Wednesday, December 18, 2013

Medication: Menace or Miracle?

Medications can be a valuable adjunct to therapy in helping to resolve some of the distressing symptoms clients experience. Low mood, perseverating thoughts, worry, and more severe symptoms like hallucinations or extreme mood swings, are usually very responsive to the correct psychotropic medication. And yet, I often find clients balking at a referral to a physician for an evaluation for medication. Like counseling and mental illnesses themselves, taking medication can be a stigmatizing experience. Clients worry they will become dependent on the medicine, or perceive that they are "weak" when they are unable to improve their symptoms with talk therapy alone. Sometimes clients voice a concern that their insurance premiums or job security could be threatened by a record of taking an anti-depressant or mood-stabilizing drug. Additionally, I've heard some clients voice a belief that adding a psychiatrist to their team of health providers somehow makes the clients look and feel "sicker." Some of these fears can be addressed by adequate education and debunking the myths associated with these treatment tools. Most of us can understand how a diabetic's pancreas stops producing insulin, and therefore, to maintain life, a patient will have to take insulin shots. When a person's thyroid begins underfunctioning, clients are usually willing to accept that they will be on thyroid medication for the rest of their lifetimes to provide their bodies with the chemicals necessary to keep bodily systems functioning well. And many people swear by daily multivitamins to supplement their bodies' needs for necessary elements and compounds that enhance health. Psychotropic medicines, however, are often viewed differently, despite the fact that they work in exactly the same way the aforementioned drugs do. Depression, anxiety, bipolar disorder, obsessive-compulsive disorder -- all of these illnesses share common ground with diabetes, cancer, and epilepsy: they are all biologically driven. Many mental health diagnoses are a result of too much or too little of a neurochemical in the brain. We may think that symptoms that largely are experienced or made evident in our emotions, feelings or energy level couldn't possibly be created by a biological problem. But the efficacy of psychotropic medications proves exactly that. When the dosage and type of medication is appropriate, the majority of clients taking these medicines will find their troublesome symptoms improve, sometimes dramatically. Accepting the biological, neurochemical origins of psychological distress can allow appropriate and effective utilization of medications that can greatly improve clients' quality of life.

Wednesday, December 11, 2013

Embracing the Humbug

From retailer commercials, to holiday movies and stories, we are deluged this time of year with images and messages of family harmony, abundance of gifts, treats and parties, and messages of good cheer and joy. But we all know reality can be a quite different experience. Many of us struggle with feelings of melancholy -- if not outright sadness and grief -- during the holiday season. This time of year, we feel the loss of loved ones, missed opportunities and the limitations from aging or illness in a most profound way. Sometimes, we even feel guilty or flawed because we can't seem to grasp the holiday spirit, despite our decorating/baking/shopping/carol-singing marathon of activities. I suggest we experiment with a paradigm shift this winter. Rather than force ourselves to feel jolly when we feel more like emotional Jell-o (shaky and transparent) what would happen if we gave ourselves permission to grieve our losses, to consciously choose to reminisce about those dear ones who will not be around our hiliday table this year? What would it cost us to be gentle and compassionate with ourselves and allow ourselves a holiday-free weekend unencumbered by party invitations, gift wrapping obligations and cookie-baking demands? After all, I'd wager that while some of our treasured traditions are built on generations of shared joyful experiences, others are crafted more from guilt and obligation. Do we REALLY have a genuine desire to have a freshly cut tree in the front window, even though the dog is likely to use it for a toilet, and we will be hoovering pine needles well into spring? Are we EXCITED to invite Uncle Harry to the Hannukah party, despite knowing the evening will end with Harry passed out in the hallway, like he's done the past 20 years? When my grandmother died some years ago, her baking traditions were assumed to pass on to me, her only grand-daughter. (Apparently, even in 21st-century Italian American families, grandSONS are not expected to bring anything to the holiday meal beside their appetites.) The thing is, Gram's honey-rum cookies are a b%+@! to make, and I never really liked the pizzelles, despite their pretty, lacy designs and cool waffle-maker-like baking appliance. I chose to let my sister-in-law take the honors for those recipes, and I bake the two -- and only two -- kinds of cookies I like. It was one small choice I made to avoid a weekend stuck in the kitchen preparing desserts I detest just so I could demonstrate a devotion to my Gram's memory. In fact, honoring my Gram is more evident when I choose to model her love for her family, or when I enjoy a glass of her favorite Chianti (which is also my own, thanks to Gram's introduction to the joys of the screw-top jug.) I will cop to still feeling a slight panic if I have to deviate from my extended family's decades-long history of producing typed, catalogue and photo-laden Christmas lists at the dessert table on Thanksgiving. And I've not yet developed the courage to tell my Mom it would be more convenient for my family if we could push Christmas breakfast back an hour or so. But come December 26th, I will risk my wife's displeasure and my son's eye rolling when I continue my lifelong tradition of lolling about the house all day in my pajamas. My wife is welcome to hit the mall for a frenzy of returning gifts and scoring after-Christmas deals. My son is free to keep a wide berth from my flannel-clad form. I have found that learning to honor the parts of the holidays that bring me joy -- and to avoid the ones that don't -- may be one way to ensure I'm able to add some cheer to everyone else's.

Wednesday, December 4, 2013

The New Pioneers

I'm continuously amazed by the creativity, courage and resilience of transgender folks, as they carve a path through the unchartered world of transitioning between genders. We are a binary society: we are most comfortable with black and white, right and wrong, male and female. Transgendered clients don't fit easily into this "if not this, than that" mold. Who else has to consider which public bathroom to use? Who else fears for their personal safety based on whether they appear feminine "enough" to avoid a second glance from strangers? Who else has to worry that her newly legal first name doesn't match the gender box checked on a job application or a drivers license? The potential obstacles to everyday activities seem never-ending to my transgendered clients. Fear, rejection, frustration -- these emotions are constant companions to these brave souls who want, more often than anything, to simply fade into the background, to garner no more attention than any other person in the room. And yet, due to society's ignorance and rigidity, transgendered folks are barraged with discrimination, ridicule and regularly singled out for harassment and abuse. Insurance rarely, if ever, covers medical treatment beyond hormone replacement therapy. The economic costs of legal processes and employment instability can threaten the well being of even the wealthiest client. In the 15 years I've counseled transgender clients, I've not met a person who hasn't experienced suicidal thoughts, hopelessness and the loss of significant relationships as a result of their bodies not matching their internal experience of who he or she is as a person. As a culture and a society, we lag woefully behind in our efforts to understand, embrace and celebrate the gifts that transgender people can teach us about what it means to be male, to be female, to be human. To walk beside these extraordinary human beings is an honor, and a chance to witness people who are destined to change not only their physical selves, but also the course of history.

