Karuna Counseling’s Newsletter Articles

November 26, 2012

The Already and the Not Yet: The Paradox of Acceptance and Change

by Elizabeth Eiland, LMSW

 

We begin to find and become ourselves when we notice
how we are already found,
already truly, entirely, wildly, messily, marvelously who we were born to be.

~Anne Lamott

 

Like many of us, I have been known to read Oprah Magazine.  Probably like many of us, I might read an article or two in a doctor’s office waiting room, and promptly forget the article’s contents as soon as I put down the magazine. When I first read this particular passage by author Anne Lamott, however, I got to thinking about the paradox she presents.  For long after my time at the waiting room, I asked myself: How is it that we find ourselves only when we start to notice that we are already found? How is it that we are, at the same time, already exactly where we are meant to be and yet still evolving? How is it that change happens when we accept that we are already—perfectly—who we are, and yet also on our way towards becoming someone new?

My own response to these questions echoes Anne Lamott’s: accepting ourselves as who we already are allows us permission to access who we are not yet but still hope to become. It is precisely when we accept where we already are that change can occur. For me, this is a critical piece of the therapy process.

Many of us might come to therapy hoping to become someone different, looking to shed a familiar burden of pain, or seeking to become free from a place we’ve been stuck for so long.  Perhaps the place that we are starting from is the absolute last fact about ourselves that we would ever want to accept; perhaps the reason we come to therapy is the thing about ourselves that we most wish we could push away.

Paradoxically, it is precisely in the midst of this desolation where the seeds of change lay already planted.  Spiritual teacher Anthony DeMello shares a personal example of his desired changes coming into fruition though acceptance:

I was neurotic for years. I was anxious and depressed and selfish. Everyone kept telling me to change. I resented them and I agreed with them, and I wanted to change, but simply couldn’t, no matter how hard I tried. Then one day someone said to me, Don’t change. I love you just as you are. Those words were music to my ears: Don’t change, Don’t change. Don’t change. . .I relaxed. I came alive. And suddenly, I changed!

However profound his transformation, it is my guess that DeMello’s experience of acceptance and change wasn’t as sudden as his story might suggest. For most of us, this process might be messy, scary, long, uncomfortable, or even (temporarily) painful. But the promise of change makes this journey possible.  We have to bravely face the already in order to get to the not yet!

The First Step

Contrary to this cartoon from The New Yorker, the first step is not to change who you are, but to notice who you already are.  This cartoon pokes fun at the idea that somehow we must change who we are at our core in order to better ourselves; rather, our core selves already offer the capacity for healing and growth.  If we desire transformation, change paradoxically happens when we notice who we already are, and, as monastic nun Macrina Wiederkehr said, “accept the truth about ourselves – no matter how beautiful it is!”

Mental health professionals and spiritual leaders alike suggest the tool of mindfulness as the first step towards acceptance.

One example of a therapeutic modality that asserts this paradox between acceptance and change, and responds with mindfulness, is Dialectical Behavior Therapy (DBT).  DBT begins with the assumption that two seemingly opposite things can both be true (in fact, this is the root of the word dialectic).  DBT’s central dialectic, then, is that people can both desire acceptance as they are and, at the same time, desire change.  Anne Lamott, Anthony DeMello, and many of us might find DBT’s basic assumptions to be familiar.

Some snapshots from my practice might further illustrate this paradox.  The 60-year old man, recently diagnosed with Early Stage Alzheimer’s disease, learns how to live with his memory loss by making changes to his daily routine. Accepting his disease allowed him to make the accommodations that transformed his life.  An 11-year old girl mourning the loss of her best friend, greets her grief with curiosity and acceptance, and over time learns to live in joy instead of fear (not to mention winning the school spelling bee). A 36-year old woman accepts that her relationship is not where she wants it to be, and gives herself permission to make the necessary changes.  In each of these snapshots, it is precisely when these folks notice where they are – scared for the future, grieving a loss, or unhappy in relationship – that their transformation can begin.

Mindfulness, then, can bring us to acceptance of ourselves as we already are: truly, entirely, wildly, messily, marvelously ourselves.

