therapy – Inspiring Change LLC

Why Do I Keep Asking you to Journal?

Daily I am asking my clients to take therapy skills with them into daily life – the foremost being the ability to think about our thinking. It builds the critical self reflection muscle that is a key to overcoming the distorted thinking of chronic anxiety, depression, chronic pain and problems with body, self and relationship image and assessment.

Here’s helpful list of what handwriting can do for you and your brain, focused on students and learning, applicable to what we are working on when we do psychotherapy.

https://ivypanda.com/blog/handwriting-good-for-your-studying/

Gendered: “girl culture”

One of the recurring themes in my therapy room for my female clients has been the reluctance and even fear of emotional conflict.

We are raised in contemporary social norms to maintain pleasant relationships. Taught as children to “get along” rather than assert ourselves physically or verbally when encountering trouble (as most boys are), we become evermore sensitive to emotional energy in the people around us. While this can become what I call a female superpower, it is an emotional preference with a great shadow side: we are often paralyzed by bullying in our families, at the neighborhood bus stop, on the playground, at sleepovers, anywhere someone with an urgent need to assert their dominance lurks. We easily become victims of other people’s inappropriate power.

Does this feel familiar? it is completely familiar to me. By the time we are deep into dating or full time jobs as young adult women, we have reinforced this emotional bias so many times we can struggle to know what appropriate personal power looks like. A large majority of women never fully heal from this expectation and gendered socialization: they become adept at sending their anger inward at themselves, sideways to those who don’t deserve it, and passively with those who do.

Bad romantic partners, bad family members, bad neighbors and bad bosses all cause enormous stress to those of us raised to not kick up a fuss when we are slighted, injured or even abused. At the far edge of this impulse to be forever pleasing is the extreme automatic adult responses of freeze and dissociation when threatened, enduring trauma or physical or emotional assaults. We have simply never given our bodies and minds the chance to push or fight back when threatened.

To become whole, happier, less anxious and perfectionistic people, we need to grow our toleration of social awkwardness, conflict, distain and stand up for ourselves when we need to do so. The need to be the people who are forever soothing others comes at such an enormous cost to us and to our relationships. No wonder women have such high rates of depression, anxiety, insomnia, body image issues, food addictions and eating disorders, emotional dysregulation and suicide attempts.

Any kind of emotional conflict is the kyrptonite of people pleasers and perfectionists. Time to see that superpower as an incomplete strategy, turn it into wonderful intuition that is BALANCED by the strength of your strong voice, confidence and skills at problem solving. But we must first become unafraid of wading into those turbulent waters. I promise you already know how to ride out that rip tide: speak up, hold on and ride it out.

Does Birth Order Matter?

For generations, family members have noted the differences that naturally arise in children raised in the same family. How is it that John, the first born and only boy, seems to have such different personality characteristics than his younger brother, raised in the same house by the same parents just two years apart? Good question!

Theories of personality abound. You may be familiar with some of the more popular models, often used in work or educational settings. The Myers-Briggs Type Indicator (MBTI), based on the four major personality styles described by Swiss psychoanalyst Carl Jung, is a favorite. The Enneagram, a model developed in religious communities and often used in spiritual direction, and other forms of personal discovery, is another. These are models that seek to describe common types of personalities. Other models, such as the Big Five theory, attempt to describe personalities using the idea of common traits shared by human beings across the world, such as extraversion or neuroticism.

Whichever way makes more sense to you to describe human beings, by types or common traits, we have a collective curiosity about how people become who they are, and how much we can or should adapt ourselves to others and our environment.

How did I get to be the way I am? When my clients ask me this question, I answer this way: our personality is constituted like a recipe, with three primary ingredients. The first main ingredient is our individual nature. We are born with a particular style of personality, inherited from our parents and our larger family system. It’s part of our genetic code, and forms the basis of who we become. Our general sense of the world, our innate optimism or pessimism, our sense of humor; this basic personality is another thing we have inherited.

The second main ingredient of our personality is formed by the way we are cared for by our parents; it’s the nurture part of the recipe. Was our mother well nourished, healthy, and ready to become pregnant? Were our parents free from addiction, major illness or injury? Was our birth relatively normal? Were we welcomed into the world with joy and cared for with love? The way our parents meet our vulnerability, suffering and growing sense of self makes up the great majority of our personality relationship style.

If our parents or primary caregivers have enough sense of self that they can sacrifice and respond to our needs consistently, we learn to trust that others will meet our needs, and that others are trustworthy. We offer ourselves to them, and get care and love in return. In the research done on this concept of emotional attachment, about half of us get just what we need to feel secure. The rest of us learn some combination of security, anxiety and withdrawal to cope with inconsistent parenting.

