Incremental is transformational

A Portrait of the Artist as a Duck

A Portrait of the Artist as a Duck

“Because no one ever learned to walk by walking”
— Moshe Feldenkrais

No one ever learned to walk by walking. It’s hundreds and hundreds of attempts and so many different motions and muscles and movements that come together that allows us to learn to walk. And healing is a lot like that too. It’s hundreds and hundreds of attempts and different motions and muscles and movement that come together to allow us to heal—to do something new, do something again. To reach forward. To move again in our lives, in our hearts, in our relationships.

I am talking about healing from trauma, but I could just as easily be talking about grieving the loss of a spouse or child, or the loss of a job, or the loss of a marriage. I could be talking about the physical healing from hip surgery or knee surgery or stroke or heart surgery. All of these things have their own trajectory. All of these things heal in pieces, in increments over time.

I think one of the most helpful things you can learn while you are healing from trauma is that you heal in steps. You loosen things up, you untangle them, you increase your range of motion, you expand your capacity to hold things. It’s the coming together of all of the pieces that allow you to move freely again. It’s not one set of moves and it’s not the same set of moves for each person.

But here’s the thing. You can’t just learn to tolerate the small steps of healing. You have to find a way to get excited about them, love them, be curious about them, celebrate them.

A few days ago I wrote about how healing was developmental, but it is also incremental. It is made up of these small steps which are building blocks. But incremental leads to something bigger.  In the world of writing about change there has been this weird false dichotomy created about ‘incremental’ change versus ‘transformational’ change—as if they weren’t interrelated. As if you could actually get transformational change without incremental change. We don’t pay attention to the incremental. We don’t pay attention to each muscle capacity a baby learns: the arched back, the lift of the head, stretch of the shoulders. We don’t celebrate each small move, we celebrate sitting, standing, walking. But these huge transformations are built on increments. Incremental leads to development, to transformation—to the big shifts that we want. You can’t always see how the small steps are coming together until they do.

I had a child client many years ago who created a game we played together. He would draw a picture using as few lines as possible, and I had to guess what the picture would be. If I couldn’t guess, he would add a line. And then another, and then another until it became a picture. And even then there would be surprises. On one particular occasion, he finished the picture and said, “Do you know what it is now?” And I said, “No.” And he said, “It’s a portrait of you, if you were a duck.” So as you are putting pieces together, you have to be ready for surprises. You have to be willing to see yourself in a whole new light.

When I say that healing is incremental, what do I even mean? What I mean is that you have to work on the pieces in increments that can feel solid and doable. When I had kids who couldn’t make eye contact we worked on talking from behind a chair, and then from under a blanket, and then just wearing sunglasses, and then moments of eye contact. We built it up in increments until it was solid enough that we weren’t even paying attention to it anymore. With each of those increments we got to stretch and grow some new muscles. The problem with any trauma, physical, mental, emotional, relational—is that you can’t always know what got damaged—you don’t always know what the trauma shattered. It is often in the healing process that you come to understand what was hurt, and what needs to be healed.

And incremental is also what allows healing to be healing and not re-traumatizing. If you work in increments, you are responsibly paying attention to dosage—how much someone can manage and take in without it overwhelming their system. If it is incremental then it isn’t ‘happening’ to the person—they aren’t being put in a position where they feel out of control again.

Healing from anything big takes an incredible patience. A mighty patience. And more compassion and self-compassion than you imagined possible. For all the people involved—for the trauma survivor, for the people who are working with the survivor and the people who love the survivor. It takes a lot of patience to create your new picture one line at a time, not sure what will come of it. You may not want to see yourself as a duck. You didn’t want to end up with a beak. But, hey, those are also wings you are growing.

© Gretchen L. Schmelzer, PhD 2015

The thoughts from Moshe Feldenkrais in this article were inspired by Norman Doidge's new book. I will be reviewing it later in the week, but if you want to beat me to it, you can purchase it below. It's fabulous.


Mindful Monday: Mindful ways of seeing

Photo: H.N.W.

Photo: H.N.W.

