Articles

by Mark Mouro, LMFT
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We are now in the last three months of the two year program at PAPPTP and have just completed a case conference course. This class has been very different from all the others and has given a glimpse into the vast possibilities of psychoanalytic psychotherapy treatment. I was amazed by the variety of interpretations my classmates would make reading from the same transcript of a session. And it had me thinking about how different a session can be depending on the unique characteristics of the therapist and the relationship they have with the client. 

In times like this, I am reminded of the parable of the blind men and the elephant. Then therapists listening to a session and each one giving their own perspective based on personal experience, emotional reactions, and clinical desires. Only when taken as a sum do you really get a more complete picture of the client and a more in-depth understanding of the case.

I should note that this is not uncommon and I, like most of you I imagine, have participated in similar groups in the past. Before getting licensed, I was in numerous supervision groups with other associates discussing each other’s cases; after getting licensed I enjoyed being a part of consultation groups with colleagues. But this one was different. There were a handful of guidelines that I believe made it possible to benefit from this one in a much different way.

For six weeks, one classmate was chosen to present an ongoing case each week. Right before class she sent out a transcript of one session that week and then she read it out loud during class. The professor would have her pause every once-in-a-while and ask mainly two things from the students. What thoughts do you have on the nature of the transference and what feelings and reactions does the client evoke in you in this moment? In addition, the rule was no asking the presenter questions and she would hold off on any of her own comments about our discussion.

Following these principles allowed the discussion to be more about the client and how each one of us can see things differently rather than it being a critique on how the therapist is doing in session and what we think she can do better. The collaboration of each person sharing their observation and insights helped us to identify factors that may have been overlooked as well as potential barriers to treatment. This provided a more rich and nuanced understanding of the numerous dynamics constantly at play that we most likely are not aware of. In particular, how the transference and distinct countertransference in each of us can potentially facilitate the treatment in its own unique way.

Betty Joseph (1985) defines transference as “everything that the patient brings into the relationship… gauged by our focusing our attention on what is going on within the relationship, how (the patient) is using the analyst, alongside and beyond what (the patient) is saying”. She goes on, “Much of our understanding of the transference comes through our understanding of how our patients act on us to feel things for many varied reasons; how they try to draw us into their defensive systems; how they unconsciously act out with us in the transference, trying to get us to act out with them; how they convey aspects of their inner world built up from infancy—elaborated in childhood and adulthood experiences often beyond the use of words, which we can often only capture through the feelings aroused in us, through our countertransference, used in the broad sense of the word” (p. 447).

And for the therapist presenting her case and how this class affected the relationship with her client? I recently spoke to her after the course finished and she confirmed that the classes notes subtly affected the direction of her sessions. She also remarked that there were things she never would have noticed about the client and the sessions before this exercise. But it was an intense and rigorous experience for her because she thought about the client so much due to notes after session, reading what her client said, and hearing the client being talked about in class. In the end, though she felt it was a massive amount of learning for her, this wasn't really a process for her as much as for everyone to learn from each other. This collage pieced together illustrated how complex the process of therapy can be.  And it humbled me by showing the expansiveness of the human spirit that we are not always cognizant of.  

As mental health professionals, it is not uncommon to experience tunnel vision or become overly focused on one aspect of a client’s case. Sharing with a group of professionals with diverse backgrounds and experiences can help to broaden and deepen the understanding of a case; it allows to create fresh insights and ideas to the table. When we can work together to develop a more comprehensive understanding of the patient's condition, then we all benefit from it.

Reference
Joseph, B. (1985) Transference: The total situation. International Journal of Psychoanalysis 66, 447-454.

Mark Mouro, LMFT is a psychotherapist working in private practice in San Jose. He specializes in working with couples and many of his clients are parents with young children. He is currently in psychoanalytic psychotherapy training at PAPPTP. Previously, he was a therapist on staff at The Couples Institute in Menlo Park. He lists his experiences with Vipassana meditation, foreign travel, and lobbying with CAMFT as being most influential. Mark lives in Willow Glen with his tech working wife and two young sons.

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by Mark Mouro, LMFT

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I can recall being a grad student and hearing a teacher explain that the job of a Marriage and Family Therapist is to help people with their relationships. Soon after that, I will never forget working as an intern and experiencing the push and pull of transference in relation to my clients. And now, most of my training and experience is focused on the relationship between partners in couples therapy. Perhaps, then, it is no surprise that what has inspired and excited me most about being in the Palo Alto Psychoanalytic Psychotherapy Training Program (PAPPTP) is learning about the relational perspective of psychoanalysis.

Relational psychoanalysis has been defined by the APA as “a psychoanalytic approach incorporating aspects of several theoretical perspectives, such as object relations theory and interpersonal theory. It focuses on an individual’s sense of self and patterns of relating to others as developed in early relationships and in treatment it emphasizes the importance of the relationship between a patient and analyst or therapist in helping the patient understand those patterns and form new ones.”

This description really did not match up with my image of psychoanalysis: the therapist in the chair behind the patient, the patient on the couch, and never shall their eyes meet. It seems to put the interactions between the therapist and patient front and center with the various forms of communication being expressed. This shift away from the intrasubjective (our inner experiences) to focus on the intersubjective (the space between two persons or the impact of relationships) really appealed to me.

