Gestalt Therapy: Yesterday and Today by Nina Bingham

This article is a theoretical analysis of Gestalt Therapy. It is an attempt to infuse 70 years of theory into a glimpse of the origin, philosophy, interventions, and limitations of the theory.  I will also comment briefly on why Gestalt Therapy appeals to me.

     In 1947 a psychoanalytically trained German psychiatrist working in South Africa wrote, “Ego, Hunger and Aggression.” It was Dr. Frederick (Fritz) Solomon Perls’ philosophical “maiden voyage,"  making a sharp departure from orthodox psychoanalysis to a never-before heard-of therapy in America called Gestalt. Dr. Perls dissatisfaction with Freud’s psychoanalytic system awakened after he studied the writings of pioneer German Gestalt founders Kohler, Wertheimer and Koffka. Said Perls, “While I was living entirely in the psychoanalytical atmosphere I could not appreciate that the great opposition to Freud’s theories might have some justification. We used to brush aside any doubt as “resistance.” But in his later years Freud himself became skeptical as to whether a psychoanalysis could ever be finished” (Perls, 1947, p.81). Perl’s first book disputed many classical psychoanalytic concepts such as the death instinct, while elaborating on others such as defense mechanisms. Perls' book introduced the concepts of the purpose of human aggression and the hunger instinct. However, it wasn’t until 1951 when Gestalt Therapy had its debut in America to an enthusiastic audience.

  

    In 1951 Perls, Hefferline and Goodman published, “Gestalt Therapy: Excitement and Growth in the Human Personality.” Hefferline was a Harvard psychology professor, and Goodman was a talented psychology writer and social critic. During the 1960’s and 1970’s Gestalt caught on like wildfire, as Dr. Perls taught groups which flocked to his Esalan Institute in Big Sir, California. American audiences were hungry for a less formal and more egalitarian approach than psychoanalysis offered, and Perls’ commanding, direct style and showmanship became a sensation. What about Gestalt Therapy was so revolutionary, new and appealing?

    
    As opposed to psychoanalysis where the therapist was out of the line of sight during therapy, Gestalt Therapists faced the client square-on. While psychoanalysis interpreted the symbolism of client’s dreams and defensive resistances, Gestalt asked the client to collaboratively investigate resistances, and be responsible for role-playing each dream character. Dr. Perls believed that to interpret for the patient was a therapeutic error; this philosophy was in sharp contrast to Freudian psychoanalysis, which interpreted everything for the client. What was the objective of Gestalt Therapy?

   
    Dr. Perls believed that maturation was the goal of psychotherapeutics, and his definition of maturation was: “The transcendence from environmental support to self-support” (Perls, 1969, p. 28). Perls would purposefully frustrate the patient because, “Without frustration there is no need, no reason to mobilize your resources, to discover that you might be able to do something on your own, and in order not to be frustrated, which is a pretty painful experience, the child learns to manipulate the environment” (Perls, 1969, p. 32). Perls staunchly believed, “Every time you refuse to answer a question, you help the other person to develop his own resources” (Perls, 1969, p. 36). Even when patients insisted they did not have the strength or answers (what Perls called “the impasse”), Perls would insist, “…these fantasizes prevent us from taking the reasonable risks which are part and parcel of growing and living” (Perls, 1969, p. 39). Gestalt directly challenges the client to take responsibility for his behavior, which is why Gestalt is considered an Existentialist therapy. Gestalt is also a Humanistic therapy, because it believes in the individual’s power to self-actualize. Perls emphasized that human nature has an inherent wisdom; that of organismic self-regulation. “With full awareness you become aware of this organismic self-regulation, you can let the organism take over without interfering…and I believe this is the great thing to be understood-awareness by and of itself-can be curative” (Perls, 1969, p. 17). Gestalt strives to increase the client’s self-awareness, believing that self-insight is the key ingredient to change and growth in the personality. What does Gestalt Therapy consider to be pathological?

    
    Freud labeled defense mechanisms as pathological, and Gestalt Therapy expounded on a few of Freud’s mechanisms, namely: neurosis, projection and transference. Dr. Perls introduced the emotional defense mechanisms of: avoidance, introjection and retroflexion, the polarities of aggression and self-expression, and how paranoia and projection are interwoven (Perls, 1947). Gestalt views psychopathology as a failure of the organism to be self-aware; that it may function, but with a scotoma, or blind spot (Perls, 1947, p. 236). How does the Gestalt Therapist enable the client to become more self-aware?

    
    An adept Gestaltist is able to reflect the client’s attitudes and beliefs like a mirror. The client can then look and sees himself more clearly. A Gestalt Therapist extensively discusses the client’s contact boundary, and the subject of polarities, asking the client to consider: are his boundaries rigid or loose? Is he isolated or confluent? Does the client polarize issues by catastrophizing, or its opposite: avoiding, denying or ignoring the problems? Gestaltists will regularly utilize experiments, or Gestalt techniques during therapy, the most renown of these being the “Empty Chair Technique,” where two polarized opinions of the clients are each role played by the client in succession. Gestaltists will also carefully monitor the client for indirect body language which are unconscious expressions of emotion. They may direct the client to exaggerate or repeat body language to give the symbolic gesture a “voice.” They will ask clients to describe dreams, and to play all the parts in the dream, giving the dream characters and items a “voice.” Dr. Perls believed every character and item in the dream is a “part” of the client, and every dream has an existential message or meaning. Gestalt Therapists may ask clients to repeat phrases for emphasis during therapy which are meaningful, and are not afraid to lead the client to a catharsis point. What are the limitations of the theory?

    
    Because Gestalt Therapy can be an intense and deeply cathartic experience, clients may experience abreactions in counseling. A strong reaction could cause some clients to withdraw prematurely from counseling. In order to mitigate this experience, I’ve learned it is important to allow time for the client to “debrief” after a particularly emotionally-charged session. Clients need an opportunity to share with the therapist what they experienced, how they intend to integrate what they learned into their lives, and to clarify unanswered questions. It is up to the counselor to provide a smooth transition from deconstruction to construction. Are there cultural limitations?

    
    From a cultural perspective, Gestalt Therapy may not be the therapy of choice for individuals from collectivist societies who are more private and reflective in nature. Gestalt encourages free outward expression of thoughts and feelings; the client is encouraged to share fears, anger and insecurities. Members of collectivist cultures which might not be accustomed to expressing anger or fear openly could be misjudged by a Gestalt therapist as withholding or resistive, unless the counselor is culturally sensitive. If the counselor understands the client’s cultural perspective, she can adapt the therapeutic approach to the client, rather than demanding the client adapt to the approach. What is on the horizon for Gestalt Therapy?

    
    Relational Gestalt Therapy is the most modern branch of Gestalt, and what I aim to practice. It has modified Dr. Perls’ abrasive style so that it is more “user-friendly” for people of all cultural backgrounds. Although Dr. Perls teachings did not focus as much on the client-counselor contact boundary as it might of, Perls admitted to its importance: “The We doesn’t exist, but consists of I and You, and is an ever-changing boundary where two people meet. And when we meet there, then I change and You change, through the process of encountering each other…” (Hycner, Jacobs, 1995, Introduction). Contemporary Relational Gestalt Therapy is dialogical and inter-relating, and what is hoped for is that it is more relational-focused than the technique-oriented Gestalt Therapy of the past. Co-founder of Gestalt Therapy, Dr. Laura Perls said about the development of Relational Gestalt, “With the gift of hindsight, Martin Buber’s philosophy of I-Thou seems the perfect antidote to the narcissistic flavor that infused Perls, Hoffman, and Goodman’s portrayal of the organism/environment field paradigm” (Hycner, Jacobs, 1995, Introduction). Based upon philosopher Martin Buber’s emphasis on the “I-Thou” relationship (Buber, M., 1958), a new generation of Gestalt Therapists are practicing warmly and sensitively, seeing dialogics as the ground upon which to find a cure rather than techniques.  Why do I feel Gestalt is a good fit for me?

   
    In the time I have practiced I have come to see one thing very clearly, and it is that the most dynamic force in therapy is not a set of techniques, or even a philosophy of practice. As Buber states: “In the beginning is relation” (Buber, 1958, p. 18). The dynamics of the therapist-client relationship, or "I-Thou" relationship is the primary defining element of success or failure. “The I-Thou experience is one of being fully present as one can to another with little self-centered purpose or goal in mind. It is an experience of appreciating the “otherness,” the uniqueness, and the wholeness of another, while at the same time this is reciprocated by the other person. It is a mutual experience” (Hycner, Jacobs, 1995, p. 8). However, I’ve also found that a set of time-tested techniques is helpful in the process of therapy, and having a clear philosophy of practice allows the therapist to structure the session cohesively. Relational Gestalt is a fascinating blend of dialogue and technique, and is well suited to my extroverted personality. I may not have the daring flair of Dr. Perls, but I do enjoy seeing what comes of a spontaneously created experiment, and the results of a technique like the “Empty Chair.” My personality is direct enough to confidently lead clients through an intervention, even if I may not know exactly what the outcome will be. Sometimes I’m unsure about where we will land…but I am working into being comfortable with the uncertainty which is Relational Gestalt Therapy. I’m no longer bound to a set of techniques, because I’m making it a priority to build a relationship with the client before me. I’m learning that the most powerful ingredient in the therapeutic relationship is what we create together, the therapeutic bond. The German world Gestalt is translated to mean, “An integrated whole.” With the emphasis being placed on relationship rather than techniques, I feel Relational Gestalt Therapy is becoming more of an integrated whole than ever before.

