HEALING SHAME THROUGH MINDFULNESS

 

The experience of shame can be unbearable. In fact, in her March 2015 TED talk on public humiliation, Monica Lewinsky noted that research has found that feelings of shame can be more intense than feelings of happiness and even anger. Shame unacknowledged can lead to deep depression, isolation, substance abuse and suicidal ideation. It is truly a toxic emotion.  We all make mistakes, but there is huge difference between the message “I made a mistake” and “I am bad or unworthy because of my mistakes.”

Shame is closely connected to fear – the fear that we will be severely punished and rejected because of our flaws. When we experience shame, we often isolate ourselves, believing ourselves to be unlovable damaged goods. Shame and vulnerability researcher Brene Brown has observed:

Shame is about the fear of disconnection. When we experience shame, we are steeped in the fear of being ridiculed, diminished or seen as flawed. We are afraid we’ve exposed a part of us that jeopardizes our connection and our worthiness of acceptance.[i]

When we are in the throes of the intense feelings of shame, we tend to forget that we all make mistakes, and that we all experience shame at times. This knowledge can help us develop compassion for ourselves and others, and helps us remember that none of us are perfect. As Brene Brown has noted, “Shame cannot survive being spoken. It cannot survive empathy.”[ii] Staying silent and isolated will only increase the feelings of shame and disconnection. It may take some discipline to get out of your self-imposed exile, but do it. Having even just one trusted empathic friend, family member or therapist with whom you can speak about your feelings of shame will go a long way to easing those feelings.

The experience of shame can be alleviated through mindfulness and awareness. The first step is to acknowledge it when it arises. Our body sensations are the best signal of what we are actually experiencing, including the feeling of shame. Through practice and discipline, we can actually let go of shame as soon as we feel it in our bodies, and before it blossoms into negative thoughts about ourselves.

Shame and fear are often felt in the pit of the stomach, or solar plexus, as a tight ache or fluttery sensation. Breathe into those feelings and explore them. Use your breath to explore the sensations, including their texture, temperature, color, movement, shape and size, so that you become so familiar with them that you recognize and pay attention to them as soon as they arise.  As thoughts of unworthiness or fear of disconnection or rejection arise, simply come back to your breath and to the body sensations associated with your feelings, and allow the thoughts to dissolve. Keep coming back to your breath and body.

In energy work, the solar plexus is the location of the third chakra, the source of our will and self-power, and is yellow in color. The following is a visualization I spontaneously created, using the energy of the third chakra,  to heal my own feelings of shame. It has benefited me greatly, and I share it with you with the aspiration that it is of benefit to you as well.

  1. Breathe into your solar plexus, which we sometimes call the pit of our stomach. Feel the achy tightness or other body sensations that arise.
  2. Imagine yellow light in the area of your solar plexus as you feel the body sensations. Explore those sensations with your breath.
  3. Let the yellow light grow and brighten, and start to glow like the sun, loosening the tight feelings with its warmth. As you do so, memories of childhood shame may arise. Allow yourself to feel them as well as current feelings of shame with compassion, as if you were holding that young child within you.
  4. As you experience this self-compassion, imagine others in your life also holding you in compassion and love, and allow the yellow light to grow and glow. Extend gratitude to yourself and others holding you in compassion and love.
  5. Allow the yellow light to transform into a beautiful golden halo that surrounds you and those who are there supporting you. Let the golden halo protect you. As you experience the sensations of this healing golden light, let your fears and shame dissolve, knowing that you are human, perfect in your imperfection, and that you are safe and loved. Breathe into those feelings of safety and love.
  6. As you continue to experience the warm protective glow, remember that we are all flawed, and that we all sometimes experience shame and fear when we make mistakes. Expand the golden light with your breath and extend it outward to all beings who are caught in the web of shame and fear. Extend the compassion you are developing for yourself to all other beings who are with you on this journey that we call being human.

 

[i] Brene Brown (2008). I Thought It Was Just Me (but it isn’t). New York: Gotham Books, p. 20.

[ii] From Oprah Winfrey interview with Brene Brown, posted on huffingtonpost.com on August 26, 2013.

COPING WITH GRIEF AFTER LOSING YOUR JOB

 

Many of us think that grief should be reserved for the death of a loved one. However, grief can be experienced after any life transition, and one of the biggest life changes is the loss of a job. Here are some tips for coping with job loss.

