Legs dangling off a high building“So, first of all, let me assert my firm belief that the only thing we have to fear is fear itself.”

FDR’s famous line from his first inaugural address used to strike me as a universal truth. He describes fear as “nameless, unreasoning, unjustified terror which paralyzes needed efforts to convert retreat into advance.” I have interpreted this line as a call to be brave, to take on life fully, make  the best of a difficult situation and count one’s blessings while doing so. The encouragement and sense of bravado inherent in FDR’s speech still strikes a strong cord in me… (Continue to read at Psyched in San Francisco Magazine)

Forgiveness: What and How

Hands letting go of sandWhat does forgiveness really mean?  It comes up in therapy a lot but the concept is so unclear for many of us. I have devoted hours pondering the meaning of this elusive concept. Forgiveness describes a conscious act on the part of the person forgiving and a human gift received by the person who is in need of forgiveness. And forgiveness is a close partner to intensely painful feelings and memories of things that have happened in the past.  In truth “to forgive is not to forget” so how does transformation of the past pain and damaged relationship happen?… (Continue to read at Psyched in San Francisco Magazine)

Obsession Balloon and Bad Feeling Monster

Today I want to share a tool I have created to explain the mechanisms of Obsessive Compulsive Disorder (OCD) to children who are struggling with it. I work with a mindfulness based version of Exposure and Response Prevention. In mindfulness practice I find it helpful to imagine one’s own awareness as a wide open blue sky. Thoughts and images pop up and pass through this sky like planes, clouds, balloons and other flying objects. They can appear big and loud and strong but they inevitably become smaller and finally disappear out of sight. From the perspective of the wide open blue sky they may rough up things for a bit but they don’t change the sky. If we can treat the thoughts and images our mind creates with non-judgmental awareness, look at them, appreciate the feeling that comes with them and then let it drift away, we can become “unstuck” and our emotional pain can diminish. When we practice mindfulness we can learn to accept our inner experiences without avoidance. I will write more about this later and this book about “Acceptance and Commitment Therapy” (ACT) is a fantastic introduction, “Get out of Your Mind and into Your Life: The New Acceptance and Commitment Therapy,” by Stephen C. Hayes, PhD.

For people who struggle with OCD certain intrusive, repetitive, negative thoughts and images (obsessions) create intense feelings of anxiety. To relieve these feelings they tend to engage in concrete or mental rituals. The way our mind tends to work, however, when an anxiety provoking thought gets negatively reinforced via a response (a compulsion) it comes back bigger and stronger. To explain this mechanism to children I have created these images:

1st page obsession balloon  Copy of 1st page obsession balloon

Children can write one of their obsessions into the first balloon and can fill some of the other flying objects with thoughts that are not coupled with anxiety for them. They can then also fill in a compulsion they use to feed the “Bad Feeling Monster.” On the second page they can see how the monster and the balloon have grown and are still right in front of them while the other “thoughts” have moved away and are leaving their “sky of awareness.”

Let me know if you find this tool helpful!