Event Reviews

  • Tuesday, October 04, 2016 2:10 PM | Anonymous

    Michelle W. Joy, LMFT with The Couples Institute in Menlo Park, presented Effective Interventions
 for Hostile, Angry Couples at our South Bay Luncheon on June 26, 2015. Michelle has been with The Couples Institute for 15 years, and has completed advanced training with founders Ellyn Bader, Ph.D. and Peter Pearson, Ph.D.

    Michelle explained that blaming, fighting, angry couples are the most difficult to treat because we, as therapists, have to do so much in the moment. We need to be strong leaders with this type of couple.

    The developmental model of couple’s therapy is based on the notion that couple relationships pass through developmental stages that mirror early human development. The hostile-angry couple is arrested in the first developmental stage, the Symbiotic stage.

    With hostile-dependent couples, the focus is on the first two stages: Symbiosis (stage 1) and Differentiation (stage 2).

    Hostile, angry couples have difficulty moving from symbiosis to differentiation. While in symbiosis, their boundaries are merged, differences are minimized, and similarities are emphasized. The emphasis in this stage is on bonding. As couples move into differentiation, they begin to notice each other’s flaws. When the individual in each emerges, disillusionment and disappointments occur. Often the couple is tempted to return to symbiosis.

    Hostility is a pervasive aspect in the hostile-dependent relationship and couples expect their partner will meet all their needs. Each is sensitive to confrontation and exhibits a minimal level of self-responsibility. They often lack skills to repair relationship ruptures and tend to search for symbiotic solutions. These couples will demand intimacy and then push their partner away.

    Some of the reasons these couples are so challenging to work with include:

    1. Sensitivity to confrontation

    2. Pervasive search for symbiotic solutions

    3. Lacking skills to repair relationship ruptures

    4. Triggering trauma in each other

    How do we work with these couples? Michele said the therapist must:

    1. Establish leadership

    2. Define their role as someone active and intrusive in the couple’s system

    3. Explain that it takes both of them to fix their negative cycle

    4. Gather information from their family of origin, present challenges and future vision

    5. Set effective individual goals to create the relationship they want to have

    6. Facilitate positive interactions

    In early sessions, Michelle talks to the couple about the brain chemistry. By explaining the function of the amygdala and the fight, flight and freeze responses, the therapist normalizes these human responses that do not work well in intimate relationships.

    It is also important for the therapist to gather data from the couple about their past, present, and future. Finding out about trauma or negative experiences and how emotions were handled in their respective families of origin is crucial. Asking the couple about what kind of future they want to create and what will be required from each is also helpful with a hostile, angry couple.

    The next step is to help the couple set future goals. These couples resist setting self-focused goals. By helping them identify the most common coping strategies and explaining how they are a problem, directs the couple to a solution. The couples will then discuss what attitudes or habits each will need to release and what each partner will do to make it easier for the other.

    Michelle taught the Initiator- Inquirer exercise. This exercise is an effective communication exercise to support differentiation by helping couples develop skills and teaching them how to talk about their problems differently.

    Initiator-Inquirer Exercise (I-I)

    Initiators start the conversation, expressing their own thoughts, feelings, wants and desires clearly and without blame. Initiators start being accountable for moving toward their partner.

    Inquirers listen and inquire, manage their own reactions, and Inquirers learn to delay gratification and manage their own reactivity thereby developing an increased ability to tolerate anxiety.

    The Initiator learns “differentiation of self”, the ongoing ability to identify and express important aspects of their self, their thoughts, feelings, wants and desires. The Inquirer learns “differentiation from partner”, the ability to be curious about their partner’s self- disclosure while managing their own reactions.

    The therapist will get a clear picture of the couple’s dynamics and developmental level. When couples can manage reflexes, they are able to have a good discussion for the first time in years.

    When explaining the I-I exercise, it is important to emphasize it is not problem solving. It is slowing down, learning how to talk about problems and how to manage their reactivity.CTOBER 2

    The Initiator will bring up one topic; be open to self-discovery; and create a psychologically safe space for their partner. The Inquirer will listen and ask questions like a journalist, getting to know their partner. The therapist monitors and watches the Initiator for any triggers, blaming, criticizing or guilt inducing, and staying with one issue. With the Inquirer the therapist monitors and watches for arguing, trying to change the partner, defensiveness, recapping accurately or becoming too triggered to stay in their role.

    I have recently enjoyed reading “In Quest of the Mythical Mate” A Developmental Approach to Diagnosis and Treatment in Couples Therapy by Ellyn Bader, Ph.D. & Peter T. Pearson, Ph.D. which fully explains the developmental stages with examples of different types of couples in therapy sessions.

    Michelle referred us to the Couples Institute website at www. couplesinstitute.com for packages of

    I-I exercise cards to use with clients, as well as packages of “Stepping Stones to Intimacy,” which succinctly describe the five developmental stages.

    Here are more resources from The Couples Institute: • For more Articles and Resources or online training program: www. couplesinstitutetraining.com/ developmentalmodel

    • How to get the most from couples therapy: www.couplesinstitute. com/getthemost/

    • On-site training programs and workshops (Menlo Park): www. MichelleJoyMFT.com

    Kera Burdick, MFTI #81082 and PCCI #1349, Supervised by Kirsten Kell, LMFT #41953, works in Private Prac- tice in San Mateo, and loves working with individuals, couples, children and teens. 

  • Tuesday, October 04, 2016 2:01 PM | Anonymous

    Dr. Matthew May was our speaker at our March luncheon in Mountain View. Dr. May kindly submitted this article outlining his presentation.

    This is a story about “Wendy,” a young woman from rural Virginia who sought treatment for Social Phobia the year after she graduated from college. Wendy’s problems began in middle school, when the “mean girls” would make fun of her and call her “fatty.”

    In retrospect, Wendy believes that her response to the bullies at school played almost as much a role as the bullies, themselves, in creating her problems. Afraid of being teased, she would call her mother from school every day rather than going to recess and facing her tormentors. Her fears increased such that it became emotionally challenging to be in any social setting. She never attended any dances or social functions during high school and felt lonely, isolated and terrified she would never meet anyone to date or marry.

    In college she developed an infatuation with one of her classmates and experienced a devastating breakup. She moved home after this and with- drew even more. She was convinced that the few friends she had left would look down on her, judge her, and reject her because she had failed to succeed in her relationships. She was fearful of job interviews and remained unemployed, worsening her shame and sense of hopelessness.

    Noticing her depression, a family member recommended the book, Feeling Good, by Dr. David Burns. After reading this, she began to feel better and develop more hope for her future. She reached out to Dr. Burns, who spoke with her and empathized with her experience. Through him, she was referred to my practice in Menlo Park, California. She came to therapy every day, two hours per day, for five days.

