DREAMS AND THE GROWTH OF PERSONALITY

July 11, 2012 By

DREAMS AND THE GROWTH OF PERSONALITY

John Porterfield, MFT and Jungian Analyst

Why do we dream, and how are we to understand the meaning and purpose of these visions of the night?

Our dreams are “living images” from the unconscious that reflect and respond to our personal life, our loves, our conflicts, and the as-yet unknown possibilities that await us.  Dreams tell us more about the person we are, while leading us to the person we may more fully become through personal healing and growth.

By acknowledging and relating to the images and symbols of our dreams, we acquire a better understanding of ourselves, as well as those others who are important to us – be they friend, or foe.

Through an active engagement with our dreams, we are able to gain a fuller insight and perspective into our lives – past – present – and future.

Rather than being merely the processing of the day’s residue, or the result of a spicy meal eaten too late in the day, dreams are a spontaneous self-portrayal, in symbolic form, of the actual situation in the unconscious.

Dreams articulate the immediacy and authenticity of our experience in ways our conscious mind does not yet understand.  They are a living art form and communication that asks us to reconsider our perception of who we are, and the choices we make about how, and for what purpose, we are living.  Dreams reveal the conceptions (and deceptions) that determine many of our actions and primary concerns in waking life.

If, for example, our conscious attitude is too one-sided or biased in some way, we will have a dream that reflects this problem in an attempt to correct it.  If we disregard or fail to integrate this new perspective into our consciousness and the matter is of real importance, we will find that we begin to have repetitive dreams whose themes, for some, can go on for years.  In such cases, it is generally a deep issue that is being addressed, which will take time and much conscious effort – even suffering — to resolve.

In addition to these ongoing thematic dreams, the unconscious will send us symptoms that all is not well, such as anxiety or depression, angry outbursts or feelings of overwhelming hopelessness.  In such situations it is essential that we look inward for the resolution of our problems, rather than projecting these internal conflicts onto others, thinking that if only they would change, we would feel better.  If we do not come to terms with our inner adversary, peace with our neighbors will be impossible, since we will always blame them for what is in us.  As Carl Jung states, “That which remains unconscious, we are destined to live outside, as fate.”

Most often, the content of our dreams provide a striking contrast to our conscious sense of self and the world in which we live.  For most, the vast, overwhelming complexity of the rapidly changing external world has torn their attention away from the depths of their own inner life, bringing a sense of self-alienation and dis-ease that they are hard-pressed to address or overcome.

Yet by paying careful, respectful attention to our dreams we are awakened to a deeper sense of the depths and dimensions of our Being.  Dreams reveal our relationship to both the practical and the spiritual dimensions of life.  Just as our instincts have been honed and developed over the millennia, dreams connect us to archetypal images and drives that influence our lives whether we are aware of them, or not.

The interplay between the archetypal and personal levels within us is expressed in a symbolic language.  If we are to understand and benefit from our dreams, we must understand their symbolism.

As one begins to delve into the many layers of the unconscious, at the threshold he or she is certain to meet the shadow, which Jung describes as “the thing a person has no wish to be.”  Here we come face to face with all of the things one cannot accept about oneself.  Whether the shadow is experienced as our friend or foe depends entirely upon ourselves, for the unconscious shows us the face we show it.   When we repress the unconscious in an attempt to lock it out of our lives, the shadow often appears in dreams as intruders or attackers whom we flee or attempt to kill.

An African tribe teaches its children that when they are chased by a devouring monster they must stop running, turn and face it, and hold out their hand and say, “Give me a gift.”

This is the essence of what is required of our conscious attitude.  We must stop making the unconscious an unwelcome threat, and learn to expect something positive from it.  For example, a woman was terrified by a series of dreams in which a dangerous man was trying to break into her house.  After much work she came to understand that this figure represented her own inner masculine that she needed to accept and face.  In her final dream of the series, she heard the man knock on the door.  Rather than panic, she went to the door and opened it.  On the porch stood a smiling deliveryman who handed her a beautiful bouquet of flowers.

Our relationship to our dreams can bring us psychological healing and the consequent growth of personality.  A successful partnership with the unconscious increases the possibility of fulfilling our potential and consciously living from a place of wholeness, and experiencing our incomparable uniqueness.

Filed Under: Dreams Tagged With:

How to Treat Financial Fear, Stress and Angst

July 11, 2012 By

A New Niche Practice for Psychotherapists:

How to Treat Financial Fear, Stress and Angst

By James Gottfurcht, Ph. D. and Zoreh Gottfurcht, ICF Certified Coach

According to the American Psychological Association, money has been the number one stressor for Americans for many years.  The financial meltdown of 2008 has been a game changer by causing stock market and real estate crashes.  Over 5 million people have filed bankruptcy since then, and according to the Bureau of Labor Statistics, we still have 12.7 million who are unemployed.

We can easily feel compassion for the trauma these people have experienced and the PTSD that follows.   Many will need more than job training to overcome their financial fear, guilt and shame.   They will require psychotherapy or coaching.  Our profession will continue to be among the first responders to the psychological fallout from this crisis.

