Friday, 6 February 2015

What a Shaman Sees in A Mental Hospital

http://themindunleashed.org/wp-content/uploads/2014/08/shamann.jpgBy: Stephanie Marohn with Malidoma Patrice Somé
The Shamanic View of Mental Illness 
In the shamanic view, mental illness signals “the birth of a healer,”  explains Malidoma Patrice Somé. Thus, mental disorders are spiritual emergencies, spiritual crises, and need to be regarded as such to aid the healer in being born.
What those in the West view as mental illness, the Dagara people regard as “good news from the other world.” The person going through the crisis has been chosen as a medium for a message to the community that needs to be communicated from the spirit realm. “Mental disorder, behavioral disorder of all kinds, signal the fact that two obviously incompatible energies have merged into the same field,”says Dr. Somé. These disturbances result when the person does not get assistance in dealing with the presence of the energy from the spirit realm.
One of the things Dr. Somé encountered when he first came to the United States in 1980 for graduate study was how this country deals with mental illness. When a fellow student was sent to a mental institute due to “nervous depression,” Dr. Somé went to visit him.
“I was so shocked. That was the first time I was brought face to face with what is done here to people exhibiting the same symptoms I’ve seen in my village.” What struck Dr. Somé was that the attention given to such symptoms was based on pathology, on the idea that the condition is something that needs to stop. This was in complete opposition to the way his culture views such a situation. As he looked around the stark ward at the patients, some in straitjackets, some zoned out on medications, others screaming, he observed to himself, “So this is how the healers who are attempting to be born are treated in this culture. What a loss! What a loss that a person who is finally being aligned with a power from the other world is just being wasted.”
Another way to say this, which may make more sense to the Western mind, is that we in the West are not trained in how to deal or even taught to acknowledge the existence of psychic phenomena, the spiritual world. In fact, psychic abilities are denigrated. When energies from the spiritual world emerge in a Western psyche, that individual is completely unequipped to integrate them or even recognize what is happening. The result can be terrifying. Without the proper context for and assistance in dealing with the breakthrough from another level of reality, for all practical purposes, the person is insane. Heavy dosing with anti-psychotic drugs compounds the problem and prevents the integration that could lead to soul development and growth in the individual who has received these energies.
On the mental ward, Dr Somé saw a lot of “beings”hanging around the patients, “entities” that are invisible to most people but that shamans and psychics are able to see. “They were causing the crisis in these people,” he says. It appeared to him that these beings were trying to get the medications and their effects out of the bodies of the people the beings were trying to merge with, and were increasing the patients’ pain in the process. “The beings were acting almost like some kind of excavator in the energy field of people. They were really fierce about that. The people they were doing that to were just screaming and yelling,” he said. He couldn’t stay in that environment and had to leave.
In the Dagara tradition, the community helps the person reconcile the energies of both worlds–”the world of the spirit that he or she is merged with, and the village and community.” That person is able then to serve as a bridge between the worlds and help the living with information and healing they need. Thus, the spiritual crisis ends with the birth of another healer. “The other world’s relationship with our world is one of sponsorship,” Dr. Somé explains. “More often than not, the knowledge and skills that arise from this kind of merger are a knowledge or a skill that is provided directly from the other world.”
The beings who were increasing the pain of the inmates on the mental hospital ward were actually attempting to merge with the inmates in order to get messages through to this world. The people they had chosen to merge with were getting no assistance in learning how to be a bridge between the worlds and the beings’ attempts to merge were thwarted. The result was the sustaining of the initial disorder of energy and the aborting of the birth of a healer.
“The Western culture has consistently ignored the birth of the healer,” states Dr. Somé. “Consequently, there will be a tendency from the other world to keep trying as many people as possible in an attempt to get somebody’s attention. They have to try harder.” The spirits are drawn to people whose senses have not been anesthetized. “The sensitivity is pretty much read as an invitation to come in,” he notes.
Those who develop so-called mental disorders are those who are sensitive, which is viewed in Western culture as oversensitivity. Indigenous cultures don’t see it that way and, as a result, sensitive people don’t experience themselves as overly sensitive. In the West, “it is the overload of the culture they’re in that is just wrecking them,” observes Dr. Somé. The frenetic pace, the bombardment of the senses, and the violent energy that characterize Western culture can overwhelm sensitive people.
SCHIZOPHRENIA AND FOREIGN ENERGY -  With schizophrenia, there is a special “receptivity to a flow of images and information, which cannot be controlled,” stated Dr. Somé. “When this kind of rush occurs at a time that is not personally chosen, and particularly when it comes with images that are scary and contradictory, the person goes into a frenzy.”
