Therapy in 2024

In my first draft of writing this post I used the new AI tool built into Squarespace …and it what it produced was pedantic and annoying. I might have been projecting, but it felt cold too. It definitely wasn’t anything I would want to read. Of course AI has value and improves the more it learns, but even in what I just tried, it demonstrated the “artificial” part in its name. Artificial is fine and even good sometimes, but not in therapy.

Therapy in 2024 will be what it has always been — warm, human, socially and emotionally intelligent, not artificial but natural. Therapy will always bend and flex as the science progresses and as cultural needs evolve, but the elements of being human and of understanding pain in a way only other humans can will never be obselete.

Autoimmune disorders and mental health

One of my specialties is working with patients with autoimmune disorders. What does a psychologist have to do with autoimmune disorders? A ton, and in ways we’re only just beginning to understand.

If you have an autoimmune disorder, this is in no way news to you. You’ve lived through the anxiety of not knowing what the issue is prior to being diagnosed, adjusting to the diagnosis once it’s been made (and then changed, or when other diagnoses are added), the stress of navigating healthcare systems that might not understand, and all the feelings that come with living with a chronic invisible illness that can shape all or part of your life. Therapy can be helpful with the adjustments, coming to terms with it, and figuring out how to still be you and not let the disorder run your life.

Autoimmune disorders can be activated when you go through traumatic events or endure prolonged stressful situations, really anything that puts your immune system in hyperdrive (including just having two X chromosomes, who knew?). So, chances are, you already need to talk to someone.

But also, management of symptoms/flares once the disorder is activated is partially related to the experience of stress because of how it creates inflammation in the body through the “fight or flight” stress response system. Therefore, management of stress is crucial to learning to live with autoimmune disorders. Psychotherapy has actually been shown to reduce frequency of symptoms, increase quality of life, decrease depression, and decrease anxiety in a 2019 randomized control trial.

While I don’t like autoimmune disorders, I am very much excited about some of the research coming out. For instance, how depression might have evolved to protect us and others when we are sick, meaning depression might have originally served the purpose of not spreading illness through changing out mood when we having inflammation in our bodies. Or that women might experience the vast majority of autoimmune diseases because of how we’re set up to protect ourselves and a baby during pregnancy (the pregnancy compensation hypothesis, see Radiolab podcast episode “The Unsilencing”).

While there is nothing currently that cures autoimmune disorders, research is accelerating. In the mean time, therapy can be an effective way to actually still enjoy your life. As a therapist, I might be biased, but the research isn’t.

Pandemic Parenting Stress

Recently I recorded a talk for my church on coping with the stress of parenting during this pandemic, and I wanted to share it with all of you as well (as mortifying as it is to see myself on video…).

Please note: as it was recorded for a church audience, I do integrate spiritual coping methods, which might not apply to my entire audience here but can be helpful for those who identify with such beliefs. (For further information on psychology and religion, check out this previous post.)

The Full Range of Human Emotion

No matter how many times people say "Crying shows strength" or "You have to feel your feelings" it is still hard for people. This can be too abstract in a scary sort of way. In the history of modern culture, this concept is relatively new still. Also, being told to feel your feelings can be just as frustrating as being told to just stop being sad. It just doesn't happen that easily for many people.

In a technical sense (forgive me for a second), sayings like that reinforce a false dichotomy of either feeling your feelings or not. Totally bogus. It is not an on or off switch. You're feeling feelings all the time, you might just not realize them or know how to engage with them.

The alternative to the cliches that I love is simply allowing and appreciating the full range of human emotion. Imagine, in baseball, if you're trying to swing at a ball but keep yourself tight and don't really fully engage, that ball isn't going anywhere. However, when a batter fully engages their whole body when they swing. Magical things happen. (#GoAstros)

This is not, however, swinging the bat around heedlessly. This is not being emotional reckless. This is not giving yourself permission to fly off the handle or to act out in a way that harms yourself or others. This is not pulling a Kanye and allowing yourself to be irresponsible in managing a serious mental health disorder, heedless of the harm it can do when unmanaged.* 

This is allowing and appreciating the value of emotion. This is respecting all of what our emotions can lead us to experience in a way that brings depth and richness. This is getting to know and understand over time how you personally experience and express different kinds of emotion.

