Stress Management 101

Next in my series of ‘how to’ topics is how to manage stress more effectively. Previous posts include Relapse Prevention Essentials and Learning How to Manage Unpleasant Emotions.

Stress. It’s a word that gets used often in today’s busy-ness obsessed world, but do we really know what we are talking about when we say we are “stressed”. What is stress, really? Stress is anything which causes a person to feel unable to cope or pressured beyond what is comfortable, from feeling the urgency of a looming deadline to the blind panic one might feel whilst running from a dangerous predator. Both these examples place the person under stress to a degree.

Types of stress: internal and external

The term ‘stress’ is used in both physics and psychology. Both mean similar things, something is causing the system (you) to move beyond a state of equilibrium. When applied to humans, stress can be anything that causes feelings of pressure, tension or discomfort. There are generally two types of stress that humans experience: Internal stress and External Stressors.

Internal stress is stress arising from thoughts, emotions, bodily sensations (feeling hungry, tired, sick) and as a result of trauma. All these things increase tension which we experience as “stress”.

External stressors can come in the form of time constraints, deadlines, traffic, obligations, appointments, demands from others and financial burdens. These are all forms of external stress.

They both play off each other, in that external stressors cause internal stress, and internal stress can make it more difficult to adapt to external stressors.

Dealing with internal stress

Managing internal stress can be tricky. Much of it happens below the level of consciousness and it can seem like our thoughts, reactions and emotions are automatic or just ‘how we are’. This is not the case. Internal stress can be managed by increasing awareness of the content of our thoughts; paying close attention to the words we are saying to ourselves in private, tuning in to our emotional responses; asking questions of oneself such as, what sensations are present when I think these thoughts and generally listening to our body. Sometimes we are just tired, hungry, angry or thirsty. Sometimes, managing stress can be as simple as tending to our physical needs as they arise. For example, you might be tempted to work through lunch because you feel stressed about the volume of work you have to get through. However, working on an empty stomach makes it difficult to focus and you end up making a mistake. This ends up increasing your feelings of stress and overwhelm. If you had stopped when you were hungry and had something to eat, you would have saved yourself hassle later on.

Given that internal stress affects our thoughts, how we feel, and our actions, it is important to have tools on hand to manage all three types of internal stress. CBT (Cognitive Behavioural Therapy) strategies and Mindfulness based behavioural therapies (such as DBT, Dialectical Behavioural Therapy and Mindfulness Based Stress Reduction are all good therapies for understanding how our thoughts, emotions and actions affect each other, and how getting a handle on how these three things can impact our ability to manage stress.

Managing stressful thoughts

Often the way we think about a situation causes us to feel differently. For example, if we think of things in a negative way then we are likely to feel upset and that may cause us to act irrationally or impulsively. And, usually when we act from a stressful place, we usually end up doing things that ultimately make our situation worse, and that of course, leads to more stress. For example, you get invited to dinner with a group of people you don’t really know all that well. This is a situation in which a lot of people may experience some nervousness or anxiety about anyway. However, if your mind starts coming up with thoughts such as “I’m hopeless in these situations, I never know what to say, What if nobody wants to talk to me, Why am I so ridiculous… You get the idea, it’s easy to see how one negative thought leads to another, and another, and how pretty soon the idea of cancelling altogether seems like a good idea. However, if you had stopped yourself at any point from thinking these thoughts and consciously made a decision to think different thoughts, more positive or even neutral thoughts, the negative thought train may not have had a chance to build momentum. Learning how to tune into your thoughts and deciding whether or not these thoughts are helpful, useful or accurate takes time and patience, but it is a skill well worth practicing. At first, you may find that you have already allowed your thoughts to get the better of you and have already acted on those thoughts and are feeling regretful before you remember that you are supposed to be practicing this new skill. Don’t let that worry you. At least you picked up, albeit after that fact, that you could have chosen to think differently. Keep at it, eventually you will catch yourself mid-negative thought and actively change how you think about a situation and then choosing more positive thoughts, change how your feel and act. It takes courage, patience and practice but it gets easier the more you try.

Handling stressful emotions

Focusing on your thoughts, thinking patterns, unhelpful beliefs about yourself is a great start. However, sometimes, stress seems to hit us out of the blue. Like an emotional storm that feels uncontrollable and all consuming. It all happens so fast that before we know it, we have said something, done something or taken something we regret. When this happens, our ability to think, act rationally or even speak can be affected. The opposite can also be true. Emotional stress can build up gradually, or we may experience a series of emotionally stressful events. Sometimes, our tendency is to ignore these feelings, to push them down, or to sometimes drink or use substances as a way of ‘self-medicating’ or coping. This can sometimes go on for some time and become a way of being and merely existing, but it is not really thriving or sustainable.

The best way to handle emotional storms or feelings is to stop. That is, stop whatever it is you are doing, pay attention to the feeling or the emotions as they are happening. If you are in the middle of an emotional storm, you often act out that emotion in ways that you usually regret. The best thing you can do if you find yourself in an overwhelming emotional storm is to hold on and wait for it to pass, and it will. Ground yourself in the present moment, (breath, feel something, look at something in the room) and count to 10, breathing in and out slowly as you do. Sometimes, going for a quick walk or a run can do wonders to settle an emotional storm. And yes, it’s o.k. to cry if you want to.

Learning to experience, process and attend to your feelings as they happen is also a skill that may take some practice. Sometimes, we have old ideas about feelings that may hold us back from experiencing certain emotions. Old “programming” from childhood that may tell us that this emotion Is bad, or not acceptable. What is important to know is that all emotions are healthy, and are neither right nor wrong, they just are. They are our truth in the moment. Emotions don’t harm us it is what we do to avoid feeling those emotions or when we allow our emotions to get the better of us that causes the most damage.

Stress inducing habits

Sometimes, stress can encourage us to take short-cuts in an attempt to manage day to day or because we fear dealing with the underlying cause of our stress. Sometimes this fear is valid. We may have responsibilities, debts to pay, or children to look after and taking time out to manage our stress properly can sometimes seem like too much of a big issue to tackle, or it can slip way down on the ‘priorities’ list of school runs, work meetings, deadlines and bills etc. However, often the short-cuts we take to manage our stress in the sort term unfortunately tend to be not so good for us in the medium to long term. Alcohol, just for example, can lead to serious health problems, relationship issues, loss of time and even premature death in some cases (car accidents, mishaps, violence). In-fact, addictions in general are linked quite strongly with childhood trauma and PTSD (Post Traumatic Stress Disorder). Trauma reactions generally increase stress in the body and an affected person may be more likely to turn to addictive behaviours or substances as a way of coping with the ‘unspeakable’. However, it is important to know that addictions don’t really solve a problem, they just delay the inevitable. Other stress inducing habits include poor time-management, staying up late (when you know you have to get up early the following day), eating junk or takeaway food in the name of ‘convenience’, leaving things to the last minute rather than attending to them as they arise,

External Stress: Prevention is better than cure

External stress as stated above involves stress that is external to you. First thing I recommend is doing what I call a ‘stress audit’. That involves simply writing down a list of all those things that cause you stress and working out what items you can do something about and those you can’t. For a very simple example, driving to work often causes a lot of stress because the traffic is out of control and getting worse. Consider taking public transport or leaving 15 minutes earlier. Or if your work is flexible, arrange for a later start time to avoid the peak hour crush. That is a very simple example and granted, there are some stressful situations which are out of your control. For those situations, practice letting go of struggling with unhelpful thoughts related to a situation you cannot control and try to focus your attention on those things that you can do something about. However, for those things that are in your control, small changes can add up to huge benefits when you put your mind to useful thinking and problem solving.

Making concrete lifestyle changes can be challenging, especially when coupled with having to give up an addiction or habit which previously seemed like your only way of managing or coping. It is well worth the effort however when you find out how to properly deal with stress in ways that truly benefit you and those around you.

Complex trauma and stress management

O.k. time for a disclaimer. The above advice is general in nature and you should consider your individual circumstances before following my or any advice you read on the internet for that matter!

