Relational Therapy Quotes

The most traumatic aspects of all disasters involve the shattering of human connections. And this is especially true for children. Being harmed by the people who are supposed to love you, being abandoned by them, being robbed of the one-on-one relationships that allow you to feel safe and valued and to become humane—these are profoundly destructive experiences. Because humans are inescapably social beings, the worst catastrophes that can befall us inevitably involve relational loss. As a result, recovery from trauma and neglect is also all about relationships—rebuilding trust, regaining confidence, returning to a sense of security and reconnecting to love. Of course, medications can help relieve symptoms and talking to a therapist can be incredibly useful. But healing and recovery are impossible—even with the best medications and therapy in the world—without lasting, caring connections to others.

I’d entered therapy hoping to alleviate the suffering related to both my food issues and my mother, but without having to make any actual life changes in either area.

Debriefing-style counseling after a trauma often aggravates a victim's stress-related symptoms, for example, and 4 in 10 bereaved people do better without grief therapy.

Each person is born with an unencumbered spot, free of expectation and regret, free of ambition and embarrassment, free of fear and worry; an umbilical spot of grace where we were each first touched by God. It is this spot of grace that issues peace. Psychologists call this spot the Psyche, Theologians call it the Soul, Jung calls it the Seat of the Unconscious, Hindu masters call it Atman, Buddhists call it Dharma, Rilke calls it Inwardness, Sufis call it Qalb, and Jesus calls it the Center of our Love. To know this spot of Inwardness is to know who we are, not by surface markers of identity, not by where we work or what we wear or how we like to be addressed, but by feeling our place in relation to the Infinite and by inhabiting it. This is a hard lifelong task, for the nature of becoming is a constant filming over of where we begin, while the nature of being is a constant erosion of what is not essential. Each of us lives in the midst of this ongoing tension, growing tarnished or covered over, only to be worn back to that incorruptible spot of grace at our core. When the film is worn through, we have moments of enlightenment, moments of wholeness, moments of Satori as the Zen sages term it, moments of clear living when inner meets outer, moments of full integrity of being, moments of complete Oneness. And whether the film is a veil of culture, of memory, of mental or religious training, of trauma or sophistication, the removal of that film and the restoration of that timeless spot of grace is the goal of all therapy and education. Regardless of subject matter, this is the only thing worth teaching: how to uncover that original center and how to live there once it is restored. We call the filming over a deadening of heart, and the process of return, whether brought about through suffering or love, is how we unlearn our way back to God

The charge of blasphemy is loaded. The point is to pack a wallop behind the charge that in our worship services God simply doesn't come through for who he is. He is unwittingly belittled. For those who are stunned by the indescribable magnitude of what God has made, not to mention the infinite greatness of the One who made it, the steady diet on Sunday morning of practical how-to's and psychological soothing and relational therapy and tactical planning seem dramatically out of touch with Reality - the God of overwhelming greatness.

The things most people need to learn in therapy are related to attachment, abandonment, love, and fear. We are trying to access basic emotional processes that are organized in primitive and early-developing parts of the brain. The language of these emotions is also very basic; it is the language of childhood. The more complex the language and ideas you bring into therapy, the more likely you are to stimulate your clients’ intellectualizing defenses.

Eating disorders are so profoundly a coping mechanism for failures in human relationships that to get over one it’s essential to strengthen the capacity to relate to another, which is a lot of what happens in therapy. Underneath my desire

I realized that “being prepared” can sometimes be a euphemism for being scared to let go. How much we carry—whether it is on our bicycle, in our bag, or in our home—is often directly related to how little we trust in life to guide us well, and in others to help us out in a pinch. To this day, I have found that traveling light yields a far richer experience.

Your feelings do not determine your worth, simply your relative state of comfort or discomfort.

People whose cognitions fuse are likely to ignore direct experience and become relatively oblivious to environmental influences.

Would You Notice Me" is a beautifully intense read. The imagery is engaging....”the Merlot waterfall” and “confetti’d parts” lines for instance, and the the voice of the poem as a whole.

The Magician should devise for himself a definite technique for destroying "evil." The essence of such a practice will consist in training the mind and the body to confront things which case fear, pain, disgust, shame and the like. He must learn to endure them, then to become indifferent to them, then to become indifferent to them, then to analyze them until they give pleasure and instruction, and finally to appreciate them for their own sake, as aspects of Truth. When this has been done, he should abandon them, if they are really harmful in relation to health and comfort.

In therapy we discover that we heal through relating, for the wounds that occurred in relationships must be healed in a relationship, a relationship where the therapist doesn’t talk at us but with us.

An openness to being changed by the client is required of the person-centred therapist. A person-centred therapist who is closed off from being changed implicitly denies the full humanity of the client.

Object relations theorists are interested in understanding how formative interactions between parents and children become internalized by the child and, akin to cognitive schemas, serve as mental representations that shape or guide how children establish and carry out subsequent relationships with others.

When people recover from depression via psychotherapy, their attributions about recovery are likely to be different than those of people who have been treated with medication. Psychotherapy is a learning experience. Improvement is not produced by an external substance, but by changes within the person. It is like learning to read, write or ride a bicycle. Once you have learned, the skills stays with you. People no not become illiterate after they graduate from school, and if they get rusty at riding a bicycle, the skill can be acquired with relatively little practice. Furthermore, part of what a person might learn in therapy is to expect downturns in mood and to interpret them as a normal part of their life, rather than as an indication of an underlying disorder. This understanding, along with the skills that the person has learned for coping with negative moods and situations, can help to prevent a depressive relapse.

Although most psychotherapeutic approaches "agree that therapeutic work in the 'here and how' has the greatest power in bringing about change" (Stern, 2004, p. 3), talk therapy has limited direct impact on maladaptive procedural action tendencies as they occur in the present moment. Although telling "the story" provides crucial information about the client's past and current life experience, treatment must address the here-and-now experience of the traumatic past, rather than its content or narrative, in order to challenge and transform procedural learning. Because the physical and mental tendencies of procedural learning manifest in present-moment time, in-the-moment trauma-related emotional reactions, thoughts, images, body sensations, and movements that emerge spontaneously in the therapy hour become the focal points of exploration and change.

first started therapy, I found it very hard to cry. I feared I’d be carried away by the flood, overwhelmed. Perhaps that’s what it feels like for you. That’s why it’s important to take your time to feel safe, and trust that you won’t be alone in this flood – that I’m treading water here with you.’ Silence. ‘I think of myself as a relational therapist,’ I said. ‘Do you know what that means?’ Silence. ‘It means I think Freud was wrong about a couple of things. I don’t believe a therapist can ever really be a blank slate, as he intended. We leak all kinds of information about ourselves unintentionally – by the colour of my socks, or how I sit or the way I talk – just by sitting here with you, I reveal a great deal about myself. Despite my best efforts at invisibility, I’m showing you who I am.’ Alicia looked up. She stared at me, her chin slightly tilted – was there a challenge in that look? At last I had her attention. I shifted in my seat. ‘The point is, what can we do about this? We can ignore it, and deny it, and pretend this therapy is all about you. Or we can acknowledge that this is a two-way street, and work with that. And then we can really start to get somewhere.’ I held up my hand. I nodded at my wedding ring. ‘This ring tells you something, doesn’t it?’ Alicia’s eyes ever-so-slowly moved in the direction of the ring. ‘It tells you I’m a married man. It tells you I have a

The study reported a 24 percent relative increase in the risk of breast cancer among a subset of women taking HRT, and headlines all over the world condemned HRT as a dangerous, cancer-causing therapy. All of a sudden, on the basis of this one study, hormone replacement treatment became virtually taboo. This reported 24 percent risk increase sounded scary indeed. But nobody seemed to care that the absolute risk increase of breast cancer for women in the study remained minuscule. Roughly five out of every one thousand women in the HRT group developed breast cancer, versus four out of every one thousand in the control group, who received no hormones.

On the bodily level, tension resulting from introjections may settle in the throat, stomach, or gut. In terms of body language, this is related to distress over difficulty swallowing, stomaching, or digesting something noxious. In this sense, introjections can be toxic. Sometimes work on these areas causes release of intensely uncomfortable feelings, such as nausea, gagging, or disgust. Disgust is an instinct that stimulates the elimination of or repulsion from what is harmful to us.

Unacknowledged privilege and the subtle or blatant use of power over others inevitably create division, anger, disempowerment, depression, shame, and disconnection.

If growth is to occur in any relationship, both—or all—of the people involved have to change

Ginny could see me more realistically, she could begin to de-idealize me and relate to me on a more human basis.

The key verbal relations in the development of perspective taking are “deictic,” which means “by demonstration.

If we believe that people are inherently good, we react less intensely to distress. We assume that people generally don't want to hurt us—we trust that the world is relatively safe.

Because people with a disembodied structure often have no bodily sensation, they also cannot sense where they begin and end, which reflects being highly underbounded. They also often have distorted sensations of how big or small different body parts are and frequently believe their head is much bigger than it actually is. The lack of bounding results in people with a disembodied structure being engulfed by the relatively unfiltered input streaming in from the environment. They are also prone to project their fantasies onto the outside world.

One great help here - and I make no claim that it is the only help or even a necessary condition for forgiveness - is sincere repentance on the part of the wrongdoer. When I am wronged by another, a great part of the injury - over and above any physical harm I may suffer - is the insulting or degrading message that has been given to me by the wrongdoer: the message that I am less worthy than he is, so unworthy that he may use me merely as a means or object in service to his desires and projects. Thus failing to resent(or hastily forgiving) the wrongdoer runs the risk that I am endorsing that very immoral message for which the wrongdoer stands. If the wrongdoer sincerely repents, however, he now joins me in repundiating the degrading and insulting message - allowing me to relate to him (his new self) as an equal without fear that a failure to resent him will be read as a failure to resent what he hs done.

