THE INSIDIOUS FORCE OF MISOGYNY

 

Misogyny is an insidious and often subtle force that brings many women to therapy. The demeaning of women in the workplace, gender inequality at home, rape, sexual harassment, domestic violence, and other emotional and physical abuses against women result in symptoms ranging from depression and anxiety to PTSD.

Many of the women in my psychotherapy practice have experienced a significant increase in their symptoms due to the misogyny pervading our society since the election of Donald Trump.   Indeed, it has been widely reported that there has been a significant increase in existing, new and returning clients seeking help with post-election anxiety. As the Seattle Times recently reported (3/25/17) ,as many as 80 percent of potential new therapy clients are seeking help for post-election distress.

What makes misogyny so insidious is the unconscious acceptance — by women as well as men — of behaviors that demean women. For example, if a woman is attending a business meeting with male coworkers, she is more likely to be asked to take notes or fetch the coffee than one of her male colleagues. Even if the woman feels this is wrong, she may feel powerless to do anything but acquiesce. She may even offer to offer these “traditionally female” services out of her own unconscious conditioning. Compounding matters, women simply are not used to saying no or being assertive with male peers.

Women who are ambitious and successful are often seen as unlikeable “bitches.” Hillary Clinton recently said, in her interview with journalist Nicholas Kristof at the Women of the World Summit, “Certainly, misogyny played a role [in my loss of the presidency]. That just has to be admitted.” In his summary of the interview, Kristof wrote:

“[Clinton] noted the abundant social science research that when men are   ambitious and successful, they may be perceived as more likable. In contrast, for women in traditionally male fields, it’s a trade-off: The more successful or ambitious a woman is, the less likable she becomes (that’s also true of how women perceive women). It’s not so much that people consciously oppose powerful women; it’s an unconscious bias.” (New York Times, 4/9/17).

The constant barrage of bad news about the mistreatment of women in our society has caused significant re-traumatization in clients with a history of sexual abuse.   Events like the surfacing of the video of Trump with Billy Bush bragging about grabbing women’s genitals and the disclosures of Trump’s history as a sexual predator are triggers for anxiety and trauma. News of the culture of sexism at Fox News and elsewhere has re-triggered women who, like Hillary Clinton, have faced painful challenges in traditionally male fields.

One of the most disturbing aspects of misogyny is its unconscious acceptance by women, as Hillary Clinton noted. In fact, when I worked as a corporate attorney and executive, women were more apt to call me a “bitch” than men were (although sexism by my male peers certainly existed).

Women’s unconscious bias also spills over into heterosexual marriages. As a broad generalization, women tend to look to their husbands as the decision makers and tend to take on traditional roles of homemaking. In addition, women are generally expected to make less money than men (which is borne out by statistics of income inequality). This expected income inequality may also lead to marital conflicts, including resentment by women who earn more than their husbands, and self-esteem issues by men whose wives are the chief breadwinners in the family. While these gender-based norms and attitudes are changing, my clients report that they still pose significant challenges in their marriages.

The good news is that the recent presidential election and upsurge of reports of misogyny and sexual harassment by men in powerful positions has raised awareness of sexual oppression. As a child of the anti-war and feminist movements of the ‘60s and ‘70s, I am optimistic that the resistance and consciousness raising that have begun will continue and will reap positive results, as it did in ending the Viet Nam War, Nixon’s resignation and more equality for women in the ‘70s. The Women’s Marches the day after the inauguration in January augured a renewed sense of solidarity and confidence that we can all make a difference.

This renewed awareness of misogyny, sexism and inequality has already reaped positive results. Male clients have reported more understanding of and sensitivity regarding the challenges their female partners and colleagues face, and are willing to be more open and vulnerable with them. Women are less willing to ignore sexist behaviors and are speaking up more and more.

In addition, the onslaught of news in the media of sexual inequality and assaults provides an opportunity for women to look at their own assumptions and prejudices regarding men. As James Gordon, a psychiatrist and founder of the Center for Mind Body Medicine, wrote in The Guardian (2/9/17), Donald Trump represents the archetypal fool or trickster, who holds a mirror up to our own foibles and failings. Gordon aptly states:

“[The fool] performs a vital social function, forcing us to examine our own preconceptions, especially our inflated ideas about our own virtue. Trump was telling all of us – women and minorities, progressives, pillars of the establishment, as well as his supporters – that we were just like him.”

Ultimately, the fool is not there to taunt us, but to teach us to look at our conscious and unconscious preconceptions and prejudices. As Gordon concludes:

“The joker who is now our president has served an important function, waking us up to what we’ve not yet admitted in ourselves or accomplished in our country. He is, without realizing it, challenging us to grow in self-awareness, to act in ways that respect and fulfill what is best in ourselves and our democracy.”

The time is ripe for awakening and the dawn of an enlightened society. Instead of shunning and demonizing the Trumps in our lives, it is time to look at them with compassion for their ignorance and self-destructive aggression and arrogance. And, it is time to look at ourselves and work to promote understanding, healing and equality for all.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

© 2017 Beth S. Patterson. All rights reserved

OVERCOMING THE NEGATIVITY BIAS: A MINDFULNESS APPROACH

As neuropsychologist and mindfulness teacher Rick Hanson says “the brain is like Velcro for negative experiences, but like Teflon for positive ones.”[1] What Dr. Hanson describes is known as the “negativity bias.” The negativity bias is hardwired in the human brain. Early humans needed this brain bias for survival purposes. The negativity bias allowed our ancestors to learn behaviors that became hardwired in the brains of their descendants in order to avoid danger and stay alive. The negativity bias remains part of the human brain today, and impacts our wellbeing in many ways.

