Missing, But Not Lost

We are on the cusp of winter and as we usher out this difficult year, I find myself reflecting on those I have lost. I imagine the empty spaces that are left in the homes of those who have passed, the Zoom calls or visits that would be scheduled, the socially-distanced connections. This is a time of heightened loss for our country and world as the pandemic continues to rage. For many of us, keeping up with family and friends has been a challenge, which folds into the grief of many other losses we are exposed to currently.

It has only been six full months since I left the health system (I absolutely cannot believe that) and it has been a lot to process. There has been so much I have learned about grief and loss in the eight years I was working in a large health system. I worked in inpatient general medicine, gerontology, palliative care, and outpatient oncology. I covered many disease groups over the years. The ones I feel most familiar with are in hematology and oncology: leukemia, multiple myeloma, lymphoma, prostate, bladder, renal, head and neck and sarcomas were the cancer populations I covered. I also had the privilege of covering the anemias including sickle cell anemia.

As you can imagine, I was responsible for supporting many patients from all walks of life as they encounter a challenging and oppressive system, and cope with life altering illness. For some, I only had the privilege of serving for days or weeks. Some patients I had years with and, unfortunately, countless more were for only hours or minutes before death.

I am sure I will have many other pieces on the deeper parts of grief. For those interested in grief posts I have already written, check out this other post where I discuss grief counseling. However, this post is more of a dedication to those with whom I worked and not the specifics of our connections. This is an honoring of them and my grief.

For any clinicians or people who have multiple losses, this can be an important process to provide yourself. We know ourselves based on the vital relationships we have had with others, so honoring those relationships honors our own being.

For those whom I have unparalleled gratitude…

You were a patriot and a badass motorcyclist. You were the most gentle and open person I have ever come across. I couldn’t believe how strong your were the whole way through surgery, radiation and chemo. Those treatments may have stripped you of your biker beard, but they didn’t strip you of your spirit. Whenever I give thanks to veterans or drink a good beer, I raise my glass to you.

You were in so much emotional angst the entire time I knew you, but you didn’t let that angst dictate your life. You were whimsical. You brought back my love for reading. You deserved so much more in life. I hope you are at rest and got that chance to go to Disney World and Universal Studios. I hope to continue reading Stephen King with you.

You and I were just a few years apart. You also had a young family and you were so angry. You had every right to be. Leukemia isn’t fair and you didn’t have to come to terms with that. We talked about anger. We talked about our inner Hulks and how we can channel it for good. It’s our super power. You died much too soon. Your Hulk was always showing through, even towards the end. Hope you are at peace, friend.

Our relationship was, unfortunately, only in the ICU setting. You were awaiting a liver transplant. You were too healthy to get listed, but then rapidly declined to the point where you were no longer a candidate for transplant. It. Was. Not. Fair. You had just retired. Again, not fair. We talked of legacy, life lost, regret and we wept. We were four decades apart in age, yet we were on the same plane during our meetings. The human plane.

You were also a health care provider. You had only recently retired (sort of, retirement really wasn’t your style). It was hard for you to let go of teaching others. I got to know you over the course of a year and some change as you battled your blood cancer. You kept on teaching as you were slipping away from this plane. I am glad that you were able to make it home and find some peace and time with family. You were in so much pain.

You were a retired counselor and I was just starting off my career working with cancer patients. You embodied resilience. Your mind was so much stronger than your body gave it credit for. While so incredibly sad and painful, you were so graceful as your body failed you. I learned some of my most important therapeutic and life lessons when we shared space together.

I worked with you and your husband for over two years of brutal cancer treatment. You were a young couple experiencing more trials and tribulations than most people have to experience coming right out of college. I walked with you through your aggressive chemotherapies, your eventual stem cell transplant and recurrence. You were beautiful in your spirit and writing. You had so much more to offer this world. We are worse off for not having your voice with us right now. You have a legacy larger than you could know.

You would rarely schedule appointments with me, but you would drop by regularly when you were in clinic to ask if “Mr. Jesse” was around. You taught me so much about the history of Charlottesville and America, especially, our Black history. We talked about distrust with the medical system and your experiences of racism, both, inside and outside the medical system. We had a relatively long relationship (not long enough). You gave me a beautiful photo and note when you knew you were transitioning to hospice. I was fortunate to spend some time with you in your last home. We shared popsicles. You swore they were better than any palliative therapy available to you.

