Satisfactory Self-Disclosure

Photo by Aarón Blanco Tejedor on Unsplash

For many in mental health, self-disclosure is a point of disagreement. Do we self-disclose? Does self-disclosure make it more about us than our clients? Can it get us in trouble? I know my graduate program in counseling urged caution about self-disclosing for a variety of reasons, which were again reinforced by my first job in juvenile corrections. Messages were shared like, protect yourself! Listen, don’t talk! Disclosing could invalidate a client’s experience! Don’t do it! And so on.

Therefore it took me several years to see the value of self-disclosure in connecting with clients at a deeper level in their therapeutic work. For example, watching the disclosure help them relax, knowing they weren’t alone. Seeing them take a deep breath to know it isn’t just them. Having clients report they feel seen in receiving reassurance or validation. Witnessing these meaningful shifts, I can now admit I’m a fan of self-disclosure, within reason of course. There’s a time and place for self-disclosure that feels satisfactory to both us as providers and to our clients. Let’s take a look at some of the suggested structure of self-disclosure and how it can be beneficial in client work.

#1 Keep It Short

Keeping self-disclosure condensed to one or two sentences keeps us from oversharing.

Example: “Yes, I’ve experienced anxiety too.”

#2 Focus on Your Client

By holding the focus on your client, you avoid making the session feel more about you than them.

Example: “I’m curious, with my sharing of having experienced depression before, what does that mean to you and the work we can do together?”

#3 Identify the Purpose of Self-Disclosure

Before you decide to disclose, slow down to ask yourself what the purpose of the disclosure is. Is it to build rapport? Provider reassurance? Validate or normalize? These are worthwhile reasons to self-disclose, as opposed to feeling like we have an agenda, a point to prove, or we are oversharing with no therapeutic direction to go.

Example: “In working with other clients with social anxiety, they found being able to talk about it brought them some comfort. How is it for you?”

#4 Check in

Once you’ve self-disclosed, check in on how it landed for the client. Notice any shifts in their face or body language that would indicate their current level of comfort. Recognize if they shift to caregiving you or keeping the focus on your experience instead of their own. Ask them outright if the self-disclosure was okay with them.

It’s also important to see how the self-disclosure landed for you. Did it feel natural? Worthwhile? Did you find yourself worrying that you shared too much? Perhaps you recognize that you self-disclose with this client more than others in liking them or seeing them more like a friend. These are important elements to notice and track through supervision and consultation to maintain a healthy therapeutic relationship.

Self-disclosure can enrich your therapeutic work when embraced and applied thoughtfully. It can help a client open up, build trust, or show up more authentically in session. It can also isolate or discount a client’s experience when used too liberally or when it comes out in a way that minimizes their experience. Therefore I hope these tips can help you identify the sweet spot for self-disclosure in your own work, embracing it when it feels right and holding boundaries to keep the focus on your client and their growth as the top priority in therapy.

“Don’t Just Tolerate Me, Love Me.” Love Languages in the time of COVID-19

Online for Love via Unsplash.com Images

We are more than four months into the pandemic and relationships are feeling stretched, like a too-small shirt across our shoulders, threatening to bust at the seams.  Perhaps you are separated from your loved ones, making the miles, restricted travel, and lack of contact feel unbearable. Maybe you or your loved one is an essential worker, choosing the difficult decision to distance from family and friends in order to reduce the risk of exposure. Or perhaps you’ve been following stay-at-home and safer-at-home orders with your partner or spouse, finding your relationship put to the test.

Some love languages are benefitting from the changes whereas others are being placed on the back burner. Folks with love languages of physical touch and quality time may be the lucky ones to benefit from unexpected, increased time together. Gary Chapman, Author of The Five Love Languages lists them as:

·      Physical Touch

·      Quality Time

·      Words of Affirmation (positive words)

·      Acts of Service

·      Gifts

So how have the love languages been stretched in the time of COVID-19? Quality time may be challenged because even though we are at home or in the same space working, it doesn’t mean it’s quality connection to one another. For physical touch, are we feeling the absence of platonic or comforting touch of others in having to self-isolate at home? Gifts may be limited, acts of service amplified, and words of affirmation may not come easily as we experience the brain fog and exhaustion of the pandemic. In fact, although couples are adapting to the changes, there are several challenges romantic relationships are facing under the strain of COVID-19.

