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Thursday, November 30, 2017

The Mind-Body Connection in Psychotherapy: Looking Beyond the "Happy Talk"

While I believe in positive psychology and optimism, over the years, I've seen too many psychotherapy clients who use positivity as a defense mechanism.  In other words, they only focus on the positive aspects of their life and avoid dealing with serious emotional problems  (see my article: Are You Using Your Idea of "Positive Thinking" to Deny Your Problems?).

The Mind-Body Connection: Looking Beyond the "Happy Talk" to Underlying Emotional Issues
When people only focus on the positive aspects of their life, not only do they avoid thinking about their problems, they also avoid taking action to try to change their problems.

There's often a fear of dealing with unpleasant aspects of their life, so they'll say that everything is "fine" and everything about their childhood was "great."

In the meantime, it takes so much psychic energy to maintain this defensive attitude that it often leaves people feeling mentally and physically exhausted.  And underneath it all, they feel miserable, but they just can't admit it to themselves or, initially, to their therapists.

The people who avoid their problems aren't delusional--they're in denial--and their unresolved problems manifest in other ways: insomnia, headaches, backaches, muscle spasms, excessive drinking, drug abuse, compulsive gambling, and so on.

They're often so busy "looking on the bright side" that they don't want to see other areas of their life that are falling apart.

Aside from avoidance and denial, part of the problem is our culture's infatuation with positive thinking.  For more than 50 years, we've had dozens of books on "how to be happy" and "choosing happiness" that many people develop unrealistic ideas of how their life should be.  They think they're supposed to be happy all the time and if they're not, something must be wrong with them.

Fictional Vignette:  The Mind-Body Connection: Looking Beyond the "Happy Talk"

Edna
Edna came to therapy because she was having problems sleeping.

The Mind-Body Connection: Avoiding Problems Can Cause Insomnia and Other Physical Problems

She told her therapist that she wanted to learn mindfulness meditation so she could de-stress at the end of the day, and she chose her therapist because she had an expertise in mindfulness and the mind-body connection.

One of the first things that her therapist noticed during the initial psychotherapy consultation was that Edna was stiff.  She sat rigidly at the edge of the couch with her hands tightly clasped, eyes wide open, and a rigid, tight smile on her face.  She was also clinching her jaw.

When her therapist asked her about her family history, Edna brushed this off saying that she had a "great" childhood and she didn't see any reason to dwell on her family history.

When the therapist told her that they didn't have to dwell on her family history, but it's customary to get basic information about the family, Edna reluctantly agreed to talk briefly about her family.  Then, she seemed to flounder for a few minutes, finally asking, "What do you want to know?"

Her therapist told her that she would like to know about her relationships with her parents and her siblings, how they got along, if there were any significant events when she was growing up that impacted her, and so on.

Edna thought for a moment, and then she said that she got along well with her parents while they were both alive, and she also got along with her older brother.  Her father died when she was nine "...but I got over that," and her mother and brother were still alive.

When her therapist asked her how she got over her father's death, Edna told her that she, her mother and brother "just put it behind us and we went on with our lives."

Although Edna continued to smile, her eyes were welling up with tears and she was grasping tightly to the sides of the chair.

Since this was the initial consultation, her therapist noted Edna's reaction to herself, but she didn't press her about it.

Edna went on to say that she has had a "very happy life" and it would be "perfect" if only she could overcome her problems with insomnia.  This is why she wanted to learn mindfulness meditation in therapy because she tried it on her own and she couldn't focus.

During the next few sessions, her therapist guided Edna through mindfulness meditation, but Edna continued to have problems focusing.  She also got headaches, neck pain, and backaches during the meditation and she got spasms in her right arm.

The Mind-Body Connection: Looking  Beyond the "Happy Talk" 

Edna told her therapist that she would frequently have these physical problems and her doctor told her that there was nothing medically wrong with her.  He suspected that these physical problems were psychological and possibly related to stress.  But Edna discounted this and told her doctor that her life was "wonderful" and she wasn't under any particular stress, nor did she have any psychological problems.

Her therapist asked Edna if she would be willing to try a hypnotherapy technique called the Affect Bridge where clients sense into their physical and emotional reactions to see what comes up (see my article: The Body Offers a Window Into the Unconscious Mind).

Edna told her therapist that she would be willing to try it, but she doubted that anything in particular would come up.

Using the Affect Bridge, her therapist asked Edna to sense into the tightness in her jaw and go back to  the earliest memory she could remember that was related to this physical sensation.

After a couple of minutes, Edna's jaw began to quiver and tears rolled down her face, but she seemed totally unaware of her emotional and physical reactions because she told her therapist that nothing came up for her.

When her therapist pointed out to Edna that her jaw was trembling and tears were streaming down her face, Edna seemed surprised.  She appeared to be cut off from these sensations.

