Lisa Find Love

You know your friend is struggling with depression or anxiety or some other mental health issue, but you don’t know what to say. You feel like anything you think about saying just sounds stupid and patronizing.

You also aren’t sure what to do. After all, you don’t want to intrude. You don’t want to be pushy, or bulldoze over their privacy. Or you already feel overwhelmed by something difficult in your own life.

Still you want to help. You just wonder, How?

Psychotherapist Colleen Mullen, Psy.D, LMFT, noted that many of us worry that we’ll just make the other person more upset or uncomfortable by revealing that we know something’s wrong.

Or maybe we don’t realize the extent of their pain. “I’ve seen many times how family members said in reflection, ‘I thought they were just going through something’ or ‘I didn’t think they were that depressed,’” said Mullen, founder of the Coaching Through Chaos private practice and podcast in San Diego.

Before her bipolar II disorder diagnosis, Julie Kraft also might’ve distanced herself from friends with mental illness—“not out of not caring, but rather, out of not knowing how to care. My silence would have only been a result of being terrified of saying or doing the wrong thing.”

However, there are many ways we can help—small ways that can be significantly helpful and supportive.

For Fiona Thomas, a writer who has depression and anxiety, this looks like a loved one ordering takeout and making her a cup of tea. “Feeling taken care of is a massive support because often I feel so mentally stimulated that I can’t do simple tasks or make decisions,” she said.

Thomas also finds it comforting when her husband tells her these words: “You won’t feel like this forever.” He reminds her of specific times they’ve laughed or enjoyed themselves, which reminds Thomas that “sad feelings do pass eventually.”

Below are other tips and examples of small ways to sincerely support someone when they’re struggling.

Check in. According to Thomas, author of the book Depression in a Digital Age: The Highs and Lows of Perfectionism, “the worst thing you can do is assume that someone with a mental illness will ask for help when they need it.” That’s because their instinct might be to isolate themselves (plus withdrawing from others is a symptom of depression).

Thomas suggested simply checking in, which might be anything from sending a text to see how they’re feeling to stopping by with food or their favorite coffee just to talk.

As Mullen added, you also can simply say, “Hi, I was thinking of you and wanted to connect.”

Ask directly how you can help. Kraft, author of the book The Other Side of Me: Memoir of a Bipolar Mind, suggested asking this question when the person is feeling well. “Doing this increases the chances of getting an honest answer, without a wall of defensiveness, hurt feelings, pride getting in the way, or being completely shut out,” she said.

Carolyn Ferreira, Psy.D, a psychologist in Bend, Ore., suggested saying: “I want to help you, but I’m not sure how. How can I really help you? What would you like me to do? What would you like me to say? What do you want me not to do?”

Offer specific examples. Sometimes, the person isn’t sure what they need. Sometimes, they don’t want to burden you. And sometimes, they’re simply too overwhelmed to think about it.

Ferreira shared these specific examples you might suggest: helping with finding a therapist or an inpatient program; providing childcare so they can get to a counseling appointment; giving a hug or advice; or just listening. For instance, you can say: I’d be happy to watch your kids while you go see your therapist.

Help with daily tasks. “During my darker times, it is easy for me to get overwhelmed by the normal daily tasks that come with being a busy wife and mom,” said Kraft, who has three children. “Getting groceries, keeping my house clean, or doing laundry can sometimes seem like climbing Mount Everest.”

This is why having a friend help with these daily tasks or just offer their help can be invaluable. “Sometimes just knowing that I have a support system waiting in the wings is enough to help me push through,” Kraft said.

Express your love and acceptance. Both Kraft and Ferreira stressed the importance of telling the person that you love and care for them. “This can fill our tanks and give us a reservoir of positivity to light up even our darkest moments,” Kraft said.

Ask thoughtful questions. For Kraft, it also means a lot when people take a genuine interest in trying to understand what it’s actually like to live with bipolar disorder. After all, part of being a compassionate friend is trying to see the world through the other person’s eyes, and heart.

Honor their tendencies. Respect how the other person wants to be supported—and how they are (if you know this). For instance, for Kraft, a self-described extreme introvert, phone calls are uncomfortable and “represent a million possible requests that I won’t be able to say ‘no’ to.” So when a friend texts or emails her, it means that they’ve not only listened but “are now respecting the way I’m wired.”

The same goes for when a friend suggests a coffee date a few months in advance, as “spontaneity does not exist in my world.”

“I feel incredibly safe and understood in that relationship. It all sends a powerful message to me that I’m not weird, I’m not high-maintenance, and I’m surrounded by people who are willing to help make life a little easier for me.”

Ask if they’re suicidal. This, of course, can feel like a scary topic to bring up. Many people also worry that if they ask this question, they’ll be putting the idea in the other person’s mind. You won’t. As Ferreira said, if the person is struggling with depression, chances are they’ve already thought about suicide.

She suggested directly saying: “Sometimes people who are depressed have thoughts of suicide; I’m wondering if you’ve had thoughts of suicide.” If they say they haven’t, she suggested telling them that they should let someone know if they ever do have these thoughts.

If they say yes, Ferreira shared these additional suggestions:

• Take them seriously, and encourage them to seek professional help. “Don’t assume that they’re looking for attention or being dramatic; they are more likely than not hurting greatly emotionally if they are thinking that death sounds better than living.”
• Empathize. Saying something like “I can see why you would be having those thoughts given your situation” can help the person to “feel heard and less likely to commit suicide.”
• “Tell them how much you love them and care for them.”
• Offer to keep them safe. Ask them if they have any specific suicidal plans—and if you can store any weapons they might have. (If you don’t want to do this, ask if there’s anyone else they can give the weapons to.) Some of Ferreira’s clients have asked their friends to hold onto their firearms when they’re suicidal.
• Check in regularly. “Some of my suicidal clients find it helpful to have some type of accountability or something to look forward to, so suggest a time when the two of you can send a quick text throughout the day.”
• Ask about their reasons for living—“and encourage them to keep showing up for those reasons.”
• Let them know that a lot of people experience depression (or whatever their illness) and suicidal thoughts at some point in their lives—and both are highly treatable. “People do feel better.”

For more information, check out this article on what to say to someone who’s suicidal, which also includes other helpful resources.

Ultimately, the kindest thing we can do is what we’d do for any loved one struggling with anything: Be there. Be there to listen. Be there to sit with their pain. Be there to encourage them to seek help. And be there to take some of the load off their shoulders.

“It is so comforting for me to simply have the knowledge that I have people in my life that haven’t backed away and have accepted me for who I am,” Kraft said. “People who have stayed. People who have let me know that if I did need them to deliver a meal or pick up my kids from school, they would. Without judgment.”

Through discoveries in immunology, we know that inflammation has an impact on physical illness. What remains unclear is how inflammation influences thoughts and behaviors — a question that intersects the fields of immunology, neuroscience, psychology, and psychiatry. In The Inflamed Mind: A Radical New Approach to Depression, Edward Bullmore explores how inflammatory changes could impact the way the brain works, resulting in symptoms of depression as a result of the inflammation.

Bullmore is certainly knowledgeable about this area. A psychiatrist with expertise in neuroscience who is in the development stages of anti-inflammatory drugs for depression, he leaves the reader with a promise of more to come.

Bullmore provides a thorough analysis of the latest research on how inflammation might cause depression. Although much is still unknown, he confidently states, “we can move on from the old polarized view of depression as all in the mind or all in the brain to see it as rooted also in the body; to see depression instead as a response of the whole organism or human self to the challenges of survival in hostile world.” With more holistic treatments available for mental health than ten years ago, our culture is at least moving in the right direction to see more than one option for managing ailments like depression.

Bullmore explains, “Your body’s state of inflammation, your immune system’s level of threat arousal, can have a direct effect on how you feel, and what you think about.” Although this is not a direct statement of cause, it implies a relationship that cannot be ignored. Bullmore goes on to say, “Inflammation of the body can cause changes in how the brain works, which in turn causes the changes in mood, cognition and behavior that we recognize as depression.” In this scenario, traditional talk therapy is not enough to address symptoms if there is a clear physical component.

