By Pamela Mueggenberg LMHP, MA
​
A few weeks ago I heard a polite bellow from our waiting room.
"Hello? Your food is here!" 
"Oh, thank you! Here, let me just sign this..."
The deliveryman shifted his weight. "What do you all do here?"
"Well we do meditation and therapy. I'm an art therapist."
"Oh!" he laughed, "I tell all my friends I'm crazy! Maybe I should come here!  If you think you can handle me!"
 
This short interaction is fairly common for anyone who works in mental health.  There is a discomfort, a feeling of vulnerability or alienation, which sometimes arises when a person who is unfamiliar with the work of therapy is unexpectedly introduced to it. There is a curiosity about something new, but so often it is paired with fear.
"Can you tell what's wrong with me if I draw something for you?" 
"Are you diagnosing me right now?"
"Oh no, I shouldn't have told you that!"
 
To me, these kinds of comments illuminate just how urgent the need for transparency is in mental health. Working one on one in a soundproof room, discussing intimate details of ones experience - and the necessary confidentiality of those conversations - makes it more difficult to openly describe what therapy looks like. 
 
Within that private space we as clinicians are using evidence-based, reasonable, concrete exercises, interventions, and ideas to help people better understand themselves and navigate their world. Unfortunately, if you don't know that, you may assume (as many do) that therapy is something more nebulous or spooky.
 
One of my biggest priorities when working with my clients is to be transparent in the work. I want to make sure that everyone who comes to see me knows exactly what they're getting into and, as informed and empowered consumers, they are able to make their own decisions regarding their care. In that spirit, I would answer a few questions I've been asked about therapists and the therapeutic process.
 
Q: Why is my therapist checking the clock? Is she bored?
 
A: No! As you are talking, your therapist is listening intently to your words and coming up with ideas, questions, or interventions that might help you. If there is a question that could open up a bigger topic, she wants to make sure you both have enough time to get through it. 
 
It wouldn't be fair if she asked a big question five minutes before you have to go.  As with any deep conversation, we need to plan for a transition from that depth, to you walking out the door. It feels weird to walk about of therapy without getting yourself ready for the outside world.
 
Q: Why do we have to meet so often?
 
A: Thinking of therapy as a medical or emotional intervention can often lead to frustration about scheduling. Therapy is not a doctor's visit. Therapy is more akin to physical therapy, where you are exercising muscles to heal from an injury, or a class where you are learning a new skill. 
 
Therapy can also be seen as regular part of your overall well-being, like brushing your teeth or taking a shower. While some sessions can lead to dramatic bursts of insight or compassion, most of the work is done one small step at a time, as your brain and body reorient themselves.
 
Q: What if I scare my therapist?  How can I trust that he will be able to handle what I have to say?
 
A: There is a common pop culture trope of the villain going to a well meaning, but incompetent therapist and promptly blowing their minds with thoughts of death, despair, or audaciousness. While your therapist hasn't heard your exact story, he'll be okay. 
 
Most therapists have built a team of support around them to help them process the pain they hear in a day. Supervision, integrated loving relationships, supportive colleagues, and of course their own therapist are all integral to helping him stay grounded. A professor of mine once remarked "anybody can be a therapist, you just have to care. You come to school to learn how to be a therapist and not go crazy." 
 
Therapeutic ethics, boundaries, and professional support are all in place to make sure that you can speak to your full experience, and trust that your therapist can hear you and help you.
  
If you are interested in therapy, or have questions about your current therapy, please don't hesitate to ask! We love talking about our profession, and sharing just how awesome this work can be.

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By Daniel Tipton, MA

Do you ever find yourself looking at your phone and not knowing why? Increasing accessibility to screens and technology has provided us with a means to escape reality, essentially any time we want. Screens and the programs running on them offer us distraction and pleasure that is difficult to beat. "What if I miss something?" You might say.
Putting the phone down is a mindfulness practice within itself. Life presents us with challenges and we look for ways to escape, even for a moment, whether it be with alcohol, food, social media, crossword puzzles, video games, gossip, or other things that help us avoid the present moment. We forget to tune in and see all the wonderful "distractions" that are available with a little attention.