What is required in this situation is first to separate the person’s energy from the extraneous foreign energies, by using shamanic practice (what is known as a “sweep”) to clear the latter out of the individual’s aura. With the clearing of their energy field, the person no longer picks up a flood of information and so no longer has a reason to be scared and disturbed, explains Dr. Somé.
Then it is possible to help the person align with the energy of the spirit being attempting to come through from the other world and give birth to the healer. The blockage of that emergence is what creates problems. “The energy of the healer is a high-voltage energy,” he observes. “When it is blocked, it just burns up the person. It’s like a short-circuit. Fuses are blowing. This is why it can be really scary, and I understand why this culture prefers to confine these people. Here they are yelling and screaming, and they’re put into a straitjacket. That’s a sad image.” Again, the shamanic approach is to work on aligning the energies so there is no blockage, “fuses” aren’t blowing, and the person can become the healer they are meant to be.
It needs to be noted at this point, however, that not all of the spirit beings that enter a person’s energetic field are there for the purposes of promoting healing. There are negative energies as well, which are undesirable presences in the aura. In those cases, the shamanic approach is to remove them from the aura, rather than work to align the discordant energies
ALEX: CRAZY IN THE USA, HEALER IN AFRICA - To test his belief that the shamanic view of mental illness holds true in the Western world as well as in indigenous cultures, Dr. Somé took a mental patient back to Africa with him, to his village. “I was prompted by my own curiosity to find out whether there’s truth in the universality that mental illness could be connected with an alignment with a being from another world,” says Dr. Somé.
Alex was an 18-year-old American who had suffered a psychotic break when he was 14. He had hallucinations, was suicidal, and went through cycles of dangerously severe depression. He was in a mental hospital and had been given a lot of drugs, but nothing was helping. “The parents had done everything–unsuccessfully,” says Dr. Somé. “They didn’t know what else to do.”
With their permission, Dr. Somé took their son to Africa. “After eight months there, Alex had become quite normal, Dr. Somé reports. He was even able to participate with healers in the business of healing; sitting with them all day long and helping them, assisting them in what they were doing with their clients . . . . He spent about four years in my village.” Alex stayed by choice, not because he needed more healing. He felt, “much safer in the village than in America.”
To bring his energy and that of the being from the spiritual realm into alignment, Alex went through a shamanic ritual designed for that purpose, although it was slightly different from the one used with the Dagara people. “He wasn’t born in the village, so something else applied. But the result was similar, even though the ritual was not literally the same,” explains Dr. Somé. The fact that aligning the energy worked to heal Alex demonstrated to Dr. Somé that the connection between other beings and mental illness is indeed universal.
After the ritual, Alex began to share the messages that the spirit being had for this world. Unfortunately, the people he was talking to didn’t speak English (Dr. Somé was away at that point). The whole experience led, however, to Alex’s going to college to study psychology. He returned to the United States after four years because “he discovered that all the things that he needed to do had been done, and he could then move on with his life.”
The last that Dr. Somé heard was that Alex was in graduate school in psychology at Harvard. No one had thought he would ever be able to complete undergraduate studies, much less get an advanced degree.
Dr. Somé sums up what Alex’s mental illness was all about: “He was reaching out. It was an emergency call. His job and his purpose was to be a healer. He said no one was paying attention to that.”
After seeing how well the shamanic approach worked for Alex, Dr. Somé concluded that spirit beings are just as much an issue in the West as in his community in Africa. “Yet the question still remains, the answer to this problem must be found here, instead of having to go all the way overseas to seek the answer. There has to be a way in which a little bit of attention beyond the pathology of this whole experience leads to the possibility of coming up with the proper ritual to help people.
LONGING FOR SPIRITUAL CONNECTION  - A common thread that Dr. Somé has noticed in “mental” disorders in the West is “a very ancient ancestral energy that has been placed in stasis, that finally is coming out in the person.” His job then is to trace it back, to go back in time to discover what that spirit is. In most cases, the spirit is connected to nature, especially with mountains or big rivers, he says.
In the case of mountains, as an example to explain the phenomenon, “it’s a spirit of the mountain that is walking side by side with the person and, as a result, creating a time-space distortion that is affecting the person caught in it.” What is needed is a merger or alignment of the two energies, “so the person and the mountain spirit become one.” Again, the shaman conducts a specific ritual to bring about this alignment.
