I am excited to share today my very first guest blogger, Janet Bayramyan, MSW. She is a wonderful clinician with extensive experience working with adults on trauma, addiction, and intimacy issues. Here is her very informative post on EMDR and what it would look like to use it in therapy. Happy Reading!
As a mental health therapist, I used to be the biggest skeptic when it came to EMDR (Eye Movement Desensitization and Reprocessing) therapy. EMDR involves the movement of the eyes back and forth in what's called bilateral stimulation. Earlier in my career, I thought to myself 'How can moving eyes back and forth help heal someone from trauma and minimize anxiety?' Luckily what changed my opinion is in my own experience with EMDR as a client. I can now say that I successfully drank the EMDR Kool-Aid.
Accessing Beyond the Pre-frontal Cortex
I am a big believer in talk therapy, and feel as though this is a necessary part of mental health treatment. We need talk therapy to build a positive relationship with our therapists, and verbally share the information we need to share. Thought process occurs in the pre-frontal cortex but what’s so missed with talk therapy and trauma is that trauma is stored beyond the prefrontal cortex. Trauma is stored in our nervous system. Trauma additionally is stored in our limbic system, the mammalian part of our brain. This part of the brain is where our survival mechanism exists (fight, flight, and freeze) and information and experiences get translated into emotional responses. This occurs beyond the frontal lobe. And that’s why EMDR therapy works. It’s a non-talk therapy where you don’t need very many words in this intervention. You actually access more body, and somatic experiences through the mammalian part of the brain.
Role of the Eye Movements
EMDR attempts to mimic REM sleep during the intervention process. Therapists typically, in a formal sequence of EMDR therapy, instruct the client to move their eyes back and forth for a period of time, in relation to a particular traumatic experience. The point of the eye movements are to mimic REM sleep, the most restorative time during sleep. This is where cellular regeneration occurs, and this is where short term to long term memories get transferred in the hippocampus. So the point of this exercise is to allow for an unconscious memory, core belief, fear, body memory, or really, whatever was stored in the memory network to come to surface in conscious memory for healing and re-defining. The brain has been made to heal itself, however a traumatic experience prevents the brain from fully healing. A traumatically stored memory is stored in an isolated bubble of an experience, which means that the sight, thoughts, smells, emotions, and feelings get frozen in time. Therefore, the past is the present, according to the brain. In addition, the developmental age with which the traumatic event occurred is stored in the brain. Hyperarousal as well as hypoarousal freeze time and space, which can mean that external events that are similar to the past trauma can trigger the same reaction from the time of the developmental age. How we think of ourselves get frozen at the time of the trauma. So what I'm trying to say here is if you experienced some form of trauma at age 7, a part of your brain stays about 7 years old as a survival mechanism for you.
My Own Experience With EMDR
In my own personal experience with EMDR therapy, I was astonished. After bilateral stimulation (my eyes moving back and forth), all of these memories and thoughts came forward that I hadn’t thought about in many years. What I'm describing here was my brain was reprocessing a past memory. Additionally, some of these thoughts were thoughts that I had never known existed in my conscious brain. I had conscious access to a new part of my brain, the part that stored and froze my past pain. I also had access to the negative beliefs that were stored in those places. This therapy is also not for the faint of heart. You have to be willing to think and feel distressing things, while handling the intensity of those memories. If you’re interested in exploring this, you’ll need to find a really skilled therapist who will prepare you and who will guide you. EMDR is not just eye movements. There's a comprehensive format that therapists follow. It’s not recommended to jump right into this therapy either, especially the bilateral eye movements. Of course every case is different, however I would caution people to start bilaterals right away because you need to learn how to manage your triggers, and learn how you will manage and take care of yourself when negative thoughts and challenging memories come forward. You have to learn how to calm down your nervous system, you have to learn how to manage emotions and anger.
It took me a year of talk therapy to even be open to this, because I really needed to establish trust with my therapist, and I also needed a reality check. While I had a lot of intellectual insight, my behaviors weren’t changing. The adult part of me was not connected to the child part of me. Much of my symptoms were not improving, and through just talk, it turned into venting and re-exploring the same issues over and over. My relationships and my challenging experiences in present day, as well as how I reacted to those experiences were all connected to my challenging past in early childhood. Remember, trauma freezes the mammalian part of the brain, and often freezes people at that time of their development when the trauma occurred. How I reacted in my early years, was much of how I was reacting today. And thus, my early past needed to be looked at with EMDR.
