Archive for the ‘Uncategorized’ Category
Couple Therapy & Premarital Counseling
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I am passionate about helping couples who want to improve their relationship. I bring to my clients science-based techniques and 20+ years of experience with a broad range of situations.
Couple Therapy
Most of us, deep down, long to be able to count on a safe, tender, loving, committed partner. So how do we stray so far from this? We may feel hurt, disrespected or not loved enough. We may feel alone and distant even though our partner is sitting right next to us. We decide to seek couple therapy.
I’ve successfully helped couples:
- Learn how to co-create deeper closeness, empathy and love
- Make it safe for each other to let down defenses
- Be better heard and understood as one’s full, honest self
- Better hear one’s partner deeply and empathically
- Share our deepest longings, wishes, goals and desires
- Avoid slipping down into repetitive dead-end arguments, criticism or defensiveness
- Identify what isn’t working and figure out what changes are needed
- Break through stuck-ness to share more satisfying emotional, physical and sensual intimacy
- Become conscious of habits that can undermine – or even destroy – relationships – and practice changing them
- Begin to heal broken trust
- Cope with issues around pregnancy, parenthood, empty nest, retirement, grief, loss, illness, fidelity, financial problems, caretaking, aging, and mental health issues
Affection, Sensuality and Touch
Couples just do better with plenty of tender physical and emotional affection and touch, both non-sexual and sexual. But sometimes we can get stuck and can’t find our way…..
- When I work with couples sometimes we figure out that there are external blocks, such as stress or medications.
- But other times the triggers aren’t so obvious…. Sometimes underlying issues that we may not even be aware of are interfering with us expressing, welcoming and participating in affection, tender touch, sensuality and sex.
- Fears, embarrassment, shame, resentments, past traumas, family-of-origin and cultural patterns and social pressures, misinformation, unrealistic expectations, resentments, porn, and emotional blocks may be among the culprits.
All these are personal areas, and can feel vulnerable, so I invite couples to co-create a non-shaming atmosphere of love, understanding, acceptance and gentle curiosity.
Pre-Marital Counseling
It seems ironic, and kind of out-of-whack really when you reflect on it, that society often pressures couples to put more planning, thought, attention and financial investment into ONE day, the “Wedding Day”, than to the DECADES of life together that will follow!
Because, even in the happiest marriages, two human animals living together side-by-side are naturally going to rub against each other at times. And eventually, as much as they love each other, there WILL be conflicts!
“Not us!” you might be thinking! “We are in love. We are in sync! Our love is special.” You may be entirely right in that your conflicts ahead might be minimal….
But learning more about your particular couple dynamics, and the specific areas where there might tend to be more “bumps in the road” for you specifically, can result in you not being surprised and unprepared when they come up. Planning ahead now how you might understand and manage later, including practicing specific skills, can be more valuable than any other aspect of planning for your wedding or your lives together after the wedding.
So why not give yourselves the best start, and become aware, informed and prepared?
And why not improve your odds? The statistics are harsh: 30-50% of marriages end in divorce.
But research shows that pre-marital counseling work can greatly improve the odds of a successful “ever after.”
RESOURCES
Attached: The New Science of Adult Attachment and How It Can Help You Find – and Keep – Love by Amir Levine
The Seven Principles for Making Marriage Work: A Practical Guide from the Country’s Foremost Relationship Expert…, John M. Gottman and Nan Silver, 2000
Hold Me Tight by Susan Johnson, founder of Emotionally Focused Therapy (EFT)
Wired for Love by Stan Tatkin, founder of Psychobiological Approach to Couple Therapy (PACT)
Ten Lessons to Transform Your Marriage by John M. Gottman and Julie Schwartz Gottman
FAQ’s about ISTDP
INTENSIVE SHORT-TERM DYNAMIC PSYCHOTHERAPY
(ISTDP)
Frequently Asked Questions
What is ISTDP?
ISTDP is a form of one-on-one therapy that is unique in helping target and resolve both physical and emotional problems. At times, I myself utilize a variety of therapeutic approaches.
The treatment approach I use most predominately and frequently is based in the ISTDP modality.
What problems can ISTDP-style therapy help relieve and resolve?
Research has shown ISTDP to be a uniquely effective treatment for depression, anxiety, and a broad spectrum of emotional problems and self-defeating behaviors. It can also help with physical problems that your doctor has not been able to find an explanation for, including digestive problems, neck, shoulder and back pain, other types of body pain, dizziness, mental fogginess and difficulty with concentration. It helps with ailments that are worsened by stress, such as migraine or tension headaches, tension-myositis syndrome (TMS), chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome (IBS), and overactive bladder.
What can ISTDP-style therapy do for me?
ISTDP is designed to help you become healthier in the shortest amount of time. In fact, many ISTPD patients report feeling calmer, empowered, emotionally and physically lighter, more capable of handling the challenges of everyday life – and happier – often after the first few weeks of therapy – or sooner.
Successful treatment usually results in a significant (or complete) reduction of symptoms, greater success in work and relationships, and the restoration of emotional vibrancy.
It is very efficient, and research shows the people often keep improving even after finishing therapy, so many people have found it well worth their time.
How Does ISTDP Work More Quickly?
ISTDP often succeeds where other therapies fail because it specifically targets and removes the barriers that interfere with progress in therapy – habits and defenses that patients are often unaware of, and that the therapist confronts head-on at the beginning of the therapy.
Also, an ISTDP approach integrates the some of the most powerful aspects of:
- Psychodynamic psychotherapy
- Cognitive-Behavioral therapy (CBT)
- Mindfulness and the mind-body connection
- Neuroscientific research
For these reasons, ISTDP is frequently used to treat people whose persistent symptoms have not resolved in the course of other therapies or with medication.
How does ISTDP feel different from other therapies?
ISTDP is not typical “talk therapy.” In this unique model, therapist and client work together in a structured, purposeful way. The therapist plays a much more active role than in typical therapy.
Initially, this may seem strange for people accustomed to using their therapy hour to discuss whatever they wish in an open-ended or free-flowing manner. But most people soon come to appreciate the power of this directed approach. People typically know after one or a few sessions whether ISTDP-style therapy is the right therapy for them.
What can I expect when I get into the treatment room?
Treatment usually begins with a detailed inquiry into the precise nature of your problem and your goals for therapy.
Once goals are set, you and I will work closely together to investigate your difficulties. While doing this, I will help you learn to monitor your feelings and body sensations moment-by-moment, which will expose any habitual ways of functioning that may be holding you back.
The ultimate goal is to help you replace suffering and pain with healthy emotional regulation so you can achieve your full potential in all areas of life.
What exactly do you mean by “Short-Term” therapy?
My experience is that, for the most part, using an ISTDP-style foundation and approach typically cuts to the chase much faster, and therefore shortens the length of a course of therapy, and also deepens the impact, in comparison with other therapeutic modalities I know.
However, as mentioned on the Homepage, sometimes my therapy is not short-term. Some traumas start very early in life or in a primary relationship, and require a longer course of treatment. Or problems can be very complex. Struggles with mind-altering substances or habitual self-sabotaging behavioral patterns can further complicate emotional difficulties. I may not see what is happening quickly, despite my best efforts. And sometimes smaller chunks of therapy spread over longer periods of time are more effective.
What will you be doing in our sessions?
In your sessions I will carefully attend to your current life and what brings you to therapy, as explained on Homepage and repeated here. I will also focus on what is happening in the moment between us, and between you and your partner in couples counseling:
- How are you conveying feelings?
- What is not being said or said indirectly?
- What is happening with your anxiety?
- What patterns are emerging in your interactions with me that are also prevalent in your life?
- To what extent and in what circumstances are you aware of your feelings?
- Are certain feelings more difficult for you than others?
I will share my observations in real time. My observations could be inaccurate and you can tell me what I missed or misinterpreted. You may like what I say or be annoyed or feel sad or have mixed feelings.
We can learn about you very quickly by observing together how you handle your feelings with me, which is most likely how you handle the same feelings outside of therapy. This focused immediate experiential component is essential to getting to the bottom of your problems and shortening the duration of therapy. While intellectual knowledge is important, it will be these in-vivo experiential therapy experiences that are most important to achieving deep and profound change.
How can I fit longer sessions into my schedule?
- An initial longer 3-hour “Trial Session” is highly recommended as it is very helpful in evaluating if we are a good fit, if the therapy style is a good match for you, giving you a full experience of the therapy, and getting off to a strong start. The initial 3-hour session is scheduled to start in the morning or early midday.
