Sunday, August 28, 2022

Sleep Better

 

 Click  to watch this video on improving sleep





Having trouble sleeping is common. You are not alone. Let’s stay hopeful and overcome this challenge.

Your body is designed to welcome sleep. It needs sleep to rejuvenate and get you ready to have a productive day when you wake up in the morning. You can start by reminding yourself the simple fact that sleep is a natural part of life, and you deserve a restful sleep. Normalizing this process can reduce the anxiety you might have about sleep.

When you are trying to sleep, by focusing on not being able to sleep or reasons behind having trouble sleeping, you probably are not going to fall sleep. When you focus on problems with sleeping, or any upsetting thoughts, you won’t feel relaxed. Such thinking can activate your nervous system and make it harder for you to go to sleep.

Instead of worrying about sleep, let’s create a supportive bedtime ritual. I am going to describe an example of such a ritual that you might find helpful.

As a start, when lying in bed, take a minute and remind yourself of few things you feel grateful about the day you just had. It could be something simple like you feel grateful for having a pleasant lunch with a colleague or having fun playing with your pet. Just a simple reminder of good things you experienced today along with feeling of gratitude is good enough. By practicing gratitude, you are starting your sleep journey on a positive note.

In general, embracing gratitude can help your body and mind shift into a calming state. A daily gratitude practice is a simple way to invite positive emotions into all aspects of your life including sleep.

 

After practicing gratitude, take a minute or two and give yourself a loving hug. Fold your arms around your body, positioning them in a way that feels comfortable, and squeeze yourself with just enough pressure to feel a pleasant sensation. All you need is just a moment of feeling good because you deserve compassion.

You can try this self-hugging practice anytime you wish because loving yourself is a foundation for loving everything else.

After the gratitude and self-hugging practices, remind yourself you are making a conscious decision to sleep. Affirm the fact that sleep is good for you. Perhaps a part of you might not want to sleep. By telling yourself that you are making a choice to sleep, and you believe a good night sleep is essential for your health, you might be able remove all doubts about not sleeping.

Again, your body is designed to welcome sleep when you need it. Sleep is one of the gifts your body offers you toward good health. So, normalize the sleep process as much as you can.

When you are in bed, instead of focusing on negative self-talk or anything else that might be on your mind, try to connect to your body in a positive way. For example, focus on the support of the mattress that your body is receiving. Our bodies love to feel supported.

By taking a deep breath and bringing your awareness to comfort and the sense of support your body is receiving from the mattress that you are lying on, you can help your nervous system shift to a calmer state. Often the anxiety about not being able to sleep can activate your nervous system and keep you awake.

Your body and mind can work in complete harmony and support your sleep. Focusing on safety, and comfort that you experience in your body, can relax your mind. Give yourself permission to smile when you feel relaxed. The act of a gentle smile can also help you to feel safe and relax before falling sleep.

After practicing this bedtime ritual, just relax and surrender to the wisdom of your body. Again, your body knows how to go to sleep and your mind supports that process. No need to overthink it. Just let yourself drift into a peaceful sleep.

What I just described is one approach to a better sleep. I hope you find it helpful. There are so much more to be said about this topic which I plan to present in upcoming talks.

On a side note, always talk to your physician for any health-related concerns including trouble sleeping. In some cases, there may be underlying medical issues that might contribute to having challenges with sleep, and it is very important to treat those issues.  

 

© Dr. Payam Ghassemlou MFT, Ph.D. is a mental health counselor in private practice in West Hollywood, California.  www.DrPayam.com

 

Thursday, July 14, 2022

Authoritarianism and the Harm to Psychotherapy by Payam Ghassemlou Ph.D.

 

My journey of becoming a psychotherapist with a passion for serving the LGBT community started over three decades ago. In those days, AIDS was devastating our community, and I wanted to make a difference. I started my counseling internship at the Los Angeles Gay and Lesbian center with a focus on helping people living with HIV/AIDS. As I look back on my journey of studying psychology and becoming a psychotherapist, I am realizing an obvious point. I learned how to practice psychotherapy in a democratic society. This is a crucial point because the kind of society where mental health services being offered makes a substantial difference.

Given my experience with living or visiting other parts of the world, especially in places ruled by authoritarian regimes, I have learned psychotherapy can be a transformative process when practiced in a free society. It is difficult to help individuals reach their true potential in a closed society where fear dictates people’s lives. In places where freedom of speech is protected, it is much easier to openly discuss all external events that can impact a client’s mental health including relevant sociopolitical issues. For example, in my Los Angeles based counseling practice, I have helped many people from all walks of life including lesbians, gays, bisexuals, transgenders, and queer or questioning people to become comfortable with their identity. Learning how to love themselves despite their homophobic and transphobic upbringing has been transformative. Practicing psychotherapy in a free society makes it possible to validate my client’s pain regarding homophobia, transphobia, sexism, racism, xenophobia, Islamophobia, anti-Semitism, classism, ableism, and other degrading situations. The safety to openly discuss and condemn such obstacles is necessary for many clients’ healings process. Those of us who are trained in somatic psychotherapy and have studied the impact of trauma on the autonomic nervous system, know how hateful acts can dysregulate the nervous system. In a free society, it is much easier to help the body and mind to heal from the impact of trauma.

