Restorative yoga is a good practice. It helps relieve the effects of stress by providing a completely supportive environment where you alternately stimulate and relax the body to move toward balance. This quiets the fight, flight or freeze responses and provides a “recovery phase” for all the activity of the world. Here’s a simple restorative yoga posture that you can try at home.

This posture is adapted from Judith Lasater’s book Relax and Renew: Restful Yoga For Stressful Times. Judith is one of my mentors and I learned to teach restorative yoga from her. She says, “The practice of yoga is fundamentally an act of kindness toward oneself.” As I wrote in an earlier blog post, The Antidote to Self-Hate is Compassion, learning to be kind to ourselves is a vital practice.

Yoga, and restorative yoga in particular, is a nice adjunct to any kind of therapeutic work you may be doing. Finding a teacher you connect with is important too. Many yoga studios now offer restorative classes or workshops. Judith also has a second website, Restorative Yoga Teachers, where you can search by city and state for teachers who have completed her training program. From time to time I offer restorative yoga workshops for fellow therapists and counselors as a form of continuing education.

So here is the posture, Legs on the Couch. All you need is a thin blanket, an eye pillow (if available), and a couch or sturdy chair.

Legs on the Couch
Lie on your back with your legs bent at the knee, and let the couch (or a large enough chair) support your calves and feet. Your calves and thighs are at a ninety degree angle to each other.

Place a thin, folded blanket under your head and neck for additional support. Close your eyes and place an eye pillow, if available. This helps remove any ambient light and supports you in turning inward. Lower your chin slightly. Focus on your breathing. Feel your spine supported by the ground, the tension draining from your legs.

Stay for 5-10 minutes, or even longer if you feel comfortable. If your mind starts wandering, simply come back to your breath and the sensations in your body.

To come out of the pose, remove the eye pillow, open your eyes, and rest for a few breaths. Bend your knees toward your chest and gently roll to one side. Pause for a few more breaths and bring yourself up with the help of your arms.

April is National Child Abuse Prevention Month. The first Federal child protection legislation was passed in 1974 and growing awareness of child abuse and child welfare continued to develop through the 80s and 90s. My practice includes adults who are survivors of child abuse who grew up during these time periods. While much of Child Abuse Prevention Month is focused on the well-being of today’s families, it’s a good opportunity to share information and resources for adult survivors too.

Child abuse shows up in a number of different forms: physical, sexual, emotional, and now child neglect is recognized as a form of abuse as well. The common thread among these is the emotional harm that children go through. Adult survivors have the task of understanding and making sense of their history and finding the things that help them heal. Here are a few resources.

Knowing You are Not Alone
It can be extremely helpful to read the memoirs and stories of other adults who have survived abuse. You get a chance to see how they have navigated these waters, with their own mistakes and triumphs.

Good Self-Care
There’s an acronym I like to share with clients called SELF: Sleep, Exercise, Laughter and Food. These are the foundations of self-care. Some symptoms of depression and anxiety can be alleviated by consistent self-care, and the ones that cannot be alleviated will help give you (and a therapist, if you have one) a road map for where to work on things.

Trustworthy People
It’s good to be around people you like and can trust. Sometimes this is easier said than done. When you’ve experienced abuse, trust and safety can be hard to come by. Therapy can be a good place to work on this. A well-trained therapist will strive to provide a safe environment for trust to develop between the two of you. Finding a support group can be a good addition or alternative. Also, getting involved with an activity, perhaps sports or volunteer-related, can be a nice way to develop connections that are focused on a common interest.

Spending Time With Yourself
Learning mindfulness meditation, practicing yoga, going to a prayer service, walking in nature. All of these cultivate the relationship with yourself and help to tolerate and understand your own thoughts, emotions and sensations.

It’s Not Your Fault
Part of the emotional harm that comes from child abuse is thinking that you are responsible for what happened to you. It’s just not true. You may have found ways to adapt and manage pain that are no longer serving you, and part of the work in therapy is unraveling these adaptions and finding new, creative ways of living.

image © lapas77 – Fotolia.com

Robert Sapolsky, the Stanford neuroscientist and writer, revealed an important fact about primates under stress during an interview on KQED: one of the most effective ways to diffuse stress is to take it out on someone else. I was struck by how relevant this is for couples. In fact, couples do this to each other all the time, and they often regret it. So how can you change this behavior?

