Experiencing Physical Pain

I have practiced working with chronic pain for many years, using my mindfulness meditation practice as an aid. However, nothing prepared me for the experience the acute pain I recently endured.

I tried to relax around the pain, experience the physical pain directly without adding thoughts about it that lead to suffering, etc. – all the things that I tell my therapy clients and mindfulness meditation students. However, while in the throes of the most intense and excruciating moments of the pain, it was almost impossible to remember to breathe and relax. The following tips are intended as a reminder for myself , and an offer to others, when experiencing acute physical pain:

• Breathe and visualize creating space around the pain. Imagine soothing water or an elixir bathing the area in love and light.
• Listen to soothing music. Music can be so healing. Allow yourself to enjoy its beauty.
• Have someone rub your back, hold your hand, simply be a caring presence. It is so easy to isolate ourselves when we are in pain of any kind. Remember to reach out for support.
• Take a bubble bath, get a massage. Be kind to yourself.
• Listen to the song of a single bird. Notice the beauty of a single flower. Focusing on one thing helps calm the swirling emotions that accompany pain.
• Banish negative self-talk. This pain is not your fault or bad karma!

• Know that everyone experiences pain, and use this opportunity to develop compassion for yourself and others.
Of course, follow your doctor’s advice. When you are experiencing unusual pain, it is important to speak with your health care providers. Emotional and spiritual care are complements to physical care. As I have learned, pain is global – physical, emotional, social and spiritual. It is therefore important to support ourselves in all of these domains when experiencing physical pain.

Using Mindfulness Meditation to Tame Intrusive Thoughts

Intrusive thoughts — those pesky thoughts that can spiral from a simple thought into a full-blown novel — can interfere with our work life, as well as our life in all other areas, interrupting our sleep, intruding in our relationships and in enjoying our lives in the moment. We give so much power to our thoughts. Learning to let them go and not attach importance to them can be tremendously liberating. This is especially so with thoughts that are self-critical.

The first step in dealing with those intrusive thoughts is to be aware of them. Mindfulness meditation can be extremely helpful in dealing with our thoughts. Here are some basic instructions:

• Sit comfortably in a chair or on a cushion, making sure your back is straight yet relaxed, so that your breath can flow freely. If you are sitting in a chair, uncross your legs, feeling both feet on the floor. Unclench your jaw muscles, by resting the tip of your tongue directly in back of your teeth. Have your hands rest comfortably on each thigh, palms down.

• Breathe — notice your in-breath: the rise of your abdomen and chest, the feel of the cool air coming in through your nostrils. Then notice your out-breath — warm air coming out your nostrils, letting go of stress, the fall of your abdomen and chest. Notice the pause before the next in-breath.

• Continue breathing in this fashion. As thoughts arise, simply label them “thinking” and come back to the breath. If you find yourself caught in a story or discursive thinking, simply notice that, without judgment, let it go and come back to the breath.

Practice this for a few minutes each day, slowly increasing the time of each session. The key is to do this every day.  It may be helpful to have an experienced meditation instructor guide you through this practice.

Another technique that I often use with my clients is called “the container”:

• Visualize a container or box with a lid or other top, something you can evoke simply.

• When thoughts arise that are getting in your way, consciously say to yourself, “I do not need these thoughts right now”, and put them in your container, and close the lid or top.

Something else you can do is to visualize your energy going from your head — where all those intrusive thoughts are buzzing around — to your feet. Put both feet firmly on the ground, feeling the floor or ground beneath you, and bring your energy to your feet. This is very grounding as well as a good way to release those pesky thoughts.

It is amazing how much time we spend in our heads, and are not present with whatever it is we are doing or feeling. This is a “curse” of being a thinking human being. With our fast paced world, we are often multi-tasking, on our iPhone, iPad and MacBook all at the same time!. Take a break from your devices.

Another very effective way to slow down those intrusive thoughts is what I call “driving meditation”. The goal of this exercise is to drive when you are driving. Here are the steps:

• When you get in your car, turn off your cellphone and all other devices, including the radio.

