(347) 506-1612 DrWolkin@BrainCurves.com
POETRY THERAPY: POETRY AS Rx 

POETRY THERAPY: POETRY AS Rx 

There is research that those experiencing PTSD reported improved well-being in response to poetry therapy. This might be the case because a hallmark of having experienced trauma is the subsequent difficulty processing the experience, which results in avoiding and suppressing associated emotions/memories.

Poetry therapy has provided an outlet for those suffering with PTSD to start to integrate many of these feelings, and even more so, to start to reframe the traumatic experience.

Poetry therapy itself is a bit abstract to describe, but there are a few ways to engage with it. Here is a multi-model poetry therapy practice developed by Nicholas Mazza, the founding and continuing editor of the Journal of Poetry Therapy.

According to Mazza’s model, poetry therapy involves three main components:

  1. Receptive/prescriptive: This part of therapy involves the clinician/therapist reading a poem out loud, and then subsequently encouraging the client to react to it, either verbally, non-verbally, or both. The therapist might even prompt: “Is there a particular line in the poem that resonated with you?”, or “I noticed you started to become teary-eyed when I read this line…”
  2. Expressive/creative: This entails actual creative writing. The therapist promotes stream of consciousness writing that might aid in discovering blocked emotions, parsing felt emotions, or retrieving memories that are difficult to articulate. The therapist might offer a prompt to help someone get started.
  3. Symbolic/ceremonial: This includes working with metaphor/simile to help further explain emotions that are hard to describe in a more literal sense. The ceremonial part may consist of writing a letter to someone they may have lost and then burning it.

 

The efficacy of poetry therapy is still being studied. Most of the empirical evidence for its effectiveness comes through James Pennebaker’s (a pioneer in the field of Positive Psychology) work in the therapeutic use of expressive writing. His studies have indicated that the use of expressive writing, even for as little as 15 minutes over the course of 4 days, resulted in positive health effects. In addition, his initial work dealt with the use of expressive writing to heal wounds from traumatic stressful events.

One case in point is that in the aftermath of 9/11, poetry was utilized as a healing mechanism. According to a New York Times article on October 1, 2001:

“In the weeks since the terrorist attacks, people have been consoling themselves—and one another—with poetry in an almost unprecedented way … Improvised memorials often conceived around poems sprang up all over the city, in store windows, at bus stops, in Washington Square Park, Brooklyn Heights, and elsewhere. …”

In some ways poetry gives us the way to speak about the unspeakable. It is more and more common for those suffering with medical challenges to write their story, many times in poetic form, to aid in their own healing. As always, it is crucial to note that just like with mindfulness approaches to trauma, poetry therapy is most often used in conjunction with other therapies.

On a personal note, I’m particularly drawn to this type of therapy and recently started studying for my MFA at Queens College. I am touched by the profound pain that is both individually and collectively felt, how this pain can displace someone from others and their selves, and yet, the profound capacity for resilience, healing, and growth. Aside from writing my own work, I hope to employ poetry as a technique to help my clients say what they couldn’t otherwise say.

Here’s an example of a poem that I recently published in the British Journal of Medical Practice in this vein:

This is part 3 of a 4-part series of excerpts from the latest 2018 edition of Dr. Wolkin’s PTSD Packet

RECOGNIZING THE COMPLEX TRAUMA OF PROLONGED VIOLENCE

RECOGNIZING THE COMPLEX TRAUMA OF PROLONGED VIOLENCE

Children inside U.S. Customs and Border Protection detention facility at the Rio Grande Valley Centralized Processing Center in Rio Grande City, Texas. CBP/via REUTERS 2018

Complex trauma (C-PTSD) is still, relatively, a new term. It was coined in the 1990’s by trauma expert Judith Herman to connote repeated, prolonged (protracted, chronic) trauma. Another name sometimes used to describe the cluster of symptoms referred to as Complex PTSD is Disorders of Extreme Stress Not Otherwise Specified (DESNOS).

