AAIM | 21st Century Medicine

The Journal of the American Association of Integrative Medicine

Bio for Dr Shawn K Centers

Bio for Dr Shawn K Centers

Dr Shawn K Centers, DO, MH, FACOP, is the Medical Director of the Osteopathic Center for Children and is a Board Certified Pediatrician, specializing in Integrative Medicine and Osteopathic Pediatrics. Dr Centers is an internationally known expert in Osteopathic Pediatrics, nutrition, and herbal medicines as they apply to children. He was a student of the world famous Dr Viola Frymann, who developed cranial osteopathic treatment for children. Dr Frymann was a direct student of Dr William G. Sutherland, DO, the founder of Cranial Osteopathy. Dr Centers studied under Dr Frymann for over 25 years and has worked personally with Dr Frymann for the last 15 years.

Dr Centers is the founding President of The American Academy of Pediatric Osteopathy, A Component Society of the American Academy of Osteopathy (AAO). The AAO is the recognized authority on Osteopathic Manipulative Medicine to the federal government. Dr Centers is a Fellow of the American College of Osteopathic Pediatricians. He has been named a “Top Pediatrician” in San Diego County, California, by the International Association of Pediatricians, (IAP). He is a Distinguished Fellow of the American Pediatrics Council and a Lifetime member of the American Council of Pediatrics Specialists. He is a Master Herbalist and a founding Diplomate of the American Board of Holistic and Integrative Medicine, (ABHIM).

Dr Centers trained in pediatrics and served as a Pediatric Chief Resident at the Children’s Hospital of New Jersey, one of the largest children’s hospitals in the nation; Dr Centers was Board Certified in Pediatrics in 2000. During his residency, he continued his studies in Advanced Osteopathic Principles and was very active in developing and integrating Osteopathic Principles into the educational program for residents and medical students. In medical school, he was one of only four students from a class of 150 to be chosen as a Clinical and Teaching Fellow in Osteopathic Medicine. As a Clinical Fellow, Dr Centers gained extensive experience in the unique practice of Osteopathic Medicine, research methods, and had the opportunity to study and learn from the foremost practitioners in the field including Dr Frymann, Dr Becker, Dr Larry Jones, Dr Thomas Schooley, Dr Robert Fulford, and others.

Dr Centers’ credentials include a Certificate of Competency in Cranial Osteopathy from the Cranial Academy in 2003. He is Board Certified in Integrative Medicine, BCIM®, and a Diplomate of the College of Mind Body Medicine of the American Association of Integrative Medicine®. He is a member of the Americana Academy of Pediatric Osteopathy, the American College of Osteopathic Pediatricians, American Association of Integrative Medicine®, the American Academy of Osteopathy, The Cranial Academy, the American Herbalists Guild, and the International Association of Neurolinguistic Programming. In additional to his training in Conventional Medicine, Dr Centers is trained in Biomedical, Nutrition and Botanical Medicine. Dr Centers has exceptional skill and knowledge in applying osteopathic approaches, herbal medicine, and treatments that address the whole child and in developing a comprehensive health care plan. His pediatric practice encompasses both sick and well visits. He also performs routine physical exams, sports, and osteopathic exams for newborns, children and teenagers.

Dr Centers is most noted for his development of innovative osteopathic and integrative medical techniques in children with complex medical problems, especially children with Autism. He studied Herbal Medicine under John R Christopher of Springville, Utah. Dr Centers is additionally known for his mind-body approaches in the treatment of children. He has extensively studied the techniques of John Grinder, Richard Bandler, and Thad Everet James. Dr Centers utilizes the Time Line Therapy techniques developed by Tad James, PhD in many of his treatment approaches. Dr Centers is a Master Trainer of Neurolinguistic Programming and Time Therapy and was certified by Tad James.

He is the Chief Executive Officer of the Frymann Institute and maintains an integrative medicine and full-time pediatric practice at the Osteopathic Center for Children in San Diego, California. He is also the founding President of the American Academy of Pediatric Osteopathy, a component society of the American Academy of Osteopathy. Dr Centers is a Clinical Professor of Pediatrics and Osteopathic Medicine at a number of osteopathic medical schools in this country and abroad including Touro University, AT Still University and the Osteopathic College of Bologna, Italy (CIO).

Dr Centers has extensive experience with treating children who have rare, difficult to treat, developmental and neurological disorders including children with Epilepsy, Cerebral Palsy, learning disorders, Attention Deficit Disorder, Asthma, allergies, Autism, Traumatic Brain Injury, and rare diseases. Dr Centers has received international and national recognition for his work with autistic and Autistic Spectrum Disorder children. His use of Cranial Osteopathy combined with the use of therapeutic grade essential oils, diet and nutrition, and the therapeutic use of sound and light have greatly advanced the care of many children with autism. Dr Centers worked closely with the late Dr Bernard Rimland from the Autism Research Institute in San Diego and has been a featured speaker at the National Autism Conference. Dr Centers was one of the first physicians to be trained in the Defeat Autism Now Protocol and has been a Defeat Autism Now Doctor for over 15 years. Because of Dr Centers work with autistic children, the Osteopathic Center for Children was the recipient of a Las Patronas Grant which was used to purchase Vibroacoustitic Sound Therapy equipment representing the latest innovation in Neuroscience and Psychoacoustic Technology. This equipment which consists of a custom made treatment table and a specially designed chair allows the practitioner to send special tones and frequencies to pre-designated areas of the mind and body – as the child lays on the table or sits in the chair they actually feel sound, tones, and vibrations in their body creating profound states of comfort and relaxation. The sounds, music, and tones are specially designed to reach and heal injured areas of brain and body as well as enhance the deep osteopathic work done by Dr Centers.

In addition to his clinical work, Dr Centers is a sought after lecturer and teacher. He teaches regularly at medical schools, national specialty meetings and continuing education courses in both the United States and abroad. He has been a featured lecturer for the American Osteopathic Association, the American College of Pediatricians, the Western States Osteopathic Association, The AutismOne Conference, The National Autism Conference, The American Holistic Medical Association, Touro University, University of California, San Diego, San Diego State University, University of Minnesota, and others.

Dr Centers was the lead author of the Pediatrics of the Foundations Of Osteopathic Medicine which was published by the American Osteopathic Association and is a required text used in all 32 Colleges of Osteopathic Medicine and in over three hundred schools worldwide. Dr Centers wrote key chapters in Cutting-Edge Therapies for Autism, Updated Edition which was endorsed by the National Autism Association.

Is Emotional Maturity Required for Success?

Is Emotional Maturity Required for Success?

By Erica Goodstone, Ph.D., LMHC

With political debates, caucuses and name -calling campaigns in full swing, it seems as though emotional maturity is not only unnecessary for success, but a negative attribute.  Those candidates who quietly withstood attacks and refused to retaliate have lost their standing and several have already dropped out of the race.

What does this mean for mental health professionals, addiction specialists, holistic practitioners and spiritually focused therapists?  Are we advocating a model of mental health that does not serve us well in this society?  Do we advocate for a morally appropriate type of mental health that may actually put our loyal clients at a competitive disadvantage out in the real world?

The “Criteria of Emotional Maturity” were developed by William C. Menninger, MD (1899-1966), cofounder of Menninger © 1966. These criteria are as follows:

• The ability to deal constructively with reality
• The capacity to adapt to change
• A relative freedom from symptoms that are produced by tensions and anxieties
• The capacity to find more satisfaction in giving than receiving
• The capacity to relate to other people in a consistent manner with mutual satisfaction and helpfulness
• The capacity to sublimate, to direct one’s instinctive hostile energy into creative and constructive outlets
• The capacity to love

Has the world changed so drastically that these criteria no longer serve our clients’ best interests?  If what I am suggesting here is true, what would be an effective solution to help our clients navigate through the current competitive, oppositional and confusing world in which we live?

The first two qualities listed above seem to provide the solution.  We need to discover constructive ways to cope with reality as it is, not how we are told it should be nor how we want it to be.  Additionally, we must learn to adapt to changes since these are an inevitable part of reality. In fact, change is one of the few things in life that we can truly count on.

In some cases, children who have been neglected, abused, suppressed or abandoned may have developed greater resources for coping with a changing world than those who have been loved and protected, pampered and supported.  If a child always views the world as loving and supportive, how does that person cope with bullies and abusers, people who view loving behaviors as weak and spineless?

One quality that seems to be missing from this list is the ability to stand up for what you believe is right and having the courage to take on your adversaries. The ability to fight back with the strength of your convictions is a powerful and positive characteristic. Another missing quality is the ability to align and influence others, to be a bridge between ideas, attitudes, projects and actions.

Anyone who is able to stand up for what they believe in and influence others for the larger and more inclusive benefit of all, will naturally gravitate toward having the other qualities as well.  When you stand up for yourself and others you will naturally have fewer stress-related ailments, be happier to give than to receive, more easily create mutual satisfaction in your relationships, be able to express your creative energy with less need for hostility and your life will be a triumph of love.

Take a moment to evaluate your own criteria for mental health and make sure you include standing up for yourself as well as developing the capacity to guide and influence others for the greater benefit of all concerned.

Please feel free to send me your questions, comments, subjects you want to see covered and topics which you, as an expert, would like to share here.  If you are ready to collaborate and share on social media, join the Marketing Our Practices Facebook group https://Facebook.com/groups/MarketingOurPractices

I look forward to working together with you to strengthen our professions in the coming months.

Erica Goodstone, Ph.D., LMHC, LMFT, LPC


Integrative Treatment Pilot Study: An Extended Care Holistic Treatment Facility for Women with Co-occurring Disorders

Integrative Treatment Pilot Study:
An Extended Care Holistic Treatment Facility for Women with Co-occurring Disorders

Tricia Chandler, PhD, LPC, BCPC
Consulting Clinical Director and Researcher

Key Words: Integrated care, co-occurring disorders, addiction, mental illness, complementary therapies

Learning Objectives

1. Discuss the differences in needs of women from men in treating addiction issues and underlying co-occurring disorders.

2. Describe integrative treatment modalities.

3. Explain the role and significance of personal relationships in women’s lives.

4. Compare the relevance and presence of various caregiver roles that women assume throughout their lives.

5. Discuss the unique medical issues facing women with co-occurring disorders.

6. Explain positive psychology and the movement toward wellness and its implications for treatment modalities.

7. Describe therapeutic modalities that have demonstrated efficacy in treating mood disorders and addiction issues.


A longitudinal pilot study conducted in 2011/2012 researched the efficacy of an integrated protocol that provided treatment to women with co-occurring disorders in an extended-care group home environment. Eight women who had been referred from in-patient thirty-day substance abuse facilities participated in the study while receiving holistic care that included: recovery groups, somatic experiencing, dialectic behavioral therapy, individual psychotherapy, mindfulness groups, yoga, acupuncture, Reiki, massage, art therapy, vocational assistance, nutrition and exercise, along with daily AA/NA meetings. Assessment measurements included the Beck Depression Inventory, Purpose in Life Questionnaire, URICA inventory on stages of change, and an Anxiety Scale. These were administered at intake, discharge, three-months after discharge and at the twelve-month interval to examine long-term efficacy of the model. Results demonstrated positive change from baseline to discharge. Gains were maintained at the three-month interview and continued to show improvement at the twelve-month interview for those women that participated.

Historical Context for Protocol

Over the past twenty years research has begun examining the differences in regards to how and why men and women develop addictions. This research has concluded that women have special needs within substance abuse treatment. This research has produced a great deal of information into the differences in physiology, interpersonal issues and risk factors relating to women with these issues (Becker, 2011; Gudrais, 2011; Kauffman et al, 1997). The Substance Abuse and Mental Health Services Administration (SAMHSA, 2011) has noted specific “risk factors associated with substance abuse” in women include:

• Sensation-seeking
• Anxiety
• Depression
• Eating disorders
• Posttraumatic stress

Further research suggests these additional risks are due to histories of trauma and childhood sexual abuse, as well as interpersonal abuse and socioeconomic issues all relating to the issues of regulating affect (Bloom and Covington, 1998; Chandler, 2010; Manhal-Baugus, 1998; Najavits, 2002; Nelson-Zlupko et al, 1995; US Dept of Health and Human Services, 2000, 2003; SAMHSA, 2011).

Two different research studies by Engstom et al (2002/2008) at the University of Chicago Center for Health and Social Sciences, found that in over 400 women being treated for opiate addiction in a methadone clinic, 58% had experienced childhood sexual abuse, 90% had experienced intimate partner violence and 29% met the criteria for posttraumatic stress disorder. Similar findings have been substantiated by Robert Jamison (2011), a clinical psychologist at Harvard Brigham and Women’s Hospital, who discovered correlations between women who abuse pain medications having sexual and/or physical abuse histories, as well as psychological distress as motivating factors for their drug misuse. These findings further substantiate the complicated relationship between trauma and substance abuse for women that were included in the research conducted by this writer in relation to determining resiliency in women with childhood sexual abuse histories (Chandler, 2010).

Based upon years of research into the special needs females in substance abuse treatment, SAMHSA has identified core principles for gender responsive treatment. These core principles include:

• Recognizing the role and significance of personal relationships in women’s lives
• Addressing the unique health concerns of women
• Acknowledging the role and importance of different socioeconomic issues among women
• Promoting cultural competency that is specific to women
• Endorsing a developmental perspective
• Attending to the relevance and presence of various caregiver roles that women assume throughout their lives (SAMHSA, 2011/PIT 51)

Although the reasons behind substance abuse have been acknowledged as being different for women than for men (Kauffman et al, 1997), treatment protocols have been slow to acknowledge this difference and to change in accordance with the need for integrative treatment protocols specific to women’s needs. Traditionally substance abuse treatment has offered a specialized treatment protocol that has been provided for both women and men in the same facility.

While primary residential facilities state that women and men are treated separately, in actuality most of these facilities intermingle groups, resulting in findings that women have greater risk for relapse after completing treatment in these environments (Gudrais, 2011). And, although men and women are housed in different wings of the same facility although they have access to one another in group interactions and within a social context.

The normal length of stay to address the substance abuse issue for both genders is usually thirty days. Primary treatment has traditionally included cognitive therapy and recovery based protocols with a strong element of 12-step indoctrination aimed solely at the substance abuse issue, while deferring additional issues that the individual may have.

