Atlas Complex: The Weight of the World

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Have you ever felt like the weight of the world was on your shoulders? Like you have to take on all the projects, help everyone around you, just to maintain a sense of order? By modern standards, this experience is identified and defined as the Atlas Complex, thus describing a need to take on all the responsibility and all the stress of the world as you navigate through it. Why would one experience the state of mind that they must take on the world? There are many reasons that encourage the behavior of being responsible for everything around us, including internal and external factors that drive us to action in search of relief.

 

Need to be Needed

One external motivation for taking on the world can be our relationships. For some, the avoidance of conflict by saying yes to others’ needs is enough of a reason to take on more than we can handle, and to make do for the sake of friendship, approval, or respect. Connecting and helping others isn’t all negative, however when our own needs are sacrificed for others with no opportunity for self-care, resentment, burnout, and poor mental health can follow. So how do you know if you are experiencing symptoms of the Atlas Complex in the scope of relationships and boundaries? Below are some questions you may ask yourself:

  • Do you secretly resent the request to help but feel you can’t say no?

  • Do you feel like you are the only one who can help, so you say yes?

  • Do you feel like you have to say yes out of avoidance of conflict or judgement?

  • Do you fear disappointing someone if you don’t take on their request?

  • Do you need to be needed? Do you feel most worthwhile when helping others?

It isn’t uncommon to identify with one or more of the questions above when connecting with others. One way to check in with yourself around your boundaries is to explore how you are helping yourself in addition to others. Remember that you can’t take care of others if you don’t take care of yourself first. Similar to the airline directives about oxygen masks, you must first put on your own oxygen mask before helping others, implying you are no good to them or yourself if you aren’t conscious from lack of oxygen in trying to address others’ needs before your own.

 

Escalating Anxiety

Having solid definition of your boundaries with others can be important in having quality relationships and can also improve expectations of what you are able and willing to do to help. You may feel anxious enforcing new boundaries when they weren’t present before, especially if loved ones’ question or push back against new boundaries out of confusion around the change. Change itself can also be a trigger for anxiety. The Atlas Complex can be present out of a desire to control something because you feel out of control in other areas. For example, if you feel like you can’t control the declining health of your parent, you may find yourself controlling your living environment, cleaning compulsively, and snapping at your partner when small messes are left in the kitchen. This increased irritability and urge to control several things at once manifests in response to internal anxiety that isn’t as easily controlled, making things more difficult in your relationships, work, and home life.

Awareness of your anxiety can be a first step in addressing it in healthy ways. By being aware, you can track patterns and make changes in your thoughts or behaviors, which can then have a positive effect on your emotions. Below are some ideas of what you might say or do to address the anxiety you feel:

  • Change the scene. Try getting out or away from an area that aggravates anxiety to gain some relief or perspective on what’s happening in your life.

  • Move your body. Movement can help reduce anxiety in the form of exercise. Take a walk to think things through, which helps anxiety by both serving as light exercise and as a processing tool, giving you time to explore what’s happening that stresses you out.

  • Think happy thoughts. Studies show that how we interpret a challenge can impact our anxiety.  For example, if we think, “nothing will ever change,” our emotional reaction will feel heavier and more helpless than if we think “this is temporary, I can do this.”

  • Try coping skills. Taking a drink of water, breathing, listening to music, or healthy distraction can help address the anxiety you feel to make it more manageable.

Managing the Atlas Complex and all it represents can have positive effects on your mood, relationships, and life. Check in with yourself frequently to determine the motivation behind urges to hold the world on your shoulders and you may just find that the world looks and feels lighter than it once did.

“Optimism is a happiness magnet. If you stay positive, good things and good people will be drawn to you.” Mary Lou Retton

Making Meaning of the Dance: A Journey Through the Couple Cycle

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“From the cradle to the grave, humans desire a certain someone who will look out for them, notice and value them, soothe their wounds, reassure them in life’s difficult places, and hold them in the dark.”
The practice of Emotionally focused Couple Therapy: Creating Connection by Sue M. Johnson

The Tango, The Charleston, The Swing, and The Cha-Cha. Yes, I know these are famous dances, but I would like to talk about another kind of dance. Within a relationship we all long to move toward our partner. To sway in the rhythm of passion, and desire. We long to feel the power of true connection that comes with being able to say “I need”, and get a loving and empathetic response in return. The dance I’m speaking of is the common relational exchange called the Emotionally-focused Couples Therapy Cycle. Emotionally-Focused Therapy or EFT as it is commonly referred to was the forward and remarkable thinking of Dr. Sue Johnson. In the 1980’s very little in therapy was being done to explore the scientific concept of adult attachment, which is a stark contrast to this same time period when so much emphasis was being placed on the continued study of childhood attachment theories and models. As Sue begun to delve into the attachment science, she began to see a potentially incredible model that could not only address attachment injuries both from childhood, and adulthood, but could systematically uncover relationship fractures, and invoke new and lasting connections. According to the ICEEFT website using the EFT model leads to couples being to move from distress to recovery 70-75% while 90% of couples showed significant improvements.

So how does this beautiful, and empirically proven model work? Well then, let’s begin!!

EFT is made-up of 3 stages i.e; Assessment and Cycle De-escalation, changing interaction patterns, and creating new bonds, and consolidation, and integration.

STAGE 1: ASSESSMENT AND CYCLE DE-ESCALATION

  1. Ascertain primary concerns, and set couples goals. Then, explore relational history.

  2. Interactions, and patterns are explored, and delineated. Therapist supports and assists in seeing historical interplays that have negatively impacted the coupling.

  3. Partners comprehend attachment-related emotions. Couple first acknowledges covered emotions, and feelings, and discuss those emotions, feelings, and behaviors with their partner.

  4. Couple and therapist with analyze cycle, triggers, and behavior output which results in two defined roles which are pursuer, and withdrawer. Therapist will also be mindful to notice, and name triggers present in the cycle.



STAGE 2: CHANGING INTERACTIONAL POSITIONS AND CREATING NEW BONDING EVENTS

  1. Space is created for transparency in order to state attachment needs, for which partner had not received in the past, which cause bond fracture.

  2. Couple develops the ability to compassionately respond to identified needs, and begin to accept the hurt, longing, and emotions that have been impacted by their partner.

