Hello, Ashland

Goodbye to Bend and all the great people, clients, professionals, and friends and acquaintances, I met and helped or was helped by. It is time to move on, though. While we felt as if, after 3 growing seasons, we had finally mastered small greenhouse gardening in an  inhospitable climate with no soil,  what we really wanted was a place to grow food and watch nature thrive.

Hello Ashland! Up here in the woods, amazingly only 15 minutes from town, clients will be invited to see me in a private space, with the sounds of nature to add to the ambiance. It was gratifying to see our garden immediately begin to thrive as it never had in Bend, and I know the beautiful environment will enhance the healing that occurs for my clients. In-person sessions will begin Sept. 1 in this new space.

I also welcome intensive clients starting Sept. 1: Medford is 30 minutes away and Ashland less than 15, and both have a variety of hotels, motels, B&Bs, and hostels, as well as a fine selection of eateries and groceries. We are 30 minutes from the Medford airport. While a therapy intensive is hardly a vacation, traveling to a beautiful spot far from your daily environment offers a unique opportunity to break old patterns and create new ones. Follow-up in person or via video-chat assists you in maintaining your new learnings in your home environment. 

It has been stressful to move many miles for the second time in 2 years, and perhaps I have learned some new things about managing stress and the ways in which change affects me and others as well. Stress is always both good and bad: it forces new ways of seeing things and behaving, but it can cause strain on the system. Moving changes one's relationship to others, to resources, and to oneself. Out with the old, in with the new, to coin a phrase!

The new incarnation of the Center for Conscious Living will offer individual and family therapy, Rational Emotive Therapy, which is the elegant, effective precursor to CBT,  Sensorimotor Trauma Therapy, and clinical hypnosis. I will continue to focus on physical symptoms that bridge the mind-body gap such as gut issues (irritable bowel, cyclic vomiting), headache (migraine, cluster headache), and chronic pain (RSD, CRPS 1, fibromyalgia); those difficult-to-treat issues that often defy medical treatment. Call for a free phone consultation.

Meanwhile, I shall be learning about my new environment and preparing a new space for seeing clients.

Memory Again

Today is a snow day, so between bouts of shoveling in 5 degree weather, I am perusing the web. Coincidentally, today's hot topic in the places I read is memory. How accurate is memory?, how easily can memory be falsified?, is there such a thing as recovered memory?, what does memory research teach us?

For me professionally, understanding memory is important in the process of doing psychotherapy. After all, it is with people's memories that I work all day.  Early in my career, I learned that with psychotherapy the validity of a memory is less important than its impact. A client might recall an event as a painful experience, and that memory can have a present-day effect on his mood. That effect does not affirm the accuracy of the memory, just its impact. The impact is what I work with, as I can never know, minus sources of corroboration, whether my client's memory is precise.

Whose Pain Is It?

Having recently arrived in Oregon, studied diligently for (and yes, passed) my ethics exam, and at long last, received my license, I had a few months in which to explore the clinical issues prevalent in my new environment. Chronic pain kept popping up in conversation, sometimes right after "oh, you do hypnosis," and sometimes before.

What I gleaned from my participation in clinical groups and meetings was that the chronic pain treatment pendulum has swung once more. In short, and without citation: Long ago, MDs prescribed heavy doses of medication for pain patients, chronic or acute. The pendulum then swung to a fear of creating addicts. This was not entirely unfounded, as overprescribing of serious pain medication was rampant, and addiction was up. (When my children left a dentist with Vicodin for the removal of wisdom teeth, I knew something was not right). So docs lived in fear of government repercussions for overprescribing, and, as with most pendulums, now it had swung too far, and even deathly ill patients were constrained from receiving comfort, by over-regulation. Back it went, and back came too many addicted patients along with, guess what? too much chronic pain.

The Pain, You See, Is in the Brain

I know--really I do. You are in pain. Real pain. Nothing seems to make it go away--medications dull it but little, and you are earning to plod along in life with pain. You feel as if everyone thinks you are faking; especially doctors who tell you to see a psychologist, and refuse to renew your prescriptions. You are indeed pretty tired of doctors. Your physical therapist keeps pushing you to exercise, but everything hurts. What is going on?

You know you are not faking, but you are really confused: why do the standard treatments not work very well? And when are you finally gong to get a decent night's sleep?

I shall start at the beginning and work my way around to your question.

