O. CARL SIMONTON

JUNE 29 1942-JUNE 18 2009

 

2. EXCERPTS FROM GETTING WELL AGAIN: O CARL SIMONTON, MD, STEPHAINE SIMONTON AND JAMES CREIGHTON

1. OBITUARY: DR. O. CARL SIMONTON: JUNE 29, 1942-JUNE 18, 2009

2. EXCERPTS FROM GETTING WELL AGAIN: O CARL SIMONTON, MD, STEPHAINE SIMONTON AND JAMES CREIGHTON

3. PAUL DURBIN: SIX SESSION PROTOCOL FOR CANCER: ADAPTED FROM SIMONTON MODEL IN GETTING WELL AGAIN

1. OBITUARY: DR. O. CARL SIMONTON: JUNE 29, 1942-JUNE 18, 2009: VALERIE J. NELSON, LOS ANGELES TIMES: DR. O. CARL SIMONTON / RECOGNIZED THAT POSITIVE ATTITUDE HELPED TO FIGHT CANCER

Dr. O. Carl Simonton, a radiation oncologist who popularized the mind-body connection in fighting cancer and helped push the once-controversial notion into mainstream medicine, has died. He was 66. Dr. Simonton, who founded a cancer care clinic in Pacific Palisades on the west side of Los Angeles in the early 1980s, choked to death June 18 during a meal at his Los Angeles area home in Agoura Hills, said his wife, Karen. Early in his medical career, Dr. Simonton noticed that patients given the same dose of radiation for similar cancers had different outcomes. When he looked into why, he concluded that people who had a more positive attitude generally lived longer and had fewer side effects.

Talking openly about cancer was groundbreaking in the 1970s, as were such Dr. Simonton techniques as meditation and mental imagery, said Julia Rowland, director of the National Cancer Institute's Office of Cancer Survivorship. "For an oncologist to pioneer a mind-body approach was very provocative at the time, and yet very humane," Dr. Rowland said. "It gave people more of a sense of control over their illness and allowed patients to think differently about their role in the healing process."

After implementing an early psycho-social oncology program while chief of radiation therapy at Travis Air Force Base in Fairfield, Calif., in the early 1970s, Dr. Simonton founded a cancer counseling and research center in Fort Worth, Texas, that included emotional support as a key component. His own research indicated that when lifestyle counseling was added to medical treatment for patients with advanced cancer, their survival time doubled and their quality of life improved.

A study by Stanford University and the University of California, Berkeley researchers concluded in 1989 that women with advanced breast cancer who received emotional counseling lived about twice as long as those who did not. The study was independent evidence that Dr. Simonton's "whole body" approach to battling the illness made a difference, Dr. David Siegel, a psychiatrist and Stanford professor who wrote the study, confirmed in an e-mail to the Los Angeles Times.

Dr. Simonton outlined his "will to live" philosophy of cancer care in "Getting Well Again," a 1978 book written with his second wife, a psychotherapist then known as Stephanie Matthews-Simonton, and others. It drew on first-hand experience with patients at his Fort Worth cancer-care center. The book was "highly praised" by officials at the National Institutes of Health and doctors who specialized in cancer and heart problems, the Times reported in a 1981 article with the headline, "Medicine's 'Other Side' -- the Mind." Thousands of counselors have trained in the Simonton Method, which includes teaching patients to visualize their bodies fighting cancer cells -- and winning the war.

According to the American Cancer Society, "available scientific evidence does not support claims that imagery can influence the development or progress of cancer" but it can help reduce stress, depression, manage pain and ease side-effects, in addition to creating "feelings of being in control." The use of guided imagery is much more accepted and widely used today, especially to manage side-effects, a development that can be traced to Dr. Simonton's research, said Dr. Rowland of the National Cancer Institute. Differences over theory sparked his divorce from Ms. Matthews-Simonton, who went on to establish a more psychologically oriented clinic in Arkansas. Dr. Simonton's first marriage also ended in divorce.

In 1984, he was seeking a professional climate that would be friendlier to his controversial work when he founded the Simonton Cancer Counseling Center in Pacific Palisades. The center will continue operating.

