Tag Archives: Therapy

M is for Mad

I went to bed anxious last night. I’m sure that I was not the only one—and while I do have personal reasons to be very anxious, my anxiety is nothing compared to that of the protestors, the families who have lost their children, their fathers, their mothers, their cousins, their neighbors, and friends, aunts, uncles, grandchildren, grandparents. Generations of family members lost to the violence and madness of racism.

I woke up mad. Mad about everything: mad that I’ve been cooped up for months now, cut off from life as I once knew it; mad that this country seems hell bent on self-destruction; mad that we don’t have a functional leader; mad that white people cannot seem to wrap their heads around the systemic damage done by centuries of racism. Mad that I had given up my morning runs at my favorite running trail because when lockdown began, people started swarming to the same trail, no one apparently concerned about spreading germs or vectoring the virus. Mad that so many people I know cling to their Facebook accounts; mad that I still post on my Instagram feed even though I know it’s owned by Zuckerberg; mad that he and Sheryl “Lean In” Sandberg refuse to make any changes. I mean, my mad has no end. Or so it seems.

So, I did what I know to do (I’m a therapist, after all, literally schooled in these things): I tried Mindfulness and Meditating. I put down my phone and my computer for two blissful hours yesterday and went kayaking, basking in nature: ducks, herons, turtles, geese. I felt better in the moment, but today the anxiety returned, so I called my therapist for an emergency session. That helped. Buoyed, I decided to try returning to my favorite trail, for a walk, with a mask. Big Mistake.

Two other people on the trail today were wearing masks. Two! Out of dozens: old people, children, mothers pushing strollers, dads on bikes with their children. I get why runners might not wear a mask—I had trouble breathing through mine while I was walking, but put on something: a bandana, a scarf, a balaclava to pull up when approaching someone. I started to get mad again.

And then I remembered. I remembered why I had stopped going to my favorite trail (to any trails, really) for the past three months: I cannot control what anyone else does. I decided back on April 1 that I couldn’t keep coming home from my morning runs mad because so many people were suddenly out there. That was defeating the purpose. I remembered, as I felt like screaming at the other walkers today “PUT ON A DAMN MASK!” that I can only be responsible for my actions. As I felt my blood pressure rise, I remembered, that I had made a choice to be here, and if I wanted things to be different, I needed to make a different choice.

So often, when we feel miserable (mad, sad, anxious, depressed, angry, lonely), we look outside of ourselves for both the reasons and for the answers, when in actuality, the key to changing our feelings lies within. We think “if only they would change, life would be better” while we continue to do the same things, over and over and over again, expecting a different result. That, my friends, is madness. We have done the same things over and over and over again in this country. Silence hasn’t worked. Tolerance hasn’t worked. Action might.

I am reminded of a short parable, that I’ll probably butcher, but it goes something like this:

I walked down a street and fell into a hole. (Distress)
The next day, I walked down the street and walked around the hole. (Anxiety)
Finally, I walked down a different street. (Choice)

Want to stop the madness? Make a different choice.

For some, a different choice is protesting. Standing up, speaking out, marching. For others, a different choice is listening. Listening to understand, not to reply or to defend, but to hear. For others it is donating, writing, making art, singing. Reaching out. Linking arms. Lifting up.

Choose to do something.

As a counselor, I am ethically obligated to stand for social justice, to stand with those who face systemic oppression and disenfranchisement. And I do. I believe Black Lives Matter. I stand with the protestors.

L is for Loneliness (and Logic)

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Let’s try this again. Yesterday’s L is for post was an aberration. No other way to explain it.

Loneliness is such a difficult emotion. When we are feeling lonely, we are probably also experiencing so many other emotions at the same time: depression, anxiety, shame, frustration, for starters. And, behind all of these feelings is probably fear: fear of being judged, fear that we will never find our people, fear of rejection.

With all of these emotions swirling around inside of us and with a perceived lack of support, we often are reluctant to take the steps that are necessary for connection. When we are depressed and anxious our natural inclinations are to curl up further, to retreat more deeply into ourselves. We may even reject overtures of kindness as “pity asks” if we allow ourselves to believe what our emotions are telling us.

