I recently watched the first season of Bloodline. One of the main characters, Danny, behaves very badly to his family, including lying, threatening and manipulating. At the end of the season, he reveals his psychological truth and why he behaves this way.

(Beware, spoiler alert.)

Surprisingly, Danny’s motivation doesn’t come from revenge or anger or wanting to hurt others, but from an unbearable and desperate desire for communication and understanding.

In the penultimate episode of the season, brothers Danny and John finally confront each other, and John apologizes for some of his actions during their shared childhood. He also insists that Danny leave their hometown immediately because he’s been acting so dangerous. Over and over again, Danny refuses.

As the tension builds, an exasperated John finally says, “What the fuck do you want?”

Danny lets loose with his deepest wish: “I want you to know how it feels! Just to know what it feels like to have to beg, to have to go through your whole life apologizing for everything, I want you to know. You want me to leave — beg me! Get down on your knees and you beg me to go. Beg me!”

All of his lying and fakery comes down to this: Danny is incredibly isolated in his pain.

Throughout his childhood and adult life, he has felt radically misunderstood and hasn’t been able to express himself honestly using words and language. He hasn’t been able to truly relate one human to another and seems desperate for his pain and experience to be seen and understood by his family.

He can’t have this soothing experience and probably hasn’t been able to have it his entire life. To Danny, the only recourse is to force the others in his family to feel this wretched, unbearable pain. If John can’t understand, then Danny will bend reality by lying, threatening and manipulating until John is forced to feel this desperate pain himself.

I think that Danny believes this is the only way to get relief and end his suffering. And if his own suffering doesn’t end, then at least he will have brought his closest kin into the fire with him, and he will no longer be alone. It’s a poignant, heartbreaking portrayal of why people do bad things.

The month of October was marked as Infant Loss and Awareness Month in 1988. One of the intentions is to provide information and resources for parents impacted by miscarriage, stillbirth, interruption of a wanted pregnancy after prenatal diagnosis, or death in the first year of life.

These experiences affect many families, yet there is much quiet suffering.

Death is a challenging subject to talk about, and the loss of an infant or a pregnancy can be even harder. For bereaved parents, having a supportive and understanding atmosphere makes all the difference.

We’re fortunate to have many good resources in the Bay Area, including HAND of the Peninsula. HAND, Help After Neonatal Death, is a volunteer group of parents who have experienced the loss of a baby before, during or after birth. They offer empathetic peer support to other parents and their adult relatives and friends during the normal mourning that follows such an experience.

Some of the services that HAND offers include:

• Grief support meetings where parents can share their experiences.

• Subsequent pregnancy meetings for parents expecting another baby.

• One-on-one peer support from a HAND volunteer.

• Information and referrals for bereaved parents and professionals.

• Hospital visits and labor support to parents experiencing a neonatal loss.

HAND also offers services and meetings in San Francisco and Santa Cruz.

One of my colleagues is undergoing surgery in a few months, so I’ve been thinking about the power of guided imagery and affirmations when preparing for and recovering from surgery or other medical procedures.

Belleruth Naparstek, the maven of guided imagery, and her company, Health Journeys, have a wonderful set of meditations called Successful Surgery. The set includes a complete guided imagery journey, a series of affirmations, and a long recording of music to be listened to during procedures.

Christiane Northrup’s book, Women’s Bodies, Women’s Wisdom, also has a section on mindful preparations for surgery. She includes a set of affirmations that can be read directly to patients before and after procedures, which is a powerful form of support.

Doctors, nurses and other healthcare professionals are often willing to support patients with mind-body practices that aid in healing. Don’t be afraid to ask! These kinds of tools can be extremely helpful in bringing forth calmness, confidence and a sense of meaning that is unique to each person and each situation.

I’m back at the office after an extended leave, and while I was away, I completed a number of continuing education courses. As a licensed Marriage and Family Therapist with the California Board of Behavioral Sciences, I complete at least 36 units of continuing education every two years.

The Board requires a six-unit Law and Ethics class for each renewal period. Staying fresh on these foundational issues is key, as is learning about any modifications to our legal and ethical obligations.

During this recent two-year period, I took a class offered by Ricki Boden called “Law, Ethics and Supervision: The Use of Authority.” We reviewed basic legal and ethical considerations, as well as the particular responsibilities facing supervisors who oversee the work of unlicensed interns.

As a supervisor, I aim to promote an open and collaborative relationship so that my supervisees feel comfortable coming to me with their questions and challenges. At the same time, I also foreground legal and ethical considerations for the protection of both interns and their clients.

As Boden says, “One of the most complex and challenging aspects of supervision is the way authority is used by the supervisor…. Supervisors with a solid foundation of training and knowledge can sit most comfortably in their authoritative voice. They become skilled in moving between the collaborative and directive modes.”

The capacity to move between these two modes is important for everyone involved — client, therapist and supervisor — and was a strong component of Ricki’s class.

Other courses I took during this renewal period included:

Overview of Harm Reduction

Understanding Panic Disorder

Bullying in Children and Youth

Existential Issues in Psychotherapy and Couples Counseling

image courtesy of The Farm Road

I’m on an extended leave from the office until June 2013. If you’d like to speak with a therapist while I’m away, you are welcome to call my colleague, Linda Cunningham, Ph.D., at 415.346.6363. If you’d like to be notified when I return, please fill out this form on my contact page. Thanks for your understanding.

Some of my favorite follows on Twitter are teachers and mentors who post aspirational quotes and sayings. They serve as momentary breaks from the action of the day and reminders that we can connect more deeply with the moment and with ourselves.