The other beauty with EMDR is that it points to the psyche’s incredible gift and drive to wholeness and health. The brain knows exactly what to do. By storing the trauma in an old memory network, it’s helping people survive that trauma. EMDR helps get the brain out of survival mode. And the brain helps us to connect to our compassion, wisdom, and empowerment, our true core selves. In EMDR, the brain helps from moving from a distressing emotion to an adaptive resolution. It’s quite magical.
If you're looking for an EMDR therapist, you can find either EMDR trained therapists or EMDR certified therapists on www.emdria.org.
Janet Bayramyan, MSW, ACSW# 71442
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When getting help for your mental health needs you may end up considering whether adding medication will be helpful or necessary.
There are two significant benefits of medication. The first would be symptom relief and the second would be to make therapy more effective. Some challenging experiences such as insomnia, sad mood and anxiety partially caused by chemical imbalance in our brains. Medication is often an effective tool in repairing the chemical imbalance and as a result, leads to improvement with these challenging experiences. In addition medication helps with sleep, anxiety and concentration. As a result, you may become more able, present and receptive to the discussions and tools offered in your therapy sessions. Similar to your relationship with your therapist, it is crucial to find a psychiatrist that you feel safe around and trust, who spends an ample amount of time with you and in understanding your needs. The goal is for you to make an educated decision with the guidance of a professional.
One of the most challenging aspects of medication management is that most people may have to try multiple medications with varying dosages before they find the right one that works best with their brain chemistry. Unfortunately, due to this trial and error process, most people either become hopeless that medication will never work for them or become too overwhelmed by their ongoing mental health symptoms to keep trying.
There are common questions people have about medication. Such as “is medication right for me” and “when is the right time to take medication?” First of all, no, medication isn’t for everyone and not everyone has to be on medication to see an improvement in his or her mental health. However, it is also important to note that many research studies have found a combination of medication and evidence based treatments such as CBT to be effective in treating anxiety and mood disorders (Bipolar & Major depression).
Other questions that people often contemplate are “will I rely on it too much, like a crutch?” and “will I become addicted?” These are also great questions to ask and discuss with your psychiatrist and your therapist. Utilizing medication can become a barrier only if medication management is the only tool in your toolbox! Therefore, it is important to always incorporate medication management along with other effective coping skills to see the best results. Seeking medication can be a short or long-term treatment option that depends on multiple factors, such as severity of symptoms, other medical conditions and individual circumstances.It is also very common to have fear of taking medication. Some people view medication as a weakness. Therapy sessions can be utilized in addressing the underlying worries and stigma you may have around medication that has become a barrier to you reaching your goals.
In his book, Everyday Mindfulness for OCD, Jon Hershfield, MFT, and Shala Nicely, LPC, outline three tools to live joyfully with medication. The first is to incorporate mindfulness to manage the side effects. The essence of Mindfulness is to be present of one’s experiences and non-judgmental. So according to the authors this would look something like this: “my mouth is dry” instead of “I hate these meds and nothing ever works for me” and “I am frustrated that I am still having symptoms” instead of “my medication was waste of time and money.” Through mindfulness, you can observe your experience without attaching a meaning to it. The second tool is to practice common humanity statements, such as “many people are wary of the idea of taking medication” or “these sensations are common for people on this medication, and nobody enjoys this part of it.” These statements focus on how universal your experience is so that you remember you are not alone. The last tool to practice is self-kindness. The authors define self-kindness as “opening yourself up to the feeling out of control and not having all the answers each step along the way” (pg.180). A self-kindness statement would be “I am doing the best I can, and I’m going to invite myself to stay off of Google, and if I’m still feeling this way tomorrow, I’ll call my psychiatrist” (pg.181).
If you are currently taking medication or may be considering it, therapy can be the right place for you to seek support in your treatment options.
Let’s play a trivia game! Can you name the author whose first children’s book was rejected by 23 different publishers? What about a famous athlete who was cut from the varsity basketball team his sophomore year in high school? Who is a famous author who lived on welfare for years in an apartment infested with mice? Drum roll...The answers are Dr. Seuss, Michael Jordan, and J.K. Rowling. Can you tell what these famous people have in common? Their stories remind us that path to success is not linear. Despite having ups and downs or fallbacks, success is attainable.
