Category: Reflections on Counseling

What’s “Normal” In the Slow Fade of a Pandemic?

What’s “Normal” In the Slow Fade of a Pandemic?

Even as the pandemic begins a slow fade, the mental health crisis that the pandemic ignited in kids, teens grownups, and caregivers for elders is sticking around. In my therapy office of late, I’ve heard clients name rumination, depression, grief, more alcohol and marijuana, new existential questions about meaning and purpose, relationship challenges, parenting stress, exhaustion, preoccupation about weight, intrusive thoughts, and lots and lots and lots of anxiety (social anxiety, health anxiety, traveling anxiety, etc.) In fact, we now have a name for all the inner debris that the pandemic has left in us: Post Pandemic Stress Disorder. This is on top of all the stress, anxiety, depression, and relationship stuff many of us carry around even in non-pandemic days.

So here are a few points I wish we could all keep track of:

1: Sometimes my clients think that if an event is over, they should be over it. But our brains, nervous systems, and bodies don’t work like light switches. Rather our nervous systems are like cars — needing time to rev up and time to slow down. So it’s normal to not feel normal right now. It’s normal to be experiencing residual exhaustion, more sensitivity to stressors, and to generally feel on edge and like you don’t quite have your social sea legs. Does this mean it’s fun? No. But is having a disrupted nervous system normal given the completely abnormal last 16 months? Yes. Absolutely, yes.

2: During the last year plus, we’ve all been taking stock of our lives: what we like, what we don’t like, what we want more of, and what we want less of in our lives. If you are still looking around trying to figure out what you want your new normal to include and exclude, you are doing something important – and normal. Many of us have had a break from friends, commutes, social obligations, work travel, etc. and now, to some extent, we have some choices in front of us. Do we want to socialize more, less, or differently than before the pandemic? Do we want to advocate for different hours or different amounts of times at our jobs? Do we want to set different boundaries with our families or around our time? These questions are normal. And it’s normal to re-evaluate our priorities following a big, terrible event.

3: If you have gained weight during the last 16 months, congrats on being normal. As far as coping strategies go, eating a bit more than we need is not the worst thing ever. We’ve been going through an ongoing trauma, and our bodies naturally crave sugar and salt when we’re stressed. I hope you can give yourself a break over the weight gain. And maybe even learn about the Health At Every Size movement. Or if you can’t be kind to yourself about your body, please come see me and and let me give you a break.

4: Finally, if you’re feeling bad for feeling bad (as in “I have so much privilege, I don’t deserve to be having a hard time”) then congrats – also normal. Think of this like survivor’s guilt. There’s a guilty feeling that’s hard to shake. But guess what – this too is normal. And while I know it’s hard to stop guilt once it’s ramped up, your guilt does not help anyone.

So – what to do? Consider self-compassion. Surround yourself with people who will be supportive and not make you feel like a weirdo (unless you’re a weirdo in all the good ways). Remind yourself that your experience can be normal AND still be really, really hard. And help your nervous system know it’s now safe to calm down: through regular sleep, nourishing food and relationships, movement, time outside, and – the hardest for many of us – not pushing yourself too hard. Does all that sound impossible? If so, no worries… that’s normal too (and why we therapists are here).

Courtesy of Rahul Jail on Unsplash.com

“COVID is (Almost) Over: Why Don’t I feel OK?”

This past 15-plus months of pandemic life has been a crash course in tolerating uncertainty. Remember when we weren’t sure how COVID spread? Remember when we weren’t sure if we should be wiping down our newly-purchased cereal boxes and bananas? Remember when we weren’t sure what school was going to look like in the months ahead? (Oh, wait… I think that last one about school is STILL true. Yikes.)

