Know Thyself: self-knowledge is a precursor to relationship


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Anyone who has trained to offer mental health, spiritual, or psychosocial care knows that part of the training process in coming to a greater understand of oneself. It is important as self-knowledge can help each of us understand those things that trigger adverse reactions and learn how to both recognize and work within those triggers. The same holds true for all life’s relationships. In the following article, the authors describe the value of self-knowledge in our personal relationships as well.

Why Knowing Yourself Helps All Your Relationships

One goal common to many types of psychotherapy as well as psychoanalysis is to learn about yourself, who you are (your inner self and outer self) at present and how you got there.

Yet knowing yourself may be one of the hardest tasks you’ll ever attempt.For many of us, a myriad of obstacles spring up when we attempt it.

If you tend to be intellectual or philosophical, you might get mired in questions such as: “Who is the me/self that is assessing the me/self?”

If you tend to be emotional, you might get bogged down in less-than-positive emotions around the issue.

If you are more likely to be spiritual, questions such as “Why am I here” or “Why was I created” can sometimes stymie self-knowledge.

But knowing yourself is important to all your relationships, helping you fine tune your sense of humanness.

Parents and Kids

Effective parents, for example, know themselves. Self-awareness without self-centerdness, is an important ingredient in any relationship but essential to healthy parenting.

In order to deeply understand what your child needs, to really “get” where your child is coming from, and how he experiences the world around him, it’s essential that you know who you are: what makes you tick, what brings you down, what uplifts you, what turns you off.

When we know who we are, we are more open to seeing beyond the surface in others.
But in order to understand who we are, we have to take the time to do so. By learning more about who you are and how you feel about yourself, your child, and life in general, you’ll be able to interact more effectively—and lovingly—with your child.

—From The Parent-Child Dance: A Guide to Help You Understand and Shape Your Child’s Behavior by pediatric behavioral specialist Miriam Manela, OTR/L and C.R. Zwolinski (PsychCentral’s Therapy Soup)

One of the most important things I’ve learned while working on The Parent-Child Dance with Miriam, is that in any relationship, having an appreciation for who you are and an understanding of how you “take in” the world, how you experience life, really makes a difference to how you relate to others.

Seems obvious, doesn’t it?

But sometimes you have to hear an obvious fact over and over again before it sticks.


You have to know what makes you tick, in order to find satisfying work. You also need to have an appreciation of what makes others tick, in order to create satisfying work relationships. This can be on the smaller scale, for example, you don’t need to know everything about that person in another department who you meet once a month, but knowing the person you are teaming with on a project can be vital.

Coworkers get together after work to relax and unwind, but this is the best time to pay attention and really listen to your coworkers. You may see a sense of humor you’ve never noticed before, or learn about the personal pressures they are under. Carry your knowledge through to your work relationship so you can be supportive, as well as tap into their talents and interests.

Friendships and Personal Relationships

Sometimes, we can be a little obsessed with having our own needs met. And sometimes we can push our own needs to the background, so much so that we forget who we are. Striking that balance requires paying attention and learning all the ways in which you cope, deflect, or deny.

Knowing yourself doesn’t mean that you cannot change yourself. You have to know yourself well enough to sense whether change will enrich your relationships, emotional well-being, and life in general.

Richard Zwolinski, LMHC, CASAC is the author of Therapy Revolution: Find Help, Get Better, and Move On Without Wasting Time or Money and is an internationally licensed psychotherapist and addiction specialist with over 25 years experience as well as a consultant to organizations and companies in the fields of mental health and addiction. Learn more about Richard here.

What death can teach the living


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I find death reflection to be a very honest look at living. While it is only a microcosm of the mindset of the dying, reflecting on what it means to have limits to life is a valuable exercise. The following is one person’s death reflection looking at meaning in life after experiencing multiple deaths in the first week of 2015.

4 Things Death Teaches Us About Life
Posted: 01/08/2015 3:07 pm EST Updated: 01/08/2015 3:59 pm EST
Renee Lo Iacono

“Go confidently in the direction of your dreams. Live the life you have always imagined.” — Henry David Thoreau

“No, there have been four deaths,” my mom’s husband corrected me. “Your cousin’s mom died yesterday.” Talk about a grim way to start off the New Year. The man who lived across the street from my mom, the elderly lady my mom cared for years ago, my brother’s friend’s wife — she was only 32, four years younger than I am — and now my aunt. How is that for the first week of 2015?

The interesting thing about death is that if we’re not “old” or in poor health, it isn’t something that is at the forefront of our mind. Meaning, we think we have plenty of time. It’s this false sense of time that keeps us in jobs we’re unhappy with for a decade or in passionless relationships or from chasing our dreams.

Five years ago my brother’s friend Jona found out he had a rare form of cancer and within a few weeks he passed away. Jona documented his last six weeks in a blog — prepare to shed some tears. He was only 27. What would you do if you knew you only have six weeks left to live?

To have four people within my extended circle of family and friends die within the same week, made death feel not only inevitable, but closer to home. Regardless of how much or little time we have left, here are four things death teaches us about life.

“It often takes suffering and lost in order to remind us of how precious life is.” — Rob Bell

1. Our time is limited. Whether we live to be 27 years old like Jona or we live to be 107 years old, until science is able to figure out a way to make us live forever, one day our life on this planet will come to an end. Meaning, that we don’t have time to wait to take that trip to Italy we’ve been dreaming about the last few years or to start a business or to spend more time with our family because, like it or not, the clock is ticking. So how do you want to spend your precious days or weeks, or even minutes?

Six months ago while in France, I had a brush with death when a motorcycle nearly ran me over. That was enough to make me speed up the changes I was considering making at the end of the year. I’ll just give it a few more months and see, I kept thinking, when in fact I already knew what needed to happen and was basically procrastinating.

