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Medical Boundaries: Which Are Necessary?

AsklepiosPrize

Did you hear the one about the doctor who went fishing with his patient?

Neither had I until a friend told us about a trip he’d taken with his doctor to go fly fishing.

I wondered if he always went fishing with his doctor and he said, “No, if I have to take off my pants we meet at his office.”

This set me to thinking, as usual. In my training as a social worker, boundaries were—if you can imagine this—simultaneously rigid and blurry. They were rigid when it came to three basic things:

  1. Whatever is done must be done for the benefit of the patient. Period.
  2. No sexual relations whatsoever—implied, verbal, or physical—with any patient even when that patient has been terminated from treatment.
  3. No manipulation of the patient for personal gain, e.g., getting particularly close so you can meet his Hollywood producer cousin.

After that, however, the rules are fuzzier. In social work, the office is not the only place treatment takes place—it happens in the home, on the street, in homeless shelters, domestic violence advocacy centers, in schools, and just about anywhere else people get hurt or feel unhappy or need help. It is one of the few schools of psychotherapy that accounts for the person in situ—that we are more than a conglomerate of neural impulses or internal motivations. We live, breath, and move in an environment. We are driven not only by our own minds but by the currents that surround us. Interventions, then, must not only take those forces/currents into account, but deal with them. Sometimes that means that we move the office outside into the patient’s life.

But what about being—rather, more specifically, would I become friends with a patient? Or, conversely, would you be friends with your doctor?

Personally, there’s something about the idea that makes me nostalgic. There was a time, not that long ago, that a doctor was not a deity surrounded by the impermeable membrane of incomprehensible technology. A doctor was just another member of the community. He raised children that went to school with our children. He went to religious services with (or near) us. He got sick, took walks, bought food, and went fishing just like everyone else. We knew his first name. He knew all of ours.

Healing was not some private province. It was part of the large, bumpy wheel of living and dying.

If I’ve told you all this story before, forgive me, but it’s one of my favorites. My father is a doctor. Retired for 15 or so years, he still goes to Grand Rounds at 91 years old to learn and talk shop. Besides my mother, his only true love was and still is medicine. After he served on an army hospital ship in the South Pacific, he opened a small office in the Bronx.

Most of his patients came and went like they do in most physicians’ offices. One couple was different.  Harry was a strapping Scots-Irish trucker who was as easy-going as a man could be and as hardy as an oak tree; his wife, Irene, was as delicate as a porcelain tea cup and a consummate worrier. They came in for physicals or those occasional minor complaints that fill a family practice, until one day he came down with a fever of unknown origin. (There were far more of those fevers then than there are now.)

They called my father’s answering service in the middle of the night. The phone rang in our home and my father ran out with his medicine bag (he still has it) at 1 or 2 in the morning. He stayed there with them, holding Irene’s hand and doing whatever doctors did for mysterious and dangerous fevers until it broke. It was hours and hours.

The point of the story is not just that Harry got well or that Irene was happy. They became friends. They stopped at my father’s office to say hello, to bring pastries, to help with odds and ends. They started coming to the house for birthday parties and holidays. We called them Uncle Harry and Aunt Irene. And they still went to my father for medical care until the day they moved into a retirement village hundreds of miles away. And even then, they did nothing without consulting my father first.

How would that fare today? I honestly don’t know how most medical doctors would handle it. I suspect that most would avoid it for a number of reasons, not the least of them being liability anxiety. In social work, it is a bit easier to go out on a limb for a patient, to step out of the office for a moment. I have done it more than once—gone to graduations of clients whose families were far away, attended baptisms, stood quietly at memorial services, and walked frightened patients into health care centers when they wouldn’t (or couldn’t) go alone. It sits well with me. And it seems to have been good for them, which is how I measure it. I mind the basics (those three rigid rules) scrupulously, but I leave liability to the side, where it belongs.

Maybe I shouldn’t be so carefree about it, but I believe that proper (meaning spiritual rather than romantic) love—more than technique—is the source of cure. Especially in my work. Maybe not so much in the emergency room…but even there I think a point could be made for it.

I occasionally meet with one M.D., who is also a classical homeopath,  to discuss cases. He has been a teacher and a friend over the last few years. I’ve watched him work and he seems to feel the same way about medical boundaries. I don’t think he walks his patients into advocacy centers, but I’ve seen him attend his patients in his home office with a compassion and warmth that is unique in the business today. He dresses casually. He listens. He offers water or tea. He makes himself available both in terms of time and emotion. I don’t think he frets too much about liability either.

I guess people just have to do what they are comfortable with. If they are afraid of being sued, then perhaps they should take the precautions they need to avoid it. I don’t know if that makes it better or worse. They say we draw in what we fear most. I do know one thing. Harry and Irene lived a long time and they loved my father till the day they died.

 

 

Homeopathy and Cancer

This is a guest blog by Faith Franz, who researches and writes about health-related issues for The Mesothelioma Center. One of her focuses is living with cancer. I am presenting it here in the hope of offering information and options to people who are looking to be healthier and happier. 


calmBenefits of Homeopathy for Cancer Patients as an Alternative Medicine

Cancer patients turn to treatment to reduce their symptoms, boost their mental health, improve their quality of life and – if possible – reverse tumor growth. Homeopathic approaches and allopathic approaches both yield some or all of these benefits, but the way that they achieve them is drastically different.

Homeopathy provides benefits in a much gentler manner with fewer risk factors than traditional medicine. Traditional cancer medicine uses the most potent dose of therapy available in gross molecular quantities, while homeopathic medicine aims to use what is called “the minimal dose,” as few active ingredients as possible. Often the dose is below Avogadro’s number (the mole) and the medicine given is delivered energetically.

Homeopathy also encourages patients to use only one remedy at a time, switching treatments only if the first is not the right fit. As a result, patients typically experience do not experience what are commonly referred to as “side effects” from homeopathic treatment as they do from a traditional treatment regimen, which adds one drug to the next to the next, often to deal with the problems caused by the first drug.