Loneliness is particularly difficult because as humans we are wired to be in connection with others, and yet we are also oriented to danger, evolutionarily speaking. We are constantly scanning our environment, looking for danger. This predilection is what kept us alive and kept the gene pool advancing. But this tendency to look for danger resides in our reptilian brain and kicks in without us even knowing, and it keeps us from reaching toward others.

How do we get out of the place of loneliness then? How can we trust that our friends are genuine and not just reaching out to us because they feel sorry for us? I once had a therapist ask me if I really believed that all of my friends were in cahoots to take me on as a “project.” She asked me if I truly believed that they only called and invited me places because they had agreed that no one else would if they didn’t.

The good news is, we don’t only have our reptilian brain, but also our pre-frontal cortex which is where logic and reason reside. Emotions are powerful, but so are our developed brains. I didn’t have to think very long to realize that was a very unlikely scenario. Did I trust my friends, she asked? What did I know about them? Did this strike me as even a remote possibility? Of course not. My friends don’t have time for such projects, nor the inclination to trick someone into feeling loved. The very thought struck me as absurd. And that’s the thing about emotions—they are generally based on a faulty belief, i.e. “I’m lonely because no one likes me.”

When we are confronted with these unpleasant emotions we can develop tools for coping. First, allow yourself to have the feeling. I’ve said it before, and I’ll say it again, emotions come and go. If we can expand our ability to sit with them and to recognize that nothing terrible will happen if we allow ourselves to fully feel our loneliness, we develop resilience. And we learn that we don’t have to be afraid. The feeling might not be as bad as we imagined.

Next, access what you know. List your friends and all of the people in your life that like you. Coworkers, classmates, teachers, family members, book club members, running buddies. Your spouse. Let the names wash over you, feel the love.

Take action. Pick up the phone, send an email, go for a walk and wave at your neighbors (from at least six feet away and wear a mask). Write a letter. Put up reminders around the house that you are loved. Chances are good that your reaching out will touch someone else who might be feeling similarly. If we can remember that we are more alike than different, we will feel more connected. I know that taking action can be difficult, but trust me when I say that not taking action will not alleviate your loneliness. You have to put yourself among your people to find them, and sometimes you have to do it over and over and over again.

We don’t have to be ruled by our emotions, but neither do we need to fear them. Let yourself feel them, get acquainted, and then take charge. I’ll write more about learning how to recognize emotions and how to work with them in my next blog, M is for Mindfulness, so stay tuned. And for anyone who read my initial and awful L is for post, my most sincere apologies. I let my emotions run away with me.

J is for Just a Feeling

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Humans have emotions. That is just how we are wired—to feel things, to experience pleasure, pain, loss, grief, jubilation, jealousy, ecstasy, disappointment. Doubt. Trust. Trouble comes when we decide we no longer want to feel our feelings, and we undertake just about any distraction or vice to render ourselves numb: work, sex, booze, exercise, food. And in trying to avoid our original feeling, we’ve added more: guilt, just for starters.

But feelings themselves don’t even last very long. Theories vary, but various experts say feelings last between 90 seconds and 20 minutes. We all know that at times, mere seconds can feel like hours if it’s negative, so if we have an unpleasant feeling, we rush to squash it rather than sit with it.

But sublimating our feelings or chasing them away with numbing agents, doesn’t help us learn to live with them. People come to therapy because they need help managing their feelings: sadness, grief, anxiety, fear, anger, contempt, jealousy. I say “it’s just a feeling” to my clients on a regular basis. “You can learn to welcome the feeling,” I add. “Invite it in for tea. Get to know it.” I often follow up with “it’s like training a muscle.” Meaning that if they practice enough, tolerating negative feelings will get easier eventually. And I believe that. I do. But it is so hard to put into practice.

I encountered some intense feelings of my own this week in my personal therapy. I’ve been trying to sit with it. I’ve asked for additional sessions with my therapist. I have been trying to dampen the feeling down with television and other distractions, but nothing is helping. Finally, I decided to try inviting it in. Just sitting with it. Just asking it what it wants, what it’s afraid of, what it needs. What it is trying to protect me from.

