articles
articles
Subscribe and receive helpful information & updates.
Relationship Check-Ins
It is so easy to coast when things are going well in a relationship. Little frustrations and annoyances seem insignificant, so we go along without feeling a need to bring anything up and upset the good vibes. What goes unnoticed is on a very subtle level those “little” things are sitting in the back of our minds are starting to build. Eventually, something will be the final straw and all those unspoken issues show up with gusto. We come to the table with raw emotion and a sense of justified anger, ready to get things off our chest. As you can imagine this barf-bag approach to working through things is not ideal. We tend to walk away hurt and confused as to why resolution remained out of reach while the other person feels attacked, flooded, and looking for a mountain day spa to get away.
Luckily, this does not have to be the relationship’s destiny. Moving from the miserable cycle of coasting to crisis, regular check-ups can create a chance to talk through things while they are still small or before resentments get traction. I was recently introduced to Multi Amory’s R.A.D.A.R model, a clear step-by-step process that provides both parties a way to prepare for and implement a constructive conversation. I’ll summarize core concepts here (and add a little commentary), but feel free to review the linked resources below to learn more.
- Grab the paper listing the outline of topics to cover. The authors also have a format to follow that includes how to start the conversation and the core topics to cover. Of course, each party might have additional items to discuss, but the list covers the major components of a relationship. I recommend having an adorable cat to pet or some chocolate to share.
- Know exactly what you want from the conversation. This may include sharing, validation, advice, problem-solving, etc. Let the other person know so they do not have to guess.
- Make sure you can show up as your best self. Already agitated because of a lack of sleep, angry, stressed, or compromised (ex: intoxicated) will only make things harder. As Bierce said, “Speak when you are angry and you will make the best speech you will ever regret.” I encourage both parties to consider the qualities that are inviting: tone, word choice, body language, and facial expressions. Starting off with a pleasant tone goes a long way. In addition, from the start to the finish, do all you can to ensure the exchange maintains an overall quality of respect, curiosity, and a desire to show up well. As a colleague said, “Let your heart connect with another’s heart.”
- Once ready to address something tender, the folks at Multi Amory borrow from the recommendations made with Rosenberg’s Nonviolent Communication approach. For those familiar with Dialectical Behavioral Therapy, this is similar to “DEAR”. Basically, the speaker provides a factual recount of the situation, void of assumptions and hurtful adjectives. Feelings are then shared followed by the stated need/core request. Once the context is clear to all involved, the parties are ready to discuss the options and determine how to move forward. Example: “I’ve noticed you’ve been coming home a half hour to an hour later from work than usual for the last week or two. I’m concerned about your stress and frustrated that things are unpredictable. If you would call me if you are going to be more than twenty minutes late, I can start working on other things in the meantime. Then when you get home, I can have chores done and be ready to connect.”
Isn’t it fantastic that there are so many wise people to draw from?!? Enjoy capitalizing on their suggestions: skillful check-ups can make all the difference in the world to keep a relationship healthy and loving. Here’s to meaningful conversations that help us grow individually and in relationships!
Resources
Relationship anarchy smorgasbord
Getting the Most Out of Therapy: Part 2
I’m about to go into a lengthy metaphor, so bear with me. There is a time in a plant’s life when it is given special attention because it’s struggling. It starts with a dedicated look into overall health of both the plant itself and the environment, then it’s time to create and implement a plan of action. There may be places to prune because shoots or dead branches drain away energy it needs to grow. Sometimes it needs medicine to remove bugs or infection that create a battle for survival. Drastic changes may be required on occasion, like a relocation to a more hospitable location where there is enough sun, shade, good soil, and water to meet basic needs. During this process, nurturance is essential to ensure adequate attention and care is provided. I can’t think of a better metaphor for the role you and therapy can play in your life.
As mentioned in my last article, there is so much that can be done to make the most of this important process. Building on those ideas, here are a few more to consider:
DURING YOUR SESSION
Stay focused on you. Take advantage of the uninterrupted time you have with someone else who is dedicated to your wellbeing. Consider:
Are you the primary focus of the topic? One way people protect themselves from going into hard areas is to talk about other people and what they need to work on instead of focusing on themselves. This is especially true for couples because it is safer to focus on what one person thinks the other should change rather than doing the courageous, humbling work of looking within.