2. Follow our heart. As Steve Jobs so famously said, “Remembering that you are going to die is the best way I know to avoid the trap of thinking you have something to lose. You are already naked. There is no reason not to follow your heart.” I know it can be scary chasing after our dreams, ask anyone who has tried, myself included. Following your heart, following your passion, dreaming big is not easy, because if it were everyone would be doing it. But, here’s the thing, would you rather live a life of What ifs? or a life of I’m going for it!

“You are never too old or too broken. It is never too late to begin, or to start all over again.” — Bikram Choudhury

3. Second chances. Life is all about second chances. Bikram Choudhury, the founder of Bikram Yoga said “You are never too old or too broken. It is never too late to begin, or to start all over again.” Each day, each breath, each moment is an opportunity for us to try again, a chance to create the life we truly want and to go after our dreams. When was the last time you asked yourself, Am I living the life I really want? If the answer is no, then maybe it’s time to figure out what you can do to change it.

4. The present moment. Now is the only guarantee we have. Now is what matters most in life. In the Power of NOW, Eckhart Tolles says, “Realize deeply that the present moment is all you have. Make the NOW the primary focus of your life.” Although some things take time and cannot be created overnight, the now is where the miracles happen. Now is when we have the opportunity to experience the intricate details of life. However, to fully experience the joys of watching your child take their first step or the majestic Na Pali coast, it is important for us to be fully present, to live in that space of wonderment where life is currently happening.

How addicted to technology are we?


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Psychological research is working to uncover how addicted we are to our smartphones.  In a recent study, there was physiological evidence to suggest that people not allowed to use their Iphones saw increases in anxiety and blood pressure.  Scary.  I think it is a reality that most of us are adapting to.  The challenge of course is being able to make the choice to reduce usage or at least acknowledge “iphone separation anxiety.”

Proof That Being Away From Your iPhone Causes Psychological Problems

Researchers at the University of Missouri have found that iPhone users lose the plot when they’re without their much-loved devices.

The University of Missouri (MU) has published a study that shows iPhone separation causes “serious physiological and psychological effects” and leads to poor performance in cognitive tests.

The researchers behind the study even go as far to say that iPhones are capable of becoming “extensions of our selves” — and that we fall into a negative physiological state when they’re far away. MU also suggests that when we’re doing important tasks, we shouldn’t be without our iPhones, as otherwise things go badly wrong.

Published on Jan. 8, the study reveals analysis that was carried out on 40 iPhone users to better understand the impact of smartphone usage and “specifically what happens when people are separated from their phones”.

MU explains its team asked iPhone users to sit at a computer cubicle in a media psychology lab. Participants were told the experiment was actually to test the reliability of a new wireless blood pressure cuff — when in fact they were under the microscope to see just how reliant on their iPhones they are in daily life.

The participants had to complete a word search puzzle — first with their iPhone by their side, MU writes, and then without it. The group was told their phones were causing “bluetooth interference” for the second half of the study when they had to part with their devices. Their heart rates and blood pressure levels were monitored — and the people also recorded their own levels of anxiety and how unpleasant they felt during both tasks.

Russel Clayton, a doctoral candidate at MU and lead author of the work, says on the MU website: “Our findings suggest that iPhone separation can negatively impact performance on mental tasks. Additionally, the results from our study suggest that iPhones are capable of becoming an extension of our selves such that when separated, we experience a lessening of ‘self’ and a negative physiological state.”

Clayton worked with the University of Oklahoma’s Glenn Leshner and a doctoral student from Indiana University-Bloomington on the project.

The team writes: “The researchers found a significant increase in anxiety, heart rate and blood pressure levels, and a significant decrease in puzzle performance when the participants were separated from their iPhones as compared to when iPhone users completed similar word search puzzles while in possession of their iPhones.”

The findings underpin just how addicted we’ve become to technology. Researchers say that being apart from your iPhone could result in “poor cognitive performance” when doing things like sitting tests, attending conferences, or taking part in meetings

Read more:

Social Media usage for Seniors can be good


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It seems that not all social media usage is negative after all.  There was a study indicating that teaching the elderly about social media improves their well being.  The training increases cognition and increases connections to others.

By Senior News Editor
Reviewed by John M. Grohol, Psy.D. on December 15, 2014

Teaching Elderly to Use Social Media Improves Well-being

A new landmark study from the UK finds that training older people in the use of social media has a myriad of benefits.

Researchers found that proficiency in social media improves cognitive capacity, increases a sense of self-competence, and could have a beneficial overall impact on mental health and well-being among elderly individuals.

The two-year project gave a group of vulnerable older adults a specially-designed computer, broadband connection, and training in how to use them.

Those who received training became more positive about computers over time, with the participants particularly enjoying connecting with friends and relatives via Skype and email.

The ageing population is one of the major challenges facing our society. It is expected that between 2010 and 2060, the number of people aged 65 will grow from 17.4 percent to 29.5 percent of the total population.

The project, called Ages 2.0, aimed to assess the extent to which the internet and social media offer a tool for promoting active ageing and addressing the social isolation that is too often a feature of older age.

Researchers discovered that those trained had heightened feelings of self-competence, engaged more in social activity, had a stronger sense of personal identity, and showed improved cognitive capacity.

These factors indirectly led to overall better mental health and well-being.

Dr Thomas Morton of the University of Exeter, who led the project said, “Human beings are social animals, and it’s no surprise that we tend to do better when we have the capacity to connect with others. But what can be surprising is just how important social connections are to cognitive and physical health.

“People who are socially isolated or who experience loneliness are more vulnerable to disease and decline. For these reasons finding ways to support people’s social connections is a really important goal.

“This study shows how technology can be a useful tool for enabling social connections, and that supporting older people in our community to use technology effectively can have important benefits for their health and well-being.”

Participants in the study were all vulnerable older adults between the ages of 60 and 95 years of age who were receiving support from a government supported community or residential home. The 76 volunteers were drawn both from those receiving care in the community and those living in any of the not-for-profit organization’s 31 residential care homes.

Half of the participants were randomly assigned to receive training and the other half to a control group who received care as usual. The training involved the installation of an ‘Easy PC package’ consisting of a touch screen computer and keyboard, and a broadband internet connection. They were able to keep the computer for 12 months, including a three-month training period.