  • The challenge, however, is that very few therapists and coaches have been trained or are proficient in psychology of money and business.  Our profession is notorious for being under-informed in both areas.  Fortunately, there is a rapidly growing field of specialty practice in the psychology of money led by our colleagues who are financial therapists, coaches, financial life planners, wealth managers, estate planning attorneys, etc. who understand that financial success is an “inside job.” Who knows better than psychotherapists that prosperity is much more determined by what’s happening inside our clients’ minds rather than by what’s outside?
  • The first purpose of this article is to let you know that with your training and experience, you are ideally positioned to serve the huge market of people with financial fear, worry, stress and trauma.  Our February talk to LACAMFT demonstrated how to serve these clients by using a tool we call the “Six Psychological Money Traps.”  Although we do not have space to review that tool, the money traps’ names are:  Rationalization, Avoidance, Projection of Blame, Idealization, Denial and Splitting.  You can discover how to apply them with your clients later in the article.
  • Our second purpose is to introduce another tool to financially empower yourself and your clients, The Psychology of Money Profile.  The Profile measures seven psychological money skills associated with financial success.   We have used it with thousands of clients.
  • To give you a jumpstart in helping clients with financial challenges, we will share one of the Profile’s questions.  Then we will tell you which psychological money skill the question assesses, why that skill is important and how well you have developed the skill.
  • Please answer the question below.  It represents only a small sample of the questions the Profile uses to measure that skill.  So, your response will be only a partial indication of your true score.

Your answer may be influenced by your state of mind at the time you respond.  If something financially negative is influencing you, your score could be biased negatively. This would mean your true score could be higher than the way you score today.  If something financially positive is influencing you, your score could be biased positively.  This would mean your true score could be lower than you score today.

We want to clarify that our definition of financial success is much broader than the amount of money you have or your material possessions.  Financial success is about how healthy your relationship with money is.  It includes your security, satisfaction, fulfillment and peace of mind with money.  It’s about having enough, enjoying it and experiencing financial freedom.  Remember, you are more important than the money!

Please respond to the following item honestly rather than how you would like your answer to be.  If none of the answers fits, simply choose the response that is most true for you.

My overall financial plans are:

a.  ____ clearly stated in written form and/or in my mind

b.  ____ partially developed

c.  ____ mostly developed

We define financial planning as:

1) integrating financial feelings, beliefs and values into a cohesive set of goals and

2) identifying and taking concrete action steps that lead from your starting point to your destination.

Choice “a” indicates a high financial planning score.  This is financially empowering and accelerates manifesting financial success.  Unfortunately, not many people respond this way.  Choice “b” is a low score and implies a scarcity mindset.  Many clients and even therapists respond this way.  Scarcity responses hinder financial success.  Clients who have minimal money trauma can be treated primarily with financial CBT or coaching.  For those who have experienced more trauma, we recommend financial CBT and psychodynamic financial therapy.  We have developed many assessments, tools and exercises for our clients.

Financial planning enables you to organize your thoughts and actions in a systematic way and to develop a set of efficient action steps to reach your destination. Training, therapy or coaching will often increase your scores, your true skill levels and your financial success.  A case story of how to apply financial CBT or coaching with a client who is trapped in Rationalization can be found at the link: www.psychologyofmoneyblog.com/2009/06

We feel passionate about serving clients with money challenges and about collaborating with our interdisciplinary colleagues.  We especially enjoy exchanging perspectives with our allied professionals and sharing individual, couples and family referrals.  We hope the article stimulates your curiosity to discover more about this rapidly growing niche and the abundant opportunities it offers.

To learn about your scores on all seven psychological money skills, we are offering the first 100 readers the opportunity to take the Profile on the Internet for no cost and receive several pages of feedback at www.psychologyofmoney.com/profile

You can discover more about the Profile in a journal article describing how Dr. Gottfurcht used it to coach a couple with their certified financial planner about sudden wealth and sudden romance. (http://www.psychologyofmoney.com/download/financialplanningassnjournal.pdf)

James Gottfurcht, Ph. D., Clinical Psychologist and President of Psychology of Money Consultants, 310-828-1818, DrGottfurcht@PsychologyofMoney.com

Zoreh Gottfurcht, ACC, ICF Certified Coach and Associate Director of Psychology of Money Consultants, 310-472-6703, CoachZorehGottfurcht@PsychologyofMoney.com

Filed Under: Money - Fear Stress Angst Tagged With:

Into The Dark Woods: Jung’s Path of Individuation

June 22, 2012 By

John Porterfield, MFT

Individuation: the possibility by which the individual can attain the full development and completion of our incomparable uniqueness.

The possibility of self‐realization is built on the foundation we have laid in the first half of life. Our society devotes much preparation of its youth for the first half of life in terms of education, training,
and the clearly expressed expectations that success is to create deep roots in career, in relationship through marriage and the creation and rearing of a family.

