Attunement Helps Love and Intimacy Last

A Key Ingredient to Lasting Love and Intimacy

When two people come together in a romantic relationship, there are countless factors that contribute to their success or failure. However, one of the most important elements of a healthy, happy partnership is attunement. Attunement is the ability to be fully present with your partner, to understand and respond to their emotional needs, and to create a deep sense of intimacy and connection.

In this blog post, we'll explore what attunement means, why it's so critical to a couple's relationship, and how you can cultivate it in your own partnership.

What is Attunement?

At its core, attunement is the ability to tune in to your partner's emotions and needs, and respond in a way that demonstrates understanding, empathy, and support. It involves being fully present in the moment, listening actively, and paying close attention to nonverbal cues like body language and tone of voice.

Attunement requires a high degree of emotional intelligence and self-awareness, as well as a willingness to prioritize your partner's needs and feelings over your own. When two partners are attuned to each other, they are able to create a deep sense of connection and intimacy that can weather the challenges of life and strengthen their bond over time.

Why is Attunement Important in a Couple's Relationship?

Attunement is critical to a couple's relationship for a number of reasons. First and foremost, it allows partners to feel seen, heard, and understood by each other. This is essential for building trust, emotional safety, and a sense of security in the relationship.
When partners are attuned to each other, they are better able to navigate the inevitable conflicts and challenges that arise in any long-term partnership. They are able to communicate effectively, manage their emotions in a healthy way, and work together as a team to overcome obstacles.

Attunement also plays a key role in creating a satisfying and fulfilling sexual connection. When partners are attuned to each other's needs and desires, they are better able to communicate about sex and explore each other's bodies in a way that feels safe, respectful, and pleasurable.

How Can You Cultivate Attunement in Your Relationship?

While attunement is a natural and intuitive part of some relationships, it can also be cultivated and strengthened over time. Here are some tips for building attunement in your own partnership:

1. Practice active listening. When your partner is speaking, give them your full attention. Put down your phone, make eye contact, and ask questions to show that you're engaged and interested.

2. Pay attention to nonverbal cues. Sometimes, what your partner isn't saying is just as important as what they are saying. Pay attention to body language, tone of voice, and other nonverbal cues to get a better sense of how they're feeling.

3. Practice empathy. Try to put yourself in your partner's shoes and imagine how they might be feeling. Validate their emotions and offer words of support and encouragement.

4. Make time for quality time. Attunement requires presence and connection, so make sure to set aside dedicated time to spend with your partner without distractions or interruptions.

5. Practice self-awareness. In order to attune to your partner, you need to be aware of your own emotions and needs. Take time to check in with yourself and understand how you're feeling before trying to connect with your partner.

Attunement is a key ingredient in any successful and fulfilling relationship. By prioritizing your partner's emotions and needs, practicing active listening, and cultivating empathy and self-awareness, you can build a deep sense of intimacy and connection that will sustain your partnership for years to come.

Author: Crystin Nichols
Book Appointment: https://SouthTampaTherapyBOOKAPPT.as.me/CrystinNicholsMFTI

Can Gottman Couples Therapy Help Your Relationship Improve?

If you are facing relationship struggles, Gottman Couples Therapy can provide you and your partner with the support you need to work through your problems. This approach to couple’s therapy is based on over 40 years of research conducted by Dr. John Gottman and his wife Dr. Julie Gottman.

The main goal of Gottman Couples Therapy is to help couples strengthen their relationships by improving communication, enhancing love, and building trust. The therapy process focuses on evidence-based interventions that have been shown to be effective in strengthening relationships.

One of the key elements of this therapy is the concept of “The Four Horsemen of the Apocalypse” which refers to four negative communication patterns: criticism, contempt, defensiveness, and stonewalling. These patterns can be some of the most significant predictors of relationship breakdown. During the therapy sessions, the couples learn to recognize and avoid these patterns, which helps them to communicate more effectively.

Another essential component of Gottman Couples Therapy is the “Love Maps” exercise. This exercise involves creating a detailed understanding of each other’s inner worlds, including dreams, hopes, and fears. By building these Love Maps, couples can stay connected and understand each other better.

In addition, Gottman Couples Therapy helps couples to develop conflict management skills. During the therapy sessions, couples learn how to navigate argument and disagreements by expressing their own needs while also listening to their partner's feelings and concerns.

Gottman Couples Therapy also emphasizes the importance of reinforcing positive behavior. Couples are encouraged to express appreciation, admiration, and affection towards one another regularly. This allows the couple to build and maintain a strong foundation of love and positivity.

Overall, Gottman Couples Therapy is an evidence-based approach to counseling that can help couples work through various relationship challenges. By focusing on improved communication, increased trust, and building stronger emotional connections, couples can learn ways to enhance their relationship and increase their overall happiness.

How to cultivate a positive mindset for active aging

Last month Supervised Therapist Kaitlin Lowey was featured on WFLA TV’s Bloom. She dispelled stereotypes about aging and provided tips on how to foster a positive mindset and stay active as we age. You can view the full segment here. Below is a summary of the clip. 

https://www.wfla.com/video/mindset-active-aging/8430170/

Exercising our minds and bodies, staying socially connected, and living with purpose are all connected to longer, more fulfilling lives as we age and reach retirement age. But given the stereotypes about aging that pervade Western cultures, it can be difficult to overcome doubts about staying active, healthy, and engaged as we get older. 

So, how do we cultivate a positive mindset for active aging? 

• Reject the stereotypes about aging

• There are a lot of misconceptions about aging in America – false ideas like as people age, they are doomed to poor health, cognitive decline, and general decline in life satisfaction. These are myths. (And as part of a generation with parents entering this phase of life, I’m passionate about dispelling these myths.) 

• The truth is that subjective well-being increases with age, and we see a jump in subjective well-being around age 50, and this persists until the very oldest stage of life. 

• Why? One explanation is that as we age we become more emotionally stable. We’re better able to handle stress and weather storms with hard-earned wisdom. 

• Another reason may be that, contrary to the myth that older adults become more set in their ways, older adults actually report more openness to the future. 

• In addition, older adults report more satisfaction in their social relationships. 

• And finally, as we age we care less and less about what people think! There is freedom in this. 

• All of this is important to remember because a 2022 study from Harvard revealed that people with more positive attitudes about getting older tend to live longer and healthier lives than those with negative perceptions. 

• Be intentional about connecting to purpose and people 

• Having a purpose gives our lives meaning. We spend so much time planning for retirement, that it’s easy to forget to plan the retirement itself! Consider the legacy you want to leave behind in this new chapter. Is the purpose of this chapter to teach others, spend more time connecting with loved ones, building a new skill you’ve always wanted to try? There are so many exciting possibilities for projects that align with your values. 

• Post-retirement years are also a great time to join a club and get involved in a community organization. 

• Make a plan for exercise 

• Research shows that exercising regularly has immense physical, emotional, and cognitive benefits – especially in our older years. But we’re not always motivated to do it. The key is to make a plan for when you’ll exercise and also make a plan for how you’ll respond if you don’t feel like it.

• For instance, you could tell yourself you’ll just try exercising for a few minutes and see how it goes. Chances are, you’ll find the motivation to do more. You can also take a moment to envision all the benefits you will get from exercising to create the kinds of positive feelings that then lead to motivation. 

• Another great way to stay motivated is by recruiting your friends and family members to exercise with you or help keep each other accountable.  

• Finally, fit activity into your lifestyle. Take the stairs. Park in the back of the parking lot. Take the dog for a long walk. These small moments of activity add up. 

• Cultivate gratitude, openness, and curiosity

• Research shows that the number one factor happy people have in common is gratitude. Actively noticing and being thankful for the small things in life can give you the boost you need to maintain a positive mindset.

• Make use of that openness you’re experiencing. Lean into it. Get curious about what’s out there waiting for you in your retirement years. Who knows if you’re the next budding photographer, master’s high jumper, or champion pickleball player.

To Book with Kaitlin Lowey: https://SouthTampaTherapyBOOKAPPT.as.me/KaitlinLowey

How to get unhooked from difficult thoughts and emotions with ACT

By: Kaitlin Lowey, MHCI

You’ve likely heard the phrase uttered by Benjamin Franklin, “...in this world nothing can be said to be certain, except death and taxes.” As a mental health professional (and fellow human being), I would add one other inevitability: experiencing uncomfortable thoughts and emotions. 

“I’m not good enough.” “It’s breaking my heart.” “I totally freeze.” “Something feels off in my gut.” “What is wrong with me?” “I feel depressed.” “I’m so scared.” “What if I get it wrong?” “Do they actually like me?” “Why did I say that?” “What if I fail?” “What if I end up alone?”

Our difficult thoughts and emotions are 100% normal.

Many psychologists and counselors, especially those practicing Acceptance and Commitment Therapy (ACT), would argue that experiencing such thoughts and emotions is just part of being a human. In fact, emotions like anxiety serve a purpose – they protect us from threats (like a charging lion or a dimly-lit alley). Uncomfortable emotions only become a problem when they show up in non-adaptive ways and stick around long past when they’ve served their purpose – in other words, when the degree of emotion we feel outsizes the actual threat. Our emotional responses are both innate (such as fear of snakes) and learned (such as fear of touching a hot stove). Some emotional wounds experienced in childhood, particularly those related to relationships, can continue to impact our emotional responses well into adulthood. 