  3. As cycle awareness increases, and new cycle, and interactional goals are practiced new conversations and interactions present themselves, which increases likelihood of bonding experiences.

STAGE 3: CONSOLIDATION/ INTEGRATION

  1. Couple integrates techniques, communication, and transparency, as they discuss the old cycle, and practice the new one. Practice is done outside the sessions in their own environment that exposes them to their domain that has been a potential trigger. Work with the therapist explores issues that came from those practices, and post conversations.

  2. With heightened awareness of skills, and deeper bonds couple and therapist focus on the celebrating efforts, and future methods to enhance new found rituals. To safeguard couples success, and decrease history of emotional breaks safety risks are addressed and prepared for.

Real-life example:

In an EFT therapy session, a wife pursues her avoidant and emotionally absent husband. Her protest becomes a sense of loneliness, abandonment, and sadness that she no longer feels connected to her spouse. In the past she felt that she was assertive, and asking for her needs to be met, by demanding, yelling, screaming, and sometimes becoming violent. Over a period of time, her protests turn to withdrawal, as her pleads go unanswered, and she is tired of getting so big to be seen, but yet still remains invisible. “I want to be wanted, loved, and cherished”, so please stop avoiding me, walking away, and pretending that my yelling doesn’t mean more.

Her husband’s stark hallow shell, becomes empty, but rumbles underneath as a fire, and a quiet storm brews behind a cold and distant face. The separation turns from heartbreak to fury, as he doesn’t understand why his wife hates him so much and just wants to yell at him all the time. “I walk away because it hurts”! “I leave because my space no longer feels safe, and threatens any bit of quiet we have left”. “Why can’t you just see, that you are tearing us a part”.

She has grown, learned, and observed the hurt, and pain that both her and her partner are experiencing. This shared pain has given her a new perspective, and has gotten her closer to a man that she felt was lost. She has discovered that she can still be seen as she quiets the storm of her own pain, and brings her partner closer and shows him that loneliness that brought her right to the edge. He has found the passion, and strength to expose his vulnerability and deep need to be loved, and comforted without fear. His transformation travels from “you don’t care, and your cruelty is just too much”, to “this is really hard, for me, but I want to trust this feeling”. “Please be with me, and make me feel safe within this relationship”.

New cycles of closeness contact interactions appear and dissipate previously established cycles, criticize-defend or pursue-withdraw, withdrawer reengagement, or pursuer softening. As the partners experience the cycles together in safety and empathy these behaviors are reinforces, which leads to a positive and permanent change. Space for healing, and a new sense of having a brand-new safe haven sparks connectedness, and fulfillment previously missing.

“EFT can be thought of as a postmodern therapy in that EFT therapists help clients deconstruct problems and responses by bringing marginalized aspects of reality into focus, probing for the not-yet spoken, and integrating elements of a couple’s reality that have gone un-storied.”
Becoming an Emotionally focused Couple Therapist: The workbook by Susan M. Johnson


Guest post written by Jamie Benson MFT-C, M.Ed, EFCT

Guest post written by Jamie Benson MFT-C, M.Ed, EFCT

Jamie Benson MAMFT, MFT-C, EFCT, M.Ed has been providing therapeutic services to Denver area children, adults, couples and families since 2015. She holds a Master’s Degree in Marriage, Couples, and Family therapy, as well as a Masters Degree in Education with an emphasis on Applied Behavior Analysis. Jamie currently works at Allhealth Network in Littleton Colorado and her work is centered around at-risk populations, including human trafficking, homelessness, human services, PO/probation, and substance abuse.

Community Confidentiality: Supporting Collaboration with Consent

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“I cannot confirm or deny.” How do you maintain confidentiality for your client? It may seem easy enough when there is a clearly written, signed release or when your client refuses a release, thus declining collaboration at this time. However, what does it look like in the following situations?

  • Your client is involved in an open Child Abuse and Neglect case.

  • An attorney calls you saying they represent your client and would like copies of your client record for a disability claim.

  • An insurance company calls to report the client listed you as a provider and they want to know your diagnosis to award the client a life insurance policy.

  • You outreach an organization about who they serve. They respond by wanting to obtain additional information from you on the client you want to refer.

  • A referral source wants to know if their client called to set up an intake and begin services with you.

  • A community resource shares that your client scheduled an appointment with them for next week.

  • A foster parent wants to know why the parent isn’t engaging in services to reunify with their child.

  • A CASA volunteer wants to know if the family is working on their fighting in your sessions because they believe it would be helpful.

  • The spouse of your client calls asking you how sessions are going.

  • Your client acknowledges that their friend is also your client.

  • Their probation officer includes you in a group text or email to schedule a meeting on behalf of the client with several parties you don’t know.

These are just a few of what could be dozens of examples of sticky situations when it comes to maintaining your client’s right to privacy. Let us look at possible responses to the above scenarios to determine what could be best. And as always, seek consultation, supervision, or legal advice if you have needs or concerns.

 

Signed Release

When a third party reaches out to you by email, text, or voicemail, it can be helpful to notify your client and obtain a release in the next scheduled session. Notifying your client of the outreach you received can support trust and transparency in the therapeutic relationship. It can also help facilitate a discussion on the importance of getting a client’s written permission to respond to an inquiry on their behalf, whether it’s an insurance company, secondary referral, family member, or community partner.

 

Legal Requirements

Perhaps your client is involved in an open Abuse and Neglect case, diversion, or probation. These entities have been assigned to your client as part of a larger treatment plan to address a legal concern. Whether your client is mandated to complete therapy or the third party referred directly to you, there is a different level of confidentiality implied due to the collaboration needed from you to provide progress reports and updates as appropriate around your client’s engagement in services. If you client is resistant to signing a release, helping them identify the specific pieces of information to share—and thus restricting some information in the effort of privacy—can be helpful to the client’s anxiety about personal information that is disclosed to others. When submitting a progress report to DHS or probation for example, providing your client with a copy can also demonstrate a sign of transparency and trust in encouraging them to review it and provide feedback on their level of comfort with the material shared.

 

Sense of Urgency

The desired scenario is one of those mentioned above, where we have the client complete a signed release of information highlighting exactly what is released and for what purpose. However, there are times that a sense of urgency may arise in getting permission quickly to collaborate with a community partner in a timely fashion. Depending on the frequency of client contact including regularly scheduled appointments, you may need to get email or verbal permission over the phone from your client as a temporary measure in obtaining consent prior to a written release. Standard practice is to have permission in writing so email can feel slightly more comfortable than verbal permission to us as providers. Either way, documenting your client’s permission with intention to get a full release in the immediate future can be helpful in allowing collaboration and sharing of information under a time restriction.

