health · healthcare · integrative psychotherapy · mental health · psychological inquiry · wellness

New Year’s Reflections

Slowing down took a few days. My psychobiological system had been going non-stop with no time off for almost three years; ever since COVID shut down Silicon Valley on March 15, 2020. I and my organism forgot what time off—genuine reflective time—feels like physically, autonomically, emotionally and conceptually. I am slowly returning to an old friend—myself.

I’ve had many patients (mostly engineering types) tell me with great pride “I haven’t taken a single vacation day in years”. And proceed to recite how many vacation days they have accrued. Sometimes it was in the triple digits. That used to be the zeitgeist in this non-stop work locale. And so, I too succumbed to that outlook all in the name of service to those who suffered so much during the pandemic.

I am not a fan of New Year’s resolutions. No one keeps them past Jan 31. And unlike intention setting, goal-setting is often quite limiting. As my system has slowed and weighted itself in time and in body, my view of what constitutes a good life is shifting. This shift is not an outer endeavor nor is it about where to focus my efforts as I move forward into 2023. It is an inner inquiry into what is genuinely helpful and meaningful to put out in the world. That inquiry is in process and it will lead to significant creative shift for the Groundless Ground Podcast and Integrative Psychotherapy Blog. And that feels super exciting for the artist in me.

My entire professional life could be viewed as continuous waves of content creation, flowing from medium to medium consistently reflecting the ocean of clear awareness that pervades all thought, all speech, all action. Being a light in a world of darkness is for me the highest aim of everything I have ever and will ever produce.  Returning to this, this most precious attribute of my life has been a great gift of this time off. I have a few more days of basking in the slow beauty of passing time. May your New Year be filled with incandescent beauty.

exercise · health · mental health · mind · nature · philosophy · podcast · psychology · wellness

As We Think?

I start most days racewalking the Creek trail. In late Fall and Winter my headlamp illuminates a few feet ahead, until dawn finally lights the path. Raccoons scurry by; egrets perch quietly. Though skunk smell often hangs in the air, I have never seen one.

This morning my mind produced a disturbing thought/image… what if I got sprayed by a skunk? How would I remove the smell? With no answer in mind, I continued enjoying the special feeling of a Winter Solstice sickle moon hanging low in the sky.

A little more than halfway through my walk, the trail dips closer to the creek and I hear familiar bubbling waters and duck calls. It is too dark to see any of this. Suddenly I detect a faint movement of white close to the ground on my left. My mind races to determine what it is.

As my head turns, the headlamp illuminates a beautiful skunk, white tail straight up in the air. I startle and chuckle quietly… synchronicity? Power of mind? Intuitive foreshadowing? Please don’t fear me and spray! My body speeds up to avert the very image mind conjured up only a short while ago.

We are such strange creatures—so at the ready to connect dots, create meaning, assign deterministic frames to what are probabilistic random events. Randomness does not sit well in a meaning-making animal that spins tales of thought’s power and intentionality. We believe as we think, so life occurs. The grandeur we accord to our inner thought world is astounding. And we use this exceptionalism to distinguish ourselves from all other mammalian brothers and sisters. Want to hear how much we actually share with these animals? Listen to the Groundless Ground episode I recorded several years ago with Professor Kristen Andrews author of “Animal Minds”. It will blow your mind.

I finished my walk musing on my own penchant for meaning-making. How pattern recognition and superstition marry in my brain fooling me into believing I somehow made that skunk appear! Silly human.

Alzheimers disease · compassion · death and dying · dementia · emotional suffering · emotions · family · health · love · mental health · mental suffering · neurobiology · psychology · relationship

Love remains…

When Alzheimer’s disease progresses—annihilating ability to word-find, understand language, and speak cogently to loved ones—what remains is affect; particularly affection. In the early stages, this disease has periods where sufferers exhibit highly reactive emotions that often present as angry, nonsensical or delusional. These periods are particularly hard on close relations and caregivers.

One very difficult experience I recall happened eight years ago in a favorite Upper East Side restaurant. Mom and I were dining and suddenly her neighbor came up to the table to say hi. Startled that she didn’t recognize him, Mom launched into a hysterical rant about how I was planning to kill her. Increasing agitation caused her to suddenly get up and leave the restaurant. I ran after her knowing she would never calm down if I caught up with her. So instead I followed her as she wandered the streets agitated and lost; finally ending up at her building. From across the street I saw her smiling and talking with the doorman. When I entered the lobby she sneered at me. Then let me accompany her up the elevator and into her apartment. She never spoke of what happened in the restaurant. Just as she never admitted to having Alzheimer’s, even through the five years she spent living in a Memory Care facility.

