative, creating new ideas; actively exploring, experimenting and solving problems; making errors, decisions, and choices; communicating and reflecting upon their experiences.  They are struggling to find balance between initiative and guilt; too much initiative and too little guilt leads to bullies; too little initiative and too much guilt leads to inhibited children.  Through positive relationships with caregivers, children learn to devise and follow through on goals without riding roughshod over others.  

"Never help a child with a task at which he feels he can succeed." ~ Maria Montessori 

Young children need:

  • Experiences that will help them develop fine motor skills (holding a pencil, operating scissors)
  • Experiences that will help them develop gross motor skills (skipping, balancing)
  • Encouragement of language development in the form of talking, reading, and singing
  • Activities to develop a sense of mastery
  • Opportunities to develop social skills like cooperation, helping, sharing
  • Opportunities to experiment with writing and reading

Middle Childhood / School Age (8-12 years of age)

This is the age where children develop competency.  There is a rapid personal development of cognitive skills, personality, motivation, and the ability to engage in inter-personal relationships. During middle childhood children also become more socialized; they grow beyond their egocentricity, and begin to explore a larger context of cultural differences and societal values.   School age children learn to integrate their own individual development with development as an individual in a social context.

School age children need:

  • Opportunities to share and cooperate
  • Support in learning and becoming competent at increasingly complex, developmentally appropriate skills and tasks
  • Patience from caregivers, as their independence might be reflected in an increase in disobedience and rebellion

 

Mindfulness

Our consciousness is almost completely preoccupied with memory and expectation. We do not realize that there never was, is, nor will be any other experience than present experience. We are therefore out of touch with reality. We confuse the world as talked about, described, and measured with the world which actually is. ~ Alan Watts

In general, I like to write about what I know, but this blog post will be about what I'm actively learning, and will evolve as I learn more. Mindfulness is something I've always been interested in; I've dabbled, but haven't yet explored it deeply.  That said, I always find myself drawn to, and admiring of people who seem to exhibit qualities like harmony, peace, and groundedness.  When I talk to these people, they often turn out to regularly practice mindfulness in some way.

Stress is a normal part of life.  There's no way to eliminate it, but we do have the power to choose how we respond to it, both physically and emotionally.  A mindfulness practice can help us regulate our responses, and experiences of stress, and come to recognize that everything is in a constant state of change.

My experience of mindfulness:

I like a tiny bit of chaos in my life; in moments of stillness, I want to shake things up, and create movement.  The mindfulness practices that have worked best for me have been moving meditations like yoga, or walking mindfully.  I find that both are stress relievers, mood boosters, and bring my focus into my body and out of my thoughts.  

Trying new things is another way I bring myself to mindfulness; when I can't anticipate what's going to happen, I find myself fully in my body, and engaged with experiences as they happen.

Art and Nature are both means for me to detach from stress, and thoughts, and lose my sense of self in my appreciation of beauty.   

Mindfulness and Trauma:

For some people deep breathing, or focusing inward might be difficult.  This can be particularly true for people who have suffered physical trauma; the body might not feel like a safe place to be.  There are ways to do mindfulness work that take this into account; the focus can be external, as opposed to internal, until the feelings of trauma have been resolved.

Talk therapy might not be enough when working with trauma and stress; the central nervous system can develop conditioned stress responses to any stimulus reminiscent of the original traumatic event.  These triggers can cause people to react immediately to the stimulus, without having time to think about or choose a preferred response.  Often these triggered reactions are self-protective and people come to regret them after the fact.  The body manifests stress well before the conscious mind does; these reaction times can be so rapid that people don't have time to recognize the chain of associations, so they might be left confused as to their own behaviors.  A mindfulness practice can help people learn to slow these reactions down, giving them time to understand what is happening, and choose deliberate and thoughtful responses.

Benefits of a mindfulness practice:

  • Reduced rumination
  • Reduced stress & anxiety
  • Improved working memory & focus
  • Less emotional reactivity
  • More cognitive flexibility
  • Increased relationship satisfaction
  • Increased empathy & compassion
  • Improved quality of life

Mindfulness is great for children, too!

  • It results in better social behavior, and less aggression among peers
  • Improved math skills
  • Less hyperactivity, and fewer ADHD symptoms
  • Significantly lower suspension rates
  • Lower depression and stress scores, and improved well-being

 

Mindfulness Practice

 

Some ways to practice mindfulness:

Mindful BreathingOne of the most basic ways of practicing mindfulness is to turn your attention to your breath: you can just focus on it as it is, without changing anything.  When thoughts arise, as they inevitably will, you can notice them without judgment, and redirect your attention to your next breath.

