Finding Strength in Vulnerability

"When we were children, we used to think that when we were grown-up we would no longer be vulnerable.  But to grow up is to accept vulnerability...to be alive is to be vulnerable."  ~Madeleine L' Engle

The definition of vulnerability...having the capability to be hurt...implies our need for protection, our inherent need to shield ourselves from danger so that we will survive. We are born with the will and instinct to protect ourselves.  So you might say that it runs counter to our natural inclinations to allow ourselves to be vulnerable, to lower our defenses and become open to intense emotions like fear, loneliness, or insecurity; sadness, shame or grief.  Sometimes it's even difficult to open ourselves to what would be considered the more positive or desired feelings, like compassion, or love.  So we are faced with a dilemma.  Do we continue to protect ourselves as we are naturally wired to do...possibly remaining disconnected or isolated in efforts to avoid rejection or pain?  Or do we somehow allow ourselves to live fully, to experience the most whole version of our selves and our lives, opening ourselves up to feel our feelings, to express our feelings and then to experience purpose and possibility?

If I were 20 lbs lighter I'd be an architect...

What is it that causes us to see only the flaws, the imperfections and the things we want to change about our appearances?  What motivates us to attend with such scrutiny to the folds, the sags, the creases and the wrinkles?  What prevents many of us from seeing the beauty and uniqueness that we do actually possess—no matter what our shape or size?  What stops us from accepting ourselves as we are?  The answer is, ALMOST EVERYTHING.  Our body image evolves over time and resides in some complex amalgam of messages and experiences gained over the years through family, friends, community, culture and society. Women are bombarded by messages on a daily basis about how they are in need of improvement, about how they are not OK the way they are. 

Lose 20 lbs in 8 days!  2 weeks!  A month!  Women are assaulted by these assertions daily while standing in the supermarket checkout line, commuting or surfing the web.  Magazine headlines, billboards and flashing sidebar messages promise that the secret to happiness and success hinges on weight loss, and reinforces that it needs to happen now! Fast! So that life can actually begin.  This can lead to the indefinite postponement of projects, career moves and/or relationships because we feel that we are not worthy or deserving of satisfaction, success or even comfort at our current weight—the way we are NOW.  As stated by Geneen Roth in Women, Food and God, “The relentless attempts to be thin take you further and further away from what could actually end your suffering: getting back in touch with who you really are.  Your true nature. Your essence.”  In other words, it may be a matter of learning--training ourselves--to pay attention to what we already feel, need, know and want, to the signals and signs that our bodies and souls are giving us in the present moment that frees us up to pursue what we truly need and want, what fuels our souls.  Mindfulness-a here and now connection to our bodies and feelings- could possibly help end our obsessions with weight loss and perfectionism and allow us to live our lives to the fullest.  

Recent research states that on average, most women have somewhere between 13-50 negative body thoughts per day.  Advertising strategically harnesses this overwhelming anxiety about body image.  The media-along with the multi-billion dollar weight loss industry-convinces girls and women that physical appearance is inextricably wrapped up in self worth, encouraging dieting and prompting the purchase of products that will somehow smooth, flatten and tighten us.  And they almost never work.  A 2006 study reported in The New England Journal of Medicine states that most people participating in weight-loss programs “regain about one-third of the weight lost during the next year and are typically back to baseline in three to five years.”  Dieting tends to be one of the main factors that instigates an unhealthy relationship with food and disordered patterns of eating.

The lens of critical hyper awareness that society provides and through which girls and women learn to view their bodies frequently leads to obsessive thinking about food and disordered eating, as well.  This critical lens can also trigger fear-fear of failure, fear of loss, fear of love because, as Geneen Roth suggests, we don’t want to surrender to love in a relationship because we don’t want to give ourselves to something we might eventually lose. Emotional discomfort—feelings of fear, sadness, grief, loneliness or boredom tend to scare us, which sometimes conditions us to run—to numb out, to turn to obsessive thinking about food and/or weight loss to distract us from feeling what is actually there.  We get into a cycle of thinking about food, and instead of listening to the cues in our bodies and eating to satiate hunger, we eat to soothe ourselves for relief or comfort which then leads to feelings of guilt, shame and contempt for our actions and our bodies. According to Jean Kristellar, PhD, Co-founder of the Center for Mindful Eating and the Mindfulness Based Eating Awareness Training Program, “It is extraordinarily common in our food abundant society for ‘unwise’ eating patterns to develop and become entrenched, resulting in eating disorders and obesity.  Patterns, developed since childhood, interact with societal pressures to override basic nutritional needs.  The use of food as a viable source of pleasure and emotional satisfaction becomes distorted." Kristellar’s research has shown that mindfulness, when applied to hunger, fullness and eating can help transform our relationship to food and our bodies while also helping us to address our inclinations to flee from our feelings.