Is the time largely spent working on things or describing past conversations? It is tempting to go into great detail about a past interaction, yet this only results in living something twice. It robs you of the chance to work through whatever is at the crux of the issue. Unless asked for detailed information, stay focused on the meat of the matter.
Don’t miss the chance to experience of having a need met! Clients often talk about the pain of being misunderstood or feeling alone because no one listens. I check in to see what it is like to get the need met with me and many times they are surprised to realize that what they long for is happening during the session, in real time… and they’re missing it. Similarly, within moments, folks often express grief around how long they have gone without this connection. While this is understandable and there will be time to reflect later, the focus on the past steals away the chance to feel satisfied. I encourage you to savor! Hopefully it will be the start of more to come!
Experiment. Ideally, therapy is a place where it is safe to take risks. (If not, that is a whole different conversation). Bring in your sense of play, experimentation, and imagination. They are the core tools to venture beyond the familiar/habitual and create the potential for something new. There is no need to already have things figured out or to be a master when something is brand new. So be messy, make mistakes, and fail brilliantly! (I know I’m a great model for this.) If expectations for perfection are removed, who knows where your intuition will take you.
RIGHT AFTER YOUR SESSION
Allow time to ensure you’ve captured the important take-aways. In times when sessions are especially emotionally charged, short term memory largely goes offline and your ability to synthesize the information can be compromised. Writing down your thoughts will provide time to make sense of your experience and allow for further reflection throughout the week. And please, please, please don’t forget to enjoy successes!
THE ONGOING WORK
With those notes in hand, consider how you want to implement what has emerged. Therapy is usually an hour once a week or biweekly, while our entrenched views/behaviors can be practiced all the hours in between. This is when intentional focus is especially important. Some examples:
- Pay attention to a given pattern to understand when it emerges, its impacts, etc. Focus on understanding how it is helpful in your life. We do things because they either have or still have a purpose. Unless this need is identified and met in another way, change is simply unsustainable.
- Perhaps you encounter a new and novel perspective. Chew on it. Observe what impact this new view might have. Is it accurate? Is it helpful? Is it a good fit? Is it doable?
- Implement a skill.
- Read books, listen to podcasts, and talk to trusted others to deepen your understanding.
- Engaging in activities that further enhance self-care.
- All work and no play…. makes us crabby. Ensure there is time to work while also having balance with activities that feed you.
Back to the metaphor (last time, I promise). Make the most out of therapy by being both a gardener and a plant. As you learn what is needed and apply it regularly, health and strength are restored and the plant (you) can then grow into the best rose, daisy, shrub, or tree it is destined to be!
Getting the Most Out Of Therapy: Part 1
There is that moment of clarity when you realize it’s time to get the support and expertise therapy provides. It is a decision that says you are a priority worth investing in, dedicating time, resources, and your heart to the process. For some, they are well-versed in this unique partnership. For others, it’s a new frontier that is unfamiliar and sometimes even intimidating. In my case, hopefully my warmth, staff of stuffed animals, and tendency to kick off my shoes will soon put you at ease so it feels safe enough share those private parts of your life. However, this is not a time to sit back and absorb another’s wisdom and follow everything recommended (although I understand the temptation). Instead, I encourage you to take an active role to ensure you get the most out of this partnership. In the next two articles, I will provide ideas of how to do just that.
Goals
Be clear about what you need and hope to accomplish. Ideally, this begins as early as the intake paperwork, a time where you can narrow down the messy factors going on into something concise and realistic. The first session or two then becomes a conversation where needs are placed into meaningful steps. As the work progresses, these goals will evolve so regular check ins are advised.
Focus
Now that goals are clear, make an intentional commitment to work on these regularly. In session, bring in a notebook to write down insights, thoughts to chew on, and any potential homework. Refer to these regularly between sessions. Therapy is only an hour out of your week so for change to occur, time is needed to try on a given perspective, enhance what has been discussed with further exploration, and practice.
Prior to a session, review your notes. This will help clarify what has evolved, what has stagnated, and anything that got in the way. Knowing that a lot can happen from one session to the next, I never assume that where we left off is where we will start the next time.