Traditional medicine tries to eradicate tumors and their associated symptoms as quickly as possible. Homeopathic medicine takes the time to heal the underlying cause. Homeopaths understand that sometimes patients will experience a brief increase in symptoms before the disease is cured; this is the body’s natural way of releasing the disease.

Patients also benefit from the highly personalized nature of homeopathic medicine.

Each remedy in the repertory (the master guide to homeopathic solutions) is matched to a specific set of conditions. In traditional medicine, doctors prescribe one or two medicines to treat the same general symptom. Homeopaths choose from dozens of remedies for each symptom after evaluating the other characteristics of the patient’s case.

For example, an allopathic doctor would prescribe a patient Metoclopramide or Prochlorperazine if they become nauseated after chemotherapy. A homeopath might prescribe the patient one of the following remedies, based on the patient’s other symptoms and overall constitution:

  • Cadmium Sulphate
  • Kali Phoshorpicum
  • Nux Vomica
  • Sepia
  • Ipecacuanha
  • Uncaria tometosa

Because the solutions are chosen specifically to be closely tailored to the patient’s overall condition, patients will obtain highly individualized benefits from homeopathic remedies.

What Cancer-Related Conditions can Homeopathy Treat?

Even when a cancerous condition is very advanced, homeopathy can yield benefits for a number of physical cancer-related conditions. These include:

  • Pain
  • Fatigue
  • Nausea/vomiting
  • Constipation
  • Diarrhea

Homeopathic remedies can also relieve symptoms that are unique to a certain cancer. For example, patients with asbestos-related cancers of the respiratory tract can take antimonium tartaricum or related remedies to curb dyspnea and coughing that includes a great rattling in the chest.

Although classical homeopathy does not seek to suppress, rather to cure, in some cases, alleviation (or palliation) of symptoms is the moral mandate, for even when we are beyond cure, we seek to ease suffering.

Thus,  homeopathy can also be used to help patients manage emotional complications that stem from their cancer diagnosis. Homeopathic remedies can help diffuse stress, fear and mild depression without the use of anti-anxiety medications. This mental health aspect of cancer treatment is just as important as the physical care, and often, the two overlap. When stress and other emotional symptoms are under control, patients are much less likely to experience insomnia and other anxiety-related conditions.

Some patients take homeopathic remedies with the intent of reversing tumor growth. These treatments require a homeopath’s prescription. Data varies regarding the efficiency of these remedies. Because they rarely cause any harm in the process, many patients choose to see if their body positively responds to the solution.

 

Judith’s note:  As always, when presented with a medical condition, please consult your physician and/or a classically trained homeopath with experience in the treatment of your complaints. Please do not use homeopathic remedies over the counter without engaging in your own study or benefiting from the advise of someone with training. 

 

 

Trending Now: Prescription Addiction

pill-manIs the medical profession finally catching on? I recently saw signs of hope.

In the February 22/29th edition of Jama (*1), the editors described a report issued by the CDC in a splendidly titled tome, Morbidity and Mortality Weekly Report.

Throughout the dryly presented data were intertwined subtle sirens of alarm: The rate of unintentional drug overdose deaths in the United States has risen over 600% in the years between 1997 and 2007.

We are not talking about heroin or methamphetamine or crack. We’re talking about prescribed analgesics. Prescribed. According to the CDC, “drug distribution through the pharmaceutical supply chain was the equivalent of 96 mg. of morphine per person in 1997 and approximately 700 mg. per person in 2007,” a dose high enough for everyone in this country to take a standard 5 mg dose every 4 hours for 3 weeks.(*2)

The report continues its assessment and finally makes this stunning observation: “Prescription drug abuse is the fastest growing drug problem in the United States…and has been driven by a class of prescription drugs called opioid analgesics.”

It goes on: “For every unintentional overdose death…nine persons are admitted for substance abuse treatment, 35 visit emergency departments, 161 report drug abuse or dependence and 461 report non-medical uses of opioid analgesics.”

Why? How could this be? Are these drugs being stolen? Manufactured by thugs in a trailer in the desert? Sold by wayward pharmacists? Smuggled from Canada? Hardly that dramatic. In fact, we are being addicted by the people we trust the most: “In an attempt to treat patient pain better, practitioners have greatly increased their rate of opioid prescribing over the past decade.”

Did someone say there was a war on drugs?

Allow me to share a more personal and human rendition of these statistics. One was a patient (name and details changed) whose situation was far too common, and one was a personal experience I had after a back injury.

The patient came to me with minor anxieties and some depression in large part due to unresolved grief. She was in her mid-thirties, a nurse, without major medical complications. Almost all her complaints centered on her fear of abandonment in relationships. Early on in treatment, she slipped at work (trying to move a large man from bed to a wheel chair) and injured her shoulder. After MRI’s and doctor visits that lasted months, they finally determined that she had some injured tendons. They put her on Vicodin. They refused her any other form of treatment.

That was 15 years ago. Needless to say her doses increased dramatically over the years as did her anxiety, her depression, and finally she was able to witness the abandonment she so feared. Her marriage fell apart. She was so addicted to the Vicodin that the withdrawal was more frightening than the dissolution of her family.

I have seen this scenario in different forms at least a hundred times. I have made phone calls begging physicians to please reconsider their choice of medication and allow for other medical solutions: acupuncture, physical therapy, massage, homeopathy, mindfulness meditation, hypnosis. With the exception of a few truly open-minded practitioners, the answer was a uniform “no.”

Why would anyone object to an alternative treatment if it brought relief at lower cost and without the risk of addiction and all the associated medical risks?

I found this out for myself personally not more than a few years ago. I fell (hard) and twisted my back. When it happened, I was more embarrassed than in pain and told myself (and everyone else watching), “Oh, I’ll be fine. It’s fine.” Within the time it took for my adrenal glands to stop pumping, the pain became intolerable. I could not walk. My husband took me to urgent care and they told me it was a muscle sprain because there was nothing on the x-ray. They urged me (I mean this literally) to take pain killers.

