What Silence Taught Me: Six months with no voice

I began seeing that most of what came out of my mouth was about my discomfort with silence. It felt too naked. My incessant talking was a way to fill the void. As I accepted that I couldn’t sing, and I couldn’t speak, the voice in my head began to quiet.

I had a sobering experience several years ago. Not the Betty Ford, detox, sobering kind, but the life changing, you-gotta-be kidding, “Help Me Rhonda” sobering kind.

You know how people have that sexy whispering voice? Well, I woke up one day and sounded like that—sore throaty and sexy sounding. I’m thinking, “OK, I guess this is what laryngitis is,” and of course I immediately wanted to change my answering machine.

“Hi… this is Susan…Oooooh…you know what to do…”

But as the day went on, I intuitively felt something was definitely wrong. By the end of the day I went from sounding like Lauren Bacall in “The Big Sleep” to Darth Vader, double reedy and very breathy.

Personally, I’m natural in my approach to life and not quick to run to Doctors, but given my foreboding sixth sense, I went straight to the Vatican: The ear, nose and throat specialist.

He checked my throat every which way. He finally looks up and says, “Your vocal chord is paralyzed.”

I said, “_ _ _ _!”  (By that time nothing was coming out.)

He looked at me grimly, “98% of people who have this kind of paralysis never get their voice back.”

You know those moments in life where you get all hot and have that feeling in the pit of your stomach? This was definitely one of them. “Oh God,” I thought. “_ _   _ _ _,” I said.

Then something clicked inside of me. My whole being went, “No Way! How dare you tell me my voice won’t come back! Just watch me!”

But this is not a “poor me” story. Believe me; compared to most, I’m a lucky pig. This was my first introduction to silence, which, coming from a New York Jewish background is more foreign than eating pork, hunting and buying retail combined.

It took almost 6 months, but I was finally able to speak, shout, and even sing (my dancing, not so good).

The experience of not being able to use my voice was stressful and frustrating to say the least, especially when I was outside. I felt vulnerable with no voice. Could I get help if I needed it? Asking directions was completely out of the question. So was a simple, “Hi” or “Good Morning.” I perfected the guy nod, you know, slight jerk with the head and no eye contact. When I tried to speak, the little that did come out sounded hideous. People would respond by talking extra loud, like if they could hear it in the Philippines somehow I would too.

My heart cried with compassion for people that are handicapped in this society and raged at the stupidity of the rest of us. But as frustrated as I was, silence was becoming my teacher.

I began seeing that most of what came out of my mouth was about my discomfort with silence. It felt too naked. My incessant talking was a way to fill the void. I saw how my personality and jokes were most often coming from a place to get people to either like me or regard me in a certain way. I saw that talking was a way to control, to feel safe. I saw that words can actually push us apart, connecting us only from our heads, instead of full out with our hearts. As I accepted that I couldn’t sing, and I couldn’t speak, the voice in my head began to quiet.

One morning I woke up and realized: It was a relief!

Noise has taken over our lives. Instead of listening to our inner soul, to nature and each other, we are listening to a drone of 24-hour perky, news casting, talk-show experts pushing fast relief, cubic zirconium and pharmaceutical miracle cures.

All this noise is beside the point and leaves us emptier and emptier. If you are having trouble in your life or in your relationships, take the time to listen. In the space of silence you will find your answers. In stillness there is everything.

OPTIONAL ASSIGNMENT

Take one day out of your life and get silent.

Let it surround and enter you.

At first your mind will seem as noisy as a Chihuahua on amphetamines, but hang in there; just allow it.

In time the volume decreases, and you’ll find that you’ve become more present and more peaceful.

The bottom line: it’s what’s inside of our own heads that makes the world so truly noisy.


This blog has been brought to life by PESI speaker Susan Pomeranz, MFT, B.B.S.E., Certified Hypnotherapist, Certified Tai Chi Leader, Psychotherapist. Susan has had over 20 years in private practice in Los Angeles. After a flourishing practice, Susan began experiencing the devastating and far reaching effects of burnout, and not having a framework for prevention nor treatment to draw from, spent five years researching and compiling evidence based practices that reduce stress and beneficially change the neurochemistry of the brain.