I had to ask myself why this approach speaks to me personally. In my teenage years, play was a huge part of my life through sports. I expressed a lot of emotions and made close connections through athletics. Upon entering college, I discovered the theater and fell in love with improvisation and co-creation of a new reality. It was both in play and spontaneity that I felt most alive. Both gave me a sense of risk, adventure, and reward. Now, as a professional, I find that vitality exists more often when these elements are present in session.

In many of these sessions, when the client’s level of trust in me is good enough, improvisation can lead the way. The two of us can play with ideas and feelings. This spirit produces a dynamic space where we build on each other’s contributions. They tell me their version of reality while I add some elements to it that I experience. They acknowledge and disclose additional details that they are aware of. Only together, can we both understand what is really going on. It becomes a sort of negotiation of different perspectives.

In relational psychoanalysis, interpersonal relationships are seen as the basis of human development. The emphasis is added on the role of relationships in both creating and healing suffering. Therefore, the therapeutic process is seen as a reciprocal system. The relationship between client therapist provides the best opportunity for intervention since the organization of mind is most accessible in the room between two people.

This two-person psychological model is built on mutual influence and equality. A definite shift away from the expert dictating to the sick person who they are and what they want. Less interpretation and more self-disclosure here. There is not one person in charge of the truth. This approach to psychotherapy demands authenticity on the part of the therapist. A real showing up, coming to the table, and being available in many ways to engage. This makes sense to me given that mutual regulation and mutual influence are always happening at some level or another. I can definitely say that I am a different version of myself with each client and that is due to who the client is and the unique way we connect.

The difficulty I encounter most often is disrupting the universe. Just like my clients, I have a hard time changing the dynamics of the relationship after the gel has solidified. There are various clients with whom I feel we are locked into certain roles at some point. From the get-go, the client uses me as an object, and over time I start to feel the sessions becoming narrow in scope. My participation feels contained to a rigid frame. As a result, the client restricts themself to cursory explanations. There is no mutual give and take, no openness to exploration, right or wrong. There is no discovery. The sessions have become flat. There is no wondering and much less, any wandering.

From a relational perspective then, my stretch would be to face it head on with questions that give context to the mutuality of our experience. This means frequently asking my clients what they imagine I am thinking or feeling in reaction to them. Or “I think you think I am feeling….” or “I think you have the impression that I…..”. Taking it even further might be when I tear up and they have a blank face I ask them if they have any thoughts about why I am tearing up and it does not look like they are being affected emotionally. Or even “I wonder why I said that as a therapist, why do you think?”

This co-creation of interpretations is something I am still struggling with. It feels like a big risk. Yet, I know that most of the time when I venture out there, a big reward is awaiting. And isn’t that part of our work? Leading by example with vulnerability. It is the glue that binds us all together.

Mark Mouro, LMFT is a psychotherapist working in private practice in San Jose. He specializes in working with couples and many of his clients are parents with young children. He is currently in psychoanalytic psychotherapy training at PAPPTP. Previously, he was a therapist on staff at The Couples Institute in Menlo Park. He lists his experiences with Vipassana meditation, foreign travel and lobbying with CAMFT as being most influential. Mark lives in Willow Glen with his tech working wife and two young sons. 

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by Jessica Sorci, LMFT

Jessica Sorci, LMFT is a Certified IFS (Internal Family Systems) Therapist and a Certified Perinatal Mental Health Professional with advanced training in Intimacy From the Inside Out (working with couples using IFS). In her early adulthood, Jessica devoted her life to her own emotional healing; as a Founding Director of Family Tree Wellness in Silicon Valley, she brings her wealth of compassion and knowledge to the clinical training and supervision of therapists as well as the healing journeys of clients. Jessica blends her love of IFS with her extensive background in creative expression and spirituality to create one-of-a-kind trainings and workshops that reach people's hearts and open their minds. With a view that mothering is the heart of our humanity, Jessica knows that the health of our world depends upon women and families receiving attuned support during their most tender times in life.

Our Western medical model understands and addresses the suffering that many women encounter perinatally as a disorder. This lens implies pathology. The concept of matrescence provides a more soulful, holistic, and empowering lens to look through when we think about new motherhood. Diagnostically, this territory is known as the realm of Perinatal Mood and Anxiety Disorders or PMADs. About 85% of women experience some type of mood disturbance postpartum and 15-20% of new mothers have a more significant, pervasive or unrelenting suffering, most commonly called Postpartum Depression (PPD) (MGH Center for Women's Mental Health, 2019). If the majority of women experience profound discomfort during the transformation to motherhood, how can we call what appears to be nearly ubiquitous, a disorder? Changing the current patriarchal paradigm in which new moms are “disordered” to one in which new motherhood is widely understood to be the most radical and challenging transition in a female human being’s lifetime is necessary for the health of our humanity.  New motherhood is deserving of more attention, funding, compassion, care, support, and appreciation than it has ever received.