- You can choose to come in initially for a complimentary (no charge) 30-minute pre-therapy “Meet and Greet” meeting, where you can meet me and ask any questions….
- Or you can take advantage of a discount I offer on the 3-hour initial Trial Session.
- Then, because of the complex nature of treatment, I sometimes recommend follow-up sessions of 90-minute length, but if 90 minutes is not feasible, I typically recommend 60-minute ongoing weekly sessions, depending on the individual. Some commuting patients prefer two-hour or longer block sessions. But weekly 60-minute ongoing follow-up sessions typically provide enough opportunity for your therapy to flourish. We can assess what works for you and your situation.
- I start at 7 or 7;30 in the morning, so if you can snag one of those in-demand early-morning spots, you could possibly come in before y0ur work day. I’ve even been known to start at 6:45 am!
- As you experience recovery, you may cut back to biweekly or monthly, etc. The time it takes to achieve this stage can vary greatly, depending on your goals and the severity and intensity of problems.
Research Support for the Efficacy of ISTDP
A large and growing body of research supports the effectiveness of Intensive Short-Term Dynamic Psychotherapy, including research on significant medical cost-savings related to treating common or chronic medical problems with ISTDP.
In addition to the United States, ISTDP is becoming increasingly prominent in Australia, Belgium, Canada, Denmark, Germany, Iran, Israel, Italy, Lebanon, the Netherlands, New Zealand, Norway, Sweden, the United Kingdom, and other countries.
For more information on ISTDP, you can visit the following websites:
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To find out more or to make an appointment,
Call: (310) 488-5292
Email: CL@CatherineLockwoodMFT.com
CATHERINE LOCKWOOD, MA, LMFT
Office on South Barrington Place, Brentwood Village, Los Angeles, CA zip 90049, on the “Westside” of the city of Los Angeles
www.CatherineLockwoodMFT.com Tel: (310) 488-5292 CatherineLockwoodMFT@Gmail.com
For Therapists: Applying ISTDP to Couple Therapy
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IN THE HOT SEAT: APPLYING INTENSIVE SHORT-TERM DYNAMIC PSYCHOTHERAPY (ISTDP) TO COUPLES COUNSELING
By Catherine Lockwood LMFT and Reiko Ikemoto-Joseph LMFT
Reprinted with permission of the the American Psychological Association (APA) [1]
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Collaboration is at the heart of all psychotherapy models. Therapists collaborate with their clients to achieve desired outcomes. And therapists often collaborate with other therapists – to coordinate care, provide consultation, and develop their clinical skills. It’s this last form of collaboration that brought the two of us together to solve problems common to our couples work. When we met, Catherine Lockwood was an AACAST accredited Couples and Sex Therapist with over 20 years of experience in the field. I was a relative newcomer to the profession. We met in a course on Intensive Short-Term Dynamic Psychotherapy (ISTDP) held at UCLA. This course began an extremely exciting time of discovery and innovation in our work.
If it’s possible to fall in love with a model of psychotherapy, we both fell hard. ISTDP is a visually and viscerally exciting model. Most ISTDP clinicians videotape their work to improve the timing, dosage, and precision of their interventions, and to review exactly what occurred in a given session. This means that therapists new to the model have a unique opportunity to observe the work of master clinicians achieving in-session results that look (to the novice) like magic, or close to it. In class, we observed clients on video leaning into intensely painful feelings in undefended and deeply moving ways. And we observed clients encountering long-buried memories and images that often emerged in rapid, detailed, and stunning succession. As newcomers, it was thrilling to witness both the artistry of the process and the end results, which when viewed on time-lapse video appeared utterly dramatic. It was undeniable to the viewer that a deep and profound transformation had taken place for these clients.
Shortly after, Catherine and I enrolled in 3-year ISTDP core training programs. We began to consult with each other on cases and collaborate on ways to integrate the most effective elements of ISTDP with couples therapy. As ISTDP was originally designed for work with individuals, we found there was a scarcity of information in the professional literature on the subject of ISTDP and couples therapy (exceptions: Have-de Labije, 2006; Solomon, 2001). We were both excited by the prospect of applying a new metapsychology and set of interventions to a series of common difficulties encountered in our work with couples. This paper is a distillation of our research, refinements, and ongoing experimentation, which culminated in a joint presentation in 2015 to members of the long-running Couples & Sex Training program developed by Dr. Walter Brackelmanns at UCLA’s David Geffen School of Medicine.
In this paper, we aim to share our experience with collaboration, innovation, and the cross-pollination of theoretical models. But first, we thought it useful to provide our readers with a very brief overview of Intensive Short-Term Dynamic Psychotherapy (ISTDP).
A Very Brief Introduction to Intensive Short-Term Dynamic Psychotherapy
Dr. Habib Davanloo’s groundbreaking development of ISTDP in the 1960s has inspired a deeply passionate legacy of researcher-practitioners who continually expand, debate, elucidate, and innovate on Dr. Davanloo’s original model (Abbass, Town & Driessen, 2012; Johansson, Town, & Abbass, 2014; Malan & Coughlin Della Selva, 2006; Neborsky, 2006).
ISTDP operates on the principle that early ruptures in the bond between parent and child lead to intense, complex feelings and impulses that are pushed out of awareness by anxiety and defense mechanisms. Over time, adaptive defenses once necessary for survival become maladaptive to healthy emotional regulation and generalized to all relationships. It’s this intra-psychic conflict between unconscious feelings and impulses and the defenses erected against them (resistance) that leads to symptom formation, including psychiatric disorders, functional and somatic disorders, relational difficulties, and self-defeating behaviors (Abbass, 2015; Davanloo, 1989; Have-De Labije & Neborsky, 2012).
Clinicians trained in ISTDP collaborate with their clients to recognize and relinquish self-defeating patterns of defense, especially defensive barriers against emotional closeness. Treatment often begins with the clinician addressing the tactical defenses clients put into operation to keep the therapist at an emotional distance. The ISTDP clinician encourages intimacy in a direct and honest way, which strengthens both the therapeutic alliance and the client’s emotional capacities (Fredrickson, 2013; Kuhn, 2014).
Equally important is the ISTDP clinician’s ability to help clients healthily regulate their underlying anxiety, which increases when defenses are confronted and relinquished. Working collaboratively in this precise and attuned way quickly builds client capacity, which allows for the breakthrough of long-buried affect and repressed memories in what is termed an “unlocking of the unconscious” (Davanloo, 1990). Once mobilized, these intense feelings, memories, and related attachment ruptures can be deeply processed and healed. This careful restructuring of emotional regulatory capacity together with intense breakthroughs of unconscious affect lead to rapid symptom relief and characterological change, as well as increased self-compassion and improved relationships (Malan & Coughlin Della Selva, 2006).
What Exactly Do We Mean by Anxiety and Defense?
In our opinion, one of the most revolutionary features of ISTDP is its precise understanding and attention to the physical ways in which anxiety manifests in the body and how anxiety functions together with defense to regulate core affect. We’ve observed that most clients are unaware of how anxiety is channeled in their bodies. In ISTDP, clinicians are trained to carefully monitor (and teach their clients to monitor) precise symptoms of anxiety (Fredrickson, 2013) so as to work within the client’s optimal “window of tolerance” (Siegel, 1999; Ogden, 2006).
ISTDP clinicians track anxiety in four major channels. The first and healthiest channel is the patient’s voluntary or striated muscles. Anxiety in this channel frequently manifests as deep sighs, tensing, clenching, and fidgeting. We also monitor anxiety in the sympathetic nervous system, which takes the form of dry mouth and throat, racing heart, sweating, cold hands, or shivering. With the parasympathetic or smooth muscle system, the patient might report dizziness, drowsiness, nausea, diarrhea, urgency to urinate, constipation, acid reflux, and sudden loss of muscle tension (e.g. wobbly legs). Cognitive perceptual disruptions may appear as incoherent, delayed or racing thoughts, or reports of visual disturbances such as tunnel vision or auditory disturbances such as tinnitus. Symptoms in these last two channels – the parasympathetic system and cognitive perceptual functioning – indicate that the client has exceeded his or her window of tolerance and can no longer healthily regulate anxiety. In other words, he or she has gone over a safe anxiety threshold, and the therapist must intervene immediately to reduce anxiety (Fredrickson, 2013; Have-de Labije & Neborsky, 2012).
