Category Archives: Book Excerpts

Focus and Mindfulness

But it sometimes happens that I cannot easily shake off the village. The thought of some work will run in my head and I am not where my body is, I am out of my senses. In my walks I would fain return to my senses. What business have I in the woods, if I am thinking of something out of the woods?

-Henry David Thoreau
Woman Painting Focus Mindfulness

Focus can be improved

Focus can be improved using mindfulness-informed tools that are designed to increase mental concentration and inner calm. The art and science of focusing has many faces. It may look like a man sitting in solitude on a meditation cushion, or a woman sitting in a café slowly sipping from a paper cup, mindfully watching her thoughts. At other times the face of focus is a person absorbed in an art project, or a group of friends on a ten-mile run, or a teen absorbed in her favorite music. Of course, all of these activities can be done unmindfully – without focus – but they are infinitely more rewarding when performed with attention to the present moment. When we focus on our present moment experience, the brain rewires itself in such a way that it makes the experience more satisfying. With practice, we can gain the ability to focus on demand. Take a minute to think of an area in your life that could benefit from more focus.

Focus can arise when we are moving just as easily as when we are sitting. Stilling the mind is what matters. If you are feeling especially physically or mentally agitated or if the busyness of your life is getting you down, try these suggestions calling for stillness or internal focus. Building mental focus will benefit each one of the four domains of your life: balance, belonging, focus, and meaning.

Take note of what is distracting you – if you don’t feel ready for a meditation practice it’s okay. Start by noticing what is distracting you.

  • Are your distractions fear-based – are you worrying about some future outcome?
  • Are your distractions fantasy-based – is there something you don’t have that is stopping you from living your life in the here and now?
  • Start by noting what takes you out of the present moment – just taking note of what is keeping you in a state of distraction is a step toward mindfulness.

Perform a single routine task mindfully – fold laundry, wash dishes, feed the dog without slipping into autopilot. So often, we get up in the morning and do our routine in zombie mode.

  • Get out of bed and stretch for half a minute. What is the first thing you usually do in the morning? Can you do it with all your senses engaged?
  • Resist automatic thoughts and mentally rehearsing your to-do list.
  • You might find that the routine task is actually enjoyable, or you may decide to change the start of your day so that the very first task is something that feels pleasant, like reading a few pages in a good book versus checking your email.

Take a slow walk or run – routine exercise is another place where we can easily check our focus.

  • Take your walk or go to the gym as usual, but consciously slow down your pace.
  • Notice something new about the gym or the walking/running route you are on.
  • Refrain from projecting into the future or thinking about the past. Sure, you may burn a few less calories by slowing down, but what you gain in tranquility and calm will more than make up for it.

Pet or play with an animal – if you have one, your dog or cat can become your Zen master.

  • Take time out today to be with your pet and just with your pet. Animals are experts in being in the present moment.
  • Get down on the floor and get on your pet’s level. Gaze into their eyes as you play with or pet them.
  • Thank them for being your Zen master.

Belly breathe with a baby or small child – babies and young children can also anchor us to the present moment in a special way.

  • If you have an infant in your life, take some time to watch them while they nap. Babies have not learned the bad habit of taking shallow breaths. Take long, slow breaths like a baby.
  • If you have a toddler in your life, ask him or her to lie on the floor next to you. Place pillows on your bellies. Watch them as they float up and down on your belly as you take
    long, deep inhales and exhales.
  • Take some time to giggle with your toddler as the pillows rise and fall.

Walk barefoot – if the temperature allows, kick your shoes off and walk in the grass for a few minutes.

  • Walking barefoot requires mindfulness to avoid sharp objects or other outdoor goop.
  • It is also immensely grounding and healing.
  • Focus on how it feels to connect directly with the earth.

This is a good start to using mindfulness techniques to increase your ability to focus. Remember, without mindfully focusing on the present you will miss much of the experience.

Mindfulness for Emerging Adults Book Release

Excerpted from Mindfulness for Emerging Adults by Donna Torney, MA, LMHC, RYT.

Holiday Stress Habits

‘Tis the Season to be Jolly!

Christmas, St. Lucia Day, Chanukah, Kwanzaa, St. Nicholas Eve, New Year’s Eve, December Solstice, Boxing Day, St.Stephens Day, St. Ambrose Day,  and   we can’t forget December 15th – National Cupcake Day!

So, this is a time of joy, family, and good will to all…right? For lots of folks, it is. Many of us, however, find this season stressful. We expect good tidings of great joy, but end up feeling stretched to the max and unfulfilled. The holiday we remember from our childhood just isn’t there.

  • Are you struggling to complete shoulds?
  • Do you feel guilty because others are loving the holidays and you aren’t?
  • Are you overindulging, overscheduling, overspending, and still feeling unsatisfied?
  • Do you feel emptier at the end of the holidays than you did at the beginning?
Holiday Stress Habits

Holiday Stress Habits

If you answered yes to these, you are probably trapped in some negative holiday stress habits. Now some stress is good for you and pleasurable. It can fire you up; give you energy, supply zest and excitement. Too much stress, however, can wear you down, sapping your energy.

What about last year? Make a list of the positive things you enjoyed such as caroling, midnight church services, Chanukah get-togethers, and reunions with friends and family you rarely see.

Now make a list of the other side of the coin. What wore you out? Was it last-minute gift shopping, lack of sleep, planning an open house for 50 and having 75 folks arrive, dealing with Great-Aunt Grizzelda?

To some extent, the same events can provide both good and bad stress. Your open house was a raging success, but you were really worried about running out of food. You loved seeing the rest of your family, but if you had to hear Great-Auntie say one more time, “Well, in my day it was better,” you might actually do her harm.

Popular wisdom says that negative stress is simply the way we are reacting to circumstances. You might freak out with 25 extra people while others find it stimulating. You might love baking 30 kinds of cookies for the party while your sister buys them at the bakery. Take a quick look at a couple of stressors lots of folks find difficult and make a plan to avoid having to hide in the attic with the cocktail shaker.

Holiday Traps

The Santa Claus Trap, often known as the “I’ve got too many people to buy gifts for and not enough time or money to do it.”

Make a list of the folks with whom you truly want to exchange gifts. Be honest with yourself. To pick on Auntie Grizzelda again, if you are stressing out buying her old-lady notepaper just to have her disparage your choice; take her off the list. Contact your friends and see if they are enjoying gift giving with your group or dreading the cost and effort. You might decide to give each other time and get together after the holidays for a celebration of absolutely nothing.

Once you’ve made an accurate list of those you really want to gift with something special develop a budget and stick to it. Many are great at the budgeting part… sticking to it is another story. Promise yourself you will be tough and won’t overspend. Plan a post-holiday reward for yourself when you succeed.

Budget and list in hand either hit the local stores or the internet. Today with free shipping readily available it is tempting to stay home and click away your shopping duties. Remember the sights and sounds of your community at the holidays. It might be worth scheduling a day to enjoy the bustle, street singing, and bell-ringing and to pick up some unique gifts at the same time.

The Activity Trap. We aren’t always good at checking our calendars before we say no and find ourselves due at a party, a dance recital, a kid’s sports event, and a date with our spouse all at the same time. On the other hand, some folks find themselves with little to do and miss the interaction with others. Again, make a list of what you need to do and what you really want to be part of. Don’t say yes without time for thought. Do you really want to go to your kid’s coach’s wife’s tea? Are you looking forward to the all high school Holiday Concert where you will sit in the same auditorium seat for four hours?

If you are over scheduled get out a pencil and delete those things that you don’t want to do. If you don’t have enough contact with others, call the Salvation Army, your local soup kitchen, the local volunteer coordinator, your mosque, church, or synagogue, or check in with your neighbor who lost her husband this year and schedule some time helping others. Nothing feels better!

The Tradition Trap. Okay, I admit it, this is my personal stressor. I want to do everything that I’ve been part of all my life, and I’m a grandmother! I want to provide the kind of environment my stay-at-home mom did. I want to have all the same decorations I had growing up. I want my kids and their kids to show up when I want them, not when it works for them because, “We always went to church together. It won’t be Christmas without everyone being there.”

Choose the traditions that really mean something to you. Accept the fact that you work full time and can’t bake sixty different kinds of cookies, have three open houses, decorate the synagogue, decorate your home, and still be alive when it is over. Traditions are great as long as they contribute to the enjoyment of the season. If they don’t, be brutal; toss them out. Find new and interesting ways of celebrating. Enjoy the process of learning something new.

Kind of in the same vein, we often fall into The Life Script Trap. When the holidays roll around we fall into feelings and roles remembered from the past.

No matter how old we are, the holidays give us permission to be childlike. Festivities become magic and full of meaning as we bring the past up to the present, still enjoying the familiar sights and sounds of the past. Celebrate your heritage, but look out for the pitfalls that have caused problems in the past. Cherish those events you hold dear. Stay away from those that cause you pain.

The Magic Trap: expecting the perfect holidays. We expect to feel just as we did in the third grade when we got new skates, or on that first holiday with our first child. If we don’t feel the way we remember feeling we are disappointed. What are we missing that the feeling isn’t there? Try to limit your expectations of others. We can only control ourselves. Think about the things that enrich the holidays for you now, and experience them to the fullest.

As Nancy Loving Tubesing andDonald A Tubesing who wrote Kicking Your Holiday Stress Habits said,

Your holiday preparation agenda resembles the space shuttle prelaunch checklist. Holiday trap or holiday treasure? It’s up to you!

You could put on your martyr’s cloak and try to fulfill your grandiose expectations in suffering silence. You could work your fingers to the bone cleaning and sewing and cooking and wrapping and writing and orchestrating and pleasing others.

OR you could take this opportunity to relinquish your stranglehold on the holidays, inviting others to share in the burden (and benefit) of getting ready.

OR you could assemble the clan for some values clarification, polling family members about what they really treasure about the holidays, and then making a plan that includes everyone.

OR you could decide that this is theyear for some kind of alternative celebration.

Tubesing and Tubesing

What moves you to choose a holiday treasure instead of a holiday trap? Often it is your belief system – your views about yourself, the world, and what makes life worthwhile that is guiding your choice.  If one of your values is the value of work above all else, no wonder you are running yourself ragged. If you really want to kick your holiday stress habits you will have to decide what is really important to you. Once you’ve figured that out, the rest is pretty easy.

Ask yourself three questions:

  • What’s of major importance to me?
  • How do I hope to accomplish it?
  • If that doesn’t work, how else could I meet the need – or what would be a satisfactory substitute?

Take the time to make a list of what you need to make your holiday season meaningful. Be specific… just listing holiday joy doesn’t count. What do you need to feel that joy? Then look at what values those things encompass. You will recognize what will fill your holidays with what you need. (Not what Auntie Grizzelda needs! What you need.) Ask for what you need. Don’t expect your family and friends to intuit it. Tell them. If the answer is no, give yourself permission to find an acceptable substitute.

  • Refuse to suffer. Do the “have tos” quickly and efficiently and get them out of the way.
  • Keep the things you enjoy for yourself. If you love wrapping gifts, don’t farm that out to Cousin Bill.
  • If you hate the whole Christmas Card thing don’t do it. Surprise folks you care about with a phone call. Not just an email or a text, but a chance to hear the joy in your voice when you reach them.
  • Make positive contact with folks you didn’t know. At a party seek out those you haven’t met. At the church social find someone sitting alone and get to know them. Just chat with the clerk at the store in a pleasant and friendly way. You’ll make their day.
  • If your list of friends and family is disturbingly short, look for others in the same boat. Reach out to the crisis shelter, local hospitals, a halfway house, homes for the elderly, etc.
  • Make your gifts meaningful. Rather than just tickets to an event plan to go along and share the experience together.
  • Write something special for those you love. Tell them how much they mean to you.
  • Give to some of the charities that are trying to make others’ lives better.
  • Don’t forget to give yourself something.

One thing especially important: Take time to laugh. Laugh at yourself, at silly things you see and hear, look for the humor in holiday dilemmas. Put the wrong color in the cookie dough? Make purple trees. Enjoy telling the story about how you did it to everyone eating them.

When all is said and done, pay attention to your spirit. Take the time to reflect. Listen to your core. Think about what you believe. What’s really important to you?  Where did those values come from?

Light a candle every evening. Focus on the flickering flame and allow your thoughts and prayers to rise shimmering upwards into the silence.

Tubesing and Tubesing

Focus on the flame and allow your thoughts and prayers for others to rise up into the silence. Sit in a chair for a few moments while your family and friends are busy around you. Cherish the sounds and smells and essence of your holiday.

Make a plan. Reflect on the Tubesing’s suggestions. Choose the things that resonate with you and yours.

Happy Holidays!

Excerpted from Kicking your Holiday Stress Habits by Nancy Loving Tubesing, EdD, and Donald A. Tubesing, MDiv, PhD.

Mindfulness for Emerging Adults: A Blog Series, Part II

Mindfulness Sleep Tips

On the Road to Mindfulness: Finding Balance

The information from the series of articles on Mindfulness focuses on learning to be mindful by, in part, regaining balance as we teach emerging adults stress reduction skills, ground participants in their present surroundings, and help them make the important connection between daily routines and health. It is designed to reset an overwhelmed nervous system so emerging adults and others are then free to focus on finding strong social connections, and meaningful, sustainable work. Emerging adults will have an easier time rediscovering motivation and happiness after anxiety, stress, and low energy are addressed, and routines that foster self-confidence are established.

October’s blog focused on food and exercise issues. This month we are looking at the all-important issue of getting a good night’s sleep.

Mindfulness Sleep TipsAn important part of finding balance in our lives is discovering a way to get the sleep we need. Many college students, new mothers and fathers, the elderly, and almost everyone in between seem to be overtired all the time. A few folks will sit in the coffee shop, drink their third double espresso, and brag about how little sleep they need. Surviving on a caffeine buzz and adrenaline from deadlines, they think they are still performing at their optimum level. They are ignoring the fact that all things in the natural world have rhythms and routines. Consider the phases of the moon, the waves of the ocean, the seasons of the year. Humans, too, have rhythms. Unlike the rest of the natural world, we often work against the natural cycle of work and rest by denying our bodies and brains enough sleep every night.

Sleep Tips and Sleep Facts

Read the sleep facts below and choose a couple of sleep tips to try. Remember, change doesn’t happen over-night – pardon the pun – so don’t expect results the next morning. Practice the new behaviors for a month and you will see a positive change in all aspects of your life.

Sleep fact: Memory consolidation – the ability to learn and record new ideas – is greatly enhanced by a good night’s sleep, as is our ability to be creative. This is the science behind the phrase, let me sleep on it. During sleep, neuronal pruning takes place, helping us shed neuro networks that we no longer use, experience mental clarity, and make better decisions.

Sleep tip: The next time you have a big decision to make, write down a summary of the situation. Place the summary away from your sleep area. Ask sleep to help you with the answer. In the morning notice if you slept better and have more clarity. By following this process, chances are good that you will come up with a creative answer to your problem.

Sleep fact: Ghrelin, the hunger hormone, is released when we are sleep deprived. When we deprive our body of sleep, the nervous system receives a stress signal, making us hungrier.

Sleep tip: Going to bed with a stomach that is too full or too empty may disturb your sleep. An hour before bed, have a small, easy to digest snack, like a small bowl of yogurt, whole-wheat toast, or a glass of warm milk.

Sleep fact: Studies show that one night of poor sleep inhibits the immune system by 25 to 30%. Take note of the connection between your seasonal allergies and colds and your good sleep habits.

Sleep tip: Note in your journal how many hours you slept. At the end of the day enter how your seasonal allergies and/or colds felt. Note the correlation between adequate sleep and how your body reacts to outside stimuli such as pollen.

Sleep fact: Experimenting with your ideal sleep schedule is an essential part of getting quality rest.

Sleep tip: Try to go to sleep and wake up as close as possible to the same time each day. If this seems boring or unsustainable, try adjusting your sleep/wake times to something that works for you.

Sleep fact: Shaking off physical and mental stress at the end of each day will lead to better sleep.

Sleep tip: Practice gentle stretching to release the day’s tension before you get into bed. Take note of one or two accomplishments of your day in your centering journal. Resist the natural tendency of noting what’s left on the to-do list.

Sleep fact: Make your room a sleep sanctuary by limiting activity.

Sleep tip: Keep your room cool, dark, and quiet. If noise and light are a problem, try earplugs and an eye mask. Break the habit of falling asleep in front of a screen. The blue light from electronics sends a signal to the brain to stay awake. Instead, get into bed and take some long, slow breaths with extra-long exhales. Relax all the muscles in your body staring at your feet, think about feeling heavy and relaxed. Welcome sleep!

Mindfulness for Emerging Adults Book ReleaseThe sleep tips and sleep facts material above has been excerpted from Mindfulness for Emerging Adults by Donna Torney.

Teenage Anxiety

Teenage Anxiety

Teens experience stress about a great number of situations and circumstances, and anxiety is a normal reaction to stress. For teens, circumstances such as speaking in public, moving to a new neighborhood, dating issues, taking tests, making good grades, and competing in athletic events may all cause stress. For some teens various circumstances or events can cause more than the usual amount of stress. This leads to anxiety. Anxiety has been defined as a state of intense apprehension, uncertainty, and fear resulting mainly from the anticipation of a threatening event or situation, often to a degree that disrupts normal, everyday physical and psychological functioning. Fear is an emotional response to a real or perceived threat.

Teenage AnxietyAnxiety is anticipation of a future threat. Anxiety is normal in the everyday life of everyone and can actually be a good thing. Anxiety motivates one to accomplish goals and warns a person of a dangerous situation. However, intense anxiety can involve debilitating symptoms and affect performance in school, athletics, and interpersonal interactions. Some teens persistently experience excessive amounts of worry and fear about everyday situations and this may lead to depression. Persistent anxiety and fear can interfere with daily activities. Often, these symptoms are difficult to control.

