Tag Archives: yoga

Moving through trauma

By Jessica Smith November 7, 2018

I am a wounded healer. I remember a professor in graduate school telling our class that most counselors are wounded healers. As human beings, we gravitate toward what we know. As counselors, many of us are attracted to this work because of our difficult life experiences. These events in our lives often include trauma.

Trauma is woven into the tapestry of my life. My hope in sharing my story is to continue the discussion around personal and vicarious trauma for counselors to remind others that they are not alone. I also wish to provide tools and strategies to assist counselors and their clients in moving through and releasing the trauma that is stored in their bodies and hearts.

My story

At age 17, I was sexually assaulted at a New Year’s Eve party. My life and my perception of the world instantly altered in that moment. Before the assault, I was the captain of my varsity field hockey team and was taking Advanced Placement courses to pursue my dream of going to an Ivy League school. My primary focus at the time was finding a date to the senior prom, but after that night, I lost all direction and shut down.

From that point on, I went to school and then went straight home each afternoon. I started avoiding my family and friends because I feared the questions they would ask and the suffering my responses would reveal. I slept a lot and found myself drifting off in the majority of my classes. Sleep was one of the few activities that allowed me to escape my thoughts and emotions, so I found refuge in the silence as often as possible. I isolated myself by spending most of my time alone in my bedroom, which was one of the only places where I felt physically and emotionally safe.

When sleep wasn’t enough, I turned to alcohol to numb the pain. Substance use issues run in my family, so drinking was modeled for me at a young age as a way to release and relax. When I was crumbling on the inside, drinking allowed me to appear stronger on the outside. In social situations, drinking helped replace my anxiety and insecurity with confidence and courage. I was aware that drinking offered only a short-term fix, but at the time, it was the only way I knew to cope with my discomfort and pain.

I managed to finish my senior year of high school and go off to college. I thought I would reinvent myself in college and leave behind my past experiences, but the drinking and my desire to numb myself followed me to this next stage of life. I would stay up late drinking with friends and subsequently miss most of my morning classes, even though attendance counted for a large portion of the grade.

I thought I was doing well, but in reality I was barely keeping my head above water. My grades suffered, and I ended my first semester of college with a C average. School had always been a grounding force in my life when everything else felt like it was floating away, so I knew that something had to change.

As a high school athlete, I had used sports and exercise to move through and release difficult emotions, so I once again began exercising and taking longer walks on an almost daily basis. Still, I felt that something was missing. My college was located in a rural town in southwest Virginia, but I managed to find a yoga studio to try out the practice, telling myself that it would serve as a beneficial cross-training exercise to my running. The prospect of cross-training was what brought me to my mat, but it was not what kept me there.

I still remember my first class. It was a hot yoga series with a set sequence of 26 standing and seated poses in a room heated to 92 degrees. I recall the teacher saying that if we needed to take breaks during the class, we could sit on our mats in Hero pose. Hero pose (see photos in Counseling Today‘s print magazine) is a kneeling pose, which also makes it a vulnerable posture. Although it is a grounding and surrendering pose, it is also a strengthening and activating pose.

About halfway through that first class, I felt dizzy and nauseated from the heat and the movements. I had believed I was in good shape at the time, but yoga challenged both my mind and my body in ways that I wasn’t accustomed to. My pride told me to continue to stand and attempt the series of poses, but my heart told me to sit down and take a break. I decided to listen to my heart instead of my mind for one of the first times since my childhood. I knelt down in Hero pose, stared at myself in the mirror and began to cry. I had been avoiding the metaphorical mirrors in my life for so long after the assault that I did not recognize the person looking back at me.

In that moment, I allowed myself to feel the pain I had been avoiding for the past year. I felt safe and comforted on my mat in that space. The class continued to go on around me while I closed my eyes and breathed in the pose. “I’m here for you,” I said silently to myself. “I’m not going anywhere. You’re safe now.”

Initially, I attended yoga once a week, but that eventually turned into two and three times a week. Each time I stepped on my mat, I felt a little piece of myself coming back and healing where it had been broken apart. Gradually, my heart also began to open again. I was able to begin getting out of my head and into my heart, which had been a struggle for me much of my life. At first, I gravitated toward yoga for the physical practice, but what kept me coming back was the spiritual and heart connection that it continually fostered.

Breathing in

In college, I began learning and experimenting with pranayama, or breathwork, practices in yoga to try to manage my overwhelming emotions with something other than alcohol. My connection to my mind was powerful and familiar, but my connection to my body and breath felt feeble and foreign.

I knew it would take time to nurture this new relationship with my breath. I kept going to yoga even when I wanted to give up and choose the quick fix. I continued to show up to experience the sporadic moments of quiet I achieved each time in my practice. Even if that happened for only 10 seconds at a time, those 10 seconds were more of a reprieve from my thoughts than I had experienced at any other point in my life.

