Articles by Nan Keyser

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5 Ways to Develop a More Positive Body Image

by Nan Keyser, M.Ed.

Body image issues can be complex and deep-seated. However, these simple practices can help you cultivate a more positive relationship with your body, ease body shame, and help you to learn to enjoy your body:

1. When you start to think about what you don't like about your body, instead try to focus on one aspect of your body that you feel good about. For example, if you are thinking, "My thighs are big," shift your thoughts to, "I have a kind smile." If you can't find something positive about the way you look or any of your physical attributes, then find something that is neutral to appreciate about your body, for example "my arms hug my children, so I appreciate them for what they do."

2. When you see others, notice how unique each person is and find a quality, attribute, or characteristic about that individual that is positive. The more we can appreciate others' unique positive qualities, the more we can begin to appreciate ourselves and vice versa.

3. Find a form of exercise or physical activity that is playful and fun. The key here is the exercise feels good. For example, a woman I spoke to last week said she wants to take up the hoola hoop. Another woman I know loves to dance in her bedroom with her favorite music blasting. A man I know loves to play frisbee in the park with his children. A young woman just loves playing with her dog in the park and running after him. A trans man I know finds it very empowering to lift weights and feel his strength. Exercise doesn't need to be a 'should' or a punishment. A benefit of this practice is that it brings lightness to our lives- and when we move and get active, we often feel more connected with and less alienated from our bodies. With active play and fun, we may find a surprise sense of belonging and acceptance in our bodies.

4. Explore what feels good inside yourself rather than being concerned with what you look like on the outside. Explore what feels good, comforting, soothing, pleasurable, empowering, and enjoyable in your own skin. Here are some suggestions: wear clothes that help you to feel at home in your own skin, be nourished in nature by taking a walk, dance as though nobody's watching and forget about doing the 'right' dance steps or looking the 'right' way when you dance, touch or embrace a baby or your loved one and allow yourself to feel how soothing and grounding touch can be, take an exhilarating bubble bath, gaze at the clouds for a few minutes, listen to some music and feel the vibrations and sounds of the rhythms and melodies. These activities may be simple but they can engage your senses and take your focus away from the constant negative mind chatter and unhealthy focus on body image dissatisfaction. Take the time to be present to your sensations and explore what feels good INSIDE your body rather than obsessing about what you look like on the outside.

5. When you are ready, take the "I Love My Body Pledge" by Harriet Brown:

I _________________________, pledge to speak kindly about my body.

I promise not to talk about how fat my thighs or stomach or butt are, or about how I really have to lose 5 to 15 or 50 pounds. I promise not to call myself a fat pig, gross, or any other self-loathing, trash-talking phrase.

I vow to be kind to myself and my body. I will learn to be grateful for its strength and attractiveness, and to be compassionate toward its failings.

I will remind myself that bodies come in all shapes and sizes, and that no matter what shape and size my body is, it's worthy of kindness, compassion and love.

- Harriet Brown, 2007

Reproduce freely and distribute widely. Spread the Love!

Shame in the Shadow of Trauma

Published in The Ontario Society of Psychotherapists newsletter PrOSPect in 2011

by Nan Keyser, M.Ed.

Last year’s OSP professional development day, held on 30 October, featured keynote speaker Dr. Judith Herman, Professor of Clinical Psychiatry at Harvard, prolific author, clinician, and pioneer in the field of trauma. The well-attended and well-received day hosted seventy-seven OSP members and non-OSP colleagues. The theme for the day, “Shame in the Shadow of Trauma,” featured a host of panellists and workshop facilitators, and highlighted the role of shame as an after-effect of trauma.

There was a lively panel discussion in the morning, and throughout the day there were interesting workshops by Lisa Herman, Clarisa Chandler, and Danny Yeong. In this article I wish to focus on Herman’s contributions. She came to us via teleconference with an accessible, warm, and conversational way of relating her work-in-progress, entitled “PTSD as a Shame Disorder.” I felt the palpable excitement in the room that an “elder of elders” (as panellist Yeong aptly referred to her) was with us. It was moving to hear a colleague say that Herman’s research and insights had been for her “a guiding light,” first in her own healing process and later in her professional life as she became a psychotherapist.

