Monthly Archives: February 2009

Making the mind-body connection

Jenny Christenson February 15, 2009

Insights on wellness

Counseling Today asked seven American Counseling Association members to describe how they use mind-body wellness techniques and concepts in their counseling.

Stuart Bonnington has been a counselor since 1973. He is also a licensed marriage and family therapist and a counselor educator at Austin Peay State University. He practices qigong daily and has studied with two of the leading qigong masters in the United States, Michael Mayer and Ken Cohen. Bonnington will present the Education Session “The Quest for Balance and Attunement: Qigong and the Healthy Counselor” at the ACA Annual Conference & Exposition in Charlotte, N.C.

Abby Seixas is the founder of Deep River Seminars. She is in private practice outside Boston and conducts groups, based on her book Finding the Deep River Within, designed to help women embed wellness practices into their daily life.

Jeanmarie Petrino is a Licensed Professional Counselor practicing at the Mind Body Health Center in New Providence, N.J. She is a Reiki Seichim master.

Charles V. Lindsey is an LPC, an assistant professor of counseling at the University of Wisconsin, Oshkosh and a child and adolescent counselor. He trained and practiced under Thich Nhat Hahn in the 1990s at Plum Village in France.

William F. Mies studied at the University of Massachusetts Medical School in the field of mindfulness-based stress reduction. He has taught mindfulness practice for 10 years, first as a volunteer and now as a full-time professional.

Katlin Hecox is a life coach/certified massage therapist at the Inner Light Healing Center: Danville Yoga and Meditation Center in Danville, Va. She will present the Education Session “Spiritual Intelligence: Mindfulness, Meditation and Restoring” at the ACA Annual Conference.

Geri Miller is a professor of human development and psychological counseling at Appalachian State University and president of the North Carolina division of the Association for Spiritual, Ethical and Religious Values in Counseling. Miller will present the Education Session “Utilizing Mindfulness Skills in the Care and Development of a Therapist” at the ACA Annual Conference.

The connection between a healthy mind and a healthy body is apparent to counselor Charles V. Lindsey, who worked for several years as a mental health counselor in a cardiac rehabilitation program. He learned that a stress-filled life is a factor in the development of heart disease. Furthermore, he says, “It seems that some clients truly received greater mental clarity and awareness as they practiced the heart-healthy components of regular exercise, eating a wholesome diet and engaging in relaxation and reflective activities.”

Others incorporate mind-body wellness techniques into their counseling practices after first using the techniques themselves and witnessing personal growth. “Mindfulness practice has been the focal point in my own evolution,” says counselor William F. Mies. “If the mind-body is not treated, we have missed the point. Each only exists in relationship to the other.”

Geri Miller explains that mind-body wellness has always been a part of her clinical work — particularly the spiritual component — from the time she entered the helping professions in her 20s. “Mindfulness has really helped me personally and professionally,” she says, “and it has really helped my clients.”

Describe what mind-body wellness encompasses.

Abby Seixas: It is based on the recognition that the mind affects the body and vice versa, and that both mind and body are interrelated parts of a whole. It involves using techniques to enhance the mind’s influence on the body to improve how people feel — mentally, emotionally and physically. Mind-body wellness often implies and includes the spiritual dimension as well. So, it recognizes that all of these human dimensions — body, feelings, mind and spirit — are interrelated. By mind, we are talking about emotions. All these different dimensions interrelate with each other. They are not totally separate spheres.

Charles V. Lindsey: I think it is easy to fall into the trap of believing that mind-body wellness is a destination point — a place where one arrives and then doesn’t have to work or struggle with as much intensity. In simple terms, I share with my clients that mind-body wellness is a journey, and something that has to continuously be practiced. I explain that mind-body wellness truly involves being a steward of one’s own mind and body. It means being more aware of the interrelationship between what we think and what we feel and of how our care, or lack of care, for our bodies affects the way we think and how we behave. Ultimately, mind-body wellness involves a deeper awareness of self that enhances possibilities of operating in daily life with a greater sense of intentionality and purpose.

William F. Mies: Mind-body wellness is the healthy person functioning in a healthy way because he or she is in touch with the most fundamental aspects of human nature. Ultimately, this involves love, compassion, wisdom, joy and equanimity. The healthy body is an expression of the flowering of the mind and heart. This state can become evident through mindfulness practice.

Jeanmarie Petrino: Mind-body wellness integrates Western and Eastern psychological, medical and alternative therapies. Its goal is to facilitate mental, emotional, spiritual and physical healing in clients presenting a wide variety of issues and conditions.

Katlin Hecox: I believe that our life force is energy.  When our thinking is healthy and we love and care for ourselves, we have the vitality, the aliveness to manage what enters our experience.  A person with physical or mental health challenges still has a true ability to live a life of vitality, quality and connection.

Explain how your counseling practice touches on mind-body wellness.

Stuart Bonnington: How we live in relation to our body is of prime importance. I think it is our primary relationship. My practice these days consists of doing supervision with post-masters clinicians working toward full licensure and seeing students at the university who gravitate to me in part because I teach in the psychology department. I have more of a “coaching” role with students, as I may see them when they are distraught, stressed out. I refer out to our counseling center for those needing ongoing work. I also make time for our master’s level counseling students who need to process what is going on with them as they go through the process of becoming counselors.

I focus a lot on emotional regulation. Body states often overwhelm cognitive processes. I help people recognize subtle shifts in their bodies that cue them into what is going on emotionally. I have taught a number of people energy psychology techniques such as emotional freedom techniques. This is a meridian-based approach that really helps people deal with blocked energy. I find that strong negative emotions are almost always accompanied by energy blocks. Keeping the energy flowing in the body is a large part of what wellness is all about.

