Jessica Brohmer, LMFT

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 It is differently painful to watch a strong, independent person become hesitant and withdrawn in their confusion.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.

Grieving Body Changes

Whether from aging, medical treatment, or an accident, our bodies change. Like other forms of grief, the story we tell ourselves about how and why these changes happened is the source of our peace or distress.

Body changes are often our most public changes. When we start a new habit or learn a new language, others can’t tell just by looking. But the people around us take notice when chemotherapy leads to hair loss, an accident takes an arm, or aging makes us need glasses at work.

Medical treatments can cause some of the most extreme body changes. Treatments may cause us to gain or lose a significant amount of weight, we may lose a limb or an eye, we may lose our reproductive capability. Even when these treatments were medically necessary and we understand logically that this was the best path, we still grieve these losses.

Aging-related changes can be difficult to accept, particularly in cultures that value youth and appearance over age and wisdom. Even though we all know that we will age every year, some people fight hard against the reality of growing older.

Accidents are the most likely to result in complicated grief for the simple reason that they are not something we might choose (like medical treatment) or reasonably foresee (like aging). And accidents often have someone to blame, whether that’s yourself or someone else.

Blaming narratives lead us down a path of grief that is likely to keep us stuck in a vicious cycle of negativity. Blame helps us hold onto anger at the person or situation that caused our grief and keeps us away from taking productive action toward the present and future.

Grief that keeps us stuck in the past can be resolved through work around changing your story of what happened and why. Even when someone is clearly at fault, your narrative needs to incorporate the facts in a way that acknowledges what happened while still allowing you to accept your present reality so that you can continue to create your life moving forward. We need to balance our natural desire to know the reason for our suffering with the fact that there are some things we need to accept that we will never fully know.

As you notice the changes in your body, try to also notice the thoughts you have surrounding the changes. Notice if you are worried what others might think, if you are missing your ability to do a particular activity, or if you tend to blame someone in particular for your loss. This noticing allows you to begin to be aware of the narrative your mind has already created about the situation. These narratives are instinctively formed from your past experiences and your emotions. Notice with compassion and non-judgment, but also notice where your automatic narrative might be creating additional problems for you.

Once you’re aware of your narrative, you can work to shift it in a way that leads you to peace and mental freedom. Your reality is the same, but your thoughts and perspective can move from a focus on the past and what you lost toward acceptance of your current situation and a hopeful future.

Understanding Loss is Losing Trust in the World

We all have automatic assumptions about the way life works, how things should be. In general, we tend to see the world as generally fair. If you work hard, good things will happen. If you are kind to people, people will be kind to you. Mean people will get what’s coming to them.

So when something big happens, and it feels fundamentally unfair, we start to question our automatic assumptions about how life works. We as humans like having a connected story about how and why things happen around us. We like stories that make sense and connect the dots. So when a lifelong addict dies of an overdose, we feel sadness and empathy but the story generally fits. And when someone dies of old age after a full life surrounded by family, we may miss them but we see death as a natural conclusion.

But it’s more difficult to wrap our minds around the story when a child dies, or an otherwise healthy person gets a cancer diagnosis, or a spouse decides to leave a relationship that felt like it was going well. We have to confront the reality that there is no factual basis for our assumption that life will be good or fair or fit our stories of how things should go.

How do we make sense of the world when we realize the fundamental unfairness? What kind of story can we tell ourselves about life when something truly awful happens? Can we find meaning and purpose in a world where children die, good people lose everything, and kind people get cancer? The fact is, we will have to find a way to understand the awful, unfair things that happen in life so that we can keep going and not lose our way.

The two extremes here are either to bury our heads in the sand and insist that things will work out despite all evidence to the contrary, or to maintain a stark awareness of how unfair life is and stay in a state of despair that we will ever be able to progress in the face of deep injustice. Of course, we want to find a middle way. We need to know that life is not fair, that goodness does not protect us from bad things. But we also need to know that there is hope, that our choices toward goodness still count for something, that it’s worth trying and striving in the face of an unfair world.

As someone going through loss, you will naturally find yourself wanting to construct a story of grief. Your mind wants to understand what happened and why. Sometimes, these answers are given to us- if you have a genetic predisposition to Huntington’s Disease, it doesn’t matter how healthy or unhealthy your lifestyle is. It doesn’t matter if you volunteer with at-risk children or give generously to charities, you have a certain likelihood of inheriting the disease based on your parents’ disease status. Sometimes, the answers don’t come easily- why children get bone cancer, why the car crash happened at that moment, who is at fault for a workplace accident.

Walking the middle path means retelling these stories in a way that accounts for the fundamental unfairness of life. Yes, your disease might be genetic, but it was a chance that you were born to those particular parents. Yes, sometimes children get cancer and other serious illnesses, and sometimes they die after only a short life. Our story of how life works has to be able to make sense of these things without assigning blame or coming up with a secret agenda working against us. We have to learn how to see tragedy as something that happens to good and bad people alike without them deserving it.

Can HSPs be extroverts?

In short: yes!

While the Highly Sensitive trait is commonly associated with introverts, it’s also totally possible to be a Highly Sensitive Person and be an extrovert.

Going back to basics, extroversion and introversion are descriptions of how we deplete and recharge our energy. Extroverts gain energy from being around people and can be drained by being alone. Introverts are the opposite- gaining energy from being alone and drained by being around people.

You can see how it’s hard to differentiate. Highly Sensitive people can be overwhelmed by lots of stimulation, like the amount found at a party or a crowded event. But there’s a key factor- the high sensitivity is reacting to the amount of noise or light or social pressure at the event. An introverted HSP might feel each of these drains similarly. But an extroverted HSP feels both energized by the human energy of the situation and drained by the overstimulation.