Programs that do attempt to incorporate an integrative approach are extremely expensive and are not accessible to individuals without significant financial resources. Funding grants from SAMHSA for substance abuse treatment is less than it was seven years ago, when considering inflation, per Harold Pollack, faculty chair at the Center for Health Administrative Studies. This adds to the difficulty in accessing appropriate substance abuse treatment (SAMHSA, 2011).

While the need for gender specific treatment has been identified, few protocols have been identified to treat the whole person relating to the issues that women have in substance abuse treatment. One 12-week pilot study of substance abuse treatment done by Shelly Greenfield, in connection with Harvard Medical School, found that women’s self-efficacy improved with a combined woman-centered approach and group dynamics in treatment (Gudrais, 2011). This writer’s research in what methods assist in reclaiming resiliency in women with childhood sexual abuse histories uncovered a variety of modalities that work to treat all issues simultaneously and this became the basis of a truly integrative approach to healing. This preliminary research provided the data used in a structured protocol that was utilized within a longitudinal pilot study for an extended care residential facility for women with co-occurring disorders in 2011.

Pilot Study: Extended Care Program

Client Demographics

Over the course of seven months, eight women with co-occurring disorders of substance abuse and psychological disorders moved through a suggested ninety-day treatment facility that provided holistic integrative treatment modalities designed to treat the whole woman. Each of these women had been referred for extended treatment from a primary residential facility after completing a thirty-day program to regain sobriety.

Demographics concluded that all of these women were Caucasian from middle to upper-middle class socioeconomic status. The average age of the women was 39 years, with a range from 21 to 58 years of age. Most of the women had college educations, although only two of the women had careers that were not adversely affected by their co-occurring disorders. All of the women had some family support, but it was tenuous at best.

Each of the women had been treated for a variety of substance addictions that included alcohol, opioids, methamphetamine, and in a few women, poly-substance abuse. In addition, each of the women had co-occurring diagnoses of major depression and anxiety, and three of the women had an eating disorder diagnosis. Physical problems included chronic pain, fibromyalgia, reoccurring benign tumors, and one woman was aware she carried the gene for a life-threatening genetic disorder.

Additional, all of the women had severe interpersonal problems, six of them had experienced trauma in the form of physical, emotional, spousal or sexual abuse, and all of them were facing legal issues related to substance abuse. When admitted, four of the women were dealing with marriage issues and the potential loss of their custodial rights to their children.

The treatment protocol included a thorough assessment, including having the women complete a psych-social-medical history at intake. The Beck Depression Scale, the Purpose in Life Inventory, the URICA Inventory on stages of change, and an Anxiety Scale were completed at intake, discharge, and after discharge at three months and twelve months. The assessments led to the development of individualized treatment plans based upon clients’ specific issues.

Treatment Milieu

The women lived in a house within a middle-class community and were provided some form of round-the-clock supervision and holistic services that addressed all areas of functioning. The house was run like a home, with the women specifying their food preferences, planning menus, and helping with shopping. They were responsible for cooking as a community and for maintaining the cleanliness of the house. Once per week a professional chef came and the women helped him prepare a family meal with their children and spouses, or other family members who were welcome to share in the meal. Sundays were allocated for family visits and the women could go off site for those visits. Family and couple counseling was provided during the week and community outings occurred on Friday nights.

Clinical Services

Clinical and healing services included:

• Three 60-minute individual sessions per week
• Three 90-minute recovery groups that included: Somatic Experiencing, Dialectic Behavioral Therapy, and Addiction Recovery themes
• Three to five 90-minute psychotherapy groups on mindfulness, guided visualization, identifying and developing personal spiritual values and practices, positive cognitive therapy, vocational/educational planning, and budgeting skills
• Two 90-minute acupuncture sessions that included National Acupuncture Detoxification Association (NADA) protocols, Emotional Freedom Therapy (EFT) and/or Psy K
• Two 120-minute expressive art therapy sessions
• One 60-minute massage (and/or Reiki) weekly
• An initial nutritional assessment and follow up as needed.
• One 90-minute yoga session weekly
• Daily AA/NA meetings

In addition, a gym membership was made available to the clients that included yoga, a pool, weights and a climbing wall. As women progressed through the program, if they had careers or jobs, they were allowed to pursue those vocations and eliminate some parts of the program. If they needed vocational counseling or resumes updated they were assisted with those endeavors and/or volunteering at some community projects was made available one to two times per week. Transportation was provided until they had moved into the status of using their own forms of transportation.

Rationale for the Modalities of Treatment

Protocols were based upon a holistic or transpersonal model of care with the idea that treating the whole person simultaneously is the most efficient and efficacious way to help people heal from the multiple problems that lead to substance abuse. Positive psychology has developed a ‘wellness’ philosophy over the past few decades that build upon clients’ strengths as opposed to just focusing on pathology (Seligman, Stein, Parks, & Peterson, 2005).

Research in regards to which attributes support having good life outcomes for people who have experienced serious adversity in life, strongly endorses resilience as a key factor (Bogar & Hulse-Killacky, 2006; Valentine & Feinauer, 1993; Chandler, 2010). Resilience has been associated with stable characteristics such as wellbeing, optimism, faith, wisdom, creativity, self-control, morality, gratitude, forgiveness, and hope (Liem et al, 1997; Werner & Smith, 2001). Thus the treatment modalities used in the pilot study were meant to provide clients with positive psychotherapy and recovery modalities, mindfulness training within both a cognitive and spiritual framework, outlets for creativity, somatic therapies to help with balancing and integrating both hemispheres of the brain, energetic healing modalities to assist with activating the client’s own immune systems, and practical skills to develop self-control, self-efficacy, and to build self-esteem.

Literature Review

Cognitive Based Mindfulness Therapies

Mindfulness-based cognitive approaches are a departure from traditional, cognitive-behavioral treatment. Cognitive-behavioral therapy includes a clear goal of changing negative behaviors and irrational thinking patterns, while mindfulness practice suggests that clients observe their thoughts as impermanent and refrain from judging them. Mindfulness-based stress reduction, and dialectical behavior therapy (DBT) have shown promise as therapies that support women with trauma histories and co-occurring disorders to focus on strategies that support improved health.

Dialectical behavior therapy (DBT) is one example of a cognitive approach that embraces humanistic principles toward personal growth (Baer, 2003; Hayes & Shenk, 2004). DBT is a multifaceted approach that was initially conceptualized as a treatment for individuals diagnosed with borderline personality disorder but has been expanded to use with addictive behaviors (Baer, 2003; Hayes, et al., 2004). Clients in the study learned mindfulness practices including nonjudgmental observation of thoughts, emotions, sensations, environmental stimuli, acceptance of personal histories and current situations while working to change behaviors and environments that support building better lives.

Mindfulness-based stress reduction has demonstrated its effectiveness for treating anxiety and panic (Kabat-Zinn et al., 1992; Miller et al., 1995). A meta-analysis of 20 empirical studies suggested that mindfulness-based stress reduction help individuals cope with depression, anxiety, pain, cancer, and heart disease (Grossman et al., 2004). By integrating cognitive behavioral approaches with humanistic, transpersonal theories, and mindfulness practices, creative healing strategies are promoting wellness.

These treatment modalities show promise as therapies that support women with trauma histories by helping them to integrate their past abuse experiences with their current substance abuse issues and encouraging them to focus on strategies that support improved health.

Consciousness and Developing Spiritual Practices

Consciousness has been linked with awareness, attention, and memory (Farthing, 1992) and has been highly correlated with resiliency (Liem et al., 1997; Werner & Smith, 2001). Jungian theory suggests that the unconscious mind retains information not readily available to the ego. While the personal unconscious holds repressed memories, the collective unconscious contains dreams, visions, religious experiences, and the myths of all cultures throughout the ages.

Murphy (1963) wrote that the unconscious mind possesses infinite wisdom that is available to the conscious mind when it is open and receptive. Thus human consciousness can be viewed from a multidimensional perspective that includes both a psychological and a spiritual context (Chandler, 2010). While we have access to our everyday consciousness to assist us in dealing with daily activities, we can be adversely impacted by what lies in the repository of our personal unconsciousness, of which we may be totally unaware (Chandler, 2010). Traumatic events narrow the focus of consciousness, and “the mind at large has to be funneled through the reducing valve of the brain and nervous system” (Huxley, 1954, p. 23). Meditation and other mindfulness techniques have been shown to lessen the hypervigilance, restlessness, anxiety, and fear associated with severe trauma (Miller, 1993).

In researching what practices and therapies helped abused women regain resiliency, personal spiritual practices were endorsed as providing meaning, hope, increased self-esteem and a sense of belonging (Chandler, 2010). Additionally, research is integrating spiritual practices with science such is seen with power of prayer (Bensen, 2006; Byrd, 1988; Krucoff & Crater, 2001) and other nonlocal healing techniques to assist in healing a variety of medical issues (Achterberg, et al., 2005; Chandler, 2010; Shealy, 1999; Shealy & Myss, 1988).

While organized religions have been found to be detrimental for certain trauma survivors (Chandler, 2010), the development of a spiritual practice can significantly aid in one’s search for meaning and purpose (Ryan, 1998), which echoes Frankl’s (1962) position that the way a person deals with suffering is a key to adding deeper meaning to life. Jaffe (1985) further asserted that adversity might become the cornerstone of a new identity, as a person discovers meaning in life’s struggles. It is, therefore, important for counselors to assess clients’ spiritual functioning and assist them in addressing spiritual concepts while searching for meaning in traumatic life experiences (Ganje-Fling & McCarthy, 1996).

Creativity and Expressive Arts

Sikes (2001) suggests that creativity plays a central role in the healing process. Creativity has been cited as one of the factors that assisted in the maintenance of resiliency (Seligman et al., 2005). Creativity embodies our natural impulse for change, without which stagnation would occur (Sikes, 2001). Throughout human history, people have used creativity to adapt and recover from stress, loss, trauma and pain. Seeking meaning (Frankl, 1962) is vital to the healing process, and humans have always found a structure in which to contain difficult experiences such as through rituals, ceremonies, storytelling, and songwriting (Sikes, 2001). Creating art has an established history of being a helpful adjunct therapy for working with psychological and physiological disorders, as well as for its cathartic properties (Chandler, 2010; Lusebrink, 1990/2004; McNiff, 1992).

Body Psychotherapy

Bessel van der Kolk, the medical director of the Trauma Center in Boston, found evidence that trauma affects the entire person and that treatment is most effective when it integrates psychotherapy with somatic, body-memory treatment such as EMDR, art therapy, and massage (Collinge et al., 2005, van der Kolk, 1994/1996). Van der Kolk’s findings concurred with Burgess, Watkinson, Elliot, MacDermott, and Epstein’s (2003) similar research.

Field (2000) demonstrated that massage benefits the musculoskeletal, circulatory, lymphatic, and nervous systems, and mental disorders associated with sexual abuse (Field, 2000). In studies of PTSD, depression, and anxiety, massage was shown to decrease symptoms and to improve mood and behavior.  A chronic fatigue study concluded that massage decreased depression, anxiety and pain, and improved immune function (Field, 2009).

Although research on the treatment of trauma with alternative medicine is limited, studies on the neurobiological findings of trauma support the need for an integration of both somatic and cognitive therapies to treat the layers of problems that affect victims with trauma histories and subsequent co-occurring disorders (Chandler, 2010).

Somatic experiencing, a mind/body modality developed initially by Peter Levine (1997), is a modality in the mental health field that goes beyond talk therapy. It teaches ways of recognizing, reducing, and discharging stressful energy from the nervous system. It helps the client understand exactly how the body is managing overwhelming, stressful, or traumatic events. In a gentle, yet powerful way, somatic experiencing helps people to let go of accumulated trauma in the body and allows the body to regain its innate ability to self-regulate and be resilient.

Three studies were found on the use of somatic experiencing method by social workers who had worked to help victims of both Hurricane Katrina and Rita. According to the authors of the study, the treatment group showed statistically significant gains in resiliency indicators and decreases in symptoms of PTSD. Although psychological symptoms had increased in both groups at the three to four month follow-up, the treatment group’s psychological symptoms were statistically lower than those of the comparison group (Leitch, Vanslyke, & Allen, 2009). The limbic center of the brain is where the pain and pleasure center is located that is affected by trauma and substance abuse and it appears to be another powerful technique for helping individuals with both disorders.

Acupuncture and Energy Medicine

The National Acupuncture Detoxification Association (NADA) was developed in the 1970s when it was discovered that a five-needle ear protocol was effective in reducing tremors, shakes, and both physical and mental agitation in heroin addicts while in detoxification units (Huff, 2007). Although the results of clinical studies have been mixed on demonstrated effectiveness for addiction treatment using the NADA protocol, more than 1,500 clinical sites around the world currently use these protocols.

The NADA protocols began to be used with traumatized populations in New York after the September 11, 2001 attacks. The group Acupuncturists Without Borders has been going to natural disaster sites since then to provide trauma relief using the NADA protocols (Huff, 2007). A pilot study by Hollifield, Sinclair-Lian, Warner, and Hammerschlag (2007) at the University of Louisville School of Medicine in Kentucky examined the effects of acupuncture on depression and anxiety in 73 individuals diagnosed with PTSD. During a 12-week period, participants were assigned to acupuncture, cognitive-behavioral, or wait-list groups. Both acupuncture and cognitive-behavioral groups had similarly improved symptoms that were superior to those of the wait-list control group and maintained the effects for three months after the end of treatment (Hollifield, Sinclair-Lian, Warner, and Hammerschlag, 2007).

Charles Engel, MD at the U.S. Army Walter Reed Medical Center, has been conducting an on-going randomized, wait list controlled trial from 2006 through 2008 to evaluate the efficacy of acupuncture for PTSD based upon the reported results on the study by Hollifield, Sinclair-Lian, Warner, and Hammerschlag (2007) stating that acupuncture improved wellbeing, stress, anxiety, sleep, digestion, and pain conditions, and that it held promise as a treatment option for PTSD.

