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Hakomi: The Principles, Part 2

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(Photo Credit: Benjavisa Ruangvaree)

By Paul Hubbard, MA, AMFT

Mind-Body Holism

While there are influences that the body has upon the mind, in Hakomi, the focus is more on how the mind influences the body, specifically how core beliefs and early memories affect someone somatically or physically (Kurtz, 1990).

In Hakomi, the focus is on the “mind-body interface” where beliefs, images, and emotions interact with bodily experiences and where these interactions take place in both directions (Kurtz 1990, p. 31; Myullerup-Brookhuis, 2008).

Mind and body are part of one system and interact at different levels. Hakomi looks at some ways that the body reveals one’s beliefs and emotions. Mind-body holism, which borrows from Reichian therapy and Bioenergetics, allows one to view “the body as an expression of mental life” by studying body posture, structure and behavior. The therapist tracks the client’s “bodily signs of inner experiences” (Kurtz, 1985, p. 4).

Unity

Psychotherapists work to get differing aspects of communicating, including family members, body and mind or various aspects of the mind. This requires some skill in order to coax the disowned aspects out of the unconscious and give them a voice with which to speak in a more open and direct way by creating a dialogue. When the dialogue can happen within a safe and nurturing context, then the opportunities for integration are that much better (Kurtz, 1990).

“In therapy, we attempt to establish and enhance communication between conscious and unconscious and between mind and body. In using mindfulness, we create opportunities which allow the unconscious a clear chance to express and be seen, heard and felt. In our focus on the mind-body interface, we work to create channels of communication between them. When we work with the child, we are often hearing from a part that has long been suppressed and silent. When the client comes to insight, meaning and self-acceptance, again it is one part understanding or accepting another” (Kurtz, 1990, p. 33).

In Hakomi, the principles are much more important than techniques. Techniques emerge spontaneously from knowing the principles. It’s better to have the feel of the work than to have the theory (Kurtz, 1990).

“No preferences. No fighting with what simply is. This Zen attitude is basic to both mindfulness and nonviolence.” When there are no preferences, there is no holding on (Kurtz, 1990, p. 37).


References

Kurtz, R. S. (1985). Foundations of Hakomi Therapy. Hakomi Forum, 2, 3-7.

Kurtz, R. S. (1990). Body-Centered Psychotherapy: The Hakomi Method. Mendocino, CA: Liferhythm Press.

Myullerup-Brookhuis, I. (2008). The Principles of Hakomi. Hakomi Forum, 19-21, 69-84.

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Mindfulness: A Brief History, Vision and Purpose

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(Cover Art from the album “The World Is Mind” by KRS-One)

By Jason Briggs, MA, LMFT

“When in our right mind, everything is viewed as an expression of love or a call for love. In other words, the way I am toward you, the way I behave toward you, the way I think about you, the way I feel about you, is not changed by what you do…love would be the content (a perception I have of you), nothing would change.” – Kenneth Wapnick, Ph.D.

There is a place in you, where no change has occurred, nor will occur, and is completely at rest. This place is nowhere and everywhere because it isn’t seen with eyes but is perceived with the mind. Helen Keller, the blind and deaf author and political activist, points to the activity of the mind and wisely names it vision, stating, “It is a terrible thing to see and have no vision.” So, it is clear that Helen is speaking to what we perceive, and perception doesn’t require the eyes to see and the ears to hear. This begs the question, what is it that perceives? It is the mind, and here in the mind, we find a vision and a purpose for our existence and our service to others that allows for acceptance.

Extant philosophies on mindfulness point to how long we have been formally studying and writing about the subjective experience. We can trace the history of mindfulness through spiritual and religious texts, back to Pakistan, in the Vedic scriptures of Hinduism and later in Buddhism. However, many references to mindfulness exist in other spiritualities and religions as well. “…Some commentators argue that the history of mindfulness should not be reduced to Buddhism and Hinduism, as mindfulness also has roots in Judaism, Christianity, and Islam (Trousselard et al., 2014). So, there is more to explore here but roughly the earliest Hindu texts put mindfulness in the realm of study at about 4500 BCE and in many other texts, on through to the present and through many philosophic branches.

The movement and practice of mindfulness can be defined as a purposive activity of will, to be present to and aware of what is perceived here and now. One can view therapy as a mindfulness practice of sorts, as research on healing and growth shows that clients unexpectedly at times address many different issues in therapy, that they never knew existed upon commencing therapy. As the client and therapist grow more mindful, awareness of what were once unconscious issues become conscious. Also, for many clients, they see the same old issues they have had and may begin to recognize them on ever-deepening levels. So when we talk about being mindful, we must include the idea of slowing down as a task in therapy, being present to what is here and now and being open to what is.

Being present means we are not only looking with our eyes or hearing with our ears but rather, we are also perceiving with our mind. Our purpose determines what we see. As Kenneth Wapnick instructs in the psychospiritual book, A Course in Miracles, “Do I want to shift my attention from the world out there, to go back in my mind…and look upon it with love, gentleness, and kindness or with anger, judgment, and hate…”.

So whatever decision we make, it is our purpose that determines what our vision reflects, a purpose we may or may not be aware of and one that reflects our right-minded perception or wrong-minded perception of how we perceive ourselves, others and our world. If we look with the right mind, what we see will reflect a vision that is mindfully aware of the fact we are joined with others, and we are accepting of this fact. If we decide a wrong-minded or mindless purpose, we will see separation as the only reality and suffer accordingly. Identification of our purpose is a passive act of will and shouldn’t be considered mutually exclusive to normal ways of acting in the world, as we may be busy working with others personally and professionally in many varied roles and we can do so mindfully or not, depending on our purpose.