You were so young. Too young to be bed bound in the hospital so far away from family for so long. We spent countless hours together talking about videogames, music, movies, and wrestling. Cancer had taken your family away from you…it was also aggressively taking you. Again, it wasn’t fair that such a gentle soul had to come to terms with life so early on. You weren’t ready. I can’t imagine any of us would be. I always worried that you weren’t expressing enough of how much pain you were truly in. I am glad you finally allowed us to care for you.

You were my first long-term oncology therapy patient. We were the same age and we both had a kid not far apart from each other. I was with you and your wife on diagnosis through surgery, radiation, chemo and immunotherapy. You gave me tips on being a new dad. I gave you space to talk about your grief as a father and husband. You were a veteran, a fighter, and so gentle. Your daughter was lucky to have you. I weep about how much the both of you are missing. Thank you for the joined experience and the “Pickle Rick” pin (from the show Rick and Morty).

To all of you, and so many more…you have spaces in my heart and I will be forever grateful to have had the privilege to get to know you in such deep ways. What I have learned from y’all about grief, death, dying, family meetings, and more is so much more than I could ever be taught in academia or from a book. I am a better person, therapist, and advocate because of y’all.

Its been a year or two since many of you passed, but it doesn’t feel that way. I remember our conversations, the ambient noise of IVs and critical care monitoring. I honored each of you in my own way closer to the initial loss, but I found myself compelled to keep your memories on paper. Thank you.

The Swearing In of A Therapeutic Space: How to Therapeutically Swear and Fucking Mean it!

As therapists, we are aware of how powerful language is for both healing and harm. We are also appreciative of how limiting language is of human experience. Otto Rank, Sigmund Freud, and Wilfred Bion all theorized that we are born into trauma due in part to not being able to verbalize our initial experiences. Imagine if we had the capability to just exclaim a big “WHAT THE FUCK!?” when we were ripped from our mother’s wombs how cathartic it would have been.

While I was made aware of how important language was throughout my education and training, I received no formal education around the usage of expletives during a therapeutic encounter. I was fortunate enough to have one field supervisor who actually touched on this deficit in education. He noted that he found a lot of catharsis in swearing— especially, a well timed, well enunciated, “Fhhuck.” These F-bombs were sometimes sprinkled into our supervision sessions. I noticed how they made our supervision space feel more genuine and leveled the playing field. We didn’t have to censor ourselves, and I could feel stronger vibrations of how my emotions resonated with my supervisor. There is definitely a vulnerability to being able to swear with others.

Those interactions with my supervisor were pivotal in my growth as a clinician, and allowed me to learn about the intricacies of “use of self” in therapy. So what have I learned since that time? A shit ton.

Therapeutically Speaking

The Do’s

Be true to yourself.

If you swear in your day-to-day life, you can bring that part of yourself to the table in session too. Growing up near Boston, I feel like I grew up with swearing as a birthright and also as punctuation. Fucking right, guy?!

Be intentional.

Choose how and when you swear, just like you would with any other language you use. As you attune to your patient/client, it is important to pick up on the emotional tone they are setting. While you can wait for the client to initiate swearing, it is also reasonable to take a first stab at this based on content and their tone. You are serving someone who told you they just recently totaled their car in a car accident…Shit! You are serving someone who was just diagnosed with cancer…That is bullshit! Your client hasn’t seen their family since March because of the pandemic…Fuck that.

Take cues to reattune from your client.

I was once in the first session with a client who had been recently diagnosed with a blood cancer right after retiring. As part of us meeting each other and exploring the shock waves he was feeling, I suggested that “This is such bullshit.” He made direct eye contact with me and said, “No, this is FUCKING bullshit.” He was right. That “fuck” was necessary to hit home his emotions.

It is more than just swearing.

Eliciting and using the cursed words with your client can be more than therapeutic. It can also be a form of restoring justice for those who are labeled by society as being “young, angry, and Black.” Or victims of the “Angry Black woman” trope. While this is just a small piece of awareness for practicing therapy multiculturally, it can be important.

 I had a devastatingly short relationship with a young Black male (around my age at the time—early 30’s) who was going through difficult treatment for an aggressive blood cancer. He wanted to talk to me because he felt like he was having problems controlling his anger. We both riffed a lot about comics as this was an interest we shared. He saw himself as the Hulk because he wasn’t under any control of himself. While it was almost too “My secret is I am always angry” vibes, we had a big shift in our relationship when I asked him about what it was like feeling angry and Black as he interfaced with healthcare. Together we induced the Hulk (through a lot of swearing in our sessions) without judgement and with purpose. He had every fucking right to be as angry as he was. The beautiful part about it was we were able to get a much better depth for who he was as a person after we realized he didn’t have to struggle with “Hulking out.” We could embrace, hold, and release that anger through descriptive emotional words and a large quantity of “fucks.” 

