Using Lifespan Integration in My Therapeutic Practice

Posted on by Wendy E. Smith, MA, LMHC

In the last ten months I have been using a relatively new type of therapy–Lifespan Integration (c) developed by Peggy Pace–as part of my therapeutic practice. This kind of therapy is based on the latest brain research and on attachment theory.

One of the things Lifespan Integration is very useful for is helping people integrate all kinds of traumas into regular memory so that they no longer have the “here and now” quality that makes unprocessed traumatic experience so troubling for people. Recent traumas, such as a car accident, can often be neutralized in one hour-and-a-half session. Older, childhood traumas, especially if they represent a pattern that occurred over time (such as a pattern of abuse or neglect) may take multiple sessions to process. In either case, Lifespan Integration works gently without re-traumatizing.

Even in cases where clients do not come in with post-traumatic stress as a presenting issue, Lifespan Integration can be used effectively to help them clear current troubling life patterns (e.g., shame attacks) through following unconscious connections to the early life events that formed these patterns and then integrating those. Often times, as children, clients did not have an attentive adult present to help them understand troubling situations in their lives. By bringing the client’s current adult self back into the childhood scene to support the child, the childhood experience can be integrated with the knowledge and understanding of the (now) adult. To use the example of shame attacks, whereas other forms of therapy help the client to cope with painful bouts of shame when they arise, Lifespan Integration can result in the disappearance of this reaction all together.

In addition to using Lifespan Integration to treat trauma, I have found it effective, although much more slowly so, in integrating the “parts” of people who dissociate (become detached from present experience) and, in this way, are more fragmented than other people. We all have different parts to our personalities, but we do better when these parts are well-coordinated through co-consciousness and self-leadership. Dissociation can be caused by trauma and it can also exist in such conditions as Borderline Personality Disorder. As parts are integrated through Lifespan Integration, the client’s current life becomes less confusing and chaotic and more coherent and peaceful.

Finally, Lifespan Integration is very good for helping people who become overwhelmed by their feelings and find it difficult to self-sooth learn to regulate their emotions. People with poor emotional regulation were not well-soothed by attentive parenting as very young children and, therefore, never got the chance to learn this skill for themselves. Through Lifespan Integration, they can re-parent themselves and thereby become less dependent on other less adaptive strategies for coping with feelings, such as overeating or substance abuse.

In my practice, I think carefully about if and when to suggest Lifespan Integration sessions to a client, depending on timing and appropriateness, and I usually recommend interspersing Lifespan Integration sessions with “talk” sessions in a strategic fashion.

Disability: Overcoming versus Integrating

Posted on by Wendy E. Smith, MA, LMHC

This short article was originally published on www.goodtherapy.org.

Media accounts of individuals with disabilities who have achieved something will often refer to such people as having “overcome” their disabilities in order to become successful. Sometimes such people will also be referred to as “brave,” as if they had another alternative to living with their disabilities.

The problem with this formulation is that it suggests that people with disabilities ought to, essentially, disown their impairments; it suggests that we succeed despite our disabilities, and not with them, or because of them. They are not really a part of us—just some sort of encumbrance—and they are certainly nothing we would claim as part of our identity as human beings. The best thing we can do, this way of thinking goes, is, through our achievements, render our disabilities invisible.

So, we end up with this condition (blindness, paraplegia, a learning disorder, or whatever it is) which is like some unwanted appendage that we have to drag around with us and feel ashamed of, get rid of, “overcome”. And our experience is dissonant and uncomfortable, because the truth is that being disabled is inseparable from who we are. We have developed from infancy with our disability, or acquiring a disability has markedly changed our lives. Either way, we wouldn’t be who we are without our disability, and having a disability is woven into the multi-faceted fabric of our everyday life. On the one hand, we are having disability-related experiences all the time, and, on the other hand, society is pushing us to consider our disability as irrelevant.

People with disabilities will often end up in therapy with anxiety disorders and/ or depression resulting from this dissonance. They often can’t feel comfortable in their own skins; they are burdened by shame and a sense of constantly needing to prove themselves; they are hyper-vigilant , self-conscious, self-blaming and/or self-punishing; they are workaholics or, on the other hand, feel blocked in their lives; they feel empty and say they don’t know who they really are.

The work of therapy is often to help people integrate their disabilities into their sense of self and let go of society’s mandates for them. The work is often to help people figure out how to live as themselves in the way that will be most fulfilling for them, given all the parameters of their lives, including their disabilities—society be damned.

So, if we are “successful” as people with disabilities, it is actually because we have succeeded in integrating our disabilities into our sense of self, and not because we have “overcome” them. Then, being disabled is a part of us, just as being Jewish or Turkish or short is a part of us. It is not THE thing about us, and it is not irrelevant.

Granted, we very likely will still have to deal with social discrimination (not to mention downright foolishness) and we still will have to deal with all of the pain-in-the-behind aspects of living with a disability on a daily basis and in an inaccessible world; but, psychologically, we will be freer.

