Unpacking Stress

February 20, 2012

in Therapy

A client sits down across from me.

“How are you?” I ask — not the social “How ya doin’?” of casual interactions, but the “How are you, really?” of therapeutic inquiry.

“I’m feeling stressed.”

My internal radar flickers with interest. “Stressed” is a term that obscures far more than it reveals. Endocrinologist Hans Selye chose the word back in the early ’50s to describe the body’s response to any demand made upon it to adapt, and it has since entered the popular lexicon as a synonym for tension. (It’s amusing to note that “stress” has been adopted verbatim into many other languages, as in el stress, der stress, il stress.)

But what does this vague word mean, really, right here and now, in this body, in the present moment? What does it feel like? Sadness? Anxiety? Dread? Irritation? When we explore, we find that what we call stress is different at different times and in different ways. The term is used for all sorts of unpleasant sensations. The question that ultimately matters the most is: What are the specifics of your own personal experience?

B. inquires more deeply within himself. First of all, I feel sad, he reports. And anxious. And reluctant, unwilling.

We explore each of these in the body/mind, making our way through restlessness, emptiness, and defensiveness, a burning gut and a tight throat, to — eventually — a loosening and resting in the bones, a sense of calm deep in the skeletal structure.

All this rich specificity of experience was hidden by the blanket term stress. My objection is not so much to the word itself as the wholesale adaptation of it.

It’s similar to the word depression. Whenever a new client reports to me s/he’s depressed, I immediately want to know: What does that mean to you? How do you experience that, exactly? Are you feeling sad, or lonely, or angry; anxious, or disconnected, or confused?

Amazingly, I have yet to meet a person who sticks with the generic term depressed. On inquiry, this apparently blank facade dissolves into richly textured layers of nuanced emotion. Painful emotion, perhaps, but emotion nonetheless. And voila – we are no longer in the blank territory of ‘depression’, but in sadness, or fear, or anxiety – painful but real, and in substance much closer to the heart of the matter.

B. and I spend a moment pondering this all at the end of our session. It seems easy to define it with that word single word ‘stress,’ he says, but that’s an illusion. Really, the feelings are just sitting there, needing to be explored. And it’s such a relief to do that.

Yes, it’s kind of indigestible, isn’t it, I say. Stress can’t really go anywhere on its own terms – it needs to be unpacked.

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The Master and His Emissary

December 7, 2011

in Neuroscience

I’ve been reading this brilliant book by Iain McGilchrist.

The Master and His Emissary: The Divided Brain and the Making of the Western World is as big as the lengthy title suggests. It’s about the right brain and the left, the different ways of seeing and being these two hemispheres have, and the relationship between them. McGilchrist quite eloquently demonstrates how this relationship has shaped not just individual human perceptions, but cultures, societies — indeed, all of life.

He synthesises vast quantities of neuroscientific research to demonstrate how the right hemisphere’s approach of flexibility, integration and context contrasts vividly with the left hemispheric functions of  focus, division and abstraction. Here, his background as an Oxford English professor and a London psychiatrist and brain researcher comes into its own: the book covers not just brain science, but European culture, history, philosophy, music, and more. In a quick flip-through just now, my eye landed on mentions of the French revolution Nietzche, King Lear, Phaedo, and the Ghent Altarpiece.

Basically, McGilchrist maintains that the brain is the filter for all our experiences — not a determinant, but an organising principle. The split hemispheres have different tasks and functions, as well as values and priorities. The right brain experiences itself as connected to the world, the left as removed from it. And, the left (the Emissary of his title) has dominated throughout much of Western history, to the point where the current mechanistic world view separates us from happiness and the world itself.

Possibly my greatest delight in this book comes from the unexpected quarter the message is delivered from. It’s beyond refreshing to read a scientist with heart, who argues so passionately and intelligently for right-brain values.

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Some Therapeutic Myths

September 22, 2011

in Therapy

A few popular myths I’ve encountered over the years that seem to inform the general perception of therapy:

Pushing through things is the way to go: “If I can just talk about my problems enough, think about them enough, figure them out with my head, they’ll eventually be solved.” Endurance is the main virtue espoused by this perspective, and while there is something to be said for persistence, it’s a mistake to imagine that intellect alone can resolve everything. If it could, everyone in our exceedingly smart society would have become problem-free a long time ago. This myth ignores the power of the unconscious, intuition, silence, the felt sense, and everything below the neck.