At the time that Herman came on the scene in the 1980's, PTSD discourse and research centered around short-term trauma and the stories of soldiers. Herman’s groundbreaking books, such as Trauma and Recovery (1997) and Father-Daughter Incest (2000), told the stories of chronic trauma survivors and made visible the silenced pain of incest survivors, women abused by their partners, children abused by parents, and survivors of accident and political violence. Her work brought dignity, hope, and understanding to the lives of repeated trauma survivors and helped to make the term “PTSD” a lexicon of everyday life. She remains a key advocate for women and children, and she mapped a compassionate and effective treatment-strategy for clinicians by treating complex PTSD as an adaptive strategy, not a pathology. Herman extended the PTSD diagnosis to include a disorder called “complex PTSD.” Complex PTSD clustered the symptoms of prolonged trauma—as in incest and relationship-abuse survivors—and identified the relational, violent, and chronic nature of some forms of trauma.

Herman rallied to have complex PTSD included in the DSMR-IV in the early 1990's. This was a time when many survivors of trauma were being re-traumatized in therapy. Some of the faulty assumptions that caused mistreatment proposed that trauma therapy is only about treating anxiety and rooting out traumatic memory. It was assumed that trauma could easily be “fixed” by memory retrieval, and this oversimplification of treatment lead to patients being exposed to, and triggered by, traumatic material without the resources, therapeutic alliance, or inner reliance to cope. In the anthology, Treating Complex Traumatic Stress Disorders, Herman and other practitioners examined the complexities of dissociation, somatization, self-harm, and affect dysregulation. She showed that the context of domestic abuse and political violence trauma was often one of violence, power, subordination/domination, and gender imbalance, and that an integrative healing process must be realized within the respectful container of a therapeutic alliance. She also did some groundbreaking work linking trauma and grief, by illuminating how a loss of control and identity can be central to a trauma survivor’s emotional experience. Despite the fact that most traumatologists are aware of the biopsychosocial effects of complex trauma, individuals suffering complex PTSD continue to be misdiagnosed with psychological disorders. Mental health professionals today continue to lobby for the inclusion of complex trauma in the DSMR.

Ever the pioneer, Dr Herman, who has been practicing for 39 years, is currently challenging the DSM definition of PTSD as an anxiety disorder. She shared with us the ways in which shame and terror are central to the subjective experience of trauma. Drawing on the brilliant research of her mother and psychologist, Helen Block Lewis, she asserts that shame “is one’s own vicarious experience of scorn in the other.” As she points out, there is a break in attachment when shame arises, a drawing within oneself and away from another, leaving a person feeling exposed, isolated, and helpless. Herman’s point is clear: shame can be just as debilitating as anxiety.

What I remember most about her talk is what I value most about Herman’s work in general: her willingness to listen, hear, see, and identify a trauma survivor’s pain and resilience for what they are. She shared with us a deeply poignant drawing by a patient who, as a child, had suffered chronic sexual violence from a family member. With a simple scrawl the drawing outlined a shape that looked like a lake: what the patient called "a shameosphere." This is an apt description of what we as therapists might call the “global nature of shame.” Within the lake of the shameosphere were smaller clouds or puddles that depicted pockets of the patient’s life: the perpetrator’s name, the school yard, work, and friendships. Even the small everyday aspects of life were infused and soaked with shame. Here the proverbial, “a picture speaks a thousand works,” is true.

Herman elucidates how the shame of trauma creates the split self: a feeling of self-loathing, guilt, internalized disgust, a shut-down parasympathetic response, and a desire to hide. Trauma symptoms can elicit feelings of shame that tend to divide the personality into a sense of safe-self and other, making us feel exposed, defeated, alienated, and wanting to retreat from human connection. While I have understood the importance of shame in trauma treatment for some time, I was stuck viscerally by this picture: by how unhelpful and potentially damaging it would be to treat Herman's lake-of-shame patient as having an anxiety disorder, without acknowledging the suffering shameosphere of the patient’s worldview. For the therapeutic relationship to be healing, the therapist must incorporate at least a cursory understanding of the physiology, social aspects, and characteristics of shame.

At the end of her talk, Herman spoke of healing and repair. She urged us to remind our clients that shame is a natural reaction to relational trauma and to show them that, “you still belong.” Another panellist at the OSP Professional Development Day, Clarissa Chandler, held strongly that respect is an antidote to shame. She urged us to explore what respect means to our clients rather than assuming what it might mean to them. In helping another to restore a sense of self beyond fear and shame, we therapists assist in restoring the human connection and a sense of self-worth in our clients. Of course, it is the patient who does the brave and hard work of looking beyond shame, to see that we offer understanding and respect and to build a sense of self that is whole and healthy. As a therapist and advocate of female trauma survivors, I am wonderfully inspired by Judith Herman’s perseverance and insight, and deeply grateful for the opportunity, offered by the OSP, to have been in her virtual presence.

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