Living with the uncertainty brought on by COVID has been no joke. And the stress is still impacting our bodies even as life returns to some semblance of pre-COVID normalcy. Every week I see clients describing difficulties with concentration and focus and irritability and motivation and – last but not least – exhaustion. Is it possible that these clients are anxious or depressed or have ADHD? Yes, of course. But it’s also true that we’re still reeling from a catastrophe most of us couldn’t have imagined two years ago. We all just experienced – and are still experiencing – an ongoing trauma. Our lives were just turned upside down – and stayed that way for more than a year. Of course we’re not going to feel great. Of course we’re going to be struggling.

This relates to an insidious kind of suffering that I see a lot (and that I’m not immune to myself). It happens when we have an unpleasant experience (like “ugh, I’m exhausted”) and then judge ourselves for that experience (like “I shouldn’t be exhausted”). It has variations: I’m grieving a death or break up, but I should be over it by now. Or: I just had a promotion fall through, and something’s wrong with me because I can’t let it go yet. Or: I am struggling but I have so much, so therefore I am wrong to be struggling. (See: privilege syndrome.)

I find that it’s always useful to help clients set realistic expectations for the time and effort it can take to recover from a difficult experience or a trauma. And just because COVID is almost over, that doesn’t mean your body has gotten the message. Our stress is not, unfortunately, a switch that we can just turn on and off. That’s why – if you go on vacation – you don’t automatically feel relaxed. Your body and mind can be in stress-mode even if you’re wearing a swimsuit drinking a mojito.

Think about it like this: your nervous system has likely been on overdrive for more than a year straight at this point, with many more “fight and flight” moments (complete with the release of stress hormones like cortisol and adrenaline) and many fewer “rest and digest” moments. At this point, your body has developed a stressed-out baseline rather than a baseline that’s neutral or even relaxed. So it can take some intentional effort to reset and to re-teach our bodies that we are safe with no imminent threat to ourselves or the people we love.

BUT YOU ARE NOT A LOST CAUSE. YOU DON’T HAVE TO LIVE LIKE THIS FOREVER. There are some things we need to learn to accept in life (the need for sleep; the reality of pollen; the deliciousness of pizza). But feeling agitated, panicky, and anxious ALL THE TIME is NOT something we need to accept.

The brain is beautiful, and complicated, and capable of changing. So is your body. So are you, as a person who has survived long enough to be able to find and read this blog post. You deserve to feel okay, no matter your privilege or lack of privilege. You deserve to feel okay, no matter who you are.

It doesn’t have to be like this. Photo by Aarón Blanco Tejedor on Unsplash.
We Are STILL In A Pandemic

We Are STILL In A Pandemic

We Are STILL In A Pandemic

I say these words multiple times a day, multiple times a week: We are STILL in a pandemic. I say these words when a client with depression can’t figure out why they aren’t feeling better, despite their best efforts: We are still in a pandemic. I say these words when a client with anxiety can’t figure out why therapy and exercise aren’t making them feel zen: We are still in a pandemic. I say these to people suffering from loneliness and grief as well as from chronic professional and financial and relationship uncertainty. We are still in a pandemic.

I say these words because it’s easy to dismiss the effort it takes to act normal – and perform normally – in hugely abnormal times. We think, Oh, it’s been a year, so I should have acclimated. This should be easier. But we are still in a pandemic. We believe, Well, I still have my job/home/health/privilege, so I shouldn’t be struggling. To you I say: We are still in a pandemic.

It doesn’t matter how much privilege we have and how much we have been spared. Chronic stress is real, and we are still existing within an extended period of trauma. This trauma affects not just those who have been sick with COVID, but also those of us (and it’s most of us) who have watched the slow-moving epic disaster of COVID wreak havoc on our communities, neighbors, families, economy, schools, the U.S., and the world.

When we beat ourselves up for feeling stress, loneliness, sadness, or worry, we make ourselves feel worse. When people with financial security wallow in guilt about what we have – when so many others live in scarcity – this does not help. Our self-flagellation serves no one and gets in the way of harnessing the energy to figure out how we can be useful to those around us.

So, in the words of the great Bob Newhart in the skit below: STOP IT. (And sheesh – if only it was that easy!)

