Teflon for Cravings

Cravings and urges are like powerful gusts of wind that can appear quickly and powerfully. If you’re not ready, these gusts can spin you out of control and sap your ability to stay on course, not to mention diminish your clarity and resilience. To better manage unexpected (or familiar) cravings, do this…

Cravings and urges are like powerful gusts of wind that can appear quickly and powerfully. If you’re not ready, these gusts can spin you out of control and sap your ability to stay on course, not to mention diminish your clarity and resilience. To better manage unexpected (or familiar) cravings, do this:

— How —

  1. Get curious about the craving instead of fighting it or giving into it. You can inquire:
    • How intense is this craving?
    • How frequent is this craving?
    • Where is the craving located—is it in the body or is it in the mind?
    • Was there a feeling that preceded this craving—such as loneliness, sadness, abandonment, or boredom, etc.? Give this feeling a name.
    • Does the craving really address the underlying feeling? Or, is it just a temporary escape or distraction from an uncomfortable feeling?
  2. Notice and rate the intensity of the craving on a 1-5 scale, with 5 the greatest intensity.
  3. Observe and monitor the craving for 1-3 minutes. Notice how the craving is temporary and not permanent, and how its intensity changes over time.
  4. Notice how observing and accepting a craving or urge lets you detach from it, even slightly.
  5. Not that you have disengaged, consider an alternative choice, behavior, or distraction that turns you away from the craving and toward a more beneficial direction.

— When —

Become Teflon for cravings whenever you find clarity is being lost due to a craving. This approach lets you outlast the craving, learn more about yourself, and be less vulnerable to unhealthy cravings over time.


Sign up for a FREE CE video: One Minute Mindfulness featuring Donald Altman, M.A., LPC.

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This blog is based on the writing of Donald Altman, M.A., LPC. You can read more in Donald’s book, 101 Mindful Ways to Build Resilience


Donald Altman is a psychotherapist, award-winning writer, former Buddhist monk, teacher and adjunct faculty at Portland State University. He is also a faculty member of the Interpersonal Neurobiology program at Portland State University and teaches various classes blending mindfulness and Interpersonal Neurobiology.

Behavioral Stress Tolerance Plan: A worksheet for therapists and clients

An excellent way to manage both your stress and your client’s is to incorporate a Behavioral Stress Tolerance Plan. Get the worksheet and find out how it’s different from most emotional management plans.

This morning I got up late, couldn’t find the toothpaste, and was down to my last pair of matching socks. In Houston, the traffic is as variable as a Loch Ness Monster sighting making my hectic morning more frazzled. I arrived late to work, had 78 emails to respond to, prep work for client sessions, and a nagging insistence to confirm an automatic bill payment. Top all of this off with the fact that I hardly slept last night; constantly alerted by a short in our alarm system going off randomly between 1:00am and 4:00am.

Needless to say, I am stressed and tired. I’m not alone. One-third of Americans are living with extreme stress and nearly half of Americans believe that their stress has increased over the past five years (APA).

The 10 most common daily stressors include:

  • Difficulty focusing at work
  • Problematic interactions with a coworker
  • Poor communication
  • Over-populated “to-do” list
  • Lack of time for self-care
  • Not able to stay on a time table
  • Financial concerns
  • Maintaining a daily schedule
  • Poor sleep

Individually, these stressors are not likely to impede the course of our day, but compounded we “go off the rails,” our blood pressure rises, our thinking becomes deterred, and we lose energy faster than we can recoup it.

If, like me, you are a therapist with a full caseload, and concerns over billing, office management, session management, and high risk clients, you’re probably feeling some strong levels of stress.

An excellent way to manage both your stress and your client’s is to incorporate a Behavioral Stress Tolerance Plan.

A Behavioral Stress Tolerance Plan is different from most emotional management plans out there for several reasons.

