Accepting “clean pain” and letting go of “dirty pain”

A few winters ago, I broke my toe when I rammed it into the corner of my couch. I knew I had injured it, but promptly went into denial. I ignored it for a few days, walking on it, exercising, jamming my feet into snow boots (gotta love Chicago winters), till the swelling and pain became so excruciating that I could hardly walk. I got it checked out and was given one of those open-toed orthopedic shoes to wear. Turned out, I had probably started off with a small fracture but made it worse by continuing to bear weight, jump, run, kick, etc.

I was PISSED. I would stew on how pissed I was as I hobbled down the street, furious and impatient with myself for taking twenty minutes to walk a mere two blocks. I griped about having to “waste” money on cabs and bus fare for distances I normally could walk. I cried with frustration about not getting to exercise or do yoga, and I felt SUPER antsy. I cursed my body for failing me and cursed myself for being such a klutz. I went back over the scene of crime dozens of times, each time agonizing over how I “should have” been more cautious, should be more coordinated, should be smarter. The thoughts in my brain made me feel like a total idiot for messing up the simple act of walking across a room. I have a tendency to be pretty harsh towards myself.  After all, in the scheme of things, it was just a few weeks of my life where I was inconvenienced while healing an injury.

Reflecting on that incident, I can see just how silly and irrational all of those nasty thoughts were at the time. But that didn’t stop my brain from giving me all of that BS.  If you’re a fellow human, you can probably relate to the feeling of RAGING against yourself when you make a mistake or get hurt. Maybe you can relate to raging against your body for experiencing pain at an “inconvenient” time. Have you ever been upset that you got sick right before a big event and had to miss it? Or run outside to catch the bus, only to see it pulling away, then started cursing everyone and everything for your bad luck? Or guilted yourself for getting upset at something that “isn’t a big deal?” We’ve all been there.

In Acceptance and Commitment Therapy (ACT), this is explained by the concepts of “Clean Pain” and “Dirty Pain.”  Clean pain is natural.  Pain is a part of being human.  We fall and scrape a knee, and it hurts. We get broken up with, and the rejection hurts. A pet or a loved one passes away, and it hurts. The fact that these experiences naturally create pain is not BAD or WRONG. It’s just an inevitable part of life. Clean pain is any pain that arises from the experiences we have as humans moving through the world.

So to recap: we experience pain, and there’s nothing we can do to change this fact. However, us humans like to be TOTALLY IN CONTROL of everything, everywhere, all of the time. So we get upset when pain happens because it reminds us that there are things we can’t control. We naturally fight against our pain, either by getting caught up in thoughts about how it’s NOT FAIR that we are dealing with pain, or looking for someone or something to blame for it happening. We get stuck in beliefs about how it is BAD or WRONG that the pain happened. We beat ourselves up for being human (e.g., when that bully in your brain starts saying stuff like “I’m so stupid! I’m such a failure. I’m never gonna get it right. I’m overreacting. Other people have it much worse than me. This is really not a big deal at all. It’s ridiculous that I’m upset by this”). Or we blame others for causing us pain, and we stew on feelings of resentment or even hatred (“How could he do this?  Who does she think she is? He only cares about himself. Why do they keep screwing me over? I hope he gets his heart broken”). We get sucked into feelings of anger, frustration, shame, impatience, sadness, and hopelessness. We look for ways to “solve” the pain, by numbing out through drinking or drugs, making efforts to control our bodies and minds through self-harm, restricting, binge-eating, purging, and exercising, ignoring or distorting reality, or trying to avoid any situation we think might cause us more pain. Does any of this sound familiar to you?

When pain happens, we try to comfort ourselves by looking for ways to prevent future pain. We try to regain that false sense of being “totally in control” of everything. Our brains don’t think we “should” experience pain, so we treat it as something “wrong” with us or consider ourselves “weak” (especially if the pain comes in the form of a difficult emotion that we were taught we should not have).  These responses to “clean pain” are examples of what’s called “dirty pain.” Dirty pain is any reaction to clean pain that we inadvertently create, like beating ourselves up mentally for being so clumsy, ignoring an injury and making it worse, or self-sabotaging in our next relationship out of fear of getting hurt again.

If you’re familiar with my whole philosophy on human experience, you know that I talk a lot about how we can’t control what thoughts or feelings arise in us.  So you might be wondering, “If we can’t control what we think about or how we feel, how can we ‘stop’ our unhelpful reactions to pain?” That’s a fair question, and a good point. We can’t stop the thoughts or feelings from popping up, but we CAN start seeing them for what they truly are: unhelpful reactions (often in the form of commentary from that “bully” voice inside our brains). That bully or inner critic has a field day every time something unwanted happens to us.

The key to dealing with those dirty pain reactions is to practice acceptance. Acceptance doesn’t mean you like, want, enjoy, or welcome something. After all, who WANTS to feel grief and sadness when they suffer a loss? Acceptance just means we are allowing something to be a part of our current reality.  It means we are willing to tolerate something uncomfortable, painful, or unpleasant for the sake of getting to be alive. Accepting clean pain helps us to disengage from the dirty pain, and as a result, the clean pain naturally feels a little less “painful.” It becomes a little less intense and overpowering. The key though is that you have to stop trying to make the clean pain go away in order for this to work, which can be tricky.

In numerous research studies, when folks with chronic pain learn to practice mindfulness and acceptance, they become more functional and they experience their pain as subjectively less distressing and less intense than it was before they accepted it. The SAME pain felt LESS painful because they changed their relationship to the pain. Cool, right? (Click here to check out a randomized controlled trial on ACT with pediatric pain, and click here or here for some correlational studies).

When I work with people on clean/ dirty pain, we talk about all of the ways they’ve tried to control or avoid certain internal experiences (thoughts, feelings, memories, sensations, or physiological pain) and how each strategy has worked for them.  Often, people realize that they’ve spent so much energy trying to make pain go away or trying to make sure they never experience a certain type of pain (like rejection or embarrassment) that it’s taken over their lives and has become a central focus. Learning to let go of efforts to control or prevent pain can be challenging (it means you have to FEEL the pain, which can be pretty intense or uncomfortable), but the trade-off is that you gain freedom. When you accept that “it is what it is,” you allow yourself to invest your energy into things that will actually have a payoff. It takes practice, but through mindfulness and acceptance, you learn to have a different type of relationship with pain.

