It's Not Personal

"Don't Take Anything Personally" is Don Miquel Ruiz's second suggestion in his book The Four Agreements. I initially assumed he was talking about choosing to overlook negative feedback, as harsh criticism can be damaging to our self-esteem. But further reading highlights this agreement's connection to the practice of humility.

...And It's Not About Me

Not only does Ruiz believe that others' words and actions are about themselves and not about ME, he is adamant that taking other's truth as our truth is an example of practicing our "personal importance"--- a form of selfishness that assumes everything is about ME. He promises that a sense of freedom and autonomy will come from not accepting others' beliefs about us -- good or bad. When we know that what others say is simply a reflection of their own inner world, the lens they are looking through, the ever-running script in their heads, we can become immune to the poison that may be the toxic agreements they have made with Life. We have the responsibility, and the choice, to avoid the suffering that accompanies accepting others' beliefs as our own. I'm NOT the center of the universe, but I can achieve more centeredness by leaving others' words and actions to them. 

Truth to Tell

In Don Miguel Ruiz's classic self-help book, The Four Agreements, he offers four rules for living that he suggests will allow us to "escape hell" and live in a "heaven on earth" of our own making. The first agreement is more than a challenge to speak only the truth.

Be Impeccable with Your Word

On first reading, this agreement seems to echo a common value: "Tell the truth." But Ruiz expands the concept to include what we tell ourselves. We can understand the social niceties that encourage us to speak kindly to others, to soften criticism with helpful suggestions, and to avoid sharing information that will only hurt, and not help. When it comes to our own self-talk, we are much less likely to be as selective. We may berate, shame, guilt and demean ourselves with an almost automatic frequency when we falter or misstep in our lives. And we can be just as quick to believe these false scripts. Ruiz maintains that telling the truth to ourselves requires that we acknowledge what is real: our goodness, the softness of our hearts, our boundless ability to love. Only in recalling our own beginnings from the stuff of stardust and unending energy can we live, and speak, our truth.

Learning to Forgive Ourselves

"Guilt's strength lies not in the failure of others to grant us forgiveness, but in our failure to forgive ourselves." -- Kelseyleigh Reber 

Nobody's perfect. We learn from a young age that everyone makes mistakes. And most of us have had to forgive someone who's hurt us, whether it was a betrayal of trust, harsh words spoken in anger, or an act of spite or disrespect. And yet, forgiving ourselves for our missteps can seem like a tougher task. Why?

The Golden Rule 

Forgiveness is a gift we give ourselves, even as we provide grace to those who hurt us. Letting go of the bitterness, disappointment and pain allows us to move on, to loosen the hold the betrayal has on us. But when we are the guilty party, we may engage in severe self-shaming and -recriminations. Rarely do we afford ourselves the same leeway we do for others. Maybe we believe continuing to persecute ourselves will ensure we don't screw up again. Maybe we inflate the damage we've caused, imagining that our failings will have unending repercussions. But we fail to recognize that, in holding ourselves to a standard higher than we may others, we are assigning our actions an inflated influence on our world. Humility means owning that both our successes and our failures are on par with others'; we don't "fall" harder from our mistakes than do our counterparts, nor do we "soar" higher when we reach our goals. If we believe that no one person's worth outweighs another's, we need to treat ourselves as equal in every way, whether that's celebrating our achievements or forgiving our transgressions. 

When Fit Promotes Functioning

Therapy is not a one-size-fits-all endeavor. Nor does modern-day counseling share much in common with the stereotypes of a client laying on a couch, the therapist interpreting clients' dreams, or people spending decades in counseling to resolve issues. Finding the right modality of therapy and the correct clinical orientation to address different issues can help create a successful treatment experience.

Choosing the Right Therapeutic Approach 

While most types of therapy can address most any issue a client may present, some particular approaches have been proven successful for work on specific issues.

Cognitive-Behavioral Therapy (CBT): Many studies document the efficacy in mitigating anxiety and depressive symptoms using techniques like assertiveness training, rewriting negative scripts, addressing mistaken beliefs and learning coping skills.

Exposure Therapy: This approach is considered the hallmark technique to help clients overcome phobias.

Supportive Psychotherapy: Clients may choose this type of counseling when they are looking for short- or long-term support to deal with life stressors, if they are unsure of their treatment goals but enjoy the validation and support they receive from the therapeutic relationship, or see therapy akin to "working out" (i.e., as an essential, regular part of self-care.)

Insight-Oriented Psychotherapy: Usually longer in length than CBT or exposure therapy, this orientation aims at helping the client create long-lasting change through developing insight into themselves, patterns of behaviors, family of origin dynamics and unconscious processes.

Solution-Focused Therapy: This specific approach utilizes directed questions and a strong focus on client goals, rather than problems, to help clients move forward.

Eye-Movement Desensitization Response (EMDR) or Holographic Memory Resolution: Both techniques tend to be shorter-term, using as few as one to six sessions to help trauma survivors diffuse distressing memories and somatic experiences of trauma, and to provide relief from PTSD symptoms.

Many other clinical orientations are available to meet clients' individual needs.  If you are interested in pursuing individual, couples or family counseling, ask the potential therapist to educate you about their preferred approach, and whether data exists to support that philosophies' effectiveness in working on the particular issues you'd like to address. 

Not Just Child's Play

Play therapy is a viable treatment modality for working with children, as it utilitizes their "words" (i.e., toys) in their "language" (i.e., play). For many children, talk therapy is not enough to access inner conflicts and help create behavioral change and relieve emotional stuckness. Play therapy uses the dynamic of play to help children develop social skills, address growth and development issues, aid in emotions management and to resolve trauma. 

The Power of Play 

Play therapists will offer many tools to youngsters to explore their emotions and experiences. From story telling and role play to using puppets, sand trays and art mediums, children are allowed to choose those activities that best allow them to express their internal realities. Play therapists may interpret and reflect back the material presented by a child, based on their training and data collected about the meanings behind much of play's symbolism to children. Having a safe space to feel in control of play activities and to play at their own pace can provide young clients with a sense of empowerment and control of their own choices. Play therapy's flexibility allows adaptation to the developmental and emotional stages of each child. Organizations like the Association for Play Therapy (APT) are helpful resources for information and referrals to play therapists in your area. 