I am a Founding Director at Family Tree Wellness, a group psychotherapy practice dedicated to reproductive mental health, located in Campbell, California. Most of the new mothers we see in our practice come to us seeking support for PPD or PPA (postpartum depression or anxiety) and are experiencing intense symptoms of insomnia, anxiety, despair, shame and self-criticism. What we commonly call postpartum depression is actually the amalgamation of significant brain changes, hormonal surges and identity transformation that sweeps perinatal women into raw vulnerability, from which they encounter the additional challenges of sleep deprivation, parenting an unsettled newborn and sometimes birth-related trauma, all set against the backdrop of their own attachment histories, as well as the reality of their present-day resources or lack thereof. In that complex equation there are abundant opportunities for essential elements of critical care to fall through the cracks. The biopsychosocial environment of a new mother, met with the inherent vulnerability and dependence of new motherhood, breeds either wellness or an experience of danger and survival threat. The experience of real or perceived survival threat, commingled with shame, produces what we diagnose as PMADs.

We introduce these women to the concept of matrescence as a way of describing the normative adaptation to motherhood, with the recognition that this transformative phase of life is wild, dramatic and difficult, without pathologizing them. The term matrescence was coined by medical anthropologist Dana Raphael, PhD in the 1970’s (Zimmerman, 2018) to capture the reality that new motherhood is simultaneously stressful, growth-inducing and inherently full of ambivalent feelings. Ambivalence can be very triggering for people who have been indoctrinated to believe that good mothers feel only positive feelings about themselves and their babies. In fact, ambivalence is natural and is viewed as an inevitable aspect of growth and change through the lens of matrescence. Matrescence refers to a phase of life, not unlike adolescence, in that it describes an uncomfortable and critical physiological, developmental transition that entirely reworks one’s biology and identity. Polarized feelings are common in this time of life—immense love for the new baby as well as opposing feelings about dislike of the job itself. Women are given a forgiving, expansive lens through which to look at their experience, where they are allowed to feel and express their grief and loss along with their pride and confidence. The normalization of these feelings of ambivalence, grief and loss supports the growth of self-trust and resilience that are crucial to a mother’s healthy development.

In our experience, we see that a large portion of the suffering in matrescent women is shame-based and stems directly from taboos around acknowledging the dark side of mothering. “One study found that mothers feared that disclosure of depression would meet with an unsympathetic response, and would imply that they had failed as mothers” (Kumar & Brockington, 1989, p. 174). This feeling of failure and its accompanying shame are a backdrop to nearly all perinatal mental health struggles. As informed clinicians, we can understand and anticipate this dynamic, and destigmatize the shadow side of motherhood to help relax and soften the way new moms feel about themselves.

Body Changes, Brain Changes, Loss
The biological and physical changes of new motherhood are undeniably challenging, but the dynamics of matrescence on a woman’s psychological and spiritual existence are even more earth shattering. In less than a year, a woman’s former body and her familiar sense of her physical and psychological identity are gone, and an entirely new, rather shocking constellation of experiences emerge. The typical biology of pregnancy and new motherhood include the rising and falling of reproductive hormones that dramatically color mood and perception in mothers. During pregnancy, estrogen and progesterone levels have increased 10 to 100 times, but within 24 hours of giving birth, those hormone levels crash down to roughly zero (Colino & Fabian-Weber, 2021). These hormonal fluctuations are designed to facilitate the symbiotic relationship between mother and infant, and along with measurable changes in mom’s brain, these hormones equip her to bond with and feed her baby. Much of mom’s biology gets behind this critical symbiotic mandate. Her nervous system must essentially download and replicate itself in her infant, and the shared identity and oneness help mom intuit and prioritize the baby's needs, even over her own. Margaret Mahler (as cited in Koenisberg, 1989) defined symbiosis as “that state of undifferentiation, of fusion with mother, in which the ‘I’ is not yet differentiated from the ‘not I’” (p. 1). This biological imperative for mom to bond and for baby to attach to mom as an auxiliary nervous system forces new moms into what we refer to as “the portal'', an inner dimension that houses mom’s implicit knowledge of what it is to be human, to be close, to be dependent and vulnerable. This portal sensitizes moms to their own early attachment knowledge, which is essentially implicit survival-related experience, most of which was laid down in the right brain, in her first years of life.

In looking at the neuroscience underlying perinatal experiences, we see that the brain changes significantly in matrescence, to enable symbiosis and right brain, portal access. According to Allan Schore (1994), it is the emotional right hemisphere that is more connected with the emotional state of the fetus and later the baby—not the left hemisphere. Babies are right brain dominant until their second year, meaning they experience the world non-verbally, somatically, and emotionally. The shift away from the verbal, logical and linear world of left brain dominance is necessary for new moms to make sense of their nonverbal baby, connect deeply with that baby, and ultimately wire their implicit attachment system to that baby. Studies show that these significant brain changes “predicted the quality of maternal bonding and the absence of hostility toward their newborns in the postpartum period. These reductions continued for at least two years post-pregnancy and prepared women for the transition into motherhood” (Gholampour, Riem, & van den Heuvel, 2020).