Pain is a signal from the brain to the body to stop doing what it is doing because something is wrong. Most of the time, this is a good system. You do not walk on a broken leg until it is set. You take your hand off the hot stove and treat the burn. You go to the doctor when your stomach hurts and find out why. Pain tells you something is off and you get it taken care of.

A grey area exists after you have gotten treatment or discovered why you have a headache. The pain persists to remind you to be careful. Most of the time this is useful--you do not want to re-injure yourself nor do you want to overdo something after surgery. On the other hand, these are things you can figure out on your own and perhaps get help to minimize the pain. That is why it is ok to take pain medications after you have had the issue diagnosed and especially after it has been treated, but has not fully resolved.

So far, so good. But your pain, you say, has been treated, and nothing more is wrong that a doctor can discern, but it has not at all gone away. This is where that referral for psychology comes in. NOT because "it is all in your head", but because it is all in your head! To be clear, all pain comes from your brain, right? But if the pain in the brain did not subside with proper treatment, then the brain is signalling something is still wrong. Now the something is more difficult to discern, because the causal link is not clear. A broken leg gives you leg pain. This pain might be in your leg, your back, or your shoulder, but apparently that does not mean you have a problem in your leg, back, or shoulder this time.

Vexing Illnesses!

I am just back from presenting at the American Society of Clinical Hypnosis Annual Meeting with my colleagues, Julie H. Francis, GCFP, and David C Flemming, MD. We presented our fascinating workshop on uncovering the reasons for puzzling medical problems such as intractable chronic pain, migraine, IBS, interstitial cystitis, and autoimmune disease. The blanket term I use for these problems is "medical disorders of dysregulation."

These illnesses are vexing to physicians because they do not follow the rules. Medications tend not to work, there is no surgery that fixes them, and even the cause is elusive.

These problems are even more vexing to those of you suffering with such a condition for those same reasons. No one seems to be able to help. Now and then something seems as if it is helping and then you are let down when your symptoms return.

The work I have done in my office, and the work I have shared with various colleagues, leads to some interesting conclusions with the potential to help many of you. First and foremost, we know that you are not pretending, faking, or, worse, crazy. You have symptoms, some of which are visible or measurable, others of which are subjective--you hurt, but it cannot be seen by others.

The Myth of Mental Illness and the Late, Great Thomas Szasz

For those who know me, you know that I dislike diagnoses. My clients have to specially request a diagnostic code to put in the little box their insurance demands in order to reimburse them. I treat people, not diseases. I treat people, not disorders. I treat people, not symptoms. I work at treating them with respect--respect for the ultimate fact they while I guide a healing process, it is the client who cures herself. Or to use words Dr. Szasz might use, it is the client who solves her own "problem in living".

People come to me with vexing life problems. They have chronic pain that has mystified a handful of competent physicians. They have had anxiety since grade school, and it has now blossomed into panic attacks. They feel depressed and unmotivated. They have failed to lose weight despite having tried a score of conventional means. My job is to look at the individual in front of me, and learn what ails her and how it may have come to be so. I apply a kind of scientific method where I form hypotheses with the help of the individual in my office, and we challenge the hypothesis with a treatment plan--if it works, it was likely true, or at least close enough to true to solve the problem.

Dr. Szasz and I have had our differences on some delicate points--can some of this material I help to discover and interrelate be hidden in the unconscious, and my client not know about it? Can historical events cause strange symptoms today that the client has not chosen as a solution, but rather that seem to have chosen her? Can my client essentially develop symptoms that solve a problem in an unfortunate way that she is consciously, directly, unable to alter? Is there a scientific way to apply psychotherapy? Dr. Szasz was quite clear that the answer to all of these questions was no. I, on the other hand, am clear that the answer is yes.

Those minor differences aside, the legacy of Dr. Thomas Szasz is immeasurable. He championed the human mind. He fought the psychiatric state--the ability of the government to control individuals by means of their mental state. He fought the medicalization of psychology, thus attempting to empower the individual to change himself rather then being at the mercy of a physician. Dr. Szasz did not believe in "helpful coercion" --a phrase that chills the blood. For me, reestablishing or maintaining the power of my client to change is the essence of good therapy.