·      Increased fighting

·      Too much togetherness

·      Feeling overstimulated

·      Feeling numb

·      Experiencing low libido

·      Increased stress and anxiety 

·      Difficulty separating work from home

·      Increased irritability

·      Feeling on edge or restless

·      Experiencing financial strain

These stressors don’t necessarily make or break a relationship by themselves, it could be that the accumulation of several factors like these would put a relationship at risk. Therefore it is important to attempt to adjust or adapt in an effort to keep the relationship healthy. Here are some ideas to try when your romantic connection is feeling itchy and uncomfortable.

·      Creative Quality Time: How creative can you get with quality time at home? A movie marathon in the living room full of pillows and blankets? Cooking a meal together? Taking a walk or a bike ride?

·      Rituals to Transition: What rituals are in place to help you both transition from work? Do you have a designated space to work? Can you change your clothes or walk up and down the hall to feel like you are moving from one role to another? Is it a matter of powering down your computer, closing the office door, or putting your laptop away?

·      Choose to Check-in: When do you like to check in on how things are going? Can you choose to check in during a meal or before the day takes off? Is there eye contact to support active listening? 

·      Communicate: It’s going to take additional effort to increase communication when you are already feeling stressed or overwhelmed. Share how you feel. Advocate for your needs. Ask for help. Partners can’t read our minds so it remains important to speak up.

·      The Art of Apart: Time apart can be good for the relationship if you feel like you are right up under one another. Is there a way to engage in hobbies or outdoor activity that gives you permission to miss one another? They say that absence makes the heart grow fonder, perhaps this is possible with a little time apart.

Relationships can grow leaps and bounds through hard times like these. The gratitude you can feel for being in this together is a powerful tool. Embrace new ideas to strengthen your relationship, knowing that blips along the way are expected and normal. The hope is with a little TLC and creativity, your relationship can move from surviving to thriving during COVID-19! 

Exploring the Enneagram: Relationship Reinforcement

I can’t handle it when others are upset. I throw myself into work to avoid emotions. I want to be left alone. No one understands me. I want everyone around me to be happy. Can you relate to any of these statements when it comes to how you operate in your world? Does this describe your reactions when relating to others? If so, there is good news! The Enneagram is a personality test that not only looks at your strengths and weaknesses, but also allows insight into relationships with others in order to strengthen compassion and connection.

Personality Test Popularity

For many of us, we’ve been exposed to personality tests in the past, whether it was part of high school psychology class, a component of starting a new job, or a viral quiz on social media. Myers-Briggs Type Indicator (MBTI) was the go-to personality test for several decades starting in the 1940s when exploring a person’s extraversion, intuition, and decision-making skills. The Enneagram has been around almost as long, making an introduction in America in the 1950s. Praised as a tool for deeper awareness, self-understanding, and self-discovery, The Enneagram classifies personality into 9 categories or types, identified below by The Enneagram Institute as:

• Type 1: The Reformer

• Type 2: The Helper

• Type 3: The Achiever

• Type 4: The Individualist

• Type 5: The Investigator

• Type 6: The Loyalist

• Type 7: The Enthusiast

• Type 8: The Challenger

• Type 9: The Peacemaker

The Enneagram also claims that a person’s designation as one of the nine types is solidified in childhood based on traumatic or impactful experiences that reinforce behaviors that support feelings of safety and security.  For example, someone who tests at Type 2, The Helper, may have a core belief that “I am good and ok if I help others.” The authors of several Enneagram books, Don Richard Riso and Russ Hudson further describe each person’s capacity to equally develop into any one type, however the type that ultimately defines us is reinforced by our environment at a very young age. Another example that can highlight this concept is the child who is praised for every positive performance or good grade, allowing them to feel pride when sharing their accomplishments at a young age. In continuing to seek that valuable praise to feel positively about themselves, they might find themselves pursuing various accomplishments throughout their life in a series of patterns of achievement, categorizing them as Personality Type 3, The Achiever.