The Don’ts

If you don’t swear normally, don’t push it in session.

Your clients will be able to see right through you. An example of me pushing myself outside of authenticity was when I first started providing therapy as an intern. I was working with teenagers in a residential school setting and I found myself casually swearing throughout sessions. I noticed that I would sometimes say “fuck,” or “shit,” to try and loosen things up and break the ice during my sessions. These kids were wise to me and one actually told me “You talk like you don’t even know how to swear good.” That really fucking hurt my feelings and my ego.

Swearing should be used to emphasize and allow better expression.

If used exclusively, as the full range of expression, it may actually hinder naming of important emotions. For example, something can “really fucking suck,” but that doesn’t mean that identifying whatever that “fucking suck” is isn’t important. It is still important to dig into if grief, sadness, hopelessness, helplessness, and fear are a part of that “fucking suck.” The cursing can be a catharsis, or release valve, but doesn’t necessarily help to create space for tough emotions or traumas.

Don’t swear gratuitously.

Not because it would make you a bad person, or make you sound like less of an expert, but because, like with any word, gratuitous use tends to lessen the meaningful impact said word has. I love using “notice” in sessions, but I notice (get it?) that if used too much the mindful intent of that word gets lost and feels more casual. Just as if I used “fuck” too much in sessions it would loose all fucking emphasis and just be another fucking way for me to take a fucking breath, rather than exclaim on how fucked up someone’s fucking situation is.

Don’t dive right in.

With some exceptions, don’t go for F-bombs right out of the gate. A thorough psychosocial assessment and initial rapport building with your client can be helpful in navigating how therapeutic swearing will be. Who knows, they may even give you a dose of their own swear-laced narrative within that first meeting.

I hope that this examination of cursing in session is of benefit to new and seasoned therapists, alike. I also hope that it is eye opening for clients who may be worried about how they censor themselves when first meeting with therapists.

How I Built Me

   For this post, I am going to offer an exercise that is rooted in mindfulness and narrative practices. This is an exercise I would offer to someone who is having trouble with self-compassion, or may rely on intellectualization a lot. This exercise can be conducted with a client (as a therapist), or something that can be done on your own. You may even want to record your interview!

 

                       The Setup 

 

   Have you ever listened to the podcast/radio show How I Built This with Guy Raz? It is a great show where Guy interviews a business mogul about how they established their successful business. He asks his interviewees to speak to their humble beginnings, mistakes made, risks taken, and everything that lead them to where they are now. At the end of the interview he also asks them about what they see for the future of their business. The common thread in all of his interviewees stories are that they have had multiple failed attempts at success. They have taken risks, made mistakes, and have received help and support from a variety of people in their lives. Ultimately, every interviewee gets to speak to their particular resilience. In less than an hour Guy is able to capture how someone built the legacy that they have. How awesome is that?! This concept very much applies to a narrative exercise that can be used for working on our own broader stories.

 

 

                      The Exercise 

 

   Envision being interviewed on a podcast about who you are and how you have got to the place that you are in. Right now you might feel that you haven’t really accomplished anything. Maybe you are feeling like you are actively struggling with where you are in life. You may even believe that you are a complete failure. Don’t worry, this exercise is still for you.

 

   These negative beliefs do not necessarily need to be challenged. However, let’s assume that if you are continuing to show up for yourself, even in reading this, that you are resilient and you are a survivor. You are a work in progress (as all of us are). How might you talk about your journey? How did you get built? What is left to be done? What is your next project? Write out, record, or talk out your answers to these interview questions and prompts:

Interview

  1. Tell me a little bit about your upbringing and what your initial interests, drives, hobbies and passions were. Who supported you in these things along the way?  What were your first aspirations? Who were your inspirations?
  2. How was your view on life or success formulated growing up? What were you taught was possible for you? 
  3. What mistakes, risks, or trouble did you get into? What have these experiences taught you about yourself? What did you learn about life?
  4. What does success mean to you? Choose a couple roles you might speak from (relationship with self, as a partner, child, parent, employee, citizen, or academic) to describe how you became successful, or are noticing success within these roles. Did anything about your previous experiences or risks you took inform you in this success? If you don’t identify as feeling successful, what has allowed you to stay strong enough to continue working on yourself right now? 
  5. What is the next step for you in continuing to build the best you? What changes will be made and what would you need to make these changes? Who do you need to connect with for these endeavors? 