The Impact of the Negativity Bias in Daily Life

Research in neuroscience shows that the brain reacts more strongly to negative stimuli than positive ones. We hold on to negative memories much longer and more strongly than positive ones, like what Dr. Hanson describes as Velcro.  This hardwiring stimulates the brain’s fight, flight or freeze hyper-vigilant responses to perceived threats, and affects us physically, cognitively and emotionally.

On a physical level, hyper-vigilance affects our adrenal and cortisol systems, resulting in sleep disturbances, fatigue, shortness of breath and numerous other physical issues. Emotionally, we may experience anxiety, fear, confusion or anger. Cognitively, we may develop strong negative beliefs, such as “I don’t deserve love”, “I cannot trust others”, or “I am not safe.”

For example, if someone has experienced the sudden death of a loved one, she may react with great fear and anxiety each time she is unable to reach another loved one. If someone is judged or ridiculed at work for suggesting a novel approach to working with a challenge, he may be less inclined to offer suggestions again. And, if one grows up with an abusive parent, she may come to believe that she is unlovable and that no one can be trusted. These associations the brain makes are like tangled knots in a ball of thread that link new experiences with old negative experiences.

Overcoming the Negativity Bias through Mindfulness

The good news is that the negativity bias can be overcome through mindfulness, and the tangled knots of association can be loosened and untied. The first step is to become aware of the brain’s negativity bias and that the brain links different events and experiences together, like the 0’s and 1’s of a binary computer. This awareness helps us then determine if something we are experiencing is truly a threat to our safety or wellbeing. If it is a threat, we can take appropriate action. If it is not a threat, we can learn to let go of the impact of a perceived negative experience, seeing it for what it is.

Mindfulness can actually rewire the brain to hold on to positive experiences in a productive and healthy way – more like Velcro than Teflon. The practice of mindfulness meditation teaches us to be present, moment-to-moment, and not just live in our thoughts. The irony is that through mindfulness meditation, we become more aware of our thoughts. The difference is that we no longer need to get carried away by our thoughts, and expand a single thought into an epic novel. We learn to let thoughts go and return to the experience of the present moment.

Being mindful also makes us more aware of the negative and self-limiting thoughts that have kept us from being fully and joyfully alive. Mindfulness is not limited to sitting on a cushion and watching our breath. In fact, in addition to sitting meditation, I often “prescribe” mindful walking, mindful dish washing and mindful driving to my clients as ways to learn to be present with whatever it is they are experiencing. The key is to notice the thoughts and come back fully to whatever it is you are experiencing.

Without mindful awareness, our negative thoughts are the omnipresent background noise of our lives. Becoming aware of our negative self-talk and thoughts allows us to separate ourselves from them, to challenge and even eliminate them. Cognitive therapy, including mindfulness-based cognitive therapy, offers another way to do that, and works well with mindfulness practices.

The more present we are, moment-to-moment, the more we can experience the small joys of being alive.   We are more able to fully savor positive experiences and make them a part of who we are, without judgment. We come to realize that joy and presence is our birthright.

A highly effective way to rewire the brain to respond more to positive experiences is the “gratitude exercise”: Every night before you go to bed, write down five things you are grateful for that happened that day. When I assign this exercise to depressed clients, I may hear the complaint “but I have nothing to be grateful for.” I respond to this by pointing out positive things in the environment they can experience directly, such as a sunny day or a bird singing outside my office window.

The gratitude exercise and learning to be mindful in the present moment allow us to short circuit and rewire the brain’s negativity bias. We can then open our eyes and hearts to life, with all of its joys and sorrows, and fully appreciate who we are.

 

[1] R. Hanson, “Take in the Good”, www.rickhanson.net, June 2015.

 

 

© 2016 Beth S. Patterson. All rights reserved.

 

STAYING SANE IN AN INSANE WORLD

The world around us may seem chaotic and downright insane these days. Here are some tips for remaining sane amidst the world’s seeming insanity:

Impose news and media “blackouts.” It is so easy to get caught up in the frenzy of the ever-changing news these days. Imposing limits on watching television and looking at and interacting with social media is of critical importance.

Limit news watching to one hour a day. The 24/7 news media like CNN work by sucking you in. Resist the temptation to be glued to your television or digital news media, and limit watching to one hour a day.

Be aware of triggers and trauma. The insanity of the world around us can make us feel unsafe and distrustful. In fact, many of my clients have been reporting an increase in anxiety and reactivation of old traumas, due to the pervasive news of sexual assaults, deceptive practices, gun violence, racism, war…and the list goes on. It is important to understand these triggers and develop self-compassion around them. Professional support can help us heal and develop a sense of safety and trust.

Spend time with friends and family. When we are feeling stressed out, anxious or depressed, it is so easy to isolate ourselves. Be sure to make time for the people in your life who nurture and support you.

Be mindful of negative thoughts. Negative thoughts of anger, fear, hopelessness and despair can proliferate automatically when the world around us seems chaotic. If we are not mindful about our thoughts, they can become epic novels! If you have a mindfulness meditation practice, make sure to practice and stay vigilant about discursive thoughts. If you do not have a mindfulness practice, there are many apps, such as HeadSpace that can be helpful.

Practice self-care. Stress is exhausting, both emotionally and physically. Get a massage, take a walk in nature, cuddle with your pets and loved ones. This is particularly important for those of us in the caring professions. Do all you can to not take on the traumas and stress of clients or patients. Maintain healthy boundaries. Be mindful not to take on others’ stress or trauma by maintaining healthy boundaries. Get support from others if you are experiencing secondary trauma or overwhelm.