Anxiety affects one’s general well-being and manifests itself physiologically, behaviorally, and psychologically. The following are some of the affects of teenage anxiety:

  • Apprehension
  • Chills
  • Cold or sweaty hands and/or feet
  • Difficulty concentrating
  • Dizziness
  • Dry mouth
  • Emotional tension
  • Fear of anticipation of the worst outcome
  • Feeling as if one’s mind has gone blank
  • Feelings of powerlessness
  • Feelings of extreme fear
  • Heart palpitations
  • Inability to act
  • Inability to express oneself
  • Inability to sit or stand still
  • Inability to sleep and/or remain asleep
  • Inexplicable feelings of dread
  • Irritability
  • Jittery feelings
  • Muscle tension
  • Nausea
  • Over-alertness for signs of danger
  • Panic attacks
  • Mind racing
  • Shortness of breath
  • Tingling of hands and/or feet

“Normal” Anxiety vs. Intense Anxiety Disturbances

Anxiety manifests itself in the everyday life of most teens in many different ways. Some of the most common types of everyday, “normal” anxiety:

  • Situational Anxiety – Feelings of apprehension and dread related to a specific situation such as taking a class in physics, moving to a new community, or trying out for the soccer team at school.
  • Anticipatory Anxiety – Feelings of apprehension and dread when one confronts something that has been frightening in the past, or that has resulted in a negative experience such as speaking in front of classmates.
  • Anxiety Disturbances – These can be distinguished from the everyday, “normal” anxiety because they are more intense (panic attacks), last longer (often months or years instead of going away after an anxiety-producing situation), and interfere with a person’s ability to function effectively in daily life (i.e., afraid to go to school, fear of getting bullied, etc.). 

Different types of disturbances related to thinking and behavior are conveyed and expressed in different forms:

  • Panic Disorder: Teens have feelings of extreme terror that strike suddenly and often without any warning. Teens with a panic disorder often experience sweating, chest pain, and/or heart palpitations. They feel as if they are out of control during one of their attacks of fear, and they attempt to avoid places where panic attacks have occurred in the past.
  • Social Anxiety Disorder: Teens have feelings of overwhelming worry and experience extreme self-consciousness in everyday social situations. These worries include fear that others will judge them harshly, they will do something that may be embarrassing, and they fear being ridiculed by other teens. Teens with this disorder often are very anxious around other people and have a difficult time talking to others. They will stay away from places where there are other people and have a hard time making and keeping friends. This can lead to avoidance and selective mutism.
  • Generalized Anxiety Disorder: Teens exhibit excessive, extreme, and/or unrealistic worry and tension, even if there is nothing (or very little) to be worried and/or tense about. Teens with this disorder may be worried about just getting through the day and doing everyday tasks. They often have trouble falling and staying asleep, relaxing, and concentrating in school.
  • Specific Phobias: Teens experience intense, unwarranted fears about an object or a situation. The fear involved in a phobia is usually inappropriate for the phobia-producing object or situation and may cause people to avoid specific everyday activities in order to avoid the object or the situation. Some common phobias include snakes, speaking in public, clowns, fear of situations where escape from bad things is perceived as difficult. Phobias are intense fears resulting from real or imagined exposure to a wide range of situations.
  • Post-Traumatic Stress Disorder (PTSD): Teens experience anxiety caused by exposure to traumatic events (i.e., child abuse, abandonment, accident, house fire, loss, victim of crime).
  • Anxiety Disorder Due to Another Medical Condition: Teens experience anxiety attacks directly attributed to an existing medical condition (i.e., cancer diagnosis), and it often parallels the course of the illness.
  • Obsessive-Compulsive Disorder: Teens have repetitive thoughts that will not dissipate (obsessions) and/or engage in ritual behaviors to dispel anxiety (compulsions)

Which Teens are at Risk?

Many risk factors or things that might make teens more vulnerable or sensitive to experiencing anxiety have been identified. Some of these risk factors include genetic factors such as living in a family with a history of mental health issues; personality factors such as high sensitivity or extreme introversion; environmental factors, such as experiencing ongoing stress or a single stressful event that occurs in the teen’s life; and medical factors such as ongoing physical illness.

When to Worry?

Symptoms related to intense anxiety can be very complex and difficult to cope with. The good news is that teens can develop the skills needed to manage the symptoms and progress forward to begin enjoying life more. Undergoing the stress that accompanies many of the mental health issues can be a very frightening way to live.

A teen experiencing anxiety and stress over time is at risk of developing a serious mental or physical illness and needs to seek a medical professional.

Suicide Warning!

People who experience intense anxiety may feel suicidal, harbor suicidal thoughts, and plan to die by suicide. Sometimes they think that the only way to escape the physical, psychological, and emotional pain is suicide. Remember to take any talk about suicide or suicidal acts very seriously.

Signs of Suicidal Thoughts

  • Calling or visiting people to say goodbye
  • Drastic changes: angry person becoming super happy, style of clothes, shaving head
  • Dropping out of school
  • Engaging in reckless actions
  • Expressing feeling of being trapped with no way out
  • Expressing severe hopelessness about the future
  • Giving away possessions
  • Increasing use of harmful substances
  • Making a plan for dying by suicide
  • Purchasing a weapon
  • Talking about harming oneself or another person
  • Withdrawing from family, friends, and activities of interest in the past

Managing Anxiety Workbook for Teens - Teenage AnxietySerious Mental Illness

If participants have a serious mental illness, they need to be taken seriously and facilitators can take an active role in their finding help immediately. All disturbances related to intense anxiety need to be thoroughly evaluated by a medical professional and then treated with an appropriate combination of medication and group and/or individual therapy.

The material above was excerpted from Managing Anxiety for Teens by Ester R A Leutenberg and John J Liptak, EdD.

The Breakup Experience

The Breakup Experience

A committed relationship in this article is defined as one based on mutually agreed-upon parameters that might involve exclusivity, honesty, openness, loyalty, trust and other implicit and explicit characteristics. Forms of committed relationships can be varied and might be short or long-term. These commitments may be reflected in domestic partnerships, religious and civil unions, single-sex and heterosexual couples living together, commuter (or long distance) marriages, and other arrangements.

breakup-divorce-separation-relationship-coupleCouples become separate entities when they break up and must chart their individual ways. Loss of a relationship can mean the end of dreams, routines, stability, emotional and financial security, companionship, and family as it existed before the breakup. The resulting trauma is one that impacts on the partners, of course. To varying degrees, children, extended family, friends and colleagues suffer from and grieve the loss as well.

In addition to grieving the loss, those in the midst of ending a committed relationship face a great many practical challenges:

  • Children
  • Parenting
  • Housing
  • Finances
  • Legalities
  • Division of property
  • Establishing an independent life

The legal break up of couples through divorce adds significantly to the complexity of working through the emotional and practical issues inherent in the process. Divorce involves legal considerations, binding agreements, and an economic reality that can alter the expectations and security of all family members.

Ending a committed relationship is an extended process with different phases. Educating your clients about this progression is an important part of working through the confusing, challenges and difficult experiences of breaking up. The following are phases your clients might encounter:

  • Significant relationship distress over time
  • Increased distance from each other
  • Confrontation(s) with partner and family
  • Permanent or temporary separation
  • Temporary reconciliation
  • Decision to end the relationship permanently
  • Selection of legal representation in the case of a divorce
  • Negotiations for the financial break up
  • Creation of a co-parenting plan
  • Day by day co-parenting
  • Creating a new, single life

Divorce is a legal dissolution of a marriage by a court or other competent body. Many of the same concerns involved in divorce can apply to domestic partners and others in a committed relationship even though resolving legal issues associated with marriage may not be necessary. Laws governing divorce differ from state to state, and from country to country. Facilitators need to be particularly sensitive to the cultural differences that may have a significant impact on the way in which individuals, families and communities think about and handle divorce.

The following will help your clients work through these tough issues.

Discuss these aspects about your client’s present situation:

Trust – How safe do you feel emotionally? How safe do you feel physically?
Safety – How safe do you feel sexually?
Love – Is your love romantic, platonic, intermittent, evaporating, or other?
Cooperation – How do you help each other with day-to-day responsibilities?
Respect – What level of respect does your partner have for you? What level of respect do you have for your partner?
Physical intimacy – How are you and your partner “in sync” about intimacy and sex? How are you and your partner not “in sync” about intimacy and sex? How would you describe your sex life?
Communication – Do you talk to each other about finances?  Are you only sharing information or are you able to discuss feelings, worries and excitement?
Values – How much do you agree on ethical and moral issues? How does that influence your relationship?
Religion and spirituality – Describe how you share a religious and/or spiritual belief system. If you do not, describe how that works in your relationship.
Raising children – If you have children, describe how you have or have not been able to find common ground regarding discipline, guidance, medical decisions, educational plans and goals.
Family-of-origin relationships – Do you believe you and/or your partner are more loyal to your own families-of-origin than to each other?
In-Law relationships – How have you or have you not worked out relationships that avoid high levels of conflict with each other’s families? Do you have close relationships with your in-laws? Is that likely to continue if your relationship breaks up? Why or why not?
Finances – Are you both contributing to the family economy, either by working outside the home or inside? How does that work for you? How do you agree or disagree on methods of spending money? How do you agree or disagree on a budget or saving money?
Arguing – Do you and your partner stick to the issue at hand when you argue? Do you or your partner bring up wrong-doings of the past when arguing? Does your fighting ever become physical? When you are arguing with your partner, how safe does everyone in your family feel?
Future – How do you believe your life (and that of your children, if applicable) would be better without this committed relationship? How do you believe your life (and that of your children, if applicable) would be worse without this committed relationship? Explain.

Discuss which answers were surprises. What is the take-away for your client?

Breaking Up Is Hard To DoEnding a committed relationship is very difficult, full of twists and turns and unexpected potholes. As you help your participant on their personal journey the following worksheets (from the workbook, Breaking Up Is Hard To Do) will help them clarify their position. The worksheet versions of To Stay or Go, Being Left, The Quality of Current Relationship, and Goals are available to download here.

Mindfulness for Emerging Adults: A Blog Series, Part I

Mindfulness for Emerging Adults in the Digital Age

Mindfulness for Emerging Adults Book ReleaseMindfulness has been a hot trend this year. We hear all kinds of inspiring stories about how folks have used this ancient tool to become a better employee, student, partner, and person. Since the scientific community has become interested in mindfulness and other age-old contemplative arts, studies have proven the value of the ability to be fully present in what you do.

Mindfulness has been described as, “A state of mind in which people can observe mental activity without attaching to it or evaluating it.” (Leutenberg, Liptak, 2013) Using mindfulness, people can forge a path to find authentic identity and healthy personal and community connections, creating a good life in the digital age.

Emerging adults who are today defined loosely as those between 18 and 33 years-of-age, have always had rites of passage as they move from youth to a fully functioning adult. In today’s world of constant change and pressure to succeed, these milestones have changed drastically, even since our grandparents time. Although we can now communicate with the world at the drop of a cell phone, more and more people are finding themselves disconnected and lonely.

As they learn about mindfulness and how to incorporate it into their lives, both young adults and their mentors will become more grounded in the present moment and experience more ease, contentment, and life satisfaction – a state that positive psychologists refer to as well-being. From this place of growing comfort and ease, young adults will become more discerning and forward thinking, ready to take on the challenges of emerging adulthood with youthful common sense.

We at Whole Person Associates will present a series of articles which will include materials to clarify the problems facing emerging adults and a path to overcome these issues. We hope you find them useful and encourage your comments.

Mindfulness 1

Why do we need Mindfulness for Emerging Adults in the digital age?

Just as it is a toddler’s developmental task to master walking and talking, it is the developmental task of emerging adults (young adults roughly 18 to 33 years old) to build independence and intimacy. However, if we want these emerging adults to truly thrive in our society, we need to go beyond the developmental basics. We know toddlers need to feel loved and safe for optimum development to occur, but we sometimes forget that emerging adults need to be resilient, compassionate, optimistic, and connected to community to reach their full potential.

There are many advances in neuroscience that encourage seeing mindfulness and other contemplative practices as indispensable life skills. These ancient and now rigorously researched practices are more important than ever in our age of accelerated change, media overload, and chronic busyness. Because of the large interest in mindfulness by the scientific community, we now have evidence that these practices create positive change in the mind and body. By exploring and adopting mindfulness and other contemplative practices, emerging adults can forge a path to find authentic identity and healthy personal and community connections, creating a good life in the digital age.

Universally and eternally emerging adulthood is a transition time full of excitement and potential as well as risks and challenges. Facing our fears during times of transition is brave work. It may seem counterintuitive, but staying open-hearted and open-minded during the rollercoaster ride to adulthood gives us an opportunity to employ values-based decision making that will lead to balance, connection, and contentment.

In a series of eight articles we will explore four important categories: Balance, belonging, focus, and meaning. Each category will enable readers to build a personalized toolbox of skills. These skills will empower emerging adults to take control of stress and navigate difficult emotions. Both young adults and their mentors will become more grounded in the present moment and experience more ease, contentment, and life satisfaction – a state that positive psychologists refer to as well-being. From this place of growing comfort and ease, young adults will become more discerning and forward thinking, ready to take on the challenges of emerging adulthood with youthful common sense.


The Benefits of Mindfulness Meditation and Conscious Breathing.

No matter what our personal stress style, all human bodies respond physically to stress in the same way. Fortunately we have some simple and free tools at our disposal to help us counter the stress response. These tools can be practiced anywhere! Deep breathing allows us to access the underutilized rest and digest response. This response causes blood pressure to decrease and slows the heart rate. Gastric juices are released so that the body can digest and absorb the maximum amount of nutrition available in food.

The opposite of the rest and digest response is the over-utilized fight or flight response. In fight or flight mode, the heart rate increases, pupils dilate, and blood flow is rushed to the limbs to help us escape danger. This response happens whether the stressful situation is at work or at home; whether it is real or imagined.

The fight or flight response helps us remove ourselves from dangerous situations. Problems occur when these stress reactions happen too frequently and/or too close together. Then occasional stress becomes chronic stress. The body is then bombarded with stress hormones such as cortisol, and we run the risk of developing conditions such as sleep disorders, depression, heart disease, and chronic fatigue, among others. Stress can make us more vulnerable to illness and can prematurely age us. How we respond to chronic stress – going for a walk as opposed to smoking, for instance – will ultimately slow down or speed up these unwanted processes.

The exercises that follow will help with food issues and exercise issues.

Click here to download free exercises.

The material above has been excerpted from Mindfulness for Emerging Adults by Donna Torney.

Effects of Loneliness

Exploring the Forms and Effects of Loneliness

In November of 1960 Elvis Presley sang Roy Turk’s lyrics to teenagers through their transistor radios:

Are you lonesome tonight
Do you miss me tonight?
Are you sorry we drifted apart?

-Roy Turk – 1926

The theme was so popular the song was released by popular singers and bands more than seven times…each time becoming a hit.

What is Loneliness?

Human beings are social by nature and need human interaction and connectedness. When people experience adequate levels of human interaction and connectedness, they feel a sense of satisfaction. On the other hand, when people are experiencing inadequate levels of interaction and connectedness, they feel lonely – something’s missing.

Therefore, loneliness is a noticeable difference between people’s desired level of social interaction and the actual level of social interaction. Loneliness is a sense of connection to others who help to satisfy one’s needs. It is the feeling of no one to talk, relate, or share with – even though people are all around. Being with loved ones does not guarantee absence of loneliness.

Loneliness is not synonymous with being alone. People who are alone are by themselves and not with other people. Some people view aloneness as a positive and others see it as negative.

In our society filled with people who communicate primarily with a wide variety of technology, face-to-face social interaction has become less common, feelings of connectedness are rare, and people are lonelier than ever before. Technology can provide a false sense of being connected twenty-four hours a day, seven days a week. This feeling of virtual connection, however, may be deceiving, and people benefit with social face-to-face connections with other people.

People experience loneliness for many different reasons. Most of these reasons are related to feeling a lack of social support and fall into five basic categories:

  1. Life Changes – Loneliness often occurs in the midst of major life changes such as loss of loved ones, moving to a new city, or not being able to work because of an illness or disability. These types of major life changes often discourage people to meet others.
  2. Getting Older – As people age, they experience the death of friends and family and often feel as if they have fewer people who share their life experiences.
  3. Inadequate Social Skills – When people are unable to communicate with others because they have weak social skills, they are at risk for loneliness. A lack of adequate social skills can make it difficult for people to develop and maintain relationships with others.
  4. Personality Characteristics – People often are shy or lack the power of self-esteem to make friends easily, and therefore receive fewer responses to their overtures and less support from other people.
  5. Situational – People often experience loneliness when they are surrounded by people who have different ideas, values and interests. Therefore, when people do not have friends, family members, and acquaintances with whom to share experiences, they perceive themselves to be different, and feel lonely.

Almost everyone will experience loneliness from time to time. Different forms of loneliness exist.

Situational Loneliness –people feel lonely due to a situation or experience. This is a temporary situation.  An example would be moving to a new city where a person does not have any friends and has not made any acquaintances. Even though this situation brings on feelings of loneliness, these feelings will naturally disappear once the person has made new friends. This state of loneliness is usually a transient form of loneliness that changes as the situation or circumstances change.

Chronic Loneliness – This is a form of loneliness that persists over time, regardless of the situation or circumstances. This chronic form of loneliness usually results from having a weak or non-existent support system, a lack of social skills, shyness, and/or low self-confidence. An example would be a person who lacks the self-confidence to initiate conversations when meeting new people, or a person who fears being alone. This type of loneliness often requires the person to take action and build a new set of social skills. A specific type of this loneliness involves people with mental health issues. Even if they have a great support system and are surrounded by those who care, their issues cause them to feel alienated and lonely. They need to see a medical professional if it continues.

As loneliness becomes a bigger problem for people on all levels of society, it is important to distinguish the specific symptoms of loneliness. Because loneliness is an extreme emotional state in which people experience powerful feelings of isolation from others, it is accompanied by a variety of thoughts and feelings. People who are lonely will exhibit many of the following symptoms:

• Crying a lot of the time

• Feeling “hollow” inside

• Feeling alienated from other people

• Feeling as if you are alone, even though you

are surrounded with others

• Feeling as if you are not accepted

• Feeling as if you are not as worthwhile

• Feeling as if you are not loved

• Feeling as if you cannot make friends or build

stronger relationships with acquaintances


• Feeling as if you do not have the same

interests and values as those around you

• Feeling as if you have nobody with whom to

share personal concerns and experiences

• Feeling cutoff or disconnected

• Feeling damaged and unloved

• Feeling empty

• Feeling lost with no direction

• Feeling physical pain akin to a “broken heart”

• Feeling sad


Effects of Loneliness

Negative feelings of loneliness can lead to a variety of other health-related concerns and stress-related conditions including heart disease, high blood pressure and stroke. In addition, loneliness is often related to addiction, various forms of anti-social behavior, disrupted sleep Effects of Loneliness - Coping with Lonelinesspatterns and various mental-health conditions. People experiencing long-term (chronic) form of loneliness are more susceptible to experiencing these wider effects of loneliness. If your participants are experiencing any of these effects, suggest they see a medical professional.

