Breaking the Cycle: How to Treat Addiction



Learning about addiction is one thing. But treating it is something totally different.

A few weeks ago I wrote an article about addiction that you can read here & today I'll discuss how to treat it. 

For many addicts, addiction has stripped them from love, support and connection. Too often I see those experiencing the isolation that addiction causes; from family cutting ties, employers letting them go, or simply society distancing itself from a person labeled as an “addict.” Sometimes this isolation can create a sense of desperation for the individual and in turn a desire to seek treatment but unfortunately, it can just as likely lead to overdose and death. One of the most common phrases I hear from patients is their loved ones saying “if you love me, you’ll stop using.”

But in reality this assumption falls flat.

Anyone who is an addict will tell you that they didn’t just wake up one morning and think, “today is the day I become an addict and isolate myself from my friends, family and everything I know and love.”

How do we help those suffering from addiction?

This blog's most important lesson: addiction is treated with an open mind, love, support and connection to community.

It’s the only way for someone in addiction to experience recovery. Yes, in actuality, there are numerous ways to treat addiction from support groups to treatment centers – all of which I’ll discuss briefly – but I promise you, none of those are effective if a foundation of love, support and connection isn't created.

So what do we do? We reach out and keep our arms open. Even if the person is in addiction and doesn’t want help, you make it known that you’re still there for them and you will continue to be when they do want help – You continue to love them! If you remember nothing else from this article remember that!

Why addiction detox is important

Coffee. Have you ever been without it for a few days? It’s terrible right?! The headaches you experience can stay with you and seriously put a damper on your whole day. Those headaches are a direct response to your body withdrawing from caffeine.

Now imagine what it must be like to stop taking a drug like heroin or Xanax – headaches are just the beginning and the end could result in death if not careful treated. Not everyone in addiction requires detox but coming off of/withdrawing from substances like opiates, benzodiazepines, and even alcohol can be lethal if not carefully weaned off of. So, when an addict is finally ready to seek help, their first step towards recovery starts with safety. Depending on the length of use and the type of substance being used, your loved one might need to go to a Detox facility. These facilities are designed to monitor their patient’s vitals and slowly wean them off the drug(s) they have been using.

The best way to know if you or your loved one needs medical detox is to get a consultation with a medical professional who is familiar with the signs of dependence and substance abuse.

Treating addiction: Choosing the right program

The next step towards recovery can be the hardest and most daunting for those in addiction and the people closest to them. This is because at this point in recovery there are several options to choose from and research varies widely in regards to the best option. There are some organizations that mix and match or even combine these different options but primarily treatment can be broken down by levels of care (i.e. levels of intensity/structure).

From the most intense to the least invasive types of care, the treatment options are as follows: residential treatment, partial hospitalization programs (PHP), intensive outpatient programs (IOP) and traditional outpatient counseling and psychotherapy.

How do residential addiction programs and treatment centers help?

There are countless treatments centers each with their own way of treating addiction but the best programs focus on two things; education and connection. During their time in treatment, addicts will learn the cycle of addiction, how substances affect their body, how relationships (family, friends and significant others) can perpetuate and/or prevent relapse, coping skills/grounding techniques to help manage stress and cravings, and so much more.

Depending on the program they might also learn about the 12 steps and how to connect with a power greater than themselves. The second point of focus is connection. Throughout treatment, they will be establishing and growing a network of sober social support. This network will consist of the individuals they attend programming with, the staff that work at the treatment center and the people they connect with if they attend any outside support groups for people in recovery ((i.e. Alcoholics anonymous (AA), Narcotics anonymous (NA), Cocaine anonymous (CA), etc.)) which is a critical component in the prevention of relapse.

It is up to all of us to ensure those seeking treatment for their addiction feel supported and loved throughout their recovery process.

To schedule an appointment with Kendall Campbell, LMFT-Associate, call 512-920-3654.

Logo Only Small.jpg

The Practice ATX


The Long Road Ahead: How Harvey and Irma Survivors are Grieving and Surviving



While we may be past the initial shock of hurricane Harvey, the lasting impact of such a tragedy is something we must all cope with. 

Whether they were evacuated themselves or knew someone who was or didn’t know anyone, many of my clients continue to be emotionally impacted by the effects of such a traumatic event in our community. Here are a few questions to think about in terms of grief associated with the kind of loss hurricane survivors might be experiencing.

How do survivors of trauma grieve?

Grief is a deep sorrow or sadness and usually associated with the death of a loved one. This is an obvious and appropriate understanding of grief for some hurricane survivors. But there is another kind of grief that a large portion of survivors are living with called unresolved grief. Unresolved grief can happen because of many different life events or in one traumatic experience. The grief hurricane survivors are dealing with is ongoing. For them, life is described as “before Harvey” and “after Harvey.” Everyday they face the reality that whatever normal they knew before Harvey, will never be again; there is only a new normal, a new reality.

They aren't just mourning the loss of homes, material things and people; they're mourning the way their daily lives looked and felt while being forced to lean into a new reality.

How do I help those whose grief is unresolved?

Empathy comes from the ability to see or feel another person’s experience or perspective.

When was the last time you didn't have a roof for your children to sleep under? How would you feel if you had nothing to feed your baby and no diapers? Can you imagine telling your child that you wont be returning to your same school or home because its not longer there? Can you imagine what it might have felt like to hunker down to ride the storm out, constantly checking the radar for tornados, not sure if your house would flood to dangerous levels, trying to calm frightened children for several days?

You can imagine the impact that kind of stress would have on the mind and body. This kind of trauma can have a lingering effect on survivors and inspire a wide range of emotions. Many people who experienced Hurricane Harvey have seen destruction and felt fear we have not; with that comes a harsh disillusioned experience of human suffering and emotion. Compassion is empathy, understanding is empathy and acceptance is empathy.

How can I support and help others cope with their new reality?

Everyone has basic needs, and some are more urgent than others. Are their basic needs being met? It might be that a family still isn't sure how they will feed themselves in the months to come with no home and no jobs. How can you help ease their transition?

You can help others cope by asking questions. Ask them to specify exactly what they need or how you can assist.

Ask about their experience. No two hurricane survivor stories are alike. Allowing people to share a story invokes a sense of community, love, empathy and respect. Hearing an individual’s or family’s unique experience create community and support by giving them a place to be heard.

Point out their resiliency and strength. Show appreciation for their endurance and will. 

As more time passes it’ll continue to be business as usual for us, but remember that survivors are living their new reality in the midst of grief, loss and transition. And while they may not ask for it, they’ll still need our support, encouragement and empathy as they carve out a new and different “Post Harvey” life. 

Practice compassion, understanding and acceptance.

To schedule and appointment with Caroline Harris, LMFT-Associate, call 512-861-4131.

Logo Only Small.jpg

The Practice ATX


7 Time Management Tips to Help Your Work Week

Monoar Rahman/CC0

Monoar Rahman/CC0

Time is a coveted resource. More time to travel, more time to work out, more time with loved ones, more time to check boxes off our lists, more time to rest and the list goes on. We have the same amount of time each day, yet some days feel more productive than others. So is it really about the time, or is it what we do with the time that truly makes the difference?

Why is time management so difficult?

We over-commit. We stretch ourselves too thin. We struggle to prioritize. We put things off. We don’t set goals. We’re overstimulated. – Needless to say, there is an extensive and exhaustive amount of things that demand our time. Some of our time consumers feel like a choice, like having fun with friends. Other things feel like we have no choice, like meeting a deadline at work. So how do we balance those facets of life that we choose to spend our time on versus those that are required of us and can they coexist?

Consider your values. I find this is a helpful place to start since many if not all of our choices are fueled by our personal beliefs. What’s important to you? Dig deep here because when you start to explore this question, you’ll likely discover where your priorities lie and in turn start to find clarity on where you’d like to actually spend your time.

Why is time management important?

When we choose carefully, we feel more accomplished, productive and fulfilled, and you’re the only one can decide what that means to you. When we consider what’s important to us, we’re able to prioritize where we’d like to spend our energy.