So, what do our minds do when we experience these emotions? They view the emotion as a problem to be solved – to be gotten rid of. Again, the mind’s problem-solving nature is normal. It’s how humans have survived and adapted for thousands of years. For instance, humans built homes to shelter us from animals and the elements. We created the wheel to transport objects more easily. We even invented the remote control to save us from the inconvenience of having to move to turn up the volume on the TV. Our brains are hard-wired to problem-solve, and that’s usually a great thing! However, it’s not so great when our brains’ well-intentioned but ill-fated attempts to get rid of uncomfortable feelings only makes those feelings stronger. 

So, what happens when our emotional response and our problem-solving are both operating on overdrive? Russ Harris, the author of ACT made simple: An easy-to-read primer on acceptance and commitment therapy, describes the effect as getting hooked. Getting hooked means our brains automatically label the thoughts as a threat, something we have to act on, or something requiring all of our attention (what ACT theorists call cognitive fusion). We may do everything in our power to get rid of them (what ACT theorists call experiential avoidance). In addition, we might start to fuse these thoughts with our self-concept (e.g., If I keep thinking I’m bad, then I must be a terrible person.) We can also lose contact with the present moment, instead narrowing our focus on the thing that’s making us uncomfortable, disconnecting from our experience, or disengaging. Ultimately, we can lose sight of our values (what we care about and want out of our lives) and instead attempt and reattempt the same ineffective strategies to gain control over our thoughts and feelings. In other words, we use just about every strategy we can to banish our discomfort. This might look like denial, obsessively ruminating on whether or not our thoughts and feelings are true, procrastinating, engaging in addictive substances, and other attempts to control and escape. 

The problem with these strategies is that they are not likely to work. Not only do they not solve our emotional discomfort in the long run – they actually move us away from the kind of life we want to lead. And to top it all off, they often result in a spiral of shame and self-loathing. It’s a vicious cycle. 

At this point, I want to pause and remind readers that it’s not our fault our brains are wired this way – it’s extremely normal and entirely human! And, once we accept this, we can begin to make changes that help our minds work for us, instead of against us.  

So, what’s a human to do? And how can ACT help?

ACT proposes an alternate strategy (with many concepts borrowed from Yogic and Zen principles) to deal with our emotionally uncomfortable thoughts and feelings: accepting them. What if, instead of fighting our emotions and accompanying thoughts, we accepted them for what they are: our bodies’ and minds’ attempts to protect us? What if, instead of living our lives constantly running away from our discomfort, we were able to view our discomfort as separate from ourselves, accept that feeling discomfort is normal in the situation we are in, and make choices that are workable and that move us in the direction we want? In other words, what if we were able to get unhooked?

Several tools from ACT can help us unhook from uncomfortable thoughts and feelings. For instance, mindfulness strategies work to reduce emotional intensity by enabling us to attend to our emotions and the present moment with compassion and acceptance. They can also get us into the habit of viewing our thoughts and emotions as things we are experiencing in this moment, rather than the absolute truth or indicative of who we are. 

One of my favorite ACT tools involves the concept of workability versus absolute truth. As Harris states, ACT isn’t interested in whether thoughts are true – the concept of truth could be endlessly debated. Instead, ACT is interested in whether our thoughts and what we do with them are workable. If a thought or a behavior is workable, it has worked for us in the past and/or is likely to work for us in the future. It will move us closer to our long-term goal. This is a simple question we can ask ourselves when we find ourselves getting hooked and in auto-problem-solving mode: is this thought or behavior workable? Or will it be ineffective or cause other problems? 

Finally, ACT asks us to get really clear on our values. What kinds of concepts (such as love, compassion, resilience, integrity, and authenticity, for example) do we want to guide our actions? If our problems did not exist, how would we operate? Once we know our values, we can endeavor to live in alignment with them. And living in alignment with our values results in less emotional discomfort, improved self-concept, and greater fulfillment. 

Who can benefit from ACT? 

Evidence shows that ACT can be effective for a myriad of mental health problems, including anxiety, obsessive-compulsive disorder, depression, stress, phobias, chronic pain, addictions, and adjustment. But I believe that just about anyone can find usefulness in the approach. As Harris writes, 

“Who wouldn’t benefit from being more psychologically present; more in touch with their values; more able to make room for the inevitable pain of life; more able to defuse from unhelpful thoughts, beliefs and memories; more able to take effective action in the face of emotional discomfort; more able to engage fully in what they’re doing; and more able to appreciate each moment of their life, no matter how they’re feeling?” (Harris, p. 36) 

There is much more to ACT – more than can fit in this article. But I hope this post provides a basic understanding of how ACT can help us humans get unstuck and live a more meaningful, fulfilling life. 

By: Kaitlin Lowey, MHCI

Kaitlin joins her clients as they find relief, healing, hope, clarity, and transformation. She has helped individuals experiencing struggles with anxiety, stress, relationships, life changes, obsessive-compulsive disorder, intrusive thoughts, grief and loss, fertility and postpartum, motherhood and parenthood, athletic and career performance, perfectionism, identity, and self-worth. As an integrative therapist, Kaitlin collaborates with her clients to identify goals and choose research-supported therapeutic approaches that fit best. She offers in-person and online appointments.

Book with Kaitlin Lowey, MHCI here: https://SouthTampaTherapyBOOKAPPT.as.me/KaitlinLowey

The Steps and Stages of Emotionally Focused Therapy for Couples

EFT for Couples is a three stage nine step process that takes a couple out of their negative repetitive fights that are causing a couple distress, anguish and pain and into a new place of bonding and connection where the fights are resolvable and solutions can be found. It was created by Dr. Susan Johnson and based on research in attachment theory and emotion, as well as, on systems, humanistic, and experiential treatment models. As a model itself, it has been validated by research to help about 70% of couples achieve some long term gain.

Stage One - Stabilization (assessment and de-escalation) 

In stage one of EFT, the therapist works empathically with the couple helping them identify and break the negative cycle, pattern or what Dr. Johnson calls the dance that keeps them separated and in emotional distress. During this stage of therapy, the therapist helps the couple begin to get more in touch with the underlying feelings, fears, and unmet relationship longings driving the negative dance. Experiencing these emotions and seeing their partner experience them, helps the couple to start to feel close again. Things at home start to go along more smoothly. There is a sense of calm and hope. Finally, in this stage, as de-escalation begins to take root, the individuals in the couple pair begin to see, feel, and understand that together they have created this dance of distress. Each person begins to understand more deeply the effect of his or her behavior on the other. Couple learns to work together as a team to stop the cycle.

Step 1: 
Assessment: Delineate conflict issues. Assess how these issues express core conflicts in the areas of separateness/ connectedness and dependence/ independence.
​
​Step 2:
Identify the negative interaction pattern or cycle.

Step 3:
Dive more deeply into and feel and share the emotions underlying and fueling each partners position in the cycle. 

Step 4:
Develop an understanding and experience of the problem (reframe) in terms of the cycle, the underlying emotions driving the cycle and the attachment needs which are normal and longing to be meant.

Stage Two - Bonding 

Once the couple begins to understand the dance they do together and is able to step back and stop it or repair it when it gets going at home, they are ready for stage two of EFT. Stage two essentially involves bonding moments where the couple begins to learn how to communicate their vulnerabilities to each other in a new and non-reactive manner. They are supported by the therapist to take risks in expressing their core sense of self, in asking for the other to be there for them and in requesting understanding and acceptance. Partners take turns reaching out to each other in vulnerability and responding back with empathy creating a new sense of togetherness and secure attachment.

Step 5:
Delve into and identify disowned needs and aspects of self that have been hidden for each partner.

​Step 6:
Promote acceptance of these tender and hidden parts, aspects of self and new ways of relating.

​Step 7:
Facilitate the expression of needs and wants, and restructure the interaction to create true emotional engagement.
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Stage 3 - Consolidation of Change

After the couple has finished the bonding and restructuring events of stage two, they will begin to feel more secure with each other. During stage three, they feel like a team again. The narrative of their relationship has shifted to one where the distress and conflict is understood, resolved, and just part of the story.

Step 8:
Facilitate the emergence of new solutions to old problematic relationship issues.

Step 9:
Consolidate new positions and cycles of emotional closeness and attachment.

Sure, people still fight and sometimes even go back into their cycle. This is normal and will happen especially during times of stress. However, they are able to pull themselves out of it and be there for each other because their sense of self and experience of the relationship has changed. Because of this new ability and sense and during stage three, the focus is more practical and mostly involves consolidating gains and problem solving.

A Lesson for those who feel Unworthy or “Never Enough”

The topic of self-worth is common amongst therapists who are passionate about guiding their clients towards relief from negative thinking, anxiety, and low self-esteem. To gain a sense of self-worth it is important to identify what subconscious (or conscious) beliefs you hold that might be blocking you from offering yourself UNCONDITIONAL positive regard.

