I Knew A Lot More Before...

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I knew a lot more before....

- I got married
- I had a child
- I had a second child
- I found gray hair

.... in that order. Is that a coincidence?

When I first began my career as a therapist, I didn't get it. I mean, I wanted to get it. I got it intellectually. But that's not the same thing.

- I didn't understand the courage it takes to bring your precious child to therapy
- I didn't understand how you could feel so much love and so much numbness for the same person
- I didn't understand how people could let so much time pass, so busy living that they forget to live well
- I didn't understand why money was the #1 reason for divorce in America
- I didn't understand how someone could ignore their own mental health issues because they are too busy caring for everyone else.

... I understand that now.

The best gift of my career is that I get to walk alongside so many different kinds of people. And I've learned over and over (and over!) that someone's life looks so different from the inside. I am honored by the stories we share.

What's funny is, the more I learn the less I know what to write about. Life doesn't seem as easy to contain within black and white letters. The breathless, quiet, fierce and sacred. And after 8 years of formal education and 5 years of a supervised internship and 9 total years of seeing clients.... I find myself more contemplative. More reverent. What do I know?  I ask myself.

Well truthfully, I know a lot.
But I am only growing in understanding.

Thank you for the humbling journey,

I Have A Beef.. With The Word Therapy

Therapy.

It's a loaded word. And what does it even mean?

Depending on what movies, tv shows, stories, experiences you've had... it can wildly vary. And really I blame us, the therapists, for this. If you sat 10 therapists in a room and asked them "What is therapy?" You'd probably get at least 4 vastly different responses.

You see, therapy has different schools of thought (called theoretical orientations). Hundreds actually! (Although many of them group under umbrella headings).

One brilliant therapist could say that therapy ought to be "brief" and "solution-focused" while another therapist could say its an "insight-oriented process" (read: "longer") and still another could brag that their longest client relationship spans decades! (Yes, I have heard this).

So how do you know what you're getting? And how do you know what you need or want up front? If I were a potential client, I'd be confused!

Like many other areas, I find the turf-wars to be tiring. I don't know why we have to act like "effective therapy" can only be one thing.  Actually, recent research suggests that (more than any theoretical orientation) the "goodness of fit" with the therapist is what matters most for a successful outcome.

Highly respected, intelligent, experienced theorists have resorted to screaming matches over this issue. I can't pretend to have The Answer. But I can tell you what I think... and do with it what you will.

I think that it's crazy to act like the same issues bring everyone into therapy... so it's crazy to act like the same kind of therapy will help all clients! (*ducking... as I'm sure I'll take heat somehow*)

If you come in with trauma from a car accident (and had a perfectly functional life before the accident), I don't think it's worthwhile to deeply explore your childhood. I think- lets get this trauma fixed! Let's apply some rapid and research-oriented solutions, like EMDR or Hypnosis. Similarly, simple phobias, chronic pain, or panic disorders are not the same thing as a long-term childhood chaos. And on the flip side, if you are a pretty satisfied and healthy individual who is in a troubled family relationship, my response is going to be different than if you are deeply depressed and dissatisfied with life. 

Sometimes people need a quick solution- either because their problem is specific and acute, or because that is all they have the energy for at the moment. And sometimes people need time, space, processing, and insight. They don't want to be rushed through their process. Much like a spa day for the mind, they enjoy that therapy is a retreat from ordinary life where they are free to focus entirely on their own health. How on earth could one word- therapy- apply to all that!? Who better than the client, to decide what they need?

So I think I'll begin to use different vocabulary. After all, who knows what you need better than you?

Some ideas, and I'm just spit-balling here:
Therapy: Insight-oriented, deeper addressing of complex issues through specific techniques
Strategizing: Solution-oriented, short-term addressing of a specific issue 
Counseling: A longer-term, "walking beside" of a person through life transitions or for support.
Relationship Work: A workshop for a family or couples' systemic issues which focuses on improving connectedness and communication.

I'm wondering if we started teasing out the different reasons people go to therapy then maybe it would become clearer for all involved. Maybe clearer labels would lead to clearer benefits and a better therapy/client fit?

What do you think? What labels would you give to therapy?