    Wendy and I worked together, using the methods described by Burns in his books, Feeling Good, Intimate Connections and When Panic Attacks. At the time she began treatment, she was dressed in dark, baggy clothing, avoided eye contact, spoke haltingly and, as the title suggests, appeared
to be hiding behind her hair. By the end of therapy she had a new look, a new wardrobe, a new hairstyle and had the confidence and social skills to go out in public, talk with strangers, eat meals, even to act in silly and spontaneous ways. On her last day, she noticed an attractive man in a pet store working behind the counter. She approached him and asked for his phone number, leading to a wonderful romantic date and a lasting friendship.

    Social Phobia (SP) is the third most prevalent psychiatric diagnosis, with around 15 million suffering from this disorder in the United States. Individuals with SP worry about social situations, such as public speaking, entering a crowded room, or talking with strangers. The symptoms interfere with activities of daily living and with the attainment of those things we

    hold most dear: meaningful relation- ships, gainful employment, pleasurable recreation, creative play, and the ability to feel good about ourselves in public and in private. Individuals with SP have worse medical outcomes and are more likely to have legal difficulties or to commit suicide.

    Therapy that includes social exposure and response-prevention has robust evidence supporting its efficacy in treating individuals with SP. Despite the effectiveness of available treatments, several barriers prevent care from reaching those in need. These include feelings of shame and avoidance behaviors characteristic of individuals with SP and the reality that many therapists lack familiarity, practice and skill in utilizing the methods that are required for successful treatment of SP.

    Dr. David Burns has spent a large part of his career addressing these problems. A wide array of materials and information is available for therapists through his website www. FeelingGood.com. Additionally, there are training opportunities at the Feeling Good Institute in Mountain View, California: www.FeelingGoodInstitute.com. The model developed by Dr. Burns is based on tenets of Cognitive Behavioral Therapy (CBT) but goes beyond typical CBT paradigms. It is called TEAM therapy, which stands for Testing, Empathy, Agenda Setting, and Methods.

    CBT proposes that one way to understand our emotions, including anxiety, is the cognitive model, which states that our feelings are caused by automatic negative thoughts (ANTs). According to the cognitive model, we ‘feel the way we think’ and the thoughts which create our suffering are distorted and can therefore be refuted, leading to improvement in mood. Just as importantly, the behavioral model states that we must change what we do in order to change how we feel and includes exercises that boost motivation and eliminate our fears.

    TEAM therapy incorporates sever- al other models, in addition to those of CBT. The author believes that the most important of these, and what accounts for the profound and rapid responses seen in patients treated with TEAM, is ‘Paradoxical Agenda Setting’ (PAS). PAS acknowledges that therapists are powerless to overcome both types of therapeutic resistance:

    Outcome Resistance: Not wanting change, even if it were as easy as pressing a button.

    Process Resistance: Being unwilling to do what is required to recover.

    Paradoxically, when therapists ac- knowledge that they are powerless to make the patient’s decisions for them, and let go of the need to convince and change their patients, is when they are most effective.

    The magic of therapy is not in the therapist. It is within the individual who is seeking help. For example, in the initial phone call with Wendy, I allowed her to decide whether she wanted the type of help I was offering:

    “I’m very optimistic that you can recover using some combination of these methods. However, I’m not sure you would want to work with me. Some of the required methods for overcoming anxiety involve facing one’s fears. I would be willing to face them with you. However, there would be a temporary increase in anxiety while we did this. I would understand if that is too high of a price for you to pay. At the same time, I would be very eager and willing to work with you.”

    On the phone, Wendy was able to convince me that she wanted change and that she was willing to pay the ‘price’, including feeling more afraid before she felt relief. However, when I met her, I realized there was another problem that was going to defeat our work.

    Question: Based on what you know, why would Wendy NOT benefit from social exposure?

    The clue is in the title of the talk, “The Girl Who Hid Behind Her Hair”. When individuals have anxiety, it is natural for them to respond by avoiding their fears and protecting them- selves in a variety of different ways. A patient with a phobia of germs and contamination will ‘respond’ by washing his or her hands excessively. Those with a fear of losing control will count their steps and engage in repetitive checking behavior. For Wendy, she tended to hide herself by covering her face with her hair and wearing baggy clothes. This ‘response’ was in- tended as protection and was a reflection of her belief, common to those with SP, that people are judgmental and critical. Someone who engages in exposure exercises without letting go of their ‘protective’ responses and self-defeating beliefs will not benefit. They often will continue to think “yes, but if I hadn’t protected myself by [washing my hands/counting and checking/concealing my appearance], then I would have [become sick/lost control/been judged and rejected].” In this way, the thoughts that cause the fear are not defeated and the fears persist.

    What this meant, for Wendy, was that her recovery depended on not only facing her fears, using social exposure exercises, but also giving up her protections and preventing her natural ‘responses’ to anxiety (response prevention). Giving up these safeguards increases anxiety, how- ever, so there is usually an element of ‘process resistance’ when asking whether patients are willing to do this (see above).

    As soon as I told Wendy that this would be an additional price for her to pay, she became extremely fearful and refused to agree to this approach. After empathizing with her new anxiety and the unfairness of this previously unmentioned ‘cost’, I utilized a PAS method, ‘open hands’: “You don’t have to continue further in our work if you don’t want to. I am curious, however, what you would be afraid of if you were to wear a nice dress, makeup and pull your hair back?”

    The patient was horrified by this idea and said, ‘I couldn’t dress that way. People would think I’m a prostitute!’

    Realizing that this belief was holding back the therapy, I suggested we address it through a safer form of exposure called the ‘Feared Fantasy’. She accepted and we took turns practicing responses to a judgmental and critical stranger:

    Critic: ‘Eww, what are you doing? I can’t believe you’re out in public!’

    Patient: ‘Wow, I’m a little hurt and angry you would say that. You’re definitely a straight shooter, though. Perhaps you have some good fashion tips for me? After all, you do look fantastic in that outfit.’

    Critic: ‘No way! You look like a prostitute! I’d never be seen talking to a tramp like you!’

    Patient: ‘It’s true; I’ve been dressing more adventurously, to help overcome my shyness. That has been a thrill and I’m much more confident about myself. To be honest, your feedback is a tad hurtful and I’m a bit wary of you. Have I done something to offend you?’

    Critic: ‘You’ve offended my senses with that terrible outfit. You need to get away from me as soon as humanly possible’.

    Patient: ‘I’m waiting to meet someone, actually. I see an exit sign in that direction, though, if you need to get going. I’m still confused, though. What part of my outfit is most off-put- ting to you?’

    Critic: ‘Everything about it is gross and weird’

    Patient: ‘Yikes! I suppose I am in need of an urgent fashion consultation. I’m glad someone as sophisticated and savvy as you was around to make me aware. Is there anything else you wanted to add?’

