HEALING RITUALS - North Star Behavioral

HEALING RITUALS:Strategies to develop rituals that promotewellness and help patients meet their goals.

PREVALENCE AND POWER OF RITUALS Rituals are foundacross all cultures andare documentedthroughout time.Rituals reduceanxiety, alleviateemotional pain,provide opportunitiesto experience joy, andbuild relationshipswithin communities.

PAIR DISCUSSION Talk with someone at your table about a personalritual that you do or you have developed withinyour family that is meaningful to you. Has itchanged over time? How does it help you? Howdo you feel when you are talking about thisritual?

HOW DO RITUALS HELP US? Create a structure to express intense emotion Mark transition so that we can hold duality Create opportunities to gather Describe what cannot be said with words Cause growth and change Impact thoughts and feelings positively Improve confidence

HOLDING SPACE FOR DUALITY Rituals are the vehicle for focusing on healthwhile you simultaneously accept the illness ispresentRituals allow the mundane to shine and becomespecial.Allow you to be in the old role and the new role atthe same timeCreate a safe place to hold the incongruitiesbetween the actual and the ideal

RELIGION IS OFTEN THOUGHT OF THEPRIMARY PLACE FOR RITUALS

RITUALS CAN BE FOUND EVERYWHERE You can have many rituals as a part of your lifeand not be associated with a religionWomen faired better than men in concentrationcamps because they built networks, bondedquickly into family-like groups and made ritualsthat celebrated or honored special days andevents.

ARE THERE RITUALS IN MODERN DAYWESTERN MEDICINE THAT HELP HEALING? Yes!The bedside exam is a healing ritual Patients expect this ritual to build therelationship Studies show that the context, locale, andquality of the beside evaluation are associatedwith neurobiological changes in the patient.(Benedetti F., Carlino E, Pollo A. How placebos change thepatients brain. Neuropsychopharmacology. 2011;36:339-54PubMed )

HOW IS THE BEDSIDE EXAM A RITUAL? Permission to be touched which is a marker of vulnerabilityindicating the acceptance that this ritual is important for thetransfer of knowledgeTakes place in a special roomThe exam is a visual display of the trust in the relationshipbuildingValidates that the patient is being included in the process ofhealing because the patient is being “seen” and the doctor hasto be curious about what information the body and mind canprovideConveys to the patient that they have the physicians time andcompassion

LOVE, MEDICINE AND MIRACLES Bernie Siegel, MD, taught his patients toembrace rituals of love during cancer treatments.He made the research visible that praying beforesurgery improved outcomes.Patients beliefs about their illness mattered.“The truth is: Love heals.”Bernie Siegel

USING RITUALS TO CHANGE A HABIT Replacing the behavior you want to change witha new ritual is found to be effective in decreasinganxiety and creating hope.Identify the cues and rewards, you can changethe routine through use of a ritual.

ARE WE UNDER RITUALIZED AS ACULTURE? Maybe . We have anabundance of ritualsaround passages andhealth problems. Can we name some?WeddingsTwelve-Step ProgramsGraduationsRetirement partiesFuneralsShiva Bar-MitzvasQuiceanera’sFuneralsAnointing of the sickFasting during Lent

TABLE DISCUSSIONTalk at your table about patients or familymembers that you have encounter thatdisconnected from rituals (under ritualized). Whatdid you notice? What were the consequences?

WHAT EVENTS LACK CULTURALLYACCEPTED RITUALS IN THE U.S.? Divorce Onset of menstruation Blending of step families Illness Moving Adoption Death through violence

HOW ARE RITUALS A PART OF THERAPY? They create structure for the therapy session. They focus on health Engage patients in creatingtheir own change

DEFINITION: Prescribedsymbolic acts that mustbe performed in a certain way and ina certain order and may or may notbe performed with verbal formulas.They involved preparation andmeaning. (Rituals in Psychotherapy:Transition and Continuity -Mickey Van der Hart)

DEEPENING THE DEFINITION Open aspects of therapeutic rituals allow for theclient to add evolving and idiosyncratic meaningClosed aspects of the therapeutic ritual addsafety and structure for strong affect and pass onnew cultural information and give form to theactionHollow or empty rituals don’t allow for themeaning to be reinforced and are moreperfunctory than transformational( Mickey Van der Hart)

THREE PHASES OF A RITUAL Preparation Experience Integration

WHAT ARE THE RULES? Rituals can be created within new systems andthey don’t need to be accepted by the largerculture norms to be effectiveThey can be performed once, many times or witha prescribed interval of time. They can include others or be performed alone They require preparation

WHAT MAKES A RITUAL HOLLOW? Rituals can lose their meaning and value whenthey become more about status, dogma and lackmeaning.Rote repetition of attending events or goingthrough the motions of the event make themineffective.If a therapist begins the closure portion oftherapy without being connected to the client theritual is minimized.

TALK IN PAIRS Think of a wedding ceremony that you attendedthat reminded you of your own commitments tolove and your role as a community membersupporting this new relationship. Contrast thatwith another wedding ceremony that you didn’tfeel the connect to the event or even notice how itimpacted your own life? What was different?