What does it feel like for mom to shift into right brain dominance?
As the right hemisphere of mom’s brain comes actively online and engages in its non-verbal dance with her baby, mom can feel awash in evocative emotional material that might be destabilizing, depending on its content. There is an experience of being more present, less connected to time, less verbal, less logical, and more emotionally alive. This phenomenon is sometimes referred to disparagingly as “mommy brain”, but rather than being a diminution in function, these profound changes are in fact a heightened kind of functioning, designed to connect moms to their babies. And yet…that does not always feel so good for mom.

As it turns out, a huge component of matrescence involves contending with one’s attachment history and weaving that history into the present-day relationship with this precious new baby. Sleep deprived, emotionally raw moms become more aware of ways they could falter, and so they often double down, becoming perfectionistic in an effort to not “screw up my baby”. It's a monumental task for many moms with preexisting emotional wounds, to do that weaving in a way that feels, in the words of Donald Winnicott (1953),  “good enough” (page 89). And it is common for anxious new moms to forgo self-care and become very preoccupied with this task of not screwing up (which never produces good results). For most moms, nothing has ever felt so critically important as being a good mom, and they have never been so exclusively responsible for a dependent being. This territory is ripe for feelings of high-anxiety, failure, shame and despair!

What Supports Best Outcomes?
Moms can only relocate to their right brain and move into symbiosis with their babies when they feel safe and well supported, when their environment allows them to exist peacefully in a less verbal, linear, logical world, while they symbiotically merge with their baby and begin to download their (hopefully) calm, attuned nervous systems. Moms who do not feel safe and well supported (inside and/or outside) will get caught in an experience of survival threat, will automatically shift out of right-brain connection mode, and into a more defensive position, or “protection mode”. When moms mother from protection mode, families do not thrive.

Matrescence, as a holistic paradigm, acknowledges the growth and expansion of new motherhood, and also the extensive losses new motherhood brings to women. Women certainly disproportionately experience losses around career, power, influence, and earning (Sandler & Szembrot). Less measurable are all the personal losses: her body, sex drive, sleep, freedom and time to herself. Even when things are going well in matrescence, there is loss, which often comes as a total surprise and a deep disappointment to new mothers, who commonly work very hard to avoid the reality of their grief and the shame associated with feeling such loss in the wake of the beautiful new life they have created. Culturally, women are steeped in intense critical messaging that has a lot to say about how new moms SHOULD feel. As a result, these common and natural feelings of loss, regret and loneliness, seem to walk hand in hand with shame and isolation.

Thriving in matrescence, like thriving in adolescence, requires steady, attuned support from outside. Unfortunately, in current American society, women in the perinatal phase of life are subjected to oppressive burdens unique to motherhood, full of high-pressure, high-stakes messaging around how to mother best: breast over bottle, cloth vs. disposable, home birth vs. hospital birth, sleep training, how much weight you should gain, how fast you should lose it, etc. This messaging permeates our families of origin and our larger culture, which in turn, sets new moms up for immense disappointment and failure. Experiences of disappointment and failure in new moms morph quickly into symptoms that constellate around perfectionism, self-doubt, guilt, inadequacy, intrusive thoughts and shame. It is in this painful soup that new moms start to identify as “bad moms” and lose trust in themselves. There is so much shame in feeling like you are not a good mom and when new moms lose trust in themselves, they inevitably disconnect from their babies.

Building Self-Trust and Healing Humanity’s Wounds
A primary developmental task of matrescence is developing trust in one’s self as a good enough mother. The development of self-trust is delayed or challenged by preexisting traumas, legacy burdens (racism, oppression, poverty), inadequate resources, and biological dysregulation. On the whole, mothers are highly motivated to mother well. As the challenges and difficulties of matrescence emerge, new moms tend to be more open to deep inner work and more receptive to help and to change than in more stable phases of life. When the portal is open, we have an opportunity to access the deepest implicit matriarchal wounds humanity carries—and heal them. Growing self-trust in mothers infuses their mothering with confidence, calm, compassion, curiosity, clarity, creativity, courage and connectedness (Schwartz, 2020), all of which nourish her baby, who then grows up to propagate those qualities. When a new mom learns she can trust herself, she has natural resilience and moves successfully through the challenges of matrescence, toward a sense of greater wholeness. Trust and self-compassion are antidotes to the self-doubt and self-criticism that fuel so much perinatal suffering.
At Family Tree Wellness, we know that mothers are the greatest influencers for the next generation. Helping mothers find calm and confidence gives society our best shot at future peace and wellbeing. Techniques and models that we find helpful are those that acknowledge and honor matrescence inclusive of its shadow side. Family Tree Wellness is an Internal Family Systems informed practice, and we deeply appreciate the model’s holistic, nonpathologizing and validating nature. Along with affirming new mom parts and helping women unblend from harsh inner critics and other extreme protectors, we also offer psychoeducation and facilitate support groups that are respectful of the unique needs of this developmental time. We hold a feminist stance that values the work of mothers and acknowledges that our social policies fall abysmally short. We also know that it is equally important to help fathers, partners and our larger communities understand the support new moms need.