First, it starts with maintenance, which helps the person filling it out identify areas of wellness and how to maintain them. Secondly, it walks you through early warning signs, exacerbation of these signs and your response to slow or stop stress there. Lastly, it identifies community, personal, and professional (i.e., you the therapist) areas of support while also incorporating clear identifiers of success and healing.


Download the Worksheet:
Behavioral Stress Tolerance Plan


I have found this Behavioral Stress Tolerance Plan to be helpful not only for myself, but also for my clients. The plan is useful regardless of their educational level, background, or emotional inhibition. Here’s a sample worksheet filled out with your client.

If you’re ready to have greater control over that creeping STRESS, give the worksheet a try. And if you’re looking for me, you’ll find me at Starbucks grabbing a Dark Roast coffee because it’s a “treatment that works” for me.


This blog was brought to life by Daniel J. Fox, Ph.D. 

Daniel J. Fox, Ph.D. has been treating and specializing in the treatment and assessment of individuals with personality disorders for the last 14 years in the state and federal prison system, universities, and in private practice. He is a licensed psychologist in the state of Texas and has published several articles on personality, ethics, and neurofeedback. He is the author of The Clinician’s Guide to Diagnosis and Treatment of Personality Disorders. His specialty areas include personality disorders, ethics, and neurofeedback.

Married to the military: 6 tips to support the military couples we work with

If we want to help our clients (enlisted, Guard and Reserve, vets) we should arm ourselves with some skills and resources. Here are six tips to utilize when working with these clients…

The media hums with dramatic tales of the downside of military relationships. We hear about domestic violence, substance abuse, PTSD, suicide, and infidelity. With the flurry of negative news we may marvel that any military marriages make it.

But they do. Military sociologist Jacey Eckhart studied 1,200 military couples married over 15 years and still in the service. Her findings reveal an upside to military marriages that may help us as we support these couples.

  • The long-lasting couples see their engagement with the service as a calling, not just as a job. They find this to be a meaningful role that provides financial stability and opportunities for advancement. In successful couples, the non-military spouse understands and supports that view of service.
  • The strongest couples have a non-military spouse who provides structure and normalcy at home during deployments and time apart. Deployments are expected, and the couple figures out ways to manage time away from each other.
  • Couples with the strongest relationships figure out how to pull the partner back into family life upon return from deployments. They talk openly about the challenges and how to navigate them.

If we want to help our clients (enlisted, Guard and Reserve, vets) we should arm ourselves with some skills and resources. Here are six tips to utilize when working with these clients:

  1. Learn about military culture. Speak their language. Find out what their lives are like.
  2. Provide resources for couples. A couple of good websites are militaryonesource.mil and www.military.com/spouse. There are many others worth passing on as well.
  3. Normalize their experiences, and be their cheerleader and guide them as they work through struggles. Instill optimism and hope.
  4. Arm yourself with knowledge of evidence-based treatment strategies for depression, relationship problems, nightmare and sleep disorders, PTSD and other clinical concerns of service members. Here’s just one example of a training on military family issues by PESI speaker Dr. Patrick Brady.
  5. Suggest that couples, families, and small groups take advantage of Reconnection Workshops, small group modules offered by the American Red Cross Service to the Armed Forces. These 2 hour groups are facilitated by licensed mental health professionals and are offered at no cost and are available anywhere in the country. Topics for adults include communication, anger, stress and trauma, supporting children, and depression.
  6. Read Eckhart’s study to better understand military marriages.

By enhancing your skills in working with military couples you will be better able to help them serve our country and sustain healthy, long-term marriages.


This blog was contributed by PESI speaker Martha Teater, MA, LMFT, LCAS, LPC. She is part of the work group that developed Reconnection Workshops through the American Red Cross Service to the Armed Forces. She is also a lead instructor for Coping with Deployments, another Red Cross military program. 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. Visit her website: www.marthateater.com.


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.

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Read more from Martha!