He insisted that feelings of hopelessness contribute to a hastier death. "Most of us kill ourselves with unconscious emotional pain," he said in a 1995 interview and warned to beware of those who say there is no hope. "Label those people as ill-informed and hazardous to your health," he said. Oscar Carl Simonton was born in west Los Angeles on June 29, 1942. He was the youngest of four children of a Baptist minister and his wife. Following undergraduate work at an Arizona college, Dr. Simonton earned his medical degree from the University of Oregon.

In his late 30s, Dr. Simonton was described as having "a penchant for four-letter expletives and a willingness to appear on a platform in his jogging shorts" to give a speech. His wife said that remained an apt description of her husband, who loved to crack jokes and thought nothing of accidentally wearing tennis attire to a formal dinner

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2. EXCERPTS FROM GETTING WELL AGAIN: O CARL SIMONTON, MD, STEPHAINE SIMONTON AND JAMES CREIGHTON: 1978 J. P. Tarcher, Inc. (St. Martin's Press) NY

Everyone participates in his or her health or illness at all times. We use the word participate to indicate the vital role you play in creating your own level of health. Most of us assume that healing is something done to us, that if we have a medical problem our responsibility is simply to get to a physician who will then heal us. That's true to a degree, but it is only part of the story. We participate in our own health through our beliefs, our feelings, and our attitude toward life, as well as in more direct ways, such as through exercise and diet. In addition, our response to medical treatment is influenced by our beliefs about the effectiveness of the treatment and by the confidence we have in the medical team. (p.3)

If the difference between the patient who regains his health and the one who does not is n part a matter of attitude toward the disease and belief that he could somehow influence it, then we wondered, how could we influence patients' beliefs in that positive direction? Might we be able to apply techniques from motivational psychology to induce and enhance a "Will to live?" Beginning in 1969, we began looking at all the possibilities, exploring such diverse psychological techniques, "mind development" courses like Silva Mind Control, and Mind Dynamics, and biofeedback. (p. 5-6)

From our study of biofeedback, we learned that certain techniques were enabling people to influence their own internal body processes, such as heart rate and blood pressure. An important aspect of biofeedback, called visual imagery, was also a principal; component of other techniques we had studied. The more we learned about the process, the more intrigued we became.

Essentially, the visual imagery process involved a period of relaxation, during which the patient would mentally picture a desired goal or result. With the cancer patient, this would mean his attempting to visualize the cancer, the treatment destroying it and, most importantly, his body's defenses helping him recover. After discussions with two leading biofeedback researchers, Drs. Joe Kamiya and Elmer Green, of the Menninger Clinic, we decided to use visual imagery techniques with cancer patients. (p, 6)

It is our central premise that an illness is not purely a physical problem but rather a problem of the whole person, that includes not only body but mind and emotions. (Durbin - in later works Dr. Simonton adds spiritual as well as physical and emotional.) We believe that emotional and mental states play a significant role both in susceptibility to disease, including cancer, and in recovery from all disease. We believe that cancer is often an indication of problems elsewhere in an individual's life, problems aggravated or compounded by a series of stresses six to eighteen months prior to the onset of cancer. The cancer patient has typically responded to these problems and stresses with a deep sense of hopelessness, or "giving up." This emotional response, we believe, in turn triggers a set of physiological responses that suppress the body's natural defenses and make it susceptible to producing abnormal cells.

If the total integrated system of mind, body and emotions, which constituted system of mind, body and emotions, which constitutes the whole person, is not working in the direction of health, then purely physical interventions may not succeed. An effective treatment program, then, will deal with the total human being and not focus on the disease a alone, for that would be like trying to treat a yellow fever epidemic with sulfa alone, without also draining the ditches in which the sickness-bearing mosquitoes breed. (p. 10)

Of course, duration of life after diagnosis is only one aspect of the disease. Of equal (or perhaps greater) importance is the quality of life while the patient survives. There are few existing objective measures of quality of life: however, one measure we keep in the level of daily activity maintained during the after treatment compared to the level of activity prior to diagnosis. (p. 11)

While stress may predispose to illness, the significant factor still seems to be how the individual copes with it. Clearly the meaning of an event - even a stressful one - is construed differently from person to person. Loss of a job at age twenty will usually be less stressful than will loss of job at fifty. When a person is enthusiastically looking forward to retirement, eager to spend time on a number of important projects, then retirement is much less stressful than it is when it is impose by mandatory retirement rules. Some divorces are extremely bitter and shattering while others are more amiable. The same logic applies to all the other items on the stress list: since the events involve change, they will all produce some stress; but the amount of stress varies with the individual. Stress may accumulate to the point that the individual can no longer cope and consequently becomes ill. (p. 46)