Grieving Acquired Disability

Posted on by Wendy E. Smith, MA, LMHC

I originally wrote this article in my capacity as Disability Topic Expert for Goodtherap.org. I now repost it here.

Physical or sensory impairment or the onset of disabling illness often entails multiple concurrent losses which can lead to complicated grief processes, including depression and post traumatic stress disorder. Most obviously, people who acquire a disability or disabling disease lose a part of their bodies and/or the functionality of parts of their bodies. Additionally, they may lose physical comfort, vigor, mobility, spontaneity, the ability to engage in certain activities, aspects of their previous lifestyles, privacy, a sense of dignity, a sense of control, a sense of efficacy/agency, a degree of independence, actual or perceived life roles, friends and other social supports, the ability to work, financial stability, their previous sense of identity and purpose, the ability to pursue previously established dreams, previous assumptions about themselves and the world, their previous body-image, and, all in all, their previous sense of self as a whole. Therapists should be attuned to what a newly disabled person may have lost, or may perceive himself to have lost, beyond the obvious loss of physical or sensory functionality.

How well people adjust to this potentially staggering array of losses is usually much more closely correlated to who they have been prior to the disability, and what social, emotional and financial resources they have available to them, than to how “severe” the impairment itself is. The huge importance of social support after a disabling event cannot be overstated; people with new-onset disabilities may realize how lucky they are to have loving people in their lives as they have never realized it before, or they may feel almost completely socially and emotionally isolated. The most difficult disabilities to deal with with regard to social support seem to be “disenfranchised” disabilities (e.g., those resulting from Fibromyalgia/Chronic Fatigue Syndrome) in which others do not quite believe.

Non-professionals wishing to support a newly disabled person can be most helpful by being available to her as a friend who is willing to listen to her and meet her where she is emotionally. Trying artificially to cheer the person up or suggest that he does not, or will not, have losses is not helpful. Newly disabled people will “cheer up” once they have finished grieving their losses and reorienting themselves to their new situation, often with the assistance of a counselor or therapist.

Another key to successful adaptation to a new disabling condition (and here is where therapists can be particularly helpful) seems to be successful identity reconstruction; this may often entail psychological, existential, and/or spiritual shifts in perspective towards valuing innate qualities (as opposed to physical or comparative ones), authenticity, and taking life slowly and savoring it. Identity reconstruction, it should be noted, is not necessarily a finite process, as some disabling conditions are progressive and require constant readjustment.

Keep in mind also that a large number of the losses with which a person with an acquired disability must learn to cope are not due to the physical impairment itself but, rather, to limitations imposed on the person with the impairment by society. Therefore, therapists should not insist that people with disabilities “accept” their condition of disablement as theirs to adjust to, rather than, say, as an invitation to fight injustice.

Ultimately, it is much more helpful for therapists to view identity reconstruction, rather than “acceptance” of one’s disability, as the end-stage of grieving an acquired disability.

Over-achieving and Under-functioning Among Young Adults with Disabilities

Posted on by Wendy E. Smith, MA, LMHC

I originally wrote this article in my capacity as Disability Topic Expert on Goodtherapy.org. I now repost it here.

When I was 16 and an academic superstar, I set up a number of appointments to visit Ivy League and other colleges that I might attend the following year. Most of these visits involved campus tours on which my parents would accompany me. A few involved the opportunity to be hosted overnight by current freshmen in their dormitories. Although extremely socially uncomfortable, I managed the Princeton overnight with a modicum of grace. The Princeton campus was suburban and reminded me a lot of the university town in which I had grown up.

Then came the Yale overnight. My mother and I arrived in New Haven, a gritty, tough, urban town, and I went into an office to sign in for my overnight adventure. I came out with maps, keys and information, and was suddenly so overwhelmed with anxiety that I felt I couldn’t follow through with the plan. My mother and I spent the night in her hotel room, and I returned home with my tail between my legs, begging my mother not to tell the rest of my family what had really transpired.

What was this sudden loss of nerve about?

Looking back on it, I now understand that the lore in my family had been that, as long as I over-achieved academically, the fact that I had what was, at that time (I have since gotten some correction), a pretty severe visual impairment would not be an issue in my life. We all bought into that denial and the result was that, while I most certainly was over-achieving academically, I was under-achieving in the areas of developing social skills and confidence and acquiring life skills that I would need to function as an independent adult. Additionally, while I was under-functioning in these areas, others were both over-functioning and over-protecting me. This behavior was so ingrained in our family that even my baby sister participated in it; when we went into an ice cream parlor, she would immediately start whispering all the flavors in my ear so that the spectacle of me straining to see something I could not see or asking publicly for assistance, and very likely holding up the line in the process, could be proactively avoided.

After leaving home at 17, I acquired the life skills I needed pretty quickly and was a fully independent adult, able to work and travel in Europe, by the time I was 21. Acquiring ease with social skills took another few years beyond that and, even now, in my forties, I still struggle internally with social dis-ease on a regular basis.