    Critic: I reject you! Patient: Rejection accepted!

    Practicing like this led to laughter as Wendy realized that the ‘critic’ was ridiculous and just a figment of her imagination. Even if someone were to respond like the ‘critic’ of her ‘feared fantasy’, they would be the one with the problems.

    After this exercise, she did multiple social exposure exercises while wearing attractive outfits and makeup. She emerged from beneath her hair and eliminated her social anxiety. These exposure activities included ‘Smile and Say Hello’ practice and ‘David Letterman Technique’ (asking questions and paying compliments). After success with these, she tried more difficult exercises, like ‘Self Disclosure’ (sharing vulnerable feelings and truths about ourselves, like, saying, ‘I’m a shy person’ or ‘I feel a bit nervous’) and ‘Survey Method’ (asking what other people really think). Wendy even did the most difficult social exposure exercises, ‘Rejection Collection’ and ‘Shame Attacking’.

    In Shame Attacking, the therapist and patient will intentionally do ridiculous (but safe) things in public, challenging the idea that people are judgmental and critical. Wendy, for example, went running around in circles in a crowded coffee shop, victoriously pumping her fists and whooping happily. This led to the realization that people were remarkably non-judgmental and frequently wanted to join in the fun! It also helped generate confidence that if she encountered judgmental people she could tolerate the judgment or even tease them back.

    The results were impressive, as indicated on the measurement of the patient’s mood and feedback of therapy, where she stated that it was hard, now, for her to understand what she was afraid of in the first place!

    Years later, the patient is now in great spirits. Shortly after the treatment she developed the urge to move out of her parent’s home and she now enjoys a vibrant social life and is successful in her work. She maintains her gains by continuing to socialize and engage in shame-attacking and rejection practice.

    Other techniques discussed included common automatic negative thoughts in SP, tactics to “talk back” to these ANTs, use of the cost-benefit analysis tool, and uncovering techniques such as the “what-if” exercise to understand deeper fears, beliefs, and values that underlie a patient’s patterns of thinking and feeling.

    Two other important aspects of TEAM therapy include Homework and Relapse Prevention. Homework is a requirement for patients in TEAM therapy to actively participate in their recovery by doing daily homework exercises. Research has shown that active participation and practice is required for recovery from depression and anxiety, just as it is required to learn a musical instrument, new language, or martial arts.

    Relapse Prevention is a necessary part of psychotherapy because of the “inevitability of relapse.” When we feel better, it is tempting to imagine that a permanent state of enlightenment has been achieved. This unrealistic expectation is a ‘setup’ for prolonged and severe relapse, rather than brief, self-treatable relapses. Patients will think to themselves, when they relapse, ‘even that therapy didn’t work, I really am a hopeless case’ unless they are prepared for this eventuality and given the reminder, when they feel that way, to use the methods that worked for them. Just like our physical health, our mental health is a work-in-progress, requiring regular maintenance. Developing healthy mental habits is part of Relapse Prevention.

    The remainder of the talk was focused on identifying problems and risks associated with exposure exercises for anxiety. The speaker noted that many therapists were understandably reluctant to use exposure methods and acknowledged that there were problems associated with these methods, including:

    a. Forcing exposure on the un- willing patient, which is ineffective and damaging

    b. Inadequate duration, frequency and intensity of exposure

    c. Failure to address co-morbid problems like depression and sub- stance-abuse

    d. Inappropriate use of ‘anti-anxiety’ medication, defeating the exposure work

    e. Excessive focus on the expo- sure model when other models are more appropriate

    f. Failure to include ‘response prevention’ as part of the ‘exposure’

    g. Failure to include ‘relapse prevention’ to prepare the client for relapses

    h. Exposure to the wrong stimulus, failing to address the appropriate fears

    Also, many therapists, due to a lack of experience and training, feel uncomfortable using these methods despite the strong evidence for their efficacy. Therapists treating individuals with anxiety can increase their familiarity and skill with TEAM methods by participating in training and certification through the Feeling Good Institute in Mountain View, California (www.feelinggoodinstitute.com).

    In conclusion, the speaker ex- pressed concern that Social Phobia (SP), like many psychiatric diseases, remained under-diagnosed and under-treated, with approximately 13 million un-treated cases in the United States. Fortunately, there are now powerful and rapidly-effective forms of treatment available to patients who are willing to participate in the type of treatment outlined and described by the author.

    Dr. Matthew May is a board-certified psychiatrist and an adjunct clinical faculty member at Stanford’s Department of Psychiatry and Behavioral Sciences. He has a private practice in Menlo Park. He can be reached at matthewmaymd.com

     

  • Tuesday, October 04, 2016 1:46 PM | Anonymous

    Domestic Violence in Affluent Communities was presented by Ruth Patrick, M.A., Domestic Violence Outreach Specialist and Director of the Women/SV Program at Family & Children Services in Palo Alto.

    Ms. Patrick began her talk by outlining the Women/SV Mission, which is to “eliminate domestic violence and abuse by

    • ·      providing support, education and resources that empower women and children to more safely and effectively address abusive situations, heal from the emotional and physical health consequences of all forms of abuse, and create a new and healthier life;

    • ·      educating professional providers and the public; [and]

    • ·      promoting women’s and children’s basic right to live in peace, safety, and freedom in their own homes.”

    Ms. Patrick reviewed some key points about domestic violence (DV): DV occurs in all walks of life, all neighborhoods, and includes not just physical abuse, but emotional, financial, legal, and technological abuse, these last four most common in affluent communities. Ms. Patrick provided statistics about children affected by DV, and noted that while some DV victims are men, “85-95% of . . . victims are female,” and that DV is “the leading cause of injury in women in the U.S. between the ages of 15 and 44.”  Ms. Patrick , who is a DV educator and not herself a therapist, reminded the group that “marriage counseling and assertiveness training are . . . contraindicated” when abuse is present. [Ms. Patrick was pleased to learn that our BBS training directs us NOT to engage in couples counseling when we suspect DV, but to guide both partners into individual therapy.]

                After reviewing the effects of abuse (trauma, shame, helplessness), the cycle of abuse, and the “power and control” wheel, Ms. Patrick reviewed trauma-informed ways to help DV survivors recover (safety first, respect boundaries, collaborate, empower, and minimize re-traumatization).  She introduced the “Equality” wheel as a tool to use with survivors of abuse, to help them recognize the elements of a healthy relationship. 

