The Emotional Journey of an Abortion Decision and How Therapy Can Help

The Emotional Journey of an Abortion Decision and How Therapy Can Help

By: Anikó Blake, LMFT

Grief, relief, uncertainty, and direction. These are only a few of the many coexisting feelings that can arise after having an abortion. This highly nuanced experience is one that thousands of people go through every year—sometimes more than once—and yet many find themselves feeling isolated and alone. Most likely, you or someone you have known has been impacted by an abortion. At a time when narratives that narrowly define and represent the abortion decision-making and recovery process fill the political discourse, it is more important than ever that accessible therapeutic support exists. This includes supportive spaces that allow diverse voices to be safely heard, foster self-compassion and empowerment, and grow community. Someone who has received an abortion will likely benefit from the same mental, emotional, and relational care that we extend to other significant life moments. They will need access to the care that allows us the healing and peace we need in order to develop and thrive. 

There is a human tendency to reduce experiences in order to make sense of or categorize them in one way or another. This rigid, black-and-white thinking offers us a temporary feeling of being in control at the cost of being able to honor the full complexity of being human. This is especially the case when it comes to broader social discourse and political views about abortion. By focusing on one component or fact, we fall into the trap of creating an argument void of empathy and humanity. Singular and narrow talking points overlook or ignore that abortions are not chosen for one specific reason. It is impossible to fully capture all of the unique circumstances that factor into someone choosing to abort their pregnancy. General themes to these factors include the timing in someone’s life, their gender expression or sexuality, their goals and life aspirations, and their own health or the health of the embryo or fetus. In addition, people can feel a myriad ways about their abortion(s) before, during, and after the surgical or medical procedure. This includes emotions that arise immediately afterwards, months later, and years down the line. Some emotional themes are relief and direction from the ability to terminate relationships and pursue goals, self-assurance and ease from greater LGBT+ identity alignment, disappointment and anger from breaks in trust with a partner(s) and support system, and sadness and longing from one’s connection with parenthood and their aborted baby.

Connecting with one’s own abortion story is neither immediate nor linear. And it can be different from one abortion to the next. For many who have had an abortion(s) hearing simplified narratives about abortions on a public level, making claims about the type of people who tend to receive them and how someone should feel about their abortion(s), can feel minimizing; It leaves out the many facets of their abortion(s) experience that are woven into their daily lives.

Grief is a tricky word to use when talking about abortion since it can be misconstrued as regret. While not everyone regrets their abortion decision, transitions and significant life decisions can often bring some type of grief. Abortions are typically a surgical or medical procedure that occur with limited time for preparation and someone may need time to make sense of how they feel about their experience. In fact, generally speaking, not knowing how we feel right away is ok. Some people may not feel any grief about their abortion(s) while others may feel a great amount of it. Abortion grief might be tangible, such as acutely experiencing the physical loss of a pregnancy or ending a relationships with someone in their life due to the abortion. Grief also can be ambiguous, such as experiencing the emotional loss of connection to aspects of one's identity or to their imagined parenthood had they carried to term. And grief might be delayed and complicated, particularly when the abortion happens in tandem with other loss or reconnects us to unresolved loss from our past. For some, abortion(s) can be another teachable moment in acknowledging the legitimate grief we can still feel when we let go willingly. The process of exploring emotional nuance can include sorting through conflicting emotions in order to make sense of each of their origin stories. Then we can build a map for moving forward with mixed or coexisting emotions about the same event. Over time, emotions such as grief, sadness, and anger can be felt harmoniously with relief, peace, and even hope and determination. 

As therapists, we learn that adequate support improves the outcome of a significant life event. On one hand, someone can have a trauma response to the surgical or medical abortion itself, whether it relates to someone’s physical experience during the procedure or how their care was managed. On the other hand, someone’s trauma can be related to the response they receive about their abortion(s) from others, or the non-decision makers: such as partner(s), family, friends, broader communities, and leaders. Abortion stigma, agendas about abortion access, and personal values, beliefs, and goals from non-decision makers can become barriers to helping people who are considering an abortion make an informed decision and identify their own reasons and emotions. These barriers reduce access and availability to support resources and can ultimately create more mental, emotional, and relational complications later on. They can also increase mismanagement of care which can result in health risks. It is common for people having an abortion to receive misleading or incomplete information about the surgical or medical process, to experience ineffective collaboration across their care teams, and to not receive critical follow-up physical, emotional, mental, and relational support afterwards. These issues are heightened by rapidly changing abortion laws and policies and inconsistencies across clinics and states.

Offering someone accurate and comprehensive information about their abortion options and providing non-agenda based listening as they explore their decision are some of the ways that non-decision makers, including partner(s), family, and friends, can support someone who is considering an abortion. 

Therapy is a confidential and carefully structured form of support for aiding people through life transitions. Those who choose to have an abortion, including life-saving or medically necessary abortions, deserve clinically informed and ethically grounded treatment for their emotional, mental, and relational healing. This type of treatment improves self-awareness and empowers someone to make informed and intentional decisions about their lives. Therapy before or after an abortion may be focused on grief, identity development, shame healing, trauma recovery, relationship repairing, and community building all at the same time. Knowing if, how, and when to talk about an abortion(s) with a therapist can be difficult and sometimes scary. If you are currently working with a therapist, ask them if this is a clinical area they have worked with before. You can also ask them about the type of therapeutic model or approach they would use for working with a client who is considering or has received an abortion. If your therapist is unable to support you in processing your abortion options or decision experience they may be able to refer you to another therapist more specialized or familiar in this area. These recommendations also extend to those who did not receive an abortion but were impacted by another’s abortion decision and would like therapeutic support.

Therapy is a form of treatment where client information is protected (with exception to the reasons listed in Illinois law for Mandated Reporters). Your safety is of utmost importance. If you are concerned about risks to your safety by talking with a therapist about an abortion you are considering or have received, collaborate with them on a plan to increase safety. For example, consider working with a therapist without using your insurance, since insurance companies may ask for diagnostic codes and treatment summaries to assess coverage for therapy services. If you are in couple or family therapy and do not want your partner(s) or family to know about your abortion, consider starting individual therapy. If you are looking to process the abortion with your partner(s) or family in therapy, make sure everyone is in agreement about the confidentiality of what is shared in session. Make sure you and your therapist are in agreement about documentation and case consultation, particularly if they have your consent to speak with another clinician on your care team. If you are not open about your abortion with someone in your place of residence, consider working with a therapist who can offer in-person sessions in their office versus attending virtual sessions in your home. Use caution when emailing, texting, or leaving voicemail messages with private information. A phone conversation via a therapist’s confidential and direct number and electronic message sent through their secure HIPAA-compliant software system (EMR) are safer ways to share information about yourself with a therapist. 

If you are looking for additional resources, for you or someone else, you can find them below. Please make sure to assess any resource, clinic, and provider before receiving care to make sure that they are a good fit for you.

3 Simple Ways to Show Affection

3 Simple Ways to Show Affection

By: Taylore Mountain, AMFT

Giving affection is not always natural for everyone. However, it is a skill that can be learned with a little bit of practice. A verbal message of love or care to your partner is most ideal, but if that’s not your speed, here are three simple ways to let them know you see them and still desire them:

  1. Not enough hours in the day to connect with your partner? Try this: send a flirty text!  Send your boo a text about what you like about them, your favorite romantic memories, or ask about turn ons. Love connections don't need to be big. This small gesture can mean a lot!  

  2. Is there some treat or item they like? When you see that during your store run, pick it up. 

  3. Physical affection is also nice, even in small moments. Holding your partner's hand or a shoulder rub can be just what your partner needs. 

If you are still unsure of what to do, ask your partner this question: “How do you want me to show you affection? What is an example of how I can let you know I care for you?" 

Every little bit helps!

Calming our Inner Critic with Curiosity

Calming our Inner Critic with Curiosity

By: Melissa Larmon, AMFT

If you are like most of the population, you have an inner voice or part of you that is a tad bit (or a lot bit) self-critical. There is not a day that passes that my inner critic doesn’t have something to say, nor a session with a client that their inner critic doesn’t appear in some way. Inner critics are pervasive and persistent! The problem is, we’ve been living with them so long that we become very accustomed to their presence and often don’t realize how much they are affecting us in less-than-helpful ways.

Some examples of what an inner critic might say to us…

·      What’s wrong with you?

·      Why are you so (insert what you are feeling here…tired, sad, frustrated)?

·      You should be able to handle this.

·      That was a stupid thing to do/say/think.

·      You’re lazy/stupid/a mess. Get it together!

·      You’re behind. Everyone else is doing better.

·      You’re failing.

·      You should have done better.

·      You should have made a different choice.

·      You should be doing (insert task or behavior here).

·      You’ll never make it.

·      Everyone else has this figured out.

·      “Normal” people don’t do this.

It’s heavy just to read all those statements, isn’t it? And how does it make us feel when we say them to ourselves repeatedly? Sometimes, we are so familiar with our inner critic that we might not even notice how it is influencing our mood and making us feel.

Now, imagine if another person walked into the room and said the same things to us that our inner critic is saying. How would that feel? Would we allow someone else to speak to us that way? And if we wouldn’t allow someone else to speak to us that way, should we allow ourselves to?

It can help to externalize our inner critic as a way to shift our thinking into something more helpful. You can start by, as above, pretending the inner critic is another person. Once you’ve done that, you can interact with the inner critic instead of just absorbing and accepting what it says.

Sometimes when we do this, we are can more easily challenge what the inner critic is saying. We might be able to talk back and say something like, “That’s not true,” or “that’s not helpful right now,” or “Back off.” Any of these types of responses can allow us the space to move forward with the moment without the weight of judgment.

Other times, it can be helpful to get curious with our inner critic. This takes a little more time, but allows us to better understand our inner critic, which can help us gradually shift its voice over time, reduce its frequency, or increase the speed at which we process and move forward each time. Next time your inner critic shows up, try externalizing as described above, and sit them in a chair across from you and ask these questions:

  • Question to Inner Critic: What purpose do you serve? What are you trying to accomplish?

  • Question to Inner Critic: What are you trying to protect me from?

  • Question to Yourself: How do these messages affect me/make me feel?

  • Question to Both: Can we accomplish your goal/intent in a different way?

Here is a brief example of how that might look in practice. I am sitting on the couch and my inner critic says, “Why are you being so lazy? You should get your butt off the couch and do something.” I notice this familiar voice, externalize my inner critic, and ask the questions…

Q: What purpose do you serve? What are you trying to accomplish?

A: I am trying to motivate you.

Q: What are you trying to protect me from?

A: I am trying to keep you from feeling bad about not accomplishing your goals/tasks.

Q: How do these messages affect me/make me feel?

A: I feel like I’m failing. I feel heavy and not good enough.

Q: Can we accomplish your goal/intent in a different way?

A: Yes. I can encourage myself with kinder words. I can ask myself if it would be helpful to do something instead of judging and pressuring. I can acknowledge my capability. I can think about how good I will feel AFTER I do something. I can create other tools to support and positively reinforce my goals/tasks, and I can give myself permission to take breaks when I need them.

Now, instead of yelling at myself to motivate, I can see that yelling at myself does NOT make me feel motivated, and explore what would be helpful instead. And the more I do that, the more I will develop NEW habits that are more helpful than the inner critic’s approach.

Lifting and shifting the inner critic may not solve every problem or address every underlying cause, but it will make a difference. Alleviating one layer pain and pressure may allow you to better address and tackle other challenges. For instance, if you stop poking at an open wound, that alone won’t heal the wound, but it will reduce the pain and allow for healing to happen.

But don’t just take my word for it…Give it a try and see how it feels. Start by simply noticing your inner critic when it shows up…start to identify the phrases it tends to repeat. Then try externalizing, and then engage the inner critic with curiosity. From there, you just might find kinder and more effective ways to interact with yourself and accomplish whatever healing or progress you (and your inner critic) seek.