 

Curbing Curiosity

Collaboration is a helpful component of therapy, within reason, to support and validate client efforts. It may become apparent that there are other parties involved who may want updates on your client’s progress. This could include caseworkers, probation, child advocates, other mental health providers, foster parents and more. Where it can feel confusing is when third parties know you are actively working with the client and make assumptions that you can share information in the spirit of collaboration. For example, the foster parent is wanting to know how the parent, your client, is doing in services in order to encourage their child of the parent’s hard work. The inquiry may feel innocent enough, however the foster parent is not your client, and is therefore not privy to this information without your client’s consent. Something as innocent as attendance or participation in services can be reported back to other parties and could result in information being misconstrued or shared without permission.

 

Encompassing Electronics

In an effort to not have information shared unintentionally with third parties, being mindful of how your electronic correspondence is recorded can be helpful. Being aware of emails with additional recipients or group text messages requesting scheduling of a team meeting can feel nebulous regarding confidentiality. Documenting your effort to send correspondence only to approved parties identified on a signed release supports your client’s wishes as well as ethics compliance. Providing disclaimers in your electronic signature in email composed on your computer or phone can also support limiting liability if information is sent to the wrong recipient or forwarded to a third party outside of your control.

 

Limiting Liability

Documenting each of your efforts to maintain confidentiality as a standard of your practice can limit liability. Obtaining regular releases yearly from your client can keep their record up to date. Utilizing encrypted email and electronic health records for client progress notes can restrict situations where their information could be compromised. When it comes to confidentiality in direct interaction with third parties, identifying a statement of “I cannot confirm or deny they are my client” can feel unhelpful, restrictive but necessary in not admitting unapproved information to family, friends, referral sources, or legal representatives without permission. This feels most challenging by phone when even acknowledging your need to obtain a release is admission of your client’s connection to you. For many, having to share that a release has been revoked can feel even more challenging. You may say something like “permissions have been revoked and we suggest you contact the person of interest directly” can provide enough information for them to understand you won’t be interacting with them further and prevents direct identification of your client by name or circumstance.

Communication with community partners is an intricate dance that can feel challenging when caught off guard by emails, texts, or phone calls asking for updates on your client’s work. Demonstrating your ethical capacity in delaying disclosure of information until a release is obtained can indicate your professionalism in the community and willingness to collaborate under the appropriate circumstance. Be sure to follow up with the community partner once a release is signed to further demonstrate your willingness to collaborate together. Lastly, thinking about the possibly scenarios that put privacy at risk and obtaining signed releases upon introduction to the client can streamline this process by simply asking who else is involved in their treatment or care. Having a scripted response ahead of time for situations where a release is not yet completed can support you in making the best decision to support client confidentiality and community engagement with consent.

Goal Setting: Measurable Motivation

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As the year comes to a close, you may be looking to the new year to create resolution or revisit goals in the hope of change. It’s a time to explore goals that are measurable and attainable; it’s a time to create small steps to build self-confidence to remain motivated and hopeful. Perhaps you say “I want to join a gym to help my depression.” You want to work out every day to help your mood but aren’t currently working out on a consistent basis, and not at a gym. So, you find it important to explore your motivation as well as the perceived strengths and challenges of reaching your goal. You learn that smaller steps can support success and agree to working on short-term goals to build confidence and to move towards your long-term goal of working out daily.

 

Monitoring Motivation

Why is it important to explore motivation around a goal? Research tells us goals around fitness and gym attendance peak in January and dramatically decline by February and March every year. Additional research tells us that we must do something consistently for a minimum of 30 days for it to become a habit. What this conveys to us as human beings is that we need to see results or progress to continue to work hard at a goal. You may normalize this for yourself in understanding the pattern of motivation. You may also explore research on the Stages of Change from Motivational Interviewing as a visual to support yourself in identifying strengths and barriers to change. By being open and honest with yourself, you will be setting yourself up for success. Ask yourself the following questions to fully discover where your motivation lies (and note the Stages of Change in parentheses):

  • What do you want to change? (Precontemplation to Contemplation)

  • What makes that a problem for you? (Contemplation)

  • Is it a big enough problem to want something different? (Contemplation)

  • How would you achieve the desired change? (Preparation)

  • What do you need to support change? (Preparation)

  • What would help you to begin? (Action)

  • How will you know when you are ready for change? (Action)

  • What would help you keep going? (Maintenance)

  • Who/What would hold you accountable?

  • What would happen if you don’t succeed?

By exploring these questions, you can identify any current strengths or barriers to succeeding and further explore what is needed to progress through the Stages of Change.

 

Make it Measurable

It isn’t uncommon for someone to identify a goal but not know how to attain it, thus remaining in the stage of contemplation. It becomes our responsibility to break down a long-term or larger goal into measurable, smaller pieces for it to feel worthwhile. Here are some examples of how to make it measurable when identifying a larger, more abstract goal:

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Smaller, more measurable efforts can support short-term goals blending into long-term goals over time. By identifying and writing down goals that are measurable, can be reviewed regularly, and can be celebrated when attained, the effort it takes to achieve these goals can feel validated and encourage motivation for the long-term work as well.

 

Accountability Buddy 

Motivation can be internal such as, “I can do this” or external, “she said I can do this.” Identifying a trusted support as an Accountability Buddy can help you achieve your goals. Accountability Buddies are selected as a support person who is aware of your goals and holds you accountable by remaining in regular contact with you on your progress. They may meet with you weekly, monthly or on whatever schedule can help you remain focused and present on the goals you are working towards. Sometimes Accountability Buddies have a similar goal and may participate alongside you, such as going to the gym with you three times per week. Not having to work towards a goal alone can serve as an incentive in absorbing someone else’s positivity when you begin to question your own motivation. You may struggle to recognize the small but important shifts in progress and begin to question why you are working so hard for minimal results. Perhaps they help you recognize the smaller changes that have taken place when you feel the seeds of doubt are planted, thus preventing you from giving up on a goal that is supporting healthy change. By identifying an Accountability Buddy that is supportive throughout the process, you can experience motivation and recognize goal progression, allowing the ongoing growth and change you desire.