If what we decide that our vision is of the mind and not of the eyes, then we have been given great freedom as decision-makers. Countless decisions must, of course, be made in the world related to our roles and responsibilities. However, on the level of the mind, there are two decisions possible. One reestablishes vision as an activity of the mind and the other blocks vision and produces conflict within. So if I want to engage my roles and responsibilities as a partner, husband, father, teacher, student, lover, I can do so mindlessly or mindfully. My peace or lack thereof will follow and if I choose to perceive mindlessly, fear will be engendered. Fear indicates a mindless decision and so we can decide to return to the mind, in a way that completely looks at and accepts a mindfulness stance.

As the Course in Miracles encourages, “When your peace is threatened or disturbed in any way, say to yourself:

‘I do not know what anything, including this (the mindless perception we are having, that induces fear), means.
And so I do not know how to respond to it.
And I will not use my own past learning as the light to guide me now.'”

Well, the obvious implication is that we will be willing to have a complete acceptance of what we are seeing and see that it is precisely our interpretation from the past that we are bringing to this experience and to then not decide to interpret it.

Let us take the great Bard of the West’s example when we forget to be mindful, remembering we can be like Shakespeare’s Cordelia who mindfully chided her father’s egoic false love in King Lear. Cordelia, turning away from her father’s demands to profess her love of him in public, pivots instead professing, “I will love and be silent.” The world is in the mind and when we decide to join it, ever so gradually, consciously, increasing our time we spend mindfully, purposely and with a shared vision, we can come to accept where we are right here and now. We can learn to shift our purpose, vision, and way of being from mindlessness to mindfulness.


References

Bibliography

Trousselard, M., Steiler, D., Claverie, D. Canini, F. (2014). The History of Mindfulness put to the test of current scientific data: Unresolved questions. Encephale-Revue de Psychiatrie Clinique Biologique et Therapetique, 40 (6), 474-480. doi: 10.1016/j.encep.2014.08.006

Mozilla Firefox 10-2-18

http://www.jcim.net/acim_us/TxtChap-14-7.php?dig=your+minds

https://www.sparknotes.com/nofear/shakespeare/lear/page_6/

https://www.brainyquote.com/authors/helen_keller

https://www.google.com/search?q=Hellne+Keller&ie=utf-8&oe=utf-8&client=firefox-b-1

Online Learning

Foundation for A Course In Miracles: Youtube Channel:
https://www.youtube.com/watch?v=Nad7AjRBY3M

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Boundaries and Types of Touch In Psychotherapy

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(Photo from the Mother Love Bone’s album ‘Apple’)

By Jason Briggs, MA, LMFT

“Art…We are flesh and blood and full of faults. But we are also full of warmth. The world is full of confusion, but there is compassion in its midst. Communication via simple touch can transmit so much of us in just one minute. Like a painting or a piece of music. I want to touch your soul. I only wish I could be sure it was the right thing to do.”
– Jay Woodman, SPAN

In this piece we will explore ways to be boundaried when integrating touch in psychotherapy. Therapeutic touch is defined as any physical contact between a client and her therapist while participating in psychotherapy, which is non-sexual in nature. In this missive, we will address how therapists can use touch to help heal their clients.

Touch is often highly avoided by psychotherapists, partly because it’s rarely discussed in schools and training programs, and because of an over-arching lack of interest and understanding by gatekeepers in the field of psychotherapy, both historically and present. I will discuss how not using touch can be neglectful when a client needs exactly this type of support. Touch is an important and equally healing form of communication, possibly on par with words (i.e., Fridlund, 1994; Young, 2005). Given that touch, so often confused with sexual touch by therapists and clients alike, is so healing, we as therapists must no longer abandon considerations when using touch in psychotherapy and instead explore what using touch can do for our clients to facilitate a greater healing in the therapist-client relationship.

When using touch, one must always consider her rationale for why this adjunct type of support is being used, considering both client and therapist and the boundaries they share and are surrounded by. Touch enacted in therapy by the therapist in traditionally more rigid ways may stem less from an awareness of healthy boundaries and excellent standards of practice and instead from a lack of awareness or interest in the various standards of practice regarding touch and the benefits of the use of touch in psychotherapy. Maybe a therapist considering using touch hasn’t thought of what is barring their interest and ability to use touch as a viable form of communication in psychotherapy. Myths, as unchecked assumptions, are perhaps the most pervasive reason therapists don’t suss out how to use touch in their practice. Here is one such myth:

“There is a myth of the slippery slope that non-sexual touch inevitably leads to sexual touch, which is unfounded, scientifically unsupported and basically is paranoid. It’s pretty crazy actually if we just look at it. The assumption that soothing touch leads to sexual touch is nonsensical. In spite of numerous therapeutic approaches, theories and practices that systematically and effectively use touch in therapy, it has been marginalized, forbidden, called a taboo, often sexualized and at times criminalized by many schools and ethicists, licensing boards as well.” – Ofer Zur

What is the cost of a therapist’s lack of interest and awareness of touch in psychotherapy? Here is one possible outcome: “Indeed, touch deprivation has been consistently linked to aggression, delinquency, social isolation and depression in children and adults (Field, 2003).” Given this knowledge and the standards of practice in the field of psychotherapy, standards rooted in a larger philosophic service-based assumption known as the Hippocratic Oath (to always do no harm), it bears to reason that touch in psychotherapy cannot be ignored as a matter of the wellbeing of the clients we serve.

Boundaries that bar touch are likely to be too rigid and may prevent necessary information from being received by the client, possibly to sooth or calm, and prevent ongoing dissociation, etc. Touch that communicates harmful information to the client by her therapist needs to be withheld by the therapist, as this places her below the standard of care and practice and is illegal.