However, I do want to acknowledge for some people who have experienced significant and extended trauma or who suffer with the effects of Complex-PTSD the above information may seem contrite or over-simplistic for your situation. I get it, however, trauma is not what happened to us but how our body responds to what has happened. This response creates added intensity to our experiences of and dampens our ability to handle every-day stress. The above techniques and ideas may not be and is not intended to be an overarching solution to complex stress, but the basic ideas are sound and can help with some of the effects of complex trauma such as anxiety, addiction, depression and avoidance.

If you are experiencing the above symptoms, seek out help. Your GP is often the first port of call however, it is easier than ever to find a therapist online or try out some of these online based courses for managing stress and anxiety. Most of them are free too which is not a bad thing.

https://mindspot.org.au/

https://moodgym.com.au/

Relapse Prevention Essentials

So, you have completed detox and you have promised yourself, and others, that you will stay sober.

Now what?

Recovery is about more than just quitting a particular substance, like alcohol or drugs, or stopping an unwanted behaviour, such as gambling or masturbating to porn. (If it were that easy, there would be no reason for me to be writing this guide!) Recovery is a personal journey, and it is different for everybody. For many, it is essentially a journey into unknown territory, so it is essential to have a plan, or at least a compass to make sure you don’t get lost or keep going around in circles, like the diagram above which shows the stages of change conceptualised by psychologists Prochaska and Di Clemente. The more times you cycle through the different stages, the easier it gets apparently, there-for creating more of an upward spiral, rather than a repetitive cycle.

But how can you turn your cycle of change into an upward spiral instead of a merry-go-round that never ends? Rehabilitation services are lengthy for a reason. It takes time to undo months, or sometimes years of dependency and habitual use of alcohol, drugs or unhealthy behaviours that have developed over time. But, not everyone can take the time to attend an inpatient service, or have obligations to family, pets or work commitments. If you fit into this category, and you have just completed a detox of some sort, then the below are essential for improving your chances of success this time around.

The Change Spiral according to Prochaska & Di Clemente

Recovery Essentials:

1. Get the basics right. Focus on sleeping, diet, exercise, taking prescribed medication as directed, water, nutrition. Getting as good a night’s sleep as possible is the single most beneficial thing you can do to improve your physical, mental and emotional health. Look up sleep hygiene for some tips on getting a good night’s sleep. Watch what you eat, move away from fast or pre-packaged food and try to fit in some home cooking. Look up recipes on YouTube or ask a friend to help if you can. Drink plenty of water. Take any medication as prescribed. Exercise daily. Give your body the love and care it deserves, even if you don’t feel like doing so at times.

2. Connect. Find a peer support group. AA and other 12 step groups or SMART recovery are both free support groups for anyone reaching out for help. The benefits of finding and connecting with a group to support you have been well documented.  Informal friends, online supports and communities are also available nowadays thanks to the internet. Recovery can feel like a lonely place. It helps to know you are not alone.

3. Counselling. See a counsellor or psychologist regularly. Counselling in conjunction with peer support can help you to explore, reflect on and focus on your recovery goals with a supportive, compassionate other. Understanding what led to your addiction can help provide insight, motivation and direction when needed. Simply having someone to talk to, honestly, about your journey can be invaluable.

4. Utilize day programs. Free day programs are available, use them if you are not working or studying full time. Look up out-patient rehabilitation services in your area. Most day programs run 3 times a week, some are daily for 6 -12 weeks on average. Day programs are helpful when you have commitments to children or pets as you get to go home each day.

5. Talk – to your friends, family and community. Addiction is often clouded in shame. Because of this, many people find it difficult to talk about their struggles. Shame thrives on silence. I’m not saying, shout it from the rooftops, however, those closest to you care about you and are in most cases willing to help. Of course, it is important to be discerning when it comes to who is worth sharing with but don’t think you are in this alone. Connection is the opposite of addiction. This is another reason why formal support groups such as AA or SMART Recovery are so valuable.

6.  Read, listen, watch. There is a lot of ‘quit lit’ out there, starting with the big book of AA (worth a read). If reading is not your thing, check out podcasts, apps and watch YouTube videos about recovery. Learn from others and educate yourself on addiction, brain science and the latest interventions. You will feel less alone and it will help you to stay motivated to continue with your sobriety.

7. Cleanse. Cleanse your device, your social media feed and your life of all potential triggers or people that remind you of your addiction, as much as possible. It is important that you prioritise your recovery especially in the early days/months. Detox is not just for your body. In many instances, detoxification is a process of systematically removing those things, people, places and habits from your life that no longer serve you. You may have to delete several numbers from your phone. At the very least, delete and block your dealer’s number!

8. Get creative or busy. Write, draw, paint, sculpt, tinker, redecorate, fix, repair, renovate, plant something, play something, collect something. Use that brain and fire up those neurons in a way that stimulates novel thinking. Creative pursuits and hobbies can also help with stress reduction.

9. Learn something. If you are not working full-time, recovery is a great opportunity to re-train or up-skill. If there is something you’ve always wanted to learn to do, now is the time to do it. Learn a new language. Learn how to play an instrument. Take a short course or go back to school/uni. Use that newly created space which you created in a positive way. Make a decision to only add things to your life that are joyful, positive or beneficial to you in some way, which brings me to my last point…

10. Cultivate a mindfulness practice. Whether in the form of a formal meditation practice, or simply moments of ‘dropping in’ to the present moment throughout the day. Learning how to pay attention to the present, mindfully, non-judgementally and on purpose is the essence of mindfulness and will help you immensely with your newfound sobriety. In a sense, mindfulness is also the opposite of addiction in that it is the opposite of what happens when we are intoxicated, drunk or high or in some other way ‘out of our minds’. Learning how to tend to ourselves in the present, to sit with and accept all our thoughts, emotions and sensations without trying to change or avoid them takes practice but is worth the effort. In essence you are learning how to be yourself, to be with your self and to accept yourself as you are, compassionately and non-judgementally. There are many resources, including apps, websites and books on Mindfulness available now, a simple internet search will provide you with a tonne of information.

So that’s it. My top 10 essentials for a successful recovery and relapse prevention plan. Of course, this list is not exhaustive but if you think I have left anything out that should be there please feel free to comment below.

Hope lost and found

Photo by Pixabay on Pexels.com

It is Sunday afternoon, December 20th. As I write this, I am sitting in the back yard (if you can call it that) of a little townhouse in Melbourne where I live with my husband, dog and cat. The sun is out. The cat is sitting in her favourite wicker chair and the dog is probably on his favourite spot on the lounge. My husband is having an afternoon nap. For those things, I am truly grateful. However. This morning, I was still hopeful that I would be heading off tomorrow to see my friends and family in Sydney for Christmas. That hopeful state has since been withdrawn as the Victorian premier has announced that he will be closing the borders as of midnight tonight, due to a recent outbreak of the dreaded Covid-19 virus in Sydney. After months of lockdown, and numerous other cancelled trips, I had been looking forward to ending the year on a bright note. Alas it was not to be. However, given that it is still 2020, I shouldn’t have been surprised.

I now find it ironic that my mother-in-law had asked me to prepare and read out a small prayer on the topic of hope for the Sunday service that morning (my husband’s parents are both ministers). I admit, I had not given myself much time to prepare it as I had spent the last two days busily running about buying Christmas presents, and generally preparing for the expected week away. On Saturday, the premier had announced a “traffic light” permit system for returning travellers from NSW. On Saturday, I still held hope as were not going to be travelling anywhere near the “red zone”. By the time the service ended at 11:15 on Sunday December 21st, that hope was gone.

So I found myself sitting through and participating in a service all about ‘hope’ without really giving it much thought I admit. It was not until after the service, when I arrived home (to a message from a friend on Facebook asking me if I had seen the news) that I really understood what hope was and was not. It was not until then, when my hopes were finally and utterly redacted, that I realised what hope truly was. Hope is the absence of hopelessness. Or in other words, the presence of a potential future that contains a desired outcome. Without that future, hope vanishes.

Hope as the antithesis of depression.