References:

Perls, Frederick, S. (1947). Ego, Hunger and Aggression: The Beginning of Gestalt Therapy. Vintage Books, A Division of Random House, New York.

Perls, Frederick, S., Hefferline, Ralph., Goodman, Paul. (1951). Gestalt Therapy: Excitement and Growth in the Human Personality. The Gestalt Journal Press, Inc.  

Perls, Frederick, S. (1969). Gestalt Therapy Verbatim. Real People Press, Lafayette, California.

The Counseling Dance by Nina Bingham

    Counseling is a little like couple's dancing: two people are endeavoring to link up and learn to step together. In this endeavor, every therapist walks a fine line with her client of knowing when to lead, and when to follow. I'm seeing it depends upon the client's personality. Some clients appreciate the unconditional positive regard and empathetic listening skills of a receptive counselor, while others crave a more assertive, solution-focused and goal-oriented approach. For a personality like mine which is direct and expressive, being completely non-directive or "Person-Centered" in approach (Rogers, 1942), doesn't come naturally. For me, learning to "follow" the client's lead is a learned skill. It takes a great deal of restraint on my part not to "dash off" in dialogue towards the "obvious" solution, and to allow the client to discover the answers in her way, in her own time; to allow an organic process of self-discovery to unfold for the client. An ancient Chinese proverb says, "Give a man a fish, and he eats for a day. Teach a man to fish, and he eats for a lifetime." As an expressive and extroverted personality, I'd be just as happy handing the "fish" to the client as teaching her how to fish for herself. However, as this Chinese proverb teaches, if the client discovers for herself how to fish, she will have learned a skill which will serve her well the rest of her life. And, some clients will benefit by the ego-strengthening which comes by leading the therapist. So as a therapist, how do you know when to lead, and when to follow?
 
    I admit that I still struggle to understand how much help is too much. Many clients come to counseling to find their own unique voice in the world. How can they exercise their will if they don't speak it in the safe confines of the counseling room? Therefore, some clients are not helped by directive counseling, and would benefit by a receptive counseling approach, such as Person-Centered Therapy. And yet it is the client low in self-esteem, ego strength and identity who appear to need the most direction. Many will present as "lost souls," having been blown off-course, and seemingly directionless. A therapist's first instinct will be to "rescue" the "drowning" person. Yet if Rogers was correct that all people have an "actualization tendency," which is the potentiality to be self-directed, the therapist should only act as the environment that the client "pings" off of, in order that she may make her way in the darkness. It was Gestalt Therapy's co-founder Laura Perls who wisely advised, "Give the client the least amount of support necessary for growth." According to Roger's theory, "The client centered-therapist does not intend to diagnose, create treatment plans, strategize, or employ treatment techniques" (Corey, 2009, p. 171). However, in times of crisis, the Person-Centered therapist makes suggestions, offers guidance, and even direction might be called for if clients are not able to function effectively (Corey, 2009, p. 179). If a client's mental illness has incapacitated their ability to navigate, that client will benefit from a directive approach from the healthcare provider. For them, the provider becomes their "port in the storm."

    How to assess whether the client would benefit from a receptive approach or a directive approach can be based on the client's reaction to the therapist's attempts at intervention. I think of a client I had who became defensive, suspicious,  and perturbed when I attempted even the slightest of experiments. She scoffed at my attempts to introduce even small interventions into the dialogue. When I brought this to her attention, she would again retreat into defensive postures. It was as if she was daring me to "get through to her." What I learned from this "resistive" client was quite important for my growth as a therapist. I learned that some clients have a high need to be "heard," and to direct the operation. She had a low tolerance for others  opinions, and a high opinion of her own. Gestalt Therapy's Dr. Fritz Perls would have referred to her as a "closed system." And yet, she had presented in therapy. Perls used to refuse to work with these sorts of "difficult" clients. However, perhaps the therapist should give the client what they are asking for...what they can assimilate, rather than what we wish they could assimilate! If a baby isn't ready for table food, we don't demand he eat it anyway. Instead, we spoon-feed the baby, until such a time when they develop a tolerance for adult food. With no insult intended, there will be clients who are not ready or able to assimilate the interventions the counselor would like to make. Should counselors be willing to work with this kind of emotionally immature client? Moving slowly, cautiously and tentatively will require great patience from the counselor, and he will need to abandon his "agenda." All his great skill, techniques and experiments will have to be put away, and what he has left to work with is simply himself, his personality, and his ability to empathize, to understand, and to confirm the client. He is stripped of his therapeutic "armor," and left standing in what sometimes feels like his undershorts! Then, he will be asked to follow rather than lead. He will have to find a way to "check" his ego, so that the client can shine. For an extrovert who doesn't enjoy dancing in the first place, taking my cues from the client (in my underwear) is uncomfortable business. And this is why I believe Dr. Perls wouldn't work with resistive clients; he wasn't accustomed to "following." But for some clients, this may be the best they can do to make contact.

    Contact is a strange thing. Too much of it and it causes repulsion. Too little, and longing for contact sets in. Most clients struggle with making contact with the therapist. I watch clients talk to the wall, the ceiling and their feet to avoid making contact with me, to avoid "being seen," as it were. They are avoiding my reactions and expressions. What they are "tuned into" is their inner world. The client who struggles to make eye contact in therapy is lost internally. They have disengaged with the environment, and lost touch. They have withdrawn. They do this to protect themselves. Hyper-verbal clients use words as a shield to keep others from seeing them; almost as if they keep talking you will be distracted and not notice them. Both methods of avoidance are ways of retreating from contact. When there are obvious signs of contact boundary problems, the person has often been the victim of abuse or neglect. They may have survived boundary violations but consequently, these violations served to breakdown healthy contact with others. In simplest terms, "getting too close to the fire" frightens these skiddish, ego-fragile individuals. The hope is that through a process of unconditional positive regard in therapy, the client learns it is safe again to trust the therapist with feelings.

    It takes a large portion of academic skill and humanistic sensitivity to become an integrated, whole of a counselor. In fact, I can see I'll be working the rest of my life on it. I'm finding that what may feel like modest gains for me may feel like milestones for clients. When I see them progress, I know that in a sense, I have, too. I'm learning as much about this dance as they are. I'm learning how to establish contact in the counseling room, and so are they. This is a collaborative journey. Sometimes I'm not real sure where we're headed, and in those moments of blind faith in their ability to grow, and in my ability to catch them if they slip, I'm learning to relax my grip and let the client lead. Sure enough, they don't disappoint. They pick up the dialogue and we're off again exploring from a different angle. The longer I do this, the more I'm willing to set aside my my theoretical learning and to discover how to dance with the unique and sometimes puzzling individual before me. Clients don't "fit" perfectly into the "boxes" or diagnostic labels psychology has given them; these are real human beings before me, with real lives, and their challenges are about as diverse as they are. I'm learning to "toss aside" the way the books say it should be done in favor of whats happening; my hypothesizing and theorizing is lost in trade for exploring with the being before me. This "being with" is what Relational Gestalt Therapy refers to as the "between" which is created in the space of two people trying to relate to one another. And this is the magic of the therapeutic relationship! It is in the relational, dialogical interactions that the bond is formed. This bond is therapeutic, and is the goal of humanistic therapy. When I am attending to the person rather than to the problem, then I am in a position of effecting the healing work which is psychotherapuetics. This is what I've trained for! I am finding there is wisdom in waiting to be asked to dance.

References:
Rogers, C.R. (1942).  Counseling and psychotherapy. Boston: Houghton Mifflin.

Corey, G. (2009). Theory and Practice of Counseling and Psychotherapy. Eighth Edition. BROOKS/COLE CENGAGE LEARNING.

Saving Face: How Chinese Mental Health Care Is Evolving by Nina Bingham

Saving Face: How Chinese Mental Health Care Is Evolving

    This article will address how Chinese and Chinese Americans have been under served in mental healthcare. Stigma, shame and feelings of having to “save face” for both Chinese, and Chinese Americans regarding individual and familial mental illness originates in ancient Confucianism, and therefore, Chinese are less apt to seek mental health treatment. Traditionally, Chinese absolve themselves of mental illness symptoms by somatic symptoms which “explain” their illness. This paper will show how culturally sensitive systems can improve mental health delivery to this cultural group, reducing the stigma of mental illness, thereby  evolving from shame to “saving face” for mentally ill Chinese, and Chinese Americans.

    To say that Chinese, and Chinese Americans have been an under served population in mental healthcare, and delay seeking treatment, is an understatement. “The majority of Asian Americans (even though all met criteria for a psychiatric disorder) did not use specialty mental health services. However, the rate of mental health service use by U.S.-born Individuals were almost twice that of immigrant Asian Americans. This is consistent with Abe-Kim et. al (2007) who also found that U.S.-born individuals used mental health services at higher rates than immigrants” (Le Meyer, O., Zane, N., Cho, Y. I., Takeuchi, D.T., 2009). However, this does not mean Asians do not need mental health care services. “Lower utilization rates and delay in accessing Western health services contributes to Asian Americans exhibiting more serious mental disorders when treatment is ensued” (Flaskeruddltu, 1992; Yeh et al., 2002). What are some of the issues which keep Chinese and Chinese Americans from seeking mental health care? 