Dr. Somé believes that he encounters this situation so often in the United States because “most of the fabric of this country is made up of the energy of the machine, and the result of that is the disconnection and the severing of the past. You can run from the past, but you can’t hide from it.” The ancestral spirit of the natural world comes visiting. “It’s not so much what the spirit wants as it is what the person wants,”he says. “The spirit sees in us a call for something grand, something that will make life meaningful, and so the spirit is responding to that.”
That call, which we don’t even know we are making, reflects “a strong longing for a profound connection, a connection that transcends materialism and possession of things and moves into a tangible cosmic dimension. Most of this longing is unconscious, but for spirits, conscious or unconscious doesn’t make any difference.” They respond to either.
As part of the ritual to merge the mountain and human energy, those who are receiving the “mountain energy” are sent to a mountain area of their choice, where they pick up a stone that calls to them. They bring that stone back for the rest of the ritual and then keep it as a companion; some even carry it around with them. “The presence of the stone does a lot in tuning the perceptive ability of the person,” notes Dr. Somé. “They receive all kinds of information that they can make use of, so it’s like they get some tangible guidance from the other world as to how to live their life.”
When it is the “river energy,” those being called go to the river and, after speaking to the river spirit, find a water stone to bring back for the same kind of ritual as with the mountain spirit.
“People think something extraordinary must be done in an extraordinary situation like this,” he says. That’s not usually the case. Sometimes it is as simple as carrying a stone.
A SACRED RITUAL APPROACH TO MENTAL ILLNESS - One of the gifts a shaman can bring to the Western world is to help people rediscover ritual, which is so sadly lacking. “The abandonment of ritual can be devastating. From the spiritual view, ritual is inevitable and necessary if one is to live,” Dr. Somé writes in Ritual: Power, Healing, and Community. “To say that ritual is needed in the industrialized world is an understatement. We have seen in my own people that it is probably impossible to live a sane life without it.”
Dr. Somé did not feel that the rituals from his traditional village could simply be transferred to the West, so over his years of shamanic work here, he has designed rituals that meet the very different needs of this culture. Although the rituals change according to the individual or the group involved, he finds that there is a need for certain rituals in general.
One of these involves helping people discover that their distress is coming from the fact that they are “called by beings from the other world to cooperate with them in doing healing work.” Ritual allows them to move out of the distress and accept that calling.
Another ritual need relates to initiation. In indigenous cultures all over the world, young people are initiated into adulthood when they reach a certain age. The lack of such initiation in the West is part of the crisis that people are in here, says Dr. Somé. He urges communities to bring together “the creative juices of people who have had this kind of experience, in an attempt to come up with some kind of an alternative ritual that would at least begin to put a dent in this kind of crisis.”
Another ritual that repeatedly speaks to the needs of those coming to him for help entails making a bonfire, and then putting into the bonfire “items that are symbolic of issues carried inside the individuals . . . It might be the issues of anger and frustration against an ancestor who has left a legacy of murder and enslavement or anything, things that the descendant has to live with,” he explains. “If these are approached as things that are blocking the human imagination, the person’s life purpose, and even the person’s view of life as something that can improve, then it makes sense to begin thinking in terms of how to turn that blockage into a roadway that can lead to something more creative and more fulfilling.”
The example of issues with an ancestors touches on rituals designed by Dr. Somé that address a serious dysfunction in Western society and in the process “trigger enlightenment” in participants. These are ancestral rituals, and the dysfunction they are aimed at is the mass turning-of-the-back on ancestors. Some of the spirits trying to come through, as described earlier, may be “ancestors who want to merge with a descendant in an attempt to heal what they weren’t able to do while in their physical body.”
“Unless the relationship between the living and the dead is in balance, chaos ensues,” he says. “The Dagara believe that, if such an imbalance exists, it is the duty of the living to heal their ancestors. If these ancestors are not healed, their sick energy will haunt the souls and psyches of those who are responsible for helping them.” The rituals focus on healing the relationship with our ancestors, both specific issues of an individual ancestor and the larger cultural issues contained in our past. Dr. Somé has seen extraordinary healing occur at these rituals.
Taking a sacred ritual approach to mental illness rather than regarding the person as a pathological case gives the person affected–and indeed the community at large–the opportunity to begin looking at it from that vantage point too, which leads to “a whole plethora of opportunities and ritual initiative that can be very, very beneficial to everyone present,” states. Dr. Somé.
Excerpted from:  The Natural Medicine Guide to Schizophrenia, or The Natural Medicine Guide to Bi-polar Disorder, pages 178-189, Stephanie Marohn (featuring Malidoma Patrice Somé).

