Richard Raubolt

Ten Steps to Ease the Symptoms of PTSD

2008-08-01T21:07:00.003-04:00

Familiar yet terrifying, disorienting and disruptive feelings associated with trauma can come on without warning. A word, sound, smell or image can trigger disturbing thoughts as well as emotions. This happens because the right side of the brain, which is faster and “comes on line” sooner than the left side, leaves us unable to think clearly about what is happening and we can be cast into a different time zone known as the past. Since we do not know whether or how to fight or flee, we end up freezing and are unable to move from this place in time. Frequently, we cannot reason our way out of such emotionally charged events, so other strategies are needed.

Here are Ten Steps, that in my years of work with trauma and PTSD, I have found helpful:

Identify the present date and the time down to the specific hour if you can.
Keep your eyes open. There is no rush, so take your time. Look around at your surroundings and notice the shapes. Notice and count, for example, all the objects that you see which are square and all the items that are round.
With eyes open continue to slowly and gently look but this time notice the colors. Again see red or blue or green and count them, still remembering the date and time. Your attention is focused outward to both see your world and orient yourself.
If not seated, please do so. Sit erect and forward in your chair, so your back is not touching the back of the chair. Let your hands rest on your thighs. Your feet should be firmly on the floor with shoes off. Press your weight forward a bit so you can feel the floor beneath you as firm and solid.
Take a tennis or handball and with one foot firmly planted lift the other and roll the ball along your arch. Then do the same with your other foot. This might be a bit tender at first but feel your foot gently relax and give into the ball, as you remain present and aware of your surroundings.
Return both feet to the floor and still sitting erect, pay attention to your body checking for points of tension. If you feel any point of tension, just notice and comment: “My neck is tight,” “My legs are heavy.” Try not to judge or interpret, just notice.
Focus on your breathing with your lips slightly parted. Feel the air enter your body through your nostrils, traveling to your stomach and diaphragm and then back up and out. Become aware of the rhythm, be it rapid and shallow or slow and deeper. Slowly drop your gaze to about three feet in front of you and feel yourself breathe with no effort to control it.
Begin to count or name your breaths; for example, 1 on the inhalation and 2 on the exhalation or name them “in” and “out.” Just focus on the rhythm of your breathing, knowing your mind will wander but bringing it back each time you are distracted by simply saying, “thoughts.” Continue for five minutes to start if you can and build up to twenty minutes.
Attend again to your body to note any tension. If you still notice discomfort, assign a feeling phrase to the area: “My stomach feels nauseous and I am anxious.” Just notice the feeling and let the sensation linger to see what else you become aware of without interpreting or assigning meaning.
If the feeling and sensation fades or lessens some, say to yourself, “That was then, this is now,” and alternate light tapping on your thighs with your hands. You are “tapping in” the present experience, as such bi-lateral stimulation helps the brain integrate the experience.
If you are still uncomfortably anxious image yourself sitting in your favorite place: a place where you enjoy and have experienced calm and relaxation. Fill in as many details as you can, like the temperature, sounds, smells, textures, etc. If you wish and you have a special friend, relative or pet, for example, imagine them with you as you breathe and rest. In the present you can care for yourself.

Repeat these steps or if you so choose change them to fit your needs.

May a sense of peace be with you.

Richard Raubolt, Ph.D.
www.richardraubolt.com

Podcast 1: What's Wrong with Therapists & Counselors, or Why Are Dr. Laura and Dr. Phil Mistaken as Either?

2008-01-08T21:12:00.000-05:00

My first podcast, entitled "What's Wrong with Therapists & Counselors, or Why Are Dr. Laura and Dr. Phil Mistaken as Either?"

Listen:

Download:
MP3 Format | AAC Format

Book Review: The Heebie Jeebies

2008-01-01T18:59:00.000-05:00

My Review of
Do You Ever Get The Heebie Jeebies?
by Jill Reiling (Falcon Books 2006)
Available at adventuresofgracie.com

It has been some fifteen years since I have seen young children in my psychotherapy/counseling practice. I have, however, continued to see the ravages of childhood abuse on the adults and young adults I meet with regularly. Quite often I hear a plaintive plea: "Where were the adults, an aunt, uncle, teacher, mother or father to protect or guide?" It is one of the saddest questions I have had to face and one for which I have had no satisfactory answer.

How do we protect our innocent, wide-eyed, curious children? How do we shield rather than scare our little ones? How do we keep them safe when they are out of our sight?

I have been on a search to find answers, tentative as they may be, to this question. Now with the help of my precocious, lively and dear sweet niece, Ella, I can offer at least one recommendation.

"Our recomnation, Tio" as Ella reminded ( "Tio" is family Spanish for Uncle): it's the" heebie jeebies".

Jill Reiling has written a marvelous, witty, playful children's book, Do You Ever Get The Heebie Jeebies?, that also contains a compassionate but serious message. This book, the winner of the Gradiva Award for outstanding psychoanalytic writing for children is smart, attractive, clever and simple in directing children to listen to their own feelings of uneasiness. Ella got the message immediately: "Oooh, I know the heebie jeebies. They freak me out. They make my tummy squishy so I look for mommy". Now nothing really bad has happened to Ella but she knows, or is beginning to know, what frightens her. She then asked, "Do you know about heebie jeebies, Tio?" Yes, I do Ella, sometimes more than I want to at times but this I kept to myself. What I did say was "Yes. Ella and I want you to be safe". "Me too, she answered," 'sides the pictures are cool". Indeed they are as illustrated by Alexander Juhasz.

