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Voting Resource
Good news! We’re nearing the end of this election rollercoaster. That means it is time to buckle down and engage in the great privilege of researching, discerning, and most importantly- voting. It is so tempting to be caught up in identity politics or have the headline of the day overshadow our civic duty of thoughtful consideration of the candidates and issues. This Carl Sagan quote seems to fit the moment:
We can judge our progress by the courage of our questions and the depth of our answers, our willingness to embrace what is true rather than what feels good.
The link below will hopefully make it a little easier to make sense of all the information out there. A few questions to consider:
- Does my vote consider all angles of the issue including who it impacts ? Have I considered what it would be like to be on the receiving end of this change?
- Does my vote lead to collaboration and community? (versus hostility)
- Are the sources I’m using to make my decision known for honesty or focused on persuasion?
- Is the candidate someone I would be willing to hire? Example: what kind of conduct and integrity have they shown? What does their resume show- qualifications, experience, etc. Who is financially connected to them? Who is willing to endorse them (and connect their reputation to this person)?
Thank you for doing all you can to ensure the voice of the people are represented in our leaders!
My Wishes for Trying Times
Sadly, this is not one of those articles where my wacky humor helps turn heavy topics into something light. This time my heart aches after reading about a group of kids who had to stay home from school for two days because political rhetoric led to a bomb threat at their school. Luckily, when I was ready to cry into a bucket of ice cream, a well-timed hug brought much needed balm. Now I am enjoying the quiet contentment of my geriatric cat purring next to me as I write. Thank goodness for the sweet moments that soothe an aching heart.
As we move into the frenzied time prior to the election, the divisive messaging is intensifying. But I refuse to accept that we have to tolerate this as the new norm. Not only is it mean, the news story mentioned above highlights that it is dangerous. We do not have to embody this vitriol! Let’s reconnect to our core ethical values for how we relate to each other. I know it will take focused intention, but I know we can do better, be better than what is being modeled. Here are my wishes for each of us as we go forward:
Let’s Be Respectful
Respect involves showing the other person that they deserve to be treated with dignity. This trait cannot be dependent upon conditions. It’s easy to be respectful when we agree, but it takes real maturity and character to be respectful even when there is hurt and anger.
Let’s Practice Humility
Searching to be right, the greatest, or the most accomplished only serves to separate us from each other. We all have positive and negative attributes, and if we can recognize this, we can engage in the very vulnerability that leads to connection.
Let’s Look for the Positive
We are all human. Our interactions may not always come in pretty packages and we may make enormous mistakes. Seek out the positive in people. We tend to get what we expect to find.
Let’s Lead with Compassion
To me, compassion involves practicing the radical act of living out of our shared humanity. No matter who we are or the afflictions we have, we wish from the depths of our being that the other can be relieved of suffering and find peace.
Let’s Embody Kindness
Kindness is to be caring without the need for personal benefit or gain. Dr. Doty said, “Kindness ripples out and makes it more likely that your friends and those around you will be kinder. It is a social contagion that puts our society right.”
Let’s Be Good Company
We can act like a benevolent grandparent who receives another without judgment or distortion, asks for nothing, yet takes pleasure in learning, observing and understanding the life experience of another just as it is. We manifest this attitude by being non-manipulative, non-clinging, non-demanding. We let the other be themselves.
Let’s Love with Abandon
Give love freely and abundantly. Maintain concern for others and embrace the part we each can play in helping to make life more comfortable for others.
Let’s Hold on to Hope
When we have hope, we see that above the clouds lives the beautiful shining sun. We have the capacity to see potential, even if this means rethinking assumptions, changing attitudes, and taking fresh action.
There is so much good in this world, I hope we never lose sight of it or take it for granted. Together, let us bring out the best in ourselves and each other.
The Difference Between Panic Attacks and Overwhelming Anxiety
I was all set to write about the “joys” of panic and anxiety but found a great article that summarizes the differences so why reinvent the wheel? The article includes the diagnostic criteria so you can label what is taking place in the body and accurately identify what is happening to distinguish the experience from a medical emergency. It also provides you with concise language to share with providers should medication be part of the treatment plan.
Of course, no link can be provided without a little commentary, specifically about panic attacks. As the article mentions, a panic attack usually last around ten minutes. I have found that this is true only in the times when someone allows the sensations to run their course and thoughts remain minimal. Most of the time, however, people suffer much longer due to the internal chatter that keep the elevated state intact.
When working with a client, this is one of the places I focus first: to ensure this is “only” a chemical misfire rather than additional mental suffering. I start by identifying the core fear which usually speaks to the confusion that comes with these experiences. A mantra is then the antidote, keeping the meaning machine (brain) focused so the body can get back to homeostasis. Here are common examples:
- I’m dying, I’m going crazy Antidote: This is panic.
- I’m trapped, it’s not going to end Antidote: This will pass.
- I can’t make it stop Antidote: Just breathe.
I personally have delt with panic disorder for years and have become so familiar with the experience that I know exactly what is happening. I have affectionately named my panic “Henry.” When the adrenaline surge happens, I name it as soon as possible, “Oh ‘hi’ Henry. I wasn’t aware that we were getting together today.” Then I find a comfortable spot, close my eyes, focus on slowing my breath down, and with a few other tools sprinkled in, stay the course until the rush passes.
While I do not wish panic attacks on anyone, I can personally attest that they do not have to dominate your life. Understanding, tools, and resources go a long way. Don’t hesitate to find support to help you figure out the strategy that is best suited for you.
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!
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