That winter with my broken toe, what helped me let go of the “dirty pain” was gratitude. I realized how much I took for granted the fact that I had ten functional toes that supported me every day, and allowed me to balance and move my body with ease. I realized how lucky I was to only be inconvenienced for a couple of months, when plenty of people have injuries far more debilitating and permanent.  I tried to challenge my restlessness by finding moments of joy in stillness, and exploring other forms of meditation instead of my preferred physical activities.  I challenged thoughts from my inner bully that were urging me to ignore hunger cues or change my eating behaviors to “compensate” for being more sedentary than usual.  I listened to my body’s cues and forgave myself for being human. None of these responses were my natural, instinctive reactions, but I got there eventually.

Nobody is perfect, and even the most mindful and self-aware people will struggle at times to let go of their “dirty pain.” Be patient with yourself and with others.  Remember that I am always here to help you strengthen that mindfulness muscle and would be honored to join you in your journey towards acceptance.

Want to enjoy your life more? Think about death.

I recently saw an exhibit at the Field Museum called “Evolving Planet” that completely blew my mind. The display takes the visitor through four billion years of life on Earth, starting with single-celled organisms and moving all the way up through the evolution of every species till present-day humans. I knew from biology classes over the years that a ton of species have gone extinct over the course of Earth’s history, but it was still surreal to see it all laid out in a timeline (#nerdalert).

Every 50 meters or so, throughout the exhibit, a sign would indicate that at that point in the timeline, there was a “mass extinction,” where a bunch of species were killed off and only those most well-adapted survived to the next era. To refresh your memory if it’s been awhile since your last science class, that’s what happened when the dinosaurs were killed off—only the birds survived. Earth has had five mass extinctions in its history, and apparently we are on track for a sixth. (As a side note, did anyone else forget that birds were descendants of dinosaurs? Crazy, right? I definitely forgot that. Apologies to my fifth-grade teacher.)

Based on my rudimentary understanding of evolution, I realize that since humans have only been around since the most recent mass extinction, we aren’t destined for long-term greatness on this planet. It seems likely we will be killed off in the next mass extinction and/or we will evolve into some even more advanced species. So when you think about it, our lives are really not that big of a deal at all.

I walked out of that exhibit feeling surprisingly peaceful, thinking about how the years representing my birth till my death probably wouldn’t occupy more than a few millimeters of space on the timeline in that museum. As someone who is not naturally very “chill,” I was reminded that all of the time I’ve ever spent worrying, over-analyzing, and over-planning was a completely unnecessary use of energy, and I could let it go. My significant other walked out with the same awareness that his tiny human life is little more than a blip on the radar of this planet’s existence. But he didn’t share my sense of peace; in fact, he felt more anxious and a nagging sense of meaninglessness.

So why does the awareness of our inevitable mortality (which researchers call “mortality salience”) upset some of us, and relieve others? It depends on how you understand and define your life. It depends what you’ve been through, your spiritual beliefs, and perhaps where you see yourself on the timeline of your dreams, goals, and lifespan development. It also depends on how frequently you think about your mortality and how mindfully you live.

If you react like my partner, with panic, you’re in good company. After all, according to Terror Management Theory (developed in 1986 by Greenberg, Pyszczynski, & Solomon), all human behavior is motivated by the fear of our impending deaths. Often, human awareness of our unavoidable demise “generates a state of anxiety that triggers a defense mechanism for the control of thinking” (according to Gordillo & colleagues).

In several recent studies published in the European Journal of Psychology, researchers have explored whether people evaluated an individual’s personality differently or felt more positively or negatively about a person based on whether the person was dead or alive. It turns out that we think more highly of people when they’re dead. We are more positive in our appraisals of a person when they are dead, and rate our impressions of them more favorably even when we didn’t like them very much while they were alive.

This gets me thinking about how it’s socially taboo to “speak ill of the dead.” We can see from heartfelt eulogies that we often focus on a person’s positive qualities quite easily (and forgive their negative ones) once they’re dead. But wouldn’t it be nice if we could harness that same perspective while we (and the people around us) are still alive?

All of this comes right back to the freedom and peace I felt walking out of the Field Museum that day. While it may be a tough sell to some people, I believe it can be profoundly beneficial to think about death. It can take awhile to develop the willingness to sit with that fear and not let it drive the bus (and this is where mindfulness skills come in handy). Despite the discomfort that may arise, though, thinking of death can actually enhance your overall satisfaction with life and enrich your feelings towards loved ones, friends, enemies, and even strangers.

Personally, here’s how I’ve found it helpful:

~Remembering that I will die one day reminds me that there’s no need to strive for perfection. In the grand scheme of things, the way you look, your grades, your salary, and your accolades will literally mean nothing. Isn’t that great? There’s no pressure to do everything “right” all of the time! Given this information, the only reason to strive for an accomplishment or work hard to pursue a goal is out of genuine care for that thing. You don’t have to work hard for stuff that’s on someone else’s agenda (including any culturally-prescribed expectations that don’t resonate for you). This is why it helps to get clear about what matters to you in life, so that you can focus on those values and priorities.

~Remembering that everyone around us will also die one day reminds us that there’s no point in holding grudges or harboring resentment. After all, the person you’re pissed at has an expiration date, too. This applies to all living creatures. I feel boundless love and gratitude for my dog when I remember that one day, he will no longer be with me. I find it much easier to forgive him when he snaps food off my plate or destroys the sofa. I’ve heard from people who have young children that thinking about their limited time on this planet helps soften towards them for throwing a temper tantrum or breaking a mug. Mortality salience can also make it easier to get over the guy who cuts you off in traffic or the rude grocery store clerk.

~Similarly, recognizing loved ones’ mortality helps us to forgive them for honest mistakes, accept their flaws, and deepen our appreciation for our relationships. It makes confronting them when we are hurt a little less scary. It becomes more worthwhile to work through conflicts so that we can make the most of our time together and spend it loving and enjoying one another. It also makes it easier to let go of a relationship when it becomes clear that it isn’t serving you to keep investing, since as the cliché goes, “life is too short” to waste on that BS.

~Since the only thing that’s certain in this life is that we will die one day, we can accept that most of what happens in the universe is completely out of our control. This can be freeing. We are literally only responsible for our own individual actions, and therefore might as well invest what little time we have on this planet to making our actions meaningful and worthwhile.