I always say toward the end of the hour: “Let’s take a minute to look at how you and I are doing today.” Or, “Any feelings about the way we are working and relating?” Or, “Before we stop, shall we take a look at what’s going on in this space between us?” Or if I perceive difficulties, I might say something like: “Before we stop, let’s check into our relationship today. You’ve talked

For example, in order to identify these schemas or clarify faulty relational expectations, therapists working from an object relations, attachment, or cognitive behavioral framework often ask themselves (and their clients) questions like these: 1. What does the client tend to want from me or others? (For example, clients who repeatedly were ignored, dismissed, or even rejected might wish to be responded to emotionally, reached out to when they have a problem, or to be taken seriously when they express a concern.) 2. What does the client usually expect from others? (Different clients might expect others to diminish or compete with them, to take advantage and try to exploit them, or to admire and idealize them as special.) 3. What is the client’s experience of self in relationship to others? (For example, they might think of themselves as being unimportant or unwanted, burdensome to others, or responsible for handling everything.) 4. What are the emotional reactions that keep recurring? (In relationships, the client may repeatedly find himself feeling insecure or worried, self-conscious or ashamed, or—for those who have enjoyed better developmental experiences—perhaps confident and appreciated.) 5. As a result of these core beliefs, what are the client’s interpersonal strategies for coping with his relational problems? (Common strategies include seeking approval or trying to please others, complying and going along with what others want them to do, emotionally disengaging or physically withdrawing from others, or trying to dominate others through intimidation or control others via criticism and disapproval.) 6. Finally, what kind of reactions do these interpersonal styles tend to elicit from the therapist and others? (For example, when interacting together, others often may feel boredom, disinterest, or irritation; a press to rescue or take care of them in some way; or a helpless feeling that no matter how hard we try, whatever we do to help disappoints them and fails to meet their need.)

Gene patents are the point of greatest concern in the debate over ownership of human biological materials, and how that ownership might interfere with science. As of 2005—the most recent year figures were available—the U.S. government had issued patents relating to the use of about 20 percent of known human genes, including genes for Alzheimer’s, asthma, colon cancer, and, most famously, breast cancer. This means pharmaceutical companies, scientists, and universities control what research can be done on those genes, and how much resulting therapies and diagnostic tests will cost. And some enforce their patents aggressively: Myriad Genetics, which holds the patents on the BRCA1 and BRCA2 genes responsible for most cases of hereditary breast and ovarian cancer, charges $3,000 to test for the genes. Myriad has been accused of creating a monopoly, since no one else can offer the test, and researchers can’t develop cheaper tests or new therapies without getting permission from Myriad and paying steep licensing fees. Scientists who’ve gone ahead with research involving the breast-cancer genes without Myriad’s permission have found themselves on the receiving end of cease-and-desist letters and threats of litigation.

Another, related issue is that longevity itself, and healthspan in particular, doesn’t really fit into the business model of our current healthcare system. There are few insurance reimbursement codes for most of the largely preventive interventions that I believe are necessary to extend lifespan and healthspan. Health insurance companies won’t pay a doctor very much to tell a patient to change the way he eats, or to monitor his blood glucose levels in order to help prevent him from developing type 2 diabetes. Yet insurance will pay for this same patient’s (very expensive) insulin after he has been diagnosed. Similarly, there’s no billing code for putting a patient on a comprehensive exercise program designed to maintain her muscle mass and sense of balance while building her resistance to injury. But if she falls and breaks her hip, then her surgery and physical therapy will be covered. Nearly all the money flows to treatment rather than prevention—and when I say “prevention,” I mean prevention of human suffering.

Presence is not a question of judging or evaluating a client or a client’s situation. Presence is to see the client’s situation in a positive and creative light with a vision for how the present situation of the client relates to his further spiritual development. It is to accept a person as he is. It is to understand that the person is exactly where he needs to be in order to take the next step in his spiritual development. It is not about fighting with problems, darkness, drama and defences on the personality level, it is about becoming aware. It is about lighting the light in the inner being of another person.

Following Strupp (1980), clients change when they live through emotionally painful and long-ingrained relational experiences with the therapist, and the therapeutic relationship gives rise to new and better outcomes that are different from those anticipated and feared. That is, when the client re-experiences important aspects of her primary problem with the therapist, and the therapist’s response does not fit the old schemas or expectations, the client has the real-life experience that relationships can be another way. When clients experience this new or reparative response, a response that differs from previous relationships and that does not fit the client’s negative expectations or cognitive schemas, it is a powerful type of experiential re-learning that readily can be generalized to other relationships (Bandura, 1997).

To summarize, the rationale for using the here-and-now is that human problems are largely relational and that an individual’s interpersonal problems will ultimately be manifested in the here-and-now of the therapy encounter

... the silent client may be experienced as withholding, oppositional, and sulking or as holding the therapist "hostage" in ways that elicit resentment and other negative responses. Because it is not unusual that relational and other forms of traumatization began when the client was preverbal, he or she may not have words. The lack of access to emotions or to words to describe them is known as alexithymia and is a common response to trauma. What the client is likely to have instead is somatosensory, behavioral, dissociative, and relational manifestations that therapists must seek to understand and translate into words, a process that involves hard work and intense focus.

Secondary structural dissociation involves one ANP and more than one EP. Examples of secondary structural dissociation are complex PTSD, complex forms of acute stress disorder, complex dissociative amnesia, complex somatoform disorders, some forms of trauma-relayed personality disorders, such as borderline personality disorder, and dissociative disorder not otherwise specified (DDNOS).. Secondary structural dissociation is characterized by divideness of two or more defensive subsystems. For example, there may be different EPs that are devoted to flight, fight or freeze, total submission, and so on. (Van der Hart et al., 2004). Gail, a patient of mine, does not have a personality disorder, but describes herself as a "changed person." She survived a horrific car accident that killed several others, and in which she was the driver. Someone not knowing her history might see her as a relatively normal, somewhat anxious and stiff person (ANP). It would not occur to this observer that only a year before, Gail had been a different person: fun-loving, spontaneous, flexible, and untroubled by frightening nightmares and constant anxiety. Fortunately, Gail has been willing to pay attention to her EPs; she has been able to put the process of integration in motion; and she has been able to heal. p134

People with an entertaining rigid structure are brought up in environments in which the parents are uncomfortable with expressing feelings. This is not to say that the parents do not care, but they do not express feelings like affection, warmth, and caring or feel comfortable with expressing such feelings (Keleman). The experience within the family is not one of intimacy and true interchange of feeling. To contend with the situation, the child may learn to draw out the parents by being cute, entertaining, or charming. Although being charming is something most children do naturally to some extent, the difference in the case of people with an entertaining rigid structure is that this becomes the primary mode of relating. Furthermore, the entertaining rigid structure pattern is reinforced as the parents respond primarily to the child's charm, rather than to their own feelings. Therefore, such children effectively learn that they will not get the reaction they crave without using that behavior. At the same time, these children are also developing or have developed a discomfort with intimacy that is similar to that of their parents. As a result, people with an entertaining rigid structure as adults act out this pattern in which they are energized or emotionally fed by being able to cause another person to be attracted to them, but they become anxious if the person becomes too close or expresses "real" feeling. Love is what they are really craving, and they think they are getting it, but are not. In other words, they have mistaken the energy of attraction for love.

And most important, nobody could love or relate to you. It would be impossible to feel any love for someone who was flawless and knew it all. Doesn't that sound lonely, boring, and miserable? Are you so sure you still want perfection? Part V Defeating Hopelessness and Suicide

Frosh (2002) has suggested that therapeutic spaces provide children and adults with the rare opportunity to articulate experiences that are otherwise excluded from the dominant symbolic order. However, since the 1990s, post-modern and post-structural theory has often been deployed in ways that attempt to ‘manage’ from; afar the perturbing disclosures of abuse and trauma that arise in therapeutic spaces (Frosh 2002). Nowhere is this clearer than in relation to organised abuse, where the testimony of girls and women has been deconstructed as symptoms of cultural hysteria (Showalter 1997) and the colonisation of women’s minds by therapeutic discourse (Hacking 1995). However, behind words and discourse, ‘a real world and real lives do exist, howsoever we interpret, construct and recycle accounts of these by a variety of symbolic means’ (Stanley 1993: 214). Summit (1994: 5) once described organised abuse as a ‘subject of smoke and mirrors’, observing the ways in which it has persistently defied conceptualisation or explanation. Explanations for serious or sadistic child sex offending have typically rested on psychiatric concepts of ‘paedophilia’ or particular psychological categories that have limited utility for the study of the cultures of sexual abuse that emerge in the families or institutions in which organised abuse takes pace. For those clinicians and researchers who take organised abuse seriously, their reliance upon individualistic rather than sociological explanations for child sexual abuse has left them unable to explain the emergence of coordinated, and often sadistic, multi—perpetrator sexual abuse in a range of contexts around the world.

Therapy, for us, is related to a growth process that takes place naturally in lives and in families. We assume that the will and the need to expand and integrate experience are universal; and the family that enters psychotherapy is simply one in which that natural process has become blocked. Therapy is a catalytic “agent” which we hope will help the family unlock their own resources. Therefore, we place great emphasis on the family’s own initiative, assuming that if they cannot discover their own power to change themselves, therapy will have no enduring effect. Like

Trust of others is in short supply for many adult survivors, as complex trauma generally involves major relational betrayal. It is, therefore, expectable (although paradoxical) that clients with these histories are predisposed to be mistrustful at the outset of therapy, precisely because of (and in proportion to) the actual trustworthiness of the therapist. When past experiences have thought hard lessons, namely, that one can least afford to trust the people who should be most trustworthy, it stands to reason that confusion about trust results. The therapist must understand and not take offense either personally or professionally and not react judgmentally or defensively. Practically speaking, this involves the therapist being prepared to patiently and empathically respond to active or passive tests or challenges to trustworthiness as legitimate and meaningful communication that deserves a respectful reply in action as well as in words.

