The Mind is Like the Ocean

Sculpture by Jason deCaires Taylor

I recently attended a 2 day workshop called The Wise Heart and the Mindful Brain. The workshop was led by Jack Kornfield and Dan Siegel. It was an incredible 2 day event and was attended by about 750 people – the majority of us in the healthcare and therapy field. Over the 2 days we explored many subjects through dialogue and direct meditation experiences. I have been meaning to write some posts about this event since it happened. However, I think that there was so much learning and new things to process that I felt a bit overwhelmed to be quite honest! (But it was overwhelmed in a good way – when you just have too many wonderful things you want to share, and don’t know where to start).

I am looking forward to sharing some of my experiences with readers in this post and continued blog posts. To begin with, here is a little information about the 2 presenters.

  • Jack Kornfield is a psychologist, ordained Buddhist monk, and expert in the integration of Buddhist psychology with Western psychology. If you are interested, visit his site at: Jack Kornfield
  • Dan Siegel MD is psychiatrist, mindfulness practitioner who has dedicated much of his life to researching interpersonal neurobiology and exploring the impact that mindfulness based practices has on the therapeutic relationship and the brain itself. You can find out more about his work at: Dr. Dan Siegel
Sculpture by Jason deCaires Taylor

The mind is like the ocean. And deep in this ocean, beneath the surface, it’s calm and clear. And no matter what the surface conditions are, whether it’s flat or choppy or even a full gale storm, deep in the ocean it’s tranquil and serene. From the depth of the ocean you can look toward the surface and just notice the activity there, as in the mind, where from the depth of the mind you can look upward toward the waves, the brainwaves at the surface of your mind, where all that activity of mind, thoughts, feelings, sensations, and memories exist. You have the incredible opportunity to just observe those activities at the surface of your mind. 

– Dan Siegel, MD ~ The Mindful Brain
When I was little I used to sometimes worry about what happened to all of the fish and sea creatures during a big storm at sea. I pictured the boats and people on the surface being buffeted around by the huge waves and the torrential rain. At some point in my childhood, someone pointed out that the fish were actually safe during the storms. 
“Why?” I asked?
The reply was that the fish were safe because they lived deep under the surface of the ocean, where the chaos on the surface could not touch them.
(You can imagine how comforted I was by this newly found knowledge. Now I could focus my animal-loving attention on saving a different species of animals).

Perhaps this link to my childhood musings is part of what drew me to this particular visual metaphor. In the week since the workshop, I have often conjured up this vision of the ocean – beneath the surface. When I stop for a moment to do this, it automatically creates a space in between my experience and my reaction to that experience. This type of practice is what breaks the cycle of reactivity and “living on autopilot.” Try it out next time you find yourself in a very reactive state (whether anxious, angry, or just rushed). Picture yourself at the bottom of a deep blue ocean, looking up calmly at the ever-changing surface (of your mind). You may observe (and even laugh) at all of the activity on the surface. But the core of who you are resides in that still place.

Many mindfulness teachings and practices say exactly the same thing, only with different words. There are many different arrows pointing to consciousness and awareness, but they are all pointing towards the same center. 

Another arrow pointing to the center is art therapy and creativity development. Mindfulness based practices and art therapy (really, all of the creative arts therapies) are often a very natural and powerful integration of experiences. In more recent years they have been blended together more formally and referred to as Mindfulness-Based Art Therapy (MBAT). 

Sculpture by Jason deCaires Taylor

There are many specific approaches to art therapy and mindfulness practice. However there seem to be a few core similarities between the two based on my own experiences. In art therapy I encourage my client to focus on the process of creating art, rather than the finished product. In mindfulness practice we place our attention on the present moment; making space for whatever thoughts or feelings arise. In both practices, the emphasis is placed on experiencing the present moment in a non-judgmental way. A painting is not inherently charged with “good” or “bad” qualities. Rather, it is our own perceptions and thoughts about the art which will assign it ultimate meaning. Similarly, life experiences are not truly “good” or “bad,” but our thinking and interpretation places each experience into one of these categories. 