This foundation has allowed our world to develop great civilizations, which allow us to coexist in some form of order that works for the benefit of the tribe, the group, the nation. This is what our psyche wants us to do: to build a strong ego, to be deeply connected in the world, to be grounded by the trials, tribulations and triumphs of life.

In contrast, in regards to the second half of life our society seems rather clueless. We are not at all prepared for the tasks involved in this stage of life, which many seek to avoid altogether. Says Jung, “What youth found and must find outside, the man of life’s afternoon must find within himself.”
The tasks of the second half of our life are a process of letting go of the external ways in which we identify ourselves, and turning inward to find our own unique path to psychological and spiritual maturity.

It is a process of maturation in which the psyche ages or matures in much the same manner as the
physical body, but unlike the eventual diminish‐ ment of our physical strength and endurance, the human psyche is able to continue to expand and renew itself.
As a result, it can become for us, in our years of aging and decline, a wellspring of life and joy.
For most people, reaching this place usually comes only after a profoundly unsettling realization that the things which we have dedicated our lives to are not going to last forever.

A long‐term relationship or marriage ends through divorce or death. Our children move away into their own lives, and we become empty‐nesters. Or perhaps, even worse, our children grow older and do not move away.

We may lose our job, or find that we are no longer satisfied or challenged with the work we’ve done for a lifetime. The rewards we found in the past may no longer seem enough. The well has run dry. Something integral is missing, and we are left with no sense of what to make of it.

Feelings of emptiness and depression are common. Addictions can crop up. We come up against the fact that what have been our strengths have turned into personal limitations of character and imagination that leave us rigid and defensive to change and transformation. For many, this leads to what is commonly known as “The Midlife Crisis,” when that which has formerly propelled us forward in the past or held great meaning begins to ring hollow. In the process, we find that we hardly know ourselves. “Midway in life’s journey, I found myself
in a dark wood, having lost the way.” So begins Dante’s spiritual pilgrimage and revisioning of his life’s meaning.

What we are experiencing is actually a death of the old, which hopefully leads to the birth of a new stage of life that opens the door to new possibilities of iving a vastly enhanced and meaningful life. It is not unlike the little caterpillar that weaves its own cocoon, and surren‐ ders into the darkness, where it under‐ goes complete transformation and emerges as a butterfly, freed to fly the winds of the world in new form.

As in our first birth, at midlife we are taken from the only world we have known and confronted with a new reality for which we have little preparation or knowledge of how to proceed. Just as sincerely as the infant, we need help.
And here is the good news. While this may be over‐ whelmingly new terrain to us as individuals, it is a reality of life that is as old as the human race itself. If we have a proper attitude towards this new stage of life and the demands it places upon us, by deepening our connections to the unconscious we will find that we have a great inner friend who is there to guide us through every step of the unknown journey. The answers we need are all within us. They come to us through the images and themes in our dreams, which are there to guide us, to correct our partial or mistaken perceptions, and to lead us on our path of individuation into the deepest recesses of ourselves and the wholeness of life.

Tune in next issue for more on the Jungian approach to working with dreams.

John Porterfield, MFT, is a Jungian Analyst who specializes in helping individuals and couples develop effective solutions for lingering problems and improve their relationships through psychoanalytic psycho‐ therapy. John has extensive experience providing individual and group supervision to mental health professionals serving private practice clients as well as clinicians working in an agency environment. He is a Training Analyst and past President of
the C.G. Jung Study Center of Southern California. John leads Case Consultation groups for therapists working from a psycho‐ dynamic perspective, as well as occasional dream workshops. He maintains a private practice in Sherman Oaks. For further information, please visit: www.johnporterfieldmft.com or contact John at johnporterfield@me.com or 818.784.0633

Filed Under: Individuation Tagged With: ,

Thought Field Therapy

June 22, 2012 By

Nora Baladerian, Ph.D., LMFT

You may have heard of Thought Field Therapy or its derivative EFT. But how do these Energy Psychology or Energy‐based therapies work in the real life of a licensed therapist?
I have been a practitioner and teacher of Thought Field Therapy since 2000. I have found its usefulness to be essential
as I work with clients. My primary focus is on survivors of sexual assault or other traumas, anxiety and depression. TFT allows clients to actually feel better within the session.

TFT uses a combination of psychotherapy and energy meridian stimulation (tapping) on the meridian points used in acupuncture and
acupressure. While in the past acupressure was used ony for physical maladies, it has been discovered that TFT merdian point stimulation releases negative emotions such as trauma, sadness, grief, anger and rage among others. The theory and foundations of TFT are complex, but the actual application appears quite simple. Of course one needs to understand the foundations, but for the patient, application is relatively easy.

Dr. Roger Callahan is the psychologist who discovered TFT. He says any theory must be in line with reality. Thus the patient must experience the desired effect if the theory is correct. After administration of the therapy, the patient must feel that the prior feeling is no longer present. After using this therapeutic technique, I invite my patients to try to recover the feeling they had prior to TFT. They cannot. Why? The energy of that feeling has been released from the body.