This article was excerpted from Coping with Loneliness
By Ester R.A. Leutenberg and John J. Liptak, EdD

Coping with Chaos in the Twenty-First Century

Chaos and Confusion

Coping with Chaos Workbook and Card DeckExcerpted from Coping with Chaos
By Ester R.A. Leutenberg and John J. Liptak, EdD

Definition of chaos: a state of utter confusion – Complete disorder – a jumble.

One thing that all people can count on in the twenty-first century is living with chaos. Chaos refers to a state of confusion in your life, the experience of random or unpredictable occurrences, and/or a lack of order to your daily life, space and belongings. Chaos can be seen in the many changes in the workplace, cell phones ringing and people constantly beset with interruptions, the barrage of new information flooding into your brain, thousands of choices, new and improved product ideas, new technologies that arrive daily, and new family structures. Often a family member volunteers or is forced to take on a new role such as caregiving. These are just a few of the many ways people are experiencing increased chaos in their lives which leaves them feeling irritated, frustrated, exhausted, angry, overwhelmed and/or confused.

Many people are interested in returning to the days when life was simpler, calmer, more controllable and more predictable. People want their lives to be full of events, people, and things they can predict and count on. Instead, they feel like they are losing their sense of purpose, control and predictability, and the result of these feelings is a sense of exasperation and weariness.

Faced with many choices, loads of information at everyone’s fingertips, and complex technological systems, people seek to establish order and control in their chaotic lives. More than ever before, it is important to understand chaos and attempt to find patterns in the chaos.

This can be seen throughout history:

  • Religion – Various religions have tried to make sense of the world by coming to terms with evil and making sense of a world that seems aimless, violent, and full of random acts and events.
  • Science – The history of science is an ongoing attempt to discover patterns in the physical world and to understand incomprehensible and disorderly events. Scientists usually spend their lives searching for laws and patterns that can be repeated and therefore understood.
  • Mythology – Myths have been handed down through the ages to help cultures make sense of the randomness of events. Myths include parables related to birth, death, journeys to distant lands, magical beasts, mythical heroes and heroines, and gods and goddesses.

People often ask, “Why worry about chaos…there’s nothing you can do about it?” The fact is that people can control the chaos in their lives. It can be quite liberating to realize that chaos, although unsettling, need not be as frustrating as people believe. They can learn to define patterns of chaos and redirect their energies and abilities.

A New Way of Looking at Chaos

The Chaos Theory is one of the best theories for dealing with the chaos in the lives of people. This Chaos Theory was developed in the 1970s when James Gleick and Edward Lorenz found that small changes and fateful events set off patterns that could affect everything in their surroundings. They referred to this as the “butterfly effect” when they observed that a butterfly flapping its wings in China could affect weather patterns in Europe.

Therefore, even though chaos finds its way into the lives of every person, it is critical that people find ways to effectively cope with and overcome the chaos. The Chaos Theory suggests that there is no chaos; rather, there is a pattern and underlying order that can be defined by observing it with the right lens.

There are several ways to embrace and manage chaos:

  • Expect it – In the twenty-first century it is almost impossible to avoid chaos in life. People need to be aware that their plans are likely to be interrupted and changed, and that everything cannot be predicted and controlled.
  • Understand it – By seeing chaos for what it is and accepting and controlling it, people can see chaos as freedom from predictable routines and constraints. Eventually, chaos can be seen as a transition point to a more controlled, calm and satisfying life.
  • See it for what it is – Chaos Theory reminds people that even in chaos one can find distinct, critical life patterns. When people are able to identify the patterns in their lives, they can work to control the chaos and live simpler lives.
  • Control It – Chaos Theory suggests that there is always going to be chaos in the lives of most people. The secret is to be alert to the opportunities chaos brings and find ways of doing one’s best to control it so that it does not negatively affect one’s life.

All people at some point will experience chaos that will come from a wide variety of sources and can cause people to feel frustrated, stressed out and weary. Most people see this chaos as a symptom of the twenty-first century and feel that there is nothing they can do about it. In reality, chaos can be seen for what it is. People can do something about it and control it in their own lives.

The following worksheets will help your clients begin the process of controlling the chaos in their lives. Try them first yourself so you can guide participants through the process.

Click here to download these worksheets.

Finding Intellectual Well-Being

Enhancing Your Intellectual Habits

Excerpted from Intellectual Well-Being Workbook
By John D. Liptak, EdD, and Ester R.A. Leutenberg

Finding Intellectual Well-Being

Intellectual Well-Being Workbook

Developing our mental functions can be a challenging task, but you can do this! The following tips will help:

  • Take one step at a time. By working on one behavior at a time, the task of changing your behavior will not feel insurmountable. Because mental functions are so difficult to develop, it is important to start with small mental functions and work slowly to change one at a time. By trying to change more than one behavior at a time, people set themselves up for failure. Keep it simple!
  • Create a support system to help you develop your intellectual functioning. Who can you ask for help and support in modifying your intellectual functions? Choose people with whom you feel comfortable, people who would be helpful in a specific area of your life, and people who know that you are trying to make changes. You don’t have to suffer in silence to successfully develop new, more effective thinking skills. Let people know about your desire to change and allow others to support you.
  • Write everything down. Saying you are going to make changes will not suffice. Working on defined behaviors and writing concrete goals that you set for yourself will help you to be successful.
  • Be persistent in your efforts and do not give up on yourself. Remember that it takes time to change ingrained thinking patterns. Do not expect immediate results. The purpose of setting goals is to help you take smaller steps leading to your overall goal.
  • Be accountable. If during your efforts to make positive changes you slip and go back to old thinking habits, don’t let this stop you. Attempt to learn from your setbacks and use your newfound knowledge to make successful choices to move forward. Monitor your progress.
  • Reward yourself for a job well done. Healthy and meaningful rewards provide you with positive feedback and motivate you to continue in your efforts to develop greater intellectual well-being. Find ways to reward yourself for each job well done.

The following are some ideas to help you broaden your intellectual well-being. Open your mind, avoid rejecting ideas as going too far, or being too outrageous for you. Journaling about these questions will help you refine where you are and where you want to go.

Am I thinking outside the box?

For what problem are you having a difficult time finding a solution?

With whom does this problem occur?

Is this problem at work, in school, in the home, in the community, or somewhere else?

How do you typically solve your problems, or find solutions to your problems?

Who can help you solve this problem?

Is there any reason not to ask this person for help?

Think outside of the box. What are a few possibilities of actions you can take to solve this problem?

Am I open to new ideas?

Do you consider yourself flexible or rigid? Explain.

Do you consider yourself open to new ideas or closed? Explain.

What was a time you were presented with a new idea, refused it, and were so glad?

What was a time you were presented with a new idea, refused it, and were sorry later?

What was a time you were presented with a new idea, immediately open to it, and sorry later?

What was a time you were presented with a new idea, immediately open to it, and it worked out great.

How does this quotation from Edward de Bono relate to you?

Studies have shown that 90% of error in thinking is due to error in perception. If you can change your perception, you can change your emotion and this can lead to new ideas.

Am I using my imagination?

How would you describe your imagination?

In what ways do you use your imagination?

What is an example of a time when you used your imagination and it enhanced your intellectual growth?

How does your imagination help in solving problems?

How do you use your imagination by picturing images in your mind?

What has been a barrier to your using your imagination?

Some tips to help you along the way.

Outside the Box

  • Try to look at a situation or task from a different perspective.
  • Think differently with an open mind and find new ways of functioning creatively.
  • Challenge your assumptions and beliefs. Where did they come from? Just because some things have always been done a certain way does not mean that they must continue to be done that way.
  • Break pre-conceived norms or rules to get ideas or the solutions you need. Try doing something backwards to get a new perspective.
  • Gather a few people together and free-style, brainstorm solutions.


  • When you have ideas, jot them down to avoid forgetting them.
  • Brainstorm for ideas. When brainstorming, state ideas regardless of how different they sound at the time. Write down all ideas and then revisit them at a later time. You can do this by yourself or with partners.
  • Get away from habits and routines. When you do, you will find that the mental habits which are stifling your creativity will disappear.
  • As you daydream, jot down ideas that simply pop into your head. Because your subconscious continues to work while daydreaming, you will generate more creative ideas than when you are concentrating on a task.
  • Keep a piece of paper and pencil by your bedside. If, during the night, a thought pops into your head, write it down and go back to sleep. There might be more!


  • Be creative and try different ways of thinking by engaging in puzzles like crossword puzzles, number puzzles, jigsaw puzzles, etc.
  • Read books that will take you to new worlds. This will allow you to experience sights and sounds that do not exist in your present world. Regardless of the plot of the book, think about new ways that the story could have ended.
  • Think about stores, businesses, and online shops where you interact and how you could improve upon their products, packaging, logo, service, etc. Think about ways (in your mind) that you could envision each working more effectively.
  • Try new hobbies and activities such as learning a new language or researching a country you know nothing about. You will look at the activity from a different perspective.
  • Try a guided imagery CD to help you visualize.

Good luck as you develop true intellectual well-being. Remember that this is a difficult task to master, just as learning to play a Bach toccata or shoot consistent free-throws takes time. Practice, practice, practice and you will be successful.

Stress Management

Stress – A Problem for All Ages

Stress Management Coping With Everyday StressorsStress Management article and exercises excerpted from Optimal Well-Being for Senior Adults, Vol. 1 by Ester R.A. Leutenberg and Kathy A. Khalsa, CPC, OTR/L and Coping with Everyday Stressors  by Ester R.A. Leutenberg and John Liptak, EdD.

We live in a world fraught with stress. Stress has many sources and can bestress  generated from within a person through self-imposed thoughts and feelings, while others stressors come from the environment: Stress is completely age tolerant. Our reactions to stress might be different as we get older, but it is out there waiting to pounce.

Stress generated from within a person ‒ Stress can be self-imposed through low self-esteem, anger, feelings of hopelessness, feelings of helplessness, anxiety, perfectionistic tendencies, jealousy and hostility. For example, people who are perfectionistic often bring stress upon themselves by being too careful and worrying about tasks being perfectly accomplished.

Stress generated from the environment – Stress can be felt from the results of environmental catastrophes such as severe storms, earthquakes, tornadoes, hurricanes, floods and acts of war. For example, people who are trying to rebuild their homes and lives after a hurricane find themselves struggling to meet their most basic needs.

Stress generated from conflicts – Stress can be the result of situations in which people are faced with an incompatibility with people, needs, demands, opportunities or goals. For example, a person who does not get along with a co-worker will experience stress on the job.

Stress generated from daily hassles – Stress can be the result of minor irritating annoyances that occur in daily life. Some of these daily hassles may be losing keys, car breaking down, waiting in long lines at a store, waiting for appointments, and getting stuck in traffic. For example, a person having to sit in traffic going to and coming home from work will experience stress.

Stress generated from economic factors – Stress can be the result of economic factors such as losing money in the stock market, not having enough money in retirement, growing inflation, and amassing too much debt. For example, many people have to work later in life because of a lack of enough money to live on in retirement. People may struggle with overcrowded housing, inadequate heating or air-conditioning, dangerous neighborhoods, etc.

Stress generated from changes in families – Stress can be the results of changes in the family such as parents’ separation, divorce, blended families, loss of loved ones, change in residence, birth of a child, adoption, changes in health of family members, and caring for aging parents. For example, people who are forced to care for aging parents often feel guilt, and are stressed because it takes time away from work and other family obligations.

Stress generated from changes at work – Stress can be the result of changes on a job, loss of work, changes in a role played at work, uncomfortable physical demands in the workplace, a lack of safety, interpersonal demands such as an abrasive supervisor or co-worker, and having too much work to complete. For example, a person who must work with an abrasive supervisor will feel uncomfortable most of the work day. In order to successfully deal with all of the various types of stress, people must find creative ways of coping. The exercises that follow will help you manage your stress and move forward to lead a happy, healthy life.

The stress experienced by seniors is greatly impacted by past lifestyle choices and the tools we have learned to cope with our stress. Stress Management – Past and Present will help clarify those skills that work well and those that do not.

Stress Management – Past and Present

The lessons we learned in our past inform us on how we manage stress now. Answer the following questions in your journal or discuss them with a friend. If you wish, click here to access a printable version of the worksheets.

In your past:

  1. Think back to your childhood. How did the adults in your life manage their stress?
  2. As a child or teenager, how did you manage your stress?
  3. What is a memory from your childhood or teen years when you managed stress in an unhealthy way?
  4. What is a memory from your childhood or teen years when you managed stress in a healthy way?

In the present:

  1. What was one way in the last month that you managed stress?
  2. When you are at home, what is one stress management activity that is immediately accessible?
  3. Who is one person in your life, who can support you in managing stress well?
  4. What is one goal or boundary that you can set to assist you in stress management?

How did the lessons you learned in your past inform how you manage stress now?


Physical Distress Symptoms

How you move and hold your body tells a great deal about your level of stress and physical wellness.  Look at the list of stress symptoms below. Which of these do you exhibit and when do you find yourself experiencing them? In your journal list the symptoms and write about when and with whom you experience them. Write about how you might overcome this. If you wish, click here to access a printable version of the worksheets.

Foot tapping (impatience)

Tight, hunched shoulders (anxiety or frustration)

Tightly folded arms (anger or disappointment)

Sagging shoulders (fatigue)

Biting nails (anxiety or worry)

Frowning forehead (worry or fatigue)

Clenched teeth (stressed)

Biting or Licking Lips (nervousness)

Downturned corners of mouth (disapproval)

What other physical distress symptoms do you exhibit? Write about those as well.


Stress Relief A to Z

Good coping skills are a must to handle the stress we all experience. On the left you will find a list of skills. In your journal write what you would do, following the A to Z pattern. If you wish, click here to access a printable version of the worksheets.

Stress Relief A to Z


Your Own Stress Relief A to Z Suggestions


Avoid negative people. A
Be yourself. B
Change your thought. C
Don’t think you know all the answers. D
Exercise often. E
Feed the birds. F
Give someone a hug. G
Hum a joyful song. H
Invite a friend to dinner. I
Join others when invited. J
Keep a journal. K
Look up at the stars. L
Make duplicate car or house keys. M
NO! Just say it with no excuses. N
Open a door for someone. O
Pet a friendly dog or cat. P
Quit trying to fix other people. Q
Repair things that don’t work properly. R
Stand up and stretch. S
Take a shower. T
Use time wisely. U
Visualize yourself relaxing. V
Walk in the rain. W
X–plore a new idea. X
Yak with a friend. Y
Zoom into a healthy restaurant. Z

To download a digital copy of these stress management worksheets, click here.

Sleep Issues: Exercises and Worksheets

Sleep :  Are we getting what we need from the sleep we get

We often hear how important it is to get enough sleep… the right kind of sleep. Even setting the alarm on a cell phone can trigger an electronic lecture. “Join us to learn better sleep habits.” Many of the suggestions we hear make perfect sense for dealing with sleep issues. Go to bed at the same time every night rings true to us. It follows that if we have regular bedtimes we will fall asleep easier. We know our bodies respond to habitual behaviors. We’ve trained them to do so. However, reality steps in and we find it almost impossible to get to bed at the same time every night, let alone get up at the same time each day. Where do we go from here?

sleep issuesThe following material is excerpted from the Coping with Sleep Issues Workbook by Ester R.A. Leutenberg and John Liptak, EdD.

Many people feel that their sleep issues are just a normal part of their everyday life. Sleep issues can be disruptive and leave one feeling tired and sluggish throughout the day. These issues can continue, get worse, and become a sleep disorder.

Identifying and awareness of your sleep issues will help. Things pertaining to your sleep habits that you take for granted may be okay, or they may not be okay. Use the following information to help you document your sleep issues.

If you know or live with someone with sleep problems, send them a link to this blog and ask the person to do the exercises. Even better, interview the person by asking the questions posed below, and writing the answers down.

Your responses will also serve as a guide to take to your medical provider who can guide you to healthier sleep.

Click here for a set of printable worksheets covering the following topics.


My Sleep Issues

Name ______________________________________ Date ______________________

How many of the items below that pertain to you and/or your situation? Describe your experiences in your journal or print out a copy for your use of the worksheet.

While Sleeping …

I am able to recall a frightening nightmare.

I am afraid I will leave the house when I sleepwalk.

I am confused upon waking after I sleep walk.

I am hard to console when I awaken after sleep walking.

I am often sleepy during the day.

I am sweaty and my heart is pounding after a bad dream.

I dream about doing work while I am sleeping.

I awaken out of breath.

I am confused if someone wakes me up.

I awaken feeling frightened.

I engage in aggressive behavior.

I awaken sweating and breathing fast.

I awaken with a dry mouth.

I awaken with a sense of panic.

I awaken with my heart pounding from fear.

I cannot fall back to sleep when I have a nightmare.

I do not respond to others when walking in my sleep.

I feel scared at the end of my dreams

I have difficulty staying asleep.

I often choke or gasp during the night.

I often have headaches in the morning.

I scream and shout.

I snore loudly.

I wake up and sit upright with a look of panic on my face.

I walk around while I am sleeping.

I will often scream while sleepwalking.

My dreams feel like they threaten my safety.

My dreams become more disturbing as they unfold.

My nightmares are so realistic they are scary.

Others say my breathing stops when I am sleeping.


Sleep issues can become worse if not treated. Treatment usually consists of a combination of cognitive-behavioral activities like the ones in this workbook as well as medication. Consult and bring the three pages that you just completed with you to a medical or sleep professional to ensure you are doing everything possible to treat your sleep issues.


My Self-Care Sleep Habits

Sleep habits are often dependent on wellness habits that you display during the day. Think about some of your wellness habits and how they may be negatively affecting your ability to sleep at night. In the chart that follows, write about how you can make positive change in your wellness habits.

Self-Care Habit My Present Self-Care Habits How I Can Take Better Care

Eating habits

I eat a heavy snack an hour before bedtime.


I can take a light snack a few hours before bedtime.


Eating habits



Consistent bedtime rituals






Intake of liquid



Medications/drugs legal or illegal



Nap during the day












Highlight each Self-Care Habit you can change immediately to ensure healthier sleep.


