Thursday, July 5, 2018

THERAPEUTIC PRESENCE

Did your training as a psychotherapist or counsellor emphasize the importance of being a caring therapeutic presence? Did your training discuss how to cultivate and enhance your therapeutic presence? My training certainly did not. If course theories and techniques of psychotherapy are also important. However, over 40 years of experience in private practice have taught me that cultivating and being a caring therapeutic presence is essential. Without that our theories and techniques are much less effective. It is important for us to remember that the literature on effective psychotherapy consistently has reported that when clients are asked, "What was most helpful to you?" their response is some version of: "My therapist genuinely cared about me as a person"; "My therapist was really there for me,not just using techniques."
It is not easy to find adequate words to describe therapeutic presence. A vital aspect of it is our intention to have our whole self engaged in the session as much as possible on that day with that person. It means physically being there not exhausted or distracted by other objects in the room. It means cognitively discerning what therapeutic perspective and technique will be most responsive to the needs of this person today. It means being emotionally engaged with an open heart trying to sustain an empathic compassionate connection. It means being spiritually open trying to access guidance and wisdom from our own personal Higher Self and whatever other sources of assistance that might be available.
To be that kind of caring presence for many hours each day with a wide range of clients over many years is a profound challenge. Perfection is not possible. However, there is lots of good news for those of us who are trying to be that kind of presence. First of all, brain research has indicated that taking the time before each session to have the intention to do so activates the neocortex which then aligns other parts of the brain so that the probability of deep presence occurring is enhanced. Second, brain research has also validated my experience of over 40 years of doing this work. The more you cultivate therapeutic presence the more brain patterns develop and then get strengthened over time. So gradually the capacity to be that kind of presence becomes easier to access and then you also have a deeper reservoir to draw upon.
Cultivating and accessing a caring therapeutic presence is the work of a lifetime. There are several helpful pathways for each of us to explore. Because this is a brief blog I will just mention some of them and then describe one in more detail. For a thorough elucidation of this topic I would suggest reading, "Therapeutic Presence: A Mindful Approach to Effective Therapy" by Shari Geller and Leslie Greenberg(2012). That work inspired and informed this blog, broadened my understanding particularly of the brain research,and validated my years of experience.
Our own personal psychotherapy is an essential pathway that will help us become more conscious of our personal issues that might be triggered by our clients and are reducing our effectiveness. Also being attentive to our own self-care is vital so that we are not tired from or distracted by the responsibilities of the multiple roles of our lives. Because we are often not good at taking care of ourselves I have written elsewhere(see blog and book chapter on Recharging) on what are some of the psychological blocks that you may have to good self-care. In addition we need to work on developing more compassion - particularly self-compassion - so that we can be more open-heartedly compassionate towards our clients. We may also need to cultivate being a more compassionate presence in our everyday lives. An important question for each of us to explore is: "To what extent am I more present to my clients than I am to other people in my life?" I am not saying that we should be therapists with our family and friends. Rather I am saying there are probably many brief moments in each day when we could be a more compassionate human being. Why that is important is that the brain research indicates that the more that we cultivate presence throughout our lives the stronger those brain patterns become. We then have a deeper reservoir to draw upon during sessions.
I now want to share several practices that I have incorporated into my life that have helped me to develop and deepen a more caring therapeutic presence. Five minutes before I begin my morning or afternoon's work I sit in my therapist's chair and ask my Higher Self and other sources of guidance for help in fulfilling my intention for my clients to be a source of compassion, peacefulness and strength. I follow that with meditational breathing imagining with the out breath that I am letting go of whatever might be blocking me from being present that day. For a few minutes between clients I do the same. This is a practice I have been doing for many years. It is a way of acknowledging to myself that I am consciously moving from the ego realm of ordinary life into a different level of consciousness where my therapeutic self resides. It is fascinating for me recently to learn that brain research is now validating the importance of taking the time to set my attention which then calls into alignment other brain patterns.
In my meditational practice I have developed a relationship with certain nature places that have helped deepen my capacity to be present to my clients. This was certainly not my original intention in developing that aspect of my spiritual practice. However, it has evolved in such a way that is helpful to my work. Often I sit in meditation with my back up against an old ash tree with its thick roots exposed above the ground. For me the tree symbolically represents strength, stability, rootedness. That individual tree has become a living connection to the archetypal "Tree of Life". I also have a poster of a giant redwood in my office. When I look at the poster it reminds me of my local ash tree - and my actual experience of having meditated inside a redwood tree - and connects me at that moment to my intention to be a reliable source of rooted strength for my clients.
I also sit near a local pond and meditate. For me that pond symbolically represents stillness, peacefulness, equanimity. When I sit there I am trying to cultivate those qualities in my own consciousness not only for myself,but also so that I can project - perhaps even transmit - the energy of those feeling states for the people in my life. I have a painting of a pond in my office. When I look at it before I begin my work and during sessions it connects me to my intention to be a source of peacefulness.
I am extraordinarily blessed to have a small brook that is thirty feet behind our home and flows through our property. When I stand or sit by it I ask the brook to help me more connect to the flow of life. There is so much to learn about what the Taoists refer to as "the watercourse way" that is relevant for the human journey. Increasingly, witnessing the ways of the brook have helped me to be more in the flow of a session with each particular client on that day. To be able to let go of my need to control, influence or even know what's going on in a session and simply trust the process. What a challenge for my ego! Yet the brook is a good teacher. Having spent so many hours in the presence of that old tree, the pond and the brook have helped me to cultivate those qualities of a rooted strength, peacefulness and trust in the flow of life. I am then able to offer the presence of those qualities to my clients.