This brief book should be in every elementary school library, church nursery and home with young children. It is a hard book to purchase although printed by Falcon Press. If you can' t get it let me know. I'll make sure you receive a copy even if I pay for it myself. It is that special. "Right on, Tio" says Ella.

Book Review: Let Them Eat Prozac

2007-12-04T20:38:00.000-05:00

My Review Of
Let Them Eat Prozac: The Unhealthy Relationship Between the Pharmaceutical Industry and Depression
by David Healy, M.D. (New York University Press)

This is a far different book that I am including in my “Healing List.” It is scholarly, scientific and professional. It is also well written, accessible to general readers and most importantly packed with provocative questions and crucial information.

David Healy is a distinguished research and practicing psychiatrist and former head of the British Association for Psychopharmacology. He is an expert on treating depression and has run clinical trials for major anti-depressant drugs. While Healy doesn’t deny the effectiveness of these medications (SSRI’s) and has prescribed them to his patients, he vehemently challenges the simplistic “biobabble myth” that depression is only the result of a deficiency of the neurotransmitter serotonin in the brain. Instead he demonstrates that no causation has been found, that there is no known depression center in the brain, but that 95% of our serotonin is found elsewhere in the body. Most concerning to me is that he has also found that raising this one “selective” neurotransmitter decreases others (dopamine and adrenaline) that are natural “feel-good” chemicals.

When depression is viewed from the vantage point of this myth then feelings of sadness, grief, loss or even shyness are often misdiagnosed as disorders rather than the results of painful but natural experiences in life. In the parlance of marketing by pharmaceutical companies this is known as “condition branding” where a need is developed for medication disbursement. Who among us has not heard of Zoloft, Prozac or Paxil? Even if we have not taken any of them, we all “know” they are treatments of choice for depression. “Big Pharma” says so, Healy notes.

These are not benign medications and withdrawal symptoms can be severe and include dizziness, anxiety, nightmares, nausea and agitation. Now Healy is not opposed to the judicious use of these drugs and neither am I (see my newsletter on medication) so long as they are properly prescribed for treating severe, chronic depression and patients are warned of potential side effects.

This is a first hand well researched and balanced account of the development, marketing and use/misuse of one of our most popular types of medications.

Living with Chronic Pain

2007-11-06T23:25:00.000-05:00

Living with chronic pain is draining, disturbing, frightening, debilitating and terribly disruptive. Sometimes the injury or ailment is visible like the results of a severe automobile accident or stroke. Frequently there is no apparent "cause" as the pain results from stenosis, immune disorders or fibromyalgia.

Seen or unseen symptoms are often deceiving. We can see symptoms but we can’t see pain. Oh, we can catch glimpses like a wince or more dramatically a sudden collapse. But we can’t see inside the body to measure, know or really appreciate what the pain feels like to someone else. Does it cut like a dull, rusty knife? Throb like the sounds of a beginning drum student? Does it come and go like some mysterious, sadistic phantom? Or is it like both all of these and none of them at the same time?

Frequently what we have to rely on are the descriptions by the patient/person. Words. Words express what is felt so individually and uniquely. These words can reveal or hide a great deal. They can be a cry for help, relief or for attention. They can exaggerate or minimize the pain or at different times under different circumstances they can do either or both.

With chronic pain all areas of a person’s life can be drastically affected: emotions, physical movement, thinking such as attention and concentration and activities. Sometimes even the capacity to love or believe in a future or in God are compromised or missing. Then there are the financial uncertainties about health care, savings or even the basic ability to earn an income.

What I have come to realize is that chronic pain can also create relationship problems with loved ones be they children, parents, friends or especially spouses/partners. Young children, for example, can miss out on normal activities when a parent is in pain and can’t participate. Children can also become protective and anxious leading them to curtail their lives by staying close to home to the point of not developing friendships or even attending or having problems learning in school.

Friends can express concern and make themselves available but usually only to a point. They move on with their lives and activities, often forgetting about a friend in pain. The person in pain is inadvertently dropped from the circle of friends who are vibrant and active. Life goes on.

Parents of adult children can feel guilty that their son or daughter has such pain and no amount of nurturing or guidance can make it go away. Some often wonder why their children and not themselves are stricken and as a result may become overly involved in an attempt to manage their own guilt and sense of failure.

The most difficult, confusing and disruptive problems, however, most often occur in marital/partner relationships. For the "healthy" one there is often an overwhelming feeling of helplessness, sadness and loss. The nature of the relationship can change as favored activities and plans have to be abandoned and worry about the future can set in with a vengeance: "What will we become?" Patience can run dry and spouses can say hurtful, angry words that deepen the anxiety and despair. Couples may need help in offering a "safety net of love" for each other.

There are very effective medications to relieve pain or at least some of it, there are non-traditional approaches such as acupuncture, yoga and massage that can also be wonderfully helpful and relaxing. To this list I would add psychotherapy where couples can talk honestly and openly about their individual feelings and experiences and where words can begin to heal the pain in the relationship if not the body.

