The first thing that you deal with is calling to set up the appointment. I generally try to get a little information from you regarding what your problem is (without going into a huge amount of detail) so that I’ll know if my areas of expertise match up to the problem you’re calling about. If they don’t, I’ll let you know and offer to refer you to someone that might be able to address your needs a little better than I could. However, if your need is something that I treat, then we talk about finding a time for an appointment.

I work evenings and weekends, and that’s usually a good time for people to come and see me. I tell people up front, though, that I don’t work days at this point in time, and that I don’t bill insurance, so you’ll have to pay up front. I do offer to give you a copy of a receipt that you can submit to your insurance company for reimbursement though. Once we set the appointment, I ask you to come to that first visit about 15 minutes early so you can fill out my paperwork.

My paperwork is pretty simple. I have a client information sheet, which asks for things like name, address, phone numbers, and email. I have a financial policies handout and a professional policies handout, which deal with my fees and billing procedures (including what happens if you don’t show up for scheduled appointments) as well as privacy issues, confidentiality and contact information.

Once you’ve arrived, if I can I’ll pop out of my office and greet you and introduce myself. If I’m in a session, I can’t do that right away, but will as soon as possible. When the time arrives for your appointment, I’ll gather your paperwork and invite you into my office.

Ok – here’s where it gets interesting. One of the first things I say is that I have a great amount of respect and admiration for you – coming to a stranger’s office and trusting me enough to tell me all your secrets, problems, and fears. That, quite honestly, takes courage and “guts” and I’m not afraid to tell you that. In fact, I think you NEED to hear that because it lets you know that I respect you.

Once we do that, I give you a little “road map” of what our first session will looks like. I tell you I’m going to give you some information first, then give you a chance to ask me any questions that you feel are important. From there, I ask you a lot of questions about your history and the problem you’re facing right now.

I start by telling you that I have to give you some information on confidentiality – specifically when I need to break it. I also give you information like my supervisor’s name and my contact information. We then go over the two handouts. When going over the financial policies, we determine what fee I will charge you for my services. Since I work on a sliding scale, I ask people to bring proof of income; if you don’t I assume you can pay the top level of the sliding scale. I also go over the professional policies, and we talk about things like what happens if you miss a session without calling, how much notice I need if you’re going to cancel, and who to contact if you’re not satisfied with my services.

Once these formalities have been completed, I give you the chance to ask me questions. I think it’s important you be given that chance, as a matter of respect. Once you’ve had the chance to ask me your questions, we go to the “intake” portion of the interview.

An “intake” is basically an initial interview, where I gather information about you, your family and other significant history, and the history of the problem that’s bothering you. I usually begin by asking you to “tell me your story.” I like and need to hear in your words what happened, and why you’re here. This gives me a basis for figuring out what’s going on from a psychological perspective. I ask you questions about your family, your significant other(s), friends, education, and a whole lot of other things depending on what your issue is.

One thing I want to mention is that I *always* ask about certain sensitive topics. I ask these questions of everyone, because they affect the way I work with you and also affect who you are as an individual today. These questions include gaining information about alcohol and illicit substance consumption, prescription medications, physical abuse, sexual abuse, and emotional abuse. I also ask about whether or not you’ve been suicidal, and if so, have you attempted to hurt/kill yourself and what you did during those events. I also ask about the outcome – who found you, who cared for you, how did you recover, how do these events affect you today? These are very important questions/topics and I make sure to ask everyone these questions. So, if you come to see me, expect me to ask about these.

Once I’ve gathered all the information I think I need, I ask you if you think there is anything else I need to/should know. If not, then I ask again if you have any questions. Finally, I ask if you think that working with me would be a good fit for you. If so, we set another appointment to begin our work, and go from there. If not, then I again offer to refer you to another practitioner who might be better able to meet your needs.

So…that’s what happens when you visit me for the first time. I hope I was able to take out some of the mystery surrounding what happens in a therapist’s office, at least at first. If you have any other questions, please feel free to contact me!

Please Note: The content on this blog is intended for informational purposes only. This is not therapy, and if you wish to work in therapy, please contact your local mental health agency or your physician for a referral.

If you are in crisis or danger, or are thinking about hurting yourself, please call 911 for immediate help. Please, again, realize that seeking out help really IS a sign of strength and not a sign of weakness. You don’t have to be alone in facing these things – there are people who care and who will help. Email me at: theothersideofthecouch@live.com

But what about those people who aren’t able to do that? What’s anxiety like when it takes over? It’s paralyzing, in short. Anxiety can take over your life – whether around specific things like certain phobias, or around entire large chunks of your life like interacting with people (social phobia) or even going about your life in general. I’ve seen people wanting desperately to live normal lives, that aren’t able to because of the fear that holds them back.

Anxiety, is in large part, fear. Fear of the unknown, fear of the known, and sometimes both all rolled together. So what do you do when you feel paralyzed by worry, uncertainty and/or insecurity? Well, therapy tells us that the best treatment is to confront whatever it is that makes you anxious, but that’s WAY easier said than done. And yet…it’s a way out of the hell that anxiety boxes us into.

Years ago, I had a phobia of driving. I’d been in a few accidents in my teens and early twenties, and would not get behind the wheel of a car. I was certain that if I did, I would crash and hurt myself or someone else. I was afraid of the other drives, because I couldn’t control what they did. Getting behind the wheel of the car provoked panic attacks: I felt like I couldn’t breathe, I sweated and shook, and felt like my heart was going to jump out of my chest.