In a field that is filled with unremitting stress, where can you go to restore your sense of self and purpose? Get the answers from Susan Pomeranz in this CE seminar on DVD. Bonus: you’ll earn CE from the comfort of your home!

DVD: Burnout

Yoga for Trauma Treatment: 3 somatic interventions

When you use trauma-sensitive yoga as a therapeutic intervention with your clients, part of your role is to monitor the state of your client’s autonomic nervous system, and to use somatic interventions when they need to bring it back into regulation. Here are 3 somatic interventions you can use with your client.

In recent years, trauma experts have come to understand that psychological trauma can occur when the body cannot move to escape a threat. Recognized authorities, Doctors Bessel van der Kolk and Peter Levine, have confirmed that following the traumatic incident, patterns of immobility can remain stuck in the body, limiting the client’s connection with their inner and outer experience. Helping your client to explore body movement can be essential to trauma recovery. Research has shown that yoga can be a safe, gentle way to help your clients become reacquainted with their body and regain the ability to move.

But when it comes to yoga, not all styles are created equal. Trauma-sensitive yoga, in particular, is a safe, gentle style which helps your client re-regulate their nervous system and recover from trauma.

When you use trauma-sensitive yoga as a therapeutic intervention with your clients, part of your role is to monitor the state of your client’s autonomic nervous system, and to use somatic interventions when they need to bring it back into regulation.

Here are 3 somatic interventions you can use with your client:

  • Ask your client to shift his or her focus from the thoughts and emotions—that may be skewed to the negative or focused on a perceived threat— to the positive body sensations experienced in a yoga pose.
  • Pause the narrative and engage in a regulating activity, such as taking a deep breath.
  • Interrupt and slow down habitual movement patterns, allowing your client to break through to a deeper awareness of what is happening in his or her body.

Practicing yoga postures can give your client additional experience and skill in achieving these shifts, and this approach encourages the client to keep their cognitions in the positive zone, where healing occurs.


This blog was brought to life by PESI speaker Joann Lutz. She has been training mental health professionals to bring trauma-informed yoga into their healing work nationally and internationally for the past six years, bringing this work to universities, conferences, hospitals, ashrams and yoga centers.


Would You Chain Your Client to a Tree?

You don’t have to tell Martha Teater about the mental health crisis in Africa. She’s witnessed the tragedy with her own eyes. Here she describes her time spent at the only Zambian psychiatric hospital where the patients appear to be either clearly psychotic and agitated, or over medicated to the point of drooling and appearing almost catatonic.

A recent New York Times article and video shed light on the gruesome plight of Africans with mental illness. Graphic images of mentally ill people chained to trees or cinderblocks for years on end seem unbelievable. Surely these barbaric conditions can’t really be happening.

But they are.

And in the time it takes for you to order and receive your pumpkin spice latte, you can see it with your own eyes by viewing the video or reading the article from the New York Times.

Having traveled to Zambia recently, I witnessed the abysmal state of mental health care there. I can tell you first-hand how mental health services in Africa lag decades behind care in developed countries.

In many African countries there is wrenching poverty coupled with a lack of resources. In Zambia, there are 6 psychiatrists for a country of 15 million people. There is one psychiatric hospital.

I was stunned by what I saw in the psychiatric hospital. The severity of people’s needs and the lack of appropriate care were tragic. People there were severely mentally ill with conditions like schizophrenia, alcoholic psychosis, unstable mania, and AIDS-related psychosis.

The only medication used was Haldol, an older antipsychotic that is rarely prescribed in the U.S. due to its side effect profile. Some of those side effects include a mask-like expression, muscle spasms, twisting body movements, a shuffling walk, and drooling. This medication costs about $4 per month in the U.S., but even at that low price few Zambians can afford it.

People seeking treatment in the mental hospital appeared to be either clearly psychotic and agitated, or over medicated to the point of drooling and appearing almost catatonic. There was no structured therapy, activities, or rehab services. People wandered around glassy-eyed and confused, or slumped and dazed on the dirt floors.

The glaring lack of resources was evident as I worked with medical students to guide them in dealing with mental health issues.

Photo: Martha Teater, MA, LMFT, LCAS, LPC, with Zambian medical students.
Martha Teater, MA, LMFT, LCAS, LPC, with Zambian medical students.