I am always drawn to autobiographies because true stories can install the highest form of hope, inspiration and motivation. While these famous people are widely celebrated it seems as though our culture is still prone to only celebrate victories while hiding away the failures. If we were to take a poll, I believe people would say that failures and past mistakes most often trigger feelings of insecurity, embarrassment, guilt and shame. Partly due to these feelings, it becomes a big challenge to learn to accept failures. Past failures may also be hard to accept because they remind us of our imperfections and shortcomings. We often view them as sign of weakness and I think that’s where growth is blocked. I believe the key to accepting our failures is recognizing that many good come out of failures! Let’s revisit the stories of Dr. Seuss, Michael Jordan and J.K. Rowling. Michael Jordan is quoted as saying; “I have missed more than 9,000 shots in my career. I have lost almost 300 games. On 26 occasions I have been entrusted to take the game winning shot, and I missed, I have failed over and over and over again my life, and that is why I succeed” (Greatist.com). Can the tips and tools to success be lie in our failures? What is that we can learn from failures? Once we can see that growth happens while having failures not in the absence of them, we then can explore ways we can learn from our past failures and mistakes.
I like to share with you few benefits of failure I have come to learn. Most often we find out what we like and don’t like, what works and what doesn’t work, what we want and don’t want through things not working out the way we planned. It has been quoted that it has taken Thomas Edison 10,000 tries before he got the filament right for the light bulb. Edison was quoted as saying: “I have not failed 10,00 times. I have not failed once. I have succeeded in proving that those seven hundred ways will not work. When I eliminated the ways that will not work, I will find the way that will work” (Forbes.com). When things don’t go as we planned, our problem-solving skills as well as ability to tolerate the discomfort and distress improve. In addition, our ability to stay on task and remain accountable is well tested through times of failure. Many of our strong traits such as determination and ambition can be born out of past failures. Failures not only build our character but can also improve our relationship with others. Most often we learn to be more empathetic and non judgmental towards others due to our own past history of failures. After all if we have been there and done that, we are more likely to show understanding, patience and support to those struggling with the same challenge. I believe that there is a strong correlation between number of past failure and capacity for empathy. Being able to shift our perspective on past failures can provide us with all these benefits as well as arriving at a place of acceptance and peace. If you have some past failures that are unresolved, then therapy can be the right place for you!
The summer has ended, the schools have started and you start to see holiday decorations in the stores. You know another very busy season is ahead. A busy life can offer some sense of satisfaction and fulfillment as we can multitask and attend to different areas of our lives. However, one big fall out of such business is that taking care of ourselves becomes the first thing we neglect. Let’s do a quick test! Look over your to-do list and tell me how far down on the list is there an item about you? How often the first few things on the list are about running errands, completing tasks and attending to others’ needs. Let’s be honest, was there even an item on the list about you? It seems like there is a lot of talk around self-care but not enough action! It feels as though we are creating some type of a culture that promotes and support self-care but how well have we integrated this notion of self-care into our daily choices and actions? In order to truly engage in self-care, I like to tackle some on-going underlying believes we have around it. I believe there are still some of us who think self-care is just not the term for a busy person. Do you think how busy must I be if I have time for myself? Do you some how measure your sense of productivity and success with how busy you are? Most importantly how do you define self-care? Now this is the deal-breaker. For those of you that view self-care as some fancy word that mean you must be self-absorb, selfish, or self-indulgent, then it won’t make it on your to-do list. However for those of you that view self-care as a necessity and act of self-love and compassion, then you have the right mindset to master the art of self-care. A recent quote I read from Serene Williams effectively captures how self-care is a necessity.
Serena Williams recently shared one of her conversations she had with her trainer who mentioned to her the Oxygen mask theory. Before taking off, all flight attendees review the use of oxygen mask in the case of a change in altitudes. All passengers, especially parents, are advised to put on their oxygen mask first before helping the one next to them, even if it is a minor. This safety tip has now become a very popular analogy to help people understand the concept of self-care. The moral of the story is that you cannot help others if you don’t take care of yourself first. In the context of physical health, most of us can agree quickly that we do need to secure our oxygen levels first before helping anyone of else. However we tend to minimize that this works exactly the same way when it comes to our emotional and mental health. The truth is we are not going to be good or effective in being there for others if we are feeling exhausted or burnt out. So self-care is the “oxygen mask” of our emotional health. We have to make sure we are emotionally well rested, re-charged and refreshed in order to attend to those around us. Here is another popular quote to make my point: “You can’t pour from an empty cup; you must fill your cup first.” When you take care of yourself and make sure you are feeling good you become a better version of yourself for those around you.
Like all changes, it starts with having the right mindset. I hope reading this blog has helped challenge and reframe some of your viewpoints around self-care. Once you truly believe in the power self-care, then I suggest you start with small changes. Throughout your day take 5-minutes break from work or when kids are napping, to take a walk, get some fresh air, shower, text a friend or meditate. With practice, increase the duration. Once you can allocate longer periods for self-care, it can include activities such as getting a haircut or massage, taking a trip or eating at one's favorite restaurant, as well as attending to one's basic daily needs.