Somewhere I read that a relaxed person takes about seven breaths a minute.  By slowing your breathing, and focusing on the exhale, you are stimulating your parasympathetic nervous system, and physically calming your body down.  

Mindful Eating - One of my favorite objects to explore with clients is citrus: you can look at it, appreciate its shape, color, and beauty; feel it and observe its texture; score it with your fingernails, breathe in and smell the fragrant oils in the peel; you can taste the sweet, tangy, or sour flesh of the fruit, or the bitterness of the whites and peel; and you can notice how your body reacts to all of those observances and sensations.     

Progressive muscle relaxation - The sympathetic and parasympathetic nervous systems cannot be stimulated at the same time; in other words, you cannot simultaneously become more stressed and more relaxed.  In progressive muscle relaxation you methodically tense and release your muscles which leads to a whole body relaxation.

Visualization - I almost always use visualization with clients, especially if we are planning to do EMDR processing.  Your body and mind are connected; visualization, or active imagination, can create a physical feeling of deep relaxation, and peace.  Clients emerge from it feeling rejuvenated and energized; almost as if they've been on a vacation.

Mindfulness can help with pain management, or chronic pain - Frequently, pain is related to emotions; for some it can be a mere fact to be ignored, for others it can tap in to primal fears related to vulnerability or survival.  Mindfulness, can help reduce the emotional contribution to pain, and regulate the amount of focus given to the physical sensation of pain.

Mindfulness can help with addictionsAddictions invariably manifest with intrusive, obsessive, and repetitive thoughts and feelings.  "Thought stopping" is a practice of mindfulness that involves noticing and concentrating on a thought, or feeling state, for a short period of time, then interrupting it, and without judgment turning the mind to a preferred positive thought, that has been developed ahead of time.  This can be difficult in the beginning, so it is best to build facility by starting with less intrusive thoughts.    

“Being heard is so close to being loved that for the average person, they are almost indistinguishable.” ~ David Augsburger

Mindful Communication - When listening in a conversation, many people might want to jump ahead to their next talking point.  Mindfulness in communication might look like concentrating on active listening and engaging, staying in the moment, rather than giving advice or judging.  Whoever you're talking to is very likely to notice a difference in the quality of conversation, and feel appreciated and heard on a deeper level.

Mindfulness can help with depressionThere is a therapy called Mindfulness Based Cognitive Therapy that is designed to create a new relationship to the automatic thoughts that can trigger a depressive episode.  By interrupting these automatic thoughts, and noticing them without judgment, the theory is that you can control your reaction to them, disengage from them, and reflect upon them as processes external to the self, observe them, and move on. 

Mindfulness as a means of managing anxiety and panic - When working with clients who are in the process of experiencing a panic attack, I've found directed and detailed attention to something external and pleasing, to be very effective in calming the body and the mind.  Mindfulness can also help with self-consciousness and social anxiety; it can reduce the presence and impact of dual-thinking, and improve relaxation and engagement.

Mindfulness in the face of difficulty - Emotions are temporary, they crest and fade like waves.  Conscious awareness of this when facing difficulties can help to keep perspective, and hope alive.  Mindfulness practice can develop access to this awareness, making it easier to recall when in difficult circumstances.

Mindfulness Workshop

Here is more information on an upcoming experiential webinar on mindfulness.  I'm excited about learning more, and I urge everyone to check it out!

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Link to registration and fee page

DAVID BEHRENS DSH RSHom: mindfulnessprograms.org
David is a highly experienced and knowledgeable mindfulness practitioner. He has worked in the private and voluntary sector for addiction treatment and currently runs mindfulness courses for leading treatment facilities in London. He teaches mindfulness based stress management courses for staff working in the NHS (National Health Services) in Gloucestershire and has experience of working broadly with a range of complex mental health issues. David was a teaching monk for 27 years at an international retreat site in South India. He transitioned from monastic life in 2007 to further his studies of mindfulness and homeopathy and apply his work in a therapeutic setting.

BOWBAY LIANG-HUA FENG, M.A, LMFT

Bowbay Liang-Hua Feng is a Licensed Psychotherapist, with a private practice in Berkeley, CA. She comes from a multicultural background and has traveled and lived internationally. She brings over 20 years of experience in mindfulness, meditation and martial arts. Bowbay’s practice is built on cultivating inner strengths, and helping people heal from trauma, and manage transitions, relationships, stress, and quality of life issues. She uses an integrative approach and is trained in EMDR (Eye Motion Desensitization Reprocessing), Mindfulness and DBT (Dialectical Behavior Therapy). In addition to her clinical work, Bowbay is an adjunct professor at the University of San Francisco in the Counseling Psychology Graduate Program, presents at conferences, and facilitates multiple workshops. 

