Narrative Therapy and Re-Authoring
Many titles have been heaped upon the late Michael White for his development of Narrative Therapy, ranging from genius to prophet to guru. These titles, I believe, provide a framework for the impact that his work has meant to the field of psychology and therapy. He has created a forum for individuals to reclaim their sense of identity and purpose and to begin to live into a new story. As Alan Carr writes, “within a narrative frame, human problems are viewed as arising from and being maintained by oppressive stories which dominate a person’s life. Human problems occur when the way in which people’s lives are storied by themselves and others does not significantly fit with their lived experience…Developing therapeutic solutions to problems, within the narrative frame, involves opening space for the authoring of alternative stories, the possibility of which have previously been marginalized by the dominant oppressive narrative which maintains the problem” (Carr, 1998, p. 486).
A critical component of narrative therapy is the concept of externalizing the problem whereby the person objectifies or personifies the problem as a separate entity from the individual. In doing so, the person is able to “separate from the dominant story that has been shaping their lives and relationships” (White, 1988/9, p.7). When persons are able to externalize the problems they are then able to identify times when their experience contradicts the problem (White, 1988/9, p. 16). In the end, the problem becomes the problem allowing the person’s identity to become separate. The problem no longer represents the truth about who the person is and this realization unleashes incredible opportunity for hope and resolutions to occur as the person is able to step back and view the situation from a less personal and problem saturated perspective (White, 2007, p. 9). Carl Tomm suggests that externalizing the problem provides, “a linguistic separation of the distinction of the problem from the personal identity of the [person]. It opens ‘conceptual space’ for [people] to take more effective initiatives to escape the influence of the problem in their lives (Tomm, 1989, p. 54). Externalizing the problem and then becoming aware of ‘unique outcomes’ where the client finds that their life is no longer tied to these negative conclusions allows them to begin the process of re-authoring their story (White, 2007, p. 27).
The process of re-authoring allows a client suffering from substance abuse to begin to develop their story but to integrate significant unique outcomes that were out of step with the dominant storyline. These unique outcomes are the starting point for re-authoring. The therapist can support the client in exploring alternative storylines by having the client “…recruit their lived experience, to stretch their minds, to exercise their imagination, and to employ their meaning-making resources” (White, 2007, p. 62). In so doing, the client engages more deeply into their alternative stories and begins to root their storyline in a new history and perspective which establishes a new foundation for them to address their externalized problem. As the client steps to becoming the author of their life, they begin to play with the terms Jerome Bruner coined ‘landscape of action’ and ‘landscape of consciousness’ which, “…bring specificity to the understanding of people’s participation in meaning-making within the context of narrative frames” (White, 2007, p. 80). Michael White found that landscape of consciousness encountered too much confusion so he reframed the term to become the landscape of identity which, I believe, aptly describes what occurs when one re-authors their story and renegotiates their own identity. Using landscape of action and landscape of identity allows the therapist to build a context, “in which it becomes possible for people to give meaning to, and draw together into a storyline, many of the overlooked but significant events of their lives” (White, 2007, p. 83) which are crucial for re-authoring.
In January we’re launching our Recovery and Aftercare programs, and we would love to work with you to re-write your story in your recovery. Please have a look at the program on our website, and we would love to hear from you!
- Carr, A. (1998). Michael White’s Narrative Therapy. Contemporary Family Therapy: An International Journal, 20(4), 485-503.
- Tomm, K. (1989). Externalizing problems and internalizing personal agency. Journal of Strategic and Systemic Therapies,16-22.
- White, M. (2007). Maps of Narrative Practice. New York, W.W Norton and Company Inc
- White, Michael, 1998/9. The externalizing of the problem and the re-authoring of lives and relationships. Australia, Adelaide: Dulwich Center Review
It’s been a difficult couple of months holding back on this announcement, but I’m excited to announce that we will be expanding to South Surrey and White Rock in January 2018! We have wanted to get into Surrey for a while to bring our services closer to home for some of our clients, and we have found a great space in the Morgan Crossing neighbourhood. For those of you wondering, yes, it’s right next to the shopping centre some of you love!
One of the challenges in expanding is that our goal is not simply to expand and build a brand. If we were a retail shop, expansion may come down to different goals and principles, but we’re not – we’re an integrated health clinic and our goal has always been to embed ourselves in the community, find out what the needs are, and try our best to meet those needs. So, our expansion needs to be intentional, meaningful, and to model after our growth in South Delta. We’ve been searching for the right location to allow us to do this, and I believe we’ve found a great space that will allow us to do exactly what we hope to do again – that is, get to know the community of White Rock and South Surrey, find out what the needs are, and bring those services that the community is asking for.
Thus, we are starting small. We’ve found a great space that our colleague, Dr. Jeff Morley has graciously allowed us to come into. It’s one large room that will allow us to provide individual, couples, and family counselling, neurofeedback, registered dietitian services, as well as bring our Dialectical Behaviour Therapy (DBT) group program to the area. Over the next year, I’ll be spending a great deal of time, along with my wife, Meg Neufeld, getting to know the community better and connecting with key partners to figure out the best way to serve the needs of the community.
Now, we have a bit of a head start. I had the privilege of working with White Rock Mental Health at Peace Arch Hospital for a number of years and have been able to build relationships with many of the agencies in the area. Scott McNeil, our associate, worked there as well as did Share Forde, who provides Dialectical Behaviour Therapy with us. There are some great resources already in the area, and we hope that, like in South Delta, our services will help to fill some of the gaps and that we’ll be able to work collaboratively with the community agencies that are already serving in the area.
Who is going to work in the new office, you might wonder? Well, that’s a great question. We’re kind of taking the same approach as we did in South Delta, that is, jumping off the proverbial cliff. I’ll be in the office there on Thursdays, and likely spending much of my Fridays in the community networking. We are working on hiring staff for the office, but as many of you know, we are very careful with who we bring on because we don’t want to simply hire a bunch of staff, we want to hire the right staff. So, we are building as we go. We have one staff hired, some of our South Delta staff will be working there as well, and we’ll be adding more soon. Stay tuned for more announcements on that front!
