is the private practice of Eric Greer, a licensed Marriage & Family Therapist since 1998. A full range of counseling services are offered to individuals and couples. Don’t let the license in marriage and family therapy fool you. Family therapy is simply a holistic perspective that takes into account the systems and groups of which you are a part or have been connected with in the past. It does not require working with additional people in session, although family therapists are the only discipline of licensed mental health providers with extensive experience and training in doing so. I have also done extensive training in evidenced based therapies like ACT and EMDR for trauma, anxitey, depression, and addictions. The thoughts in my blog will range from random to professional and will have a smattering of “God stuff” throughout. Why? So, when people see me for counseling they can read my thoughts on these matters without thinking I have some particular agenda or need to proselytize. My writings are meant to make me more transparent as a person who happens to be a therapist.
Many people are familiar with a therapeutic approach known as CBT (cognitive behavioral therapy). It is well documented by research that CBT is an effective treatment for many sorts of mental disorders. Basically, clients gain a greater sense of self-awareness through CBT learning skills like mindfulness. They are taught to identify negative thought patterns and replace them with alternative thoughts which promote greater health.
Central to the CBT model is the belief that negative thoughts are responsible for creating the context for the symptoms of the client’s mental disorder to grow. Now, there is no arguing that CBT is effective. Research has proven so time and again and most insurance companies specifically ask providers if they practice this method.
However, there are some clinical reasons to second guess the use of CBT. Here are some questions that I have and that reflect a growing body of clinical critiques of CBT. Should we assume negative thoughts always precede negative emotions? If so, why does research demonstrates CBT is largely ineffective with depression? Should we assume that every negative thought is “pathological?” If so, what about the psychological scars that may be a part of a person’s experience of past abuse and trauma? Why would a CBT therapist work with a client to “reframe” them when reality is that they are quite accurate in many cases.
CBT is a pragmatic and sometimes useful tool but it has a serious limitation in that it seeks to create within a client’s experience a sort of “idealist” version of their world. In essence, a core piece of CBT work seeks to sever the relationship between what is and what we hope things to be in this world. And, the last time I turned on the news, “what is” in this world has not improved at all. Maybe it’s time we learned to quit avoiding what we experience and learn to cope with it in a way that allows us to move forward with life even though this world is not what we hoped.
That is why ACT (acceptance and commitment therapy) make so much sense to me as a person and a practitioner. I take notice when the Veteran’s Administration spends a lot of money researching what works with people who have serious trauma, addictions, and depression. It’s impossible to “reframe” what happened to a lost mate in combat or a missing limb. Reality is that these things are what they are. ACT has taught me as a person and a practitioner that it is the struggle (i.e. avoidance) of our negative thoughts that is most responsible for the mental anguish we experience.
The research evidence for ACT (now a 30 year old therapeutic method) continues to validate its effectiveness. More, it is a therapy that grounds us in the world in which we live. If one learns the skills of ACT, they will discover an application to a wide variety of circumstances. In the real world many people do not experience a full remission of symptoms of depression, anxiety, or addictive cravings. ACT will help you to accept that this truth does not mean you cannot go on living and even thriving. Learn how to stop obsessing over those things which may be beyond our control. Instead, create new lifestyle patterns and healthier choices. Be present in the moment without having to fight unnecessarily against thoughts or feelings that you might be experiencing.
There are a lot of conversations in the mental health world today about mindfulness. Attention to this issue is related to the hectic lifestyle lived by most of us and our deficits related to awareness of the present moment. It is more than just a “stop and smell the roses” sort of mindset. It is an awareness of what is taking place in us by way of feeling and thought. Often those important messages go unnoticed and can become the impetus for what we choose next leading our emotions – which can be unhelpful guides – to decide our next course of action.