The term unconditional positive regard was coined by the American psychologist Carl Rogers. Carl Rogers believed that all humans are inherently “enough” and “worthy.” It was Rodger’s mission to bestow upon all his clients the experience of being treated with unconditional positive regard. Spoiler alert: that is also my mission! 

Ok, but for the sake of this post let’s define the terms. I want to focus on the “unconditional” part. Unconditional means that no condition sets you up against your inherent worthiness. To believe you are worthy of unconditional positive regard you must identity what Rodgers called “conditions of worth.” Conditions of worth are the beliefs that block you from accepting unconditional positive regard and from feeling worthy for just being you. 

Conditions of worthy might go something along the lines of……

• If I am funny, people won’t notice my insecurities

• I am safe and worthy if I keep this job or make x amount of money

• If I am agreeable and quiet, I am acceptable.

• It is not okay to show who I truly am I can be a chameleon and be loved

• I must make peace; conflict will show that I am an angry person

• As long as I stay beautiful, my husband will love me

I could probably write thirty pages of hypothetical “Conditions of worth” but I will spare you from that. The point is that we all have internalized “conditional worth” beliefs learned from caregivers, parents, teachers, cultural messages, or religious institutions. 

Once you have taken in these messages as fact, your brain starts to scan for evidence that will validate that belief. 

For example, if you believe that “good people are agreeable and don’t pick fights,” every time your partner picks a fight or confronts you, you might push down your feelings or reactions to appease them.

You do this because, “good people don’t fight back” right? “Good people are agreeable” right? You can’t possibly share your truth or advocate for your feelings because if you do, you won’t be good, and everyone wants to believe they are good right? 

Do you see the danger in this type of thinking? Continuing to live in reaction to these beliefs, with a brain that is wired to scan for evidence that bolsters them, is essentially what creates the “inner critic” in our heads. The voice that does not sound warm and fuzzy. The voice that certainly does not speak unconditional positive regard to our dear souls. 

So, step one is to think about your parents, your family, your spouse, or your religious organization. Try to identify any messages you’ve learned that set you up against your inherent worthiness with any “condition” that you must meet. 

Once you are aware of these messages you can begin to externalize them. For example, when you hear the thought: 

“I shouldn’t speak up because I will be seen as too much” you might say “I notice I am having the thought that I shouldn’t speak up because I will be seen as too much.” You might say, “I am hearing my moms voice in my head.” At that, you might begin to chuckle as you notice that some of the thoughts in your head are not your true thoughts but merely conditioned beliefs that your little child brain absorbed as absolute truth. 

At this point, you have awareness which is a powerful tool. Once you’re aware you can choose not to put energy towards that thought and more importantly you can choose not to act in reaction to that thought. 

Sometimes we have all these negative feelings towards ourselves and fears that drive us. We identify with them and think they are us. What a relief when we can understand that those thoughts aren’t us. The inner critic is not you and you don’t have to act in reaction to it. 

My final thought is that when you experience anxiety when trying to go against the thoughts, remember that you can tolerate it. The only reason it feels scary is because you have never opposed those thoughts in the past. The more you notice them, do the scary thing and act from your thoughts (not your conditioned thoughts) the more you essentially become you. 

Maybe it is just me, but I don’t want to live in a world where I must earn my worth or worthiness. Most people when looking at an innocent child, inherently know there is something worthy about them regardless of what they do, how they look, what they say, etc. We are still those innocent children deep down. The more we live from a place of worthiness the freer we become to treat others with such unconditional positive regard. 

I hope this blog taught you something or sparked an insight. If you have questions about this topic or want to explore your past and conditions of worth, I offer free 15 min consultations and would love to get to know you. 

Shaundra McGuire, MFTI 813-298-8905

Book With Shaundra: https://SouthTampaTherapyBOOKAPPT.as.me/ShaundraMcguireMFTI

How Psychotherapy Retrains the Brain to Expect (and Feel) Better!

People enter psychotherapy with the desire to feel better, but they are often unsure how therapy will help them accomplish this goal. A common refrain from people hesitant to enter therapy is, “How is talking going to help?” People are used to talking to other people to get practical solutions to problems, and while problem-solving does have a place in therapy, change also occurs on a much deeper and unconscious level. This process has to do with the way the human brain is programmed and cannot easily be mimicked outside of a relationship with a psychotherapist.

Our brains are always evolving unconsciously through our relationships. People who experienced painful relationships growing up have been trained to expect hurtful experiences with others. It takes a new type of relationship—in particular, a therapeutic relationship—to retrain the brain to expect more positive experiences, which is a big part of ultimately feeling better. 

WHY CAN’T A THERAPIST JUST TELL ME WHAT TO DO?

To understand why the therapeutic relationship can be so valuable and cannot be mimicked by, for example, advice in a self-help book, it is instructive to look at how the human brain has evolved. Broadly, there are three parts of the human brain that represent different phases of evolution: There is the reptilian brain, which evolved first and is responsible for the automatic control of vital bodily functions such as breathing; the limbic brain, which evolved second and is responsible for the regulation of emotion and behavior; and the neocortex, which evolved last and is responsible for higher-order functions such as symbolic thought, language, and reasoning.

When a person asks their therapist or a friend what they should do about something, they are essentially asking for a neocorticol solution—something that is rational and can be consciously implemented. Often, however, their problems are a result of hurtful experiences in their earlier relationships that have caused changes in their limbic brain, and only a new type of relationship can alter their limbic brain to produce fewer negative emotions and more positive ones.

BRAIN WIRING IN OUR YOUTH: HOW EMOTIONAL ISSUES BEGIN

Our emotions are meant to help us survive in a world in which we need the help of others. Over time, our limbic brains evolved to automatically create emotions, such as anger and sadness, that are meant to help us navigate the social world. When someone mistreats us, evolution has programmed us to become angry to try and change their behavior. When someone rejects us, we feel sad so we can mourn the loss of what we wanted with them and move forward with our lives.

However, when we are young and particularly dependent on others for survival, whether our emotions actually help us navigate the world has a lot to do with how other people—our parents in particular—respond to them. A child who responds to unfair or disappointing experiences with anger and is further punished for doing so may, over time, come to unconsciously pair the expression of anger with pain. As this occurs, rather than directly experiencing anger at times of unfair treatment or disappointment, they may instead experience anxiety about having anger because their brain has been trained by their social environment to expect that anger will hurt rather than help. Their limbic system is in effect attempting to prevent further emotional pain in the form of being punished, but the cost is another type of emotional pain in the form of persistent anxiety. This can be particularly problematic when people enter into new relationships (friendships, romantic relationships) where there would not be the same costs associated with the open expression of an emotion like anger, but earlier experiences still create anxiety and inhibit its expression.

RETRAINING THE BRAIN WITH PSYCHOTHERAPY

A psychotherapy relationship allows a person to essentially retrain their limbic system to no longer expect negative reactions to the expression of certain emotional experiences, and in doing so can alleviate the anxiety and unconscious emotional suppression their earlier experiences programmed into them. The therapeutic relationship does this in part because the parameters of psychotherapy recreate the type of relationship in which a person was first forced to suppress their emotions: one where they are dependent on another person to meet their needs.

A successful course of therapy helps restore a person’s emotional flexibility and empowerment so they can have greater agency in their relationships.

Just as a parent has a daunting task in meeting all of a child’s needs, so too does a psychotherapist, especially since many people arrive to therapy wanting a conscious, rational solution to their problems when such a solution often does not exist. Therapy presents a unique opportunity to heal and feel better by the way the therapist solicits and responds to feelings such as disappointment, anger, and sadness that emerge over the course of treatment. Rather than punishing a person for having these emotional experiences in the same way that may have occurred when they were younger, a therapist can actively solicit, explore, and normalize their feelings. This helps to retrain a person’s limbic system to no longer pair the expression of those emotions with punishment. As this de-coupling unconsciously occurs, the person becomes more easily able to tolerate the experience and expression of emotions.

THRIVING IN ADULTHOOD

This shift in tolerance for emotions naturally causes a person’s anxiety level to diminish because their mind is no longer fighting to ward off their innate emotional impulses. In addition to symptom relief, the beautiful part of this process is it restores a person’s ability to constructively access their emotions for their original purpose—as a way of helping to navigate the social world. It is hard to thrive in relationships when we have been programmed to believe we must accept the mistreatment of others or that we cannot show others when we are hurting and in need of care. As adults, this is often no longer the case, but our early experiences may make such underlying beliefs unconsciously feel true.

A successful course of therapy helps restore a person’s emotional flexibility and empowerment so they can have greater agency in their relationships. The result can be genuinely transformative, and studies suggest people who have been through therapy show less activity in the areas of the brain responsible for creating negative emotions. Talking, it turns out, can help quite a bit when the person you are talking to is a skilled and compassionate therapist.

If you’re struggling, reach out to a therapist in your area for help.

