anorexia treatment seattle

Guided Visualization Meditation to Build a Sense of Safety

by Abby Birk, LMFT

Recently, many of my clients (and I) have desperately needed to revisit our regulation skills. Skills that bring us back to a sense of calm, ease, relaxation or restoration in our bodies. In today's world, this state of being can be elusive between the go-go-go pace of life and the incessant call to be more and more productive. The need for intentional mindfulness and somatic regulation keeps increasing as we fall more and more into the trap of "I just don't have the time" day after day.

Below, I've written out the script I use to walk my clients through a visual meditation called Safe Place, to cultivate safety and security in the here and now. Many have their own version of this skill; here is the one I utilize in my sessions. My hope is to demystify these types of skills and make them accessible for practical, everyday use. As you continue, I recommend reading through (or listening to) the entire script at least once before trying it on your own with your eyes closed or gaze lowered.

Listen to the audio below:

Or read the script here (and maybe record it for yourself, or have a loved one record it for you!):

Find a comfortable seated, reclined, or supine position. Whatever position you choose, make sure you are not holding any tension to support this position, rather lean into and feel the support of your chair, floor, or object you are resting on, in, or against. It's best for grounding purposes (if you are in a position that allows it) to rest the soles of your feet on the floor. Let yourself get weighty and heavy as you allow your body to rest fully supported. You may place your hands wherever you'd like, on your thighs, in your lap, or on your heart and chest.

Now draw your attention to your breath. Do not seek to change anything yet, first observe with gentle curiosity the quality of your breath, the parts of the body that move or don't move as you breathe, the speed or sound of your current breath cycle...

As you observe, you might notice your breath starting to change anyways, that's okay. You can soon begin to intentionally lengthen your inhales and exhales. For this visualization meditation, we want to focus on elongated our exhales more than our inhales to better turn on our vagus nerve and calming parasympathetic nervous system.

Take a few rounds of deep breaths with longer exhales.

Minds wander, that's what they do. Label your thoughts as "thoughts" or "thinking" and return back to an aspect of your breath that can provide a bit more focus: the quality, speed, depth, length, feel, temperature, movement, etc.

Now you will select a safe place that you can imagine or think about for the rest of this exercise. It can be real or imagined. A place you've been to or never visited. It can obey the laws of physics or not. Whatever place you choose, you are in control here, you decide what is in the scene and what is not: if there's anyone with you, the weather, the way you feel here. You are completely safe and at ease in this landscape of your choosing. Take a minute to select a place or try a few different images to see which serves you today.

You will then explore your safe place through your 5 senses, starting with sight.

As you imagine looking around in your safe place, what can you see? How far can you see into the distance? What living things are around? What colors? What's the weather like? What buildings or people or nature fill up your space, if any? What surrounds you, what do you sit or stand or lay on? Once you've taken time observing, take some deep breaths simply enjoying the sensations that arise just by being in this place and looking around you.

When you're ready to move along, we'll continue our exploration through our sense of touch. What textures make up your safe place? Is there sand running through your fingers? Water? Are you surrounded by cozy blankets or laying on a fuzzy rug? Petting an animal? There are no wrong answers. Take stock of what you can feel on your skin, temperature, breeze, weather, etc. Take a few deep breaths once you're done observing with your sense of touch to enjoy the sensations that arise from the textures of your safe place.

Next, imagine closing your eyes in this place, identifying all that you can smell. If there are no naturally derived smells in your safe space landscape, you can invent some: maybe pulling in some of your favorite smells from different parts of your life like perfume/cologne, essential oils, warm drinks, nature, candles, etc. Take a few more deep breaths enjoying how the sense of smell in this place interacts with your body to create more safety and relaxation.

Now, you can continue imagining your eyes closed as you pay attention to the sounds that exist in this safe place. Further ground yourself into this landscape by singling out various sounds around you. Maybe you prefer your safe place to be silent, that is okay too! Whatever you find, just give yourself time to experience it fully and pay attention to how your body reactions to what it can hear in this space.

