(800) 379-9220, (732) 246-8439     Highland Park, Jersey City, Freehold       Margaret Nichols Ph.D., Director

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Issue 4 - January 2006

      Welcome to the fourth issue of Growing, the newsletter of the Institute for Personal Growth. In the last issue, we departed from our previous format because we published the results of our internet survey on female sexuality. Despite our best intentions, it’s taken a year to put out another edition of Growing. In the meantime, we added another consulting room to our Jersey City office, we’ve gathered hundreds of responses to our male sexuality survey, and we are scheduled to present the results of both sexuality surveys to members of the professional community at several national conferences. We hope you forgive us for the long wait, and that you enjoy the newsletter.

Peace and love,

Margie Nichols, Ph.D., Editor

THE FUTURE OF PSYCHOTHERAPY: The Science of Helping
Margaret Nichols, Ph.D.

The New York Times recently featured an article called “Psychotherapy On the Road to... Where?” in which journalist Benedict Carey described a profession troubled by a dearth of ‘superstar’ heroes that could match the fame of founders like Sigmund Freud or Carl Rogers. The central conflict in our field was described as whether it should be “guided by the cool logic of science or a spirit of humanistic activism.”

There need not be a conflict. It seems clear to us at IPG that ‘humanistic activism’ is the heart and soul of psychotherapy. ‘Humanism’ means approaching each client with respect and love, as an equal and as a unique, precious individual. It means seeing psychotherapy as a vocation, not a job, believing that we as therapists view our lifework as a personal, perhaps spiritual, path. ‘Activism’ means advocating for our clients and educating the public about problems our clients face.

But ‘science’ means having the tools to help in the most effective way possible. Without skill we are well-meaning but limited in our ability to help. Although psychotherapy is part art-form, to be sure, it is also information, research, data, technique, and the new paradigms that emerge from continued scrutiny of what we do. The trend to ‘evidence-based treatment’ in medicine has affected psychotherapy and, while it is hard to imagine counseling reduced to formulaic treatment plans based strictly on diagnosis, and it is also foolish to ignore the new information coming from psychology and neuropsychiatry.

Using science to inform psychotherapy also means subjecting therapeutic methods to rigorous experimental outcome research – and then paying attention to the results. At IPG all therapists are familiar with the tools of Cognitive Behavior Therapy (CBT) because CBT has consistently been shown to ameliorate depression and other mood disorders. We have trained and supervised sex therapists in all offices because sexual dysfunction is a specialized field with knowledge and techniques not taught to the psychotherapy generalist (check out the IPG News segment).

Indeed, IPG has often been ahead of the learning curve on developments in psychotherapy. We forged alliances with psychopharmacologists in the late 1980’s, when Prozac first hit the market. When most therapists were warning that antidepressants ‘masked’ problems, we realized that properly administered medications enabled clients to function effectively, thereby stopping the downward spiral of depression. Moreover, with mood stabilized, depressed people could use psychotherapy for unearthing root causes instead of just for crisis management.

Nearly ten years ago we innovated a psychoeducational program in “Emotional Intelligence” that included techniques of Buddhist psychotherapy, including meditation, and cognitive behavioral practices of compassion, gratitude, and living fully in the moment. Now, these techniques have all shown efficacy in the treatment of disorders ranging from depression to borderline personality disorder, and are incorporated into new treatment methods like Dialectical Behavior Therapy and Positive Psychology. Martin Seligman, a founder of positive psychology, told The New York Times that “the zeit is really geisting on this idea right now.” These techniques and theories of treatment constitute a paradigm shift that includes less focus on individual family of origin issues and more on developing skillful techniques of living and different ways of viewing the world.

A second paradigm shift is occurring in our field. Sometimes called “Information Processing Theory,” it is based on the new findings of neuroscience. For example, through new techniques in ‘brain science,’ we are beginning to understand the neurological basis for the effectiveness of what we already do. Psychiatrist Dan Seigel has looked at brain imaging studies to understand attachment and nurturance. These studies, he says, show that psychotherapy changes the wiring of the brain. “When I’m telling you my feelings, discussing memories, in this close relationship, I’m achieving better neural integration. I’m repairing the connections in the brain.”