Is there a label above that you like better than "therapy"? A label that would convince you to give it a try? Or one you recommend? I'm taking ideas here! Really!

I think the clearer we therapists can be with potential clients, the better. 

Whoah Nelly

Four years ago, I had less wrinkles and brighter eyes.

The End.


.... I love doing that. Okay, not "The End." But that would be funny right? No?

I'm avoiding. Someone please stop me

Ahem.

Four years ago I sat down (as someone with more free time) and wrote an article detailing everything I wished I could tell people before they used insurance. I had sat on the phone far too many times that week, on hold, waiting to be forced to give personal information out on my clients... again. Just so they could get the money they were due.

Idealistic and younger me thought: "Don't you think if you were a client you would want to know this information?"
And I answered myself, "Yes! I would!"
Idealistic and younger me asked, "Well then isn't it like you have a moral imperative to educate the consumer here?"
And (full of hubris and naivete) I answered myself, "YES self! I do!"

And a blog post was born. No biggy. Like 10 people read it and I knew them all.

And I thought THAT was the end. Really.

Then I got clients a few months later (who actually thanked me for the post and said they chose me and chose NOT to bill insurance because of it). That's cool.

Then I got therapists a while later (who secretly said they agreed but would never post it). That should have been my warning sign.
But time passed and I forgot it existed.... until managed care became an even hotter topic. And somehow, due to the gods of google (or Bing, or Yahoo, or If-I-Knew-Why-I'd-Be-Amazing-But-I-Don't) I suddenly started getting eyes. Lots and lots of eyes. Over 3000 and counting to be exact.

And with the eyes, came the hate. Oh yes, lots of that. You're not new to the internet- you know this is something to assume right? Commenters will be harsh! Haters be hatin.... (anyone? no?).

So now I have a debate in my mind. Keep it up? Take it down? Does it help? Does it hurt? Is it relevant? Is it necessary?

And my words haunt me- I would want to know. So... for now it stays.

But geesh! I'm a therapisty type. It means I'm kind of sensitive. Get it? Yikes! Thank goodness for comment moderation.  So mostly, I'm whining here. My apologies! What was my point? Oh yeah, managed care.

2014 has become another huge shift. We don't have to be surprised there. It's on the news 24/7. No one can predict where this journey will take us. No one can even predict what mental health care will look like in 10 years- as there is still debate about what/if it is medical care or not. And since we don't know what medical care will look like... it is anyone's guess.

Articles like this one speculate that private practice therapists will be a thing of the past. They will become one more "office visit" as part of a large HMO or even a state-run institute. With tight time limits and quick diagnosis/treatment timelines.

Is this tragic? Or wonderful? I guess it depends on your view and how it turns out. But for now, I know that my clients and I are in this together. I am doing my darnedest to serve them while protecting the integrity of my care, and the confidentiality of their services. And I am thankful to say, that this has meant a full calendar for the last 4 years. Even though I am not on any insurance panels.

Being able to treat what my client deems important. Being able to treat with skills and tools my client feels are the most helpful. Being able to see a couple or a whole family when my client feels that is necessary... and being able to do all this without reporting it to a database... is so precious to me. That kind of freedom thrills me.

Why speak of this? Partly because I'm a nerd and find this kind of socio-political stuff fascinating. :)
Mostly because I believe you have a right to know. I would want to know. You have choices here. They are not easy ones, but they exist.

So what are your thoughts? Are you glad I told you all this? Would you rather know? Or not? I'm taking your comments!

Facebooking Death

My client said something so brilliant- I can't stop thinking about it.
She'd lost a friend tragically. And as we unraveled all the particulars of her experience, she grappled for the right words to express her feelings.

"Facebooking Death"

...I sat with that for a minute. 

She went on to describe a phenomenon (one I've seen personally) of people expressing well-wishes for the grieving family via Facebook (or any number of care websites really). Sending posts and even gift cards, while remaining on the outside.

The longer we talked, the more I got a visual. I've seen it myself.
The absolute OVER involvement on one hand... while still leaving the mourning in total isolation.

Most ancient traditions and religions have a communal response to tragedy. Sitting shiva, for instance. And even until very recently, I can remember stories about family "bringing a casserole" to the grieving- every night for the next 3 months.  What every grief tradition seems to have in common: they tell the grieving person: "You are not alone in this."

