Therapist in crisis? When the professional and personal roles collide.

The world feels quite tumultuous these days. As a therapist, the U.S. elections and the COVID-19 pandemic have been taking up a lot of space with my clients — causing anxiety and deep feelings of unrest. It has also been an incredibly hard couple months for me personally. I’ve had to ask myself some difficult questions regarding self-disclosure with clients and also about self-care for myself.

Therapy in the age of the internet and social media raises a number of ethical considerations about the boundaries between therapist and client, and also speaks to changing social mores of our time. I am a drama therapist, and a part of my clinical training involved utilizing the body as a source of knowing, along with more traditional cognitive resources. Over the past few months, I’ve come back to my own body for answers often: What feels most ethical in my gut? What disclosure is in service of my clients and the physical space we co-create in our sessions? What boundaries do I need for my own self care?

A simple Google search will tell you that my mom passed away on January 16th after an open heart surgery at the age of 69. What you won’t read is that my family and I spent eight awful (and surprisingly special) days in the hospital with her in a coma trying to process the impossible concept of her dying before we removed life support. You also won’t read that during this time my two year old son had the flu, and a few days before my mom went in for surgery, I slipped a disk in my lower back, causing severe sciatica pain. Along with the general unease in the world right now, 2020 has been rough so far for me. Painful, devastating, sleepless and slow. (Reminder: it’s only the middle of March.) Through it all, I’ve also maintained my private practice. In doing so, I’ve made very intentional choices around how this personal crisis would interact with my professional role.

Therapists are human. We hear this time and again. And yet, the protection of certain personal details of my own life as therapist often serves to cultivate a healing space where the focus can solely be on the client and their needs, desires, concerns, or fears. As we know, therapy is different from sitting down with a friend over coffee.

At its best, the therapist can be a mirror or transitional object for the client, allowing the client to gain a truer understanding of self and clarity about growth. If the client is concerned for the therapist or feels guilty about burdening them with their own struggles, this space is threatened. And yet, the therapist still brings with them all the feelings of loss and hurt that make them human into this therapy room. How do I as clinician remain true to my own grief while also maintain a level of distance from it so as not to fall apart? How do I share what is important for both the client and myself without taking up space that does a disservice to both our our goals?

Of course, I took some time off. A few clients knew that a family member was going in for surgery because I had to reschedule at the last minute. Most clients understood when I shared that I had to attend to a family emergency for a week or two. But then I went back to work. I found that my greatest joy and peace in those couple weeks after my mom passed was either in sessions with clients or with my 2.5 year old son. The roles of therapist and mother helped guide me through the sickening “business of death” that happens after a loved one dies. I found comfort and strength in holding space for others — or just playing dinosaurs.

I disclosed the details to only a couple clients who either asked directly or knew information through other connections in the community. With those people I shared briefly that my mother died, but I then made a point of telling them that while I appreciated their concern, I was receiving support and help in my own therapy. This space was respectfully theirs.

While this was an ethical choice, it also was necessary for me to maintain a professional boundary. I couldn’t touch the well of breathsucking grief that lay beneath the surface with my clients for fear of being flooded. Nor did I want to. I utilized other spaces for that processing, and I still am finding those spaces — in my own personal therapy, in peer supervision, with friends and family. In circles with women. Alone on a mountain where I spent a night solo. I am taking care of myself, but I also am finding comfort in the structure and the simplicity of the therapy space with my clients. Where the focus is not about me. Where I can lend my heart and body to listening and being with someone else.

We are hurt in relationship to others, also known as trauma, and the thinking is that we must be healed in relationship as well. There are many words for this healing dynamic — one name is therapy. However, healing relationships can take on many different shapes and power structures. While the primary goal of therapy is healing for the client, I experienced a profound source of healing while holding space with my clients.

Is this caretaking impulse me trying to avoid my own grief? Maybe. But maybe it’s also a way for me to deal with the impossible in managed doses. There is no “right” way to deal with grief (as they say). It would be unethical to work through my grief on my clients’ time, but connecting with other human beings, holding boundaries for them, empathizing with their feelings and struggles, and sharing in their joys or small successes — this is also a deeply fulfilling way of being in relationship.