Happy New Year! Your WEIGHT is NOT your WORTH.

Contemplating a new year’s diet? If so, please first consider these words by Anne Lamott:

We need — I need — to have the same little talk we have every year at this time: I know you might be starting a New Year’s diet. I used to start diets, too. I hated to mention this to my then-therapist. She would say cheerfully, “Oh, that’s great, honey. How much weight are you hoping to gain?”

I got rid of her. No one talks to me that way.

Well, okay, maybe it was 10 years later, after she had helped lead me back home, to myself, to radical self-care, to friendship with my own heart, to a glade that had always existed deep inside me, to mostly healthy eating, but that I’d avoided all those years by achieving, dieting, binging, people-pleasing and so on.

Lamott goes on to say:

It’s really okay, though, to have (or pray for) an awakening around your body. It’s okay to stop hitting the snooze button, and to pay attention to what makes you feel great about yourself, one meal at a time. Unfortunately, it’s yet another inside job. If you are not okay with yourself at 185 pounds, you will not be okay at 150, or even 135. The self-respect and peace of mind you long for is not out there. It’s within. I hate that. I resent that more than I can say. But it’s true.

Sometimes people seek out counseling because of the pesky problem of a diet that just won’t work. Or in the middle of talking about depression or anxiety, a client will also mention a weight gain that’s simply intolerable. If weight’s not in the foreground, it’s always hovering in the background.

And there are good reasons why. In general, here’s the message that our culture gives us:

Weight is something that can and should be controlled: the more tightly the better. Weight – and appearance – matter more than health and happiness. Fat=bad, and too much if any fat makes us undesirable (to self or others). If we don’t fit the current white ideal of beauty, we should feel ashamed and make a massive effort (often using lots of hard-earned money) to “fix” what’s seen as a problem.  If we’re unhappy and dissatisfied, the messaging goes, losing weight will make us happy and satisfied, fixing all our issues with relationships and self-love and self-worth and self-confidence.

Sometimes these messages are so convincing, so embedded in the fabric of white American culture, that we don’t realize these messages are beliefs, not facts. And when we examine them for their truthfulness, it turns out that these beliefs range from complete bull to containing a bit of truthiness to being only partially true if placed appropriately within a larger context.

But here’s what I know.

*Weight can only be controlled to a certain extent.

*While “dieting” acts like it’s on the outs with certain crowds, it’s merely gone underground. It goes by code words now like eating “clean” and eating for “health.”

*The connection between weight and health isn’t as well established as we’ve been led to believe. The Health at Every Size movement and Lizzo (yay!) are challenging those of us who were raised to believe that being healthy means being skinny.

*When people lose weight, it usually doesn’t change how happy they feel.

*The energy that so many women spend trying to control their weight could be used for SO MANY OTHER IMPORTANT THINGS including: self-care, friendships, walks, exploring interests, toppling outdating systems of oppression, etc.

*We need to look at WHY we feel such a desperate need to control, WHY we can’t imagine being happy without being a certain (different size), WHY our self-love is tied up with weight.

I am so excited to be supporting clients to explore weight, body image, self-worth, and to begin to disentangle weight – and the overall need to control – from happiness. Best of luck to you this year as you experiment with different ways of being in – and thinking about – your body.

 

 

 

Tips for Election Anxiety

Hi y’all. It’s Dana here, your friendly local therapist with some unsolicited thoughts about getting through this upcoming election in one piece. 

Probably by now you’ve received a hundred texts, phone calls, emails,and  social media notifications letting you know about the election on November 3 and asking you in increasingly desperate pleas to PLEASE PLEASE VOTE. Lots is being written about making a plan for voting: requesting absentee ballots and returning them and confirming they’ve been received by your local election office OR voting in person and preparing for long lines, tech snafus and possible voter suppression. 

But there’s another sort of election planning that needs to happen that we also can’t neglect. This planning is more personal, and in some ways more challenging. After all, how do you brace yourself for the uncertainty of a hugely important election, especially given that results will likely not be known for days if not weeks? 

