Thought Roll

Intention and Attention in Psychotherapy and Meditation

January 15th, 2017 by Dr. Nina Asher

I have thought a lot about the concept of intention as it applies to both psychotherapy and meditation. My life’s intention is an ongoing commitment to working on myself. My work as a psychotherapist allows me to help others in their commitment to this journey. My meditation practice creates a space in which I can quietly reflect on my thoughts, and like in contemplative psychotherapy, see what is arising.

Whereas psychotherapy is a relational process that involves a steady attuned connection between two people, meditation is a contemplative process of being in relation to oneself. The two interface in their intention of bringing awareness to that which is waiting to be seen.

I have thought of specific intentions for myself over many years. They often take the form of stating a commitment to a particular area of myself that I feel needs “more work.” For example, “I want to be kinder with myself when I am struggling;” or, “ I need to work on reaching out more quickly when I need or want contact with someone.” At other times, my intentions go to how to “do” more – be more active in things I believe in such as self-expression through writing and social action.

Recently, while meditating, the word attention arose. In the next breath, I saw the word intention. Then I felt my breath contract with urgency. I paid attention to the tightening, noticing that the word attention resurfaced allowing me to relax. I wondered if at times the concept of intention revealed pressured thoughts about things I “should” do. By contrast, attention provided openness of noticing. And both words emerged in a meditative state amid insight.

Maybe the best way to hold to the intention of working on myself was to make a commitment to paying attention to that which calls for it?

Once the words “more,” or “should,” or “trying,” or “doing” came into the picture, I felt pressured and trapped with expectations that might never be met. I have seen myself locked in lofty, albeit good intentions, that do nothing but keep me stuck “trying” to do, losing track of simply being.

I see this in my work with patients who want to, “get better,” as if this is a goal with a direct, perfect route. I focus with them on what I believe helps the most; that is, staying in a process of looking inward within the therapy relationship, and learning from each piece that unfolds. In doing so, I gently set the intention to pay attention.

Intention and Attention

January 3rd, 2017 by Dr. Nina Asher

2017 rolled in and with it the days prior, filled with people speaking about their intentions for the coming year. This tradition of setting resolutions, more recently referred to as intentions, is an old one. Like with anniversaries and birthdays, each new year compels us to take stock, reflect, and anticipate what is coming next, and what we would like to do differently.

We know that the newness of 2017 is really an extension of the dwindling days of 2016; but somehow, we ponder the landscape of the unknown, looking towards it as a kind of beginning. We fear the unknown, and yet, we reach for it, coloring it with hope for improvement.

2016 was not an easy year. But with all its troubles, most of us had moments of peacefulness and gratitude. As far as we know, 2017 will reveal its own distinct challenges; and hopefully we will still experience moments of gratefulness and calm.

When I began to reflect on the coming year, I could not think of a quality or concept that reflected an intention for 2017. Many familiar ideas emerged such as “being kinder with myself when I am struggling” or “reach out more quickly when I need or want contact.” But somehow, none of these took hold as something new for the coming year.

I thought a lot about the world picture that began forming itself many months ago, but is now here, known and not known for what it will bring. Many of us had good intentions, but somehow they got in the way of us paying attention to what was evolving in front of our eyes, and behind closed doors.

A week or so ago, while meditating, the following word arose: ATTENTION. And in the next breath I knew that INTENTION was not the right concept for me this year. Unless, I thought, my intention is to pay more ATTENTION to that which calls for it.

As the days inched towards 12/31/16, I let the word ATTENTION live inside me. When my mind wandered to a particular intention, it quickly drifted away to the words, “rest your attention on what needs it.” And, when my attention felt cluttered with the needs of others, I found myself remembering what is hardest, but most necessary. That is, keeping my attention on my felt experience.

Be it fear or confidence, confusion or clarity, paying attention will guide me to what comes next.

The Day After

November 15th, 2016 by Dr. Nina Asher

I am shell shocked, in a daze. The unthinkable has happened and it screams out ignorance and hatred. My heart is aching; sadness washes over, seeps inside every pore.

This is not a simple loss.
I am grieving for us all.

I feel like I did the day the World Trade Center was attacked.
9/11; today, 11/9
Then, like now, there was no way to make sense of what happened, but I know we are experiencing something that we cannot process, yet.

My father died on 11/11, 17 years ago. He was a leftist, a cynic of “the system,” but he had a kind, loving heart. What would he have made of this atrocity? In times like this, he often said, “It has to get worse before it gets better.” And yet, today, those words hold little comfort.