Which leads me to questions I am exploring today. In a co-created space such as therapy, how much do you feel is appropriate for a therapist to share? Do you appreciate it when your therapist shares personal details? With personal information so easily accessible online, do you seek out your therapist’s information? Do you Google them?

And for you clinicians, how to you deal with the moments when your professional and personal identities collide? Might it be that when our own humanity shows up in the therapeutic space, we are tapping into a larger transpersonal connection that serves as a cornerstone for a corrective emotional experience? I wonder.

To read this article on Medium, click here.

On the scribble story technique

Scribble drawing activity (aka Scribble Story Technique or SST) today in my eating disorders recovery group! ✒️ *this is the one I made alongside the clients*

✔️Start with a blank piece of paper and a pen. Ask group members to start scribbling all over their pages, in a way that allows for lots of lines to overlap.
✔️Take a step back, and observe the page of scribbles. Rotate the page and keep looking, allowing different images to emerge naturally.
✔️Start coloring in sections that stand out, gradually allowing a larger image or images to come forward.
✔️This could be an abstract piece (colors, shapes, patterns) or more literal (a dog, a symbol, or like I have here, a person’s face). The point is to explore the process, and while coloring, to observe your breath and body. Process is more important than product.
✔️After people are finished, invite them to title and share the story of their image. This could be a fable or myth, or it could be a description of an emotion. Does it relate in any way to your recovery? If so, how?

We had an intense process group in the morning, and this was a helpful exercise in allowing a more creative outlet for expression and release. The images are purposely disjointed and disconnected, a healthy challenge for clients who struggle with perfectionism or a need for control.
It can also be used for clinical supervision (see Dr. Laura Wood’s article here) or can just be a fun activity for kids and teens – or yourself – to get out of your head, into the present moment, and to see the world from a slightly different perspective. Let me know if you try it!

#dramatherapy #creativeartstherapy #eatingdisorderrecovery #grouptherapy #losangelestherapist https://ift.tt/37rhVHc

On eating disorders recovery treatment

My work in 2019 took on a number of new shapes that I wasn’t expecting. Doesn’t life always surprise us that way? A part time job at Reasons Eating Disorders Treatment Facility led to a deeper understanding of the underlying factors involved in ED, while simultaneously my private practice started to *magically* attract more individuals struggling with similar issues. Perfectionism, control, self-criticism, trauma, and loss all began showing up in the room, and I found that I was HERE for it.

The term “eating disorder” is a misnomer in many ways – maladaptive coping tools manifest themselves in an unhealthy relationship with food, but the reason for the ED runs so much deeper. I have found a deeply compassionate and loving place in my heart and body for people struggling to love themselves, their shape, their image, and the way they take up space in the world.

The impact of social media, while it can be a lifeline in many ways to some people who are isolated, can also disrupt the process of embodied mindfulness and intuitive self-awareness. It can present a mirror that is so skewed, so targeted, and so discouraging, that individuals fall into a well of embodied self-hatred. Intelligence often complicates the situation even more. Rationally, so many of my clients understand the harm they are doing to themselves, but the felt sense is one so hard to access and so painful to engage, that fleeing or putting getting help off for tomorrow becomes a regular action.

Know that you are not alone. There are incredible resources available to you!
@theinnergem offers unique weekly groups for people in recovery from ED
@neda offers articles and links to more resources
And I’m available for clients in my private practice seeking a more embodied understanding of how to heal. We often start with talking and only move into embodiment when the time feels right. But the space is there.

Please reach out via DM or email me at danielle.levanas.therapy@gmail.com

Posted @withrepost • @thechalkboardmag Don’t wait your whole life. #tcmlivingwell @nayyirah.waheed

#dramatherapy #eatingdisorderrecovery #anorexianervosarecovery #bulimiarecovery #orthorexiarecovery https://ift.tt/36Nu2xQ

On addiction treatment and drama therapy

When working with people seeking help for addiction, the addiction is often the entry point to therapy. Underneath the addiction are sometimes years of trauma or loss that have gone unaddressed. I have worked with incredibly creative and dynamic survivors who have just never had the opportunity to fully explore their story. When we look at substances as the primary coping tool for a person in distress, we are able to reframe the narrative away from a moralistic view – and help our clients do so too.