Exercise for Better Sleep

There is a specific correlation between stress and a lack of sleep. Research has shown that exercise is critical in the reduction of stress. Physical activity earlier in the day can be a key factor in your ability to let go of some of the stress and sleep well. Answer the following questions in your journal or print a copy of the worksheet for your use.

  • What types of exercise do you do regularly (jogging, walking, swimming, aerobics, etc.)?
  • How much time do you spend regularly in the activities above?
  • Which types of exercise do you like best? Why
  • Which types of exercise do you like least? Why?
  • What exercise classes would you like to take?
  • What stops you from taking those exercise classes?
  • Are there any team sports that you could join?
  • Why don’t you exercise more? (Be honest!)
  • How can you compensate or overcome the reasons you do not exercise more?


Nutrition Influences of Sleep

Your food habits may have an influence on the amount and restorative power of the sleep you are currently experiencing. Journal about your current food habits, and then identify changes you would be willing to make. Note your current habits about the food group in question, and then identify the changes you want to make.

Proteins (example: milk, eggs, meat, poultry, fish, dried beans, oats, rice, whole-grain bread, whole-grain pasta, cashews, broccoli, peanuts)

Fats (example: butter, cheese, chocolate, pork, bacon, beef, veal, hotdogs, margarine, mayonnaise, canola oil, lunch meats)

Bad carbohydrates (example: sugar, corn syrup, sodas, doughnuts, cookies, cakes, pies,sugary cereals)

Good carbohydrates (example: potatoes, sweet potatoes, fresh fruit, fresh vegetables, corn, oats, wheat, soybeans, black-eyed peas, kidney beans)

Vitamins (example: liver, fresh fruit, fresh vegetables, whole-grain bread, milk, cheese, salmon, tuna, potatoes, poultry, peas, soybeans, whole-grain cereals, seafood, carrots, seeds)

Drinks (example: water, alcohol, coffee, sweetened fruit juices, sodas, hot tea, iced tea, lemonade)


Stress Management for Better Sleep

The relationship between stress and your ability to sleep well has been well documented. People who are experiencing a great deal of stress do not typically sleep well.

Write down the stress management techniques listed below that you will commit to trying.

  • Avoid hot-button
  • Be assertive with others – you have needs and wants too.
  • Breathe deeply.
  • Do not try to control what cannot be controlled.
  • Eat nutritionally.
  • Enjoy life’s simple pleasures.
  • Express your feelings in a safe, effective manner.
  • Focus on the positive.
  • Forgive yourself and others.
  • Journal about your feelings associated with stress.
  • Keep and prioritize a to-do list.
  • Learn how to say “No” when you feel overwhelmed.
  • Look at the big picture of life and see where your issue fits in.
  • Manage your time well so that you have time for yourself.
  • Plan your time effectively.
  • Prepare and accept that unexpected problems will arise.
  • Relax with calming music.
  • Schedule time for Yoga or stretching exercises.
  • Spend less time with people who stress you out, if you can.
  • Take control of your own environment.


Sleep Concerns

People who have sleep problems or disorders often have concerns when retiring for bed because of some of the issues that go along with their sleep patterns. Going to sleep with these concerns, and worrying about falling asleep, can make it more difficult to fall asleep. Sometimes, talking or writing about the issues will help.

In your journal identify three of your concerns associated with your sleep.


Taking Worries and Fear to Bed

We often worry and fear things we cannot control. Read the Serenity Prayer out loud. Make photocopies of it, cut it out, and tape it to your bathroom mirror, by your bedside, or any places where you can easily see it and re-read it.

God grant me the serenity

To accept the things

I cannot change;

Courage to change

the things I can;

And wisdom to

know the difference.


Bed-Time Self-Care

Print out this page. Cut out the tips below that pertain to you, and those you need to remember. Post them in places that you will see them. (bathroom mirror, refrigerator, etc.)

Reduce your liquid intake before bedtime.


Refrain from eating a large meal or snack before bedtime.


Remember that your bedroom is for sleep and intimacy only.


Get at least seven hours of sleep.


Have a bedroom free of and electronic products.


Turn your alarm clock around so that you cannot see it from bed.


Don’t go to bed unless you are sleepy.


Go to sleep and rise at the same time each day – even on weekends.


Avoid watching television shows that are upsetting before bedtime.


If you aren’t asleep in 20 or30 minutes, get out of bed until you are tired.


Keep a comfortable room temperature. Cool, but not cold.


Think positive thoughts as you are falling asleep.


Establish relaxing bedtime rituals.


Maintain a healthy diet.


Consider the things you have to be grateful for as you are going to sleep.


Make sure that your bedroom is quiet.


Review the good things that happened during the day as you get undressed.


Free your mind as you get into bed.


Avoid alcohol before bedtime.


Use caution with sleeping pills that can become addictive.


Do not allow cats or dogs in bed with you no matter how much you love them.


Exercise regularly but not three or four hours before bedtime


If there are noises, use a fan or white noise to block out the sounds.


Avoid stimulants like nicotine and tobacco before bedtime.


Avoid caffeine several hours before bedtime.


Lower the lights a few hours before bedtime


Finish eating anything an hour before bed.


Reduce the number and time of naps during the day.


Make an appointment with a medical professional.


Make an appointment with a sleep professional.



Using Mental Imagery

Mental imagery (or guided imagery) harnesses our brain’s natural tendency to create vivid mental representations of our beliefs, desires, experiences and goals. It’s also a simple, inexpensive, and powerful tool for soothing symptoms and creating positive change. The use of mental imagery has been found useful with some sleepwalkers as well as people with other sleep problems.

Mental imagery is using memories of visual events to project a mental picture in your mind.

An example:

I picture myself at a beach in Delaware where I used to live. When I begin to feel anxious or stressed I can project myself back to that beach and begin to feel relaxed and sleepy. I just close my eyes and picture myself sitting in the sand. I notice how blue the water looks and how white the waves appear as they come in. I imagine walking along the beach looking for seashells. I smell the fresh air and hear the seagulls chirping above. The sun is warm on my body and I feel safe. With each breath I take I imagine breathing in the beautiful, vivid colors that are present. This is my personal paradise.

 Now, write out a pleasant imagery scene that you will like picturing and remembering.

Before going to sleep each evening, you can begin to imagine this scene vividly.


Support for My Sleep Issues

In overcoming any sort of sleep issue, regardless of how minor or severe, support is important, and sometimes critical. Support can come in many different forms and from many individuals in your life. In the following boxes, list people whom you can rely on to suggest healthy lifestyle changes and activities that allow you to have a healthy bedtime sleep.

Make a list in your journal of all those who could support and help you with your sleep issues. Note how you believe that person can help you. Possible supporters could come from medical professionals, sleep issue professionals, family members, friends and acquaintances in the community, people with whom you work at a volunteer job, spiritual sources, or other groups you might know. Print the worksheet for your use if you wish.

Click here to download printable worksheets related to this article.

Mental Health Issues: Erasing the Stigma

Erasing the Stigma of Mental Health Issues

Managing Intense Anxiety WorkbookExcerpted from Managing Intense Anxiety Workbook
By Ester R.A. Leutenberg and John J. Liptak, EdD

Mental health stigma can be divided into two types. Social stigma is characterized by prejudicial attitudes and discriminating behavior directed towards individuals with mental health issues. Perceived stigma is the internalizing by the people with mental health issues of their understanding of discrimination.

The following worksheets will help you learn to change the stigma of mental health issues and deal with their impact in a more effective way. Click here for a printable version.

The Stigma of Mental Health Issues

People who experience mental health issues in their lives are prone to reoccurring symptoms. When this happens, they often have a stigma placed on them by other people. Often the stigma attached to this issue stops one from moving forward—being unable to talk about it for fear of being judged or labeled. We can erase the stigma of any mental health issues by starting to discuss it with one person at a time, and taking the time to explain the anxiety you lived through in the past.

Let’s start with people with whom you have already shared your story.

With whom have you discussed your issues?


What did you say? What was this person’s reaction? What did the person say?


How did you feel?








People in your community or your house of worship








If any one of the above reacted in a negative way, to what do you attribute that reaction?






If we stamp out the stigma attached to mental health issues, shed the shame and eliminate the fear, then we open the door for people to speak freely about what they are feeling and thinking.

~ Jaletta Albright Desmond

Journal about what this quotation means to you. How can you do your part to erase the stigma of mental illness.

Glenn Close said, “The most powerful way to change someone’s view is to meet them … People who do come out and talk about mental illness, that’s when healing can really begin. You can lead a productive life.

Name a time when you have changed someone else’s view – about anything.




How did that feel to you?






Name a time you were tempted to talk about your anxiety issues, but didn’t? Why not?






Write about a situation in which you talked about your anxiety issues.







How did that feel? How did it work out?






Who is a trusted person you can talk with and begin to heal? Anyone else?




Who is a trusted person you can ask for a referral of someone to talk with in order to begin to heal




Anyone else? In an ideal world, how can you lead a more stable life?






How can you contribute to changing stigma?






Ways I Am Treated

Think about some of the ways that people treat you because of the symptoms you show due to your mental illness. In the spaces below, write about those who treat you unfairly and why.

I am criticized by my family and/or friends …






I am ignored by my family and/or friends …






I encounter problems at work …






I encounter problems at home …






I am subjected to teasing or harassment …






I am laughed at …






I treat myself unfairly by …






I treat myself fairly by …






The Stigma of Going to a Mental Health Therapist 

Many people have pre-conceived ideas about anyone seeking therapy.

Do you know of anyone who has gone to a mental health therapist? Write what you know about

the experience. ______________________________________________________________________










Here are some facts about mental health and mental health therapy.

  • Mental health includes how you act, feel, and think in different situations.
  • Mental health problems can be caused by many different things including medical health issues, abuse (emotional, physical, verbal, sexual), stress, worry, loss of a relationship, food issues, ADHD, STD’s, family changes, addictions, traumatic event, problems, wanting to build up self-confidence, etc.
  • If someone goes to a mental health therapist, this does NOT mean the person is crazy. Mental health therapists treat people the same as any other medical doctor treats problems.
  • There needs to be a good connection between you and the therapist. Your therapist should be someone you feel you can trust.
  • This might take a few meetings and/or a few therapists, to find the right one for you.
  • Non-judgmental people who truly care about you will not judge you in a negative way. They will be proud of you for seeking help.
  • The therapist does not assume that you have a mental illness. The therapist assumes something is troubling you, knows that no one leads a perfect life, and admires you for trying to make changes in your life.
  • The therapist’s job is to help you understand what’s going on.
  • The therapist will not tell you how to live your life, or how to think, act, or believe.
  • The therapist is not an advice-giver, but will help you think about how to increase your quality of life.
  • The therapist may have some thoughts, and with you, will help you make changes.
  • The therapist can help you to increase your life management skills.
  • The therapist will help you recognize and express your feelings in a healthy way.
  • The only person who can “fix” your problems is you, but a therapist will help you with an action plan.
  • The mental health therapist may suggest that you see a medical doctor for medication.
  • Therapy can be a slow or long process. Being open and honest, and wanting to feel better, will make the difference.

Place an X by the facts that you were not aware of.

What are your concerns about talking with a mental health therapist?_ __________________________








After learning about these facts, consider making a commitment to speak with a counselor or therapist.

National Military Appreciation Month

May is National Military Appreciation Month

Excerpted from Veterans: Surviving and thriving after trauma
By Ester R.A. Leutenberg and Carol Butler, MS Ed, RN, C

Forward by John Sippola, LTC, ret., MDiv

Veterans front coverDeclared by Congress in 1999, May was selected National Military Appreciation Month as a month-long observance honoring the sacrifices of the United States Armed Forces.  There are more military related observances during the month of May than any other month, so it is an appropriate time to celebrate the men and women in uniform.  During May, we recognize Loyalty Day, VE Day (the end of World War II in Europe on May 8, 1945), Armed Forces Day, Military Spouses Day and Memorial Day.

War casts a long shadow. For far too many service members and their families, the initial expressions of welcome, joy and relief are soon overshadowed by hidden wounds to mind, body and spirit. Too many veterans find they are engaged in yet another desperate battle. And, in this hidden war after the war they discover enemies they feel ill-equipped to fight. Aftershocks of war-related trauma and dangerous undertows of depression sabotage their mission for a more satisfying life in community. Moral injury drowns the quest for inner peace, and substance abuse undermines hard-won gains.

Initially, homecoming is happiness, applause and affection, but reintegration to daily life does not resume as they knew it. Veterans, their partners and families have changed. The labor market may not welcome their skills; their finances may plunge. Statistics show alarmingly high suicide and unemployment rates.

Help abounds via the Department of Veterans’ Affairs, Department of Defense, Wounded Warrior Project and numerous governmental and private agencies. Many veterans are reluctant to seek assistance due to the perceived stigma of asking for help; others are too overwhelmed, unaware of available resources, or receive little or no help for other reasons.

As more veterans return from combat, society is increasingly aware of their needs. They will be directed toward professional and spiritual counselors. Veterans differ from other abuse survivors; they have seen atrocities and experienced horrors most civilians cannot comprehend. Their intelligence, determination and resilience that served our country are now needed to save themselves, to heal their invisible and visible wounds.

One of the issues Veterans face is how to problem solve when they are overwhelmed with problems. They often need help finding a way to break their difficulties down to something manageable. The exercise, Problems Can Be Opportunities, will help them discover a way to prioritize their issues and work through a solution…a solution that works for them. A facilitator’s guide is supplied here.

A downloadable version of the exercise “Problems Can Be Opportunities” is found here.


Difficult People: How to Deal with Them

Types of Difficult People and How to Deal with Them

Excerpted from Coping with Difficult People
By Ester R.A. Leutenberg and John J. Liptak, PhD

Coping with Difficult PeopleDifficult people are everywhere. Difficult people are those who frustrate us to no end. (In fact, others may view each of us as a difficult person.) We encounter difficult people at home, in the workplace, school, grocery market, anywhere. Often how much they affect us depends on our self-esteem, ability to recognize “hot buttons” and effectiveness of communication skills. Although one meets many different varieties of difficult people, we have suggested six types that seem to be the most common. These difficult people will have some or all of the following traits:

WHINERS are people who find fault in others and everything they do, blame others for what happens in their lives, and know for certain what should be done but rarely work to improve or correct a situation. They whine in a high-pitched tone, cry and grumble to complain about problems rather than working to fix them or find solutions for them. They are often able to see problems that need solutions, but choose to complain about the problems rather than working to solve them.

KNOW-IT-ALLS are people who think that they know more than everyone else. They believe they have more knowledge and expertise and have all of the answers, and they know they are always right. They do not like to be corrected and will often be impatient, defensive, defiant and sarcastic with people who disagree with them, or they shut down or argue without reason. They feel they are experts on all subjects, behave arrogantly and take exception to anything said to them.

AGGRESSIVE PEOPLE are often angry, impatient and explosive. They use strength, coercion, force, and power to make their point. They often intimidate others into agreeing with them or giving up their point of view. They are critical of people who do not agree with them, and they use ridicule, belligerence, accusations, and verbal, emotional, and/or physical abuse as a way of putting people down. People who interact with them feel a need to be cautious (as if they are walking on eggshells.)

PASSIVE PEOPLE are hard to understand and hard to get to know. They are usually shy, quiet and reserved; they simply want to blend in and not be noticed. They rarely share their opinions or assert themselves to get their views across. They do not talk or share a lot and do not feel the need to respond to questions, especially personal ones. They often appear aloof and detached.

NEGATIVE PEOPLE are usually pessimistic people who will always say such things as “that will never work” and “we have tried that in the past.” They are skeptical that anything will turn out right or be right. They drag others down and make everyone’s environment as negative and as pessimistic as they are. They are unable to see the positive in anything and will always believe that things will not work out.

YES-PEOPLE are super pleasant and agreeable. They usually promise something that they cannot deliver. They seek approval and are afraid to say no to other people, especially the important people in their lives. They say what people want to hear and will agree with each person’s opposing views or opinions.

Here is a model that you can use to build positive relationships with difficult people.

In this model, participants can deal effectively with difficult people in their lives by following a few critical steps including:

  1. Identify the person’s personality type and what makes the person so difficult for others to handle.
  2. Learn and utilize critical communication and listening skills to build a positive relationship.
  3. Cope effectively with the person.
  4. Learn skills to respond effectively and/or to confront the person.

Sounds simple. Now for some tools to help.


Interacting with Whiners
Don’t . . .


•       agree with the person’s complaints

•       get defensive

•       counter-attack

•       say “You’re such a whiner”

•       be tough on the person if it’s not their usual style

•       be sarcastic (“poor poor you”)


Do . . .


•       listen attentively

•       ask clarifying questions for precise information

•       ask “how could it be better?”

•       create a problem-solving scenario: “What if…”

•       be supportive

•       kindly point out the person whining when he/she might not realize it

•       listen for a bit and then try to solve the problem with the person



Interacting with Know-It-Alls
Don’t . . .


•       attack the person’s ideas

•       put yourself or your ideas down

•       ask the person cite their source debate

•       think the person doesn’t know a lot –they might!

•       try to make the person look bad


Do . . .


•       listen attentively

•       respect the person

•       paraphrase the person’s points

•       suggest alternatives to the person’s viewpoint

•       remain neutral throughout your conversations

•       keep your humor



Interacting with Aggressive People
Don’t . . .


•       argue

•       retaliate

•       escalate the hostility

•       fight against the person

•       try to win the argument

•       take the behavior personally

•       submit to their wishes

•       wait for them to run out of steam


Do . . .


•       divert attention, if possible

•       offer information that explains your situation

•       look for common interests and agreement

•       remain calm

•       acknowledge the person’s feelings

•       explain your feelings using “I” statements

•       set limits on violence and aggression

•       walk away if necessary



Interacting with Passive People
Don’t . . .


•       fill in the silence with conversation

•       exclude the person in activities

•       complete the person’s sentences

•       talk too much too soon

•       ask too many questions or appear nosey

•       exclude the person in conversations

•       assume the person is disinterested


Do . . .


•       ask open-ended questions

•       provide opportunity for the person to speak

•       wait in silence

•       be attentive

•       expect responses

•       find a topic the person has interest in

•       be playful, fun loving and friendly



Interacting with Negative People
Don’t . . .