When we know where we’d like to spend our energy, we’re able to better outline our day in a way that leaves us feeling satisfied and content once it comes to an end. When we feel accomplished, we have a higher sense of self-worth, confidence and mental wellness, which diminishes our stress levels and leaves us feeling happier and healthier. This fulfillment replenishes our energy stores and helps us stay motivated and focused. When we aren’t refueling our energy stores, we end up feeling more stressed and as a result.

What are some time management tips?

  1. Explore your values: As described before, this can serve as a helpful step to painting a clearer picture of where you’d like to spend your energy. When we align our lives with our values, our hearts feel fuller, our minds feel nourished and our lives feel richer.

  2. Set small, attainable goals: When we break down a larger goal into small, more approachable steps, we gift ourselves the opportunity to not only reach them but feel more accomplished as a result. When we attain these smaller goals, we consequentially feel more inclined to keep working towards the bigger picture and are more likely to reach it!

  3. Say "No.": How many different directions is your energy being pulled? Are you committing to too much and spreading yourself too thin as a result? Saying no can be difficult and can feel more like an energy drain than actually just doing whatever you are contemplating. But when we allow our bodies space to breathe, we feel more rested, rejuvenated and less stressed. Give yourself the space you need.

  4. Delegate tasks: Do you really have to do this ALL on your own? Asking for help can be tricky for some, but surprisingly enough, people are more willing to help than we may think! We have a tendency to get into our own heads about the burden it might cause or what it might say about us if we reach out, so instead we suffer and stress and push ourselves to the breaking point. Sounds silly right? Ask for help and share responsibilities if you can - relinquish some of that weight, you are not alone.

  5. Schedule realistically: Many of us frequently overbook ourselves thinking we can do it all. Maybe it’s a fear of missing out, or maybe it’s because we really want people to know how much we care? Whatever the reason, think about how you are spending your precious time. Are you going to enjoy your massage at 530PM if you know you have to be at dinner by 545PM? Probably not. Schedule according to your priorities and make time to be as fully engaged as you can be with them.

  6. Take a break: Self-care is so important here. When we are pushing ourselves to meet deadlines, or filling our schedules with coffees, lunches, dinners, dates, etc. we are depleting our energy and are emptying our cup, leaving us feeling drained and moody. Make sure to take time to practice self-care to restore your levels. Remember, you cannot pour from an empty cup.

  7. Limit distractions: Life demands our attention. There’s no question about that. But are there things in your space that are attempting to distract you from your focus? Silence your phone when out to dinner. Turn off the TV when working on a blog (uh hum..). Do what you need to do to minimize as much stimulation as you can so you may be as fully present as possible in whatever you are choosing to spend your energy on.

Remember, life happens. It can be hectic, busy and exhausting at times. So allow yourself some grace during those periods. Be as flexible as you can. I encourage you to lean into that unpredictability and check in with what you may need before hopping back into your to-do lists.

To schedule an appointment with Alyssa Cornett, call 737-226-8803.

Logo Only Small.jpg

The Practice ATX



4 Ways that Listening Helps Relationship Communication



Listening is the foundation of all good relationship communication.

Many couples I work with often list “communication” as one of their struggles- listening is not as easy as we may think sometimes! Poor listening can lead to partners feeling unloved or unimportant. Good listening can lead partners to feel more connected and can minimize conflict that results from poor listening.

We all know what it feels like to be in a heated discussion and sense our partner isn’t listening. When you ask if they are listening they say, “Yes! I’ve been listening to everything you’ve been saying…” Only then they quickly jump back with arguments to what you have just shared. It’s frustrating to say the least and when this frustration begins to brew so does the conflict.

How is listening different from hearing?

            Listening is a choice. Hearing is not. I can hear my husband vent to me all day long but not truly listen to what he is saying or pick up on what he needs. The whole time he is venting I could easily be thinking of many ways to disprove his points. If I am hearing to disprove and win the argument I am not listening. I am focused more on my own thoughts and feelings versus his. Listening means you focus on your partner’s thoughts and feelings. You will get a chance to respond but wait until you have a good understanding of how he or she feels and why.

How does listening work in intimate relationships?

            Effective listening takes practice, and I think we sometimes have to sort of train ourselves to shift away from simply hearing to actively listening. To help you shift into becoming a better listener here are three steps to try out to make listening more effective:

1. Listen for what's being said:

It’s often easy for people to switch into lawyer mode to try to find numerous ways to disprove what the other person is saying- to interrogate.

It may seem more natural to do this than to focus on just hearing and taking in what the other person is actually saying. Think of how your listening may change if you took more of an interviewing approach versus an interrogative one. Switch your mindset from the lawyer mentality to the curious listener. It will help put potential defensiveness and interruptions aside.

Your curiosity will keep the focus on your partner and how he or she is feeling and why. You can ask yourself why is he/she upset? What specifically happened to cause him/her to begin to share what is on his/her mind with you? What is it that he or she needs from me? While these may be questions you're internally working to find the answers to, it also doesn’t hurt to ask these same questions if you feel your partner isn’t clear. It's important to uncover all of these answers before trying to jump to solving whatever problem at hand- you may be solving for the wrong problem if you jump too soon.

2. Listen for what's not being said:

Sometimes it takes more energy to clearly communicate your needs to your partner versus just venting and exploding with emotion. It's likely there are times when the affected person shares just the surface level frustrations but may leave the depth of their concerns out.

Be curious about what they may be trying to say but unable. Body language will be helpful here. Is she crying? What do the tears mean?)Is he looking away? Does she feel safe? Does he feel ashamed? Is she fidgety? What may be causing him to feel nervous or anxious? Asking questions about what is not being said can help the other person sense your concern and attention on getting to the depth of the emotion she is experiencing. Notice again that all of your attention is on your partner.

3. Listen to what the other person is feeling.

Sometimes, your partner will tell you specifically how they're feeling, and other times they may not. When I work with couples, there are often challenges with people being able to focus inward and to express “I am feeling (insert emotion here).”

Intense emotions can cause people to be flooded with emotion, which may lead to pointing fingers and defensiveness. Notice that the pointing fingers and defensiveness may mean your partner needs more validation. Although it's still up to them to tell you what they need, you can help them by actively listening well.

When people make it a point to bring something up for discussion they're doing so with the need for some type of validation. Listening for what he is feeling will help you be able to validate his emotional experience. Someone once told me “validation is not agreeing” and this is huge when it comes to listening. If my partner is angry with me for being irritable and I say, “you’re mad because you feel like I’ve been irritable all day” this does not mean I agree that I was irritable. It means I am validating that he is mad and that I have heard and validated his concern. Once those concerns are validated, the emotional flooding can subside and make room for problem solving together.

4. Multi-task

Here's the hardest part. When we listen, part of what we have to do is manage how we feel so we can put our agendas aside. It may sound weird, but we often forget that we feel upset by what our partners say to us. The key to listening well is to be aware of how you feel, even if those feelings are negative. Then, hold off speaking up about those emotions and keep listening like a curious witness to your partner. Do two things at once: listen and self-regulate.

            Listening isn't always as easy as we would like it to be and that’s because emotion is involved. It clouds our headspace. Recognizing this cloudiness in your own mind during conflict can help you focus back on your partner and what’s being said, what isn’t, and his or her emotions in need of caring for. Listening more can open up more room for connection and less room for conflict.

To schedule an appointment with Mandi Roarke, LMFT-Associate, call 512-537-0995.

Logo Only Small.jpg

The Practice ATX


How to Win a Guilt Trip

Image by Pixabay/CC0

Image by Pixabay/CC0

We guilt trip ourselves more often than we guilt trip any other person, partner, friend, family member or colleague. And we’re losing. ALL. THE. TIME. If we’ve been told how manipulating and hurtful it is to do to someone else, why do we do it to ourselves?

Where does guilt come from?

