What Are Your Internal Dialogues Trying to Protect You From?

By Concentric Therapist Intern Mara Hundrieser-Acosta, B.A. (Clinical Mental Health Counselor M.A.)

I know I am not the only one that has internal conversations with different parts of myself. Just going back and forth with what I should have done, said, or even experienced. I recently lost my mother to cancer. When someone asks me “How are you doing? I answer with “ I am doing ok, just taking it one day at a time.” but on the inside, my brain is struggling. The actual answer in my mind is, “ I miss my mom, I wish I could see her.” and then another part of my mind answers “I have to cook dinner, wash clothes, put them away, and so much more to do, I feel so overwhelmed.” and another part says, “People will think you don’t have a handle on your life if you let them know how you truly feel.” So, I end up giving a generic answer and smile. 

The conversation inside my mind keeps going even though on the outside I am smiling and making small talk. Sometimes when we have been through hard times, we develop a strong voice that keeps us “in check.” When we view this through an Internal Family Systems (IFS) lens, it's called a Manager. We all have these internal conversations. No, there is nothing wrong with us; it’s just part of how we take care of ourselves internally. You might wonder what I mean about how we take care of ourselves internally. We all go back and forth with all of our parts to try to navigate our lives through stress, anxiety, depression, painful situations, and trauma. Through IFS we can learn what these parts need in order to feel at peace in our life. 

“IFS guides us to offer deep understanding and credible help to the critic and the innumerable other parts who populate our clients’ inner worlds, some of whom long to transform but are stuck in extreme, destructive roles.” -Schwartz & Sweezy (2020)

What is IFS?

Internal Family Systems (IFS), a model of therapy and an approach to better understand ourselves, was developed by Dr. Richard Schwartz. He has worked on the development of IFS for over 40 years.  Dr. Schwartz holds a Ph.D. in Marriage and Family Therapy and was trained to view and understand people through a systematic lens.  After years of working with families and individuals, Dr. Schwartz noticed how clients would speak about their different inner parts. Just like I shared my internal dialogue about being asked about me in relation to my mother. 

While in session with clients, Dr. Schwartz’s patients would share how they would go back and forth with different parts of themselves.  Dr. Schwartz noticed those parts also operate within a system similar to how a system of family operates. For example, a family system consists of different family members, roles or parts (e.g. parents, children) that interact with each other.  

If we look at humanity or systems with a very wide lens, we notice a system is always in place, starting with our solar system. Dr. Schwartz was able to recognize there is a system that consists of people’s inner parts.  These parts are called Managers, Firefighters, and Exiles. These parts have developed to protect us from harm, trauma, and difficult experiences that have left a wound inside our psyche. They all have a specific role that falls under a three-group system. All of our parts are good, even though they might seem mean or aggressive at times. 

The goal of IFS is to help people become Self-led, which means that their various parts feel loved by the Self and trust the Self’s leadership. IFS therapy has a gentle way to ease the pain of people’s experiences and parts and to help navigate the internal turmoil one often faces throughout life. 

The Roles of Parts: A Three-Group System

In order to understand further this three-group system we need to understand that each group or also called protective parts (Managers, Exiles, and Firefighters) doesn't have just one personality. There are different kinds of Managers; each one has its own role to play, as well as the Exiles and the Firefighters to protect us internally. These three-group systems work with each other and sometimes what feels like against each other in order to keep us safe internally. 

In other words…

One group tends to be highly protective, strategic, and interested in controlling the internal or external environment to keep things safe. In IFS, we call the members of this group Managers. 

A second group contains the most sensitive members of the system. When these parts feel injured or outraged, Managers will banish them for their own protection and the good of the whole system. We call them Exiles. 

A third group tries to stifle, anesthetize, or distract from the feelings of Exiles, reacting powerfully and automatically, without concern for consequences, to their distress as well as to the over-inhibition of Managers. We call these members Firefighters. 

Trauma & Internal Family Systems 

According to Schwartz & Sweezy (2020), internal systems (parts) that are responding to trauma not only divide into these roles, but the protective parts (Managers and Firefighters) also form alliances and get into conflicts with each other and can be very harsh or smothering with the Exile they are trying to protect or ward off. The sadder, more terrified, ashamed, rageful, or sexually charged an Exile is, the more protectors legitimately fear its release and the more extreme they become in their efforts to suppress and constrain them. In turn, the more an exile is suppressed, the more it tries to break out. In this way all three groups become victims of an escalating cycle of internecine* conflict. 

*internecine: destructive to both sides in a conflict.

Example: The more ashamed I feel about a traumatic event that happened to me the more scared the Managers and Firefighters are of me releasing or admitting this shame. So, the Managers and Firefighters will try really hard for me to suppress that shame. Which can mean one can begin to use drugs and alcohol to control that shame, or become very narcissistic in order to push it way down. The Managers and Firefighters believe that if one releases or admits this shame, it (the part) will ultimately fall apart. 

Childhood & Internal Family Systems

The Self can be forceful and protective. Children who have experienced developmental trauma or any abuse of their independence, spontaneity, leadership (or other traits that rely on courage themselves) begin to suppress their courageous side. It takes tremendous courage to go toward terrifying places in the psyche. Many protectors avoid stepping out of their roles because they believe the person would be weak and passive without them. Protectors always have intense fears about allowing clients to open the door to Exiles they locked away years ago in inner dark places. When a client says they are afraid to do something, we know a part in their inner world is speaking. But once the part understands the fearless nature of the Self, its fear (and emotional pain, shame, and rage) surrenders.

IFS Therapy has 4 Goals:

1. To liberate parts from the roles they have been forced into, freeing them to be who they were designed to be.

2. To restore faith in The Self and in Self-Leadership.

3. To re-harmonize the inner system.

4. To encourage the person or client to become increasingly Self-led in their interactions with the world.

So, What Does This All Mean? 

The intention of IFS is for the client to access, experience, and be Self-led, to feel safe, to learn their inner world, and understand how their parts work together or against each other in order to protect them. The more we learn and understand about our parts and what they are trying to tell us; it then becomes easier to identify when they get activated. Understanding who we are, where we have been, and what has hurt us, is what is going to give us the opportunities to heal ourselves. The end goal is to be able to be our own saviors, but to get there we must be willing to surrender and be open to learning. 