  1. Remember to have compassion for yourself.

Feelings of shame often arise after losing a job. Shame is one of the most poisonous emotions humans experience. It can lead to self-punishment, which can come in the form of berating yourself for not doing a better job or for making a mistake that led to the job loss. Self-punishment may also play out in negative behaviors like substance abuse or promiscuity. Take time to understand that we all make mistakes, and that no one is perfect – including you. Self-compassion is so important in all aspects of your life. Be gentle and kind with yourself. Take the time to nurture yourself in body and mind. Do things that bring you peace and comfort, such as reading a good novel, getting a massage or taking a warm bath. Do them with the intention of caring for yourself with kindness and compassion, and breathe that into your heart.

  1. Develop skills to banish negative thoughts.

Thoughts of shame, blame, regret and doubt are inevitable after losing a job. The key is to not let those thoughts develop a life of their own. Mindfulness meditation techniques can be particularly helpful at this time. Learn to notice those negative thoughts as soon as they arise. Instead of following a thought, breathe into the feelings in your body that accompany the thought. It might be tightness in your chest or stomach, a clenching of your jaw or some other body sensation. Allow your breath to loosen those physical sensations. When the thoughts come up again, simply breathe into the accompanying body sensations. You may want to enlist the aid of a mindfulness meditation instructor or friend who practices mindfulness if this is a new technique for you.

  1. Take some healthy alone time.

The shame and other negative emotions that accompany losing a job may lead you to want to isolate yourself and avoid social interactions. It is fine to take some time to recover from the shock of losing your job. At the same time, it is important to use that time in a healthy way. Avoid the urge to overindulge in food or alcohol. Exercise can be extremely beneficial to help you combat depression, and the best form of exercise I have found is walking. Feel each footstep as it hits the ground, and when you notice yourself getting lost in negative thoughts, return to feeling your feet hit the ground. Treat yourself to a massage or other activities that help you feel better.

  1. Take some time each day to do something positive.

When we lose a job, we may feel hopeless or even worthless. Do something each day that reminds you of your worth. It may be something as simple as helping an elderly person cross the street, saying hello and smiling to people on the street or giving someone directions. You can offer to help your neighbors walk their dog, or volunteer your time for a cause you believe in. Being of service to others, even in the simplest of ways, will remind you that you are worthy and have something to offer.

  1. Express yourself.

It is so important to get the swirling emotions of grief out of your body in a way that is beneficial. Keeping all that stuff inside will only lead to depression and dis-ease. Keeping a journal is a great way to express yourself, and can help you not only get out all those messy emotions, but also may help you clarify what is now important to you and your next steps on your career path, or if applicable, your path to retirement.   If writing is not easy for you, there are other forms of expression that can also be beneficial, such as drawing or painting, dancing, singing or playing music or simply moving. The important thing is to move that energy outward.

  1. Evaluate and call on your support systems.

One of the most difficult things for me after losing my job many years ago as an attorney in the entertainment business was the loss of people I always believed would be there to support me, especially my colleagues in my corporation. It felt like they were staying away from me because they believed that the loss of my job might be contagious! This is what we in the grief field call a “secondary loss.” That is, the loss of my colleagues, and the lack of support from them was an offshoot of the loss of my job. I was given the opportunity to evaluate who was really there for me and, and to develop a greater appreciation for those who stepped forward to support me on my new path, and to actually allow myself to be vulnerable enough to let them to be of support to me. In retrospect, I now know that this process helped me develop as a compassionate human being in my personal and spiritual life, as well as in my professional life.

  1. Use this time to reflect on what is important to you.

Undoubtedly, people trying to be supportive have told you that losing your job can be a “blessing in disguise.” When you first lose your job, it feels like a blow and not a blessing. While you may not see your job loss as a blessing, it is nonetheless a great opportunity to take the time to reflect on, and perhaps re-evaluate, your passions, priorities and values. For example, when I was laid off from my corporate job as an entertainment lawyer, it felt like a death blow. I no longer knew who I was, because I had so strongly identified myself as my job. When I got over the shock of losing my job, it became apparent to me that I was being given the opportunity to find a new career path that more suited my spiritual path and my personal development. The loss of my corporate job and following the steps described above allowed me to fulfill my dream to become a psychotherapist and grief counselor and to express who I really am.

 

 

           

 

 

           

 

 

 

GRIEF CAN BE MESSY

 

A common complaint of my grief therapy clients is that they don ‘t think they are “grieving right.” I assure them that’s there’s no “right” way to grieve, and that, in fact, grief can be downright messy.

Just from a superficial point of view, the face of a grieving person can be pretty darn messy – bloodshot eyes, runny, red nose, puffy eyelids, red nose and other outward appearances that we might want to hide. Grief can also throw other physical aspects out of whack. Individuals who are grieving may either not sleep well or get too much sleep. Eating patterns can get interrupted as well, and it’s not uncommon for a bereaved person to either lose or gain too much weight.