Put it to the Test

So now that your curiosity is peaked, why not put it to the test and see for yourself? You might have an idea of your type just from the names above, however there are several options that can clarify your results.  The Enneagram Institute (enneagraminsitute.com) has an online test that can define your type and any other connections to other types based on your responses to a series of questions. A faster option can also be found in a free App called EnneaApp, that can allow you to explore your type and read more about what the results mean in shortened form, ideal for those who want family members and loved ones to also test and identify their personality types. The Enneagram has risen in popularity due to its use in various contexts to help people better understand themselves and others.

• Premarital Counseling

• Individual and Family Therapy

• Workplace Efficacy & Human Resources

As you can imagine, clarity about your type and The Enneagram type of others around you can help you rise to your fullest potential, including strategizing on projects in the workplace or connecting at a deeper level interpersonally. Therapists value the Enneagram due to its ability to start conversations about similarities and differences between people, as well as its ability to provide opportunities for growth and self-discovery.

Discovering Depth

Self-discovery with the Enneagram reflects the effort you put in the results and your ability to have an open mind. Designation of your personality type includes implications for balance and wellness by looking at the positive characteristics (which will please you) and the negative characteristics (which will make you want to hide). In other words, you will have positive traits that you feel fit your personality very well, and negative traits you will want to reject due to the painful accuracy of things you want to keep hidden from others due to embarrassment or shame.

Allow me to illustrate. If you are found to be a Type 8, The Challenger, you, like all the types, have both positive and negative characteristics. Some of your positive characteristics include having a powerful vision of your future, being vocal about your goals to get results, getting others cooperation in those goals, and being described as passionate.  So far so good right? You sound like a force to be reckoned with. On the other hand, your negative traits include speaking over others, a ‘my way or the highway’ mentality when challenged, being described as bossy and overbearing, and being intimidating when expressing anger. As you can imagine, balance between positive and negative characteristics is important in exploring shifts to support connection with others both personally and professionally as well as workplace success.

Enneagram Enhanced

The Enneagram can go much deeper into passions, difficulties, relationships, team work, and more. Just look for trainings in your community and online to move into further discovery after you identify your type or the type of those you value. By beginning your journey into The Enneagram starting with your own reflection, you will uncover unlimited possibilities regarding how to successfully connect with strengths in yourself and with others! 

 “The point of it isn’t to just be a type, but to use the awareness of our type as a kind of entry into a more full-bodied humanity and a greater and greater capacity to embody and flow with all the different qualities of our humanness.” Russ Hudson

Mirroring in Relationships: Manifesting and Maintaining Connection

What does it mean to feel connection with another person? How do you know when you are building rapport in your interactions with others? For many of us, connection starts with body language and conversation when determining relatability and ongoing engagement. Engagement can lead to belongingness and belongingness is a crucial element of positive mental health and overall wellness. So why wouldn’t we want to pursue belongingness and connection in our relationships and throughout our lives in support of optimal wellbeing?

Monkey See Monkey Do

Connection can be measured externally in how we interact with one another, but also internally through brain activity. Mimicking one another, often described as mirroring, was first discovered by Giacomo Rizzolatti, MD and his colleagues when studying monkeys.  Rizzolatti recognized that there was similar, observable brain activity indicating pleasure when a monkey consumed a banana as when the monkey observed a researcher consuming a banana. This brain activity involving neurons, called Mirror Neurons, provided implications that our brain activity responds in relation to others, thus encouraging development of an empathetic response. A more recent article was published in the UK on research involving infants and their mothers. With eye contact, the brain waves in the infant responded and attempted to synchronize with their mother, implying efforts at deeper connection and communication, according to scientists at the University of Cambridge.

Bonding in Business

Mirror neurons are important for close relationships; however, they can be influential in working relationships as well. Business gurus have developed interpersonal programs to support connection and reciprocity in business interactions, including awareness of body language, eye contact, and mannerisms. These programs can teach a person to be more aware of cues in social interactions and introduce subtle mirroring behaviors to increase engagement, likeability, and reciprocity. 

Mirroring behavior in conversations is adaptive, such as noticing when one party begins to unconsciously mimic the other in their posture, speech, and/or gestures during an interaction. As you can see from the picture we’ve chosen above, several members of the group are mirroring one another in their hand gestures, indicating connection or attempted connection in the moment. When learning these interpersonal skills for yourself, you may experiment with subtly shifting your posture to mimic the other party, exploring any observable differences in the interaction, including how you each feel towards one another. Mirroring research shows that when you make subtle attempts to mirror another person, they will find you more approachable, likeable, and connected, all which can be valuable when conducting working interactions or achieving rapport.

