In therapy, when a disaster strikes it’s usually not my disaster. Usually it’s my patient’s crisis that we address. Usually I exercise my empathic superpowers to identify with them so that they are assured I understand what they’re going through. Therapeutic empathy means identifying feelings in oneself (the therapist) that nurture the working relationship while keeping clear boundaries. Your feelings are yours, not mine. The ‘Not Mine’ part keeps me emotionally detached enough to help you.
In graduate school, professors drilled into us how important it was to keep a proper clinical distance from our patients, the same way a surgeon learns to cut in and muck around in a person’s insides without feeling that person’s pain. If we don’t, our ability to do our best job to help people with their distress is compromised.
This election of 2016 made many of us feel as if we were hit by a huge Mack truck; the same Mack truck many of our patients were hit with. What do we do then? What does a therapist do when there is little if any distinction between the trauma their patient is experiencing and their own?
First, we do not bring up any Mack truck trauma unless our client does. That’s important. If our client does not suffer from *PTSD and is feeling perfectly comfortable and satisfied with the state of the world we focus on what is important to them. But if they do, and you are having a hard time yourself, try this:
1. Be human. A little self-disclosure can be a gift to the patient, a way of saying I get it because I’m there. The therapist has to be skilled to do this with just the right touch, not too much, not too little; but when does right it can be powerful. After she disclosed her panic, I told one patient that my brain was running away with me, leaping from “this is going to happen, then this, then that, until nuclear holocaust.” She opened her arms to me in a gesture of inclusion and said with a grateful exhale, “Yes! Thank you for saying that! That’s exactly what happens to me.”Read More...
Therapists are loath to publicly disclose their political leanings. Tradition from Freudian times has held us to the blank slate standard. Generally we see it as unprofessional to let show anything that smacks of personal opinion. It’s key to give people the opportunity to trust us not to be judgmental. Non-judgment is a fundamental platform of a good, trusting, working, therapeutic relationship. Therapy is about you not me.
The presidential election season of 2016 turned that standard on its head. Many well-respected psychotherapists across the country and the world felt they had to say something. This election was like no other in so many ways; this was on of them. Therapists spoke their truth out-loud due to their sense of civic duty.
I did this quietly one person at a time. If someone asked me a question directly, “Who are you voting for?” I told them. Hillary. Often the talk, regardless of which candidate my patient was for, quickly turned to anxiety. Everyone expressed worry of the outcome. There were plenty of stories in the news media about anxiety being the dominant mood in the electorate. So much, in fact, that I chose not to write about it here, on this blog.
I’m sorry about that. I feel like I let you down.
No more. We need to live on. We have people who depend on us. We need to take care of our kids. We need to work. We need to take care of our homes and parents, our clients and businesses.
To do this under the weight of the unbelievable becoming real, we need to take care of ourselves, too. I want to help. So I will share with you my recovery plan which I am sort of making up on the fly.Read More...
From Dr. Aletta: EWN continues to grow! The latest member of our team, Dr. Amy Brook, brings with her seasoned knowledge and experience helping people who fight the demons of depression, anxiety and trauma. Her new workshop “ACT on Depression” provides a model for anyone who has recovered from a major depressive episode and want an effective and kind way to maintain a healthy perspective.
Here she is in her own words:
“I believe that sometimes healing involves telling your story to a compassionate, skilled listener, and that sometimes being stuck in the story is part of the problem. I meet each person I work with where they are in their process and offer skilled collaboration and support in deepening their awareness of their own internal experience in ways that facilitate healing and living a fuller, more satisfying life. I have a general practice with a specialty in trauma treatment and am happy to consult to other professionals.
I draw on mindfulness based approaches to treatment ranging from the skills-based, behavioral strategies of Dialectical Behavioral Therapy (DBT) to the values-driven approach of Acceptance and Commitment Therapy (ACT). Somatic Experiencing offers a powerful way to access the body’s organic intelligence and restore balance after trauma.
My work at Explore What’s Next will focus on groups and workshops rather than individual therapy. In early November I will be starting an exciting new group, ACT On Depression, based on Acceptance and Commitment Therapy with a focus on teaching skills to heal from depression.”
