Showing all posts tagged therapy

Your Devotion to Healing

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Your Devotion to Healing

We all want to know how people feel about us. Most of us want to know how our therapists feel about us. “Does he think about me in between sessions?” “Does she think I’m smart? Funny? Doing a good job?” “Does my therapist like me?” I think of clients often, both past and present. In fact, I think of our work together and how I’ve received immeasurable benefit from knowing each and every client.

 

Every single day I’m aware of the gifts of this profession. I’m deeply thankful and appreciative to be in a position that allows me to make contact with so many different members of my community. I’ve wanted to write a thank you letter to past and present clients for some time, but I’ve been fearful that I couldn’t express my gratitude as clearly as I’d hoped. I decided that it’s better to try than to stay silent.

 

We start out as strangers. You call or email, looking for help with your pain and suffering, questions, and frustration about your situation. Sometimes you’ve been suffering for years. Other times your discomfort is recent.

 

I know how hard it is to make that first contact, to come in for the first few sessions, before we’ve established a connection. You feel a mix of trepidation and cautious optimism. You’re afraid I might judge you. You’re afraid of stigma. You’re afraid there’s nothing anybody can do to help you, that you’re beyond hope, but you’re not ready to give up just yet. Thank you for your fight.

 

You show up and share your history, parts of yourself. You answer my questions. Little by little, you start to let go and engage in the process. You fight against the urge to clam up when you’re visited by self-judgment and fear. Sometimes you win. Sometimes the urges win. You keep trying. Thank you for your persistence.

 

I am awe-struck by your courage. You’ve been through so much life. We live in similar worlds so, I know that you’re working against years of people telling you to suck it up, that your pain isn’t a big deal, that there is more pain, worse pain out there, and that you’re lucky. I know you tell yourself this, too. But there’s a small part of you that doesn’t believe it. Thank you for your courage to hold onto this small part.

 

You come to our sessions when you don’t feel like it, when you’re thrown around by life, when you’d rather finish that work project or Netflix show or go out with friends. You come to our sessions when you’ve got a million responsibilities, when you’re afraid to face your feelings, when you’re embarrassed about what you shared last session. Thank you for your commitment to this work.

 

Somehow, you push through your own self-judgments, fear of judgment from me, discomfort, and you bring your authentic self. You allow yourself to ask revealing questions. You face your vulnerability and insecurity. You tell me what makes you feel joy, loneliness, hate, fear, and rage. Thank you for your authenticity.

 

For these and so many other reasons, I am inspired by you. You remind me that, while life is undoubtedly a painful experience, it is also wonderful. You remind me that it’s better to take chances instead of staying grounded in fear. Thank you for your inspiration.

 

You have changed me. I’m not the same person I was before I started this work. You have inspired me to become more self-aware, more patient, more curious, more direct. You’ve inspired me to learn and to embrace my vulnerability, to live more authentically. You’ve taught me to stop getting angry at people for being who they are and instead be curious. You’ve taught me to look and listen more closely and more compassionately. I would not be who I am today without our work. Thank you for changing me.

 

It is an honor and privilege to work with all of you. I hope my words and actions demonstrate my gratitude for you. Thank you for all you share with me.

 

Love and Be Loved,
Natalie

 

 

I am a licensed mental health professional serving Portland, OR. 97205.

As It Turns Out, Time Doesn’t Heal All Wounds.

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As It Turns Out, Time Doesn’t Heal All Wounds.

Have you ever noticed that one guy at work, the one who you’ve never liked, but couldn’t put your finger on why? Or the neighbor who, for some reason, when she smiles at you, you feel irritated? Or why you can’t stand the smell of a certain laundry detergent? Or why, even though you’re accomplished in your field, you feel like an idiot before you give a presentation?

We all have an information processing system hardwired into our brains. This processing system has evolved to help us integrate emotional turmoil into our mental health and is essential for healing. This system helps us to let go of what is not useful information and make connections to what is useful about an experience so that we can adapt, grow, learn, and face similar situations more intelligently.