"The explanation, we suspect, is that the activity of coping can lower resistance to disease, particularly when one's coping techniques are faculty: when they lack relevance to the ... problem to be solved. This approach to illness is a lesson in human finitude (reminding) us that we have only so much energy, no more. If it takes too much effort with the environment, we have less to spare for preventing disease. When life is too hectic, and when coping attempts fail, illness is the unhappy results. (Holmes and Masude) (p. 46)

Chronic stress frequently produces hormonal imbalances. Since hormones play a critical role in regulating body functions, these imbalances can lead to high blood pressure and eventually damage to the kidneys. The damage to the kidneys can, in turn, lead to sever hypertension (high blood pressure), which will reinforce the chemical imbalance. (p. 49)

SUMMARY OF EMOTIONAL STRESS FINDINGS:

(1) High levels of emotional stress increase susceptibility to illness.

(2) Chronic stress results in a suppression of the immune system, which in turn creates increased susceptibility to illness - and especially to cancer.

(3) Emotional stress, which suppresses the immune system, also leads to hormonal imbalances. These imbalances could increase the production of abnormal cells at precisely the time the body is lease capable of destroying them.

(4) It is significant that the amount of emotional stress caused by external events depends on how the individual interprets or copes with the event. Even though researchers are able to predict illness based on the number of stressful events in people's life, a number of individuals in these studies did not get sick, even though they experienced high levels of stress. It is necessary to look at the individual's unique response to a stressful event. (p. 51)

People with similar personality traits don't all develop the same illness any more than all people subjected to the same carcinogenic agents develop cancer. Many other factors play a significant role. (p. 57)

Based on Dr. Elilda Evans' ( A Psychological Study of Cancer (1926) ) analysis of one hundred cancer patients, Evans concluded that many cancer patients had lost an important emotional relationship before the onset of the disease. She saw such patients as people who had invested their identity in one individual object or role (a person, a job, a home) rather than developing their own individuality. When the object or role was threatened or removed, such patients were thrown back on themselves, with few internal resources to cope. (We, too, have found the characteristic o putting others' needs before one's own in our patients.) Evans also believed that cancer was a symptom of other unresolved problems in a patient's life, and her observations have since been confirmed and elaborated on by a number of other researches.(p. 57-58)

When we considered cancer a purely physical problem, we viewed patients' descriptions of their emotional states as something to be responded to with sympathy and understanding but having little to do with the course of the disease. As we learned that the "whole person" participates in the course of the disease, we began to pay very close attention to everything our patients said. (p. 63)

GETTING WELL AGAIN: We have observed four psychological steps that occur in the upward spiral of recovery:

(1) With the diagnosis of a life-threatening illness, the individual gains a new perspective on his or her problems.

(2) The individual makes a decision to alter behavior to be a different kind of person. (p. 71)

(3) Physical processes in the body respond to the feelings of hope and the renewed desire to live, creating a reinforcing cycle with the new mental state. The renewed hope and desire to live initiate physical processes that result in improved health. Since mind, body, and emotions act as a system, changes in the psychological state result in changes in the physical state. This is a continuing cycle, with an improved physical state bringing renewed hope in life and with renewed hope bringing additional physical improvement.

(4) The recovered patient is "weller than well." Karl Menninger, founder of the Menninger Clinic, describes patients who have recovered from bouts with mental illness as frequently being "weller than well," meaning that the state of emotional health to which they have been restored is in fact superior to what they had considered "well" before their illness. (p. 72)

We have all experienced what are called self-fulfilling prophecies - that is, because we expect something to happen, we act in ways that increase the likelihood that the expectation will be met. (Durbin - this can be good or bad, depending on the expectation.) (p. 75) The most significant finding of the study was that a positive attitude toward treatment was a better predictor of response to treatment than was the severity of the disease. That is, patients who had serious prognoses but positive attitudes did better than patients who had relatively less serious prognoses but negative attitudes. In addition, patients who began to view their treatment positively often reported reduced side effects. (p. 77)

THE QUESTION OF "FALSE HOPE" : We are sometimes asked, "Aren't you giving your patients false hope." Our answer is "No," we are giving our patients reasonable hope. Our approach does not guarantee recovery. But the question of "false hope" suggest that people should never have hope if there is a good chance they will be disappointed. Such a belief provides no basis for living a full lie or for dealing with a threat to life. (p. 81)

Patients who have worked hard using our approach have still died, although in many cases they have significantly outlived their prognoses - and lived a more rewarding life than they would have had they not actively participated in their treatment. Yet death appears inevitable for us all. And our program includes activities designed to help the patient confront the possibility of death openly - an attitude that frees energy for living.