When motherhood has not been valued or respected, women have forged through these difficult years isolated and depleted, judging ourselves and other women, stripped of the soulfulness and sisterhood that was our birthright, missing the celebration of ourselves as matrescent—as brand new moms being birthed right alongside our babies. In a world where matrescence is not recognized and respected, new moms look for ways to measure some sort of success and validation, often landing on things like material acquisitions, the shape and weight of our bodies, our babies’ achievements and milestones and our ability to juggle 1000 things simultaneously as proof of our worth. The result? Mommy wars. Maternal depletion. Auto-immune disease. Helicopter parenting. Loneliness. Depression and anxiety.

Matrescence is a powerful and unique developmental phase of life that forces new moms to reckon with individual and collective pain and trauma. By showing up in an informed and supportive way, clinicians can affect fundamental security in a woman, in her baby and ultimately in society as a whole. This is a critical shift in our cultural paradigm. Mothering is, in fact, the very heart of our humanity; the developmental phase of matrescence deserves to be held with reverence and extreme kindness for the ultimate development of a benevolent society.  

References:

Colino, S., & Fabian-Weber, N. (2021, July). Postpartum anxiety: The other baby blues we need to talk about. Parents. Retrieved from http://parents.com/
Gholampour, F., Riem, M. M. E., & van den Heuvel, M. I. (2020). Maternal brain in the process of maternal-infant bonding: Review of the literature. Social Neuroscience, 15, 380-384. doi:10.1080/17470919.2020.1764093
Koenisberg, R. A. (1989). Symbiosis and separation: Towards a psychology of culture. New York: Library of Social Science.
Kumar, R., & Brockington, I. F. (1989). Motherhood and mental illness. Cambridge, MA: Academic Press.
MGH Center for Women's Mental Health, Reproductive Psychiatry Resource & Information Center. (2019, June). Postpartum psychiatric disorders. Retrieved from https://womensmentalhealth.org/
Sandler, D. H., & Szembrot, N. (2020, June 16). New mothers experience temporary drop in earnings. Retrieved from https://www.census.gov/
Schore, A. N. (1994). Affect regulation and the origin of the self: The neurobiology of emotional development. Hillsadale, NJ: Lawrence Erlbaum Associates.
Schwartz, R. C., & Sweezy, M. (2020). Internal family systems therapy. (2nd ed.). New York, NY: Guilford Publications.
Winnicott, D. W. (1953). Transitional objects and transitional phenomena: A study of the first not-me possession. International Journal of Psychoanalysis. 34, 89-97
Zimmerman, E. (2018, May 25). The identity formation of becoming a mom. The Cut. Retrieved from: https://www.thecut.com/

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by Geetha Narayanan, LMFT

Geetha Narayanan is a first generation immigrant and parent working with teens, adults, and families to renegotiate and rediscover meaningful connections. Geetha has experience treating anxiety, depression, and life transition issues. Apart from English, Geetha is fluent in Hindi and Tamil. She has a private practice in San Jose, and can be reached at https://therapistsinsanjose.com/geetha-narayanan-mft/

Raise your words
Not your voice
It is rain that grows flowers,
Not thunder - Rumi

In his book Brainstorm: The Power and Purpose of the Teenage Brain, neuropsychiatrist and UCLA clinical professor Daniel Siegel describes the changes in the structure and functioning of the brain during adolescence. In one of his interviews for a teen magazine, Dr. Siegel talks about an architectural restructuring of the teenage brain and an emergence of the adolescent mind that is wonderfully creative, adaptive, and vibrant.  According to Siegel, "the adolescent brain is a construction zone: creativity, innovation, the capacity for abstract thinking, and the need to experiment are traits that drive this period. Unfortunately, as adults, we sometimes see the adolescent drive towards experimentation only as a negative, a sign that the teen is being ‘crazy’ or ‘immature’”.

Raising kids is tough and parents are not born with a manual for raising their children. Teens go through social, emotional, and psychological changes between 12 and 18. No two teens are alike, and the values, culture, beliefs, and the environment they grow up in all play a vital role in their wellness and health. The reality is a teen's brain is in the process of remodeling.

Indeed, adolescence can be a challenging time, to say the least, while seeking a secure emotional base or a container where they feel loved and accepted as each teen is going through changes so rapidly. Family can assist in building and supporting a teen's confidence, help shape their identity and be available during their trying times.

In India, summer meant playing outside for hours with occasional breaks for food or snacks. We never had many toys, including digital games or social media. Today's generation of teens, on the other hand, do not have any time for free play. Their days are packed with structured activities, even in summer, to build up a portfolio for the so-called top schools. When my daughters were in high school, they would share how their peers were planning to take many AP courses, online classes, internships over the summer, and more: schedules were packed. Many parents want their teens to go to their chosen top schools only. They have an unrelenting focus on academics at the expense of everything else, including mental health. These expectations and wishes put so much stress on teens, resulting in a growing epidemic of anxiety disorders, migraines, panic attacks, to name a few, and even auto-immune conditions, in some cases.

How can parents help
Create a stress-free zone: Parents and teens can develop a zone out time together. It could be watching their favorite buzz feed videos/TV, cooking/baking: a time of leisure without judgment or life lessons.

