MIND-BODY SKILLS GROUPS FOR CANCER
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Presenters: James S. Gordon, M.D. and Nancy Harazduk, M.S., L.C.S.W.
Session: Sa15; June 12, 1999I. Abstract
In this session, Dr. James Gordon, MD, and Nancy Harazduk, MS, LGSW, described their mind-body skills group, a support group, which teaches mind-body skills for balanced living. Although cancer patients were the focus of the presentation, this approach to group therapy is beneficial for anyone willing to learn from the experiences of others and develop mind-body skills. Throughout the two hours, they discussed the motivation behind these groups, the principles involved, and why they love their work. In particular, these healing groups help people live fully in the present by providing a safe group setting and teaching mind-body skills such as meditation, imagery, and art therapy. For anyone interested creating or leading a mind-body skills group, Dr. Gordon and The Center for Mind-Body Medicine offer an annual professional training program in November.
II. The Cancer-Related Issue Addressed
See abstract above.
III. The Program
Because Dr. Gordon and Nancy Harazduk wanted participants to understand the feeling of a mind-body skills group, an atmosphere of openness, they organized this session much like an actual mind-body skills group session. Dr. Gordon began the group with a meditation to help bring the audience into the present and set the mood.
Sit comfortably in your chair. Allow your eyes to close. Breathe in through your nose and out through your mouth. Allow your belly to be soft. If you hear sounds, notice them and let them go. Bring your attention gently back to the breath, breathing in through the nose and out through the mouth, allowing your belly to be soft, perhaps saying to yourself "soft" as you breathe in and "belly" as you breathe out. If thoughts come, let them come and let them go. Gently bring your mind back to soft belly. If part of your body feels tense, imagine that your breath is going to that part and softening it. Open your eyes when you are ready. Come back….
Next, Dr. Gordon explained why he leads these groups – "This work should be in the deepest sense of the word, a joy. The people who lead the groups feel significantly better after the groups, even if they are working with people who are dying. The experience of doing these groups is one on deep connection and deep sharing, and it grows and evolves over time."
Dr. Gordon, a psychiatrist by training, began to work with non-conventional therapies as soon as he started medical school in 1962. He became particularly interested in non-conventional therapies while working on the psychiatric wards where he saw "an appalling incongruence between the needs of the people in the wards and the treatment they were receiving." Early on he realized that it was possible to get in touch with those called "mad," and that madness has a deep meaning. "It was simply a matter of changing the mental attitude, and the setting, and not to see individuals as pathological entities. If people were given the opportunity to go through their journey, then all things were possible."
While working with patients on LSD or STP, both hallucinogens, as a resident in San Francisco, Dr. Gordon had a very powerful experience. Individuals on drug trips who were taken to the emergency room at Mt. Zion hospital often did not recover as well as similar patients who came to a free clinic in Haight Ashbury. In fact, many of the emergency room patients were given clinical drugs and placed in the psychiatric ward, whereas the free clinic visitors went home the next day in reasonable shape. What was the difference? In the free clinic, these people were allowed to be in a quiet place where they were told, "It’s okay man, we go to some bad places but you will come out on the other side." In other words, the people were given a supportive setting in which they could find themselves. The emergency room did not provide this emotional support. Thus, Dr. Gordon witnessed the difference a setting makes.
After this experience, he became interested in "how to create a place where a person’s experience is accepted, understood; where the person is guided, guarded, given the tools they need to go through the experience and not hindered from having the experience. How do we do that individually and how do we do that collectively?" Dr. Gordon worked with runaway and homeless kids for many years, and realized that he could help people create an effective atmosphere. These kids, who were resisting every kind of psychotherapy, were given the chance to analyze their situation and problem-solve. Often they resolved to speak with their parents. Even very young people, with guidance, were able to reach good solutions when given the appropriate environment in which to explore their feelings.
In 1990, Dr. Gordon organized The Center for Mind-Body Medicine. After years of working with complementary therapies, he wanted to create a place where he could 1) accommodate his interests by working with children, HIV patients, seriously ill, medical students and professionals, and 2) work with other people. He began the Center with help from friends, all volunteers, and together they organized educational programs and earned non-profit status.
At the same time, Dr. Gordon was supervising a group of psychotherapists, running a private practice, and teaching techniques such as meditation and biofeedback. To reach more people given these time constraints, he decided to start groups. In one a year, there were far more groups than one person could handle. A training program was organized with the conviction that the only way to lead a group is to experience one yourself as someone who is working on his or her own issues. "Every year we say, ‘please come to this training expecting to work on your own physical, emotional, spiritual issues. This is the laboratory by which you will learn.’ Every year this surprises people. But, these mind-body skills have to be learned on yourself by your own deep experience - knowing when to use which technique with whom comes from that experience," explained Dr. Gordon.