Counsellors and psychologists often use the K10 as a measure of psychological distress. The K10 is a short 10 question survey which asks clients a series of questions about their mental health state. Question four on the K10 asks about ‘hopelessness’. Its placement on this widely used measure of anxiety and depression is a testament to the importance of hope as a measure of wellbeing. The lack of hope signifies something is missing, something important and necessary for good mental health. A state of hopelessness certainly makes it very difficult to get out of bed in the morning. A sense that nothing good will happen, that your efforts are useless or that nothing holds any meaning, are among some of the hallmarks, and clinical symptoms, of depression. If hopelessness is a symptom of depression then hope, its opposite, is a sign of a healthy individual. But what is hope, really?

Defining hope.

We often use the word hope in everyday language without giving much thought to its deeper meaning. How often have you heard yourself say, “I hope I get through these next set of traffic lights” or “I hope my boss doesn’t notice that I’m running five minutes late.” Hope is so much a part of our everyday language and expression that its true meaning and importance are often overlooked. So, for a basic definition I turned to Webster’s dictionary online. Hope is defined firstly as an intransitive verb, meaning “to cherish a desire with anticipation or to want something to happen or be true”. That, I would say is how most of us use hope in everyday language, as in the examples I give above. However, the transitive definition hints at a deeper, more nuanced meaning, “to desire with expectation of obtainment or fulfillment” and “to expect with confidence”. Webster’s also links the definition of hope to the word “trust”. Hope, it seems, is something more than a simple desire or wish as it is sometimes defined. Hope is a desired outcome expected to come about.

Hope, a vital ingredient

In psychotherapy research there is a concept called the “common factors approach”. This came about when a bunch of researchers[1] got together and did a lot of reading of many studies of different types of therapy models, compared apples to oranges so to speak, to see which therapy style was the most effective. They ultimately found that there was little difference between therapy styles. All were more or less equally effective in helping clients to change in the ways they wanted to. This has come to be known as the ‘dodo effect’. The idea borrowed from Alice in Wonderland when the dodo bird declared, “All have won, and all shall get prizes!” The next logical question that these researchers asked was, well if the type of therapy isn’t what matters, then what is it? What is it about therapy that clients find actually helpful?

It was from this research that the idea of the common factors approach emerged. That is, there are factors similar to all types of therapy models that form the key ingredients of change in therapy. You see, psychology has always had a bit of an inferiority complex, it has always wanted to be seen as a ‘real science’ (ignoring that people are not as easy to study as other mammals or nature in general). In order to be accepted as ‘scientific’, psychology has tried to measure the effectiveness of specific, (usually manualised) psychological approaches on certain populations, comparing this approach with that approach, and generally attempting to treat people as laboratory specimens and mental health issues as biological diseases. These approaches are similar to those used in medicine and clinical trial research which prioritizes random controlled trials and generalizable statistics. What these researchers discovered was that the answers to what works in therapy are not that ‘clinical’ it seems, but more human and relational in general. The four common factors were identified as

  • Extra-therapeutic factors (things external to the therapy sessions such as getting a new job, relationships etc.)
  • The strength of the therapeutic relationship
  • Theoretical knowledge
  • Hope and expectancy

As you can see, hope forms a vital ingredient in the value of counselling and without it, therapy usually stalls. Quoting psychotherapist Jerome Frank in his article, Hope – the neglected common factor, Denis O’Hara echoes the importance of instilling hope in counselling as he notices, “Hopelessness can retard recovery or even hasten death, while mobilisation of hope plays an important part in many forms of healing.”

So there you have it. Hope gives us energy, motivation and direction. Without it, we flounder, flop and fail to thrive. The year 2020 has been a terrible year for humanity and we have all suffered to a degree due to a variety of factors, the covid-19 pandemic being just one of them. Though I started writing this post 10 days ago it is now the eve of 2021. If ever there was a need for hope, now is that time. Not just the simple hope that we throw about mindlessly, but the hope that is bound in faith, trust and gratitude – the kind of hope that I imagine Christmas was meant to be about.

So here is my little prayer for hope that I shared that day. It is my sincere ‘hope’ you find it comforting in some way.


A prayer of hope

Lord,

Help us to live in hope, rather than in fear.

And help us to understand that hope equals faith when it is linked with love

Teach us to live with hope in our hearts, so that we can fill our days with quiet assurance, instead of anxiety.

Please shine a light where there is darkness.

And let truth, love, joy and peace reign instead of hate, lies, fear and grief.

Right now, the world needs hope more than ever!

For hope is the spark that sets good things in motion,

So hope turns to gratitude, and gratitude to peace.

We trust that your light will show us the way and to help us

To live in hope, love and fearlessness.


[1] Duncan, B. L., Miller, S. D., & Hubble, M. L. (1999). The heart & soul of change : what works in therapy / [edited by] Mark A. Hubble, Barry L. Duncan, and Scott D. Miller. Washington, DC: American Psychological Association.

Mindfulness at the coffeeshop

I wrote this piece a few years ago when I first started practicing mindfulness.

The other morning I was on the way to a training class for
my upcoming clinical placement. I stopped into this newish
coffee shop that had just opened around the corner. A typical
hipster joint so I wasn’t expecting too much in the way of
friendly service. However I was still rather shocked when
the young and expressionless barista abruptly raised her hand at me,
in a kind of ‘talk to the hand’ gesture, as I was giving my
order. Apparently, I had spoken out of turn. (According to
some new world social order in which barista’s held the
highest authority and us mere customers were supposed
to wait until spoken to before opening our mouths.)
It took me a second to register what had just happened. My
internal dialogue went something like this, “Did she just
raise her hand at me, essentially treating me like a child?
Did I just see that?” My first instinct was to say something
in order to voice my sense of righteous indignation, but
instead, I stopped. And asked myself the question, “What is
really going on for me here, right now?” And, I observed that
my heart rate was going a little faster, and I could feel
my cheeks get a little hotter. In other words, I was pissed
off. In that one simple gesture, she had made me feel like
I was about 3 feet tall.
So I let it go. Somehow, simply acknowledging my anger and
just sitting with it for a few seconds, it had lost its
sting. And then I thought, is this what they call being
mindful. Is this mindfulness in action? Well, if it is I guess it
works. I had been attempting to learn meditation over
the last few weeks and up until that moment, I had thought
it wasn’t having any effect at all, but maybe it was…

Addicted to Outrage?

Can we be addicted to negative emotions? Such as outrage, anxiety, fear, anger, depression, guilt or feeling ‘hard done by’?

We normally associate addictions with more or less positive things. Substances and behaviours that make us feel good or better in some way. Alcohol, helps us to relax, or feel happier or intoxicated. Cannabis can help us to chill, calm down or get lost in the music. Amphetamines can makes us feel confident, energised or ‘on top of the world’. Porn can makes us feel powerful, in control and aroused. All these things can help us to forget or distract us from pain, discomfort or relieve stress in some way. So it would make sense that some of us could get ‘addicted’ (attached to if one goes by the old definition of addiction as I discuss in an earlier post Why is the word addiction so controversial?to these sorts of things. However, it has recently occurred to me that perhaps we can also become addicted to negativity in some way.

You may balk at the suggestion. Anxiety feels awful. Depression is terrible. Why would anyone want to continue with such negative emotions? I guess one needs to look at the pay off. What does one get by continuing with these emotional states that make us feel bad or worse in some way. Or, another way to look at it is, what do you get out of doing by continuing to feed the negative emotion?

Let’s take anxiety as an example. What does anxiety stop you from doing that you might otherwise do. Drive a car? Get a job? What do you get to do by not doing those things…. well you get to avoid the discomfort, fear and the possibility that you may get hurt in some way. You get to feel safe. You get to avoid uncertainty. And you get to avoid having to change. And, ever notice how the more you give in to your anxiety, and the more you allow depression to weigh on you the bigger and heavier they tend to get? It’s as if you are carrying around a heavy load or burden around with you…

Eckhart Tolle, author of The Power of Now, spiritual teacher and all round amazing human often talks about the concept of the “pain body“. The concept of the pain body is a strange one to get your head around. It is, according to Tolle, made up of all the slights, painful experiences and unfinished business that you carry around with you in your body, unconsciously. Any painful experience or trauma memory that has not been adequately faced or resolved at the time it occurred becomes part of our pain-body. In a healthy person, it may lay dormant most of the time, but some people live entirely through and completely identify with their “pain-body”.