All this to say, we’re excited to be entering another community that is near and dear to our hearts. We look forward to bringing the same heartfelt, evidence-based, collaborative community care to South Surrey and White Rock that we’ve been providing in South Delta since 2015. We’d love your help! If you’ve benefitted from our services and know people out that way, please help us spread the word! We’re working on revamping our website and updating things, but in the meantime, here’s a google map of our new location, and the address:
208 – 2630 Croydon Drive
Phone number and fax numbers, emails, and everything else remain the same!
We look forward to serving the community in White Rock and South Surrey as we grow out there, and if you are a service provider in the area and would like to connect with us, please give me a call or contact us; and if you know of one we should connect with, please let me know!
At Alongside You, we’re always looking to see where needs are in the community and how we might be able to meet those needs. Together with our associate, Richard Somerset, we’ve found that there are areas of need in recovery and aftercare programs. Richard and I have worked for many years in addictions and recovery and one of the needs we’ve identified is services for people once they have come home from treatment centres. Of course, treatment centres are wonderful and needed, but what happens to clients when they come home?
In order to fill this need, we have been working on developing comprehensive Recovery and Aftercare programs for clients once they return home, as well as developing relationships with the major treatment centres to provide referrals for treatment for those that need it. The goal is to have a seamless transition and experience both going to, and coming back from treatment to support each client in their recovery.
One of the advantages we have at Alongside You is being able to provide all of these needed services under one roof. We’ll be able to handle individual, couples, and family counselling, neurofeedback, occupational therapy, yoga therapy and trauma-sensitive yoga, registered dietitian assessments and nutrition planning, therapeutic arts programs, and group therapy that incorporates process groups and dialectical behaviour therapy. Along with our community partners, we’ll be tying in exercise and martial arts programs, sober living activities, sober coaches, and more. Recovering from an addiction or problematic use of a substance is a long-term recovery process and we are here to provide the long-term support. We attended the Recovery Capital Conference of Canada this past September and one thing that was highlighted, that we see daily in our practice, is that it takes an individual’s brain two to five years to recover from misuse of substances. A 45-day stay at a treatment centre is a great reset and start to a recovery program, but it’s only the beginning. Our hope is that our Recovery and Aftercare programs will fill the void and support clients on the two to five-year journey it will take for their brain to rewire itself.
We can’t do everything at once, and so we’re starting with a three-month, recurring program that addresses the core needs we see from clients returning from treatment – that is, continued group work and individual counselling. Additional treatments and services are available as add-ons based on client need and interest to support the core program. We also want this program to be open to those who may have been able to stay at home and recover. We will be providing an assessment to see if our program is a good fit for those who may not even have gone away to treatment and are looking for an ongoing recovery solution closer to home.
We’re excited to launch these programs and meet more of the needs that we are seeing. At the end of the day, the number one focus for us is complete and comprehensive client care that is client-centred and recovery focused. Recovery Capital is the sum total of the resources available internally, and externally to people in recovery and our goal is to increase recovery capital in our community and with our clients. Recovery capital is client-centred, trauma-informed, and strengths-based. It builds on the internal resources of the clients, helping each of the clients rewrite their story and to have a life worth living. If we have a life worth living, we have a life worth striving for.
For more information as we launch our program in January 2018, please see our website. If you are interested in signing up, please give our office a call or contact us and we will be glad to start the intake process with you!
You may have heard talk of DBT, but have absolutely no idea what it stands for, after all, psychology loves its acronyms. DBT stands for Dialectical Behaviour Therapy, a newer therapeutic orientation that shares some similarities to Cognitive Behavioural Therapy (CBT), but with many substantial differences. Originally developed by Marsha Linehan, DBT was first and foremost meant as an effective method of treatment for individuals with chronic suicidal thoughts and suicide attempts, and later identified as a primary treatment for Borderline Personality Disorder (BPD). The scope of usefulness of DBT has expanded, incorporating primarily eating disorders, anxiety disorders, and mood disorders.
Regardless of the populations, this treatment was developed for, one thing that has become apparent to me is that everyone could benefit from the skills taught in DBT. Often, I’ll find I’m sitting there thinking, “Wow, I don’t even know how to handle these situations…” DBT isn’t just for people with BPD or people that have something “wrong with them,” but rather for anyone and everyone looking to improve their coping and interpersonal skills.
The basic premise of DBT is dialectics, which refers to the philosophical principle of opposite truths. This idea suggests that an individual can hold opposing viewpoints simultaneously while looking for truth in both positions; opposite views can exist in one person at the same time. This concept can often ring true in individuals struggling with suicidal thoughts. It is entirely possible that someone can both want to die and want to live while finding truth in both of those contradicting statements. These opposing viewpoints lead to tension and conflict, which may be necessary to bring about change. Dialectics identify multiple truths inherent in any situation and promote flexible thinking, a nonjudgmental stance, and active application of mindfulness.
DBT is comprised of four main modules: mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation. Let’s have a look at what those modules involve!
Mindfulness is the first core skill taught and one might say the most instrumental; without mindfulness, the other modules may prove ineffective. One of the main concepts of mindfulness is the concept of “wise mind.” This is a construct that is returned to time and time again throughout skills training. Wise mind is the idea that every individual has a rational mind and an emotional mind with the wise mind being a healthy balance of the two. If someone is too far into rational mind then they are not experiencing any intuition; if an individual is too far into emotional mind they may not be able to make sound decisions. Returning back to the idea of dialectics there are truths inherent in both rational and emotional mind and it is important to learn to balance the two. The purpose of mindfulness is to cultivate nonjudgmental attention to the present moment for the purpose of activating and maintaining wise mind by observing, describing, and participating without judgment and with the intent to be both effective and mindful.
Distress tolerance can also be viewed as “crisis skills.” In this module, individuals learn how to tolerate strong dysregulated emotions when immediate solutions are not readily available. Some skills taught in this module are distracting or self-soothing activities, with a later emphasis on willingness and radical acceptance for more enduring life challenges. Let me tell you, after learning about radical acceptance I can say without a doubt that it is one of the toughest skills and I will be hugely proud the day I can effectively utilize this skill. Radical acceptance is not saying something is right, fair, or permissible, but rather saying that what is, is and that it is outside our power to change in the moment.