Way back in the day, the Stoics believed that maintaining awareness of mortality was important and allowed them to experience more gratitude. Recent research has shown these positive effects in modern times, too. When people are reminded of mortality, either consciously (by being asked to think about death) or unconsciously (like walking past a cemetery), they behave more kindly and compassionately towards others and make positive changes in their lives. Their actions are more authentic and more in alignment with their personal values and priorities. When something is time-limited, it becomes more valuable. And when it’s more valuable, we appreciate it more and we focus more on making it worthwhile.

I’m not saying it’s always fun to be aware of your own or others’ expiration dates. Like anything, accepting our inevitable demise can involve a curly, non-linear grieving process. It can mean going through those classic “stages of grief,” sometimes living in a state of denial about it, and other times feeling angry, depressed, or trying to “bargain” away mortality (many wellness companies capitalize on our death anxiety by promising long lives if we use their product or take their supplement). And don’t even get me started on our cultural emphasis on “youth” and “anti-aging,” which could be an entirely separate blog post. Essentially, we find it tempting to ignore, dismiss, or fight against the fact that we all inevitably age and expire.

However, if we can resist the pull to drown in panic or anguish over our lack of importance, and resist going down the rabbit hole of “why even bother trying if none of it matters?” we can use this awareness to deepen our appreciation for life and shift our focus to the things that truly matter to each of us.

Do you agree, disagree, feel ambivalent, or feel totally indifferent? Does all of this “death talk” bring up fear, gratitude, mixed emotions? Whatever your reactions, I’d love to hear from you!

Demystifying Mental Health Treatment: What to do if you’re feeling “stuck” in therapy

A couple weeks back, I shared my #2018resolution to work harder to demystify mental health treatment. One of the things that makes therapy so complex is that it’s designed to treat somewhat abstract human experiences, so it’s tricky to point to exactly what works and what doesn’t.  Because no two humans are exactly the same, there is no formula that guarantees therapy will go a certain way.  So today we address another common concern: what to do when you’re not “getting anything” out of therapy.  I’ve broken things down into three parts: exploring your options, analyzing the situation, and how to “break up.”

Part 1: Exploring your options

Remember that you have options! The best way to get what you want out of therapy is to find the right therapist. It’s useful to reflect on a few key things before you begin. If you’ve already started with someone, it’s not too late to consider these points for the future or to discuss in your next session.

  • It’s okay to shop around. Finding a therapist is a bit like finding a home. Everyone’s “wish list” is different, and not every home is suited to every renter. You might have some general ideas of what you’re looking for, but until you actually meet someone, you can’t be sure whether you really feel a connection. It’s totally natural to want to explore more than one possibility. A few things to think about if you shop around:
    • Ask to set up phone consultations before deciding to make an appointment. Many therapists offer these phone calls free of charge, and they will give you a chance to ask questions, get to know their style, and decide whether you feel they understand your unique situation. This also helps you screen and find the right person without having to juggle multiple appointments and tell your story over and over again.
    • If you make appointments with multiple therapists, keep in mind that some insurance plans won’t cover multiple therapy sessions in the same day (or week). If you are using insurance, you may end up having to pay out-of-pocket for some of these appointments unless you check ahead of time or spread them out over the course of a few weeks.
    • Be mindful of how many times you meet with a therapist before deciding to commit. If you’re meeting with two different therapists several times each, you’re at risk of developing “multiple relationships.” This makes it hard for either one to really be effective, since you may be inadvertently opening up to one more than the other, or focusing on comparing them instead of actually getting into the work. It may be best to meet once with each, and then pick one person. If after awhile, you aren’t getting what you wanted and are curious to go back to the other one, you can change your mind down the road.
    • Consider letting the therapists know that you are shopping around. This sets up an open dialogue from the start, and makes it easier to “break up” with them if you do go with someone else. It also opens the door to talking about what you’re looking for. Most therapists will be able to help you find a good match, even if it’s with someone else. Our egos can handle the rejection, and besides, it’s more important that you get the care you need.
  • Be clear about what you need. It’s okay if you’re not sure what exactly it is that you need, but be clear about the fact that you’re not sure! Some people are just looking for a sounding board, a place to “vent,” or a place to be validated and feel understood. Others are looking for a fresh perspective. Or, you might want to be challenged and given “tools” to take away and use in daily life. Often, people are sure on what they want the outcome to be (feel better, be more confident, have a healthier relationship, etc.) but are not sure what they want the journey to look like. That’s okay—tell your therapist those desired outcomes. That’s a good place to start.

Part 2: Figure out what is and is not working.

Therapy is one of those things in life that “works if you work it.” That is, you get out what you put in. If you are actively engaged and motivated to apply what you learn, it can enhance your life in a very meaningful way. Of course, this is most true if you have a strong therapeutic alliance, which I discussed in my last post, as well as if your therapist’s approach is right for you. If you’re giving it a fair shot, committing to the work, and regularly attending sessions, and you’re being honest with your therapist and with yourself, you’re doing your part. It’s important to be patient, but not passive. Keep in mind that things won’t change overnight, but if after several sessions you don’t think it’s working, here are some things to consider:

  • Therapy is not “one size fits all.” Every therapist has a unique style. This is influenced by differences in education, training, experience, personality, and preferences. You can read more here about different levels of therapist training. Many therapists consider themselves “integrative” in their approach to treatment, meaning they blend or pull from a variety of psychological theories. Some will rely more heavily on one theory or one treatment modality than others, or will pull from a given theory based on what symptoms or conditions the client is struggling with.
    • For example, I am trained in a variety of theories, but when I’m treating Obsessive-Compulsive Disorder (OCD), I rely most heavily on Cognitive-Behavioral Therapy and exposure therapies. These two theories have the most scientific evidence for successfully treating OCD symptoms, and I am confident in applying them. However, another therapist might use a totally different theoretical approach to the same set of symptoms, and can be just as effective. You can read more about some of the main theories of psychology here and here.
  • In addition to theoretical approaches, every therapist has a different degree of training and experience with certain populations, symptoms, and disorders. Ask your therapist about his/her specialty areas, but also keep in mind that a lot of us are trained to work with a variety of issues, so it’s not vital to find someone who “specializes” in order to receive effective treatment.
    • If you’re feeling stuck, you may need a different specialty or style than what your therapist is providing. It’s okay to ask your therapist what theoretical approach(es) they are using and why, and if you’re curious about trying others, ask whether they’ve been trained in other approaches or if they can refer you elsewhere.
  • Speak up when we do something that either helps or doesn’t help. I sometimes guide clients through a meditation at end of session, and I always appreciate when someone comes in and tells me they want to do it, instead of just hoping I suggest it myself that day. I’ve also had clients ask for more structure, so we set a clear agenda at the start of the session to be sure we get to all of the topics they wanted to cover.  This is always helpful feedback to give your therapist so they can tweak what they’re doing and you can walk away from sessions feeling like you’re getting something from them.
  • This one is tough: talk about your relationship with your therapist. I know it can be a little awkward, especially at first, to open up to a therapist because the focus is on YOU entirely. This is different from how most people interact in everyday life, where it’s polite to have a more back-and-forth Q&A with other people and not just have one person do all of the sharing. You might not know much about your therapist, and that’s typically a purposeful ethical decision your therapist has made. However, even though we don’t disclose about our personal lives, you can still get to know your therapist’s personality. You’re not talking to a robot or a brick wall. Some use humor, while others are more serious. Some focus on thoughts, some focus on feelings, some focus on your physical posture, and some focus on a combination of these. Some will want to dive deep into your past and unravel childhood experiences, while others will only be concerned with the present situation. If you are struggling to trust your therapist, or if you get upset or offended by something your therapist says or does, as tough as it is to address this, it will only help you in the end.