Darkness, Lightness and the Unintegrating Mind

2007-11-03T00:30:00.000-04:00

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Trauma, Psychosis and American Apocalyptic Christianity: Analysis in the Midst of Spiritual Warfare

2007-11-02T18:21:00.000-04:00

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Book Review: Wounded Monster

2007-11-01T22:36:00.000-04:00

My Review of:
Wounded Monster: Hitler’s Path from Trauma to Malevolence
by Theodore Dorpat, MD

Published as a book review in Journal of Trauma Practice,Vol 3, #3, 2004.

In Wounded Monster Dr. Ted Dorpat brings his forty years of experience in psychiatric research, psychoanalysis, forensic psychiatry and history to the study of Adolf Hitler. Still, this was a personally difficult book for him to write as he empathically sought to understand Hitler’s thoughts and deeds from the inside out: “…in my struggles over my feelings of anger and repugnance, I have sometimes been able to break through my blinders and view Hitler as another human being, imperfect and suffering, like myself” (intro. pg. xv).

From this empathically informed understanding, Dorpat has written a comprehensive and impeccably documented book on Hitler’s psychology. His unique contribution, in this crowded area of inquiry, is his explanation of “how, when and why Hitler became malevolent” (intro. pg. ix). Using contemporary trauma theory, Dr. Dorpat presents the premise that Hitler’s chronic childhood trauma, and particularly his chronic combat trauma of World War I, resulted in severe psychiatric disorders and served as the foundation for Hitler’s malevolence.

Adolf Hitler’s childhood abuse included severe sadistic beatings and constant verbal humiliation at the hands of his father, Alois Sr. On one occasion when young Adolf sought to escape his home by building a raft with friends, his father beat him so cruelly his father thought he killed him.

Adolf’s mother, Klara, was depressed and unhappy with her marriage and guilt ridden over her incestuous relationship with Alois. She became over-solicitous, inconsistent, and preoccupied with Adolf’s health. She also failed miserably to fairly discipline and contain young Hitler’s fits of rage.

Such trauma from both parents, abuse and neglect respectively, leads Dorpat to diagnose Hitler as Borderline Personality Disorder by age 11. While this is not an unfamiliar diagnosis for Hitler ( Miller, 1990), Dr. Dorpat does an excellent job of delineating in detail the many disappointments, batterings, and trauma that left Hitler so unprepared for social, intellectual and occupations pursuits. He also identifies and defines the dynamics of a sadomasochistic style of relating and especially his avoidance of shame that became so characteristic of Adolf Hitler’s later conduct.

Dorpat’s truly stunning contribution, to my reading, is his description of Hitler’s combat trauma. He is the first to apply the diagnosis of PTSD to explain Hitler’s mental breakdown in 1918 with the additional subsequent diagnosis of Anti-Social Personality Disorder, to define Hitler’s horrific descent into malevolence.

Hitler served four years of military service, on or near the Western Front and was one of a very few on either side of the war that was exposed to repeated combat stress for the entire duration of the war. He was one of eight to ten dispatch runners and toward the end he was partially buried by a British artillery shell that exploded near him. This explosion resulted in symptoms of hysterical blindness and mutism which required a brief hospitalization.

Dr. Dorpat suggests that while Hitler’s violent, mendacious, and antisocial behavior occurred soon after the war, the roots of his malevolence were shaped by his chronic childhood trauma and the resulting Borderline Personality Disorder. It is nevertheless true, Dorpat asserts, that before Hitler’s military service he shared most of the values of his society. Following his combat trauma (PTSD) Hitler became increasingly indifferent to human suffering. Actually Dorpat believes the diagnosis of Complex Post-Traumatic Stress Disorder (Herman, 1992) is necessary to account for Hitler’s severe and pernicious personality transformation. Due to this emotional numbness, a lack of empathy and guilt developed and grew into an idealization of violence as an emotional ‘turn on’ to provide a sense of personal vitality.

In an insightful summary of the effects of these dual, chronic traumas Dorpat presents a clear, easily understandable definition of a vertical split. On one side Adolf Hitler held the image of himself as inferior, shamed and defeated, while the other side held the image of a grandiose self; omnipotent and victorious. Each side of the split, which was disavowed to the contradictory self state, linked up to certain emotions making Hitler’s behavior erratic, contradictory and explosive in extreme. The defeated side, which eventually led to his suicide, was linked up with helplessness, hopelessness and self hatred. The grandiose self state, which led to the Fuhrer myth, was activated by omnipotent power, omniscience, heightened self esteem and elation.

In this review, I have focused on the central role Dorpat believes trauma played in Hitler’s malevolence. There is much else I have not been able to highlight given space constraints: an extensive literature review of PTSD during the Vietnam War, Hitler’s failed Beer Hall Putsch and subsequent imprisonment and the antisocial personalities that formed Hitler’s leadership core. This is an excellent book well worth reading, although some may find Dr. Dorpat’s empathic understanding of Hitler’s malevolence challenging, controversial and perhaps emotionally disturbing.

REFERENCES

Herman, J.L. (1992). Trauma and Recovery. New York: Basic Books.
Miller, A. (1990). For Your Own Good: Hidden Cruelty in Child-Rearing and the Roots of Violence. New York: Noonday Press.

Book Reviews: Achilles In Vietnam

2007-11-01T21:45:00.000-04:00

My Review of:
Achilles In Vietnam
by Jonathan Shay, M.D., Ph.D.

In this remarkable book Shay uses Homer’s Iliad, a 3,000 year old poem, to help us understand the psychological and emotional damage done to soldiers of the Vietnam War. In the process he gives a cogent, clear voice to what went very wrong in both wars. His arguments are incisive and convincing. Yet as thorough as his analysis is, it is the words of soldiers that are most compelling and provide the heart of the book.