Since the Trump Presidency and all the divisiveness and rampant polarization that came with it, I have noticed a troubling shift in American politics. For me, the notion that someday there would be a competition between democracy and autocracy in the Unites States of America was unthinkable. Especially as a foreign-born gay man who found America as a safe refuge. I cannot imagine the possibility of living under authoritarian regime again. I know how precious democracy is because I have experienced how oppressive autocracy can be. Now, my nightmare about autocracy over democracy is beginning to feel real. The other day I found myself defending voting rights talking to another therapist who believed voting is a privilege and not a right. Moreover, I have spoken with many Fox News viewers who are willing to shift toward autocracy if such a regime would ban abortion, uphold conservative values, and keep non-White immigrants out. They do not realize what is it like living in autocratic countries like China, Russia, and Iran where people are miserably oppressed. Autocratic leaders do not care about issues like human rights, climate change, and the freedom of press. They lock up or execute anybody who challenges the way they govern. I understand the U.S. is considered a republic and not a democracy. However, no matter how I define it, America, unlike an autocratic country, makes it possible for a psychotherapist like me to provide a socially responsible way of practicing psychotherapy.

Despite of all the positive elements that make this country great, many of us are noticing disturbing situations that are jeopardizing our freedom. For example, some U.S. Supreme court judges were nominated by presidents who did not win the popular vote. These conservative judges, who do not represent the American majority, are making decisions that are negatively impacting our lives. Also, the continued use gerrymandering coupled with the voting restrictions in various states is paving the way toward totalitarianism. Many mental health therapists are concerned about the future of psychotherapy and its transformative potential as American democracy erodes. If the anti-democratic trend continues, and our freedoms keep getting chipped away, it would be only matter of time before they start policing our counseling profession. Some of us already are being restricted and controlled by some health insurance companies for greed and profit. Once a dictatorial system of government begins to dominate the U.S., it will have major impact on how we conduct psychotherapy. For one thing, I will not feel safe to freely explore how clients’ emotional pain might have something to do with the environment they live in. Also, since the mental health of the individual and sociopolitical factors are deeply intertwined, how a country is being run can impact people’s well-being. The stress of living under an authoritarian rule can lead to depression, anxiety, hopelessness, low self-esteem, and suicidal thoughts.

I hope I am wrong about U.S. democracy being replaced by an autocracy which could negatively impact the delivery of therapeutic services. Before the events of January 6, 2021, when a racist mob attacked the United States Capital, I would not have entertained the notion that U.S democracy is at risk. Now, I do. The events that led up to January 6, and the role that many far right politicians played to shape such assault on U.S. democracy has made many freedom lovers in this country alarmed. Many Americans do not feel safe knowing a major portion of the population are manipulated to believe a strong leader, who does not have to worry about oversight from Congress and elections, is good for them. Many of them believe a strong Caucasian leader can protect their European heritage, which is central to their identity, from cultural diversity. Moreover, some believe a forceful leader can protect their so-called Christian values. Some uneducated low information voters believe a Putin-like leader is necessary to stop homosexuals from turning their children gay and imprisoning doctors who provide abortion services. These individuals, who are brainwashed by right-wing media to believe in such absurdity, are part of our current problem with the rise of autocracy in the U.S.

When it comes to offering psychotherapy services, theoretical approaches are an integral part of the therapeutic process. Such theoretical approaches can provide a framework and guidance for therapists to help their clients. I believe, any psychological theories that teaches people to differentiate, and not remain a sheep in the flock is a threat to fascism or any type of dictatorial government. For example, a psychotherapist who utilizes feminist theory could have a tough time working under a fascist type of establishment since such theory focuses on gender inequality and discrimination among many other themes. Moreover, therapists who specialize in helping young people embrace their sense of curiosity, sexuality, and independence could become a threat to a system of government that thrives on repressive family structures, fear of authority, and sexual repression. Psychotherapy, as I know it, will change and therapists may no longer be allowed to help clients in cultivating a free mind. We could lose our freedom to choose our theoretical orientation when America becomes one of those autocratic countries, and any books including psychology books that are not ardent in its support of dictatorial government may be burnt.

As a cis gender gay man of color, I understand we currently have a lot of problems with racial injustice, sexism, homophobia, and transphobia in America, especially, for African Americans who have suffered so much from racial inequality. As of now, we are not a fascist state yet. I hope everyone including mental health professionals who care about freedom of speech and the right to free elections take the current push toward autocracy very seriously. Far-right hate groups in America have gotten stronger. Once we completely lose our precious American freedoms, everyone including psychotherapists may be required to adjust to the authoritarian order and submit to it. I hope that day never comes. There is still time to save American democracy.