As Shakespeare wrote:

for there is nothing either good or
bad, but thinking makes it so
So the next time you are finishing a piece of art, music, writing, conversation, or a day at work – take a pause. Before you assign an objective thought about whether that experience was good, bad, beautiful, or ugly, just allow it to be itself for a moment. Don’t worry…your thoughts aren’t going anywhere. I promise they’ll still be there waiting for you when you get back. And there’s nothing wrong with that!

Podcasts to Check Out

I recently discovered 3 wonderful podcasts that I wanted to share with readers. There are so many free podcasts to choose from that at times it can be overwhelming! However, I feel that these particular podcasts are incredibly well done, articulate, interesting, and illuminating.

Shrink Rap Radio
Shrink Rap Radio

Tagline: “All the psychology you need to know and just enough to make you dangerous.” 

David Van Nuys, Ph.D. (“Dr. Dave”) is a psychologist and the host of this podcast. The podcast explores psychology, psychotherapy, and psychiatry in a way that both therapists and non-therapists can understand and appreciate. I was initially drawn to this podcast because Dr. Dave had done a series of interviews with therapists who utilize mindfulness in their approach and this is an area of great interest to me. Each podcast explores a theme through interviewing a specific expert in the field of psychology. Topics are rich and varied and have included: the neuroscience of meditation, the highly sensitive person, archetypal dream-work, Buddhist perspectives on psychotherapy, and creativity and the brain.
“Dr. Dave”
The Wise Counsel Podcast
This podcast is also hosted by Dr. Dave and explores similar topics to Shrink Rap Radio, but has an entirely different collection of interviews with mental health experts. Topics are diverse here as well, and the interviews explore multiple theoretical approaches to psychotherapy. I am particularly excited to listen to the interview with Marsha Linehan on Dialectical Behavioral Therapy, an interview with Natalie Goldberg on Expressive Arts Therapy, and the episode with Jeffrey Young on Schema Therapy.
Tara Brach
Tara Brach
Tara Brach is a psychologist and world-renowned expert and teacher of Buddhist Meditation. She has written a number of books, including: Radical Acceptance: Embracing Your Life With the Heart of a Buddha.
Her podcasts are recordings of talks and teachings that she has given over the years. She has a soothing voice and is incredibly articulate. She weaves stories and humor into her talks, which makes her teachings accessible and engaging.
I hope that you explore one or all of these podcasts! At the very least, they will make your daily commute much more bearable. I found myself strangely pleased when my train was delayed for a few minutes the other day…

Art Therapy Techniques: 3 Self-Portraits

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Woman In Yellow ~ Sara Roizen~ 2010
I do not paint a portrait to look like the subject, rather does the subject grow to look like his portrait.    –Salvador Dali
Art therapists use countless approaches and techniques when working with individuals and groups. Sometimes specific therapy techniques are also called “interventions” (not to be confused with the dramatic drug “interventions” we watch on TV)!
Although an art therapy intervention may be presented in a specific way, the ways in which an individual or group may respond are infinite. Therefore, even though interventions tend to be specific, they must always be presented with the unique individual in mind. Art therapists are trained to make interventions based on what they feel about their client’s needs at that moment.

In traditional “talk” therapy, interventions take place through the therapeutic dialogue. In art therapy, the therapist is able to blend the verbal process with the visual process.  