Could my family, who loved me dearly, have done something to help me develop more normally? I ask this question because I now see young disabled clients of mine in the same position I was in the day I panicked at Yale. Regardless of whether or not they are academic superstars, they are under-functioning in the areas of life and social skills development, while others—their parents, extended family members and teachers–are over-functioning for them. The more these well-intentioned authority figures over-function, the more my clients lose both the opportunity to practice the skills they need to develop and the confidence to try, fail, and try again, until mastery is achieved. The subtle message the over-functioners are, probably completely inadvertently, sending is, “I don’t think you’ll be able to do this.” In some cases, of course, it’s true that people with disabilities can’t do things in the same way that other people do them; but, more often than not, if left to our own devices, we can figure out our own ways of doing things that work just fine for us–including ways that involve asking for help.

Scary and painful as it may be for our parents to watch us attempt things that they don’t think they could do if they had our disabilities, often times, the best thing that they could do for us is stand back, with confidence, and let us try. In the specific case of our being socially excluded because of the ignorance of other children and adolescents, I think the best way parents and teachers could help us is to look for opportunities to teach young people to respect and include people with disabilities; in some (or, perhaps, most) cases, this might require our parents and teachers first to spend time examining their own feelings, beliefs, and/or prejudices.

“Passing” as Non-Disabled

Posted on by Wendy E. Smith, MA, LMHC

I wrote this article in my role as Disability “Topic Expert” on GoodTherapy.org. I’m now reposting it here.

While some disabilities are immediately evident to people who see a person with a disability, other disabilities are “invisible.” Beginning in childhood, people with disabilities who have the option of “passing” as non-disabled often get in the habit of automatically hiding their disabilities. For example, a visually impaired person who is being shown a map might pretend that he/she can see the map while actually listening for verbal clues as to the correct way to his/her destination. In this way, and hundreds of others each day, the disabled person “lives as” non-disabled.

What are the reasons for “passing”? Generally speaking, people with disabilities are depicted in media of various kinds as either pathetic, or as “overcoming” heroes. There isn’t much middle ground. People with disabilities internalize this stereotyping just as much as non-disabled people do. Not at all sure that they can be heroes, and not wanting on any account to be seen as pathetic, people with disabilities will often try simply to erase the fact of their disabilities from perception. And, to top it off, they get praise for this too. Non-disabled people seem to believe that it is the highest compliment to say to a person with a disability, “I never think of you as disabled”. If we can downplay our disabilities, almost to the point of disappearance, we figure, maybe we can have a normal life with friends who find us appealing.

Additionally, on a practical level, unemployment among people with disabilities who are perfectly capable of working is at staggering levels (and I’m talking pre-recession here too). Practically speaking, if you are a person with a disability who can “pass” at a job interview, you should do it; it may very well make the difference between employment and unemployment. That’s a really painful fact, and I, for one, have had a lot of trouble swallowing it; but, I’ve learned the hard way that if you can’t get a foot in the door of the workplace, you can’t begin to change it.

So, clearly, there are times when passing is the best (if unpalatable) choice. What I want to emphasize, though, is that passing is only empowering when it is a choice. If one passes by habit and/or based on an internalized belief that disability is a shameful, embarrassing attribute, then one has little chance of living an authentic, integrated life. People with disabilities who spend their lives passing can never relax, as any moment of letting down their guards may lead to detection. Additionally, their capacities for self-awareness and for intimate relationships with others are diminished by the fact that, on some level, they are always putting on an act.

Liberation from passing comes through casting out shame and through recognizing that without one’s disability, one would not be the person one is/ is becoming. Certainly, for example, I would not have become a counselor if I had been able-bodied–and I love being a counselor. That casting out process, though, is not a short or easy business. When I think of the agonies of self-consciousness I went through in first persuading myself to publicly wield my monocular (for reading street signs, wall menus, subtitles, etc.), I remember what a grand endeavor self-liberation can be.

In addition to the great emotional, personal, and interpersonal tolls that internalized oppression and passing can take on people with disabilities, passing causes a lot of practical problems too. If I want to get to my meeting on time, and I can’t read the number on the bus approaching the stop, then I need to ask the stranger standing next to me what the number is and I need to tolerate whatever that person’s judgments of a person who can’t read bus numbers may be. If I don’t ask for help, then I may get on the wrong bus or I may miss the bus I need. At a certain point, my desire to accomplish my own goals and live my life as I see fit surpassed my horror of what people would think. But, leading up to that point, I had a lot of anxious moments at bus stops.

Both my personal and my clinical experience suggest to me that asking for help is particularly difficult for people with disabilities as, even more than others in this do-it-yourself society we live in, disabled people are terrified of being perceived as “helpless,” which is, after all, so dangerously close to the “pathetic” label that is our greatest fear. One thing that I suggest to my disabled clients who are struggling with the issue of asking for help is that they start looking for opportunities to help others. In actuality, whether officially disabled or non-disabled, we all need help sometimes. Helping and being helped is, in fact, what holds humans together in community.

I dream of the day when our disabled children will grow up without having to learn to pass, and, subsequently, be able to mature without having to spend 20 years unlearning that procedure.

In the meantime, there’s counseling.