Already, We Belong


Poet Mary Oliver affirms that the place where we already are is exactly where we need to be.  She tells us in her poem Wild Geese,

You do not have to be good.

You do not have to walk on your knees

For a hundred miles through the desert, repenting.

Here she asserts that we do not have to do or be anything different than we already are. Later in the poem, even all of nature affirms that we belong – just as we are, already.

Whoever you are, no matter how lonely,

the world offers itself to your imagination,

calls to you like the wild geese, harsh and exciting —

over and over announcing your place

in the family of things.

_________________________________________________

Contact Information:

Elizabeth M. Eiland, LMSW

elizabethe@karunacounseling.com

404.215.0577

________________________________________________

Works Cited:

Anne Lamott for Oprah Magazine, November 2009. “Becoming the Person You Were Meant To Be.”  <http://www.oprah.com/spirit/How-To-Find-Out-Who-You-Really-Are-by-Anne-Lamott/1&gt;

Anthony DeMello, Song of the Bird (1982). New York: Doubleday.

Jon Kabat-Zinn, Wherever You Go, There You Are (1994). New York: Hyperion.

Advertisements

April 2, 2012

Acceptance and Commitment Therapy (ACT)

Open window
by Darby Christopher, LMSW
A new wave of well researched and effective therapies has emerged in recent years. Examples include Eye Movement Desensitization Reprocessing (EMDR), Emotional Freedom Technique (EFT), Dialectical Behavior Therapy (DBT), Acceptance and Commitment Therapy (ACT), and others. This article will focus on the process and benefits of ACT, which primarily provides tools that can be applied to everyday life, with or without the help of an ACT therapist.
Overview
The primary goal of Acceptance and Commitment Therapy, according to Dr. Russell Harris, is the attainment of “psychological flexibility.” This refers to an ability to be open to the present moment, a perhaps deceptively simple yet powerful concept. When we are psychologically flexible, we are able to feel and to observe what shows up in our lives, without clinging to it too tightly.
If much our suffering results from how we respond to sadness, a depressed mood, anxiety or anger, then ACT provides the tools necessary to not worsen the situation by reacting to it or fighting with it. The result is greater self acceptance, less time focused on negative possibilities, and more time invested in valued action.
ACT often uses metaphors to convey its ideas, and a metaphor is helpful here. Suppose  that a certain set of circumstances triggers a depressed reaction in me, and let’s say that this depressed reaction is like a branch that is floating down a stream. Any of the ways that I fight with this depression – whether by feeling badly about it, denying it or trying to avoid it by destructive means – are ways that I am damning up the stream that will not allow the branch to flow through. ACT provides the tools that will help keep me from doing this, so that I will be more able to watch the branch come, flow through and float by.
Acceptance and Commitment Therapy falls under the broad category of Cognitive-Behavioral Therapy (CBT). However, it also follows a current trend in CBT to avoid counteracting symptoms, and to instead embrace the stance and practice of mindfulness.
ACT Tools
What are these tools? Acceptance and Commitment Therapy focuses on 6 core processes that work together. Each one requires effort, and will probably not be mastered over the course of a life time. The goal is to get better at them and experience more freedom, rather than perfection. Let’s look at each one individually.
  • Defusion. This refers to an ability to watch and observe our thoughts and emotions, and to create a little distance between our selves and the thought or feeling. This step is not easy because we often tend not to be aware of our thoughts. With defusion, we slow down and observe ourselves having thoughts and feelings. Next, if appropriate and helpful, a step can be taken to see the thought as perhaps a part of me, but not attached to my deepest identity, and therefore capable of change. 
  • Acceptance. This refers to how I relate to the thoughts and feelings that show up in me. Am I mad at them? Do I hate them and wish they would go away? Do I treat them like unwanted guests? Or, conversely, do I welcome even the painful thoughts and feelings that show up in me, knowing they could have some useful information for me? Do I love these parts and treat them with compassion? Loving what shows up in us leads to relaxation and an ability to listen to ourselves.
  • Contact With The Present Moment. To make contact with the present moment is to experience some sense of vitality right now. The requirements for this may shift as our moments shift. When we engage our observing self, we may pay attention to our sense of sight, smell, hearing, sound or touch, we may look inward and pay attention to our inner sensations, and we might do both of these at once. If we are dealing with a painful experience from our past, we will pay attention to our bodies and feeling experience, rather than ruminating over the facts of the past. Staying focused on the feeling sensations in our bodies allows us to be informed by them, as opposed to diverting our attention and missing out on the message they may offer us. Contact with the present moment often involves slowing down to be present with others, nature, and our own selves.
  • Self-As-Context. This refers to an ability to be in touch with the deeper part of me that is doing all of this observing. When we build our “self-as-context” muscle, we are able to know that there is a part of us that endures and stays steady through the day to day and even moment to moment changes in our lives. Why is this important? Knowing ourselves in this way facilitates the goal of psychological flexibility. If I know that I am so much more than my thoughts and feelings, then I won’t get too attached to them. (However I will still know and honor them as important, and give them their proper place in my life.)
  • Values. This refers to an ability to know what is important to me, and to allow myself to be guided and instructed by this knowledge. We are all given a certain amount of time on this earth to live in this life time. How do I want to spend it? What matters to me? What do I wish to leave behind? Getting in touch with my values both gives me a compass and a sense of deeper meaning.
  • Committed Action. Once I know what my values are, what do I want to do to act on them? What possibilities am I willing to try out? How could my life take on more vitality by my action(s)? 
Conclusion
Acceptance and Commitment Therapy provides useful tools to stay open and present to the moment. There are times when using these tools may seem difficult, if not impossible. With practice, however, they can be useful in even the most difficult situations. ACT does not take the place of other types of important work that also help us be more present to our lives, such as grief work, trauma work, and understanding how our past experiences affect us. ACT can stand on its own as a useful and healing therapy, and can be used in powerful ways in conjunction with other types of therapies.
Resources
The Happiness Trap: How To Stop Struggling And Start Living, by Russ Harris, 2008
Act Made Simple, by Russ Harris, 2009 (Note: This book is written primarily for therapists, though anyone may benefit from reading it.)