One of the study’s participants, Margaret Keohone, said, “Having this training changes people’s lives and opens up their worlds, invigorates their minds, and for lots of us gives us a completely different way of recognizing our worth as we age. I was just slipping away into a slower way of life.”

Emma Green, the Care Technologist who delivered training to Margaret and others in the study, said, “As the training program developed with my participants their confidence grew and they were keen to tell me how family members had emailed back, Skyped or ‘liked’ a comment or a picture on Facebook. Seeing the smiles on my participant’s faces when they Skyped a family member in the UK or abroad was such a special moment.

“One of the best Skype calls was during a visit to my caravan in Cornwall when I Skyped a client who used to enjoy camping. We were around the camp fire and he was able to be a part of our group from the laptop, looking at the fire and joining in. They all know that I am only an email or Skype call away and it has been fabulous being a part of the Ages 2.0 project.”

Those behind the Ages 2.0 study hope its findings will help inform future policy on digital inclusion and the delivery of tele-health and tele-care strategies.

Is there a right way to Grieve


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Current understandings of grief has shifted away from looking at grief as a continuous upward process through stages and instead looks to how individuals integrate loss into their lives. In the following description, we see how misperceptions of grief can be a hindrance for people, as the expectations of moving through grief are often unrealistic. With these misperceptions, when grief doesn’t move forward, people often get increasing anxious and concerned, and a vicious cycle begins. In the bereavement group I co-run, we had a person attend who shared she hadn’t cried for her husband for many months and worried something was wrong. We discussed how tears come for people at different times and in different situations. In a subsequent meeting, she shared that she had finally cried, as she was no longer trying to force herself to shed tears, the tears came.

Getting Grief Right

By PATRICK O’MALLEY JANUARY 10, 2015 1:16 PM January 10, 2015 1:16 pm

By the time Mary came to see me, six months after losing her daughter to sudden infant death syndrome, she had hired and fired two other therapists. She was trying to get her grief right.

Mary was a successful accountant, a driven person who was unaccustomed to being weighed down by sorrow. She was also well versed in the so-called stages of grief: denial, anger, bargaining, depression and acceptance. To her and so many others in our culture, that meant grief would be temporary and somewhat predictable, even with the enormity of her loss. She expected to be able to put it behind her and get on with her life.

To look at her, she already had done so. The mask she wore for the world was carefully constructed and effective. She seemed to epitomize what many people would call “doing really well,” meaning someone who had experienced a loss but looked as if she was finished grieving. Within a few days of the death of her daughter she was back at work and seemed to function largely as before.

The truth of her life was something else. Six months after her baby’s death she remained in deep despair. She was exhausted from acting better than she felt around co-workers, friends and family. As is so often the case, she had diagnosed her condition as being “stuck” in grief, believing that a stubborn depression was preventing her from achieving acceptance and closure.

Was she in denial, she wondered. She also wondered if she was appropriately angry. The bottom line was that she knew she was depressed — a psychiatrist had prescribed an antidepressant — and that is what she wanted me to treat.

Earlier in my practice, I would have zeroed in on that depression. Was there a family history? Had she been depressed before? Was the medicine helping? What were her specific symptoms? Knowing the answers might suggest why she was stuck. Or I would have reviewed the stages of grief, as she had, looking for one in which the work remained incomplete.

But I had begun to operate differently by the time Mary showed up, which was 10 years after my own loss. My firstborn child had also died before he was a year old. It was why Mary had chosen me.

In our first session I put Mary’s depression aside. I asked her to tell me the story of her baby rather than describe the symptoms of her grief. Though she was resistant, she eventually started to talk.

Like most other things in Mary’s life, the baby, whom she named Stephanie, was planned. Mary was delighted with her pregnancy and had wonderful dreams for her daughter. After a routine delivery, Mary stayed home with Stephanie for the first three months. Returning to work had been difficult, but Mary was comfortable with the child-care arrangement, and managed to balance motherhood with her busy professional schedule.

Then Mary told me about the Saturday when she went to check on her napping daughter and found that Stephanie wasn’t breathing. She began C.P.R. as her husband called 911. There were moments of surreal focus as she and her husband tried to save their baby. Then this woman, so accustomed to being in control, had to surrender her daughter to an emergency crew. Her husband drove as they followed the ambulance to the hospital.

She described the waiting room in great detail, down to the color of the furniture. When the hospital chaplain walked in with the doctor she knew her baby was gone. She and her husband were taken into a room where they held the baby for the last time.

At this point in her story Mary finally began to weep, intensely so. She seemed surprised by the waves of emotion that washed over her. It was the first time since the death that the sadness had poured forth in that way. She said she had never told the story of her daughter from conception to death in one sitting.

“What is wrong with me?” she asked as she cried. “It has been almost seven months.”

Very gently, using simple, nonclinical words, I suggested to Mary that there was nothing wrong with her. She was not depressed or stuck or wrong. She was just very sad, consumed by sorrow, but not because she was grieving incorrectly. The depth of her sadness was simply a measure of the love she had for her daughter.

A transformation occurred when she heard this. She continued to weep but the muscles in her face relaxed. I watched as months of pent-up emotions were released. She had spent most of her energy trying to figure out why she was behind in her grieving. She had buried her feelings and vowed to be strong because that’s how a person was supposed to be.

Now, in my office, stages, self-diagnoses and societal expectations didn’t matter. She was free to surrender to her sorrow. As she did, the deep bond with her little girl was rekindled. Her loss was now part of her story, one to claim and cherish, not a painful event to try to put in the past.

I had gone through the same process after the loss of my son. I was in my second year of practice when he died, and I subsequently had many grieving patients referred to me. The problem in those early days was that my grief training was not helping either my patients or me. When I was trained, in the late 1970s, the stages of grief were the standard by which a grieving person’s progress was assessed.