Patients are asked to measure how intense their level of distress is on a scale of 1 to 10, 10 being worst. While focusing on the feeling of distress, the therapy is administered. At the end of the first administration of the appropriate algorithm, they are asked to re‐rate their level of distress. Treatment continues until the patient is at a 1. Often the patient sighs, yawns, or looks up with surprise saying they feel much better now, and asks how long it will last. At this question, the therapist knows that relief has been achieved. When the patient wants to know how long this improved feeling state will last, I explain that negative thought energies have been dissolved and cannot be retrieved. This is a mind‐ body energy therapy, and the negative emotions prior to the memory have been dissolved. The memory is intact.

Here are the six main reasons I use TFT: 1) it works; 2) it works fast; 3) the effects last; 4) there are no negative side effects; 5) the process does not cause pain or discomfort; 6) the patient leaves feeling much better than when they came in for therapy.
Anyone can learn TFT. I conduct training programs six times per year and offer ongoing peer consultation sessions to enhance and reinforce the skills of TFT practitioners.

For more information, please visit: www.healingwithtft.com

Dr. Nora J. Baladerian, Ph.D., LMFT, has maintained a private practice since 1979 in the West L.A. area. She specializes in treating trauma, depression, and anxiety as these effect individuals, couples and families, including those who are monolingual (Spanish) and individuals with developmental disabilities. She is the Director of the Disability and Abuse Project. You may contact her at: nora.baladerian@verizon.net or 310.473.6768

Filed Under: EFT

The Impact of Mindfulness and Group Process on Eating Disorder Recovery

June 22, 2012 By

Pam Siegel MPH, MFT and Lea Roussos, MS, MFT.

Mindfulness has been around for centuries but is finding a new level of credibility, particularly in the treatment of eating disorders.  We have found success in applying mindfulness practice in a group setting for eating disordered clients.  This article provides a brief introduction to mindfulness, an explanation of both formal and informal mindfulness practice, a discussion of the application of such practice in group sessions, and insight into the success of such sessions of individuals with eating disorders.

An Introduction to Mindfulness

While the concept of mindfulness is rather simple, its benefits are powerful and far-reaching.   Mindfulness has been used in both monastic and secular settings for over 2,500 years. The term “mindfulness” is an English translation of the Pali word “sati.” Pali was the original language used in Buddhism centuries ago.   Mindfulness is the core teaching of this tradition; “sati” connotes awareness, attention, and remembering. Mindfulness is paying attention to what is happening in the present moment. (Germer, Siegel, and Fulton, 2005)

When used in a therapeutic setting, the definition of mindfulness includes the aspect of being non-judgmental. Jon Kabat-Zinn, a renowned meditation teacher and researcher, defines mindfulness as “the awareness that emerges through the paying attention on purpose, in the present moment, and non-judgmentally to the unfolding of experience moment to moment.”(Kabat-Zinn, 1990)  Basically, mindfulness is a particular way of looking deeply inside to promote understanding and healing with an acceptance of “what is.” As Carl Rogers observed years ago,  “the curious paradox is that when I accept myself just as I am, then I can change.”(Schwartz, 2011)

In recent years, mindfulness has proliferated into the field of psychotherapy and is gaining popularity in areas such as education and business. Studies on the neurobiology of the brain show that by practicing “mindfulness” we actually change our behaviors right down to the synaptic level, enabling us to be aware of our mental processes without getting swept up in them.  When we go inside and are “mindful” of our feelings we can reduce their intensity—“to name them we tame them.” Dan Siegel, one of the foremost innovators in the field of brain science, has spent 25 years of clinical work in this field.  He concludes that by focusing our attention inward to the workings of our mind, we can “get off the autopilot of ingrained behaviors and habitual responses and move beyond them.”  (Siegel, 2010) His work and those of other researchers have given a new level of credibility to the practice of mindfulness meditation that is now used to treat a variety of disorders including eating disorders, depression, anxiety, and attention deficient disorder (ADD).

Mindfulness in Practice

Mindfulness can be learned.  There are two types of mindfulness training: formal and informal practice.  Formal mindfulness practice involves setting aside a specific amount of time, usually thirty minutes or longer, to consciously “go inside” and be aware of what is sensed or felt in the mind and/or body, using the breath as an anchor.   This practice can include a sitting/walking meditation, body scan (systematic inward scan of body parts), or yoga session.   Informal mindfulness practice involves finding brief moments in everyday life to pay attention to events and surroundings in the present.   Instead of multi-tasking and spending extended periods on automatic pilot, a person practicing informal mindfulness would focus on paying attention to one thing at one time.  For example, while walking outside or listening to music, one would intentionally focus on that activity without distraction.