Abby Seixas: In my practice, that translates into not just using talk therapy. Although I do use talk therapy, I also draw from a variety of other techniques and modalities, including guided imagery, relaxation techniques, inner dialogue and EMDR (eye movement desensitization and reprocessing), which is an integrated method of psychotherapy used originally for healing trauma. I also help clients work with their feelings through body awareness, tuning into physical symptoms or sensations as a way of helping them gain access to and understanding of their emotions. In addition to my private practice, I do groups based on my book, which are designed to help women embed certain practices in their daily life that are wellness practices, for tapping into places of depth and meaning. So it touches on the spiritual, as well.

Jeanmarie Petrino: The Mind Body Health Center’s multi-disciplined staff of professional counselors, medical doctors and a massage therapist offer a holistic approach to health and wellness. The staff works together to create a supportive environment in which clients can learn to relax and access their own healing abilities. Treatments offered at the Mind Body Health Center include cognitive behavioral therapy supplemented with Reiki energy therapy, hypnosis, and/or biofeedback. Medical acupuncture and massage therapy are also offered.

In my individual practice at the Mind Body Health Center, I integrate cognitive behavioral therapy with Reiki energy therapy. Reiki energy therapy is one of the many alternative treatments known as “energy medicine.” Acupuncture, tai chi, qigong and yoga are some other forms of energy medicine. Energy therapies influence the body’s flow of life energy, or chi, to promote health and well-being. A Reiki treatment works with the body’s chi to induce a state of deep relaxation. In this state, a client can be guided by a professional counselor to release emotional, physical and/or spiritual pain that blocks chi and creates energy imbalance.

Geri Miller: The mind and the body are really an integration. There’s a tendency in western culture to separate them. The strongest way that I view working with them is through the five senses. My presentation at the ACA Annual Conference in March is going to be on mindfulness. What we need to do is have mindful attention to the discrete differences in how we’re aware of our senses and of how we process them and then the interrelationship of those senses. And so how my practice touches upon it. Mindfulness gives me a model and some methods to work with. This is captured in the phrase, “Our bodies don’t lie.” So if we learn to be mindful of our bodies, we can make more aware choices.  If we get aware of our senses we can make choices of how to respond to those things we’re aware of.  The whole aim of mindfulness is to slow down, and as a counselor, I have to start paying attention to myself. In that way, I model assessing and understanding to my clients.  To explain, clients come in to see me and they may not be mindful of what’s happening for them. If I can help them get aware of themselves and the context of their lives, and other people in their lives, we can make them a behavior-change plan. We can take their awareness and weave it into goals that are connected to create wellness and stress management.  Living in the middle of the present moment, being right where I am. By being attentive to myself, and working with my own senses, if I’m taking good care of myself, then what I can do is respond more to you in the present moment.  Then, I’m modeling that to my clients and we’re in the present moment together. Being aware requires trust.

Charles V. Lindsey: As a child and adolescent counselor, it is important for me to gain a broad and deep picture of how my clients are actually living out their daily lives.  Therefore, I investigate such areas as eating, sleeping, and exercise patterns; I explore issues and circumstances that take them into a variety of different emotions.  Together we examine how the mind and body are connected and focus on the evidence that we have for this being the case.  I also introduce to my clients the idea that they have a “center” – a “grounded place” within themselves from which they may draw strength and support.  We then practice discovering that center and utilizing it as a resource as we continue our work together.

How is mind-body wellness related to stress management?

Katlin Hecox: I developed a paradigm that I call “Restoration,” and it is based on the understanding that we are energy. Negative thoughts are a form of energy that depletes us. Sometimes these thoughts are held in the body. Anyone who does massage for a length of time will experience a client having body memory and, often, the massage provides a release. Our field is now very aware that reactions to high-stress situations may be “freezing,” where the trauma experienced gets lodged in the mind-body. When the experience and the thoughts it created are shifted, wellness becomes stronger. Positive thoughts can result in the ability to get through stressors with grace and health.  For instance, the installation of healthier thinking that you see in EMDR can shift a life path. Stress is part of life, and the vitality we can bring to the stresses predicts the level of wellness.

Stuart Bonnington: I expose students, clients and mental health professionals to qigong. Qigong is a discipline that has arisen out of the early folk wisdom of China. Many of the techniques and practices are thousands of years old. It comes out of the Daoist tradition. There is a concept in that tradition that talks about “right action” or “right energy.” Basically, what is the correct amount of energy to use when doing anything, whether it is just sitting quietly or doing something physically or mentally taxing? What is the right amount of energy to use? Not too much or too little, what is the right amount? If I am overly stressed, I most likely have not been using my energy in the right amount in the right way.  Am I breathing correctly, meaning the right amount of energy being used in the most efficient way? What is the right amount of energy to put in my body? Am I eating foods that serve me well? If my diet is off, that means that my energy balance will be off. During the many years that I was a full-time counselor, I routinely asked my stressed out clients what they had eaten that day or what they had done to nurture themselves in some way. They usually had not been taking care of themselves: energy was blocked in their body and negative energy loops manifested as depressive/anxious thinking was looping in their heads.

William F. Mies: Stress is a manifestation of the mind and body being out of sync. When the mind, heart and body are not aligned, friction or stress arises. Mind-body wellness stands in a reciprocal relationship with stress management. As the mind-heart-body becomes more in alignment, stress reduces; as stress reduces, the mind-heart-body finds even deeper wellsprings of happiness and freedom within.

Abby Seixas: I think of mind-body wellness involving techniques and practices that reduce stress. For example, relaxation techniques, meditation.  I think there is a direct connection with techniques for mind-body wellness and stress management. I definitely would put that one of my six core practices is the practice of presence, which is mindfulness. This is training the mind to attend to the present moment.  The effect is incredibly calming to have that kind of focus on the present. A lot of our stress comes from thinking about the future and worrying about it, or thinking about the past and wishing it were different. Training the mind to be where we are when we’re doing it is a stress reliever.