Hiding Our True Selves

As Halloween approaches, the stores are full of spooky decorations, pumpkins for carving, and costumes for adults and children, even pets. Rows of masks crowd shelves overflowing with orange plastic Jack 0'lanterns and bags of candy. Masks of former Presidents, movie stars, scary clowns, devilish ghouls. For most consumers, these masks will be worn for one day, then discarded. But many of us wear masks of a different type every day of the year.

Take Off the Mask 

Whether we present a confident facade during a job interview or a stern countenance when reprimanding our children, we sometimes show the world what we want it to see, rather than who we truly are in that moment. Certainly, adopting a certain persona can help us deal with a stressful situation or allow us to feel more in control when we are feeling uncertain. But these adopted roles can also prevent genuine connection. Only when we are authentic can others respond to our true selves and messages. We can only know others when they allow us to see their authentic reactions and uncensored responses. Connecting with one another takes the courage to be real, to risk shedding the masks and allowing our real selves to see the light. Let's leave the masks for those singular days of make believe, and treat ourselves to the opportunity to meet each other in genuineness and truth. 

Why so SAD?

Tearfulness. Apathy. Fatigue. Negative thinking and anxiety. Most people are familiar with the behavioral and emotional presentations of depression. But Mood Disorder with Seasonal Pattern Specifier (previously known as Seasonal Affective Disorder (SAD)), can be overlooked or misdiagnosed precisely due to its hallmark--a connection to the change of seasons.

Season of Sadness

Fall is many people's favorite season. The cooler air, radiant colors, and cozy sweaters bring joy and peace to fall fanatics. But the dawning of autumn, and the end of summer's longer, light-filled days, can bring about a drop in mood, energy and affect. Most commonly experienced between summer and fall, Mood Disorder with Seasohal Pattern Specifier occurs less often as a result of different seasonal shifts. A trained medical professional or therapist can help clients discern the difference between a situational stressor and depressive symptoms that recur every year at the same time due to seasonal changes. Treatment may include a combination of short-term medication and therapy to develop skills to increase awareness of impending symptoms and develop a plan for mitigating the effects of adapting to the new season. Just because depressive symptoms can blow into our lives like the fall leaves carried by a strong wind, don't assume you are consigned to emotional challenges for the next four months. A proactive plan can help keep your mood level and your energy stores high, so you can function at your best through every season of the year. 

The Stories of Our Lives

We all have stories to tell. And when it comes to stories about ourselves, many people don't recognize that those tales aren't necessarily factual. Rather, perspective, magical thinking, flawed memory, subconscious scripts, all influence how we see ourselves and experience our lives. For example, in families members are often unconsciously assigned to "roles": who believes they are the "cute" one, the "smart" one, or the "troublemaker"? I've had clients describe themselves as "perpetual failures," "never going to amount to much", or "a committed rescuer." These stories, at one time, served a purpose. Perhaps they helped us make sense of a bizarre family system, provided a sense of protection, or allowed others to "dictate" who we were and how we behaved that best worked for them. But these identities are far from based in absolute truth. And most of them need to be re-written if we are to fully flourish as human beings.

Re-Telling Your Story

I encourage clients to get a photo of themselves from when they were young, preferably just beginning school, and to display the photo somewhere they will see it daily. I ask clients to consider that child, filled with possibilities and largely stilled unformed, and rewrite a description of that child from a place of objectivity, openness and compassion, almost as if they were talking about someone else.  Invariably, people describe their young selves using mostly positive phrasing--"you are fearless and funny", "you are kind and love to give hugs and play with your pets." Clients reframe their childhood selves as "curious and big hearted and interesting" and as "loved and loving." With these new "stories" in mind, I ask clients to look at their photo several times a day, letting them allow the new script to sink into their sense of  themselves, to anchor itself into their conscious understanding of who they are. Our stories can spring us forward or hold us back. With a more expansive, comprehensive vision of who we were, we can embrace who we are with affirmation and true esteem. 

Change, Change, Change

The only constant in life is change. -- unknown

Change is the law of life. -- John F. Kennedy 

God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference. -- Serenity prayer, regularly used by 12-Step groups 

Change makes me uncomfortable. Like many people, I function best with consistency, predictability and routine. I like to know what to expect, and love both creating my daily to-do lists and the satisfaction of crossing off duties when they're finished. But after almost five decades on the planet, I'm wise enough to know that change finds all of us, constantly, no matter how hard we try to outrun it. We can't know for sure what the future will bring, who will still be walking alongside us a year from now, what careers or partners our children will choose.  Still, despite all that is unknown and uncertain, I find reminders of the certainties that pervade my world--the birch tree on the corner that begins to flame red each September, the vibrant pink peonies that burst from our backyard bush for a scant two weeks in early summer. The sun's predictable slant through my bedroom window each afternoon, and the mint that grows wild through our garden each spring, intoxicating the entire courtyard with its refreshing scent. Annual school supply lists, prom season, holiday traditions. Then there are the less pleasant repeats -- the Christmas decorations that appear in stores before Halloween, quarterly tax bills, twice-yearly dental visits. Whether we anticipate these rituals with excitement or anxiety, we are reminded that patterns that make up our lives, loops of sameness, then difference, newness and consistency. As changing as the ocean waves, as predictable as the tides. 

Process Addictions -- Beyond Drugs and Alcohol

Process addictions, like compulsive gambling, sexual behavior, shopping, are similar to addictions to substances in the way they affect the brain. But unlike abstinence from substances, some  triggers to process addictions can be difficult to avoid. Human beings have a need for food and for sex. We need to purchase groceries and clothing. How can individuals find sobriety when the same behaviors that we need to survive are possible pitfalls into the spiral of addiction?

Compulsion Drives Addiction 

Alavi, Ferdosi, et al. wrote that "when a habit becomes an obligation, it can be considered an addiction." Indeed, any behaviors that are stimulating to the brain and body have the capacity to become an addiction. Process addicts struggle with restraining from engaging in these behaviors and activities, failing to maintain a balanced relationship with these actions. Treatment for process addictions does not differ widely from substance abuse treatment. Twelve Step programs, such as Gamblers Anonymous, Sex Addicts Anonymous, and Overeaters Anonymous, are useful supports to help process addicts gain a sense of community, education and accountability that can lead to sobriety. Medications that treat impulsivity, anxiety and compulsive thoughts can be useful in the treatment process. Holistic endeavors like mindfulness training, meditation and yoga can help addicts learn to regulate their emotional and physical states to loosen addiction's grip on their sanity. Understanding the true and devastating price of all addictions can encourage more compassion for the addict, more interest in funding research into addiction treatment, and help develop effective prevention programs that can curtail addictive behavior before it takes root. 