In reality, C-PTSD is still actually just a proposed disorder: because 92% of individuals with Complex PTSD also meet diagnostic criteria for PTSD. Complex PTSD is not added as a separate diagnostic classification. 

I’m included in the group of many clinicians, however, who render it extraordinarily useful as a separate diagnosis. The current PTSD diagnosis often does not fully capture the severe psychological harm that occurs with prolonged, repeated trauma. While some symptoms may overlap, there are additional possible symptoms as well as possible conceptual differences.

Certainly, more precision in diagnosis leads to more precise treatment, and treatment for PTSD often fails with those experiencing C-PTSD. So, regardless of how one’s cluster of symptoms is labeled, it is crucial for a clinical to know the hallmarks of C-PTSD.

 Another trauma expert, Dr. Christine Courtois, wrote that complex trauma is “a type of trauma that occurs repeatedly and cumulatively, usually over a period of time and within specific relationships and contexts.” In her well-known article, Understanding Complex Trauma, Complex Reactions, and Treatment Approaches, Dr. Courtois continues to summarize the characteristics of complex traumatic events as:

  • Repetitive, prolonged, or cumulative.
  • Most often interpersonal, involving direct harm, exploitation and maltreatment including neglect/abandonment/antipathy by primary caregivers or other ostensibly responsible adults.
  • Often occur at developmentally vulnerable times in the victim’s life, especially in early childhood or adolescence, but can also occur later in life and in conditions of vulnerability associated with disability/disempowerment/dependency/age/infirmity, etc.

 

While there are many types of repeated trauma, it is most often experienced by children who are victims of long-term physical and/or sexual abuse. It also can include: experience in a concentration camp, POW situations, long-term domestic violence, prostitution/brothel situations, and organized child exploitation rings. In all of these circumstances, according to Dr. Herman, the trauma victim is generally held in a state of captivity, physically or emotionally, and in a situation in which there is no actual or perceived way to escape.

As I write this, I humbly and painfully think about how the current #BorderCrisis is a #MentalHealthCrisis, and how this will impact these children long-term. At the heart of C-PTSD is the idea of emotional neglect. When it comes to human beings making emotional attachments and proper development – we need more than just a bed to sleep in.

C-PTSD is not a psychological death sentence, so to speak, and there is treatment, but it needs to be recognized in general, and particularly with regards to what is going on at the border. People need to know that these children need help, and like any challenge, the earlier there’s intervention, the better.

People who experience chronic trauma often report symptoms that are additional to those seen in those diagnosed with PTSD. Dr. Herman initially identified this list of additional symptoms, which aren’t all included in the diagnosis of standard PTSD:

  1. Difficulty Regulating Emotions: May include persistent sadness, suicidal thoughts, explosive anger, or inhibited anger.
  2. Alterations in Consciousness:Includes forgetting traumatic events, reliving traumatic events, or having episodes in which one feels detached from one’s mental processes or body (dissociation).
  3. Alterations in Self-Perception:May include helplessness, shame, guilt, stigma, and a sense of being completely different from other human beings.
  4. Distorted Perceptions of the Perpetrator:Examples include attributing total power to the perpetrator, becoming preoccupied with the relationship to the perpetrator, or preoccupied with revenge.
  5. Difficulties with Relationships to Others:Examples include isolation, distrust, or a repeated search for a rescuer.
  6. Somatization and/or medical problems: Somatic reactions may relate directly to the type of abuse suffered (or any physical damage endured) and can involve all major body systems.
  7. Alteration in One’s System of Meanings:May include a loss of sustaining faith or a sense of hopelessness and despair.

 

Personal Clinical Note: Patients of mine who have experienced complex trauma, consistently describe feeling a lack of sense of self, very low self-esteem, extreme self-loathing, difficulty in interpersonal relationships, and an inability to discern between any real or potential threats to their minds and/or bodies. Often, and while this can happen in other diagnoses and from enduring a solitary trauma, it is more likely for someone who is chronically traumatized to engage in self-destructive and self-mutilating behaviors.

