Thursday, October 13, 2016


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."

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.


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


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?


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.

Monday, May 30, 2016


How can we help our clients develop some of the personal character patterns and inner feeling states that will improve their lives? How can we help them: have more perseverance, feel more inner peace, become more assertive, feel more inner strength...? How can we help them cultivate these qualities and emotional states?
Because these are primarily emotional states and because emotional states are controlled by lower level brain functioning(which overrides neocortical processes) rational/cognitive techniques are less effective in producing change. What I have found quite effective is to help clients invoke symbolic images because of their capacity to evoke powerful emotional states.
I'll start the discussion with a personal example. My lifework as a psychotherapist requires me to have a sense of grounded inner strength when presented with the myriad strong emotions of my patients. The work also requires me to have a reliable degree of stamina, especially on those days when I feel personally tired, and yet have to be with patients for hours. For me the image of an old tree with its roots above ground reaching deep into the earth symbolizes inner strength and endurance. On my weekly woodland walks I have sat and meditated many times with my back against a particular old deeply rooted tree. On several occasions I have imagined what that old tree has "witnessed" and "endured." By my frequent visits coupled with breathing meditations I am symbolically imbuing the image of that tree with those qualities and also creating brain patterns. In my office I have a poster of a giant redwood - I have meditated inside redwoods several times - and a stained glass image of the "Tree of Life." Before starting my day's work and also during those sessions when I feel tired, I look at those images and take a few deep breaths. Through this practice I can feel myself tapping into those deep inner states. This usually overrides the tiredness of my ordinary self and enables me to be fully present to my patients.
When we are helping clients develop their own images it is important to emphasize that the symbol needs to come from them - something resonant with their life narrative. Walt was anxious most of the time even when his life was going well. From prior experiences with other psychotherapists Walt knew the reasons for his "inner river of anxiety." He was quite close to his mother whose pervasive fearfulness permeated the atmosphere of his childhood home. As a sensitive child he absorbed her fearful energy into his own consciousness and it became strengthened through brain patterning. In an attempt to counteract this engrained pattern I asked Walt "Is there some place either now or earlier in your life where you have felt more peaceful?" Within a few minutes he began to talk about a local pond that reminded him of a lake near his childhood home. He used to go there to escape the tremendous tension at home. I recommended to Walt that he begin to go to this local place regularly by himself, sit near the pond, say out loud the word "peace" and do fifteen minutes of relaxational breathing. He was so determined to change this lifelong pattern that he started to visit the pond several days a week and quickly lengthened the time of his visits. One day Walt reported that he had taken a picture of the pond. Now that is the image he first sees when turns on his computer. He also hung a framed copy of the picture on his living room wall. Each time he opens his computer or stands in front of the picture he pauses, recalls time at the pond and takes a few breaths. Walt was amazed at how he started to feel internally more peaceful. "My wife has commented how more relaxed I am." Pleased by these results he became even more diligent about incorporating "pond time" into his daily life.
Carla had a lot of difficulty standing up for herself, protecting herself from personal verbal attacks or asserting her own ideas and feelings. She grew up with loving parents who had a pollyannish worldview and refused to acknowledge the dark side of people. She never witnessed them get angry, nor did they allow her to express anger. She felt loved, but totally unprepared deal with a lot of life situations. I asked Carla, "What animal comes to your mind when you think of an animal protecting her young?" Within moments she said "A tigress. I remember as a girl loving pictures of them in National Geographic magazine." Carla talked about the confident way the tigress moved, the sounds she made, her overall attitude of "don't mess with me." I encouraged her to watch tigress videos and to read more about them. I recommended to Carla that when she was alone in the house to imagine herself as a tigress walking around. We also did some deep breathing imagining the tiger inside of her. I asked her to imagine the tigress walking alongside her available whenever she needed her. She continued this work at home for several months. One day she demonstrated for me her tigress growl. She particularly loved the image of her tigress walking alongside her always available. Carla started to stand up for herself more and also to advocate more strongly for her children in their school.
I could offer more examples - the Vietnam vet who developed the image of a Native American shaman as a "Warrior" who helped him with his PTSD symptoms or the psychotherapist who grew up in Cape Cod using a lighthouse as a beacon of hope in her own despair. What is common in all these stories is that each of the symbols taps into some personal experience that resonates with the needed personality trait or desired inner emotional state. Imbuing them with symbolic power so that they can be reliably sustained and strengthening them so that new brain patterns can form and become engrained requires conscious effort and a lot of diligent hard work. Once patients begin to feel the difference and envision a better future they are usually able to do the hard work.