The “3 Self-Portraits” experiential can be a powerful and transformational process for many. Below is a description of how I have introduced this technique to clients:
If this is the first time creating the 3 self-portraits, I tend to use dry materials such as oil pastels, chalk pastels, colored pencils, or markers. This can be an emotionally charged experience, and wet materials (such as paint) tend to be more regressive and are more likely to trigger emotional “flooding” in the client. Whenever possible I give the client the highest quality paper that I have available. If this kind of paper is not available, then of course even white computer paper will do.
Create 3 different self-portraits on 3 separate pieces of paper.
1) how you see yourself
2) how you think others see you
Hungry Ghost II ~ Sara Roizen ~ 2010
3) how you would like to be seen  
I encourage the self-portraits to be more abstract in nature for two reasons. One reason is to prevent the artist from getting overly caught up and distracted by trying to create a perfect “likeness.” The other reason is to encourage the artist to think “outside of the box” and free them up to explore with color, lines, and forms. The individual may work on the portraits in any order that feels natural, and may even alternate between drawings during the time period.
I recently used the “3 Self-Portrait” technique during an art therapy group for clients who were newly diagnosed with HIV. It was a talk therapy group, and I was invited by the therapist to be a “guest art therapist” and lead the group for a night. The group had been meeting for a few weeks already, and so there was a level of warmth and overall comfort among the members.
The group expressed a great interest in making art, but were understandably a bit apprehensive at the same time. I encounter this all of the time when working with adults in particular. Many adults haven’t made art since they were children, and there is often a great deal of anxiety related to the pressure to create “a masterpiece.” For this reason I spent the first few minutes of the group addressing the client’s anxiety and even exploring some of their earliest memories with art. As the group members spoke about art making as a child, they became increasingly eager to “play and explore” again using the art materials. As always, I emphasize the importance of the process over the product, and encourage clients to ease into the experience while relaxing expectations about the finished piece.
The group members clearly took this advice to heart, because a few minutes later they were all working away silently – completely immersed in their art making. When I gave them the 5 minute time check towards the end, I was met with requests for more time! (I am always amazed by how quickly the art process can transform a group in this way).
As the group members shared their self-portraits, the process unfolded organically as it so often does. One client shared a portrait that showed a close-up of one of his eyes. He told us that he had been “afraid of the image” at first because of what a strong image it was. He revealed that most people are caught up in his physical features (specifically his beautiful eyes). He felt that even though people saw his eyes, they did not see through his eyes – and therefore did not truly see him.  The eyes are often referred to as “the window to the soul.” Here is an example of art therapy and working with metaphors, to express one’s feelings on a deeper level.
Another group member was touched when he realized that his “future” self-portrait portrayed himself in a hopeful light. When he shared this the other group members realized that their future self-portraits were all hopeful as well. This surprised many of them, as they had associated being newly diagnosed with HIV with a bleak future. The self-portraits revealed hidden strengths in each of the clients and helped to imbue them with a sense of hope and purpose.
With this group, the dialogue evolved very naturally as a result of the process. Some groups may need a little more guidance from the group leader. Below are some examples of questions that might encourage group discussion.
Questions to encourage further exploration and provide insight might include:
·      Which portrait was the easiest to create? Which one was the most difficult?
·      Do you see any similarities between the portraits? What are the differences between the three?
·      Speak as if you are the image. What do you need to feel complete as the image, or do you already feel complete?
·      Were there any surprises in creating the portraits?
·      If you strongly dislike one of the portraits, what would the image need for you to like it?
·      If this was done in a group setting and the members have built some trust with one another, you may invite group members to share what they see in each other’s portraits. (Often the sharing of images can encourage very powerful exchanges among members).
If you are interested in some of my past posts about art therapy techniques, just click on the “Art Therapy Technique” label in the right hand corner of my blog. Topics include techniques such as: mask making, mandalas, and altered books. 
A-part ~ Sara Roizen ~ 2001

Art Therapy and Dreams

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All that we see or seem is but a dream within a dream.
–Edgar Allen Poe
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The other night I had a dream that I was dreaming about dreaming…Confusing? A little. It was a dream within a dream within a dream! When I woke up I half-wondered, was I still dreaming? My take on “reality” had temporarily shifted, and I was inspired to write a little about my work with dreams and art therapy.
The combination of dream-work and art therapy can be a powerful and illuminating experience when approached in a way that honors the dreamer and his or her relationship to the dream.

