Michael Singer’s The Untethered Soul: The Journey Beyond Yourself is a book that compelled me to pull out my highlighter as I read. It contains a lot of valuable nuggets I’ve been implementing and sharing with the people I work with in therapy.

Here are some of my big takeaways:

1. Instead of identifying with the incessant chatter in our heads, we can bear witness to it. In doing so, we create awareness and separate ourselves from it, rather than get caught up in it.

We all have that voice in our heads—the one that tells us what to do, what not to do, how we could have done something better. The one that shames us, criticizes us, reminds us. It rarely takes a break, keeping us from falling asleep at night and waiting for us the first moment we stir. Singer compares it to a backseat driver, doing its best to maintain some semblance of control. It narrates the events we experience, but it doesn’t do so objectively. It manipulates. It often causes us to feel as though we’re not okay, or that we’re in need of protection.

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What can you do to separate yourself from this chatter?

Singer states that if see yourself as an observer of the voice, you can view it more objectively. You can say to yourself, “These are just my thoughts. Just because they are doesn’t make them true. I don’t have to identify with them.” That awareness is key. Singer encourages us to live in the “Seat of Self”—that space where we sit back and allow events, thoughts, and emotions to pass before us, and keep ourselves from drifting off into the current.

Another strategy is to attribute the chatter to a separate individual. Chances are that “backseat driver” is annoying enough to warrant you banishing it. Would you choose to hang out with a naysayer, criticizer, or catastrophizer? You might tell them you had other plans.

2. We often try so hard to avoid our pain that we construct lives designed by it.

Singer explores how we work hard to create an illusion of safety and control. We define how our lives need to be okay and see alternatives as a threat, taking things personally when they don’t go according to plan. If we don’t face our pain head-on, we orchestrate ways to cover it up or avoid it, thereby letting it rule us.

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He gives a wonderful example of having a thorn (your pain) embedded in you and what happens when you don’t do the work of removing it. You start avoiding bumping into things so as not to disturb it; you can’t get too close to people because you don’t want it to be touched; and you can’t sleep because you roll onto it, so you construct a contraption to keep it from touching your sheets. You then need to get specially tailored clothes to accommodate the contraption. That thorn, the pain you are trying so adamantly to avoid, eventually dictates all you do.

If we face our pain and fear instead of working so hard to protect, we grant ourselves permission to be free and to grow.

3. We tend to either cling to or resist things.

Singer describes clinging as “focusing your awareness on one particular object,” so your “emotions stay in one place long enough to become the building blocks of your psyche.” What we focus on expands. If we cling to something, we are likely operating out of fear. We are not allowing it to pass through us so we can be fully present in the next moment. We hold on and get stuck instead.

When we no longer cling or resist, we see fear or pain without satisfying the impulse to protect ourselves from it.

When we resist, we struggle to make the world fit into precepts we’ve defined: what we believe is fair, right, or good. When our world doesn’t match up, we find ourselves fighting, defending, rationalizing, or becoming angry or frustrated. If we let go of the limits we’ve decided upon, we no longer resist. We accept that events exist outside of our comfort zone and relinquish the effort to control or change that.

When we no longer cling or resist, we see fear or pain without satisfying the impulse to protect ourselves from it. This frees up our energy and enables us to be present, not caught in the past or paralyzed by what might happen in the future.

4. We unnecessarily expend a lot of energy reacting and then recovering when we could be enjoying freedom and happiness.

Singer compares this process to a pendulum. So much of our energy is wasted swinging from one extreme to the other—reacting and recovering. A healthier response is to notice a reaction and then choose to relax and release it.

We are most effective when we are balanced. If we forgo the extremes, we naturally have more energy available to us to live our lives fully and with purpose.

5. We qualify our happiness.

We tell ourselves “if/then” statements. If I am 10 pounds thinner/if I get married/if my boss treats me with respect, then I’ll be happy. Singer states choosing happiness can be simple. He provides a wonderful example of a starving man being asked what kind of food he wants, and the starving person simply answering “food” rather than requesting something specific. He’s not picky about the kind of nourishment he receives.

When we are too particular regarding how we define happiness, it becomes less available to us. If we choose it in its broadest sense, we let go of our parameters and opt to be happy with more far more ease and frequency.

Reference:

Singer, M. A. (2007). The untethered soul: The journey beyond yourself. Oakland, CA: New Harbinger Publications, Inc.

One of my favorite books is Paulo Coelho’s The Alchemist. It’s a story about a shepherd boy who journeys in search of a treasure about which he has dreamed. What I love about the story is that there are so many life lessons embedded in it. Where you are in your life determines what the salient messages are for you. I will do my best to impart some of the lessons that ring true for me without giving away too much of the story.

