Thank You, From Your Therapist

Thank You, From Your Therapist

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

Love and Be Loved,
Natalie

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

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

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

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

Here is an example:

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

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

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

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

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

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

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

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

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

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

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

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

 

Love and Be Loved,
Natalie

7 Checkpoints for Your Anger

7 Checkpoints for Your Anger

Humans are wired for anger. It’s an important part of our evolution. Anger tells us when something needs our attention, when we have an unmet need, or when something is missing. The problem with anger is in our mismanagement of it. And it can be incredibly destructive.

 

The best way to curb the destruction caused by anger and to use it more intelligently is to understand the feeling, to be curious about it. The more we understand our triggers and patterns, the more present we can be with our anger.

 

Start by identifying what activates it. Get a pen and paper and answer these questions.

 

What triggers your anger? (Here are some common ones)

-yelling

-loud sounds

-having to wait (for someone, for something to happen)

-receiving critical feedback or being corrected

-deceit

-when someone talks over or interrupts you

-being/feeling avoided

-being/feeling smothered

-being in conflict with someone

-rudeness

-inconsiderate actions/remarks

 

Then, start thinking about your pattern of anger. Once your wire is tripped, how do you react?

 

What’s your typical expression of anger?

-lashing out directly at someone, yelling, attacking

-passive aggression, withholding affection/love, trying to control someone using emotional manipulation/guilting, off-handed comments, gossip, isolating

-blame, resentment

-avoidance, defensiveness, stonewalling

-punishing, intimidating, judgment, criticizing, contempt, threatening, using ultimatums

-revenge

-throwing things, breaking things

-physical violence

-broken promises

 

What’s it like for you when you engage any of these strategies? Does it get the job done/ get your needs met? At what cost? Do you like yourself when you use these strategies?  

 

What unmet need underlies your anger-trigger?

Here are some common needs that when unmet, cause us to feel anger:

-Feeling disrespected/ need to feel respected

-Feeling invalidated/ need to feel validated

-Feeling scared or unsafe/ need to feel safe

-Feeling abandoned (physically or emotionally)/ need to feel continuity of relationship or proximity

-Feeling or being out of control/ need to feel in control

-Feeling worthless/ need to feel worthy

-Feeling unlovable/ need to feel lovable

-Feeling inadequate/ need to feel adequate or good enough

-Feeling mistrusted/ need to feel trusted

-Feeling wronged/ need to be treated justly

 

When we stay caught in anger, we behave regrettably. We have no idea what our unmet need is. And we don’t even care; all we know is that something has pissed us off and whoever or whatever it is needs to pay. We can go so far off the rails that we forget we love the person with whom we’re angry. When we don’t know how our anger works and it just happens to us, we can’t catch it, pause, and redirect ourselves. Left uninvestigated, anger can kill or deeply wound any relationship.

 

It’s not easy to respond wisely to our anger. I know that. We run on the fumes of righteous indignation. We feel powerful when we yell or stonewall or manipulate or judge. We’re right, and they’re wrong. If the person really loved us, they wouldn’t do this. Given a choice between fully experiencing our vulnerability or a quick jolt of power, most of us would choose the quick jolt. But learning how to take care of ourselves, translate our anger, and address unmet needs is a much more satisfying, viable, and supportive power. This gives us the opportunity to connect on a deeper level and know true intimacy.

 

“When the gentleness between you hardens
And you fall out of your belonging with each other,
May the depths you have reached hold you still.
When no true word can be said, or heard,
And you mirror each other in the script of hurt,
When even the silence has become raw and torn,
May you hear again an echo of your first music.
When the weave of affection starts to unravel
And anger begins to sear the ground between you,
Before this weather of grief invites
The black seed of bitterness to find root,
May your souls come to kiss.
Now is the time for one of you to be gracious,
To allow a kindness beyond thought and hurt,
Reach out with sure hands
To take the chalice of your love,
And carry it carefully through this echoless waste
Until this winter pilgrimage leads you
Towards the gateway to spring.”
-John O’Donohue

 

Love and Be Loved,
Natalie

The Benefits of Changing the Way You Communicate

The Benefits of Changing the Way You Communicate

I’m a huge fan of the TV show, The Office. There’s an episode during which boss, Michael Scott, says something to his employees about wanting to make an announcement. He starts talking and an employee, Oscar Nunez, says, “These aren’t announcements…” Michael says, “Yes, they are; you just don’t care about the information.” And we do this kind of thing all the time with each other.