Friday, 16 January 2015

Perspective: Finding Purpose in Recovery

by Susan R. (Munro)

calling-240x240I have spent most of my sobriety in fluctuating states of change and transformation, while trying to remain grounded and balanced – another great paradox of recovery. I have gained professional experience and as a result of living a program of recovery have become a respected member of my community and society as a whole.
My life before recovery had very little purpose; purposelessness was more my mantra back in those days. I may have thought that feeding my compulsion to drink was my purpose and in fact it did occupy a lot of my mental and physical energy and certainly a lot of determination on my part. Nevertheless, it was really purpose with very little substance (or much too much substance, depending on how you look at it).
I am continually reminded of another paradox of this program of recovery; we connect in order to be free. We find purpose, become intentional and determined and then the rest falls into this good orderly direction (GOD). We find purpose where there once was none at all. WOW – this blows me away every time.
My experience with finding continued purpose in recovery for me meant working on creating my dream job and finding yet another level of meaningful work in my life. I am not referring to livelihood exclusively, as everyone’s need for work means something different and personal to them.
Service work in AA is has been and continues to be an incredible source of learning and rewarding work for me, as well as my volunteer work with many organizations. It pays well, just a different kind of currency than a salary. I have also served on a Board of Directors for several years now which is incredibly rewarding for me. In addition, this is an honest contribution to my community – far from when I only took from my community and my loved ones, before recovery.  READ MORE

Wednesday, 17 December 2014

Fixing Cognitive Distortions

Fixing Cognitive Distortions

By JOHN M. GROHOL, PSY.D.