I said, “No, thank you.”

The doctor on staff looked at me cross-eyed and said, “What do you mean, ‘no, thank you?’”

I said, “I mean no. I don’t want them. How about some aspirin or ibuprofen or something like that?”

He reluctantly gave in and wrote the prescription but not without saying, “You’re going to be sorry.”

The pain was not going away as quickly as I’d hoped but I had seen what opioid analgesics could do and was determined to do whatever I had to do to avoid it. After putting up a fight with the insurance company that lasted two months, I finally went for an MRI where they found the bulging disc that was impinging on my sciatic nerve.

I found a physical therapist who was a hands-on genius and she relieved the pain with a combination of deep tissue massage and abdominal strengthening. We also used guided meditation. She used to tell me to “imagine the butter melting” as she focused on releasing the Iliopsoas, particularly Psoas Major which is the muscle that connects the hip to the spine. It was miraculous and immediate joy.

It was getting better. I was still in pain and not as limber as I used to be, but it was moving in a good direction. And I was willing to work hard to get better. That is, until the insurance company insisted on a new doctor. He looked over my chart and said, “You’re going to need Vicodin.”

I said, “No.”

Once again, that same look: “What do you mean, ‘no?’”

I said, “I don’t want dope. The massage and exercise works. Why can’t we continue that and forget the drugs?”

“Because you’re at maximum improvement. You can get the drugs but not the therapy.”

It was my turn to look at him cross-eyed and I said, much to the amusement of the nurse in the room with us,
“Are you crazy? Who are you working for?”

“According to the insurance company, this is medical standard now.”

I wanted to ask him when the insurance companies and bureaucrats became the arbiters of medical ethics and practice. It became clear to me that because of the structure of medical care today, people who would have otherwise had options and been good doctors, were being led in another direction, a new “standard” set by insurance companies and pharmaceutical interests.

Instead, I just said, “What about your oath?”

“I’m sorry.”

I looked at him and said, “Yes, you are,” and that was that. I walked out. No therapy and no Vicodin. And I had to pay for my own massages and take responsibility for my own recovery. And perhaps this is simultaneously the crux of the problem <em>and </em>the solution. Taking charge of my own healing instead of laying it on the doctor’s shoulders and demanding an immediate pain solution was not easy. In fact, it is an ongoing decision because I still have days with spine-shivering pain. But it has been infinitely better than what I’ve seen with my patients, people who had been struggling with aches and pains or broken hearts turned into addicts with broken homes, empty pockets, and symptoms so wildly erratic they were sometimes mistakenly diagnosed as bipolar instead of addicted. So rather than getting them off the opioids, they were given ever-increasing doses of medication that eventually made reaching–or treating–them impossible.

So, this war on drugs we’re waging? Maybe we should start in the doctor’s office. And it seems to be up to us in more ways than one. I don’t see the pharmaceutical companies leading the battle. Do you?

*1.    CDC Grand Rounds: Prescription Drug Overdoses–a U.S. Epidemic, MMWR, 2012;61:10-13, cited in The Journal of the American Medical Association, February 22/29/20120, Vol. 307, No. 8, page 774
*2.     Ibid.

People to Watch: Hudson Valley

Judith Acosta PhotoThis was one of the best welcomes I have ever had, or could hope to have. While I’m still missing New Mexico terribly, this article about Verbal First Aid, The Next Osama, and my general practice as a psychotherapist and homeopath certainly took some of the sting out.

Hudson Valley Magazine People to Watch 2012!

 

A Primer in Classical Homeopathy: How to Make the Interview Easier and More Productive

 

(this is an expanded version of the piece currently on Huffington Post)

Children-of-the-Mind-2

I’ve been a psychotherapist for 25 years. I believe it’s an important part of my job to make my clients as comfortable as possible from the first phone contact. Despite all reasonable efforts, though, the first interview seems to still be somewhat awkward and difficult for new patients. Really, it’s very understandable. They don’t know me. They feel vulnerable and unsure because they don’t know exactly what’s expected. They’re sometimes not even fully clear about why they’re there except they know they want to feel better.

The homeopathic interview may be even more of an unknown for some people. Not only does it start with the same “unknowns” as the social work assessment, but it adds some new ones, like the simple but monumental fact that it turns allopathic or “standard” medical practice on its head. You may have called the homeopath to get rid of that recalcitrant psoriasis, but he or she keeps talking about whether you kick the covers off at night, how you feel about injustice, or whether your sadness is worse in the morning or at night.

Knowing what to expect of the process and what your homeopath is hoping to learn from you may make the experience more comfortable and more productive. The following is not a medical manual, but a primer for those looking to work with a classical homeopath. Hopefully, it will give you a good idea of what to expect and how to participate so you get the most out of it.

Preparing Yourself  Philosophically

One of the fortunate aspects of my practice is that I see people more frequently because the primary focus of it is mental health treatment. Even though it also takes physical conditions into account, people almost always call me because they’re sad, anxious, grief-stricken, panicked, or in some way emotionally distressed.

Unless a person comes specifically to be treated homeopathically and has already had some experience with the philosophy and practice of classical homeopathy, I usually anticipate spending at least some time in the first or second session on education. I give material for reading, lead them to the National Center for Homeopathy website, and take as much time as he or she needs answering questions.

What you can do, then, to make the time you spend more efficient and effective when you are actively seeking treatment from a homeopath is to learn a little bit about it beforehand.

In my opinion, the best book for the starting patient is Impossible Cure by A. Lansky. It is written in clear, concise prose and doesn’t fall back on “homeospeak” so you can follow her all the way through. And hers is an amazing, personal story of hope.

The principles of classical homeopathy are the following:

Like cures like.

This is the manner of cure. It is also called the Law of Similars and it is the way all proper remedies are chosen. It means that the practitioner is going to ask you a host of questions intended to draw out information that will help him or her choose the remedy that is most “similar” to your totality of symptoms.