Another technique is learning how to do deep-breathing. This involves learning how to take deep breaths. The breath is the bridge between the body and the mind. We all have it, as long as we’re live, and we can make use of it. When we get stressed, our breathing tends to get shallow. In this case, you can learn how to drop the breathing down, and have deeper breathing, that has a calming effect on the mind.

Charles V. Lindsey: It seems that a key component in the management of stress is being able to identify and recognize the potential causes or triggers of stress.  In working with my child and adolescent clients, we often need to spend a significant amount of time exploring and investigating where the “roots” of the stressors might be growing.  We will explore where stress tends to “live” in their bodies, and then connect that bodily location with the thoughts and feelings they might be having.  From the other direction, we will also explore stress-laden or toxic thoughts and then investigate how this tends to impact their physical bodies.  This makes the mind-body connection clearly evident for clients, and once identified, also provides us with key coordinates (awareness) for how we might go about diffusing the stress.

How can counselors maintain their own mind-body wellness?

Katlin Hecox: This is a wonderful question and a critical one! If you agree with the energy paradigm, then you understand the importance of the level of positive energy a therapist brings to a session. Therapists need to be aware of their own energy. Are you energized or depleted by your client? If you are being depleted, you need to act to restore yourself. This may mean doing things out of the session that increase your energy. It may mean learning a practice such as meditation, prayer, tai chi or Donna Eden’s energy tune-up. It may be looking at what thoughts you are having and making sure that you have done your own work on the issues brought into the session. Self care is essential (as we often tell our clients!)

Stuart Bonnington: There ought to be a question on counselor license renewal forms: “Explain in detail what you do to maintain your own well-being.” To be mindful of others, we have to be mindful of ourselves. I believe that counselors are wise to maintain some time type of wellness practice that includes a focus on the body and spirit. If you have been a counselor long enough you can sometimes let that slide a little, but it’s like running your car on your battery without it charging. You might get a few miles as long as you t urn all the nonessentials off (air conditioning, radio, lights), but you will run down very soon. I firmly believe that my energy field affects the energy fields of others. When I am mindful of keeping a good energy flow in my body and its surrounding energy field, others can benefit from that. Carl Rogers taught us about being attuned to our clients. For me, that had to do with the flow of energy within and among people. We know that infant/caregiver brainwaves can synchronize when there is secure attachment. That is attuned energy. All thought/action is energy.

Abby Seixas: I think that’s a really important question because as counselors, we are attending to others’ needs a lot, and we really need to be able to recharge and renew ourselves. One of the fundamental practices in my book is the practice of taking “time-in,” which is stepping away from attending to other people, cutting down on distractions, stepping away from the to do list and centering ourselves. The effect of this practice is not just renewal; taking time-in is also one of the primary ways to contact the deeper currents within us, what I call the “deep river within,” where we can tap into our inner resources of patience, compassion, wisdom and other qualities we need to live our lives well, with intention and meaning.  Another thing that is important is to have some way of really shifting gears, whether doing something physical, going outside, or getting a massage—something that shifts you away from meeting someone else’s needs. Most counselors are sitting in a chair all day, so shifting gears and doing something physical is important. It changes channels in our brains. We’re often better at coaching our clients to take care of themselves this way, than doing it ourselves. We can use all the encouragement we can get.

Geri Miller: Anything that enhances sensory integration. I’m 53, and at 52, I learned how to hula hoop.  It became a practice of mindfulness. It took me three months to learn how to d o it, I was so bad, that I couldn’t focus on anything else.  I began to do some mind-body things to deal with stress, and I tried boxing and hula hooping. They became a meditative practice and exercise.  We need to find activities where we lose ourselves, and where we integrate our senses. It also has a playful dynamic to it. My office is full of toys. As a counselor, we hear some very hard stories, so this breaks that up. As a spiritual practice, we find things that feed our spirit. I think we need to find, as counselors, what works for us.  Something that gives us awareness of our senses, that pulls it together.

Charles V. Lindsey: This is a very unique and individualized question, and I imagine the answer varies widely from person to person.  There are some good existing wellness models (see Witmer, Sweeney, & Myers, 1996) that depict various contributing factors in mind-body wellness.  Counselors themselves can visit and self-reflect on such models, taking a realistic look at their own areas of strength and needed growth.  Figuring out a personal wellness action-plan that can be sustained is another key piece and in much the same manner as we inform our clients, small and realistic steps are important.  There is also something to be said for practicing mind-body wellness with other people, as support and accountability can play an important role in sticking with a plan.  Counselors tend to be passionate people, and I believe it’s important to turn some of that passion toward our own self-care as helping professionals and actually model this for the people with whom we have the privilege to work.
William F. Mies:

– Regular mindfulness meditation practice

– A practice known as the three-minute breathing space

– Keep focus and attention on the task at hand

These efforts give rise to a sense of what is true in the present moment, wherein we find all reality, truth, and love.

How can counselors advise their clients to maintain mind-body wellness?

Katlin Hecox: There are many great ways to maintain mind-body wellness. What makes sense to one individual will be different from another client. The first thing is to make sure that clients understand that their thoughts and actions will impact their state of wellness. The second step would be to have clients become aware of their energy level. If the task at hand depletes them, they need to do something that will at least restore them to a healthy level. As an example, if a person is depleted by contact with another person, they may want to create a time of nourishment afterwards. Nourishment can be listening to music, eating a healthy meal, spending time with a person who energizes you, practicing mindfulness; the list is huge. I believe burnout is the result of not doing this mind-body maintenance.

Stuart Bonnington: There is a lot of good, reliable information out there on mindfulness approaches. I strongly suggest counselors learn about these approaches. I have been talking with an Iraq war veteran who has complications due to multiple concussions. His emotional states have been all over the place. His limbic system has been on overdrive. I introduced him to some very basic qigong and gave him a book on meridian-based approaches that he could use on himself. The results from his self-reports have been very positive. Wellness to me comes down to what are you doing to take care of and nurture yourself in bodymind and spirit?