Monday, March 28, 2016


I have a dear friend who has been hosting for over forty years a late night radio show about psychological and social issues wherein listeners call in to speak about their struggles. He frequently encourages them to seek professional help for their psychological problems. He has shared with me on multiple occasions that the #1 complaint from these listeners who have had unhelpful experiences with psychotherapists and counselors that they have consulted is "I didn't have any sense that they cared about me as a person." Moreover, the literature on effective psychotherapy has consistently reported that when clients are asked what was most helpful to them they say,"my therapist cared about me as a person." As a reader I ask you,"How often in your professional training and supervision was it emphasized to you the importance of treating your clients with compassion,loving kindness and other forms of heartfelt caring?" From my personal experience in my own training,with the therapists that I've supervised and from the responses I get when I tweet about this topic it is an area that is underemphasized and undervalued in most people's training.
I think that there is an overemphasis on the importance of maintaining professional distance. YES, it is important to have appropriate boundaries, especially with clients whose body and psychic boundaries have been violated. YES, our hard-earned knowledge about what produces psychological problems and our techniques for reducing them are important. AND, it is essential that we move away from the hierarchical, superior-inferior aspects that are culturally built into the roles of therapist-client to move to a more deeply human-human interaction. Through our compassion, simple acts of loving kindness, warmth, sharing of relevant personal stories, encouragement, welcoming attitude, celebrations of moments of growth, emotional nurturance.... and other expressions of heartfelt caring we shift the relationship. It becomes more between two human beings, one of whom is suffering, and the other who has expertise that will alleviate that suffering.
YES, it is very possible and liberating to be both a professional and a loving human being.


Ii my daily period of meditational preparation before I open the door to see my clients I pray,"Help me to be a vehicle of peace, brotherhood and love with my clients today." [In prior blogs I have talked about being a vehicle of love and peace] With this prayer my intention to place my lifework as a psychotherapist into a larger context - an acknowledgement of our connection of human to human, of the interconnectedness of all beings. The word brotherhood is the term I am using for this connection. Perhaps, if I were a woman I would use the word sisterhood.
Underneath our roles of client-therapist is this human to human connection. When we share relevant aspects of our personal stories that reveal our empathic connection to what our client is discussing we are breaking down barriers to heart to heart connection and underscoring, without minimizing their suffering, that their struggle is part of our common human journey. When we show our caring in whatever way fits for this particular client and our unique personality we are honoring our heart to heart connection. Our clients experience this genuine caring at multiple levels of consciousness. AND, it makes them more receptive to our techniques, insights and suggestions.
It is a massive understatement to say that we live in an area of great divisiveness wherein the experience of "other" as different, inferior/superior, frightening is pervasive throughout most cultures.It is well beyond the limits of a brief blog to even attempt to discuss the why's of this increasing sense of separateness. However, rather than be overwhelmed and paralyzed by the bigness of the problem we can help our clients develop a greater sense of brotherhood/sisterhood and thereby contribute to some of the change that needs to happen.
First,by being both a professional therapist/counselor and a loving human being we are modeling for our clients a way of being in all the varied roles of their lives.
Second, by exploring with them what aspects of their personal histories have contributed to their inner self-criticalness ands judgmentalness of themselves. Then discuss with them how that is directed toward others. It is these aspects of each client's inner landscape coupled with the fear of being vulnerable to psychological attacks by others that contribute to their defensive barriers to a deeper human to human interaction.
Third, in addition to their personal history it is important to discuss the impact of living in the competitive atmosphere of Western culture. This underlying competitiveness - which is so insidiously pervasive that we are usually unaware of its psychological impact - places us in an adversarial position with others. I have found it quite helpful to explore this often unexamined territory with my clients to help them move from an adversarial relationship to a greater sense of feeling their common humanness.
Imagine the ripple effects if thousands of therapists and counselors were helping their clients feel a greater sense of brotherhood, a deeper valuing of our human to human connection.