*Modification

 

   If someone is really struggling with self-worth and self-esteem, try conducting this interview in third-person. (Ie. Jesse grew up..) This can help to access a narrative in a less threatening way.

On Productivity and Balancing Rest

Productivity Fight

I am going to paint you a quick picture of the space I am currently occupying. It took some internal fight to find the productivity to sit at my desk to write. “What’s the point?” has been going through my head a lot recently. It has felt really difficult to focus for a while. As I write this, I also feel my stomach sinking, chest tightening, and tears welling up. This past week I have been feeling stagnant, stuck, unproductive. I have been feeling like I lost that juice or motivation, and I have been, in a lot of ways, wondering why I am not able to power through this. Why can’t I use my own knowledge of mental health to get myself unstuck? I have been posting tweets that I share with the world, but I realize how much I am sending these messages to myself. (Much like how I have also literally been sending texts to myself after completing the daily meditations in my Calm app with the inspirational quote of the day).

The best example of a total self tweet is my 9/9/20 tweet: 

“Putting this out there because I definitely need to hear it today. Just a PSA that your worth is not dependent, nor defined by your productivity. That goes for today and everyday! #WednesdayThoughts #selfcare #selflove.” 

Also the most apt self Calm app text is definitely:

I truly believe both of these sentiments. However, it is so, so, so, so, so hard to feel that, and allow that compassion to soak into me. I don’t believe I’m alone in this. Many people I work with often report values to me that they, themselves, find a lot of difficulty actually applying to themselves. 

Rest versus Recovery

I have been brought up in a culture where a “hard days work,” meant that I come home physically, emotionally, and spiritually exhausted. This was life as I knew it as a medical social worker and therapist. This way of being was also affirmed by our institution and others that I worked with. I would come home at the end of a day and I wouldn’t have much to offer in ways of connection or emotional labor at the house. Weekends were not necessarily for rest, but rather, for recovery. A majority of my career has been a recovery, survival, productivity struggle. When I left the medical world, I thought that some of this mentality would change. It did. My survival mode has transitioned into creativity, my recovery into vitality. Productivity, however, is that beast that is still entrenched deep in me. It threatens to rob me of the other two healthy shifts that I have experienced. 

That beast rises up often to question whether I am enough. If and when I can have a down day. If and when I can schedule some “me time,” or allow myself to not work on the business every chance I get. Ironically, I know that sitting down to write this is also me working on my business too, but I will put it on record that I initially sat down with the selfish motive to figure my own self out. The act of sitting down to write was also a convenient reminder to schedule a time with my own therapist. So here it is, an ode to reclaiming what we all need. Rest. How might I reclaim that, you ask? 

Finding Balance

  1. Name the productivity beast for what it is —The part of myself that is a shitty manager
  2. Allow myself to feel present with what has been giving me some life during these difficult times. Right now it’s “The Last Dance,” documentary about the Bulls and Michael Jordan. I don’t know why it is giving me so much life, but I am going ahead and going to let myself have it.
  3. Stay connected with my family and friends who are right here for me no matter what condition I am in.
  4. Practice gratitude for what I have, what I have already accomplished, and for being free of an oppressive system that I used to work in. I can change the shitty boss inside of me much easier than a large system.
  5. Get back to relating to my body in a different way. So many feelings and emotions and energy can be stored in our body in different ways. I can’t remember the last time I got some true exercise. I know that I need to feel like I am offering something to the temple that holds me. 

Looking for more?

I hope this post finds you in a space where you also could use the self compassion and a dose of humanity being instilled in your life. Feel free to follow me on Twitter @brbhealth. I tweet primarily about mental health and health related issues. There is also a lot of sarcasm and self deprecation tweets. 

When it comes to this particular topic, do yourself a favor and follow @thenapministry. The Nap Ministry has many daily doses of offering you ways to practice radical self love and rest. Go on. Get yourself a nap. 

Anger: Holding Both – The Power of “And” Part 2

This is the second installment of Holding Both: The Power of And.  Please refer to my initial post to read about why I created this series.

For this installment, we will be comparing quotes, wisdom, and thoughts on anger. This isn’t a battle royale of thoughts and people, but rather a way for us to dig deeper into this shared wisdom. In this comparison we are examining whether anger is destructive or constructive. To kick us off, we are going to examine a quote attributed to Buddha..you might be able to guess Buddha’s stance on anger.