People who are concerned with "false hope" often see themselves as realists, people who see life "as it really is." But a life view that does not include hope is not realism but pessimism. This stance may avoid disappointment, but it does so by actively shaping negative outcome.

Hope is an important element in survival for the cancer patient. Indeed, as the studies indicated, hopelessness and helplessness ar frequent precursors of cancer. The hope we try to impart is essentially a stance toward life. It is not just a matter of philosophy, but of survival. For each patient, the process of getting well includes redefining his or her own stance toward the experience of a life-threatening disease so that there is hope. (p. 82)

PARTICIPATING IN YOUR HEALTH: If you think back, you will probably see how many small ailments in your life, such as colds or headaches, occurred when you were tired, overworked, under tension or emotional stress. You have probably said many times that you caught a cold because you were "run down," and you most likely meant not just physical fatigue but also emotional depletion, a lack of vigor and enthusiasm. (p. 104)

Serious ailments, too, such as heart attacks and ulcers, have been observed to follow periods of overwork, tension, pushing too hard. They tend to occur when the body has reached its upper limit and can carry no more, but the signals of this situation have been ignored. Anyone who has had an ulcer is aware of how it acts as a feedback device for emotional overload, an index of the "state of the organism," because pain from the ulcer is most likely to occur when one is tense or anxious. A physician friend says that in a way he regrets having had surgery for an ulcer because without the ulcer's reminder, he can't tell anymore when he is overly tense, and he worries about what other effects the tension might have on his body.

All of us participate in becoming sick through a combination of mental, physical, and emotional factors. You many have been very tense or anxious for a long period of time without doing enough to relax. You may have maintained unreasonable work loads or gotten so caught up in meeting everyone else's needs that you ignored your own. You may have maintained attitudes and beliefs that prevented you from having satisfying emotional experiences. In sum, you have failed to recognize your physical and emotional limits.

To the extent that you ignored these legitimate needs, you participated in your own illness. When the body's and mind's requirement for relaxation, rest, exercise, emotional expression, even for meaning in life are neglected, then the body may communicate this failure to pay attention by getting sick. (p. 105)

It is not our intent, nor is it desirable, for you to feel guilty for having recognized that you've participated in your disease. There is a difference between being "to blame" for something and having "participated" in it. It makes no sense to blame persons living in his society for becoming ill in light of the rules they were taught for dealing with their emotions and feelings. (Few individuals in our culture have been taught how to deal with emotions appropriately.) Blame suggests a person consciously knew better and yet decided to respond or act in a self-damaging way. That is certainly not true of people who respond to stress by developing a physical illness. Like most people in our culture, you were probably not even aware of a link between emotional states and illness. Thus, the way in which you did participate are almost certain to have been a result of unconscious beliefs and habitual behavior. (p. 115)

THE BENEFITS OF ILLNESS: In a culture where feelings are given little importance and emotional needs vital to a person's well-being are frequently ignored. disease can fulfill an important purpose: It can provide a way to meet the needs that a person has not found conscious ways of meaning

Illness includes much pain and anguish, but also solves problems in people's life. It serves as a "permission giver" by allowing people to engage in behavior they would not normally engage in if they were well. Think for a moment of some of the things that people get when they are sick: increased love and attention, time away from work, reduced responsibility, lessened demands, and so on. Because cancer patients are often people who have put everyone else's needs first, they have obviously had difficulty permitting themselves these freedoms without the illness. In this way, illness works to suspend many of the attitudes that block people from paying attention to their own emotional needs. In face, when you are ill may be the only time it is acceptable to drop the responsibilities and pressures of your life and simply take care of yourself without guilt or the need to explain or justify. (p. 117)

Several other patients have found that their disease temporarily removed them from an intolerable job. Again, because the disease only suspends the problem for them, it is important they they confront the personal attitudes and behaviors that permitted the situation to become intolerable in the first place - or they are likely to recreate the situation and the disease each time they return to work.