In Zambia, medical school lasts for about 6 years beyond high school, and those attending will be trained to be general physicians since there aren’t residency programs around. They receive very little training in mental health issues even though that is a large part of what people present with. Most students are trained in Zambia and remain there to practice medicine.

The lack of options available to those suffering is staggering.

Therapy? Nope…there are no therapists to be found.

Maybe the person could try a 12-step program? Sorry…none exist.

How about a psychiatric referral? Not an option…no psychiatrists are around.

Could we refer to an addictions treatment center? We could…if such a thing existed.

There are many reasons for the complete lack of mental health care in Africa: abject poverty; stigma; belief in witch doctors; lack of therapists, psychiatrists, medications; conflict and war; and the devastation of AIDS.

It would be easy to feel defeated and discouraged by this tragic situation. But frustration isn’t productive unless it moves us to action. Here are two solid ways to help:

• Photographer Robin Hammond has documented this situation in his book, Condemned, and has issued a call to action.

• Gregoire Ahongbonon founded the advocacy group Saint Camille-de-Lellis and is a champion in this work. Read more about his work.

As Ahongbonon says, “…as long as there is one man in chains it is humanity that is chained.”


This blog was contributed by PESI speaker Martha Teater, MA, LMFT, LCAS, LPC. Martha trains across the U.S. and internationally on such topics as compassion fatigue, DSM-5, and the treatment of trauma. A prolific writer, she has published over 175 articles in newspapers and magazines, and is the coauthor of Overcoming Compassion Fatigue: A Practical Resilience Workbook.


Join Martha to sharpen and enhance your ability to treat trauma with the most effective, evidence-based treatment approach. Bonus: You’ll earn up to 6 CE hours all from the comfort of your own home.

DVD_Treating_Trauma_with_CBT


Read more from Martha!

Does Sugar Mimic or Increase ADHD Symptoms?

Have a cranky, irritable, and unmotivated child or teen that cannot concentrate well? Perhaps sugar-loaded foods are to blame!

The following is based on the new release: ADHD: Non-Medication Treatments and Skills for Children and Teens A Workbook for Clinicians and Parents: 162 Tools, Techniques, Activities & Handouts by PESI author Debra Burdick, LCSWR, BCN.


Have a cranky, irritable, and unmotivated child or teen that cannot concentrate well? Perhaps sugar-loaded foods are to blame! Eating foods high in sugar results in a surge of sugar in the bloodstream followed by a dumping of energy a short time later.

Your hyperactive client may be sensitive to the effects of sugar, and they may become extremely hyper when they have it. But as their body adjusts to a sudden increase in blood sugar, it will trigger an increase in insulin which will rapidly lower the sugar level in the blood. As the blood sugar level decreases, it can worsen the already low brain arousal level of the ADHD child or teen and aggravate behavioral problems.

Studies are contradictory about the effects of sugar on hyperactivity and behavior, and many indicate no change in symptoms (Wolriach, ML, 1994). Yet many of my clients have discovered that sugar was a culprit in making symptoms worse.

Discover if sugar is impacting your client’s ADHD symptoms by downloading and completing the following worksheets with your client. You’ll find skill building and integration thoughts below.


Worksheet Downloads

Handout 19.1.1. | Food Diary 

Handout 19.1.2. | Food Symptom Diary Example

Handout 19.1.3 | Food Symptom Diary


SKILL BUILDING: Find out how much sugar your client consumes. Help them keep track by using a Food Diary (Handout 19.1.1.) to write down everything they eat for 1-2 days. Review it with them to see what food choices they are making and how much sugar they are eating. Teach them to look at food labels, and show them where the sugar content is listed. Discuss with parents, older children and teens the effects of sugar on the symptoms of ADHD.

Explain that sugar affects some people with ADHD by increasing hyperactivity, poor concentration and irritability. If they consume a lot of sugar, use the Food Symptom Diary (Handout 19.1.3) to determine if sugar is increasing and/or decreasing their ADHD symptoms. You can see a completed example of the food symptom diary using Handout 19.1.2.