Practicing mindfulness, both formally and informally, can be especially helpful for individuals with eating disorders.  Mindfulness provides a way to cope with the obsessions, shame, and anxiety that accompany individuals with eating disorders, many of whom have a difficult time feeling and/or managing their feelings. Food and body preoccupation can distract from accessing true emotions.  Mindfulness helps create a tolerance and comfort for those feelings.  In 1993 Marsha Linehan developed a “dialectical behavioral training” (DBT) program, of which mindfulness is an integral part, to help borderline personality clients who have difficulty regulating their emotions, similar to clients with eating disorders.  She found mindfulness practice to “increase self-awareness, increase self acceptance, reduce reactivity to thoughts and emotions, improve ability to make adaptive choices, and improve capability to respond to aversive experience.” (Linehan, 1993) National Institute of Health funded studies by Jean Kristeller show how mindfulness meditation helps individuals with Binge Eating Disorder (BED) reduce binges and improve self -esteem and body image. (Kristellar, 2003 and 2006) Informal and formal mindfulness practice also helps individuals with eating disorders slow down and look inside to see what really feeds their “hunger.”

The Benefits of Group Process

The benefits of group process for eating disordered clients is well supported.(Costin,1996, 2007)   According to Irving Yalom, a group can offer “hope, universality, altruism, group cohesion, and interpersonal learning.” (Yalom, 1995) Eating disordered clients often display certain characteristics that make them particularly well suited for group treatment such as feelings of interpersonal distrust, low self-esteem, ineffectiveness, social isolation, and distorted thinking.  These “symptoms” are challenged by the interpersonal nature of group process and are vital in helping eating disorder clients in their recovery.

A therapist can provide support both directly and indirectly within a group setting.  Direct support is given by personal engagement, empathic listening, and understanding while indirect support is provided by building a cohesive group in a safe environment.  However, it is the interpersonal interactions within groups that are the most powerful agents of change. (Yalom, 1995)

Our Group Experiences

As group facilitators/therapists, we created a “mindfulness” group for clients with eating disorders for personal and professional reasons. We have experience with in-patient and outpatient eating disorder treatment centers and have seen first hand the strong benefit of groups in these environments.  Also, we have both undergone extensive mindfulness training ourselves (taught by Jerome Front) and practice regularly through yoga and other types of mindfulness meditations. We have seen how informal and formal mindfulness practice has changed our own lives, as well as the lives of our clients. We both have seen a difference is our ability to “”hold” feelings as they ebb and flow in our personal and professional lives.  We are more likely to “respond rather than react” to our family members and generally feel more calm and centered.  Mindfulness meditation has certainly affected our ability to be present with our clients and friends and to be more comfortable with silence in sessions. Having our own mindfulness practices enables us to be more authentic with the group as we teach and share our own experiences.

This then is the genesis and reason why we wrote this article; not as a scientific study, but rather as an overview of our experience using mindfulness practices in a group setting for clients with eating disorders. We noticed positive changes with the members who regularly attended our group sessions and practiced the mindfulness skills.  Our experience is consistent with the literature on the effects of mindfulness. (Germer, Siegel, and Fulton, 2005, Katat-Zinn, 199O) Specifically, many group members changed their food behaviors (reduced bingeing/purging with Bulimia or BED and increased food intake with Anorexia) and improved their self-esteem, body image, and social relationships. They also were able to handle their emotions without going to their habitual reactive behaviors. The following stories of four group members exemplify the success of this process. Lisa has been struggling with Binge Eating Disorder (BED).  After eight months in the group she is now feeling good enough about herself and her recovery to start graduate school in psychology; Jessica, a writer who has been struggling with Anorexia, is now at a new job and doing well.  She has stopped isolating and is even in a new intimate relationship; Marissa, a teacher, is now leading a student trip to South America, something she never dreamed she could do because of her severe bulimia.  She says she is now “present” in her life rather than being caught up in thinking about ED; and Marni was able to go on a vacation with her husband and feel comfortable in her bathing suit.   While she and most of the members still struggle with their body image (it is the hardest part of recovery and the usually the last area to get better) at least she was able to get into a bathing suit and have moments of fun.

Our eating disorder group has met consistently for over two years, emphasizing mindfulness both through meditation and psycho-education. The group, led by both of us, meets once a week for 90 minutes. The participation of two therapists is both a luxury and a necessity.  We complement and support each other, adding greatly to the therapeutic power of the group. We work in different but complementary ways to enhance group cohesion and openness.  For example, Pam being an ex-teacher, at times uses a more instructional approach (using biblio- therapy or psycho-education) while Lea may help the members go inward and be more mindful of their feeling states.

A typical group session begins with the introduction or review of a mindfulness skill to help clients enhance their mindfulness work. Usually one therapist presents the skill, but we recently encouraged a few group members to teach the others.  This process has proven to be an excellent way for group members to learn from each other, which can be more effective than learning from the therapist. When a member sees how another uses a tool successfully, she often copies the behavior. A group member was having a particularly difficult time handling the ups and downs of her emotions and began using journaling extensively as a way to center herself and become more “mindful” of her inner world. Writing increased her ability to identify, feel, and tolerate her moment- to- moment experience.  Journaling became a ‘meditation’ for her as it calmed her and helped her understand herself. She enthusiastically shared her experiences with the other members and little by little, almost all of the group members began to use this tool.