 

Productive communication is just as much about the way we hear something as it is about the way we say something. I see a lot of couples who try therapy specifically because they want to address the way they communicate with one another. This usually doesn’t mean what they think it means.

 

There are a million ways we send each other messages- by doing something (or not doing something), the way we ask, when we ask, arguing, avoiding arguments, passive-aggressively, literally a million (or more) ways.

 

Most of us think that when our partners accept an idea, think we’re right, or validate our self-concept we’re experiencing “good communication.” If we disagree, argue, or are invalidating of each other’s self-concept we believe we’re experiencing “bad communication.”

 

A breakdown or disturbance in our communication can happen when we don’t like the messages we’re receiving. We stop talking or argue in circles. Sometimes we acquiesce to one another’s demands or plans. We’re still communicating, but it’s become unproductive because we don’t like the information; the messages don’t make us feel good. We try various efforts to get the other person to understand what we are saying. We think, “Well if they really understood what I am saying, they wouldn’t react this way.” Sometimes that’s true. Sometimes, though, we just disagree with each other or can’t manage our emotions around conflict, and no amount of rephrasing will change that.

 

What do we do when someone knows exactly what we want, they just don’t want to (or can’t) give it to us? What if one person wants a lot of deep, personal conversation and the other person doesn’t? Or what if what one person thinks is a lot of conversation, the other person thinks of as minimal? Going from here, it wouldn’t be that hard for one partner to feel like the other is emotionally withholding nor for the other partner to feel constantly under attack.

 

Our need for a reflected sense of self is often the culprit. Don’t get me wrong, in the moment it feels great to have someone validate us, our ideas, experiences, and feelings. But we can’t plateau here. The drive for other-validated communication can end up being a relationship killer.

 

Here is an example of other-driven need for validation:

“I want to tell you about myself, and then I want you to understand, validate, and accept me. I’ll tell you about myself and then, to make it equal and to make me feel safe, you have to tell me about yourself regardless of your desire to share. Whatever I disclose, you must make me feel that you are trustworthy and you must disclose something that’s just as revealing, if not more.  This is how we will deepen our intimacy and develop trust.” This is most common. In a dynamic like this, the person who requires less intimacy is the one in control.

 

Here is an example of self-driven validation:

“I want you to know me, to see me, to hear me. I believe that in order for you to really love me, you first have to know me. I know that I am taking a risk by sharing this with you, but it’s a risk I’m willing to take because 1) I want to see the real me and 2) I know that I am capable of taking care of myself in the face of rejection. My sense of safety in this relationship is not dependent on your validation of me.  You don’t have to disclose something to me just because I have disclosed something to you. I acknowledge and accept that we are separate, different people.” This is a lot less common. In this dynamic, control isn’t relevant. It’s about the intimacy and security made possible by self-support.

 

The road from other-validation to self-validation is not short, and it’s not at all easy. Most of us grew up in families where other-validation is the ideal. It’s also pervasive in our greater culture. Self-validated intimacy takes acceptance, self-confrontation, practice, and commitment. We have to be willing to know and accept ourselves first. We have to have a willingness to be curious about ourselves and to face things we don’t like.

 

So what are the benefits of shifting from the aim to be validated by others and the aim to validate ourselves?