Four months ago her deteriorated physical condition required a transfer to a medical model nursing care unit for memory patients. Though it is considered the best unit of its kind, it is nothing like the family-oriented, loving memory care environment she thrived in. She no longer eats and sleeps most of the time. Mom is making it clear: I am ready to bring this horrible last 10 years of my life to a close.

For the last four years Mom has not known who I am. Yet, when I arrive, though she cannot speak much, she immediately brightens in her affect. The love is palpable. She laughs when I make jokes. I can’t tell if she understands anything I say, but her eyes display interest as I relay the goings-on of my life. I hold her hand when she lets me. Play Beatles songs she and my Dad adored. If she gets agitated I stand behind her wheelchair holding her shoulders gently to restore parasympathetic response.

These days it is especially hard to leave at the end of a visit, knowing it may be the last time I see her alive. Sadness pervades the field between us. We stand together in the awful knowing that she, a highly intelligent and deeply caring woman, has been utterly decimated by Alzheimer’s. And even so, our mutual love remains… triumphing spectacularly over this dread disease like a victorious army refusing to lose its most precious treasure.

Buddhist philosophy · Buddhist practice · Buddhist psychology · Buddhist Teachings · compassion · health · integrative psychotherapy · meditation · meditative experiences · meditators · mental health · mindfulness meditation · mindfulness psychotherapy · neuroscience of meditation · podcast · psychology · psychotherapy · wellness · wisdom · yoga · yoga therapy

Meditation is not a performative act

Listen to Groundless Ground Podcast Episode 60

This is a very special and quite different kind of episode to finish out Groundless Ground Podcast Season 5. I have a frank discussion about the pitfalls of packaging and delivering meditation as a performative act in health contexts with Donna Sherman—clinical social worker and teacher of practical wisdom from yoga sciences, mindfulness meditation and behavioral sciences. Since Donna has studied extensively in the Tantric yoga tradition and I have expertise in Buddhist psychology, we interview each other about the ancient science behind Yogic and Buddhist meditative practices. Donna’s Therapeutic Yoga Nidra is the NSDR (non-sleep deep rest) practice I refer to my patients. And Donna is also a longtime dear friend and colleague from whom I have learned so much. It is hard to imagine a good life without her along for the ride! And wow, 5 years and 60 episodes. What an adventure Groundless Ground has been and much gratitude to every listener! GG listeners continue to be my greatest inspiration.

awakened mind · change · clinical mindfulness · health · integrative psychotherapy · mental health · mindfulness · mindfulness psychotherapy · psychology · psychotherapy · somatic psychotherapy · Uncategorized · wellness

Graduating Psychotherapy

“I’ve graduated!” Most mental health professionals would not expect a patient to utter this proclamation at the end of therapy. Yet I have heard it more than once. The first time I was a bit taken aback as even I was lacking appropriate context for this framing. At the time I remember inquiring, “What about your accomplishment feels like graduating?” Their answer was so simple. “I have learned so much and radically changed because I have embraced this knowledge and use the skills in my daily life. I am still me, and yet, I am a me I could not have imagined being before I started this work. Therapy was not school but it feels like I have earned a degree!”

Though I don’t agree, psychoeducation is often considered separate from the therapy itself. I have always been a big fan of educating patients as part of the therapeutic process. Getting them excited about knowledge I have worked so hard to gain. Wisdom from biology, neuroscience, social science, psychology, and contemplative science is often as much of an ‘ah-ha!’ moment producer as directly perceiving mind, or landing firmly in embodied presence, or experiencing how goodness, kindness, openheartedness melt away anxiety, depression, loneliness and meaninglessness. It is all part of delivering an integrated package of resources for symptom alleviation and awakening.

Completing therapy fully equipped to meet life’s challenges with intelligence, humility, flexibility and inner strength is the aim. If accomplishment of that goal that feels like graduation I am all for it!

integrative psychotherapy · mental health · social media · Uncategorized

The Creatrix and Post.news

My first 24 hours on Post.news and wow… the artist in me has reignited. The angst and grief of the last few weeks of Twitter dissolution has given way to the fascination of interacting in a cauldron of intelligence, realness (weirdly enough), and a chance to diversify to other communities and voices I rarely had access to because of the ever-present social-media-generated algorithms dictating who I am and forcing me to stay in that box. So far relatively bot-free! And no ads! And a virtuous intent I can get behind.