WHY DO WE NEED RITUALS IN THERAPYRich opportunity to intervene on multiple levels Provides clarity (symbols, repetition, songs,words) Provides you with a spiritual connection – We allneed to be connected to something bigger Fits into any therapeutic model Verbal and non-verbal Helps us to develop change Integration of different parts of self

RITUAL THEMES Membership Healing Identity definition Belief expression and negotiation Celebration

BUILDING RITUALS WITH CLIENTSCollect data about the history of rituals in his/herlife and systems Assess language for cues for symbols that fit withthe individual or the system Therapist provides the directives Client provides the directives Timing and space

IN SESSION RITUALSIn session rituals are usually used in unexpectedand unusual ways to engage families and tobreak up rigid frames and to introduce change. Therapist use in session rituals when: It is more likely to happen in the session thanat home A witness is needed Therapy has become a “rigid ritualized”experience Requires a safe place and someone to help theaffect stay in a tolerable range

OUT OF SESSION RITUALS Repeated over several days or weeksConnection to people that do not come to therapyis requiredLocation outside of therapy is deemed important(Past home, outdoors, place of worship)

RITUALS OF THERAPY SESSION Greeting Managing symptoms Process oriented ClosureHow are clientswelcomed? Do they know what todo when affect getstoo intense in thesession? Are they aware ofwhat phase oftreatment they are in? How are we going tosay goodbye?

FamilyTherapy

FAMILY THERAPY AND RITUALS Rituals tap deeply into a family’s shared sense ofidentity and will tell you a lot about thefunctioning and health of the system.Rituals are things people often want to talk aboutRituals clarify family roles, delineate boundaries,transmit information about family identity acrossgenerations

FAMILY SYSTEMSThree types of rituals present Celebrations Traditions Patterned routinesWhat types of interventions are available to us? Changed Dropped Revised

ASSESSING FOR RITUALS IN FAMILYSYSTEMS Orienting questions Has bedtime changed for the children over the years?Have birthday parties changed?Are the same people involved in night time rituals?When someone has either entered or left the familyhow has that been marked?Reflexive questions Five years from now, when Maria is living out of thehome, how do you think her birthday will becelebrated?If you were to experience a loss in this family, how doyou think you would mark it?What new rituals has the family created?

FAMILY DYSFUNCTION Ritual disruption – Stressful events caused theritual to be stopped or negativeDisorganized of ritual activity –Unplanned orlast minute vacationsLow ritualization – Eating dinner by the TVHigh rigidity in the ritualizes – Overschedulingevents and forcing attendance

FAMILIES THAT LACK RITUALS Orienting questions How do you think any ritual process was interrupted (bywar, death, suicide, migration)?Who did this interruption impact?Reflexive questions If members of your family had been able to celebrate theritual more openly with more support from the culturehow might they have done it differently?If you were to complete the ritual now in some way, whatmight you do?Who would it be important to include?What other resources can be called in to provide asupportive and safe environment?

RITUALS HELP PROTECT AGAINST THENEGATIVE IMPACT OF ALCOHOLISM Researchers have found that children that havegrown up in families in which both parents arealcoholics, their children are less likely to becomealcoholics if the family rituals surrounding meals,holidays, vacations, visitors, evenings, andweekends remain intact during periods of heavydrinking. (Rituals for Familes and Family therapy (NewYork: W.W. Norton & Co., 1988)

ADDICTIONIndividual ritual Design a ritual to help theperson in recoveryacknowledge the drinking vsnon-drinking self.Creating a healing ceremonyto repair past hurts anddiscuss new ways offunctioning.Imagine that your youngerself is with you anytime youhave a desire to use thesubstanceFamily system ritual Work with the family to add apatterned ritual to restorefunctioning and connection.New rituals to repair timesthat were disrupted byintoxication.Creating a healing ceremonyto repair past hurts anddiscuss new ways offunctioning.

DIVORCEIndividual Design a being “seen”ritual for the age you wereat when the divorceoccurred. Have someonethere that validates yourstory and reminds you thatyou will heal.Write a letter to youryounger self explainingwhat happened.Family system Create a ceremony thathonors the good that wascreated in the marriageand discusses reasons thatit ended.Create a place in the homewhere we can grieve theending and talk about itroutinely.Develop a new contract forco-parenting

ILLNESS OF A PARENTIndividual/Long termillness Develop a symbol of hopeand healingBuild a symbol around thenew responsibilities theyhave because of the illnessCreate patterned ritual withthe child that offersopportunity for ageappropriate play.Create a deck of cards foreach member to describedifferent aspects of how theillness has impacted them.Family/Long term illness Create a visual imagethrough a symbol thatacknowledges that theparent does not havephysical abilities butmaintains strengths.Invite another adult tocome into the system(during a session) thatcan help the systemhave power.

RITUALS FOR RESILIENCE AT WORKGroup ritualsDebriefing sessions Breaks Meetings Using core values fordecision making Goodbye parties Individual ritualsWearing specialclothing Routine workgatherings thatprocess stressfulevents Routinely talkingabout mission orpurpose

DAILY RITUALS Centenarians show us the value in a daily ritual.Dr. Mario Martinez did a study with 700 healthycentenarians and revealed that they indulge inpleasurable rituals daily, like one cigar, a smallscotch, or a brownie. (Not a mindless binge)Daily rituals acknowledge the challenges withbeing human and give us a vehicle for nurturing,awareness and managing an uncomfortableaffect.

DO WE NEED RITUALS AT WORK? Without honoring the pain and challengesassociated with our work, we can get compassionfatigue.Rituals at work allow us to ease anxiety and dealwith change.How can rituals help us deal with challengingpatients?

TALK IN PAIRS Identify an area where you are struggling.Discuss ideas for an new ritual you canimplement at work.

WESTERN MEDICINE THAT HELP HEALING? Yes! The bedside exam is a healing ritual Patients expect this ritual to build the relationship Studies show that the context, locale, and quality of the beside evaluation are associated with neurobiological changes in the patient. (Benedetti F., Carlino E, Pollo A. How placebos change the patients brain.