“Holding on to anger is like grasping a hot coal with the intent of throwing it at someone else; you are the one who gets burned.”

– Buddha

I actually found myself using this quote quite a few times recently in helping some of my clients clarify if they feel like their anger is serving them or not serving them (ie. Does it feel like that coal?). I think any of us who feel like we have been swept away by anger could relate to this quote. Most of the time we feel like the ones assuming the burden of our own anger, especially, if we aren’t able to use it to drive us to some sort of catharsis. Reading this quote, I am reminded of how the anger argument tends to lead towards a conversation on what embracing forgiveness could look like. This is definitely an act for oneself, which will likely be explored in a future post. 

“Whatever is begun in anger, ends in shame”

– Benjamin Franklin

Ol’ $100 spot may also be aligned with Buddha in his thoughts on anger as well. Have you ever popped off and felt absolutely terrible about it later? Many of us likely have. When anger prevents us from being able to take intention in our actions and leads us to feeling like we have lost control and impulsively explode we are left over with a lot of remorse. Not many feelings are quite as terrible as this. So the shame spiral begins. 

So what does all of this mean? Should we restrain, pause and hold onto or fight our anger? Is it purely a destructive force? Well there is probably one thing we can all agree on. Anger doesn’t feel good. I think this is about to get a little bit more complex.

“Bitterness is like cancer. It eats upon the host. But anger is like fire. It burns it all clean.”

– Maya Angelou

Counterpoint to the above blanket statements on anger. I love how Maya differentiates bitterness from anger, especially in the context of society where Black female voices are seen as “angry.” Placed in a pathological light, this differentiation is important. Anger can lead to movement. Anger can lead to needed change.  Anger can be the action on our moral compass. Maya also notes that anger can be the catharsis we need to actually feel and complete a necessary emotion to cleanse ourselves of bitterness and toxicity of resentment. If anyone can demonstrate how anger is not only necessary but beautiful, it is Maya Angelou. 

“Usually when people are sad, they don’t do anything. They just cry over their condition. But when they get angry, they bring about a change.”

– Malcolm X

To piggy-back on Maya’s quote, Malcolm speaks more to how anger leads to progress and social change that I also alluded to. Anger serves to prop our ego up, helps to energize and motivate, and can bring power where vulnerability feels like it might crush us. I think we are seeing this anger/outrage a lot in our current political environment and we are seeing the movements that are harnessing anger to institute progress. Anger is a powerful fuel for the engine of change. 

“Love implies anger. The man who is angered by nothing cares about nothing.”

—Edward Abbey

Lastly, in support of allowing space for anger as a driving force, this quote speaks so much truth to me. Just as I believe, to love someone or something is to also set ourselves up for pain and vulnerability, it is also an avenue for anger because we are passionate, care, and need to take a stand. It is hard for me to see someone as being fully authentic when they are not able to admit to or express their anger. I truly wonder if someone’s capacity to love is limited if they are unable to express and acknowledge their anger?

So how do we put this all together? Read on with my closing argument:

“Anger is just anger. It isn’t good. It isn’t bad. It just is. What you do with it is what matters. It’s like anything else. You can use it to build or to destroy. You just have to make the choice.”

– Jim Butcher, White Night

This quote is very in line with how I see the nature of anger. It is just like the nature of all emotions. It would be a little too simple to label any emotions as good or bad, right or wrong. They just are. I would also argue that we don’t have control over how, or when they present. All we have control over is our capacity to notice and acknowledge our feelings and choose how we want to engage with them.

This line of thought captures Acceptance and Commitment Therapy philosophy, which I weave into a lot of my work. This quote also captures how bringing in awareness, acknowledgement, and intention can make the biggest difference in determining if the overall experience of an emotion is helpful or unhelpful to us. This quote is a perfect synthesis of the wisdom of both sides of the anger argument. In a lot of ways both sides are true AND context matters (He did it! He referenced his own blog them! We can wrap this up!)

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My parting word of wisdom comes in form of another quote: 

“When angry, count four. When very angry, swear.” – Mark Twain

Pretty much says it all. Be on the lookout for a future post about swearing in therapy and why it’s f*cking great! Also, check out my BRB Video Channel. I will update that as frequently as possible. 

A LOVE Letter To My Clients

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One of the most influential debates I remember from school was, “Is it okay to love your clients?” I am going to let that sit there for a bit….

