The Holiday Season: Strategies for Coping When you are Feeling Less Than Cheerful

Broken red Christmas ball. Eps 10

This time of year there are images of family and holiday “cheer” all around us.  I started seeing Christmas decorations at my local CVS the day after Halloween, so the season as it were, seems to be several months long.  As I reflect on this, I’m struck with this thought:  what we take in are in fact images, but not necessarily reflections of our own truths which can trigger a variety of responses depending upon our own experiences when it comes to family and holidays.

Perhaps, then, it could be useful to become mindful of the way in which we can feel both celebratory and nostalgic, at times, during the holiday season while also having pockets of grief, loneliness, or even resentment.  And, if the latter is most resonant with your experience, rather than wishing for a period of hibernation that ends promptly on Jan 2nd, consider the following strategies to support and nurture yourself this season:

Creation of a gratitude or blessing bowl:  A glass bowl with colored paper is a unique a mindful way to help bring to life all of the sources of hope you can name even when in touch with other unpleasant emotions.  I’m not suggesting that in times of upset you merely “turn that frown upside down”, but rather inviting you to also find a contained space to hold on to what is also true about your life, even as you are in touch with negative emotions. I like to put the bowl with paper and colored pens in the center of my dining room table so that anyone who comes over is invited to contribute.  Then, on New Year’s Eve I take the blessings and gratitudes out and read them aloud to help set the intention for a new year. For me, this is a ritual of containment, and a conscious way I endeavor to remind myself that I am of many minds with many emotions at any given moment.
Taking your inner child out on a date:  I like to ask my littlest self what would feel fun or yummy as an activity if I’m feeling particularly lonely or disconnected, which many of us can feel around the holidays.  This year, my little one and I are making a gingerbread house out of graham crackers & went to visit kitten adoption locations so we could hold and play with kittens.  In past years, I’ve gone and made myself something at Color Me Mine or gotten a facial or massage, just because.  While both may seem like frivolous or unimportant to my adult self, my little self will benefit from the attention and self care so that I can manage feelings of being depleted or overwhelmed, which are both personal triggers around this time.
As a family therapist, I often meet people for whom family and family members are sources of stress or even trauma.  If this is your story, and “going home for the holidays” feels like revisiting the scene or a crime, it is critical that you find ways to reclaim the holiday period with new memories of your own, new rituals, and new narratives. Maybe you reclaim the holiday to be celebrated on an alternative day, or with family of choice rather than family of birth. Or perhaps you seek out opportunities to be of service with a charity or volunteer organization. Or maybe you seek connection with like minded folks on in the form of a support group or spiritual community (for example, Overeaters Anonymous has 24 hour meetings scheduled in Los Angeles on many holidays because its members know how triggering holiday events can be with managing food triggers).

Families are where we come from, inform where we are going, and are exquisitely and beautifully complicated for most of us.  If, then, you feel a mixture of emotions this holiday season, you are in good company, and as do all seasons, it will pass and something new will emerge very soon.

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Resilience can be learned, cultivated, and practiced.

There’s a line is a song by Pink: “We’re not broken just bent” that always strikes a resonant chord deep within me.  The song is all about a couple who is going through rough times and the perspective of the woman to whom all is lost and there is no hope for the love that once was. The song progresses, and she keeps grappling with the finality of the feelings she is having about how hopeless things are. She is diagnosing the relationship as terminal and truly cannot see a way out. Then there’s this moment when she awakens to the idea that maybe what is happening is that her perspective of hopelessness throws shade on any which way she tries to see herself through the relationship the pain. And then the shift happens, the tone of the song changes, and…you know the rest.

My point here, and I have one, is that being “broken” as a perspective doesn’t give us human beings any place to go. It’s the end of the line…humpty dumpty can’t be put back together again. We are not a bunch of broken people bouncing from one painful experience to another. Because if we are, why even bother doing something like going to therapy, getting into a support group, trying a meditation class, etc?

Here’s what I’ve come to know about healing and recovery, both personally and professionally. The “It Factor” seems to be a matter of resilience. And by resilience, I mean, the willingness and ability to look at one’s own suffering and have the heart to take the next step, even if all of you feels like there’s no point and all hope is lost. Being able to accept oneself as flawed, bruised, and sometimes downright flat on one’s back in emotional distress, but with at least one eye toward what is the next indicated step is an act of resilience.