 

  • Vulnerability doesn’t have to be a four-letter word anymore.
  • We stop being dependent on an other to make us feel loved and important.
  • We learn that we can disagree without turning it into a knock-down-drag-out fight.
  • We stop taking disagreements personally.
  • We trust ourselves.
  • We break free from feeling controlled by someone else.
  • We stop having the kind of conflict that ruins our whole day or week.
  • We get to know the other for who they are, not for the role we need them to play.

 

 

Changing communication patterns isn’t always about empathy, active listening, acceptance, and reciprocity. Those are great skills to have, but they won’t necessarily bring your relationship back from the brink. If you can bring yourself back from the brink, your relationship has a better chance.

 

“Communication is no assurance of intimacy if you can’t stand the message.”
-David Schnarch, Ph.D.

 

Love and Be Loved,
Natalie

Why Are Relationships So Hard?

Why Are Relationships So Hard?

What We Want:

We all long for fulfilling, stable, and safe connections to others. We want to be understood and hope for people to experience us as we experience ourselves. We long for someone who will take care of us and reassure us that everything will be ok. We want to feel held and contained. We want our rage and defiance to be tolerated. We want to feel that someone understands our experiences of the world and we want those our feelings about those experiences to either be validated or soothed.

Why That’s Challenging:

We will often be misunderstood by and misunderstand others.

We don’t always know how to tolerate someone else’s rage and defiance. Some of us were taught that rage and defiance are intolerable and unacceptable. We were taught that in order to be lovable we had to be “good” which meant being pleasing and accommodating.

We all have some degree of self-idealization, over-inflation of certain qualities and that is often in conflict with a) others’ self-idealization and b) others’ self-concepts. It gets in the way. I might think of myself as a smart, fantastic listener and you might consider yourself a smart, effective communicator. If we come across a misunderstanding or a fair amount of tension during an encounter in our relationship, depending on how psychologically flexible we are, both of us might jump to the conclusion that the other is not as smart as they think they are or not a great listener/communicator.

We are a complex constellation of inner experiences and reduced to words as a means of communication.

Some of us have been deeply hurt by intimacy. Some of us respond to this wound by avoiding intimacy. Others respond by developing a preoccupation with it. Depending on the experiences endured in childhood, we might view safety as either boring, untrustworthy, or elusive. (And plenty of people would say that safety is downright illusory.)

A lot of us don’t know how to manage our own difficult emotions, let alone tolerate high emotionality in others.

What We Can Do:

 We can begin by learning to accept that we are never going to be completely understood by nor completely understand others. Having some understanding can be enough.

At any moment, we can slow down and label what is happening to give us space from the immediate interpretations calculated by our brains.

We can look at our expectations.

We can start to be more curious about which narratives we’re living by that aren’t serving us.

We can remind ourselves that, at the core, what we want from others is often what they want from us and that we might define this differently.

We can learn to balance between our attunement to others’ needs and our own.

Listening is an ineffably effective tool. When we’re willing to listen to ourselves and others we create an open, stable environment. Listening allows us to contact an experience on a deeper level and then make choices that are more in alignment with what is needed.

As always, none of this exhaustive but it’s off to a good start. Happy relating!

 

Love and Be Loved,
Natalie

What Is Gender

What Is Gender

Gender is confusing. It’s often used and understood as a synonym for sexual genitalia. Consult any dictionary, and you’ll see. And while, in our culture, both terms are inextricably linked with one another, they are different. They’re associations with one another (and our staunch adherence to them) have proven oppressive and dangerously limiting.

For some, it’s never an issue; they’re born, they are raised as the sex they were assigned at birth, identify with that sex and its associated gender, and it’s all good. For many others, it’s not so easy. Some of us feel confined by the limits of our current conceptualization of gender upon which our society has agreed and enforced for generations.

Even in places where people self-describe as open-minded and accepting, a cis man wearing a dress is assumed to be in costume, and a femme or high femme woman with fully grown out leg hair is a spectacle.