Illness give patients temporary permission to act in more open ways emotionally. But if they cannot learn to give themselves that some permission when they are healthy, then the moment they get well the old rules again apply, and they find themselves in the psychologically and physically destructive situation that first contributed to their illness. (p. 120)

The task that faces the patient includes:

(1) identifying the needs being met through the illness, and

(2) finding ways of meeting those needs directly without illness. (p. 121)

RELAX AND VISUALIZE RECOVERY: The first step in getting well is to understand how your beliefs and emotional responses have contributed to your illness. The next step is to find ways of influencing those responses in in support of your treatment. In this chapter, we will tell you about a relaxation process for reducing the effect on your body of stress and tension associated with the onset of cancer and with the fear of the disease, which itself becomes a major source of stress. We will also show you how to use mental imagery, once your relaxed, to create positive beliefs that will activate your body's defense against disease. (p. 125)

It is important to note that, in clinical terms, relaxation does not mean spending an evening in front of the television, having a few drinks, or talking to friends. Although these certainly can be pleasurable activities, laboratory studies show that such forms of "relaxation" do not result in an adequate discharge of the physical effects of stress.... Fortunately, researchers have developed a variety of simple relaxation techniques - certain forms of meditation and progressive relaxation, autogenic training and self-hypnosis. (p. 126)

Relaxation and mental imagery are among the most valuable tools we have found to help people learn to believe in their ability to recover from cancer. In fact, we mark as the conception of our present approach the first time Carl used mental imagery with a patient. Since then, we have discovered that mental imagery is not only an effective motivational tool fro recovering health, but is also an important tool for self-discovery and for making creative change in other areas of life.(p. 129)

The common thread running these disciplines was that people created mental images of desired events. By forming an image, a person makes a clear mental statement of what he or she wants to happen. And, by repeating the statement, he or she soon comes to expect that the desired event will indeed occur. As a result of this positive expectation, the person begins to act in ways consistent with achieving the desired result and, in reality, helps to bring it about. "self-fulfilling prophecy" (p. 130)

VALUE OF RELAXATION AND MENTAL IMAGERY:

(1) Decrease fear: Most fears comes from feeling out of control - in the case of cancer, feeling your body is deteriorating and you are powerless. Relaxation and mental imagery help you see your role in regaining health so that you begin to sense your own control.

(2) The process can bring about attitude changes and strengthen the "will to live."

(3) It can effect physical changes, enhancing the immune system and altering the course of a malignancy. Since mental processes have a direct influence on the immune system and hormonal balance in the body, physical changes can be directly attributed to changes in thought patterns.

(4) The process can serve as a method for evaluating current beliefs and altering those beliefs, if desired. Alterations in the symbols and pictures that you can dynamically alter beliefs to those more compatible with health. (p. 137)

(5) The process can be a tool for communication with the unconscious - where many of our beliefs are at least partially buried. (p. 137-138)

(6) It can be a general tool for decreasing tension and stress. The process of regular relaxation by itself can decrease tension and stress and have a significant effect on underlying body functions.

(7) The process can be used to confront and alter the stance of hopelessness ad helplessness. We have seen again and again how this underlying depression is a significant factor in the development of cancer. As people begin to picture their bodies regaining health, their ability to solve the problems that existed prior to the malignancy, they weaken their sense of helplessness and hopelessness. Indeed, as the patients proceed toward health, they gain a sense of confidence and optimism. (p. 138)

OVERCOMING IMAGERY PROBLEMS: Some people are more visual than others; they think in images. Some people tend to sense things. Others feel things. Some think words. Because of these individual difference, we have found that when we use the word "see" in our instructions to the the mental imagery process, some people might instead "feel" what it is like to be well. When we say "See yourself becoming well," they might have the "sensation" of energy and health. It has become increasingly clear to us hat a person should stay with the process or way of thinking that he or she is most comfortable with, rather trying to become primarily visual. (p. 138-139)

Another problem we have found to be very common during mental imagery is the tendency for a person's mind to wander. This often represents a lack of concentration which can be aggravated by certain medication, by pain, or fear. From time to time it is a problem that affects everyone using the process regularly. One of the most effective ways of dealing with distractions is to stop the process and ask yourself what is going on: "Why is my mind wandering?" Pursue that line of thought for a short time. Then focus back on the exercise and go through it with whatever degree of success you can attain.