Abby Seixas: Obviously, some of the same things that we might do for ourselves. It really depends on the client and their individual style, needs and life situation. For some clients, I do a relaxation tape using my voice. For others, I recommend keeping a journal. For others, what’s most important might be doing something fun, giving themselves a break. It really depends on the client. I often encourage people to learn meditation, or I will give them a jump-start on how to meditate, or I will encourage them to go to a class or a retreat for meditation. The fact that this culture that we’re all living in has such a rapid pace that anything we can do for both our clients and ourselves to slow down our pace is valuable. There are a lot of clients coming in with pace of life issues, overscheduling issues. It’s good to have a range of ways, practices and a lot of encouragement for valuing down-time.

Geri Miller: The same kind of thing that I would say to counselors, I say to clients. Find out what fits that person. Me, I’m into hula hoping; others might be into something else. This is where the therapeutic relationship and having trust with each other comes in. We can brainstorm together. Why not just try something once? It may take some trial and error for us to find something that really gives us hope about living, about ourselves. What is it that keeps your spirit alive? I encourage clients to think of themselves as vessels; what are they putting into themselves? The folks that I counsel don’t have much money, time and energy, so we really look at what they can do that has the least cost for them that gives them hope and encouragement.

Jeanmarie Petrino: Counselors can educate clients regarding mind-body wellness, encourage them to explore various modalities and teach them how to incorporate wellness into their lives. Counselors can suggest exercise, adequate sleep, healthy diet and any of the many alternative therapies, including but not limited to Reiki, tai chi, qigong, yoga, meditation, prayer, self-hypnosis, self-relaxation techniques and biofeedback.

What are some current trends in the mind-body wellness field?

Abby Seixas: One thing I’ve noticed is the proliferation of mindfulness techniques and practices. Mindfulness was sort of an unheard of term 10 years ago, and now it has come into the mainstream. For most of us, our daily lives are so filled with distraction and interruption that there’s a great need for mindfulness, for opportunities to focus our attention and come into the present moment.

The other thing affecting the field is the ability to study the brain. Richard Davidson at the University of Wisconsin has studied people’s brains while meditating. His research is showing that systematic training of the mind can significantly shift people’s level of happiness. The understanding of the brain’s neuroplasticity, or ability to adapt and change, and other subjects of current and future neuroscientific research are going to be very important factors in mind-body wellness trends.

Charles V. Lindsey: A number of strategies have gained additional ground or have emerged within the past 10 years. Among these are mindfulness-based cognitive behavioral therapy, dialectical behavior therapy, and acceptance and commitment therapy. The terms “mindfulness” and “wellness” are also receiving much greater use and attention in the helping professions as evidenced by the amount of recent literature and research utilizing these terms. While the use of a variety of mind-body wellness interventions in the counseling field is gaining traction, there continues to be a debate surrounding the empirical support for such interventions, how they might most appropriately blend with other approaches and whether third-party payers should reimburse for mind-body based counseling approaches.

Jeanmarie Petrino: A recent trend in the mind-body wellness field that I am pursuing is incorporating Reiki energy therapy with grief and loss counseling.

Katlin Hecox: The first trend I see is that there is a move towards mind-body being a more mainstream paradigm.  With this trend, there is a more holistic way to view health.  Fields that were far apart are becoming more connected.  As a therapist who values systems, this makes perfect sense.  I have often felt alarmed at how different healing paths seem so disconnected and the trend towards more integration is exciting.

How is mind-body wellness related to spirituality?

Stuart Bonnington: Spirituality is an integral aspect of wellness. Spirituality is our relationship to that which permeates all of us and is greater than the whole. As we all know, spirituality does not have to be limited to religion. I remember hearing about someone struggling with the concept of Higher Power in Alcoholics Anonymous. The response to the person was that all you need to know about Higher Power is that “You ain’t it.” Spirituality is about transcending our alienation, our sense of separateness. Spirituality is realizing that human systems are not closed systems. Energy/life force permeates all creation, however you might want to conceptualize that. Harm comes when we close our systems, when our flow of energy becomes blocked.

Abby Seixas: Mind-body wellness is a potential doorway to spirituality. I don’t think it is a given that progressive relaxation or other mind-body techniques will open the door to the spiritual realm. Part of what these techniques do is to slow people down so that they become aware of more subtle energies and they listen to themselves. That brings them naturally to a place of depth that has a spiritual dimension to it, even if people don’t call it anything that has to do with organized religion. I think that in some ways because of the norm of speed and interruption and distraction in our culture, that people are really hungry for a spirituality that can be really nourishing to them. I think that this is one of the positive effects or results of mind-body work—it can connect people to their own spirituality.

William F. Mies: Spirituality is the heart of mind-body medicine. We have long ago grown out of the notion that the physical precedes the spiritual. Rather, we now accept that the physical and external worlds are a reflection of our grounding in the world of the spirit. I define spirituality as our innate capacity of love, compassion, wisdom, joy and equanimity, together with the activities that promote this evolution.

Jeanmarie Petrino: Mind-body wellness naturally enhances spirituality by encouraging daily practice of meditation, prayer and or breathwork.

How is mind-body wellness related to creativity?

Katlin Hecox: When we are mindful, when we are full of our own energy flowing, when we are appreciating the connection and beauty of that connection to all, we express our full selves. When this happens, creativity is its ultimate expression.

Stuart Bonnington: The term “flow” has been around for decades. When we feel truly creative, it feels effortless; the energy is flowing. I have had the good fortune of knowing many highly creative musicians and songwriters in my life. I have heard many of them say that when that burst of creativity comes along, it feels like it is in the air. They merely grab hold of it and let it flow through them.