There are endless ways we guilt ourselves: “Did I tip enough?” “I should’ve responded to that message sooner.” “I shouldn’t have eaten all of that.” “I have to stay home with the baby.” “I’m exhausted, I’ll do it tomorrow.” Sound familiar? Guilt has a way of building up, sneaking in and often unexpectedly settling in our bodies in ways that we tend to negate - an inward struggle for a murky outward experience about something we did or didn’t do. Kind of sounds like a lose-lose right? So how do you actually win with guilt? Hang tight, you’re in luck.

What does guilt feel like?

Our bodies recognize guilt as a less than desirable emotion – in short, it hurts. But when we experience this hurt, are we actually feeling guilt or is it shame rearing its ugly head? Brené Brown shares that the difference between shame and guilt is the difference between ‘I am bad’ and ‘I did something bad.’ Take that in for a quick minute because we’re on the verge of a perspective shift here.

When you imagined the examples described before, what came up for you? Was it uncomfortable because it challenged your values? Or was it unworthiness because you felt flawed? If it was discomfort – that’s guilt. If it was a lack of worth – that’s shame. Neither feels good, but there is a difference.

Why is guilt important?

So what does this difference mean for guilt? Guilt is uncomfortable, but it has a purpose. When we experience guilt, we are gifted with the opportunity to adjust our actions and behaviors because we have held something we’ve done (or not done) up against who we want to be. Does this mean that guilt can actually be…good? In moderation, yes! When we feel guilty, we are given the chance to acknowledge the values we cherish, actively shift gears and evaluate what we could do differently and how. In other words, we create change.

By implementing healthy changes into our lives, we improve our sense of mental, physical and emotional well-being.

How does guilt impact me?

Imagine being confronted by a wild lion. Your body would immediately goes into survival mode. Your survival instincts would kick in to make you think and react super fast. Guilt is like that lion. It increases the same stress hormones – cortisol and adrenaline. Although these hormones can be helpful when we need to protect ourselves, avoid danger, or fend off immediate threats, they can be damaging in large amounts. Imagine if you were standing in front of that lion for hours on end! Your body would go into a consistently flowing state of survival. Imagine the exhaustion.

This is what it would feel like to be overwhelmed by guilt. When we have prolonged exposure to these hormones, our blood pressure increases and heightens our risk of heart disease, diabetes, depression and anxiety. Learning how to decrease our guilt will help our bodies respond in tandem and improve our overall health and wellness.

So how do I get rid of guilt?

I think it’s safe to say that it’s difficult to rid yourself entirely of guilt. But there are things you can do to diminish it in order to live a healthier and more fulfilling life.

  • Acknowledge when you feel it. This awareness will help you identify the underlying meanings to the guilt you are feeling and discover if there are conflicting values being challenged.
  • Stop ‘should-ing’ on yourself. Social constructs demand a lot from us. Do what feels good for you and be compassionate with yourself along the way. Those outside pressures can make the guilt feel that much more difficult to break free from.
  • Practice self-care. When we take time for ourselves, we are allowing our bodies to rejuvenate so we may fully immerse ourselves into the lives we choose to live. If we don’t allow time for this, we are essentially pouring from an empty cup.
  • Use guilt as a motivator for action. If you are consistently feeling guilt over a similar topic, listen to that guilt and begin to implement small changes. When you take small steps towards a larger goal, you will begin to feel happier and more balanced.

You wouldn't guilt trip someone else. So why do it to yourself? Be curious about guilt. Ask what purpose it serves, and then take action. Be watchful that guilt isn't actually shame in disguise and practice self-compassion and letting go. Here's to winning your own personal guilt trip!

To schedule an appointment with Alyssa Cornett, LMFT-Associate, call 737-226-3803.

Logo Only Small.jpg

The Practice ATX


How to Be There for Someone Who's Lost Everything


Many of us at The Practice have loved ones who've been impacted by Hurricane Harvey. And now with Hurricane Irma on the way, it seems like there's no one who'll escape the trauma of these massive catastrophes. It's hard to know how to be there for someone whose whole world has been turned upside down by a national tragedy, a personal tragedy or some other kind of trauma. The good news is that it doesn't take much to be there for someone when they need you the most.

Sometimes simply acknowledging loved ones’ struggles can help them continue to push foreword. Try acting as a sounding board. Avoid the urge to fix their problems with advice. Be patient enough to allow them to come to their own solutions.

You might say… “I am here.”  “I truly care.” “ Please tell me what this experience is like for you.” 

 When should we talk about it?

It can be very tempting to remain silent until your loved ones ask to talk. However, ignoring the elephant in the room is not helpful for people in crisis who desperately needs to know others care. It is often a huge relief for people dealing with grief to simply be given the opportunity to talk about their loss. 

You might say… “ I am grateful you are safe.” “I am so sorry this is happening.“ “I would like to hear about it when you are ready.” 

What should I avoid saying?

·      “Don’t cry. It will all be okay. ”

·      “It could have been worse.”

·      “Oh, you poor thing.”

·      “ I know exactly how you feel right now.”  

·      “God has a reason for doing this.”

·      “You should have…”

·      “You should do…”

These are commonly heard attempts at comforting people.  However common and well intended they are, these attempts often send messages we do not mean to send. They can be interpreted much differently on the receiving end…

·      Button up those emotions because they are making me uncomfortable.

·      You do not have it as bad as others, so you should just be grateful and not sad.

·      I am superior to you and am pitying your life. 

·      I have done it before, and it is not that big of deal. 

·      God is mad at you and is punishing you. 

·      You were not smart enough to protect yourself from this loss.

·      I know more than you. You are not capable of taking care of yourself.

Try holding space for someone instead.

Holding space is like offering to sit with someone in their grieving process or walk alongside them in their journey to healing without trying to fix them, without making them feel inadequate, and without trying to change their actions or the outcome of their journey. Holding space means sitting with someone’s pain with ears and arms wide open.  Holding space means asking to learn about their heartbreak while letting go of any desire to criticize them or control the outcome. 

You might say… “ I cannot imagine what you are going through. Help me understand.” 

“ You are not alone. I am here with you. “ “ My heart feels broken for you.” “ I really value our relationship and am glad you are sharing this with me. “ “ What can I specifically do to help you in this time?”

Being the trail guide with all the directions and answers can be stressful. That kind of pressure could prevent you from getting close. Walking next your loved ones as fellow trailblazers on their journey to healing can be much less daunting.  Showing up in this way will likely help both you and your loved ones experience a stronger sense of support and togetherness. 

To schedule an appointment with Lindley Domingue, LMFT-Associate, call 512-953-7085.

Logo Only Small.jpg

The Practice ATX


What Does Criticism do to A Relationship?

Image by mrdonduck on Flickr

Image by mrdonduck on Flickr

Criticism is a not-so-silent destroyer of relationships: relationships with your partner, friends and family or even with yourself. Destroyer is a pretty bold way of describing what criticism can do to relationships but in my work with individuals, couples, and families, I have yet to see a positive outcome from criticism.

Some people may think if they don’t share criticism with their partner that nothing will ever change for the better in their relationship. This is when the meaning of criticism versus feedback gets mixed up.

Why is criticism destructive?

Criticism is when you are clearly showing your disapproval of something or someone due to perceived faults or wrongdoing. I think of it as when someone just wants to pick apart a person or a situation with a tone of “I’m picking you apart because I disapprove…”

Maybe it is due to anger, insecurity, sadness, loss of hope, or a tendency to always be critical of one’s own self and others. People who are more critical in their relationships have often been surrounded by criticism their entire lives (their upbringing, friendships or work group). Criticism becomes the way in which they try to give what they think is feedback to others.

There's really no such thing as constructive criticism. We don't have different parts of our brains that take things personally and parts of our brains that don't. We have one brain. That brain goes with us to our business meetings, when we have sex and when we argue. So basically, that means everything is personal. Positive feedback, offered compassionately and carefully is much better, especially intimate relationships.

What's the difference between criticism and feedback?