Why is this important? Because high, unregulated anxiety can exacerbate somatic and depressive symptoms and invite intense projections and misalliance. At lesser levels, it prevents healthy emotional experience and triggers destructive defenses that push others away, including intimate partners and the therapist. The most common defenses we encounter in couples therapy are blaming, criticizing, justification, dismissing, explosive discharge of affect, distancing (also known as withdrawal or stonewalling), sarcasm, intellectualization, rationalization, ignoring, devaluing, dismissal, giving behavioral instructions (e.g. “You shouldn’t feel that way!”), playing the victim and in extreme cases, dissociation. It goes without saying that if both partners are in an anxious, dysregulated state, they cannot contain and metabolize their own feelings let alone the feelings of their partner. In such cases, empathy, healthy co-regulation of affect, and intimacy are impossible.
Why Couples Enter Couples Therapy
In our experience, when couples enter therapy, a great number of them will cite “communication issues” as their presenting problem. Rarely have we observed that couples suffer from an inability to communicate. Rather, they have difficulties in regulating intense feelings, and as a result they become trapped in destructive patterns of dealing with their feelings and each other. Many great couples clinicians, researchers and theorists have observed similar behavioral patterns with couples and have detailed them in evocative terms. For example, Susan Johnson (2004) describes repetitive patterns of relating in terms of “Negative Interactional Cycle,” while John Gottman (1993) describes certain fixed, hostile interactions as “The Four Horsemen of the Apocalypse.” To our mind, all skilled couples therapists seek to apply interventions in a coherent way to interrupt destructive relational patterns and encourage in their place healthy attachment longings and intimacy.
An ISTDP-Based Approach to Increasing Intimacy and Repair in Couples
At its heart, ISTDP can be described as an attachment-system-repair therapy. As ISTDP clinicians who also treat couples, we began to identify the most powerful components of ISTDP that could be applied to interrupt negative interactional patterns while removing barriers to emotional intimacy and facilitating repair between partners. In this paper, we will address two of these components: The first is the systematic restructuring of the couple’s patterns of anxiety and defense, and the second is the positioning of the therapist as a temporary transference figure (Marvin Skorman, personal communication, February 24, 2015).
Restructuring Anxiety and Defense with Couples
One of the advantages of ISTDP is its ability to show clients in real time what is getting in their way. From our perspective, the thing getting in their way is a reciprocal pattern of anxiety and defense that blocks vulnerability and complex feelings, which in turn blocks intimacy.
For example, when Partner A begins to detail her frustrations with Partner B, the therapist can help both partners observe that Partner B’s anxiety is being channeled into his striated muscles and sympathetic nervous system in the form of full body muscle tension and a dry mouth, which then results in the defenses of intellectualization and breaking eye contact, which he deploys in an attempt to regulate both his rising anxiety and his underlying feelings of anger and sadness.
These precise, moment-to-moment interventions work especially well because they keep the focus on what is happening emotionally in the room. The couple’s anxiety and defense patterns can be directly observed by both partners with the help of the therapist and restructured on the spot. If skillfully applied, this approach has the advantage of doing real-time repairs to the couple’s capacity to healthily co-regulate anxiety and complex feelings. Also, helping the couple to observe together their precise emotional and physical responses in vivo also allows them to see their problem from an entirely new, neurobiological perspective, which serves to interrupt their habitual pattern of attacking and then distancing from one another.
Our unique challenge was how to systematically introduce anxiety-defense work into our therapy with couples. The most natural solution was to engage in small blocks of restructuring with one partner at a time in full view of the other partner. This only made sense after establishing a mutual understanding of the couple’s problem, including the specific ways in which each partner contributes to their painful interactional pattern vis-a-vis anxiety and defense. At that point, we could consistently link the partners’ real-time responses back to their presenting problem, while encouraging them to use a healthy alternative.
Finally, we found that asking the observing partner to recap what he or she has just witnessed is a powerful aid in bolstering empathy and consolidating new learning. We then ask the couple to practice co-observing and using their healthy alternatives between sessions.
Taking the Transference Heat
It goes without saying that couples enter therapy with a deep reservoir of feelings toward each other (and usually toward past attachment figures). Often, these feelings are of such intensity that exploring them safely is difficult. One or both partners may lash out, verbally pummel or devalue the other in the therapist’s presence, which usually requires the therapist stepping in to play the role of mediator, interpreter or traffic cop in order to prevent iatrogenic damage.
In our collaborations, we began to adapt ISTDP interventions to draw fire away from the partner under attack by redirecting it into the relationship with the therapist (in psychodynamic terms, “in the transference”). Rather than halt, interpret, or reframe the attack, we would invite the partner to precisely examine the physiological manifestations of the intense feeling under observation, while helping him or her to distinguish between the feeling of anger, anxiety, and defense (e.g. discharging, venting, lashing out, etc.). This shift in focus from interpersonal conflict to intra-psychic exploration invariably leads to the mobilization of feelings toward the therapist, which are subsequently explored in the same manner and then linked back to the couple’s presenting problem. Care is taken to let the other partner know that he or she will have an opportunity to do the same investigation with the therapist.
In our experience, this intervention, if done with skill, offers the following advantages: (1) It prevents in-session damage to the partners and further damage to their attachment bond without diffusing the intensity of feeling. (2) It improves the partners’ capacity for self-observation and emotional regulation. (3) It offers the couple a new, intra-psychic understanding of their interpersonal problems. (4) It interrupts the couple’s repetitive, negative interactional cycle and (5) lets the observing partner see that the problem is not occurring only in relation to him or her.
There are of course many psychodynamic therapies in which the therapist encourages and then interprets the patient’s positive and negative transference feelings, but there are few models in our experience that so vigorously position the therapist in the transference hot seat. The therapist’s willingness to “take the transference heat,” especially when confronting patient barriers to intimacy and engagement, is a key feature of ISTDP that we found highly effective in our work with couples. When combined with anxiety and defense restructuring, transference work can significantly de-escalate negative interactional patterns and accelerate intimacy and healthy co-regulation of affect within the couple.
A Final Word on Collaboration and Sharing Best Practices
We’d like to re-emphasize that our work is an ongoing learning process and that what we have presented here is not a complete therapy. Rather, we view our work as a form of collaboration and cross-pollination in which we seek to apply powerful elements of one modality to improve our work in another. In our efforts to coherently integrate ISTDP into our work with couples, we have discovered areas of enormous potential in addition to certain roadblocks and challenges.
Needless to say, we are excited by the ways ISTDP can add considerable value to couples therapy. Working together on utilizing two different modalities has also increased our awareness of the value of sharing aspects of theoretical modalities and clinical experiences as they might apply to different treatment units, populations or theoretical orientations. We imagine you too are encouraged when therapists from different schools of thought share best practices, and in so doing, work collaboratively to bring the highest value to ourselves and our patients. We would welcome your comments or questions at CL@CatherineLockwoodMFT.com and ReikoJosephMA@gmail.com.
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References
Abbass, A., Town, J., & Driessen, E. (2012). Intensive Short-term Dynamic Psychotherapy: A systematic review and meta-analysis of outcome research. Harvard Review of Psychiatry20(2), 97-108. doi: 10.3109/10673229.2012.677347
Abbass, A. (2015). Reaching through resistance. Kansas City, MO: Seven Leaves Press, LLC.
Coughlin Della Selva, P. (2004). Intensive Short-term Dynamic Psychotherapy. London, England: Karnac Books, Ltd.
Davanloo, H. (1989). Central Dynamic Sequence in the unlocking of the unconscious and comprehensive trial therapy. Part I. Major unlocking. International Journal of Short-Term Psychotherapy, 4(1), 1-33.
Davanloo, H. (1990). Unlocking the unconscious: Selected papers of Habib Davanloo, MD. Chichester, England: John Wiley & Sons.
Frederickson, J. (2013). Co-creating change: Effective dynamic therapy techniques. Kansas City, MO: Seven Leaves Press, LLC.
Gottman, J. (1993). A theory of marital dissolution and stability. Journal of Family Psychology 7(1), 57-75.
Have-de Labije, J. ten (2006). ISTDP in couples therapy: Unlocking marital collusion by experiencing the murderous impulse towards the partner and the accompanying guilt, grief and love. Foundation for Intensive Short-Term Dynamic Psychotherapy Ad Hoc Bulletin, 10(2), 34-62.
Have-de Labije, J. ten & Neborsky, R. (2012). Mastering Intensive Short-term Dynamic Psychotherapy: A roadmap to the unconscious. London, England: Karnac Books, Ltd.