Relationship skills are divided into three sections: reaching goals, making and maintaining relationships, and maintaining self-respect. A common challenge to this module is the complaint that the skills taught are less effective when the other party is unwilling to engage in these techniques. If an individual is learning these skills so that they might better interact with family, friends, or partners, how much more useful would it be if the other party also participated? The most common answer is “very useful,” or, “they need these skills just as much as I do.” This is also one of the reasons that family DBT groups are becoming more popular.
Emotion regulation is taught in the context of self-validation and requires a constant application of mindfulness skills. Individuals learn to name and identify emotions, how emotions are triggered, and gain an awareness of associated bodily sensations that give rise to various thoughts and action tendencies. My favourite part of DBT thus far is the idea of self-validation around emotions; no emotion an individual feels is wrong but perhaps the way they are expressing it can be attended to. In other words, there is nothing wrong with feeling angry; anger is a natural emotional reaction to certain situations, but if our bodily response to anger is to punch someone in the face then this behaviour may need to be addressed and adapted to a more socially and legally acceptable action.
All in all, the more I learn about DBT the more I find myself thinking, “it all makes so much sense!” The validation inherent in DBT provides a sense of not being broken, but rather just needed to make a few adjustments. As a student I balance dialectics every day thinking, “I can do this,” and, “there is no way I can do this;” this is all part of the learning process that I intend to keep following, because at the end of the day if we stop learning, we stop living – and the whole goal of DBT is to have a life worth living!
Please call us at (604) 283-7827 if you have questions about what our DBT Group is about and if it’s the right fit for you
If you’d like to learn more, email me directly at email@example.com.
 Lenz, A. S., Del Conte, G., Hollenbaugh, K. M., & Callendar, K. (2016). Emotional regulation and interpersonal effectiveness as mechanisms of change for treatment outcomes within a DBT program for adolescents. Counseling Outcome Research and Evaluation, 7(2), 73-85. doi:10.1177/2150137816642439
 Long, B., & Witterholt, S. (2013). An overview of dialectical behavior therapy. Psychiatric Annals, 43(4), 152-157. doi:10.3928/00485713-20130403-04
 Rizvi, S. L., Steffel, L. M., & Carson-Wong, A. (2013). An overview of Dialectical Behavior Therapy for professional psychologists. Professional Psychology: Research and Practice, 44(2), 73-80. doi:10.1037/a0029808
You know those airline safety announcements where they tell you to put your own oxygen mask on before your child’s?
There’s a reason they do that. Without us making sure we are safe first, we can’t guarantee the safety of our child. If they pass out, you can protect them. If you pass out, they cannot help you.
Being a parent isn’t just about giving your child everything they need all the time. It isn’t just about telling them to brush their teeth more. It isn’t just about giving them all the right answers, or making sure they’re doing their homework. It isn’t just about encouraging them to ask questions and explore their world, telling them they can do whatever they put their mind to – though these are all wonderful, beautiful things. Being a parent is about being who you are. That’s who your child needs you to be.
Children need safety and security more than anything. They need to know, “I’m okay. Mom and Dad have got this. I can play and explore, and be everything I want, because I know I’m safe. I don’t need to worry.”
When they don’t know what to do in a situation, they look to you and wonder, “How is mom going to act here? What does she believe is important in the world? What are her priorities? How does Dad see himself? What does he care about?”
It’s the old classic line: do as I say, not as I do. We want the best for our children, because we love them. And we will make tremendous sacrifices to that end, which is an incredible testament to human love and attachment.
But, if we lose ourselves in the process, we can’t be the answers our children desperately need. We need to learn to take care of ourselves before our kids will internalize how important self-care is. Want your kids to brush their teeth at night? Brush alongside them. Care about your own health; not because you’re supposed to but because you genuinely believe that you’re worth taking care of (because you are!).
To be who you are means taking time for yourself. Time to rest, to reflect, to have fun, to connect with people you care about, to sort out what you believe about the world, to exercise – to learn and grow. To make yourself better and happier. Take a painting or cooking or music class if that’s what you’re into, even (actually, especially) if it feels like the world would end if you took just an hour for yourself. Go get a massage, or rehab for that old sports injury that’s been getting you down. If all of this seems like a fairy tale, I’d love to sit down and have a chat with you about it sometime. Parental guilt gets in the way of self-care a lot – and we give in. We say things like, “I can’t do that because my kid needs me,” or, “I can’t go get a massage because that’s selfish,” and more. What we model to our kids, and the resources we equip ourselves with matter.
When your kids see their parents loving themselves, they will love themselves too. They will grow up believing they’re worth something, just because we, who believe we are worth something, care so deeply about them.
Lastly, when you make time for yourself to grow, recover, and rest, the time you spend with your child, your partner, and your friends and family will be of such better quality. You will have more to give in that time. Even if the world is falling down around you, you will be able to cope better with that stress. If you’re the type who likes hard evidence for this type of stuff, I’d encourage you to check out the work of Dr. Dan Siegel, or check out this playlist of TED talks about the importance of self-care.
One other thing to remember, this is a lifelong journey – it’s not a quick fix. But taking the first few steps toward taking better care of yourself, or even just towards believing that you’re worth caring about – those are some of the best steps you can take. You will be really, really glad you did, and your kids will be better for it!
We know this is hard to do as parents, if we can be of any help as you walk through this, please give us a call, we’d love to help!
If you’d like to learn more, email me directly at firstname.lastname@example.org.
You wake up and it’s still there; that dull pain in your body that reminds you of your chronic condition. You feel like staying in bed all day, but you know that would leave you in even worse shape. So, what can you do to get through the day? Here are five ways to manage daily chronic pain:
- Begin to breathe – with intention.
Yes, breathing is essential to live, but doing mindful breathing can calm our body, focus our mind, and alleviate stress. Sit comfortably with your eyes open or closed. Start by breathing in and out, noticing the rise and fall of your breath, and the sensations in your body (shoulders, stomach, nostrils). Notice all the sensations all around you (smells, sounds, presence). Take deep breaths through your nose as slow and controlled as possible, and exhale through your mouth as slow and controlled as possible. Try to make this process of breathing in and out last for a total of 7 seconds or more. Refocus your gaze to end the exercise.
- Be realistic of daily goals.
