“What I Be”: A Defusion-Based Art Exhibit

“What I Be”: A Defusion-Based Art Exhibit

Words are amazing. Our minds attach a great deal of importance to words and verbal labels. Our ability to use language is an amazing tool, and yet, a fundamental assumption in Acceptance and Commitment Therapy (ACT) is that this ability may also be at the root of human suffering. According to ACT, words, and other forms of language, gain much of their power when we stop treating them as merely words, but instead as what they say they are. You’ve probably seen this in your clients (and in yourself too); words and labels, whether they be “broken” or “stupid” or “fat” or “unlovable”, can result in such shame that people will greatly restrict their lives and will turn away from doing what is meaningful and important in order to try to hide those labels from others and themselves. What if it didn’t have to be that way?

The concept of defusion in ACT is aimed at helping individuals see thoughts as thoughts, to see them for what they are and not for what they say they are. For those of you who have been to an ACT experiential workshop, you might be familiar with the defusion exercise where you write down a difficult thought you have about yourself on a name badge and then wear that name badge on your chest for the remainder of the day. In the abnormal psychology class that I teach, I have students do a similar exercise, but they wear other people’s labels. It can be a very powerful experience to encounter what others are hiding.

Steve Rosenfield has taken this concept to a whole new level through a photography exhibit entitled “What I Be”. In this project he has photographed people from all walks of life with their difficult thoughts or words about their histories written in bold black marker across their skin for all the world to see. The exhibit can be seen as a visual display of what we are often working with clients around the concept of defusion. And I’m very excited that this exhibit will be coming here to the Portland, OR / Vancouver, WA area. Yogi Roots in Vancouver, WA will be hosting an event with Steve Rosenfield on Thursday, November 29th from 7:30 pm – 9:00pm. There is also an opportunity to have a photo session with Steve for the “What I Be” project from Fri-Sun November 30th through December 5th. It might be potentially a very powerful experience for our clients (or ourselves) to be involved in this project. And if being a part of the photo shoot isn’t feasible, it might be an interesting homework assignment for clients to have them go to one of the following pages to view some of Rosenfield’s photographs:

“What I Be” photos 1

“What I Be” photos 2

ACT for Body Image Difficulties and Disordered Eating

ACT for Body Image Difficulties and Disordered Eating

I frequently struggle when trying to find referrals for therapists who work with individuals around issues of body image and disordered/dysregulated eating. The most common refrain I hear is “Oh, I don’t work with eating disorders.” Many of my colleagues even feel reluctant to work with individuals with subclinical levels of dysregulated eating or struggles with body image.

My sense is that there are probably many factors that contribute to clinicians’ reluctance to work with issues related to body image and weight. Many seem to feel like their training didn’t equip them to be effective in working with those difficulties. Some seem to buy into the stigma that clients who struggle with eating disorders and body image are “difficult”. But I also wonder if part of it could be because for many of us, it’s an issue that we have our own struggles with. Chances are, if you have a body, particularly if you are a woman in this culture and have a body, you have your own varying degree of dissatisfaction with it. And maybe because of that we feel like we aren’t the right ones to help someone else with those difficulties.  As clinicians, we know that we struggle with many of the same difficulties that our clients do; for example, many clinicians know first-hand the struggles of anxiety, depression, substance use, or trauma. But all these things can be hidden struggles. In contrast, our bodies are highly visible. Our bodies can be (and are) judged by ourselves and by our clients. Talking about issues related to food, body image, and weight often highlight that uncomfortable fact.

Many years ago, when I first started working with individuals around their body image difficulties, I felt an incredible hypocrisy. My body wasn’t (and still isn’t) shaped the way most people in American would say is the beauty ideal. Even so, I used to feel I needed to reflect back to my clients, even if only non-verbally, that I felt GREAT about my body, that I had conquered this whole body image thing and thus I could help them too by golly! Problem was that I didn’t and don’t always have universally positive thoughts and feelings about my body. No matter how hard I have tried, I too still have some of the same difficult thoughts and feelings about my body that my clients were coming to see me for; I too have a mind that was programed by this culture. So I was in a bit of a bind.