Johansson, R., Town, J.M., & Abbass, A. (2014). Davanloo’s Intensive Short-term Dynamic Psychotherapy in a tertiary psychotherapy service: Overall effectiveness and association between unlocking the unconscious and outcome. PeerJ, 2:e548 https://dx.doi.org/10.7717/peerj.548
Johnson, S. (2004). The practice of emotionally focused couple therapy. New York, NY: Brunner-Routledge.
Kuhn, N. (2014). Intensive Short-term Dynamic Psychotherapy: A reference. Belmont, MA: Experient Publications.
Malan, D. & Coughlin Della Selva, P. ( 2006). Lives transformed: A revolutionary method of dynamic psychotherapy. London, England: Karnac Books, Ltd.
Neborsky, R. (2006). Brain, mind, and dyadic change processes. Journal of Clinical Psychology: In Session, 62(5), 523-538. doi: 10.1002/jclp.20246
Ogden, P., Minton, K., and Pain, C. (2006). Trauma and the body. New York, NY: W.W. Norton & Company, Inc.
Siegel, D.J. (1999). The developing mind: How relationships and the brain interact to shape who we are. New York: Guilford Press.
Solomon, M. F. (2001). Breaking the deadlock of marital collusion. In Solomon, M.F., Neborsky, R., McCullough, L., Alpert, M., Shapiro, F., & Malan, D. Short-term therapy for long-term change (130-154). New York, NY: W.W. Norton & Company, Inc.
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[1]Reprinted with permission from the American Psychological Association, “Psychotherapy Bulletin”, 2015 Vol. 50, # 4, link: IN THE HOT SEAT: APPLYING INTENSIVE SHORT-TERM DYNAMIC PSYCHOTHERAPY (ISTDP) TO COUPLES COUNSELING
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For Physicians: About ISTDP
Dear Physician –
I’d like to tell you about Intensive Short-Term Dynamic Psychotherapy (ISTDP), an evidence-based modality which has proven to be a uniquely effective treatment for a broad spectrum of patients who have some of the most challenging problems for physicians to address, including:
- Depression, anxiety and panic attacks
- Medically unexplained back and neck pain, headaches, and medically unexplained neurologic and digestive symptoms
- Somatoform disorders
- Disorders exacerbated by stress such as chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, and overactive bladder
ISTDP is designed to help patients become psychologically and physically healthier in the shortest amount of time. Most patients feel noticeably calmer, more hopeful and in less pain after the first session.
In fact, during the first ISTDP session, frequently patients report it is unlike anything they’ve ever experienced – and they want more.
Many people have found it well worth the investment in terms of efficiency, durability of positive results, and continuing post-therapy improvement.
I have many years of experience and have trained in many psychotherapeutic modalities, and I find ISTDP to be hands-down the most powerful in relieving suffering from medically unexplained conditions. I’ve attached overview of ISTDP for patients and some business cards.
I’m always passionate to talk about ISTDP so please feel free to call or email me to discuss.
If you’d like to more information on the research, copies of an informational flyer for patients (see below).or business cards, let me know.
Sincerely,
Catherine
Catherine Lockwood, MA, LMFT
Brentwood Village, Los Angeles, California 90049
Tel. (310) 488-5292 – press # to skip voicemail message
Email: CL@CatherineLockwoodMFT.com
To find out more or to make an appointment,
Call: (310) 488-5292
Email: CL@CatherineLockwoodMFT.com
Thank you for your interest.
Catherine Lockwood, MA, LMFT
Brentwood Village, Los Angeles, California 90049
TMS: Tension Mysositis Syndrome
Can ISTDP really help relieve and resolve Tension Mysotitis Syndrome or TMS?
Yes, it definitely can.
Intense Short-Term Dynamic Psychotherapy – ISTDP – is evidence-based, and research has shown it to be a uniquely effective treatment for a broad spectrum of medically unexplained disorders such the diagnosis of Tension Myositis Syndrome (TMS). This can include such physical symptoms as tension or migraine headaches, digestive/ GI tract problems, neck, shoulder, body and back pain, fibromyalgia, psychophysiological disorders (PPD), medically unexplained physical symptoms (MUPS), medically unexplained symptoms (MUS), and other health issues.
Oftentimes depression, anxiety, emotional problems,self-defeating behaviors, undeserved guilt, shame, repetitive negative thoughts, self-sabotage, underperformance, distractibility, and other emotional and relational problems accompany physical body problems. ISTDP can be effective helping heal both body and psyche, and often results in improved life satisfaction, relationships and performance.
Have you personally helped people with TMS?
Yes, absolutely. The results can be quite amazing. Most people experience some positive benefits after one 90-minute session – and more benefits after several sessions.
Can you give an example of a TMS patient you’ve helped with ISTDP?
Yes. I’ve changed details in this account to ensure complete confidentiality:
Recently I helped a man who suffered from chronic intense body pain and dysfunction 24/7 for almost 3 years, as well as intermittant symptoms before that. He had been in a wheel chair at times, and was struggling to accomplish ADL (basic activities of daily living). His doctors were mystified about the cause. Nothing seemed to help. This man did considerable online reading and research and decided to consult a physician familiar with TMS. He had to travel some distance, but it was well worth it to him, because the doctor confirmed his suspicions that he indeed had TMS. This patient educated himself about treatment with ISTDP psychotherapy and was highly motivated to try it when he contacted me.
After our very first 90-minute session, he experienced significant relief. After 5 sessions, he reported his symptoms and body were much improved. Through the therapy and accompanying homework exercises, he has trained himself to pay close attention to his body and emotions. Most of the time he experiences no pain. However if a pain just barely starts to develop, right away, before it gets worse, he notices it and uses strategies he’s learned in therapy and practiced on his own, to contain it. Now he can do things he so longed to do, such as carrying his toddler, taking walks with his family, playing with his children and planning extensive summer vacation travel. In the fall he wants to continue with ISTDP therapy to address additional trauma issues and consolidate the gains he has made.
How does ISTDP work?
You can read about it on this very website on a link to the left under:
ISTDP FAQs – Frequently Asked Questions About Intenseve Short-Term Dynamic Psychotherapy
ISTDP: A Brief Introduction to Intensive Short-Term Dynamic Psychotherapy
What is TMS?
Tension myositis syndrome (TMS) was the name John E. Sarno gave to conditions characterized by psychogenic musculoskeletal and nerve symptoms. Psychogenic diseases are physical illnesses that are not medically explained, but stem from emotional or mental stresses. Back pain is frequently mentioned, but symptoms can occur in all parts of the body. The TMS diagnosis has not been commonly accepted by the mainstream medical community, however prominent recovered patients have received national attention in the media. ISTDP has gained increasingly greater recognition in the world medical community for the successful treatment of psychogenic symptoms and disorders.
What if I’m too ill to travel to your office?
I recommend treatment in my Los Angeles office, or in the office of an ISTDP practitioner in your area, as your best choice. As a practice, I do not offer internet video therapy. However, if you live far from any local ISTDP therapist and are unable to travel, internet video therapy can be fruitful. That was the case with the man described above, so we worked via internet video therapy.
Important consideration:
- Sometimes my therapy is not short-term. Some traumas start very early in life or in a primary relationship, and require a longer course of treatment. Or problems can be very complex. Struggles with mind-altering substances or habitual self-sabotaging behavioral patterns can further complicate emotional difficulties. I may not see what is happening quickly, despite my best efforts. And sometimes smaller chunks of therapy spread over longer periods of time are more effective.
More resources:
TMS Help Forum: www.tmswiki.org/forum/
TMS Wiki: www.tmswiki.org/
To share with your physician:
- I would be happy to talk with your physician personally about ISTDP treatment for unexplained medical symptoms and conditions. I am very passionate about sharing it with other professionals.
Books and Kindle:
“Unlearn Your Pain,” Howard Schubiner, 2012: http://www.tmshelp.com/forum/topic.asp?TOPIC_ID=8126&whichpage=4
Living Like You Mean It: Use the Wisdom and Power of Your Emotions to Get the Life You Really Want, Ronald J. Fredrick, 2009.
Evidence-based research:
Let me know if you have questions or wish to discuss.
Catherine Lockwood LMFT
Brentwood Village, Los Angeles, California
310-488-5292
CatherineLockwoodMFT@gmail.com
Resources, Good Faith Estimate Notice
Below are resources, as well as the Good Faith Estimate Notice required by the Federal No Surprises act.