Wednesday, November 20, 2013

Survivor: The Isle of Holiday Celebrations

Television etiquette experts recently suggested routes to avoid potential family conflicts at our upcoming holiday celebrations. I had to laugh--my extended family celebrations don't end UNTIL there's a conflict a-brewing, just hopefully not involving firearms or flying crockery. (My mother still publicly mourns the death of her favorite gravy boat each time we sit down for Thanksgiving dinner). The (clearly) more civiled pros offered ideas like "focus on what the family is grateful for this year" or rehearsing conversation-diverting remarks designed to thwart Aunt Rita's criticism of cousin Jordan's green Rasta locks from evolving into a full-on family throw-down. "Avoid contentious topics" was another gem tossed out by the Etiquette Mafia. No talk of religion, politics, or sensitive social issues once the bird is on the table. Yeah, good luck getting my clan to sign on to that plan. What are we left with: should baby Jessica be enrolled in the Montessori school or the arts academy that requires child AND parent interviews? My family has had more heated debates over loyalty to the Sox versus the Cubs, or fake vs. real Christmas trees than about any political stance. Seriously, we suffered a decades-long cutoff when my uncle challenged my aunt's claim that Frank Sinatrs was the finest singer who ever lived. (To this day, I experience searing pain behind my eyes at the first bars of "My Way.") I can't imagine the stares of incomprehension I'd receive if I tried to whittle down the topics of "acceptable" dinner conversation. That act, in itself, would guarantee a few choice hand gestures in my direction. But, before you go thinking my family is a bunch of boorish, backwards heathens without the sense to come in out of a snowstorm, I maintain that we are also fiercely devoted to our -- and each other's -- kids; always willing to bring a meal or run an errand for a sick sister or nephew; and slavishly committed to a range of sentimental, heart-tugging rituals and traditions that brand our family as uniquely our own. This holiday season, I've decided to make one change, and like the church hymn says, "let it begin with me." Rather than dictate others' discussion parameters, or take responsibility to diffuse an insult from hitting its intended mark, I've decided to approach this year's festivities with an energy of openness. All the rules and recommendations, ultimately, come from a place of fear and anxiety, and we all carry enough of that baggage already. Sure, gathering around the table is akin to an open invitation to fisticuffs in my families' domiciles, but I doubt I help the process when I approach my family girding for the worst. I can't change them, and I'm not respecting their autonomy when I try to run interference. But perhaps, stepping across the threshold with an air of positive anticipation and joy at our motley gathering, rather than adopting the protective stance of a defensive lineman, may alter the course of the evening's energy for the better. Still, I'll probably choose the seat closest to my older brother: his bodybuilder girth is good cover if the salad plates go flying.

Tuesday, November 12, 2013

The Scars of Self-Injury

Few of us can imagine inflicting the kind of physical pain and damage that self-injurers inflict on their own bodies. For many people, the concept of self-injury is as foreign as imagining picnicking on the moon. But in our counseling rooms, we see the reality of self-injury far too often. Cutting, burning, poking, slapping -- these violent behaviors can be regular occurrences in the lives of some of our clients. What would drive someone to hurt him- or herself? Isn't self-injury just a bid for attention? Is there a difference between self-injury and suicidal ideation? Loved ones of those who self-injure struggle with these questions. And while the specific instigating factors behind one's self-injurious behaviors are as varied as the individuals themselves, some commonalities can be noted. People who hurt themselves often engage in an addictive-like relationship with this behavior. They initially find some sort of emotional relief -- either in the form of distraction or a sense of release from psychic pain -- from the harming behavior. Later, either due to a lack of appropriate coping resources, or the relative speed with which self-harm usually provides relief, the person continues to use these actions to deal with more distressful life situations over time.

Most of us can recall a moment of self-loathing or a period of hopelessness in our histories. For those who self-harm, self-hatred, a sense of continuous personal failure and a fear of relinquishing the tool that has brought them relief are constant companions. And while the behavior can appear dramatic and attention-seeking, self-injury is rarely a casual choice by the individual. Due to the addictive nature of the dynamic, someone who hurts himself can quickly become reliant on this maladaptive coping skill. We can understand someone getting a sense of relaxation, increased well-being, a distancing from their problems, by drinking alcohol. Tobacco smokers often report feeling instantly calmed and/or energized, not just from that first puff, but even through the rituals of igniting their lighter or smelling the sulphur of a dying match. Similarly, self-injurers can experience a lowering of stress via the habit of self harm.

People who self-injure are at a higher risk of suicide, not only due to their struggles with depression and hopelessness, but because the risky behaviors associated with self-harm could inadvertently creat a risk to one's life, even if she isn't intending to end her life. Self-injurers have mistakenly nicked a major vein or artery, causing them to hemorrhage before help could be obtained. Some wounds can get so infected they can lead to sepsis, a potentially life-threatening blood infection.

The treatment for self-injury almost always involves a holistic approach, including individual therapy, medication, group therapy to teach skills like stress management, frustration tolerance, emotion regulation and appropriate self-care. Centering skills like mindfulness and meditation are other helpful tools that can help clients to learn to manage their painful life experiences without resorting to self-harm. Occassionally, hospitalization is necessary to ensure an individual's continued safety.

Self-injury is always a sign of deep distress and a loosening of one's ability to manage their pain in effective ways. But clinical and medical intervention can help these clients regain control of their lives, and offer a path of hope and recovery into a life marked by positive self regard, rather than haunting scars.

Wednesday, November 6, 2013

The Gifts in Gratitude

November is marked by colorful leaves, falling temperatures, an abundance of turkey-related products at the supermarket and the varied modes giving thanks takes. Recently online, I've seen groups of people daily enumerating the things in their lives for which they are grateful. From sentimental to sublime, folks are counting their lucky stars for their spouses, a warm home to return to after a busy day, a full refrigerator, health and autonomy, even a close parking space at the crowded Target on a rainy Saturday. These sentiments are not meant to be a Pollyanna approach to dismissing or minimizing the suffering that goes on in our world everyday. Rather, they are a reminder that there is, indeed, a yin and yang to our lives, times when we are deep in shadow countered with periods of lightness and grace. Being conscious of our blessings will never negate the losses and sadness that mark some days. But those bright spots do provide us with an opportunity to connect with grace, to be reminded that good and love and hope are around us if we choose to look for them. Some days we may need to look long and hard to find the glimmers of sweetness. They may appear hidden deep in the loam, barely visible save for the one small glint that we catch only if the light is right. Or they may appear as evident as a gold star on a spelling test. Resilience is found in remembering to grasp the good, risking the reaching. By training our eyes to view life through the lens of gratitude, we discover, like the many-hued leaves at our feet, gifts unending.

Thursday, October 31, 2013

Hiding in Plain Sight

My wife took our son Halloween costume-shopping over the weekend. They kept me in the loop, messaging me photos of themselves in all kinds of getups: as Wild West Cowboys, chefs in aprons and torques, spooky witches complete with brooms and black hats. They seemed to favor the masks, though-- political figures, celebrity faces, spooky goblins. In the pictures, the masks were so detailed and enveloping that I didn't know whether my wife or my son was the model. He finally settled on a creepy clown mask, which he customized at home with gruesome splashes of fake blood. In his mask, my son could be anyone, a stranger I'd never know or a neighbor down the street. Kind of unnerving to think about. But not all that different from the masks we wear everyday. Whether its the confident face of a businessperson as we enter a sales meeting, or the calm expression we adopt to ease the tantrum of a wailing child, we may adopt different faces to fit the range of experiences that fill our day. And certainly, many of those masks are truly functional, moving us forward or producing a benefit in the end. When we approach our child's teacher to discuss a failing grade, we're most likely to experience a positive outcome from that interaction if we approach the teacher with an expression of openness, seriousness and concern rather than with the outrae we may be feeling beneath the surface. Or if we are considering asking the boss for a raise, we're better primed for success if we enter his office with a pleasant affect and energized demeanor, even if we are fearful about the rumors of layoffs or frustrated by a coworker not pulling his weight. But, just as easily, we may find ourselves adopting a mask that holds us back from taking risks, connecting, or speaking our truth. I've seen couples "put on their best face" for each other, trying to avoid painful losses or minimize the chance of conflict. Similarly, I've worked with teens whose masks of bravado and insolence hide the deep pain of rejection and the fear of failure. But only through authenticity can another truly know And empathize with our experience. We may think its kinder to "smile and nod" when asked for our honest opinions, but we may actually be communicating subtle disrespect by giving someone less than our real truth. Manners, grace and politics will always have their place. But showing the world our true selves is a courageous choice that can bring us closer to one another, and build connections with the potential for deeper intimacy, for a truer knowing of each other and ourselves. That's a treat that will last through countless seasons.