Photo by cottonbro: https://www.pexels.com/photo/photo-of-a-sad-girl-holding-paint-brush-3778361/

"My relationship is starting to get abusive and toxic." (Anonymous Q&A Response)

"My relationship is starting to get abusive and toxic." (Anonymous Q&A Response)

By: Gabe Seldess, LMFT

A recent query was posed to our anonymous blog Q&A : “My relationship is starting to get abusive and toxic.”

     Indications of abuse and toxicity are the red flags everyone should pay the most attention to in a relationship.  This may sound obvious, but abuse can be subtle.  Partners can be loving and caring and still act in harmful ways.  Not all abuse is big, loud, and obvious – small actions can cause a lot of damage, especially built up over time.  And behaviors don’t need to be intentional for them to be abusive.  It may be tough to catch on to problematic behaviors.  When it comes to the pros and cons of staying in a relationship, generally give indications of abuse more weight than you think you should (maybe even a lot more). 

If you are wondering about behaviors, or just being proactive, here are some indications of abuse in relationships from the National Coalition Against Domestic Violence:

https://ncadv.org/do-you-think-youre-being-abused

https://ncadv.org/signs-of-abuse

     If any of the above signs start to feel familiar, consider the fact that you do not need to stay in any relationship.  Your first responsibility is to yourself and your happiness and safety.  You do not inherently owe your partner any effort to fix or correct their abusive interactions and behaviors.  You can leave.  Not everyone will understand your actions, but you do not have to endure anything you don’t wish to endure.  And while many people have the ability to change, you don’t need to stick around for it.

     Leaving is not always easy, of course, when control and threats of violence are involved.  Please consider connecting with a Domestic Violence Agency for assistance in gaining immediate safety and planning a safe exit from a home or relationship:

National Domestic Violence Hotline:  800-799-7233

https://www.thehotline.org/?utm_source=google&utm_medium=organic&utm_campaign=domestic_violence

     If you’ve weighed your pros and cons and feel there is enough to salvage and hold on to in your relationship, there may be some things to try.  It may be possible to educate your partner around their behaviors, the ways they impact you, and the ways in which you prefer to be treated. 

     Begin with making “I-statements” about how you feel, what you see, and what you prefer in relationships.  For example, “I feel hurt when you use that language to describe me”; “I get anxious when your voice rises in traffic”; or, “I get embarrassed when we fight in public… I prefer to have conversations in private… Can we wait to talk about this?”.  A good I-statement takes blame and accusations toward your partner out of the equation and focuses the conversation on your needs.  Hopefully, this can provide education to your partner, awareness of the impact of their behaviors, and motivation to change in order to be more caring and supportive of your needs.  If your partner appears to not care, dismisses your comments, or can’t seem to make any changes – consider adding weight to this red flag when evaluating pros and cons in your relationship.

     Another strategy is to be more firm with your boundaries and preferences.  As mentioned, through “I-statements” you can teach your partner what you need and what you are willing to tolerate.  You can inform your partner that you will leave the room if they become too loud in a situation, that you will not discuss a topic unless they can control their criticisms, or that you will hang up if they won’t let you share your thoughts too.  For example, “I’ve asked you several times to try and speak softer to me in public.  I don’t feel like you have.  I’m going to leave now.  I’m looking forward to watching TV with you later, when we are both relaxed, and we can try to talk about all this again tomorrow in private.”  You don’t always need to leave the relationship, if you are able to leave certain situations.  Plenty of good elements can exist in a relationship to enjoy, but you may need a plan for avoiding the less desirable parts as well.  If you are attempting to set limits and boundaries and your partner continues to push through them, consider that an especially heavy negative on the relationship scale.

     Begin to consider friends or family you may be able to spend time with, should you feel a need to get distance or safety from your partner.  For example, if you feel a need to leave a restaurant and don’t feel that home is the best place to be yet – have some options of where to go in mind.  Similarly, plan to carry extra money or have a credit card on you in case you need to leave an outing on your own.  Try not to trap yourself in an uncomfortable situation because your partner was the one who drove.  Again – if your partner cannot respect your autonomy or your attempts to establish boundaries, that’s a problem to consider.

     There can be significant benefit to working with a couples counselor to assist with communication, boundary setting, I-statements, and effective ways to take Time Outs in relationships.  Counseling can help establish protocol for how to manage difficult situations, talk about what took place, and find ways for reconnection.  Additionally, each partner may benefit from individual therapy in order to better understand triggers and personal behaviors, as well as with developing more effective ways to communicate feelings, preferences, and needs. Please note -  if there is active physical abuse occurring in the relationship, then couples counseling is not indicated in that situation, and immediate action should be taken to separate for the time being, and seek safety and individual counseling before considering whether to come back together again.

     People can change.  People can learn.  Sometimes it’s quick, but usually it takes a bit of time.  You may wish to see what abusive behaviors can change through communication and counseling, and there may be good reasons to try.  Be mindful of how long you wait and what you are willing to endure, however.  You are still a good person, even if you don’t wish to try.  Safety first.

Is it Worth Fighting For? (Anonymous Q&A Response)

Is it Worth Fighting For? (Anonymous Q&A Response)

By: Angela Nguyen, AMFT

We recently had a reader submit the following to our anonymous blog Q&A section:

“My question is, although he says he loves and cares for me, does that actually count in truth? Especially when he says that he no longer wants to put in the effort to work things out and find solutions? Should we just break up or take a break? What does it even mean to take a break? I do have so many questions and every day it hurts because I really care for and love this person but I also don't like feeling like I am not worth fighting for, and just overall feeling bad sometimes.”

This reader summarized their situation as one where they’ve been feeling inadequate for their partner, especially when their partner’s liking certain photos on other people’s social media and his pornography usage. Then when this reader tries to bring up their frustrations to their partner, the partner explains that he doesn’t feel as motivated to put in the effort to try in the relationship, “because he has been [putting in effort] so for so long and that he just doesn't really care anymore.”

First and foremost, thank you so much for submitting your question. This is such a common dynamic that I think a lot of readers here can deeply relate. I do want to preface that everyone’s situations are unique and delicate to their specific dynamic, and I also don’t know this reader’s entire full picture. What I’m seeing so far though is this very common cycle between person A feeling inadequate (this could mean feeling not good enough or wanted enough), which usually has an underlying fear of being abandoned. Person A’s experience then impacts person B’s experience where they might end up feeling a deep sense of inadequacy (e.g. they’re not doing enough), which usually has an underlying fear that they’re not acceptable for who they are (i.e. fear of rejection), and they might then withdraw (e.g. try less since what they’re trying isn’t good enough anyway). This withdrawal/silence/space then feeds person A’s possible fear of abandonment and so on and so forth. As you can see, it would be incredibly easy – and expected – for us to fall in and be stuck in this feedback loop from hell. 

So what do you do?

Identifying and naming your specific cycle together is a helpful step. Recognizing what’s going on can help ground us away from the cycle, especially when it’s incredibly easy and tempting for us to sweep it under the rug and stick to status quo.

Then, it may be helpful to reflect on how we’re both individually feeling about this machine that we both feed: Do we feel sad? Do we feel justified? Do we feel embarrassed? Do we feel regret? I’m encouraging that introspection mainly for a reflection on what your individual and couple’s goals may be after recognizing what’s actually going on. It’s possible that person A’s needs would be to feel connected and secure enough so that they no longer worry about being abandoned, and it’s possible that person B’s needs would be to feel appreciated enough so that they no longer need to worry about feeling as helpless, inadequate, rejected. If that’s applicable, then perhaps it would be helpful for person A to temporarily self-sooth their anxious experience and re-channel that energy to help person B feel more confident in the relationship (I’d recommend a lot of reassurances and compliments), and as person B feels more motivated to emotionally invest, then person B can use their more charged emotional battery to validate and empathize with person A’s emotional struggles, especially since they also know what it feels like to feel inadequate!

Simply, a lot of the time, person A just wants to feel understood and person B wants to feel like they’re doing a good job/they’re accepted. Of course, each couple’s situation’s a bit more nuanced than that and that’s why reflecting on what we may want too is important. Getting a therapist can help elucidate that for us as well.

This leads me to the question I took away from the reader’s submission. Reader, I’d imagine that it’s a very lonely, scary, and even confusing experience not to feel good enough for your partner when maybe you have felt that way with him before. It probably adds more pain to the mix when you’re frequently exposed to comparing yourself to these other girls on social media and porn too. Like you said, you’re hurting everyday! You not only need to feel like you’re good enough, but you deserve it too. As you asked about whether his love’s real despite his lack of efforts, I thought about how it truly can be difficult to differentiate between if a person’s disinterested because they’re just withdrawn and need help feeling motivated to be interested again or if it’s because they genuinely are too emotionally far gone. It’s hard to say, honestly. I’ve seen people change and it would actually be surprisingly beautiful for me to witness, I’ve seen people struggle to be that vulnerable but still loved their partner, and I’ve seen people who actually both didn’t want to change and admitted that they lost their love for their partner too. It’s a scary conversation to have, but if either or both of your needs are still unmet after trying to put in the work, then that’s also a conversation that needs to be had too. As scary as it is though, I believe that you’d be indirectly meeting your needs by having such a (temporarily) difficult conversation.

But first, try to put in the work. Prioritize your mental health and coping skills, help uplift your partner’s, and maybe seek external support to help guide you both on getting off the hamster wheel. It’s a lot of work, but 100% worth it for your mental health.

Thank you again for sharing your story and good luck!

Photo by Ann H: https://www.pexels.com/photo/sign-texture-typography-school-11082254/

How to "Change the Channel" & Rewire Your Anxious Brain

How to "Change the Channel" & Rewire Your Anxious Brain

By: Josh Hetherington, LMFT

I’ve been listening to a workshop presented by Catherine Pittman Ph.D., on the operation of the Amygdala and the Cortex and how this relates to anxiety. She’s written a book called Rewire Your Anxious Brain:  How to Use the Neuroscience of Fear to End Anxiety, Panic, and Worry. Good stuff! Here’s what I have so far:

The Amygdala is a set of two almond shaped (amygdala is almond in Greek) portions of the brain that are among the oldest. That is- animals like rats and snakes and lizards have this in their brains and are largely governed by it.

The Cortex is the part of the brain that allows us to analyze with critical thought. Humans have a lot of this, rats have much less.

The Amygdala is able to see all stimulus coming in from all or our sense organs before the Cortex sees. The Amygdala decides if there are threats, or if there is safety.

So there’s an envelope on the table.

Our eyes see it, our Amygdala sees it and determines it’s not a threat- it’s just an envelope.

There’s a fire in the kitchen.

Our eyes see it and our Amygdala determines that it’s a threat and commands us to run out of the house. The Amygdala fires before any thoughts can arise from the Cortex. This is the home of the “fight, flight or freeze” response. It creates extremely strong, emotional impulses in reaction to unsafe situations.  The Amygdala reacts first. If there is a danger identified by the Amygdala, the Cortex doesn’t get a good chance to analyze it. It’s go time. Your body is moving long before your cortex sends the conscious thought- “Run!!!” Or, if you’ve ever touched a hot pot and dropped it before you actually “felt” the pain of the burn- that’s the Amygdala doing it’s thing. You were less burned because it read the damage signals coming from your hand before your Cortex, and commanded your muscles to release the hot pan, to mitigate the damage as quickly as possible. It’s lightning fast and it has access to all of the systems of the body.

But, the Amygdala isn’t just watching the outside world, it’s also checking out the Cortex.

The Amygdala sees all. It watches the Cortex like a television screen. If we have a scary thought in the Cortex, the Amygdala starts to go into action. So continuing to  promote scary, anxious thoughts is a way to keep the Amygdala activated.