Prepare
Give yourself some time before session to deepen into this special time you’ve dedicated to your health. The moment you walk into the therapist’s office or sit down for telehealth, there are no chores to do, no conversations to take care of, nor any social media to engage with. All the pressures get to be put on hold! Enjoy the space to “just be.” Breathe, experience the room, and fully soak in the present moment.
As the noise clears away, it is not uncommon for wisdom or urgent issues to emerge and reveal how best to use the time together. It’s not uncommon for a variety of needs to surface that may not be attached to your goal. There is absolutely room to pivot. However, if you find that this is a regular occurrence, the goals may need to be revisited. Don’t worry if you cannot prioritize what emerges because help is just a few moments away.
Ongoing Self-Care
The is no question that self-care creates resiliency against mental health hardships. It also makes sure you have time to restore, create balance between dealing with issues and enjoying what the world has to offer, and further your efforts to treat yourself in loving ways. The following are a few ways this might be done: healthy sleep habits, laughter, play, meditating, structure, boundaries, novelty, nutrition, exercise, and snuggling with a loved one. (One of mine is furry and purrs ) For a new take on the statement made in the movie The Shining, “All work and no play…. makes us burdened and crabby.”
Take agency to make therapeutic work what you need it to be. A therapist is there with training and wisdom, but you are the expert of your life. Let’s make this a partnership with you in the driver’s seat so you can enjoy the rewards of relief, resiliency, and new horizons.
Playing With Your Meds
Fun Facts
- Herbal options are not regulated by the FDA
- You should not eat grapefruit if you are on a certain medication
- Lithium changes the amount of salt in your blood so it has to be closely monitored by a doctor to avoid impacts on your heart
- There were over 12 ads for medications during the Academy Awards show.
- Sometimes missing a dose can feel as pleasant as attending a conference on toe fungus
One day, as a client and I began to settle in, it took only minutes to notice she was talking fast, jumping from one topic to another, and angrily declaring that people were holding her back from her full potential. She stopped short when I asked the question, “When did you stop taking your meds?” She gave a sheepish smile, figuring no one would notice. I think I can speak for all those around her: she was wrong.
In the world of mental health medication, there is a tendency to take matters into our own hands. Without consulting the prescribing provider, the medication or dosages are tinkered with. The reasons are varied. For example, someone might stop medications because they no longer seem necessary or take extra when having an extra difficult time. Perhaps different dosages are tried to minimize unpleasant side effects. Sometimes, people stick to the same dosages but keep forgetting to take the medications or take them at different times of the day. That poor brain and nervous system!
Psychiatrists and doctors are important allies, armed with expertise to sift through all kinds of data to make sure what they prescribe is the safest, most effective option available. Before medication is even provided, there will be a thorough history taken to determine genetic vulnerabilities might be at play as well as asking about your current health status to discern what issue might be exacerbated or what new issues might emerge on a given medication. Anything that might be contraindicated (a med that doesn’t play well with what you’re already taking) must be ruled out and dosages calculated based on weight, gender, and age. Then there are the ongoing challenges of maneuvering the unique way each person’s body responds. Being a therapist, not a doctor, I’m grateful others have dedicated years to this process.
Rather than taking matters into your own hands by messing with medications and dosages, focus instead on how best to advocate for yourself. Get all your ducks in a row. Put your thoughts down in writing and bring two copies to your appointment, one for you and one for your doctor. This will ensure the doctor can get a lot of information quickly, provide documentation to reference at the next visit, determine changes over time, and ensure you cover everything you want to know.
Topics to cover
- Symptoms- what are your current symptoms? Please reference medication side effects and ensure you know if meds might be part of the picture. Have symptoms improved/stayed the same/worsened since the last visit. When did they start?
- What current factors in your life are impacting how you are doing? Ex: life stressors, hormones, medical issues, other medications, substance use, adherence to the recommended treatment
- A list of medications you are currently on to ensure the doctor can make sure it is safe to take them together. ***Feel free to double check with your pharmacist- they’re happy to advise and it is of no cost to you.
- Questions/concerns. Should a new medication be recommended or a dosage change, ensure you feel informed. Remember, this is a team effort! Feel free to cut and paste the information below to include on your document.