Bruce Moon is an art therapist who often explores dreams within an existential framework. (For an excellent read, I recommend his book: Existential Art Therapy: The Canvas Mirror). He describes existential art therapy as “a journey of self-discovery that is shared by the client and the art therapist.” He believes that the overall purpose of engaging in dream-work and art therapy is to help the client discover and create meaning in his or her life.

In my work with clients and their dreams I deliberately refrain from offering my own interpretations of dreams. To analyze another’s dream is to assign meaning to something that belongs solely to the dreamer.  In this way, I approach a client’s dream in the same way that I approach his or her art work. I do not interpret the creations based on my point of view. Instead I serve as a witness and guide to the client’s unique journey.
During a session, clients may be open to creating an image of the dream. Since dreams are layered (and laden with many images) it can be helpful to ask the client to pick just one scene from the dream to depict. Some clients may work abstractly and capture the feeling of the dream in colors and shapes, while others may work in a more representational style. I have had clients draw, sculpt, or collage artwork about their dreams, based on their material preferences. When the client is finished with the piece, we usually place the art in between us. The client speaks freely about the piece and what he or she sees in it. Sometimes I will offer to take notes for the client, so that he or she has a record of initial responses.  Again, in this way of working, it is important to remember that there are no “cookie cutter” dream meanings. For example, one person might associate dreams of falling with feeling unencumbered by gravity and experience it as a symbol of freedom (for those of us who enjoy skydiving:) Another person may experience a dream of free falling as terrifying. The meaning is entirely derived from the client.
Sometimes I have asked clients to imagine themselves as different elements of the dream, and not just as “themselves.” For example, if a client has a dream about their mother, father, and sibling I might ask the client to re-inhabit the dream from each family member’s perspective. This way of exploring a dream will often provide additional insight to the dreamer. It also encourages the client to practice flexibility in interpersonal relationships and strengthens the ability to “try on someone else’s shoes.”
Since I was a child I have almost always remembered my dreams upon waking. Many clients have told me that they have difficulty remembering their dreams though. Keeping a dream journal by your bed can be a helpful method in strengthening dream recall. If a dream is particularly intense or even disturbing it can also help to write it down immediately upon waking up from the dream, even if it is in the middle of the night. Once the dream is jotted down, the intensity often diminishes and the dreamer is able to get back to sleep more peacefully. Writing dreams down upon getting up in the morning is also very useful. The writing does not have to be long, but can just include some key elements or words that are associated with the dream. Sketching an image from a dream is another way to record the dream.
Dreams provide clients with insight into the self, and they can also serve as rich sources of inspiration for creative work: art, writing, music, and movement. Dream-work can be further enriched by the addition of these creative modalities – for example, finding a song that seems to evoke the essence of the dream. There is no right or wrong way to explore a dream, as long as the dreamer is the one creating meaning.
Interested in diving deeper into the world of dreams? Here are a few movies I’d highly recommend – all exploring dream states and questions of what is really real?
Inception (2010)
Eternal Sunshine of the Spotless Mind (2004)
Spirited Away (2001)
Vanilla Sky (2001)
Waking Life (2001)
Avatar (2009)
The Matrix (1999)
What Dreams May Come (1998)

Spotlight: Depression

It is interesting to note that in this day and age, psychological terms have trickled down into our everyday conversations. For example, it’s not rare to hear someone complain, “oh god – she is SO obsessive compulsive!” Or, “I’m so depressed right now!” What are the actual definitions of these terms though?