Picking oneself up, brushing off, and putting one foot in front of the other is sometimes the only thing to be done. And it is courageously and beautifully resilient to do so. Being resilient isn’t a static state, and it doesn’t come naturally to us all. But, it definitely can -be learned, cultivated, and practiced.

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Social Media’s affect on self perception

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The idea of having a quick and relatively easy way to both find and reconnect with friends and colleagues sounds harmless. And for some, perhaps it is. However, here’s my experience that I later started to observe in my clients, as well. Facebook: I was actual friends with very few of my “friends”. People from high school, kids who I actually never had any sort of actual interaction, were asking to be friends. And then there are all of the random birthday wishes and e-cards and people “tagging” me in photos from forever ago (without my permission!) and the constant stream of updates and links to articles about everything from politics to silly pet videos. Wha??!

It actually has an addictive quality to it for many with whom I’ve spoken personally and those I work with professionally, myself included. You see people updating their statuses and checking the status of others in line at the store, in their cars (yikes!), and anywhere else they might otherwise look up from their electronic device and interact with the actual world around them. Socializing in this way is an illusion of connection with others without all the messiness of actual human interaction.

Facebook, twitter, instagram, etc. promote exchanges where users start collecting “followers”. I’ve worked with teens who say that the number of followers they have and “likes” of a picture are incredibly important to their sense of social status and actual experience of being “liked” in real life. I’ve also worked with teens and adults, alike, who have intense regret over postings they’ve made themselves or by others about them. Not every moment should be documented for others to judge, scrutinize, and ultimately like or dislike. With such long lists of friends and followers, why is addiction so rampant? Why are we all so lonely and isolated despite being ever more “connected”? Why aren’t we feeling more esteem for ourselves and more grounded in our relationships with others?

In twelve step communities there is a saying about addicts engaged in an endless cycle of “compare and despair”. In other words, there is always someone lesser or greater than you, someone smarter, thinner, in or out of a relationship, in a better career, etc. Seeking out opportunities to size yourself up against others (and isn’t that really what is mostly going on with these sites?) is often a way to find things to feel bad about, especially for someone struggling with mental health challenges who is already feeling out of balance. Isn’t it hard enough to find one’s sense of self without a constant state of feedback from the outside about one’s worthiness? Beyond the obvious concern about posting unflattering photos or making statements in a forum from which they can never really retracted, I’m very concerned about how this form of relating to one another is and will affect our emotional development and ability to be with each other in real and authentic ways.

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The Body as an Emotional Barometer

imageHow often have I heard a new client say to me something like, “I don’t know. All of the sudden I felt this wave of panic and my heart started racing, I felt dizzy, and I felt like I was smothering.” These waves of intense emotions can be both mystifying but also terrifying. Paying attention to the more subtle signals our bodies are giving us prior to these really intense emotional states can help us tune into feelings that we aren’t conscious of before they have to turn into a panic attack, bout of serious depression, rage, etc.

The flight or fight response is hard wired into us, biologically, to protect us as a species. Cognitions are not separate from what we feel, physiologically. The expression “She took my breath away”, or “I’m so angry I can’t see straight” are examples of the way both extreme positive and negative emotions can change our physiology. How many of us have heard the doctor say we need to cut down on “stress” for our physical health? For most of us, much of what triggers the physical stress response that our doctors worry about (raised blood pressure, increased adrenalin and stress hormones, imbalance in blood sugar, etc), are unconscious emotional responses to environmental triggers (ie stuff we aren’t even aware of that is bothering us).

Everyone is different, but if you consider your body’s response to stressful situations, you can use your body signals as a barometer, of sorts, to help guide you. Personally, when my breathing changes or the cadence of my voice increases, I know I’m angry about something.  I had a client once describe a feeling of tightness in her throat and we soon discovered this frequently happened when she was “choking back” something she needed to say but was afraid to, usually with regard to setting a boundary with someone she loved. Another client described whenever his appetite seemed to increase outside of his normal eating routine, it was often that he was “craving” some affection from his partner but couldn’t seem to ask for it. Obviously, sometimes a physical complaint is just that and needs to be attended to medically, so please seek medical advice to be certain about any underlying physical causes of a symptom.  But, other times we can see patterns in our bodies, especially if medical causes for our ailments have been ruled out by an MD.