EMDR Part I


Things that wire together fire together

Trauma is an adaptive response distinguished by emotional volatility, anxiety, hyperarousal, and pervasive fear.  The evolutionary purpose of trauma is to prevent people from re-experiencing these dangerous situations in the future, a very helpful response when learning to avoid lions on the savannah.  But when taken out of a useful context it can leave people in this state of hyperarousal, always victim to a useless vigilance.  

PTSD is a disorder of both association and generalization, where stimuli such as sounds, smells, somatic sensations, images, thoughts, and emotions related to the traumatic event are wired together through neural networks.  A trigger of one of these associated senses or perceptions can create an automatic and overwhelming fight-or-flight emotional response, long after the original trauma has passed.  This can be an everyday torture for people who can’t avoid their triggers. 

Historically people have treated PTSD with talk and exposure therapy directed at these associations.  The premise of talk therapy is that by repeatedly talking about the trauma you can externalize and defuse it to a certain extent: you can explore feelings, notice patterns, develop an ability to sit with the discomfort, to differentiate the present from the past,  and you can receive validation for your reaction to the experience thereby normalizing it. 

Exposure therapy is still lauded today as one of the best ways to work with PTSD.  With exposure therapy you expose the client in various ways to the traumatic stimuli in a safe and controlled environment.  You do the exposure so slowly that the client never reaches a panic state, and then you maintain that level of exposure until the client becomes acclimated, and the body and mind relax.  You gradually escalate the degree of exposure over time until the fear is gone.  Both of these methods have been proven to work well, over time.  The problem I have with both of them is that when used independently the process can take a LONG time, years even.  And the process can be so grueling, that it can be difficult for clients to maintain the level of motivation necessary to endure it over that amount of time.

EMDR is in many ways an expedited exposure therapy, where the exposure takes place in your mind through the use of your memories and imagination.  I wish that I could explain to you exactly how it works, but the truth is that in spite of the many studies done on EMDR, no one has quite figured it out yet. 

There are various theories that involve activating the parasympathetic nervous system (the calming one), to defuse a sympathetic nervous system response (the anxious one).  This seems plausible because we know that you can’t stimulate both systems at the same time, if you’re having an anxious response but then are being soothed that’s a very natural way of emotional healing.  The bilateral stimulation can be seen as similar to the rocking that one might receive as a baby, rocking being such an intrinsic rhythm that neglected infants still learn to self-soothe that way.  Another theory is that bilateral stimulation, and the resultant eye movements mimic the eye movements of REM sleep.  This sounds reasonable because it is well known that REM sleep is necessary for some kinds of long-term memory processing. 

What is clear is that when someone is experiencing a trauma, the brain doesn’t process that memory the same way it would a neutral memory.  Do you remember what you had for lunch exactly one month ago?  Unless you ate somewhere special, the likelihood is that you don’t.  Traumatic memories don’t fade the way neutral ones do.  Someone with PTSD can have perfect recall, as if the trauma is happening right now.  All those associations connected by that neural network are stimulated together, and the strong emotion is as real today as it was in the moment of the original trauma.  Memories like this can have a profound and destructive effect on a person’s life.

EMDR is an exposure therapy in that you light up that same neural network.  This part can be difficult for the client, although there are distancing techniques and other safeties that should be put in place to regulate the difficulty.  It is not like traditional exposure therapy in that it’s possible to process the trauma very quickly.  It’s not a magic pill, and the efficacy is related to other aspects of therapy like trust between the client and therapist, or readiness of the client to tap into the pain, or even the degree to which the client has a cognitive understanding of the trauma.  I have seen traumas resolved in seconds (literally), but I’ve also seen it take months of difficult processing to find the right link to the neural network (and then it resolved quickly).  More often than not processing tends to go pretty quickly, which is why I'm such an advocate for EMDR.  

To be continued...

Sugar & Mental Health

photo credit: kurtis garbutt

photo credit: kurtis garbutt

It’s common knowledge that sugar can contribute to mood swings and hyperactivity.  It’s now been shown that sugar can be directly related to certain mental health disorders as well. 

Sugar and Mental Illness:

Psychiatric researcher Malcolm Peet did a cross cultural analysis of the relationship between diet and mental illness.  He found that increased sugar is correlated with increased risk of depression, and worse 2 year outcomes of schizophrenia symptoms.  