Although there is progress in mental health treatment, there are still silos in the medical field. Most medical doctors are trained to look at labs and scans, which offer a black and white picture of an illness. Their role is not about being attuned to behavioral symptoms or psychological complaints.

Also, our pharmaceutical approach is still one-size-fits-all, with SSRIs a common treatment offered by providers, even though serotonin biomarkers are not easy to measure, and without a biomarker, there is not a definitive guideline for patients about whether they should take an SSRI for their depression. Where there is evidence is for inflammation — “depression is associated with biomarker evidence of bodily inflammation.”  That said, Bullmore still recognizes that that is not a causal relationship. But additional research shows that inflammation can precede depression, further indicating potential causality.

With the stigma that remains, patients unfortunately may view their depression as personal failure. If depression is resolved with new thinking patterns, the thesis is that depressed people need to change the way they think to find healing. Further confusion and feelings of failure may occur for patients if a medicine does not work for them when clinical evidence says it should.

Bullmore says, “Maybe we’ll see new drugs that, unlike the old drugs, are not vaguely supposed to work equally as well for everyone with depression but are scientifically predicted to work particularly well for some people.” So, although The Inflamed Mind does not offer a clear treatment plan, it does offer hope. People who may not understand the origination of their symptoms or why they do not experience improvement through traditional mental health treatment will learn more about the potential physical component to their experience.

If depression is not all in the mind and can also come from inflammation in the body, it makes sense that traditional antidepressants will not always be effective. For those who do change their thinking patterns yet do not recover, Bullmore’s work is encouraging. Readers may find that depression is more than just in their heads.

The Inflamed Mind: A Radical New Approach to Depression
Picador, Macmillan Publishing Group, December 2018
Hardcover, 256 pages

For people to reach their full potential, they need to first understand who they are. In Defining You, Fiona Murden offers her readers exercises that incorporate reflecting, collecting, and doing. Murden believes that when people spend time thinking about who they want to be and explore available opportunities and their place in world, they will know who they truly are.

Knowing one’s purpose helps people understand intrinsic motivations for the things that keep them going regardless of what else is happening in life. Readers identify areas where they feel they want to change or grow, the values that define them, and how it all aligns with their primary purpose. Each step in the book builds on what is learned in earlier exercises. Ultimately, readers will have identified short-term goals and a development plan, as well as the long-term goals for what they envision in the future.

Murden separates her book into three parts: Reflecting, Insights, and Doing, which represents the process people go through in self-discovery.

Reflecting, the first part, reveals insights and inspires action to build understanding of a person’s profile, and most people in this busy world don’t do it enough. Murden encourages readers to demonstrate curiosity by seeking out new experiences, by simply observing what is around them, and by observing reactions to things so they know what may need changing. Reflection includes understanding the meaning that people create, which is what keeps people going even when times are tough.

Collecting, part two, introduces the use of psychometrics. Murden focuses on five dimensions of personality: openness, conscientiousness, extraversion, emotion, and agreeableness — traits that influence how people interact with each other. Gathering this insight about strengths and weaknesses points to areas for development. As people gain insight into themselves through psychometrics, they can start to take action.

Doing, part three, takes the insights from part two and allows a person to take behavioral steps towards meaningful change. Murden explains that Doing gives you a chance to “summarize the themes relating to your core personality, values, passions, and strength, and look at defining your purpose, all of which describe you.”  This knowledge inspires the appropriate action.

Since none of these changes are simply going to happen, it is up to the reader to take action and make the changes in small steps that will result in the outcome of defining who they are.

But the journey for readers does not end when this book is over. There is always work people can do on an ongoing basis to enhance their potential. The steps of defining the self and how people relate to oneself is a lifelong process for everyone. The author cautions readers to not do too many things in one go because the brain can’t take on that much change at one time. Change is an ongoing, complex process that looks different for everyone and can be dependent on external circumstances. This is why she walks readers through a detailed step-by-step process.

Defining You is not a textbook. It is written for motivated readers who are ready to take action but need guidance to make changes. Murden helps people profile who they are and understand what drives them so they know the best conditions for moving forward.  Defining You is a lengthy and time-intensive process, so readers should plan extended periods to work through each step in the book and build on what they have learned. It will not be as useful for people when read it out of order.

Although the book is well-researched and comprehensive with case studies throughout, it is not a complicated book requiring clinical knowledge to use it. It is written for everyday people that may not have particular struggles but know there is more they want to get from their lives.

Defining You: How to Profile Yourself and Unlock Your Full Potential
Nicholas Brealey Publishing, July 2018
Hardcover, 272 pages

Imagine sending an email to about a dozen friends proposing a four-hour get-together “to do a little experimentation around human touch.” You assure your friends that nothing sexual will be involved, clothes will stay on, and the gathering will not take place in a bedroom.

Are you up for that?

Epiphany Jordan, author of Somebody Hold Me: The Single Person’s Guide to Nurturing Human Touch, hopes you are. For at least five years, she has been running a business, “Karuna Sessions,” in Austin, TX, in which clients can cuddle with two practitioners as part of a ritual of human connection. In Somebody Hold Me, Jordan wants to persuade people to take the initiative to incorporate more “nurturing human touch” into their own lives, by hosting touching get-togethers with their friends and in other ways, too.

“Nurturing human touch,” Jordan explains, is a light touch that “conveys kindness, warmth, calmness, compassion, comfort, and support” and is not erotic. She is a true believer in its power. “Touch can make you feel valued and connected to other humans,” she says, “and lack of touch can make many health problems worse.” In separate, short chapters, she spells out the most important reasons to engage in nurturing human touch (e.g., you will get off your phone, you will feel comforted, and there are potential health benefits, which she attributes largely to the release of oxytocin).

Jordan explains that we don’t even realize how much we need nurturing human touch. That’s in part because we are misled by cultural myths that discourage us from seeking touch or recognizing that we need it. In one of the early chapters, she describes 10 of those myths, such as “you’re weak if you need others,” “pets will fulfill your touch needs,” and “sex is the only way to get your touch needs met.”

The prevailing misguided ideas about touch have contributed to what Jordan believes is an epidemic of lack of touch. Too many of us are suffering from “touch hunger,” which is “an emotional response to lack of human touch after a long period without physical contact from another human.” Jordan lists 10 symptoms so you can get a sense of whether you may have that malady.

Once Jordan has established the context and the rationale for trying to incorporate more nurturing human touch into your life, she offers a step-by-step guide for hosting that gathering of your friends — or perhaps a whole series of gatherings. A chapter on the basics explains different ways of touching in a nurturing way. Another describes in detail how to create an environment that feels safe to the participants.

Perhaps the touchiest part of the whole idea of touch gatherings is approaching your friends about it. Jordan has a chapter on how to do that. She also tells you exactly how to proceed once your gathering is underway. It is all very structured. The touching exercises are organized into sets, starting with the most casual touches and building up to more. For example, the third set includes a unit on hugging while standing up. Two people face each other, and one asks the other, “Would you like a hug?” If the answer is yes, they hug for 3-5 seconds. Then the other person asks the same thing, and if the answer is yes, a timer is set for 30 seconds and they hug until it goes off.

Included with each of the exercises is a series of questions to be discussed immediately afterwards. For example: “Were you desperately waiting for the timer to go off, or did you feel like you could get lost in it [the hug]?”

Interspersed throughout the book are brief profiles of people (such as Amma, “the hugging saint,” and friends with whom Jordan has engaged in nurturing human touch) and suggested exercises. Also included is a quiz for determining how much touch is right for you.

My initial reaction to the title of the book was quite negative. Somebody Hold Me reads to me as, “somebody — anybody! — please hold me.” That sounds desperate, and if acted upon, maybe even dangerous. Compounding my concerns was the subtitle that pointed straight at single people and no one else: The Single Person’s Guide to Nurturing Human Touch. That made me wonder whether Jordan thinks that if you are part of couple, your need for touch will automatically be perfectly satisfied — you will be getting as much or as little touch as you want, in the ways you want it and at the times you want it, and your partner will, too, because as romantic partners, of course your needs and desires will mesh perfectly.