In response to these important issues, The Women’s Health Resource Center at California Pacific Medical Center has created an innovative program called BodyLOVE, a 12 week group for women co-lead by Janet McBride, a nutritionist/dietician and Helena McMahon, a psychotherapist who both specialize in women's health, body image and eating disorders.  Such topics as Mindfulness and Mindful Eating, Food and Mood, Binges and Cravings, Expressing Needs/Assertiveness, Creating Safe Food Surroundings and Building Energy and Movement are explored from both physiological and psychological standpoints, allowing for optimal learning and exploration of these central themes in efforts to create a more positive and healthy relationship to food, eating and our bodies.  In a safe, comfortable and contained environment, a variety of creative approaches and learning points are integrated to help guide participants toward understanding and incorporating important new information, gaining new perspective and reflecting upon their own relationships with food, eating and body image.  The groups also provide women with a safe space to explore relationships generally and to build trust and self-confidence, and offer participants a unique opportunity to identify unhealthy patterns and to learn how to change them.  Groups meet on Wednesday evenings from 6-9PM.  Call Barb Silver, CNP, Director of the Women's Health Resource Center at CPMC at (415) 600-0502 for more information and/or to sign up for the group.

It is a joy to be hidden, but a disaster not to be found. ~D.W. Winnicott

I am reading a wonderful book right now entitled How To Be An Adult In Relationships: The Five Keys To Mindful Loving, by David Richo.  He explains in his book that we all need the "five A's"...attention, acceptance, appreciation, affection and allowing... to have a successful and healthy adult relationship.  But what exactly does "successful and healthy" mean in regard to relationships?  It means a lot of different things.  To have boundaries--allowing each other the space to grow and be individuals in the midst of real connection, closeness and togetherness; to accept one another fully--whether or not we understand or agree with the other's feelings or choices; being open to giving and to receiving; knowing what we need to feel loved and learning how to ask for it--not expecting our partners to be mind readers...and on the flip side learning what it is that our partner's need to feel loved and giving this to them; loving someone the way they are--letting go of control and trying to change our partners or getting them to be the way we think they should be; allowing our partners (and feeling the freedom ourselves) to express our feelings or to disagree and to fully be ourselves.  

Richo connects all of these essential elements in intimate adult relationships to our early childhoods-whether or not our parents were able to allow us to separate and individuate to become the unique people we were meant to be.  As one might imagine-this process of separation and individuation does not always go smoothly, or even well.  Our parents might have been overprotective and afraid to let us venture out to explore the world around us, sending us the message that the world was too dangerous and that we could not trust ourselves to know what we needed or wanted; or they might have had difficulty seeing us for who we were, needing us to be what they wanted us to be, presenting us with the challenge of becoming and later being our true selves, so that we became dependent upon other's evaluation/approval/reassurance rather than knowing within ourselves our worth, who we were and what was right for us.

The question always comes back to, so how do we get there?  How do we do it?  How do we create the kind of relationship that allows for individual freedom and continued growth while also fostering true closeness, intimacy and connection?  How do we let go of our need to cling and control or to distance and withdraw to get what we think we need from another?  

The answer might be surprising-but perhaps it will make a lot of sense.  

Richo posits that "in healthy intimate relationships we do not seek more than 25% of our nurturance from a partner; we learn to find the rest within ourselves."  So while we all need another to  feel mirrored, safe and to help define us...to allow us to come out of hiding and to be found...we cannot rely on this "other" to do all of these things for us.  The main source of these experiences needs to come from within ourselves.  The reassurance that we are worthy, special and will be "OK" in light of whatever occurs externally resides most fully inside of us.  For many of us, this is a new concept!  Scary, maybe, but also exciting, as we can have more control over our wellbeing and happiness than we ever thought was possible.  As Richo states, rather than relying on ourselves,  many of us have been looking for the "perfect partner"  to fulfill all of our needs, the oasis that will offer us everything we lack--total happiness and emotional fulfillment.  We have not had the opportunity while growing up to develop this strong inner sense of security, and we have learned to search for or to rely upon someone else to give it to us...often ending up frustrated, dissatisfied or even desperately disappointed that another was not fully capable of filling all of our needs for wellbeing and emotional satisfaction.   