But I have seen those traditions disappear around me. In suburban modern america we don't know our neighbors. We don't build community. We "facebook life"... and so, of course, we "facebook death".

We allow a photo of a newborn and a wall post to substitute for bringing the new family a meal or washing a dish. We allow a birthday wish to substitute for a phone call or a card or a party. We allow blogging to substitute for being together. It was only a matter of time before death became the same.

You've all seen it- the Facebook page serves as a virtual yearbook of sympathies from every person they've ever met. Meanwhile, the grieving person sits alone on the other end of the screen. 

Is this good for us? It feels so wrong to me.

And here's where I'll confess something that's hardest of all: therapy used to be about helping those with mental health issues. I find this is less and less the case in my office. More and more, therapy is about people needing to be less alone. Don't get me wrong, I still see plenty of nitty-gritty. But often what keeps people coming back, week after week, is that there is real connection to a living breathing person. A person (me) who will set aside everything to be there.

I am honored to be that person. And it breaks my heart that I am that person.

It is my fervent belief that we need to stop facebooking life and start living it. To tighten our circles of influence but increase our investment in that circle. To dig deeply into the people around us. To express our love through action. To enter into their messy, grieving moments and not leave them alone staring at a screen.

We've never had so many friends, and been so alone. 

Wishing you a full, messy, connected life-

My Theory Of Everything (Motherhood)

Once Upon A Time...

Once upon a time, women learned about the ancient traditions of motherhood through experience. The age gap between mother and child was short: generations were compact. Extended families dwelled together, weaving mother and child, niece and cousin, until a tapestry of women all coexisted along the life span.

There were no retirement communities, no preschools. Babies bounced on old knees. Aunts were both sisters and mothers. To look from the outside, one would not easily know the dividing lines between each family. Who belonged to whom? They all belonged to each other.

By the time a girl became a woman, and then a mother, she had all the benefit of this multi-generational school of life. Since the time she was born, she had seen people pregnant, give birth, raise children, grow old and die. The lifespan was a continuum on display at every moment. Life, and its traditions, were mapped out in living color.

When her time came to give birth, she would do so in the manner of her people. She would know every part of this rite of passage- having witnessed it countless times. She would be surrounded by her fellow women, each one having experience, wisdom, and strength to share.

Her baby would be no mystery to her, having cared for her siblings, nieces, nephews and cousins her entire life. What to do when baby cries? How to feed baby? How to hold baby? How to get baby to sleep?... she would have learned by watching and doing. She would have learned at the feet of the eldest woman of her family. She would have learned by tradition.

…. Times have changed. In many ways, they have changed for the better. Modern medicine, institutions of education, women’s equality, birth control… all these things have meant dramatic change for the lifespan of a woman.

No longer do we share our daily lives with our elders, learning from their wisdom. Modern medicine has meant that the elderly live much longer- but they do so in separation. And when they die, they die without grandchildren at their feet.

We benefit from schools. Widespread literacy is a wonderful accomplishment. It has meant equality and opportunity like the world has never before seen. But it also means we do not learn at the side of our mothers. We do not take in their instruction through observation.

Women now get a choice over their life’s path. They can delay parenthood, or avoid it altogether. They can pursue any goal they choose. This also means that when a woman chooses to be a mom her mother is often older; and her friends in a different life stage.

No longer do we share our homes. We move cross-country. We work sun up to sun down. We go to organized events. We park and close our garages. Our children play behind fences.

Some changes are for the better. Some are not.

What does this mean?

When a woman chooses to become a parent, she suddenly realizes what is missing. Classes, and doctor visits, and books, and websites must suddenly make up for a lifetime of lost learning. Childbirth educators, obstetricians, doulas, lactation consultants, pediatricians… all struggle to fill in the gap. The missing tradition. The missing roots. The missing support. The missing narrative. The missing mothering.

And while there is a plethora of information out there, there is an absence of connection. It feels like a generation of women flying “solo”, flying blind.