 

 




© Dr. Payam Ghassemlou MFT, Ph.D. is a Licensed Marriage and Family Therapist (Psychotherapist), in private practice in West Hollywood, California.  www.DrPayam.com , www.SomaticAliveness.com

Saturday, June 25, 2022

A Queer Perspective on Somatically Befriending Vulnerability By Payam Ghassemlou Ph.D.

 



Since being vulnerable does not always come easily to many of us, it is important to have empathy for anyone who struggles with it. The internet is flooded with writings and talks on encouraging people to show vulnerability. Having trouble expressing it often gets associated with a lack of authenticity. Such judgmental interpretations can frequently trigger shame in people who don’t feel safe enough to be vulnerable due to certain socio-demographic factors. There is a misconception that expressing vulnerability is a matter of courage or just making a mental decision. By helping others reclaim it, I have realized the issue has little to do with bravery or honesty. It has more to do with the state of one’s nervous system. By having a somatic perspective on understanding vulnerability, we can open a new path toward befriending it.

There are many different paths toward befriending vulnerability which includes using the body to build a greater capacity to embrace it. Our response to many emotional experiences can be felt in our bodies. For example, Lucas, a 30-year-old cis gender gay man, disclosed having difficulty asking guys on dates. Doing so makes him feel very vulnerable. Among other bodily reactions, he reported tightness in his chest along with uncomfortable restricted breathing when faced with uncertainty to his invitation. Lucas has a history of growing up with the stress of homophobic mistreatment. He often felt unsafe at school due to the devastating experience of being bullied or called derogatory names. Fight or flight was not an option when he was feeling helpless and hopeless dealing with his traumatic school environment. Instead, his body resorted to numbing and shutting down. This response became his default whenever faced with overwhelming situations like entering a vulnerable state. Lucas’ reactions to becoming vulnerable had nothing to do with a choice or a lack of courage. It had more to do with his body’s threat alarm being frequently on.

In general, LGBTQ children are often at risk for being bullied, and they need protection. Lucas and many other queer youngsters growing up place their trust in individuals and institutions who were supposed to protect them from harm. Failure to receive such a protection at a critical developmental phase became a source of hurt and betrayal. The trauma of growing up gay in a world that did not embrace LGBTQ identity with kindness and acceptance led Lucas and many others to associate vulnerability with fear and betrayal. Given his traumatic history, Lucas needed help learning how to feel safe in his body when becoming vulnerable. Regulation of his psychophysiological arousal in response to vulnerability has been an important healing task for Lucas, especially when it came to making connections with other single gay men.

Taking a somatic approach toward working with vulnerability involves understanding the role of the autonomic nervous system (“ANS”). The ANS is the part of the nervous system that governs the fight, flight, or freeze instinct and is responsible for the unconscious bodily functions like breathing, digesting food, and regulating the heart rate. It also plays a vital role of supplying information from our organs to our brain. This system works automatically (autonomously), without a person’s conscious effort. The ANS is central to our experience of safety, connection with others, and our ability to bounce back from life’s overwhelming experiences. Relying on neuroception, a term coined by Dr. Stephen Porges, our ANS can differentiate between safety, danger, and a life threat. Neuroception, as Deb Dana (author of The Polyvagal Theory in Therapy) explains, is automatic, and it does not go through the thinking part of our brain. Everything from sound to smell to temperature in our environment, people’s tone of voice, and eye contact can influence our neuroception. It is like “internal surveillance” that looks for cues of safety and danger inside the body, in one’s environment, and in relationship with people. It helps us take immediate action in the face of danger or threat. The goal of neuroception is to keep us safe and alive. Based on my training in Somatic Experiencing®, Touch Skills Training for Trauma Therapists, Polyvagal Theory, and other body inclusive approaches, I have learned the autonomic nervous system is a relational system that has been shaped by experience. We now know previous negative life experiences and traumas can significantly affect how our neuroception accurately assesses safety, danger, or a life threat. This can explain why many people including Lucas with history of being judged, humiliated, and violated often avoid entering a vulnerable state. Their faulty neuroception causes them to feel unsafe in the absence of real danger.  

Since “how we move through the world is guided by our ANS,” it is important to examine how growing up in a homophobic and transphobic environment negatively affected the working of  the ANS. In my counseling work with gay, lesbian, bisexual, queer identified, and transgender people who have experienced homophobic or transphobic mistreatment, I have noticed their nervous systems are often shaped toward self-protection versus making connections. Repeated past humiliation and rejection by others have made it difficult for many of them to be open and willing to love and be loved. Given the important role that ANS can play in people’s ability to embrace vulnerable situations and form relationships, it is important to learn how to regulate it. When working in a regulated way, the ANS does not enact the response to the present moment situation based on one’s past conditioning.