Here are a few ideas from my toolkit when working with couples:

Prevention
Take care of yourself first and you will be less vulnerable to stress. This means employing the SELF acronym in daily life: Sleep, Exercise, Laughter and Food. People often question whether taking care of themselves first is selfish. Actually, it gives you a much better opportunity to be present and available to other people.

Get to Know Yourself
Become familiar with your sensitive spots. For one person, changing plans at the last minute is no big deal, but for another person this can touch sensitive areas around neglect and abandonment. The more you know about your own sensitivities, the more quickly you can recover from emotional injury, and the more capacity you have to talk to your partner about what hurts.

Build Up the Good Stuff
John Gottman, the marriage and relationship researcher, refers to this as the “magic relationship ratio” of 5:1. In relationships that work, there are five times as many positive things going on as negative things in a conflict. It helps to practice these kinds of interactions, so when the crap hits the fan, so to speak, these behaviors are more accessible to you. Positive behaviors you can practice regularly include:
• showing interest
• asking questions
• being kind
• being affectionate
• being empathic
• sharing appreciations

You might also be interested in another blog post I wrote, Helpful Practices for Couples, which features practices such as mindfulness, cultivating wise mind and sharing appreciations.

[image courtesy of Emmalynne Photography]

Language is one of the ways to connect our conscious and unconscious worlds. Things we don’t yet realize we know have a chance to rise to the surface. This allows our perceptions to become more deeply felt and understood. Sometimes we forget this amazing function of language in a culture that overflows with data and information.

However, one of the more language-deficient areas in our culture is finding words to describe our positive qualities. Sometimes people are afraid to do this because they think it sounds self-centered. But this isn’t about narcissism or grandiosity. In fact, I think many people have trouble naming their positive qualities because they don’t quite believe that they’re true.

One of my colleagues recently gave me a list called “Recognizing My Positive Qualities” from the McKinley Health Center at the University of Illinois at Urbana-Champaign. The instructions are to circle 10 or more of your strongest positive qualities and post them in a prominent place where you can see and affirm them each day. If you’re working with self-esteem, depression, anxiety or grief, this can be a good exercise to assist in your healing.

The link above will take you to a copy of the full list, and I’m including an abridged version below. What are the words that best describe you?

accepting
adaptable
affectionate
artistic
broad-minded
calm
capable
cautious
cheerful
clever
courageous
dependable
determined
empathic
enterprising
faithful
fit
funny
generous
good-natured
growing
honest
hopeful
humorous
idealistic
imaginative
independent
kind
learning
leisurely
likable
logical
mild
moderate
natural
non-judgmental
organized
original
patient
persistent
polite
quiet
realistic
reflective
resourceful
robust
sexy
sincere
spontaneous
talented
tenacious
trustworthy
understanding
uninhibited
unique
versatile
warm
whole
witty
zany

You might also be interested in another blog post I wrote, The Antidote to Self-Hate is Compassion, which features practices for cultivating more empathy and compassion for yourself.

The holidays can get hectic. But the winter days are also a good time to slow down and have some quiet, contemplative time. It helps to set a few intentions before everything gets busy. I know that “setting intentions” can sound serious and time-consuming, but all it takes is finding an idea you like and saying a simple one-line statement to yourself.

If you want to get fancy, you can write down your intention and stick it by your computer. Here are a few ideas for making the most of the season:

• Take a few minutes to think about what is meaningful about a particular holiday or celebration.

• Spend time outside: Take a walk and appreciate the changing of the season.

• Schedule some time for yourself away from the busyness and social activities.

• If you are feeling the loss of an important person, talk about this with a friend or trusted person.

• Keep up with exercise. Even if it’s one walk per week, you will feel better and can build on your momentum.

• Try a gratitude practice: Take 10 minutes to write down what is going well and who has helped support you.

• Don’t beat yourself up for not doing more.

• Get in touch with your deepest wishes for yourself, your family and the world in the coming year.

You might also be interested in another blog post I wrote, Saying No Gracefully, which talks about saying no in ways that are respectful to both yourself and to the asker. This is often helpful around the holidays, too.