Wednesday, October 23, 2013

The Pursuit of Happiness

Our practice resides in a part of Chicagoland with many benefits: beautiful homes, excellent schools, relative proximity to downtown attractions, vibrant shopping and dining options. But alongside these positive attributes comes, at times, a focus on material success and financial, academic and occupational achievement. Although I am a proud social worker and strong believer in equality and parity in opportunities and options for all folks, I am far from a Marxist. I believe in capitalism, self-responsibility and working hard for our goals. However, I am consistently faced with young clients struggling beneath the burden of the achievement-oriented philosophy so rampant amongst most of America. In some of the communities I serve, kids in middle school are already more aware of the impact of ACT scores on their educational opportunities than I was when I took my ACT at 17. I've heard young clients describe anxiety and somatic symptoms created by a belief that taking less than 4 honors or AP classes will doom them to a second-rate college. And, sadly, I have counseled some parents who have vehemently defended their focus on Junior achieving straight As as a reflection of their inherent parenting responsibilities. Perhaps my perspective is a function of my age, or of the current prediction touted by the media that no longer can future generations expect to do better socioeconomically than their parents. But it seems to ring true, time and again, that academic and professional achievement is not the only road to a happy, fulfilled life. Should a child choose to be a clerk at the electric company rather than an electrical engineer, is he or she doomed to a life of physical and emotional squalor? Or is it possible that a life rich with rewarding relationships, a solid spiritual life and a desire to improve the world can be a path just as desirable? Indeed, no parent looks forward to their children struggling in adulthood. But any counselor can recount ad nauseum story upon story of people whose emotional,spiritual and relational struggles were as devastating to them as living on a paltry paycheck. Our responsibilities as parents includes not only offering our children the finest educations and career exploration opportunities we can find, but also to guide our children into developing the life skills of relationship-mending, spiritual development and emotional resilience. I'll admit, it's easy for me to adopt a laizze faire attitude toward my child aiming for the Ivy League. After all, when my adolescent son scored a 50% on his biology exam, his (completely non-ironic) response was, "Hey, that's halfway to 100%!" Still, I'd like to think that, even if my child dreamed of a career in the operating theatre rather than the Broadway venue, I'd still try to communicate the importance of less-material trappings as being vital to his happiness. Achievement may be one road to happiness; our children can benefit from being shown that other paths can lead to their own happy ending.

Come Together...Right Now

The Beatles were onto something with that idea. Coming together as a community, for a common good or a shared goal, creates benefits that go beyond the efforts extended by the group. Feeling a sense of belonging, of having a "tribe" helps us feel less isolated, lowers anxiety and stress, and provides a sense of identity and purpose. Community can be found anywhere; indeed, expanding our definition of community allows us a more unique and broader menu of opportunities to connect with our fellow travelers on this planet. Some communities are more formal and structured, requiring dues or membership, like a union, a sorority or the health club. Others orbit around a shared interest, like a book club or knitting circle, and others around a shared purpose, including a church's lay ministry team or a group of Meals on Wheels volunteers. Even our workplace can be a place of community, despite it's potential politics and perhaps "bottom-line" mentality. Who recalls the early days of their working life, when the "newbies," often the younger folks in an organization, would regularly meet for beers after work to offer each other support and attempt to navigate through the confusing, overwhelming and sometimes frightening new world of corporate America? Feeling like other people "get" our experience helps us feel known and seen, and therefore more empowered in our lives. Now, I'm the last person you'll see at a PTA meeting, and my job is draining enough that I often balk at opportunities to volunteer that require more than writing a check. But I find myself smiling more through my workout after I use a few minutes pre-elliptical machine to chat with Joe and Bob, two 70-ish retirees who frequent the park district gym the same hours I do. Bob will fill me in on his grandkids' latest sports achievements, and Joe will gently rib me about STILL not following up with his financial advisor to ensure my retirement is well-funded.("You'll be us before you know it!" he says, curling s thumb in his and Bob's direction. "Hopefully with more hair!" I tease back, nodding at their bald pates.) I never see these men anywhere but the gym, despite our shared commitment to some level of fitness and the likelihood that we live in the same town and drive the same streets. But instances like these are potent reminders of how small, seemingly inconsequential connections can bring a sense of "sharedness", of how intertwined our lives truly are, if only we adopt the lens to SEE them that way. This is an age of Skyping and IM-ing, of quick tweets replacing long chats. Still, if we choose to open our eyes to the ways walking through the same door as another can highlight our "sameness", we can recognize that we are never really very far apart at all. The Fab Four were truly sages before their time.

Wednesday, October 9, 2013

Behind the Shadows

October brings thoughts of children in costumes, overflowing bags of candy, vibrant fall leaves, the crisp taste of apple cider. But October also commemorates a more ominous phenomenon -- this month is National Domestic Violence Awareness Month. The past decades have brought the reality of domestic violence out of the shadows and into the national consciousness. Most people know, or have heard of, someone who has survived domestic abuse, and movies, television, print and digital media regularly provide information or portrayals of family violence. Services for survivors of domestic violence exist in most metropolitan areas, and shelters for victims are present, though sometimes purposely invisible, throughout the country. But despite the increased awareness of domestic violence, may people are unaware of the signs that domestic violence may be occurring in the lives of friends, coworkers, and loved ones. Following are examples of behaviors that signal the presence of domestic violence:

1. Fear of one's partner
2. Yelling, humiliation, criticism
3. Being forced to participate in sexual behavior against one's will
4. Physical abuse (including pushing, shoving, grabbing, restraining, slapping, kicking)
5. The THREAT of physical violence
6. Threats to hurt/limit contact with one's children, friends or family members
7. Attempts to limit one's contact with friends or family
8. Destroying belongings or property
9. Controlling the movement and freedom of a partner
10. Excessive jealousy or possessiveness
11. Limiting one's partner's access to money, phone or the car

These are only a few examples of physical domestic violence that can occur in relationships. Many others exist, and the emotional abuse that inherently accompanies violence can be so subtle as to be difficult for the victim to feel confident that emotional abuse is actually happening. Historically, women have been the main victims of domestic violence, but men and children can easily fall prey to this abuse as well. Violence is ALWAYS the choice of the person perpetrating it. But information and awareness of the forms violence can take can help us to identify this dynamic in our own lives or those of people we care about. Help is available through doctors, mental health professionals, law enforcement, and domestic violence hotlines and shelters, to name a few. If you suspect you or a loved one are experiencing domestic violence in a primary relationship, seek help. Visit the National Resource Center on Domestic Violence website at, talk to your physician (who legally must keep your information confidential), a clergy person, counselor or trusted friend. Perhaps someday the month of October can be associated only with the joy of jumping in a pile of leaves, apple-picking and bonfires.

Wednesday, October 2, 2013

One Step at a Time

Twelve-step programs are a well-known, and some argue, an essential part of the recovery process. Whether a
person struggles with alcohol or drug addiction, eating disorders, co-dependent relationships, or process addictions like gambling or sex addiction, 12-step programs can provide guidance, education, support and a sense of community crucial to behavior and lifestyle changes. Accountability, spiritual connection and service to others are components of this tool in recovery. Members are encouraged to get a "sponsor", an experienced member with significant time in recovery and a willingness to guide new members through the steps and into a life of sobriety and recovery. Progress through the steps of the recovery group can take months or years to complete; each individual is encouraged to go at their own pace in order to get the most understanding and benefit from the work of that step. Members learn that recovery is never mastered, and the work on the steps never ends. An appropriate progression through the 12 Steps often includes an individual finishing work on the twelfth step, only to begin over again with Step One, as new insights and emotional truths can come to awareness with each cycle through the steps. Recovery from addictions or compulsive behaviors is considered a lifelong undertaking. Twelve-step programs can be a lifesaving component to recovery, offering people opportunities to share their experiences, gain strength and cultivate hope for a healthy, vibrant life.