            Feedback feels different. Even the word feels better to me- less attacking. Feedback is different from criticism in that you’re offering information about reactions you have to someone or something. And I think you may naturally be more compassionate with feedback because it is you offering your feelings versus pointing fingers immediately to someone or something else.  

To give good feedback, you have to turn inward and asking yourself what it is you need (maybe more of the same or something different) and then express this to your partner, or friend, colleague, or family member. It’s vulnerable.

How do I overcome criticism?

I struggle to recognize when criticism isn’t destructive. Maybe you can relate: I’m most critical of myself when my relationship and my surroundings aren’t the way I want them. It can be a vicious cycle when you pick yourself apart for not meeting expectations, and nothing else in your life seems to be going right either. Beating yourself and your relationship(s) up doesn’t feel good to anyone, and self-esteem and relational strength can suffer. So any time criticism starts knocking on my door I have to tell it to go away and focus inward on what I need- feedback.

Maybe this feedback is just for myself. Like, “Hey Mandi, you’re doing good enough. You got this.” Maybe all I really need is to recognize what I am doing versus what I’m not. Maybe offer myself a little compassion.

In my work I look for where more compassion is needed. It may be some clients need more self-compassion and others need more compassion from the people they love. Sometimes people get into a rut where the world seems really negative and they’re only aware of when things go wrong.  And sometimes, after years of history and experiences, the tone of a relationship has evolved into just a critical one.

Criticism can become the default to how one communicates with him/herself but also with his/her partner. It’s like an infection in the relationship that has now taken over and the fever isn’t fighting it, but feedback can.

So, look inward for some feedback.

Ask yourself: What is it that you are feeling? What is it that you need- from yourself or from others? What is a realistic expectation for yourself and others? This inner dialogue can help you slow down a rapid-fire critical response to a more compassionate one.

Ask your partner the same questions and ask your partner to do the same. Look inward some feedback. Criticism can go away now.

To schedule an appointment with Mandi Roarke, LMFT-Associate, call 512-537-0995.

Logo Only Small.jpg

The Practice ATX


Five Steps to Make Back to School Simple

Image by U.S. Dept of Education on Flickr

Image by U.S. Dept of Education on Flickr

Ya’ll. It’s back to school time and maybe this year we can all decide we’re not going to freak out.

As summer winds down, we usually start to notice clients have a shift in energy around family relationships and transitions. Its a new school year! New teachers, new faces and new classrooms. Getting back to school and starting that new fall routine can be stressful, for kids and parents alike.

Back to School Stress: You’re Not Alone

Summer brings looser schedules, family trips, camps of all kinds, later bedtimes and more ice cream— all of which can be fun, relaxing and hectic all at the same time. Fall brings seasonal changes, earlier bedtimes, new subjects and more homework than last year. It also means potential anxiety for parents— worrying about how our children will adjust in the first weeks of school.  Its no wonder this time of year can be a challenge for everyone in the family!

The good news is you are doing the best you can. The better news is you're not alone. We can all do something different to our daily routine to make life easier, but its not always simple figuring out what to change. Especially when you're in the thick of a transition. 

How to Make Back to School Simple Again

  1. Talk about it - when was the last time you talked with your child, really with them? When the day gets busy with extra curricular activities, chores and homework it’s easy to focus on the day’s lists. Is your homework done? Do you like your teacher? Did you take out the trash? Try asking questions that encourage your kids to actually tell you more than the dreaded one-word answer. Tell me more about your day. What was the best part of your day? What was the most challenging? Is there anything I can help you with?
  2. Take it slow, day by day - Change doesn't happen over night and neither does adjusting to a new school environment or home routine. If someone doesn’t cooperate with the new divvied up chore list, roll with it and try again the next day.

  3. Create new family traditions, or stick with the old ones, just do something- Consistency and predictability are key here. Is Wednesday night make your own pizza night at your house? Great! Your children and spouse will know they have guaranteed family time. When you build in consistent routine time together it allows your children more autonomy to decide when or if they need to talk to you about something. They might wait to bring up a school issue until pizza night, or if its something more pressing they’ll bring it up sooner. Either way, guaranteed quality time creates safety and comfort for your family.

  4. Build in time together that doesn’t focus on school - easier said than done. Especially given multiple children and working parents. Everyone needs one on one time with family members. Parents and children and spouses. Kiddos have enough pressure from teachers and the school system about their grades and behaviors, sometimes they need to focus on something else. Spending one on one time together is great way to let them do that. For busy working parents, even a small amount of time helps. If both parents help at bedtime, then parents can trade off each night doing something pleasurable while the other plays the task manager role. If you’re a single parent and can’t depend on support, make five minutes an evening your goal. Even a little bit makes a strong impact.

  5. Get a family calendar - ugh, organization. It helps though. A calendar of schedules, trips planned and household duties supports the predictability in the new family routine. Maybe your calendar includes consequences for certain behaviors. If it’s written out for everyone to see, there’s no question about what consequences result from specific behaviors. In my work with teens, I find this really helpful. They can know, for sure, if they chose to do xyz behavior or skip school, their grades start to fall, insert your own idea of problematic behaviors— the consequences are clear.  The cell phone is taken away, tv time is cut in half, they are grounded from social activities for x amount of weeks. You get the picture.

Consistency Makes Back to School Simple

Laying the ground rules creates consistency and will likely relieve some of the parental anxiety that is associated with household daily tasks and consequences. Deciding what is best for your family and illustrating those values and rules through a family calendar or giant poster gives you a baseline for navigating daily family life. And theres no pressure if you stray from that baseline, but at least you always have a place to come back to.  

If these ideas don't seem to fit for your or your family, then I urge to think about your own time in school and how you managed transitions as a child or young adult. What do you wish your family would have done differently? What did you do well? How can you translate those experiences into your family life today?

Practice never makes perfect, but practice does make change. So give yourself break and pat yourself on the back, you're doing a good job.

To schedule an appointment with Caroline Harris, LMFT-Associate, contact us today at 512-861-4131.

Logo Only Small.jpg

The Practice ATX


What is Addiction, Really?

Image by Airpix on Flickr

Image by Airpix on Flickr

What is addiction like?

Addiction is like the matrix. You remember Morpheus, sitting in front of Neo asking him to take the red pill, or the blue one? People who suffer from addiction eventually feel like whatever substance their addicted to becomes their entire world. Heroin. Cocaine. Alcohol – all of these substances become the world pulled over their eyes to blind them from the truth. What truth? That they’re in pain. Or that they’ve experienced trauma. Or that life outside of their substance is very, very hard. Put simply, addiction is a process that occurs when a person becomes dependent on a substance to self-medicate emotion, pain, loss, stress, trauma boredom or other challenges.

We often talk about addiction and it's relation to drugs, video games, gambling, food or sex. Some would say you could be addicted to any of those items and others might disagree.

Regardless of what form you believe addiction takes, one fact will always remain; Addiction sucks. It’s an epidemic in our country and affects the lives of millions of people. Surprisingly, we tend to avoid talking about it. Sure, you hear about addiction on the news and see addicted people in movies and TV but when it comes to everyday conversation, we don’t talk about it, because maybe…we don’t know what to say.

Why don't we talk about addiction?

Like other forms of mental illness, it’s a stigma. We don’t talk about addiction because it often hits too close to home and brings up feelings of hurt, guilt, shame and sometimes embarrassment. But when we avoid talking about addiction, we isolate the people who need to be heard and we continue to create silence where we should be creating connection. There’s an estimated 23 million people battling drug and alcohol addiction in the United States alone. That’s about one out of every 10 people and damn close to the total population of Texas. T

o be honest, until I started working as a therapist at an addiction treatment center, I didn’t realize how far-reaching this illness spread, nor did I have a comprehensive understanding of how it affected addicted persons’ support systems.

Addiction needs to be discussed and normalized so that those affected by it feel safe to seek comfort from their friends, family and those around them when they need help. As a society, we can help bring addiction to its knees if we simply take a few minutes to educate ourselves about it.

What does addiction look like? Who does addiction target?

