ChangeThroughCreativeChoice

DBT for Eating Disorders Program Begins November 7th at The Counseling Group

noreply@blogger.com (ChangeThroughCreativeChoice) — Wed, 25 Sep 2013 12:44:00 +0000

The Counseling Group's DBT program is expanding with the addition of a skills training group for eating disorders. In addition to our two adult, one adolescent, and one multi-family DBT skills training groups, we will begin offering a DBT skills training program specifically for eating disorder recovery starting on Thursday, November 7th. The program, which is designed to last six months, includes:

(1) one individual DBT session per week with a DBT-trained clinician to track progress on target behaviors and reinforce use of skills and elimination of symptoms. During the period of the program contract, clients may continue seeing their outpatient psychotherapist but also must be engaged once-per-week with the DBT therapist in compliance with the DBT model.

(2) one group skills training session per week led by Inge Sengelmann, LCSW, SEP and Cristina Oliver, MFT on Thursdays at 6:30 – 8:00 pm.

(3) one nutrition counseling session per week with our DBT-informed registered dietitian or with the client’s existing dietitian (preferably an eating disorder specialist). These sessions may happen less frequently with the agreement of the client’s therapist and dietitian team and only if the client is stable in their symptoms.

The Counseling Group's Eating Disorder Team

We don’t admit solely on the basis of need, but assess for willingness and commitment to the model. After a thorough intake assessment prior to admission, and up to three pre-treatment sessions to establish goals and commitments, clients will engage in five months of skills training. Skills training consists of four modules (Core Mindfulness, Emotion Regulation, Interpersonal Effectiveness, and Distress Tolerance). Each module runs for 4 weeks, and are closed during those four weeks, with one transition week in between during which clients may discharge and new clients may be admitted. Clients are expected to complete all four modules, and may repeat if they feel they need to in order to attain mastery over the skills. Clients who miss four sessions of DBT during the contract period are assumed to have dropped out and need to reapply. Clients who miss two sessions of a module need to repeat that module when it is next offered. Many clients opt to take the skills a second time to master the skills and eradicate problem behaviors or work on quality of life issues.

DBT is validated as an effective treatment for binge eating disorder and bulimia. If you are interested in participating, or know someone who is, please call our office to inquire about enrollment, obtain insurance coverage verification, and schedule an intake assessment with one of our DBT therapists. To enter by November 7th, we must conduct the intake prior to October 15th, If a client is unable to enter by November 7th, the next transition date will not be until December 19th, and then again on January 30th.

Making Lemonade out of Lemons: Dialectics and the end of Suffering

noreply@blogger.com (ChangeThroughCreativeChoice) — Tue, 23 Jul 2013 23:48:00 +0000

I recently completed a six-month-long training in Dialectical Behavior Therapy (DBT), a comprehensive mode of treatment developed by Marsha Linehan, Phd, ABPP for people whose intense emotions are overwhelming and lead them to use destructive behaviors (such as self-harm, suicide attempts, substance abuse, compulsive shopping or gambling, eating disorders) to regulate them. Dr. Linehan found that these suicidal and self-injuring patients struggled with traditional cognitive-behavioral therapy and because they felt invalidated by its focus of change. And yet, they also desperately wanted to change in order to stop suffering. Dr. Linehan incorporated mindfulness-based acceptance strategies into her treatment to balance out the focus on change – making it a dialectical approach.

“Dialectics” is a philosophy that sees the truth as the synthesis of a thesis and an antithesis, meaning that we must always try to see the “kernel of truth” in each conflicting position, thus eliminating the seeming contradictions that keep therapists and patients “stuck” in unsolvable conflicts. The concept of “Wise Mind” in DBT, for example, is the dialectical integration of reasonable mind and emotional mind. Emotional balance, then, is not achieved by denying, invalidating or exterminating emotional reactions, but rather by balancing them wisely with reason, taking in all points of view.

DBT focuses on teaching people skills to manage difficult emotions, deal with painful situations and improve relationships. The treatment components include individual therapy, skills training group, skills coaching between sessions to generalize the skills to real-life situations, and a team treatment approach that requires the treatment be applied to the therapists as well as the patients. Skills are taught in a class format in the following areas, or modules: Mindfulness, Emotion Regulation, Distress Tolerance and Interpersonal Effectiveness.

Patients are required to keep a diary card to monitor their urges, emotions, and practice of the skills. Therapists meet weekly as a team to enhance their effectiveness as DBT therapists.

A DBT therapist seeks to understand a behavior’s function, thus removing the judgment about the behavior’s “right-ness or wrong-ness”, and then coming up with solutions based on whether the behavior is caused by a skills deficit (remediated by skills enhancement), an inability to tolerate distress (solved by exposure), a cognitive distortion (helped by cognitive remediation) or reinforced conditioning (solved by contingency management strategies).

The functions of a good DBT program are to enhance the capabilities of the patients by teaching them skills, to improve their motivation to recover through the use of cognitive modifications and contingent reinforcement, to assure generalization to the patient’s environment through the use of after-hours coaching and homework assignments, to help structure the patient’s environment to help with recovery through contingency management, and to enhance therapist motivation and effectiveness through the use of treatment teams and consultation.

Making lemonade out of lemons is one of the “dialectical” DBT strategies that requires a DBT therapist to take something problematic in the client and turn it into an asset; for example, seeing problems that arise in therapy or in life as opportunities to practice skills, or interpreting the patient’s “resistance” to change as a strength that allows the person to persevere until changes are made. In her textbook, Cognitive-Behavioral Therapy ofBorderline Personality Disorder, Dr. Linehan explains that her rejoicing over someone’s expressed calamity forces the recipient to stop and take in new information about how this event will allow the person to practice skills. Looking back on all the many crises in my life, I see a jar full of lemonade, a lemonade that I now serve to others who are thirsty for acceptance and change.

The Counseling Group has a team of intensively trained DBT therapists ready to help those who are eager to find alternative ways to deal with their suffering and want to create “a life worth living.” I am proud to be a part of this intensively trained team. For more information about the DBT program, please visit The Counseling Group’s DBT page or call 305-857-0050.

