When I was a girl, my doctor mother taught me to be kind. When she left the house in the morning, she would say, “Your assignment today is to help someone,” and when she returned at night, she would ask, “What was your good deed for the day?”

My grandmother told me that our job was to leave the world a better place because we lived in it. Our small-town’s library’s shelves were stocked with books about good little girls and inspirational adults. And our Methodist Church, the church of the early abolitionists, taught that our salvation came from good works. In short, I received a big dose of training in compassion and responsibility. Many of us were raised this way.

This guidance was easier to follow in the 1950s in the small society of Beaver City, Nebraska, with its 400 people. We had only our local weekly paper and Look magazine to give us information about the world at large. We didn’t have television or computers; we mostly had conversations and stories from people we knew. Now, when I have access to the news of about 8 billion people, it’s much harder to be kind to everyone.

My heart breaks for the migrant children now excluded from Head Start, the starving people of Gaza, and the innocents imprisoned in El Salvador or Alligator Alcatraz. I feel sadness for the Haitians and South Sudanese in lawless countries, and for the citizens of Myanmar, Tibet, and North Korea. And I worry about the planet itself with its climate change and constant weather-related disasters. I mourn the loss of bees and monarchs and the near extinction of polar bears.

Most of us are traumatized by our 24/7 news cycle. Humans were not designed to absorb this amount of information. Nor were we designed to ignore suffering. We evolved to respond to what we could see and touch.

Compassion is the building block for understanding our human family. Without it, we’re imprisoned on the small, lonely island of self. Without it, all our relationships are exploitive and transactional, and we have no ability to love. Psychologists know that what makes humans happy is the high quality of our relationships. Happy people are loved and loving. Truly enlightened people know we’re all brothers and sisters and that, unless we learn to get along, we’ll perish.

I like this Buddhist prayer that includes all living beings: May all beings everywhere, with whom we are interconnected, be awakened, fulfilled, liberated and free. May there be peace on earth and throughout the universe and may we all complete the spiritual journey. Really, this prayer is ecumenical. All great religions teach us to be kind.

Thich Nhat Hahn managed to carry the tragedy of Viet Nam with an incredible lightness of being. Buddhist teacher Joanna Macy encouraged her followers to open their hearts fully so that all the world could rush in. I admire this idea, but I find it a challenge. The pain and grief I know often exceeds the carrying capacity of my heart.

Action is the antidote to despair. Empathy plus action gives us hope. Yet we cannot always act on behalf of those who are suffering. Empathy without action leads to despair. This awareness of the suffering is stored in our bodies. We struggle to find a solution for this complicated pain.

People try to cope with the constant bombardment of upsetting information in all kinds of ways—by psychic numbing, by using drugs and alcohol, by zoning out on television and computer games, or by exploding into anger. Others find ways to be of help.

We all have a causal scope, which is the area within which we have agency. My causal scope includes the people in my family and my town. Just as in Beaver City, I have a reasonable number of people I can help. So do you, dear reader. We can still manage to do a good deed every day and strive to make the world a better place because we lived here.

Both Joanna Macy and Thich Nhat Hahn devoted their lives to worldwide organizing. Macy traveled the world to form groups that do what she called “the work that reconnects.” Thich Nhat Hahn founded The Order of Interbeing and created a community called Plum Village. He spent his life working for peace.

We can increase our causal scope by joining a group. When we work with others, we can tackle more complicated problems than those we can tackle alone. Group work inspires us and allows us to progress toward the largest of goals. We won’t be able to improve all situations, but we can have an impact on the environment, democracy, social justice, and peace. Groups make us feel more hopeful and less alone.

Our pain for the world doesn’t mean we can’t be happy. In fact, it’s critical that we balance our sorrows with our joys and that we find enough love in the world to balance out the cruelty. The greater our suffering, the wilder and more ecstatic should be our dance.

We can arrange our lives so that we have good daily, weekly, monthly and yearly habits. With attitude and intention, we can build a good day. Every morning, we can set our intention to look for joy, humor, or opportunities for gratitude. Every day, beauty and kindness rain down all around us. If only we pay attention, we can see the luminous everywhere.

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At Psychotherapy Networker, we make it our mission to create space for clinicians to be humans—with their own stories and raw, unvarnished pain. In that spirit, at our annual Symposium, we host an intimate evening of storytelling, where we take in the exquisite vulnerability inherent in our shared humanity. This year, grief specialist David Kessler told a version of the story below about his own grief journey after the tragic death of his son.

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In 1969, Elisabeth Kübler-Ross identified the five stages of dying in her groundbreaking book On Death and Dying. As a psychiatrist, she saw that patients who were dying appeared to go through common experiences or stages. Her work captured the world’s attention and would forever change the way we talk and think about death and dying.

Decades later, I was privileged to have been her protégé, friend, and coauthor. In the second book we wrote together, On Grief and Grieving, Elisabeth asked me to help adapt the stages she’d observed in the dying to account for the similar stages we’d observed in those who are grieving. The five stages of grief are denial (shock and disbelief that the loss has occurred), anger (that someone we love is no longer here), bargaining (all the what-ifs and regrets), depression (sadness from the loss), and acceptance (acknowledging the reality of the loss). There’s nothing easy about this final stage. It can be extremely painful, and acceptance doesn’t mean that we’re okay with the loss, or that the grieving process is now officially over.

These stages were never intended to be prescriptive, and this holds true for both dying and grieving. They’re not a method for tucking messy emotions into neat packages. They don’t prescribe: they describe. And they describe only a general process. Each person grieves in his or her own unique way. Nonetheless, the grieving process does tend to unfold in stages similar to what we described.

In the years since that book’s publication, I’ve experienced a great loss myself, and I can confirm not only that the five stages really do capture the feelings we experience as we grapple with the death of loved ones, but that there’s actually a crucial sixth stage to the healing process: meaning. This isn’t some arbitrary or mandatory step: it’s one that many people intuitively know to take. In this sixth stage, we acknowledge that although for most of us grief will lessen in intensity over time, it will never end. And we come to understand that through meaning, we can find more than pain.

When a loved one dies, or when we experience any kind of serious loss—the end of a marriage, the closing of the company where we work, the destruction of our home in a natural disaster—we want more than the hard fact of that loss. We want to find meaning. Loss can wound and paralyze. It can hang over us for years. But finding meaning in loss empowers us to find a path forward. Meaning helps us make sense of grief.

What does meaning look like? It can take many shapes, such as finding gratitude for the time we had with loved ones, or finding ways to commemorate and honor loved ones, or realizing the brevity and value of life and making that the springboard into some kind of major shift or change.

Those who are able to find meaning tend to have a much easier time grieving than those who don’t. They’re less likely to remain stuck in grief. Because ultimately, meaning comes through finding a way to sustain your love for the person after their death while you’re moving forward with your life. That doesn’t mean you’ll stop missing the one you loved, but it does mean that you’ll experience a heightened awareness of how precious life is.

All that said, nothing in either my personal or my professional life as a grief specialist had prepared me for the loss I experienced with the death of my 21-year-old son. This was a loss so shattering that despite all the years I’d spent helping others through their grief, I didn’t know if there was anything that could assist me through my own. And despite my awareness that the search for meaning is one of the keys to healing from grief, I didn’t know if there was any way I could find meaning in this loss. Like so many others who grieve, something in me felt that my grief was too great to be healed.

In 2000, I’d adopted two wonderful boys from the Los Angeles County foster care system. David was four years old and his brother, Richard, was five. By that time the two of them had been in five different foster homes and had one failed adoption. Addiction in their family background had hindered their permanent placement, as had the fact that David had been born with drugs in his system. When I heard that, I feared that it might mean something was wrong with him that wouldn’t be fixable. But it only took looking at the faces of those two little boys to tell me that love conquers all. The adoption went through, and in the years that followed, my belief in the power of love appeared to be confirmed. David and Richard both made an amazing turnaround and were wonderful kids.

Unfortunately, the trauma of David’s younger years came back to haunt him when he became a teenager. At around 17, David began experimenting with drugs. Luckily, he came to me not long afterward and told me he was addicted and needed help. In the next few years, our lives were filled with rehab and 12-step programs. By the time he was 20, however, he was sober, in love with a wonderful woman who was a recent social work graduate, and entering his first year in college. David had shown a real interest in following a career in medicine, and I felt hopeful. But then a few days after his 21st birthday, he made some typical relationship mistakes, and he and his girlfriend broke up. That was when he met up with a friend from rehab who was also having a tough time, and they used drugs again. The friend lived. David died.

I was across the country on a lecture tour when I received a call from Richard, sobbing that his brother was dead. In the months that followed, I was in an agony of grief. Fortunately, I was surrounded by friends and family who saw me not as a grief expert, but as a father who had to bury his son.

My friend Diane Gray, who headed the Elisabeth Kübler-Ross Foundation at the time and is a bereaved parent herself, told me, “I know you’re drowning. You’ll keep sinking for a while, but there will come a point when you’ll hit bottom. Then you’ll have a decision to make. Do you stay there or push off and start to rise again?”