Reiki, which means universal energy in Japanese, is a nonintrusive, hands-on and distance healing technique, which originated in Japan by Dr. Mikao Usui (1865-1926) at the beginning of the 20th century. Research on Reiki healing shows it to be effective in treating emotional trauma, releasing toxins, reducing side effects of drugs after surgery or chemotherapy, improving immune system function, increasing vitality, creating deep relaxation, and releasing stress and tension (Chandler, 2010).

Quantum physicists have acknowledged that the human body generates an electromagnetic field and that negative emotions that occur in response to trauma, influence the physical tissue in the body (Oschman, 2000; Smith, 1988, 1994; Tiller, 1997). Acceptance of Reiki in the medical world has been limited by a lack of empirical investigations, but professional nurses have recently led the way in exploring Reiki’s healing benefits (Oschman, 2000; Vitale, 2007).

Two Reiki studies of surgical patients showed less use of pain medications and quicker recovery with Reiki treatments (Alandydy & Alandydy, 1999; Motz, 1998). A study at St. Vincent’s Medical Center in New York demonstrated that Reiki lowered anxiety in 30 heart patients (Rand, 2009). Three cancer studies found Reiki to be useful for palliative care and pain management (Bullock, 1997; Burden, 2005; Olson & Hanson, 1997). The Department of Veterans Affairs uses Reiki in their Hepatitis C treatment program, and most recipients report a peaceful sense of relaxation and reduction in pain, anxiety, fear, and anger.

Further findings have suggested that Reiki fits easily within a harm-reduction model and can be used successfully as self-treatment by people with HIV, in conjunction with appropriate medical and/or psychiatric care (Miles & True, 2003). Reiki was found to be a helpful treatment modality for women with childhood sexual abuse histories in the Burgess Watkinson, Elliot, MacDermott, & Epstein (2003) study. Additional research into the efficacy of this treatment modality specific to treating women with co-occurring disorders is indicated.

Based upon the collective research being done to validate the efficacy of all these healing and mindfulness modalities with a variety of psychological, physiological, and substance abuse issues, they were all included in the extended care facility’s regimen. Each woman had an individualized treatment plan that included access to consistent use of treatment modalities that fell within the body-mind-spirit continuum to fully explore the core principles of integrated treatment as stated by the SAMHSA findings (SAMHSA/PIT 51).

Results of Longitudinal Research

While this was a small sampling of women with co-occurring disorders in an extended care facility, the results were encouraging that a holistic, integrated treatment model is an effective strategy. Using the self-administered Beck Depression Scale, an Anxiety Scale, the Purpose in Life Inventory, and the URICA Inventory of Stages of Change to quantify baseline, discharge, three months after discharge, and twelve months after discharge provides some statistical data to substantiate findings.


Beck Depression Scale – 20% is considered significantly depressed.

Baseline                       Discharge                    3-Months                     12-Months

AVG.    20.38                             8.38                              3.3                                .75

At intake the average depression rating for the women was 20.38%, which is considered significantly depressed. The average depression scaled diminished over the ninety-day stay to 8.38%, which indicates minimal if any clinical depression, and the average percentage continued to decrease among the women.

Anxiety Scale – Five-point scale with 5 being the worst.

Baseline          Discharge              3-Months                     12-Months

4.75                  2.63                             .5                                  >.25

All of the women indicated high anxiety upon intake, with the average point distribution being 4.75%. This scale related to how effective acupuncture was in addressing anxiety symptoms. After three months of weekly acupuncture sessions, the average anxiety scale for the women was 2.63% and anxiety levels continued to decrease after discharge from the program.

Purpose in Life Inventory – Below 90 = No Purpose; Over 112 = Definite Purpose

Baseline         Discharge                 3-Months                  12-Months

88.25                103                              114                               119

The Purpose in Life Inventory rates sense of purpose, which is tied to resiliency and hope for recovery. The survey’s instructions state that a score below 90% indicates the individual feels she/he has no purpose in life. At intake the baseline average of the women who participated in the treatment protocol was 88.25%. At discharge average scores were 103%, which is in the contemplation or more hopeful stage, and this score continued to increase on average to the women feeling they had renewed purpose in life.

URICA Inventory

Precontemplative                    Contemplative             Action             Maintenance

Baseline                                        Discharge               3-Months             12-Months

AVG. P/C                                           C/A                        A/M                          M

The URICA inventory suggests where the individual sees herself in relation to recovery from substance abuse. At intake the women were pre-contemplative or contemplative about their ability to recover from substance abuse/dependence. At discharge all of the women had developed action plans to maintain the sobriety they had developed through treatment. By the twelve-month follow up, those that were willing to be interviewed had maintained sobriety and were actively pursuing lifestyles that supported their continued sobriety.

The findings at baseline were that even after a thirty-day primary inpatient program the majority of the women were still depressed, extremely anxious, had a low score on purpose in life inventory, and ranged in the pre-contemplative to contemplative range on wanting to maintain recovery from substance abuse. All of the women came into the extended program with a sense of being overwhelmed with their lives and some sense of hopelessness that they could not improve the quality of their lives and build their self-esteem. The average length of stay for the eight women was 2.75 months. Only five of the original eight women could be reached at the twelve-month mark, but those that were contacted had maintained the gains made and, in some measures, continued to improve.

During the stay in the extended care house, three of the four married women resolved that divorce was inevitable and began that process. They felt empowered to take the necessary steps to provide for joint-custody of their children, and they were able to advocate appropriately for themselves with their ex-husbands. The one woman that remained married continued in outpatient therapy and marriage counseling, and determined after several months of both, that enough growth in the relationship had occurred to warrant staying in the marriage.

The women that had careers resumed those careers and were among the ones that responded at the twelve-month mark. Three of the women began to explore how to re-vitalize their careers and two of the women began to explore returning to college. The women who had struggled with dysmorphic body image issues and eating disorders were able to develop healthy eating strategies through proper nutrition, regular exercise programs, and somatic/mindfulness therapies such as yoga and meditation.

Of the group, the two women under 30-years-old had the hardest time committing and staying committed to their sobriety. They each committed to stepping down in treatment to sober living facilities and extensive outpatient programs to continue their therapeutic work. In addition, several of the women developed a real bond with one another and maintained that connection, even at the twelve-month mark.


As a small pilot study, there were not sufficient participants for the results of the study to be considered quantifiably significant. In addition, the integrative techniques were offered collectively along with traditional therapeutic approaches, which do not expressly demonstrate how any of these therapies offered exclusively would or would not be beneficial in additional studies. Thus, from a scientific method perspective, validity or reliability cannot be established for retest possibility. The premise of this study was to provide a variety of holistic services in a clinical setting and to monitor the progress of clients from a longitudinal perspective to determine efficacy of the whole program to affect positive change in clients.

As a clinical treatment protocol, a major issue with this program was cost and the lack of insurance carriers that would pay for the program. Insurance carriers that were approached would not consider the whole program, and would only consider paying piecemeal to practitioners that were on their specific insurance panel, and in this, effectively managed to discount the program.

While considering the nature of the program received, as well as room and board, the cost was $7500 per month, which is about half the cost of a month in a primary treatment facility in the same geographical area. However the reality is that the majority of families with this need cannot afford even one month of this cost, much less three months. This dilemma suggests that a comprehensive, integrative program would need to be funded through federal grants to continue research into its efficacy, and developed as a teaching model to take into the non-profit sector.

In this way the efficacy of therapies could be further tested with individuals that currently do not have access to alternative therapies and may be of diverse cultures and economic statuses. The pilot study may provide opportunities to develop research protocols to further elucidate efficacy of therapies in other settings such as in community mental health settings and in traditional residential treatment facilities for the treatment of substance abuse. While providing therapies piecemeal has been the way co-occurring disorders have been traditionally treated, this might be an appropriate way to begin incorporating some of the other therapies into mainstream treatment facilities.


The outcomes for the eight women in the three-month pilot study into integrative holistic treatment for co-occurring disorders was a reduction in depression and anxiety, a renewed sense of purpose, raised self-esteem, and the ability to face interpersonal and legal problems with increased self-efficacy. Of the five women that responded to repeating the assessment measurements a year after treatment, all of them maintained and increased gains of treatment, which provides encouragement for potentials of integrative treatment.

Additionally the interpersonal, vocational, legal, medical, and Axis I issues of each individual were addressed in a comprehensive and holistic program, which encouraged more research into integrative care. Even with the inherent problems of developing funding for a change in rationale from piecemeal treatment protocols to an integrative model, the encouraging trend noted in this pilot study suggests that the overall problems of recidivism for substance abuse and the underlying gestalt of co-occurring issues in women being treated simultaneously with a holistic model may produce more lasting and effective changes.

Further research is needed in integrative and alternative therapies for the treatment of mental illness and co-occurring substance abuse disorders. There may be ways to do additional research within community mental health and substance abuse treatment facilities to elucidate efficacy of treatment modalities. Specific treatment modalities could be provided in set participant groups to determine treatment efficacy for those modalities. From the clinical perspective of holistic care, it is not one or two therapies that provided the treatment outcomes, but the therapeutic perspective of a holistic and fully integrated treatment program that treated the whole person that made the difference.

Providing specific care to women with co-occurring disorders from the holistic perspective suggests a need to consider the relational issues that may be causal to women becoming dependent upon substances, along with co-occurring disorders, and the core principles noted in SAMHSA for gender differences to develop protocols that lead to healing.


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About The Author

Dr. Tricia Chandler, PhD, LPC, BCPC, has been working in the field of psychology for the past nineteen years as a Licensed Professional Counselor and Art Therapist with children, youth, and adults in a variety of milieus. This has created the opportunity to research and develop holistic therapeutic practices for individuals with considerable trauma histories and co-occurring disorders. Dr. Chandler has trained in transpersonal psychology, energy medicine, personal spiritual/mindfulness practices, and somatic therapies she researched resiliency in healing from childhood sexual abuse for her dissertation in 2010 and developed a holistic model to treat women with co-occurring disorders after noting that therapeutic techniques for women lack an understanding of the multiple problems that face women seeking treatment for addiction issues. In addition to completing the longitudinal research presented in this paper, Dr. Chandler has a private practice and teaches graduate counseling and psychology students in online format for three universities where she teaches diagnostic psychopathology, family systems, biological basis of behavior, introduction to addiction counseling, counseling theories, advanced research, and professional ethics.

The Compassionate Mind: A New Approach to Life’s Challenges

The Compassionate Mind:
A New Approach to Life’s Challenges

Written By: Paul Gilbert, PhD
Publisher: New Harbinger Publications Inc., 513 pages
Reviewed By: Dr. Susan Stuntzner PhD, LPC, CRC, NCC, DCC, FAPA
Assistant Professor
University of Texas Rio Grande Valley
School of Rehabilitation Services and Counseling

College of Health Affairs

Compassion and self-compassion have gained momentum as topics of interest to psychologists, counselors and allied helping professionals in the past decade. During this time, there has been an expansion and application of these skills and constructs to professions. This includes education and the teaching of children in the public school system, rehabilitation counseling and its application to the coping and adaptation needs and concerns of persons with disabilities (i.e.,  see Stuntzner, 2014a, 2014b; Stuntzner& Dalton, 2014; Stuntzner& Hartley, 2015), medicine as it may relate to patient care or self-care of the medical professional, as well as discussion and momentum towards how to integrate compassion and self-compassion into a societal paradigm and way of life.

Additionally, there has been an increase in the number of books written and published about these skills and approaches. These generally focus on specific parts of life such as weight loss and dieting (i.e., The Self-compassion Diet: A Step-by-Step Program to Lose Weight with Loving Kindness), self-esteem  (i.e., Self-Compassion – I Don’t Have To Feel Better Than Others To Feel Good About Myself: Learn How To See Self Esteem Through The Lens Of Self-Love and Mindfulness and Cultivate The Courage To Be You) and self-compassion and mindfulness practices as part of psychotherapy (i.e., Self-Compassion in Psychotherapy: Mindfulness-Based Practices for Healing and Transformation).

Such a burgeon in awareness and application of compassion and self-compassion suggests that there is a need within our own culture to understand, study, and cultivate self-acceptance and kindness. Some of this need is evident as we live in a culture, while advanced in many ways, has not historically given people permission to be kind and compassionate towards themselves and more recently, towards others. Evidence of this is everywhere in our daily lives as there is increased pressure to perform, work harder and longer hours (sometimes without financial compensation), juggle multiple demands in an ever-changing society, survive and flourish in what may appear to be borderline-hostile work environments, and so forth.

The point being that we live in era where there is heavy competition for jobs and many people feel the need to out-do the next person. Similarly, some feel it is hard to relax or give themselves permission to go on a vacation and ‘unplug’ from the computer or electronic devices (i.e., i-phones) out of concern they will miss an important memo. Related to this notion is the fact that much of our culture is very ‘production-oriented’ and is based on work and the perceived value it holds.

While employment and work are definitely important and a necessary component of life, so is the need to learn about, understand, value, and practice life-affirming skills such as compassion and self-compassion. Gilbert’s book, “The Compassionate Mind: A New Approach to Life’s Challenges” helps bring to light the struggle society (and the world as a collective) has in relation to understanding the ways of being, living and approaching life from an evolutionary standpoint and how those same ways of living, currently, can hinder and hurt us.

For example, thousands of years ago, people and tribes had to be on guard for threats and danger on a regular basis. Survival was based on their ability to ward off possible threats; thus, their brains were hard-wired for anxiety, concern, and self-protection which were all essential. Gilbert (2009) also sheds understanding that the “primitive” and old ways of living were functional, at the time, and necessary but that they may not be so presently. Related to the evolutionary skills of man-kind is the notion that people are a by-product and influence of history, their biological-inherited genes, and of their upbringing. Gilbert (2009) repeatedly reinforces throughout the book that much of how we are today (as human beings) is evolutionary, in our genes and for those reasons is not our fault.

The concept of something (i.e., a personal trait or characteristic) not being our fault is an interesting one to consider, especially in an era where much of societal behavior focuses on “who is at fault” for something. According to Gilbert (2009), however, much of our undesirable traits can be viewed as a product of the past. These were useful and invaluable for survival when life was much harder and not as ‘comfortable’ as it is today. Much of the human-condition is explained as that which is biological, inherited, and conditioned or learned, and therefore, not our fault, is an interesting perspective for many reasons.