The simplest example of the Law of Similars is what we do when we get grease on our hands. We clean it with soap (or, if you’re out in the garage, Goop), which is little more than fat. The soap removes the grease because it is grease.

In a homeopathic case, it may look like this:  A little boy suddenly gets a raging fever with a pounding headache, dilated pupils, cheeks so red they could be purple and becomes delirious. The remedy a homeopath would choose (and there would be a couple of contenders) would have to produce those symptoms in a healthy person. By giving the remedy that would generate that particular type of febrile state to a person with it, it is cured.

This is why quinine works curatively for malaria—because when it is given to a healthy person over and over, it creates symptoms similar to malaria. Like cures like. This principle goes back to Hippocrates and has been considered by homeopaths as the basis for all true healing.

Hering’s Law.

This is the road of cure in homeopathy. In simplest terms it refers to the way and the order in which the pathology will be healed. Cure moves from top down, from present to past, and from in to out (from the spiritual-mental-emotional down through the organs from most to least important and finally out to discharge in a benign way, e.g., a runny nose, brief diarrhea, fever, or skin eruption).

One remedy at a time.

This is the technique of cure and it is an obvious but overlooked wisdom. If multiple remedies are given too frequently and in too rapid a succession (except in extreme and acute situations), the case can be lost. This is even more true with combination remedies (pharmacy concoctions that include multiple remedies, even those that antidote one another).

It is terribly important to let each one reveal in its time what it must. Some remedies take longer than others. We all respond differently at different times to our environments. Remedies are no exception.

The Nature of Pathology:  Layers

This is not a standard homeopathic “principle” but it’s one that leads me to ask of patients regularly: Patience. We are not out to just make a symptom disappear at the expense of your vitality and health. We want to get rid of the psoriasis but not at the expense of seeing you develop uterine fibroids or heart disease.

We want you to be healed. And that takes time. When patients ask me, “Well, how much time,” I have to say, “As long as your organism needs. You’ll tell me how much time.”

The reason for this is that there are layers to everything today. Including pathology.

Western practitioners often mistake the presenting problem for the only problem they need to cure, not having been trained to see the embedding of one pathology over the other or the inheritance one may have received from one’s ancestors.

These are levels of defense. We know this by what happens in our relationships. First bad joke, we get a giggle and a snort. Second bad joke, we get a “cut it out.” Third bad joke, we get kicked in the shins.

It is common knowledge that when an organism is injured, it inflames. It is a mechanism of repair. Homeopaths trace what happens if the injury is not healed (by itself, with proper medicine or the removal of inflammatory agent): the inflammation worsens, leading to induration (hardening). If that is not healed, then the organism resorts to its last defense to save the whole. Thus a cancerous tumor or an ulcer is a result of this process at the genetic level.

In homeopathy there are three basic levels:

The Psoric

Physical level:  Inflammation (fevers, rhinitis, cystitis), pain, spasm, constriction, sensitivity

Emotional level:  Anxiety, apprehension, irritability, anger, sensitivity, insecurity.

The Sycotic

Physical level: Accumulation (calluses, warts), synthesis, deposition, and proliferation

Emotional level:  Hyper-anxiety, fearfulness, hypervigilance, Super-vivaciousness, showmanship (most of American TV), boasting, rigidity, hardness (like calluses), precocity, collection (OCD).  Also the opposite:  too relaxed (a loss of collagen, dropped uterus), looseness in character, overly yielding, shame, frivolousness, bashfulness

The Syphilitic

Physical Level:  Exaggeration, distortion (pointed teeth, curved spine), destruction (cancer), auto-immune diseases, mutations (scoliosis)

Emotional Level: perversion, cruelty, hysteria or mania, (borderline personality disorder, psychosis), distortion of reality and loss of connectedness, delusions, destruction, fearlessness, loss of will to live, loss of senses (smell, sight etc…).

Less Really is More

This concept is one of the major reasons why people have a hard time understanding and choosing homeopathy.

In homeopathy we do not use gross quantities of a substance. We use smaller doses, often below Avogadro’s number—meaning that if you looked at the medicine with an electron microscope you would see nothing. This is also called a “mole.” The mole, as defined by Wikipedia, “is a unit of measurement used in chemistry to express amounts of a chemical substance, defined as an amount of a substance that contains as many elementary entities (e.g., atoms, molecules, ions, electrons) as there are atoms in 12 grams of pure carbon-12 (12C), the isotope of carbon with atomic weight 12. This corresponds to a value of 6.02214179(30)×1023 elementary entities of that substance. It is one of the base units in the International System of Units, and has the unit symbol mol.” (http://en.wikipedia.org/wiki/Mole_%28unit%29)

The way I explain it to patients is this: Homeopathy is an energy delivery system, like a musical instrument or a beating heart or a scream of “fire” in an auditorium. So if the remedy is sulphur 30c, there are no molecules of sulphur in it. It acts on the vital force (and this is important!!!) by energetic resonance. It does not work on our bodies directly the same way that taking an aspirin or steroid does. It seems to work more along the lines of quantum physics than Newtonian law. (Poitevin, Bernard (2005). “Jacques Benveniste: a personal tribute”. Homeopathy 94 (2): 138–139. doi:10.1016/j.homp.2005.02.004.)

The rule of thumb is: The smaller the dose, the more potent.

How does this happen? According to one study, homeopathy works because water has memory.

(E. Dayenas; F. Beauvais, J. Amara , M. Oberbaum, B. Robinzon, A. Miadonna, A. Tedeschit, B. Pomeranz, P. Fortner, P. Belon, J. Sainte-Laudy, B. Poitevin and J. Benveniste (30 June 1988). “Human basophil degranulation triggered by very dilute antiserum against IgE” (PDF). Nature 333 (6176): 816–818. doi:10.1038/333816a0. PMID 2455231. http://www.nature.com/nature/journal/v333/n6176/pdf/333816a0.pdf.)