References:

1. Bowlby, J. (2005). A secure base: Clinical applications of attachment theory (Vol. 393). UK: Taylor & Francis.

2. Cozolino, L. (2010). The neuroscience of psychotherapy: Healing the social brain. New York, NY: W.W. Norton & Company.

3. Damasio, A. R. (2006). Descartes’ error. New York, NY: Random House.

4. Grecucci, A., Theuninck, A., Frederickson, J., & Job, R. (2015). Mechanisms of social emotion regulation: From neuroscience to psychotherapy. In Emotion regulation: Processes, cognitive effects and social consequences, pp.57-84.

5. Karlsson, H. (2011). How psychotherapy changes the brain: Understanding the mechanisms. Psychiatric Times, 21.

6. Lewis, T., Amini, F., & Lannon, R. (2007). A general theory of love. New York, NY: Vintage.

7. MacLean, P. D. (1990). The triune brain in evolution: Role in paleocerebral functions. Berlin: Springer Science & Business Media.

Narcissistic Abuse: Tips for Recognizing and Recovering

When I bring up the word “Abuse” with my clients I notice they are prone to discount their experience because they don’t’ see their situation as being “real abuse.” Abuse is a spectrum, and the word doesn’t do justice to describe the many forms of subtle and overt abusive behaviors and toxic relational dynamics. Narcissistic abuse is a very real form of abuse. The power and control dynamics might not include physical or sexual violence, although they can, but the psychological, emotional, interpersonal, and spiritual effects devastate individuals who find themselves trapped in the narcissistic abuse cycle. This post intends to do two things: 

1. Describe the Narcissistic Cycle of Abuse to help those suffering recognize they are not “crazy.” This is a definable pattern that many others are experiencing.

2. Provide some practical tools and tips to cope and eventually recover from said abuse.

The narcissistic abuse cycle can be defined as a “pattern of highs and lows in which the narcissist confuses their partner through manipulation and calculated behaviors aimed at making their partner question themselves” (Hammond, 2015). I want to make it clear that your partner does not have to have an official diagnosis of “narcissist” for your situation to be a valid case of narcissistic abuse. Media and pop culture usually only portray the most extreme examples of narcissism thus exacerbating the problem and preventing victims from getting help. 

The cycle involves three phases that work in tandem with each other. 

The first stage is Idealization. 

This is the stage where your partner makes you feel like the most special person in the world. The term “love bombing” comes to mind. You might feel as if you’ve never been loved or adored for like this before. The pursuer will become vigilant in giving attention to you and will shower their “target” with gifts, compliments, and promises. 

The idealization phase may include: 

• Love-bombing

• A lot of attention given to partner

• Grandiose gestures

• Elaborate gifts and dates

• Discussing marriage

• Lack of boundaries

• Attempts to isolate partner in the name of love

• Quickly moving into intimacy

• Creates a sense of ownership of partner and the relationship (Hammond, 2015).

The second phase is devaluation.

During this stage, you might start to notice your partner acting one way with you and one way in public which makes it hard to understand which person they really are. If you express concern, you might be labeled as “jealous” or “needy” or a “nag,” The disillusionment at this stage makes some cling harder to the memory of when things were ideal. You might have an intuitive feeling that something is wrong but because of the hot and cold nature of their affection for a time, it is easier to push that voice down. A huge red flag is that you begin to doubt yourself. You begin to see the real person for who they are, and you notice more incongruency in their behavior. This is where the abuse really starts to hurt and many start to exhibit anxiety, depression, obsessive thoughts, develop a trauma bond, amongst other symptoms. Visit this resource to learn more. This is where people get trapped because they are so beaten down and confused, it seems easier to just stay for fear of what might happen or what threats might be made.  

The devaluation phase might include:  

• Attempting to change their partner

• Increasing criticism and insults

• Gaslighting

• Physical threats

• Poor communication

• Increased violation of boundaries

• Triangulation

• More isolation or control over their partner

• Withholding physical, emotional, and sexual intimacy (Hammond, 2015).

Finally, the third phase is rejection. 

In this phase, the narcissistic partner rejects their partner and essentially places complete blame of the downfall of the relationship on their partner. In healthy relationships conflicts and disagreements are navigated with patience, grace, and the use of helpful problem solving skills. In narcissistic abuse relationships, there are no compromises. It is if the victimized partner doesn’t even exist, and they begin to lose any power or autonomy. Sometimes the cycle repeats itself over and over. Sometimes, once the phases are complete, the abuser become disinterested and finds another partner to begin another cycle with. 

The rejection phase may include: 

• Feelings of contempt and rage

• Betraying the relationship

• Invalidating their partner’s emotions and placing all the blame on them

• Playing the victim

• Physical, emotional, and verbal abuse

• Ending the relationship permanently or temporarily with attempts to continue this cycle of abuse (Hammond, 2015).

Now that I have described, briefly, common signs and symptoms of the narcissistic abuse, I will provide some tips for coping. At the end of the article, I have provided additional resources for you to begin your journey to safety and recovery. 

1. Label the Abuse

Once you recognize the abuse and have educated yourself about it labeling it is a vital step towards healing. Consider communicating what you are learning out loud to a trusted person.  

2. End the relationship if you haven’t already done that.

Get in touch with a trusted person, a professional, or your family to create a safety plan if necessary before you leave. 

3. Set Clear and Specific Boundaries

Setting clear boundaries requires discipline but it is vital to protect you from getting manipulated or tricked again. If you share children with your ex-partner and must make contact, make sure you have clear boundaries and a safety plan.  

4. Seek Support

The resources attached to this blog are a great way to find support during this hard time. Additionally, reaching out to a therapist will help you tell your side of the story, be validated, and learn how to grief. A therapist can support you in creating new patterns of living and implement new coping skills. 

5. Rediscover Yourself

In many cases, the abusive relationship has taken over your mind, emotions, physical health, and schedule. Once you are ready it is important you take the time to rediscover who you are, what you want, what you like, what you enjoy, what you need, and how you want to see yourself. This can seem daunting but there is not rush. Rediscovering ourselves is a life long process and we change throughout life. The key is that you recognize you have been deprived of your voice and allow yourself to rediscover it. 

There is no way I can describe all that narcissistic abuse is and how to recover in this short blog but my hope for you is that you feel validated and affirmed if you or someone you know is suffering or trapped in this cycle. There is hope, people can leave their partner, grief the loss, and heal. If you are unsure if you want to start therapy as a part of your healing, I offer free consultations and it would be a pleasure to hear your story and get to know you!

By Shaundra McGuire, MFTI Book With Shaundra: https://SouthTampaTherapyBOOKAPPT.as.me/ShaundraMcguireMFTI

Additional Resources: 

Stages of Narcissistic Abuse - Narcissist Abuse Support

https://narcissisticabusevictims.org/

You Are Not Alone - Educate Yourself - Find Support - Get Healed - Find Peace Again - Narcissist Abuse Support

Couples Therapy: Like you’ve never experienced before…

In a Nutshell, What Is Couples Counseling?

If you're reading this, your relationship is likely struggling right now. You might even be considering divorce.. Let me start by telling you I'm sorry to hear that you're going through such a difficult time.

If you're like most couples I see, you've probably come across an online article claiming that all of your relationship's difficulties can be traced to communication breakdowns.. If you could effectively communicate with your partner, you would be able to fix things.… 

And that’s true! I have the tools to teach you how.

That's the problem: it is ineffective advice when you're in the middle of a disaster.. Obviously, if you could communicate better, your relationship would be better. But you can’t, so it’s not. 

But there is hope! I will guide you in session and give you evidence based tools to use between sessions, to apply 4 easy steps to communicate to get to the root of the issues.

Whenever you and your partner try to communicate – Even deciding what to have for dinner can be tough, You may as well forget about trying to have an actually meaningful conversation. – it just turns into another fight, nothing gets resolved, and makes everything even worse.

Then it is just brushed under the rug to linger... until the next argument. Ugh... How exhausting! 

And sure, that might be because your partner is trying to pick a fight (not realizing that all attacks are unskilled ways of trying to get a need met). And more than likely, there was an emotional injury at some point in time that went unaddressed – a crack in your friendship that never healed. Over time, you’ve grown more distant and further apart, until you’re constantly feeling resentful, annoyed, frustrated, hurt, disappointed, and down right angry.

Oftentimes, we know something is wrong but can't seem to put our finger on the problem. If this is where you're at, don't worry.

I am here for you both! I want to help you uncover the root of the problem, rekindle your relationship, and equipped you with the right tools for future success. most likely, the issues are learned behaviors. The beauty of working with learned behaviors is that we can learn how to SHOW UP in our relationships with ourselves and our partner in a much healthier and powerful way.

4 Ways Couples Therapy Is Different with Me:

1. I get to the CORE of the issue.

Too often, couples therapists begin couples work without adequately assessing for each person’s background and the couple’s joint history related to the presenting problems. 

This is where the Gottman Assessment really helps me to conceptualize the problem to formulate a game plan from the get-go!

If you only go to therapy and talk about the problems you're having RIGHT NOW, it's like putting a band aid on a wound when the actual problem is internal bleeding. If you want to work through your problems more effectively, we’ll get to the root cause of the issues you’re experiencing based on each of your needs. 