I soon discovered that feelings influence breath and breath influences feelings. I used breathwork to move through a variety of emotions in college, including stress, anxiety, frustration and exhaustion. Prana is translated as “life force,” and yama is translated as “control,” so pranayama means to control the life force within. When I felt like so many things were out of control in my life, it was empowering to have one area in which I could temporarily regain my sense of power and control. With each breath I took in yoga, I felt like I was coming back to life again.

My breathwork practice started with basic diaphragmatic breathing, in which you place one hand over your heart and one hand over your stomach while breathing deeply into the belly. Diaphragmatic breathing is still a touchstone in my practice when I am struggling to connect with my breath.

Early on, I also learned kapalabhati, or “breath of fire,” in which you place one or both hands on your stomach and use forced exhalations through your nose to move your stomach and increase fire or energy in your body. Through practice, I discovered I could use breath to activate or energize myself (kapalabhati), and I could also use breath to deactivate and calm myself (diaphragmatic breathing).

Sitting down

My interest in breathwork eventually evolved into a meditation practice. I attended a mindfulness-based stress reduction intensive in graduate school to strengthen my meditation practice. I remember learning about walking meditation and practicing this form of grounding for an hour outside in nature. I had moved from 10 seconds of stillness in my mind to minutes of stillness during this walking practice.

I began to use walking meditation while moving around campus during my internship. I noticed that I felt more present, relaxed and grounded in sessions with students. When I was in a rush and forgot about my meditation practice, I felt irritable, worried and distracted in meetings.

My meditation practice has changed over time, but I always come back to walking meditation and the basic breathing techniques I learned in college and graduate school. I typically meditate for at least 20 minutes each day during the evening. This allows me to quiet my mind before bed and to release anything I am holding on to from the day that is no longer serving me.

Recently, I started beginning my meditation practice with a mantra statement. Mantra is translated as a “mind tool.” A mantra I use often in my practice is “Ham-sah,” which is Sanskrit for “I am that.” I am divine. I am light. I am love. I breathe in “ham” and breathe out “sah.” I use a mala, a string of 108 beads, to recite the mantra. The mind is like a puppy; the mantra serves as a toy for the puppy to play with and explore while settling into your meditation practice.

I also use mudras, which I call yoga for the hands. We have thousands of nerve endings in our fingers that are linked to various organs and other parts of our bodies. When we place our hands in specific positions, this activates certain sensations in the mind and body.

One of my favorite mudras to teach to clients and students is Auspicious mudra, in which you place one hand over your heart and then the other hand, while intentionally sending your breath to the space around and through your heart. I use this mudra to nurture and show compassion to my heart and body.

Standing up

After the assault, I blamed my body for what had happened, and I wanted to punish it. Because of this, I disconnected from my body through alcohol and other means. Yoga helped me come back to my body and feel safe in my body again. It allowed me to reclaim my relationship with my body that I had severed a connection with out of fear and shame. The poses and postures reduced the negative thoughts I carried about my body and encouraged me to open up to the beauty and wonder it had to show me.

One definition of yoga is a practice to “calm the thought waves.” Yoga asks us to move out of our heads and gently into our bodies. Yoga encourages us to push ourselves to our edges and sit with the sensations but to back off when we experience pain. Yoga reminds us that we can be uncomfortable in a moment but that, eventually, the discomfort will pass. Yoga connects us to our physical, mental, emotional and spiritual bodies. Yoga invites us to play, explore and discover the magic of our minds, bodies and souls.

As with my breathwork and meditation practices, my yoga practice has evolved over time. My movement usually reflects what is going on with me internally. When I need calm and peace in my life, I turn to restorative or yin postures, which are cooling and relaxing. When I need strength and power in my life, I seek out vinyasa or hatha poses, which are heating and energizing.

One pose that I return to each day in my practice, both personally and professionally, is Tree pose. Tree pose is a balancing pose. Balancing poses are particularly helpful in bringing ourselves into the present moment rather than focusing on the past or the future. It is difficult to stand tall and securely in a balancing posture when our minds are wandering or drifting out of the present moment. To not fall in a balance pose, we have to be fully in the here and now.

To begin, stand in Tadasana, or Mountain pose, with your shoulders stacked over your hips, knees and ankles. Inhale to lengthen up through the spine and the crown of the head, and exhale to ground and release into the feet. Feet are hips-width distance apart and parallel. Arms can gently rest by the sides with the palms facing up.