A third difficulty is the feeling that saying the cancer is "shrinking" is actually lying to yourself. We've heard statements such as, "I've got a cancer growing on my shoulder, I can feel it, it's not possible for me to see it shrinking when I know it's growing bigger." The problem her is a confusion about the purpose of the mental imagery process. We are attempting to help the patient visualize the desired outcome, not what may be happening at the time. It is possible to picture the cancer shrinking even when in reality it is growing; you ar picturing in your mind what you want to come about. Understand this distinction is very important. Mental imagery is not a method of self-deception; it is a method of self-direction. (p. 139)

CRITERIA FOR EFFECTIVE IMAGERY:

(1) The cancer cells are weak and confused. It is important to depict your cancer cells as anything soft that can be broken down, like hamburger meat or fish eggs.

(2) The treatment is strong and powerful. The treatment is clearly capable of destroying the cancer. (3) The healthy cells have no difficulty repairing any slight damage the treatment might do. Since the treatment usually touches all cells, not just the cancerous cells, you should visualize your normal, healthy cells as being strong enough so that the treatment does little damage to them, and they are capable of repairing any minimal damage. The cancerous cell are destroyed by the treatment because they are weak and confused.

(4) The army of white blood cells is vast and overwhelms the cancer cells. The white blood cells are a symbol of your body's natural healing process, so your imagery should reflect vast numbers of these cells and great strength. The victory of the white cells over the cancer should be seen as inevitable. (5) The white blood cells are aggressive, eager for battle, quick to seek out the cancer cells and destroy them. (p. 144) Visualize your white cells overwhelming the cancer cells, leaving no doubt about which cells are stronger.

(6) The dead cancer cells are flushed from the body normally naturally.

(7) By the end of the imagery, you are healthy and free of cancer. This image represents your desire for the final outcome; it is important that you see your body clearly as healthy, vital and energetic. (8) You see yourself reaching your goals in life, fulfilling your life's purpose.(p. 145) It is important to visualize your treatment as a friend and ally. (p. 147)

OVERCOMING RESENTMENT: Processes that help people release resentment, express negative feelings, and forgive past wrong (whether real or imagined) may well be a major part of the preventive medicine of the future. And because cancer patients often have unresolved resentments, and other emotional ties to the past (as we have seen, perceived abandonment or rejection by one or both parents may be an antecedent to the development of cancer). helping our patients learn to release the past is often essential in helping them get well. Resentment is not the same as anger: Anger is generally a single, relatively short-lived emotion (one with which we are familiar) whereas resentment is a long-term restressing process. (p. 164) No matter how justified those feelings may have been when the experience first occurred, continuing to carry them has tremendous physical and emotional costs. If you are harboring such feelings, the first thing you must acknowledge is that you - not the other person - are the ultimate source of your own stress. (p. 165)

MENTAL IMAGERY FOR OVERCOMING RESENTMENT:

(1) Sit in a comfortable chair, feet flat on the floor, eye closed.

(2) If you feel tense or distracted, use a relaxation process.

(3) Create a clear picture in your mind of the person toward whom you feel resentment.

(4) Picture good things happening to that person. See him or her receive love or attention or money, whatever you believe that person would see as good thing.

(5) Be aware of your own reactions. If you have difficulty seeing good things happening to the person, it is a natural reaction. It will become easier with practice.

(6) Think about the role you may have played in the stressful scene and how you might reinterpret the event and the other person's behavior. Imagine how the situation might look from the other person's point of view.

(7) Be aware of how much more relaxed, less resentful you feel, Tell yourself you will carry this new understanding with you.