Koshas, Gunas and the Autonomic Nervous System

noreply@blogger.com (ChangeThroughCreativeChoice) — Mon, 15 Jul 2013 16:16:00 +0000

As part of my ParaYoga Master® Training, I recently finished reading the book Yoga& Psychotherapy: The Evolution of Consciousness by Swami Rama, Rudolph Ballentine, MD, and Swami Ajaya, PhD*. I couldn’t help but bring in my understanding of the autonomic nervous system, through the lens of StephenPorges’ Polyvagal Theory.**

The book examines concepts of ancient yoga traditions and modern psychology, and provides insights into the methods of yoga as therapy. It makes comparisons between yoga philosophy and Western psychological theories, as well as identifies connections to neuroscience and the awakening of specific brain centers. Psychology is a science that is fairly recent.

Only in the last couple of centuries has Western science questioned man’s “inner being,” mental processes, motivations, and potential. Yoga, on the other hand, is the oldest continuous discipline and developed a philosophy of mind and consciousness based on internal experimentation. In yoga “body” and “mind” are just part of the picture.

According to yoga philosophy, five “sheaths” or “covers” (known as koshas) obscure the more subtle consciousness that lies within. It identifies an evolution in the development of human consciousness to universal consciousness as these sheaths are explored and embodied (or ‘enlivened’) by pure consciousness. These five levels of being each observe and control the one below. For example, the physical state is an “embodiment” of a mental state. Although body, or Annamaya, is the entry point, it is only one dimension of our being. The five sheaths covering the “Self” or truest essence include: Annamaya (food sheath); Pranamaya (energy sheath); Manomaya (mental sheath); Vijnanamaya (intuitive sheath or Buddhi); and finally Anandamaya (blissful sheath).

As a somatic psychotherapist, I enjoyed reading about the history of body psychotherapy and its relationship to yoga, which understands more than any other science that posture and body habits influence mental and emotional states, are intrinsically linked to personality, and can either help or hinder growth and evolution. In yoga, asana and mudra can be used to create desired mental (and energetic) states. It is this “tuning in” to the body that provides the first contact with the inner realms of experience generally outside the field of our awareness. Although only the first sheath, it is a critical link to accessing the other four sheaths and experiencing a true connection of body, mind and spirit.

The second sheath or Pranamaya relates to the energy body, which is controlled by the flow and alterations or rhythms of the breath. These rhythms, the authors propose, are intimately tied to the earliest and most fundamental layers of mental life. In this sense, breathing is the most efficient intermediary between mind and body. If one can learn to consistently and deliberately control breath, mental and emotional states can be shifted. Regulation of breath – union between ida and pingala, the sun and the moon channels -- leads to mastery over mental and emotional states, which in turn influences body states.

Finally, yoga provides a comprehensive understanding of mind as having various levels that interact with one another, and we must be able to observe and not get caught up in manas, or lower mind (consisting of sensory-motor impressions); chitta, or the memory bank of all our experiences; asmitaor ahankara, which may be known as “ego” in the West, and which provides a sense of “I”-ness; and finally Buddhi, which is our capacity for wisdom, discrimination, and discernment. Beyond these is Atman, or the highest Self.

Patanjali classifies thought forms, or vrittis, in two ways: as obstacles (kleshas) and in terms of function: 1) accurate perception; 2) inaccurate perception; 3) fantasy or imagination; 4) memory; and 5) sleep. Through disentanglement from the thought forms, pure consciousness can begin to emerge. As in Jungian psychology, which seeks to bring subconscious process and symbolic content to conscious awareness, a vichara process in yoga helps us to become more intimately aware of these subconscious patterns and tendencies.

Why is all this important? To see the yoga, or union, between various theories for understanding human consciousness and behavior helps me to be more helpful to those seeking to grow and expand mentally, emotionally and/or spiritually, including myself.

The understanding of the various levels of mind correlate with my understanding of neuroanatomy and the triune brain: The primordial/instinctual/primitive/reptilian brain equaling manas; the limbic system, primarily the amygdala and hippocampus, equaling chitta; the sensory-motor cortex, insula, and anterior cingulate cortex equaling asmita/ahankara; and the most evolved areas of the prefrontal cortex perhaps being the abode of Buddhi (although I believe Buddhi may be non-local).

Additionally, my understanding of Porges’ Polyvagal Theory also matches up with concepts of yoga, including the gunas (in Samkya philosophy, the fundamental operating principles of universal nature, , which are Tamas, or inertia; Rajas, or activity; Sattva, or essence). In 1995, Stephen Porges introduced a new perspective of the autonomic nervous system, identified neural circuits involved in the regulation of autonomic states, and interpreted autonomic reactivity as evolutionarily adaptive. He proposed that there are two vagal motor systems – dorsal vagal (immobility) and ventral vegal (social engagement) – and that primary emotions are related to autonomic function (therefore residing in the Annamaya, but responding to the Manomaya). He re-conceptualized the autonomic nervous system to include target organ, afferent and efferent nerve pathways, and bidirectional communication between the heart and the central nervous system (therefore one could imply a relationship to the seven energy systems in Pranamayaknown as Chakras).

Porges stated that the autonomic nervous system responds in a highly sequenced response hierarchy to environmental stimuli, based on a neural process he calls “neuroception” that evaluates risk and modulates vagal output, triggering or inhibiting defense strategies for survival. Neuroception, as a process, determines whether specific features in the environment elicit specific physiological states that would support either a dorsal vagal immobilization response (tamas, or inertia), a sympathetic fight-flight response (rajas, or action), or a ventral-vagal or social engagement response (sattva, or universal consciousness).

As a dialectical behavior therapist and somatic experiencing practitioner, I teach people to observe sensations and behavior (Annamaya, and possibly Pranamaya for those more sensitive), as well as thoughts and beliefs (Manomaya), in the hope of creating greater awareness, cohesion and regulation (Anandamaya, or bliss) through the use of “Wise Mind” (Vijnanamaya or Buddhi).

By having a clearer understanding of the inter-relationship between the sheaths, and grasping the importance of combining the right set of practices (or therapies) for each particular individual, we can maximize the desired effects: whether it is for greater emotional balance, optimal physical health, clearer mental focus, or reaching enlightenment.

*Swami Rama, Ballentine, Ajaya (1976). Yoga & Psychotherapy: The Evolution of Consciousness. Honesdale, PA: Himalayan Institute Press.

**Porges, S.W. (2011). The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication and Self-Regulation. New York: W.W. Norton.