With an inhale, bring the right foot to rest on the left ankle or calf like a kickstand. Exhale to root into the left foot and then move the gaze to a wall or object 3 to 6 feet in front of the eyes. Inhale and bring the hands to heart center in Anjali mudra, or Prayer pose. Exhale to release the shoulders down the back. Inhale to lengthen in the pose, and exhale to settle in the pose. Remain in Tree pose for five additional breaths, then switch sides and repeat.

Flowing through

I am a survivor. At one point in my life, I was only surviving, just trying to get through each minute and hour of the day. Now I can confidently say that I am truly thriving.

We deserve to thrive rather than just merely survive in our lives. Yoga, breathwork and meditation have helped me to survive and also thrive in my life. The yoga text, the Bhagavad Gita, reads, “Yoga is the journey of the self, through the self, to the self.” When I lost my way, breath and movement led me back home to my true self.

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Jessica Smith is a licensed professional counselor, licensed addiction counselor, yoga teacher and owner of Radiance Counseling in Denver. She believes self-care is an act of self-love, and she is passionate about spreading this message to her fellow healers and clients. She is currently writing a collaborative memoir with a former client in the justice system and a memoir on healing from burnout. Contact her at jsmith@radiancecounseling.com.

Letters to the editor: ct@counseling.org

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having an article accepted for publication, go to ct.counseling.org/feedback.

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Finding balance with bipolar disorder

By Laurie Meyers April 24, 2018

Licensed professional counselor (LPC) John Duggan didn’t plan on bipolar disorder becoming one of his specialties, but providing emergency room support gave him a close-up view of the consequences when the disease was left uncontrolled. Duggan, who is also a licensed clinical professional counselor (LCPC), noticed the escalation in manic and hypomanic crises that accompanied the increased light and time change in spring. He also saw people who had been diagnosed with depression but whose manic or hypomanic symptoms had gone undetected until they ended up in the emergency room with full-blown mania, psychosis or dysphoria.

Some of these individuals had no one to help them remain stabilized after leaving the hospital. Seeing the need for, as Duggan puts it, “boots on the ground,” he began seeing more and more clients with bipolar disorder in his private practice in Silver Spring, Maryland. Duggan, who is now the manager of professional development at the American Counseling Association, says some of those clients came as referrals from counselors who didn’t feel qualified to work with individuals struggling with bipolar disorder.

It is not uncommon for counselors to be hesitant to take on clients with a bipolar diagnosis, according to practitioners who specialize in the disorder. At the same time, there are many individuals with bipolar disorder who truly need the support of counselors and other mental health professionals to help them manage their condition. Although the public — and perhaps even some mental health professionals — may think that the disease is rare, the National Institute of Mental Health (NIMH) estimates that approximately 2.8 percent of U.S. adults currently have bipolar disorder and that 4.4 percent will experience it in their lifetime. NIMH also estimates that approximately 2.9 percent of adolescents currently have bipolar disorder.

Some mental health practitioners may buy in to the stereotype that clients with bipolar disorder are volatile and resistant to treatment, whereas others may be daunted by the disorder’s elevated risk of suicide. The Substance Abuse and Mental Health Services Administration estimates that for those with bipolar disorder, the lifetime risk of suicide is at least 15 times higher than it is for the average person. However, Duggan and others who treat bipolar disorder say that counselors have a crucial role to play in helping clients manage the disease.

Bipolar basics

Counselors are already trained to obtain a detailed client history that includes, among other things, emotional symptoms, family history and sleep and lifestyle habits, all of which can be crucial to spotting bipolar disorder.

“Bipolar clients often seek help only when depressed. Because of this, their manic or hypomanic symptoms are often not reported or observed,” explains Valerie Acosta, an LPC who counsels a number of clients with bipolar disorder in her Richmond, Virginia, practice.

A first step is for counselors to educate clients. Although they may be familiar with the symptoms of depression, they are much less likely to know how mania or hypomania present, adds Acosta, a member of ACA. Many clients think mania involves feeling very “up” and happy, but symptoms actually include intense irritability, anxiety and distraction, she explains.

Sleep patterns are also instructive when looking for evidence of mania or hypomania, says Regina Bordieri, a licensed marriage and family therapist in New York who specializes in bipolar disorder. “If they’re not sleeping, are they feeling energetic or tired?” she asks. Most people feel tired after a short night’s rest, but in hypomanic or manic phases, those with bipolar disorder feel energized despite very little sleep, Bordieri explains.Bordieri also asks clients about times when they weren’t depressed. Did they have high levels of energy and feel like they could get a lot done? Depressed moods that alternate with periods of intense activity and feelings of almost limitless energy may be signs of bipolar disorder.