Charles V. Lindsey: I help clients to identify and explore their “centers,” or the place within them that is “grounded.” There are a number of mind-body approaches that might be utilized in helping to reach this inner place — yoga, relaxation training, meditation and tai chi, to name but a few. It was T.S. Eliot who said that “at the still point of the turning world … there the dance is.” I have seen a number of clients respond in highly creative and innovative ways as they infuse mind-body interventions into their lives, and I have felt the personal creative benefits of working toward this “dance” in my own life.

Jeanmarie Petrino: Mind-body wellness can release emotional, mental and spiritual blocks to creativity, thus allowing creativity to flow freely.

Is mind-body wellness a necessary thing for people?

Stuart Bonnington: Looking at what is killing people in America these days. The leading causes of death are related to behavior, of not taking care of ourselves, of not practicing wellness. I teach a course called Health Psychology in which my students get a very healthy dose of information on wellness. One of the assignments I give them is to study the chronic diseases that run in their families. In many cases, it is the stuff that will shorten their lives. Many don’t have to look much further than their parents. Being in their early twenties, most of their bad habits or lack of wellness that my students have, have not caught up with them in a dramatic way. For many of them though, it has caught up with their parents and grandparents. I have seen some pretty dramatic positive changes in personal wellness activities as a result of this project.

Geri Miller: I don’t know that mind-body wellness is necessary, but it is helpful for living because there is a thoughtful focus. It is helpful for people to have a mindfulness practice, such as yoga or breathwork — anything that slows them down. This mindfulness practice can make them aware their mind and body are connected, so they then can live a more integrative life that expresses what they value. That flow, that wordless dialogue, is just a part of our life. So spirituality, then, is seamless with our life. It is fused. Then we can express our spirit. Mindfulness makes you more of who you are.

Jeanmarie Petrino: Mind-body wellness is extremely necessary for everyone in the 21st century. Our fast-paced lives are not conducive to wellness. Mind-body wellness forces people to slow down and center themselves in a hectic world and makes self-care a priority in all our lives.

Is the thought of seeking help for mind-body wellness less threatening to people than the thought of seeking counseling?

Abby Seixas: When the focus is not on “what’s wrong with” but rather on wellness, perhaps that’s less threatening. But I also think that counseling is becoming more accepted in our culture.

Geri Miller: It might be. When I go over to the wellness center, for example, I don’t see people walking in there with shame or fear. Mind-body wellness might be an avenue for people to do counseling in a more acceptable way.

Charles V. Lindsey: I believe that it is. As an example, I work at a community mental health clinic and also consult at a “wellness” center that is affiliated with a gym in my community. There are a couple of clients I work with through the wellness center who have told me directly that they didn’t want to be associated with a mental health clinic, but they were completely open to consulting a counselor affiliated with a wellness center.

Do you focus on mind-body wellness with all your clients as a regular part of counseling? Are there certain clients who need help with this more than others?

Abby Seixas: Yes, there are certain clients who need help with it more than others. But it really depends on the needs of the client. The client takes the lead, and I will often look for openings to suggest where these practices might be helpful for them. Not everyone is receptive. But I wouldn’t say that I always focus on it. What’s important is not my agenda; it’s the client’s agenda.

Geri Miller: One of the areas in which I’ve worked a fair amount is addictions and habitual patterns of behavior. I see mindfulness as very helpful in terms of people breaking out of habitual patterns. If, for example, I have someone who is addicted to cigarettes, I have them slow down their mind and get aware of what’s going on with them. What usually happens with habits is that we just get caught in them. It’s like a movie going at fast speed; we need to slow it down frame by frame. That’s where wellness can be a side benefit. If someone can slow down enough to find out what triggers them to crave a cigarette, then they can make a choice not to act on the craving. If we can go frame by frame and make different choices, healthier choices, it really is a tool. I’m inviting someone to be as alive as they can be in the present moment, and then they can carry that into their lives to make some choices.

Charles V. Lindsey: In one way or another, I do emphasize mind-body wellness with all of my clients. Sometimes it’s more overt than at other times. It really depends on the client and the relationship we are developing. As an example, there are some clients who really gravitate toward the idea of mindfulness activities and examining the relationship between their own mind and body. With other clients, I might take a less direct approach but still utilize techniques such as deep breathing or progressive muscle relaxation during our sessions. I have found mind-body wellness approaches particularly helpful in working with ADHD, anger, anxiety disorders, adjustment disorders, stress and burnout, pain and other medical conditions, and crisis situations.

Katlin Hecox: Being mindful (and respectful) means being present with the client and creating an interaction that supports their wellness.  I introduce mind/body and restoring concepts to all my clients and I also listen to the choices they make regarding how they choose to work.  I look for ways to help the underlying beliefs I have make sense to the client.  Biofeedback is a wonderful resource for this and the work of HeartMath helps those who want tangible feedback understand how their thoughts and their life force (in the form of breath) has a direct effect on their wellness.

What made you decide to emphasize mind-body wellness as part of your counseling practice?

Stuart Bonnington: It has been an evolution for me. I almost did not become a counselor. I had a severe chronic stuttering problem all of my early life until well into my master’s program. I almost quit because of my dysfluency. I was fortunate to be referred to the university counseling center, where I was treated with systematic desensitization. I learned to not tense up — to basically not block my energy flow. I learned to relax. I have since learned that our natural state according to the ancient Daoist is one of relaxed alertness. That is what I continue to aim for and return to when I start blocking my own energy and getting stuck in my negative anxious head. I, like most of us, teach what has profoundly worked for me.

Abby Seixas: Definitely my own experience with the benefits of meditation, the benefits of yoga and the benefits of journaling. The other thing is my training in psychosynthesis, which is a very holistic understanding of the psyche and approach to therapy. So that’s a base and an orientation that I work from, even though I’ve added lots of other things to my toolbox.