1. We must be able to make choices about how to move forward, and perhaps the best way to seek an answer from ourselves is to ask specific questions that require a yes-or-no answer.

There’s a point in The Alchemist when the shepherd receives two stones, one black and one white, signifying “yes” and “no.” The purpose of the stones is to help the boy “read the omens,” or understand the signs the universe is giving him as well as what his intuition is telling him. He is instructed to make his own decisions but is told to ask the stones a clear, objective question, if he struggles, and then go with the answer (black or white stone) he pulls from the bag.

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People who have trouble making decisions sometimes put them off indefinitely, leaving themselves feeling stuck. There are often “signs” that signal us which way to go, but if we are stumped and don’t really know how to proceed, it’s still best that we make a choice. Soon enough, we will know if we are on the right track, and if we aren’t, we can course-correct. The point is to move forward. If we don’t choose, we are electing to stay still and let things remain the same. Not choosing is often the equivalent of not taking action.

When you ask questions of yourself regarding what to do, ask specific ones that reflect what you really want so that the concrete answers you generate propel you forward rather than mire you in further confusion.

2. How we perceive our circumstances has everything to do with motivation, perseverance, and psychological well-being.

There are several examples of this in the story. As the shepherd encounters an unfamiliar place, he originally labels it as “strange” only to subtly change its description to “new” upon further consideration.

If we learn to strategically put our fears aside, and really consider the possibilities that are available to us, we can continue to take steps toward our goals.

The protagonist also shifts his view of himself from “victim” to “adventurer.” And when he takes stock of the fact he has chosen to remain in one spot for a long time on his journey, instead of bemoaning it, he recognizes “he was actually two hours closer to his treasure … the fact that the two hours had stretched into an entire year didn’t matter.” He took note of the progress rather than dwelling on the length of the journey ahead or how long he remained in one particular spot.

Shifting his perception toward the positive and that which was encouraging energized him and enabled him to recommit to his goal of reaching his treasure, rather than retreating to what was safe and already known.

3. Our beliefs about ourselves are incredibly powerful and can enhance or inhibit what we ultimately accomplish.

“Whether you think you can or you can’t, you’re right.” —Henry Ford

The boy in The Alchemist is tested time and again on his journey. Each time, he is forced to determine just how important his goal is and whether the love he feels and how attuned he is to his inner voice outweighs fear and the discouragement or challenges he receives from others. It is because he so clearly believes in the possibility of his treasure that he is able to persevere in search of it.

4. Fear is what keeps us stuck.

“There is only one thing that makes a dream impossible to achieve: the fear of failure.” —The Alchemist

Coelho illustrates how we hold ourselves back with fear, surrendering to thoughts that tell us we can’t or we aren’t worthy or we might suffer in the process of trying to attain that which we seek. He addresses the fear of failure as well as the fear of success. Coelho points out that “the fear of suffering is worse than the suffering itself.” The fear of suffering is often what results in anxiety. It’s being paralyzed by the thought, “What if the worst happens?”

If we learn to strategically put our fears aside, and really consider the possibilities that are available to us, we can continue to take steps toward our goals.

5. Awareness is key. Be able to recognize opportunity.

The Alchemist makes many references to omens, encouraging its protagonist to pay close attention to the here and now, implying that if he is alert he will become more aware of what action to take next. The story explores the concept of the universe offering us clues to see us through to our goals. It suggests if we lose the capacity to pay attention to those clues (by becoming cynical, focused on the negative, or close-minded), they become more scarce, “abandoning” us.

If we approach life’s choices with a sense of clarity and purpose and are aware of the gentle nudges we receive along the way (our intuition and the messages the “universe” seems to send us), if we can separate that from fear and negative beliefs we have about ourselves and the world, then we can carve a path to the things that are important to us, the treasure reserved for each one of us.

What can YOU take away from reading The Alchemist? (If you haven’t read it, I urge you to.)

Reference:

Coelho, P. (2006). The Alchemist. New York, NY: HarperOne.

“…Not all psychological impacts can be encompassed by a list of symptoms or disorders.” —From Principles of Trauma Therapy

Make no mistake about it, Principles of Trauma Therapy: A Guide to Symptoms, Evaluation and Treatment is a psychiatric textbook. However, it is a rare breed of psychiatric textbook. It has a soul. To borrow from the dialectic wisdom of Marsha Linehan, the question in mental health treatment is often “What is being left out?” This book fills the void in terms of a comprehensive examination of the causes of trauma. It is not solely focused on the lists of symptoms. There are some areas where the book has “left out” important information, but emphasis on cultivating compassion for trauma survivors makes up for it.