Change will not come if we wait for some other person or some other time. We are the ones we’ve been waiting for. We are the change that we seek.” Barack Obama.

Canine Assisted Substance Abuse Treatment

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Imagine that you have a guarded new client with a history of substance use. You try everything to make them feel comfortable and they still show reluctance to engage in treatment.  There may be several valid reasons for being closed off. This can lead to an increase in the stress hormone cortisol, possibly causing cravings for relapse. The next session you bring your certified therapy dog. The dog is welcoming, non judgmental and accepting of your client and is happy when they arrive. What has just happened in the client’s body? Meeting the dog caused their cortisol level to decrease. Their bonding hormone, oxytocin, has increased. They used to get the release of dopamine from their drugs but now they are getting oxytocin from your dog instead. Their heart rate has stabilized, their blood pressure has reduced and their frontal lobe is back online (Odendaal and Meintjes, 2003). Now, they may feel less guarded and more comfortable in therapy.

Often times, clients are more willing to trust a canine therapist versus a human therapist. They are more open to touch and comfort when it comes from a dog. They feel the attunement from the therapy dog and get to experience what a healthy attachment feels like. They finally feel heard and seen. As a certified canine assisted therapist you notice when your client and dog have bonded. The therapeutic relationship has accelerated and you are ready to try many different interventions over the course of their treatment. You come up with a few interventions to try. One might be having the client teach the dog a trick to help them practice healthy communication and relationship skills. Another intervention to try might be discussing what they have in common with the therapy dog. This can be drawn out to increase empathy for the dog and themselves. Now that they have the experience of a healthy attachment with your dog, they can move on to practice attaching to healthy people in their lives. Now they are ready for canine assisted family therapy to start. Eventually the desire to use substances begins to diminish.

Practicing animal assisted therapy comes with many challenges and it’s no easy feat. I have been practicing canine assisted therapy since 2005. I’ve seen 65% of my clients obtain sobriety which is double the national average. I incorporate it in individual, couples and family therapy sessions. It is extremely important that you and your dog have proper training and that your dog enjoys the work. It is necessary that you know your dog’s calming signals and can advocate for them. In order to ethically practice canine assisted therapy you need to follow the recommended animal assisted therapy competencies written by the American Counseling Association. They suggest attending a canine assisted therapy training, having your dog pass the canine good citizen test and obtaining regular consultation among many other things.

If you want to learn more about canine assisted therapy go to my website:
http://www.pawsitivetherapeutic.org/aat-qa/

References
Odendaal, JS and RA Meintjes. “Neurophysiological Correlates of Affiliative Behavior Between Humans and Dogs.” Veterinary Journal, May 2003, pp: 296-301.


Guest post written by Amanda Ingram, LCSW, CAC III

Guest post written by Amanda Ingram, LCSW, CAC III

Amanda Ingram, LCSW, CAC III, graduated from the University of Denver (DU) Graduate School of Social Work with an Animal Assisted Therapy (AAT) Certificate in 2007. She also trained Guide Dogs for the Blind for seven years. Ms. Ingram currently owns Pawsitive Therapeutic Interventions, LLC where she trains mental health providers in animal assisted therapy and also offers individual, couples and family therapy in the Stapleton community.

Oxytocin for All: Uncovering Secrets to Treating Client Isolation

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Just for a moment, imagine yourself at a family gathering for the holidays. Look out onto the faces of the people you love.  Feel the stripping away of the stress of daily life and the warmth of realizing that these people that you love also love you back. Nice feeling, right? I would venture to say that oxytocin plays a big part in that feeling.  Many of us know about oxytocin and have probably encouraged our clients to get more social interaction with others to alleviate symptoms of anxiety and depression. After all, it is known as the “love” hormone. But not all of us have someone to love!  Social isolation can be a stressor for many people. We are, after all, social beings. I’ve read that prairie voles have similar social conditions to humans when it comes to isolation. At some point, a few years ago, I became interested in the social and physiological implications of isolation among other mental health issues. Isolation seemed to be common in people transitioning and/or suffering from depression and anxiety. We all probably have those clients that are isolated and disconnected from others. Whether it is because the client has distrust for people, has a mental illness, just moved here, lives in a rural area, is mobility challenged or any number of other issues. In some of the more difficult cases, clients can be resistant to self-care suggestions and/or have lifestyle structures that prove difficult. It can be hard for our clients to know what is healthy alone time verses unhealthy alone time. When I first started out, I panicked when I kept finding my skills were lacking in this area because my suggestions to clients were largely limited to my own experiences. I realized after working full-time and going to grad school full-time, my lifestyle left me with little free time to socialize. I had no family in Denver and I set my life up to be dedicated to my goals but not dedicated to seeking connections with people.   

There is also the issue of technology fostering disconnection even though it appears connection should be easier. One of the ways I have grown into my therapyhood (that’s a word) is to help clients find other ways to be connected even if that meant they were doing it ‘alone’.  It was through my own journey that I researched alternative ways of thinking about this issue.  Denver, for some people, is perceived to be an isolating place. There are many activities around the city, but mostly, I hear complaints from clients that when they put themselves ‘out there’ to try to make friends, they felt shut down or ignored by the object of their efforts. I have to admit when I moved here my experiences had been somewhat similar. I did not share that with clients necessarily, but I am uncertain I was able to confidently respond with effective tools that would help them when I struggled too. At that time, in just wanting to be accepted by others, most connections I found were unhealthy and probably produced negative effects of oxytocin (for another time). To make things worse, some of the clients that I came across were resistant or unable to make changes in their lives and were less likely to find what they were seeking, which was connection. Certain clients can further internalize the voice of society regarding being alone and isolate even more, which can turn to loneliness and shame. Research I have come across contend that loneliness and depression share some characteristics, but are in fact separate from each other, and that loneliness increases the risk for depression.

One of the ways that I approached this gamut of problems with clients that are isolated is to talk about the science of neurotransmitters in the brain and how they can be produced with a little manipulation from them. More specifically, I began discussing ways to stimulate oxytocin and possibly vasopressin in the brain. Oxytocin is known for its ability to make people feel more connected when they are with others, but what about ways to increase oxytocin when you are not around people.

