Long-simmering dissent about the leadership and direction of the American Association for Marriage and Family Therapy (AAMFT) broke into the open last April, when the New Jersey division sent an impassioned letter to AAMFT division heads, posting it on the national organization's listserv and calling for "organizational transformation to prevent obsolescence." It gave voice to growing concerns that marriage and family therapists (MFTs) have lost their once-prominent position among policymakers, insurers, and the general public as the professionals best equipped to provide couple and family therapy. Furthermore, they claim, AAMFT leadership has become isolated from its members and resistant to open dialogue and fresh ideas. The letter called for long-time AAMFT Executive Director Michael Bowers to resign. At stake, they say, is the viability of the MFT profession.

AAMFT insists it's protecting the pro

AAMFT Family Feud

By Garry Cooper

Long-simmering dissent about the leadership and direction of the American Association for Marriage and Family Therapy (AAMFT) broke into the open last April, when the New Jersey division sent an impassioned letter to AAMFT division heads, posting it on the national organization's listserv and calling for "organizational transformation to prevent obsolescence." It gave voice to growing concerns that marriage and family therapists (MFTs) have lost their once-prominent position among policymakers, insurers, and the general public as the professionals best equipped to provide couple and family therapy. Furthermore, they claim, AAMFT leadership has become isolated from its members and resistant to open dialogue and fresh ideas. The letter called for long-time AAMFT Executive Director Michael Bowers to resign. At stake, they say, is the viability of the MFT profession.

AAMFT insists it's protecting the profession and has been open to dialogue. It points with pride to the organization's success at establishing MFT licensure in every U.S. state. For well over a year, says Board President Linda Schwallie, "We've been engaged in a comprehensive review of our strategic objectives and have planned for it to extend into 2010."

That response exemplifies the problem, say critics, who insist "the organization has been moving too slowly, focusing on the wrong issues, pursuing stale ideas, and providing only the appearance of listening to its members." Universal state licensure for MFTs, for example, says Maria Seddio, board president of the New Jersey AAMFT division, is a misleading indication of effectiveness when, in the past four years, New Jersey has licensed only one MFT (with one more close to licensure), while losing 56 members last year alone.

AAMFT expresses concern, but not alarm over membership totals. In the past four years, says Schwallie, student membership has increased by 9 percent and associate membership (the level between student and clinical) by 29 percent, while clinical membership "has remained level," and there's been "a modest growth" in licensed MFTs nationwide. Calling that kind of response obfuscation, Seddio says that AAMFT should release raw, year-by-year numbers.

AAMFT responded to the New Jersey division's letter by saying it was inaccurate, harmful, distracting, and "a challenge to the governance, processes and culture of the organization." That ignited an initiative among the dissenters to garner support for a Call for Change, specifying the need for a comprehensive, organization-wide audit. According to Schwallie, many AAMFT leaders at the national and division levels are concerned about the methods being used to generate support for the Call for Change. The AAMFT now has a netiquette agreement on its listserv, which participants must agree to before posting.

Schwallie insists that the dissidents, coalescing around a group called MFTers for Change, are a small, highly vocal minority. Statements like that, says Seddio, "highlight our concerns precisely. I'm sure that they'll bring in a statistician to show what an outlier nuisance these voices represent by percentage points and think that all is settled."

Meanwhile, some prominent members of the organization have joined the AAMFT critics. Supporting the call for Bowers's resignation, family therapy advocate William Doherty of the University of Minnesota, in a letter to the AAMFT board, wrote, "The AAMFT is not promoting the profession adequately and its way of relating to members is gravely deficient."

"I'm reminded of a scene in a movie where a young boy is trying to get his father's attention," e-mailed Peter Doherty, president of the Alberta, Canada, division of AAMFT, before the listserv was shut down. "The father, absorbed in reading his newspaper, responds to his son's questions in monosyllabic grunts. Finally the boy lights the newspaper on fire while his father is still reading it. The boy effectively gets his father's attention. Thank you, New Jersey, for lighting the fire."