One of the biggest strengths I see in using Drama Therapy is that it allows people to expand their understanding of themselves beyond just the roles of “Addict” or “Lost One.”  Many people come to treatment for addiction with shame, guilt, and self-hatred for hurt they have caused their loved ones. Much of the process of healing starts with tapping into a radical self-compassion. Drama therapy is perfectly suited for holding the complexity of both taking responsibility for one’s actions as an adult, while simultaneously expressing anger or loss at the trauma one experienced as a young person. 

I’ve worked with clients at a number of addiction treatment settings and levels of care. Drama therapy looks drastically different in each! What is possible and helpful in a long-term residential or dual-diagnosis treatment facility is different from a 30-day rehab or 8-day detox. In long-term residential, my relapse prevention groups integrated Playback Theatre and Theatre of the Oppressed techniques. The 30-day rehab program allowed for a structure where men and women could have drama therapy groups separately to deal with histories of trauma or abuse, and address toxic masculinity or internalized oppression.

Currently, my work using short-term interventions at a detox facility is focused on mindfulness, grounding in the body, and managing acute physical pain and anxiety. It can be exhausting going deep with new people each week and then almost immediately terminating. I’ve also had to adjust my expectations to make space for the physical illness of detox. My drama therapy groups might look like guided meditation or friendship bracelet making to an outsider – but it’s still drama therapy!  The common thread across sites is that the space we create for people to feel seen and heard is incredibly and irrevocably meaningful.

This ability to adjust my drama therapy interventions to fit the needs of each treatment level/site is something I attribute to the depth of my training at the NYU Drama Therapy Program. In our Clinical Populations course, Prof. Sara McMullian would often say that ‘the work is small.’ I thought I understood what she meant at the time, but years of working in different addiction treatment systems have deepened my understanding. At every level of care, I’ve found that my work in the room is impactful for the clients, however sometimes I forget how much power we have to impact a person/group/system with our interventions.

Just the other day, I was walking out of detox heading home, and I said goodbye to some clients by the elevator. Thanks and best wishes were exchanged. As I turned the corner, I overheard one man say to his peers with all sincerity, “She did her job today… because I didn’t leave.” My heart exploded! Sometimes our job is small, so small we don’t even realize we are making an impact. However, when we keep people in the room and in conversation with their healthiest selves, we plan the seeds to change the way they define themselves in the world. That step can be enough.

On mindfulness and drama therapy

So much of Drama Therapy is about integrating the body with the mind and spirit. The body holds trauma and emotions that our mind often works to avoid. By learning to listen to our body’s messages, we can start to process, tolerate, and cope with feelings that can be deeply uncomfortable but necessary for growth. We do this in many ways, often utilizing breath work, movement, storytelling, play or writing.

Often people think that Drama Therapy is about creating a performance or finished product to share. While it can be that, so much of the work is also process oriented. We work through fear, anxiety, pain and shame by practicing different ways of expressing ourselves. The moment is experienced fully and then let go. We process and release, making space for new roles, new narratives, and new goals in our lives.

The work is often small, much smaller than we expect. An exercise that I have been using a lot lately at the Eating Disorders Treatment Facility where I work is the “co-created one sentence story.” We go around the group circle with each person contributing a sentence to a story. Sometimes we start with a theme, but often we allow the story to unfold organically informed by the dialogue or check in before it. This game is one that children might play in summer camp, but used in a treatment setting, it can go very deep. There is a beauty in crafting a story together in the moment. The group must allow each individual to take control of the narrative and also trust that the individual will carry the group’s momentum. Each individual must also be open to letting go of the need to plan out what they are going to say. When given time, space, and depth, the exercise can delight, surprise, and connect people to their individual bodies and to the group as a whole. It is a practice in true mindfulness and creativity. We always start and end with a collective breath.

Maybe you’d like to try it sometime. It can be as silly or serious as you would like, but the shared experience of creating something together is always powerful.

On detox and thanks

Found this on my desk a couple weeks ago from a client at the #detox recovery center. So much talent in one little frame. The client was a special individual – even though he struggled to see it. Addiction doesn’t discriminate. And it continually amazes me the power of human connection and fortitude even when the body is going through hell. 🌹

#addictionrecovery #addictiontreatment #detoxtreatment #creativeartstherapy #traumarecovery #mentalhealthawareness #arttherapy #selflove #selfkindness https://ift.tt/2Pd6edt