First, a few facts about oxytocin. Oxytocin is produced by the hypothalamus and then released by the posterior pituitary. It can also be synthesized in many peripheral tissues including the heart and sex organs. Oxytocin is released in response to activation of sensory nerves not only during labor and breastfeeding, but also in response to skin-to-skin contact between mothers and infants, during sexual intercourse in both sexes, in connection with positive, warm interactions between humans and interaction between humans and animals (in particular dogs), in response to several kinds of massage and even in response to suckling and food intake. It can also play a role in generosity and helps with trust and depressive feelings. Oxytocin can also amplify both positive and negative social experiences equally depending on the area of the brain where receptors take up the neuropeptide, but that is for another time. Vasopressin is molecule that has a similar structure to oxytocin and can act as an agonist (activator at the receptor). Oxytocin agonists or antagonists (blocking at the receptor) are able, because of their similar structure, to bind to the oxytocin receptor (OTR) and create physiologic responses.

My interest in discussing this topic is that it is very easy to find oxytocin stimulation when one has companionship in the form of a partner, friends and family around. The problem arises when someone has completely isolated themselves or have very little access to support. How do we as therapists help these clients find connection or at least mimic the physiological response to companionship by manipulating certain molecules. Here are some of the ways that I have suggested clients elicit production of oxytocin and vasopressin in an effort to help increase connected emotions.  

  1. Oxytocin or vasopressin supplementation. Since I am not a doctor, I cannot recommend particular frequency, dosage or brand. I simply mention to clients that these exist but that I cannot suggest anything in particular and advise they check with their primary care doctor or psychiatrist.

  2. Orgasm via masturbation or intercourse increases plasma oxytocin. Of course, psychoeducation about healthy masturbatory habits will help the client normalize this behavioral intervention so that there is not further harm.

  3. Hugs provide skin-to-skin contact that releases oxytocin, but I also suggest clients hug themselves in a butterfly hug. I am unsure if this is as effective, but if nothing else, it may be possible to get a placebo effect from doing this.

  4. Petting an animal is something I suggest quite often. Suggestions for getting a faux fur blanket at work, in the car, and at home have also been effective when an animal is not accessible.

  5. Eating has apparent rewarding and also relaxing effects. It represents an important pathway to achieve wellbeing and stress relief and eating or overeating for self-soothing is very common. If I make this suggestion, I generally provide psychoeducation and determine boundaries as guidance. Mostly, the suggestion is framed in a mindfulness promoting way. Like savoring their favorite piece of chocolate, for example. Additionally, eating foods that contain tryptophan such as eggs, chicken, turkey, bananas, yogurt, whole grain rice and quinoa, sesame seeds, cashews, walnuts, salmon, spirulina, potatoes, beans and legumes. Dark chocolate has also been known to increase dopamine and oxytocin.

  6. Exercise is a great way to increase neurotransmitters. Whether it is at the gym or on a sports team, vasopressin and oxytocin are released in the plasma during exercise.

  7. Massage is a great way to get oxytocin. Oxytocin can be released by various types of sensory stimulation, for example by touch and warmth. Bloodstream levels of oxytocin have been shown to rise during massage. Clients can also self-massage.

  8. Intranasal administration of oxytocin causes a substantial increase oxytocin. It can be purchased online and possibly in health stores but recommendations cannot be made in this forum as to amount and frequency. It is a good idea to recommend the client speak to a doctor.

  9. Talking to mom or a loved one is also a way to get oxytocin even if it is just on the phone. Only, however, if the person is a loving and supportive connection.

  10. Singing or playing an instrument. The tactile and visceral experience can raise oxytocin levels in addition to other peptides.  Listening to music can create this response as well.

  11. Travel, even alone. This can foster passive connection with others who are also traveling and can raise oxytocin. It is also more likely when you travel alone that you are forced to interact with others.

  12. People watching is a great way to trick the brain into releasing oxytocin.  I suggest clients try to guess the story of others. If the situation organically arises, I invite clients to practice social skills.  Occasionally, social skills are lacking in clients that are isolated.

  13. Reduce misconceptions of society. Your client might isolate because they see the world and other people as dangerous. Reframing distrust of society may help the client to feel less disconnected and alone and feel reconnected with society.

  14. Bumble, where best friends meet online. Suggesting this in the context of being alone is to suggest that the act of seeking others to connect with might trick the brain into releasing oxytocin. As an added benefit, it also increases the possibility of connecting with someone online or in person.

  15. Crying for long periods of time releases oxytocin and endogenous opioids, otherwise known as endorphins. These can help ease both physical and emotional pain.

  16. Looking at pictures of loved ones and recalling memories. When the memory of an oxytocin-producing event is repeatedly brought to mind, oxytocin is produced and fear systems are depressed. This means reduced anxiety for example.

  17. Vitamin B supplements take care of your brain’s health. They also support the promotion of dopamine and oxytocin levels. 

So whether your clients are meditating, dancing, sinking in the warm bath water or hot tub, going on a lone quest, watching a comedy, snuggling with a pet, playing an instrument, crying or any number of things mentioned here, the client is letting their body know that it is loved and taken care of. Translation, oxytocin production in one form or another can act as a buffer for isolation.


Guest post written by Marsha Evans, MA, LPC

Guest post written by Marsha Evans, MA, LPC

Marsha Evans, MA, LPC is a licensed professional counselor in Denver who has a medical and science background that led her into the psychology field. Her Master’s degree in Counseling Psychology was earned in 2012 from the University of Denver. She currently has 2 private practice locations with 4 independent contractors. Marsha works mostly with adults, but has worked with teens in the past.  She uses an eclectic mix of interventions both in-person and online with clients and specialties include mental/medical comorbidity, LGBT, trauma, and anxiety. Please check out her website at www.evanscounselingdenver.com

Tuning into Your Body for Information as a Therapist

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When you are sitting with a client, do you ever notice yourself leaning in or tensing up?

I’m sure you have heard the term mirror neurons and how our body (especially our facial expressions) are hard wired to mirror others’ body language to increase our non-verbal sense of connection. But did you know that you are also constantly analyzing and responding to nonverbal expressions of emotion and belief patterns in your clients?

Our bodies hold a wealth of information that we are often in denial of, bypassing emotionally, or defended against. Our bodies are truth tellers. Somatic indicators of repressed emotions and fears can be seen in people’s body language and patterns of tension/holding in their bodies.