I was wrong about that. Jordan does realize that coupled people can have needs for touch that are not satisfied by their romantic partners. Still, her title puts a bulls-eye on single people. I’ve been working for more than two decades to push back against the stereotyping and stigmatizing and shaming of people who are single, so I have little tolerance for depictions of singles as particularly needy.

Jordan offers no evidence that single people are especially likely to be suffering from “touch hunger” (apart from some misleading claims — more on those later). With regard to the kind of touching she emphasizes in this book, platonic touching, I think it is quite plausible that single people — perhaps especially single women — are getting more of that in their everyday lives that people with romantic partners. We already know that single people, on average, have more friends than married people do, and they do more to nurture those friendships. Sometimes that includes the kinds of touching that go beyond the perfunctory hugs that people sometimes exchange upon greeting or leaving. I’ve seen groups of women friends sit at a meal or on a couch watching TV with their arms draped around each other’s shoulders nearly the whole time. I find it touching. That kind of spontaneous affection strikes me as far more appealing than the kinds of touch that comes with timers and instructions. I realize, though, that it is not available to everyone.

If Jordan thinks that single people are especially likely to suffer from touch hunger not just because they are supposedly deprived of platonic touch, but also because they don’t get as much sex as married people, well, she may well be wrong about that, too. Research shows that the gap between single and married people in the frequency with which they have sex is closing, and by some measures, single people are having as much or even more sex.

I was wrong in assuming from the title of the book that Jordan was proposing something potentially dangerous. Among the real strengths of the book are the ways in which the importance of consent, and of establishing and maintaining boundaries, is emphasized and explained throughout. Jordan insists that you have the right to say no and that you must respect an answer of no from other people.

Somebody Hold Me perpetuates popular claims that are consistent with the story Jordan wants to tell but are not really true. Over and over again, we hear that there is an epidemic of loneliness, but that is unlikely to be true. We are told that people in the U.S. have dramatically fewer confidants than they had in the past. That claim has gone viral. The study, though, has been debunked. Jordan worries about the loneliness of people living alone. That’s misguided, too. In fact, a study of more than 16,000 adults found that when people living alone were compared to similar people living with others, the solo dwellers were actually less lonely.

Setting aside the misleading hype about various epidemics and pinning the blame for them on single people and people who live alone, I think some of Jordan’s main messages are important, powerful, and true. First, I do not doubt that many people would appreciate having more nurturing human touch in their lives. I also believe that there are people who would greatly benefit from more of that sort of touch but don’t even realize that it is something they are missing.

Importantly, I also believe in the power of human touch. I used to teach courses in nonverbal communication. On days when I taught about touch, I would begin my lectures by telling students about studies showing that even the slightest of touches, including incidental ones, can be meaningful. For example, if a librarian grazes your hand while returning your library card, you will feel more positively about the library than if your card is returned without a touch. Of course, more deliberate, personal touches are much more significant, psychologically.

The significance of Somebody Hold Me probably will not be evident for some time. Is Epiphany Jordan at the cutting edge of a phenomenon that is likely to sweep through the nation and beyond? Cuddle parties, the version of Jordan’s get-togethers that involve strangers rather than friends, do seem to be growing in popularity. Random people offering free hugs seem to be popping up with increasing frequency, too. Alternatively, maybe the active pursuit of nurturing human touch will never break through the myths and squeamishness of contemporary Western culture and will remain a fringe phenomenon for the foreseeable future.

In the meantime, for people who are craving nurturing human touch but had no idea how to go about getting it, Somebody Hold Me may be that rare and cherished gift they never even imagined they would find. With clear, compassionate, and wry prose, Jordan will take them by the hand and show them the way.

Somebody Hold Me: The Single Person’s Guide to Nurturing Human Touch
Significant Otter Publishing, January 2019
Paperback, 202 pages

I made a film on the weekend.

The idea had come to me as I was walking to work on Friday morning.

The others wouldn’t be back until Monday, so it was something to do to pass the time. It was going to be a film about being alone in the empty house, and about myself, about them.

It used to be like that every night — where I used to live — in a neighborhood so poor, in an apartment so small with a horrible smell that did not disappear, an apartment without hot water, or heating. There, in that life, there was nothing; there was me at the kitchen table staring blankly at the wall, there was silence, isolation.

There is a contrast now, I wanted to capture it.

I filmed my weekend. I recorded myself and edited it over three days. And even though I ran out of food, it did not occur to me that I could have walked to the supermarket to buy something to eat. In fact, I did not leave the house at all, not once.

I drank a bottle of wine, but it had no effect on me. I drank a lot of coffee too.

My project swallowed me up into deeply focused concentration. Trying to stop myself felt like tearing velcro away from a felt wall.

Even cleaning the dishes, or wiping down the table, left my body screaming in resistance. Do not stop, do not stop, there is so much more to clean! There is so much more to do!

Watching, and re-watching, and watching again, and again, and again, the same clips, over and over, almost obsessively. My body clung on so tightly to the sort of comforting pleasure that each replay gave me.

On Saturday morning it took me six hours to remember to eat breakfast. And that breakfast, which had became afternoon tea, well those dishes were still there but it was 7pm. It left me in confusion as my eyes switched between the time on my phone, to the pan, the plate, the knife and fork on the table.

Accelerated. I was accelerated. Everything was accelerated. I moved with such urgency as if washing a cup was life or death, as if there was a clock, ticking down. Fifteen seconds to go, three seconds to go. Fast! Fast! Go! Go! Go!

And, I was in love. I was deeply in love. It was on that weekend that I realized I was. I was overwhelmed with desire to see him, and to tell him everything that I felt. I swore to myself in frustration. I wanted him to come back. “Where are you? Come home.”

At one point I found myself staring at my reflection in the mirror. I was making funny faces. I studied these distorted expressions. It was strangely hypnotic — exciting — “What am I doing?” I suddenly thought to myself in panic, “I don’t like to see my face like this!” I didn’t look in the mirror again.

I would have taken a pill, if I had been brave enough to face the depression that would have followed the next day. Instead, before I went to sleep, I hurriedly wrote myself a note and left it next to my bed to read in the morning. I wrote to myself, that if I were to sleep for less than four hours, I would take a pill.

But I slept well and woke up calmer than I had been the previous day.

I finished the film, and my housemates came home on Monday. Their company was nice, but a part of me wished they would leave. I had been having so much fun by myself.

I floated around all morning. I cleaned everything, and I laughed.

My housemates laughed with me. When I smiled, so did they. Each time I spoke, which was frequent, they shook their heads in good humor. Positivity and energy flooded through my body like rushing water — it felt so clean and refreshing. The water was purifying. It was lightly scented, it smelled like fresh linen. There was a spring, in my stomach, in my mind, in my hands and feet. It sparkled in the sunshine. It looked so beautiful. I could have bent down, cupped some of the cool water in my hands, and drunk until I was full.

Work in the afternoon was not stimulating. It was too slow. I sat in a hard chair and listened to my students speak. I taught five classes. I taught until 8:30. The boredom, the lack of excitement, drained me. I wanted to close my eyes or stab myself in the hand.

I got home at 9pm and they were all in the kitchen, they were cooking dinner and eating prosciutto and cheese.

“Have you eaten yet, Jeannie?” Antonio asked me.

“No. Where is Daniel?”

“He’s gone to buy some wine.”

Daniel returned with three bottles. “Are you already drunk?” he asked me as he opened the first one.

“Drunk? I don’t understand. What are you talking about?” I took the bottle of wine from his hands. I poured myself a glass, I drank it like water. I poured a second and I drank it again, like water. “Oh, would you look at that. Yes, Daniel, I think you may be right.”

The energy was extreme. Pushups did not help. Burpees made me want more. Sit-ups left me infuriatingly unsatisfied. It was an energy that wanted to be purged from my body, but how could that have been done in my bedroom at 12am? How frustrating! It was like love that was threatening to fade because the courage had never been found to do something about it, to declare it.

Why did I move out of that apartment on the sixth floor? I began to wonder. I salivated over the thought of Purgatorio ad Arco and all those stairs that there were to climb. Oh, I would have done anything in that moment to move back into my old room.