 Many C-PTSD researchers and clinicians report that using the same treatment paradigm as one would use for PTSD (see below), might not cut it, and might even prove problematic. In response to this, the recommended course of treatment involves the sequencing of healing tasks across several main stages of treatment. These stages include (1) pre-treatment assessment, (2) early stage of safety, education, stabilization, skill-building, and development of the treatment alliance, (3) middle stage of trauma processing and resolution, and (4) late stage of self and relational development and life choice.”

This is part 1 of a 4-part series of excerpts from the latest 2018 edition of Dr. Wolkin’s PTSD Packet

Repost: April Showers Bring Poetry Pitter Patters: My Favorite Poems and Why They Resonate

Repost: April Showers Bring Poetry Pitter Patters: My Favorite Poems and Why They Resonate

This blog post originally appeared on The Huffington Post

It’s April, and while that means more rain showers, it also means it’s time to recognize a literary style “in which special intensity is given to the expression of feelings and ideas by the use of distinctive style and rhythm”. Or, simply put, poetry!

In honor of National Poetry Month, I would like to present these 4 poems that not only resonate deeply with me, but have also helped to inform my work with my clients.

One of the beauties of poetry, I think, is that there is no single meaning to any one poem. The poet pens a narrative in verse that can be interpreted in all ways; I would even go so far as to say that a reader of poetry projects upon a poem what he/she needs in that given moment. The interpretation is never static, and likely the reader will experience something different with each reading or recitation. So, if it stirs something within you right now – and moves you to greater awareness of self, others, and the world – then honor those things!

Vulnerable alert: These works have seen me through difficult times. As my post-doc and a romantic relationship were both simultaneously coming to an end in 2010, the feeling of loss led me to these poems. I recited them every time I needed a reminder that not only was it was okay to feel every iteration of my feelings, but that those feelings were also healthy, and important – serving as a springboard for new endeavors and a greater openness to identifying, and then saying yes to, those things I desired that were beyond my comfort zone.

Reciting the poems, as I power-walked around the Charles River, comforted me, and also allowed me to notice and feel the pain of confronting the changes in my life. The more I recited, the more I let myself feel, and the more facile it became to just put one foot in front of another, trusting that those small steps would lead me to my somewhere new. The words reverberated over and over until I found my way towards healing.

There is much to be learned from a poetic journey inward. I hope that one, or more, of these poems bring you some of the peace that they have brought me.

 

1. The Journey

by Mary Oliver

One day you finally knew

what you had to do, and began,

though the voices around you

kept shouting

their bad advice—

though the whole house

began to tremble

and you felt the old tug

at your ankles.

“Mend my life!”

each voice cried.

But you didn’t stop.

You knew what you had to do,

though the wind pried

with its stiff fingers

at the very foundations,

though their melancholy

was terrible.

It was already late

enough, and a wild night,

and the road full of fallen

branches and stones.

But little by little,

as you left their voices behind,

the stars began to burn

through the sheets of clouds,

and there was a new voice

which you slowly

recognized as your own,

that kept you company

as you strode deeper and deeper

into the world,

determined to do

the only thing you could do—

determined to save

the only life you could save.

Why it resonates:

The Journey resonates with me because it speaks to the idea of individuation and separation.

It is hard for most of us to leave our family of origin, mentally speaking. It’s a challenge to go out into the world, without the protection and grounded-ness that our primary attachment figures provided (if we were lucky enough) when we were younger. It is also just as hard, because despite wanting to “become ourselves” as individual entities, we often stay enmeshed in the maladaptive patterns of our ancestry. Their traumas, and subsequent triggers, sometimes become ours, and though we want to shed those layers from our own psyches, it is what we know – the familiarity is resoundingly comforting.

My clients and I have learned that we sometimes make unconscious agreements with ourselves to hold on to the pain, until we realize we can’t breathe from the bearing of it, and we need to let go of it in order to save ourselves.

2. Autobiography in Five Chapters

by Portia Nelson

I

I walk down the street.