I’ve been reading Cheri Huber’s book, There is Nothing Wrong With You: Going Beyond Self-Hate. She talks a lot about how self-hate works, and how to intervene on your own behalf. She says that spiritual practice is essential because “in order to be free of self-hate, we must find the unconditional.” Not everyone who comes to psychotherapy is interested in spiritual practice, so here are some of her suggestions that are free of spiritual or religious requirements.

I think these are good practices to try, especially if you would like to cultivate more compassion in your life:

• Think of at least one loving thing to do for yourself each day.

• Stop and appreciate yourself for every thought and act of kindness.

• Each time you give a gift to someone else, give something (even if it’s just little) to yourself.

• Ask the child inside you what it needs to hear you say.

• Say thank you to yourself when you do something kind.

• Each time you receive a gift, give something (even if it’s something little) to someone else, and really let yourself feel the joy of doing it.

• Get comfortable saying, “I love you” to yourself and say it many times each day.

• Take out pictures of yourself when you were little, frame them, place them in prominent places, and let yourself begin to appreciate that little person.

• Journal regularly, especially noting the self-hating ways you speak to yourself and treat yourself. Each time you become aware of a self-hating thought or action, remind yourself that even though you were taught to treat yourself that way, you are now committed to treating yourself with unconditional love and acceptance.

• Find a time of quiet and solitude each day (i.e. meditation or mindfulness practice) in order to be more present to yourself.

Finally, I leave you with this little gem from the book: “From the innocent, compassionate heart it is clear that life just happens. We don’t need to take it personally. We are not being punished, and neither are we being rewarded.”

image © LenLis – Fotolia.com

I’ve been hearing a lot about orthorexia, a term developed by Steven Bratman, MD, to identify an unhealthy obsession with eating healthy food. Orthorexia is not a recognized mental or medical disorder, but it identifies a phenomenon that Bratman sees in his practice and has experienced personally. The quest for good nutrition and healthy eating seems like a positive goal, but the unhealthy obsessiveness seriously complicates the picture.

The term itself comes from the Greek: ortho meaning “right” or “correct” and orexis meaning “appetite.” It is intended to parallel anorexia nervosa and indicates a link to anxiety and/or obsessive thinking and behavior. In his original essay on orthorexia, published in Yoga Journal in 1997, Bratman writes:

“Orthorexia begins innocently enough, as a desire to overcome chronic illness or to improve general health. But because it requires considerable willpower to adopt a diet which differs radically from the food habits of childhood and the surrounding culture, few accomplish the change gracefully. Most must resort to an iron self-discipline bolstered by a hefty sense of superiority over those who eat junk food. Over time, what they eat, how much, and the consequences of dietary indiscretion come to occupy a greater and greater proportion of the orthorexic’s day.

Orthorexia eventually reaches a point where the sufferer spends most of his time planning, purchasing and eating meals. The orthorexic’s inner life becomes dominated by efforts to resist temptation, self-condemnation for lapses, self-praise for success at complying with the self-chosen regime, and feelings of superiority over others less pure in their dietary habits.

Pretty interesting. Here in the Bay Area, we hear a lot about dietary nutrition and eating heathy, local, organic, etc. It’s useful to identify when the focus on food and nutrition is accompanied by an unhealthy obsession or by a kind of spiritual materialism, when the pursuit becomes an ego-building endeavor.

These distinctions can be explored in a non-judgmental, curious and empathic atmosphere, whether with a counselor or a good friend. Tom Billings of BeyondVeg.com has a useful article called “Clarifying Orthorexia” on identifying a middle ground of moderation and how to tell the difference. Michael Pollan, author of In Defense of Food and Omnivore’s Dilemma, also writes about nutrition and orthorexia in our culture— a short take of his views are available on his website.

If you have questions or comments on orthorexia, I’d be happy to hear from you. Here are some other resources for learning more:

Steven Bratman’s website on orthorexia

the Something Fishy eating disorders website on Orthorexia Nervosa

“Orthorexia: Can Healthy Eating Be a Disorder?” in Time magazine

Orthorexia nervosa on Wikipedia

You might also be interested in another blog post I wrote, Intuitive Eating, which introduces the ten principles of intuitive eating and some practices for making peace with food.]]> http://jodiperelman.com/learning-about-orthorexia/feed/ 0 http://jodiperelman.com/motivational-interviewing/ http://jodiperelman.com/motivational-interviewing/#comments Tue, 15 Mar 2011 06:46:45 +0000 Jodi http://jodiperelman.com/?p=1930

Motivational Interviewing is a directive, client-centered counseling style for eliciting behavior change by helping clients explore and resolve ambivalence. It was developed by William Miller and Stephen Rollnick and evolved from the treatment of problem drinking. It’s a useful approach for working with clients around change and can be integrated with other treatment goals.