For their side, seven presidents and past presidents of the AAMFT have written an open letter to their membership, stating in part, "We have been disturbed and saddened by recent efforts on the part of some members to foment a crisis of confidence in the association leadership and in the association itself. These efforts, while presented as well-intentioned, are misguided."

The debate may intensify at the AAMFT national conference in early October in Sacramento, California. According to Seddio, the traditional town hall meeting has been removed from the program and rolled into the business meeting. Nevertheless, she promises that members of the reform movement are working to get their concerns raised at the business meeting and will be making their presence known at the conference.

Liability Issues for Electronic Records

E-mails and other electronic means of recordkeeping have become common features of therapists' practices, but their use raises new legal and ethical issues. E-mails have a way of lingering in inboxes, where anyone who uses the computer can read them. Even innocuous e-mails about scheduling raise issues of confidentiality, so legal experts caution that they fall under the same privacy requirements as those governing other forms of therapeutic communication.

The simplest way to address the privacy issue is to make sure that no one else has access to your computer. Once the computer is adequately protected, it's best to take the further precaution of moving e-mails into clients' files and deleting them from the inbox and outbox.

Another relevant question is which e-mails need to be saved. An article in the American Medical Association's May 18 American Medical News says that e-mails pertaining to innocuous issues like scheduling can safely be deleted, as long as the procedures for doing so are applied consistently to all clients. In case of legal action, an inconsistent policy sets up the perception that there may have been a deliberate reason, such as concealing evidence of malfeasance, for saving one client's e-mails but deleting another's.

E-mails that have anything to do with the content of therapy must be treated in the same manner as notes and other records that need to be saved and filed. Therapists who have a high volume of e-mails or other electronic data, or who wish to be extra cautious, have two choices for storage. The first is to store e-mails and other records on their own computer, and make backups on a separate file-storage system, such as a CD or auxiliary hard drive. Saying that your computer crashed and all the data were lost isn't a legal defense. Both the original and the backup need privacy protection that's at least the equivalent of a securely locked file cabinet for hardcopy records.

Another option is to use an electronic archiving service. Therapists who use archiving services are advised to add an encryption program, which ensures that no one at the service can read the information. Companies such as Proofpoint (www.proofpoint.com) offer archival services covering everything from e-mails to entire record systems.

Group Therapy Redux

Back in the '60s and '70s, encounter, self-help, psycho-education, substance abuse, and other forms of group treatment were seen as being on the cutting edge of therapeutic approaches. But in more recent years, group therapy's prominence faded because of changing perceptions and times. In part, the decline of groups may have resulted from the administrative difficulty of coordinating client schedules and periodically introducing new members to ongoing groups. In addition, in movies like One Flew over the Cuckoo's Nest," says psychiatrist Molyn Leszcz, head of the group psychotherapy program at the University of Toronto, "the media portrayed group therapy as something populated by misfits, people out of control, and crazies." Today, according to an article in the March 24 Wall Street Journal, group therapy comprises only about 10 percent of the therapy market.

Now group approaches are making a comeback. The current economic squeeze makes it more attractive to clients—groups cost about half as much as individual therapy. But the resurgence began a few years earlier. Since 1994, the number of certified group therapists in the United States has tripled, so noneconomic factors are influencing the trend. Whenever there are major shifts in the fabric of society, says Leszcz, group therapy attendance increases because groups give people the comfort of being with others and satisfy their longing for social connection. They also give people a chance to learn and practice many of the skills for breaking the cycle of social isolation, which isn't just a symptom of many disorders, but a major contributing factor.

Another reason that group therapy is positioned for a comeback, says Leszcz, is that it's changed with the times. Group therapists are getting away from manualized treatment models and are adapting more flexible approaches recognizing individual needs and the importance of group dynamics. For instance, he recalls a time-limited psychoeducational group of spouse abusers, to which the group leaders introduced a new member who was so intimidating—physically large, with a history of assault—that the others cringed. Says Leszcz, "The group leaders used the anxiety that this guy provoked in the other men to help them understand what it might be like to be in the presence of someone much more powerful. It helped increase their empathic understanding of their spouses."