These are the questions I pose to my clients. I ask them to externalize, to imagine the feeling or emotion or problem as something separate from themselves. Naming it helps. I ask what color it is, what shape, how big, how heavy, what texture. Then I ask the client to imagine talking to the feeling, taking charge. Telling it it can come in, have a seat, and be quiet. Telling it they understand it is there to protect them. It helps to imagine our anxiety riding shotgun rather than as a part of ourselves.

When I cannot tolerate my emotions, and when my feelings seem overwhelming and impossible, I don’t feel like a very good example. And yet, I am the perfect example. A perfect example of what imperfection looks like: someone just trying to sit with the feeling and getting to know it. It won’t hurt me. I might learn something. It’s just a feeling.

I is for Inside, IT, and iTunes, Indecision, and Irritation All the I Words

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My apologies in advance. I had wanted the Title to look like this: I is for Inside, IT, and iTunes, Indecision, and Irritation All the I Words but I can’t make it work, so it looks stupid. And also, this is a long blog, and I sort of nerded out for the first few paragraphs, but it gets better (?) as it goes along. So, enjoy.

We are taking a break from therapist talk today. It’s Sunday, a day of rest (well, it was when I started this iteration of the I is for blog).

Today has mostly been an inside day. Luckily, April has been mostly sunny here lately in the ‘ham. I’ve managed to get a lot of color in the past few days, even burning the tops of my feet, but today hasn’t been as nice out as previous days, so I’ve spent most of it inside. I’ve been working on my jigsaw puzzle, grooming the cat who is 19 and has some really awful matted fur, doing three Sunday crossword puzzles, futzing with my ancient Dell desktop so it will play my music properly, trying to find drivers for the keyboard but I only have use of one of those stupid ball mouses (since the keyboard drivers don’t seem to exist), so that is extremely time consuming.

Before I was a therapist, I worked in IT for about 15 years, so I know computers, but ugh. This project is ridiculously tedious. I have never really wrapped my mind fully around iTunes, but that is where nearly all of my music is trapped—in iTunes on the very old Dell with 4GB of RAM. I usually only use the music on said computer during the summer when I hook up the deck speakers, but summer is here early this year due to this pandemic, and the days I’m not seeing clients, I’ve got nothing but time, so.

I wanted to get the music from the Dell to my iPhone but when I plugged the phone into the PC, iTunes didn’t recognize it as a device. (For those who care, I can’t find a thumb drive anywhere in my house though I know I have a few somewhere, and my Time Machine doesn’t register on the Dell, so the iPhone it is). Long story short, I updated iTunes. Which worked to move the music (i.e. iTunes sees my iPhone) but now when I play music from the computer, it cuts off mid-song and goes to the next one. And when it’s not doing that, it stops playing to ask me for my iTunes password which is actually my ex-wife’s and I have no idea. But it wasn’t doing this until I updated the software. (Thanks Microsoft, this is why I have a Mac and an iPhone and am no longer in IT).

Ultimately, I did a system restore and that has helped some but not completely. I give up. There are many more productive projects to tackle, like cooking and figuring out how to get groceries and pondering just exactly what to do with my hair. Can I do therapy wearing a hat? Is that worse than what I am currently seeing in the mirror?

(Beware, major change of topic). So many people have much more pressing and life-altering issues, and the injustice of this virus, the indiscriminate way it has wreaked havoc around the world only serves to highlight income inequality and racial disparities, particularly here in the US. As I consider how I can truly meet my clients in their pain, confusion, anxiety, and/or depression, I have to remind myself that none of us know the future. None. Of. Us. We can only live in this one moment, inhabit this moment, and the next one, and the next. One step at a time.

I found myself in a state of panic yesterday after catching a glimpse of a reference to The Handmaid’s Tale on social media. I had just also seen the photo of the shutdown protesters pressed against a store window, looking like so many of the Walking Dead. Before I could rein it in, my mind spiraled into a horror show so awful I could hardly catch my breath. “This is how it begins,” I thought. “Can Gilead be far behind? Also, I would be a terrible Aunt and an even worse Martha, so my chances are not good in dystopia (I am far too old to be a handmaid, thank the good lord).”

And that’s when I reached out to my friends for a bit of reality. It helped. What they said was “We have no idea what tomorrow will bring. We cannot predict the future, all we can do is make the best and most of this moment. Worrying will not change anything.”