When we work together, I will begin by asking you to tell me more about:

• your individual narratives

• your family dynamics and how you saw your parents argue (or not)

• your communication styles when fighting

• how your relationship started

• the current state of your relationship and how you got here

• what your ideal relationship looks like (among other questions)

I hear it time and time again from clients about how the assessment procedure was beneficial to them, how it helped everything click for them to finally start seeing a difference in their relationship. 

I also understand that talking about your history might make you feel vulnerable and taking this step requires bravery, but I assure you it's worth it..

2. I equip you with the tools and know-how to achieve long-term relationship success..

Oftentimes, clients come to me and say that couples therapy has failed them in the past because it didn't provide concrete tools for long term success and accountability. While addressing particular issues or complaints can be beneficial, without the necessary communication and listening abilities to interact with one another empathically – and listen compassionately - any discussions we have about your challenges will be ineffective.

So, we start working on specific skills. Such as:

• How to initiate a conversation in a softened way

• How to repair or de-escalate heated conversations

• How to emotionally self-regulate when you feel triggered

• How to come into dialogue in a productive way

• How to compromise based on feelings and needs

Couples are surprised at how quickly they’re able to talk with each other in a calm, compassionate, and respectful manner.

Once you and your partner have worked through some tension and built up resentment in an emotionally safe way, you will be able to understand each other on a much deeper level. Trust builds when we learn how to implement compassionate communication (NVC).

“Well,” you may ask, “Isn't it rather simple? Why haven't we been able to solve this on our own"? "Please understand, this isn't your fault".

When you've been stuck in this vicious cycle and these patterns are ingrained, you may tend to keep creating these predictable bad habits of how you deal with conflict. You start to make assumptions about your partner, your armor goes up and you go into self-protection and defensiveness mode. It becomes less and less easy to give each other the benefit of the doubt that is necessary to sustain a long-term compassionate relationship.

My goal is to help you rediscover that grace, that softness. And ultimately, to help you hit the rest button to INTENTIONALLY create the relationship that you desire and rediscover yourselves too.

3. I help you recognize and understand the role comorbidity (anxiety, depression, ADHD, trauma, addiction, etc) may play in your relationship. 

Basically, comorbidity means your brain is wired a little differently.

And honestly, the more I learn about comorbidity, the more I see just how common it is. Yet so often, it is either not acknowledged, or is seen as something that is wrong – something to blame. 

Even if you don’t have comorbidity in your relationship, this approach is still highly applicable. The basis of comorbidity couples counseling is to help each partner understand, accept, and embrace their differences while working together as a team to overcome obstacles together without blame. 

Comorbidity or not, in working with me your way of seeing the world will be acknowledged, not criticized. 

For many couples I see, discovering comorbidity may be a freeing discovery. It allows them to reframe their relationship, and everything begins to make sense. 

With my trainings in both the Gottman Method, Compassionate Communication, and Comorbidity Couples Counseling, I’m able to provide an organized framework for you to work within, while still flexibly tailoring my approach to your specific relationship needs. 

4. We don’t have to stop at the 50 minute mark. I offer add-on time to customize sessions to meet your needs

You can choose to do 90- 150 minute sessions (or more), not just 50-minute sessions. 

If you've been to couples counseling before, then you know the drill. You describe the problem, communicate your feelings, make steps in the right direction… but just when you really start to dig into it, and peel back the layers~ time's up. You have so much left to say. And by next week’s session, you’ve lost your train of thought, and there are new and more pressing issues to address. 

By offering longer sessions, I’m able to devote the time needed for you to see real progress each week.

We're able to take on large-ticket items and actually reach a resolution that you may put into practice immediately.

Practice Empathy in Three Ways: Cognitively, Emotionally, and Somatically

You must first take off your own shoes to put yourself in someone else's shoes.

We stretch our hearts and minds beyond our own experiences, viewpoints, and feelings in order to imagine what it's like to be inside someone else's head. We employ imagination, creativity, and instinct to envision what life is like for them.

Listening with empathy is a fundamental component of coming from curiosity and care, as well as the foundation of discussion. Here are three strategies to start practicing incorporating more empathy into your daily life that integrate living purposefully and empathetically.

PRACTICE: Empathy

It's important to remember that practicing this doesn't have to be limited to situations in which you are the center of attention. Its easier to feel for others when you aren't being attacked. Remember that empathy isn't something you put into words; it's a quality of presence in your heart. Aim to comprehend the other person's situation and let the conversation unfold organically.

SILENT EMPATHIC PRESENCE: Practice listening completely, with the heartfelt intention to understand and "feel into" what the other person is saying. How is this issue for them?

PARAPHRASE: After listening, summarize the gist of what you've heard. What are the key features of what they've said? It's also possible that repeating just a few words will be enough.

EMPATHIC REFLECTION: After listening, check that you understand by reflecting what you hear is most important to them. This may include how they feel and/or what they need. What's at the heart of this individual's narrative? What can you do to assist them to feel understood? Remember to phrase your reflections as questions and double-check that you're correct.

There are other methods for conveying compassion. We may convey empathy by giving a kind word, with a loving touch, or by describing how we're feeling in response to what we've heard. By expressing interest with open-ended questions like "Tell me more," "What else?"

As an example, my daughter's friend a freshman who is usually cheerful and bubbly, began showing up early to practice. I struck up a conversation and realized how much she was struggling. This friend was saying, "I don't want to go to this school anymore," and was thinking about dropping out. I noticed the impulse to go into problem-solving mode, an old habit of mine. Having just finished another book on empathy, I paused and decided to try listening instead. "Tell me more. What's going on?"

She began to open up. She was being bullied. She felt sad, alone, and depressed. Every time I noticed the urge to fix or solve, I attended to feeling the weight of my body and my feet on the floor, and resisted the temptation to offer solutions. I focused my attention on what she was feeling and reflected what I was hearing. She began to cry, oscillating between speaking, sobbing, and awkwardly making eye contact as if to check whether all of this was okay. There were a lot of tears, tissues, and long moments in which I simply held her gaze.

She spoke more about her feelings of sadness, loneliness, and not feeling valued. "I've felt like this since first grade," she mentioned. "Was that the first time you felt so sad and alone?" I inquired. No, it started when she was three, when her dad left. They looked at each other, realizing they'd hit the root of her pain. Eventually they explored what she might need at school. They came up with some strategies to address the bullying. She decided to stay in school and to make a public art piece for the classroom about depression.

This is the power of which empathy may help us. With a listening spirit, we can absorb each statement made, each emotion felt. Healing and change are possible if we come from a place of curiosity and care rather than our usual mode of behavior.

PRINCIPLES

People are more likely to be willing to listen when they feel heard. To build understanding, reflect before you respond.

KEY POINTS

The desire to comprehend is frequently expressed through listening, which entails putting away our own ideas, emotions, opinions, and views temporarily.

We can listen in many ways:

• With complete, wholehearted presence

• To the content of what someone says

• To the feelings and needs beneath the content

Staying connected in conversation helps us build understanding and

collaborate:

DON'T LET THE CALL DROP: Seek to establish and maintain connection in conversation.

REFLECT BEFORE YOU RESPOND: Confirm that you're hearing each other accurately before moving on. This "completes a cycle' of communication.

At the heart of listening is empathy, which includes:

• Cognitive empathy: seeing things from another's perspective

• Affective empathy: feeling another's emotions

• Somatic empathy: sensing another's embodied experience

Q & A

Q: What if someone wants advice? Is that ever okay?

Of course. When someone asks for advice, you might try offering empathy

first. I'll often say, I'm happy to share some of my ideas, but first I just want

to take in what you've said. I'll follow that with an empathic reflection of

what I'm hearing and check if I've understood. This can help the other

person process their experience and clarify what matters. I then circle back

to inquire if they still want advice; sometimes it's no longer relevant.

If the tables are turned and you want to give someone advice, check

first. Let them know: "I have an idea that I think might be helpful. Are you

open to some advice?" This honors their autonomy, minimizes the chances

that your input will be disempowering, and guards against giving advice

as a way of soothing your own anxiety.

Q: I've been exploring these empathy tools with close friends and family

and my new approach creates a lot of awkwardness. What do you do

when others expect you to communicate in a certain way?

It can be confusing when our attempts to create more connection backfire.

Part of what you are experiencing is the relational dimension of communication habits. They occur in a dynamic, so when we shift it affects others.

It also may simply be the learning curve; it takes time to find an authentic

voice with these tools.

Let go of the form and focus on your genuine intention to connect.

What would help this person to feel heard? If someone is used to us

showing care by asking questions or agreeing and we respond by reflecting

their needs, that may throw them off. Try to tune in to what they want.

When all else fails, let people know that you're trying something new that

you hope will bring you closer. Ask them to humor you while you learn.

What is violent and nonviolent communication?