What she said felt true. I knew in that moment that I was still in the deep end of the ocean, and I also knew that I was going to have to stay there for a while. I wasn’t ready to surface. But even then, I felt I would continue to live, not only for the sake of my surviving son but for my own sake as well. I refused to allow David’s death to be meaningless or to make my life meaningless, but I had no idea what I would do to wrest meaning from this terrible time.

At first, I wasn’t able to find any consolation in memories of my love for my son. I had a lot of anger at that time—at the world, at God, and at David himself. But in order to go on, I knew I’d have to find meaning in the grief I was feeling. In my deep sorrow, I thought about a quote I share at my lectures: grief is optional in this lifetime. Yes, it’s true. You don’t have to experience grief, but you can only avoid it by avoiding love. Love and grief are inextricably intertwined.

As Erich Fromm says, “To spare oneself from grief at all costs can be achieved only at the price of total detachment, which excludes the ability to experience happiness.”

Love and grief come as a package deal. If you love, you will one day know sorrow. I realized I could have skipped the pain of losing David if I’d never known and loved him. What a loss that would have been. In the moment when I really began to understand that, I found gratitude for my son having come into my life and for all the years I got to spend with him. They weren’t nearly long enough, but they’d changed and enriched my life immeasurably. That was the beginning of my being able to see something meaningful in my grief.

As time goes by, I’ve been able to keep finding deeper meaning in David’s life as well as in his death. Meaning is the love I feel for my son. Meaning is the way I’ve chosen to bear witness to the gifts he gave me. Meaning is what I’ve tried to do to keep others from dying of the same thing that killed David. For all of us, meaning is a reflection of the love we have for those we’ve lost. Meaning is the sixth stage of grief, the stage where the healing often resides.

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The words interpersonal neurobiology don’t exactly roll off the tongue—and for most people, they’re even harder to parse. So it’s only natural you’re feeling some trepidation as you prepare to watch Dan Siegel’s recent Symposium workshop, “Temperament, Attachment, and Personality: Individual Development through the Lens of Interpersonal Neurobiology.” Maybe you’re wondering whether this brainy-sounding training is yet another attempt to scientize the beautiful, heart-centered, and often nebulous work of therapy. You wouldn’t be wrong, but you also wouldn’t be right.

Sure, Siegel is a Harvard-trained psychiatrist, a former clinical professor of psychiatry at UCLA’s School of Medicine, and the author of books like Brainstorm, The Developing Mind, The Yes Brain, and The Whole-Brain Child. But before you think you’ve got him figured out, just give this workshop a few minutes. Chances are you’ll be surprised.

“I’d like this experience to be as immersive as possible,” he tells the audience moments after walking onstage. “I want the material to be something you feel into, not just think about. We’ll be doing some things that aren’t my usual. We’ll be going on a journey.” Intrigued yet?

There’s a reason why Symposium staff refer to Siegel as “The Keynote Machine.” He’s undeniably brilliant and accomplished (after all, he’s written five New York Times bestsellers), but he isn’t slick, stiff, or pontificating. And he isn’t squirrely or neurotic the way you might expect from someone of his intellectual stature. Rather, he’s warm, gentle, and unassuming. He speaks slowly and intentionally, as if channeling the spirit of Fred Rogers—with a hint of Bill Nye the Science Guy. As comedian Chelsea Handler—who personally chose Siegel to be her therapist—will attest, he can also be deceptively witty.

“If you were born into a body, then you have a nervous system,” he says. “And that shouldn’t make you nervous! Now if you’ll reach under your chair,” he instructs, “you’ll find a take-home model of the brain. Reach down and pull your hand out,” he says, making a fist, “and you’ll find attached to your wrist is … a hand! This is your own model of the brain.” The audience laughs, and Siegel proceeds to break down the different parts of his fist-brain, including the top part, the limbic area. “This is the part that’s always learning, learning, learning,” he says. “And if I do my job right today, hopefully this part of your brain will grow.”

The Ghost in the Machine

As the workshop continues, Siegel walks through temperament (“a feature of a child present at birth, not learned through experience”) and personality (“enduring patterns of emotion, thought, and behavior that persist across all situations and stages of life”). But just as you start to wonder what any of this has to do with therapy, the revelation comes: when you understand the machinery under the hood, Siegel says—the things that science can explain—you get a little bit closer to understanding the things it can’t, like the invisible, connective energy that exists between lovers, friends, or family, or between a therapist and client in a moment of shared discovery. This connection, Siegel says, is the interpersonal half of interpersonal neurobiology—and a function of the mind.

It’s here that the essence of Siegel’s workshop begins to come into focus—and it’s also where he diverges from the scientific establishment. “For more than 30 years, I’ve been trying to translate the science for clinical application,” he says, “but also explain that the mind is not just the brain.” This was especially controversial during the ’90s, known as “The Decade of the Brain” and the heyday of the pharmaceutical industry, and he was chided by many colleagues who insisted that “relationships don’t matter unless we’re talking about the genes.” But Siegel was, and remains, undeterred. “It’s an error to say the mind is a synonym for brain activity alone,” he says. “So hopefully you realize that as therapists, you’re specialists in both the embodied and relational mind.”

Whether you call it rapport or the therapeutic alliance or something else, this invisible force that materializes between the therapist and client—perhaps the most vital element in successful therapy—can’t really be explained or measured. And therein lies the problem: 25 years after The Decade of the Brain, our field still puts a premium on processes that can be objectively measured. Manuals, diagnoses, and evidence-based treatments certainly have their place, but have we assigned them too much value? And if so, at what cost? Even if you believe the key to healing is something elemental and mysterious—a function of the mind, as Siegel contends—would you openly admit this to your clients and colleagues? Or would you hold your tongue to maintain the appearance of “credibility”? This is what makes Seigel such an excellent advocate for this invisible force: he can sway the naysayers with a little science—and once they’re listening, guide them toward the heart of healing.

Thirty minutes into the workshop, Siegel begins to make this pivot. As he’s breaking down human development—the meeting of the sperm and the egg—his voice softens and slows. “Two halves become one,” he says. “Just feel into that. Two halves become one. Of all the many sperm and all the many eggs, that’s a miracle. Of all the infinite possible combinations,” he continues, extending a cupped hand toward the audience, “something happened from this vast sea of possibility, which is you. You are … a sacred being.”

The tone in the room is different now. Some audience members nod their heads; others give a knowing Mmmm—in that way that therapists often do. Siegel continues. “This miracle that is you—and I don’t want to shock anyone with this one—gets about a century to live.” You start to wonder where Siegel is heading with this, and then his voice begins to crack.

“Twelve weeks ago, when the fires were erupting in Los Angeles, my mom had to be evacuated from her assisted living home,” he announces. “The air was terrible, and two days later, she died from a lung complication at age 95. She died peacefully, surrounded by everyone she loved: her kids, her grandkids, and her two dogs. She had a smile on her face before she passed away,” he continues, “and as she looked at us, her last words were, ‘You’ve all been so wonderful.’”

It’s an unexpected, bittersweet disclosure. Several audience members let out audible, empathic sighs. But Siegel keeps moving. He shares how he recently attended a friend’s memorial service, where he heard a song that not only made him think of his mother, but lingered with him long afterward.

“My growth edge is to try to do things that are new and uncertain and filled with fear, so now I’m going to sing it to you,” Siegel announces, raising a finger. “Actually, I’m going to teach you the chorus, and we can sing it together.” More than a few audience members exchange sidelong glances. After all, this is a conference workshop. Singing feels a little out of place. And what does a song have to do with therapy, anyway?

The Measure

This song, Siegel tells the audience, is called “The Measure,” by Bob Sima. “Not only is it amazing,” he says, “but it’s totally relevant to what we’re learning about today. Mom got about a century to live, and many of us will get even less. So what are you going to do with it? With this wild and precious life? That’s what this song is about.”

Siegel takes the microphone with both hands. “Inside this body called Dan, I’m incredibly anxious,” he confesses. “I have no training as a singer. I can’t sing on pitch, and I’ve never sung in public—not even in front of my family. I make sure the door is closed and the shower’s running. But I’m going to sing this with you.” He closes his eyes, takes a deep breath, shakes out his shoulders, and begins:

Tell me what is the measure

Of a life well done?

Tell me how do you count

An uncountable song?

A collection of your minutes,

Your hours and your days,

The number of heartbeats, breaths,

And the lines on your face.

Siegel keeps going, pinching his thumb and forefinger together to accentuate the final notes. The audience is silent, seemingly moved and entranced. Then, he pauses.

“You know, at the end of life you have nothing more to give because your body has given out, and you have nothing left to receive, and the symbol of that is your empty hands. So here’s the chorus.”

When your hands are empty

And your heart is full,

And you can smile on your very last day,

There is nothing you need to measure

And nothing you need to say

And nothing to take with you

But what you have given away.