Back to the envelope on the table… the envelope is from an IRS lawyer. The Cortex sees this lawyer and fires up some fearful conclusions- “I’m getting sued!” “I’m in trouble!”. These thoughts are accompanied by scenes from a prison movie. The Amygdala sees this movie and starts to rev up. The Cortex is telling the Amygdala this is a threat. The body surges with adrenaline and cortisol and other chemicals and hormones, and…. It’s junk mail. Whew! It takes a while for the ingredients of the fight, flight or freeze cocktail to be reabsorbed, but they do get reabsorbed.

This is one of the main ways our thoughts connect to our emotions. We can have some control over our Cortex and the movies that are being played for the Amygdala. This is a critical point for Anxiety. If we allow ourselves to “watch” the anxiety “channels” in our Cortex all the time, our Amygdala will be in a regular state of activation. This means our bodies will be often reacting to fear and deciding whether or not to run away, fight, or freeze. We can replace anxious thoughts. We can change the “channel” that is playing for our Amygdala.

I currently trying to screen a short film about snuggly bunnies rather than Saw 3: The Slicing Game. It doesn’t always work, but it’s a practice worth trying.

Catherine Pittman, Ph.D  has written and spoken a lot on neurobiology and anxiety. She’s an excellent teacher and therapist. Also a graduate from one of my favorite colleges, Central Michigan University- Fire Up Chips!

Pittman continues her workshop with a description of adaptive worry. Worry has played a big part in our survival as a species. It’s the ability to imagine negative outcomes. That’s not the primarily effective part though. It’s also a call to create a plan for adaptive change. The second part is the part that has helped us survive. If we don’t respond to our worry with a plan for change, we’re just running a scary TV show over and over on our Cortex which then amps up our Amygdala (see above!).

So listen to your worry, and come up with a plan, and execute the plan. And don’t forget to “change the channel” when you notice yourself spending too much time on scary thoughts.

One of My Favorite Couples Therapy Exercises, & Why it’s Important!

One of My Favorite Couples Therapy Exercises, & Why it’s Important!

By: Madalyn Simpson, MFT

If you take a peek at the early history of the field of Psychology, you may notice a significant focus on pathologizing- focusing on what is abnormal, unhealthy, or wrong. While there have been significant shifts in the field since then (such as the introduction of the field of Positive Psychology and a strengths-based approach), you may still notice this phenomenon in any given therapy session, or in your own day-to-day lived experience. Do you notice yourself registering or focusing on what has gone wrong in your day, or what is a potential deficit of your relationship? One explanation of this is what Psychologists called the human Negativity Bias, which essentially refers to the fact that negative events have a more significant impact on our brains than positive ones. Not only does this mean we tend to pay more attention to negative stimuli, but this attention bias also means our brains code these experiences and memories as having more importance than neutral/positive events. (And if in this exact moment you are judging your brain for this bias and the impact it may have had on your life/mood/relationships- I invite you to extend a compassionate lens to this concept. From a developmental/evolutionary perspective, it is this exact negativity bias that primes us to scan for threats around us- we need to notice these more readily and prominently than neutral stimuli in order to keep ourselves safe. This ‘scanning for threat’ tendency in our brain that has protected us and kept us alive- So thanks, negativity bias!)

AND, let’s think about what this means relationally-  One conclusion we can consider is that as humans we are naturally disproportionately primed to notice every time our partners do something we consider ‘wrong’ or let us down, and not every time they do something ‘right.’ This does not mean we should then simply discredit the ‘wrongs’ we are experiencing in our relationship and chalk them up to a hard-wired bias, but instead that there may be value in considering that we may unconsciously be overlooking some of the efforts, extensions of care, or general ‘positive’ attributes of our partners or relationships on a regular basis.

If you have a sneaking suspicion that this may be taking place in your relationship(s) and impacting your relational satisfaction or decision making, I offer you my own personal twist on psychologist Richard Stuart’s Caring Days exercise:

Step 1: Set aside 5-10 minutes to sit down with your partner(s)- grab two pieces of paper and two pens

Pro tip: find some time when you both can be as present as possible and dedicate your full attention/thought/care to the activity

Step 2: Your assignment: Silently write down a list of all of the small, day-do-day things that your partner does that make you feel loved - we’re not thinking grandiose gestures here, we’re thinking specific, small acts of care (ex: asking my how my day was, picking up my favorite __ from the grocery store, turning the coffee maker on in the morning for me)

Pro tip: If you notice yourself wondering what your partner is writing, who will have the longer list, or whether your items are ‘good enough’- you are human. This is not a competition- notice these thoughts (they are just thoughts), and gently refocus your attention on the task at hand. Do this over and over if needed.

Step 3: Turn towards your partner, and explore together the process of making these lists (NOT the content- we’ll get there!). What emotions, physical sensations, thoughts, or behaviors did you notice while making the list? Do you feel heavier or lighter than you did prior to the activity? How do you feel towards your partner?

Step 4: Pick one item on your list and read it to your partner, explain why this gesture makes you feel loved/ why it is important to you (take turns)

Step 5: Exchange lists. (If you struggled creating the list, give yourself 24 hours to continue to think/add to your list, and exchange them at the end.)

Step 6: You guessed it, do some items on the list this week!

Arguably the most important, Step 7: Shine your intention this week NOT on noticing how many things on the list YOU are doing, but on NOTICING your partner’s loving gestures. Be on the lookout (scan, if you will) for all of the things your partner does on a regular basis to communicate their love and care.

Step 8: At the end of this week (or in your next couples therapy session!) create some time to sit down together and explore what you noticed. Practice some positive reinforcement here- what did you appreciate that your partner did? What did you admire? Did you notice any shifts in your feelings/judgments towards them throughout the week?

 

You will leave this exercise essentially with a blueprint of how to make your partner feel loved and cared for on a daily basis. The original exercise involves turning this list into alternating special, ‘caring days,’ in which the intention of the day is for one partner to shower the other with care. However, if we consider our earlier discussion of our automatic negativity bias, I would argue that using this exercise to bring conscious attention to your partner’s loving gestures on a daily basis is a great first step toward rewiring our brains attention towards appreciation, gratitude, and admiration in our romantic relationships.

Give it a try, and share your experience in the comments!

 

***To read more about the human negativity bias, check out this recent blog post by CCRC’s own Josh Hetherington- https://chicagocenterforrelationshipcounseling.com/ncrc-blog/2021/10/6/the-power-of-bad

 Cacioppo JT, Cacioppo S, Gollan JK. The negativity bias: Conceptualization, quantification, and individual differences. Behavioral and Brain Sciences. 2014;37(3):309-310.

 

Meaning in the Time of COVID

Meaning in the Time of COVID

By: Sara Morrow-Han, LMFT

It’s a new year--I don’t know about you, but it doesn’t quite feel like it! I wish we could’ve left COVID behind in 2021. I acknowledge a lot of internal frustration about the situation we, as a world, are currently in. I think a lot of us share in a sense of tediousness right now. But, given that we haven’t left the pandemic in the memories of last year, I wanted to share a psychological practice that has helped me during the pandemic, especially when it has felt like we’re just “going through the motions.” The time feels ripe for such a thing…

Meaning in the Small Things

A resounding sentiment in 2020/2021 was that things sometimes felt a tad pointless with all the big problems at hand. Especially, because it was like life got smaller: isolation, anxiety and monotony being the key culprits, in my opinion. Through my work, I started thinking about what brings us a sense of meaning in life. But what does “meaning” mean? Steger (2017) defines meaning as the over-arching concept that includes a sense of purpose and significance. Furthermore, he writes: “meaning in life seems to play a substantial role in reducing psychological suffering. Meaning in life consistently is negatively related to levels of psychological distress and mental illness, such as symptoms of eating disorders, substance use disorders, post-traumatic stress disorder, depression and anxiety” (Steger, 2017, p. 76).

 Things like work, family, friends can bring us a sense of meaning; it’s important that we have purpose/significance in these “major” life arenas. The next time you’re catching up with a friend, take a moment to internally name how valuable he/she is to you. Perhaps even share it. The point is, we want to make the moment more salient so that we can call it to mind later.

With all the isolation and monotony of the last couple years, meaning in the “big” things can feel hard to grasp. That said, we can still cultivate a sense of significance: sometimes, it’s ok to find meaning in the small things! One of my regular practices since 2020 has been to identify any things of significance. For example, I remember walking the dog while it was snowing one evening last year: he started running around, kicking up snow everywhere, clearly very excited. It made me smile, and that was my thing of “meaning” for the day. Small, but significant, to me.  

 

References:

Steger, M. (2017). Meaning in life and wellbeing. In M. Slade, L. Oades, & A. Jarden (Eds.), Wellbeing, recovery and mental health (pp. 75-85). Cambridge University Press. https://doi.org/10.1017/9781316339275.008

A Boundaryless Song: Community Healing 

A Boundaryless Song: Community Healing 

By: Michelle Ahmed, LMFT

Our brains and bodies are incredible. From the moment we are born, we look to our caregiver’s face and analyze what we see—a smile, a furrowed brow, wide eyes, rigid arms, gentle kiss, soft voice, loud cry—our bodies search for safety, and we attune to each other. We are boundaryless as we begin writing our narratives—our songs. And so, must we not be boundaryless and unconstrained in our healing process?

Therapy is designed and therapists are trained to be bound by laws and ethics that work within a very intricately white supremacist system. Like redlining, we are given our territories—our bounds—and told to stay within them right down to what we wear. They—the white supremacist system—call it professionalism; they call it ethics. I have been afraid to sing aloud because my song is an undeniably frightening reality that this system continues to fail me. However, my song has been sung and is still ringing throughout my body as I have attuned to the collective songs around me including my colleagues, friends, family, and clients—you.

You sit across from me, waiting—for the right words, for compassion, for me to tell you what to do, and for my healing song. Your eyes and body language say, “Therapists are supposed to—,” and my heart begins to race because your song, our songs, both drip with a longing and expectation. You need me, and I need you.

I coexist in a world and in a profession where my clients carry the systemic power and privilege that fails me in the same way that we BIPOC are repeatedly failed. I keep circling back to what I am expected to say as a therapist, but I am often lost. How do you live in a world where the system not only fails you but also traumatizes you? What happens when I identify and share that same kind of trauma my clients have experienced, a trauma that continues to remain unresolved because it could result in retribution if you decide to step away, sing alone, or sing at all? It would be the greatest disservice for me to dismiss that the system is broken and attempts to break us—my BIPOC family—continuously. Thus, I have reconciled that the greatest compassion I can offer you as a fellow human is the truth—our truths. 

Today when I sing, I sing our truths; I sing our songs. You give me the courage and the strength to sing it for us all. And without you, there is no me—Michelle the Brown Therapist, the healer, the singer, the song writer, the creative, the human. I see you just as much as you see me, and I thank you for inspiring me to write this new song today.

“Community healing,” pours out of my lungs.

Community healing—how one heals within a community and as a village—is something I have been grappling with my entire life, and here is what I have come up with. Community healing must aim to lift up the schools, neighborhoods, family systems, and individuals within it. “It takes a village,” and so a community cannot be a community without every single individual involved. We create this village together, and so healing—our BIPOC healing—must be created together. It is a wonderful, loving collectivistic idea that has been fused within me and you through the blood running through our veins, through the stories that our parents and ancestors have passed down to us, through the moments that we share with our friends and neighbors, and even through the times when our colleagues and our clients have grown with us. Community healing is sharing a wealth of love, acceptance, truth, and support—not something we hold onto on our own—so that we can continue to learn and grow to love and accept ourselves and each other.

Your eyes and body language usually say, “Therapists are supposed to—,” and instead you say, “So what do YOU do?” My body relaxes when I realize you don’t want me to heal you, you simply want me to sing to you my human song like so many of our ancestors used to. Here are the lyrics my village passed down: healing is boundaryless, full of pain and grief, full of stories and memories, full of love and hope, full of art and color, and full of diversity and clamor. Today I break free of our bounds to form our healing bond. Thus, I buy your art and I go to your concerts, I promote your businesses and interests, and we make a lot of art together—in therapy and in the streets. “We heal together,” I sing.