A Life Worth Living: Embodying Your Dharma Code

noreply@blogger.com (ChangeThroughCreativeChoice) — Mon, 14 Jan 2013 17:05:00 +0000

What are you? Where do you live? Why are you here? What do you do? How do you do it? What is it for? These were questions posed by Rev. Chris Jackson at Unity on the Bay yesterday, ageless questions humans have been asking themselves for millennia, questions that have spawned the world's religions and philosophies.

For me, pondering these questions has led me on a quest for deeper meaning, and all roads lead to the same place: within. Last week I was in Northampton, Massachusetts at an intensive training in Dialectical Behavior Therapy, a third-wave behavior therapy grounded in a dialectical worldview and mindfulness practices. For several months, I have also been involved in self-reflection and yoga practices in the tradition of Rod Stryker's Para Yoga.

Whether in a professional development training or personal self-realization workshop, the roads are converging for me. This is a nice feeling, because I want to be authentic and transparent, regardless of the setting. I am aware that I am not a typical wine-drinking, Botox injecting, Ferragamo shoe-wearing, hair coloring "Miami girl." I have never injected Botox and I haven't had a drop of alcohol in almost 25 years. I will never pay $500 for a pair of shoes. I am a down-to-earth, Børn-wearing, quinoa-eating, yoga-practicing, cancer-surviving, gray-haired, (hopefully gracefully) aging woman in search for peace and enlightenment.

I was especially excited about the DBT worldview that DBT is therapy between equals. I might know some skills that I teach a client who is the expert in their own experience. I influence them and they influence me. They may engage in therapy-interfering behaviors, and so might I. We are engaged in a graceful dance. Does this approach mean I can bring more of my authentic self into the equation, and let people know that I also need to practice skills to suffer less? I hope so.

Working on Rod Stryker's "Four Desires" exercises, I have identified my Dharma, or life code, as embodying the Divine, expressing Divine ideas, writing and speaking words that inspire and change lives. I am here to heal, myself and others. I do this by attempting to see things with clarity, by nurturing my connection with Spirit daily, by trusting in the abundant love of God (as I understand God), by resting in a benevolent Universe, by releasing all attachments, by having the courage to be transparent. This is a lofty task, given my judgmental, opinionated, and self-righteous nature. But I am up for it.

Can I release self-judgment and become more real? Do I have the courage to walk through fear and reveal who I truly am? I want to. It might be helpful to me, and maybe to others as well.

Meditation: Tasting the Sweet Nectar

noreply@blogger.com (ChangeThroughCreativeChoice) — Sun, 16 Dec 2012 19:55:00 +0000

I learned to meditate when I was 12, from a disciple of the Maharishi Mahesh Yogi. My motives were not pure. I wanted to experience something mystical, anything to take me out of my bodily experience and rocket me into another dimension. Existing in bodily form had never been comfortable, but nearing 13, my body curving and getting denser felt almost excrutiatingly unbearable. He taught me to meditate on the mantra AUM, the sound said in the Yoga Sutras to lead to the ultimate realization of the Self because it represents nothing less than the essence of the Universe, the Source of all Being. All I recall are his large hands doing something resembling a blessing, his mala beads, and the basic instruction to repeat the mantra in my head over and over while seated in a semi-lotus position. Nothing more extraordinary than that.

Without further instruction, I delved in, learning pranayama from books, and experienced the most profound mystical experience of my life -- until earlier this month. Sidetracked by the world of illusion, I forgot the feeling of Oneness, the loss of the "I" identity, the merging with nature I experienced sitting under a guava tree in my backyard when I "saw" God in every leaf, a shining light flowing in the leaf's veins as if breathing, the entire universe present in it, while both the leaf and the universe were also present in me. The sense of bliss (with a capital B) I felt was a nectar I wanted to hold onto, but the "I" voice called back, reminding me that I could not stay out in the garden (of Eden) forever. So I returned inside, to the TV blaring a Mexican telenovela and my abuelita asking me if I wanted a snack.

I did not have a teacher to help me sort out the experience, or to develop a consistent and disciplined practice. The bliss I experienced (call it the pearl of great price, the kingdom of God, or the nectar of devotion) called me, but I did not know how to return to it. After 13 years of digression, I returned to the quest for spiritual enlightenment, searching for (but not finding) a teacher I could follow and respect.

I was never one to fall for men with long beards in white robes who expected admiration. I followed my inner guru, and finally, my inner guru led me to the right teacher(s). And finally, I tasted, once again, the sweet nectar that resides deep in all of our hearts. Hari Om Namo Narayana, Om Namo Narayana. May we never give up on the spiritual quest, and may we always be vigilant and waiting for the teacher to arrive. May we be silent and "hear" the mantra that speaks to our soul.

Use Your Pen, Heal Your Pain Workshop

noreply@blogger.com (ChangeThroughCreativeChoice) — Tue, 09 Oct 2012 14:50:00 +0000

Mindful Writing to Balance Emotions and Increase Creativity at The Counseling Group
Saturdays, 2:00 – 3:30 p.m. - once a month
Dates: Starting January 26, 2013

Expressing our deepest thoughts and feelings on paper has been shown by research studies to have deeply beneficial effects on emotional and physical wellbeing. Mindfulness for emotional regulation and stress reduction has an even greater empirical support. Combining both, in the tradition of Natalie Goldberg (author of Writing Down the Bones), provides a safe container for processing painful experiences as well as engendering creativity and intuition. Experience the power of the written and spoken word to heal. The group is facilitated by a psychotherapist, mindfulness practitioner, creative writer and former journalist. Call The Counseling Group at 305-857-0050 to register for this workshop.

Embodying Your Intuition: Creative Self-Care for Professional Helpers in and out of Sessions

noreply@blogger.com (ChangeThroughCreativeChoice) — Tue, 09 Oct 2012 01:23:00 +0000

Research has shown that helping professionals often suffer from burnout and stress, yet barely a quarter of them practice the self-care they teach their clients (take the self-care assessment here). One of the reasons people don't engage in wellness activities, is that many of those traditionally recommended take time (e.g. exercise, yoga, meditation, journaling, hobbies, volunteering, going out with friends). Then stress-reduction activities become stressors, cancelling out any benefits. And yet, there are intrinsic mechanisms for self-regulation within us that, with the right understanding, and given the focus of our mindful awareness, we can access moment-by-moment, at no cost, and for significant stress-reduction benefits. I have created an all-day retreat/workshop for psychotherapists, bodyworkers, healers and caregivers who want to learn skills to access their somatic intelligence and creative self-regulation capacity. When we are operating from a space of coherence (mind, heart, breath oscillating in rhythm), our consciousness is open to accessing greater intuition. Come and learn some creative ways in which you can incorporate stress reduction and balance throughout your day without having to add more to your “to do” list and making self-care another stressor. The practices we will explore are grounded in an understanding of neurophysiological processes within an embodied mindfulness framework. The inaugural workshop will take place on Saturday, November 17, from 9:30 am to 4:30 pm at The Counseling Group. Investment in yourself is $108, and 30% discounts will be extended to active members of iaedp and NASW.