Addiction looks like a disease; like HIV, diabetes or cancer. While researchers and medical professionals are still unsure whether addiction should be classified as a disease, it seems to operate like one. Just like diabetes, addiction may be genetic, meaning your family history may increase your risk of addiction.

Like HIV, there is no magic pill or vaccine to cure it, only ways to manage it. Like cancer, treating addiction early is best to prevent worse outcomes. And finally, like any of the diseases mentioned already, anyone can be affected. Addiction does not discriminate between race, gender, religion, sexual orientation, economic status or even astrological sign. Addiction can affect anyone.

Why addiction is NOT a choice

No one chooses illness. This is true of addiction, just like it's true for other health challenges. While addiction usually begins with someone choosing a substance, the powerlessness over that substance isn't something anyone wants for themselves. It's a mental health challenge.

For someone in addiction, that first use stirs something up within them. It begins the phenomenon known in the 12-step community as the mental obsession.

The mental obsession is the notion that you have just found something [a substance] that has solved the answer to all your questions. Experiencing chronic pain? Here, take this, viola! All better! Tired of feeling alone, disconnected, awkward, anxious, fearful, angry, misunderstood, victimized, abused and/or unwanted? Not anymore you’re not. Suddenly – if only for a short time – you’re fixed!

But there’s a problem. The “fix” is only temporary.

Even when another option is provided, like therapy or medication, and problems start to disappear, an addicted person still poses the question of “Okay this is working, but what would happen if I drink now?”

How bad can addiction get?

When it gets really bad, drugs and alcohol become more than just a substance to be put in the body, they become the person’s identity; one, which overrides all other priorities like friends, family, and loved ones. Sometimes, the addict will still hear pleas to stop and calls of action to seek help, but feel powerless to do anything about it. This is because at that point the substance is no longer pleasurable, but rather it’s just a means to avoid, distract and/or numb problems and survive.  

The vicious cycle only begins to compound itself. Addicts will start to feel emotions like shame, guilt and misery even when using, knowing as well that the substance that once saved them, the substance that became ingrained into their identity, is now killing them and they have no means to stop it.  

It's at this point (hopefully) that they become, what those in recovery say, desperate for the psychic change. But it doesn’t have to be this way. Treatment can start sooner.

What else does addiction impact?

There’s so much to consider when it comes to addiction. Over the next month, I’ll be going more in depth about addiction and answering questions like, how does Addiction impact the family? How does Addiction affect marriage? And most importantly, how is Addiction treated? I hope you all enjoyed this post and I look forward to seeing your reactions and comments.

To schedule an appointment with Kendall Campbell, LMFT-Associate, call 512-920-3254.

Logo Only Small.jpg

The Practice ATX


When Anxiety Becomes too Much.

Image by Ryan on Flickr

Image by Ryan on Flickr

I don’t know anybody who hasn't faced anxiety.

Odds are you have suffered from anxiety, someone in your family has anxiety, and your friends struggle with it as well.  The truth is we all feel anxious during the day and at different times in our lives.  Sometimes it is manageable, sometimes we need help.

On any given day, most of us travel through a wide range of feelings associated with four primary feelings: anxiety, sadness, anger and happiness.  Anxiety tends to rear its head when you are going through major changes, such as moving or changing jobs, or when experiencing ongoing challenges, such as financial worries or family conflict.  Sometimes you are not aware why anxiety has arrived, but there it is.

You may notice anxiety when it comes and be able to move through it.  However, for many, anxiety is not a passing state.  It can be frequent, unrelenting, and take a toll on your life.  It can rob you of your ability to spend time with your family, perform at work, and generally engage in your life.  And everyone says the same thing.  Anxiety—It’s exhausting!  Agreed.

People often ask if they need professional help for their anxiety. There is no official marker for anxiety, no blood test we can take that tells us if our anxiety has become too much.  Odds are if you are asking the question, anxiety has taken its toll, and you could benefit from seeking help.

What does anxiety feel like?

Anxiety, in its most simple form, is a sense of fear that puts your mind and your body on alert.  Biologically, anxiety is a heightened sense of awareness so that we can identify potential threats and take care of them. This fight or flight response can ideally be engaged and disengaged as needed to deal with threats.

So, what’s the problem?  When anxiety is part of your everyday life your body simply does not turn off your fight or flight response.  Living in a constant state of anxiety can cause dire physical and emotional effects.  Long story short, anxiety is systemic: it’s in your brain and your body.

Many people who have anxiety will at some point face depression.  Both anxiety and depression are thought to stem from the fight or flight response.  This may help explain why so often people feel symptoms of both.  It’s also why the same tools that help with anxiety also help with depression.

How do I know if I have anxiety?

The National Institute for Mental Health (NIMH) reports that over 40 million people in the United State over the age of 18 suffer from diagnosed anxiety.  Bear in mind this is data for those who have been diagnosed.  What does this mean?  Millions of people suffering from anxiety go undiagnosed, which means they are not getting the support they so need.  It’s time to address anxiety—to move past shame and into the light where help is waiting.

If you have any of the following symptoms fairly regularly, you may want to consider that anxiety is on the scene:

·      Excessive worry

·      Sleep problems

·      Muscle pain  

·      Indigestion

·      Self-consciousness

·      Self-doubt

Understanding anxiety and the toll it is taking is the first step to getting help.  Rest assured: anxiety is real and you are not alone.

What helps anxiety?

Good news. You have lots of options.  There are things you can do for yourself to help with anxiety.

1. You can overcome fear, but you have to develop skills to manage anxiety.  The best thing about developing these skill is that once you identify some things that help you, you can pull them out of your tool box whenever anxiety resurfaces. Skill building happens through tools and resources. Very few people know how to deal with anxiety naturally. It's something we all experience and most of us need help along the way. So reach out to resources that can educate you or help you talk through what it's like.

2. Be gentle with yourself.  The less gracious and kind you are with yourself, the worse your anxiety will be.  What would you say to a loved one suffering from anxiety? Kristin Neff's work on self-compassion can be a tool to help you learn how to be gentle with yourself.

3. Get busy.  Have you ever noticed that when you engage in activities that require your focus, anxiety decreases?  Be strategic. This could mean taking a run, playing a game of cards, going to the movies.  Whatever works for you.

4. Talk with a therapist.  Research shows that talking with a therapist can lead to remarkable benefits when facing anxiety.  Some report immediate relief knowing they have reached out for help and started to face their anxiety.  A therapist can help you understand your anxiety and help you troubleshoot it. The best results happen when you combine therapy with medical intervention, if necessary. So don't be afraid to reach out to a psychiatrist, a nurse practitioner or holistic medical specialist of your choice.

5. Learn. Then learn some more.  Austin is full of opportunities to help you manage your anxiety.   For example, NAMI provides information, education, and support groups that can help. 

6. Tell your people.  If you’ve been enduring anxiety quietly, consider telling those closest to you.  Odds are they will be supportive.  Maybe you don’t want them to troubleshoot for you?  Let them know that the best way to support you is by being with you and lending an ear.  Who knows, sharing your story of anxiety may free others to share theirs? You could be their light.

Practice self-care.  Practice managing your anxiety.  It's a journey that never ends and you're not alone in it.

To schedule an appointment with Robyn Strelitz, LMFT, call 512-434-0868.

Logo Only.png

The Practice ATX


I Have Depression. What Do I Do Now?

Image by Pierre Guinoiseau on Flickr

Image by Pierre Guinoiseau on Flickr

At least 16 million people ever year experience one episode of major depression.

That means that right now, either you or someone you know and love is significantly impacted by depression. If it's not you, it's your partner. Your colleague. Your friend. Your son. Your daughter. Your priest.

If it's you, then you know exactly what this feels like, even though it's hard to put into words. Language utterly fails as a vehicle for understanding the experience of depression. If you've never experienced it, then you may not know it when you see it. It's sneaky like that. In fact, one of depression's siblings is shame - convincing those afflicted with depression that they must keep it a secret.