Several parts of this blog have been inspired or influenced by my recent reading of: Therapeutic Presence: A Mindful Approach to Effective Therapy by Shari Geller and Leslie Greenberg.

Wednesday, January 24, 2018

EVOLVING AS A PSYCHOTHERAPIST

As I reflect upon my over 40 years as a psychotherapist I can now see there were stages in my evolution. I have also witnessed similar patterns in the therapists I have supervised and in colleagues that I've known for many years.The evolution has not been completely linear. There were certainly moments of creativity during my imitation period and there continue to be moments of imitation during the this later more authentic epoch.
IMITATION AND IMMERSION
In my earliest years as a psychotherapist I usually simply imitated what my therapist had done with me.At times it was pure mimicry - using the same words, gestures and tone of voice. My first therapist was a psychoanalyst. When I realized that I needed more training and supervision I went for four years of point-doctoral study to the same institute where he had trained. For those four years I read extensively and almost exclusively the writings of Freud, his followers and the neo-Freudians of the next generations of psychoanalysts. I immersed myself in that tradition.
If Freud witnessed how I worked now he would probably turn over in his grave or more likely excommunicate me for betraying him, the psychoanalytic tradition and my teachers. Yet I strongly feel that period of imitation and immersion was essential for the foundation of my lifework as a psychotherapist. I also acknowledge that I still use some of those concepts and techniques - they are now expressed through the unique synthesis that is my more authentic self.
Imitating our therapist or supervisor or favorite author was not a negative, it was necessary. We read extensively or entered a training program and assimilated ideas and techniques within a particular theoretical framework that we were initially drawn to or exposed to. It was important to immerse ourselves so that a solid foundation got built through practicing certain techniques and internalizing ideas within that paradigm.
Perhaps it might be fitting to describe that initial stage as an apprenticeship.
During this early period of our development some of our initial expressions of creativity and movement toward a more authentic self often show up as acts of rebellion or subversion. My second therapist was the head of this analytic institute. In therapy with him I refused to lie on the couch. In the atmosphere of that psychoanalytic institute that was a very rebellious act - an early signal that I was going to follow my own path.
With some of my early patients who were adult children of alcoholics I went against what was then a cardinal rule of psychoanalysis - to remain neutral and not disclose yourself. I revealed that my father too was an alcoholic. My patients deeply appreciated that empathic linkage. I took a further step and submitted an article describing my unorthodox ways of working with that population of patients. Somewhat to my surprise it was accepted by a respected psychoanalytic journal.
MASTERING THE CRAFT
As we practice the techniques that we have assimilated we learn: what works for some clients and not others; what ideas explain issues that our clients are struggling with and what does not; what ways of working are a good fit for our personality and what feels inauthentic.
In order to further evolve in the craft of psychotherapist it then becomes essential to intentionally expose ourselves to other theoretical perspectives and to expand our repertoire of techniques and strategies. This stretches us in that we are not rigidly adhering to a particular framework and broadens what we can offer our clients. As we explore and incorporate these other pathways what occurs - often unconsciously - is an internal reorganization of theoretical perspectives and a synthesis into a new therapeutic self. I explored Jungian,humanistic, cognitive-behavioral, psychosynthesis and many other perspectives. Increasingly we then find it hard to answer the frequently asked question,"Are you a Jungian, cognitive-behaviorist, Freudian...? What would you call yourself?"
BECOMING MORE AUTHENTIC
Many therapists over a number of years are able to develop a high level of mastery of the craft of psychotherapist. They expand what they can offer their clients by synthesizing the ideas and techniques of these other approaches. Yet they tend to stay within the boundaries of the known and familiar rarely breaking out to try something radically new, something that is their own unique insight or technique.
From my perspective it is important in the later stage of our evolution as a psychotherapists to consistently take more risks - to say or do more things with our clients that are authentically our own, that we have not consciously heard or read about others doing. To be more creative. This is not to say that we haven't been creative before or that these ideas are not influenced by others.
Sometimes these creative movements emerge from a personal life experience. For example, my ideas and strategies for helping my patients with self-forgiveness evolved from an identity crisis precipitated by my initiating a divorce. Nothing in my professional experience provided a clue how to forgive myself for the overwhelming guilt I felt for causing so much pain to people that I loved. I then developed ways of helping my patients to forgive themselves that were inspired by my personal journey.
Another, the technique of The Council, emerged from a weekend retreat in an isolated cabin that I took when I was turning 60. I had decided to imagine that the different parts of my personality were on this retreat and were addressing the question,"What is happening in my inner life as I enter my 60's?" I took a yellow legal pad - the same kind that I am writing on now to compose this blog - and unexpectedly I wrote pages and pages of thoughts and feelings. That led to the concept of The Council - a very effective tool that I now utilize when patients are facing a major life decision or entering a transitional moment in their lives.
Two medical crises, one was a very aggressive cancer in my mid-60's and the other seven months ago shortly after my 75th birthday, wherein I almost died liberated me to be more self-disclosing in unexpected ways. My patients dealing with their own medical crises or issues of aging and dying have been profoundly grateful for these moments of empathic connecting.
At other times these creative moments just spontaneously arise during a session where we suddenly find ourselves saying something to or doing something with a client that we've never thought of or done before. And its on the mark! It's exactly right for that person and that moment. Afterwards we find ourselves wondering,"What just happened? Where did that come from?" It is our creative and courageous - going beyond the boundaries of what is familiar and known - response to that moment.
These moments off letting go and being receptive to "something" flowing through me have increased since about ten years ago I started to more actively cultivate my relationship with my own personal Higher Self.In addition to my conscious efforts to engage my Higher Self during my contemplative walks in nature I started a practice of meditational preparation before starting work. Before I begin seeing my first patient I spend at least five minutes in meditational breathing and asking my Higher Self, "Please help me to be a vehicle of compassion and heart wisdom." Also, "Help me to connect to other sources of wisdom and healing beyond myself. Help me to be open to the assistance of the Higher Self of my patients." During sessions, particularly at moments when I feel uncertain what to say or confused by what is happening or overwhelmed by the amount of emotion that my patient is expressing, I ask my Higher Self for help. These "prayers" have helped to create a receptive space in my ordinary consciousness so that these creative moments of inspiration from multiple sources of consciousness can occur. At these times I feel more fully alive and authentically present to the moment.