THAT model is still deeply and rigidly embedded in our cultural consciousness and psychological language. It inspires much self-diagnosis and self-criticism among the aggrieved. This is compounded by the often subtle and well-meaning judgment of the surrounding community. A person is to grieve for only so long and with so much intensity.

To be sure, some people who come to see me exhibit serious, diagnosable symptoms that require treatment. Many, however, seek help only because they and the people around them believe that time is up on their grief. The truth is that grief is as unique as a fingerprint, conforms to no timetable or societal expectation.

Based on my own and my patients’ experiences, I now like to say that the story of loss has three “chapters.” Chapter 1 has to do with attachment: the strength of the bond with the person who has been lost. Understanding the relationship between degree of attachment and intensity of grief brings great relief for most patients. I often tell them that the size of their grief corresponds to the depth of their love.

Chapter 2 is the death event itself. This is often the moment when the person experiencing the loss begins to question his sanity, particularly when the death is premature and traumatic. Mary had prided herself on her ability to stay in control in difficult times. The profound emotional chaos of her baby’s death made her feel crazy. As soon as she was able, she resisted the craziness and shut down the natural pain and suffering.

Chapter 3 is the long road that begins after the last casserole dish is picked up — when the outside world stops grieving with you. Mary wanted to reassure her family, friends and herself that she was on the fast track to closure. This was exhausting. What she really needed was to let herself sink into her sadness, accept it.

When I suggested a support group, Mary rejected the idea. But I insisted. She later described the relief she felt in the presence of other bereaved parents, in a place where no acting was required. It was a place where people understood that they didn’t really want to achieve closure after all. To do so would be to lose a piece of a sacred bond.

“All sorrows can be borne if you put them in a story or tell a story about them,” said the writer Isak Dinesen. When loss is a story, there is no right or wrong way to grieve. There is no pressure to move on. There is no shame in intensity or duration. Sadness, regret, confusion, yearning and all the experiences of grief become part of the narrative of love for the one who died.

Patrick O’Malley is a psychotherapist in Fort Worth.

This is an essay from Couch, a series about psychotherapy at Some details have been altered to protect patient privacy.

Mindfulness techniques for caregivers


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Being a caregiver is often one of the most taxing and emotionally draining tasks someone can take upon him/herself.  I have been witness time and again to the burnout that occurs to the best of people, to people who’s hearts are in the right place but eventually wear down because of the details needing attending to.  I came across a list of 5 ways to practice mindfulness as a caregiver which can combat feelings of being overwhelmed.

When Caregivers Need Healing

Here are five ways you can bring mindfulness into your caregiving.

Photograph by Corey Kohn

By Nell Lake

Many of us find ourselves caring for loved ones braving old age, decline, and dying. Caregiving is demanding—at times overwhelming. Yet it can also cultivate intimacy, wisdom, and insight. For my book, The Caregivers: A Support Group’s Stories of Slow Loss, Courage, and Love, I chronicled the experiences of the members of a caregivers support group for more than a year. Here are some things I learned about mindful caregiving:

1. Be where you are

It’s a central principle of mindfulness: trying to do one thing at a time, and knowing that you’re doing it, and doing it with kindness toward yourself.

Caregiving often requires responding to seemingly countless needs, appointments, tasks. Studies show caregivers face higher rates of stress and illness than non-caregivers. If you’re feeling overwhelmed, lonely, frequently angry and irritable or guilty, and/or crying a lot, you’re likely at risk of burnout. Some suggestions for easing your stress:

• speak with your doctor. He or she should be able to help you find resources that help.

• call your local senior center to ask about sources of support such as senior day care and/or respite programs and support groups.

• make a list of activities that nourish you, and try to build one or more of these into your days: journaling, say, or taking walks outside, calling a supportive friend, taking some time to do yoga, meditating—whatever helps you come back to yourself and the moment you’re in.

It’s so easy to adopt the habit of mind that another person’s needs matter more than yours, but one of the most important things you can do to prevent burnout over the long haul is to value your own well-being.

2. Be gently aware of loss and change

Much caregiving is for people with dementia or other long-term chronic illness. Your family member is changing, going through decline—very slowly. Your mother might be losing her ability to communicate; your father’s personality might be changing. It can feel as if your family member is “gone but not gone.” Caregivers often experience long-term uncertainty—and this can be very stressful.

It helps to be aware of slow loss and its particular challenges—and to give yourself permission to feel grief and the other feelings that arise along the way. Letting the feelings simply exist, seeing that they change, can help you gain more clarity, control, and a sense of space.

Mindful awareness doesn’t mean ruminating on loss in a negative way. Thoughts such as “this shouldn’t be this way; this isn’t my mother!” will mostly feed stress. Yet taking time to see the stressful thoughts and storylines that form in your mind can help you not get completely caught up or identify with them. You may even find more acceptance of what’s happening—to see it as natural, a part of life, rather than an aberration.

3. Meet your family member where he or she is

Try to accept the effects of your family member’s aging and illness, the way their mind and body work at this point in their lives. With people with dementia in particular, it’s really helpful to try to create good feelings in as many moments as possible. Studies show that, even for someone who doesn’t remember something you said five minutes before, good feelings last for quite a while. A person with dementia might have a good laugh or hear a song they love or watch a wonderful scene from a movie—and hours later they’ll still be feeling the effects of these. Arguing with their perceptions—saying, “it’s Tuesday, not Thursday” or “you already said that six times today”—is not just futile; it creates stress for both of you.

“Meeting them where they are” is a good principle no matter your family member’s particular illness or impairment. Maybe he or she can’t walk up the stairs anymore and feels cranky about losing mobility. If you can let go of the story “this shouldn’t be this way,” you’ll likely save yourself a lot of suffering. Instead of all this happening to you, it just is. It happens to everybody.

4. Seek out support. Ask for help. Share your story.

Caregiving is isolating; it usually happens in private homes, behind closed doors. Yet connection is vital to us as human beings. The support-group meetings I followed gave the caregivers a chance to connect with others who understood. The members felt trust with one another and usually said whatever they needed to—even shared thoughts and feelings that they didn’t share with others outside the group. Mutual support helped them to be resilient in the midst of their challenges.