Some of my fave follows include:

• Judith Lasater, a San Francisco-based yoga teacher and educator

• Cheri Huber, a Zen teacher and practitioner

• His Holiness the Dalai Lama, who among his other affiliations, describes himself as a simple Buddhist monk

Here are the links and a handful of tweets from each:

Judith Lasater

It takes a lot of awareness and sometimes even effort to create simplicity in our lives. Try for simplicity at least one day a week. Jai! – 14 Nov

Sometimes it is also the mind’s job to forget. Jai! – 17 Oct

Even with the best of intentions, we will make mistakes. Love yourself anyway. Jai! – 21 Jun

Cheri Huber

Trying to figure something out? Put your attention elsewhere and wait. – 15 Sept

Spend a little time today just sitting and breathing. Be aware of being alive. – 29 Mar

Create a mental broom. Then sweep those bothersome voices out of your mind with gusto. – 2 Nov

I repeat, there is absolutely NOTHING wrong! – 16 Nov

His Holiness the Dalai Lama

Altruism means that we should not be exclusively preoccupied with our own welfare. This does not imply that one should become a martyr! – 7 Mar 11

Generosity is the most natural outward expression of an inner attitude of compassion and loving-kindness. – 2 Mar

Genuine love should first be directed at oneself – if we do not love ourselves, how can we love others? – 26 Jan 11

Honest and well-written memoirs are good to read when going through a hard time or processing big life events. Hearing someone else’s story can help us understand what we’re going through and feel less alone. Here are a few memoirs that I’ve read and recommend. They’re very different from each other, but each one affected me deeply.

My Pet Virus: The True Story of a Rebel Without a Cure
by Shawn Decker

Shawn was born with hemophilia and at age 11 was infected with HIV from tainted blood products. He faces an incredible amount of adversity, including being expelled from school, and manages to write about his situation with a lot of grace and humor. He chronicles his adventures in the dating world as a hetero, HIV positive man living in a rural town and how he finds meaningful work as a writer and speaker.

The Center Cannot Hold: My Journey Through Madness
by Elyn R. Saks

Elyn Saks offers an incredibly honest and detailed portrait of living with mental illness. After being diagnosed with schizophrenia, she continues her professional path through graduate school and law school, eventually becoming a professor of law with a specialization in mental health law. Along the way she struggles with taking medication, doing intensive psychotherapy, having psychotic episodes and creating a life worth living.

In Stitches
by Anthony Youn

At age seven, Anthony Youn tells his father that he may want to do something else with his life other than go into medicine. His father, a physician himself and an immigrant from Korea, says, “Doctor is the only thing. Every other job is no good for you. You have to make Daddy proud.” So Youn sets off on the grueling and expensive course of a becoming a doctor, finding a specialty, finding a love relationship, and perhaps most poignantly, finding his own unique voice within medicine.

image courtesy of Lola’s Room Photography

I’ve been reading an excellent book by Barent W. Walsh called Treating Self-Injury: A Practical Guide. Walsh draws important distinctions between self-injury and suicide, which is useful for both clients and therapists to understand. He deconstructs the stigma and misunderstanding that self-injuring people go through and helps clinicians develop the most relevant ways to think about and help their clients.

Walsh defines self-injury this way: “intentional, self-effected, low-lethality bodily harm of a socially unacceptable nature, performed to reduce psychological distress.” While body modification occurs in cultures throughout the world, the acts of self-injury we are talking about here are not endorsed by the prevailing culture. Walsh says that “among teens there may be considerable social reinforcement for the behavior … however, there are no organized, culturally endorsed rituals that surround it.”

Self-injury tends to be effective in terms of modifying and reducing psychological discomfort. Edwin Shneidman, Ph.D., the founder of the American Association of Suicidology, noted the “unendurable, persistent pain” that drives a suicidal crisis. A suicidal person experiences intolerable psychic pain and wants to find a lasting solution. In contrast, a self-injuring person experiences intense and uncomfortable pain too, but it is temporary — the self-injury itself offers a way to interrupt and reduce the discomfort.

The intent is also different between the two. As Shneidman wrote in Definition of Suicide, the intent of a suicidal person is to “terminate consciousness.” In a self-injuring person, the intent is not to terminate consciousness, but to modify it. Walsh writes, “The overwhelming majority of self-injurers report that they harm themselves in order to relieve painful feelings.” These painful feelings may involve too much emotion (anger, shame, anxiety, sadness) or too little emotion (dissociation, “dead-like” or “zombie-like” experiences).

Walsh identifies a number of other areas of difference between self-injury and suicidal attempts and advocates a thorough assessment so that therapists can better understand the person they are working with and take appropriate therapeutic action. These include:

• Level of Physical Damage and Potential Lethality — suicide methods vs. self-injury methods.

• Frequency of the Behavior — self-injury usually occurs at much higher rates than suicide attempts.

• Multiple methods — self-injury usually involves more than one method over time.

• Constriction of Cognition — suicide viewed as the only way out vs. the perception of options.

• Helplessness and Hopelessness — when these feelings are central vs. some optimism and sense of control that characterizes self-injury.

• Psychological Aftermath of Self-Harm Incident — no immediate improvement after suicide attempt vs. successful “alteration in consciousness” after self-injury.

• The Core Problem — depression and rage over inescapable, unendurable pain vs. body alienation or a combination of intense stress, inadequate self-soothing skills and peer influence.

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