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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
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!)

Prepping for COVID Winter and an Unusual Holiday Season

Now that election season is almost over, it’s time to prep for COVID winter. Anticipating and preparing for the mental health (and life) challenges of a COVID winter is a must – especially if you’re worried about stress, Seasonal Affective Disorder, depression, anxiety, or increased isolation. Being proactive about mental health isn’t always at the top of our list (especially when the to-do list is LOOOOONG) but our efforts NOW can pay off in important ways.

The Mayo Clinic has this helpful list of suggestions for prepping for COVID winter. One recommendation that stands out is that we should EXPECT that our winter holidays are going to be different. Let’s wrap our heads around that now: our winter holidays will not be the same as usual. We’ll have to adapt traditions that typically involve family and friends or let them go altogether, at least for now. We may not get to have big Hanukah or Christmas parties, Kwanzaa celebrations, Christmas caroling, or New Year’s extravaganzas.

You don’t have to be happy about these traditions going on pause. In fact, give yourself some time to feel grouchy about these losses. (They ARE losses!) It’s hard to move forward if we don’t first mourn our losses. So, here’s a tip: allow yourself a day or even a week to feel all the feelings, whether it’s annoyance, frustration, sadness, anger, or depression. These losses of tradition are worth feeling bad about. (And for those of you saying “But I can’t! Other people have it SO MUCH WORSE” — I appreciate your consideration of others, but stop with the Privilege Syndrome. You trying to convince yourself you have too much to feel so bad doesn’t help anything… and actually gets in the way of letting emotions move through you in healthy ways.)

After that day or week of allowing all the feelings, THEN it’s time to look forward.

First: when it comes to the holidays, allow your imagination some room to roam. If you’re not doing the usual things during this holiday season, what might you be able to do? What might you want to do? What new traditions might you want to create? In other words: what opportunities can you find in the space that COVID has created?

Finally, when it comes to the possibility of anxiety and depression emerging or getting worse, you can be proactive here as well. What extra care do you need that’s realistic? Care can take a lot of forms: checking in with your doctor, taking vitamins, using light therapy, hosting Netflix parties or virtual game nights, and so on and so forth. Make a list and ask friends or family members for their ideas as well. And then put that list somewhere you can regularly see it (like a bathroom wall or on the refrigerator) so when (or if) the winter doldrums hit you don’t have to use energy to think – but can instead just act on the ideas you’ve already brainstormed.

I hope these tips are useful for you! And please reach out if we can be useful to you in other ways.

Yes, you can be “successful” and feel like shit

Yes, you can be “successful” and feel like shit

Restauranteur Chef David Chang has it all. At least on the surface. He’s the founder of a gazillion restaurants, is star of the TV show Ugly Delicious, and has won too many awards to count (really). He. Has. It. Made.

Except he doesn’t. In recent interviews publicizing his new memoir, he’s naming what’s been beneath the surface even as he’s been accumulating accolades: depression and bipolar disorder. I was really moved to hear this interview with him, and in particular his naming that professional success is not a protective factor when it comes to mental health. In other words – it’s great if you’re rolling in money, and have an awesome job, and people adore you. But checking off those boxes and looking good on paper, on the surface, doesn’t guarantee ANYTHING about your mental health.

I’m so glad David Chang is speaking up. So many of my clients believe they “shouldn’t” be feeling like shit because their life looks good on paper. (And there are some specific barriers that get in the way of Asian Americans speaking up about mental health challenges.)

I’m grateful for all those famous folks like David Chang who are speaking up about their experiences with depression (including Trevor Noah, Michelle Obama and Lady Gaga, to name a few). Each person who speaks up helps reduce the stigma of mental health challenges. And when we reduce stigma, we bring light to darkness – and it’s THEN that we can get and receive help.

David Chang at one of his massively successful restaurants.

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.

Staying Safe Means Staying Sane – Virtual Therapy in COVID Insanity

How do we stay sane during a pandemic? It’s not just a rhetorical question. The CDC’s thinking about it and offering advice. And for good reason. In virtual sessions, my colleague Maggie Akstin and I are helping clients respond to unexpected financial instability, changes in routine, job losses, grief, and uncertainty about the future. These are all things that can understandably make calm people anxious and depressed – and can make people already vulnerable to depression and anxiety pretty fearful about their own sanity. Oh, and that brain fog you feel making it hard to get anything done? It’s real. So is moral fatigue, especially in places like Atlanta where politicians and public health officials are offering contradictory advice for us to sort through.

Here are a few suggestions I’m offering clients:

Seek out things that make you smile and laugh. Puppy cams and silly memes are two possibilities. It may be that you have a dog at home ready to help with this. Good boy, Harold!

Be realistic (and kind to yourself) about all the COVID projects you may be tempted to take on. Sure you *may* have more time on your hands – but what about your energy level? Do you really need to learn a new language right now? If you start something and then realize it’s adding to your sense of overwhelm, instead of helping you feel sane, then please stop or scale back. SMART goals are realistic, and what’s realistic for each of us today may be different than it would have been two months ago.