The emotional side of grief is equally messy and can also be unpredictable. Emotional outbursts can seemingly come out of nowhere. I remember many times after a significant loss sitting in my car at a red light and screaming or pounding on my steering wheel. At times like those, I’m tempted to say to the driver next to me: “Don’t worry. I’m not crazy. I’m just grieving.”

People who pride themselves as being patient and calm can find themselves being angry, irritable, intolerant and impatient in their grief. I reassure clients who are concerned about this that these are normal grief reactions. At the same time, however, I am vigilant as a clinician to make sure these clients are not depressed. There is a major difference between normal grief and depression. Whereas grief, though difficult is usually “normal”, depression is not, and needs additional care.

A pitfall for some grieving clients is that they believe grief should follow an orderly fashion, and may point to the five stages of grief described by Dr. Elizabeth Kubler-Ross, i.e., denial, anger, bargaining, depression and acceptance. Dr. Kubler-Ross never intended for these stages to be linear and predictable, but rather, touchstones in the grief process. We cycle in and out of these stages in a sequence that is neither predictable nor orderly, but rather, can be downright messy. However, if a griever believes these stages to be linear, after experiencing some initial denial, he or she may think “OK, I’m done with that stage. I’ll check it off my list and go on to the anger stage.” They may point to Kubler-Ross’s model as proof that they aren’t grieving “correctly.”

There are many ways to work in a healthy and healing way with the mess that is grief. Because grief’s myriad expressions and emotions are unpredictable, grief can be stressful and exhausting. Therefore, the first step in healing grief is to take care of your physical being, making sure to get enough sleep, eat healthily and get exercise.

Telling the story of your loss can also be immensely helpful, as a way to make meaning of the loss. This will help with the feelings of confusion, helplessness, hopelessness and despair that can accompany grief. In addition, telling the story can help the bereaved maintain an emotional connection to his or her deceased loved one. Telling the story can be done by talking to others, journaling, writing a letter to your loved one, painting, or by any other form of expression. Expression helps to literally push out all of the swirling, messy feelings in a way that makes them workable.

Reaching out for support is also extremely important in working with the mess of grief. Calling on friends, family or one’s spiritual community and calling on one’s inner strengths and resources are all very beneficial in preventing isolation and depression.

Working with the messiness of grief can be like tending an unruly garden. Gently pulling the weeds, giving the dirt nutrients and carefully tending to the growing plants allows them to bloom. Similarly, giving our grief tender loving care can allow the mess of grief to transform into healing and growth.

THE GIFT OF THE PRESENT MOMENT IN THE THERAPY SESSION

 

Therapy is not all about talking about the past, as many incorrectly assume. Rather, the psychotherapist’s goal is to work with the client in the here and now, while both therapist and client observe how past experiences inform the present moment. Psychotherapy works best when the past is being re-experienced in the present, in a safe and non-judgmental space. It is not about just talking about the past, but feeling the accompanying body sensations and emotions as fully as possible, and experiencing the energy and dynamics of the relationship between the therapist and client. As the client-therapist relationship grows, and the client is able to trust the therapist to maintain a safe environment, the client can re-experience the past more fully, and can then learn from and heal past wounds and transform the present.

For example, a client I will call “Joan” came to see me after the death of her father. Joan’s grief process was complicated by the difficult relationship she had with her father. It soon became apparent that Joan had a hard time in relationships with others, including me, as a result of her father’s domineering and controlling personality and her resulting lack of trust in herself and others.  Joan’s lack of a sense of safety and trust was apparent in our sessions together and in the dynamics of our relationship. Joan constantly questioned my motives and often threatened to quit therapy. She would get inordinately angry when she felt I was not listening to her, and resisted seeing her father as anything but perfect.

I knew from my own work that fear of judgment and abandonment are also core issues for me, as they are for many people. As a result, it was difficult for me to stay present with Joan, especially when she threatened to leave or criticized me. I often felt like I was walking on eggshells with Joan, afraid to say or do something that would set her off. I found myself becoming defensive, and tended to retreat into intellectual theories, trying to sound smart and look good. When I was able to slow down, take a breath, simply observe my experience and not react, I was able to choose a more authentic and skillful approach to my work with Joan.