A different approach to body image struggles

But then I started studying  Acceptance and Commitment Therapy (ACT). From an ACT perspective, the problem isn’t that my clients or I had negative thoughts or feelings about our bodies. Rather than focusing on the importance of thinking or feeling more positively about our bodies, ACT suggests that what is most important is focusing on not letting those difficult thoughts or feelings stand in the way of doing what would be meaningful and important.  For some that will mean choosing to be physically intimate with your partner even if doing so will bring up self judgments about how you look naked. For others, it might mean exercising regularly so that you have the energy to be an active participant in your kids lives even though no matter how many times you go to that yoga class you might always have the same “YUCK!” thought that goes through your mind as you look into the mirrors at the front of the class.

ACT psychologist and assistant professor at University of Louisiana at Lafayette Emily Sandoz, Ph.D. is one of the country’s leading experts on in the area of body image and disordered eating. She is the author of several ACT books including Acceptance and Commitment Therapy for Eating Disorders, The Mindfulness and Acceptance Workbook for Bulimia, and the upcoming Mindfulness and Acceptance Workbook for Body Image. Dr. Sandoz’s recent interview in the Huffington Post offers a great synopsis on an ACT approach to dealing with body image concerns. In her interview, Dr. Sandoz highlights that in ACT we ask our clients the following questions:

“Would you be willing to have these terrible thoughts and feelings about your body if it meant you’re able to live the life you want to live? Would you be willing to feel distress about your body image if it meant you could be more present with your children? If it meant you could be more active in your community? If it meant you could pursue companionship? Would that be worth it to you?”

When I have a new client on my schedule and I see that eating dysregulation or body image are one of the presenting concerns, I still at times get a quick flash of anxiety. My own self judgments show up, as do fears about how I will be judged by that person I am about to meet. But then I practice what I encourage my clients to do; I thank my mind for that thought and then ask myself this question, “If I were free to choose, would I rather important trying to avoid having negative thoughts about my body or would I choose to important being fully present with this next person that is coming in to my office?”. Once I am centered on what is actually important to me,  I can get on to the valued work of connecting with peoples’ suffering, even when that suffering brings up discomfort for me.

Renouncing “reparative therapy”: A giant in the field admits his humanity

Renouncing “reparative therapy”: A giant in the field admits his humanity

Robert Spitzer, MD, one of the most influential voices in modern psychiatry, readily admits that he has always been drawn to controversy. He definitely has been at the heart of the controversy about sexual orientation and identity since the 1970s. It was during that time that Dr. Spitzer was instrumental in getting homosexuality removed from the DSM-III thereby declassifying it as a “mental illness.” However, the biggest controversy he may have been a part of was his more recent work on so-called “reparative therapies.” And now his recantation of that work may be one the last (he’s 80 years old now) and possibly one of the most important contributions Dr. Spitzer will make. In an inspiring act of courage and scientific integrity, Dr. Spitzer has written a letter to be published in the Archives of Sexual Behavior in which he states, ““I believe I owe the gay community an apology for my study making unproven claims of the efficacy of reparative therapy.”

The study that Spitzer is referring to is the highly influential 2003 study he conducted and that was published in the Archives of Sexual Behavior (published, it should be noted, without going through the standard peer-review process) in which he concluded that the majority of participants in his study, who were self-selected as being highly distressed about their sexual orientation, reported having changed their sexual orientation from homosexual to heterosexual. The result was a study that has been widely misused for political purposes to state that homosexuality can (and should) be “cured.” While Spitzer has, reportedly, always disagreed with this interpretation of his study, he has now publically denounced the study as being based on flawed science. All of the findings in the study were based exclusively on self-report from a “highly motivated” sample. In addition, this was not a study of the effectiveness of any type of particular therapy–nearly ½ of the participants never even engaged in any therapy at all. Basically, his study, which has been cited for nearly 10 years as “scientific proof” that sexual orientation/identity can be changed, consisted of interviewing people who reported that they had, in the past, been highly distressed about identifying as homosexual and now felt that they were more strongly identified as heterosexual.