COMMUNITY WAS HELD IN A LONG ROOM with tall barred windows that overlooked a redbrick wall. The smell of coffee was in the air, mingled with traces of Yuri’s aftershave. About thirty people were sitting in a circle. Most were clutching paper cups of tea or coffee, yawning and doing their best to wake up. Some, having drunk their coffees, were fidgeting with the empty cups, crumpling, flattening them, or tearing them to shreds. Community met once or twice daily; it was something between an administrative meeting and a group therapy session. Items relating to the running of the unit or the patients’ care were put on the agenda to be discussed

This reorienting is not an attempt to avoid or discount clients' pain and ongoing suffering. Rather, it is a means to help them observe, firsthand, how their chronic orienting tendencies toward reminders of the past recreate the trauma-related experience of danger and powerlessness, whereas choosing to orient to a good feeling can result in an experience of safety and mastery. As clients become able to do so the new objects of orientation often become more defined and & Goodman 1951). Rather than attention being drawn repeatedly to physical pain or traumatic activation, the good feeling becomes more prominent in the client's awareness. This exercise of reorienting toward a positive stimulus can surprise and reassure clients that they are not imprisoned indefinitely in an inner world of chronic traumatic reexperiencing, and that they have more possibilities and control than they had imagined. These orienting exercises need to be practiced again and again for mastery.

The redirection of orientation and attention can be as simple as asking clients to become aware of a "good" or "safe" feeling in the body instead of focusing on their physical pain or elevated heart rate. Or the therapist can ask clients to experiment with focusing attention away from the traumatic activation in their body and toward thoughts or images related to their positive experiences and competencies, such as success in their job. This shift is often difficult for clients who have habituated to feeling pulled back repetitively into the most negative somatic reminders of their traumatic experiences. However, if the therapist guides them to practice deeply immersing themselves in a positive somatic experience (i.e., noting the changes in posture, breath, and muscular tone that emerge as they remember their competence), clients will gain the ability to reorient toward their competencies. They experience their ability to choose to what they pay attention and discover that it really is possible to resist the somatic claims of the past.

In fact, the same intervention or response may even have the opposite effect on two different clients with contrasting developmental histories and cultural contexts. For example, if a client’s parent was distant or aloof, the therapist’s judicious self-disclosure may be helpful for the client. In contrast, the same type of self-disclosure is likely to be anxiety-arousing for a client who grew up serving as the confidant or emotional caregiver of a depressed parent. Greater sharing with the therapist may help the first client learn that, contrary to her deeply held beliefs, she does matter and can be of interest to other people. In contrast, for the second client, the same type of self-disclosure may inadvertently impose the unwanted needs of others and set this client back in treatment as, in her mind, she experiences herself back in her old caretaking role again—this time with the therapist. This unwanted reenactment occurs because the therapeutic relationship is now paralleling the same problematic relational theme that this client struggled with while growing up.

Ironically, many of the institutions that run the economy, such as medicine, education, law and even psychology are largely dependent upon failing health. If you add up the amounts of money exchanged in the control, anticipation and reaction to failing health (insurance, pharmaceutical research and products, reactive or compensatory medicine, related legal issues, consultation and therapy for those who are unwilling to improve their physical health and claim or believe the problem is elsewhere, etc.), you end up with an enormous chunk. To keep that moving, we need people to be sick. Then we have the extreme social emphasis placed on the pursuit and maintenance of a lifestyle based on making money at any cost, often at the sacrifice of health, sanity and well-being.

The fact that someone understands is enough, even though one cannot understand oneself then the temperature drops and a certain quietness comes, and then perhaps the patient may also understand. Archetypal contents are sometimes far away and if the patient is not drawn to them in these terms you cannot get the meaning across, but the feeling that somebody else understands has a calming effect.

Our sin is our resistance to going along with God's initiative in making suffering reparative. We are deeply drawn towards God, but we also sense how following him will dislocate and transform beyond recognition the forms which have made life tolerable for us. We often react with fear, dismay, hostility. We are at war with ourselves, and responding differently to this inner conflict, we end up at war with each other. So it is undoubtedly true that the result of sin is much suffering. But this is by no means distributed according to desert. Many who are relatively innocent are swept up in this suffering, and some of the worse offenders get off lightly. The proper response to all this is not retrospective book-keeping, but making ourselves capable of responding to God's initiative. But now if that's what sin is, then one can sympathize with a lot of the modern critique of a religion which focuses on the evil tendencies of human nature, and the need for renunciation and sacrifice. This is not because humans are in fact angelic, or there is no point to sacrifice. It's just that focusing on how bad human beings can be, even if it's to refute the often over-rosy views of secular humanists with their reliance on human malleability and therapy, can only strengthen misanthropy, which certainly won’t bring you closer to God; and propounding sacrifice and renunciation for themselves takes you away from the main points, which is following God's initiative. That this can involve sacrifice, we well know from the charter act in this initiative, but renunciation is not is point.

Group therapy was the only place I could feel “not crazy.” Every time we met, I exhaled. Because when you’ve been raped, you really feel like you’re on an island. Then to be in this room, where everyone could relate, changed everything. Wow, that girl is getting straight A's. That girl got a great internship. This girl is engaged. It gave me the calm I so desperately needed. I saw the possibility of hope.

{W]hat counts in therapy is not techniques but rather the human relation between doctor and patient, or the personal and existential encounter. [...] A purely technological approach to psychotherapy may block its therapeutic effect. [...] [A]s soon and as long as we actually interpret our assignment merely in terms of techniques and dynamics we have missed the point—and we have missed the hearts of those to whom we wish to offer mental First Aid in their predicament.

We live in the world, Jacob thought. That thought always seemed to insert itself, usually in opposition to the word ideally. Ideally, we would make sandwiches at homeless shelters every weekend, and learn instruments late in life, and stop thinking about the middle of life as late in life, and use some mental resource other than Google, and some physical resource other than Amazon, and permanently retire mac and cheese, and give at least a quarter of the time and attention to aging relatives that they deserve, and never put a child in front of a screen. But we live in the world, and in the world there’s soccer practice, and speech therapy, and grocery shopping, and homework, and keeping the house respectably clean, and money, and moods, and fatigue, and also we’re only human, and humans not only need but deserve things like time with a coffee and the paper, and seeing friends, and taking breathers, so as nice as that idea is, there’s just no way we can make it happen. Ought to, but can’t.

having clients orient to the stimulus on which they are very fixated helps them consciously and directly attend to reminders of past trauma. This provides the opportunity for the reactions to the trauma-related stimulus to change from involuntary and reflexive to reflective awareness and assimilation. The client's sense of control and efficacy is often enhanced, whereas simply orienting to new, neutral, or pleasurable stimuli may not accomplish this (Ford, personal communication, August 12, 2005).

The patient brings with him into therapy all the failures and suspicions and losses he has experienced through his life. The defensive forms of insecure attachment - avoidance, ambivalence, disorganisation - will be brought into play in relation to the therapist. There will be a struggle between these habitual patterns and the skill of the therapist in providing a secure base - the capacity to be responsive and attuned to the patient's feelings, to receive projections and to transmute them in such a way that the patient can face their hitherto unmanageable feelings. To the extent that this happens, the patient will gradually relinquish their attachment to the therapist while, simultaneously, an internal secure base is built up inside. As a result, as therapy draws to a close, the patient is better able to form less anxious attachment relationships in the external world and feels more secure in himself. As concrete attachment to the therapist lessens, so the qualities of self-responsiveness and self-attunement are more firmly established in the inner world.

Anxiety (loneliness or “abandonment anxiety” being its most painful form) overcomes the person to the extent that he loses orientation in the objective world. To lose the world is to lose one's self, and vice versa; self and world are correlates. The function of anxiety is to destroy the self-world relationship, i.e., to disorient the victim in space and time and, so long as this disorientation lasts, the person remains in the state of anxiety. Anxiety overwhelms the person precisely because of the preservation of this disorientation. Now if the person can reorient himself—as happens, one hopes, in psychotherapy—and again relate himself to the world directly, experientially, with his senses alive, he overcomes the anxiety. My slightly anthropomorphic terminology comes out of my work as a therapist and is not out of place here. Though the patient and I are entirely aware of the symbolic nature of this (anxiety doesn’t do anything, just as libido or sex drives don’t), it is often helpful for the patient to see himself as struggling against an “adversary.” For then, instead of waiting forever for the therapy to analyze away the anxiety, he can help in his own treatment by taking practical steps when he experiences anxiety such as stopping and asking just what it was that occurred in reality or in his fantasies that preceded the disorientation which cued off the anxiety. He is not only opening the doors of his closet where the ghosts hide, but he often can also then take steps to reorient himself in his practical life by making new human relationships and finding new work which interests him.

The overarching principle of a therapeutic relationship is that therapists should be ever mindful of a variant of the Hippocratic oath and, to the degree possible, strive to "do no more harm" (Courtois, 2010). Complex trauma clients have already experienced considerable harm, much of it at the hands of other human beings. As a result of the ubiquitous processes of transference, attachment styles, and IWM [Internal working models], these clients often view the therapist's behavior and their relationship through the lens of their trauma-related negative interpersonal expectancies and unhealed emotional wounds and injuries. Therapists should not be surprised to be "guilty until proven innocent", not because clients with complex trauma histories are "unfair" or "unreasonable" but precisely the opposite - because the most realistic self-protective stance for them (given the fact that betrayal and harm have been more the rule than the exception) is to "distrust first and verify" (or to be hypervigilant) rather than to start with an expectation of safety and trustworthiness.

A useful first step is to reverse engineer the situation back to the triggering event and to define the specific problem you are facing. You can then determine options for handling it. The various manifestations of anger reflect a sense that something is “not fair,” which is related to a should statement, such as “this should not happen.” Dealing with “shoulds” involves acknowledging that you obviously are not happy that something happened, but that you must still face the fact that it did happen. Thus, the task then turns to dealing with the situation.