Practice staying in the present moment, moment to moment. Being in the present moment is like an oasis in the desert. Mindfulness isn’t limited to sitting on a cushion. Our time “on the cushion”, so to speak, prepares us for out daily lives “off the cushion.” For example, if you are washing the dishes, be present with that: Notice how your hands feel in the soapy water. Feel the sensations of your sponge wiping the plates. When thoughts arise, simply return your attention to washing the dishes. This can be done with any daily activity, such as driving.

COMPASSION: A REMEDY FOR TURBULENT TIMES

The world today is full of turbulence and uncertainty. We wake up to bad news every day. News of mass shootings, terrorist strikes, political dysfunction, natural disasters and other woes dominate the news and social media. On top of that, of course, are the personal struggles, losses and challenges of daily life. Compassion is the remedy for staying open and kind in turbulent times.

In these difficult times, it can be challenging to maintain open-heartedness and kindness toward ourselves and others. We may feel that we are being tossed by the stormy waves of chaos. We may experience anxiety or trauma hearing about all of the misfortunes and confusion in the world. These times can reawaken our feelings about prior struggles we have endured, whether personally or societally. For example, terrorist bombings can bring up our feelings after the attacks on 9/11, as if it were yesterday.

When we are experiencing inner turmoil, it can be easy to harden our hearts, isolate ourselves, and get swept away in the contagion of negativity, hatred, aggression all around us. However, these turbulent times also provide an opportunity to open our hearts and develop compassion for ourselves and all other beings. In Buddhist terminology, this is the path of the Bodhisattva, those who strive to benefit all beings. Compassion is the key that opens our hearts with kindness toward ourselves and all others.

THE THREE-STEP EMOTIONAL RESCUE PLAN

If we are not mindful, we may automatically react to hatred with more hatred. I had a chance to notice and work with this reflexive impulse recently. A transgender acquaintance told me that she was brutally attacked by two men for how she looks and dresses. I noticed that my automatic urge was to say “what idiots!” Instead I used the “Three-Step Emotional Rescue Plan” described by Dzogchen Ponlop Rinpoche, in his new book Emotional Rescue: How to Work with Your Emotions to Transform Hurt and Confusion into Energy That Empowers You.

Instead of immediately afflicting more hate, I took the first step of the three-step plan, “mindful gap”, and breathed in my bodily and emotional response. Stepping back in this way, I was able to take the second step, what Rinpoche calls “clear seeing”, to get a more panoramic view of the situation. In doing so, what I said instead is “those poor ignorant men, who are so frightened by people who don’t look like them.” This pacified my negativity, and allowed me to “let go” (the third step of the emotional rescue plan), with a sense of compassion for my acquaintance, for these men, and for all of us who sometimes act wrongly out of passion, aggression or ignorance.

COMPASSION FOR SELF AND OTHER

Self-compassion does not mean resignation or self-pity. Rather, it means allowing yourself time to feel your pain and difficult emotions without judgment. Notice when you are under the sway of negative self-talk, negative thoughts or intrusive memories. It is helpful to think of these negative thoughts and memories as leaves floating down the stream. Despite their seeming power, thoughts and memories are fleeting and ephemeral, and have no true substance.

The word compassion literally means “suffering with.” Self-compassion is the first necessary ingredient for extending your compassion to others, with the understanding that pain and suffering and the wish for peace are universal. You cannot really extend compassion and “suffer with” another without self-compassion.

This concept was beautifully described by the Japanese writer Haruki Murakami in his book Colorless Tsukuru Tazaki and his Years of Pilgrimage:

One heart is not connected to another through harmony alone.
They are, instead, linked deeply through their wounds.
Pain linked to pain, fragility to fragility. There is no silence
without a cry of grief,… no acceptance without a passage
through acute loss. That is what lies at the root of true harmony.

I would like to offer some practical suggestions for maintaining compassion in difficult times:

• Take a break from the media. It can be tempting to watch the news all day and obsess about the woes in the world on Facebook and other social media.

• Take breaks from your devices. Staying glued to them day and night can increase stress and prevent us from being in the present moment.

• Turn off the television and all digital devices at least 30 minutes before bed. Instead, read a good book, cuddle with your pets, talk with your partner or take a warm, soothing bath or shower.

• Do something that you enjoy fully every day. Take the time to relish and appreciate those moments as they are occurring. Make the wish that all others have moments like these.

• Take time to smile and laugh. Exercising our smile muscles naturally relaxes us and creates feelings of positivity and optimism. It is said that laughter is the best medicine, and indeed it is. Moreover, a sense of humor creates perspective and more spaciousness.

• Practice self-care. It is important in stressful times to take care of your physical health. Although it may sound obvious, make sure to get plenty of rest, eat healthily, drink water and herbal tea, cut down on caffeine and alcohol.

• Create a good balance between caring for yourself and caring for others. Devoting all of our time and energy to the well-being of others without taking care of ourselves can result in what is called “compassion fatigue.”

• Maintain a healthy balance between alone time and time with others. It is important to take time for yourself, to meditate, journal, exercise, take a quiet walk or read. At the same time, be vigilant not to isolate yourself. Spending time with friends, family and your spiritual community are as important as alone time.

• If you have a spiritual practice, maintain it. This will help you open your heart to yourself and others.

• Notice the tendency to judge others. For example, when passing a homeless person on the street, notice any tendency to cast judgment. Instead, extend compassion to that person, knowing that he or she is suffering.