I thought it would be interesting to do a series on this blog that I am calling the “Spotlight” series. In it I will explore some of the better known (but often misunderstood) mental illnesses, such as Depression, Bipolar Disorder, Obsessive Compulsive Disorder, and Borderline Personality Disorder. In each post I will include the official DSM IV description (Diagnostic & Statistical Manual of Mental Disorders, 4th Ed.). I will also highlight current treatment approaches – both medical and therapeutic. I am starting off with a spotlight on Depression. I hope these posts are informative, and give you a jumping-off point from which to explore further. Please keep in mind that thousands of books have been written on each diagnosis, and that these blog posts are only intended to give the reader a brief introduction to each disorder.
Before talking about the different types of Depression, it is helpful to define what a depressive episode consists of. According to the DSM IV, a person must meet 5 (or more) of the following symptoms during the same 2 week period, and one of the symptoms is either 1)depressed mood or 2) loss of interest or pleasure to meet the criteria for having a Major Depressive Episode:

1) depressed mood most of the day, nearly every day
(in children and adolescents this may present as an irritable mood)

2) noticeably diminished interest in activities that are usually pleasurable

3) significant weight loss or weight gain (not due to dieting)

4) insomnia or hypersomnia nearly every day (not sleeping or oversleeping)

5) noticeable psychomotor agitation or retardation nearly every day (rapid or slowed speech)

6) fatigue and loss of energy nearly every day

7) feelings of worthlessness or excessive and inappropriate guilt

8) trouble thinking and concentrating, indecisiveness

9) recurrent thoughts of death, suicidal ideation with or without a specific plan

From this list it is helpful to remember that any 2 people diagnosed with a major depressive episode may present very differently. For example, one may lose weight, have insomnia, and speak more rapidly, while another person may gain weight, sleep too much, and speak much more slowly. In addition, it is now known that children and adolescents may present very differently with depression than adults do. Often times, children and adolescents who are clinically depressed may act out and be irritable (and be mistakenly diagnosed with ADHD) when they are actually exhibiting signs of depression.

Types of Depression
A look at a few different forms of depression…

Major Depressive Disorder
(Also called: Unipolar Depression, Clinical Depression, & Major Depression)
This is the most well known type of depression and falls under the diagnostic category of Mood Disorders (as do all forms of Depression). Mood disorders are identified as a person presenting with a disturbance in mood as the predominant feature.

There are two types of Major Depressive Disorder: Major Depressive Disorder (Single Episode) and Major Depressive Disorder (Recurrent). A single episode indicates that the person meets the criteria for a Major Depressive Episode (see above) and that this is their first or only episode. In the recurrent form of Major Depressive Disorder, the person has had 2 or more separate episodes, with an interval of at least 2 consecutive months between episodes.

Dysthymic Disorder
The DSM IV definition for Dysthymic Disorder is a “chronically depressed mood that occurs for most of the day more days than not for at least 2 years.” Although Dysthymia is seen as a milder form of Major Depression, the course of this illness is much longer. People suffering from this form of depression may have lived with it for so long that they have difficulty remember a time when they ever felt “good.” In addition, people with Dysthymia are less likely to seek treatment, because they may believe that feeling this way is just part of who they are, instead of seeing it as a mental illness that may be treated.

Bipolar Depression
I will be writing a future post on Bipolar Disorder, which will cover Bipolar Depression in more detail. For now, it is important to know that Bipolar Depression meets the same criteria as seen in a Major Depressive Episode, but that the treatment (especially medication-wise) is usually very different. In addition, a bipolar depressive episode will later be followed by a manic or hypomanic episode.

Depression Due to a General Medical Condition
There are a number of medical conditions that may cause mood symptoms such as those found in clinical Depression. Examples of conditions include degenerative neurological conditions (e.g. Parkinson’s disease, Huntington’s disease), stroke, metabolic conditions, endocrine conditions (e.g. hyper and hypothyroidism), autoimmune conditions, viral or other infections (e.g. hepatitis, HIV) and certain cancers. It is obviously important to discern whether the Depression is due to a medical condition, as the medical treatment approach will vary greatly.

Seasonal Affective Disorder (SAD)
SAD is a form of Depression that affects the person during certain parts of the year. A person with SAD exhibits the indicators of Depression with a pattern that is related to the time of year (usually seen during the winter and/or fall months). In addition, the depressive episodes are not linked to external stressors (such as unemployment or strained family relations).