•       agree with the complaints

•       get defensive

•       counter-attack

•       think it is a reflection on you

•       accept blame

•       spend more time with the person than you need

•       lose focus on your own energy and positivity


Do . . .


•       listen attentively

•       ask clarifying questions for precise information

•       ask “how could it be better?”

•       create a problem-solving scenario

•       be supportive

•       remain detached

•       say, “now tell be something positive”



Interacting with Yes-People
•       Don’t . . .


•       help them out by doing the work they agreed to do, and aren’t doing

•       get caught up in their need for approval

•       ask more of them than they can do, even if you know they’ll say yes

•       let them get you in the middle by saying yes to say yes to someone of a different opinion

•       give them praise when they say yes, again


•       Do . . .


•       help them turn down activities

•       be clear about priorities

•       show them ways to say no

•       if they do accept a task, help them create a timeline for completion

•       help them set boundaries

•       build a relationship and try to talk to them

•       make suggestions for alternatives



For each of these types of negative folks answer the following questions:

The person I know that behaves as a _____________________ is ______________. (It is suggested that you use code names that only you will recognize for this exercise.)

This person behaves_____________________________________________________________





My strategy for dealing with this person has been ____________________________________





A better way I might deal with this person __________________________________________





A downloadable version of the above is information is available here.

Recognizing Unwanted Thoughts and Feelings

Recognizing Unwanted Thoughts and Feelings

Managing Unwanted ThoughtsExcerpted from Managing Unwanted Thoughts, Feelings & Actions Workbook

By Ester R.A. Leutenberg and John Liptak, PhD

People who encounter unwanted thoughts, feelings, and actions face frightening experiences. They may have a difficult time distinguishing between what is real and what is not real. They usually regret what they thought and felt, and/or how they acted. They find that often this interferes with their work, school, family relationships, and interactions with friends and people in their community. Unwanted thoughts, feelings and actions can cause confusion, be difficult to deal with, and disrupt any setting. Mental health issues contribute to unwanted thoughts, feelings and actions. When adults experience these symptoms, they are typically challenged by being and remaining in touch with reality. They have difficulty coping with the stressors and demands of their daily lives.

How Do Unwanted Thoughts, Feelings and Actions Issues Manifest Themselves?

Because there are so many bizarre ways these feelings can manifest themselves, disturbances can be very difficult to identify and manage. It is critical to be aware of, to understand, and to acknowledge how symptoms are commonly experienced. Although most or all symptoms do not have to be present, those that are present will typically cause significant distress and/or impairment in daily functioning. Listed below are some possible symptoms:

Agitation Cold manner Confused thoughts
Dangerous actions Delusions Detached from others
Difficulties in the workplace Disinterest in maintaining personal hygiene Disorganized speech
Feelings of entrapment Flat affect Forgetfulness
Hallucinations Inability to understand and accept reality Inability to communicate well with others
Inability to express emotions Inability to make good decisions and judgments Inability to think clearly and rationally
Inappropriate behavior Incoherent speech Increased drug/alcohol use
Intense anxiety Loss of appetite Loss of interest in everyday activities
Loss of touch with reality Mood swings Problems maintaining relationships
Problems in school Rigid actions Strange actions
Suicidal thoughts Unusual movements Withdrawal from others socially

Sources of Unwanted Thoughts, Feelings and Actions Issues

As with many different types of psychological problems, the origin of these unwanted thoughts, feelings and actions issues are difficult to pinpoint. Because of their complex nature, these issues are often brought on by one or a variety of these sources:

Genetics and Biology

Psychotic disturbances often run in families and thus researchers believe that they are inherited, but that is not the only cause. A complete medical and psychological history should be collected by a medical professional to identify family members who may also have experienced disturbances with unwanted thoughts, feelings and actions.

Brain Chemistry

The structure and functioning of the brain has been shown to have an effect on the incidence of psychotic disturbances. Chemicals in the brain (neurotransmitters) that communicate between neurons, also seem to play a role. In addition, the structure of the brain found in healthy individuals is different from that of people who experience disturbances with unwanted thoughts, feelings and actions. An examination to explore the structure and functioning of the brain should be conducted by a medical professional.

Life Events

An inability to cope with major stressors can be a factor in disturbances in thoughts, feelings and actions. Some of the major stressors might include traumatic shock or abuse. An examination of the person’s life events that may be causing unwanted thoughts, feelings and actions needs to be conducted by a medical professional.

Medical Conditions

Disturbances with unwanted thoughts, feelings and actions are more likely to occur in people with poor medical health in general, or those who suffer from an existing psychological problem. A medical history can reveal conditions that might induce problems in thoughts, feelings and actions, and should be examined by a medical professional.


A history of problematic drinking, tobacco, marijuana or other drug use has been associated with the development of disturbances with unwanted thoughts, feelings and actions. A history of a person’s drug, tobacco and alcohol use should be examined by a medical professional. People experience many different types of problems related to unwanted thoughts, feelings and actions.

In order to help participants deal successfully with unwanted thoughts, feelings and action issues, facilitators need to have a variety of assessments and activities to help their participants open-up and begin to feel they can manage the symptoms of their unwanted thoughts, feelings and actions and realize that they are not alone.

When to Worry?

Disturbances in unwanted thoughts, feelings and actions are difficult to manage because they blur the line between what is real and what is not real. The good news is that people can develop the skills needed to manage the symptoms and progress forward to begin enjoying life more. Unwanted thoughts, feelings and actions that accompany many of the mental health issues that people deal with daily can be a very frightening way to live. People who experience these issues over time are at risk of having a serious mental illness and need to seek a medical professional.

Suicide Warning!

People who experience severe bouts of unwanted thoughts, feelings and actions are often at risk for suicide. Sometimes they can become irrational and think that the only way to escape the pain is to attempt suicide. Remember to take any talk about suicide or suicidal acts very seriously.

Signs of suicidal thoughts
Withdrawing from family, friends, and activities of interest in the past Increasing use of harmful substances
Giving away possessions Expressing severe hopelessness about the future
Making a plan for dying by suicide Calling or visiting people to say goodbye
Getting legal affairs in order Engaging in reckless actions
Talking about killing or harming self Expressing feelings of being trapped with no way out
Purchasing a weapon

Serious Mental Illness

If participants have a serious mental illness, they need to be taken seriously. Facilitators can take an active role in their finding help immediately. All disturbances of thoughts, feelings, and actions need to be thoroughly evaluated by a medical professional, and then treated with an appropriate combination of medication and group and/or individual therapy.

RCT: The Power of Connection Through Student and Professional Mentorship

Relational-Cultural Theory Series Previous Articles:

What is Relational-Cultural Theory?
Transforming Community Through Disruptive Empathy
Combining the Neuroscience of Relational-Cultural Theory and Clinical Practice

Relational-Cultural Theory (RCT) in Practice:

The Power of Connection Through Student and Professional Mentorship

By Connie Gunderson, PhD, Jane Larson, MSW, Corrie Ehrbright, MSW, Vanessa Thoennes, MSW, Amy Anderly-Dotson, MSW, Anthony Klar, MSW, Ashley Tuve, MSW, Will Wales, MSW

Relational-Cultural theory (RCT) recognizes the primacy of relationship, and emphasizes the intrinsic human desire for connection through mutual empathy, radical respect, community and social justice. The purpose of this paper is to share the voices and experiences of MSW students who completed an advanced practice course in Relational-Cultural theory at The College of St. Scholastica in Duluth, Minnesota with the instruction of Dr. Connie Gunderson. Core aspects of learning included the opportunity for students to collaborate with faculty at the Jean Baker Miller Training Institute at Wellesley College in Boston, Massachusetts and participate in a mentorship program with RCT practitioners throughout the USA and Canada. Their experiences demonstrate that with the power of connection and the value of intrinsic inter-relationship mutual learning, growth and change are possible as students integrate Relational-Cultural theory into field placements and other professional settings. Connie Gunderson, PhD, LISW may be contacted at

This article shares the voices of MSW students who completed a course in Relational-Cultural theory at The College of St. Scholastica. It will briefly describe the course curriculum for your frame of reference and focus on students’ learning and reflections of their professional growth during the course, and the implications of applying RCT in clinical social work practice.


Brief Introduction to Relational-Cultural Theory

Relational-Cultural theory evolved as a developmental and psychological model in the 1970s through the collaboration of four women psychologists, Jean Baker Miller, Irene Stiver, Judith Jordan, and Jan Surrey, in Boston, MA. These women, along with other scholars and practitioners, began to challenge mainstream, traditional psychologies of human development that were grounded in a belief of the separate-self. From their perspectives, psychological theories that valued and fostered a separate-self worldview, based on individualism and autonomy, promoted a culture that was fundamentally antithetical to the health and wellbeing of persons and communities. In refute, the women posited that health, well-being, and growth are based on the primacy and centrality of relationship and relational movement rather than the focus of acting in one’s sole interests (Miller, 1976). This paradigm shift in thought and action has affected how counseling, therapy, organizational development, and policy changes are understood and practiced. In 2012, an editor at the American Psychological Association recognized Relational-Cultural theory as one of the top ten psychological theories of our time (Carlson, 2012). This is a tribute to the scholarship of the women who dared to challenge the status quo in the field of psychology.


Relational-Cultural Theory (RCT):

An MSW Course Curriculum

In the fall of 2014, MSW students at the College of St. Scholastica had the opportunity to study Relational-Cultural theory and its approach to human development, clinical practice, and social justice.

The course curriculum included an in-depth exploration of RCT theory, collaborative mentorship with RCT clinical practitioners, an introductory training experience at the Jean Baker Miller Training Institute at Wellesley College in Boston, MA, and two community-based educational events, hosted by the College of St. Scholastica and the Duluth community, featuring Dr. Judith Jordan and Dr. Connie Gunderson. The course was designed to engage students to learn about growth fostering relationship with each other, RCT mentors, and RCT scholars. The students were encouraged to reflect and practice the tenets of RCT in all aspects of the course. To assist in this process, students worked in small groups with RCT mentors to examine RCT through comprehensive literature reviews and collaborative discussions. Each small group critically reflected on how the theory and tenets applied to clinical social work practice.

A student reflected that RCT mentorship was a unique way to build relationship and foster learning:

I feel very fortunate to have had the opportunity to work with our mentors. They brought a wealth of experience, wisdom, knowledge, and fun to the table. They were willing to answer questions, share resources, and offer guidance. Most importantly, they brought themselves to the relationship and, I believe, we did as well. In true RCT fashion, our mentoring relationship was one of a reciprocal nature with all of us engaged in mutual learning.

This next section includes brief summaries of the students learning and reflections of some of the primary RCT tenets.


Basic Tenets of Relational-Cultural Theory

Mutual Empathy

Mutual empathy is one of the essential factors necessary for growth in relationship (Jordan, 1986). According to Hartling and Miller (2004), mutual empathy is not a static one-way process, nor is it a relational courtesy, but rather a complex skill that helps us “know” another person’s experience. To be empathic requires vulnerability. Jordan (1992) likens mutual empathy to a “life-giving empathic bridge” where people with different views and perspectives can come together and engage in dialogue that creates change (p. 2).

The practice of mutual empathy in therapy encompasses not only empathizing with clients’ experiences but also with their strategies of disconnection (Miller & Stiver, 1994). It is also a corrective experience allowing clients to build positive relational images and know they can have an impact on the world and the people in their lives which, in turn, contributes to a sense of empowerment (Walker, 2004). As clinicians, being mutually empathic also means identifying and empathizing with our own experiences and strategies of disconnection which can interfere with the ability to be fully present and engaged with our clients (Jordan, Walker, & Hartling, 2004).

Walker (2004) notes that all people deserve to be treated with dignity. Radical respect is a key aspect of mutual empathy. Without radical respect it is unlikely that clients would allow themselves to be vulnerable enough to authentically engage in a relationship. The practice of mutual empathy is paramount – without it, healing cannot take place. A student allowed herself to experience mutual empathy as she wrote:

Boston was an opportunity for me to join and experience the special bond the class already seemed to have. I wasn’t sure what to expect. When I walked into the airport the morning we were flying out, ready to cry over the fact I had to leave my babies, two of my classmates greeted me immediately with smiles, hugs, and words of reassurance. It was in that moment that I knew I was going to be part of something special. Special seems like an understatement here. The bond we all created in Boston was nothing short of extraordinary, and that bond continues to grow.



Authenticity is being able to fully represent oneself honestly in relationship (Jordan, 2004). When we are able to be authentic we are able to better know, understand, and discuss our thoughts and feelings with others (Miller & Stiver, 1997). The benefits of authenticity have been stressed in many fields including psychology, sociology, philosophy, and spiritual traditions (Chen, 2004). For example, a recent study on authenticity, life satisfaction, and distress indicated that the ability to be authentic in relationship was connected to an increased feeling of life satisfaction and decreased levels of distress (Boyraz, Waits, & Felix, 2014). As an example of this, a student wrote:

Authentic interpersonal relationships are critical to client health. Yet so many clients come to therapy in a state of profound isolation. RCT is refreshing because the focus is on healthy and authentic relationships, rather than on symptoms of mental illness.

Another student reflected:

The RCT class was like nothing I expected. The class was small and intimate. We got to know each other’s quirks and personalities on a deeper level. This was something new for me, since I was used to blending in, and being unnoticed. In the RCT class I was visible. When I spoke, people heard me, and that was something I had never experienced before. In this environment I learned my voice was accepted. For the first time, I realized I could make a difference outside of the classroom, and connect with others on a deeper level.

These results support the importance of helping clients share their personal stories, explore thoughts and feelings, be true to themselves, and feel free to engage in meaningful ways with others.


Social Justice

As clinicians it is important to understand that chronic exposure to social disparities, such as race, gender, and class-based stereotypes, are painful and foster self-doubt and feelings of unworthiness (Comstock et al., 2008). RCT invites clinicians to think beyond symptom reduction and remedial helping interventions (Comstock et al., 2008). Clinicians are encouraged to explore the social challenges and barriers clients may deal with on a daily basis. For example, Birrell and Freyd (2006) describe in their article, Ethics and Power, how cultural oppression, social exclusion, and other forms of social injustices underlie the pain that individuals in marginalized and devalued groups routinely experience in their lives. During the training in Boston, Dr. Maureen Walker explained that although oppression is often institutionalized at societal levels, it is necessarily enacted in the context of interpersonal relationship, therefore the fragmentation caused by the violation of human bonds can only be healed by new and healing human bonds (Walker, 2014). While at the training in Boston, a student became more aware of an important social justice issue while attending a lecture by author, Allan G. Johnson, who wrote The Gender Knot. The student noticed:

During the training, I was introduced to new perspectives about gender and privilege in our culture. I began to understand how white males have a status of unearned privilege in our society. As a white male with this unearned privilege, I became increasingly aware of how I may be perceived by others based on this unearned privilege alone. For example, I recognized how women are often discounted in our culture by being referred to as “guys.” This demonstrated how “male dominant” our society is.

As a clinical social worker, it is critical to be cognizant of the deep-rooted issues of power and privilege and to be able to address clients’ experiences with their environments and systemic assumptions and practices from a relational human rights perspective.



Many traditional therapeutic models view boundaries as a rigid line of separation. Clients may be subject to what the therapist determines as rules or boundaries. This perspective often carries connotations of control and separateness. From an RCT perspective, boundaries are viewed as an opportunity for connection and a place of meeting and exchange (Walker & Rosen, 2004). One method that fosters a power-with relationship is a conversation initiated by the therapist with a client at the beginning of the relationship. To create an environment that is mutually respectful and safe, therapists and clients need to discuss and clarify the purpose and focus of their therapeutic relationship. Here, boundaries are discussed and mutual agreements are developed to establish a constructive therapeutic relationship. For example, therapists respect clients by focusing on the clients’ needs during the therapy hour, and only use a “judicious use of self” when offering feedback and responses. Clients respect therapists by honoring the therapists’ need for personal privacy inside and outside of the office. This is critical in establishing a positive relational connection (Walker & Rosen, 2004). During the semester, there were discussions about the need for healthy professional boundaries. A student reflected:

I have struggled with the some of the traditional models of mental health treatment. For example, a therapist who is intentionally aloof and objective (if that is even possible) exudes judgment and superiority. Sadly, I have witnessed clinicians who repeatedly tell clients what is wrong with them, interpret clients as manipulative and treatment resistant, and unilaterally design treatment plans that clients must follow or face significant consequences. This does not model a growth fostering relationship, or offer a client a safe place to be vulnerable. An RCT clinician tries to relate with a client in a professional manner with mutual empathy, fluid expertise, a judicious use of self, clear boundaries, and clarity of purpose.



RCT focuses on safe and healthy therapeutic relationships. So the concept of power is central to RCT. Power is present in every relationship. How power is perceived and manifested is critical. RCT suggests that power is defined as the ability to facilitate change (Jordan, 2010). For example, relationships that strive to acknowledge and respect each person’s ability to contribute, while recognizing the different roles and needs each person may have creates an environment that supports empowerment, connection, and growth (Miller & Stiver, 1997). The students explored how they experience power in their work with clients and in their organizations. Recognizing how people use power to interact in relationship has been insightful. One student wrote:

The privilege of going to Boston to learn from the founding scholars of RCT was life changing for me. It’s not every day that someone like me, has the opportunity to meet people like Dr. Jordan, Dr. Banks, and Dr. Walker. They generously supported our efforts, and they invited us into mutually responsive relationships. How amazing to be invited to call or e-mail them with a question, or a thought, and get a response! How amazing to be asked to share our personal experiences, so they could learn from us.


Constructive Conflict

Relationships are not static. They are quite dynamic. In therapy, clients and therapists naturally move along a continuum between connection and disconnection (Comstock et al., 2008). Disconnections and resulting conflicts may cause fear. Conflicts in therapy can be seen as pathways for transforming misunderstandings to empathy, and for building bridges between one another through collective relational struggle (Comstock et al., 2008). RCT suggests that with increased mindfulness and a willingness to address inevitable conflicts that occur in therapy in a constructive “win-win” manner, clients can feel safe, become more attentive and responsive to relational movement, and gain confidence in their ability to grow in relationship. A student reflected on her insights about the importance of providing a safe climate for conflict and struggles to occur:

I have learned so much about the value of relationships and the importance of building them with clients. Many clients have experienced loss and trauma and are searching for safety, so it is important to be able to provide that for them.