One love,

Michelle Ahmed, LMFT

 

Acknowledgements:

To my kind and loving partner and editor, Eros Joshua Gonzalez, who continues to teach me more about community healing every day through his experiences as a dancer and as someone who works in the service industry.

The Power of Bad: How The Negativity Effect Rules Us and How We Can Rule It

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The Power of Bad: How The Negativity Effect Rules Us and How We Can Rule It

By: Josh Hetherington, LMFT

In The Power of Bad , authors John Tierney and Roy F. Baumeister lay out some of the intense ways that we respond to “bad” feedback more strongly than “good” feedback. Two of the best examples they explore are the negativity bias and the Fundamental Attribution Error. 

Negativity Bias

The negativity bias is pretty simple. We are more focused on events that make us feel angry, sad, hurt, threatened, than we are on events that make us feel happy, joyful, proud, calm, and delighted. There is a pretty clear evolutionary value in paying more attention to the scary/bad experiences in life then the ones that bring us happiness and joy. On the primordial savanna it was important to know where the predators lived, what they sounded like, how they smelled, and what their habits were. This knowledge kept us alive. How tasty a type of berry was, or how beautiful a sunset looked was not as critical to survival. If we missed the aesthetic value of a sunset we may be a little bummed out. If we missed the signs that a tiger was stalking us, we’d be dead. So, our brain is tuned to paying attention to fearful threats to our wellbeing. This is the negativity bias. 

Fundamental Attribution Error

The Fundamental Attribution Error occurs when we see something more globally than it may actually be. When our partner doesn’t do the dishes and we experience this as a sign of our partner’s character flaws, and put this event on a list of other slights we may be making the fundamental attribution error. The event may be related to a context happening outside of us. It may have nothing to do with us. Our partner may have skipped the dishes because they wanted to connect with us after dinner and planned to do the dishes in the morning. The Fundamental Attribution Error causes us to see the event in a personalized, global, hopeless way. And sadly, the authors found that it only happens for negative events. We don’t automatically collect examples of our partners triumphs and kindnesses and attribute them to their excellent character traits, hard work or personal growth. If we see our partners doing something nice, we may instead find a way to attribute it to something WE have helped them with or assisted in! Selfish humans!

Intentions Versus Impact

Conflicts related to intentions versus impacts are loaded with both of these phenomena. It is very easy to defend your intentions when the impact of your actions caused hurt in your partner. This defense of intentions can be caused by the Fundamental Attribution Error and made worse by the negativity bias.

Here’s an example: 

I thought my wife wanted to be recognized as a strong, independent woman who didn’t need flowers on Valentine’s Day to prove that she was beautiful and worthy of my love. My intention in not getting her flowers was to show her that she could stand alone and be valuable without my validation and that I would love her and be inspired by her strength and independence, even on her worst day. And, that Valentine’s Day is capitalism at its worst!

The impact of not getting her flowers was hurt feelings. She felt rejected. Not only did she feel rejected, she made the Fundamental Attribution Error and assumed that I didn’t love her and that this was another example of me being emotionally distant and, in fact, maybe we were “not meant to be”. 

These feelings were intensely negative! They felt to her like a tiger on the savanna! My emotional ineptitude was a major threat to her well being and her brain registered me as the enemy. Her negativity bias caused her to use all of her emotional and cognitive resources to protect herself from me. I was the enemy! She lashed out with anger to protect her vulnerable, hurt parts. 

I saw her anger and sadness and immediately wanted to defend my intentions. I was trying to celebrate her strength, after all! I committed the Fundamental attribution error by telling myself that she was a needy moving target. This went on my list of times when I was trying and acting and still not getting it right. I felt hopeless and helpless.

My negativity bias kicked in and I saw her anger and sadness as a threat. She was going to rage on me, like a tiger on the savanna! I was going to need to withdraw or else I’d be destroyed.

How can we manage this?

I need to take responsibility for the impact of the choice to not get her flowers and ignore my intentions. I need to apologize for the impact and acknowledge the reality of it over the reality of my intentions. She was really hurt. That is what happened!

We both benefit from noticing the negativity bias in our lives and the power of the Fundamental Attribution Error. Seeing these forces, noticing them all the time, allows us to make other choices. We can see more nuance if we don’t listen to our fears as they creep out of the primordial savanna. It’s only me, not a tiger! 

Take responsibility for your impact! If you notice yourself defending your intentions (“that’s not what I meant!”, “you’re not understanding me!”, “what I said was….”) then you need to take a look at your impact. 

And, use your understanding of the negativity bias and the Fundamental Attribution Error to make your choices thoughtfully. Don’t keep it to yourself. Check out your thoughts with your partner to see what they really want from you. You’re different people with different needs. Don’t just act based on the “Golden Rule”, do unto others as you would have done unto you. Instead, act on the “Platinum Rule”, do unto others as they want done unto themselves.

The Illinois Telehealth Act and What It Means for Psychotherapy

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The Illinois Telehealth Act and What It Means for Psychotherapy

By: Anikó Blake, LMFT

The past year and a half have brought significant shifts to the field of psychotherapy. In March of 2020 Illinois Governor JB Pritzker signed Executive Order 2020-09, enabling therapists to quickly shift their clinic work to a virtual format, with minimal disruption to their client’s care and insurance coverage. Insurance companies were required to reimburse health care providers for telehealth with the same payment rates as in-person care, and some waived the client’s usual copayment responsibilities, making therapy more financially accessible than ever. 

While virtual therapy (or telehealth) is hardly a new concept, prior to 2020 many therapists had a steady in-person caseload and felt little need to venture into the world of phone and video sessions. There were few secure platforms available and the understanding of the state and federal laws and therapeutic guidelines for conducting virtual sessions was still quite vague and unresolved. And most graduate programs hardly taught how to navigate virtual interactions with clients beyond standard emails and phone calls for scheduling, billing, and emergency purposes. That all changed when virtual sessions became a vital format for continuing care through a global pandemic. This was true for therapists who have practiced for many years and graduate students alike, the latter of which ushered a new cohort of therapists who are more familiar with virtual than in-person therapy. 

As we begin to move towards in-person interactions, many therapists are considering a hybrid model for offering services: some in-person sessions and some virtual sessions. Others are shifting their caseload entirely back to in-person and a new wave of therapists are making their practice completely virtual. Of course, as essential workers, some therapists never stopped offering in-person sessions throughout the pandemic for various reasons. 

Given the coronavirus (COVID-19) safety concerns that led to the large-scale shift to virtual sessions in the first place, safety is at the forefront of these decisions. Both client and therapist will be choosing how to meet based on a series of delicate, informed, and consent based conversations. Since consent is an ongoing process, what is decided on at one point in the therapy may be changed later on. This means starting therapy virtually or in-person does not guarantee that the format will be the same throughout treatment. Should clients prefer a different option than what their therapist can offer, alternative options, such as making a referral to another clinician, may be discussed. 

The option for continued access to phone and video sessions in Illinois, beyond the initial Executive Order, has been made possible for therapists and clients alike by Illinois House Bill 3308/Senate Committee Amendment 1. This Bill, signed into law by Governor JB Pritzker on July 22nd 2021, was achieved after a hard fight by therapists, other health professionals, politicians, and organizations during the prior month. The Bill, referred to as the Telehealth Act, ensures several protections to clients and providers, including the following: 

  1. Bars insurers from requiring patients to prove a hardship or access barrier in order to receive healthcare services through telehealth.

  2. Prohibits geographic or facility restrictions on telehealth services, allowing patients to be treated via telehealth in their home.

  3. Protects patient preference by establishing that a patient cannot be required to use telehealth services.

  4. Ensures patients will not be required to use a separate panel of providers or professionals to receive telehealth services.

  5. Aligns telehealth practice with privacy laws for in-person practice, while giving healthcare professionals the latitude to determine the appropriateness of specific sites and technology platforms for telehealth services.

  6. Aligns telehealth coverage and payment with in-person care, making appropriate patient access to care the priority and removing harmful barriers that shift costs to the patient and healthcare professional.

As Governor JB Pritzker proudly stated during the public signing, "The legislation I'll sign today will solidify Illinois as a leader in telehealth access and expansion in the nation… Illinois is now one of the first states in the nation to turn our emergency pandemic response into a permanent reality….We are taking great strides to make sure that where you live no longer impacts how long you live. Thanks to this new law, we are one step closer to that reality today."

The continuation of phone and video sessions still comes with a number of risks and benefits. A client signs-off on these items when they begin meeting with their therapist virtually: they understand that virtual therapy helps with accessibility and consistency of care, but can cause issues with building a connection with their therapist due to technological glitches and being in separate physical locations. For some, virtual therapy is the ideal way to attend therapy, for others it’s a temporary or as-needed format, and there are those who find it prohibitive of progress. All of these experiences are valid, and ideally a conversation to be held collaboratively with one’s therapist when deciding to begin or continue sessions with them in-person or virtually.

Along with health safety considerations, such as mask and social distancing guidelines and COVID-19 vaccination status, below are some additional considerations to include when making a decision: 


Consider how you will implement before and after therapy rituals. 

  • Will you have time before and after your session (even just 5-10 minutes) to shift your focus from whatever you were doing prior to therapy or from therapy to the tasks you will need to focus on afterwards? 

    • Much like a walk to your car or the bus after an in-person session, virtual sessions benefit from a brief pause before and after. 

  • Are there certain activities that you have found or might find useful to make time for before or after sessions? 

    • Examples of this are journaling, taking a walk, having a bite to eat or drink of water, etc. 

  • If needed, are there ways you can advocate at work for a specific time of the day to schedule your session?

    • For those who use shared or team scheduling applications at work, make sure to block-off your session time so that others cannot double book your schedule. It's also worth considering adding in a few minute buffer that will help you make the transition in and out of therapy. Therapy is different from work meetings and requires particular intention on how you want to be present for that time. 

  • If you schedule a session during your lunch break, will you still have time in the day to nourish your body? 

    • Consider choosing another time of the day, such as the time before or after taking your lunch or the start or end of your work day, and adjusting your work hours as needed. You and your therapist may be comfortable with a small snack, but large meals can interfere with communication. 


Consider where the therapy will occur.  

  • Are you able to find a spot that is non-work related to minimize distractions? 

    • If you’re at an office space, consider scheduling available conference rooms or (safety and weather permitting) attending from your car. 

  • Will this location be consistent each week?

  • Will this spot offer adequate internet or phone connection? 


Consider how to prepare for the sessions.

  • Have you identified how to turn-off notifications on your phone or computer? 

    • Similar to being in the therapy room, phones ringing and text dinging can disengage you from your thought or emotional process.  

  • If you’re at home or at your office, are there ways to remove distractions around you that might interfere with the content you want to focus on in the session?

  • Are there things you might need to prepare for the session, such as a particular journal, art supplies, pillow, or glass of water? 

  • If privacy is an issue, are you comfortable using the chat feature on the video software to communicate sensitive information to your therapist?

  • If the client is younger or needs support with technology, is there someone available to assist them before, during, and after the session? 


Considerations for couple and family sessions.

  • Are you able to arrange the room so that everyone can view each other?

    • Don't worry too much about looking at the computer (and your therapist) throughout your session, what’s most important is connecting with those in the room with you. This means you can arrange your chairs with each other versus the computer in mind. Just make sure your therapist can see and hear everyone in the room.

  • Are you open to considering a hybrid option for therapy, such as some sessions in-person and some sessions virtual? 

  • Conversations about the experience of virtual therapy are ongoing, even after you decide you can change your mind. What is the structure that you and your therapist can agree on for continuing to check-in on how the chosen format is working?

    • An example would be at the end of each month starting the session by discussing how the virtual, in-person, or hybrid therapy experience has helped or inhibited progress in your goals and relationship building with your therapist. 