Although she couldn't associate any particular memory with her physical and emotional reaction, she realized that she was feeling a little calmer--as if something in her had been released.

Her therapist recognized that the work would be slow because Edna was defending against feeling her emotions and physical reactions, and going too fast would be overwhelming for her.

When Edna returned for her next session, she said she slept better after their last session and that hypnotherapy technique, the Affect Bridge, seemed to help her--even if she didn't understand why.  So, she agreed to continue to work with the Affect Bridge.

Edna made slow and steady progress in therapy, although she continued to maintain that there wasn't anything in particular, other than her sleep problem, that was affecting her.

During that time, she was assessed in a sleep lab, and she was told that she didn't suffer with sleep apnea and there weren't any other medical problems that could explain her sleep problem.  The sleep specialist recommended that she continue to attend her psychotherapy sessions.

Over time, using the Affect Bridge, Edna began to identify an emotion that was associated with the stiffness in her jaw:  Anger.

This surprised Edna, "I can't imagine where that came from.  I don't have anything to be angry about."

Although she couldn't identify anything that she was angry about, she said that she could sense the anger in her jaw as well as in her throat and neck.

When they focused on her throat, Edna said she felt a tightness in her throat as well as tears behind her eyes.

Although this was a little frightening for Edna, she becoming more psychologically minded in therapy and she was curious as to where all of this would lead.

As usual, her therapist told Edna at the end of their session that if she remembered any dreams, she could bring them in.  Usually, Edna would say that she never remembered her dreams.

But the following session, Edna came in and she looked upset.  She told her therapist that she had a dream the previous night that disturbed her.  Her therapist asked her to tell the dream in the present tense as if she was still in the dream.

The dream was about her father on the day that he died.  He never had any health problems, but he had a sudden heart attack when Edna was 10, and in the dream she was telling him not to leave her.  As a 10 year old, she believed that if she prayed, he would be all right, but he never recovered and he was pronounced dead on arrival at the hospital.

Edna said that when she woke up from the dream, she was clinching her jaw and her jaw hurt.  She also realized when she woke up that she was crying in her sleep.

As they talked about the dream and how close it was to what actually happened 20 years ago when her father died, Edna told her therapist that she thought she had "put all of that behind me."

Even talking about the dream was disturbing to her but, by the end of the session, she was feeling calmer.  And when she came back the following session, she reported sleeping better that whole week.

Reluctantly, she acknowledged that it was obvious to her that she had never mourned her father and she was still holding onto a lot of grief.  She was also still angry about her father leaving her and that her prayers for his survival went unanswered.

Edna told her therapist that when her father died, there was no one to talk to about it.  Her mother and older brother refused to talk about it, and the other family members told her that she needed to "move on" and focus on her studies.  Now, looking back on it, she realized how ridiculous it was for her relatives to tell a 10 year old this, and she felt angry about this too.

Edna said that, in the past, she thought that if she just focused on being positive, doing affirmations, and remained goal-oriented and motivated that she would have a sense of well-being, but it was clear to her now that her body and her dream were trying to tell her something else.

Edna was now ready to accept that her insomnia and other physical symptoms were connected to trauma related to her unresolved grief.  She was now willing to listen to her therapist talk to her about the connection between the mind and the body and to work on her unresolved trauma.

Conclusion
Anything can be used as a defense against feeling uncomfortable emotions, including positive thinking, positive psychology and affirmations.

There's absolutely nothing wrong with positivity and affirmations.  The problem arises when people use positivity to avoid their problems.

This avoidance is usually due to fear of dealing with the problems and develops into denial.

When clients avoid dealing with their problems, especially unresolved trauma, these problems can manifest in physical ways (as seen in the fictional vignette above).

If clients are fortunate enough to have a medical doctor who rules out medical problems and understands the mind-body connection, the doctor will recommend psychotherapy.

There are certain mind-body therapy modalities, like the Affect Bridge in hypnotherapy, that can help clients to tap into physical sensations to understand the underlying issues.

When clients have a good therapeutic rapport with their therapist, they are usually more willing to be curious and explore the underlying issues.

When underlying traumatic issues are identified, a trauma-informed therapist can help the client to work through these issues.

Getting Help in Therapy
Fear and denial can be very powerful.

Sometimes, when people are very emotionally invested in believing that they only need positive thinking or positive affirmations--to the exclusion of dealing with underlying problems--they blame themselves when positivity isn't enough to make them feel better.

A skilled trauma-informed psychotherapist will work in a gentle way to help clients to overcome their fear and denial so they can eventually work through their underlying trauma.

If you have been feeling stuck and you think you might be avoiding dealing with emotional problems, you could benefit from seeking help from a skilled psychotherapist.

Rather than suffering on your own, you could free yourself from your traumatic history so you can lead a healthier, more fulfilling life.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples.

I have helped many clients to work through psychological trauma so they can move on with their lives.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (212) 726-1006 or email me.







































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