Siegel repeats the chorus—a bit slower this time—and invites the audience to join him. The sound fills the room, gentle and melodic. The notes are a little sharper now, refining Siegel’s tune, and his face lights up with a smile as he lets the audience carry the rest of the chorus alone. Suddenly, you realize what’s happening. Between their rapt attention and Siegel’s nerves fading into a smile, brains are stirring. Pleasure and learning centers are lighting up, secreting cortisol, then endorphins, then serotonin and dopamine. But something else is happening too, a timeless and beautiful call and response that humans have been performing since the dawn of civilization. This, you realize, is what Siegel was talking about all along: this is the invisible force, it’s connection in real time.

Siegel shifts to another verse:

In the final-hour curtain call,

Did you sing the song you came to sing?

It’s the thoughts and the words and the actions you choose.

It’s paying it forward and speaking your truth.

It’s a call to love a little deeper, and kiss just a little bit sweeter.

Then, with just a sweep of Siegel’s hand, the audience sings the chorus once more before Siegel sings the final verse:

You’re an accumulation of the lives that you touch.

You’re a celebration of the wind and the dust.

You were put here for a reason.

Be of service and be a beacon.

“Was that okay?” he asks.

The audience erupts into applause, and Siegel brings a hand to his heart. “Thank you for singing that with me,” he says. “That song plays in my head every day. It’s about getting interpersonal neurobiology out into the world,” he explains. “We’re relational beings, and in our work as therapists, if we can help our clients—and our inner selves, too—achieve what Bob Sima is saying, then we can smile, like my mom did, on our very last day. We’re all going to die one day, so why not die with dignity? That’s what we’re trying to help people do.”

Truth, Inside and Out

Several weeks after his Symposium workshop, Siegel is still metabolizing things. Not just what unfolded that afternoon, but the confluence of it all: his mother’s passing, his life and work, the role of therapists, the gifts and limitations of science, the mysterious energy that connects us all, and the song that helped him put his thoughts and feelings and call to action into words. “My work has always been about trying to seek truth,” he says, “and that song is full of truth.”

A scientist with a poet’s heart, who’s unafraid to muse on the mysteries of the mind and human connection, Siegel’s internal compass has always seemed to point toward the truth. But even now, he seems to be working toward a truer version of himself, a version that thinks and acts more intentionally about what it means to live a life fully and well. He confesses that his decision to sing “The Measure” wasn’t always part of his agenda, but the night before the workshop, he had an epiphany.

“I realized I should walk the talk and show what a growth edge looks like,” he says. “Sometimes as a professional, you feel like you’re supposed to take a neutral, objective, professional stance. I certainly know how to do that, being trained as a scientist, and I can teach that way too. But I think we need to be more than that. When I got onstage, I didn’t just want to be present as an intellectual. I wanted to be present as a person.”

For now, some truths, like the intangible connections that unfold in therapists’ offices, or on hospital beds, or in conference rooms, will remain a mystery. And it’s just as likely that the field will continue to chase interventions that can be measured and proven with numbers and data. But just because something can’t be seen under a microscope—like the wetness of water, Siegel says—doesn’t mean it’s not there. That energy is a very real, scientific thing, he explains. “It’s the feeling of being alive.”

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Jeannette, my first therapist, is staring at me—and has been for longer than feels comfortable. I reach into my purse, pull out my Marlboros and a yellow Bic. “Is it okay to smoke?” It’s 1980, after all. She nods silently and passes me a mosaic ashtray. I light up, inhale, and try not to fidget. The room is still. I shift in the chair, which feels enormous—like my father’s recliner when I was a kid. The leather swallows me.

I fixate on the tissue box. I’m not crying, but I’m already plotting my route to it. How many people sit here and sob every day? Does she make weekly tissue-box purchases? Why isn’t she talking? I glance at the clock. 4:07 p.m. I look at her. Perfectly composed, like a portrait that hasn’t quite dried. No expression, no smile, no head tilt. Hair in a ponytail. Giant tortoiseshell glasses. Her beige cardigan, plaid skirt, and practical pumps match her uptight demeanor. She looks like a school librarian moonlighting as a minor court judge.

We’ve been sitting in silence for what feels like an hour, surrounded by books by all the psychological heavyweights—Jung, Piaget, Freud, Rogers—all staring down like they’re grading me. I wonder if I’m failing. I’ve read most of them already, imagining a future where I’m the one sitting in the other chair—her chair.

“I guess you’re waiting for me to talk,” I say. No reply. Just more quiet staring. God, this is awkward. Is she even allowed to talk? Is she writing notes in her head? Does she think I’m already too far gone? Do I start with my boyfriend or my mom? I glance at the door. It feels both too far away and dangerously close. I imagine standing up, grabbing my purse, mumbling, “This isn’t for me,” and disappearing down the stairs.

But I stay. My face is hot. My heart pounds. A familiar panic rises—the feeling that maybe I’m too much, too messy, too broken to be helped. What if she’s already given up on me? I’ve barely said anything, and already I’m unraveling. A sob ambushes me. Tears mix with mascara and electric blue eyeshadow. I reach for the tissue box. Still, she says nothing. I want her to rescue me. To say something. But she doesn’t. And something in me snaps. I’m angry. How dare she sit there like some blank screen while I’m falling apart? I’m not a puzzle for her to simply contemplate. I’m a person—crying, reaching—and she can’t even offer me a nod? I glare at her through the smoke. I want to ask, “Do you enjoy this? Watching people squirm until they break open?”

After a few months, I begin to like her—and the therapy starts to work. We meet every week for a year. As I talk things through out loud, my confidence grows. With her quiet nods and occasional questions when I get stuck, I start making my own connections. I can see myself in this chair, figuring out my life, for a long time. Then one day, Jeannette says, “I think you’re done.” I’m stunned—and furious. I beg her to let me stay. “Please don’t end it yet. I’m not ready to be done.” She gives me a quiet smile. “You’re ready,” she says. In truth, I never wanted it to end.  And maybe she’s sensed my growing dependence. That’s a thing in the field, at this time: “don’t let your clients rely on you too much.”

Time moved on. Fifteen years passed. I got married, had children, and earned my MSW. I started out at an agency, then found a private practice that gave me the flexibility to see clients while raising a family. Life was busy, and I didn’t give myself time to reflect on my own happiness. My husband and I spun around each other, both of us busy co-parenting and volunteering at our Synagogue, but rarely did we find time for each other.  I felt a steady undercurrent of tension and loneliness. In spite of it all, I kept going—packing lunches, carpooling, managing a household—afraid to look at the truth, which was that I was miserable. I’d chosen a partner who couldn’t receive my love, rejected gifts, and was constantly angry about money. Over the years, I’d lost myself while taking care of everyone else. Then one day, putting on makeup, I stopped—really stopped—and looked in the mirror. “I can’t do this for another 40 years,” I said out loud. That was the moment I knew I needed someone again—a therapist—to listen to me.

Claire’s office is in a small basement that feels more like someone’s den. I sit on a white rattan sofa with my legs pulled under me, a blue crocheted pillow in my lap. Soft lighting and plants surround me.

“What brings you to therapy?” she asks.

“I’m not happy in my marriage, and I’m terrified of what that might mean. I seem to pick the wrong men. I don’t know why I keep doing this.”

She gives me a small, knowing smile. “You keep choosing people who can’t meet you not because you’re broken, but because that’s what you’ve known. But patterns aren’t permanent.”

Immediately, I feel connection and warmth—like I’m home, at least for now.

Claire’s in in her early 70s. She’s got short white hair and wears jeans and a flannel shirt. Her casual approach is a marked departure from my first therapist. Over the course of working together, she offers me feedback and advice when I ask for it, and sometimes even when I don’t. She’s direct and interacts with me conversationally. We maintain an easy back and forth that helps me get clear about my marriage. She fully supports me in the face of the terrifying decision to get a divorce and my guilt about my children.

By the time she retires the following year, I’m navigating single motherhood while learning to hold my own therapy clients through their major life changes. Although I don’t return to therapy for several years, I often think of Claire and what she might say, especially as I begin to date.

After two years of online dating that never went beyond the first date, my parents introduced me to the son of their new friends.  We saw each other for over a year and things started to get serious between us. This time, I wanted to be sure I was making the right choice before a big romantic commitment. I wanted a sounding board. This time, I found Phillip.

As a therapist, Phillip is kind and fully present. We meet weekly in early spring on Tuesday mornings at 9 a.m. His office is in the country, and I enjoy the drive there as I pass old farms outlined with century-old stone walls. Phillip’s consulting room is modern and comfortable, with a long sofa and several chairs arranged around a rectangular coffee table. Past therapists had felt hierarchical, but Phillip’s approach is truly collaborative. He interacts with me as a client but also respects me as a colleague.

On Tuesday, September 11, 2001, I pull into a parking spot outside his office just as the news from New York broke over my radio. Planes are crashing into the World Trade Center. As I step out of the car, I see him waiting for me in the doorway of his office, a big smile on his face.

“Something bad just happened,” I stammer. A moment later, his wife joins us and confirms what I’ve just heard. We huddle together and cry.

We hold the weight of a changed world in our bodies as we part quietly. They reenter their house, and I get back in my car, drive home, and cancel my own therapy sessions. The next day, I begin seeing clients again, knowing they need someone who can remain steady and present with them through their confusion and grief.