Thursday, September 19, 2013

Stronger in the Broken Places

Resilience is defined as "the ability to become strong, healthy or successful again after something bad happens." In the counseling session, we hear from our clients story after story about all the bad things that can happen in life. Our nightly news shows and daily papers highlight the horrors, tragedies and frightening circumstances that humans can't escape. And yet, go on we do. In the face of great uncertainty (will our government shut down due to budget disagreements?), nstural disasters (the flooding in Colorado) and human loss (the rising desth tollmfrom gun violence), we find ways to put one foot in front of the other. As a species, we've endured through cataclysmic events like the Holocaust and the World Wars in the past century, and plagues and bloody revolutions throughout known history. What allows us to survive, even thrive, amidst horror, devastating losses and mind-numbing pain? Some would say survival is a testament to the strength of the human spirit. Others would argue that our biological instinct is to survive and procreate at any cost. Hemingway wrote, "The world breaks everyone, and afterward many are strong in the broken places." We cannot avoid the pain that comes with living, with loving. But we CAN choose to mend ourselves, and each other, so that we are stronger where we were once broken, strong enough to reach out to each other, hold each other up, and keep moving.

Sunday, September 15, 2013

Building Our Parenting Muscles

We all know them. We've all been haunted, at some point, by these evil entitities, these demons that cast doubt and shame into the life of every parent. That's right -- The Perfect Parent. You know, those parents who bake gluten-free, nut-free and yet delicious snacks for the school bake sale. Or who arrive at 10 pm play rehearsal pickup wearing freshly pressed chinos or flawless makeup. The mom who not only attends every one of her child's performances/games/speech competitions, but also heads the PTA and hand sews her children's Halloween costumes. I will never be the parent who purees my own baby food from organic produce, or creates homemade flash cards to ensure my child is reading fluently in two languages before he is potty trained. But my work with families over the last three decades has taught me that I don't need to be in order to be a good-enough parent to my child. I've not come across any data that suggests that stressing myself out to parent "perfectly" will somehow earn my child entrance to his Ivy League school of choice. Not to mention a recipe for failure. None of us are perfect, as parents or otherwise. But the good news is we don't need to be. In counseling, we teach parents that being a "good enough" parent provides our children with a healthy foundation to grow into functioning adults. "Good enough" parenting focuses on what kids really need: nurturing, challenging, safety and structure. Most of us are comfortable with our skills in a least a few of these areas. I, for one, am confident that my affection, love, and empathy for my child communicate my love for him. But my "muscles" in challenging my child can be woefully week. Really, does my 14-year-old need me to cut his nighttime snack of an apple? Or would encouraging my child, who struggles with fine motor tasks, to tackle this task be an opportunity for him to develop competency and self-esteem? The good news is that our awareness can be the beacon that directs us to focus on those parenting behaviors that need strengthening. Whether you need to remember to deliver more praise, or to enact a bedtime schedule that ensures your child gets adequate sleep, becoming a "good enough" parent is within the grasp of all of us. Reject the myth of the Perfect Parent. Go ahead and bring that store-bought cake to the Scouts' bake sale. Letting your 10-year-old count out the bills at the checkout is a lesson for you both.

Thursday, September 5, 2013

Respect the Rest

Nap. Snooze. Shut-eye. Bedtime. If you are like most people, these words conjure images of snuggling beneath covers, curling up on a comfy couch or otherwise retiring for some well-deserved rest after a demanding day. But, if you are also like most people, you are woefully, chronically short of the amount of sleep your body and mind need. Science is increasingly studying the phenomenon of sleep, and discovering its vital role in health and longevity. Poor sleep has been linked to every ailment physical and psychological -- from depression and post-traumatic stress disorder, to cancer and heart disease. We need sleep not only to refresh our bodies and minds from the exertions of our day, but also to allow our bodies and minds time to HEAL. Many parents have had the experience of waking their children in the morning to discover that their little ones seem to have grown overnight. While these changes are more a function of perception than a factual happening, it IS true that our bodies and minds use the time during sleep to regenerate and renew. Sleep slows us down, allowing tension and inflammation to ease. Sleep is a time for our thoughts to quiet, for our list making snd to-dos to take a breather. Like a cleansing breath, sleep rewards us with needed energy and stamina and offers an opportunity to leave behind thoughts and behaviors that may not have served us the day before. Sleep is a necessary boundary between "what was" and "what can become." We have become accustomed to hearing about the importance of a healthy diet or making time for regular exercise. Perhaps we will soon hear that sleep is as essential to our well-being as low cholesterol or vitamin supplements. And while we will sacrifice sleep at times to get in a workout or finish a project, we may be even better served by hitting the snooze and rolling over. If we could approach our bodies' need for sleep the way we consider it's need for fuel and exercise, we'd be more likely to give rest the respect it deserves. Invest in a good pillow. Try those high-thread-count sheets when they go on sale. Notice the sensation of your body sinking into the mattress, the feel of the covers conforming to your body, the sound of your breath as it slows and evens. I wish you sweet dreams.

Tuesday, August 27, 2013

Psstt...I've Got a Secret...

Boundaries are a frequent focus in counseling: how to create healthy ones, learning when to flex or enforce them, understanding their importance for emotional and physical safety. Privacy is a boundary that can be tough to navigate in intimate relationships, families and close friendships. It's not uncommon for people to confuse privacy with secrecy. These concepts are actually very different. Privacy is an innate human right. All people need to have thoughts, space, behaviors and belongings that are theirs alone. Contrary to some beliefs about communication snd relationships, NOT EVERYTHING needs to be shared. A person's thoughts, wishes or desires can remain unspoken. And sometimes NEED to be. (Really, what good will be gained from me telling my son that I don't like his haircut? Or from correcting my relative's constant pronunciation of "pitcher" to "PIC-ture"?) I often tell clients that privacy is as vital to a healthy sense of self, safe boundaries and productive relationships as is good communication. However, many people confuse privacy with secrecy, it's not-quite-healthy close cousin. Generally, secrets create distance, mistrust, fear and a sense of being unsafe. A good rule to discern the difference is to ask the following questions:

1. Does this behavior or choice impact the well-being of someone else?
2. Would knowing or not knowing this information affect someone else's behavior or choices?

In general, if my behavior affects only me, or if sharing information has no bearing on another's well-being or future choices, chances are that information would fall into the category of "private." Think of whether I choose to avoid exercise for a week, or if I choose one path of education versus another. Conversely, if information I have, or behavior I enact, involves or impacts someone's welfare -- whether they know about it or not -- withholding that information could be construed as "secrecy" and therefore be destructive. Consider a spouse who is sexting a work colleague, or a child who witnesses bullying and doesn't alert an adult. While secrets exist, of course, that can be playful and exciting (a surprise party, an engagement) , in general most secrets in relationships and organizations are the downfall of a thriving, healthy system. Privacy enhances safety; secrets can destroy it.

Monday, August 19, 2013

To Schedule or Not to Schedule? (or, Why Can't I Manage to Wear Real Clothes When Im Driving the Car Pool?)