Autonomic regulation has less to do with talking about our past trauma events and more to do with shifting our autonomic state that can be stuck on FFF (fight/flight/freeze) toward safety and relaxation. When Lucas was invited to share about his history, it was done for the purpose of having greater empathy for his suffering and learning how fear became associated with vulnerability. Lucas’ personal stories with homophobic mistreatment was handled with care and in a titrated manner to avoid re-traumatization. In general, encouraging people to get into their trauma stories all at once can become overwhelming for them because the nervous system cannot tell the difference between the original event and the telling of the event. Healing does not always need to involve re-telling the story. As Peter Levine, the founder of Somatic Experiencing International, stated, “Trauma is not in the event, but in the nervous system.” Based on my personal and clinical work, I also concur that trauma becomes embodied during a person's life and can affect the working of the ANS. Much of the healing from this trauma needs to happen through the body. In particular, the nervous system needs to be regulated.

The work of Stephen Porges’ Polyvagal Theory has brough to light the role of the vagus nerve in how we experience safety and connection. The vagus nerve which is divided into two pathways, the dorsal vagus and the ventral vagus, is the main component of the parasympathetic nervous system. The ventral vagal of parasympathetic system plays a crucial role in our experience of safety in our bodies. Activation of the ventral vagal force in the ANS includes but not limited to awareness and tracking of pleasant bodily sensations. For example, when I invited Lucas to notice his body being supported by the couch, he commented, “I can sense my body feels relaxed and comfortable.” By bringing awareness to comfortable sensations in his body, he began to breathe deeper and noticed a sense of expansion in his chest area along with his shoulders becoming more relaxed. For Lucas, tracking bodily sensations that were comfortable invited the flow of the ventral vagal of safety and connection.

Another useful somatic intervention involved identifying and embodying helpful resources that contributed to his healing journey. For example, attending LGBTQ Pride events and volunteering at the Los Angeles LGBT+ Community Center felt empowering for Lucas. By tracking his pleasant bodily sensations as he was sharing about these helpful resources, he was creating a physiological event in his body which contributed to regulating his nervous system. As the therapy session progressed, he found it easier to imagine and plan on asking a guy he met at his gym on a date without experiencing tension in his body. Repeated awareness of pleasant sensations in his body increased his ability to distinguish sensations of distress versus sensations of well-being. The more he focused on what felt good on the inside the more his autonomic dysregulation settled, and his window of tolerance expanded.

What makes each one of us feel vulnerable is unique and personal. What feels vulnerable to Lucas can feel quite different to another. Regardless of what activates it, the admission ticket to a more meaningful life for Lucas involved embracing vulnerability. It was important for him to liberate vulnerability from years of cumulative stress of dealing with homophobic bullying, and other fearful situations that he had to endure. By welcoming vulnerability and learning how to work with its transformative power, he was able to enrich his life. A “body-inclusive” therapeutic approach offered Lucas tools and practices to lower his activation and regulate his nervous system in response to his life stresses.

 




© Dr. Payam Ghassemlou MFT, Ph.D. is a mental health counselor in private practice in West Hollywood, California.  www.DrPayam.com

*Names and other details have been changed for privacy and confidentiality.

 

 

 

 

 

 

 

 

 

 

Tuesday, December 8, 2020

My Coming Out , A Journey Held by the Earth

 

My Coming Out , A Journey Held by the Earth

By

Payam Ghassemlou MFT, Ph.D.

There was a time I was struggling to make sense of being queer. I recall feeling shame for being different. It was a lonely and confusing period not being able to “act straight” and flow with the mainstream. At the time, I needed a refuge from my oppressive homophobic environment. Sometimes, I escaped into the safety of my imagination, and I saw myself as a river on a sacred land. As a river, I could move freely and flow into an ocean. The image of a flowing river felt liberating in my body, and it was a delightful contrast to feeling stuck in the closet of shame. I was too young to realize through such an image I was experiencing movement as an antidote to my oppression. I am grateful for the offerings of my imagination during such a painful period.

In my imagination, I often saw myself on a sacred ground. The concept of resorting to a sacred land was something I learned growing up. When faced with overwhelming feelings, some people in my family found peace by visiting sacred locations on the Earth. That is what my grandmother did. She traveled to Mecca after the loss of her husband to experience relief. The holy land made it easier for her to find solace. I thought about finding my version of a sacred land, a safe zone, free from judgment to locate my gay self and arrive at a place of self-acceptance.

The place that eventually offered me a refuge, and connection with other queer people was not in Mecca. It was a dance floor inside a gay bar. For an isolated gay youth starved for love and struggling to breath air that was not contaminated by homophobia, a  dance floor was his sacred site. I felt safe there. Living in a world that is tainted by racism, sexism, homophobia, transphobia, and xenophobia, any place that offers a sense of safety for marginalized people is sacred. In today’s perilous world, such a feeling  is sacrosanct. In June of 2016 when I heard about a mass shooting inside Pulse, a gay nightclub in Orlando, Florida, I felt devastated for those innocent queer souls who lost their lives. Perhaps many of them were there to find safety and connection just like I had done when I was in their age.

 My coming out was not only an inner journey of embracing my gay essence, but also a journey that is held by the Earth. At the time, I did not have the understanding that the Earth held space for me to come out . All the resources that helped me make sense of being queer were located on the surface of the Earth. For example, a coming out group, a dance club, a psychotherapy office, a gay Pride Parade, the LGBT Center, and the local gay bookstore can all be considered sacred locations. Any location that one’s authentic self emerges becomes blessed with a powerful transformational energy. The Earth has been a host to countless, meaningful, and transformational experiences which has contributed to the sacred nature of the Earth.