This is not another article calling you to put your phone down. I struggle with the same problem daily. My call here is to simply notice. Pay attention to how you feel when you are in each of these scenarios:

• On the phone
• Wanting to reach for the phone
• Off the phone for a short period of time
• Off the phone for a long period of time
• When you are around others and on your phone
• When you are compelled to reach for the phone when driving

Something I noticed is that I have to have a pep talk with myself in order to put it down. I say something like, "Daniel, you are going to be okay if you put the phone away for a while. 99.9% of notifications that come, you can respond to later. If there is an emergency that you can do something about, you will know in enough time. Remember how good it feels to give your attention to the present moment, even during challenging times."

This little affirmation helps me a great deal.

By Kara Cavel, PhD, CMSW, LIMHP
 
Knowing what one needs and how one feels is not predetermined and does not happen in isolation. D.W. Winnicott, a pediatrician and psychoanalyst, believed the caregiver, if attuned to the child's physical and emotional needs, provides a holding environment for the child to experience the feeling of becoming real. Ideally, this happens in the relationship between a child and primary caregiver, but the relationship between a therapist and client can also serve as a source of consistency, predictability, and comfort, facilitating the feeling of becoming real. With the help of the caregiver or a therapist, an individual eventually learns to regulate their emotional states and tolerate feeling what they feel, and knowing what they know (van der kolk, 2014, p. 115).  
 
When we are unable to feel what we feel or know what we know, we become vulnerable to "shutting down the direct feedback from [our] bodies, the seat of pleasure, purpose, and direction" (van der kolk, 2014, p. 116). In other words, we shut down our intuition. When this happens, our inner sensations are ignored. When intense sensations are associated with safety and comfort we can learn to self-regulate and self-soothe. When they are not, we fail to have a sense of agency over our bodies and mind.
 
In the spirit of Winnicott's work who emphasized the power of play in his work with children, other tools or anchors can be utilized to invite safety in moments of distress. These tools serve to anchor us in the present moment and invites us to tap into our visceral sensations and ultimately the truth of who we are. This brings us to the use of tarot in one's own practice in developing intuition and self-regulation.
 
Several years ago, a friend gifted me a deck of tarot cards. I was immediately intrigued and wanted to know more about how I could use tarot as a source of guidance in my life. A tarot deck consists of Major Arcana and Minor Arcana cards. The Major Arcana cards are emblematic pictures that represent archetypal themes influencing one's life journey. These archetypal themes are reminiscent of Carl Jung's contributions who also worked with archetypal images and their role within the unconscious. The Minor Arcana cards comprise four suits (Cups, Swords, Wands, and Pentacles) each of which has distinctive characteristics.
 
At first, I understood the tarot to be THE guide, a power outside of myself, used to give me direction and clarity about a situation in my life. As I began to utilize the cards more and study the purpose of tarot, I began to understand how this power resided within me and not the cards. I became my own "midwife of the soul" a term used by Mary Greer (first coined by Sigmund Freud), an author and teacher of tarot. This allowed me to utilize the tarot to gain access to my own intuition and bodily wisdom. In times of distress, I would remind myself that I already know what I need. I would turn to the tarot to bring that knowing to light.
 
Recently, I was introduced to Lindsay Mack's work, the creator of Soul Tarot. She interprets and utilizes the tarot as a tool for self-care, healing, and evolution. Her work inspired me to use tarot as an anchor for myself and others. I have found that tarot has served as an adjudicative tool to assist in helping me know what I know, and feel what I feel. It is an unconventional practice used to move into the present moment. The tarot serves as a way to "visually and tangibly clarify another way of viewing our inner experiences, and allows us to be with them in a different way" (from Trauma and the Tarot taught and presented by Lindsay Mack).
 
Using tarot has given me a creative way to understand my experiences. I have learned to better tolerate the discomfort of not knowing the outcome of an event, and instead tap into my intuition using the cards to guide me. Pausing, breathing, and using the cards to support myself in a particular moment and remain calm and connected to my wisdom, has deepened my relationship with myself and has steadily become a practice of mindfulness, helping me to know what I know, and feel what I feel.
 
