Archive for the 'Uncategorized' Category

group therapy revisited

May 11th, 2018

“Since I joined group, I don’t feel so alone anymore—now I know there are others who want the best for me.” I hear this sentiment over and over again from clients who commit to weekly group therapy—a place to both learn about oneself while helping others learn about themselves. Clients typically come to group because they have longings for deeper contact, and group is where they get to take risks, be vulnerable, and as a result, experience deeper connection.

In the early ‘80s, my dad was part of a men’s therapy group in Philadelphia. I was in high school at the time and didn’t really understand why he attended these mysterious meetings. Because we lived in a somewhat sheltered suburb in South Jersey, it seemed quite revolutionary that he would travel into the city every Tuesday night to meet with a diverse group of men. All I knew is that he was devoted to this weekly ritual, and he returned home with a more optimistic outlook. After five years of going to his men’s group, my father built up the courage to separate from my mother and start a new life for himself. Discovering his true voice allowed him to make a bold decision after thirty years of marriage, and this was a formative event in the history of my family and my life.

In the late ‘80s I started graduate school at UCLA to study clinical social work, and in 1992 I became an associate in a busy private practice in Los Angeles where I was asked to lead a men’s psychotherapy group. How ironic—I was now leading a men’s group after my dad’s influential experience as a group member just a few years earlier. Although I felt as if I was treading water at times, I slowly built up clinical muscle and returned every Wednesday night for eight more years—and this turned out to be one of my most significant growth experiences both personally and professionally.

Through the course of my career, I’ve led several long-term therapy groups, and today, I call them interpersonal process groups with an emphasis on here-and-now relationships in the room. As a former group leader of many types of groups, I firmly believe in the therapeutic nature of the group experience, but nowadays, I view the groups in my practice through a process group lens.
With that said, here are some of the typical themes that emerge during a group session:
• Relationship Challenges
• Trauma
• Anxiety and Depression
• Addictions and Codependency
• Career and Money
• Shame and Loneliness
• Sex and Sexuality

When I meet a client for the first time, I’m already assessing his eventual appropriateness for group. Once a client has identified and started to explore the issues that brought them into therapy, it may be time to introduce the possibility of joining a group. There’s no cookie-cutter approach to the timing of a client considering group therapy, but I always hold this possibility for the client if my instincts tell me that they would benefit from a group experience. Because most of my individual clients know that I lead groups, they may initiate interest, or I may plant a seed about future group membership. Although I may be eager to transition a client into group, I always need to check in with myself to make sure that the client wants group more than I want it for them.

Here are a few questions that may reveal whether a client is ready to participate effectively in a group:
• Is the client able to offer empathy and attunement?
• Is the client able to receive empathy and attunement?
• Does the client appear enthusiastic about a group experience?
• Is the client interested in developing more honest, satisfying relationships with others?
• How does the client respond to conflict and/or anger?
• Is the client willing to comply with group guidelines?

In order to foster longevity in therapy groups, the following ingredients will promote greater trust and safety:
• Cultivating honest relationships with the members of the group and the group therapist.
• Giving and receiving clear, honest feedback.
• Understanding one’s impact on others.
• Accessing and articulating one’s internal world.
• Exploring deeper longings and desires.
• Assessing sexuality and sexual expression.
• Expressing anger safely and productively.
• Acknowledging and processing shame.

Bringing together a therapy group requires perseverance from the group therapist, but it can also be one of the richest clinical experiences. Clients learn how to be more fully themselves with one another—a rare transformation that far transcends the challenges group formation requires. Having led therapy groups since 1992, I remain deeply grateful for the opportunity to learn and grow along side my clients. As my dad shared with me many years ago, “my group helped me reclaim my life.”

rethinking infidelity

April 15th, 2018

Esther Perel’s recent release “The State of Affairs” is a masterful look at relationships in the 21st century—masterful because it invites us to think outside the proverbial box. Not only does it focus on the intricacies of infidelity, but it also explores the state of intimate relationships in our world today. When I read Esther Perel’s previous book, “Mating in Captivity”, it opened the aperture on working with intimacy and desire with couples in my practice. Her refreshing, internationally-infused perspective introduced an expansive clinical dialogue, and once again, Perel offers us a unique angle on infidelity, exclusivity and every imaginable variation.