There is a deep hole in the sidewalk

I fall in.

I am lost…

I am hopeless.

It isn’t my fault.

It takes forever to find a way out.

II

I walk down the same street.

There is a deep hole in the sidewalk.

I pretend I don’t see it.

I fall in again.

I can’t believe I’m in the same place.

But it isn’t my fault.

It still takes a long time to get out.

III

I walk down the same street.

There is a deep hole in the sidewalk.

I see it is there.

I still fall in…it’s a habit

My eyes are open; I know where I am;

It is my fault.

I get out immediately.

IV

I walk down the same street.

There is a deep hole in the sidewalk.

I walk around it.

V

I walk down another street.

Why it resonates:

Both personally and professionally I know so well that change is hard. Actually, that’s the understatement of the day! When we have engaged with certain unhealthy thoughts, feelings, and behaviors for a long time, the path towards wellness takes extra patience, perseverance, time, and trust. This poem resonates for me because it reflects a sequence of change that is authentic.

Portia beings by speaking to the deeply painful reckoning with bumps in the road. Then, she begins to recognize patterns that might be holding her back, but does so with a gentle nudge and compassion for herself. She continues by putting just one step in front of the other, supporting herself through each step, not blind to the challenges, but not beating herself up either for the slow progress, which includes literally falling into the same old maladaptive patterns.

She recognizes that patterns are like habits, accumulations of ways of being and showing up in a world that used to work for us, and that most likely previously protected us from our pain. Ultimately, she finds a new path. This doesn’t mean her journey is over. In fact, in some ways, it has just begun.

3. The Guest House

by Rumi

This being human is a guest house.

Every morning a new arrival.

A joy, a depression, a meanness,

some momentary awareness comes

As an unexpected visitor.

Welcome and entertain them all!

Even if they’re a crowd of sorrows,

who violently sweep your house

empty of its furniture,

still treat each guest honorably.

He may be clearing you out

for some new delight.

The dark thought, the shame, the malice,

meet them at the door laughing,

and invite them in.

Be grateful for whoever comes,

because each has been sent

as a guide from beyond.

Why it resonates:

Rumi, the Sufi poet, waxed poetic in his ‘The Guest House’ a long time ago about how we should treat every emotion as a visitor, without looking to get rid of any of them, but rather to understand their message and purpose.

Emotions are neither inherently good nor bad, and to think of them in such dichotomous terms is to do oneself a disservice. Emotions just are. In fact, every emotion tells us something about our inner experience that might be informing our outer experience.

What Rumi alluded to in his writing was also recently confirmed by research (https://www.scientificamerican.com/article/negative-emotions-key-well-being/) – which indicated that well-being is actually predicated on having a wider range of emotions, including the negative ones! Yes, that’s correct, the more you can feel, in all of feeling’s iterations, the better off you are.

While relaxation is a beneficial byproduct of mindfulness practice, its salutary effects are associated with the ability to help us expose ourselves to our emotions, to truly feel them, with compassion and as little judgment as possible. That’s why techniques like mindfulness have gained anecdotal significance, and their effectiveness is being confirmed through rigorous research.

4. Wild Geese

by Mary Oliver

You do not have to be good.

You do not have to walk on your knees

For a hundred miles through the desert, repenting.

You only have to let the soft animal of your body

love what it loves.

Tell me about your despair, yours, and I will tell you mine.

Meanwhile the world goes on.

Meanwhile the sun and the clear pebbles of the rain

are moving across the landscapes,

over the prairies and the deep trees,

the mountains and the rivers.

Meanwhile the wild geese, high in the clean blue air,

are heading home again.

Whoever you are, no matter how lonely,

the world offers itself to your imagination,

calls to you like the wild geese, harsh and exciting —

over and over announcing your place

in the family of things.