Time to Celebrate Breast Cancer Awareness Month

noreply@blogger.com (ChangeThroughCreativeChoice) — Sun, 07 Oct 2012 23:02:00 +0000

Seven years ago this month, I was completing four months of bi-weekly, dose-dense chemotherapy for Stage II breast cancer and about to embark in seven weeks of radiation treatments. I am now cured and grateful to be alive. I was fortunate to have taken my family's history of breast and other cancers seriously, and began to monitor with mammograms prior to the age of 40. I was also blessed to have excellent health insurance so the burden of treatment was bearable without the added distress of financial ruin. Not all Americans are that lucky. I calculated that one year of treatment cost approximately $250,000 including all hospital bills, diagnostic tests, treatments and medications. Sadly, despite all the research, about 40,000 continue to die of breast cancer every year. Nevertheless, most women survive and never experience a recurrence. I hope to be one of those. To insure that, I do what is within my power: I don't drink alcohol, I don't smoke, I eat a healthy diet, and I exercise regularly. On the emotional side, I try to lead a balanced, stress-free life, forgive and let go of hurts, and exercise gratitude every day. Although I no longer run, I was proud to participate in a number of Susan G. Komen races. I no longer wear pink, mainly because I don't endorse the marketing craze. It just doesn't really seem that the money ends up in research. During Breast Cancer Awareness Month, I want to take this opportunity to thank my oncologist, Dr. Leonard Kalman of American Medical Specialties; my surgeon oncologist, Dr. Robert Derhagopian; their wonderful staffs; and the Cancer Support Community of Greater Miami for all their wonderful support programs offered at no cost to cancer survivors and their caregivers. When I was diagnosed, it did not come as a complete surprise. My mother had been diagnosed at the same age. But I was surprised because I felt I was the healthiest I had ever been. I had just finished running my fifth (and now last) marathon. I was training for and competing in sprint and international distance triathlons. I had not visited a doctor's office in at least five years. I maintained a healthy lifestyle and only visited an acupuncturist and a chiropractor periodically. In fact, I had to go to the FIU (I was in graduate school) women's clinic to get a check-up and a prescription for a mammogram. My bias toward alternative medicine caused me to worry about embarking in traditional Western treatment, but I knew this is what I had to do. I decided that my experience would be contingent on my attitude toward the people I encountered. My experience turned out to be wonderful. Everywhere I turned I met helpful, caring individuals who were concerned for my wellbeing. The journey through cancer turned out to be a blessed one, filled with insights, awakenings and spiritual growth. It is for that reason that I write this blog today. Today I celebrate life with gratitude to all those who helped me during those difficult months -- making me soup, bringing me books, giving me rides to chemotherapy and reading me poetry when all I could do was stare at the ceiling in a "chemo fog." Thank you all!

Raising Awareness About Weight Stigma

noreply@blogger.com (ChangeThroughCreativeChoice) — Fri, 21 Sep 2012 13:53:00 +0000

September 24 - 28 is Weight Stigma Awareness Week. Weight discrimination is spiriling upwards as fast as obesity rates. It "occurs in employment settings and daily interpersonal relationships virtually as often as race discrimination, and in some cases even more frequently than age or gender discrimination," researchers reported in a 2008 issue of the International Journal of Obesity. The negative effects of this form of bias, which is peppered with all sorts of misconceptions and misrepresentations on the causes of obesity, are painful at an individual and collective level. We fail to take responsibilities for the socio-economic and cultural causes of obesity, placing the blame solely on the individual. Ongoing reseaerch is discovering the detrimental impact that high fructose corn syrup in industrialized foods has on insulin and metabolism, body weight, and brain functioning. Yet packaged and processed foods are quite often cheapest and the only accessible foods to low income families. Let's stop discriminating against overweight and obese individuals and become consciously aware of our biases so we can take responsibility for effective changes in socio-economic and cultural influences. Let's recommit to end "fat talk" and reclaim our health through actions.

Alleviating Suffering, One Human Being at a Time

noreply@blogger.com (ChangeThroughCreativeChoice) — Wed, 27 Jun 2012 16:58:00 +0000

“I understood that centuries of chains and lashes will not kill the spirit of man nor the sense of truth within him.” --Ayn Rand. This is my experience in working with survivors of torture and ritual abuse. The spark of life, the determination to conquer, the conviction that to fully live is the best revenge, prevail against seemingly unbearable experiences. Last night I was inspired by the story of Mohammed, a refugee from Chad who survived imprisonment and torture for his political views, and of Dr. Miriam Potocky, whose grandparents were killed in Nazi gas chambers. I was honored to receive a Human Spirit Award for my humble contribution in providing pro-bono counseling services to survivors of torture through the Florida Center for Survivors of Torture. The FCST used the event to commemorate the United Nations International Day in Support of Victims of Torture. FCST director Kristen Guscovict reminded the audience that 400,000 survivors of torture live in the United States, which Mohammed described, in his native French language, as "the best country I've evern seen." The evening culminated with a performance of "Death and the Maiden," a play by Chilean playwright Ariel Dorfman which depicts the aftereffects of political torture and asks critical questions about what justice means. I leave you with Dr. Potocky's formula to help alleviate suffering and eradicate inhumanity: a) Advocate; b) Befriend a survivor, show kindness to help someone heal from the experience of man's inhumanity to man; c) Ask critical questions and don't turn a blind eye. And for that, I am responsible...