Now, my ex-husband (another long story) got tired of having to drive everywhere, and he encouraged me (ok – told me flat out) that I had to get behind the wheel of the car. This was, to be honest, terrifying. At first, I opened the door, and just sat in the driver’s seat. I couldn’t even turn on the engine. I just sat there, and kept on sitting there until I could do it without the panic attack, and that took a few weeks. Next, I turned on the car. I didn’t have to go anywhere, but I turned on the car. By this time, it wasn’t taking as long to get comfortable, and by the end of the week, I was okay. Next came backing out and driving VERY slowly around the parking lots of our apartment complex. Again, this took time and I was completely panicked the first time I drove. I was out all of about 5 minutes because I couldn’t stand it. Eventually, though, I was able to drive around the complex, and from there to easy, simple places. All in all, this took about 3-4 months.

The point I want to make with this story is that first, anxiety and phobias can be overcome. You have to be motivated and willing to do what it takes -which means confronting the fear. In therapy, we make up what we call a “hierarchy of fears” where you list the things that cause you panic from least panicky to completely and overwhelmingly terrifying. We start from the easy stuff and gradually work our way up to the tough stuff – just like I did with driving.

Second, it’s important to know that you’re not alone in dealing with these. People all over the planet – therapists included – have dealt with these fears and anxieties. Anxiety, worry, and fear can be overwhelming – for anyone. I can’t tell you this often enough: You are not alone. I’ll say it again: You are NOT alone in this. Please remember this – when it feels darkest and it doesn’t feel like there is a way out of the anxiety, you really aren’t alone and there is a way.

As Always:
Please Note: The content on this blog is intended for informational purposes only. This is not therapy, and if you wish to work in therapy, please contact your local mental health agency or your physician for a referral.

If you are in crisis or danger, or are thinking about hurting yourself, please call 911 for immediate help. Please, again, realize that seeking out help really IS a sign of strength and not a sign of weakness. You don’t have to be alone in facing these things – there are people who care and who will help. Email me at: theothersideofthecouch@live.com

I’ve also heard it said that sometimes the best thing you can do is recognize when it’s time to quit. In this case, I don’t plan on quitting any time soon. I may work doing something like fast food for a while, to bring in some dollars – good,honest work is never a bad thing. However, while I’m doing that I’m also going to keep on keepin’ on. I’m going to continue to make fliers, advertise my DBT group and therapy practice, continue to hand out business cards and brochures and continue to call local therapists, psychologists and doctor’s offices about my business. In the end, what else can I do? In the end, I move. I do one thing. I use active trust and distress tolerance and emotion regulation – all my DBT skills. I network, I promote, and I advertise the best I can given my budget constraints. I take care of myself the best that I can.

Life in general is pretty much like that too. Sometimes it feels like what we do is 99% effort and 1% (or less) reward. It can be in relationships – spousal/intimate, child-parent, or even friendship – or in other areas such as when the work we’re doing or the job we’re at seems unbearable, or that we’re lonely and nothing will ever change, or even that life and everything else is just damn overwhelming and you want to break down or hide. In any of these, that 99% perspiration comes into play. Folks, living is HARD work. Surviving is hard work. Sometimes even being aware is hard work. I’m not being facetious here, either.

We’ve got to keep on keepin’ on. Sure, there are ways out – alcohol/drugs and other self-destructive escapes may seem seductive at times. But in the end, we’re hurting ourselves by doing these things. There just really isn’t any easy way out sometimes, and sometimes the best thing you can do is gut it out and hope for the light at the end of the tunnel. And the thing is, if we look for it – REALLY look for it and accept it when we see it – it’s there. The hard thing is that it may not be what we expected, or even what we wanted. That can be a pretty hard thing to accept, and accept it we must. Compromise occurs in life, too – and many times it’s us doing the compromising.

AND, we move. We do one thing. We use our skills and talents, and we take care of ourselves. We “network” – we rely on each other and learn about each other and help each other. The power of each other is there for us, if we’ll only see will eventually come and that we’ll realize the reward or success in due time. Is this a guarantee? I wish it were – life would be a lot easier if we knew without a shadow of a doubt that success would arrive. How we define success is critical here, though – if success is limited to one thing – say, financial wealth – then feeling like we’ve failed is a lot more likely. If we define success much more broadly, we increase our chances of feeling like a success. Asking am I a better person because I tried this? What benefits did I get out of doing this anyway? might lead us to feel better than if we define things more narrowly. All this boils down to being resilient – no matter what happens, we will survive it and can thrive in spite of it.

So with me, I may not be able to practice full-time yet – I may have to find other work that helps me pay my bills while I work on setting this up. In the end, though, my sense is that it will be worth it and that I’ll be stronger for the struggle. I don’t see anything wrong with working hourly labor – as I said earlier, good honest work is a good thing in my book. So, I’m going to be seeking out work wherever I can find it AND still keep on working on my practice. I’ll be using my active trust – when my heart tells me it’s never going to work and I feel depressed and discouraged, I’m going to let my head take control and continue to trust that it WILL work out in the end.

The bottom line for me is that a lot of this doesn’t have to be an either/or proposition. There is, and can be an “AND” in there. I can still work toward being a licensed psychologist AND work at a fast food place or bookstore or department store. I can feel disappointed, discouraged, depressed, and anxious AND still have faith and hope. And, I can keep on keepin’ on, because in the end it’s the journey that will matter and I want to come out of this the strongest, best person I can be. I plan on being resilient and thriving, and keepin’ on keepin’ on is what will get me there.

First, let me say that in this post when I talk about “anxiety” I’m talking about a general sort of anxiety. Clinically speaking, “anxiety disorders” are a whole category of things that include PTSD, OCD, phobias including social phobia, and panic disorders. Obviously, a lot of these specific conditions have symptoms that are going to overlap with a more generalized form of anxiety.

Everybody experiences anxiety – it’s a fact of human life. Anxiety is generally a protective thing – it warns us when something might be unsafe or unhealthy for us. When anxiety is ongoing, though, and severe and NOT related to any realistic danger or situation, it gets in the way of living.