• Have the intention to be present with your driving.

• Notice how it feels to put the key in the ignition, then listen to the sound and feel the vibrations as you turn on the car.

• Feel the tires on the road as you drive. When your mind wanders, notice that without judgment, and come back to being present driving, feeling the tires, seeing the road and the flow of the traffic, listening to your car engine and the other cars around you.

• When you get to a stop sign, actually STOP and take a breath, noticing where you are, both inside and out, and then proceed. As my Buddhist teacher says, “Don’t do a California Roll through the stop sign!”

We all have an inner-critic — that voice inside our heads that judges and criticizes ourselves. These mindfulness techniques are so helpful in freeing ourselves from these self-negative thoughts. After meditating for a while, I actually gave that critic a name that was different from my real name, as well as a different voice than my actual voice. After a year or so of meditating, a friend asked me how it helped me. After pondering her question, I answered, “Wow! I no longer mentally beat myself up, and that’s a miracle!”

Using Anger Mindfully

Many of us, especially those on the spiritual path, tend to look at anger as an entirely negative emotion.  However, anger used mindfully can be extremely positive, powerful and ultimately healing.  Anger is simply energy, and we always have a choice as to what to do with it. Dzogchen Ponlop, in his recent book Rebel Buddha (2010) aptly states:

We usually think of anger … as negative.  Ordinarily, our impulse would be either to cut through it and get rid of it or to transform its intense energy into good qualities like clarity and patience….[T]he  direct experience of our unprocessed, raw emotions can generate a direct experience of wakefulness. These emotions are powerful agents in bringing about our freedom, if we can work with them properly (p. 144).

So, what do we do that that energy?  We are often afraid to feel its raw power, and fear that expressing it will make us seem less than the kind compassionate people we are.  However, using anger mindfully will actually awaken our compassion, starting with compassionate lovingkindness toward ourselves.

In fact, many people who are compassionate toward others do not treat themselves with the same degree of compassion, and are self-critical and often depressed.  It has been said that depression is “anger turned inward.”  One of the major goals in treating depression in psychotherapy and in grief counseling is to help clients feel safe to express their anger, and turn the energy of anger outward.  “Ex-pressing” anger literally means pushing it out, so that it becomes workable and is not a toxic agent against oneself.

Anger in its pure form, without the “additives” of concept and labeling it as a bad thing, is simply energy.  The key is to harness that energy through the use of mindfulness.  Mindfulness enables us to recognize the anger without simply reacting — either spitting it out against another or turning it against ourselves.  By looking at it without reacting, we have the ability to choose to use our anger productively.

The following are some suggestions for using anger mindfully:

  • Notice how anger manifests in your body — is it a burning sensation in your heart?  A cold tight clenching in the pit of your stomach?  A flush of heat in your face or hands?  Become as familiar as you can with your own unique physical “early warning signs” of anger so you can catch its energy without reacting.
  • As soon as you notice the physical sensation of anger, stop and breathe.  Allow the energy of anger to wake you up to what is actually happening at that moment.
  • Give yourself permission to feel hurt, abandoned, scared, frustrated or sad with a sense of compassion for yourself.  Breathe in light, peace and compassion, and breathe out the dark, heavy sensations of anger without judgment, accepting it just as it is.
  • If you notice the anger turning inward against yourself, continue to breathe it out more forcefully.  Use your body to keep the energy of the anger outward — shake it off your hands into the air, stomp it into the ground with your feet  — whatever it takes not to turn that energy against yourself.
  • Be curious.  Ask yourself:  “What is this feeling?  What is it telling me?”
  • Trust your body to tell you the appropriate course of action.  Is there something you need to say to someone who has hurt you, in a way that will forward your own healing and contribute to the growth of the other person and your relationship with him or her?  Is it something you can simply let be, making sure not to turn the anger inward?