Lastly, we will engage with your sense of taste in this space. Like smell, you may have to manufacture a taste in your safe space if one is not naturally derived. You may pull from favorite foods, flavors, crisp, clean autumn air or the taste of the air after rainfall. Let yourself enjoy, with a few deep breaths, whatever flavors show up in your safe place.

Integrating all 5 senses in this imagined location allows for further grounding and experiencing of this beautiful internal resource. It allows your brain to fully simulate what it is like to exist in that safe, secure, relaxed state.

Take a few more breath cycles allowing yourself to simply exist in this safe place, remembering to see how your body feels. You will end the meditation with a body scan -- checking in slowly from head to toe (as if you were going through a scanner) for any sensations, feelings, emotions, etc. that arise. Then, you can wiggle your toes, eyelashes, and fingers: opening your eyes to fully come out of the meditation.

Remember, you are the author and originator of your own safe place, which means you have access to this space whenever you need it. Come to ground, regulate, relax, or restore yourself anytime you'd like! Visit when you need and just because you can, even allowing yourself a visit once daily or weekly. The more often we practice skills like these, the better utilized they will be when we actually NEED them in a difficult moment. Your safe place can change however you'd like or remain the same, time after time; don't forget, there are no rules, no "right" or "wrong" way to do this exercise. The important part to keep in mind is that YOU have full agency and autonomy over your safe place. View this guide as an invitation of cues to further ground you in your own experience -- which is all you, baby! Allow this guide to remind you of your own internal resources that you can avail yourself of anytime you'd like. Enjoy!

If you’d like to meet with a therapist to build a safe place together, or to further process stress in your life, Riverbank Therapy has therapists with openings, in person and virtual! Click here to schedule your free 20 minute consultation.

4 Steps to Feeling Your Feelings

Got a lot of feelings right now? Me too. Like...so many.

And you’ve probably heard therapists the world over say “feel your feelings” or “make space to feel” or “honor those emotions.” But what does all of that really MEAN?

It's important to make space to feel your emotions. If you don't, then they will make themselves known, and likely not at a moment of your choosing. Emotions aren't meant to be ignored and put away. They are there to spur us to do something and care for ourselves.

but HOW do you feel a feeling? Here's a quick guide:

1) Name it. Pull out an emotion wheel (google it) and find a few words for what you're feeling. It might be one emotion, it might be a bunch at once. There are no rules here. Find some feeling words! Anxious? Sad? Angry? Content? Excited? 

Here are some emotions grouped together that you might be feeling:

anger

rage

exasperation

irritation

envy

disgust

agitated

frustrated

annoyed


shocked

surprised

powerless

stunned

astounded

speechless

confused

disoriented

disillusioned

engaged


sad

disappointed

despairing

depressed

guilty

hurt

ashamed

grieving

lonely


happy

proud

content

satisfied

enthusiastic

optimistic

cheerful

delighted

amused

curious


anxious

nervous

insecure

terrified

overwhelmed

panicked

worried

dreadful

scared

2) Name how your body is feeling. Really feel those sensations, don't just think them. How your body is experiencing these emotions gives you a lot of information. Checking in with your somatic experience keeps your more connected to yourself and more able to take care. What do you feel? Tension in your chest? Heaviness in your belly? Tingling in your arms? Constricted breathing? 

Here are some body sensations you might notice:

tense

tight

tender

nauseous

sore

achy

constricted

bubbly

tingly

shaky

trembling

queasy

fluttery

electric

prickly

burning

radiating

congested

thick

dull

frozen

buzzy

heavy

cold

numb

hot

hollow

empty

knotty

warm

cool

airy

spacious

expansive

fluid

solid

floaty

cool

smooth

Approach all of this with the mindset of "this emotion is tolerable, and I don't have to get rid of it right now." That's it! You felt a thing!

After you've done this, you might want to do something about it. You might want to soothe the feeling or give yourself some care and compassion.

3) What thoughts are attached to this feeling? Our thoughts, the stories we tell ourselves about something, can exacerbate the feeling or calm it. Are your thoughts judging the emotion? Are you telling yourself the emotion must end RIGHT NOW? See if you can practice some self-compassion: "It makes sense that I am feeling X" or "it is okay to feel X". Removing judgement can make the emotion easier to tolerate. Ask if the thoughts accompanying that emotion are true, kind and useful. If they're not, try to generate a thought or two that is.