June 28, 2011

Book review: The Mindful Way Through Anxiety: Break Free from Chronic Worry and Reclaim Your Life, by Susan M. Orsillo, Ph.D., and Lizabeth Roemer, Ph.D.

Filed under: 2011 Articles,Anxiety,Lisa's Articles,Mind-body-spirit Integration — karunacounseling @ 2:37 pm
Tags: ,
Mindful Way Through Anxiety
A book review by Lisa Anyan Smith

We live in a stressful world.  Anxiety is a part of the human condition.

Many people complain of feelings of anxiousness, ranging from occasional mild worrying to full-blown anxiety disorders such as Generalized Anxiety Disorder, Obsessive-Compulsive Disorder, Panic Disorder, Social Phobia, or a specific Phobia.

Although anxiety is a normal human emotion, we find feelings of anxiety unpleasant and typically try to avoid experiencing them.  Attempts to avoid  anxious feelings may include overeating, drinking alcohol, watching TV, taking prescription medications, or staying away from situations or people that may trigger anxiety. In their new book, “The Mindful Way Through Anxiety: Break Free from Chronic Worry and Reclaim Your Life,” Orsillo and Roemer propose that avoiding anxiety or attempting to control it does not ease pain and suffering.  Rather, avoidance brings its own costs.  The authors suggest that to break free from anxiety, instead of avoiding anxious feelings, we practice coping strategies that allow us to turn toward and pay close attention to anxiety.  Turning toward something that we would usually avoid and taking a fresh look at habitual responses are crucial components of mindfulness.

Before exploring how mindfulness can help us break free from the grip of anxiety, let’s look at an example of what anxiety is.

Jody recently moved to New York City from Alabama to start a new job.  Heading into a corporate meeting, she notices that most of her coworkers are already seated and chatting with one another.  She takes a chair between two groups already engaged in conversation and begins shuffling through her papers.  She feels her anxiety rising.  Some of the thoughts that go through her mind include, “I don’t fit in here,” “My clothes are all wrong,” and “They must think I’m an idiot.”  She feels her face flushing, palms sweating, and pulse quickening.  Thinking of the friends she left behind at her former job, she feels a wave of sadness and regret.  She despairs as she thinks about the years ahead of her, just knowing that she will always feel alone.  For the duration of the meeting, she keeps her eyes downcast, contributing nothing to the discussion.