    Chinese present stress somatically as compared to Individualistic cultures. They view physiological complaints as due to the external environment; what might be termed, “externally oriented thinking” (Heine, S.J., Bagby, R.M., 2008). Why would the Chinese express psychopathology as somatization? The Chinese language itself is not conducive to emotional expression.  Leff, 1981, argued that, “Chinese somatization results from a lack of well-developed emotional vocabulary in the Chinese language-Chinese individuals, lacking necessary words, resort to somatic symptoms mainly. Mainly Chinese words which are terms for emotional expression are rooted in the body, so Chinese respondents use somatica when asked to express emotionally” (Tung, 1994). A survey of Chinese immigrants reported seeking counseling for somatic symptoms while Chinese Americans reported psychological symptoms” (Yen, Robins, and Lin, 2000). “Commonly reported somatic symptoms were: headaches (90%), insomnia (78%), dizziness (73%), pain (49%) and depressed mood only 9%” (Ryder, A.G., Yang, J., Zhu, X., Yoa, S., Yi, J., Heine, S.J., Bagby, R.M., 2002).      

    Another factor in keeping Chinese from mental health care services has been social conditioning by ancestry to conceptualize mental illness as a “loss of face and shameful” (Zane & Yeh, 2002), and as a stigma. “A psychiatric stigma is a sense of spoiled identity, which motivates individuals to avoid psychological classification” (Goffman, 1963).  The word “face” in Chinese is “mientz,” and is a powerful social concept among Asians, meaning a concern over public image which represents both the individual, and her family’s social class. In Collectivist cultures like China, etiology of mental illness is considered social or due to personal weakness, while Western culture attributes mental illness to genetic predisposition, brain and nervous system and environment factors (Mallinokrodt, Shigeoka, & Suzuki, 2005).  “Desiring to “save face” can “inhibit emotional expression and help-seeking behaviors among Asians and Asian Americans” (Mak & Chen, 2006).  However, for Chinese Americans, the more acculturated they become, the more help-seeking they become (Atkinson & Gim, 1989; Tata & Leong, 1994;  Zhang & Dixon, 2003).      
 
    American health providers must understand Chinese society and their attitudes about what it means to be a Chinese person before they can provide culturally-sensitive care for Chinese mentally ill and their families. “Personal identity is judged on how one behaves according to one’s relation to the group” (Chan, S., 2008). Therefore, “Chinese people pay great attention to relationships with others, especially family members” (Hwang, 2000). In Chinese culture, family is perceived as the “great self” (Bedford & Hwang, 2003). “A Chinese individual feels obligated to do whatever it takes to maintain a well-functioning family. This is in contrast to Western Individualism which emphasizes an individual’s autonomy” (Sing et al., 1962, Tarwarther, 1966). For example, “Chinese children are brought up to pay great concern to their own families honor and reputation” (Ji et al., 2001). In China, to be a person is to, “…fit an individual’s external behavior to the interpersonal standards of the society and culture” (Chan, S., 2008). Therefore, “loss of face” (through mental illness) not only reflects on the individual patient, but also on the families and their ancestors (King & Bond, 1985). Additionally, “Traditional Chinese culture places value on self-restraint, suppressing and controlling emotions, and places little value or concern for them” (Tracey, Leong & Glidden, 1986).      
 
    Beneath these Chinese ideas of personhood is the religious philosophy of Confucius, upon which China has rested since 551–478 BC. Confucianism defines five types of relationships:
1. Sovereign and subordinate 2. Father and son 3. Husband and wife 4. Elder brother and younger
5. Friends. It also defines the guiding behaviors for these roles. “Individuals who act outside of the roles are seen as trouble-makers” (Hwang, 1978). Failure to fulfill your given Confucian role results in guilt and shame to that person. A Chinese person who is mentally ill may be prohibited from fulfilling their familial and societal role due to their symptoms, and to avoid this loss of role “Chinese families will go to great lengths to avoid the label of mental illness and it’s stigmatization effects” (Yang, Lawrence H., Phelan, Jo C., Link, Bruce G., 2008). Yet, however taboo mental illness has been in Chinese society, depression and suicidal ideation has exponentially been on the rise among young Chinese women and men over the age of 60 (Jianlin, J., 2000). The rise in mental illness among these two groups is understandable if you are aware of the Chinese socialization process for women and the elderly. “Chinese women, in particular, suppress emotion of suffering and anger. This suppression of emotions leaves them vulnerable to suicide” (Pearson et al., 2002). Regarding the rise in Chinese elder  mental illness rates, “We found that age differences in the effect of social exchanges apply only  to depressed affect, not to life satisfaction. One reason may be that life satisfaction is a relatively  stable construct that involves a global evaluation of life, whereas depressed affect is a mood state  that tends to be transient and to respond more quickly to social stimuli” (Lydia W. L. and  Liang,  J., 1991). Since 1991, economic reform has been in full swing, and with it, familial demographics have changed: “Similar to many developed nations, the Chinese population is
 aging rapidly (Kinsella & Velkoff, 2001). Family has been the primary institution for supporting  older people in Chinese society. Confucian teaching emphasizes that children should take care of  their parents (Leung, 1997). The lack of pensions and formal services in China also leaves many  older persons no choice but to depend on their families (Gu & Liang, 1994). While the economic  reform since 1978 has led to rapid economic growth, the Chinese government has not increased  public support in old age (Hsiao & Liu, 1996; Jackson & Howe, 2004). Meanwhile, Chinese  families are under stress to care for their older relatives as a result of increasing migration to  cities for jobs, an erosion of traditional status of older persons, and a disintegration of communal  systems in the countryside (Leung, 1997; Jackson & Howe, 2004). It is easy to surmise why, as  children leave the family to migrate to the cities, traditional honor for the aged is on the decline,  and generations of cohabitating families are no longer the norm, that Chinese elders are  experiencing depression in record numbers. “Verbal abuse was frequently associated with  depression amongst Chinese people” (Zhang et al., 1997), and, “…patient’s psychological  distress emerged when the patients did not receive family member’s support” (Phillips and  Pearson, 1997).
 
    Clearly, the clinical goal is to provide culturally-acceptable means by which Chinese  and Chinese-Americans can utilize more mental health services without experiencing a “loss of  face.” This goal can be accomplished by utilizing three interventions :

1. Public service media campaigns which psychoeducate the Chinese public should  advertise “respectable” methods of accessing mental health services for Asians, and  publicize that these services are being underutilized.
2. More culturally-sensitive health care professionals must be willing to  psycho educate their Asian patients (such as traditional community healers, and  primary healthcare providers) that there is no shame in seeking mental health  services, and encourage patients to do so if needed.
3. Lastly, Chinese and Chinese Americans need culturally sympathetic caregivers  who can recognize, accept, and display empathy for their patient’s cultural values and  beliefs.
“Therapy which aims to understand the impact of Chinese cultural values, interpersonal  conflicts, and on the sense of guilt and shame may need to be provided for Chinese patients and  their family members” (Carson, 2000).  Ways of “Saving Face” which “bridge the gap” in public  between East and West could include integrating mental health services with primary care, “so  individuals can access mental health care without explicitly seeking mental health services”  (Fang & Chen, 2004; Yeung et al., 2004). Another covert way of offering mental health services  to university students is to integrate mental health into the already established student health  services (Constantine, Chen & Ceesay, 1997).
 
    In Shanghi, China in 1994, in a period of 2 years, 8, 214 callers utilized an anonymous “Telephone Hotline to discuss and resolve problems” (Seeley, 1994). “Of these callers, 57%  called to seek help with marriage disputes, 51% called due to troubled love affairs, 3.5%  requested intervention for psychosis, 3.2% called to seek help with sleep disturbances, and 2.2%  called with suicidal ideation. Since that time, 26 Mental Health Hotlines in Shanghai have been  established. They are cost-effective, easy to contact, and anonymous, protecting the caller’s  privacy. In addition to the above, callers discussed the following psychological problems:  Emotional problems (anxiety and depression): 12.4%, Interpersonal Disputes-10.3%, Marital  Problems-9.1%, Health Problems-8.5%, Occupational Problems-8.3%, Family Disputes-5%, and  Sexual Problems-4.8%, Study Difficulties-4.3%, Psychosis-3.5%, Sleep Disturbances-3.2%,  Education and Child Care Concerns-3%, and Self-Harm- 2.1%” (Jianlin, J., 1995).  These  Hotlines are telling the whole story: Chinese and Chinese Americans are suffering in silence. In a  shocking example, “In the country of Tibet, no psychiatrist or special mental healthcare services  are available” (Jianlin, J., 1995). 
 
    Though it may seem like an impossible challenge to meet the mental health needs of the  Chinese, given the traditional view of “saving face,” transforming China’s Mental Health System  has been addressed by The “National Mental Health Project of China: 2002-2010.” With  depression and suicide rates rising every year, an estimated 16 million Chinese are already in  need of mental health services. 21% of the world’s population is Chinese, and 25% of the  world’s suicide rates are Chinese. The Chinese Ministry of Health, Civil Affairs, Public Security  and Disabled People’s Federation have agreed that China must “raise awareness of China’s  mental health needs and treat mental illness” (Jianlin, J., 1995).  The National Mental Health  Project of China 2002-2010 recognized this and called for Community-Based Services in place  of hospital care” (Kelly, T.A., 2002). The reality is that within the Chinese healthcare system  “There are no social workers and few clinical psychologists working. Most clinical work and  social or community service for mental patients are conducted by senior psychiatric nurses  trained in short courses” (Jianlin, J., 2000). Obviously, there is a higher need for trained  mental health clinicians who can work successfully with Chinese and Chinese American  mentally ill, and their families. “Some examples of the problems that two cultures can pose in  clinical care include the issue of maintaining confidentiality regarding the illness, and how to  interpret the high involvement that Chinese families have in the treatment process. What  Western Individualism would say is confidential communication, Chinese collectivism would  integrally involve the family in such communication” (Hsiao, F.H., Klimidis, S., Minas, H., and  Tan, E.S., 2006).
 
