Effective therapy is a balance between the “Magic” of deep dive processing modalities (like Sensorimotor Psychotherapy, MFR, EMDR, IFS, and other bottom-up internal process-based approaches) and the “Spinach” of doing hard work, facing fears, learning about faulty thinking, and recognizing that some current modes of being are no longer helpful (as in CBT, DBT, and other top-down systematized approaches). Please be aware that I am intentionally oversimplifying the intricate nature of the therapeutic process to shed light on a heuristic (framework for thinking about something) as I discuss the "Magic/Spinach" dynamic. Making "spinach" changes means having to feel some productive shame. I got the term “Spinach,” which refers to rote work and doing hard things, from Harvard professor of happiness Arthur Brooks. Love it.
Before I continue, I am going to take a pause and discuss how shame can be productive:
The concept of "productive shame" refers to a perspective in therapy where the experience of shame is channeled in a way that leads to positive outcomes and personal growth. While shame is generally considered a negative and distressing emotion, shame can also be viewed as a potentially transformative force when navigated effectively and in the appropriate context. Here are some ways in which shame might be considered productive in a therapeutic context:
Awareness and Insight: Experiencing shame can bring attention to underlying beliefs, values, or behaviors that may be contributing to distress or maladaptive patterns. It can serve as a signal that there is something important to explore within oneself.
Motivation for Change: Feeling shame about certain behaviors or aspects of oneself may motivate you to seek therapy and make positive changes in your life. The discomfort of shame can act as a catalyst for personal growth and self-improvement.
Fostering Empathy: Experiencing shame can enhance empathy for others who may be going through similar struggles. It can create a sense of connection and understanding, both within oneself and in relationships with others who have faced similar challenges.
Facilitating Vulnerability: Acknowledging and working through shame requires a degree of vulnerability. Therapeutically, being able to share and explore these feelings can strengthen the therapeutic alliance and create a safe space for deeper emotional processing.
Promoting Accountability: Shame can be a powerful force for promoting accountability. Taking ownership of one's actions and their consequences, even if this accountability initially involves feelings of shame, can be a crucial step in the process of change and growth.
Catalyzing Change in Belief Systems: Shame can prompt individuals to reevaluate and challenge their belief systems. The discomfort of shame may lead to a willingness to question long-held beliefs that are no longer serving them well.
Cultural and Social Reflection: In some cases, experiencing shame may prompt individuals to reflect on societal or cultural norms that contribute to these feelings. This broader awareness can lead to social change and advocacy for more inclusive and compassionate communities.
It's important to note that the term "productive shame" doesn't imply that shame is inherently positive. Rather, it suggests that within the therapeutic context, acknowledging and working through shame can contribute to personal development and positive changes. Therapists must approach this aspect of therapy with sensitivity, empathy, and a deep understanding of the individual's unique experiences and cultural background.
Ok, back to Magic Spinach… or is it Spinach Magic? Anyhow:
“Magic” refers to any modalities that provide what Bruce Eckert calls memory reconsolidation. Memory reconsolidation can be thought of as brain surgery by means of words. The therapist supports the client in opening their memory pathways that are trained on past wounds. The therapeutic dyad then reroutes those pathways by inserting reparative experiences. You can think of this as rewriting history as far as the brain is concerned. History itself does not change, but emotional aspects of the brain act as if history has, in fact, changed in a way. Often, clients experience a change in their belief system or behavior following, at times, as little as one session. It usually takes a few passes plus integration work to really make that change. It's so spectacular, you really need to experience it in the role of a client to see how strong the change can be. The original neural pathways of the wound never go away and can be triggered again but can greatly diminish in their ability to influence a person.