I knew that staying with Joan’s experience of pain and confusion, and being a calm, compassionate and consistent presence in the face of her anger and threats, were the keys to helping Joan heal.   This was a long and exhausting process for both of us. Joan finally came to realize that I wasn’t going to abandon her, no matter how much she fought to keep me at a distance. As Joan gradually felt safe opening up to me, she was able to acknowledge that her father was not perfect, and that he did not provide her with a sense of safety and security in the world.  Like me, Joan tended to retreat into intellectualizing and analyzing, asking me “why” I thought her father was that way, and “why” she reacted the way she did. Joan would revert to over-intellectualizing and anger when her pain and vulnerability felt too raw and scary for her.

Giving Joan intellectual answers to her “why questions” was not what she needed. Instead, I continued to work on my ability to stay present and open with Joan, and we worked together on enhancing Joan’s ability to stay present and open with me. I encouraged Joan to notice when her anxiety with me increased and what triggers led to her urge to lash out. We focused on what she felt in her body: where the anxiety manifested physically, and what her body was telling her when she became anxious.

Staying in the body is a great way to directly experience the here and now. We Westerners tend to believe that our thoughts and mental processes are of more value than our bodies, but our bodies are far more useful in helping us access the truth. Joan eventually was able to get out of her head and into her body. She learned that she experienced tightness in her stomach when she became anxious. I asked her to fully experience that sensation by describing its shape, color, texture, temperature and other features. When Joan had a clear experience of that, I asked Joan what the sensations in her stomach were telling her. She saw that the message from her body was “run away, fight back. If you let yourself open up and be vulnerable, you’ll be attacked. You’re not safe.”

Joan’s increased ability to stay present in her body provided a number of important tools for her. She was able to tap into that feeling more quickly, and with a sense of curiosity instead of immediately striking back in a vain attempt to avoid her pain, anxiety and fear. The more quickly Joan could feel that sensation, the more she was able to choose whether she really needed to fight back, or to breathe into the sensations and allow herself to open up. As Joan started to open up, her awareness became more panoramic. She was able to slow down and experience the ebb and flow of energy between her and those she interacts with, and was more able to read others’ body language as well as her own in order to more ably attend to what was needed in that very instant.  Working together in the here and now of the therapy session, Joan and I have co-created a workable and authentic relationship.

One of the many gifts of therapy is what I learn from my clients, and my work with Joan made me realize that I must remain vigilant in staying open despite my fear of being judged or left. I became aware that when I felt Joan was about to attack me or denigrate what I would say, I felt a quickening my heart pound. I learned to breathe into that feeling and was more able to be present with Joan. As I became more authentic and vulnerable with Joan, she felt safe to be authentic and vulnerable with me. We can now appreciate each other and our shared humanity more fully, despite our pain and confusion at times.

Joan still has a long way to go to heal her shame and fear. The more Joan is able to stay with me in the present moment, the more she is able to do so in all of her personal and professional relationships. Joan is learning to slow down and open her heart to others without fear, and to be open to all that is available to her in the present moment.

 

HOW UNDERSTANDING IMPERMANENCE CAN HEAL DEPRESSION AND GRIEF

 

One of the most important tenets in Buddhism is that all phenomena are impermanent. All things and all beings are constantly changing. Nothing stays the same, and ultimately everything dies. We tend to consider this bad news. However, accepting impermanence can also be considered good news. If everything stayed the same, there would be no possibility for growth. Also, understanding that nothing stays the same can alleviate feelings of hopelessness, helplessness and overwhelm.

We all struggle to hold on to others and to things, and resist impermanence. This leads to tremendous suffering. The incorrect belief that things are “stuck” and will never change also results in great suffering.   I have observed in my years as a psychotherapist that the struggle to resist impermanence and the belief that things don’t change are universal. It is only through letting go of the resistance to change and impermanence that true healing and growth is possible.

For example, many of my clients with depression feel mired in difficult situations that they believe are permanent. It can take a lot of work for them to give up the beliefs that keep them stuck. I too am prone to depression. My Buddhist practice and study have been invaluable in helping me let go of my negative beliefs. I now know that those beliefs are just insubstantial thoughts that I no longer need to hold on to. Of course, I get thrown back into feelings of hopelessness on occasion. When that happens, I call on a friend to remind me that whatever situation is getting me down is impermanent and will change. My friend’s reminders are just what the doctor ordered at those times, and I feel a tremendous weight lifting and the restoration of hope just from hearing the words “remember that it’s impermanent.”

A big part of my psychotherapy practice is working with grief and loss. I have found that clients who have difficulty acknowledging that everyone dies have a very difficult time processing their grief. Of course, the death of a loved one or beloved pet is never easy. Although death is never easy for those left behind, always remembering impermanence helps ease the way, and despite profound sadness and grief, those who “grieve well” know that death is a natural part of life.