This harmlessness of using touch and assessing the potency of touch includes the therapist learning the client’s preferences, background, history, ability to stay in the present, power differentials and much more. Consent allows sharing of information, verbal or non-verbal (touch), to be given and received in ways that are experienced as healthy by client and therapist alike. It goes to say that negotiating boundaries around touch must be learned by therapists to raise touch into the realm of healing and that healing must be raised to unequivocal predominance. Boundaries allowing information to be shared in a defenseless way allows bonds to be felt between client and therapist. This sharing is like a cell whose nutrients are present and released, even when toxins exist. Toxins are contained for the time being and released when shame and fear can be let go of by the relational field found in the client-therapist relationship.

There are three types of touch in the literature on touch. The first is those adjunct forms of touch shared by psychotherapists, which complements verbal therapy and can take many forms. The second type of touch is therapeutic touch by body psychotherapists whom use their training in somatic psychotherapies to dictate what type of interventions may be used when considering touch for their client’s needs. The third type of touch is inappropriate or hostile touch and these are sexual, hostile or punishing touches and are illegal and unethical in the field of psychotherapy. With sexual touch the initiator intends to sexually arouse the therapist, client or both. In the first type of touch there are many forms and purposes for using touch with our clients.

Therapists who learn more about their clients and their own relationship to touch and how to use it effectively have advantages over those therapists who don’t have touch at their disposal as an important healing intervention. Raising our voice and awareness regarding touch, as therapists, means embracing the simplicity of touch, its complex applications, and preparations on how to use it in therapy. Doing this means raising touch to its rightful and helpful place in psychotherapy, not only as a valid form of communication but one that embodies a combination of silence, caring and connection, which words simply fail to communicate.


References

O. Zur , Nordmarken, Nola (2015) Touch and Boundaries in Psychotherapy: To Touch Or Not To Touch, Exploring the Myth of Prohibition On Touch In Psychotherapy And Counseling, Clinical, Ethical & Legal Considerations, Online Education.

O. Zur (2007). Touch In Therapy and The Standard of Care in Psychotherapy and Counseling: Bringing Clarity to Illusive Relationships. United States Association of Body Psychotherapists Journal (USABPJ), 6/2. 61-93. Copyright USABP www.usabp.org

Mozilla Firefox, Google search, (2018, July 15, 9:10 pm). https://www.goodreads.com/quotes/tag/touch

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Come Get Your Pride On With Healing Pathways Psychological Services On June 10th!

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PRIDE FESTIVAL

The festival is on Saturday June 10th from 11am-5pm, costs $10 per person (children 10 and under are free), and is located on the Capitol Mall between 3rd and 7th streets. More about the festival…

ABOUT SACRAMENTO PRIDE

Sacramento Pride 2018 is the 34th annual local commemoration of a pivotal moment in civil rights history, the Stonewall Riots of New York in June, 1969. This moment represented the start of a movement to bring lesbian, gay, bisexual, and transgender (LGBT) Americans out of the shadows and into everyday society. More recent achievements along these lines have included the repeal of the military’s “don’t ask don’t tell” policy as well as court victories to equalize marriage rights.

The event has evolved into a high profile celebration and cultural festival, both on the national and local levels. Pride was moved from Southside Park in 2010 to the streets along Sacramento’s symbolic Capitol Mall, with the State Capitol building on one end and the iconic Tower Bridge on the other. Pride 2018 will build upon our successes and continue to grow and improve.

Sacramento is already nationally known as a city with a relatively high gay population. The City of Sacramento is estimated to have a gay population of 9.8%, the sixth highest in the nation. The larger metropolitan area comes in at 5.5% which is still higher than the national average of 4.1%.

Pride is more than just a great parade and festival, however. It is produced by the Sacramento LGBT Community Center and is the largest source of funding for the Center’s programs and services. The Center provides unique services for at-risk youth, a free weekly legal clinic, HIV/AIDS prevention and support services, transgender support, and numerous discussion groups and other activities for LGBT adults. The Center is a 501c(3) charitable organization.

OUR COMMUNITY

Healing Pathways Psychological Services is excited to join the celebration of Sacramento Pride 2018. Our contribution to the event not only educates people about what we’re up to in our city, but we will be putting smiles on their faces with fun activities and prizes. We are so delighted to share these festivities with all of you and look forward to sharing this rare opportunity…

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Hello, It’s Nice to Meet You!

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Alicia Cox, MA

By Alicia Cox, MA, AMFT

I’d like to introduce myself to all of you. I am one of the newest marriage and family therapist associates at Healing Pathways Psychological Services and am so excited to be working with such an amazing and supportive team. I am currently gaining hours towards my license and am working under Dr. Kashersky’s advisement.

As an undergraduate, I majored in genetics and psychology. I think my science background gives me an interesting perspective with clients. I sometimes like to view problems from an evolutionary psychology perspective and use cognitive behavioral therapy in practice. I also have training in Mindfulness and use it in as a therapeutic invention with my clients.

Before going back to school for my graduate degree, I worked in the field of clinical research. I initially started as a research coordinator in a pain medicine clinic, working on research studies focused on pain medication addiction.

Most of my career in research was spent at the UC Davis MIND Institute, where I worked for 9 years. In my position as a clinical research coordinator, I worked with families who had children, adults and families impacted by Autism Spectrum disorder, Fragile X syndrome, Attention Deficit Hyperactivity disorder, Tourette’s syndrome, Down syndrome and adults being treated for strokes. Even though I loved my work, I realized the limitations of my position and wanted to pursue a career in which I could contribute more to the treatment of individuals and their families. My trajectory then shifted and I decided to become a marriage and family therapist.