Most people associate meditation and other spiritual disciplines with Buddhism. In fact, Buddha said our are like a tree full of jumping monkeys. It is this chaos of a busy mind from which people seek escape and find themselves distracted by the next thing or an activity to distract from disturbing thoughts. Buddha nails that down well. However, most people are unaware that the Christian worldview offers many tools to break through the the gnats clouding our minds with obsessive thinking, worry, and anxiety.
In Philippians 2:5 and following, Paul writes that Jesus “emptied himself ” (Greek: kenosis), taking the form of a servant. Jesus’s many acts of service and healing did not come from a mind that was thinking and analyzing about what to do or say, but rather from a mind that had emptied itself into God. Jesus’s mind was emptied of self-reference and the force of merely personal preference. In his “emptiness,” God’s infinite love could shine through Jesus’s human form unencumbered. Through him, the invisible could become visible. In this way, the purified Christian mind is analogous to Tibetan Buddhist emptiness. This spiritual emptiness is not a rejection of ultimate meaning, but rather a deep focused detachment of mind and heart that has been shaped within a profound ethical context.
The medieval Dominican friar Meister Eckhart taught that detachment (emptying ourselves) from every self-centered affinity and fear is such an important spiritual practice that he, with tongue in cheek, put it above love. Even our ideas about God can lead us away from God, so we must walk lightly among them too. As he says,
We ought not to have or let ourselves be satisfied with the God we have thought of, for when the thought slips the mind, that god slips with it. [This discipline] requires effort and love, a careful cultivation of the spiritual life, and a watchful, honest, active oversight of all one’s mental attitudes toward things and people. It is not to be learned by world-flight, running away from things, turning solitary and going apart from the world. Rather, one must learn an inner solitude, wherever or with whomsoever he may be. (Raymond Bernard Blakney, tr. & ed. Meister Eckhart: A Modern Translation. New York: Harper & Bros., 1941, p. 9.)
One shouldn’t forget that Eckhart was steeped in the Gospels and living in Christian community when he wrote this. He may not have been thinking about God, but he was continuously surrounded by and digesting the words, images and gestures of the Christian life. Still, he was convinced that God is greater than any picture or feeling about God. Trusting in God’s invisible presence one’s mind comes to a still point of presence he called Gelassenheit, a complete letting-be.
From the Desert Fathers and from the Greek philosophers before them, Eckhart inherited the insight that our eyes must be without any color in order to be able to register all colors. Dwelling in this detachment from our personal ideas about reality, we come to a consciousness that Paul described when he declared, “it is no longer I who live, but it is Christ who lives in me” (Galatians 2:20). Jesus has colorless eyes. And when Paul said that “we have the mind of Christ” (1 Cor 2:16) he meant all of us who follow the path into God’s Love. We are not Jesus, but we are like him. We too can have the “empty” or “detached” mind and heart of Christ that sees all colors and registers all suffering and joy. Eckhart describes the Christ-mind’s way of knowing as “daybreak knowledge” in which all things are perceived without distinction as coming forth from, and going to, the light of God.
Similarly, in the 16th century, John of the Cross counsels that after, and in the midst of, our liturgies, hymns and discursive prayers, we Christians must also occasionally enter a dark night of the senses and soul, emptying ourselves of our self-centered preferences and ideas about God and everything else. Jesus modeled this discipline of self-emptying love for us, but he did not do it instead of us. We ourselves need to clear our minds of self-centered and habitual thinking. We must become inwardly detached in an ambience of love that continuously connects us to others and to creation. Our contemplative tradition tells us that when we open ourselves to the Divine movement within, the Holy Spirit will help us do this work. We do the work of creating a space within us for God, and then trust that the Holy Spirit will do the work in us: as we flow out of ourselves, the Holy Spirit flows in.