Many of the ideas expressed in this blog have been influenced and inspired by writings about creativity in Oliver Sacks recent posthumous book,"The River Of Consciousness."

Thursday, October 19, 2017

RESTORING OURSELVES

My wife Jeanne and I recently returned from a much-needed eight day vacation in the town of Wellfleet on Cape Cod in Massachusetts. That section of Cap Cod is only three miles wide. On one side is the Atlantic Ocean and on the other is the bay. Every day we walked on the beaches at the water's edge. We focused on what it felt like to walk in the moist sand, to hear the comings and goings of the waves, to feel on our bodies the warmth of the sun and the coolness of the onshore breeze, to smell the salt air. We sat on the sand and did our meditation taking it all in physically, psychologically and spiritually.
It was so restorative. The cumulative tiredness and depletion of the effects of my recent medical crisis and the many months of our work as psychotherapists gradually ebbed away. We felt nourished by this immersion in the natural world, our dormant and depleted life energy was being replenished. It was a reminder to both of us that whenever we have experienced a physical/psychological/spiritual crisis spending concentrated time in nature has been the most reliable source of reconnecting to the life force both within and outside of us.
Who knows why spending that kind of time by the ocean is so restorative. Certainly there is something primordial about being at the ocean's edge. Is there some resonance with our reptilian brain that reminds us of the origins of our species? Is there some connecting with the primal memories of being in the nourishing waters of the womb? Is there something about the intake of negative ions that affects us at a cellular level? Is the unending ebb and flow of the tidal waters connecting our spirits with some feelings about eternal life? Maybe all of the above.
As psychotherapists and counsellors it is essential for all of us to have ways of restoring ourselves. We all spend many hours each week in the energy field of the suffering and struggles of our clients. Each of our clients needs us to be an open-hearted compassionate presence. After work when we return home our partners and children also need us to be emotionally available. How do we sustain that level of presence and not become exhausted, overwhelmed, emotionally distant, resentful and numb?
In order to sustain that level of empathic connection which is necessary for our most optimal work each of us needs to find our ways of restoring ourselves that uniquely fit us. From over 40 years of experience in private practice I have learned that a primary pathway is to regularly spend solitary time in some local nature setting. Whenever I sit, stand or walk alongside the brook that is behind my home or the water flowing at the bottom of the small gorge several miles away or at a local pond I feel reenergized. My psychological and spiritual batteries are being recharged. Standing or sitting by the water, acknowledging this felt sense of the presence of life giving energy, I take some meditational breaths. With the inhale I say "Water of life" and with the exhale breath I release the feelings of depletion.
When I am in the office in the psychological energy field of my patient's strong feelings, that sometimes can be overwhelming, I look at the painting of a pond that I placed on the wall behind my patient. Using that image to tap into the memory of the feeling state of being by the water I quietly do a few meditational breaths. With the inhale breath I imagine myself accessing the felt sense of being by the water and with exhale breath releasing the feelings of anxiety about being overwhelmed by the power of my patient's feelings. Gradually I begin to feel that some larger source of life is sustaining me at that moment. I am again able to be fully present with an open heart.