For more clarification on the myths versus facts of telehealth see the resource located here. Please note that the state location of both the client and therapist must be considered. Your therapist must be licensed in the state you permanently reside. If you are temporarily visiting another state while meeting with your therapist virtually, be sure you review their current telehealth laws (here is one resource to find that information). Clients cannot be required to meet with therapists virtually, however your current or intended therapist may not be offering in-person sessions at this time and a referral would be necessary. Verify coverage and benefits with your specific insurance plan before beginning telehealth treatment with your therapist. 

Photo by Sora Shimazaki from Pexels

Worry Is As Worry Does: Making Peace with Anxiety

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Worry Is As Worry Does: Making Peace with Anxiety

By: Taylor Pettway, LMFT

A few years ago and for the first time in my life, someone looked me in my eyes and told me that I was displaying signs of anxiety. I was incensed to say the least. I repeatedly replayed the incident in my head, attempting to decipher at just what point she had me confused with someone else. Every day for the next seven days, I looped over and over again into various crevices of this rupture of our relationship. I heavily weighed the idea of no longer sharing intimate details about my plans for the future or dating or grief about my mother. I reimagined every conversation that I had had with her to find evidence of her predetermined plot to diagnosis me. I planned out tactfully how to address yet another microaggression. The day I saw her again, I climbed atop my soapbox and threw down all the reasons that it was misinformed to attribute anxiety to Black folks who have legitimate reasons to be more than cautious, that we had suffered enough mislabeling and marginalization to gather yet another label, and that I was worried, not anxious. Not only did I have no idea that the signs I was experiencing were anxiety, I was even more clueless that the very process that I had crawled through to invalidate her label of anxiety for me was, in fact, the quintessence of it.

It is easy to think that what you’re experiencing is a normal thing or the way everybody does it, and worry is easily one of those parts of life that can fall into one of those categories. Maybe yours looks like replaying each of your social interactions to assess where you could have acted differently. Maybe it’s to-do lists and color-coded calendars and Apple watch notifications, or maybe you’re up at three a.m. working most nights because the ideas and the plans and the hopes and the dreams will not rest. While these instances and many more can start off harmless and as natural worries and defenses against danger, the slope from worry to anxiety is a slippery one, tattered with days and weeks of ruminating and distress in other areas of your life, such as work, school, your relationships, and the like. Now, let me be clear: this is not meant to diagnosis you or for you to diagnosis someone else. The tools below are meant to support all of us in taking better care of our worries BEFORE they start taking from you.

  1. Say (and See) the Words Out Loud

    For both your self-critique and your self-compassion, there is power in talking to yourself out loud (you know, that thing we all do already). In fact, when you speak all those thoughts and feelings that run on loop in your head, they lose some of their power because your brain just realizes, “Oh! This actually doesn’t make any sense,” or your heart says, “Nope. We’ve done that work already. This just simply isn’t true.” By speaking the compassion to yourself out loud, such as “You did the best you could today” and “You really are great out here and taking care of yourself and loving on you”, you emPOWER yourself. Journal if that’s better for you. Simple activities, such as stream of consciousness writing where you literally write down everything that comes to mind, can have a big impact in showing you what really may be causing your anxiousness. You will be able to see these very real thoughts of yours on paper and can make better connections about what is really going on for you.

  2. Track Your Thoughts

    Connecting situations to their subsequent thoughts and emotions can help you replace those negative thoughts. By inserting more realistic and informed reflections, you place yourself on the road to literally rebuilding the way you think about yourself, others, and the world. The process of completing a thought record (found here) has the potential to become a mental exercise that you do when worry begins to creep into your life. You’re welcome to try this tool on your own, and if you have questions, I definitely suggest getting connected to a professional for more guidance (reach out to me, and I’d love to connect you with some good healers).

  3. Soothe, Don’t Distract

    Binging shows, reading, making wigs, playing 2K, baking… no matter the tool, the wealth is in HOW you actually use them versus what the activity really is. If you say to yourself (out loud, don’t forget), “I’m going to go home, and I’m going to watch four episodes of my favorite show because my mind is racing and I want to relax,” you are using your tool to soothe. If your favorite streaming service’s infamous “Are You Still Watching?” screen pops up for the fifth time and after 10 episodes of your show, you could be distracting. Have you ever been aimlessly scrolling Twitter, check your feelings temperature, and realize you are feeling emotions that you are not sure of the origin? You could be distracting. Is it after work and you say “Hmm… I’m going to check my Instagram feed for 30 minutes, see what happened in the world today, have a few laughs?” This is more soothing. You set a time. You set an intention. 

Anxiety is a very real phenomenon and can be debilitating, if left denied, unchecked, and unacknowledged. We deserve to speak life to our experiences so that we can both connect with others and get the help that we need. If you are losing sleep, fatigued often, restless, having difficulty concentrating, constantly overthinking situations or perceiving wrongdoings, AND all of these symptoms are causing some actual real deal stress in showing up to your life, I am proud of you for getting this far. You deserve to show up for what you are feeling, call it by name, and learn to manage. We need you, and we need your mind. Take care of you. Anxiety truly does happen to the best of us.

Why Am I Still Feeling Anxious if the Pandemic is Winding Down?

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Why Am I Still Feeling Anxious if The Pandemic is Winding Down?

By: Emily Gabelman, LMFT

It’s finally here! Most of the United States population is vaccinated. We can go mask-less in most situations. Businesses are opening up. People are getting together in person again. Hooray!! It’s what we’ve been waiting for! But wait…something feels off. You’re not experiencing the relief and joy you were expecting. You still wear or consider wearing a mask even in situations deemed by experts as not necessary. You still get an automatic stress reaction when people get too close to you. When questioned about this, you aren’t really sure of your reasoning. You just don’t feel quite ready.

Even if you are enjoying the return to normalcy and the most prominent emotions are relief and joy, you still have fleeting thoughts of worry cross your mind. “That person isn’t wearing a mask! Oh wait, I’m vaccinated and they probably are too…this feels really strange being around all these people, what if I get sick? Oh wait, I shouldn’t worry about that...Experts say this is okay, but is it really? It feels scary still.” These thoughts are then paired with a mild yet pesky and lingering feeling of nervousness and hyper-vigilance. You feel confused by these reactions. CDC says this is safe right? The vaccines have been thoroughly researched and proven effective, right? So why do I feel this way?

Before going further, let’s be clear that despite my use of the past tense, I am by no means implying that this pandemic is completely over. Vaccines are not 100% effective, some communities have low vaccination rates due to systemic barriers, there are still unknowns about some new variants, etc. The past tense simply refers to pre-vaccine and when numbers were higher. Also, this post is strictly talking about the United States as there are many nations at the peak of the crisis (links to help are at the bottom). We must maintain an appropriate level of caution and continue to do what we can to fight the spread in the communities and nations that desperately need it.

That being said, for those of us fortunate enough to have access to vaccines and live in communities where numbers are low, here is what we know. The CDC says, in non-healthcare settings, we can (1) resume activities without a mask and distancing unless required by law, (2) resume domestic travel with no testing or self-quarantine before and after, (3) leave the country without being tested unless required by the destination and refrain from self-quarantine upon coming back, (4) refrain from testing and quarantine after a known exposure unless showing symptoms or in specific settings, (5) refrain from routine screening testing (CDC, 2021).

This is great news! So why are many of us still feeling anxious, worried, hyper-vigilant, or uneasy? Well, it’s simple. This past year and a half has been nothing but trauma. Some people had a severe case of COVID, some had a mild case they were scared would turn into a severe case, some had someone close to them suffer or pass away from COVID, some were frontline workers and suffered vicarious trauma, some had to comfort friends and family who lost someone due to COVID, etc. Trauma trauma trauma.

Even if you were fortunate enough to experience none of the above, we all had the daily threat of a deadly disease. We had to be on guard at all times. Every time we left the house; every time those in our household left the house; every time we calculated risk; every time we coughed, felt more tired than normal, or had a headache; every time someone we care about informed us they were exposed to COVID, we experienced a spike in our cortisol levels and the survival centers of our brains lit up.

This happened repeatedly. Every single time you stepped outside- cortisol levels through the roof. Every second you waited for an update on your sick loved one- cortisol levels are out of control. Every patient you treated, every news update, those 3-5 days you had to wait to get test results- yes, those adrenal glands were hard at work releasing that cortisol. 

So now bring us to June 2021 and life is starting to resemble normalcy. Our sympathetic nervous system, however, didn’t get the memo. In fact, those adrenal glands are so used to releasing nonstop cortisol for a year and a half that they are too worked up to even read and comprehend the memo. The frontal lobe (rational, planning center of our brains) is trying so hard to tell the sympathetic nervous system it can stop; but it can’t seem to stop. It’s been taught that people coming close to us, lack of masks, mild cough and headache, groups of people, etc. are threats that we need to be protected from. And at this point, it doesn’t remember any other way.

So that sympathetic nervous system is still hard at work, doing its thing, trying to keep us safe. It so badly wants to keep us safe that it’s still telling us there is a high level of threat to our safety, even when our frontal lobes objectively know that the threat is much lower.

You may be reading this thinking, “this doesn’t sound like me.” Of course, not everyone was affected this way, as everyone’s nervous system is different and everyone was affected by COVID differently. Some of you, however, may be fully identifying with this; and even find this trauma response to be debilitating or have a significant impact on your life. This is because the trauma reactions can become full-blown Post Traumatic Stress Disorder.

PTSD is an often debilitating disorder following a traumatic experience. The DSM-5 has a long list of symptoms, including intrusive thoughts, dissociative reactions, psychological and physiological distress when reminded of event, avoidance of reminders and triggers, negative beliefs of oneself, persistent negative emotional state, reckless behaviors, hypervigilance, etc. (DSM-5, 2013). This list does not even scratch the surface of the ways PTSD can affect a person and the impact it can have on a person’s life.

A recent study conducted in Italy found that 30 percent of participants (note the racial and cultural bias, as all participants were Italian and White) with severe COVID cases developed PTSD (Janiri, et al., 2021). A meta-analysis found that 21.5 percent of frontline healthcare workers now have PTSD (Li., et al., 2021). Many of those with loved ones who suffered from or passed away from COVID have also developed the disorder. Being forced to stay home has also created a situation where domestic abusers have more access to those they abuse, causing at least an 8.1 percent increase in domestic violence (Rodiguez, 2021). This also can cause PTSD. That’s a whole lot of people who now walk around in their day to day lives with a serious mental illness they didn’t have before.

Ideally, society would be prepared for this influx in trauma-related mental health issues, and we would have easy and affordable access to care. Unfortunately, that is not the case. Therapists are swamped (not to mention our own vicarious trauma, but that’s a conversation for another day). Our healthcare system doesn’t allow for mental healthcare to be accessible for everyone, especially after the financial impact of the pandemic. We also weren’t trained in treating pandemic-related trauma, as we never in a million years thought it would be something we’d be doing. 

So what do we do? Let’s go back to the sympathetic nervous system. Right now, we’re stuck in that hypervigilant state where our sympathetic nervous system is screaming “danger!” and our frontal lobes are saying “no, we’re safe!” and they can’t seem to come to an agreement. But the frontal lobe has a few tricks up its sleeve! Sisters Emily and Amelia Nagoski discuss in their book, Burnout, ways to complete the “stress response cycle.” Basically, this means to tell the sympathetic nervous system to chill out and help the adrenal glands release less cortisol. Learn more about the stress response cycle here.   

The Nagoski sisters emphasize that moderate to intense exercise is the most efficient way to complete the stress response cycle. They recommend 20-60 minutes per day. Other ways to complete the cycle include:

  • Physical activity- Even if it’s not an intense workout or run, just moving your body can help.

  • Breathing techniques- There are many breathing techniques involving counted breaths and breathing from your diaphragm.