The literature on motivational interviewing distinguishes between the spirit of the approach and the techniques that are utilized. This spirit can be characterized in a few key ways:

• Motivation to change is elicited from the client and not imposed from the outside.

• It is the client’s task, not the therapist’s, to articulate and resolve his or her ambivalence.

• Direct persuasion is not an effective method for resolving ambivalence.

• The counseling style is generally a quiet and eliciting one.

• The therapist is directive in helping the client to examine and resolve ambivalence.

• Readiness to change is not a client trait, but a fluctuating product of interpersonal interaction.

• The therapeutic relationship is more like a partnership than expert/recipient roles.

Miller and Rollnick say that for a therapist accustomed to confrontation and giving advice, motivational interviewing can appear to be a slow process. However, the proof is in the outcome. More aggressive strategies, sometimes guided by a desire to “confront client denial,” can easily slip into pushing clients to make changes for which they are not ready.

Miller also says that motivational interviewing is like an interpersonal style. If it become a trick or a manipulative technique, the essence of it has been lost. The literature identifies several specific and trainable therapist behaviors that are characteristic of this style. Foremost among these are:

• Seeking to understand the person’s frame of reference, particularly via reflective listening.

• Expressing acceptance and affirmation.

• Eliciting and selectively reinforcing the client’s own self motivational statements; expressions of problem recognition; concern, desire and intention to change; and ability to change.

• Monitoring the client’s degree of readiness to change, and ensuring that resistance is not generated by jumping ahead of the client.

• Affirming the client’s freedom of choice and self-direction.

Motivational Interviewing is frequently used in the treatment of addiction and a lot of research has been generated on this work. The MI website also keeps a bibliography of research articles and information on professional training opportunities.

Many clients today are interested in egalitarian, client-centered approaches, especially when it comes to change around drug and alcohol use. Clients also want a competent, empathic and well-trained therapist. I think Motivational Interviewing responds to these needs and is an important approach for contemporary therapists to have in their toolkit.

image courtesy of Emmalynne Photography

The health benefits of meditation and mindfulness receive a lot of well-deserved attention in our culture. These practices can help people with everyday suffering, as well as specific health concerns. The image associated with these practices is frequently a calm and peaceful meditator. So the question is, do we have to be calm and peaceful in order to be healthy?

Larry Dossey, M.D., a leader in the field of mind/body medicine, recently published an article on the role of chaos and disorder in health, and I found his approach refreshing and informative.

Dossey uses the term “coherence” to describe the idealized, harmonious state that we associate with meditation and mindfulness. The current paradigm in our culture says that coherence is always necessary for healthy functioning. But Dossey writes, “Evidence suggests that coherence — harmony, order, regularity, periodicity — in human function can sometimes be pathological, that chaos can be necessary for health and longevity, and that the loss of chaos is involved in aging.”

Dossey’s article challenges the simplified notion that coherence is good and chaos is bad. In fact, both coherence and chaos coexist in our lives all the time. From a psychotherapeutic perspective, recognizing the truth of our experience — the good and the bad, the coherent and the chaotic, and everything in between — is one of the foundations of health.

You might also be interested in another blog post I wrote, Arthur Kleinman: Questions for Clients, which discusses the important questions that Kleinman, a medical anthropologist, suggests clinicians ask clients about their own health and illness.

I’m writing an article for the Winter 2011 issue of Bridge on the topic of assertiveness and guilt. Assertiveness is an often-misunderstood communication style, so I begin the article by contrasting it with other styles and then identifying this mysterious link to guilt.

Guilt is a feeling of responsibility or remorse for bad behavior. Many people aren’t used to asking for their needs in an assertive way, so feelings of guilt can arise, as if they have done something wrong. In fact, in some families, asking for your needs is like a violation of the system.

I’m posting the whole article below and welcome your feedback. Bridge is a local journal for therapists and other health care providers and is frequently read by the general public too. If you’d like to join the mailing list, just drop me an email and I’ll be glad to add you.