Creating Meaning Through Ritual

Ritual is necessary for us to know anything. - Ken Kesey

At my best friend's wedding, I was able to anticipate the various components of the ceremony. Because we are familiar with the components that make up a wedding service, we can expect to see the bride walk down the aisle, an exchange of rings, an officiant ready to bless the union. We can smell the floral bouquets the attendants carry, and hear the vows the couple speak. We know what a wedding is because we have seen them happen in film, on TV, and in our own lives. We know what happens next because the ritual of marriage remains more or less the same as we move through time.

The Comfort of Ritual 

Rituals bring meaning and perspective to our lives. They help us create a sense of continuity, of purpose, to and between experiences. Rituals give us something to lean on, to mark time, to commemorate. Rituals bring us together, providing a common language with which to connect and understand our experiences and each other. Rituals provide predictability, a sense of sameness that can make us feel secure in uncertain times. Because we often look forward to the consistency that comes with pleasant rituals, whether it's the cake and presents at the end of a birthday party, or capping the Christmas tree with a generations-old gilded star, our joy can be heightened and shared. Even rituals that mark somber occasions, like the procession of pall bearers at a funeral, can bring us a sense of our united humanity. Rituals remind us that we are in this together, that the journey of life is made more poignant, more powerful, by the rites by which we mark it. 

Trust--A Path to Freedom from Fear

Anxiety is more than "jitters", nervousness and worry. For many sufferers, anxiety ultimately is rooted in a sense of being unsafe, out of control or mired in unpredictability.  If we peel back the worries, examine the distorted thoughts that fuel anxiety and panic, we find that people struggle with trusting that things will work out. They fear the worst, predicting horrible outcomes and creating potential responses to negative situations that haven't yet happened. When clients slow the internal maelstrom to look critically at their mental scripts, we can work together to develop a plan to help clients recreate a sense of trust in the world. Through tools like thought stopping, mindfulness, addressing mistaken beliefs and exploring their spirituality, clients can begin to learn that the Universe will provide for them, that risks are worth taking, and that the outcomes that await them are filled with possibilities.

Medical Collaboration in Therapy

At the initial therapy appointment, your counselor may ask you to sign a physician collaboration form. This consent allows your therapist to contact your internist, family practitioner or medical specialist to ensure you receive the most consistent, comprehensive care throughout your therapy experience.

A Team Approach

More often than not, clients initially question the need to have their primary care physician involved in their counseling. "Why does my doctor need to know I'm seeking therapy?" clients may wonder. Issues of confidentiality may also arise; I've had clients express concern that the information they share in counseling will be automatically communicated to their physician. The therapist should educate and reassure the client that only information pertinent to the client's physical health will be shared, and even     then, only with the client's knowledge and complete agreement. Perhaps even more importantly, therapists need accurate information about a client's current and past medications and dosages, illnesses that may affect emotional health (i.e., thyroid disorders, diabetes) and previous or planned medical procedures that may impact a client's mood or functioning. Creating an effective, individualized treatment plan for each client requires a thorough understanding of the individual's physical and emotional health. Collaborating with your physician helps ensure that all treating providers are fully informed of how to help support you through the therapy process, providing the best chances of an efficient and effective therapy experience. 

Lessons from the Desert

The Arizona desert seemed like an odd vacation destination in the beginning of August. My family was sure they would melt in the heat, and I had to cajole them with promises of daily ice cream outings and a hotel room next to the pool. But in the midst of the stark, dry landscape, we discovered these timeless lessons:

A change of scenery creates a new inner perspective. Our three-hour flight from Chicago brought us from a humid, muggy, and flat landscape to a terrain of cactus-pocked mountains, arid rolling desert and hiking paths framed by red dirt. Arizona is as different from Illinois in topography as an elephant is from a shark. A two-hour time difference showed us how vastly disparate reality can be; no ONE perspective or viewpoint is the absolute truth.  All we know and feel is influenced by our surroundings.

Beauty, danger and sustenance co-exist naturally. During our tour to the Grand Canyon, we learned that certain cactus bloom with vibrant, gorgeous flowers that dot the desert with fiery color. Other succulents contain a toxin that can create illness and even death in other creatures. And others contain enough moisture to keep a lost hiker alive for days. Those things that scare or amaze us can be our savior as easily as they can be our ruin. 

Risk can bring reward. Hiking the trails of the Grand Canyon is arduous and even frightening at times. I considered turning back when the temperature rose above 110 degrees, and the path narrowed to a foot-wide ledge dipping dangerously into a steep decline. But when the guide urged me to continue through a low-hanging arch, I was gifted by eons-old pictographs etched into the canyon's face, images of animals, fish, human handprints left by our ancestors. Pushing past my fear and fatigue brought me a sense of connection to generations past that I could have easily missed.

The Child Inside

As my son enters his junior year of high school, I am regularly reminded that he will soon be launching from our everyday lives into a more independent, autonomous incarnation.  This summer has been chock full of milestones: he got his drivers license, his first part-time job, and braces within a two-week span. His height and hairiness alone are constant reminders that a man-child occupies the bedroom down the hall. My son would like me to focus on the "Man" part of his identity (I.e., provide him with unlimited driving privileges and throw my support behind 17-hour video game marathons), and I have found myself praising his use of mature logic and a burgeoning understanding  of consequences of his behavior. (When a recent all-night gaming session was followed by 6 hours of herding grocery carts in 90 degree heat, my son assured me he "wouldn't be doing that again anytime soon.") Noting that the browser history on his iPad included "college scholarships" and "saving for a car", I feared my son's childish goofiness was being replaced too soon by a grown-up seriousness, a focus on planning his future.