Advances in Internet technology also have helped make group approaches more accessible. CRC Health, which runs substance abuse treatment centers, now runs videoconferencing treatment groups that go far beyond online support groups. Under the supervision of two therapists, group members discuss homework assignments and talk with each other, and the therapist can privately backchannel with individual members during sessions, at either's request. This April, a study in the Journal of Substance Abuse Treatment found such Internet groups to be as effective as face-to-face outpatient groups.

More people may be rediscovering the healing power of groups, whether they're conducted electronically or face-to-face. "Group therapy," observes Leszcz, "facilitates the social connection that people need in today's fast-paced times." In a world of escalating troubles, that social connection and shared insight may prove not just valuable, but essential.

Dreamwork

When a psychotherapy researcher claims that far too few therapists have received training in interpreting dreams, you might assume she's coming from a psychoanalytic perspective. But it's University of Maryland cognitive-behavioral therapist and researcher Clara Hill who believes that therapists who downplay or ignore dreams are shortchanging their clients.

Hill argues that modern dream theory suggests that dreams aren't metaphors for unconscious wishes, but replays—sometimes literal, sometimes symbolic—of events in our waking lives. As such, she says, they're reenactments of how clients respond when awake. By encouraging clients to take the initiative in exploring their dreams, therapists can help them discover important insights and make behavioral changes. Hill's approach to incorporating dreams in therapy takes away much of the mystery of dreamwork. Instead of needing specialized training, therapists can use skills they already possess.

For working with dreams, she recommends the same three-stage process—exploration, insight, action—that her widely used cognitive-behavioral textbook, Helping Skills, outlines to teach psychology students the fundamentals of psychotherapy. The first stage of her model is to help clients retell their dream in the present tense, including as many details and feelings as possible. After this retelling, the next step is to encourage clients to choose the most salient parts of the dream and go over them a few more times—which usually results in emotional and cognitive insight. The final stage is to help clients develop plans for bringing their dream knowledge into their waking life.

Additionally, according to Hill, therapists can use their own dreams for personal growth and clinical insight. In a study of therapists' dreams reported in the January Psychotherapy Research, Hill and psychology doctoral student Patricia Spangler document how therapists have used dreams to understand clients better and gain awareness of their own practices issues. One therapist had dreams about feeling unsure how to react to former clients when she ran into them in social settings. Focusing on her dreams helped her realize that she'd been inadequately processing her terminations.

The Biology of Political Differences

It often seems that people who hold political or social views diametrically opposed to your own are so bull-headed that they just won't listen to logic and facts. Now a study by a team of political scientists and psychologists suggests that the reason for such impasses lies deep in the primitive areas of the brain.

The study, reported last fall in Science, found that people who reacted most strongly to disturbing photographs—such as the image of a large spider on the face of a frightened woman or of a dazed man with a bloodied face—were likelier to endorse policies viewed as protecting the existing social structure. For example, they were likelier to favor increased defense spending, capital punishment, warrantless searches, and the Iraq War. Those who had the mildest physiological reactions to the photographs strongly favored more generous and liberal policies, such as foreign aid, relaxed immigration laws, and gun control. The findings suggest that those who advocate more aggressive social and political policies may have a stronger need to protect their boundaries, and that what may seem like bellicose aggressiveness may just as often be a fear-based response.

This is the first study that suggests that sociopolitical positions may evolve out of physiological hardwiring. Understanding how that happens is well beyond the scope of the study, but political scientist John Hibbing of the University of Nebraska Lincoln, one of the researchers in the study, argues that it makes sense that people who experience threats more viscerally would develop attitudes different from those of people who are innately more sanguine.

