MOVING FROM SURVIVING TO THRIVING

It's so hard to change the patterns of a lifetime. It requires hard, conscious work. And compassion towards ourselves. Our patterns of behaving are deeply rooted. Because these behaviors have been repeated and reinforced so many times during our lives they are so well engrained neurochemically that we are brain-wired to repeat them.
We are also afraid to change our ways of acting and thinking because they serve a self-protective function. They helped us to survive when we were younger. Some of us come from backgrounds of significant physical, sexual or psychological abuse or profound emotional neglect. For many of us the impact of our earlier environment was more subtle. Without an awareness of the impact upon us our parents,teachers et al were critical or judgmental of our sensitive Selves. Or there was a familiar atmosphere of fearfulness, tension, anger or sadness. This felt, at some level of consciousness, unsafe. So our Selves went into a self-protective hiding place and developed outward ways of behaving in order to survive. Although the use of the word survive may,in some instances, seem exaggerated or unnecessarily melodramatic, for the sensitive Self the stakes feel very high and the notion of surviving in a hostile or neglectful environment is very fitting.
For most of our patients - although this is not true for those who are currently in abusive situations - the need to be in a survival mode no longer exists. However,before they are able to put in the very hard work of changing, our patients need to understand how their patterns initially developed. Also, they need to perceive that unwittingly they are continuing now to act as if the same degree of physical or psychological threat still exists. After that initial therapeutic work is done I tell my patients,"It is time to move from surviving to thriving." In order for their Self to develop more fully - to thrive - they will have to do some hard work. While this is happening I encourage them to say to themselves the phrase/mantra, "I'm moving from surviving to thriving." Simple aphorisms - because in a few words they embody a simple and profound truth - like that can be very helpful and potent in this deep inner work.
As therapists it is very important for us to embody and express compassion for how difficult it is to change these patterns. Patients usually become judgmental and angry toward themselves because they are having such a difficult time changing. It seems to them that it should be simple. I often say,"Be gentle with yourself. Be compassionate towards yourself. It is very hard to change the patterns of a lifetime." I remind them that our brains are wired to respond in these ways, that the patterns are deeply engrained neurochemically and that, at some level of consciousness, they serve a self-protective function. Gradually, through my repeating."Be gentle with yourself" my patients internalize this phrase and become more compassionate toward themselves during the difficult process of changing.

AN ISLAND OF SANITY

For some of our clients we are an island of sanity amidst the madness of their lives. Sometimes there are so many things happening in their lives that they are completely overwhelmed and on the edge of panic much of the time. Sometimes what is happening is mostly internal. They are feeling so much conflict among different parts of themselves or some unwanted long-repressed feelings are emerging from underneath or there is some deep sense of dread about what is going to happen next. Our clients in these situations are feeling very anxious - near terror - that they are going to "crack up" or totally collapse.
During these very difficult times they look to us to be a reliable source of stability - an island of sanity - when everything around them and within them feels like an unending turbulent storm. Our peaceful and compassionate presence provides a sense of refuge that they do not feel with other people in their lives. Our office space,by how we have furnished it and the objects we've place within it, also helps to create this sense of tranquility. This aspect of psychotherapy is rarely ever talked about in our training with its emphasis on theories, techniques and professional objectivity. Yet, I have experienced the importance of this way of being for our clients especially when their outer world or inner world is coming apart.
Jennifer,an old patient of mine, recently called me. The company where she had worked for twenty years decided to close, her husband was diagnosed with cancer and her daughter - the mother of her beloved granddaughter - had inexplicably become closed off. She was having frequent nightmares, daytime panic attacks and felt like "I'm falling apart and I'm going to crack up." Jennifer felt quite embarrassed that she was in this state after having done so well since we ended her psychotherapy ten years earlier. I let her know that I was not disappointed in her and felt honored that she was seeking me out during this very difficult time. I also said it was not unusual for patients to reconnect with me during these kind of crises.
Jennifer felt so relieved to be in the sanctuary of my office where she could feel the reliable safety and peaceful security of my presence. I helped her to understand that part of the reason for her being so overwhelmed and terrified was that these current events were triggering the chaos and profound neglect of her childhood home. This perspective helped her to feel somewhat more stable. However, increasingly she felt flooded by these memories. Combined with the powerlessness created by the unfolding events of her life she continued to feel very anxious about having a breakdown.
I did with Jennifer what I have done with other patients under these circumstances. I gave her something personal from my office that she could take home. I handed her a carving of a tree that I had brought back from a vacation in the redwood forests of Northern California. Redwoods, of course, are trees that heave survived many storms, fires and attacks from insects. They are an iconic image of strength and stability. I held the carving for a while, rubbing my hands on it and said, "Bring this home with you as a reminder of what it feels like to be with me in this office. When you're feeling overwhelmed pick it up and hold it. Keep it until this storm is over and then bring it back to me." My perspective in doing this is that she will be borrowing my strength for a while until she can reclaim her own.
I also asked Jennifer if she felt like there were any other places where she felt safe and sane. She remembered that throughout her childhood she had always gone into the woods near her home. She felt safe there and not alone - like the big trees were protecting her from the emotional insanity of her home. I encouraged her to spend a lot of time in the woods now to recapture that childhood sense of sanctuary and tranquility. I also asked whether she had any photos of those woods or some similar woodland setting. She recalled that she did have a photo of a wooded place that reminded her of that childhood refuge. I told her "Put that photo up in your home. Whenever you're feeling very anxious look at it, remember what it was like to be there . Then do some meditational breathing. Amidst the powerlessness and panic of what's happening in your life now you can reconnect to that old familiar sense of sanity and peacefulness that at some level of consciousness you still carry inside of you." Jennifer smiled warmly, "I like that idea, I can do that."