Meanwhile they gave one another very little advice. Probably no one likes unsolicited advice, but to caregivers, being told how to handle unique, personal, and challenging situations can be particularly frustrating. The group understood this, and mostly just told stories and listened. They did, however, learn practical things through their listening: They heard about ways others had solved problems, and about available resources. A person caring for someone in the early stages of a disease often learned by listening to another person caring for someone in later stages.

I saw enormous value in the group that I followed, and think a good group can be a profound source of support. But support groups are not for everyone, of course, nor do I think all groups are equal. You may join one, decide it’s not helpful at all, and go looking for a different one. You may find other ways to receive connection and support. This is the central point: to recognize when you need support and seek it out.

5. Be kind but don’t try to be a saint

One of the caregivers I followed, Penny, was upset one evening. She’d brought home two cannoli to share with her mother—a rare treat in their household. Before Penny had had a chance to offer them, her mother had found them and scarfed them both down. Penny discovered this and felt like yelling. Instead she went into another room and wrote “wrathful emails” to her sister. She vented, in other words, which helped. A few days later, she laughed about the incident in her support group.

Being kind doesn’t always mean feeling kind. It does mean doing the right thing in a particular moment. Of course, trying to feel compassion, having that as an intention, is good—but of course one isn’t going to feel compassion in every moment.

Again, it’s important to direct kindness inward. There’s a teaching: when you’re being generous, know that you’re being generous. When you have good qualities of mind, being aware of them can help to further cultivate them. In your caregiving, acknowledge that you’re being caring. You’re helping someone. Even when caregiving feels hard, it can be sustaining to recognize your generosity. You’re helping someone to have a good end to her or his life.

Nell Lake is the author of The Caregivers: A Support Group’s Stories of Slow Loss, Courage, and Love, published by Scribner and released in paperback this Spring. Names in both the book and in this blog are pseudonyms.

This article also appeared in the February 2015 issue of Mindful magazine.

Can Yoga help with Grief?


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People search for different modes of coping with the emotional upheavals related to grief.  For some, it is finding comfort in a spiritual practice, such as Yoga.  Here is a short piece explaining how Yoga can help in grieving loss.

Yoga: A Treatment for Grief?

The practice may help people heal from the inside and out when coping with loss.

Young woman and friends practicing yoga in health club

Grief has traditionally been thought of as a psychological experience, but mental health experts are beginning to realize it involves a complex relationship between body and mind.

By Jan. 7, 2015 | 10:51 a.m. EST+ More

Abby Saloma was physically and mentally crushed from caring for her mother, who was dying fromovarian cancer. To make things worse, the then 27-year-old was hours away from the District of Columbia yoga studio that had helped her cope with her mom’s diagnosis.

So Saloma did the only thing she could think to do: She called the one yoga teacher in her hometown near Reading, Pennsylvania, she knew of​ – and begged. “I am desperate for a yoga practice,” Saloma told the woman, who led her in a private session in the loft of a barn. “It was just such a powerful, powerful experience,” Saloma says.

Now, more than 10 years after that session and the death of her mom, Saloma has become a certified yoga instructor and has led a yoga workshop specifically for people who are dealing with grief. Another “healing workshop” ​​ is in the works for March.

“The premise of it is, in our society, we really push death under the rug – we’re terrified to talk about it,” says Saloma, whose workshops include journaling, guided meditation and poses aimed at opening the heart and hips. “Yoga allows us to be present with it​, and I believe that being present with it allows us to live a fuller, more awakened life.”

New Thinking on Grief

Research has shown that mind-body practices including yoga and meditation can help reduce symptoms of various conditions such as depression, anxiety, negative mood, fatigue and stress.

But mental health experts are beginning to recognize the power the practices can also have on people coping with grief, which used to be viewed as a largely psychological experience, says Kait Philbin​, a psychologist and a certified yoga teacher in Redwood City, California.

“It used to be that [therapists] just thought that all you had to do was look at the mind, but they’re realizing that there’s a complicated relationship going on between the body and mind,” Philbin says. Her research has shown that a six-week yoga therapy program for grief and bereavement significantly improved participants’ vitality (a measure of appetite, energy level, sleep, relaxation and body stiffness) and positive states​ (the ability to get good rest, concentrate and be intimate).

The theory of grief, too, as a five-stage process including denial, anger and acceptance, is also shifting. Today, professionals are more likely to endorse the perspective that everyone experiences grief differently, says Heather Stang​, a yoga therapist and meditation instructor in Frederick, Maryland, and author of “Mindfulness & Grief.” “There’s no right or wrong way for grieving, [and] there’s no right or wrong way to practice yoga for grief,” she says.

In her eight-week yoga for grief course, Stang first leads breathing exercises to help participants relax, since “the bereaved body is so wound up and so stressed out,” she says. Stang then guides students through protective poses like child’s pose, as well as lengthening movements​, and gives them time to journal and share their experiences with one another.

She also uses her background in thanatology – the scientific study of death, dying and bereavement – to educate participants about ​death and normalize their experiences. “We have to not make grief a disease – it’s not a disease,” she says. “It’s as natural as birth and death itself.”

Why Does It Work?​ ​

When Antonio Sausys’s​ mother died from a stroke when he was 20, the physical manifestation of grief was striking: After two and a half years of ignoring his pain, he discovered his breastbone had popped out.

“What my mind could hide, my body showed with pristine clarity: I had a broken heart,” says Sausys, a yoga instructor in San Anselmo,​ California, who went on to earn a master’s degree in ​body-oriented psychotherapy and to publish “Yoga for Grief Relief.”

“If the body is left out [of grief treatment], it becomes a very important source of expression of the pain, and it easily falls in deep dysfunction,” Sausys says.

Indeed, grief often presents itself physically – in stomach pain and fatigue for Saloma, in headaches and a loss of appetite in others. “We hold grief, we hold pain, we hold stress – we hold that in our bodies,” Saloma says.