The third part of our personality is made up of all the unique, individual experience we have in life and what we do with it. It’s the fall you took in second grade from school jungle gym, the trip to the hospital, and the cast that you had to wear through the summer. How did that fall affect you? How did it shape the way you think, feel and respond to the world? What happens, and how you chose to respond, makes up a large part of your personality.

What about birth order? I think it fits in this third “what happens to us” category of personality development. While research is still battling it out whether first born children actually are more independent than their second born siblings, therapists and other social scientists have found a common pattern in family position that seems to fit many families, at least in Western cultures. In general, first born and only children are commonly more self determined and disciplined, having been born into an adult system and most closely associated to adults, even as infants. The second born child is less connected to the adults in the family, and if followed by a third child, may feel a bit lost in their parents’ strong relationship to the first born and emotional focus on the baby of the family. The farther away from the parent system, the more independent and even rebellious that child may become. (Sulloway, 1997) Additionally, the more older siblings a child has, the more accustomed they often become to letting other people lead, and can more easily go “with the flow” than those born first.

Family therapists differ in the amount of importance they place in this theory of birth order, but most will inquire about how a client’s family is constituted, and where in the family their client “fits.” Why it matters at all is that it may help people better understand some of their unconscious preferences for friendships, marriage partners, relationship styles, and even how they may connect to or discipline their own children. It’s all just part of our individual personality recipes.

Sulloway, F. J. (1997) Born to Rebel: Birth Order, Family Dynamics, and Creative Lives. New York: Vintage.

(Originally written for GoodTherapy.org profile/topic expert page)

Video You Should NOT Be Watching

Smart cellphones are everywhere, and ever since the advent of very high definition small lenses and amazing software, so are self-made video clips. Everything from stupid pet tricks to police high speed chases are there on YouTube, FaceBook, Instagram and any number of other social and media platforms.

But just because they are watch-able, doesn’t mean you should be watching them.

Today on the Minneapolis StarTribune website was posted a caught-on-tape — from one lane over — a high speed rear-end collision of a heavy dump truck hitting a line of cars stopped at a light in my neck of the cities. Now: I am, like many adults, the victim of a violent car crash, caused by a drunk driver. It was, in fact, the central trauma of my young life and while I have found significant healing from its effects, that event reshaped my life in profound ways. I have never expected driving to be perfectly safe. I worry about car accidents while trying each day to be a relaxed driver. I have to mentally work to trust that my family can make it home safely from the roads every day.

I saw that video come up on the site today. And though a part of me was curious, along with over half a million other viewers of the video were, I knew that another part of me would be re-traumatized seeing that clip. (And I bet you expected me to post a link to that very video: Nope, I’m not going to.) A great deal of traumatic experience is processed through our eyes and into our bodies in an instant. To run that clip was to reinforce a part of my brain I have worked so hard to heal. It is not worth days of increased anxiety, hyper-vigilance, or plain worry just as our young adult daughter starts her new job she has to drive to in St. Paul. So I didn’t watch. That was a choice of good self care.

I know that today, 9/11, there are those that are remembering by watching those twin towers fall again and again. Or recalling the heroes aboard the flight that crashed in the fields of Pennsylvania instead of Washington, DC. You don’t need to re-watch the video of that awful day to be a proud American.

Are there experiences in your life that have caused serious harm to you or loved ones that arise in videos, TV series or films? Pay attention. You may not need to participate in those visual experiences, even though they are many steps removed from you. Your emotional system has a life-long memory, and awakening the dragons of our past isn’t always the best medicine. As the old bible camp song goes, “Be careful little eyes what you see….”

Sometimes it IS About You

As a family therapist and systems thinker, I view the conflicts and discussions in my therapy office as shared events and problems. We are all connected; what I do effects my spouse, my children and other close relationships, just as what they do effects me.

But there are times when one person’s habits, behaviors, attitudes, or choices are the source of a system’s pain. A problem frequently has a source. And it just might be you.

One of the most pained expressions I hear after couples therapy is the complaint that “therapy is always about me” and never focused on their partner. I hear it most frequently from my male clients. This reflects, I believe, the fact that men don’t often start conflict conversations in their relationships, leaving their women partners to do all that heavy emotional lifting. If their troubled patterns have been going on long enough, and the woman, despite how often she requests help or change, is always doing the complaining, the man is inevitably backed into his corner. Of course he feels that therapy is always about him. Because he has to travel so many emotional miles to catch up to where his partner has been.