                Ms. Patrick focused the rest of her talk on DV in affluent communities. Many people believe that DV doesn’t happen among upper class individuals, and that even when it does, women have all the resources they need to combat it.  One of the goals of Ms. Patrick’s organization is to correct this misperception.  An affluent abuser, according to Ms. Patrick, may not “look” like an abuser because he can use his “power, money, influence, [and] technical expertise” to present a very polished public image.  The abuser then hides behind this public image. Ms. Patrick painted a picture of the affluent abuser based on her DV work with over 300 women in the affluent community.  The abuser is often “highly educated or has an advanced professional career,” “looks good on paper,” presents or performs well in public or in court, and is often “involved in philanthropic work.” 

                The victims of DV in the affluent community are often as educated and professional as their abusers and vice versa. Both include engineers, lawyers, religious leaders, entrepreneurs, CEOs and stay-at-home parents. Affluence makes it difficult for the DV victim to admit that anything is wrong because she has so much to lose (reputation, image, status in community, a beautiful home, good schools for her children, a privileged lifestyle).  Money magnifies the power imbalance, for “the distribution of money . . . is sharply skewed in the man’s favor,” putting the woman at an “enormous disadvantage.”   

                The kind of abuse that happens in affluent communities includes not just physical abuse, but emotional, financial, legal, and technological.  Emotional abuse causes the most long-lasting damage because of shame, diminished self-esteem, and fear of being hurt or killed.  Ms. Patrick gave the example of an abuser who was an MD, who held power over his victim by saying “I know ways to make it appear that a woman died naturally.”  Abusers also maintain control through financial abuse, making their partner financially dependent and withholding funds, for instance, or “embezzling” their life savings, or depleting their partner’s resources in other ways.  Abusers use legal abuse by using the court system to their advantage, making the victim look like she is the abuser or punishing her by seeking full custody of the children.    Technological abuse includes using surveillance to keep track of a partner’s whereabouts, inventing false text messages, and using “spousebusters” spyware to listen to her phone conversations, manipulate her phone settings, or monitor her interactions on social media.

                Ms. Patrick concluded her talk by making suggestions to help therapists address the needs of affluent clients who may be experiencing DV.  First and foremost, as with all DV cases, create a safe environment that encourages clients to talk about their experiences.  Help clients to see the abuse for what it is, to recognize and label “financial abuse,” “emotional abuse,” or “technological abuse.” She provided lists of questions to ask clients when abuse is suspected, as well as lists of statements to make to let clients know we are concerned about abuse. Ms. Patrick cautioned never to ask a DV client why she hasn’t left yet; instead, help her to assess for danger in her home and create a safety plan.  Ms. Patrick emphasized doing individual therapy with a DV victim because couples counseling might inadvertently enable the abuser who might use the conjoint therapy to his advantage. When you suspect abuse, Ms. Patrick advises, find good resources for your client.  Informal support groups have been most helpful in promoting safety and helping the women she has worked with to move forward.

    The WomenSV Directory www.womensv.org; http://www.fcservices.org/ includes a list of providers.  You can also reach Ms. Patrick at 650-543-5406 or rpatrick@fcservices.org to ask for referral resources, or for any comments or questions you have about her presentation.

    Janine R. Reed, LMFT, is bilingual Spanish/English and counsels individuals, couples, and families at her Private Practice in Mountain View. Janine also offers therapy groups that focus on writing-to-heal and is a writer herself.

  • Saturday, October 01, 2016 1:07 PM | Anonymous

    On November 13th, 2015 SCV-CAMFT gathered for a wonderful lunch and an extremely thoughtful presentation by Francine Lapides, LMFT.  Ms. Lapides began her talk by reminding us that infants are primarily right-brained and this right-brain development continues for the first two to three years of life.  Attachment templates are stored in the right brain.  The take away is, in order to heal trauma we need to address both the unconscious and conscious areas of the brain.  As therapists we see first hand how these early traumas can shape a person.  Some of these traumas leave us with resiliency while others leave us more rigid.  Francine then took us through some basic neuroscience.  This part of the presentation served as our “infancy” in neuroscience (if we did not already have that knowledge).  Even if you did have prior neuroscience knowledge her information was a great review. 

    She shared a quote from Winnicott, ”There is no such thing as a baby ... if you set out to describe a baby, you will find you are describing a baby and someone.’’  (Winnicott, 1947).  The relationship heals because we are relational beings.  We start life in relationship or if not, trauma is likely present.  We can help our clients make meaning of early trauma.  This healing is rooted in the physiology of neuroscience and is more helpful if done bottom up (or body to head direction).  The limbic system and attachment theory dominate as stated on Ms. Lapides’ slide: “Early life experiences create potent affective ‘knowing’ in implicit, non-verbal, unconscious, memory which underlie and have a profound influence on personality, dominate mood, symptoms, and relationships throughout life.”  

    As we transitioned to the second section of the talk, Ms. Lapides invited someone to come up to the front of the room and summarize what they had just learned about neuroscience.  No one volunteered. There were crickets. We all behaved as though we were glued to our seats. She let the perfect amount of silence play out before she joked that she was just getting our heart rates up so we could feel our prefrontal cortex at work.  As many of you likely know, the prefrontal cortex is the part of our brains that helps us regulate emotion.  Francine’s “experiment” was perfectly set up as a process experiential learning exercise.  We have the basics of neuroscience, we are asked to come talk about it in front of the group and then upon finding out we actually don’t have to, we can then re-regulate.  

    Just like in therapy (week after week), we invite our clients to talk, or draw, or move through their trauma.  They might turn us down but as the relationship and trust grows we can begin to help them heal.  This ability to manage activation helps us access our unconscious beliefs.  There are, as Francine shared, “implicit relational schemas” or unconscious beliefs that all of us have.  For example, we may unconsciously believe that, “If I try to perform and fail, people will think less of me.” These are, of course, the thoughts and feelings we want to target in therapy.  We have seen many of these beliefs in our clients and at times ourselves: “Other peoples’ needs are more important than my own,” “It’s too dangerous to be vulnerable and let others close,” and/or “Something is terribly wrong with me.” (powerpoint slides).  These relational schemas defined by B. Ecker, R. Ticic, & L. Hulley, (2012) dig deep into the root of our work.  

    In the article titled “A Primer on Memory Reconsolidation and its Psychotherapeutic use as a Core Process of Profound Change” (2012) the authors state:  “The emphasis in the Emotional Coherence Framework is on the coherence of the emotional brain—subcortical and right-brain coherence, the coherence that is intrinsic to implicit emotional learnings and, when retrieved into conscious awareness, creates new autobiographical coherence most meaningfully and authentically.”  This quote sums up this section of the talk.  Many of the symptoms we see in therapy are generated by these “implicit (unconscious) relational knowings” (powerpoint slide).

    When she spoke of the “bottom up” way of working with our clients she mentioned poetry because it has more of a right-brain connection.  Using poetry or other right-brain activities with our clients can help them access and heal their trauma.  If at this point you find yourself wishing you had trained more somatically you are not alone.  If you are aware of the work of Pat Ogden and Ron Kurtz, you may be on your way to what Ms. Lapides is urging us to use, more of our right brain.