Trauma needs to be talked out: “If I repeat the story often enough, it will lose its effect on me.” While desensitization therapy can help reduce certain phobias, simply talking about trauma is a blunt instrument for a delicate job. Telling the story over and over again can reactivate the trauma, wearing the grooves deeper. Working with the physiological charge of trauma in a more skillful and intuitive way (such as Somatic Experiencing) can help rewire the nervous system, releasing the frozen experience that is the essence of trauma.

If I can just understand why I do something, that knowledge will solve the problem: This misconception — that intellectual understanding is the silver bullet– is the source of a great deal of disappointment. I can’t count the number of people I’ve worked with who, thanks to years of therapeutic work, are able to intelligently articulate the sources of their problems, yet still wrestle with them mightily.

Once you have understanding, what comes next? Often it’s being with the body, listening to what it has to say. A more skillful, nuanced approach to one’s inner world brings the ability to listen at a different level — to sensations, symptoms, dreams, images, internal voices. We bring in open, nonjudgmental awareness, the most single powerful agent for change. And compassion, opening the power of the heart to oneself.

All a therapist has to do is listen: Note how this fits hand in glove with the above myth, that talking alone will solve the problem. Nonjudgmental, open awareness is a fundamental attribute of therapy, but it doesn’t always equate with silence. Again, I’ve heard too many stories from individuals who faithfully reported their story, worked their process, examined and explored and puzzled over their feelings — for years — with therapists who said little more than ‘mmmm-hmmm’ and the occasional “I see.”

There is a tremendous power in silence, a deep art in letting the client go over her own edge into the unknown. But that is no excuse for years and years of coasting.

Experience should be pathologised rather than worked with: The medical model currently applied to therapy reinforces the tendency to view symptoms as manifestations of disorder/disease, rather than the efforts of a highly intelligent and well-organised system to heal itself. I think that every problem, every symptom, has a very good reason for being there. Often that’s one of our first tasks in therapy — to figure out what that might be.

Symptoms, whether they are mental or physical, are doorways into inner reality. Simply labeling something as screwed up is deeply unhelpful, and can create a great deal of self-blame and despair. At root, it is deeply unskillful — in fact, impossible — to attempt to change anything we haven’t first accepted. James Hillman writes eloquently about this.

My problems are the result of my character faults: I’m just too lazy, disorganised, uncommitted, or stupid to do things differently: Well, maybe you are. On the other hand, if you’re paying a therapist a fair sum of money to work on them every week, and managing to make it to your sessions, you are clearly not any of the first three. Maybe there’s more going on than meets the eye.

Personally, I am blown away by the under-diagnosis of trauma in individuals, families, communities. I see its effects everywhere, in depression, anxiety, ADD/ADHD, addictions, loneliness, anger, relational problems. So often people are unaware of the cause of their pain. They may not even have a story, or they brush it off with “It was a long time ago, doesn’t really bother me.”

Trauma’s web spreads far beyond the standard diagnostic criteria of PTSD to touch every one of us, as individuals, families, communities. The symptoms weave themselves into our very identity. It can take a lot of patient work to disentangle the effects of early trauma from who we are. We’re living in a good time, though. Recent research is revealing exactly how trauma engraves itself on the nervous system, as well as the ways in which mindfulness and a focus on embodied experience can undo its effects.

Here’s an interesting article on the neurobiological effects of trauma and the effectiveness of a body-oriented psychotherapeutic approach.

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Dark Night of the Soul

May 24, 2011

in Uncategorized

It hits every one of us at some point in our lives. Loss, be it sudden or slow. Loss of job, partner, child, health, home, success, financial security. Sometimes all of these at once.

And that external loss precipitates the loss of everything we navigated by, everything that gave our lives meaning. Pluto pulls Persephone down into the underworld, and we find ourselves in the dark night of the soul.

We try desperately to find something to hang onto – our health, our savings account, our sole successful or least-floundering child. But even these betray us. “Everything I relied on is gone,” we say. “My professional identity, my financial security, the sense of knowing where I’m going …”

It is distressing, to be taken down to the bones. Stripped to the studs.