I often notice when sitting with a client what my body is doing. Of course, being trained in Sensorimotor Psychotherapy, a somatic psychotherapy, has taught me to do so. I notice when I am leaning in or pulling away, crossing my limbs, lowering my volume, increasing my energy, and when i am holding patterns of tension in my body. These are important indicators of what is happening in the client’s body. Often I will mirror my clients’ nonverbal cues in this way.

And what does it mean, you may ask. Well, if you are holding tension in your heart space, you may feel that the client is struggling with a matter of the heart and soul path. If you notice forward movement in their body, the client may have a pattern of hustling to keep busy in order to avoid difficult emotions. If you notice yourself tangled up in your limbs, your client may feel small and a need to protect their body from others. While there is not manual on what each body cue means, simply checking in with your client can be an incredible intervention.

When you check in with a client about a body cue you are noticing, you bring awareness to information the body holds in the less conscious part of their brain. Often our bodies give away how someone is truly feeling, bypassing their intellectual defenses.

Additionally, you can even hold space for clients to find a reparative experience by slowly shifting your body language to a more relaxed and open state. The client will likely mirror your calm body state and shift to a more calm state in themselves.

So next time you are sitting with a client, check it out! Notice what is happening in your body and check in with your client. You may be able to provide valuable insight through simply noticing and bringing awareness to what their body is trying to tell them.


Guest post written by Kimberly Massale, MA, LPC, ATR-BC

Guest post written by Kimberly Massale, MA, LPC, ATR-BC

Kimberly Massale, MA, LPC, ATR-BC is the owner and founder of Brave Embodiment Counseling LLC in Capitol Hill Denver. Brave Embodiment is a team of holistic healers specializing in guiding women to heal from trauma and self-defeating behaviors. Our therapists are specially trained in cutting edge scientifically proven trauma and attachment based methods to get you "unstuck" from old patterns that hold you back from your full potential. We use alternative methods that ease and accelerate the healing process including Trauma Sensitive Yoga Therapy, Art Therapy, EMDR, Psychospirituality, Somatic (Sensorimotor) Psychotherapy, Acupuncture, and energy healing and can guide you in your journey of complete transformation from the inside out.

Setting Boundaries with Parents Who Have None

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Working with children in a therapeutic setting can be very rewarding and can prevent further problems with mental health and behavioral issues down the road. Most therapists that choose to work with kids are comfortable sitting on the floor, engage easily with children and are comfortable setting boundaries around safety in the play therapy room. Engaging and setting boundaries with parents can be an entirely different ball game. And unfortunately, establishing a supportive and collaborative relationship where firm boundaries are set in place with the caregivers may be as important as your relationship with the child in order to facilitate positive change. If you are in a private practice setting, there is another layer of importance to engaging parents. Your income depends on you maintaining a caseload of happy parents, as well as children who are improving.

You and the child can do great work in the play therapy room, improving self-regulation, verbalization of feelings, and allowing for an unconditional, child-centered relationship to allow the child to process the most difficult situations and it can be completely unraveled once the child returns home for the week if they are not set up for success at home. Taking two steps forward and then one or two steps back each and every week can be disheartening for the child, caregivers and us as therapists. This is why it is paramount to engage your parents to be a helpful partner in this process. So what do you do if a caregiver to one of your kids is unwilling to make changes or is so stuck in their trauma or emotions regarding a divorce that they are not acting as your partner in the therapeutic process? What if all they are looking for is for you to provide testimony in family court that supports their beliefs about the family situation? How can we as therapists, advocates, and potentially the only objective person in the situation bring about positive change in the lives of these children?

Thorough Preparation is Key

In my twelve years of experience working with children and teens in a therapeutic setting, I have learned that the most important aspect of creating an appropriate and collaborative relationship with caregivers where boundaries are respected and maintained starts before your first interaction. It is important to have a clear understanding of your scope of practice, what you are or are not willing to provide for families, the laws around decision-making and custody in your state, the laws of age to consent to mental health services in your state, and the policies and procedures for your practice or the agency you work for before you call that parent back to set up an initial session. If you are not clear in your own mind of these things, you are more likely to set up a relationship where you have to back track or get stuck in a situation later on.  For example, if a parent calls to get their child in for counseling with you and you do not inquire if there are any issues with custody or if any other parent shares decision making responsibilities in that initial phone call, you do not know if you are able to see that child. You are putting yourself and credentials at risk by not asking the right questions during that initial phone call. If there is shared decision making responsibilities, then you can educate the parent about the laws of your state and request the appropriate court documents to show any current orders in place. Along with having clarification in your own mind about these issues, you also have to have them represented in your initial paperwork so that you have a way to discuss all of these issues with the caregiver. It is important to have fees, policies around communication, policies around providing court summaries or court testimony (including fees), and the rights of the child in your disclosure and consent. This way, the parent has the information upfront and has signed in agreement that this is in fact how you will be running the show. And then, it’s up to you to put it into practice.

Documentation

How do you engage parents and maintain this engagement even when they do not agree with you or have a specific agenda they expect from you? Even if you have started off the relationship with strong boundaries, many parents are still so stuck in their own stuff that they will test your boundaries. Working with these parents is frustrating to say the least.  You see the positive changes that the child is making in session and know that they could improve significantly more if the parent followed your recommendations or if they weren’t so focused on making the other parent look bad. Two things…continue making the recommendations that will benefit your kiddo, continue being their advocate, and document, document, document. Unfortunately in our very litigious culture, you will need to have good documentation of what was recommended and why, as well as if caregivers followed through with the recommendations. If you are ever grieved, you have everything you need documented to show appropriate care.  It can also be helpful for you to keep track of specific recommendations that were attempted, versus the ones that are not. This can inform the recommendations you make in the future.

Communication Strategies

Another area that I have consulted with many child therapists on is how to manage parents going through a conflictual divorce, specifically so that they are not being triangulated into the relationship and can continue to focus on the best interest of the child. Again, the importance of having the discussions around your policies is paramount. I typically have two separate intake sessions if I have the chance, so that I can go through the information thoroughly and so that there is not the perception that I have a better relationship with one parent or the other. I also recommend that most correspondence is done through email (if both parties agree to using email for therapeutic information after understanding the possible issues with confidentiality), and that all correspondence is sent to both parties. This way there is less possibility for he-said-she-said concerns about what your recommendations are. I stick to this policy unless there is a significant safety concern or if there is a no-contact or restraining order in place between parents. I ask that caregivers put the other parent on any emails sent directly to me, however this boundary is always broken. I have already let parents know that anything I send out will go to both parents, so if they need a reply, it will get sent to both parents. If it does not need a reply, I keep the emails as documentation, reply that it is important that all emails go to both parties unless there is a safety issue, and use it as data for my own conceptualization of the case.