Efforts versus grades: We can counsel them without an obsessive focus on scores. It can be a life lesson that will help them focus on what they need to do and not stress about outcomes beyond their control. Constantly setting stretch expectations, leading to a relentless pressure to meet them, is toxic for teens’ health.

Sharing your past: Share your college experiences more as an understanding and awareness for your teen, not necessarily to communicate only how your (parent) generation's methods are correct. Such communication would make any teen feel that they never measure up and can damage their long-term self-esteem.

One-on-one: Celebrating your teen's accomplishments, sharing their disappointments, and supporting their hobbies helps your teen know you are  interested in them. You do not have to make a big deal of this. Sometimes it is just a matter of showing up to watch your child play a sport or music, reading together, or cooking or baking, and arts and crafts activity or giving them a ride to extracurricular activities.

Treats: Treats worked in elementary school, and they still do, such as a Starbucks drink or a Jamba Juice. Some parents feel that appreciating their teen's effort or journey would defocus them and stop putting in their efforts. However, research has shown that positive encouragement is vital for teens to succeed in any environment. It is not a bribe but an acknowledgment of their effort. In addition, an encouraging comment along with the reward will help make the message clear to your child how much you appreciated their efforts.

Be empathetic: Using active listening when you are conversing with your teen without interrupting with your own opinions or judgments, being curious and open-minded about their point of view, and having patience as they solve their problems can be the best thing you offer your teen. You need to increase your capacity to listen actively, be open, and provide a non-judgmental stance. For example, when a teen comes home heartbroken as they did not get their desired result in their quiz, a parent could respond, "I saw how much you worked on that; I am so sorry to hear that." This kind of empathy is powerful to hear someone say and soothes them.

Only STEM mindset: There are some misconceptions that only a few majors guarantee a job. Other than STEM majors, there are other majors in public health, global health, economics, nursing, etc., leading to great jobs and careers. Parents should encourage their children to create a career path that brings them joy as well as a paycheck.

Chores/jobs: As parents, we would like to rescue and complete our kids' activities and chores. However, it is an excellent time for teens to develop and mature with independent living skills. Managing simple tasks like laundry, cooking, or running errands for the house once they start driving, teaches them accountability/responsibility and time management.

Limit setting/boundaries: By setting up rules, boundaries and standards of behavior, you give a teen a sense of stability and predictability. Regular family meetings and explaining the benefits and consequences of following rules/boundaries would help. It also helps them internalize the concept of delayed gratification. Of course, there will be pushbacks, yet this practice is integral in a time of chaos.

Conclusion
Trust and respect are earned not by doing only heroic, victorious deeds, making significant changes, saving lives around you, but also by paying close attention to your teen's emotions and feelings. Dr. Siegel reemphasizes the importance of how young adults need to be seen and soothed by their parents. Relationships with our teens provide a template for relating with people when they step outside our homes. Developmental relationships are connections that help young people become their best selves.

For Parents:

Goleman, D. (2010). Emotional intelligence: Why it can matter more than IQ. New York, NY: Random House Publishing.

Siegel, D., & Payne Bryson, T. (2011). The whole-brain child: 12 revolutionary strategies to nurture your child’s developing mind. New York, NY: Random House Publishing.

Siegel, D. (2013). Brainstorm: The power and purpose of the teenage brain. New York, NY: Penguin.  

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Dmitry Vulfovich, LMFT

The use of medicines to treat the psyche is not an original advent of Western civilization. In fact, for thousands of years, prehistoric societies have used psychedelic medicines to treat mental and spiritual illnesses throughout the world. Indeed, the effects of psychedelics are much more profound than those of modern psychopharmacology due to their ability to uncover the core materiel of a person’s psychology.  Modern psychiatry is at a turning point as psychedelics gain recognition and legitimacy through clinical trials and public awareness. We are seeing a tremendous shift away from symptom reduction, and a move in the direction of healing trauma and transforming mental health on an experiential level.

The word shaman originally comes from Siberia and Central Asia, and actually derives from the Russian Tungus Saman, which could be translated into whole man or holy man. According to Terence McKenna (1992), shamanism is the “practice of the Upper Paleolithic tradition of the healing, divination, and theatrical performance based on natural magic, developed ten to fifty thousand years ago" (p. 4). Almost every indigenous culture has its own psychoactive medicine. Some of the major medicines include: psilocybin mushrooms and Salvia Divinorum in Southern Mexico, Iboga in Western Africa, the Peyote and San Pedro cactus in North America and Peru, and Ayahuasca in the Amazon Basin. Clinical research with psychedelics in the United States is now being allowed by the FDA in institutions across the country, as well as around the world, with such substances like MDMA, psilocybin mushrooms, Ibogaine, DMT and LSD to treat disorders ranging from alcohol addiction, depression, to post traumatic stress disorder (PTSD), to cluster headaches and obsessive-compulsive disorder (OCD).