RESOURCES
For Individuals:
For Couples:
The Seven Principles for Making Marriage Work, John Gottman, 2000.
Couples-and-sex issues:
Sex Smart Films, www.sexsmartfilms.com/, Mark Schoen Ph.D. founder. More than 350 films in 34 different categories. This is a really excellent website on many relevant sexual topics: Ignore that some of the videos may seem dated because the education, information and techniques are solid.
Slow Sex: The Art and Craft of the Female Orgasm, Nicole Daedone, 2012. Ignore what you don’t like and just study the techniques presented, which are revolutionary and have helped couples in my practice enormously.
For Co-Parents, Separating/Separated or Divorcing/Divorced Parents:
“The Co-Parents’Handbook Raising Well-Adjusted, Resilient, and Resourceful Kids in a Two-Home Family-From Little Ones to Young Adults” by Karen Bonnell
“2houses” https://www.2houses.com/en/ Free resource to help separated parents or busy/modern families, facilitate communication and organization, critical for children’s happiness.
Children ages 4-8: It’s Not Your Fault Koko Bear: A Read-Together Book for Parents and Young Children During Divorce. Vicki Lansky and Jane Price, 1997.
–
Federal No Surprises Act Good Faith Estimate Notice
Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance a “Good Faith Estimate” of the expected charges for medical services, including psychotherapy services. You have the right to receive a “Good Faith Estimate” explaining how much your medical and mental health care will cost.
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services.
You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.
# # #
Meditation Practice
Serenity, Peace of Mind, Meditation, the Breath, Creativity, Presence, Awareness, Relaxation, Balance, Healthy Sleep and the Observer Self
I recommend that all my patients take up meditation of some sort. If that sounds a little intimidating, see below where you will find a surprising variety of easy ways to “meditate” for long to very short periods of time – far beyond the common conception of sitting for an eternity with your legs crossed and your eyes closed. Hopefully it will spur ideas for what kind of meditation might best suit you, including moving meditations or meditating during our day-to-day activities.
Scientists, doctors and brain researchers are finding more and more health benefits from meditation practice.
- Positive effects on your brain, heart and immune system
- Increased longevity
- Improved focus, attention and mood
- Decrease in chronic pain, depression, pain intensity and insomnia
- Lower cortisol stress hormone, supporting memory, healthy weight and sleep,
- Increase in antibody levels, helping the body fight off illnesses and infection
This partial list of benefits make meditation look like a Miracle Cure!
Cultivating mindfulness simply means making a conscious decision to direct our attention to the present moment, the here and now. To do this, we focus on the present moment: when worries or thoughts pop up, interfering with our focus on the present moment, we notice them, thank them for sharing – then purposefully bring our focus back to the now. We let go of criticism or judgment and just let everything be as it is in this moment.
It’s a skill that you can easily learn – and it doesn’t have to be hard or complicated as it’s sometimes made out to be. What makes it hard is when we criticize ourselves for not doing it perfectly! Here are lots of ideas about how to cultivate mindfulness and with it, more balance, health and serenity in your life.
Meditation
Many forms of meditation and contemplation have been practiced in every culture and religion for millenia. We usually think of meditation as a practice of concentrated focus upon a sound, object, visualization, the breath, movement, or attention itself in order to increase awareness of the present moment, reduce stress, promote relaxation, and enhance personal and spiritual growth. And in our Western “yang”-oriented culture, it’s important to create balance so that our lives aren’t all stress and “go-go-go!” Nurturing peace and serenity can help provide that balance.
There are a multitude of forms of meditation: Buddhist-mindful, Christian, Transcendental, Zen and Vipassana meditation as well as Biofeedback are just a few of a range of possibilities. There’s no “better” or “right” way to meditate. The important thing is that the way feel right to you. And you don’t have to meditate for hours to enjoy the benefits – even 2-5 minutes of meditation can be very helpful when you don’t have 20 minutes or a half hour to spare. And daily practice is best, but any practice is much better than none.
Instructions for Easy, Short Self-Guided Breath Meditation
This is one classic technique that you can try out on your own. Also see below resources for guided meditations.
Important Note: Sometimes, especially when you first start meditating, it may seem like nothing is happening. Some days you may feel frustrated at the difficulty of such a seemingly easy process or when your mind wanders. You may berate yourself when you have trouble even making yourself stop what you are doing and meditate, especially when it’s so nice when you finally do it. Do NOT berate yourself. Have patience! Go easy on yourself. No self-criticism. You will experience benefits – even if you do it “less than perfectly” – I promise! It’s the process that counts – basically bringing back your attention each time it wanders – that’s it.
- Get into a comfortable position in a quiet, peaceful environment (OK to use earphones or white noise if environment is too noisy) with your back straight if possible.
- If you wish, you can set a timer for the time you wish to meditation: You may choose 2 or 5 or 15 or however-long-you-want minutes.
- Close your eyes and focus on your breathing as your abdomen rises and falls.
- When your your mind wanders and you realize you’re thinking about other things, notice where your mind went, then gently bring your focus back to your breath. It’s the process of meditating that will help you – so don’t worry if your mind wanders repeatedly during some sessions. Some days you may have to bring your attention back many, many times during a meditation session – and that is just fine.
That’s it! That’s all there is to it!
Resources
- There are free guided meditations online. For example, UCLA’s Mindful Awareness Research Center, MARC, in Los Angeles, offers free guided meditations at http://marc.ucla.edu/body.cfm?id=22
- Did you know the health benefits of laughter? Even the Mayo Clinic practically calls laughing a miracle drug for what ails you! https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/stress-relief/art-20044456 Do you know that people all over the world participate in LAUGHTER YOGA meetings almost 24/7/365 – many on Zoom? Fifteen minutes a day can have amazing effect on your health and well-being. Try it! It’s free! https://laughteryoga.org
- The public library is a great free resource for guided practices. Check out their books, CD, and DVD collections.
- Group classes, workshops and retreats – depending on where you live, your local recreation department, community college or spiritual or religious center may training and support at a reasonable price, such as MARC at: http://marc.ucla.edu/. Some spiritual organizations offer free classes. Meditating in a group creates considerable power. .
- If you prefer to purchase your own copies of guided meditations, try going to a music store or bookstore first to listen to an audio clip before you buy it – to make sure you like the voices. Also, some online websites that sell CDs, DVDs, or audio downloads allow you to listen or view a snippet.
- Check out guided meditation videos. Many enjoy the music and visuals.
- There are many wonderful teachers who come from different backgrounds and cultural and religious traditions, augmented by science, technology and research. Look for ones that appeal to you personally.
Here are just a few of the greats to get you started on your path toward finding your teachers: Jon Kabat-Zinn, Shinzen Young, Jack Kornfield, Deepak Chopra, Thich Nhat Hanh, Eckhard Tolle, Lawrence LeShan Ph.D., Tara Brach, Pema Chodron, Louise Hay, the Dalai Lama, Emmet Fox (Christian), James Finley (Christian), Shakti Gawain, and Elisha Goldstein, Ph.D.
Helpful Books and Guided Meditations
Audio:
- Guided Mindfulness Meditation Series 1 Audio CD, Jon Kabat-Zinn, 2005
- Stress-Proof Your Brain: Meditations to Rewire Neural Pathways for Stress Relief and Unconditional Happiness Audio CD, Rick Hanson, 2010
- Beginner’s Guide to Meditation Audio CD, Shinzen Young, 2010
Book or Workbook + Audio CD:
- Real Happiness: The Power of Meditation: A 28-Day Program, Sharon Salzberg, 2010
Book, Kindle, Audio & Audible:
- Wherever You Go, There You Are, Jon Kabat-Zinn, 2005
- Meditation for Beginners, Jack Kornfield, 2008
Book, Audio, Audible, Large Print & Kindle:
- The Book of Awakening: Having the Life You Want by Being Present to the Life You Have, Mark Nepo, 2000
Moving Meditations and Mindfulness
Not everyone likes to sit still – or stay in one spot!
There are alternatives that are more active. Check with your doctor first before starting a new exercise or movement activity.
Here are a few ideas:
- Integrate meditation and mindfulness into everything you do throughout your day . This book will help: The Miracle of Mindfulness: An Introduction to the Practice of Meditation, Thich Nhat Hanh, 1999.
- A walking meditation – whenever possible, in nature and away from traffic! Nature can be very healing to body and soul. Letting our thoughts fade into the background, and focusing on the moment and the sounds and sights of trees, birds, flowers, clouds, sunlight, water – as well as our own inner and outer awareness of our body sensations and feelings – can be relaxing.
