Category: about therapy

New Book Is Out!

If you’ve been following me for a while, you might remember that book 2 of the DIY Therapy series was supposed to be out in January. After some delays, it’s finally here!

Managing Chronic Insomnia is designed to help people who have been dealing with the stress, anxiety, and sheer weariness of chronic insomnia. Therapy techniques are effective in over 70% of insomnia cases, more than double the long term effectiveness of sleep medication.

Insomnia treatment is based in Cognitive Behavior Therapy which is an evidence-based manualized treatment. Because of these factors, CBT is totally doable on your own- no sleep therapist or doctor needed. By following the guide and going through sleep retraining on your own, you should be able to manage your chronic insomnia!

And if you decide part way through that you do want to work with a specialist, they’ll likely be using CBT as well, so you’ll be able to pick up right where you left off and all the terminology should be familiar to you.

This book does not replace therapy, but it does provide an option for you to learn the skills, practices, and techniques of CBT and get relief from your insomnia without needing outside treatment.

Sound like something you’re interested in? Check out the universal link here. If you like it, consider leaving me a review on the platform where you got it.

When do we return to normal?

In the beginning of the pandemic, we all experienced a collective event that hit many people as a trauma. And as a predictable result, many of us got brain fog, lost confidence, experienced physical changes in our bodies, and difficulty keeping up with the rapid changes in policies within our companies and cities.

But most of us expected to be better by now. It makes sense that you’d react to a sudden shift in lifestyle by getting stressed, sleeping poorly, missing deadlines, and gaining weight. After years, it seems like we should be adapted by now. The continued stress and trauma only added up, they didn’t get better. And the longer this goes on, the more we lose confidence in ourselves and our ability to bounce back.

Our inner critic is the key here. It’s bad enough to be stressed and going through a collective trauma, but when your inner critic piles on the shame, you add the sense of ongoing failure to the list. It’s the inner critic who keeps you from being resilient and accessing your strength because it keeps you in the mindset of comparison, shame, and failure. Even when we know consciously that these are normal reactions, the inner critic’s blame and shame tell us the story that it’s okay for everyone else to be struggling, but it’s not okay for you to struggle.

This belief creates a sense of isolation from others. It’s hard to look at someone else who seems to be doing so much better and admit that you’re struggling. And it’s equally hard to be around friends who are struggling and resist the pressure to put on the face of doing just fine. This isolation keeps you from accessing the community, mutuality, and support you need to actually bounce back.

We return to normal only when we can accept what happened, admit to ourselves and others when we are not doing okay, and enter into supportive community in order to truly heal.

Lent Intersecting Therapy

Lent is usually a season of giving up oppressive habits and taking on new patterns of living. We often think of Lent in terms of giving up chocolates or coffee for a time, but when we think of Lent in the broader sense of observing and breaking the chains that lead us on a negative path, we can see how it plays into our mental health.

This year, I’m going to stop drinking coffee because I’ve noticed I get irritable and am prone to withdrawal headaches if I don’t get my morning cup. Coffee is a good thing, but it’s become a weight on my life- I have to have it, I’ve grown dependent on it.

Similarly, I’ve noticed a pattern of thinking that’s unhelpful. When I’m worried or have a concern, I’ve fallen back into ruminating on all the possibilities. This makes me feel tense, and I can feel it all through my body. And when I start to feel the anxious tension in my body, the mental distress escalates which again turns back to mental chatter. It’s a vicious cycle and I don’t like it at all. So this year, I’m also giving up anxious thinking.

Breaking a thought pattern is very different from breaking a physical habit. I can stop drinking coffee by simply not picking it up or ordering it. But thoughts are often unconscious, and there’s not an option to simply not think at all or to filter your thoughts to block out the ones you’re trying to avoid. Wouldn’t that be nice?

In the Christian tradition, we’re told to “take every thought captive” (2 Cor 10:5) and “think on things that are true, noble, pure, right, admirable, and lovely” (Phil 4:8-9). These suggest two key points: first that thoughts happen unconsciously, and when they do, we have a choice about that to do with them when we notice them. Second, that we can consciously direct our thoughts, and we are not entirely at the whim of our unconscious minds.