Two basic concepts, thémis (what's right) and mênis (indignant rage), serve as counterpoints and as such are crucial to understanding the many broken spirits (otherwise known rather clinically and coolly as Post Traumatic Stress Syndrome PTSD) of war veterans.

The betrayal of what is right came in many forms in Vietnam: M-16 rifles that didn't work, victories that were not victories; where innocent civilians or some of their own fellow soldiers were killed and yet such actions could be reframed as a great daring success for which bewildered soldiers received medals and where distribution of risk was unjust. In World War II 77 colonels died in combat, or one for every 2,206 men, while in Vietnam only 8 colonials died for every 3,407 men. This while there was a full colonel for every 672 enlisted men in the Second World War as opposed to a colonel for every 163 men during Vietnam. These are but a few of the examples that lead to demoralization, bitterness and ultimately for many either emotional numbness or mênis, indignant rage. Such betrayal is not restricted to Vietnam but now continues in Iraq. Retired Gen. Greg Newbold recently described this very sense of betrayal when he wrote: "My sincere view is that the commitment of our forces to this fight was done with a casualness and swagger that are the special province of those who have never had to execute these missions - or bury the results (New York Times, OP-ED, A13, April 15, 2006).

Drawing on reading of the Iliad, Shay writes:

Homer and the Greek tragic poets held the terrifying view that
apparently stable adult character continues to be dependent and
vulnerable, even after it has been established by good nurturing
in childhood. According to these tragic poets, good character
is dependent on good-enough stability and reliability of thémis
and remains vulnerable to high-stakes betrayal of thémis by power
holders. The moral dimension of trauma destroys virtue, undoes
good character (pg. 37).

Trauma, where thémis is violated regularly, ruptures and ultimately destroys a sense of safety leaving even adults terrified and disoriented. Under such conditions character can unravel to the point where even the soldier himself no longer recognized what is right or wrong and any and all types of behavior which were morally repugnant previously now become possible. There is a disconnection from the human community and there is a grave risk that as a result all restraint will be lost: "December 22, 1967 is the day that the civilized me became an animal..." (pg. 82). This was a repeated feature in the stories of many Vietnam vets Shay treated, but generated by grievous betrayals of trust such sentiments were also present in the Iliad: "I built up such hate, I couldn't do enough damage...I lost all my mercy."

These soldiers from ancient Greece and more recently from Vietnam had to survive and somehow sustain themselves in terribly difficult situations. They spent long periods of time living with uncertainty, danger, violence and betrayal. Despite the horror I felt for some of the actions perpetrated by fighting men in both eras I also experienced a greater understanding and empathy for the vulnerable nature of what we can so glibly refer to as character. Since we are all more human, more alike than not, we really don't know how we would respond if or when our sense of justice and decency was continually violated. What would we do if those in our life who are supposed to be the most trustworthy expose us to mortal danger or lie to us constantly or selfishly disregard our emotional well being and health? Is there really any truth in the Platonic ideal that "good character will always prevail" or, as I have come to believe, is "good character" inexorably tied to the human connections that provide dignity, respect for others, maturity and the like? And when there is "the undoing of character" isn't it these same kind of relationships that offer measures of repair and healing, a restoration if you will of what is right? Yes, a return journey to thémis.

Book Review: Memories of My Melancholy Whores

2007-11-01T21:44:00.000-04:00

My Review of:
Memories of My Melancholy Whores
by Gabriel Garcia Marquez

The title of Marquez’s latest novel, his first work of fiction in ten years, will probably raise more than a few eyebrows, especially in West Michigan. Let me say from the start this is not a book for the timid yet it is also a book of great humanity if the reader can surrender preconceived moral judgments.

The unidentified narrator upon the eve of turning ninety writes: “My ninetieth birthday is arriving. I’ll never know why, and don’t pretend to, but it was under the magical effect of that devastating evocation that I decided to call Rosa Cabarcas for help in celebrating my birthday with a libertine night.”

Rosa Cabarcas is the madam of one of the brothels our protagonist has visited on and off for most of his life. (“Whenever someone asks I always answer with the truth: whores left me no time to be married”) His “libertine night” is wild love with an adolescent virgin.

Quite a beginning for a work I place on my Healing Books list. Well, actually it is healing for the narrator and I hope for the reader. This adolescent girl of fourteen is never violated rather she is given the name Delgadina (from a favorite song about a king’s daughter, wooed by her father) and serves as a first love. The ninety year old philander comes to realize: “sex is the consolation you have when you can’t have love.”

This is not love in our usual way of our understanding the emotion. He never knows her name, they don’t talk and exist only laying side by side in a brothel bed. Delgadina becomes his fantasy of what love is, feels like and he transforms his life accordingly. He begins with a perceived review of time wasted, loves lost, potential underutilized (he is an undistinguished journalist). Living this fantasy of love he learns to write with wisdom and meaning. Most poignantly he comes to face his aging long denied by selfishly encasing himself in the past, often defiantly.

His “love” leads to new considerations of others, (not in a maudlin or saccrine fashion) to the point of taking in a cat, the first pet of his life. Unknown to him this birthday gift is also quite old and in his illness has to be taken to the local veterinarian shelter. Our protagonist becomes enraged when he finds they want to put his cat “down”: “I thought in a rage that they could also roast me alive in an oven filled with cats. I felt caught between two fires: I had not learned to love the cat, but neither did I have the heart to order him killed just because he was old.” Through his uncorrupted love he learns to feel his age with vitality and integrity.