Several weeks later, Philip and I have our last session. He’s shown me what it looks like to be fully present alongside whatever role we inhabit. We both agree that I’m done. And this time, I’m ready for the therapy to end.

In December, the man my parents had introduced me to, who’ d become my boyfriend, proposed, and we married soon after. By then, I’d gathered enough experience to understand what truly matters in my life—and what matters as a therapist for my clients.

I think about all the chairs I’ve sat in over the years, each one shaping the therapist I’ve become. Jeannette taught me how to sit in discomfort and let emotions rise. Claire taught me that warmth and wisdom can coexist—and that it’s okay to laugh through pain. Phillip taught me that presence can connect people in crisis, even more sometimes than words.

What I didn’t know then—but realize now—is that emotional availability isn’t the same thing as emotional connection. Reliability isn’t intimacy. And silence, the kind that once made me angry, can be a gift. It’s not usually indifference; often, it’s space. Space to think, feel, and be heard.

The truth is, no therapist ever gave me definitive answers—but each one helped me ask better questions.

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How do we support our clients in moving beyond limiting stories? How do we help them experience life’s rich complexity in the midst of what can feel like a never-ending barrage of emotional burdens? How do we help them focus on hard-to-face issues and make meaningful changes?

Here, some of the wisest souls in the world of psychology and psychotherapy share their answers to the biggest, most slippery questions we face—as therapists and humans.

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TARA BRACH: How Do We End Suffering?

Clinical psychologist and renowned Buddhist teacher sheds light on the shadow sides of therapy and the spiritual path.

IRVIN YALOM: How Do We Live Our Best Life?

Psychotherapy’s most famous storyteller believes we should focus less on symptoms and more on the great, timeless issues of freedom, meaning, and mortality.

EUGENE GENDLIN: How Do We Cultivate Wonder?

The developer of the mind-body approach Focusing highlights the value of tapping into the dynamic experience of the “felt sense.”

DANIEL KAHNEMAN: How Do We Change Bad Habits?

Nobel Prize-winning cognitive research psychologist explores the role of automatic responses in human thought, and just how instinctively unwise we can be.

***

A version of this article was originally published in March/April 2013.

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I entered psychiatry as many people did in the 1950s, seeing a traditional, Freudian psychoanalyst four times a week. She was older and had a suite of five offices, all of them rented by therapists she’d once analyzed. She was like a grandmother analyst, and I guess you could say I spent 700 hours being psychoanalyzed by my grandmother.

Looking back, it’s clear it wasn’t 700 hours well spent. In fact, it offered a good instruction on how not to do psychotherapy. Despite all the time and expense, we never dealt with any of the issues that came to seem to me more and more the central concerns of life in later years: mortality, freedom, the search for meaning, and our ultimate existential isolation.

Then in 1958, psychologist Rollo May came out with his book Existence and, suddenly, I saw there was a third way for psychotherapy—something that wasn’t biological or psychoanalytic, but a way of grappling with the great existential challenges of life. I decided to write a textbook to further explore this new, alternative pathway for therapists. To do that, I felt I needed to do something bold that nobody else was doing at that time: I needed to talk to people facing their own mortality close up.

My ordinary patients weren’t prepared to do that, so I asked the other professors at Stanford and the faculty in the medical department to send me their dying patients so I could talk with them. By then, I had quite a bit of group experience, so I started seeing these patients in groups.

That experience was extremely anxiety provoking, for me and my students. It was so poignant and moving to listen to people trying to cope with the idea that they were going to die shortly that I actually developed night terrors, and many of my students watching these group sessions from behind a one-way mirror often ran out of the room in tears.

Psychotherapy’s Biggest Challenge

The thing that’s most troubling to me about our field is the demise of training in the kind of psychotherapy that I’m familiar with. These days, I feel that I’m a bit of a dinosaur. I’m in a group of 11 other therapists, a bunch of white-haired therapists, all with full practices who have more patients than we can see. But there aren’t going to be people like us in the future. If somebody wants a referral to a good psychotherapist now, I’ve got to really strain to find one. I find myself thinking, “They’ve got to see someone with gray hair, because the young psychiatrists aren’t being trained to do depth psychotherapy—or really any kind of psychotherapy.” Cognitive-behavioral therapy has taken over.

Recently, I met with a bunch of group therapists who each led, on the average, five or six groups. That meant there are about 80 therapy groups represented in our little seminar, almost all of them short-term, behaviorally oriented. The emphasis was on imparting knowledge, teaching people about subjects like panic attacks or other anxiety symptoms, giving them exercises to work on, and doing manualized treatment. None of them was interested in helping people focus on how they came across interpersonally or how to solve other interpersonal issues. That’s sad to me.

Being 82

I’m a little bit mellower about facing my own mortality at this point. I don’t have the uprising terror and anxiety that I used to feel. The other day, somebody sent me a picture of the Stanford faculty in 1963. It was wonderful seeing all my old friends. I thought, “Oh, I’ll e-mail this to some other people.” Then I realized that almost everybody else in the photo was dead. That was a sad moment for me.

At this stage of my life, I’m finding that once you get your mind around the idea that death isn’t so far off, you can actually learn to live a little bit differently. My wife, Marilyn, is slightly younger—a half-year younger than I—and we’re enjoying our times together very much. Recently it’s been warm weather, and Marilyn doesn’t want to do anything but sit outside in the sun and read the newspapers with me. It feels so good. We keep making jokes saying, “I guess these are the Golden Years,” and they really are.

I learned a long time ago from my group of cancer patients that there are many people, even in the midst of this awful illness, who actually start to change in a positive way. They grasp that they’re going to die and begin to say, “Why am I spending time doing what I don’t want to do? Why am I seeing people I don’t want to see?” They begin to reexamine what’s really meaningful and what’s trivial in their lives; they start saying no to things they don’t want to do.

Once you fully realize that you really are mortal and that you’re going to die, you can come to appreciate life more fully. You don’t waste quite so much time striving for material goods. As German philosopher Arthur Schopenhauer said, if you strive for objects all the time, eventually, you don’t have them: they have you.

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As therapists, we train rigorously and passionately because we want to get better at easing other people’s suffering. We want to support and understand our clients in new ways so they can grow into their best selves. We don’t become therapists because we crave the spotlight or want to be recognized on the street for our massive social media following. And we certainly don’t become therapists to create Instagram reels between sessions, scroll through website templates, or distill a mission statement into a catchy logo or six-word tagline.

And yet, in today’s world, branding has become an essential tool for therapists who want to attract clients, build a career, and even shape the cultural conversation around mental health. Time magazine’s most influential people list includes psychiatrists Vikram Patel and Bessel van der Kolk, and psychotherapist Esther Perel has been named to Oprah Winfrey’s list of visionary leaders. Even though developing a brand may feel uncomfortable and overwhelming to many introverted therapists, few can opt out of it entirely.

To help, we asked nine successful mental health practitioners about the most powerful steps they’ve taken to brand themselves—and learned that great branding can be counterintuitive. So don’t be surprised if you’ve never heard advice like this before.

SAHAJ KAUR KOHLI: Go Public with Your Story

The founder of Brown Girl Therapy shares her countercultural secret to building an online community.

NEDRA GLOVER TAWWAB: Keep Social Media Simple and Real

One of the world’s most popular Instagram influencers offers her evolving take on social media.

ALEXANDRA SOLOMON: Collaborate Wisely

After landing a Masterclass series, a renowned relationship expert shares her hard-won formula for discerning what projects to accept and which to turn down.

TERRY REAL: Find the Right Mentors

The developer of RLT recounts the surprising path he took to write his first bestselling book.

SARA KUBURIC: Tell the Truth—Even When It’s Hard

The Millennial therapist who took social media by storm shares what sets her apart from other influencers.

VIENNA PHARAON: Let Changing Priorities Shape Your Focus

Bestselling author and podcaster shows you how less can be more in branding.

DENÉ LOGAN: Be Willing to Challenge Norms

Popular podcast host and author reveals the key she discovered to showing up authentically in the public sphere.

ELIZABETH EARNSHAW: Do the Opposite of Branding

A renowned therapist, author and influencer challenges the popular wisdom behind branding yourself as a therapist.

MARIEL BUQUÉ: Align Your Brand with Your Mission

Trauma expert and author offers some key questions she used to bring meaning into branding a practice.

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One key thing I did to enhance my “brand” as a therapist was share my own story publicly.

I’ll be honest—this wasn’t an easy thing to do, nor was it supported by all my colleagues. As therapists, we’re trained to hold space for others, to listen, to be safe and nonjudgmental. The unspoken rule is that we should maintain a bit of mystery about who we are and what we’ve gone through.

Before becoming a therapist, I’d worked in media/journalism, so writing about myself didn’t feel particularly difficult. However, I was told early in my graduate program by an older professor to delete everything I’d written online about myself and even forgo building Brown Girl Therapy, the first and largest mental health community for adult children of immigrants (now at a quarter of a million people!), which was born of my early struggles as a child of immigrants.