Being able to scream/ ugly cry/ sob to a loved one or at home in bed alone doesn't feel good, but man is it important.  

Why? Because then you can know pain and not be afraid of it. You can know that it will come and it will go. Because you ask for help from others when you acknowledge the sadness and hurt and grow more connected and build stronger relationships. Because it is important to know that we are not perfect and can't do it all/be it all and certainly can't do it alone. Because our bodies need an emotional release valve when that stress builds up. Because we need to know whatever hurt is us important, really important to us. ...just for starters. 

This includes fear and anxieties about feeling the more positive feelings too, such as anxiety about laughing in the midst of grief or showing excitement when you're usually stoic. It can include letting yourself be happy even if when you've been happy before it has led to hurt. 

The full range of emotion is healthy.* We don't need to feel bad for having certain feelings or thoughts or be afraid of them. We don't need to force ourselves to be a certain way all the time if it isn't genuine. We need every gradation of feeling just like we need every gradation of color and light and sound. It may take time to listen to what that thing is that is stirring inside you, let along figure out what to do with it, but I encourage you to take that time. It will be worth it. 

*The fully range of healthy emotion does not include erratic and harmful emotional experiences. If you have such extreme emotions that you have difficulty functioning or difficulty maintaining relationships or want to hurt yourself or someone else, please consult a trained mental health professional to learn how to manage these specific experiences. 

Book Chapters, Chapter 1: It's OK That You're Not Ok

My apologies for the delay, what I had intended to be two weeks to follow-up on the last post turned into some months. Human things come before digital things, and sometimes it's hard to get ahead of the wave. But I can say to myself the same thing I say to my clients who are late to sessions -- "you're here now, and that's what matters."

Hopefully you've had a chance to check out the book - It's Okay That You're Not Okay, and if not, maybe this will give you a sample of what it has to offer and how it, or Megan Devine's ideas, might be helpful.

As I mentioned last time, the central idea is that we, as a culture and as individuals, could definitely to be aware of and probably adjust how we think about grief, suggesting that it is not a problem to be solved but "an experience to be tended." As a culture and as individuals, we're pretty terrible at tolerating, respecting, and knowing how to respond to negative emotion in others, and grief in particular.  In reality, it is a normal, painful, important, and very individualized process that happens a lot slower than we want it to. 

Months after finishing the book, there are a few things that still stick with me... 

One thing I love is that where other people gloss over the initial shattering experience of grief and loss, she takes it on, all the pain and shock and things there just aren't good words for, she has some good words. You have permission to fall apart or do whatever you need, in whatever way, at whatever pace. She even offers some concrete things that might be helpful for people in this place with grief, check those out for sure. 

For those experiencing grief, time is different. After a loss, no matter how long it has been, it can feel just like yesterday. This is normal. Respect it and let it be. It doesn't mean you're broken or "doing grief wrong" if years later it is still incredibly hard.  

One of the most helpful things in the book and that I also address in my work with clients is what can happen if you don't let yourself grieve. If you are told explicitly or implicitly that you need to be strong (for your kids, mom, partner, etc) and can't have times where you fall apart the pain doesn't just go away. Over time, if ignored or minimized, grief can turn into anger, depression, insomnia, etc. The grief just changes shape. So word to the wise, let yourself feel the grief and sadness before it turns into another issue entirely.

Throughout the book there is a heavy sense that nothing others can do to help, which is frustrating for everyone involved. And she is right, there is nothing that can fix it, but later on in the book she does offer some thoughts one how to offer support and comfort, how to scoot up close to the person grieving and let them know they are safe and you are their to hold their hand even if you can't walk the path of grief they have to walk on their own. How? In short - Be there. But not too much. Listen, even to the silence. And bring food. 