First is the fact that much of what has been written about compassion and/or self-compassion has been derived from Buddhist psychology or spiritual practices. In this book, although these concepts are mentioned, they are not the focus of it. Rather, much of the context and the first half of the book explain the rationale for people being who and how they are from an evolutionary and a brain-functioning perspective.

Second is that if our brain is ‘hard-wired’ to be a certain way to help promote survival at in the past, there is no need to ‘beat one’s self up’ for not being more compassionate or self-compassionate. Third is the connection between how people are raised and their ability to be compassionate and self-compassionate. Throughout the book, Gilbert shares that people who experience difficult or traumatic experiences (i.e., abandonment, lack of parental comforting or emotional soothing, abuse), torture, and earlier developmental life challenges are likely to have some kind of alteration in relation to brain development and maturation. As a result, people’s brains are affected or hindered in their ability to identify and practice self-calming and compassionate approaches as a natural way of life.

Fourth is the notion that peoples’ brains evolve and change throughout life and the lifespan. More specifically, as people go through life and have experiences, they are also afforded opportunities to interpret situations and to change their focus, intention and their brains for the better. Understanding this concept is important because it points out the fact that regardless of a person’s genetic disposition or life events, s/he can change one’s brain, its wiring, functioning and capabilities.

An example of this is a quote Gilbert (2009) shares extensively throughout, “Neurons that fire together, wire together……” The fundamental take away from this quote is the idea that people can choose to change their focus (i.e., focus on compassion and the cultivation of self-compassion versus operating according to threat, loss, safety, and survival). If they train their brain to be more kind, loving, tolerant, and self-compassionate, it will follow-suit and begin to function accordingly. Similarly, if people behave and react according to the ‘old brain’ patterns (i.e., anxiety, angst, threat/safety), so will their brain.

Fifth is the idea that change is possible and that there is a solution for better living. As the reader, it was helpful to fully consider the past and the way people’s brains have functioned and evolved over time, but it was also invaluable to understand how our “old brains” or ways of keeping ourselves safe were simply trying to help us survive until we could get to a better, more kind and loving place. Chapter 6 helped set the stage for exploring the connection between a person’s thoughts, feeling, and brain functioning.

Gilbert (2009) references that change is not easy but it is possible. He also begins to set the stage to assert that people can cultivate self-compassion and self-soothing as viable and healthier alternatives to self-criticism and judgment. He further explains that compassion and self-compassion can be used as a new “mind pattern” or generator for our brains and that as people learn to cultivate compassion within themselves, they may also experience changes in motivations and personal competencies (p. 192). All of these changes translate into an improved sense of well-being.

The second half of the book focuses extensively on information, skills, and exercises the reader can use to build and cultivate self-compassion and to create a more compassionate mind-set. Collectively speaking, it is the reader’s experience that the chapters are presented along a developmental continuum. For instance, Chapter 7 introduces the concept of deep breathing, followed by mindful breathing, mindfulness, mindful relaxing, exercises and suggestions for applying relaxation techniques to a person’s everyday life.

Introducing mindfulness and self-compassion appears to be fairly common among teachers and trainers due to the fact that these skills can help people learn to quiet their mind, listen to their breathing, and tune into their inner body experiences. Similarly, for those who are not used to practicing or integrating self-compassion and mindfulness techniques, learning to quiet one’s mind and experience one’s bodily sensations and feelings can be challenging until they become more accustomed to their regular practice. For this reason, such approaches are sound beginning steps.

Chapter 8 covers a number of exercises pertaining to compassion cultivation and mental imagery. Of importance is the idea that compassion-cultivation does not mean people will not experience hard or different times: challenges, hurt, and pain are a part of life. But, what can happen through the development of self-compassion is an alternative way to face, cope with, and address the pains we encounter (p. 242). Because some people have difficulty embracing and allowing themselves to be self-compassionate, the author suggests that people try to recall someone they know “who was caring, kind,  and warm towards them” at an earlier time in life as part of this process (p. 246).

The reader is encouraged to remember an event that was too difficult, so as prevent one from dwelling on the pain and to focus on the experience and the feeling of what it was like for another person to be kind them during this trying time. Readers are then directed to reflect on an experience where compassion was ‘flowing’ out of them towards another who was in distress. From this exercise, later in the chapter, readers are given an opportunity to imagine and create in their ‘mind’s eye’ an image of a ‘compassionate other’. More specifically, readers are asked to consider what the compassionate image looks and feels like. How does it sound? Further, the compassionate image is someone or something that “understands what it is like to be human and to go through difficult events” and has the ability to “endure and tolerate” difficulties, perhaps provide strength if needed. Also of relevance is the importance of this image being non-judgmental, critical, or condemning (pp. 256-257).

Chapter 9 is about compassionate thinking. Of relevance to helping professionals and to the people they serve is that learning to and cultivating compassion and self-compassion is a process and one in which our minds and feelings may not cooperate as desired. When this happens, when our minds wander, or when people find their old critical self and feelings resurface, readers are encouraged to be gentle and compassionate with themselves as they acknowledge (i.e., notice) what is taking place and gently redirect themselves back towards compassion/self-compassion or the practice of it should they be in the middle of an exercise. Related is the notion that our thoughts and feelings are related and when “people change their thinking they change their minds…..” (p. 274).

One part of this chapter the reader appreciated was the exploration and explanation of how compassion and self-compassion may fit into various counseling and therapeutic approaches. Some of those mentioned include Cognitive Behavioral Therapy (CBT), Rational Emotive Therapy (RET), Dialectical Behavior Therapy (DBT) and Acceptance Commitment Therapy (ACT). Although the explanation of how compassion and self-compassion were related to these approaches was not detailed, it provided another perspective for the reader to consider. This is especially interesting as these constructs have typically referenced in relation to Buddhist psychology but not towards a counseling approach. Professionals striving to understand how compassion cultivation and self-compassion fit into the therapeutic or helping relationship may find such reference of help within their own professional work with clients.

Many points of interest and self-compassion building exercises are covered in Chapters 10 to 13. Gilbert (2009) discusses the connection between shame and self-criticism, shame and disappointment, the power  and sources of self-criticism, self-esteem versus self-criticism as well as various exercises to enable the reader to get in touch with negative thoughts and feelings (i.e., conflicted feelings, self-criticism). Of importance is the mention of forgiveness, whether it is towards one’s self or others.

Forgiveness, self-compassion, and compassion tend to go hand-in-hand. For instance, it can be difficult to consider or even try to cultivate self-compassion and compassion if people are not willing to forgive. When people hold onto their negative thoughts, feelings, and/or resentments they are not able to feel or generate compassion toward one’s self or others; thus, at some point, it is likely the exploration of forgiveness may enter the therapeutic and healing process.

The book also points out that people may experience negative emotions in their pursuit of compassion cultivation. Understanding this is essential because people often assume that just because they are working towards being more compassionate and self-compassionate that this will not occur. Then when they feel negative emotions they may become discouraged. However, people can remind themselves that our brains are “hard-wired” by history, genetics, and upbringing to survive and to pay attention to perceived threats which can take the form of anger, anxiety, threat and so forth.

It is also important to know that the surfacing of negative thoughts and feelings does not mean compassion cultivation is not working; our minds and feelings wander. However, the more regular and consistent people become in their practice, the easier and more fluid compassion and self-compassion become. In essence, these skills become a way of life and a way of dealing with difficult and trying events, thoughts, and feelings. Gilbert also provides a “step-work” plan to aid the reader in coping with anxiety and anger. People who are particularly challenged by these emotions may find this information of use (see pp. 367-387).

Professionals wanting to learn more about compassion and self-compassion can learn a lot from this book. One of the ways this book differs from others on the topic is that it draws a clear connection between the brain ‘hard-wiring’, history, genetics and upbringing. This point is mentioned throughout the book but it is worthy of mention again, because it explains from a scientific/biological perspective, not just a spiritual practices approach, reasons many people may have difficulty being kind, self-compassionate, tolerant, and forgiving. Ideally both approaches are important, but the scientific/biological view is not one many scholars write about and it may be particularly helpful to those (i.e., clients) who have difficulty embracing spiritual or religious approaches as a part of the healing process.

The information presented by this book offers the reader another point-of-view about compassion and self-compassion that they might not have previously considered. Additionally, professionals are given a number of exercises which they may use or adapt as a part of the therapeutic and healing relationship. Professionals wanting to consider another view point about the challenges people may face while working towards compassion and self-compassion cultivation are encouraged to read this book.


Fain, J.  (2011). The self-compassion diet: A step-by-step program to lose weight with loving kindness. Boulder, CO: SoundsTrue, Inc.

Lindstrom, S. (2014).Self-compassion – I don’t have to feel better than others to feel good about myself: Learn how to see self-esteem through the lens of self-love and mindfulness and cultivate the courage to be you.CreateSpace Independent Publishing Platform

Stuntzner, S. (2014a).Compassion and self-compassion: Exploration of utility as essential components of the rehabilitation counseling profession. Journal of Applied Rehabilitation Counseling, 45(1), 37-44.

Stuntzner, S. (2014b). Self-Compassion and sexuality: A new model for women with disabilities. ACA’s VISTAs, Summer Issue.

Stuntzner, S., & Dalton, J. (2014). Living with a disability: A gateway to practicing forgiveness and compassion. American Association of Integrative Medicine®, October Issue.

Stuntzner, S.,& Hartley, M. (2015). Balancing self-compassion with self-Advocacy: A new approach for persons with disabilities. Annals of Psychotherapy and Integrative Health®, February Issue.

Tutu, D., & Davidson, R. (2015).Self-compassion in psychotherapy: Mindfulness-based practices for healing and transformation.W. W. Norton and Company.

About The Author

Dr. Susan Stuntzner PhD, LPC, LMHP, CRC, NCC, DCC, BCPC, DAPA, FAPA, is an Assistant Professor  in the School of Rehabilitation Services and Counseling at the University of Texas  Rio Grande Valley. She currently trains students to become rehabilitation and rehabilitation counseling professionals and to work directly with individuals with disabilities in numerous employment settings. Her research interests include: adaptation and coping with disability, resiliency, self-compassion and compassion, forgiveness and spirituality, development of intervention techniques and strategies, and mentorship of professionals with disabilities. She has written three books pertaining to coping and adaptation and/or resilience-based skills. Her works are entitled, Living with a Disability: Finding Peace Amidst the Storm, Reflections from the Past: Life Lessons for Better Living, and Resiliency and Coping: The Family After.  These books are available on Amazon.com or those interested may contact her directly at susan.stuntzner@utrgv.edu if they are interested in hard-bound copies. Dr. Stuntzner has researched and written articles on self-compassion, forgiveness, and resilience and their potential relationship to the needs of individuals with disabilities. She has also developed two interventions (i.e., resilience, forgiveness) for persons with disabilities to assist them in their coping process. These works are entitled, “Stuntzner and Hartley’s Life Enhancement Intervention: Developing Resiliency Skills Following Disability” and “Stuntzner’s Forgiveness Intervention: Learning to Forgive Yourself and Others”. Dr. Stuntzner has also written previous book reviews on the topic of compassion and self-compassion as well as given a number of professional presentations on forgiveness, resilience, compassion, and coping with disability. Additional information can be found on her website: www.therapeutic-healing-disability.com

Allergy Season – You know it is bad when….

Allergy Season – You know it is bad when….

Published April 16th, 2014 in Allergies

Every year we look forward to spring, the longer days, warmer temperatures, flowers and outdoor activities. What many of us don’t look forward to, are seasonal allergies, sinus headaches, itchy eyes and skin. This year we knew allergy season was going to be a bad one when our Sadie girl dog had to go visit Dr. Blair, DVM for uncontrollable scratching. After several sleepless nights for her and us it was time to call in the big guns for help.

sadieWhat I found interesting is whatever is contributing to her environmental allergy seems to be giving me the special treatment too. I know I don’t have flees…. And after visiting Dr. Blair with Sadie, I broke down and purchased my first box of Benadryl™ for myself, to curb the itching skin, sinus pressure, and so forth.  Now I’m not an over the counter or behind the counter visitor – it is funny it took my vet to remind me about the need for allergy medication sometimes.

I’m glad to report the Sadie and I are both scratching far less now, and this week reminded me of how many clients suffer from allergies and what they can do to minimize their over the counter drug use. Some due to high blood pressure have to be especially cautious of any medications they take. Antihistamines are notorious for elevating blood pressure, causing dry eye and mouth, throat irritation, drowsiness, brain fog, irritability…. Just to name a few of the side effects.

Over the years we have found several nutritional supplements to be useful, elimination of dairy foods and eggs that increase mucus production, Netty pots for nasal irrigation, homeopathic eye drops and herbs to improve lung function. And during especially bad times we break out peppermint oil along with essential oils to put in the diffuser for relief.

Don’t overlook Mold.

Mold, black mold in particular is most active when the weather turns warmer and is damp. Mold sickness and related illnesses from mold exposure are real. Mold has been linked to lung damage, brain damage, cancer and even death.

If mold spores are inhaled or ingested you can become seriously ill. As mold continues to grow inside your body it produces poisons called “Mycotoxins”, these poisons leach into your body day after day.

Different species of mold produce different toxins and people will suffer a wide range of symptoms.

The most commonly reported symptoms of short term mold exposure:

  • Sneezing
  • Itching Skin
  • Redness and skin irritation
  • Watery Eyes
  • Itching Eyes
  • Headache

Here are a few other suggestions:

Bee Pollen: Bee pollen has been used for centuries in China for seasonal allergies. It dries up the nasal cavity and slows or stops that annoying post nasal drip that leads to nagging coughing, sore throat and drippy nose. Clinically, I have found the pollen does not have to come from local sources to work. The two brands used most by our office are Nature’s Way® and Glory Bee®. Make sure it is straight bee pollen, not one with ginseng added.

Chinese Herbs: For years now I have managed the bulk of my allergy symptoms with Chinese herb tea’s blended by a local provider for me. Now, I won’t lie to you and say the stuff tastes great – it doesn’t- but it works and I only have to do between 4 – 8 oz daily to keep my lungs happy and my head clear.