Generational Gaps

Engagement in working and personal relationships can support successful interactions, and it can also change how a person feels about themselves, including shifts in self-confidence and self-worth. Jean Twenge, a Psychologist researching generational differences including mental health, substance use, technology, and social engagement, speaks of this in depth in her book iGen. Her book highlights the dramatic shift in social interaction away from face to face contact to more technology-based connection. Her book also highlights a possible correlation between technology and lack of belongingness, even when those surveyed reported, on average, more than three hours per day of technology use including social media. Twenge’s research identifies some concerns about connection, including individuals reporting minimal person to person engagement, low self-confidence or preparedness in social situations, and thus identifies questions needing to be answered around technology and mental health.

Regardless of how we measure it, connection is important. One way of encouraging connection is getting out in the world and finding people who have things in common. This can be a pleasant opportunity to engage over shared interests and build relationships. Identifying activities you enjoy can be a starting point to engaging others around shared interests, with organizations like Meetup.com bringing groups of people together around enjoyable experiences. Pushing yourself to get out and meet people can have a positive result, as belongingness and social interaction continue to be vital parts of what it means to be human.

“You're imperfect, and you're wired for struggle, but you are worthy of love and belonging.” Brene Brown

Engaging Adolescents and Caregivers in Family Therapy

“Do I have to do family therapy?”

Yep, that's such a common question I get from my adolescent clients at the start of therapy. Here are some other common questions and statements a therapist may receive in regards to parents and caregivers being a part of an adolescent's therapy process:

"So how much are you going to tell my parents?"

"I hate these family things; i just feel so awkward."

"Do I have to be in the room when you talk to my mom/dad/guardian?"

“I’ll talk to you, but I will not talk to my parents about this!”

“Why try, nothing is going to change!”

“They/she/he just doesn’t understand me.”

Do any of these sound familiar in your therapeutic work?

When reflecting on these common initial responses and questions about family therapy, it has been my professional experience that I see a clear pattern of fear, lack of trust and shame arise as barriers to adolescents getting their needs met by their caregivers. Additionally, many adolescents seem to have a common misunderstanding (and caregivers too) that family therapy is about pointing fingers and being the “problem” of the family. So with this in mind, I’m excited to share some strategies I use to build rapport, connection and trust with adolescents to empower them in engaging with caregivers in family therapy.

1) Be Transparent! In other words, BE REAL with your client. Adolescents are smart, clever and can read through any BS or tip-toeing going on in the room. I give them the direct and transparent version of confidentiality and expectations of what therapy entails. 

“I know you may or may not be wanting to communicate certain things with parents, but I want you to know what I must report immediately. Any safety concern including suicidal ideation/planning, abuse, neglect, witness to violence, and self-injury must be reported to caregivers or appropriate authorities. With that being said, there may be things that come up that you are not open to sharing but would be beneficial to do so in order to get your needs met from your parents/guardians. When this happens, I want you to know I will challenge but not force you, and together we can figure out the best way to schedule a family session around it when you are ready.”

2) Build trust immediately: I know this one is a given, but I start with every first session letting my adolescent client know that I don’t expect them to trust me right away in an effort to ease any tension or pressure someone might feel.

“I want you to know that I don’t expect you to trust me right away. Trust takes time and is earned so that’s exactly what we are going to do. We will take time to get to know each other. You can ask me any questions you need to about myself or the process. I’ll let you know if I can’t answer it for any reason. And I want you to know if I ever ask or discuss something that you are not ready to answer, you say so, and we will use the time for what you are ready for and need. This is your time and space, and I want you to feel safe.”

3) Share the responsibility and “workload”. It’s essential to dispel any myth or belief with the adolescent and caregivers that a) they are the problem child and b)your job is to “fix” them in some way. Again, this is where I use transparency in the first session or parent consult (as well as throughout ongoing treatment) to set clear expectations for all involved.