Once a person experiences faith in The Self and in Self-leadership, the IFS therapist seeks to help the client develop the Eight C’s. 

The Eight C’s

Curiosity: The client learns to be inquisitive, and have interest rather than be judgmental or fearful. This is where one comes with no agenda, one just wants to learn, know, and understand. There is a sense of feeling at ease and moving forward with wonder. There is a sense of safety that opens the door to vulnerability. 

Calm: After being in a high alert state, where one’s nervous system is often aroused, Self-leadership does the opposite by creating a sense of calm that is both physical and mental. The client is able to accept life on its own terms and there is a sense of resilience and assertiveness. 

Courage: When a client says they are afraid to do something in the inner world, we know a part is speaking. But once the part understands the fearless nature of The Self, its fear (and emotional pain, shame, and rage) surrenders. 

Confidence: The Self validates and comforts its Exiles bringing about an infectious air of confidence, conveying to protector parts that it is safe to relax instead of trying to “let it go and move on” (the typical protector advice that encourages people to abandon and isolate their burdened young parts), injuries can be healed. When Exiles are unburdened, the system becomes less delicate and less reactive, and protective parts are more inclined to trust Self-leadership. 

Connectedness: The Self, in its natural state, experiences the sense of connectedness. Instead of trying really hard to obtain a connection with someone, through trauma bonding.  The Self can now move through the world in harmony. Connectedness links with calm and confidence which altogether links up The Divine. 

The Divine: Through extensive research by Dr. Richard Schwartz this is what he describes as The Divine. “Though they used different words, all the esoteric traditions within the major religions – Buddhism, Hinduism, Christianity, Judaism, Islam – emphasized their same core belief: we are sparks of the eternal flame, manifestations of the absolute ground of being. It turns out that the Divine within – what the Christians call the soul or Christ Consciousness, Buddhists call Buddha Nature, the Hindus Atman, the Taoists Tao, the Sufis the Beloved, the Quakers the Inner Light.” 

Clarity: One can see things more clearly. The distortions are no longer in effect and the extreme beliefs ease as one can see authenticity. Our vision is clear when we see through the eyes of the Self versus when our vision is distorted through the eyes of extreme parts.

Creativity: It’s believed that once the inner turmoil and constant struggle start to quiet down and The Self becomes the leader (aka Self-led), creativity can emerge naturally. This means once the managers start to relax, we can problem-solve with greater ease which becomes second nature. 

Compassion:  Once a client finds some separation or healthy distance from their angry or scared part, they can now see these parts from a compassionate lens.  They can express how sad or sorry they are for those parts and are willing to help them heal. This inherent desire to help their suffering parts signifies and taps into compassion. 

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I hope that after reading all this information there is a part of you that feels compelled to explore IFS. I want to say to “the part” of you that has that interest, that feels like it has been lost, in pain, or any other unresolved feelings; you are important and you deserve to be seen and heard. If you are wondering which part that might be, I am talking to your Self-led part; the part that might be hiding in the shadows for a while. 

We live in a time where we are overworked, overwhelmed, on the go, not getting enough sleep, expecting to be everything and nothing at all, where we have to walk on eggshells, but make a difference. It’s no wonder that our Self-led part feels so overwhelmed and just lost. This is the time when we need to slow down and rebel; which translates to going inside, getting curious about your parts, and reconnecting to who we truly are meant to be.

I know it might sound like a big ask, yet if you go back and read about The Eight C’s and imagine experiencing them, I think it’s all worth the journey of healing. The idea of feeling liberated is what motivates me through the IFS lens. I wish for you and my clients to feel liberated from whatever has been holding you back from being your most authentic self and be connected to your Divine. 

So, next time you have those internal conversations bring awareness to what each part is saying, and ask them what they truly need. They are trying to protect you even if they might sound very harsh or act maladaptively; they just haven’t learned a better way, yet, to communicate with you. Even if you don’t think you have the power within you to heal, to reframe those inner dialogues; you actually do, it’s inside you.

Resources for Consideration

Books: IFS online store | IFS Institute 

Videos: Dr. Richard Schwartz explains Internal Family Systems (IFS) Dr. Richard Schwartz Has A Radical Approach To Healing

Podcast: Multiplicity of the Mind: An Approach To Healing the Inner Self | Dr. Richard Schwartz X Rich Roll

The Misunderstandings of Anger

By Concentric Counselor Ashley Smith (Guerrero), LSW, CADC

Anger is a tricky thing. Emotions are not often identified as tricky and complex, but anger is one of few exceptions to this. To be angry, is to be described as negative, bad, destructive, and heavy. While anger is neither good nor bad, its constant bad press interferes and hinders our desire to reflect and understand it. If we do not understand it, how can we include it when communicating emotions?

Anger is an internal call deeply rooted in our body’s fight or flight system, built, and strengthened through the millions of years in which humans existed. Simply put, this system is our body’s most primitive one and when needed, provides us with a boost of energy (from cortisol/adrenaline) so that we can respond to external dangers and triggers.

This primitive system at its core is an automatic defense mechanism that alerts us to promptly respond to triggers and dangers in moments of stress. While the basic function of this system is well intended and perhaps necessary, it highlights the complexities of the anger emotion and therefore, makes it that much more difficult to explore and understand.

Albeit confusing and difficult to unpack, the key to understanding anger is a deep exploration of its misunderstandings.

Let us explore some of the misunderstandings of anger.

Misunderstanding #1: Anger is a bad emotion.

Anger is neither good nor bad however, in the absence of control, it is paralyzing and igniting. To equip ourselves from it taking control of us, we must become curious about what it is and how it flows through the body. Although anger is often viewed as a silo of an emotion, it consists of not one, but three components: emotional, behavioral, and cognitive. All three occur simultaneously, creating a synergy of responses.

Behavioral Response: Behavioral responses to anger range in expressions from being internal (resentment, irritability), external (verbal, throwing, aggression) and sideways (manipulation, sarcasm). Such responses are what people often see and hear and is the crux of its bad rap.

There is no denying such behavioral responses are unpleasant, but it is simply one aspect of anger, and we need to allocate as much attention to the emotional and cognitive responses as we do to its behavioral counterpart.