For more information or to schedule a thirty minute screening session with Dr. Brook, please contact her directly at firstname.lastname@example.org or 307.278.9040.
New guidelines calling for pregnant women and women who recently gave birth to be screened for postpartum depression came out this week. Well it’s about time, I thought.
Honestly, I’m a bit confused that the frequency of postpartum depression is presented by the media as some kind of revelation. For ages it’s been known that the majority of new mothers report lowered mood after giving birth. The majority! Back in 2009, when I wrote “Bad Mommy! The Baby Blues & Postpartum Depression,” the Mayo Clinic reported as many as 80% of mothers said they experienced the baby blues and that postpartum depression occurred in 10-20% of women after giving birth. Today it’s like, Wow! a whole new finding that “one in eight and as many as one in five women” develop symptoms of postpartum depression. Which, btw, translates to 10-20%.
Whatever! When it comes to women’s health the sands of awareness and change are slow indeed! At least in this case we are going in the right direction.
“Depression is among the leading causes of disability in persons fifteen years and older. It affects individuals, families, businesses, and society and is common in patients seeking care in the primary care setting. Depression is also common in postpartum and pregnant women and affects not only the woman but her child as well.“
The preamble to the latest recommendation statement from the U.S. Preventive Services Task Force is clear. It would be a good thing for medical professions who care for women to know about postpartum depression and make an assessment for it part of their routine exam.
Please, medical professionals, get some training in how to do this from a behavioral health professional! Sensitivity is just as important as a valid screening tool. Women may be reluctant to report their lowered mood because she ‘should be happy’ about her new baby. Anything less would be failure.Read More...
You would never know that the days are getting longer and my mare, Annie, is actually shedding. Anyone living in the deep North of the US is acutely aware of our sub-zero days, endless snow with drifts as high as an elephants eye! In other parts of the world it might be hard to imagine what we are dealing with. Over the weekend my sister who lives in Southern California sent me this picture of the view outside a beach house.
My reaction surprised me. Instead of being filled with envy and bitterness, I was relieved! Thank God! Somewhere in this world there is color and palm trees! It made me smile and shed a tear of gratitude.
Then I sent her this video of the view outside my window on the same day:
So the envy and bitterness wasn’t that far off after all. There it was lurking in the cold corners of my house, my neighborhood, my town, waiting to suffocate me any minute now.
These are tough times for the snow and cold bound. In my practice, just about everyone I see has something anxious, angry or depressing to say about the weather. No matter what the real theme they want to work on is, the coda plays: “…and then there’s the weather.”
Like labor pains, I don’t remember how bad past winters were. We tend to think that whatever we are experiencing now is the worst ever! But in this case, I really think this winter is the worse winter ever! A few years back I shared eight things that helped keep me warm, happy and sane despite the freezing temps after the holidays and without football to distract us. They still apply:
1) Alpaca fiber socks. These socks are the best socks in the world! They are called Survival Socks for a reason! Warm, soft and amazing at keeping dry. If you wear boots for any reason, for sport, for work, to dig out of the snow or walk your dog through the snowdrifts, these socks will not let you down. Even after coming in, I keep my alpaca socks on to pad around the house. A favorite sweater, wrap (#4), velvet-y soft pants and top, on some days can feel like a warm hug from Mom when we really need it.
2) Bonjour Primo Latte battery operated whisk. I am not big on kitchen gadgets but this is one I love! For under twenty bucks you can make your own skinny vanilla latte at home any time you want! Try this recipe: 3/4 cup 1% milk + 1/4 cup water heated in the microwave for 30 seconds, 1/2 tsp sugar, 1 tsp instant Espresso, a drop or two of real vanilla extract. Whisk with your new toy and Voila! A steamy, frothy, low cal treat!
3) Hot chocolate. Not just any hot chocolate. Ghirardelli Chocolate Mocha! I take my chocolate very, very seriously. This stuff is the Rolls Royce of hot chocolate. All other hot chocolate will turn to chalk in your mouth after you taste this rich goodness. That’s all I have to say.