Bioflavonoid Complex from Vitamin Research Products is natures “singular,” the combined benefits of this nutrient product benefit blood pressure, circulation, heart health and the combination of bioflavonoids work as a mast cell inhibitor.

OPC or grape seed extract: All of the antioxidants including Vitamin C and E play a major role in the reduction of inflammation. As we have seen allergies are a form of inflammation and they respond well to antioxidants. OPC stands for “Oligomeric Proanthocyanidin” a very powerful antioxidant found in grape seed and a truck load of other foods.  As with all natural health options synergistic combinations require lower doses and provide more bang for your dollar.

Mullen from HerbPharma™ is my daily go to. This herb has been used since the Middle Ages in Europe for colds, lung ailments, allergies, and ear congestion. It is one of the few herbals I use that doesn’t taste like it came out of some dirty sweat sock….always a good point when taking twice daily. hahahaha

What Therapy Options Work?

Acupuncture: Extensive research supports the use of Acupuncture for a host of conditions, especially those involving inflammation. Over the last ten years research has proven acupuncture is effective in the reduction of sensitivities resulting from allergies.

Chiropractic care is also very useful in reducing the inflammation response within the body; these practitioners as a whole have not only adjustments but Nutraceuticals available to help clients this time of year.

Buy a good air filter for your bedroom, living room, or office areas. This investment helps keep the cost of supplements, medications, and doctor’s visits down. It is especially important in the bedroom where you are lying down and congestion increases. Make sure it is a HEPA filtration system and spend the money for the ultra-quiet ones.  I know Costco has some nice ones on sale generally this time of year, and as a rule are better priced than through other retailers.

To pleasant spring days without Kleenex


Spotlight on Eating Disorders

Spotlight on Eating Disorders

By Erica Goodstone, Ph.D., LMHC, LMFT, LPC

February 23-March 1 – National Eating Disorders Awareness Week

Many of us have some “disordered eating” but do not actually have an “eating disorder” diagnosis. 

With so much information in the media, we are increasingly more concerned about our weight, our diets and our eating habits.  Knowing that certain foods are unhealthy for us, we often cannot seem to stop craving and choosing those foods. We eat too much, we eat too fast, we restrict certain food, we often eat to suppress emotions and we  later pay the price in terms of feeling stuffed, uncomfortable, gaseous or  in physical pain.  What differentiates the average person’s poor eating habits from a more serious and eventually debilitating “eating disorder”?

Early Intervention Can Save Lives.

Eating Disorder is a disease, a serious disease, which can be masked in broad daylight for a long time.  Unlike a drinking or drug addiction, a person with an eating disorder cannot abstain from food. We need food to eat, every day, several times each day.  And this is a progressive disease so that relatives and friends may not quickly recognize the symptoms until the disease has already progressed to a dangerous state.You can catch it early by noticing that someone you care about is having unhealthy thoughts, attitudes and behaviors around food and eating.  No longer just a young person’s problem, men and women of all ages are exhibiting eating disorders, the fastest growing group being middle-aged women and women with diabetes.

Types of Eating Disorders

Anorexia Nervosa

When we talk about an eating disorder, what immediately comes to mind for most of us is the image of a very underweight female in her late teens or early 20’s, who has been starving herself.  But the reality is that Anorexia affects both men and women of all ages. Dieting is the most common behavior that eventually leads to a full blown eating disorder.  The emotions involved have a lot to do with feeling anxiety and low self-esteem yet wanting to please and toperform life activities perfectly. The process may begin with a simple diet, followed by increasing restriction of food, obsession with feeling overweight, and unwillingness to recognize the danger of inadequate food intake.

Bulimia Nervosa

A person suffering from Bulimia Nervosa can often easily camouflage his or her disorder by appearing to be of normal weight and appearing to eat normal meals.  If someone is paying attention, though, they will notice a pattern of over-eating at meal time, binging or excessively snacking, and then either fasting, excessively exercising, purging (inducing vomiting, taking laxatives and enemas) or alternating between all of these actions.  Disturbing the natural digestive functions of the body, increasing the acidity in the throat, and uncontrolled exercising can lead to serious physical problems.

Binging Disorder

Food can be soothing, comforting, and act like a drug.  Binge eating is certainly not just a problem for women.  An increasing number of men of all ages have developed maladaptive coping mechanisms that result in binge eating. This and all the other eating disorders are bio-psycho-social illnesses that can be healed and overcome with mental health, medical and body awareness counseling.

Orthorexic Nervosa

Not recognized by many as an actual eating disorder, orthorexic nervosa resulting from “clean eating” behavior can actually be unhealthy for the body.  In an attempt to be exceptionally healthy, a person with this disorder may be inadvertently eliminating important foods that contain necessary amino acids, minerals and vitamins.

Eating Disorder Recovery

Treatment of an eating disorder differs depending upon many factors.  Often, a team of practitioners is involved including a physician, nutritionist or dietician, psychiatrist, psychologist or mental health counselor or family therapist.

• Specific type of eating disorder
• How early the eating disorder is detected
• If there is a co-existing addiction
• Whether there is a concurrent mental health diagnosis

There is Life Beyond Eating Disorders. http://www.blogtalkradio.com/drericag/2016/01/19/life-beyond-eating-disordersListen to this recent interview with Johanna Kandel, founder and CEO of The Alliance for Eating Disorders Awareness and find out more about Eating Disorders Awareness Week.http://nedawareness.org/

Have a healthy, happy, forward thinking and successful 2016.

Please feel free to send me your questions, comments, subjects you want to see covered, and topics which you, as an expert, would like to share here.  If you are ready to collaborate and share on social media, join the Marketing Our Practices Facebook group https://Facebook.com/groups/MarketingOurPractices

I look forward to working together with you to strengthen our professions in the coming months.

Erica Goodstone, Ph.D., LMHC, LMFT, LPC

Forgiveness Therapy

 Forgiveness Therapy

Edward Mackey CRNA, MS, MSN, Ph.D., FAPA
Associate Professor
West Chester University of Pennsylvania
West Chester, PA 19383
610-738-0543 emackey@wcupa.edu 

Keywords: Forgiveness, Self Help, Brief Focused Therapy

Learning Objectives:

Upon completion of this course, the participant should be able to:

1.  Describe an informed definition of forgiveness
2. Explain at least one strategy for managing feelings of hurt
3   List at least three responses to a negative affect state
4. Identify how to practice positive self talk

AAIM approves this activity for 1 Continuing Education credit. All certified members are required to complete 30 hours of approved Continuing Education credit in their 3 year recertification period to maintain their certification.


Patients present practitioners with a myriad of complaints. These complaints cover a range from physical to psychological. Many of the presenting symptoms and ramifications of the disease process can be the result of psycho-physical relationships between all human beings. The practice of forgiveness has been discussed throughout history, usually through a religious lens, yet research points to forgiveness as a means to reduce anger and depression, to improve health and happiness, as well as to increase self-esteem (Luskin, 2002). It is interesting to note that it is forgiveness work that enables individuals to enable lasting personal change and move forward in a positive fashion (Enright, R 2001, Ferrini, P. 1991, Luskin, F. 2002).  It is also interesting to note that forgiveness therapy is a crucial part of the hypnotherapeutic interaction when dealing with pain and other discomfort (Mackey 2009, 2010).

Forgiveness Therapy

Forgiveness therapy involves an interaction between an individual (victim) and a perpetrator (cause). This interaction does not need to be one that is a personal encounter, and many times should not be, but rather one in which the victim will ultimately let go of the anger, fear, shame and bitterness toward the perpetrator. When this forgiveness occurs, the victim no longer feels the sting of the past and can begin to move forward. (Luskin, 2002).

There are many definitions of forgiveness, some based in religious belief, others for more pragmatic reasons. It is important to understand some of the more popular definitions of forgiveness. One common definition:  The handling of another person’s real or believed inappropriate and harmful deeds in such a way that it helps the forgiver (the person who forgives, the injured party)  find healing and wellness, peace and tranquility. Another definition: Forgiveness is the refusal to hurt, strike back at, get even with, to prove another is wrong with arguments or protests, violence or to harm the one who hurt you.  Another definition as simple as: “I forgive you.” It is important to distinguish differences in definition as this pertains to individual victims. Robert Enright in his book “Forgiveness Is a Choice” (2011) discusses these and other definitions of forgiveness. Enright states, however, that forgiveness is a process, and if you are willing to use the forgiveness process, you may be able to find freedom from the anger, resentment and bitterness of the past.

Forgiveness researchers have identified that simply saying, “I forgive you,” is not enough. Saying the words does not prevent the anger and resentment and bitter feelings from returning (Enright, 2011; Ferrini, 1991; Luskin, 2002). Individuals must go through the process in order to forgive and move on. I have discovered over several decades of doing hypnotherapeutic work with patients exhibiting many differing problems and diagnoses, especially pain, that one commonality exists in order for them to move forward. The common ground for all these patients is forgiveness.

Therapeutic work can be done in identifying causation for problems both physical and psychological. For instance, it is common practice for many practitioners in hypnosis to use age regression techniques to identify an Initial Sensitizing Event (ISE) (Mackey 2009, 2010). Age regression is one of the phenomena identified in the hypnotic trance (Crasilneck& Hall, 1985: Watts, 2005). Techniques of age regression usually guide a patient back in memory to re-experience an event either vividly, called hypermnesia, or as if they are reliving the event itself, called revivification (Yapko, 2003). Age regression is perhaps one of the most widely utilized techniques in hypnotic work. At the same time, it is suspect for confabulation and thus remains

a controversial technique (Kroger, 1977; Rossi & Cheek, 1988; Yapko, 2003). The use of proper age regression techniques limits confabulation (Cheek, 1994; Ewin& Eimer, 2006).

Despite the controversy, using age regression and Ego State therapy can identify the ISE and then help to identify Subsequent Sensitizing Events (SSE) that occur at various times later than the ISE that leads to development of symptoms both physical and psychological (Christensen, Barabasz & Barabasz, 2009; Watkins & Watkins, 1997; Watts, 2005).  Once the ISE and subsequent SSEs have been identified, then therapeutic techniques can be used to reframe events that occurred in the patient’s life. This reframing many times leads to a more informed or moderate understanding of a particular occurrence. With new understanding the individual begins the process of recovery. This recovery process often progresses to resolution of a particular problem, but at the same time many clients return with familiar symptoms. It has been noted over hundreds of client records that forgiveness work is the key to lasting resolution, that utilizing some form of forgiveness process is crucial to lasting resolution. (Mackey 2009, 2010).

Many patients suffer from grievances for years. These sufferings many times lead to long lasting physical and/or psychological problems. Anger and depressions create harmful effects if not relinquished quickly. Aside from the effects of anger, depression, resentment and other negative feelings, the loss of joy, peace and tranquility as well as love and intimacy are lost during these times. The loss of these emotions and feelings is often as devastating as the trauma itself (Luskin, 2002: Yapko, 2003). Working with these clients has shown how the power of forgiveness helps the individual toward lasting healing. Those patients that did forgiveness work had successful resolution. Those that did not have sustained resolution were those who still need to work through the forgiveness process (Enright, 2001; Luskin, 2002). It is interesting to note that there are a number of individuals that despite all the therapeutic intervention will relentlessly hold on to anger, hatred and resentment. These individuals are seemingly driven by those forces, and it has been my experience that some will hold on to those feelings until death.

When working therapeutically with clients that hold on to resentment and not let go, using “Death Bed Therapy” has been beneficial for some (not all) to be able to forgive and let go (Banyan & Kein, 2001). Death bed therapy involves using the hypnotic phenomenon of Age Progression. Age progression involves suggesting to the subject they are progressing forward in time (similar to age regression only now moving forward). The subject is progressed to a point in the future where they realize death is imminent. When this point is reached, the individual is again suggested to let go of the negative feelings and emotions and be free of those bonds. Unfortunately, some patients still refuse to let go.

It is also important to note that when working through past events, both ISE and SSEs, that an individual may find it is not only necessary to forgive others (the perpetrator) but it is also necessary to forgive themselves. The client/patient finds that they have feelings of guilt or anger with themselves for “letting themselves get into that situation” or to feel that “I must have done something to bring this upon myself” or perhaps even “I caused this to occur”. This self-forgiveness is many times overlooked by practitioners. If not resolved those feelings of self-guilt will fester and boil over sometime in the future (Mackey 2010, 2011).

One method of doing self-forgiveness work is to use ego state therapy (Federn, 1952; Watkins & Watkins, 1997). This involves utilizing the ego psychology as described by Paul Federn and further developed by John and Helen Watkins. The hypnotized patient is deepened using a fractionation technique (Barabasz & Watkins 2005; Watkins & Watkins, 1997; Yapko 2003). The subject is then asked while in hypnosis about the part of him/her that may feel some conflict with themselves. The “part” or ego state is then asked to simply announce its presence with verbalization of “I am here.” This may at first seem unnerving to both therapist and client, and perhaps a better method to use at first (to avoid crating artifact) is to simply have the individual imagine going down a safe stairway, with sturdy handrails and anti-slip treads. Suggest to the client that at the bottom they will enter a room through a doorway. In the room they see a plush comfortable chair in front of them. The subject is then suggested to imagine anyone involved with their feelings of guilt. At this point it is not unusual to have the individual age regress to a childlike ego state and describe themselves at a certain age, wearing certain clothing etc. When this occurs, that particular ego state has a need and wants to be heard by the therapist (Watkins & Watkins, 1997). Some individuals may prefer a “safe room” or “safety cocoon” if they have some trepidation or fear about this. In any case, it is important to assist the client to a point where they realize self-forgiveness is needed. They will come to a realization that they have blamed themselves for whatever role they may have played in the particular troubling event. That role may be real or imagined to them, in either case it is the same (Watkins & Watkins, 1997; Mackey 2009). Helping the client/patient with forgiveness of self begins with the individual knowing they need to forgive themselves.

Strategies for feelings of Hurt

Several positive methods for self-management of hurt feelings are available for individuals doing forgiveness work. Management of these feelings is a positive step. Luskin in his text Forgive for Good (2002) talks about not losing sight of the good things in your life. He discusses that all of us do have positive things in each of our lives and we need to refocus on those items. He calls this second step Positive Emotion Refocusing Technique or PERT. It is relatively simple to do and leads to a quick change when one notices negative feelings encroaching.