From Benveniste’s observations, it appears that what’s been in it has a resonant effect. It is similar to the way our bodies remember a trauma. We have body memory even when the trauma is long gone and resonate with similar states or situations, until that original traumatic injury is healed.

As a psychotherapist, I think the tendency of trauma victims to unconsciously set themselves in traumatizing situations again and again is a desire to self-heal in some ways…they are searching for the similar agent. Freud was close to this when he talked about the repetition compulsion. People are often horrified (and not unreasonably) when they engage in unhealthy behavior time and again. They rightly want it to stop. But when it is framed this way and they can see that they have only been seeking resolution, it becomes not only easier to understand but to actually resolve. They feel less guilty with unconscious complicity, less victimized by their pasts and more empowered to move towards change. I’ve seen this understanding alone start to bring about healing even before a remedy has been delivered.

Yegads! No Coffee???

Perhaps the hardest thing for some patients is the need to temporarily give up coffee. I’ve seen patients give up vicodin, birth control pills, marijuana, and essential oils quicker than their daily java joy.  I can absolutely understand it, too. I love coffee. But it is an unavoidable part of the homeopath’s process.

Although I’ve met some homeopaths who do not worry about coffee or other known antidotes (steroids, marijuana, camphor) very much, many of us do take the more conservative path. In general, it’s best to be prepared to have your homeopath ask you to leave the java (and the camphor) aside until you’ve reached a solid plateau of good health. It doesn’t antidote everyone or every remedy, but for most homeopaths it isn’t worth the risk of complicated the case.

What Do They Need to Know THAT For?

Come to the interview ready for a lot of unusual questions. It will not be enough for us to just “name that disease.”

What is important when we look at a patient and what are we going to ask you? We will generally work along the following areas even though we all have different styles and personalities.

Interior function (most important):

Creativity, compassion, forgiveness, centeredness, relatedness, empathy, adaptability, consistency in relationships, integrity/honesty, and consistency between intention and behavior.

Exterior function:

This may not coincide exactly with interior function. However, I believe and have found that our pathologies normally express themselves poetically or holographically. You may recall the expression, “as above, so below.” It is true for us, as well. So we will ask you about situations that reveal your capacity for appropriate behavior (clothing, responsiveness to social cues), money management, job status, time management, socialization, housing.

Physiological function:

Parents’ medical history, personal medical history, current disease state (psoric, sycotic, syphilitic), diet (especially cravings and aversions), exercise, chronicity (how long the problem has persisted), periodicity (how often it occurs and whether there are specific cycles), and modalities (what makes it better or worse).

Spiritual function:

Rigidity, belief system, presence, judgment, fear.

The Art of the Interview

When I teach clinicians and medical personnel (Verbal First Aid, crisis protocols, and alternative healing principles, etc…), I always remind them that questions, no matter how clever or how technically astute, are no substitute for the therapeutic relationship. There is an art to homeopathy that is not “technical” and cannot be acquired solely by accumulating knowledge. I’ve met people who could recite remedies and their exact properties by memory, but could not see a patient in his totality and could not, therefore, come up with the right remedy.

Part of what makes a homeopathic interview successful is the synergy between you, the patient, and your homeopath. There must be a give and take, a relationship of trust, and an open dialogue. If you have questions, ask them. If you have fears, share them. The homeopath must observe and listen, but no one can see what you do not present.

If in fact there is as much art as science to a good case-taking, then you are as much a part of that creative process as your homeopath. Be as open and as honest as you can and you will reap the rewards in the health, vitality and freedom you have always longed for.

 

 

On Real Parenting

This is meant for all parents who need just that small amount of recognition and encouragement to really help their children.

http://www.huffingtonpost.com/judith-acosta-lisw-cht/limit-setting-and-parenti_b_682565.html

Getting Sober the Old Fashioned Way: Fear

Some people need rehabs. Some people need one-on-one psychotherapy. Some people need consequences. Dire ones.

Everyone is different when it comes to their addictions.

There was one woman who needed surgery.

She was in her 80′s when he went to see a colleague of mine for an unrelated ailment. She had been beaten and cut by her husband for years. To deal with it, she took up drinking. She took it up so well, that she forgot about the abuse but became physically ill. She finally succumbed to the alcohol and had to go in for surgery for her gall bladder.

“They told me my liver was so soft, they almost couldn’t do the surgery at all. So, I said to myself, ‘Barbara Ann [name changed], you may not be very smart, but you ain’t dumb enough to drink yourself to death neither.’ So I just quit.”

That was in 1981. She’s been sober since.

Fear, as they say, can be a great motivator.

Stillness and Trusting in God? Yegads.

Be Still & Know That I Am God.

 

Be still…It’s really such a simple request and such an impossibly difficult task for so many of us as we get older and more acculturated.  It certainly has been for me. I can barely talk on the phone for 15 minutes without washing the dishes or multi-tasking in some other way. America is a culture of action.  We do. We don’t sit.

The problem is that with constant busy-ness comes chronic spiritual insensibility. We can build things, accumulate things, and get from one point on a line to another faster than any other group of people on Earth. We are the cleverest, quickest, and most acquisitive culture in our planet’s history. But we see, feel, and understand less. We have collected data and sacrificed wisdom. We have built colossal glass cities and relinquished our sight.

By the time we are in high school, probably earlier, most of us are set into a rhythm of living. Our eyes are focused ahead and our peripheral vision shrinks with each passing year until we can barely see the tips on our own noses. And unless we can see not only ourselves but ourselves in context, the truth is that we can know very little. It becomes more and more difficult to see any evidence of God, no less know Him. Unless, of course, we’re in deep trouble and a sense of urgency is dramatically renewed.  As one Patriarch of the Russian Orthodox Church has said, “Unless there is thunder, people don’t make the sign of the cross.” The American equivalent: “Everyone believes in God in the trenches.”

