Embracing Pain, Relieving Suffering

By jmaddoux

Emotional pain is a part of the human experience.  Throughout each of our lives, we will all be faced with difficult and painful situations, such as heartbreak, the loss of a loved one, disappointment, and the list could go on and on.  Suffering, on the other hand, is not necessarily a part of being human.  Unlike emotional pain, suffering occurs when we are unwilling or unable to fully accept the situation that is causing us the pain.  When we are suffering, we become stuck in the pain rather than being able to move through the pain.  Being stuck in suffering can have a huge and negative impact on our lives, such as increased feelings of sadness and depression, lack of motivation, and feeling hopeless and helpless.   Below are some ways to move through emotional pain and free ourselves from feeling stuck in suffering.

Physical Pain versus Emotional Pain

When I put my hand on a hot stove, it will burn causing my physical pain.  Furthermore, if I put my hand on a hot stove one time, I will probably learn that putting my hand on a stove is going to hurt.  As such, I will likely avoid putting my hand on a stove in the future.   In the context of physical pain, it makes perfect sense that we would avoid doing things that we know will hurt us.  In fact, it can be extremely adaptive and protective for us to avoid physical pain and injury.

On the flip side, avoiding (or attempting to avoid) emotional pain, in the long term does us a disservice.  For example, if I were to get hurt by someone who was close to me, I may find myself withdrawing from others, building emotional walls, and other attempts to avoid getting hurt again.  However, in this example, by attempting to avoid future emotional pain, I may actually be setting myself up for more emotional pain, such as loneliness, sadness, and by continuing to suffer from the original pain caused by the sense of betrayal from the original conflict.    Furthermore, unlike the example of touching a hot stove, I am not able to control or predict what is going to hurt me emotionally, and as a result, I really cannot avoid emotional pain.

Embracing Emotional Pain

This may sound counter-intuitive on the surface; however, one of the easiest ways to move through emotional pain is to embrace it.  I would imagine that as some of you read this last sentence, you might begin to wonder what embracing might look like.  I wish there was a clear answer to this very fair question; however, each of us experience pain differently, and the way in which we move through the pain will again be unique to our own experience.  That being said, here are some ways that some of you might find helpful in moving through and embracing emotional pain.

First, slow down and take a moment to acknowledge the fact that you have been hurt.  As you do this, notice what sensations you feel in your body and where these sensations are occurring.  What emotions and reactions come up for you?  Embrace each sensation and emotion as it comes to the surface.  If you feel like crying, practice allowing yourself to embrace these tears.  As you do this, remember that there is no wrong way to feel; notice and practice letting go of thoughts that tell you otherwise.

Another way to move through emotional pain is to practice self-compassion.  I would imagine that if most of us saw a small child crying, our natural urge would be to embrace and comfort that child through his or her pain; however, many of us do not offer this compassion towards ourselves.  When you are in pain, practice comforting yourself in the same way that you might another person.  Many of us can be quite hard on ourselves, and in early self-compassion practice this can become rather apparent.  Practice embracing being perfectly imperfect.

You might also begin to practice letting go of emotional pain.  Again, what “letting go” looks like will vary from person to person, but for me, letting go feels like a spiritual, emotional, and even at times, physical relief.  One way that I practice letting go, is to imagine that my pain is a balloon.  What I do with the balloon is my choice.  I can choose to hold on the balloon, and carry it around with me everywhere I go.  I also have the choice to let go of the balloon, and watch it, and my pain with it, float away into the sky.  This choice is completely up to me, and depending on the situation, I might choose to hold on to my pain for a while to experience and make peace with it before I let go.  Other times, I might choose to let go of the pain more quickly.  Sometimes, I may find myself walking through life with no balloons.  Other times I might have an entire handful of balloons, but it is only when I am ready and choose to let go of them that I can begin to move on through the pain.

Experience emotional pain is a part of being human; however, to a certain degree, what we do with that pain when it shows up is our choice.  It is my hope that in reading this, each of you will have a greater understanding of how to compassionately embrace your pain, and begin to accept it fully as a part of life.  Like I have mentioned a few times, we all experience and work through pain differently, so if there are other ways that you have found helpful in working through pain, please feel free to share them below.  If it worked for you, I would imagine that others might also find this to be helpful.

 



Introducing Mindfulness

By jmaddoux

There are many approaches to psychotherapy that include a mindfulness component, ranging from Dialectical Behavioral Therapy (DBT; Linehan, 1993a, 1993b) to Acceptance and Commitment Therapy (ACT; Louma, Hayes, & Wasser, 2007) to Mindfulness-Based Cognitive Therapy (Segal, Williams, & Teasdale, 2001), and the list goes on and on.  While the foundational roots of mindfulness across all these treatment approaches generally stems from the ancient practices of Zen Buddhism, the way in which mindfulness is introduced to patients/clients may vary across the theoretical approach to treatment.  While I personally tend to approach therapy from a DBT perspective, I also pull from these and other orientations in my work.  Below are some considerations that I have come across in my experiences in introducing patients/clients to mindfulness.