And non-verbal therapeutic modalities are being developed that claim to impact neurological connections in ways not possible in ‘talk therapy.’ The most well-researched of these modalities is EMDR (check out our feature article on EMDR). EMDR, considered a first-line treatment for Post Traumatic Stress Disorder, has also been shown to help speed the course of treatment for a wide range of other problems, and is even used for performance enhancement much as visualization methods are used in sports psychology. Several IPG therapists have received advanced training in EMDR and use it regularly, often with clients who come specifically to take advantage of the technique after ‘talk therapy’ has failed to ameliorate their symptoms.

The New York Times describes a battle between therapists working from the heart and those working from the mind. We don’t see the conflict: ‘wholistic’ treatment means therapists using all aspects of themselves in their work as much as it means working with the totality of the client.

BEEN DOWN SO LONG IT LOOKS LIKE UP TO ME: Depression – Or Just The Blues?
Susan Menahem, L.C.S.W.

So, is it “bah humbug,” winter blues, or a full blown clinical depression? There are many reasons or even a combination of reasons why a person might become depressed, and although the types of depression may differ, many of the symptoms can be very similar and may only vary in their severity and duration. Some common symptoms of depression include feelings of sadness or hopelessness, changes in sleep patterns or appetite, loss of concentration and focus, loss of interest in social or daily activities, feelings of tiredness and fatigue, irritability and anxiety and even thoughts of suicide. If you are feeling any of these feelings and think that you may be depressed, it may be important to figure out which type of depression you have since the treatment options may vary.

Depression during the holiday season is usually the result of encountering “memory sparkers” or having expectations that go unmet. A memory sparker is anything that can trigger a previous memory – a smell, a place, a song or even a date on the calendar. Unless it’s a special day marking a specific event, if I asked you to tell me where you were and what you were doing over the last 10 years on March 12, you probably couldn’t tell me. But, if I asked you to recall Christmas when you were 12, New Year’s Eve 2004 or the last five Valentine's Days, I’m sure you could. If these events were marked with sadness in the past, or if these events were filled with happiness in the past and are no longer a source of joy, you could be feeling symptoms of depression.

Unmet expectations during the holidays could be anything from not having loved ones around you this year or not being able to create the type of Christmas that grandma was, to not having enough money to purchase gifts that you feel are suitable or having the family dinner go awry because Uncle Joe and Aunt Suzy have chosen this day to finish their own personal World War Three. Let’s face it, regardless of what all the songs say, there is nothing necessarily magical about the holiday season. If you don’t get along with your sister during the year, you’re not going to get along with her on Christmas.

Dealing with holiday depression, while it may take some effort, is really a matter of reprogramming your brain. Before the holiday arrives, decide for yourself what the holiday means for you and figure out how you’re going to make it as positive as possible. This also means adjusting your expectations to match your current situation. Realizing that your sister is probably going to be the pedantic show off that she’s been since she was 5, understanding that it really has nothing to do with you and deciding not to take it personally will make a huge difference in how you feel on the ride back home. Deciding that this year’s Valentine's day (regardless of your current relationship situation) is going to be about pampering yourself and treating yourself in a special way will thwart off whatever the media tells you this day should be about.

Making time for exercise and doing other things to increase your own levels of seratonin (a chemical in the brain that effects your mood) can help significantly, as will activities that take the focus off of your current situation. Additionally, most of us increase our sugar intake during the holidays, and while it may feel slightly uplifting for a moment, we will also experience that sugar crash which can intensify feelings of sadness and depression.

But, what if your feelings of depression aren’t linked to the holidays? What if you’ve begun to realize that as soon as we’re done carving pumpkins and we’ve changed the clocks, you begin to feel those ‘winter blues' that you can’t snap out of? If this is the case you may be experiencing Seasonal Affective Disorder, or S.A.D., where symptoms of depression appear in the Fall, reach a peak in the Winter and usually resolve themselves in the Spring. S.A.D. is caused by the effects on the brain’s chemistry during periods of reduced natural sunlight.

