Self-Therapy For People Who ENJOY Learning About Themselves

A good therapist provides many "permissions." A permission is a statement which helps you feel "allowed" to do well. The statements below are some of the many permissions I've sent your way in these topics.

If you are looking for some good ideas to speed your changes, you will find them here.

Refer back to the original topics when something seems particularly fitting for you.

PERMISSIONS FOR CHANGE

Permissions from "Three Styles of Relationships"

IT'S OK...
... to be dependent if you need to be.
... to get what you need and go for what you want.
... to expect your relationships to grow and change.
... to show yourself you can make it on your own.
... to know you are always more important than your relationship.
... to stay independent if you are happy that way.
... to have so many friends that you are never lonely for long.
... to choose people who can give you what you need.

Permissions from "How Much Change Is Possible?"

IT'S OK...
... to accept yourself as you are.
... to say "No" to people who order you to do things.
... to say either "Yes" or "No" to people who ask you to do what they want.
... to have greater hopes - while realizing that all hopes are fantasies.
... to have fewer fears - while realizing that almost all fears are fantasies.
... to judge your future based on your determination and skill, instead of judging it based on your past.

Permissions from "What Is A Therapist's Job?"

IT'S OK...
... to want help and get it.
... to decide what you want to change.
... to direct your therapy toward your own goals.
... to shop around for a good therapist.
... to challenge your therapist.

Permissions from "Are You Expecting Too Much?"

IT'S OK...
... to throw away your expectations about other people and directly ask them for what you want instead.
... to stop trying to meet other people's expectations.
... to expect only that people will keep their word.
... to know what you really want, regardless of whether others approve or disapprove.
... to establish new habits.
... to get help when you don't know what you want.

From "Loneliness"

IT'S OK...
... to need and to get plenty of attention every day.
... to put your need for attention higher on your priority list than anything except basic physical needs.
... to get plenty of attention even when you aren't at your best.
... to take reasonable risks in order to get close to people.
... to regulate the degree of closeness in your relationships.

From "Changing Your Personality"

IT'S OK...
... to notice how much you've changed your opinions and beliefs.
... to know your opinions and beliefs will keep changing.
... to take charge of your changes and decide about their direction.

From "Personal Freedom"

IT'S OK...
... to know that you are not anyone else's property.
... to get rid of all "freedom poisons" (money, success, addictions...).
... to accept that, as an adult, that you do make all of your own decisions (even when you think you don't).
... to take full responsibility for the decisions you make, the decisions you keep, and the decisions you change.

Permissions from "Who Is The Real You?"

IT'S OK...
... to know that your friends and acquaintances have the best view of who you are socially.
... to accept that your feelings are the best guide to who you are personally.
... to be confident that you know the real you.

Permissions from "What Terror Does To Us"

IT'S OK...
... to know you will automatically take excellent care of yourself when you are in a real crisis.
... to know that the fear that comes from a true crisis should subside after a few weeks.
... to know that any painful fear that lasts longer than a few weeks shows the need for professional help.
... to be proud of how well your childhood safety plan worked back then.
... to admit that your childhood safety plan may be of little use in the adult world.

Permissions from "Feel Safe"

IT'S OK...
... to get away from people who abuse or threaten you.
... to throw away fear you have about anything that isn't happening right now.
... to know that you can think about bad things later, if they actually do occur, instead of thinking about them now.

Enjoy Your Changes!

Everything here is designed to help you do just that!

next: Stages of Therapy

Did You Eat Anything?: A Drama

Caryn is very concerned about her daughter, Brooke, who looks too thin to her. She feels that Brooke may have gone too far with her diet.

Caryn: Did you eat anything?

Brooke: I had a half a bagel.

Caryn: Did you put anything on it?

Brooke: Mom, who are you? The Food Nazi?

Caryn: I never see you eat anymore. You're getting so skinny.

Brooke: Well, who told me I was fat in the first place?

Caryn: I said that you should exercise. I said that you should exercise with me. That we could go to the gym together.

Brooke: You said that I was heavy. And that I should stop eating junk. We went to McDonalds and you said that I should order the broiled chicken. When we went for pizza, you said that one piece was enough for me. You thought I was fat.

Caryn: Don't be ridiculous.

Brooke: Admit it, Mom. You told me to go on a diet. So I did. And now you don't like it. Funny. You didn't like me fat and now you don't like me skinny. I can't win with you.

Caryn: Of course I love you. I love you any way you are. I just don't want kids to make fun of you. You told me they were.

Brooke: Well they're not anymore.

Caryn: I'm glad about that.

Brooke: Do you think I look good?

Caryn: You look too thin.

Brooke: I don't think so.

Caryn: Your father told me that when you were there this weekend all you ate was a salad.

Brooke: Please, I went out with friends.

Caryn: You've got to eat, honey.

Brooke: Who are you to talk? You're always on a diet. The refrigerator is filled with Slim Fast. Or you just eat steak and eggs all week. You're the one who is obsessed with food. Not me.

Caryn: Sweetie, of course I watch my weight.

Brooke: You spend half of your time at the gym. You never like the way you look. Ever.

Caryn: Brooke, I try my best. I'm not perfect.

Brooke: Neither am I. So just stop bothering me. Believe me, I'm not going to starve myself to death.

Caryn: I'm worried about you. Aren't you tired?

Brooke: No ,Mom. I feel fine. I'm not that thin.

Caryn: You are. You don't see yourself. You're disappearing. You're practically nothing.

Brooke: I feel fine.

Caryn: Are you getting your period?

Brooke: Mom, don't worry about me.

Caryn: I think I've messed things up here. I've been so worried about my own weight that I've given you the wrong message. Brooke, it's time to start eating normally . To be healthy.

Brooke: Mom, you're jealous. Because I've succeeded. And you just go up and down.

Caryn: Don't be ridiculous!! I've made peace with my weight. I'm always going to have to watch what I eat.

Brooke: Well so do I.

Caryn: You're watching too much. I'm making an appointment with a nutritionist for you. Today. You have to learn to eat better. You don't have to look like Calista Flockhart.

Brooke: Don't make the appointment. I'm not going to go.

Therapist's Comments on Eating Disorders

This is a classic example of a conversation between Mother and daughter who want to connect, yet lack the skills to communicate. The Mother is clearly concerned about her daughter's well being. She is attempting to convey the message that she cares. The daughter, on her part, is expressing her anger, yet at the same time indicating a need for the Mother's approval.