Why it resonates:

We are socialized from a young age to think that being “good” means that we will be rewarded. What does “good” really mean though? The need to “be good” for the sake of approval, or the idea that one needs to repent to be redeemed, is immediately refuted here. How do we differentiate our own moral compass, and being a “good” person versus a “bad” person, from how other people interpret “good” and “bad”? When we try to base our actions on other people’s definitions, it can often lead to stifling expectations and guilt, which leads to deep suffering.

This poem, perhaps, then, speaks to a freedom that defies the need to be “good” as a way out of punishment or scorn by others. In this poem, Mary Oliver invites us to shed the shackles we so often place upon ourselves for the sake of pleasing others. She makes room for us to let go of that, to fully embrace our essence, without judging it, without labeling it good or bad or right or wrong.

There is a chance for catharsis here, as we let ourselves connect to the “soft animals of our body”. Beyond the layers of somatic tension, clenching, and a protective posturing, is softness. The soft part of ourselves doesn’t need to hide. We shouldn’t deny what we love or whom we love or how we love.

To me, the most poignant part of this poem is the invitation to shed those limiting layers, and to look at the bigger and grander picture; that is, all of us, every living creature, are immortally bound by our smallness and bigness all at once. Perhaps, this collective truth is the most healing of them all.

You may have noticed that two of the poems I shared are from Mary Oliver’s oeuvre. I tried to be more diverse in my choices, but Mary has become a role model and mentor (read-she doesn’t know who I am!) for me in my own journey as a poet. A few years ago I attended one of Mary Oliver’s rare readings and signings at the 92nd Street Y and scored this!

Buy more of Mary Oliver’s poetry here

~

Sometimes the only way out of a trying situation or time in our life, is to journey inward, and a great place to start is by peering into a poet’s own journey. I hope that one, or more, of these poems bring you some of the peace that they have brought me.

‘Inside Out’ Goes All Out!

‘Inside Out’ Goes All Out!

New E-motion picture teaches us to embrace all of our emotions

I recently had the opportunity to see Disney Pixar’s latest animated feature, ‘Inside Out’. I didn’t need much prompting, given that it IS a movie about feelings, and well, as a psychologist, it was an easy sell! It did not disappoint.

Here’s a quick synopsis of the film’s premise before I share my experience of it!  An 11-year old girl named Riley, moves cross-country with her family. A move is a huge transition, especially at such an impressionable age, and she experiences a gamut of emotions as she leaves her home, friends, and hockey league behind. Enter the main characters, Riley’s feelings: Joy, Sadness, Anger, Fear, and Disgust who provide a glimpse into the workings of Riley’s mind as she navigates this life-changing experience.

From the moment it started, I couldn’t contain my excitement. The nerd in me was blown away at the extraordinary way in which many of the movie’s messages “measured up” from a neuro-scientific perspective. For example, the way a day full of short-term/working memories is then consolidated during sleep.

While the film gave up some scientific integrity for the sake of storytelling (i.e., conveying parts of Riley’s personality as destructible islands) its poetic license didn’t drive too far away from the reality that we are, essentially, made up of personality traits that wax and wane in prominence during different points in our life and under different circumstances.

Beyond the intricate science of it all, what ‘Inside Out’ did do so well was to provide the empowering message about how to understand, connect to, and accept our feelings and memories in a way that is conducive to thriving…to kicking butt at life!

Here are 5 ways I feel it did this:

  1. ALL of our emotions exist for a purpose

Emotions are neither inherently good nor bad, and to think of them in such dichotomous terms is to do oneself a disservice. Emotions just are. In fact, every emotion tells us something about our inner experience that might be informing our outer experience.

Inside_Out_2015_film_posterIn fact, Rumi, the Sufi poet, waxed poetic in his ‘The Guest House’ (see below) a long time ago about how we should treat every emotion as a visitor, without looking to get rid of any of them, rather to understand their message and purpose.

What Rumi alluded to in his writing, was also recently confirmed by research that indicates that well-being is actually predicated on having a wider range of emotions! Yes, that’s correct, the more you can feel, in all of feeling’s iterations, the better off you are.