To be aware is to be responsible. In Gestalt therapy, this word is used in two ways. First, we are responsible if we are aware of what is happening to us. To take responsibility means, in part, to embrace our existence as it occurs. The other and related meaning of responsibility is that we own up to our acts, impulses, and feelings. We identify with them, accepting all of what we do as ours. These are distinct and different meanings. We are responsible for things we clearly do - for being angry, or obstinate, or irresponsible; for breaking dishes and giving gifts. We are responsible as well for the injuries inflicted on us, and the presents we receive, for what is done to us. Here we are responsible for our part in the event - for the pain we feel and the taking of the gift. When it rains, we get wet. While we didn't make it rain, we are responsible for being wet. We are also responsible for our middle mode experiences, for the things we participate in and give ourselves to. We do not make ourselves love, or hate, but they are the feelings we have. We are responsible for having those feelings, not because we caused them to be, but because they are our existence at this moment.

The sides of my head throb. My knees feel weak. “You need therapy.” Mom laughs the most over-the-top, hysterical laugh I’ve ever heard. “It’s not funny. There is something wrong with you. Who treats their kids this way? There’s a reason none of us want to be around you. There’s a reason Shoji wants to live with Dad, and why Taro spent the rest of the summer with his friend, and why I want to go to art school thousands of miles away from you.” My face burns with frustration. “You are so obsessed with yourself that there isn’t any room for anyone else’s feelings. You don’t care about anything unless it somehow relates back to you.” I start to walk away, intent on leaving her alone in her chair. But something stops me. Spinning back to face her, my breathing erratic and my voice hoarse, I growl, “And I’m not imagining what happened to me. Your sick brother sexually abused me. I don’t care what you think it’s called, because that’s what it is. Sexual abuse. I was sexually abused. Do you get that? And if you were any kind of mother, that would have mattered to you. You wouldn’t have tried to justify it or rationalize it away by saying it wasn’t rape and therefore isn’t as bad—it was bad. That’s it.

We can't leave the past in the past because, the past is who we are. It's like saying I wish I could forget English. So, there is no leaving the past in the past. It doesn't mean the past has to define and dominate everything in the future. The fact that I had a temper in my teens doesn't mean I have to be an angry person for the rest of my life. It just means that I had allot to be angry about but, didn't have the language and the understanding to know what it was and how big it was. I thought my anger was disproportionate to the environment which is what is called having a bad temper but, it just means that I underestimated the environment and my anger was telling me how wide and deep child abuse is in society but, I didn't understand that consciously so I thought my anger was disproportionate to the environment but, it wasn't. There is almost no amount of anger that's proportionate to the degree of child abuse in the world. The fantasy that you can not be somebody that lived through what you lived through is damaging to yourself and to your capacity to relate to others. People who care about you, people who are going to grow to love you need to know who you are and that you were shaped by what you've experienced for better and for worse. There is a great deal of challenge in talking about these issues. Lots of people in this world have been hurt as children. Most people have been hurt in this world as children and when you talk honestly and openly it's very difficult for people. This is why it continues and continues.If you can get to the truth of what happened if you can understand why people made the decisions they've made even if you dont agree with the reason for those decisions knowing the reasons for those decisions is enormously important in my opinion. The more we know the truth of history the more confidently we can face the future without self blame.

Melancholy is that a scrambled egg can't be unscrambled--entropy increases--experience is subject to the arrow of time. And the infinite sadness of my life consists in that I only recognize the beauty of simple arrangements from the relative vantage of the scrambled; memory, not experience, is my only access to it. Anxiety is the progression toward equilibrium. Despair is the inescapability. Insanity is the rationalizing of it all. Sanity is the irrational acceptance of it all. Indifference is just detached therapy. And progression--activity / toil / tasks / success / failure--just coping distraction and procrastination, just ill-placed deferment--my preferred route. And crisis--

Though diagnosis is unquestionably critical in treatment considerations for many severe conditions with a biological substrate (for example, schizophrenia, bipolar disorders, major affective disorders, temporal lobe epilepsy, drug toxicity, organic or brain disease from toxins, degenerative causes, or infectious agents), diagnosis is often counterproductive in the everyday psychotherapy of less severely impaired patients. Why? For one thing, psychotherapy consists of a gradual unfolding process wherein the therapist attempts to know the patient as fully as possible. A diagnosis limits vision; it diminishes ability to relate to the other as a person. Once we make a diagnosis, we tend to selectively inattend to aspects of the patient that do not fit into that particular diagnosis, and correspondingly overattend to subtle features that appear to confirm an initial diagnosis. What’s more, a diagnosis may act as a self-fulfilling prophecy. Relating to a patient as a “borderline” or a “hysteric” may serve to stimulate and perpetuate those very traits. Indeed, there is a long history of iatrogenic influence on the shape of clinical entities, including the current controversy about multiple-personality disorder and repressed memories of sexual abuse. And keep in mind, too, the low reliability of the DSM personality disorder category (the very patients often engaging in longer-term psychotherapy).

In sensorimotor treatment, traumatized clients are taught to become aware of trauma-related tendencies of orientation and to redirect their attention away from the past and toward the present moment. Repeatedly "shifting the client's attention to the various things going on outside of the flow of conversation [evokes] experiences which are informative and emotionally meaningful" (Kurtz, 2004, p. 40). Redirecting orientation and attention from conversation to present-moment experience-that is, from external awareness to internal awareness, and from the past to the present⎯engages exploration and curiosity, and clients can discover things about themselves that they did not know previously (Kurtz, 2004).

Research has established that, oftentimes, when kids are struggling, it is not therapy for the child himself but coaching or therapy for the parent that leads to the most significant changes in the child. This is powerful research, because it suggests that a child’s behavior—which is an expression of a child’s emotion regulation patterns—develops in relation to a parent’s emotional maturity. There are two ways to interpret this data. The first is, “Oh no, I’m messing up my kid because I’m messed up. I’m the worst!” But there’s another, more optimistic and encouraging interpretation: “Wow, this is amazing. If I can work on some of my own emotion regulation abilities—which will feel good for me anyway!—my

As I talked, I found that no matter how distressing the details I related, I could feel nothing. I was disconnected from my emotions, like a hand severed from a wrist. I talked about painful memories and suicidal impulses—but couldn’t feel them. I would, however, occasionally look up at Ruth’s face. To my surprise, tears would be collecting in her eyes as she listened. This may seem hard to grasp, but those tears were not hers. They were mine. At the time I didn’t understand. But that’s how therapy works. A patient delegates his unacceptable feelings to his therapist; and she holds everything he is afraid to feel, and she feels it for him. Then, ever so slowly, she feeds his feelings back to him. As Ruth fed mine back to me.

EB: 'Ll showed me a long verse-letter, very obscene, he’d received from Dylan T[Thomas] before D’s last trip here [New York]—very clever, but it really can’t be published for a long, long time, he’s decided. About people D. met in the U.S. etc.—one small sample: A Streetcar Named Desire is referred to as 'A truck called F———.' RL: 'Psycho-therapy is rather amazing—something like stirring up the bottom of an aquarium—chunks of the past coming up at unfamiliar angles, distinct and then indistinct.' RL: 'I have just finished the Yeats Letters—900 & something pages—although some I’d read before. He is so Olympian always, so calm, so really unrevealing, and yet I was fascinated.' RL: 'Probably you forget, and anyway all that is mercifully changed and all has come right since you found Lota. But at the time everything, I guess (I don’t want to overdramatize) our relations seemed to have reached a new place. I assumed that would be just a matter of time before I proposed and I half believed that you would accept. Yet I wanted it all to have the right build-up. Well, I didn’t say anything then.' EB: 'so I suppose I am just a born worrier, and that when the personal worries of adolescence and the years after it have more or less disappeared I promptly have to start worrying about the decline of nations . . . But I really can’t bear much of American life these days—surely no country has ever been so filthy rich and so hideously uncomfortable at the same time.

One study showed that omega-3s were equivalent in effect to Prozac in treating depression, and the combination was more effective than either one alone.64 In a related study, administration of omega-3s to patients with recurrent self-harm (e.g., cutting, picking, scratching, burning—the ultimate expression of anxiety) showed a reduction in suicidality, depression, and daily stress.65 A recent trial gave omega-3s along with minerals to eleven-year-old kids with conduct disorder or oppositional defiant disorder (the ones who routinely find themselves in the principal’s office), and within three months their aggression was reduced, and way better than talk therapy.66 Lastly, omega-3 consumption can help ward off depression in children67 and adults,68 and can serve as an adjunct to SSRIs in its treatment.69

What was I doing right before I felt like that? Where was I when I felt like that? Are there places where I never have those feelings? How was I acting just beforehand? What was I thinking about before those feelings started? Are there certain beliefs I hold that seem to increase those feelings? Whom was I with when I felt like that? Do I feel like that with everyone? ​For example, some people may feel sad and hopeless in relation to a fear that they will be alone their whole lives. Focusing on that situation, you could notice the fact that this feeling might arise more often when home alone late at night, but rarely feel this way when spending time with friends. You might realize that you think things like “I will never find a girlfriend/boyfriend” based on negative beliefs about your desirability as a partner.

Patients who develop ME/CFS often lose the natural antidepressant effect of exercise, feeling worse after exercise rather than better. Patients may have a drop in body temperature with exercise. Thus fatigue is correlated with other symptoms, often in a sequence that is unique to each patient. After relatively normal physical or intellectual exertion, a patient may take an inordinate amount of time to regain her/his pre-exertion level of function and competence. For example, a patient who has bought a few groceries may be too exhausted to unpack them until the next day. The reactive fatigue of post-exertional malaise or lack of endurance usually lasts 24 hours or more and is often associated with impairment of cognitive functions. There is often delayed reactivity following exertion, with the onset the next day, or even later.