Part 3: Maybe you just need to break up. We get it. No hard feelings.

Ultimately, I can give you all of these pointers but the biggest thing to remember is to trust YOURSELF when it comes down to who you keep in your life and who you let go. If you realize your therapist isn’t right for you, perhaps it’s time to say goodbye. If you’re still unsure what you’re looking for, this article talks about some more ways to assess whether your therapist is helping you.

  • Honesty really is the best policy. It might be tempting to “ghost,” especially if you’re someone who struggles with confrontation. Nobody will stop you from ghosting, but consider what you could gain from the tougher alternative. Sharing your feedback and being clear about your intentions are communication skills worth developing. Being able to express your feelings honestly, even if it’s uncomfortable to do so, might be one of the reasons you started therapy in the first place. It can be meaningful to walk away from a relationship that’s not working in your life (whether with your therapist or anyone else) by first asserting your needs, and then saying goodbye.
  • You might think that you’re sparing someone’s feelings by ghosting, but remember that your therapist is a person who cares about you and is invested in your wellbeing. You don’t owe us anything, but if you’re open about breaking up, we will know not to worry about your safety if we don’t hear from you again.
  • Most importantly, if we know you’re breaking up with us, we can help you find someone who is a better fit for you. You can let your therapist know that you’re ready to move on in person, by phone, or by email. If you tell us what didn’t work or what else you’re looking for, we can help you find a therapist who is a better match for you. Or, if you want to take a break from therapy entirely, we can discuss a game plan to check back in down the road and see whether you want to resume (or respect your wishes to be left alone if you no longer wish to receive communication).

The bottom line is that it’s YOUR life. At the end of the day, you’re the only one living it, and nobody else can tell you what you need. If you aren’t getting your needs met, please do what you need to do to advocate for yourself, as tough as that can be. If you need help learning to navigate these types of awkward encounters, that could be a great topic to explore with your next therapist!

Demystifying Mental Health Treatment: How long will I need therapy?

It’s the start of a new year, and while you don’t need the calendar to tell you when to make a change, the whole #resolutions thing makes it a convenient time for many to reflect on goals for themselves in the upcoming year and start taking action steps. My #resolution is to do my part to bust myths around mental health treatment, so that nobody has to feel embarrassed or judged for struggling. To get things going, I’ve decided to start off 2018 with a series of posts demystifying the process of therapy. I’ve noticed that many people considering therapy have the same questions and concerns about the process. Today, I’ll address the one I most frequently get: how long will this take?

Well… at the risk of sounding wishy-washy, the truth is that it’s different for everyone. People seek therapy for various reasons, so treatment is not “one size fits all.” Some people are struggling emotionally with things like depression, anxiety, or grief, or having difficulty coping with a past trauma, navigating a difficult relationship, or managing self-criticism. Others may be struggling to stop engaging in certain behaviors, like addiction, substance abuse, compulsive behaviors, or unhealthy eating and exercise habits. Some people may be looking for help adjusting to a major life change or while going through a life transition (such as graduating from college, starting a new job, getting fired, going through divorce, moving to a new city, grieving for a loved one, or having a child). The list could keep going on—humans are complex and messy, and so it is natural at some point in our lives to experience a disruption to our mental health, just like it’s natural to get sick or injured physically at some point.

I suspect that the reason this question is so common is that we like to know what we’re getting ourselves into. Totally fair. Humans are wired to solve problems. When something is bugging us, we want to figure it out right away so that we can fix it and move on. If you’re coming to therapy, you might have been experiencing difficulties for a long time and are finally ready to commit towards change and growth. Or, maybe something just recently popped up, and you want to “fix it” before things get worse. Either way, you probably want some instant gratification. So even though I can’t give you a straight answer about how long it will take, I can do my best to help you get some immediate relief, as soon as the very first session. In fact, it’s a good rule of thumb when you’re looking for a therapist to consider when you walk out of the first session whether or not you feel understood, supported, and hopeful about the possibility of change (even if you don’t feel “better” right away).

Research over the last several decades has shown that therapy has the best chance of being “successful” when the client and therapist have a strong rapport, or therapeutic alliance. Rapport is developed when the therapist and client build trust in one another and work as a collaborative team. Most people need a little while before they are comfortable opening up. However, if you’ve been going to your therapist for awhile and still don’t trust them, this is important to address. I’ll be writing a future post about what to do if therapy isn’t helping you or if you want to break up with your therapist, so stay tuned for more on that later. In the meantime, just know that the sooner you and your therapist form a connection, the sooner you can get to work.

The length of therapy also can depend on how long you’ve been struggling with certain behaviors or experiencing symptoms, how motivated you are to change, the approach your therapist is using, and how open you are to trying new and sometimes difficult things. I often will suggest something many times, over the course of weeks or even months, before a client is willing to give it a try, and that’s okay. We can’t force change—you have to be ready for it when you’re ready for it. So that might take a degree of patience from both of us. Plus, it sometimes takes a lot of repetition before something finally “clicks,” since therapy involves shifting belief systems and worldviews that have been in place for many years. I like to tell people, “you didn’t get this way overnight, so you won’t change overnight either.” If you’re trying to change a lifelong habit, it can take some time to start seeing results because the habit might be really deeply ingrained, and you may not have ever really used other tools (or even known there were other tools available) for dealing with certain experiences. That being said, just because someone has been stuck in a certain pattern for 10 or 20 years does not mean it will take 10 or 20 years to change it. Just don’t expect to break longstanding habits in one session. If you find yourself feeling impatient with the pace of change, speak up. Therapists are not mind readers and if we know you’re feeling frustrated then we can figure out how to get “unstuck” and moving again.