One of the most significant moments in my meditation practice occurred about fifteen years ago. My wonderful cat Andy was “meditating” with me at the time. I recall having a clear realization that Andy would not be with me forever. My emotions went from sadness to acceptance. I was left with a profound sense of the preciousness of life, knowing that the fact that nothing lasts is what makes life so precious. Andy, who died last summer, has ever since been my reminder of both impermanence and the preciousness of life. As the great Buddhist master Dilgo Khyentse Rinpoche said:

                                     Life is fragile, like the dew hanging delicately on the grass,  crystal drops that will be carried away on the first morning breeze.                                

                                                                            

GRIEF AS AN ESSENTIAL INGREDIENT IN GROWTH AND HEALING

 

As a psychotherapist, I am constantly inspired by my clients’ courage and commitment to change, and their willingness to face their struggles with open eyes, minds and hearts. My clients have taught me that an essential ingredient in overcoming and healing from life’s difficulties is grieving what has been given up in the name of growth– even if it is something negative or dysfunctional like addiction or an abusive relationship.

My work with “Sally” beautifully illustrates the healing power of grief in growth. Sally came to see me regarding her difficult relationship with her mother. It became apparent to me early on that Sally was tethered to her mother and that her mother was controlling, narcissistic and manipulative. Sally clearly loved her mother, and it was understandably difficult for her to see how her life was enmeshed with her mother’s and controlled by her mother’s neediness. Despite being a “grown up” with a keen intellect, wonderful sense of humor and a successful career, Sally still lived with her mother. When declining health forced her mother to enter a nursing home, Sally lived alone for the first time in her forty years of life. At first, she was fearful of living alone, and was unclear about what she wanted in her living situation. Sally has gradually gained more confidence in her ability to live independently, and eventually bought the family home, which is now in her name alone.

More importantly, with the perspective of space and time, Sally was finally able to clearly see who her mother is and the impact she has had in Sally’s life. She has essentially gone through the stages of grief described by Dr. Elizabeth Kubler-Ross, a psychiatrist who delineated the process people in grief experience.

The first experience Dr. Kubler-Ross describes in the grief process is denial. Sally was in denial for many years about her mother’s manipulative and narcissistic nature. People consider denial a “bad” thing, but it is necessary to our survival until we are ready to move on. Sally’s denial allowed her to maintain the status quo, which included career success. It was only when the status quo became uncomfortable and no longer workable that Sally was able to move forward in her process of growth.

The second grief experience described by Kubler-Ross is anger. I was hopeful that at some point in our work together Sally would have the courage to be angry at her mother as a step on her path to separate and differentiate from her. As a deeply spiritual person, Sally believed that anger was “wrong.” It took a while for Sally to understand that there is an inherent wisdom in the energy of anger, simply telling us that something is not right. Sally was ultimately able to express anger about her mother’s manipulation and control. This was a huge factor in Sally’s emotional separation and differentiation from her mother. She was able to use the energy of her anger to make the wise decision to buy the family home.

The next stage in Kubler-Ross’s model, bargaining, played out in a number of ways in Sally’s journey to healing and growth. When her mother first moved to the nursing home, Sally visited her daily, at a great cost to her own health and emotional wellbeing. On the brink of exhaustion, Sally has made a “bargain” with herself to visit her mother less often. This has been a gradual process for her, and has become increasingly easier despite her mother’s protestations as Sally has come face to face with her mother’s control.

When I assess for depression in the grief process, I always listen to how the bereaved talks about the loss. If the focus is inward on what he or she “should” have done, it may indicate depression, whereas if the focus is outward toward what has been lost, it is a sign of healthy grief. Sally rarely presented as depressed in our sessions. However, in her process of healing and asserting her independence, Sally did have some moments of depression. For example, she would berate herself for allowing herself to be manipulated by her mother and not seeing how her mother controlled her. I assured her that she did the best she could at that time, given her mother’s narcissism.

The last stage in the Kubler-Ross model is acceptance. It has been inspiring and beautiful to watch Sally work with the process of acceptance. Acceptance necessarily includes forgiveness. Sally has come a long way in understanding who her mother is, and she now sees that her mother’s mental ills resulted in large part from being emotionally abused by her own mother. Sally has also come a long way in seeing that her mother’s actions toward her were also abusive. She is grieving the opportunities she has missed because of her enmeshment with her mother, and has developed self-understanding and self-forgiveness. In giving up what she considered an idyllic relationship with her mother, Sally has been grieving the loss of what was, while also rejoicing in her new wisdom, confidence and growth.

