“The Tripledemic” —Week of 11/27/22

Every week I will be reviewing a reputable news article and engaging with it from a mental health professional standpoint. These will be short posts following a three segment model: 1. The News=short synopsis of article 2. The View= My initial impression of the article, and the news impact in the mental health world 3. The Reflection= Useful ways to engage with this information/applications to caring for our mental health. These posts will be published 8am on Mondays!

The News: You may have heard about the “tripledemic” (Covid, flu, and RSV). Here is what you need to know: Since the pandemic there has been less seasonality with flu and RSV (and other typically seasonal illnesses). We were hit early with these viruses this year after pandemic public health precautions had been terminated. Children and immune compromised adults are most at risk for requiring hospitalizations with these infections, and many hospitals are reporting high numbers of cases, including patients coming in with multiple infections. Here are the referenced articles.

The View: Many people concerned about community health, risk to self and others, and parents have been feeling a lot more fatigue and anxiety with navigating what is already a stressful time of year with illnesses. I’ve seen a lot more burnout and weariness in this regard in my practice, especially, with many of the young parents I work with. I’m definitely feeling it too. While we might feel more connected to community in some ways with less restrictions, it has felt like a relentless slog of coughs, sneezes, and symptoms to be worried about. Ultimately, posing issue to connection (in addition to health).

The Reflection: Hit the brakes and breathe. So many of us are probably feeling on overdrive with the “normal pace” to schools, colleges, work, and life. I’ve been seeing more strain in coparenting and relationships, and more stress with managing work and family responsibilities. Give yourselves grace.. and see this shared desire in my recent tweet. Trying to measure ourselves in any of our roles is going to be quite distorted. We haven’t been through this before.

Additionally, it’s been more of a quadrupidemic with how many times I have been hearing about the local schools going on lockdown for risk assessments and mass shootings. Just in Virginia we have had two recent well publicized mass shootings. One at UVA…see my open letter to the community here. We also had the more recent Walmart shooting earlier last week. Suffice it to say, there is nothing I would want to consider normal about our community environments. The more focus we can put in on prioritizing the safety of ourselves and our neighbors, the better we can weather these pandemics and hopefully create some necessary change. Be kind to you and the shared spaces we occupy.

To A Community in Mourning— To Charlottesville

Please visit this link to an open letter I wrote to our community in the aftermath of the shooting on 11/13 if interested.

Avoidance, Procrastination, and Hiatus, Oh My!

So. Well….This is awkward…  

It has clearly been a long, long while since I have published anything on my site. To be exact, I haven’t written a piece since 2021 rolled over. I have an unfinished draft of a piece I was writing on depression that also spoke to how I was feeling during the late winter months of the pandemic. I have an unfinished piece on grief and many bullet point ideas that haven’t been touched. I have had invitations to be a guest on podcasts, and also to develop content on other sites and programs. Everything has been left in stasis gathering that dust. 

This piece right here is for all of my fellow writers, creatives, and people who start up projects, promptly neglect and abandon them, and then revive those said projects (hopefully), or just feel guilty about having half-baked creative efforts. What the fuck is up with that?

I am sure many of you reading this identify with this avoidance dynamic. It shows up even with things that we value and things that we hold as important (especially true for those of you with ADHD—you are not lazy or procrastinators, but I digress into another hopeful blog post). I had a good feeling about keeping up with this writing practice this time around because I viewed it as a part of my job too. I have always been a diligent worker so of course I wouldn’t let this website go right? Well, it turns out when you have a good group therapy practice that you work with at Virginia Family Therapy, you don’t actually need your own site for marketing. This site has actually been a project for myself, and also a part of my own legacy work, which is something I constantly think about being a grief focused therapist. More on legacy and grief later.

When we start up projects and practices of any sort that we value and label as important in our lives, and then inevitably abandon those projects for long periods of time, what does that mean? I think it can often feel like an abandoning of a tending to ourselves. What an awful thought. The longer and longer we notice we are not engaging in that important value, the more and more avoidance can mount. Its avoidance of shame with not working on ourselves. Before we know it, that project that is so important to us has been offered solitary confinement in the recesses of our mind because, hey, the rest of life is chalk full of shit to keep up with. 

So, if this dilemma isn’t avoidance of work, isnt avoidance of self care, and sure as shit isnt laziness (that doesn’t exist, and I will die on that hill), what the fuck is going on? 

Here is a helpful way to think about it. We don’t always avoid activities or people, but we do often avoid our own emotional reactions to these things. We avoid our internal experiences that come up as a result of not doing something, or doing something that is inconsistent with who we want to be. For me, I haven’t been avoiding my writing, per se, but I have absolutely been avoiding letting myself down, feeling like a failure, and feeling like I am not enough. The irony? I often provide therapy around how this avoidance impacts our daily lives, our identities, and our relationships. My forehead is still red from the facepalms.

*A quick caveat on internal experiential avoidance…Not all avoidance of internal experiences are unhelpful. Sometimes avoidance is protective, insignificant in the larger scheme of our life, or allows us to triage what we attend to. So how do we know when avoidance is unhelpful and leading to a painful pattern like the one I have captured? What do we do about it?

Notice—- What is your mind telling you about the project or experience that you want to engage in? Here is just a snippet of what my mind tells me about my blogging project:

“I can’t keep up with writing (something that I love to do), even though I stepped outside of a 9-5 job to be able to make more time to do this. I will never be able to keep up with everything I need to do. People probably don’t even care about what I put out on the internet, so what’s the point? Look at everyone else keeping up with writing, podcasting, while they are working and supporting a family. How come I can’t get my shit together?” The mind train takes off fast. It takes off so fast and has so many of these heavy cars to it, why the hell would I want to try and face that? It would be like stepping in front of that entire train. 

Distill—- If that thought stream was heard as advice from a loving friend or family member for how to overcome your concern, would it be felt as supportive, helpful, or wise? If not, we can identify that these thoughts and feelings are only contributing to a narrative of our deficits, which is a toxic narrative to work from when trying to exercise our creativity. 

Allow for flexibility and gaps in attention —- Cultivating curiosity around your own creative pacing can be crucial to allowing yourself space to complete tasks and projects that are important to you. Remind yourself of what you value. This can cue you into taking actions in ways that are consistent to who you want to be, but, again, that doesn’t mean that the pacing, or speed of production with how you interact with this part of you is set in stone.

Working from a grief counseling lens, I would view these hiatuses as parts of struggling with grief. Creating and creativity are inherently legacy building parts of ourselves, which we can act on. When these feel stunted, jeopardized, or unreachable, we feel the profound loss of ourselves, of what we could be accessing, of who we could be reaching, of how we could be connecting. Oofph.

So what do we do about this grief? Don’t shy away from it. Allowing yourself to open up to disappointment, shame, sadness, anger, frustration, or whatever comes up for you, is necessary in acknowledging the loss you are feeling. When we can more fully acknowledge and open up to that sense of loss, we are able to free ourselves up to take action, rather than simply judge ourselves.

Remember, grief complicates in isolation, and even more so when bathed in shame. Reach out. Connect with those who know you and inspire you. 

So here I am, acknowledging the profound loss that I have experienced over these past 6+ months, and what I have been avoiding. I have connected with others and myself in ways that have allowed me to come back to the well and continue my legacy work. One more drop in the legacy pool.

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.

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