Florida Center for Survivors of Torture Offers Hope to Many Who Have Suffered Indignities

noreply@blogger.com (ChangeThroughCreativeChoice) — Sun, 06 May 2012 14:53:00 +0000

There are approximately 500,000 survivors of politically-motivated torture living in the United States, according to the U.S. Center for Victims of Torture. Torture means an act committed by a person acting under the color of law specifically intended to inflict severe physical or mental pain or suffering upon another person within his custody or physical control. These survivors come to the United States seeking asylum to escape the horrific abuse they suffered in their home countries, but they are often rendered ineffective by their symptoms to testify on their own behalf. Trauma's impact on a person's nervous system often causes extreme distress that impairs memory and the ability to express a cohesive story in words. I have been assisting the Florida Center for Survivors of Torture (FCST) to help their clients receive the care that they need so they can heal and become empowered to rebuild their lives. I have not done much, other than offer a few pro bono sessions, provide information about the effects of trauma, and encourage other psychotherapists to offer pro bono services when needed. I am honored that they have chosen to recognize my small efforts with a Human Spirit Award next month at an awareness-raising event to be held at Florida International University. This is an opportunity for me to also increase people's awareness about this problem, and the needs of this special category of refugees. I have worked with an African man who received electric shocks to his genitals during an unwarranted detention and interrogation; a young Eastern European man who was arrested, beaten and raped for being gay; a South American man who was kidnapped and held at gunpoint on his knees for hours simply to harass and frighten him into changing his political views. In 1998, the U.S. passed the Torture Victims Relief Act of 1998 (P.L. 105-320), which authorizes the Secretary of Health and Human Services (HHS) to provide grants to U.S. programs to cover the costs of services for the rehabilitation of victims of torture, including treatment of the physical and psychological effects of torture; provide social and legal services for victims of torture; and conduct research and training for health care providers outside of treatment centers. These programs are administered through the U.S. Department of HHS's Office of Refugee Resettlement. I urge you to learn more about this issue and donate money, time or services to the FCST by calling 305-805-5060.

Happy Valentine's Day? It Can Be!

noreply@blogger.com (ChangeThroughCreativeChoice) — Mon, 06 Feb 2012 18:50:00 +0000

On February 14th, we celebrate love. From the Lupercalia fertility festivals in ancient Rome, to the 58 million pounds of Valentine's chocolate we consume today – we celebrate romance. And why shouldn’t we? According to Dr. Stan Tatkin’s new book, we are Wired for Love, neurobiologically designed to connect, pair up and bond to survive and thrive. Dr. Tatkin designed, teaches and researches a Psychobiological Approach to Couple Therapy® (PACT) that utilizes our understanding of how early attachment impacts brain and nervous system development and specific neuroendocrine pathways to interpersonal stress. Using PACT, a therapist attends to the “moment-to-moment variations and shifts in affect and arousal as observed in the face, body, and voice” in order to engage partners in behaviors that reduce the arousal and increase healthy bonding. Dr. Tatkin has also co-authored a book for professionals titled Love and War in Intimate Relationships, with Marion Solomon, another couple therapy luminary. Read Dr. Tatkin’s free downloadable Ten Commandments for Relationship Essentials and share them with your sweetheart this Valentine’s Day. If you want to take preventive measures to improve your romantic relationship, you also may want to pick up a copy of Wired for Love to understand how you and your partner’s brain and attachment styles can help you build a secure relationship.

Why New Year's Resolutions Fail, And How to Succeed Instead

noreply@blogger.com (ChangeThroughCreativeChoice) — Thu, 29 Dec 2011 17:05:00 +0000

This is the time of year when people reevaluate their lives and set intentions for a new beginning. Among the most popular new year resolutions are: lose weight, stop smoking, eat healthier, get fit, save money, get a better job. And yet, 88% of new year's resolutions end in failure. Gym memberships go up, diet programs get started, and within a few short weeks, all is forgotten. We are creatures of habit and return to what is comfortable, familiar, mindless,habitual or conditioned.

In his new book, The Four Desires: Creating a Life of Purpose, Happiness, Prosperity, and Freedom, Rod Stryker (creator of Para Yoga, or yoga of fulfillment) does a good job of explaining the difference between a resolution and an intention, called a sankalpa in Sanskrit. A sankalpa is an intention that is aligned with the deepest desire of your soul to evolve and achieve the fulfillment of its dharma, a life's path guided by universal principles and spiritual discipline.

When we make resolutions that are not aligned with our highest good, or, as Stryker explains, there are forces greater than what we intend (called a vikalpa), we fail to sustain the effort required to manifest our sankalpa. A vikalpa usually refers to erroneous thought governed by unruly emotions and desires. These interfere with the discipline to engage our will and determination in service of the sankalpa, or highest intention. A simple example would be to determine, "I want to lose weight," but be overwhelmed by emotional cravings and revert to comfortable patterns of soothing distress that do not support the behaviors that lead to weight loss. Stryker offers suggestions for breaking these negative habits or patterns, as well as a pathway for creating a fulfilling life.

It requires spiritual effort to be true to yourself, uncover what blocks you from achieving your good, and dedicate sustained energy toward your soul's desires. It requires awakening your awareness and consciousness and not allowing yourself to "fall asleep" again and falling back into unconscious, conditioned ways of being. So in the next few days, resolve to spend some time in quiet self-reflection, going within and inquiring into the deepest truth of your being. If you want, follow Rod Stryker's suggested exercises to uncover the true desires of your soul for its greatest unfolding, and determine what your sankalpa for the coming year is. May you be successful in maintaining your resolve to evolve in 2012, and to achieve your greatest dreams and desires. May your success contribute to the success of all humanity to awaken to a more peaceful, harmonious, sustainable world.

May all beings be happy, may all beings be at peace, may all beings be free from suffering. Namaste!

Nourishing the Hungry Heart: A 12-Week Workshop for Compulsive Overeaters

noreply@blogger.com (ChangeThroughCreativeChoice) — Fri, 11 Nov 2011 18:00:00 +0000

Do you want to change your relationship with food and body image through mindfulness, emotional processing, and body awareness exercises? You might be ready to participate in this 12-week series of experiential exercises conducted in 90-minute sessions and designed to explore all dimensions of hunger (mental, physical, emotional, and spiritual), promote self-acceptance, and motivate sustainable, long-term behavior change. This workshop offers a non-diet approach to healthy eating that encourages self-awareness of eating behaviors and triggers to achieve balanced eating by addressing and extinguishing the underlying issues contributing to overeating. The workshop will teach the use of body-awareness, mindfulness, yoga and movement, and concrete emotion regulation skills to alter disordered eating patterns and achieve a healthy, biologically appropriate weight.