“Affairs have a lot to teach us about relationships—what we expect, what we think we want, and what we feel entitled to.” And this is the premise of her research and her work. Affairs come in all shapes and sizes, but do we punish one another or offer opportunities for growth and learning? Keep in mind that Perel’s definition of affairs includes one or more of the following: secrecy, sexual alchemy, and emotional involvement, and it only requires one of these ingredients. Yet, infidelity is a much larger window including sexual infidelities, emotional affairs, compulsive use of porn, strip clubs or erotic massage. The list goes on and on.

One of the primary themes of “State of Affairs” is the opportunity to learn from infidelity rather than being sentenced to wearing the Scarlet Letter. Perel makes a clear distinction between shame and guilt. “Shame is a state of self-absorption, while guilt is an empathic, relational response, inspired by the hurt you have caused another. In the aftermath of betrayal, authentic guilt, leading to remorse is an essential repair tool.” Again, her healing focus is on movement toward repair—not pouring more salt into the wound.

Shame is like quicksand, as clients often lose themselves in the experience of feeling defective. If not addressed, shame often cycles into resentment and despair. Yet, excavating the layers beneath the suffering can be a productive process toward shame resiliency, and in turn, the recognition of guilt often becomes a more useful emotion–promoting connection rather than division.

Perel emphasizes how infidelity is a growth opportunity for the couple if they’re open-hearted enough to do the deeper work on themselves and their relationship. When a couple makes the courageous choice to work on their relationship after an infidelity, Perel feels that the person who had the affair needs to explicitly re-commit to the partner and express the deep value of the other person and the relationship.

The mental health community is divided about disclosure after an affair. Some clinicians believe in full disclosure and some do not. Perel offers a wise clinical suggestion when it comes to sharing the details of an affair. “Respect is not necessarily about telling all, but about considering what it will be like for the other to receive the knowledge.” In other words, disclosure is not a one-size fits all process. Before you unload onto an unsuspecting partner, consider, whose well-being are you really thinking of? And what is your partner supposed to do with this information?” It’s a delicate moment requiring meticulous assessment and thoughtful planning with the couple.

Disclosure is often used as a therapeutic tool with couples recovering from sex addiction. Many couples have found healing through this approach, yet others have been harmed or even re-traumatized. There isn’t an absolute right or wrong approach, but it’s a significant decision not to be taken lightly. As much as our training and experience may be extensive, we’re still learning, and a dose of humility goes a long way as we grow beside our clients.

Perel also writes at length about couples who love each other, who are devoted to one another, but have never been able to stay faithful. There is a myth that infidelity is always connected to dissatisfaction in the relationship. But this isn’t true. The reasons for betrayal are limitless but not always related to the relationship itself.

In her practice, Perel asks the unfaithful party to work through all rationalizations—stories that have been constructed to justify continuing the infidelities. She suggests this three-part method:
1. Take RESPONSIBILITY for the hurtful behavior—the way he rationed his closeness by only giving her a fragment of his divided self.
2. Be VULNERABLE about his own proclivities and how for years he justified it to himself at her expense.
3. Pour out his LOVE for her and fight for their relationship.

Instead of writing an inventory of offenses often utilized in sex addiction treatment–Perel suggests a Love Letter instead. Not that this takes the betrayer off the hook—the betrayer still needs to be accountable for their actions, but the minute details of the transgressions may not always be necessary. Perel often asks partners, “Do you really want the answer to your question, or do you want your partner to know that you have the question? It’s okay if you don’t want all the details. Let him carry the burden of that knowledge and take responsibility for figuring out who he wants to be as a man, as a person.”

Not only is “The State of Affairs” intended to enlighten mental health professionals, but it’s also written in such a way that is helpful and meaningful for clients. Whether you specialize in couples therapy or not, this book spells out the complex challenges and genuine opportunities that reveal themselves in “affairs that are universally forbidden yet universally practiced.”

soul-searching

March 20th, 2018

It’s been fourteen years since I’ve collaborated face-to-face with my coach, and I’ve just returned from Asheville, North Carolina after a very productive and revitalizing two-day intensive with Sandra “Sam” Foster, PhD. As I’ve mentioned, Sam is on the faculty of the College of Executive Coaching where I became a certified coach in 2002. I’ve been seeking her wisdom and support on and off since then, and once again, it felt like an opportune moment to spend some high-quality time together as we explored the next leg of my professional journey.