As a graduate student, I completed some clinical training at the MIND Institute. I was a co-leader for multiple social skills groups. I also worked in the ADHD and Learning Differences clinic, helping with a parent education group and completing intakes for new clients in the clinic. From working on research studies and in the clinic, I also gained a lot of experience and training in administering psychological, neuropsychological and academic testing.

My clinical interests include working with families and individuals diagnosed with neurodevelopmental disorders and/or chronic illness. I also have an interest in working with individuals experiencing pregnancy loss and infertility.

In my time at home, I have a very active life with my husband, two sons, two dogs, two cats and two fish. We are animal lovers and have adopted 4 pets to prove it! I also enjoy traveling, running, playing tennis, reading, gardening and listening to podcasts in my free time.

I look forwarding to working with my colleagues at Healing Pathways and with many of you. Also, look at for my future blogs featuring topics on neurodevelopmental disorders, chronic illness and women’s issues.

 

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On Parenting: A Classroom for Healing the Generational Conflict Cycle

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(Photo Credit: ESB Professional)

“…The universe is part of this one cry,
every life is noted and is cherished,
and nothing loved is ever lost or perished.”
Madeleine L’Engle, A Ring of Endless Light

By Jason Briggs, MA

According to the Global Survey of Violence Against Children put out by the United Nations, “every year, between 500 million and 1.5 billion children worldwide endure some form of violence”. 1 Alice Miller, PhD, is a psychologist, sociologist, philosopher and renowned author of many books on child abuse describes in her book, Thou Shalt Not Be Aware: Societies Betrayal of the Child, how past child abuse is meted out against children in innumerable ways and typically by parents who assume consciously or not, a “for your own good” maxim.  Miller shows how the many parenting approaches endorsed in western society produce a multi-generational conflict cycle, through overt and covert trauma bonds. These bonds within the child/caregiver relationship are felt and aren’t impacted by analytical thought so they touch all our families equally, regardless of educational level, socio-economic status, race, etc. This blog will explore one aspect of this generational conflict cycle and be a part of a series of blogs with some solutions offered in each blog. The goal is to help parents identify and begin healing to eventually resolve the generational conflict cycle. (See Alice Miller’s book: For Your Own Good: Hidden Roots of Cruelty and Violence in Child Rearing for exploring the ways this cycle is perpetuated.)

The generational conflict cycle begins when parents with unhealed emotional wounds unconsciously attempt to get their own emotional needs met by their children. Parents will do this both consciously and unconsciously and often see their children through the veil of their own unfinished business (by bypassing this aspect of their powerful inner life), which consists of “…past internalized perceptions, which are ‘frozen’ and usually stemming from childhood.” The effects on children are they must idealize their parents to survive as their own healthy needs go unmet, the ability to soothe themselves is further perceived as hopeless, and the true self (the entire access to ones innate inner life: feelings, thoughts, wants, needs, choices, decisions, beliefs, sensations, dreams, fantasies) goes into hiding in the unconscious while a false self emerges. This child’s false self is the one that complies and relates from the parental emotional wounds as solidified judgments, which are projected onto their children, seen predominately as children’s misbehavior, oddities, attitudes, or any other judgement. This is the way a parent unconsciously ends up placing the emotional needs of the parent above their children’s emotional needs and maintains the generational conflict cycle.

Emotionally neglected children, commonly grow up to be adults who in turn, emotionally neglect their inner emotional world and those of their children. Our neglected emotional and psychological needs by the now adult parent are automatically passed on to the next generation. This generational conflict cycle, when denied, operates as generational conflicts maintained in the parent/caregiver/child relationship and takes many forms (See Alice Miller’s book: Thou Shalt Not Be Aware: Societies Betrayal of the Child, for exploring more in depth ways we function in society to hold power over children, to the betrayal of children).

As parents, cultivating a mindful stance that addresses the neglect of our own unmet emotional needs helps shift the parenting stance from mindless to mindful. The hope of making this shift from the mindless to the mindful means choosing to end the bypassing of doing one’s own inner work and being self-responsible for the condition of one’s own mind. One way to do this is by choosing to see our pain as an opportunity for healing and growth, rather than a curse. Exploring that opportunity as a healing choice means to begin addressing one’s own generational conflict cycle, regardless of the time, patience, and persistence required. Therapy that helps promote healing maintains that parents focus on certain essentials to recovery, by: 1) slowing down and understanding the steps in going from ‘zero to sixty’, 2) learning about projection and it’s guises (projection is an emotional wound that is seen in another, because it is been denied in ourselves), 3) seeking therapy that focuses on experiential work that at some point includes body awareness work, 4) learning about the nature of the psyche, what constitutes its dynamics, and explore if and when a self-help approach is limiting our efforts to heal (as we may be unknowingly perpetuating a belief  that we must do our inner work alone), 5) being willing to learn about mindsight research in attachment and effective parenting (see Daniel Siegel’s work), and the way the caregiver’s role, emotions, and psyche condition impact our children’s healthy and unhealthy development, 6) exploring new and creative ways to heal and nurture ourselves as parents, as the cause for our truly being there for our children, 7) being willing to cultivate understanding and compassion in our healing and growth process, as parents.