Violent communication, also known as a harsh startup, is when a person is trying to communicate something to their partner/child/parent/etc and the language being used comes out aggressive, attacking, blaming, belittling...I think you get the point. A big reason why communication comes out this way, is usually because the person has a need that is not being met and they are unsure how to communicate this need. For some of us, violent communication is the only form we know and for others, we may not know the correct language to identify how we feel or need. This is where nonviolent communication comes in. It completely changes the way we communicate. Communication is not only about speaking, listening and truly hearing the other person is a key component.

Nonviolent communication, also known as a soft start up, is where the speaker expresses I AM without blaming or criticizing and the listener empathically receives how YOU ARE without hearing blame or criticism. NVC has 4 parts to it:

1) Observations

- What I observe that does or does not contribute to my well-being (free from my evaluations)

- "When I (see. hear)....."

2) Feelings

- How I feel in relation to what I observe (emotion or sensation rather than thought)

- "I feel..."

3) Needs

- What I need or value that causes my feelings (rather than a preference or a specific action)

- "...because I need/value..."

4) Requests (Don't be demanding"

- The concrete action I would like taken

- "Would you be willing to...?"

The listener will verbally mirror back everything that the speaker says when using this script for a soft start up. I hope this helps when trying to express your needs through communication with your partner/child/parent/etc.

Let's continue to grow into better versions of ourselves(:

By Crystin Nichols, MFTI

The Starved Brain: Why does your loved one with Anorexia think, feel, and act the way they do?

The Starved Brain: Why does your loved one with Anorexia think, feel, and act the way they do? 

If you have a loved one with Anorexia, you know more than anyone that eating disorders impact the entire family. It can feel like everything you know and have come to expect from your loved one changes overnight. I have had family members report to me: 

“It’s like he is a whole different person”

“Is my precious happy girl still inside that body?”

“My wife has always been the life of the party. That’s one of the reasons I married her, now I can’t get her to leave the house”

 It can be tremendously confusing and sometimes feelings of hopelessness emerge. That is very normal. It is scary. To understand these jarring changes, it is helpful to remember that Anorexia is a physical illness. It manifests, if not treated early, in significant weight loss and calorie restriction.  Your loved one is acting, thinking, and feeling the way they are because of what research tells us about The Psychology of Hunger. 

The Psychology of Hunger: The Starved Brain 

The most notable study conducted the starved brain was undertaken in 1948 by Ancel Keys, called “The Biology of Human Starvation or popularly known as “The Minnesota Starvation Experiment.” The purpose of the experiment was to demonstrate how the body and mind are affected by not eating, or by restricting food. In this study, healthy young men were observed under normal conditions then exposed to caloric restriction (1570 calories a day for 6 months). After the semi-starvation period, they were rehabilitated with the purpose of determining the most successful form of nutritional rehabilitation. Such a study would never be conducted in modern research, but the results were foundational in shifting perceptions and guiding modern treatment interventions for Anorexia. 

The Results

Below are the symptoms that were found at just 1570 calories a day for 6 months. *It is noteworthy that most sufferers of Anorexia eat far less than 1570 calories a day* 

• Physical: Less energy, reduced heart muscle mass, lower heart rate and blood pressure, headaches, decreased hormone levels, sensitivity to noise and light, a feeling of being cold all the time, loss of strength and greater fatigue and hair loss and dry skin.

• Emotional and Cognitive changes: Depression, anxiety, irritability, increased mood fluctuations, intense and negative emotional reactions, decreased enthusiasm, reduced motivation, impaired concentration, problem solving and comprehension, increased rigidity, obsessional thinking, and reduced alertness.

• Attitudes and behaviors related to food: Thinking about food all the time, eating very slow or very fast, increased hunger, unusual food routines and rituals, binge eating, increased use of condiments for flavor.

• Social changes: Feeling more critical of others, withdrawn and isolated, loss of sense of humor, feelings of social inadequacy, neglect of personal hygiene and strained relationships.

These men had no previous mental health diagnosis, significant childhood trauma, or any health conditions that would skew the results in any meaningful way. 

Implications

When working with sufferers and their family members I always share this study and pay special attention to highlight the results in the emotional/cognitive changes and social changes sections. I have seen the implications of this study reduce shame and destigmatize the individual suffering. I try to communicate that your loved one is still the same person you know; they are just experiencing the brains response to starvation. With appropriate nutritional rehabilitation and patience there is no reason to believe that most, if not all, of these symptoms will go away completely. The first step to treating Anorexia is weight restoration. Getting stuck in the “Why” vortex is tempting because the sufferer and family want to believe that if they knew why their loved one developed Anorexia it would give them the solution. Sometimes family members blame themselves: endlessly analyzing and hypothesizing about some unknown error they made. It is important to make sense of or peace with your loved one’s diagnosis but if there is anything you can do to support your loved one, it is to encourage them to seek nutritional rehabilitation first and foremost. I ask family members to avoid pathologizing their loved one. Going to therapy once a week while severely malnourished can be unfruitful  because of the starved brain. A therapist role is to encourage motivation for recovery, educate and normalize Anorexia, and celebrate the little wins. Once your loved one is weight restored, the deeper work can be done from a healthy nourished brain. Should you be a family member of a sufferer in early stages of recovery, the primary take-away is to remind yourself and your loved that their brain is starving and the way they feel, think, and behave are survival responses. Remind them that it is not their fault, and it will not feel like this forever. Your loved one is not ‘CRAZY’ nor has their character or personality fundamentally changed they are just starving.  

By Shaundra McGuire, MHCI

Book an appointment with Shaundra Mcguire:

https://SouthTampaTherapyBOOKAPPT.as.me/ShaundraMcguireMFTI

Additional resources for you and your loved one:  

https://www.nationaleatingdisorders.org/

https://www.gaudianiclinic.com/videos-press

References: 

https://www.eatingdisorderhope.com/information/anorexia/how-malnourishment-affects-the-brain-research-on-anorexia-and-neurobiology

https://eatingdisorders.dukehealth.org/education/resources/starvation-experiment

https://nedc.com.au/eating-disorder-resources/find-resources/show/issue-59-i-the-starved-brain-can-what-we-eat-determine-how-we-think

https://www.apa.org/monitor/2013/10/hunger

SELF COMPASSION IN EATING DISORDER RECOVERY

SELF COMPASSION IN EATING DISORDER RECOVERY  

Many of my clients express to me that as their symptoms and eating disorder behaviors increase so does the volume of the eating disorder “Ed” voice. Let me tell you, Ed’s voice could not be further from one of compassion but rather it is critical, shaming, cruel, persuading, and even violent. Some clients have told me “It’s like a drill segreant. If I do not obey my safety feels threatened.” I am not suggesting that people suffering from eating disorders literally have another person living in their head, but once eating disorders are triggered the thought patterns that fuel the behaviors are par for the course and addressing Ed’s voice is a fundamental part of treatment and treatment outcomes.

I will make a quick statement that as one becomes nutritionally rehabilitated (regardless of weight) with a balanced meal plan provided by a registered eating disorder dietician the voice will quiet naturally. Addressing malnourishment is the first step of recovery but that does not mean that starting the work of self-compassion cannot go hand in hand. Self-compassion is a life practice not just a recovery practice. 

WHAT IS SELF-COMPASSION? 

Dr. Kristen Neff is widely recognized as one of the world’s leading experts on self-compassion. She was the first person to operationally define and measure the construct around 20 years ago. You can check out her website here. Here is how Kristen understands self-compassion. 

“Self-compassion is extending compassion to one’s self in instances of perceived inadequacy, failure, or general suffering.” 

Kristen’s three key ingredients to self-compassion are: 

1. Mindfulness -a non-judgmental, receptive mind state in which individuals observe their thoughts and feelings as they are, without trying to suppress or deny them.

2. Common humanity-suffering and personal failure is part of the shared human experience rather than isolating.

3. Self-kindness -being warm towards oneself when encountering pain and personal shortcomings, rather than ignoring them or hurting oneself with self-criticism.

TIPS TO START PRACTICING SELF COMPASSION IN RECOVERY

Imagine you are carelessly strolling down the street and suddenly you catch your reflection in the shop window and BOOM Ed voice says…

 “I can’t believe you chose to eat that gelato with lunch. I told you not to and now look at you, you’re bloated. Honestly your stomach is disgusting. You are so weak. I can’t believe you have the nerve to be out in public right now. You need to get your act together and (insert ED behavior) exercise, restrict, purge, isolate, cut etc.” 

Instead of mindlessly obeying Ed you could instead take a Self-Compassion Break.  Even if you end up following through with the behavior pausing and trying something different is building towards your recovery and diminishing the power of ED. 

 SELF COMPASSION BREAK: 

Mindfulness: Recognize you are experiencing some form of struggle. Emotional, physical, or mental pain. Identify the pain and in a compassionate tone, you might say “This is scary, I am afraid I gained weight. I am afraid if I don’t punish myself for the gelato I have failed. I feel guilty.” The goal is to recognize and validate the difficulty with a compassionate tone.

Common Humanity: Remind yourself that everyone (especially others suffering with ED’s) have experienced this form of suffering and know how you feel. You are not alone, and it is exactly suffering and relating to one other through empathy, validation, and compassion that binds humans closer to one another.  