For you see, even if you are lucky enough to replace the “tribe” from above with one of your own making (through friendships)… you will soon learn that there are many dividing lines now. Natural birth or medicated? Breast or bottle? Co-sleeping or crib? Cry-it-out or attachment-parenting? Ferber or Sears? Stroller or Ergo? Preschool or homeschool or unschool? Work-outside-the-home or stay-at-home? The list is endless.

…And we fight, and we pick labels, and we blame, and we polarize ….

… And we substitute judgment and righteous indignation for inner knowing…

Because what we’re trying to capture here, what we’re desperately seeking: is the wisdom of generations. The wisdom of a wise grandma with a wink. The wisdom of sisters, aunts, mothers and friends who will wipe your brow and whisper “You can do this, you have the strength of a million women behind you”.

So I want to say, whether you know it or not, whether you feel it or not: 

You have the strength of a million women behind you.

Find the women in your life who will tell you that. Cling to them. Forget the rest.

Photo Credit: B℮n via Compfight cc
Photo Credit: lifeography® via Compfight cc
Photo Credit: Quique Mañas via Compfight cc
Photo Credit: Matilde B. via Compfight cc

My Ankle Is Jacked Up

I had to go to physical therapy this week. I've never been before, but I've heard scary things, so I was a little nervous.

I blame the mouse.

In case you're wondering why... let's just say: Chuck E Cheese, newborn baby exhaustion, and Sketchers Shape Ups are a bad combination. My ankle made unnatural noises. So I did what any reasonable person would do- pretended it would get better on its own. "There's nothing the doctor can do for a sprained ankle."- my friends and family agreed.

But it didn't get better on its own. Instead, I found myself staring at a (slightly judgmental) doctor 6 weeks later: "You didn't go see anyone when this happened?"

When I went to my physical therapy appointment, I learned something else: I can't walk downstairs. This was new and upsetting information. How could a person NOT realize this?

Then the therapist had me walk for him. I felt about as awkward as anyone in rolled up yoga pants would feel while walking up and down the carpet. Should I catwalk it? Saunter? Do a little spin? His level of concentration was uncomfortable.

In the end, he nodded knowingly. "Your gait is a little askew." I must have looked confused because he followed it up with: "It makes sense. Your body has this way of realizing what movements hurt. Soon you're guarding it and you don't even know you are."

So the verdict? My range of motion is extremely limited now. All that "guarding" the pain has left me with very little mobility. My foot can only do the most basic "askew" walking on level ground.

The treatment? A series of: heat, followed by intense exercises that force me to use my foot in ways I don't want to, capped by electrical shocks and ice socks. FUN!

You see, my brain is crafty. It will find ways to avoid the pain. I will jiggle my knee instead of my ankle. I will turn my body to achieve rotation. I will lift my heel and "hop" off a step. And I don't even know I'm doing it! The only way to attain the full and healthy use of my foot- is to carefully  HURT myself. In other words: I have to ignore what my brain is saying to me: "Stop, this hurts!" and go on blind faith that the trainers are giving me sound advice. You want me to what? This seems wrong.

The whirlpool for my feet. I could get used to this part...

And while I sat on the table at the end (in the ice sock and electrodes) it occurred to me. Physical therapy is well named (in my humble opinion). It has a lot in common with the therapy I do for people. 

When people come in, they don't always know the ways their live are affected. They just know there's something not right. And it can be pretty disturbing at first- to realize how "not right" it really is. Then comes the work: the part where you have to ignore the fear, and do what hurts. My clients are superheroes in my book because that takes a tremendous amount of personal courage, strength and faith in your therapist. 

... and sorenesss. Oh, the soreness...

But last night, I stood up from the rocking chair and I didn't want to cry. So... there are glimmers of hope too.

Wishing you promise for the pain,



ps- I'm coming back to work soon! Yay! I'll call them and get my current clients squared away with appointments first, and then open up to new people. Can't wait to meet you!

Vertigo

Let's talk about work-life balance, and how I achieve it....


BWAAAAAAA-HA-HA-HA!
Good one. Did I have you going for a second at least?

Instead, I want to muse about the teeter-totter that is my "work-life" balance. Namely, that it seems I can only balance one thing at a time. And that doesn't sound very balance-y, does it?

For example, an interesting thing about my business (therapy) is that it's very seasonal. Did you know that? You would think that my office would be flooded with phone calls around the holidays, what, with all that 'quality family time'? But in fact, most people are just trying to survive the holidays. They don't have time to examine their mental health!