All parents have a thankless job with most never consciously wanting to harm their children, and appealing to that truth, I see this daily in service to my clients who are parents, and see this is true, being mostly out of awareness. The generational conflict cycle may mean we need help in understanding its causes, effects, and what heals it.  One way to explore essentials to healing it is to enjoy a great read by Charles Whitfield, MD, researcher and psychotherapist from Atlanta, Georgia, titled, Boundaries and Relationships, Knowing, Protecting, and Enjoying the Self. For help with understanding these skills more experientially by using emotional, psychological, or spiritual disciplines, ask yourself, “Is it time to give a gift to myself and my children by seeing my own emotional and psychological pain as a classroom for learning about my inner life?” For me, the answer is an unequivocal YES! Before I cultivated a proper focus on addressing my own unmet emotional and spiritual needs, I was a smiling, charming and successful parent but was only one half alive, meeting only my physical and mental needs! We are here to live life fully and with joy. As parents, one way of taking steps toward that fullness of life is to explore our choices for healing, and when ready, to decide to begin to explore what it means to see parenting as a classroom for healing our own generational conflict cycle.


References

Miller, Alice (1984). Thou shalt not be Aware, society’s betrayal of the child    Toronto, Canada. Collins Publishers

Miller, Alice (1997).  Drama of the Gifted Child, the Search for the True Self   Garden City, New York.  Basic Books

Trout, Susan (1990).  To See Differently, Personal Growth and Being of Service Through Attitudinal Healing. Three Roses Press

Whitfield, Charles (1993).  Boundaries and Relationships, Knowing Protecting and Enjoying the Self.  Health Communications, Inc.

https://www.compassion.com/poverty/child-abuse.htm United Nations, Special Representative of the Secretary-General on Violence against Children. Toward a World Free From Violence: Global Survey on Violence against Children, October, 2013.

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The Healing Power of Sound Intensive Meditation Experience

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Crystal Singing Bowls Mind/Body Connection

Healing Pathways is very excited to bring you the crystal bowls to bring balance to your mind, body, and spirit. The bowls are pure crystal and tuned to specific frequencies and chakras to enhance the meditator’s experience, taking you deeper into meditation. Most ancient cultures used the magical power of sound to heal and to bring the body back into resonant balance. Regardless of your level of meditation practice, the crystal bowls will assist you in reducing stress, anxiety, and pain, promote happiness, peace of mind, and help you hear the music of your life-purpose.

Come and learn to open up to your deeper wise self while resonating with the healing sounds of the crystal bowls. Regardless of your level of meditation practice you will be able to experience a richer grounding, healing and/or connection to your higher source. Mindful practitioners of all levels are welcome to come and enjoy this unique meditative experience. Feel free to bring a blanket and pillow for the meditation portion of the program.

Given her background in evidenced-based healing models, Dr. Leona Kashersky is presenting this ancient practice of crystal singing bowls, chakral system theory, rhythm and mantra meditation with the modern principles of EMDR (Eye Movement Desensitization and Reprocessing). This fusion of past, present and future is sure to enhance your inner work of integrating your heart and mind at a serene location provided by Healing Pathways.

Stay Tuned! Next event date to be posted soon!

For registration call: 916-595-7233
Email soundhealinghpps@gmail.com for registration details
Cost $140 3 hour instruction and experiential didactic.

 

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Mental Health Access and Equality: 3 Steps to Freedom!

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(Photo Credit: Shutterstock)

By Dr. Leona Kashersky, PsyD

According to the U.S. Department of Health and Human Services, as many as one in five Americans will experience a mental health issue at some point in their lives. This report is likely an underestimation of how many Americans experience mental health challenges during a lifetime. Of the nearly 60 million Americans who experience mental health concerns each year, many will never seek treatment for a variety of reasons including social stigma, cultural norms, and lack of access. In fact, a recent report published in the journal Psychological Science and the Public Interest found that an estimated 40% of individuals with serious mental health concerns either never receive care or start an intervention program without completing it.

The stigma surrounding mental health issues can be a significant barrier to care. Unfortunately, many people unknowingly contribute to the stigma simply with their everyday language choices. A poor choice of words not only stigmatizes, stereotypes, and creates unrealistic assumptions about certain people, but also can trivialize serious mental health conditions and their accompanying experience. As we move forward into a more enlightened future where mental health access and needs are considered just as normal and standard as the need to address a flu or more chronic physical health challenges, let’s dream of this brighter and more hopeful world together here!

In this new and more beautiful world our hearts know is possible, we would accept mental health hygiene and seeing professionals as part of living a normal and healthy life. Acknowledging and discussing symptoms wouldn’t be secretive or shame-based. Just as our communities gather to support those with physical illness, we would gather to do the same for those with depression, anxiety, and neurological differences. We would have more open dialogue about how this gathering would look different because the needs of these individuals are different than those suffering from flu or other chronic physical health challenges. This more beautiful world would allow us to come together armed with education and support to face life’s most challenging mental health setbacks without the shame and judgement we often face in our world today.

In this more beautiful world our health plans would adequately cover inpatient and partial hospitalization, intensive outpatient, and outpatient programs. All of us would have access to appropriate levels of care when we need it. Communities and families would know how to embrace and integrate individuals who are struggling with appropriate and supportive boundaries. Substance abuse treatment would be easy to access and affordable, saving countless lives. If we really want this beautiful new world, we can begin this journey by taking 3 simple steps.

  1. Accept what is! All of us need mental health maintenance. All of us grieve. All of us suffer. It IS the human condition. Let’s accept it and help each other.
  2. Suspend judgement! Judging ourselves or others in their mental suffering only serves to extend the duration of suffering. LET GO of the shoulds and other criticisms.
  3. Dream of the life you want and believe it is possible! Imagine how you will feel when this happens. Allow yourself to experience the full emotion and somatic sensation of those emotions. Allow your mind to fully appreciate all that is there for you.

These steps will allow you to magnetize to your ‘More Beautiful World’ tribe. This community will be the seeds to this more beautiful world in our hearts we all know is possible. These roots are already growing and taking hold, so let’s keep dreaming together. We are manifesting our hearts desire and creating a new reality together!