As Stephen Levine (1987) eloquently says, “the investigation of anger…leads us directly to the love beneath, to our underlying nature. When we bring anger into the area where we can respond to it, where we can investigate it, where we can embrace it, it emerges into the light of our wholeness….Then anger is no longer a hindrance, but a profound teacher.”

References

Dzogchen Ponlop (2010).   Rebel Buddha: On the Road to Freedom.  Boston:     Shambhala Publications, Inc.

Stephen Levine (1987).  Healing into Life and Death.  New York:  Doubleday, a division of Bantam Doubleday Dell Publishing Group, Inc.

© 2011.  Beth S. Patterson, MA, LPC.  All rights reserved.

Mind the Gap: Living in the Space Between Loss and Healing

One of the most difficult phases in any life transition is the space of the unknown between a loss or change, and healing or new beginning.  All life changes, even positive ones, entail a sense of loss or grief.  For example, there is a sense of loss in giving up addictive behaviors like cigarette smoking, despite the fact that the change is a positive one.  Even the change of getting a better job or promotion entails loss — you might be giving up security, relationships and the comfort of the known in making such a change.  The most difficult changes involve the death of a loved one or death of a relationship.

Our lives are always in transition.  Every breath we take involves a transition, from inhaling to exhaling, to the gap or space before the next inhalation.     After the end of a phase in our lives, we have a tendency to jump into something (or someone) new, because that space of the unknown can be so uncomfortable.  William Bridges (1980) calls this space the “neutral zone.” As Bridges explains (p. 112), “one of the difficulties of being in transition in the modern world is that we have lost our appreciation for this gap in the continuity of existence.  For us, emptiness represents only the absence of something.  So, when the something is as important as relatedness and purpose and reality, we try to find ways of replacing those missing elements as quickly as possible.”

Resting in the space of the neutral zone — feeling the pain of our loss, exploring our options, getting to know ourselves on a deeper level — is the key to transformation and growth.   How can we sit in that space of the unknown that feels anything but neutral, without giving in to the impulse to do something?  The first step is to be rather than do, which sounds much easier than it is, until we develop some friendliness toward ourselves and our anxiety.  Notice the impulse, and instead of acting on it, explore it with curiosity:  Where do you feel it in your body?  What is it telling you?  Breathe into it and let it be without having to change it in any way.

Mindfulness meditation, especially mindful breathing, is very helpful in learning how to be in the gap or neutral zone:  Feel the cool air entering your nostrils on the in-breath.  Pause and then feel the warm air leaving your nostrils on the out-breath.  Notice in particular how the out-breath dissolves and experience the space before your next in-breath.

Journaling can also be helpful in navigating the neutral zone.  Journaling helps us get those swirling emotions out of our bodies and head in a way that is workable and spacious.  We can gain some perspective on the stages of our journey — a major function of the neutral zone, and get to appreciate that time as a time for renewal.

Finding a regular time and place to be alone is also helpful in the neutral zone.  The period after a loss is a natural time to turn inward. This time of year, the barren stillness of winter, is also a natural time to turn inward.  Experience the loss of summer’s richness and the loss of the autumn leaves.  Know the gap before spring comes again as a time for renewal.  Without death, there can be no rebirth.

The Christian mystics call this gap and time of turning inward the “dark night of the soul.” It is a time to allow ourselves to feel the pain and despair that is a universal part of the human condition in the face of loss and change.  We may feel bereft and spiritually arid, and it is necessary to feel those feelings in order to transform them.  Despair can be seen as the manure from which spiritual growth and personal transformation arise.  As Michael Washburn so beautifully says in the aptly titled article The Paradox of Finding One’s Way by Losing It (1996), “It is only in the depths of despair that genuine spiritual life is found.  It is a paradox that we sometimes have to lose our way in order to find our true self.  We sometimes have to die to the world and to our worldly self before we can discover that our deepest and truest self was within us all the time.”