There are many other logistical tips that could be provided to working with difficult parents. The tip that I have found the most helpful in maintaining positive relationships with parents that I have to continually challenge or set firmer boundaries is to remember that they are human beings with their own histories. I believe that most parents are doing the best they can with what they’ve got at the time. This may not be very good at all, but there are reasons for their behavior. Remembering this allows me to be personable with them even when extremely frustrated. And remembering that you may be the only safe person in your child’s world at this moment, provides enough incentive to do the hard work of managing their caregivers.


Guest post written by Sybil Cummin, MA, LPC, ACS

Guest post written by Sybil Cummin, MA, LPC, ACS

Sybil Cummin, MA, LPC, ACS is the owner and clinical director of Arvada Therapy Solutions, PLLC. Sybil's specialties include working with children, teens and families dealing with family trauma including conflictual divorce, child abuse and neglect, sexual abuse, and domestic violence. As an Approved Clinical Supervisor, she also supervises Master's level interns and clinicians working towards licensure, as well as providing business consultation to therapists embarking on the world of private practice.

The Power of Ritual in Healing

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As a long-time bereavement counselor I have had the privilege of working alongside clients whose grieving is both complicated and intense. Even as we together tease out the knots and kinks that make relationships tangled and messy, we also focus on the beauty, the memories, and the pain. Whether it is the individual flow of mourning or grief that is heightened by society’s focus on anniversaries or holidays, using rituals and ceremonies to move through the grief is something I encourage all therapists – and clients – to be open to.

What causes us to tear up over a favorite song or poem that reminds us of our loved one? Our body provides us with a natural healing outlet for our grief when we are confronted with memories that trigger our emotions. Not everyone sheds tears easily or willingly after a loss, but the process of grieving can allow us the opportunity to work through this physical pain.

What can we do to encourage our own healing in way that is both respectful of the death and mindful of our life? Memorials and rituals are excellent ways to personalize the life of the person who has died. While many traditions encourage the sending of flowers or food to the bereaved family immediately after the death, there are other, longer-term gifts, memorials, or rituals that can carry forward the meaningful life that is no longer on this earth. 

In our Western culture, many have found solace in placing a tombstone where they can visit the deceased on a regular basis. We have also begun seeing additional options for creating a living memorial. Purchasing park benches, planting trees, buying a brick at a museum walkway, making donations to a cause that inspired your loved one are all options that are lasting reminders. But beyond the public shows of support, there are smaller daily or weekly things that can help keep the conversation open in your heart. Finding a place or creating a time for “sacred space” is a way of elevating the emptiness to a different level within your consciousness. 

 

Individualizing the loss

Consider a theme that resonates with you and the person who is gone: nature, sports, travel, music, food. Think about how you remember that person. Create a process or memorial that embodies that idea. Spend some time thinking about what feels authentic and what you feel comfortable with. Begin your journey when you feel ready.

  • Perhaps nature is a theme. Collect small rocks from your hikes or nature walks that you keep in a spot in the garden or in a glass jar. Allow yourself the freedom to know your loved one was with you as you enjoyed nature and that you are respecting his or her presence by bringing it home.

  • Hobbies can offer us a way to connect. Be mindful of the time you spend allowing your emotions to be present while you garden, bowl, or cook. Make a decision to incorporate your loved one in the process – cook his favorite meal once a month, print her name on your bowling bag or plant their special flowers annually. 

  • If you are so inclined, take on an activity that you dedicate to do as an internal connection with your loved one. Take an art class, begin blogging, volunteer to read in an elementary school. Embrace the feeling of doing the activity together in your heart.

  • Meditate or spend a portion of time each day in a safe spot for you to grieve and remember. Read a favorite poem, look at photos, or play a special song and let yourself cry or laugh.

What I have found is most effective in soothing the grief is to work with clients to discover what makes them connect with the soul of their loved one. It matters not at all that others don’t “get” it – it can be an inside joke. One woman felt comforted going to the golf course where her father used to play; another donated her husband’s clothes to a shelter where he had volunteered; another family whose young child died collected donations to enhance the playground at his school. And for those whose memories were bitter, I’ve suggested planting herbs or vegetables whose sharp quality can ultimately become something valuable. Making meaning of their life and honoring that which feels good and familiar is the key.

 

Grief and the (many) holidays

Being in a vulnerable state during the holidays can cause anxiety and depression. While those around you are celebrating and enjoying what they have, you may be feeling the loss of what you no longer have. The rule for observing a holiday is: trust your gut. If you don’t feel able or celebrate with others, don’t – you are allowed to say NO. Change it up. Have Thanksgiving with a neighbor, go away for the week, volunteer at a shelter for Christmas, have another family member host the Easter or Passover dinner.    

While seeing the trappings of public holidays can cause pain, there are other more personal observances that no one may be aware of or choose to remember, and the same principle of ritual can help. Whether you share these moments with others who can support you or you gain strength from the intimacy of privately remembering, know that your journey is unique and unless your activities are taking you out of living, you should feel comfort in your rituals.

  • Create a special memorial cup that celebrates your loved one, and use it only on holidays, anniversaries or birthdays. 

  • Offer a toast or a blessing or a prayer with those you love.

  • Visit the gravesite or a spot sacred to you in the weeks prior to a remembrance date.

  • Buy an ornament or decoration that acknowledges the loss and display it .

  • Wear an item of clothing or jewelry that brings to mind your loved one; keeping a physical reminder can be comforting.

  • Buy or make a card and write loving thoughts on an anniversary; keep it as long as you wish.


Guest post written by Tia Amdurer, LPC, NCC

Guest post written by Tia Amdurer, LPC, NCC

Tia Amdurer, LPC, NCC, has her private practice, Heartfelt Healing Counseling, in Lakewood, CO, where works with individuals healing from grief, loss, abuse, low self-esteem and family of origin issues. She is the author of Take My Hand: The Caregiver’s Journey (www.TakeMyHandJourney.com ). www.HeartfeltHealingCounseling.com

Getting To The Goals - The Journey of Setting Them And Getting Them

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When doing a “goals list” exercise in therapy sessions, start by telling telling clients to DREAM BIG!