I invite you to consider the use of alternative forms of knowing in your practice to grow your intuition and tap into the truth of who you are.
 
Reference:
van der Kolk, Bessel (2014).
The body keeps the score: Brain, mind, and body in the healing of trauma.
New York: Penguin Books, ISBN: 978-0-14-3122774-1

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​Although medication plays a role in managing chronic pain, it is important to use alternative pain management methods as well. One such alternative is the eliciting of the Relaxation Response first described by Dr. Benson and his colleagues at Harvard in the 1970's. The Relaxation Response includes 1) taking a deep breath and 2) having a passive mind.

Dr. Benson's research revealed that these practices elicit a response that calms and heals the body. It is a way to combat the automatic fight or flight response that often occurs in reaction to pain. The immediate benefits of obtaining the Relaxation Response are lower blood pressure and heart rate. The long term benefits include a decrease in anxiety, depression, and pain. Therefore, regularly practicing an activity for eliciting the Relaxation Response is essential.

A tried and true Relaxation Response activity is diaphragmatic breathing. Pain disrupts normal breathing, causing it to be short and shallow and focused in the upper chest, mimicking the breath patterns associated with tension.

A diaphragmatic breath is the opposite of chest breathing. It requires engaging the diaphragm, a thin layer of muscle separating the chest cavity from the abdomen. At the beginning of each inhalation, the diaphragm contracts, air enters the lungs, and the stomach extends.

As the breath is expelled, the diaphragm relaxes, and the abdomen flattens. It is believed that such deep breathing oxygenates the blood, which triggers the release of endorphins which, in turn, helps to decrease pain.

Research suggests that regular practice will maximize a person's ability to elicit the Relaxation Response as needed to cope with pain. Using an app such as "Calm" or "Insight Timer" to guide deep breathing exercises can make daily practice an enjoyable self-care activity. Minimizing distractions and making the environment comfortable also enhances the experience.
 
In addition to a regular practice, it can also be helpful to have reminders to take a breath throughout the day. Taking a moment during the day to focus on breathing can provide a small break from the stress of the day, which can help decrease pain and prevent it from building. It also keeps the focus on the present moment, instead of on the worries of the past or future.

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"And I was some of the mud that got to sit up and look around. Lucky me, lucky mud."
- Kurt Vonnegut

The Mindfulness Study Group recently started Jack Kornfield's, "A Path With Heart, a Guide Through the Perils and Promises of a Spiritual Life."  

As we explore the "path" Kornfield shares, I experience the chapters as gardens of teachings and stories about mindfulness and life. There are blooms of peace, inspiration, and wisdom. Each time I visit, I see something new and I am changed. Yet it's not romantic or idyllic. It is honest and real, with a heartfulness that experiences and allows all that life brings. Here, all is present and abiding.

I was struck at our last session by the insights on "the preciousness and brevity of life." Since then, this has been a recurring theme each day. Here is how:

We Croak - In the spirit of the adage, "to be a truly happy person, one must contemplate death five times daily," the We Croak app shares quotes that inspire daily contemplations of death. These inspirations against the backdrop of a Path With Heart have infused my meditation and mindfulness with simple reflections on the dear and fleeting nature of life. 

Far from the Shallow - This reflection has helped me wade into a deeper, more embodied understanding and honoring of my own mortality and the beauty of life - an understanding well beyond a shallow intellectual understanding.  To go pop culture and quote the Lady Gaga-Bradley Cooper song Shallow, there are times when I feel "far from the shallow now."

Room for a View - Rather than dark or gloomy, these reflections pave the way for a clear seeing and savoring of life. It affects one's view of the world, life and self. It crystallizes one's deepest values and intentions. In the ordinary is now seen something extraordinary, in difficulty is known some equanimity, in pain compassion, in confusion clarity.

Letting Go - From this place of reflection, understanding and intention, it gets easier and easier to naturally let go of the unnecessary and unwise in life - as they say "abiding without clinging."
 
Please join us for the Mindfulness Study Group the first and third Sunday each month 4-6pm. Freely offered, drop-ins welcome, and no registration necessary. We read together and discuss each chapter. Books are available for use in session.