Structured vs. Informal

Different orientations have varying levels of structure applied to the introduction of mindfulness.  DBT, for example, tends to take a more structured approach (at least within the context of skills training), and explicitly lays out the whats and hows of mindfulness (Linehan, 1993a, 1993b).  ACT on the other hand may present mindfulness in a more informal and general sense, encouraging clients to connect with their bodily sensations and experiences.  Both of these approaches, structured and informal, have their merits, and in my experiences both can be effective.  Factors to consider when deciding whether to have a more structured or informal introduction to may include treatment modality (i.e., inpatient vs. outpatient, group vs. individual), patient/client level of functioning, length of treatment, etc.

Mindlessness vs. Mindfulness

When I find myself introducing the topic of mindfulness, I typically will start with an explanation of what mindlessness is.  Specifically, I will often talk about mindlessness being our brains “auto-pilot.”  The example that I most frequently use is driving to the grocery store on my day off, and finding myself driving to work without even noticing.  It has been my experience that most people can relate to and recall times in which they have been mindless.  From this place, I tend to introduce the concept of mindfulness, which is the exact opposite of mindlessness and consists of being as present and connected to the present as we are capable of being.  To build on the driving metaphor, I will sometimes describe mindfulness as being stuck in traffic.  When I am stuck in traffic, I tend to be very aware of the fact that I am not moving towards my goals.  I notice feelings of stuckness, frustration, and find myself becoming increasingly impatient.  I share this experience with the group as an example of a more spontaneous example of being hyper-aware to my experiences, and then discuss the role of control and choice when it comes to mindfulness practice.  Again, I will refer back to being stuck in traffic, and highlight that I can chose to continue to sit in frustration and irritation, or I can choose to turn my mind to focus on other sensations in my body.  An important aspect to highlight is that I do not chose to ignore my internal experience, because I cannot control my internal experiences; rather, I do have control on where I place my attention and focus.  As such, in that moment, I may actively choose to shift my attention from the frustration and stress of traffic to the soothing sensation of the air conditioner on my skin.  From here, I will often encourage patients/clients to share any similar experiences that they may have had in the past.

Sharing Personal Experiences with Mindfulness

For many clients/patients, the concept of mindfulness is often new and foreign, and as such, they may struggle with early attempts at mindful practices.  In order to normalize and validate these experiences, I will sometimes share some of my experiences with early mindfulness practice or even immediate reactions or experiences that I had to an in-session mindfulness exercise.  For example, it is not uncommon for me to say something to the effect of “I found my mind wandering a lot during that exercise” or “when I first started practicing mindfulness, it was really hard for me to stay focused on the exercise.” In my experience, these simple statements have been very powerful and served as a point of connection in the therapeutic relationship.

Cultural Considerations

When introducing mindfulness, it may also be helpful to acknowledge and address any cultural beliefs, values, or practices that may impact a one’s ability to engage in mindfulness.  As is most often the case when considering culture, each patient/client comes in with their unique experiences with culture that need to be addressed on a case-by-case basis.  Some cultural considerations that you might benefit from exploring in session might include majority culture values, such as the “go-go-go” nature of current American culture, religious/spiritual practices, or any other diversity variables that appear salient.

There are many ways to introduce mindfulness, and these are some of the factors that I consider before introducing mindfulness in session.  However, there is no cookie-cutter approach to introducing mindfulness, and it will be most beneficial for you to find a way of orienting clients/patients to mindfulness that fits best with your therapeutic style.  For those of you who have had experience with using mindfulness in session, please feel free to leave comments below sharing some of your experiences with introducing mindfulness practice in session.



Practice What You Preach

By jmaddoux

Throughout my years of training, I have received a lot of feedback and advice from my peers, colleagues, supervisors, and faculty members.  However, above all, the most powerful piece of feedback that I received was from one of my supervisors at my current site.  We were discussing a client of mine who was struggling pretty badly, physically, mentally, and spiritually.  Over the course of my work with this client, I found myself getting caught up in his feelings of stuckness, hopelessness, and helplessness.   Additionally, I found myself carrying around a lot of sadness following my appointments with this guy.  The advice that my supervisor gave me was so simple and yet so powerful.  “Sometimes we do very difficult work.”

It would be my guess that most psychotherapists at one time or another have struggled with a particular client, took on too many clients, felt burnt out, and/or struggled with compassion fatigue.  Again, even as I wrote this last sentence, I find my mind reflecting back on my supervisor’s words: “Sometimes we do very difficult work.”  While I find my work as a therapist to be very rewarding, it can also take a lot out of me physically, emotionally, and spiritually.