I read a heap of books to prepare to write my own. Valuable works about art crime include The Rescue Artist by Edward Dolnick, Master Thieves by Stephen Kurkjian, The Gardner Heist by Ulrich Boser, Possession by Erin Thompson, Crimes of the Art World by Thomas D. Bazley, Stealing Rembrandts by Anthony M. Amore and Tom Mashberg, Crime and the Art Market by Riah Pryor, The Art Stealers by Milton Esterow, Rogues in the Gallery by Hugh McLeave, Art Crime by John E. Conklin, The Art Crisis by Bonnie Burnham, Museum of the Missing by Simon Houpt, The History of Loot and Stolen Art from Antiquity Until the Present Day by Ivan Lindsay, Vanished Smile by R. A. Scotti, Priceless by Robert K. Wittman with John Shiffman, and Hot Art by Joshua Knelman. Books on aesthetic theory that were most helpful to me include The Power of Images by David Freedberg, Art as Experience by John Dewey, The Aesthetic Brain by Anjan Chatterjee, Pictures & Tears by James Elkins, Experiencing Art by Arthur P. Shimamura, How Art Works by Ellen Winner, The Art Instinct by Denis Dutton, and Collecting: An Unruly Passion by Werner Muensterberger. Other fascinating art-related reads include So Much Longing in So Little Space by Karl Ove Knausgaard, What Is Art? by Leo Tolstoy, History of Beauty edited by Umberto Eco, On Ugliness also edited by Umberto Eco, A Month in Siena by Hisham Matar, Art as Therapy by Alain de Botton and John Armstrong, Art by Clive Bell, A Philosophical Enquiry into the Sublime and Beautiful by Edmund Burke, Seven Days in the Art World by Sarah Thornton, The Painted Word by Tom Wolfe, and Intentions by Oscar Wilde—which includes the essay “The Critic as Artist,” written in 1891, from which this book’s epigraph was lifted.

TRUST IN ONE’S ORGANISM A second characteristic of the persons who emerge from therapy is difficult to describe. It seems that the person increasingly discovers that his own organism is trustworthy, that it is a suitable instrument for discovering the most satisfying behavior in each immediate situation. If this seems strange, let me try to state it more fully. Perhaps it will help to understand my description if you think of the individual as faced with some existential choice: “Shall I go home to my family during vacation, or strike out on my own?” “Shall I drink this third cocktail which is being offered?” “Is this the person whom I would like to have as my partner in love and in life?” Thinking of such situations, what seems to be true of the person who emerges from the therapeutic process? To the extent that this person is open to all of his experience, he has access to all of the available data in the situation, on which to base his behavior. He has knowledge of his own feelings and impulses, which are often complex and contradictory. He is freely able to sense the social demands, from the relatively rigid social “laws” to the desires of friends and family. He has access to his memories of similar situations, and the consequences of different behaviors in those situations. He has a relatively accurate perception of this external situation in all of its complexity. He is better able to permit his total organism, his conscious thought participating, to consider, weigh and balance each stimulus, need, and demand, and its relative weight and intensity. Out of this complex weighing and balancing he is able to discover that course of action which seems to come closest to satisfying all his needs in the situation, long-range as well as immediate needs.

Each new human life retraces this ancient story. Young children are the very essence of human innocence. They run, play, and feel—and, as in Genesis, when they are naked they are not ashamed. Children provide a model for the assumption of healthy normality, and their innocence and vitality are part of why the assumption seems so obviously true. But that vision begins to fade as children acquire language and become more and more like the creatures adults see reflected every day in their mirrors. Adults unavoidably drag their children from the Garden with each word, conversation, or story they relate to them. We teach children to talk, think, compare, plan, and analyze. And as we do, their innocence falls away like petals from a flower, to be replaced by the thorns and stiff branches of fear, self-criticism, and pretense. We cannot prevent this gradual transformation, nor can we fully soften it. Our children must enter into the terrifying world of verbal knowledge. They must become like us.

In our society today, much is made of treating children as persons, human beings who have a right to be heard. But many family leaders today bend so far in the direction of consensus, in order to avoid the stigma of being authoritarian, that clarity of values and the positive, often crucial benefits of the leader's self-differentiation are almost totally missing from the system. One of the most prevalent characteristics of families with disturbed children is the absence or the involution of the relational hierarchy. While schools of family therapy have different ways of conceptualizing this condition, which may also be viewed as a political phenomenon regarding congregations, it is so diffuse among families troubled by their troubled children that its importance cannot be underestimated. What happens in any type of family system regarding leadership is paradoxical. The same interdependency that creates a need for leadership makes the followers anxious and reactive precisely when the leader is functioning best.

Human evolution is not over, but the chances of natural selection adapting our species in dramatic, major ways to common non-infectious mismatch diseases are remote unless conditions change dramatically. One reason is that many of these diseases have little to no effect on fertility. Type 2 diabetes, for example, generally develops after people have reproduced, and even then, it is highly manageable for many years.8 Another consideration is that natural selection can act only on variations that affect reproductive success and that are also genetically passed from parent to offspring. Some obesity-related illnesses can hinder reproductive function, but these problems have strong environmental causes.9 Finally, although culture sometimes spurs selection, it is also a powerful buffer. Every year new products and therapies are being developed that allow people with common mismatch diseases to cope better with their symptoms. Whatever selection is operating is probably occurring at a pace too slow to measure in our lifetimes.

I have practiced psychotherapy, family therapy, and hypnotherapy for over 25 years without a single board complaint or law suit by a client. For over three years, however, a group of proponents of the false memory syndrome (FMS) hypothesis, including members, officials, and supporters of the False Memory Syndrome Foundation, Inc., have waged a multi-modal campaign of harassment and defamation directed against me, my clinical clients, my staff, my family, and others connected to me. I have neither treated these harassers or their families, nor had any professional or personal dealings with any of them; I am not related in any way to the disclosures of memories of sexual abuse in these families. Nonetheless, this group disrupts my professional and personal life and threatens to drive me out of business. In this article, I describe practicing psychotherapy under a state of siege and places the campaign against me in the context of a much broader effort in the FMS movement to denigrate, defame, and harass clinicians, lecturers, writers, and researchers identified with the abuse and trauma treatment communities….

Dr. Morris Netherton, a pioneer in the field of past-life therapy (and my teacher),7 relates the incident of a patient who returned to her previous life as Rita McCullum. Rita was born in 1903 and lived in rural Pennsylvania with her foster parents until they were killed in a car accident in 1916. In the early 1920s she married a man named McCullum and moved to New York, where they had a garment manufacturing company off Seventh Avenue in midtown Manhattan. Life was hard and money short. Her husband died in 1928. In 1929, her son died from polio, and the stock market crashed. Like many others during the Great Depression, Rita succumbed to bankruptcy and depression. On the sunny day of June 11, 1933, she hanged herself from the ceiling fan of her factory. Because this memory featured traceable facts, Netherton and his patient contacted New York City’s Hall of Records. They received a photocopy of a notarized death certificate of a woman named Rita McCullum. Under manner of death, it stated that she died by hanging at an address in the West Thirties, still today the heart of the garment district. The date of death was June 11, 1933.8

We’ve become so focused as a society on the question of whether a given sexual behavior is evolutionarily “natural” or “unnatural” that we’ve lost sight of the more important question: Is it harmful? In many ways, it’s an even more challenging question, because although naturalness can be assessed by relatively straightforward queries about statistical averages—for example, “How frequently does it appear in other species?” and “In what percentage of the human population does it occur?”—the experience of harm is largely subjective. As such, it defies such direct analyses and requires definitions that resonate with people in vastly different ways. When it comes to sexual harm in particular, what’s harmful to one person not only is completely harmless to another but may even, believe it or not, be helpful or positive. If the supermodel Kate Upton were to walk into my office right now and tie me to my chair before doing a slow striptease and depositing her vagina in my face, I think I’d require therapy for years. But if this identical event were to happen to my heterosexual brother or to one of my lesbian friends, I suspect their brains would process such a “tragic” experience very differently. (And that of my not-very-amused sister-in-law would see my brother’s encounter with said vagina differently still.)

One year later the society claimed victory in another case which again did not fit within the parameters of the syndrome, nor did the court find on the issue. Fiona Reay, a 33 year old care assistant, accused her father of systematic sexual abuse during her childhood. The facts of her childhood were not in dispute: she had run away from home on a number of occasions and there was evidence that she had never been enrolled in secondary school. Her father said it was because she was ‘young and stupid’. He had physically assaulted Fiona on a number of occasions, one of which occurred when she was sixteen. The police had been called to the house by her boyfriend; after he had dropped her home, he heard her screaming as her father beat her with a dog chain. As before there was no evidence of repression of memory in this case. Fiona Reay had been telling the same story to different health professionals for years. Her medical records document her consistent reference to family problems from the age of 14. She finally made a clear statement in 1982 when she asked a gynaecologist if her need for a hysterectomy could be related to the fact that she had been sexually abused by her father. Five years later she was admitted to psychiatric hospital stating that one of the precipitant factors causing her breakdown had been an unexpected visit from her father. She found him stroking her daughter. There had been no therapy, no regression and no hypnosis prior to the allegations being made public. The jury took 27 minutes to find Fiona Reay’s father not guilty of rape and indecent assault. As before, the court did not hear evidence from expert witnesses stating that Fiona was suffering from false memory syndrome. The only suggestion of this was by the defence counsel, Toby Hed­worth. In his closing remarks he referred to the ‘worrying phenomenon of people coming to believe in phantom memories’. The next case which was claimed as a triumph for false memory was heard in March 1995. A father was aquitted of raping his daughter. The claims of the BFMS followed the familiar pattern of not fitting within the parameters of false memory at all. The daughter made the allegations to staff members whom she had befriended during her stay in psychiatric hospital. As before there was no evidence of memory repression or recovery during therapy and again the case failed due to lack of corrobo­rating evidence. Yet the society picked up on the defence solicitor’s statements that the daughter was a prone to ‘fantasise’ about sexual matters and had been sexually promiscuous with other patients in the hospital. ~ Trouble and Strife, Issues 37-43