  •  One theory is that sugar suppresses a growth hormone (BDNF) that is very low in people with both depression and schizophrenia.  BDNF is vital in both the maintenance of healthy neurons and in the growth of new connections between neurons, which relates to the creation and maintenance of memory. 
  • Sugar is also a cause of chronic inflammation, which disrupts brain function, and the immune system.  Chronic inflammation is also positively correlated with depression and schizophrenia.

In one study by the University of Toronto it was found that depression patients displayed a 30% increase in some markers of brain inflammation.  The rates of inflammation correlated strongly with the severity of the patients’ depression.

Sugar Addiction:

Sugar floods the brain with its own natural opioids (like endorphins), and the feel-good neurotransmitters dopamine, and serotonin (that act as hormones), activating the same reward centers as many drugs, like cocaine.  People with addictive eating patterns feel a high merely by looking at sugary foods.  A study at UCSD used brain scans of obese children to show that they have a higher sense of food-reward when tasting sugar than do children in a healthy weight range; this could indicate a predisposition to crave sugar throughout their lives.

One study presented at the annual meeting of the Society for Neuroscience in SanDiego (2007) showed that rats will prefer sugar water to that laced with cocaine, and they will exhibit tolerance and withdrawal symptoms when denied sugar; this is true even for rats already addicted to cocaine.  

"The brain's pleasure center, called the nucleus accumbens, is essential for our survival as a species... Turn off pleasure, and you turn off the will to live... But long-term stimulation of the pleasure center drives the process of addiction... When you consume any substance of abuse, including sugar, the nucleus accumbens receives a dopamine signal, from which you experience pleasure. And so you consume more. The problem is that with prolonged exposure, the signal attenuates, gets weaker. So you have to consume more to get the same effect -- tolerance."

Sugar rich diets overstimulate these neurotransmitter pathways, draining the body’s reserves, and can contribute to symptoms of depression.

"And if you pull back on the substance, you go into withdrawal. Tolerance and withdrawal constitute addiction. And make no mistake, sugar is addictive." – Dr Lustig, UCSF

Increased anxiety and susceptibility to stress:

Sugar inhibits the body’s ability to regulate stress.  Panic, including hypervigilance, shaking, tension, brain fog, irritability, blurry vision, and fatigue can all be the result of sugar consumption.  Blood sugar levels spike, and then crash.  The crash when sugar intake is limited can appear very much like opiate withdrawal in terms of brain chemistry.

Severe or long-lasting traumatic early childhood experiences are risk factors for susceptibility to psychiatric disorders; they are correlated with increased cortisol, a stress hormone, and decreased volume in certain areas of the brain, including the hippocampus, a region of the brain vital to memory function and particularly susceptible to cortisol.  A recent rat study conducted by the University of New South Wales, Australia, and the Indian Council of Medical Research, India found that chronic consumption of sugar produced similar changes in hippocampal gene expression to those derived from early life stress.  “[diets rich in sugar promote] the expression of inflammation-related genes, and [reduce] the expression of genes involved in neurogenesis and neuroplasticity.” These changes directly affect the ability to recover from stressful situations. 

Cognitive function – A diet high in sugar will negatively affect learning and memory:

A study by UCLA showed that rats previously trained on a maze were unable to remember their way out after six weeks of consuming a diet rich in fructose.  Insulin resistance caused by the high sugar diet damaged communication, or synaptic activity, between brain cells which affects memory and learning.  In general insulin strengthens synaptic activity allowing better communication between cells and improved memory, so it makes sense that insulin resistance would damage it.  In contrast, rats fed a healthy diet, and rats fed a diet high in fructose but that also included omega 3 fatty acids were able to remember their way out of the maze faster.  The omega 3’s seemed to lessen cognitive impairment by protecting the synapses between brain cells.

80% of foods in the American diet contain sugar.  Foods high in sugar and fat have been shown to relieve stress and anxiety; it’s no surprise that stress and poor diet often appear together.  Furthermore, food addiction is frequently connected to unresolved emotional patterns.

All this is to say:

The more I learn about sugar and its relationship to mental health, the more I encourage my clients to take a close look at their diet and develop awareness of how their diet is related to their mood.  For some, we even go the extra step of trying to limit the consumption of sugar, at least for a while to track if they notice any effect.