For more about this topic I encourage you to read another blog entitled "A Walk In the Woods" and the youtube video called "Recharging" www.youtube.com/WilliamPRyanPhd

Thursday, July 13, 2017

I ALMOST DIED

Two months ago, while home alone, suddenly without warning my body was wracked with chills. Then for the next four hours I had alternating bouts of vomiting and diarrhea. When my wife Jeanne arrived home she found me in this depleted state and called my physician who fortunately picked up the call and said go to the emergency room. In the ambulance my body temperature was 105 and my blood pressure was plummeting to dangerously low levels. The emergency room team treated me aggressively with antibiotics, intravenous fluids and norenephrenine to regulate my blood pressure. I was in the intensive care unit for five days with a diagnosis of streptococcal pneumonia and severe septic shock made worse by the fact I have no spleen because it was removed twelve years ago as a result of very aggressive lymphoma. On the third day of my stay in intensive care, as my body was recovering unexpectedly quickly, the RN revealed that when I arrived I was the sickest person on the unit. At that moment I became increasingly aware that if everyone(Jeanne, my physician, the ER team) had not acted in such a timely way I would have died.
PLEASE CARRY ME
In the ambulance en route to the hospital, in the emergency room and throughout my five day stay in the intensive care unit I frequently asked my Higher Self, "Please carry me." And it did. My dear wife Jeanne, who was fully with me throughout this major medical crisis - including sleeping on a couch in my room every night - said it was amazing to witness that my consciousness was present during the whole experience. My primary care physician, who is a dear friend, visited me at home two days after I returned from the hospital and asked,"Were you freaking out at times?" I was perplexed by her very understandable question. After a while I realized that at no time in this ordeal did I feel fearful or anxious. WOW!
My Higher Self carried me through what one of the RN's described as "the most massive stress test that your body could ever experience." That transcendent part of my consciousness helped me to be fully present so the I could: collaborate with the medical staff, be unafraid so that fear did not interfere with my treatments and recovery, and most importantly to feel deeply that I was going to be "OK."
This is profound for me. It has deepened my faith that no matter what happens in my life, including my dying, my Higher Self will be present as my companion,as a source of strength and equanimity to carry me through. WOW!!! For many years I have cultivated a personal relationship with my Higher Self - whom I call Wiseheart. This medical crisis bore to me the fruits of that ongoing work. With my psychotherapy patients I encourage them also to develop that ongoing relationship and teach them how to access their Higher Self in everyday life. This experience has affirmed the importance of that work. I encourage you too to cultivate an ongoing relationship to your personal Higher Self.
I AM ALIVE
There are no adequate words to describe the level of gratefulness that I feel to my body, to the medical staff at Cooley Dickinson Hospital in Northampton Massachusetts, and to all the people whose presence, love and prayers helped me through this ordeal. Coexisting alongside these feelings of immense gratefulness I was also carrying and contemplating - for several weeks after my return home - this unanswerable psychospiritual question "What is it like to not exist in this form?"
About a month after my hospital stay Jeanne and I felt we needed some time away and we went for three days to a town an hour and a half from our home. Our first night over pizza and beer we were discussing again all the thoughts and feelings we were each having while I was in the hospital. Then a man walked up to our table and said, "Do you remember me?" I looked up and said "Yes,but I don't know from where." He said,"I'm Matt. I was your nurse at the hospital." Both Jeanne and I got up, hugged him and expressed our great gratitude. I said," I can't imagine any hospital in the world giving me any better care than you and the rest of the staff at Cooley Dickinson gave me." He introduced his wife and son and we expressed our feelings to them. After he left Jeanne and I expressed our awe at this moment of synchronicity. What are the odds that at the moment we were talking about the hospital Matt - who lives two and a half hours from this pizzeria - would be there with his family.
Later that night,lying in bed while Jeanne was asleep, I began to have flashbacks of being in the hospital. After a while something inside me said "You are alive." Then it shifted to "I am alive' and then became a robust "I AM ALIVE." To affirm this statement I decided to do two things that I could not do in the hospital: one,get up and walk around; two, open a window and breathe outside air. Since that moment I say aloud robustly several times each day "I AM ALIVE." I do this to strengthen that inner feeling and to respond to the call to be more fully alive. The earlier question,"What is it like not to exist in this form" has receded. It is as if that synchronistic moment of Matt's appearance acted as a psychospiritual bridge to move me along from my thoughts that I almost died and ruminations about non-existence to a way-of being-in-the-world more connected to the life force. WOW!!!




