Quite a few people who want to begin therapy ask me this. Of course, this is a perfectly reasonable question, but I still usually find myself searching for a good response. The answer should be easy. My specialization as a therapist is the treatment of anxiety and my subspecialty is OCD therapy. Many people, therefore, contact me because they are struggling with one of these issues or both. Of course, I have experience as well as training and skills working with people on these matters, so I could just say “Yes” with confidence and conviction.
I grew up with the saying “The head is round so that the thoughts can change direction.” When the debate around legislation permitting physician-assisted suicide in California hit the news lately, I was reminded of this saying when I examined my own thoughts and opinions around this law. As a member of the disability community, I am engulfed in the discussion around its implications for disabled lives. I wrote against proposed assisted suicide laws from a disability activist position when I lived in Europe and they were introduced there. The nightmares Jack Kevorkian and Peter Singer created are still powerful and the concern over a law that could ever be used to suggest from the outside that anybody’s life is unbearable (or less worthy, or too expensive) and should therefore be ended prematurely is well justified by history.
What does forgiveness really mean? It comes up in therapy a lot but the concept is so unclear for many of us. I have devoted hours pondering the meaning of this elusive concept. Forgiveness describes a conscious act on the part of the person forgiving and a human gift received by the person who is in need of forgiveness. And forgiveness is a close partner to intensely painful feelings and memories of things that have happened in the past. In truth “to forgive is not to forget” so how does transformation of the past pain and damaged relationship happen?… (Continue to read at Psyched in San Francisco Magazine)
Today I want to share a tool I have created to explain the mechanisms of Obsessive Compulsive Disorder (OCD) to children who are struggling with it. I work with a mindfulness based version of Exposure and Response Prevention. In mindfulness practice I find it helpful to imagine one’s own awareness as a wide open blue sky. Thoughts and images pop up and pass through this sky like planes, clouds, balloons and other flying objects. They can appear big and loud and strong but they inevitably become smaller and finally disappear out of sight. From the perspective of the wide open blue sky they may rough up things for a bit but they don’t change the sky. If we can treat the thoughts and images our mind creates with non-judgmental awareness, look at them, appreciate the feeling that comes with them and then let it drift away, we can become “unstuck” and our emotional pain can diminish. When we practice mindfulness we can learn to accept our inner experiences without avoidance. I will write more about this later and this book about “Acceptance and Commitment Therapy” (ACT) is a fantastic introduction, “Get out of Your Mind and into Your Life: The New Acceptance and Commitment Therapy,” by Stephen C. Hayes, PhD.
For people who struggle with OCD certain intrusive, repetitive, negative thoughts and images (obsessions) create intense feelings of anxiety. To relieve these feelings they tend to engage in concrete or mental rituals. The way our mind tends to work, however, when an anxiety provoking thought gets negatively reinforced via a response (a compulsion) it comes back bigger and stronger. To explain this mechanism to children I have created these images:
Children can write one of their obsessions into the first balloon and can fill some of the other flying objects with thoughts that are not coupled with anxiety for them. They can then also fill in a compulsion they use to feed the “Bad Feeling Monster.” On the second page they can see how the monster and the balloon have grown and are still right in front of them while the other “thoughts” have moved away and are leaving their “sky of awareness.”
You make my skin crawl when I hear a noise in the night
You send jitters down my spine when I climb to scary heights
You make me run, run, run…
Forward, don’t look back, never rest!
You remind me I have a heart that can beat out of my chest
You come to me in the night with memories and visions, a punch to the gut
And then you push me out of the gates with incredible speed.
Fight or flight! Freeze or death! You keep me going, my weird friend, my racing breath, forward, don’t look back, never stay, never rest…
In this short poem I was trying to touch on some of the contradictory aspects our experience of anxiety can contain. While it originates in our basic survival mechanism of “fight, flight or freeze,” our emotional makeup as humans that comes with the knowledge of our own mortality, a keen memory and a sense of imagination of the future can transform it into a force that works against us. I sometimes describe this aspect of anxiety as an “emotional and mental autoimmune condition.” Like our immune system, anxiety is there to let us survive but it can turn into an enemy. When we experience the detrimental effects of overbearing anxiety, we tend to lose touch with not only its truly protective aspects but also with its potential as a driving force. I will certainly write more about this in future posts but would love to hear more from you about your thoughts and reflections on anxiety.
A little while ago an amazing poem by a 6-year-old boy circulated on the internet. It is charming for its misspelled words and the last two lines convey this beautiful image, “We danst to the mozik/We made personal space” (spelling as in the original).
These lines so perfectly capture the idea of this small area of space around us that moves with us when we move and whose size depends on the situation we find ourselves in. This physical personal space is something we are unconsciously always aware of and we learn to sense and respect other people’s personal space as well. Continue reading →
I am currently reading a book by Caroline Knapp “Drinking: A Love Story,” in which she details her struggles with alcoholism and the story of her recovery. I highly recommend the book! So many people are living with chronic addictive illnesses either in the active stages or in recovery from it. As a therapist I find myself discussing addictions of different stripes with my clients almost daily. I have read more books about the topic than I can count and am always seeking out more information and training on the matter. A recurring theme related to addiction is the description of people using a substance (or sometimes a behavior such as gambling or binge eating) to cope with a feeling. Addictive illness is an intensely complicated topic, so the accounts of the feelings and situations that drive people to drink or use are individual and diverse. Continue reading →