- Being “in the moment” in everyday activities: focus on all the sights and sounds and feelings in your environment, your body and your activities. Give your thinking and judging mind a break and keep bringing your awareness back to the present moment. As in meditation, when you find yourself thinking about something in the past or future, notice the thought, and gently bring your mind back to the present moment. For example, if you’re doing the dishes, bring your awareness to all five senses: watch the movements of your hands and fingers, feel the warmth of the water, listen to the gentle splashing, smell the scent of the soap, become aware of your body supporting you….
- Active practices such as Yoga, Feldenkrais, Tai Chi Chuan (Tai Chi), Qi Gong, Gyrotonics and Continuum. Again, check out studios, gyms, your city recreation department or community college.
- If you don’t have time to attend a class, check out websites like MyYogaOnline, at http://www.myyogaonline.com/home, which offers has a nice 19-minute Gentle Hatha Yoga Class that is easy, mindful and relaxing – as well as providing a warm-up and stretch for your body and muscles. You can join up for a moderate monthly charge to use all their offerings, or purchase a single download for a low cost. They also offer guided meditations, Feldenkrais, and dance classes on their site.
- Really immerse yourself in a wonderful, inspiring experience – with a friend or loved one or by yourself – such as a sunset or ocean waves or ducks on a lake…. Laying under a tree and focusing on the clouds and the birds and the sound of the leaves and branches in the wind…. Let the noisy chatter and worries in your brain fade away for awhile.
- Focus on a musical piece. Enjoying a concert in the park.
- Do a Body Scan Meditation: Closing your eyes, starting at your toes, and moving up your body, and focus on the sensations and feelings in each part of your body. This can be extremely relaxing. (Both Shinzen Young and Jon Kabat-Zinn and have wonderful body scan meditations – check out their CDs.)
- A Body Scan Meditation is also great to help you go to sleep: as you move your focus up your body, just add squeezing each muscle group tightly, then releasing, as your attention moves from body area to area.
- Dancing, sports, walking, painting, sculpting, arts & crafts, playing an instrument, singing, chanting, Pilates, gardening, surfing, swimming, sailing, taking a bath – in short, any activity performed mindfully, staying in the experience and the present moment. Let go of any critical voices telling you that you “should” be performing better!
- Making love to yourself or another. Holding hands, hugging, cuddling, spooning, rocking, massage – while letting go of extraneous thoughts while staying connected to the moment and accepting present experience. Let go of any performance anxiety – and just enjoy the moment. For more ideas about meditating with your partner, Google “meditations for lovers” or “tantric meditation.”
- Read inspirational literature and contemplate on it afterwards
- Focusing on the present moment won’t be all pleasant. When pain or discomfort come up, relax and meet them with calm compassion and curiosity. Don’t fight pain or chase it away, stay present and aware as it unfolds. Notice if it changes and transforms.
- Use search engines with the phrase “ways to meditate” and you’ll find lots of ideas. You will eventually find ways that work for you and – most importantly – that you enjoy!
* * *
Adjunct Bibliotherapy
My recommendations for using the book:
“Living Like You Mean It”
A book by Ronald J. Fredrick
Here are some suggestions for reading and using this book as a possible adjunct to your psychotherapy.
By the way, author Ron Fredrick reviewed these suggestions and publicly stated to the International Experiential Dynamic Therapy Association professional worldwide community that he “loves them!”
Psychotherapy gains can continue to increase and expand even when one is not in session. If you have any desire or inclination, here’s a way you might choose to continue the work between sessions:
Get a copy of the book, “Living Like You Mean It” by Ron J. Fredrick.
I recommend not reading it quickly and not reading it through like you might read a novel, a non-fiction book – or any other regular book.
Before you start the book: Read all of these suggestions through to the end.
Then, when you have at least 15 minutes:
Step 1
First get calm and present: check in with yourself. As needed, you might engage (briefly or longer) in a relaxing, mindful activity of any length, e.g. slow breathing, a yoga pose, smelling a flower, a walk, gentle movement, stopping to feel the air on your skin…
or to notice the sounds around you, watching the sky, water, stars, fire, etc., meditation, music, drawing, dancing, journaling, poetry, whatever helps you relax, a bath, playing, a game, nature, singing songs or lullabies, humming, rocking, massage, hugs – Self-Care and Self-Soothing activities – until your anxiety level doesn’t exceed 4 on a scale of 0-10 and you are present in the moment, mindful, and energized.
Then if it feels right, you can continue to Step #2…
Or…
If you feel like it, you can stop right here: In fact, if you’d like to stay awhile in the state you’ve created for yourself during Step #1, that’s doing therapy “work” too. Why? Learning to allow ourselves to take time to relax and enjoy calm and pleasant feelings is just as important as any other “work” we do in therapy!
Step 2
Read the very first paragraph of the book. Do not read further, even if it’s tempting.
Step 3
Self-Check-in:
This is very important: Stop and take your time – a couple or few minutes – to check in with your self, your body, your mind, and any arising feelings or impulses:
- Pay careful attention as to whether anxiety, body discomfort, distracting thoughts, or physical symptoms are starting to rise, for example if you are getting weak or tired or starting to “check out” or feel hopeless or ruminate or worry – or if other resistances or defenses are coming up and starting to take you over.
- The material and case examples in the book can bring up feelings about our own experiences in childhood, and in our lives, as well as possible past traumas great or small. If in response to rising feelings, anxiety, resistance, defenses or physical symptoms are being triggered in you, it’s important to respect these “stop-sign” messages from within yourself and stop reading further at this point.
So if disturbing memories or over-strong feelings come up, STOP and choose a Self-Care or Self-Soothing activity(ies) that might work for you, such as those described in Step #1 above, or a Self-Expression activity such as those mentioned three paragraphs below.
IMPORTANT:
If you feel you might be going into crisis or experience the beginnings of an anxiety or panic attack, and Self-Care and Self-Soothing activities aren’t working:
- Call 911 or call an emergency mental or behavioral-health hotline or go to your nearest emergency room at a hospital or clinic.
- Call your therapist or medical provider.
If you think you might need an emergency plan or emergency hotline for any reason, discuss this with your therapist or physician or other medical or social services resource before you proceed further.
Step 4
After checking in with yourself…
If you are upset or triggered:
- Take whatever time seems good – 2 minutes, 5 minutes, 25 minutes – as long as you need or want – to restore and calm yourself (see Self-Care and Self-Soothing activities above).
- Make sure your anxiety level doesn’t exceed 4 on a scale of 0 – 10 before proceeding.
Or…
You can stop this reading activity and go onto another life activity of your own entirely, and perhaps talk about what happened in your next session.
SO
If you find you are feeling okay and choose to continue reading…
Step 4
Proceed with reading the next paragraph of the book (or, later in the book, doing the next exercise) and repeat process.
Or…
You might choose to reflect on your inner experience by doing a Self-Expression activity such as: Journaling, writing as if you are writing to me or to someone very loving and accepting of you, making an audio or video recording of yourself expressing yourself, talking with someone who typically encourages you to share your experience(s) and can contain their own anxiety and suggestions while you share (and vice versa), writing a poem or free-flow writing or making a drawing or whatever seems expressive and calming.
You might find activities like the above helpful in exploring and expressing your internal reactions, feelings, impulses and thoughts, and/or bringing you further back to a regulated, calm, present state.
Or…
Stop this reading activity entirely and go on to your own next life activity.
Step 5 … and beyond:
- Read the next paragraph or do the next exercise
- Continue from Step 3
- Repeat
Notes:
You could discuss this with your therapist before you start the book, and your experiences in future sessions.
Or share with an accepting and understanding friend, family member or medical/psychological professional.
You could do these exercises in tandem with a friend or mentor, and discuss your experiences.
These exercises could be one way of continuing the work during breaks. Through this process, you might increase your:
- Capabilities to bring down anxiety
- Capacity to recognize and disempower defenses
- Awareness and connection to physical body sensations, body impulses and body pain as they arise
- Ability to feel safe and tolerate giving your time, attention and focus to what’s happening in the present moment inside you, and in your interactions with others – without become anxious or blocked
- Memory and perhaps greater understanding about what has happened to you in the past and how it has affected you since, and is affecting you now
- Capacity to get in touch with your deeper unconscious self and its gifts
- Skills at calming anxiety and conquering depression
- Openness and feelings of safety as you begin to open a pathway for your feelings, your unconscious, and your real self to emerge, be seen and express itself.