Clinically, we call this generalized anxiety disorder, and the criteria for diagnosing it are (taken from the DSM-IV-TR)

Excessive anxiety and worry occurring more days than not for at least 6 months, about a number of events or activities (like work or school performance)

The person finds it difficult to control the worry

The worry and anxiety are associated with 3 or more of the following 6 symptoms, with some occurring more days than not

restlessness or feeling “keyed up” or “on edge”
being easily fatigued
difficulty concentrating or or mind “going blank”
irritability
muscle tension
sleep disturbances

The anxiety or worry is not limited to another disorder (in other words, it’s not anxiety about being depressed, an eating disorder, or a specific phobia or any other disorder). The anxiety also has to be separate from any anxiety that someone might feel with PTSD (PTSD would be the diagnosis in that case).

The anxiety, worry or physical symptoms cause “clinically significant distress” or impairs the person’s ability to function in everyday life.

Finally, the anxiety or worry is not related to a medical condition or the effects of substance use or abuse.

Ok, as you can see, that’s quite a list.  If you think about it, 6 months is a long time to deal with anxiety on that level – and many people do, and deal with it longer even because they don’t want to look foolish seeing their doctor about it. I’m going to tell you – it’s not foolish, and it helps.

So you know now how to tell when we clinicians consider anxiety to be a diagnosable problem – does it have to be clinically diagnosable to be causing impairment? NO.  If you’re feeling severe anxiety that doesn’t go away – even if it IS related to another disorder or medical condition, I recommend seeing your doctor. It’s tough to live with. A lot of people who are diagnosed with generalized anxiety disorder say that they’ve felt this way all their lives, and it does tend to run in families.

So what does it feel like? Well, not being able to sleep – get to sleep, stay asleep, get good sleep – leaves you feeling irritated, edgy, exhausted. Irritated more on top of it – some people describe the feeling like “a sinking feeling in the pit of their stomach,” “always waiting for the other shoe to fall,” “a sense of impending doom,” or “like I swallowed a ball of barbed wire that’s just sitting there.” You can’t focus - it may feel like your mind is jumping all over, or that you’re “thinking through mud.” You may feel like you can’t escape your worries, or can’t get away from the anxiety. It’s NOT comfortable, but it CAN be helped.

So what works? Well…I know some of you aren’t going to like to hear this, but there are medications that can help. There are some medications that help short term, but can be addictive – these help short-term. There are some antidepressants that help as well. Getting some good therapy can also help – talking over some of the issues and learning some good coping skills helps. When I work with clients I use an analogy that seems helpful – the house with the cracked foundation. Medication is like shoring up the house, and therapy helps you go in and fix it so that you can cope better when you stop the medication.

The bottom line is that if anxiety if interfering with your life, there is something you can do – you don’t have to suffer. It’s not showing weakness and you’re not crazy if you go to get help. You’re very, very sane in my opinion – it takes strength and courage to get help, and chances are you’ll feel better for having done so.

As Always:
Please Note: The content on this blog is intended for informational purposes only. This is not therapy, and if you wish to work in therapy, please contact your local mental health agency or your physician for a referral.

If you are in crisis or danger, or are thinking about hurting yourself, please call 911 for immediate help. Please, again, realize that seeking out help really IS a sign of strength and not a sign of weakness. You don’t have to be alone in facing these things – there are people who care and who will help. Email me at: theothersideofthecouch@live.com

I’m not going to say that we should lower the walls and let everyone in – to do so would be self-injurious in the end. Not everyone deserves to be trusted. But what do you when you WANT to let someone in and just don’t know how? What do you do when you doubt your own feelings, instincts and needs/wants? Too many of us have learned through far too much experience that not only can we not trust other people, but that we can’t trust ourselves.

In psychology, we have a lot of theories about how we develop as people. Some concern our physical development and others our cognitive development. Not surprisingly, there are theories that concern themselves with our emotional and social development as well. The point here is that there are many, many ideas about how we are able to develop as healthy human beings and function in our societies. There is one that is especially related to this discussion though.

Erik Erikson came up with a theory of development that proposed a series of stages characterized by fundamental life crises that had to be resolved before an individual was able to move on to the next. While his theory has come under more critical scrutiny in recent years, his trust vs. mistrust stage has some resonance here. According to Erikson, this is where infants learn whether or not the world and the people in it can be trusted to meet her/his needs. Developing trust means that the infant learns that basic needs are satisfied consistently and that the people around him/her are secure and safe.

And what happens if the child learns that the world is NOT a safe place? That her/his needs will be met only sporadically or conditionally? Guess what – trust doesn’t develop. Whether or not you buy into Erikson’s idea that this has to occur before other development is up to you, but I see many people who have not been able to develop a fundamental trust either in themselves or in the world around them. And it’s impossible to trust other people if you can’t trust that your needs – your basic human needs – are going to be met.

Along the way, many of us have learned that other people’s needs and wants come first. The way this happens is different, but the end result is basically the same – what I want and need doesn’t count; what counts is pleasing this other person who DOES count. As result, we learn that we can’t trust ourselves and our sense of what is right and good for us, because it’s often at odds with what this powerful other person wants and needs. We’re told we’re selfish, we’re bad, we’ll never be good enough…and on and on. And so…we grow and learn to ignore, push down, marginalize and denigrate our needs and eventually ourselves because this is how we survive.

Realizing this dynamic is the first step in changing it. Because our instincts have been so trained to consider everyone else first, it feels somehow wrong and/or bad to take care of ourselves. Frankly, we don’t get a whole lot of support, either, especially if we’ve spent most of our time and energy taking care of everyone else first. It’s a shock for others to realize that we’re going to take care of ourselves and that they’ll have to adjust. People who truly care for us and love us, though, will end up being supportive.