Here is an example:

You have a stressful interaction with your mother-in-law while she is visiting for a holiday. You feel angry, disappointed, and resentful. Your chest is tight, and your stomach is in knots. You think negative thoughts about her (“She’s always such a cold, demanding jerk.”) and about yourself (“What is wrong with me that after so many years, I can’t seem to avoid these situations with her? Is it me?”)

You keep mulling over what happened, talk about it with friends, maybe even have a stress dream about it that night. The next day, you still feel a bothered by it but not nearly as much. You’re able to think more clearly about it and understand that you two interpret things differently and that there are ways that you can skillfully manage this. This is your brain’s information processing system at work. It’s transformed this disturbing situation into a learning experience. (You can also thank your REM sleep phase for this since this is the time during which wishes, learning/lessons, survival/stress experiences are processed through the action of “synaptic pruning.”

Because of this uninterrupted time to process, your brain was able to associate the memory of the interaction with your mother-in-law and useful information already stored in your brain (from other stressful interactions with her and others) to create resolution. You remember what happened, what worked, what didn’t, and that it isn’t personal, that this is just the way she is and that you have useful tools for interacting with her. The intense emotional reaction you felt the day before is gone.

Unfortunately, our brains do not adaptively store all of our experiences in this way. Sometimes we encounter traumatic experiences or otherwise stressful experiences that overwhelm our brain’s capacity to process and adaptively store information received during these experiences. This is often referred to as “going off-line.” It’s kind of like short-circuiting.

When we encounter extreme stress, the emotional and physical reactions we experience during the event keep the brain from identifying useful information about the situation; there is no resolve. What happens instead is that the event and its information is maladaptively stored. This means that the event and its components are stored in the brain and body as it happened. Everything you saw, heard, felt (physically and emotionally), tasted, smelled, thought remain in their original, unprocessed form.

You do your best to move through it, but whenever any of these senses are triggered, your emotional disturbance level sky-rockets and you have a reaction. Many times, multiple unprocessed events are linked to one another in such a way that if one is triggered, all are triggered. These events, while often linked to one another, are stored in isolation so that they are not linked to anything adaptive.

No amount of time will help them to integrate. It’s as though these events are frozen in time. An event could have happened 40 years ago, but when triggered it’s as though it is still happening or just happened.

Our personalities, coping skills, perspectives, and beliefs about ourselves and others can develop through the lens of these unprocessed events and impact our emotional and physical capabilities.

Research shows that it’s not just clearly identifiable traumatic events that are responsible for this outcome, but any event or pattern that our brain experienced as overwhelming.

It could be the way someone spoke to you as a child, your interpretation of someone’s behavior you witnessed at three years old or making a mistake during an academic oral exam in second grade. We don’t always know how our brains will store an event.

The good news is that we’re not stuck here. There are therapeutic tools that can help us to free ourselves from the suffering of an unconscious cycle or unprocessed event. One of the most efficacious and reliable tools is EMDR (Eye Movement Desensitization and Reprocessing) Therapy. This therapy helps us to safely contact the disturbing event or maladaptive cycle and process it, giving us a new understanding of the situation so that we can use its information intelligently.

If you would like to know more about EMDR Therapy, please call or email me. I would love to talk with you more about this process and see if it’s right for you. If you’re not quite ready to reach out yet, that’s ok, too. You can find more information on EMDR Therapy here and here.

 

Love and Be Loved,
Natalie

How Do I Know If I Need Therapy?

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How Do I Know If I Need Therapy?

“So about how long should it take until I feel better?” “How long do you think I’ll need therapy?” “How many sessions should I expect to attend before my problem is solved?” I have asked all of these questions during time spent on the other side of the couch. I know what it’s like to want concrete answers and expectations met. Everyone wants a sure thing in the face of so much uncertainty.