To caregivers: “I want you to know that if i’m working with your child, I’m working with you also.  In many ways, this work can be equal or more for the parent.  My job is not to “fix”. Rather, i’m here to provide assessment, education, skill-building and a safe space to process and build awareness so that you and your child can more effectively communicate, understand one another and connect in a meaningful way to address the barriers.” I always let adolescents know that I’ve had this conversation with the caregiver(s) as well so they know it’s a joint effort.

4) Empower the adolescent voice. I like to give my adolescent clients as much choice and opportunity to lead as possible when it comes to parent involvement. Here are a few different ways, I frequently go about this in session:

“Would you like me to check in with mom/dad alone or with you it the room?”

“Is there anything you’d like to share with mom/dad/caregiver from our session today?”

“Is it alright if we bring mom/dad in at the end to share any skills we worked on so they can practice it too?”

“Is it ok if I emailed mom/dad about (a specific one or two things from session) so that they can be more aware and better understand what you are going through or how to support you?”

“Is there anything you want to teach mom/dad today?”

“Would you like me to explain (specific pattern or skill) for you to caregiver with you in the room?”

“Would you want to do a family session with mom/dad on this? If so, when do you think you’d like to do it?”

5) Parent Coaching Sessions are a must! Along with letting parents and adolescents know that this is joint work, I let them know that some sessions will be just with the parent(s). I am transparent with the adolescent and parents about the purpose of these sessions from the start.

“These sessions with your mom/dad are NOT to report all that you’ve said or processed in session. Instead, they are an opportunity for you parent to explore their own barriers getting in the way of supporting or connecting with you. I will always let you know when i will be having a session with you parents in case you have any questions or anything you would like me to share or work on with your mom/dad.”

To caregiver: “These are sessions where you can explore challenging emotions, patterns, behaviors that you are struggling with that might be acting as barriers to your relationship with your child. The main goal is to empower you as a caregiver and strengthen your relationship.”

6) Provide Outside Resources to Caregivers and Adolescents from the start.

At the end of an initial session or consult, I provide at least one book and internet-based resource that will help parents get a head start on some of the topics and ideas we will be addressing in therapy. Throughout the process, I continue to provide both the caregivers and the adolescent ongoing supports based on what is coming up in therapy and what the family barriers may be.

Some of my favorite resources are:

Ted Talks: Especially for the adolescent and caregiver to watch together at times.

Wellcast videos: Here is one of my favorites, but they have them on all topics! I often show to adolescent in session and send to both caregiver and adolescent after session. https://www.youtube.com/watch?v=UMIU-Uo8cZU

Phone apps: mood meter, calm.com, Headspace are just some of my favorites.

Books: there are so many; here are a few favorites

The Gifts of Imperfection, Daring Greatly and Rising Strong by Brene Brown (also has great ted talks to introduce the concept of vulnerability and shame)

Whole-Brain Child, Yes Brain and Brainstorm by Dan Siegel and Tina Payne Bryson

Emotion Focused Family Therapy resources: This includes caregiver webinars and in-person workshops, book recs, links to articles, etc. All greatly support parent coaching and family work. http://www.emotionfocusedfamilytherapy.org and http://www.mentalhealthfoundations.org are two helpful websites.

Review/summary emails: These I send with adolescent permission to specifically review a skill, idea or new strategy that would be helpful for the caregiver or adolescent from session. This way, they can refer back to it as needed.

Engagement with adolescents and parents can be difficult at times, but I have found the more i’m able to focus on empowering families and setting clear expectations of what family work is and isn’t, the more willing adolescents and caregivers are to engage in the process. My goal is never to be the one the adolescents trust or “go to” the most, it’s to help them build that with their parent(s) or caregiver to be able manage their challenges and barriers in life in a sustainable and connected way.

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Guest post written by Meaghan Burns Sablich, LCSW

Meaghan Burns Sablich, LCSW is a Licensed Clinical Social Worker, Licensed Colorado State School Service Provider and clinical supervisor with 10+ years experience in the field. Meaghan received her Masters Degree in Social Work from the University of Denver with a concentration in Families and Children. Meaghan has worked in a variety of therapeutic settings including inpatient hospital, residential treatment center, day treatment center, schools, non-for profit organization and private practice. Areas of clinical focus include: depression, anxiety, ADHD, eating disorders, family therapy and parent coaching, grief and loss, school/learning concerns and self worth work.