This time of year is dominated by school clothes shopping, last-chance trips to the pool and my son trying to stay awake as long as possible on the few nights left of summer. Before we know it, we will be immersed in email reminders from teachers, midnight runs to the all-night drug store for forgotten poster board, and interminable hours spent in our cars: picking up, dropping off, shuttling less-than-grateful offspring from one activity to the next. Regularly, I hear complaints from my parent clients that, by mid-October, they are depleted and snarky about the time and energy requirements their kids' busy lives suck from their parentS' energy stores. And there are still more than 7 months left of the school year. I routinely give my clients the same recommendation. SCALE BACK. And do it without guilt!! Well, this year, I hang my head in shame to realize I have fallen into the very same trap I warn other parents about. Physician, heal thyself? Ha!! At this point, I'd need a team of Harvard-educated specialists to scale me back to any sane expectations of myself or my abilities. This year, my soon-to-be high schooler was accepted to his school's auspicious show choir. As part of his participation, it was "suggested" that he make the most of his "vocal gifts" by beginning weekly voice lessons. With a member of the Lyric Opera. (Cha-ching!) And of course, show choir members must also participate in the school's regular choir. Both groups, of course, rehearse on different days, for several hours at a time. Add to that menu of all-things-singing related the various fundraisers each student is expected to run, to augment the FOUR-FIGURE fee that's been passed on to parents for their little stars' inclusion in these illustrious organizations. Not to mention the time, money and energy that will be added to our energy depletion when he tries out for the four plays and two musicals produced yearly by the school. And now my future Hugh Jackman would like to hone his critiquing skills by reviewing current movies, with the mission of saving his peers from wasting time and money on a film unworthy of them. Now, I know that WE choose to have these children join our lives, and I believe in providing my child with every academic and cultural opportunity in which he's interested. But, when he got a role in a summer theatre musical, and I was sitting in a church parking lot at 11:30 pm on a rainy Wednesday night (the fourth consecutive day, I might add), sweating in my pajamas because I was afraid I'd run out of gas if I used the energy on the defroster, I seriously considered praying that my son be struck mute or, at the very least, suffer a week-long bout of laryngitis. I am coming precariously close to becoming one of those parents who earn the mockery and eye-rolling of other (read: saner) parents. One of those parents who will sacrifice sleep, groceries, and the wearing of daytime clothing to further their little performer's budding career. While I would love nothing more than to see my son make his debut on the Great White Way, in my more logical moments, I have to question whether I am truly HELPING my son by supporting all these activities. I can't remember the last time my child complained, "I'm bored!" How could he? He can rarely remember to bring his backpack/song sheets/glasses home from his dad's or to eat more than a granola bar before we rush off to the next rehearsal/lesson/performance. I've never been a big fan of technology, but isn't part of being a teenager spending hours on the phone with friends talking about nothing in particular, and playing video games until he qualifies for carpal tunnel surgery? I may sound like I'm advocating for our kids to lower their sights for their futures, that I'm suggesting they skip a few classes and hang out on the "smoking lot" (remember that?) rather than aim for developing their artistic gifts or athletic skills. But don't we want our children to learn that success takes all forms? While getting into Harvard or being a first round draft pick is commendable, I'd like my son to value his ability to be a good friend, to be creative in his use of free time, to be willing to stretch and try activities he's wretched at just to see if they are FUN. The time has come for me to put my money where my mouth is. When the show choir director "recommends" dance class or acting tutorials, I may best be advocating for my son if I answer "No, I don't think so." Keeping my night shirt and sweat pants ensemble INSIDE my four walls is a gift my neighbors will appreciate.

Monday, August 12, 2013

A Yen for Zen

Meditation. Contemplation. Prayer. Clearing the mind. All concepts being touted as helpful to sustaining the ability to live in the moment, to be "mindful". Meditation has been shown to help with emotional issues including anxiety and stress, and to enhance physical health by lowering blood pressure, increasing oxygenation of the blood via deep breathing and improving sleep. But here in the West, meditation practice is often linked to the idea of long hours twisted into the lotus position, chanting mantras and gaining enlightenment. Not that enlightenment wouldn't be a welcome visitor to our stressed, harried lives. But, unlike cultures who grow up with meditation being as much a part of their daily life as bathing or eating, we Westerners (wrongly) assume that there is a "right" way, time or duration in which to meditate, and we simply can't fit it into our already packed schedules. The truth is, meditating can last as little as a few seconds, and can be done standing, sitting, laying down or in almost any position in which we find ourselves. Standing in line at the grocery store is a particular favorite of mine. I use the time to take deep breaths, focusing my attention on the sensation of my lungs unfurling in my chest, and the feeling of the breath exiting my body as I exhale. Walking my dogs is an opportunity to try walking meditation. Instead of planning my grocery list or perseverating about an argument with my wife, I notice how my heels make contact with the sidewalk, the different parts of my feet following suit until my toes push off the cement for my next step. When I am feeling an intense emoTion, like fear or anger, I try to remember to "watch" my thoughts that are fueling those feelings. I imagine the thoughts filling my mind like a cloud, and then a breath of cool air clearing the cloud from the field of my mind. These simple, short exercises have a remarkable ability to positively affect my mood, my energy and even the tension in my body. As experienced meditators know, these efforts are called a "practice" for a reason - we will never become experts. More than a few veteran practitioners have reminded me that the truly wise know that the practice of meditation will never be mastered, and the more one practices, the more one realizes there is no "end point." And there's something freeing in feeling like I don't have to do it "right" to reap the benefits. So instead of berating yourself for not having the time or knowledge to effectively clear your mind, try washing the dishes with a focus on the rainbows glistening in the soap bubbles, or noticing the individual feathers on the robin outside your window. Enjoy your next cup of coffee with a focus on the swirls your spoon makes in the liquid as you stir. Remember, you don't need to do it perfectly. You just need to start.

Thursday, August 1, 2013

Pollyanna WHO?

A wise old sage once said, "You can't swing a cat without hitting a life lesson." OK, so no sage--wise, old or otherwise-- ever said that. Just a tired, middle-aged working mother whose skills with metaphors sorely need a jumpstart. But you get the gist. We are daily confronted with challenges that are ripe with learning and growth. Now, I'm not going to get all Pollyanna-ish about these challenges. Indeed, many of the hiccups, obstacles and plain ol' terrifying choices we face are nothing short of brutal and harrowing. A nasty divorce, a frightening diagnosis, the death of s beloved pet are all experiences that many of us barely survive without resorting to fantasies of fleeing to another country under an assumed name and living out our days aa far from the site of our tragedy as we can humanly get. I'm not parroting the gems like "everything happens for a reason" or "God won't give you more than you can handle". (Try saying that to the Lost Boys of the Sierra Leone or to a parent who has lost a child. ) No, I will struggle all my days with the grief that comes with undeserved suffering. But I'm starting to believe that the smaller, daily irritations, failures and mistakes are chances for me to challenge myself to be my better self. Who hasn't wanted to respond snarkily to the co-worker who criticizes our project/ideas/latest do-it-yourself hair color? (You know who you are.) Yet, I've found that, when I can muster up the patience, or courage or self-discipline needed in such moments, I walk away feeling not only better about myself, but more optimistic about us as a species. (OK, call me Pollyanna). After all, if a flawed, fearful weakling like me can choose to wish grace on s noxious neighbor, or practice patience when my son loses his $150 calculator for the THIRD time, then there is hope for all of us. Life will never be a smooth, even road. Being willing to see the bumps as opportunities to practice those life skills that make our daily lives easier, more peaceful, even just more bearable, is a lesson I try to be willing to sign up for every chance I get. And like most of us, I get plenty of chances. So much for being a freckle-faced redhead.

Tuesday, July 23, 2013

Re-thinking Co-dependence

"Co-dependence" is a word that is tossed about frequently in the recovery community, as well as in arenas focused on developing and maintaining healthy relationships. A loaded and largely pejorative concept, co-dependence is characterized by poor boundaries, enabling behaviors and feeling (misplaced) responsibility for others' feelings, decisions snd lives. While people of nearly any age, or gender, can be labelled as co-dependent, it is a tag that, historically, has been slapped largely on women. Cultural review suggests that the initial focus on substance abuse recovery for male alcoholics via the 12-step program of Alcoholics Anonymous generated the idea of supporting and educating the wives of these men, with the hopes that informed, knowledgeable wives would provide essential support to alcoholics in recovery. Even today, most AA meetings are male-dominated, although over the years, we've seen a boom in groups created specifically for women, adolescents, people of color and lesbian, gay, bisexual and transgender folks. The initial purpose of including spouses in the 12-step programs was to provide them with much needed support, but also a forum for them to explore their roles in the dynamics that facilitated their partners' drinking snd changes they could make to support their husbands' quest for sobriety. Along the way, though, the concept of co-dependency has grown to a scope and reach I'd suspect was never part of the plan when Dr. Bob and Bill W. first welcomed a group of drunks to the initial AA meetings. It seems to be applied so broadly that the seriousness of the unhealthy behavior, thoughts and choices made by true co-dependent people, not to mention the often grueling recovery co-dependent folks have to undertake to free themselves from this soul damaging condition, is watered down and misinterpreted. Additionally, using the term to label unhelpful, ill-guided or ineffective ways of relating casts a negative light on people who don't really fit the parameters of true co-dependency.
The reality is that co-dependency, like most patterns of behavior, is complex, individual and generated by a variety of different origins. Lumping all caretaking behaviors, or any fluid boundaries, under the label is harmful and confusing. Many of the behaviors and attitudes called "co-dependent" are actually well-learned lessons that folks absorb from their environments. Young girls, studies show, are still more encouraged to share, let others "go first" and compromise their own wishes for the good of the group, than young boys are. To burden women with the label of co-dependency when they are simply enacting generations' worth of messages about what makes a "good woman" seems unfair, at best, and destructive, at worst. Feminist theorists have long argued for a view of human psychology that better encompasses female experience, learning and voice. We can help our clients grow and change without blaming them for being good learners. Perhaps the genesis of co-dependent behaviors is less compelling than the benefits of changing them: healthier relationships, boundaries that are firm but flexible; self-responsibility and self-love; expectations of equal treatment with others. But until we change what we teach about gender roles, self-sacrifice and nurturing -- and who we expect to do the nurturing -- the phenomenon of co-dependency, and the path to recovery, will likely continue to be struggles for clients in our therapy rooms.