Sometimes, we are chugging along nicely, and then – surprise – life drops a metaphorical bomb. Unexpected stressors can barge in (a breakup, a medical diagnosis, an accident, etc.) and interrupt progress or take priority over whatever we had originally been working on. That might mean we shift course and then return to the original plan at a later time (or abandon the original plan if necessary). It’s important to stay flexible as we go along. I’ve also found that as we progress, we sometimes uncover or make room for other topics to address that weren’t the original reasons for seeking therapy but that are still worth focusing on. For example, maybe you came in to treat your anxiety, but along the way we realize that most of your anxiety is work-related and it’s because you’re in a work environment that just isn’t right for you, so we start to explore a job change. Or, once we’ve helped you resolve depressive symptoms, we start to look at an unhealthy romantic relationship that you weren’t ready to address before.

If you’re dealing with trauma or grieving for a loss, the change may be slower than you’d like it to be, since the healing process often involves feeling an increase in pain or discomfort before experiencing any decreases. If you’re dealing with symptoms of an eating disorder, phobia, or obsessive-compulsive disorder, you also might notice symptoms worsening before they improve, because a component of treatment involves exposure to things that you prefer to avoid in order to get you more comfortable with anxiety “triggers.” This is often a very challenging and stressful process, but ultimately if you stick with it, you will find relief in the long run.

Typically, I like to start off meeting once weekly, and then scale down and meet less frequently as treatment progresses and you start to see change, to give you a chance to try things on your own. Occasionally, we may increase frequency to twice-weekly sessions for a brief period of time in situations where a person needs more support than once-weekly sessions can provide, and there are many clinicians who will meet two, three, or even four times weekly with their clients (this is not my policy). In the initial session, we can get a sense of what’s going on and what level of support would be best, and if you need more than what I am able to provide in a private practice (such as inpatient/ residential treatment or intensive outpatient treatment), I will refer you elsewhere. While it’s important to consider your unique situation when making decisions about how frequently to meet, I have generally found that people who commit to coming in regularly and making it a priority to stick with therapy have seen the fastest change.

Now, I don’t take it personally that you might not want to see me every week forever and ever. In fact, I have the opposite perspective. I don’t want my clients to have to come any longer than necessary. Once you’ve reached your treatment goals, we discuss whether anything new needs our attention, and if not, we decide that it’s time to say goodbye. My goal is to essentially make you into your own therapist, so that you can internalize our work and go about your merry way. As much as I love working with my clients, I also love sending them off into the world to spread their wings! That being said, in times of high stress, it’s not uncommon to slip back into old habits or patterns of thinking, feeling, and behaving. So my door is always open for a “booster” session down the road, even if we haven’t worked together in awhile.

Some clear outcomes of therapy include:

  • Developing skills for effective communication and problem-solving
  • Feeling more self-confident and becoming more compassionate towards yourself and others
  • Learning new ways to cope with stress and anxiety
  • Becoming more equipped to manage and regulate your mood
  • Improving your social, intimate partner relations, and family relationships
  • Changing old behavior patterns and developing new ones
  • Gaining self-awareness and a better understanding of your values

The start of a new year is the perfect time to begin making changes to enhance your life, and therapy might be part of the plan.

If you are considering therapy and want to know more, or if you have a question about how therapy works and would like to see a future post about it, comment in the section below or send me an email, drpaulafreedman@gmail.com.

Am I “Normal?”

One of the most common questions I’m asked by therapy and testing clients is “Am I normal?” It’s a fair question, and it makes sense that some people view psychologists as the people trained to give a solid answer. After all, one of the core educational requirements of anyone seeking a graduate degree in psychology is a course in “Abnormal Psychology.” It can certainly be fascinating to learn about “outliers” in any human trait—intelligence, athleticism, narcissism, and so forth. Plus, in order to accurately assess and diagnose, we need a framework for organizing whatever it is we are assessing and diagnosing. As such, the foundation of our field for the last century has been rooted in “mental illness” being just that—a diagnosis or label, assigned to people whose presentations are “not normal.” So I get why this is the burning question.

“Normal” in 2017 is more elusive than ever. With technology at our fingertips, we ask Google, Wikipedia, and WebMD to weigh in. Social media has perhaps been most influential, taking the “am I normal?” question and providing “answers” by showing us what “everyone else” is doing with their lives. What does a “normal” body look like? A “normal” family? A “normal” person’s Saturday night? Consult social media, where you can decide if you measure up to the curated online images of people popping up in your newsfeed. For some people, it’s easy to feel lame and unsuccessful when it’s “normal” to censor ourselves and only show the public the highlights reel. For others, it’s a constant competition to set the new standard. I wonder what would change if everyone knew how much everyone else was asking whether “it’s normal to [fill in the blank]?” Maybe we’d have more tolerance for the full spectrum of our daily experiences if we could accept that “normal” doesn’t exist.

Perceptions, thoughts, feelings, sensations, and memories are subjective. They are often driven by context and filtered through the lenses we’ve developed through life experience. So what’s “normal” in one context may not be seen as normal in another. Walking down the sidewalk with one’s nose to the ground, sniffing for discarded food scraps = unusual for a human, “normal” for a dog. Sucking one’s thumb = unusual for a 45-year-old, “normal” for a 2-year-old. However, context isn’t always as clear as one’s species or age. Is it “cautious and smart” to lock and then double-check the locks on your doors and windows at night, or is it “paranoid and obsessive” to do so? It depends.

It’s “normal” (natural?) to be curious about whether our experiences and behaviors can be considered appropriate, acceptable, or healthy. But who is the authority on what is considered appropriate, acceptable, or healthy? Psychologists? We’re people too! I’m not the authority on “normal” just because I can tell you if you match up to an agreed-upon set of criteria published in a scientific manual. The reality is that you are the authority on yourself, so only you can answer whether your experience is adaptive or not.