Early in my counseling career, I was faced with difficult questions: What if being honest makes me seem unprofessional? What if I’m not allowed to be a therapist and share my story?

Thankfully, I had professors and mentors who supported my work and believed in what I was doing. After all, I’m a community member first, who identifies as bicultural, who’s navigating many firsts in my immigrant family, and who’s been in therapy on and off for a decade and takes antianxiety medication.

As a narrative therapist, I firmly believe that storytelling shapes the way people make sense of their lives. We all have a story we tell ourselves about who we are, where we’ve been, and where we’re going. But I’ve also realized something else: the stories we don’t tell, the parts we hide or skip over, often hold the key to our healing.

My vulnerability is what’s created connection in the enormous online community I’ve built, one that’s a bridge for so many of us who’ve been left in the margins when it comes to mental health care.  When I shared my story, beyond the confines of an individual therapist’s office, it became a conversation and a shared experience between lonely humans who didn’t see themselves—or their experiences—represented in the culture at large.

Since then, I’ve continued to be open about my mental health journey, most recently in my book, But What Will People Say?. Turns out, the parts of myself I thought were too raw or messy to share were what resonated the most with others. And far from being a hindrance to building my career, it’s made me a more authentic, relatable, and effective therapist.

For me, success hasn’t been about “branding,” but about showing up honestly and truthfully, and meeting the community—my community—where they are. The process has been humbling. I’m not the expert of other people’s lives, but by being more forthcoming about my own experiences, I’m able to help others live a little more well.

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I welcomed my second child into my life eight months ago, and it’s reshaped my relationship not just to my work, but to the way I think about “brand development.” We often hear that parenthood helps us develop the capacity to say no and get clearer on the things that are a wholehearted yes. That’s been true for me. Parenthood has helped me reshuffle priorities personally, socially, and professionally.

Branding and visibility have become less about numerical growth (such as getting more followers on social media platforms) and more about nurturing the people already in my life and practice, encouraging them to deepen their interest in the work I’m putting out into the world. Instead of chasing expansion, I’m focusing on depth and fostering richer engagement with the community I’ve already built—the clients I still see; the people who’ve read (or will read) my book, The Origins of You; my current followers on Instagram, and the people who’ve subscribed to my newsletter.

This shift has meant making some big decisions. I’ve said yes to fewer things, and been deeply intentional about what I take on. Now, I only step onto stages with people I respect and admire, recognizing that part of building your brand or your business is about allowing yourself to be influenced by others and to collaborate with those where reciprocal elevation is available.

One way I’m doing this is by co-creating a course with a friend and colleague called “Secure and Thriving: A Nervous-System-Based Path to Healthy Love.” This project feels expansive and aligned with my values, but also my bandwidth. There’s hard work involved, of course, but because I’m doing it within the context of a richly nurturing friendship, there’s also laughter, play, and fun. These kinds of sustainable collaborations have taken center stage for me, right now.

I’ve also made the difficult decision to see fewer clients. I adore working with people one-on-one, and in an ideal world, I’d still see 25-30 clients per week. But this chapter of my life requires something different. Instead of pouring all my energy into the therapy room, I’m channeling it into work that reaches more people while also allowing me to be present for my family.

This change hasn’t been easy. Friction accompanies shifts in identity, but friction and tension contribute to growth and expansion. I remind myself that evolving my brand doesn’t have to mean losing what I love—instead, it can mean reshaping it. Right now, my brand isn’t about more. It’s about meaning. It’s about creating with intention, collaborating with care, and building something that sustains not just my career, but my life.

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When I think back on what I’ve done over the years to grow my work as a therapist and my business—which includes my couples therapy practice, my writing, and my social media presence—I realize that I often did the opposite of what many influencers tell people to do.

Many influencers encourage therapists to grow their income and build their practice by charging for almost any service, including speaking engagements and consultations. But as my online presence has grown over the last decade, I’ve taken an approach that might be counterintuitive. I don’t charge for everything, and this has helped me grow my income. Even now, after writing books, cultivating a large online following, and creating a successful practice, I still agree to free speaking engagements, offer consultations to other practices at no cost, and do pro bono sessions.

Of course, we all need to make a living. However, I’ve found that there are often opportunities—like connecting with others and lifting them up or taking a meaningful speaking engagement—that are priceless in many ways. In fact, it’s often the unpaid events that have had the largest impact for my career, even years later.

When I first started my practice years ago, I sold almost everything I owned so that I’d have the money to rent an office space and buy a new computer. I spent many nights cobbling together a website and learning the nuts and bolts of SEO. I also did a ton of networking to grow my clinical skills. I reached out to supervisors I admired (paying for their services with credit cards I knew I wouldn’t be paying off for a while), and drove all over the country to learn from experts I felt drawn to and maybe take them out for coffee, just to pick their brain and share a little bit of who I was.

I also held free workshops for churches and universities and shared my therapy knowledge on Instagram (before it was a thing). I knew many people didn’t really understand what couples therapy entailed, and I wanted to demystify it. Since then, my Instagram account has grown to nearly 300K followers. I’ve founded A Better Life Therapy, a group practice dedicated to helping people improve their mental and relational health. I’ve also written several books for couples and developed my signature couples weekend intensives aimed at helping couples get through crisis.

There’s a lot of noise out there claiming that therapists wanting to grow need to brand quickly so that eventually they’ll create an easy life for themselves where they’re simultaneously doing important work, enjoying lots of free time, and making loads of cash. But I’ve found that when it comes to growing professionally, that’s the exception, not the rule. Instead, I think we should be willing to make sacrifices and stay open to opportunities. Fortunately, that’s been the formula for success for me, and I’m grateful for where I’ve landed.

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Not long ago, my heart leapt the moment I saw the email in my inbox from my talent agent. “Please be a TV show, please be a TV show,” I whispered to myself as I clicked. It was! A network was looking for a therapist … yes … for a new television series … yes … on a major network … yes … about nude psychotherapy … no.

I’ve been building my brand as a public-facing relationship educator and clinician for many years, and I’ve had to learn how to practice discernment regarding partnerships. At the start of this journey, I was so grateful for any opportunity to get my name out there that I said yes to everything.

“Want to be a guest on my podcast?” Absolutely!

“Can you write a 500-word article for my website?” Of course!

“Can you come speak to my group of 30 people? We don’t have the budget for compensation, but it’ll be great exposure.” I’ll be there!

As my platform grew, so did the number of inquiries I received. Soon, I was feeling overscheduled and on the road to burnout. I quickly realized that my inclination to say yes to everything was going to lead me to a point where I’d have to say no to everything.

To prevent this from happening, I use a simple formula to rein myself in. I like to visualize the formula as a triangle with a question in each corner. Corner 1: Is it financially lucrative? Corner 2: Does it expand my audience? Corner 3: Is it an inherently fun, rewarding, and/or meaningful experience? To qualify as a potential yes, it needs to hit two of the three corners.

You should know that I have a love-hate relationship with this formula. Just like a budget keeps you from buying everything that looks cute at Nordstrom, and just like a portion keeps you from eating a full sleeve of Thin Mint cookies, this formula keeps me from straining my neck from nodding yes too much. This formula is both good for me … and a total buzzkill.

The nude psychotherapy show was a clear no, but another opportunity I recently had easily hit all three corners: creating a new series for MasterClass, called MasterClass In Practice. My yes wasn’t just about their enormous audience (4.2 million on Instagram?!) or the fact that I’d be one step closer to meeting my icon, Gloria Steinem. It was also about an opportunity to do what I’m passionate about—teach people how to practice Relational Self-Awareness—on a scale I can’t possibly reach on my own. Being part of the MasterClass faculty is a BHAG (Big Hairy Audacious Goal) for sure, a peak experience built atop thousands of my Instagram posts, blogs, talks, books, and podcast and media interviews.

Had I not implemented this formula years prior, I wouldn’t have had the bandwidth to say yes to this incredible opportunity. I wouldn’t have had the time or the mental energy to put together a quality curriculum. Saying yes to too many okay things would’ve forced me to say no to the really big, incredible thing. As I continue to grow as a public-facing clinician and thought leader, the triangle formula ensures that I keep moving forward and let go of things that no longer serve me.

Still, it’s never a perfect journey. Each next step is a risk. You may say no to something that takes off, leaving you feeling like you missed the boat (been there!), and you may say yes to something that ends up being largely a dead-end. What I try to come back to again and again is that each risk is a learning experience that teaches me and readies me for what’s next. Regardless of what happens, I feel sure I won’t regret saying no to nude therapy.

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I’m a therapist, and my husband, Mike, just got certified as a life coach. He’s standing in front of me in the kitchen as I chop vegetables, reading me a letter from his coaching school’s CEO. It’s loaded with praise for having completed the program. You’re incredible. I’m proud of you. You’ve earned this. You’re part of a vibrant community that’s cheering you on.

“And here’s how it closes,” Mike says, pausing for a few seconds, either for dramatic effect or because he’s choked up and struggling to get the words out. “It’s time to change lives around the world. It’s time to serve.”