Each is attempting to reach out, yet neither side knows how to connect. The overall experience is one of frustration and distance.

The Mother begins by focusing on the food. Through the food she is expressing her concern for the daughter's well being. The daughter, Brooke, instead hears her Mother's comments as critical and attacks in return. Brooke feels locked in, backed into a corner. She can never get her Mother's approval - she is either too thin or too fat.

Brooke hints at her need for approval/acceptance by asking "Do you think I look good?" The Mother, feeling parental concern and the need to set limits responds, "You look too thin." Brooke, once again, feels criticized and just 'not good enough'.

By the end of the conversation, the Mother has journeyed from being the "Interrogator" to the "Martyr" to the "Authoritarian", who comes down hard. The daughter retreats and resorts to her role of being negative and rejecting.

As the parent of an adolescent with an Eating Disorder, it is important to recognize that food is a symptom, a smoke screen for other issues. Often the teenager is feeling confused, insecure and out of control. Unable to express these concerns directly, she turns to food.

Attempting to change her eating habits directly usually ends up in a power/control struggle. Instead, try strengthening other aspects in the relationship. Let her know that she means more to you than what she does or does not eat. The road to eating disorder recovery is often a long and difficult one and eating disorder treatment is a must. Stay focused on small and positive gains. There is hope for the future.

next: Teenagers with Eating Disorders
~ eating disorders library
~ all articles on eating disorders

Sexual dysfunction associated with the use of serotonin reuptake inhibitors (SRIs) has been reported in 30% to 70% of treated patients and is a significant contributor to discontinuation of these medications. In a multicenter, university-based, double-blind, prospective study that was funded by the manufacturer of , 90 antidepressant-treated men with sexual dysfunction and remitted depression were randomized to receive 6 weeks of treatment with (50 to 100 mg) or placebo (mean age, 45; duration of antidepressant use, 27 months). Sexual dysfunction was defined as erectile problems, delayed ejaculation, or lack of orgasm. Most patients were taking an SSRI.

On standardized rating scales, significantly more Viagra recipients than placebo recipients showed marked improvement in sexual function (55% vs. 4%); however, Viagra had little effect on sexual desire. In both groups, scores on depression scales remained consistent with remission. Other than headache (reported by 40% of Viagra recipients) and flushing (17%), few adverse effects were noted.

Comment: This patient group was highly selected: All participants were healthy, had no medical conditions that could impair sexual function, and had no sexual dysfunction prior to antidepressant treatment. Nevertheless, these results indicate that sexual dysfunction in at least half of these SRI-treated patients improved with Viagra treatment.

SOURCES:

Nurnberg HG et al. Treatment of antidepressant-associated sexual dysfunction with sildenafil: A randomized controlled trial. JAMA 2003 Jan 1; 289:56-64.

next: Herbals For Antidepressant-Induced Sexual Dysfunction

"The way to stop reacting out of our inner children is to release the stored emotional energy from our childhoods by doing the grief work that will heal our wounds. The only effective, long term way to clear our emotional process - to clear the inner channel to Truth which exists in all of us - is to grieve the wounds which we suffered as children. The most important single tool, the tool which is vital to changing behavior patterns and attitudes in this healing transformation, is the grief process. The process of grieving."

From Codependence: The Dance of Wounded Souls

"We are all carrying around repressed pain, terror, shame, and rage energy from our childhoods, whether it was twenty years ago or fifty years ago. We have this grief energy within us even if we came from a relatively healthy family, because this society is emotionally dishonest and dysfunctional."

In order to do the inner child work we need to be willing to do the grief work.

Emotions are energy and that energy needs to be released through crying and raging.

We need to own our feelings about what happened to us.

We need to own our right to be angry that our needs were not met.

Grief is energy that needs to be released. We need to give our self permission to feel our pain, sadness, & rage. We need to own and honor the feelings.

Part of grief work is simply owning the sadness and the anger.

We need to own the grief about what happened to us as children - and then we also need to own the grief over what effect it has had on us as an adult.

"It is when we start understanding the cause and effect relationship between what happened to the child that we were, and the effect it had on the adult we became, that we can Truly start to forgive ourselves. It is only when we start understanding on an emotional level, on a gut level, that we were powerless to do anything any differently than we did that we can Truly start to Love ourselves."

Grieving is a very different experience from being depressed.

While we are grieving we can still appreciate a beautiful sunset or be happy to see a friend or be grateful to be sad.

Depression is being in a dark tunnel where there are no beautiful sunsets.

The deep grieving work is energy work. Once we can get out of our heads and start paying attention to what is happening in our body - then we can start releasing the emotional energy. When we get to a place where the emotions are coming up - when the voice starts breaking - the first thing I have to tell people is to keep breathing. We automatically stop breathing and close our throats when the feelings get close to the surface.

At that point the technique is to locate where the energy is concentrated in the body - it can be any place from head to feet - much of the time it is in our back because that is where we carry stuff we don't want to look at, or in the area of the solar plexus (anger or fear) or heart chakra (pain, broken heart) or chest (sadness) - then the individual breathes directly into that place. Visualizes breathing white light into that part of the body. That starts breaking up the energy and little pieces of energy start getting released. These balls of energy are the sobs. This is a terrifying place to be for the ego because it feels out of control - it is a wonderful place to be from a healing perspective. Empowering the healing is going with the flow - inhale the white Light, exhale the sobs. Sobs, tears, snot from the nose, are all forms of energy being released. You can be in the witness watching yourself and controlling the process at the same time you are in the pain and releasing it.

By controlling the process I am referring to choosing to align self with the energy flow, surrendering to the flow, instead of shutting it down as the terrified ego wants to do. It is very hard to learn this process without a safe place to do it, and someone who knows what they are doing to facilitate it. Once you have learned how to do it then it is possible to facilitate your own grief processing.

The anger work is also an energy flow process. The bat (tennis racket, bataka, pillow, whatever) is lifted over the head as you inhale and then as you hit the pillow you expel the energy - in shout, a grunt, a "fuck you", a scream, whatever words come to you. Inhale, exhale - open your throat to say whatever needs to be said.

Own your voice. Own the child's voice.

It is vitally important for us to own our right to be angry about what happened to us or about the ways we were deprived. If we do not own our right to be angry about what happened in childhood it greatly impairs our ability to set boundaries as an adult.