Living the Unlived Life

Tara Brach is a clinical psychologist and one of the foremost American teachers of Buddhist practices, who’s developed a distinctive approach to healing that bridges Western psychological knowledge and Eastern spiritual traditions.

In the following excerpt, Brach not only conveys the message of Buddhist acceptance and wisdom, but illuminates the differences between therapy and the spiritual path.

Tara Brach is a clinical psychologist and one of the foremost American teachers of Buddhist practices, who’s developed a distinctive approach to healing that bridges Western psychological knowledge and Eastern spiritual traditions.

In the following excerpt, Brach not only conveys the message of Buddhist acceptance and wisdom, but illuminates the differences between therapy and the spiritual path.


Of Spirituality and Therapy

One of the things that distinguishes therapy from a purely spiritual path is the engagement with one’s personal story.

On the spiritual path, suffering arises from any identification as a separate self. The key inquiry on the spiritual path is how is this identification being fueled and what awakens us to our wholeness.

On the therapeutic path, the therapist collaborates with the client to look at the personal patterns that play out in daily life and discover what might help in coping more effectively and finding more ease and happiness. In other words, therapy’s main concern is the story of the personal self. Spirituality includes that story, but emphasizes who we are beyond the limiting notion of self.

In Western psychotherapy, sharing one’s personal story creates rapport and intimacy and serves as a portal to discovering where experience lives in the body and in the heart, but many people can get fixated on the story and never go beyond it. This is the shadow side of psychotherapy.

The shadow side to the spiritual path is sometimes a dismissal of the story and the sharp cluster of feelings and emotions that surround it.

I think it’s important to find a middle way, where you honor the story, but don’t get lost in it.

The Tibetan teacher Tsoknyi Rinpoche talks about our beliefs, stories, and emotions as “being real, but not true.” That means we need to acknowledge that our beliefs feel real in our bodies and hearts, but don’t actually translate into the truth of reality itself–just like our thought of an apple isn’t the same as biting into and tasting it.

The Power of Intentionality

When clients come to me for help, my assumption is that something in them is longing for what I call refuge, or for really coming home to a place of inner peace and a loving heart. I think that we’re all longing for that.

I sometimes think of William James, who said “All religions begin with the cry for help.” We all sense the uncertainty of this existence, so everyone of us on some level is looking for what will allow us to feel more at home in our own being. Becoming conscious of our longing for refuge–for peace, for freedom–is an essential part of what energizes our path.

Right from the start, I want to hear what the client’s deepest intention is. I invite them to go to the most sincere place in them and say what it is they’re really wanting. That lets me know how large a view they have of what’s possible, and it helps me say, “OK, this is where you are right now. Let’s take the first step.”

What I’m doing is asking, “What’s your hope? What’s your aspiration?” Because when we aren’t aligned with our deep aspiration, we suffer.

Trying asking your client, “What’s asking for attention in your life right now?” 

Opening to the Larger Self

There’s a wonderful teaching from Carl Jung that says whatever within us that is unlived controls us. When we’re traumatized, we’ve got unlived fear in our body that needs to play itself out, and unlived grief that needs to be grieved. When we live the unlived life, that very process opens us to a larger sense of wholeness.

The process of emotional and spiritual healing is one of living the unlived life.

By pausing and becoming present, we can tap the inner resources that give us our power and our freedom. We’re able to open to the unlived life and integrate this vital energy into the larger whole of our being.

Self-Compassion

The practice of self-compassion trains us to let ourselves be touched by the suffering in our own bodies and hearts, and actively offer care. In this culture, that’s radical, because we’re taught to pride ourselves on being rough and tough on ourselves, always trying to be in a self-improvement project.

Our survival-oriented brain makes it hard for us to stay with the places that are difficult inside us. We don’t want to be with unpleasantness.

But there’s a very wise spiritual equation: Pain x Resistance = Suffering.

