Winter Is Coming…

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We walk through stores littered with decor saying “Give thanks!” and “Be grateful!”, and as clinicians, I’m sure we’ve all recommended that our clients write a gratitude list, or share with us the things they are grateful for. But why do we do this? It seems that gratitude is pressed upon for maybe one season of the year, but is that enough?

The truth is that gratitude runs much deeper than recognizing the possessions you have or saying thank you to a friend.  The difference between giving thanks and being grateful is that gratitude is a profound quality inside of you, a pure and genuine feeling of appreciation and compassion; it can’t be forced or faked.  Not only is gratitude a pleasant feeling in the moment, recurrent gratitude has been shown to have a plethora of positive mental and physical effects, including decreasing stress, irritability, and negative cognition.  Further, gratitude can also increase motivation, empathy, and even our physical energy. By being grateful, we can live happier and more optimistic lifestyles, improving our overall quality of life.

Gratitude redirects focus away from the negative, i.e. what we want and don’t have, or negative self talk, to a more positive perspective. Routine practice can change maladaptive behaviors, like acting on frustration about having to stop to get gas or getting angry at your spouse for accidentally burning a hole in your favorite shirt, and help reframe the situation to appreciating that you have a car or the effort intended in trying to iron the laundry.  Gratitude can also have positive effects on our own image of ourselves, helping us to see all the good qualities we have rather than those we consider less healthy.

While it can’t be forced or faked, gratitude can be learned.  We can foster genuine gratitude within ourselves with frequent and focused practices.  Practicing gratitude means paying attention and functioning with intention, the lists and letters don’t mean much if there isn’t thought behind them.  Learning to be grateful can at first require daily effort and routine, such as in the Loving Kindness meditation below, but over time these practices can become habitual, and being grateful can become a state of mind.  

To aid you in your gratitude efforts, whether in session with clients or in your own lives this holiday season (and after), below are Three Practices.  The attachment provides instructions for each practice and how each one can help improve the ability to be grateful, as well as improve relationships with others.

Access the Three Practices here!

The first practice is a Loving Kindness meditation, described by Sharon Salzburg to help deepen our spiritual connection with ourselves and with others.  This practice takes only a few minutes, and is designed to “soften and break down the barriers that we feel inwardly to ourselves, and then those that we feel towards others”.

The next, a gratitude letter, is a direct practice in gratitude designed for recognition of a benefactor, i.e someone that has made a positive impact.  This practice helps the client to identify a person and explain specifically what they’ve done to better the client’s life and allow the two to deepen and appreciate their connection.

And finally, from narrative therapy, a third practice called a “thickening story”.  This is a daily practice that focuses on internal gratitude and changing negative cognition in the client to improve self image and worth.  It’s a simple practice that over time has a powerful impact.

And the most important thing to remember is this: true gratitude is not based on the expectation of exchange; we need not have the favor returned in order to reap the benefits for ourselves.

Happy holidays!


Here’s something other than my usual shameless self promotion

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Hi All,

I want to make sure that you don’t miss this opportunity with my friend and colleague Dr. Diane Poole Heller.

Diane is launching her Attachment Therapy & Trauma Mastery Training Program. She has been working on this program for a year and is very excited to be sharing this with you. I have featured Diane several times on my programs and she is amazing.

She has three free videos that you don’t want to miss  – over an hour of very rich educational material on the transformative power of Attachment work. This 3-part series includes: The Future of Attachment, The Four Attachment Styles, and Mastering Attachment.

Click here: Mastering Attachment Series

You don’t want to miss these videos.

They will be available for only a limited time so I would encourage you to watch them.











P.S. You’ll  be really glad to have watched Diane’s videos and will gain a greater awareness of how to help your client create a bridge back to Secure Attachment.


Click here: Mastering Attachment Series

Thank You for Spreading the Word!

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New educational resources for ‘becoming very good at what you do’. 

The newest DVD in the Master Clinician Series is now available.

For more information, click here.

Evidence-Based Tx DVD new

and, the latest book by Linda Curran.

For more information, click here


“This is an imminently practical workbook that shows a variety of invaluable techniques to get centered, calm and organized. An effective and enjoyable guide to help you feel in charge of yourself.” 

~ Bessel van der Kolk, M.D.



