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Cars, Bathrooms and Closets:  Psychotherapy during Quarantine

Cars, Bathrooms and Closets:  Psychotherapy during Quarantine

by Kristin R. Krueger, Psychologist, Single-Mom

When we got our stay-at-home orders and the weight of it all sank in, I immediately went into action mode.  After all, I’m well schooled in responding to crisis and all that might go with a pandemic lock down.  First, I worked for years in our county hospital, putting in a number of ER shifts in a mental health capacity.  Seconds, I was raised by a father who spent his early years in post-WWII Europe and then lived a tenement-like existence in Chicago from 7-years-old through high school.  My mother was raised on a farm.  Long-story short, I know all about do-it-yourself, grow-it-yourself, reduce, reuse, reuse, reuse and recycle.  I’ve spent much of my adult life trying to not feel the weight of these lessons of my upbringing, but those skills are ingrained.  Third, I spent much of my 20’s living abroad teaching English, and thereby, picking up survival tricks here and there.  Finally, I’m an improviser, so I was ready, “Flexibility!” “Surrender to the ensemble!”  I thought, we would all have to change.  I want to be part of this solution.  Where do we start? I was built for this time – in which we have to use resources well, live with uncertainty, and work together. 

The mental health implications for medical front line workers were obvious early on and I wanted to and felt I should be a part of this.  I became obsessed with this idea.  So, I reached out to the coordinators for the physicians wellness program for which I work, and asked how I could help.  I signed up for the volunteer page for our state health department.  I even looked up the licensing process for New York State, which at the time was hardest hit.  “I have the skills!  I’m ready to help!” 

When I woke up from my ego-driven heroism fantasy, I settled into my reality.  I have a 4-year-old and was already struggling to watch her while working and attending to calls/conferences.  In between meetings, we baked, planted herbs, went biking and rode on the scooter.  We cooked 500 meals a day and washed 6,000 dishes.  She started virtual pre-K programing and I attended to internet and tech problems.  At times frustrations were high and my patience wore thin.  On one important phone call, I attempted three times to distract my daughter.   Embarrassed that I would have to ask the others to hold on a 4th time, I silently grabbed a cupcake and pushed it towards her.   It worked.

And at the end of the day, my 80-year-old parents were my only viable option for childcare.  My other sitters had high-risk situations.  I hesitated due to not fully knowing the risks of us all being together early on.  Ultimately, we all quarantined together and have been healthy.  I initially used them sparingly – mainly to cover my time in telehealth psychotherapy sessions two days per week.  I was grateful to be able to work in some capacity.  To accept my reality, it helped to remind myself often what we learn as improvisers:  Your role is sometimes to not join a scene.  Not every scene needs you to walk on stage.   Having the success of the ensemble in mind helps you make the best decision for that scene.

I focused on treating my patients via telehealth.  Telehealth is awkward at first, but everyone learns to accommodate.  Because most patients live with others, they often seek out privacy in places, such as their cars, closets and bathrooms.  In one case the situation provided an opportunity for a visual so strong, that I was grateful for the closet setting.  This patient, with a history of OCD, was able to show me each of the 7 T-shirts – nicely folded and with a distinctive logo – that they had recently chosen to wear and then rejected because of an association with an obsessive thought.  ‘If I wear this one, my partner will get sick.  If I wear this one, something will happen to my friend., etc’

Some patients began the lock down with an increased sense of solidarity or enhanced motivation to address their anxieties.  The pandemic pushed them to dig deeper or it somehow put things into perspective for them – both resulting in better emotional management.  As the pandemic and lockdown have gone on, they express being weary – having good days and bad days – and increased anxiety.  In the most devastating situation thus far, I learned the following from a patient I see every two weeks.  In that 2-week interim, the spouse had gotten sick, received a COVID diagnosis, and died in the home.  My grief for this patient is tempered only by the beauty in the community’s response.  Since family members in the home have also tested positive for COVID, extended family and friends have gathered every evening to pray outside the home, which family members can watch from their window. 

So, what do we do with the pain, grief, weariness and uncertainty?  We do well to find the little joys in the changes.  The joys and benefits are there – if we are open to see them.  Sometimes we need to stop and create some joys – even when finding them is contrary to our productivity based mentality.  Embrace your creativity and know that doing so often comes with a limitation of our own or others judgment.  And as always, we do well to focus on the things that matter and allow the voices of criticism or dismissal – from yourself or others – to let go. 