We perpetuate our suffering because we have all sorts of clever strategies to resist emotional pain. Whether we busy ourselves or distract ourselves or judge ourselves, we just keep away from that pain. So the practice of self-compassion means training ourselves to quiet our minds, stay with our experience, and remind ourselves to come into the body and heart.


Mindfulness Meets Clinical Practice: A New Paradigm for Healing is a 6-session online video series that will help you deepen your understanding of how and why Mindfulness works in clinical practice and introduce you to the Mindfulness-based approaches and tools that can transform your practice—and your life.

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This post is based on an article originally brought to life by our partner, Psychotherapy Networker.

The full article, “The Many Faces of Wisdom” written by Tara Brach, Eugene Gendlin, Mary Pipher, Daniel Kahneman, and Irvin Yalom, appeared in the Mar/Apr 2013 issue of Psychotherapy Networker magazine.

ASK ESTHER: Stable ambiguity and the rise of ghosting, icing and simmering

“I’ve been dating a woman for three weeks, but after we had sex for the first time, she’s stopped texting me back. WTF?” – Edward, 36

Rejection has always been a part of the relationship landscape. But are the new trends of ghosting, icing and simmering increasing our acceptance of ambiguous ends?

From the desk of Esther Perel, MA, LMFT, and modern relationship expert.


“I’ve been dating a woman for three weeks, but after we had sex for the first time, she’s stopped texting me back. WTF?” – Edward, 36

Rejection has always been a part of the relationship landscape. But are the new trends of ghosting, icing and simmering increasing our acceptance of ambiguous ends?

Last month, I spoke about modern love at a conference with 2,500 millennials. There, I was introduced to these new norms of intimate relationships and the corresponding vocabulary (we made you a chart, with the help of my friend Adam Devine).

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These tactics of maintaining unclear relationships and prolonging break-ups all produce what I call stable ambiguity; too afraid to be alone, but unwilling to fully engage in intimacy building — a holding pattern that affirms the undefined nature of the relationship, which has a mix of comforting consistency AND the freedom of blurred lines.

We want to have our cake and eat it too. We want to have someone available to cozy-up with when it’s snowing, but if something better comes along, we want the freedom to explore.

In this relationship culture, expectations and trust are in constant question. The state of stable ambiguity inevitably creates an atmosphere where at least one person feels lingering uncertainty, and neither person feels truly appreciated or nurtured. We do this at the expense of our emotional health, and the emotional health of others.

It’s time to bring back relationship accountability.

In situations like Edward’s, the ghostee hopes the ghosted will just “get the hint,” as opposed to having to communicate that he/she is no longer interested. However, inaction has causality. At first, Edward runs the gamut of reasons he hasn’t heard back: She must have a really busy work week. She lost her phone. She doesn’t want to seem too eager. At first, relaxed and patient, Edward tries to be understanding, but his attempts at insight soon morph into uncertainty and self-doubt.Am I bad in bed? Did I say something to offend her? Am I unlovable? In the absence of information, he will fill the gaps, and what he imagines is most likely worse than reality.

Ghosting, icing, and simmering are manifestations of the decline of empathy in our society — the promoting of one’s selfishness, without regard for the consequences of others. There is a person on the other end of our text messages (or lack thereof), and the ability to communicate virtually doesn’t give us the right to treat others poorly.

I encourage you to end relationships respectfully and conclusively, however brief they may be. Act with kindness and integrity. This allows both people to enter into his/her next relationship with more experience and a clear head, rather than filled with disappointment and insecurity.

Ideas to incorporate into a final conversation:

  • Thank you for what I’ve experienced with you.
  • This is what I take with me, from you.
  • This is what I want you to take with you, from me.
  • This is what I wish for you, hence forward.

Of course, duos dancing in the stable ambiguity zone don’t always end in breakup. Sometimes this state is the training wheels period needed for one or both parties to realize he/she wants something more. This is normal for a brief, beginning phase, but not as the defining mode of a relationship.