Sounds like a pretty loaded question, huh? At first blush, we might feel like that’s too messy of a feeling to be able to allow and would lead to significant concerns with boundaries. Maybe it is first important to clarify what love is. (Cue Haddaway and Night at the Roxbury)

Love as an action and a feeling is complex, but these are some descriptions that I am hoping have some universal applicability: 

Webster’s Dictionary’s first definition for love is very apt, “strong affection for another arising out of kinship or personal ties.” The verb definition “to thrive in,” is also equally apt. 

While I could get kind of clinical with what love is, I prefer to stick with some quotes that speak to love. Keep in mind this isn’t an exhaustive or diverse list, but rather quotes that captured the general love I refer to in this specific context. I will likely revisit love in a different way later and capture more diversity and depth with those quotes. Without further ado: 

“Love is the ability and willingness to allow those that you care for to be what they choose for themselves without any insistence that they satisfy you.”

-Wayne Dyer

This quote really speaks to me as I think of my love for my clients as their therapist. Reminding myself of this definition helps keep in context that I am focused on my client’s definition for wellbeing. I also love the application of this quote because when we consider transference within the therapeutic relationship, a lot of it, I would argue comes from the unconscious insistence that our client satisfies us, or that they look to us to satisfy them. 

“Where love rules, there is no will to power; and where power predominates, there love is lacking. The one is the shadow of the other.”

-Carl Jung

Being a psychotherapist himself, it makes sense that his definition of love would have good application to our field. I greatly appreciate how this captures a dynamic in many professional relationships where power can be an issue. While I wouldn’t necessarily say that love can conquer all power differentials, I would argue that truly letting yourself love your client would go a long way to balancing the power differential out. 

“Love is our true destiny. We do not find the meaning of life by ourselves alone – we find it with another.

-Thomas Merton

This really resonates with me. I find that I am in my spiritual sanctuary every time I step foot into the counseling space. It is precisely because I know that with some dedication and being open to feeling love for my client, I will be joined in an experience where we get to continue to discover the meaning of life together. This is what makes therapy such an intimate and sacred space. 

So by now you can probably see where my argument is going.

It is not only okay to love your client, it’s necessary to do effective therapy. To know someone is to love someone, right? Our clients share their most vulnerable parts with us and allow us to know them in a way that no one else does. If it helps to understand why loving our clients is important, let’s continue to speak to love as being an action rather than just a feeling. Every time we step foot into the therapy room we act as helping, healing, loving agents. How do we do ethical, effective, good therapy? Don’t be afraid to love your client, flaws, strengths, and all.

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Below is an acronym I follow to allow myself to love my clients. 

L- Listen and Locate

Listen to hear, not to respond. Locate the pain, suffering, joy, or growth that your client is communicating to you. Allow yourself to explore these experiences more and not just assess, diagnose, or intervene with them. Get curious about these experiences with your client.

O- Open Up and Observe

Open up to your clients experiences and create a therapeutic “holding environment” for their emotions, narratives, and being. Cultivate a willingness to be with your client no matter their state or narrative content. Observe the space you take up in the room and how you and your client co-create this space. 

V- Validate and Value

A huge part of our job in therapy is to validate the experiences we are hearing, normalize them, and find the humanity within these experiences. In doing so, we value our client, their experiences, and what they hold to be true. Affirming our clients in this way is to love who they are, not just who they want to be.

E- Empathize and Energize

Allow yourself to feel your client’s pain, passion, joy, successes, and losses. Join in this experience and show your empathy to energize your therapeutic connection and relationship. This constitutes the therapeutic alliance and partnership that is needed to seek and work towards a better quality of life for your client. Empathy is the basis of all therapy and love.

Toxic Positivity

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The necessity of self kindness

Put at odds with the comfort of blindness

Shedding light on that which is neglected

Intentionality and avoidance bisected 

But not a word

Lest we speak ill 

Lest we speak ill 

So we search for the sun and soak up its ray

Warning of the danger of the shade’s gray

Practicing gratitude

Purchasing stock in platitudes 

But not a word

Lest we speak ill

Lest we speak ill 

If money can’t buy pride

and joy can’t numb the pain

Focusing on the bright side

Is like trying to run while lame

But not a word

Lest we speak ill

Lest we speak ill

It has its place; it has its time; I have had it up to the gills

Forcing positivity does not pay the emotional bills

Focusing on what brings joy doesn’t fix society’s ills

Checking In: My Journey with OCD

If you have a pulse, you have experienced anxiety at some point in your lifetime. Anxiety takes many forms and manifests in different ways for different people. During the season of this pandemic and civil unrest most of our general anxiety levels have ticked up. As I have noticed the impact of this global anxiety, I have also been reflecting on how I got started on my journey towards being a psychotherapist. My own journey started with a unique flavor of internal unrest, OCD.

