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!"