Assistance with the symptoms of S.A.D. includes regular exposure to full spectrum light, which mimics the light of the sun. You can purchase full spectrum light bulbs or even a full spectrum light box via the internet or at some hardware stores, and keep them in rooms where you usually spend at least a half hour or more. In addition spending at least an hour a day outside, regardless of weather, will also help a lot. Some people frequent tanning salons for exposure to full spectrum light but the effects on your skin may make that option undesirable. Psychotherapy with a trained counselor and a possible evaluation for medication during the winter months also prove to be helpful in treating Seasonal Affective Disorder.

If you don’t feel like you have S.A.D but you are experiencing depressed mood levels, crying spells, sleep problems, feelings of guilt and/or thoughts of death or suicide, and these symptoms persist for more than 2-3 weeks, you’re moving beyond the holiday blues and you probably have a major depression. It's important to realize that major depression is not a weakness or a character flaw – it is a real illness. People who suffer from major depression are not just moody or have "the blues" for a few days. Their experience with the symptoms of depression is often debilitating and can last for long periods of time without relief. Telling yourself to “snap out of it” or thinking good thoughts is not going to help here.

Major depression can be broken down into two categories: situational depression and chemical depression. Situational depression is usually caused by a traumatic life event such as the death of a loved one, the loss of a job, the loss of a significant relationship or even a move to another town or state. If a person is feeling major depression but cannot identify a triggering event, he or she is likely experiencing a chemical depression, meaning certain chemicals in the brain are out of balance. In cases such as this, there is usually a family history of depression. In addition, hormonal changes in the body can have an effect on brain chemistry and bring on a chemical depression.

In any event, symptoms of major depression will not subside on their own and it is usually necessary to seek professional help. Situational depression typically requires therapeutic counseling, sometimes coupled with medication; chemical depression usually requires medication, sometimes coupled with professional counseling. A trained therapist can provide the needed therapeutic counseling and can also be a good referral source for medication.

Being in need of medication is not likened to taking the easy way out. Quite simply, if I asked you to accompany me on a hike up a mountain and expected you to keep up with me, but gave you a 50 pound boulder to carry with you, keeping up with me would be impossible no matter how hard you tried. Medication to assist with depression would be like putting the boulder down on the hike. You would still have to watch your step, you would still have to exert the effort, you would still have to keep the pace – but the expectations of keeping up would be fair. Medication for depression is not the equivalent of taking 'happy pills.' They take the edge off the depression, allowing you to deal with any issues that may also be there.

Whether you are experiencing holiday blues, seasonal affective disorder or a major depression, the symptoms are very real and can be debilitating. The good news is that you don’t have to go through the depression alone and there are ways to reduce the symptoms. As with all physical and emotional problems, if you are unsure of what to do and are in need of assistance, reaching out to the proper people who can help is essential.

IPG NEWS
Sex Research/ Sex Therapy At IPG

IPG has an international reputation as an organization that not only provides psychotherapy to members of sexual minorities, but also fosters research and theory about sexuality. Here’s how we’re living up to our reputation:

1) Our Online Survey Of Sexuality Is Groundbreaking – And It's Getting Huge
We have 1500 responses from women and more than 500 from men. Dr. Nichols has published two papers using survey results in 2005: a journal article on lesbian sexuality, entitled "Rethinking 'Lesbian Bed Death'"; and a chapter in the first international medical text on female sexual function and dysfunction, entitled "Sexual Function in Lesbians and Lesbian Relationships". We’ll be presenting results to the audiences of at least two national sexology conferences in 2006.

Help us out... Take the survey!
Women: Take our anonymous female sexuality survey
Men: Take our anonymous male sexuality survey

2) Our Qualifications Are Constantly Expanding
Five IPG therapists are being AASECT-certified through training with Dr. Sandra Leiblum at the University of Medicine and Dentistry of New Jersey and supervision with Dr. Nichols, who is AASECT-certified and a diplomate of sex therapy since 1985. This gives us the capacity to do sex therapy in all three offices of IPG.