“Spinach” refers to the work that helps the magic become relevant in the first place and then stick in the long run. There are a few different situations where the Spinach looks different. If someone comes to therapy in crisis, after we validate and regulate, the “Spinach” is looking at and acknowledging one’s part in the crisis. The person has to face shame in doing so but then tends to feel empowered to start making different choices. I have had this phase last up to 4 YEARS with folks going around the validate-regulate-take ownership block. I am sure this phase can take much longer than that and that it is appropriate for some clients to not progress past this phase. All three of those actions are equally important but we may be emphasizing validate-regulate over taking ownership for along time because we are working though a back log of woundedness that causes overwhelming nervous system dysregulation. Taking ownership in the beginning often looks more like accepting that they dysregulation is not the clients fault but is her responsibility. Taking ownership for life choices comes later.
Let me offer an example because the above can sound “victim-blaming.” The above does not refer to cases involving children and teenagers in abusive households because they are trapped without other options. The course of action for working with individuals such as these is different. Let’s take a classic example of a domestic violence situation—still a very bad situation with an obvious victim and persecutor. Someone trapped in a DV scenario should never be blamed for the violence perpetrated on him.
In a domestic violence situation, the power dynamic is characterized by a pervasive imbalance of power and control, where the perpetrator seeks to assert dominance over the victim through various forms of abuse. This can include physical, emotional, psychological, and financial abuse, creating an environment of fear and subjugation. The victim often experiences a profound sense of powerlessness, exacerbated by the perpetrator's tactics to isolate, manipulate, and diminish their autonomy. The belief system of the victim, shaped by the abuser's constant reinforcement of their worthlessness or dependency, plays a crucial role in perpetuating the cycle of abuse. Victims may internalize the belief that they are incapable of living independently, finding support, or escaping the abusive relationship. The pervasive fear of the unknown, coupled with the daunting prospect of starting anew, can make breaking free from the cycle of abuse an exceedingly challenging and complex process.
Unfortunately and unfairly, if the victim never looks at the belief he has about himself that, for example, he is unable to live and make a life without his abuser, he will continually go back to the abuser. This is a really scary and, at times, almost impossible belief to confront. It is so scary, in fact, that the abused often goes back to the abuser because that feels less scary than starting over, facing poverty, finding another relationship, or allowing the crisis to end even though the abuser might kill the abused.
The step of confronting the belief system of the abused can take years, but time and again, I have witnessed people in these situations one day realize they are viewing the world in this way. The abused begins to see how the abusers’ behavior causes this belief system and that this belief system causes them to keep choosing the same partner or the same type of partner. At this point in the therapy, the abused person has done so much work that they have also rendered themselves capable of finally being able to align with a different belief. In the past, before all of this work, their nervous system dysregulation made that choice impossible. So, the word “spinach” can make it sound like we are taking this activity lightly. Absolutely not. This confronting work can be the hardest thing one has ever experienced in one's life. And, to make matters worse, when the abused finally realizes they have been duped into this way of thinking, they then blame themselves and go through a period of shame as they undo the damage. Thus shame is an unfortunate but natural part of the healing process.
Moving on to situations that are post-crisis:
Once the crisis has passed or a client comes to therapy because things are going well on paper but they feel “flat” or “blah,” that means the spinach is to encourage the client to “get stirred up” by doing something scary in their life that they would choose for themselves and actively want to do but are avoiding. That could be starting a business, pursuing a romantic relationship, adopting a suitable health regimen for themselves, etc. Basically, you support the client in introducing the pursuit of a major life change that the client deep down wants for themselves but is avoiding due to a limiting belief system.
This is when therapy can get a little “coachy.” I strongly believe that it is important to have this element in therapy because clients and their therapists can collude in patterns of avoidance. The client avoids getting out of their comfort zone, and the potential of getting triggered, and the therapist avoids the client's discomfort and distress because they either don’t understand the value of stressing your client a bit or don't want to deal with areas of avoidance in their own lives. There is a fine line that must be walked here in the spirit of honoring client autonomy. Supporting the client to get out of their comfort zone should come with a lot of consent on the part of the client.
As a therapist and not a coach, it is important to let go of the outcome of the client's actions. We are not so concerned with getting the client material world results like a coach is. Rather, we are looking for how pursuing a goal or even the thought of pursuing a goal triggers the client. When you are engaging in potentially triggering territory with a client, you must monitor for dissociation and other adverse reactions that indicate the client is too triggered, out of their window of tolerance, and needs support in decreasing the triggering stimuli. Therein lies the client's belief system; where there is an unhelpful belief, there is a wound to be processed.