"We need to own and release the anger and rage at our parents, our teachers or ministers or other authority figures, including the concept of God that was forced on us while we were growing up. We do not necessarily need to vent that anger directly to them but we need to release the energy. We need to let that child inside of us scream, "I hate you, I hate you," while we beat on pillows or some such thing, because that is how a child expresses anger.

That does not mean that we have to buy into the attitude that they are to blame for everything. We are talking about balance between the emotional and mental here again. Blame has to do with attitudes, with buying into the false beliefs - it does not really have anything to do with the process of releasing the emotional energy."

It is terrifying to face healing the emotional wounds. It takes great courage and faith to do the grief work.

The only real way to do it is with a Spiritual Program.

Recovery is not "self-help" - we are not doing this work alone.

Our Spirit is guiding us. The Force is with us.

"There is no quick fix! Understanding the process does not replace going through it! There is no magic pill, there is no magic book, there is no guru or channeled entity that can make it possible to avoid the journey within, the journey through the feelings.

No one outside of Self (True, Spiritual Self) is going to magically heal us.

There is not going to be some alien E.T. landing in a spaceship singing, "Turn on your heart light," who is going to magically heal us all.

The only one who can turn on your heart light is you. The only one who can give your inner children healthy parenting is you. The only healer who can heal you is within you.

Now we all need help along the way. We all need guidance and support. And it is a vitally important part of the healing process to learn to ask for help.

It is also a vital part of the process to learn discernment. To learn to ask for help and guidance from people who are trustworthy, people who will not betray, abandon, shame, and abuse you. That means friends who will not abuse and betray you. That means counselors and therapists who will not judge and shame you and project their issues onto you."

Therapy that fosters dependence and does not include emotional release is not very healing.

"Psychoanalysis addressed these issues only on the intellectual level - not on the emotional healing level. As a result, a person could go to psychoanalysis weekly for twenty years and still be repeating the same behavior patterns."

"Our mental health system not only does not promote healing - it actually blocks the process. The mental health system in this country is designed to get your behavior and emotions under control so that you can fit back into the dysfunctional system.

Drugs that are designed to disconnect you from your feelings block the healing process. Mental health professionals who need to have you see them regularly in order to be financially supported, need to have you be dependent upon them, need to keep you a patient in order to survive."

Learning is remembering.

Teaching is reminding others that they can remember too.

No one outside of you can define for you what your Truth is.

Nothing outside of you can bring you True fulfillment. You can only be fully filled by accessing the transcendent Truth that already exists within.

This Age of Healing and Joy is a time for each individual to access the Truth within. It is not a time for gurus or cults or channeled entities, or anyone else, to tell you who you are.

Outside agencies - other people, channeled entities, this book - can only remind you of what you already know on some level.

Accessing your own Truth is remembering.

It is following your own path.

It is finding your bliss.

next: Inner Child Healing Techniques

Hydrotherapy is supposed to alleviate body tension, muscle soreness and joint stiffness and instill a sense of calm. Here's what the science says.

Before engaging in any complementary medical technique, you should be aware that many of these techniques have not been evaluated in scientific studies. Often, only limited information is available about their safety and effectiveness. Each state and each discipline has its own rules about whether practitioners are required to be professionally licensed. If you plan to visit a practitioner, it is recommended that you choose one who is licensed by a recognized national organization and who abides by the organization's standards. It is always best to speak with your primary health care provider before starting any new therapeutic technique.

• Background
• Theory
• Evidence
• Unproven Uses
• Potential Dangers
• Summary
• Resources

Background

Hydrotherapy (also called balneotherapy) involves the use of water in any form or at any temperature (steam, liquid, ice) for the purpose of healing. Water has been used medicinally for thousands of years by many cultures, including ancient China, Japan, India, Rome, Greece, the Americas and the Middle East. Modern hydrotherapy can be traced to the development of "water cure" spas in 19th century Europe.

Today, a wide variety of water-related therapies are used:

• Immersion in a bath or body of water (for example, the ocean or a pool)
• Placement of wet towels (hot or cold) over the skin
• Douches with watering cans or hoses
• Water birth
• Arm and foot baths
• Rising-temperature hip baths
• Sitz baths (soaking in hot or cold water below the hips)
• Steam baths or saunas
• Rubbings with cold, wet towels
• Spa-, hot tub-, whirlpool- or motion-based hydrotherapy
• Purifying mineral baths with additives such as sea salt or essential oils
• Dead Sea water treatments

Some therapies include the use of water as only one aspect of the technique:

• Nasal irrigation
• Colonic irrigation or enema
• Physical therapy in pools (Physical therapy or exercise in water makes use of the ability to float and resistance of water against motion.)
• Drinking of mineral water or "enriched" water
• Steam inhalation or humidifiers
• Coffee infusions
• Aromatherapy or baths with added essential oils
• Water yoga
• Water massage (including Watsu, a form of bodywork conducted in pools)

Theory

Various theories have been proposed to explain how hydrotherapy works, depending on the specific technique used. Some hydrotherapy practitioners and textbooks suggest that water treatments and wraps may detoxify the blood, stimulate blood circulation, enhance the immune system and improve digestion. Scientific research is limited in these areas.

Some theories are based on the observation that applying warmth to the skin causes vasodilation (expansion of blood vessels), which brings blood to the body's surface. Warmth can also cause muscle relaxation. Cold temperatures have the opposite effect.

Evidence

Scientists have studied hydrotherapy for the following uses:

Low back pain
Several small studies in humans report that regular use of hot whirlpool baths with massaging jets reduces the duration and severity of back pain when used with standard medical care. Additional research is needed to make a strong conclusion.

Anorectal lesions (hemorrhoids, anal fissures)
There is early evidence that sitz baths may help relieve symptoms of anorectal conditions, although research is not definitive. Sitz baths are often available in hospitals.

Skin bacteria
There is not enough research to determine if hydrotherapy reduces bacteria on the skin, or if hydrotherapy offers any benefit.

Knee rehabilitation
Limited research is available. Further study is needed to make a conclusion. td>

Labial edema during pregnancy
Limited research is available. Further studies are needed.

Fibromyalgia
Research results are mixed. Further well-designed trials are needed to make a recommendation.

Heart failure
Study results are mixed in this area. For example, one randomized controlled trial suggests repeated sauna treatment may reduce the risk of arrhythmias. Another randomized trial suggests this therapy may improve heart failure-related symptoms and heart rate response to exercise. However, some studies report no benefits. Further well-designed research is needed before firm conclusions can be drawn.