Christian contemplatives hold up the possibility of unity with God in our minds and hearts. They tell us that we are coming close to this unity when we empty ourselves of all the labels we paste onto others and our own experience. John of the Cross tells us that this emptying is a kind of “darkening” whereby we become naked before God and with God. Paradoxically, it is a darkening that brings Light. In this dark night of the mind the invisible God of love transforms us, freeing us from our cocoons of fear, anxiety and blame. John’s contemporary, Ignatius of Loyola, called this Christian practice Indiferencia or “holy indifference”. In this view, one stops trying to control God. One trains one’s mind to seek God in all things evenly, to have no personal preference for where God will show up. This practice of emptying is quite radical for some like Meister Eckhart and John of the Cross. They even counsel us to let go of our “religious” and “spiritual” thoughts about God. So, Eckhart says, sometimes we must let go of God, for God’s sake.
What does that mean? I think we all struggle with a battle in our minds. Often we seek to avoid that battle altogether because we don’t want to sort through the disturbing thoughts and emotions that accompany them. Avoidance is a sort of god in that it becomes the way by which we deal with life concerns. Letting go of that god for God’s sake is a practice by which we observe the thoughts and feelings in our own minds not for the purpose of “fighting against them” but to surrender them to God and his healing. Paul puts it this way, “Take every thought captive and make it obedient to Christ” (2 Corinthians 10:5).
Sometimes, when I am alone – particularly during early morning hours – I recall certain past events with almost no effort on my part. Great ones, sad times, lost opportunities, stories of pain, courage, fear, and loss. Some that were negative are no longer so. I survived and now they tend to invoke a chuckle or two.
In a small way, I’m reliving and recalling memories. I can smell the smells. I can feel the tension. I can feel it and see it. And I didn’t even try to recall either the good or the bad. They just appeared.
This is how traumatic memory works. You experience a trauma and later flashes of memory–painful, shocking, unwanted–appear after the subtlest of triggers. You do not merely remember it, you feel it. You taste it, as if it were happening again. They come in bits and pieces, flashes and images; rarely in a linear sequential fashion. Having such an experience does not mean you have PTSD but for those who do, this can be a frequent and unsettling occurrence combined with other symptoms like avoiding situations that might stimulate the memory or having a sort of heightened sense of alarm.
While most good and bad memories fade and are replaced by new experiences, some memories consistently intrude into the present. Even when we tell ourselves, “We’re safe now. We are no longer in danger” or “You’re not a child anymore, you are grown up and don’t have to be afraid of being hit,” the memories and associated feelings keep coming. It is as if your logic and perceptions aren’t able to moderate the response.
Let me share an example. I had a pretty serious accident when I was 15 years old that involved a 40 foot fall and a lot of rocks. My left leg sustained a fracture and my right leg was shattered including a full dislocation of my ankle. To this day I cringe when I think about it. I remember watching live as Lawrence Taylor crushed Joe Theismann during Monday Night Football about a year after my accident and having waves of nausea flood over me. A few years later, I witnessed a partially dismembered leg and found myself on my knees throwing up. Or, when our daughter had surgery on her foot a couple of years ago, I blacked out just looking at an x-ray film of her foot while the Doctor shared with us how successful the surgery had been. That experience was more than 30 years ago. Yet still I react. I know a sports highlight film or an x-ray can’t injure me but it doesn’t seem to matter to my stomach. Sure, the reaction I have is minimal and faded compared to immediately after my accident. But it is not gone.
Why does this happen? What are the processes in play that keep us experiencing and reliving what may be old and distant–as if it were still present? What follows is brief and a relatively simplistic summary of two very complex processes. Use them to help you understand yourself or a friend and to increase your empathy for those trapped in such processes.
Memory and the Connected Self
Psychology focuses much of its work on the individual person–the self. However, the self never exists outside of social connections (or disconnections) with others which is why I find my training in family therapy to be so valuable. Our understanding of our self begins at birth with billions of interactions (smiles, frowns, words, touch, etc.) with others. As we develop and become aware of ourselves, we often have key experiences of success or failure that continue to shape our sense of self long into the future. Find someone with a powerful sense of failure and you will find someone who will struggle to interpret a success as such. Whether success or failure oriented, both outlooks form on the basis of how we perceive that others see us. It seems that shame and humiliation act as intensifiers making it hard to alter our sense of self even after corrective experiences. They turn me from “bad things happened to me” into “I am bad.”