• One of the best and most healing ways to practice compassion is to extend it to those we see as aggressors and perpetrators. For example, as an eyewitness to the horrors of 9/11 in New York, part of my healing was to extend compassion to the nineteen terrorists who flew the planes into the World Trade Center. I remembered that they were young and confused and acted out of ignorant passion. This truly helped me heal.

• Feel gratitude. Despite all the ugliness in the world, there is much to be grateful for: friends and family, the beauty of nature, appreciation of others’ generosity and compassion, the song of a bird, the purr of a cat.

• If you are experiencing secondary trauma from witnessing or hearing about the horrors in the world, or if you are experiencing compassion fatigue or increased anxiety or depression that are interfering with your daily life, seek guidance from a spiritual advisor or psychotherapist. The world today can be overwhelming, and professional support can be helpful in alleviating your personal suffering.

References:

Dzogchen Ponlop. (2016). Emotional Rescue: How to Work with Your Emotions to Transform Hurt and Confusion Into Energy That Empowers You. New York: Tarchen/Perigee.

Haruki Murakami, (2014). Colorless Tsukuru Tazaki and his Years of Pilgrimage. New York: Alfred A. Knopf.

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.

 

 

USING EMDR TO UNCOVER AND HEAL SHAME AND EXISTENTIAL DESPAIR

Shame is one of the most difficult feelings for humans to acknowledge and express.  It becomes a vicious circle:  We feel shame about an event or action in our lives, and then feel shame about our shame.  Shame causes self-doubt, depression and deep suffering and prevents us from living freely, fully and authentically.  Our shame causes us to monitor what we say and do, out of fear of saying or doing the “wrong thing.”

As a humanistic, existential and Buddhist psychotherapist, my primary goal is to help my clients uncover the truth about the cause of their suffering so that they can live full and satisfying lives. Through my work with a client I will call “Bill”, I have discovered the power of EMDR[i] as a tool in this process.

Bill came to see me complaining that he was not able to experience joy or passion in his life, and felt that nothing he was doing had any meaning.  This is an apt description of existential despair. Bill had not suffered any recent crises that would account for his angst, and on the surface, his life looked quite successful:  Bill is a brilliant scientist, in a good marriage and has a high paying job.  He is athletic and is an avid cyclist and skier.  However, Bill was unable to experience any joy, passion or satisfaction from his accomplishments and activities, saying that he had a “nagging feeling that something is missing.”

Bill and I spent many sessions trying to identify the source of his existential despair.  He described growing up in a small mid-western town.  His parents divorced when he was 16 years old, and he and his brother lived with his father.  Bill has been estranged from his mother for over 20 years.  He described his mother as having an “alternate lifestyle” as a Lesbian and artist.  It was clear to me that he was doing what we therapists call “splitting” – seeing his father as all good, and his mother as all bad.  However, my attempts to go there with him were futile.

Bill tended to describe painful experiences, like the recent death of a friend and his parents’ divorce, intellectually, factually and with little emotion. My attempts to go deeper would be met with the response “I don’t know”.  After several months together, Bill acknowledged a deep fear of expressing his emotions, saying, “what if I express myself and no one accepts it?”  Attempts to explore his fear more deeply were met at that point with more “I don’t knows” and intellectualizing.  I observed how difficult it was for Bill to directly experience his body sensations and emotions.  He acknowledged that he has always relied on his intellect as a way to cope.

In addition to Bill’s fear of rejection if he expresses himself, he came to realize his deeply held belief that “If I were a good enough person, my life would have more meaning and joy.”  We explored what this meant to him, and I asked Bill what unfinished business he might need to complete, and what he would need to accomplish if he had a terminal diagnosis – the big existential question.  It was clear to me that his estrangement from his mother was the elephant in the room, but Bill was unable or unwilling to go there at that point in our therapeutic relationship.  I believed then that EMDR (see footnote 1) would help forward Bill’s journey of self-discovery. Bill agreed to give it a try.

Our first task in preparing Bill for EMDR was to get him to feel safe feeling his body sensations and emotions, and our next task was to identify a target for our EMDR work.  He identified the target as his fear of being emotional, and described the incident representing the worst part of this issue as being rejected by a girl in elementary school after he gave her a gift.  The negative belief he took from that experience was “I will get hurt if I express my feelings”, and the positive belief he wanted to have instead was “I am safe to express myself.”  Bill was able to complete the work on this target in one session.  However, we both came away with the feeling that there was something more.  I encouraged Bill to note any insights and new memories that might arise during the week before I saw him again.

Bill came in the following week saying that after our EMDR session, he started experiencing profound shame about his parents’ divorce and his feelings about his mother’s lifestyle.  We discussed how painful shame is, and I validated his difficulty in acknowledging it.

My experience as a therapist, and as a former client in therapy, has taught me how unbearable the experience of shame can be.  We will do almost anything to avoid it – risky behaviors, blaming others, acting out in any number of ways.  Shame unacknowledged can lead to deep depression as a result of internalizing the negative messages we received earlier in life.  In acting out his shame, Bill made his mother the “bad guy” and was unable to take pleasure in his life, a form of self-punishment.  He had internalized his family rules “don’t air our dirty laundry” and “don’t express your feelings” to such an extent that he was living an inauthentic life, leading to his existential despair.  Bill’s fear of feeling the full panoply of life’s emotions resulted in his dissatisfaction and belief that his life lacked meaning.

