How to make your therapy go further...

Dear readers,

My apologies for blog radio silence for a few months. I've been having a period of reading rather than writing, learning rather than teaching--of taking in rather than putting stuff out there.

I've been researching primarily based on a question that has become a major area of interest for me: what kinds of activities or practices best augment psychotherapy? One very straightforward way of expressing the question I've been asking is:
Someone comes to therapy and spends money on it. What can a person do in between these 1-hour-a-week sessions to get the most benefit from that hour?
Or even more straightforward:
What can I tell my clients to do to make therapy work better?
Or really bluntly:
How can I make sure clients are getting the most for their money?

There are some great classic answers to these questions... Here are a few:

Contemplation and Creative Expression

For a long time, it's been clear to therapists like me that pursuits like art, writing, talking about personal stuff with warm friends and other forms of introspection, self-reflexion and self-expression help. What works best depends on the person. Some people draw or paint. Others write. Journaling is great. I often even just encourage people to have a white board they write things they're thinking, their goals, dreams, ideas. In a busy world, this helps a person focus on what's really important.

Exercise

Likewise, research suggests that for mild to moderate depression and anxiety, different forms of physical exercise may actually be the most effective intervention. Oriental medicine chimes in that moderation is key.

Medication

Likewise, In some cases, taking a good medication is an indispensable adjunct to therapy: if someone is in such rough shape that they can't focus during therapy sessions or can't look at what's happening easily, therapy won't go far. It's like trying to have an important conversation with loud music on: first thing to do is turn down the music. Of course--in my view anyway, the long term idea is to eliminate (or at least significantly reduce) medication. 

Bibliotherapy

Sometimes I will recommend a book. This can work in a number of different ways. The most straightforward way is that I might recommend a book that talks about some of the issues we're talking about in therapy, or which connects to a technique we're using. I recommend some books on my website. Feel free to check them out.
Sometimes, I'll also recommend a book that's less straightforward. For instance, I might recommend a fiction book or a book of essays. When I do this, I'm usually thinking about a client's need for a certain kind of psychological nourishment. If this sounds woo-woo, you should take it literally instead of figuratively: just like our bodies need good food, so do our minds. A good story provides nourishment. Put another way, reading a story can make someone feel less alone, or it can give someone strength, or even provide a map for how things could work out. This is necessary sometimes. Just like a person needs good food to heal from a physical injury or in order to gain muscle, a person needs good psychological food to recover from a psychological injury or to grow strong psychologically. Actually: good (physical) food helps a lot too.

Continuing the session...

There are also some more subtle things: one of my favorite therapists and I would often talk about the process of internalizing one's therapist. Or as I sometimes frame it to my clients: "even though you have to leave my office, you should take me home and continue therapy by yourself. Think about what we've talked about. Continuing talking.  Imagine me responding. Then, when you come back, tell me about our conversations."

What this really speaks to, of course, is something we all do: we rehearse and imagine conversations with people. If you have a skilled therapist that you like, no matter what kind of therapy you're doing, you'll probably find yourself doing this.

Rather than proof of some kind of psychotic process, this is a good thing (as long as you're aware your therapist isn't actually in your head). What you're really doing is continuing the session. When you come back and talk about your conversations (as I suggest) you're honing your internal imagine.

Effectively you're crafting your own internal therapist--one not limited to a regimented hourly schedule. And isn't what anyone who felt alone with a world of hurt has always wanted?--someone with wisdom and caring closer than their own nose?

More soon...

One of my major interests, of course, is meditation and other mental practices as an adjunct to therapy. I've studied mindfulness based approaches in great depth over the years. Likewise, of course, loving kindness (metta) practice, after which this blog is named. There are (of course) other practices.  I will write more about some soon. 

Home Practice?

I want to write today about home practices.

Home practices are "homework" I give as an adjunct to therapy to make therapy more effective.

I would say "to make therapy more efficient" but efficiency is a tricky idea especially when it comes to mental health: sometimes things change fast and sometimes slowly when it comes to mind. So efficient mental health care is elusive. But effective therapy--therapy you can look back on and say, "I got something out of that!"--that peaks my interest and is something I've been studying and thinking about for a few years now.

In a nutshell, home practices are activities, exercises or guided meditations I recommend people do when not in the office with me. One premise of this is simply that one hour a week (on average) of meeting with a therapist, though helpful, is not that much time. Anything that bolsters it is a good thing. 

I've been particularly interested in meditation practices that augment therapy.

There have been a number of studies over the last 20 years that document meditation's helpfulness when working with particular mental health issues. In certain cases, such as with Mindfulness Based Stress Reduction, an eight week course that utilizes mindfulness meditations as part of a program to manage stress and promote well being, the results have been quite dramatic.

The exploration of home practices has really just begin, though. The MBSR program, as amazing as it is, only uses a small portion of the array of mindfulness practices that exist. There are a number of others out there that are also potentially helpful.

Even the realm of mindfulness meditations is restrictive: though certainly a kind of "gold standard" for mental health promoting meditations, these meditations aren't the only type of helpful meditation out there. It's worth noting that just because one particular style or category of meditation helps one person, it doesn't mean it will help another.

The application of mindfulness to every mental health problem is like taking tylenol for every kind of physical illness. Though no one would argue that tylenol isn't helpful, it's not going to help everything. Traditionally, different practices are given to different types of people based on temperament and problems. As we learn about meditation in the West and apply it to our problems and our ways of understanding, we're learning how to do this.