    As mental health care evolves, what can the American mental health model contribute to the  Chinese Collectivist tradition of keeping it “all in the family?” “America has relied on  institutionalization but is finally beginning to move towards community-based  services,” said Dr. T.A. Kelly, a speaker at the 2005 Pan Asian Pacific Conference on Mental  Health, in Shanghi. “By community-based we mean providing flexible services in the home and  community rather than forcing people into brief hospitalizations too often followed by discharge  to inadequate care. The ultimate goal is recovery (as opposed to dependence on mental health  care systems). This would allow people with serious mental illnesses to have a real job, a stable  home, and fulfilling relationships.” Understanding the cultural values and beliefs of the Chinese  as I do now, to isolate a Chinese person from his family in an institution with a formal label of  seriously mentally ill could be crushing to that person’s self-esteem , self-worth and identity, and  devastating to his family as well. However, caring for him at home without any clinical guidance  or supervision is neither safe nor the most effective for recovery. “China would do well not to  replicate the institutionalization of American psychiatric care, but rather develop effective and  innovative community-based mental health-care, as China has historically benefited from strong  family and community” (Kelly, T.A., 2007). Perhaps traveling psychiatric nurses could make  discrete home visits, checking on the patient’s condition, medications and the family’s coping  and caretaking skills? Perhaps small community mental health care clinics staffed by  psychiatrists or psychiatric nurses could join holistic community practitioners such as  acupuncturists and Chinese Naturopaths where the patient could be treated and then return  home? There is an ancient Chinese proverb that says, “If you are planning for a year, sow rice; if  you are planning for a decade, plant trees; if you are planning for a lifetime, educate people.” In both China and America, the time is right to educate a host of mental health care providers   who are dedicated to learning to become sensitive to the needs of the mentally ill within their  own culture. In America, health care workers are grappling with how to serve a culturally diverse  public, and in China, families are struggling with the issue of how to provide mental healthcare  for their loved one in a society where it is not acceptable to be mentally ill. As the international  mental health care community faces these cultural challenges, we do so together, so I hope our  willingness to learn and grow from one another increases over time.

References:
Chen, Sylvia Xiaohua, Winnie W.S. Seeking Professional Help: Etiology Beliefs About
Mental Illness Across Cultures. Journal of Counseling Psychology, 0022-0167,
2008, Vol. 55, Issue 4. Print.

Jianlin, Ji. Suicide rates and mental health services in modern China. Crisis: The Journal of Crisis Intervention and Suicide Prevention, Vol 21 (3), 2000. pp. 118-121. Germany: Hogrefe & Huber Publishers, Inc. Print.

Jianlin, Ji. Hotline for Mental Health in Shanghai, China. Crisis: The Journal of Crisis Intervention and Suicide Prevention, Vol 16 (3), 1995. pp. 116-120. Germany: Hogrefe & Huber Publications. Print.

Yang, Lawrence H., Phelan, Jo C., Link, Bruce G. Stigma and beliefs of efficacy towards traditional Chinese medicine and Western Psychiatric treatment among Chinese Americans. Cultural Diversity and Ethnic Minority Psychology, Vol 14 (1), Jan. 2008 pp. 10-18. Education Publishing Foundation. Print.

Le Meyer, Oanh, Zane, Nolan, Cho, Young Il, Takeuchi, David T. Use of specialty mental health services by Asian Americans with psychiatric disorders. Journal of Consulting and Clinical Psychology, Vol 77 (5), Oct, 2009. pp. 1000-1005. Publisher: APA. Print.

Ryder, Andrew G., Yang, Jian, Zhu, Xiongzhao, Yao, Shuqiao, Yi, Jinyao, Heine, Steven J., Bagby, R. Michael. The cultural shaping of depression: Somatic symptoms in China, psychological symptoms in North America. Journal of Abnormal Psychology, Vol 117 (2), May 2008. pp. 300-313. Publisher: APA. Print.

Leung, Angela, K.Y., Cohen, Dov. Within-and between-culture variation: Individual differences and the cultural logics of honor, face and dignity cultures. Journal of Personality and Social Psychology, Vol 100 (3), Mar, 2011. pp. 507-526. Publisher: APA. Print.

Hsiao, Fei-Hsiu; Steven;  Minas, Harry; Tan, Eng-Seong. Cultural attribution of mental health suffering in Chinese societies: The views of Chinese patients with mental illness and their caregivers. Journal of Clinical Nursing. Print.

Chan, Sally. Commentary on Hsiao F. H., Klimidiss, S., Minalt & Tan E.S. (2006). Cultural attribution of mental health suffering in Chinese societies: The views of Chinese patients with mental illness and their caregivers. Journal of Clinical Nursing, 15, 998-1006. United Kingdom. Wiley-Blackwell Publishing, Ltd. Print.

Kelly, Timothy A. Transforming China’s mental health system: Principles and recommendations. International Journal of Mental Health, Vol 36 (2), Sum, 2007. Special issue: Community health collaborations from Michigan to China. pp. 50-64. Print.

Domingo, G. (1982). Psychology and Psychiatry in the People’s Republic of China. An annotated bibliography. Summarizing 8 studies between 1973-1982. Print.

Research which encompasses cultural problems and solutions (Belgun, D, 1978), Chinese Schizophrenia (Bloomingdale, L.M., 1980, Hsia, Y., Tsai, N., 1981), Chinese  Somatization (Cheung, F.H., 1982, Cheung,

F.M., Lau, B.W.K., Waldman. E., 1981), Alcoholism among the Chinese (Lin, T.X., Lin D.T.C., 1982), The stigma of mental illness (Mechanic, D., Kleinman, A. (1980),Traditional Chinese Medicine) Tseng, W., (1973), Psychiatric Problems and Traditional Chinese Management (Visher, J.S., Vischer, E.B., 1979), Problems with Chinese Adolescents, Yang, K. 1981). Print.

Li, L.W., Liang, J. (2007). Social Exchanges and Subjective Well-Being Among Older Chinese: Does Age Make a Difference? Psychology and Aging Copyright 2007 by the American Psychological Association, 2007, Vol. 22, No. 2, 386–391.  Print.

Genius-Level Thinking by Nina Bingham

“Your task is not to seek for love, but merely to seek and find all the barriers within yourself that you have built against it."

Jalal ad-Din Rumi quote

Our Proximity To Greatness
Genius is the power to think originally.
Quoting others, or re-singing what's already been sung is like mining for fool's gold.
To stand outside of one's own level of thought and create is what's needed.

The dividing line between finite life and infinite afterlife is as thin as a veil.
Therefore, we can reach beyond the veil for knowledge. When we do, an answer will appear.
This is the process of prayer. The seeker asks the Sovereign for enlightenment. The answer is born in the mind of the seeker, and genius cracks it's whip again.

How close are we to the answers we seek? Living in a state of perpetual possibilities, we are in the epicenter of knowledge. How, in the lap of infinite mind, can we claim we have lost our creativity? If Divine Mind knows you exist and you suspect It exists, what is preventing you from receiving It's unlimited resources: happiness, health, peace, prosperity, creativity and love?

Imagine sitting on a bus, and the seat next to you is empty. Imagine a wise elder standing because there are no seats left on the bus (except next to you, of course). You move your bags, and invite the elder to take a seat beside you. You wonder why the elder didn't ask you to move your things so they could sit down. Then you realize they would rather be invited. This elder only goes where they are welcome. Divine Mind is like that; it waits for an invitation.

The Cover Up
JK Knight (Ramtha) said it is the "peeling off of layers," which is our work if we want to get to the genuine self. It is not that we must add knowledge; instead, we must uncover and lay bear our intrinsic beauty. Like protective padding, I can shed others ideas of who I "should be" for the unique soul I am. Once I have beheld my own worth and am secure in that, I'm empowered, even if for a short while, to believe that I am capable, and I can be at peace. Tranquility is the absence of anxiety (if only temporarily). What would it be like to live in the bliss of the sea of tranquility every day of your life? Spiritual masters say it is the way we were meant to live. We know they transcended daily stress, anxiety and fear to remain peaceful and compassionate in the midst of adversity. How do we ourselves rise to this level of spiritual awakening, and more importantly, how do we sustain it?

It is identity problems which are the problem humans most suffer from. I see this in my counseling practice on a daily basis. The soul struggles to transform and as it does, it's reality is shaken. More like, it's self-concept is shaken. If the growth of the individual can be imagined or visualized, conceived of, the  individual can entertain the possibility that the goal could become reality. However, if the goal seems improbable, many people disqualify themselves, because they haven't been able to imagine themselves living in that reality. In effect, they haven't entertained it in their thoughts, so they feel unprepared to speak about it in the world of possibility. However, these "undreamed" dreams are what have been calling to them. If they want to be anything other than the limited collection of introjections they've been handed by their heritage and culture, they must hault the cover-up.