While perhaps not Marquez’s best book, which is reserved in my opinion for One Hundred Years of Solitude, this is still masterful story-telling from the Nobel Prize winner of 1982.

Book Review: The Notebooks of Joseph Joubert

2007-11-01T21:42:00.000-04:00

My Review of:
The Notebooks of Joseph Joubert
Translated and with an introduction by, Paul Auster

Some readers may find this to be an odd book to include; indeed it is not a book in the usual sense. In point of fact Joubert only prepared to write a book and despite 900 pages of densely recorded text gave up on the idea. Instead his notebooks, which recorded his daily thoughts for forty years, represent the sole body of his writing. Auster has chosen about one tenth of those entries from 1783 to 1824. But oh, what writing it is: clear, intelligent and insightful thoughts and reflections about philosophy, literature, and psychology. These are some of my favorites:

“Are you listening to the ones who keep quiet?”

“It is necessary that something be sacred.”

“Here in the desert. In this silence everything speaks to me; in your noise everything falls silent.”

“Those who never back down love themselves more than they love the truth.”

“All things that are easy to say have already been perfectly said.”

I could go on and on as each time I read this slim book of 159 pages I find more wisdom. Evidently I am not alone. In his introduction Auster tells of giving a copy of Joubert’s book to a painter friend, David Reed who in turn “loaned” it to a friend who had been recently hospitalized suffering a “nervous breakdown.” After he read the book he gave it to another patient who gave it to another and so it passed around the ward until groups of patients would gather in the dayroom to read passages of Joubert’s notebooks to each other. When David’s friend asked for the book back he was told it was no longer his or as one patient said, “It’s our book. We need it.” Ah, words as medicine for the soul.

Book Review: Blink

2007-11-01T21:40:00.000-04:00

My Review of:
Blink
by Malcolm Gladwell

Gladwell is a bit of an intellectual gadfly and translator of social science research for popular consumption. A staff writer for the New Yorker he has achieved enormous success with both the I Pod generation and Fortune 500 business in large part because he is both optimistic and pragmatic with a breezy and engaging writing style.

As a psychologist there are two areas Gladwell covers that are of particular interest. The first is the work of Tim Wilson on the “adaptive unconscious.” Wilson’s research suggests that a good deal of sophisticated and complex thinking about decisions making, setting goals, generating and communicating ideas and actions occur on an unconscious level. This mode of thinking is most often on display when we must respond quickly in unique or novel and stressful situations where prior preparation hasn’t been possible. In other words we rely on this adaptive unconscious to make quick decisions with little information.

An essential element of such rapid decision making is known as “thin-slicing.” Gladwell suggests that “thin-slicing” refers to the ability of our unconscious to find patterns in situations and behavior based on very narrow slices of experience. A fascinating and most relevant example is the work of John Gottman. Gottman, with an astounding degree of accuracy, can determine which couples will remain married and which will divorce by eavesdropping (thin-slicing) on a couple’s conversation in a restaurant. What does he listen for, what is the most pertinent “thin-slice”? Contempt; which he defines as speaking from a superior position which is condescending, dismissive and drenched in disgust for one’s partner. Gottman has found the presence of contempt in a marriage can even effect the immune system as he has discovered he can predict such illnesses as how many colds a husband or wife gets.

This brief book is full of interesting, insightful, and compelling examples based on Gladwell’s mantra: to understand how things work is to have control over them. This is a book well worth the read and the arguments the thoughtful reader will find available.

Book Review: New and Collected Poems: 1931-2001

2007-11-01T21:39:00.000-04:00

My Review of:
New and Collected Poems: 1931-2001
Czeslaw Milosz

I hesitated before recommending this book, and a rather large book at that (775 pages), of poetry. Many people are put off by the confusing nature of syntax, odd rhyming and the elusive nature of meaning in most modern poetry. Even if you are not a fan or regular reader of poetry this is a book to be greeted with respect and welcomed for its humanity.

Czeslaw Milosz worked with the Polish resistance in Warsaw during World War II, witnessed the devastation of Lithuania and Poland by Nazi and Stalinist tides, immigrated to France in 1951, and in 1960 became a professor of Slavic languages and literature at Berkeley. Milosz won the Nobel Prize in 1980. In other words this man lived a lot of life, life in dangerous and horrific times. He lived through what he wrote (he died in 2004 in his early 90’s). Much of his writing is a testimony to the human spirit to survive and hold on to some semblance of integrity while bestiality freely reigned. He wrote not of heroes but of most of us: survivors who feel a mix of guilt and contentment about our lives. Despite his many accomplishments Milosz was a man of humility, writing near the end of his busy life, “I feel relief thinking I was no better and no worse than many, and together with them I wait for forgiveness.” While many terrible events are chronicled here Milosz never loses sight of a perpetual promise of renewal in dreams, contemplation and observation of life’s simple pleasures and in honest self reflection. These are a few of many favorite passages: “I’m unkindly greeted by this awakened state. / During the day, on my cane, asthmatic, I creep. / But the night sees me off at the traveler’s gate. / And there, as at the outset the world is new and sweet.” And the delightful lines: “Cathedral of my enchantments, autumn wind, I grew old giving thanks.”