Memory and the (dis)Connected Brain
In simplistic language, the brain is an amazingly connected and efficient organ firing constantly day and night. Memories are stored and accessed, intensified or eroded, and often altered through the firing of neurons. The efficient brain “learns” to access information quickly. Just as you no longer have to think about how you will floss your teeth, you also no longer have to consciously recall a memory–it just happens. Because multiple hormones and structures in the brain are involved in memory formation, it stands to reason that ignoring a life-altering memory (and the full-bodied experience of it) is next to impossible. Our brain is an incredible collection of systems: structures like the brainstem, amygdala, hypothalamus, hippocampus are evaluating and communicating (or not) with high-level processing within the cortex even before you know it. Thus, a memory and its reaction is already well-underway before a person can think and critique such a memory.
So, are we doomed to be controlled by our past?
No. There is ample evidence that we can form new connections and minimize intrusive and unwanted memories. The brain is plastic. It is adaptable and changeable. And yet, we are not in the age of the MiB neuralyzer. God does not usually remove us from our histories or make them so distant they have no effect on us. Adaptation takes time and energy and rarely is so complete that the person no longer feels anything when they recall a painful event (in fact, feeling nothing might be rather dangerous as it would be a denial of reality).
So, the next time you are beating yourself up for still struggling with the past (or are questioning why a loved one can’t move beyond a trauma), be gentle. Consider instead how you might develop a corrective response that accepts what has happened and gives opportunity for a new second response after the first automatic reaction.
First, “The Good.” As of today, I am now a provider in the Blue Cross Blue Shield network of Massachusetts. I am on the preferred provider network (PPO), the HMO Blue (managed care) and the Indemnity list. If you are a Blue Cross member in Massachusetts, I am taking new clients and would be glad to speak with you about an appointment.
“The Bad” I opened my private practice here in January and it has taken this long to complete the credentialing process with BCBS. They have actually come in ahead of schedule as the process can take 90 days. I am still waiting to complete the process with Beacon Health and Tufts. It should not be much longer for either of these networks. So, stay tuned.
Finally, “The Ugly” I completed grad school in 1995, was licensed in 1998, have years of additional training and experiences and even teach at the graduate level in my field. However, providers such as United Behavioral Health (Harvard Pilgrim) and Aetna have denied me access to their panels as a preferred provider. “Why, what did you do?” someone might ask. I have never had a complaint of any sort…not the smallest blight on my record. In fact, I have hundreds of satisfied clients from my two decades of practice. The reason insurance companies drag their feet or completely deny access to new providers is that it would cost them money. Currently, I work with a client who has Harvard Pilgrim and I file the insurance as an out of network provider. Either my client eats the extra expense or I do. In this case, I choose to accept the reduced fee.
When insurance companies deny access to new providers they are actually denying access to the people they serve. By disallowing new providers there is a smaller pool of providers from which the client may choose. Now the client (you) has to call current contracted providers and make an appointment for which you have to wait weeks or months or you can call an out of network provider like me and be seen within days but pay a higher fee or I must accept a reduced rate.
So, that is the math behind it all. That is why you may have to wait to see a provider of any health care service. Often, it has nothing to do with whether a qualified provider is nearby and has available appointments and has everything to do with how much your insurance company is willing to pay out even though they are increasing your fees all the time. Just thought you would like to know.
Are you hurting today? I’m sorry. I can’t give you answers, but I can remind that you matter. The author of an ancient letter called Hebrews pens these words from the mouth of the creator of the universe. “I will never let you down, never walk off and leave you.” I’ve found that to be true, even when life is no more than a scant tree on a barren hilltop bent to the ground by brutal, bitter winds.
That tree survives because of its roots. You will too, my friend. Let your roots soak in the truth that you are not alone. You matter. All storms eventually give way to sunlight again. I sometimes invite people to, “hang in there like a hair in a biscuit.” Do that today. Hang on for you and those who love you. This storm will pass.
