While I rarely share the same post more than once, given that Mother's Day is upon us, the topics herein are so very relevant for many parents that I felt compelled to share it again. 

In a 2011 issue of the Pennsylvania Psychological Association Public Newsletter, the article "Working Women: Take Care of Yourselves" by Rachel Milner, Psy.D., caught my attention as being particularly important any time of year. As children go back to school, working moms are often faced with not only the demanding daily responsibilities of their jobs and housework, but now children's class selections, teachers, specialized learning programs, various therapies, sports, clubs, high school or college applications and other social activities are once again begging for mom's finite time and attention.

According to the article, while the number of  women in the workforce has increased from one in three in the 1950's to more than half of the current workforce in the US, "women continue to have primary responsibility for home and family matters, [and] many forget to take care of themselves and many run the risk of exhaustion, burnout or becoming ill". (Milner, 2011) In order to decrease the likelihood of these negative outcomes,  Dr. Milner suggests taking the following steps:

• Learn to set limits - You cannot accomplish every- thing yourself. Know your limit and set it.
• Take breaks - It is important to take short beaks during the day. Get up and take a short walk, speak with a co-worker, or do some relaxation exercises at your desk.
• Say no - It may be difficult to say no for fear that you will be negatively evaluated. However, if you take on too much you will not be able to give sufficient attention to anything.
• Take days off - It is important to take time away from the office to rest and regain your energy.
• Give adequate attention to your life outside the office. - If you are having problems in your personal life, your work may suffer.
• Work reasonable hours - Everybody needs to come in early or stay late sometimes, but avoid this becoming a pattern.
• Communicate - It is important to communicate with your supervisors and co-workers so that they know what your needs are and when you may need extra support on a project. 
• Recognize signs of burnout - Know the symptoms of burning out, such as having a short attention span, getting annoyed easily, and feeling unmotivated. When you recognize that you are burning out, make some of the changes mentioned in this article. 

Learning how to recognize our needs and learning to take care of ourselves is not only important for our own self-preservation, thus giving us more energy and resources to tackle more of life's difficulties, but it also models to our children the importance of self-awareness, limit-setting, and balance.

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It seems that everywhere we look these days, we encounter yet another person or study underlining the various benefits of mindfulness mediation. While to some, the idea of meditation conjures up yogis in a cross-legged positions, spending hours inside their heads, those that have any intimate familiarity with mindfulness know that the practice of mindfulness meditation leads to the exact opposite of being in one's head. In fact, practicing  mindfulness meditation can lead to a more direct and in-the-moment interaction with the world around us.

The idea behind mindfulness is learning to tune in to the present moment, and becoming fully aware of one's inner sensations and the environment, while trying to avoid unconscious or habitual activity. [1] If we stop to think about how much time we spend in our heads, trying to think through, prevent, predict, or understand some sort of event that is either in the past or in the future, we start to realize just how much we may be missing in the present moment. While we may feel that doing all of this mental gymnastics may lead to better outcomes, thereby giving us a sense of control over our day to day lives, many of us know all too well that this type of rumination actually reinforces already established, often negative thinking patterns.

The practice of mindfulness meditation trains our minds to notice what we are doing mentally and physically in the moment, a process that may be so mechanical that it may seem unconscious. By giving ourselves the space to notice what may feel to be automatic, we are actually acknowledging that what we are experiencing is, in fact, under our conscious control, and is most likely learned. And we all know that anything that is learned, with some effort and understanding, can be unlearned, albeit not forgotten.

While there are a number of great ways to start a mindfulness practice, I have found the app "10% happier" to be very clear, helpful and dare I say, "mindful" of a busy schedule.

References:

• ​1. Hyperion Books. Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life. Accessed at http://books.google.com/books?hl=en&lr=&id=QnYBXlX2bPwC&oi=fnd&pg=PR13&dq=mindfulness+meditation&ots=iaiedsPYPb&sig=eUtL03wBBA9CSgxAcmTF7yVi3NM#v=onepage&q=mindfulness%20meditation&f=falseon May 1, 2014.

Individuation is no simple task. In fact, individuation can be seen as one of the most important developmental tasks to work towards in order to attain self-knowledge, self-realization and even personal freedom. Individuation is defined as "a process through which a person achieves a sense of individuality separate from that of others..." (GoodTherapy.org, 2016 ). While this process is certainly ongoing, it can be particularly difficult in young adulthood, when the overarching questions sound something like "who am I now that I am an adult " and, perhaps more importantly, "who do I want to be?"