Now, as adults, we have a renewed opportunity to revisit this space within ourselves, and rather than allowing our fear to create distance from ourselves by looking for another to fix us or to fill us up, we can face our fear--by allowing ourselves to feel it--and we can look within for our own wellbeing and comfort.  We do not have to be as reliant on another for how we are going to feel from one moment or one day to the next, but rather look within ourselves for this reassurance.  Instead, we can turn toward our partners for support, love and closeness--which can free us up to do the emotional work that we were meant to do to become fully ourselves.

Calming our anxious minds and bodies

“I am an old man and have known a great many troubles, but most of them never happened.” ~Mark Twain

Anxiety is necessary.  It helps us to accomplish tasks that need to get done, it often helps to motivate us to make decisions or changes, and it can be very helpful in letting us know that our stress levels are too high or that things are out of balance in some way in our lives.  In the best of circumstances, this can help us to slow down, take time to breathe and reflect on our situation in efforts to understand how we need to proceed.  Anxiety acts as an internal warning sign for us of danger or trouble, and it can prevent us from doing things that may cause us physical or psychological harm.  We need a certain level of anxiety to stay safe, progress and move forward in our lives.  When the level of anxiety gets too high, though, it can get in the way and stop us from living the life we truly want to live.

Anxiety can manifest in many different forms.  It can occur in our thinking, through recurring negative thoughts, a.k.a. worry and/or rumination; it can occur in our bodies in symptoms of stomach upset or pain, headaches, back pain, chest pain, heart palpitations, general restlessness or fatigue.  It can affect our appetite causing us to eat more or less, it can affect our sleep patterns, making it difficult to fall or stay asleep or causing distressing dreams; it can interfere in our relationships and our sex lives and negatively impact our general ability to function at work, school or home.  When anxiety seeps into many or all of these areas in our lives, it can cause other symptoms, as well, such as phobias, panic, irritability and depression.  Anxiety can be extremely uncomfortable, which makes it difficult to let ourselves just feel it and move through it.  It can sometimes leave us not knowing what to do or where to turn for relief, which can lead to quick fixes like food, drugs, alcohol or spending.  Most of us have soothed an anxious mind or relaxed from a stressful day with a drink, some chocolate, a trip to the mall or some combination of all three.  These calming strategies can be helpful in moderation, but if we start to rely on them too heavily or too often, they can become new problems layered upon what was once just an uncomfortable feeling.  They can also rob us of the ability to learn how to handle these challenging feelings in a natural and healthy way.

Here are six proven strategies for relief of anxiety that you can start to practice right now:

1)    Deep, slow diaphragmatic (abdominal or “belly”) breathing (This is the type of breathing taught in yoga or singing, that originates in your belly rather than in your chest.  Inhale slowly through your nose for five counts, hold the breath for five slow counts, exhale through your mouth for five slow counts.)

2)    Mindfulness Meditation (This is simply the process of being present in the moment, and letting go of thoughts of the past or future.  Paying attention to your breathing, noticing your surroundings-sounds/smells/sensations-bringing your awareness back to your breath each time your mind wanders to past or future.)

3)    Regular exercise (aerobic/yoga/dance/running/sports etc)

4)    Identifying your negative, distorted, repetitive thinking habits and learning to challenge them and replace them with more accurate, positive and soothing thoughts.

5)    Learning to identify and express your feelings/needs appropriately and assertively.

6)    Analyze your diet / habits and modify intake of caffeine/alcohol/nicotine/other drugs.  Get help with this if necessary through a support group like AA, NA or MA; or with the help of a physician or therapist.

Recent Studies from the Norwegian University of Science and Technology have found that attending theatrical performances, art shows or other cultural events, volunteering or participating actively in the creative process oneself can significantly lower levels of anxiety.  What creative pursuits do you enjoy?