Your pain-body can be awakened or ‘triggered’ by anything – an event, a person, an argument, a situation. Often it is awakened by something that happens to remind us of a past trauma or event. The current painful event awakens the pain-body and in that moment we become the pain-body. That is, we identify with our pain-body 100%. In ACT we call that “fusion“. Fusion is when we are so caught up in our beliefs, thoughts, memories, or pain that we believe those thoughts and are overwhelmed by the emotion generated that we in a sense, stuck to those thoughts, so much so that we become those thoughts.

The pain-body wants to live, according to Tolle, like any other entity, and it feeds on negativity and pain. And, the more we feed it, the more it wants and the stronger it gets. When we are living through pain, or in our pain-body, it can seem as if everything and everyone is against us. We see the world in terms of black or white, us vs them, good and evil. When we are in pain, we often lash out at others, and want others to be in pain too. We want to be right about our pain and therefor unconsciously seek more pain in order to prove ourselves right about how bad everything really is. The more we live through our pain-body the bigger, stronger and more dominant it becomes.

When we identify 100% with our painful thoughts and memories, we can sometimes act in ways that are unhelpful, hurtful to ourselves and others and are generally unpleasant to be around. We can act in ways that take us further and further away from our goals, values and true self. When we act in the service of our pain-body, we may think that we are doing something about our pain, but we often act in ways that bring us more pain. I am reminded of another famous quote by Eckhart Tolle is,

addiction starts and ends in pain.

We can also become so used to being in our pain-body that we may come to prefer it. We may become more comfortable being angry, depressed or outraged that we no longer remember what it is like to not be those things. In essence, we can become addicted or attached to our pain because for some of us, that is how we identify.

But there is another way to be. When we realise that the only power our pain-body, or our trauma history, has over us is the power we give it then that is the first step towards becoming free of our free-loading pain-bodies. Often in therapy, at some point in time clients often say they feel lighter, more at ease, or as if a weight has been lifted from them. Maybe, this is their pain-body dissolving? It is worth a thought.

A positive affirmation to help dismiss or weaken our own body of painful experiences:

The only power the past has over me is the power I allow it to have.

I allow myself to be free from the past,

I release all pain, resentment and anger,

I am at ease with who I am today,

I am free to be me.

Online counselling service now available

I’ve decided to start offering online counselling sessions for anyone who is interested. Please visit my counselling website: FrancescaPcounselling.com for more information.

Just in time to cash in on today’s social distancing trend I might add… 😦

However, seriously, I work as an addiction counsellor full-time, so I can only offer sessions after hours (AEST) and on weekends. I will be offering video sessions only (I’ve been using google meet but can do zoom, skype or FaceTime etc)

Those who follow this blog may know that my speciality and interest is in addiction, but I am trained as a generalist counsellor so whatever your concern or issue is, please feel free to contact me for a confidential chat and we can go from there.

I have a profile on psychology today which I keep updated regarding my availability so you may want to check that out too.

What’s it like living with a “porn addiction”? Lonely, according to the results of my research.

Exploring the Lived Experience of Problematic Users of Internet Pornography– A Qualitative Study is a research project I conducted as part of the requirements for the Master of Counselling & Psychotherapy course I have recently (finally) completed. While it’s soon to be published in the peer reviewed journal Sexual Addiction & Compulsivity, published by Taylor & Francis, in this post I reflect on what it was like to research this topic and I share some of the responses I received which highlight, to me, the seriousness of this emerging problem. I will post a link to the peer reviewed article here soon as it is published but I have uploaded a preprint version to Research Gate which I have linked to above.

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In 2019 I completed the last few subjects of a Master of Counselling & Psychotherapy course I had started in 2016. As a qualified counsellor, working as a clinician in a youth mental health service at the time, I decided to take my time and just work through the units one subject at time. With a couple of semesters off here and there, three years later I was happy to see the end in sight with the last hurdle being the big research project which took up 4 out of the 12 units I needed to pass to complete the course.

I decided to do my research project on sex “addiction”, specifically, problematic use of internet pornography (note, there is no DSM diagnosis of sex addiction, to date, however, the ICD-11 now has a diagnosis of Compulsive Sexual Behaviour (CSB) disorder, which covers problematic sexual behaviours.) Having encountered several young male clients through the youth mental health service I worked at who were experiencing problems with their porn use, as well as previous experience with a partner who disclosed his own struggles with porn use (which I initially discounted as nothing to worry about!) – I thought there was something to this issue which needed to be looked into further. At that time, (2015 ) when I first started to research the literature on problematic internet porn use, I was completely unaware of the extent of the problem. In my informal research, however, I found the website www.yourbrainonporn.com and Gary Wilson’s now infamous TED talk (The Great Porn Experiment) and other TED talks on the subject, which was a wealth of information as well as an eye-opener. In my academic research I found some very interesting papers, including A. Cooper’s prophetic 1998 paper: Sexuality and The Internet: Surfing into the New Millennium which described some of the ways the internet was having an effect on human sexuality. In this paper, which has been well cited, Cooper highlights three aspects of the internet which he predicted, accurately it seems, could transform human sexuality. These were access, affordability and anonymity. The results of these three factors has resulted in an explosion (pardon the pun) of pornography on the internet and to give you just a drop-in-the-ocean statistic, Porn Hub boasted a whopping 42 billion visits in 2019 alone. And that’s just one website. That figure alone is staggering. (In my literature review which forms part of my research report I provide an extensive overview of the literature for and against the conceptualization of problematic porn use as an addiction.)

But despite these numbers and the overwhelming amount of academic research I found, including this 2019 review which did a pretty good job of summarizing the research and some of the controversy surrounding the, still ongoing, debate on sex and pornography, there are some who insist on downplaying the issue. Despite the inclusion of CSB disorder in the World Health Organization’s ICD-11, I found articles which went so far as to say Sex Addiction and Porn Addiction “do not exist”, or were not “real” or a “myth” and that believing you are addicted to porn is the cause of your symptoms, not the result of engaging with porn itself. I noticed pretty quickly that these authors tend to selectively quote studies which support their position, whilst stating that there is no “scientific evidence” to support the notion of sex or porn addiction (I found plenty). These types of articles all seem to share common themes; that religious beliefs or morality play a big part in why people struggle with porn use, and that those who voice any opposition or concern about the effects of excessive porn use are “anti-sex” moral crusaders, puritans or religious prudes. Granted there is the understandable concern that the term “sex addiction” is problematic in that it could potentially pathologize activity that is just a normal variant of a natural human behaviour, but their contention that porn addiction does not “exist” is “harmless” or is beneficial to society is itself problematic. Granted, there is evidence that moral conflict about pornography plays a part in users’ distress, (how could it not) however, it is a factor only, there are others. Rarely do they mention the potential effects of exposure to extreme pornography on children, the extreme and highly concerning content available to anyone, the links between internet pornography and sex-trafficking and rarely do they take into account the ocean of anecdotal evidence from users themselves. If anything, pro-porn advocates actively dismiss the growing tide of anecdotal evidence to be found online.

So, what’s the real story here? Are users getting addicted to internet pornography use, or not? Or are we too hung up on semantics? Does it really matter whether we label something an addiction or not anyway? In the end I suspect not, however, to blanket deny that there is an issue is the height of irresponsibility, somewhat delusional and invalidating in the extreme for those who self-identify as problematic users of internet pornography, or “porn addicts” – for want of a shorter term. Perhaps the issue is the word “addiction” and what can and can’t be called an addiction, medically speaking. Well, that is a topic for a whole other post, but if we can get over the linguistics for a moment, surely, what really matters here is that people, men mostly and their families, are suffering. Why, in this age of #metoo am I so interested in men’s suffering? Because, as a society, we cannot afford to ignore men and their suffering because men who suffer often affect others around them negatively too. Children, partners, other men and society in general. We all have a stake in this issue. That is why, for my research I wanted to find out why there are more and more people turning up on internet forums and sub-reddits, such as nofap and reboot nation to name two of the most popular ones, complaining of their struggle to give up porn and related problems, which they attribute to their ongoing and excessive use of internet pornography and masturbation.