The busyness of life doesn’t stop for someone who has chronic pain. Those of us who have daily pain, however, need to prioritize daily activities and goals based on how we are feeling on any given day. It’s a hard pill to swallow realizing that we can’t do it all. Start with having just one or two things on your “to do,” list for the day, week, or month. Empty the dishwasher, check. Pick up library books, check. Starting small and completing a short list of manageable goals will reward you with a great sense of accomplishment.
- Get moving.
Even though our natural tendency is to want to curl up in a ball when we are in pain, staying stationary is one of the worst things we can do. Our brain and body need stimulation and range of motion to heal and to cope with pain. Staying active may look different to people based on their pain. For some, a successful active session can be as simple as walking down the block and back each day and for others, doing moderate cardio activity for 20 mins a couple times of week is right for them. Change it up every once in a while to make exercise fun and interesting. Don’t forget to add some intensity or to lengthen the duration of your exercise sessions every now and then. Doing too much too soon may backfire, but test your limits – you never know if you can do something until you try!
- Rest well
Alternate your day between periods of activity and periods of rest. Start by setting aside just 30 mins of your day to rest your body and mind well. By well, I mean ‘set the stage’ to help you have the best rest possible. Based on your pain, find a comfortable place to rest with some of the following: low light, heat pack, ice packs, eye patches, soft music, a mindfulness meditation app or even have a hot bath. Maximize your time of rest and it will help get you through other parts of your day!
- Tap into your spiritual side
Yes, this may be uncharted territory for some, but reading, journaling, praying, making art, or listening to something meaningful can help you to self-reflect, manage your emotions, set goals, and can really put things in perspective. There are times in your chronic pain experiences where you will need to draw inner strength, so make sure to build it up!
For many of us, chronic pain is here to stay so we might as well learn how to cope….HAVE HOPE.
Want to learn a new way to cope with your chronic condition or chronic pain? I am leading a new course on chronic condition and chronic pain management through mindfulness based art practices in January. See below and check it out, I’d love to have you!
Meg Neufeld, (MA) is the co-founder of Alongside You, an integrated health clinic that offers yoga, pelvic rehab, registered dietitian services, clinical counselling, group therapy, and therapeutic arts. As a cultural anthropologist and an artist herself, Meg seeks to make art accessible to people of different abilities, diagnosis and age. She is trained in Mindfulness-Based Art Therapy practices and has a particular interest in using art as a pain-management strategy in her own life.
What is chronic pain?
Most of us have felt physical pain before: we’ve pulled a muscle, had a headache or bumped our funny bone (which really isn’t very funny at all!). The pain we experience is our body telling us something is wrong and after a period of rest and healing (up to three months), we can typically go back to normal activities. Chronic pain is when our brain is in an ongoing state pain and heightened sensitivity that persists longer than 3-6 months. Despite common understandings of pain as being a purely physical reaction, pain is actually directly linked to our brain and nervous system. This video highlights the complexities of our brain and nervous system and identifies the ways in which medication, exercise, diet, medical procedures and emotional processing can help retrain the brain and improve the quality of life for those who suffer from chronic pain.
Whether persistent pain takes the form of back pain, migraines, arthritis, fibromyalgia, endometriosis, lupus, other invisible illnesses, the chronic pain experience affects the body, mind, and soul. While each person’s experience with pain is different, there is a range of common threads:
- Everyone has their own definition of a good day and a bad day. Simple tasks may be manageable one day and not the other.
- In order to “self-manage” daily symptoms, there is a constant need to balance or carefully plan periods of rest, work, exercise, social activities, diet, sleep, and spiritual connectedness.
- It is challenging to talk to family and friends about our pain. The impact on family and friends can be devastating as roles, expectations, and relationships change because of the pain.
- Pain is challenging to treat. The constant rotation of medical appointments, medications and medical procedures can be exhausting and what may work for one person, may not for another.
- Chronic pain goes hand-in-hand with mental health and evokes strong emotions as attempts are made to cope with a loss of purpose, former abilities and relationships.
How can we tackle chronic pain?
The chronic pain experience is riddled with complexities; it has both physiological and psychological components, making a holistic approach in tackling chronic pain the most effective way to approach treatment planning. This video highlights the importance of a multi-disciplinary approach. As a result, we need to find ways to reboot our nervous system, learn productive skills to manage our symptoms, help educate others on chronic pain experiences, and strive to have a better quality of life.
HOW MINDFULNESS-BASED ART ACTIVITIES CAN HELP PEOPLE WITH CHRONIC PAIN
“Art gives a face to the ambiguity of chronic pain …
it gives a visual expression to something that is often elusive.”
–Dr. Steve Feinberg, American Chronic Pain Association
What are the overall health benefits of making art?
Using art for its health benefits is widely becoming a critical component of healthcare. Art helps us explore, practice and develop our creativity as a means to promote health and well-being. Making art has several benefits in key areas:
- Mental Health: Making art reduces stress, protects against depression and anxiety, can improve self-confidence[i] and encourages positive self-care. Doing something creative in a supportive and safe environment encourages experimentation and risk-taking, two essential qualities of the art-making process.[ii]
- Social Health: Those that participate in creative activities are more likely to have wider social networks with people from different backgrounds, have a sense of belonging, and are less likely to be socially isolated and lonely.
- Brain Health: Art making is an effective preventative tool in managing symptoms of diseases such as Dementia, Alzheimer’s disease, and other chronic conditions. It also improves memory processing, problem solving, and helps to maintain neuro-spatial functions as we age.
- Emotional Health: Creative engagement can provide a healthy outlet or path to healing for those who have suffered trauma, abuse, or significant life changes. Doing something creative can act as a distraction tool and is another way to preserve self-identity and move forward.
Using Mindfulness-Based Art Therapy (MBAT) techniques to tackle chronic conditions
According to Jon Kabat-Zinn, a leading researcher on mindfulness-based programs, mindfulness is, “the ability to become fully present in this moment, in a particular way, with a non-judgmental attitude.” [iii] Combining mindfulness skills while making art can be an effective way to manage symptoms of depression and anxiety, improve pain tolerance, and elevate the quality of life of people with chronic pain [iv] [v] and illness,[vi] including those with arthritis[vii], Dementia and Alzheimer’s disease[viii], and cancer.[ix]
Why does MBAT work for chronic pain management?