3) We Boldly Go Where Others Are... Too Old Fashioned To Go?
We run New Jersey’s only psychotherapy group for transgendered people, now meeting two Sundays a month. If you’d like to inquire about this group or our transgender services, Debbie Williamson, Assistant Director of IPG, will be happy to answer all your questions. Please call the Highland Park Office at 800-379-9220 or 732-246-8439

FREE ASSOCIATIONS: Editorial Comments
Another #@$*! Growth Experience
Margaret Nichols, Ph.D.

I do not believe that sheer suffering teaches. If suffering alone taught, all the world would be wise, since everyone suffers.
To suffering must be added mourning, understanding, patience, love, openness, and the willingness to remain vulnerable.
                                                                                                                                - Joseph Addison

Those of you who know me, or who have read the last edition of Growing, know that the last two years have been the worst of my life. In March of 2004 my precious daughter Jesse was diagnosed with brain cancer and she died June 2 of that year, four days before her tenth birthday. Her death devastated us all: it nearly destroyed my son, who was hospitalized in 2005, it caused fights among some family members, and it sent the rest of us back into therapy. If you saw my life in a movie, you would say it was too melodramatic to be real.

But, amazingly, we’ve all survived. Appropriately enough, in this issue Alison Grant, a therapist in our Jersey City office, has written a review of book about how growth can come from crisis and tragedy.

I hate that I/we have had to go through this. I’d give anything to have my old life –Jesse – back. But she’s gone and I’m not and – I have to grudgingly admit that some productive things have been wrested from this experience. Cory, my twenty-two year old son, rose up phoenix-like from the depths of his personal hell and is more mature, insightful, responsible and caring than ever before. Jesse’s Dad, my co-parent and friend, is engaged to be married. My return to psychotherapy has given me a renewed understanding of the process (thanks, Bruce!) – it’s really useful to be on the other side of the couch, so to speak.

But the most significant growth has been the result of love. First, during seven trips to Guatemala last year, I was able to bring money and goods donated by many of you to sixty children living in an orphanage in Guatemala City. At least for that time, it made their lives better.

And – four of those children now have homes. In August of this year I brought home Alejandra and Diana Nichols, ages eleven and seven, sisters who lived in the orphanage for six years after being abandoned. And in a month or two my friend Susan will bring home two other girls, another pair of sisters abandoned to the same orphanage.

Jesse’s death has been the greatest tragedy of my life. But at least we’ve been able to turn it into something positive. Because she died, four other children have been saved from a life of poverty and likely abuse and/or prostitution. It is hard for me to bear my loss. But when I’m at my breaking point, I think of Alejandra and Diana, Heidi and Sherley, and I think: I can get through another day.

P.S. – If you want to read about Jesse’s life and death, my survival, and my ongoing journey with Alejandra and Diana, please visit my blog. If you know anyone who has lost a child – they might feel less alone by reading my story.

POETRY IN EMOTION: Reflections from the Spirit
Partners Meditating Together: The Music of Intimacy
Neil Selden, L.C.S.W.

You are musicians playing a duet together.

You are architects and builders creating a spiritual home for each other and family and friends.

To do the lifetime dance of friendship and passionate love with a partner, nothing is more difficult to believe and act upon, nothing is more useful, than the heart, head and gut-level knowledge of responsibility for your own feelings, the knowledge that all emotion is energy and can be channeled by the choices you make in speech, actions and thoughts.

What can be more liberating, refreshing and exciting than to accept and act upon the knowledge that you and only you can decide what you say, do and think, and thereby give and receive love in creative and imaginative ways more fulfilling than you could have otherwise imagined?

For a romantic relationship to grow and prosper, both partners have to see signs of the other trying to put the partner first, signs of trying to love the other unconditionally, trying to cherish each other’s exploration of her/his physical, emotional and sexual needs.

And no practice is more practical in the mutual journey to achieve such a romantic relationship than some form of meditation, focusing on one’s breath, or on the repetition of a sacred phrase or prayer, or on the uncontrolled flow of thoughts, memories, images, physical sensations.

Any such daily practice of meditation will, gradually and inexorably, enable you to become a spectator of your own spectacle, and as a spectator you will more and more expertly decide on and act upon the most skillful thoughts, speech and actions in the giving and receiving of love.