“We only see what we look at. To look is an act of choice. As a result of this act, what we see is brought within our reach—to touch something is to situate one self in relation to it. We never look at one thing; we are always looking at the relation between things and ourselves.”
— John Berger, Ways of Seeing

Mindful Mondays are a chance to hone your practice, to give yourself another way to renew, recharge and rejuvenate. As Jon Kabat Zinn states, ‘mindfulness means paying attention in a particular way: on purpose, in the present moment, and non-judgmentally.' Mindfulness can increase your capacity for self-awareness and self-control. It can help you feel more grounded. And while everyone can benefit from mindfulness, for people who have lived through trauma, mindfulness is a crucial skill for healing. It allows you to take on the work of healing in a healthy and sustainable way. It helps you stay connected to yourself and the physical world when the work of healing gets difficult. It rebuild self-awareness muscles.

Today we are going to look at the mindfulness of seeing, of looking, of taking in your world visually.

The funny thing about seeing is that you can be looking at something, the screen you are currently looking at, the road ahead of you, or the pile of papers you are sorting—and you can also be thinking of another event in your mind and be ‘seeing’ that event at the same time in your mind’s eye. Your capacity for visually engaging with information can come from outside stimulation or inside stimulation. In fact your mind is always moving so fast you are lucky if there are only two competing visuals.

So today, or for this week, let’s bring the practice of mindfulness to looking at your world. Take a moment even now to just look around wherever you are, just 10 seconds. Really look. Notice what you see, notice what the light hits, notice what you often ignore. Notice, as Jon Kabat Zinn stated:  on purpose, in the present moment, and non-judgmentally.

See if you can play with seeing and breathing. Breathing comfortably, notice what your eyes pay attention to as you breathe. Think about how you take in breath, how you absorb it. How the oxygen from the air gets absorbed into your cells. Now turn your attention to seeing. See if you can visually take in your world. See if you can feel yourself seeing so intently that you absorb it. Take in the colors, the light, the textures you are seeing, and let them get absorbed.

Over the course of the day today, take a moment and stop. And look. Really look at something. Breathe and really take in what you are seeing. Use moments of mindful seeing to bring you into the present. Just notice what effect is has. Notice if it is different for you depending upon your attention, what you are looking at, or the context you are in. There’s no right answer. There is only the discovery.

Mindful seeing can be your experience in quiet moments, or it can also be something that feels more playful. I got my first car ever, a 1978 Buick, during the Fall in 1988, and my commute to work was on the back roads in the towns near Boston. I created a game I called “Best Fall Tree of the Day.” I would drive to work each day and look at the fall trees with the plan to give out the prize for that day to the tree that was at its height of its autumn color.  And if you are really observing each tree you know exactly the tree that wins each day, there is never any question. It seems to shine and shout out, “I’m wonderful.” And I would just smile at the tree and congratulate it on its win. And the game would pick up the next morning.  

When autumn turned to winter I shifted the game to my evening commute and the ‘best Christmas lights display’ and in the spring and summer the prize was offered for the best garden flowers of the day.  You can create your own awards depending on your landscape or the crowds of people you see as you commute.

Mindful seeing is a wonderful way to practice the art of perspective taking. You can look at something at close range like a blade of grass or the snow on your car and look at it so closely it can lose its particulars. And you can look at something, like the skyline or the landscape, so that it can seem to take on a shape all of its own, like the picture above of the mountains making George Washington in repose.

And the practice is being able to see and shift your perspective. To see it as you see it and see it as an ant might see it and see it as a tree might see it. So this week, really look and see. Look at your world the way a tourist might, with fresh eyes. We only see what we look at. To look is an act of choice. And what you look at and how you choose to look can be a source of mindfulness.

© Gretchen L. Schmelzer, PhD 2015

For more on Seeing:

For more on Mindfulness:



Healing from Trauma is a Developmental Process

“To explorers in general and mountaineers in particular it is a well-known fact that each successive attempt at the solving of a problem makes that problem easier of solution. Few great mountains have been climbed, a few passes crossed, at first, second, or even third essay. ”
— Eric Shipton & H.W. Tilman, Nandi Devi

Healing from trauma is typically described as a process of steps, but not necessarily developmental steps. I believe that the primary reason that healing from trauma has not been discussed in developmental terms is that there is a fear that it will make it sound like a long term process (which no one wants to hear) and it will make the people going through the process feel like they are being called “babies or children.” Both are reasonable concerns, but I think there is so much to be gained from understanding healing from trauma as a developmental process.