For more interesting information about the effects of sugar on the brain and body:

Peak Experiences

photo credit: louise hedberg

photo credit: louise hedberg

"Peak experiences involve a heightened sense of wonder, awe, or ecstasy over an experience." - Privette, "Defining moments of self-actualization: Peak performance and peak experience," 2001

"...a highly valued experience which is characterized by such intensity of perception, depth of feeling, or sense of profound significance as to cause it to stand out, in the subject's mind, in more or less permanent contrast to the experiences that surround it in time and space." - Leach, "Meaning and Correlates of Peak Experience," 1962

A fun exercise is to collect memories of the most wonderful experiences in your life: times when you were truly and completely invested in the moment; times of ecstasy, fulfillment, spiritual completion, awe.  

Can you think of a moment like that?  A moment of perfect happiness, relaxation, safety or excitement, unencumbered with thoughts of the past or future, complete in itself?  Some questions to ask yourself are:

  • Where were you?  
  •  Were you with anyone?  
  • What did the scene look like?  
  • Sound like?
  • Smell like?  
  • What sensations could you feel in your body?  
  • What was the temperature?  
  • The weather?  
  • The emotion?

I've noticed that by the time I've brought the memory alive, complete with all of these details, I begin to feel a buzz in my body that is almost as if I'm there.  Once developed these memories can be called upon as resources for EMDR.  And even without EMDR, it's invigorating to revisit them.

Please feel free to share your peak experiences in the comments; I'd love to hear about them!

 

Probiotics & Mental Health

photo credit: Jules

photo credit: Jules

You are what you eat!

First of all, you’re probably aware that there are complex and diverse microbe communities in our guts which help to regulate our metabolism and immune systems.  Well, in recent years there’s been a buzz about how these gut microbes may affect mental health.  This is super exciting because someday, when we learn a lot more about it, it might mean new, natural options for regulating mood. 

In case you haven’t heard, let’s start with a fun and interesting NPR animation about the human microbiome, its function, and how to support it:  

New studies suggest that probiotics may actually help in mitigating anxiety and depression symptoms, and decreasing emotional reactivity.  Some studies show that probiotics can increase emotional resilience, decrease depressive thoughts, and lower levels of cortisol (a stress hormone, also relevant to metabolism, and how the body stores fat).

At this point, more research is needed, but as an adjunct treatment for depression, it seems possible that a bowl of yogurt in the morning might be a good idea.  It's clear that there is a powerful brain/body connection where emotions can disrupt digestion and digestion, in turn, can affect emotions.

Most of the studies thus far have been conducted on animals.  But the results have been so impressive that researchers are creating more human studies.

The first study I heard about was a small stress test study conducted at the University College Cork, Ireland. This study found that probiotics have a direct impact on mood neurotransmitters in mice.  The mice who received the probiotics took more than twice the risks of mice who received the placebo, and were less likely to give up in a life or death situation, suggesting reduced anxiety. The effects of probiotics were comparable in significance to those seen in study mice for antidepressant drugs.  Brain changes were reflected in the hippocampus, an area of the brain that regulates emotion and mood.  They showed half of the corticosterone (a stress hormone) and also a redistribution of brain receptors for GABA neurotransmitters, the same receptors affected by anti-anxiety medications like Valium.  These differences only held when the vagus nerve, which allows communication between the guts and the brain, was intact, indicating that the vagus nerve is crucial to the process.  

UCLA did a small study of women who ate probiotic dairy and found that they showed a decrease in emotional reactivity when doing an emotion recognition test where they had to match up pictures of angry and frightening faces. The researchers further found that brain effects could be seen in sensory processing areas of the brain, not just those associated with emotion.

The gut microbe community is reflected in the physical structure of the brain; this may be one reason why brain function is different from person to person.  A question this raises is how do repeated courses of antibiotics affect the brain, especially the developing brains of children?  Might there be any long-term consequences?  I don't have an answer to this, but I'm curious.

Oxford University did a study on prebiotics, carbohydrates that healthy bacteria feed on:

“After the three weeks had passed, the researchers completed several computer tests assessing how they processed emotional information, such as positive and negatively-charged words.

The results of one of the tests revealed that subjects who had taken the prebiotic paid less attention to negative information and more attention to positive information, compared to the placebo group, suggesting that the prebiotic group had less anxiety when confronted with negative stimuli. This effect is similar to that which has been observed among individuals who have taken antidepressants or anti-anxiety medication.”

Leiden University, Netherlands did another study on how probiotics affect emotional resiliency:

“The people who took probiotic supplements began to see improvements in their moods; they reported less reactivity to sad moods than those who took placebos. In other words, the people who took probiotic supplements were better able to overcome sad moods than the others, and thus had fewer depressive thoughts following bouts of sadness.”