The training, which began as a year-long program including an internship, has now evolved into a week-long session in November, followed by four days in the spring for more advanced work. The following principles are taught during the training and are fundamental components to the success of a mind-body skills group.
1. Safe Place – complete confidentiality is necessary for people to feel safe in the group. In addition, the outside should be left behind when one enters the group. The basic idea is to create a safe environment in which people are not in a frantic rush and where you can feel welcome and present.
2. Respect – there needs to be full respect for whoever comes into the group and each person’s experience is considered valuable.
3. Education – the groups are educational and members receive several handouts. People can learn what they need in order to take care of themselves. The science behind some of these techniques is helpful. In addition, members are taught to be students of their own lives and to learn from their experiences. Experience is a valuable teacher - if you can learn from your experience, it redeems the experience from hopelessness, helplessness, and worthlessness.
4. Staying in the Moment – the focus is on the present moment. People can talk about the past if the past comes up, but how you are feeling right now, how are you using the techniques taught in the group is what matters most. For this reason, the whole basis of these groups is meditation. If you are in the moment, you realize that right here is what you have. When people are not in the moment, the group starts to wander off.
5. Leader as a Teacher and Real Person – everyone has a different way of running the groups, it’s all about experimenting and finding what works. The leaders are there to teach and to be real. If they can not be authentic, how can they expect other people to be?
6. The Power of Each Person – the possibility in each person is enormous. People are taught that anything is genuinely possible and miracles have happened. (reference Carol Hirschberg, Remarkable Recovery).
7. Group is Mutual - genuinely give help, not out of arrogance, condensation, or out of some sense of feeling sorry for someone else. "Compassion is possible only between equals," to quote the Dalai Lama. When one equal extends herself to another equal, amazing things happen. When someone reaches out to help another, both experience healing.
8. Group Grows and Changes Considerably - groups come together at different time and there are certain conditions that make it easier to lead a group. For example, groups of people with cancer sometimes grow together the fastest.
9. Flexibility - there are plans for each session in the training program and for which exercises work best at particular times. But, you should always be willing to let the whole structure go. Order with flexibility is one of the challenges of leading the group.
Next, Nancy Harazduk discussed how she became involved with the mind-body skills group and why she strongly believes in this approach to therapy.
Nancy began her career as an elementary school teacher, but after the death of her husband, she became a hospice volunteer to heal herself. After attending social work school, she heard Dr. Gordon speak about the mind-body skills group training program and this is how she discovered the passion she feels for leading these groups. She said, " It is a miracle and I cannot explain why but I believe it has to be love. We help people create a full, whole life, and heal themselves. It’s as if they are embarking on a new journey. This is about embracing your fear and then letting it go. It’s about living a compassionate, loving, healing life." In her groups, anything is welcome including tears, joy, sadness, anger and laughter. There is no judging, analyzing or advice giving. "I say that the intention is to support each other and to give each other love and then miracles begin to happen."
Nancy begins each session by ringing a gentle bell which leads the group into a mindfulness meditation. She teaches people to focus on the breath and to notice thoughts, accept them, and let them go. Next, Nancy lights a candle to symbolize presence and to remind people to bring their minds back into the room. With the mood set for the rest of the session, Nancy proceeds to teach people skills to use for life.
One such skill is imagery, using the imagination to help the body heal. Nancy said, "Images come from your heart, from your subconscious. They can reach the depth of our soul and weave our lives back together again." For example, 65-year-old woman with cancer had to have an MRI and she was claustrophobic. So, the group did a safe-place imagery. For her safe place, she envisioned walking on the beach in Maui with her new husband. This enabled her to get her MRI and make it through just fine.
Another skill is autogenic training or self-hypnosis to tell the body what to do. For example, you say, "I want my arms to be heavy and warm." While saying this, imagine your arms becoming this way. This physiologically relaxes your body.
In addition, they teach biofeedback, a method of giving you information from your own body. Skin temperature is measured with a heat sensor. When the temperature goes up it means your body is relaxing. When it goes down it suggests that you need to do relaxation techniques.
Art therapy is also used. Members are instructed to draw a picture of themselves, a picture of their conditions, and a picture of how they want to be. One 70-year-old man drew a picture of himself sitting on the porch with his brother, who he had not talked to for eight years. That night he went home and called this brother. Thus, art therapy helped him to release resentment and heal a relationship.