Gender is a construct, and we have agreed that being masculine means one thing and being feminine means another. Many of us who disagree with this construct do so while following the rules. We feel that we are following these rules against our wills. When people do break free and live authentically, however outside the norm, they are mocked, isolated, bullied, attacked, and even killed.

For years, in the Trans community, “passing” has been a goal. Some want to pass in hopes of feeling in alignment with who they know themselves to be. Some want to pass to look and feel like and be accepted as a “real” man or woman. (Please note that I am absolutely simplifying this concept.) This is a testament to the generations of patriarchy, toxic masculinity, sexism, and misogyny that inform our culture. Men must “look like men, ” and women must “look like women.” To this day it’s still an issue of safety as MTF (male-to-female) people are the most targeted members of our community. (And MTF People of Color make up a substantial portion of that group.)

Obviously, this is not true for every Trans person. There are plenty of people in the Trans community for whom passing isn’t much of a goal, and there are many who’ve found more peace and happiness after transitioning. Happiness is a universal goal, and many eventually find it after they have transitioned. (Most people don’t find immediate fulfillment; transitioning is often a long and arduous process during which a person can face various types of rejection and self-doubt. Years of managing the stress brought on by denying oneself, living in fear of being rejected for living authentically compounded by the stress of letting go and allowing oneself to transition is an enormous undertaking.)

But there is a whole group of people who identify as Trans and don’t want HRT (Hormone Replacement Therapy) or surgeries. Some Trans people want HRT but not surgery. Some want some of the surgeries but not all and don’t want HRT. Some FTMs will never look the way we’ve been conditioned to identify as male, and some MTFs will never look the way we’ve been conditioned to identify as female. Most of us assume that when someone transitions they’ll start behaving and presenting in a way that our culture affirms as masculine enough or feminine enough.

We have decided what is masculine and feminine, which characteristics are ok to swap and which are definitely not ok. Straight men can have long hair, but they can’t wear makeup. Women can have buzz cuts and abstain from shaving body hair, but they’d better be Lesbian. Our culture puts an incredible amount of pressure on its members to conform to its rules and has assembled a loyal and persuasive army of militant enforcers who are always more than willing to defend these rules.

In response, so much dangerous adherence to these limits is the notion of being gender-fluid. Gender fluidity is gaining momentum. A lot of people don’t feel they should have to comply with a certain presentation based on their genitals. So they don’t. They identify and present however feels most authentic to them. They don’t ask for permission. They don’t appease. People who are gender-fluid have looked at the gender, and sexual constructs created by the dominant groups in our culture and have opted out. They are creating a safer, more inclusive culture where we are not defined by our presentations or ruled by binaries and either-or options.

I’m often asked about “detransitioning” and how common it is. This is a complicated subject and will take time and commitment to discuss. If you have any questions about what I’ve written or would like to discuss detransitioning, please contact me. I’d be more than happy to talk about this with you.

 

Love and Be Loved,
Natalie

Can My Relationship Be Saved?

Can My Relationship Be Saved?

Most of us want security in our relationships. We’re wired to be social so, when we feel like our social standing is threatened or that our intimate connections are unreliable, our brains process it as actual danger, and we freak out.

Some of us crave security and validation of our places and safety in our relationships but can’t seem to find partners with whom we get that. We tend to find and are attracted to people who provide us with incredible highs (and incredible lows), drama and a push-pull style of interacting. When we’re in relationships with partners who help us to feel more secure and receive validation of being loved, respected and cared for, we often feel bored. We mistake the tension-relief cycle and the excitement of the highs and lows for love. This type of behavior is common in those of us who have an anxious attachment style. We think we want security (and we do but getting it also stresses us out) and then when we get it we’re not interested.