Self-Kindness: The final steps is offering yourself kindness amidst the suffering ( fear, guilt, and ED’s mean voice) through giving yourself kind words and actions. Kristin Neff has called this the yin and yang of self-compassion. The yin being kind words to oneself and yang being kind actions. Kind words could be “You are brave for facing your fears and pursuing recovery. You enjoyed that Gelato and it was so such a fun lunch with your friend. There are others who would be inspired by your recovery action today.” For a kind action you can choose any out of your self-care toolbox as long as it represents kindness towards self-amidst the suffering and goes against the will of Ed’s voice. 

I encourage you to try using Self-Compassion Breaks as much as you can. The Ed voice will not get any weaker unless we become mindful of it, validate and feel our feelings, and respond with kindness. 

Follow this link for more tools to practice self-compassion! 

By Shaundra McGuire, MHCI

Book an appointment with Shaundra Mcguire:

https://SouthTampaTherapyBOOKAPPT.as.me/ShaundraMcguireMFTI

REFERENCES: 

https://self-compassion.org/

https://www.edcatalogue.com/3-mindful-self-compassion-tools-eating-disorder-recovery/

Couples Counseling South Tampa: Couples Reveal What They Have Learned In Therapy

As a marriage and family therapist in Tampa, Florida, I have received feedback from several different clients. I combine some of the most powerful approaches utilizing Internal Family Systems, Compassionate Communication and Non-Violent Communication, The Gottman Method, Emotion Focused Therapy, Holistic Psychology, CBT, and DBT.

Here are the 10 best lessons couples learned from therapy.

1. Go to therapy sooner rather than later.

   It is best to go to a counselor before sh*t hits the fan. This way, you can start to develop conflict resolution and communication skills before resentment builds. Establishing a therapeutic relationship with a counselor early on can be beneficial when and if you find yourselves in a rut. Having an unbiased and supportive counselor can help you and your partner maintain a healthy relationship when and if you need support along your relationship journey.

2. You are on the same team.

   There is no winning and you don’t need to fight against each other. Therapy is a great tool and safe space to really work through things together. Meeting both of our needs, growing, and thriving together is the goal. We often ask ourselves, are you trying to listen to understand or are you trying to be right?

3. Play and have fun together.

   Unstructured quality time to just be living purely in the moment increases connection, creativity, and releases negativity. A couple that plays together stays together!

4. Unfinished business of childhood can show up in adulthood.

   Continuing to work on intrinsic positive change is a lifelong learning process. Insight and empathy can help partners understand conflict in a whole new light. When we create an awareness of patterns and habits we are able to create awareness regarding intentional choices in real time. If we are not aware, we keep reacting. Responding intentionally knowing what is happening is being awake to our inner experiences. Self-witnessing is a tremendous tool that can be used in so many facets of our lives. Practicing compassion for our partner's story, and becoming more empathetic to each other, we could actually help our partner heal from their painful childhood experiences.

5. It is not about changing the issue, it is about understanding.

   We have learned so much about communication and the ways to really listen to understand one another. Most people listen to try to change the other person’s perspective. When we get into trying to change the other person, defensiveness comes into the game. When defensiveness shows up, it creates disconnect. Communication either connects us and helps us get needs met or it disconnects us and sabotages our needs. We feel all sorts of negative feelings when our needs are not being met. However, we are in homeostasis when our needs are met and feel positive emotions. Our feelings are always signals to pay attention to which provide data about whether our needs are being met or not. When we know what we need, we are in a powerful position to get the needs met intentionally. When we do not know what we need, we will probably be in autopilot, reactionary-mode. Tune into your inner worlds so that you can understand yourself. When we understand, we can communicate honestly about what is happening internally.

6. Our thoughts are the root cause of anger.

   Anger masks more vulnerable feelings like hurt, disappointment, and sadness. It's helpful when both partners understand that the words or behavior hurts their partner, even when their partner tends to react with anger or stonewalling. Therapy can help couples connect — which includes learning how to get calmer and go slower rather than to lay out their arguments about who's "right".

7. Hear your partner out before letting emotions get in the way.

   Getting guidance from a therapist around how to listen to each other without being emotionally charged about the topic can help couples stay engaged in the conversation, to accept influence from one another, and compromise based on needs. This is huge! We can stay curious about what is actually happening in the moment. When our partners feel heard and understood, they are in a better position to hear us too. Listen to each other without reacting! This sounds so simple but bad habits can be hard to break and its beneficial to have a therapist as a sounding board to make neutral observations.

8. Conflict is normal, you will have different perspectives at times, and disagreements are inevitable in every relationship.

   There will be different stages throughout life and couples will never stop getting to know one another. The most important thing is that you listen, respect, and acknowledge each other's viewpoints. Many times, people listen to respond and not to understand — which is one of the biggest reasons why many relationships fail. Attending couples therapy, can help partners communicate feelings, emotions, and concerns more effectively. Counseling equips couples with valuable skills that will be instrumental throughout their lifetime and once they become parents.

9. Marriage therapy taught us how to communicate about our needs and desires without hurting the other person.

   When we are emotionally and intimately disconnected, it is challenging to help each other to feel heard and understood. The way we deal with conflict is directly correlated to intimacy. Change the way we fight, change the way we love. When we trust each other more and give each other the benefit of the doubt, we're less hurt when the other person isn't in the same place as us in the moment, We may still have issues and hurt feelings from time to time, but we're better equipped to handle those problems when they come up.

10. Psycho-education and therapy helped couples identify patterns.

    One partner was pretty direct and the other partner tended to be more thoughtful in the way he delivered information. One partner said the thing that stuck with her the most was that the therapist was able to reframe and articulate her partner's concerns in a way that he couldn't — which then helped her to understand him better. Therapy can help couples become aware of how reactions to difficult situations can be unhelpful. Attempting to respond in a way that is more productive for the relationship can feel very different. Psycho-education can be of tremendous value when co-morbidity plays a role in relationships. Trauma informed therapy can help partners empathize, respond to each others needs, and heal together. It is advantageous to the relationship when partners learn about mental health together.

To learn more about how therapy can help you, please text or call Dr. Mahaney directly 813-240-3237 or book an initial consultation: www.SouthTampaCounselor.com/BookAppointment

Why I Only Accept 50% of Insurance Clientele & 50% Self-Pay In My Private Practice (50/50/❤️ MODEL)

WHY I ONLY ACCEPT A FEW NEW INITIAL INTAKE INSURANCE APPOINTMENTS

USING MY MORAL COMPASS AND COMPASSION FOR HUMANITY, I’M CHOOSING TO CREATE A 50/50/❤️ MODEL:

50/50/ ❤️= 50% SELF PAY 50% INSURANCE ❤️SLIDING SCALE FEE

Sliding Scale Fees help advocate for affordable mental health care and create an opportunity for highly qualified INTERNS to co-counsel clients in need. I interview interns extensively, decide selectively, and supervise very closely and yet very trustingly. I will be an active participant in each session.

I initially started accepting insurance 15 years ago when I felt a strong need to support my community, who needed financial support, to get consistent help. Despite hearing horror stories from colleagues about insurance paperwork and clawbacks, I joined a few insurance panels. I loved every minute of being a therapist! I hated everything about the administrative process when it came to dealing with insurance companies. Don’t get me wrong, I love my insurance peeps! We have connected over the years and I will continue to support my clients who choose to use insurance as they should!

I too, have health insurance. I get it, we have health insurance for a reason, pay high monthly premiums, and should be able to use insurance when we need it!

Regardless, I will show-up powerfully for ALL of my clients.

I feel good about my choice to create a 50/50/ ❤️BALANCE in my Private Practice!

As a healthcare member and a private practice provider, I’ve had the unique experience of seeing both perspectives of the healthcare system in the US.

As my specialty has continuously evolved, I have realized that mainly accepting insurance no longer make sense for the advanced work that I do. Ultimately, my decision came down to acting with integrity and practicing what I preach to my clients.

Here are some key points to help you understand my decision to create this model for my Practice:

LACK OF PRIVACY & CONFIDENTIALITY

When insurance companies pay for your treatment, it also means that their employees (clinicians or not) will audit my treatment plans and read what we talked about in my session notes. These employees are paid to save the insurance company money by searching for fraud and determining whether you're overusing your insurance coverage. In turn, the insurance company may decline authorization of additional sessions because you're not progressing fast enough; our work in psychotherapy does not qualify as "a medical necessity": or because my treatment approach isn't recognized by the insurance company as an "evidence-based treatment" (that's code for short-term, as in 6-8 sessions).

Hell, some insurance providers don't reimburse for 60-minute sessions anymore!

This doesn’t seem right.

I recently got audited by an insurance company. This audit took me countless hours, staying up late at night, time away from my family, unnecessary stress and scrutiny to provide tedious paperwork and specific details to prove that my clients needed the services provided. This is just not okay in my book. I totally understand documentation for integrity but demanding extra proof during a pandemic when I am already submitting the necessary information and feel overwhelmed and overworked helped me create the awareness and opportunity for me to reflect on MY CHOICE to accept insurance.