Does everything that gets worse always get better?
Is that the natural cycle of things?
What is the new normal?

Yesterday the unthinkable happened. It feels like what it must be like to have received a terminal diagnosis.
We all know we will die but somehow we don’t really believe it, even though it happens to everyone, time and after time. We know death spares no one, but we keep it at arm’s length, perhaps as a way to keep living.

Death is a part of life.
But is ignorance? Is hatred?

Yesterday, this country voted for ignorance and hatred.

My daughter, now 30, worked on both of Obama’s campaigns, and Kerry’s before that. That first decade of her adulthood taught her history; it brought out her passion for justice. Her grandfather would have been proud.

She was hopeful yesterday, until she wasn’t.

I see her heart breaking as her world turns upside down, and I can’t reassure her. I have no way to understand this. My head is pounding, my ears ringing. I am terrified. A part of me shuts down, a dull ache in my heart, in the pit of my stomach. A sharp bullet wakes me up.

Today, through tears, my daughter said, “I guess I have taken the bubble I live in for granted. Maybe I need to be more grateful.”
To which I respond, “Bubbles exist to remind us that we are in this together, holding each other. They are protective but we also need to see outside our bubbles because the truth of how things lives in both places.”

I say these words – I want to believe them now, and protect her. So why do I feel so afraid, and alone, vulnerable and fragile? How can something so awful bully itself upon us as if this is the way it was meant to be?

Up is down and down is up.
We do our normal things so as to stay steady, but right now, nothing feels real, except grief.

PROTECTION – WHAT IT IS AND ISN’T

November 10th, 2016 by Dr. Nina Asher

What is it to be protective – to protect in a real way – which is to hold a space for someone to see, speak the truth and be heard? It is not bubble wrapping someone with trigger warnings but rather it is holding someone when they bump up against painful realities – personal or societal. If the words aren’t spoken, a true, deep layer of feelings can’t be experienced. If we spend all our time removing places where safe speech can exist, how will our children grow to know kindness, wise speech, empathy, compassion for their own and others experiences?

So when colleges ban books, words or ideas from the normal dialogue, they are making a serious assumption. That is, they are presuming to know what will offend, disturb a person when what triggers one person might not register to another.

Universities then become more paternalistic – that is, they determine what is damaging instead of letting words, books, speakers exist in a climate of openness where what is triggered can be discussed and understood in the context of the individual or the group.

All of life is about the context and circumstances that exist in a particular time, place, or person. Omissions limit discussion.

Protection is not being over-protected or coddled. Rather, people feel protected when they are held with respect, listened to, heard, and are allowed to experience their truth without judgment.

THOUGHTS ON THE DIGITAL AGE

November 9th, 2016 by Dr. Nina Asher

The digital age continues to be an ongoing topic for parents, schools and children. We hear a lot about what is problematic about “screens,” and we hear a lot about how parents feel they have no control over their children’s screen time.

Screens can be addicting
Screens as transitional objects
Screens as pacifiers
Screens as attachment devices

Screens as a way of bonding with friends in a world separate from adults.
Bring awareness to what is so compelling about screens and some part of it will likely be the longing to connect with someone, or something.

Multi-tasking makes us think we are accomplishing a lot when brain research shows we are accomplishing much less b/c we are so scattered.
What we remember when we write with our hands vs. when we use a computer.

Violent games don’t create violent teenagers but they do stimulate violent parts of ones self.
How does one differentiate between isolation that is a reflection of a disturbance vs. a kid needing privacy, liking alone time etc.

DOUBT

May 3rd, 2016 by Dr. Nina Asher

Doubt is a wonderful thing because it allows for questioning, thoughtfulness, reflection and discernment. However, much of the time when we notice ourselves doubting it takes us to the place of giving up. We don’t simply doubt; instead we believe the self-doubt, which says, “I don’t know why I even thought of that idea; I didn’t want to do it anyway.” This inevitably leads to backing away and trusting the story of “I can’t do this.” From there, we experience a constriction of the self.

I often wonder what would happen if we simply paused for a moment, letting the statement, “just doubting” live expansively within us? Perhaps we could pause long enough to investigate further the experience of doubting, rather than lurching into an action or decision based on a constricted, fear or doubt based story.

People often speak of compassion fatigue as the ongoing depletion that accompanies caring for another person. The more I practice psychotherapy, and the teachings of insight meditation, the more I think what those of us in the caregiving professions, or in caregiving roles feel is not compassion fatigue, but rather empathy fatigue.