You probably already have quite a few ideas of your own on how you might lower your current level of anxiety.  Identifying and organizing them can help.  Try making a list of activities that help you relax and start doing them.  Here’s my top 10 (other than the one’s named above):

-Taking a hot bath or shower

-Calling a friend or family member

-Collaging in my journal

-Listening to and discovering new music

-Spending time with my dog

-Writing

-Reading

-Watching a movie

-Musical Theater

-Completing a task that I have been putting off, like cleaning my house

The Wisdom of Pema Chödrön

Much of therapy and the therapeutic relationship, as I see it, involves working together to get to a place where we see ourselves more authentically--all parts of ourselves. The process involves moving toward acceptance, understanding, forgiveness and self compassion--whatever is necessary to allow us to be present in the moment with ourselves as we are, and with our true feelings and experiences.  Pema Chödrön , the famous Buddhist scholar is a wonderful guide when it comes to facing our fears--the dark places-- rather than running from them.  Sitting with our most difficult feelings and finding that we can move through them allows us to know and to trust ourselves, to heal, to truly be free and live life to the fullest.  I find her teachings to be both wise and inspiring, and they inform greatly my approach to counseling.  Here is just a taste of her wisdom.


"Compassion is not a relationship between the healer and the wounded. It's a relationship between equals. Only when we know our own darkness well can we be present with the darkness of others. Compassion becomes real when we recognize our shared humanity." 
— from The Places That Scare You: A Guide to Fearlessness in Difficult Times


"If we learn to open our hearts, anyone, including the people who drive us crazy, can be our teacher." 


"Meditation practice isn’t about trying to throw ourselves away and become something better. It’s about befriending who we are already."

"There is a story of a woman running away from tigers. She runs and runs and the tigers are getting closer and closer. When she comes to the edge of a cliff, she sees some vines there, so she climbs down and holds on to the vines. Looking down, she sees that there are tigers below her as well. She then notices that a mouse is gnawing away at the vine to which she is clinging. She also sees a beautiful little bunch of strawberries close to her, growing out of a clump of grass. She looks up and she looks down. She looks at the mouse. Then she just takes a strawberry, puts it in her mouth, and enjoys it thoroughly. Tigers above, tigers below. This is actually the predicament that we are always in, in terms of our birth and death. Each moment is just what it is. It might be the only moment of our life; it might be the only strawberry we’ll ever eat. We could get depressed about it, or we could finally appreciate it and delight in the preciousness of every single moment of our life."
— from The Wisdom of No Escape: How to love yourself and your world


If you are up for it, you can try Pema Chödrön's "Spiritual Detox," which happens to resemble very closely how therapy works!  Check it out the next time a stressful situation arises and you feel like running for the hills:


1) Think about the outer situation, what just happened to provoke  your reaction-anger/fear/desperation?
2) Ask yourself, what feelings did this situation bring up?
3) Sit with the feelings, try to become aware of the layers of feelings.
4) Now try to become aware of your "strategy," what habit do you use to move away from the rawness of this feeling that you don't want to feel?  Yelling?  Acting out?  Berating yourself?
5) For the next few minutes, let your strategy go.  Try to put that strategy aside and just be with what's there.
6) Observe.  


Insight comes out of being kind to yourself, not out of saying you are broken and need to be fixed, changed or made over.  Staying with your feelings instead of acting them out, repressing them or trying to fix them allows  your own inner wisdom to come forth.



Pema Chödrön is an American-born Buddhist nun and one of today's leading meditation teachers.  She is the director of Gampo Abbey, the first Tibetan Buddhist monastery in North America.

To feel or not to feel, that is the question...

"I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel." ~Maya Angelou


I'll never forget the butterflies in my stomach and the way my hands ached just after my first kiss in junior high, or the racing of my heart and accompanying surge of electricity when I was recently reunited at the airport with my dear friend from abroad.  These bodily sensations helped me to identify my emotions...nervousness, excitement, warmth, affection.


On the other hand, I am often reminded of the fear and anger that I felt when my parents fought...the tightness in my stomach and shoulders, the headaches...and could never forget--even if I tried--the extreme empty pit of desperation and sadness that I experienced at the age of 8 when my Opa Leo died.