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Most recently, I stopped in a bookstore, and like any good therapist, I did most of my perusing in the self-help section. I found a book entitled "The Artist's Way" by Julia Cameron. 
A woman perusing the same section gave the book a ringing endorsement. Even more, a few days prior, my dear friend had talked about this book. It seemed like a synchronous moment. I purchased the book and took it home.
 
Julia Cameron, a poet, playwright, fiction writer, and essayist, provides guidance to the reader to retrieve the creator within. I had beaten myself up over the past several years for not writing enough, for not creating enough. 
This was it! I had found my guide to help me fulfill my intention to create more.
 
Cameron suggests writing "morning pages" to retrieve the creative self.   In this practice, she invites the reader to sit down first thing in the morning and write long-hand, using a stream of consciousness style, for three pages. 
This has become my practice for the last several weeks. The act of writing down my thoughts, worries, struggles, feelings of anger, sadness, joy, and fear first thing in the morning seems to have a lasting, calming effect on the rest of my day. 
The act of allowing the paper to hold all of that somehow cleared the way for my creative self to emerge. Ideas have begun to flow easier, and the practice itself is a form of energetic discharge.
 
As I write about the practice of morning pages, it reminds me of the practice of mindfulness. Cameron (1992) writes "attention is an act of connection" (p. 53). 
The morning pages is the process of paying attention to one thing for about 20 minutes a day. Mindfulness and morning pages go hand in hand. Mindfulness invites us to pay attention to the "right now." The morning pages invites me to do the same...stay in the moment, sit down, write with no distractions. 
The act of paying attention to the present, disables us to worry about the future or mourn the past. The present invites us to heal and connect to ourselves in the moment. Finding a way to connect with my creative self, through the act of morning pages, is both a healing and mindfulness practice.
 
If you want to try this form of mindfulness, feel free! 
Perhaps find Julia Cameron's book and read more about the guidelines she offers about the morning pages and how to honor this practice. Observe what happens, if anything at all, when you invite this practice into your life. Pay attention and notice how this practice may serve as a way to connect to yourself and others.
 
Cameron, J. (1992). The artist's way: A spiritual path to higher creativity. Penguin Putnam Inc.: New York.

When couples get into arguments, a common behavior that derails effective communication is called stonewalling. This occurs when a person becomes flooded with emotion and chooses to utilize the "flight" portion of the "fight or flight" response. 

"Flight" can be anything from actually fleeing the room (maybe with a door slam or middle finger to add emphasis) to giving the "silent treatment." We have all been there. 

It is perfectly reasonable to disengage when you have had too much but it must be done with care in order to preserve the respect and dignity that relationships need. I instruct couples to utilize self-awareness to know when they need a break. Ideally, stepping aside to cool off is done by stating why you cannot engage at the moment and a time when to return and try to sort out the problem in a more respectful way.

What typically happens is that couples slam the door shut on communication, usually leaving the other person out in the cold. This comes in several forms including: ignoring, only communicating in disingenuous ways (sarcasm, stubbornness), leaving without saying where you are going or when you will be back, or refusing to acknowledge the other person's point of view. 

These behaviors are harmful to relationships and should be avoided as much as possible. The antidote to stone walling, according to Dr. John Gottman, is to practice self-regulation. Essentially, it is knowing when you are past your limit. Often, it can be measured by a heart rate of 100+ beats per minute. Another way to look at it is knowing personal signs that you know mean you are very angry. Most people have signs like, tightness in the neck or chest, a feeling of heat in the face or abdomen, a deep feeling of dread, etc... 

When you can manage it, simply say you need a break and try to meet up again within one hour. This lets the other person know you aren't abandoning the issue or "getting off easy." With consent on both sides, a little break can prevent a painful blowout.

Click here to read the complete January newsletter.

By Laura Crosby
 
If your first inclination is to shrug off the possibility of simplicity and stillness during this time of 'tis the season, you're not alone. If you are thinking that exhaustion and feeling overwhelmed are more likely, fair enough.
 