Cognitive distortions have a way of playing havoc with our lives. If we let them. This kind of “stinkin’ thinkin'” can be “undone,” but it takes effort and lots of practice — every day. If you want to stop the irrational thinking, you can start by trying out the exercises below.
1. Identify Our Cognitive Distortion
We need to create a list of our troublesome thoughts and examine them later for matches with a list of cognitive distortions. An examination of our cognitive distortions allows us to see which distortions we prefer. Additionally, this process will allow us to think about our problem or predicament in more natural and realistic ways.
2. Examine the Evidence. 
A thorough examination of an experience allows us to identify the basis for our distorted thoughts. If we are quite self-critical, then, we should identify a number of experiences and situations where we had success.
3. Double Standard Method. 
An alternative to “self-talk” that is harsh and demeaning is to talk to ourselves in the same compassionate and caring way that we would talk with a friend in a similar situation.
4. Thinking in Shades of Gray. 
Instead of thinking about our problem or predicament in an either-or polarity, evaluate things on a scale of 0-100. When a plan or goal is not fully realized, think about and evaluate the experience as a partial success, again, on a scale of 0-100.
5. Survey Method. 
We need to seek the opinions of others regarding whether our thoughts and attitudes are realistic. If we believe that our anxiety about an upcoming event is unwarranted, check with a few trusted friends or relatives.
6. Definitions. 
What does it mean to define ourselves as “inferior,” “a loser,” “a fool,” or “abnormal.” An examination of these and other global labels likely will reveal that they more closely represent specific behaviors, or an identifiable behavior pattern instead of the total person.
7. Re-attribution. 
Often, we automatically blame ourselves for the problems and predicaments we experience. Identify external factors and other individuals that contributed to the problem. Regardless of the degree of responsibility we assume, our energy is best utilized in the pursuit of resolutions to problems or identifying ways to cope with predicaments.
8. Cost-Benefit Analysis. 
It is helpful to list the advantages and disadvantages of feelings, thoughts, or behaviors. A cost-benefit analysis will help us to ascertain what we are gaining from feeling bad, distorted thinking, and inappropriate behavior. Note: 1) clinical concept of secondary gain; and 2) refer to cost-benefit analysis.
Reference: Burns, D.D. (1989). The feeling good handbook: Using the new mood therapy in everyday life. New York: William Morrow.

Friday, 5 December 2014

Urge Surfing - Relapse Prevention

Urge surfing is a term coined by Alan Marlatt as part of a program of relapse prevention he developed for people recovering from addictions to alcohol and other drugs. It can actually be used to help with any addictive behaviour such as gambling, overeating, inappropriate sex or any other destructive impulses.
Urges for substance use rarely last for very long. In fact, they almost never last for longer than about 30 minutes, if there is no opportunity to use. People admitted to a high quality detoxification centre where there is no access to their drug of choice often find it remarkable how little craving they get.
If there is no opportunity to use then there is no internal struggle. It is this internal struggle that feeds the cravings. Trying to fight cravings is like trying to block a waterfall. We end up being inundated. With the approach of mindfulness, we step aside and watch the water (cravings, impulses & urges) just go right past. This is true for everybody, but few addicts ever give themselves the chance to prove it.