It was 2am, I was in bed, and I was thinking. I was thinking about my weekend. I was thinking about it so enviously, I was envious of her, the girl who remained there, living on within that memory in my mind. I thought about it as if it had been a holiday, as if I had gone away to a luxury resort, or to a party island, or to a little country town where I had met the person of my dreams — it was like that, it felt like something that had been so beautiful, something worth missing, something worth the nostalgia.

My eyes snapped open after just a few hours of sleep. I immediately felt the worry — I could feel it starting to seep through the thick clouds of fantasy in my mind. I got up. I cancelled my classes for that day, and focused on my writing instead. In the late afternoon, I forced myself to take a break and eat something.

And it happened that night, in the supermarket, while I was staring at polystyrene trays of sliced zucchini. There were mushrooms too, and a woman beside me was reaching for the lettuce.

I wondered if I was going to vomit, or collapse. I bought my groceries and left.

If only I could have seen where it had gone. I would have chased after it. I would have picked it up off the floor, gathered it up in my arms, and like paper mache, plastered it across my body, back to where it had been before.

I felt the difference as I walked. Walking without the full body cast of energy and brightness, walking without the plaster that had cracked and crumbled away while I was looking at something else.

I was left with a small frame, a frame that was too weak and frail. Worn away by excessive adrenaline. I felt exposed, naked, to be stumbling home like that, all my fragility on show.

I thought about the people I loved, and how much I needed them in that moment. But they were so far away, in other places, doing other things and they had no idea that I stood in that dark street, in confusion and fear, and that I was crying out for them, for help, to be told that I was going to be okay.

You see a Facebook post with a picture that immediately gives you pause and—as cliché as it sounds—your stomach plummets. It’s your close friends at a party, and you’re not there, because you weren’t invited.

Or maybe you get to work, and everyone is talking about the cool event they went to the night before—and no one asked if you wanted to come. Or maybe it was something else altogether.

Either way, the fact remains, you didn’t get an invite, and you feel awful. You feel left out.

Why does feeling left out feel so painful? Why does it affect us so much?

It’s so powerful because our desire to belong is primal. It’s vital to our survival. As clinical psychologist and yoga teacher Sophie Mort, Psy.D, said, “social connection has been integral to the survival of our species.” Being included in a group meant sharing resources, and being protected. Being excluded meant missing out on all of this, and possibly death.

So we developed an exquisitely sensitive alarm system that alerts us to any possibility of rejection or exclusion, so we can fix it—by appeasing the rejection, and avoiding these situations in the future, said Mort, who is working to get effective psychological information out of the therapy room and into people’s lives in a way that feels both understandable and practical. Because exclusion is seen as a “threat to our survival.”

Clinical psychologist Therese Mascardo, Psy.D, said that belonging is a core human need. “In Maslow’s Hierarchy of Needs, belonging is noted as one of the most foundational human needs, after physiological needs like water, air, etc., and the need for safety.”

We also develop our sense of self-worth through our relationships with others—a concept that stems from self-psychology, developed by Heinz Kohut. Kohut postulated that we do this through mirroring, idealization, and twinship. When we’re left out, we miss out on all three, said Mascardo, who offers therapy and leads courses and groups to help individuals thrive in the life of their dreams.

That is, in mirroring, others reflect back our value. For instance, a mother cooing back to her baby sends the message that they matter, Mascardo said. In idealization, “we see someone we look up to and think ‘I want to be like that person’”—and we believe we can become those traits, too. An example, Mascardo said, is when kids want to be superheroes to save the day. In twinship, we see elements of ourselves in others, which validates our own existence. “We see someone that looks like us, thinks like us, or dresses like us, and we think, ‘Hey, I must be pretty OK!’”

In other words, feeling left out is totally, absolutely normal. It is an adaptive response. And there are many things we can do to handle feeling left out in a healthy way. Here are seven strategies to try.

Acknowledge and allow your emotions. Both Mort and Mascardo stressed the importance of giving yourself permission to feel whatever feelings arise—which might be anything from sadness to jealousy to loneliness to anxiety to anger. Sit with your feelings, without judging them or criticizing yourself for feeling them.

Tell yourself that this is a moment of suffering for you, Mort said, and then do something soothing to trigger a relaxation response. For instance, she recommended this breathing technique: Inhale for a count of four, hold for one, exhale for a count of six, and hold for one. Or try this grounding technique: Name five things you see; four things you can touch (“actually touch the items, and notice how they feel”); three things you hear; two things you smell; and one thing you taste (“you may want to sip a drink”).

Soothing ourselves also is important because this prevents us from immediately lashing out and later regretting it. Which we can do if we’re angry about being rejected, Mort said.

Reach out to someone else. Mort noted that research has found that people who feel rejected have a sudden boost in their desire to connect, “so make the most of this.” Talk to a friend about how you feel. Meet a colleague for lunch. Join a running or book club. Reach out to people in a supportive online community, Mascardo said.

Calm catastrophic thinking. When you feel left out, you might have a variety of catastrophic thoughts. Everyone is mad at me. Everyone hates me. They intentionally excluded me. This is why Mascardo suggested examining the evidence for your fears. Because even though our fears feel real, they tend to be illogical and inaccurate.

Try this exercise: Create two columns. In the first, list all the evidence that supports your fear (e.g., “everyone hates me”). In the second column, list the evidence that refutes the fear. For instance, Mascardo said, you might list the names of people you know care about you; some of the experiences you’ve had that made you feel loved; and the people whose lives are better because of you or something you did.

Shift your mindset. What if it turns out that your worst fear is true? What if your friends did exclude you on purpose? What if they are furious with you? What if they did gossip about you? This is upsetting, of course. And it’s also an opportunity.

As Mascardo said, “instead of focusing on how you don’t feel chosen…you can seize the opportunity to reexamine what you value in relationships and ask yourself if your relationships reflect what’s important to you.”

Plus, “you get to decide how much you allow other people’s decisions [or] rejection to inform how you feel about yourself. Do they deserve that real estate in your head? Do they deserve that power to make you feel a certain way about yourself? What makes them so special that they get to have more of a say about how worthy you are than you do?”

Mascardo also suggested these two perspective shifters:

• Say “That’s great because ______.” For instance: “That’s great because now I have clarity on who is really for me,” or “That’s great because I can focus my energy on other people who are more worthy of it,” or “That’s great because now I know for sure that I don’t want to be friends with people like that.”
• Say “Thank you because ______.” For example: ”Thank you because now I know that these people are not worth my investment,” or “Thank you because now I have the energy to devote to something or someone who truly matters to me,” or “Thank you because now I know they are not my people.”

Strengthen your self-confidence. According to Mascardo, we can do this in simple ways. This includes practicing self-care, starting with the basics, such as sleeping well and moving our bodies. It also includes practicing positive self-talk, “speaking to yourself the way you would a dear friend.”

And it includes saying affirmations. This “may seem inauthentic at first, but the more we repeat positive messages, the more we are able to internalize them.” Mascardo gave these examples:

• I am worthy of love.
• My life is a miracle.
• I’m important and have valuable things to contribute to the world.
• I’m thankful for me, my body, and my life.
• I can trust my instincts.
• I will get through this.
• I am worthy of good things.
• I’m in charge of my life.
• My life and relationships are up to me.

Approach the person. If you’re feeling left out often, or the situation feels particularly painful, Mort suggested having a one-on-one, face-to-face conversation with the person. Reflect on the outcome you’re hoping for, she said, and approach them when you’re calm.

Instead of saying “you did this…,” use the “positive, negative/honest, positive sandwich.” This increases the likelihood that the other person will actually hear you—instead of getting defensive.

According to Mort, this might look like: “I love being with you and our group. Recently, I have been feeling really left out whenever there has been a party and I haven’t been invited. I would really like to spend more time with you and the rest of our friendship group as I value our friendship so much.”

Remind yourself the sting will dull. “[T]ime is a great healer,” Mort said. She suggested thinking back to your last rejection. Remember that it felt awful at the time, and slowly you started feeling better. You found a way to get through it. Maybe you also reflect on the healthy resources you turned to last time, and see if you can use them, again, she said.