Tuesday, July 9, 2013

"Would You Rather Be Right--Or Happy?"

Am I the only one who would answer, "I'd rather be BOTH!" I'm pretty sure I'm in vast company. I've heard therapists, self-help books and TV talking heads suggest that, in relationships, we can choose to stick to our guns on a point of contention with our partner, or we can choose to accede to our partner's wishes and views and "be happy." But in my practice and in real life, I've found that many people find this choice excruciating. It's not the simple no-brainer it appears to be initially. People often feel intensely tied and loyal to their needs, viewpoints and desires; asking them to choose between strongly held positions and their longing for happiness can feel like a lose-lose proposition. I struggle with framing the choice as an "either-or": "If you choose to be right, you can't be happy. And vice versa." In actuality, what we are hoping for is our clients to see that winning an argument or proving their point can't preclude the satisfaction ("happiness") of knowing they are caring for the needs of the relationship FIRST, before their individual needs. I try to help clients understand that meeting the relationship's needs is DIFFERENT from "giving in." In this case, Jane isn't letting Joe "get his way." By focusing on what's best for the relationship, clients are taking their eyes off of what each partner WANTS--it's what the partnership NEEDS that matters. Sometimes, that's the same as what one partner wants. But often, the relationship is like a separate entity all together. I envision, and educate clients, that the marriage is the "third client" in the room: what it needs to thrive and grow must be addressed, or it will wither away. People caught in conflict, bent on winning the latest match in their relationship's Grand Slam tournament of arguments, can sometimes buy into doing the right thing for the benefit of the partnership. We don't think twice about making effective decisions about our children, even when we are angry at our spouse. We can look at relationship challenges the same way. After all, when the partnership wins, BOTH sides win, too. And really, is the fight about stopping for directions really about directions, anyway? Most conflicts are generated by deeper symbols and values than what two people are quibbling about on the surface. If we approach our conflicts with an eye on a resolution that aids the relationship, we may find ourselves getting to a place of peace with our partners more quickly and with fewer lasting wounds. That is, except for when my wife asks me, for the thousandth time, WHERE she put her car keys. If I could just get her to put her keys in the little dish on the counter, like I've told her...

Sunday, June 23, 2013

The View from Home

Vacation's over. Luggage is unpacked. Sand is shaken out of sandals and beach towels. Shoulders are peeling and swimsuits are stuffed back into drawers. Other than kitschy souvenirs, tan lines and fuzzy cell phonier photos, what do we bring back with us into our regular lives of work, home and family life? I'd like to think I can keep the sense of peace and calm I had on our trip, and sustain it as I juggle seeing clients, shuttle my child to endless summer activities and find time to pay the bills and change the sheets that are still on the bed from BEFORE we left. Why is that such a staggering task? Just days ago, I was enjoying a poolside cocktail, oblivious to the demands of voicemail and the deadlines of paperwork. I was watching the wind shake the fronds of the palm trees and hanging my son's bathing suit over the hotel balcony railing to dry in 95-degree heat. clearly, we vacation to get away from our everyday lives and to refuel ourselves to be able to face the challenges of our stressful lives. How do we keep the "glow" of our downtime from fading? I haven't discovered any easy answers, nor have I been successful in keeping the pressures of life from crowding out my bliss within days of returning home. Sometimes it helps to spend a few minutes scrolling through those lopsided phone photos. Or to use the time between appointments to close my eyes and remember the sensation of zipping down the water slide, my son whooping and hollering behind me. I pick up the seashell and study it's ridges and dips, catching the faint whiff of sea water trapped in it's whorls, and I let the sense of ease wash over me, like the waves washed over my feet as I huddled in the sand just days ago. There's no way to keep the vacation energy flowing as easily in "real life" as it does when we're off in the tropics. But using our sensory memories, reviewing photos and shared memories with those we vacationed with, and taking time out daily to slow down our bodies with focused breathing, stretches and sitting quietly can keep us moving forward, at least until the next chance we get to unplug and head out of town.

Friday, May 17, 2013

It Smells Like Teen Spirit

As the end of the school year approaches, I'm struck again by the transitions and milestones that constantly dot the landscape of parenting. Whether it's signing your child up for a "real" baseball team after he's conquered the challenge of tee ball, anticipating your teen's first prom (and all the accompanying risks, drama and excitement that comes with it) or trying to whittle down the guest list for your graduate's party, the changes and challenges in our children's lives, and our own, seem never ending. The cliche that "They grow up so fast!" rings with a truth every parent can relate to. I can remember with clarity the entire outfit my son wore to his first day of preschool (complete with the camouflage backpack that was larger than he was), and now we are headed out to buy his eighth grade graduation suit. Like most parents, I look back with some regret for not capturing every milestone on film or appreciating every grimy grasp of a little hand around mine. But I have to admit, the teen years are by far my favorite (so far!) I can hear the groans and imagine the eye rolls of many parents who have weathered the angst-filled and admittedly dangerous teen years and come out the other side with ulcers, thinning hair and even sometimes legal bills. Those parents would warn me that I ain't seen nothing yet from my only near-14-year-old. And I would agree. The broken curfews, hidden beer cans and muttered F-bombs that await me will undoubtedly try my patience, frighten me in the early morning hours, and have me catastrophizing about breaking my little jailbird out of the Big House. But I have to admit that I am looking forward to the teen dramas with more than a little anticipation. Maybe it's my experience providing therapy for the last 20 years. Or maybe it's the memories of my own risk-taking adolescence that lures me into believing my little angel couldn't POSSIBLY be as bad of a kid as I was. (I'm dooming myself to eating my own words, aren't I?) But these years when my child has grown into his personality, when he has learned to use his voice and stretch into his personhood a bit more, have been a source of delight and wonder for me. The infant and toddler years were so challenging and fear-filled: for me, there was nothing more anxiety-producing than hearing my baby wail and not knowing for sure how he needed me or whether I was meeting his need in a way that did more than just quiet his crying. Apparently, I function much better in a relationship where I receive comprehensible feedback, when I can ask and get answers to questions about what my child needs and desires, and direction on how to best meet those requests. I was frantic and frightened by my catastrophic forebodings that I would "miss" some crucial sign from my small child, thereby causing mortal physical or psychological harm from which neither he nor I would ever truly recover. I know I am fooling myself now in thinking I have more clues about what my son needs--or doesn't need-- from me. Although a rather chatty kid, I'm aware that there is much in the mind and life of a teenage boy that I will never be privy to. But at least now I can ASK-- and if the only response I receive is a grunt or an eye roll, I can soothe myself with the reassurance that I've kept up my side of the parent/child bargain. I'm still mystified by my friends who long for those baby years, and who jump at any opportunity to nuzzle any infant in close proximity. Equally baffling to me are those folks who get more joy from the 35th reading of "Good Night Moon" to a willful two-year-old than from a long(solo) soak in a tub. Nope, I'll take those moments with my teenage son over almost any other outlet for my energy-- even if those moments involve smelly gym clothes, drooping jeans and a ravaged refrigerator. What about you? Was there a favorite time for you with your kids? Were you surprised at the ways you managed the different phases and tasks in their childhood? I'd love to hear your stories!