Cause and Effect
Causes are etiological, the root of action. Any cause is concerned with epistemology; that which investigates the nature of knowledge. Cause acts upon; it is pro-active. Conversely, effect is acted upon, it's nature is receptive. If the sun shines, the pedals open, and if the rain falls, the pedals close. An effect is the recipient of a cause. In every circumstance of life you must know what effect you are having, and aim to have the maximum positive effect you can. In this way you will contribute what you alone can contribute to universal good. You also want to be a cause in the world; a change-agent for good. Action is that which ultimately separates a cause from an effect. It is not until one takes action that a reaction can occur (and reaction is an effect). Our actions, or behaviors, are what ultimately define a human's life. In the end we are defined and evaluated by the action we took in life (or failed to take).

In Sum
To uncover our greatness, and by greatness I mean our ability to access genius-level thinking, we must not disqualify ourselves simply because we have never imagined our lives taking this unexpected turn. We must realize unexpected events can be fortunate. "We must be willing to risk for what we want" (Matt Garrigan). The essential you is a genius mind-in-the-making, and a cause. When you come to the realization of the power you have, you will take action and behave in ways which are healthiest for you. Unhealthy choices are a direct result of denial of our own power. If we have the capacity to be influenced by an infinite wisdom, we should ask for genius-level thinking! 

Inviting Divine Mind into your life: "Divine Mind, I invite you into my heart and into my head. Into my emotions, and into my thinking. Influence me in every area of my life. Your will for me is good, and to do good. Manifest genius-level thinking today in my life." 

The Comparison Trap

The Comparison Trap by Nina Bingham

It is a senseless act to think I've suffered more than you. For what one person considers suffering, another would call a blessing. It is our selective perspective that determines our attitude about life; how we "hold" our life, whether we cherish it, or curse it. There is a distinct cross to bear in every life. A "thorn in the side," as Saint Paul deemed it. Every life has it's own share of pain and turmoil. It is futile to compare my problems to yours; we are different souls. Therefore, our challenges will be different. It is said, "What is one person's trash is another person's treasure." For example, one person can be single and hating it, while another person, recently divorced, is shouting, "Freedom at last!" What one person believes is a cross to bear can be another person's salvation. Ironic, isn't it?

Slippery Slope
Comparison is a slippery slope. The mind likes to compare; it is a simple heuristic (rule of thumb) that the brain uses to judge one thing from another. We start comparing early. By the time we are in kindergarten, we can judge between boys and girls. Between good behavior and bad (just look at the teacher's face), and that glue is good as an adhesive, but not so good to eat. We use comparison as a measurement between one thing and another. It helps us make choices. We utilize this common heuristic all the time without thinking about it. It is one of the brain's most useful reasoning tools. However, I mentioned that it can be a slippery slope, because there are times when it is better not to judge; yet our brains, which have been "wired" by the neurological pathways to compare, have difficulty not thinking this way. For example, take the issue of suffering. I may look at my circumstances, seeing clearly the cross I have to bear, and compare my circumstances with yours. I may conclude: they have an easier time of it than I do. And you may be doing the same. You may be envying my life, thinking that your cross is heavier. We slip into this deceptive game of comparison early in life, and unless we use our critical thinking skills, we can fall prey to taking the role of "done to." There are people who feel completely uninspired by life because comparison is taking all the wind out of their sails.


Keeping Up With The Joneses
Americans are the worst when it comes to gratitude. It's not that we intend to forget our blessings, but, travel to any developing country where the citizens live in poverty, and you'll be grateful upon returning to the U.S. We live in a country where life's necessities are met for the majority of Her citizens. Our nation is so developed that immigrants worldwide long to live here. The majority of Americans do not live with disease and starvation. Most of us have never gone hungry, and have never been homeless. And yet, we forget our affluence and complain. We complain because we compare. If the Joneses get a vacation, we deserve one, too. If they get a newer car, ours suddenly seems dingy. As a bumper sticker declared, "He who has the most toys wins." This is what Capitalism has come to. Yet, it is our affluence that makes us greedy, or is it that our brain likes to compare? I have known wealthy people who were generous, and I have known poor people who were greedy. I believe what makes a person generous or greedy, complaining or content, is one ingredient, and that is gratitude.

The Attitude of Gratitude
You've probably heard this analogy, but it bears repeating: "You can see the glass half empty, or the glass half full." Returning to our earlier example of the single person,  if you were able to see singleness as a blessing instead of a curse, you would be able to make the most of your singleness. You would celebrate your freedom. You would focus on the positives. You would feel grateful instead of griping about what you don't have. We can get so problem-focused, so problem-centered, that we stop seeing the positives about our lives. We loose our objectivity, our perspective, until that is, someone comes along whose circumstances remind us that maybe our glass is not as "empty" as we had made it out to be. Their problems put things into perspective and we feel, if only momentarily, a reprieve from our troubles. The critical difference between the satisfied and the dissatisfied is an attitude of gratitude. By simply "counting our blessings" we can turn a day around which got off to a bad start. I'm not suggesting slapping a phony smile on your face and chirping irritating aphorisms all day. I am saying that, "If you are having a bad day, simply decide to start over. Re-choose your day" (Matt Garrigan). We have the power to choose, at any point, to disengage from the stress and decide to start over attitudinally. When we choose to think positive instead of negative, the emotional field of our mind will become clean and clear, like the de-fogged window of a car, and we'll be able to enjoy the ride again.

Starving In A Country of Plenty
You wouldn't think that something so basic and necessary to reason as comparison could get us in so much trouble! However, a common theme heard by mentally ill clients is comparison. What Freud called the Superego, and what Dr. Fritz Perls called the Topdog are names which describe the critical, judging, complaining voice which also compares. Some people's lives are ruled by the wrong use of comparison. There are people who have harmed themselves or committed suicide because they compared themselves to others and felt they "came up short." Anorexia and Bulimia Nervosa are eating disorders which are a direct result of the ill use of comparison. A young girl reasons, "I have to be thin to be liked," because American society has glamorized being thin. She begins a tireless comparison game which she can never win, because there is always someone thinner...unless she starves herself. The maladjusted use of comparison can lead to starvation and death. This is the ultimate in irony; starving in a country of plenty. And it all started by taking a lethal dose of comparison.

Don't Worry, Be Happy
Listen to the words of this popular reggae song by Bobbie McFerrin: "Everybody will have their troubles, if you worry, you make them double. Don't worry, be happy." If it was only that easy to stay focused on the positives! However, when you have what is known in Psychology as an "Internal Locus of Control," life seems quite manageable. What this term means is to be self-directed, and have self-efficacy, or to believe in your own abilities. It means following an "internal compass" and being self-determining. An Internal Locus of Control is opposite of having an External Locus of Control, which is being controlled by one's environment. An External Locus of Control is not proactive; it is reactive. It waits for something to happen, rather than making it happen. It is the dependent role, which waits for the circumstance, or another person, to determine it's fate. Individuals who have an Internal Locus of Control have liberated themselves and are self-propelled. They do not need a map because they are the map. It is scientific fact that individuals who have an Internal Locus of Control are much happier than those who do not: "Locus of control is a MAJOR part of our psychology which affects our lives and our happiness. People with an internal locus of control believe that they are in control of their lives. They accept full responsibility for what happens. They tend to understand the theory of cause and effect - every outcome is the result of a cause. They tend to blame other people or uncontrollable events less than externally focused people. This means that internally focused people are often achieve more and are generally happier. Simply because they feel in control of their own lives" (maximumlearning.co.uk). People who have an Internal Locus of Control see the glass as "half full." They prefer to take a positive, can-do attitude towards life because they are the architect of it. An architect may become discouraged during a project, but if she wants a structure built, she cannot "scrap" her plans because someone else's building seems better than hers. I am saying when we hold ourselves responsible for the outcome of our lives, we will persevere through the challenges to erect our own monument! When you are using an Internal Locus of Control, you will stop the senseless comparison game. You will be so interested and absorbed by your own goals and projects that you will hardly have time to notice what others are doing! You'll be so engrossed in your own growth that it will make little difference to you what the Joneses are doing this year for vacation. Every time you look to your environment to make decisions for you, a piece of your own powerfulness is eroded. I'm not saying to resist help offered, nor to make all decisions by yourself! What I am saying is that in the big decisions of life, nobody gets to choose but you. And, nobody can choose your attitude except for you: whether it be grateful and optimistic, or complaining. Whether it be to compare, or decide your going to use your own compass as your gold standard. Like the song reminds us, we can be happy when we DECIDE to be. The next time you're stuck in miserable, fruitless, frustrating comparison, reclaim your joy by re-focusing on who you uniquely are, and what you already have to work with.

So don't compare, be happy.

The Philosophy of Being

The Philosophy of Being by Nina Bingham
As I struggle to fall asleep, to "be" instead of "do," I am flooded with "shoulds" which threaten to steal, or at least, poison my peace. Barraged by a "to-do" list which is relentless and insistent, marching like an army through my mind, I pop a sleeping pill and hope for the best. Something has to put the "breaks" on the wheels turning endlessly in my head. Perhaps you've heard the saying, "I slept like a baby?" I'm envying that innocent ability children have to flop in bed and seconds later to be sound asleep. Children don't "toss and turn" unless something's bothering them. As I begin to feel groggy and slightly more relaxed I think, "What's bothering me that I can't relax when I want to?"