Thus, we encourage the client to pursue a goal, the client begins to do so, gets triggered, and then we can swoop in with the magic of processing and begin memory reconsolidation, installing a new pattern. After this process, the client may realize they want the goal to look different from what was originally imagined. Often, something more in alignment with the client is determined, and the client successfully completes a similar but improved goal in the end.
While the client pursues the goal, the therapist has to watch for when the client needs to be encouraged to face their fears (spinach) or if the client needs to process (magic). These two, together over time, create a positive feedback loop, ultimately launching our clients towards their dreams with as little time lost and, frankly, as little discomfort as possible.
Again, therapists sometimes avoid supporting clients in pushing themselves because it's uncomfortable, but if you understand this positive feedback loop, you are drawn to empowering you clients in this way because you have confidence that your clients will potentially be able to extract themselves from the pain of avoidance and into the bliss of agency. The longer the client is in avoidance, the longer the pain is prolonged. Timelines may vary here so it is important to expect this process to take years or, at times be impossible to complete. Therefore, this does not mean you are overwhelming your clients with pushiness. Rather, you are testing the waters regularly to find the best pace and direction for them.
To recap, effective therapy can be thought of as threading the needle between the transformative "Magic" of deep processing modalities and the essential "Spinach" of confronting challenges and acknowledging faulty modes of being. The "Magic" involves memory reconsolidation, akin to rewriting emotional history, with the potential for rapid shifts in belief systems or behaviors. Meanwhile, the "Spinach" represents the hard work required to make these changes enduring. Whether addressing crises or encouraging clients to stir up their lives during moments of stagnation, therapists navigate a fine line between coaching and therapeutic interventions. Emphasizing the importance of facing fears and engaging in deep processing, therapists play a crucial role in steering clients toward their goals while remaining attuned to the balance of discomfort and growth. By understanding and embracing the positive feedback loop between "Magic" and "Spinach," therapists aim to guide clients towards agency and fulfillment, reducing the duration of pain associated with avoidance. This nuanced approach, avoiding undue pushiness and adapting to individual needs, creates a therapeutic journey that minimizes discomfort and maximizes progress over time.
Unfortunately, humility sounds an awful lot like “humiliation,” and individuals can project a sense of “going to be punished” on the concept. However, a strong sense of humility is a marker of good mental health because when one is oriented towards reality, you can't help but feel humble.
What is Humility?
Humility is a virtue characterized by modesty (i.e., not grandiose; properly estimating how much of one’s power enabled a positive or negative outcome) and a respectful attitude toward oneself and others. It involves an awareness of one's limitations, a lack of arrogance or excessive pride, and a willingness to acknowledge and learn from mistakes. Humble individuals tend to be open to different perspectives, value the contributions of others, and approach situations with a sense of curiosity and a willingness to grow.
Humility does not mean self-deprecation or a lack of self-confidence. Instead, it involves recognizing one's strengths and accomplishments while also acknowledging that limitations will always exist and there is always room for improvement. Humble individuals often demonstrate a sense of empathy, gratitude, and a genuine interest in understanding and supporting others.
Humility is often considered a key virtue and is seen as a foundation for personal and interpersonal growth. It can foster positive relationships, effective collaboration, and a continuous pursuit of knowledge and self-improvement.
What’s not to love about humility?
My faviorite thing about humility is how it helps us to relax and appreciate life.
Humility contributes to a more relaxed way of living:
Reduced Stress from Perfectionism: Humble people tend to be more accepting of their imperfections and mistakes. This acceptance can lead to reduced stress associated with the need to be perfect or constantly meet unrealistic standards.
Openness to Learning: Humility involves a willingness to learn from others and from one's own experiences. This open-minded approach can alleviate the pressure of feeling like one must have all the answers, as humble individuals are comfortable with the idea that there is always room for growth and development.