Have you been ghosted? How did it feel? Do you wish you could redo a break-up? Leave your comments below: I would love for you to be part of this conversation.


Esther Perel is a master trainer and an acknowledged international authority on couples, culture, and sexuality. She’s the author of the international bestseller Mating in Captivity: Unlocking Erotic Intelligence.

 

How To: Getting Kids to Chip In Around the House

When everyone in the family contributes to the chores, you teach a valuable lesson: The family is a team. Here are some tips and tricks to getting everyone involved with household chores.

We often make the same resolutions every year: drop some weight, save more money, read more. While these are all worthy resolutions, we often abandon them just days into the new year.

What if we instead focus our effort into meaningful goals that benefit the entire household? Goals like getting everyone to help with household chores.

Rewards often don’t work for getting kids to chip in around the house. Let me ask you, do you really blame your kids for not wanting to take out the trash, set the table, sweep the floor or clean up their rooms? Do you want to do it? Does paying them work in the long term? If you’ve tried the reward system, you know that it doesn’t work forever.

Here are 4 tips to get your kids on board with helping out around the house:

1. Explain why doing the chore is necessary.

A chore that is not fun or interesting can become more meaningful if you can show your kids that it is part of the bigger picture. Explain that if each family member does one small chore each day you will have more time for the fun things your family gets to do…such as swimming or watching a movie together. You can draw pictures of each person’s contribution to show how your family operates like a machine with moving parts that helps the house run smoothly.

2. Say out loud… “Yes, I know that this chore is BORING.”

Let your kids know that you understand that cleaning their room isn’t a lot of fun. This isn’t a lecture…it is empathy.

3. Let the kids do their chores their own way. Don’t control them.

You can tell them that you want the table set, but you don’t have to micro-manage where the fork and spoon go. Let them have fun and use their creative minds while doing their chore. All that matters is that it gets completed.

4. And if all else fails, use the Tom Sawyer method.

If you remember the story, Tom is white washing the fence and he is not having fun, but then he gets an idea. He tells his friend that painting the fence is not a grim chore, rather a fantastic privilege. His friend asks to try, but Tom won’t let him, saying it is way too fun. Finally, he gets his friend to give him an apple to try painting. Soon after, more boys arrive and vie for the privilege of painting the fence. So pretend you are so enjoying washing the dishes. When you make it look fun your kids will soon be begging you to help!

When everyone in the family contributes to the chores, you teach a valuable lesson: The family is a team. I hope this positive change can help make your family’s new year a little brighter for everyone.


 

This blog was brought to life by PESI speaker Susan P. Epstein, LCSW. Susan is the author of the best selling books, Over 60 Techniques, Activities & Worksheets for Challenging Children & Adolescents and 55 Creative Approaches for Challenging & Resistant Children & Adolescents. She has also authored Your Out of Control Teen, The Little Book With a Lot of Attitude: A Guide to Effective Parent-Teen Communication (2009), two parenting books Are You Tired of Nagging: How to Get Cooperative Kids (2008) and The Take Back Your Parenting Powers System (2007) & and has co-authored a children’s book about death, loss and healing, The Cat Who Lost Its Meow (2008).

In addition to her clinical work, Susan is a parent coach, certified health coach, national child behavior expert, and has contributed to magazines Family, Parents, American Baby and New York. She founded Parenting Powers, a coaching company that provides parent coaching and supervision and training to professionals working with challenging kids.


 

Internal Family Systems: No part left behind

Developed by Dick Schwartz in the 80’s, IFS started as a grassroots therapy model and is quickly becoming a sought after treatment. We sat down with Frank Guastella Anderson, M.D., and director of the Center for Self Leadership, to get the scoop on what makes this emerging therapy the hot new kid on the block.