Qualitative research is used in the social sciences to describe something in detail and more depth. It mainly uses words rather than statistics and is not meant to be generalized, but rather a deep dive into a particular topic. It is specific and often descriptive. So, my study took the form of an online anonymous survey of 20 open ended questions which asked participants who self-identified as problem users of internet porn, to write about their experiences. The questions asked were general and required participants to write out answers in their own words. There was no word limit, so I got a broad selection of answers, some short and to the point and some lengthy and detailed.

The survey was live for around 6 weeks and altogether 53 participants took the time to answer all 20 questions and submit their responses. I remember reading the first few survey responses as they came in, and immediately started highlighting and taking notes of what I was finding. I was firstly surprised at the level of apparent openness and honesty of some of the answers. It soon became apparent to me that these participants, (99% men), had clearly struggled with an issue that was bigger and more formidable then they had first thought. Concerningly, many reported first accessing online pornography as children, and the youngest said he was 6-years-old the first time he viewed internet pornography:

I must’ve been aged 6, I was laying in bed—alone—flicking through channels, & from nowhere came, well, porn. I can distinctly remember being: traumatised, intrigued, disgusted & aroused. My innocent infantile mind couldn’t process it.

At the other end of the scale, one man reported first finding online pornography at age 40. As you can see, quite an age range. Yet, the average age of first-time-viewers of porn on the internet turned out to be 14.89 years. I put together some super-simple stats that came out of the study below.

  • 36% (19) respondents mentioned erectile dysfunction (ED) or weak/flaccid erections or inability to maintain an erection during actual sex.
  • 70% (32) respondents report engaging with online porn instead of doing other important tasks, such as going to school, university or work
  • 88% (46) reported their porn tastes changing or escalating to more extreme porn over time.
  • Only 9 mentioned seeking professional help for this issue.

Whilst my study was very small, only 53 complete responses, the answers were far richer and more detailed than I had even hoped for. It was overwhelming to be honest. After painstakingly coding and collating the codes into themes, I slowly built up a picture of what it means to live with a pornography consumption and masturbation problem. And while I ended up with three main themes, the one overarching feeling I personally got after reading through answers could be summed up in one word: Loneliness.

Loneliness, disconnection, isolation, feeling cut-off from other people and society, an overwhelming inability to engage with other human beings, and ultimately the Self, in a positive, meaningful, joyful or authentic way. The spectre of porn addiction appears to cast a long, diffuse and murky shadow on its followers, and it looks to be one that many users struggle to get themselves free of. Comorbidity is a factor (as it is in substance addiction) however, that does not discount the specific issues reported that seem to be directly related to these users’ excessive porn use.

But enough from me, the whole point of my study was to essentially let the data speak for itself. I will certainly post a link to my study when it gets published, but in the meantime, in order to do justice to the participants who took time out of their day to share their experiences, I thought I would post a “sampler” if you will of some of the particularly poignant responses I received, of which there were many. Too many to post here.

Selected responses from Exploring the Lived Experience of Problematic Users of Internet Pornography: A Qualitative Study.

“After 16 years old, after my tastes escalated, I was very sad (nearly depressed). I had low self confidence, ashamed of myself and some social anxiety.   I had no concentration also, porn may be related.   I had no love or desire to search someone other than to have sex or for the social benefit of it (bragging to friends). So I had no relationships during highschool, I think porn impacted it deeply.   In the beginning of college, I was alone in my appartment so I could watch when I wanted. Then I developed a very strong social anxiety, I was very stressed. I was very depressed as well, it occurs a lot when I drank alcohol. I still had friends but no love relationships.   No erection without porn.   Less ambition.   I was more introverted and not very open to people.”

“I have never been in a serious relationship. My sex life is non-existent and I have an unhealthy sexual ideal. I have noticed mental, emotional and physical symptoms similar to the high and crash from drugs/alcohol. During the time in adolescence that I should have been learning and building social skills and healthy connections, I isolated and defaulted to porn and video games as well. Instead of pursuing real sexual relations and healthy friendships with women, porn has served an easier, quicker solution.”

“Guilt. The sense that I continue to let myself down, and let others down. The fact that it has any kind of hold over me is disconcerting. Then there is the sheer amount of time I have spent viewing internet porn rather than doing something constructive.”

I’m lonely and depressed. I’m scared of trying to connect with women and commit to stopping because I’m ashamed of being inexperienced.”

I’m not doing well in life, i barely have sex i love fapping ive become an under achiever and have achieved nothing worthwhile i entertain too much i dont sow but wish to reap a huge crop.” 

“For a very long time I have been dealing with depression, anxiety, loneliness and isolation and it’s difficult to determine what is the relationship of my porn use to these problems. On the one hand, porn has brought me relief and even a better mood in many difficult moments. On the other hand, porn might have influenced my view of women in a negative way.”

“It took away my ability to process the world with any emotion. My porn use put me into a state of emotional and social withdrawal in almost every aspect of my life, and because of that, I suffered significantly socially, romantically and academically. I lost many years of my development because I could not feel any pleasure and I could not make sense of the world – my mind was in a state of constant turmoil.”

“I never had a partner because porn kept me from even looking for one. I was scared to interact with someone in general but then also having to slowly bond with them and constantly working on maintaining a relationship seemed like too much of a struggle and not worth pursuing. Porn was a way easier “fix” for my loneliness.”

“I don’t really have relationships. That’s why I view internet porn. But a couple of times I’ve come out of short-term relationships and felt a sense of relief that came from knowing I was free to go back to internet porn, and I know that that can’t be a good thing.”

The above are direct quotes from the survey responses I received as such they have not been edited. As I said, these are just some of the answers received to my survey. I just want to take the opportunity to say a big thank you to all the participants who took time to complete the survey. I was humbled by their honesty, vulnerability and willingness to participate. I wish anyone struggling with this issue healing, connection and encouragement to seek help and support. Some resources are listed below. I am currently taking on a limited number of private clients (via Zoom only) for individual therapy. My counselling website is www.francescapcounselling.com

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Lifeline: 13 11 14 / http://www.lifeline.org

Mensline: 1300 78 99 78 / http://www.mensline.org.au

Beyond Blue: 1300 22 4636 / http://www.beyondblue.org.au

Mantherapy: 1800 2738255 / http://www.mantherapy.org

http://www.yourbrainonporn.com

 

 

 

 

Why is the word “addiction” so controversial?

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At the time of writing, there are now numerous studies including several reviews of internet pornography use, which indicate that compulsive use of internet pornography, like drugs or alcohol, is addictive. Yet there are some researchers, scientists and even clinicians who refuse to accept that sex or internet pornography can become addictive. They are a relatively small group but, as the saying goes, small does not mean quiet. In-fact, they are very vocal with their assertions and are often cited in the general media as “experts” in the field. One of the more prominent ones even offered therapy advice via an internet pornography cam site. In-fact a casual search on the internet will net you many articles claiming to ‘debunk’ the ‘myth’ of sex and/or porn addiction, citing a select few researchers and studies which support their “porn is harmless” stance or to explain the reported negative effects as the “belief” that you are addicted to porn that is a problem, not your viewing habits themselves. There also seems to be a current and ongoing Twitter battle for the hearts and minds of anyone who cares to listen on what can and cannot be called an “addiction”.