Objectives:
1. Monitor eating behaviors and identify triggers (“what are we really hungry for?”)
2. Increase motivation to change behaviors by identifying obstacles and discovering solutions with support from other group members
3. Learn basic mindfulness, emotion-regulation and stress-reduction skills to maintain healthy eating and eliminate chaotic patterns
4. Enhance awareness of the internal cues that tell us what is “too much” or “not enough” and learn to live from the “inside out.”
5. Develop tools to cope with emotions, manage body-image dissatisfaction, overcome compulsions and celebrate progress!

Dates: January 11 through March 28, 2012
Days & Times: Wednesdays, 7:00-8:30 pm
Location: The Counseling Group, 2840 SW 3rd Avenue, Miami, Florida 33129
Cost: $50/session (insurance may cover and we can check your benefits)

Facilitator:
Inge Sengelmann, LCSW, SEP is a Somatic Experiencing® Practitioner who specializes in eating disorders and the resolution of disorders of extreme stress resulting from overwhelming life events.

Group will be limited to 8 participants, so please contact me for more information at The Counseling Group by calling 305-857-0050 or emailing info@counselinggroupmiami.com

Dialectical Behavior Therapy Skills Training Group Begins January 2012

noreply@blogger.com (ChangeThroughCreativeChoice) — Fri, 11 Nov 2011 17:47:00 +0000

Do you want to develop skills to achieve emotional balance and fulfilling interpersonal relationships? DBT skills groups can be a valuable addition to individual therapy because they offer practical strategies for managing strong emotions. Group members are encouraged to participate in the whole cycle of skills training, which may take up to six (6) months. The group will be limited to 8 participants and be closed after the first skills cycle. Both male and female clients are welcome. Group members are required to be in individual therapy, which does not have to be with The Counseling Group therapists as long as the individual therapist is willing to support the use of DBT.

The skill areas are taught in 4 modules, each lasting 4-6 weeks, so this is a 6-month commitment to learn and apply the skills. There are practices assigned for each week and reviewed at the beginning of the next group. The skills are:

•Mindfulness: The "core" DBT skill is to learn to cultivate non-judgmental awareness of present-moment experiences, thoughts, emotions, and behavioral impulses. Because mindfulness is so central to DBT, we not only spend 4 weeks on learning this skill, but we also do a mindfulness practice together every week.

•Emotion Regulation: Understanding what emotions are, their functions, and skills to de-escalate or change them is key to reducing suffering.

•Interpersonal Effectiveness: Specific relational skills are taught to balance personal needs without damaging relationships or feeling overwhelmed by them.

•Distress Tolerance: When emotional experience is overwhelming, and you feel unable to change it, there are ways to tolerate this distress without engaging in self- or other-destructive behaviors.

Dates: January 10, 2012 through June 26, 2012
Days and Times: Tuesdays, 7:00 – 8:30 p.m.
Cost: $75/session (the fee may be covered by insurance and we can verify your benefits)
Location: The Counseling Group, 2840 SW 3rd Avenue, Miami, FL 33129.

Facilitators:
The first step in joining the DBT Skills Training Group is to meet with one of the facilitators individually, Inge Sengelmann, LCSW, SEP or Kristin Jones, MS, MHC

Call 305-857-0050 for more information.

Asociacion Estima Trains Professionals in El Salvador about Eating Disorder Prevention and Treatment

noreply@blogger.com (ChangeThroughCreativeChoice) — Mon, 03 Oct 2011 00:28:00 +0000

More than 30 psychologists, counselors, psychiatrists and nutritionists participated in a full-day workshop I offered on Friday in San Salvador, El Salvador on the subject of advances in the understanding and treatment of eating disorders, at the invitation of Asociacion Estima, a non-governmental organization established to raise awareness and educate the public and professionals about prevention and treatment. It was a dynamic, interactive workshop that ignited the curiosity of the local professionals about new theories and interventions that are based on insights from neuroscience. A second, half-day seminar was geared to helping parents and family members recognize the symptoms and understand how to navigate the sensitive path of dealing with a loved one who is struggling. More than 50 participants attended and mentioned cases of young men with anorexia and bulimia, shattering the myth that these disorders only affect women in developed nations. Participants also reported cases in all socio-economic groups. The nation's main newspaper, El Diario de Hoy, today published a story about the presentations and highlighted some of my remarks. I am grateful to Julia Raquel Aguilar de Orellana, president of Asociacion Estima, for her tireless work on behalf of the foundation and her gracious efforts to make me feel welcome. Her passionate dedication to this cause is changing the attitudes and perceptions of both professionals and the general public in El Salvador about eating disorders.

Ending the Battle with the Body to Restore its Wisdom: Somatic Awareness and Eating Disorders

noreply@blogger.com (ChangeThroughCreativeChoice) — Sun, 25 Sep 2011 18:41:00 +0000

Eating disorders, at their core, are disorders of autonomic distress regulation. Dissociation from bodily experience leading to disruptions in response to the body’s needs are a hallmark of these disorders. In persons with eating disorders, the body has become the battlefield for uncontrolled emotions, and the war manifests as self-destructive behaviors that are, paradoxically, attempting to maintain the organism’s integrity. Characterized by pervasive core deficits in the self-regulation of food intake, emotion, cognition, behaviors, eating disorders (and their often-accompanying self-mutilation) represent dissociated compensatory attempts to serve self-regulatory functions.

Early histories of persons with eating disorders often include injuries to the secure attachment system, without which it is veritably impossible for the neural pathways that mediate affect regulation to develop. Because these pathways between the limbic and cortical areas of the brain are missing or insufficient, people with eating disorders live in a constant flux of autonomic dysregulation – or become dorsal dominant and “numb” to most stimuli, including hunger and fullness signals.

Studies of brain functioning in individuals with anorexia and bulimia have shown impairments in the functioning of the insula and the anterior cyngulate gyrus, areas responsible for interoceptive awareness, the integration of sensory information and emotions, the regulation of aggressive impulses, as well as behavioral motivation and coordination of motor impulses. The insula also is responsible for assigning reward value to foods, a function disrupted in persons with anorexia who respond differently to taste stimuli. Furthermore, these same areas of the brain are largely responsible for the perception of the body-in-space, and when impaired, lead to symptoms of body dysmorphia (at worst) or body dissatisfaction (at best).