Arthritis
Hydrotherapy is traditionally used to treat symptoms of rheumatoid arthritis and osteoarthritis. There is evidence that hydrotherapy may reduce pain and increase functional activity. Several studies have been published, but because of design flaws, the benefits remain unclear.

Atopic dermatitis
Research is limited, and no clear conclusions can be drawn.

Burns
Research is limited, and no clear conclusions can be drawn.

Chronic obstructive pulmonary disease (COPD)
It is not clear if deep breathing exercises in heated pools are beneficial in people with COPD. There is evidence that suggests water training may improve overall physical fitness, but additional research is needed to confirm these results.

Chronic venous insufficiency
Hydrotherapy is used in Europe for chronic venous insufficiency, a syndrome that may include leg swelling, varicose veins, leg pain, itching and skin ulcers. A few studies report benefits of leg stimulation with cold water alone, or in combination with warm water. However, this research is only preliminary, and additional study is necessary to make a firm conclusion.

Common cold
Research is limited, and no clear conclusions can be drawn.

Diabetes mellitus
Research is limited, and no clear conclusions can be drawn.

Claudication (painful legs from clogged arteries)
Research is limited, and no clear conclusions can be drawn.

High cholesterol
One randomized controlled trial suggests that repeated sauna therapy may protect against oxidative stress, which leads to the prevention of atherosclerosis. Further research is needed before firm conclusions can be made.

Insomnia
Preliminary study of hydrotherapy for insomnia shows inconclusive results.

Labor, childbirth
There is preliminary research examining whether giving birth in water reduces labor pain, the duration of labor, perineal damage to the mother and birth complications. However, this research is not reliable enough to form clear conclusions about safety or benefits.

Pain
Hydrotherapy has been studied for various types of pain, with inconclusive results.

Pelvic inflammatory disease
Research is limited, and no clear conclusions can be drawn.

Pressure ulcers, wound care
Research is limited, and no clear conclusions can be drawn.

Psoriasis
Evidence regarding hydrotherapy for psoriasis is varied. There is not enough research available to make a recommendation.

Spinal muscular atrophy
There is not enough research available to make a recommendation.

Varicose veins
There is not enough research available to make a recommendation.

Bone density in menopause
There is preliminary evidence suggesting that aquatic exercises, like other forms of weight-bearing exercises, may help increase bone mass.

Unproven Uses

Hydrotherapy has been suggested for many uses, based on tradition or on scientific theories. However, these uses have not been thoroughly studied in humans, and there is limited scientific evidence about safety or effectiveness. Some of these suggested uses are for conditions that are potentially life-threatening. Consult with a health care provider before using hydrotherapy for any use.

Potential Dangers

The safety of some hydrotherapy techniques is not well studied.

Sudden or prolonged exposure to extreme temperatures in baths, wraps, saunas or other types of hydrotherapy should be avoided, particularly by patients with heart disease or lung disease or by pregnant women. Warm temperatures can lead to dehydration or low blood sodium levels, and hydration and electrolyte intake should be maintained. Cold temperatures may worsen symptoms in people with circulatory disorders, such as acrocyanosis, chilblains, erythrocyanosis or Raynaud's disease.

Water temperature should be carefully monitored, particularly for patients with temperature-sensitivity disorders, such as neuropathy. People with implanted medical devices such as pacemakers, defibrillators or liver infusion pumps should avoid high temperatures or therapies that involve electrical currents.

Contact with contaminants or additives in water (such as essential oils or chlorine) can irritate the skin. Skin infections may occur if water is not sanitary, particularly in patients with open wounds. There are several reported cases of dermatitis and bacterial skin infections after hot tub or whirlpool use.

People with fractures, blood clots, bleeding disorders, severe osteoporosis or open wounds and pregnant women should avoid vigorous therapy with water jets in. Although water births are popular, safety is not well studied. The effects of prolonged labor in hot or cold water are not known.

Hydrotherapy should not delay the time it takes to see a health care provider for diagnosis or treatment with more proven techniques or therapies. And hydrotherapy should not be used as the sole approach to illness. Consult with your primary health care provider before starting hydrotherapy.

Summary

There are many hydrotherapy techniques used for a wide variety of health conditions. Early evidence suggests that regular use of hot whirlpool baths with massaging jets improves the duration and severity of low back pain. Additional research is necessary to make a strong recommendation. There is no conclusive evidence for any other condition.

Prolonged treatments, particularly in extreme temperatures, should be avoided. Skin irritation or bacterial infections may result from additives or contaminants in the water. People with fractures, blood clots, bleeding disorders, severe osteoporosis or open wounds and pregnant women should avoid vigorous therapy with water jets. Although water births are popular, safety has not been well studied. Hydrotherapy should not be used as the sole approach to any illness. Consult with your primary health care provider before starting hydrotherapy.

The information in this monograph was prepared by the professional staff at Natural Standard, based on thorough systematic review of scientific evidence. The material was reviewed by the Faculty of the Harvard Medical School with final editing approved by Natural Standard.

Resources

1. Natural Standard: An organization that produces scientifically based reviews of complementary and alternative medicine (CAM) topics
2. National Center for Complementary and Alternative Medicine (NCCAM): A division of the U.S. Department of Health & Human Services dedicated to research

Selected Scientific Studies: Hydrotherapy, Balneotherapy

Natural Standard reviewed more than 920 articles to prepare the professional monograph from which this version was created.

Some of the more recent studies are listed below:

1. Aird IA, Luckas MJ, Buckett WM, et al. Effects of intrapartum hydrotherapy on labour related parameters. Aust N Z J Obstet Gynaecol 1997;May, 37(2):137-142.
2. Aksamit TR. Hot tub lung: infection, inflammation, or both? Semin Respir Infect 2003;Mar, 18(1):33-39.
3. Altan L, Bingol U, Aykac M, et al. Investigation of the effects of pool-based exercise on fibromyalgia syndrome. Rheumatol Int 2003;Sep 24.
4. Ay A, Yurtkuran M. Influence of aquatic and weight-bearing exercises on quantitative ultrasound variables in postmenopausal women. Am J Phys Med Rehabil 2005;84(1):52-61.
5. Barsevick A, Llewellyn J. A comparison of the anxiety-reducing potential of two techniques of bathing. Nurs Res 1982;Jan-Feb, 31(1):22-27.
6. Beamon S, Falkenbach A, Jobst K. Hydrotherapy for asthma. Cochrane Database Syst Rev 2001;(2):CD001741.
7. Benfield RD. Hydrotherapy in labor. J Nurs Scholarsh 2002;34(4):347-352.
8. Blazickova S, Rovensky J, Koska J, et al. Effect of hyperthermic water bath on parameters of cellular immunity. Int J Clin Pharmacol Res 200;20(1-2):41-46.
9. Bodner K, Bodner-Adler B, Wierrani F, et al. Effects of water birth on maternal and neonatal outcomes. Wien Klin Wochenschr 2002;Jun 14, 114(10-11):391-395.
10. Brucker MC. Management of the third stage of labor: an evidence-based approach. J Midwifery Womens Health 2001;Nov-Dec, 46(6):381-392.
11. Buman G, Uyanik M, Yilmaz I, et al. Hydrotherapy for Rett syndrome. J Rehabil Med 2003;Jan, 35(1):44-45.
12. Buskila D, Abu-Shakra M, Neumann L, et al. Balneotherapy for fibromyalgia at the Dead Sea. Rheumot Intl 2001;Apr, 20(3):105-108.
13. Burke DT, Ho CH, Saucier MA, et al. Effects of hydrotherapy on pressure ulcer healing. Am J Phys Med Rehabil 1998;Sep-Oct, 77(5):394-398.
14. Capoduro R. Does balneology still have gynecologic indications? Rev Fr Gynecol Obstet 1995;Apr-May, 90(4):236-239.
15. Cider A, Schaufelberger M, Sunnerhagen KS, et al. Hydrotherapy: a new approach to improve function in the older patient with chronic heart failure. Eur J Heart Fail 2003;Aug, 5(4):527-535.
16. Coccheri S, Nappi G, Valenti M, et al. Changes in the use of health resources by patients with chronic phlebopathies after thermal hydrotherapy: report from the Naiade project, a nation-wide survey on thermal therapies in Italy. Int Angiol 2002;Jun, 21(2):196-200.
17. Constant F, Collin JF, Guillemin F, et al. Effectiveness of spa therapy in chronic low back pain: a randomized clinical trial. J Rheumatol 1995;22(7):1315-1320.
18. Constant F, Guillemin F, Collin JF, et al. Use of spa therapy to improve the quality of life of chronic low back pain patients. Med Care 1998;36(9):1309-1314.
19. Crevenna R, Schneider B, Mittermaier C, et al. Implementation of the Vienna hydrotherapy group for laryngectomees: a pilot study. Support Care Cancer 2003;Nov, 11(11):735-738. Epub 2003;Sep 13.
20. Cunha MC, Oliveira AS, Labronici RH, et al. Spinal muscular atrophy type II(intermediary) and III(Kugelberg-Welander): evolution of 50 patients with physiotherapy and hydrotherapy in a swimming pool. Arq Neuropsiquiatr 1996;Sep, 54(3):402-406.
21. DiPasquale LR, Lynett K. The use of water immersion for treatment of massive labial edema during pregnancy. MCN Am J Matern Child Nurs 2003;Jul-Aug, 28(4):242-245.
22. Eckert K, Turnbull D, MacLennan A. Immersion in water in the first stage of labor: a randomized controlled trial. Birth 2001;28(2):84-93.
23. Ekmekcioglu C, Strauss-Blasche G, Holzer F, et al. Effect of sulfur baths on antioxidative defense systems, peroxide concentrations and lipid levels in patients with degenerative osteoarthritis. Forsch Komplementarmed Klass Naturheilkd 2002;Aug, (4):216-220.
24. Elkayam O, Wigler I, Tishler M, et al. Effect of spa therapy in Tiberias on patients with rheumatoid arthritis and osteoarthritis. J Rheumatol 1991;Dec, 18(12):1799-1803.
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33. Gotz HM, Tegnell A, De Jong B, et al. A whirlpool associated outbreak of Pontiac fever at a hotel in Northern Sweden. Epidemiol Infect 2001;Apr, 126(2):241-247.
34. Green JJ. Localized whirlpool folliculitis in a football player. Cutis 2000;Jun, 65(6):359-362.
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38. Hawkins S. Water vs conventional births: infection rates compared. Nurs Times 1995;Mar 15-21, 91(11):38-40.
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Here's how to determine if the sexual dysfunction is from the antidepressant medication rather than from depression.

Sexual dysfunction happens too often but is rarely asked or discussed in the doctor's office. Some physicians and patients feel embarrassed about this subject. When you have concerns, be open to your physician. Discuss the possibility of switching medication to an antidepressant (such as bupropion or mirtazapine) that doesn't significantly impair sexual functioning. Also, talk to your doctor about adding another drug such as bupropion, yohimbine, or even mirtazapine to counteract the sexual side effect. ..

How do you know if the sexual dysfunction is from the pill rather than from depression? If the dysfunction persists despite successful remission of depression, then you should consider other causes such as drug-induced dysfunction or other medical causes e.g. diabetes.

Sexual side effects include decreased sexual desire (libido), erectile dysfunction, delayed ejaculation and diminished orgasm. These effects can last throughout treatment. Selective serotonin reuptake inhibitors (SSRIs) are more likely than other antidepressants to cause sexual side effects, particularly delayed orgasm or inability to achieve orgasm (anorgasmia). Tricyclic antidepressants (TCAs) are more likely to cause erectile dysfunction.

Did you know...

More people experience sexual dysfunction (SD) resulting from antidepressant use than previously thought, according to research presented at the May 2001 American Psychiatric Association annual meeting. The researchers questioned nearly 6300 patients at 1101 United States clinics concerning their use of eight newer antidepressants.

The antidepressants studied were:

• buproprion SR (Wellbutrin)
• citalopram (Celexa)
• fluoxetine (Prozac)
• mitrazapine (Remeron)
• nefazodone (Serzone - no longer available)
• paroxetine (Paxil)
• sertraline (Zoloft)
• venlafaxine (Effexor)

Study participants were 18 years old and older, sexually active during the past year, and willing to discuss sexual functioning. Researchers Dr. Anita H. Clayton and Dr. James Pradko note that of all patients asked to participate in the study, 70 percent were willing to do so. Clayton points out that this shows a willingness by patients to discuss sexual functioning with their health providers, if asked. Participants filled out a questionnaire designed by Clayton.