Because it can be difficult for individuals to recognize their mood and behavioral shifts, family members and partners can also play a significant role when it comes to identifying and gauging symptoms, Bordieri says. Then, of course, there is the other role that family plays in diagnosis — namely, family history. Bipolar disorder is strongly tied to genetics, so clients with a family history of bipolar disorder are more likely to develop the disease.

Duggan urges counselors who are treating clients with bipolar disorder to work closely with medical professionals. Consulting a client’s primary care physician (with the client’s permission) is particularly crucial during diagnosis so that physical causes such as sleep disorders, thyroid disorders or a reaction to medication won’t be mistaken as symptoms for bipolar disorder.

Counselors — and clients — should also be aware of their ideas concerning which symptoms and forms of bipolar disorder are most debilitating, say Acosta and Bordieri.

“Bipolar II is not a milder form of bipolar I, but a separate and different diagnosis,” Acosta explains. “Bipolar I is also not necessarily more difficult to treat. … While the manic episodes in bipolar I can be severe and dangerous, the depressive episodes associated with bipolar II can be longer lasting, causing severe impairment to the individual. While clients with bipolar II have hypomania and not full manic episodes, their depressive episodes can be more debilitating than the depressive episodes of bipolar I.”

Although the depression of bipolar II may take a greater overall toll and be harder to treat, the mania inherent in bipolar I comes with its own set of “baggage.” In the popular imagination, mania — especially more extreme episodes — is the phase most associated with bipolar disorder and contributes to the perception that those who have the disorder are “crazy.” Mania is also extremely disturbing for clients and is highly stigmatized, especially when it leads to hospital stays, Bordieri says.

Ultimately, however, each client’s experience of bipolar disorder is different, Acosta says. “A therapist might be working with two people with bipolar II, and these individuals may present with very different symptoms,” she says. “Helping clients and their families to understand the individual’s unique symptoms, and have a variety of tools and strategies for managing their moods and specific symptoms, is essential for recovery.”

Managing medication

The counselors interviewed for this article stress that because of the neurobiological nature of bipolar disorder, medication is an integral part of treatment. Cheryl Fisher, an LCPC practicing in Annapolis, Maryland, whose specialties include bipolar disorder, says that counselors should work closely with a psychiatrist when treating these clients. In fact, when Fisher sees new clients with bipolar disorder who are working with a primary care physician, she strongly urges them to begin seeing a psychiatrist. Fisher, a member of ACA, believes that psychiatrists possess the specialized psychopharmaceutical knowledge necessary for prescribing the medication “cocktail” that works best for each individual with bipolar disorder. And because counselors see clients more often (and for longer chunks of time) than their physicians do, Fisher thinks that counselors are in a better position to track the effectiveness and side effects of clients’ prescriptions.

Counselors can also help clients become better self-advocates, says ACA member Dixie Meyer. Sometimes clients aren’t comfortable speaking up at the doctor’s office or are unaware that they are even experiencing side effects, she says. Counselors are in a position to spot such problems.

Meyer gives the example of a client who was showing signs of lithium toxicity. “I asked him when was the last time he had his blood levels checked [lithium requires regular blood testing to guard against toxicity]. He asked me what I was talking about. Somehow, he never knew he needed to have levels checked regularly.”

Meyer, an associate professor in the medical family therapy program at the St. Louis University School of Medicine’s Relationships and Brain Science Research Laboratory, says counselors should also be aware that clients with bipolar disorder might be given antidepressants for depression that can cause the onset of mania or hypomania.

“Clients might feel like, ‘Wow, I’m really starting to have a good mood,’” she notes. “They don’t really think to bring that up to the doctor, but the counselor can easily recognize the difference between remission of depression symptoms versus the development of manic symptoms. [Clients] might become more impulsive, snippier, their motor behavior more agitated … Counselors and family members are often the best [resources] to spot mood shifts.”

Sometimes clients don’t want to take medication for bipolar disorder because they have experienced unpleasant side effects, says Meyer, who frequently gives presentations to counselors on the importance of understanding their clients’ medications. She urges counselors to talk through this decision with clients. Meyer informs her clients with bipolar disorder that all medications have side effects, some of which may be temporary. She then asks these clients to give the medications some time and encourages them to talk to their physicians about which side effects might be permanent.

If the side effects of the medication aren’t going to go away, Meyer talks with clients about whether the side effects are something they can live with. In some cases — especially with medications that cause significant weight gain — the client’s answer is no. In those situations, Meyer says that she, the client and the physician go back to the drawing board and look for other medications or explore whether lifestyle changes might help reduce the side effects.

Meyer says all counselors should have a copy of the Physicians’ Desk Reference on hand so that they can quickly look up any medication. She also recommends Drugs.com as an excellent online resource.