As people, we make mistakes all the time, but we tend to vary in the way we respond to it emotionally. Some of us feel embarrassed, angry or disappointed. Many of us feel guilt and/or shame but only few might know the differences between these two emotions. In order to tolerate, accept and learn from our mistakes, it is important and helpful to be able to separate these emotions. First off, let’s define these emotions. Here is the most commonly agreed definition:
Guilt is “I have done something wrong; therefore I FEEL bad about it”
Shame is “I have done something wrong; therefore I AM bad.”
Guilt is about feeling badly about the actions; which helps us separate our actions from our self -identity, and in turn have the motivation to change those actions. However, shame influences our view of our self as a whole. It leads us to think that it was not just “some” action I have taken that is bad, but it’s me and who I am that is bad. Shame can lead to the view of self as inadequate, inferior, and/or unworthy which are ingredients to having low self-esteem. As a result, change becomes much more challenging and daunting because now we are faced with the question of how can I change who I am at my core. Shame leads to a negative evaluation of our self whereas with guilt it is about the negative evaluation of the action. Guilt is “I made a mistake” vs. Shame is “I am a mistake.”
When shame is tied to who we are it has additional negative consequences. When feeling shame and thinking badly of ourselves we often isolate and disconnect. When guilt guides us to look at the behavior, it also allows us to reach out and repair by owning up to our actions and making amends. Therefore, guilt has a more healing power to bring us together and strengthen our connections. When you notice the differences between connections vs. disconnection, then it goes without saying that guilt is a healthy emotion where shame is unhealthy.
Now that you have a clear distinction between these two emotions here are some helpful tips:
1. When addressing a conflict, focus on your actions and take responsibility for them by saying, “OK I did say (blank) or I did do (blank).”
2. Avoid making any connection between the action and yourself, for example: do not make the conclusion that “because I did (blank), I must be (blank)” such as “because I cheated on my partner, I must be a bad person.”
3. Identify few ways you can make amends giving the context of the mistake and the relationship it affected, i.e. professional vs. personal relationship.
Part of this awareness is to look at how mistakes were handled when you were growing up? What did the process of forgiveness look like? Were there a lot of grudges and mistakes being used as ammunition? If these questions are sparking an interest, then therapy might be the right place to explore more. Let’s talk!
Tell me the first word that comes to your mind when you hear the word Love? Is it: romance; passion; understanding; respect; trust or security? Love means different things to different people. So is there a right answer? Absolutely not! The key is to simply ask yourself the question; what does love mean to me? How do I define it? Maybe some of the words described above will be the answer or maybe it’s more complicated than just one word. Many of us are in search of love but haven’t taken the time to figure out how we define it and how we like to give and receive love. Once you figure out how you define love; then you must communicate it! What do I mean by that? It’s the process of assessing if the elements that you use to describe love are present in your current relationship. For example, if love means trust and intimacy; and you find out that there are plenty of trust but little intimacy; then you focus on addressing the intimacy. In any couple’s relationship, it is crucial to voice our needs and wants but also know when we need to re-assess and re-negotiate. Re-assessing and re-negotiating mean taking the time to communicate whether your needs are being met. If you decide to improve the intimacy in your relationship, after making some changes, you want to check in with your partner and communicate if the new actions you two have taken are working. On Valentine’s day and throughout the year, love not only be celebrated but also explored, communicated and worked on!
When you first thought of what love is, how quickly did you think of the question in relation to another person? Since we are wired for social connection, it’s very common to explore your definition of love in context of a romantic relationship. However when we jump right into thinking of it in context of a relationship with a partner, we miss a very crucial step: the Self-Love. One thing that is well known and agreed upon is that you can’t love someone else if you don’t love yourself first. Now let’s think about how you define love in context of you! What are the words that come to your mind when you hear “Self-Love;” is it authenticity; self-identity; compassion; boundaries or respect? Do the words change or remain the same when you think of self-love vs. love for someone else? Self-love is not different in that when we define what it means for us, we also need to practice it. Maintaining healthy boundaries and a stable balance in our lives are just some ways we can maintain self-love. How do you practice elements of love for yourself? How do you engage in self-respect or self-compassion? What about honesty with one self? If any of these questions gets you thinking, then therapy might be the right place for you to explore more.