The Earth needs to be included in my coming out story because I am never separate from her. In fact, my body is made up of elements that belongs to the Earth. Given the current consumeristic mentality and the ecological crisis, I welcome any opportunity to bring awareness to “the cry of the Earth.” We can no longer live life unconsciously, given how much we know about the state of the planet. It makes me feel sad to witness humanity replacing fish in the oceans with plastic, rivers with nuclear waste, forests with urban housing, clean air with pollution,  and turning the ecosystem into a garbage bin. As I painfully witness ecocide on Earth, I feel the urgency to respond to her cry.

My coming out story is part of the larger story of humanity’s movement toward love and liberation. We all want freedom to love. It hurts deeply to shame a human being for such a natural desire. Throughout human history and in most places on the Earth, countless numbers of innocent LGBT people have lost their lives through hateful acts; therefore, I consider the Earth as one giant shrine. The Earth has been witnessing humanity’s story, and I witness her mistreatment and exploitation of her natural resources.  

As a gay man, I honor my gay ancestors who had strong bonds with all life on Earth. As a LGBTQ community, I hope we relate to the Earth as our shaman ancestors did. Our survival depends on treating the planet as a sacred being in need of love. As the Earth’s holocaust is taking place, we as queer people can play a major role in stopping it. The LGBTQ community suffered their own version of a holocaust when the AIDS crisis took many lives of our people. Triumphs like the way we took care of our dying people during this crisis, and how far we have come in our struggle for equal rights are truly a reflection of how courageous we are as a community. Our courage can continue to stop forces of greed that are destroying our echo system. There's still time to love the Earth back to health.

 



© Dr. Payam Ghassemlou MFT, Ph.D. is a Licensed Marriage and Family Therapist (Psychotherapist), in private practice in West Hollywood, California.  www.DrPayam.com , www.SomaticAliveness.com

 

 

 

Monday, July 20, 2020

The Queer Body Remembers: Somatic-Focused Trauma Healing By Payam Ghassemlou MFT, Ph.D.

For many LGBTQ (lesbian, gay, bisexual, transgender, queer/questioning) people growing up was  distressing due to homophobia and transphobia. Schools felt like a scary place for those who were scapegoated as queer. LGBTQ people of color reported even worse experiences due to the additional stress of racism and racial bullying. Many of the gay men’s personal narratives that I have heard are not vastly different from my own. Regardless of national origin or skin color, we are part of a tribe with similar stories of growing up in a homophobic and transphobic world where our true essence was repeatedly assaulted. As LGBTQ people, we have connected around the theme of “love is stronger than hate” which raised awareness about our injustice and suffering. Addressing these issues have helped people to become more concerned about the mistreatment of not only LGBTQ kids, but also any youngsters who do not flow with the mainstream. More work needs to be done to make the world a safer place for marginalized people. Anyone dealing with oppression does not deserve to suffer in silence and needs encouragement to reach out and get support. Love and healing  is more accessible than our painful moments want us to believe.

Injustice and trauma that were inflicted on LGBTQ people as result of growing up in an oppressive environment deserve empathy and healing. When it comes to healing, psychotherapy offers a variety of approaches to work with trauma, including the ordeal of growing up gay in a heterosexist world. Many mental health professionals who work with LGBTQ clients often rely on a “top-down” approach, which  focuses on the highest form of cognition that involves changing thoughts. Moreover, it challenges clients’ negative belief systems and their cognitive distortions. Many clients have benefited from cognitive restructuring in psychotherapy and developed skills in identifying and disputing irrational or maladaptive thoughts. In my clinical experience, when it comes to healing from years of assault on one’s core identity including feelings of shame and humiliation for same sex attraction, a cognitive approach is neither enough nor always possible. For many queer trauma survivors whose thinking brain gets hijacked by  trauma memories and their bodies default to a fight-flight-freeze response, a body-centered approach or bottom-up processing is necessary to calm their arousal systems. Relying on the thinking brain as the only path to deal with the root cause of trauma symptoms is not effective. The brain parts that are responsible for reflexes, memories, and automatic survival responses are in the deeper regions of the brain, and trauma informed therapy needs to begin by focusing on those areas.

Educating clients about a bottom-up approach, and the basic working of the nervous system can help enhance and clarify the somatic focused therapy process. For many LGBTQ clients, trusting a professional or an authority figure might not be easy due to their history with a discriminatory health care system, religious bigotry, police violence, school trauma, and family betrayal. Establishing a therapeutic alliance with LGBTQ clients can be facilitated by explaining the therapeutic process including the key role the nervous system can play in trauma recovery and asking their permission to provide somatic-focused therapy.