January, is another story. The relatives go home, the kids go back to school, the tinsel is vacuumed off the carpet and WHAM! now there's finally time to realize and devote energy to your mental state.

So this means, at the times when I'm most busy personally (like Christmas) I am least busy professionally. And vice versa.

Doesn't it seem like this should lead to fabulous work-life balance in which my teeth are always white and my clothes always match? I keep waiting.






What it means in reality is that my work pace slows *just* enough to let me catch up on that never ending to-do list. Meanwhile, as soon as I leave the office I walk into a wrapping-paper war-zone full of parties, and presents and ... well, you know the drill.


January comes, life settles, and  I start to think I'm kind of a 'together' person. (I like to savor those moments when they happen.)


Then I walk into my work day with lots of clients I can't wait to see... and a desk piled full of paper that I neglect in the meantime. Tax forms, insurance billing, malpractice insurance... oh my! Running a business at its finest.

Imagine this times a billion... that is my wrapping paper 'organizer'.

What is my point? 


Well partly I just wanted a moment to whine in text (it is so therapeutic!) But also, I wanted to say these very controversial words: I don't believe there is such a thing as a perfect work-life balance. There, I said it.


*Ducking as gurus and shrink-types are likely throwing things at me*


I'll even go one further: The illusion that there is some perfect balance to achieve causes more suffering (I believe) than the imbalance itself. We make ourselves crazy trying to 'have it all' and keep our teeth white... meanwhile we're chasing an illusion.

For me, the work-life balance occurs in the moments between the teeter-totter. You know, the moments where the teeter-totter is temporarily balanced because it is tipping the other direction? That millisecond? That's what I'm talking about.


The trick (I think) is to live in the imbalance. To embrace the chaos. To make room for love and happiness and meaning and connection while you're waiting for that perfect balance to happen. Because (I've got some bad news for perfectionists) you can waste your entire life waiting for the balance to happen first. 


So me? I'm going to drink some eggnog (if my husband has left me any) and wrap a few more presents tonight. The paper is already conveniently strewn about the floor, so I won't even have to hunt it down. (Hopefully my dogs didn't eat it today).
And I will laugh.
And for a moment, my teeth will look whiter and I will feel at balance... even if my teeter totter is still in motion.

Wishing you a life of abundance!

The Tree

"The wind needs to be able to move through the tree" my dad explained. "At least that's what the tree guy said. So every few years you have to cut off every third branch. That way the tree doesn't get disease and it gets nice and full."

I looked at the tree- it didn't look full. Not yet. It looked barren. A two-story clump of sticks punctuated with a few leaves. In comparison to the before-pruning version of the tree, it looked like it was missing something. And yet, according to the expert, it needed to be 'missing something' so that the health of the tree could be preserved.

You see where I'm going with this. (I know you do!)

Often my clients will come into my office because a part of their life is "diseased". It's stagnant, or unhealthy in other ways, and they can't seem to clear the rot. They know the disease well. I often don't even have to point it out- they will tell me it's there on their own. But the inevitable question becomes "What do I do about it."

And then, there is the moment of truth. The moment where things must be surrendered, before the health can be restored. The moment where the tree will feel bare. "The air needs to be able to move through the tree." I try and say in a thousand different ways. "That way the tree can withstand storms, the tree doesn't get diseased, and the limbs get enough sunshine to become nice and full."

But the bare tree is scary. It somehow doesn't add up: cut away green limbs to save the whole.

The air needs to be able to move through the trees...


Wishing you sunshine and lots of fresh air on your limbs,

The Blame Game

How I wished I looked when at home

Okay, I'm gonna give you a glimpse into my personal life and sell out my husband at the same time (sorry hon!) But what else would you expect from me by now?

About how old I feel when handling poop.

Here's a day in the life of this (part-time) stay-at-home-parent: After a busy weekend, our house is in chaos.  My attempts to cook lunch or dinner are thwarted by the semi-full dishwasher and overflowing sink. My toddler's poop-splosion (yes, it's a word!) in his "big boy pants"  means that I rush with a dripping bomb of clothing to the utility sink (full of other stuff) and then to the washing machine (full of musty-smelling damp clothes). My attempts to throw away the clutter are met with frustration when I find out that there is no garbage can liner... again....