    The interventions Ms. Lapides offered at the end of her talk were extremely helpful. Instead of asking left-brained questions we can shift statements to a more right-brain experience.  For example, instead of stating “Your father’s anger was uncontrolled and made you feel unsafe”, the right brain is more able to hear, “When you father exploded in rage, you felt terrified and small.”  Instead of offering “It will be important for you to know I’m here”, clinicians can try a more right-brained approach such as asking, “Can you look at me, can you feel me here with you”?  

    If you were at the luncheon you heard Francine’s calm, caring, seasoned voice. It was healing in a room of nearly 100 colleagues.  I hope you get a sense of her way of being from this short description.

    If you are just learning of Ms. Lapides as I did in November, I recommend you seek out training with her.  She’s offering a study group in 2016 focused on the field of  psychoneurology.  This training is designed to help therapists apply the new research from brain science to every day clinical problems in the treatment of emotional, mood, and behavioral challenges we all face, and to untangle the difficulties that can plague us in our most intimate relationships.

    Francine’s upcoming intensive study group will address the question of how this can be done while integrating neuroscience.  She will address the clinical skills of “trusting your intuition, somatic transference, intimacy and self disclosure, rupture and repair,” and much more.  I wish I lived closer to Santa Cruz!  This group will surely be helpful.  She stated, “While the overwhelming bias in western psychotherapy has been a top down primarily left-brain model of conscious and verbal attempts at change, neuroscience is increasingly confirming that we must work in this right brain, unconscious, body-based arena as well.”  

    One could call Francine our local Dan Siegel.  She has studied with him for years and additionally, has been a part of Allan Schore’s Berkeley study group.  Francine Lapides has been a licensed MFT since 1974.  She is a decades-long member of SCV-CAMFT and is in private practice in San Jose and Santa Cruz, California.

    For more information about Francine and her trainings you can reach her through her website at www.francinelapides.com

    Bridget Bertrand, LMFT #83020 is a therapist in private practice working with individuals and children in San Mateo.  She will open a long-term process group in 2016 with her suite-mate Ari-Asha Castalia, LMFT #82973.  She can be reached at bridget@bridgetbertrand.com  


  • Monday, June 27, 2016 5:28 AM | Deleted user

    On Friday, March 26, 2010, Dr. Myrtle Heery, spoke to the SCV-CAMFT Chapter at Michael's at Shoreline in Mountain View.

    Her specialty is in Group Work with an interest in issues of the Aging. Dr. Heery is a Psychology Professor at Sonoma State University and at The Institute of Transpersonal Psychology. She is both a Psychologist and a licensed MFT.

    Most of the talk was about staying present with one's self and with the patient as a psychotherapeutic style. Her work is from the model of Existential Humanistic Psychology. From the start, she taught about the importance of self-disclosure as a way of being real, in the moment, and modeling for a patient. The purpose of this is to further the relationship between the therapist and patient. She reminded us that the quality of the relationship is the most important part of psychotherapy according to the research on successful outcomes.

    Dr. Heery was warm and engaging. From the beginning, she effectively involved the audience in the discussion. She talked about the layers of resistance in all people and recommended the acknowledgement of the resistance without judging. Patients who feel accepted are more open to the change they are wanting in their lives. Mortality is a common thing in all lives. People want to have "meaning" in their lives. Acceptance leads to meaning, and this leads to making "choices" in our lives. It also leads to taking "responsibility" for our lives. People both feel a part of, and apart from, others. Meaning helps to lessen the sense of “isolation.” She told us to be curious and to ask patients about their experiences without judgment. She said that the body always holds resistance, so that we should first notice what our own bodies are telling us, then to notice the other.

    Dr. Heery believes that group psychotherapy is the wave of the future in our field. She recommended that therapists get training in group psychotherapy. She offered a handout on an 18-month training that she is conducting (see www.humanstudies.com). Her style is being with the experience without much “analyzing,” which moves one into their head and away from their experience (our gut's reaction).

    The speaker told us that successful groups come from the therapist's passion for the subject of the group. She mixes process and psychoeducational styles in her groups. Following the flow of a discussion can lead to process work. Successful groups are formed from the leader's passion for the subject of the work. Retention of group members is also a result of the leader's passion for the subject. Dr. Heery strongly recommended individual interviews before allowing someone to join a group (especially for those of us in a private practice). The leader should be very clear about the goals for the group ahead of time. She suggested that we run our goals by other practitioners for their feedback, and for our own clarity.

    Someone asked about "open" versus "closed" groups. Dr. Heery believes that closed groups are best. They provide safety and containment for the patients. Also, the patient's commitment to the group is extremely important and this is to be assessed in the interviews. Her groups tend to be for 8 weeks. She then reassesses the group and asks the patients to do the same. Then, those who want to continue are asked to commit again for the next 8 weeks.

    Another question was about what to do with group members who dominate or monopolize the sessions. Dr. Heery will move the energy around the room by asking the other members about their reactions to the talker "in the moment." Then, she asks the talker about his or her reaction to the comments of the other members. Sadness is often the outcome of not being connected to the other group members.

    Finally, Dr. Heery recommended always handing out a piece of paper at the end of the group with some advice or assignment. People leave with a sense of taking something away from each session.

    Dr. Heery and colleague Dr. Gregg Richardson (a Neuropsychologist) have edited a new book entitled Awakening to Aging, Glimpsing The Gifts of Aging. Sixteen experts have contributed. They are from the fields of psychology, law, gerontology, and spiritual disciplines. The book is available on www.Amazon.com

    Author: George I. Deabill, PhD, MFT
    Presented by: Dr. Myrtle Heery

  • Friday, February 26, 2016 10:14 AM | Deleted user

    On February 26th, 2016, SCV- CAMFT came together at Michael’s on Shoreline for yet another great lunch and wonderfully informative presentation. While feasting on delicious food, we had the pleasure to meet Beth Killough, MA, LMFT, and listen to her present on the topic of Equine Assisted Psychotherapy. Now, for those of you not familiar with this term, equine is a horse.

    We’ve all heard of Animal Assisted Therapy, but most often it is in the context of dogs and cats and sometimes even dolphins. But we might not be as familiar with how horses factor into the therapeutic process. The questions that naturally come to mind include: Where does this type of therapy happen; Do you ride the horse? What if you are scared of horses? What can a horse teach me about myself?

    After Beth’s presentation it all became crystal clear. Let’s begin with the basics. It happens at a barn, with horses (and your therapist) on the ground, for the purpose of learning about ourselves and possibly others through an interactive experience with a horse, in a way that takes away the client’s self report of symptoms and issues and allows for real time and objective observation of behavior and patterns as they emerge.