Therapy is not exactly a sure thing. Surely, it can and does help, but it’s not as simple as basic input of time and results yielded. Results depend on client honesty (with themselves and the therapist), right fit with a therapist, client’s commitment to the work both in and out of the therapy office, and right fit with whatever therapeutic modality is used.

Therapy is almost never a quick fix, but there are quicker-fix type/brief therapeutic modalities available. Whether or not these protocols are right for someone depends on a lot- personality, history, diagnosis, whether or not a person has experienced complex trauma. Even in the best of scenarios, it still requires the practice of skills through time to maintain results.

Under the psychotherapy umbrella, there are five really (really) broad categories we use to organize treatment strategies:

Psychoanalysis and Psychodynamic Therapy:

Makes the unconscious conscious, insight oriented. Emphasis on client-therapist relationship. Brief therapy model (20 session maximum) is not the rule, but is available for single-incident trauma like an attack, rape, catastrophic event, targeting a single life shift.

Examples of Psychodynamic Therapy: Jungian, Dream Work, Attachment-based

Often used for: Increasing self-compassion, improving self-concept, self-actualization, mood disorders, relational problems, trauma, developing insight to identify and manage internal conflict, shifting external locus of control to internal locus of control, couples, families,

*Psychoanalysis: Multiple times per week. The therapist is a blank slate onto which client projects their beliefs and experiences. Relies heavily on free association.

 

Behavior Therapy:

Focuses on conditioning new behavior. Uses brief therapy model.

Examples: Applied Behavioral Analysis, Aversion Therapy, System Desensitization

Often used for: Phobias, Addiction, Anger issues, Impulse control problems, self-injury

 

Cognitive Therapy:

Focuses on changing thought pattern. Uses brief therapy model.

Examples: Rational Emotive Behavioral Therapy, Cognitive Behavioral Therapy

Often used for: Phobias, Addiction, Schizophrenia, Bipolar Disorder, Suicidal ideation, Anxiety disorders

 

Humanistic Therapy:

Focuses on cultivating personal accountability and reaching highest potential. Emphasis on free will. Uses both brief and long-term therapy models.  

Examples: Gestalt, Client-Centered, Transpersonal, Solution-Focused, Adlerian  

Often used for: Improving self-concept, self-actualization, improving communication with others, cultivating self-awareness, shifting external locus of control to internal locus of control, couples, families, existential crises  

 

Integrative or Holistic Therapy:

Often referred to as “Eclectic Therapy.” (Some practitioners will basically fight to the death in disagreement over whether or not Integrative is also Eclectic.) Uses various modalities depending on what is indicated for each client. One therapeutic modality combines various features of the previous four categories. Uses both brief and long-term therapy models.  

Examples: EMDR, Narrative, Cognitive Behavioral, Dialectical Behavior, Internal Family Systems, Gottman Method, Transactional Analysis

Often used for: All of the above

 

Some people prefer to see the same therapist for various issues they’d like to target while others seek out a different specialist to treat each issue. There’s no right way to do this, just whatever feels like it’s working for the client. Some clients come with an agenda and leave when their goals have been reached. Some stay for a while after because they like having a professional to talk to who’s all about them. Plenty of people try therapy and find it difficult to give themselves over to the process, take a more passive route to treatment, get frustrated and give up. Sometimes this is because traditional psychotherapy is not a good fit for them right now, maybe ever. There are so many other great therapeutic options. Traditional psychotherapy is not the only way to heal or feel better.

 

I know it’s overwhelming to look for a therapist and decide which kind of therapy would be best for you, especially when you’ve been dealing with a problem for years, and you’ve finally decided to take the plunge and ask for help.