Bill’s nascent awareness of his shame placed him in what Naranjo (1993, pp. 52, 63) has called “a limbo where the surface games of the personality have been dropped and self-awareness has not [yet] taken its place.  Shame… [is] not [a] pure experience[] of reality, but the outcome of attitudes in which we stand against that reality, denying or resisting it, fearing to perceive it….Shame  [is a] mind-created curtain that we interpose between ourselves and the world.” [ii] This curtain of shame prevents us, like Bill, from fully and directly experiencing life and all of its riches, whether painful or pleasurable.

Bill asked to do another EMDR session around this issue.  The negative belief he has carried about his shame was “I am insignificant” and the positive belief he wanted to have instead is “I matter.”  The emotions that he felt were grief, despair and shame.  Through the EMDR process, Bill discovered that he has spent an inordinate amount of time trying to avoid his feelings and be “perfect”, and that he projected his shame on his mother and others who he perceived as not good enough.  He also felt tremendous guilt about the way he treated his mother.  After processing the disturbing feelings, Bill discovered that truest positive belief for him was “I forgive myself.”  This was a deeply moving session for both of us.

Bill came in to our next session saying that he felt that our work was complete for the time being.  He said that he had blamed his mother for everything, in his black and white thinking, and was in the process of writing a letter to her to acknowledge this and hopefully begin a relationship with her.  Bill said he had a tremendous sense of relief about this, and he felt more appreciation for his life. I encouraged Bill to use “I forgive myself” as his mantra when he felt the tendency to retreat behind his curtain of shame. Bill knows that he is on the path to continued healing, and, with his newly gained tools, is not afraid or ashamed to meet the challenges that lie ahead.

[i] EMDR is a scientifically proven therapeutic protocol for overcoming trauma and other life difficulties.  EMDR utilizes “bilateral stimulation”, i.e., sensory stimulation alternately on both sides of the spinal cord to release traumatic material from the brain in a way that makes it workable. Trauma that is locked in the brain leads to the “fight, flight or freeze” response. EMDR helps release traumatic images, transforming them into memories that no longer have a deleterious hold on the individual.   In addition to this physiological response to trauma, the traumatized individual also develops negative beliefs about him or herself (such as “I do not deserve love, “I was at fault,” etc). EMDR allows the individual to replace negative cognitions about him or herself with positive ones (such as “I deserve love”, “I did the best I could”, etc.).  EMDR also works on a somatic level, with the therapist guiding the client to feel the traumatic images and negative beliefs in the body, thus further facilitating the transformation of the images into non-intrusive memories, and also transforming the negative beliefs into positive, useful ones. Therapists need to be trained to practice EMDR, and follow a standardized protocol in EMDR work with clients. (The foregoing is a brief summary of EMDR, and is not intended to be a full explanation of the process.)

[ii] Naranjo, C. (1995).  Gestalt Therapy:  The Attitude and Practice of an A-theoretical Experientialism.  Gateways/IDHHB Publishing:  Nevada City, CA.

Using Mindfulness Meditation to Overcome Trauma

  • Interview with Jaleh Donadlson, MFT, published by Yahoo Associated Content

Have you experienced a trauma in your life that seems to interfere with your daily living? If you answered, “yes” then mindfulness meditation could be a great way for you to overcome the impact that the trauma has had on you. To help understand what type of impact a trauma commonly has on someone’s life and how mindful meditation can help you overcome trauma, I have interviewed therapist Beth Patterson.

 

Tell me a little bit about yourself.

“I am a licensed psychotherapist and grief counselor in Denver, specializing in grief, loss and life transitions, depression anxiety and trauma.  After a long career as an entertainment attorney in New York City, I moved to Colorado and obtained a masters degree in transpersonal counseling psychology fromNaropa University, a Buddhist-inspired University in Boulder.  I have received advanced training in EMDR, which has been proven to be highly effective in treating trauma, anxiety and other issues.  I am also a certified mindfulness meditation instructor.  In addition to my private practice, I am the Life Care Coordinator and Bereavement Coordinator for SolAmor Hospice in Denver.”

 

What type of impact can a trauma have on someone’s overall life?

“Unresolved trauma can affect every aspect of a person’s life: physically, socially, emotionally, cognitively and spiritually.  Intrusive thoughts and images can impact a person’s sleep, eating and overall health.  The flight, fight or freeze response in coping with unresolved grief can impact a person’s social and emotional life.  Trauma is usually accompanied by negative beliefs such as “I am not safe”, I do not deserve love”, “The world is a terrifying place”, “God cannot help me”, “I deserved to be hurt”, etc.  This obviously affects the traumatized individual’s cognition and spirituality.”

How can mindfulness meditation help someone overcome their trauma?

“There are a number of ways that mindfulness meditation can be a powerful tool in healing trauma.  Mindfulness meditation helps free people  (whether traumatized or not) from the seeming power of their thoughts, helping them stay in the present, rather than dwelling on the past or worrying about the future (which don’t exist any way, from a Buddhist point of view!). In addition, I have found in my practice that many people dealing with depression, anxiety or trauma are not connected to their bodies. They literally live in their heads.  Mindfulness meditation helps a person focus on the breath and notice where thoughts and emotions are felt in the body. This experience can help the traumatized person get grounded, which is the first step in working with trauma.  As the person with trauma gets more in touch with his or her body, using the breath as a vehicle for grounding and staying presence, the traumatic images and thoughts can be released.”

What would a typical mindfulness meditation session be like for someone who wants to recover from their trauma?

“It has often been said that a healthy relationship between the therapist and client is what ultimately creates healing. Thus, the first step in working with traumatized individuals is creating an atmosphere and relationship of trust and safety.  Each individual is different, and different approaches may need to be used to create safety, trust and grounding.  In addition, for deeply traumatized individuals, the process may be more gradual, as it may be difficult for those individuals to stay in their bodies and in the present.