Although empathy and compassion are similar, the terms often used interchangeably, these two concepts differ in several ways.

Empathy asks us to put ourselves in someone else’s shoes. We reach out into their pain, as our neural, hard-wired systems work at identifying with whatever is being felt. Empathy asks us to have a vicarious experience of another person’s feelings, thoughts or attitudes. This quality often implies that we, as listeners or responders be in harmony, or agreement with the person in need of our empathy. That is, the condition of one person induces a parallel or reciprocal condition in the other.

Those of us in the helping professions know that we can tune into a client and actually feel for them in whatever they are experiencing. We care about the other person as we reach into their feelings and reflect back our concern. This empathic wiring has served humanity well. Without it, we wouldn’t be able to sense what those in pain might need.

However, empathy calls for a hierarchical relationship between two people in which the empathizer enters into the world of the person in need of understanding. It is through empathic reflection and mirroring from one to the other that allows a person/client to be heard.

In contrast, compassion begins with caring for oneself first, and in that, opening to care for another. Christopher Germer, psychologist and meditation practitioner says “ Self-compassion is taking care of ourselves just as we’d treat someone we love dearly.” When we beat ourselves up for struggling, making mistakes, or simply feeling sad or angry, we stray from compassion for ourselves. Why wouldn’t we allow ourselves the same kind of care and warmth we extend to others who are suffering?

Compassion asks us to accept all parts of ourselves, even the ones in which we struggle. It is in the seeing of our problems that we can begin to accept them as teachers. As caregivers, we can help clients turn towards their pain as we not only empathize, but hold or witness the whole experience with acceptance and compassion.

Pain is not an abstract concept. We all feel pain, but we often believe that we are alone, no one understands what we feel, and we are the only ones to have had this experience. We are in a contracted state of need. Compassion creates an expansive container in which suffering is known.

We share the pain of another because although the stories are different, the underlying fear, pain, or shame is universal. We cultivate compassion as we draw from the wholeness of our experience, including all parts. We meet the other person from a place of “We are all in this together. Your story may differ from mine, but we all have and will suffer; and we all will die.”

From this perspective, we are not so different from each other. Pema Chodron, Buddhist nun, says, “Compassion is not a relationship between the healer and the wounded. It is a relationship between equals. Only when we know our own darkness well can we be present with the darkness of others. Compassion becomes real when we recognize our shared humanity.”

Whereas empathy helps the person in pain, compassion is like a loop of connection and love. It is inclusive and reciprocal. In holding compassion for another, we are also receiving compassion back. It is an invisible, often wordless flow of all-encompassing space of acceptance. It feeds back, and unlike empathy, it is not experienced as fatiguing.

CROOKED GRIEF

November 22nd, 2015 by Dr. Nina Asher

My meditation teacher called it “crooked grief.”
I loved that image, as I wondered, “what in the world could that mean?” She explained, and I pondered.

Crooked grief slips out the side door of your body in the form of anxiety, fear, distractibility, irritability, and annoyance. We see it in our tone turning toxic with judgment and blame. We notice it in the breathy, speedy pace of long “to do” lists begging for our undivided, immediate attention. It haunts us as we engage in compulsive “overdoing.” Like a hawk on high alert, we find ourselves in crooked grief, sweeping down, flying upward, bypassing what we truly need.

There is no blame in crooked grief. It appears as a reminder that grief is there, wanting to be held, felt. Grief becomes crooked when it goes unacknowledged. It longs for a place to be seen and heard, a protected space in which to live.

Crooked grief is a place holder; that little tugging we feel lurking just outside our heart. It calls to us when we can’t “find time” to honor the presence of grief.

That is all it asks of us.

HAVING A PROBLEM IS NOT A PROBLEM

November 22nd, 2015 by Dr. Nina Asher

And yet, people enter therapy with the idea that they can fix their problems, or at the very least, make them go away. They have an entrenched notion that if only they try hard enough, or find the right therapist with the “perfect” instructions on what to do differently, all their problems will conveniently disappear forever.

I like to think of “problems” as doorways to growth. The word problem connotes bad, wrong, needing fixing, something which elicits shame and blame. Everyone has problems. No one is immune to them. So to acknowledge a problem with openness is a different way to think about the things that get in our way. Problems are there to help us see ourselves more clearly; they help us reach out to touch the edge of clarity.