At a time when most people are faced with mounting personal and professional responsibilities, it can be quite trying to figure out how to manage everything and prioritize that which is important. This is an even more daunting process when one does not know what exactly is important, how to get it and perhaps most problematically, how to feel good about it. Even more challenging, is when one's most salient role models on how to be "a successful adult" have different priorities and very different rules of how to go about attaining them.  

This is where the process of individuation comes in. Namely, learning how to recognize ones' own inner voice and differentiating that from the internalized opinions or values of others. While learning to recognize one's own voice is a crucial step to self-realization, the trickiest part, in my experience, is learning how to trust and be guided by this voice, so that it is heard above those of all others.

While this process is challenging for most people, individuation is particularly difficult for those folks who come from more collectivist cultures, where the opinions of the family, and particularly, of the elders are valued more than the opinions of the self. In this case, choosing one's own path in life, no matter what it is, can lead to feelings of betrayal and abandonment on both sides. Additionally, in collectivist cultures individuating from one's family of origin not only can be seen as a form of disrespect, but is often deemed to be quite unwise. In the words of Otto von Bismark "only a fool learns from his own mistakes, a wise man learns from the mistakes of others".

These powerful messages can be quite difficult to disavow, particularly for those who have been conditioned to please and value the wisdom of the collective, above their own. It is precisely this invalidation of the self that can lead to a grave and debilitating fear of making mistakes, no matter how valuable the lesson within. The process of individuation then, requires tremendous courage to not only recognize, trust and pave one's own path, but to make a few mistakes along the way, in hopes of finding that which is truly one's own.

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There certainly is a lot of evidence out there suggesting the myriad of health benefits of cultivating a mindfulness meditation practice. For some of us, however, anything that requires practicing may seem rather daunting, and may feel like just another item on the list of things that we "should do", like exercising or eating healthy. As such, meditation can also be one of the things that we berate ourselves for not doing, or not doing right, and thus making it all the more difficult to initiate.

It does not have to be that complicated, however. Surprisingly often, all it takes is a few minutes of slow deep breaths to slow down our heart rates, loosen our bodies and connect with whatever is right in front of us. The breath is our vehicle to sync back up with our bodies and disconnect from our thinking, planning and judging minds. It gives our bodies the opportunity to relax and brings our systems out of the highly-taxing fight or flight mode, that is characteristic of any stressful work or personal situation. When our inner resources are no longer being taxed by needing to either flee or proverbially and/or literally go to battle, we naturally shift into a more balanced and spacious mode of being, where more of our inner resources are suddenly at our disposal.

By simply taking slow, deep breaths we are literally sending our systems the much needed resources of reassurance and support in order to keep on going! Furthermore, slowing down our breathing gives us the space to truly engage with whatever is physically in front of our eyes, instead of forsaking our only tangible reality for the often-demanding and intangible plans in our heads.

When I first picked up Dr. John Sarno's book Healing Back Pain, I thought that there was a chance that I would learn something that would help me feel better, but I never imagined that it would offer me a newer and deeper way to look at certain types of chronic pain. 

Dr. Sarno's theory posits that certain types of chronic back, neck and limb pain, as well as some gastrointestinal issues, which are not relieved by standard medical treatments are largely psychosomatic in nature. Dr. Sarno's belief is that while the pain is certainly felt in the body and physical examination will confirm corresponding areas of tightness, the root cause of the perseverance of the pain stems from one's psychological and/or emotional functioning. The reason for the pain, according to Dr. Sarno, is that this physical pain acts as a type of distraction from the more systemic and less easily identifiable repressed psychological, emotional and oftentimes unconscious issues. 

The treatment for this type of pain (Tension Myositis Syndrome) involves verifying the TMS diagnosis (thus ruling out any abnormal structural causes for the pain), thorough patient education about the way that TMS works, and perhaps most importantly, getting in touch with whatever conscious and unconscious emotional material may be causing discomfort and distress. Many TMS sufferers will attest that once their distressing repressed issues have been adequately addressed, the physical pain no longer has the purpose to distract from the underlying emotional pain and begins to subside. 