From this bleakest of landscapes, the question emerges: What do you rely on when everything else falls away?

What do you know for sure?

Janet says it’s hard to know what she wants to do. Everything’s shifting. She picks up a project and drops it multiple times during a day. It’s hard to give up doing, but sometimes that’s the season being offered up. Not a time for harvest, or growth, just the bare bones, the dormancy, of winter. Everything is frozen, life’s gone underground.

A roughly sketched road map for this territory:

*Acknowledge the enormity of this process. And the rightness. The leaves drop away and the tree stands bare for a season so that new life can come through. We don’t mourn the loss of the leaves: we accept the rightness of the seasons, even the barrenness of winter.

*Take care of yourself. There can be an extraordinary comfort in simple actions: a conversation with a friend, a walk outside, a consciously made cup of tea. Nature can provide an enormous amount of solace. Go and hang out with the natural rhythms, soak up how they move – in their own time, their own cycle of completion. It’s when we lose touch with these that we lose our ability to navigate through the underworld.

*Grieve the loss of what you’ve known. If it was worth having in your life, it’s worth grieving.

*Be courageous enough to let go of that which is being taken away, open enough to surrender. Brave enough to trust in the process. Wise enough to sit patiently with the empty and sometimes achingly lonely space.

*If painful parts of the past show up, work with them with kindness and compassion; give them what they need so they can be put to rest. Clear your path so that no obstacles block the new impetus that will eventually come.

*Cultivate your receptivity, your intuition, your awareness, your connection with your body.

*Get to know the territory of the dark night, however unwelcoming it might seem. Treat it like a dream, with the same respect, curiosity, open awareness, mindfulness.

*If you’re stuck, explore that stuckness. Really well.

*Surrender. Trust the process that is taking place, which may be bigger, deeper, wider than you can yet see. Sometimes it’s necessary to trust the wisdom of the dark to work its way through.

Here’s a poem called ‘Lost’, by David Wagoner:

Stand still. The trees ahead and bushes beside you

Are not lost. Wherever you are is called Here,

And you must treat it as a powerful stranger,

Must ask permission to know it and be known.

The forest breathes. Listen. It answers,

I have made this place around you,

If you leave it you may come back again, saying Here.

No two trees are the same to Raven.

No two branches are the same to Wren.

If what a tree or a bush does is lost on you,

You are surely lost. Stand still. The forest knows

Where you are. You must let it find you.

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Meditation … Isn’t

May 9, 2011

in Uncategorized

Here’s a really common misconception I regularly encounter in my professional practice as a Buddhist-oriented psychotherapist: that meditation means stopping thoughts, entering a state of not feeling, not thinking (and probably not breathing, while you’re at it).

While settling the mind is a basic meditative practice, it’s not attained by struggling to repress thoughts. At least in the approach I’ve trained in (the Tibetan Buddhist approach of Dzogchen), this kind of struggle is utterly beside the point. The mind’s nature is to think. That’s simply how it is, just as water is wet, just as fire is hot.

The glitch lies in thinking that meditation is something we need to do, a task to accomplish, like brushing our teeth or going to the gym. Meditation is not about preventing thoughts or emotions from arising. Rather, it is about recognising the particular state we are in — the awareness that embraces our present experience, yet is not tied to it.he mind’s basic nature is cognizance, knowingness, awareness. Recognising this, and how this basic nature is not attached to any particular thing, we gain a sense of ease.

Thoughts come and thoughts go. What is their origin, or their destination? Where is the thought you had at 4:38 pm last Tuesday? Can you show me that thought, bring it to me? Try this for a while.  It seems like there’s an ‘I’ producing these thoughts, just as  it may seem like there’s a solid thought –  but it’s all sleight of hand, the smoke and mirrors of self-grasping.

The Dzogchen approach to meditation is to relax. Deeply. No effort is required (by definition, efforting involves an ‘I’, someone who is making the effort). Simply relax into the natural state.

There’s a Tibetan saying: “Gom ma yin, kom yin” – which, roughly translated, means, “Meditation isn’t; getting used to is.” In other words, meditation isn’t about doing anything. It’s simply about getting used to the natural state.

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