REFERENCES

Bridges, W. (1980). Transitions:  Making Sense of Life’s Changes. Cambridge, MA:  Perseus Books.

Washburn, M. (1996).  The Paradox of Finding One’s Way by Losing It:  The Dark Night of the Soul and the Emergence of Faith.  In Sacred Sorrows, Nelson, J.E and Nelson, A., eds. New York:  G. Putnam’s Sons.

A Buddhist Approach to Grief Counseling

Grief theorists, in keeping with Western culture’s emphasis on autonomy and individuation as signposts of psychological health, have long held that disengaging from the deceased is necessary for the successful resolution of grief (Marwit & Klass, 1995).   For example, according to the psychoanalytic view of Freud (1917), grief work entails decathecting, or detaching libidinal energy from the deceased.  Furthermore, the attachment theory of Bowlby (1969) posits that the bereaved individual attempts to maintain a bond to the deceased until he or she realizes the impossibility of doing so, and eventually “lets go” of his or her relationship to the deceased.

The predominant beliefs in the importance of disengaging and letting go in resolving grief have been gradually giving way to the concept that continued attachment to the deceased loved one is a healthy and necessary task of the grief process (Silverman & Klass, 1996).  The work of Worden (1981, 1992, 2002) can be seen as a bridge between the majority view of theorists beginning with Freud and the more contemporary view of the importance of continuing bonds. Worden originally described one of the major tasks of mourning as “withdrawing emotional energy from the deceased and reinvesting it in another relationship” (1981, p. 13), in keeping with the goal of decathexis described by Freud.  Significantly, in subsequent editions of his work (1992, 2002), Worden acknowledged that the bereaved do not in actuality decathect from the deceased.  Accordingly, Worden now describes this task as “emotionally relocating the deceased and moving on with life” and suggests that finding a place for the deceased in the life of the bereaved “will enable the mourner to be connected with the deceased but in a way that will not preclude him or her from going on with life” (2002, p. 35).

My approach to grief counseling is strength-based and solution focused.  Narrative therapy, a relatively new model of cognitive therapy (Carr, 1998), is in accord with this focus.  Narrative therapy has been found to be useful for helping clients access continued attachment and spiritual beliefs about death as a means of making meaning and finding the strength to emotionally relocate the deceased and move on with life.

Grief as a Holistic and Spiritual Process

Worden (2002) has identified four tasks of grief: (1) to accept the reality of the loss; (2) to work through the pain of grief; (3) to adjust to an environment without the deceased; and (4) to emotionally relocate the deceased and move on with life.   Worden’s formulation recognizes that grief impacts the bereaved in the physical, behavioral, cognitive, emotional and spiritual domains (Worden, 2002; Attig 1996).  Similarly, Marrone (1995) has identified the following phases in the grief process:  (1) cognitive restructuring, in which the bereaved reorganizes and restructures his or her thoughts and concepts to assimilate a loss; (2) emotional expression of the experience of the loss; (3) psychological reintegration of new coping behaviors and cognitive strategies for adjusting to life without the deceased; and (4) psychospiritual transformation, “which involves a profound, growth-oriented spiritual/existential transformation that fundamentally changes our central assumptions, beliefs and attitudes about life, death, love, compassion or God” (p. 498).

The fourth phase or task identified by both Worden (2002) and Marrone (1995) as described above provides the ground for working to transform and maintain the bereaved’s relationship with the deceased loved one.  As observed by Silverman and Klass (1996), “we need to consider bereavement as a cognitive as well as emotional process that takes place in a social context of which the deceased is a part….People are changed by the experience; they do not get over it, and part of the change is a transformed but continuing relationship with the deceased” (p. 19).  Cognitive interventions are useful for accessing and working with this transformative process, and as discussed below, narrative therapy provides a powerful cognitive container for the transformative work of grief.

Spiritual belief in continued attachment as a source of strength.