A Little More Than Teenage Angst

In my mid-teens, I thought I was quite literally losing touch with reality and felt like I was unable to control my own mind and body. I considered myself crazy and felt helpless and hopeless. I was experiencing crippling anxiety, which turned into a deep depression, which in turn made me more anxious. Some days, I swear I could feel and smell my brain synapses frying. 

What I was experiencing felt so embarrassing, I didn’t want to acknowledge it with anyone. I got to a breaking point and my parents helped me identify a need to see a professional. I would soon come to discover that I have Obsessive Compulsive Disorder (OCD), and I was so relieved to find out that there was a name for the cluster of symptoms and behaviors I was experiencing. Hilariously enough, during our stupid high school days with everyone claiming to be “so OCD,” and some how sound like valley girls even though I grew up in Massachusetts, it didn’t occur to me for one moment that I may have legitimately have this disorder. I was messy, disorganized, averagely hygienic, and barely noticed imperfections in the world around me. 

My OCD Diagnosis 

I learned that my particular subset of OCD surrounds checking. Basically this means that I don’t have the benefit of cleanliness, order, or even whimsical magical thinking. I just have the benefit of REALLY knowing if I locked the door or turned off the lights. It is the bullshit of OCD subsets. I am just anxious with no productive benefit to name. 

What if I didn’t lock the car or the lights are still on? I definitely did not close the fridge. What if I said something really offensive to my best friend. Let me make sure I packed my school bag for the zillionth time. I know I definitely offended someone, and my house is going to burn down because I left the stove on. Thankfully I also left the kitchen sink running so they will even out. But what if the heat from the house burning down and the cold water running mixes and causes a barometric depression and there is a fucking hurricane where my house used to be? This is why I can’t have nice things.

I knew the obsessive intrusive thoughts were not realistic, making things all the more maddening. It’s like my body was being possessed by Obsessia, the patron saint of making sure that everything that is fine, is in fact fine, and she is not a very forgiving saint. My therapist assured me that I wasn’t being possessed, but rather I was experiencing compulsions. “An action or behavior that you engage in, in an attempt to find relief of….” Yeah, yeah, yeah..whatever, lady. I know you are just in cahoots with Obsessia. Through some mindfulness based CBT treatment and handy dandy Zoloft, I was well on my way to recovery.

Survivor Model

With OCD, and any mental illness for that matter, there is definitely some controversy on using a recovery model when thinking of treatment versus managing a chronic illness. Weirdly enough, the longer I have worked in this field, the more useless I find diagnosis criteria because the reality is mental illness is a part of mental health. It is all on a health spectrum.

When someone is stabilized from a deep depression, I don’t consider them to be a recovered majorly depressed person. Much like I don’t find myself to have recovered from OCD, I still have it. Sometimes it flares worse than other days, but overall it is much better managed. I am surviving with OCD. Like with most mental health issues, nights tend to be harder and I have my series of checks that I do, but I am okay with it right now. It doesn’t feel as dark as it once was. 

Get Connected

Treatment for OCD can be very painful. I know. I have been there. While it isn’t necessary to find a therapist who also has OCD to treat you, there can be some wonderful benefits when it comes to the normalization of such a stigmatized diagnosis. Also, the way that your therapist can relate to the particular type of anxiety, which can be so hard to articulate, can be really helpful. I remember how influential it was for me to meet the psychiatrist I had that prescribed my Zoloft. He told me about his battles with OCD going through medical school and provided me with so much hope. The first thing he advised was that I don’t need to feel like I will have to rely on medication, or hardline CBT, or exposure therapy for the rest of my life. It gets better. I can regain mastery over my mind and body again.

I am here to also let anyone suffering from OCD know that too. This is a highly treatable part of your health, but it takes a lot of work. If you are suffering from OCD, and live in Virginia, please don’t hesitate to reach out to me. If you are a therapist treating someone with OCD and are seeking peer consultation, I would also be equally happy to make time for you as I can! Stay tuned for additional posts I have on OCD where I will be tackling more specific nuances. 