Some of us may not even KNOW what we need or want because considering ourselves is foreign to who we’ve become. Try an experiment with me, ok? Get a piece of paper and a pen or pencil and find a comfortable place to sit. Do this during a quiet moment when you won’t be interrupted, and then close your eyes. Just sit with yourself and think about what YOU need. Not what the kids need, or your partner needs, not about the PTA cookie drive or the repairs on the van. Just what YOU need. Now, write down what you came up with. Ok, well and good – and here come the hard part. Write about what it felt like to think about yourself. Really be honest with yourself – what did it feel like to consider what you need, apart from everyone else?

For some of us, it’s a very difficult thing to do. It’s frightening to contradict these early messages, and it’s a lot easier to think of everyone else first. I don’t know about you, but I think there’s a lot of grief there too – that we didn’t get to consider our own needs, that we didn’t learn to trust ourselves and feel that what we needed and wanted counted for something. That’s a hard, hard thing to face. And yet, continuing to focus on everyone else and exclude ourselves only perpetuates the problem. So…what do you need?

One thing that occurred to me as I was thinking about and starting to write this post was that active trust is something that may be a useful tool here. Our hearts have learned over time that we can’t trust ourselves, and so we feel that it’s dangerous, wrong, or bad to do that. This is a time when it’s perfectly appropriate and in our best interest to let our heads overrule our hearts – we DO deserve to pay as much attention to and consider as lovingly our own needs and wants as much as we do other peoples’. Use active trust to help you here – active trust is as much for you as it is for other situations.

I read an interesting quote the other day, which spurred me to think and write about this topic. It was posted on Facebook (the group is called Women Shifting Consciousness and the author is Beverlee Garb) and read:

Trust yourself, and you will be able to trust others.

Trust starts internally. Trusting that you know what’s best for you, trusting your inner radar for what is acceptable and not acceptable, trust who you want as part of your inner circle of support and who you do not…Once you trust yourself, it is easy to trust others because they cannot disturb your inner friendship with yourself.

I don’t know about inner friendship, but I do know that trust has to start someplace. Fear, anxiety, tension – all these are related to having learned to deny your basic self in order to survive. We feel these emotions when there is a disconnect between what we deeply know we need and what we have to do to survive. Try one thing – think of one way you can first know what you need and then trust yourself that it’s real and that you can do it. Use active trust, and do one thing…just do it.

As Always:

If you are in crisis or danger, or are thinking about hurting yourself, please call 911 for immediate help. Please, again, realize that seeking out help really IS a sign of strength and not a sign of weakness. You don’t have to be alone in facing these things – there are people who care and who will help. Email me at: theothersideofthecouch@live.com

Do any of these situations sound familiar? One of the workshops I’m going to be offering as part of my practice will be on assertiveness training. I’ll admit something to you here: Being assertive is something I still am working on, and probably will be working on for a while. So let’s start at basics: What is assertiveness?

Assertiveness is first of all a way of communicating. It’s worth discussing what assertiveness is not as part of this definition: it’s not aggressive, disrespectful, or mean – it’s not looking for a fight. Assertiveness is also not passive or passive aggressive – it’s not doing things behind someone’s back even if you think you’re right, it’s not giving in or letting someone run roughshod all over you. It’s not a tactic for getting your own, way, either. In both of these ways of communicating, you have trouble saying “no” or maintaining and respecting boundaries (your own, or someone else’s). I’ve talked about saying no and boundaries in other posts, so I won’t spend a whole lot of time on these, other than to say that assertiveness is more than these two important aspects. These are also skills that are used in DBT, in the Interpersonal Effectiveness module.

Ok, so what IS assertiveness then? As I mentioned, it’s a style of communication. Here’s a quote from a workbook I use (and draw upon heavily):

…it recognizes that you are in charge of your behavior and that you decide what you will and will not do. Similarly, the assertive style involves recognizing that other people are in charge of their own behavior and does not attempt to take that control from them. When we behave assertively, we are able to acknowledge our own thoughts and wishes honestly, without the expectation that others will automatically give in to us. We express respect for the feelings and opinions of others without necessarily adopting their opinions or doing what they expect or demand” (Paterson, 2000, p. 19).

The bottom line is that being assertive means being respectful of ourselves and of others. It means being aware of what we want and need, and working to meet those needs in honest, open, and respectful ways, and respecting other people as they try to do the same. Learning to say and hear “no” and developing, maintaining and respecting healthy boundaries are techniques used in assertiveness – they are part of it, but not the whole. Here’s some examples of an assertive statements:

“I can’t join this committee now. I’m on two other committees and I need to have some ‘down time’ to take care of myself.”
“I just bought this book yesterday, and I noticed today that there is a page missing. I’d like a replacement, please.”
“Excuse me, I’m next in line.”

So, what gets in the way of being assertive? Lots of things. Again, drawing heavily from Paterson’s book, our own fears, the reactions of others to us being assertive, power differences in relationships (e.g., employer/employee, doctor/patient, parent/child, man/woman – I’ll address the gender thing in a bit), stress (this is hard work!), our own beliefs about what being assertive means. Stress reactions can be calmed with stress reduction and relaxation techniques. I don’t want to minimize the importance of these, but they are a different set of skills and can be covered in a different post (and that will be next post related to skills you can use).

The other stuff leads up to the stress component, so let’s focus on those things. Our own fears and beliefs about assertiveness get in the way in several ways. First, we may worry that we’ll offend someone, or that they’ll be angry at us. And the reality is, that may be true. Let’s go back to our working definition of what assertiveness is, though – they are responsible for their emotions, reactions, and behavior. Your job is to take care of yourself, in a way that’s respectful – but that means respectful of yourself as much as anything. Dealing with someone else’s anger is tough, I’ll admit. (When you’re in a relationship where abuse is possible, it can be downright dangerous, and this is where you want to have support – people you trust and that can help, a place to go if you need it, and a safety plan. This post isn’t meant to address abuse situations.) Anger comes up a lot when you’re changing your style of interacting – if you’ve always been passive before, seeing you change may be a shock to the people who are used to having their own way. And you know what? They’ll adjust. Your fear, though, can get in the way.