Mindfulness is a frame of mind; a decision is made to intentionally pay attention to the present moment when doing an activity. It is an effective way for the brain to concentrate on surrounding senses other than the pain itself. It involves resting the physical body (doing body scans) and the psychological mind. Art therapist and facilitator Margaret Jones Callahan describes mindfulness-based art therapy (MBAT) as the “appreciative inquiry mindfully applied to the empty page or the open space. The practice of holding one’s awake attention fully in the present moment, non-judgmentally, while in the act of creating and expressing,[x] acknowledges the presence of pain and helps to get through it, moment by moment. While mindfulness is the lens in which to approach a particular moment, making art is the vehicle with which you experience it. Mindfulness-based art therapy:
- Promotes both the healing and rehabilitation process and is a way for chronic pain sufferers to “’lose themselves’ in the moment,”[xi] (also known as “being in the flow”) giving the nervous system a break.
- Provides temporary respite from physical symptoms of pain (headache, nausea)
- Is an effective method of distraction and promotes positive self-management skills to filter emotions and is a way to express suffering.
- Can build social alliances, companionship, and social affirmation, creating a wider support system with family, friends, and peers. Making art with others lends another way to talk about or communicate with others about pain experiences.
- Allows space to be self-reflective and helps monitor growth and progress in a visual manor.
- Affirms a sense of control over surroundings in the decision-making process of selecting colour, shape, and images.
At its core, MBAT, strives to create a peaceful environment where one can be completely absorbed in the moment while immersed in the process of creation. Along with healthy changes to our diet, sleep, and exercise regimes and with attentiveness on empathy, intentionally putting time aside to do something creative (read, write, paint, knit, sing, do yoga[xii], or dance) can help lower stress levels, give our nervous system a rest, and helps to promote self-care habits. By using a variety of creative processes, health difficulties can be better expressed, understood, accepted, and transformed.[xiii]
If you’d like to experience how MBAT can help you manage your chronic condition, please feel free to give me a call, or email, or come to our Open Studio Sessions where we go through many of these techniques! Give art a try!
[i] McNiff, Shaun. Chapter 2: The Role of Witnessing and Immersion in the Moment of Arts Therapy Experience. P. 40. In Mindfulness and the Arts Therapies: Theory and Practice. Laury Rappaport ed. Jessica Kingsley Publishers. 2014: 38-50.
[ii] McNiff, Shaun. Chapter 2: The Role of Witnessing and Immersion in the Moment of Arts Therapy Experience. P. 41. In Mindfulness and the Arts Therapies: Theory and Practice. Laury Rappaport ed. Jessica Kingsley Publishers. 2014: 38-50.
[iii] Jon Kabat-Zinn. http://www.mindfulnesscds.com
[iv] Ann Behav Med. Eds. Mindfulness Meditation for Chronic Pain: Systematic Review and Meta-analysis.2017 Apr;51(2):199-213. https://www.ncbi.nlm.nih.gov/pubmed/27658913
[v] Kabat-Zinn, J., Lipworth, L. & Burney, R. J The clinical use of mindfulness meditation for the self-regulation of chronic pain. Behav Med (1985) 8: 163.
[vi] “The Art of Pain Management.” American Chronic Pain Association: https://theacpa.org/uploads/Art_and_Music_final.pdf
[vii] Reynolds, Frances and Sara Prior. Strategies of Adapting and Replacing Artistic Leisure Occupations to Maintain Participation and Identity: A Qualitative Study of Women with Arthritis. Journal of Activities and Adaption and Aging, March 2011. http://www.tandfonline.com/doi/abs/10.1080/01924788.2010.545970?journalCode=waaa20
[viii] Quintana Hernández DJ et all. The effects of a neuropsychology program based on mindfulness on Alzheimer’s disease: randomized double-blind clinical study. Revista Espanola de Geriatria y Gerontologia [2014, 49(4):165-172]
[ix] Monti, Daniel W., Caroline Peterson, et al. A Randomized, Controlled Trial of Mindfulness-based Art Therapy (MBAT) for Women with Cancer. Thomas Jefferson University, Philadelphia, PA, Psycho-Oncology 15:363–373 (2006)
[x] Callahan, Margaret Jones. Mindfulness Based Art: The Sparks Guide for Educators and Counselors. Friesen Press. 2016.
[xi] Dr. Daniel Potts. How art therapy enhances the life for Dementia Patients. 2014 http://www.alzheimers.net/2014-04-29/art-therapy-for-alzheimers/ Accessed September 15th, 2016
[xii] Ward et.al. Yoga for functional ability, pain and psychosocial outcomes in musculoskeletal conditions: a systematic review and meta-analysis. Musculoskeletal Care. 2013 Dec;11(4):203-17. doi: 10.1002/msc.1042. Epub 2013 Jan 9. https://www.ncbi.nlm.nih.gov/pubmed/23300142 Ward L1, Stebbings S, Cherkin D, Baxter GD.
[xiii] McNiff, Shaun. Chapter 2: The Role of Witnessing and Immersion in the Moment of Arts Therapy Experience. P. 40. In Mindfulness and the Arts Therapies: Theory and Practice. Laury Rappaport ed. Jessica Kingsley Publishers. 2014: 38-50.
Whether you have kids or not, you’re likely aware that the parenting experience is often extraordinarily challenging. Young children are wonderfully headstrong, and their deep sense of fairness ensures that rules, when enforced (regardless of their rationality), carry the risk of tears, screaming, or both. The temptation to rationally explain to an upset four-year-old why he “can’t” hit his baby sister, or draw on the floor, or keep the dead bird he found in the backyard, is a trap many of us fall into – and it turns out not to work very well.
Kids often appear selfish, and rightly so: they haven’t had a chance to develop the higher order brain structure that adults have (the human brain generally takes until the age of 25 to fully develop). Consider this long developmental span (and the frustration that means for parents!), a trade-off for humans being so incredibly awesome; other species’ brains develop quite quickly by comparison. Childhood is the time when our brain does almost all of its developing.