Emotional Response: Anger is a secondary emotion meaning it occurs in response to other emotions (sadness, worry, guilt, embarrassment, betrayal). The key is to not only understand anger but also where the reaction is coming from. When we understand its driving forces, we expose the internal confrontations of our emotions and begin the journey towards strengthening our emotional intelligence and sharpen our communication with others.

Cognitive Response: Expressions such as “that person made me so angry” overlooks that thoughts occur prior to and during angry feelings. Our thoughts and interpretation of an event influence behavioral responses. Similarly, to our emotional response it is important to recognize thoughts passing through our mind and where they stem from…” Do I need reassurance? Am I longing for something?”

For the reasons above, anger is a necessary emotion that requires exploration and tenderness, understanding and cultivating. Understanding anger requires a relationship with it; one filled with patience, curiosity, and compassion. When we befriend our anger, we can safely explore its activators, and therefore harness, and channel it in a productive manner. When anger is harnessed, we are more empowered, motivated towards change, and able to deepen connections within ourselves and others.

Misunderstanding #2: Other people make me angry.

It is important to reflect on where the anger is stemming from, not who. When looking into where anger arises from, a place often overlooked is a person’s value system. We all have values but don’t always allow space to reflect on what they are, and more importantly, why specific values are of importance. Oftentimes, anger can be triggered when a “value chord” is struck. When this happens, it is a physical reminder of your value (s) and requires questioning and exploring the following: 

1.     What value is the trigger striking?

2.     Why is this value important to me?

3.     What is this reaction showing about me?

Reflecting and exploring the origins of the anger provides an opportunity to explain it, rather than haphazardly express it. When we welcome others into this space, it opens doors to solutions, rather than arguments.

Misunderstanding #3: Venting anger is helpful.

Venting anger stems from a Freudian theory of emotional catharsis. This theory suggests that it not released, bottled feelings of frustration and aggression lead to internal pressures, in the same way air fills a balloon until eventually, it pops.

Research has since debunked Freud’s emotional catharsis theory and in fact, found that venting can lead to increased difficulty to cope and even, manage anger. Contrary to Freudian’s theory, current research shows that acting out anger and aggression leads to increased hostility, allows for lashing out and increases levels of distress. Repeated acts of venting anger allow for faster and easier triggering. This constant and automatic, reinforcement increases the odds of anger being a quick and automated response when triggered. The act of lashing out anger is counter-productive; it leads to less-than-ideal responses to stressors. Science has taught us that acting out anger through benign behaviors such as punching or yelling into a pillow is both unsustainable and ineffective when learning to understand and control it.

When we reflect on where anger comes from and our triggers to this emotion, we can learn more about ourselves and how to effectively explain our feelings of anger and moreover, learn to experience the emotion in ways that are healthy and sustainable. The key to navigating our anger is to understand, explain it and channel it through constructive outlets.

                                                            References and Additional Resources

Cirino, Erica. “Anger Management Exercises: 9 Exercises to Help Curb Your Anger.” Anger Management Exercises to Help You Stay Calm, Healthline Media, 4 Dec. 2018, https://www.healthline.com/health/anger-management-exercises.

Hayes, Stephen. “The Simple Guide to Value Triggers | Psychology Today.” The Simple Guide to Value Triggers, Psychology Today, 11 Aug. 2019, https://www.psychologytoday.com/us/blog/get-out-your-mind/201908/the-simple-guide-value-triggers.

Oldenburg, Don. “Angry? Don't Punch That Pillow -- Calm down Instead.” The Washington Post, WP Company, 29 Mar. 1999, https://www.washingtonpost.com/archive/lifestyle/1999/03/29/angry-dont-punch-that-pillow-calm-down-instead/5fcea917-965e-41c5-a0ef-738a1f56a823/.

Roberts, Caroline. “ 5 Healthier Ways to Deal with Anger Instead of Venting.” Venting Your Anger Can Make You More Stressed out -- Do These Things Instead, CNET, 16 Nov. 2019, https://www.cnet.com/health/5-healthier-ways-to-deal-with-anger-instead-of-venting/.

Salters-Pedneault, Kristalyn. “Venting Anger May Not Be Good for Borderline Personality Disorder.” Is V\Venting Your Anger a Good Idea?, Verywell Mind, 19 July 2019, https://www.verywellmind.com/how-you-vent-anger-may-not-be-good-for-bpd-425393#:~:text=Research%20suggests%20that%20letting%20off,way%20to%20control%20your%20anger.&text=While%20you%20may%20temporarily%20feel,your%20anger%20down%20the%20road.

Scott, James. “Exploring the Complexity of Anger ...” Scott Free Clinic, 1 Dec. 2017, https://www.scottfreeclinic.org/2017/11/29/exploring-the-complexity-of-anger/.

Seltzer, Leon. “6 Virtues, and 6 Vices, of Venting.” Psychology Today, Sussex Publishers, 2 Apr. 2014, https://www.psychologytoday.com/us/blog/evolution-the-self/201404/6-virtues-and-6-vices-venting.

Heal!

By Concentric Counselor Jordan Perlman, LPC, NCC

The following post is based on the documentary "Heal", Written, Directed, and Produced by Kelly Noonan Gores and Produced by Adam Schomer. "Heal" can be streamed on Netflix and/or iTunes or purchased on DVD or book from www.healdocumentary.com.

What If Mind Over Matter Is True?

Contrary to what many of us have been told, the latest science supports the belief that we are far from victims of unchangeable genes. We can control our health and life by taking a holistic approach to healing. One that remembers just how intelligent the body is and the way our thoughts, emotions, and beliefs affect our overall health. Therefore, healing begins in the mind and can be extremely complex and deeply personal. To treat oneself, one needs to get to the root of what caused the imbalance in the first place.