So when you account for all those people whose depression isn't diagnosed or recognized for what it is, then the number of people who experience depression is staggering, beyond comprehension.

How will depression affect me?

If you've recently been diagnosed with depression, then you may just now be recognizing your symptoms as depression. It's hard to know exactly how depression impacts each person individually, but here are a few common experiences:

  • Sadness
  • Apathy
  • Fatigue
  • Lack of interest
  • Weight loss/gain
  • Feeling worthless

Sound shitty? That's because it is. And keep in mind that this is not a willful diagnosis. What that means is that no one chooses to be depressed. Like all things, we choose how we respond to our physical and psychological afflictions, but even that's a different story when it comes to depression.

The problem with depression is that it's the kind of experience that steals motivation. So unlike some other diagnoses, the very things you need to do to compete with depression are the very things you don't want to do. Apathy is one of the most commonly reported symptoms associated with depression, so when a doctor tells you that you need a lifestyle change - eat a healthier diet, move more, be more social, etc. - these are all things you need and they're also the last things you want to do.

That's the struggle with depression. It doesn't just afflict, it steals away your desire to heal.

How will depression impact my family?

Depression is such a personal experience. We think about it and talk about it in such individual ways that not much attention is paid to how depression will affect the people you love. But for people who experience depression, this issue is vital. Depressed folks isolate themselves to protect the ones they love from depression, despite that their loved ones don't want to be protected, they want to be useful.

Depression usually makes everyone feel powerless. That's the most common consequence. Family members, friends, colleagues and other loved ones simply don't know what to do if they're not educated about depression. The most powerful response to someone who is depressed is usually to listen and offer gentle reminders that you remain there with them despite their suffering.

Depressed persons tend to believe that they're alone in the world. So when they get gentle reminders that the ones they love still love them, will still be there with them, for them, it contributes to an environment of recovery.

The most important thing to remember is that depression will not impact your family and friends more than it impacts you. Mostly, people just want to feel useful. That's hard when you don't know how to tell them how to help you, but most friends and family can endure anything as long as they feel like they're contributing in some way that helps.

So remind them that sometimes you're not going to know what you need. And in those moments, their simple presence is enough.

So what should I do if I'm depressed?

Ah, we get to the million dollar question. First, your response to depression doesn't actually start with action, but with acceptance. Accept that depression is what you're experiencing, that's it's okay, that it's not a sign of moral or personal failure, that lots of people experience it and that you'll get through it. In fact, you're getting through it.

Second, accept that one of the things you're going to struggle with is doing the very things you need to do to compete with the symptoms of depression. This is okay. It's normal. So set smaller growth expectations for yourself than you might usually. If you'd expect to feel more motivated in a month, give yourself two. Talk to people who know you that might help you set more realistic expectations for yourself.

Here's a list of common ways folks have lived well with depression:

  1. Psychotherapy & medication - the best outcome research on depression recovery demonstrates that the best one-two punch for depression is when you combine some kind of talk therapy with medication. We also recommend that you choose a medical intervention plan that suits your own worldview. Consult with a psychiatrist or nurse practitioner who can help you make the choice that feels the best.
  2. Move - I hate the term "exercise." A part of me believes that it was invented to get us to spend more money at the gym or on supplements we don't need. I don't meant to sound skeptical. Probably I don't like the term because it means I have to do it. But I digress. I much prefer to think of the concept of movement. I can move anywhere. I can only exercise in designated spaces. But whatever term you use, you need to move. Start small. Get up out of bed a little earlier. Move around your house in ways you normally wouldn't. Stand at your desk for 10 minutes of every hour. Your body needs endorphins and your endorphins need you to move in order for you them to kick in.
  3. Socialize - You need your people. Even when you don't want to. When depression is convincing you to stay in another night. Or another day. Be around people. A small goal you may set for yourself if you work from home, for example, is to work from a coffee shop one day a week. Or perhaps start working from one of those cool co-working environments that are popping up all over the place. If you're an introvert, and you're around people all day, consider one introvert trick that most people don't know about. It's not that introverts don't like people. Introverts can actually be quite social. It's actually the nature of social interactions that either drains or gives life to introverts. So if you've been in a working environment all day, you've been "on" all day. You still need to be social in a way that feeds you. Be careful not to generalize your social fatigue to all social situations. In other words, pick your one or two friends who feed you - with whom you can just let go. Plan to be with them.
  4. Education - There are innumerable resources for you to increase your knowledge and awareness about depression. NAMI is an organization that has plenty of information that will help. And education tends to happen in public spaces like groups or seminars. Maybe you'll meet someone who knows exactly what you're going through, which can accomplish two things at once. You're learning and you're being social.
  5. Mindfulness - Finally, there's some great recent research on the benefits of meditative practices like yoga or mindfulness breathing that can really help with depression because they ground you in the present moment. Depression has a way of keeping our thoughts and feelings rooted in past mistakes or future worries. It's like time travel. Meditative practices remind us that we are in the present.  A quick google search for yoga studios or meditation practices can help you find resources in your area.

Depression impacts almost everyone. Whether you are depressed or know someone who is, no one escapes its impact. So consider yourself enlisted in your own or someone else's healing. It's an ongoing experience. It's never completed.

It's a practice.

The Practice ATX


When A Family Member Has Cancer.

Image by A_Peach on Flickr

Image by A_Peach on Flickr

In his book, The Emperor of All Maladies, Siddhartha Mukherjee, remembers how, during his rotation in a medical oncology clinic, he would experience his patients as a surrogate family. He laments that he would spend hours and days with his patients, and because of the nature of their illness, they would sometimes die. Mukherjee explained that every physician has to handle grief differently, but I got the feeling from reading his work that he never got used to losing people he cared for.

These are just the reflections of an oncologist who cares enough about his patients to get close to them. Imagine what it's like when a family member discloses that she has cancer. Or maybe you already know. And you're here because someone you love has recently received a diagnosis.

How can families support cancer patients?

This is a good time for us to stop and let you know about an incredible organization in town called The Flatwater Foundation. The Flatwater Foundation is an organization that pays for the cost of mental healthcare for cancer patients and their families.

In our work with Flatwater, we've experienced some of the most powerful therapeutic conversations we could have imagined. We've witnessed clients grow and change as they endure invasive cancer treatments, we've watched families struggle and thrive as they learn to live with cancer and we've lost clients to cancer, which has caused us to throw typical counseling conventions out the window when it comes to dealing with our own losses.

Cancer sucks.

There's no way around it. When a family member receives a cancer diagnosis, any cancer diagnosis, it's enough to shake the foundation of safety that many families enjoy. Patients are in shock. They're thinking about their own mortality for perhaps the first time. Families jump into action mode and start treatment planning before the patient may be ready.

No one knows what to do because there's no script.

In our experiences working with families, the first thing we do is "hold space" for whatever is in the moment without getting too far in the future. What this means is that we make sure the patient has the space to grieve, despair, be fearful or even question his own treatment. This is often quite difficult for family members who identify with a caregiver role out of their own anxiety and fear because their loved one isn't taking as much initiative in their own recovery as the family member would like.

But patients work on their own timing. And as therapists, we encourage family members to let patients work through their own decisions and attitudes as they feel is most appropriate. We usually find that patients settle into a resolve for their own health in their own time.

So how do families cope with cancer?

When patients are in this place of uncertainty about what they should do, how they should participate in their own treatment, or whether they think they'll survive, it leaves families feeling powerless. It's at this point that we suggest a strong self-care practice that can help family members wait on their loved one's timing while also feeling like they're doing something.

There's no way to ask family members not to do research, not to look for alternative treatments, not to find support groups or be proactive. But what families may consider is that they withhold that information from their loved one until she's ready to receive it. There's an emotional and mental experience that a patient is going through that you can only truly understand if you've experienced it yourself. It needs it's own schedule.

And you need to feel empowered. So do your research, seek your own caregiver support groups, find organizations like Flatwater, change your family's diet, seek alternative treatments and talk extensively to your physician, oncologist and nursing staff. Just be prepared to wait on your loved one to catch up when they're ready.