Taking unconscious thoughts captive starts with awareness. We can’t capture a thought that we don’t know is even happening. And awareness starts with slowing down and paying attention. Most of our life happens on autopilot. And most of the time that’s okay. You don’t need to pay close attention to every detail of your commute, and it’s normal to want to zone out a bit after a busy day. But sometimes autopilot goes wrong, and our default thoughts turn toward the negative.

That’s what happened to me- I consciously managed my anxiety years ago and haven’t been super prone to anxious thoughts for a while. But lately, it’s crept up again, and it’s important to deal with it early so it doesn’t get out of hand. My autopilot has turned to worry, and that’s not okay with me.

You may be surprised to hear this from a therapist, but I’m not the best at noticing my emotions. It’s something I’m working to get better at through this conscious practice of noticing and increasing my awareness. I usually notice my anxiety when my neck and shoulders start feeling tense and I notice the shift in my breathing. Once I notice these physical shifts, I can usually trace them back to the frantic thoughts. Taking time throughout the day to check in with my thoughts, emotions, and body feelings is so helpful in allowing me a chance to notice in advance what’s going on in my mind before it starts affecting my body.

But what to do with anxious thoughts once you notice them? They feel like they’re racing so fast, they almost have a life and power of their own. I think it’s enough to simply say no to the thoughts. No, I’m not doing this right now. No, this isn’t helpful. No, you’re just going in circles and getting nowhere. No, no, no. Some theories say that it’s helpful to debate the thoughts or analyze them to see if they’re true. And if that works for you, go for it! But that doesn’t work for me.

I’ve mentioned before about how a tree branch fell on my car in a windstorm and I would get super anxious when it got windy with the thought that another branch could fall again. It wasn’t helpful to challenge those thoughts because my anxious mind doesn’t care that a branch fell only once in the ten years I’ve lived here- it happened once and could happen again. The only thing that truly helped was saying no from a place of acceptance. Yes, the tree could blow around so hard that another branch falls on the car or the house or a person. But my worry thoughts can’t stop it. If I stay up awake at night worried about what the tree might do, that won’t keep it from falling if it’s going to.

This brings us to the second part. You may have heard the saying “Life abhors a vacuum.” This is equally true of our thoughts. It’s not enough to simply say no to the anxious thoughts, we have to replace them with something else or another thought will quickly come up from our unconscious minds.

Whatever is true, whatever is right…
The “what-if” thoughts aren’t true. They’re hypothetical. They’re future focused. The best way to think of what is true and right is to turn your attention to the present. Give direct, focused, mindful awareness to who you are, where you are, and what you’re doing.

Whatever is pure, whatever is noble…
The “worst case scenario” thoughts aren’t pure. Pure means “without unnecessary elements” or “without contamination.” Worry adds to your reality with all the ways things could go wrong. And again, the antidote is present focus, getting back to what is currently happening without the added extras that the anxious thoughts are focused on.

Whatever is admirable, whatever is lovely…
Anxious thoughts often take us to the lowest place. Thinking of things that are admirable or lovely helps to lift us back up. When we set our minds on higher things, we are reminded of the good things in this world. Lately, I’ve seen articles of studies that show how good it is for people to experience things like awe, wonder, beauty, and glory. Whether it’s going out in nature, experiencing art, or simply marveling at the majesty of the world, focusing outside ourselves helps us get out of our minds and back into a proper perspective of who we are and how we fit into the world.

As we approach the beginning of Lent, I hope you consider how Lenten practices can intersect your personal work in your thoughts and habits. If you have a similar experience or want to join me on this journey, leave a comment and share your perspective!

Exploring Motivation

Motivation seems fairly straightforward on the surface, but when you don’t have the motivation to complete basic daily tasks, it suddenly becomes complicated. And it can be frustrating to know that you’re on top of everything you need to do at work and at home but feel like you don’t know how to get yourself to want to work out every night when you get home.

Motivation is huge in therapy. Many people come to therapy looking to regain the motivation they used to have, to explore why they can’t seem to do the things they want to do, basically how to get yourself to want to do the things you have to do.

Motivation is also a bit of a paradox. My clients who are depressed, lost, and frustrated are all looking for the motivation to get them going in life. But my clients who are high functioning don’t see motivation as a relevant factor. They don’t work out every day because they want to, but because it’s built into their routines.