According to Joan Borysenko, Ph.D., "90% of what takes people to the doctors is stress-related illnesses". "Stress" is a broad term and can be broken down into three primary sources, all of which can knock our brain and body out of balance:

• Physical (accidents, injuries, falls, physical traumas)

• Chemical (bacteria and viruses, hormones in food, heavy metals, hangovers, blood sugar levels)

• Emotional (family tragedies, loss, job, bullying, finances, emotional and sexual trauma, and neglect)  

Most interventions focus exclusively on physical and chemical sources of stress, leading doctors to overprescribe medications that treat the problem's symptoms without addressing the cause, which can often be emotional. A dependence on pharmaceuticals temporarily fixes the symptoms yet this approach neglects the root emotional cause. For many, this approach leads to the development of additional symptoms/diagnoses as a result of the untreated root imbalance. One way to combat this model's limitations is to focus on a holistic healing approach that emphasizes the internal environment that focuses on disease’s emotional causes. Therefore, every person is the architect of their healing and their destiny.

The Incredible Power of the Autonomic Nervous System

Our systems are incredibly smart and adaptive, and long ago, this primed us to face threats that we no longer meet in modern times. Although this function once served us well, it can cause us a bit of trouble in today's society. For example, the nervous system that once primed us for survival in the face of a Saber-Toothed Tiger looks more like an upcoming work meeting that we're anxious about or a fight with our partner. In either case, the untrained nervous system often can't tell the difference and releases Cortisol, Adrenaline, and Noradrenaline designed to mobilizes your energy to run away from and/or fight the predator. When that happens in response to incidents that don't require that level of response, we might be operating outside our windows of tolerance far more frequently than is sustainable.

According to Stem Cell Biologist and Author Bruce Lipton (Ph.D.), when you perceive a threat, your body activates the Adrenal System (fight or flight). Whether you're preparing for an exam or fighting off an attacker, the result is the same, and the Adrenal System is activated. When this starts in response to a relatively benign threat, often, it increases negative, disease-causing consequences. Over time, this chronically impairs your:

• Memory

• Concentration

• Digestion

• Elimination of toxins

• Immune system

This impairment is due to resources being mobilized from the gut, elimination system, immune system, and higher brain centers. The resources are reallocated into the muscles to fight/flight for your life, which is excellent when used in a true life or death situation. However, when this frequently happens, as a result of let’s say chronic stress, this can cause pH levels to rise. If pH levels are high, this leads to an acidic body. An acidic body causes inflammation that, in turn, destroys the body and causes disease. Therefore, it is vital to reduce stress in the body to reduce inflammation and reduce disease. 

The Placebo/Nocebo Effect on Healing

To access our full healing potential, we have to get our minds on board with the belief we can heal. One way to do this is to focus on creating tonic thoughts as tonic thoughts produce tonic chemicals, while toxic thoughts produce toxic chemicals. If we're not careful, our thoughts and beliefs can prevent us from healing even with the best medical intervention. Therefore, if I change my perception (the mind) and change my view about life (and healing), I change the signals adjusting the cells' function, which has enormous implications. 

Although the Placebo Effect is not entirely understood, a consensus assumes that our minds can control the body. The Placebo Effect relies on positive thinking or believing that an intervention can heal by being open to the possibility of getting better via a "treatment" without an actual chemical, physical intervention or remedy. Many have heard of the Placebo Effect (commonly discussed when looking at research). Yet, there is a lesser-known and equally influential phenomenon that also has the potential to alter your life, known as the Nocebo Effect.

The Nocebo Effect occurs from negative thinking, which can cause illness and disease and even cause death. As a result, the power of belief or "mind over matter", is almost everything. Whatever you are thinking and believing in a given moment, your immune system is either told to "stop working" because we have to respond to a stressor, or "everything is cool." In the first example, the Sympathetic Nervous System is activated and pulling resources from the body's other functions. The latter is a parasympathetic response, which puts the body in a mode ideal for rest/digest/healing; your beliefs toggle that switch.

The experience of Dr. Joe Dispenza illustrates an example of the incredible Placebo Effect in action (Read his full story here). In 1986, at the age of 23, Dr. Joe Dispenza was run over by an SUV while competing in a triathlon in Palm Springs, California, and was paralyzed. Instead of opting for the high-risk surgeries recommended to him by his doctors, he focused on using visualization to move his paralyzed limbs and imagined his shattered spine mending. By the power of his mind, Joe was able to make a full recovery, which further supports the notion that one's beliefs can shift biology. 

The Conscious/Subconscious Mind

The Placebo/Nocebo Effect also extends to Epigenetics, which tells us that our environment can select cells' genetic activity. Our beliefs affect our nervous system, and then our nervous system sends information about its environment. The cells adjust to interact with the world, which stems from consciousness, which is an interpretation of one’s perceived reality. Therefore, my mind is interpreting my environment; by changing the environment, or the perception of their environment, one can control their genetic activity. This takes people from a space of being victims of hereditary to a master of gene activity capable of creating a different reality. 

All of this sounds relatively simple, right? Wrong. The majority of this process is unconscious, which complicates things exponentially. We know that our Conscious Mind and our Subconscious Mind are two interdependent minds that work together. When the conscious mind is engaged in thinking, the subconscious mind is the autopilot's default program, carrying out whatever chore needs doing. The subconscious mind is comprised of downloading (mostly) other people's behaviors. Think of your Mother, Father, siblings, and community during the first seven years of your life when you're essentially a sponge to the world, absorbing other's patterns with little discretion. When our environment growing up is healthy, that's excellent news. However, that's not the reality for many who grew up with less than ideal upbringings.

Regardless of your situation, we all developed blueprints on coping and processing emotions based on what we saw growing up. For some, these memories may not have fully developed, leading to reexperiencing that unprocessed memory every time we get triggered as if it's happening for the first time. One can attempt to outrun the subconscious mind. Though to heal, it's crucial to face it, see the problem, and recognize the systems and stressors as meaningful and intelligent and necessary to wake us up to our patterns to choose a different way. These unconscious beliefs are often running our lives. By asking, "what is this pain or disease trying to tell me?" you can create space for answers to come (Pro-tip: you can use that trick with any thought, feeling, memory, behavior, and you might be surprised what might come up). Additionally, therapy can help make the unconscious conscious, helping release stuck energy trapped in the body via processing previously unprocessed emotions and memories. 