Y’all, it’s time to prepare yourself internally and internally for what’s to come. I’m hearing from friends, family members and clients about spikes in anxiety, a heightened awareness of uncertainty, and a general sense of being out of control. 

So, in hopes that this can be useful, here are some tips and strategies for the coming weeks: 

  1. Do what you can to remember the big picture – the scope of history and space. Even though this moment feels big and impossible it is, in the grand scheme of things, this is just a moment. This may be a good time to watch a documentary about space or nature. It may be useful to print out a photo of the world’s oldest living tree or Stonehenge as a reminder that now is not forever.
  2. It’s time to create a bit more structure and ritual in your day. A friend of mine is now spending 20 minutes first thing in the morning outside walking, followed by 5 minutes of stretching and 5 minutes of guided meditation. I’ve been trying to end each day with a hot bath and an unrealistic mystery novel. For other people, useful ritual might mean a daily habit of morning pages, a daily text check-in with a good friend, or having a mini mid-day dance party. 
  3. Get on a regular sleep schedule if possible. “Sleep hygiene” is the ultimate unsexy phrase. But there’s something to it. The more regular structure we create in the hour or two before sleep – and the more consistent we are about what time we get in bed – the better chance we’ll have of a good night’s sleep. (Pre-bed ideas: reading, letter writing, stretching, listening to music, connecting with a friend, hot bath or shower, or a small snack. Not so helpful for sleep: social media or news.)
  4. Replace doom scrolling with something less crazy-making (such as stretching, audiobooks, online games, etc.) The negative consequences of compulsively scrolling the news or social media have been well documented. In Jenny Odell’s book, How to Do Nothing, she names that this can be quite challenging – especially at first, and especially when so much is happening around us. She writes, “To pay attention to one thing is to resist paying attention to other things; it means constantly denying and thwarting provocations outside the sphere of one’s attention.” It’s time to consider unplugging, at least a little bit.
  5. Figure out what’s within your control and what’s not. Focus on what’s in your control.  What can give you a sense of purpose? If you’re anxious, how do you want to use that nervous energy? It’s unlikely that more information won’t make you feel any more settled. Instead, focus on what’s before you. If the election is important to you, can you write letters, make donations, call friends, post information in your community, or volunteer in another way? Other things that are in your control: how much attention you give the daily media rollercoaster, what you do to relax and unwind (and unplug!), and how you match your actions to your values. Research shows people feel better when helping others, so it may be time to do something for others. Bake brownies for a neighbor. Write and send love notes to your friends. You get the idea.
  6. Allow yourself some comfort. With heightened anxiety comes an understandable need for heightened comfort and soothing. Now is the time to start thinking about what provides you comfort and what might be soothing in the days leading up to the election. Some ideas: comfort foods, cans of soup or frozen pot pies, aromatherapy, nightly hot showers or baths, journaling, movies or TV or books that are soothing and easy. Time outside weeding or walking. Time with pets. Time with hobbies. 
  7. Connect with your people. Social isolation makes everything harder, and being connected to one another usually makes everything easier. If you’ve been out of touch with important friends or family members, it’s time reach out or set up a phone date.
  8. Work to have realistic expectations of ourselves and others during this wild time. Anxiety does not make us do our best work (or best parenting) and we are going to be distracted in relationships and work. Please, give yourself a break. If you give yourself a break it will be easier to give others around you a break as well.
  9. Finally, make a plan for how you want to spend election day and plan something to look forward to after November 3rd. If there’s a chance that anxiety will spike on election day itself, how can you prepare to meet that anxiety? Would it be helpful to keep busy, or to plan to have a quiet day? Is there a meal or a phone call that you could look forward to? Is it possible to plan for a hike or special outing the weekend after? If so, do it!

Managing the Chronic Stress of Parenting during COVID

Managing the Chronic Stress of Parenting during COVID

Photo by Raychan on Unsplash. Parenting can be so isolating, especially right now. Hang in there, folks.