My suggestion: read a poem or two each night as a reminder of your humanity, both your goodness and your failings.

Book Review: When Things Fall Apart

2007-11-01T21:33:00.000-04:00

My Review of:
When Things Fall Apart
by Pema Chodron

Chodron’s book is written in a direct, earthy and engaging style. While a Buddhist nun the reader does not need a background in this religion or even to agree with some of their beliefs. This book is about courage in the face of adversity and loss. So often we attempt to cope with fear through efforts to quiet ourselves by reassurance, distraction or avoidance. We run from our fears out of the mistaken belief that they are bigger and more powerful than we are and we will be easily overwhelmed. Chodron leads us in the opposite direction: into our fear, to lean into that which we fear. She once had a sign over her door at the abbey which read: “Only to the extent that we expose ourselves over and over to annihilation can that which is indestructible be found in us.” Chodron suggests that through meditation practice, we stay with our anxieties, hurts, betrayals, feelings of revenge, and in the midst of chaos we learn not to panic.

Chodron is a strong believer in, and writes well about, developing “maitre” or loving-kindness: to practice gentleness and letting go. Instead of struggling against confusion or engaging in a rigorous regime of self improvement she suggests we relax, nurture, accept and meet our troubling experiences with curiosity.

For those interested in developing mindfulness or learning about meditation her instructions are simple, inviting and written with a light touch. This is a book I return to again and again for the gentle strength contained in these pages.

Medication vs. Psychotherapy

2007-08-01T21:08:00.000-04:00

For far too long “vs.” has designated a combative stance which has interfered with a useful combination of psychotherapy and medication.

Medication can be a vital aid when prescribed properly especially for severe depression, bi-polar disorders and psychosis. Of course each patient needs to be carefully evaluated but medication can help reduce some of the major symptoms that can be so disruptive.

Often medication can alleviate suicidal thoughts; contain explosive and impulsive acts, calm panic, and regulate extreme mood swings.

Frequently severe problems necessitate the use of medication to assist in making psychotherapy productive. Since self exploration, for example, can and often does generate anxiety some medication on a short term basis may help someone stay with the process of psychotherapy long enough to gain beneficial results.

Medications are not silver bullets and can cause significant problems in therapy. For some people a recommendation to consider medication can leave them feeling hopeless and mentally ill. This reaction requires patience and skill to explore the personal meaning of taking any medication for emotional difficulties. Questions of side effects, family history, ineffectiveness or, on the other side, a belief that problems are beyond them and a pill will make all right with the world, are some of the areas that need discussion.

People can sometimes feel they must choose between psychotherapy and medication. It is unfortunate and ill advised for someone in the medical profession to state that all emotional problems are the result of a biochemical imbalance and that medication is all that is necessary. Some can be so convinced of this position that multiple “high dose meds” are prescribed leaving patients feeling terrified, confused, “not themselves” and “numbed out”.

On the other side some therapists believe all problems are exclusively psychological/emotional and fail to make a timely referral, which could alleviate unnecessary suffering. Someone in the midst of a manic episode or immobilized by severe depression can benefit from all the help they can get, including medication in a number of cases.

When consulting with either a physician or psychotherapist about emotional struggles it is fair and necessary to ask each about their professional experience with and attitudes about medication and psychotherapy. It is also important to look for someone who has a reputation of respecting allied professionals in order to maximize the help you receive.

Finally, by all means question both your therapist and physician if you are unclear why medication has been prescribed and how your therapy might be affected. You deserve the best treatment available.

Tell Me Again, What Does EMDR Mean?

2007-04-01T21:10:00.000-04:00

Since my area of specialty is working with trauma of all kinds, I am often asked this question about EMDR because it was originally developed as a method of treating post traumatic stress syndrome.

Eye Movement Desensitization and Reprocessing is considered a mind-body approach that focuses on bi-lateral stimulation, which is a fancy way of saying moving the eyes back and forth by following a light bar or experiencing alternating pulses from hand held sensor pads. The client focuses on a mental image of distress, emotions, beliefs ("positive" and "negative") and body sensations during this process.

As first developed, this approach was considered a stand alone form of brief psychotherapy. Remarkable changes in stress levels, anxiety, and depression were reported in as few as four to eight sessions.

I have been trained in EMDR and use it in my practice in a highly modified form. The standard eight-step protocol used offers little room for therapist/client (or patient) discussion and pays no attention to the crucial necessity of the therapeutic relationship. It can feel like a manual driven and mechanized approach with proscribed steps and responses and with little creativity or spontaneity encouraged. Some of the focus on separating beliefs into positive or negative can over simplify complex processes of decision making, abstract reasoning and thoughtfulness. Beliefs as positive or negative, black or white leaves no room for F.Scott Fitzgerald's definition of first rate intelligence:

the ability to hold two opposed ideas in mind at the same time and remain capable of functioning.

Since I believe any form of therapy should address the unique individuality of the client/patient, I have sought to humanize this approach. I now use some of the techniques in on-going therapy when there is an impasse or an issue that might be more helpfully explored from a different angle. Used in this way, it can be helpful to offer the opportunity to bring a specific memory to mind, pay attention to what was felt emotionally and physically, and then allow for a drifting into the experience with alternating gentle sounds from a headset. Such modifications are less disruptive, sterile and more personal.