 

FACING THE GRIEF OF AGING AND EMBRACING YOUR LIFE

I look in the mirror and see new lines on my face, a bit of drooping in places that never drooped before. I could wallow in self-pity and mourn the loss of my youth.  Instead, I choose to celebrate my years and experience.

I reflect on the rich, crazy and wonderful times I experienced in my life – being a hippie in the ‘60s; being a denizen of CBGB’s and part of the burgeoning punk rock scene in NYC in the ‘70s; coming into my own in the ensuing years; experiencing life as an entertainment lawyer, and giving it up to follow my dream to become a psychotherapist.

Here are some tips I have learned for embracing aging and letting go of grieving the loss of youth:

  • Know that wisdom comes from life experience, not from reading about it.
  • Appreciate yourself and what you have learned.
  • Celebrate your accomplishments.
  • Acknowledge your imperfections without judgment.  No one is perfect, young and old alike.
  • Accept your limitations.  So what if you can no longer run a four- minute mile?
  • Embrace patience.
  • Have compassion for yourself, and for all others on this path called human existence.
  • Celebrate impermanence.  After all, if things were permanent, nothing whatsoever would be possible.
  • Relish interdependence.
  • Reinforce your personal sense of spirituality through the beauty of nature, the arts and life’s little miracles.
  • Share your gifts and experience with others, and teach them what you have learned through life’s trials and triumphs.
  • Enjoy the quiet times.
  • Create a list of things you’d like to accomplish, and set about doing them.  It’s not too late.
  • Have a sense of honest humility about the things you’d like to accomplish but know that you may not be able to.  It’s OK.
  • Don’t dwell on regrets.  Again, nobody is perfect.  Acknowledge what you’ve learned from mistakes along the way.
  • Maintain a sense of humor and perspective, and laugh often.

TREATING TRAUMA AND GRIEF: A HIERARCHY OF NEEDS

John was referred to me for counseling after his wife was killed by a drunk driver in a head-on collision witnessed by John.  Mary came to see me for grief counseling after her husband died a painful and horrific death from cancer.  Louise is seeing me to deal with intrusive memories of her brothers’ emotional abuse when she was caring for her dying father.

These three situations are different in many ways – different relationships, different coping mechanisms, different types of deaths.  However, each of these individuals is experiencing traumatic grief.  It might be more accurate to say that they are experiencing the effects of trauma that are preventing them from processing their grief in a healthy way.

Through my work with many clients experiencing traumatic grief, I have come to understand that trauma must be processed before the loss of a loved one can be processed in a healthy way.  This truth brings to mind “Maslow’s Hierarchy of Needs.”

Abraham Maslow was a psychologist who posited that basic physiological needs, such as food and shelter, and then safety and security, must be attended to before one can accomplish “higher” needs, such as a sense of belonging, and ultimately, self-actualization and the achievement of one’s potential.  The classic diagram for Maslow’s Hierarchy of Needs is a pyramid, with fundamental physical needs at the broad base of the pyramid, and self-actualization at its pinnacle.

In describing self-actualization, Maslow (1943) said:

“[S]elf-actualization… refers to the desire for self-fulfillment.  This tendency might be phrased as the desire to become more and more what one is, to become everything that one is capable of becoming.”

The prioritization of needs to be attended to in the work of healing trauma and grief strikingly parallels Maslow’s hierarchy of needs.  This hierarchy is reflected in trauma therapies like EMDR, which works first on the physical realm, then the behavioral, cognitive, emotional and ultimately the spiritual realm of existence.

The physical effects of trauma can be tremendous.  Many traumatized individuals have difficulty sleeping due to intrusive images and thoughts.  They are often hyper-vigilant, leading to imbalances in the adrenal and other bodily systems. These physical effects can lead to other dire effects, such as deep depression and suicidality. It is thus critical to treat these physical effects of trauma as the first priority.  Moreover, if one is experiencing the physical effects of trauma, it is virtually impossible to process the loss of a loved one in a healthy way.

Moving up the pyramid, once physical symptoms are managed, it is necessary to deal with the behavioral dysfunctions that often result from trauma.  For example, a person trying to cope with trauma may turn to drugs or alcohol in a vain attempt to ease the pain.  He or she may also self-isolate and cut off sources of social support.  Finding healthy ways to cope and and cultivating support are important in healing trauma and grief.

Cognitive work can be seen as the next priority in processing trauma.  Negative self-beliefs go hand-in-hand with trauma.  For example, the surviving partner of a sudden or violent death may believe “it’s all my fault.” An individual dealing with an abusive relationship may believe “I don’t deserve love.”  Cognitive therapeutic work is thus necessary to let go of the power of such erroneous thoughts.