  • Positive social interaction- This can be with friends and family, or just having small talk with someone in an elevator. Even something as simple as telling someone to have a nice day can help complete the cycle.

  • Laughter- Laughter in general is good, but laughing with people we like is even better.

  • Affection- This should be from someone who cares about and respects you, and who you care about and respect. The Nagoski sisters mention John Gottman’s six-second kiss and the twenty second hug.

  • Crying- Watch a sad movie, search “videos to make you cry,” on YouTube, whatever gets the tears rolling.

  • Creative expression- This includes painting, drawing, music, theater, creative writing, etc.

These are activities you can do on your own that physiologically are shown to help cope with traumatic stress reactions. But despite what I said earlier about therapists being swamped, don’t assume professional help is not an option. If you have the means, there are plenty of resources for finding a therapist, such as Therapy Den, Psychology Today, BetterHelp, or just word of mouth. Chicago Center for Relationship Counseling is currently taking new clients at a reduced rate at the Phoenix Clinic.

Lastly, as mentioned previously, the pandemic is not over. It is not over in the United States, and certainly not over globally. Specifically, India and Nepal need our help. You can donate through the COVID-19 Solidarity Response Fund, Project Hope, Give2Asia, and AID (Association for India’s Development).

 

Sources:

https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2776722

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0246454

https://www.globalcitizen.org/en/content/domestic-violence-covid-19-increase-us-ncccj-study/

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated-guidance.html

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition: DSM V, 2013

Burnout, Emily and Amelia Nagoski, 2019

Cover Photo by Anna Shvets from Pexels


Democracy and Identity in America

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Democracy and Identity in America

By: Josh Hetherington, LMFT

I was never very interested in history as a high school and college student. It was always presented in a rather boring way. In retrospect, American History seems like it was offered to me as something that I shouldn’t look too closely at. I came into adulthood thinking about Washington, Jefferson, Madison and Franklin, and much later Hamilton, as these enlightened, pro-people, revolutionaries. They started a revolution for the common man- even though I always understood it was the common white man- and by man, they definitely didn’t mean women.

They wrote, “…all men are created equal.” We fought the British for this idea and for freedom, right?

That was an unquestioned part of my identity as an American up until very recently. Maybe it’s because of my age, maybe I was paying much closer attention to our system as Donald Trump worked to push it toward a totalitarian dictatorship, maybe it’s because of the Black Lives Matter movement and Anti Racism, maybe it’s because our country is finally starting to talk more about its past in an attempt to repair deep damage done. I don’t know why it’s happening now, but I am hearing more and more about the true beliefs of America’s founding fathers, and their purposefully controlling design of our allegedly democratic system. This new information - undeniable documentation from their own writing - is affecting me and I wonder if it’s affecting others who come across it.

These ideas about our democracy are well laid out in Scene on Radio, Season 4. I highly recommend it! Specifically, the story about the British Proclamation of 1763. George Washington was a British soldier, fighting against the French and Indigenous folks on the American Frontier, in what is now Ohio and Pennsylvania. The British promised to pay him and other prominent generals in land that they captured. This was, of course, indigenous land. Once these wars were over the British declared that they would not pay the general in land. They had determined that taking land from the indigenous people would destabilize the region and make it easy for the French and the Spanish to return and take it back. So they told the wealthy general that he wasn’t going to be paid in land after all. This outraged General Washington. He was an aspiring oligarch at the time and wanted to expand his land holdings. He didn’t think that the common people should have the right to vote. He wasn’t interested in Enlightenment ideas about the common man. He just wanted to get paid. This was the main reason he decided to enter the revolution. Once we won the Revolutionary War, he was free to collect his land from the indigenous people and to sell it off. And all the while, he was using slave labor at his plantation.

So, now, my identity as an American is shifting. I see us as living in an oligarchy that was planned from the start. We were not meant to be purely democratic. We are not the world’s greatest democracy.  I have been lied to, or I have been a poor student. It’s time to question all of my beliefs about the system I live in. Are you ready to question these ideas and make a change?

It turns out striving for true democracy is a lot of hard work. Paying attention to how our government treats our most vulnerable citizens is a responsibility that I’m starting to take more seriously. It doesn’t just happen. Voting rights are at risk in many states. But there are opportunities to step forward, and work to make changes happen. There are groups you can join. There are local politicians who are trying to make something different happen. There are organizations looking for volunteers and donations. If we don’t work at it, we won’t get it.

Who are you and who do you want to be?

An Offering to The Age-Old Question: "...But What Do I Do?" 

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An Offering to The Age-Old Question: "...But What Do I Do?"

By: Madalyn Simpson, MFT

Several times a week I am met with the age-old question: “Okay, Madalyn, but… what do I DO?” And while I hope to remind my amazing clients of how profoundly resilient and capable they are in these distressing, helpless, uncertain moments, I also absolutely understand where this question comes from. What feeds our desire for clarity and direction more than uncertainty, fear, and distress? These moments often send us ping-ponging between feeling as though we have zero options in front of us or too many options to make sense of, with no clear direction either way. If you’ve ever found yourself in this space, wondering “What the hell do I do with this?” or “Well what now??”- I offer you DBT’s 5 Options in Distress.

Created in the 1980’s by researcher Dr. Marsha Linehan, Dialectical Behavior Therapy offers a skills-based, behavioral approach to the topics of mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. DBT’s 5 Options in Distress (in some handbooks referred to as 4 options), provides a framework to explore with curiosity and compassion: 1) What options feel the most familiar to me when in distress? and 2) What other options are at my disposal and may be more value-aligned long-term? It is human to feel as though we have no choice or power in moments of distress, AND ultimately YOU get to choose how you respond. So what are these options? Let’s use the (perhaps all too familiar) example of your internet crashing amidst a busy work day to follow what this may look like! 

  1. Solve the Problem- If there is an option for a quick solve, making the problem disappear- go for it! Marsha likes to explain, if you fall in a pool full of sharks, and there’s a ladder out of the pool, climb the ladder! The tricky part here is that as humans we typically are skilled at intuitively solving the solvable problems in front of us, and thus they do not cause us as much distress. If this is an option in your current situation, great! But if not, we have other options for you! 

    • Example: Turn the internet back on. 

  2. Change my Perspective- We often get fused to our initial perspective, which can blind us to more effective ways to interact with the problem at hand. And what we know about perspective/thoughts is that how we interpret a situation hugely impacts the emotions, behaviors, and physical sensations that follow. First, identify your immediate perspective. Then ask yourself- how else could I interpret this? Come up with as many as possible! 

    • Expert tip- The goal here is to practice cognitive flexibility- even if you don’t completely buy into your other interpretations. There is value in expanding our awareness of what other interpretations may offer us, even if we still notice resistance here. 

    • Example- Initial interpretation- “This sucks, I’m doomed.” Other possible interpretations- An opportunity to take a break from staring at a screen. A moment of rest for my eyes. An opportunity to be more present with the sensory experience around me. A moment of pause from my routine. A moment to reflect with gratitude on all the times my internet works! 

  3. Radical Acceptance- The practice of radical acceptance is a complex skill all in itself, which I would encourage digging into. RA involves radically turning the mind towards acceptance of the reality in front of us- both the things we like and don’t like, the things we can control and can’t control. Acceptance does not mean that we agree with, condone, or like this reality. This is not an act of submission or throwing our hands in the air, rather its a commitment to working within the present reality rather than against it. Once we have radically accepted the reality in front of us, we open ourselves up to change within the pieces of our situation that we can control. 

    • Example- I turn my mind towards the reality that my internet is out, with no current way to fix it. What CAN I control? I could… call my internet provider for assistance? Hop over to the local coffee shop/a friend’s house to use their internet? Ask for an extension on the work I was doing? Take a break for an hour to soothe my distress (Warm shower! Hot cup of tea! Walk around the block! Stretch my body!), and see if the internet works again after that? Call a friend for support through my distress? 

  4. Do nothing- We always have this option. There may be days we need to take this option- we’re human. AND often we notice that taking this option actually passively moves us into option number 5, making the situation worse or even creating new problems 

    • Example- Ignore the problem completely, do not finish what I was working on or fix the internet. Sit and ruminate on the problem. 

  5. Make the situation worse- I’m sure we can all get creative with what this may look like for us, and I want to offer a non judgmental perspective here! When we are in distress, maybe especially heightened distress, we are often looking for a quick, short-term relief because of the discomfort of whatever it is we’re feeling. Numbing, escaping, lashing out, etc. may offer us that exact momentary relief or catharsis that we so desperately desire, so we can offer ourselves compassion for the moments that we have leaned into this option. AND, this option often takes us even farther away from our goals and values, creating even more long-term distress. 

    • Example- Break my computer. Shout at my partner or the internet customer service agent. Numb my distress with substances or screen time. Give up on my work completely. 

As someone whose job depends on reliable internet, this example hits close to home. AND, let’s expand this framework to our relational self-awareness- which option feels most familiar to me when confronted with challenges in my relationships? What feels familiar when in conflict with my partner? What feels familiar when I fear I’ve let down those around me? What might it look like to shift my approach and consider my other options? Let’s return to the question at hand- what do I DO? DBT’s 5 options provide a framework to help build insight into past behavior, tap into our own choice and agency in even the moments that feel the most out of our control, and build intentionality by taking a beat to consider our options before reacting. Next time you’re feeling stuck, I invite you to ask yourself what it might look like to follow through with each of these options? Which may be the most effective or value-aligned in this moment, and what might it look like to take one step in that direction- even if that first step is to stay put, take a deep breath, and offer yourself some compassion for tolerating a painful moment. 

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Linehan, M. M. (2015). DBT® skills training manual (2nd ed.). Guilford Press.

Rathus, J. H., & Miller, A. L. (2015). DBT®skills manual for adolescents. Guilford Press.

Pregnant & Post-Partum in COVID: A Therapist’s Journey

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Pregnant & post-partum in COVID: A therapist’s journey

By: Shira Galston, LMFT

There are already tons of posts out there about the specific difficulties and issues that come with being pregnant, delivering, and going through post-partum during this pandemic. I certainly don’t want to be repetitive, and I hope this won’t be. Rather, I want to come at this topic from the perspective of therapist who is going through this herself, to give a glimpse into what goes through my head during this time, given my professional knowledge and experience.

We therapists have been through a lot with this pandemic – trying our best to be there for our clients while experiencing many of the same problems, fears, and pain that the rest of the population is going through, all while being there emotionally for our families and ourselves at the same time. Everyone has their own trials in this, and there is no way to compare the pain of total isolation living on your own with the pain of supporting a large family in quarantine, or the fear of being immunocompromised with the fear of never getting to hug your parents again. I am in no way trying to put my own struggles up against others’, nor am I saying that my experience has been particularly unique or hard compared to anyone else’s. But it has been mine, and thus, it’s what I can write about. So, with all of that disclaiming aside, here goes.

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We found out we were expecting back in March. After about 6 months of feeling “ready” but still holding off, waiting until it felt like “just the right time” for our family, ensuring that our three sons seemed stable emotionally and that our marriage was in a strong enough place to handle a fourth, we finally pulled the trigger and began trying. We had heard about a virus across the oceans, but it still seemed so far away, certainly not anything that should impact our family planning. It happened quick, and a month later, there was that second line on the test. Joy!

10 days later, the state shut down the schools.

We were terrified. We had no clue how the virus could affect the pregnancy, no clue how we would weather my own physical illness during those early months while simultaneously caring for three boys ages 7-and-under at home with us, no clue how the epidemic would progress and whether we would be able to have any help along the way, no clue about anything. It was just plain scary. In the face of the unknown, we tried our best to think positive, to believe that G-d runs the show, to break the news to our families with a chuckle about best laid plans, and to be there for one another through anxiety, exhaustion, and nausea.