Explain that the glycemic index (GI) is a scale that indicates how fast the body will convert a particular food to glucose (sugar). The higher the number, the faster the rise in blood sugar will be. A low GI value is 55 or less, medium is 56 – 69 and high is 70 or more. Encourage them to serve foods that have a low glycemic index.

For example: One 20-ounce bottle of a popular orange soda contains 83 grams of sugar. That translates to 21 teaspoons of sugar. They might replace that with a flavored water such as 0 calorie SoBe® LifeWater Fuji Apple Pear which is sweetened with a stevia extract and has 0 grams of sugar. (At the time of this writing stevia has been found to be safe and non-toxic, but as always, encourage clients to consult with their doctors before use.)

INTEGRATION:

  • How much sugar is the client consuming?
  • How much impact is sugar having on the client’s ADHD symptoms?
  • Were they able to complete the Food Diary?
  • Did they discover a pattern of increased ADHD symptoms following consumption of sugar when they completed the Food/ Symptom Diary?
  • Are they finding ways to decrease sugar intake?

Get over 100 more tools, techniques, activities and handouts in the new ADHD Non-Medication Treatment & Skills for Children and Teens workbook.

ADHDBurdick


Learn more from Debra! 


Reference: Wolraich, M.L., Lindgren, S.D., Stumbo, P.J., Stegink, L.D., Appelbaum, M.I., & Kiritsy, M.C. (1994). Effects of diets high in sucrose or aspartame on the behavior and cognitive performance of children. New England Journal of Medicine, 330(5), 301–7.


Go ahead—put some love into yourself. (We dare you)

Now I’m not proud of this, but I’ve been known to pretty much drive folks off the road so I’m not late for my Yoga class. We’re all so busy running around to get it all done that it’s easy to forget the real deal: the peace and possibilities that comes from being in the moment.

Most of us are so crazy busy helping others and living our lives that unless we’re getting up at 4 am for some kind of group meditation at a Zen retreat, our lives don’t lend themselves to the time it takes to deepen any kind of mindful practice. We can actually create even more stress and tension just trying to pull off some kind of balance for ourselves.

Now I’m not proud of this, but I’ve been known to pretty much drive folks off the road so I’m not late for my Yoga class. We’re all so busy running around to get it all done that it’s easy to forget the real deal: the peace and possibilities that comes from being in the moment.

We can do Yoga, or we can be Yoga.
We can practice Mindfulness, or we can just be mindful.

It doesn’t take much.


Try this:

• Close your eyes.

• Take one minute. That’s it: 60 brief seconds.

• Take your hands, and lovingly stroke your face.

Don’t wait for someone else to do it, stroke your sweet face.

No one’s looking.

…Go ahead, put some love into yourself.

Take moments like these throughout the day.

In these simple moments, you’ll find all that you’ll ever need anywhere; the present, cut loose from the past, and unhindered by the future. And in each precious moment lies our freedom from fears, confusions, attachments and memories.

Every second, of every moment, offers us a door into the present which grants us such deep liberation.

Mindfulness is just saying yes to the present moment.


This blog has been brought to life by PESI speaker Susan Pomeranz, MFT, B.B.S.E., Certified Hypnotherapist, Certified Tai Chi Leader, Psychotherapist. Susan has had over 20 years in private practice in Los Angeles. After a flourishing practice, Susan began experiencing the devastating and far reaching effects of burnout, and not having a framework for prevention nor treatment to draw from, spent five years researching and compiling evidence based practices that reduce stress and beneficially change the neurochemistry of the brain.


In a field that is filled with unremitting stress, where can you go to restore your sense of self and purpose? Get the answers from Susan Pomeranz in this CE seminar on DVD. Bonus: you’ll earn CE from the comfort of your home!

DVD: Burnout


Joaquin’s Deadly Fury: How to help others while not hurting yourself

The same CBT techniques that you may suggest to your clients can be equally beneficial to you in preventing compassion fatigue. If thoughts identified in a distressing situation involve a “what if” or “worst case scenario” thinking pattern, a technique from the book Overcoming Compassion Fatigue can help. Bonus: Free worksheet “De-Catastrophizing When Thinking the Worst.”

We’ve all seen horrific images in the aftermath of an angry hurricane Joaquin. Seeing massive flooding, loss of life, and a container ship presumably lost at sea with 33 crew members on board can leave us emotionally ragged even if we’re safe and dry in our own homes.