For example, anxiety is “normal.” In fact, it’s a human necessity. It keeps us alert to danger and motivated to complete tasks. Without any anxiety, we have no urgency to get anything done. With too much anxiety, however, we become too overwhelmed to be productive. Finding that “sweet spot” of optimal anxiety for optimal performance on top of the inverted “U” illustrated by the Yerkes-Dodson Law  is the key to success. That sweet spot, however, is subjective to the individual experiencing it.

Current research shows that mental “illness” might be more of the “norm” than the outlier. The Dunedin Study in New Zealand has followed over 1,000 people from birth and over the course of their lives for the past 40 years, assessing them every few years to look at various health and mental health conditions. The most recent “check in” with study participants took place when they were 38-years-old. So far, only 17 percent of the sample has never met any criteria for a psychiatric disorder at any time in the study’s assessment points. This means that at some point in your life, it is likely that you meet criteria for a psychiatric diagnosis (most commonly something like depression, anxiety, an adjustment disorder, or substance abuse). While of course no single study can be generalized to reflect the whole world’s population, it gives us some pretty solid data.

Given these findings, we could argue that it’s “normal” to experience depression at some point in one’s life, just like it’s “normal” to get the flu or break a bone at some point in life. Whether your symptoms warrant treatment depends on how the symptoms are interfering with your life. Everything falls on a spectrum; just as there is a difference between bumping your head and bumping your head with such force that it’s deemed a concussion, there is a difference between feeling a flash of anxiety before a big presentation and feeling such debilitating anxiety that you cannot speak.

The newest version of the Diagnostic and Statistic Manual of Mental Disorders (DSM5), which mental health professionals use for making clinical diagnoses, has shifted towards a more dimensional approach that matches this concept of everything falling along a spectrum. Hopefully, in future editions, it will move even further away from categorizing people as “normal” vs. “abnormal” and help us remove the stigma from these diagnoses, especially since most diagnoses can be temporary. So is it “normal” to struggle at some point, and to have symptoms intense enough to meet criteria for a diagnosis? Absolutely. It’s part of being human.

Maybe we can let go of the need to know if we are “normal” and instead ask ourselves, “does this work for me?” or “is being this way helping me live a meaningful life?” When I first meet with someone seeking therapy, I ask them the “miracle question,” some variation of the following: “If I waved a magic wand and you walked out of here today completely cured of your [depression, anxiety, painful trauma memories, addiction, etc.], what would be different about your life? What would you be able to do?” Usually, the answer has something to do with more meaningful relationships with loved ones, a rewarding job, more energy, etc. Those answers become our treatment goals. If you’re able to move towards your values, the things that truly matter to you, then isn’t that more important than knowing if you’re “normal” by someone else’s standards?

The “Inner Detective” inside of each woman

The other morning, I decided to cut through a nearby park on my way home from a workout. As I was strolling along, a man approached, clearly staring me up and down. When we crossed paths, he said to me, “You’ve got the face of an angel!” I smiled politely and he continued on, “Do you know that you’ve been kissed by God?” I responded with another smile and kept walking. I felt myself exhale as I saw that he continued walking in the opposite direction. It wasn’t until the interaction ended that I even realized that my subconscious had been hard at work for the duration of the 15-second exchange, evaluating threats and calculating the most “appropriate” ways to react. I took in his appearance, body language, tone of voice, and physical size.  There was an automatic analysis of his likely intention (to hit on me? to be friendly? to give me his input on my identity as an angel?) and my wisest response (to laugh? to nod? to ignore him?) and never once did I consider what I felt like doing because the focus was on keeping him non-threatening and getting on with my day.

Someone recently shared with me a piece in the Huffington Post by Gretchen Kelly, titled “The Thing All Women Do That You Don’t Know About.” She points out the various ways that women de-escalate and shrink our everyday experiences to avoid confrontation. As soon as I read it, I felt validated and shared it with several of my female friends, colleagues, and clients. It resonated with each of them. I realize as I write this that I conveniently “didn’t think about” sending it to any men. Perhaps on some level, I assumed they wouldn’t be interested, or wouldn’t find it as powerful as I did (which would feel invalidating and make me question whether my reaction was “right”). As social creatures, we naturally look to others for external validation, and when we don’t get it, we naturally question whether our perceptions were accurate. That’s why groupthink is a thing. We like to “belong,” to feel like people agree with us and believe that what we bring to the table is important.  So I guess I played it safe by sharing the article with people I could count on for validation– fellow women.

I share Kelly’s worries when it comes to discussing women’s issues. I worry that I’ll be accused of exaggerating or overreacting, or being “sensitive.” In another part of my brain, though, there’s a voice that says “It doesn’t matter. I’m a person, and dammit, all human experience is valid!” It’s a newer voice, probably fueled by my training as a psychologist, but I sure am grateful it chimed in. The fact that this voice is not the most familiar message my brain gives me tells me that as human beings, we need to talk about what’s happening, so that we can stop invalidating each other and start connecting more authentically.

As a woman, I’ve been programmed to do the type of split-second assessment I did at the park the other morning everywhere. It’s something that happens as automatically as blinking. Nobody ever sat me down and taught me to dissect the environmental, social, physical, and emotional elements of my daily interactions with men, but I still learned how to do it. I learned the necessity of de-escalating, as Kelly calls it, to keep myself functioning in the world.

I know that regardless of gender, anyone can commit or become a victim of sexual assault and other forms of violating interpersonal behavior. I also know from experience that when we feel attacked or accused of something that feels “icky,” we become defensive. You could ask me about the race of the man who approached me in the park, and argue that had something to do with my fear. I can already feel my defenses gearing up to “prove” that my fear response was not based on the man’s race, because “Oh my gosh, what if I seem racist?” You could tell me I should have been flattered by his compliment, and I feel myself start to question down another self-doubting road, “Oh my gosh, what if I’m overreacting to something harmless and he was just being friendly?” Those reactions are there because there’s some truth underneath.

Here’s the thing, though. As I mentioned in my post last Thanksgiving, I know that I have biases. I make implicit associations based on race, gender, age, appearance. We all do.  We can’t possibly know about all of them, but when we discover them, we can try our best to acknowledge and own them instead of denying them. It’s an uncomfortable process that nobody is ever truly “done” figuring out. But here’s the other thing. I don’t think it helps anyone to pin this womanly “detective work” on racial or any other type of bias. I have had this feeling in response to looks, gestures, and comments from a diverse range of men. Maybe race plays a role, maybe age plays a role, maybe my mood that day plays a role in how I perceive someone… but these are not even close to being the only factors at play. I learned to assess and respond to men to keep myself safe, to prevent a scoff and a muttering of “bitch” under a stranger’s breath, to avoid angering or provoking.