Questions to consider
- Describe the type of medication and how is it supposed to help bring you relief (SSRI/SNRI/Benzodiazepine/Anti-convulsant, etc.).
- Explanation for the recommendation, including lab results and current research findings.
- How is it to be taken and when?
- What is the amount of time it takes to reach a therapeutic benefit? How will you know when the medication is working?
- What is the range of dosage that can be prescribed? It is important to know just in case you accidentally take too much. What happens if you miss a dose?
- Are there any over-the-counter medications that should be avoided?
- There may be financial components to consider. Perhaps there are samples available during the trial phase or a generic version that is covered under insurance.
- Ensure the process to get refills is clear. For example, some psychiatrists will not respond to a pharmacy reaching out on your behalf but must hear the request directly from the patient.
- Review side effects, including any risks associated with sudden discontinuation. The most common concerns are around weight gain, libido (especially with SSRIs and SNRIs), and insomnia/drowsiness. How are these managed? The goal is to make sure the benefits far outweigh the drawbacks.
- Resources that can provide quality information when dealing with an internet full of questionable sources.
You are the expert of your experience and have the important responsibility of advocating for your mental health. After all, you are the one who ultimately lives with the impacts of the medication. But you are not alone: you’ve got medical professionals and your therapist there to support and advise you. Work together to make sure any medications provided make a safe, positive difference in your life!
______________________________________________
Under Attack: Transphobia’s Deadly Consequences
You may have heard the tragic news…. On February 9th, 2024, while at school, sixteen-year-old Nex Benedict was assaulted in a bathroom by three older girls, causing the teen to fall and hit their head. The next day, Nex died from these wounds. Sadly, acts of violence are not an unfamiliar reality in the trans community. Each year on November 20th the Transgender Day of Remembrance is dedicated to those murdered during the past year due to transphobia.
Although transgender people are only .05% of the population, they have become social and political targets. According to The Williams Institute, transgender people are over four times more likely than cisgender people to be victims of violent crime. Between 2016-2017, the FBI reported an increase in trans-related hate crime by 9%. With the dark shadow of social media putting fuel on the fire, there is a surge of online harassment that bleeds over into hate crimes and discriminatory legislation. This year alone, there have been 115 bills proposed to limit transgender rights that range from access to medical care to what pronouns are allowed. An author with the Anti-Discrimination League writes, “These bills send the clear and dangerous message that those in power are invested in policing and enforcing a gender binary rooted in inaccurate and outdated stereotypes.” It is painful to watch the gains made for equality and acceptance continue to devolve.
I have been privileged to work with the community in Wheat Ridge for over twenty years and continue to be awed by their willingness to live authentically, despite the hostility they face. I hope each and every one of us can rally behind legislation like the Equality Act that helps validate, protect, and affirm these beautiful people. Let’s vote for representatives dedicated to this cause, willing to fight against any kind of rhetoric aimed at compromising the rights of our citizens. It’s time to call out hate speech so we never become desensitized to ugly, harmful attitudes and actions. If this is a community you want to help protect, please contact The Center on Colfax for their suggestions. This is a place in Denver dedicated as a safe and welcoming place for Colorado’s proud, diverse LGBTQ community.
“It takes no compromise to give people their rights… it takesno money to respect the individual. It takes no political deal to give people freedom. It takes no survey to remove repression.” — Harvey Milk
For further Consideration:
Violence Against Transgender People Is Not A Myth
PBS Poll Shows Overwhelming Opposition to Anti-Transgender Laws
Eruptions and Disruptions
Ever wondered why a specific tone of voice can send you through the roof, or why you want to shrink away when a certain person walks into the room? Does your family want to stick you in the shed outside because you get surly every September? You may not realize it, but these could be flashbacks.
It is usually assumed that flashbacks develop after an extreme trauma like war, assault, or a life-threatening crash. The person must endure a replay of the event, fully immersed in the worst moment of the trauma as if it is happening in the present. These excruciating periods of sheer hell do exist but that is not the only form flashbacks take. They can be forms of dissociation or panic attacks, or subtler types like the emotions of dread, fear, anxiety, and shame. Flashbacks in the latter categories rarely have accompanying images or recognized as memories so a person is left with unnerving distress, confusion about “why” they are feeling/behaving a certain way, and clarity. Whatever form it takes, the single most important component is the inability to experientially separate the past from the present.