KIDS WILL BE KIDS

And then last weekend happened. My wife, son and I met up with my best friend, Monica, and her daughter at the mall to shop for wedding attire for Monica's upcoming nuptials. I overheard the kids kvetching about how long it would talk them to save money for a car of their own, and compared experiences with rubber bands and braces. Listening to them, I was again reminded of the swiftness of time, of how quickly our children go from holding our hands in crowded stores to rolling their eyes at our fashion suggestions. But in the midst of my melancholic musings, Riley and Courtney decided to pretend the escalator was an opportunity to show off "surfing poses." (Mind you, we live in the Midwest--neither child has seen a SURFBOARD in real life, much less ridden a wave). They challenged each other to surreptitiously take candid photos of fellow shoppers, and they imitated the awkward contortions of store mannequins. Courtney teased Riley about his penchant for eyebrow waxing, and he blushed crimson when we busted him checking out a young lady exiting a dressing room.  We laughed all afternoon at our kids'  sarcastic jokes and goofy attempts to get me to try on outfits 20 years too young for me. Their playfulness reminded me that our childlike "parts" are never fully buried. No matter how old they -- or I -- become, the silliness, energy and lack of self-consciousness that speak of childhood is still available to us. If we can notice and celebrate the "child" in our growing children as a gift they never need to fully leave behind, we impart the lesson that adult-ness is not the "end-game" of living. And by keeping alive the child within US, we can ensure that playful connection with our kids and our world is but a decision away. Next time I encounter an escalator, watch out, because I call "SURF'S UP!"

Expecting the Best

A healer and energy therapist, Carol Tuttle challenges us to assume the BEST. Of ourselves, our circumstances, the motivations of others. That simple shift opens us to possibilities that anxiety, fear and negativity can never provide. When I invite a calm, productive day to unfold before me, I am much more likely to notice glimmers of grace: an effortless drive into the office, a blue jay perched in a tree above me on my morning walk, a Facebook shout-out from an old friend. Even when obstacles creep into my awareness, my expectation for positive happenings somehow cushion me from their sharp corners. I used to consider "looking on the bright side" to be naive, a Pollyanna-ish approach to a complex, sometimes scary world. But, as Tuttle suggests, if we assume the Universe is moving more and more towards operating on a higher energy level than ever before (I.e., more rapid medical and technological advances than in past centuries combined, longer human life spans, more people adopting lifestyles conducive to spiritual wellness), we can more genuinely embrace the belief that goodness and plenty ARE boundless. My capacity to love, to invest more deeply in my work and my relationships, even my physical activity levels are expanded when I turn my focus from what is broken, scary, and stuck to an expectant invitation to all that is lovely and nourishing and forward-moving to enter my awareness. No, I haven't forgotten that pain and trauma and loss and injustice exist around the globe, even around the corner. (I AM a social worker, after all!). But, time after time, I find that looking for the good, even inviting and EXPECTING its arrival, is a practice with no negative cost. Why wouldn't I choose to delight in my dogs' cute wiggling behinds as they chase each other in the yard, or flood my senses with the comforting smell and feel of my son's hair fresh from the shower? A driving teacher in high school, of all people, was a wise philosopher of sorts when he warned me, "You'll STEER at whatever you STARE at." In the past, I could easily drive myself into the chaos of depression, hopelessness and fear. But today, I'm choosing to steer toward joy.

"For Life and Death Are One" -- Khalil Gibran

I attended two memorial services over the weekend. Jim, a friend from church, died after a long illness, and my high school friend's mother, Marilyn, passed unexpectedly. Both of these beloved people were past 80, although their lengthy lives don't alter the grief of their family and friends. As I connected with old friends, church members, and family members of those who had passed, we shared stories about our loved ones. We laughed at old tales from our childhood, joked about church politics, teased one another about graying hair or faulty knee joints.

LETTING GO, MOVING ON 

As the sharing went on, our memories of Julie's mom, of Jim's decades-long commitment to the church, gave way to queries about each others' kids: had they started college visits? who was anxious about the ACT? which parents would be delighting in their empty nest, and which would be caught off guard by sorrow? We provided updates about our own aging parents, fussed over Jim's widow and children. We pencilled in coffee dates that were long overdue. We updated cell numbers and email addresses, traded names of tutors for reliable referrals to orthodontists. Even in the midst of our breaking hearts, we couldn't resist attending to the daily tasks of living. As we wept, we were aware of the breath catching in the person beside us, could hear the signs of the mourner behind us. I realized that, as much as I tried to wrap my mind around the reality that I would not share space again with Jim or Marilyn in this incarnation, my heart was filled with love for the people around me, my mind with plans for the future. I was aware of a knee-jerk guilt for not mourning "more" for the souls who wouldn't be here for the next holiday, the missed hugs and family portraits. But equally present was the sense that, even in grief, our instinct needn't be to STOP living, but to look FORWARD. Despite the holes in our hearts, the space our loved one's one leave that will be forever gaping in our lives, we can choose to move ahead, to embrace one another, to honor those who are gone by loving and living with all that we have. Perhaps that's the truest, most honest memorial of them all. 

The Many Faces of PTSD -- Part III

SEEKING HELP FOR PTSD 

Treatment for PTSD can help symptoms from getting worse, especially if help is sought soon after the event. But regardless of how long ago the traumatic event occurred, the following therapy options can help sufferers move forward, away from the feeling of being "trapped" in the trauma, to a future of calm, strength and hopefulness:

1. Family therapy

2. Trauma-focused cognitive behavioral therapy

3. Medication to alleviate secondary symptoms like depression, difficulty sleeping, panic or agitation

4. Eye Movement Desensitization Reprocessing (EMDR) therapy

Like a home that needs to be rebuilt after a devastating tornado, the life of a survivor with PTSD can as surely be refashioned to allow the survivor to reclaim her power and step confidently into a resilient future.

If you or someone you know has been diagnosed with PTSD, reach out to your physician or contact a mental health professional in your area for help, The suffering of PTSD doesn't have to last--you have the right to take back your life and to move forward with health and happiness.

The Many Faces of PTSD - Part II

Clients with Post-Traumatic Stress Disorder (PTSD) experience symptoms in a myriad of individualized ways. But some  similarities in their symptoms are shared by all survivors.

SYMPTOMS OF PTSD

After the traumatic event, survivors report the following characteristics:

1. Distressing memories of the trauma

2. Dreams related to the event

3. Flashbacks of the experience

4. Avoidance of stimuli associated with the event (I.e., a survivor of a catastrophic car accident may choose not to drive or even to travel in a car; a sexual assault survivor may avoid approaching the neighborhood in which she was attacked.)