Practicing PERT is done when one is feeling the effects of an unresolved grievance. There are four steps to this practice as Luskin points out (Luskin, 2002). First: Focus on the stomach as you take in two deep breaths, pushing your belly out as you breathe in. Then as you breathe out, simply relax your belly completely making it soft. Second: Take in a third breath, think about and visualize an image of someone you love or a beautiful scene. This should be one that fills you with awe and as you do this focus on the area of your heart. Thirdly: Continue with the belly breathing as above. Fourth: Ask the relaxed part of you what can be done to resolve the difficulty.  It is a most important to persevere with this practice. Forgiveness is a process and not something that is done in an instant. Through perseverance positive feelings will begin to come through.

Taking responsibility for our feelings is a most important facet in the forgiveness process. We all have choice. We may not have the ability to decide what happens to us, but we do have the choice of how we react to it. If something bad occurs, we always have a choice, we can choose to become angry, enraged, strike back, or we can simply remain still for a while and then make an informed decision on how we will react. In my practice, many patients have had traumatic events occur in their lives in the past. Many of these patients remain angry and resentful that these things occurred to them! I reiterate to them that “yes” a terrible thing occurred on some date in the past (usually long ago, but not necessarily so), but that is no reason to feel angry or resentful today!

An effective method for a patient to manage hurt feelings is simply to focus on positive elements in your life. To stop your focus on the negative items or individuals that have been instrumental in causing these hurt feelings and move beyond to new happy, good, comfortable feelings is something we all can do. This requires us to “let go” of the hurt we seemingly want to hold on to and reach out for the good. In my office, I demonstrate this by holding out my left arm representing holding onto the negative hurt feelings, anger, etc. Then I reach out with my right arm representing reaching for new, better, happy, positive things.  I sit there with both arms outstretched and it becomes evident to the patient that in order to move to where you want to be, you must let go of the other or no movement takes place. Luskin (2002) speaks to “changing the channel” (p.111) in an effort to move away from the stagnant pose. Unfortunately this “stagnation” is what most patients come into the office with.

Effects of Negative Affect

It has been demonstrated that negative affect states lead to physical calamity (Barabasz & Watkins 2005; Enright, 2001; Luskin, 2002). If this negative affect is not remediated, negative effect is sure to occur. Hurt feelings, anger, hatred, resentment become fuel for a powerful engine idling beneath the surface. This powerful engine goes unnoticed many times, yet is causative in so many “psychosomatic disorders”. Using an affect bridge technique, as described in Watkins & Watkins text (1997), a practitioner can follow the negative affect back into the patient’s memory and discover the root cause behind many physical ailments. It is important indeed to have a patient referred to the office for some unresolved neck pain that is not responding well to other treatment, and when using hypnotic ideomotor techniques for questioning, we find it is related to negative self-talk. This negative self-talk is frequently heard in these patients using phrases such as: “This is such a pain in the neck” or other body part. This is then reflected into physical sensation plaguing that individual (Ewin, 2002; Ewin & Eimer, 2006).

Practicing Positive Self Talk

It is important for all of us, not just patients and clients with problems, to use positive self-talk daily. Psychologists have long understood that giving ourselves positive, self-referenced, present tense suggestions continuously through the day is not only invigorating but over time leads to positive outcomes. This is no surprise when one understands that what we expect, we tend to get. This being so, we should desire to always expect the best! Unfortunately, we mostly do the opposite. Why? First: The sympathetic nervous system, which is our fight, flight or freeze system, has a protective function that has served us for thousands of years and has protected us from harm. Secondly, we are being bombarded through our lives with negative suggestion from all sides. Well-meaning parents, significant others, friends, family, etc., all seemingly wanting to help but delivering negative suggestion disguised as sage advice. How many times have you heard: “Expect nothing and when you get something it is a plus?” “If you don’t have any expectations then you will not be disappointed.” These are two of the most common bromides that we have heard one time or another.

It is important to begin changing the prevailing suggestion flow for ourselves and others. Positive self-suggestion is important for our wellbeing both physically and mentally. This leads (Ferrini, 1991; Turk & Gatchel, 2002, Mackey 2009). The authors tell their students and clients to “focus on what you want in your lives” rather than focusing on what you do not want. Patients are in my office constantly telling me what they do not want to happen, what they do not want in their lives, and I tell them bluntly to stop!  “Tell me what it is that you do want,” I ask. Many times, this makes them pause and think. For most clients and patients, they must admit they have not given thought to what they want.  It takes a few minutes, but I get a response sooner than later. It is refreshing for most individuals to begin changing their thoughts to positive outcomes to a new feeling for most. Sometimes the most positive feeling they have had for some time.

Forgiveness work goes hand in hand with positive thought. There can be no negative feelings, no wishing for revenge, no focusing on the past hurts, feelings. There can only be a new focus on a comfortable future free from past negativity, a more comfortable feeling inside oneself without the fear and frustration of wondering if it is going to happen again? (Enright, 2011; Luskin, 2002). Positive self-suggestions such as, “I forgive all others, I forgive myself, I am forgiven,” repeated to oneself frequently every day go a long way to solidifying forgiveness of others and forgiveness of self. This work is a process, and this process takes time and perseverance. Only with perseverance and a positive goal for the future will one be successful in letting go of the chains of the past.


Forgiveness work is an essential part of therapeutic intervention for those suffering from past transgressions. Emotional as well as physical baggage from the past can haunt individuals causing present day physical and emotional problems. Identifying the need for forgiveness work is an essential tool in the armamentarium of the practitioner. Successful resolution of these troublesome past events consists of a process of forgiving the perpetrators (real or imagined) and then the process of forgiving oneself (Enright, 2011; Luskin, 2002; Mackey 20012; Turk and Gatchel 2002).


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Barabasz, A.(1977). New techniques in behavior therapy and hypnosis. South Orange, New  Jersey: Power Publishers.

Cheek, D. (1994). Hypnosis: The application of ideomotor techniques. Needham Massachusetts: Allyn and Bacon.

Christensen, C., Barabasz, A., & Barabasz, M. (2009). The effects of an affect bridge for age regression. International Journal of Clinical and Experimental Hypnosis, 57, (4).

Craslineck. H.B., & Hall, J. M., (1985). Clinical hypnosis: Principles and applications. (3rd ed.). Boston: Allyn & Bacon.

Enright, R. D. (2001). Forgiveness is a choice: A step by step process for resolving anger and restoring hope. Washington, D.C. APA Press.

Ewin, D. (2002). Ideomotor signals: Their value in hypnotherapy. American Society of Clinical Hypnosis Newsletter, 43, 6-7.

Ewin, D. M., Eimer, B. N. (2006). Ideomotor signals for rapid hypnoanalysis. Springfield Illinois: Charles C. Thomas Publisher.

Ferrini, Paul (1991). The twelve steps of forgiveness. Brattleboro Vermont: Heartways Press.

Luskin, F. (2002). Forgive for good: A proven prescription for health and happiness. New York; New York, Harper Collins Publishers.

Mackey, E. F. (2010). Effects of hypnosis as an adjunct to intravenous sedation for third molar extraction: A randomized, blind, controlled study. The International Journal of Clinical and Experimental Hypnosis 58(1): 21-38.

Mackey, E. F. (2009). Age regression: A case study. Annals of the American Psychotherapy Association 12(4) 46-49.

Mackey, E. F. (2012). Forgiveness Therapy. Workshop Given at West Chester University of Pennsylvania.

Turk, D., C. & Gatchel, R., J.(2005). Psychological approaches to pain management: A practitioner’s handbook 2cnd ed. New York: The Guilford Press.

Watkins, J.G. & Watkins, H.H. (1997). Ego states: Theory and therapy. New York: W.W. Norton and Company

Watts, T. (2005). Hypnosis: Advanced techniques of hypnotherapy and hypnoanalysis. Eagan, MN: Network 3000 Publishing.

Yapko, M. (2003). Trancework: An introduction to the practice of clinical hypnosis 3rd ed. New York: Brunner-Routledge.

About The Author

dr0edward0f0mackeyDR. EDWARD F. MACKEY, CRNA, MSN, Ph.D.

Dr. Mackey is an Approved Consultant in Clinical Hypnosis for the American Society of Clinical Hypnosis (ASCH), is a Fellow in the American Psychotherapy Association® (FAPA), and maintains a long standing private practice in hypnosis/hypnotherapy/psychotherapy in Kennett Square, Pennsylvania. Dr. Mackey is an Associate Professor in the Department of Nursing at West Chester University of Pennsylvania.

Dr. Mackey is a member of the American Psychotherapy Association® (APA), The Association of Applied Psychophysiology and Biofeedback (AAPB), The American Association of Nurse Anesthetists (AANA), The American Society of Clinical Hypnosis (ASCH) and The Greater Philadelphia Society of Clinical Hypnosis (GPSCH). Doctor Mackey is a Diplomate in the American Board of Hypnosis in Dentistry (ABHD) and the American Board of Hypnosis in Nursing (ABHN).

Salt Vindicated-a personal case study

Salt Vindicated-a personal case study

Published February 27th, 2012 in Hormones for His & Her Health, Minerals & Vitamins, Eat for Health, Heart Health, Alternative Therapies

by Tammera J. Karr, PhD, BCHN, BCIH

In 2005, I thought I was developing hypothyroidism; I was tired, overweight, with high triglycerides, and muscle pain, all symptoms. I was eating real food, but I was under a lot of stress. Remember I have said several times over the last three years that stress is the number one cause of illnesses, and can kill you.

I saw a doctor I had confidence in, had her run a battery of tests and found out – nothing. So I cut back on salt, red meat, grains, and cut all sugar out of my diet. By 2006, I was running very high heart rates, triglycerides as well as my LDL’s were still elevated, I felt like crap, and my stress had doubled. Now my thyroid test began showing elevations in my TSH (thyroid stimulating hormone), my free T4 and free T3 numbers changed also.

This scenario would have continued to escalate and in fact did – my TSH levels reached 8, my doctor told me I was too difficult of a patient and I needed a specialist, I couldn’t tolerate thyroid medication due to my elevated heart rate, and refused to take medications to slow my heart rate for the rest of my life.

I kept looking till I found the answers that made sense to me, and am very pleased to say today my thyroid numbers are all perfect without medication. My current nurse practitioner, when reviewing my labs from the last 7 years, admitted she had never seen anyone turn their thyroid around. Oh and my heart rate is normal again!

Dr. James Wilson told me in 2006, “If you don’t treat the Adrenal Glands before the thyroid, the client will never get better.” I went back to eating Celtic sea salt, lean red meat, and took supplements for thyroid support and stress. The hardest part was acknowledging what the major stress triggers were, and over time cleaning house so to speak.


In 2011, the medical communities called on food manufactures to cut sodium in commercial foods. GOOD, why, because the forms of salt used in commercial foods are nitrates and nitrites, not natural salt with all the trace minerals for health.

A study released October 2011, in the American Journal of Hypertension, brought into question the time honored belief salt is bad for you. When I first viewed this article on Medscape the opening sentence was, “critics don’t believe study findings”, and of course after reading the conclusion of the study I can see why – it is throwing salt in their eyes. The study titled – Effects of Low-Sodium Diet vs. High-Sodium Diet on Blood Pressure, Renin, Aldosterone, Catecholamine, Cholesterol, and Triglycerides.

At this point I need to tell you several of the aforementioned named in the study title are either manufactured in the adrenal glands or in the liver –salt, is a detoxification agent for several glands and organs. Cholesterol and triglycerides are also elevated by poor thyroid function. Beginning to see the connection here? This is what the study found to my hearts delight.

“sodium reduction resulted in a significant increase in plasma cholesterol (2.5%) and plasma triglyceride (7%), which expressed in percentage, was numerically larger than the decrease in blood pressure of 1%. These results do not support that sodium reduction may have net beneficial effects in a population of Caucasians.”

Aldosterone is a steroid hormone produced by the outer-section of the adrenal gland, and acts on the functioning unit of the kidney, to cause the conservation of sodium, secretion of potassium, increased water retention, and increased blood pressure. The overall effect of Aldosterone is to increase reabsorption of ions and water in the kidney — increasing blood volume and, therefore, increasing blood pressure. So if this hormone goes up, so does your water retention and BP, salt prevents this from happening according to the study.

Renin is an enzyme released by the kidneys that breaks down proteins and helps regulate blood pressure. This enzyme is the key to activating a complex process in which it increases the secretion of Aldosterone, and stimulates the hypothalamus to activate the thirst reflex, each leading to an increase in blood pressure.

Catecholamine is a compound that acts as a neurotransmitter or hormone; neurotransmitters are used in the brain. They include dopamine, as well as the “fight-or-flight” hormones adrenaline. Dopamine is the neurotransmitter lacking in Parkinson’s patients, and when under stress our fight or flight hormones increase. That’s why Dr. Wilson and Dr. Brownstein believe salt to be critical for adrenal health, when under constant stress the adrenal glands dump salt through the kidneys, creating an imbalance in electrolytes. When potassium levels elevate, tachycardia can result. (An excessively rapid heartbeat, typically regarded as a heart rate exceeding 100 beats per minute in a resting adult)

Cholesterol, is painted as the evil one, in fact it is far from it. Without cholesterol we would not be able to think or make hormones. All forms of cholesterol are important to the body as a constituent of cell membranes, and involved in the formation of bile acid. Cholesterol is necessary for the synthesis of vitamin D and the steroid hormones, including the adrenal gland hormones cortisol and aldosterone.

Now this doesn’t mean you can eat all the salt you can stuff in, but the reasonable use of high quality salts from Selina Naturally and Redmond, are indeed a recommendation for everyone living with stress. It won’t fix all of your health challenges; you will have to take back control of your health just as I did with the right supplements and dietary changes.

There is more to good health than the Status Quo.

Tammera J. Karr, PhD, DAAIM, BCIH, BCHN, CGP, CNC, CNW, CNH, is an author, public speaker, educator, and clinician. Tammera has served as a nutrition advisor for several wellness programs and groups. Additionally she writes a weekly health column, reviews and contributes to national board exams, and is a contributor to online newsletters.