Those first couple of months were an interesting study in private vs. public spheres. We don’t generally tell anyone we’re expecting until we’re past the first trimester, and this time that secrecy only amplified the sense of isolation and loneliness of quarantine. While the world out there was falling apart and thousands were dying, we holed up in our family quarantine, knowing that new life was slowly but surely growing within. It was a comfort and a terror, all at once. We told people sooner than we normally do, just to feel some connection to others in our experience. We made our private world that much more public to stave off the disconnection. We tried to welcome some of the outside in, through zoom and facetime and other such apps, even as we kept a hard line of physical separation from others. We tried to celebrate our news with our loved ones; mostly, it just fell flat in translation over screens and through the noise of the rest of the news going on around us all. At least, that’s how it felt to me.

Through months of uncertainty, isolation, and fear, we both kept working, our kids kept kidding, and the baby kept growing. I went to prenatal appointments alone, sorely missing that moment when we both get to hear the heartbeat for the first time, or get to see the baby on the ultrasound screen, searching for blurry hints of our noses, lips, and chins. My belly grew bigger and bigger, which no one ever really got to see or comment on with a smile. It was sad to be alone and hard to move through those months with so much darkness around us, but I remained appreciative of what we had been given, knowing so many others who have difficulty getting pregnant at all. At least, I tried to.

As a therapist, I knew about the importance of my relationships during times of trauma, transition, and uncertainty. I tried my very best to nurture them as best I could; to stay on zoom with friends and family, to plan “date nights” at home with my husband, to give each of my kids personal attention. But I must admit, as the months wore on, none of this stuck. The zoom calls happened less and less often, the date nights disappeared into the sheer monotony of watching Netflix in exhaustion each evening, and the kids suffered from a tired pregnant mom who just wanted some peace and quiet rather than play yet another round of superheroes in the basement with them. Basically, I failed. Or, I felt like I did. The therapist in me knows exactly what I would say to a client in my place: “Of course you feel that way. It’s normal. It’s hard. It’s exhausting. No one can be perfect, and the imperfections themselves are gifts to your children, you’re teaching them resilience. Self care, self care, self care, SELF CARE, damnit!!!! I see you. I get you. You’re not a failure, you’re a human. Etc. etc. etc.” But does any of that work when you say it to yourself? It should; that’s what self-soothing is, after all, and a healthy mature adult needs to develop that skill in order to function. But it of course never works well enough to stave off the underlying feeling completely; there’s always that voice saying, “well, if you had pushed a bit harder…” If I had only pushed harder, I would’ve been a better mom, a better wife, a better person.

Throughout this time, we were blessed to have help; we went months without any backup at all at first, but eventually we were able to welcome back our sitter to help out with the kids, which made a huge difference and allowed us to actually get some real work (or sleep) accomplished. But then, when it came to planning for the birth, we were at a loss. Every other time we’ve relied on family and friends quite easily to watch the other kids for us while we went off to the hospital at a moment’s notice; we had our village, and we gratefully called upon it. This time, family was out of the question as they all live COVID-impossible flights away, and friends would be a much more complicated endeavor in terms of safety for all involved. We tried our best to figure out a plan, and some incredible neighbors and friends did come through for us in the end, jumping in to help with the kids at the last minute and giving us a sense of peace as we made our way to the hospital. They literally risked their own health and lives to support us. I will be forever grateful to them for that, even as I mourn not having the comfort of my own family around.  

I won’t go into the details of labor and delivery; suffice it to say, it wasn’t the smoothest of experiences. All in all, I’m thankful my husband could be there with me, thankful I could go through (most of it) without having to keep my mask on, and thankful for a healthy and happy baby at the end. No visitors at the hospital: another tough one. No kids allowed to come and meet their baby sister, no grandparents to come hold their first granddaughter. I was overjoyed to have my baby, and I felt guilty for feeling any sadness at all over these lacks; but there it was. I was sad. And ashamed for the sad.

Homecoming was really nice; getting to see my sons again after a couple of days away, and see their joy in welcoming home their new sister was one of the best moments of this entire experience. Unfortunately, it was quickly followed by the hardest part of all: post-partum in COVID.

Post-partum in COVID means no one to come and gush over your newborn with you. Post-partum in COVID means your mom can’t be there to hold you when you’re feeling the baby blues. Post-partum in COVID means you can’t show anyone the milestones, the outfits, the latest thing the baby started doing today. It means taking endless photos to send off to family and friends, followed by the endless fear and shame of being judged for over-sharing, or coming across as annoying or too baby-focused while the world has more important things to tend to, like elections and insurrections and new presidents. Post-partum in COVID means that the exhaustion and pain of recovery must be weathered all alone, just me and my husband, my incredible, selfless, strong, resilient, overworked and underappreciated partner in life who would go to the ends of the Earth and to the limits of his own physical and emotional strength to provide for me and our family. No one else is here to take some of the burden, pick up some of the slack. Life still goes on with a new baby in the house; kids need to get off to school (thankfully ours was still in-person, though it’s been on and off, with weeks at a time of everyone at home at once,) and meals still need to be shopped for and cooked and served and cleaned up, and work still needs to get done, all on only a few hours of sleep and an infant crying to be fed every couple of hours. And honestly, most of that work was and still is being done by my husband. I’ll never be able to thank him enough for everything he does. And the guilt over that is hard, too. Seeing him so tired and overwhelmed, knowing it’s because I can’t do as much as he can right now, is painful. And I’m sure he can’t help but feel some resentment, even as he knows it’s not my fault. As a couple’s therapist, I know this dynamic well. And I know that communicating about it is essential, so we try to do that as often as we can. But it’s never enough. And the tension ebbs and flows between us as the weeks bear on.

Post-partum in COVID means appreciating the strength of my marriage and everything my partner does for me, more than ever before.

Post-partum in COVID means crying alone in the shower so that your family doesn’t have to deal with your whining about loneliness yet again. It means missing out on celebrating and connecting with others over one of life’s greatest joys. It means feeling guilt and shame for your sadness because others are suffering more. It means missing your parents and siblings more than ever before. It means their missing out on moments with your infant that they can never get back. It means accepting help from wherever it is offered, even as you hold your breath (literally) in fear of spreading the virus further all due to your own selfishness and desire for support. It means pinching yourself to remind yourself how good you have it, to snap out of the sadness and back into reality, to look at your baby and recognize the miracle of life in these times filled with so much death.

 So here we are, two months out. We are so very blessed. Our family is functioning, and we have the privilege and means to have paid help in our home thanks to our incredibly generous and loving parents. They’ve found a way to be here for us, even across the miles, and it has made such a difference.

I realize how incredibly privileged I am. I know that countless others are going through this without any help at all, without friends or family to support them even from afar, without a partner, without even their health. Thousands have died, or are sustaining long-term complications from the virus. Millions can’t conceive or carry a baby to term, regardless of the pandemic. I have no right to complain about any of this. And yet, here I am, writing it down, publishing it even. Like I said at the outset, I know that we can never compare struggles, and that each person’s difficulties are legitimate and valid and real. I know that, and I tell my clients that all the time.

Still, part of me has a hard time believing my struggles are legitimate. It just feels so petty and small compared to what others are facing. So perhaps that’s part of why I’m writing this. To give a small voice to those struggles that feel too small to express, yet are painful enough to cause damage if left unspoken. To make space for other women to do the same. To let everyone know that therapists struggle with the same things you do, that even as we know the “right” way to approach these difficulties, we still fail, often. And that’s ok. We’re all ok. We’re all going to be ok.

10 Minute Adventure

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10 Minute Adventure

By: Laura Hagen, AMFT

We find ourselves in the doldrums of a particularly dreary Chicago winter.  There is little refuge, and we are positively exhausted from a year of, well, y’know. It feels like the world has shrunk, and the path back to a semblance of “normal” is yet unclear.  In the next 10 minutes, I want to help you find a moment of respite.  In order to do this, we’ll need to call upon an old friend that you may not have spoken with in a while: your imagination.  And not the part of your imagination that pictures everything that could go wrong, that part gets enough practice.  We want the part of your imagination that hearkens back to your childhood, the fantastical part, the part that used to take you on adventures as you gazed out the window in math class.  

It may seem frivolous or mistuned to the reality around us to start daydreaming, but the reality we are in right now is exactly what makes it crucial to allow our minds to take us elsewhere, if only for a brief time.  If you’re anything like me, you could probably use a healthy dose of hope right about now.  The founder of positive psychology, Martin Seligman, was recently interviewed by the New York Times; he spoke about how daydreaming fosters optimism, resilience, and hope (all of those beautiful, currently depleted qualities).  A recent brain imaging study shows that when we imagine a perceived threat, our brains and bodies respond similarly as they would if the threat were happening in real life.  If we take a bit of a leap, then, it seems reasonable to expect that our brains and bodies respond similarly when we imagine positive experiences, as to when we actually have them.  Hopefully now with a bit of buy-in on your end, I can show you what this feels like, you just have to promise you’ll give it an honest shot.  

Somewhere

If you could be anywhere on earth, where would you be?  Perhaps somewhere you had planned a vacation to that got canceled this year.  Maybe a locale from cherished childhood memories.  Or even somewhere that you completely make up yourself-- a place of impossibly dramatic sweeping mountain views or infinite rolling hills of wildflowers.  Picture this place.  

  1. First, what do you see?  Close your eyes, breathe deeply, and imagine. 

  2. What do you hear?  Maybe there are birds flying above, maybe there’s music playing, or waves crashing or people laughing… Add in these details as you close your eyes and imagine again.

  3. What do you smell? Maybe it’s the scent of fresh-cut grass, or lilac bushes, or freshly baked bread or summer rain on hot pavement.... Add these in…

  4. What do you feel?  Maybe there’s sunshine on your face, or a light breeze through your hair, maybe it’s humid and the air is heavy and hot on your skin.... Add in these details, close your eyes, take deep breaths, and dream.  Sit quietly in your place and observe all of your sensations.  Stay a while.

Someone & Something

If you could be with anyone, doing anything, what would that be?  Perhaps with your partner (real or imagined) enjoying a romantic seafood dinner at a restaurant overlooking a balmy sunset on the Mediterranean.  Or maybe with a big group of your friends and thousands of strangers at a music festival, sweat dripping down your grinning face.  Maybe something as simple as being with your entire family at a backyard BBQ, hugging and laughing and lovingly making fun of each other.  

  1. What do you see? 

  2. What kind of sounds are you hearing? 

  3. What do you smell in the air around you?  Are you tasting anything?

  4. What do you feel?  Take note of the weather.  Notice if you are in contact with anyone.  How does their touch feel on your skin?  

  5. Combine all of these sensations, close your eyes, take deep breaths, and imagine.  Play out the day or the evening in your mind’s eye…

. . . 

Now that you’re back, tune into your body and notice any physical sensations or emotions that your imagination evoked.  Maybe there’s a sense of warmth, lightness, pleasure, or intimacy… there could also be some sadness or frustration that you’re not able to have those things right now.  That’s valid.  We’re not through the tunnel yet, but I can see a glimmer of light.  By allowing ourselves to imagine the joy that awaits at the end of the tunnel, we can buoy ourselves through the months to come.  While it’s not the real thing, your brain is in fact awe-inspiringly capable of conjuring the next best.  Next time you find your attention drifting from you in the middle of the afternoon… give yourself permission to dream again.  It’s time.    

Self-Compassion Playlist

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Self-Compassion Playlist

By: Teresa D’Astice, ALMFT

Over the years, music has provided me with a space for community, pleasure, and healing. Sharing playlists with my people, traveling for concerts, hosting a radio show, getting to know new artists, and singing in the car all bring me a sense of calm, presence, and connection. 

I’ve personally and vicariously experienced the healing that comes from engaging in an expressive art; these include, but are by no means limited to, painting, singing, writing, cooking, dancing, building, and theater. Being present in an activity helps us regulate our emotions; creative outlets that we enjoy help us to express the energy we feel internally.

2020 filled us with plenty of energy that needs release. I want to acknowledge that it has been particularly challenging to tap into self-compassion and presence at different points throughout this year. 