We use a variety of different mindful skills in our group sessions including some techniques from Marsha Linehan’s Dialectical Behavioral Therapy workbook such as “wise mind’ or “riding the wave.” (Linenhan, 1993 and Moonshine, 2008)

Each week, we review the skill learned the previous week and then present a new one. The next 20 minutes is a group meditation that is led by the therapists or by playing a meditation CD (such as one from Jon Kabat Zinn, Jerome Front, or Diana Winston). Most often the group will do a sitting meditation, but occasionally we do body scan meditations as well.

After the meditation, we take a few minutes for members to process their immediate reactions to the meditation, including what they notice during this process.  For example, we often hear that a member feels like she has “monkey mind,” a mind jumping all over and not able to settle and concentrate on the breathing.  We reassure them that this is normal and that even long time meditators have this occur at times.  We stress the importance of gently bringing their attention back to their breath without judgment.

In the last part of the session, the group members discuss their week with their eating disorder (ED) and what skills, if any, they were able to access to help them deal with their issues.  Other members are invited to offer feedback (without giving advice) based on their own experience.  One example of this occurred recently when one member, Jan, spoke about her difficulty finding her voice in dealing with her parent’s negative comments and lack of boundaries.  Another member, Marni, had similar issues and was able to relate how she handled her own parents. “Before coming to this group, I had no way to handle my emotions and I did not have a voice.  I would let my parents say terrible things to me and then act out with ED to calm myself.  This group has taught me to be mindful and “ride the wave” of my emotions, knowing that they will ebb and flow without having to go to ED behaviors.” This interaction was beneficial for all members to hear.

The cohesion of this group has been quite strong and we see how effective it has been in preventing group members from relapsing (going back into their eating disorder behaviors such as restricting or binging/purging) Group members text each other during the week and, at times, meet for meals for additional support.  We continuously encourage the members to reach out to each other whenever they feel urges to act out their eating disorder behaviors.  Isolation is a key problem with eating disordered clients, and the group forces them to become more social.  One member has been struggling with being alone with ED and slowly we are seeing her begin to participate more. Recently she expressed that she was going to a yoga class with another member in the group.  This was a huge step for her.

Group members must meet specific guidelines to qualify for the group.  First, they must be in individual therapy, as the group is not a substitute for individual treatment.  Group work can bring up a variety of difficult issues, particularly with a mixed group of eating disordered clients (both anorexic and bulimic clients in the group) and it is imperative that the members have a safe place to process such issues with their therapist individually.  Often clients are triggered by what they see or hear from the other clients.  For example, when members see others relapsing it can cause anxiety and/or hopelessness in other group members. Other clients may be “triggered” by the size of the other group members, whether they are smaller or larger than themselves.  Again, they need to talk about these issues with their individual therapist.

Second, the members must commit to maintaining an environment that feels safe for group members to be open and share their struggles. Group confidentiality and non-judgmental feedback to other group members is emphasized on a regular basis.  Third, group members must also commit to attend the group sessions consistently. Finally, they must be able to pay a nominal fee for the sessions. We initially screen each member carefully to discern if they meet these qualifications and continue to do so as time goes on.

Our mindfulness support group has been an amazing journey for us, both personally and professionally. The impact of mindfulness and the power of the group have been dramatic and this entire experience has provided enormous gratification for us personally. There have been times of crisis when members have cried or relapsed, and other times when we have shared laughter and joy. We have learned from the group members as much as we hope they have learned from us.  As our own mindfulness has grown through meditation practice and professional training, we have seen ourselves become more empathic, patient, and non-judgmental. These changes have clearly impacted the group members. We are challenged at each session, constantly trying new skills and evaluating the outcomes but feel committed to continue using mindfulness as our primary tool to treat eating disorders.

One member, who has been in the group since its beginning and who is training to become a therapist, is now ready to leave.  Her parting words sum up the impact this mindfulness group has had on her recovery.  “Learning about and practicing mindfulness has changed my life.  I am now behavior free for 18 months.  I feel confident in my ability to use the tools to remain free from ED; I now feel empowered and strong enough to handle my emotions in a more positive way. The group has been an amazing source of support and encouragement.  I am so grateful for this amazing experience and I want to now pass this on to my own clients.”

Pam Siegel MPH, MFT. 310.475.3461
www.Pamsiegel.com

Lea Roussos, MS, MFT. 800.844.4545 1460 7th St., Ste. 206 Santa Monica, 90401 www.Learoussos.com

 

References

Costin, C. (1996) The Eating Disorder Sourcebook.  Los Angeles: Lowell House

Costin, C. (2007) 100 Questions and Answers about Eating Disorders. Canada:

Jones and Bartlett Publishers, Inc.

Germer, C., Siegel, R., and Fulton, P. (2005) Mindfulness and Psychotherapy.  New      York: Guilford Press.