A study done by the ETAP (Ethologie Appliquée) lab in France found that people who took probiotics for 30 days had decreased levels of psychological distress.

All of these studies support the hypothesis that there is a strong connection between gut bacteria and mental health, that probiotics can alter the way people process emotional information, which, in turn, can affect behavior.  These findings need to be confirmed by further research, but it seems natural that the brain, an organ, would be affected by nutrition just as any other organ might. 

In the meantime, while waiting for these studies to be conducted, I’m going to be eating yogurt.

Other sources of probiotics

Self-Care

Photo credit: Heather Paul

Photo credit: Heather Paul

What is self-care?

Goodtherapy.org defines self-care as the actions that an individual might take in order to reach optimal physical and mental health.”

I think of it as intentional ways of nourishing and building resilience in the spirit and body; deliberate efforts to support physical, mental, and emotional health.

 Why is self-care important?  You can't pour from an empty cup.

 My answer is that when I was in grad school, one of my professors, Dr. Bernadette Torrez, made the point that we (therapists) are “the instruments of therapy.”  I understood her at the time, but as I came to practice I realized in a more profound way how my energy level, health, and mood affect sessions with my clients.  Like most therapists, I developed a certain ability to set my problems aside, and be present for my clients, but certain things, like migraines, can't be ignored.  It's on me to do my best to prevent those sorts of things from happening in the first place.  Self-care is especially significant in my field where I am helping people process, contain, and navigate heavy emotional experiences.  There is a high rate of burnout in my profession, and I don’t want to fall victim to it.  The field as a whole recognizes how important an issue this is, and places a strong emphasis on learning to prioritize and practice self-care.

A self-care plan involves:

  • Recognizing why self-care is important to you.
  • Creating a list of ideas that work for you and your lifestyle.  I think that it’s good for the ideas on your list to vary in terms of ease, commitment and expense.  After a hard day at work, you might not want to go on a hike, but an Epsom salt bath might be just the thing.
  • Setting aside time in your schedule to incorporate those ideas.

Some of my favorite self-care ideas, and some links to more information:

  •  Spend time in nature!
  • Regulate your sleep, and when that’s not possible: 
  • Take a nap – This could be a 10-15 minute “power nap,” or it could be a luxurious 2 hour nap, depending on your needs and available time.  
  • Create a happiness journal.  This can be an excellent resource when you are feeling over-extended.  Imagine a book where every page reminds you of something positive in your life that you have a personal connection to.
  • Vary your routine.  This will create a shift in energy and thoughts.
  • Bring mindfulness to ordinary activities.  Maybe 15 minutes of meditation in the morning is too much of a commitment, but slowing down to savor your food, feeling your feet on the ground as you walk, rubbing your fingers together and trying to feel your own fingerprints; these are things that can be done easily and will still bring your focus into your body, and into the present.
  • Find a swing and use it!  Play connects us all with our happy memories.
  • Breathe deeply and with intention.  This might be the easiest way of practicing self-care.
  • Drink lots of water; our bodies need it!
  • Eat healthfully
  • Practice saying no to things you don’t want to do.
  • De-clutter.  Some people function better in chaos; I am not one of them.  When my space is clean and clear, I find myself being much more productive and creative.
  •  Dance, stretch, move your body.
  • Unplug from social media.
  • Indulge yourself.  This could be a small indulgence like a piece of chocolate, or it could be a getaway to a tropical island.  It all depends on your tastes and budget.
  • Activate your self-soothing system.  I do this by putting lotion on my arms, or getting a massage. 
  • Create a compassionate mantra for yourself (see earlier blog post on how to do this).
  •  Laugh – whether this means watching a comedy or calling your best friend, laughter is truly the best medicine.
  • Come up with a list of compliments for yourself.  Don’t limit yourself by what you think.  What would your favorite aunt have to say about you?  Or your best friend?  Or your cat?
  • Look for beauty.  Try using your phone to take pictures of 3 beautiful things a day.
  •  Write a heartfelt thank you note to someone who has been of help to you.  Whether or not you send it, the writing will put you in touch with your feelings of gratitude.
  • Buy a set of Mixed Emotions Cards.  These are one of the best tools I know of to help identify emotions, resolve conflicts, and make decisions.
  •  Find an animal to play with or cuddle: unconditional love wrapped in soft fur.
  • Take time for yourself.  Many of us have over-packed schedules and overwhelming responsibilities.  Take a break; you deserve it.
  •  Take a bath, preferably with a lot of Epsom salts.

