During my internship after graduate school, I worked as therapist at an intensive out-patient eating disorder (ED) clinic. One of the patients, Amber, was a slender 32-year-old with a long history of bulimia, alcoholism, and enmeshment with her family. Amber’s main complaint was that her mother constantly dismissed her feelings and experiences. This was not just a deep wound, but a trigger for Amber to practice her symptoms.
One cloudy, wintry afternoon I found myself in my cramped office, facing both Amber and her mother. When Amber, having finally gathered her courage, shared how devalued she felt by her mother, the mother straightened up in her chair and categorically denied ever acting that way—dismissing her daughter’s experience right before my very eyes! I was aghast. I’d just witnessed a massive pothole on my client’s road to recovery and change. In the moment, I lamely pointed out what had just happened, but that affirmation was of little consolation to Amber.
Looking back, I’ve come to see that what Amber really wanted was her mother’s unconditional acceptance and love. Her ED symptoms were a call for her mother to change, albeit one that went unheard. But over time, Amber’s sense of identity had become strongly fused with her ED. She more than once said to me, “Who would I be without it?”
While that experience happened early in my career, I’ve since repeatedly heard the refrain “Who would I be without my (anxiety, depression, etc., fill in the blank)?” Sometimes it’s subtle, other times explicit. Either way, I know that while clients express a need for change, a deep fear of tearing down a well-crafted, life-long identity still exists. This is why I often call the identity—the ‘I’ ‘me’ ‘my’ and ‘mine’—the Wizard of I, the voice that fragments the wholeness of our present moment experiences into little pieces of good, bad, right, and wrong.
So how can we stealthily get clients to change without knowing it? I know that sounds like one of those “how do you change a lightbulb” jokes, but it’s worth considering, and may not be as daunting as it sounds.
Present Moment Awareness as Stealthy Change
The movement in therapy nowadays is toward an integrative approach, bringing together mind and body practices. That’s a good thing, because understanding the experience of wholeness and integration helps us know when we’re getting too stressed, out of the body, or stuck in unproductive thought. This is why the experience of being present in the here and now is so important in therapy and is being applied in various ways across all client populations. Mindfulness-Based Exposure Therapy, for example, is being used with combat vets, who are taught to move their awareness away from rumination and back to the present moment, where they can recognize that they’re safe and respond to what’s happening right around them.
Whether clients recognize it or not, learning to get in the present moment strengthens the prefrontal cortex, or what I call the Reflect and Relate Module of the brain. In other words, helping them practice presence stealthily rebuilds the pause, think, and respond circuitry of the brain, as opposed to the react circuitry of the stress system. Here are three easy-to-use practices for getting clients started:
Savor an In-Between Moment. Have you ever noticed how easy it is to lose sight of what’s happening right here, right now in your own “backyard”? The practice of noticing the in-between helps clients to pause, come back to the moment, and steep themselves in the here and now. I’ll forever remember the time when a client with acute depression shared a simple but profound moment after we’d discussed his practicing this in session. “I heard a bird chirp,” he said, adding, “That reminded me of springtime, and it gave me hope.” Clients can journal these “little, ordinary moments” to start. Make sure that they share those moments with you and others. In this way, they’re not only reflecting, but relating these little moments. By Reflecting and Relating together, the brain will more strongly encode these memories—and value them as precious moments that make up a life well lived!
Find One Pleasant Thing in the Here and Now. The practice of noting pleasantness can help shift clients out of negativity and toward joy. Often, I begin by asking clients to find one pleasant thing in my office. This can be a color (ask them to find their favorite color), an object, a sound, or even a shape. Before leaving my office, I instruct them to find one more pleasant thing outside. Then, with each threshold they step over (into a new room or space), I ask them to find yet one more pleasant thing. This is stealthy repetition that rewires the brain and trains them to get out of the head and into the here and now moment!
Share Your “Strength” with Another. There’s a mountain of research showing how strength-based therapy can reduce depression and even enhances one’s own identity as a socially caring contributor. One strengths intervention, for example, has clients use their top strength one time a day for an entire week. The next week, individuals put another of their key strengths into action—again once a day for a week. This was shown to be an effective tool for increasing affect and reducing depression. If you’re interested, clients can assess their 24 top character strengths here.
These are just a few of my favorite stealth methods for creating change. And you never have to use that scary six-letter word.
Donald Altman, MA, LPC, is a psychotherapist, award-winning writer and former Buddhist monk. He is also a faculty member of the Interpersonal Neurobiology program at Portland State University and teaches various classes blending mindfulness and Interpersonal Neurobiology. A prolific writer whose career spans more than 25 years, Donald has authored several pioneering books on mindfulness, beginning with Art of the Inner Meal. (HarperOne, 1999). His book, The Mindfulness Code (New World Library, 2010) was named as “One of the Best Spiritual Books of 2010.” He has also authored The Mindfulness Toolbox for Relationships: 50 Practical Tips, Tools & Handouts for Building Compassionate Connections (PESI, 2018), Stay Mindful & Color: Find Calm, Clarity and Happiness (PESI, 2016), and many more. Donald works extensively with mindful meditation in his own life, as well as offering these tools to others through his books and classes. He teaches mindfulness and spiritual values around the country.