So what do you do? Well, imagine you’re a coach – what would you tell your client or athlete? First of all, ask yourself what you’re afraid of? What is the worst that can happen? Are your fears realistic? If so, how can you help yourself, respect yourself and still be assertive? (Tough question, I know!) Second, try it out. See what happens – you may be surprised. Success is the best reinforcer here; if you succeed and have a good experience you’ll be more likely to do it again. As the title of one book says, “Feel the fear and do it anyway.” Here’s the thing – if our fears get in the way, we tend to act out of our fears rather than acting out of the need to respect and meet our needs. The result is, we don’t get our needs met.

Your other beliefs about assertiveness can get in the way as well. Do you belief that being assertive is unladylike or bitchy? Do you believe that it’s selfish, or that other people’s needs come first? These are all things that women who are assertive face in this society, by the way – there’s that gender thing. Do you think it’s impolite to disagree or say “no”? Many of us were raised to disrespect our own needs and focus on others. Being assertive after all this training otherwise is hard. Examine these, and look at how these beliefs affect your behavior. Then try an experiment – just try, once, to contradict one of these and be assertive anyway. See what happens.

Ok – now what about how everyone else reacts? Well, we’ve already noticed that other people may react by being angry, offended, or puzzled by your new assertiveness. This is where your boundaries become important. Don’t back down, but don’t get aggressive either. It’s important to keep and maintain those boundaries.

Here’s a good rubric for being assertive:

Ok, believe it or not, this is just a little part of the workshop. (It’s a long post, I know). As Always:

If you are in crisis or danger, or are thinking about hurting yourself, please call 911 for immediate help. Please, again, realize that seeking out help really IS a sign of strength and not a sign of weakness. You don’t have to be alone in facing these things – there are people who care and who will help. Email me at: theothersideofthecouch@live.com

References:
Paterson, R.J. (2000). The Assertiveness Workbook. Oakland, CA: New Harbinger.

Stephen Ministry Leader’s Training Manual. (2000). T-6, Assertiveness: Relating Gently and Firmly. St. Louis, MO: Stephen Ministries.

Depression feels like a heavy weight, a wet blanket, and day upon day of lousy weather all rolled into one. AND, it’s more than that. To use the example of an antidepressant commercial, depression hurts in a lot of ways – physically, emotionally, mentally, and interpersonally. You feel rotten, it’s hard to think clearly and/or move, life sucks and nobody around you seems to understand or care, or care enough. It’s bleak.

I’m not going to lie and say there’s an easy way out – there isn’t. Honestly, what I’ve found works the best is a combination of medication and psychotherapy, and I’ll tell you why. From what I’ve seen, it’s like fixing a house with a cracked foundation. Having the foundation cracked doesn’t mean that the house is broken or useless – far from it. It means that some repair work needs to be done, and that the house can be and is worthy of saving.

So…to begin the repairs, you first have to shore up the house, right? Using medications is like shoring up the house – it helps get the biological, chemical piece working again so you can get at the root cause and work on that. That’s where psychotherapy comes in. Even if there is no deep, dark past to examine, therapy can help you figure out what triggers depression for you, how to recognize it and the warning signs, how to cope when it hits, and how to let other people know how to help you. Therapy also gives you a chance to really let loose and talk about what it’s like to feel and deal with depression – with someone who’s not going to judge you, tell you to “pull yourself out of it,” or try to fix your problems for you. It will give you someone to talk to, who’s got some training in how to deal with it, and can help you develop and practice skills for dealing with it.

Now, that said, I realize that for some people depression is more biochemical than anything else – therapy can help you too, though – in the ways I mentioned above. If you do happen to have things in your past that are affecting your mood, therapy will almost certainly help you with that – but you don’t have to have had trauma, abuse, or other painful past experiences in order to benefit from therapy.

Ok, before I start sounding too much like an informercial…what can you do on your own? As trite as it sounds, I usually recommend that people start at the beginning. Accept the reality that you’re dealing with depression. For some people, that alone is a huge step – there is still stigma out there about mental illness and many people don’t understand what depression is, or how it affects you. So, accept reality and then realize you have a choice in how you’re going to deal with it. (Yeah, I’m taking a page from my DBT training – radical acceptance again!)

Dealing with depression takes a LOT of energy. Depression is a condition that saps your strength – emotionally and physically. It feels sometimes like you’re trying to slog through thick, sticky mud and is every bit as exhausting. You can choose, though, whether you’re going to stay in it or not, and there are consequences either way.

Choosing to try to move out of it means choosing that you’re going to move, even if it’s just a little bit. It may mean something as simple as getting up and taking a shower, or making yourself go outside for a few minutes. It may mean more – calling a friend, a doctor, or someone you trust and asking for help (and believe me, I know that’s HUGE.) Either way – if you’re going to choose to deal with it, it means YOU have to do something. And, as I always say (and mean), seeking help really is a sign of strength, and not a weakness in any way, shape, or form. Moving – and then moving consistently are important parts of this process.

If you choose not to deal with it, then you have to be willing to take those consequences – it may mean that someone else has to make decisions for you, if you’re not able to do so. It may mean giving up some control so that someone can get help for you…for me, those are scarier than making myself do something, but that’s me.