Being Vs. Doing
As adults, our days are jammed-packed with work, school, family and social commitments. So full that there are drive-through restaurants so we can gulp it down in the car while we talk on the speakerphone, all while driving (oh come on, I've seen you do it!). Back at work, we type emails while simultaneously talking on the speakerphone. At the grocery store, we shop and talk because thanks to the earpiece. At the gym, we workout while watching TV, or enjoy our favorite music piped in through ear buds. The point is, we are a society of multi-taskers. Americans prize efficiency because it leads to greater profits. The belief is: Do more and you'll get more. Our society is one of "doers." Like worker ants, we take our morning coffee in a commuter cup, hurry to work so we can produce, produce, produce, so we can hurry back home in time to gobble something for dinner, so we can get to the next activity on our agenda. At night, though we should be exhausted, we lay awake and rewind the problems of the day which increases our anxiety, until we have to resort to a sleep aid. Tomorrow morning, the cycle begins all over again. Our society believes that being unproductive (what I will refer to from this point on as "being") is a drag on society. The philosophy is: if you want to get ahead, don't get caught standing still. So we madly rush ourselves and others. We push ourselves and others. In the quest to produce, we view one another less as human beings, and more as "objects" to be manipulated. We don't intend it maliciously; we're just trying to get ahead of the next guy.

Equinimity
Buddhists have a belief about how life should be lived, and it is encapsulated nicely in one word: equanimity. The word means: all things being held in balance by a check and balance system. The dictionary defines it as: "Evenness of mind, especially under stress" (merrium-webster.com). The simplest synonym might be: even-tempered. Imagine the evenness of balancing perfectly on a balance beam, or treading water so you are buoyant. Perhaps you've seen a person balance a load upon their heads seemingly effortlessly? These are physical demonstrations of equanimity. Equanimity is not a physical term. It refers to a state of mind, or a "being-ness" vs. a "doing-ness". The word itself sounds like the word "equal," meaning balance. Maintaining balance is a prerequisite to how equal you treat another. If I have an image of myself as a "doer" than when others around me are "being," I might envy it, or the opposite, I might denigrate it. Many people have no relationship to "beingness" and do not know how to feel or what to do when they're required to simply "be."
A common Buddhist meditation practice is to silent retreat for a weekend, or an extended period of time in which the participants learn to appreciate quiet, and to still their busy minds through the practice of silent meditation. They greet one another in silence, eat together in silence, and meditate together in silence. They are training in being instead of doing. They are learning to welcome and honor serenity, and thus, find their center place, their equanimity.

There are people who, if they had to attend a silent retreat, would rather do just about anything else. It is because they have no relationship with equanimity. To them, the "doers" of the world, silence is a senseless waste of time. For these task-masters, learning to balance their doing with healthier doses of being is vitally important. What happens when the brain and body are not allowed to rest, recharge and stop processing is the early breakdown of the mechanism. You wouldn't expect a car to operate unceasingly, would you? Eventually, heart attack, hypertension, stroke, cancer, and brain problems begin to get our attention. If it hurts bad enough, eventually even the toughest "doer" has to listen.

Wise Up
Wisdom is the blend of experience and knowledge applied. We can tell our children to eat their vegetables and don't smoke, but when we ourselves have experienced a brush with cancer, then we have hard-won wisdom about it. This is the difference between knowledge and wisdom. Knowledge is learned, wisdom is lived. Knowledge boasts, "I know." Wisdom just nods its head and smiles. When you are wise, you have internalized the knowledge. It is part of you, like a vitamin or mineral you absorbed. People who are wise do not feel they have to prove or pretend they are wise. Have you ever noticed that the older people get, the less they tend to be verbal and the more they listen? I heard it said, "God gave us two ears and one mouth for a reason." When you are at peace internally, you will be at peace externally. Life isn't chaotic; life is whatever we make it. If our lives have become "unmanageable," it is not because everyone experiences it that way. It's time to wise up when we've lost our equanimity. If we've lost touch with our peaceful, quiet selves, our creative, carefree selves, be assured we've projected the resultant impatience and irritation onto others.

The Art of Being
Being comfortable with being is an art form. I say this because it is in being, not in doing, that we express the finest parts of our humanity. When we are relaxed, at-ease, being mindful, present and aware, it is a graceful expression of our gratitude for life. Funny that the word "dis-ease" means an illness. When we are most ill at ease, we are stressed, and too much stress eventually manifests in physical and/or mental illness. For the worriers among us (I'm raising my hand), for the producers, accomplishers and over-accomplishers, how in this mad, mad world do we put ourselves in low gear, and how long should we stay there?

R and R
Rest and relaxation. They can look like different things for different people. It relaxes me to write, so I commonly cozy up in bed and write up a storm. Other people exercise to relax; they need that physical release and the endorphin rush. Others spend time with their family, pets, listening to music, tending the garden, or conversing with a friend. Many people find television relaxing. Some create art or enjoy crafts, or building things. Others have to "get out of town" to let their hair down. Others find socializing at a dinner party or dancing wonderfully liberating. The point is, when life becomes all work and no play, it's time to use our "wise mind" (Linnehan), and give ourselves permission to explore our lighter side. When's the last time you laughed until you cried? Couldn't stop smiling even though your face hurt? Life is not a "rat-race," and we are not rats! The encouraging thing about life is that it can be as busy or quiet as we allow it to be. We are the architect of our own lives. If you're not "sleeping like a baby" anymore, perhaps you could benefit by a rest from responsibilities that will allow you to have a day (or even a few days) of play.

Conclusion
In review, the magic of being is that in rest, in repose, there is no "earning" our keep, or striving to "get ahead." There is no justification necessary for taking space on the planet. You deserve to rest, just as you should accomplish. Being is the "other side of the coin" of doing. The philosophy of  doing says: More is better. The philosophy of being says: Enjoy what you already have. Give yourself permission to be in the moment and give thanks for what you have.

Breaking Down The Walls Keeping Us From Intimacy by Nina Bingham

Breaking Down The Walls To Intimacy
Think for a moment about the most intimate moments of your life. By intimate, I mean moments when you let your guard down, allowing another person close enough to see the real you, all of you. Perhaps you recall a romantic moment, your wedding vows, looking into your newborn's eyes for the first time, or any other emotionally-charged circumstance when you allowed another human being to trespass the gates of your soul. These powerful points of contact are nourishing because we are sharing ourselves with another. We are risking, by becoming vulnerable. We are melting the barrier and trusting another to reciprocate with kindness and tenderness. We have dropped the everyday facades we wear in favor of exposing the "real" us; imperfections and all. What makes intimacy meaningful is that it requires another reciprocating human. Intimacy implies reaching out to another vulnerable person, and trusting them to reach back. For most people, their most profound intimate moments happen with lovers or close family. For me, it happened in a crowded room with strangers.

Seeing Eye To Eye
A decade ago I had a friend who was a New Age enthusiast, who persuaded me to participate in a weekend-long self-actualization training course. On the first day, to break down the barriers between the participants, they had us stand in two lines facing each other, about two feet apart. They instructed us not to talk or touch one another once the bell rang. They said we were to look into each others eyes without diverting our gaze for two minutes, at which time the bell would ring, and we were to move on to the next person. The room was instantly filled with gasps, snickers and groans as we contemplated looking into the eyes of a complete stranger for two minutes. Immediately the bell sounded, and the deafening silence began. Instantly I felt incredibly nervous, uncomfortable and mildly violated. What was the person seeing in me? What were they thinking about me? I couldn't wait for the bell to ring! When the chime sounded, I shifted to the next person. This time it seemed a little easier. The room seemed lighter; people were giggling and smiling. It was seeming less scary and not so serious. My partner and I were having trouble not laughing out loud. Hey, I thought, this isn't so bed after all. Soon the chime sounded, and I stepped to greet another partner. The longer I gazed into people's eyes, the less they felt like strangers, and the more it felt like we were partners, in this together. After 10 minutes of eye gazing I began to be aware of not the "us" feeling, but finally, the individual before me came clearly into focus. The saying, "Eyes are a window to the soul" became true for me. I didn't notice the color of their eyes, or their facial contours or their hairstyle. It didn't seem to matter if they were young or old, male or female, because all I was seeing was their soul. The room's atmosphere had transformed from nervous to sacred. With each successive partner, I began to see uniquely beautiful characteristics: some souls were joyous and effervescent, some were passionate and fiery, some were wise and consoling, and some were youthful and energetic. With people who had, minutes before been complete strangers to me, I was witnessing a spark of life inside of them, which was showing me, in a way I have never been able to fully comprehend, their unique brilliance and beauty. I noticed tears trickling down my face, and heard the others sniffing and softly weeping, too. Something was happening to us. We were breaking down the walls which usually keep us apart by making genuine contact with one another. Standing there I remember wondering, "Why have we all been so afraid of each other?"

We're All In This Together
Psychologists tell us humans have the same basic needs; essentially, humans crave the same things (Maslow). Since fundamentally we have the same needs, when then are we so hesitant to make meaningful contact with one other? The strangers who, for that special weekend became my friends, were very diverse: males and females, young adults to seniors, some poor and others affluent, some with minimal education and others with college degrees, and varying ethnicities. However, looking in each others eyes that day, those socially constructed divisions melted away. All we saw, after we worked through our self-consciousness, was a reflection not unlike ourselves. It was like looking in a mirror. We cried because we were astounded and relieved to find that there was nothing to be afraid of after all. All the differences that seemed so important before the eye gazing had simply evaporated, as if it had been a figment of our imagination, or a bad dream. The tears fell because we were amazed at the unguarded gift each soul was offering us, and because we had been such blind fools not to see it before.