 

If you describe the issue and a little bit about yourself, many of us will be able to direct you in the right direction. There are plenty of therapists who won’t do this because they are sure that they can handle it regardless of their training and orientation. While I would like to believe that this is mostly the exception rather than the rule, it happens. If you feel too overwhelmed or busy or exhausted to educate yourself on various therapeutic tools and modalities, remember that you can interview multiple therapists at a time to see who feels like the best fit for you. (You can also do this regardless of your stamina to self-educate.) Once you start seeing a therapist, you can audition us. If you’re not feelin’ it for some reason, you can switch. It’s ok not to like your therapist or to like them, but feel like they’re not actually helping you. Therapy is an investment, and you have the right to switch providers at any time for any reason. If you’re feeling like you need to discontinue treatment, I usually recommend addressing this with the therapist; sometimes it just takes a little direct communication to shift things. Even if you don’t plan on continuing your work with the therapist, honest feedback is good for both sides.

 

If you’d like to talk more about this, please email me or call and I would be happy to answer any questions. This is one of my favorite subjects!

 

Love and Be Loved,
Natalie

Advice for Anyone Seeking Therapy or Counseling

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Advice for Anyone Seeking Therapy or Counseling

I’ll admit that when I’ve experienced a problem I’ve waited until I’m pretty desperate to address it. I’ve also waited until I just can’t take it anymore to get help. First, there are the, “Oh, maybe it’ll resolve itself” thoughts. Then I think, “Well, it hasn’t gone away, but I’ll just look around out there to see if there’s anything that seems helpful.” It’s usually around the “I can’t go on like this” thinking that I’ll decide to seek help and by that time, I’ve been white knuckling it for so long that I’m craving instant relief and resolution.

Sound familiar?

This happens all the time. Many of us don’t seek a solution at the first or second sign of a problem. There are many reasons why people don’t seek help right away. Sometimes it’s pride, sometimes fear. Some of us grew up in homes with unresponsive adults on whom we couldn’t depend for help so, we learned that healthy support isn’t an option. Many of us believe that our circumstances are “just the way life is” and we don’t believe a better alternative is available to us. Whatever the reason behind it, the longer problems exacerbate, the more resources we burn through trying to hang in there.

Often, by the time a person reaches my couch they’re ready to either quit a job, send their kid away, get a divorce, cut off their family, or throw in some other kind of towel. They’re over it (and they’ve been over it) and are looking immediate relief. They’re hoping for a major shift in the first session or two. And this can make for a pretty rough start to therapy.

There are some therapeutic protocols that can yield faster results, but they’re not indicated for every presentation. When they are indicated, there is often a lot of groundwork that has to be constructed before any of these modalities can take hold for a person. It takes practice to become more self-aware of our behavior, to gain insight, to change our thoughts, and to change our behavior. It’s a process.

It’s not that it takes years and years of therapy before anyone can benefit from its tools. It’s just that it’s not going to change things overnight. It took time and action for the problem to build, and it will take time and action for it to resolve. Therapy can sometimes be a painful, scary, and frustrating endeavor. It’s also totally worth it.

So, if you’re reading this and have been thinking about starting therapy, go ahead and start making the calls to the therapists who seem like they might be a good fit for you. If you’re reading this after what feels like a failed therapy attempt or still need to know more about what to expect, read on.

You probably already know that there is no magic elixir, no magic pill or incantation or book that will make all (or any) of your problems disappear. Therapy doesn’t offer a magic cure either. What it does offer is a supportive space to tell your story, reflect with an experienced professional on what has and hasn’t worked and why, and practice new ways of trying to work out the problem. Sometimes people report that it’s felt as though things have gotten worse before they’ve gotten better. It’s messy and challenging to open up the can of worms we’ve been carrying around for years. Other people say that it felt more like slow and steady progress. There are people who felt like they made progress and then crashed again or plateaued. As many people as you gather in a room are as many different stories about the therapeutic experience.

Sometimes you won’t find the right therapist for you, and that will be frustrating. Sometimes you will find the right therapist, and you’ll be frustrated by certain questions or homework assignments or the fact that you have opened up to a stranger, and you’re still really suffering. This is all part of it. In therapy, on your road to wherever it is you want to be, you are going to feel a multitude of emotions, some uncomfortable, some wonderful. You are going to try things that work, and you’re going to try things that don’t work so well. You’re going to make gains, and you’re going to have setbacks. The difference is you won’t be doing it alone. You’ll be doing all of this with an enlisted ally who wants you to succeed, who reflects back to you what they see, and who will offer variations on an approach based on their intimate knowledge of you, your situations, and human behavior.