Along with mindfulness practices, I've also been particularly interested in compassion practices (another heavily studied grouping of Buddhist meditations), and in what I call hypnoyogic practices--yoga nidra and forms of guided imagery--for their usefulness in augmenting therapy. All three of these groups of practices are forms of practice that are part of ancient understandings of how to work with the mind. 

What I've noticed is that people who have been willing to embark on the adventure of some of these practices are finding their therapy more effective. When I've discussed these practices with other therapists, I've gotten similar reports: those who do and stick with the proper practice do get results. 

You may notice I stuck the word "proper" in there. Really, this just goes back to the tylenol metaphor: what works for one person with a particular problem won't necessarily work for another person with another type of problem. I used to think that doing any kind of meditation practice was better than doing no practice. And (and not to contradict myself entirely), there is truth to that notion.  But there definitely cases where an expert is handy. I think anything where a clinically significant mental health issue is at play is a situation where it's best to consult an expert.

Of course, personal preference (and a host of other factors) also should be noted here.

Some people, for whatever reason, do not want me to give them home practices. This is okay. Therapy on its own is also a powerful practice for working with the mind. (If it weren't, I wouldn't be in this field.) Some people also have trouble making time in their schedules or find it difficult to take the risk on these sorts of adjunctive practices. This is also understandable.

That said, meditation isn't just about sitting on a cushion. Back to my old favorite, loving kindness (metta) practices: after you know how to do it, I think metta is just (if not more effective) to do out in the world: while driving, walking, shopping at the grocery store or waiting for a bus. Give it a try. It doesn't take any extra time--you just do it while going about your day. 

 

 

The new blog...

When I first began my private practice in Northampton, I started a blog. As things started getting busier and I started having some technical problems with blogspot, I reluctantly abandoned the project. But given the new things I've been doing and the kind of work I've been developing, it seems like the time to reinvigorate it. I named the old blog "The Metta Project" and wrote a post long ago about how that name originated. I'll share it with you now.

The Metta Project?

Metta is a state of mind that's intimately connected with mindfulness. Traditionally, it's said that mindfulness-awareness and metta are two wings of a bird. You need both to be a whole bird, and to be able to fly.

Metta the word translates roughly to something like "loving-kindness" or "loving-friendliness" in English. It's like compassion, and is related to all positive inter- and intrapersonal feelings.

In a nutshell, it's the feeling of unconditional love--or the kind of caring you'd give to your closest friend... It's the feeling you have for people you care deeply for and that you (ideally) have for yourself. Traditionally, it's also described as the feeling a "mother has for her only child"--although that might confuse the issue more than clarify it, depending on your mother. I think, though, that it's a good reference if you are a mother or father--it's that heart feeling of willingness to suffer and exert oneself for the sake of someone precious--that you often feel for your kids.

Metta is a lost art in some ways--especially when it comes to caring about oneself. Loving oneself is where it all starts: you can't love others without loving yourself. Unfortunately, most people lose track of themselves as deserving of love in the midst of all the messages we get about being better, and about acquiring the external things we're told we need, trying to acquire love and trying to change ourselves to get what we want out of life.

As a psychotherapist, I see the lack of metta and its effects pretty starkly. I'd say that the problem of 90% of the people I see in my work--and I'm not exaggerating here--is caused by an inability to love oneself for who one really is.

Wrap your mind around this. 90%. Of clients over my professional life. Addiction, depression, schizophrenia. People who can't accept and love themselves (and then can't accept others)--can't "say yes" to their own being, like in the guided meditation I posted.

The Buddha says this even better than I do... There's a scripture in which he lists a bunch of profound and righteous actions that people can do in order to develop good karma.

(Note, if you dislike about hearing about the Buddha and karma--you can pretty much substitute "a really great therapist" for the Buddha and "psychological health" for "good karma" and you'll still have the story.)

He lists a bunch of great things people can do... Stuff like feeding and clothing people--especially holy people--and supporting people who're trying to cultivate their minds. Everyone's delighting at knowing that if they give food and their possessions to holy men, they'll be happy and healthy. Seems pretty cut and dry. I can imagine people packing up to go home, pretty clear that they get the message. And then he says:

As great as all of these might be, it would be even more fruitful to develop metta even for the time it takes to squeeze the utter of a cow.  [AN 9:20]

I'm dramatizing a bit here--but I can just imagine people wrinkling their brows and looking around, confused: Weren't they supposed to give everything they owned to the Buddha? What's this about loving kindness?... It takes maybe 5 seconds to squeeze the utter of a cow. How could that be better than feeding the hungry and giving your wealth to spiritual teachers and stuff?

The Buddha goes on and says more about mindfulness.  But for our purposes, this is the punchline: Metta is a big key to psychological health. And to dig a little deeper into what he's saying, it's actually also a key to the health of the greater society. If everyone loved themselves and loved one another fully, imagine the world we'd have. You wouldn't need to feed anyone; no one would be going hungry to start with. If you have metta in your heart, you will end up helping other people, yourself--and the world--more than you know.

One day I was sitting around contemplating all this, and I thought, "If my life was a project that involved helping people find and develop their metta--even for a moment--it would be worthwhile." And so the Metta Project was born.

All the best,

Nick

A few years later, it's interesting to note that the idea I had here still stands. Though loving kindness isn't the only curative aspect in play in life today, a handful of years after I wrote the above post, I still think it's a big one. In this blog, I hope to talk about these various pieces of mental wellness from the integrative perspective that I've come to establish a name for myself by. Feel free to join me. 

Nick