Now, these little irritations are not a big deal by themselves. But when you're exhausted, overwhelmed and alone with a toddler on a messy Monday... and *ahem* some of these events *may or may not* be the fault of an absent member of your household who is now at a beautiful sparkling office which is quiet and poop-splosion free? Well, let's just say my attitude and I had to have a little talk. You pickin' up what I'm puttin' down?

Dramatization of "the text"

I could turn into that wife who greets her hubby with steam coming out of her ears (yup, I've been her before). I could turn into that wife who does the clean up but plays dramatic violin music in her head as she imagines the closeup video shot of her martyrdom (maybe I've known her too). Or.... I could *gulp* skip the blame and ask for help.

Because the truth is, I hadn't been on top of my game all weekend either (its been known to happen!) And I'm perfectly capable of lending a hand with any of those issues above. And somehow, when I have a bad day and I'm not very productive... I look for compassion from my husband; yet when he's off his game- he needs to pay.  And that's not a very happy way to go through a marriage.

My valiant hubby...

So I skipped the blaming text (oh, you know the one!) and went straight for the SOS text- "I need helllllllp!"

And guess what I got? We skipped the fight and got straight to the fixing. Within a short time of my darling hubby's return home- I got a sympathetic hug and all the help I needed.

 Which made me think: I could have pitched a fit (and would have felt oh so justified) but then my overwhelmed and stressed-out self would have also had a fight to fix too. Or, I could make the revolutionary choice to skip the blame and ask for help. Which meant I got what I really needed.

Wow, I learned something new yesterday. :) Just thought I'd share!

pssst- Sorry it's been a while. I've been doing some writing for others, including MacaroniKid

Beyond Words

WARNING: DISTURBING REAL IMAGES OF SEPTEMBER 11
Out of respect for what real men and women endured, I thought real photos were a necessity. Please take care to avoid this if you need to....






























I'll never forget the first body I saw fall through the air. It seemed suspended in air, suspended in time... as I sat staring in suspended disbelief.

















I'll never forget the first of the twin towers falling. The sheer enormity of the weight of it. Every cell in my body whispering: "this can't be happening". Every part of me wishing that the scene would stop, the hero would fly overhead, the movie would role credits.

This can't be real, I thought. And yet it was.

September 11, 2001 was a day where tragedy heaped upon tragedy... each moment seeming more unspeakable until heartbreak couldn't describe it.

That was the first lesson of September 11 for me: that indescribably horrific things can happen to people who don't deserve it. That cruelty and hatred and rage can become so murderous... that it can take thousands of innocent people with it.

Oh sure, I've read history books. I stay informed on current events. This was not new information intellectually. But it was new information in my heart: the pure powerlessness of watching people fall to their deaths, watching people crash to the ground with a 1500 foot building, watching people run screaming from the bomb-like cloud of debris and fire. The pure powerlessness that my gasp, my horror, my tears, my cries... could do not one thing to stop the terrible events unfolding in front of me. That is a lesson of the heart. And it was a horribly bitter one to swallow.

But that wasn't all I learned that day. Freeze that frame. Look again.

Because on the same day I learned about the capacity of the human heart for bravery. I learned that a person fleeing for their lives could stop in their tracks to lift someone from the rubble. I learned that firefighters hugged one another goodbye before they charged up the stairs. I learned that ordinary citizens rushed back into the smoke and flames to check among bodies for a single survivor. I learned that people fled the debris without trampling one another. I learned that volunteers assembled on that very day to go back into the warzone they fled, to check for survivors.





You see, September 11 will be a day frozen in my mind. But when it plays in my mind- it includes the worst and the best of humanity. The cruelty and the compassion, the cowardly and the brave. What a moment: the stark contrast of the murder of innocents... against the dignity of caring for another before your own survival. And it is my belief in the "better self" that keeps propelling me forward.







Because if all I learned that day- was sheer powerlessness in the face of hate... then I would have only learned the lesson taught by the few. But if I honor the courage and the compassion... then I honor the lessons of the many. And how beautiful they are.

I'll never forget,