How Psychedelics Work

While it is still being researched regarding the neurochemistry, psychological pioneers of psychedelic exploration like Stan Grof, MD and Ralph Metzner, PhD, often depict the experience as one of “consciousness expansion”.  A simple way of understanding this term is by looking at the inverse definition, which is “restricted consciousness.” People are often restricted and limited by their self-perceptions or self-concepts.  A person may be identified with a certain identity, sometimes due to traumatic events or systemic conditions, and the psychedelic experience has the potential to broaden the self-concept beyond the ordinary parameters. In other words, people have the opportunity to see themselves as something much greater and feel interconnected with all of nature and the cosmos itself. The most principal commonality in the psychedelic experience is ecstasy, which is described as an “experience that transcends duality; it is simultaneous terrifying, hilarious, awe-inspiring, familiar and bizarre” (McKenna, 1992).

A good metaphor for the process of transcending the ego is the hermit crab: as the crab grows it eventually finds its shell increasingly uncomfortable and restrictive because it has outgrown it.  At that point, it has to move out and be vulnerable enough to find a new house. In some ways, the same processes occurs in human personal transformation. As a person is confronted with a limiting belief or identity, they have the opportunity to let go of certain identity structures in order to out-grow their ego. A person may find it no longer useful or meaningful to identify as a victim or may choose to no longer be involved with resentment towards their parental figures, for example. So, psychedelics are a powerful tool to aid and assist the process of personal and spiritual growth, as well as healing emotional pain and trauma along the way.

The psychedelic experience is not a walk in the park though: often times it can be scary, uncomfortable, and provocative. A common phenomenon, although with exceptions, is called an initiatory sickness.  This happens when the physical body undergoes a type of shock and vulnerability experienced as nausea, disorientation, or dizziness (McKenna, 1992). This, in turn, is speculated to have an effect on the mind and its susceptibility to new information that it receives in the trance state. This is how the ego is broken down and real emotional and psychological changes can be made. Healing trauma requires an attentive and holding environment for the client to access core material and repair missed moments and incomplete processes deep within them. For this reason it is important to have a guide, therapist or indigenous leader to support this journey. The therapist or sitter can be very valuable in steering and creating a space for the client to explore the inner dimensions. If the client is feeling trapped in some emotional realm and cannot seem to get out, the therapist can be a friendly voice that interrupts the client’s mental rotation and bring them back to the present moment (Danforth, 2010).

Preparations for Psychedelic Therapy

Regardless of the increase in popularity of psychedelics, both precaution and sacredness need to be incorporated in the process.  A proper therapeutic setting and intentional purposefulness, or set, must be in place before participating. The set is important, which is the primary component of this type of therapy refers to the traits, mind state, and expectations of the client regarding the experience (Danforth, 2010).  An overall structure of the session should also be thoroughly discussed and agreed upon, starting with the rules and agreements between the therapist and the client such as: staying on the premises until all have agreed that the session is over; agreement that the client is not destructive to themselves, anyone else, or any property; agreement that no sexual activity between the client and therapist is allowed, as well as, agreement to follow all instructions from the therapist (Greer, 1998).  One of the most basic preconditions in this type of therapy is having the client meet with the sitter, typically a psychotherapist, numerous times before the psychedelic therapy takes place in order to develop and maintain rapport and trust, which has been found to minimize the danger of adverse reactions to the medicine (Goldsmith, 2011).

Similar to dream work, the psychedelic experience can sometimes be scary and contextually difficult to understand. Especially for beginners, the experience can be disorienting and confusing.  Supplemental psychotherapy, also known as pre-integration, is essential to begin psychedelic therapy. There are also various somatic grounding and body-oriented techniques taught to the client to optimize the therapeutic benefits of the medicines. One highly effective method of pre-integration therapy is called Focus-Oriented Psychotherapy (Focusing), founded by Eugene Gendlin, which emphasizes awareness, concentration, and acute receptivity in regards to the body’s innate wisdom. The pre-integration therapy helps the client to cultivate the faculties to localize their problem through meaningful somatic sensations and the ability to shift and signal particular changes in an assisted self study. This can be exceptionally effective with clients who are stuck and able to recognize their problem, but could not work through it completely during the ceremony.

This style of therapy is highly conducive for the psychedelic experience because it allows for the immediate felt sense of the experience to guide the therapy, and the preparation entails practicing how to orient inwardly and experience problems from a holistic bodily sense. A therapist involved in Focus-Oriented Therapy typically follows three main guidelines in relation to treatment planning. First, the therapist has to track and name the client’s felt sense of the issue. Second, they aid and assist the client to attune to their bodily sensations to allow the emergence of felt senses (Danforth, 2010). The third function of the therapist is to redirect the client from self-criticism or any attitudes that could hinder the momentum of their process (Danforth, 2010). Gendlin (1996) proposed a concept called absolute listening, which provides authentic gestures from the therapist that reflect understanding of clients’ inner process. Focus-Oriented Therapy essentially provides considerations and preparations for psychedelic therapy, and offers essential components of an overall meta-theme called the inner guide, which promotes self-trust in the client through the immediate felt sense of the body.  This, in turn, allows clients to rely more deeply on their inherent intelligence for guidance during a psychedelic session, as well as identify the primary goals for the session (Danforth, 2010). Focusing was originally its own type of therapy and is effective as a somatic-experiential type therapy, but has been adopted in the literature for preparation for psychedelic use.