Thursday, February 2, 2017

DEVELOPING A PSYCHOLOGICAL IMMUNE SYSTEM

One of my patients gave me a copy of "The Book of Joy". It describes a series of conversations between two of the most respected contemporary psychospiritual teachers - the Dalai Lama and Desmond Tutu. Thee two men - now both in their 80's - share their thoughts about how to experience joy amidst all the pain and suffering and conflict in the world.
Among the myriad insights of the book one notion presented by the Dalai Lama inspired me to write this blog. He raised the question: since we emphasize the importance of having a strong physical immune system why don't we also encourage people to develop a strong mental immune system? "Of course" I thought,"that makes sense. As psychotherapists and counsellors we can help our clients to do that." Some of what follows flows out of their discussions and some emanates from my own work with patients.
The central concept is that by developing our psychological immune system we are taking a proactive preventative approach. As with physical illness is it not wiser to try to prevent problems rather than wait until an illness occurs? When we have a strong psychological immune system negative emotions(fear/anxiety, powerlessness/helplessness etc.) usually arrive in an attenuated form and are not overwhelming. Also when a large stressor does occur we have more internal resources to deal with the situation.
All of what follows will involve active work by our clients between their sessions with us. Or as some of my patients describe it - homework. The active work is necessary because so many of our usual psychological patterns are deeply engrained and have been reinforced repeatedly over our lifetimes. And - it is important to remember - are physiologically wired through brain patterning. A plethora of brain research in the last decade confirms this neurological patterning - including the important insight that our brains are "wired for negativity." The concurrent hopeful news is that the research results are also reporting that it is possible to change these patterns through active effort.
BREATHING TECHNIQUES
I teach all of my patients a simple breathing technique as a tool for dealing with anxiety and for releasing negative thought patterns. I say to them,"Physiologically with your in-breath your body takes in what it needs (oxygen) and with your out-breath it gets rid of what is not good for it(noxious gases). Let us now imagine that with your in-breath you are taking in what you need psychologically(peacefulness, relaxation,positive thoughts/energy etc.) and with your out-breath you are releasing what is not good for you(anxiety/fear, helplessness/powerlessness, self-criticism etc.)" We practice this in the office for ten minutes. The enables my clients to experience the process, give feedback and to receive from me individualized tweaking of the technique. Then I encourage them to do this for ten minutes each day until our next session. At the next visit, and periodically in the following months, I inquire about their efforts. We discuss difficulties in the mechanics of the technique and any psychological/practical resistances to incorporating this tool into their lives.
I also recommend that during their everyday life whenever they are feeling anxious or being overly self-critical to take a few minutes to do the breathing technique. Each time that they do that they are strengthening a new psychological and brain pattern.
Of course there are a number of my clients who already have some form of a meditational practice that involves breathing(e.g. mindfulness) or an active practice(yoga,tai chi etc.) that incorporates breathing. For these folks I encourage them to bring these practices more into their daily life utilizing mini meditational moments throughout each day to release noxious emotions. I also now say,"The more you do this practice the stronger your psychological immune system becomes."