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

“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

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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.

Oxytocin for All: Uncovering Secrets to Treating Client Isolation

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.

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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

The Power of Ritual in Healing

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.

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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

Exploring Equine: Therapeutic Focus and Interventions

I have lived around horses since I was pretty young and have always been drawn to these magnificent animals. Their size alone fascinates me and the temperament of each horse is as unique as you and I. The relationships between our clients and horse therapist is something that we are not able to provide. Horses seem to have an extra sense when something is wrong or when a person needs a hug, a shoulder to cry on or just someone to walk with. These horses know when a person is struggling with traumatic incidents, self defeating behaviors, self control and low self esteem. 

We have all started to hear more about Equine Assisted Psychotherapy groups and other sessions that involve animals in our practices. The terms are somewhat new to the world and started getting more attention in the 1990’s- many years after we knew the impact on mental wellness that is provided in equine work. Horses are non-judgmental and will easily meet the client where they are at. The types of therapy that we provide at Peace Within Counseling and many other equine treatment facilities is extensive. 

• Ground work- grooming, leading, obstacles. These activities lead to a greater sense of relationship by being able to touch the horse, telling secrets to the horse and allowing the horse to get to know the human as well as getting to know what the horse likes or dislikes.  Matching the breath of a horse is very grounding. Connections are important, and at times, easy to gain with a trusting horse and companion. However, when putting a traumatized companion with a horse who also has faced trauma it can be a bit of a human challenge.  The person may have numerous hesitancies and extreme anxieties when facing this 1000 pound figure in front of them. However, most times the horse can sense the hesitancy and be able to pull in where no other human can emotionally touch. The horse can bring a comfort that the person may not accept from others. For instance, a young child who recently lost a parent was working with one of our horses. This child was shutting down and afraid to connect or accept others. The horse recognized this and pulled this child in for a huge hug. This boy broke down at this moment and was able to allow the touch and continued to work through his struggles and grief.
   
• Ground driving horses- a new phenomenon to me as of last month. We had a group of about 30 people join us in a group with 2 Percheron horses- each about 2000 pounds! The group had a chance to bond by brushing, petting, talking and even being able to sit on these gentle giants. Everyone faced a huge hurdle by walking behind these beauties while leading them around the round pen! These humans were able to control 4000 pounds of animals with a slight tug on their reins. We were able to fight the fear of the intimidation of an 18 foot horse that towered over everyone. This was a great time to understand the power that we posses and the control we can have if we allow ourselves to focus. 
   
• The horse can be another tool to add to ones toolbox. This is where people find total relaxation by being near to the horse. Energy work can be done at this point. We are able to lead the horses around the arena with our energy- no leads, no halter, no whips. Pure energy and pure exhilaration! We can gain a sense of accomplishment, leadership and regain lost self control when we are able to be at one with the animal. We teach the human companion to vision what they want the horse to do and the horse will follow. And when the horse does not listen to our desires, we have a great teaching moment with our humans as to how sometimes life doesn’t go as planned. We all struggle at one time or another and we incorporate these mindsets into our clients. Many times, people can relate to this and compare to a time in their life where things went wrong and maybe even notice the strengths that were gained from this. Then we try again with the horse- maybe some relaxation has happened through this acknowledgment and our horse will listen, maybe not.  
   
• Riding is another way to use horses in therapy. This is another fantastic opportunity for the human to feel the power and strength under their body. It can be a cathartic experience to be able to lead this horse around the arena with a small nudge or a slight pull of the reins. The movements that ensue are very relaxing and beneficial to those traumatized clients. I’ve known many people who trailride and end up being so relaxed that they have fallen asleep on their companion- not a goal we pursue in therapy, however.