Ever seen a movie where the hero gets punched right in the face? A gruesome slow-mo close-up, where a spray of sweat and blood flies through the air? Notice how you wince, or flinch, or turn away even though you know it’s only a movie? Even though you know it’s make-believe, you can’t help relating to it on some level. How ironic is it that we can so easily relate to the nonexistent pain of a fictitious movie character, but we often completely forget about the very real pain of the people we love? Humans are social animals. When it comes to affairs of the heart, most of us are pretty similar. We want to be loved, respected, and cared for. We want to get along with others and generally have a good time with them. When we fight with, reject, or distance ourselves from the people we love, we don’t feel good. And when they fight with, reject, or distance themselves from us, we feel even worse. So when you fight with your partner, you both get hurt. Your partner may not reveal his pain to you; he may just get angry, or storm out of the house, or quietly switch on the TV and start drinking, but deep inside he hurts just like you. Your partner may refuse to talk to you, she may criticize you in scathing tones, or go out on the town with her friends, but deep inside, she hurts just as you are. It is so important to recognize and remember this. We tend to get so caught up in

If the symbolic father is often lurking behind the boss--which is why one speaks of 'paternalism' in various kinds of enterprises--there also often is, in a most concrete fashion, a boss or hierarchic superior behind the real father. In the unconscious, paternal functions are inseparable from the socio-professional and cultural involvements which sustain them. Behind the mother, whether real or symbolic, a certain type of feminine condition exists, in a socially defined imaginary context. Must I point out that children do not grow up cut off from the world, even within the family womb? The family is permeable to environmental forces and exterior influences. Collective infrastructures, like the media and advertising, never cease to interfere with the most intimate levels of subjective life. The unconscious is not something that exists by itself to be gotten hold of through intimate discourse. In fact, it is only a rhizome of machinic interactions, a link to power systems and power relations that surround us. As such, unconscious processes cannot be analyzed in terms of specific content or structural syntax, but rather in terms of enunciation, of collective enunciative arrangements, which, by definition, correspond neither to biological individuals nor to structural paradigms... The customary psychoanalytical family-based reductions of the unconscious are not 'errors.' They correspond to a particular kind of collective enunciative arrangement. In relation to unconscious formation, they proceed from the particular micropolitics of capitalistic societal organization. An overly diversified, overly creative machinic unconscious would exceed the limits of 'good behavior' within the relations of production founded upon social exploitation and segregation. This is why our societies grant a special position to those who specialize in recentering the unconscious onto the individuated subject, onto partially reified objects, where methods of containment prevent its expansion beyond dominant realities and significations. The impact of the scientific aspirations of techniques like psychoanalysis and family therapy should be considered as a gigantic industry for the normalization, adaption and organized division of the socius. The workings of the social division of labor, the assignment of individuals to particular productive tasks, no longer depend solely on means of direct coercion, or capitalistic systems of semiotization (the monetary remuneration based on profit, etc.). They depend just as fundamentally on techniques modeling the unconscious through social infrastructures, the mass media, and different psychological and behavioral devices...Even the outcome of the class struggle of the oppressed--the fact that they constantly risk being sucked into relations of domination--appears to be linked to such a perspective.

With regard to complex trauma survivors, self-determination and autonomy require that the therapist treat each client as the "authority" in determining the meaning and interpretation of his or her personal life history, including (but not limited to) traumatic experiences (Harvey, 1996). Therapists can inadvertently misappropriate the client's authority over the meaning and significance of her or his memories (and associated symptoms, such as intrusive reexperiencing or dissociative flashbacks) by suggesting specific "expert" interpretations of the memories or symptoms. Clients who feel profoundly abandoned by key caregivers may appear deeply grateful for such interpretations and pronouncements by their therapists, because they can fulfill a deep longing for a substitute parent who makes sense of the world or takes care of them. However, this delegation of authority to the therapist can backfire if the client cannot, or does not, take ownership of her or his own memories or life story by determining their personal meaning.Moreover, the client can be trapped in a stance of avoidance because trauma memories are never experienced, processed, and put to rest. Helping a client to develop a core sense of relational security and the capacity to regulate (and recover from) extreme hyper- or hypoarousal is essential if the client is to achieve a self-determined and autonomous approach to defining the meaning and impact of trauma memories, a crucial goal of posttraumatic therapy.

The story begins with the revelation Alicia murdered her husband. Why do you think the author made this admission at the very start?   2.  Alicia’s diary plays a key role in the book. What purpose do you think it serves? And does your perception of Alicia change the more you read?   3.  Alicia’s silence is related to the Greek myth of Alcestis. How do you feel about the story of the myth? Why do you think Alicia is silent?   4.  Theo’s motives to work with Alicia are complicated. Do you think he wanted to help her?   5.  Both Alicia and Theo had difficult childhoods. Early on, Theo says no one is born evil. That who we become depends on the environment into which we are born. By the end of the novel he appears to change his mind, saying that perhaps some of us are born evil, and, despite therapy, we remain that way. Which do you think is true?   6.  Weather plays a large role in the book, such as the heat wave during the summer. What purpose do you think the description of the weather serves in the novel?   7.  Do you think the world of a psychiatric unit was convincingly portrayed? How do you feel about Diomedes and the other psychiatrists?   8.  We never enter Kathy’s mind in the book. Do you have any sympathy for her?   9.  What do you think happens at the end of the book? The last line is ambiguous. 10.  It’s a psychological thriller with a twist. The author has said he was influenced by Agatha Christie. Did you feel this was simply a detective story or are there any other influences you can spot?

The development of a working alliance is crucial because it addresses a psychic phobia associated with relationships that is common in complex trauma clients. As we discussed, when primary relationships are sources of profound disillusionment, betrayal, and emotional pain, any subsequent relationship with an authority figure who offers an emotional bond or other assistance might be met with a range of emotions, such as fear, suspicion, anger, or hopelessness on the negative end of the continuum and idealization, hope, overdependence, and entitlement on the positive. Therapy offers a compensatory relationship, albeit within a professional framework, that has differences from and restrictions not found in other relationships. On the one hand, the therapist works within professional and ethical boundaries and limitations in a role of higher status and education and is therefore somewhat unattainable for the client. On the other, the therapist's ethical and professional mandate is the welfare of the client, creating a perception of an obligation to meet the client's needs and solve his or her problems. Furthermore, the therapist is expected to both respect the client's privacy and accept emotional and behavioral difficulties without judgment, while simultaneously being entitled to ask the client about his or her most personal and distressing feelings, thoughts and experiences. Developing a sense of trust in the therapist, therefore, is both expected and fraught with inherent difficulties that are amplified by each client's unique history of betrayal trauma, loss, and relational distress.

In 2012, the U.S. government estimated that 660,000 Americans were using heroin and more than 3,000 dying of it every year because Mexico was boosting the supply.22 About a quarter of all people who try heroin will become dependent on it, according to government estimates,23 and the precise appeal of methamphetamine to Mexico’s Sinaloa drug cartel was that it was “ragingly addictive,” according to the New York Times.24 Forbes reports that there is “little doubt” that the heroin that killed Philip Seymour Hoffman came from Mexico.25 These aren’t “big city” problems: They’re Mexico-is-on-our-border problems. Missouri had 18 heroin overdose deaths in 2001; ten years later, there were 245.26 Heroin deaths in Minnesota shot from 3 to 98 between 1999 and 2013.27 Michigan saw fatal heroin overdoses surge from a few dozen a year in 2002 to more than 100 a year starting in 2009.28 In just one year, heroin-related fatalities in Connecticut nearly doubled, to 257 in 2013.29 Between 2007 and 2012, heroin use in the United States is estimated to have increased by almost 80 percent.30 And that’s just heroin. More than 40,000 Americans were killed from all illegal drug use in 2010, surpassing car accidents and shootings as a cause of death.31 The addicts who die may be the lucky ones. In 2001, a seventeen-year-old boy in New Jersey who scored 700 on the math SAT took a heroin overdose that left him unable to stand, walk, or bathe himself. His mother, a globetrotting executive with Citibank, was forced to quit her job and become his full-time caretaker. After a year of hospitalization and more than a decade of therapy, he still needs his mother to carry him to the toilet. He has no recollection of taking an overdose, but packets of heroin and marijuana were found stored in a secret compartment in his bedroom.32

If you're involved in a motorcycle accident, this can result in devastating injuries, permanent disability or perhaps put you on on-going dependency on healthcare care. In that case, it's prudent to make use of Los Angeles motorcycle accident attorneys to assist safeguard your legal rights if you are a victim of a motorcycle accident. How a san diego car accident attorney Aids An experienced attorney will help you, if you're an injured motorcycle rider or your family members in case of a fatal motorcycle accident. Hence, a motorcycle accident attorney assists you secure complete and commensurate compensation because of this of accident damages. In the event you go it alone, an insurance coverage company may possibly take benefit and that's why you'll need to have a legal ally by your side till the case is settled to your satisfaction. If well represented after a motorcycle collision, you may get compensation for: Present and future lost income: If just after motor cycle injury you cannot perform and earn as just before, you deserve compensation for lost income. This also applies for a loved ones that has a lost a bread-winner following a fatal motorcycle crash. Existing and future healthcare costs, rehabilitation and therapy: these consist of any health-related fees incurred because of this of the accident. Loss of capability to take pleasure in life, pain and mental anguish: a motorcycle crash can lessen your good quality of life if you cannot stroll, run, see, hear, drive, or ride any longer. That is why specialists in motor cycle injury law practice will help with correct evaluation of your predicament and exercise a commensurate compensation. As a result, usually do not hesitate to speak to Los Angeles motorcycle accident attorneys in case you are involved in a motor cycle accident. The professionals will help you file a case within a timely fashion also as expedite evaluation and compensation. This could also work in your favor if all parties involved agree to an out-of-court settlement, in which case you incur fewer costs.