One thing I want to make crystal clear here is that I don’t think that being hospitalized is shameful. In fact, I believe that it’s helpful, and that getting well and being able to function is the goal – and I realize that there are many of you who disagree with me, and I respect your right to do so. After all – I’m not walking in your shoes. However, if you’re not able to or are unwilling to make decisions for your care – or if you’re self-harming or threatening to self-harm, hospitalization is a possible outcome.

The point of all this is that I’m assuming you don’t want to deal with feeling depressed. You can’t control what’s coded in your genes, but you can choose how you’re going to deal with it. And I’m not saying that positive thinking, affirmations, etc. are going to magically pull you out of it. These may help, but depression is a lot more than negative thinking. You can choose to shore up your foundation with meds, or you can choose not to. You can choose to use therapy, or not. You can choose a combination of the two – the point is, you have a choice.

When you’re in the throes of a major depression, it may not feel like you have any choices, or that no matter what you do it’s not going to work. This is where you have to use your active trust – your emotions are not necessarily giving you the best information, and you may have to let your head overrule your heart on this one. Get help if you need it, and help yourself. Depression is nothing to be ashamed of, any more than kidney disease or diabetes is. It’s a treatable condition, and there is hope.

Does getting help mean it’s going away for good? For some people, maybe…for others it means that the beast is pushed away again for a while, but will keep following you. For you…well, learning about your triggers, symptoms, etc will help you. Learning this stuff also helps you feel more in control and stronger – nice side effect, huh? One great program, developed by a lady who both does therapy and has bipolar disorder is called the “WRAP program.”

WRAP (Wellness Recovery Action Plan) is a system that helps you recognize your triggers and symptoms, and put into place a plan to help yourself feel better. If that plan doesn’t work, WRAP also helps you develop a plan that tells who you want involved in your care, how you want to be treated, and who can make decisions for you. It’s a great system, and Mary Ellen Copeland (the creator) has some great articles on her website. The purpose of WRAP? “Getting well and staying well.” Copeland is also the author of several wonderful self-help books/workbooks for coping with depression and manic-depression – her work is widely respected and used. (I highly recommend her books both to clients and non-clients.)

So, bottom line is that even if it feels like there is nothing you can do or that nothing you do works or has an effect, there ARE things that will help. Talking to a therapist (heck, talking to someone you trust, period!), working with medications, using some great self-help resources, and your own strength all help. (And yes, you ARE strong – it takes a lot of energy to deal with this!) Cognitive behavioral therapy is one route that seems to help a lot of people – Copeland’s books actually use a lot of CBT-style work. DBT skills help too – trying them won’t hurt, and you have a lot to possibly gain.

Just remember – you’re not alone, even if it may feel that way. There are many, many people who are dealing with and have dealt with depression. I have tremendous respect and admiration for those of you dealing with this, whatever the root cause may be. It takes a lot of energy and strength, and pulling yourself out takes even more. You’re not alone – really.

As Always:

If you are in crisis or danger, or are thinking about hurting yourself, please call 911 for immediate help. Please, again, realize that seeking out help really IS a sign of strength and not a sign of weakness. You don’t have to be alone in facing these things – there are people who care and who will help. Email me at: theothersideofthecouch@live.com

Wagon and Barn near Fort Collins, CO (copyright 2009, Laura Burlingame-Lee)

This sorting process is a metaphor for what we do in our lives – how many times do we “save” relationships that don’t work/are dysfunctional/we’ve outgrown? Or “store” our resentments, anger and/or crappy life experiences? All of us do, to some extent, and some people find it easier to let go of these things than others. Some of us are more like me and my “stuff” – it’s hard or maybe even impossible to let go. We may not want to, we may not know we’ve accumulated this much “stuff,” or we may simply not even know HOW to let go. We may feel paralyzed by fear and anxiety – “Where do I even start? This is overwhelming and I’m not sure I can do it!”

In my basement, the first step was to start sorting – and I started with one corner of the room. “Stuff” went into three piles: Throw away/recycle, Give away, and Keep. Here’s one thing that applies when we’re doing our mental sorting – pay attention to where your emotions are during the process. Strong emotions usually indicate something going on; in my basement they indicated some kind of attachment to the object. In some cases, I couldn’t bear to throw it away, but couldn’t keep it, either (playyard, anyone? Little Tikes Castle?) – those all went to Goodwill. *I* didn’t have them anymore, but someone else could enjoy them and use them.

In our lives we have this kind of stuff too…relationships we don’t want to give up, but that aren’t really helping us or other person anymore, or activities we hang on to “because it’s always been done this way,” but that don’t work for us either. So what do you do with these? You can’t exactly give them away. For me…I release them. I don’t necessarily take direct action, but I “give it away to the universe” and let it go emotionally. I figure that the old saying of, “if you love something, set it free and if it was meant to be it will come back to you,” applies here. Some kind of releasing ceremony or ritual may help you here…writing a good-bye in your journal, blowing dandelion seeds into wind and watching the breeze catch and carry them away – something that will help you emotionally release the situation. When it crops up again, think of what you did to help release and revisualize letting go again. It may help.

The stuff that you “throw away/recycle” may be tougher in a lot of ways. Much of this stuff is composed of dead relationships that you still hang on to, situations or memories that you dredge up and use to nurture old resentments and/or anger, anger at the past that you can’t change – there are so many things that fit here, it’s impossible to list them all. What do you do with these? There isn’t exactly a cosmic stretchy-trash bag you can throw them in, right? These take longer to heal, and acceptance and forgiveness is a part.

Now, before you jump all over me with, “How can I forgive what s/he did to me? It’s unforgivable!” or “S/he doesn’t deserve my forgiveness,” etc. I want to tell you that I’m talking about acceptance and forgiveness in a different light than any religious context. Acceptance and forgiveness is a process where you realize you can’t change what happened or change the person who did it (it’s actually radical acceptance) and you begin moving on – for your sake. Acceptance here is “radical” because it’s total – there is no room for fantasy, for imagining “what you’d do if…” or “if only I’d…” – this is dealing with what actually IS, rather than what we want it to be or what it could have been. And it’s hard. We don’t always like what we see – and it’s also necessary to clear out the clutter of these resentments. It also doesn’t happen overnight – it’s a process and takes time, and you’ll likely be doing it over and over for a while before it starts to feel right.