Sometimes clients with bipolar disorder get stabilized and decide that they don’t need to take their medications anymore. When that happens, Acosta says that she “reflects back” what happened the last time the client stopped taking his or her medication. (Spoiler alert: It wasn’t good.)

Fisher tries to educate clients about bipolar disorder, emphasizing that a biochemical reaction underlies their mood shifts and that the medication helps buffer that process.

Medication, however, is not the only tool in the box to help individuals with bipolar disorder. Counselors can provide the emotional and lifestyle keys that help clients manage and, hopefully, decrease their mood and behavior shifts.

Prevention and stabilization

Multiple research studies continue to demonstrate the link between the circadian rhythm and bipolar disorder. Researchers are still teasing out the specifics, but what is clear is that maintaining a schedule — particularly a sleep schedule — that hews to the circadian rhythm plays a key role in controlling the disease.

Research has shown that insomnia is not just a symptom of depression but can also cause it. Likewise, Bordieri says, disturbed sleep can be either a symptom of hypomania/mania or the trigger for an episode.

Sleep is one of the first things that Fisher investigates with all clients, but it is particularly important in those with bipolar disorder. “I ask them what their sleep routine is,” she says. “How do you end your day? How do you prepare your body to rest? What is your sleeping environment like?” Fisher talks about how the blue light from devices such as smartphones and tablets disrupts sleep and advises clients to establish total darkness in their bedrooms.

Some clients reveal that a racing brain regularly prevents them from going to sleep. For these clients, Fisher recommends tools such as guided meditation or performing what she calls a “brain dump” — emptying the mind by writing down all of the thoughts that are keeping clients awake.

Acosta encourages clients with bipolar disorder to go to bed at the same time every night, wake up at the same time every day and take their medications at the same time daily. She has found this routine has a stabilizing effect.

Fisher and Duggan both believe sleep is so essential to mental and physical health that if good sleep hygiene isn’t working, they advise clients to get a sleep aid from their physician.

Duggan has found that the changing of the seasons can also have a profound effect on bipolar disorder. It’s a component of the bipolar resiliency program he came up with called SMART.

S — (Control) stress, sleep, maintain a schedule, seasons: Duggan asks clients with bipolar disorder to track their moods and sleep. He also teaches sleep hygiene and makes note of clients’ responses to the different seasons. Summer, when there is a lot of activity going on and plenty of sun, is usually a good time for many clients with bipolar disorder. But as the season draws to a close, Duggan reminds them that once fall arrives and there is less light, they are likely to start feeling less upbeat and may feel overwhelmed. He urges these clients not to overschedule themselves in summer and to step up their self-care efforts when the calendar turns to September.

M — Medication as prescribed

A — Adjunctive treatment such as yoga, acupuncture, massage or other complementary or alternative practices: Duggan says these are all areas that are outside of his expertise but that clients have found helpful. He also works with clients on self-soothing techniques and meditation. If a client is going through a severe manic or depressive phase, however, he strongly recommends against mindfulness. “I don’t want them to ‘be’ with the bad depression or the bad mania,” he explains.

R — Recreation and relationships: Duggan urges clients with bipolar disorder to stay engaged socially and to “do things that bring you joy, that you love, that give you a sense of flow.”

T — Therapy and counseling as needed

Fisher is a proponent of what she calls “nature therapy.” Research has shown that nature has a beneficial effect on mental health, so she urges clients to find a way to get outside — even if only for a short time — every day.

“Encouraging clients to track their moods can be a very valuable tool,” Acosta adds. “There are a wide variety of apps that clients can download to help with tracking their moods. Daylio is one that a lot of my clients like to use. By recording this information over time, clients learn about how their moods cycle, and this helps them to better understand the nuances of their moods, their triggers, and what helps and does not help with stabilizing their moods. I routinely review data from these apps — or paper mood charts — with my clients. I also routinely review symptom charts with my clients to help them monitor their symptoms.”

Some of Acosta’s clients have also had their own highly personal methods of tracking problematic mood changes. One client monitored her mood elevations by the number of packages that appeared for her in her apartment lobby (overspending). Another client could connect his manic symptoms to times when he would spend several days engrossed in building things (an increased focus on goal-directed activities).

Developing this degree of self-awareness can be beneficial for clients with bipolar disorder. “Linking symptoms to behaviors, thoughts and triggers can help to foster recovery,” Acosta says.

Meyer also teaches clients to spot patterns. She has premenopausal women chart their menstrual cycles so they will be aware, for example, that three days before their periods begin, they will feel more depressed. Meyer instructs clients to note their moods throughout the day and record what was going on. She believes that when clients can identify these patterns and recognize that there was a specific reason they were particularly manic or depressed, it provides them a greater sense of control.

Meyer teaches clients to self-soothe on hard days by going for a walk, going to the park and sitting on a bench or doing whatever else makes them feel good in a healthy way.