So, take a moment and do a quick body scan. Are your shoulders hunched up near your ears? Is your lower back aching? How about that kink in your neck that comes and goes? What might your body telling you about what you are feeling that you haven’t been able or willing to examine?

Posted in Addictions, Anxiety, Bipolar, Depression, Experiences in Therapy, Relationships, Trauma, Women's Issues | 1 Comment

Personal Growth is Not a Linear Process.

image My experience, both personally and professionally, has shown me that it is a “combing through” of tangles in our lives that leads to lasting change. We often desire an easier and less painful process, but when we are really in knots patience and perseverance are the orders of the day. These stuck points and areas we can’t seem to move through comfortably on our own often require many passes before we are find our way through, as it were.

It can be exceedingly frustrating to find yourself stuck in old defenses and behavior patterns despite knowing and believing we should or shouldn’t do this or that. Self help books are fantastic for helping us see what we are doing “wrong”, but often fall short because insight avails one only an intellectual understanding of a problem. A client may find themselves engaging in co-dependent interactions with a romantic partner, for example, multiple times during the course of treatment and feel bewildered as to why they can’t seem to “get it right”. But, each combing through of an experience can yield a deeper understanding of unconscious triggers and motivations and help slowly build the emotional muscle to finally discontinue a toxic relationship, for example.

One way to think about it is this: We can’t digest and metabolize monstrous size bites of food. We don’t eat a whole meal in one mouthful, right? We have to take each bite, chew, and swallow so our bodies can take in the nourishment we are offering it. Our minds aren’t much different, really. We have to bite off each experience, take it in at a measured pace, and then prepare for the next experience.

Posted in Addictions, Anxiety, Depression, Experiences in Therapy, Relationships, Theories and Intervensions, Trauma, Women's Issues | Leave a comment

Alarming Trend: Prescription pills in our schools

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In recent months, I have become increasingly alarmed and truly pained by the rising incidence of prescription pill use in middle schools and high schools all over Los Angeles. It seems to be particularly rampant in many of the private school settings where youth have access to more financial means and increasing pressures to perform, academically, to compete to get into Universities. Our youth are overexposed and overwhelmed, and many are just not equipped to handle the pressure they are facing at school. The big offenders: Stimulants (Adderall and other meds prescribed for ADHD) , Opiates (Norco, Vicodin, etc), and Benzodiazapines (Xanax “bars” and Valium are the ones most readily available). Just one dose of an opiate, for example, can be sold for up to $80!

Here’s the time we are living in: Realtors are now telling their clients that they should lock up all of their prescription medications prior to any open house event so as to prevent prescription meds being stolen. Really??!! So, I am telling all of my client’s parents to be ever mindful that prescription medications are readily available and that they need to be talking to their kids about them just as much as they are about street drugs. They also need to continue to educate themselves about the symptoms and signs of various prescription pills as you would with any other drug. Teens mistakenly think that, because a pill is from a pharmacy, that it is somehow less “dangerous” or “addictive” than a street drug. This false belief, coupled with the invincibility associated with the developmental stage they are moving through, is a pretty toxic combination.

Parents and caregivers, be mindful of your own thoughts and beliefs about prescription drugs. Anecdotally, many teens tell me they need only go to their parents medicine cabinet and don’t believe a few pills here and there will be noticed, which often they are not. Lastly, and very importantly, substance use is different than abuse. If you discover your child is experimenting or using with regularity, act quickly. Individual therapy is but one avenue of support. I always recommend a family approach so that a young person doesn’t feel like they are the problem, but that they are having a problem that they can sort out as part of a team.

Posted in Addictions, Parent-Child Relationships, School Aged Children | 1 Comment

Is my child a liar, or just a good storyteller?

imageWhen a parent comes in with a chief complaint being that their child seems to compulsively lie its time to pause and consider how to think about this issue in a different and more constructive way.  Any problematic behavior, be it in childhood or adulthood, has what is referred to as a “secondary gain”.   In the case of a child who is lying to the adults in her/his life, the idea is that she/he isn’t lying merely for the sake of doing so.  Rather, they are engaging in a behavior that is getting a need met, even if negative consequences are encountered along the way.  This need could relate to attention seeking from an absent or disengaged parent, it could be distraction technique from another problem, it could even be out of plain old boredom. It could also be an expression of anger, frustration, sadness or some other negative emotional state.  My job is to try to translate what a behavior, in this case lying, “means” and help identify ways to get the needs to be met in less self destructive and socially inappropriate ways.