Mindful Eating

In recent years, the principles of mindfulness meditation have become part of many new therapeutic approaches, such as Dialectical Behavior Therapy, Mindfulness-Based Cognitive Therapy, Internal Family Systems, and Acceptance and Commitment Therapy. Now it appears that mindfulness may be a powerful tool for successful dieting and the treatment of eating disorders. The preliminary research is promising enough that the National Institute of Mental Health has funded a project studying a treatment called Enhancing Mindfulness for the Prevention of Weight Regain (empower).

Psychologist Ruth Wolever, from Duke University's Center for Integrative Medicine, one of empower's developers and researchers, points out that food-related problems are inextricably tangled with issues that mindfulness addresses. People who struggle with their emotions and thoughts often externalize their psychological battles by denying themselves nourishment to starve unwelcome feelings or overeating to smother them. They often have difficulty recognizing the physical sensations of hunger or satiation, conflating them with feelings of panic, sorrow, or anger.

"Mindfulness teaches people that control can be achieved not through struggle, but through acceptance of their unwelcome emotions, thoughts, and physical cues," says Wolever. "It helps people practice identifying and experiencing emotion without reacting to it."

Mindfulness seems to produce not just a psychological realignment, but physical changes. In a study of another mindfulness-based program for binge eaters, researchers found that participants showed significant improvement in metabolizing glucose—which would affect not just weight, but cravings.

Using breathing and imagery exercises, empower teaches people the mindfulness principle of calmly, nonjudgmentally observing their thoughts, physical sensations, and feelings. People learn that thoughts don't necessarily have a basis in reality; thus, the cue "I want to eat" may not mean they're physically hungry. They learn to notice, explore, and sit with their urges, not to fight or deny them. If the urge to eat feels like a hollowness in the stomach, for example, they allow themselves to explore it. Is the hollowness localized? Does it expand and contract? They may then breathe into the hollowness until they feel full.

Clients learn to focus on taste, too. In one exercise, a single Hershey's Kiss serves as a 10-minute study. They look at it, smell it, and let it melt in their mouths, noticing which parts of their mouths and palates experience which kinds of taste, following what happens as the chocolate goes down their throats and into their stomachs.

When people eat with mindfulness, food becomes a direct experience of pleasure, sensation, and enhanced awareness, not a substitute for other issues. Clients learn to identify their true needs and address them directly. Are they hungry for food or for something else? If something else, how can they get it?

In today's world of competing needs and interests, says Wolever, "mindfulness is a way to anchor people to what they really want. It helps them feel genuinely empowered."

Resources

Electronic Records: American Medical News (May 18, 2009) www.ama-assn.org/amednews/2009/05/18/bica0518.htm. Dreams: Psychotherapy Research 19, no. 1 (January 2009): 81-95. Political Arguments: Science 321 (September 2008): 1667-69. Mindful Eating: "Mindfulness-Based Approaches to Eating Disorders," in Clinical Handbook of Mindfulness, New York: Springer, 2009, 259-87.

fession and has been open to dialogue. It points with pride to the organization's success at establishing MFT licensure in every U.S. state. For well over a year, says Board President Linda Schwallie, "We've been engaged in a comprehensive review of our strategic objectives and have planned for it to extend into 2010."

 

That response exemplifies the problem, say critics, who insist "the organization has been moving too slowly, focusing on the wrong issues, pursuing stale ideas, and providing only the appearance of listening to its members." Universal state licensure for MFTs, for example, says Maria Seddio, board president of the New Jersey AAMFT division, is a misleading indication of effectiveness when, in the past four years, New Jersey has licensed only one MFT (with one more close to licensure), while losing 56 members last year alone.

AAMFT expresses concern, but not alarm over membership totals. In the past four years, says Schwallie, student membership has increased by 9 percent and associate membership (the level between student and clinical) by 29 percent, while clinical membership "has remained level," and there's been "a modest growth" in licensed MFTs nationwide. Calling that kind of response obfuscation, Seddio says that AAMFT should release raw, year-by-year numbers.