Wednesday, January 27, 2016


In my few moments of meditational preparation before I see my first person of the day one of the prayers I say is "Help me to be a vehicle of Divine Love with my patients today." This prayer reflects an evolution of my thinking regarding my role as a psychotherapist. Increasingly some of the notions of the mystical traditions have become central to my evolving worldview, my view of myself in the world, and my lifework as a psychotherapist. My twice weekly contemplative walks in the woods and my meditations sitting with my back against a tree have contributed to what is unfolding. I playfully think of myself as an "aspiring nature mystic."
Most of the mystics(including Meister Eckhart in the Christian tradition, Abraham Heschel in the Judaic tradition, Rumi in the Sufi tradition) teach about the interconnectedness of all beings. They also say that there exists a metaconsciousness(which has different names in each of their traditions) the essence of which is love. They talk about the Divine and Divine Love.
One of my intentions in my woodland walks is to connect more to the Divine. In my efforts to make the relationship more personal I use the sun as an image of the Divine and refer to it as "the Old One." I find it helpful, and yet I acknowledge that it is a limited attempt to grasp the unknowable. Moreover, I imagine the rays of the sun shining through the trees as emanations of Divine Love - a love that shines on everyone and everything. It is this Divine Love that I'm trying to access in my prayers before seeing my patients.
Periodically people ask me how I have been able to be in the presence of so much pain, doubt, sadness, fear, depression for so many years without getting burnt out. I reply that if I were reliant only upon the small heart of my ordinary ego the accumulated weight of carrying all that would become overwhelming long ago. However, many years ago I began to find it very helpful to access my personal Higher Self as a source of a much greater capacity for compassion and other forms of love. Since then whenever I am able to transcend my ordinary ego and access my Higher Self - whom I have named Wiseheart - during sessions I am able to be a compassionate presence for hours. Moreover, for many years I have thought of Wiseheart as being connected to an infinitely larger consciousness capable of an amount of love that is beyond our ability to understand. Gradually my thinking about that larger consciousness has evolved into the notion that my old friend Wiseheart is an aspect of the Divine and a conduit of Divine Love. Recently I've thought that when I'm connecting to Wiseheart I am being a vehicle or conduit of that source of love. So in my prayer before beginning work I am asking Wiseheart,"Help me to be a vehicle of Divine Love with my patients today."


It is essential that our patients feel that they "are in good hands" when they come to us with their problems. As their psychotherapy sessions continue they become more vulnerable and reveal to us their innermost thoughts and feelings. Periodically they say,"I've never told this before to anyone." This is a "sacred entrusting." Although they have been wounded by others they are expecting and hoping that we will be different and that we will them with respect, compassion and loving kindness. From my perspective we make with them a sacred agreement, often unspoken, to be that entrusted person.
As part of the evolution of my work, increasingly I feel that there is another sacred entrusting - between me and Life. Between me and the Divine. In whatever way the referral originally occurred Life has presented me with these patients. The Divine asks me, in addition to using my skills and experience, to treat each of them with respect, importance and love. Although I don't usually consciously acknowledge it, I feel that at some higher level of consciousness I am saying "Yes" to that sacred pact.