These exercises might:
- Start to point the way toward the road out of suffering…
- Contribute to a sense of relief, being more alive, vital, whole and connected to the now and/or
… Or you may never experience any of these.
Whatever your experience, that’s what was meant to be…
I hope you enjoy this and get a lot out of it!
Sincerely yours,
Catherine
Catherine Lockwood, MA, LMFT
Brentwood Village, Los Angeles, California 90049 USA
Phone: (310) 488-5292
CatherineLockwoodMFT@Gmail.com
IMPORTANT NOTICES:
- If you have any doubts whatsoever about whether the above exercises are appropriate or safe for you to do, discuss first with a mental or behavioral health professional, counselor, doctor, clergyman or trusted counsel.
- Please note that this communication and the ideas therein do not constitute therapy, psychotherapy, nor a therapeutic, personal or professional relationship.
* * *
“SUGGESTIONS FOR USING THE BOOK: LIVING LIKE YOU MEAN IT”
© 2015 Catherine Lockwood Psychotherapy, Couples and Family Counseling, Inc.
Adjunct Bibliotherapy
My recommendations for using the book:
“Living Like You Mean It”
A book by Ronald J. Fredrick
Here are some suggestions for reading and using this book as a possible adjunct to your psychotherapy.
By the way, author Ron Fredrick reviewed these suggestions and publicly stated to the International Experiential Dynamic Therapy Association professional worldwide community that he “loves them!”
Psychotherapy gains can continue to increase and expand even when one is not in session. If you have any desire or inclination, here’s a way you might choose to continue the work between sessions:
Get a copy of the book, “Living Like You Mean It” by Ron J. Fredrick.
I recommend not reading it quickly and not reading it through like you might read a novel, a non-fiction book – or any other regular book.
Before you start the book: Read all of these suggestions through to the end.
Then, when you have at least 15 minutes:
Step 1
First get calm and present: check in with yourself. As needed, you might engage (briefly or longer) in a relaxing, mindful activity of any length, e.g. slow breathing, a yoga pose, smelling a flower, a walk, gentle movement, stopping to feel the air on your skin…
or to notice the sounds around you, watching the sky, water, stars, fire, etc., meditation, music, drawing, dancing, journaling, poetry, whatever helps you relax, a bath, playing, a game, nature, singing songs or lullabies, humming, rocking, massage, hugs – Self-Care and Self-Soothing activities – until your anxiety level doesn’t exceed 4 on a scale of 0-10 and you are present in the moment, mindful, and energized.
Then if it feels right, you can continue to Step #2…
Or…
If you feel like it, you can stop right here: In fact, if you’d like to stay awhile in the state you’ve created for yourself during Step #1, that’s doing therapy “work” too. Why? Learning to allow ourselves to take time to relax and enjoy calm and pleasant feelings is just as important as any other “work” we do in therapy!
Step 2
Read the very first paragraph of the book. Do not read further, even if it’s tempting.
Step 3
Self-Check-in:
This is very important: Stop and take your time – a couple or few minutes – to check in with your self, your body, your mind, and any arising feelings or impulses:
- Pay careful attention as to whether anxiety, body discomfort, distracting thoughts, or physical symptoms are starting to rise, for example if you are getting weak or tired or starting to “check out” or feel hopeless or ruminate or worry – or if other resistances or defenses are coming up and starting to take you over.
- The material and case examples in the book can bring up feelings about our own experiences in childhood, and in our lives, as well as possible past traumas great or small. If in response to rising feelings, anxiety, resistance, defenses or physical symptoms are being triggered in you, it’s important to respect these “stop-sign” messages from within yourself and stop reading further at this point.
So if disturbing memories or over-strong feelings come up, STOP and choose a Self-Care or Self-Soothing activity(ies) that might work for you, such as those described in Step #1 above, or a Self-Expression activity such as those mentioned three paragraphs below.
IMPORTANT:
If you feel you might be going into crisis or experience the beginnings of an anxiety or panic attack, and Self-Care and Self-Soothing activities aren’t working:
- Call 911 or call an emergency mental or behavioral-health hotline or go to your nearest emergency room at a hospital or clinic.
- Call your therapist or medical provider.
If you think you might need an emergency plan or emergency hotline for any reason, discuss this with your therapist or physician or other medical or social services resource before you proceed further.
Step 4
After checking in with yourself…
If you are upset or triggered:
- Take whatever time seems good – 2 minutes, 5 minutes, 25 minutes – as long as you need or want – to restore and calm yourself (see Self-Care and Self-Soothing activities above).
- Make sure your anxiety level doesn’t exceed 4 on a scale of 0 – 10 before proceeding.
Or…
You can stop this reading activity and go onto another life activity of your own entirely, and perhaps talk about what happened in your next session.
SO
If you find you are feeling okay and choose to continue reading…
Step 4
Proceed with reading the next paragraph of the book (or, later in the book, doing the next exercise) and repeat process.
Or…
You might choose to reflect on your inner experience by doing a Self-Expression activity such as: Journaling, writing as if you are writing to me or to someone very loving and accepting of you, making an audio or video recording of yourself expressing yourself, talking with someone who typically encourages you to share your experience(s) and can contain their own anxiety and suggestions while you share (and vice versa), writing a poem or free-flow writing or making a drawing or whatever seems expressive and calming.
You might find activities like the above helpful in exploring and expressing your internal reactions, feelings, impulses and thoughts, and/or bringing you further back to a regulated, calm, present state.
Or…
Stop this reading activity entirely and go on to your own next life activity.
Step 5 … and beyond:
- Read the next paragraph or do the next exercise
- Continue from Step 3
- Repeat
Notes:
You could discuss this with your therapist before you start the book, and your experiences in future sessions.
Or share with an accepting and understanding friend, family member or medical/psychological professional.
You could do these exercises in tandem with a friend or mentor, and discuss your experiences.
These exercises could be one way of continuing the work during breaks. Through this process, you might increase your:
- Capabilities to bring down anxiety
- Capacity to recognize and disempower defenses
- Awareness and connection to physical body sensations, body impulses and body pain as they arise
- Ability to feel safe and tolerate giving your time, attention and focus to what’s happening in the present moment inside you, and in your interactions with others – without become anxious or blocked
- Memory and perhaps greater understanding about what has happened to you in the past and how it has affected you since, and is affecting you now
- Capacity to get in touch with your deeper unconscious self and its gifts
- Skills at calming anxiety and conquering depression
- Openness and feelings of safety as you begin to open a pathway for your feelings, your unconscious, and your real self to emerge, be seen and express itself.
These exercises might:
- Start to point the way toward the road out of suffering…
- Contribute to a sense of relief, being more alive, vital, whole and connected to the now and/or
… Or you may never experience any of these.
Whatever your experience, that’s what was meant to be…
I hope you enjoy this and get a lot out of it!
Sincerely yours,
Catherine
Catherine Lockwood, MA, LMFT
Brentwood Village, Los Angeles, California 90049 USA
Phone: (310) 488-5292
CatherineLockwoodMFT@Gmail.com
IMPORTANT NOTICES:
- If you have any doubts whatsoever about whether the above exercises are appropriate or safe for you to do, discuss first with a mental or behavioral health professional, counselor, doctor, clergyman or trusted counsel.
- Please note that this communication and the ideas therein do not constitute therapy, psychotherapy, nor a therapeutic, personal or professional relationship.
* * *
“SUGGESTIONS FOR USING THE BOOK: LIVING LIKE YOU MEAN IT”
© 2015 Catherine Lockwood Psychotherapy, Couples and Family Counseling, Inc.
Better Sleep, Sweeter Dreams
You deserve – and need – to sleep peacefully and soundly – and awake refreshed. Sleeping well is a habit you can learn with a little practice and effort. Each small change you make can add to big effects. Start today to take steps toward good sleep habits.
Take care of your body:
- Do not drink caffeine after 4 o’clock: no tea, coffee, cola, energy drinks or chocolate.
- Cut down on caffeine in general. Caffeine can cause sleep problems up to ten to twelve hours after drinking it!
- Do not eat a big, rich, heavy, fatty, acidic or spicy meal late in the day.
- Do not go to bed hungry. (See “light snack before bed” below for snack suggestions.)
- Avoid alcohol as it interferes with sleep.
- Avoid drinking too many liquids in the evening.
- Quit smoking. Smoking causes sleep troubles in numerous ways.
Physical exercise
- A brisk walk in the late afternoon can help to make your body tired and help you to sleep.