The other piece of this equation, forgiveness, is also not quite what it might seem on the surface. We’ve all heard the maxims, “forgive your enemies,” “turn the other cheek,” etc. This is not the kind of forgiveness I’m talking about. Our process may end up leading us there, but that’s not the important part at this moment. The important parts are that a) forgiveness is for US, for OUR peace of mind and that b) we try. Like acceptance, this is a process and doesn’t come overnight. Forgiveness here tends to take the form of coming to terms with our past or with the relationships that are not right for us in a way that we feel healthy about. It’s NOT a blanket, “I forgive you and let’s forget and move on.” First of all, there is no way that many of us COULD forget what was done to us and second, moving on is for US.

When we’re stuck in these relationships, in our pasts, or in our hurt and resentments, we’re not moving on, and we’re hurting ourselves. I’m not going to minimize the pain of what others do or have done to us, but we don’t have to continue their process of hurting ourselves by not letting go. Acceptance and forgiveness here is oriented toward ourselves – and letting go is the process by which it happens. Note the word “process” – this isn’t something you decide to do in the morning and be all done with by lunchtime. Like the other processes I’ve mentioned, you’ll have to come back to it over and over again, and do it over and over again.

I’ve also noticed that in a lot of these situations, there is so much self-blame and hurt – forgiveness here means forgiving yourself. (Some of you may be saying, “What? I have nothing to forgive myself for! I wasn’t the one who hurt me!” You’re right – and you’re in a different place from the people I’m addressing here. And honestly? Good for you if you don’t have it! ) A lot of us carry guilt, or harbor feelings of “If only I’d…” or “I should have…” Forgiveness here means again, first accepting the reality of what you did do and realistically could control, and then also accepting the reality that you did what you could do. Forgiveness here means letting go of the punitive “shoulds” and being gentle with yourself so healing can happen. And as always in this post, it’s a process, and learning to trust the process is an important part of letting go.

Some of the ideas I gave you earlier in “giving away” things also work here – creating a “farewell” ceremony, writing a eulogy in your journal, or releasing the pain and hurt to the universe (burying it or a symbol of it, maybe) sometimes help. The key work is done inside you, though.

Some of the things in my basement were hard to throw away – my dissertation articles (“What if I need them again?”), boxes of things I”d kept from my first marriage (they reminded me of what a jerk my ex was/is) and letters from old loves (“what if I’d…” “I wonder what could have been…”). And as hard as it was, it was a necessary process. The clutter is about half clear, and I’m still excavating. Occasionally, I’ll come across things I still need: teaching materials, art supplies, old photographs…these are like the things we keep in our lives. These are the things that lift us up, remind us of who we are, and of what’s important to us. And once the clutter is cleared, it’s easier to remember and easier to appreciate these things.

As Always:

If you are in crisis or danger, please call 911 for immediate help. Please, again, realize that seeking out help really IS a sign of strength and not a sign of weakness. You don’t have to be alone in facing these things – there are people who care and who will help

The other way we work is being process-oriented. A process orientation involves more than looking for results – it’s looking at what’s going on between the two people in the room, in terms of how they’re relating to each other, and how this relating reflects what’s going on outside the therapy room for the client. It also means paying more attention to the deeper meaning of what clients say, and how their words reflect their emotions and experiences, as well as their growth.

Process is more than that, though. Process is the flow of life that runs through us and with us and by us. How we react to life often reflects the process we’re experiencing. Trusting the process means letting go of control that’s keeping us from growing and trusting that our process – our lives – will eventually be ok.

Letting go in this way is a scary thing to do. It’s something I learn and re-learn every day, and have to consciously practice – trusting the process is an active trust kind of thing for me.

I have several “mantras” I use to remind me to trust the process. One of my favorites is, “It is what it is.” I usually follow that up with a question that gets at the heart of the issue: “Now, how do you want to deal with it?” or “How can you let go and trust here?”

There are several situations where I’m currently using this process…and none of them are easy. I’m finding for me, though, that letting go and trusting the process at the very least brings me some peace of mind. I take care of what I need to take care of, and the rest will be what it will be.

To me, one key to being able to trust the process is using one of my DBT skills: Radical Acceptance. The basic idea is that you realize that you first have to see what reality IS rather than what you want it to be, and then next, work on accepting that this reality exists. It’s a tough process – but once you’re there, you’re better able to deal with what is, and won’t get caught up on what should be, or what’s not fair. Radical acceptance is key to learning to trust the process, because you can’t begin to see the process until you accept the reality you’re facing. It’s that simple.

Another key piece is letting go. For me, this also takes conscious thought and action – I ask myself, “Ok, how important is this really? Am I going to be worrying about this, or be angry at this 10 years from now?” If the answer is no, it’s probably a good thing for me to let go of. And I again struggle with this a lot – and am learning that the process is again, worth it.

So, trusting the process means first accepting reality for what it is, and then letting go of our expectations of what’s fair or what “should be.” What next?

Here’s where it gets a little less behavioral…one of the things that DBT emphasizes is mindfulness, and I believe that mindfulness is another important key to trusting the process. Once we’ve accepted and have started letting go, mindfulness (being aware with compassionate nonjudgment) will allow us to be open to the possibilities and opportunities that DO exist. Mindfulness also allows us to be aware of what’s going on around us, what triggers us, and what our choices are – it’s an incredible tool for increasing awareness and connection, if we choose to use it that way – it’s how we see the process part that’s going on here.