From the time we are born, our “base” brain is the most active, controlling all of our necessary biological functions such as breathing, heart rate, thirst, temperature and so on. As we go through childhood, our “emotional,” brain develops: it controls emotion, facilitates the formation of our significant trusting relationships, assigns significance and memory to events, and determines much of our motivation, among other things. It isn’t until late childhood and early adulthood that we really begin to develop our executive brain, which allows us to reason and act appropriately and flexibly to the situations we encounter. Since the “emotional,” brain is associated with survival functions, negative emotions feel intensely painful and threatening to children, and trivial issues may seem like a matter of life and death. We can’t expect kids to simply “behave,” because we have told them something 1000 times – biologically, they are in survival mode.
Another fun fact – kids have very little conscious awareness of when they’re tired, or hungry, have extra energy that needs expanding, or have had enough attention (which is a real need for all of us). They also aren’t yet endowed with the ability to ask for what they need when they need it: rarely will you hear your child politely ask you for “a moment of your time at your earliest convenience.” We have the responsibility of ensuring their four “tanks,” are as full as possible: their hunger tank, their sleep tank, their exercise tank, and their connection tank. Kids’ appetites for attention are great, but not insatiable; often once they’ve had their fill of it, they will generally run quite nicely on their own.
A central task of what we call brain-based parenting is that of building resiliency – preparing our child’s brain for the stressful situations it will encounter as an adult; i.e., not getting what they want, or enduring conflict, sadness, and heartbreak. We can do that with consistency, love, and warmth, amongst other things. It’s important for us to remember during a meltdown that our child’s brain is overloaded; they couldn’t behave, even if they really wanted to. Young children, especially, are physically incapable of holding mixed feelings. The best thing we can do is provide the connection and safety they need to make it through. They may not be able to regulate alone, but we can help them to do so.
When your child has a meltdown, or you sense one coming, remind yourself that this is normal, which will be especially difficult in public if you’re feeling the acute shame of the scene you might be creating. Then, try some of these techniques:
- Take a moment to gather them with eye contact or touch and warmth when possible (Gordon Neufeld calls this “collecting”). By doing this, you activate the attachment response, inviting them into relationship and reinforcing your unwavering desire to understand them.
- Crouch to at or below their eye level. Dan Siegel and Tina Payne Bryson, authors of The Whole-Brain Child, show how getting down to a child’s level keeps threat-level low (imagine being confronted by someone four times your size!). By towering over a child, we risk activating and overloading their mid-brain circuitry beyond what it can handle.
- Listen to their screams or cries with as much empathy as you can muster. Pretend, if it helps, that the two of you are teaming up against the tantrum. Hold them if they need to be held, hear them if they need to be heard, no matter how inane their words might seem. Sometimes a warm and simple, “I can tell that you really, really want to keep that dead bird,” goes a long way towards making them feel heard.
- The calmer you are, the easier your child can use your calm to help regulate their own emotion. If the normally safe mom and dad are in panic or anger mode, it’s hard to blame kids for feeling overloaded. You can also teach your kids to breathe deeply when they are feeling overwhelmed, sad or stressed. Our bodies respond very well to deep breaths when stressed.
- Be curious about what is going on in yourself and in your child. This is a teaching moment for both of you. See if you are able to notice and observe your own impulsive reactions to your kids’ actions. These situations can be seen as a challenge to overcome, rather than a disaster to stop or avoid at any cost.
Suffering through tantrums alongside your child will help you understand and know their needs at a deeper, more intimate level, which will strengthen the bonds between the two of you and help you to see the signs earlier next time. I use the word suffer intentionally; these situations aren’t fun. We’re going to feel like we’ve screwed up time and time again, are going to acutely feel the disapproving glares of strangers at the supermarket, and may try the techniques in this post only to find they often don’t seem to work. Above all, try to find some grace for yourself. Maybe your own tanks need refilling, or your brain needs a break – we’re all just learning. Maybe this time he can just keep the stupid bird, and when he’s asleep, it will miraculously find its way to bird heaven.
If you have questions about this, or you’d like to learn more, there are many resources for brain-based parenting across the lifespan. Search the web, check out the list below, or email me directly at email@example.com.
Dan Siegel and Tina Payne Bryson: The Whole Brain Child
This is a great book with lots of information on brain development strategies for raising calmer, happier, more empathetic kids.
Check out Vancouver-based child psychologist Gordon Neufeld, including his best selling book Hold on to your Kids
Try these five short and easy videos on brain-based parenting from Dr. Carrie Contey.
Growing up I remember hearing colloquialisms such as “suck it up”, “rub some dirt in it”, or “laugh it off.” These phrases seem automatic and designed to negate any potentially uncomfortable discussion of how a person might truly feel in a given situation. For myself, this brings up concerns that we are teaching children how to repress and avoid their emotions. Do some of these phrases actually serve a purpose? Can someone really just “laugh it off,” if they are sad, hurt, or even depressed? The answer is no, but fear not, there is a time and place for humour!
Humour serves as an important tool to mediate embarrassment or discomfort, to distract, to entertain, and, apparently, to develop resiliency . Although humour is the not the “cure-all,” answer to mental health, it can serve as a protective factor and help to develop resiliency. Protective factors simply refer to qualities, characteristics, or circumstances which allow a person to develop a support system of coping skills, resources, and people to rely on in times of need. In other words, think of humour as a preventative tool in your tool belt; humour may not fix a situation, but it may help to mediate some of the more negative effects.
Trauma is becoming much more of a frequent topic of conversation, news media, and professional circles. It seems that the main topic surrounds why some people react differently to the same or similar experiences. Why do two soldiers return from the same combat zone, having had similar experiences, but only one soldier experiences post-traumatic stress?
There is now talk of something called post-traumatic growth (PTG), which is a phenomenon where people are able to grow in positive ways after experiencing trauma . Of course, this phenomenon has those of us in the mental health field wondering how we can predict PTG and what we can do preventively to resource people before they experience trauma. What factors buffer the potentially devastating impact of trauma? While it’s a complex question without one answer, humour can be a resource. Humour can be a tool through which people are able to view a painful reality with a defiant attitude and a bit of a buffer . Humour has the unique capacity to transform a negative situation into something positive; however, there needs to be an understanding that humour is multidimensional and not all humour elicits positive effects .