Structure and habit seem to be the key to bypassing motivation. If you only get out of bed when you want to, there will be some days when you simply don’t feel like it. But if you get out of bed every morning when your alarm goes off, you don’t have to check in with yourself to see how you’re feeling first.

This is why many unmotivated people can do well at work but are unable to follow through on what they would like to be doing with their personal time. The external structure of work creates certain obligations- be up and ready by a certain time in the morning whether you want to or not, do your routine job tasks regardless of how you’re feeling, attend meetings when they’re scheduled even if it’s not your preference. At home it’s flipped. You want to start reading more, take up a new hobby or craft project, do a puzzle. But then the “I’ll just watch one episode with dinner” becomes a few episodes, or you’re comfy on the couch and it feels easier to stay seated than to get up and do some yoga.

How do you motivate yourself? By creating a habit. By creating a new narrative of how your evenings go. By deciding that I am a person who works out every day after work whether I feel like it or not. By deciding that every night at 9pm all the screens go off and I’m going to read until it’s time for bed.

The narrative is the key. It shapes your new identity as someone who does these things instead of someone who wants to start doing those things someday. Identity stories are powerful. When it’s 5am, an identity story of “I’d like to be a runner but I’m not there yet” isn’t going to get you out of bed. But when you decide “I’m a morning runner,” you find that your motivation shapes itself to the identity that you declare for yourself. Of course it isn’t as simple as naming yourself a runner, but that’s often the first step.

Try it on with something you’ve been meaning to start or get better at.
“I’m the kind of person who……”
“I ……….. every night after work.”
“I like to ……….. at least three times a week.”

These decisions are powerful. If you work out every day after work and have that as part of your narrative of who you are as a person, it shapes your schedule. When coworkers ask if you want to get drinks after work, you can draw on your identity story to protect your time and let them know you’ve got to work out first and you’ll join them after.

As you shape these identity narratives into a habit, the action becomes routine. Motivation is not a relevant factor. You wake up early to run because that’s just what you do. Think of other routines you have. Severely depressed people often don’t shower or brush their teeth because they can’t motivate themselves to get up and take care of their hygiene. But most people don’t even think about it. They brush their teeth at certain times of the day whether they feel like it or not, even when they’re rushed or exhausted.

Focus on motivation isn’t helpful because it requires you to be monitoring your internal state which is naturally highly variable. You will not always “feel like” doing things you need to do. Deciding that you want to take on a new habit means that you decide that you will do things regardless of your internal feelings about the new routine.

Here’s the lesson: if you’re focused on motivation, you’re looking for internal resources to create an external structure. Try it the other way instead. Create the external structures- scheduling, habit forming, identity narrative- and don’t worry about waiting until you feel like following through. Because once you’ve created that habit, it doesn’t matter if you internally want to keep going, it’s just something that you do.

Developing a Philosophy of Wellness

Your philosophy of wellness shapes your expectations of what you want to get out of your time in therapy. In the first few sessions, I try to get a picture of what my clients are looking for. Most give an answer like this:
“I want things to go back to how they were before”
“I just want to feel normal again”
“I want to feel good and for everything to be okay”

Many people have a philosophy of wellness that looks something like the above examples. They have some idea of a time when things were going well, and they want to have that feeling all the time. There are two problems with this kind of philosophy. First, it’s not realistic to expect that things will be good for you all the time if only you can reach a particular point of wellness. Second, the idea of “good” and “normal” is undefined and nebulous, and it’s hardest to hit a moving target.

To address these problems, we can safely say that we need to develop a philosophy of wellness that accounts for the normal ups and downs of life. Your definition of what it means for you to be and feel well can’t depend on your life circumstances always being positive. And your understanding of wellness should include specific, measurable targets that are well defined and understandable.

With that in mind, what does it mean to be well? What does it look like in terms of how I behave? How does it feel mentally and emotionally? How do I handle negative experiences when I am well? I’ll show you how I answer these questions and how I use them to develop an overarching philosophy of wellness.