Out With The Old, In With The New
It's a strange experience to find intimacy with a room full of strangers. It's an even stranger thing not to have it with the people in our lives. In order to be closer to the people we care about, to "let down the walls," it is a prerequisite to see these people anew, to appreciate them for their good attributes, as well as the bad. We build walls which prevent us from recognizing all of the other person. We get focused and transfixed on what's gone wrong, and that's the only lens we can see them through. To "update" our perspective is essential to being able to see others for who they really are. There isn't any hope of renewal if we are using outdated "glasses" to view them with.

Our Own Worst Enemy
As I described, initially in the eye gazing exercise, the participant's reactions were: fear, dread, nervousness, and embarrassment to the point of mortification. All these reactions could fall under the heading of self-consciousness. When we are self-conscious, we have split ourselves into the performer and the observer (Perls): "The pathological phenomenon of self-consciousness is differentiation into performer and spectator has occurred." Simultaneously we feel pressure to perform, or respond correctly, while another part of our mind observes as a critic would. When we are self-conscious, there is no room for anybodys opinion except our own. We do this so as to divert our attention from what others might think about us, to what we think about us. After all, we unconsciously reason, if I am the harsh critic of myself first, others will take pity on me, and not be as harsh with me. Being self-conscious is being our own worst enemy, because our criticisms are usually much worse than others would be. The person who suffers from self-consciousness is listening to the relentless voice of the Superego (Freud), or in Gestalt Therapy, it is called the Topdog. It is a superior voice which makes unattainable demands of perfection. People with Obsessive Compulsive Disorder are barraged by the orders of a hyperactive Topdog who is relentless, and won't cease it's demands until the sufferer has performed the rituals obsessively. Maybe you've never thought about how obsessive thoughts and self-consciousness are connected, but they have in common a relentless task-master and tyrant who demands perfection. Intimacy requires putting aside self-conscious behaviors, and staying in contact long enough to break through the all-consuming ego centrism which is self-consciousness.

Seeing Past The Meat Suit
I heard a Quantum Physicist refer our bodies a "meat suit" (Byrne). He said, "If you think you are just a "meat suit" running around, you're wrong." He explained how our bodies are mass, but that mass, on a molecular level, is unstructured energy (M=mc2). Though we wear bones and skin and dress it up, on a molecular level, we are all the same. We are composed of energy which cannot be destroyed. Because we are composed of constantly changing cells, our "meat suits" will look different 10 years from now, and much different 20 years from now. The point is, to judge by the "meat suit" someone wears today is to believe only what you can see. What you can't see is the person's energy fluctuating and evolving, changing even as you read this. To judge others by how they appear on the outside is a slippery slope, because not only will their body change, but the brain is constantly revising itself (called "plasticity"). Therefore, if you base your acceptance of others on their looks, or even what they think, you're asking to be disappointed. Whoever you think is "perfect" now cannot, as hard as they may try, escape the relentless march of time. Once you can see beyond the clothes, hairstyles, gender and ethnicity of others, you might have a chance of actually perceiving THEM.

The Gem
During the eye gazing exercise, once I had overcome my self-consciousness, I could see the soul within the person. It seemed to me like a sparkling gem. A gem which was clear in it's viscosity and sparkled with unique attributes all it's own. Like a fingerprint or a snowflake, no two souls were alike, except that they all appeared as sacred gems to me. They each had a distinct color and vibrational energy. I remember thinking that each soul was priceless.

The Pearl of Great Price
A pearl, like a gem, is precious. It's valuable. In Christ's time, living among fisherman, pearls were a known commodity. There's a story Jesus told about a man going and selling all he had to buy a field where a pearl of great price was hidden. This Bible story is referred to as "The Pearl of Great Price." While Bible scholars have interpreted this story many ways, and most believe the pearl represents salvation, I think Christ could have been saying that we must look to find the goodness in others. Kind of like a pearl buried in the dirty field, or a gem buried deep inside the eyes of another person.

Conclusion
Intimacy requires us to invest something of ourselves. To be willing to risk. To wade in a little deeper in our relationships. It all begins with a willingness to be willing. Next time you're feeling alone, look into someone's eyes and really see them, as if for the first time, and then allow yourself to be seen. Realize this type of human contact is nourishing to the soul--both for you, and for them. See, it wasn't so hard after all.

The Existential Message From "Horton Hears A Who" by Nina Bingham

Every movie has a message. Even "Horton Hears A Who." My daughter and I went back to the movie theater in 2008 for a second helping. However, I failed to see it's existential meaning both times. How I could have missed its symbolism is beyond me now. It wasn't until one "Dark Night of the Soul" that I suddenly realized what "Horton Hears A Who" was all about.

Dark Night of the Soul

Dark Night of the Soul is the title of a poem written in the 16th-century by a Spanish poet and Roman Catholic mystic Saint John of the Cross. The poem describes the painful experience that people endure as they seek to grow in spiritual maturity and union with God. Like Saint John, every soul will have its dark night. Some, like those suffering with depression, experience more dark nights than others. The late Sylvia Browne, world-famous psychic said in her book, Souls Perfection (2000), that if we simply survive an earthly incarnation, we have done something heroic! She believes we choose to come down to Earth before we are born in order to experience certain trials and to learn from them. To Sylvia, Earth is a sort of school of hard knocks – the soul's “boot camp” if you will. The message from both these authors, a saint and a psychic, is that life is no cake walk. Or remember that Buddha said it, and Christ also demonstrated it, that here on Earth, they'll crucify you every time (metaphorically speaking). This is not an "easy" planet to be born into. Think about it-we arrive with a cold slap on the butt, and exit as they throw dirt in our face! By now, you must be thinking, "Wow, Nina must have been having a really bad night!" The point is: we've all experienced them. Moments when life which seemed impossibly cruel, a sadistic joke. When we grieved with no answers because life seemed both random and harsh. Moments when you've said to yourself, or said to God, "What's the use? What's all the suffering for?" These dark nights of despair leave us questioning the meaning of our existence. Strangely, it's not until we experience dark nights like these that we begin to notice the light.

The Light At The End of the Tunnel

You've heard the saying, "I can see the light at the end of the tunnel"? The light, in this case, looks brighter because of the darkness around it. The polarity of life is the breadth, depth and meaning of it. Not until we have seen our shadow can we appreciate our light. In Jungian psychology, the shadow or shadow self is a part of the unconscious mind consisting of repressed weaknesses, shortcomings, and instincts (Wikipedia.com). Simply, the contrast between darkness (unknowing) and light (knowing) defines our living, giving it meaning and significance. The cool drink is cooler on a hot Summer's day. The explosion into laughter, orgasm or grief is relieving, and wouldn't be cathartic without the precipitous state of withholding. We humans experience life as meaningful because of it's polarities. The Dark Night of the Soul, though painful, enables us to savor and appreciate the morning's bright dawn. The meaning of "Horton Hears A Who" broke upon my mind two years after I saw it when suddenly, in the foreground of my mind, the Dr. Seuss-ish characters seemed less cartoonish and surprisingly spiritual. It seemed to me what was originally a touching child's story was offering a profoundly adult lesson that I had missed the first, and even second time around.

We Are Here!

During my "Dark Night of the Soul," as I pondered why there has to be so much such suffering, I sent out a question, or maybe it was a prayer, but it sounded like this: "Do you know we are here?" As I did, the story line of Horton Hears A Who came rushing back to me. Do you recall how the Whos in Who-ville had, in desperate distress, trumpeted a similar message to the Universe: "We are here, we are here, we are here!" Suddenly, I was feeling as small as a Who. A single voice in a minuscule colony who lived on the pin-point sized dot on the head of a dandelion. I wondered if God was like Horton, a goofy but kindly-hearted elephant, living a carefree and blissful existence, caught unawares by the tiny sound of the Whos urgent message: "We are here! We are here! We are here!" I thought: if there is a God, I hope He is a big fellow with a soft heart, like Horton. I don't even care if He is goofy like Horton. I also thought about how, even in Horton's world, there was an antagonist; a disparaging, vengeful voice (played by Carol Burnett). And I smiled all over again when I thought about the yellow puffball named Katy, our favorite character in the film, whose one-liner delighted my daughter and I: "In my world, everybody eats rainbows, and poops butterflys." In Horton's world, as in our world, there are agonists, antagonists, and the clueless, quirky souls, too. I thought, if Horton represents God, and we humans represent the Whos, so small, seemingly insignificant and randomly falling through space, what's the message of the film?

A Person Is A Person, No Matter How Small 

Throughout the movie, Horton kept repeating a mantra which kept him "saving" Who-ville from destruction. It was: "A person is a person, no matter how small." What I believe he meant was: regardless of the immense size difference between Horton and the Whos, the Whos were as important to Horton as he was. He couldn't let them perish because he had the power to save them. What the audience found endearing about Horton was how much he valued life. He held it sacred. Even life that was so minuscule by comparison that he couldn't even see it, and had to strain to hear it. If there is a God, I hope in this regard, He is like Horton. In our Dark Nights of the Soul, I believe we are sending out a message, whether it is whispered in a prayer, a thought, or shouted from the rooftops: "I am important, so don't forget about me!" The existential message I finally saw in "Horton Hears A Who" was: Everyone matters, no matter how small. If you believe there is a God, or a Higher Power, or whatever you want to call it, then allow this simple child's movie to remind you, as it did me, that the Creator, like Horton, hears us, and is moved to help us. And if you are an atheist, and do not believe, then consider the movie's theme anyhow: we are all equals, and therefore, everyone is worthy of compassion. Regardless of your spiritual leaning, there was a hidden message for you in "Horton Hears A Who," and I wanted to share it with you.