Other symptoms include a negative alteration in cognition and mood, People who may have been high functioning and coping well with typical life struggles may find it difficult to combat depressive moods, panic or anxiety, and may experience difficulties in concentration and memory. It's not uncommon for survivors to report being unable to remember important aspects of the traumatic event. Calm, passive imdividuals can become quick-tempered or even exhibit verbal or physical aggression. Difficulties with sleep, emotional regulation, fatigue and somatic complaints often plague survirors.

Next week: Treatment and recovery from PTSD. 

The Many Faces of PTSD - Part I

"PTSD is a whole body tragedy, an integral human event of enormous proportions with massive repercussions." Susan Pease Banitt 

June is National Post-Traumatic Stress Disorder Awareness Month. Most people are familiar with PTSD as a syndrome often experienced by combat soldiers. In reality, PTSD is a challenge for people of all ages, from all walks of life. 

Defining PTSD

PTSD can result from experiences of actual or THREATENED death, injury or sexual violence. Sufferers may be diagnosed with PTSD even if those experiences occurred to a family member or close friend. In addition to war veterans, survivors of abuse, physical assault, violent crime, natural disasters, severe automotive accidents and witnessing domestic violence are also at much higher risk of developing PTSD. Children, who may have less resilience and underdeveloped coping skills due to their limited life experience, are especially vulnerable to being diagnosed with PTSD as a result of trauma exposure. 

Next week's blog will detail symptoms of PTSD. 

The Four Pillars of Emotional Fitness

Movement is essential to keep our bodies in good working order. We walk on the treadmill, lift weights or practice yoga to improve our physical health and increase our lifespan. The characteristics that determine peak physical health can also be applied to our emotional health.

1. FLEXIBILTY.  Emotionally healthy people are able to adapt to various situations and responses. They can bend to accommodate different life realities, and are able to embrace the "gray" in life, rather than seeing the world as "black or white."

2. RESILIENCE. Resilience can be defined as the ability to bounce back quickly from injury or setback. Resilient people see failure as part of the path to success; they don't allow obstacles to keep them from their goals, and they can pick themselves up when life knocks them over with unexpected circumstances.

3. ENDURANCE. Emotionally healthy people can withstand the pressures of life without breaking. They have developed the emotional "muscles" to delay instant gratification and stick with a task or relationship fraught with challenges without giving in to the impulse to bail out or seek out the easy fix.

4. STRENGTH. Just as physically healthy people have bodies that can life heavy weights or hold challenging yoga poses, emotional healthy people have the fortitude to weather difficult emotions, longstanding pressures and psychological stressors without losing confidence in their abilities and self-worth.

A gym or yoga studio membership can provide us with a venue to work out our physical selves. Consider investing in your emotional health by engaging in therapy, reading self-help books, developing a meditation practice and surrounding yourself with positive, supportive people. Whether or not you can finish a marathon, enhancing your emotional fitness is a a finish line everyone can cross. 

The Stories of Our Lives

"Despite the habitual turning away, the 'now' is always better than the story about it...Because there is no way to engage with, move on from or handle the to-ing and fro-ing of a story."  -- Geneen Roth 

I got stuck on this passage in Roth's Women, Food and God. So stuck, in fact, that I misstepped on the treadmill and nearly catapulted off the back. I read and re-read it, feeling like the words were identifiable, but the meaning was beyond my grasp. Then it sunk in. There is NOW. And then there is our STORY about NOW. 

TELL ME A STORY? 

Anxiety is a sign that we are either revisiting the past ("why did I have to say that to my boss?") or projecting into the future ("have I ruined my career? How will I ever find another job? What if I end up destitute and homeless?") We spend untold hours ruminating on our mistakes, and negatively predicting future outcomes. All of this cognitive energy prevents our presence in this moment. And in this moment, we are absolutely fine. We may be sitting on the couch, snuggled in comfy clothes, listening to soft, doggy-scented snores. We may be cutting an apple for our toddler's snack, or folding laundry or paying bills. Whatever we are doing in this moment, we can be present to it, or we can be creating a story about it. This moment is rich with sensation, emotion, thoughts and beliefs. We can feel this moment in our bodies, through our breathing. The story is unnecessary, and yet, when I reflect on troubling moments in my life, events that still squeeze my heart with regret or pierce my gut with fear, I realize my memory is less about how I truly experienced the event and more often about what I've told myself about it. My story distances me from my truth. It lays a gauzy film over what I felt and thought and did, making the essence of the experience more like a waking dream than a lived event. My stories can be exciting or frightening, morbid or hilarious. But whatever they are, they communicate only a version of the truth that is so much less than the actual realness of those moments. Inside the "now", I can feel and taste and smell and intuit the wisdom and grace that surrounds me. My story, no matter how fantastic, can never come close. My story can, and should, change over time, with insight and new life lessons that allow for new perspectives. But this moment, this now, is meant for me to live. I can leave the storytelling to someone else. 

Let's Talk About Sex

When I first started working as a therapist, I expected to hear about people's proudest moments, their deepest shame, promises that had been broken, dreams and relationships that had turned sour or died an agonizing death. I was (semi-)prepared to hear about profound pain and loss. What I didn't expect was to talk so much about SEX.

NOT Just the Birds and the Bees

My clients have educated me as much as I have them. Over the past 20 years, I've helped couples create ethically open relationships, learned about the searing pain caused by sex addiction, and been schooled about the difference between consenting BD/SM behavior and fetishistic activity. I've aided clients in discovering their long-buried sexual identities, and helped clients rediscover their sexual energy after years of it laying dormant. Clients share fantasies, desires, and fears that either fuel them or create great fear. I have developed an appreciation and respect for the range of human sexual feelings, behaviors, and energies. Many believe the human sex drive is a manifestation of the life force; I've certainly witnessed the courage and power within many clients as they have striven to develop their sexual selves in healthy and dynamic ways. As happens so often, I am humbled and privileged to be a witness to the strength and creativity my clients demonstrate. I can only hope I provide them with a safe and respectful space for them to discover their best and fullest sexual selves. 

Investing In Resentment

Resentment can be defined as holding onto pain, anger or the wrongdoing of another. In the recovery movement, letting go of resentment is part of the foundation of sobriety. Most of us can't imagine WANTING to sit with resentment; it's discomfort is the emotional equivalent of rubbing sandpaper on sunburned skin. I can easily identify the behaviors of others that create my resentment, but when it's my own choices that fuel my internal wrath, my awareness is sometimes less than crystal-clear.