Once a safe and trusting relationship has been created, mindfulness meditation instructions are given. The first step of mindfulness meditation is the posture. Sitting in a relaxed yet upright position so that the breath can flow freely, and feeling both feet firmly on the floor.  This simple instruction to feel one’s feet on the floor can be incredibly grounding for a person experiencing trauma, and in fact anyone.  The next instruction is to follow the breath, noticing the coolness of the breath on the inhale, and the warmth and sense of release on the exhale.  When thoughts arise, simply notice them and let them go, coming back to the breath.  The client would then practice, first with verbal instructions, and then on his or her own, for a few minutes.  We would then review what occurred during the mindfulness meditation.  Of course, it is not easy for someone in a heightened emotional state to stay with the breath, and this would be validated and any progress made acknowledged.  I would ask the client to practice on his or her own between sessions, for no longer than ten minutes at first, then gradually increasing the length of the sessions. I would encourage the client to keep a journal of what is noticed.”

Would other forms of therapy need to be included in order to maximize the impact of mindfulness meditation?

“Cognitive therapy is always a component of trauma work, as noted above, helping traumatized clients realize that their negative beliefs about themselves and the world are not accurate, and ultimately replacing those beliefs with more positive and productive ones.

I have had wonderful success with EMDR in healing trauma.  EMDR stands for Eye Movement Desensitization and Reprocessing.  It was discovered that some form of stimulation on both sides of the body, whether in the form of bilateral eye movements, tapping, and sounds or other forms, releases the traumatic material that is literally stuck in the brain in a way that makes it workable.  EMDR helps release traumatic images, transforming them into memories that no longer have a deleterious hold on the individual.   The beauty of EMDR is that it works on a cognitive level as well as the physiological level, not only facilitating the release traumatic images from the brain, but also allowing the individual to replace negative cognitions about him or herself with positive ones.  EMDR also works on a somatic level, with the therapist guiding the client to feel the traumatic images and negative beliefs in the body, thus further facilitating the transformation of the images into non-intrusive memories, and also transforming the negative beliefs into positive, useful ones.

Dream work, journaling and letter writing are other useful adjuncts in working with trauma.”

Thank you Beth for doing the interview on how mindfulness meditation can help someone overcome trauma. For more information on Beth Patterson or her work you can check out her website on http://www.bethspatterson.com/.

EMDR as a Healing Tool in Transforming Traumatic Grief

The intense and painful experiences of grief are generally considered “normal.”  However, when those experiences are extremely distressing, unduly interfere with day-to-day functioning or do not subside to a manageable level over time, the bereaved may be experiencing complicated or traumatic grief.  Complicated grief has been proposed as a new diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders (DSM), and suggested components of the diagnosis include (1) that sufferers experience bereavement by death; (2) that their reactions include intrusive and distressing symptoms, including yearning, longing and searching for the deceased; and (3) that the bereaved exhibit at least four marked and persistent trauma reactions, which may include:  “avoidance of reminders of the deceased,  purposelessness, feelings of futility, difficulty imagining a life without the deceased, numbness, detachment, feeling stunned, dazed or shocked, feeling that life is empty or meaningless, feeling a part of oneself has died, disbelief, excessive anger or bitterness related to the death, and identification symptoms or harmful behaviors resembling those suffered by the deceased” (Mitchell et al, 2004, p. 13).

Even in cases that do not fit the criteria for complicated grief as described above, the events surrounding the death may be sufficiently traumatic to interfere with daily functioning or result in unrelenting distress.  As a psychotherapist specializing in grief and loss, I have found EMDR (Eye Movement Desensitization and Reprocessing) to be an effective tool for alleviating trauma in grief.  As in grief, trauma affects the whole person — body, mind and spirit, and on a hierarchy of needs, trauma must be dealt with in order for the healing process of grief to proceed in a healthy, and healing, fashion.

What is EMDR?

In brief, EMDR was developed by psychologist Francine Shapiro after making a chance discovery that the lateral movement of her eyes reduced the intensity of disturbing material she was dealing with in her life (Shapiro, 1995, p. 2).  Dr. Shapiro spent several years scientifically studying this phenomenon, and found that bilateral stimulation, i.e., stimulation on both sides of the body — whether in the form of eye movements, tapping, sound or other forms — released traumatic material from the brain in a way that made the material workable. Trauma that is locked in the brain leads to the “fight, flight or freeze” response, and EMDR helps transform traumatic images into memories that no longer have a deleterious hold on the individual.

In addition to this physiological response to trauma, the traumatized individual often develops negative beliefs about him or herself (such as “I do not deserve love, “I was at fault” etc).  The beauty of EMDR is that it works on a cognitive level as well as the physiological level, not only facilitating the transformation of traumatic images in the brain, but also allowing the individual to replace negative cognitions about him or herself with positive ones (such as “I deserve love”, “I did the best I could”, etc.).  EMDR also works on a somatic level, with the therapist guiding the client to feel the traumatic images and negative beliefs in the body, thus further facilitating the transformation of the images into non-intrusive memories, and also transforming the negative beliefs into positive, useful ones. Therapists need to be trained to practice EMDR, and follow a standardized protocol in EMDR work with clients.