Perhaps you find yourself just "pushing through," making your lists and checking them constantly. Looking toward the promise of some peace and some space, sometime beyond the holidays.
 
And yet ...
 
What if sprinkled everywhere amidst the frenzy there are moments of pure stillness and natural simplicity? What if the peace and space is always there - even during holiday parties and family gatherings, shopping and decorating, cooking and cleaning, bundling up and shoveling out?
 
Deepak Chopra shares, "In the midst of movement and chaos, keep stillness inside of you."  
 
It can seem as if the demands and busyness take over and squeeze out any hope of stillness and simplicity, let alone the deep contentment they make possible. At times like these, even moments of great beauty and joy are often under-savored, distracted as we are by the hustle and bustle.
 
Yet there can be stillness and simplicity within a full life and even within a demanding time of life. We needn't surrender to one at the price of the other. Stillness makes the full life fuller. Simplicity makes space, time and heart for the demands to soften into promising possibilities.
 
This stillness and simplicity are far more available inside and around us than we think - even and especially during life's most hectic and stressful moments. You might experiment with accessing your own stillness and simplicity this season in the following ways ...

• Incline with Intention
  Consider inclining toward some stillness and simplicity with an intention for the day. "When you set your intention, it sets the compass of your heart and your psyche," as Jack Kornfield reminds us.
  
  
• Sense into your own stillness
  When you find yourself sitting still - in a meeting, at a stop light, at a meal -sense the stillness in your body, heart and mind. You may also see whether you notice any simplicity in the moment.
  
  
• Turn it off and let the simple silence in
  Experiment with turning off the radio, the news, the music for 5-10 minutes each day. Choose one stretch of your commute or your errand-running and notice the stillness and simplicity within and around you.
  
  
• Know you are breathing
  When you get in the car or just before you get out of the car (or both!), take one natural breath, sensing the body's simple in-breath and simple out-breath. 

• Drop one thing from your list
  Consider whether there is one thing on your to-do list - including your mental to-do list - that you can delete. Play with erasing it from your list as entirely as you can. 

• Slow down
  Notice when you are rushing and see what it's like to slow down even 10%. Bring some attention to the sensation of slowing down, noticing what happens in the chest, stomach, jaw, eyes, throat and hands. 

• Notice when you're stirred up
  When you find yourself whipped up into a worry or a hurry, see if you can tune in to the sounds around you for a few minutes, listening mindfully. 

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By Pamela Mueggenberg, M.A., LMHP, LPC
 
I had the great pleasure of attending an intensive review of the current research in trauma this past month. As a trauma therapist, I want to be able to bring the most up-to-date, scientifically minded understanding of trauma and its treatment to my clients.
 
The man who taught the class, Dr. Robert Rhoton out of Phoenix, Arizona was a brilliant, warm man who would not stand for any foolishness when it came to our best treatment of clients. "Just try to suck less every day," he tossed out to the group as we were struggling with new concepts and interventions. I was very pleased to see that my philosophy of integrating creative expression and mindfulness in my work was held up by numerous studies as being very effective, but one thing that I need to pay more attention to with everyone - including myself - is how our human bodies physiologically respond to stress.
 
"Our clients are not doing ANYTHING wrong!" Dr. Rhoton roared. "Their bodies are doing exactly what they have been designed to do when faced with a threat - these behaviors are NORMAL! They are PREDICTABLE! It is up to you as a therapist to UNDERSTAND them and let them know they don't need to be ashamed!"
 
Let's imagine that you have a paper cut. When you first injure your skin, your body immediately attempts to draw energy to that area, swelling the cut with platelets and white blood cells to begin the healing process. This actually causes more pain - the paper cut hurts worse a few minutes after than it did right when you got cut.
 
This is called a physiological adaptation - the body is attempting to draw energy to the injury to speed healing and create space between ourselves and whatever threat or distress may be looming. Unfortunately, sometimes those adaptations can bring added discomfort.
 
Now let's imagine the psychological version of a paper cut - someone is rude to you, your boss gives you an unreasonable deadline, your car won't start in the cold. Your body responds to this injury in the same way it would a physical injury, by diverting energy into the area to create space between you and the distress.
 