Exercise: Reflecting on Urges
Ask yourself whether there have been times when you could not give in to an urge when it presented. Did the urge pass?
 Most of us will have had past experiences of urges passing. This is an important strategy to identify, as it can greatly improve self efficacy for riding out urges. The main message is that urges do not have to be acted upon.
Exercise: Experiencing The Changing Nature & Impermanence of Urges
    Sit with back unsupported in a chair or on a cushion on the floor
    Start Mindfulness Meditation
    Wait for any sense of discomfort
e.g. Restlessness, an itch
    Note the desire to move and resist it
    Notice thoughts that arising. “I wish this itch would go”…………..”It is driving me crazy”…………..”This too will pass” – in a calm tone………..”This too will pass” – in an irritable tone…………..”It is is not bloody well passing!”………….”I would love to scratch right now” etc etc
    These thoughts are just thoughts. So gently bring your attention back to your breath and bodily sensations
    Note the changing position, shape and quality of the discomfort over time. Be interested in feeling it as precisely as you can. Notice how the shape and intensity changes with the cycle of the breath. Is it stronger during the in breath or during the out breath?
    You might find your thoughts spontaneously going to other matters,
e.g. Your shopping list, a fight with you partner, a football game, planning a holiday
These are still just thoughts. Gently bring your attention back to your breath and body sensations. They are probably different again.
You have just observed the changing nature and impermanence of urges. When you notice the physical sensations with interest, you are directly facing the urges rather than feeding them through fighting them.
How fighting urges feeds them
Often people try to eliminate the urges by distraction or talking themselves out of them. This usually just feeds the urges and creates the illusion that they are interminable until you give in to them.
Suppressing a thought feeling or sensation, including pain ultimately increases it. 
For example Wegner et al (1987) conducted a series of experiments to assess the effects of thought suppression called the “white bear” experiments. The bear was chosen because one of the researchers remembered reading that when Russian author Tolstoy challenged his brother not to think of a white bear, the brother remained perplexed for quite a while.
In one of the more sophisticated experiments people were shown a movie about white bears. These people were then given a sorting task which required concentration. They were then divided into two groups. The first group was instructed to suppress the white-bear thoughts. The second group was given no instruction to suppress these thoughts. Both groups were asked to hit a counter button every time they thought of white bears while doing the other task. The initial suppression group reported a significantly higher rate of “white bear” thoughts during this time.
Prochaska (1992) et al in their study of how people change habitual behaviour, note that most people go through a long contemplative stage before they actually change. This stage is marked by ambivalence. Argumentation usually results in the client completing the other side of the ambivalent equation thus maintaining a state of therapeutic paralysis. It is reasonable to assume that the same problem exists with the client’s internal disputation over the ambivalently regarded behaviour. (e.g. “I have to give up smoking because I could get cancer” receives a reply “Yes but that isn’t going to happen to me – at least not for a long time.”)
The Technique of Urge Surfing
Mindfulness allows us to bypass these problems associated with avoidance and disputation. Instead of trying to distract from or argue with the unpleasant thoughts, feelings or urges, mindfulness simply makes the thoughts, feelings or urges less important. When we use mindfulness we stay exposed to the thoughts feelings or urges for their natural duration without feeding or repressing them.
In fact, if we just let an urge be – non judgmentally – without feeding it or fighting it (Fighting it is just another way of feeding it anyway) then it will crest subside and pass.
Of course they come back again but over a period of time. However each time you overcome a bout of cravings they become less intense and less frequent if we don’t feed the urges and if we don’t give in to the addiction. Moreover our mindfulness technique of urge surfing improves. If we have a slip and give into the impulse we will have increased urges for a while. However we can still apply urge surfing all over again.
Urges can be compared with feeding a stray cat. In the beginning, you may want to feed the cat because it cries for food and attention. You may find that it is a nice thing to do and you feel good for being kind. However, your act of feeding the cat encourages it to repeat its cries and attention seeking. You find yourself giving in each time. Over a period of time the cat grows bolder and other cats join it in crying for food and attention.
You may begin to regret your actions, as a large number of strays are now contributing to noise and other problems. But you cannot resist the feeling of ignoring their cries. You may believe that their survival now depends on you, and that your actions are more important than ever. They have you trapped in a cycle of your own pattern of repeated problem behaviours.
If you make a decision to resist feeding the “cat army,” there will be loud and pitiful cries for a few days. In fact they will be at their strongest when you have decided not to reinforce their behaviour. Soon, however, they will come to realise that they are no longer being reinforced, and will gradually diminish and disappear. Your decision to stick with the action you know is best for you will “undo” the problem that you unknowingly built up in the first place.
Urges do go away, but they may be very strong for a short while immediately after quitting. Knowing that they will weaken will help you to continue to surf the impulses that you feel, especially in response to your personal triggers.
Urge Surfing Summary
Purpose