John N. Briere and Catherine Scott describe how challenging behaviors exhibited by people who have gone through traumatic events are normal and within the context of psychological resilience: “Although therapists may interpret these behaviors as ‘resistance,’ such avoidance often represents appropriate protective responses to therapist process errors.” (p. 170). The adaptive functioning—or attempts to “metabolize” the trauma—is often interpreted as sabotaging or therapy interfering, but in reality, it suggests the clinician is in error (e.g., moving too fast in therapy). Unfortunately for the person in therapy, these attempts to lessen the pain can inadvertently prolong their trauma (this is what’s called the “pain paradox”). The unskillful attempts used to extinguish the pain often produces an increase in pain for the individual.

[fat_widget_trauma_ptsd_right]The pervasive message in Principles of Trauma Therapy is that a person’s symptoms due to a trauma can resolve via therapeutic engagement within a safe, therapeutic environment. The treatment approach is eclectic, and it weaves together strategies from various models (e.g., cognitive behavioral therapy, psychodynamic approaches, and mindfulness). People in therapy are given the opportunity to develop a coherent narrative of their past experiences, while learning stress reduction skills and psychoeducation through validation, respect, and supportive encouragement.

At the heart, Principles of Trauma Therapy comes from the theoretical perspective of exposure therapy and much of the content centers around this orientation for treatment. The clinician invites the person in therapy to develop alternative perceptions to their negative beliefs about themselves (oral and written) and the environment where the trauma manifested, while reducing “conditioned emotional responses” (CER).

To simplify, the recollection of the traumatic memory (i.e., exposure) occurs by activating the emotional states and schemas. The “disparity” that occurs is based on the idea that the therapy space is safe, so the person in therapy is counter-conditioned to realize they will not be harmed by experiencing the intense emotions that surround the memories. The integration of memories and emotions through exposure—along with the inability to avoid (i.e., CER) in the moment—creates resolution. The emotions are no longer as powerful. The positive results occur if the clinician is able to finesse the client’s capacity to “regulate and tolerate the associated painful affect” (p. 267). Briere and Scott advocate a titrated exposure to avoid both undershooting the level of exposure and not overwhelming the person in therapy. This person should be emotionally activated to allow processing to take place, but not to the point that their coping resources are overwhelmed, which leads to avoidant behaviors (i.e., to seek safety from the distress).

Exposure therapy techniques are undoubtedly effective and reliably decrease posttraumatic stress. However, the dysregulated elephant in the room during my review of this book was a question of ethics: is exposure therapy humane?

There are a couple of areas that should have been addressed more thoroughly in the text. Exposure therapy techniques are undoubtedly effective and reliably decrease posttraumatic stress. However, the dysregulated elephant in the room during my review of this book was a question of ethics: is exposure therapy humane? This form of therapy elicits pain for the person in therapy, often expressed in the form of panic attacks, dissociation, and intense anxiety through a re-experiencing of the trauma. Is it morally right for clinicians to prescribe this approach? Does the end justify the means? Or, are there other treatment approaches that can be used to relieve the immense amount of suffering experienced by trauma victims?

Principles of Trauma Therapy provides only a brief conceptualization of eye movement desensitization and reprocessing therapy (EMDR). In 2004, the APA acknowledged EMDR as a recommended effective treatment of trauma. According to Shapiro (2001), EMDR is the most empirically studied treatment for posttraumatic stress (PTSD). The philosophy of EMDR treatment does not differ drastically from exposure therapy: deconditioning disturbing input, redefining the event, finding meaning in it, and eliminating self-blame, while integrating new skills (Shapiro, 2001). The stark difference between EMDR and exposure therapy is the method of delivery, as well as the path a person in therapy takes toward healing. Exposure therapy is analytical with a narrative-driven process that involves a significant amount of “homework” assignments for the person in therapy. It also runs a risk of vicarious traumatization (for both the therapist and person in treatment) due to repeatedly describing the often horrific events.

The internal process of EMDR utilizes an approach of holding a negative cognition (e.g., “I am unlovable”) paired with what is often an image of the traumatic event (a pre-established target). The person is instructed to focus on the image, negative thoughts, and body sensations while simultaneously engaging in EMDR processing using sets of bilateral stimulation (e.g., eye movements, auditory stimuli, or tactile sensors). They are witnessing in their mind’s eye what surfaces. The clinician does not hear all of the details of the trauma, nor does he or she provide analysis of the experience. Dialogue is at a minimum. It is provided through repeated, brief check-ins between sets of bilateral stimulation; “What comes up now?” or “What did you notice that time?”