“It’s really important … that our clients be empowered with a strategy for their symptoms,” Fisher says. For instance, if clients with bipolar disorder are having a down day and feel as though they are shifting toward a depressive episode, they could start to manage the switch by making a plan to get together with a friend or even just calling someone close to them.

Acosta tries to equip clients with bipolar disorder against life stressors. “They need to find healthy ways to cope with stress,” she says.

Acosta teaches clients mindfulness meditation and gives assignments outside of session, such as trying yoga or a new form of exercise. She believes that physical activity helps rein in racing thoughts. Acosta also recommends music for relaxation.

Seeking support

In addition to individual therapy, Acosta has found that group therapy is very effective for clients with bipolar disorder. She runs a monthly support group for adults over 18. “Some participants have been living with bipolar disorder for decades, and some have just been diagnosed,” Acosta says. “This is an open group, so members are constantly joining and leaving the group. On average, we have three to 10 participants per group. Because this is a therapy group, participants bring in and discuss any issue that they’re currently dealing with in their lives. Some of the topics of discussion include challenges such as the struggle to be on time for work or losing a job because of their bipolar symptoms, relationship conflicts, the side effects of medication, healthy strategies for managing symptoms, grieving the losses in their lives caused by their illness and building healthy living strategies.”

Acosta also provides education as needed in the group on topics such as understanding symptoms, exploring apps to track mood and locating resources for further education and support. She believes the peer support is what is most helpful to group participants.

“Many people have never met someone else with bipolar disorder, and learning that they are not alone or the only person dealing with the challenges of bipolar disorder can be extremely comforting and helpful,” she says. “Seeing peers recover, build healthy relationships and obtain their goals and dreams is most powerful.”

Support for these clients is essential, agrees Meyer, who recommends that counselors help recruit family members and romantic partners as a kind of support team whenever possible. Loved ones can be there when counselors can’t and are often the first to spot mood changes, she explains. “We also know when clients are in good, healthy relationships, it helps stress levels, and that helps keep them in good health,” Meyer adds.

Sometimes support can come from the strangest of sources, notes Fisher, relating the story of a woman who was in particular need of connection. “I had a client who had a trauma history in addition to bipolar disorder, and she was engaging in really unhealthy behaviors and self-loathing. She was just not in good shape,” Fisher says. “She came in one day, I did a checkup, and she showed really high levels of depression.”

Fisher didn’t think the client was in immediate danger, but she felt bad leaving her without another source of support, particularly because it was a Friday and Fisher was going away for the weekend.

“I asked, ‘Who can you be with? Who can you talk to?’’ Fisher says. “The client said, ‘No one. There is no one.’”

The woman was estranged from her family, and her only “network” involved her sexual hookups.

Suddenly, Fisher had an idea. She had just bought a betta fish for her office, so she asked the client to watch it for her over the weekend.

Fisher saw the client the following Monday — sans fish — and asked how she was doing. The client replied that she was feeling better and more upbeat.

“Then she started talking about her weekend and spending time with ‘Olive’ and watching TV with ‘Olive,’” Fisher continues.

She asked the client who Olive was. Olive was the name the client had bestowed on the betta fish. The client had neglected to bring Olive back because she didn’t want to leave the fish in the car but promised to return her later in the week.

Fisher told the woman to keep the fish but was curious as to why she had named her Olive. The client said that Olive made her think of hope — like the olive leaf the dove brought back to Noah’s Ark to show the waters were finally receding after the Great Flood described in the Bible.

What lesson did Fisher take away from this experience? “We have to get our clients to connect — even if it’s just with a betta fish,” she says.

Fisher urges counselors to overcome any reservations they might harbor about treating clients with bipolar disorder. “Get more training if you’re uncomfortable,” says Fisher, who encourages counselors to ask themselves why they might be uncomfortable and then to address those reasons.

Counselors already possess the skills needed to empower these clients, Fisher adds. “We have clients who are walking in the door with this diagnosis and identifying it with who they are,” she says. “Bipolar disorder is not who they are — their diagnosis is not their identity. People think, ‘My body is betraying me. I feel like crap. I’ve alienated all my friends — I am the monster.’ Counselors can exorcise the demon of the [bipolar] diagnosis.”