Our body comes with an already built-in autonomic nervous system (ANS) that provides many vital functions. The ANS is the part of the nervous system that governs the fight, flight, or freeze instinct and is responsible for the unconscious bodily functions like breathing, digesting food, and regulating the heart rate. It also plays an important role of supplying information from our organs to our brain. The ANS is central to our experience of safety, connection with others, and our ability to bounce back from life’s overwhelming experiences. Relying on neuroception, a term coined by Dr. Porges, our ANS is able differentiate between safety, danger, and a life threat. Neuroception, as Deb Dana (author of  The Polyvagal Theory in Therapy) explains, is automatic, and it does not go through the thinking part of our brain. Everything from sound to smell to temperature in our environment, people’s tone of voice, and eye contact can influence our neuroception.  It  is like a “guardian angel” that helps us take immediate action in the face of danger or threat. The goal of neuroception is to keep us safe and alive.

Pat Ogden’s, Stephen Porges’, Bessel van der Kolk’s, and Peter Levine’s research and writings have expanded my understanding of the autonomic nervous system as a relational system that has been shaped by experience. We now know previous negative experiences and traumas can significantly affect how our nervous system accurately assesses safety, danger, or a life threat. This can explain why many LGBTQ people with history of being judged, humiliated, and violated often suffer from anxiety that stems from faulty neuroception.

Neuroceptive conditioning based on previous homophobic and transphobic mistreatment can cause many LGBTQ people to feel unsafe even where there is no real threat. What we hold inside in the aftermath of trauma can cause us to over-react in a safe environment or not react correctly in a dangerous situation. A body inclusive therapy can help to support the ANS to move out of a dysregulated state into a biological state of safety and connection.

There are many body-oriented methods for trauma healing including Somatic Experiencing (SE) which was founded by Peter A. Levine, Ph.D. His curiosity about animals in the wild getting exposed to life-threating situations without getting PTSD while humans frequently succumb to the disorder was the start of  SE’s development. SE is a body first approach that helps people discover where they are stuck in the fight, flight, or freeze responses, and how they can “resolve these fixated physiological states.” SE is a powerful trauma healing medium that includes working with sensations, movements, postures, and gestures as a way of deepening resilience and to reset the nervous system. According to Dr. Levine, the ANS can become dysregulated due to “the thwarted responses of fight, flight, or freeze” in the aftermath of trauma. A body-oriented approach like SE can help stop trauma to become “a life sentence”  through “gently releasing thwarted survival energy bound in the body.” To do this, Dr. Levine developed SIBAM as a method to accurately track a client’s inner experience. In his writing, he described SIBAM as an acronym for: “Sensation (Internal-Interoceptive), Image, Behavior (both voluntary and involuntary), Affect (feelings and emotions) and Meaning (including old/traumatic beliefs and new perceptions). These five elements are the channels of experience that occur during a session.”

LGBTQ people who grow up with mistreatment can discover the tales of their abuse written in their nervous system. The queer body remembers the experience of growing up in a world with cruelty. Having over two decades of providing LGBTQ affirmative psychotherapy along with research and numerous trainings on body-mind therapy, I have learned cruelty and cumulative stress of mistreatment can become embodied during a person's life and affect the working of the ANS. For example, one gay high school student with symptoms of anxiety disclosed to me that he hears several homophobic remarks a day along with experiencing bullying and harassment. Such ongoing stress from homophobia can activate his sympathetic system (“stress response” or “fight or flight” response). Naturally as a target of hate and mistreatment, he wants to defend himself or escape the abusive situation. Often due to lack of protection for many LGBTQ youngsters, during such abusive situations neither fighting nor fleeing can resolve the overwhelming situation. As a result, the energy that gets locked inside him for not being able to fight or flee causes trauma symptoms. In other words, the thwarted or incomplete fight and flight responses can become “trapped” within the youngster’s body and dysregulate his nervous system. Such a dysregulated nervous system is likely to get stuck on “high” or hyper-arousal. Anxiety, panic attacks, rage, hyperactivity, mania, hypervigilance, sleeplessness, exaggerated startle response, digestive problems, and many other symptoms are the result of a dysregulated nervous system that is stuck on “high” or hyper-arousal.

On the other hand, there are those of us whose nervous systems can stuck on “low” or hypo-arousal, which can result from being terrorized growing up with no hope of protection or escape. For example, faced with isolation, confusion, bullying, physical attacks, and ongoing lack of safety is too stressful for any child to endure, especially when there is no empathic other to help the kid. Such experience is often beyond the youngster’s “window of tolerance” (a term coined by Dr. Daniel Siegel). This is when the dorsal vagal (dorsal branch of the vagus nerve as discussed by Dr. Porges’ Polyvagal Theory) can shut down the entire system, and the mistreated youngster can go into freeze. In other words, the child suffers in silence with numbness or dissociation as his only available survival mechanism. Dorsal vagal is instrumental in activating the “shutdown” of the body in cases of overwhelming fear which can result from trauma. This automatic survival mechanism can become a long-standing pattern of how individuals might cope with fear and stress in life. For instance, people whose nervous system is stuck on “low” or hypo-arousal when faced with life stresses can default to shutting down, disassociation, chronic isolation, detachment, numbness, and suicidal thoughts.