Why is this so? Anyone who cares to do their own actual research into the matter will find many studies and a growing number of systematic reviews of the research (a systematic review is when you do a search of a topic, collate all the studies you find, and attempt to come to some consensus of what the studies are reporting). However, Gary Wilson of the website Your Brain on Porn has a very thorough job of collating a long list of reviews and studies on the effects of porn which you can access here – if you have a free week or so to wade through them all! One thing I can tell you at a glance is that these studies are all primarily peer reviewed research articles and some are reviews of the research. It is hard to argue against the sheer volume of literature out there now on the topic, yet the T’war (Twitter War) rages on. There are even legal proceedings underway indicating that what started out as an academic debate is now getting real-world serious, with a number of individuals filing defamation suits against one particular researcher who seems to have taken things very personal indeed.

My own thorough review of the literature, which my own study supports, is that the research on problematic pornography use is leaning towards the classification of this phenomenon as a ‘behavioural’ addiction. Meaning, the person is “addicted” to an activity or behaviour, rather than a substance. The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) has already included one behavioural addiction in its category called “Substance Use & Addictive Disorders” (APA, 2013). However, interestingly, the terminology of the DSM-5 does not use the word “addiction” to describe any of the diagnoses in this category, despite the use of the term “addictive” in the category heading. In fact, as Richard et al. (2019) point out, they specifically state that the use of the word “addiction” has been removed because of its “uncertain definition and its potentially negative connotation’ (APA, 2013, p. 485). Despite its seemingly awkward welcome/not welcome guest status, the word “addiction” refuses to leave the party graciously. It continues to hang around in common usage and in both academic and social media circles, lurking about like the friend that no-one wants to admit knowing.

So why is the word “addiction” so controversial?

At the centre of this academic and social media tempest seems to be the word “addiction” itself. In order to make some sense of the passionate debate that is still raging as we speak, I thought it might be time to take a closer look at this currently unfashionable, problematic yet persistently sticky word “addiction”. Firstly, I shall look at some definitions, then I will attempt to look at the history of the word and finally I will add my own, humble, opinion at the end.

The American Society of Addiction Medicine (ASAM) defines addiction broadly, as “a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviours. Addiction is characterized by inability to consistently abstain, impairment in behavioural control, craving, diminished recognition of significant problems with one’s behaviours and interpersonal relationships, and a dysfunctional emotional response.”

The Centre on Addiction’s definition of addiction is similarly broad, “Addiction is a complex disease, often chronic in nature, which affects the functioning of the brain and body. It also causes serious damage to families, relationships, schools, workplaces and neighbourhoods. The most common symptoms of addiction are severe loss of control, continued use despite serious consequences, preoccupation with using, failed attempts to quit, tolerance and withdrawal.”

Popular psychology website, Psychology Today states that a “person with an addiction uses a substance, or engages in a behaviour, for which the rewarding effects provide a compelling incentive to repeat the activity, despite detrimental consequences. Addiction may involve the use of substances such as alcoholinhalants, opioids, cocaine, and nicotine, or behaviours such as gambling.”

The APS defines addiction in terms of criteria for diagnosis relating to substance use disorders, and only mentions gambling and internet gaming as examples of behavioural addictions in line with the DSM it publishes.

Of course, there are others but I’m sure you get the idea. The common theme seems to be this: Addiction affects the reward centre of the brain, which causes the addicted person to want to engage in the activity or use the substance repeatedly, which in time causes the person to be unable to stop or reduce using the substance despite wanting to, and in the face of increasing problems caused by the addiction. But what does the actual word “addiction” mean and where does it come from?

Etymology of Addiction

According to Richard et al., (2019) the word addiction has a long and interesting history. It originally appears in the early Roman republic. The latin root addicere, was used as a legal term meaning “to speak to”. In the later Roman period, it was also used to describe indebtedness, usually in relation to gambling debts. In Roman times the person (addictus) who owned a gambling debt was in a sense, attached or enslaved to his debtor until the debt was paid. By Elizabethan times it was used to describe an intense attachment to some person, cause or object. Mostly the word “addict” was used as a verb, as in to attach or devote oneself to something. Attachments could be either positive or negative, so the use of the verb was in itself neutral. Richard et al. (2019) argue that it is the flexibility of the word addiction and its ability to be used to denote either an extremely negative or positive attachment which has led to its longevity and popularity in common usage, as well as causing diagnostic ambivalence.

The connecting of the words addiction and attachment makes a lot of sense to me clinically. While running a substance-use recovery group for offenders, I would often start the group with an activity which involved various definitions of the word “addiction” in order to facilitate discussion. There were various definitions, including some medical, some from official sources such as the DSM and some quotes from famous ex-users. I would then ask the group members to choose which quote they felt mostly described their own experience. Most often the users chose a quote by Dr Patrick Carnes, (who specializes in treating sex-addiction and has written several books on the topic including, Out of the Shadows ) in which he describes addiction as a “pathological relationship”.  That this quote, written by a sex addiction specialist, was the one that these men would choose most often is interesting to me. They would then go on to describe their relationship to drugs as the most intimate, reliable and consistent relationship they had experienced. Their attachment to their drug of choice was very real and often, it had been the only thing they could turn to for comfort. Most of these men had histories of dysfunctional, abusive family lives, and most often they were let down by the very people you and I expect to be able to trust, again and again. No wonder their attachment, their addiction to their substance was so hard to give up. Carnes goes on to say that the pathological relationship with sex is a replacement for a healthy relationship with people. The same can be said for excessive substance users, problem gambling and those who consume pornography compulsively, which is what my own research documented:

“I don’t really have relationships. That’s why I view internet porn. But a couple of times I’ve come out of short-term relationships and felt a sense of relief that came from knowing I was free to go back to internet porn, and I know that that can’t be a good thing”

If we take the word “addiction” to mean simply an attachment, devotion, or enslavement to something, whether it be a substance, like alcohol or drugs, or an activity, like gambling, gaming or internet pornography, then the term addiction does seem to fit, at least as a descriptive term if not a diagnostic one. Any negative connotation to the word may well be attached to the substance or the behaviour which becomes problematic in that case, not the word “addiction” itself. Furthermore, those headlines claiming that porn addiction “does not exist” or is a “myth” because it is not listed as a diagnosis in the DSM are technically correct, because, in the current DSM there is no disorder with the actual term “addiction” listed at all. They are all disorders attached to the substance or behaviour, as in Alcohol Use Disorder or Opioid Use Disorder etc. – even though all these disorders fall under the umbrella of Substance Use & Addictive Behaviours.

Goodman (2001) made a, still, convincing case for the term “sexual addiction” to describe the phenomena of sexually related behavioural problems. He noted the similarities between substance use disorder and sex addiction and found them to be almost identical. In the proceeding 20 years, advances in neuroscientific imaging have shown these similarities are observable in the brain. So, if the term “addiction” where to be removed from the debate what would we be left debating? That excessive and compulsive use of sex or pornography does no harm? That people who describe themselves as addicted to internet pornography are delusional or wrong? I don’t think that’s helpful at all. The fact is, problematic use of internet pornography and sex exists, and is a real problem for many. Those that are experiencing this phenomenon firsthand no doubt care less for what you want to call their affliction, but more about getting help, recovery and healing from this issue, whatever it is called. As a counsellor, it is not my job to debate with clients about whether or not their issue is a “real addiction” or not. My job is to listen, to help facilitate change and to support my client create a better life for themselves and loved ones.

 

 

 

 

 

 

 

 

 

 

American Psychiatric Association. 2013. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: Author.

 

Goodman, A. (2001) What’s in a name? Terminology for designating a syndrome of sexually driven behavior. Sexual Addiction & Compulsivity. 8:191–213, 2001. DOI: 10.1080/107201601753459919

Richard J. Rosenthal & Suzanne B. Faris. (2019) The etymology and early history of ‘addiction’, Addiction Research & Theory, 27:5, 437-449, DOI: 10.1080/16066359.2018.1543412

 

 

 

 

 

 

 

 

 

 

 

 

 

Learning how to manage unpleasant emotions

ACT – Acceptance and Commitment Therapy can be summed up in three key skills or processes. Be present, open up and do what matters. Being present means taking a moment to moment, curious and mindful approach to our experiences as they happen. Being present simply means noticing. But what happens when our present moment experience is unpleasant, uncomfortable or distressing? Well I came across a short Ted Talk this morning which I thought explained how to manage these unwanted emotions in a clear and helpful way and which I’d like to share with you.