Assertiveness and Guilt

Clients often come to therapy when they’re trying to make important changes in their lives. This can require developing a more assertive communication style in relationships at home and at work. While it sounds easy, becoming more reliably assertive takes a great deal of practice and skill. Many people encounter a particular type of stumbling block or resistance along the way, known as guilt.

Defining Terms

Assertiveness can be defined as affirming one’s rights or point of view without either aggressively threatening the rights of others, thereby assuming a position of dominance, or submissively permitting another to ignore or deny one’s rights or point of view. (Dorland’s, 2007).

Assertiveness can be contrasted with a few other communication styles, such as passive, aggressive, and the ever-popular passive-aggressive. In a passive style, people try to avoid conflict by not expressing their opinions or feelings and tend not to protect their rights. Grievances in a relationship can easily build up. In an aggressive style, people express their feelings and opinions and advocate for their needs in a way that violates the rights of others. In a passive-aggressive style, people appear passive, but actually act aggressively in subtle and indirect ways. Ironically, each of these styles may be related to a sense of powerlessness or helplessness. (Benedict, 2010).

Guilt can be defined as a feeling of responsibility or remorse for some offense, crime or wrong, whether real or imagined. John Grohol (2007) writes that guilt can be an emotional warning sign with a purpose: we have a chance to examine our behavior and how it affect others. However, he writes, “the problem arises when our behavior isn’t something that needs re-examining, nor is it something that needs to be changed.” This is known as unhealthy or inappropriate guilt. The trick here is to differentiate between feeling remorse in order to learn something and making a desired change and then noticing a sense of guilt arise.

Understanding Shame

While guilt is feeling bad about what one has done, shame is feeling bad about who one is. Laura Gollnick writes that a shame-prone person tends to be very self-focused and have a limited sensitivity to what is actually happening with others. This can lead to a depressive way of looking at the world. “Differentiating shame from guilt may also be helpful, as many clients confuse the two, and culturally, the words are often used interchangeably.” Gollnick says that shame is often decreased by sharing what has happened and how one is feeling. Because shame often includes feelings of internal badness, talking about the experience can be a usefull way to recover a sense of self. (Gollnick, 2004).

The Roots of Guilt

The Control Mastery community has written extensively on the subject of guilt. According to the model, unconscious guilt stems from distorted irrational beliefs about having harmed or been disloyal to someone we feel a special sense of attachment with, such as a parent, sibling or child. This experience of guilt produces anxiety and can erode self-esteem and self-confidence, creating a predisposition to accept mistreatment. (Bush, 1989).

Marshall Bush writes that “irrational guilt arises because children make false causal connections between their own behavior and harmful things that happen … children often blame themselves for mistreatment they experience at the hands of their parents … [and] ordinarily do not know that their parents may irrationally blame, punish, abuse, reject, or neglect them because of the parents’ own psychopathology.”

Because children need to maintain good relations with their family, they may condemn as bad any wish, idea or goal that they believe could harm another family member. This could include independence, autonomy, intimacy and even happiness. (Bush, 1989). Because this happens unconsciously, when children grow into adults they may encounter strong internal resistance to building assertiveness, especially if this communication style threatens the status quo in their early family life.

According to Control Mastery theory, therapists can help clients gain insight into their unconscious guilt by disconfirming these irrational beliefs and helping them master the traumatic childhood experiences that gave rise to those beliefs.

References

Assertiveness. (2007). Dorland’s medical dictionary for healthcare consumers. Elsevier. Retrieved December 10, 2010, from mercksource.com

Benedict, C. (2010). Assertiveness and the four styles of communication. Retrieved December 10, 2010, from serenityonlinetherapy.com/assertiveness.htm

Bush, M. (1989). The role of unconscious guilt in psychopathology and psychotherapy. The Menninger Foundation.

Gollnick, L. E. (2004). Skilled empathy: creating safety through therapeutic attachment. Altadena: Wellness Plus.

Grohol, J. M. (2007). 5 tips for dealing with guilt. Retrieved December 23, 2010, from psychcentral.com

You might also be interested in another blog post I wrote, Saying No Gracefully, which talks about saying no in ways that are respectful both to yourself and to the asker.

image courtesy of Best Art Studios 2