That’s one of the reasons why yoga and its myriad physical benefits – from lowered blood pressure to improved strength and balance – can be an effective way to manage the pain of grief.

“When you’re grieving, there’s a defense mechanism that kicks in to protect yourself – you kind of go into survival mode,” Saloma says. “And by really opening your heart, you’re able to express some of that vulnerability and let some of that out and be more present with it.”

Some of yoga’s benefits for people coping with grief might also be achieved through other forms of physical activity like running, says ​Robert Neimeyer​, a psychology professor at the University of Memphis and editor of the journal Death Studies. In one of his ​studies comparing the effects of yoga, running and group therapy on people with depression – some of whom were grieving – he and colleagues found that both yoga and running had superior long-term benefits ​compared to group therapy.

His more recent research tested an intervention for grief that encourages people to reflect on the idea that nothing is permanent and to create a new “self-narrative” in light of their loss. He and a colleague found that the intervention – which included poetry reading and storytelling, as well as meditation and slow physical movement – was effective in reducing grief-related pain. It’s not a stretch to see why yoga, especially types that foster mindfulness through meditation, might do the same, Neimeyer says.

“This [intervention] is not a panacea,” he says, “but it can be perhaps a less anguished perspective that helps us find some meaning or sense in our suffering.”

New Year’s Resolutions: What works and what doesn’t


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A new year on the calendar is usually a time when people set new goals to attain and strive for in the upcoming 12 months of the calendar.  Most people do this because it is an easy demarcation point to start fresh, even though the idea of a new year is somewhat arbitrary to the calendrical system on follows.  Nevertheless, most resolutions fail.  In the first of two pieces “This Is Why Your New Year’s Resolution Will Fail,” the author presents three reasons resolutions tend not to stick.

New Years Resolution Fail

Did you even bother to make a New Year’s resolution this year? Most people didn’t.

According to a national public opinion poll conducted by Marist Poll on December 18, 2014, only 44 percent of Americans are likely to have made a New Year’s resolution for 2015. And it’s no surprise – given how high resolution failure rates are, many simply don’t even bother. The poll found that 41 percent of Americans couldn’t even keep their resolution for at least part of the year, let alone see it through to success.

Weight loss is the most popular resolution, with other common resolutions including quitting smoking and spending less money. Whatever your resolution is, here are six reasons why we fail to accomplish our New Year’s resolutions – and how you can get around them.

1. We Set Unreasonable Goals

Amy Cuddy, a social psychologist and associate professor at Harvard Business School, put it simply. “We’re really bad at setting reasonable goals,” she told Business Insider.

Rather than resolve to start going to the gym once a week for 30 minutes, we resolve to commit to a gruelingP90X exercise regiment. Why? Is it because human ambition makes us think big? Is it because we believe a New Year’s resolution must be something huge? Or can it be that we’re just really bad at judging what is reasonable to accomplish? Regardless of the reason, these grandiose goals set us up for failure.

“When you set weight loss goals, you don’t really know how your body is going to react or what is going to be attainable,” says Lisa Ordonez, a professor at the University of Arizona’s Eller School of Business whose research focuses on goal-setting in organizations. “If you haven’t done it for awhile, you need to do your research and revise your expectation.”

Don’t buy into the “go big or go home” mentality. If you want your resolution to succeed, then don’t be afraid to think smaller. There are penalties to failure beyond the obvious, which leads us to our next point…

2. We Have Failed Before

“Every time we fail, we damage our own self-esteem,” says Janet Polivy, a psychologist at the University of Toronto in Mississauga. “We make ourselves less able to bounce back the next time. One thing we see is that, when people fail, they don’t blame the diet. They blame themselves. And that makes it hard to start again.”

Did you fail to achieve your 2014 resolution? That makes you that much more likely to give up on your 2015 resolution. In general, failure is a poor motivator, and there’s something to be said for momentum: when you’re on a streak of victories or failures, it becomes easier to ride the high – or low.

The Marist Poll found that younger Americans are more likely to make resolutions than older Americans. Can that be because older Americans have given up on trying after repeated failures? We can’t say for sure, but we can say that avoiding failure will help you keep your future resolutions. Setting more realistic goals is a good start, but be sure to follow up by avoiding our next point…

3. We Turn Mistakes into Failure

“The research has been replicated fairly frequently,” Polivy says. “There seems to be this sense of, ‘well, I ate something I shouldn’t, this day is ruined, I’ll just start again tomorrow, or next week, or next month.'”

Polivy is describing the “what the hell” effect, which is an easy trap to fall into. We let a cheat – or a mistake – turn into a failure. Rather than concede that we slipped up and immediately resolve to redouble our efforts, we mulligan the rest of the day, breaking our forward momentum and instead building up momentum towards resisting getting back on track.

“What the hell; I already had that slice of pie. I may as well have the milkshake, too.” Avoid this kind of thinking.

However, not to just offer a negative perspective, here is a second article offering suggestions for creating resolutions that have a greater chance of lasting.

The amazingly simple psychology of successful New Year’s resolutions

(BPT) – The arrival of cold weather and Valentine’s day aren’t the only predictions you can reliably make about February each year. It’s a pretty safe bet that many resolutions passionately adopted in January will be broken by the end of February – if not sooner. New Year’s resolution success, however, is possible, and the first step in the right direction is to change your mindset.

“New Year’s resolutions can be a good opportunity to start healthier habits and personal improvement projects,” says Dr. Jim Wasner, program dean at theIllinois School of Professional Psychology at Argosy University | Schaumburg. Think of resolutions as a reminder of the larger goals and plans you have for your life. These life changes should be planned carefully with both long-range dreams and desires and short-term actions on how to get there. Just because you have difficulty in achieving a short-term objective doesn’t mean you have to give up your aspirations. You may just need to revise your actions and fine tune your solutions,”

Here are some suggestions to consider when making New Year’s resolutions:

* Make fewer resolutions. Too many promises to make drastic life changes can be overwhelming. A shorter list will feel more manageable.