I’ve worked with many clients who struggle to heal from trauma. What I find hardest about treating people who have been abused, assaulted, and raped is that there is this larger-scale minimizing that works against them. We can sit together and validate like there’s no tomorrow, but it often feels like just a drop in the bucket. We still live in a world where de-escalation is the norm. At the society level, we are denying, distorting, and invalidating people’s experiences. I get it; this type of stuff isn’t exactly fun to acknowledge. It’s much easier to say to someone (or to yourself) that “he was just joking around” than to say to someone (or to yourself) that what he just said was inappropriate. It’s much easier to blame the recipient of unwanted advancements (“if you don’t want to get hit on, don’t dress in a tight shirt”) than to turn inward and acknowledge that we said or did something that made someone uncomfortable. Plus, these exchanges often happen so automatically that it isn’t always possible to recognize them before they’re over.

Peel back one more layer of the onion and it’s clear that many of us choose not to bother speaking up, often until things “cross the line” and get dangerous. The shaming/ blaming/ dismissing responses that tend to come from calling out inappropriate and intrusive behavior makes it easier sometimes to just shame/ blame/ dismiss it within ourselves before even acknowledging that something bothered us. We’ve done it a billion times. It often ends up being seen as “overreacting” if we say that someone’s behavior felt scary, creepy, or hurtful. And who wants to be labeled as “dramatic” or “blowing things out of proportion” or “playing the victim?”

Here’s my challenge to all of us: speak up, let yourself speak up, and let others speak up without dismissing.  If you’re a woman, admit that something didn’t feel okay to you and let yourself get pissed off. Teach your children that their experiences are always valid, and that if something feels threatening, they aren’t overreacting. If you’re a man, let yourself consider that what I’m saying might be accurate. Notice if you become defensive and think, “it’s not fair to blame us for your reactions,” or, “I’m a nice guy/ social worker/ philanthropist/ feminist/ mensch, don’t try to make me feel guilty about this stuff,” or “men can be victimized, too.” Then, see if you can get to something else, below your automatic reaction. I’m not saying men can’t be victimized, and I’m not saying all men have done this type of thing. I’m just asking for everyone to listen and take it seriously.

I’m not pointing fingers at anyone; this isn’t about casting certain people as villains based on their gender or any other demographics. It’s about getting one another to start listening openly and without defenses. Asking yourself if you’ve invalidated someone is not an easy thing to do. I hate having to admit when I have minimized someone else’s experience, because I feel guilty and ashamed, but I also know it’s the only way to change things. And I know from the number of people I see, day in and day out, who bravely share the pain of their experiences, that we need to make this change.

Why is language so trippy?

Have you ever done that thing where you start saying a word over and over and over again until it sounds sort of singsongy and you forget what it even means? When I was little, I used to do this a lot  with random “simple” words, like “awhile” and “because.” Yes, I was apparently born a word nerd. I don’t recommend doing it in public unless you really want to annoy everyone around you, but try it out and you’ll see just how nonsensical and strange words become when you repeat them. Language is trippy, and the unconscious process we have for interpreting language can be fucking weird. Think about how right now, your eyes are automatically scanning the shapes on this screen and making sense of the shapes based on how they are structured and combined with one another. Really, stop reading and think about that…

It’s kind of mind-blowing, right? We have these intricate webs of connections between words and what they represent, and our minds are constantly on autopilot interpreting those connections. It’s the process that lets us communicate with each other, and the reason we can remember something that happened years ago. We do this without being guided to do it. Okay actually, we are guided early on, but it quickly becomes second nature.   While we aren’t born with the ability to read written language, we are born with innate “reading” abilities that then get shaped and developed as ways for us to survive in a language-based world.

Unless you’re a word nerd like me who grew up thinking words and letters were just as fun to play with as Legos and dolls, you probably don’t notice language doing its thing on a regular basis. If you start to think about it and notice yourself thinking in words, and notice the associations you make with whatever the words bring up for you mentally, you get sucked into kind of this “meta” space.

The Lemon Exercise is a great way to illustrate the power of verbal associations and sensory experiences. Close your eyes and picture a lemon.  The bright yellow color of it, the bumpy, textured peel, the round, footballish shape… imagine slicing into it and noticing the way it looks, the pinwheel design with seeds in the middle, picture the juice dripping onto your fingers as you hold a slice, inhaling the fresh, citrusy lemon scent… now imagine yourself putting the slice in your mouth, feeling your mouth salivate as the sweet, tangy tartness of the lemon hits your tongue…

Without the presence of a physical lemon, you can conjure up a “lemon reaction” in your brain and body just by visualizing its properties. If you had never heard the word lemon or seen a lemon, let alone tasted a lemon, it would literally just be a sound to you when you heard the word, and this exercise wouldn’t be possible. That’s why foreign languages sound so, well, foreign (duh); we don’t have any context for interpreting the sounds we’re hearing until we attach a meaning to those sounds. Collectively, we give words meanings, and then based on our life experiences, those meanings become implicitly fine-tuned to the degree that they can even evoke strong reactions inside of us without us realizing it.

What does this have to do with mindfulness? EVERYTHING. I like to use my little repeating game with clients who have a hard time recognizing that thoughts are just words in the brain. Usually, the culprit is a thought along the lines of “I’m worthless/ not good enough/ not smart enough/ can’t do it/ never going to get what I want.” Most of the time, we don’t notice our thoughts because they act like a continuous inner dialogue, our brain’s voice sort of narrating things as we live life. We don’t usually stop to reflect on this narration– we just take it at face value, as a fact of life, and keep going on with our days. This isn’t always a big deal, but it can get messy when our brain’s little narrator voice is saying stuff that’s bullying, judgmental, or not serving us in some other critical way.

When we have a particularly troubling or unpleasant thought, we sometimes get “hooked” on it.  For many of us, it’s usually fears, worries, areas of insecurity, or that growing to-do list. When thoughts of this flavor come up and start to bug us, that’s where the mindful pause is helpful. If you can slow down and go to that trippy “meta” place where you notice yourself interpreting the words your brain is saying to you, you can step away from all of those subconscious associations between words and their meanings and instead see them as just words.