A Native Oregonian, Tammera established an Integrative Medicine Partnership in 2006 and currently works in a clinical setting with DO’s, FNP-C, Bio-Feedback Specialists, and others to provide clients with tools to take control of their health. Tammera provides personalized nutrition consultations, in states not restricted. Her clinical and education practice is ever-evolving to meet the needs of clients, the public and fellow practitioners striving to empower those they meet.

She received her PhD with Honors in Holistic Nutrition from Clayton College of Natural Health and holds national board certifications through the National Association of Nutritional Professionals (BCHN), the American Association of Integrative Medicine (BCIH), American Naturopathic Certification Board (CNW), and the American Association of Drugless Practitioners (CNH). Tammera has served as Committee Chair for the Wellspring School of Natural Health, Holistic Nutrition Education Review Board, 2012-2014.

Tammera became a Certified Gluten Practitioner (CGP) in 2013 through Thomas O’Bryan, DC and theDr.com gluten awareness/education program. In 2012, she became a Diplomate of the College of Biologically Based Practices in the American Association of Integrative Medicine.

Additionally, she serves on the Board of Directors for the National Association of Nutritional Professionals, the Accreditation Commission for the American Association of Integrative Medicine (AAIM) and works as one of many in Oregon promoting National Food Day to communities. Tammera has actively promoted local food awareness and sustainability through her service on the Think Local Umpqua Executive Board, 2010-13.

tammera-karrTammera J. Karr, PhD, BCHN, BCIH
Certified Gluten Practitioner

Author of “Our Journey with Food”

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“Patients with autoimmune diseases should avoid health care professions who make them feel pessimistic about their condition.” Dr. Andrew Weil

“Every patient carries her or his own doctor inside.”
– Albert Schweitzer (1875 – 1965)

Please Note:

The information provided in this communication is for informational purposes only and is not intended as a substitute for advice from your physician or other healthcare professional or any information contained on or in any product label or packaging. You should not use the information in this communication for diagnosis or treatment of any health problem or for prescription of any medication or other treatment.

Consult with your healthcare professional before starting any diet, exercise or supplementation program, before taking any medication, or if you have or suspect you might have a health problem.

You should not stop taking any medication without first consulting your physician.

“A Different Kind of Pregnant”

“A Different Kind of Pregnant”

Wendy Iglehart, MA, LCPC, LLC
Cockeysville, Maryland


One out of 15 couples experience infertility (National Institute of Child Health and Human Development, 2013). According to the medical model, infertility is diagnosed when a couple has struggled to conceive and carry full term after one year of unprotected sex. Treatments for infertility focus solely on the deficiency of the body. When a psychotherapeutic approach is implemented, the patient or couple explores the meaning and experience of infertility, gains insight and becomes empowered to understand his or her thoughts, feelings and behaviors. The research presented demonstrates how the psychotherapeutic alliance and the treatment process increase rates of pregnancy and overall well being. In addition, as therapists, we need to understand personal and ethical considerations while working with the specific issue of infertility.

Key Words: Infertility, Couple Counseling, Grief, Stress, Psychotherapy

Learning Objectives:

1. Explore significance of fertility and recognize taboo of disclosing about infertility.
2. Understand the science of conception.
3. Define infertility and treatment according to the medical model.
4. Access psychological grief and loss of infertility.
5. Examine ethical considerations in working with patients or couples who struggle with infertility.
6. Describe the use of counter transference as a way to deepen the therapeutic relationship.

Conception and Pregnancy

Conception happens when the man maintains an erection and releases semen carrying sperm to unite with an egg. The embryo is carried to a 40-week full term. In healthy couples under the age of 30, who have intercourse at least twice a week, the chance of getting pregnant is about 25% to 30% per month (Medline Plus, Feb 2014). A woman’s fertility peaks in her early 20s and after the age of 35, especially she turns 40, the chance of pregnancy begins to decrease. A man, however, continues to produce sperm from puberty at around age 15 and continues to do so well into his eighties.

Infertility Medical Model

One out of 15 couples experience infertility, which is diagnosed when a couple has struggled to conceive and carry full term after one year of unprotected sex. For women who are over the age 35, it’s diagnosed after six months. Within this ratio, chances are related to a third of either the woman, the man, or unknown causes. (American Pregnancy Association, 2014)

Causes and Medical Treatments for Infertility

The science of pregnancy entails hormones, healthy organs, healthy lifestyles and age. Furthermore environmental factors such as, pollution, cancer, or toxins consumed like smoking or alcohol, could impact the ability to conceive and carry a full-term pregnancy. (Medline Plus, Feb 2013) For women, common causes for infertility are related to the inability of the ovaries to produce healthy eggs or the eggs to move from the ovaries to the womb. Another cause could be the fertilized egg does not attach or the embryo does not survive once stuck to the lining of the uterus.

Usually the first option in treatment is a daily injection of medication stimulating the ovaries to develop eggs and the follicles, which is the structure in the ovaries that contain developing eggs. The side effects of such treatment can include bloating, weight gain, headaches, and nausea. If unsuccessful, In Vitro Fertilization (IVF) might be the next step. This entails having eggs surgically removed from the ovaries and combined with sperm. Weekly ultrasounds and estrogen blood levels drawn twice a week to assist the doctors in determining the best time to retrieve the eggs. The last resort for infertility treatment is the egg donor cycle, where an embryo formed from another woman’s egg is transferred to the uterus of the woman trying to conceive. More coordination and time is involved since two women are being monitored for a transfer.

Male infertility may be due to an inability to have and sustain an erection. The testes might not be maintaining the right temperature. Sperm could be low in volume, blocked from the testicles, limited in mobility, or even deformed. There also might not be enough semen to carry the sperm to fertilize the egg.

Medications are available to help sustain an erection or help with hormonal levels. Types of treatment for sperm analysis include retrieving the most mobile and best shape sperm from the testicles. Surgery sometimes is an option. For example, if a tube is allowing blood to flow into the testicle, which increases the body temperature, surgery could be a viable option (Hambleton, Aug 26 2013).

Cost for Infertility Treatments

Based on the Shady Grove Fertility website the average cost for one cycle of IVF is $9,500. For six completed IVF cycles, which includes the cryopreservation, thawing and transfers, the cost ranges between $20, 000 to $26,000. For six completed donor egg cycles, the cost is from $18,600 to $52,000. For the Intra-Cytoplasmic Sperm Injection (ICSI) the average cost is $11, 000 per cycle.

Couples may utilize several options to pay for treatment. Depending on which state they live in and what type of insurance they have, a maximum of IVF or egg donor cycles could be covered. Clinics sometimes offer a share-risk-refund, which is an option for reimbursing for cost if treatment is unsuccessful. This is a limited option that some clinics offer and it usually has various requirements for use, such as the age of the patient. Some couples take out loans such as a second mortgage, home equity line or dip into their 401k. There could be a tax benefit to buffer the medical cost, depending up the state.

Demystifying Impact of Stress

Schenker explored if stress is the cause of the inability to become pregnant via IVF (Schenker, Jun 1992). The biological interaction of stress was measured by the stress hormone at the brain level. Infertility causes stress as times passes. Usually by the time the couple comes in for treatment, they are already highly stressed, especially if they’ve been trying to conceive for a long time.

Infertile women expressed higher rates of suffering and anxiety than fertile women, which peaked in a 2 to 3 year period (Domar, 2000). Domar and her colleagues gathered 184 women who were trying to conceive for between 1 to 2 years. The women were randomized into a cognitive behavioral (CB) group, support group, or control group. Interestingly, the dropout rate within the control group was significantly higher during the study due to the dissatisfaction of having minimal relief. However, those who participated in the CB and support group reported an increase in overall well-being and had a higher pregnancy rate.

The relationship between mental state and fertility continued to be explored by Clay (Sept 2006). Researchers believed biological factors are the primary source of infertility. So what is the impact of stress? In 1993, Domar affirmed the same levels of distress in infertile women compared to women with conditions such as cancer, HI V or chronic pain. Stress might also trigger negative coping skills such as drinking or smoking, increase marital conflict, reduce libido and social isolation.

Is Psychotherapy a Viable Cure?

Research showed that psychotherapy had a positive impact on pregnancy rate. (www.ncbi.nlm.nih.gov). There is a significant correlation between depressive and anxiety symptoms and the decrease in sperm mobility, lower number of retrieved eggs and lower pregnancy rates (Pearson, 2010). Furthermore, Pearson showed women who coped poorly with stress during the infertility treatment had higher rates of first trimester miscarriages and depressed men had decreased sperm concentration. Chen emphasized the importance for proper assessment, diagnosis and treatment of anxiety and depression since his study showed a higher prevalence of the disorders in the infertility treatment clinics. (2004)

Ramezanzadeh evaluated the effect of psychotherapy and pharmacology intervention on the pregnancy rate of infertile couples (Jan – Mar 2011). One hundred and forty couples with at least one spouse who was diagnosed with depression were assigned into either the treatment or control group. Pregnancy occurred in 47% of the couples in the treatment group with 5% success in the control group. Faramarzi determined both psychological and pharmacotherapy is effective treatments in reducing the stress created by infertility (2013). Eighty-nine infertile women with depression were separated into 3 groups: CBT, antidepressant treatment and the control group. Based upon the completed study, the CBT group reported a significantly higher rate of quality of life and reduction of stress than the antidepressant group. The antidepressant group reported a lower level of depressive symptoms, yet concerns such as marital or financial strains were still significant problems.

Boivin (1999) examined the sources of support patients utilized while experiencing infertility or the treatments. Majority of the patients relied on their spouse or family when distressed. The function of distress determined the quality of coping. Less distressed patients found the support system of the spouse, friends and family sufficient while more distressed patients did not engage in formal counseling due to cost and uncertainty of how to initiate such treatment.

The Value of Fertility

The value of pregnancy, procreation and fertility expands across religious and cultural arenas. Some religious faiths hold the theological belief that producing a linage of children is evidence of divine approval. Biblical stories tell of women in agony and envy of the other women who have their husband’s children. The barren women are ostracized and humiliated by the community.
In various cultures such as Latin American or African American, being fertile is a reflection of the obligation a woman has to produce children especially a son. Having a son was a reflection of the husband’s manhood and their authority or right. For some couples, a child reflects a shared experience or produces a lineage of family to care for the aging parents or family members. (Jennings, Jun 1970)

In some countries fertility compensates for losing children in high-risk military activity. Having a family is typically valued as an important social institution. In an example of this, in Tel Aviv, Israel, infertility treatment is free and unlimited for up to two babies until a woman is 45. (Kraft, 2011)

The Health of Collaboration and Good Grief

Research demonstrated talking improved overall well being and increased pregnancy rates. Effective therapeutic treatment facilitates healing and strengthening the connection between the couple. Our role as care providers is to help educate patients about the myths of stress, empowering them to cope with a challenging journey, facilitate good choices and enhancing their coping skills, all within a safe environment.

The emotional complexity of infertility begins before the formal medical diagnosis. The dream of starting a family or the maternal desire to be pregnant is the vision that keeps the couple and a woman excited about the future. After a year of possible miscarriages or unsuccessful conception, grief and loss could create a sense of distraught, anger and helplessness.

When a person’s vision of an ideal world is shattered, emotions like guilt and blame can arise. These feelings can interfere with the couple’s connection creating isolation and withdrawal from each other. For example, the husband might withdraw from his wife because he is ashamed he cannot impregnate her. In turn, the wife starts to feel alone and vulnerable while coping with the situation.

Emotions can appear erratic between the intervals of medical treatment. Numbness represses the desire or hope to conceive or become a parent. In other words, the lack of feeling overpowers the rage of the unfulfilled desire to be a parent. For example, after an unsuccessful IVF a woman doesn’t want to attend her sister’s baby shower because she is envious and distressed.

Understanding the conflict of family obligations and the suffering from infertility, the woman could explore options which empower her to utilize internal and external strengths. Also, it could be helpful to explore how detachment is or is not useful. For instance, lack of anxiety facilitates endurance for another round of hormones, which have unpleasant side effects. The therapeutic work would be to discuss how to plan for the anticipated migraine or various other effects she might feel. Ideally have the couple share this experience together.

Edginess and negative thoughts like “I won’t survive another treatment cycle,” initiates an important discussion about feelings. For example, the husband has anxiety about dipping into the retirement fund to pay for treatment while his wife believes using the 401K is a viable option.

Creating a plan to bear the grief and/or anxiety associated between treatment cycles or previous miscarriages empowers the couple to cope with the anticipated stressed and possible loss. For instance, if the couple is spiritual, they could write a prayer for the endurance, guidance and healing.


For an authentic alliance with our patients, as therapists we need to understand our counter transference and its impact on the treatment. Should we lose sight of ourselves, the treatment and the alliance fail. Thus, it behooves us to understand our patient’s value in pregnancy and having children and to also understand our own beliefs and values about fertility and infertility.

Infertility converges on multifaceted political, personal and medical beliefs and values. Politically, infertility falls under the category of disability, touching on the categories of physical causes with medical interventions, psychological aspects and social implications (Khetapal, Jun 2012). The case of a California woman, who had octuplets after using IVF, motivated doctors and couples to attempt to lower the rate of multiple births. According the Centers for Disease Control and Preventions, forty-six percent of IVF babies are multiples with majority twins and 37% are born premature. (Marchion, 2013) Therapy sessions would be one forum to discuss the desire for single or multiple births, the risks and preferred quality of life.

What is the best way to handle the disruption of treatment? For example, phone sessions or Skype are not billable for insurance and not ethically or legally defined within parameters in certain states. Furthermore, payments for missed sessions or cancellations should be discussed in sessions. A well-meaning therapist might believe it would be compassionate to not charge for a missed session. But therapeutically, the unilateral decision may not be in the best interest of the couple. A conversation about what policy should be is powerful and insightful in understanding the couple. It also allows them the opportunity to be involved in decisions and expressing feelings during a difficult and sometimes helpless journey.

If you are inclined to provide referrals, such as to an acupuncturist, it is imperative in your consent and contract to state you are not accountable for how treatment progresses with another provider and you are not receiving any payment for the referral. The couple shares a story about their friend who used massage therapy to assist in becoming pregnant and they ask you if you are familiar with the positive results of massage. Before giving the information, ask the couple if they are looking for support or information.