The outcome of my coaching experience with Sam is always similar—I return inspired, refreshed and grounded. Coaching is partially about goal-setting, values clarification and accountability, but it’s also an existential and sometimes spiritual collaboration, as I choose to re-visit my purpose and mission within my practice and related to my upcoming book project.

Through powerful questions and honest conversations, I was able to distinguish between my Wanna do’s and my Supposed to’s. It became evident to me that they blend at times, but my supposed to’s often feel heavy and obligatory where my wanna do’s create ease and lightness. Because I have a lot of interests both professionally and personally—a high-quality problem— I can sometimes stretch myself too thin. And this leaves me with less focus and attention available for my higher priorities.

I also went into the weekend with the hope of mapping out the next ten years of my professional life infused with some personal intentions as well. Although ten years turned out to be too much of a stretch, I did map out the next five years and feel relief and hope as I now see where my true priorities lie, and how I can keep my sanity and balance intact along the way.

As I anticipate the unfolding of my current book project in 2019, I felt compelled to examine my heart’s desire for my home life, my professional life and beyond. As a result, it reminds me to keep self-care in the forefront no matter what. Coaching has always provided me with a touchstone for what matters most to me—also known as values—and this past weekend steered me in that direction seamlessly.

As a result of my soul-searching discussions with Sam, I now feel more freedom and clarity to say Yes, No, or Maybe to the limitless menu of options in front of me. Not that anything has to happen, but simply what could happen—a reminder Sam has shared with me since we first met in 2001.
It also became clear to me that all future choices and decisions have to originate from Love and Ease. As a result of Sam’s reflections and provocative questions, I now know that love and ease will be a litmus test as I venture back into my practice this week and beyond. Expert coaching infused with the wisdom of Positive Psychology is truly the gift that keeps giving as Sam continues to walk beside me in this uncharted territory.

coaching and positive psychology

March 13th, 2018

In 2001 I completed an 18-month coach training program which helped turn the course of my clinical career. In the 90′s I was trained very traditionally as a psychodynamically-oriented, family systems informed therapist. At the time I found the training and the clinical work very challenging and helpful to my clients, but something changed inside of me.

I had been working part-time in private practice and part-time for a local health management organization, and little by little, I was feeling more burnt out. I knew I needed to leave the HMO but didn’t know exactly how or when to do it. I saw an announcement for a 1-day seminar on the principles of coaching given by a Southern California psychologist, and the light bulb went on. Coaching encompassed theories including Rogers, Adler, and Maslow, and it focused on strengths and resources rather than deficits. This newly-coined theory called Positive Psychology was a breath of fresh air that didn’t replace my former theoretical orientation but complemented it seamlessly.

I then met Sandra “Sam” Foster, PhD who taught a class on Peak Performance, and immediately I felt that Sam was speaking my language in an inspirational and clinically-sound way. I asked Sam if she would be my coach which was part of the requirements of the program, and her influence has stayed with me to this day. Not only did she believe in me in ways I couldn’t believe in myself, but she helped me open creative doors that I never imagined. In 2004 she helped me envision a workbook which became a reality years later (“From Now On: Seven Keys to Purposeful Recovery”).

This weekend I’m fortunate enough to be traveling to Asheville, North Carolina to work with Sam once again as I give shape and voice to my current book project (more details to follow!) In my 27-year career I’ve been blessed with a few fantastic mentors including Sam. And in turn, I also get to give back what I’ve been given.

open house

March 9th, 2018

It’s been 10 years since we moved into our professional home that I now call the “Overland Suite”, and what a great excuse to bring together friends, family and colleagues to celebrate a decade in our terrific healing space. Our Open House will take place on Sunday April 15th at 11am, and we welcome all of you to come on over for a bagel and coffee as well as wonderful camaraderie. We’re located at 2550 Overland Avenue, Suite 100 in Los Angeles (90064) just three blocks south of Pico near the Westside Pavilion. No need to RSVP–I do hope you can join us.