They teach movement therapy as well, and in fact, during this session Dr. Gordon decided to lead movement exercises both as an illustration of flexibility in planning and so people could enjoy the benefits of movement therapy. Dr. Gordon commented, "Everyone needed to stand and move around. We want to move with what’s happening now. It is time to change. This is the way we make decisions about what we do with the group. We work a lot with movement, which is something that needs to be done much more, especially with patients who have cancer - they tend to see their bodies as alien and as an enemy. At every moment, you’ve got to move and love that body. Regardless of what it has, you can love it and celebrate it. We give people the opportunity to open up by moving. People with chronic illness tend to get stuck in the illness. We try to un-stick people by shaking things up; literally, we shake."
We were instructed to stand up, close our eyes, take two deep breaths, and begin shaking.
Shake from your feet up through your knees, hips, shoulders, let your jaws go – you hold a lot of tension there. Keep shaking. Let your arms go. If thoughts come, let them go. Just keep shaking. Beautiful!
After shaking for several minutes with positive coaxing from Dr. Gordon, we continued the movement exercise by dancing with all of our hearts to Latin American-style music.
Nancy concluded the session with experiential imagery. We were instructed to follow her voice the best we could.
Find a comfortable position so that your body is fully supported. Allow your eyes to close. Start by taking a couple of deep cleansing breaths, inhaling as fully as you comfortably can, sending the warm energy of your breath to any part of your body that is sore or tense or tight, and releasing any discomfort with the exhale. Feel your breath going to all of the tight, tense places, loosening and softening them. Gather up all of the tension and breath it out so more and more of you can feel safe and comfortable, relaxed and easy. Watching the cleansing action of the breath with friendly but detached awareness, send out any unwelcome thoughts or feelings you might have with the breath, so that inside you can be still and be quiet like a lake with no ripples. Now visualize, imagine, or feel a bright beautiful light entering your body at the top of your head, and allow your mind to choose the color of this light. Everything that this beautiful light touches as it spreads down your body, every tissue, every organ, every muscle, every fiber and cell of your body, will relax completely, getting rid of all of the aches, pains, and discomforts. The light will deepen the level of your relaxation, and you may be already feeling deeply peaceful and tranquil. Now see or feel or imagine the bright beautiful light spread down from the top of your head, down past your forehead, behind your eyes, relaxing you even more; see, feel, or imagine the light spreading down throughout your scalp and into your jaw, deepening your state of relaxation even more. Now the light is flowing into your neck completely relaxing the muscles of the neck and throat, smoothing out the lining of your throat and relaxing you more and more. Visualizing, imagining, or feeling the light which relaxes and heals every muscle and nerve in your body, spreading into your shoulders, down both arms, and all of the way into your hands and fingers. Seeing, imagining or feeling this healing light flowing into your upper back and chest and into your heart which pumps the light through every blood vessel in your body and into your lungs which are glowing beautifully. The muscles of your upper back and chest are relaxing completely, and now the light is spreading into your spinal cord, from your brain to the tip of your spine, flowing along your entire nervous system, to reach every muscle and cell of your body. You are feeling a deep tranquility, a marvelous sense of peace. Seeing or imaging or feeling this beautiful light completely surrounding your body as if you were in a cocoon or a halo or light, and this protects you and relaxes your skin and your outer muscles; you feel even more peaceful and calm and relaxed. When you are ready, inviting an image to form of your ideal self, an image of yourself as you would most like to be, and welcoming this image into your awareness whatever it is. Welcoming the image that comes, this image of the ideal you, the way you would like to be if you could be exactly how you wanted to be, noticing how you look, how you move, how you are dressed, and how you seem to feel as you observe this image. Notice the qualities in your ideal self that you really value and appreciate, and when you are ready, allowing yourself to become that unique, beautiful, ideal self, stepping into your new self and just noticing, what that is like and listening to the message in your new heart. What would your heart like to tell you? Listen to the message, accept the message, and learn from it. And noticing what the world looks like through your new eyes, what message would you like to give all those who come after you, what would you like them to know, to remember, to learn. Notice how it feels to be this ideal self, and notice too where you feel those ideal qualities in your body. Do they seem to center or concentrate somewhere specific in your body? And allowing those ideal qualities to spread throughout your body, radiating inward and outward, and filling your whole body with acceptance of yourself and opening every cell, of your new self to light and love and allowing your new self to become a part of you too. And now as this imagery comes to an end, allowing your breathing to deepen, feeling your body against the chair and beginning to move your fingers and toes, bringing yourself back into this body and this room at this time. When you are ready, slowly and gently allowing your eyes to open.