References

Corrigan, Patrick. (September 4, 2014). Stigma as a Barrier to Mental Health Care. Association for Psychological Science. Retrieved from: http://www.psychologicalscience.org/index.php/news/releases/stigma-as-a-barrier-to-mental-health-car.html

Mental Health America. Mental Health Information. Retrieved from: http://www.mentalhealthamerica.net/mental-health-information

Eisenstein, Charles. (November 5, 2013). The More Beautiful World Our Hearts Know is Possible. North Atlantic Books.

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Using Meditation to Tame this Mind of Ours

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(Photo Credit: Dollar Photo Club)

By Nicolina Santoro, MA

Mahayana Buddha, the progenitor and prophet of the middle way, had encapsulated an entire philosophy into short, clear directives. “Commit not a single unwholesome action, Cultivate a wealth of virtue, To tame this mind of ours; this is the teaching of all the Buddhas” (Rinpoche, 1993). Meditation is part of the practice of taming the mind. Often described as the still mind, or still waters of the mind, meditation appears to be a kind of martial art for one’s thoughts. To even begin to feel the stillness of mind that comes with the practice of meditation, one must endure the onslaught of thought as it runs through the beginning meditator’s mind rampantly. Even more interesting, is the realization that this pattern of thought is a regular occurrence in the mind. Meditation highlights the never-ending barrage of thought, as the student tries to negotiate the noise to a place of quiet within the mind.

Meditation is actually a common practice among many different platforms of faith, although called many different names throughout time, but the goal of calming the turbulence in the mind remains the same. The practical applications of meditation have far reaching benefits to those who suffer from a variety of illnesses. Mental illnesses such as anxiety, depression, obsessive-compulsive disorder, and manias have all shown to be positively affected by the regular practice of meditation. Some of the therapeutic benefits of regular meditation practice include enhanced self-esteem, reduction in feelings of hopelessness and depression, and a sense of spiritual connection.

Since the mind, by its various sense mechanisms can create and maintain a subjective reality, one seems to be at the mercy of the mind and its myriad of emotional states of being. Thoughts create emotional experiences based on the electrical impulses that send messages to various chemical centers to whip up recipes for certain emotional states. These emotional states hold tremendous power over self-efficacy, and emotional well-being. Most people have had the experience of having a “bad” day, or a lack of desire to get out of bed. These types of feelings and their sources are often overlooked by people experiencing them, as the emotional tide they create has a strong influence in coloring one’s perceived reality. Over time, the continuing pattern of similar emotional states can create long-term relationships between neurons in the brain. In other words, relationships between a thought and the subsequent emotional state that the thought triggered become a learned response with different chemical markers for different emotional states.

Meditation is the act of awareness, noting a thought as it travels through the mind’s eye, rather than grabbing on to it for dissection. It is in the act of dissection that the emotional response is created. A sort of fixation then occurs, making it very difficult to regain a sense of calm detachment which is the focus of the meditation practice. Observe, but be not of the waves of thoughts that roll through the ocean of conscious awareness, and breathe which is certainly not as easy as one might think.  Buddhism imparts that suffering, and dis-ease are certainly inevitable in life however, there is an opportunity for personal transcendence in the observation rather immersion in this state of suffering  (Rinpoche, 1993). A meditation posture is grounded, comfortable yet deliberate. One may elect to sit on the floor with legs crossed in front of them, arms relaxed and poised comfortably in the lap, eyes closed. One then begins to notice their breath, every inhalation and exhalation is noted in the awareness space. As this practice begins, the mind seems utterly flooded with thoughts, worries, randomness, and chaos. However, through each breath, the subject becomes accustomed to the flow of thoughts which become a sort of background noise, and the central focus of breathing creates an altered or trance like state in the consciousness of the meditator. This altered state of being allows the meditator to observe self from a place of detached compassion which is the place of mindfulness that the Buddha described.

Common mistakes that people make when entering into the practice of mediation exists in the misapplication of the quiet mind concept. The term is slightly misleading. The mind, it seems, is never truly quiet. Thoughts run constantly because the mind is always taking in information, processing it, encoding it, retrieving it, and deciphering it. The stillness of mind exists in the unfettered observance of this process. Unfettered meaning that one never holds on to, or tries to single out the thoughts as they steadily move through conscious awareness of the subject. As meditation becomes familiar to the mind itself, the thoughts no longer control the emotional state of the meditator, and stillness is observed by a state of total acceptance, and symbiosis.

The meditation process has been reported to be difficult, and even frustrating to those who are new to the experience, but long term benefits have also been relayed by those who were able to get through the frustration, and experience the trance-like state where feelings of calm and clarity exist. Meditation as a response and treatment for stress is now common advice from health practitioners even in the west because of the positive impact it has on the central nervous system (CNS), (Fontana, 1992).  The effect that mediation has on the body is noted further in the American Psychological Association’s book entitled Integrating Spirituality into Treatment. Meditation lowers respiratory rate, heart rate, and brain wave states, placing the body in a state of rest which is very helpful in dealing with chronic anxiety. Meditation has also been used frequently in the redirection of addictive behavior because of the altered state that it can enhance bio-chemically. In behavioral and cognitive behavioral types of therapeutic interventions, meditation is also useful in the reprogramming of negative thinking, through the natural change in thought patterns that are facilitated by the practice.

Research conducted by Lindgren & Coursey, published in 1995 shows a strong positive correlation between the use of meditation practice and increased feelings of well being among those who suffer from severe forms of anxiety and depression.  Those who are being treated for more severe mental illnesses such as schizophrenia and bipolar disorder have also reported positive cognitive effects on mood and self-esteem. These trends can enhance the level of care that practitioners bestow upon their clients, giving them the tools to help alleviate some of the distress associated with negative automatic thinking, placing some of the control back in their hands with regard to better self-care.