4) A ruana, shawl, cosy blanket, throw or snuggie. OK, maybe not a snuggie but I love my favorite ruana, a soft wrap that traps my body heat just where I want it and it looks good, too! Which, let’s be honest, a snuggie can never do, even a leopard print one. Just thinking about my ruana makes me feel warm. I think I’ll go get it right now. (see #1)
5) Treadmill. If it weren’t for my treadmill I would be a squirrelly mess. Activity is a depression buster, and not being a skier, walking on my treadmill gives my cooped-up energy a place to go. Otherwise I’d be hurling large objects at my husband for no good reason. You don’t need a treadmill to move. Put on your favorite jam and dance wildly! Go through some yoga poses throughout the day. Stand and walk around while you’re on the phone calling the furnace guy.
6) Oil popped popcorn. Microwave popcorn is good but real oil popped popcorn has that special almost like movie popcorn taste. Some people say popping your own is healthier than microwave. I don’t know but I do know it’s cheaper! Popcorn is not that hard to make once you have the knack. Try this recipe.
7) A dog or a cat or any cuddly pet. Their furry goodness warms the heart and makes the frozen days feel less isolating. If they let you get close, their body heat is a good as any heating pad. They are great entertainment value as well! My dog happily hopping in the deep snow makes me laugh every time. Winter depression busted!
8) Binge Watching. All the Mindy Project and The Good Wife episodes you can stand passes the time during a blizzard.
Try this. Work out first (#5), break a sweat doing any kind of movement, then settle down with #1-#7. Give yourself permission, to not be as productive as usual, to sleep a little more and eat carbs. You’ll be purring with contentment in no time.
What helps you survive the winter? Please share! I’ve added a few more ideas in the comments section. I’d love to hear from you, especially if your situation if different. Do you have kids? Are you an older person or have a disability? What do you do to cope with our crazy environment?
Editor’s Note: The self-injurious nature of cutting is so alarming that people, even professionals, shy away from it. And yet there is a real need to address the reality of cutting head on, illuminate the whys of cutting and get everyone involved expert help. Explore What’s Next has tried to do just that in this series of articles about cutting. In this article, Kate Maleski, LCSW, Explore What’s Next therapist, offers eight helpful ideas if you are cutting and want to stop.
Why do I feel so much pain? Why am I like this? Why can’t I be more like them?
These are some of the questions that have lead people to think: I deserve pain and I want to physically feel pain. You may find yourself hurting yourself because you feel like nothing else works. Cutting doesn’t heal your pain…Read More...
Editor’s Note: Today we lost an hour! That would be totally unacceptable except that going into Daylight Savings mode is a sign that Spring and Summer are just around the corner despite the crazy weather. After this endless winter, especially for those of us in the Deep North, I can really use Kate’s post on how to break out of those bad winter habits!
This morning I woke up to chirping of the birds and I thought “we are almost there.” The past week I have really been noticing the days seem longer which has showed me that there is light at the end of the tunnel. This winter has really left me feeling sluggish and I am ready to make some changes. Here are a few ways that have worked for me!Read More...
“Humans, especially men, are notorious at forging ahead until the wheels well and truly fly off the trolley. Why is it that we only start looking after our heart after we’ve had a heart attack? The same can be said for our mental health. Look after it now, for a better future.” ~Matthew Johnstone
Describing what it’s like to be severely depressed to someone who’s never been there can be like describing the color blue to someone who was born without sight. Produced by the World Health Organization, written, illustrated and narrated by Matthew Johnstone, this video uses the metaphore of a Black Dog to help understand and validate what depression can feel like and what it takes to find hope again.
Thanks to my friend Mac MacDonald for sharing this with us! You’re the best, Mac!
Editor’s Note: Here is a great post from EWN Associate and psychotherapist Nicole Newcomb.