Yet, we are continually surrounded by the evidence. We are in a world filled with miracles. Clues are in every corner of our lives. Amma, the Hugging Saint of India, exclaimed that God is everywhere: “If you ask me who is God, I tell you, you are my god. The lion is god. The flowers are god.” Yet most of us don’t see it. Or don’t recognize these clues as such if we do see them. Some of us just forget to look.  But miracles are not empirical. They do not present themselves in the linear, organized manner of double-blind studies. We try but we cannot collect miracle data to analyze. Most people think they will believe it when they see it, but the truth is that we see it when we believe it or are at least willing to entertain the possibility. This is what is meant in Mathew and why we must be as little children to see the truth in the evidence that is all around us.

Two experiences have illustrated to me the urgency of keeping my eyes and mind open.

The first experience occurred when I was 12 years old and I was allowed to take an after-school art class. It was a small, unpretentious event held in the backroom of an old woman’s apartment in the Bronx but it changed the way I saw everything. Instead of looking at a thing and seeing its function first (how it pertained to me, how I could use it, eat it, play with it), it now had a life and a charge all its own. I saw light, form, color, shade, placement in its surroundings. If I tilted my head this way or that, the thing—and all those aspects of it—also tilted. I was suddenly in relationship with the world in a new way.

The second was studying for nearly five years to become a homeopath after already being a psychotherapist for about ten years. Classes would not start until we had all closed our eyes and sat still for a period of time, sometimes for as much as a half-hour. Even as I write this some years later, it hardly sounds like much—what’s a half-hour? But for me sitting still and letting myself be quiet so that I could receive impressions from my patients without actually collecting them, without any judgment or interference on my part was initially as easy as teaching a puppy not to run after a rabbit.  But by my last year (and it was a struggle every time) I began to notice something odd—I started to see more. Information was not just more available, it was clearer and more understandable. This, I began to understand, was where the miracles were to be found.

But understanding was far from enough for me. Humans are a complex and mixed bag of needs, desires and defects. Poised precariously between good and evil, heaven and hell, life and death, dangling between light and dark, the human heart is by nature a busy place, a shifting ground where there is both endless dance and relentless battle.

Stillness does not come easy for me.

I do not sit with much grace.

I have had to find a way to be still of heart and let my body move as it will. So, I do yoga. I walk in meditation and I pray as I hike. Sometimes on those hikes I talk. Sometimes I listen. Sometimes I’m hurt and fearful. Sometimes I’m grateful and delighted. All I can do is bring myself—all of me—to Him, assuming that He can handle it, the awe, the anger, the confusion, the good, the indifferent, all of it, all of me, from the loftiest impulses to the darkest corners of my soul. And what I found was unexpectedly simple: Finding God was like being married. You have to show up for the relationship. All of you. Build it and they will come. The same is true of God.

Be there and He will come.

Shocked by Suffering

In a recent episode of Bones, the psychiatrist on staff, Sweets, is on a train with a kid who’s just received a text. He looks like he’s crying, so Sweets leans over and asks him if everything’s all right. The kid is weeping and excitedly recounts for Sweets how he’s had lymphoma for years and has finally been declared cancer-free. He tells Sweets all the things he’s going to do with his new lease on life. The kid is obviously overjoyed and Sweets is clearly moved by the good news. Because it’s a dramatic series, as the Producers would have it, an earthquake rattles the train, turns the cars up and over, and throws the delighted kid into a pole, killing him instantly.

No one over ten years of age would be terribly surprised by that sort of turn on a dramatic television show.

But Sweets, a psychiatrist whose job it is to support the people who face the most gruesome deaths on a regular basis, is utterly shocked and rattled.

And that interested me even though it was a droll stretch in the script. Because the truth is we are utterly unnerved by the Irony of the Universe. We come unhinged when someone we know has died. “He’s dead? What do you mean?!” we want to know.

Why are we so shocked by death? Why are we so stunned by suffering when it comes, finally knocking on our door? Why does the death of a young man unhinge us when we have lived in the world (in Sweet’s case for a few decades) and seen what the world is made of? Why—when we know there are NO exceptions to the bruising life gives us—do we still think happiness, good endings, and success is some sort of birthright?

I pondered this for a few hours and then it dawned on me: We forget the world is fallen. And it is fallen, all of it…all the time. I don’t much like it and apparently I’d rather forget, too, but I keep getting reminders.

Once I had the misfortune of seeing a large hawk pick at a dying, but still-breathing rabbit underneath a juniper to the side of my garage. It was horrifying, but the deed was done and there was nothing I could do except weep as I walked away.

Sometimes, even years later, that image–that most intimate suffering–will pop up unbidden and unwanted while I’m driving or walking or resting. Every time, even now as I write this, I wince in pain.

As a psychotherapist and homeopath, I work with people whose lives are filled with undeserved misery, whose suffering sometimes boggles the mind and keeps me up at night. I have seen enough to know and it should be enough for me to remember what life is really like.

Yet, I’m no different than Dr. Sweets. I forget because I live in America where I can enjoy long periods of relative ease and comfort. I forget that things are fallen when all seems to be going well, the dogs are healthy, my husband is happy, and my family is at peace. I forget because I’ve been damned lucky.

Up until not too long ago (it embarrasses me to think just how not so long ago that was), I operated under the delusion that somehow everyone else would die, but I would just keep going. And that if I “just did this” or “just avoided that” or “just avoided flying” that somehow my ticket would never get punched. One can get very wrapped up (knotted, really) by this sort of thinking.

I know I’m not the only one, though. I think most of America operates under this delusion and because of it many, many people spend a great deal of their lives anxious—fearful, to be more accurate—and trying desperately yet vainly to control as much of their environment as they can.

Acknowledging the fallen nature of the universe does not mean we stop lamenting suffering, or stop praying for the recovery of a loved one, or ignore injustice or walk away from a wounded animal.

To the contrary.