Formulating a goals list is different for every individual. Counselors can be interested not only in the goals people choose but also in their reaction to creating the list itself. Sometimes people say they can’t think of any goals, which is an informative statement. It sends an important message about the person’s sense of value in the world. When a therapy client makes this statement, he/she provides the counselor with incentive and direction. It is rewarding to watch clients who start out by saying they have no goals, or can’t think of any goals, only to end the session with a goals list to take away with them for future reference.

In developing this exercise, counselors can work with clients to tap into their resilience, a tool which is helpful when attempting to work through a personal or professional setback. Also, the hope is that by creating this goals list a client will be improving their positive self-esteem. Next is the hope that a client will utilize the goals list to open his/her mind to a positive outlook - a world where the glass might be half full as opposed to half empty. Even if the goals list is not ‘realistic’ in terms of real life, just the actual act of writing down any dream or thought or hope a client might have is an exercise for the mind and the spirit.

Some clients have no problem coming up with long and varied goals lists. For them, the challenge is the move toward action in achieving the goals on their lists. In other instances, however, clients say they can’t think of goals because they believe they are not “allowed” to have goals for themselves. For whatever reason, throughout their lives, these clients were “programmed” not to consider their own individual thoughts, feelings, hopes, plans and dreams. Resistance is high with these clients, and asking them to think of goals for themselves stumps them, because it almost feels “wrong” for them to consider what THEY want.

There are other clients who come up with well planned and realistic goals, only to reject them because to follow these would somehow be “too good.” It’s as if they are so invested in the chaos of being “stuck” that even a glimmer of the possible is too scary, because then they have to give up a lifetime of investment in the chaotic lifestyles they have come to find “safe” or “comfortable” which is really code for “familiar” or “known.” Again, this gives the counselor clues in terms of directions forward therapeutically, in that the counselor is faced with massive resistance to change, even though the client talks the game of wanting change - a typical paradox.

When formulating goals lists with clients, there are some guidelines. First and most important, the items on the lists are to be goals they want for themselves, not based on the others in their lives, and not based on what they think they are “supposed to” want as goals. For example, of course I’m not opposed to the “get married and have a family” goal or the “graduate from college” goal, if those are on someone’s list. However, that still seems like something someone else (society, our parents, peers, etc.) tells us we’re “supposed to” want or do.

In terms of considering goals, counselors can encourage people not to think in terms of “supposed to.” Also, there are no restrictions - money or time or age or marital status or children or aging parents - or any of the other “reasons” people will identify as obstacles preventing them from achieving their goals. For example, people with children don’t need to write down, “I want to see my kids grow up and be happy and successful.” Counselors can remind people who are parents that the goals lists are to be about nobody else but themselves. Also, there can be no time deadlines - the “by a certain age I have to make a certain amount of money,” kind of thinking. And regarding the the subject of money, there can’t be dictates from others about how much money is “enough,” or that earning some amount of money will imply success. Again, it’s about what the individual believes for him or herself, not what someone has “programmed” the person to believe about money or success.

As mentioned above, the point of this exercise is to help clients open their minds to the limitless possibilities of life. For some, this is a difficult concept because they believe life is about a certain way of doing things, usually whatever way they were taught to believe as they were growing up. Then the ideas they were taught were further reinforced by others in their peer group. After all, most people want to “fit in” or be the “same as.” To be different from, or be the rugged individual in the group is sometimes to feel isolated and outcast. However, at this stage, clients are in a counselor’s office because of trying to fit in or be like everyone else, and discovering the emotional problems that go along with those efforts. They come in with their resistance, their unwillingness to change, even as they are acknowledging that they want things to be different from how they have been in the past. A paradox to be sure.

With the goals list, therefore, the counselor introduces the concept of all things possible, including the exercise of thinking about themselves in a selfish way. The counselor challenges clients to put their own needs first, to think in terms of their own personal priorities. The counselor encourages clients to define success as it relates to them personally, not in terms of money or possessions, but in terms of emotional well being. The role of the counselor is to provide a brainstorming conversation with the client in which resistance may be addressed, because there may be resistance to even attempting a goals list. Sometimes clients ask why they even need to have goals. Just the fact that they choose the word ‘need’ answers the question, doesn’t it?

Once the guidelines are out there, counselors can again encourage people to dream big! Some folks have an understanding of how this is helpful, and they start to write down their goals - large and small, real or imagined, practical or impractical, perhaps possible, perhaps not. For others there are still difficulties around feeling compelled to “be practical” or using phrases like, “that could never happen.” Not everyone is able to envision right away what it feels like to be selfish in a good way, thinking of self not in terms of anyone else. For them, the counselor can encourage continued talking and thinking and imagining. Eventually, just about every client understands how this exercise is worthwhile, because it takes clients out of the problem place and into the possible place - never a bad thing, right?

Do you have a goals list? Try it for yourself, and then keep it and refer to it from time to time. For one thing it’s a chance to dream, always worth some head time and space. For another, isn’t

it satisfying to achieve what you strive for? And lastly, it keeps clients in touch with forward motion, with listening to and following their hearts and thinking from a self place. Remember, when clients learn to put themselves and what they need at the head of their lists, they have that much more to give to the others in their lives who are valuable to them. Learning to do that and then putting it into action is in itself an excellent goal. When this is achieved, so much else is able to be done, and clients will know what it is to live life in that possible place.


Guest post written by Valerie J. Shinbaum, MS, LPC, MAC, NCC

Guest post written by Valerie J. Shinbaum, MS, LPC, MAC, NCC

Valerie J. Shinbaum, MS, LPC, MAC, NCC, is a practicing psychotherapist since 1992. She is a published author, national speaker, college professor, and former radio talk show host. Ms. Shinbaum is a Licensed Professional Counselor, Master Addictions Counselor and National Certified Counselor. She works with individuals, couples, teens, and families. Her areas of expertise include addictions (process and substance), marital/couples treatment, adolescent issues, family of origin/inner child work, empowerment/self esteem building, career choices/changes, trauma, learning differences, relationship obstacles, mindfulness, grief/loss, and more. www.bodymindandbalance.com.