This is an example of what happens when a thought is mindless: the brain-voice says “You look stupid today,” and you instantly, automatically react, sometimes in the form of a flurry of additional thoughts (“ugh, I always look like such a mess,” and “I hope I don’t run into anyone I know”), feelings (self-conscious, embarrassed), and/or memories (of a time when you felt more confident in your appearance, for example).  Here is what happens when a thought is mindful: the brain voice says “You look stupid today,” and we start to react but then notice what we’re doing and SLOW DOWN for a second. Maybe you say back, “that’s an interesting thing to say, brain, what’s up with that?” or maybe “that’s one thought, what’s another one? What else do you have for me?” And see if the brain gives you anything else. If the brain voice doesn’t come up with any new material, we can start to more intentionally repeat it over and over until it loses meaning. If you say “I look stupid” enough times, you realize you’re just saying words, and okay, so what does it really mean then, if the words are true? How can you be SURE? Why do you care? What do you want to DO about it?

As a side note, mindlessness (and mindFULness) applies similarly to how we experience emotions and behaviors, but I will save that little ramble-fest for another time.

Given all of this, that old playground chant of “sticks and stones may break my bones, but words can never hurt me” seems incomplete. Of course words can be hurtful, who are we kidding here? But only in certain contexts.  Stupid is just a word. And words are just sounds that we put together to mean something. But when we slow down, we don’t have to mindlessly go with those meanings. Perhaps we should be teaching kids that sticks and stones may break my bones but words can never hurt me because I choose how much I buy into their intended meaning.  Less catchy, but more accurate! What does your brain-voice say about that?

 

If you had a weird rash, you’d go see a dermatologist… right?!

I feel such a mixture of puzzlement and sadness whenever I think about our country’s minimization of mental healthcare.  It’s funny (but no one’s really laughing here…) because so many of us are self-proclaimed “health nuts” who value wellness and want to live happy, fulfilling lives.  However, the reality is that many people, somewhere along the way (probably early in life), learned that when you feel a certain type of way, you “should” be able to change it or simply will yourself to feel differently.  And if you aren’t able to do that, you must not be “strong enough,” right? If you can’t just flip the figurative “switch” in your own brain and motivate yourself out of a difficult emotion, something is “wrong” with you, according to this belief system.  We therapists are here to remind people how warped and self-destructive that view can be. Let me explain…

When someone has a heart disease, you don’t say to them, “just stop having heart disease!” If you did, they’d either call your bullshit or, if they were a little more trusting initially, they’d sure find out pretty quickly that your advice is bogus! Without a real understanding of the healthy lifestyle choices and behavior changes necessary to improve cardiovascular health, a person cannot heal.  That’s why cardiologists exist. Sometimes, something more is required, maybe a medication or medical intervention.  Without the open-mindedness to see that something needs changing and the willingness to do what it takes to change it, we cannot heal.

Of course, we like to convince ourselves otherwise because change is uncomfortable.  But the discomfort of facing the pain is usually nothing compared to the fancy mental tricks we play on ourselves to try to avoid facing the pain. I’ll be writing more about this in a future post, on the ACT concept called “experiential avoidance,” but it pretty much goes like this: If I have a toothache and I don’t go to the dentist because I’m afraid of the pain that might come with the drill, I’ll have a toothache indefinitely… and it probably will end up getting worse and causing more problems down the road. Plus, on top of having the tooth pain, I’ll also have the fears and worries that come along with ignoring it. So not only have I not “solved” the problem of my toothache, I have also made the problem a bigger and more central part of my daily life.

Pretending something doesn’t exist has never worked out when it comes to our health, whether physical, mental, or spiritual. Let’s make it okay to seek treatment.

The Mental Health Association of Greater Chicago (MHAGC) is an organization that basically counteracts the logic of “just get over it” by raising awareness of mental health conditions and working to decrease stigma.  I think what’s coolest about MHAGC is that they intervene early with 9th graders to help educate them on mental health at the same time they are learning about physical health in school. I hope this will help reduce bullying in high schools by making kids more sensitive to mental health issues.  I also believe learning about conditions such as depression, bipolar disorder, and anxiety disorders can teach kids to recognize when they themselves might be struggling, and make it okay to seek help.  MHAGC’s first-annual “Breakfast with the Stars” will be held on Wednesday, November 11, 2015, Veteran’s Day.  To learn more about their powerful initiatives, or make a donation, visit http://www.mentalhealthchicago.org/mhagc/

Don’t you wish you had learned as a child that it’s normal and human to experience emotional pain, and that if it becomes overwhelming, you don’t have to go through the pain alone? I know I do.

If you are struggling or if someone you know is struggling, please visit the pages on this website to learn more about my practice and who I treat.

Welcome to my practice!

Mindfulness means purposefully paying attention- without judgment- to what’s happening in the present moment, according to Jon Kabat-Zinn, a psychologist who developed Mindfulness-Based Stress Reduction.  What I love about this definition is that it encompasses what Kabat-Zinn calls the full catastrophe of life. We tend to focus on the stuff we want to change, ruminate on the past, or anticipate the future. Many of us have a hard time slowing down and taking it one breath at a time.  Life involves the full catastrophe of experiences… it’s sometimes hard, sometimes easy, sometimes fun, sometimes painful… it’s oftentimes all of these adjectives rolled into one experience.  And it’s easy to get stuck in the rough patches.
Do you ever feel like a hamster in one of those silly wire hamster wheels, constantly running and watching the wheel spin faster, yet feeling stuck and unsatisfied? I know how overwhelming it feels to get lost in life’s messy complexities. It’s easy to forget that we humans are strong, brave, and resilient beings, capable of growth and change. When we get caught up looking for answers and solutions, we feel hopeless. I will join you in facing the challenge of letting go of the search for “answers,” in favor of finding freedom and fulfillment in life.
I am warm and authentic, and I treat you as the expert on yourself. I’ll meet you with curiosity and compassion. My style is integrative, and I am intentional about determining the best fit for your unique needs. My philosophy is rooted in Acceptance and Commitment Therapy.
I’m not one to sugarcoat, nor will I minimize your challenges. I hope to help you tune into yourself, and live a fulfilling, enriching, and meaningful life.
Check out the pages above to learn more about me and the services I provide.  Whether you are looking for individual therapy, group support, or testing and evaluation to confirm a diagnosis or get accommodations for a disability, I am here to help you move towards greater health and balance.
https://therapists.psychologytoday.com/248977