I know they’re right. There are infinite possibilities regarding the future. What I have is right here, right now. Be in the moment. So simple. So difficult.

H is for Honesty. And Humanity.

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If I am to be honest right now, I have a heaviness sitting in my chest. I just finished my weekly personal therapy session and while it was great to see my therapist and know that she is healthy and well, there is also a sadness that I cannot quite describe.

I tried to explain it to her, how it came over me yesterday when I ventured out into the world for the first time in over a week. I had to go get a prescription refilled and pick up an order at the local cidery (yep, part of my self-care). I was at a normally vibrant and bustling intersection, waiting for the light to change noticing how very still it was there. The car dealerships that populate that particular junction were mostly shuttered, and hundreds of brand-new cars were lined up in the lots with nary a buyer in sight.

The scene felt apocalyptic. I can’t think of a better word, and a deep grief welled up inside of me and I thought “What if this is it? What if we never get back to normal? What if these cars just sit here into perpetuity, unsold, un-driven, rusting into the next millennium?” I wanted to put my head down on the steering wheel and just sob. Finally.

But I didn’t. I allowed the wave of hopelessness wash over me, and then I pushed it away. I had to get home and start seeing clients. I didn’t know what I would able to bring to my sessions, if I allowed myself to break down in that moment, to realize the anxiety and fear I had been carrying as I’ve been soldiering on through this pandemic/lockdown/quarantine.

The anxiety would not go away, though. As the clock raced toward my first session, the more distressed I felt. So, I texted my therapist friends and my own therapist for advice. To a person, they all said the same thing: “Of course you are feeling anxious. We are too. We are human. The best thing you can do for your clients is show up as fully present and just be with them in these strange times.” I asked my therapist specifically if she felt anxious before sessions. Her answer in the affirmative was the most helpful of all. Her honesty, her humanity, shone through in that moment.

And I realized that is what I wanted to bring to my sessions, more intentionally than ever before: honesty and humanity. I cannot sit here and pretend that I’m skipping through this pandemic, successfully using all of my coping skills and shedding the anxiety like so much water off a duck’s back. I feel it. I carry it. I cope as best I can. That is what I have to offer, my humanity.

As we struggle through this strange new normal, I can offer moments of grace, acceptance, and honesty.

F is for Friends (and Family)

E is for Ease Up (or Enough is Enough)

C is for Consciousness and Choice

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The past few weeks have been a seminar on awareness, being conscious of what is going on around me as well as within me. I have been noticing so many things. So many things. I thought I should start making a list of all the noticing but as is usually my wont, I figured I would remember. And, of course, now that I sit down to write about what I have noticed, I’m having difficulty remembering all of the things.

When clients come in (or as it is now, log on) to see me, I work with them to become conscious of their thought patterns, the unconscious messages they are sending themselves, the subconscious beliefs they hold about life and circumstance and beliefs and other people. When we become conscious, or aware, we can begin to make choices (also a great word that begins with C), and when we make conscious choices, we take back our power. We discover our agency, either for the first time or again.

To use a slightly silly example, I have noticed that there are a lot of dandelions in the grass just outside my front door. Usually I mow once a week and pay no attention, but now, as I sit on the front steps and comb the cat to while away the hours, I am aware of the sheer number of dandelions. More dandelions than grass in many spots. In this moment I realize that I have a choice about how I feel about the unwanted yellow and green plant pests. I can be annoyed by them, or I can be grateful that today is sunny and getting warm-ish and I have time to spend in the yard, eradicating them.

Recognizing the choices gives me a sense of power. I can choose what to do and how I want to feel. I can feel in control and powerful regardless of my choice, just knowing that I have options. Without choice, I could become a victim to the dandelions, feeling sorry for myself that I don’t have a beautiful lush lawn, for example.

Instead, I make a conscious decision to spend a few hours weeding, moving, bending, kneeling, focusing.

My lawn looks like it has a terrible pox, but I am invigorated.