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Additional resources

To learn more about the topics discussed in this article, take advantage of the following select resources offered by the American Counseling Association:

Counseling Today (ct.counseling.org)

“Healthy conversations to have” by Kathleen Smith
“A light in the darkness” by Bethany Bray
“Client, counselor, prescriber” by Lynne Shallcross
“Tossing and turning in the digital age” by Laurie Meyers

Books (counseling.org/publications/bookstore)

Assessment in Counseling: Procedures and Practices, sixth edition, by Danica G. Hays
Cognitive Behavior Therapies: A Guidebook for Practitioners edited by Ann Vernon and Kristene A. Doyle

Podcasts and webinars

“Bipolar Resiliency Program” with John Duggan (HT056)
“Depression/Bipolar” with Carman S. Gill

Practice briefs (counseling.org/knowledge-center/practice-briefs)

“Counseling Adults Who Have Bipolar Disorders” by Victoria Kress, Stephanie Sedall and Matthew Paylo

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Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

Letters to the editor:ct@counseling.org

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Getting adolescent boys to buy in to yoga, meditation and relaxation

Carol Marks-Stopforth September 14, 2009

“Yoga? I’m not doing no yoga! Not enough testosterone! Yoga’s for girls! It’s just not me!”

These were the kind of comments thrown at me when I first introduced a yoga/meditation/relaxation (YMR) group to 15 adolescent boys. Now, three years later, when a new boy joins the program, I still hear the same lines of protest. But before I can open my mouth, one of the older residents will say, “No, you have to do it. It’s not so bad. I didn’t want to do it when I first came, but it’s straight. You’ll see – you’ll like it. And the best part is the relaxation. She hypnotizes you.” Thwarting any questioning of my powers, he quickly adds, “She levitates, too.”

The new boy generally looks puzzled. The guys informing him that he’ll like yoga are pretty tough looking; they don’t appear to be lacking in testosterone. So despite his skepticism, he bows to peer pressure and gives it a try.

The boys in my now twice-weekly YMR group have been placed at a 90-day residential facility for adolescents with substance abuse and other co-occurring disorders. I started the group because I wanted to find a means for the boys to calm themselves. Most of these adolescents’ relationships are filled with conflict. They are fighting with their families, are doing poorly at school, have serious legal charges and are on probation. They carry a lot of stress, which shows up in their distractibility, their impulsivity and the hair-trigger nature of their anger – if these boys were thermometers, their temperature would rise from 1 to 100 in a couple of seconds.

I began thinking about a group that would teach these adolescents techniques for self-regulating and managing their stress more effectively. I needed something that would work with both body and mind while also being fun. I knew firsthand about yoga and meditation’s ability to counteract stress as a practitioner myself for more than 30 years. But how could I present it effectively to a group of adolescent boys?

Initially, the boys were extremely resistant, almost to the point of mutiny. To name a select few of their diversionary tactics: The guys wouldn’t leave their shoes outside the room; they would tell me it was against their religion to do yoga; many of them suddenly developed “scoliosis”; everyone dropped onto their mats as soon as they had them and refused to get up; they wouldn’t even try the yoga postures, and if someone ventured an attempt, the others would laugh and insult him until he stopped; they threw things at each other; they pushed each other; someone would mimic my voice during the relaxation, and someone else would shout, “Shut the (expletive) up!”; two guys would be playing cards, while another would be listening to his iPod and handing one of the earphones to his neighbor so he could also listen as they tapped in time to the music.

There were many times when I said to myself, “This just isn’t working. I can’t do another one of these sessions.” But I always did, and over the years, I learned from the adolescents what worked for them and what didn’t. Along the way, the hour-long group developed a life of its own.

The process

Before the group begins, the boys help me get the mats. They leave their shoes outside the group room and assume a standing position on their mats. The adolescents complete the residential program at different times, so I describe the YMR group again whenever a new resident arrives, explaining that the group is divided into three parts: yoga to relax the body, meditation to relax the mind and a guided body scan to relax both body and mind.

I begin the group by asking the boys to rank on a Likert scale how they are currently feeling, with 1 being the least relaxed and 10 the most. I note the responses and then lead group members through a series of yoga postures. The postures begin very vigorously with Sun Salutes. By the time this exercise is completed, the boys have released some of their tension, are feeling more relaxed, are more accepting of the subsequent poses and are forming some group cohesion. We then do a series of balancing exercises. Because we have to concentrate to stay balanced, these exercises make us more focused. The remaining poses are designed to be calming. By the time we come to the shoulder stand, which heralds the end of the yoga session, the guys have released enough tension to move on to the next and most demanding section of the group – seated meditation.

I tell the boys that starting now, they must focus only on themselves. There is to be no side talking. After they have settled into a seated posture, I explain the technique, which is to focus on the breath. I talk a little about how the mind tends to wander, finding it extremely difficult to concentrate on the breath. I liken the mind to a wild horse that must be tamed, instructing the group members to simply return to the breath when they realize they are thinking about other things. Finally, I tell them I am going to stop talking and we are going to practice the technique for five minutes. I used to guide the group throughout the entire meditation until one of the boys said, “I can’t concentrate if you talk all the time. I think you should stop talking and let us do it on our own.” He was right, and I am moved each time by how good they have become at doing this very difficult thing. After the meditation, we have a 10-minute discussion about what it was like for them to engage in this practice.