AAMFT responded to the New Jersey division's letter by saying it was inaccurate, harmful, distracting, and "a challenge to the governance, processes and culture of the organization." That ignited an initiative among the dissenters to garner support for a Call for Change, specifying the need for a comprehensive, organization-wide audit. According to Schwallie, many AAMFT leaders at the national and division levels are concerned about the methods being used to generate support for the Call for Change. The AAMFT now has a netiquette agreement on its listserv, which participants must agree to before posting.

Schwallie insists that the dissidents, coalescing around a group called MFTers for Change, are a small, highly vocal minority. Statements like that, says Seddio, "highlight our concerns precisely. I'm sure that they'll bring in a statistician to show what an outlier nuisance these voices represent by percentage points and think that all is settled."

Meanwhile, some prominent members of the organization have joined the AAMFT critics. Supporting the call for Bowers's resignation, family therapy advocate William Doherty of the University of Minnesota, in a letter to the AAMFT board, wrote, "The AAMFT is not promoting the profession adequately and its way of relating to members is gravely deficient."

"I'm reminded of a scene in a movie where a young boy is trying to get his father's attention," e-mailed Peter Doherty, president of the Alberta, Canada, division of AAMFT, before the listserv was shut down. "The father, absorbed in reading his newspaper, responds to his son's questions in monosyllabic grunts. Finally the boy lights the newspaper on fire while his father is still reading it. The boy effectively gets his father's attention. Thank you, New Jersey, for lighting the fire."

For their side, seven presidents and past presidents of the AAMFT have written an open letter to their membership, stating in part, "We have been disturbed and saddened by recent efforts on the part of some members to foment a crisis of confidence in the association leadership and in the association itself. These efforts, while presented as well-intentioned, are misguided."

The debate may intensify at the AAMFT national conference in early October in Sacramento, California. According to Seddio, the traditional town hall meeting has been removed from the program and rolled into the business meeting. Nevertheless, she promises that members of the reform movement are working to get their concerns raised at the business meeting and will be making their presence known at the conference.

Liability Issues for Electronic Records

E-mails and other electronic means of recordkeeping have become common features of therapists' practices, but their use raises new legal and ethical issues. E-mails have a way of lingering in inboxes, where anyone who uses the computer can read them. Even innocuous e-mails about scheduling raise issues of confidentiality, so legal experts caution that they fall under the same privacy requirements as those governing other forms of therapeutic communication.

The simplest way to address the privacy issue is to make sure that no one else has access to your computer. Once the computer is adequately protected, it's best to take the further precaution of moving e-mails into clients' files and deleting them from the inbox and outbox.

Another relevant question is which e-mails need to be saved. An article in the American Medical Association's May 18 American Medical News says that e-mails pertaining to innocuous issues like scheduling can safely be deleted, as long as the procedures for doing so are applied consistently to all clients. In case of legal action, an inconsistent policy sets up the perception that there may have been a deliberate reason, such as concealing evidence of malfeasance, for saving one client's e-mails but deleting another's.

E-mails that have anything to do with the content of therapy must be treated in the same manner as notes and other records that need to be saved and filed. Therapists who have a high volume of e-mails or other electronic data, or who wish to be extra cautious, have two choices for storage. The first is to store e-mails and other records on their own computer, and make backups on a separate file-storage system, such as a CD or auxiliary hard drive. Saying that your computer crashed and all the data were lost isn't a legal defense. Both the original and the backup need privacy protection that's at least the equivalent of a securely locked file cabinet for hardcopy records.

Another option is to use an electronic archiving service. Therapists who use archiving services are advised to add an encryption program, which ensures that no one at the service can read the information. Companies such as Proofpoint (www.proofpoint.com) offer archival services covering everything from e-mails to entire record systems.

Group Therapy Redux

Back in the '60s and '70s, encounter, self-help, psycho-education, substance abuse, and other forms of group treatment were seen as being on the cutting edge of therapeutic approaches. But in more recent years, group therapy's prominence faded because of changing perceptions and times. In part, the decline of groups may have resulted from the administrative difficulty of coordinating client schedules and periodically introducing new members to ongoing groups. In addition, in movies like One Flew over the Cuckoo's Nest," says psychiatrist Molyn Leszcz, head of the group psychotherapy program at the University of Toronto, "the media portrayed group therapy as something populated by misfits, people out of control, and crazies." Today, according to an article in the March 24 Wall Street Journal, group therapy comprises only about 10 percent of the therapy market.