Kabat-Zinn, J. (1990) Full Catastrophe Living.  New York: Bantam Dell

Kristellar, J. (2003) Mindfulness, Wisdom, and Eating: Applying a Multi-Domain                   Model of Meditation Effects.  Journal of Constructivism in Human Sciences                  Vol 8 (2) 107-118

Linenhan, M.  Skills Training Manual for Treating Personality Disorder.  New York:                   Guilford Press

Siegel, D. (2010) Mindsight-The New Science of Personal Transformation.  New            York: Random House

Siegel, D.  (2010) The Mindful Therapist. New York:  W.W. Norton and Co., Inc.

Schwartz, R.  (2011) When Meditation Isn’t Enough.  The Psychotherapy Networker.              September-October 2011 35-38

Yalom, I. (1995) The Theory and Practice of Group Psychotherapy. New York: BasicBooks.

Filed Under: Mindfulness

Beyond the Couch – An Introduction to Equine Assisted Psychotherapy

June 22, 2012 By

Vallerie E. Coleman, Ph.D.

Over the last couple years, interventions using horses have gained popularity due to media exposure and films such as Buck and Horse Boy.  However, as I share about the work I do, I find that most people are very confused about the different forms of Equine Therapy and many have never been exposed to Equine Assisted Psychotherapy.

Often people hear the term Equine Therapy and assume this is the same thing as Equine Assisted Psychotherapy (EAP).  Typically, Equine Therapy refers to Therapeutic Riding, an intervention for differently-abled individuals designed to help them relax, develop muscle tone, coordination, confidence, and well-being.  In contrast, EAP, is a cutting-edge experiential, psychotherapeutic modality that can stand alone as a form of treatment or serve as a powerful adjunct to traditional psychotherapy.  It is not about riding or horsemanship. EAP typically takes place on the ground and is comparable to being in a live sand tray – where the interactions with horses provide clients with experiences and exercises that move them out of their comfort zone and into new ways of being and relating.  The EAP process uses experience, projection, and metaphor to help clients create change by integrating cognitive, emotional, and somatosensory processing.

EAP has proven to be a successful intervention with a wide variety of

diagnoses and populations.  It initially gained recognition due to its success with clients who were unlikely to seek out therapy or had difficulty benefiting from traditional methods – such as substance abusers, at-risk youth, veterans, violent offenders, and children with autistic-spectrum disorders.  In recent years, it has been found to be an effective treatment for issues such as:

  • PTSD and Trauma recovery
  • Depression and anxiety
  • Couple and family conflict
  • Conduct and oppositional–defiant disorders
  • ADD and ADHD
  • Eating disorders
  • Anger management
  • Fears and phobias

Because “past experience is embodied in present physiological states and action tendencies” (Van der Kolk, 2006, p. xxiv) engaging with the horses offers immediate insight into how clients relate in the world as well as opportunities to shift those states and behavioral tendencies.  I often have clients referred to me by their therapists with the goal of using adjunctive EAP to help their clients decrease intellectualization, improve affect-regulation, reduce trauma symptoms, and gain insight into how their behaviors are often incongruent with what they say and know.

The work clients do in the arena is then taken back to be further processed with their therapist.  In addition, it can be very powerful for therapists to come out and observe their clients EAP session(s).  This offers clinicians direct information about the process and their client’s experience.

Why Horses?

Unlike humans, horses are prey animals.  As such, they have highly developed senses – smell, hearing, body-awareness, and vigilance – that keep them safe and in-tune with their environment.  This animal wisdom and their centuries-old connection with humans enable them to be powerful messengers that reflect back their experience of us.  Horses are completely congruent, authentic, and unbiased and they provide clear, direct, non-judgmental feedback about what they experience.  As a result, clients are challenged to be present in the moment and congruent in thought, affect and action.  This offers them opportunities to work on goals and dynamics in real time.  Areas that are commonly addressed include boundaries, assertiveness, trust, powerlessness, and frustration tolerance.

What does a session look like?

At Stand InBalance, EAP is either provided by a mental health professional (MH) who is also an equine specialist (ES) or it may be co-led by an MH and ES.  The professional(s) track clients’ affect and behaviors as well as their interaction with and feedback from the horses.  This information is then used to form verbal and non-verbal interventions.  The activities of a session may range from connecting, bonding and moving a horse with a halter and lead rope to building metaphorical challenges out of materials and having clients use personal power and intention to direct these large animals without a lead rope or physical touch.

Whether clients are engaged in individual or group activities, interacting with horses provides them with a powerful opportunity to work on intra-psychic and interpersonal dynamics – leading to shifts that can help them develop a healthier sense of self and healthier interpersonal relationships.

 

More information and references

Equine Assisted Growth and Learning Association – www.EAGALA.org

van der Kolk, B. A. (2006). Foreword. In P. Ogden, K. Minton, & C. Pain (Eds.), Trauma and the body (pp. xvii – xxvi). New York: W.W. Norton & Company.