Charles V. Lindsey: During my own life journey, I have had the good fortune of being exposed to various mind-body wellness approaches. For me, these approaches have always fit incredibly well with the way I conceptualize the counseling process. My primary mission as a counselor is to assist people in living more productive, fuller, more aware and healthier lives. Simply put, I see mind-body approaches as having the potential to serve as powerful nutrients in the process of change.

Jeanmarie Petrino: While I was in graduate school, I started practicing yoga for stress relief and relief from a chronic illness. My yoga teacher was a Reiki master who introduced me to Reiki, meditation and other Eastern modalities. This piqued my interest in integrative medicine. As I saw the benefits of mind-body wellness in my own life, I realized that I wanted my counseling practice to also educate clients in mind-body wellness.

Katlin Hecox: I understood elements of mind-body wellness long before I became a therapist so that I was naturally drawn to this work.  I recognized that when I brought this work to the sessions, clients had greater benefit, and the gains persisted.  Additionally, clients had tools they could use and they became the expert in their own wellness.

Jenny Christenson is a staff writer at Counseling Today. Contact her at jchristenson@counseling.org.

Letters to the editor: ct@counseling.org

A reality too horrible to consider

Jonathan Rollins February 14, 2009

Kathi Anderson has grown accustomed to the often-involuntary reaction that many people have upon hearing that she works with survivors of torture. “The word torture sticks in people’s minds more so than survivor,” says Anderson, a National Certified Counselor and member of the American Counseling Association. “They step back from me like it’s a disease, so can you imagine what it must be like for a survivor to reveal that to someone?”

Even in a post-9/11 world, the prominence of politically motivated torture is too awful or seems too far removed for most Americans to consider, and the thought that more than a handful of torture survivors might be living in the United States is to most, well, a “foreign” concept. But according to government estimates, the number of torture survivors residing in this country approaches half a million.

“This continues to be a virtually invisible population — very, very marginalized,” says Anderson, who, along with Rev. William Radatz and Rev. George Falk, founded Survivors of Torture International (notorture.org) in San Diego in 1997. She serves as executive director of the nonprofit organization, which provides a holistic program of psychological, medical, dental, legal and social services.

“What I have learned is that with therapeutic interventions, survivors can and do heal, which minimizes the possibility of the trauma being transmitted to subsequent generations,” says Anderson, who has a bachelor’s degree in international relations and a master’s in counseling. “Many counselors to this day don’t consider the possibility that the clients they are serving may be torture survivors and, as a result, aren’t as effective as they could be. Torturers oftentimes tell their victims that no one will care or that no one will believe them when they are released. We, as counselors, have an opportunity to both counteract the torturers and
assist the survivors who are in need of
our services.”

Coming to America

Worldwide, individuals are tortured because of their ethnicity, political or religious affiliations, sexual orientation, gender or involvement in causes opposed by ruling powers. Many survivors of torture are exiled from their home countries and separated from their families. For some, escape is the only option, even if they possess only the vaguest notion of where or what they might be escaping to.

Andersonrecounts the story of an
Afghan woman who was a teacher. When the Taliban took power, she was no longer permitted to work because of her gender. She lost not only part of her identity but, being unmarried, her means of supporting herself. Several of her neighbors asked her to continue teaching their daughters in secret in her home because the Taliban had also outlawed the education of girls. The Taliban eventually found out what was happening and raided the woman’s home. She was incarcerated, tortured and released back into the community to serve as a visible example of what would happen to those who disobeyed the Taliban’s orders.

To show their gratitude for the woman and because they didn’t want to see her life further put at risk, her neighbors collected money, gave it to her and encouraged her to escape. She took a circuitous route from Afghanistan to San Diego (pre-9/11), finally crossing the porous border into the United States. Upon seeing a taxi driver who had emigrated from Afghanistan, she presented him with the address she had been given — an address that happened to be for a city on the East Coast, on the other side of the country. Fortunately, the taxi driver called his sister and told her the woman needed a place to stay. The sister took the stranger into her home without question and allowed her to stay until she was granted asylum. Today, the woman is once again teaching, helping Afghan children who are growing up in the United States to learn the customs and native tongue of their mother country.

Kerstin Palmer, an LPC, tells similar stories about the asylum seekers who come to Denver’s Rocky Mountain Survivors Center (rmscdenver.org), where she serves as director of therapeutic counseling. She talks about a young Ethiopian woman who was tortured before a group of people raised money and bought her a plane ticket to South America. For the next three months, she rode in the back of a pickup truck, slowly making her way north. After being smuggled into Mexico, she finally crossed the river into the United States, where she was promptly picked up by the Border Patrol. Housed in a detention facility for several months, she had little idea of what might happen to her next because she couldn’t speak English and most of her fellow detainees spoke only Spanish. She was released only after an attorney engaged in asylum work volunteered to help her. She eventually moved to Colorado and obtained assistance from the Rocky Mountain Survivors Center.

“These survivors are amazingly courageous and resilient people,” says Palmer, who has specialized in the treatment of trauma throughout her career, including working with abused children and their families. “Being an immigrant myself (she moved from Sweden to Colorado in 1983), I understand what it’s like to change countries, and even under the best of circumstances, it’s hard.”

In fact, she says, helping torture survivors deal with issues centered on identity change is no less important than working through issues of trauma and grief. “We have to help this population with social reconnection as they struggle with becoming a different person in a different land,” she explains.

Andersonsays torture survivors often experience nightmares, night terrors, sleep deprivation, intense anxiety and other symptoms related to post-traumatic stress disorder. Depression is another common struggle. “The psychological scars from being tortured take much longer to heal than the physical scars,” she says.

Some effects of torture aren’t necessarily visible to the eye but potentially are more debilitating, Palmer says. “Survivors of torture often feel like failures and can become preoccupied with ‘Why didn’t I do something differently?’” she says. “They often feel like they’re dirtied somehow. Their shame issues are high, and they sometimes feel contagious. As counselors, when you hear what they have gone through, you have to be careful of your reaction to the severity of the trauma, or they might think, ‘Even my therapist can’t handle this. Now I’ve made her feel bad, too.’”