There are other cautions to the standard use of EMDR when used exclusively. Since it can be a powerful tool, it can generate strong and conflicting emotions that need to be attended to with patience and skill. If one is to seek this approach, make sure the therapist is experienced and knowledgeable in handling intense feelings and capable of integrating or making sense of trauma and not just in "opening someone up". Retraumatizing anyone helps no one. Also, EMDR is a validated approach with post traumatic stress. If or when it is presented as a cure all i.e. performance enhancement, developing creativity, ADD and such, look with a skeptical eye. No one approach covers all the emotional landscapes. We are all far more complex and interesting than such a narrow view would suggest.

Mindfulness in a Mindless World

2006-12-01T21:18:00.000-05:00

In a world that has gone so far out of control many are seeking some comfort in practices of certainty. Many want to have some stability, tradition and thereby peace of mind. Not surprisingly the “good old days” are remembered with relish even if they weren’t “so good” at the time. We, myself included, want some assurance that “all is well.” Wanting simple, direct, irrefutable answers we can begin to blame others when we feel especially unsettled. Since there are few easy answers there are plenty of people and institutions to blame. There is, however, a difference between blaming others and holding them accountable for their actions.

If we are to return some sanity to this world we share we must hold ourselves accountable, develop compassion, exert healthy self-control and become more thoughtful in our words and deeds. Once helpful way of conducting ourselves in the fashion I describe is through “mindfulness.” Through such a practice we enhance our strength and capacity to face our disappointments, fears and anger. I am not describing a religious orientation although some may incorporate mindfulness (for example contemplative prayer) in their spiritual beliefs. I am instead suggesting we learn how to sit quietly in the midst of our many conflicting thoughts and feelings. Rather than rushing to action on the basis of this or that emotion or conclusion we sit in silence paying attention to how our thoughts, feelings and bodily sensations shift and change. By noting our breathing and focusing as fully as we are able on the in-breath and the out-breath we can achieve a powerful centeredness and clarity of thought. As the former Catholic priest, Daniel Berrigan used to say, “Don’t just so something, sit there.”

Now, of course if we begin such a practice of mindful breathing we will notice our mind becomes busy and our attention is drawn away from the simple awareness of our breathing. Since we can expect this as the way our mind works we can simply name it as “thinking” and return to our next out breath. Such an attitude is about developing a non-judgmental attitude or “unconditional friendliness” with ourselves.

You, the reader, might be saying at this point that with the troubles so complex, huge and frightening isn’t this practice an avoidance of the responsibility to act in a humane, forceful fashion? Perhaps, but perhaps too, thoughtful action taken from a place of self knowledge and patience may be even more effective. At a minimum it is likely our enemies will be fewer.

This is of course a brief introduction to a well researched topic. The best simple explanation and training in mindfulness can be found in the step-by-step course: Insight Mediation with Sharon Salzberg and Joseph Goldstein (Sounds True)

Drop me an email and let me know what you discover.

Whose Therapy is it Anyway?

2006-10-01T21:19:00.000-04:00

Recognizing Coercion and Control in Therapy

Recently I have edited and written chapters in the critically acclaimed book Power Games: Influence, Persuasion and Indoctrination in Psychotherapy Training. This book is a description of the structures, methods and applications of dictatorial and authoritarian training many therapists experience. As with any such doctrinaire approaches, there are causalities strewn along the way. Sometimes they are the therapists and all too often they are the people these therapists see in their practice. Unless mental health professionals are able to titrate, question, challenge and mute the misuse of power I describe, the services they offer are contaminated by the same fundamentalist, inflexible thinking.

The book I am currently writing, Whose Therapy is it Anyway describes patients experiences and revels some of the means by which therapists insist upon what is proper, healthy and worthy. The aims, hopes and dreams of patients are upended and dismissed if not to the liking of the therapist. Therapy is no longer, but instead is replaced by re-education or indoctrination.

So what are some of the signs to watch for?

An aggressive, demanding and righteous stance by the therapist spells trouble. Such a stance is often characterized by challenge, impatience and at times ridicule.
The provocative use of language which is demeaning and dismissive has no place in psychotherapy. The purpose of such language is to precipitate a crisis so the patient becomes more amenable to change as directed by the therapist.
Sessions dominated by what the therapist deems important, and any contrary views that might challenge this dominance are interpreted as resistance (non- cooperation with the therapy process) or more dangerously as self-indulgence, are potentially terribly harmful
A heightened emotional quality to the therapy hour is to be viewed with caution. Feelings can be inflamed with a "more is better" expectation. Thinking, considering, reflecting are inimical to emotional re-experiencing.
The use of touch to soothe the patient after or during an emotional discharge or difficult session often reflects a blurring of appropriate boundaries. Such techniques foster dependency and compliance. The attitude seems to be "there, there now that wasn't so bad was it? And daddy (or mommy) still loves you."
Personal language is stolen. Certain words or phrases that reflect complexity, metaphor, symbolism, abstraction, or challenge the theoretical stance of the therapist, are banished. Self assertion is apparently encouraged but contained within narrow, rigid boundaries i.e., "you can disagree with me if I agree that you can disagree." Such therapy is a confusing mix of smoke and mirrors, ripe with contradiction and desperately driven by the therapist’s need to be right and in control.

If you, the reader have additional examples or personal experiences you wish to share, please email me or send a letter to my office. I will keep any such correspondence strictly confidential. Finally, anyone in or contemplating therapy may want to remember that it is first and foremost your therapy.