CULTIVATING COMPASSION
Both the Dalai Lama and Desmond Tutu place a strong emphasis on cultivating compassion. Since the need for connection with others is a fundamental part of our humanity they emphasize that it is essential that we develop a greater sense of concern for the well-being of others. Interestingly evolutionary scientists see cooperation(including empathy,compassion and generosity) as fundamental to our species survival. There is additional research that indicates that the reward centers of the brain are activated when we feel compassion and do something for others. Psychologically each time we do something for someone who is suffering we expand our heart's capacity for compassion.
Often when our patients are describing their own pain they will also report that they are aware that there are people in the world who are suffering more than they are. Not infrequently this makes them feel less entitled to their own pain. My response is"I have a different perspective. Whether your pain is greater or lesser than others is not the issue. It is not a competition. Our common pain is one of the things that connect us to others. Imagine that your current pain is part of the universal pain and that our hearts go out to each other." Another common comment by my clients when they are reporting the losses or big life trauma of someone else,"I cannot imagine what it would be like to lose your...or to have that kind of trauma." My usual response is,"I have a different perspective. Even though to do so is hard I think that it is important to take the time to try to imagine what it would be like to be them experiencing that pain. It will increase your compassion for them. Both of you will benefit. You will feel closer to them and they will feel the energy of your compassion. They will feel less alone."
Whenever my patients are overly critical of themselves I say to them,"It is important to be compassionate towards yourself." After they have heard this phrase from me a number of times they gradually internalize it and begin to say it to themselves. Developing self-compassion significantly increases our resiliency to stress because we are no longer attacking ourselves.
CELEBRATING OUR ACCOMPLISHMENTS
Many of my clients have difficulty taking in praise from others and in genuinely feeling good about their own accomplishments. Some of this difficulty is personal and related to their life narrative.(Please refer to the chapter entitled "Love Blocks" in my book "Working From the Heart" or an earlier blog also entitled Love Blocks" for an in-depth discussion of this issue). Some of this difficulty is cultural in that there is an overemphasis in our society on constantly striving and being productive. For many people this contributes to self-criticalness and unrealistic self-expectations. The resultant diminished self-esteem is not good for our psychological immune system. It leaves us with a sense of less inner strength to deal with life's stressors. I try to counteract this personal and cultural pattern whenever possible. When one of my patients reports some moment of psychological growth I stop the flow of the session to acknowledge the accomplishment. Then I encourage him or her at that moment to use their in-breath to take in more deeply the sense of accomplishment and with the out-breath to release some of the inner feelings of low self-worth. For some bigger moments I extend a "high-five"; for even bigger moments I will give a "double high-five" or a hug at the end of the session. These moments during the session are also a modeling. I encourage my clients as "homework" to take a few moments during their everyday life to use the breathing technique to acknowledge, celebrate and take in more deeply their daily accomplishments.

CULTIVATING GRATITUDE
One of the areas that Desmond Tutu and the Dalai Lama emphasize in order to experience more joy is to encourage us to cultivate gratefulness. They discussed how our competitive culture focuses on the accumulation of things, success/failure and external measurements of status. I also witness how often my patients focus on what is missing or insufficient in their lives. As a Buddhist the Dalai Lama has practiced for over seventy years non-attachment to externals and cultivating gratitude for life. He expressed his delight about the research that grateful people report more positive emotions, better physical health,vitality and life satisfaction combined with lower levels of depression and stress.
Introducing a more grateful attitude into our life does not mean we deny or minimize our pain and struggle. What it means is that we are acknowledging that coexisting with our current suffering are things and people in our life for whom we are grateful. To help cultivate gratefulness I teach my patients to use the word "and". For example,,"I am really struggling right now and I am grateful for friends who really care about me." I also think that ritual can be helpful in cultivating gratefulness. For example, at the end of my meditation I always spend several minutes thinking about the people now and in the past who have contributed to my growth including those who have caused me problems and forced me to grow. Several years ago I also started another ritual. After I have seen my last patient for the day I kneel down in my office and give thanks for the patients who came to me that day who by opening themselves to me sustain my work and my life. I am also grateful for all the sources,known and unknown, who have provided guidance that day so that I could help my patients. As these practices have evolved my life has felt increasingly rich and full.
In conclusion I would like to reiterate that all of these ways of developing and strengthening our psychological immune system inquire conscious effort and hard work. We are often going against the patterns of a lifetime that are psychologically engrained and neurologically wired. The results,however,are worth the work.

Thursday, October 13, 2016

AGING

At this time in my lifework as a psychotherapist I am seeing an increased number of clients in their 60's and 70's. Recently - in the same week - I started work with a man who is 87 and had a final session with a long time client who was 86 and dying. I am 74 and have my own personal experience with the aging process that I was able to bring into the conversations. As an elder in the field of psychotherapy with over 40 years of experience in private practice I would like to share my insights in the hope that they will help you with your clients who are aging.
For many of my patients in this stage of life there is an awareness - at some level of consciousness - that "their time is running out." For each of them there has been some life event that has begun that awakening. For some,like myself, it is a medical crisis that has triggered the process. Twelve years ago I had a very aggressive lymphoma which took thirty pounds from my tall and lean body. My very enlarged spleen was surgically removed followed by five months of chemotherapy. I was then and still are now very grateful to still be alive. At that time I became more acutely aware than ever before of the preciousness of time. The way I describe it to others,including my patients, is that "I now have two companions Aging and Death who walk with me every day. I have befriended them and are grateful for them because my awareness of them affects my decisions every day."
Every day there are multiple moments in which we make decisions about how to spend our time. A small example: one day while I was writing this blog I was really struggling about how to describe some notions. I stopped and asked myself,"What's going on?" Quickly the answer came. "I don't want to be doing this today." Years ago I would have just kept going and slogged through. At this time my two companions helped me to frame the question,"What do you want to do with your time today?" And the answer came back, "I want to continue that book about coyotes." I stopped and read with pleasure and peace of mind. The next day the writing flowed easily.
For others there is a minimization or denial of the aging process. One client initiated therapy at 71 saying,"For the first time in my life I wake up in the morning anxious and I don't know why." Another patient at 66 after looking forward to retirement for so many years was losing weight and feeling quite depressed and confused regarding these unexpected feelings that were showing up after he stopped working. For these clients my initial therapeutic task was to bring into awareness their underneath feelings about aging and dying. For them the phrase that I used that that most deeply resonated was "MY TIME IS RUNNING OUT."