It’s understandable that these nuanced forms go unrecognized. The triggers themselves can be hard to spot because they may be commonplace or even undetectable: a facial expression, a specific word, a tone of voice, a smell, an age, gender, time of day, or even a time of year can serve this purpose. Whatever the cue, the flashback comes on suddenly, seemingly out of nowhere, taking the person by surprise. It is also hard to spot a flashback when the trauma itself is not recognized, such as events that are repeatedly experienced or seen as part of life. (See my article on Big T versus Small t traumas). There are some traumas we can all relate to: repeatedly enduring criticism/shame, being deliberately left out/rejected, or dealing with a string of broken promises. While they may be familiar to many, we cannot ignore that for some, they leave a legacy of pain. Finally, flashbacks may fly under the radar because they do not come on as sudden eruptions, but lingering disruptions. Frequent feelings of inadequacy, social anxiety, shame spirals, or visceral aversions to trusting others are examples. An expert in the field, Janina Fisher, refers to these as chronic flashbacks. Whether dramatic or parasitic, these intrusive, re-experienced memories range from unnerving to debilitating.
Trauma research has unearthed fascinating information about our beautiful, complex brains and nervous systems that offers some explanation. The front part of the brain, the prefrontal cortex, is where our sensations, emotions, thoughts, and images are integrated into a meaningful narrative. During a time of threat, this area goes offline, freeing us to act out of instinct without being bogged down with attempts to reflect. For example, my brain does not care if the shark I am suddenly swimming with is one that finds me tasty….. it only cares that I survive. My body will catapult me out of the water so I can go pant, scream, and possibly throw up. Once the danger has past, the prefrontal cortex will resume functioning, but it will not have access to the traumatic chunk of history. Instead, the memory will be stored as disconnected data; a record of what happened absent of any ability to retrieve or understand it.
The good news is healing is possible. It starts by recognizing when a flashback is occurring, not some indication of madness. Even though it feels like the danger is real, there remains recognition that this is really an echo of what has already happened. With the help of therapy, the work also includes identifying triggers, gathering up memory shards that offer clues to the experience it is connected to, clarifying what the body needs to realize the past is over, and creating new experiences that promote a sense of safety. It is work, but with support, patience, and perseverance, it’s possible to find solid footing in what has felt like chaos. If this kind of work is something you are interested in, please feel free to contact me.
Meanwhile, for those who have not had to endure flashbacks but know someone who does, this information is also for you. Even with good intentions, beware of any messages that suggest to someone highly upset that their experience is not real or they are overreacting. You might suddenly find yourself locked out of the house staring at a “do not disturb” sign hanging on the door.
Developmental Needs of the Elderly, Part II
The Complex Issue of Control
The desire for control is a something we can all relate to. We can see this displayed in little kiddos who struggle to find independence in a world run by adults. Given the patronizing label of a “temper tantrum,” kids can become overwhelmed with distress when things don’t go as hoped. They may cry, throw their toys, or run off to hide in their closets. For my generation, our need for control may not be as apparent because we usually have it, we know it, and we use it. (But when I don’t have control I am also prone to cry, throw my toys and run off to hide in my closet). For an elder, control takes on greater importance. Not only do they want to maintain independence and the ability to direct their lives, it is also a biproduct of loss. At this stage of life, loss is a constant presence that can come at any time, both in subtle and life-altering ways. The stakes are high so the natural tendency is to try to control whatever possible. If the connection between control, independence, and loss is unclear, people can unfortunately label the elder as difficult, bull-headed, and unreasonable, yet if time is taken to understand the factors/priorities at play, their responses may make a whole lot of sense.
Loss
I can honestly say that when I think of what elders face each day, it can take my breath away. There are so many losses younger generations rarely have to consider let alone navigate. Here are just a few:
- Physical strength and energy. I love this quote from Bob Hope, “I don’t feel old. I don’t feel anything until noon. Then it’s time for my nap.”