Tuesday, April 23, 2013

Anxiety: Normal Worry or Serious Symptom?

As the world begins to make sense of the tragedy of the bombing in Boston last week--and the equally harrowing pursuit and capture of one of the alleged perpetrators--we might expect that our anxiety levels and feelings of being unsafe in our surroundings would start to ebb as the days go on. But for some people, that relief won't come quite so easily. They may find they are still hypervigilant, still metaphorically (or actually!) looking over their shoulders for the next disaster to approach. They may still suffer insomnia, eating and sleeping disruptions, and obsessive thinking that is hard to rein in. They may avoid all news reports of the bombing or be consumed by the need to know every detail of the investigation, the rationale of the criminals behind the act. And the individuals cotinuing to suffer with these kinds of distress are not simply post-traumatic stress disorder survivors who are being retriggered by reports of violence. Even people who've never before reported experiencing anxiety symptoms or trauma history are being challenged by worry, fear, obsessions about their safety and concerns abOut the future. Perhaps it's the media saturation we now live with, or a heightened knowledge about safety issues and concerns, but whatever the genesis, we need to be able to recognize when anxiety is growing beyond our control and know how to seek help. If you experience three or more of the following symptoms for more than a few weeks, consider contacting your physician for a referral for counseling:

1. Restlessness, irritability or agitation
2. Inability to control your worrying
3. Fatigue
4. Difficulty concentrating
5. Muscle tension
6. Sleep or eating disruption
7. Worrying about several different topics/life areas

Counseling can assess whether therapy alone can help to alleviate your symptoms, or whether an assessment to evaluate for medication is called for. Data supports that cognitive behavioral therapy (CBT) is highly effective in helping people manage their anxiety. The world is likely to continue to run at a rapid pace, and we are probably not going to be able to avoid exposure to tragedies and struggles. But empowering ourselves to pursue help when we need it can be the first important step in feeling more in control, and safer, in our own lives.

Monday, April 15, 2013

Faith Over Fear

As I watch the coverage of the tragedy that has occured at the Boston Marathon, I find my faith in the benevolence of the Universe shaken and doubting. I regularly teach my clients about the power of positive thinking, of having faith in the face of fearful circumstances. I encourage clients to believe that the world is a safe place overall, and that people are, more often than not, wired for good. I usually struggle with the idea of evil: perhaps idealistic and naive, but my sheltered, suburban life has allowed me to believe that evil is an "idea", a concept more than a reality. And then these tragedies happen. Is evil real? Are we at it's mercy, whenever it desires to strike? Is our belief in a loving, protective Higher Power a fallacy? Or are these tragedies reminders that faith is easy to have when we feel safest, but it is exactly when we face our most fearful times, when we are riddled with doubt and questioning, that we most need to rely on our faith. I wish i could say I am able to take strength from my faith, that I can lean back into the arms of Universal Love and trust that peace will reign in the end. But I'm unsure, at best, of how I feel and what I believe. I'm hoping to learn from all of you how you have faced tragedy and learned again to trust, to believe, and to hope.

Sunday, April 7, 2013

Positive transitions = Vulnerability

When we think about the developmental milestones that mark our lives--weddings, births, graduations, first jobs--we often think about the positive feelings, achievements and sense of empowerment we expect to accompany these tasks. But just as often, people experience an equal amount of vulnerability and emotional risks. I've had clients who are nearing the end of their college careers, and find themselves struggling with anxiety, fear, and depressive symptoms they believed were long in the past. Clients who change jobs to positions with more status, power or pay are confused by the sense of doubt and stress that accompany this change. And most of us know of the perils of post-partum depression, when new mothers may struggle with sadness, anxiety and a fear of not being up to the tasks of parenting. However, while new mothers are in the midst of tumultuous hormone changes that affect their mood and sense of efficacy, I've worked with men who experience similar challenges when they add children to their lives. The myths associated with these celebrated events are part of the problem. We feel ashamed, "broken" or wrong for having negative feelings alongside a joyous event. We feel confused and doubtful about our ability to navigate even positive life events with ease. Sometimes, we feel cheated by sadness, grief, anxiety or anger that prevents us from being present to joy. But all change brings stress, because it's a shifting of the status quo to a state that is a bit unknown. And even positive stress (eustress) taxes our emotional, mental and physical capacities. We would do better to expect a range of emotions to accompany exciting life changes, rather than assuming we will only feel happy, joyous or grateful. Being gentle and compassionate with ourselves during times of transition helps to lessen the strain and ensures we notice and attend to our feelings. When change is looming, we need to increase our self-care: get plenty of rest, healthy food and exercise, and stay hydrated. We might benefit from taking extraneous responsibilities off our plates. The next PTA meeting, Pinewood Derby or church rummage sale may have to run, this one tine, without us. And when we experience unpleasant emotions side by side with positive life events, we can try our best to be tender with those feelings, for they are there to teach us something. Perhaps the fear about a new job is a reflection of our perfectionistic streak as much as it is a fear of failure. That anxiety can clue us in to be conscious of our self-expectations, and to accept that, in some cases, doing "good enough" is better or healthier than doing "perfect" work. Sadness at leaving a beloved college campus and dear friends reflects the depth and meaning we've built into those relationships. Failing to acknowledge our full range of feelings can create unconscious self-sabotaging or worsening of symptoms. We respect ourselves most when we don't expect positive life milestones to come without some less-than-positive feelings. It's by embracing all our emotions that we reap the richness of all life offers us.

Wednesday, March 27, 2013

Meeting Your Match: Finding the Right Therapist

I recently had a potential client come in to a session to "interview" me for the job of his therapist. This wasn't the first time I've been vetted for that position, but the occurence is realtively rare, as colleagues I questioned confirmed. It lead me to questioning "Why don't more people interview potential counselors before signing on as a client?" Certainly, most providers in the field would welcome these encounters--as helping professionals, our priority is the client's optimum care. If that care can be better provided by another counselor, we are happy to facilitate that connection. After all, it's all about what the client needs. And, like any relationship, the therapist/client connection works best when there is an atmosphere of comfort, the ability to build trust, and a shared vision of what the client is looking for. If you are considering pursuing counseling (or even changing therapists) here are some things to consider:

1. Insurance limitations. The recommendation you got from your neighbor or the suggestion from your doctor may end up being the perfect fit, save one tiny detail: the counselor doesn't accept your insurance. If using your insurance benefits is important to you (as it is to most folks!) check out your insurance company's website to see if the counselor is listed as an approved provider. Or better yet, as those websites are notoriously inaccurate and out-of-date, call the counselor and ask him yourself. We understand potential clients' desire to utilize their insurance benefits. We will let you know if we take your insurance so you can either set up an interview appointment or move on to the next name on your list.

2. Compatability. Consider what you are looking for in a therapist. Do you need someone who will be direct and blunt, who will push you to make needed changes in your life? Or are you looking for a supportive presence, someone who will provide reassurance, a safe sounding board, and nurturing to help you decide what life path is best for you? Maybe you have no idea what would work best for you. In that case, think about other professionals you've worked with, whether they be your physician, your dentist, even your accountant. Some people benfitted from their mechanic taking the time to walk them through the car repairs, even providing diagrams of the problem and solution. Perhaps they would prefer a counselor who is willing to explain theories, map out treatment goals and benchmarks for meeting them, and suggest books or videos that could be helpful to the treatment process. Perhaps you've enjoyed your phsyician's willingness to take extra time during vists, when needed, and listened thoughtfully and empathically to your physical complaints before partnering with you to create a solution. You might match best with a clinician who is nurturing, supportive and willing to build a long-term relationship with clients, versus having a short-term, behavioral approach to dealing with life issues. Whatever your preference, you are most likely to get your therapy needs met from someone who makes you feel comfortable and understood.