You may snap at the person, become passive aggressive, roll your eyes at your boss as she turns away, kick your tire. You are not acting as your "best self" in those moments, but you are doing what your body needs you to do. This is predictable, and normal.
 
Now let's up the ante.
 
Instead of a paper cut, you have suffered a major injury to your leg and you are losing blood quickly. A physiological adaptation will not be enough to spur healing, so your body turns to mitigation. A mitigation is when your body cannot create space between you and the threat - the threat is here - so instead it creates space between your distress, and the perception of that distress.
 
This is similar to taking a pain pill; the medication does not stop you from hurting, it blocks your perception of the pain so you feel more comfortable. Your body can do this during times of catastrophic injury by going into shock, losing sensations to parts of your body, or more frequently, fainting.
 
If we look at psychological mitigations, in the face of uncomfortable distress we may go numb, distract ourselves, use alcohol or drugs, or in many other ways detach our bodies from our experience. You may not be proud of yourself for bingeing on Netflix, but what you are doing is predictable, and normal.
 
We need to understand that our bodies are not computers with which we can assign our values and watch them effortlessly appear. Our bodies are built to keep us alive, to adapt to and mitigate threat, and seek out comfort. We have these wonderful super powered monkey brains that are doing the best they can.
 
Let's all forgive ourselves just a little bit for not being perfect, and instead try to help our minds and bodies heal. To judge ourselves with shame is to bring more distress upon us, which triggers more of these behaviors.
 
The next time you are stressed out, do a little experiment: don't blame yourself for your behaviors, go underneath them and see if you can regulate your body. Breathe. Stretch your muscles. Remind yourself that you are safe, you are loved, you are worthy. Wiggle your toes. Explore your senses, what you can see, hear, touch, taste, smell? Do you need some water, or a snack? Is there anyone around - human or pet - that you can snuggle?  
 
You might notice that once you re-regulate your body, new options open up and you are able to make choices based on who you want to be rather than what you want to avoid.
 
As we approach this holiday season, stress will be lurking behind every uncooked turkey and politically alienating family member. Let's all try to be kind to ourselves and take good care of our bodies and minds. You are a fully developed human being with so much more to you than just your behavior. Be diligent in your compassion to yourself, and we'll all get through this together.

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By Daniel Tipton, MA

Why are relationships so hard?
 
One of the reasons is that the person with whom you've chosen to journey represents a mirror; a reflection of yourself. When you get angry at the other person, it is because you are seeing something about yourself in them.
 
As hard as this may be to believe sometimes, it is always the truth. When you decide to commit to a person, you are committing to facing the most vulnerable parts of yourself. When you share deeply with somebody, your flaws (and also your greatest strengths) inevitably surface. It can be frightening to face vulnerability. And when you are frightened, when your core self seems to be threatened, the primitive brain often activates and goes into fight or flight mode. You may see it as something the other person says or does, but your reactions are always due to a "threat" to something within yourself.
 
Herein lies the beauty and necessity of relationships.
 
If you are triggered, it is certainly because there is something inside you that is asking for healing. In your heated moments of yelling, name-calling, etc..., is the little voice inside you saying, "Please, love me. I am so afraid."
 
This is why forgiveness is the ultimate calling in any relationship. It is the greatest tool, in my opinion, for leading a happy and healthy life. A relationship presents you with innumerable opportunities to practice, make mistakes, and try again.
 
Forgiveness is the answer to every question. There will always be situations that seem too complex, but with free-flowing love and acceptance, they can be addressed with greater ease. An important thing to remember is that you don't forgive the other person to pardon them from wrongdoing. You forgive to set them free and also release yourself from the burden of holding a grievance.
 
When you choose to forgive, you are forgiving the part of yourself you judged and attributed to the other person. What a loving thing to do for yourself! 
 
Ideally, all of us could let go of grievances right away. It is difficult and we often could use somebody to offer validation and mediate our reactions. Sometimes, a third party is helpful for allowing strong emotions to be brought forth, respected, organized, and reframed. This is how a good couples counselor can help you out of a stuck place in your relationship.
 
Always remember:
 
When in doubt, forgive.

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