My friend Suzanne, juggling two kids at home and a full-time job, found relief recently when she heard pandemic parenting advice from psychiatrist Dr. Matthew Biel on a podcast (last six minutes or so). “We’re not trying to get it right, get it perfect,” he said. “We’re just trying to do something that feels reasonably responsible.

I’ve been thinking about that advice – to aim for reasonably responsible parenting – ever since Suzanne shared that quote with me. The advice stood out because it goes counter to the belief that many of my counseling clients have that they should be rocking parenting out of the park – even during this COVID catastrophe and the depression, anxiety, stress, and isolation that has come with it. So many parents right now are struggling with a gap between their expectations of themselves as parents and the reality. For instance: Many parents have the expectation that they should always be able to be calm and patient with their kiddos. Next to perfect, really. But the reality is that most parents are struggling to do an impossible juggling act right now, and even under ideal situations it’s impossible to always be our best selves with our children.

I want to say that last bit again: It’s impossible to always be our best selves with our children. It’s not realistic. It sets us up for failure and the belief that we’re “bad parents” the minute we scream or stomp our feet or create an irrational or extreme consequence.

And the truth is that good parents scream and stomp our feet and do things we regret. Especially right now. And for good reasons. For the most part, we have more responsibilities right now and fewer resources (such as childcare, money, community, etc.). More responsibilities+fewer resources=stress. Big stress.

Parents, we need to lower our expectations of ourselves right now. This is not the time to aim for excelling. This is the time to aim simply for being reasonably responsible – making sure our kiddos are alive, safe, eating, drinking and sleeping, and aware most of the time that we love them even when we’re not acting like it. Is it ideal for kids to exist mostly on cheese and bread and cereal? Nope. But these are not ideal times, and they’ll still grow. Good enough. Is it ideal that most kids are spending tons of time on screens right now? Nope. But these are not ideal times, and this screen-gorging will not last forever. Is it ideal that parents are stretched beyond belief? Nope. But these are not ideal times, and our kids will survive our divided attention. If we give ourselves a break and aim simply for “reasonably responsible” so will we.

White clients, it’s time to talk about whiteness

I have been thinking lots about what psychologist and writer Natasha Stovall wrote almost a year ago, before the police killing of George Floyd, before the COVID pandemic exposed (yet again) racial disparities in our country. Stovall wrote this:

The couch in my therapy office is occupied mostly by white people. Anxious white people and depressed white people. Obsessive white people and compulsive white people. White people who hurt people and white people who hurt themselves. White people who eat too much, drink too much, work too much, shop too much. White people who are bored, envious, guilty, numb. Racist white people and antiracist white people. White people who look across the room and see a white therapist listening. We talk about everything. Except being white.

Stovall goes on to make the point (and this is a gross simplification; the article is worth reading in full) that white therapists need to support white clients to explore racial identity, including the negative ways white culture impacts all of us—even those of us who also benefit from it due to our whiteness.

I’ve been exploring my own white identity for the last few years, primarily through the workbook Me and White Supremacy, through regular meetings with other white therapists wanting to dismantle our own roles in systemic racism, and through expanding my reading list so it does less to center whiteness. I keep coming back to this checklist about white supremacy culture only to cringe as a recognize myself and many of my attitudes and behaviors on this list.

I am committed to doing my best to support all clients. That means continuing to work to become as anti-racist as possible, and, when clients are ready, helping them unpack the ways their challenges may reflect and result from our problematic culture. This is our work right now. This is my work right now.

Trevor Noah, Depression, and The Ongoing Gaps in Mental Health Care

I just love Trevor Noah. And he’s just given me one more reason. He’s using The Daily Show to raise the issue of why black people and other people of color have a hard time seeking out therapy and finding useful therapists.

Trevor Noah has been public about his own experience of depression in the past, using his leverage as a celebrity to speak bravely and truthfully about what so often goes unsaid and unspoken. Is it a surprise that this extraordinarily funny and smart man also struggles with depression? It shouldn’t be. Noah reminds us that we can never know from looking at someone what their internal experience is. Never.