As this story illustrates, components of anxiety include thoughts, emotions, physical sensations, and behaviors.  Evolutionarily, humans are hardwired to feel fear.  Fear is actually a helpful warning that alerts us to potentially dangerous situations.  When we perceive a threat, the fight-or-flight response kicks in to ready us to combat or escape from harm.  The physical symptoms we experience when this response occurs (increased heart rate, rapid breathing, adrenaline rush, etc.) are merely side effects of the body getting ready to fight or flee.

Compared to fear, anxiety is a more subtle but chronic state.  Whereas fear is an automatic response to a threat we perceive as immediate, anxiety includes thinking about or imagining some possible threat we may come up against in the future.

Orsillo and Roemer’s research indicates that our struggle with fear and anxiety does not come from any actual harm caused by the physical sensations of these emotions.  Rather, it arises from our reactions to these emotions and the thoughts, sensations, and images that accompany them.  Criticizing ourselves for feeling fear or anxiety is what hurts us, not the fear and anxiety themselves.  This is where the turning inward is helpful.  Mindfulness can help us replace self-criticism with compassion.

Simply put, mindfulness is a specific way of paying attention.  It involves “purposefully expanding your attention to take in both what you are experiencing inside – your thoughts, feelings, and physical sensations – and what is happening around you.” (p. 81)  The key concepts of mindfulness include 1) Noticing – becoming fully aware of the thoughts, feelings, physical sensations, and images that you experience, as well as the details of your environment; 2) Curiosity – approaching experiences with openness; and 3) Self-Compassion – acknowledging that the reactions we have are part of being human, accepting what cannot be controlled, and treating yourself with kindness and care.

The authors provide a series of exercises progressing from a 5 minute breath exercise through a number of informal and formal techniques to practice mindfulness.  Readers are also encouraged to download audio recordings from the book’s website to listen to while practicing or to record their own scripts.

Shane trembled as she waited her turn to stand behind the podium and deliver her speech.  She had agreed months ago to make a presentation before her colleagues at the real estate convention, even though she was terrified of public speaking.  As the previous speaker was concluding his remarks, Shane felt her stomach churn.  Her neck felt tight and sore, she felt the blood rushing to her face as she blushed, and she began sweating profusely.  “Why, oh why did I ever agree to this?” she thought.  She recalled the incident in high school when she had forgotten her lines in the school play, and now she relived those old feelings of embarrassment.  “It will be just like in high school!”  “These people will think I’m so stupid.”  “No one will ever refer any business to me again, ever!”

Orsillo and Roemer would say that Shane is experiencing “muddy” emotions.  This occurs when we bring in memories of past events – and conjecture about future possibilities – into the current moment.  If Shane were to take a moment to be mindful of the immediate challenge, she would realize that she is muddying her current anxiety by worrying about “what if” rather than focusing on “what is.”

The authors write in a style that is easy to follow and offer many vignettes to provide examples.  They also address the questions that many readers may be asking:

But isn’t mindfulness a Buddhist principle?  Is it a new age fad? What if I have different spiritual beliefs?  

The term mindfulness indeed originated with Buddhism, but the idea has recently been included in research and therapeutic settings.  In fact, mindfulness practice has been shown to decrease anxiety, insomnia, stress, risk of coronary heart disease, substance use, chronic pain, and fibromyalgia, and increase attention, sexual functioning, quality of life, and immune system functioning.  The book does not focus on the religious aspect of mindfulness.

How can I find the time to practice mindfulness?

While research suggests that more practice is associated with greater benefit, the authors offer a variety of techniques including exercises that only take 5 minutes a day.  They also point out activities that you can do mindfully, such as eating, walking, washing dishes, folding laundry, petting your dog, cooking, listening to music, or hugging a friend.

How can mindfulness help with anxiety? 