Sometimes, it is pretty clear from the outset what a behavior is communicating, as in the case of a child who’s experienced some acute loss or whose parents are divorcing, for example.  Other times, it can be quite subtle and less obvious and take a little more time and patience to identify.  But there’s always a reason for a behavior, and it can comfort parents to know that once these reasons are uncovered, the behavior usually decreases significantly or disappears altogether as the child starts to find new coping skills and healthier ways to meet their needs.  Lying can also be a learned behavior, so engaging the parents and getting as much info about the environment is vital.  I’ve found that if I outright challenge the lies with a client, I often don’t get very far and/or it starts to feel like a power struggle which is really counterproductive.  I also coach parents to take the same approach at home.

 Lastly, a very helpful way to look at lying behavior, in particular, is to reframe it as “storytelling”, when appropriate, and try to find a way into the stories to discover themes and meaning.  The use of narrative therapy can be a useful tool here with some children as well as therapeutic play.  I’ve even helped children develop interests in things like writing or acting as more socially appropriate ways to express and explore needs to tell stories or act out different characters.  Ultimately, the more open a parent is to the process of tuning into their child’s needs and working in partnership with me, the more effective and creative I can be in finding ways to stop a problematic behavior.

By Samantha Wright Wakach, LCSW

Posted in Parent-Child Relationships, School Aged Children | 1 Comment

Panic attacks and their impact on our relationships

 

In my practice, I often get people coming in describing the abrupt onset of a panic “attack”.  This is a perfect description of what these escalated anxious episodes feel like for the sufferer: as if they are suddenly and relentlessly under attack from some unseen and sinister force.  Their bodies and minds mysteriously feel as if they are no longer under their own control.  It is a life altering state of mind and can truly debilitate the sufferer and, if left untreated, can lead to other complications such as alcoholism and drug addiction as the sufferer uses substances as a way to self medicate.

Coupled with the disabling body symptoms, obsessive scary thoughts, and overall mental demoralization, many people describe a sense of increasing alienation and shame with loved ones and close relationships as the panic disorder progresses.  That is, those who’ve never had a panic attack sometimes find it challenging to relate and support the sufferer over long periods of time, especially when their support seems to have little impact on the condition of the sufferer.  imageAnother commonly seen complication is the fact that people with panic disorder often become extremely reliant, some times overly so, on loved ones to help them feel “safe”.   This is especially true for those who are agoraphobic and avoid specific places and/or people to avoid feeling anxious. They form unhealthy dependencies on others perpetuating idea that something or someone outside of themselves can stave off a panic attack.  Unfortunately, this type of thinking is misguided and counterproductive to true recovery.

In light of the ways panic and anxiety affect the whole person, including relationships, a key component in the beginning stages of treatment for anxiety and panic is to help my clients understand how to describe their condition to their loved ones and the nature of their condition.  Seeking treatment for panic and anxiety can not only assist the sufferer, but ultimately, serve to preserve and better interpersonal relationships in unforeseen ways

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By Samantha Wright Wakach, LCSW

Posted in Anxiety, Relationships | 1 Comment

Healthy Boundaries in Relationships

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Having “Healthy Boundaries” is a concept I hear thrown around a lot by people who’ve had experiences in therapy, my fellow clinicians, and even pop culture/media these days.  It is also, unfortunately, an often misrepresented and misunderstood concept, in my experience.  What exactly is “healthy” about a “boundary”, and how does one diagnose a boundary as healthy or not?  And who is in a position to make this judgment in the first place?  Is it really about keeping a firm distance between yourself and others and why would we even want this?  How can having a “boundary” create closeness with others? What a paradox!