When the therapist is pregnant during the treatment, it could be painful for the patient. Do not assume it would be in the best interest to transfer or terminate working with the patient. If the patient is open to explore, you could provide the forum to continue a safe and insightful exploration.

Self-disclosing one’s own struggle with infertility is a blurry line. The APA guidelines emphasize not interfering with one’s autonomy and life direction (2014). Before any self-disclosure, it would be useful to do an inventory of transference and counter transference.

There is a lack of research regarding the LGBT community who desire to have a family and the accessibility to treatment. The therapist could support the couple in deciding who donates the sperm if the gay couple decides to use a surrogate. For lesbian couples who want to be involved in the conception of the child, through IVF one could donate the egg and have the embryo implanted into the social mother, who would be the carrier.

Case Study

For several years I had been seeing Claire for psychotherapy. She was married and a successful professional in her mid-thirties with a significant history depression and anxiety. She had a warm sense of humor and loved to learn about herself. During the first couple of years working together, she feared her future children would be genetically predisposed to suffer from similar aliments and struggled between the desire to feel a child growing inside of her and her desire to adopt.

During the course of our therapy, Claire forgave herself for having a diagnosable mental illness and she realized the illness did not define who she was or her ability to love and care for a child. She and her husband decided to conceive naturally. After one year of not getting pregnant, Claire was diagnosed with infertility. The medical doctors had no clear diagnosis about why she didn’t get pregnant and she suffered throughout that time from a continual sense of loss. She had always dreamed of being a mom and having a family and now she had to face the fact that it might not happen.

With the bond of pregnancy most valued, Claire and her husband pursued infertility treatment. Claire got her period for several continuous months during the course of IVF, which launched her into an instinctive survival mode of emotional detachment to endure the treatment. This came at a cost which lead to her becoming isolated, emotionally and sexually detached from her husband.

She did her best to function at work, but the clock ruled over her as she anticipated lab results. Her job performance began to suffer and the cost was guilt, shame and embarrassment. Work started to feel heavy and dreadful. Her depression ignited, leaving her brooding in isolation and sleeping for 17 hours or more every day. Her “should” cognitions were in overdrive and they kept her paralyzed.

As I witnessed Claire’s physical and emotional agony and the suffering in her marriage it caused, I began to judge her harshly. How could she brutalize her body from treatments and spend so much money just to conceive and carry a child. I hated her for choosing to participate in the infertility treatment process and for holding faith in the medical model. I felt lonely and betrayed that she conformed to society’s pressure to attempt pregnancy, no matter the costs. I wanted her to join me in rejecting this awful and debilitating process and to redirect her energies toward adopting a child and connecting with her husband.

It was disturbing to have such an intensely negative reaction to a patient, so I began to repress these feelings and thoughts in an attempt to protect both of us. In the process, however, I became increasingly disconnected from Claire.

What was happening between us strained my belief in the Humanistic approach, which emphasizes that we are in control of our destiny, our choices and the discovery of meaning for our life’s narrative. This approach makes use of the relationship created between the therapist and patient as a catalyst for exploration and change. A safe arena was vital for Claire to share her narrative and to discover the meaning of her experiences, the energy in the room could then provide an atmosphere conducive for healing. Regardless of my opinions and beliefs, I wanted to support her destiny and choices.

In order for me to have the freedom to accomplish this, I disclosed the pain of my challenges with my weekly peer supervision group. My peers validated me and understood why I felt threatened, but also challenged me about my counter transference and helped me to work through it. Other colleagues were offended by the infertility treatment process and called my patient “greedy.” A few of them had been adopted and were exasperated that it wasn’t Claire’s first choice. Others were sympathetic with her plight and could relate to her need to biologically conceive a child. Through the group process, I was able to witness all the different parts of myself being voiced through my peers and I felt safe and free enough to get to some of my own core fears and doubts about infertility. Ultimately this freed me up to be much more present with Claire in the coming months.

During a subsequent session, Claire tearfully shared how painful it was to have no control during the infertility process. My inner voice whispered, “Ask her if she feels she has the ability to choose to stop the infertility process.” Before working through counter transference with my supervision group, I would have suppressed this voice, believing it was my own “stuff” and would not be helpful to Claire. Now my heart pounded and I couldn’t help but speak up, “Who says you need to continue to fail with the pregnancy attempts?” Something in the room shifted. After a pause, Claire affirmed, “I could stop.” I exhaled. We had finally found a moment of empowerment and connection.

Therapy is not immune to the disruption of the infertility treatment process. The scheduling of appointments revolved around Claire’s menstrual cycle and she canceled appointments due to the side effects of medications and clinic appointments. We had lapses between appointments while waiting for the doctors to contact her for the next treatment cycle. All of this meant that I needed to figure out what would take care of me during her infertility series. That involved answering questions such as: How do I cope with my anger? How do I keep from getting stuck in her holding pattern of waiting? Do I charge for missed appointment?

With the ongoing support of my supervision group, I continued to explore my emotional reaction. Claire and I collaborated about payment for missed appointments. She willingly paid and the joint collaboration made her an active participant in an otherwise helpless period.

The Breakthrough

“I’m afraid you’re mad at me for the last minute cancellation last week,” Claire said. “I’m failing at everything.” In fact I was angry about the appointment. Missed appointments touch on my vulnerability around not being recognized as valuable. But our agreement for her to pay for missed sessions, combined with my own awareness of the reasons behind my counter transference, made it possible for me to process my response outside of session. This allowed me to bring my full attention to figuring out what she was enacting and what it meant for her. I responded, “You think you should be able to manage life better. But things are dropping all around you. Your relationship with your husband, your work, your friendships and especially not getting pregnant. You’re feeling so alone.” I watched her reach for a tissue, look down at her lap, and wipe her tears. “What are the tears saying right now?”

In her soft voice, Claire answered, “I’m afraid my husband will be angry at me for not controlling my emotions. My anxiety is through the roof. I want to be in my bedroom with the covers over my head. It’s unfair to expect my colleagues to do my work. I want to be with my friends but it hurts too much because they have babies or are pregnant.” She believed she needed to be perfect and worried about disappointing everyone around her, including me.

But this conversation about failure and disappointment positioned Claire to begin healing her marriage and bring her husband, family, and friends back into her life. Through addressing her loneliness, Claire articulated her envy about her friends being pregnant or having newborns. She felt conflicted about whether to maintain her connections or isolate herself because it was too painful to be subjected to swollen bellies and to the innocent scent of newborns.

She also acknowledged she pushed her husband away because she did not want to be perceived as a “burden.” He had a demanding job that made him unhappy, but it provided them with medical insurance to pay for the infertility treatment. She secretly fantasized about him attending medical appointments with her and being readily available to abruptly leave work to provide comfort when she received bad news. I encouraged her to share her emotional burdens with her husband, to let him feel her burden, as that is part of what it means to be intimate with another person. She began to feel less guilty and apologetic about her struggles and to share the craziness of the process with him. They became closer and her sex life began to thrive again.

Over the two-year period of her IVF treatments, Claire’s visits to the reproductive health center would evoke a sense of helplessness and lack of emotional safety. She often felt rushed because she didn’t get satisfactory information to her questions and the clinic became increasingly more uncomfortable and sterile. As our work progressed, she was more assertive and less apologetic about demanding the attention of the nurses and doctors until she was satisfied with the gathered information. To increase her comfort at appointments, she brought her own pillow and blankets.

Unfortunately, Claire was given a lot of unhelpful advice from her own support system of family, friends and even medical doctors. She was told, for example, to “just relax” because her stress could be interfering with the infertility process. In the therapy sessions, we worked on how to handle unwanted and sometime hurtful advice and not absorb the harmful implications. When she deemed it appropriate, she informed people about what would be helpful or harmful.

Different Kind of Pregnant

When the IVF failed, Claire and her husband opted for the final remaining option, an egg donor. Our sessions were spent with her describing how a donor was selected and the various reasons they donated their eggs. It was a surprisingly fun process for both of us.

After her second cycle with the egg donor, she curled up on the sofa in my office, hugging a pillow with a distant look in her eyes. Her lip trembling, she said, “For four days, I was pregnant. Now I’m pissed off.” Her rage demonstrated no guilt. She did everything right but was unable to carry her first pregnancy.

The following month, her third attempt was successful.

One day, well into her second trimester and beaming with life, Claire elated, “My boobs are huge!” She shared her ultrasound pictures of her healthy son and we talked through her stress about finances with the arrival of her baby. In her desire to save money and prepare for the baby’s arrival, she requested a break from therapy. I encouraged her to go and create a loving home for her son. Tearing up, she said, “I can’t believe I can hear ‘my son’ after all of these years.” Claire would soon be a mom.


Research demonstrated the success rate with quality of life and increased pregnancy rates with psychotherapeutic treatment. However, before the endeavor of medical infertility treatment it is apparent, screening for depression and anxiety need to be mandated. Ideally a couple would be collaborating and working with a therapist during the journey of attempting conception. Lastly, as therapists, we need to understand the personal and ethical considerations while working with the specific issue of infertility, ultimately having the psychotherapeutic work remain fertile.


  • http://americanpregnancy.org/infertility/what-is-infertility/ (Sept 2014)
  • http://www.counseling.org/Resources/aca-code-of-ethics.pdf
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  • Chen T-H, Chang S-P, Tsai C-F, Juang K-D (2004) Prevalance of depressive and anxiety disorders in an assisted reproductive technique clinic. Human Reproduction 19 (10) 2313-2318.
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wendy-iglehartWendy Iglehart, LCPC, is a Licensed Psychotherapist, Clinical Supervisor, and Collaborative Divorce Coach with over 19 years of experience and has her private practice in Cockeysville, Maryland. She has presented for the Licensed Clinical Professional Counselors of Maryland on the topic of infertility. The professional website, Pyschotherapy.com, published her article, “Infertility & Its Discontents: The Struggle & Transcendence from Both Sides of The Couch.” She has contributed various articles to divorce information websites about the Collaborative Divorce process. For her work as a Collaborative Divorce Coach, she has been featured in The Washington Post & Baltimore Child Magazine, as well as, an expert guest on the radio. In her private practice, she counsels adult individuals and couples through difficult transitions.

Build a Thriving Practice in 2016

Build a Thriving Practice in 2016

by Erica Goodstone, PhD, LMHC, LMFT

No matter how successful, or barely surviving, your therapeutic practice was during the past year, that year is now over.  Are you ready to begin anew, or are you carrying unresolved baggage from last year?  As therapists, we know the value of exploring our personal history – the events, actions, emotional responses, and both positive and negative results that have brought us to our current state.  Your practice has a life of its own, with a unique history of events, actions, successes, and disappointments.  You have worked with some loyal clients who have shown great appreciation for your help, some clients with whom you may not have been a good fit, and others who have disappeared without explanation.

At the start of this new year, we all have the opportunity to begin anew.  Now is the best time to assess the current state of your practice, whether or not the actions you have taken and the results you have achieved align with your dreams and goals.  Now is the time to decide what has worked well, what has slowed or blocked your success, and what aspects of your practice-building strategies could use some improvement.

Past and Current State of Your Practice

Be honest with yourself and answer these two questions:

  • Has my practice been thriving or just barely surviving?
  • What practice-building steps do I plan to continue because they have worked well for me, what activities do I plan to discontinue, and what additional strategies would I like to implement?

Putting Your Goals Into Practice

In college and graduate classes, we do not often receive adequate training on how to go about building a successful practice.  If we are lucky or proactive, then we can find a willing mentor to guide us to take positive practice-building steps as part of our daily activities.  Many therapists spend time joining insurance panels, networking, advertising, lecturing, and presenting workshops locally, building local referral sources.  Some therapists speak at national and international conferences, creating a referral source of professional colleagues.  These strategies remain the bedrock of building a strong practice.

However, far too many therapists seem to shy away from what is possibly the most efficient and effective way to establish credibility and authority in the minds of other therapists and potential clients.  The internet is not some passing fancy, some fly-by night scheme for unethical charlatans; it provides the platform to showcase the powerful work that therapists do.  Coaches already understand this, and they are thriving financially, leaving many therapists to wonder why.  Coaches often fearlessly post their simple success formulas, PDFs, videos, podcasts, e books, and digital programs at sometimes hefty fees.  They create webinars and virtual summits to rapidly build their opt-in lists and quickly become seen as experts without anywhere near the amount of training and credentials that most therapists have.

So, here are my questions for you as you begin this new year:

  • Are you ready to embrace the internet and all it has to offer, including creating your website, blog, articles, and videos, as well as promoting your practice on social media?
  • Are you willing to spend the time, and sometimes money, to learn for yourself the type of marketing skills required in this new and exciting virtual world?  Or would you rather pay someone else to do it for you for hefty fees and without guaranteeing the success you desire?

A recent article by Kyra Bobinet, MD, MPH, in Experience Life magazine provides a valuable technique to create desired behavior change.  She tells us to think like a designer because designers “tinker and experiment” to reach a solution.  Designers, according to Dr. Bobinet, focus “on the process of solving a problem and the joy that comes from figuring something out.”  I have adapted her “Putting It Into Practice” technique for you to focus on creating a more powerful internet presence this new year.

Here we go:

  • What is your unique area of expertise that sets you apart from your colleagues and that you would like to showcase online as an authority, expert, and brand?
  • I want to figure out how to ________ {the online image you want to portray}
    by trying _________ (web site, blog, podcast, video, webinar, digital product, etc.).
  • If I get stuck or the process makes me unhappy, I will also try _________ or _________ until I learn what works for me.
  • I will search for a solution and update my thinking whenever I see _________ (a negative emotion, like loss of joy or fear, or a relapse to my old ways).
  • I am the designer of my own practice and the image I present to the world.

Have a healthy, happy, forward-thinking and successful 2016.

Please feel free to send me your questions, comments, subjects you want to see covered, and topics that you, as an expert, would like to share here.  DrErica@DrEricaWellness.com

If you are ready to collaborate and share on social media, join the Marketing Our Practices Facebook group https://Facebook.com/groups/MarketingOurPractices

I look forward to working together with you to strengthen our professions in the coming months.


Erica Goodstone, PhD, LMHC, LMFT, LPC