Postpartum Depression
Postpartum Depression describes the time of onset of a depressive episode. With Postpartum Depression, the new mother experiences a depressive episode within 4 weeks of giving birth to a child. It should not be confused with the “baby blues” that some new mothers may experience 3-7 days after delivery (but which disappears quickly). A mother experiencing Postpartum Depression may experience increased anxiety (even panic attacks), difficulty sleeping, trouble concentrating, spontaneous crying, and a lack of interest in her newborn.

Treatment Options
These forms of Depression can be treated in multiple ways, either with medication, therapy, or a combination of both.

Medication Treatment Options
The most widely used (and known) brand name antidepressant medications are in a family called Selective Serotonin Reuptake Inhibitors (SSRI’s). Common SSRI’s include: Prozac, Luvox, Celexa, Paxil, Lexapro, and Zoloft. These medications work primarily by regulating a chemical in the brain called Serotonin. Although SSRI’s seem to help many people with depression, the exact way that they work within the brain is still unknown.

Atypical Antidepressants affect neurotransmitters such as serotonin, norepinephrine, and dopamine. Brand name drugs in this category include: Wellbutrin, Effexor, Cymbalta, Remeron, Desyrel, and Serzone. Often times, prescribers will try a medication from this category when an SSRI has not helped alleviate depression. As with the SSRI’s, the exact mechanism of action is still not fully understood with these medications.

In addition, some presribers may turn to older classes of antidepressants, such as the Tricyclics, and MAOI’s (Monoamine Oxidase Inhibitors). However, these drugs are more commonly used as a last resort, since they have a lengthier list of side effects and less selective mechanisms of action.

Currently it is not uncommon to add a second drug to the primary antidepressant (called augmenter drugs). Two of the most popular brand name augmenter drugs are Buspar (also used to treat anxiety) and Wellbutrin.

Lastly, a (rather controversial) development in treating depression has been the addition of lower dose antipsychotics to the antidepressant. I’m sure many of you have seen the most recent commercials for adding Seroquel or Abilify to your antidepressant treatment (both are antipsychotics). This practice remains controversial in part because of the additional side effects that treating with an antipsychotic creates.

Therapy Approaches
Here I’ve highlighted just 2 different therapy approaches for Depression (although there are many more to be explored in future posts).

Art Therapy (Yes…I am biased!)
There are too many approaches, techniques, and theories on art therapy and depression to fully delve into within this post. A future post is planned to explore art therapy and its applications to mental illness. For many, the process of creating art is intrinsically healing in itself. Often, the experience of depression can be paralyzing. The act of creating art can serve as a way of reconnecting with the world around us, using our hands constructively, and re-engaging with dormant energy. When a person is depressed, it can seem overwhelming to put their feelings into words. However, it is at these times that art can serve as a more direct expression of what the person is feeling. Frequently the therapist and the client are amazed at what surfaces within the art, providing insight into deeper issues and themes.

Cognitive Behavioral Therapy (CBT)
CBT is a form of psychotherapy that is based on the idea that what we think directly influences how we feel (emotions) and what we do (behavior). Therefore the focus is on retraining our brains to think differently, which in turn will directly change/impact our feelings and behaviors. CBT utilizes many approaches during therapy, with a strong focus on “homework assignments.” These assignments are all part of retraining the brain and becoming more cognizant of our thoughts – so that we become aware of some of our more harmful automatic thoughts. Unlike psychoanalysis, little attention is paid to the person’s past, and emphasis is placed on the person’s present day experience of life. CBT has been increasingly used and combined with other treatment modalities and is generally shorter term than other approaches to therapy.

These are just 2 therapy approaches for Depression. In future “spotlight” posts, I will be exploring many other types of therapy and their applications to different populations.

I’ll end this post with a quote by R.W. Shepherd:

“If depression is creeping up and must be faced, learn something about the nature of the beast: You may escape without a mauling.”