IT'S NOT YOU, IT'S ME

On Mother's Day, we got invited to my mother-in-law's for brunch to celebrate the day, and to my brother's for dinner to fete my mom. Both houses are an hour apart, and nearly as far from our own home. That meant I would be spending my Mother's Day largely in transit between two points, and while I love both the moms in my life, I had also been looking forward to wiling away the afternoon on my couch, reading a trashy novel and eating junk food provided by my loving family. To be clear, neither my mom or mother-in-law "required" my appearance. In fact, they would've signed off on my hedonistic plans with complete support. But my sense of propriety or guilt, habit or belief about what was the "right" choice to make, led me to decide to spend the day meeting what I believed was everyone else's needs over my own. Which, not surprisingly, led me to a state of exhaustion and resentment that I didn't do what I wanted to do. I couldn't blame my wife, my mom or mother-in-law for my emotional state. I couldn't hold society's expectations that we spoil our mothers on Mother's Day to task for MY decision. Ultimately, how I spent my day was my choice. By not being conscious and present to my decision, I denied my moms my full participation in their celebrations as much as I denied myself some R&R. I need to accept the mantra I tell my clients: to value our selves equal to others is not selfish, it's self-ist. I won't wait until the next holiday to listen to my feelings and respect my own needs alongside others'. I've felt the burn, and I'm ready to drop that rock. 

Peeling Back the Label

Labels help us understand what's before us. Without labels, grocery shopping would be impossible. How would we know which can contained the green beans, and which housed the creamed corn? How would we  know which pair of jeans would offer the right fit, if a little white tag wasn't nestled in the waistband? Imagine searching for the latest best-seller at the bookstore without the headers of "Biography", "Cookbooks" and "New Fiction" pointing the way? Labels make life run more efficiently, save time and reduce confusion. And they can be hurtful and reductive.

WHAT'S IN A NAME?

Labels can be limiting. They can reduce a person or an experience to a bite-sized morsel of information, when, in reality, a platter wouldn't hold the whole truth. For example, for centuries society has labelled humans with two genders: male and female. Yet I work daily with folks who are transitioning from one gender to another, or even discarding the notion of gender altogether. In our binary, either/or world, how do we acknowledge or understand someone who is rejecting labels that have categorized our "reality" for as long as we can remember? Similarly, clients diagnosed with conditions like bipolar disorder or depression can often be regarded as their "label" rather than their personhood. Certainly, certain characteristic are shared by all people with schizophrenia; otherwise, the diagnosis couldn't be consistently applied. But each person's experience, wisdom and consequences with an illness is unique and particular to him. Some labels conjur up positive feelings or associations, while others engender fear or rage. Labels provide a starting point for conversation, an entry into someone's internal world. When it comes to people, labels don't guarantee what's inside. We enrich ourselves, and respect others, when we are willing to go beyond a label to truly understand and empathize with another's human experience.

NOT Child's Play: When Adults Were Ill as Children

Most of us have weathered childhood health issues like chicken pox, broken bones, stitches and tonsillectomies. And other than some faded scars, we probably have few continuing reminders of those early afflictions. But for some adults, especially those who have experienced severe or chronic childhood illnesses, like cancer, juvenile diabetes, or cystic fibrosis, the impact of those experiences continues to play out in their grown-up lives and bodies.

THE COST OF CHILDHOOD ILLNESS 
Experiencing a severe or chronic illness as a child can have long-term, adverse effects.  Some adults missed out on significant developmental milestones as their peers, not being able to attend prom or get a driver's license due to hospitalizations or limited mobility. Depression, anxiety and strained family relationships can continue for years after a childhood health condition has resolved. Occasionally, clients will report unresolved trauma symptoms related to medical procedures or conditions they experienced decades before.  Others become aware that their coping or relationship skills have been stunted by extensive time away from the childhood millieau of school, sports and play dates. Counseling can be instrumental in helping adults address and move past these obstacles. Therapy can be a safe place to access stored grief, resolve trauma, obtain psychoeducational training to develop delayed life skills and recognize resiliencies that enhanced survival. If you struggled with health concerns as a child and experience any of these challenges, consider contacting a therapist to bring  healing to  your mind and spirit as well as your body.

Understanding Binge-Eating Disorder

Many of us have had the experience of over-eating to the point of abdominal pain. Just think about your last Thanksgiving feast: how many people pushed away from the table, groaning with discomfort, loosening their belts, unsnapping the waistband of their jeans? Occasional over-eating is not a clinical diagnosis, but more usually a sign of distracted eating, intense enjoyment of a particular meal, or a result of indulging in a special treat. Binge-Eating Disorder, however, is a serious eating disorder that can have life-threatening consequences.

DIAGNOSING BINGE-EATING DISORDER 

Specific behavioral and emotional characteristics are present for clients with Binge-Eating Disorder(BED), including: 

1. Recurrent episodes of binge eating, characterized by eating much more food in a specific amount of time than most people would, and feeling a lack of control over the eating episode.

2. Binge eating episodes include three or more of the following components:

      A. Much more rapid eating than normal

      B. Eating until uncomfortably full

      C. Eating large amounts of food when not hungry

      D. Eating alone out of embarrassment about the amount one is eating

      E. Feeling disgusted with oneself,  depressed or very guilty afterward

3. The person feels marked distress about his/her binge eating.

4. Binge eating occurs at least once a week for three months.

5. The binge eating is not associated with the recurrent use of compensatory behavior (i.e., over-exercising, abuse of laxatives) like in bulimia nervosa, and doesn't occur only during the course of a person suffering with bulimia or anorexia nervosa.

PUTTING BED TO REST

Various treatment options exist for BED. Inpatient, partial hospitalization, intensive outpatient and outpatient therapy modalities provide the appropriate level of care and oversight for clients' differing needs. Besides counseling, the treatment team also includes a nutritionist, medical doctor and psychiatrist to help manage the client's physical health. Obtaining a comprehensive evaluation from a certified physician or therapist specializing in eating disorders is essential to ensure the correct level of care is initiated, and to screen for other co-morbid diagnoses, including substance abuse, personality disorders, depression and anxiety. Like all eating disorders, recovery from BED can be a lifelong process. But early intervention and a commitment to the therapy process can provide BED sufferers with the skills and resilience to triumph over this complicated disease. 