The office is closed and will reopen on March 6, 2017. I’ve gone in search of the Boys of Summer. Meanwhile, enjoy a quote from the fictional but still great Terence Mann from Field of Dreams.
“Ray. People will come, Ray. They’ll come to Iowa for reasons they can’t even fathom. They’ll turn up your driveway not knowing for sure why they’re doing it. They’ll arrive at your door as innocent as children, longing for the past. “Of course, we won’t mind if you look around”, you’ll say, “It’s only $20 per person”. They’ll pass over the money without even thinking about it: for it is money they have and peace they lack. And they’ll walk out to the bleachers; sit in shirtsleeves on a perfect afternoon. They’ll find they have reserved seats somewhere along one of the baselines, where they sat when they were children and cheered their heroes. And they’ll watch the game and it’ll be as if they dipped themselves in magic waters. The memories will be so thick they’ll have to brush them away from their faces. People will come Ray. The one constant through all the years, Ray, has been baseball. America has rolled by like an army of steamrollers. It has been erased like a blackboard, rebuilt and erased again. But baseball has marked the time. This field, this game: it’s a part of our past, Ray. It reminds us of all that once was good and that could be again. Oh…people will come Ray. People will most definitely come.” (Terence Mann).
The final word of that sentence has been burned into the hard drive of your brain from some of your earliest experiences. That is why learning to replace a thought is often impossible. Try it. Just repeat the phrase, “blondes have more…” and see if you can avoid thinking about the word, “fun.” You may notice it came to mind and then you replaced it with another word just to prove me wrong but, “fun” is still there and you cannot erase it. Barring significant damage through invasive surgery, a debilitating disease, or suffering a stroke your mind will retain every memory.
Why is it that so many therapies for addiction, depression, anxiety and other mental health concerns offer solutions like, “change your playgrounds, playmates, and playthings,” thought replacement, or thought suppression? I don’t know. You are going to expend a lot of extra mental energy trying to avoid a thought rather than simply recognizing its presence. Often that extra energy comes at the expense of getting better.
“Blondes have more fun,” is not a very troubling thought for most people but consider the other automatic thoughts that we have. “I am…” Complete that sentence and you will most likely notice some challenging thoughts and feelings even when you try to crowd them out with positive self-talk. What about troubling memories of abuse, abandonment, or loss? What of chronic pain and your work to avoid it through filling your mind with as many alternative activities as possible? Or how about those nagging cravings for food or other substances that you try not to think about?
Learning how your mind works and exploring your own personal values can go a long way in sorting through painful thoughts, memories, emotions, and other sensations. The power of human language has given rise to the most creative of souls. It allows for problem solving skills that are of such exponential power that humanity is far from the reaches of our potential. Language is also the source of our greatest suffering because within our mind we have messages that will never be forgotten. The neurological term is cognitive fusion.
Acceptance and Commitment Therapy or ACT involves the process of learning to observe and accept all of our thoughts, feelings, and emotions without allowing them to lead our life. It doesn’t erase memories but it can help you to “defuse” (cognitive defusion) from them so that they don’t lead your life. A much more reliable map to guide one’s life is our own personal values. Those, you will find are sometimes or often at odd with what you actually think or feel. The “win” in therapy and in life is when we learn to expend our energies not on suppressing thoughts that we don’t like and instead learn to have them while using the energy we have to follow the values that we hold dear.
Thoughts are like advisers. In my experience, every adviser has a bad day meaning not every thought is accurate. Emotions should be followers; never leaders. Otherwise, you and I will get lost very easily. If you are struggling with emotions, thoughts, and sensations leading your life rather than the values that you hold most dear, maybe it’s time to pick up the phone and make that call. Having a thought that blondes have all the fun? Maybe it’s true that brunettes, gingers, black hair, or no hair at all can have just as much fun as a blonde any day.