Case Studies

Two cases in my practice are illustrative of the effectiveness of EMDR in resolving traumatic grief.  “Carol”, the mother of two small children, came to see me complaining of ongoing distress after the death of her husband nine months before.  “Bill” was in a motorcycle accident, sustaining a broken leg. After being admitted to the hospital, Bill suffered a stroke and brain swelling, and died after being taken off life support two days later.  Carol was concerned about her irritability, particularly toward her children, and her anger toward Bill for dying and leaving her with two small children to raise alone. She also expressed guilt regarding her anger toward Bill, which I spent time validating and normalizing, since anger is often exhibited as a normal grief response.   Carol spent much time telling her story — a useful healing tool for making meaning of a seemingly senseless situation (White, 1995).  She did not exhibit signs of trauma for the first few months that we worked together.  However, as the anniversary of Bill’s death approached, Carol found it difficult to sleep, being awakened by intrusive images of Bill lying in the hospital bed and her shock when she learned of his condition.  We explored Carol’s negative cognitions around these images and Bill’s sudden death. The negative belief that that most impacted Carol was her belief that Bill’s death was her fault because she had a premonition that he would be in an accident, and she did nothing to prevent it.   In describing the images of Bill lying in the ICU and her belief that it was her fault, Carol felt tightness in her chest and had difficulty breathing. After two 90-minute EMDR sessions, Carol was able to replace her negative belief “I was at fault” with the positive belief “I did the best I could.”  She reported that she still, of course, experienced memories of Bill’s death, and reported she was very pleased that that she could feel sadness without guilt.  Carol was thus finally able to process her grief and loss in a healthy way.

My work with “Mary” was deeply profound and moving.  Mary’s husband “Don” suffered with Lou Gehrig’s disease (ALS) for three years, and Mary witnessed the horrible, inexorable ravaging of Don’s body while his mind stayed strong.  Mary’s expressed purpose for coming to see me was that she was unable to feel Don’s presence in her life.  Mary described Don as her soul mate, and I assured her that because of the strength of their bond, she would find a place for Don in her heart and feel his presence as a support in order to move forward. However, it was clear that she would first have to deal with the traumatic images that prevented her from fulfilling this step in her grief process.  The most disturbing image, and target for our EMDR work, was finding Don lying in a pool of blood on the bathroom floor after falling out of his wheelchair.  I taught Mary the “butterfly” technique, in which the client crosses his or her arms across the chest in a hug and taps alternately below each shoulder, simulating the bilateral stimulation used in formal EMDR sessions. I instructed Mary to use this technique at home as a resource when traumatic images arose.  After two sessions, with Mary working at home with the butterfly hug when disturbing images and emotions arose, Mary reported that those images had receded as mere memories that were no longer unduly disturbing.

Mary came into our next session glowing, and reported that she had felt a tug at the back of her shirt while sitting quietly one day and “knew it was Don, back in my life.”  She reported that she subsequently felt Don’s presence coming to her every night before she fell asleep.  Our trauma work was done, and Mary was well on the way to healing her grief.

Conclusion

My work with both Carol and Mary, as well as many others, has enhanced my confidence in my therapeutic skills in identifying and working with traumatic grief, and has increased my trust and faith in the effectiveness of EMDR as a healing tool in grief.

References

A. Mitchell, Y. Kim, H.G. Prigerson, M.K. Mortimer-Stephens. (2004). Complicated Grief in Survivors of Suicide. Crisis 25(1), 12-18.

F. Shapiro. (1995). Eye Movement Desensitization and Reprocessing:  Basic Principles, Protocols and Procedures. New York:  Guilford Press.

M. White. (1995). Re-authoring lives. Adelaide:  Dulwich Center Publications.

Children and Grief: A Story of Trauma, Abuse and Healing

In my therapy work with grieving children and adolescents, it is important for me to keep in mind that the child’s age and stage of development at the time of the loved one’s death will strongly influence the ways in which the child reacts and adapts to the loss. An understanding of the child’s emotional and cognitive development will enable me to determine how best to communicate about death with the particular child, to understand and empathize with the child’s experience and guide the child through the grieving and healing process with appropriate interventions.

For example, I successfully worked with a grieving twelve-year old girl, who I will call “Abby.” I worked with Abby both individually and in a small group with other grieving pre-teens at a hospice-based children’s grief support group. Abby’s maternal grandfather died suddenly and violently two years ago while cleaning his gun.  There is some uncertainty as to whether the death was accidental or a suicide.    Abby is an only child, who lives with her mother.   Although Abby did not speak with me about it, her mother has reported that Abby’s father physically abused Abby when she was four or five years old and he has been court ordered to not have contact with her. Abby has not seen her father (who is divorced from her mother) since she was six years old.  She had a very close relationship with her grandfather, and spent every Saturday with him, doing special things together.  Abby reports that since her grandfather’s death, she spends her Saturdays alone, mostly sleeping.

The Interdependence of Grief and Development

Childhood grief and development are interdependent:  The early death of a parent or other loved one affects a child’s development, and the child’s development affects how he or she will grieve and reconstruct his or her relationship with the deceased.  Furthermore, children re-experience their grief as they reach each milestone in their development.  .

Capacity to Grieve and Understand Death’s Finality

A child’s ability to understand the meaning and finality of death corresponds to his or her cognitive development.  For example, a three to five year old believes that the deceased person has gone away and will return at some point.  Thus, it is common for a child of this age to constantly ask questions such as “Where’s Daddy?”  and “When is Mommy coming home?” A child of five to approximately nine years of age  believes that death can be avoided.  Furthermore, a child in this egocentric phase also believes that his or her parent died because either the parent was bad or the child was bad, and that if the child is good, the parent can return.  This is thus seen as one of the most vulnerable and difficult developmental stages for adjusting to a parent’s death

In working with Abby’s grief over her grandfather’s death, I always kept in mind that she was dealing with her loss both from her current cognitive developmental stage, and from the earlier stages she was in when her father abused and then left her.  Thus, she was likely relating to her grandfather’s death emotionally from that earlier stage, and may believe that she is somehow be responsible for his death. The child at this stage needs someone who can clarify what the child is thinking and feeling, and can reassure and build self-esteem by praising the child’s accomplishments.   This is something that I tried to do each time I met with Abby.