In other situations, it may be that addiction is stealing away all the relationship and family stability. Or infidelity and secrets have damaged the sense of safety and closeness. Or one partner’s failure to care for their health, or work life, or family of origin problems weighs the entire family down. While all of these issues have system impacts, it just might be true that therapy, at least as we begin to unwind the issues, may truly feel like it’s All About You.

When Severe Mental Illness Strikes a Loved One

Book Review: “I Am Not Sick, I Don’t Need Help” by Xavier Amador, PhD. (Vida Press, 2012)

For the last 20 or so years, brain research has helped doctors and therapists understand that the serious mental illnesses of schizophrenia and bipolar disorder are diseases of brain function. During the century before the “Decade of the Brain (the 1990’s)”, these rare and frightening mental diseases were blamed on bad or inadequate mothering (the “schizophrenogenic mother”), thanks to the early theories of Freud and subsequent generations of psychology, puzzling over the cause and treatments of such life-altering and permanent mental illnesses.

In his wonderfully personal and helpful book “I Am Not Sick,” Dr. Amador explains that the primary feature of these severe mental illnesses is the core belief that the sufferer is “not sick.” In medical terms, this disbelief in their illness is called “anosognosia” (ã-nõ’sog-nõ’sê-ã). Sufferers may be homeless, talking to voices in their head, unable to sleep or put together a clear sentence, believing that aliens have made inroads to their cells, but to these ill brains, the beliefs and thoughts are as real as sunlight and gravity.

If you have ever been in a relationship with a loved one who has become mentally ill and whose illness has this feature of anosognosia, you know that trying to convince them to get to the hospital for treatment or to take their medication is a futile, frustrating, and relationship damaging exercise. But this is how almost everyone attempts to get their loved one’s the help they need to be safe and recover.

In his best-selling book, Amador explains the model of engagement that he has developed over 30 years of living with his older brother, who was a schizophrenic, and working as a professional forensic psychologist and therapist. He walks the reader through this counter-intuitive but effective model that listens, understands and collaborates with the sufferer, who, in the end, must participate in their care in order to get better.

He calls this program “LEAP,” which stands for Listen, Empathize, Agree and Partner. Utilizing the tools familiar to therapists of Client-Centered/Active Listening, Cognitive-Behavioral, and Motivational Interviewing models, Dr. Amador provides tools, examples, and scripts as examples of learning to use this strategy with loved ones who need help.

I read this book as a way to help one of my clients, whose loved one is beginning to demonstrate marked personality changes, delusions and strange behaviors. As we talked about how to be helpful short of calling 911, this book has become a welcome addition to my library and therapeutic models. If you have someone in your life you are seriously worried about and wonder how to help. I urge you to get this book or log onto his website, LeapInstitute.org.

Healing Traumatic Memory

If only life was one long, beautiful, inspirational journey. But it’s not. Some of us know that life can include experiences of such fear, helplessness and pain that we wonder how we survived. Over time, and with support, most of us get back to what we would call our normal. Yet others of us discover no matter what, we just can’t.

We call these experiences psychological trauma, the kind of experiences that steal our mental equilibrium. Many traumas have their origin in childhood; our bodies and minds are dependent, small, developing and vulnerable. The younger we are when they occur, the more impact they may have on the way we learn to relate, think, feel and trust the world around us.

Traumatic memories happen within the brain when we survive a life-threatening event and experience overwhelming shock, loss, fear, horror and helplessness. The words we have for what we experienced are just not enough to explain it to others. Motor vehicle accidents, physical, sexual and emotional abuse, parental neglect and addiction, domestic violence, plane crashes, witnessing homicide, military combat, escaping house fires: these are among the experiences that can overwhelm our emotions and capacity to bear what we have seen and known. The memory of the experience is stored in a kind of jumble in the brain, never blending into what we would call our normal sense of self, our everyday explicit memory.

Neurologists, psychologists and other researchers have made wonderful strides in the last 30 years in understanding how trauma effects the brain. And as the science of trauma becomes clearer, so has the clinical work of seeking effective treatments: treatments for the post-trauma effects that are expressed in our bodies in the form of chronic pain, sudden panic attacks, visual and auditory flashbacks, depression, anxiety, relationship and work problems, addictions and patterns of emotional dissociation.

First generation psychological care for traumatic memory was talk therapy; some relief was attained by patients helped to fully describe their experience in a private, compassionate therapeutic environment. Second generation care added strong prescription medications to calm the nervous system, limit emotional affectivity or target psychotic symptoms. What the most recent research has shown is that both methods are insufficient; talking uses the cognitive portions of the brain without adequately engaging the emotional and survival systems, systems that were in charge during a trauma, and dulling trauma memories or disengaging them temporarily with psychotropic drugs won’t heal the damaged and chronically misfiring memory patterns.