The DSM-5: A Not-So-Extreme Makeover

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As I write this post, after thirteen years, DSM-IV is-and will forever remain-a great bargain on the discount book rack, as the fifth edition (DSM-5) was released in May 2013.
Before evaluating the specific revisions made to the area of traumatic stress, let’s quickly review the purpose of the DSM and the controversy surrounding this version’s publication. According to the American Psychiatric Association’s website:
“DSM stands for “Diagnostic and Statistical Manual of Mental Disorders” and is published by the American Psychiatric Association, the professional organization representing United States psychiatrists. DSM contains a listing of psychiatric disorders and their corresponding diagnostic codes. Each disorder included in the manual is accompanied by a set of diagnostic criteria and text containing information about the disorder, such as associated features, prevalence, familial patterns, age-, culture- and gender-specific features, and differential diagnosis. … (DSM) provides standard criteria and common language for the classification of mental disorders.” (1)         ~American Psychiatric Association website (
Due to its “radical changes,” this particular iteration-the manual’s first major revision in nearly 20 years-has been contentious within and outside the field. Reactions range from fear to neutrality to anger and disgust, with many professionals-clinicians and researchers alike-voicing concern and lodging formal complaints, while consumer groups are filing lawsuits. In an article titled, The New Crisis in Confidence in Psychiatric Diagnosis, Allen Frances, MD, chair of the DSM-IV Task Force and one of the new manual’s staunchest critics, suggests that we use the DSM-5 “cautiously, if at all.” Frances summarized the majority of complaints
“The DSM-5…lacked sufficient scientific support and defied clinical common sense. It was prepared without adequate consideration of risk–benefit ratios and the economic cost of expanding the reach of psychiatry just when the field is about to achieve parity within an expanded national insurance system. … I found the DSM-5 process secretive, closed, and disorganized. … Field trials produced reliability results that did not meet historical standards. I believe that the American Psychiatric Association (APA)’s financial conflict of interest, generated by DSM publishing profits needed to fill its budget deficit, led to premature publication of an incompletely tested and poorly edited product. The APA refused a petition for an independent scientific review of the DSM-5 that was endorsed by more than 50 mental health associations (8). Publishing profits trumped public interest.” (2) (Frances, 2013)
Heated arguments will likely continue, but for now, it’s here and some of us have to use it. So let’s review some of the general changes.
Spoiler alert-the first notable change is in the title, right there on the cover. The DSM has converted from Roman numerals to Arabic numbers. Entirely reasonable, as Arabic numbers are less cumbersome, and let’s face it, hardly anyone speaks Roman anymore. Essentially, all future text revisions (prior to the manual’s next complete revision) will have simpler designations, e.g., DSM-5.1, DSM-5.2. DSM-5 Task Force Chair, David Kupfer, M.D., summed up this change: “We used ‘5’ because V.0 and V.1 just don’t look good.”
Further modernizing the manual, some of the more defamatory terminology has been eliminated and some of it replaced. Here are a few examples: Mental retardation is now Intellectual disability; Hypochondriasis is Illness anxiety disorder; The paraphilias are now Paraphilic disorders; and temper tantrums are now Disruptive mood dysregulation disorder.
The DSM-5 has eliminated four of its five axes. Going forward, clinicians will assess criteria solely for psychological disorder(s) and record diagnoses on the last axis standing. No reason for opposition here either, as the five axial diagnostic system wasn’t without problems, however, the majority of my complaints have historically been reserved for “Axis II.”
Good ole’ Axis II. That inexplicable combination of poorly named, yet universally disparaged disorders, including: disorders that developed in childhood, but not mental retardation; personality disorders; and, …wait, what was the other one? Right, mental retardation. That categorical nightmare, peppered with stigmatizing terminology, will not be missed.
The modest changes mentioned above are all well and good, but, I was promised something more. I was led to believe that besides the long-awaited name change for the pejorative diagnosis, Borderline Personality Disorder, we were going to see BIG CHANGES within the Personality Disorders category.
In an article entitled, DSM Section Contains Alternative Model for Evaluation of PD, Mark Moran reported: “John Oldham, M.D., a past APA president and a member of the Work Group on Personality Disorders, told Psychiatric News, ‘From the beginning of the development process for DSM-5, the personality disorders were identified as a place where we needed to move beyond the categorical diagnostic system of discrete disorders in DSM-IV toward a more dimensional system.’’’Scientists and researchers alike recognized the necessity of change. Nick Craddock, Chairperson of the Academic Faculty of the Royal College of Psychiatrists wrote: “We are entering a transitional period of several years during which psychiatry will need to move from using traditional descriptive diagnoses to clinical entities (categories and/or dimensions) that relate more closely to the underlying workings of the brain.” (3, 4) Expounding on its necessity, Oldham wrote: “…The alternative model is intended to move toward a way of diagnosing disorders that fits the patient who comes to the clinician’s office with a variety of presentations, rather than fitting the individual into a preconceived categorical scheme.”
For months I followed along with the workgroup’s process, which held such promise. I watched as a diagnostically and empirically useful alternative model was developed, and according to Oldham, “well received by clinicians and greatly preferred over that in DSM-IV.”
I applauded and enthusiastically awaited the manual’s completion and subsequent publication, because I was sure that this revision would be the one that improved the care of a historically misunderstood and underrepresented personality disordered population, a.k.a., my treatment population.
Change was inevitable. Most assuredly inevitable.

We Have Got an Intervention for You!

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From May 1st till December 1st, in celebration of our upcoming publication, 101 Trauma-Informed Interventions: Exercises, Experiments and Activities for Moving the Client and Therapy Forward, we will be posting right here (Trauma Matters Blog) one trauma-informed intervention per week. You are hereby invited to visit the blog and collect one or all of them. (Each intervention will be available for one week, then replaced by another. So, check back weekly!)

Check out what the trauma community is saying about

101 Trauma-Informed Interventions: Exercises, Experiments and Activities for Moving the Client and Therapy Forward