What have you been noticing?

p.s. Other things I have noticed/become conscious of:

my cat Mittens has a nemesis neighbor cat that visits/harasses him daily
the deer parade through my yard daily as well and boy are there a lot this spring
my freezer doesn’t seem to be working
I don’t mind the noise in the neighborhood
there’s a tiny hold drilled above my front door that seems to be bug related
I have and can wield a caulk gun
volunteer pansies in my flower pots
I can be content staying home
I am saving a ton of money by not eating out nearly every night
I don’t mind cooking

E is for Ethics (and also, a bit, for Exam)

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So, I wrote in yesterday’s blog that I had taken and passed my licensure exam. The state licensing exam is also the exam used for those counselors who want to be recognized as Nationally Certified Counselors. It measures competence in several areas: Research, Theories, Assessment, Ethics, and a few other categories. Overall, I did okay on the exam. I didn’t ace it, but I did far better than the minimum requirements for licensure. Also, I totally rocked the Ethics section.

I love Ethics. Ethics, like counselor self-care, permeate every aspect of counseling. Ethics play such a critical role in counseling that the ACA (American Counseling Association) has its own handbook on ethics. Every branch of health practitioner has a code of ethics by which its members choose to abide. Nurses have a code of ethics, as do doctors and nursing assistants and pharmacists. All health care professionals in Washington state have an ethical code, including chemical dependency professionals, massage therapists, physical therapists, psychologists, and so on. Strong ethics provide safeguards and protect clients at their most vulnerable: when they are sick and/or seeking help.

The ACA Code of Ethics covers everything from whether or not to accept a gift from a client (if it cost less than $20 and to not accept the gift would cause the client more harm) to how and when to refer a client to a different therapist (when the therapist has to leave her practice or if a client is just not making progress after many sessions).

Abiding by an ethical code isn’t just good for our clients. Counselors risk losing their licenses and livelihoods if they don’t adhere to robust ethical standards. Holding firm boundaries keeps us out of trouble. I subscribe to a Dept. of Health newsletter that lists the practitioners who have run afoul of the ethics board. This list is a good reminder of the possible costs of boundary crossing, no matter how well-intentioned.

We have ethical codes governing the use of electronic devices such as smart phones, laptops, tablets (must have passcodes if client information is stored there) and software: videoconferencing, electronic health records, email, text and voice messages, social media, and the like (ethics dictate don’t engage with clients as “friends” on social media, and we must only use text and email messages for scheduling. Personally, I’ve mostly gotten offline since becoming a counselor).

Last spring, I attended a day long workshop on the ethics of marijuana in counseling. The surprisingly diverse range of topics included whether or not a counselor or therapist could ethically accept weed as a form of payment from a client who might be strapped for cash but has a job at a pot farm and is thus awash in weed (in states where marijuana is legal, of course, and NO, NOT OKAY for many reasons, primarily because legally, in Washington at least, one can only possess a certain amount of weed at a time, and a therapist would cost more weed than she could legally possess). Also, whether or not a group of therapists and counselors could sit around a campfire, pass around a bong while discussing cases (a resounding NO, but not for obvious reasons. Turns out, sharing weed is illegal in Washington State. Even sharing a joint or giving a friend an edible is illegal). Violating these laws means losing ones license. This was one of the liveliest and most well-attended workshops I’ve been to since I got into this field. Everyone had so many questions.

We have ethics around multicultural counseling (ethical counselors have multicultural awareness training), staying within our scope of practice (only provide services you are trained in), and self-disclosure (does sharing personal information with the client, help the client? What is the point of sharing the personal stuff? Personal gain or therapeutic?)

Most importantly, ethical counselors and therapists do not engage in personal relationships, sexual or otherwise with clients. The ACA Code of Ethics states a counselor must wait five years after a client has discontinued treatment before becoming personally involved with that client. Washington State law says two years. A counselor must be able to relate to a client without the client having any worries whatsoever about the counselor’s motives. The counselor is there strictly for the client, not for themselves (except as related to salary or fees). Personal and intimate relationships with a mental health provider become problematic as boundaries get blurry. Counselors should always avoid dual relationships, i.e. providing counseling to your neighbor’s husband or to your child’s teacher.

The counseling office is a sacred space and a strong code of ethics maintains the integrity of that space. We are not there to befriend our clients, but to assist them in becoming better friends to themselves. We are there to hold up a mirror and to simply reflect.

B is for Beliefs, or We Can Choose what We Believe

Therapy with Pam

Because we all need someone in our corner