THE MAIN EVENT
As we age there are inevitable changes in our bodies and minds. Each of us in this stage of life to varying degrees is experiencing losses or diminishments in what our bodies are able to do. Also our brains are experiencing difficulties in accessing memories and feeling diminishments in our cognitive processing. In this brief blog it is not necessary for me to list the myriad possibilities. What is important is how we psychologically deal with these changes. It is essential for us to do the difficult task of acknowledging, grieving and accepting these losses. But it is also key not to over focus on them. Yet, probably because our culture overemphasizes the externals of physical appearance and fast efficient mental processing, many people frequently give a litany of these physical and cognitive diminishments. It is vital to acknowledge and honor that something else is also happening which from my perspective is the MAIN EVENT of aging. COEXISTING with the body losses and diminishments are the increased needs of our souls. As time in this body form is "running out" there is important, exciting and scary soul work to be done. We need to help our clients pay more attention to that process.
What are the core needs of our soul at this time? One of the primary needs of our soul is to be able to look back at our selves at earlier stages of our life with compassion, loving kindness and forgiveness.
It is a very human tendency for most of us to look back and see the mistakes we made, the pain we caused, our failure to do more for loved ones... Usually we look backward through a critical or judgmental or guilt-filled lens. My approach is to say to my clients,"You are looking from the perspective of your now self. You have evolved into a more developed person. At those earlier times in your life you were a less evolved person and you made those choices from your stage of development at that time. I would encourage you at this stage of your life to begin to look at those earlier versions of yourself with compassion and loving kindness." During the therapy process I will repeat that multiple times. Gradually my patients internalize my compassionate voice and then do it more for themselves. The way I theoretically conceptualize this process is that the source of that self-compassion is their personal Higher Self and that I am embodying that inner aspect for a while until they re able to access it themselves.
When talking about the needs of the soul I often use the metaphor of a jewel with many facets. When we arrive at this stage of life some of those facets(or aspects of our essential being) have been highly developed; others have been suppressed because of the need to support ourselves and raise a family; others are underdeveloped because they have never received any nurturance; others are deeply damaged by how others in the past have treated them; still others are so hidden that we have no awareness of their existence. From my perspective it is our task at this stage of life to reawaken and resurface those aspects of our soul to be honored and nourished in the time we have left. One example of this is the retired 70 year old furniture maker who had been a political activist in his early twenties who now wanted as a result of his therapy to find ways of doing service in his community. Through the assistance of his pastor he befriended an older couple in his community and he visited them regularly providing companionship especially for the husband whose wife was showing some early signs of dementia. Another example is the 65 year old successful businesswoman. who after selling her business decided to write songs, reawakening her long neglected passions of writing poetry and singing.

CLAIMING THE STATUS OF ELDER

Our culture does not provide pathways of honoring the role of elders. Of course there are exceptions wherein some public figures and some members of our local communities are respected and valued for what they can offer to younger generations. From my perspective, however, every aging person has something to offer, some area(s) of accumulated knowledge and experience. They too should be respected as elders. In our culture, however, people past a certain age are expected to step aside- some are tossed out - for the next generation and then to go away into some state called "retirement." What is not done is to honor and provide for the role of elder and encourage younger people to seek them out as a source of guidance. That leaves many of us aging people in the position of having to personally claim the status of elder and offer ourselves to those younger people who are open. That is what I have done with my book(Working From the Heart: A Therapist's Guide to Heart-Centered Psychotherapy), my blog, Twitter accounts and Youtube videos. What I say in each of those vehicles is "At 74 years old with over 40 years of experience as a psychotherapist I want to pass on what I've learned." I encourage my aging patients to think of themselves as elders who have something to offer and find ways to offer it. Most of them have never thought of themselves as elders and are reluctant to acknowledge it because they question what is it that they have to offer. Gradually,though, they grow into the notion of being an elder and like it. One example: A patient who was involved with computers long before they became an essential tool for everyone has many years of experience in adapting to all the changes and solving the problems that inevitably arise. He decided to offer himself as a "computer pastor" who would make "house calls" for people who were struggling with computer problems He found an important and fulfilling niche in our community especially with people post 40 years of age who were really struggling with this now essential tool.
I know that the topic of aging is complex and a blog of a few pages cannot discuss everything. My hope is that some of these notions that I have offered are evocative to you and helpful in your work with your clients.