A review of the literature indicates that individuals with eating disorders are more likely than others to have a history of trauma and, conversely, those with trauma are more likely to report disordered eating patterns – making trauma a risk factor for eating disorders. Studies report rates of up to 45 percent of eating disordered patients endorsing traumatic experiences, with the highest trauma rates reported by patients with bulimic symptoms. These rates are much higher, closer to 80 percent, when taking into account a broader definition of trauma that might include any event that taxes the person’s capacity to protect their integrity and is perceived as life threatening at a conscious or subconscious level. Any history of trauma in these eating disorder patients is correlated with increased levels of impulsivity and dissociation, both of which increase symptom severity and are correlated to longer length of illness and poor prognosis. Again, symptoms of eating disorder serve functional, albeit distorted, survival strategies to overwhelming, chronic, inescapable stress and acute trauma in childhood.

All of these factors support the use of practices that increase interoceptive awareness, assist in the regulation of autonomic hyperarousal or hypoarousal, and discharge the “un-digested” (pun intended) survival energies of trauma. Mindfulness, particularly mindfulness of body sensations, is a great adjunct to any treatment of eating disorders. Scientific studies have shown that mindfulness practice increases gray matter in the areas of the brain known to regulate emotion. Antonio Damasio, who introduced the concept of somatic markers, posited that rational decision making cannot be divorced from emotion or body awareness. These qualities of awareness of self must be cultivated and enhanced to increase our resiliency and wellbeing.

Finally, Somatic Experiencing® is particularly suitable in the treatment of eating disorders, where eating behaviors have been equated with stress at a sub-cortical level – whether the stress comes from hunger, which is regulated by over-feeding in binge eating, or by fullness, which is regulated by starvation in anorexia. In bulimia, food serves to soothe sympathetic over-activation, while the purging cycle discharges serve as a way to 'purify' or cleanse the self, and serve as a metaphor for expelling uncomfortable or "dirty" feelings and experiences from the body, returning the person for a moment to a dorsal vagal state of numbness. On the other extreme, men (more often than women) who pursue over-muscularity (some call it “bigorexia”) are creating a “body-shield” sourced in past physical abuse.

In eating disorders, needs are overcoupled with shame, people become mistrustful of cues related to hunger and fullness, want to eliminate signs of sexuality from the body, and feel like they are “too much,” or “not enough.” Society, and sometimes family, fosters that sense of shame when it does not permit physical, sexual, or emotional diversity to exist. Living in a world where hunger is in constant conflict with the “thin ideal” and where being “fat” in a “thin world” oppresses young men and women every day, can be “traumatic.” Wanting to restrict food intake and “failing” leads people to feel “betrayed” by their own bodies. When bodily responses fail to measure up to these impossible standards, eating disorders brew.

Regardless of the presentation, somatic awareness to deepen therapeutic interactions, provide access to disconnected emotions, and nurture a sense of “safe” embodiment becomes crucial to healing. Using SE, treatment providers can “titrate” (gradually expose) all aspects of treatment, including nutritional and weight restoration, within the person’s “window of tolerance.” All overcoupled and undercoupled aspects of the person’s experience (sensation, image, behavior, affect and meaning) can be gradually discharged or integrated to restore a person’s sense of wellbeing and resilience. This includes the internal hunger, fullness and satiety cues necessary to long-term recovery and the end of the dieting, starvation, binge eating, purging cycles.

Coming Home to Self: A 50 Year Quest

noreply@blogger.com (ChangeThroughCreativeChoice) — Mon, 29 Aug 2011 12:19:00 +0000

“Dichoso el árbol, que es apenas sensitivo, y más la piedra dura porque esa ya no siente, pues no hay dolor más grande que el dolor de ser vivo, ni mayor pesadumbre que la vida consciente.” These words of Ruben Dario, the iconic Nicaraguan poet who revolutionized literature in Latin America and died an alcoholic, capture the essence of my discontent in being born into this sentient life. I was born September 4, 1961, the dawn of a new era of rebellion and discord, attempts at transformation through the destruction of traditional structures and constructs. It is the year the Frente Sandinista de Liberación Nacional came into existence, and a group of idealists began to plot the bloody overthrow of a decades-long dictatorship in the country of my birth. The Nicaraguan civil war will rage as I enter my equally forlorn adolescence, as will the war within my family, and the endless battle for the right to take up space, to breathe my own air. War, external and internal, will rip apart everything that held me together in one piece, giving me a sense of permanence, solidity and identity. I will be grasping for years at some sense of meaning and belonging in the midst of global cultural and political upheaval, old concepts falling away while a collective birthing process of new ideas rocks the world with labor pains. The Russian missile crisis, the Bay of Pigs Invasion (with Nicaragua as a launching pad), JFK’s and Martin Luther King’s assassinations, the Vietnam War, protest marches and the anti-war movement, the sexual revolution, the birth of feminism, the death of racist structures, transcendental meditation, LSD and psilocybin psychedelic explorations into altered states of consciousness, peace, love, rock & roll and flights to the moon.
This is the world I was born into, the daughter of a Nicaraguan-born German whose parents escaped war-torn Germany in the 1920s and lost their German citizenship because they refused to recognize Hitler, and a Nicaraguan mother from a family of 11 children whose father died when she was nine (of an alcohol-related highway accident or a politically-motivated assassination, no one knows for sure). My father wore pleated pants and pencil-thin ties in black, brown or navy with a starchy white shirt. My mother was a hippie-wanna-be painter who grew marijuana in the back yard. Fifty years later, they are ultra-conservative, right-wing, born-again and still married. I have come full circle from my socially conscious upbringing by the Teresiana nuns. After searching for a true identity through various cultures and cities, I have come home to myself - or should I say, my Self. I have embraced my existence and love this journey called the human experience. I even love this body that I used to condemn and despise, for it is the vehicle for a Pure Consciousness that is sweet and enduring. I know who I am, why I am here, and how to serve. In the words of Andrew Cohen, I have embraced "the mysterious compulsion to become more conscious." A far cry from Dario's words that the conscious life is the most painful thing to endure.