The final key in trusting the process is simply, trust. Many have us have learned, and learned well that we can’t trust anyone. Life has let us be hurt or injured maybe even by people who were supposed to love and protect us. Other people take advantage of us, or make fun of us, or generally make the world an unpleasant place in which to live. And here I’m telling you to trust. Yeah, right….

Here’s where you use active trust. If you’ve learned to trust no one or anything, it may be time to try and see if the time is right to experiment a little with trust. To trust the process though, at some point, you have to take that leap and just let go and trust. Something, someone, sometime…Use your active trust if it helps, and realize that it’s likely going to be worth the effort.

Trust the process – and see where life takes you. Even if you trust no other process than the fact that the sun will rise the next day, it’s a start – and a good one. You may find yourself going in a direction you’d never considered, or meeting people you’d never have known otherwise. Let go, let yourself have an adventure…and trust the process.

As Always:

If you are in crisis or danger, please call 911 for immediate help. Please, again, realize that seeking out help really IS a sign of strength and not a sign of weakness. You don’t have to be alone in facing these things – there are people who care and who will help. Email me at: theothersideofthecouch@live.com

I always wanted to be Samantha on “Bewitched” – even if she got into messes, she could twitch her nose and all would be well. (Of course, she did have to put up with that dork of a husband…anyway…) Wouldn’t it be nice if we could make ourselves look the way we want, make other people behave the way we want and do the things we want? If we could control everything and have it our way? (OK, there’s an Endora streak in me too – I admit it.)

Well…no. As hard as it is sometimes, we learn from our struggles. We don’t choose or deserve many of the things that happen to us or are done to us – but we have a choice in terms of learning to deal with it or letting it control us. I know that sounds harsh, and I apologize – I never, ever want to minimize someone’s pain by being flip. Here, though – this really is our choice. Recovery, healing, and moving forward are all “dealing with it.”

The thing is, it’s awfully easy to let whatever happened or whoever hurt us control us and I know that from experience. Emotions and mood states are POWERFUL, and can distort how we perceive reality. These things are also REAL – depression, anxiety, PTSD, anger, fear – they all are very real and affect us deeply. As tough as it is, our task is to try to see ourselves objectively and to try to do the best we can without further hurting ourselves or hurting other people. And doing so is not easy at all. It’s a growth process, and a rebirth in many ways.

This process is not an easy thing to learn either. When I was doing my training, I used to keep a kid’s magic wand in the little office where I did my counseling. Sometimes people would come in and would want to change someone else – like their children or spouse, their boss or coworkers, or extended family members. Other times, I’d hear people talk about how unfair things were and how others should do things/see things their way, or how life should be different. At this point, IF I’d established good rapport with my client, I’d take the magic wand and bang it on the end table or chair and say, “Look…it doesn’t work. NOW what are we going to do? We’ve got to figure how to handle this, because the magic wand doesn’t work!”

This almost always got a laugh – and made an important point. There is no easy fix for a lot of these issues. In fact, many of the issues that people talked about WERE unjust. However, we can’t change other people, and sometimes we can’t change what happens to us.

What we can do, however, is change ourselves. Again, it’s not easy – this is hard work. It involves letting go of our “shoulds” for others, our attempts to make them do what we want them to do and accept them as they are, and deal constructively with the things that happen to us. (For the record: Accepting other people as they are does NOT mean accepting their behaviors, the harm they do, or the hurt they cause. We’re not condoning or accepting in any way, shape, or form abuse or other harmful/hurtful behaviors. We’re let go of trying to change them, and instead focus on what we can do to help ourselves.)

This is the essence of psychological healing, in my opinion. Therapy ideally gives someone a safe place to learn about and practice letting go, acceptance, and self-change. It’s not a magic wand, but it can be a magic place because the work that’s done in the therapy room, when successful, is completely transformational.

The old analogy of the caterpillar going into the cocoon and emerging a butterfly really is apt. It’s a cliche, but it’s one that fits. The struggle to emerge from the cocoon is not only difficult, it’s necessary for the butterfly to survive. Helping the butterfly emerge -even when well-intentioned – kills the butterfly. Human birth is similar – the process of being born and being pushed/squeezed out the birth control compresses the newborn’s lungs, so that when s/he emerges, they expand to bring the infant the breath of life. (With humans, we’ve learned to compensate – the “magic wand” of medical science does help here.)

The point with these analogies is that the “magic wand” – the quick fix, easy way out, getting someone else to do it for us, etc. – robs us of our ability to grow into the person we’re meant to be. Without that struggle, we don’t get to learn and grow in quite the same way. In my field, we call this ability to “bounce back” and heal resiliency – and resilience can be developed and strengthened over time. We learn to develop healthy boundaries, we learn to cope with strong emotions and tolerate distress, we learn to think in a healther way, we learn to be mindful of ourselves and all of these as we grow and heal. We learn – or relearn – how to interact with other people and grow relationships.

These things said, would I wish abusive, harmful, traumatic, or painful experiences on anyone in the sake of growth? NO. I can’t say that emphatically enough – NO. We can’t control what other people do or many times We CAN work to heal ourselves and grow, though. We can die in our cocoons, or we can struggle and emerge reborn to face the world. It’s up to us. It’s not easy. It’s not pretty – and there really is no magic wand.

The magic is instead in us, in our ability to overcome.

As Always:

Please Note: The content on this blog is intended for informational purposes only. This is not therapy, and if you wish to work in therapy, please contact your local mental health agency or your physician for a referral.

If you are in crisis or danger, please call 911 for immediate help. Please, again, realize that seeking out help really IS a sign of strength and not a sign of weakness. You don’t have to be alone in facing these things – there are people who care and who will help. Email me at: theothersideofthecouch@live.com