As with any catastrophic change in a person’s life, acceptance of the situation and assimilation of it will help us act.  Acting gives us a sense of purpose and will likely move us forward in a positive direction.   We cannot and do not have to plan and predict to the extent we did in the past.  We can trade in a part of our competitiveness in exchange for enlarging our circle of compassion. 

I continue to be fascinated with this colossal world reset.  I’m curious and hopeful that a similar evolution in our ability to be inclusive of others will occur.  I believe the scientists will figure out a vaccine and human ingenuity will propel us towards a healthy economy.  I hope our city planners will help us learn how to thrive with a new social spacing structure.  And mainly, I look forward to an increased understanding of the importance of mental health.

When I picked up my daughter yesterday, I heard about the adventures of three mermaids that had to swim through the sea to find a treasure.  And these mermaids survived, found the treasure and then ate sweet rolls, ice cream, candy, donuts…

Note:  If a situation becomes overwhelming, then seek professional help!  Call 911 or go to the nearest emergency room if you have thoughts of hurting yourself or others. 

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How to Find Your Inner Map

by Brooke Campbell, MA, RDT-BCT, LCAT

We are on an unexpected journey at the moment and we each hold the individual map to get us to our destination. Our destination is not to an outward place, but towards the inner landscape of ourselves. As humans, we are quick to want to escape when life becomes hard and
challenging. Yet, we are well-equipped to stay with ourselves during this time and journey inward, which is more about becoming and less about doing more.

Our map consists of becoming more aware and attuned to our mind, body, and heart.

Our Mind Map – Our brains are on a journey. We can experience a roller coaster of being in a primitive freeze, flight, or fight reaction as a response to the collective trauma we are experiencing. If we have a map of our mind, we can be the captain of our ship and observe
lovingly to check in to see where we are at the moment. Are we feeling triggered? If our brains sense a threat of safety and danger, our amygdala becomes fired up and reacts in a freeze, fight, or flight response. This response exists as a way to survive. There may be times our amygdala senses a threat when there is no actual danger. An example of this would be if we are feeling the emotion of fear. Using our awareness, we can check to see if we are feeling triggered and emotionally activated. During a real actual threat, we could go into a tuned out, shutting down state to protect ourselves.

When we feel relaxed and safe, we can stop and acknowledge our fears and then lovingly venture to the part of our brains that are responsible for problem-solving and executive functioning, which is the frontal lobe. Some ways we can access our frontal cortex is through creativity, play, and social engagement. What playful, fun, and creative activities bring you joy? What people light you up that you could connect with? When we are engaged in a playful, free, creative state while remaining social (in a safe, social distancing way) we’ll be able to feel more joy and relaxation. As a result, we are able to problem-solve effectively and make positive decisions for ourselves.

Our Body Map – As trauma informed medical doctor Bessel van der Kolk states, trauma resides in our bodies. It is through our body that we can heal. If given a map of our physical body, what places are we holding stress? Our body stores memories and emotions. How can we be in
touch with our bodies and what it needs on a consistent basis? Basic needs like rest, exercise, movement, eating healthy foods, and staying hydrated are essential at this time. More than ever before, we are needing to care for and not abandon ourselves. Now is the time to fully
care for and listen to our bodies.

Our Heart Map – As a society, we are often given the message that our minds are more important than our hearts. Our hearts hold our insight, our inner knowing, our dreams, hopes, and feelings. What are our hearts telling us? What are we deeply needing at this time? If we get still and quiet, what message is our heart telling us that we need to hear at this time? Is our heart feeling full and connected or alone and needing more love? How can we show ourselves more love and compassion?

Learn more about Brooke at: http://www.creativekinections.com/

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Roles aren’t just for Actors

by Jamie Lynn McCoppin, MA, RDT

Have you ever felt like you were standing in your own way? Self sabotage is very common, but less common is the practice of examining and playing with these parts of ourselves. We have a wealth of roles inside of us such as familial roles (mother/daughter, father/son) and social roles (friend/lover), gender roles (man/woman) and professional roles (boss/employee) and the list goes on. 

There are roles we are very practiced in and familiar with… For instance, I’ve been a daughter all my life. I know the role well, and I play it well. Other roles are less familiar to me. The role of “boss” is new and unfamiliar territory, even though I’ve had many bosses in my adult life, I haven’t played one myself. How would that feel? How would I talk? How would I carry myself as someone’s “boss”?