Although Abby is able to grasp and verbalize abstract concepts about death, her grief process was still informed by early developmental issues of safety and trust, as well as the magical thinking of the child in latency.  Abby’s grandfather’s sudden and violent death, coupled with her father’s abuse and abandonment, seems to have made it unsafe for Abby to trust and truly connect with her peers at a life stage when peers and feeling accepted are so important to social and emotional development.

Developmentally, even in more “normal” circumstances, 12-year olds yearn to belong, but may feel different and isolated, as the brain and body go through a dramatic growth spurt instigated by a surge of hormones. Physically, a 12 year old girl is starting to become a woman, and may experience self-consciousness and awkwardness that may lead to withdrawal.  Emotionally, she may experience a strange and seemingly uncontrollable roller coaster of highs and lows exacerbated by pubertal hormonal changes, as well as grief over the impending loss of her childhood.  Cognitively, in moving from concrete to abstract thought, an introspective and intelligent 12-year old like Abby is increasingly aware that others may not share her feelings, thoughts and values.  A grieving pre-teen, like Abby, may also feel different because so few of her peers have experienced the loss of a loved one.  This recognition can lead to the first taste of existential alienation, causing further withdrawal.  Those who are more firmly in the formal operational stage of abstract reasoning can have a more panoramic view about these differences, and develop true compassion and empathy for others.  The child not quite out of concrete operational thought, especially one dealing with profound grief like Abby, may have a difficult time getting to that stage, and may regress to more egocentric behaviors, like those I have witnessed in Abby’s case.

Tasks of Children’s Mourning

Worden (1996) has identified four tasks of mourning:  (1) accepting the reality of the loss, (2) experiencing the pain and emotional aspects of the loss, (3) adjusting to an environment without the deceased, and (4) relocating the dead person in one’s life.  The satisfactory completion of these tasks depends on both the child’s stage of development at the time of the death and his or her adaptability and ability to attend to any unfinished tasks at later stages of development.

Accepting the Reality of the Loss

A child can accept the reality of losing a loved one when he or she understands, through the achievement of formal operational thinking, “the nature of abstractions such as finality and irreversibility” (Worden, 1996, p 13, citing Piaget, 1954).  Some grasp of such abstractions is possible during the concrete operational stage of cognitive development, and is only fully understood at the formal operational stage.  Thus, if a loved one dies before formal operational cognition has been achieved, the child will experience a deeper level of grief when he or she attains that cognitive stage and fully and deeply comprehends the finality and irreversibility of the loss.

This was clearly the case for Abby.  Abby has an understanding of the abstraction of death’s finality.  She has been grappling in our sessions with giving spiritual meaning to the finality of death.  My job was to empower Abby’s cognitive work by normalizing and validating her process and the private thoughts she has chosen to share with me, while at the same time providing a safe space for her emotional process.  Furthermore, as Abby was then a pre-teen on the cusp of profound developmental challenges, I needed to stay aware that as she comes to terms with the meaning of her grandfather’s death, her new cognitive abilities also opens her to a new level of understanding – and pain – about the loss of her father.

Experiencing the Pain and Emotional Aspects of the Loss

The pain and emotions of grief can be frightening for a child to experience. Awareness of the child’s capacity based on his or her stage of emotional development to cope with strong emotions is important. It is also important to assess the child’s coping and defense mechanisms, and their effect on how the child experiences the pain of the loss.

In Abby’s case, the abuse and abandonment by her father early in her life has left deep developmental holes and she has split off from her emotions, which has complicated her grieving process over the death of her grandfather.  Journaling in a group setting proved to be an effective means for Abby and the other group members to deal with their feelings, as well as allowing them to connect with the others and feel less isolated, empowered by the realization that they have all experienced a loss, and they are not so different, after all.

Adjusting to an Environment without the Deceased

This task is an ongoing process through progressive stages of development as well as important transitions throughout one’s lifetime.  The child– as well as the adult he or she will become –  re-experiences his or her grief at each stage of development as a result of his or her growing cognitive abilities, and also as he or she comprehends the vacuum left by the dead loved one, who is not there to nurture and support the child’s growth and achievements. An intervention I used with Abby was the creation of a memory box for her grandfather, in which she has placed pictorial depictions of their relationship.  We also did an art therapy project together when Abby returned from summer vacation.  This was primarily a non-verbal exercise in which Abby was able to “tell” her grandfather through the medium of collage about her summer activities and experience her emotions of loss and sadness on a somatic level.  My job in this process was to simply sit beside her and be an empathetic witness.  In joining with Abby in this way, we established a good degree of contact and trust.

Relocating the Deceased in One’s Life

As the child grows and changes, his or her relationship with the deceased parent or other loved one also changes (Christ, 2000).  Thus, according to Worden (1996), another ongoing task is to find new ways to memorialize the deceased loved one with the attainment of each developmental milestone:  Children need to “find a new and appropriate place for the dead in their emotional lives – one that enables them to go on living effectively in the world.”  The above-described art therapy projects have been helpful with Abby in this regard.  The narrative therapy intervention of letter writing was also helpful at this stage, having Abby write a letter to her grandfather.  This process helped Abby clarify her feelings and create a safe container for them, allowing her to relocate her grandfather and live an effective life.