The results of the study showed that nearly 40 percent of people taking these antidepressants experience sexual dysfunction. This number is twice what the researchers had predicted prior to the study. Of the eight antidepressants, , Wellbutrin and Serzone were less likely to cause sexual side effects than Prozac, Paxil, Zoloft and Effexor. Additionally, Wellbutrin was also less likely to cause sexual dysfunction than Celexa and Remeron. Prozac was less likely than Paxil to cause sexual dysfunction. These differences were reported as "statistically significant" by the researchers. According to Clayton, the reason for fewer sexual side effects with Wellbutrin and Serzone is most likely the result of these drugs affecting different receptors in the brain than the other antidepressants.

The researchers also found a number of risk factors which may increase the chance of sexual dysfunction resulting from antidepressant use. The following factors may increase a person's chance of having sexual side effects on these antidepressants:

• increased age
• higher dosage
• being married
• lower education level (less than college)
• lack of full-time employment
• comorbid illness also associated with sexual dysfunction
• other medications
• low interest in sexual functioning
• smoking 6 to 20 cigarettes daily
• history of sexual dysfunction with antidepressants

If you are experiencing sexual dysfunction and are taking an antidepressant, talk with your doctor. Be sure to have a physical in order to rule out other causes. If it is your antidepressant, discuss options with your doctor. If your doctor is not receptive to such discussion, consider seeking another opinion. As seen from this study, Wellbutrin and Serzone cause far fewer side effects than the other antidepressants. These and other antidepressants, as well as various combinations, offer numerous options for people experiencing sexual dysfunction. Also, Viagra currently is being used to treat this side effect.

Coping strategies from the Mayo Clinic

• Talk to your doctor about finding a dose that minimizes sexual side effects but still works for you.
• Consider a drug that requires only a once-a-day dose, and schedule sexual activity before taking that dose.
• Talk to your doctor about adding or switching to an antidepressant that may counteract these effects, such as bupropion (Wellbutrin, Wellbutrin SR, Wellbutrin XL) or mirtazapine (Remeron, Remeron Soltab).
• Talk to your doctor about taking a medication intended to directly treat sexual dysfunction like Cialis, Levitra, or Viagra.
• Talk to your doctor about a "drug holiday" — stopping the medication for a day or so each week.

next: Guidelines for Treatment Antidepressant Induced Sexual Dysfunction

Sharon is 27 years old. She doesn't plan to be 28. She is lonely, and hurting and desperate. She's decided as a final attempt to seek counseling; however, the few counselors covered by her insurance company all have waiting lists. She also understands that her sessions might be limited to as few as three sessions. The soonest she can be seen is three weeks from now. She isn't sure how she will make it through the day. She contacted a crisis line only to find that the line had been disconnected.

Robert is 34. He is divorced with 3 children to support. After child support is taken from his check, and rent and other essential living expenses are paid for, he only has $21.00 a week left over. Therapy would cost him a minimum of $50.00 per session. He has a $200.00 deductible, and once this is met he will still be responsible for $25.00 a visit. Robert's anxiety is growing by leaps and bounds. He hardly sleeps, has lost his appetite, and has begun experiencing sharp pains in his chest. Twice last week, he has had to leave work early because he thought he was having a heart attack. His doctor informed him that he was experiencing panic attacks and suggested counseling. He has no idea how he can afford it, however he feels as though he's running out of time faster than he's running out of money.

Both of these individuals are feeling out of control. Both seek counseling, yet it is unlikely that the traditional once per week therapy session offered indefinitely will be available to them. While this is unfortunately the reality, there are other realities as well: (1) they need help soon; (2) they are not alone; there are many Americans in similar positions; and (3) we who live in this "kinder, more gentle nation" have some responsibility ("the ability to respond") to offer assistance.

The days of close knit families and communities that provided ready-made support for just about every American are over for many of us. Instead, the average adult today must often find his or her own way, constructing a safety net piece by piece. Children are often required to fend for themselves as their parents frantically struggle to keep the family intact, the bills paid, and maintain the necessities. In this mobile and fast-moving society where we have grown dependent upon grocery stores, electric companies, etc., we are required to develop a new kind of self-reliance these days. Often we must deal with the complexities of parenting, relationships and life crisis's without the loving concern of family, mentors, and old friends nearby. More and more, individuals who used to turn to built-in support systems now seek the assistance of a stranger, a trained therapist during difficult times. It sadly seems that while a growing number of people are more amenable to utilizing such services; many individuals who are in need of psychotherapy cannot afford it. Those who are in a position to seek therapy all too often do so with the expectation that the therapist will somehow administer a cure while the recipient remains relatively passive. For some it's as if the therapist need only to hear their prayer in order for the answers to be provided. Others are prepared to work hard within the comfort of the therapist's office and then resume their normal activities once the session is concluded. Few recognize that healing requires as much and often more effort outside of the therapist's domain. Most who utilize the services of a psychotherapist are being forced to recognize the limits of psychotherapy, as (ready or not) the number of sessions available to those who rely on insurance to subsidize the cost are often dramatically reduced.

It is commonly believed that therapy occurs once per week. This is not necessarily so, and for some it is not even financially possible. Therapy can provide significant benefits without the old constraints of a 50-minute weekly session, particularly when utilized in conjunction with other resources. If the needs of individuals such as Sharon and Robert are to be responded to whole heartedly: (1) we, as therapists, must offer alternatives to the traditional psychotherapy format; (2) Robert and Sharon must assume more responsibility than traditional psychotherapy clients have in the past; and (3) a growing awareness must evolve within our society regarding the necessity of mutual support while assuming ("taking upon oneself") more fully that which is required of us to become more accountable ("liable to be called to account") for our own health and well-being.

As usual, times are changing. One of the changes that will be occurring more frequently due to the crisis in health care costs is the alterations in medical benefits increasingly overseen by managed care companies. In my own little corner of the Universe, this is most dramatically represented by the wide spread adoption of Brief Treatment methods. While the transition has created a number of challenges, like all transformations that are spawned by crisis, this shift also offers opportunities. We are clearly not the only ones suffering the aches and pains brought on by the transformation of the health care system. Our clients are sustaining tremendous losses as well, and they should not be ignored. I have tried to minimize my clients' losses while ignoring the losses of the population at large for the most part. I busily redesigned my practice to some extent and repaired my lifeboat, so to speak, in order to survive the incoming tide of managed care. The truth of the matter is that my practice has grown as a result of my successful attempts to figure out the politics and win the favor of managed care companies. They really like me, and I am grateful. Perhaps too grateful! I have heard of the frustration of clients who were working with someone they cared about and trusted only to be informed that the therapist was not covered by their new and "improved" insurance policy. I have witnessed the anguish of a severely depressed woman who's therapist informed her that weekly sessions would need to be reduced to monthly in order to ensure that her sessions would be covered by her insurance. I am aware of the many in need of services being placed on lengthy waiting lists. I have tried for the most part to not think about them too much. My own little lifeboat is solid and sea worthy, and I have places to go, people to see. I have tried, until now, to direct my energy elsewhere. Now I am forcing myself to look and see. During this health care crisis, we, as providers, are all preoccupied with saving our own practices and that is understandable; however, the dust has begun to settle, and it is time that we examine how we can individually and cooperatively create the most beneficial environment to our clients. The good old days may be over but the new ones hold great promise as well if we actively commit to exploring the possibilities.