Why is this?  Why is it that feelings are imprinted upon us so totally and completely, to the point that we might never forget how another person or situation made us feel?  Why is it that even when we want to let go of feelings, they seem to follow us, sneaking up on us when we least expect them, catching us off guard and impacting us so deeply?  


Feelings get stored in our bodies and our brains.  This storage process was built into our neurobiology as human beings to keep us on alert and safe in the face of danger.  As new discoveries have been made related to brain chemistry and circuitry, it has become an essential component within the therapeutic process to involve both body and mind in the process of healing for true change to take place.  This process almost inevitably involves learning to feel our feelings from head to toe, and accepting and believing that they will not kill us or make us go crazy.


"Nothing fixes a thing so intensely in memory as the wish to forget it." ~Michel de Montaigne


One might say the same of feelings.  A client of mine just recently stated in our session, "it's really difficult being human."  He was referring to the fact that no matter how strong we are, no matter how ready we might be to let go of difficult memories or experiences, we still have to learn to move into rather than run from our feelings when they come up, in order to get to a point where they won't shake us to our core when they arise.  This is hard work, and can seem overwhelming.
Sometimes feelings (especially if imprinted from an earlier time) can feel so big that they are all consuming, taking us over and making it difficult to think or to act rationally.  We develop ways to take care of ourselves when this happens, to protect ourselves from the onslaught.  We learn to run from the feelings, to shield ourselves from the anxiety and the loneliness, the fear and the sadness.  We distract, we consume, we restrict; we reach out or act out, we self medicate or self destruct, we move, we freeze.  


So what, if anything, might we choose to do as an alternative?


Like the stamina and strength building exercises required to train our muscles for a marathon, so must we train our minds and bodies to feel.  Each time we make the choice to identify what we are feeling in our bodies and minds and allow ourselves to move through these feelings, we are building strength and growing the inner endurance necessary to experience our feelings more deeply.  At the same time that we are experiencing our feelings more deeply, we are literally changing our brain chemistry and creating new neural pathways that will open us up to think and function in healthier ways. Feeling intense emotion is often scary, so self care is central to this process...deep breathing, calming self talk and the introduction of self compassion are all components that can help us sit with strong emotions.  Meditation, yoga and other forms of movement and relaxation are also excellent ways to support yourself in this work, along with a trusted therapist as your guide.


So what's the point?  Why bother choosing to take the more challenging path to feel more deeply or change the brain circuitry, especially when we have developed perfectly effective methods of coping?


It's a great question, and the best person to ask is yourself.  

The Power of Listening and Truly Being Heard

"Being listened to is so close to being loved that most people don't know the difference." ~David Augsburger


As it turns out, it's impossible to talk about how we tell our stories without talking about the power of listening and truly being heard.  This dawned on me this past Monday in my consultation group at the Couples Institute, as we discussed how important it is for couples to feel heard by one another, along with the dilemma that listening to one another involves skills that many of us just do not learn along the way.  Misunderstandings, disagreements and conflict happen for many reasons, with one main principle in common--that we are not truly listening.  So many things get in the way of listening--distractions, exhaustion, emotional overwhelm.  We want so deeply to convey our caring to one another, to share with each other our stories, dreams and fears, yet so often we fail.  So what are the essential skills that seem to elude us?

-Begin with a quiet space, bodies facing one another and eye contact--creating an attentive atmosphere.  Slow, deep breathing to feel more relaxed might be a good idea to help get into the right frame of mind.
-A caring, non-judgmental attitude is next.  Listening involves putting aside our own needs, desires and competing thoughts, and completely taking in what the other is saying.
-Noticing the feelings that accompany what is being said-how is my friend/partner/daughter/sister feeling while he/she is telling her story?
-Next and perhaps most importantly is reflecting.  It might seem strange to repeat or summarize what you have heard the other person say, but the satisfaction, comfort and connection that someone experiences when his or her words have been absorbed and deeply understood is staggering.  This involves simply reflecting back to the other person what you have heard them say, and checking in with them to make sure that you have it right.
-Finally, if you want to bring more depth to the listening experience, ask questions that help you understand better what the other person is saying.  Not necessarily questions related to what you want to know, but rather that help the other person tell his or her story.

We are not used to doing this kind of committed listening, and it will involve setting time aside and possibly at first feeling a bit awkward, but it will almost definitely be worth the effort.