Factors Scientifically Proven to Contribute to Healing

So now that you know you're more in control of your healing than perhaps previously thought, what can YOU do about it? First and foremost, healing cannot occur while you're chronically operating in a state of Sympathetic Nervous System (fight/flight) activation. One must move into the Parasympathetic Nervous System (rest/digest) to heal. There are a variety of ways to do this, and some of them are listed below.

Meditation

Based on the research by Dr. Herbert Benson, meditation is said to "shut down fight or flight response and stimulate the parasympathetic (relaxing) nervous system of the body. Meditation has the potential to relieve stress, purify the mind, and purify consciousness. Meditation connects us to our core being or core consciousness (soul or Self). While in meditation, the Pituitary Gland releases Oxytocin, Dopamine, Relaxant, Serotonin, Endorphins when making a spiritual connection. It's an internal process that can switch on like a light switch when we take a moment to connect.

If meditation isn't your jam, try going for a walk in nature or another activity that shuts off your mind and causes breathing to slow to a feeling of unshakable peace. Even something as simple as imagining someone is sending you love, helping you, holding you, can help you heal. By visualization alone, your body releases Oxytocin which is associated with increased natural killer cells and increased white blood cells (which trigger an immune response) necessary for healing.

Support Systems

Surround yourself with people that provide support and love versus adding to your fear. For those in your life that contribute to fear, can you explore healthy boundaries to support more beneficial relationships? As tricky as relationships can be, humans are hard-wired for connection. It’s essential to establish and nourish healthy relationships with others.

Gratitude

Gratitude can help boost your immune system, cause feelings of happiness, and help you shift your world view; think Placebo Effect! When we learn lousy news, a common emotion is fear or sadness. Regardless of what is said, if you fear, a positive thought will never reach the body. Fear triggers fight/flight response in the brainstem, which takes our emotional state out of alignment and offline. Suppose you can change your emotional state into one of gratitude. In that case, you believe whatever you're grateful for has already happened. Primed with gratitude, when you say the thought or new belief, your body can receive it, and your body responds accordingly. The more we can feel the feeling as if the feeling is, our body is triggered to grow the nerve cells to make the connections to trigger the brain chemistry to reflect the healing.          

You might consider starting a gratitude practice. For some, this can look like writing down a few things you are grateful for each day. For others, you might pair mentally recalling things you're thankful for while doing an activity such as showering or brushing your teeth.

9 Healing Factors Associated with Radical Remissions 

Kelly Turner, Ph.D. (researcher, author) discovered in her research studying case studies and interviews from those around the world who experienced radical remissions from their illnesses, the nine key healing factors (listed below). Dr. Turner found radical remissions for every single type of cancer occurring in various stages. She found over 75 different things that people have tried to get well, though not everyone used all 75 factors. In her research, she discovered that everyone who got well used these 9 (note only 2 of the following are physical, the rest are mental, emotional, and spiritual):

1. Radically changing your diet

2. Taking control of your health

3. Following your intuition

4. Using herbs and supplements

5. Releasing suppressed emotions

6. Increased positive emotions

7. Embracing social support

8. Deepening your spiritual connection

9. Has a strong reason for living

Counseling

Specifically, to explore patterns (the way our thoughts, feelings, behaviors all influence each other) and shadow (subconscious) work. It's beneficial to have a trusted confidant outside your social network to: vent to, sort through feelings, identify unhealed wounds, process emotions in a healthy way, work to implement behavior changes, find healthier coping mechanisms, assess and enforce healthier boundaries, and help you identify areas where you can move from a space of surviving to thriving.

Conclusion

In conclusion, by doing different things, making other choices, getting beyond certain emotions, and overcoming limited thinking, more possibilities begin to open up. That's when magical things start to happen in a person's life. That tells us that seemingly incurable illnesses are reversible by focusing on the whole person and root causes of disease versus symptoms, which traditional Western medicine tends to focus on. Conventional medicine relies on the old belief system stating illness is tied to genetics and biochemistry, requiring prescriptions to treat these ailments. However, many believe that very few diseases are truly organic (as a result of genetics). The rest is due to the consequences of dealing with chronic stress. According to Dr. Deepak Chopra, medicine is useful in 10% of acute illnesses (physical traumas, emergency, injuries, infections). He recommends a holistic approach to treat chronic diseases (cancer, heart disease, auto-immune diseases. A holistic approach treats the mind, body, emotions, and energetic body, shifting your experience of mind, body, emotions. 

Remember, we regulate ourselves with the choices we make in our lives. Based on what we think, feel, believe, and specifically, the emotions we choose to respond to create what life brings us. It pays to make your mind a healthy place to be. 

Essential Workers & COVID: Time and Space for You

By Concentric Psychotherapist Kylie Cherpes, LCSW, MFT-IT, CYT

In times of great stress, such as now with the COVID-19 pandemic, we each find that we have our own unique way of getting through. Some people find comfort by burrowing in at home and disconnecting from constant reminders of their fears. Others juggle between caring for their vulnerable loved ones and carving out time to connect with the support that they themselves need. Some turn their stress into energy towards solving problems or creating something new. While others hit the ground running, called to serve their community. Though we are all under cumulative stress and doing our best to face changes in our day-to-day norms, some, such as Essential Workers, are being impacted exponentially. Essential Workers are being asked to do more and risk more, all while having less access to what would normally help them respond to and recover from their stress.  

Essential Workers continue their work in environments physically underprepared for a pandemic. In a time that feels precarious, Essential Workers are asked both to stay calm and to stay flexible while managing ever-changing recommendations on how to keep their workplace, selves, and families safe. They spend hours reading, learning, and preparing protocols and responses to “what-if” scenarios that breed uncertainty and anxiety. Even after all of the precautions they take, they wonder if it will be enough to keep their work-family safe. When they leave work to go home they find it hard to relax as guilt, worry, and fear about possibly carrying the virus home to their loved ones enters their mind. Though they may have reached for their family and friends for help, love, and reassurance before, it now seems too risky. Where they would go for support and stress relief before, like churches, gyms, bars, and social outings, are no longer options. And even when there is time for it, it is hard to get restful sleep. 