Survivors’ assessment of the “contagiousness” factor aren’t necessarily off base if the aftereffects of torture are left unchecked. According to Anderson, research shows that if torture survivors don’t receive therapeutic interventions, their children and grandchildren have higher incidences of mental health disorders and face greater risk of school failure and family violence. “Torture has a ripple effect on families and even communities,” she says. “It can be toxic.”

As Palmer explains, survivors of torture often live their lives on edge. This sense of unease can easily transfer to their families if left untreated. “There is more fear present in the room with survivors, in part because they are so hypervigilant,” she says. “They are constantly geared toward fight or flight. It is a different operation for them to concentrate or to simply do boring things because they never feel totally safe.”

Both Palmer and Anderson say that, thankfully, therapeutic interventions can decrease the anxiety levels experienced by survivors and help them to restore their sense of self-worth, dignity and hope.

Multicultural competence

While counselors should have training in trauma work before treating torture survivors, practicing with multicultural competence is also a must. When she helped to found Survivors of Torture International, Anderson assumed the majority of its clients would come from Latin America, given the organization’s location in San Diego. In actuality, most hail from African and Middle Eastern nations. Overall, the organization has served approximately 800 clients from nearly 60 countries.

A hallway at Survivors of Torture International features a map that indicates the country of origin of each of its clients. That visual aid helps clients realize that, “‘Oh my gosh, it’s not just me’ or ‘It’s not just my country,’” Anderson says. “It makes their experience a lot less isolating.”

Offering therapeutic groups is another consideration, both for helping survivors to normalize their experience and to show sensitivity to their cultural norms. “When working with people from diverse cultures, one-on-one work can be foreign to them,” Anderson says. “In many cases, doing group work makes much more sense to them and makes them feel more comfortable.”

Likewise, counselors may have to take steps to decrease survivors’ suspiciousness of therapeutic services and entice them to participate. “As care providers, it’s really incumbent on us to meet them more than halfway,” Anderson says. For example, her organization doesn’t publicize its physical address (using a P.O. box instead) and is located away from a main street so clients can guard their privacy. In addition, her organization rarely uses the term “mental health” in describing its services. Many torture survivors already are burdened with a sense of shame or guilt, she explains, and in most of their countries of origin, a strong stigma is attached to mental health services. “So when providing counseling services to this population,” she says, “we might just call it ‘help’ or even ‘going on a nature walk to talk.’”

The Rocky Mountain Survivors Center is also careful about the way it presents available services to clients — asylum seekers who otherwise receive absolutely no services from other sources. “Most of the world doesn’t have counseling as it is practiced in the United States,” Palmer says. “Many of (our clients) don’t know what counseling is, so we explain it to them in simple language that makes sense. But they do know about ‘insane asylums’ and that those people are never accepted back into society in their culture, so they fear anything labeled ‘mental health.’ We present ourselves as people others can come and safely talk to about what has happened to them, much like the role elders serve in their culture. We try to describe their condition as being more like an injury instead of an illness that we are going to help them ‘heal’ from.”

Palmer has learned a couple of other interesting cultural lessons while working at the nonprofit survivors center. First, she says, some clients, particularly those from Africa, regard anything offered for free — including legal representation, health care or psychosocial services — as being “bad,” or at the very least view the offer with suspicion.

Palmer also noted that clients from Africa were more likely to accept offers for help but then not show up to take advantage of the services. She finally had an African client tell her, “We are ‘yes’ people.” He explained that people from his culture automatically answer “yes” to any offer, whether they want to accept or not; to decline the offer in front of the person is considered rude. From this encounter, Palmer learned to give clients from Africa specific options. For example, instead of asking, “Would you like to come in for an appointment?” she will now ask, “Would you like to have your appointment in a week, in two weeks, or would you like to call me when you are ready?”

When it comes to multicultural competence and sensitivity, Palmer says, “There are two key words to remember: respect and curiosity. Be respectfully curious about the person.” She also gives counselors another piece of advice: Don’t have preconceived notions about what is “right” or “wrong” based on an exclusively Western point of view. She admits this is sometimes easier said than done.

Palmer recalls one instance in which a 63-year-old woman from Sudan arrived at the survivors center. She had been in slavery and had been tortured (“The fact that she reached age 63 is a miracle,” Palmer says as an aside). Fellow villagers had raised money to help her escape and reunite with her daughter, who was married and living in Denver. The therapists and other service providers at the survivors center ran into a roadblock, however, when they tried to help the woman. “In her culture,” Palmer explains, “women cannot speak until the man tells them they can. We don’t like that thought here in the West.”

Palmer respectfully asked the son-in-law if she could meet with the woman one-on-one, but the woman said she would refuse to speak unless her son-in-law was present. The initial session eventually was carried out with a therapist asking the son-in-law for permission each time before the woman spoke. “It didn’t seem like a big power trip,” Palmer says. “It just seemed like, ‘This is how we do it in our culture.’”

After that first session, the woman was comfortable enough to meet with a male therapist and an interpreter by herself. “Because she had been a slave and been tortured, we were trying to teach her self-empowerment,” Palmer says, “but we first had to understand that we weren’t starting from the same point culturally.”

Meeting needs

When treating survivors of torture, “therapy” can take many forms, much of it extending beyond the traditional realm of counseling, says Anderson. She points to a cooking class that Survivors of Torture International offers its clients. “This is a nontraditional approach,” she says, “but everybody likes food, so you can pull a lot of people and a lot of cultures in. It’s therapeutic because they are preparing and eating a meal together, reestablishing human connections, laughing and having joy. But it’s also practical because they are learning how to cook for themselves, which many of the men don’t necessarily do in their cultures. We try to meet our clients where their needs are. As they learn to trust us through these experiences, they often open themselves up to other kinds of therapy.”