Benefits for Counselling
There are four types of humour: affiliative, self-enhancing, aggressive, and self-defeating. Whereas benign types of humour, such as affiliative and self-enhancing have shown positive effects in lowering incidence rates of depression, anxiety, and stress, aggressive and self-defeating humour has shown to have negative effects . Affiliative humour refers to the tendency to say funny things, tell jokes, and exchange witty banter, whereas self-enhancing references a humourous outlook on life . One study by Sirigatti and colleagues (2017) has shown positive correlations between self-enhancing humour and overall life satisfaction, self-esteem, optimism, happiness, and psychological well-being.
So we have determined that like all things there is a balance. Some types of humour can create a more positive mindset and overall feeling, while more negative, self-deprecating humour does the opposite (Gladding, Wallace, & J, 2016). Some humour can hurt instead of fostering healing . However, let’s focus on the positive. There is some truth in the saying “laughter is the best medicine.” Although laughter definitely is not “medicine,” nor a curative remedy, it leads to strengthening physical and mental well-being and is positively correlated to longevity. Humour can help with the constructive expression of strong feelings, offer perspective and balance, and assist in coping .
In conclusion, no, you can’t just “laugh it off,” but like with anything in life, our outlook can greatly affect how we deal with the obstacles that arise. Can positivity and optimism really hurt too much? If you’re having a tough day, week, or even if you’re not, just remember to take a second to enjoy yourself and laugh.
Q: What do you call a cow on a trampoline?
A: A milkshake!
 Tucker, T. M. (2017). Resilience development through humor. Dissertation Abstracts International, 78.
 Boerner, M., Joseph, S., & Murphy, D. (2017). The association between sense of humor and trauma-related mental health outcomes: Two exploratory studies. Journal of Loss and Trauma, 22(5), 440-452. doi:10.1080/15325024.2017.1310504
 Gladding, S. T., Wallace, D., & J, M. (2016). Promoting beneficial humor in counselling: A way of helping counselors help clients. Journal of Creativity in Mental Health, 11(1), 2-11. doi:10.1080/15401383.2015.1133361
 Sirigatti, S., Penzo, I., Giannetti, E., Casale, S., & Stefanile, C. (2016). Relationships between humorism profiles and psychological well-being. Personality and Individual Differences, 90, 219-224. doi:10.1016/j.paid.2015.11.011
Last week my wife, Meg, wrote about her journey with her invisible illness and chronic pain, in her article titled My Life With Chronic Pain; the feedback has been phenomenal. We’ve heard from people close by, and as far away as New Zealand who appreciated her candor and vulnerability in sharing her struggles and what she has learned over the last 6 years since the car accident. So many people struggling with invisible illnesses feel isolated, alone in their journey, and feel as though they can’t share their struggles because it’s viewed as complaining, or because people simply do not understand.
This week, I want to share a bit of my story over the last 6 years, as a husband to a wife with chronic pain, and father to our two beautiful daughters who have also been a part of our journey. As little information as there is from those suffering from invisible illnesses, I come across even less information from those who are alongside those struggling with the illness, such as partners and family members. I hope that sharing my story can be helpful to those who are also wrestling with this complex, often heart-wrenching journey.
As I was driving into Vancouver this morning, I was trying to figure out how to start what I was about to write – how to sum up concisely the impact of the accident, and my wife’s struggle with her chronic pain. I’m also fairly guarded in sharing my emotional world publicly for many reasons, but I came up with a very succinct and specific conclusion: it broke my heart. Even as I sit here at the Railtown Café writing, it’s all I can do to hold back the tears.
You see, for better or for worse, I have always put Meg on a pedestal. If you’ve met me in person, you’ve likely heard me refer to her as my “far better half,” or comment on the fact that she is the “smart one.” This isn’t pithy banter on my part – it is truly the long-held belief about Meg that I have held, and still do. What I wasn’t prepared for, however, was the impact of seeing my brilliant, high functioning wife, laid out on the couch for weeks on end, unable to function in daily life, and struggling to figure out how many plates she needed to put on the table for dinner. I can’t begin to describe how seeing this changed my life, and changed my focus.
I immediately went into survival mode. I was working for the Fraser Health Authority at the time, and immediately started seeking out jobs closer to home as I was suddenly the only functioning adult in our house, with two children under the age of 4. I was Dad, Mom, housekeeper, breadwinner, and more. Now, I have to say that we have been so fortunate to have an unbelievably supportive family and friends who have given us an amazing amount of support for which I am extremely grateful. I honestly have no idea how we would have survived without them.
Even with all of this help, and even as we started seeing improvements, I was and quite frankly, still am heartbroken. When I’m working with kids, parents, and families I often explain that one of the hardest things in the world as a parent is to see your child in pain; I’m not sure, however, which is worse: seeing your child in pain or your spouse. At this point, I was seeing both and it was overwhelming.
If we fast forward to present, things have gotten significantly better and while Meg can never return to her career, she is forging a new career using art and helping people recover. Although it’s still difficult, it’s amazing to see the changes and to be able to see the proverbial, “light at the end of the tunnel.” What I’ve discovered though is that I’ve been stuck in “emergency mode,” since 2011, and as a part of this, haven’t processed a lot of the emotions involved and the personal trauma involved in the experience.
Part of my struggle and what I’ve been working through is how to move from heartbreak to acceptance (and Meg will find this hilarious because acceptance is a regular topic of conversation between us, mainly my encouragement to her to find acceptance in her new life and role). I’ll admit, I do not want to accept that my wife has chronic pain, and that the wife I knew prior to 2011 is never coming back. I don’t want to accept that our lives have changed irrevocably through no fault of our own, but because of a car accident. I don’t want to accept that my children have had to endure two parents in emergency mode for 6 years and have had their own challenges in response. I don’t want to accept – well, a lot of things. But as I preach to my clients almost on a daily basis, I have to choose to accept because the alternative isn’t helpful. I can’t change the situation, and fighting it isn’t going to bring positive results.
As I’ve wrestled with this for the past 6 years, I’ve learned a few things that have been, and continue to be helpful to me in managing our family life and my own emotional world. I haven’t mastered any of them yet, but hopefully they’ll be helpful to those of you sharing the struggle as a partner of someone with an invisible illness and/or chronic pain.