At least for me, finally coming to terms with the nature of existence and my own mortality has set me free. I no longer have to struggle against the way it is. I no longer worry about “what ifs.” I no longer try to control the things that are uncontrollable. I know that there is little I can do about suffering (though I will never learn to shrug it off) and I accept its inevitability.

What I can do, though, is be truly present to those who are in its grip and I can give more of myself to the things I really can do something about. For instance, the other day my husband and I stopped by a wild bird supply store to pick up some seed. We got to talking with the shopkeeper and we asked her about the sudden disappearance of all the smaller song birds in the area. Where we used to get flocks of robins, finches, titmice, bluebirds and juncos, now we saw absolutely nothing. Not a one in the birdbath. No one on the feeder.

She said, “That’s odd. Maybe you have a predator?” I hadn’t seen anything, but I yielded the possibility. We are, after all, in the foothills of a large mountain and federal land.

The next day while driving home I saw something bizarre: a young hawk standing in front of our house by the edge of the road. I thought it was a hawk, anyway. I stopped the car and the bird looked at me with utter indignation and tried to fly away.

Instead he flopped. His wing was broken. I ran into the house, yelled for my husband to come out with a towel and leather gloves. I said, “Don’t ask, just hurry.”

It was getting dark and I knew if we let him stay there, by morning the coyotes would have found him. Or he would soon die of the pain, an infection or starvation.

We ran after him a little while and finally managed to throw the towel over him. My husband picked him up and we held him in one of the dog crates, covered, until we got in touch with a friend who’s not only a medic but a top-notch expert on raising birds of prey. When we brought the bird to him, he looked at it and exclaimed, “It’s not a hawk. It’s a kestrel. He’s a full grown falcon!”

It was a joyous relief to learn the next day that he’d been handed over to a rehab, Talking Talons, for surgery and hopefully release back into the wild. So, the birds have started returning.

But it is all such a frail thing; it all hangs in so precarious a balance. For them to come back, one kestrel had to be severely wounded.

I am no great mystic. I understand relatively little about how things are the way they are. But I have learned a few things that help me to observe truly and keep my center. The most important one is the simple knowing that if the world is indeed fallen, there was a fall. And if there was a fall, there was a place, a higher place from which it fell. That means that it was created to be quite different than the way it actually is and that it can—and will—be restored to its proper condition, as God intended.

This I do believe—we all, the falcon, the small birds, the Boy on the Train, and all that suffer will one day be redeemed and made new. There will be no balance beam to totter along, no “ironies” of natural law, no struggle to make palatable that which is intrinsically intolerable, no need for philosophical pockets big enough to hold the suffering of the innocent.

One day, the debate will be over. The train will be made to set right on the tracks again. In my mind I hear some of the last words of the last book of the Narnia series when the battles are all over and Lucy, Edmund and Peter stand at the end of all they have known, before all they have ever hoped to know: “Welcome, in the Lion’s name. Come further up and further in!”

On The Way to Becoming A Healer: The Journey of a Young Social Worker

(This article is dedicated to R.M. who inspired it. Thank you for reminding me of what we are supposed to be doing.)

For some reason lately I have been seeing quite a number of brand new social workers for supervision, some of whom are still in graduate school. It has been a poignant and privileged rite of passage for me after all these years to be passing on what I’ve learned.

One in particular touched me. She worked some time ago in a hospital emergency department in another state. As you might imagine, she bore witness to countless tragedies and sorrows, the worst of which was one little girl who had been beaten so severely by her mother’s boyfriend that they didn’t know if she would make it.

When she originally came on the ward she had been warned by the other professionals on staff to “watch her boundaries.” That’s a trigger point for social workers who, as a group, have been known to go the extra mile for patients and clients. This has become an “issue” for the profession as it has grown over the years and tried to maintain its status along with psychologists and physicians. What the well-meaning advisers meant was that she would be facing horror and that she needed to “detach” and “not bring it all home with her.” The real meaning: don’t get involved.

Those were their words. People warned me the same way when I started out.

I have been a psychotherapist and crisis counselor for nearly 30 years. I have worked with rape victims, survivors of war, children who had been abducted by drug lords, parents who were abused by their own offspring, addicts who had been lost and left to die on the street, and a full retinue of the mildly neurotic. I have stared into the abyss with friends and colleagues at Ground Zero and had to breathe the acrid smell of death.

But what I have learned is that there are boundaries and there are boundaries. Some should be zealously guarded and some not so much. And whenever I have made a real difference I have absolutely become involved though not in the way you may imagine or some may fear.

I will explain through her story.

As the baby was being treated, she called the proper authorities, as was legally required. She watched as the mother and boyfriend were carted away. And she stood nearby as the baby, broken and battered, moaning in pain, was gently set to rest in a small bed in PICU.

She was told to go home, that she’d had a hard day, and to have a glass of wine. There was nothing more to do.

But something inside her rebelled at that: there’s nothing more you can do.

And, against all the advice of authority, against all the warnings, she went into the PICU and sat with that little girl, breathing gently with her, resting her own fingers carefully in the child’s small hands, smoothing the downy hair on the little girl’s head, the one place that had gratefully been spared from the brute’s rant. She sat with her for hours until the little one was able to rest. She talked to her. She sang to her. She hoped for her. And then she reluctantly went home.

The case moved on from there and she doesn’t know what happened to her or the family. But there she was in my office, years later, wondering if she’d done something horrible by not letting go, by not listening to the advice of the nurses and administrators who told her to detach, to not take it home. “Did I make a terrible mistake?” she wanted to know.

Through tears as I listened to her and through tears as I write this, I said “No. You did everything right.”

She didn’t understand how she could be right and feel pain that way and disobey the warnings she’d been given. But I did. And I have found that when you do the right thing, there is often no way to sidestep the pain and sorrow that is common to us all. Nor should there be.

Suffering and Professional Boundaries

Social workers’ boundaries are important, but not in the way we might think.

I think there are actually two separate questions in this larger issue and it is a far more complicated topic than people might imagine.