Tracking Teen Development: When to Intervene

Seemingly out of nowhere, my previously sweet, considerate and affectionate 15-year-old son is sometimes replaced by a surly, disrespectful and eye-rolling teenager who doesn't hesitate to point out my every shortcoming and flaw. In the past, my son would join me in our "Car Dancing"--maniacally rocking out to our favorite songs on the radio. Now, he FORBIDS me not only from dancing in the car, but even singing along (which, of course, necessitates my immediate need to belt out song lyrics as loudly as I can WITH THE WINDOWS DOWN). His behavior irritates and frustrates me, but I am  familiar  enough with adolescent development to understand my son is a typical teenager. But how do we tell the difference between normal adolescence and behavior that indicates a need for intervention?

TYPICAL TEEN -- OR TYRANNICAL TERROR? 

According to experts Dinkmeyer and McKay's seminal books on parenting, teens can generally be grouped into three categories. Review these attributes and behaviors and consider where your teen falls:

Typical Teenager--This teen exhibits a greater interest in friends than in family. He may try out different values as a way of separating and creating a sense of self distinct from his family. She may experiment with smoking cigarettes, trying alcohol, swearing, and minor rule-breaking at home or school. Lying, pushing againt established boundaries and occasional disrespectful behavior fall into this category.

At-Risk Teenager--This teen may isolate from family, demonstrate a more consistent use of  alcohol or marijuana, and express less interest in school or other achievements. She may experience conflict with authority figures, disregard house rules, engage in sexual experimentation at an earlier age or deliberately express disregard for family values and activities.

Out-of-Control Teenager--This adolescent regularly uses substances, may he skipping classes or even dropping out of school. He may be sexually active indiscriminately or engage in risky behaviors. He may be involved in the juvenile justice system, and have difficulty in sustaining healthy relationships.  A high level of disengagement from prosocial activities and an investment in dangerous or unhealthy behaviors is a consistent theme.

Clearly, at-risk and out-of-control adolescents are in need of immediate interventions, including a referral to counseling. Typical teens, however, can also benefit from individual, family or group counseling. This challenging and vulnerable stage of development is a time ripe for growth and insight. Counseling can provide teens -- and exasperated parents -- with support, education and skills to navigate these years with limited eye-rolling and exaggerated sighs. Just don't expect car dancing lessons. Some talents are simply inborn.

Parental Guiding Suggested

Wiping runny noses. Driving carpool. Answering the same question 12 times. Scheduling doctors' appointments. As parents, we expect and accept that these tasks are everyday obligations in our roles as caretakers. As the American population ages, however, many adults find themselves in the role of caretaker for their parents as well, with sometimes ambivalent feelings  about the tasks involved in this balancing challenge.

PARENTING OUR PARENTS

Different cultures approach aging, and caring for the aged, with varied perspectives. While some families believe that caring for aging parents is always the responsibility of family members (usually the adult children), others feel that older folks receive the best, most informed care from trained providers, whether in-home care or professionally-staffed facility. No single approach works for all families, nor for the needs of each aging member.  If you are exploring the best care options for your aging parent, consider the following points:

1. Call your township. Most areas have a senior services department, which can help schedule Meals  on Wheels and volunteer visits, offer financial or transportation assistance and suggest area resources to help you and your parent.

2. Establish a "treatment team." With your parent's doctor as the center point,  develop

a circle of providers to help manage your parent's needs. Consider a counselor, home health staff, nutritionist, physical therapist, attorney and accountant who specialize in older clients--whoever can best advise you and your parent and sustain his independent functioning for as long as possible.

3. Research options sooner, rather than later. Aging people's health status can change quickly. Start looking into different levels of care, including assisted living, independent living and nursing home facilities, so you and your parent are not caught off guard if the need arises.

4. Join a support group. Just as your parent can benefit from time with his peers at the senior center, caregivers can get replenished, educated and understood by peers experiencing the same developmental milestones. Check with local hospitals, senior centers, and your parent's physician for referrals to area support groups for adults caring for aging parents. 

5. Keep communicating. The changes and limitations that come with aging can be challenging to accept--for both parent and adult child. Talk regularly about your feelings about your parent's functioning, your fears and concerns for them and your opinions about their care options. Encourage your parent to share her feelings with you. When we love someone, we sometimes "hide" truths from them that we fear may be upsetting. In reality, the "known" is much easier to cope with than the "unknown." Whereas we are unable to craft a response to the unknown, with the known, we are empowered to act and choose. 

Better Safe than Sorry?

Our family has just begun navigating the college exploration process. My son is actively researching various schools for programs heavy in the arts -- film, screenwriting, directing. We, as parents committed to bankrolling (at least in part) his higher education, are studying our income flow and funds management to see how to make his dream work without crippling our family's future. From day one, I've voiced unequivocal support for my son's pursuit of his dreams. Whether it was Broadway or Wall Street, I let him know that I'd be behind him no matter what. Now, however, I find myself examining my parenting values with a more critical eye.

QUESTIONING THE VALUE OF VALUES 
It was easy to champion singing lessons, acting class and play auditions when my required investment included chauffeuring, soliciting for ads for the play program and donating old clothes for use as costumes. I find myself questioning whether a degree in filmmaking or screenwriting is my son's wisest educational course. Should I suggest accounting? Health care? Some profession in high demand, that risks less personal rejection than the arts? Or do I live my long-stated values that life is too short not to go after your dreams, that taking risks is a valiant and worthy endeavor? That a steady paycheck in an unfulfilling career may not cushion him from regret? Do I truly believe that creative expression and fulfillment is worth the possibility that my son may have to work several jobs while he tries to craft his masterpiece? I wrestle with what is "best", what is "sure", what is "reasonable." And then I remember the joy in his voice when he first discovered show tunes, the pride in his face when he "screened" his first film. I remind myself of the parenting truth I value above all others: to love him as he takes flight -- not to guide his direction or his landing.

Individual + Couple's Therapy=Success

Couples in joint counseling are sometimes surprised when I recommend that one -- or both -- members also initiate individual counseling with their own therapists. Some people worry that spending time in solo sessions will create further distance in the relationship, providing a space for secrets or avoidance of tough couples' issues. Occasionally, I hear clients say that they feel my recommendation is code for "There's something wrong with you. Go get fixed in individual therapy before you can expect your marriage to work. " In reality, individual therapy is an effective adjunct to couple's work, and is a common suggestion made by therapists treating marital discord.

