How to Do the Work

Dr. Nicole LePera

• Publisher: Harper
• Year: 2021
• ISBN:
  9780063012103
• Topic: Psicología
• Subtopic: Relaciones interpersonales en psicología

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From Dr. Nicole LePera, creator of "the holistic psychologist"—the online phenomenon with more than two million Instagram followers—comes a revolutionary approach to healing that harnesses the power of the self to produce lasting change. As a clinical psychologist, Dr. Nicole LePera often found herself frustrated by the limitations of traditional psychotherapy. Wanting more for her patients—and for herself—she began a journey to develop a united philosophy of mental, physical and spiritual wellness that equips people with the interdisciplinary tools necessary to heal themselves. After experiencing the life-changing results herself, she began to share what she'd learned with others—and soon "The Holistic Psychologist" was born.

Now, Dr. LePera is ready to share her much-requested protocol with the world. In How to Do the Work, she offers both a manifesto for SelfHealing as well as an essential guide to creating a more vibrant, authentic, and joyful life. Drawing on the latest research from a diversity of scientific fields and healing modalities, Dr. LePera helps us recognize how adverse experiences and trauma in childhood live with us, resulting in whole body dysfunction—activating harmful stress responses that keep us stuck engaging in patterns of codependency, emotional immaturity, and trauma bonds. Unless addressed, these self-sabotaging behaviors can quickly become cyclical, leaving people feeling unhappy, unfulfilled, and unwell.

In How to Do the Work, Dr. LePera offers readers the support and tools that will allow them to break free from destructive behaviors to reclaim and recreate their lives. Nothing short of a paradigm shift, this is a celebration of empowerment that will forever change the way we approach mental wellness and self-care.

1

You Are Your Own Best Healer

This scenario will likely feel familiar: You decide that today is the day that you’ll change your life. You’ll start going to the gym, eat less processed food, take a break from social media, cut ties with a problematic ex. You’re determined that this time these changes will stick. Later—maybe it’s a few hours, maybe a few days or even weeks—mental resistance enters. You start to feel physically unable to avoid sugary soda. You can’t muster up the energy to go to the gym, and you feel compelled to send a certain ex a quick text message to check in. The mind starts to scream at you with convincing stories to keep you in your familiar life with pleas like, “You deserve a break.” The body joins the mind with feelings of exhaustion and heaviness. The overwhelming message becomes: “You can’t do this.”

Over my decade of work as a researcher and clinical psychologist, “stuck” was the word most commonly used by my clients to describe the way they felt. Every client came to therapy because they wanted to change. Some wanted to change things about themselves by creating habits, learning new behaviors, or finding ways to stop disliking themselves. Others wanted to shift things outside themselves, like changing a problematic dynamic with a parent-figure or a spouse or a colleague. Many wanted (and needed) to make both internal and external changes. I’ve treated wealthy people and people living in poverty; hyperfunctional, high-powered types; and those who have been incarcerated and shunned by traditional society. Unanimously, no matter their backgrounds, every client felt stuck—stuck in bad habits, damaging behaviors, predictable and problematic patterns—and it made them feel lonely, isolated, and hopeless. Almost all of them worried about how this “stuckness” was perceived by others and often obsessed about the many ways everyone in their lives perceived them. Most shared a deep-rooted belief that their consistent inability to sustain change reflected evidence of deeper, intrinsic damage or “unworthiness”—a description used by many.

Often my clients who were more self-aware could identify their problematic behaviors and could even visualize a clear path to change. But few were able to take that first step from knowing to doing. The ones who could see a way out expressed feelings of shame about their instinctual falling back into patterns of unwanted behavior. They felt ashamed that they knew better and still could not do better, which was why they had ended up in my office.

Even my help and support were often of limited value. Fifty minutes of therapy per week did not seem sufficient to effect meaningful change for a majority of my clients. Some became so frustrated by this unfulfilling merry-go-round that they stopped seeking therapy altogether. Although many others benefited from our time together, the improvements were painfully slow to come. A session would seem highly productive, and then the same client would return the next week with stories that reflected the same predictable set of problems. Many clients expressed incredible insight in therapy, piecing together all the patterns that held them back, and would then feel unable to resist the instinctual pull toward the familiar in real life (outside of my therapy office). They could look backward and see the issues, yet they hadn’t built the capacity to apply that insight in real time to their present life. I observed similar patterns with people who went through deeply transformative experiences—those who attended intensive retreats or mind-altering ayahuasca ceremonies—and then, over time, slid right back into the old, unwanted behaviors that had sent them looking for answers in the first place. Their inability to move forward after experiencing something so seemingly transformative threw many of my clients into crisis: What is wrong with me? Why can’t I change?

