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Case Studies - Page 2

I begin, as any therapist would, by asking Theresa what happened a month ago, right before her depression. She says she'd just ended a relationship, and she tells me that at almost 40, she still doesn't have a man who loves her, and she still doesn't have a child. I listen carefully as she describes the inhibition and despondency that shadowed her childhood; the recent breakup with her boyfriend has plunged her into the same kind of hopeless darkness she remembers from that time. A thousand miles away, she tells me, her mother's arthritis has slowed her to irritated immobility, and her father's sight and vigor are fading. Theresa feels she should be with them, but she doesn't want to, and feels guilty about that. "I carry my whole organization on my back, too" she says ruefully, "women's rights for everybody except this woman."

As I take in what Theresa is telling me, I encourage her to see herself as a student and adventurer, an active participant in our work together. Indeed, she's the one primarily responsible, with my guidance, for helping herself. "Self-care," I often tell clients, "is the true primary care." From our first session, I convey to her my belief that she has within her the resources for her own healing. I begin to help her recognize what she's already doing that's helpful to her. In her case, the morning yoga she still sometimes does gives her energy; and phone calls or visits with her best friend, Barbara, dispel, at least for a while, her loneliness. I write these activities down on a prescription pad, as another physician might an antidepressant drug, crafting "a Prescription for Self-Care" at the end of the first session.

I teach Theresa (and virtually all of my patients) a simple meditation technique called "Soft Belly," involving slow deep breathing in through the nose, out through the mouth, with the belly soft and relaxed. I encourage Theresa to close her eyes as she breathes so as to remove distracting stimuli. I suggest that she say to herself, "soft" as she breathes in through her nose and "belly" as she breathes out through her mouth. If thoughts come, I say, let them come, and let them go.

"Soft belly" is, I explain, an antidote to the fight-or-flight and stress responses, which figure prominently in the development and deepening of depression. Soft belly brings more oxygen to the lungs and stimulates the vagus nerve, which is central to relaxation. Slowly, I tell Theresa, the relaxation of the belly will spread to the other muscle groups also.

I explain to Theresa that though the research studies are most often done on 30 to 40 minutes a day of meditation, just a few minutes several times a day will help balance her physiologically, slow her anxious, pressured thought patterns, and give her a better perspective on her life. Equally important, as she sees she has the capacity to help herself, she'll be overcoming the helplessness and hopelessness that are hallmarks of depression. I add "Soft Belly 3–5 minutes, 3–5 times a day" to Theresa's Prescription for Self-Care.

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