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.

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!

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.

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.

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.

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.

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.