If you can work through the intermittent discomfort, there’s a whole other world waiting for you on the other side.

 

Love and Be Loved,
Natalie

“Help- my partner is depressed.”

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“Help- my partner is depressed.”

Having depression is painful, really, really painful. It’s a draining and dreadful experience. It zaps its target of joy. Doing even the simplest task becomes a burden. Frankly, everything becomes a burden. It’s almost impossible not to feel sensitive and irritable. Depression causes people to feel tired, unmotivated, and insecure. It’s incredibly isolating.

But people with depression aren’t the only ones suffering. Their loved ones are also impacted by these symptoms. This is especially pronounced if the person suffering from depression is your partner.

Of course, it’s essential to be compassionate and empathic toward your partner. Offering love and support is valuable. And of equal importance is your own self-care. It’s ok for you to have needs and desires. It’s ok for you to want those needs and desires to be met. I’m sure there are plenty of you who can attest to the challenge of navigating this particular conflict in your relationship.

The most common complaints of people whose partners suffer from depression are things like, “S/he doesn’t want to have sex anymore”, “S/he never wants to do anything”, “I can’t depend on him/her to fulfill household responsibilities”, and “I can’t seem to feel as connected to him/her as I used to”.

Depression slows everything down, way down- libido, thought processing speed, motivation, and in some cases, even movements and speech. Your partner isn’t trying to make things difficult; they are exhibiting normal symptoms of depression. Having this knowledge doesn’t make it better, but it’s important to differentiate between your partner and your partner’s symptoms. Your partner is still in there.

While you can’t force your partner to do anything, you can encourage them to get help for the depression, seek therapy, etc. You can also get assistance for yourself. Therapy can help you get the clarity and support you need to navigate this difficult part of the relational road. Both individual and couples’ therapy can fill this need.

In addition to trying therapy, my advice is to continue to do the things that you enjoy. Don’t stop living your life. While you might feel guilty about enjoying yourself while the one you love is suffering, your guilt won’t make them feel better. It won’t be the demonstration of solidarity or love you hoped it would be. This is where resentment can trickle in.

Most relationships work because of shared interests, intimacy, reciprocity, and mutual respect. When depression is present, interest, ability to share intimacy (both sexual and emotional) and reciprocity can take a pretty big hit.

Your needs don’t evaporate or necessarily change because your spouse is struggling. And sometimes this can be the beginning of a lot of resentment- on both ends. You resent your partner for their inability to meet your needs, and they resent you for having needs that they can’t meet right now. It can be helpful for you to address this with them in a gentle and assertive way. Sometimes just speaking to the presence of this shift in the relationship is enough. It isn’t always enough, but it’s an important start. It’s important for you to feel like you have a voice; don’t force yourself to suffer in silence because you afraid of burdening your partner. You have the right to say, “I know you’re depressed and haven’t felt like doing much. This is hard for me, too. I still need help running the household, and I miss feeling close to you.” There’s room enough for everyone’s feelings.

It’s important for you to know that you didn’t cause your partner’s depression. That’s not how this works. Depression is a response to chemical fluctuations and or situational changes in a person’s life. Their recovery is not your responsibility. You can offer support and empathy, but you can’t make them better. You can get help for yourself. You can continue to live your life and find joy.

For more information about depression, symptoms of depression, and your role in the life of a loved one who is experiencing depression, please contact me via email or phone. You can find this information in the “Contact Me” section of my website.