As an extrovert who works at home, I love going out for dinner on Friday nights. I feel like I’m literally buzzing with energy from being around the other people at the restaurant. Similarly, if I have more than one social event on the weekend, I feel totally drained because social events tend to be overstimulating for me. Often, I can feel the tipping point between the buzz of people energy and the overwhelm of social engagement.

But it’s also true that the majority of Highly Sensitive people are introverts, and if you’re an extrovert you may find that you can’t necessarily relate to information or posts that are supposed to reflect the HSP experience but are actually about introversion. You are not alone in your Highly Sensitive extroversion, and you are not less valid as an HSP because of your extroversion.

Are you a Highly Sensitive extrovert? Let me know! I’d love to connect.

Book Review: 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.

The Importance of Sleep

Sleep is key to good mental health as well as general physical wellness. Not getting enough sleep- or not getting quality sleep- is a huge blow to your ability to maintain your emotions, feel good in your body, and stay mentally sharp.

We are armed with modern technology that allows us more understanding of our personal sleep cycle than ever. Most smart watches and fitness trackers can detect the depth and length of your sleep cycle. Some phones are also able to monitor your sleep.

Despite this knowledge, we are not sleeping well. Part of this is natural- as we age, we spend less time in deep sleep and may need less sleep. But part is cultural. For those who work during the day, night is often the only time you have to yourself to relax or to do your own activities. Sleep is one of the first things we sacrifice when we have a major deadline coming up or we want to spend more time with friends.

Good sleep starts with routine and sleep hygiene. Going to bed and waking up around the same time every day creates a routine that supports quality sleep. This flies in the face of our idea of weekends, days off, and holidays as time to “sleep in” so creating a sleep routine means finding alternatives to sleeping in as a benefit of a day off.

Sleep hygiene means keeping non-sleep activity out of the bedroom. Even though fewer people own TVs or keep them in the bedroom, our phones and tablets create a similar disruption in our sleep hygiene. Those living in a single room or studio can benefit from having a couch or comfortable chair for other activities. Those with multiple rooms should avoid the bedroom except for sleep.

We know the problem- poor sleep- and the solutions- sleep hygiene and routines. But the problem goes beyond just a poor night’s sleep. A habit of too little sleep can leave you susceptible to anxiety, depression, and other mental health issues.

Interested in discovering how your sleep cycle affects your mental health? In therapy, we can go over your sleep routines, explore any resistance to sleep, and go through the process of discernment to find out how much sleep you actually need. Call or text 831-531-2259 or email leftcoastmft@gmail.com to schedule a free consultation to find out how we can work together to transform your sleep habits to work for you.

Not quite ready for therapy? My Foundations of Mental Health course is coming soon and will go over sleep as one of the foundational habits that are key to health and wellness.

Silence and Solitude

My new course on the Foundations of Mental Health has been a wonderful opportunity for me to practice the basic skills and habits as I am writing about them.

Two of these practices are silence and solitude. When I worked in the high school, many of my students would tell me they actively avoided silence because they didn’t want to be alone with their thoughts.

Adults avoid silence too. We use media, busyness, and action to fill our time and our thoughts. Even people who crave silence and solitude- parents of small children, caregivers, those sharing a room or a home with others- will fill time spent alone with other things.

Not to say that media, busyness, action, parenting, caregiving, or any of these things are bad or wrong. Only that mental health and wellness depend on having a rhythm that includes both busyness and stillness, loud bustle and silence, togetherness and solitude.

I recently noticed that my life felt hectic and overfull. During the past week, I have engaged in intentional times of silence and solitude to refresh my soul.

This looks different for everyone. I am still growing my private therapy practice so I am not able to take time away for a week long mountain retreat. But I have been waking up earlier to have time separate from everyone else in the house, time without music or media or books or anything else to give myself space to sit alone in silence and see what comes up.

It’s a life-giving experience. Today as you are reading this, I would challenge you to examine your life and its rhythms. How much space do you allow for silence and solitude?

If you feel like you need help starting a practice of silence and solitude, or the thoughts that come up for you are distressing, therapy can help. Call 831-531-2259 or email leftcoastmft@gmail.com for a free consultation. Interested in the Foundations of Mental Health course? Follow my Instagram @leftcoastmft or join my Patreon to keep up to date with the release.

Clarify Your Values

Many people find it difficult to think meaningfully about their ideal life. Try this exercise instead and clarify your values by looking at things you dislike instead.

Many clarity exercises ask you to look at your ideal day, your ideal life, or your ideal partner as a way to discover your values. But that’s often not helpful. We would all like to find a way to make an excellent living while working part time and traveling the world, writing the Next Great American Novel, or being fully devoted to family.

Instead, this exercise looks at what you don’t like or don’t want as a way to discover where your values truly lie. It can be overwhelming to think of what you do want in life, but often it’s easy for us to think of things we haven’t liked. Your ideal is often nebulous and may change as you grow. But things you dislike often stay dislikes.

So here are the statements. Fill them out with sentences or bullet points, and don’t worry about how much you may put down. And once you have a picture of what you don’t like and don’t want in your life, look at how you can change your life to minimize and eliminate the things that you hate and replace them with things you don’t hate.

I feel most unhappy when I…
I dread …
I am good at but do not particularly enjoy…
I cannot imagine doing … every day for the rest of my life.
I don’t understand why anybody would…
… does not appeal to me.

If you want help looking at your life with a view of minimizing what you truly dislike, therapy can help you look deeper at your history of negative experiences and pull out what in particular you disliked. And therapy can help you shift your relationships at home, at work, and within yourself to shift your life away from the things you hate and toward something richer and fuller.

Contact me at 831-531-2259 or leftcoastmft@gmail.com to schedule a consultation.