Self-care is something that even mental health practitioners overlook for themselves. In the mental health fields, burn-out among therapists and social workers is high. The culprit seems to be a lack of self-care and over extension according to the APA. Regular meditation practice can also help alleviate the stress that in the field of mental health seems almost inevitable to its practitioners. Self-care processes that the APA advocates include the awareness of the levels and types of stress in the practitioner’s environment, case load management, outside support networks, and extra-curricular activities that promote a sense of health and well being. A professional support network, boundaries, and realistic expectations upon the self are also highlighted as areas to which the practitioner should attend for optimum results. The clarity that accompanies regular meditation can also invigorate a flagging practitioner, providing a sense of calm and clarity toward the greater good of all concerned.


References

American Psychological Association. ed. by Miller, W.R. (2006). Integrating Spirituality into Treatment: Resources for Practitioners. Washington: American Psychological Association.

Berger, K. S. (2006). The Developing Person. New York: Worth Publishers.

Fontana, D. (1992). The Meditator’s Handbook. Rockport: Element Books, Inc.

Lindgren, K., & Coursey, R. (1995). Spirituality and Serious Mental Illness: A Two-Part Study. Psychosocial Rehabilitation Journal, 18(3), 93-111. Retrieved from EBSCOhost.

Rinpoche, S. (1993). The Tibetan Book of Living and Dying. New York: HarperCollins Publishers.

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A Series of Writings for Clinicians on Common Factors Research and What Promotes Change in Couple and Family Therapy, Part 2

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(Photo Credit: Dmytro Zinkevych)

By Jason Briggs, MA

What motivates a client to change and what are the processes therapists can use to help?

In the last writing, in this series on Common Factors research, the discussion was on aspects of two Common Factors used to promote effective outcomes in therapy.  They were client factors and therapist factors. These two Common Factors will be addressed in this second writing as well, along with how they interrelate with a third Common Factor called the therapeutic alliance, all within the Stage of Change known as Contemplation. I will also discuss what some of the change processes I use are and how they are also supported by Common Factors researchers. I will begin with what Common Factors researchers find is essential to Motivational Interviewing, since this was not discussed in my last post. Again, as with all my writings on Common Factors, I am reviewing three Common Factors researchers’ work, authored by Douglas H. Spenkle PhD, Sean Davis PhD and Jay L. Lebow, PhD, referencing information found in their book Common Factors in Couple and Family Therapy, The Overlooked Foundation for Effective Practice.

Motivational Interviewing has elements that when brought together in the context of our clients’ lives, can help therapists join with clients, inviting them to engage in and explore change in whatever Stage of Change they might be experiencing. Common Factors researchers contend and I agree with them, that “within the Motivational Interviewing approach there is no such thing as an unmotivated client. There are only therapists that are out of sync with a client’s motivation” (Spenkle, Lebow and Davis, 2009). So, working systemically, it is often the case that each member in an individual, couple or family system, is in varying Stages of Change and thus motivated at different levels with the different issues they might wish to address. Common Factors suggests part of the therapist role is to shift homeostasis within an understanding of each person’s motivation and the there are five principles to consider, to help us form a better connection with our client and help them move through whatever Stage of Change they are in. We can “(1) express empathy, (2) develop discrepancy, (3) avoid argumentation, (4) roll with resistance, and (5) support self-efficacy” (Miller and Rollnick, 2002) (Spenkle, Lebow and Davis, 2009). These five principles are suggested to fall into three broad therapeutic alliances, which therapists can use three interventions within each stage and they are: “(1) building motivation for change, (2) strengthening commitment to change, and (3) the follow-through (Spenkle, Lebow and Davis, 2009). So what exactly do Common Factors researchers know about the value and importance of these five Motivational Interviewing principles?

“Unpacking” what these Motivational Interviewing principles ignite in our clients, is a great way to motivate therapists to learn these concepts both intellectually and experientially with their clients. As noted above, these Motivational Interviewing principles inherently ask each therapist to embody a sort of attitudinal stance in therapy that helps facilitate a client’s movement toward change. They are (1) expressing empathy and is particularly effective with client ambivalence and is promoted by a listening stance and abandoning a superior/inferior stance, typically embodied by telling a client what meaning we give to their story. Common Factors researchers describe the Therapists’ Alliance in this way: (to be) “a supportive companion and knowledge consultant, (rather) than a forceful instigator of change” (Spenkle, Lebow and Davis, 2009). (2) Developing discrepancy, the second Motivational Interviewing principle is reflected in understanding that most, if not all humans’ emotional and psychological pain exists in direct proportion to the disparity/discrepancy between where they are now and where they want to be, “and when they know better, they will do better” ( BJ Davis, 2012). Common Factors researchers point out, “Depending on which Stage of Change the client is in, the therapist focuses on gently amplifying the discrepancy that is already there (for those in contemplation or preparation stages) or developing a discrepancy (for those in the pre-contemplation stage)” (Spenkle, Lebow and Davis, 2009). Here, we see an emphasis on the therapist knowledge about the Stage of Change in general and needing to know where one’s client is in terms of each Stage of Change and on differing issues, exploring the likelihood of a client having varying levels of motivation to change depending on any given issue and the Stage of Change the client is in with each issue. (3) Avoiding argumentation is the third principles used in helping a client experience the motivation to change. Expecting a client to embrace a certain protocol type therapy, a label, etc. is one way an unsuspecting therapist can invite arguments  against, instead of for change (with us or within the client and likely both). Helping to understand a client’s point of view regarding their preferences in therapy, how they have experienced labels, even “mental health issues” can be one way we can allow their meaning to be held up to unequivocal predominance and then join with the meaning our clients make about how they identify this meaning, amplifying, and reflecting it to them. Closely related Motivational Interviewing principle (4), rolling with resistance, which is an essential facet of Motivational Interviewing and the idea of accepting and not rejecting a client’s ambivalence to change. Emphasis is placed on joining with the client not on any particular interventions, trusting a solution will, if acceptance is present, naturally emerge within the client in the space created for them to explore their problems. This assumes an intention on behalf of the therapist, which trusts the client has their own answers within them, assuming a stance of psychological and emotional safety around any issues the client is considering facing. If the therapist achieves this stance and creates emotional safety for a client to explore what they need, want, and are willing to do based on the clients view, their therapist is seen as an “enlightened witness” (Alice Miller, 97). Supporting this safe emotional and psychological space means supporting the next principle in Motivational Interviewing, (5) supporting self-efficacy, the belief that a client can change and unless this empowering attitudinal stance is demonstrated by the therapist in relationship with their client, “a discrepancy crisis is likely to resolve into defensive coping (e.g., rationalization, denial) to reduce discomfort, without changing behavior” (Miller, 1995, p.5) (Spenkle, Lebow and Davis, 2009).