  1. To have emotion is to have a compass

The importance of every emotion is a good segue to this next idea, which again, the movie illustrates with beautiful clarity. Having emotions are much healthier, productive, and adaptive then not feeling at all. In the movie, Joy tried to have Sadness stay as far away from Riley as possible.

Although she felt other emotions, including anger, the inability to feel sadness, coupled with her mother’s request for Riley to stay happy, ultimately lead to a cold and numb existence. This state only generated poor judgment and unhealthy choices. It wasn’t until she allowed herself (SPOILER ALERT: rather, until Depression got back to HEADquarters) to feel sadness that Riley was able to see more clearly and reach out for support.

  1. Our realities AND memories are filtered through our emotional lens

Just like our present reality is seen through the framework of our past experience, the memories we look back upon are colored by our present-moment experience. In Riley’s case, she recalled a championship hockey game several times during the movie. At one point she remembers missing the winning shot and feeling sad about it. At another point, she literally remembers the same moment, but this time, she recalls smiling as she is championed by her teammates who pick her up onto their shoulders to let her know how valuable she is to the team. Same memory, the only difference being that it was recalled through a sad lens, and then through a lens of joy.

This is a very powerful idea. What we really “need” to remember is that our memories are a part of our personal narrative, but that in many ways, we construct the narrative we believe. We can CHANGE our story at any time. We can’t delete certain paragraphs that ooze with negative facts and daunting realities. We can’t cut out chapters that we rather have not had. They will always be there, and that’s ok. Research suggests that the actual experiences we have are less impactful than the story we tell ourselves about them.

  1. Having the language to talk about emotions is empowering

Probably the most remarkable part of the movie is its existence as an E-motion picture ;). As long as more than a modicum of scientific integrity exists, whether or not science was upheld to the nth degree doesn’t really matter. What’s important is that an illustration of the concept of emotion can now be reflected in the dialogue we have with our children.

I am a big believer that this kind of dialogue can’t be started early enough! If children learn earlier on to embrace the way they feel, that it’s not just ok, but crucial to feel all of their emotions, we can hope to see more adjusted adolescents and adults. Really, though, animation aside, this movie’s target audience is feasibly all of humanity. Why? Because to have the language to talk about our emotions, all of its iterations, is to be empowered with an ability to learn from them, to respond to them with the utmost of compassion and less judgment.

  1. Feeling our emotions is a universal human experience

Pixar knew what it was doing when it used 5 scientifically validated universal emotions, a la Dr. Paul Eckman’s work (the 6th universal emotion is surprise). Through his research he showed that certain emotions are felt and expressed through universal facial expressions across cultures around the world. And so, the movie reminds us of our intrinsic humanity, how similar we all actually are despite our differences.

Inside Out - Emotion Poster Collaboration

This is a very powerful idea, especially in the wake of discriminations based on skin color and/or gender/sexual identity. At the end of the day, no matter who you are, you experience the capacity for the same gamut of emotions. Therefore, if we can realize that we are all just fighting our own hard battles, we might show up in this world with more compassion and less judgment.

The Guest House

By Rumi
This being human is a guest house.
Every morning a new arrival.
A joy, a depression, a meanness,
some momentary awareness comes
As an unexpected visitor.
Welcome and entertain them all!
Even if they’re a crowd of sorrows,
who violently sweep your house
empty of its furniture,
still treat each guest honorably.
He may be clearing you out
for some new delight.
The dark thought, the shame, the malice,
meet them at the door laughing,
and invite them in.
Be grateful for whoever comes,
because each has been sent
as a guide from beyond.

Click here to download a special ‘Inside Out: Guided viewing with BrainCurves’ question sheet to help start the conversation with your children, loved ones, or even yourself, about how you connect with your emotions and memories in your daily life. 

Dr. Jen’s ‘Inside Out’ Movie Discussion Guide

www.braincurves.com (2)

PDF Preview

Have you seen ‘Inside Out’? What were your takeaways from the film? Please share them in a comment.

Let’s embrace ALL of our emotions and BrainCurves! 

– Dr. Jen