It’s time to serve dinner, I think.

“Kudos,” I mumble. “That’s great. I’m happy for you.”

The truth is, I’m not in the mood to celebrate anything, right now, especially his prospective coaching clients. I’ve been seeing therapy clients all day. One is struggling with chronic depression, which has worsened since he got furloughed from his job. An older couple is on the brink of divorce after one of them gambled away half their retirement savings. Another client’s mother has been diagnosed with early Alzheimer’s, and my client is overcome with ambiguous loss and grief.

Mike snaps the letter back into the white binder they sent him when he paid his tuition. It contains the coaching school’s policies and detailed protocols for leading structured, pre-planned sessions around nine core themes.

“Once I get my website up, I’ll start seeing a few clients, maybe from your office on your off-hours,” he says. “There’ll be a learning curve, but I know I can do this.”

“Yup, I’m sure you can,” I say, spraying a frying pan with oil.

“How about a little more enthusiasm?” He raises a hand for a high five.

I roll my eyes and tap his palm.

“Come on—you can do better than that!” Mike assumes a power position with his arms raised. This coaching thing has really gone to his head. “Give me a real high five.”

There’s no denying that something has changed between us. Ever since he decided to become a coach, I’ve been asking myself, Who is this man? Can I even trust him? It’s like I’m sleeping with the enemy now, professionally speaking.

“Fine, you want a real high five?” I mutter, swinging my arm back up over one of my shoulders. A moment later, when our palms collide, the ringing echoes through the kitchen like a clap of thunder. It takes a few seconds for the sound to fade out completely.

“That’s more like it!” he laughs, shaking his hand like it’s on fire.

“Well, you sure became a coach fast, I’ll give you that,” I say as the tingling in my own palm subsides. I return to chopping vegetables.

“Are you implying it was too fast?” he asks as he lifts a jug of water from the fridge. “I earned this certification, honey. We covered a ton of material. I was online from 8 a.m. till 6 p.m. for five days straight.”

Now it’s my turn to laugh.

“Five whole days. Wow! You must be wrecked. Maybe you should take a vacation.” Obviously, this isn’t my proudest supportive-spouse moment.

“There’s no need to get competitive about this,” he responds, filling both our glasses with water and depositing them on the dining room table alongside our forks and napkins. “You’re a therapist, I’m a coach—they’re completely different things.”

I push the vegetables off the cutting board into a pan. They sizzle.

“Do you remember how long it took me to become a therapist?” I’m sure he remembers, since we were living together at the time, but that’s not the point. I’m teeing up my argument. “First, I got a master’s degree, which took me two years. Then, I completed hundreds of supervised clinical hours, which took me another two years. That’s four years right there. How many days is that? Around fifteen hundred, I think—just slightly more than five. Oh, and then, I studied to pass an exam. Did you have to pass an exam?”

“I’m not sure why this upsets you so much,” he says.

“I’m not upset,” I lie, shaking the pan. “I’m annoyed.” A few chunks of carrot, zucchini, and onion flop onto the stove.

For years, I’ve been secretly convinced that the coaching industry would collapse like a housing bubble. Instead, it’s ballooned. Coaches are everywhere. They’re at dinner parties and pickleball meetups. They’re in buses and subways. They’re on For You Pages, in Facebook groups, and on neighborhood listservs. They’re eavesdropping on the sotto-voce argument you’re having over FaceTime in a coffee shop and preparing to offer you their Instagram handle so you can register for their communication skills mastermind program, get on their list for a bi-weekly newsletter, access their core training videos, and join their online community.

These coaches are versatile, eager, and creative. They’re unhampered by any overarching obligation to provide evidence-based treatment. Like divinities or secret agents, they go by many names: life coach, executive coach, leadership coach, health coach, decision coach, parenting coach, legacy coach, self-care coach, spiritual coach, transformational coach, pleasure coach, relationship coach, somatic coach—even, shamelessly borrowing therapist terminology, mental health coach and trauma recovery coach. They know how to lure clients off our caseloads and into casual discovery sessions. Therapists, the International Association of Trauma Recovery Coaching tells us on their website, “intervene at a deeper level to direct care, prescribe behavior, and make choices on behalf of their client. A coach never takes that much control over a client’s life. Guide and encourage, yes. Command direction, never.” After reading that description, who would you want to work with? The encouraging, nonintrusive, friendly coach or the probing, controlling, nurse-Ratchet therapist? Coaches are marketing geniuses who turn their artlessness into a competitive advantage. They’re savvy renegade healers, self-appointed modern-day shamans, resourceful urban sorcerers. They want—and get—results. They want—and get—clients who can pay them out of pocket.

Here’s the thing: I have nothing against coaches. I’ve hired a few myself, even when they’ve asked me to buy sessions in bulk and charged double what I charge my clients as a licensed therapist. One coach who loosely modeled his sessions after Byron Katie’s “The Work” helped me sort through some complicated reactions I had when my father left my brother and I out of his will (normally, I would’ve seen a therapist, but I was obsessed with Byron Katie at the time). A decade later, I met a “soul-centered” coach at a woman’s retreat who encouraged me to explore why I find the idea of God repellant. She helped me connect with my spirituality by interpreting seemingly random coincidences (like finding a heart-shaped earring in a parking lot) as signs of a loving consciousness tuning into me. My last coach was a friend and psychedelics guide who showed me how to trust my body and tune into its needs more often while taking tiny amounts of psilocybin daily (you can read about how I navigated those coaching sessions here.)

I fully embrace a world that contains more coaches, at least in theory. Why should therapists have a monopoly on helping people? Why should universities and graduate programs be the gatekeepers of healing? Different people need different kinds of help. Coaches are helpers. They’re down to earth and accessible, often more direct and hands on than therapists. You can text them between sessions about your wins without feeling like the boundary police are about to arrest you. Coaches jump into the trenches right alongside you to help you solve problems. They care. They’re passionate. They curse more than therapists do and they give it to you straight. Coaches are like smart, confident friends you can rent when your actual friends are busy doing other things—like building their coaching business.

But the truth is, I resent the way coaches have encroached upon our field. This is probably why my feelings toward Mike have gotten conflicted. Why do coaches get the instant gratification of focusing on achievable, future-oriented goals? Why do they get to divorce themselves from worrying about high-risk clients on weekends or getting stressed out over state reciprocity, ethical guidelines, and regulatory boards? How come when I give advice on the job, I’m a heretic who’s gone to the therapy dark side, but when coaches give advice, they’re “real” and “authentic”? Who gave them the right to throw around snappy jargon like solution-oriented mindset, branding your truth, and big picture vision?

I know I sound bitter. Maybe I’m suffering from compassion fatigue. I should probably seek out a self-care coach for a discovery call to see if they can help me develop a solution-oriented mindset and get clear about my big picture vision.

Mike lifts two bowls from a shelf and sets them on the counter. After spooning in some rice, I tip the pan and deposit our steaming vegetables on top. “Hey, I get it,” he says, putting his hands on my shoulders. “You’ve invested a lot of time and energy in your career, and then I come along and—presto!—I’m a coach after a couple of days. On some level, that must hurt.” He’s good alright; his coaching clients are going to love him. “But you know what I was thinking?” He picks up our bowls and carries them to the table. “There was this woman at our training yesterday—she was really knowledgeable—and when I told her I was married to a therapist, she suggested we combine forces. She said we’d make a great team. The best of both worlds!”

As we sit down to eat, I notice an expansive feeling in my chest. Maybe being married to a coach won’t be so bad after all. I picture us standing in front of a cheering crowd of people who’ve traveled from all around the globe to learn our ground-breaking approaches and techniques. Our retreat could be called something like “Therapy-Oriented Coaching” or “Coaching-Oriented Therapy,” and we could host it someplace scenic, Costa Rica or Portugal. We’d be like an older version of Vienna Pharaon and Connor Beaton, a powerhouse therapist-coach couple who do workshops in upstate New York. At the end of a learning module, before breaking for a walk on the beach or an Ayurveda treatment, we’d invite feedback from the crowd, and Mike would direct any questions about mental health my way. “That sounds like a question for my therapist-wife.” I could do the same for him: “How about you take this one, coach?”

I could also let my license lapse and become a coach myself.

Then again, the clients I saw earlier in the day—the one who’s chronically depressed, the older couple, and the one grieving her mother’s Alzheimer’s diagnosis—sought me out because I’m a trained therapist, not a coach. Therapy will probably never offer anyone—therapists and clients alike—a reliable sense of unambiguous satisfaction. It’ll probably always eschew quick fixes and seductive guarantees. In therapy, you can learn a range of approaches and techniques to create the conditions for healing, but you can’t force success. This keeps most therapists humble. Psychotherapy deepens our capacity for complexity and heightens our awareness of our own and our client’s humanity.

Mike hands me the soy sauce. I pass him the red pepper flakes.

“Anyway, I thought that was a nice idea.” Mike begins chewing.

“Uh-huh,” I say, taking a sip of water. “I guess anything’s possible.”

Maybe one day I’ll tire of the challenges that go with my job, but for now, along with the envy, resentment, and longing I feel about coaching, I’m proud of what I do.