It's possible to see how much the brand culture rubs off on even the most sceptical employee. Joanne Ciulla sums up the dangers of these management practices: 'First, scientific management sought to capture the body, then human relations sought to capture the heart, now consultants want tap into the soul... what they offer is therapy and spirituality lite... [which] makes you feel good, but does not address problems of power, conflict and autonomy.'¹0 The greatest success of the employer brand' concept has been to mask the declining power of workers, for whom pay inequality has increased, job security evaporated and pensions are increasingly precarious. Yet employees, seduced by a culture of approachable, friendly managers, told me they didn't need a union - they could always go and talk to their boss. At the same time, workers are encouraged to channel more of their lives through work - not just their time and energy during working hours, but their social life and their volunteering and fundraising. Work is taking on the roles once played by other institutions in our lives, and the potential for abuse is clear. A company designs ever more exacting performance targets, with the tantalising carrot of accolades and pay increases to manipulate ever more feverish commitment. The core workforce finds itself hooked into a self-reinforcing cycle of emotional dependency: the increasing demands of their jobs deprive them of the possibility of developing the relationships and interests which would enable them to break their dependency. The greater the dependency, the greater the fear of going cold turkey - through losing the job or even changing the lifestyle. 'Of all the institutions in society, why let one of the more precarious ones supply our social, spiritual and psychological needs? It doesn't make sense to put such a large portion of our lives into the unsteady hands of employers,' concludes Ciulla. Life is work, work is life for the willing slaves who hand over such large chunks of themselves to their employer in return for the paycheque. The price is heavy in the loss of privacy, the loss of autonomy over the innermost workings of one's emotions, and the compromising of authenticity. The logical conclusion, unless challenged, is capitalism at its most inhuman - the commodification of human beings.

Cannabinoids relax the rules of cortical crowd control, but 300 micrograms of d-lysergic acid diethylamide break them completely. This is a clean sweep. This is the Renaissance after the Dark Ages. Dopamine—the fuel of desire—is only one of four major neuro modulators. Each of the neuromodulators fuels brain operations in its own particular way. But all four of them share two properties. First, they get released and used up all over the brain, not at specific locales. Second, each is produced by one specialized organ, a brain part designed to manufacture that one potent chemical (see Figure 3). Instead of watering the flowers one by one, neuromodulator release is like a sprinkler system. That’s why neuromodulators initiate changes that are global, not local. Dopamine fuels attraction, focus, approach, and especially wanting and doing. Norepinephrine fuels perceptual alertness, arousal, excitement, and attention to sensory detail. Acetylcholine energizes all mental operations, consciousness, and thought itself. But the final neuromodulator, serotonin, is more complicated in its action. Serotonin does a lot of different things in a lot of different places, because there are many kinds of serotonin receptors, and they inhabit a great variety of neural nooks, staking out an intricate network. One of serotonin’s most important jobs is to regulate information flow throughout the brain by inhibiting the firing of neurons in many places. And it’s the serotonin system that gets dynamited by LSD. Serotonin dampens, it paces, it soothes. It raises the threshold of neurons to the voltage changes induced by glutamate. Remember glutamate? That’s the main excitatory neurotransmitter that carries information from synapse to synapse throughout the brain. Serotonin cools this excitation, putting off the next axonal burst, making the receptive neuron less sensitive to the messages it receives from other neurons. Slow down! Take it easy! Don’t get carried away by every little molecule of glutamate. Serotonin soothes neurons that might otherwise fire too often, too quickly. If you want to know how it feels to get a serotonin boost, ask a depressive several days into antidepressant therapy. Paxil, Zoloft, Prozac, and all their cousins leave more serotonin in the synapses, hanging around, waiting to help out when the brain becomes too active. Which is most of the time if you feel the world is dark and threatening. Extra serotonin makes the thinking process more relaxed—a nice change for depressives, who get a chance to wallow in relative normality.

Catastrophizing. Predicting extremely negative future outcomes, such as “If I don’t do well on this paper, I will flunk out of college and never have a good job.”   All-or-nothing. Viewing things as all-good or all-bad, black or white, as in “If my new colleagues don’t like me, they must hate me.” Personalization. Thinking that negative actions or words of others are related to you, or assuming that you are the cause of a negative event when you actually had no connection with it. Overgeneralizations. Seeing one negative situation as representative of all similar events. Labeling. Attaching negative labels to ourselves or others. Rather than focusing on a particular thing that you didn’t like and want to change, you might label yourself a loser or a failure. Magnification/minimization. Emphasizing bad things and deemphasizing good in a situation, such as making a big deal about making a mistake, and ignoring achievements. Emotional reasoning. Letting your feelings about something guide your conclusions about how things really are, as in “I feel hopeless, so my situation really must be hopeless.” Discounting positives. Disqualifying positive experiences as evidence that your negative beliefs are false—for example, by saying that you got lucky, something good happened accidentally, or someone was lying when giving you a compliment. Negativity bias. Seeing only the bad aspects of a situation and dwelling on them, in the process viewing the situation as completely bad even though there may have been positives. Should/must statements. Setting up expectations for yourself based on what you think you “should” do. These usually come from perceptions of what others think, and may be totally unrealistic. You might feel guilty for failing or not wanting these standards and feel frustration and resentment. Buddhism sets this in context. When the word “should” is used, it leaves no leeway for flexibility of self-acceptance. It is fine to have wise, loving, self-identified guidelines for behavior, but remember that the same response or action to all situations is neither productive nor ideal. One size never fits all.  Jumping to conclusions. Making negative predictions about the outcome of a situation without definite facts or evidence. This includes predicting a bad future event and acting as if it were already fact, or concluding that others reacted negatively to you without asking them. ​Dysfunctional automatic thoughts like these are common. If you think that they are causing suffering in your life, make sure you address them as a part of your CBT focus.

Wake up every day, expecting not to know what's going to happen, and look for the events to unfold with curiosity. Instead of stressing and managing, just be present at anything that pops up with the intention of approaching it with your best efforts. Whatever happens in the process of spiritual awakening is going to be unpredictable and moving forward, if you're just the one who notices it, not fighting or making a big project out there. •       You may have emotional swings, energetic swings, psychic openings, and other unwanted shifts that, as you knew, feel unfamiliar to your personality. Be the beholder. Don't feel like you have something to fix or alter. They're going to pass. •       If you have severe trauma in your history and have never had therapy, it might be very useful to release the pains of memories that arise around the events. Therapy teaches you how to express, bear witness, release, and move forward. Your therapist needn't know much about kundalini as long as he or she doesn't discount that part of your process. What you want to focus on is the release of trauma-related issues, and you want an experienced and compassionate therapist who sees your spiritual orientation as a motivation and support for the healing process. •       This process represents your chance to wake up to your true nature. Some people wake up first, and then experience the emergence of a kundalini; others have the kundalini process going through as a preparation for the emergence. The appearance happens to do the job of wiping out, so is part of either pattern. Waking up means realizing that whoever looks through your eyes, lives through your senses, listens to your thoughts, and is present at every moment of your experience, whether good or bad, is recognized or remembered. This is a bright, conscious, detached and unconditionally loving presence that is universal and eternal and is totally free from all the conditions and memories you associate with as a personal identity. But as long as you believe in all of your personal conditions and stories, emotions, and thoughts, you have to experience life filtered by them. This programmed mind is what makes the game of life to be varied and suspense-filled but it also causes suffering and fear of death. When we are in Samadhi and Satori encounters, we glimpse the Truth about the vast, limitless space that is the foundation for our being. It is called gnosis (knowledge) or the One by the early Gnostics. Some spiritual teachings like Advaita Vedanta and Zen go straight for realization, while others see it as a gradual path through years of spiritual practices. Anyway, the ending is the same. As Shakespeare said, when you know who you are, the world becomes a stage and you the player, and life is more light and thoughts less intrusive, and the kundalini process settles down into a mellow pleasantness. •       Give up places to go and to be with people that cause you discomfort.

Treating Abuse Today (Tat), 3(4), pp. 26-33 Freyd: You were also looking for some operational criteria for false memory syndrome: what a clinician could look for or test for, and so on. I spoke with several of our scientific advisory board members and I have some information for you that isn't really in writing at this point but I think it's a direction you want us to go in. So if I can read some of these notes . . . TAT: Please do. Freyd: One would look for false memory syndrome: 1. If a patient reports having been sexually abused by a parent, relative or someone in very early childhood, but then claims that she or he had complete amnesia about it for a decade or more; 2. If the patient attributes his or her current reason for being in therapy to delayed-memories. And this is where one would want to look for evidence suggesting that the abuse did not occur as demonstrated by a list of things, including firm, confident denials by the alleged perpetrators; 3. If there is denial by the entire family; 4. In the absence of evidence of familial disturbances or psychiatric illnesses. For example, if there's no evidence that the perpetrator had alcohol dependency or bipolar disorder or tendencies to pedophilia; 5. If some of the accusations are preposterous or impossible or they contain impossible or implausible elements such as a person being made pregnant prior to menarche, being forced to engage in sex with animals, or participating in the ritual killing of animals, and; 6. In the absence of evidence of distress surrounding the putative abuse. That is, despite alleged abuse going from age two to 27 or from three to 16, the child displayed normal social and academic functioning and that there was no evidence of any kind of psychopathology. Are these the kind of things you were asking for? TAT: Yeah, it's a little bit more specific. I take issue with several, but at least it gives us more of a sense of what you all mean when you say "false memory syndrome." Freyd: Right. Well, you know I think that things are moving in that direction since that seems to be what people are requesting. Nobody's denying that people are abused and there's no one denying that someone who was abused a decade ago or two decades ago probably would not have talked about it to anybody. I think I mentioned to you that somebody who works in this office had that very experience of having been abused when she was a young teenager-not extremely abused, but made very uncomfortable by an uncle who was older-and she dealt with it for about three days at the time and then it got pushed to the back of her mind and she completely forgot about it until she was in therapy. TAT: There you go. That's how dissociation works! Freyd: That's how it worked. And after this came up and she had discussed and dealt with it in therapy, she could again put it to one side and go on with her life. Certainly confronting her uncle and doing all these other things was not a part of what she had to do. Interestingly, though, at the same time, she has a daughter who went into therapy and came up with memories of having been abused by her parents. This daughter ran away and is cutoff from the family-hasn't spoken to anyone for three years. And there has never been any meeting between the therapist and the whole family to try to find out what was involved. TAT: If we take the first example -- that of her own abuse -- and follow the criteria you gave, we would have a very strong disbelief in the truth of what she told.