The two decades I spent in the visual art world were years of me as rebel, technical fiend, technology envelope pusher (when online visual creation tools sucked!) and advocator for every human awakening—not in today’s woke way—in the ancient wisdom tradition way. Yes art, particularly interactional installation art can do that. And the raw nature of Post.net and its UX has a similar feeling of engaging with a newborn that is learning about itself and the world simultaneously.

Slowly I am finding other mental health professionals as more people get invited and sign up. Building community will take time but Twitter feels so horrible when I visit the site that I am convinced this is the way to go. Post.news uses a points system instead of ads, which feels a little like what Clubhouse tried to do a year ago and it pretty much failed over there. We’ll see if it works here. I get that this is way to keep ads away and reward “creatives”. That label was attached to a lot of crappy content at Clubhouse which is why I didn’t stay on it.

In other news, Youtube has granted my channel a new name. You can now find it at https://www.youtube.com/@integrativepsychotherapy

impermanence · mental health · psychology · relationship · social media

All Things Must Pass Away

For ten years Twitter has been my primary resource to access and interface with colleagues nearby and far flung. Residing and working around the globe, my feed was populated by a rich mix of medical, psychological, academic, contemplative researchers and clinicians.

I was appreciative of how intentional contact curation made this possible and somehow I assumed Twitter would not change. The basic platform would remain as it was. My community would keep contributing and interacting with intelligence, care and respect. Oh how wrong I was.

Of course I knew that Twitter was a cesspool of hatred, misinformation and nefarious bots. Yet, I counted on Twitter’s infrastructure of values/rules of conduct to keep that away from my feed. Then a couple of weeks ago the specter and reality of Elon Musk arrived full force and disassembly began to erode much of Twitter’s corporate and technical foundation.

One by one my community began to close their accounts. And my feed filled with Elon Musk’s antics and the counterpoint #twitterapocalypse. The rich community I had relied on for years to offer up the latest and most interesting research links and discussion dissolved before my eyes.

And I was sad. So bereft and powerless.

And then the wave of Mastodon tweets started showing up. “Find me now @mastondon!” So I investigated Mastodon and though it seemed interesting, I kept bumping up against the futility of not finding my people. So many servers… disjointed, slow, not intuitive coding in the app. And I realized anyone could say they are me and create a profile that looked like me. Big red flag!

For years people have admonished social media sites as superfluous, consumerist, privacy nightmares, and rife with the worst humans can dish up. It was not till my community went away in a poof of Elon Musk smoke that I understood how real cyber-reality actually feels for modern humans. Especially when a user has carefully over many years orchestrated it to deliver nurturing, informative, and honest content.

Today one of my colleagues let me know that Noam Bardin, former Waze CEO, has decided to get in the game of building a new social media site Post.news dedicated to “Real People, Real News, and Civil Conversations”. They seem to be taking their time to carefully build, so now you can only join the waitlist. I look forward to my invitation arriving so I can see what Post is actually like.

I did not expect Twitter to devolve so quickly and yet I know all things are subject to impermanence. My heart goes out to all Twitter employees–whether fired or remaining. Thank you for a wonderful decade! May you find peace and healing.

change · health · healthcare · integrative psychotherapy · mental health · poetry · psychology · psychotherapy · somatic psychotherapy · trauma healing

Last week

Last week…
Over and over session after session;
Patients truth-telling.
Aliveness transforms.

Habit narratives are so damn limited.
Drop them.

I watch the beauty of learning to turn toward experience
And dive in fearlessly.

Inspired, I encourage.
“Fear not. You will not be swallowed up and chewed into bits.”
Experience opens its arms; welcomes them in.
Scoops them up and lifts them high.

Dance  sway  rest  feel
Open in wonderment!

This is real.
The alive one you have always been.

Buddhism and science · Buddhist psychology · Buddhist Teachings · concentration meditation · integrative psychotherapy · meditation · meditative experiences · mental health · mindfulness meditation · mindfulness of breath · mindfulness psychotherapy · psychology · psychotherapy · somatic psychotherapy · wisdom

Tranquility and Breath

Tranquility is a necessary component for contentment. Tranquility is also the proximate cause of insight. This is generally why teaching concentration practices precede insight or vipassana practice. Only a calm mind can realize its true nature: radiant and pure.