* Keep resolutions realistic and achievable.

* Seek support from family and friends, and ask them to provide gentle reminders and constant encouragement to help you keep the resolution.

* Create a plan that starts slow, eases you into a routine, and tracks progress with attainable benchmarks.

* Give yourself a break if you succumb to temptation now and then, but resolve to get back on track right away.

* Don’t turn your resolution into a competition and avoid comparing your progress to others’. Instead, view others’ accomplishments as inspiration.

“Life changes are an important part of our development as mature adults,” Wasner says. “Resolutions are a fun way to remind us that change is an important part of who we are as humans. Use them as an impetus to fine tune your plans and not as a weight to be shouldered.”

Finally, Wasner cautions, don’t get discouraged if it takes more than one try to succeed. “New Year’s resolutions are not a short run but more like a marathon where you must pace yourself to reach success,” he says.

When hospice becomes routine


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As with most methods of providing health care in a holistic, patient centered way, hospice has seen many changes, some of which have caused a struggle to be present to the individual needs of the family while also complying with the ever changing guidelines.  The following piece is from a hospice nurse lamenting how things are becoming mainstreamed in ways she finds dissatisfying.  I agree with her overall sentiment and am particularly keen on her final lines,

I am, and will always be, thankful to my dying patients, the only ones actually experienced in dying, who have shown me time and again to STOP, leave my agenda behind, LISTEN to their hopes and desires, and bring perhaps some insight, but not all the “answers” to their bedside. After all, as I have said before, I might be the hospice nurse, but THEY are the experts.

Listening is the key.  And there are good and tried methods of working within the changing ramifications and still supporting each particular families wishes.  We also must remember that expertise can go be offered on both sides of the aisle, and sometimes our insider knowledge can help navigate the needs of each particular family.

Back to basics: are we losing sight of what hospice care is all about?

Photo by Joan Teno

by: Amy Getter, a hospice nurse who blogs regularly at

In our ever-challenging and changing medical system, the current hospice and palliative care movement has undergone heightened scrutiny, increased regulatory stipulations, and in general has become a part of the federal government’s health care crisis (just review Medicare Conditions of Participation and billing requirements to get a head full of terms and guidelines to be overwhelmed by it all). Yes, hospice has become big business.

I am a hospice nurse. I have seen the changes in the past decade, as Medicare requirements become more stringent and hospice has moved from grassroots to mainstream; and the “evidence-based practice” mantra has precluded use of medications and treatments that have historically been effective but now lack current “research validation”. Or new results from a few cooperate-funded studies who have the most to gain by predetermining that certain treatments are not effective change our practice, and I can’t help but wonder about bias. Or large pharmaceutical companies, (providing much of the funding sources for many of the studies on medications), suddenly phase out older medications that are not profitable. Or politics become involved in deciding things like what opioid medications should be approved for public use and how people’s choices at the end of life must be managed by laws and public approval.

And I must pose the question, “Are we losing sight of what hospice care is all about?” I see younger nurses coming into the hospice profession, and learning about “best practice”, being taught that the “experts” know best. That “evidence based practice” is THE answer.

I am reminded of the middle of the last century, when birthing practices became managed and performed by experts in white coats in medical facilities, new technology and expert roles slowly removing the simplicity and normalcy of birth. I am not trying to over-simplify a complex experience, truly: not every birth and death is uncomplicated and many need to have advanced medical care. Thank goodness for advances and treatments that were hitherto unknown! But I am advocating that we not have total reliance on the science of death and dying, remembering how both birth and death have sacredness and mysticism that cannot be quantified. For centuries, birthing and dying are the human experience. Is it really only now, with our medical advancement, that we know how to provide ease of suffering in both states of humanness?

I heard, again, from hospice staff this week, how a family should let the patient be transferred out of the home and placed “where experts in end of life care could care for him”, while the loved ones could just be “the family”, coming to visit and sit at the bedside. And I was a little horrified, that we, the hospice “experts” are succumbing to the lie that caring for the dying is so complicated and combersome, we must rely on “experts” to provide the answers and often even the care. I do not believe we, “the experts”, can provide the same level of solace as a person who has loved a dying family member all their lifetime. I am and always will be an advocate for the patient and family, with the conviction and goal in hospice nursing to create confidence in family members. They can be the ones who comfort and care for their own dying loved one in their own home whenever possible. Isn’t that what most of us hope for, when we die, to be at home with family?

For centuries, caring for the dying relatives was a part of life lessons taught while children grew up in multi-generational living environments, and saw the normalcy of caring for ones’ elders through the lifespan. I like to believe that the basics of care for a dying person can be taught in an atmosphere of simplicity and loving kindness, and the gift that family receive from providing the care is a part of the lasting memorial to that loved one. In fact, this has been my experience time and time again.

I empathize with wanting to standardize and compartmentalize dying, we all would like to have it tidied up and handled for us. It might seem more palatable in the white halls of the medical experts. But I am certain that dying will always involve the messiness and unexpectedness that birthing also entails. Nor does the current body of evidence preclude learning from centuries of how people die.

I am, and will always be, thankful to my dying patients, the only ones actually experienced in dying, who have shown me time and again to STOP, leave my agenda behind, LISTEN to their hopes and desires, and bring perhaps some insight, but not all the “answers” to their bedside. After all, as I have said before, I might be the hospice nurse, but THEY are the experts.

To prayer for a patient


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There was a great article I saw from a physician describing his feelings towards prayer being important in his medical practice.  He shares two stories about situations in which through praying, there was guidance in advancing the medical help.  I was particularly taken by his candidness in acknowledging that his prayer was just a “simple plea for help.”  I would offer that prayer is just that.  Prayer can be beautiful and poetic.  But prayer from the depths, from the heart, is often plain, ugly and brutish.  It is the simple musings we feel.

Physicians’ Prayers for Their Patients During Surgery

Published Jan 5, 2015

As a physician I am often reminded of two things for which I am grateful. First, the great honor it is to care for people who are in a time of great need in their lives. Second, the many mentors in my life who have patiently taught and trained me in the arts of medicine.