One thing I wasn't a huge fan of was her hard stance on well intentioned, cliched things people say, like "everything happens for a reason" or "they're in a better place." I completely agree that we need to be more thoughtful about what we say and that we say these things often because we don't know what else to say and don't know how else to be helpful. Still, I think for some people they can be helpful, or appreciated for their kind intentions, when said at an appropriate time, when said in a way that is true for what you know about the person's beliefs, and when said by those who are closer and able to have a deeper conversation about it rather than just saying it in passing.

Overall, this book is a gem. I definitely dog-eared more pages than any book I've read in a while. I hope you got something out of it for yourself, or for a loved one. If it doesn't resonate with an experience you've already been through, it is good to have it in your pocket for when that time does come. 

If you liked this book, you might also like the podcast by Kate Bowler titled "Everything Happens." Kate is a professor at Duke seminary, a mother of a young child, and she also has stage four cancer. She has great gritty talks with some wonderful people. If you need a good cry, check out her episode with pediatric oncologist Ray Barfield. 

Feel free to leave a comment and share what you liked or didn't like about the book. 

The next book for Book Chapters will be announced soon, stay tuned. 

Book Chapters: Introduction

I'm a big reader. It is definitely how I unwind. Give me a cup of coffee or tea, a comfy chair, and a book, and I'm in my happy place. I know not all of you are big readers, but I wanted to give something a try and see what you think. I'm calling it "Book Chapters." It's a book club but not, more like book offerings, suggestions, things I find that really speak to what it is to be human, to hurt, to heal, to embrace joy. If you've been to a bookstore or flipped through Amazon lately, the amount that is out there can be overwhelming, some good, lots not so good, particularly when it relates to honest, quality writing about mental health, in self-help and in fiction. When I find something I like I'll let you know what I've found and why I love it, then I'll give you some time in case you want to see for yourself. I'll come back and blog with more depth and more take-aways in a week or two. Not every book will be for everybody, but if there's something that stands out to you, I invite you to join me. 

I had a teenage client years ago, and we would read books together. We'd take turns picking the book, read between sessions, then come back together and talk about it. It will always be one of my most connecting and most treasured experiences.

I want to share that with you. 

My first pick-- It's Okay That You're Not Okay: Meeting Grief and Loss in a Culture that Doesn't Understand by Megan Devine.

If you are not grieving something/someone right now, this will be a slow, hard read that might bring up losses from long ago. If you are grieving something/someone right now, it will be the best thing you've read and go quicker than you want. 

It is real talk from a therapist about her very real, personal experience of grief. She doesn't use cheap, showy language. She doesn't gloss things over and rush to the silver lining. If grief is where you are, this book is the grief mentor and friend that you need. When everything everyone in your life says isn't helpful, this is. When people expect you to be over it by now, this book says, "hell no, you take whatever time you need." In the introduction she hits the nail on the head with what we all need to hear: that grief isn't a problem to be solved but "an experience to be tended." She says that when we shift to this focus, we can then get what we need: "understanding, compassion, validation, and a way through the pain."

If that speaks to you, check it out. We all get different highlights and different nuggets of wisdom even when we read the exact same words. Check back here in a week or two, and I'll share what I got, but I want to give you the chance to experience it for yourself first.

"Do you take insurance?"

One of the first questions I get asked by most people interested in therapy is whether or not I take insurance.

I love this question. Only within the past decade or so has mental health coverage been mandated for all insurance plans, so I love this because it means people have coverage and want to use what they’re already paying for.

The challenge is that parity in coverage for consumers has not equaled parity for provider compensation. Most providers do not take insurance if they can, based on the demand of their local area,  because it means getting compensated below the going rate. Taking insurance means getting paid less than what their time+training+education+office space is worth as well as having a delay in payment and having time-consuming paperwork to do to submit claims.