    Phew, now let’s go into a little more detail...which is what Beth did so eloquently.

    First, did you know that you have an animal body? As Beth pointed out, some people are not super comfortable with this idea, but the fact of the matter is that if you are alive, then you are an animal. Or a plant, but probably not.

    As human animals that live in this world, we experience environmental factors such as noise, crowding, technology, time constraints, stress and general overstimulation. For many, overstimulation leads to a sense of pressure that ultimately can result in “pain.”

    Horses are clear, honest, and congruent... they refuse to accept what is not true for them.

    As an example, Beth shared her experience of simply driving from her peaceful and secluded ranch located in Morgan Hill to the heart of Silicon Valley for this particular luncheon.

    As she turned the corner she was suddenly immersed in traffic and her senses are bombarded with sounds, sights, and smells that were not present moments before. Her instinct was to retreat, to run, to escape.

    However, as human animals we have learned to conform to social rules, to not express our feelings, to not show our weakness

    Beth Anstandig Killough, MA, LMFT and one of her equine therapy partners.

    and to manage the onslaught of sensory overload. We have become accustomed to sitting in traffic, working in small offices, fighting crowds, and multi tasking.

    In order to do this, most of us have learned to shut out certain inputs. We “shut down,” “numb out,” “suck it up,” “check out,” or simply “get through.” But when we are not honest with even ourselves about our experience of overwhelm, it begins
    to build up and starts feeling like increasing pressure, often resulting
    in physical symptoms such as anxiety and depression.

    So what is the alternative? Instead of shutting down, we need to get honest with ourselves. In order to manage the pressure we need to acknowledge it’s there, understand where it’s coming from and address it.

    And herein lies the lessons of the horses: You see, horses do not share our coping mechanisms. When they feel pressure, they in fact retreat, run, escape. They are clear, they are honest, and they are congruent, meaning their outside behavior matches their inside experience, and they refuse to accept what is not true for them. So when they feel pressure in their environment, whether from another horse, a predator, or a human, they respond accordingly.

    As a prey animal, they have an acute awareness of their surroundings. They have the ability to read body language, smell adrenaline, sense your heart rate, detect eye dilation and they rely on these instincts for their survival.

    If they feel pressure, they release it by moving away from it. In turn, they teach us that to release pressure for ourselves, we need to also be clear, honest, and congruent. But
    we don’t necessarily need to run away from it. Human animals have the unique capacity to access our neocortex, which is the thinking and reasoning part of the brain.

    So, on her drive up 101, Beth had to first notice the sense of pressure coming up in her chest, that tightening sensation, and that feeling of not having quite enough air to breathe. And Beth had to be honest that this was her experience, and then become congruent with ho`w she chose to manage it. She decided to breathe through it. She had to consciously bring air into that part of her body that was holding the stress; she needed to release the feelings of anxiety that were increasing. She needed to acknowledge that she was out of her comfort zone and reassure herself that she would be ok.

    Utilizing this process we can learn to manage a myriad of different emotional experiences. Horses are great role models, offering real time feedback of how we are showing up and whether we are being honest or not. Through the horse's feedback, we are invited to dive deeper and gain more self awareness, as well as body awareness, acknowledge our feelings, stop stuffing our emotions, and make different choices. This ultimately leads to improved communication, deeper connections, and a more honest and authentic experience for us in our lives and our relationships with others.

    So, to answer that last question... what can a horse teach me about myself? Everything!

    Presented by: presented by Beth Anstandig Killough, MA, LMFT

    Amy Hublou is a Licensed Marriage and Famliy Therapist and Co-founder of Gallop Ventures. She studied at Pepperdine University and has been licensed for 15 years, with 10 years of pre-licensed training. She provides traditional therapy as well as a variety of Nature Based Therapies with a spe- cial emphasis on Equine Assisted Psy- chotherapy through Gallop Ventures. 

  • Friday, November 08, 2013 5:37 AM | Deleted user
    In his presentation on September 27th for the luncheon meeting of the Santa Clara Valley chapter of CAMFT, held at Michael’s Shoreline, Jamie Moran, LCSW/CGP, addressed the various criteria he uses in assessing individuals for psychotherapy groups. As a highly experienced and certified group psychotherapist in the Bay area, Jamie was careful to distinguish between psychotherapy groups, which work with conflict directly, and support groups, which typically interrupt and reframe conflict.

    Jamie emphasized how one of a group’s important functions is to mirror family as well as current, “here and now” dynamics for a client. This helps set the stage for important repair and re-working of original wounds that a client brings to his or her current relationships; and it provides the client with insight and new ways to address his or her issues outside the group. Most group issues, according to Jamie, involve joint responsibility.

    I appreciated Jamie’s detailed discussion of his screening process and found it very helpful to hear him review how he assesses clients. As part of his handout, Jamie also provided a detailed list of questions that he incorporates in his assessment process. In order to get a good sense of whether a client and a particular group would be a good fit for one another, Jamie spreads his interview out over two full sessions, charging his usual group fee for these meetings.

    Some of the factors he considers are: 
    • Interpersonal issues, especially depression or isolation
    • Client motivation and curiosity
    • Ability to provide and receive feedback
    • Ability to work with issues in the here and now
    • Willingness to deal with conflict
    • Ability to leave the session with unfinished issues 

    Toward the end of each assessment, Jamie expresses any reservations he might have and checks them out with his client. He might refer the client to another group or suggest continuing with individual therapy for a while. He keeps a wait list for full groups and checks-in periodically with clients whom he determines to be a good fit. I like that he does not automatically rule out clients with personality disorders -- the way I had been taught to do in my first internship -- and appreciate his perspective that “moderate Axis II can work in group”.

    After a discussion of assessment criteria for general groups, Jamie turned to placement factors for LGBTQQ clients. He takes demographic profile into account, assessing where a client fits within the group profile, and explores possible impact of the current group on the client. Critical issues such as homophobia, shame, and humiliation typically unfold, and the Therapist’s role is to invite joining of the other members, which helps break through judgment and isolation. Jamie also shared his personal guidelines around members socializing outside of group: i.e., either no socializing between group sessions or, socializing permitted with reporting during group.

    Lastly, he addressed the issue of empathic failure on the part of the therapist, sharing a personal anecdote and emphasizing the value of empathic failure repair. Interestingly, Jamie does not use check-ins to begin each group session. His view is that these serve to increase safety. While check-ins can be useful in support groups, Jamie’s preference for psychotherapy groups is to leave the responsibility of owning or sharing an issue with each individual group member.

    Jamie Moran has offices in San Francisco and Menlo Park where he works with individuals, couples, and groups. He is currently leading six different groups; he also coaches and offers various workshops and in-service presentations throughout the U.S. I found Jamie's presentation both thought-provoking and highly informative. As someone who enjoys facilitating support groups, I feel inspired to incorporate some of his techniques in my own groups.