Feeling left out is painful, and it can trigger a variety of feelings. Which is totally and completely normal. As Mort said, “everybody feels this way. The feeling of rejection is not a feeling that is linked to [you] failing in some way. It is hard-wired into [you].”

And the great news is that there are plenty of healthy ways to navigate your pain—and reconnect to others, and to yourself.

Once in love with a narcissist, it’s not easy to leave. Despite the abuse and your unhappiness, you may be ambivalent about leaving because you still love your partner, have young children, lack resources, and/or enjoy lifestyle benefits. You may want to leave, but feel stuck, and don’t understand why. Outsiders often question why you stay, or urge you to, “Just leave.” Those words can feel humiliating because you also think you should.

Why It’s Hard to Leave

When we fall in love, it’s natural to become attached and form a romantic bond. Narcissists, especially, can be exceedingly charming, interesting, and enlivening to be around. Initially, they and other abusers may treat you with kindness and warmth, or even love bomb you. Of course, you want to be with them forever and easily become dependent on their attention and validation. Once you’re hooked and they feel secure, they aren’t motivated to seduce you. Their charming traits fade or disappear and are replaced or intermixed with varying degrees of coldness, criticism, demands, and narcissistic abuse.

You’re hopeful and accommodating and keep trying to win back their loving attention. Meanwhile, your self-esteem and independence are undermined daily. You may be gaslighted and begin doubting your own perceptions due to blame and lies. When you object, you’re attacked, intimidated, or confused by manipulation. Over time, you attempt to avoid conflict and become more deferential. As denial and cognitive dissonance grow, you do and allow things you wouldn’t have imagined when you first met. Your shame increases as your self-esteem declines. You wonder what happened to the happy, self-respecting, confident person you once were.

Research confirms that it’s common for victims to attach to their abuser, particularly when there’s intermittent positive reinforcement. You may be trauma-bonded, meaning that after being subjected to prolonged belittling and control, you’ve become childlike and addicted to any sign of approval from your abuser. This is referred to as Stockholm Syndrome, named for hostages who developed positive feelings for their captors. You’re especially susceptible to this if the relationship dynamics are repeating a pattern you experienced with a distant, abusive, absent, or withholding parent.

The trauma bond with your partner outweighs the negative aspects of the relationship. Studies show that victims of physical abuse on average don’t leave until after the seventh incident of violence. They not only fear retaliation, but also the loss of the emotional connection with their partner, which can feel worse than the abuse.

Additionally, codependents, who are usually preyed upon by narcissists and abusers, often feel trapped and find it hard to leave any relationship. They can be loyal to a fault due to their codependency.

After You Leave

Narcissists are basically codependent. If you distance yourself from them, they do what it takes to pull you back in, because they don’t want to be abandoned. They want to keep you interested to their ego and supply their needs (“narcissistic supply”). Being left by someone is a major humiliation and blow to their fragile self. They will attempt to stop you with kindness and charm, blame and guilt-trips, threats and punishment, or neediness, promises, or pleas — whatever it takes to control you so that they “win.”

If you succeed in leaving, they usually continue their games to exert power over you to compensate for their hidden insecurities. They may gossip and slander you to family and friends, hoover you to suck you back into the relationship (like a vacuum cleaner). They show up on your social media, try to make you jealous with photos of them having fun with someone else, talk to your friends and relatives, text or call you, promise to reform, express guilt and love, ask for help, or “accidentally” appear in your neighborhood or usual haunts. They don’t want to be forgotten, and they don’t want you to be with anyone else — even if they don’t want to be with you. Keep in mind that they’re incapable of giving you want you need.

You might feel guilty or tell yourself that your ex really still loves you and that you’re special to him or her. Who wouldn’t want to think that? You’re vulnerable to forgetting all the pain you had and why you left.

If you resist their attention, it fuels their ambition. But once you fall into their trap and they feel in control, they’ll return to their old cold and abusive ways. Only consistent, firm boundaries will protect you and disincentivize them.

How to Leave

As long as you’re under their spell an abuser has control over you. In order to become empowered, you need to educate yourself. Come out of denial to see reality for what it is. Information is power. Read up on narcissism and abuse on my website. If you’re unsure whether you want to leave, take the steps in Dealing with a Narcissist to improve your relationship and evaluate whether it’s salvageable. Regardless of your decision, it’s important for your own mental health to redeem your autonomy and self-esteem. Take these steps:

1. Find a support group, including a therapist, 12-Step group, like Codependents Anonymous (CoDA), and sympathetic friends — not ones who bash your spouse or judge you for staying.
2. Become more autonomous. Create a life aside from your relationship that includes friends, hobbies, work, and other interests. Whether you stay or leave, you need a fulfilling life to supplement or replace your relationship.
3. Build your self-esteem. Learn to value yourself and honor your needs and feelings. Develop trust in your perceptions and overcome self-doubt and guilt.
4. Learn how to be assertive and set boundaries.
5. Identify the abuser’s defenses and your triggers. Detach from them.
6. If you’re physically threatened or harmed, immediately seek shelter. Physical abuse repeats itself.
7. Don’t make empty threats. When you decide to leave, be certain you’re ready to end the relationship and not be lured back.
8. If you decide to leave, find an experienced lawyer who is a family law specialist. Mediation is not a good option when there is a history of abuse.
9. Whether you leave or are left, allow yourself time to grieve, build resilience, and recover from the breakup.
10. Maintain strict no contact, or only minimally necessary, impersonal contact that’s required for co-parenting in accordance with a formal custody-visitation agreement.

© Darlene Lancer 2019

“The willingness to bear with our wounds opens our eyes and potentially our hearts to what is going on around us. A wounded planet is also potentially a healing planet,” write Chris Robertson and Sarah Van Gogh.

Their new book, Transformation in Troubled Times: Re-Vision’s Soulful Approach to Therapeutic Work is an invitation to reconsider the opportunity that every wounding offers — to once again restore our faith in the process of healing.

Much of the work of the therapist is to sense the possibility that exists in the connection between the ego and the soul. The authors explain, “Each therapy session is an interplay between conscious and unconscious dynamics between the therapist and the client and within each of them.”

Facilitated by learning to trust their intrinsic experiences — what Robertson and Van Gogh call “inside out” learning — students’ experiences at Re-Vision become rooted in their own subjective experiences.

“Students are imbibers of the organizational culture, both consciously and unconsciously. So where the agenda of training is instrumental (success, large group numbers, status for trainers), this attitude will be reflected in graduate’s work in the wider community,” they write.

The foundations of Re-Vision are based on exploring the margins, shadow material and uncertainty, and one of their first courses, “The Borderlands and the Wisdom of Uncertainty,” was the subject of a BBC documentary.

“This emphasis on what is at the borders — between the conscious and the unconscious, between the therapist and the client, between the therapeutic couple (of therapist and client) and wider culture — has developed from those early seeds in the ‘Borderlands and Wisdom of Uncertainty’ course into a major ingredient of the training,” write Robertson and Van Gogh.

Rather than question power in the relationship, Robertson and Van Gogh’s approach is to appreciate the mutuality of a creative interaction whose outcome holds inevitable uncertainty.

Drawing on the community for containment, Robertson and Van Gogh were reminded to listen to the voice of the exiled, to stay open to feedback even when it wasn’t comfortable, and to dare to speak the truth.

They write, “Community as a container allows for connection as well as differences. Respect for differences is so often the grit of the oyster, the discomfort that leads to change.”

Similarly, when suffering is seen as the voice of the soul longing to be heard instead of as a problem to be fixed, clients and therapists can find a way to value the journey and all of its respective parts.

“We trust that the wound is the gateway to the soul”, they write.

By remaining open to one’s own wounds as part of the healing process, Re-Vision’s therapists learn to use their self to enter into their client’s reality — an approach that likely means being subjected to intense emotions, painful states and distress of all kinds.

“For better or worse,” they write, “we regulate and shape one another.”

Likely we are more permeable and affected by one another than we realize, and we may not consider the shared unconscious life that emerges in the space between the therapist and client.