Credit: Act Made Simple by Dr. Russ Harris

 

Our ability to stay present, and fully experience uncomfortable or unpleasant feelings is important to our ability to move through the world with more comfort and ease and is the key to achieving our recovery goals or just simply feeling happier, and more comfortable in your own skin.

 

There are 8 key unpleasant emotions (which we like to think of as negative or bad but are not, they are simply unpleasant but necessary guides to what really matters to us, protection from dangerous others, reflections or echoes from past negative experiences). However, if we can learn how to be fully present for, not avoid or distract ourselves from, but fully present when these sorts of emotions arise within us – we can handle pretty much anything that life throws at us.The eight core unpleasant emotions are:

 

Sadness

Shame

Helplessness

Anger

Vulnerability

Embarrassment

Disappointment

Frustration

Our emotions are created by our brain and bodies working together but are felt in the body first as a bodily or physical sensation. A biochemical rush that last approx. 60-90 seconds. In the case of unpleasant feelings, it is this physical response that we are trying to distract ourselves from or move away from. Thing is, all emotions are necessary for healthy functioning of our entire being, not just the pleasant ones.

 

This too shall pass

 

Emotions (like urges) come in waves, they peak and then they subside. That’s the key thing to remember. Emotions always subside, both pleasant and unpleasant. The key to managing these emotional waves is to stay present whilst the wave is moving. Usually, after the wave subsides, new insights often emerge. New conversations can be had, relationships can be mended, a sense of relief is often felt and over time learning to embrace and experience all our emotions, mindfully and non-judgmentally, can ultimately lead to more self-awareness, peace and understanding of ourselves and others.

 

Listen to Dr Joan Rosenberg’s Ted talk https://youtu.be/EKy19WzkPxE

 

 

 

What are Existential Givens and Why Should You Care? A Layperson’s Guide to Existential Therapy

In 1980 Irvin Yalom, wrote his most famous text Existential Psychotherapy. In it, he proposed a new type of therapy which would allow for what he considered to be the “existential givens” of life to be brought to the forefront and dealt with head on, rather than being dodged, circumnavigated or just plain ignored, which he said had been the case in therapy circles thus far. So, what are existential givens anyway? Well, funny you should ask!

Existential ‘givens’ are essentially those things (and/or events) when we cannot change. Things such as the details of our birth, or the act of being born, or simply be-ing for that matter. Oh, and the process of dying and consequentially death, that’s a big one too. These are two main events which are common to all humans. Those are pretty much two of the biggest in-fact, but there are others, equally immutable if not as final as death or as cruelly insistent as being seems to be.

In fact, in his text Yalom (1980) narrowed it down to four big givens of existence, which he called ultimate concerns, and for the purposes of this limited exploration we shall focus on these four and how they relate to therapy and counselling. These are, in no particular order, (although one may argue that death always has the final say!): freedom, death, isolation and meaningless.

Freedom

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Being and Nothingness: A Phenomenological Essay on Ontology (Sartre, 1943), is perhaps existentialism’s greatest and most profound extrapolation on the notion and meaning of personal freedom.

We, (human beings) are essentially like a blank canvas, and unlike something like a chair, for example, we have the choice to be-come whatever it is we want to, within limitations of course. We get to paint whatever we want to on the blank canvas which symbolizes our life. Thing is, says Sartre, this freedom thing, (free will if you like), doesn’t seem like the great gift it is for many of us, in fact, it terrifies us mostly. “What, so we get to make our own decisions!?”  Wait, what, …we have to make a choice??! Sounds great, to a degree, however this thought understandably can be quite overwhelming when one then considers that with choice comes responsibility. Yes, the gift of freedom to choose our destiny means that we are more or less responsible for our own outcomes in life. For some of us, this realization is often fraught with anxiety and can sometimes plunge us into deep, dark moods and depressions. For to choose how to live your own life is a heavy, heavy burden to bear at times.

So heavy, that it is understandable that much of the time the temptation to live a life defined by what others have decided is the life you should be living, is too great to resist. Sometimes, it is really just easier to go with the flow, or to hold on to beliefs we have become so accustomed to wearing, (hand me downs usually) even though they no longer fit so well. Anything it seems, seems easier than having to shake yourself out of your stupor and utilise the freedom which is and always was our birthright.

However, once the tightness of ill-fitting beliefs become too uncomfortable to bear, or those sedimented systems which we have become so used to carrying around with us become too heavy, we start to feel uneasy. And the longer we deny the call of freedom, the more uneasy and nauseous we become. Sartre (1943) talks of the nausea that is created by the realization that we are, after-all, nothing. Nothing but the choices we have made and continue to make. Freedom of choice is sickening, overwhelming, and often unbearable. No wonder we cling, for so, so long, to the walls that stop us from falling down into the dark, unknowable void in which nothing is known and certainly, nothing is certain.

As Van Deurzen (2005) explains, “terrific loss in involved in the process of letting go of the things that determine our identity” (p.6).  Accepting freedom essentially means accepting that if nothing is holding you back, nor is it holding you up. And that, is a pretty frightening concept. One of the goals of existential therapy is to help a client be-come more comfortable with this concept of freedom, or nothingness, and to reduce the anxiety associated with it and perhaps even replace it with something more like enthusiasm, courage or even excitement. Something like the excitement felt, for example, by a painter faced with a blank canvas, on which he knows he will paint his master work. To become one’s true self seems to be the goal of freedom then, or one’s best self, one’s authentic self. But what the hell does that mean? How does one know when one is being authentic??

Authenticity

Not all writers and philosophers assume that authenticity is or should be the reward of freedom or its goal. In-fact, one writer has said that, “Heidegger’s ‘authenticity’ is a simulacrum, a vacant totalitarian formula echoing the nostalgia for the power of a god that once was – before being slain at the altar of modernism and post-modernism” (Bazzano, 2010, p.53).  (Heidegger is considered the OG of existentialism.)

Thus, are we to be thrust once again into a world of absolutes, with authenticity being the goal of freedom? Perhaps so, if as Sartre thought, inauthenticity, or bad faith is viewed as a condition of existence and we are continually striving for or from or teetering on the edge of authenticity and inauthenticity as we move between birth and death. Because if nothing is certain, then neither is authenticity, and we can never really be certain we are being authentic, but, we can at least try.

This brings us to the next existential given to examine, and that is death.

Death

Image result for death

Death is that unpleasant certainty that is forever in the back of our minds, even if we choose not to consciously think of it. Awareness of death can cause existential guilt and anxiety, a certain amount of which is healthy.

Existential guilt is brought on by a feeling of “not having done enough” or of not having lived to your full potential. It is caused by an awareness, sometimes sudden or sometimes gradual, that one has been living their life at half-mast, so to speak. Or to use a more modern analogy, that they have been coasting along in second gear and that time, which once seemed infinite, is precisely not that. Existential guilt is that psychological rude awakening that keeps you awake at night or disturbs you from your otherwise peaceful slumber so that you sit, bolt upright, anxious and sick with the realization of your own finiteness, smallness and helplessness . Nausea once again ensues.

In order to live authentically with the knowledge of death and the anxiety this produces takes “tremendous courage” (Hoffman, 2009).  Controversially, to live in denial of these ultimate truths is to limit your capacity for living, loving and experiencing life fully, because simply if overly stated, “Living is dying” (Van Deurzen, 2005).  The experience of existential guilt in therapy offers the client a positive opportunity to re-direct their life and reach a place of ‘reconciliation’ with the absolute unknown, which is death (Jacobson, 2007).

Isolation

Humans are, if nothing else, walking paradoxes. The one existential dilemma that is perhaps the driving force behind countless romantic novels and movies, and which has caused the online dating industry to become one of the fastest growing businesses of the post-modern, technological era, is the existential anxiety which is prompted by the realization of our inherent isolation. Our aloneness. We are born into this world, as a single unit and we will exit the same way.