As a drama therapist, I love Shakespeare’s “all the world’s a stage” quote. I have come to understand how valuable it is to rehearse these roles as a rehearsal for our real lives and how we show up in it. Showing up with confidence and courage is what supports us moving through life with joy and ease. According to Drama Therapy Role Theory, the more roles we have in our repertoire, the more flexible and adaptable we are. Being able to shift from one role to the next with ease is a sign of health. 

I am not only a drama therapist; I’m a courage teacher. I have designed a program called Playing It Real: Meet Your True Self. I use a combination of drama therapy methods to help people sort through the roles they play, the roles they want to play and the roles that stand in their way. Once they’ve chosen their roles they are most eager to practice, the group finds a shared central question they would like to answer in a drama. 

In this complex time, we have a chance to notice these roles that have been waiting in the wings to enter the stage of our life. It’s time to meet our true self — the one that has been waiting to take the stage and stand in the spotlight.

It’s not too late to sign up for the program that begins tonight! We have room for a few more.

Playing It Real: Meet Your True Self

6 Wednesdays starting May 20, 2020

7-10pm EST

Jamie Lynn McCoppin, MA, RDT

Pronouns: She/Her
Drama Therapist, Life Skills Coach & Stress Relief Specialist

Founder of Spark of Play@mysparkofplay on FB & IG

“Wholehearted adults play. – Brené Brown

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Pure vs. Impure Improv

by Dr. Daniel J. Wiener

Hi Everyone,

Hope you’re all healthy and happy.  This week we are starting a series of guest blogs from our amazing stars of the film.  To make sure you get them all, sign up for the Act Social mailing list:  http://eepurl.com/dKff7k 

Today’s blog is from drama therapist and pioneer of the “Rehearsals for Growth” technique, Dr. Dan Wiener.     

“Pure” and “Impure” Improv

Daniel J. Wiener, PhD, RDT-BCT

In Rehearsals for Growth (RfG), we recognize that the dominant mode of adult mental functioning is “Survival Mind,” which focuses our attention purposefully toward the future in order to get desired results, scan for dangers, and promote the feeling of being in control of/ achieving success in that future. By contrast, “Adventure Mind” activity is present-centered, follows what is interesting and is absorbed in living fully for the moment. From the Survival Mind perspective, Adventure Mind, when manifest in adult behavior, is an infrequent (and sometimes risky) lapse into childishness. On the other hand, from the perspective of Adventure Mind, there is a joylessness in the sole pursuit of success at the expense of fully present experiencing.

Imagine someone striving for social prestige who first works to make the money to dine at the finest restaurant, then orders food chosen by what will impress others and, while eating, thinks only about how to describe his dining experience to those others at some later time. What this person has missed was the opportunity to enjoy the meal at the time of eating! Clearly, it is possible to do all the rest in Survival Mind AND switch over to Adventure Mind once the eating begins, yet the ingrained habits of Survival Mind may result in the diner pursuing the anticipated triumph of boasting to others to the detriment of fully tasting his food.

Confined to the context of the individual, improv may be thought of as an activity that draws both on Adventure Mind (for its absorption in the present moment) AND Survival Mind (both for its adherence to rules and being structured by an awareness of underlying purpose). Note that this blog will focus only on the mental/emotional process of the individual improviser; the complex topic of the parts played by Adventure and Survival Minds during interaction among improvisers will be addressed in future blogging. [Suffice it to say for now that improv can also be thought of from an interactionist (Social Constructivist) paradigm as a relational construction of meaning that cannot be reduced to individual psychological constructs].

The Relative “Impurity” of Stage Improv

So what are the differences between Stage and Therapeutic improvising with respect to their “purity” of Adventure Mind functioning?  Well, on closer examination, seldom do any of us ever engage in “pure” Adventure Mind improvising. While on-stage improvisers can experience the joy of spontaneity that lies at the core of Adventure Mind functioning, it should be recognized that most improv performances draw on Survival Mind functioning as well. The primary objective of stage improv performance is typically that of entertaining an audience, where both success or failure (internal as well as external) are at stake for the performers. The tendency to “steer for” audience admiration and/or laughter may corrupt the improvisers, who may fall back on repeating elements (of topics, plotting, characters or format) that worked in the past, thereby prioritizing success over playfulness and artistry. Well-wrought, authentic examples both of competitive and uninspired improv “corruption” are displayed in Mike Birbiglia’s wonderful 2016 film “Don’t Think Twice,” where an improv troupe’s supportive friendships are destroyed by externally-imposed competition for career survival.