Mindfulness in general is an absolute prerequisite for psychedelic use, because the altered state can feel like a stormy ocean.  Therefore, it is important to be able to ground and self-regulate during uncomfortable moments.  Vipassanna, an ancient body scanning technique stemming from Buddhism, is an excellent complement to psychedelic healing. The technique teaches the meditator to develop the faculties of awareness by systematically sensing and tracking body sensations from head to toe. An equally important element to Vipassanna is the practice of equanimity, which is the ability to observe the entire field of matter in the body while neither suppressing nor expressing the feeling and sensations. Basically, the person is taught to “be with it.” This kind of preparation is extremely grounding and an excellent way to initiate and conduct the ceremony.

Post Integration: Applied Knowledge

Taking the time to process and integrate a psychedelics experience can determine how much actual psychological benefit a person can accrue from it. A trained therapist can experientially explore and revisit themes touched upon in the psychedelic experience in order to help the client make sense of the journey and its meaning. Visual content from a journey can be processed as modalities of the imagination, similar to parts work (IFS), Jung’s Active Imagination or Gestalt. The client can have the opportunity to organize components of the experience as metaphors that reflect inner dynamics and character patterns, instead of scary hallucinations.

Probably the most crucial aspect of the integration process is taking the meaning and insight and applying it into lived and practical changes in one’s life. People can of course have deep insights about themselves and the world, but the application is key. Often times, clients are encouraged to use symbols and key figures from the experiences as impetus into transformation. For example, if a person has overcome a difficult moment in their psychedelic experience as personified by a dragon or serpent, they may choose to start wearing clothes or jewelry with those totem animals, or incorporate those attributes into their dancing or other behaviors like speaking up for themselves. Clients can also continue to process the fruits of their journey and find meaningful applications for various life events, relationships, and mental challenges. If clients discover through a psychedelic experience that radical acceptance of their anxiety and depression allows them to feel peace experientially, they may experiment with ways to apply this allowing acceptance when they get stuck in resistance in other areas of everyday life.

Conclusion: The Inquiry is the Medicine

Psychedelics offer a psychosomatic inquiry into mental health disease, and with that inquiry, there is an opportunity for integrated healing and transformation out of suffering. Traditional psychiatry, although useful and necessary, pursues the utopian ideal of, eventually, getting rid of all mental diseases through the use of biomedical research, but this narrow view fails to address the subtle psychological and spiritual aspects of illness and natural living processes, which are completely incompatible with that pursuit (Capra, 1982). If we eliminate the symptoms without inquiring into the roots and mechanics of the way the disease manifests itself in the first place, on a process level, we run the risk of regenerating the disease in a new or repeated symptom. Indeed, there is an underlying unmet need or inner conflict behind the disease: to get rid of the surface manifestation of the conflict only will never lead to fulfillment and completion. Psychiatrists are also doing their best to alleviate pain and suffering in order to make the patient more comfortable through illness, which may seem like a good thing, but it may lead to a distorted view of health and a lack of meaning in regards to a person’s conglomerate philosophical orientation towards their body and how their lifestyle may impact their health (Capra, 1982).

In an attempt to integrate this difficulty, psychedelic-assisted therapy and modern holistic health disciplines consider disease as anything that limits the freedom or potential of the organism, and expands the cure for disease to include substance, activity, event, or a combination that helps to restore the biological functioning and harmony of an organism (Grossinger, 1990). It is essential to start looking at how stress causes disease in the body, as well as understanding the trauma-informed perspective and the imbalance of needs instead of an imbalance of chemicals in the brain.

Dmitry Vulfovich is a Licensed Psychotherapist and Clinical Director at the Process Therapy Institute. His specialty is treating trauma and other mental health issues using a holistic body-oriented approach. Dmitry is a long time advocate and practitioner of ethno-botanical medicines and Zen healing arts. Dmitry is also a master teacher trainer at PTI, which involves experiential one-way mirror training and classes in the Process Model. Dmitry is a community leader, DJ, lecturer and workshop facilitator.

References

Capra, F. (1982). The turning point: Science, society, and the rising culture. New York, NY: Bantam Books.
Danforth, A. (2010). Focusing-oriented psychotherapy as a supplement to preparation for psychedelic therapy. Journal of Transpersonal Psychology, 41(2), 51-160.
Gendlin, E. T. (1996). Focusing-oriented psychotherapy: A manual of the experiential
    method. New York: The Guilford Press.

Goldsmith, N. M. (2011). Psychedelic healing: The promise of entheogens for
    psychotherapy and spiritual development. Rochester, Vermont: Healing Arts Press.
Greer, R. G. & Tolber, R. (1998) A method of conducting therapeutic sessions with
    MDMA. Journal of psychoactive drugs, 30(4), 371-379.
Grossinger, R. (1990). Planet medicine: From stone age shamanism to post-industrial healing. Berkeley, CA: North Atlantic Books.
McKenna, T. (1992). Food of the gods: The search for the original tree of knowledge – A radical history of plants, drugs, and human evolution. New York: Bantam.

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