How can families fight cancer together?

When we see new clients, one of the paradoxes we have to prepare for is that clients sometimes resist their own change, or at least they feel ambivalent about it. Ambivalence is what it feels like when you're uncertain about a decision. As therapists, we struggle not to work harder than our clients. We wait on their timing and respect their ambivalence. When we push harder than clients are ready to be pushed, we usually lose them.

In this same way, families can fight cancer together by openly communicating about where each person is. Don't be surprised if you find anger as well as grief and fear. Don't be surprised to find that children worry about their parents for the first time, which may be a new experience for them.

Children need the opportunity to be afraid for their parent's life. They need to know that their fear is acceptable, that they don't have to be strong, that they can cry and that everything may actually not turn out alright. Patients need the same.

In the middle part of my years as a new therapist, I held a "caregiver support group" for family members of cancer patients. One of the things that group taught me was that it wasn't fair to assume that family members of patients were the only caregivers. As it turns out, a cancer diagnosis doesn't steal away a patient's desire to care for others also.

In fact, one of the most empowering thing a family member can do for a patient is let the patient take care of them.

This will allow your loved one to feel competent and useful. It will help them feel like they have a role to play and will temporarily relieve them of thinking so much about their illness, the next round of chemo or possibly their own mortality. Caring for another relieves the patient of the patient identity.

In our next caregivers group, I think we'll invite both patients and their families to honor the role that families play in supporting each other when one person has a diagnosis. It's a shared experience of illness anyway.

Because when one family member has cancer, its an experience everyone endures.

Logo Only.png

The Practice ATX


What to do When Trauma Impacts the Ones You Love

Image by Mastercharz on Flickr

Image by Mastercharz on Flickr

Do you love someone who is dealing with the impact of trauma?

If someone in your life is suffering from trauma, you may be wondering what you're supposed to do. If so, you're in good company. Anyone who has ever loved someone who has dealt with trauma has asked the same question.

Trauma is unique because it has this way of not only affecting the people who've been traumatized, but also those they love. We even have language to describe this: secondary trauma - which captures how partners, spouses, family members and friends can take on symptoms of trauma they didn't directly experience.

So if you've never endured trauma, but someone you love is counting on you for support, this post will help you understand a bit about what they're going through and how to help.

What is trauma?

In it's plainest and most basic description, trauma is a deeply distressing and disturbing experience that has lasting consequences.

Some people differentiate two types of trauma: big "T" trauma and little "t" trauma. Big "T" trauma would be what combat veterans and survivors of assault or abuse experience. Little "t" trauma might describe what it's like to be in a marriage with a neglectful partner. It's unfair to try and classify traumatic experiences, because everyone's different. There's good research to show that even fender benders in which the offending vehicle was traveling less than five miles per hour can have lifelong repercussions.

So no one's trauma should be judged based on what you or I think makes is big "T" or little "t". Instead, I like to think of trauma as any experience that fundamentally changes the way we experience life. I know that leaves a lot of room open for interpretation, but it also holds us accountable to understand our loved ones' experiences rather than rely on our own interpretation of what trauma is.

How does trauma impact the brain?

In my office is a file cabinet. It's a sturdy old thing that came out of WWII. It has a distressed wood foot at the bottom that wraps around the cabinet's cast iron to create a neat contrast. In the file cabinet are files that are neatly ordered by my clients' last names. There's also some odds and ends that I've stored in there because I need access to them and don't have anywhere else to put them.

And this is kind of how the brain works. 

When I need to recall something important, my brain fires off thousands of neurons that interact together to recall memory. Scientists don't yet fully understand how this works, but they seem to think that memory is stored in the hippocampus, available for recall when we need it. So if I asked you what you had for lunch yesterday, it's sort of like me trying to retrieve a file from my cabinet, whose job it is to store ordered information until I need it.

But for those who've experienced trauma, the brain doesn't quite work like a filing cabinet. Instead, it's more like an artist's studio. When you walk inside, you see paintings everywhere, disordered and colorful, overloaded with sensory information. Trying to find a single painting or image inside a studio is difficult. In fact, much like a painting in a studio, a single traumatic memory doesn't make sense until it's brought out of the studio and examined on its own. So when you try to talk to your friend feels triggered by something that reminds her of her trauma, it's her brain flooding her with a stress response to keep that traumatic memory disorganized, so that she doesn't have to relive it. Her symptoms serve a purpose.

Unfortunately, the brain may be working against recovery as Dr. Bessel Van Der Kolk acknowledges in his groundbreaking trauma book, The Body Keeps The Score. Although the brain may be working to keep trauma hidden so that the traumatized person doesn't have to relive the experience, the body still seems to experience trauma symptoms.

This is why people who have been through trauma sometimes have intense and volatile reactions to an environmental trigger (like relationship conflict or a hard day at work) without knowing why. Sometimes, the body remembers trauma before the brain does.

What does trauma feel like?

I once had a client tell me that trauma made her feel like she was walking around with a bomb that no one could see strapped to her back. And at any point, the bomb could explode all over herself and others without any apparent reason. The brain has very interesting ways of protecting us from trauma when we experience it. People will often describe not being able to remember what they felt or the sequence of events that led up the to the traumatic experience. I remember a moment when I played football in middle school and one of my friends snapped his arm in half. He got up and ran off the field, telling coach he was okay and could go back in.

Sometimes, the worst part about trauma is recovery.

Often, the symptoms you would expect people to feel during trauma show up in recovery even though a traumatized person can't remember those symptoms during the actual traumatic moments. The most important thing to know about how trauma impacts your loved one is that it's constantly with him and he can't predict when trauma symptoms will show up. Because of this, much of the recovery process is symptom management.

That means that in counseling, we help people become more and more tolerant of trauma triggers so that they can move forward with allowing their brain to place the trauma memory back in the file cabinet, ordered and meaningful.

You can help your loved one by not reacting to their seemingly out-of-context intense emotional reactions. Simply your willingness to remain calm in the midst of their chaos can be healing.

How does trauma impact relationships?

Most of us have no idea how to help someone who has been traumatized by an experience we've never been through. This is not a shortcoming. It's completely normal. In fact, it's such a normal part of the human experience that we have an entire industry called therapy dedicated to task of "being there" for people who've experienced varying levels of trauma.

So because we're not naturally equipped with the necessary tools to help the ones we love who have experienced trauma, we sometimes pull away from those relationships because we feel powerless to do anything useful. So this creates a feeling of isolation for us and our loved ones. What makes this even more difficult is that depending on the kind of trauma our partner or family member has experienced, their symptoms can make them difficult to empathize with. The real cruelty of trauma is that it sometimes causes quick explosions of anger or long periods of isolation.

So this is why education and empathy are like gold to people who have experienced trauma. Friends and loved ones who are willing to take the time and have the patience necessary to hold space for anger and loneliness are the greatest assets for healing and recovery.

Trauma isn't always something you can see.

Unless trauma has caused physical changes, it isn't like cancer or other illnesses that manifest symptoms you can see or touch. So people don't always know that what their friends are going through because they don't know what to look for. This may even lead to skepticism or misplaced judgment.

A friend of mine is one of the most courageous people I know. She was rear ended and endured a concussion that has had a significant impact on her emotions and relationships. She describes herself as being quicker to anger and, now, situations that weren't difficult in the past feel stressful. You'd never know it by looking at her, and even her close friends only may notice an abrupt mood change. Even if her friends noticed she'd been in a car accident, they may not be able to connect that mood change with her concussion. This has left her feeling lonely at times because no one can see what she's going through.

In order for her behavior to make sense, she has to disclose her trauma.

I don't know if you've ever been sick, but the last thing I want to do when I'm not well is tell everyone how my body is handling the symptoms of illness. It's embarrassing. I'd much rather just stay at home and wait for the symptoms to pass. But trauma doesn't always work that way. Sometimes, trauma symptoms can be resolved in a short amount of time. But sometimes, it takes a lifetime.

So how do I help?