- Talk to your partner with the chronic pain about the impact it has on you
For many years I struggled to share with Meg how her journey impacted me. To be honest, it’s something I still have a difficult time with. When faced with a partner who is in constant pain, it’s hard to justify your own sometimes. I’ve had times where I told myself, “Your pain isn’t important; look at how much pain she is in,” or, “If you tell her how you’re feeling it’s going to make things worse for her,” and many other variations on this theme. What we’ve discovered in discussing this point is that she has had many of the same things running through her mind and we didn’t realize it. Being able to talk about our fears in disclosing to each other has opened the door to a much more honest and helpful dialogue.
If you won’t let yourself go there, please hear this from me – your pain is just as important and your ability to connect with your partner and be supportive depends on being vulnerable.
- Feeling helpless is normal and part of the process
Anyone who knows me well, knows that I am a fixer. I look for problems and try to find solutions – I probably would have made a good engineer that way if it wasn’t for the math. I have had to wrestle with my own helplessness over the past 6 years and sit with my own fears and anxieties about the future in ways I’d never experienced before. As a husband, I want to save my wife from experiencing pain but I can’t. I’ve had to accept this, even though I don’t like it. I’ve had to come to terms with the fact that I can’t fix her body, I can’t fix her brain, and I can’t save her from the pain. But, I can be there consistently, unwavering in my love for her, even if I can’t make it all ok.
- Empathy is more important than fixing things
We sometimes struggle to differentiate between sympathy and empathy. Brené Brown has a great video on empathy, and I encourage you to watch it here. In short, empathy is the best thing that we can offer a partner who is in pain. It’s being able to say, “I don’t even know what to say or do right now to help you, but I’m here.” It’s realizing that even though we can’t truly understand what our partner is going through, we don’t have to. If we can allow ourselves to be vulnerable with them, we can connect with their experience of the pain, not try to fix it, but be there. Being with someone on a deeper level is far more important than any fix we can offer. It cuts down on loneliness, isolation, disconnection, and thus, reduces anxiety, depression, and actually, it reduces physical pain. So, it’s true – we can actually help our partner’s pain by showing them empathy, being with them where they are at, and accepting the situation we find ourselves in and wrestling through it together.
- Have fun together
There’s a saying that we all know – laughter is the best medicine. I’m not sure if it’s the best medicine, but it sure does help. Physical and emotional pain often shifts our focus off of living life and from the patterns and ways of relating to each other that have made the relationship successful. Meg and I have always had a healthy dose of humour in our relationship – mostly laughing at idiosyncrasies in life, mistakes we’ve made, or situations we find ourselves in.
One thing that chronic pain does is make it difficult to find humour in the current situation. Who laughs about pain, right? Well, we should. It took some time, but now Meg and I can laugh about some of the things we experience in life due to the chronic condition. Whether it’s laughing when a plate drops because of ulnar neuropathy, or laughing when I ask her to do something that is very obviously not possible for her and she just stares at me with that look that says, “What part of that looks like something I’m able to do,” or laughing about things that have nothing to do with our situation but make us laugh and relieve some stress, the humour allows us to lose sight of the pain for a while and get back to “normal life,” again.
- Don’t be afraid to ask for help
I have had to lean on more people in the past 6 years than ever before in my life. Asking for help is not something I’m particularly good at. My family, my friends, and my professional colleagues have all stepped in to help in so many ways and I can’t thank them enough. I’ve also had to do some counselling, and continue to do so because there are aspects of my life and my wrestling that I need someone to walk through it with. My counsellor has shown empathy, skill, and also challenged me when I need to be challenged. Whether you’ve sought counselling before or not, I can’t emphasize enough how important it has been to my journey.
- Adjust your expectations, and redefine “normal life”
As much as I’ve tried to take a positive spin in this piece, there is no escaping the fact that chronic pain and illness brings an incredible sense of loss with it. There’s no escaping the fact that the life we had prior to 2011 is, to the best of our knowledge, never coming back. I have mourned this fact for years, and to be honest, I’m still in that process. What I’ve come to, however, is that in accepting the situation I’m able to redefine our new normal and my expectations. What does this mean for me, and us a family?
It means that I’m the only one unloading dishes from the dishwasher and I do most of the loading because bending over is too hard for Meg most days. The upside is that I can load it however I want and make it efficient, which gives me joy.
It means that many nights, Meg isn’t able to put the kids to bed because she is lying on the couch downstairs and making it up the stairs isn’t in the cards that night. The upside is I get 1:1 time with my daughters, which is time that I cherish and probably wouldn’t have had otherwise.
It means that most nights, we find ourselves on the couch in front of the TV watching some silly TV show because we’re too tired and brain dead to do much else. The upside is, we get to sit in close proximity to each other, and laugh at the shows we are watching, and sometimes when we both have the energy, the TV doesn’t go on and we sit and talk for hours like we used to and connect on a deeper level. This doesn’t happen as often as either of us would like, but when it does happen, it breathes life back into us and into our relationship.
It means that having gone through the past 6 years, I am convinced that I am incredibly fortunate. I have two beautiful children who I adore, and who love Meg and I unconditionally. I have a wife who, despite all my shortfalls and mistakes I’ve made both before, and since the accident, chooses to love me for who I am and all my limitations. I have been forced to spend more time with my family and around the house because I’m needed there to pick up some of the slack – time that I may not have otherwise taken if Meg was functioning at 100%.
Last but not least, the accident was a major motivating factor to launching Alongside You, where I get to see peoples’ lives change on a daily basis. And because of our experience through the accident we can say that we understand the pain of many of our clients because we also live it on a daily basis. While I won’t speak for Meg, although I’m sure she’d agree, Alongside You has provided meaning for my pain. While I still don’t like the situation and the pain Meg is in, there is an emerging sense of purpose. I know that our experience has allowed me to help others through their own journeys in an authentic way that I would not have otherwise been able to.
At the risk of being repetitive, I want to repeat the quote from my daughter Ava because she has been a great source of wisdom for me in our journey, and I honestly can’t put it any better than she did.
Just because you have a hard life, it doesn’t mean you have to have a bad life. With challenges or disabilities, you can still have a great life. – Ava Neufeld, age 9
As hard as it has been, I am grateful for our life. I am grateful for the support we have received, and for the personal growth I’ve gone through as a result of the accident and the journey through chronic pain. I’m also grateful for the chance to make some meaning out of our experience through our work at Alongside You. Meaning is so important in our lives, and in processing our pain.
Thank you for reading this, and thank you for allowing us into your lives as Alongside You.