Robertson and Van Gogh write, “We cannot make the Third Body happen. It comes into being spontaneously yet always exists in the potential space. Paradoxically it is often as a result of an impasses or an enactment that the therapist is pushed to the edge of or even beyond their comfort zone and defenses.”

Learning to value both knowing and not-knowing, therapists at Re-Vision also learn to trust uncertainty and their embodied experience. Robertson and Van Gogh write, “Re-Vision teaches a craft that requires practitioners to integrate a developmental and transpersonal lens, through which they can look again at any aspect of life.”

By finding a deeper meaning for suffering, therapists can learn to integrate it into the work of soul-making and allow depression to guide the way to greater reverence for life.

Robertson and Van Gogh tell the story of a whaler whose practice was to kill baby whales in order to draw their mothers in close. “One day a local fisherman, despite his fear, and for some inexplicable reason, reached out to touch a whale near his boat. ‘I don’t know what compelled me to reach out my hand. The moment I touched the whale for the first time, I felt something incredible. I lost my fear.’”

Inviting uncertainty, embodiment and perspective on wounding as an opportunity for deep and powerful growth, Transformation in Troubled Times calls upon us all to listen deeply and clearly — our soul is calling.

Transformation in Troubled Times: Re-Vision’s Soulful Approach to Therapeutic Work
Transpersonal Press, September 2018
Paperback, 196 Pages

There are many ways we can try to feel better. We can try to improve the way we think. We can try to make more money. Have more stability. Get a better job.

But all of these things, say Cindy Goodman Stulberg and Richard Frey, are red herrings.

“We want to let you in on a little secret,” they write. “Your relationships hold the key to your happiness.”

In their new book, Feeling Better: Beat Depression and Improve Your Relationships with Interpersonal Psychotherapy, Stulberg and Frey offer a step-by-step guide to improve your relationships by setting and achieving goals, articulating feelings, and making constructive decisions, and feel a whole lot better in the process.

“For years, the first line of defense for depression has been pharmaceuticals, but we believe people can be taught the skills to help themselves feel better — no pills required,” write Stulberg and Frey.

Breaking therapy into eight to twelve weeks, the authors ask their readers to work on particular tasks in a particular order.

The first step is to understand depression for what it is. “Sadness is part of being depressed. So is losing interest in things that used to get you jazzed. But there’s also a whole list of symptoms people usually don’t associate with depression: trouble concentrating, indecision, loss of appetite, irritability, difficulty sleeping, and even body aches and pains with no apparent cause,” write Stulberg and Frey.

And while it is common to feel like things won’t change, Stulberg and Frey tell us depression is highly treatable. It is also okay to take time to recover.

They write, “Depression is not a sign of weakness, proof that you’re a bad person, or a form of punishment. You don’t deserve to be depressed. And you didn’t bring it on yourself. No matter how many times your mom tells you to buck up, your buddy tells you to get off your butt, or that little voice inside you says, ‘Suck it up, buttercup,’ it’s not a matter of simply trying harder and — poof — bye-bye depression.”

However, by becoming aware of the signs of depression and the ways in which it affects our communication styles, we can learn to make changes, like temporarily reducing the number of things we are responsible for.

The next step is to investigate our relationships, asking ourselves how we would describe our relationships, what we like about them, what we don’t like, and what we would like to be different about them. Through this process, we can learn to make the changes we need to feel better.

Stulberg and Frey write, “Some relationships are so painful that you don’t want to think about them. Of course, you don’t have to. But if you keep doing what you’ve always done, which is not thinking about the relationship that bothers you, you aren’t going to feel any differently than you do now.”

Naming the way we feel around other people also helps us identify the ways in which relationships affect us. Feelings themselves, however, are neither good nor bad. Stulberg and Frey write, “Don’t judge yourself harshly because you have a moment of insecurity, anxiousness or displeasure. It’s okay to feel hurt, sad and angry.”

Modifying our behavior in spite of our feelings is a lot like performing an experiment. It may feel strange, awkward and uncomfortable. Yet when we ask what we could do differently, we open ourselves to learning a new way to respond that may lead to less discomfort.

Another helpful step is to choose one problem area to work on at a time. The authors write, “When we think we have to do everything at once, we get overwhelmed. And we often give up.”

Stulberg and Frey tell us that there are three types of conflict: the ones we are aware of, the ones below the surface, and the ones where we know the relationship is over but struggle for a long time with how to end it.

By setting smart, measurable, achievable, realistic and timely goals, we can learn to stop, reflect, ask how we are feeling and reach out to those around us for advice — skills that can be used over and over again.

To be happy we need to be flexible. We need to have realistic expectations. We need to be willing to adopt a balanced perspective of life, relationships and ourselves.

Drawing on the powerful interpersonal approach, Feeling Better is a highly accessible, practical guide that makes happiness a goal anyone can reach, regardless of his or her circumstances. Offering quick tips, exercises, weekly goals and encouragement, Stulberg and Frey’s readers will feel as if they are on the journey with them, invested in the process of them feeling better.

Feeling Better: Beat Depression and Improve Your Relationships with Interpersonal Psychotherapy
New World Library, November 2018
Paperback, 304 Pages

In our practice, we’ve noticed how more and more adults are becoming familiar with the concept of mindfulness.

We know that mindfulness benefits us and improves our ability to be present and successful in our daily roles as parent, spouse, friend, and employee. It helps with our emotional regulation and improves our distress tolerance. It increases our overall happiness. It improves our focus. Basically, it has endless benefits. So why wouldn’t we carry this over to children?

After all, who needs emotional regulation, distress tolerance, and focus more than children? Children long for these skills and are actually the ideal candidates for mindfulness training. If taught correctly it can decrease bullying, increase empathy, and improve optimism and happiness in the home, classroom, and extra-curricular activities.

By definition mindfulness is a mental state that can be achieved by focusing awareness on the present moment, while acknowledging and accepting feelings, thoughts, and bodily sensations calmly. This concept is a bit above most children’s ability to understand, but the basic concept can be explained so that they not only understand it, but embrace it as well.

You may find that the core focus of “Being in the here and now” is much easier children to understand. So is accepting feelings and thoughts without judgment. Teaching them about relaxing, breathing, and enjoying a fun activity or sensory experience to the fullest makes mindfulness a concept that they will actually enjoy learning.

Making mindfulness fun not only motivates children to learn it, but teaches it in a way that they can best understand and master it. Then gradually, as they see the results, the intrinsic motivation will be there to continue to work on these skills and build a variety of techniques.

Here are a few things to remember when teaching children mindfulness.

• Keep It Simple: Make sure that you do not overwhelm them with words and concepts that they cannot understand! Teach them from the very basics and build on concepts in a way that makes sense and has a logical progression. Start with simple skills: notice your thoughts, notice your feelings, notice what you feel in your body, notice what is happening right now and right here, describe what you see or feel or hear, etc. Use one key focus at a time that brings them to the here and now.
• Don’t Force It: Do not make a child who is unwilling, uncomfortable, or unable to participate. Forcing them will work against the concept you are teaching. When possible, let them join in willingly and guide them at a pace that matches their readiness.
• Be Confident in Your Skills: To teach mindfulness successfully it is best to know what you are doing and to be able to model techniques. You do not have to be a master, but a child will be the first to notice when you are struggling. Being confident and knowledgeable will help the child to trust in what you are teaching them. Seeing success leads to them wanting to be successful. Maintaining your own mindfulness practices daily, even when not teaching, will help build a confidence that will show through to the children and encourage them to try what you are teaching.
• Be Realistic with Expectations: Expecting full and perfect participation right away is unreasonable. Expecting them to master even small tasks right away is unrealistic. Mindfulness is a skill that takes much practice and patience. Remembering this will improve the experience for both you and the child that you are teaching, allowing you to remain calm and reducing frustration.