 

Look at this scenario. Let’s say you are in the middle of a pretty unstable intimate relationship with a partner. To friends and family, the relationship is fraught with various dramas and issues; everyone thinks it’s run its course and just needs to end. You acknowledge that there are problems, but think you can work through them. You might even believe that you can’t live without your partner or that there is no one you could ever love as much. Your partner is ambivalent about your future as a couple which is weird because when you first started dating, they came on strong and made you feel like you were the only person in the world. Now, you’re lucky if you get a text back. Much of the relationship consists of a good couple of months and then a breakup or the threat of a breakup. Even when things are good, there is a lot of discord because you don’t feel prioritized by your partner and they experience you as suffocating. When it’s good, it’s really good, but when it’s bad, you feel like you might lose your mind. When you’re at work or out with friends, you are often distracted and thinking of your partner, waiting for their text or call. If they do contact you, all of your attention is fixed on them. You often threaten to end the relationship, but when an actual breakup happens, it’s either initiated by your partner or because they are the one who follows through on your threat. You think the relationship would be perfect if you partner would make only a few changes to your dynamic. After all, you’ve sacrificed a lot of your expectations and some of your values in a desperate effort to make this relationship work. You often say you’ve never loved anyone so much until now. This is also one of the most unstable relationships you’ve ever had.

 

In this example, you are exhibiting anxious attachment behavior. It doesn’t necessarily mean that you have an anxious attachment style. During the course of our lives, we are in relationships with people who might connect us to various styles of attachment. If this relationship is representative of most of your intimate relationships, then it might be more likely that you have an anxious attachment style.

 

People with an anxious attachment style (or who have enough of a propensity for it) feel themselves pulled to people who have an avoidant attachment style. The partner above is a pretty good example of someone who might have an avoidant style of attachment or at the very least displays some features. This is usually pretty rough going because while one partner craves validation and is insecure about space in the relationship, the other partner is looking for more space and is insecure about giving validation.

 

This is a pretty crazy-making, taxing cycle. To add insult to injury, the more we engage in this cycle, the more insecure we become. I know it probably feels like there’s no winning here, that you can either be with someone you love but who can’t give you the security you need or be with someone who can give you that security but not a satisfying connection. I would love to talk with you more about this. Please contact me if you would like support.

 

I recommend reading the book Attached., by Amir Levine and Rachel Heller. It’s a great resource for people struggling through these and similar patterns.

 

Love and Be Loved,
Natalie

How Do I Know If I Need Therapy?

How Do I Know If I Need Therapy?

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

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

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

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

Psychoanalysis and Psychodynamic Therapy:

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

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

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

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

 

Behavior Therapy:

Focuses on conditioning new behavior. Uses brief therapy model.

Examples: Applied Behavioral Analysis, Aversion Therapy, System Desensitization

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

 

Cognitive Therapy:

Focuses on changing thought pattern. Uses brief therapy model.

Examples: Rational Emotive Behavioral Therapy, Cognitive Behavioral Therapy

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

 

Humanistic Therapy:

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

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

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

 

Integrative or Holistic Therapy:

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

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

Often used for: All of the above

 

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

 

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

 

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

 

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

 

Love and Be Loved,
Natalie

If You Want to Be Heard, Start Listening

If You Want to Be Heard, Start Listening

A lot of couples seek therapy looking for help with their communication. They want to feel seen, heard, and understood. Pretty much all of us want to feel this.

 

Often, what ends up happening is a lot of talking and explaining and scrambling but not a lot of listening. We want to be heard before we hear. We want to be seen before we see. It becomes a rigid bartering system with the understanding that “If you listen to me and understand what I’m saying, I’ll listen to you and try to understand what you’re saying.”

 

And it’s understandable. When an intimate relationship is fraught with miscommunication and misunderstanding, there are wounds. There is pain. Most of us don’t know how to navigate our pain and the pain we’ve caused our loved ones. We are defensive when confronted and quick to point out what the other has done to hurt us. It’s hard to forge ahead together with this strategy.

 

If we’re unsure of how to navigate our hurt, we usually use anger as a secondary emotion. During an intense discussion or argument, we become angry enough that we forget we love the other person. Our stance becomes adversarial, and in a minute we say something deliberately hurtful. This kind of defense amplifies our communication problem and is a devastating hit to emotional intimacy.