There’s a good chance that by now you’ve seen, or at least heard, about Pixar’s movie Inside Out. The popular children’s film is set inside the mind of Riley Andersen, a young girl struggling to adjust to life after her family moves from Minnesota to San Francisco. Within Riley’s mind are five distinct emotions tasked with helping Riley navigate life. They include joy, sadness, fear, disgust and anger.

We can all relate to Riley’s conflicted emotions about moving to a new city. How often have you said “A part of me wants to… and then there’s a part of me that doesn’t…” as we grapple with our internal self, desires, and behaviors.

Developed by Dick Schwartz in the 80’s, IFS started as a grassroots therapy model and is quickly becoming a sought after treatment. We sat down with Frank Guastella Anderson, M.D., and director of the Foundation for Self Leadership, to get the scoop on what makes this emerging therapy the hot new kid on the block.

PESI: Now that folks have seen Inside Out and we can’t spoil anything, what’s your favorite part of the movie?

Anderson: We go through life assuming that happiness is the goal feeling: it’s what we should strive to be feeling 100% of the time. Inside Out shows us that other feelings, even those that make us uncomfortable, have a really important role in our lives. In Inside Out, Sadness isn’t just a character, she’s the hero! The film provides a great way to start normalizing the idea that our parts, even those that are uncomfortable to feel, are all equally important at protecting our core self.

PESI: What’s unique about IFS?

Anderson: IFS is an emotional, body- based therapy that focuses on a person’s internal resources to heal. The thing that really sets IFS apart from other treatment models is that it is non-pathologizing and fosters permanent healing by getting to the root cause of wounds. Other therapies, like sensorimotor psychotherapy, AEDP, and EMDR, have similar elements, but in my experience IFS is the most complete model in the experiential realm.

In IFS, we believe that all parts of the mind have good intentions (even suicidal parts for example), they are either trying to protect us or they hold emotional wounds. We work compassionately with those protective parts to gain access to and ultimately heal the wounded parts.  IFS also believes that all individuals inherently have the capacity to heal (called Self energy) and that it does not need to be cultivated or resourced, we are born with it. It’s a model that challenges some of the common assumptions made in the mental health field that are more pathology based.

PESI: Last time we talked, you told us that the Foundation for Self Leadership was focused on bringing evidence-based validity to the IFS model. Has this happened?

Anderson: We are pleased to say that IFS is now on the National Registry for Evidence-based Programs and Practices. Interventions listed in the NREPP have been subject to independent, rigorous scrutiny and are deemed to show significant impact on individual outcomes relating to mental health.

The NREPP has deemed IFS effective for improving general functioning and well-being. In addition, it has also been rated promising for each of: improving phobia, panic, and generalized anxiety disorders and symptoms; physical health conditions and symptoms; personal resilience and self-concept; and depression and depressive symptoms.

Such outcomes deepen our resolve to catalyze additional research studies, both in clinical settings and in applications beyond psychotherapy.

PESI: OK, let’s get real… this “parts” talk is a little confusing. How can we get a better feel for IFS?

Anderson: The best way to understand IFS is to experience it. When I teach clinicians about IFS, I do a number of guided meditations with everyone in the room. You can do this from home by watching the video below. In this meditation, we go inside our mind with an agenda of working with someone in our life that is triggering and activating some of our parts. Give it a try!



Frank Guastella Anderson, MD, completed his residency and was a clinical instructor in Psychiatry at Harvard Medical School. He is an executive director of the Foundation for Self Leadership and has served on the research advisory committee and the speakers bureau for the Center for Self Leadership.

He has lectured extensively on IFS, the Neurobiology of PTSD and Dissociation, and wrote the chapter “Who’s Taking What” Connecting Neuroscience, Psychopharmacology and Internal Family Systems for Trauma in Internal Family Systems Therapy-New Dimensions. He has maintained a long affiliation with Bessel van der Kolk’s Trauma Center at Justice Resource Center in Boston and maintains a private practice in Concord, MA.