Now group approaches are making a comeback. The current economic squeeze makes it more attractive to clients—groups cost about half as much as individual therapy. But the resurgence began a few years earlier. Since 1994, the number of certified group therapists in the United States has tripled, so noneconomic factors are influencing the trend. Whenever there are major shifts in the fabric of society, says Leszcz, group therapy attendance increases because groups give people the comfort of being with others and satisfy their longing for social connection. They also give people a chance to learn and practice many of the skills for breaking the cycle of social isolation, which isn't just a symptom of many disorders, but a major contributing factor.

Another reason that group therapy is positioned for a comeback, says Leszcz, is that it's changed with the times. Group therapists are getting away from manualized treatment models and are adapting more flexible approaches recognizing individual needs and the importance of group dynamics. For instance, he recalls a time-limited psychoeducational group of spouse abusers, to which the group leaders introduced a new member who was so intimidating—physically large, with a history of assault—that the others cringed. Says Leszcz, "The group leaders used the anxiety that this guy provoked in the other men to help them understand what it might be like to be in the presence of someone much more powerful. It helped increase their empathic understanding of their spouses."

Advances in Internet technology also have helped make group approaches more accessible. CRC Health, which runs substance abuse treatment centers, now runs videoconferencing treatment groups that go far beyond online support groups. Under the supervision of two therapists, group members discuss homework assignments and talk with each other, and the therapist can privately backchannel with individual members during sessions, at either's request. This April, a study in the Journal of Substance Abuse Treatment found such Internet groups to be as effective as face-to-face outpatient groups.

More people may be rediscovering the healing power of groups, whether they're conducted electronically or face-to-face. "Group therapy," observes Leszcz, "facilitates the social connection that people need in today's fast-paced times." In a world of escalating troubles, that social connection and shared insight may prove not just valuable, but essential.

Dreamwork

When a psychotherapy researcher claims that far too few therapists have received training in interpreting dreams, you might assume she's coming from a psychoanalytic perspective. But it's University of Maryland cognitive-behavioral therapist and researcher Clara Hill who believes that therapists who downplay or ignore dreams are shortchanging their clients.

Hill argues that modern dream theory suggests that dreams aren't metaphors for unconscious wishes, but replays—sometimes literal, sometimes symbolic—of events in our waking lives. As such, she says, they're reenactments of how clients respond when awake. By encouraging clients to take the initiative in exploring their dreams, therapists can help them discover important insights and make behavioral changes. Hill's approach to incorporating dreams in therapy takes away much of the mystery of dreamwork. Instead of needing specialized training, therapists can use skills they already possess.

For working with dreams, she recommends the same three-stage process—exploration, insight, action—that her widely used cognitive-behavioral textbook, Helping Skills, outlines to teach psychology students the fundamentals of psychotherapy. The first stage of her model is to help clients retell their dream in the present tense, including as many details and feelings as possible. After this retelling, the next step is to encourage clients to choose the most salient parts of the dream and go over them a few more times—which usually results in emotional and cognitive insight. The final stage is to help clients develop plans for bringing their dream knowledge into their waking life.

Additionally, according to Hill, therapists can use their own dreams for personal growth and clinical insight. In a study of therapists' dreams reported in the January Psychotherapy Research, Hill and psychology doctoral student Patricia Spangler document how therapists have used dreams to understand clients better and gain awareness of their own practices issues. One therapist had dreams about feeling unsure how to react to former clients when she ran into them in social settings. Focusing on her dreams helped her realize that she'd been inadequately processing her terminations.

 

The Biology of Political Differences

It often seems that people who hold political or social views diametrically opposed to your own are so bull-headed that they just won't listen to logic and facts. Now a study by a team of political scientists and psychologists suggests that the reason for such impasses lies deep in the primitive areas of the brain.