Principles of Trauma Therapy has an agenda in terms of promoting exposure therapy, but it also offers a holistic array of coping strategies—for both the therapist and the person in therapy—to increase one’s awareness of bodily reactions and ways to create a vocabulary for the feelings that arise. This mindful mentality is more than a subtle emphasis. Empirically validated mindfulness interventions are presented (e.g., acceptance & commitment therapy, dialectical behavior therapy, mindfulness-based stress reduction, and mindfulness-based cognitive therapy) as to disillusion the reader from the spiritual, Buddhist connotation. Clinicians are encouraged to maintain an open awareness to their own mental states (e.g., reduction of reactivity) without judgement, in order to mirror this process for people (e.g., attending to the breath, a here-and-now focus). There are also scripts for new clinicians and comprehensive assessment material that is applicable to anyone in therapy.

Principles of Trauma Therapy has a final, comprehensive directory of trauma-centered psychopharmacological interventions with content relative to psychobiology. This is extremely informative, but one has to question some of the research that was referenced. One concluding statement regarding the efficacy of selective serotonin re-uptake inhibitors (SSRIs) as antidepressant medication gave me pause. It was noted that SSRIs “have been found to be equally effective in reducing symptoms and improving quality of life across most clinical trials” for many diagnoses. The example reference was to a 2000 study comparing monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants and some selective serotonin re-uptake inhibitors (SNRIs) for depression. ^[1] The citation did not match the broad sweeping claim as the study itself notes “clinically insignificant” differences in efficacy as well as tolerability between SSRIs. ^[1] Read this section with a grain of salt and consider newer research when determining the efficacy of medication for victims of trauma.

Despite the focus on the individual in this book, the reader is walked through the “victim variables”, “characteristics of the stressor”, and “social response and supports” that affect the outcome for the trauma victim, which forces a cultural vista. Briere and Scott implicitly connect to the fact that our society’s disenfranchised groups of individuals (e.g., people of color and in poverty) are much more susceptible to posttraumatic symptoms.

Trauma is no longer just a micro level problem, but an issue of social justice and equality. The book maps out the generational influences and cyclical effects of trauma. There is an “additive effect” of multiple traumatic events throughout one’s life. For example, a survivor of childhood abuse who has residual effects into adulthood will react with “especially severe, regressed, dissociated, or self-destructive responses to the adult trauma” (p. 22). Earlier treatment interventions are essential to desensitize these reactions to stress.

Briere and Scott provide a stylish blend of the metaphysical and tangible aspects of trauma. They do this with learned experience, academic research, and hope as a means to expose the wide-ranging consequences of trauma. If you are a clinician searching for an in-depth examination of the components, conceptualization, causal mechanisms and treatment of trauma, then Principles of Trauma Therapy is here to the rescue.

References:

1. Mace, S. and Tayler, D. (2000). Selective serotonin reuptake inhibitors: a review of efficacy and tolerability in depression. Expert Opinion on Pharmacotherapy: 1(5). 917-933.
2. Briere, John & Scott, Catherine. Principles of Trauma Therapy: A Guide to Symptoms, Evaluation, and Treatment (2^nd Edition). SAGE Publications, Inc; Second Edition – DSM-5 Update edition (March 26, 2014).

A biography of Marilyn Monroe by Lois Banner, professor of history and gender studies at the USC Dornsife College of Letters, Arts, and Sciences, reveals a complicated woman determined to be the best at everything. Published around the fiftieth anniversary of Marilyn Monroe’s death (August 5, 1962), Marilyn: The Passion and Paradox also reveals Marilyn Monroe’s troubled psyche and tragic childhood, including her childhood experience with sexual abuse, which led to a life-long struggle with sexual addiction. In an act that continues to strike us for its bravery—especially in a society like ours that is obsessed with objectifying women—Marilyn Monroe acknowledged and spoke publicly about her struggle with the consequences of childhood sexual abuse.

Banner builds on Monroe’s own statements to create a picture of a woman battling sex addiction and seeing herself as an object to be possessed by men and women. In one particular interview she gave to the British press, she stated “I sometimes felt I was hooked on sex. I could not stop having sex with almost every man I met.” Her persona as America’s “sex symbol” speaks loudly to America’s twisted relationship to sexuality, which takes tragic self-objectification and makes it something desirable rather than identifying it as a defense to trauma that causes suffering and requires treatment.

Aside from celebrities having affairs and sometimes excusing this behavior under the guise of “sexual addiction,” our society does not talk about the topic, and therefore we do not fully understand sexual addictions. The first thing to note is, oddly enough, sex addiction is never about sex. It is about a repetition of trauma and a craving for intimacy. Sex becomes the tool a person uses in order to find love and acceptance. Of course, the aim is never satisfied because the intimacy created through frequent sexual encounters is never really intimate or loving.