Some extraordinary therapeutic moments have emerged from these discussions. I recall one young man from the inner city who exhibited a very tough exterior. His friend had been killed less than a year before. The other group members considered this boy a leader and tried to emulate his walk and style of dress. He talked softly and sparingly to his peers and refused to speak in group. “It’s just not me,” was his stock answer.

But when I invited responses after a YMR group, he said, “It was weird. I was listening to your voice, and when you said ’Breathe in darkness,’ I could see me and my boys fighting the other boys. I was fighting in the corridor, then everyone was running away. I went back to where the fight started. They were all gone, and my boy was lying on the floor bleeding. I took off my shirt and sat down with him and tried to stop the bleeding, but I couldn’t, and he died. Then I breathed out light, and I knew he was OK. He’s in heaven, and I don’t have to worry about him.”

For the first time since meeting him, this young man was looking me directly in the eye. Then he asked, “Can we do meditation again tomorrow?”

The boys like the last part – the guided relaxation – best. They sit or lie on their mats, eyes open or closed according to what is most comfortable for them. I then guide them through a detailed body scan using the breath to induce deep relaxation. After this final section of the group, I commonly hear comments such as, “I wasn’t asleep – I could hear your voice – but I wasn’t awake either. It’s like dreaming but being awake.”

After the body scan, I again ask them to rank on a Likert scale how relaxed they feel at that moment. Generally, there is a significant difference between the first and second Likert scale. The first time, about 80 percent of the boys will rate their relaxation level as a 4 or a 5; the second time, their relaxation level will jump 4 or 5 points. It is not unusual for the boys to report 10s. The other 20 percent of the boys will begin at 0, 1 or 2 and jump to a 4 or a 5 on the second scale. Regardless of where they began, they experience a significant decrease in tension.

Evidence of positive results

The boys’ reports of being more relaxed are reflected in their behavior. This has been noted anecdotally by direct-care staff, who report that after the YMR group, the boys are “easier to deal with, not as demanding and nicer to each other.” Significantly, no incidents are reported that day following the YMR group. Parents or guardians do not directly acknowledge the benefits of YMR, but they sometimes comment they are amazed that their son is doing yoga and seems to enjoy it. When graduating from the residential program, the boys often talk about how much they grew to like the YMR group.

According to a study published by George Parks and Alan Marlatt in 2006, a meditation program involving severely addicted drug and alcohol users serving sentences at a prison in Washington state showed decreases in alcohol-related problems and psychiatric symptoms as well as increases in positive psychosocial outcomes. According to studies conducted in 2007 by Farris Tuma, the practice of yoga produced notable reductions in stress and post-traumatic responses in veterans suffering from post-traumatic stress disorder. Bessel van der Kolk, medical director of the Trauma Center outside of Boston, has recently received a National Institutes of Health grant to study the effect of yoga on traumatized women considered to be treatment resistant. Evidence is increasing that yoga and meditation are viable tools for relieving stress. That has certainly proved to be the case with the adolescents in my program.

As clinical director of the residential treatment facility, my emphasis is on providing a multidisciplinary approach to addiction and other co-occurring disorders. Ninety days is not a long period of time to work with disorders that have been a long time in the making, so our aim is to provide these young men with as many different approaches to care as we can.

In group therapy, we tend to lean toward the expressive therapies. For example, every youth in our program makes a body map while he is with us (the maps line the walls and are both aesthetically pleasing and instructive). Literature and poetry readings form the basis of other groups, while yet another describes the steps to recovery through an art project.

More traditional counseling is provided in individual and family sessions, which take place once a week. Here, too, YMR proves to be very helpful. I often begin both individual and family sessions with a brief guided meditation, having found that it defuses stress and allows clients to talk more easily about their problems. If clients are extremely tense, I do a few simple yoga postures with them. This tends to decrease their tension level and makes them more willing to engage. I even assign some clients “homework” – a five-minute meditation every morning when they wake up. They write a few sentences about what this was like for them, and during our next individual session, we go through their notebook together. Other clinicians in our program report that their clients have talked about how they use YMR to calm themselves. In particular, some of these clients have shared that if they do the relaxation part of the process, it helps them to fall asleep at night.

Carol Marks-Stopforth is an ACA member and a licensed mental health counselor. She is the clinical director of a residential treatment facility for adolescent males and is involved in a research project to study the effects of YMR on adolescents. She also runs a private practice in Boston. Contact her at cmarks1111@comcast.net. Letters to the editor: ct@counseling.org.