Mental health advocacy groups worked hard to achieve parity in consumer coverage, and it represents a cultural shift toward increasing access to services and ending the stigma of mental health treatment. I was trained in programs that believed the role of the psychologist involves also being an advocate for our clients and potential clients, and as a private practice psychologist, I want to be able to further this mission. (I get fired up about this, can you tell?)

I firmly believe that everyone who needs mental health care should be able to get it, no barriers, no stigma, just the same as any other health care.

Providers in private practice have no negotiating power in terms of compensation, and must simply accept the company’s rate as is. That’s fine, however, the rate and the additional paperwork burden often is not sustainable for many in private practice, leading many to not try to bother with insurance. That is fine for many, and there is nothing wrong with that, but it narrows the options for those who need to use their insurance.

I think back to my life in grad school, before that when I worked two jobs as a time sometimes, and before that in college, times when I was making almost no money. (News flash: being poor usually comes with more stress and problems than having a healthy income.) Thankfully there were providers I was able to find who took insurance in the part of the country where I was. Those people were were life-changers. But there’s no way I would have been able to see them if I had to pay their full fee instead of a copay.

There are many ways to find low-cost counseling for those who need it: community clinics and graduate school training clinics, for example. I have been a provider at multiple and loved it. Yes there can be more turn-over and difficulty scheduling with such clinics because the need for low cost services is so high, but I believe the larger point is that clients should be able to have their choice of providers and not be limited.

For me, this means jumping through all the hoops (so many hoops…) to hopefully be able to take insurance, even if it means more work and less pay. Bowing out of the system doesn’t help clients and doesn’t help change the system.   

So the answer to “Do you take insurance?” right now the answer is no, I am an out-of-network provider, and I can give you a bill to submit claims to your insurance company. I can do a sliding scale for people in specific situations, and/or we can have sessions every other week to make it more affordable. This is not the answer I want to give and hopefully it won’t be for much longer. 

Edit: Actually the answer is now Yes, I take Blue Cross Blue Shield PPO plans, see my FAQ page for further information.

New Year's Resolutions

I make the least psychologist-y resolutions. Most articles you’ll read about resolutions talk about building habits and setting S.M.A.R.T. goals that are small, measurable, and achievable. Goals like “work out three times a week” or “spend 20 minutes a day playing with the kids.” These are great, and if these work for you, do it. More power to you.  

(Knowing what works and doesn’t work for you is always the most important thing. Nothing works for everyone, and few things work all the time.)

Last year my resolution was “have more fun” (which was desperately needed after years of grad school and training…). That’s pretty much the least scientific goal you could imagine, not measureable at all, completely vague, and not behavioral. It worked for me though. Did I have more fun in 2017? Without a doubt.

Having fun was something I valued but had been neglecting. I didn’t need to say: go to X number of events or spend Y number of hours with friends. For example, different resolutions might be, “become a kinder person,” “be more generous with love,” or “be healthier.” These are ways of talking about values and stepping into embodying that value in greater and greater ways throughout the year. For some people and for some resolutions, identifying the value and then trying to keep it in mind can be more helpful and effective than concrete, measureable behaviors. What do you value but have been neglecting?

If you are in the habit of feeling like you are never enough, like you will never be good enough or like you are always falling short, this might be a good exercise.

Resolutions don’t have to be a time to bring to life your inner masochist, rigidly holding yourself to arbitrary marks or finding new and creative ways to fail yourself. Identifying values and setting them as resolutions, like “have more fun,” involves the opposite. It implies and ultimately involves allowing you to let yourself be enough.

I’m not saying it is a gimme by any means, but it is a practice in allowing yourself to set reasonable aspirations and then more fairly assess your progress. A lot of people tend to over or underestimate their success or failure. Don’t be that person who is perpetually striving. Allow yourself to stretch and be satisfied.