What I came to realize is that therapy and singular transformative experiences (like ayahuasca ceremonies) can take us only so far along the path to healing. To truly actualize change, you have to engage in the work of making new choices every day. In order to achieve mental wellness, you must begin by being an active daily participant in your own healing.

The more I looked around, I saw the same frustration, even beyond my practice among my circle of friends. So many of them were taking medication for insomnia, depression, and anxiety. Some hadn’t officially been diagnosed with any type of mood disorder, yet they were channeling a lot of the same symptoms into seemingly acceptable expressions, such as hyperachievement, constant traveling, and obsessive social media engagement. These people were the ones who got straight A’s, who finished their assignments weeks before they were due, who ran marathons, who landed high-stress jobs and excelled in pressure cooker environments. In many ways, I was one of these people.

I knew firsthand the limits of the traditional model of mental health care. I started therapy in my twenties, when I was plagued by near-constant panic attacks while dealing with my mother’s serious heart condition. Antianxiety medication helped me through, but I still felt listless, detached, tired—older than my years. I was a psychologist, someone who was supposed to help others understand their inner world, yet I continued to be a stranger to, and unable to truly help, even myself.

MY PATH

I was born into a typical middle-class family in Philadelphia. My dad had a stable nine-to-five job, and my mom kept the home. We ate breakfast at 7:00 a.m. every morning and dinner at 5:30 p.m. every evening. The family motto was “Family is everything,” and by all outside estimations that motto rang true. We were the picture of middle-class normalcy and happiness—an all-American projection that clouded the reality.

In fact, we were a sick family. My sister suffered from life-threateningly serious health issues as a child, and my mother struggled with her own phantom pains that confined her to bed for days. Though my family never talked openly about my mother’s illness, I was aware. I knew that my mom was suffering. I knew that she was sick. I knew that she was not present because she was in pain. I knew that she was distracted and chronically anxious. Amid all the stress, my emotional world could understandably be forgotten.

I was the third and last child—a “happy accident,” they’d say. My siblings are significantly older than I (my brother could vote by the time I came around), and they never really shared my experiences. As many of you know, even if you live in the same home, you never truly live the same childhood. My parents joked that I was their “Christ child.” I slept well, hardly caused issues, and more or less kept out of trouble. I was an active kid who was filled with lots of energy and was always on the go. I learned very early on to ease any burden of my existence by being as near to perfect as possible in all of the ways I knew I had excelled.

My mother was not particularly expressive with her emotions. We were not really a “touchy” family and physical touch was minimal. To my memory, “I love yous” in childhood were very inconsistent. In fact, the first time I really remember hearing those words expressed openly was when my mother was undergoing heart surgery when I was in my early twenties. Don’t get me wrong, I did have an inner knowing that my parents loved me very much. I would learn later that my mom’s parents had been cold and detached in their own displays of love and affection. My mom, a wounded child herself, had never been shown the love she craved deeply. As a result, she was unable to express love to her own children, whom she did love deeply.

Overall, the family lived in a general state of emotional avoidance where anything unpleasant was merely ignored. When I started acting out (briefly dropping the Christ child pose), partying before I’d even officially become a teenager and stumbling home with red eyes and slurring my words, no one said a word to me about my behavior. This avoidance would carry on until someone’s repressed emotions would bubble up, overwhelm them, and explode. That happened once when my mom read a personal note of mine, discovered evidence of my drinking, and became hysterical—throwing things, crying, and shrieking “You’re going to kill me! I’m going to have a heart attack and drop dead right this moment!”

Growing up, I often felt different from others I met and, for as long as I can remember, I was drawn to understand what made people behave as they did. Not surprisingly, eventually I found myself wanting to be a psychologist. It’s not only that I wanted to help people; I wanted to understand them. I wanted to point to research and be able to say “See! This is why you are the way you are! This is why I am the way I am!” That interest led me to Cornell University, where I studied psychology, and then to a PhD program in clinical psychology at the New School for Social Research in New York. Because of the “scientist practitioner model” the program followed, I was required to both do research and provide therapy. I was a sponge, eagerly soaking up all the information I possibly could about various approaches to therapy, knowing I wanted to practice in a way that would truly help others to understand themselves and to heal.