These ideas are based on the Sanctuary chapter of my book, "Working From the Heart: A Therapist's Guide to Heart-Centered Psychotherapy

CARRIERS OF HOPE

Not all of our patients reach levels of despair or profound discouragement wherein they feel a sense of hopelessness or some significant diminished of their capacity to be hopeful. More than a few clients,however, do experience that dark place at some point in their therapy or counseling.

Sometimes it's because nothing in any area of their life is going well and everyday life feels so overwhelming that they cannot see a away out. Sometimes they feel a sense of powerlessness to change any of the externals of their lives. Sometimes they feel that whatever changes need to occur are so daunting that they are beyond their own inner resources. Sometimes it's because they feel consciously or unconsciously that they are unworthy of a better life. Sometimes it's because they are over attached to certain desired outcomes or over identified with some self-concept or certain ways of being-in-the-world. Usually it is a toxic mixture of several of the above factors.

It is in these moments that our patients need us to be "carriers of hope". It is not necessary for us to offer them reasons to be hopeful,nor is it essential for our client to think of things to feel hopeful about. During these times of profound darkness any imperative to find reasons to be hopeful place too much pressure on our client or us. What we can offer though is companionship in the darkness - to be alone in the dark is more scary - and a persistent willingness to keep working with them on these issues until some light appears. What I usually say to my patients during these difficult times is,"I have experienced my own version of this place a couple of times in my life and I've been with other patients in this dark place. For now I will carry the hope until it reawakens in you."

Whenever I've said that most patients have voiced that they feel relieved and grateful. Occasionally there is some client for whom that message is no conscious source of solace. I simply accept that they are unable to take in my offer at this time and I continue the work placing no extra pressure on them to acknowledge that message.

Twice in my life I have experienced periods of sustained suicidal ideation. I have never acted on those thoughts. Because of my own toxic mixture of the feeling states that I described earlier I know what it feels like to feel that the only way out of the overwhelming darkness is death. Obviously I am grateful that I never acted on those feelings. I am also grateful that I have experienced those states. It is both an additional source of deep compassion for my patients who are suicidal and also helps me to be less fearful about being in that place with them. With most patients who are feeling suicidal I share that aspect of my personal story. It enables them to know that there is an additional source of my genuine empathy - as a human being who has suffered similar states in addition to being a professional who cares. I am also offering myself as a beacon of hope.They are usually grateful for that moment of sharing our humanity. Periodically I do not share my story because I sense for reasons that are idiosyncratic to that patient, that it would not be helpful.

Never in my training was it ever mentioned that one of our important roles was to be "carriers of hope". Increasingly I feel that it is an essential aspect of our work. I'm not sure why. Perhaps in these complicated times wherein the political, economic and environmental issues are placing so much conscious/unconscious pressure on our clients that the need for us to be a source of hope in their individual lives is greater.