This is just the beginning of understanding Equine Assisted Psychotherapy. Many people become certified in Equine Work through many programs. At PWC we have Equine programs where we ( the therapists) work closely with a horse handler or certified coach- someone to watch and  make sure the horses and humans are safe and to teach the do’s and do not’s of working with horses. Those certified in Equine Work as coaches are going to be able to share activities and sense things within the horses that most of us may not understand. Coaches can teach the roles of the horses in the herd and how we can relate this to our family, social and work dynamics. As a therapist, we are able to help relate to the dynamics that happens before our eyes to what the human is needing at the moment. We are able to focus more on leadership or focus more on boundaries with the obstacles that the coach can help lay out. We can fill in the clinical gaps that the coach may not be able to understand. By having a relationship with our clients, we can give them what they need through the relationships with the horses. It is a fabulous, amazing and miraculous bond to watch form in just moments.

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If you would like to learn more about our programs, please feel free to reach out to me at (303) 888-9042. We are offering Individual, Family, Couples and Group sessions this Summer and Fall. We offer kids and teen groups and soon will be adding groups for adults, cancer survivors and those struggling with PTSD and other traumas. We will also be hosting a brunch and team building morning in July for all therapists- watch for info soon.

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Guest post written by Nakoma Garcia, MS, LPC

Nakoma Garcia, MS, LPC graduated from Indiana Wesleyan University with a bachelor's degree in Social Work in 1997. She later went back to grad school for Professional Counseling at Grand Canyon University. She is a licensed professional counselor in the state of Colorado. She is trained in EMDR and also offers Equine Assisted Psychotherapy in her practice. She has worked with hundreds of individuals and families who have dealt with life changes and helped them find peace and strength. Nakoma is passionate about working with people who feel change is hard and helping them understand that it does not have to be.

Bedroom Bliss: Have Better Sex Tonight with this Trick!

Now that I have your attention...

I want to talk about mindfulness. Not the sexy topic you may have expected, but bear with me, I promise I wasnt just teasing you with some clickbait blog title. 

Sex is pleasurable and fun and connecting and even spiritual at times. But F### what Cosmo or Maxim might say, the way good sex happens is not through circus act moves or potions or having the perfect body. Its by being mindful.

Mindfulness is paying attention and choosing your focus on purpose. You can have the best techniques and all the right moves, but if youre doing your taxes in your head or critiquing the size of your butt, you're missing out. You need to be mindful to fully be there to notice your own feelings and pleasure, and to communicate what you need, and to be fully present and connected with your partner. 

Now Cosmo and Maxim aren't totally wrong. New moves, exotic smells, and feeling sexy thanks to the latest health and fashion tips may help. But why do they help?? Because trying something new, using your senses, and feeling confident aid us in staying present and being focused on the moment. 

But you cant expect to go around being a mindless robot, thinking of the past or the future or not thinking at all, and then expect to suddenly be good at staying present for sex. That's crazy. We get good at what we practice. So practice being in your body. Notice when it feels good. Notice what makes it feel good. Get good at staying present with your self. 

Good times to practice tuning into your body are: 1. when you're getting dressed (notice what clothes and textures make you feel sexy and sensual), 2. when you're bored (often we self soothe when bored. Do you play with your hair or rub your neck or tickle your arm or ???), 3. When you dance or exercise (its a great opportunity to be in your body and pay attention to sensations in your body that give you pleasure) 4. When you masturbate (if you don't know how to turn yourself on, you will struggle to guide your partner)

Another quick mindfulness practice to jump start your practice. Do this as often as you like to use your five senses to be more aware of the present moment.

1. Notice 5 things you can see right now
2. Notice 4 things you can hear right now
3. Notice 3 things you can touch right now
4. Notice 2 things you can smell right now
5. Notice 1 thing you can taste right now.

So, since sex sells, heres reason #592 for practicing mindfulness consistantly: being more mindful will make you a better lover!

Namaste. Happy practicing!

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Guest post written by Erika Holmes MA, MFT

Erika Holmes MA, MFT, lead clinician at Colorado Couples and Family Therapy (www.coloradocft.com) is a  native Californian who now lives and works in beautiful Denver Colorado. With over 10 years of clinical experience both in agency work and in private practice, her work has included individual, couples, and family therapy, group therapy, parenting classes, behavioral assessments, and professional consultations. Her special areas of interest and training include working with 20 – 40-year-old sassy women, people in distressed relationships, people with mood disorders, trauma, eating disorders, and borderline personality disorder. She has also been privileged to contribute to "Rehab with Dr. Drew" and "The Mental Illness Happy Hour" podcast and "Paleo Baby" podcast.