When unable to respond to stress, especially on-going (chronic) or traumatic stress, the body, mind, emotions, and spirit start to show wear and tear. Those under chronic stress may notice that raw feelings such as fear, anger, helplessness, and sadness seem to be lingering, or other common changes such as an increase in irritability, numbness, bitterness, or detachment (that “spaced-out” or “distant” feeling). Chronic stress can also show up as headaches, stomach aches, and muscle pain, or changes in appetite and sleep. Sometimes those under chronic stress may not even be the first to notice the impact it is having, but instead, those closest to them do. For instance, slips in memory or ability to recall information, mistakes at work that used to be uncommon, or shifts in hygiene and self-care regime may be noticed by work colleagues. Family and friends of those under chronic stress may see their loved one’s constant exhaustion, zoning out, adopting an abnormally cynical outlook on life, or lacking the ability to find pleasure in things they had once experienced as enjoyable. 

As therapists, we can close gaps in the care being offered to Essential Workers by providing access to the mental and emotional support they deserve. To support Essential Workers’ day-to-day functioning and healing, we hold space for them to process and release stress and trauma. Just as each Essential Worker has their own unique way of responding to their stress and trauma, each therapist has their own unique approach and is able to tailor care to each individual they work with. Whether it be brief or long-term, therapy is a safe place for self-expression and a secure place to find relief from fears, anxieties, anger, and sadness. Further, therapy is a place of creativity and strategy, used for building coping skills to reduce distress and restore feelings of stability and hope. 

At this time, we know that the Coronavirus is not going away anytime soon and that things may indeed get worse before they get better. We also know Essential Workers will continue to be asked to bear the brunt of this pandemic with limited space (time, resources, and support) to respond to their stress in their own unique ways. It is not an option to wait to address the physical, mental, emotional, and spiritual needs resulting from the chronic and traumatic stress being endured by our Essential Workers. Unaddressed chronic and traumatic stress does not just go away, it accumulates. As therapists, we see the effects of these stressful days mounting on our Essential Workers, and we respond to say, “We are your Allies.”

Special Announcement: During April through May 2020, Concentric Counseling & Consulting is offering short-term telehealth and virtual video counseling to Essential Workers during these challenging times due to Coronavirus (COVID-19). We are all incredibly grateful for all that you do and we want to give back! You can use your health insurance for teletherapy. Also, for those who do not have insurance coverage or have certain insurance plans and have endured financial hardship due to the impact of COVID, we are offering sliding fee and pro bono to a limited number of Essential Workers.

Where’s My Person? Complexities of Adult Friendships

By Concentric Counselor Kelsey Lamm Rottmuller, LPC, NCC

How do I feel by the end of the day? / Are you sad because you're on your own? / No, I get by with a little help from my friends — With a Little Help from My Friends | The Beatles

There isn't anything I wouldn't do for you / We stick together and can see it through / 'Cause you've got a friend in me — You’ve Got a Friend in Me | Randy Newman

If you wanna be my lover, you gotta get with my friends / (Gotta get with my friends) / Make it last forever, friendship never ends — Wannabe | The Spice Girls

And as our lives change / Come whatever / We will still be / Friends forever — Graduation (Friends Forever) | Vitamin C

Having come of age listening to song lyrics like these, and wistfully witnessing the implausible but admirable portrayal of kinship in the 90s sitcom Friends, I,  like many adults, developed certain ideas and expectations about friendship. For example, I grew up believing one should have a best friend and know how to not only make friends but keep those friendships thriving into adulthood.

But what happens when making friends isn’t as simple as swapping parts of your lunch with a classmate, or performing in the school play together? Even in college, school and extracurricular activities provided fertile ground in which the seeds of friendship could blossom, helped along by common interests and schedules structured around shared classes. Once the structured environment of school is removed and we are left to choose our own adventures, the work of maintaining and definition of friendship seems to dramatically shift for many adults. What perhaps once came relatively easily, now actually takes planning, work, and dedication.

In her Psychology Today article 5 Lies About Adult Friendships, Dr. Miriam Kirmayer unpacks and debunks commonly-held myths about friendships in adulthood. Primarily among these is that “by early adulthood, we should know how to make friends and handle the challenges that come with these relationships; that these are skills we learn early in childhood and adolescence, and that by the time we leave college or even high school, we should have it ‘figured out.’ The problem is, not only is this belief untrue, it can make us feel like we’re the only person who struggles and leaves us feeling disappointed, ashamed, or alone. This, in turn, makes it much less likely that we will reach out for guidance or support if (or when) we do struggle.”

The Struggle is Real

I’ve heard from clients, colleagues and compadres alike how challenging it can be to keep friendships alive, reciprocated, and not feeling like one more thing on a never-ending to-do list. Despite all the best intentions, life as an adult becomes increasingly busy as we fill our time with work, family, continued education, and expanding responsibilities. People move away, start families, follow jobs and hustle hard to build a life. This can leave little time and space for what feels like the luxury of friendship.

A friend from college once told me (before moving away and starting a family) that “being friends as an adult means you take turns texting each other ‘we should get together soon’ repeatedly until you die.” While that statement seemed morbid and pessimistic at the time, it also resonated with me as one of the many struggles faced in adult friendships. Everyone is so busy. Not spending time investing in and invigorating friendships can simultaneously feel like an uphill battle and a source of regret or shame.

Then there are those ‘rites of passage’ in adulthood that can make the lack of a best friend or even close friends acutely apparent. In the 2009 buddy/romance film I Love You Man, we see played out the challenge that can arise when one finds a partner to whom they want to commit but struggles to identify a platonic companion to stand by their side. This film has come up in my work time and again when discussing the loneliness and isolation experienced by clients who struggle similarly to identify close companions outside of family or casual work acquaintances. But why do we feel so driven toward close friendships? Why doesn’t simply having a safe, stable life, perhaps even shared with a romantic partner seem like enough?

The Psychology

In his Psychosocial Development Theory, ego psychologist Erik Erikson posited that young adults (defined by Erikson as ages 19-40 yrs) enter the Intimacy vs. Isolation (Sixth Stage) of development, in which they seek to resolve developmental conflicts related to emotionally intimate relationships. These relationships may be romantic and/or platonic in nature. Erikson believed that failure to resolve said conflicts by establishing close relationships could result in an experience of isolation and loneliness. According to the psychology, this sharing of self with others drives not only our romantic partnering, but also our urge to host a game night, share a multi-hour brunch, or schedule that phone call to dissect the latest Star Wars movie with our World of Warcraft guild buddy.