BOOK REVIEW:
Broken Open by Elizabeth Lesser
Alison Grant, L.C.S.W.

When a client shared with me how helpful Elizabeth Lesser’s book Broken Open was in giving her a new perspective as she struggled through her own pain and loss, I felt that I should read it. Since then I have recommended it to many other people. This is an excellent, supportive book for those exploring spiritual growth, searching for courage, or attempting transformation.

How do we transform a time of challenge and difficulty into a time of awakening, strength and growth? Elizabeth Lesser, cofounder of the Omega Institute addresses this question in Broken Open. Using her own personal story, as well as those of others, she explores positive life changes – what she calls “The Phoenix Process” – which can emerge from challenging life events. The personal stories she uses in the book include her own divorce and the stories of others such as life-threatening illness and the loss of a child. The book examines our relationship to the changing nature of life.

She also invokes the wisdom of thinkers such as Tibetan Buddhist Pema Chodron, the late philosopher Joseph Campbell, and her longtime friend and colleague Ram Dass to illustrate how meditation and belief in a spirit that works through people can help break through fear and hopelessness.

For more information on this particular title or on Elizabeth Lesser, visit her page at Random House Publishing.

THE PROMISE OF EMDR
Margaret Nichols, Ph.D.

EMDR therapy – the acronym originally stood for ‘eye movement desensitization and reprocessing’ but that name has proven to be a misnomer, so practicioners now simply use the initials – is a treatment that seems so strange it would never have been taken seriously, except for the fact that the research data on its use has been so impressive. Reduced to its simplest elements, EMDR amounts to having a client watch the therapist’s fingers moving back and forth across their range of vision while imagining a picture of a troubling event. Sounds crazy, but for many people it works when ‘talk therapy’ has failed.

Sharon came for EMDR at the urging of her alarmed family. When Sharon’s fiancé and boyfriend of eight years broke off their engagement a month before the wedding, she lost twenty pounds in a month, cried constantly, and finally was unable to go to work. EMDR helped her link her depression to not only the break-up, but also to the loss of her best friend in a car accident two years prior. After three sessions of EMDR, Sharon left saying she still felt bad, but not devastated, about the broken engagement.

EMDR was discovered by accident and was originally used to help victims of severe trauma – Vietnam War Veterans, rape victims, survivors of natural disasters. As such, it is considered by many professionals to be a first line treatment for Post Traumatic Stress Disorder, a mental problem that can be debilitating and intractable. But since EMDR’s development in 1989 its use has expanded to include first adult survivors of chronic physical and/or sexual abuse, then the treatment of a wide range of anxieties and phobias, and now more recently to work on what the EMDR people call ‘little-t trauma.’ Many behavioral patterns and emotional reactions that we have as adults originate in painful or frightening events, mostly in childhood and adolescence, that might not meet the formal definition of ‘trauma’ but still have a devastating impact on us.

Michael had about twenty sessions of EMDR interspersed with his regular ‘talk therapy’ sessions to deal with a history of severe childhood physical abuse by his father. When asked about its effectiveness three years later, Michael reported that memories were still there but not emotionally compelling, and that the treatment had allowed him to reconcile with his father before he died.

Neuroscientists now believe that negative emotionally overwhelming experiences can cause a kind of brain rewiring that ‘freezes’ the memory of the event in certain areas of the brain and prevents normal processing. They say that when we have ‘worked through’ such an occurrence, it is because neural connections have been formed between emotional memory, largely a right-brain phenomenon, and so-called ‘narrative memory,’ in the left brain. When the memories of such events get stuck, they repeat over and over in our mind and dreams, influencing our reactions to the world in a negative way.

It is believed that the bilateral processing of EMDR, similar to the eye movements of REM, or dream sleep, facilitates such right-left brain connections. The experience of clients is that thoughts, feelings, and memories that were at one time frightening and intrusive become less emotionally charged and thus less powerful. In addition, EMDR can prompt spontaneous insights that have deep, lasting effects.