Here are some fun mindfulness activities that you can do with children of all ages:

• Tummy Breathing: Healthy breathing techniques for relaxation and mindfulness involve breathing with your diaphragm. This causes your belly to rise up and down. Have a child either lay on their back or relax in their chair. Have them place their hands on their bellies and focus on moving them up and down with each breath. Have them drag each breath out by counting to four on both the inhale and exhale. If they need further motivation or for especially young children, having them balance a stuffed animal on their tummy and watching it move up and down provides extra stimulation and motivation.
• Listening: Focusing on the sounds in the room, on a specific sound like a bell, on a song, on the rain, or on some other sound is a great way to teach them to be present, aware, and observant.
• Mindful Walking: In other words, taking a nature walk to the next level. Focus on noticing things as they go for a walk. Pay attention to the little details that they would normally miss. What can they hear, see, smell, feel? Take the focus away from talking or playing games.
• Sensory Bottles: Take an empty water bottle and fill it with water, food coloring, and glitter. You can add soap for more texture. Then have the child shake it up and watch it go. Spending some time in silence, watching and observing the happenings in the bottle while waiting for its contents to settle. This takes their focus and puts it on one sense and one object. It allows them to practice shutting out the random thoughts and being present in the moment by observing and focusing on just one visual focal point.
• Chocolate Mindfulness: Enjoy a snack or treat and savor it mindfully. A piece of plain chocolate is perfect (as long as there are no allergies). Have them place it on their tongue and let it melt. Have them pay attention to how it tastes and how it feels. Have them note how it changes as it melts. Then have them share their observations.
• Book Balancing: Have them stand with one arm raised, hand with its palm facing up. Place a book on it. Have them hold it for a minute or two. Have them pay attention to the physical sensations of holding the book, the muscle strain, how the book appears to get heavier, etc.
• Progressive Muscle Relaxation: With a focus on individual body parts, have them tense a body part for ten seconds and then release for ten seconds while working through the body. For example, start with the feet and move up to the head.
• Sensory Boxes: Have a number of boxes with things for children to smell or feel and have them guess what they are. If they cannot guess have them, describe it in detail, focusing on description words rather than identifying the object.

“The body,” says Clara Mucci, “is the essential go-between in the relationship between the self and other.”

In personality disorders, this relationship between the self and the other is especially troubled. However, this “other” can be the body itself.

Mucci describes psychosomatic disorders as an outcome of the “problematic junction between mind and body.” The body can also act as an imprinting device in which earlier generations transmit their trauma onto us.

In her new book, Borderline Bodies: Affect Regulation Theory for Personality Disorders, Mucci places the body at the center of treatment, viewing it both as the recipient of trauma and the internalized persecutor, inflicting further harm.

“It is likely that when there is insecure or disorganized attachment in the first, traumatized generation, the second and third generations of survivors might develop personality disorders when vulnerability and even epigenetic factors combine with other environmental factors,” writes Mucci.

Interpersonal traumatization can exist on three levels. We can have early relational trauma, maltreatment, abuse, and identification with the aggressor, and we can have massive and intergenerational trauma.

Mucci explains, “The development of a personality disorder, characterized by a series of difficulties and relational dysfunctions between self and other and evident in the exchanges between patient and therapist in clinical work, finds its origin in developmental deficits (lack of attunement between infant and caregiver starting from the very early relationship or serious difficulties encountered by the caregiver attending to the child starting from pregnancy, plus maltreatment and abuse).”

In relationships, we exchange our corporeal selves. One body meets another body and in this intermedial space, neurobiological and affective exchanges lay the groundwork for how we learn to relate to others and to ourselves.

“Contrary to any theory that still privileges ‘innate aggressiveness’ and a predominance of the ‘fantasmic element’ over the reality of the rearing conditions, I view temperament as epigenetically formed,” writes Mucci.

Personality features, contends Mucci, originate in the psychobiology of the child, and the attachment exchanges that occur between the psychobiological bodies of the mother and child.

How children learn to regulate emotions, and the attachment styles they develop play a pivotal role in their future health.

Mucci writes, “If we view the right brain as the first and foremost ‘body,’ intended as a corporeal reality that is intersubjectively and epigenetically construed and shapes individual differences and personality characteristics, we are better equipped to understand how the nature of the subject is shaped through relational embodiment and mimicry, as Vittorio Gallese maintained (Gallese, 2009), and how in fact ’embodiment shapes the mind’ (Lemma, 2015, p. 2).”

Mistuning naturally occurs, but it can also be repaired regularly when the mother is emotionally available and remains accessible to the child even after momentary disruption. Through this process, the child learns to take in stimuli both from the outside and from within their own body.

Mucci writes, “Through right-brain-to-right-brain nonverbal visual-facial, tactile-gestural, and auditory-prosodic communications, the caregiver and infant each learn the rhythmic structure of the other and modify their behavior to fit that structure, thereby co-creating a moment-to-moment, specifically fitted interaction.”

The body represents for the subject the first source of relationship with the mother and also influences their relationship with the clinician.

Mucci writes, “We have evidence that representations of parents and of the self develop in synchrony (Bornstein, 1993) and that these representations become models that influence expectations and behavior with respect to the environment.”

Moreover, the right hemisphere is the neurobiological foundation of the unconscious. It is here where social and emotional behaviors are learned, and homeostatic regulation between the body and motivational states occur.

Psychosomatic disorders, Mucci tells us, therefore represent a narcissistic preoccupation with the self, whereby the body has taken the place of the external world. Mucci describes the case of John, a 23-year-old male with somatic complaints and hypochondria so severe he can only have a good day when he remains in his mind, studying, and not disrupted by physical symptoms.

She writes, “In my mind (and in accord with both McDougall’s and Green’s theories), hypochondriasis is on the dividing line between borderline disorders and psychosis — at the extreme and most pathological end of narcissism — where the encounter with the other is impossible, as in different ways is the case with antisocial personality disorder (which implies destructiveness toward the other and violence and breaking of rules).”

The body is a gift from our parents, but it is also our gift. Placing this body at the forefront of treatment, Borderline Bodies is a revolutionary way to understand how personality disorders develop, and importantly, that their symptomatology can be remedied. Drawing on psychanalytic theory, it bridges epigenetics, attachment theory, and relationships — particularly the healing relationship that ensues between the clinician and the client.

Borderline Bodies: Affect Regulation Theory for Personality Disorders
W.W. Norton & Company, November 2018
Hardcover, 480 Pages

When you’re a people pleaser, setting boundaries can feel painful. We worry we’ll hurt someone’s feelings. We fear we’ll fracture the relationship. We think saying no is rude or cruel or not compassionate—and we see ourselves as the opposite of these things.

And we simply don’t have much practice with setting boundaries. And so, it’s so much easier to simply not set them. It’s so much easier to stay quiet. But it’s certainly not healthier.

Many view boundaries as walls. But, according to psychotherapist David Teachout, LMHCA, boundaries are more like sponges.

“Nobody can escape the world they’re in, so we’re constantly being slowly saturated by our experiences until we’ve reached a personal limit and/or ‘squeezed’ ourselves to let go of what has stuck around.”

When we engage in people-pleasing behavior, we become convinced that we’re responsible for the other person. Which means we neglect to go through the “squeezing” process—quickly becoming fully “saturated” or overwhelmed, Teachout said.

But here’s a fact: We’re not responsible for other people. We’re not responsible for their emotional experiences or the stories they hold, he said.

What we are responsible for is being aware of and intentional about how we express ourselves.

In general, “boundary setting is about reminding yourself and others that you have different bodies, social and familial backgrounds, and skills,” said Teachout, who joins with individuals and partnerships on their mental health journey to encourage a life of valued living and honest communication at his practice in Des Moines, WA.

But how do you set boundaries when it’s so unfamiliar and awkward, and you’re so out of practice?

Below, you’ll find seven tips to help—from navigating your stubborn guilt to making it easier for you to say no.

Use self-soothing techniques. Setting boundaries is going to be uncomfortable, and bring up other surprising reactions. This might include everything from anxiety and fear to shame and sadness to guilt and anger, said Fara Tucker, LCSW, a clinical social worker in Portland who supports helpers, healers, and people pleasers in clarifying and communicating their needs and boundaries so they may care for themselves as well as they do others.