Grief Counseling: Keeping the light on

Most of us have experienced some form of grief in our lifetime. We know what it feels like and might even be able to describe some of the nuances of it. Many of us may feel lost when it comes to what “to do,” about grief. There comes in grief counseling. 

Grief is everywhere. It happens every time you experience the loss of something or someone important or that provides safety to you. This includes the death of someone (bereavement). It is the feeling of sadness, emptiness and loss that accompanies these life events. So, what really is grief and what do we do about it? I’ve had many great teachers in grief throughout my life, but none have been more important than some of the people I have served. Here are some of the gems that I cherish and reflect on as I recently lost such a teacher. 

Keep the light on

Traditions are so important to the grieving process. There can be great value in continuing to keep up this loving practice even well after that person is gone. This may come in the form of continuing to have conversations with that person, continuing to make space at the table, continue singing to them in the mornings, or continuing to keep the light on in their room. While you may wonder if this is trying to “hold on,” to someone or not allowing for “real grief,” consider:

Grief theory used to assume that we needed to detach from a person. Since the Freudian age, we have learned that true growth and integration after a loss means continuing a healthy attachment with that person after they are gone. This allows us to continue holding them in our heart and allowing them to shape us in some way as we continue to live life. We don’t have to deny that relationship. 

Create space and change place 

The pendulum of creating space for grief and also changing up your “place,” are worthwhile endeavors to find balance in. Perhaps this looks like keeping up a small area in your house of memorabilia of the loved entity you have lost and tending to it almost like you would your garden. A garden is even a symbolic way that some people I have worked with have tending to their grief. Again, having a dedicated space to continue practicing that tending to in the relationship can be vital.

You might also feel the need to balance this act of creating space with, perhaps, turning your dining room table 90 degrees up against the wall so that it eliminates the empty seat at the table and allows you to take a step forward into your new life, without having to always feel the empty seat. Not all avoidance of feelings are bad. 

A Willingness to feel

It takes a lot of strength and courage to open up and be willing to experience the pain of grief. This is usually the only way to remain open to the loved one’s connection and love, too. The willingness to open up to sadness, anger, anxiety and even relief or joy, can teach us a lot about ourselves. More importantly, the willingness to allow these emotions teaches us self-compassion and kindness. Many of the people that I have provided grief counseling to, often have an experience of pain due to yearning for their lost one and not feeling like they are able to connect with them or feel their presence in any way.

I usually address this through the ongoing willingness to feel as they may have unknowingly have been guarding against the full experience of the loss, and thus not allowing the full experience of a new connection. This was beautifully articulated to me in the following metaphorical gem by a recently deceased client of mine. She was expressing her own feelings of grief for a friend she had lost, and was feeling very ambivalent about reaching out to her friend’s family during her birthday because of the feelings that might accompany the call. 

Grief is like a heavy winter trench coat

She described what she was feeling as a coat that was weighing her down and restricting her movement. As we discussed her experience, we discovered that grief feels like you wear this coat all the time. Every time you try and take it off, it has a funny way of finding itself right back on you. We are tempted to try and shed it any chance that we can get so that we can move about life a little easier. It is constrictive, unpleasant to the touch, and horrid to look at. So what would happen if we were willing to drop the struggle and get to know what wearing this coat feels like and explore it? 

We might find that there is also something that would be lost if we were able to fully remove that coat. Maybe if we were to check the many pockets, there would be significant artifacts or items that we wouldn’t want to lose within that coat of grief. Those pockets had to be explored to name the treasures inside. As my client continued to develop her willingness to wear this coat, she discovered an avenue to dedicate something to her deceased friend and felt a conviction to act on this by sending flowers in her honor to their church.

The Waves of Grief are all a part of the same ocean

Our ocean of grief is made up of loss of control and loss of predictability. It has the salty sting of pain that crashes on us in waves. It feels like a free fall where we try and reach out to someone or something to help catch us. Unfortunately, this is the initial trauma we all face when we are born. The inability to express the pain of not understanding, and needing safety provided to us. We carry the need to find safety, predictability and control in life. When we suffer a loss along the way, it adds a ripple to the ocean, a wave, or sometimes even a tidal wave. To live with grief, means we find a way to surf these waves and recognize how our many griefs are connected. This is, after all, the human condition. If you love, you will lose. 

Not all grieving processes require therapy. However, if you find you’re struggling to manage your experience or feel you’re losing yourself in the waves, please consider reaching out. You don’t have to go through this process alone. Individual and group therapy can be very effective and healing. 

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