RCT has changed my interactions with others – I find myself listening more and asking more questions rather than offering solutions right away, which has always been my instinct. I have learned how to create a space that is open and safe. Through this course I have found my voice and been able to share what I have learned about RCT outside of the classroom.

RCT has also taught me the importance of fostering and maintaining relationships that have already been established, to know when disconnections occur, and how to work through them in respectful ways.


Connection and Disconnection

Therapists will likely work with clients who have been referred by social services, the courts, and other programs. Clients may wish for connection with a therapist and hope that the therapist will care enough to listen and understand their story, and, at the same time, clients may feel ambivalent and guarded about treatment. The desire for connection and authentic engagement may be overshadowed by protective strategies to stay out of relationship and to feel safe – to be relationally disconnected (Jordan, 2005).

A disconnection is defined as a psychological rupture that occurs when a child or adult is prevented from participating in a mutually empathetic and mutually empowering interaction (Miller & Stiver, 1997). According to Miller and Stiver (1997), two key features are necessary to bring about re-connection. A person must be able to take some constructive action within the relationship to make one’s experience known. And the other person in the relationship must be willing and able to empathically respond in a way that supports a new and better connection.

Clients’ disconnections are not the only ones that need to be respectfully responded to. Therapists bring their own strategies of disconnection to a therapeutic relationship. The need for connection, based on mutual empathy, with other professionals is recommended for all who are working in clinical practice. Thus, it is important for therapists to participate in professional supervision to support their own personal and professional growth. One of the fundamental beliefs in RCT is that one never needs to be isolated because of the power of connection. A student wrote about her struggles with connection:

I had a profound life changing experience when I went to the Jean Baker Miller Training Institute. Before leaving for the trip to Boston, my hope tank was on empty. I had been compassionately working for a rural agency. I was devastated when the agency suddenly eliminated my position. When I left for Boston with my cohort, I wanted to isolate. It was what I knew. However, while in Boston, I rediscovered who I was as an individual, a spouse, a mother, and as a social work professional. I realized I had been lost for over two and a half years. My life had been weighed down with shame and guilt. The environment I had been working in created these lonely and negative feelings. I noticed that the most fearful and difficult part of my journey in graduate school has been exploring who I am and who I am becoming. I have had to force myself to look at the positive attributes, skills, and passions that are inside of me.


The Five Good Things

A culture that fosters growth and is grounded in radical respect, hospitality, and community offers an environment that provides us with The Five Good Things: a sense of zest, clarity about ourselves and our relationships, a sense of worth, an enhanced capacity to participate in our world, and a desire for more connection (Jordan, 2010). From this perspective, life’s journey is inherently relational. For example, we grow through and towards relationships during our lifetime, rather than towards separateness and independence (Jordan, 2010). One student expressed her ideas: “We wish to feel safe and to offer safety to others. We wish to give and receive love and kindness. We strive to increase our capacity for relational growth by developing mutual empathy, mutual empowerment, and resilience.” Another student wrote about her experience with The Five Good Things:

Because of this course, I have zest in the face of the most trying time of my life. I have more clarity about myself, others, and my relationships than ever before. I have a sense of worth and an enhanced capacity to be productive. Most of all, for the first time in my life, I have the desire for more connection, and for that I am grateful.

Another student added how RCT concepts are intertwined:

Last year, at the beginning of my RCT journey, Dr. Gunderson spoke about The Five Good Things, growth fostering relationship, mutual empathy, and authenticity. Until then, I had never heard how these concepts could be linked together. I knew instantly, I found a “theoretical home”. Everything, from that point on, has been moving me towards learning how to live and practice RCT in my personal and professional life.

The course taught students to apply theory to real life situations. Students were able to engage with peers, mentors, clinicians, educators, and scholars. They created a safe place to explore, struggle, and support each other to develop personal and professional skills critical for comprehensive clinical practice.


Future Collaborations

The College of St. Scholastica has integrated RCT into the Masters of Social Work curriculum. There are plans to offer RCT as an undergraduate course to first year students to assist them as they adjust to college life. It is clear, scientific studies are continuing to emerge with data that supports RCT and demonstrates that humans are neurologically wired for connection (Banks & Hirschman, 2014). To assist in providing ongoing evidence in this field of study, Graff, Gunderson, and Larson completed and are in the process of publishing a study on the C.A.R.E. program with MSW students (Graff, Gunderson, & Larson, 2017). This is in the process of being published. This study focused on the relevancy of the C.A.R.E. assessment tool and specific C.A.R.E activities for the relational health of students.

In addition, in collaboration with the Jean Baker Miller Training Institute and Wellesley Centers for Women, engaged CSS faculty and staff, current students and alumni, along with other professionals organized the Transforming Community: The Radical Reality of Relationship Conference in June, 2016. We are currently establishing the cornerstone at the college and with our community to offer ongoing training in Relational-Cultural theory/ therapy in Duluth, MN.

Clearly, the “relational movement” is alive and well on this northern Minnesota campus and in our local community as CSS faculty and students introduce RCT in field placements, professional settings, and with clientele. Collaboration between the College of St. Scholastica and the RCT scholars and practitioners from Boston and elsewhere in the USA and Canada demonstrate that change is possible as we work collaboratively to foster healthier relationships for students, clients, and professionals.



Professional social work education integrates theory and practice and teaches students to engage, assess, and intervene with clients in a wide range of settings. RCT suggests working from a paradigm that places the focus of clinical assessment and intervention on relational development and interaction. From a relational perspective, we approach persons and their environments with a belief in intrinsic inter-relationship. We see the challenges for human rights through a relational lens. We incorporate a relational perspective into how we make policy decisions. For some, this is a significant shift in thought and action.

As the St. Scholastica MSW students graduate and move into the clinical world, integrating the tenets of RCT into their work may not always be easy. A student noted that she has much to learn as she embraces a relational paradigm in her personal and professional life.

I still feel like an infant or a toddler with RCT. I am still in wonder of everything. I am learning and exploring. I realize that RCT is not based on a set of facts to memorize, or quick steps to follow. It is a way of living and being with everyone and everything around me. This theory takes time to develop and understand.

Yet, as more practitioners and organizations truly recognize the centrality of relational interdependency, and as research continues to confirm that we, as humans, are literally hardwired to connect, and as persons consistently challenge power-over systems that intentionally isolate and marginalize “others”, a relational movement that is already underway will be ever-present to foster well-being for all persons and for the planet in which we live.



The students of the advanced course in Relational-Cultural theory would like to thank those who offered their assistance while writing this publication. We thank Dr. Gunderson for her endless support throughout the course. Her guidance challenged each of us to explore new ways to connect and relate with others.

We thank our mentors. We are grateful for their willingness to stand with us as we explored the tenets of Relational-Cultural theory. Their experience and insight enhanced our learning and broadened our perspective of social work.

Finally, we thank Dr. Amy Banks, Dr. Judith Jordan, and Dr. Maureen Walker. The training experience was life changing for us. We are moved by your passion for intrinsic human connection and your willingness to support each of us as people and professionals.



Banks, A., & Hirschman, L. A. (2015). Four ways to click: Rewire your brain for stronger, more rewarding relationships. New York: Penguin.

Birrell, P.,. & Freyd, J. (2006). Betrayal and trauma: Relational models of harm and healing. Journal of Trauma Practice, 5(1). doi: 10.1300/J189v05n01_04

Boyraz, G., Waits, J.B., & Felix, V.A. (2014). Authenticity, life satisfaction, and distress: A longitudinal analysis. Journal of Counseling Psychology, 61(3), 498-505. doi: 10.1037/cou0000031

Carlson, J. (2012). In e-Connections Newsletter. Spring, 2012. Wellesley, MA: Jean Baker Miller Training Institute, Wellesley Centers for Women

Chen, X. (2004). Being and authenticity. New York: Rodopi.

Comstock, D., Hammer, J., Strentzsch, J., Cannon, K., Parsons, J., & Salazar, G. (2008). RCT: A framework for bridging relational, multicultural and social justice competencies. Journal of Counseling and Development. 86, 279-287.

Graff, D., Gunderson, C., Larson, J. (2017). [Assessing MSW student’s health and wellness with the C.A.R:E. program]. Unpublished raw data.

Hartling, L. M., & Miller, J. B. (2004). Moving beyond humiliation: A relational reconceptualization of human rights. Excerpts from a paper presented at the Summer Advanced Training Institute: Encouraging an Era of Connection, Wellesley College, Wellesley, MA.

Jordan, J. V. (1986). The meaning of mutuality. Work in Progress, No.23. Wellesley, MA: Stone Center Working Paper Series.

Jordan, J. V. (1992). Relational resilience. Work in Progress, No. 57. Wellesley, MA: Stone Center Working Paper Series.

Jordan, J. V. (2004). Relational resilience. In J. V. Jordan, M. Walker, & L. M. Hartling (Eds.). The complexity of connection: Writings from the Stone Center’s Jean Baker Miller Training Institute. New York: Guilford Press.

Jordan, J. V. (2005). Commitment to connection in a culture of fear. Work in Progress No. 104. Wellesley, MA: Stone Center Publications. doi: 0.1080/02703140802146423 Jordan, J. V. (2010). Relational-Cultural therapy. Washington D.C.: American Psychological Association.

Jordan, J.V., Walker, M., & Hartling, L. M. (Eds.). (2004). The complexity of connection. New York: Guilford Press.

Miller, J.B. (1976). Towards a new psychology of women. Boston: Beacon Press.

Miller, J.B., & Stiver, I.P. (1994). Movement in therapy: Honoring the “strategies of disconnection. Work in Progress, No. 65. Wellesley, MA: Stone Center Working Paper Series.

Miller, J. B., & Stiver, I. P. (1997). The healing connection: How women form relationships in therapy and in life. Boston: Beacon Press Books.

Walker, M., & Rosen, W. B. (2004). How connections heal: Stories from Relational-Cultural therapy. New York: The Guilford Press.

Walker, M. (2004). How relationships heal. In M. Walker & W. Rosen (Eds.). How Connections Heal: Stories from relational-cultural therapy. New York: Guilford Press. Walker, M. (2014). The Power of Connection. Jean Baker Miller Training Institute Lecture. 24. – 26. October 2014. Wellesley, MA: Wellesley College.

Mindfulness Meditation and the Opioid Crisis

Mindfulness Meditation

Almost everyone in the US is aware of the current opioid crisis we are enduring. Millions of addicted are added each year. Since 1999 the use of opioids has increased five-fold. Statistics from 2016 (the latest available) show that 42,000 people died of opioid-related issues in just that one year.

What can be done to alleviate this crisis? In a paper titled “Mindfulness Meditation-Based Pain Relief: A mechanistic account”, Fadel Zeidan and David Vago report that research supports the claim that the widespread use of opioids to alleviate chronic pain has led to the exponential rise in misuse and addiction. Their paper further states that mindfulness meditation could very well be a narcotic-free tool to reduce chronic pain. (Vago, Zeidan, 2016.)

Mindfulness, research has learned, is an excellent complementary treatment for a variety of health and wellness concerns and aligns with scientifically-backed theories in modern psychology. The importance of increasing resiliency in the face of the inevitable difficulties, both physical and mental, can’t be reinforced too often. Although mindfulness-informed practices don’t magically change life circumstances, they can help cope with rapid change, life transitions, and physical symptoms (i.e. pain) as well as enable us to more fully savor success. (Torney, 2018.)

Mindfulness Meditation 30 ScriptsWith the above information in mind we present the following from 30 Scripts for Relaxation, Imagery & Inner Healing, Ed. 2, Vol. 1& 2 by Julie T. Lusk.

Relaxation and visualization can heal the body, mind, and spirit. Progressive muscular relaxation and conscious breathing help relieve tension and stress. Guided imagery encourages people to experience internal harmony, to heal emotional and physical upsets, to increase body awareness, to enhance relaxation, to get in touch with the healing source of energy for emotional and spiritual strength, to receive direction from their own inner guide, and to connect with the environment.

Here are some tips to help you use these mindfulness-meditation scripts effectively with your clients.

Working with guided meditations

Everyone is different, so each person will experience guided imagery uniquely. These individual differences should be encouraged. During a guided meditation, some people will imagine vivid scenes, colors, images, or sounds while others will focus on what they are feeling, or experience it as a concept. This is why a combination of sights, sounds, and feelings should be incorporated into the meditations. With practice, it is possible to expand your participants’ range of awareness.

By judicious selection of images you can help deepen their experience and cultivate their awareness in new areas that can enrich their lives. For instance, a person who is most comfortable in the visual area can be encouraged to stretch his or her awareness and increase his or her sensitivity to feelings and sounds. (See Flower Meditation below.)

Be careful, however, when presenting themes and techniques that are unfamiliar to you. Since people respond in a variety of ways to visualization, avoid generalizing about the benefits of any given script.

If your groups are composed of people who are emotionally ill or especially fragile, be sure you have the necessary special training or professional guidance before introducing them to visualizations.

Preparing the group or individual

Some type of physical relaxation sequence should be used prior to every guided meditation. Breathing properly is essential for complete and total relaxation. Unfortunately, very few people take full breaths, especially when under stress. When a person consciously uses deep breathing correctly, stress is reduced and the mind can remain calm and stable. It is important that people focus on their breathing, with full deep breaths through the nose. Before beginning any guided meditation, briefly describe the images you will use and ask if they make anyone feel uncomfortable. People who are afraid of water may find images of ocean waves to be frightening rather than calming. Be prepared with an alternate image. Let participants know that if they become uncomfortable, they may, at any time, open their eyes and tune out or change the visualization. As you read a script, people will follow you for a while and then drift off into their own imaginations. They will usually tune you back in later on. If they know this in advance, they won’t feel as if they are failing by being inattentive. So tell them this is normal and to let it happen.

Choosing the right atmosphere

Select a room that has comfortable chairs for sitting or a carpeted floor for lying down. Close the door and shut the windows to block out distracting noise. If possible, dim the lights to create a relaxing environment. Low lights enhance the ability to relax by blocking out visual distractions. If the room lights cannot be controlled to your satisfaction, bring along a lamp or night lights. Adjust the thermostat so that the room temperature is warm and comfortable. If the room is too cool, it will be hard to relax and remain focused. Suggest that people wear a sweater or jacket if they think they may get cold. If distractions occur—a noisy air conditioner, traffic, loud conversations—try raising your voice, using shorter phrases and fewer pauses, or incorporating the sounds into the guided meditation. For example, you might say, “Notice how the humming sounds of the air conditioner relax you more and more.” Or, “If your mind begins to drift, gently bring it back to the sound of my voice.”

Using your voice

Speak in a calm comforting, and steady manner. Let your voice flow. Your voice should be smooth and somewhat monotonous. But don’t whisper. Start with your voice at a volume that can be easily heard. As the guided meditation progresses and as the participants’ awareness increases, you may begin speaking more softly. As a person relaxes, hearing acuity can increase. Bring your voice up when suggesting tension and bring it down when suggesting relaxation. Near the end of the guided meditation, return to using an easily heard volume. This will help participants come back to normal wakefulness. You may tell participants to use a hand signal if they cannot hear you. Advise people with hearing problems to sit close to you. Another option is to move closer to them.

Pacing yourself

Read the guided meditations slowly, but not so slowly that you lose people. Begin at a conversational pace and slow down as the relaxation progresses. It’s easy to go too fast, so take your time. Don’t rush. Many script authors use ellipses…to indicate a brief pause. Spaces between paragraphs would suggest a longer pause.

Leader’s notes and script divisions should not be read out loud. Give participants time to follow your instructions. If you suggest that they wiggle their toes, watch them do so, then wait for them to stop wiggling their toes before going on. When participants are relaxed and engaged in the imagery process, they have tapped into their subconscious (slow, rich, imagery) mind—and they shouldn’t be hurried. When you’re leading the meditation, stay in your conscious (alert and efficient) mind. Pay careful attention to all participants. You may have to repeat an instruction if you see that people are not following you. To help you with your volume and tone, pace and timing, listen to a recording of yourself leading guided meditations.

As you reach the end of a meditation, always help participants make the transition back to the present. Tell them to visualize their surroundings, to stretch, and to breathe deeply. Repeat these instructions until everyone is alert.

Using music

Using music to enhance relaxation is not a new idea. History is full of examples of medicine men and women, philosophers, priests, scientists, and musicians who used music to heal. In fact, music seems to be an avenue of communication for some people where no other avenues appear to exist.

Your music should be cued up and ready to go at the right volume before you start your meditation. Nothing ruins the atmosphere more quickly than having the leader fool around trying to get the audio going. Jim Borling, a board certified music therapist, makes the following suggestions on the selection of music:

Tips on Music Selection

  • Custom select music for individual clients or classes whenever possible. Not everyone responds in a similar fashion to the same music.
  • Matching a person’s present emotional state with music is known as the ISO principle. If you can match the initial state and then gradually begin changing the music, the person’s emotional state will change along with the music. If a person is agitated or angry, begin with fast-paced music, and then change to slower-paced selections as relaxation deepens.
  • Choose music that has flowing melodies rather than disjointed and fragmented melodies.
  • Don’t assume that the type of music you find relaxing will be relaxing to others. Have a variety of musical styles available and ask your clients for suggestions.
  • Try using sounds from nature like ocean waves. Experiment with New Age music and Space music, much of which is appropriate for relaxation work. Classical music may be effective, especially movements that are marked largo or adagio.
  • Adjust the volume so that it doesn’t drown out your voice. On the other hand, music that is too soft may cause your listeners to strain to hear it.
  • Select music based upon the mood desired. Sedative music is soothing and produces a contemplative mood. Stimulative music increases bodily energy and stimulates the emotions.
  • Select music with a slow tempo and low pitch. The higher the pitch or frequency of sound, the more likely it will be irritating.

Processing the experience

You may wish to add to the richness of the guided meditations by asking participants afterwards to share their experiences with others. This can be facilitated by creating an atmosphere of trust. Ask the group open-ended questions that relate to the theme of the exercise. Be accepting and empathetic towards everyone. Respect everyone’s comments and never be judgmental or critical, even if people express negative reactions. 


Do not force people to participate in anything that may be uncomfortable for them. Give ample permission to everyone to only do things that feel safe. Tell them that if an image seems threatening, they can change it to something that feels right or they can stop the imaging process, stretch, and open their eyes. Emphasize to participants that they are in total control and are able to leave their image-filled subconscious mind and return to their alert rational conscious mind at any time they choose. Likewise, clients may want to explore what feels uncomfortable to them in the safety of the experience. Advise participants that it is not safe to practice meditation or visualization while driving or operating machinery.