Sex addiction is a byproduct of trauma coupled with loneliness, pain, and the need to be loved and accepted. It is a substitute for these needs, a counterfeit way to meet real desires. However, it always fails to meet those needs and desires and subsequently creates a greater need for more sex in order to mask what one is truly missing. In Marilyn Monroe’s case, this craving for affection probably developed early on in life as she was moved around from foster parent to foster parent. In addition, having been sexually abused by men as a child, she would likely have equated sex with attention, and attention with love.

Studies show a high correlation between childhood abuse and sex addiction in adulthood. “Sixty percent of sexual addicts were abused by someone in their childhood” (Book, 1997, p 52). If your caretakers failed to protect you, or worse, inflicted the pain, you end up repeating what you know; you are attracted to the kinds of people who will fail to protect you or cause you harm. Having been sexually abused early on in life, a child grows up emotionally starved for love and mistakenly comes to equate love with sex. To bear the pain, one begins creating a fantasy where love means sex. And so, slowly, sex becomes a tool to satisfy any kind of need, whether that be loneliness, fear, anxiety, or shame. Worse, contemporary society constantly sexualizes us, especially young women, by teaching them how to become an object for someone else’s pleasure, not a participating subject. From the TV shows that we watch to the magazines that we read, we learn about sex as a performance and, for women in particular, we are taught that our bodies are a tool to be used in order to attract people. This further prevents survivors from seeking out treatment, as our society rewards unhealthy behavior and seldom teaches us how to view sexuality in a healthy way.

Sexual addiction has many different forms: compulsive masturbation, sex with people who are prostituted, anonymous and often unsafe sex with multiple partners, multiple affairs outside a committed relationship, habitual exhibitionism, habitual voyeurism, inappropriate sexual touching, repeated sexual abuse of children, abstaining from having sex altogether, or episodes of rape (Book, 1997). Addictions are quick fixes in order not to experience pain. Adult survivors of childhood sexual abuse often find it hard to trust another, to create real intimacy, to overcome feelings of shame and rejection, and to be present in intimate relationships. Sex, then, becomes a way to create a fantasy world, to tell oneself that you are sharing with another, that you are intimate and therefore present in the relationship. But, since sex addicts don’t necessarily enjoy sex with other people, and the need for intimacy is never fulfilled, one is then compelled to act out sexually—hence the addiction.

[fat_widget_sex_left]Most people who experience sex addiction do not understand why they are acting out sexually or why they have constant thoughts of either having sex with someone or masturbating. Sometimes they associate these thoughts with being in love, when love is far from the relationship. Each new sexual encounter brings relief and the promise of a new beginning. It also brings an unconscious desire to understand the pain of childhood sexual abuse. Yet as each encounter ends, and the need is not satisfied, the person feels more helpless, more alone, more ashamed. Slowly, a preoccupation with a new sexual encounter develops, and its promise for a new beginning gives rise to fantasies of intimacy, love, and affection. Perhaps the worst pain inflicted by childhood sexual abuse, which can be easily seen in the powerful and disruptive negative thoughts of someone who is addicted to sex, is the person’s lack of self-esteem, the idea of being damaged. Thus, rather than experiencing sex as a self-affirming, pleasurable activity, it is a source of pain, shame, and suffering.

Sexual addiction is a symptom of a bigger problem, and treating the symptom does not solve the problem. Underneath the symptom, one finds a codependent, wounded soul. As a young girl, Marilyn Monroe was treated as a sexual object and like many adult survivors, she became addicted to sex, suffering in silence. In treating sexual addiction, one needs to move beyond the symptoms and work with the survivor on issues regarding shame, self-esteem, and trauma. Yet therapy also needs to go a step further: In analyzing our culture’s view of women, sexuality, and relationships, we can begin to understand how ideology contributes to negative views of sexuality and women. Perhaps the greatest task for both the client and the therapist is to explore what it means to be a subject rather than an object in a relationship—to begin creating spaces where both women and men value each other and celebrate sexuality, not as a means to an end, but rather as a ground for pleasure.

By slowly peeling away the layers, Banner’s book reveals the complexity of a human being. Through Marilyn Monroe’s tragic story, we are reminded of the painful scars created by childhood sexual abuse that, when left untreated, continue to bleed throughout one’s life.

References

1. Banner, L. (2012). Marilyn: The passion and the paradox. New York: Bloomsbury Publishing.
2. Book, P. (1997). Sex & love addiction, treatment & recovery. New York: Lucerne Publishing.