By this time you may be thinking, “Gee, thanks, but no thanks.  I’m already acutely aware of my anxiety.  Why on earth would I want to focus on it more?”  Yes, it is seemingly counterintuitive, but mindfulness can actually help us notice what we are experiencing and make choices about how we want to respond, rather than automatically reacting in ways that hold us back from fully engaging in our lives.  Let’s look at one more example that illustrates the value of mindfulness:

Sam was on a third date with Chris.  He had been single for a long time and knew that he wanted to develop an intimate relationship.  He was quite fond of Chris, and was getting signals that the feeling was mutual.  As the talk turned more personal, he felt his pulse quicken, his chest tighten, and his mouth get dry.  He felt the urge to change the subject so he wouldn’t risk feeling vulnerable and getting hurt.  He watched Chris for cues, and thought he saw a frown of displeasure when Sam talked about a low point in his life.   What Sam really wanted to do was excuse himself, pretend to go to the bathroom, and run like hell out the back door of the restaurant.  However, he really wanted to build a connection with Chris, so he chose to remain in the situation.

Often the things that really matter to us, like loving people, forming emotional connections, taking on challenging tasks, or caring for those in pain and suffering, bring with them emotional pain.  In these cases, living a fulfilling life means that we notice the pain and allow it, rather than trying to make it go away.  Mindfulness can help us to embrace our entire range of emotional experiences, making it easier to make these choices and enrich our lives.

 

Additional Reading:
Boyce, Barry (Ed.). The Mindfulness Revolution. Shambhala Publications,  Inc., 2011.
Germer, Christopher. The Mindful Path to Self-Compassion: Freeing Yourself from Destructive Thoughts and Emotions. Guilford Press,  2009.
Matheny, Kenneth B. & Riordan, Richard J. Stress and Strategies for Lifestyle Management. Georgia State University Press, 1992.
Nhat Hanh, Thich. Peace is Every Step: The Path of Mindfulness in Everyday Life. Bantam Books, 1992.
Siegel, Ronald. The Mindfulness Solution: Everyday Practice for Everyday Problems. Guilford Press, 2010.

March 9, 2006

A Guide to Mindful Living: Part III

Filed under: 2007 and earlier,Mind-body-spirit Integration — karunacounseling @ 5:35 pm
Tags: ,

by Andrea Schrage, MA, LPC, CMT

This section will be dedicated to an ongoing look at simple ways to incorporate mindfulness in your everyday life. Over the course of several newsletters you will have a set of tools to pull out to create a healthier environment within you. One way to facilitate use of the exercises will be to focus on one for the next 2 months and really become fluent in it. Then you can move on in the succession of exercises that can build on each other.

What is mindfulness? Mindfulness in simplified terms is learning to be present in the current moment. Why would one want to do this? The list of benefits is very long but here are a few:

  • Decreasing Anxiety
  • Ability to make conscious choices
  • Helps to reduce addictive patterns
  • Changes your relationship with negative thoughts
  • Allows you tune into answers from within
  • Increases your sense of peace in the world

If you missed the first exercise on Mindful Eating, please feel free to go back and look at
our article on A Guide To Mindful Living

Exercise Three:

Mindful Listening

Benefits may include:

  • Becoming more conscious of your senses.
  • Feeling more connected to what is around you.
  • Increased concentration.
  • Increased ability to stay in the present moment.
  • Stillness and peace.

Suggested Use:

  • Upon waking or before sleeping.
  • During a stressful time.
  • Short breaks during the day

“I can’t meditate!”

Many people get frustrated at meditating because they think that they are only succeeding when they are in complete silence and feeling peace. That assumption is the opposite of mindfulness because it is trying to force a result verses relaxing into what is. We have a constant barrage of voices in our heads that are always judging the world and ourselves. They are usually being critical and can keep us in a state of worry.

In the beginning it is your job to keep moving from these voices back to your focus. The more you practice this, the longer the stretches will be between your focus and the voices. What you will find in that space will very from day-to-day; some days it will be still and peaceful and some days it will be sadness or anger. Whatever is there is exactly what is supposed to be there, so just notice it. Every time you find yourself in the thoughts, be thankful that you realized it and come back to your focus. We are constantly following the voices in our heads, so every time you even notice yourself in them, you are growing.