Integrating the mind, body, emotions, and spirit opens up vast inner resources of intuition, wisdom, and personal power. The mind and body are one, and what you believe and feel is reflected in your body. Sometimes your thoughts may lead to illness, aches, and pains; and other times, they lead to exhilarating feelings of joy, pleasure, and peacefulness. Likewise, the condition of your body and the way it is feeling affect your thoughts. This is why it is impossible to worry when you feel relaxed.

So many of us live as if fragmented—thinking of one thing, saying something else, acting one way publicly, while feelings, moods, and emotions provide a constantly changing and inconsistent undertow. Guided meditations will help you focus on using the mind body connection to heal the body and emotions and to bring thoughts, words, actions, and feelings into harmony and alignment.

A definition of mindfulness

Mindfulness is the moment-to-moment attention to the present without judgment or reactivity. Mindful breathing and other mindfulness practices help you to achieve moment to moment awareness in a non-judgmental, detached way, thereby increasing the amount of time per day spent in rest and digest mode. Conscious attention to breathing is common in many forms of meditation and is used by top athletes to enhance performance. The following exercise will help your clients breathe mindfully. Download the following Mindfulness Breathing exercise here.


  • Sit in a comfortable position either on a chair with your feet on the ground, or on the floor with your legs comfortably crossed. Sit tall with your spine extended so that your breath can enter your entire torso. Relax your shoulders down and move your shoulder blades towards each other.
  • Place one hand on your abdomen and the other above your chest near your collarbone.
  • Inhale deeply from the bottom of your abdomen. Feel the expansion pressing against your lower hand.
  • Continue to fill your torso until you feel the hand on your upper chest expand. Hold the breath for one second.
  • Release the breath from the chest to the abdomen. Picture a cup of water emptying from the top to the bottom as you exhale. Note how it feels to be empty of breath just for a second before your next inhale, then repeat this long, slow even breath nine more times. Return to the breath count as your mind wanders, which it naturally will.
  • Return to natural breathing. Take a moment to stretch, and write about your experience in your centering journal. Don’t worry if mindful breathing feels awkward or uncomfortable. It will feel more natural the more you practice. Remember, these are muscle responses. You can’t throw a football like Tom Brady or play the trumpet like Wynton Marsalis right off the bat, either. Practice, practice, practice.

Now your client is relaxed and breathing properly, try reading one of the following scripts, using the tips above to make it as effective an experience as possible.


Flower Meditation (Download Flower Meditation exercise here)
Julie T. Lusk
Excerpted from 30 Scripts for Relaxation, Imagery & Inner Healing, Ed. 2, Vol. 1
By Julie T. Lusk.

Time: 20 minutes

In this visualization script, participants increase their ability to imagine seeing, touching, smelling, and feeling.

Note: Obtain fresh flowers for participants before using this script.

Feel free to modify this script. For instance, flowers could be substituted with pine cones, sea shells, etc.



Place the flowers at eye level in front of you … Gently gaze at them without straining your eyes … Look softly at the shapes of the flowers, stems, and leaves … Become aware of their shapes and sizes. See their colors.

After you have spent a few minutes looking carefully at the flowers, close your eyes and visualize the flowers in your imagination. When the visualization becomes difficult, open up your eyes and look at the flowers once again. Close your eyes once more and recreate a vision of the flowers. Repetition will increase your ability to visualize images in the mind’s eye.

Touching and Feeling

Reach out and touch the flowers, stems, and leaves. Take your time to discover how the flowers feel … Explore the softness of the flowers and the feel of the stems and leaves. Discover their moistness, noticing the variety of textures.

Investigate the physical sensations of touching the bouquet of flowers. Run your fingers through the bouquet and listen to the sound of touching them … Allow the sense of touch to sink in through your fingertips and into your memory.

Stop touching the flowers and close your eyes. Experience the sense of touch through your memory … When the memory of touch begins to fade, reach out and touch the flowers with your fingers. And then imagine touching the flowers once again.


Bury your nose and take a full, deep breath. Let the flowers tickle your nose. Smell the fragrance and the freshness of the flowers. Enjoy.

Remember how the flowers smell and recreate the aroma in your imagination. Keep practicing until you are able to imagine the scent of the flowers from memory.

Thoughts and Feelings

Sit quietly and reflect upon the magnificence of the flowers. Open yourself up for new insights and realizations.


Relax, close your eyes, and imagine looking at a glorious bouquet of flowers … You may imagine any kind of flower you wish…roses … daisies … mums … baby’s breath … marigolds … bird of paradise … any type of flowers you wish.

See the radiant colors … the rich reds … luscious yellows … deep purples … pure whites … soft pinks … gorgeous oranges … all the shades of green.

Become aware of the textures … patterns … and shapes of the petals … Look at the leaves … and the stems … Observe the flowers in their various degrees of unfolding.

This time, imagine reaching out and touching the flowers … .Feel the softness … their moistness … the texture of the petals … leaves … and stems … Imagine rubbing the flowers with your fingers … Touch the flowers … Feel them.

Experience touching the flowers … Run your fingers through the flowers and listen to what you hear.

Now imagine the scents and fragrances of the flowers … Breathe in their perfume … Smell the aroma … Fill up your lungs with the fresh smell of the flowers.

Take some time to reflect on the diversity and beauty of the flowers that grow for our enjoyment … Think about the life cycle of the flower … Enjoy.


When you’re ready, open your eyes and stretch.

Repeat the above instruction until everyone is alert.


Sun Meditation for Healing (Download Sun Meditation for Healing exercise here)
By Judy Fulop and Julie T. Lusk
Excerpted from 30 Scripts for Relaxation, Imagery & Inner Healing, Ed. 2, Vol. 1
By Julie T. Lusk.

Time: 10 minutes

In this script, participants experience the healing power and energy of the sun as they imagine it warming and relaxing them.


Allow yourself to become as relaxed and comfortable as you can … Let your body feel supported by the ground underneath you.

Slowly begin to see or feel yourself lying in a grassy meadow with the sun shining it’s golden rays gently upon you … Let yourself soak in these warm rays … taking in the healing power and life giving energy of the sunshine.

This magnificent ball of light has been a sustaining source of energy for millions of years and will be an energy source for millions of years to come … This ancient sun is the same sun which shined down upon the dinosaurs … upon the Egyptians while they built the pyramids … and it now shines upon the earth and all the other planets in our solar system and will continue to do so forever.

As the sun’s rays gently touch your skin, allow the warmth and energy to flow slowly through your body … pulsing through your bones … sending healing light to your organs … flowing to your tissues … recharging every system … and now settling into your innermost being … your heart center.

Sense your heart center glowing with this radiant energy. If you wish, give it a color … Take a few moments to allow this warm and healing energy to reach your innermost being … physically… emotionally … mentally … and spiritually.

Pause for 30 seconds

As this healing energy grows and expands, allow yourself to see, feel, and sense this energy surrounding your being … growing and growing … Allow this energy to grow further and fill this room … this building … surrounding this town … spreading throughout our state … to our country … and out into the world … and finally throughout the universe … reaching and touching and blessing all.

Pause for 30 seconds

You may share this healing energy and power with anyone you’re aware of right now … Mentally ask them if they are willing to receive this healing energy … If they are … send this source of healing energy to them … giving them the time they need to take in this energy and make it theirs in their own heart center.

Pause for 30 seconds

Now take your attention back to your own heart center … Find a safe place within you to keep this healing and powerful energy … a place to keep it protected and within your reach … Give yourself permission to get in touch with this energy whenever you wish.

With the warmth of this energy in your being, begin stretching, wiggling, and moving … Slowly open your eyes, feeling alive, refreshed, keenly alert, and completely healthy.

Repeat the above instructions until everyone is alert.

Conflict Management Styles

What is My Conflict Management Style?

Excerpted from The Conflict Management Skills Workbook
By Ester R.A. Leutenberg and John Liptak, PhD

In many ways, conflict is a basic fact of life. We have all experienced conflict in our personal and professional lives. Because conflicts are disagreements resulting from people or groups having differences in attitudes, beliefs, values or needs, there will be times when conflict is inevitable. People experience differences in any relationship. That conflict exists is not a bad situation, as long as the conflict is managed effectively. Resolving conflicts can be beneficial and lead to growth and maturity. Outcomes of constructive conflict management will increase confidence in several aspects of life management:

  • awareness that problems exist and need to be solved
  • creative problem solving and decision making
  • sense of well-being
  • motivation and energy to take action
  • implications / attitudes / responses of empathy and caring
  • commitment to relationships
  • impact of respect, trust and commitment.

Any conflict has the potential to be incredibly destructive to a relationship. Managed in the wrong way, it can lead to extreme differences between people that can quickly spiral out of control. Each person will experience this Negotiations Model based on their point of view in a conflict as they use the following format to help them resolve their issues / problems:

Negotiations Model Conflict Management

The following are types of conflict management styles. Read the short description of each style and then journal about the following three questions for each one.

What I like about this style.

What I don’t like about this style.

When does this style work, or not work?


People with a Compromising Conflict Management Style try to find a solution that will partially satisfy everyone. This is often called the middle-ground approach because participants are willing to negotiate and come up with a compromise in the situation in which both people feel satisfied. They may also be willing to sacrifice the compatibility of their relationship with others in order to reach an agreement. They give a little to get a little, and they believe that both sides should make concessions in order to reach a resolution. They have discovered that it is important to back off from some issues in order to gain on other issues.


People with a Competing Conflict Management Style attempt to achieve their goals at all costs and as quickly as they possibly can. They take a firm stand and know what they want. They usually insist that the other people let them have their way, regardless of how much it affects their relationships with others. They operate from a position of power and are usually more concerned with having their way than with the feelings of others. No matter what the cost, winning is the most important thing for them. The use of this style can leave people feeling unsatisfied and resentful.


People with an Avoiding Conflict Management Style usually are willing to give up their own goals to maintain relationships with other people. They would rather hide from and ignore conflict than resolve it. They may give up personal goals and display passive behavior creating a personal loss situation. To do so, they generally avoid conflicts within important relationships. They may avoid other conflicts by physically removing themselves from the environment or by not coming into contact with the others who represent the potential for conflict. They may avoid others psychologically by not speaking or by ignoring them and another conflict situation, and subsequently, the conflict often goes unresolved.


People with a Giving-In Conflict Management Style usually give up their personal and professional goals so that other people can achieve their goals. They usually value their relationships with others so much that they attempt to smooth over the situation and give them their way. For them, the goal is often of no importance but the relationship with the others is of high importance. By giving in, they avoid the risk of a confrontation so they can continue to get along with the other people.


People with a Collaborating Conflict Management Style tend to want to meet the needs of all people involved in the conflict. They can be highly assertive, but are more than willing to cooperate effectively and acknowledge the importance of everyone involved. They are interested in bringing together a variety of viewpoints to get the best possible solution for everyone. They want all sides to be satisfied. They support open discussions, brainstorming and creative problem solving to come to a consensus.

Please enjoy these three conflict management worksheets and exercises:

Conflict Management Quotations
Conflict Management Process Steps
Causes of Conflict

National Nutrition Month – Seven Steps and Downloadable Worksheets

March is National Nutrition Month

Healthy Food National Nutrition MonthIn that spirit we hope the following article, along with the available downloadable worksheets, will help you reach out to your clients struggling with this issue. Much of the information is excerpted from the Nutrition chapter in Physical Well-Being Workbook by John Liptak, PhD, and Ester R.A. Leutenberg.

In today’s world one would think that with information provided by schools, health care professionals, and social media everyone would be aware of what to eat and what not to eat: The basics of good nutrition. Not so. The U.S. Department of Health and Human services offers the following information about the nutritional status of our citizens.

(Retrieved from on March 7, 2018).

  • Typical American diets exceed the recommended intake levels or limits in four categories: calories from solid fats and added sugars; refined grains; sodium; and saturated fat.
  • Americans eat less than the recommended amounts of vegetables, fruits, whole-grains, dairy products, and oils.
  • About 90% of Americans eat more sodium than is recommended for a healthy diet.
  • Reducing the sodium Americans eat by 1,200mg per day on could save up to $20 billion a year in medical costs.
  • Food available for consumption increased in all major food categories from 1970 to 2008. Average daily calories per person in the marketplace increased approximately 600 calories.
  • Since the 1970s, the number of fast food restaurants has more than doubled.
  • More than 23 million Americans, including 6.5 million children, live in food deserts – areas that are more than a mile away from a supermarket.
  • In 2008, an estimated 49.1 million people, including 16.7 million children, experienced food insecurity (limited availability to safe and nutritionally adequate foods) multiple times throughout the year.
  • In 2013, residents of the following states were most likely to report eating at least five servings of vegetables four or more days per week: Vermont (68.7%), Montana (63.0%) and Washington (61.8%). The least likely were Oklahoma (52.3%), Louisiana (53.3%) and Missouri (53.8%). The national average for regular produce consumption is 57.7%.
  • Empty calories from added sugars and solid fats contribute to 40% of total daily calories for 2–18 year olds and half of these empty calories come from six sources: soda, fruit drinks, dairy desserts, grain desserts, pizza, and whole milk.
  • US adults consume an average of 3,400 mg/day [of sodium], well above the current federal guideline of less than 2,300 mg daily.
  • Food safety awareness goes hand-in-hand with nutrition education. In the United States, food-borne agents affect 1 out of 6 individuals and cause approximately 48 million illnesses, 128,000 hospitalizations, and 3,000 deaths each year.
  • US per capita consumption of total fat increased from approximately 57 pounds in 1980 to 78 pounds in 2009 with the highest consumption being 85 pounds in 2005.
  • The US percentage of food-insecure households, those with limited or uncertain ability to acquire acceptable foods in socially acceptable ways, rose from 11% to 15% between 2005 and 2009.

National Nutrition Month – Seven Steps and Downloadable Worksheets

In their book the Physical Well-Being Workbook Ester Leutenberg and John Liptak, PhD, offer a seven step plan to foster better nutrition among our clients. Downloadable worksheets for each step are available by clicking here.

The first step is to assess the level of the client’s knowledge about nutrition and what habits they have – good or bad – that can be identified. A downloadable assessment tool is attached to this article that asks questions such as do you start your day with a good breakfast? Do you make good low-fat food choices? What kind of snacks do you eat? Do you plan your meals ahead or wing it? How much salt do you consume? Do you limit the amount of sugar consumed each day? The tool is quite comprehensive and can be scored by the client. A range of scores and what they might mean is included.

The next suggestion is to develop a group of people who will support the client upon his or her journey. Not all friends will do so. We all know folks who say things such as oh come on, one more bite or beer or piece of pizza or chocolate or cookie or cake or whatever won’t hurt. It’s just one more. Finding people who are supportive is one of the most important steps. Just as AA provides sponsors for recovering alcoholics, those recovering from bad nutritional habits need someone to call when their resistance is low, when the call of that chocolate cake becomes too much to withstand.

Step number three is to begin a nutritional journal. Questions such as the following, among others, can be pondered and answered by the client:

  • How can I improve my all over plan?
  • How can I plan better meals?
  • How can I choose healthier but satisfying snacks?

Next the client is asked to set goals for themselves. Using the SMART acronym (specific, measureable, attainable, realistic, and time-specific) goals are selected. How will the goal be measured, how attainable and/or realistic is it, within what deadline will it be accomplished, and how will this help are entered in a chart that can be posted in a handy place to remind the client of where they are going. There is a tip chart supplied for those who are having trouble identifying their goals.

In step five the client is guided through the process of monitoring their success. Both by charting and journaling the client explores what they are doing, what they accomplished, and how they felt when they accomplished a goal. Reminding ourselves of what we’ve done right and how that made us feel is important to being willing to take the next step. When we are dying for a taste of a Mimosa for breakfast on a Sunday morning we need to remember how it felt last week when we didn’t have one but ate a fresh orange instead. A ripe, tasty orange, fresh and full of juice, can be satisfying. Remind your clients to record the tactile sense of what they are doing as they accomplish their goal. How did the orange smell, look, and feel in their hand as they peeled it? Did they see the squirts of juice reflected in the sunshine coming in the window? Did they get sticky from the juice? Was is sweet or sour?

When having difficulty sticking to the next goal, advise the client to re-read their journal and/or behavioral change chart. Suggest that they sit quietly and remember the sensations they recorded and experience them again. It will give them the strength to step up to the plate again.

Rewarding oneself is next. What kind of rewards will work the best for the individual client? Ask them to brainstorm what they would find fun yet still within the pursuit of better nutrition. Perhaps tickets to the local pro team might not be a good choice if the client has indicated that part of going to a game is to pig out on hot dogs and beer. The same would hold true for a trip to the symphony concert if it includes cocktails and dessert following the concert.

What small rewards would work? Large rewards? Things they can do alone and still be fun? Things they can do with others who are also seeking to improve their nutrition. Remind them that affordability is important.

Self-affirmations are also good rewards. A list is given of possible phrases such as I shopped today for the whole week, or I drank more water today. The client is asked to write them down on sticky notes and paste them where they will frequently be seen.

The final step gives tips for motivating behavior modification as the client seeks to improve their nutritional planning habits. Many of these seem quite simplistic, but not many of us observe them all, all of the time. Here’s a sample list:

  • Read food labels
  • Rely on your social network created in step two.
  • Wash your hands before and after handling food.
  • Keep your fridge clean, store food in the wrappers in came in or other suitable containers.
  • Use paper towels to dry food off and throw them away afterwards.
  • Don’t leave food sitting out. Put it in the fridge.
  • Pack a good lunch that you like to avoid the pitfalls of fast food.
  • Plan, plan, plan!
  • Avoid too much salt.
  • Avoid too much fat, saturated fat, and cholesterol.
  • Drink plenty of water.
  • Eat low fat evening snacks such as popcorn, yogurt, fresh fruit
  • Plan a balanced diet
  • If you drink alcohol, do so in moderation.
  • Use the internet to find reliable and complete food information.