I’ve written about mental health access for people of color and crappy differences in therapists’ response before here. But it’s still hard to see these disparities continue. “Disparities continue” makes it sound clinical, impersonal—but what that means is that unless you’re white and middle class, it’s still extremely hard to find a therapist who is likely to get you and understand where you’re coming from. That’s the worst. It’s deeply painful to acknowledge you need help and seek it out just to come up empty or invalidated.

It’s time for therapists, and especially white therapists, to do better. As we prepare to enter 2020, us white therapists need to consider our own limited understanding of the varied experiences of People of Color and do our own work to see how race – including whiteness – affects how we care for our clients.

Are the holidays tough? If so, you’re not the only one.

There’s no way around it: the season of Thanksgiving and the holidays that follow suck for so many of us. As I’ve written here before, grief can be extra lonely and difficult when everyone around you is wishing you a merry Christmas or Happy Hanukah or meaningful Kwanzaa. All of us with complicated families struggle as we perhaps spend more time with family members than usual – or notice their conspicuous absences. Sure, spontaneous gratitude and good cheer may arise. But also there’s the potential for surges of sadness, sorrow, disappointment, anxiety, and pain.

Here’s what I want you to know:

The cultural myth that you “should” be happy at this time of year is not based in reality. If difficult things are happening or have happened to you, especially in November or December, it would be weird if you were suddenly all cheery. Same too if you have seasonal depression. Your low mood likely makes sense given the situation. And, when you beat yourself up for feeling bad instead of good, you’re adding to your pain.

Also, I want you to know that you are not the only one struggling right now. I have the privilege of sitting with lovely, kind, intelligent people every day who are grappling with how to navigate the holiday season without feeling crazy or eating all the cookies you didn’t actually like in the first place. I wish there was a secret handshake or cool badge people could wear to say you’re part of the club of people who’d rather just skip to January, so you could all know and enjoy each other, but alas… I don’t know of anything like that yet.

So, take good care. I MEAN IT. The only way to get to January is to get through November and December. And as stupid as it sounds, drink water! Sleep regular-ish hours! Take walks! Pet animals! And know you’re not alone. Really.

If I got a dollar every time…

Say I got a dollar every time I heard the following words:

  • “But other people have it worse.”
  • “Yeah I’m depressed and anxious, but I have privilege so I shouldn’t feel this way.”
  • “I’m not sure I deserve to be in counseling.”
  • “I’m worried I’m taking your time away from people who need help more than me.”

How much $$$ would I have at the end of a year if I faithfully put a dollar in a jar each time I heard a variation of these words?

Enough to go out to a great dinner. A really great dinner.

We often wish we could decrease stress and depression and anxiety by reminding ourselves of the hard stuff that other people face. But that’s not how it works.

I’ve written on this blog before about what I call “privilege syndrome” — the belief that if we have privilege in some way, it can be easy to feel guilty or judgmental about the ways in which we struggle. And this is common.

I wish that privilege could buffer us from anxiety. I wish that knowing about climate change or homelessness would mean that people with secure housing and middle class incomes could be immune or invisible from stress or depression or trauma.

But the brain and body don’t work like that. While those of us with stable housing or relationships may be less likely to experience trauma or stress, our nervous systems aren’t designed to tease out nuances of privilege. The body just experiences a flood of stress hormones like cortisol or adrenaline. The body just knows we’re depressed or anxious. The body knows we don’t feel okay, even if we try to use our intellect to convince ourselves we should feel differently.

And the research shows that judging ourselves for our responses and reactions don’t actually do much help.

Instead, I try to help clients cultivate neutrality or even self-compassion for our experience. It’s only by accepting what’s here – the pain, the suffering, the fear, the sadness – that we can begin to move through these difficult feelings. It’s only by acknowledging what’s true for us – whether we like the truth or not – that we can begin to move forward.