Psychosocial theory also suggests that a strong sense of self enables us to form intimate interpersonal relationships. Hence, feeling disconnected or unclear about our identity during adolescence - who am I? - can contribute to the struggles faced when striving for friendships as young adults. Sequentially, failure to master the formation of lasting relationships can then additionally hinder us from ‘making our mark on the world’, which is the major task of Erikson’s Generativity vs. Stagnation (Seventh Stage) of development (ages 40-65 yrs).

With each developmental stage building or even hinging upon the completion of its predecessor, it makes sense that we would feel pressure to create and maintain friendships even if we are not sure why or tend to err on the side of introversion. How can I ever Pass Go and Collect $200 – or more so – contribute to the world at large and create greater fulfillment, if I don’t have any close friends?

What Can Be Done?

First and foremost, know that you are not alone. As Dr. Kirmayer notes, it is far from uncommon to struggle with friendship as an adult. Often times, our self-imposed beliefs about how a friendship should look, or roles we are meant to play as friends get in our way more than they motivate growth. If you notice yourself falling prey to the ‘shoulds’ and ‘have-tos’, it can be helpful to challenge and reframe those beliefs, by replacing “I really should call my college roommate back” to “I want to call them, I miss our connection”. Chances are, your friends are equally as busy and will be equally as understanding and appreciative to hear from you – even if just for a quick 10-minute catch-up while you finally fold that pile of clean laundry that’s been staring you down from atop the dresser for the past week. Small steps are ok.

A quick “I’m thinking” about you text – or even better, an actual card via snail mail still tells someone they are thought of and valued. It also goes much further than a “like” on social media or racking yourself with guilt to sustain the friendship. Lean into what brings you together rather than what pulls you apart. Did you first bond over a mutual love of quirky 80’s movies? Maybe it’s time for a movie night. You can debate the most quintessential piece of John Hughes’ filmography or how well or not The Breakfast Club translates to a post-baby-boomer demographic rather than bemoaning how you never see each other anymore despite living less than 30 minutes apart. It doesn’t have to be expensive. If going out for dinner or drinks is not in the budget while you save for a down payment on that first home or even just tickets to that music festival you’ve been pining for – perhaps split the cost of ingredients or encourage BYOB and host a make-your-own-pizza kind of night.

Finally, if you find yourself struggling with emotional intimacy in general or feel paralyzed by social anxiety or depression, consider reaching out to a trained therapist or a support group. There are those that want to help, if we let them and can find the courage to ask. It takes strength to reach out for help and trust someone – friend or otherwise – in which to confide.

Thank you for being a friend
Traveled down a road and back again
Your heart is true, you're a pal and a confidant

—Thank You for Being a Friend | Andrew Gold

The Trap of Anxiety and Trauma

By Concentric Owner Jennifer Larson, LCPC, NCC

Driving my car in my early adult years filled me with freedom and curiosity. Didn’t matter if I was driving by myself, on city streets, highways or traversing the deserts of Arizona, I loved driving. Toggling between radio stations to find the right tune, opening up the windows to feel the fresh air hitting my face and throwing my hair around, hanging out with my thoughts, or being mesmerized by the pink and purple hues of Arizona’s sunsets were met and felt with ease, peace, and freedom. Fast forward several years later, and my experience of driving catapults me into feelings and sensations of feeling trapped and crippled by anxiety, panic attacks, and at times, dissociation.

To read the entire blog post on the Anxiety Relief Project’s website, please click here.

Let's Talk About Complex Trauma

By Concentric Counselor Jordan Perlman, LPC, NCC

I imagine many people have heard of Post-Traumatic Stress Disorder (PTSD) but not nearly as many are familiar with Complex Post-Traumatic Stress Disorder (C-PTSD) which is lesser-known and unfortunately, not yet recognized in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-V). And while an individual with a PTSD diagnosis, which is often the result of an isolated incident, a person who experienced complex or repeated traumas requires different considerations.

But first, it’s important to understand the differences between each:

PTSD

According to the DSM-V, PTSD is diagnosed when an individual meets the following criteria that create distress or functional impairment last more than one month, which is not a result of medication, substance use, or other illness. The individual was exposed to one of the following: 

• Death or threatened death 

• Actual or threatened serious injury

• Actual or threatened sexual violence 

• Witnessing trauma

• Learning that a relative or close friend was exposed to trauma 

Indirect exposure to aversive details of the trauma (usually in the course of professional duties), the individual must have at least one intrusive symptom that causes the persistent re-experience of the trauma in the following ways:

• Nightmares

• Flashbacks

• Emotional distress after exposure to traumatic reminders

• Physical reactivity after exposure to traumatic reminders

The individual must also experience avoidance of trauma-related stimuli after trauma either by trauma-related thoughts or feelings, or trauma-related external reminders.

Two negative alterations in cognitions and mood must be present where the negative thoughts or feelings began or worsened after trauma in the following ways:

• Inability to recall key features of the trauma

• Overly negative thoughts and assumptions about oneself or the world

• Exaggerated blame of self or others for causing trauma

• Negative affect

• Decreased interest in activities

• Feeling isolated

• Difficulty experiencing positive affect

 Lastly, there must be alterations in trauma-related arousal and reactivity that began or worsened after trauma in the following ways: 

• Irritability or aggression

• Risky or destructive behavior

• Hypervigilance

• Heightened startle reaction

• Difficulty concentrating

• Difficulty sleeping

 C-PTSD

Trauma typically associated with C-PTSD tends to be long-term, where the individual is generally held in a state of captivity, physically or emotionally. In these situations, the victim under the control of the perpetrator has little or no chance to get away or escape from the danger. Some examples might include:

• Long-term domestic violence

• Long-term child physical and/or sexual abuse

• Neglect

• Organized exploitation rings

• Concentration/Prisoner-of-War Camps

• Prostitution brothels

• Recruitment into armed conflict as a child

• Sex trafficking or slave trade

• Experiencing torture

• Exposure to genocide campaigns

• Other forms of organized violence

Some might be wondering, why is this difference important then? This is because of exposure to long-term or prolonged or repeated trauma results in a broad range of symptoms that go beyond the diagnostic criteria of PTSD, a.k.a “simple” PTSD.  As such, the basic symptoms of C-PTSD are:

• Somatization (physical problems, associated pain, and functional limitations)

• Dissociation (a division of the personality into one component that attempts to function in the everyday world and another that regresses and is fixed in the trauma, spacing out, daydreaming, or feeling strong sensations of being disconnected from one self or the world)

• Affect Dysregulation (difficulty with emotions, such as experiencing and/or expressing them, alteration in impulse control, attention and consciousness

• Self-Perception (experience of their own perspective tends to be drastically different from how others perceive them)

• Interpersonal Relationships (tend to be a struggle, difficulty with engaging with others, feeling distrustful of others)

• Perception of Perpetrators (can be skewed, or longing to be loved by their abuser)

• Systems of Meaning (doubt there is any goodness in the world, outlook on life can be dark)

Further, a 2018 study by Karatzias et al. found the most important factor in the diagnosis of C-PTSD was negative cognitions about the self, characterized by a “generalized negative view about the self and one’s trauma symptoms; attachment anxiety which is defined as involving a fear of interpersonal rejection or abandonment and/or distress if one’s partner is unresponsive or unavailable; and expressive suppression, conveyed by efforts to hide, inhibit, or reduce emotional expression.”

For those who may wonder why people affected by a long-term trauma “can’t just get over it,” the answer lies in the fact that even after a person is removed from the event, their brain may be permanently affected by that intense and prolonged trauma. And since a person’s nervous system is shaped by his or her experiences, stress and trauma over time, can lead to changes in the parts of the brain that control and manage feelings and the long-term effects are found on a physical and emotional level.  

Symptoms may manifest as:

• Eating disorders

• Substance abuse

• Alcoholism

• Promiscuity

• Chronic pain

• Cardiovascular and gastrointestinal problems

• Migraines

• Rage displayed through violence, destruction of property, or theft

• Depression, denial, fear of abandonment, thoughts of suicide, anger issues

• Flashbacks, memory repression, dissociation

• Shame, guilt, focusing on wanting revenge

• Low self-esteem, panic attacks, self-loathing

• Perfectionism, blaming others instead of dealing with the situation, selective memory

• Loss of faith in humanity, distrust, isolation, inability to form close personal relationships

Special Considerations for Survivors of C-PTSD from Childhood 

Many survivors of C-PTSD also experience Attachment Disorder which is a huge consequence of individuals who suffered complex trauma as children. Attachment Disorder is the result of a person growing up with primary caregivers who were regularly dangerous. Recurring abuse and neglect habituate children living in fear and sympathetic nervous system arousal, which over time creates them an easily triggerable abandonment mélange of overwhelming fear, shame, and depression. 

Because a child’s main attachment (to their primary caregiver) helps them learn to control their emotions and thoughts, when a caregiver’s responses are in tune with a child’s needs, the child feels secure. The child then uses this relationship pattern as a practice to build coping skills.

However, children who receive prolonged confusing or inconsistent responses from their primary caregiver are prone to be fussy, have a hard time calming down, may often withdraw from others and may have frequent tantrums. Unlike adults who have more tools to understand what is happening to them, children often do not possess these skills or have the ability to separate themselves from another’s unconscionable actions. Consequently, the resulting psychological and developmental implications become complexly woven and spun into who that child believes themselves to be, thereby creating a messy web of core beliefs that are harder to untangle than the flashbacks, nightmares and other posttraumatic symptoms that may surface later. Further, these disorganized attachments and mixed messages from those who are supposed to provide love, comfort, and safety - all in the periphery of extreme trauma - can create even more unique struggles that PTSD-sufferers alone don't always face.

Treatment Considerations 

While the symptoms can be daunting and the future seems bleak for someone who appears to be suffering from C-PTSD regardless of whether an individual has been diagnosed with a trauma-related disorder or not, there is help out there and there are ways to manage and help the individual cope. 

Treatment challenges include, Survivors:

• Avoiding thinking and talking about trauma-related topics because the feelings associated with the trauma are often overwhelming

• Relying on alcohol or other substances as a way to avoid and numb feelings and thoughts related to trauma

• Engaging in self-mutilation and other forms of self-harm

• Who have been abused repeatedly are sometimes mistaken as having a “weak character” or unjustly blamed for the symptoms they experience as a result of victimization and often have comorbid disorders such as dissociative identity disorder (DID), other specified dissociative disorder (OSDD), borderline personality disorder (BPD), depressive or bipolar disorders, anxiety disorders, obsessive-compulsive disorders, eating disorders, and substance abuse

Since many trauma specialists see Attachment Disorder as one of the key symptoms of C-PTSD, a relational, individual, approach will often be most beneficial for many of these clients. For many survivors, therapy is the first opportunity to have a safe and nurturing relationship.  Therefore, the therapist must be especially skilled to create the degree of safety that is needed to build trust or risk adding to the attachment trauma. Working with these clients is essential to the development of trust and relational healing and the four key qualities are empathy, authentic vulnerability, dialogically (when two people move fluidly and interchangeable between speaking and listening) and collaborative relationship repair. This makes therapy a teamwork approach where there is mutual brainstorming and problem-solving in a respectful way implying mutuality. All of these steps will provide the client with a “good enough secure attachment” to serve as a model for other relationships. 

However, and as expected, there is no “one size fits all” approach to working with individuals who have survived trauma, but one thing is for certain: recovery from Complex PTSD requires restoration of control and power for the traumatized person. Survivors can become empowered by healing relationships which create safety, allow for remembrance and mourning, and promote reconnection with everyday life. 

If you feel as though you have experienced complex trauma, it is important to know what happened to you was not your fault. While it is undeniable trauma changes the way we experience the world, I strongly believe like a phoenix, a person who suffered from trauma can arise from the ashes, stronger than ever before. This “stronger than ever before” is also known as “Post-Traumatic Growth.” Post-Traumatic Growth identifies a shift in personal strength and worldview as a consequence of trauma. Although you can’t change it, you can change what your life looks like going forward. One step you can take towards recovery is calling to schedule an appointment with a therapist who can help guide and support you on your healing journey.