The holidays can be particularly hard when we are in the midst of grief and loss. We feel like a part of our holiday, as well as our soul is missing. Whether we’re going through the holiday season without a loved one for the first time, or this is the second or third, everything seems to remind us of the person we’ve lost and how much we loved them. If this is true for you, here are a few tips to help make the most of your holiday this year:
1. Set aside some time to cope. When we “stuff” our emotions and try to pretend they are not there, beware! They will resurface later at a less appropriate time, like in the middle of family dinner after a glass of wine or two! Pay special attention to how you are feeling throughout the day. Try setting aside a half hour in the morning of the holiday to give yourself permission to feel your emotions freely and take care of them. I suggest you write down how you are feeling or speak out loud to the person you miss (privately, so people don’t misunderstand and think you’ve lost your marbles! :-)). This is a healthy way to cope so that you don’t end up with too much “stuffing”.
2. Honor that person. Do not forget to show that person that you still care. Maybe you’d like to set a place at the table for the loved one, say a special prayer or express thought of gratitude about them. This suggestion only works if the rest of your family is on board. If you feel the family would not be responsive to this idea, honor the person in your own way, privately in your head. You could share their favorite piece of pie. Light a candle that is always present but only you know is the light of your loved one’s spirit and love. You could visit the gravesite and talk to them or go to a spot that held special meaning to you both. Leave a flower, a beautiful stone or note. This too will help you cope with your emotions.
3. Make a new tradition. Your holidays will never be exactly the same as they were when your loved one was present. I mean, who or what could fill that persons spot? Nothing can, and if you expect it to, you will set yourself up for disappointment. But don’t let that happen. Create a new tradition! If your tradition was to start the day by going out to breakfast, make holiday pancakes at home instead! Create a new and fun tradition to look forward to every year. One that will bring some new holiday cheer!
4. Focus on the present. Please do not forget about today! After you have given time and honored your loved one, coped with your emotions and created a new tradition, don’t forget to enjoy it! Just simply observe your surroundings by asking yourself what you see, hear, feel, taste and smell. Breathe deeply, slowly. This will quickly and painlessly bring you back to the present. All you have is this moment, so don’t forget to be in it!
Take what you like of these ideas and make them your own! Do you have an idea that’s not here that may help? Your thoughts and observations enrich our community! Please share them in the comments section!
And if you feel the need for extra support right now you may always contact us. There is no reason to feel alone.
Around this time of year I don’t think there can be enough helpful tips to keep the Happy in the Holidays. That’s why I’m sharing these classic holiday depression busters by Therese Borchard, mental health writer extraordinaire.
These 9 rules help me put the joy back into the festivities–or at least keep me from hurling a mistletoe at Santa and landing myself on the ‘naughty’ list.
1. Expect the worse. What I’m trying to say is that you have to predict bad behavior before it happens so that you can catch it in your holiday mitt and toss it back, instead of having it knock you to the floor.
2. Remember to SEE. SEE stands for Sleeping regularly, Eating well, and Exercising. Without these three basics, you can forget about an enjoyable (or even tolerable) holiday.
3. Beef up your support. If you attend Al-Anon once a week, go twice a week during the holidays. If you attend a yoga class twice a week, try to fit in another. Schedule an extra therapy session as insurance against the potential meltdowns ahead of you.
4. Avoid toxic people. This one’s difficult if the toxic people happen to be hosting Christmas dinner! But in general, just try your best to avoid pernicious humans in December.
5. Know thyself. Before you make too many plans this holiday season, list your triggers: people, places, and things that tend to trigger your fears and bring out your worst traits.
6. Travel with polyester, not linen. I’m saying that you should lower your standards and make traveling as easy as possible, both literally and figuratively.
7. Make your own traditions. Making your own tradition might mean Christmas Eve is reserved for your family and the extended family is invited over for brunch on Christmas Day. Or vice versa. Basically, it’s laying down some rules so that you have better control over the situation.
8. Get out of yourself. According to Gandhi, the best way to find yourself is to lose yourself in service to others.
9. Exercise your funny bone. Remember, with a funny bone in place–even if it’s in a cast–everything is tolerable.
Please share your favorite depression buster if it isn’t here! Click on the “Comments” tab above. We could all use your wisdom!