Worse than the devastating impact on property is the human toll of the storm. In his wake, Joaquin leaves grieving families and sorely traumatized people.

How can we better support the survivors of such overwhelming experiences? Whether our clients have been through a natural disaster or trauma of another form we have the obligation to provide the best treatment possible to help them recover.

When working with traumatized people we’re all at risk of developing compassion fatigue. Also known as vicarious traumatization or secondary traumatic stress, the symptoms can be disabling and overwhelming. Most professional ethical codes include a mandate around provider self-care.

The same cognitive-behavioral therapy techniques that you may suggest to your clients can be equally beneficial to you in preventing compassion fatigue. If thoughts identified in a distressing situation involve some “what if” or “worst case scenario” thinking pattern, the following technique from the book Overcoming Compassion Fatigue can help.

The steps involved include:

  • Identifying what future negative outcomes are being predicted.
  • Consider how likely it is that each of these will actually occur (de-catastrophizing).
  • Consider the worst outcome and what the consequences would be (de-awfulizing).
  • Asking, “How awful would it actually be if that did happen?”
  • Identifying what coping strategies could be used to deal with it.

Download and print the worksheet: De-Catastrophizing When Thinking the Worst to help explore the probabilities and consequences of negative predictions.

If you’re struggling with compassion fatigue in the wake of a catastrophe, utilizing CBT resources will help you treat traumatized people with a solid evidence base while you protect yourself from the risks of helping people weather the storms that come.


This blog was contributed by PESI speaker Martha Teater, MA, LMFT, LCAS, LPC. She is a co-lead of the Red Cross national headquarters disaster mental health support program and provides support for international deployers as well. These interventions are designed to prevent development of vicarious traumatization among those who help people who’ve gone through natural disasters or other traumas. A prolific writer, she has published over 175 articles in newspapers and magazines, and is the coauthor of Overcoming Compassion Fatigue: A Practical Resilience Workbook.


Join Martha to sharpen and enhance your ability to treat trauma with the most effective, evidence-based treatment approach. Bonus: You’ll earn up to 6 CE hours all from the comfort of your own home.

DVD_Treating_Trauma_with_CBT


Read more from Martha!

C.C. Sabathia and You: Help your clients assess their drinking privately

Yankees pitching sensation C.C. Sabathia has announced that he will miss the post-season this year to get treatment for a drinking problem. People who know him are saying they didn’t realize he had a drinking problem. Are we also missing signs in the people we serve?

Yankees pitching sensation C.C. Sabathia has announced that he will miss the post-season this year to get treatment for a drinking problem. If he is part of the post-season at all, he’ll be watching it from his room in a Connecticut alcohol treatment center.

Sabathia seemed to have it all: $25 million salary (the 4th highest in baseball), endless raw talent, a philanthropic organization of his own, a lovely wife, and four beautiful children.

Often termed a “gentle giant”, the 6’7” Sabathia has had a very public stumble. As tough as the scrutiny of the masses may be, his internal struggle has probably been even more grueling.

People who know Sabathia are saying they didn’t realize he had a drinking problem. They had seen no signs. Are we also missing signs in the people we serve? How many of our clients (and family, friends, coworkers) also have a private struggle and could use our support?

Clearly this is an issue faced by millions of Americans in every walk of life. If we can open our eyes (and theirs) we have a chance to help people get the help they need before the consequences build to a dangerous level.

If you think your client may be facing a problem with alcohol you may want to check out these resources. Both of these are online and can be taken privately and used to assess the likelihood of an alcohol problem:

We can all learn from Sabathia’s experience and work to help folks catch issues early and do whatever it takes to recover.

Even when it means missing the post-season.


This blog was contributed by PESI speaker Martha Teater, MA, LMFT, LCAS, LPC. Martha brings expertise, experience, and insights drawn from a career as a respected clinician, international trainer, and author. A prolific writer, she has published over 175 articles in newspapers and magazines, including Psychotherapy Networker and Family Therapy Magazine. Check out a preview of Martha’s article: Shedding Light on the DSM-5®: The View from the Trenches.


Book: Overcoming Compassion Fatigue