Boundary Question One: How do we face suffering and not get lost in it? How do we help people in pain without absorbing it? How do we have empathy and compassion without becoming the patient? What do we do with suffering if we can’t fix it?

Boundary Question Two: How do we treat people in a clinical setting and keep our focus on them rather than using the session or relationship as a way of working out our own lingering issues? How do we stay clear-sighted about the pathology and vigorous in our pursuit of  health and the well-being of our patients?

These are two separate issues and I believe that we often confuse them in clinical practice.

I hope I can answer them both briefly and simultaneously by drawing on my experience and explaining what I think is necessary in any healing relationship.

Over the years, despite accruing more and more “tools” for my clinical tool bag, despite learning more and more techniques and styles, I have actually simplified. One of my mentors in graduate school told me, “Learn them all well so you don’t have to use any of them.” I didn’t know what she meant then, but I do now. She also told me, “Don’t for a second think it’s you doing the healing. It’s the love.”

So, the distillation is this:

  • Presence and Pacing
  • Compassion and empathy
  • Seeing someone fully without bias and without projection
  • Spiritual context

Presence and Pacing

Presence is paramount. It is foundational. The ability to be fully present in the moment with whomever is there, with whatever situation confronts you, is to be adaptable, available, and genuinely healing. It addresses both Question One and Question Two in that being in the moment (as opposed to the past or the future) allows you to feel fully, be ready to do what is needed, and then move on to the next moment. When you are in the moment truly, you will be more adept clinically. You will know the situation at hand is not about you and that it will not last. You can fully feel and know that when you go home you will be fully present to the joy and life that is there.

This is not easy and it has taken me many years to learn. Being present has a caveat. It means we are there for all of it—the pain, the glory, the defeat, the sorrow, the loss, and the redemption. All of it.

Pacing is a term coined by Milton Erickson, M.D., the greatest hypnotherapist in American history. It  is also a technique I focus on quite a bit when I teach Verbal First Aid to first responders, medical personnel and clinical professionals. It means to “move with” or “walk along.” It can include mirroring (to some extent) but I use it mostly to stress the act of being with another person. When a person is in pain and we are hoping to move them to a state of greater comfort, we do what is called pacing and leading. We pace their pain (I can see your wound and your discomfort…) and then lead them, sometimes one tiny step at a time, to healing (…so as I hold your arm and apply this bandage, you can rest more comfortably and stop the bleeding). Without the pacing, there can be no proper leading.

Pacing requires presence. Presence implies pacing. It is an emotional and spiritual partnership that may last anywhere from a few seconds at an accident scene or at an ER or go on for years in a psychotherapy setting.

Compassion & Empathy

This is not the same thing as taking on another’s pain. It is a communion, an experience of commonality, not a sympathy or an absorption. It is also NOT a projection of our own feelings onto them and this is where our skill must be honed and refined over and over again. Sometimes it means feeling what someone else is feeling, but that doesn’t mean it’s ours. It is a subtle difference, but an important one.

Many of the patients that come to social workers have been hurt terribly. We may in fact be the first person in their lives to genuinely feel them. (S.W. Recall: Winnicott’s “The Good Enough Mother.”) This can be in and of itself enormously healing.

What I have come to both believe is that feeling is not the problem. Over-interpreting and/or ignoring feelings is the problem. And that’s where we—as healers—can get into serious logjams.

In fact, it is the social worker’s ability to feel fully (and know what to do with those feelings) that is the hub of all clinical work. If we can’t do it, how do we expect our patients to do it?

Seeing Fully

When I was in school for classical homeopathy, my teacher used to warn us, “If you can’t see your patient, you can’t heal him.” He spent five years talking to us about the power to see.

I think this is true in any clinical setting. We open the door, a patient comes in and sits down. What do we see? What do we want to know? Can we see the hurt? What’s broken or bruised? What still works? How does it still manage to work?  These are the questions we want to ask and have answered.

Seeing someone truly may also entail some detachment, but not in the way it is used colloquially, which is to “not feel” what our patients are feeling. To see the truth means not get beguiled by façade. Most patients will come to us with a well-practiced façade in place, a mask they use to get through their lives—to hide pain, to forestall an accounting, to deceive and manipulate for one thing or another. We have to see past those deceptions, both conscious and unconscious. We have to see past the acquired skills and into the recesses of a person’s heart. We have to observe carefully. They may say they feel fine, but they can’t stop biting their nails. They protest over much about how calm they are, but their feet don’t stop tapping, they sigh repeatedly, or their eyes twitch.

As healers we are observers. Both of ourselves and our patients.

Spiritual Context

I cannot imagine doing this work at this point without two backups: One is the homeopathic philosophy and Materia Medica of Samuel Hahnemann and the second, most important one, is God. Suffering is intolerable (our own or anyone else’s) without some context within which we can hold it. Suffering or pain without meaning in a purposeless, random world is utterly intolerable. When there is meaning and purpose, even the worst pain becomes manageable.

Over the years, my work has become more about serving God (this is not about proselytizing by any means) than adhering to an agency code or a diagnostic manual, more about being present and truly healing than politically correct for the moment, more about truth and love than techniques.

I explained it to that young social worker that while others may not have understood what she did for that baby, God did. And the baby did. I am as sure of that as I am of the nose on my face. That baby heard her soothing voice, felt her calming breath and heartbeat, rested in her loving hands. Is there a better “technique” than that? I don’t think so. Those few hours she spent with that child may have changed the trajectory of her entire healing process.

I no longer aim for detachment, though I respect it. I no longer aim to fix every broken thing that is presented to me, though I very much want to alleviate suffering and disease. I no longer aim solely for technical skill, though I love learning.

What I am for is this: I aim to be present. I aim to see the truth. I aim to serve. Doing this work for so many years has required that I become more like a tube than a vessel. I do not “hold” other people’s pain, but I allow it flow through me and then up to God, Who can do with it what must be done, whatever that is so that peace and health and love are restored.