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Although I’m widely known as the “millennial therapist” because of my Instagram handle, I’m also the author of It’s On Me and a spokesperson for Yves Saint Laurent Beauty’s recent “Abuse is Not Love” campaign—an initiative aimed at combating intimate partner violence. 

The reality is, I never imagined becoming a brand, and especially not one linked to voicing the hard, uncomfortable truths people sometimes need to hear. Confrontation makes me want to die inside—truly. My nervous system prefers I stay in my lane, avoid conflict, and, ideally, never have to say what someone might not want to hear. I’d rather swallow gravel than return a wrong order at a restaurant. And yet, somehow, I’ve built an entire career on the therapy equivalent of doing exactly that.

In every public offering, I’ve resisted the urge to wrap hard truths in an abundance of fluff until they lost their meaning. I don’t pat people on the back for merely trying, nor do I say things like, “You’re exactly where you need to be.” I speak my actual beliefs—directly, honestly, and with enough humor to soften the existential dread. And surprisingly, people don’t run away; they lean in.

Of course, there were moments I questioned whether I was doing it “right.” I remember a journalist requesting a photo of me looking serious and “wise,” and I had no idea how to pose—should I squint or stare into the distance as if contemplating mortality? I also remember hesitating before posting something brutally honest one time, something along the lines of, “If you have a pattern of being in harmful relationships, maybe the problem is you.” (I’m paraphrasing, but you get the gist.) I dreaded the comments section, yet I posted it anyway.

At the core of it all, I kept telling the truth—even when it was unbearably uncomfortable. So, did I build a brand? I suppose. But more than that, I forged a space where honesty feels less like an attack and more like an invitation.

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In the beginning stages of my chronic illness journey, my internal Dismissal of the seriousness of my condition was validated by External Dismissal from the medical professionals from whom I sought help. But the dismissal spell broke when I found myself in the ER for the eighth time, and my mom called and demanded to be put on speakerphone to talk to the doctor.

“Jayne has been in and out of the ER for weeks now,” she said. “She has a habit of downplaying her symptoms, and because she is young and ‘looks good’ doctors dismiss her all the time. I am a nurse, I know something is wrong here, and I will not let my daughter leave the hospital tonight. I am worried about meningitis. Do your due diligence!”

The doctor replied, “I mean, I’m always excited to do procedures, and I’d be happy to do a spinal tap to test for meningitis. But I don’t think your daughter has that, ma’am. I think she just injured her neck.”

I felt myself cringe. Why did my mom have to make a fuss? But I was also angry: Who the fuck did this doctor think he was? I hadn’t injured my neck. He didn’t know anything about me! Meanwhile, the pressure in my head was so intense, it felt like my eyes were being pushed out of my skull from the inside, like a gruesome scene from Game of Thrones. I was achy like I had the flu, and all I wanted was for it all to just stop. I felt like I was dying. In hindsight, I wasn’t far off.

Before I knew it, the doctor had snapped on a pair of rubber gloves, assembled his set of shiny, cold, pokey-looking tools, and was asking me to bend over so he could sterilize the area on my back where the needle would be inserted. I was shocked that we were going to do a spinal tap right here in our ER room. As I looked around, I saw a ball of human hair rolling on the ground like a tumbleweed. My gut clenched; this all felt too casual. Wasn’t a spinal tap kind of a big deal? But what did I know? I was the patient, and he was the expert, so I didn’t say anything.

The doctor was acting so blasé about it all, but it turns out he forgot one very important part: to measure the opening pressure of my spinal cord where my cerebral spinal fluid (CSF) was released. This measurement would have shown an increase in CSF, a small but significant detail that would prove incredibly important later on.

When he finished, the doctor said, “All right, I’ve patched you up. I’ll get that tested for you. Just wait here.”

Miraculously, as my fiancé Sean and I waited for the results, I started to feel better. The color came back to my face. I could form sentences, and I was even laughing at Sean’s jokes. And when the doctor returned, there it was again: External Dismissal. In a smug tone, he said, “Your tests came back normal.”

I was utterly confused, feeling both disappointed and relieved. I just couldn’t shake how quickly he was dismissing my pain—and yet how excited he’d been to “experiment” on me. But I was feeling better, so maybe it had all been in my head. I was sent home with some Valium, eager to get back to life as “normal.” And there it was again: my own Dismissal of my body’s wise intuition.

The next day, I saw clients and resumed my usual workout routine. I even went swimming in the pool that weekend (nobody told me you’re supposed to wait six to eight weeks before swimming after a spinal tap). “See, I’m fine!” I told myself. But five days later I couldn’t see. Walking was a struggle as my balance was off-kilter, and my pain was at an eight out of ten. By the time I ended up in the ER again, I felt like I was going crazy.

But this time my mom was in town, and she was loud enough and advocated hard enough for me that the hospital brought in the neurosurgery team. I was immediately admitted to the hospital, where I was told that I most likely had a brain tumor, sent up for an MRI, and given another spinal tap, this time checking the opening pressure. The results showed that I did not have a brain tumor and was in fact experiencing pseudotumor cerebri, also known as intracranial hypertension. The excess CS this creates causes pain, loss of sight, nausea, vomiting, loss of balance, and ringing in the ears, among other symptoms I was experiencing. The reason I felt better after the initial spinal tap was that the excess fluid being drained had relieved the pressure on my brain.

When I finally received my diagnosis, I felt both stunned and validated. All of my symptoms and pain had been real all along, but my own Internal Dismissal had been validated by the doctors’ External Dismissal. Like so many of us, I had been silenced, and therefore I continued to silence myself.

Perceived Body Betrayal

My wedding day did not turn out how I’d always pictured it. Both of my parents held me up by my spray-tanned arms as I carefully made my way down the boardwalk aisle and onto the sandy beach, where Sean, and our wedding party were all masked up for our COVID ceremony. Not only did I want both of my parents by my side for emotional support, I needed them for literal support.

In the months prior, I had undergone some of my most serious surgeries to date and begun using a rollator mobility aid. It was the exact same model my ninety-eight-year-old grandmother used. She called it “the Cadillac of walkers,” but it felt anything but sporty to me. My body was also bigger than the ones society had told me I must emulate to be the perfect bride: a single-digit size, with perfectly toned arms; a flat tummy; no scars, cellulite, or stretch marks to be seen—and certainly no neck brace! I’d put on a brave face, but if I’m being honest, I was petrified. As a newly disabled bride, not one of the Pinterest boards I’d created or looked at reflected my experience. None. Zero. I had no choice but to just do it my way.

Arriving at the rustic driftwood altar, I saw everyone swaying to the Beach Boys’ “God Only Knows.” Sean’s eyes teared up, and for a split second I forgot how much pain I was in. Waves crashed and seagulls cawed, and Gio, our little dog and ring bearer, found a cozy spot to sit in the sand next to my lace train. When I locked eyes with Sean, I saw all the pain, relief, happiness, and hope that had brought us here, and I felt it in my heart. As sappy and rom-com-y as it sounds, with an unspoken “we got this,” we really did become one in that moment. Because goddamn—neither of us had signed up for this life.

That night, as I danced with my husband—while leaning heavily on the sleek new rollator my mom had bought me as a wedding gift (which I promptly named Pearl)—and sang at the top of my lungs with my two sisters. I was in pain. I was disabled. I was in love. I was also frightened for what was to come, while grieving what I believed this moment should have looked like.

As happy and hopeful as I was for my future with Sean, this sense of grief followed me as I settled into married life. I found myself grappling with a pervasive sadness and feeling of loss mixed with confusion, denial, and disbelief. We weren’t driving off into the sunset like other newlyweds. Instead, we were sitting at home waiting for the arrival of my mobility service dog, and concern for my health was always top of mind. Had we missed out on the “fun years” before we’d even gotten started, and skipped straight to the part where our lives revolved around medical bills and fears about me falling in the shower? I loved Sean so much. But nothing about our union felt sexy or romantic anymore, and my heart was broken.

Like many of us, I am a self-proclaimed doer. I placed so much worth in my ability to get things done, and to get it done well, that grieving the significant loss of abilities that accompanied my diagnosis left me feeling helpless and less-than. I could not see or feel past my pain, and I knew by now that no treatment, medicine, or therapy would fix me. All I knew was that my body would never be able to perform the way it had.

How could the body that had been my home, that I had already helped to heal from my eating disorder, have turned on me? How could it be the cause of so much fresh suffering?

My body has betrayed me, I thought.

This is what I call Perceived Body Betrayal, the narrative that your body has somehow turned “against you.” It is the core driver of Body Grief—the sense of loss and mourning that comes with living in an ever-changing body—and what ultimately catapults all of us into a deep disconnect within our bodies and ourselves.

Body Trust

Perceived Body Betrayal is the feeling we get anytime our body changes in ways we are not able to control, does not recover fast enough from any setbacks, experiences pain, or is otherwise unable to perform on demand: that it is somehow against us. This is a maladaptive way of coping with our Body Grief; if what we are experiencing is our body’s fault, then we have something concrete to blame. And so we place ourselves at war with our bodies—when what is needed is compassion, grace, and a judgment-free zone in which to heal.