Tuesday, July 26, 2016

WHERE IS OUR EMPOWERMENT?

This is one of those periods in human history where we are being hit with one crisis after another raising big questions about what is happening, where are we going and what can we do. The list of crises include: terrorist bombings and mass shootings, increased racial tensions, income inequality, climate change, dysfunctional political processes... a powerful mixture of feelings are being evoked: fear, rage, sadness despair, injustice, powerlessness, distrust... They affect our communities, our families, our patients, us. The cumulative effect of so many feelings over a period of time can be overwhelming producing powerlessness, paralysis, apathy. So much needs to be done to make the necessary changes. As psychotherapists and counselors what is our part?

WHERE IS OUR EMPOWERMENT?

From my perspective as an elder in the field of psychotherapy one primary way we can have a lot of impact is through our work. What is common to all of you readers is that we are working with clients who are suffering and struggling in their personal lives. They are being greatly affected by all this societal instability. We can help them feel empowered amidst this turmoil and to each make their unique contributions to the changes that need to happen. Imagine the ripple effects.
The first step of this process is to help our clients to feel fully all the myriad feelings that are being evoked. This will help to reduce denial and minimalization. Our clients are often afraid of the power of their feelings and what they may trigger from their own personal journey. Through our compassionate hearts we can invite these big feelings into the safety of the therapeutic space. This will provide a container to hold the feelings so that our clients will feel less overwhelmed. This will also increase their compassion for others all over the world who are suffering too. And diminish their feelings of separateness and aloneness.
It is then important to explore more deeply what aspects of their personal story are being tapped into. How do the feelings evoked by the societal crises connect with the feelings of deep sadness,rage,fear,injustice,hopelessness,powerlessness that they have felt in their childhood,adolescence, and adulthood? Exploring this connection can provide an opportunity to deepen their personal work. This will also separate out the past feelings when they usually felt powerless from the ones now being evoked by current events. The awareness of this connection is empowering.
The next step is to encourage our clients to hold these feelings in their consciousness AND to ask themselves the question,"Where is my empowerment now? What can I do?" The cumulative impact of all these issues fell so overwhelming, the amount of work to be done seems so daunting that it produces a sense of powerlessness. However, if we ask ourselves "What connects with who I am and what my interests are? What about my life experience gives me something to offer?" then something will come into our consciousness that can be our unique contribution. We can tell our clients that we are not all called to act on the big stage, but we all can contribute our part to the larger movement for systemic change.
Ralph is a sensitive artist and naturalist; he is a Vietnam Vet in his 60's. All the terrorist attacks and the shootings of black men and policemen were triggering his PTSD. All the impacts of climate change upon "our home - Earth" combined with the political dysfunction were triggering memories of the devastation wrought upon his childhood home by his mother's bipolar disorder and alcoholism. He was feeling enraged, fearful and powerless. After several years of sobriety he had started to drink again. He was ashamed of that and was embarrassed to tell me because he thought that I would be disappointed in him. Of course I was not - it was a projection of his disappointment in himself. I told him many people are coping with the big feelings evoked by these social crises by the addictive use of substances and addictive behavior.
After we worked through more deeply the feelings of his earlier traumas that were being triggered by the current events I told Ralph"It is now important to discern where is your empowerment in these recent world issues." He felt most strongly about the climate change issue. He has a deep heartfelt connection to the Earth as "our home" and feels that we are despoiling our home. He started to think that if he could help people develop a deep personal connection to the place where they lived, the natural setting near their home, they too would develop a deep heartfelt connection. Extending this heart attachment to the natural world they would want to take better care of their home Earth and become more involved in climate change issues. Ralph started by taking his teenage son's friends on nature walks. They loved it. This evolved into him leading guided nature walks for parents and kids in the local high school. The response was very positive and Ralph began to feel that he was making a contribution.
A few other examples: Tom who had been homeless for several years in his late teens and early twenties spoke at his synagogue about "giving voice to the voiceless" including non-human creatures and about the interconnectiveness of all beings; Carla, who had always felt like a "timid mouse", joined the Citizen's Climate Lobby and traveled to Washington to speak directly to Congressman; David decided to make monthly visits to some isolated members of his community; Walter led several workshops at his conservative Christian church about the congregation becoming more inclusive. The connecting thread in all these stories is that each of them moved beyond powerlessness and a sense of hopelessness into taking some action that fit with who they were. They felt also that they were contributing to something greater than themselves.
Of course we can contribute concurrently to working on these societal issues in ways that resonate for us personally. It is important, however, to realize that we can use our unique positions as psychotherapists and counselors to encourage and empower our clients to find their individual pathway - even though it may seem small - of making a contribution.