Once the grip of erroneous negative self-beliefs is loosened, and those beliefs are replaced with positive and healthy beliefs, one can then go about the work of healing grief.  The intense emotions and unpredictability of grief can be navigated successfully on the broad base of physical well-being, healthy ways of coping, and positive beliefs.

The healing of grief, like working to achieve the stages of Maslow’s Hierarchy of Needs, is a process of transformation and spiritual growth, i.e., self-actualization. The fruition of this process includes a sense of acceptance and realism, self-compassion and compassion for others, independence and interdependence, and an appreciation of life in all of its impermanence and imperfection.

References:

Maslow, A. H. (1943). A Theory of Human Motivation, Psychological Review 50, 370-96.

Maslow, A.H. (1943). Motivation and personality. New York: Harper.

 

 

The Healing Power of Love in Grief

The way we grieve is a result of what we learned about love and relationships as a baby. We all learned certain “rules” growing up about love, such as “don’t give your heart away” or “don’t love too fully or you’ll get hurt.”

Through my work as a grief counselor, I have come to believe that the grief process is akin to the process a young child goes through in separating from his or her primary caregiver (PCG). For the first few months of life, the infant experiences no separation from the PCG – they are one and the same. Little by little, the developing child comes to understand that he or she and the PCG are in fact separate beings. The child starts to experiment by crawling or walking away from the PCG, coming back as necessary for “emotional refueling.” Playing peek-a-boo games teaches the toddler that even though something may be physically hidden from view, it still exists. Around the age of three, the child is able to understand the more abstract notion that he or she can keep a representation of the PCG, in his or her heart, and with that emotional presence and support, can venture out further into the world without the PCG. The development of this capacity is called object constancy, i.e., “a coherent mental representation of important attachment figures.” (Worden, 1996, pp. 9-10, citing Bowlby (1963, 1980) and R. Furman (1964)).

The inability to retain a sense of object constancy, and to remember that the PCG is a resource even when she or he is not physically present leads to many difficulties in forming healthy relationships and good boundaries. For example, those with borderline personality disorder or other attachment disorders were unable to achieve the capacity for object constancy because the mother or other primary caregiver was neglectful or abusive, physically and/or emotionally and did not therefore create a sense of safety and trust in the growing child.

Grief theorist J. William Worden (2002) describes certain tasks a bereaved individual to complete in order to navigate the grief process in a healthy way. The first task is to accept the finality of one’s loss; the second task involves feeling, and not avoiding, the pain of one’s grief; the third task is to adjust to an environment without the deceased; and the fourth task is to “emotionally relocate” the deceased and move forward in life. This process of “emotionally relocating” the deceased loved one is akin to the development of object constancy.

This process of grief and love was illustrated in a poignant way with one of my grief therapy clients, who I will call “Joe” for the sake of confidentiality. Joe came to see me for therapy after the death of his young wife, “Jody” as it became clear that his suffering in his grief was unrelenting. A common theme in Joe’s lamentations was that his wife was quite mean to him, especially as her cancer progressed and affected her brain. Joe was unable to talk about Jody without crying, and he developed some unhealthy coping tools to assuage his pain. As the first anniversary of Jody’s death drew closer, Joe’s suffering increased.

I recently asked Joe if he loved Jody, and with tears streaming down his face, Joe for the first time in our sessions said that he loved his wife. It felt as if a dam Joe had built around his heart had burst, and he was able to open his heart to his love for Jody. This was truly a breakthrough in Joe’s path to healing his grief.

It was clear that Joe needed to find a place for the Jody he loved in his heart in order to move forward in life. For so many of us, like Joe, this is a process of having the courage to love wholeheartedly. Many of us hold back pieces of our love out of fear that doing so will make us too vulnerable. However, vulnerability is not a weakness and does not put us at risk of harm. Rather, the word “vulnerable” simply means the ability to be open. Being open allows us to see things more panoramically and makes us stronger, not weaker. More importantly, being open to loving fully allows us to keep our loved ones with us as a source of strength and support when they are not there in person.

Loving and living fully after loss often entails completing “unfinished business” with our loved one in some way, whether through therapy, journaling or other expressive means. We may need to forgive our loved ones for their human weaknesses, and also forgive ourselves for difficulties in the relationship. No relationship is perfect, and letting go of resentments, guilt or fear is an important piece of the process of finding an open place in our hearts for our loved ones who have passed. Only then can we relocate the deceased emotionally in our hearts, heal our grief and move forward in life.