4) Ask yourself what the emotion is trying to communicate. It's not a pointless thing, it's trying to get you do move or do something to meet your needs. Ask, what do I need right now? Anxiety might mean it's time for a break. Sadness might mean it's time for connection. Anger might be time for self-expression (just examples). Ask what you need and do that thing.

How are you doing right now?

Online Counseling Tips for Clients and Therapists

Telehealth is a huge shift for most of us—clients and therapists alike. Here are som tips for you as a client during telehealth sessions:

  • change your mindset: online therapy can be equally as helpful as in person sessions. It’s new, and might feel uncomfortable at first, but this doesn’t mean it won’t be useful to you.

  • be as close to your internet router as possible to prevent connectivity issues

  • find a private space with a closed door

  • create a physical environment that feels safe and comfortable

  • boundaries--share visually only what you want to share of your home, this can be a little or a lot. You might want your therapist to see your whole living room and meet your dog, or you might want to sit down in a nondescript corner to keep the boundaries more clear and separated. Up to you!

  • close other open windows on your computer and put your phone away & on silent to minimize distraction

  • put a post-it note over your face if it's distracting to see yourself

  • talk with your therapist about what happens if you get disconnected

  • know that it might feel different than in person, and that's okay

  • get comfortable with silences, they are just like in office; you don't have to always fill space.

  • bring up discomfort with the change, process with your therapist how it's impacting your experience

The tips for therapists are really similar, below are the ones that are additional or different:

  • change your mindset: online therapy can be equally as helpful. Almost any therapy modality can be adapted to online sessions (I’m speaking from experience here—I’m a somatic therapist and online work for this can be challenging when I can’t see my client’s entire body, can’t feel their breath as I can in office, etc; but I have been able to find ways to adapt it to online. Anything is possible if we get creative).

  • find a private space with a closed door, add a sound machine if you can, especially if you're at home

  • create a physical environment that feels similar to your office. This can help with getting you into your procedural learning for “therapy session” and get into “therapist mode”. Honestly, I can’t do this if I’m in my PJs or sweatpants. I dress like I’m going to work (which is actually pretty casual), so that I feel as similar to in-person sessions as possible.

  • boundaries--share visually only what you want to share of your home. It can be uncomfortable to bring our clients into our homes, even if virtually, because we work hard to “not bring the work home” with us. Figure out a way to set these physical or energetic boundaries with virtual sessions.

  • call your clients' insurance to double check coverage. Most carriers have the same coverage for telehealth as in-person sessions, but some process the claims differently. Check with your clients’ carriers so that you can be clear with them about potential cost and coverage changes.

  • make sure your clients know what happens if you get disconnected. My rule of thumb is to call them on their cell phone, troubleshoot video issues, and if we can’t resolve them we finish the session by phone. Talk with your clients about what they would prefer if you get disconnected.

  • tell your client about what might feel different about online sessions, check in with them about all of the above. If you’re new to doing online sessions, be transparent about the fact that you’re adjusting to this new thing together.

  • be ready to process attachment and relationship changes that might come up in session. Clients might feel less connected to you, less seen by you, or on the other side, they might feel TOO see by being on video, or might feel their space being intruded upon. Be mindful of this, name it if it comes up, and be ready to process it.

  • give yourself longer breaks between sessions to move your body and to look away from a screen. Please take care of yourself! I’m finding that doing online sessions is more exhausting and my eyes get really tired. Time away from my screen and moving my body, along with longer breaks between sessions and less clients per day (when possible) has been really helpful.

I’d love to hear from you—either as a client or a therapist—how are you adjusting to online sessions? How is it feeling? What did I miss?

Interested in teletherapy during the pandemic? We are taking on new clients! Head to our contact page to reach out, let us know what you’re looking for, and we’ll fit you with one of our fantastic therapists.

