What To Tell Your Therapist

Photo by Meraki Creative Co on Unsplash

Photo by Meraki Creative Co on Unsplash

“How do I tell him/her?”

If you have ever been to therapy before, there is a possibility that the question above popped into your head at some point. If you have never been to therapy before, but are considering it or have been thinking about it, this blog post will explain the importance of addressing difficult conversations with your therapist or future therapist.

Handling expectations and finances

Just like many other things, therapy is an investment of time and money. Many people erroneously think that that their lifelong struggles can be over in just two therapy sessions. This is just not realistic for several reasons. The first one is that your therapist doesn’t know you. Maybe you talked to him or her on the phone before your first session, but he or she will have to continue to assess many variables (especially in the first few sessions) in order to get to know you. 

The second reason is that you have probably been engaging in some sort of pattern or behavior for quite some time (think dynamic with your partner for instance). Maybe you both decide to seek couples therapy because you have felt disconnected for a while or have been fighting intensely for months. One or two sessions will probably not change the way you have been relating to each other these past months. Therapy is a process and for that reason, you need to feel comfortable with whatever fee you and your therapist agreed on. Some therapists will work with you based on a fee that you can afford, while other therapists have a set fee, so it will be up to you whether or not you want to work with that therapist. Nevertheless, it is very important that you speak up if the fee is inconvenient for you. Therapists will either work with you or talk about other options (e.g. referrals).

“My therapist did not understand what I was trying to say.”

Do NOT stay quiet about this. If you feel like your therapist did not get you, let him or her know. As therapists, we are trying to figure out what is going on in your life. The reality is that we can be spot on, but we could also get it wrong. It is extremely important that you let us know if that is the case, so that we have a clearer picture of what your experience is like. You can simply say something like: “I don’t think that is what I meant, what I meant is….” or “Actually no, it is more like this…” Please correct us! I cannot emphasize this enough. Don’t think that you will hurt our feelings or disrespect us by correcting us.

“My therapist said something that triggered me.”

No therapist is a divine, perfect, human being. This could happen, either early in therapy or maybe a few months later. If something that your therapist said triggered you and made you feel uncomfortable, sad, frustrated, annoyed, disappointed—whatever it is—tell him/her. If you really like and trust your therapist, explaining what happened inside of you as he/she said X, can be very powerful. I encourage you to try it before dropping therapy and leaving. It is normal that close relationships experience some sort of rupture, but repair can be possible and practicing it can turn out to be good experience. Ruptures are opportunities to strengthen a relationship. Also, examining what triggered you is part of the therapeutic process, and there is a lot that both the therapist and client can learn from that.

“I am ready to finish therapy, but I don’t know how to say it.”

Sometimes, your therapist might be the one bringing up the idea of termination; other times you might be the one thinking about it. If you had already made a decision or are contemplating it, tell your therapist. Your decision could be based on finances or on simply feeling like you are ready to move forward on your own. Whatever the reason is, it is always a good idea for both you and your therapist to be on the same page, and to have at least one “termination” session. Usually, this is where you both can talk about what you learned from the process, form each other, what shifted or changed, and things to keep in mind for the future.

Trust your gut, and if you ever want to say something but are too shy or afraid to say it, take a deep breath and try to express it. Therapists will not criticize you for opening up about your internal experience.

To schedule an appointment with Stephanie Paez, LMFT-Associate, contact stephanie@thepracticeatx.com or call (512) 910-4052.

The Practice ATX

512-861-4131

How to Live with Loss.

Pixabay/CC0

Pixabay/CC0

I recently experienced a loss that was hard to shake. Because I felt it, I had to go through the typical steps that, because I’m a therapist, I know to go through. But it still hurt. I’m supposed to know how this goes. I’m supposed to have it all together, but that’s not the way life works. Regardless of what your loss is – person, place or thing – the way we experience loss can be powerful and it’s important you know how to handle it.

For this reason, I thought I'd share some of the important lessons I've learned in coping with the grief that loss creates.

Acknowledge what was lost and what it meant to lose it.

I lost a job. It sounds silly (even to me), maybe even ridiculous that I’m choosing to talk about a job loss rather than what some might have expected – the passing of a loved one or the ending of a relationship – but to me this job had a greater significance than just a place I went to punch a clock (if people even do that anymore). This job afforded me close and personal friendships, daily experience into a field of psychology I now love working in, financial stability for my wife and I’s future plans and a sense of pride – because dammit I was great at my job. So, naturally when I was informed that I was being let go I was a bit shocked (and sad, angry, anxious, scared, excited, discouraged, distressed, embarrassed, and about fifty other emotions).

I didn’t know what to do. I’m a therapist, yes, but I’m also human and in that moment my training and education went out the window and suddenly all I saw was my insecurities and fears – I was a failure, I was weak, and I was letting the ones I love down. Not a particularly fun ocean of thought to play in, especially if you stay in it for too long it can start to feel like you’re drowning.

Open yourself to others and allow yourself to feel/grieve

After the initial shock of loss there is a tendency to do one of two things: sit in the middle of the metaphorical ocean slowly drowning form an overwhelming number of emotions and thoughts left in its wake or bury those emotions deep down and tell yourself to get on with your life. I tried the former, attempting to disconnect from my emotions through the guise of logic, thinking my focus needed to be on finding a replacement for the things I lost. I made it my mission to occupy my time with meet-ups, interviews and/or anything that would keep me busy (aka distracted). I knew better but again, I’m human. It wasn’t until my wife made a comment – about how well I was handling the job loss – and then asked how I was really feeling that I realized what I was doing. Of course, after a meeting with a few friends… therapist friends… the following day doubly confirmed that I needed to do what I do for my clients; take a few days/weeks to work through all the emotions I had neglected and reach out to others when I needed support or started to feel overwhelmed.

Living with loss is simple, but very difficult.

Acknowledge it, feel it and talk about it. That’s it. I don’t intend for that to sound easy, because I know it’s not. To use the ocean metaphor again, loss comes in waves and just as I described before; at first it can feel like you’re drowning but, as you begin to open up and talk about your loss those waves will hit you less hard and less frequent. The last thing I want to leave you with is something that absolutely needs to be said.

There is no timeline to understanding, acknowledging and living with loss. There is no manual, book or person that says you need to be at that shoreline by a certain date or time. As I’ve already said, loss can be a powerful influence on your life and it’s important that you take the time you need and reach out to the people you trust to successfully work through it.

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

The Practice ATX

512-861-4131

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.

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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.

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The Practice ATX

512-861-4131