As we close out 2020 and move into 2021, I invite you to engage in a creative activity that brings you presence and healing. In the spirit of connection, I created a mini playlist of songs that help me tap into self-compassion, empowerment, and acceptance. As you listen to the songs, engage in your own expressive art, and enter the new year, my hope is that you find some peace, presence, and compassion within yourself. 

  1. Put Your Records On · Corinne Bailey Rae

  2. Borderline (An Ode to Self Care) · Solange ft. Q-Tip 

  3. Honey · Kehlani

  4. Keep Ya Head Up · Tupac Shakur 

  5. Self Care · Louis the Child ft. COIN

  6. Light On · Maggie Rogers

  7. Innocent Party · Jetty Bones

  8. Sarajevo · Watsky ft. Raquel Rodriguez

  9. Gold Steps · Neck Deep

  10. We Still Believe · Stick to Your Guns

Comfort in Discomfort

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Comfort in Discomfort

By: Angela Nguyen, AMFT

Humans are social beings; that's why solitary confinement's one of the harshest punishments. Even feeling ignored or unacknowledged in a romantic, platonic, or even work relationship can intensely affect us. Although this planet isn't filled entirely of criminals, we've found ourselves imprisoned in our own homes, held captive by the many current events that we have little to no control over. The majority of us, already juggling our own individual struggles, have found that the pandemic and other uncertainties to further exacerbate our stressors. So what now, besides basking in our doom and gloom? What is the meaning to life and humanity when we can't have physical social interaction?

Researchers Besser and Oishi proposes this concept of a “psychologically rich life” that humans can experience (Besser & Oishi, 2020). They define this concept as a life full of complexity and experiencing deep emotions, which would differ from a boring, monotonous life with routines and lack of depth in emotional experiences. Further studying this (Oishi et al., 2020), Oishi found that a lot of us actually prefer experiencing these difficulties in life for its role in enhancing the richness in our lives; and therefore, equating a “psychologically rich life” to be akin to a “good life.”

With the majority valuing the bumps; build ups; and life-threatening, bloodcurdling, heart-sinking, soul-crushing falls that come with this roller-coaster ride of a life (especially in contrast to those other scenic, slower rides), it would be beneficial for us to identify our safety belt, sunscreen, and ride rules to help us enjoy and appreciate the ride more. 

1.     Check in with and validate yourself.

When we're so accustomed to interacting and socializing with others, it's quite easy to forget that we also need to interact and socialize with ourselves too; we also have a relationship with ourselves after all. Making it a habit of talking to yourself like how you do with others would benefit you as you strengthen self-awareness and mindfulness. “How am I feeling right now?” “How tired am I?” “Why does my chest feel so heavy?” Upon identifying how you're doing, it's key to be empathetic, kind, and patient with yourself. Similar to how we'd like to be acknowledged, loved, appreciated by others, our bodies and inner self would also flourish when they reap those rewards from ourselves. “It's okay to feel like poo right now, you just worked for hours on end despite being yelled at by coworkers and your boss.” “Of course you're exhausted, you've been juggling work and relationship stress on top of health concerns for your family!” “It's natural for you to be upset about the world right now, you feel powerless but you care so much and that's why you're so passionate about it. It's okay.” You're allowed to feel whatever feelings you're feeling, it's valid. You're human. Please don't forget that.

2.     Check in with your needs and acknowledge them.

Sometimes we need to brood, be wistful, cry, scream, punch a wall, or just wallow in the emotion for awhile. Whatever the case may be, it's okay to allow yourself to sit in that human emotion for awhile. Go cry, listen to sad music, punch a pillow/join a kickboxing class, lie on the floor and stare at the ceiling. Ignoring and storing the emotion in the body is biologically unhealthy (not going to get into the details of change in pH level, but your body literally gets sick), your body will try to release that energy eventually. Sitting in the emotion, however long, will help yourself feel validated, loved, and welcomed for being human. Then, when you feel “bored” (i.e. no longer feeling the intensity of the emotion), that's when we can move onto the next part.

3.     Identify appreciation (especially self-appreciation) and then self-sooth.

Holidays this 2020 year may not look like how they did in the past, but that doesn't mean there's a lack of things to appreciate. Regardless of when you're reading this, there is assuredly something to appreciate, even the frustrations in life. That person chewing too loudly? We can appreciate that that person is taking care of their basic necessity and taking care of themselves. Also don't forget to appreciate that you were able to sit in the uncomfortable emotion(s) in step two! Finally, you may hear self-care being thrown around a lot. Honestly, self-care doesn't need to mean focusing on hedonistic or eudaoimonic well-being. You just sat through a really difficult emotion, how do you normally like to be consoled/soothed? What is your love language? What sparks joy for you? Do it for yourself, by yourself.

 At the end of the day, you can do whatever you want with your life – it's your life after all. Just remember that it's a human life you're living and not a robotic one that can perfect every task and every day. So while we head into the new year, you're highly encouraged to make use of these quarantine times by self-reflecting more on your development. There is the powerlessness of solitary confinement, and there is the power of solitude.

 Photo by Chinmay Singh from Pexels


References:

Lorraine L. Besser & Shigehiro Oishi (2020): The psychologically rich life,

Philosophical Psychology, DOI: 10.1080/09515089.2020.1778662

 

Oishi, S., Choi, H., Koo, M., Galinha, I., Ishii, K., Komiya, A., . . . Besser, L. L. (2020). Happiness, Meaning, and Psychological Richness. Affective Science, 1(2), 107-115. doi:10.1007/s42761-020-00011-z

It’s Okay that You’re Not at Your Best

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It’s Okay that You’re Not at Your Best

By: Melissa Larmon, AMFT

I was talking with a client recently about just how much is on her plate, and she said to me, “But I’ve always been good at juggling multiple things.” She was so frustrated that she wasn’t doing as well as she used to. I replied, “I bet you are still amazing at juggling. But it’s as if before you were juggling 3-4 regular balls and doing pretty well, but then you had to juggle blindfolded, and then the balls changed to bowling balls, and then the bowling balls were set on fire.” We started talking about how juggling right now isn't the same at all, and the increased struggle has nothing to do with her lack of effort or ability, and everything to do with reduced capacity and increased external stress. Life right now for most of us feels like juggling flaming bowling balls while blindfolded. It’s not easy, it’s painful, and while we are still capable and amazing human beings, we simply can’t operate at our best right now.

I want you to know that not only is it okay to not be at your best, but you are in the company of millions. Everyone is operating below optimal, and I mean EVERYONE…even the people who seem to have it together. It can be easy to think that because we’ve been living with this uncertainty and unrest for several months, or because we don’t actively think about it every moment, that we aren’t still affected. But we are affected…every minute of every day. It’s like when you have an App running in the background on your phone…you may not even notice it’s there, but it’s still draining energy. This drain, or reduced capacity, can show up in many ways. It may show up in anxious or depressed thoughts, unexpected or more intense emotions, relationship strain, less restful sleep or strange dreams, lower energy and motivation, or general and persistent low mood. We are living through a collective trauma, and we carry trauma in our bodies, so you may also notice a host of physiological symptoms ranging from general tiredness, to skin issues, weight gain/loss, headaches, and more. Like juggling those flaming bowling balls…this is HARD. Experiencing any or all of these symptoms is not a sign of weakness, it is evidence of the pervasive and persistent effects of living through this time.

When we are under extreme stress we tend to want to either go into overdrive to correct things, or get overwhelmed and shut down. And either way, we usually do a heck of a lot of judging ourselves as we do it… “Why am I so tired? Why can’t I do more? Why aren’t I doing better? So-and-so has it together, why don’t I? What’s wrong with me?” Sheesh…it’s exhausting.  We also like to plan and prepare as a way to prevent future pain. In balance, planning and preparation is helpful. Out of balance, it can look like what I described above: going into overdrive and setting lofty or extensive goals, and/or getting overwhelmed and shutting down completely. And as winter approaches and Covid-related restrictions increase again, a lot of people are at risk for one of those two extremes. 

So, what do we do? We keep it simple. Stay focused on a few simple tools that can help you gently care for yourself as you go through a trying time. Here are a few suggestions:

·       Do one thing that makes you feel good each day. It doesn’t have to be a big thing, just any thing that makes you feel good. Maybe it’s making a meal, or maybe it’s taking a hot shower or bath, or listening to a favorite piece of music. Do it and savor the pleasing sensation. If you are someone who makes to-do lists, add it to your list. Taking care of ourselves should be a priority.

·       Celebrate the little things. No matter the size of the moment or accomplishment, notice it and give yourself credit. There might be days that getting out of bed at all feels like a monumental effort. So, when you get out of bed, notice your effort and celebrate it. Whatever you accomplish, applaud yourself. Say it out loud, write it down, tell a friend or family member…and resist the urge to add “at least” or “only.” Don’t diminish your effort; every effort counts.

·       Talk back to your Inner Critic. Ugh…those inner critics are such jerks, aren’t they?! They love to steal our joy with their judgment. When you notice that nagging voice that is judging your small accomplishment, questioning your energy level, or comparing yourself to others or a past version of you, put up your hand and talk back. When my inner critic shows up and says emphatically, “Why are you so tired??? Why aren’t you up yet??” I talk back and let it know that I am tired because I’m living in a pandemic and I simply need more rest. It’s amazing how the tension in my body releases with this simple exchange. If it helps, externalize your inner critic’s voice and imagine if another person was to say to you what your inner critic is saying. Sometimes this makes it easier to recognize how harsh it is. What might you say back? How can you ask them to back off?

·       Move your body. Any way, at any speed, for any amount of time. Moving your body doesn’t have to be an intense workout or a workout at all. The mood-improving benefits of exercise are achieved with easy paced walking. So just move in whatever way feels good to you.

·       Plan social interaction. From extrovert to introvert, human beings are all built for connection and benefit from some level of social interaction. To help reduce the negative impact of isolation, plan for some amount of social interaction. You don’t have to plan extensive events or long Zoom calls, even a short exchange with a friend, or an intentional conversation with your partner can be helpful.

·       Practice quiet time. Whatever way feels good to you, take time to enjoy peace and quiet. Mindfulness, meditation, and prayer are options, as are quiet walks outdoors, or just sitting in a quiet space. Taking time to turn the volume down can bring our minds and bodies relief.

·       Set boundaries on your news and social media consumption. Whether you want to take a total break, or limit the time or pages you interact with, noticing how you feel when you are online and adjusting your consumption accordingly can made a big difference in your mood.

·       Focus on what you can control. Life is full of things out of our control. And that is especially true right now. When we are immersed in what we can’t control we feel overwhelmed and powerless. When we shift back to what we can control, we are more able to identify helpful action and tap into our strength and capability. When all else fails, the one thing we can always control is our breath. Tune into your breathing and take a few thoughtful deep inhales and exhales to refocus on what is in your control.

·       Take one day at a time. Or one moment, or one minute, or one breath. A marathon is run one step at a time. We can’t know exactly how we will feel at mile 25, and we can’t jump from mile 1 to that moment, all we can do is put one foot in front of the other and celebrate each step or mile along the way. As my mom always says, “don’t borrow trouble from tomorrow,” we are better able to handle the now when we aren’t consumed with trying to carry the future.

Remember, you don’t have to do everything on this list, perhaps just pick a couple that resonate with you and give them a try. And if you find yourself struggling, that’s okay. Success is defined as trying, not mastery, and good enough is good enough. We have survived a winter before, and we have survived several months of a pandemic…we just haven’t done both together, but the fact that we have survived each tells me we are capable. Be kind to yourself. You may not be at your best at this moment, but a moment doesn’t define you. Strength, resilience, and capability are not defined by a moment. It’s okay if you’re not mastering juggling five flaming bowling balls while blindfolded, you’re still a good juggler. :)

Photo by Anna Shvets from Pexels


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