If you love someone who has been traumatized, the best thing you can do is be patient. Gently and carefully remind them that you're there. Don't problem solve. Just be. We have a phrase in psychotherapy called "holding space." I don't usually like therapy jargon, but this phrase I like. It captures what we need from someone when we don't want them to solve our problems, but we do need them to listen.

Some other tips for holding space for the ones you love when they've been traumatized:

  1. Take small decisions off their plate. Strangely, choosing where to eat can turn into a nightmare. Take the initiative for some of the small life stuff and take over.
  2. Don't depend on your traumatized loved one to know what they need. Sometimes, holding space means sitting quietly with your hands open while they cry.
  3. Gently remind them you're there. Send a text message or leave a letter reminding her that you're just a phone call away.
  4. Be patient. Trauma recovery is a long road, and your loved one needs people who will walk through all the ways their symptoms will emerge.

If trauma has impacted your family members, friends or partners, be there for them in their time. It's hard to make sense of the internal studio of the mind long enough to know what to talk about or ask for.

And holding space for someone suffering is a sacred task.


The Practice ATX


Why You're Actually Communicating Even If You Think You're Not.


Ever wondered if you and your partner or spouse fight a lot because you just can't communicate?

Join the club. Almost every couple we work with tell us that they can't communicate. In fact, it wouldn't surprise us to learn that the number one reason people give for finding a couples or family therapist is because they lack communication. There's just one problem.

You can't avoid communication.

Paul Watzlawick, an early family therapy scholar, was famous for saying that one cannot not communicate. It's impossible. Think about it. Remember the last time you and your spouse got into a fight? He wouldn't listen or she was being defensive. Naturally, you got so upset about not feeling heard that you stormed out of the room. For the next two days, each of you gave each other the silent treatment.

No words.

And that silence spoke more loudly than any words could have. You were communicating. You just didn't know what you were saying. You didn't know that while you were staying quiet, she was in the other room filling the silent gap between you with all kinds of words. Words like, "He doesn't care," or, "If he loved me, he'd come over here and talk to me."

We know memory is a poor measure of reality because of how the brain works. We go back and change our memories all the time to suit our preferred beliefs, emotions or moods. We're only conscious of doing this a small fraction of the time. It's mostly outside of our awareness.

So when each of you looks back on this argument, you'll remember feelings and words and intentions the way you remember ghosts.

These ghost intentions and feelings may or may not be the result of what you actually communicated during the argument. More likely, they're a result of how you felt in its unspoken moments, or at least in the moments when you read between the line. If you've ever said things like, "I just felt that you were angry..." or "I didn't say anything becasue if I did, you'd just..."

No one can feel another person's emotion. That cannot physiologically happen. We may intuit what other people are feeling and have our own emotional response to that intuition, but intuition can be wrong. So the nasty secret about communication is that it's always happening - even if you're not saying anything. Because when you storm out of a room, you communicate loudly. When he scoffs at you, he communicates loudly. When you don't understand what she's saying, she's saying things she never intended because that's what you're hearing.

This is why communication is always happening.

Even when you don't think you're communicating, you are if your partner is hearing something from the way your body is postured, from the way you shut down an argument or from the way you say nothing. So keep in mind that you're always communicating. Even if you don't think so, you are. Even if, in fact, you've left the room intentionally to avoid saying something you'll regret, you're still communicating.

So if a lack of communication isn't the problem, then what is? The question that might serve you better is, "Are you communicating how you want to?"

Now that's a totally different question.

Practicing good communication is a lifelong practice. The overall goal is to be congruent. That is, to practice speaking and expressing what is the most authentic thought or feeling you have.

Why most authentic?

Because we're humans and we're complex. Sometimes, for example, we feel sad. And sometimes that sadness is rescued by anger. What's the more authentic feeling? Certainly the anger is functional. It protects us from feeling sad, but sadness is the most authentic feeling because it's what we felt most immediately and it's what makes us feel most vulnerable.

This is just one example of how things can get confusing. And it's why we practice healthy communication. We have to be clear with our spouses and partners that what they're seeing is actually sadness or fatigue. Not judgment or apathy. That's why this is a forever practice.

Want some healthy communication tips?

1. Slow down

Almost nothing gets solved in a hyperactive, super-aroused emotional state. Take a moment to stop and breathe when you feel emotionally triggered. Emotions work best when you're able to listen to them like data points, not use them like bludgeons. Besides, when emotions get really outside your control, it's not usually because of the original reason you were upset to begin with, but because you don't feel heard. This is why conflict escalates and also why people say they often forget what started the fight off anyway.

2. Multitask

The most common reason people struggle to communicate is not because they're bad listeners. It's because they struggle to listen and manage an internal feeling state at the same time. Have you ever tried to listen to someone criticize you and remain calm at simultaneously? It's hard. Practice multitasking by inviting your partner to tell you some concerns they have about you at a time when you're already calm and not fighting. Start slow.

3. Be self-critical

We can promise you one thing. Almost every poor communication behavior (ex. not listening, being dismissive) has an equal and opposite reaction. If you're accusing your spouse of something without inviting their input on the concern, they're almost certainly going to act defensively. We sometimes make the mistake of forgetting that our perceptions are not objective reality simply because we see it, feel it or believe it. Also, if you've ever wondered why your partner is so defensive, we can almost guarantee you that she or he has wondered why you're so critical.

So practice compassion while you practice communicating. Because this is difficult work and we all need a little help along the way.

-Posted by Dr. Mathis Kennington LMFT-S

The Practice ATX

The Practice ATX


How Does Mental Illness Start?

Image by Kristin Schmit on Flickr

Image by Kristin Schmit on Flickr

Is mental illness just in our head?

Researchers have been trying to answer this question for hundreds of years. We never even considered that the brain could be unhealthy just like every other major organ in our body until, in the early 1800s, we stopped blaming people's strange behavior on ghouls and goblins.

Once we realized that mental illness was a common experience, psychiatry found a good explanation for where it came from: the brain. It wasn't working like we wanted it to. This was the popular belief about mental illness (and still is) until relationship experts and family therapists started to challenge the idea that mental illness came only from the mind.

What about our relationships?

Is mental illness because of how we were raised?

Sociologists and relationship researchers noticed patterns of behaviors in people's families and social environments that caused people's unwanted behaviors. Conditions like poverty or abuse make mental illness more likely. Lack of quality friendships creates loneliness and isolation, which are symptoms of depression.

So, many health experts started to include social and family environments as causes of mental illness. But that still leaves us with an unclear picture of the origins of mental illness.

Where does mental illness actually come from?

Like most things, experts believe the answer is somewhere in the middle. We could be at risk for certain mental illnesses because of our genetics. Alcoholism, for example, unquestionably runs in families. But researchers don't know if this is because of learned behaviors or because of a genetic risk for alcoholism. Either way, prevention is super important because, if you have a genetic risk to abuse alcohol, there's nothing you can do about it anymore than you can change your eye color.

Except of course, to be careful with alcohol.

So no matter where mental illness begins, we should be thinking about mental health and wellness. When doctors ask us to get screened early for health risks like breast cancer or heart disease, it's not because knowing that risk will change our DNA, it's because knowing ourselves will help us create a path to better self-care and prevention.

So if you really want to know where your risk for mental illness begins, you can get genetic testing done, or maybe do a family tree. But what it really comes down to is this:

Are you taking care of yourself?

Mental illness is just like any other health challenge. You can prevent some of the major symptoms by moving your body the way it was intended, by hanging out with your friends and family (even when you don't feel like it), and by staying in the produce section of your local grocery store.

But, you can't prevent all symptoms of mental illness. That's why things like counseling and group therapy exist. Besides, mental illness is just a term we use to describe having less than our optimal mental health. 

So there's no reason to be embarrassed, ashamed or silent about mental health. We've all felt unwell. Taking action to prevent illness or intervening when you need more help is the key to all health.

Why should your mental health be any different?

-Posted by Dr. Mathis Kennington, LMFT-S

The Practice ATX