When I find myself feeling more drained than usual emotionally, that is a sign for me to increase my self-care, and one of the key components of my self-care regiment is mindfulness practice.  Recently, there has been a lot of research emerging on the benefits of mindfulness practice on mental health, quality of life, and even the efficacy of psychotherapy.  Additionally, I am a firm believer in the idea of practicing what one preaches, and my work as a therapist is no exception.  That being said, if I as a therapist-in-training encourage my clients to practice mindfulness both inside and outside of the therapy hour than I too hold myself to that challenge.

Benefits of Mindfulness

In a recent article in Monitor on Psychology, Davis and Hayes (2012) provide an overview of some of the current research on the impact of mindfulness on mental health and wellbeing.  Specifically, in the research reviewed, they noted that increased mindfulness practice has been associated with decreased anxiety, less rumination, greater emotional regulation, and higher relationship satisfaction.  From a neurological perspective, mindfulness has been associated with increased working memory capacity, greater levels of cognitive flexibility, increased attention, increased processing speed, and decreased task effort.  Furthermore, mindfulness practice has been associated with increased neuroplasticity and neurogenesis.

Additionally, there has been an emerging body of research investigating the practice of mindfulness on therapists and the outcome of therapy.  As described in Davis and Hayes (2012), therapists and trainees who practice mindfulness tend to have greater levels of empathy and compassion towards their clients, increased levels of self-awareness and insight about professional identity, lower levels of stress, and a higher sense of self-efficacy as a therapist.  Lastly, therapists and trainees who practice mindfulness tend to have a higher overall quality of life compared to those who do not incorporate mindfulness into their self-care.

Regarding the impact of therapist/trainee mindfulness practice on therapy outcomes, a recent study by Grepmair et al. (2007) found that compared to non-meditating therapists-in-training, trainees who engage in mindfulness meditation reported higher levels of self-awareness.  Additionally, clients of trainees who engaged in mindfulness meditation had significantly greater reductions in symptom severity, a faster rate of symptom reduction, higher well-being, and higher levels of perceived efficacy of therapy compared to those whose therapist did not engage in mindfulness practice.

There are clearly many benefits both on a personal and profession level for practicing mindfulness, especially among therapists and trainees.  While the majority of research has focused specifically on the mindfulness task of meditation, there does appear to be increasing attention in the literature to the impact of other mindfulness practices on well-being and quality of life.   The work that we do as therapists can be very difficult at times, and I would encourage any therapist or trainee to practice incorporating mindfulness into their self-care regiment.



Welcome to Living in the Moment

By jmaddoux

Welcome to Living in the Moment.  While the main focus of this blog will be on professional development, approaches to therapy, and my personal experiences as a psychologist-in-training, another key theme that will underlie most of what I write is mindfulness, both as a practice within the context of psychotherapy and self-care for therapists/trainees/students/everybody.  Before I jump right in to what mindfulness has come to mean for me, I would like to take the moment to write this blog about why I believe mindfulness is such an important aspect of relieving suffering.

Our minds are a lot like a see-saw, often teetering between the past and the future.  When our minds pull us into the past, it is easy for us to get caught up in regret and the coulda, woulda, shouldas.  In contrast, when our minds drift into future thinking, it is easy for use to get caught up in worry about the uncertainty of what our future may hold for us.  In both cases, past or future tripping, by allowing ourselves to get too caught up in the details of our story that are so far outside of our control, we may get caught up in undue suffering.  In other words, our thoughts may become fixated on either what has already happened or what has not yet happened, which may in some cases lead us to experience stress and anxiety or other negative emotions, such as regret, hopelessness, or despair.

When we are Living in the Moment, we make a conscious effort to bring ourselves to the middle of the see-saw, finding the perfect balance between the past and the future: the present moment.  Like I said earlier, our minds will naturally pull us in one direction or the other away from the present moment, so if we want to stay connected to the present moment, we will need to practice.

Over the course of this blog, I will share with you many different ways that you can practice Living in the Moment, but here is a simple way to begin to practice connecting to your present life. Actively notice something in the space around you using each one of your five senses, and answer the following questions to yourself:

• What do you see around you?

• What smells do you notice?

• What sounds do you hear?

• Reach out and touch something.  What does it feel like?

• What sensations of taste, if any, do you notice?

As you begin to practice with this exercise, your mind will likely begin to wonder, which is perfectly acceptable and natural.  If you notice your mind beginning to wonder, notice this, and actively bring your attention back to present moment.  Over time, you will likely find that it will become easier and easier to stay connected to your present moment and sensations.



Welcome to Living in the Moment

By John M. Grohol, Psy.D.

There is such a rich world of knowledge one learns while in school. And no place more so than in graduate school, when you’re studying to become a psychologist.

How cool would it be to pass that knowledge on to others…? About life, about learning acceptance and mindfulness techniques? About what it’s like to be a therapist in training?

That’s why I’m pleased to welcome you to Living in the Moment with John Maddoux, MA. John is going to write about a wide range of topics here on his blog, and we look forward to his contributions. You can learn more about John here.

Please give him a warm Psych Central welcome!