Estelle had a good marriage but at times found herself irrationally jealous when she thought her husband was looking at another woman. She hated feeling this way because ‘my mind tells me it’s crazy, but I can’t help being obsessed with these thoughts.’ During an EMDR session she realized the feelings replicated the fears of abandonment she had as a child when her mother was disapproving. From that session on Estelle’s jealousy was negligible.

One of the most exciting new uses of EMDR is for performance enhancement. The bilateral processing that occurs naturally in the brain during REM sleep does more than help us work through upsetting events; it is also necessary to consolidate learning. EMDR can bolster positive attitudes and behaviors, much as visualization does in sports psychology.

Jay was ‘stuck’ as an artist: he hadn’t been able to finish a painting in two years. EMDR brought up connections between childhood family events and his current lack of self-confidence, but it also helped him create the new artistic direction he needed to begin painting again.

Because EMDR is the most rigorously evaluated of the new brain-body, non-verbal treatment techniques being developed in the last two decades, IPG has chosen to have some practicioners become proficient in it. EMDR treatment is now available on a limited basis in all three offices of IPG and we plan to expand our services in 2006.

LEGALLY INSANE:
Mental Health News We Find Funny Or Interesting

Mind, Heart, And Genitals:
A recent article in the Science Times (12/27) reported links between depression and heart disease and between erectile dysfunction and heart disease. In March of 2005 the University of Maryland published research that showed a link between stress and vasoconstriction, and one between laughter and improved vascular flow. If one extrapolates from these findings and combines them with previous research showing correlations between anger and heart disease and between ‘type a’ personalities and heart problems, a picture emerges, and it isn’t pretty. It’s one of driven, ‘down,’ stressed, angry people whose sex lives are in shambles. Lighten up, folks! As Wavy Gravy says, if you don’t have a sense of humor the world situation just isn’t funny anymore, so learn to laugh, slow down, don’t take it so seriously, and... you’ll die of something other than heart disease.

Adult Children Clueless About Aging Parents
Research conducted by Brian Carpenter, Ph.D., at Washington University shows that adult children often have no idea about the health care and living choices their aging parents want. In fact, a significant number of them guess their parents wishes no better than would a random stranger. Moreover, it is difficult to predict which adult children will know their parents wishes better – neither gender nor geographic proximity are related, for example. In particular, people underestimate their parents’ desires for autonomy, independence, and personal growth; i.e., the ongoing need for cultural and social stimulation.

We wonder if factors other than simply communication are at play here. After all, isn’t it easier to stick Dad in a nursing home than to provide an environment where he can attend the opera when he’s up to it but get home health care when he’s not? Word to the wise Baby Boomer: put it in writing – and consider making your lawyer your guardian!

Learn more about this by reading Dr. Carpenter's article.

That ‘Gut Feeling’
All this time you thought that the difference between the ‘big brain’ and the ‘little brain’ was the relationship between a man’s cerebral cortex and his genitals. Now it turns out there really is a ‘little brain’ – a ‘command center’ of neurons, nerves, and neurotransmitters – that is called the ‘enteric brain’ because it is connected with the gastro-intestinal system. It is this brain – thought to be a primitive ‘emotional brain’ more like the limbic system than the cerebral cortex – that is responsible for ‘gut instincts.’

Dr. Michael Gershon of New York’s Columbia Presbyterian Hospital has been studying the ‘brain in the gut’ for more than a decade. The enteric brain is involved in conditions in colitis and irritable bowel syndrome as well as normal gastrointestinal function. Moreover there is a large and complex system of interconnections between the enteric brain and the ‘brain in the head.’ There are ‘gut feelings’ that mirror emotional states as reflected in the brain, and the ‘brain in the head’ can influence our gastrointestinal functioning – we get ‘butterflies in our stomach’ when we are afraid and we ‘choke with emotion’ – esophageal constriction- when we are sad. The enteric brain produces its own neurotransmitters and, intriguingly, benzodiazapames - tranquilizers like Xanax and Valium.

While we clearly have much more to learn about the intersection of the two brains, it’s safe to say now that it’s foolish to ignore what your gut tells you – it may know more than your head.

For more information on this topic, read the full article on Columbia University's website.