 

Vallerie E. Coleman, Ph.D. is a clinical psychologist and psychoanalyst with offices in Westlake Village and Santa Monica.  She is the founder and clinical director of Stand InBalance – Equine Assisted Growth and Learning located in Westlake Village, CA.  Dr. Coleman specializes in helping individuals and couples improve their lives and relationships through psychoanalytic psychotherapy and Equine Assisted Psychotherapy.  She is certified by the Equine Assisted Growth and Learning Association and her work is based in a combination of object relations theory, attachment theory, and somatic psychotherapy.  Dr. Coleman is passionate about horses and their ability to help humans embody their authentic selves.  To learn more about Stand InBalance visit www.standinbalance.com or contact Dr. Coleman at DrVal@StandinBalance.com or (310) 450-8136.

Filed Under: Equine Therapy

Challenges in Early Addiction Recovery

June 22, 2012 By

By Jeff Brosnan, MA, LMFT (MFCC#49984)

A Client once said to me: “My addiction to Crystal Meth is my own best friend. I know what I will get from getting high. Crystal Meth is not like some people I know who let me down time and time again.” Wow. I sat there and thought to myself, how am I going to respond to that?

Wouldn’t it be great to hand someone a pamphlet or a book and give them instructions to just follow what is written and they will remain clean and sober the rest of their lives. How about a pill that will remove all cravings for any and all addictions, and the pill would be very inexpensive? I could have recommended Crystal Meth Anonymous (CMA) meetings. I could have recommended an inpatient or outpatient program. An MD or Clinic for a full work up. A Psychiatrist for a consultation.

I remember studying for the BBS Licensing Exams and it being drilled into my head to refer out to adjunct services, especially if the issues raised in therapy were out of our scope of practice or scope of competence. That all makes sense. Let’s get back to our Client and see what we can do right now.

1) Mandated Reporting

First things first. Check for Suicidal Ideation, Homicidal Ideation,  Elder Abuse, Child Abuse and Dependent Adult Abuse. Things to check: Who they live with? Ages? Are any of those who live with them addicts, too? Is anyone besides the Client in harms way? Report if necessary.

2) Are they Clean and Sober Right Now?

If they are Clean And Sober right now, in the therapy room, great. If not, you have a choice to make whether or not to continue the session. At this point, if not already discussed when reviewing Informed Consent documentation and conversation, you have the opportunity to iterate or re-iterate your sobriety rule: It could be along the lines of being clean and sober at least 24 hours prior to and post therapy session and the reasons why.

If the Client is not clean and sober in the therapy room and whether or not you choose to terminate the session it is of the utmost importance to know how they got to therapy–public or private transportation. If they drove to therapy you may want to recommend they call someone to drive them home, or, if no one is available, offer them a telephone number of a local taxicab company and observe them calling for a taxicab.

Your Session Progress Notes need to indicate the steps you took regarding keeping the Client safe.

3) The Client is Currently Clean and Sober

The Client showed up. The Client is currently Clean and Sober. The Client indicates they want help with their addiction. Now what? There may not be a lot of time left in the initial session to fully explore the issues surrounding addiction. This may be a good time to ask the Client about the times they have been successful in remaining Clean and Sober and for how long?

4) Construct Two Timelines

Take out a fresh unlined piece of paper and draw a timeline of times in the Client’s life he or she has remained Clean and Sober. Serve up positive regard for any periods of sobriety. Take out a second piece of unlined paper and draw a timeline of 48 to 72 hours prior to the Client’s most recent usage and ask them what happened in that time period that may have begun the series of triggers to usage. (Please keep in mind that the most recent trigger which caused the purchase of drug or alcohol was only the last straw in a series of events).

Hand both Timelines to the Client and give them homework (yes!). Their assignments prior to the next scheduled therapy session are to create timelines of previous sobriety and a timeline if they use between sessions and what were the triggers and when did they begin.

5) Then talk with the Client about  to their experiences with 12 Step Programs (if any). If there is a resistance to attending, recommend they attend at least one 12 Step Meeting between sessions and report back in the next session their experience so you can better understand what happened and why they feel the way they do. If there continues to be resistance to 12 Step Programs, ask if there are any sober friends they can call and talk with between sessions. (Of course both 12 Step and sober friends would be excellent at this stage of therapy).

6) Prior to the end of the session, dialog about your inbetween sessions contact process and how to schedule additional sessions if necessary. Should you choose to at the end of the session, serve up hope and support as a true partner in their longer-term recovery.

Although there are no hard and fast rules and one size of therapy does not fit all in early recovery, it is incumbent upon us to ensure we follow all the rules and regulations that the BBS expects we follow to the letter.

In my work with those in early recovery they tend to achieve long-term sobriety only when they are ready to and not one minute sooner. There are those who constantly slip and those few who achieve sobriety on the first time they choose to. Our role is to offer a handrail for them to hold onto as they work through the myriad of issues that have led to longer term usage.

There is hope. It is something I truly believe in.

Jeff Brosnan is a Licensed MFT who works with those in early recovery. Jeff has co-created and run Intensive Outpatient Programs both in Los Angeles and Palm Springs, worked in the Psychiatric Ward of Glendale Memorial Hospital with those who are in-patient status and facilitated Groups with Gay Men at The LA Gay and Lesbian Center. Jeff is in private practice in Los Angeles.

Filed Under: Addiction