To experience the cravings in a new way and to “ride them out” until they go away
Preparation
1. Remember that urges pass by themselves.
2. Imagined that urges are like ocean waves. that arrive crest and subside. They are small when they start, will grow in size, and then will break up and dissipate.
3. Practise mindfulness regularly and especially notice any impulses or urges that appear. Then we are well prepared to ride these waves without giving in to the urge by using mindfulness.
Urge surfing itself
    Practise mindfulness
    Watch the breath. Don’t alter it. Let the breath breathe itself.
    Notice your thoughts.
    Without judging them, feeding them or fighting them gently bring your attention back to the breath
    Notice the craving experience as it affects the body.
    Focusing on one area where the urge is being felt and noticing what is occurring.
                      Notice quality, position, boundaries & intensity of the sensation
                      Notice how these change with the in-breath and out-breath
    Repeating the focusing process with each part of the body involved.
    Be curious about what occurs and notice changes over time.
The key is replacing the fearful wish that craving will go away with interest in our experience. When we do this we notice the cravings change, crest and subside like waves in the ocean. In this way it becomes more manageable.
Teaching Urge Surfing To Clients
It is very difficult for clients to understand urge surfing unless they have an experience of it. Even though the idea of watching cravings come and go makes sense, it is a skill that can only be learnt through practice. Just as it is easier to coach someone how to kick a football, when they are actually kicking a football is also easier to coach someone as to how to surf urges when they are actually having urges.
We can do this in two ways. Firstly we can create a situation where urges arise and secondly we can respond opportunistically when a craving arises spontaneously in the presence of the therapist.
Manufacturing Opportunities for Urge Surfing.
This is not as difficult as it sounds, as there are many kinds of urges apart from drug cravings. There are urges to scratch, to move, to eat, to drink, to go to the toilet etc. When we reflect on this as it becomes clear that all adults including those who consider they have hopeless addictions have the capacity to have urges come and go without acting on them. After all, unless we are physically ill we can all control our need to go to the toilet!
When we sit with our back supported in a chair or on a cushion on the floor and start mindfulness meditation, sooner or later some sense of discomfort will arise, such as restlessness or an itch. Along with these sensations there will be a urge to move. This is an opportunity to practice urge surfing. So we can notice the difficult sensations that go with this and the thoughts that arise. Instead of acting in our normal way of trying to get rid of this unpleasant feeling, we become curious. We become like natural scientists seeing a strange plant or animal for the first time. We try to describe what we are observing as closely as possible. In this way we replace an aversion with curiosity. So we do this by noticing the physical sensation that goes with the urge as precisely s possible.
If we are guiding a client through this process we then ask them to notice:
    The exact physical sensation in the body,
    It’s quality:
                      Whether it is tight or loose
                      It’s temperature whether it is hot or cold.
    The location of the sensation,
    It’s exact borders
    Whether these borders are well defined and firm like the edge of a football or soft and fuzzy like cotton wool.
    How these qualities vary with the respiratory cycle
We need to watch it for at least five cycles of breathing to get a sense if it.
Does it get larger or smaller, more or less intense or does the quality of it change?
When we find our mind turning to thoughts, notice the thoughts and come back to the physical sensations of the urge.
Opportunistically Teaching Urge Surfing
Sometimes when talking to a client an urge arrises spontaneously. Sometimes it can be spotted as a subtle smile on the face as the client fondly remembers using the drug. At this point, the therapist can say to the client:
“It looks like you might be having an urge to use right now.”
If the client agrees to this, then the therapist can ask them:
“How does this urge feel in your body? Whereabouts is it in your body?”
Then slowly guide the client through the questions that define the sensations or the urge in the body.
At first there will be a resistance and a desire to go into the story about the urges. It is then helpful to explain to the client that we can go into the story later. We can explain:
“It would be good if you could become aware of how this urge feels in your body right now. I’m very interested in knowing exactly how it feels for you. This is an opportunity for you to practice urge surfing. So see if you can just bear with it for a little while.”
Then ask the client to define the edges of this sensation, where they are and the quality of the edges, then the quality of the actual sensation itself including the temperature. And finally how it changes with the cycle of breathing. Then you can ask the client if the sensations has changed since we first started talking about it. Any observation of change is good. It does not matter if the feeling is stronger. What is important is that the client can see the sensation is not one solid unchanging entity.
So having done this, it is worthwhile to then divert the client’s attention a little by talking about the matter at hand that elicited the urge in the first place. After doing this for a few minutes, it is very useful to return attention to the body and ask the client how the sensation feels now. At this point with their increased level of mindful awareness of the physical sensation they are capable of noticing how the urge has changed. It has often changed dramatically. When a client has had the opportunity to be taken though this three or four times, they begin to have enough faith in the process to practice urge surfing successfully by themselves.