Dr. Spitzer is certainly not alone in his criticism of reparative therapies. In fact he is a bit late in his critique. In 1997, the American Psychological Association came out with a resolution specifically stating that there is no scientific merit to claims of therapies being able to change sexual orientation and condemning the practice of such therapies. In 200, the American Psychiatric Association followed suit and published a resolution challenging the “validity, efficacy, and ethics of clinical attempts to change an individual’s sexual orientation.” Just last week the World Health Organization came out with a report stating that these type of therapies are “a serious threat to the health and well-being — even the lives — of affected people.”

The problem with science is that it is conducted by humans, and we humans have our own preconceptions, egos, and agendas that can get in the way of our science. What is heartening is that someone like Spitzer, a giant in the field, can finally take a stand and correct what he has called his “only professional regret.”

Why Google+ is Good for Therapists: Respect for Diversity

Why Google+ is Good for Therapists: Respect for Diversity

“Don’t be evil”—Google motto

I just created my new Google+ account yesterday and I’m very pleased. No, it’s not because it’s the latest and greatest social networking tool (though, those circles are pretty cool). And no, it’s not because finally, after holding out from joining Facebook for all these years, my friends and family will finally get off my back about needing to move into the 21st century. Nope. Those things are fine but, what I’m really impressed by though was what I found as I was going through the process of creating my account. Specifically, under the “gender” box you could choose from an option of “male,” “female,” and “other.” Wow! Now that’s not just “not being evil,” (Google’s motto) — that’s pretty darn enlightened! Yes, of course I’d like to see them use a fill-in-the-blank format so people who identify as something other than “male” or “female” don’t have to identify as “other”, but it’s a great start. This is a great example of how something as small as demographic questions can reflect our values. We have come a long way in terms of inclusivity and awareness of the rich diversity of our world when a Fortune 500 company like Google makes a statement like this.

It also got me thinking about ways that we here at Portland Psychotherapy can further advocate for our clinic’s core value to support diversity and inclusivity and to make quality, evidence-based mental health services available to all member of our community. I came across this brochure published by the Gay and Lesbian Medical Association that offers some great suggestions to help make your practice more inclusive and affirmative. I also found this sample of a “culturally competent intake form” from the King County Public Health Department that includes ways to structure your intake forms around issues of relationships and sexuality that are most inclusive.

Ways to Improve Inclusivity in Your Therapy Practice

Here are a few other suggestions of things you might want to consider to make your practice more welcoming to all:

  • Use fill-in-the-blank spaces rather than check boxes on intake forms for categories like “gender,” “sexual orientation,” “relationship status,” and “ethnicity”.
  • If you ask about religion on your forms, be sure to also include an option for “atheist” as a viable choice.
  • If you have brochures or magazines in your waiting room, consider whether or not they represent a diverse range of experiences and lifestyles (e.g. Do you only have “Parenting” magazine in your waiting room or do you also have “The Advocate”?)
  • If it seems clinically appropriate, ask clients which pronoun (e.g., he, she, it, they) they would like to be referred by.
  • When talking about sexual or relationship partners, be cautious about assumptions about gender, legal status (i.e. married versus partnered), monogamy, sexual orientation, etc. Using the term “partner or partners” may be more inclusive than “spouse” for example.

So, take a cue from Google+ and maybe revisit your office forms and practices to see if there are ways in which you could create a more welcoming and inclusive environment for all those you serve. I know we’re going to be revisiting that issue here at the clinic as well.

UPCOMING TRAINING EVENTS

How to be Experiential in Acceptance and Commitment Therapy

Jason Luoma, Ph.D.
April 23, 2021 from 12-1pm

Acceptance and commitment therapy (ACT) is, at its core, an experiential treatment, but is frequently delivered in a non-experiential way. Experiential learning involves going beyond verbal discussion, insight, and explanations of experience. But how do we do this in ACT and how do we know when we are spending too much time engaged in non-experiential modes of learning? This workshop will outline a simple model you can use to identify when you are in less or more experiential modes during therapy and easy methods to switch to more experiential modes. You will then have a chance to practice it in breakout groups and get feedback. Read More.