However, we do not exist in complete isolation, but in relation to others. In truth we could not exist without others. One of the dilemmas of living involves resolving the paradox of… How can I be my authentic self, whilst relating to others in a meaningful, compassionate and fulfilling way? (Jacobsen, 2007). The question of intimacy and love brings up issues which can cause anxiety in an individual struggling with the paradox of their inherent isolation and the need for intimacy.

The practice of mindfulness, a concept borrowed from Buddhism and incorporated in current existential practice offers something like an answer to the concern of isolation. The anxiety produced by the desire for intimacy, for close relation to another human be-ing for….o.k. let us call it, love, is often founded on the all too real fear of its eventual loss. For implicit in loving another human being is the ultimate loss of that relationship, whether through natural entropy, conflict or death.

Claessens (2009) wrote of the four noble truths of Buddhism and related them to existential dilemmas, such as fear of isolation/intimacy; “We crave permanence, never-ending,  never changing love, eternal youth, certainty and total safety and we recoil from confronting our decay and vulnerability and the passing of joy” (p.113).  Therefore, in isolation we shiver, so we crave the closeness and the warmth of another being, and yet we fear losing the comfort before we even experience it fully.

Once again existential therapy can help, in terms of resolving this conflict, by encouraging clients to learn to appreciate and experience the joy of everyday pleasures, including love, without having to hide behind false illusions of foreverness and perfectness, which ultimately results in unnecessary emotional pain (Claessens, 2009).  Thus, as living involves dying to a degree, loving involves losing. One of the goals of counselling then could be to help the client with acceptance of the paradoxes inherent in truly living and loving.

The fear of intimacy is also linked to the notion of identity. One fears losing themselves to another, especially if their sense of identity has been freshly, or painfully carved out. But what if finding yourself involves losing yourself to a degree? (McGinley, 2011).  Is it possible that in isolation, we are not truly able to be ourselves anyway, and that it is only in relation to others that we are able to distinguish our own unique silhouette?

Yalom (1980) spoke of three types of isolation; interpersonal, intrapersonal and existential isolation. The latter refers to “the reality that we are unable to ever fully overcome our isolation” (Hoffman, 2009).  In therapy, clients may feel the force of this paradox when dealing with issues involving their personal relationships. Because while the fact of isolation may be terrifying to some, the prospect of fully relating to another being as your ‘authentic self’ involves an entirely other set of hazards. For in relating to someone as your authentic self, the possibility of being rejected involves deep, emotional risk. No wonder, many people hold a part of themselves back, even in their supposedly most personal relationships. And wonder furthermore, why they feel the ache of isolation even when they are in company.

Existential therapy talks about different ways of being in relation to others. One can choose to share a carefully selected version of oneself, and to relate to the other as less than a whole being as well, the I-It way of relating. Or one can choose to both be their authentic selves in relation, and see the other in their entirety as well, the I-Thou relationship (Buber, 1970 as cited in Hoffman, 2009).

A therapist may help their client to examine their relationships and question the types of relationships they have chosen so far, and if they are unhappy with them, to explore other ways of being with others. This is a very important aspect of life as relationships are among our most important sources of meaning in life. Without meaningful, authentic relationships, human beings are like plants without water and sun, we cease to exist in any meaningful way.

Meaningless

Which brings us to the dilemma of meaningless. If one clings to old ideals, beliefs, ways of being as if for dear life, then there must be a very good reason. Because the problem to be tackled, with the help of the therapist, lies in not just helping a client to discard old, no longer useful belief systems but in facing the inevitable question which then arises which is, What now?!  It is not simply enough to discard the old self, without, at least having some idea about what this new self is going to be. Of course, this is not always possible and thus, a person can experience a period of time in which they must exist without the (some might say illusory) solidity of a definable set of values, beliefs, goals, and/or meaning. What the existentialist Victor Frankl termed an existential vacuum (Corey, 2009).

So, it is not surprising that in counselling a person may resist facing making those choices which will eventually lead to the change they may say they seek. A counsellor may help their client, not by telling them what they ought to do, but by helping the client to face their own personal void or existential vacuum with strength, courage and purpose. Interestingly, meaning as such is like the holy grail of existence. In that, as cited in Corey (2009), meaning is quite often found by chance and not by direct pursuit. To pursue meaning as an end in itself is often a fruitless, frustrating and pointless endeavour.  Both Frankl and Yalom (1980) are in concert with the assertion that, “finding meaning in life is a by-product of engagement” (p.151).

Perhaps, as Claessens (2009) describes in her article, Mindfulness and Existential Therapy, the answer to the resolution of the dilemmas of existence and living within the existential givens as outlined above lies in what Buddhist teaches as the middle path. That is, not allowing either spectrum of the paradoxes we face to have undue influence but by consciously acknowledging their existence and proceeding, with mindfulness and compassion, anyway.

This middle path, whilst sounding quite mundane with its connotations of middle-of-the-roadness, is actually quite revolutionary when used in therapeutic application for “the middle path lies between the suppression and the venting of emotions” (p.116).  It offers acceptance and relief from the anxiety of  the question of living with dying, of existing in isolation and in relation to others, of living with the self that you choose and the self that you shed, of accepting the freedom of living on the edge of the void and finally, finding meaning in living, loving and being.

In counselling the existential therapist has three main goals they hope to achieve in order to assist their client. Helping the client find their own truth, helping the client find their own perspective and meaning in relation to their life, and to support the client to absorb these reflections and discoveries and in doing so construct a more authentic way of being in the world.

Acceptance of the givens of existence, like the four described above, can go a long way towards achieving these ends for the client. With a focus on the therapeutic relationship, being present with the client, taking a non-expert, non-judgmental and compassionate approach,  an existential counsellor attempts to help facilitate change in a client that can be truly revolutionary and long lasting. Whilst not focusing on symptoms and behaviours can seem counterintuitive to today’s therapist, existential therapy aims to address the underlying truths or facts of existence, which can be extremely liberating and healing.

 

 

 

REFERENCES

Bazzano, M. (2010). A True Person of No Status. Existential Analysis: Journal Of The Society For Existential Analysis21(1), 51-62.

Claessens, M. (2009). Mindfulness and Existential Therapy. Existential Analysis: Journal Of The  Society For Existential Analysis20(1), 109-119.

Claessens, M. (2010). Mindfulness Based-Third Wave CBT Therapies and Existential-Phenomenology.  Friends or Foes?. Existential Analysis: Journal Of The Society For Existential Analysis21(2),        295-308.

Corey, G. (2009). Theory and practice of counseling and psychotherapy (8th ed.). Belmont, CA: Thomson Higher Education.

Geldard, D., & Geldard, K. (2012). Basic personal counselling: A training manual for      counsellors (7th ed.). Sydney, Australia: Pearson Australia.

Hoffman, L. (2009).  Existential Therapy: A General Overview. Sourced from: http://www.existential-therapy.com/General_Overview.htm  Retrieved 10.4.14.

Jacobsen, B. (2007). Authenticity and our basic existential dilemmas: Foundational concepts of existential psychology and therapy. Existential Analysis: Journal of the Society for Existential Analysis, 18(2), 288-296.

McGinley, P. (2011). The Question of the Self in Existential Thought. Existential Analysis: Journal Of The Society For Existential Analysis22(1), 2-15.

Nanda, J. (2010). Embodied Integration. Existential Analysis: Journal Of The Society For Existential Analysis21(2), 331-350.

Oliveira, A. (2012). Significant Events in Existential Psychotherapy: The Client’s Perspective. Existential Analysis: Journal Of The Society For Existential Analysis23(2), 288-304.

Sartre, J.P. (1984). Being and nothingness : a phenomenological essay on ontology. Translated and with an introduction by Hazel E. Barnes. New York London Washington Square Press, 1984

Van Deurzen, E. (2005). Philosophical background. In E. van Deurzen, & C. Arnold-Baker (Eds.), Existential perspectives on human issues: A handbook for therapeutic practice (pp. 3-14). Hampshire, UK: Palgrave Macmillan.

Yalom, I. D. (1980). Existential psychotherapy. New York: Basic Books