2018 Annual Group Therapy Conference (4/27 & 4/28)

March 7th, 2018

On Friday April 27th and Saturday April 28th, the Group Psychotherapy Association of Los Angeles (GPALA) will be hosting its Spring Conference at the American Jewish University on Mulholland Drive. I will be a small group leader throughout the weekend event as we explore ethnic and racial identities and differences, and I want to personally invite all therapists to consider joining us. Here is the full description of the 2018 conference:

Callin’ In Race: Finding Words, Finding Courage in Group

Presented by Christine Schmidt and Rudy Lucas

Course Description:

Racism in the United States is uniquely structured in such a way that inequities based on the spurious notion of visible ethnic/racial difference are woven into the fabric of our society. Racism impacts our relationships, often beyond our awareness. Internalized racial oppression heightens our differences, yet we yearn for connection with others to heal personal and societal ills. As social beings, we are drawn to groups whether in therapeutic settings or communities.

This conference will offer group leaders an opportunity to learn how our racial identities are consciously and unconsciously transformed through personal interactions. Group leaders nourish responsive groups by being able to identify and respond to colorblindness, racially encoded dog whistle language and micro-aggressions with honesty and openness. Once limiting racial taboos are spoken aloud they lose their toxicity. As we expand our skills about racial dynamics, we confidently foster cohesion in groups by making space for every member to be visible and heard.

Each person attending the Conference participates in a small group experience that meets three times over the course of the two days and is led by an experienced senior member of GPALA. The purpose of this activity is to provide everyone an in vivo group experience, reminding us of our clients’ position as group members and to expose us to a different style of group facilitation.

brainspotting and grief by jen davis

January 13th, 2018

This week we have a guest blog written by my very-talented associate, Jen Davis. This is an intimate portrayal of her first experiences with Brainspotting as she learned of her mother’s terminal condition.

It is 6am. The sun is not yet out. I am bracing myself for the long journey from Los Angeles to Costa Mesa for my first introduction to Brainspotting with Dr. Pie Frey. Exactly one month ago we discovered that my mother had cancer; cancer that had spread undetected throughout her body. I have just arrived home from days in the hospital in New York. Within three weeks she will be gone, but I do not know this yet. I only know that I am terrified and bone tired and that I have to be at the training by 8:30.

I do not feel like a “therapist” today; I feel very, very human. I consider the idea of being an expert at grief, at loss. They say it takes 10,000 hours to become an expert. I have been practicing the art of losing those I love most for a decade now. I have tried to out run grief and found that it is faster than me, and I have said to grief, “okay you are in charge, take me through this,” and grief brought me to the other side. There is a hypothesises in Physical Cosmology termed The Big Rip, in which the universe is blown apart, atom by atom, galaxy by galaxy, star by star, exploding in order to serve the expansion of the universe. The Big Rip; I have found no better words to illustrate the process of loss.

Pie enters the room. She is warm and funny, intelligent and passionate. I am beginning to wake up.

There are three things that I always share with my clients. I tell them that when animals in the wild endure a traumatic experience, they isolate from the herd and physically shake out the trauma. I ask them what they they are attempting to do in their lives to shake it out, and we begin to explore if that is an effective solution for them, for their growth. I discuss the benefits of mindfulness meditation, and the ways that it can effectively begin to break apart our sensations and the stories we have attached to them, creating more space within ourselves to create a new narrative. And I talk to them about the brain. I love the brain. Every brain contains one quadrillion possible connections. To me, the brain is pure possibility.

Mid way through the morning presentation, I begin to feel as if someone has taken everything I love about psychology and created an effective formula for healing like none I’ve yet to experience. I keep thinking this is what it must have been like when Sscientists discovered antibiotics.

I volunteer for the first demonstration with Pie. I am nervous. We find a brainspot that heightens my sense of feeling, and within minutes it feels like a door in my brain has opened, a door wheren I hadn’t realized that there was a door. Possibilities. I feel as if I am watching a slideshow of my life. I do not feel scared, but curious. I am noting the sensations in my body. I am crying and I am watching. I am amazed at where my mind is taking me; it feels like a treasure hunt ,- thoughts, feelings and sensations unfolding before me. Afterward I feel exhausted, but I also feel as if a giant weight has been removed from deep within.

Over the next three days, I will witness and experience this process over and over again. I will be in awe of the healing, in awe of our bodiesbody’s ability to shake out the trauma if we only get out of our own way; if we have the feeling instead of the latte, the tv show, fill in the blank.

I am able to go back to New York and be fully present with my mother. I am holding her hand as the final tear streams down her face and she takes her final breath here on earth.