PATTERNS OF THE “SHY” What else is common among people who identify themselves as “shy?” Below are the results of a survey that was administered to 150 of my program’s participants. The results of this informal survey reveal certain facts and attitudes common among the socially anxious. Let me point out that these are the subjective answers of the clients themselves—not the professional opinions of the therapists. The average length of time in the program for all who responded was eight months. The average age was twenty-eight. (Some of the answers are based on a scale of 1 to 5, 1 being the lowest.) -Most clients considered shyness to be a serious problem at some point in their lives. Almost everyone rated the seriousness of their problem at level 5, which makes sense, considering that all who responded were seeking help for their problem. -60 percent of the respondents said that “shyness” first became enough of a problem that it held them back from things they wanted during adolescence; 35 percent reported the problem began in childhood; and 5 percent said not until adulthood. This answer reveals when clients were first aware of social anxiety as an inhibiting force. -The respondents perceived the average degree of “sociability” of their parents was a 2.7, which translates to “fair”; 60 percent of the respondents reported that no other member of the family had a problem with “shyness”; and 40 percent said there was at least one other family member who had a problem with “shyness.” -50 percent were aware of rejection by their peers during childhood. -66 percent had physical symptoms of discomfort during social interaction that they believed were related to social anxiety. -55 percent reported that they had experienced panic attacks. -85 percent do not use any medication for anxiety; 15 percent do. -90 percent said they avoid opportunities to meet new people; 75 percent acknowledged that they often stay home because of social fears, rather than going out. -80 percent identified feelings of depression that they connected to social fears. -70 percent said they had difficulty with social skills. -75 percent felt that before they started the program it was impossible to control their social fears; 80 percent said they now believed it was possible to control their fears. -50 percent said they believed they might have a learning disability. -70 percent felt that they were “too dependent on their parents”; 75 percent felt their parents were overprotective; 50 percent reported that they would not have sought professional help if not for their parents’ urging. -10 percent of respondents were the only child in their families; 40 percent had one sibling; 30 percent had two siblings; 10 percent had three; and 10 percent had four or more. Experts can play many games with statistics. Of importance here are the general attitudes and patterns of a population of socially anxious individuals who were in a therapy program designed to combat their problem. Of primary significance is the high percentage of people who first thought that “shyness” was uncontrollable, but then later changed their minds, once they realized that anxiety is a habit that can be broken—without medication. Also significant is that 50 percent of the participants recognized that their parents were the catalyst for their seeking help. Consider these statistics and think about where you fit into them. Do you identify with this profile? Look back on it in the coming months and examine the ways in which your sociability changes. Give yourself credit for successful breakthroughs, and keep in mind that you are not alone!

in order to understand how they relate to the past, the search for recurring patterns, and a focus on the therapeutic relationship to see how conflicts are repeated.

Schedule a comprehensive evaluation to not only provide a formal diagnosis, but to also delineate a clear picture of your strengths and weaknesses. You will then be ready to participate in designing a total treatment plan that meets your unique needs. Get Treatment An effective, total treatment program is essential to future success. Such programs usually include a combination of medication, psychotherapy, coaching, alternative treatments, and necessary related services (support groups, counseling, family therapy, etc.). ADHD can have serious consequences, but it is treatable with safe and effective medications that can change people’s lives. (See Question 35 for a more in-depth discussion of medications used to treat ADHD.)

brain and other nerve-related problems such as headaches from concussions, vascular dementia (dementia caused by blood vessel problems in the brain), migraines, Bell’s palsy (a paralysis of the facial nerve), and tinnitus (ringing of the ears). He emphasized he was influenced by research that had been done in Israel on light therapy and the brain. Dr. Shimon Rochkind, a neurosurgeon at Tel Aviv University, originally pioneered work using lasers to treat injuries in the peripheral nervous system, that is, all the nerves in the body except those in the brain and spinal cord. Injury to peripheral nerves can lead to problems sensing or moving.

neuroplasticity--a vision replacement therapy done by rewiring or rezoning neurons to help out when other are destroyed.  They claimed the brain is not centrally wired, but rather exists in zones.  These zones could be repurposed, rerouted.”               “We still know relatively little about how the brain works.  I guess anything’s possible.  We should know a lot more in a few hours.

One reason people might prize socially constructed reinforcement over intrinsic reinforcement is sociocultural programming.

The personal case histories were the most encouraging. A prominent Los Angeles public relations executive has been living with MM for fourteen years, rides horses, and has an altogether active life on drug maintenance. An Arizona man survived MM and with his wife set up a foundation and website for other families bewildered by the diagnosis. I learned, for the first time, that Frank McGee, host of the Today show from 1971 to 1974, suffered from MM and kept it from everyone despite his ever more gaunt appearance. When he died after putting in another full week on the air his producers and friends were stunned. Sam Walton, founder of Walmart, was another MM casualty, which led many to believe that he had established the high-profile multiple myeloma treatment center in Little Rock, Arkansas. This is a full-immersion process in which MM is the singular target under the commanding title of Myeloma Institute for Research and Therapy. There is a Walton auditorium on the institute’s University of Arkansas medical school campus, but the institute itself was founded by Bart Barlogie, a renowned MM specialist from the MD Anderson Cancer Center in Houston. The institute has an impressive record, running well ahead of the national average for survival for those who are dealing with MM. One number is especially notable. The institute has followed 1,070 patients for more than ten years, and 783 have never had a relapse of the disease. Sam Walton was treated by Dr. Barlogie at MD Anderson before the Little Rock institute was founded, but the connection ended there. Walton, who’d had an earlier struggle with leukemia, didn’t survive his encounter with multiple myeloma, dying in April 1992, a time when life expectancy for a man his age with this cancer was short. I was unaware of all of this when I was diagnosed. I took comfort in the repeated reassurances of specialists that great progress in treating MM with a new class of drugs, your own body’s reengineered immunology system, was rapidly improving chances of a longer survival than the published five to ten years. As I began to respond to treatment the favored and welcome line was, “You’re gonna die but from something else.

hospice care? Some of the services are as follows: Home visits by specialty trained hospice nurses and Medical Director Pain management and symptom control Personal hygiene care from certified home health aides All medications related to the terminal diagnosis All specialized therapies required for the terminal diagnosis Psychosocial, spiritual, and grief support services Volunteers as requested

Gibbs (2003) and others (e.g., Straus, Richardson, Glaziou, & Haynes, 2005) have provided detailed suggestions in this regard. Some general principles for clinicians are as follows. Evidence from multiple studies is always preferred to results of a single study. Systematic reviews of research are preferable to traditional narrative reviews. Thus, clinicians should look for systematic reviews, mindful of the fact that these reviews vary in quality. The Cochrane and Campbell Collaborations are good sources of high-quality systematic reviews. Clinicians can and should assess potential sources of bias in any review. The characteristics of systematic reviews described in this chapter can be used as a yardstick that clinicians can use to judge how well specific reviews measure up. The QUOROM statement (Moher et al., 1999) provides guidance about what to look for in reports on systematic reviews, as does a recent report by Shea et al. (2007). When relevant reviews are not available, out of date, or potentially biased, clinicians can identify individual studies and assess the credibility of those studies, using one of many tools developed for this purpose (e.g., Gibbs, 2003). It would be ideal if clinicians were able to rely on others to produce valid research syntheses. Above all, clinicians should remember that critical thinking is crucial to understanding and using evidence. Authorities, expert opinion, and lists of ESTs provide insufficient evidence for sound clinical practice. Further, clinicians must determine how credible evidence relates to the particular needs, values, preferences, circumstances, and ultimately, the responses of their clients. Clinicians and researchers also need to have an effect on policy so that EBP is not interpreted in a way that unfairly restricts treatments. Policymakers and others can be educated about the nature of EBP. EBP is a process aimed at informing the choices that clinicians make. It should inform and enhance practice, “increasing, not dictating, choice” (Dickersin, Straus, & Bero, 2007, p. s10). EBP supports choices among alternative treatments that have similar effects. It supports the choice of a less effective alternative, when an effective treatment is not acceptable to a client. Policymakers and others can be educated about the nature of evidence and methods of research synthesis. Empirical evidence is tentative, and it evolves over time as new information is added to the knowledge base. At present, there is insufficient evidence about the effectiveness of most psychological and psychosocial treatments (including some so-called empirically supported treatments). Policymakers need to understand that most lists of effective treatments are not based on rigorous systematic reviews; thus, they are not necessarily based on sound evidence. It makes little sense to base policy decisions on lists of preferred treatments because this limits consumer choice. Lists of selected or preferred treatments should not restrict the use of other potentially effective treatments. Policies that restrict treatments that have been shown to be harmful or ineffective, however, are of benefit. Lists of harmful or wasteful treatments could be compiled to discourage their use.

rediscovered, a ketogenic diet is returning to mainstream acceptance and is again recognized as a highly effective therapy for seizure and neurologically related disorders. In fact, there are studies to show the strong benefits of ketogenic diets on virtually every manner of neurological disorder. Some examples of neurologic uses of a ketogenic diet other than epilepsy are migraines, Alzheimer’s disease, Parkinson’s disease, Lou Gehrig’s disease (ALS), autism, brain tumors, depression, sleep disorders, schizophrenia, postanoxic brain injury, posthypoxic myoclonus glycogenosis type V, and narcolepsy, to name a few.

Genuine, authentic relating enlivens the spirit.