4 Tips to Help You Stay Sane in a Scary World

Setting boundaries with the news is crucial. I can't tell you how many sessions I have a week about how stressful the world is, whether it's politics, climate change, COVID-19 or something else. Boundaries with information are necessary.

Two questions I lean on:

1) Do I already have this information? 

If no, then sure, keep reading. Gather information to get yourself informed. Track your level of anxious activation. The news will likely get you anxious, but notice the point at which you're not getting anything new out of it other than worry and fear. That's often the point you need to step away.

If yes, then do you need to gather more information? How is it serving me or those I care about to dig deeper? Maybe it does serve--you have a partner who is immunosuppressed and so you need more information about COVID-19, or you have an LGBT friend who will be directly impacted by policy decisions in the government. Yes, gather more information. Dig deeper, and again, track when your level of anxiety surpasses the point of the usefulness of the information.

2) Is this information I'm going to take action on? 

If no, then why are you gathering more? You might just be curious: cool. You might feel slightly soothed by having more data: great.

But, if you're reading the news and spinning yourself into worry: stop. Taking action on the information you take in is a great way to challenge worry. Donate to the cause. Vote. Talk to your friends about voting. Go wash your hands and figure out your workplace's policy about sick days. But after that...stop. Set some limits.

I understand that you feel you need to be informed. I know that you want to be a good citizen and neighbor. But sometimes, we become too fearful, too anxious and too worried to be able to take effective action. It's like worrying: it gives you a false sense of control. The more you read the more you feel in control. But constantly checking doesn't help. It actually can exacerbate worry. It gives you an instant dopamine hit...and then a flood of cortisol.

Two limits I and my clients have found helpful:

-set a certain number of times a day that you get to check the news (I only check twice--during breakfast and when I get home from work).

-set time limits (I only read for the amount of time I'm eating, and then for about 15 minutes at the end of the work day).

What have you found helpful to stay informed while also staying sane?

5 Ways to Cultivate Self-Love

Self-love is a game-changer.⁠ Your life radically changes when you start to care for yourself the way you care for those around you. And love is a verb, it comes through actions. You cultivate self-love when you show up for yourself, consistently and with compassion. It takes practice.

What I’ve noticed over time, is that the belief “I am unloveable” begins to shift to a belief that “I am loveable” when people consistently treat themselves as if the latter is true, even when it doesn’t feel that way.

I don't buy the bullshit that says "no one will love you until you love yourself"...because it's just not true. You will still be loved even if you don't love yourself, but that love will be harder to accept and savor. You might find yourself pushing love away, fearing that people will leave you or “find you out”. When you practice loving yourself, you’re more able to be present with the love other people are showing you.

Self-love can come in a lot of forms, but these are five tried and true ways that I know help develop self-love:⁠

1) 🖤Stop judging others.

What you're judging in them is something you reject about yourself, or it's just plain mean and feeding into focusing on the negative about yourself. Stop judging others and notice how much easier it is to be kind to yourself and feel connected in any situation.⁠ This is a practice I adopted several years ago, and it made massive shifts in how I looked at other people and myself.

2) 🕵️‍♀️Observe your inner critic.

Notice the mean shit she's saying to you daily! Would you say that to your best friend? Are those shame-y thoughts helping you get anywhere? NO.⁠

3) 💥Challenge those statements with something that is true, kind AND useful.

Yes, all three. True (because maybe you did fuck that thing up), but how can you say it in a way that is KIND and USEFUL at the same time? Not "you're such a failure, you really messed that up", but instead "that didn't go well, you made a few mistakes, here's how you can do better next time/learn from this". Way kinder.⁠

4) ❓Ask, "what do I feel right now?"

Isn't this how we so often show people we care? We want to know how they're feeling and what's going on in their lives. Get curious about your own experience, without so much judgement. It's amazing what can change just through asking yourself "what do I feel right now?⁠

5) 🌮Ask "what do I really need?"...and give that to yourself!

This is another way we show that we care. We support our loved ones, we try to meet their (reasonable) needs, we do what we can to SHOW UP for them.⁠

How can you show up and show love for yourself today??

Want to show yourself love by giving yourself the gift of therapy? Click here to schedule your complimentary consultation.