WHAT MY CAT HAS TAUGHT ME ABOUT AGING AND DEMENTIA

My 16 year-old cat Andy has been showing the signs of dementia for the last year or so. Her symptoms worsened since the death of her beloved kitty playmate Lucy six months ago. Working with dementia patients in hospice, I have known on some level what helps in caring for them. Andy has been my personal teacher, helping me deepen my understanding of the needs of individuals with dementia, and I have learned so much from her on an emotional and heart level.

1. The need for safety.
Like children, dementia patients need to feel safe and secure in navigating their world. Andy has always been a “talker” – she may be part Siamese with her pretty blue eyes. However, her quiet meows have morphed into loud yowls. She sometimes seems to be in a panic. Talking to her in a soothing tone is helpful.

Andy has her own fleecy bed, which we bought for her after Lucy’s death. She seems to feel more secure when she is in it. The soft texture and rounded walls of her bed really seem to bring her comfort. In contrast, when she roams freely around the house, she appears lost, anxious and confused. This affirms for me that smaller rooms with familiar objects are most helpful for all with dementia.

2. The need for food, touch and motion.
I learned in my Human Development psychology class that what infants need most is food, touch and motion. That’s why we feed babies on a schedule, give them lots of affection, and rock them to calm them and help them sleep. The same applies to elders with dementia – including Andy. She asks for food like clockwork every two hours. So, we feed her on that schedule. Food is definitely comforting to Andy, and I believe the consistency of the schedule helps her too.

It goes without saying that we all need touch – Andy certainly does too. As to motion, I recently learned that picking Andy up and rocking her like a baby really helps soothe her when she is anxious. Similarly, we often see repetitive rocking motions in our hospice patients with dementia, demonstrating that rocking is an innate self-soothing response.

3. The need for caregivers to set boundaries and take care of themselves.
For a while, my husband and I followed the every two hour feeding schedule around the clock. However, we recently stopped doing this because we were becoming dangerously sleep deprived. Andy would be relentless at all hours of the day and night in her quest to be fed. It was difficult for me to stop giving in to Andy, and even more difficult to confine her to one area of our home during sleep hours. Having let go of my resistance to setting this boundary, I must say that it has been a huge help in keeping my husband and me healthy and less stressed out.

Self-care is vital for caregivers. I often remind my caregiver clients, both in my hospice job and in my psychotherapy practice, that if they don’t take care of themselves, they won’t be able to take care of others. It’s crucial to take breaks, set boundaries and get support. As they say in the safety announcement on airplanes, put your own oxygen mask on first before attending to others.

4.   The need to acknowledge grief and loss.
After witnessing my cats’ reactions to the death of their buddies, I am clear that animals experience grief. Andy’s grief is expressed in searching behaviors, seeking Lucy in the places where she would hang out before her death. Likewise, people with dementia experience grief and loss. Like young children, they may not be able to express their grief on a verbal level, but they definitely feel that someone important is missing in their lives. In caring for the bereaved with dementia, it is important to validate their feelings of loss and provide comfort and safety.

5. The need for validation, dignity and respect.
The need for validation, dignity and respect is universal. There is a tendency to treat the old and infirm like helpless beings who no longer have any worth. That is a mistake. We all want to remain independent and in control, to the extent possible, throughout our lifespan, as well as to be treated with dignity and respect, no matter what the circumstances.

The hospice staff does whatever we can to give all of our patients a sense of autonomy and dignity. This is also an instinctual need for cats, who retain the imprint of their past lives as predators in the wild. Accordingly, cats do what they can not to show weakness, to prevent becoming prey to stronger animals. With Andy, this is expressed as a need to assert herself and get her way – which we accede to within healthy boundaries.

Our elders deserve our respect, and not be abused or put down for their frailties. The same applies to cats – they are proud animals. (I guess that’s why they call a related group of lions a pride!). I do what I can to give Andy the dignity and respect she deserves.

6. The need for gratitude and acknowledgement.
We all want to be acknowledged for what we have accomplished in our lives, and to feel that sense of accomplishment. Humans do this by telling our life stories, as a way to create meaning and validate that our lives have had purpose. This is called “life review.” One way we engage in life review with our nonverbal hospice patients is to look at old photo albums together, or look at magazines about their interests and hobbies.

I intentionally take time to thank Andy for all the joy and comfort she has given me throughout the years, and for all of the richness she has contributed to my life. I don’t know if she understands my words, but I believe that she understands the loving energy that accompanies the words. So, thank you, Andy, for all of your gifts, and for this new gift as my teacher in your waning years.