Lowering Expectations of Others: Humility often goes hand-in-hand with realistic expectations of oneself and others. This can prevent unnecessary disappointment and frustration when things don't go as planned or when people don't meet unrealistic standards.
Enhanced Interpersonal Relationships: Humble folks are generally more understanding and empathetic, which can contribute to healthier and less stressful relationships. The ability to see and appreciate others' perspectives can reduce conflicts and promote a more relaxed social environment.
Freedom from Ego-driven Stress: Humility involves letting go of excessive ego and pride. By not being overly concerned with how one is perceived or constantly seeking validation, individuals can experience a sense of freedom from the stress associated with maintaining a certain image.
Embracing Uncertainty: Humble individuals are often more comfortable with uncertainty and ambiguity. Instead of feeling overwhelmed by the unknown, they can approach life with a sense of curiosity and a willingness to adapt to changing circumstances.
Gratitude and Contentment: Humility is often associated with gratitude for what one has and a contented attitude. This gratitude can lead to a more positive and relaxed outlook on life.
Humility allows individuals to approach life with a more balanced and realistic perspective, reducing the self-imposed pressures and expectations that can lead to stress and anxiety. It promotes a mindset that values personal growth, learning, and meaningful connections with others over the constant pursuit of external validation or perfection.
Practicing mindfulness and being present in the moment can be supported by asking yourself certain questions. Here are some questions that can help you be more present:
The following are particularly good if you have habitually anxious or catastrophic thoughts and feelings (i.e. a chronically dysregulated nervous system):
The next set of questions is for presence in general and can serve as a practice to encourage more of a sense of “being here now centered in your body”:
These questions serve as prompts to redirect your focus to the present moment, strengthening your in-the-moment relationship to mindfulness and a deeper connection with your immediate experience. These questions encourage groundedness and centeredness.
Psychoneuroimmunology (PNI) is a field of study that explores the interactions between psychological processes, the nervous system, and the immune system. The term is derived from three major components:
In essence, psychoneuroimmunology investigates how the mind and emotions influence the nervous and immune systems and how these interactions impact overall health. Researchers in this field examine the bidirectional communication between the brain and the immune system, studying how stress, emotions, and mental states can affect immune function and vice versa.
The findings from psychoneuroimmunology research contribute to our understanding of how mental and emotional well-being can influence physical health and susceptibility to illness. It has implications for fields such as medicine, psychology, and immunology, providing insights into the complex connections between mind and body.
What role do fascia and the interstitium play in psychoneuroimmunology?
Fascia and the interstitium are connective tissue components in the body that have gained attention in various fields, including psychoneuroimmunology (PNI). While research is ongoing, here are some potential connections between fascia, the interstitium, and psychoneuroimmunology:
Communication Pathways: Fascia and the interstitium are involved in communication within the body. They provide a network that allows signals to be transmitted between different tissues and organs. This communication system may play a role in the bidirectional communication observed in PNI, where psychological factors influence the immune and nervous systems.
Inflammation and Immune Response: Both fascia and the interstitium are associated with the regulation of inflammation. In PNI, chronic stress or psychological factors can contribute to inflammation, and understanding how fascia and interstitial tissues are involved in immune responses may provide insights into the link between mental states and immune function.
Neurotransmitter Release: Fascia contains sensory receptors, and the interstitium has been found to contain nerves. These structures may contribute to the release of neurotransmitters and other signaling molecules. The communication between the nervous system and the immune system, a key aspect of PNI, may involve these tissues.
Tension and Stress Response: Fascia is involved in providing structural support and maintaining tension in the body. Chronic stress or psychological tension can affect the fascial system. Understanding how changes in fascial tension relate to stress responses and the subsequent impact on immune function is an area of interest in PNI.
It's important to note that while these connections are being explored, understanding the precise roles of fascia and the interstitium in psychoneuroimmunology is still an evolving area of research. The interplay between psychological factors, the nervous system, the immune system, and connective tissues is complex and multifaceted. Finding metanalyses to cite this information directly is not available since this line of research is so new. The following are a few examples of where these conclusions/hypotheses are being drawn.