The first benefit if we can locate healing from trauma in a developmental frame, is that we have at our disposal decades of developmental research and theory to support us in this journey. There exists a consistent, yet somewhat malleable process of growth that organisms follow from the smallest cell to the largest community.

What I have noticed in twenty years of working with adolescents and adults who have experienced trauma, or who are in need of treatment, is that the standard protocol of treatment often starts ahead of where they actually are in a developmental sense. I worked for many years in residential treatment facilities and hospital adolescent inpatient units, and the standard treatment in these programs is cognitive-behavioral therapy (CBT). For the record, let me state that I have nothing against cognitive behavior therapy, and consider it, at the appropriate times, to be a very successful form of treatment. I believe, however, that the ‘evidence-based’ research in treatment is skewed toward CBT because it is the most easily researched—it follows a routine protocol and is often time limited.

As someone who has spent a lot of time in graduate school I can attest to the fact that the things that get researched the most are the things that can get researched in shortest period of time. Graduate students want to graduate, and they want to graduate as quickly as possible. They drive a lot of the research that gets done in academia. So, while what gets promoted as ‘evidence-based’ does mean that there is evidence that it works, but it’s often what has worked in a time-limited framework. I have always wondered what ‘evidence-based’ parenting would look like.

On the inpatient or lock-up units, the teens were required to state why they misbehaved, what feelings triggered the episode, and what they could do differently in the future. What became apparent is that the teenagers really couldn’t do this task: what they learned to do was parrot answers that they heard other kids say, or that the staff gave them. They would state, “I was angry and so I ran away. Next time I will talk to staff or a peer.”

This all sounds reasonable except that these kids didn’t actually know what they were feeling, and they didn’t trust anyone enough yet to talk to them when they are upset, so the solution was not yet a possibility. This is the developmental equivalent of expecting a toddler to type an apology note for his last tantrum. Because we get literal about developmental stages, and get hung up on their chronological age, rather than their developmental age, we ask the impossible from people who are trying to heal.

What the kids on the unit needed to realize was that they were cut off from their feelings. When the adults on the unit asked them what they were feeling, quite often they said “nothing.” This actually was the accurate answer—and it would have been a better starting point of honesty than trying to tell them what they were feeling and have them repeat it.

What is difficult about this discussion is the problem of definition or labels. In fact, I think that this alone has kept us from meeting people where they are. Fearing the implication that they are ‘behind’ or ‘young’ or ‘delayed’ we treated them like ‘adults’ with a standard of treatment and an expectation of recovery-- and everyone acts as though this will work. In therapy the client will engage dutifully and complete the sentences and say what they are supposed to say—but it isn’t actually connected to where they are so they aren’t learning about themselves. Then, when a stressor hits, they revert to what they always do because the ‘new learning’ hasn’t made any real connection.  And everyone is frustrated—therapist, client and the people who live with the client.

Our American ideals of equality probably hinder us in our ability to discuss developmental difference. We tolerate it with skill level. We have all sorts of assessment tests for various activities that test our skill level: beginner French, intermediate piano, or advanced algebra. No one likes being in the lower skill level, but we also know we can’t just jump in to algebra if we haven’t learned fractions.

We have compassion and understanding for the types of brain injuries that wipe the slate clean altogether—for stroke patients who lose the ability to speak or to walk. No one expects them to leap out of bed, or begin speaking in full sentences. When the damage to the brain, and the emotional systems is less obvious, or when the trauma interfered with how the brain developed over time, then we have no current way to understand the problem, and no easy way to  ‘let the person off the developmental hook.’ It is a reasonable question to ask how one would make a developmental diagnosis, or who would be in charge of doing it, and of course, what would it mean if someone did.

In a very real way we understand the damage a stroke does to a brain—and we can quantify it and name it—damage to the language or motor centers. But neuroscience research is now letting us see the damage that trauma can inflict—it can shrink the hippocampus, the center of memory, and it can shrink parts of the limbic system, center of attachment, and create lesions in the the amygdala, the fear and warning center. These are only some of the brain centers affected by trauma and they need time and new learning to heal. The brain must re-develop capacity.