As stated, trauma symptoms are the trapped energy from the "incomplete defensive response" (fight, flight, or freeze) and healing involves helping the body to release such thwarted responses. Working with many members of LGBTQ community, I have noticed when the nervous system gets stuck on freeze, when numbness and detachment become a gay man’s dominant state, he is more likely to engage in risky behaviors as a temporary relief from inner deadness. Thrill seeking behaviors such as, excessive gambling, hypersexuality, and crystal meth (crystal methamphetamine) use are few examples of  how some gay men escape the emotional flatness that results from experiencing the hypo-arousal state. The same behaviors can also be used to cope with ongoing activation of the fight or flight response. One person might turn to substance abuse or other perilous behaviors to escape his inner deadness while another person might use it to dampen his anxiety that often results from being stuck in a state of hyper-arousal. It is important to note that the trauma is at the root cause of such a maladaptive way of coping.

As discussed earlier, as a “bottom-up” approach, SE focuses on the brain stem and its survival-based functions first rather than insight and emotions. Dr. Levine developed SIBAM to chart this “bottom-up” process, working from body to emotions and cognitions. The SE session involves teaching the client to track body sensation including the sensations related to the traumatic event. Experiencing  body sensations related to homophobic or transphobic events in a safe way allows the client to process the trauma. Often the client might experience discharge of the traumatic energy through heat, vibration, shaking, or tears. Such healing approach can reset the nervous system and restore inner balance. For example, Cyrus (names and other details have been changed in respect for privacy and confidentiality) a cisgender gay Iranian man who grew up suffering from homophobia and racism, came to therapy to work on his “coming out issues.” After he felt safe enough to address his traumas, our work progressed in helping him to develop awareness of “felt sense” of his internal states.  We worked slowly and paused periodically to notice any sensations, movements, impulses, images, gesture, or feelings. Sometimes he experienced an uncomfortable heavy sensation in his chest and stayed with it short of getting overwhelmed. Other times he noticed spontaneous movement of his body rocking from side to side which felt soothing for him. We paid attention to any subtle movement or protective responses that was coming up. For example, one of the protective responses that was not available at the time of dealing with school bullies was emerging. I invited Cyrus to notice the movement of his hands and what might be coming up. He described sensing strength in his arms and an impulse to use his hands to push back. By slowing down the process, he was able to work with that impulse. By tracking his body sensations and movements, Cyrus was able to move through painful events and discharge the trauma energy by spontaneous trembling and shaking. In addition, alternating, or “pendulating,” between the sensations associated with the traumatic event and those that are a source of safety and strength was part of the process that supported his ability to self-regulate. Eventually, our work together led to the embodiment of his pride in being a gay person of color. It also helped Cyrus not letting his past traumas become a life sentence. He discovered love and a sense of safety is more accessible than his past wants him to believe.

On the path to recovering from trauma and living a passionate life, one needs resources. In Sensorimotor psychotherapy, Pat Ogden describes resources as, “anything that enhances the quality of our lives or provides what we need to meet life’s challenges.” She also discusses in details different categories of resources including internal resources and external resources. It is important to note, a resource needs to be tailored to the needs of the individual. For instance, some clients might find certain body movements like rocking or dancing helpful. Their body might respond positively to such an experience by releasing tension. Other clients might notice feeling lighter in their body after watching a comedy or playing with their pets. No one should feel judged for not finding certain resources helpful. One size does not fit all.

One of the resources that can benefit gay men is the discovery and the embodiment of the meaning of their gayness or queerness. In one of my articles, “Gays in Search of Meaning,” I discussed by embracing what is inherently purposeful about our gayness, we can start to live a more soulful life. Helping gay men to connect to their gay essence and find the numinous qualities inherent in being gay can be an enlightening process. Gay people have an advantage as far as enlightenment is concerned. Most gay people grow up feeling "different," and that differentness helps to not identify with the collective. As Eckhart Tolle, the author of The Power of Now, suggested,

"...realization that you are different from others may force you to disidentify from socially conditioned patterns of thought and behavior. This will automatically raise your level of consciousness above that of the unconscious majority, whose members unquestioningly take on board all inherited patterns. In that respect, being gay can be a help. Being an outsider to some extent, someone who does not fit in with others or is rejected by them for whatever reason, makes life difficult, but it also places you at advantage as far as enlightenment is concerned."

It is important to note concepts like soul, enlightenment, or spirituality can be triggering for many LGBTQ people who were harmed by homophobic religions. Throughout human history, many  religious institutes have committed atrocities against LGBTQ people. In the name of their god, they have murdered queer people or denied them their human rights. For many LGBTQ people who were target of hate by homophobic institutions, knowing their right to a soulful life with depth and purpose can be a resource. Such awakening can become embodied when it is done within the context of somatic therapy. In my experience, many gay men have added meaning and a sense of aliveness to their lives by participating in body inclusive psychotherapy while working on discovering a deeper meaning of being gay. Such feeling of aliveness and its underlying bodily sensation is in contradiction to the fear and humiliation that many gay men had to endure growing up in a heterosexist world. In Body Keeps the Score, Dr. Bessel van der Kolk writes about a body-centered approach to healing allows “the body to have experiences that deeply and viscerally contradict the helplessness, rage, or collapse that result from trauma.”