There I learned cognitive behavioral therapy (CBT), a standardized approach to therapy that is highly prescribed and goal oriented. During CBT sessions, clients often focus on one issue, maybe depression, anxiety in crowds, or marriage troubles. The objective of this practice is to help a patient identify the flawed thought patterns that underlie their behavior—a process that can help some find relief from consistent problematic feelings.

The CBT model is based on the premise that our thoughts affect our emotions and ultimately our behaviors. When we change our relationship with our thoughts, we change the cascade of emotions that floods our bodies and persuades us to act in certain ways, which is a cornerstone of the work in this book. CBT is often referred to as the “gold standard” in psychotherapy because its highly replicable, or repeatable, structure and format makes it great for lab study. While studying it taught me a valuable lesson about the power of our thoughts, it can be a bit rigid when applied in the real world. Eventually, in my practice with clients, it sometimes felt constraining and not really tailored to the unique individual in front of me.

During my graduate studies, I was particularly drawn to interpersonal therapy, a far more open-ended therapeutic model that uses the bond between client and practitioner as a catalyst for improving other relationships in the client’s life. Most of us have problematic relationship dynamics in some part of our life—whether with family, partners, friends, or colleagues—so being able to engage in a new, healthier dynamic with a therapist can be profoundly healing. How we show up in our relationships is really emblematic of our general wellness, and often indicates how we show up in life, a theme we’ll explore throughout this book. In the Holistic Psychology framework, we incorporate the understanding that our relationships are modeled on our earliest bonds with our parent-figures, an act of behavior modeling called conditioning, which we will learn more about in chapter 2.

Over the course of my training, I studied psychodynamic approaches, theories of the mind that suggest that people are driven by forces inside them. I studied these models—ones usually associated with the cliché of the couch and the pipe-smoking analyst—at both the New York Psychoanalytic Society & Institute and the Philadelphia School of Psychoanalysis. There I learned about the pull of the subconscious, the deeply embedded part of our psyche that holds our memories and is the source of our drives, or automatic instincts or motivations. As I started practicing therapy, the insight I gained into the role of our subconscious was profound. I kept noticing that all of my clients would realize the aspects of their lives they needed to change—using substances as distractions, flying into anger in romantic relationships, reverting to childlike behaviors in familial relationships—yet every time, they’d return to therapy with a story that reflected the same repeated subconscious cycle. I saw it in myself, too. That realization was instrumental in the creation and evolution of the philosophy of Holistic Psychology.

While I learned these new modalities, I started to research and work in the substance use recovery field. I ran outpatient and inpatient substance treatment groups and facilitated a program to help those with substance abuse issues develop the interpersonal skills to support their recovery processes. This helped me gain perspective into the actual lived experiences of those who struggle to control their substance use. Eventually these experiences led me to the conclusion that addiction isn’t limited to specific substances and experiences such as alcohol, drugs, gambling, and sex; cycles of human emotions can be addicting too. Emotional addiction is particularly powerful when we habitually seek or avoid certain emotional states as a way to cope with trauma. Studying addiction showed me the inextricable link between our bodies and minds, as well as the central role of the nervous system in mental wellness, a topic that we will discuss in detail later in this book.

At various points in my postdoctoral work, I tried to incorporate outside elements into my psychology practice. I felt that mindfulness gave us tremendous opportunities for self-reflection and self-awareness. After conducting and publishing my own research on this topic,¹ I tried to convince my doctoral adviser to let me study the practice of meditation and its effect on addictive behaviors for my dissertation project. I was denied. He didn’t believe that mindfulness had therapeutic value; he saw it as a fad, not something worthy of study.

Looking back now, I can see that a path was unfolding before me. My inner guide was showing me all that I needed to create a holistic model of healing. I opened my own private practice where I incorporated many aspects of all the modalities that I had studied. Though I was offering an integrative approach to therapy, several years in, I started to feel frustrated. My clients were gaining some awareness, but the changes were slow. I could feel their confidence leaving them. And simultaneously, I felt my own confidence waning.

I looked around me—really looked, as if for the first time. It’s not an exaggeration to say that every single one of my clients who came to me for psychological treatment also had underlying physical symptoms. Long out of school, I started to ask new questions: Why did so many of my clients suffer from digestive issues, ranging from irritable bowel syndrome (IBS) to constipation? Why were there such high rates of autoimmune diseases? And why did almost all of us feel panicky and unsafe almost all the time?

I can say with certainty that I would not have found my path without the mainstream training I received in school. I brought so much of what I learned in the academic setting into my creation of Holistic Psychology. But the more I discovered on my own about the mind-body-soul connection, the m...