If your clients follow these seven steps (download worksheets here) they will find the path to better nutrition. Here is another great source for good nutritional information:

Combining the Neuroscience of Relational-Cultural Theory and Clinical Practice

Relational-Cultural Theory Series Previous Articles:

What is Relational-Cultural Theory?
Transforming Community Through Disruptive Empathy

Combining the Neurobiology of Relational-Cultural Theory and Clinical Practice


Since learning about Relational-Cultural theory (RCT) and relational neuroscience, they have become key components of my approach to mental health and substance abuse treatment with my clients. Using relational neuroscience in my work has been a particularly useful tool for depathologizing clients’ experiences and helping them to understand that we are hard-wired for connection with others. Elizabeth (Libby) Marlatt-Murdoch may be contacted at

Your brain is shaped by your mind—including your conscious and unconscious experiences, your body, the natural world, human culture, and relationships (Hanson & Mendius, 2009). Relational- Cultural theory (RCT) is a psychological theory that acknowledges the radical power of relationship. RCT posits that throughout the lifespan, individuals grow through and toward relationship, and that culture has a profound impact on these relationships (Jordan, 2010). Relational neuroscience provides evidence that the brain is designed for connection and that without connection we cannot thrive (Banks, 2015). The neuroscience of Relational-Cultural theory offers a window into the mind and calls attention to the need to address not only an individual’s relationships in therapy, but also the social context in which they exist (Banks, 2015). Based on experience as a clinician, Relational-Cultural theory and relational neuroscience can positively impact individual outcomes in healthcare and psychotherapy as well as improve relationships and quality of life by providing a way to depathologize individual’s experiences. Sharing an understanding of relational neuroscience as it relates to RCT can be essential in promoting mutuality and growth in relationships in many areas. Multidimensional models for psychoeducation can provide key elements in accomplishing this.

Considerations and Connections

Sharing information on relational neuroscience with others can be powerful. Education is one way to begin this process. More specifically, psychoeducation, which is defined as information that is presented to individuals with a mental health condition and their families to help empower them to manage their condition in an optimal way (Bauml, 2006). So providing psychoeducation to clients about how the brain is hardwired for connection, and cannot thrive without healthy mutual connections, empowers individuals to push back against the hyper-individualistic social pressures that can undermine their health and well-being (Banks, 2015). In treatment, this knowledge can inform the process between client and clinician as they collaborate to come up with a plan to assess and improve the individual’s relational skills and to discover how previous relationships have impacted the client’s welfare. Outside of treatment, this same information may encourage individuals to evaluate their current relationships for mutuality, and provide the catalyst they need to seek more mutual relationships in an effort to improve their quality of life. The feelings of empowerment that come from this psychoeducation process can cultivate hope.

Relational neuroscience also has the power to depathologize an individual’s experience for them. In a culture that sees development as a means to independence and ignores the devastating impacts of social pain, having knowledge to educate individuals about connection as a basic need can normalize an individual’s experience of pain as it relates to social exclusion can be powerful (Banks, 2015). At the 2016 Transforming Community conference, Banks and Craddock presented their STOP SPOT model for empowering individuals to identify and address the pain of social exclusion. Social Pain Overlap Theory (SPOT) proposes that social pain which is the result of damaged or lost relationships, and physical pain which is the result of physical injury are experienced in the same part of the brain (Eisenberger & Lieberman, 2005). In the STOP SPOT model that Banks and Craddock presented at the conference, an individual must first See Stratification, then Talk and Tell their individual story related to the stratification or exclusion. The next steps they proposed are Open Outreach and finally Partnered Protest and Production.

Based on clinical experience, the ability to teach someone that his or her brain is working and responding in the way that it was designed to often results in the client or individual feeling validated. Instead of experiencing the shame or embarrassment of feeling like they are broken or their brain is broken; the client experiences a sense of safety and compassion from the therapist. This safety and compassion are necessary for the client to heal from the damage that may have resulted from relationships that are not mutual, are chronically disconnected, or in other ways are experienced as traumatic. Relational neuroscience empowers individuals by depathologizing her/his experience. This often results in increased self-compassion.

According to Walker at the Transforming Community conference, compassion is bearing witness without judgment. She also described in her ARC3 Model of Empathy that Awareness, Receptiveness, Curiosity and Courage, plus Compassion are all necessary ingredients for empathy. According to her model, Awareness is being mindful of “what is”; Receptiveness is being open to innovative and possibly conflicting knowledge; Curiosity and Courage are about embracing constructive ambiguity, vulnerability, and limitations. Relational neuroscience has the potential to depathologize a persons’ sense of self leading to less shame, which in turn opens that person up for more vulnerable relational skills of compassion and empathy. In the words of Alamaas (2016) “it is only when compassion is present that people will allow themselves to see the truth” (para. 1). The feelings of empathy and compassion that are created through the psychoeducation process can be essential for clients in working through difficult experiences and for cultivating healing and hope.

Understanding of Neuroscience in RCT

To understand the neurobiological roots of interdependence we must start with understanding the brain. The reptilian brain, also known as the brain stem, is designed for regulation of the most basic functions such as heart rate and respiration, and is also involved in rapid mobilization of the brain and body for survival (Hanson & Mendius, 2009; Siegel, 2010). The paleo-mammalian brain, also known as the limbic system, works closely with the reptilian brain stem and is designed for creating our basic drives, emotions, memory, and is essential in establishing relationships and forming emotional attachments to others (Hanson & Mendius, 2009; Siegel, 2010). And finally, the neo-mammalian brain, also known as the cortex, “represents the three-dimensional world beyond the bodily functions and survival reactions mediated by the lower, subcortical regions,” is involved in creating ideas and concepts (Siegel, 2010, p. 19). According to Banks and Craddock (2016) “being a part of a group is so critical to humans that our nervous system literally uses the same alarm (the dorsal anterior cingulate cortex) to register the distress of physical pain or injury AND social exclusion” (para. 3).

Additional evidence for this concept is provided in studies that show the link between connection and survival. Research has shown that the human brain responds in a similar way to both food and connection, that the brains of neglected orphans from World War II did not have enough neural activity to support life, and that relational trauma impacts our mental and physical health and well-being long term (Bowlby, 1969; Center for Disease Control and Prevention, 2016; Hanson & Mendius, 2009). By looking at the different levels of the brain, we can begin to gather insight into how the basic need for survival led to the development of connection as a basic need in mammals.

Relational neuroscience has the power to shed even more light on love and belonging as a basic need. In fact, the research has shown that “lasting strength comes from being centered, and held within healthy relationships” (Banks & Craddock, 2016, para. 21). Banks’ (2015) C.A.R.E. program was designed to illustrate how individuals can strengthen the neural pathways in their brains to encourage closeness and connection. In Bank’s C.A.R.E. acronym, each letter represents a quality of a healthy relationship dictated by the functioning of one of four neural pathways of connection. In this model, she describes C is for Calm which represents the feeling that you get when you have a well-toned smart vagus nerve. She also explains that when we encounter potential danger, or when we are feeling stressed, the subcortical regions (primitive brain) becomes active and helps prepare the person to deal with the threat.

According to Banks (2015), this primitive brain often makes decisions that negatively impact our relationships. She indicates having robust relationships helps to keep a person’s smart vagus nerve well-toned, which in turn makes our relationships calmer. She describes how having a well-toned vagus nerve will allow us to mediate the primitive brain’s response and prevent it from taking over; and, as a result, we are healthier and have greater mental clarity. In the C.A.R.E. model, Banks (2015) describes A is for Accepted, and represents the sense of belonging that comes when your dorsal anterior cingulate cortex (dACC) is functioning properly. This part of the brain is described by Eisenberger & Lieberman (2005) in their ground breaking work, Social Pain Overlap Theory (SPOT). Banks (2015) explains the dACC acts as an alarm for social exclusion; being chronically excluded or isolated can result in an over-reactive dACC, which means the alarm can go off even when others are welcoming. She describes R as Resonance you feel in healthy relationships, which is facilitated by the action of the mirror neuron system. She further states that when an individual’s mirroring system is healthy the individual is able to understand other’s experiences, actions and feelings by creating an internal neurological template of the same experience, action or feeling (ex. noticing you are crying while watching a movie where the characters are sad and crying). She clarifies that if the mirroring system is unhealthy, it results in the individual having difficulty understanding others and can cause difficulty for others in understanding the experience of the individual. She describes E as Energy which represents the feeling of euphoria and zest we get in healthy relationships if our brain’s dopamine reward system remains closely attached to connection. She further relates the purpose of the dopamine system is to reward the brain and body for activities that promote survival—including approach behaviors, such as mating.

Unfortunately, when individuals do not get enough dopamine from healthy relationships, they may turn to unhealthy alternatives or addictive behaviors such as using drugs, gambling, or compulsive shopping (Banks, 2015). In this case the individual is rewiring their dopamine pathway away from connection and relationships, so that even when they are in relatively healthy relationships they may not derive energy and motivation from them (Banks, 2015). In summary, the C.A.R.E. acronym combined with describing how the qualities of a healthy relationship reflect the functioning of the four pathways for connection provides a solid, basic understanding of relational neuroscience.


Banks (2015) cautions that concepts of neuroscience often appear more clear than they actually are.  We must always respect the complexity of the central nervous system and what we have yet to discover. When starting the process of psychoeducation as it relates to the brain, it can be helpful to begin with some basic information about the brain. For example, the brain weighs approximately three pounds and is comprised of 100 billion neurons (Hanson & Mendius, 2009). Neurons connect via synapses and get their signals from other neurons through these receiving synapses and the signal is usually a burst of chemicals called neurotransmitters (Hanson & Mendius, 2009). Neural signals represent a piece of information according to Hanson & Mendius (2009), and the mind can be defined in a broad sense as the totality of those pieces of information. It is important to recognize that no single area of the brain is exclusively responsible for regulating relationship, which means creating healthy relationships is an easier task if your central nervous system is integrated, balanced, and flexible (Banks, 2015). Every interaction an individual has with the world changes the brain in some way, and individuals are capable of neurogenesis (creating new connections in the brain) as well as neuroplasticity (altering existing connections in the brain throughout their lives) (Banks, 2015; Siegel, 2010).

Visual aids for use in psychoeducation, such as Siegel’s hand brain (2012) or van Eys’ felt brain (personal communication, July 7, 2016), allow individuals to see how the brain works so they can change what the brain does. Siegel’s hand brain (2012) provides a portable and accessible brain model for neurologists and clients alike. His model is quite simple to create: take your thumb and fold it in towards your palm, then put your fingers over the top. He describes how the wrist represents the spinal cord, the palm represents the brain stem, the thumb folded inward onto the palm represents the limbic system, and the fingers covering the thumb represent the cortex.

To understand how the brain works, it is helpful to differentiate between parts of the brain that we have conscious control of from those we do not. In Siegel’s hand brain model (2012), if you raise your four fingers then you separate these two areas. He describes the four raised fingers as representing the cortex which is the part you have conscious control over. He elaborates that the thumb folded over the palm represents the subcortical regions that are beyond our direct conscious control. The importance of this distinction can be further emphasized by pointing out that the fear activation response takes 50 milliseconds, which is about 1/20 of a second, whereas conscious thought takes 500-600 milliseconds, or half a second (Cozolino, 2010).

Using Siegel’s hand brain model (2012), you can get a visual understanding of the first component of the C.A.R.E. program—Calm. He illustrates the process of “flipping our lids” by unfolding the fingers that were covering the thumb and palm to expose the rest of the hand which represents the limbic system and brain stem. When a person is triggered, the individual’s primitive brain is responding without the protective inhibition of the cortex—the logical/rational part of the brain (Banks, 2015). When this happens, Banks (2015) indicates the individual’s brain is not experiencing the feeling of calm that results when the individual can use their well-toned smart vagus nerve to mediate the response of the primitive brain. The Siegel hand brain model (2012) can be taken one step further by showing clients the location of the vagus nerve which runs between the right hemisphere (right two fingers) and left hemisphere (left two fingers) of the brain down through the limbic system and (via the parasympathetic nerve) into the brain stem and the rest of the body. Providing a visual representation of the location of the vagus nerve can increase understanding for the client about the role a well-toned smart vagus nerve has in calming both the brain and the body. In simple terms, when an individual has good smart vagal tone, they are able to accurately read a situation or person as safe and respond with engagement behaviors that result in enhanced connections and mutuality in relationships (Banks, 2015).

The second component of Banks’ C.A.R.E. program (2015), Accepted, involves the dorsal anterior cingulate cortex which is located deep in the frontal cortex, and can be illustrated using the hand brain model by showing the underside of the two middle fingers (Siegel, 2012). In Siegel’s hand brain model (2012), the two middle fingers represent the middle prefrontal cortex, which includes the dACC. It is important to emphasize that the dACC is part of an alarm system that responds to physical pain and injury as well as social exclusion, both of which are dangerous if left unaddressed (Banks, 2015). Both individual relationships and culture can impact our dACC explains Banks (2015). Developmental models that focus on independence and promote interpersonal competition often stratify and judge human differences creating an over reactive dACC, and consequently reactive pain pathways (Banks, 2015; Banks & Craddock, 2015).

The third component of Banks’ C.A.R.E. program (2015), Resonance, reflects the functioning of the mirror neuron system which is located in the parietal, frontal, and temporal lobes. In Siegel’s hand brain model (2012), the four fingers represent the cortical areas of the frontal and parietal lobes while the thumb represents the temporal lobe where the amygdala is located. It can be helpful to explain that the area of the cortex (four fingers) that is activated depends on the particular behavior or feeling that is being mirrored (Banks, 2015). In the hand brain model, Siegel (2012) indicates that the fingers overlap the thumb and palm illustrating how mirrored messages are created in the cortical areas and then transferred downward into the limbic system, then into the brain stem, and on into the body. He clarifies that these messages are transferred via the insula, also known as the “information superhighway” between the mirror neurons areas and the subcortical regions of the brain. The existence of the mirror neuron system is further evidence that we are biologically hardwired and evolutionarily designed to be interconnected (Banks, 2015). In fact, individuals understand what others are thinking and feeling by imitating them internally (Banks, 2015).

The final component of Banks’ C.A.R.E. program (2015), Energy, involves the social motivation system/dopamine reward system. This is located in the mesolimbic dopamine pathway, which travels from the brainstem through the limbic system, into the anterior cingulate gyrus and orbitomedial prefrontal cortex (Banks, 2015). This pathway can be identified on Siegel’s hand brain model (2012) by placing the pointer finger of your free hand on the palm of the hand brain model, moving it up to and through the thumb and ending at the fingers that represent the cortex.

Figure 1: Van Eys’ Felt Brain or Brain Puzzle

Another model or visual aid for making Relational Neuroscience accessible to clinicians and clients is the van Eys’ felt brain (personal communication, July 7, 2016), also referred to as the Brain Puzzle (see Figure 1). She indicated that this model was designed to create a basic understanding of the brain and its functions and to illustrate and facilitate an understanding of the body’s alarm system response. She described the felt brain as made of several pieces of felt: a large blue piece of felt shaped like the cortex labeled “thinking brain”; a pink piece of felt shaped like the brain stem added to the bottom right of the cortex; pieces of green felt and orange felt labeled “feeling brain” and representing the limbic system placed directly under the cortex and in front of the brain stem; a light orange almond shaped piece of felt represents the amygdala which together with the limbic system and brain stem is labeled “reacting brain”. She indicated that a felt star is used as a visual representation of a trigger and is placed over the top of the amygdala. She further explained that after the star has been placed over the amygdala a black piece of felt shaped like the cortex is placed over the top of the cortex to represent the idea that the cortex is not online during an amygdala highjack. This model, much like Siegel’s hand brain (2012), can be used to communicate a wealth of information about neuroscience, including RCT’s relational neuroscience. The felt brain model can be used to communicate the elements of the C.A.R.E. program in much the same way that the hand brain model was adapted.

Both of these models can be used in an interactive way. Clinicians can ask their clients to mirror the movements of the hand brain and/or work with their client to assemble the Brain puzzle. The felt brain model described by van Eys (personal communication, July 7, 2016) was created by van Eys and Tisthammer in 2015 and also includes a script containing informal language interspersed with scientific terms that makes the script easy to read and easy to follow. Their script even includes opportunities for discussion, encourages the user to change it in any way that makes sense for the audience, and even explains an amygdala highjack—which is the same principle discussed in the first component of Banks’ C.A.R.E. program (2015), Calm. This script by Van Eys and Tisthammer (personal communication, July 7, 2016) states in part:

Now, the limbic system cannot think…it can only feel and react. Only the blue part, the thinking brain, can think. Sometimes, the limbic system gets a danger signal and it gets afraid. It feels and reacts. So the brain’s alarm goes off because the reacting brain recognizes danger. So, let’s put this red star on the amygdala to show that the brain got that kind of danger signal. Let’s call this the “amygdala alarm.”

When the alarm goes off, the brain sends out chemicals that give our body energy to cope with danger (or “to handle the danger in order to get safe”). Our hearts beat faster, we breathe more rapidly, there is more energy sent to our muscles so that we can fight or run away from the danger. Or sometimes, we freeze or hide so that the danger won’t come to us.

Here’s an important thing: only the parts of our brain that help us survive are working when the amygdala alarm goes off. The other parts of the brain shut off until we have learned that we are safe; we will talk later about how we can recognize “triggers” so that we can quickly know that we are safe and turn the alarm off. The thinking part of the brain isn’t working because it isn’t needed at this time. (p. 7-8) There are a number of things that may be taken from these two multidimensional models that can make relational neuroscience more accessible to practitioners.

  • First, simplify the concepts of neuroscience appropriately in order to more effectively educate others.
  • Second, build a foundation for understanding by introducing the intended audience to fundamental facts about the brain by using basic language to convey the message.
  • Third, think outside the box and adapt existing visual aids or models to work for a new objective—in much the same way that the hand brain and felt brain models have been adapted to provide psychoeducation on relational neuroscience.
  • Fourth, promote understanding by asking open-ended questions, gathering feedback, and experimenting with interactive methods instead of just using the model as a visual aid.
  • Finally, use caution in deciding when it is appropriate to use relational neuroscience with clients or other individuals; this comes from experience and the ability to be attuned to those we serve.

Transforming Community Relational Cultural TheoryThe importance of sharing relational neuroscience with our clients has been supported by a number of considerations based on the tenets of Relational-Cultural theory. Psychoeducation on relational neuroscience has the ability to empower the individual to make changes in addition to depathologizing and validating the individual’s experience. This can often result in increased levels of compassion and empathy necessary to be with the pain that can result from relational trauma, loss, exclusion and/or isolation. Learning and sharing relational neuroscience represents a practical opportunity to enhance well-being, develop compassion, and reduce suffering through cultivating healing and hope.



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