The therapeutic alliance, another essential Common Factor, will be given its proper weight in understanding how client and therapist factors unite within the processes of change during the Stage of Change known as Contemplation. The therapeutic alliance is defined by Common Factors as both/and, what it is, and what it is not. “It is collaborative. The alliance can be misunderstood as a quality that the therapist brings to the client. However, the alliance is fully interactional and systemic, an operation between one or more clients and the therapist (Spenkle, Lebow and Davis, 2009).” This is a foundational therapeutic Common Factor. It establishes emotional bonds between a therapist and a client to form a connection and assists with providing effective outcomes in therapy. So, helping a client see choices for healing that the therapist sees the client may identify with and find helpful is only half of the picture, the other half is seeing what our clients are contemplating and helping them negotiate the changes they seek to make within all the Stages of Change and processes of change they are in and viewed as meaningful. Stated in another way, “On more careful examination, (our) successful alliance formation is better viewed as a dance in which everyone participated as the alliance co-evolved between the clients and the therapist” (Spenkle, Lebow and Davis, 2009). I will add that a felt understanding by the therapist of the clients’ worldviews are essential, along with a sense of therapist “okay-ness” about the clients’ interactions within the therapy room. These perceptions and interactions the therapist has in turn, will impact the client in therapy, whether the client is in therapy with their family, in a couple, or individual unit of treatment. When the therapist creates psychological and emotional safety in the relationship to their clients’ ambivalent interactions, and helps the client contemplate what it might be like doing inner work using certain stage specific processes of change, the client will reveal more of their ambivalence and ideas to contemplate that which will promote change.

In the Stage of Change known as Contemplation, clients are intending to act “within the next six months.” (Prochaska, 1999) (Spenkle, Lebow and Davis, 2009).  Clients seeking to make a change in this stage are expressing discontent with their problems, want to overcome it, want to see themselves living a life without their problems, but also see why they shouldn’t try to change. Clients in Contemplation “are not very good candidates for behaviorally focused, action-oriented programs. Their motivation is not yet at the level where they will put all of their heart into behavioral change efforts. They are better suited for more passive insight-oriented approaches that help them explore their problem, weigh the pros and cons of changing and so forth” (Spenkle, Lebow and Davis, 2009). Like in the previous Stage of Change the suggestion for this stage is to continue to weigh the pros and cons of changing and decrease the number of cons. The only additional processes of change aside from three mentioned in Pre-Contemplation is self-reevaluation, to assist in transitioning to the next Stage of Change Preparation. So, the therapist is supporting the client in evaluating themselves without the problem. Aside from active imagination, guided imagery, self-acknowledgement of healing and growth, help consolidate steps the therapeutic alliance has made and clarify steps one still might make in the therapeutic alliance to successfully transition to the Preparation Stage of Change. “Values clarification, encouraging congruence between one’s own values and behaviors and the like can be helpful in this stage” (Prochaska, 1999) (Spenkle, Lebow and Davis, 2009).

A therapist being willing to build a foundational relationship with their client depends to a large extent, on a therapist’s ability to listen, explore, and respect the worldview of their clients, not as an intervention, but more as an attitudinal stance toward their shared humanity, a facet of which was addressed above in the therapeutic alliance discussion. Understanding Common Factors research is important and then applying it in our therapeutic practices can help our clients regain a sense of connection often ruptured in their past and current relationships. Common Factors research can help therapists and clients move through change in their own and their clients’ lives in a much more empathetic and meaningful way. Remembering there is always motivation present is essential, and it is the role of the therapist to identify what motivates our clients to bring about effective change, and to “stay with them” as they contemplate ways to move forward while having a timing and pacing that works for them. See the first writing in this series on Common Factors (CF), wherein I discussed what CF researchers suggested as helpful processes of change in the Stage of Change Pre-Contemplation. Doing so will enhance your focus on the processes of change you can use to help clients focus on increasing insight about moving from Contemplation to begin working in the next Stage of Change known as Preparation, our next blog topic.


References

Douglas H. Sprenkle, Sean D. Davis, Jay L. Lebow. Common Factors in Couple and Family Therapy, Guilford Press, Aug 10, 2009

Alice Miller. Jan. 7, 1997. http://www.alice-miller.com/en/the-essential-role-of-an-enlightened-witness-in-society-2/

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