To put it another way, with psychogenic pain it is not necessarily one's body that is hurt, although that is certainly where the pain is felt, but rather one's emotional and psychological state has been in some way troubled, hurt or disregarded. Unfortunately most people can go a long time repressing their hurt feelings, often not wanting to or not being able to identify the true source of the pain.  However, trying to identify and treat physical pain, particularly in our highly medicalized society, is less stigmatizing, more widely accepted, and appears, at least on the surface, easier to achieve. It is not surprising then that some of us tend to experience our internal distress in a physical form!

While this type of chronic pain is likely not uncommon, before assuming that one is suffering from such psychogenic pain, it is important to first rule out any structural physical causes of the pain by a qualified medical professional. Here is a list of physicians and therapists who often work with TMS and other mind-body disorders who can help in establishing a diagnosis. Additionally, this TMS forum is a wonderful online community established specifically to support and educate those who may be suffering from TMS. 

After having recently listened to this Invisibilia Podcast titled Entanglement, I thought it would be a good idea to share my thoughts on where the major schools of thought on psychotherapy have been and perhaps where the field may be headed...

A portion of this Podcast neatly outlines the three major schools of thought on thinking and feeling, the first being Freud's theory of the unconscious. In part, this theory posits that most, if not all, of our thoughts and feelings in life stem from our childhood experiences. The predominant change occurs when we can get in touch with the origin of these thoughts and feelings and begin to understand that the circumstances that may have governed their formation way back when, may no longer apply to our daily lives.

The second major school of thought on therapeutic change is Albert Beck's theory of Cognitive Behavioral Therapy, which states that our behaviors and emotions are very much connected to our thoughts. The theory posits that if we are able to notice, change and/or retrain our thinking patterns, our feelings and actions will follow suit. 

The third major school of thought on therapeutic change is generally referred to as Mindfulness Based Approaches, and is currently receiving a lot of attention and research. Such practices focus on teaching individuals to become aware of all thoughts and feelings that may come up and help us learn to accepting them without judgment, hence letting go of ensuing reactions and assumptions.

All three schools of thought mentioned above are widely viewed as helping bring about therapeutic change in different ways. The first school of thought focuses on understanding where the uncomfortable thoughts and feelings come from, in hopes that this insight will update the unconscious thoughts and feelings and make them conscious, thus making them amenable to change. The second and third schools of thought on therapeutic change focus instead on deauthorizing the power of thoughts. Namely that by actively changing thinking patterns, or by accepting our thoughts and suspending judgment, our cognitions will have less power to affect our feelings and behaviors.  

In my experience, there is no one correct way to enact therapeutic change, but instead there is a combination of techniques and methods that can be used in order to help each individual achieve long-lasting change. This I believe, is largely based on where (with thoughts, behaviors, acceptance practices or feelings) the individual feels more comfortable starting their therapy. I do, however, feel strongly that feelings are more basic than thoughts (feelings are preverbal, thoughts are contingent on language), and hence when thoroughly understood and updated, can lead more directly to a more holistic and sustainable change. However, meditation and mindfulness practices as well as retraining one's thoughts and behaviors are wonderful ways to appease certain symptoms and contribute to greater comfort in achieving the insight and understanding that will lead to a come comprehensive paradigm shift. 

If you would like to learn more about modern psychotherapy concepts please visit this blog of my dear friend and colleague, Dr. Richard Kestenbaum. 

This recent NYtimes article describes a number of interesting studies that suggest that the act of writing about oneself and one's experiences may change not only the way that people feel about the events that they portray, but may also alter the way that they feel about themselves. This concept is based on the idea that each one of us has a unique, personal narrative that shapes the way that we see ourselves, others and the world around us.

This personal narrative however, is typically quite static in nature. Unfortunately, once most of us have an idea of who we are, what we are good at, as well as what we expect from the world, we rarely seek out opportunities to alter these assumptions, even when our assumptions are not doing us any favors. Because a lot of our opinions about ourselves and our world are based on very early, sometimes forgotten experiences, we may feel that these ideas have always defined us, and hence we allow them to continue to do so! 

But what if we begin to question the origin of our self concept, thereby challenging our assumptions of what is possible for us? Do we not then give ourselves the chance to redefine who we are, what we are capable of and what we expect from the world at large, by simply being willing to rewrite (or retell) our own personal narrative?