To me, being well means that I am okay with just being. When I am unwell, I tend to rush around and have a sense of striving in hopes of working myself into wellness. When I am well, my actions show it by the pace. Instead of a frantic energy, my behavior is characterized by a centeredness that shows even when I am working quickly. When I am well, this centeredness allows me to be more patient with my family, more open to my friends, and more able to respond to events rather than react. My feeling mentally and emotionally is calm and open, and when I am doing very well, I am curious, creative, and energized by new ideas. When I am well, I handle negative experiences thoughtfully without being derailed by anxiety or panic. I am able to process and analyze the situation, asking for help without feeling frantic or shutting down. I am able to deal with catastrophic thoughts without being caught up in them.

My natural tendency is toward anxiety, so my philosophy of wellness is focused on my ability to move away from my unwellness- frantic, striving, rushing, catastrophizing- toward its opposite. For me, that means calm centeredness, openness, curiosity, and creativity. I feel it mostly in my chest. The sense of striving feels tight and hot, and I notice it in my breathing. I also feel it in my mind. The thoughts move from swirling, ruminating, overwhelming, catastrophizing into stepping back, watching the thoughts without being swept up in them, taking time to think clearly.

So while there’s nothing really wrong with saying that you want to feel normal again, or back to your old self, I’d like to challenge you to really dig into those statements. Make them more specific. What is it that you’re feeling right now that you’d like to manage differently? How would you prefer to handle difficult circumstances? What was different about your behaviors, thoughts, and emotions in the past? How do you know when you’re feeling well or unwell based on your physical sensations in your body, your behavior, and your thoughts?

The Equalizing Power of Grief

Grief therapy is fundamentally different from other kinds of therapy for a few reasons, a primary reason being that both the therapist and the client have had their own experiences with grief and loss. In other therapies, the client may have a problem that the therapist has never experienced, so the therapist is operating purely clinically with no personal interjection.

This different way of doing therapy can feel odd to those who are more comfortable in a therapeutic experience that is more one-sided and hierarchical with the therapist being the expert on treatment and the client bringing the issue to be treated. With grief, we are all in the same boat. Not that your therapist will give great detail about their own story- therapy should always center on you as the client- but there is a different sense of community, a feeling like right now it is you going through this grief, but we have both been there and we will both be there again at many points in our lives.

And so, grief therapy is a process grounded in a horizontal relationship of equality rather than a vertical relationship of hierarchy and expertise. We are truly traveling together on the journey of grief. This is a collaborative process of digging into the meaning and purpose of life in the face of our mortality and limits.

Dementia Caregiving- Loss Before Death

A diagnosis of dementia in a parent can feel like the beginning of the end. Many caregivers describe the day of diagnosis as the day that they truly lost their parent. It’s an isolating feeling, being with your parent while actively missing who they were.

The changes can highlight these losses. Caregivers are often struck by the sheer difference between their memories of their parent and the current reality. It is incredibly painful to watch a kind, loving person turn nasty during their sundowners and become vicious in their verbal attacks. It is differently painful to watch a strong, independent person become hesitant and withdrawn in their confusion.

The change in role can be difficult to navigate as a parent becomes dependent on their children for caregiving and decision making, and the caregiving child becomes tied down by their parent’s increasing dependence often after many years of living apart.

The issue of caregiving can break families apart as siblings either try to pass the buck to avoid the responsibility or each clamor to put their opinions in the ring and get the care decisions to go their way. As a caregiver, you may feel swamped by hearing from others what you “should” be doing from people who are not willing to lift a finger or send money to help.

All the while, you as the caregiver are navigating the day to day realities of providing care to someone with dementia. It’s not just an opinion to you, it’s your life and reality, and it can feel insulting for someone who isn’t in your situation to think they know better than you what you need to do.

At the same time, you are not just a caregiver. You are a person worth time off, breaks from caregiving, and your own separate life from your parent. There is such a pervasive myth that caregivers should be quietly dedicated to solely providing gentle care to a parent who calmly accepts our aid with gratitude. The reality is so different as you know.

Caregiving can last for years, and too many caregivers come to the end of their parent’s life resentful, burned out, lonely, and isolated. If the totality of your life has been given over to caregiving, you may reach the end of your time at a high risk for suicide.

It is vitally important that as a caregiver you stay connected to your community whether that means staying employed, keeping up with your needs, maintaining your hobbies, and nurturing your relationships. You are important in so many ways, not only for what you are doing for your parent, but in terms of your own intrinsic worth.