BRIEF TREATMENT

Brief Treatment from my view refers to therapy which is conducted in as time-effective manner as possible ranging from 1 to 20 sessions. The rapid rise of managed care not only makes utilization of brief treatment methods desirable, but necessary. As more and more providers of health care find their referrals increasingly limited by managed care companies, we are responding by attempting to adapt and adjust to the requirements of managed care.

"The Provider," a newsletter distributed to providers by MCC Behavioral Care, recently published "Eight Characteristics of Therapy under Managed Care," based on the work of Michael Hoyt and Carol Austad. The eight characteristics established by Hoyt and Austad were: (1) Specific problem solving; (2) Rapid response and early intervention; (3) Clear definition of patient and therapist responsibilities; (4) Time is used flexibly and creatively; (5) Interdisciplinary cooperation; (6) Multiple formats and modalities; (7) Intermittent treatment; and (8) A results orientation.

Clearly, such therapy is not always compatible with the traditional, open-ended psychotherapy that has so often been the treatment of choice. However, considering that the utilization of brief treatment methods is rapidly becoming a requirement of managed care, therapists are attempting in increasing numbers to respond to the demands this expanding trend involves. We make these adjustments for the most part in order to continue to serve our clients to the best of our abilities while also maintaining reimbursability by insurance companies. From my perspective, this is in some respects a time of reckoning (if we are able to put aside our indignation long enough to acknowledge the purpose of medical insurance in the first place)

Medical insurance was developed to assist subscribers in seeking treatment for illness, not subsidize explorations intended to facilitate growth or cover marital counseling. For a number of years that is exactly what insurance companies have found themselves doing all too often. Wide spread abuses of the system have contributed significantly to our current dilemma of our work policed by managed care.

Therapists being forced in some ways to develop skills in brief treatment can be viewed as a positive trend. Clients have a right to expect services to be performed in a time-effective and cost-effective manner just as do insurance companies. However, if we simply scramble to incorporate the slickest brief treatment methods available in order to get the job done as expediently as possible, we run the risk of offering, in many cases, little more than a quick and all too often temporary fix.

Holistic Treatment

Brief treatment expects much (as it should) from both the therapist and the client, and it is here that I believe holistic treatment emerges as a compatible ally. In addressing holistic treatment as it relates to psychotherapy, I would like to first examine how the advent of holistic treatment creates a shift in roles and relationships. Traditional healthcare (the allopathic approach) places responsibility for cure in the hands primarily of the caregiver. The holistic approach returns it to its rightful owner, the client. While the caregiver clearly must take an active role in the resolution of the problem presented, clients are not expected to passively accept the ministrations of the provider, but must themselves work diligently to restore well being. The central concept of the holistic approach, according to Richard Miles, (1978), is that the individual is responsible for the development and maintenance of his or her health and well being.

Miles contends that the holistic approach does not focus on problems or symptoms but rather on clarity of intention and the development and maintenance of well being and self-responsibility. In this context, problems may be viewed as important feedback messages to be dealt with on a conscious level as part of the life process. A basic definition according to Miles, of the holistic practitioner, is one who provides the client with clear information about the processes of body, mind and spirit. The client can then choose to follow with the provider's assistance, a course of action that will offer more productive and healthy life experiences. In choosing a particular course of action, the client assumes ownership and thus places responsibility where it must reside--within the individual.

In accepting the holistic model, one acknowledges that everything effects our health and well being. All aspects of ourselves including, physical, emotional, cognitive, spiritual and environmental, play a role in the quality of our lives. This first premise is easily accepted; however, when one moves on to its implication that we must attend to all of these elements, the challenge is then presented. Placing our lives in the hands of experts to render solutions can seem far less daunting then the work involved in prevention and self-care. For example, it seems simpler to follow the latest fad diet to the letter than to address the wide range of issues connected to unwanted weight gain. Further, one is reinforced when the weight fades away with the use of such a diet. All too often, however, satisfaction eventually is followed by disillusionment later, when the pounds return or when some other difficulty moves in to take their place.

Our practices are filled with individuals who ask us in one form or another to take their pain away. We would gladly oblige and often try. We even succeed from time to time. The bottom line, however, as we all know, is that if our efforts are to be sustainable over the long haul, our clients must learn what is required of them to meet their own needs. They must also possess the motivation to act upon this knowledge. In spite of impressive techniques, modalities, and theories, there is no one magic bullet--no one particular insight, behavior, drug, or technique that results in lasting wellness. First of all, the very nature of life prevents this; we are always confronted with change and new challenges. Second, as stated earlier, and in line with systems theorists, we are all made up of parts intermingling with other parts comprising various systems that continually impact and are impacted by our environment. Like the Mobile that John Bradshaw strikes during his presentation aired by PBS on the family, when one of our components shift, the others are also effected and respond. An argument here might be made that if we then simply impact one element of the system, then the others may also automatically benefit. While this is a distinct possibility, it also implies that while we might fix a system or person by adjusting one facet or problem, the entire system remains highly vulnerable to a break down in another part of the system. There is no avoiding this reality that we are all highly vulnerable, and while I welcome information to the contrary, I must operate within the context of this truth for now. Thus, in view of the fact that we are comprised of parts that make up our whole, with each segment being vulnerable to or positively impacted by the others, would it not then make sense to respond to the needs of all components to the best of our abilities?

Holistic treatment calls for the care of all aspects of a client; brief treatment requires that we offer services in as efficient, responsive, and timely manner as possible. Both of these requirements (at a glance) may not seem readily compatible, yet they still remain very clear obligations to me.

next: Guiding Principles

Although I've only been a teacher for eight years, I've already had to deal with a lot of problems in my classroom besides just teaching. By far, the worst experience I ever had to deal with was when one of my students tried to kill herself.

