Many of my clients complain of depression and low self-esteem. They think that something “out there,” such as a new relationship or job, is going to make them feel better about themselves. When I tell them that what will heal their depression is self-compassion and finding satisfaction in everyday life, some look at me as if I were speaking a foreign language. The ideas of self-compassion and a sense of satisfaction are that alien to them!

The most common complaint I hear from depressed clients in my psychotherapy practice can be summed up in two words: “Not enough.” A common plight of human beings is dissatisfaction, and may be expressed as “I’m not good enough”; “My partner isn’t good enough”; “My job isn’t good enough”… and the list goes on and on.

Spiritual Perspectives

From a Buddhist perspective, the poverty mentality of “not enough” is depicted as a hungry ghost, a being with a tiny mouth, skinny neck, arms and legs, and an enormous stomach. Because the hungry ghost’s mouth and neck are so small, not enough food ever reaches its huge stomach. The hungry ghost is always hungry. Because its arms and legs are so skinny, the hungry ghost is unable to hold on to anything. Nothing can satisfy the hungry ghost.

In the Tibetan Buddhist prayer of compassion embodied by Chenrezig, the bodhisattva of compassion, human suffering is described as being a state of “constant toil and poverty.” We are rarely satisfied with who we are and what we have accomplished. As a result, humans are in perpetual motion, seeking fulfillment and satisfaction outside of ourselves, but never finding it until we realize that we are whole and complete as we are, and that external accomplishments are simply the icing on the cake.

The theme of human dissatisfaction is common to all world religions. For example, in Philippians 4:11, it is said, “I have learned how to be content with whatever I have.” Timothy 6:607 teaches that “Godliness with contentment is great gain. For we brought nothing into this world, and it is certain we carry nothing out.”

As a Buddhist, I would describe godliness as Buddhanature, the wisdom and wholeness with which we are all born. The Buddhist teachings on Buddhanature are very helpful in developing self-compassion. Those teachings tell us that we all have Buddhanature, but due to our habitual tendencies and patterns, we have difficulty experiencing it. An image I have found helpful is that of the sun in a cloudy sky. The sun is always there, even on a cloudy day, but we cannot see it. Imagine being in a plane, and seeing the sun in a clear blue sky after rising above the clouds. Indeed, the sun was there the whole time, just like our Buddhanature.

The Practice of Gratitude

Practicing gratitude is a great way to develop a sense of “good enough” and satisfaction. I often suggest that depressed clients write down every day five things they are grateful for that happened that day. Some find this difficult because of what I call the “yeah buts” – a common refrain from depressed clients. They may say something to the effect of “yeah but, I don’t feel grateful about anything.” What about the fact that the sun is shining? Did you hear the beautiful song of that bird outside our window? It takes practice to observe and take time to appreciate the small joys of life, and get out of the tunnel vision of “not enough.”

Practicing gratitude can uncover and release the persistent negative self-beliefs that keep us stuck in dissatisfaction, for example, the belief that you don’t deserve love or happiness. Being mindful of our thoughts and appreciating the present moment are keys to healing depression and creating a sense of gratitude, satisfaction and appreciation in our lives.





© 2017 Beth S. Patterson. All rights reserved.



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.                                



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.

Do Our Pets Grieve After Loss?

Lucy and Andy, my two cats, have been best buddies ever since we brought Andy home fourteen years ago, when Lucy was one year old.  As I write, they are nestled next to each other.  Lucy, who has always been very healthy, is starting to show the signs of age:  recurrent urinary tract infections, and the beginnings of kidney failure.   As a hospice bereavement counselor, I support family members through their anticipatory grief, and their grief after the death of their loved one.  Is Andy starting to prepare for Lucy’s demise? How will she react after Lucy dies? How can I support her in the process?  I know plenty about supporting humans through their journey of grief — how do I do that with my animal partners?

Many have observed behavioral changes in their pets after their animal and human companions die.  They may search for their friend, stare out the window, seemingly in hopes that their friend will come back, stop eating, cry or seem depressed, clingy or withdrawn.

Some researchers believe that a cat or dog’s concept of death is similar to that of a young child.  Young children do not have the cognitive development to understand the finality of death, and grief counselors urge parents to talk honestly about death, in as much detail as a child can understand and tolerate — we cannot do that with our pets.  Pets can experience absence of what they became used to with their animal companions — their warmth when cuddling, their heartbeat, eating side by side.  Some behaviorists believe it is helpful to show surviving pets the bodies of their deceased buddies.  Indeed, it has been observed that a cat may stop searching for his or her playmate once shown the corpse of his dead friend.  If that is not possible, searching behaviors may continue until the surviving cat realizes in some way that his or her friend is not coming back.

So, how do we support our grieving animal friends? As a grief counselor, I always keep in mind Maslow’s hierarchy of needs, and it is therefore important to start with the physical.  With humans, I always ask if they are eating and sleeping well and getting exercise, using psychoeducation to explain that grief is stressful in all domains — physical, emotional, social and spiritual — and that if the bereaved does not take care of the physical component, he or she will not be able to move forward in a healthy way on the journey of grief.  Obviously, we cannot explain this to our animal companions.  Instead, look for eating and sleeping changes.  Not eating can be very dangerous in animals, and can lead to liver failure and death.  Hand feeding may be necessary in this case, and the physical closeness involved in hand feeding can be soothing and aid in healing.  It is also important to observe if the animal is urinating normally, as urinary tract infections can occur in times of stress.

Emotional support is also important in the healing of grief.  I have observed time and time again how important touch is in working therapeutically with those who are dealing with loss.  When I comfort a grieving spouse, a hospice patient who is scared and confused in dementia, and others who are experiencing the pain of loss, the touch of a hand or a hug is often  far more healing than words.  It is the same with our pets — massage them and talk to them in comforting tones. Continue to observe their behavior, and if they seem fearful, depressed or anxious, spend as much time as you can with them, talking to them in a soothing way and petting them so that they learn that they are safe.

Our pets are very sensitive to changes in their human companions’ emotions, and may become anxious.  Therefore, it is important for us to take care of ourselves, and get the support we need, whether from friends, a grief counselor or a support group, so that we can best support our pets.

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.