Dementia derails the entire family, but mostly the caregiving person. You are essentially losing your parent as you see the person they were giving way to the progression of the disease. You are at risk of losing yourself as well, as you are asked to do more and more for your parent. Family disagreement over the care process fuels the sense that things are breaking apart.

Caregiver support is so necessary. As a caregiver, it is important that you prioritize yourself through the process. Therapy is one possibility for support, and there are also so many groups available for you to get to meet with peers going through the same thing.

Book Review: Hunt, Gather, Parent

Hunt, Gather, Parent

I grabbed this book from the library because I read parenting books like a starving person might go after food. As you may know, I’m not a parent myself, but I’ve been a nanny, a preschool class teacher, and now a therapist who has spent a great deal of time working with children and their parents.

Side note: I became a therapist partly (mostly) because even as a child I naturally gravitated to the relationship books. Imagine an elementary school kid passing over the fun books to grab a fat stack of dating, marriage, and parenting books. Anyway, I’m fairly certain I’m in the right career path.

The book promises to give a new look on parenting strategies based on those found in more traditional cultures around the world. But unlike most other books on traditional parenting, this author wrote the book with the goal of translating these traditional techniques into something usable by fully modern parents. It’s refreshing to see how these skills are used in tiny villages and how the author then uses them back in San Francisco.

If you’re like me and devour parenting books for breakfast, you’ll recognize many of these skills like allowing kids to follow their natural helpful instinct, managing your own anger and frustration so things don’t escalate, and giving kids space to practice growth on their own.

While the skills may not exactly be new, the presentation is fresh because the author was (and is still) in the middle of raising a toddler. The author’s description of her own childhood experience of growing up in a yelling home shows her struggles to adapt to parenting from quiet and calm. Readers who come from a similar childhood home may relate. But even for those of us who grew up in peaceful homes, it can still be a struggle to keep a sense of calm in the face of a screaming, crying, hitting toddler. And yes, this book goes into managing that kind of kid.

The narratives are engaging and worthwhile reading, but for parents needing immediate help (or for readers needing a quick reminder), each section concludes with a helpful boxed summary with practical tips to implementing these new strategies.

Interested? You can find the book here on the publisher’s website.

Need parenting help as you work through this book? Many parents use therapy as a space to get coaching, support, and education as they manage their own unique families. Contact me for any questions or to get started.

Finding a Therapist in 2021

Therapy has changed
In the past, most therapy was offered in person with only a few therapists offering online sessions. Now, many therapists have shifted to online sessions which opens up more opportunities for you to find a therapist who is a good fit.

What does it mean to have a good fit?
Based on research into how and why therapy works, we know that the specific method used (CBT, EMDR, ACT, etc) or the therapist’s credentials (MFT, MSW, PCC) don’t matter as much as the quality of the relationship between you and your therapist.

Good fit can include feeling comfortable with your therapist; feeling heard and understood; having shared beliefs, history, or experiences; and many more factors. If you’ve been in therapy before, it can help to think back about what helped you connect with your past therapists and what made it more difficult. If you haven’t been in therapy before, think about others you’ve felt comfortable with and why.

Because it’s so important to be able to be open with your therapist, consider every factor. Are you more comfortable with a therapist close to your own age or one who reminds you of an older figure in your life? If you’re having relationship issues, would you prefer talking to someone of the same gender or a different gender? Do you want a therapist who feels more casual or one who is more professional in session?

Reaching out
Once you’ve found a therapist you think could be a good fit, the next step is to make sure they have an available appointment time. Most therapists list a phone number or email address on their website, and many offer a free consultation call to get started.

Consultation call?
A consultation call is a 15-30 minute phone conversation between you and your potential therapist. During that time, they may introduce themselves, ask more about what you are looking for, and tell you a bit about their approach. It’s not a therapy session, but it is a time to ask any questions you have about them to help you determine if they’re a good match.

If everything goes well during the consultation call, they will usually ask you about scheduling an appointment. Therapy usually includes weekly appointments, so think about a time and day that typically work for you week to week.