What’s Love Got to do With It?

2006-08-01T21:22:00.000-04:00

Recognizing the Seductive Psychotherapist

Psychotherapy is an intimate, private and deeply personal experience. Both therapist and patient/client co-construct, in the common professional parlance of the day, a relationship where unknown or unexpressed desires, conflicts, questions and dreams are explored. For this unveiling process to occur the therapist must reveal some “humanness”, kindness, and compassion no matter how neutral he or she is with regard to technique. There can be and often are intense, deeply experienced emotions expressed by the client/patient. The range of their feelings is broad including anger, fear, despair and love.

If the therapist is able to continue to engage and not be frightened off by such an emotional outpouring, the therapy can progress as misunderstandings are addressed, ruptures repaired and emotions integrated. The therapist is often a trusted, calm ally present for the client/patient’s self scrutiny and questioning. This is if all goes well, and as with any human enterprise such is not always the case. Often, love expressed in therapy, for example, can be confusing, frightening and fraught with potential risk for both patient and therapist.

Despite whatever emotional reactions the therapist might have, he or she has the responsibility to prevent this “love” from becoming sexual in the consultation room. Again, sadly this is not always the case. The therapist, perhaps feeling lonely or depressed, seeks to get respite from these feelings by becoming sexually involved. Other therapists may believe they deserve sexual favors due to their inflated sense of their own attractiveness and charisma. There are many reasons for such boundary violations and none of them are good. The therapist has abrogated his moral responsibility by taking advantage of the patient’s vulnerability to meet his needs. The therapist is not loved in the true sense of the word, but, as Freud reminds us, rather he is loved for what he represents (yes, it’s still called transference).

There are warning signs for clients to notice which may reflect the therapist’s intent to sexualize the relationship.

Routinely extending the session beyond the agreed upon duration.
Touching the client after the session, e.g. a hand on the shoulder, a rub on the back or most confusingly, asking the patient if she feels like she “needs a hug.”
Suggesting changing appointment times to the last hour of the day without a clear rational offered.
Spontaneously talking to the client about his feelings for her, e.g. how special she is, how she seems to understand him and his work, how no one really seems to appreciate her beauty, etc.
Being too solicitous, making calls to the client when they have not been requested.

These are but a few “seductive maneuvers”. If you as a patient experience any of them, caution is in order. Frequently a simple question about the conduct will be enough to prevent further intrusions. If, however, the therapist becomes defensive, accusatory or attempts to shame or humiliate then it is time to leave. If the patient/client is made to feel it necessary to take care of his or her therapist, therapy has also ceased. Sex, as a behavior to be acted on, has no place in any respectable therapy.

How to Select the Right Therapist for You

2006-06-01T20:43:00.000-04:00

There are thousands upon thousands of psychotherapists in this country with over a few hundred in Grand Rapids alone. It is, you might say, a growth business (pun intended) but of course not all therapists are equally well talented, ethical and responsible. Finding someone you can trust to share some of your most frightening, embarrassing and intimate details of your life, is no easy task. Finding the right fit is essential whether you consider your problems large or small. If you are going to spend the time, effort and yes, money to learn more about yourself and hopefully live with greater confidence and ease, then also spend the time getting the very best therapist for you.

How can you tell?

I suggest you start by asking trusted friends who have been in therapy. Ask what their experience was like: Did they feel safe to say what was most important to them? Could they count on their therapists to listen carefully to what they said? How did the therapists handle conflicts or disagreements that may have arisen between them? Were their therapists defensive or more open and reflective? Did their therapists have an agenda, perhaps feeling they knew what was best, a “one size fits all therapist”? Were their therapists careful about time and money? Were they on time for sessions or did they cancel abruptly. Did they bill promptly, and this may be a surprise, did they charge enough? These last issues, while perhaps seemingly insignificant, are very important to the ultimate success of your therapy. If a therapist can’t handle his or her time and money well, this sloppiness may reflect a lack of self care and potentially problems in providing a professional, therapeutic and safe environment for you.

The answers to these questions may help you decide the type of therapist you want. Still you won’t really know until you meet with him or her for at least a few times. One meeting may be enough to rule out a really obvious “misfit” but sometimes even really capable therapists take a while to warm up and for the budding therapy relationship to begin to gel. But a few more questions to consider, which may be helpful: How are you greeted? Too effusively and there are likely to be problems with boundaries i.e. you become a friend not a client/patient, too stiffly and there may well be problems with rigidity and a difficulty handling strong feelings. How is the office set up? Is it comfortable; is there respect for your privacy and confidentiality? Is it well put together, not necessarily with expensive furniture but not with “cast offs” either? The office is the therapists “second home” and if he or she spends a lot of time there it reflects who they are and what they value. How attentively are you listened to? When the therapist speaks does he or she have something important to add maybe a clarification, question, reflection or interpretation? What is the therapist’s range: emotionally and intellectually? Do you feel understood? Are you treated with respect for ideas and with your time? If need be can you see yourself meeting with this person for months maybe if not years?

If not, feel free to choose another. Don’t allow yourself to be cajoled, pressured or made to feel guilty if you decide the fit won’t work. If you experience any of these feelings you are probably right to leave. After all you have many choices and it is your life.

Charismatic Leadership as a Confusion of Tongues: Trauma and Retraumatization

2004-09-16T21:24:00.000-04:00

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