Center for Conscious Living.......a name with a meaning. I see my task as helping you, the client, my employer, to improve the quality of your life by guiding you to discover and use your personal power to change. Yes, I guide and you do the rest of the work. Sorry, but there is no magic pill. What there is is power--the power you discover to help yourself! The joy of my work comes from seeing clients find and utilize their power and--um--get me off the payroll (not that I would mind if they gratefully paid me forever.....). Stop therapy because you are better, not because you are bored! Contact Dr. Low at the Center via e-mail: drlow@pobox.com, or phone. 630-249-1983. I look forward to hearing from you!

In Defense of Pain

What?! Defend pain? Whatever for?

Because pain is an all-important indicator that something is wrong--that you should look to your body's needs, stop doing something that hurts, pay attention.  Ever since the advent of the "Excedrin headache", we have expected to be able to instantly get rid of pain.  We have developed a zero tolerance attitude.  Instead of learning from our pain, we tend to search and destroy--find a pill that will make it go away:  "I do not have time for this headache, I have to work, take care of the kids, run that marathon......"

What this attitude does is cause us to neglect the real cause of the pain, whether it be overwork, dehydration, or a brain tumor or sprained ankle.  We want the pain gone, but we do not have the patience to slow down and find the real source of the pain.  Sometimes this works fine--sometimes that trip to the doctor provides some advice and gets you a medication that works, and the pain never returns.   Your sprained ankle heals, you rehydrate and feel wonderful.  As long as you remember to follow that advice, which includes resting the ankle and hydrating regularly--actually making a long-term, but fairly easy change, you will remain fine. Other times, you end up neglecting the real source of the pain, and it just keeps coming back.  Those are the times we need to look at more closely.

So you get tension headaches every week or so, or have a pain in your side that never quite goes away, or worse, you have a chronic condition such as fibromyalgia, CRPS (RSD), migraine.  The doctor gives you a lot of medication and it dulls the pain, but you never feel quite right.

Let's start with that tension headache.   Tension, right?   What do you do in addition to taking medication?  Do you look for the source of the tension?  No, because you know it--whether it is the boss, the kids' school, your impending promotion, the mortgage, or all of those, you know what it is, and it feels unchangeable.   Not quite.  What you can change is how you perceive and handle those life stresses,   and how you deal with the repercussions in your body.   You can learn to manage stress differently AND treat your body better.   Perhaps you get a therapist to teach you Rational-Emotive Therapy and start doing massage or Feldenkrais® treatments.   Or perhaps you learn meditation and start yoga classes.  Making those two types of changes in combination, you can get many stress-based pain conditions to remit completely. 
In the case of a more serious chronic condition, the cure is similar, but less simple.  The precursors may be a lifetime of stress or a history of trauma.  Then you got hurt in a car accident, and your body just seemed to betray you.  Everything hurts, and nothing helps.  These conditions require a more detailed approach to restoring comfort--a look at your history to heal the inner pain as well as a thorough examination of how you embody and maintain the pain.  Deeply experienced stress and trauma change the body, the brain, and YOU.  But even these very deep, longstanding  changes are repairable with therapy for the mind and the body. 

Remember that your mind and body are a totality rather than two separate entities.  Thus to completely cure any pain, we need to look at our lifestyle, our habits, and our history.  Pain is a signal to stop and listen to the body.   Pay attention to your body, take care of its deepest needs, and it will rarely betray you.

Trauma, Pain, and the Freeze

I get many questions about the link between pain and trauma.......for a start, chronic progressive pain syndromes like "complex regional pain syndrome type I" (formerly known as "RSD") have their basis, not in organic injury (though they often start with an injury), but in the flight, fight, freeze syndrome. In a moment of shock or fear, the system goes into auto-pilot and cuts off certain self-healing behaviors to assure safety. Sometimes, even after the injury heals and the moment of fear (auto accident, fall down the stairs, etc.) is over, the brain does not kick into recovery mode, and continues to perceive the limb as injured. We call this dissociation--in this case a divergence between perception and reality causing faulty operation of a system. This has the effect of rendering medication, surgery, and physical therapy ineffective (sometimes even harmful), as the key to healing is actually changing the perception! The freeze mode is an endorphergically charged pattern, which prevents even the strongest pain medications from breaking through, and represents wild oscillations of the autonomic nervous system, which can cause anxiety, insomnia, digestive difficulties, memory and concentration deficits, and, of course, PAIN. The key is in the brain--getting the perceptions in line with reality and exiting the freeze. RSD? Call for more information--you can learn to feel well!