This is my list.  What is yours? 

Addiction

At their emotional root, addictions share a lot of similarities:

Pain - in all addictions there is a core discomfort or pain, and a compulsion to do something to relieve it.  

The reasons for the pain and its severity will vary from person to person; the neurochemistry involved will vary based on both the person, and the drug or activity used; and the desired state or high, will vary as well.  

Gabor Maté's thoughts on the relationship between pain and addiction:

Trauma - it could be a root trauma that the addiction was created to escape, or the traumatic results of the addiction itself, played out internally or in the community.  Either way, the trauma needs to be addressed in order to reduce or eliminate the need for relief and escape. 

Internal Conflict - common to all addictions is a conflicted internal dialogue.  

The desire, longing, and feeling of need intrinsic to all addictions is a very right-brain experience: it operates outside of time (in the now), it's not particularly logical, it's emotionally motivated, creative, driven towards positive sensory experiences, and not particularly concerned about consequences.  

The aftermath, or comedown, is when the left-brain kicks back in: suddenly consequences reassert themselves, as do logic, history, and regret; it looks at the past and sees failure, it projects this pattern to the future and leaches away hope.  This lack of hope and space of judgment pave a deeper path on this cycle of use.

By stimulating both sides of the body, and therefore both sides of the brain, EMDR can create connection and dialogue between these two unintegrated experiences; desire is undercut by the memory of regret, emotion is tempered by logic, and the big picture, once established, is there to stay.  

EMDR as a therapy was developed for trauma, and most of the research has been directed towards that, but the anecdotal experiences of therapists who use it to treat addiction look incredibly promising.  I've had positive in my own private practice, as well.

When doing addiction work, I use Motivational Interviewing in conjunction with EMDR.  These modalities work well together because both operate on the premise that every person has a pretty good idea of what health looks like.  It might seem impossible to reach, it might change over time, it might be something only seen on TV, but there is a template or foundation of belief from which to work.  Motivational Interviewing encourages people to nourish their own ideas about health, and to explore and acknowledge any internal conflicts that might be holding them back.  It requires meeting people where they are in their process, without any shame or judgment, and exploring what’s true for them.

 I enjoy doing addiction work, in-part because I’ve been around a lot of addiction, and have seen the consequences to people and their communities.  I’m also just grateful for my ability to be that non-judgmental ear that can help people relax and feel safe to explore.

Stepping Outside of the Comfort Zone

photo credit: mami hasegawa

photo credit: mami hasegawa

"In truth, comfort zones are not really about comfort, they are about fear."- Cylon George

"We pay a heavy price for our fear of failure. It is a powerful obstacle to growth. It assures the progressive narrowing of the personality and prevents exploration and experimentation. There is no learning without some difficulty and fumbling. If you want to keep on learning, you must keep on risking failure — all your life. It’s as simple as that." – John Gardner

As an animal species like any other, bent on our own survival, we are predisposed to seek safety; hence our natural inclination towards the comfort zone.  In the comfort zone our activities tend to minimize risk and stress; we create a rut of routine behaviors, a place of stasis and neutrality.  We can predict outcomes, because change is minimal; we’ve seen it all before.  By stepping out of our comfort zones, by challenging ourselves, and attempting new things, we’re running a risk; anything could happen.  That said, taking risks is how we grow, how we stretch ourselves, and how we master new tasks.

"Did you ever do something you were really proud of when you were in autopilot mode?" - Carolyn Gregoire

 Creativity is inherently linked to novelty and experimentation.  There can be no surprise that it is also linked to happiness.  And creative people, who regularly risk failure and vulnerability, when counter-balanced with the joy of flow, also have increased opportunities to build emotional resiliency. 

As children people tend to take risks: everything is new, everything is a challenge, and our minds are designed to explore, experiment, soak up new information, and make new associations.  During this period, we develop in body and mind at an amazing rate.  At some point we start to make the connections between actions and consequences, and to project future possibilities.  We learn to inhibit our actions to avoid potential failures, and the resulting blame, shame, or pain.  In so doing, in creating these buffered comfort zones, we protect ourselves, but we restrict our growth as well.  The tendency is for these comfort zones to solidify as we grow older, limiting our experiences, and our access to the world.  If we could consciously make the decision to break down those self-imposed barriers, I believe that our lives would be more fulfilling in the end.  After all, it is the peak experiences in life that we remember and treasure.