I knew, from other indicators, that Sarah was in trouble emotionally. She seemed sullen most of the time and tended to miss school a lot. Because I wanted to help her, I offered her individual attention and tutoring sessions.

I spoke to the school counselor about Sarah and my concern for her. The counselor suggested trying to help Sarah by showing her I cared and would listen if she needed a friend. I slowly gained Sarah's trust and became closer to her.

To my horror, however, I awoke one night to the sound of someone beating on my door. It was Sarah and she was holding a gun. I asked her what she was doing and she said that she had just tried to kill herself. I was horrified. I immediately called Child and Family Services for help.

Sarah was admitted to a hospital the next morning. I was relieved that she was finally getting the help she needed. Unfortunately, the nightmare didn't end there for Sarah. She had a long road back to recovery. It took several weeks in the hospital and over a year of therapy for her to fully recover from her depression. But, at least she had lived to be treated. The ending could have been much worse.

After my experience with Sarah, I was convinced that I had done something wrong. After a lot of research and talking to our school counselor, I realized I did many things right. I also realized that I could have done some things better.

Here is my list of some of the things a teacher should do if she or he has a severely depressed student:

• Mention to the student that you notice he or she has been feeling down. Offer your support and ask if they need someone to talk to.

• Know what your district policy and the law requires you to do. In every state, there is a law requiring that teachers report students who are in danger of hurting themselves. Your district probably has a set policy for the proper way to do this.

• Tell the school counselor about the student regardless of whether you approach the student to help or not. The counselor will know of help groups, facilities, etc. to help the student.

• Don't become the only person dealing with the student's problem. Make sure the counselor and administration knows of the student's situation.

• Don't lie to the student. Do not make promises about confidentiality that you cannot keep. Be up front with the student about your role and responsibilities.

• Work with the parents. Even if the parents are a part of the problem, the teacher needs to work with them, if possible.

• Don't discount ANY reference to suicide - even if it sounds joking. Often joking about suicide is a way for the student to express himself/herself less vulnerably.

• If a student seems to snap out of a depression be especially cautious. Often the student is suddenly happy because he/she has decided to commit suicide. This brings a sense of peace because the student feels as if an answer has been found.

• Finally, explore options for help. You need to have emotional and legal security when dealing with a suicidal student. Find a way to help the student without putting yourself in a vulnerable situation.

Contributed By Joyce Carnes, Indiana University - Center for Adolescent Studies

next: Talking With Your School-Age Child About Depression
~ depression library articles
~ all articles on depression

Glutamine is promoted as brain food and an alternative treatment for depression, but does glutamine work in treating depression? Find out.

What is Glutamine?

Glutamine is an amino acid, one of the building blocks of protein. We get glutamine by eating protein-rich foods like meat, fish, eggs, dairy products and beans.

How does Glutamine work?

Glutamine is used by the body to make the neurotransmitter (chemical messenger) glutamate. Glutamine is promoted in health food shops as a type of "brain food" which gives more energy and better mood. There is some scientific evidence that the processing of glutamine into glutamate may be affected in depression.

Is Glutamine effective for depression?

Glutamine has been used in the treatment of depression, but there are no studies examining whether it is any more effective than placebos (dummy pills).

Are there any disadvantages to Glutamine?

No major ones known.

Where do you get it?

Glutamine is available as a dietary supplement from health food shops.

Recommendation

There is presently no good evidence that glutamine is an effective treatment for depression.

Key references

Cocchi R. Antidepressive properties of l-glutamine: preliminary report. Acta Psychiatrica Belgium 1976; 76: 658-666.

back to: Alternative Treatments for Depression

how to have good sex

BY LANA L HOLSTEIN, MD, Author of: How to Have Magnificent Sex: The 7 Dimensions of a Vital Sexual Connection

1. Bring your sensual, sexual self back into your own "good graces." If you have become discouraged or dejected about your sense of sexual energy, now is the time to consciously resurrect and attend to a positive sexual sense of self. Plan a campaign to validate the sensual in your life by noticing colors, flowers, clothing, and textures that are erotic. You may wish to share these observations with your partner or you could keep your own diary to help remind you that pleasurable, erotic sensations are always available if we just take the time to notice them. As you get ready for bed, review your day and enumerate in your mind the encounters that you have had with the erotic.

2. Make sure you have connected with your own sexual essence. If you are female, have some corner of your day that is devoted to your ideal sense of the feminine. Perhaps that is a bath, perhaps it is a dance in your living room to a favorite song, or perhaps it is totally letting go into a warm hug from your lover. For that moment do not emphasize or even think about the masculine side of you that "gets everything done." If you are male, do something that connects you with your masculine source of energy. Maybe it is a strenuous session of exercise or weight lifting, maybe it is being incredibly focused on the femininity of your woman, or perhaps it is challenging your personal limits in some area of your life. Come to your masculine self with a sense of power and love.

3. Touch your lover every hour. For an entire weekend, whenever the two of you are together, touch your lover every hour. This means a casual brush as you walk past them, or a deep, long, nourishing hug, or of course making love, or a neck or back rub. Amazingly, we forget to energize each other with touch. Becoming more tactile contributes to great sex.

4. Open your heart to your partner. Every day for one week leave your lover a heartfelt message on his or her side of the bathroom mirror. Tell him or her which qualities open your heart. Let your partner know in words what it is you treasure about them. You may even get some notes back on your side of the mirror!

5. Delight your partner with a wild, sexy story. Make up something outrageous, filled with sensual detail, and give your lover only one chapter every night. Or, better yet, begin the tale and then hand over the story to them the next night to be continued. Make it a game of imaginary seduction that only the two of you are in on.

6. Contribute to the sexual power of another. Choose someone of your same sex to empower by letting them know something that you think is beautiful, alluring, strong or positive about them. You may comment on the glossiness of their hair, the beauty of their skin, the fabulous way they move their body when they are walking or dancing. When you do that to a "sister" or a "brother" in a way that is genuinely supportive, they will feel better about themselves and take some of that good feeling home to their sexual mate. You will also enlarge the positive approach to sexuality in the world.

7. Learn about sexuality. Consider sex a worthy subject for study, and begin to look at writings and art from traditions that honored sexuality, such as Tantra. Cultures that incorporate a positive view of sexuality often produced beautiful drawings, great rituals, and a sense of sexuality that takes us to our highest expression of love. Be aware that the most magnificent sex occurs when the body and the heart combine with the soul to achieve an ecstatic, powerful connection.

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