Finally, how far the LGBTQ community has come in the struggle for equal rights reflects how brave we are as a community. Our bravery can continue by facing traumas we experienced growing up in oppressive environments that did not nurture our true essence. Not every LGBTQ person felt traumatized growing up, but those who did can benefit from the vitality and the sense of liberation that comes with incorporating somatic work as part of the healing process As Resmaa Menakem, the author of  My Grandmother’s Hands stated, “Healing does not happen in your head. It happens in your body.”

 

© Dr. Payam Ghassemlou MFT, Ph.D. is a Licensed Marriage and Family Therapist (Psychotherapist), in private practice in West Hollywood, California.  www.DrPayam.com , www.SomaticAliveness.com



 

 

 


Sunday, April 26, 2020

A Somatic Approach on Working with Depression and Negative Self-Talk By Payam Ghassemlou MFT, Ph.D.





Depression is common and treatable. It can strike anyone at any age. Consulting with your physician or a licensed mental health provider is the best way to find out if you are suffering from depression and the type of depression you might be having.



A person with depression can experience a few or many of the following symptoms:



Feelings of sadness and emptiness



Feelings of anxiety



Experiencing restlessness or irritability



Losing interest in all or most activities



Problems with appetite that can lead to weight gain or weight loss



Sleeping problems



Loss of interest in sex



Low energy that can include feeling tired much of the time



Difficulty with concentration or making decisions



Feeling negative towards oneself including worthlessness or excessive guilt



Feeling hopeless or helplessness



Crying spells



Increased use of alcohol or drug use in order to cope with a depressed mood



Thoughts of death/suicidal ideation



Many people might not have the awareness that the underlying cause of the above-mentioned symptoms is depression; therefore, they cannot get the treatment they need. It is difficult to treat something that one has not identified yet. Over time, serious levels of depression that are not addressed get worse and can lead to other health-related issues. It can even lead to suicide.



There are different kinds of depression; hence, one person’s needs will differ from those of someone else. Psychotherapy is the most common treatment for depression. Psychotherapy can help on many different levels including integration of the clients’ body experiences in relation to their thoughts and emotions along with resolving or coping with issues that may contribute to their depression. Most mental health providers agree treatments for depression with suicidal ideation or other serious symptoms require a combination of antidepressants and psychotherapy. Some patients who might not show progress with standard treatments for depression might need additional resources.



In my counseling work with people who suffer from depression, I often notice that they have an inner critic which constantly makes them feel discouraged, inadequate and in many cases worthless. When the inner critic is the dominant voice inside a person, depression is likely to be present. Identifying the inner critic can be done by encouraging clients to pay attention to their body and their nervous system activation. For example, when Jack noticed his neck and shoulders curved forward, his head looking down, and unpleasant tension in his jaw, he was invited to become curious about this body language. The body language is a voice that does not use words and always tells the truth. He discovered an inner dialogue associated with this body posture, and it involved the following thought, “I am going to lose my job.” He realized how often he tells himself that his job is at jeopardy. When he was invited to examine all the reasons that he won’t lose his job, and all the resources that can help him to find another job in case he was let go, he noticed a shift in his body. He started sitting up straight with his shoulder pushing out, his jaw loosened, and he reported feeling more confident. He was encouraged to embody this new level of confidence by noticing all the positive shifts in his body including his deeper breath and feeling more relaxed in his shoulders. By tracking his pleasant bodily sensations that he was experiencing as result of identifying helpful resources, he was creating a physiological event in his body which led to regulating his nervous system. This can be a powerful approach to help someone suffering from negative self talk to use their body as a resource to modify such self-defeating dialogue.



There are many ways to work with negative inner dialogues and painful emotions that accompany them. It is helpful for clients and therapists to explore different treatment options as they work together. A collaborative therapeutic approach helps people to feel empowered and  in control of their recovery from depression.



Working with a mental health therapist to explore treatment options for depression is an important step toward healing. I hope anyone who is suffering from depression reaches out and gets the help they need. Everyone’s pain is unique, and no one deserves to suffer in silence. Reaching out and asking for help is a courageous act that people can do in response to suffering from depression.




 © Dr. Payam Ghassemlou MFT, Ph.D., is  a marriage and family therapist in private practice in West Hollywood, California. www.DrPayam.com 
www.somaticaliveness.com 

Sunday, March 8, 2020

Dr. Payam's Garden of Quotes



For any writers, actors, musicians, painters, and other artistic people, it takes a great deal of courage to reveal their cr


eative work. It is incredibly brave and  can make one vulnerable. My goal is to support all artists to  put their fears aside and share this valuable part of themselves.


























































https://www.drpayam.com/dr_payams_quotes