I'M OK. YOU'RE OK. NOW  WE CAN BE OK. 

As I get to know each member of a couple in joint therapy, I may notice individual issues that may be affecting or impeding their progress. Depression, anxiety, trauma, and  family of origin issues can muddy the dynamic between lovers. Often, the individual struggling with these issues can use individual sessions to become aware of and heal these components, allowing couple's work to move along in a more timely fashion. In addition, participants may not be yet ready for the vulnerability and transparency required for effective couple's work. Having an individual therapist allows each person a safe stage to vent, complain, and explore fear, anger and disappointment, until he or she is able to voice these experiences in ways that help bring the couple greater awareness and intimacy, instead of further damage. Finally, couple's work is multilayered, complex and intense. Truly, three clients are in the room: each member of the couple, and the relationship itself. Having a "team" of professionals to offer feedback and provide varied perspectives and interventions helps ensure the most comprehensive view of how to help a couple create a relationship of resiliency, trust and fulfillment.

Stressed? It Could Be...Eustress

We expect the symptoms of distress when we are under pressure, anticipating a negative event or feeling burdened with excessive expectations. But we can also experience anxiety, muscle tension, headaches, irritability, fitful sleep -- as well as a slew of other stress reactions -- as a result of Eustress, which is defined as positive life events that bring with them an increase in stress. Weddings, a long-awaited pregnancy, holidays -- these experiences can create an increase in the release of cortisol, a stress hormone, as surely as more negative life events like loss or trauma.  Turns out our bodies don't necessarily know the difference between anticipatory anxiety and dread. We may find ourselves suffering from a migraine the night of  our engagement party, or experiencing anxiety and sleepless nights after receiving a long-deserved promotion. It's not that we don't appreciate our good tidings; we are simply wired to react with similar somatic responses to sometimes widely disparate occurrences. When you become aware of a celebration looming on your calendar, take stock of your body's wisdom. Try getting some extra sleep the days before the event. Maintain a high water intake, and try to keep your exercise commitment to burn off some of the stress hormones and muscle tension. Incorporate stretching exercises into your daily routine, and jot notes of all the highlights your are anticipating to free up some brain space. We all deserve to revel in the achievements and high points that make life memorable. By focusing on a little preventive self-maintenance, we can minimize our stress and be poised to be fully present to all the revelry that's coming our way. 

Recovery Begins with "C"

Many people think recovery from addiction begins with a stint in rehab. Or that recovery commences when the addict hits "rock bottom." Or even that abstinence from one's drug of choice is the key to recovering a healthy life. But many "12-Steppers" (members of 12-step support groups like Alcoholics Anonymous, Narcotics Anonymous, Overeaters Anonymous, etc.) will attest that true recovery comes from being part of a healthy COMMUNITY.

THE HEALING BENEFITS OF COMMUNITY

Choosing sobriety is the first "entrance pass" into recovery, but most recovering addicts maintain that it's the work done within, and for, one's sober community that bolsters recovery and provides a firm foundation from which the addict can move forward confidently into a healthier way of being in the world.

The community of a 12-step group provides:

1. Accountability.   Surrounding ourselves with people with the same challenges provides a mirroring process, allowing our cohort to hold us accountable for doing "the next right thing" and to encourage us to stay honest and humble.
2. Healthy socializing. Try as they might, addicts cannot continue to hang out with friends who use and still maintain sobriety. A sober community offers opportunities to connect with others with similar values, at events void of drugs and alcohol.
3. Service. A key component to recovery is giving back to one's community. Whether that means making coffee before a meeting, taking a phone call from a struggling friend, or driving a fellow group member to an event, serving others is a consistent reminder that the world isn't "all about us." We discover that being a part of a community, having others rely on us, builds self-esteem and fights isolation.
4. Reinforcement from people who "get it." Addicts often feel unique and misunderstood. Surrounding ourselves with other addicts who understand the fears, shame and lost opportunities endemic to life in addiction is a solace most addicts deeply appreciate.
5. Reminders. Our sober community, through other addicts sharing their stories, provides unceasing  reminders of how easily we can fall back into bad habits, as well as offering a road map for how others have maintained success.
6. Spirituality. Some people's experiences of organized religion have created shame or guilt for the individual, which blocks true healing. A sober community offers a place to learn and practice one's own unique spirituality, in an environment of support and unconditional acceptance. 

Let It Go

Although my son is well past the Disney-age set, I have not been immune to the force of the cultural phenomenon of the Frozen movie, specifically it's omnipresent anthem "Let It Go." I wouldn't originally have considered Princesses Elsa and Anna to be Zen aficionados, but the message about learning to leave behind what no longer serves us is applicable to everyone. Buddhists consider "clinging" to be the root of all suffering--in essence, trying to hold on to things, people, behaviors, even thoughts, will lead to frustration, disappointment and pain. Letting go can be a challenge for the most resolute of souls. But with practice, we will discover that unclenching our fists from around whatever we are convinced we so dearly need  leads us to enlightenment, peace and freedom.

TIPS FOR RELEASING YOUR GRIP 

Not sure where to start? Try some of these techniques to practice letting go:

1. If you are troubled by shame from your past, negative thoughts about yourself or others, or long-carried anger, try writing it down. Put pen to paper and, in as much detail as possible, describe the thoughts, feelings or events you'd like to leave behind. Then rip up the paper into tiny pieces and throw them away. Or even better, burn the paper to ash, allowing the painful words to literally "go up in smoke."

2. Buddhist meditation practice may involve noticing our thoughts and learning to release them without judgement. Try picturing the person, event, feeling or thought that is troubling. Imagine "touching" them lightly, either physically or energetically, and allowing them to float away into the air, dissolving slowly into the ether.

3. Imagine standing at the edge of a pool of water. Cast your thoughts, pain or shame into the current, and watch the waves carry them away, engulfing them until they are a part of  the waves.

4. Imagine holding the thoughts or feelings in your clenched fists. Flex your hands and arms as if you need to hold on to those ideas for dear life. Then slowly open your fists, allowing the tension to drain from your hands and arms as the painful material leaves your possession. Feel the relief that comes with the release.

Letting go is not for the faint of heart, but neither do we need to have a crown and title to practice this essential action.  Even attempting to let go is a form of "un-clinging"-- an unclenching from fear and doubt as we try something new.