Ball, T. M. (2011). Structural integration-based fascial release efficacy in systemic lupus erythematosus (SLE): Two case studies. Journal of Bodywork and Movement Therapies, 15(2), 217–225. https://doi.org/10.1016/j.jbmt.2010.10.006
Lupus is an autoimmune disorder. Though this article explores this one disorder, there are many other articles that explore the role of fascia and autoimmune processes.
Bordoni B, Zanier E. Clinical and symptomatological reflections: the fascial system. J Multidiscip Healthc. 2014 Sep 18;7:401-11. doi: 10.2147/JMDH.S68308. PMID: 25258540; PMCID: PMC4173815.
The Bordoni article talks about mechanical stress and inflammation’s role in interacting with the fascia system. I would argue that psychological stress is the same as mechanical stress because people generally tense and brace against stress. Bracing and tensing happen in the muscles and fascia, adding mechanical stress to the body.
Poshattiwar RS, Acharya S, Shukla S, Kumar S. Neurological Manifestations of Connective Tissue Disorders. Cureus. 2023 Oct 16;15(10):e47108. doi: 10.7759/cureus.47108. PMID: 38022020; PMCID: PMC10646945.
^ This is an article that explores the connection between neurological and connective tissue functions, albeit by means of pathology.
Gabor Mate, especially his book “When the Body Says No”, is a great resource for a more narrative exploration of PNI and the manifestations of “dis-ease” that result from stress.
Exploring the connection between the fascia, psychology, neurological activity, and immunological processes provides an increasingly clear lever for healing trauma, its many challenging health manifestations, and a pathway forward to a sense of well-being in general, trauma or not. Ultimately, this budding research encourages us to keep moving, stretching, breathing, and developing our powers of attention and consciousness.
Here is an article by Robert Schelip on the way that fascia senses. He covers the five major nerve endings (Golgi, Ruffini, Pacini, the muscle spindles, and the interstitial free nerve endings) and how each can be stimulated to cause tissues to release.
He summarizes the takeaways at the end of the article:
Understanding how to relax and release fascia is important for not only healing from trauma but also for optimizing a sense of wellness and wellbeing. Think about a time you felt truly well. What did you feel in your body? People usually talk about feeling relaxed, strong, at ease, connected, and confident. Having a great deal of tension and lack alignment in your tissues can offset a feeling of ease and strength.
When you approach trauma healing or even the pursuit of feeling your best, it is wise to consider your fascia because when your fascia is restricted or atrophied, you feel the sensation of that. it becomes a chicken or egg scenario. Are my emotions affecting my tissues or are my tissues affecting my emotions?
It's important to take an inclusive view here. As we age we all approach a greater likelihood of chronic illness. Some of us start to experience the breakdown of the body much earlier than that. That does not mean we have to live with "dis-ease," however.
For example, I have had chronic nerve pain off and on since age 16. Today I am a little over 6 months postpartum. It's no secret that pregnancy and birth is hard on your body. My nerve pain has been particularly loud lately, so I have my fascia on my mind more than usual these days. My pain comes from misalignment in my tissues. I use a variety of fascia strengthening and releasing techniques along with nervous system regulation exercises.
Not only do I experience the realignment of my body as I rehab my system, I also experience waves of emotional release and nervous system discharge. I feel grateful for my education in bodymind regulation because, even though the regulation process can feel uncomfortable sometimes, I understand why I am feeling what I am feeling and can get to a calm, connected, and strong place quickly and reliably without having to cope or to deny my difficult feelings and sensations.
Furthermore, fascia focused practices provide a surprising result. Even when I am out of alignment or in pain I still feel able to find that calm, connected, strong energy. I no longer feel that my sense of wellbeing hinges on being pain free or not having an emotion to process. I can stay connected to beauty and meaning no matter what I am experiencing in the moment.
How interesting! As I learn to balance and regulate my bodymind, I feel less attachment to having everything sorted out inside. There is more of a sense of space and ease no matter what life throws at me, inside or out.