The best treatment/intervention techniques vary from person to person, Anderson says. She sees similarities between working with survivors of torture and individuals who have been raped because both groups have had their sense of control taken from them. For that reason, she says, counselors should collaborate with torture survivors on their treatment plans, both to restore some sense of control to them and to ensure the plan is a good fit.

“We’re also not proponents of these survivors having to tell their entire story to be healed,” Anderson says. “They may reveal pieces of it little by little, and that’s OK. As counselors, we have to go at their pace.” She has found torture survivors to be extremely appreciative of counselors and therapists who can help them put the feelings they have been carrying around inside of them into words.

This process is aided greatly by making survivors feel safe in their sharing. For example, Anderson says, when her organization does an intake with a client and takes down the person’s history, “We make it more of a conversation rather than an interview because we don’t want them to feel like they are going through an interrogation again.” Likewise, all the offices have windows that open so survivors won’t have flashbacks to when they were confined by their torturers. “We try to make the environment as warm and inviting as possible for them,” Anderson says. “We might even begin with tea in the kitchen rather than heading straight to a clinical room.”

Palmer most often uses Pat Ogden’s Sensorimotor Psychotherapy techniques in treating trauma and loss among torture survivors. She is also a proponent of cognitive therapy, but, like Anderson, believes each treatment plan must be individualized. Palmer says one of the major steps in treating torture survivors is to help them stabilize by assisting them in identifying their strengths and coping skills and understanding why trauma affects them in the way that it does.

Once again, this often involves normalizing the client’s experience. Palmer references one client who had been a mathematician for a foreign government before being tortured and exiled. When he came for treatment, he expressed deep-seated worry that he no longer seemed capable of doing even simple math. Palmer tried to help him understand that his body and mind were reacting very naturally to the traumatic events he had endured. “I told him, ‘You can’t stop and do math when a tiger is chasing you.’ For torture survivors, it is extremely tough for them to wind down and stop running from that tiger. We have to let them know that, given their circumstances, their symptoms are normal; they are not going crazy.”

The Rocky Mountain Survivors Center also employs a variety of groups in treating torture survivors, including trauma and grief groups, meditation groups and groups designed to strengthen coping mechanisms through the creative arts. The groups also serve the purpose of helping survivors rebuild their sense of community and trust. Among the treatment goals these clients most often voice, Palmer says, are to feel safe, be confident in their ability to manage their symptoms, sleep better, worry less, identify the good things in their lives and dare to reach out to other people.

Family therapy is another important component of working with torture survivors, Anderson says. In some instances, children of survivors haven’t been told or don’t really grasp what happened to their parent. Those who don’t understand sometimes feel abandoned or resentful that the parent wasn’t providing for the family. Anderson says counselors also need to help family members understand that the symptoms the survivor is exhibiting or feeling are normal based on what happened to them.

The good news, Anderson says, is that the proper treatment allows torture survivors to heal from their trauma and resurrect their hopes and dreams. “These people are true survivors,” she says. “They have survived torture. They have survived getting to this country. They have survived adapting to a new culture. They walk through our door a shell of who they once were. Through treatment and interventions, they can become who they were before they were tortured and contribute again. It’s amazing just how resilient and successful these survivors are. These are the type of people who make any country strong.”

Jonathan Rollins is the editor-in-chief of Counseling Today. Contact him at jrollins@counseling.org.

Letters to the editor:

ct@counseling.org

Will I see you in March?

Richard Yep February 1, 2009

Richard Yep

Next month, more than 3,000 professional counselors, counselor educators and graduate students will gather in Charlotte, N.C., for what is shaping up to be one of the American Counseling Association’s best Annual Conferences ever. The registration numbers are strong, the exhibitors are ready to show off their latest offerings, our preconference Learning Institutes will be led by top-notch presenters, the ACA Career Center is ready to roll, many of our best-selling books (and authors) will be available and many of our divisions have planned special sessions and events. We are anticipating a great deal of “counselor energy” when we gather.

Now, all we need is you!

Many of you who attended last year’s event in Honolulu will remember the “feeling” of the conference — outstanding sessions balanced by enough time to connect with colleagues and have fun in the local area. This year will be no different in terms of professional opportunities and the chance to connect.

And, quite frankly, after this past year, which included some fairly impactful events (politically, economically and socially), the chance to reenergize with colleagues who are as dedicated to the counseling profession as you are is something that really cannot be missed! I encourage you to find a way to join with us as we convene our 58th annual gathering.

At ACA, we know we need to bring you information, resources and commentary on those issues and projects that directly impact you as a counseling professional. For example, the recently launched ACA-ACES Syllabus Clearinghouse (online at counseling.org) contains an incredible wealth of information for those looking to improve their own syllabi or those who simply want to know what texts and resources are being used in contemporary counselor education. Go take a look. I want to personally thank all of the counselor educators who contributed their time and materials to building the syllabus library. Talk about collaborative and committed to moving the profession forward!

Many of you also are aware that last month, ACA was finally able (after working on this effort for many years) to offer a superior professional liability insurance program to its master’s-level student members as part of their membership! You read that right. Our master’s-level students, as a benefit of their membership in ACA, will now be covered by professional liability insurance. In addition, other ACA members will soon receive up to a 10 percent discount on their liability insurance.

Why did we go to extraordinary lengths to provide insurance to master’s-level students and yet another deep discount to our professional members? Because we understand the financial challenges our members are facing, especially during these tough economic times. We want you to value your ACA membership, and we want you to know how much we value all that you do.

I hope I will see many of you next month in Charlotte. If not, I still thank you for being a member of ACA, and my hope is that you will continue to take advantage of all the association has to offer!

I also hope you will contact me with any comments, questions or suggestions that you might have. Please contact me via e-mail at ryep@counseling.org or by phone at 800.347.6647 ext. 231.

Thanks and be well.