3. Constraints. Find out the therapist's hours, availability by phone or during a crisis, accessibility of her office, and modes for paying fees. While your cousin may rave about her counselor, if the worker's office hours are only during the evening, and you work at those times; or if you know you may need support by phone between visits, and the counselor has rules against regular phone contact, the fit won't work for your needs. Similarly, make sure the counselor works in modalities that you require: some therapists provide individual, couples and family therapy, while others specialize in only one type of treatment. Some therapists take credit cards for payment, others only checks or cash. Find out if the therapist bills the insurance directly, or if it will be up to you to get reimbursed by your insurer.

4. Licensure and experience. Counselors are used to being asked about their credentials, since our licensure often determines our eligibility for insurance reimbursement. Be sure that the counselor's license is accepted by your insurance carrier before you get started. Similarly, ask the therapist directly about her experience and comfort with working with people with your presenting concerns. Our goal is for you to get your needs met--if we aren't experienced with the issues you're confronting, we usually know someone who is.

5. Approach to collaboration. Will the counselor work together with your primary care physician or psychiatrist to ensure a holistic approach to your wellness goals? You may wish for your therapist to have contact with your family members; be sure that approach fits with the counselor's orientation. And ask about their relationships with other professionals in the field. It's helpful if your counselor has a network of trusted referrals if you need an evaluation for medication or are looking for a group therapy experience to augment your work with your counselor.

6. Trust your gut. While it's admirable that some clients are willing to give the therapy relationship a few sessions to determine if they feel comfortable with the counselor, it's my personal bias thar most clients know by the end of the first session if the fit will be productive. Your time is valuable; if you question whether the counselor can truly understand your issues or empathize with your feelings, feel confident in choosing to move on to the next referral on your list. You deserve the best care, and counselor's are committed to helping you get it, whether that's in our offices or the collague's down the hall.

Tuesday, March 5, 2013

The Learning Curve

Physical challenges can lead to psychological discomfort and stress, and we can all benefit from learning new ways to cope with these stressors and improve our self-care. I've recently been learning these universal lessons myself. After struggling with symptoms that were vague and inconsistent for the last 6 months, I finally motivated myself to get some answers from my doctor. My doctor's response was "It could be lots of things", and thus my journey to multiple specialists and a myriad of tests began. The process of obtaining a diagnosis can be as taxing as physical symptoms themselves. With every inconclusive result and every head-scratching response from a doctor, my frustration grew. As did my self-doubt. "Are these symptoms (fatigue, lightheadedness, numbness in my hands and feet, lack of coordination) rally that serious? Could they be in my mind, or a side effect from medication, or even anxiety? Is finding an answer really worth taking all this time off work, managing this growing medical debt?" As a therapist, I'm forever touting the importance of self-care to my clients, and here I was, feeling unsure and undecided about the steps I was taking in my own life. I'm aware that pain, illness and disease can cost us just as dearly in the realm of our mental health. Stress, fear and anxiety about the future and our abilities, depression due to loss of functioning--all these realities must now be dealt with alongside the physical ailments. No wonder we sometimes (or for many people, USUALLY) disregard our physical pain and suffering: it's just too overwhelming to deal with. But I'm a big believer in lessons from the universe, and I think our physical selves are a ripe classroom for those teachings. Besides re-learning the importance of self-care, my recent forays into the world of MRIs, EKGs, EMGs and Holter monitors has humbled me to an even more basic issue: remembering my own value. Having the tools to adequately care for ourselves, and knowing which to use when, can only work if we first VALUE what our Selves are experiencing and feeling. It's so easy for me to push aside my physical discomfort, the twinges and aches, because I've bought into our culture's unspoken mandate to put others first, to "stop your bellyaching" and get done what needs to be done. Valuing myself was easiest, I found, when evereything else--and everyone else-- was taken care of. But when my self-care began to come at the cost of my responsibilities and the needs of people around me, I was sorely tested. But that, in my philosophy, is exactly how the Universe lays out it's challenges. We don't learn by pulling back to burrow in the comfort of what we know; we learn by stretching to embrace a reality that is just slightly beyond our comfort zone currently. I've felt, at times, selfish, histrionic and even attention-seeking as I've slogged through appointments and procedures and needle jabs. But the discomfort of these experiences has been part of my learning landscape. I can't just take care of myself, VALUE myself, when it's convenient for my job, my family, my dog. True self-care means valuing my Self when it's most difficult, when I think others will roll their eyes or dismiss my symptoms as simply the downhill roll of aging. And regardless of the diagnosis (or lack thereof) or the treatment plan signed off on by my team of doctors, the most useful "pill" I can take right now is to keep my Self and my needs at the center of my perspective. Because I believe if I don't, the Universe will provide yet another variation of this challenge. And dammit, the dog needs to be walked, and the kitchen needs to be cleaned, and my billing needs to get mailed...alas, it appears I am still on the learning curve.

Tuesday, January 22, 2013

Cast Your Vote!

Current events, controversy, little-known facts and figures--what draws your attention in a blog? While this is a blog sponsored by a counseling center, we want it to be full of thoughtful, useful and even entertaining information for our readers. Are you interested in research results on mental health topics? Want to read about effective techniques and tools for managing emotional symptoms? Looking for inspiration to grow psyhcologically and spiritually? Give us a shout out and let us know what kind of articles will be most intriguing to you. We are waiting to hear from you!

Tuesday, January 15, 2013

Rethinking New Year's Resolutions

Here we are, a few weeks into 2013, and many of us are already burdened with ill-fated resolutions, intentions that, while well meaning and valuable, we have already veered away from in our busy-ness, lack of follow through and simple lack of time. Perhaps the dawning of a new year also allows us the opportunity to approach this beginning in a more productive way. Rather than resolutions, promises or efforts to change, to leave behind fruitless endeavors or to embark on healthier habits, how would our worlds shift if we chose instead to just BE? At risk of exposing my inner hippie, I propose that learning (or more accurately, RE-learning: just look at any being in infancy or toddlerhood)how to grow comfortable in BEING in the world could provide us with as many opportunities to heal, grow and transform as the loftiest resolutions ever could. Mindfulness may well be the latest term to ignite the fire of many health care professionals, but the word smacks of "expertise", a certain level of psychological and spiritual evolution that seems off-putting to bungling, messy, cro-magnon beings like myself. I rather like the playfulness, the no-expectations flavor of the word BE. Surely, every breath we take proves we have the skills to BE, right? Our senses are the only keys to unlocking the door to the domain of BE-ness. Who hasn't benefitted from a deep breath before a heavy conversation? Who hasn't lost themselves in a belly-aching laughing fit reading the Top 25 AutoCorrects of 2012 postings (and don't make it seem like I'm the only one! You know you love those!) Who hasn't, at least once, followed the trail of a raindrop down a windowpane, marvelling at the drops' inevitable melding with another streak of rain? Who is to say that these moments are not sacred, not of the same stuff as moments of psychic or spiritual stretching, of effort and sacrifice and resistance? Knowledge and wisdom are available from the most unlikely sources. How delightful would it be to embrace all we can learn from the simplest acts of life-- a breath, a touch, the "sight" of a thought as it tumbles through our brain, only to evaporate like steam in the vastness of our minds. I feel a peace when I contemplate BE-ing, a peace devoid of pressure and striving and trying. The lazy person's way out? Maybe. But I feel a smile grace my face at the anticipation of lowering my head to my pillow, smelling the scent of my love's perfume on the linen, the coolness of the cloth against my cheek, savoring the heaviness of my lids as they promise near-sleep, and know that I'll take peace any day of the week, any way it chooses to show itself to me.