Full Recovery is Possible, Costin Writes

noreply@blogger.com (ChangeThroughCreativeChoice) — Mon, 22 Aug 2011 12:24:00 +0000

Carolyn Costin, founder of The Monte Nido Treatment Center in Malibu, CA, believes full and total recovery from an eating disorder is possible,having recovered from one herself. This is how Costin (who treated Portia de Rossi and Jenni Schaefer, who have authored memoirs of their own recovery process) describes recovery: "Being recovered is when a person can accept his or her natural body size and shape and no longer has a self-destructive relationship with food or exercise. When you are recovered, food and weight take a proper perspective in your life, and what you weigh is not more important than who you are; in fact, actual numbers are of little or no importance at all. When recovered, you will not compromise your health or betray your soul to look a certain way, wear a certain size, or reach a certain number on a scale. When you are recovered you do not use eating disorder behaviors to deal with, distract from, or cope with other problems." In her new book, 8 Keys to Recovery from an Eating Disorder

She lists the keys as: 1) Motivation, patience and hope; 2) Nurturing the healthy self to heal the eating disorder self; 3) Feel your feelings; 4) Change your thoughts; 5) Change your behaviors; 6) Reach out to people rather than an eating disorder; 7) Find meaning and purpose; and last but not least, 8) It is not about the food, but it is about the food (nutritional restoration is critical to support recovery but is not the source of the eating disorder nor the sole focus of treatment).

Is the Much-Maligned, Oft-Abused Body the Key to Happiness and Bliss?

noreply@blogger.com (ChangeThroughCreativeChoice) — Sat, 30 Jul 2011 17:53:00 +0000

I am reading this book for Unity on the Bay's Adventure in Faith program and the very first chapter is about listening to the body! As a Somatic Experiencing Practitioner, I could not agree more. Awareness of body sensation discharges negative emotions and opens us up to access the bliss centers of the brain. One simple suggestion in the book is to keep your attention on distracting sensations in the body (such as pain, or tension) until they disappear. Instead of reacting to the sensation, paying attention extinguishes the stimulus-response process and stops the reaction from "fueling itself." Once the sensation passes, the body recognizes its innate, harmonious self-regulation capacity. Deepak Chopra takes it one radical step forward, stating: “Your physical body is a fiction,” Dr. Chopra states. "Every cell is made up of two invisible ingredients: awareness and energy." In his view, relaxed awareness (resulting from a coherent nervous system) is our natural state. Body awareness changes the pattern of distracting in unhealthy ways when stressed or overwhelmed.

Nourishing Secure Attachment

noreply@blogger.com (ChangeThroughCreativeChoice) — Fri, 29 Jul 2011 12:39:00 +0000

Last month I attended Diane Poole Heller's Dynamic Attachment Re-patterning Experience workshop on Creating Adult Relationships and learned skills to help people heal from early attachment wounds that disrupt their adult relationships. Continually evolving knowledge about neurobiology now confirms that we are designed to heal and that maladaptive attachment dynamics can be reconditioned to our natural, innate healthy, secure attachment design. Diane's understanding of somatic relational practices to effect lasting change on attachment patterns is a great contribution to human healing and the evolution of our authentic selves. Her work is informed by the work of Stan Tatkin, author of Love and War in Intimate Relationships and Wired for Love.

CANCER: Creating A New Consciousness Essential to Recovery

noreply@blogger.com (ChangeThroughCreativeChoice) — Sun, 11 Oct 2009 22:48:00 +0000

The other day I posted on my Facebook page some suggestions for staying cancer free:
1. Eat green, cruciferous and other colorful, nourishing vegetables.
2. Eat a variety of fruits -- 3+ a day.
3. Eat only healthy, plant-based fats and proteins.
4. Exercise at least 30 minutes a day, on most days of the week.
5. Avoid processed foods, alcohol, caffeine, cigarette smoke and excess sugar.

Then I realized that I was forgetting the most critical ingredients:
1. Practice stress relief every day -- breathwork, meditation, yoga asanas.
2. Forgive everyone everything.
3. Be grateful for at least one thing for every complaint you have.
4. Give of yourself -- even if it is a smile, a flower, a kind thought or word.
5. Create something -- a poem, a meal, a photograph or drawing.

This is my recipe for creating a new consciousness essential to recovery from cancer.

What is Evolutionary Enlightenment?

noreply@blogger.com (ChangeThroughCreativeChoice) — Mon, 20 Apr 2009 02:10:00 +0000

This interactive teaching module gives you an easy to understand overview of Andrew Cohen's teachings on Evolutionary Enlightenment to support the conscious evolution of humanity. It's all about moving beyond the Ego into the Authentic Self that seeks to live, consciously, with clarity of intention, for the sake of the Whole. Cohen outlines six principles and five tenets leading to true freedom. He defines hell as the world of the ego (or false self) that remains mired in victimhoom, faces nothing and avoids everything, and seeks to live only for its own sake.

Stop Complaining and Start Creating

noreply@blogger.com (ChangeThroughCreativeChoice) — Sun, 15 Mar 2009 12:17:00 +0000

Complaining is a bad habit, and like any bad habit, it can be changed with discipline and perseverance. Complaining is the activity of people who feel powerless. Notice I say "feel" NOT "are." Have you ever considered doing something to change the situation you are complaining about? Action removes the sense of powerlessness. And action usually involves changing something in ourselves. It requires insight into our perceptions, our fears that block us from changing. Complaining is an ANGRY energy. It is passive-aggressive. What if you were to tune in to that energy as pure sensation, without judgment, and use it to mobilize the action necessary to create the change? After all, all emotion is just that "e-motion" = energy in motion. Move the energy instead of being stuck in the quicksand of complaining. That will only create misery, instead of the opposite of what you are complaining about. How about when your complaining is about other people's behaviors? You cannot change other people. It is an impossibility. You can only change yourself. So what then? You still have options: 1) change your perception of the person; 2) accept the person exactly as they are; 3) do not have a relationship with the person ... and so on and so forth.

Mindfulness in Psychotherapy

noreply@blogger.com (ChangeThroughCreativeChoice) — Fri, 20 Jun 2008 10:56:00 +0000

Mindfulness is finding its way more and more into the field of psychotherapy, and with positive effects on those who practice it. It is helpful in reducing everything from anxiety, to impulsivity, to stress and chronic pain. Could radical acceptance and compassionate awareness be the key to ease suffering and promote change? Acceptance and Commitment Therapy; Dialectical Behavior Therapy; and Mindfulness-based Stress Reduction are some of the approaches that incorporate mindfulness at their core. Check out this May 2008 New York Times article by Benedict Carey.