- Time spent on medical issues: think of how much time is spent sitting on the phone to get assistance, talking to insurance companies, and driving to and from appointments. I’ve heard some elders talk about managing their health being as demanding as a full-time job
- The capacity to heal. “You don’t know what it is like to wake up each morning and realize today I will be the healthiest I will ever before the rest of my life.” The man who spoke these words said his days are spent preserving what he has, not looking forward to some new, inspiring achievement.
- Relevance. There are all kinds of messages that say the world has moved on- elder’s music is no longer playing on the radio, advertisements are geared towards working families, with the exceptions being prescription or other physical needs.
- Moving from having a voice to being unheard. A form of agism, this can be particularly scary when providers ignore the words of the very people they are trying to help.
- The death of peers, siblings, and parents. One person told me, “I look in my address book and there are pages upon pages of people who are no longer here.” An author mentioned that older people, as their parents die, become orphans. What must it be like to when the only person(s) who have known you for your whole life are gone?
- Touch. So many people go days without this form of caring and connection.
- Mental capacities. Memory challenges, infections that impact cognitions, slower brain processing, all impact the ability to navigate the world and make wise decisions. not understanding the unfamiliar, and the impacts of help can complicate making informed decisions. George Burns playfully remarked, “By the time you’re 80 years old you’ve learned everything. You only have to remember it.”
- General safety. Small things we usually do not think about can have major impacts. An uneven sidewalk , stairs, climbing onto a chair to get something off a high shelf…. There is no way to address them all.
- Their nest. A home is tied to the familiar, is part of a larger community, and holds memories like a living scrapbook. All that changes when a higher level of care requires a move.
- Privacy.
- Financial independence.
- Dignity.
I urge you to close your eyes and picture what it might be like to live with these kinds of realities! What does this show you? Imagine how you might respond to in these conditions.
What We Can Do
Here are some strategies to help you and the elder person navigate challenges that come up. These are basic skills to use in any relationship- we are just being extra intentional with our elders.
Respect– their values, beliefs, and opinions are important. Remove any ideas of “less than.” For example, I have heard adult children talk about become parents to their aging parents. Cohen and Eisendorfer emphatically stated, “You are not and can never be a parent to your aging parents!” You may be their advocate, confidant, nurse, housekeeper, etc., but you will never be their parent.
Honor Self-Determination– Becoming less independent does not remove the right to make decisions for oneself as much as possible. “So long as we still possess it, the power to carry out simple intentions is one of the many unnoticed pleasures of life.” Wendy Lustbader, Counting on Kindness. Action may be necessary in times of immediate threat to life or safety, but control should be returned to the elderly person as soon as possible.
Maintain Your Boundaries – Just like an elder has a right to take care of themselves, we have a right to to determine our priorities, preserve our health and sanity, and follow our own values. Please speak up and advocate for yourself.
Listen– If you want to try to understand the reasons behind their decisions, don’t be afraid to ask questions about what they want, what is at stake, and what values are at play. You may discover some choices are wise, even admirable. That said, you may not see eye-to-eye. In those cases, times, go get a massage. The situation may not have changed, but you’ll feel better.
Adapt a New Vocabulary– We want to begin speaking the language that will resonate with them. Consider words that recognize that they hold control: choose, direct, elect, determine, etc. Ex: A primary care doctor saw that after heart surgery, her patient’s chart was empty. When the elder came in for her appointment, the doctor reflected, “It’s a bit mysterious why you stopped seeing your cardiologist.” The patient shared that she takes her blood pressure regularly, has no symptoms, and didn’t want to go to the doctor to get meds that made her sick. Instead of chastising or dismissing, the doctor acknowledged her decisions. “My only question would be: since you are in such great control of these conditions, is it possible there are some other factors you may not be aware of and thus may be out of your control?” When she asked what she should do the doctor said, “I’m not sure, but you might choose…”
Interacting with elders often requires new skills and perspectives to ensure we can operate from a place of compassion. I hope that through this concerted effort, we not only have more satisfying relationships, we also learn lessons about how to approach this chapter in our own lives. Here’s to opportunities for both elders and those who love them to practice empathy, gain wisdom, and appreciate what these relationships have to offer.