    Author: Elanah J. Kutik, MA, LMFT
    Presented by: Jamie Moran, LCSW, CGP
  • Friday, August 26, 2011 5:31 AM | Deleted user
    "It is difficult to talk to patients about the relationship in the room", said Teri. "It‘s scary, it‘s vulnerable, it brings out our humanness. Nonetheless, it is a powerful therapeutic technique".

    The next ninety minutes were spent discussing why it is important, why it is challenging, and ways to make it a little less difficult. The importance of the relationship in psychotherapy is illustrated in an article published twenty-five years ago in the American Journal of Psychiatry entitled "Can We Talk".

    A patient with schizophrenia gave an account of how her therapy had helped her, and given her hope in her desperate struggle with mental illness. She said, For a long time, I wondered why my psychiatrist insisted on talking about our relationship. Our relationship was not the problem. The problem was my life. But she came to understand that the relationship with her psychiatrist was her first real relationship. She was able to bring that experience into her life in such a way that she finally felt like a part of the world and felt safe in it. In other words, the key to success in her therapy was the relationship between herself and her therapist, and talking about that relationship.

    Why is it so difficult for therapists to talk about the relationship? One reason is that it is hard to recognize transference and to acknowledge how thoroughly all our relationships are built on our own fabrications as much as on reality. Another reason is that the patient often does not want to talk about it. Teri recalled the time, years ago, when her own therapist asked her how she thought the relationship was going. "It was a straightforward question, and I remember feeling completely undone by it. The fact was that I had come to respect, idealize, and (by that time even in some respects) love my therapist. I felt seen, I felt tolerated, and I wanted to emulate her. But I also felt like a psychological cretin in her presence".

    With a comedian‘s pause, she revealed to the audience the very brief answer she gave to her therapist‘s question. "I remember my answer in the moment. I think I said, "Fine", she dead-panned. The audience laughed appreciatively and knowingly. ?But that wasn‘t the truth of it--not by a long shot, she continued. The point is that talking about the relationship can be threatening to the patient.

    Early on, Teri turned the audience into the familiar territory of a classroom, complete with small-group discussions, to explore what we do as therapists. Specifically, do we bring the relationship into the room; how do we do it; what are the difficulties; what is its impact? A show of hands among this audience gave the result that only a few discuss the patient-therapist relationship frequently. The large majority of therapists in attendance rarely, or only occasionally, discuss it.

    It is a given that our patients have a relationship with us. Not only may a patient experience the first real intimate relationship with his or her therapist; but it may be multiple relationships, such as his mother, his wife, his sister, or his lover. Simply put, transference is the imaginary relationship that we all experience, especially with those who have power over us. It is imaginary because it is built more on our imagination than on how the relationship actually is. Transference is hidden in plain sight, discernible in the patient‘s anxieties.

    Anxieties arise from the inevitable misses in the interactions between child and caregiver. Parents, even good parents, can only approximately ?get us?. We respond in a predictable pattern to those misses, and unconsciously carry that attachment style into adulthood. In one study, even in good enough homes, micro-misses were recorded at the astonishing rate of one in every 17 seconds. Nonetheless, in those homes, the misses are tolerable. However, in others, the misses are egregious and chronic, and can cause a range of anxieties that we handle by anticipating them and bracing for them, to a greater or lesser degree. ?All of us have been practicing our counter-moves since we were born, said Teri. We super-impose familiar ways of relating onto new relationships. We also, without being conscious of it, exert pressure on others to behave in ways that are familiar to us, especially on those persons upon whom we most depend, including our therapist. This makes us feel more secure because we know what to expect. From the first contact with us, our patients begin to have impressions of us, shaped by their own early relationship experiences. Those impressions can be startlingly disparate from one patient to another. An illustrative case: at the end of one quarter, Teri did an experiment by asking her students to each give a one word description of how they saw her. The diverse answers that came back were: wise, smart, controlling, open, elusive, kind, engaged, present and obsessive-compulsive.

    The therapist can use these impressions, in other words the transference, in the therapy, because in one way or another, the patient‘s world outside replicates itself inside the room.

    So instead of having to try to handle patients‘ problems remotely, the therapist can deal with them directly in the relationship that is in the room.

    Since using transference and talking about the relationship is so important, and yet so difficult, how do we do this?

    We can use both transference and countertransference, and ask ourselves these kinds of questions: What does it feel like to my patient to be in my presence? What is my sense of myself in this patient‘s presence? What is the feeling in this room? Are they deferential? Are they trying to obliterate the divide between us? What does it feel like to me to be on the receiving end of this patient? How does my body feel in his or her presence? This work is delicate and cannot be rushed. "We are inviting our patients to disarm in a war zone", said Teri. There must be a profound respect for what that client has had to deal with, and recognition that the set of assumptions they are using has saved their emotional lives. But in the end, as Freud said, "It is on the field of transference that the victory must be won".

    It is not always necessary to inquire into transference, for example when the energy in the room is fine and secure. But if there is anxiety in the air, if something is different, or off, there is no option except to go to the relationship, because if you don‘t, you will not be able to do anything else. Also, if a patient does not respond to an overture to talk about the relationship, the therapist should wait for the right time to emerge. In Teri‘s experience, it always does, sooner or later.

    Author: Michal Sadoff
    Presented by: Dr Teri Quatman

  • Thursday, July 01, 2010 5:24 AM | Deleted user

    Eddie Subega, MFT, granted us the heartfelt wisdom of the richness of his 30 years of experience working with assessment and suicide prevention. Currently, a lead clinical supervisor with the Santa Clara County Suicide and Crisis Hotline, Mr. Subega’s crisis assessment and intervention experiences span the range from Alum Rock Counseling Center to the Santa Clara County Mobile Crisis Unit, and more. Refreshingly, Mr. Subega started out the luncheon with his brilliant smile and the humble confession that, I always felt I knew nothing!

    He immediately blasted the idea that experts exist, proposing that we all have a piece of the wisdom that will heal hopelessness and despair. Soberly, Mr. Subega informed us that 93 people committed suicide last year in Santa Clara County - far outnumbering homicides.

    Attempting to be completely in the present, here and now, following the client’s emotions in a non-directive way, and being unafraid to say, "I don’t know," are techniques Mr. Subega utilizes in joining in a nonjudgmental manner with a suicidal client. As clinicians, we do not have to hold all of the answers for our clients in crisis or be ?right? about their immediate needs, but we must connect with them in order to ensure their safety. If clinicians enter into the frenzy of "fixing" in the moment of crisis, Subega has witnessed how this destructively fuels the fire of fear, tension, and agitation in the moment.