 

In the heat of the moment, it’s hard to slow down. It goes against everything our nervous systems are telling us to try hear and see the other person’s experience. But if we want to deepen and maintain our bonds, we have to learn how.

 

When we’ve experienced trauma, hearing and seeing while regulating our emotions is especially hard. Fatigue, hunger, and loneliness also stack the odds against us.  There are a million reasons that contribute to the challenge of hearing and seeing. And there is one big reason to keep trying- increased peace and understanding within ourselves and our relationships.

 

To be proficient in inquiry of others’ experience, it’s helpful to start to with ourselves. It’s also helpful to start by being pretty basic about it. Initially, try it when you’re feeling relatively calm. Pause and see what you notice. What’s happening? What do you hear? What do you smell? What do you notice in your body? Then, try it when you’re feeling slightly irritated. The more you practice it (or anything), the more available it will be to you when you need it. Eventually, you’ll try this when you are really struggling whether on your own or in relationship. If you’d like to talk more about this or have any questions, feel free to reach out.

 

Love and Be Loved,
Natalie

It’s Not About Self-Esteem

It’s Not About Self-Esteem

The US went on a real self-esteem rampage starting in the mid to late ‘80s. How-To books were written for parents, leaders, educators, executives, and anyone else who wanted to know how to cultivate high self-esteem in themselves and others. After 30 years or so, we’ve seen the impact of this practice, and it hasn’t delivered what its supporters had hoped. As it turns out, the self-esteem movement helped people approach life with more entitlement and less personal accountability. I get the intention behind the self-esteem movement and support that intention, but based on what we now know about the human brain, the application was doomed from the start.

 

Self-esteem is about confidence in one’s abilities, feeling good about oneself. I might be the most confident about my driving skills but constantly get into fender benders, get pulled over for speeding, and be a general train wreck on the road. Someone else might believe that he is an ace baseball player and yet is consistently overlooked by even the least competitive teams. Anyone can have high self-esteem. It doesn’t mean they’ve earned it. It doesn’t even mean that it’s based in reality. This goes to show that someone might have great self-esteem and a poor self-concept.

 

Self-concept is how we view ourselves, the beliefs we hold about ourselves, and the feedback we get from our environment. We categorize ourselves, then interpret those categorizations.

Part of your self-concept might be that you handle failure well because you learn from it and use failure as a way to learn strategy and increase your drive to get what you want.

 

I’m not saying that plenty of us don’t have faulty self-concepts. Most of us have incommensurate negative or positive self-concepts somewhere in there. I’m saying it’s more skillful to assess self-concept as opposed to self-esteem because it’s not about how confident or insecure we are in our capabilities as it is about looking at the evidence.

 

In sixth grade, I struggled with math. I wasn’t crazy-struggling, but I wanted to enjoy the same confidence in the subject I saw my peers enjoying so, I came to my teacher for help. If she had been concerned about my self-esteem, she would have told me something like, “Oh, Natalie, you’re such a great student! You’re not struggling that badly. Besides, you’re great and look at all the other things you can do!” Luckily, she cared more about my long-term self-concept than my self-esteem and told me something like, “Ok, Natalie, if you want to be better at math let’s look at where your performance is weak. Here’s where you’re doing well and here’s where you need help. Let’s work on it.” (Thanks, Mrs. Roloffs. I owe you.)

 

So, if you’re struggling with insecurity, instead of working on raising your self-esteem, try looking at how you’ve structured your self-concept. You’ll find it’s a much more useful tool than glossing over your experience with an I’m-ok-you’re-ok message.

 

If you want to look more closely at your self-concept, be curious. What are your values? What do you believe about yourself? What is the evidence of how true or false those beliefs are? What are the stories you tell about yourself? How do they play out in your life?

 

Love and Be Loved,
Natalie