Love and Be Loved,
Natalie

What to Expect from Therapy

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What to Expect from Therapy

In the technology age, there is a lot of information at our fingertips. When looking for a therapist people can experience this as both helpful and a bit overwhelming. First of all, there are so many of us! Depending on your location, there might be at least 30 of us within a one-mile radius. Then there are pictures, videos, mission statements, specialties, and work history to consider. By the time you have narrowed it down to a few providers you are going to call, you might have a better grasp on the questions you want to ask us, but not necessarily any idea of what your therapeutic experience will be.

The idea of sites like Psychology Today, Good Therapy, and Theravive is to supply you with information so that you will feel more comfortable making your decision. I would like to add to this by letting you know what you might experience during your time in therapy. Keep in mind that this is, by no means, exhaustive.

In the beginning (first few sessions) your therapist will usually gather a family history. This is a brief overview of relationships, experiences, and circumstances in your family. In some cases, it’s better for the therapist and client to first establish rapport before going into a family history. This approach is taken when it might be too traumatizing to discuss your past. When this happens, your therapist will strategize with you and provide coping skills to help resource you.

Next, there is the rapport-building phase. This is pretty continuous; it starts the first time you interact with your therapist whether this is over the phone, over email, or in person. The therapeutic relationship is constantly growing and changing, but rapport building is most important in the beginning. Positive rapport is our bedrock. This is when the two of you are getting to know one another and reaching a comfort level. Here, establishing trust is the main goal. This may take any length of time, but often there is a felt sense of trust and safety around the two-month mark. Safety and trust are imperative to the therapeutic process. If you can’t trust your therapist, it’s going to be difficult to explore the things with which you want help. (It won’t be impossible, just more challenging. If you are experiencing difficulty trusting your therapist, I encourage you to tell them. Some people come to therapy with difficulty trusting others in general; this is totally workable, and we see this all the time! It won’t scare us off or deter us from working with you.)

After a family history and rapport building comes the strategizing phase. During the strategizing phase, you and your therapist take an inventory of what brought you into therapy, troubleshooting the whys and hows of what has and hasn’t worked in the past. Here, you solidify your goals and come up with a plan that will help you reach them and measure your progress.

Once you and your therapist have come up with goals and a plan, you will begin the action phase. This is when you dive into what brought you to therapy. The action phase usually involves exploring your thoughts, feelings, and behavioral responses to certain stimuli. Your therapist asks questions about your experiences and makes suggestions. Many of us assign weekly homework to deepen insight and progress.

Next, is the refinement phase. During this part of therapy, you and your therapist measure your progress again and identify the areas for growth, fine-tune the strategies and skills you have learned, and begin to look at closure.

In the closure phase, you will usually find that you decrease your sessions, usually from once a week to every other week. Some people start this titration during the refinement phase. It depends on what the therapist and client decide is right for the client. Sometimes it’s at this point that the client, the therapist, or both realize that closure has been reached prematurely. If this is the case, then the number of sessions is increased. Otherwise, closure continues until the meetings have intentionally and planfully been stopped. Often the therapist periodically checks in with the client via email or phone to monitor progress, provide a bit of support, and assure the client that the therapist is still here to support the client.

It’s important to mention that these phases are fluid and quite seamlessly flow into one another. This might make the beginning and end of each phase less discernable. This means that you will most likely start the strategizing phase while you are still in the rapport-building phase, that you will begin the action phase when you are still in the strategizing phase, and so on. This is natural since these phases are interdependent on one another.

Each therapist might view or approach the phases a bit differently, but they are acknowledged as stated above. Therapeutic style, however, varies from provider to provider.

Some of us use varying degrees of self-disclosure as a tool, and some of us would never share even a shred of personal information. Some of us give advice when indicated and others will rely just on questions and interpretations to lead the client. There is no right or wrong; it depends on what you feel is right for you. I am not the best fit for each and every person seeking therapy. My client and I have to find out if it’s a good fit during our initial phone consult and our first few meetings.

If you have any other questions about what to expect in therapy, please call or email me! I would love to provide some insight as you begin your therapeutic experience.

Love and Be Loved,
Natalie