    Subega provided practical tips for obtaining appropriate responsiveness from EPS and other emergency services: 1) take time to assess the client thoroughly before sending the client to EPS, 2) call before they go, and 3) describe, with clarity, the urgency of the situation. When calling the police or sheriff’s office, clinicians may specifically ask for a Crisis Intervention Team (CIT) officer.

    Subega brought us back to critical basics, reminding clinicians that bringing up suicide to a suicidal person gives permission for the person to speak their feelings, thus decreasing the suicide risk. Mr. Subega emphasized that clinicians need to value and utilize our interconnectedness as colleagues, and to depend upon one another as we learn to trust ourselves in supporting clients in extreme crisis.

    Mr. Subega lavished upon us important reminders of self-care – a structural paradigm which we, as clinicians, need to draw from, in order to do our work effectively. To paraphrase Mr. Subega’s compassionate and encouraging words for clinicians: There’s only one of you, so don’t spoil it by trying to be someone else; You are the way you are and you’re not the way you’re not; You are just right as you are; and finally, You are enough. Mr. Subega imparted to us that as we continue to internalize that we are enough, and come to rely upon our community of Santa Clara County MFTs, we will find that we hold enough energy, support, and knowledge to be effective and supportive of each other, as we strive to provide excellent treatment and care to suicidal clients.

    Author: Michelle Myers, MFT
    Presented by: Eddie Subega, MFT

  • Wednesday, December 16, 2009 5:21 AM | Deleted user
    When you hear the term mindfulness in a psychotherapy context what thoughts do you come up with? Do you wonder how mindfulness practices can be used in a private practice setting? Do you think that mindfulness doesn’t fit with your approach or modality?

    Lisa Dale Miller’s July 24th, 2009, presentation provided an introduction to Mindfulness-Based Psychotherapy (MBP) and its uses in private practice through discussion and interactive case examples.


    She began by saying that mindfulness tools can be used no matter what modality or techniques of psychotherapy we use and that they can be the most powerful homework we can give to our clients. Mindfulness is paying attention to the present moment with a compassionate, open curiosity. Mindfulness practices provide a set of skills that help clients recognize what is actually arising within and without, and realize they always have a choice in how they respond.

    Miller read the poem The Real Work by Wendell Berry. She referred to the state of mind in Berry’s poem as “don’t know mind” and acknowledged that for many clients “don’t know mind” brings up powerful feelings of fear. This fear often arises when the client thinks she knows what will happen and it is usually the worst-case scenario. Miller further pointed out that when clients voice fears of uncertainty, more often than not, they are fixated on an automatic, habitual form of catastrophic knowing and unwilling to directly experience not-knowing. Mindfulness is a set of skills to get the client focused on fear and boredom. It opens the door to what is really going on, not just what a client tells herself and provides a means to examine this from a calm and peaceful state.

    Mindfulness has been linked with analytic psychology for almost 40 years, introduced by Jack Engler, Ph.D., and others. Jack Kornfield, Ph.D., Joseph Goldstein, Ph.D., and Sharon Salzburg studied Buddhist meditation in India, Burma, and Thailand and returned to the U.S. in the early 1970s to teach insight (Vipassana) meditation. Kornfield and Goldstein became psychologists and have spent many years training psychotherapeutic professionals in applying mindfulness to psychotherapy. Another pioneer, Jon Kabat-Zinn, M.D., founded the Stress Reduction Clinic at the University of Massachusetts Medical School in 1979, and created the Mindfulness Based Stress Reduction (MBSR) program.

    In the last ten years, MBP has come into its own. MBP combines psychodynamic and cognitive behavioral interventions, with mindfulness and heartfulness meditation practices, to awaken insight and promote active change in clients.

    The two pillars of MBP are mindfulness and heartfulness. Mindfulness meditation brings about calm, clarity, and insight, while heartfulness meditation cultivates emotional healing. Mindfulness meditation develops attentional concentration and insight. Concentration practices cultivate mental calm, stability, and vividness, primarily through mindfulness of breath meditation. Insight is cultivated through direct knowing of internal and external phenomena as they arise and pass away, not being lost in conclusions or judgments about them. It is paying attention to pleasant experiences, painful experiences, and neutral experiences, with curiosity and openness. This helps bring about wisdom and equanimity. Insight meditation provides recognition of the impermanence of all phenomena and direct experience of habitual mental reactivity to aversion and craving. The experiential focus it provides serves as an antidote to negative internal narratives, hatred, instability, and ignorance.

    The heartfulness aspect of MBP includes tools for emotional healing through the development of compassion and loving-kindness for oneself and others. Miller related that it is her experience that most people who come for therapy suffer with some form of self-loathing. She theorized that self-hatred, self-judgment, self-blame, and self-doubt are at the root of much of the suffering people experience. Through the practice of loving-kindness and compassion, we can help our clients cultivate safety, well-being, health, and ease, while providing an antidote to self-generated ill-will, self-hatred, and self-judgment.

    After her overview, Miller took case examples and questions from the audience. In brief they are below.

    Question: Can MBP be used with children? I see an 11-year-old girl who is fearful, what mindfulness practices could I use?

    Answer: Yes, mindfulness can be used with children. Until the age of 12, only walking meditation is advised. You can teach a child to walk slowly and pay attention to her breath. For the 11-year-old, I would consider both guided imagery to help her find safety in her own body and loving-kindness meditation in the form of a game or song.

    Question: What about with a 9-year-old boy who is afraid of death?

    Answer: Don’t negate it. Bring up the question of what death may be like, have an open, frank, clear discussion of what he thinks death is, where he thinks we go when we die, etc. Be creative. This may help you understand his fear. Then introduce some anxiety-reducing techniques.

    Question: How would you work with a mother who adopted three kids with extensive trauma and failed adoptions, who then become her caretakers? There is marital tension and she seems to be developing an anxiety disorder. Her husband is disappointed in her household duties and now she can’t talk to him.

    Answer: This is a family system problem — the couple needs to be strengthened, get on the same page and support each other. Mindfulness would add tools for sanity. You can’t get rid of their pain, but you can give them tools to lessen their suffering. It sounds like mom has a low opinion of herself and feels deeply incapable. Her husband may be triggering her deep wound of self-loathing and self-blaming. When we work with a couple, we can give them the skills of compassionate recognition of the other’s suffering. Model and teach through mindfulness how to think before responding and how to respond from an open inquiring place rather than assumptions. Combine the tools for heartfulness with tools for self-awareness.

    Miller ended the talk by sharing her intention to offer a MBP consultation group for clinicians. For more information we were directed to her website: http://www.lisadalemiller.com/mbpsych.htm.

    Author: Robin Mullery
    Presented by: Lisa Dale Miller, MFT

SCV-CAMFT               P.O. Box 60814, Palo Alto, CA 94306               mail@scv-camft.org             408-721-2010

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