My improv teacher, Keith Johnstone, repeatedly pointed out that scenes, when improvised with spontaneity, can be fascinating to an audience without having to be funny. He would sometimes call forth a “Boring Scene” to pre-empt the tendency of stage improvisers to “whore for laughs.”

While stage improvisers can learn to resist their overlearned Survival Mind tendencies, doing so runs counter to the strong pull of their current social and professional incentives. If your professional identity is closely linked to your career success as measured by acclaim from peers and/or job offers you will be strengthening these Survival Mind tendencies further. I make no moral judgment against doing so—we all need to make our way in this world, after all. But consider whether stage improvising is becoming a “job” rather than a “playdate” for you!

I believe that re-learning to awaken Adventure Mind will take a support network of fellow improvisers that commit to mutually exploring and practicing alternatives to the following examples of Survival Mind functioning: Being swayed by internalized standards of “competence;” Attaching importance to external signs of “success” in both rehearsals and performance; Striving for “originality” (“Dare to be Average” could be the counter-motto, here!)

As noted at the beginning of this blog, whether we are improvisers or non-improvisers, we are all trained to scan the future for opportunities and danger and to mobilize our efforts to steer for the best outcomes for ourselves. On the surface, the current, larger-world coronavirus-saturated environment tilts us all even further in the direction of heighted fear and vigilance HOWEVER, history teaches that real-world adversity, short of annihilation, does not dim or suppress the human spirit—humor, playfulness and expressed acts of imagination are not going to disappear!

The Relative “Purity” of Therapeutic Improv

I believe that therapeutic improv is closer to “pure” improv than is performance improv. By this I mean that a client who undertakes improv performing during a therapy session is less likely to be striving to impress others, even though inhibitory self-consciousness is nearly always present. Indeed, I have been impressed repeatedly by the openness and daring of so many clients who went into the unknown and courageously adventured into new territory by following their spontaneous impulses. To be sure, plenty of other clients “play it safe,” either refusing to commit to entering the playspace fully, breaking character during a Game, or blocking (often through “blanking out”) during an enactment. Such clients may merely be unconfident of their capacity to tolerate the uncertainty of having to forgo social routines and familiar ways of responding to the unexpected which often result in blocking the offer.

However, it should be remembered that improv in the therapeutic context is frequently experienced as an emotionally “high stakes” encounter for clients, given that the therapist often: (1) chooses specific games in order to “stretch” clients’ habitual boundaries; (2) deliberately offers less familiar roles; and (3) engineers scenarios that resonate with clients’ emotionally-sensitive issues (Proxy scenes). Moreover, stage improv is performed for strangers who have no knowledge of or interest in the private lives of the improvising actors, while enactments performed in therapy take place in the presence of therapists and sometimes family members who are far more alert to both the correspondences and discrepancies between the client’s performances and his/her habitual social behavior. Improvising clients thus face a more formidable audience than do stage improvisers in front of whom to display vulnerability.

By my estimate, roughly 2/3 of clients (individuals, couples or families) will, with appropriate timing, attempt improv at all; of these, about half will accept the offer to use improv in their therapy beyond their initial one or two experiences. This remaining 1/3 who go on to enact additional RfG Exercises and Games are not distinguishable by either the severity of their presenting problems or other obvious population demographics (other than for children, who are far more willing, and adolescents, who are considerably more wary). In my 34 yrs.’ clinical experience, clients who can access Adventure Mind in therapy make more rapid and durable progress. And the “Purity” of client improvising manifests in those fascinating moments during enactments when self-conscious censorship is absent.

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Dan Wiener’s NEW BOOK IS OUT!

Wiener, D. J. (2020). The Rehearsals for Growth Practitioner’s Manual (2nd. Edn). Northampton, MA: Advanced Psychotherapies Press.

Written for Mental Health professionals and students, this updated, greatly expanded 2nd Edition of The Rehearsals for Growth Practitioner Manual (first produced in 2014) is divided into two main parts. Section I, “How to Do It,” presents information, lessons from experience, concepts, and perspectives intended to supplement the user’s base of practical knowledge.

Section II, “RfG Training,” sets forth the requirements, activities, competencies, evaluation tools and assignments for The RfG Certified Practitioner (RfG-CP) Curriculum. This Manual supplements the author’s foundational text, Rehearsals for growth: Theater improvisation for psychotherapists.

Available from: https://www.rehearsalsforgrowth.com/publications/books-by-daniel-j-wiener-ph-d/