- Move or exercise every day: a minimum of 30 minutes daily is recommended. You can break up the time: a 10-minute walk here, a 15-minute bike ride there, some housework and so forth.
- In the evening: Relaxing exercises such as yoga or gentle stretching can help promote sleep.
Bedtime routine
Having a regular bedtime routine teaches your body when it’s time to go to sleep.
- Take a warm bath, or have a routine of washing your face and brushing your teeth.
- Have a soothing drink like chamomile tea or a milky drink.
- For some people, a light snack before bed can promote sleep. Tryptophan combined with carbohydrates works best. Good light snack choices:
- A banana
- Half a turkey sandwich
- A small bowl of whole–grain, low–sugar cereal or granola with low–fat milk or yogurt
- Peanut butter or cheese on ½ slice of toast or cracker
Relaxing bedtime rituals
- Read a book or magazine by a soft light
- Listen to soft music
- Do some easy stretches
- Wind down with a favorite hobby
- Listen to books on tape
- Make simple preparations for the next day
Sleep time habits – AKA “Sleep Hygiene”
- Go to bed at the same time each night.
- When in bed, think about nice things. For example:
- Think of 5 pleasant things that happened during the day – they may be big or small, such as a nice conversation, feeling the breeze on your skin, noticing a bird, a tree or the moon, smelling something pleasant, or hearing music you liked.
- Or remember the details of aspects of a past positive experience, like a flower garden or walk in nature. Let yourself experience again the sounds, sights, smells and feelings of it.
- Learn and practice healthy, supportive sleep postures. Once you get used to them, they will improve your posture and body comfort day and night.
- The book, “8 Steps to a Pain-Free Back: Natural Posture Solutions for Pain in the Back, Neck, Shoulder, Hip, Knee, and Foot” http://gokhalemethod.com/8-steps-pain-free-back by Esther Gokhale is an excellent resource.
- Try Gokhale’s stretch-lying back and side postures starting for at least 5 minutes each per night until eventually you will become comfortable sleeping longer in these healing postures.
Relaxing, sleep-inducing techniques
- Do a relaxed breathing exercise with one hand on your stomach and the other on your chest.
- Breathe deeply into your stomach instead of high in your chest.
- Take deep, slow breaths—making each breath even deeper than the last.
- Progressive muscle relaxation. This is an excellent way to put yourself to sleep! Instructions:
- First, tense up your entire body up all over, then relax. Repeat 2 more times.
- Then, starting at your toes and moving up your body, tense each set of muscles as tightly as you can, then completely relax them.
- Tense up (contract the muscles of) your toes and hold to count of 5 seconds, then relax.
- Tense up the balls of your feet, and hold for a count of 5 seconds, then relax.
- Tense up the tops of your feet and hold for a count of 5 seconds, then relax.
- Tense up your heels and hold for a count of 5 seconds, then relax…
- Tense up your ankles…… and so on up your body, working your way from your feet up to the top of your head.
- Repeat as needed.
- Look online or in your local shop that sells CDs for guided sleep and/or relaxation audio recordings that you like.
- Meditate. See “Cultivating Mindfulness” at http://www.catherinelockwoodmft.com/psychological-health/cultivating-mindfulness
- Visualizing a peaceful, restful place. Close your eyes and imagine a place or activity that is calming and peaceful for you. Concentrate on how relaxed this place or activity makes you feel.
Sleep schedule
- Aim for waking up at the same time every day, even if this is tiring in the beginning.
- If you need to make up for lost sleep, opt for a daytime nap rather than sleeping in late.
- Keep daytime napping to a minimum.
- While a nap can be a great way to recharge, especially for older adults, it can make insomnia worse.
- If you must nap, do it in the early afternoon, and limit it to thirty minutes.
- Fight after–dinner drowsiness. If you find yourself getting sleepy before bedtime, get up and do something mildly stimulating to avoid falling asleep, such as washing the dishes, calling a friend, or getting clothes ready for the next day.
Boost daytime light exposure
- Remove your sunglasses in the morning and let light shine onto your face.
- Spend more time outside during daylight. Take breaks outside in sunlight, exercise outside, or walk during the day.
- Let as much light into your home/workspace as possible. Keep curtains and blinds open during the day, move your desk closer to the window.
- Use light therapy. Uplift Technologies’ “day light” brand meets the non-profit Center for Environmental Therapeutics’ www.cet.org specifications: see http://www.day-lights.com/us/usindex.html. A good desk model is the “Sky Lamp” http://www.amazon.com/Day-Light-DL2000-Day-light-Sky/dp/B002WTCHLC. (Light therapy also helps alleviate seasonal depression.)
Raise nighttime melatonin production
- Turn off the TV and computer. Instead, listen to music or audio books, read with a soft light, or practice relaxation exercises. If your favorite TV show is on late at night, record it for viewing later at an earlier hour of the day.
- Don’t read from a backlit device at night (such as an iPad). If you use a portable electronic device to read, use an eReader that is not backlit, i.e. one that requires an additional light source such as a bedside lamp.
- Turn down lights in the evening.
- Use low-wattage light bulbs in the areas of your home where you relax in the evening before bedtime.
- When it’s time to sleep, make sure the room is dark. The darker it is, the better you’ll sleep.
- If you need light during the night, use a weak flashlight or nightlight.
- Keep noise down. If you can’t avoid or eliminate noise, mask it with a fan, a white noise machine, an air filter that makes some sound, earplugs, soft music or nature sounds, etc.
- Keep your room cool – around 65° F or 18° C – with adequate ventilation.
- Make sure your bed is comfortable
Reserve your bed for sleeping and sex only.
- Your bed should only be used for:
- Sleeping
- Cuddling and sex
- So if you cannot sleep after 30 minutes, don’t stay in bed tossing and turning! Instead:
- Get up and do another quiet activity elsewhere such as reading or listening to music.
- But AVOID THE TV AND THE COMPUTER.
- After 15 minutes, return to bed and try to sleep again.
- If you still can’t sleep after 30 minutes, get up again.
- Repeat this routine as many times as necessary.
Make your bedroom a pleasant place to be
- Keep it clean and neat.
- Introduce nice smells such as a drop of lavender, valerian, vetiver, chamomile, or sandalwood oil on the pillow.
- Have the right pillows to make yourself comfortable
- Feel safe in your home with doors locked and windows closed before you start your sleep-preparation routine.
- To harmonize the chi in your home, a wonderful book is the out-of-print “Feng Shui Directory” by Jane Butler-Biggs (2000), which is still available used online at bargain prices. It is not about old superstitions, but about how your home and environment affect your life. Highly recommended.
Nightmares and bad dreams
Some tips to try…
- Prepare in advance for bad dreams by thinking of a bad dream you’ve had in the past; then imagine a different, more positive ending for it. Practice this new ending many times whenever you have time and before going to sleep.
- Before going to sleep, prepare to re-orient yourself when you wake up from a bad dream.
- Remind yourself that you are at home, that you are safe. Imagine your street, your neighborhood, local businesses….
- Put a damp towel or a bowl of water by the bed to splash on your face.
- Place a special object by the bed, such as a photograph or a small soft toy.
- Practice imagining yourself waking up from a bad dream and reorienting yourself to the present, to safety, by splashing your face, touching a special object, having a bottle of rose or lavender essential oil to sniff, going to the window to see the surroundings.
- When you wake up from a bad dream, move your body and reorient yourself immediately by touching the object, wetting your face, going to the window, and/or talking to yourself in a reassuring way.
- The audio series, “Turning Nightmares into Dreams” by Barry Krakow M.D. Turning Nightmares into Dreams | Products … – Nightmare Treatment is available through the Maimonides International Nightmare Treatment Center website in CD or digital download formats; or on CDs elsewhere.
When to see a sleep doctor…
If you’ve given the tips above some time to work, but are still struggling with sleep problems, you may have a sleep disorder that requires professional treatment.
Consider scheduling a visit with your doctor for a referral or make an appointment directly with a sleep doctor if, despite your best efforts at self–help, you are still troubled by any of the following symptoms:
▪ Persistent daytime sleepiness or fatigue
▪ Loud snoring accompanied by pauses in breathing
▪ Difficulty falling asleep or staying asleep
▪ Un-refreshing sleep
▪ Frequent morning headaches
▪ Crawling sensations in your legs or arms at night
▪ Inability to move while falling asleep or waking up
▪ Physically acting out dreams during sleep
▪ Falling asleep at inappropriate times