What does work is helping the sufferer to carefully, artfully, and in a controlled and focused way to re-experience the memories, feel the experience again in the body while expressing the energy, body movements, sounds, sights and postures that were suppressed at the moments of helplessness, dissociation and physical restriction. To think the thoughts that seem too terrible to think, and to help the mind link up the original memory to the fuller, day to day explicit or narrative memory that we live and work in every day.

This is what the work of Francine Shapiro’s EMDR (Eye Movement Desensitization and Reprocessing), Peter Levine’s Somatic Experiencing (SE), Albert Pesso’s Psychomotor Therapy and Pat Ogden’s Sensorimotor Approach all seek in their similar models: to have the sufferer become integrated with their physical bodies, those same bodies that have experienced the trauma, to feel, tolerate, express, observe and rewrite their story in the present sense of the self.

All this is to say: there has never been a time in human history where more can be done to help the trauma sufferer than now. If you are besieged by physical and mental echoes of a terrible event in your past, please seek out care from a psychotherapist trained in the newer trauma resolution techniques. Many of us have found peace where there was no peace, and wish the same health and healing for you.

On the brink of a PTSD breakthrough

Today I was talking with two different clients about the research done at the VA in Minneapolis in veterans experiencing PTSD – finding in brain scans that traumatic memory seems to “reside” in the right hemisphere of the brain, right above the ear. So happy to have located a story on this research, and want to pin it here 🙂 On the brink of a PTSD breakthrough
Thanks to Dr. Apostolos Georgopoulos for his continuing research!

When To Get Marriage Therapy

Most couples come to therapy when they have completely run out of steam. While there is a great deal that MFTs can do to help, it’s not a time in the family when people feel resilient, optimistic or energized. In order to create permanent change, one needs a good deal of hope and energy. And so does one’s partner.

I’ve observed that for many couples (especially those who have had a less-than smooth relationship history, full of stops and re-starts, difficult emotional turmoil, previous long-term partners and/or huge life stress) there are much better times to come to couples therapy and have a much bigger chance for successful growth.

They are:

1. Before marriage. PLEASE consider pre-marital counseling, whoever you are. There are fabulous tools available to me as a therapist to assess your relationship as it is now, help you understand your unique partnership in basic system and personality terms, and help you enter the marriage more awake to your strengths and weaknesses.

2. After the FIRST really big, painful, emotionally threatening argument. Happier couples, those whose likes and dislikes, personality styles, family of origin patterns and conflict themes are more similar to each other may never even have one of these blow outs. Ever. That would be ideal. The moment a frightening, threatening, abusive fight happens, think: Help. We need help.

3. When one of you feels as if you are drifting away from your partner and couplehood in a big way : a job that takes you away from home for days or weeks at a time; when new parenthood strains the closeness; a crisis of faith or health or employment. Couple relationships are always managing their own sense of healthy emotional distance from one another. But the marriage should always feel quietly, confidently connected. If it doesn’t, don’t let it drift without comment and professional support.

These are the times I have noticed in marriages of change and opportunity, when both partners may be open to learning new things about each other and themselves, and still see the relationship as positive, life-affirming, permanent. These are the points at which relationships can be strengthened, renewed, matured. Don’t wait until you can’t stand it any more to reach out for counseling. Chances are, your chances of recovery get lower with every week you wait.

Help For Your Nerves: Review

Hope and Help for Your Nerves by Claire Weekes
My rating: 4 of 5 stars

I help people with their thinking, emotions, relationships and beliefs every day. This little gem, written back in 1969 by an Australian physician/psychiatrist should be in the hands of every person who has ever suffered with a full-on panic/anxiety disorder. We call that general diagnosis “GAD” or Generalized Anxiety Disorder today. There are a lot of great resources out there to help. This book is quite personal, clear and wonderful. It’s not perfect; she suggests leaving the family for up to several months to recover, which is not something I would easily advise to anyone. And all the advice will probably not be enough without therapy, but it’s a helpful adjunct.

Her principles of treatment, and they are right:

1. facing fear as a normal emotion running too high in your life
2. accepting that it is doing that at the moment, and it WONT KILL YOU
3. learning to rise, or float above or behind the annoying physical sensations
4. giving your body time to heal itself from the super-tuned-in experience of fear sensation that has you knotted up

This, along with EMDR, talk therapy, exercise and a lot of self reflection can and will help most anyone recover.

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