Humans are blessed with breath; an ever-present biological function that acts as a conditioner for the body-mind system. Quality of breath directly influences quality of mind and body. When we are stressed or fearful, breath is fast, short, and shallow. Conversely, slow, long, gentle, deep breathing leads to cognitive-affective-somatic contentment and restfulness. You may have noticed when you feel agitated, if you put your attention on how breath is and gently slow in-breath and out-breath, anxiety and agitation subside.

Adding awareness or what is called “relaxed attention” on breath in a focused way calms the body-mind system. When we stay with breath long enough, calm leads to interest in the mind, and joyfulness in the heart and body. Eventually, the excitement gives way to a contentment, which arises from the direct experience of the mind knowing its own radiance and clarity. This is what the Buddha famously taught in the Ānāpānasati Sutta (find more information in my textbook on Buddhist psychology for clinicians.)

If radiance and clarity is the true nature of mind, why do we not experience these qualities of mind all the time? Primarily this is due to the presence of habitual thought-generated mental hindrances, such as craving, aversion, laziness/inertia, restlessness, and doubt, which grip conceptual mind and prevent it from realizing its own empty, luminous essence.

In concentration meditation we learn to stop feeding the hindrances by starving them. We train the mind to stay present with an object like breath, which naturally leads to calm, clear, and contented states of mind. Continually choosing over and over again, to turn away from distressful states of mind and turn toward the experience of breath eventually gives us the confidence, to turn the mind toward the hindrances, and stay present with these distressful states of mind to engage in the inquiry of vipassana meditation practice. You can learn more about this on the Groundless Ground Podcast Episode with Buddhist teacher Shaila Catherine.

Buddhist philosophy · Buddhist psychology · clinical mindfulness · integrative psychiatry · mental health · mindfulness · mindfulness interventions · nondual mindfulness · psychological inquiry · psychology · psychotherapy · somatic psychotherapy

Intersubjectivity and Interdependence

Recently, a colleague shared the following, “I am more and more tuned into the reality of separateness, gradations, distinctions. I think we are being hoodwinked by this idea of universal oneness. This feels particularly true when working with patients, where I find most significant change occurs from investigating distinctions and details.”

While I agree that in-depth exploration is critical for insight, contrasting that process with notions of universal oneness rings hollow for me. And that common mistake may simply be due to widespread misinterpretations of ‘oneness’; most especially the Buddhist concept of emptiness or interdependent co-arising. Although emptiness is a concept, therapeutic dynamics provide a real-time example of how interdependent co-arising actually manifests in human experience.

The Intersubjective School of Psychoanalysis hypothesized an intersubjective field continually mediating bidirectional knowing between psychotherapist and patient. Intersubjectivity enables a psychotherapist to empathically use their entire psychophysical system to receive and mirror a patient’s cognitive-affective-somatic material. That form of empathy or therapeutic attunement, is the primary process through which a patient feels known. So, although a psychotherapist may deliberately direct patient inquiry, intersubjectivity tells us that both parties are equal participants and influencers in the therapeutic container’s ebb and flow.

Acknowledging that apparent interdependence does not discount or negate the appearance of two separate participants. Each exists from their own side in a relationship of mutual influence. Nagarjuna, the progenitor of the Middle Way School of Indian Buddhism argued that emptiness rests on two principles: (1) things/selves in the world appear nominally, and (2) because of their impermanence, interdependence and insubstantiality, these entities lack any essential (svabhāva) nature.

For example, take the device you are reading this blog on. If it was self-existing, it could not be broken down into its parts—cover, screen, content, matter, particles, quantum information and so on. It is no more than a so-called object, interdependently linked to nominal parts similarly lacking any essential nature. Though the device does have conventional or relative existence, it also cannot be found to ultimately exist separately from its myriad parts.

Similarly, though the therapeutic dyad includes two separate beings, the therapy itself is an intersubjective, co-created process. Co-creation widens the menu of possible perspectives and makes possible successful interventions that decrease systemic reactivity and increase capacity for in-depth inquiry. Mutual influence and co-creation till the soil that yields embodied awareness and cognitive-affective-somatic openness. Such that self-fixation and its concomitant feelings of separateness fall away; and along with it the oh, so ubiquitously harmful distorted notions of self and world. Clearing those obscurations of mind is not only the optimal path to less cognitive-affective-somatic distress, but also increased tolerance and connectedness with all other beings.