Ethical & Legal Considerations in Psychedelic Integration Therapy

Jason Luoma, Ph.D. and Brian Pilecki, Ph.D.
May 7, 2021 from 12-2pm

This workshop is based on extensive research and writing we have conducted into the legal and ethical issues of working with psychedelics in the current regulatory climate, as well as clinical practice doing harm reduction and integration therapy with psychedelics. It is informed by consultation with multiple experts on harm reduction, as well as attorneys knowledgeable about criminal and civil matters relating to drug use and professional practice. We will share with you all we know so that you can be more informed in the decisions you are making in your practice and be better able to decide whether to jump into this kind of work if you are considering it. Read More.


Case Conceptualization in Acceptance and Commitment Therapy

Jason Luoma, Ph.D. and Brian Pilecki, Ph.D.
May 21, 2021 from 12-2pm

This workshop provides a chance to learn concrete methods for conceptualizing cases from the perspective of Acceptance and Commitment Therapy. Formulating a useful case conceptualization is a foundational clinical skill that is essential in delivering effective treatment, and one that can be often overlooked in the process of working with clients. Participants will learn several formats for doing formal case conceptualization outside of session as a means to further develop knowledge and skill with ACT theory, as well as to learn a means to enhance treatment planning. The importance of ongoing case conceptualization throughout a course of treatment will be emphasized, as well as common pitfalls in conceptualizing client problems. Participants will also have a chance to practice newly learned skills with a case in breakout groups. Read More.


ACT Precision Training: In-Session Case Conceptualization in Acceptance and Commitment Therapy to Help You be Focused and Strategic in Your Interventions

Jason Luoma, Ph.D. and Jenna LeJeune, Ph.D
June 18, 2021 from 12-2pm

This workshop provides a chance to learn and practice in-session, in-the-moment case conceptualization of cases from the perspective of Acceptance and Commitment Therapy. This workshop focuses on helping you use ACT theory & in-session clinical markers to make more precise and strategic interventions. The main goal of this workshop is to help you become more adept at identifying in-session client behaviors that are indicators for particular ACT processes that are likely to be most relevant. The workshop uses a process we call ACT Circuit Training, which involves intensive analysis of a video of an ACT session and intentional practice in conceptualizing client behavior and generating possible ACT responses, followed by discussion and feedback. Read More.


ACT Agility Training: In-Session Case Conceptualization in Acceptance and Commitment Therapy to Increase Flexible Responding

Jason Luoma, Ph.D. and Jenna LeJeune, Ph.D
July 16, 2021 from 12-2pm

This workshop provides a chance to learn and practice in-session, in-the-moment case conceptualization of cases from the perspective of Acceptance and Commitment Therapy. This workshop is intended to help therapists be more flexible and nimble in their use of ACT processes, strengthening their ability to fluidly shift as needed between processes within sessions. Therapist learning ACT often develop tunnel vision, focusing too much on particular processes or responding rigidly when more flexibility is needed. Read More.


Therapy and Research in Psychedelic Science (TRIPS) Seminar Series

Second Friday of each month from 12:00 PM – 1:00 PM (PT)

TRIPS is an online seminar series that hosts speakers discussing science-informed presentations and discussions about psychedelics to educate healthcare professionals. This series was created to guide healthcare providers and students preparing to be professionals towards the most relevant, pragmatic, and essential information about psychedelic-assisted therapy, changing legal statuses, and harm reduction approaches in order to better serve clients and communities. This seminar series is a fundraiser for our clinical trial of MDMA-assisted psychotherapy for social anxiety disorder that Portland Psychotherapy investigators are preparing for and starting in the Fall of 2021. All proceeds after presenter remuneration will go to fund this clinical trial. Read more.

April 9th, 2021 – Ketamine 101: An Introduction to Ketamine-Assisted Psychotherapy with Gregory Wells, Ph.D.
May 14th, 2021  Research on MDMA and Psychedelic-Assisted Therapy: An Overview of the Evidence for Clinicians with Jason Luoma, Ph.D.
June 11th, 2021 Becoming a Psychedelic-Informed Therapist: Toward Developing Your Own Practice with Nathan Gates, M.A., LCPC