It also might include physiological responses, such as increased heart rate, sweating, tense muscles, upset stomach and feeling spacey, stiff, heavy, and restless, she said. This is why it’s helpful to start with your body, and physically soothe the discomfort. Psychologist Lauren Appio, Ph.D, suggested practicing deep breathing and progressive muscle relaxation, along with engaging your senses by listening to your favorite music or going for a walk.

Try empowering self-talk. Pay close attention to your thoughts, feelings, and sensations before, during, and after you set a boundary, said Appio, who specializes in working with individuals who are caregivers and people pleasers and struggle with codependency in New York City. Notice what you’re saying to yourself that makes you feel guilty or leads you to quit on boundary setting—and “come up with countering statements that make you feel calmer and empowered.”

Appio shared these suggestions for countering statements: “Everyone gets to set limits, including me,” “You’re doing the right thing,” or “It’s OK. You’re OK. You’re going to make it through this.” Tucker shared these examples: “This is hard and unfamiliar. This feels uncomfortable. I have a right to set boundaries. This is new to me. I’m scared, but I can survive this.”

Start super small. Tucker suggested setting boundaries in “low-stakes situations,” such as “telling the server they got your order wrong” (versus telling your mom you’re not going to her house for the holidays).

Practice with a supportive person. When you’re a seasoned people pleaser, it’s hard to imagine the benefits of setting boundaries, Appio said. “Your brain needs new data: People pleasing is not the strategy you have to use to keep yourself safe and maintain your relationships.”

Which is why Appio recommended picking a supportive person (e.g., a friend or therapist), and honestly expressing your preferences or setting boundaries. This way, “you can have positive experiences that will motivate you to keep trying.”

Buy time. “Instead of expecting yourself to say no on the spot, which might feel impossible, get in the habit of saying something that gives you a chance to think it through,” Tucker said. This is also important because, as she said, the point of boundaries isn’t to say no to everything. The point is to be intentional. It’s to check in with yourself and make sure you actually want to do what it being asked of you.

Think of a statement or two that you can have at the ready. According to Tucker, those might be: “Let me look at my calendar and get back to you.” “I need to think about that. I’ll call/email/text you later/tomorrow/next week.” “Hmm. I’m not sure if I’m able to do that. I’ll be in touch soon.” “I need to check with my partner first to see if we’re free.”

Realize that you have limits—everyone does. Guilt stems from having unrealistic expectations. That is, we feel guilty for setting boundaries because we believe we should be able to do it all. Teachout said “This is living in the land of “what if.” Which is based on our imagination, not the reality.

“Reality says we have limits to how many things we can keep track of, how much energy we have in a given day and the extent of our skills for working within any given situation. If someone asked someone with no training in automobiles to take apart the engine of a Tesla and put it back together, should they feel guilty for being unable?”

Similarly, saying no, Teachout said, isn’t about denying someone want they want; it’s about knowing yourself because you wouldn’t be able to do it anyway—again, because you don’t have the time or resources or energy.

Be patient and kind with yourself. Remind yourself that you’re learning a new skill, and that takes time and practice. You might have many slip-ups, and take a few wrong turns. Try to be kind to yourself the whole time. As Tucker said, the part of you that believes you don’t have a right (or it’s not safe) to set boundaries may be screaming. This part is trying to protect you, and keep you safe. “That part needs love and tenderness, not more judgment.”

Having a hard time with setting boundaries today doesn’t mean having a hard time tomorrow. That is, with practice, boundary setting will feel more natural, and it will get easier. The key is to start—and keep going. You can absolutely change your behavior. Because that’s really all it is: People pleasing isn’t some permanent trait. It’s a behavior you can alter. One boundary at a time.

I was a quirky kid who told my parents that I was “an alien baby left on their doorstep.” I suspect they believed me at times. I always felt I was out of step with my peers; running a bit too fast to keep up since I was diagnosed with asthma at age four. I wanted to both stand out and fit in. A juxtaposition that exists to this day. I surround myself with creative souls who write, draw, paint, dance, play instruments, sing and take photos of the world around them. In those groups I have found my tribe, since they too, have expressed feeling outside the constraints of what is considered normal. I have a bumper sticker on my car that says, “normal is relative.” I have also read that “normal is a setting on a washing machine.”

One of my favorite cartoons is one that portrays an Adult Children of Normal Families Convention. In it is an auditorium where two people sit.  The joke is that one of them is lying. What is normal for one person may feel totally unnatural for another

Jane is one of six children who grew up in a family that has their own business. It is expected that each child does his or her part to keep it running. She expressed that she doesn’t have a linear, logical cell in her brain and is of an artistic bent. In her mind, she travels to places of whimsy and wonder and then splashes the images on canvas. It is where she finds both her liveliness and livelihood. Her work is seen in galleries and, on occasion, her parents and siblings have attended her openings. They refer to her as a “Bohemian Artist”, a title that she wears proudly.

Mel lives in an intentional community with those considered “family of choice”. Using the pronouns they/them, Mel considers themself gender queer. Much of Mel’s life has been kept undercover from their birth family, since rejection was a likelihood if they knew who Mel truly was. When visiting home, the old persona is like a costume worn to avoid censure. Mel’s parents would see Mel’s lifestyle as so far out of their own comfort zone that they wouldn’t know how to communicate their feelings with the child they had raised who now feels like a stranger.

Sam is a multiply-tattooed and body-pierced young millennial who just turned 19 and is living at home. His parents are concerned that he won’t be able to find a consistent respectable job given his current appearance. Their mainstream sensibilities shape their perception of acceptable career paths. Sam’s best friend is a tattoo artist who designed Sam’s body embellishments. With his friends he attends music festivals and Burning Man. He comes home waxing poetic about the experiences he has had, and they can’t wrap their minds around his vision for the world in which everyone shares what they have.

Some who are labeled ‘weird,’ may have an unusual sense of humor, seeing the world through a non-traditional lens, others saddled with social anxiety and may not know how to express themselves in a way that fits in with the cultural norm. Those who view themselves as outcasts and misfits often wonder how to navigate the waters while paddling a leaky boat that they were never taught how to patch. It is those folks who were likely maligned as children who often rise to stardom.

Consider Lady Gaga, who in a 2011 interview in Rolling Stone Magazine, speaks of having been bullied for being different from her peers. I wonder if those who persecuted her in her teens remember how they treated the mega star.  She took her unique persona and made it her signature image. She attracted her following of those she referred to as little monsters, to her Mother Monster.

The Rocky Horror Picture Show which debuted in 1975 has become a cult classic as it is still played in movie theaters world-wide, and attracted its own audiences of those who perceived themselves as different as well. Dressed in costumes that resembled the characters, the story line was acted out with props such as water pistols, newspapers and rice to emulate the script. I saw it over 30 times in my college days and a bit beyond as I attended the midnight show at the TLA (Theater of the Living Arts) on South Street in Philadelphia, decked out in costume as well. When I was in that mode, I relished the feeling of being other worldly. My friends and I still fondly reminisce about those days.

Now in the seventh decade of my life, I sport purple/fuchsia hair, flowing, clothes (think Stevie Nicks meets fairy Goddess) and occasional henna tattoos. My 31-year-old son calls me his “weird hippie mom,” sometimes said with a wry smile. Ironically, his in-laws attend rock concerts, their home is decorated with rock posters bearing autographs from some of their favorite musical icons and their bathroom is embellished with peace signs. For my birthday a few years ago, they gave me a purple lava lamp. When my daughter in-law buys me clothing, she chooses something her tie-dye loving father would like.

My son also tells me that my purple hair isn’t professional, and I remind him that in my therapy practice are young clients for whom my look provides street cred. It also is a way of attracting conversation with strangers who comment on it. A few days ago, I met a woman coming out of the bank whose own short cropped tresses were a vivid, almost cotton candy pink. We admired each other’s appearance and stood for a good 10 minutes comparing notes about our lives. Of course, we friended each other on Facebook and are following each other’s antics in cyberspace.

As a tribute to those who, like me, may have been the rainbow sheep of their families, I share this hodgepodge of quotes about honoring your weird, having your vibe attract your tribe and letting your freak flag fly.