References:

(2011). Dark night of the soul. Wikipedia.com. Retrieved from the World Wide Web on July 22, 2011: http://en.wikipedia.org/wiki/Dark_Night_of_the_Soul#Poem_and_treatise_by_Saint_John_of_the_Cross 
Browne, S. (2000). Souls Perfection. Hay House, Inc.

Shadow (psychology). (2011). Wikipedia.com. Retrieved from the World Wide Web on July 22, 2011:
http://en.wikipedia.org/wiki/Shadow_%28psychology%29

Schultz, D.P. and Schultz, S.E. (2009). Theories of Personality. Wadsworth CENGAGE Learning.

Problems Are Like Onions by Nina Bingham

Problems Are Like Onions
I was considering how problems are a lot like the ordinary onion. Not an eloquent comparison, but true, nonetheless. What I mean is: like an onion, problems have layers. Like people have layers. Problems are systemic; they are not usually as simple as they look on the outside. When they appear simple, it's because you have ignored the next layer. You've only peeled away one "skin" of the problem. I see this in counseling with many new clients. A well-intentioned person comes to therapy meaning to solve a simple enough looking problem, such as smoking. As their life's story comes unraveled on the counseling room floor, with each successive layer of onion peeled back, and the next one, closer to the heart of the matter, exposed, what is left in the center is a core belief about themselves. These I refer to as "unconscious beliefs."

"I thought this was going to be easy," they lament, as we stare together at the nasty unconscious belief left on the floor. I know we've gotten to the heart of the onion (the problem) when they also stare in shocked disbelief at the core belief about themselves. A core belief I see a lot, which are always untrue, is: "I'm not good enough," or some other diatribe accusation still clinging to the soul from childhood. Some clients will look upon the uncovered core belief and exclaim, "It's true! I'm not good enough!" If the client cannot look at the heart of the onion, and see it for, in reality, what it is (a stinky lie), I know they have more work to do. And this is the soul's work: distinguishing the morality of the lies we believed about ourselves in childhood.

It All Began In Childhood 
Freud was wrong about the etiology of some things, but, he knew that childhood is the breeding ground for mistrust of ourselves. In childhood we begin doubting our innocent, inner wisdom, that knowing which has guided us, and which supersedes adult wisdom. As young children we intuitively understood our problems. We knew to ask unashamedly for what we wanted, which was innate and organismic. The healthy organism doesn't ask others what it should want, or what it is. It defines itself. It is programmed to do what it's supposed to do. We don't think of blinking or respiration: they happen spontaneously, as a result of the autonomic nervous system. Similarly, "thinking" came naturally once to us. Our thoughts at birth were simple, and as our brains grew to accommodate our environment, we became more cognitively sophisticated, more distinguishing. As our cognitive abilities appreciate, our sensory awareness recedes into the background of our awareness. Problems stand at the foreground; we are faced with the onion.

Onions Have Layers
I chose an onion to represent our day-to-day problems because it is one of the stinky vegetables, and one which has the power to make us cry when we cut into it. It is also one of the most common ingredients in cooking. What would a common recipe be without a touch of the culinary workhorse? You can find one in most every kitchen, and it's on every cook's grocery list. So it is with problems: when handled skillfully, the common, smelly onion can be transformed into a flavorful dish. Problems, like the onion, appear impossible to deal with until they are handled. Upon closer examination, we can disarm the onion's offensive qualities. Let's give an onion a good examination, a thorough once-over, shall we?

1. Pick the onion up and examine it's exterior. According to Socrates: the 'unexamined life is not worth living.' It may seem like you are faced with a central, single problem, such as: an addiction, or a relationship gone sour, or a hundred other themes (but have you noticed you tend to pick the same sort of onions?).
2. Notice there are layers to the onion. Upon closer inspection, you may, or may not be able to see how problems are systemic. I mean that our problems are caused by other problems. Example: Smoking is caused by stress. Smoking is the surface complaint, it is not the root issue. Smoking is precipitated and triggered by stress. Remove the source of stress, and you may have solved the problem. Perhaps you are lucky, and your onion has only two layers: smoking (effect) and stress (cause). For most people, their onions have more than two layers. In the case of smoking there is:

Layer 1-The obvious problem (smoking)
Layer 2-The triggers (stress, and physical and emotional addiction)
Layer 3-The Personality Hole (s)
Layer 4-The core unconscious belief that is dominant (defines behavior).

Personality Holes 
Dr. Fritz Perls, the creator of Gestalt Therapy, described what is lacking in the personality as a "hole."
Similar to the black holes in space, where stars, planets, and even constellations can become sucked in,
trapped in a galactic whirlpool and lost, is a personality hole, where what should be there is not.
In the human personality, when a common quality is lacking, a personality hole can be detected.
For example, in the case of someone with anti-social personality disorder, there is a marked lack of empathy for others. Criminals are devoid of this character quality. They have forgotten how to care compassionately for others. This is why allowing the well-behaved prison inmates to have a dog while imprisoned is a beautiful idea. It is a teaching measure. It rehabilitates the characteristics of empathy and responsibility for others. They are given a chance to  "reattach" to another living being, one who will love them unconditionally. This retraining in "having a heart" is a means of fixing what is lacking in this personality. As mercy is shown to the inmate by the correctional system, and by the unconditional adoration of a dog, they can learn to have tender feelings again for someone besides themselves.

Holes in personalities are common. People with personality disorders always, and without fail, have nothing where something should be. Dr. Perls also described the personality hole by saying, "Some people have no eyes. Some people have no ears where there should be ears." Have you ever had the experience of listening to a person talk about their problem, and the answer seemed obvious to you, yet it was as if they couldn't see what was right in front of them? This is a person with no eyes. Or have you ever talked to someone to find they heard your words, but were so preoccupied that they didn't hear your meaning? This persona has no ears. This is the frustration of Layer 3, the personality hole. People can be blind to a problem when they are in the midst of a problem. Their personality has developed a deficit; they are prevented from seeing it because to them, it is as if it is not there. How can you see that which does not exist for you? Personality holes are indicated by this lack of self-awareness. And if you make them aware, they may deny that it is there at all.

Unconscious Beliefs
Layer 4 is the final layer of the problem. It is more like a core of an avocado than the another layer of an onion. It is hardened, fixed and resistant to destruction. It is at the center of behavior. It is unconscious: like a navigating system guiding our lives, and as if we were on auto-pilot, we obey it's dictates. If the belief about ourselves is negative, such as, "I'm not good enough," we will see our circumstances through these lenses. We interpret messages other people send us through the filter of: "I'm not good enough." Then we treat those people as if that's how they feel (but we really don't know, because we never took the time to ask them). If our belief about ourselves is positive, again, we interpret our environment as reinforcing to our self-esteem: "You are good enough. You are loveable." Because most unconscious beliefs about ourselves originated in childhood,  Re-Parenting, or Inner-Child Therapy is a powerful method to touch that younger, still-hurt part of ourselves, which continues to feel "not good enough."

The Problem With Problems
The onion is a problematic vegetable. It appears like a whole mass, until you peel it. Then it multiplies. It becomes a whole system of smaller layers. Problems are similar, and this is why we avoid them: we've handled enough of them to know that if we open it we are "opening a can of worms." Worms are not pretty, and onions can be stinky.  So why even go there? The problem with problems is this: like a vegetable, if you allow it to rot, it really begins to stink! There are people whose souls are over-running with rot. Rather than correct the problem, they are like the hoarder, shoving their rotting onions everywhere until they pile up so obtrusively that there is nowhere they can go to get away from them. Hoarders are people who cannot let go. They would rather hang on to a rotting onion than experience grief. They are persons avoiding, and compensating for a loss they've experienced by hanging on to dead, rotting things. You may be saying, "How dreadful! I'm nothing like the hoarder!" However, like the hoarder, when we hang onto problems instead of resolving them, it is a refusal to grieve.

Wherever You Go, There You Are
Maybe you've heard the phrase, "Wherever you go, there you are?" All of us would like to avoid problems, to run from them. We all feel that way. And sometimes we do manage to avoid, or run from them...for awhile. Then, we return from vacation or come down from the whirlwind of romance. Eventually, we return to ourselves. Distractions from our problems aren't bad, in fact, sometimes that's exactly what we need to do-set aside the worry and de-stress! However, when problems are piling up, eventually the weight of them becomes unbearable. We realize it's time to focus on ourselves, and of course, the onion.


Being Willing To Be Wrong
MLK, Jr. said, "You don't have to see the whole staircase. Just be willing to take the first step." Admitting you have an unsolved problem takes some courage. It means you'll have to risk to get what you want. It means you'll have to "go out on a limb." I heard Reverend Matt Garrigan ask, "Would you rather be right, or would you rather get results?" Sometimes we must be willing to be wrong to solve our problems. Einstein said, "The same level of thinking used to create a problem cannot be used to solve a problem." This may mean going and finding the support we need. If we give ourselves permission to be wrong, to see mistakes as "errors in judgements, rather than sins to be judged and condemned" (Rev. Matt Garrigan), then we are free from perfectionism, and allowed to be what we are: fallible human beings who are in the process of learning and growing.

Conclusion
The next time you see an onion, think about how this common, stinky vegetable can be easily transformed. Realize your problems are just like the onion: if handled correctly, they can be used to enhance, and bring greater flavor to your life.