Nancy commented, "After such an imagery like this, I usually give group the opportunity to share any experiences they had. It is nice to be in a group to have these experiences. The beauty of these experiences is that every time they are new."
IV. Limitations
No limitations were discussed.
V. Resources
If you are interested in joining a mind-body skills group, contact Nancy Harazduk at The Center for Mind-Body Medicine in Washington DC: (202) 966-7338 or cmbm@mindspring.com. If you are interested in attending the Mind-Body-Spirit Medicine Professional Training Program, it will take place at Hilton Head, South Carolina from November 8-14, 1999. Further information is also available from The Center for Mind-Body Medicine.
VI. Audience Questions
How do you run programs for people if they are unable to attend twelve-week sessions? How flexible is this program?
Dr. Gordon - My thought is generally to work with the most accessible people first. You may offer a special program for people in the area and work with those folks. For the others, develop a one or two day program for them. Teach them what you can and then invite them to come back when they can. For example, in Kosovo, we do a three-day training program for 50 physicians. Do what you can.
What is the optional size for a group and can they be composed of anyone?
Nancy - We usually have a group of 6-8 people with a maximum of nine. The groups vary in age, gender, and cancers. This works beautifully. We create general groups now too for people who just want to learn the skills. We are all in the groups for the same reasons - to learn how to live a healthy, peaceful life. It helps to have both cancer patients and care givers in the same group because people can really grow from each other’s perspectives.
When someone is interested in joining a group, I ask him/her what the presenting problem is and why he/she wants to join the group. Then I schedule an hour-long interview with the facilitator of the group so they can meet each other.
In terms of the format, how much of it is didactic?
Nancy – Generally, in a two-hour group, I take 30 minutes to teach. For example, when I teach meditation, I usually take about half an hour to talk about meditation.
Are there follow-up groups for people?
Nancy - Usually, people are devastated when a group is about to end, so what we do is have a reunion group one month after in order for people to meet and decide what to do next. They either create a group on their own in which someone becomes the leader, or meet at the Center [for Mind-Body Medicine} once per month and I will be there. A number of groups are still meeting two years later.
Also, we have supervision twice per month for each of the group leaders. It’s not easy to lead a group, especially when people in it are dying. It is also a time in which we teach each other how to handle difficult issues. We also have a wonderful social worker who works with us to provide guidance. The graduates of our program are in communication with us. There are also internships for people who have gone through our program, and we have organized an email network so people can communicate.
How do you get a program going?
Dr. Gordon - It is important to get people to refer to you. Talk with oncologists or whatever group you want to work with so they know what you are doing. We also sponsor public talks. It’s important to find people who really get what you are doing and then things will flow.
Please talk more about the importance of being an authentic group leader.
Nancy - I do not tell people about my personal life if it is not related to what they are going through; but, I feel like if I have gone through something that relates, I will share my experience. At the beginning of sessions we have check-in during which we all share what is happening that week. I share my in-the-moment thoughts then.
Dr. Gordon - the whole spirit of these groups is to share feelings that come up. If you are concerned that people in the group will judge you for what you share, that is their problem. We encourage people to say, "I find myself judging you."
Is the training necessary or can you lead a group based on intuition?
Dr. Gordon - I started leading groups as a first year resident, but to do this I spent ten years of very intensive work with meditation and with all of these different things before I began to lead and create this kind of group. Of course you should do whatever you are trained to do and expand on it to create what you want. But, when people undergo training, an important thing happens – their lives change. Their beings change by virtue of coming with us for one week even if they were already very skilled care-givers. The second thing that happens is that people reach and find kindred spirits at a very deep level. In addition, we teach a particular format that works well and that really helps leaders develop confidence. This is especially useful if you are trying to rework how you practice therapy.
How do you create a support group in which everyone feels tended to and no one dominates?
Nancy - I’m tough, I may not look it but I am. So, what I say is: "Thank you for the information but we are running out of time and I want to give everyone a chance."
What do you feel are the benefits of support groups?
Dr. Gordon - We are doing some studies, one is in submission now, in which we have seen major changes in people across all diagnoses including major changes in attitudes people have about themselves, an enhancement of spiritual values, and a reduction in degree of stress and physical symptoms. Right now we are doing a study on anxiety and heart disease, and we will be measuring physiological and well as psychological parameters. If people feel more at peace, they are more optimistic, they take less medication, they feel more in control of their lives, they have a greater sense of hopefulness and a greater sense of connection with something larger than themselves.