Paperwork
After you’ve set up the initial appointment, your therapist will probably send you paperwork to complete before your first session. Each state has different requirements for the documents therapists need to get from each person before sessions can start.

In California, those will include informed consent about the risks and benefits of therapy, your therapist’s policies and procedures, and possibly also a questionnaire about your mental health history.

Some therapists prefer to go through the documentation and history during your first meeting together, so don’t worry if you don’t get a packet right away.

The first session
The initial sessions are all about getting to know each other in order to develop a working relationship. It takes time and trust to dig deep into your mental health, so don’t be surprised if the first few sessions feel like they’re only touching on surface issues.

If you come in with a mental health issue like depression or anxiety, or if you come in with a relationship issue, your therapist will probably teach you skills to manage that issue and practice them in session. Skills like deep breathing, assertive communication, and meditation help manage your mental health symptoms or relational conflicts. As you experience some symptom relief, therapy can stay focused on managing symptoms or move into insight-based work.

Skills vs insight
Skill-based therapy is entirely focused on teaching you how to manage thoughts, feelings, and behaviors that are bothering you or getting in the way of you living your life the way you’d like. Insight-based therapy is focused on exploring the factors in your history, environment, and internal world that are contributing to the issues you’re facing.

Therapy based on skills is typically short term. Therapy lasts for as long as it takes for you to learn and practice the right skills that work for your symptoms or issues. You’ll probably have homework between sessions to practice the skills so that you’ll be able to use them as you need when things come up in your daily life.

Therapy that’s oriented toward insight usually takes longer because you’re trying to describe and explore your internal world. You and your therapist will look at enduring patterns in your life and try to trace them back to a root belief, cause, or memory.

In my therapy work, I like to start with skills-based sessions so you experience some relief from the issues at hand. Then we can stick with skills or move into insight depending on your needs. In your consultation calls, you can ask your therapist if they work more with skills or insight to see if their focus matches your needs.

Ending therapy
If you are doing skill-based work, you can start talking about ending therapy when you feel like you’re able to use the skills you’ve learned to manage the issues that were bothering you when you started therapy. Insight work is more difficult to determine an exact ending, but you and your therapist should still be able to talk about what changes in your life will signal that things are better for you and you’re ready to move on.

Ready to get started? Call or text 831-531-2259 for a free consultation.

Seeking Connection

We had a connection crisis long before social distancing and shelter in place. For years, sociologists noted that our reliance on digital media as a means of contacting and connecting with others was problematic.

But even then, most of us worked outside our homes. Even if our friends and family were digital connections, we at least had to see our bosses and coworkers in person.

The disconnect in digital connection comes from the safe distance we feel from others when we interact online. Think about the comments section of any social media post- people are more likely to get into inflammatory arguments online than in real life. The screen insulates us from the humanity of the people we’re talking to and gives us protection from immediate consequences of saying something insulting. We don’t have to see how we hurt others, and we can’t get hurt in return.

Not that most of us are internet trolls, but the same principle applies when we try to connect. It’s harder to feel personally connected to someone on a screen because we’re used to screen people being fake people- actors on a show for our entertainment. Even if you are looking at someone you know and love, it’s hard to feel as personally connected when it’s digital.

This is a result of perception and training. The good news is it’s possible to work toward feeling connections even across screens and across distance. The bad news is that it’s hard. If you haven’t had distanced relationships before the pandemic, learning this new skill will take focused mental effort. It will be exhausting at first.

There are three key skills you can use to foster a sense of connection despite distance and digital interference.

1. Be Present. When you start a call or meeting with a loved one, take a moment to be present with them. Being in different locations, we each have environmental distractions that, if we were together, could be shared. But across distance, they only serve to divide us. Mentally set aside things outside your connected space and focus on the conversation.
2. Be Attuned. Notice their nonverbals. This can be more challenging on a phone call or with low video quality, but since most communication is nonverbal, this is a key point of connection. In person, we pick up on so much of this unconsciously, and it takes more effort in a digital format.
3. Be Honest. If you’re struggling to feel connected to someone in a particular format, ask for what you need. Some people feel most connected in email which allows for long-form expression. Others feel most connected over a phone call so you can hear their voice. You may enjoy video chats with friends but feel stressed when it’s with your parents. Be straightforward and ask for what you need.