In therapy, we don’t sit down to solve a problem, but rather, we engage in a relationship that allows us to see that the “problem” exists because at one point it helped us adapt or exist in the best way we could. As the therapy couple walks through this together, the problem begins to unstick itself, dissipate, and afford us the space to try out new ways of being.

SELF-CARE FOR THERAPISTS

July 8th, 2015 by Dr. Nina Asher

“Determined to save
the only life you could save (your own)”
Mary Oliver, poet

“Between a stimulus and a response, there is a space, and in that space lives our power and our freedom.”
Victor Frankel, psychologist


Anytime you soften your heart, you are strengthening self-care.

Anytime you turn inward and begin to see and accept the disowned parts of yourself, you are strengthening self-care.

Anytime you touch compassion for the parts of yourself that you have not liked, you are strengthening self-care.


How can therapists best take care of themselves while helping others?
Our days, often long ones, are consumed with listening and responding to the stories, and pain of others. Many of us exercise, attempt to get sufficient sleep, eat well, take vacations, and engage in hobbies that don’t involve work. And still, we feel the suffering of others settling inside us. We know all too well how to “take care” of others but seem less equipped to take good care of ourselves.

I would like to broaden the definition of self-care to include a mind-set for living our lives. What if we thought about self-care as developing a compassionate stance towards all dimensions of our being, even the parts we don’t like?

IDEAS:

1. Avoiding life’s difficulties does not equal happiness.
Set an intention to engage with all parts of yourself, even the ones you don’t like. Over time, this will lead to greater acceptance.

2. Notice the flow between pleasant and unpleasant experiences instead of clinging to the good and getting rid of the bad.

3. Perfection is an unattainable goal
Shift the focus from achieving perfection to recognizing and allowing what is to be what is. Pay attention to how you compare, judge, and try to fix. These harsh feelings derail us from inquiry, curiosity, and simply noticing “what is.” Longing for perfection does not promote self-care, but rather, increases unrealistic expectations, and disappointments.

4. Relaxing doesn’t always lead to calmer states.
The mind is very active, planning, organizing, reviewing what once was, and anticipating what is yet to come. Understanding how your mind works by watching it wander will lead to a more restful state. Bring awareness to the process of the mind wandering rather than engaging in a battle to try to stop its natural flow.

5. Therapy is a shared journey
Begin to discern the difference between “taking care” of the people with whom you work, and being present as a knowledgeable, empathic companion or witness. It is not our job to fix another person, but rather, we hold a space in which they can be heard and accepted no matter what emerges.

6. Not everything is an emergency
Notice the difference between reactive and responsive states. Reactive states occur when we work with people who are looking to us for solutions to the pain they feel. In our true wish for them to feel better, we jump in, leap to help them – we react with urgency. A responsive state allows for space for us to take a breath, pause, notice our own feelings, and then respond. Responding could mean saying or doing something, or saying or doing nothing at all. It is simply being present with the other’s experience

7. Turn towards a compassion stance with oneself – all parts of oneself, even those we don’t like
Compassion is the opposite of pity., and it levels hierarchy. Beneath every person’s unique story lies a thread of human commonality that speaks to the fact that we are all in this life together, struggling with very similar fears.

8. Taking care of oneself does not mean being completely independent
We all need one another. Looking inward and listening to oneself, allows us to meet life as it is, trusting that we will figure out what most needs our attention at a given time. This process helps settle the system, reach out to others when needed, and experience a deep connection with ourselves as well as those who help us.

SOME TOOLS FOR SELF-CARE WHEN WORKING

End sessions on time
Take a few minutes of personal transition time for re-grouping and gathering oneself.

Pause at the end of each session
This may mean taking a couple of deep, cleansing breaths, or simply standing quietly for a minute. Find a ritual that delineates one patient from the next. This allows space for the patient you have just seen to settle inside you and release; this in turn creates room for someone else.

Pay attention
There are many ways we distract ourselves from endings and beginnings. Is it really necessary to check email, phone and text messages between every session? Discern what is simply habitual behavior and what can wait.

Notice what triggers you
You will likely feel this somewhere in your body. Although you may not know what is bothering you, if you pause and open to investigation, you are engaging in self-care. Becoming curious about what the body is telling you, works against habitual judgment of feelings.

Build in moments that allow your mind to wander, and “not know.”
Ask yourself open-ended questions and notice your mind rushing to find a definitive answer. Let go of the “answer finding” and ask the question again. See if you can relax into not-knowing the answer through thinking. The mind needs time to float in open space.

Trust emergence