Part of the problem lies in language—as development is growth over time, and to be further back in development makes one ‘younger’ or ‘immature.’ We simply don’t yet have language for this problem. In the language of countries, we have language for ‘developing nations’ that has nothing to do with the chronological age of the nation. Cambodia is a third world country, and a developing nation, and the United States is a first world country and a developed nation despite the fact that the Khmer civilization had temples and irrigation canals and libraries and science centuries before the United States or Europe had any of these things. In the taxonomy of countries, we assess based on economy and resources and label the country accordingly.

When we think of development we most often think of cognitive development in its most obvious forms: speech, learning, intelligence. When we have mastered the basic elements of development: standing, walking, talking, reading, school, driving, working—we feel like we have moved ahead.

We have no common language or understanding of emotional development or cognitive development in the mean-making, or understanding sense.  My motivation to write this blog in language that clients can understand, rather just for therapists is an attempt to jump over the need for someone else to tell you your developmental level—but instead to give you some understanding and compassion and information and help you state where you think you are starting this journey of healing. What are your capacities, and where are your deficits? Where are you starting? What do you need?

© Gretchen L. Schmelzer, PhD 2015

 

Mindful Monday: Mindful Goodbyes.

“How lucky I am to have something that makes saying goodbye so hard”
— A. A. Milne, Winnie the Pooh

For the fun of it, since the last Monday Mindfulness was on Hello, I thought I would swing to the other side and look at Mindful Goodbyes. How to close the loop, finish the conversation, move to the next task or interaction with gratitude.

I joked not long ago that the four most difficult words in the English language were Yes and No, Hello and Goodbye. They are the words of boundaries, of approach and avoid and attachment and separation. All tasks which we work on our whole lives long.

So why a mindful goodbye? A mindful goodbye allows you to actually be present to where you are and what you have done. Often, we do things or we talk to people and we are so busy moving on to the next task or the next sentence or the next interaction that we actually haven’t finished the one that we are in. We haven't actually listened. We haven't actually experienced. 

When we don’t say goodbye to the task or the person we don’t get to take it in—we don’t get to feel its impact. We don’t get to be grateful for the action, the completion, the presence. Saying goodbye and attending to completion contributes to sturdiness. It’s contributes to solidity. Imagine if the builders of skyscrapers just bolted the beams in place and moved on. Decided not to bother with the whole welding thing. Finish the action you are in. Your learning, your experience and your well-being will be more solid.

One of the best pieces of advice I ever got was from my friend Donna who told me that when I finish something, like the dishes, or cleaning my desk, or raking the leaves—that I should stop, and take a full minute to look at the completed task. Take in that it was done, feel good about how it looked and pat myself on the back. A little self-gratitude can go a long way. Normally I would race through tasks and feel like “I got nothing done.” I never had a sense of completion or accomplishment, despite the crossed off to do list. But the simple act of staying with the end, instead of moving to the next beginning really shifted that experience. So go ahead--look around at what you completed, take a bow, have your own private standing ovation.

Stay with the end. This might be as radical as actually saying, “Goodbye” instead of just ducking out. And like we discussed with hello, say goodbye and wait for the response. Say goodbye and say or think something that you were grateful for in the interaction. As you are walking away think about what you are taking with you from the conversation. What you are taking with you on your journey and then breathe and be where you are.

Learning to say goodbye and stay with the end are great ways to build muscles for the bigger goodbyes that happen all throughout life. They are the musical scales of loss and expansion and growth. They allow us to feel our edges, where we begin and end, that helps us understand how we belong and how we understand ourselves.

For people who have experienced significant or traumatic loss even small good byes can be painful. Even small goodbyes can trigger the feelings of loss you once felt. It’s okay. Small tiny goodbyes can help you mend those torn muscles and rebuild them. Small tiny goodbyes. Goodbye to that phone call. Goodbye to that project. Goodbye to the grocery shopping for this week. The small goodbyes, really experiencing them, helps us remember that feelings can hurt but they aren't fatal. It reminds us of our resilience. We can feel our legs again. Start as small as you need to. Some traditions have you start with your breath. Breath in: Hello, Breathe out: Goodbye. You can practice small goodbyes with each breath.

Of course it’s a circle this goodbye and hello thing. Say goodbye to the task you just completed, to the person you were just talking to, and then notice what happens when you come to the next task and the next person. What is your hello like? Follow the circle. Hello. Goodbye. Hello. Or as the Italians would say, Ciao! Ciao! Ciao!

© Gretchen L. Schmelzer, PhD 2015