“What’s your New Year’s resolution?” A common question asked in a family gathering, a work party or a social event. It’s a question that some have a very definite answer, where others refuse to come up with one. In their defense, the New Year’s resolution doesn’t have the best reputation. Often the number of people who stick to their resolution decreases as the months go by. By the end of the year only a very few have followed through and accomplished their goals. So one wonders, if the success of the New Year’s resolution is so low, why do we still talk about it? What’s behind this annual ritual? I think that the most important motive behind the resolution is a desire for change. There are often many things we wish to change in our lives, which could be about work, relationships, physical health or leisure time. And for some reason change is often pursued at a particular time, like the first day of the week, first day of the month or the first day of the year! We seem to look for an external motivator to get us going; like a noticeable time. And I think this is where it fails; we can’t rely on some external source for change. It needs to come from an internal motivator. So you have to ask yourself what do I want different out of 2018? Why do I want that? Asking these questions are only the first step to change; but the answer to it can build the foundation to the change you are seeking.
Grief is a type of experience where no two people may respond the same way. This complicated and notably painful experience can be even more challenging during the holidays. As we come together to celebrate the Thanksgiving, it can be helpful to rely on some tools to protect and experience our grief while enjoying the holiday. David Kessler is one of the world’s foremost experts on healing and loss. Here are three important tools he discussed to help you deal with the holidays.
First of all, let go off expectations! It doesn’t matter if this is your first year without your loved one or your tenth year; every year can and may feel different. Therefore, allow yourself to let go of how it should be and be present in what it is. Kessler reminds us that releasing the expectation can release the pressure.
The second tool is that your grief is nobody else’s business! We tend to worry about what others think not only during the holidays but also throughout the year. It will be making things more difficult on us if we worry about what others think about the way we grief. Kessler reminds us that our focus needs to be on honoring the loss. That means letting go of what people think and focus on doing what you need to do to feel your grief. For example, you might want to visit the cemetery before heading out to a Thanksgiving dinner. It is OK to take the time to connect with your grief and your loved one.
Last tool to consider is to give thanks for the loved one. This might be the most challenging. It may be hard for us to find gratitude in the midst of our pain. Kessler reminds us that the goal isn’t to feel gratitude instead of the pain but in addition to it. When you remember a memory or something you love about the one you lost; you give thanks by saying, “I am grateful we went to that trip” or “I am grateful for his humor.” Kessler says, “What you water is what you grow.” How will you give thanks to feel your grief and gratitude?
When things get stressful and sometimes overbearing, we find comfort in things around us. Sometimes it’s a song or a picture that reminds us of our strength. It can also be a transitional object that belonged to a loved one or from a period in the past that made us happy. For me, it has always been inspirational quotes that guide me back to my path. Research shows that words that make up our internal dialogue have a great deal of influence on our moods and overall view of others, the future and ourselves. Negative and self-discouraging self-talk can cloud our judgments. We can connect with quotes to regain our motivation and strength. Below are a few of my favorite quotes. Now it’s your turn to find your inspiration!
We cannot start over, but we can begin now, and make a new ending- Zig Ziglar
In the process of letting go, you will lose many things from the past, but you will find yourself – Deepak Chopra
What you think, you become. What you feel, you attract. What you imagine, you create – Buddha
When you change the way you look at things, the things you look at change – Wayne Dyer
Every human being on this planet has their pain and their heartache and it’s up to all of us to find our way back to light – Diana Nyad
The inspiration you seek is already within you. Be silent and listen – Rumi
If you don’t make peace with your past, it will keep showing up in your present. – Wayne Dyer
Hardships often prepare ordinary people for an extraordinary destiny – C.S. Lewis
To the heart in you, don’t be afraid to feel.
To the sun in you, don’t be afraid to shine.
To the love in you, don’t be afraid to heal.
To the ocean in you, don’t be afraid to rage.
To the silence in you, don’t be afraid to break. – Najwa Zebian
In psychotherapy, often there are goals about emotions. In particular, finding ways to manage and reduce their destructiveness. Most avoid, repress or run away from their feelings. Learning how to manage our emotions and lead an emotionally friendly life lies in understanding and believing in the purpose of our emotions. Emotions exist for a reason. Often they are messengers; guiding us to pay attention to what is going on within or around us. For example anger often alarms violation of one’s values, needs or boundaries. Anxiety can alarm to us to danger. Depression can point to the dissatisfaction and lack of fulfillment in one’s life. We have an opportunity to grow when we start to embrace our emotions rather than reject them. In order to learn from our emotions we must first recognize and identify them. When you notice yourself experiencing an emotion, label it! Use of an emotion-chart can be helpful tool. When that emotion is recognized it is important to accept its existence. Be a good host and welcome the emotion with kindness and compassion. If we can learn to accept emotions, then we are one-step closer to tolerating them. Lastly, share your feelings. You can write about, draw it, or simply talk about it. Most importantly express it! Remember, emotions have a tendency to pile up when ignored.