(8) You are ready to open your eyes and resume your usual activities. (p. 167) Forgiving yourself is very important also. (p. 168)

The resentment imagery process is not a way to avoid expressing true feelings by turning them into unnaturally positive images. Rather, it is a way to gain insight into your old hurts and relieve the damaging side effects. After using the process repeatedly, our patients have shown - both the subjective reports and objective psychological - less tendency to repress and deny their feelings. The become able to deal with their feelings more effectively, and as a results, experience less stress and tension. (p. 171)

Since one does not simply turn negative feelings into positive feelings, it takes a great deal of effort to begin to visualize good things happening to a person toward whom you feel resentment. In the attempt, however, you began to confront your own role in reacting to the hurtful situation as you did. You may find, as have a number of our patients, that some of your resentment toward the other person may be because you yourself reacted in a way you didn't approve of, and you wish you had reacted differently. (p. 171-172)

By allowing the energy tied up in resentment to be redirected toward constructive decisions, you will be much more closer to leading the kind of life you want to live. These gains will enhance your body's ability to eliminate cancer and dramatically improve the quality of your life. (p.172)

BENEFITS OF SETTING GOALS: The most effective tool we have found for getting our patients to take specific, positive action is to ask them to set new life goals. By asking a person to set goals, we help them conceptualize and focus their reasons for living and will make an effort to achieve. It is a way to transform emotional, mental, and physical needs into a life-affirming behavior, to reinvest yourself in live. The will to live is stronger when there is something to live for. Setting goals has many other benefits for the cancer patient. (p.174)

(1) Setting goals prepares you mentally and emotionally to act out your commitment to regain health.

(2) Setting goals expresses confidence in your ability to meet your needs.

(3) The stance that you are in charge of your life builds a positive self-image.

(4) Setting goals provides a focus for your energy. It establishes priorities. We point out that the primary value of setting goals lies in being involved in your daily living and committed to worthwhile objectives, whether or not they are met. It is the process of striving to meet our goals, not their ultimate fulfillment, that give meaning to life. (p.175)

SUGGESTION FOR GOAL SETTING:

(1) Write balanced goals for what you want to do - including activities that provide personal meaning as well as pleasure. Include goals that address (1) your purpose in life: personal growth , your relationships with others, your career, and financial targets; (2) goals that are focused on pure recreation; and (3) Goals focused on physical exercise.

(2) Make your goals concrete and specific. (p. 178)

(3) Make your goals measurable.

(4) Make your goals realistic.

(5) Make your goals within your power to make happen. (p. 179) (6) Don't be afraid to dream. (p. 180)

YOUR INNER GUIDE: The means by which the unconscious communicates with the conscious self is through feelings, dreams, and intuitions. Unfortunately, our culture seems to undervalue these messages. We are taught to value external events and objects - behavior, our bodies, material things, the logical output of our minds - but not our internal environment. Therefore, we tend to ignore feelings, dreams, and intuitions from our internal self, which are attempting to provide us with resources to meet the demands of the external world. One process for permitting this communication with the Inner Guide is called "guided daydreaming," a form of mental imagery. (p. 186) For many people, the Inner Guide takes the from of a respected authority figure - a wise old man or woman, a doctor, a religious figure - with whom the patient is able to carry on an internal conversation, asking questions and hearing answers that seem to be wise beyond the individual's conscious capacities. (p. 187)

THE INNER GUIDE MENTAL IMAGERY PROCESS:

(1) Sit in a comfortable chair, feet flat on the floor, eyes closed. Use a relaxation process.

(2) In your mind's eye see yourself in a natural setting that gives you a feeling of warmth, comfort, peace, and serenity. Select the spot from your memory of your fantasies. Concentrate on the details of the scene. Try to experience it with all your senses - as if you were really there.

(3) Notice a path emerging near you, which winds toward the horizon. Sense yourself walking along this path. It is pleasant and light. (p. 195)

(4) Notice that in the distance there is a radiant blue-white glow, which is moving slowly toward you. There is nothing frightening about the experience.

(5) As the glow comes closer, you realize it is a living creature - a person or a friendly animal.

(6) As the person or creature comes closer, be aware of the details of its appearance. Is the creature masculine or feminine? See its shape and form as clearly as you can. If your guide is a person, notice details of face, hair, eyes, bone structure, build.

(7) If this person or creature makes you feel warm, comfortable, and safe, you know it is an Inner Guide.

(8) Ask the guide's name, and then ask for help with your problems.

(9) Engage the person or creature in a conversation, get acquainted, discuss your problems as you would with a trusted friend.

(10) Pay careful attention to any information you receive from your guide. It may come in the form of conversation through symbolic gestures, such as the guide's pointing toward something or producing an object that represents its advice.

(11) Establish an agreement with your guide about how to make contact for future discussion.

(12) Then when you are ready, let your consciousness come back slowly into the room where you are setting and open your eyes. (p. 196)