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.

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!

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

Psychotherapist as provocateur

Provocateur: a person who provokes dissension; agitator.

Effective therapeutic change must include pivotal moments of therapeutic provocation. Yet we all know patients most love psychotherapists that make them feel good. But honestly unconditional positive regard only goes so far and therapy that focuses on producing good feelings is ultimately unhelpful and frankly dishonest. Why? Because real change rests on the hard work of facilitating mental clarity, humility, uprightness, and fierce compassion—not just in the patient but also in the mental health professional. To accomplish that task, a psychotherapist must be willing to call patients on their blind spots, their hubris, avoidance, and plain old bullshit.

Yes, that can be uncomfortable and possibly confrontative. Therefore, a therapeutic professional has to look deeply at their own blind spots, avoidances, hubris and bullshit with courage and compassionate regard for basic human suffering. We are fallible humans too.

Some of that blind spot work involves honest assessment of whether one is clinging to pleasurable feelings that arise from being a patient’s good gal or savior. Ouch! Even writing that sentence elicits feelings of disgust when I consider how much harm is done to a patient when a psychotherapist is lost in their own ego fixation. That is the worst form of therapeutic unconsciousness.

I remember many years ago reading Irvin Yalom’s, The Gift of Therapy. This manual on how to skillfully accomplish self-disclosure blew my mind and showed me the value of continually assessing the best interests of a patient and acting solely on that. Sometimes I don’t know or I can’t decide what is in their best interest. That is when I ask them directly.

Often asking involves provocation in one form or another. Provoking by questioning a blind spot or naming an oft-discussed avoidance. Even directly pointing at hubris, assumptiveness, or outright disownment of responsibility. This kind of provocation for the purpose of clear-seeing can frustrate or even anger a patient. Anger shows they trust you. So rather than backing away in fearfulness, lean in to skillful inquiry.

It’s like surfing a wave of habit reactivity on a surfboard of mutual curiosity about the patient’s feelings. All while inviting them to join you on the surfboard of openness to accomplish shifting reactivity to responsivity. Not rejecting; not accepting—this is the way to model equanimous provocative inquiry that leads to wisdom and transformation.  

And best of all, this process allows a psychotherapist to model fearlessness and facilitate movement away from defensive eruptions and into intentional, deliberate engagement with confused or distressful thoughts and feelings. For me, that movement produces the most change. Change born from a patient skillfully facing their own internal provocations and realizations with or without the psychotherapist.

complex trauma · health · mental health · mindfulness · psychology · psychotherapy · PTSD · PTSD treatment · Somatic Experiencing · somatic psychotherapy · Trauma · trauma healing · trauma therapy · wellness

The ‘somatic therapist’ nightmare

Increasingly, I am hearing disturbing stories from new patients about what is being labeled in the SF Bay Area as ‘somatic therapy’. What is clear is how many clinical and non-clinical people are calling themselves ‘somatic therapists’ and offering subpar to damaging services to individuals in need of effective mental health treatment for PTSD. 

Frankly, I have no idea what a somatic therapist is. Yet so many people are seeking somatic therapy because these days pop psychology views everything as traumatic and somatics as the cure for all trauma. This reminds me of what happened 15 years ago when mindfulness became the clinical intervention for every malady. We all know how poorly that worked out.

Integrative psychotherapy acknowledges that mental health is interdependently determined by the systemic quality of one’s mind states, emotions, and bodily responses. Human beings are organisms in constant flux; continually homeostatically reacting and responding to causes and conditions. Our thoughts are conditioned by body health as much as physical health is undermined by a chaotic mind and highly-reactive emotions.

Because traumatic experiences impact the entire human organism, resolving traumatic experiences must be a whole system endeavor. Changing thoughts is not enough. Loosening muscles and tissues will not prevent future bracing each time a challenging-enough situation occurs. And emotion regulation is a body-mind-heart mission.

Somatic Experiencing® (SE™) focuses on and accomplishes whole system trauma resolution. SE is a complex theoretical model delivered in a three-year training program. It takes time to learn how to recognize, work with, and deliver skills for effectively resolving the nervous system dysregulation commonly found in PTSD sufferers.

Other clinically helpful trauma methodologies include Sensorimotor Psychotherapy and EMDR. However, EMDR is often too activating and unhelpful for people with complex-PTSD who experienced early developmental trauma prior to adult traumatic events. SE is an excellent methodology for those individuals.

I encourage asking anyone claiming to be a ‘somatic therapist’ what training they have undergone and if they are a licensed clinical professional. Unlicensed practitioners are unregulated practitioners with no legal or ethical oversight. That is a minefield to avoid particularly for trauma sufferers.