Whereas Freud and his followers may have seen continued attachment to the deceased as a form of pathological grief, the experience of continued bonds to the deceased is now viewed as a strength, resource and form of resiliency in the normal grief process (Benore & Park, 2004; Angell, Dennis & Dumain,1998).    Coping with loss has been called “a spiritual process that includes locating our {loved ones] in time and place, and transporting our recreated ‘experiences’ to the here-and-now” (Angell, Dennis & Dumain, 1998, p. 618).  Benore and Park (2004) have found that religious and spiritual beliefs in an afterlife and continued attachment to the deceased enable one to adapt more easily to the death of a loved one:

“The bereaved who strongly believe in [continued attachment] do not need to reconcile a loss of the person, but rather a change in the relationship.  Beliefs that the deceased person and the resulting relationship continue may eliminate the        most distressing aspects of death, whereas those who do not believe in [continued  attachment] must deal with the difficult issues of permanent loss, the void in their life and relationship network, and the sense of isolation (p. 12).

Grief and Spiritual Transformation

As one gets in touch on a deep level with his or her own suffering and resiliency in the face of that suffering, he or she can begin to get a panoramic view of the human condition and tap into his or her spiritual strength. Religious and spiritual beliefs have been observed to be one way in which individuals create meaning and a sense of order and purpose to the human condition, life and death, as well as creating an ongoing relationship with the deceased (Golsworthy & Coyne, 1999; Calhoun & Tedeschi 2000). “Because religious beliefs are central to many people’s global meaning systems, and because death is a central arena for the enactment of religious beliefs, these beliefs are likely to be a central part of the process of coping and adjustment following bereavement for many people” including beliefs in continued attachment to the deceased (Benore & Park, 2004, p.4).

The strength-based approach I use with my grieving clients, through the use of techniques of narrative and solution-focused therapy, is informed by my Buddhist practice.  In particular, I come to each session with my clients with the ground that each human being possesses inherent wisdom, or Buddha Nature, and that this wisdom can be called upon to access the individual’s strengths and resilience in times of suffering.  As Levine (1982) notes, grief fully experienced allows us to “plumb the depths” of our souls and to “touch something essential in [our] being….[W]hat is often called tragedy holds the seeds of grace” (pp. 85-86). Those “seeds of grace” are the basic goodness or Buddha Nature possessed by all, and it is my job as collaborator or partner in the journey of grief to support my clients in getting in touch with the strengths that they possess but which may be obscured by the intensity of their feelings of helplessness and loss.  Through narrative therapy, including the use of literary and other creative forms of expression, clients are able to create some space around that intensity, which in turn gives them some perspective and hope for change and transformation.

The broader perspective that can be reached through narrative therapy techniques can put the client in touch with both the uniqueness and universality of grief and suffering.  Paradoxically, contemplating the universal truth of suffering can open us to acceptance and peace.  As His Holiness the Dalai Lama (1998) observes, “if we can transform our attitude towards suffering, adopt an attitude that allows us greater tolerance of it, then this can do much to help counteract feelings of mental unhappiness, dissatisfaction, and discontent” (p. 140).  The Dalai Lama (1998) suggests that the most effective practice to help one tolerate suffering is to contemplate and understand that “suffering is the underlying nature” of existence as human beings:  “If your basic outlook accepts that suffering is a natural part of your existence, this will undoubtedly make you more tolerant towards the adversities of life” (pp. 141-142). Through allowing ourselves to experience and express our suffering, we can see that there is a way out of that suffering, through working with it as a fact of life, and finding a meaningful way to grow, transforming hopelessness into hope and possibility.  Narrative and solution-focused therapy can foster the realization that grief is not necessarily pathological, but an integral component of the human condition.  Through experiencing our own unique grief, we can tap into its universality, lessening our hopelessness and isolation, and deepening our connection with others and the human condition.  This is the transpersonal and transformative work of healing grief.

References

Angell, G.B., Dennis, B.G. & Dumain, L.E. (1998). Spirituality, resilience and narrative:  Coping with parental death.  Families in Society:  The Journal of Contemporary Human Services, 615-629.