Recently, I have thought a lot about one mentor, the late Dr. Blayne Hirsche. Dr. Hirsche was a gifted plastic and hand surgeon. He trained in surgery at Harvard and the Mayo Clinic. He founded the Hirsche Smiles foundation, which has performed thousands of reconstructive surgeries on children in Mexico and Guatemala. His legacy of compassionate care and service lives on through this foundation.

A Young Surgeon’s Prayer

Before medical school, I had the pleasure of working with Hirsche to gain experience as he performed surgeries. I cannot recall the details of why, but one day we talked about lessons he had learned during his training. One story he told has stuck with me ever since. He talked about a difficult surgery he was performing as a resident physician at Harvard. The head surgeon was world-renowned for the procedure being performed. Unfortunately, severe abdominal bleeding complicated the surgery.

At one point, it became apparent to Hirsche that the patient was going to bleed to death. Blood would rapidly fill the open abdomen as quickly as the surgical team could evacuate it, making it impossible for them to find the bleeding source. Suddenly the room became quiet and all eyes were directed toward the lead surgeon, who had stopped talking and working. A few moments later the surgeon reached into the abdomen and the bleeding stopped. His fingers had found the bleeding source, and with pressure the bleeding stopped. With the bleeding source identified, the surgeons quickly sutured the area, and the patient lived.

After the surgery, Hirsche asked the lead surgeon what had happened and why had he stopped. The lead surgeon said he stopped when he realized they were going to lose the patient, and he prayed for help. The surgeon did not say anything more. This was a profound experience for Hirsche as this surgeon was not known as a spiritual person. In fact, this was the one and only spiritual statement this surgeon ever made to Hirsche.

A Young Mother’s Difficult Heart Procedure

Most physicians are very aware of the limitations of medicine and medical procedures. Despite our best intentions, we often lose the battle to diseases. Every patient is unique, and even routine procedures can be challenging. All physicians who treat life-threatening diseases and have been in situations where they know they’re doing all they can for a patient and yet the patient’s life is slowly slipping away.

Hirsche shared his story with me nearly 20 years ago. His message found its way into my practice recently. A young mother of four children came to the hospital in severe heart failure. Four weeks earlier she had delivered a healthy baby. Now her heart was failing as 90 percent of the pumping function was no longer working.

As her heart failed, her lower heart chambers dilated and stretched, causing abnormally fast heart rhythms to develop. This further worsened her heart failure. Strong intravenous medications were started to support her blood pressure and fight impending kidney and respiratory failure. Despite our strongest intravenous medications to make the heart beat normally, as well as multiple electrical shocks to her heart, her abnormal heart rhythms continued.

It was clear she was close to dying, but we had a few options. One was to replace the heart with an artificial heart until she could get a heart transplant. Another option was to do open heart surgery to place heart pumps, called ventricular assist devices, to support her failing heart. The third was to go into her heart through her blood vessels, find the source of the abnormal heart rhythm, and destroy it. This could allow the heart to slow down and hopefully recover. Due to potential challenges with placing a heart pump, the third option was felt to be the best. For that reason, I became involved.

A Simple Plea for Help

When she arrived in our cardiac catheterization room, she was placed on a breathing machine. The room buzzed with physicians specializing in high-risk anesthesia, critical-care medicine, heart failure, and surgery. The cardiac surgery team was on standby to perform an emergency procedure, if needed, to transition her to a transplant. As we prepared for the cath procedure, her blood pressure continued to fall, requiring more medications to support it. Her blood oxygen level also started to fall, despite respiratory support. I quickly gained access to her blood vessels. In the setting of severe heart failure, these ablation procedures to treat abnormal heart rhythms often take four to six hours. I knew she didn’t have that much time.

Before I advanced the tool into her heart, I prayed silently. My prayers are not graceful and eloquent. I would characterize them as a simple plea for help. A few seconds after my prayer, I advanced a tool into her heart to the area I thought was most likely causing the abnormal rhythm. As the tool touched this area, the abnormal heart rhythm stopped. We delivered heat energy to the site to destroy the short circuit. Her blood pressure and blood oxygen began to rise. And her heart rate — once at 150 to 160 beats per minute — now beat normally at 100 beats per minute.

I have treated hundreds of these abnormal heart rhythms, but I have never seen such a quick response. Within five minutes of starting the procedure, her heart was normal. That night I was able to talk with her. She held my hand and said “Thank you.” There was not a lot more to say. It was humbling for me because I realized that a few hours earlier we both had pleaded for help. I am happy to report she is on her way to recovery. Her heart is getting stronger each day.

Faith and Hope Among Physicians

I have had many mentors who draw great strength from spiritual sources. Some have been Christians like me, while others were Jewish, Hindus, Buddhists, and Muslims. That is one of the great aspects of medicine: A tremendous diversity of backgrounds come together for a common goal. I have heard some people say that physician spirituality is a sign of weakness, but I have found the opposite to be true. These mentors of mine are world leaders in their fields and draw from all means to treat and care for people in a field that does not have all the answers. They use their faith to find inner strength and peace. To a believer of spiritual things these stories can make believing easier.

It is harder when prayers and best intentions fail. Believers will often say that when this occurs it is part of a greater plan or design. To a nonbeliever of spiritual things, perceived failures make it easier not to believe.

I am grateful for my patients who have told me that they, their family, or pastor have prayed for me and they believe everything will be all right. These gestures are filled with great faith and hope. Hope and optimism, regardless of belief, are associated with better outcomes and longevity. I once had a Catholic patient who came in for a very small routine procedure. He also took my hand and said, “It will be alright, I had my last rites read to me.” I am not sure if that was a vote of confidence. I told him thank you, but I was not planning on letting him die just yet.

I have a close friend who is an atheist. He told me one day, “You know all of this is not going to matter in the end, as we all die and aren’t coming back.”

I told him that is what makes it even more meaningful. Because when we do die, it is important to have hope in a better tomorrow.