“In becoming a person who regularly takes calculated risks, challenges yourself, and tries new things, you'll cultivate openness to experience, one of what's known in psychology as the "Big Five" personality traits. Openness to experience -- which is characterized by qualities like intellectual curiosity, imagination, emotional and fantasy interests, and a drive to explore one's inner and outer lives -- has been shown to be the best predictor of creative achievement.” -  Carolyn Gregoire

 There is a difference between failure and fault that's important to distinguish. The Oxford English Dictionary defines failure as a “lack of success in doing or achieving something,” a rather neutral definition.  In contrast, it uses the adjectives: unattractive, unsatisfactory, misguided, and dangerous to define the word fault.  In reframing the idea of failure, you lose that sense of intrinsic judgment.  In many ways we learn as much if not more from our failures than we do our successes.  The fact is that if we try new things, we are destined to eventually fail at something.  Getting comfortable with the idea seems a worthy effort.  Mistakes and failures can even be funny in the right light.  The most embarrassing moment I’ve ever had is now my favorite story; I can’t tell it without cracking up, and I take every reasonable opportunity to tell it.

 I’ve just given a bunch of reasons to step outside the comfort zone, but maybe you have some of your own to develop and contribute.  It might be worth it to take some time to think about them, and write them down… maybe put them somewhere visible for when your determination falters.  Having this list easily accessible could help you manage stress, and maintain motivation.

 The next question is how does one actually do it?  The inertia is real!

 I have a bunch of ideas I’ve gleaned from life, from conversations, and from articles I’ve read on the subject: 

 The first step might be to identify what it is that you want to do but are afraid of.  If you’re aware of the things you desire but avoid, then you will have some concrete goals to work towards.

 Then perhaps figure out what specific fear lies behind the avoidance.  Is it fear of failure, disappointment, physical harm…?

 What is the positive possibility, the answer to “what if this works?”  How would conquering this fear benefit you?  Answering these questions will on some level reframe fear into opportunity, turn nervous energy into excitement, and create a new narrative.  This might sound like an “easier said than done” moment, but it’s one of those things that would become easier with practice. (AND once this perspective is well thought out, a little EMDR would probably be very helpful in working through the fear).

 In making changes, I would take baby steps, small changes that are easy to make.  It doesn’t even matter how small as long as they are heading in the desired direction.  Whatever is doable without being too stressful would be fine.  If it’s too stressful, it becomes difficult to maintain, so it’s better to make small easy changes towards overcoming fears. Each small successful change will lead to increased comfort when attempting the next.

 When things do become uncomfortable, as they inevitably will, it might help to try to rest in the discomfort, and breathe through it.  Really, we’re talking about a kind of exposure therapy, exposure to discomfort.  Over time, with the afore-mentioned baby steps, it would become more comfortable.

 More important than the size of the step is the frequency of the efforts. Remember, in stepping outside of the comfort zone you’re trying to build a habit out of change itself, and habits are the product of repetition.

 We all have our comfort zones, (mine is alive and well).  It’s lovely to have them as a retreat, a place to rest and regroup, a place of comfort and safety.  That said, it seems like too much time spent there means denying oneself a lot of the richness life has to offer. 

Photo credit: mami hasegawa

Photo credit: mami hasegawa

Cultivating Happiness - Creativity & Flow

photo credit: dean hochman

photo credit: dean hochman

I’m currently thinking about happiness: what leads to it? Is it the goal in life? Why is it easier for some to achieve than others?  What makes a happy life? 

It turns out that money certainly isn’t the answer.  Once people have enough to get by comfortably, money doesn’t add much to happiness. 

I’m really intrigued by the idea of flow.  Flow is a state that you achieve when your challenges and your abilities are both high: when you lose yourself in your work because you are so engaged in it.

For many people this happens when in the process of creating something new; I’ve realized that for me this happens when creating art, or cooking.  This is the reason that adult coloring books are becoming so popular; it’s a kind of meditation.  You don’t have enough attention left over to focus on your problems, your body, or even your existence.  In a way, you disappear, lose yourself in the activity, or you merge with your work.  This state has been described as effortless, spontaneous, and ecstatic.

Experts who study flow have described it as a state where an intense focus leads to a sense of ecstasy and clarity; time disappears, and you forget yourself because you feel part of something larger.  You know that you can be successful at what you’re doing; you know exactly what to do from moment to moment, and you receive immediate feedback from your process.  This is effort for its own sake.  It’s a passion for doing your best and enjoying your work.

Given all of this, it might be worth a few minutes thought, no? 

What activities can you lose yourself in?  How often do you create opportunities to do so?