In Daniel Siegel’s book Mindsight: The New Science of Personal Transformation, he writes, “Loss of someone we love cannot be adequately expressed with words. Grappling with loss, struggling with disconnection and despair, fills us with a sense of anguish and actual pain. Indeed, the parts of our brain that process physical pain overlap with the neural centers that record social ruptures and rejection. Loss rips us apart.” The Big Rip.

The process of grieving is subcortical, it is primal. The DSM used to call itdiagnoses it as Uncomplicated Bereavement. It is my experience that there is nothing uncomplicated about bereavement. Many times a day I am struck by my inability to answer the question, How are you? As Siegel suggests, I cannot find the words, my language feels suddenly lost to me. With brainspotting, I have found a place of deep healing where words are not necessary.

braving the wilderness

December 29th, 2017

Once again, Brene Brown has hit it out of the ballpark with her latest book, “Braving the Wilderness”. Based on her extensive research, she shares her empirical perspective on universal truths–this time focusing on “belonging”. She asks the challenging question of all of us, what is “True Belonging”? She answers, ” True belonging is the spiritual practice of believing in and belonging to yourself so deeply that you can share your most authentic self with the world and find sacredness in both being a part of something and standing alone in the wilderness. True belonging doesn’t require you to change who you are; it requires you to be who you are.”

Instead of looking through the lens of fitting in, Brene Brown recalibrates the definition of true belonging and makes room for the possibility of being part of a larger purpose as well as covering the ground that you stand on. This balance gets talked about at length and challenges the reader to examine when you brave the wilderness and when you play it safe in order to blend in.

She also takes a look at the correlation between loneliness and shame, what she calls the “inextricable human connection” we’re biologically wired to thrive, and how love, belonging, joy and gratitude can be infused into this awareness and ongoing conversation.

I encourage you to savor the latest Brene Brown has to offer us. It’s definitely a holiday treat.

departures

December 10th, 2017

I’ve been part of a “group therapy book club” for the past seven years, and I’ve made a decision to leave this professional family for new adventures. As part of group therapy, we’re always looking at the group dynamic and the group process at all times. With this particular group of colleagues, we’ve been explorers of group therapy literature as we’ve applied these works to our groups, our book club and to ourselves. Very rich and rewarding to say the least. We’ve had members come and go, members have babies, and tragically, two members leave us through death. The club has been full of poignant hellos and goodbyes.

Now I’m moving into uncharted territory, as I move forward with a book project that has been incubating for about this same time frame–seven years more or less. Because I want to put my absolute best foot forward with the book, I’ve decided to clear my calendar from any extraneous commitments and focus primarily on the book entitled, “It’s Not About the Sex: Moving from Isolation to Intimacy after Sexual Addiction”. So this is one of those moments when I’m choosing to leave a very familiar place and step into a very unfamiliar place. Both scary and exciting.

The gratitude I hold for my book club is enormous as the group held my growing edge for all this time, and I was able to internalize the love and genuine care my friends showed me throughout this time. In contrast to death, I get to continue these relationships in a different way. Not in the usual space, but instead, both in my heart and possibly in our ongoing crossing of paths. Departures are always bittersweet, but suiting up and showing up for this goodbye gave me the opportunity to give and receive the trust and respect we’ve established. May our paths cross again in new and different ways.

media misunderstanding

November 18th, 2017

The media is doing their best to keep up with the sexual abuse/sexual offending allegations that are rampant in recent times, but there is one thing they haven’t quite gotten yet. Sexual addiction isn’t sexual offending. The allegations usually involve one person “the perpetrator” violating the sexual boundaries of the victim. And yes–the victim is being victimized because they are being intruded upon sexually in ways that they did not ask for. Although a sex addict can participate in sexually-offending behaviors, and a sex offender can have sexually-compulsive tendencies, they are not to be confused.

When it was reported that Harvey Weinstein had a long history of sexual offenses, apparently, this was common knowledge in the industry. But, unfortunately, it was reported that he was going to treatment for sex addiction which may be part of the story but only a small part of it. Only the evaluating clinician can tease out the issues with the client, but it’s important for the media to report these offenses accurately and not throw them automatically into the sex addiction category.

Yes–it’s confusing even for mental health professionals, but it’s an opportunity to understand these differences and treat the wounded individual accordingly.

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