The study, reported last fall in Science, found that people who reacted most strongly to disturbing photographs—such as the image of a large spider on the face of a frightened woman or of a dazed man with a bloodied face—were likelier to endorse policies viewed as protecting the existing social structure. For example, they were likelier to favor increased defense spending, capital punishment, warrantless searches, and the Iraq War. Those who had the mildest physiological reactions to the photographs strongly favored more generous and liberal policies, such as foreign aid, relaxed immigration laws, and gun control. The findings suggest that those who advocate more aggressive social and political policies may have a stronger need to protect their boundaries, and that what may seem like bellicose aggressiveness may just as often be a fear-based response.

This is the first study that suggests that sociopolitical positions may evolve out of physiological hardwiring. Understanding how that happens is well beyond the scope of the study, but political scientist John Hibbing of the University of Nebraska Lincoln, one of the researchers in the study, argues that it makes sense that people who experience threats more viscerally would develop attitudes different from those of people who are innately more sanguine.

Mindful Eating

In recent years, the principles of mindfulness meditation have become part of many new therapeutic approaches, such as Dialectical Behavior Therapy, Mindfulness-Based Cognitive Therapy, Internal Family Systems, and Acceptance and Commitment Therapy. Now it appears that mindfulness may be a powerful tool for successful dieting and the treatment of eating disorders. The preliminary research is promising enough that the National Institute of Mental Health has funded a project studying a treatment called Enhancing Mindfulness for the Prevention of Weight Regain (empower).

Psychologist Ruth Wolever, from Duke University's Center for Integrative Medicine, one of empower's developers and researchers, points out that food-related problems are inextricably tangled with issues that mindfulness addresses. People who struggle with their emotions and thoughts often externalize their psychological battles by denying themselves nourishment to starve unwelcome feelings or overeating to smother them. They often have difficulty recognizing the physical sensations of hunger or satiation, conflating them with feelings of panic, sorrow, or anger.

"Mindfulness teaches people that control can be achieved not through struggle, but through acceptance of their unwelcome emotions, thoughts, and physical cues," says Wolever. "It helps people practice identifying and experiencing emotion without reacting to it."

Mindfulness seems to produce not just a psychological realignment, but physical changes. In a study of another mindfulness-based program for binge eaters, researchers found that participants showed significant improvement in metabolizing glucose—which would affect not just weight, but cravings.

Using breathing and imagery exercises, empower teaches people the mindfulness principle of calmly, nonjudgmentally observing their thoughts, physical sensations, and feelings. People learn that thoughts don't necessarily have a basis in reality; thus, the cue "I want to eat" may not mean they're physically hungry. They learn to notice, explore, and sit with their urges, not to fight or deny them. If the urge to eat feels like a hollowness in the stomach, for example, they allow themselves to explore it. Is the hollowness localized? Does it expand and contract? They may then breathe into the hollowness until they feel full.

Clients learn to focus on taste, too. In one exercise, a single Hershey's Kiss serves as a 10-minute study. They look at it, smell it, and let it melt in their mouths, noticing which parts of their mouths and palates experience which kinds of taste, following what happens as the chocolate goes down their throats and into their stomachs.

When people eat with mindfulness, food becomes a direct experience of pleasure, sensation, and enhanced awareness, not a substitute for other issues. Clients learn to identify their true needs and address them directly. Are they hungry for food or for something else? If something else, how can they get it?

In today's world of competing needs and interests, says Wolever, "mindfulness is a way to anchor people to what they really want. It helps them feel genuinely empowered."

Resources

Electronic Records: American Medical News (May 18, 2009) www.ama-assn.org/amednews/2009/05/18/bica0518.htm. Dreams: Psychotherapy Research 19, no. 1 (January 2009): 81-95. Political Arguments: Science 321 (September 2008): 1667-69. Mindful Eating: "Mindfulness-Based Approaches to Eating Disorders," in Clinical Handbook of Mindfulness, New York: Springer, 2009, 259-87.