I’m suggesting a new horizon to help yourself grow. You are the only judge of whether you reached it or whether you lost sight of it.

Are there things I could have done in 2017 to have more fun? Certainly. It is also true and fair though that I sought out more fun and also appreciated fun more when it happened naturally.

Have fun and happy new year!

Side note: You don’t just have to wait for January 1st to set resolutions. You can resolve to live out your values any time, but it can be helpful to have a date to trigger you to check in with yourself on your progress for becoming better/healthier/more generous/a better friend, etc. Birthdays, anniversaries, or the first of each month can work …if that’s what works for you. 

Making it to Christmas

The Biblical story of Christmas is on one hand miraculous and holy and on the other very relatable. Yes, it is the story of a virgin birth, a light guiding shepherds, and a visit from an angel. But it is also a story of trying your best to do the right thing and having so many barriers and road blocks come up along the way.

Mary and Joseph were engaged to be married, wonderful! …and then she’s impregnated with a baby that isn’t his. What a wrench to throw into a new relationship. How would you react in that situation? I’m guessing in most situations, the man would leave, end of story. How does a relationship continue in the face of such an experience?

The Roman emperor Augustus ordered a census taken, which involved going back to your home town. Imagine everyone in America having to go back to where they were raised. Now take away cars and planes… good luck. Now imagine that you or your fiancé are super pregnant and about to pop. She would definitely not be allowed on any airplane at that point in her pregnancy exactly because it is so high risk. For a pregnant lady, riding on a donkey for days seems even more treacherous. How many times would you have given up?  

But it’s not over yet. They finally get to an inn, only to not be able to have space inside. As we all know, the best they could do was a spot in the stable. They literally had to sleep with the animals. When was the last time you had a flight cancelled or when you couldn’t get a rental car or a hotel room and were stranded? What if sleeping between piles of animal dung was your best option?

Then there was the whole birthing process, which, as often goes these days, did not follow what would have been their birth plan. Had they been able to stay at home, they would have had experienced midwives. (There aren’t stories of birth in the Bible because men were not generally present at births, and most of the books of the Bible are written by men). So, there they were, in a barn, with inexperienced Joseph being the one to help Mary when it was time.

They could have bowed out at any point and the story would have been very different. 

And yet, they did it. They endured. They persisted. Jesus was born.   

Yes, we are privileged in our culture beyond being able to really understand what it must have been like, but we can definitely relate.

We can relate to relationship upheaval. We can relate to having to jump through ridiculous bureaucratic hoops at great cost. We can relate to not having plans go our way and feeling all out of hope. We can relate to it all happening at once.

How did they get through it all?

They had a perspective that kept their focus on the bigger picture. They were blessed with the presence of angels to let them in on God’s big plan, giving them a specific bigger picture to keep their eyes on.

Many of us are not regularly visited by heavenly angels or hear a clear booming voice of God, and so it becomes difficult to grab a hold of that clarifying perspective that allows us to truly let things slide that do not matter. We struggle with the frustrations and tragedies that happen, and we struggle with wanting to understand how such pain fits into any bigger picture.

They had angels, so that we could have Jesus. Mary and Joseph didn’t have Jesus to model how to stay true to one’s highest values, turn the other cheek, care for people in times of hardship, or find love and holiness in impossible situations. They did not yet have Jesus to model how to hold tightly to faith when everything points in the opposite direction. We may never know the big plan or have answers to our “whys” but we can know the “how” of how to move forward, how to respond, how to continue. 

We have infinite choices about where to fix our eyes and about what to put our faith in these days. An infinite number of roadblocks and challenges will come and throw us off balance. We can let the frustration about the cancelled flight or whatever consume and derail us, or we can be ever turning back to what we value most. 

The Choice to Grow

Oprah has a different voice when she’s talking about growth, trauma, and spiritual things. Have you noticed? She get that wispy, deep tone and the words hang in the air.