Pay attention to what level of news consumption is useful – and what level is making your anxiety creep or jump up. Experiment with which ways of getting the news work best for you and your sanity (podcasts vs. TV vs. internet vs. scrolling vs. newspaper). If you get notifications on your phone, consider turning them off.

Go outside. If it’s safe to do so, take a walk and spend some time intentionally looking around – find all the flowers you can find, notice the shapes of leaves on trees, and see if you can sense the movement of air on your hands.

During abnormal times, it’s normal to feel abnormal. Stop beating yourself up about it if you can (and it is easier said than done).

Finally, remember there is support available for you (including therapy). You may have always thought “I’ll never go to therapy” or “I’ll never need therapy” but you also may never have thought “will there be toilet paper at the grocery store?” These are humbling times. Don’t let pride or ego get in the way of what’s best for your sanity. (And by the way – most therapists – including us – offer a sliding scale. Reach out for details.)

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.

Family Therapy Works!

There’s a lot that I’m not intimidated by. While I’m naturally a bit introverted, I’ve worked hard to talk in front of groups fairly comfortably. I’m not scared of Atlanta’s parking garages, elevators, or boats (unlike certain family members). I don’t enjoy shopping, but I can hit up an Ikea and come out alive and well. In my therapy practice, I can comfortably help clients tackle sticky issues like challenging relationships, infertility, abortion, depression, grief, and trauma. But what puts fear in my heart?

The idea of being in counseling with my parents.

And I’m not the only one. Quite often when I’m working with a kid or teen, I mention that a few family counseling sessions might help with improving communication or clarifying expectations or figuring out how to respectfully disagree with one another. And then I watch those teens as their faces go from open and interested and curious (because after all, teens are awesome if you’re not their parents) to shut-down, please-Dana-don’t-make-me-you-must-be-crazy-if-you-think-I’ll-do-that.

And I get it. Family therapy can be intimidating. Kids worry they’re going to get teamed up on or lectured. Often they hate their parents seeing them emotional and would really rather not cry in front of their parents. Teens already recognize there’s a lot they don’t control in their lives, and family counseling can appear—at first—to be another place where they won’t have control or a voice.

And yet. And yet. Family counseling can be powerful: healing, reinforcing and strengthening relationships, shifting communication patterns to be more healthy and constructive, and building trust and mutual respect. Kids and teens find they have a voice and relax as they see their parents listening to them; parents find that their kids can hear them differently through family therapy. Together, we make strides to strengthen the family. Because at the end of the day, none of us lives in a vacuum. We’re all connected. So let’s work on being connected in healthy, happy ways… even if it’s intimidating at first.

Let’s have more moments like these, okay?

Revisiting Habits, asking “How’s This Working For Me?”

A month ago I went cold turkey.

No online, paper, or radio news.

No social media.

No falling down the internet rabbit hole.

It wasn’t a particularly well-thought-out, planned-for decision. (Which defies everything we think we know about habit change – right? Conventional wisdom is that habits are easiest to change if we have a plan, have prepared, told significant others, have figured out alternatives, etc.)

But I had no plan. It was an impulsive decision, and I had prepared no one, including myself. I just knew that I felt attached at the hip to the news cycle, and wasn’t sure if it was serving me even though it’s easy to believe that we “should” be paying moment-to-moment attention. Life felt loud, like a bunch of clanging bells always ringing, shaking me out of my own thoughts and efforts. I felt attached at the hip to social media because of FOMO, but didn’t find myself happier or more connected as a result. (The research supports that anxiety and depression and isolation can actually increase because of internet usage!) I’m not morally opposed to the internet, and am grateful for the amazing things that happen on it and because of it. I hold no judgments of other people’s internet habits, but was finding that my own habits weren’t feeling particularly skillful. In other words: was it really worth the time and attention I was giving it?

Now, it’s been almost a month and I find that the impulse to open news and social media websites has mostly faded. Sometimes I find myself staring at my email, wanting there to be something entertaining and new there that somehow I missed, but then I realize – oh, I’m tired – or, oh, I’m not doing anything – and close the computer. Somehow, taking a sabbatical from most of my online world has reduced my stress and quieted the clanging.

I don’t miss the news. I hear from friends or family about what’s happening politically, and am concerned but also don’t miss the roller coaster ride. I’m finding other ways to be involved and engaged – reading more books (like The New Jim Crow and Mindful of Race), getting together more with colleagues, and listening to a series of Tara Brach’s lectures on Mindfulness and Psychotherapy. Somehow it seems like I’m experiencing more spaciousness as well – perhaps because I’m bombarding myself less with stimuli. I certainly don’t feel worse. If anything, I feel a bit healthier – a bit more here, in the present moment, with therapy clients and when I’m with family or alone.

My experience has reminded me that taking a step back to assess a part of our life – even a minute, mostly inconsequential part – can sometimes be useful. In the words of America’s favorite non-therapist therapist, Dr. Phil, “How’s that working for you?” He’s cheesy as hell, but it’s a great question.