Attig, T.  (1996).  How we grieve: Relearning the world. New York:  Oxford University Press.

Benore, E.R. and Park, C. L. (2004).  Death specific religious beliefs and bereavement:  Belief in an afterlife and continued attachment.  The International Journal for the Psychology of Religion 14(1), 1-22.

Bowlby, J. (1969). Attachment and loss: Attachment (vol. 1). New York:  Basic Books.

Calhoun, L.G. & Tedeschi, R.G. (2000). Posttraumatic growth: The positive lessons of loss. In Neimeyer, R.A. (Ed.), Meaning reconstruction and the experience of loss (pp. 157-172). Washington, D.C.: American Psychological Association.

Carr, A. (1998). Michael White’s narrative therapy.  Contemporary Family Therapy, 20(4), 485-503.

Dalai Lama, H.H. & Cutler, H. (1998). The art of happiness:  A handbook for living.

New York:  Riverhead Books.

Freud, S. (1917). Mourning and melancholia. Standard edition of the complete works of Sigmund Freud (vol. 14). London:  Hogarth Press.

Golsworthy, R. & Coyle, A. (1999). Spiritual beliefs and the search for meaning among older adults following partner loss.  Mortality, 4(1), 21-39.]

Klass, D. (1993). The inner representation of the dead child and the worldviews of bereaved parents. Omega, 26(4), 255-272.

Levine, S.  (1982). Who dies? An investigation of conscious living and conscious dying. Garden City, NY:  Anchor Press.

Marrone, R. (1999). Dying, mourning, and spirituality: A psychological perspective. Death Studies, 23, 495-519.

Marwit, S. & Klass, D. (1995).  Grief and the role of the inner representation of the deceased. Omega, 30(4), 283-296.

Silverman, P.R. & Klass, D. (1996).  What’s the problem? In Klass, D., Silverman, P.R. & Nickman, S.L. (Eds.), Continuing bonds:  New understandings of grief (pp. 3-27). Philadelphia: Taylor & Francis.

Worden, J.W. (2002, 1992, 1981). Grief counseling and grief therapy:  A handbook for the mental health practitioner. New York:  Springer Publishing Company, Inc.

Pet Loss: Grief, Meditation and Healing

I recently lost my beloved cat Lily. After experiencing Lily’s death, I had a fleeting urge to go unconscious – sleep, eat, drink wine, whatever.  As a grief counselor, I of course knew that wasn’t the way to go, and the urge passed.  Instead, I took a walk, using the opportunity to ground myself.  Breathing in, I felt my feet touch the earth, breathing out, I felt peace and spaciousness mixed with my grief.  Then I recalled the story of the Buddha and the grieving mother, who learned that everyone is touched by death and grief.  I looked up into the blue sky and saw a flock of birds flying in formation.  I was opened into a sense of wonder and heartfelt compassion.   Again, I touched my grief and allowed myself to cry deeply, feeling my heart breaking.  I was reminded by Stephen Levine’s phrase: “Tragedy holds the seeds of grace.”

Experiencing my emotions on the level of felt bodily sense energy is vital for me, and my mindfulness meditation practice is a great way for me to work with my emotions.  I have always been very intellectual and analytical about my feelings, and have learned through my meditation practice that theoretical or analytical understanding is really the booby prize in therapy and in life.

Later in the day after Lily’s death, I sat down to meditate.  Immediately as I sat down, all the pain came back.  Instead of pushing it away or analyzing it, I allowed myself to feel it – a throbbing burning pain in my chest, pounding in my heart and head, hands tingling.  I touched the painful sensations on each inhale, and let them go on each exhale.

After practicing this way for a while, the pain was transformed into the nakedly alive feeling of sadness and compassion for myself and all others who are grieving.  I welcomed my emotions without self-judgment as my friend, knowing that they are an expression of my life force.  What was left was an open hearted and tender love for my Lily.