It drives me crazy. Nothing against her, but growth is not a wispy, dreamy, philosophical breeze. It is hard and painful and every step of the way it feels like a terrible idea.

Initially when something stressful or traumatic happens there is a messy mix of being shocked, addressing concrete needs, and experiencing acute grief and loss (of a person, a home, a hoped-for life, a career, you name it and if it is meaningful, it can be grieved). After a while of grieving and feeling numb, I often see people get fed up and want something different but not know what or how.  

Then, there are a few different ways people respond in the long-term aftermath of a stressful or traumatic event. We ignore, restore/recover, or grow. It is not a linear or step-wise process, moving from one to the other, though that can happen.

Houstonians, a good metaphor for this is how people respond when they were flooded during Harvey. After the initial rescue, displacement, return, and immediate mucking there is a pause when you decide what to do next. You decide which contractors to call and how things will be put back together again. Ignoring what happened in this metaphor (and real-life situation) involves putting things back together as they were before, ignoring that there is a threat of the same thing happening again. It involves just getting through and trying to think about it as little as possible.

Restoring and recovering involves a similar process but also acknowledges the reality of threat. This is rebuilding but then intentionally keeping the drains and gutters clear, installing tile or wood floors instead of re-installing carpet. Sometimes this is all we have the capacity for. Sometimes, this is the most we can handle. That is okay; it is enough.

Growth involves taking it one step further when a person has the capacity, resources, and energy. It is renovating while we’ve got the contractor over and the house torn apart. It is looking at the blue prints and seeing what renovations might be not just be helpful but might also really spruce up the place. It is seeing the challenge of coping with what has happened and digging into how it has affected us and how we want to live in light of this experience. It is an intentional choice that involves turning away from how things have been done and turning toward something with greater complexity. Struggle and growth, when we are so able and willing to allow it to, can increase the depth and breadth of our life experience.

We don’t grow by moving forward right away. We grow by digging. It is painful, dirty and can take time.

Why bother? Weren’t things just fine before? Aren’t I too old for any of this growth business?

Novelty is good for the brain. When we try new foods, go to new places, learn new skills, it allows our brain to create new connections. Like a baby learning to use a new toy, throughout our lifetime, we can enrich and feed our brains with new experiences. This includes looking at yourself, others, and the world in new ways. This includes choosing to try to think about things differently or taking on new challenges. This gives our brain new life.

Growth can take a couple forms: perspective- or action-centered growth. Essentially, we’re growing in “being” or “doing” (or both). Both are positive, and neither one is better than the other. Perspective-centered growth is a positive change in how we mentally engage with ourselves, others, or the world, such as a significant shift in priorities, a significant positive revision in how we see ourselves. It can be existential or spiritual or purely personal. Action-centered growth involves doing things differently, trying new things, experimenting with what you are capable of.

Both, however, involve digging to see what is not working, what you’re not happy with, or what feels stagnant. It can involve acknowledging mistakes, weakness, and vulnerability. And it will certainly involve change in some way. If it makes you want to run away, you’re probably on the right track. There are an infinite number of reasons to let these things stop us from working on growing, to let the nay-saying voice in our heads keep us from trying and trying again. It involves an investment of spending some time and emotional energy (when we have it) looking around in the darkness. It involves believing that our lives are worth the investment.

Find the area of tension, the area of discomfort, the thing your mind runs away from every time it pops up. When you are ready, set up camp there. Dig. Redesign. Rebuild.

This is all still a dramatic over-simplification of the complex experience of growth, but I wanted to dip into the messy, scary reality of it. If we believe it is something hippies do or that it is easy breezy, if we try but into a challenging aspect, we might think we’re doing something wrong or that we should definitely turn back when that is not the case at all.

Allow it to be something that is complex and doesn’t make sense for a while. Allow it to not fit into a neat package or inspiring message. Allow it to not fit any words at all.