At first, I reactively felt angry resulting in thoughts and hopes that the insurance company would fire me! However, when I pause and feel to respond intentionally, I honestly and truly feel honored to hold space and care for ALL of my clients and I would feel disappointed if I were unable to offer insurance as an option.

In conclusion, I believe that everyone has a right to confidentiality of your medical records. You also have the liberty to progress through treatment at a pace that's best for YOU - one that allows you sufficient time to process everything that you're experiencing. Things unfold differently for each person, especially when our world seems chaotic (Global Pandemic)! If the insurance company fires me, they rip the therapeutic relationship apart that my clients and I have securely built over the years. Emotional injuries and attachment issues can be easily re-traumatized within seconds.

DIAGNOSIS OF ILLNESS

Insurance companies operate on a medical model, which means they require a diagnosis to establish that you have "a medical necessity" to seek services in order to pay providers. To justify that you have a "medical necessity" I have to assign you a diagnosis to be reimbursed for our work together when there may not be one that really fits what you're going through. The vast majority of insurance companies don't consider relationship issues like couples or family therapy, developmental/attachment trauma, existential issues, life-transitions, personal development, or self-improvement as "medical necessities" because there are no diagnoses for these in the DSM-V.

And even if there are appropriate diagnoses, there are some diagnoses that insurance companies don't consider debilitating enough to pay for. So, if I know what diagnoses are and are not paid for, l'd have to label you with a more severe diagnosis they will pay for, but one that may not really reflect your situation. I am not ok with this either!

You're probably wondering, "What's the harm in that? A little truth-bending never hurt anyone." Well, that's just it - it can. It can come back to bite my clients in the ass... your medical record. While that might not be such a big deal right now, it may become one later on if you want to: get life insurance, work in the financial sector managing other's assets, regularly handle firearms, or seek employment in any sector in which your decision-making might be called into question due to your emotional state. Call me crazy, but I feel that people should get the help they need without fear, stigma, or reprisal for making their mental health and personal growth a priority.

FRAUD

If I engaged in the aforementioned truth- bending, I'd essentially be committing insurance fraud. There are providers out there that are willing to walk this fine line and take this risk. In my opinion, the penalties and professional consequences of insurance fraud are huge, and frankly, not worth it. I have a strong need for peace of mind that comes with integrity.

LOW RATES

In order to be "in- network" with an insurance company, I have to agree to accept a lower fee in exchange for the insurance company listing my practice in their directory of providers and sending me referrals. In the spirit of transparency, most of my clients find me through friends, family and through searching online. And each year, insurance companies continue to cut the rates they pay therapists for their work.

Here's an example with real numbers and real circumstances of how this happens: My fee is $170 per session. But I joined XYZ Insurance Co.'s network because I had a client in need of services. I chose to help and chose to agree to the insurance reimbursement rate of $60 per session. My client would also be responsible for a co-pay of $0-$40 per session depending on his plan, bringing the total to $60-$100 per session. That means I'm waiving at LEAST $70-$110 for each session. As a healthcare professional, I want to help! I have made these types of choices for the 20 years that I have been in private practice. I will keep choosing to advocate for my clients who have insurance because I also have insurance for myself and my family.

Would you be willing to forgo ~65% of your salary?:-/

I will also continue to set boundaries with ALL of my clients and companies that I choose to work with. If you no-show as a self pay or insurance client, I will treat you the same and ban you from being able to book an appointment until we have a meeting. I get it. I want to understand one another and use empathy. Life happens. I want to turn toward these curveballs

Additionally, insurance companies have been increasing their members' premiums, deductibles, and co-pays in the last few years claiming rising costs of care. You'd think that that would translate to higher reimbursement rates to care providers, but it doesn't...at least not in the mental health fields. In fact, insurance reimbursement rates have actually decreased over the same period of time. You're probably wondering, "How do the therapists and psychologists that take insurance afford to?

For such insurance-based practices, taking on more clients than is clinically prudent is the only way to make up the difference and keep their doors open. This then leads to another problem...

BURNOUT & EXHAUSTION

Here's the reality, many providers that accept insurance overbook their schedules in order to turn a modest profit after rent, utilities, malpractice, and other expenses.

Additionally, these providers often only offer a 30-50-minute session to maximize the number of clients in a day (10 vs 8) and the chances of insurance reimbursement (remember, most insurance companies don't pay for 60-minute sessions anymore). Also, if you use the 60 min codes, you are flagged for audits which take hours and hours to complete.

DELAYED (OR NON) PAYMENTS

Despite the insurance companies agreeing to a set reimbursement rate, these companies require therapists to jump through a bunch of hoops to get paid. It is common practice for most insurance companies to reject submitted paperwork to delay payments. When they're not seeing clients, these therapists are drowning in insurance paperwork and resubmitting billing claims in order to get paid, or spending hours on the phone contesting unpaid claims.

On average, it takes an additional 1.5 hours of UNPAID work outside of the session to get paid for sessions. And remember, the therapist is already making less by agreeing to take insurance. (In my previous example, it would cost $255 of my time ($170x1.5) to get paid my $60 reimbursement rate from XYZ Insurance Co.)

The alternative is to pay a medical billing company 8-10% of the claims' costs to do the aforementioned, but that increases expenses and cuts into that modest profit I mentioned before. But let's say that I or my medical billing admin ARE able to see the claim through the labyrinthine insurance payment process, the payment will finally arrive in my bank account anywhere between 3-6 months after the session took place IF everything goes smoothly.

RETROACTIVE CLAIM DENIALS (AKA CLAW BACKS)

Now imagine that, after all that trouble, that insurance company asked you to give the money back, even years later. Yep, this really happens and, unfortunately, it's a common practice among insurance companies. They'll audit your claims and paperwork for several years back. If they find any mistakes or inconsistencies in the therapist's paperwork they missed when they originally approved the therapist's claim, the insurance company will request that the therapist return the fees she was paid.

Pretend that your employer sent you a bill requesting that you repay the income you'd earned 3 years ago. Would that seem fair to you? I didn't think so. Claw backs can amount to thousands of dollars that can bankrupt a small business like a private practice. Many insurance- based clinicians live in fear of such retroactive audits.

Before reflecting and reassessing the insurance-based private practice I founded, I recently heard from a friend and colleague that a major insurance company requested thousands of dollars be returned by the end of the month. Talk about stressful!

All together that's a recipe for a tired, overworked, and stressed out therapist.

This may have been the problem if you've ever been to therapy that you felt didn't "work" with a provider from your insurance company. I should know. I started to experience the symptoms of burnout after two years of insurance-based practice. And that's when I realized, "Crap! I'm doing the things I tell my clients not to do!" Talk about incongruence!

So I changed my business model for the sake of the well-being of myself and my team to preserve the quality of care we want to provide every client. It breaks my heart to REDUCE ACCESS to care for people in need, but I realized early on that we can't help anyone if we're stressed/burned out or have to close our doors. I am choosing the 50/50/❤️ MODEL to advocate for mental health and well-being for all!

This makes sense to me!

WHAT ARE THE BENEFITS OF PRIVATE SELF-PAY AND/OR A 50/50/❤️MODEL FOR MENTAL HEALTH CARE?

No Labeling - You don't have to carry an unnecessary diagnosis on your medical record. Although, if you’d like to create awareness and assess for diagnostic criteria, I would invite this curiosity and self exploration.

Confidentiality & Privacy - You and your psychotherapist are the only people that will know you're in therapy. You get to choose who you disclose this information to. Session notes are private records so there won't be intimate details to “prove medical necessity/ diagnosis info”.

I am highly confidential and keep minimal notes. I naturally remember our sessions together because I truly care and our therapeutic relationship is genuinely important to me.

Self-Determination - You get to work with a psychotherapist that is free to use the best therapeutic approach to help YOU meet YOUR goals. You and your psychotherapist are the only people involved in the decision about the length of your care. You won't have to seek additional authorization to continue your work or return to psychotherapy, if you have new goals you'd like to explore.

Quality Care & Attention - You'll get a psychotherapist that's alert and engaged during your session, remembering the details of previous conversations. You'll have the help of a professional that's invested in your process of growth because they've taken the time to do the same for themselves. She will be able to use the healing methods that are most appropriate for you.

You might be thinking that this is just one therapist's rant against insurance companies. Don't take my word for it. Feel free to do your own research!

If you tried psychotherapy and were disappointed with the results or the treatment didn't seem to "fit" after working with a provider from your insurance company, I hope you have a better understanding of what might have been happening behind the scenes. We urge you to reconsider getting some support now that you do. There are great providers in the healing professions on both sides of the insurance divide that can help you.

I HOPE YOU HAVE A BETTER UNDERSTANDING ABOUT WHY I HAVE DECIDED TO CHOOSE THE 50/50/❤️ MODEL!

50/50/ ❤️= 50% SELF PAY 50% INSURANCE ❤️SLIDING SCALE FEE

Call or TEXT with any questions:

📱#813-240-3237 or ***Book Now: —> ❤️