Basic Instruction for Mindful Listening

Part One:

  • Began by sitting in an upright position with your feet on the ground and your spine straight.
  • Take 2-3 breathes and relax into your body as best as you can.
  • Bring your attention the sounds around you.
  • Open your ears and keep a focused attention on what you hear. You may notice stillness, ringing, traffic, the sounds of your house, air blowing, people talking etc. judgement.
  • Open up to the most subtle of sounds and notice them without judging them. Let go of your assumptions about what is a pleasant sound and what might be irritating and listen to them as if it is the first time.
  • When your mind wanders to thoughts, gently bring it back to listening.

That is it!

You may also want to try this while listening to people when they are talking to you. Really focus on what they are saying without your mind working on an instant reply. Notice what happens in your relationships when you really listen.

February 3, 2006

A Guide To Mindful Living

This section will be dedicated to an ongoing look at simple ways to incorporate mindfulness in your everyday life. Over the course of several newsletters you will have a set of tools to pull out to create a healthier environment within you. One way to facilitate use of the exercises will be to focus on one for the next 2 months and really become fluent in it. Then you can move on in the succession of exercises that can build on each other.

What is mindfulness? Mindfulness in simplified terms is learning to be present in the current moment. Why would one want to do this? The list of benefits is very long but here are a few:

  • Decreasing Anxiety
  • Ability to make conscious choices
  • Helps to reduce addictive patterns
  • Changes your relationship with negative thoughts
  • Allows you tune into answers from within
  • Increases your sense of peace in the world

If you missed the first exercise on the 3 minute breathe, please feel free to go back and look at http://www.karunacounseling.com/mindfulness1.html

Exercise Two:

Mindful Eating

Benefits may include:

  • Becoming more conscious of what you eat.
  • More enjoyment of your food.
  • Increased concentration.
  • Increased ability to stay in the present moment.
  • Better ability to monitor food intake.

Suggested Use:

  • During meals.
  • Deciding if you are hungry.
  • Letting your body inform you of what it is craving (verses your mind or habit dictating).

Any combination of the above will teach your system that mindfulness is readily available. John Kabat-Zinn teaches that if you were jumping out of an airplane, you wouldn’t sew the parachute on the way down. You would instead, sew it ahead of time so that it would be in good shape when you need it. The best way to have mindfulness be something that you automatically reach for is to practice it as much as possible. You may want to leave reminders for yourself to do the exercise, such as, post its or putting it in your calendar.

Part one and two below may be used together or separate depending on your goal.

Basic Instruction for Mindful Eating

Part One:

  1. Begin by sitting in an upright position with your feet on the ground and your spine straight.
  2. Take 2-3 breaths and relax into your body.
  3. Bring your attention to your belly and check in to see if you are physically hungry. You may find the urge to eat, but it could be an emotional hunger.
  4. Ask your body internally or out loud, “What am I hungry for.” You may get a response from the mind, so check it out by imagining your self eating that food. You may try a few foods to see what feels like the best fit. You will find that the more you do this, the more your body will truly guide you to eating what it needs verses what you want.

Part Two:

Follow 1 and 2 above if you are just doing part two and then continue below.

  1. Start by looking at your food like you have never seen it before. Look at the colors, texture, proportions, where it is on the plate and notice the smell.
  2. Notice any judgments that the mind makes and let them go without attaching to them as true. Almost like a child who is being introduced to it for the first time.
  3. Slowly take it to your mouth and stop right before it goes into your mouth. Notice the anticipation of the food.
  4. Now place it in your mouth and chew very slowly, holding an air of curiosity. Notice the texture and the tastes.
  5. Notice how you know when it is time to swallow and then swallow the food.
  6. Put your utensil back down and notice what it is like to be one bite fuller.
  7. Continue on through the meal at a slow and conscious state noticing what feelings, sensations, and judgments come up.

Alive With Color © SuperStock, Inc.

That is it!

Food and eating can stir up a lot of emotions, so you may want to journal about them, or if they get to intense, call your therapist for guidance. Enjoy a new way to look at food and allow a newfound choice about your eating.

If you have more questions feel free to contact me at

404-818-6114 or at

andreaschrage@karunacounseling.com

Keep your eyes out for a 4 series class after the New Year to learn how to use mindfulness to prevent the recurrence of depression.

Blog at WordPress.com.