 In the most basic sense, I define a personal boundary in interpersonal relationships as the space that gives you time to think, process, and then act/react to any given interaction.  This space, as it were, is invisible, intangible, and often times intolerable for a person who struggles with issues like anxiety, depression, addiction, and co-dependence.  People who are challenged with mood imbalances, addiction to substances, food, overspending, gambling, negative and toxic relationships, or other compulsive behaviors often have real and understandable difficulties with good decision making when it comes to interpersonal relationships.  Decisions in this arena are often made quickly and impulsively and I feel it has something to do with this whole idea of boundaries.  Whether you keep too much space between yourself and others isolating yourself and/or disregarding the needs of others or are so enmeshed with others that you wear yourself thin trying to meet the apparent ceaseless demands of loved ones and even total strangers, you would do well to consider this whole idea of healthy boundaries and how they impact your life and relationships.

I see people in my practice every day that have a difficult time distinguishing between their own thoughts and feelings and those of their parents, partners, bosses, etc.  It is a subtle shift that happens in therapeutic work when one can become aware of her/his own internal voice and start to tune into it in an active way to identify needs, thoughts, feelings that are coming from within rather than being fed from an external source.  

Example: A woman struggling with chronic anxiety and depression who is having fantasies about either leaving her husband and/or having an affair starts to “tune in” to the reality that she resents having given up a career to stay at home and raise her children.  During the course of treatment, she starts to understand that the choice to leave her career was influenced by her perception that her partner had an expectation that she fulfill a role in the home, though he never explicitly verbalized this idea.  Maybe she doesn’t run right back into the workforce, but she starts to consider the impact of this resentment she now has with her husband on their current lack of physical intimacy and her thoughts of leaving the relationship.  Over time, she can identify the resentment and start to actually feel it, process it, and express it in healthy ways so she can remain in her marriage with the goal of forming a stronger bond with a partner whom she began to consciously and unconsciously blame for her discontent.  Ultimately, she discovers that she can take responsibility for her decision to leave her career, but finds new empowerment to re-discover her career when possible having shared this need with her partner and exploring in a more open way her options given the discovery that her career outside of the home is an important need for her to fulfill in her life.

The therapeutic relationship can serve as the “space” I mentioned earlier where we discover, often for the first time, our truest thoughts, feelings, and beliefs.  As a clinician, I have the privilege of witnessing this process and helping facilitate the type of change that can having lasting effects on a person’s life and well being. 

Posted by Samantha Wright Wakach, LCSW

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Anxiety Management: A Case for Doing Your Homework

 

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When someone comes to me in the throws of a full-blown Panic or Anxiety disorder, I usually start with the most troubling symptoms and begin an immediate dialogue to help reduce these symptoms as soon as possible.  This is often accomplished via use of therapeutic homework and journaling.  Doing homework in between sessions is beneficial for several reasons:

1.    It helps you practice the new and alternative coping skills we work on during sessions on a daily basis.  The mind of an anxiety sufferer becomes log jammed with negative thought patterns that, over time, turn into firmly held beliefs.  The truth is that a thought is always the culprit for an anxiety attack, be it conscious or unconscious.  Homework gives you an opportunity to tune into your thoughts in a way that you’ve never done before.  This process makes your one hour session much more strategic, particularly in the beginning phase of treatment.

2.    Anxiety homework always includes specific exercises that, in addition to writing, are used as a means of relaxation and stress reduction.  Having something in writing helps you hold on to and retain lessons learned during each session.

3.    The symptoms are never really about the “symptoms”.  Those scary body sensations and racing thoughts are just forms of communication between your mind and your body.  Think about an infant, for example.  Crying is a “symptom” in the sense that it expresses a need that cannot be verbally communicated: hunger, a dirty diaper, fatigue, etc.  A parent’s job is to tune into the needs of the infant and to anticipate these needs so as to prevent crying and screaming episodes.  The more attuned the parent, the more secure the attachment and the less frequent/intense the crying episodes.  Anxiety symptoms are just unmet needs of your “unconscious baby”, if you will.  Your homework time is an opportunity to begin a dialogue with this baby and start to learn what needs aren’t being met.  This type of dialogue takes practice and cannot be successfully accomplished, in my experience, without work in between sessions.

4.    Finally, doing something and being proactive are empowering.  Anxiety and panic attacks can be incredibly disempowering and beginning an active participation in your recovery builds confidence and esteem that are often sorely damaged, particularly for the long time sufferer.

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