As with Body Grief, Perceived Body Betrayal stems from the societal message that our productivity, looks, and abilities are the primary measure of our worth, when in reality, all bodies of all colors, shapes, sizes, and genders hold equal value, in sickness and in health, and at every life stage. But all bodies are also destined to change, age, and experience different levels of productivity over the course of a person’s life. Refusing to accommodate these shifts erodes our innate Body Trust and throws us even deeper into Perceived Body Betrayal.

This is why I say Perceived Body Betrayal, not simply Body Betrayal. Many of us believe that our physical self is separate from our psychological and spiritual self. We often hear things like “Her body is failing her” or “His body gave up on him.” And while the underlying sentiment is well-meaning, I have a big problem with the subtext.

Our bodies are not separate from the rest of what makes us who we are, and they are not betraying us—ever. We just perceive they are, based on how we have been told they “should” perform. Our bodies will in fact do everything and anything to find a homeostasis, that is, to find balance, to function, and to maintain themselves. This is, in fact, always our bodies’ number one goal.

Sometimes the journey toward homeostasis is not pretty. In fact, it can be incredibly inconvenient, even painful. In my case, my body seeking homeostasis manifested as the swelling, rashes, failed fusions, pain, and body convulsions that were part of my Ehlers-Danlos syndrome diagnosis. For you, it may manifest as fatigue, burnout, anxiety, feeling like you can’t get enough sleep, increased appetite, nightmares, or racing thoughts.

But even when it hurts, our body is always doing what it can to protect us and keep us alive. As infants, before we have language, we have no option but to trust in the nonverbal cues our body sends us. Our body lets us know when to eat, when to sleep, when to poop, and when we need a hug—and at that age, that’s pretty much all we need to know! But as we mature and language takes over, we discover all sorts of ways to override our innate bodily needs. Rather than taking a nap when we’re tired, we caffeinate. Our stomach growls at us, and instead of taking time to sit down and eat a proper lunch, we have another coffee or grab a protein bar on the go. We feel uncomfortable in a social situation, so we chug another glass of wine. We disrupt our Body Trust on the daily, but our body never stops communicating with us. Speaking in both physical sensations and emotions, it signals to us when something needs our attention—be this a physical need or ailment that needs tending to, or when something it wants and needs is being presented to us and it wants us to say yes to it. Body Trust springs from leaning into this mind-body-spirit conversation.

All my debilitating symptoms, which required multiple surgeries to address, were ultimately ways that my body was trying to protect me. But because I had been programmed to believe that a healthy body was pain-free, worry-free, fully functioning, and always happy, I felt like my body was letting me down-when really it was simply fighting to find balance. Part of being with our Body Grief, and growing our capacity to stay in Body Trust, is remembering that our body is always on our side.

***

Prior to my clinical training as a therapist, I believed that I would not grieve until I experienced the loss of a loved one. But the reality is, to be human is to experience grief, because grief is intertwined with any and all experience of change. Whether it’s a new job, a move to a new city, a divorce from a longtime partner, or recovery from an addiction, regardless of the benefits these changes elicit, they can all induce grief. We grieve for the people we used to be, for the lives we used to live, and for the futures we thought we’d have.

Yet despite grief being our instinctive physical, emotional, and psychological response to loss, society doesn’t treat grief as a natural part of the human experience. Instead, it is something to be avoided, pathologized, and compartmentalized. Or, if we can afford it, we learn that grief is best dealt with behind closed therapist’s doors. But this only stifles our grieving response, which in turn makes us more prone to stress, deepens our trauma, and exacerbates our emotions.

This is what can make Body Grief so much more complicated, emotionally charged, and hard to navigate. There are very few dedicated forums in which we can openly grieve a death, let alone our own loss of bodily autonomy. Yet our Body Grief is just as big of a grievance as a death in the family; the loss creates just as deep of a wound.

Grief in all its forms wants and needs to be felt and expressed. This is what allows us to heal. With each difficult, messy emotion that is brought to the surface, acknowledgment is how we are able to tend to our wounds.

From THIS IS BODY GRIEF by Jayne Mattingly, published by Penguin Life, an imprint of Penguin Publishing Group, a division of Penguin Random House, LLC. Copyright © 2025 by Jayne Mattingly.

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Dani’s birth was harrowing. Even in my fog, as I fought to stay conscious during a terrifying episode of hemorrhaging, I thought her crying seemed anxious as she took her first breaths. When we finally made it to the recovery room and she was in my arms, I was dismayed to see that she looked like she’d been through 10 rounds of boxing. Her nose was smushed to the side, and her face was splotchy.

At home, I sat propped up in bed for days as my mom plied me with my only food request: white bread, Duke’s mayo, and sliced bananas. I felt weak from blood loss and only moved to gingerly make my way to the bathroom or kitchen before collapsing back into bed.

The baby cried a lot, and I felt like crying, too. Breastfeeding was difficult, and I wondered if she was getting enough milk. Friends and family who came to visit filled our ears with suggestions to ease her crying. None of them worked, and we felt helpless and lonely.

Envy and Loneliness

I joined a first-time moms support group, and it soon became clear that I was struggling with the experience of motherhood more than everyone else there. At the time, I couldn’t figure out exactly why, but it felt like a fundamental failure on my part as a mother. Dani seemed to cry more than the other babies. She was difficult to feed. She wouldn’t sleep for more than a few hours at a time, no matter how many different approaches we tried.

But the part that felt the worst was not being able to comfort her. If the cradle of my arms wasn’t enough to make her feel content, then what was wrong with my arms? If the sound of my voice wasn’t a balm, then what was wrong with my voice? If breastfeeding wasn’t soothing, then what was wrong with my milk?

My closest friend at the time was Deby, a first-time mom 10 years my senior with an affinity for using the f-bomb. Her daughter, Jac, was just a few weeks younger than Dani. From the moment we met, I decided she was doing everything better than me. Jac slept better, cried less, ate better, and even seemed to babble more than Dani. If Deby didn’t know the solution to a problem, she’d find it. I couldn’t seem to solve any of my problems.

Deby and I lived in downtown D.C., and our apartment buildings were a couple of blocks apart. After every sleepless night, when my husband would leave for work and the door clicked shut behind him, I’d feel a twinge of panic rise. How would I make it through the day? But then Deby would text: “Meet me downstairs at 8?” And we’d push our strollers around the streets for hours.

It felt like a victory just to leave the house, but I was on edge the whole time, bracing myself for when the crying would start. I could see the empathy in Deby’s eyes as she watched me struggle. She was always ready with a possible solution to whatever meltdown would inevitably occur, but after a while, I began to rebuff her suggestions. In fact, her affectionate nickname for me was “rebel without a cause.” Nothing worked.

Around this time, I noticed a dark seed of envy had situated itself in my heart. Deby’s baby wasn’t necessarily “easy,” but there always seemed to be a reason for her crying. Slowly, a chasm started growing between me and the other moms I knew—moms who were amazing, intelligent, funny, caring. They were friends anyone would want in the throes of a life challenge, but I still felt myself retreating from them.

The Gray

As Dani transitioned into toddlerhood, my husband and I noticed that nearly all our attention was focused on her. Knowing this dynamic wasn’t healthy for any of us, we decided to expand our family in the hopes that it would help bring a sense of balance to our lives. But eight months into my second pregnancy, I began slipping into a deep depression. As a therapist, I knew I needed therapy, and I was fortunate to find someone who’d become my touchstone.

“I don’t know why I’m so depressed when we’re really excited for this baby,” I often said to her, only to have her point out that it made sense given how challenging my motherhood journey had been so far.

I wish I could say we spent most of our time working on how I could better manage my emotional reactivity and anger, but in most of my sessions, I had trouble accessing my prefrontal cortex, organizing my thoughts, and getting words out in a cogent manner. Sometimes I just slumped over the arm of her couch and cried, despairing that I was a terrible mother and wife.

“That’s the depression talking, Anne. It’s not true,” she’d say.

I relished every minute I could remain cocooned in her office, rather than out in the world facing the relentless onslaught of unsolvable challenges that accompanied motherhood. In the midst of the ever-present depression I referred to as “The Gray,” I soaked in her calm, steady presence. When the depression intensified, my irritability, weepiness, appetite swings, sense of impending doom, social isolation, and feeling of being a burden worsened. I called this “The Pit.” My therapist’s steady, caring presence and gentle prodding to try medication got me through this time. On the hardest days, she’d say, “If you can’t walk to my office, crawl.”

Bin O’ Beans

When Dani was three, a friend suggested I consult with an occupational therapist, who promptly diagnosed her with sensory processing disorder (SPD). It’s now painful to read what I wrote to friends and family at the time: There’s a great degree of relief that comes with this new information. We finally have a path to follow. The good news is that occupational therapy once or twice a week, combined with activities we can do at home, will have a significant impact on her symptoms. The occupational therapist thinks we’ll see a whole different child in just a few months.

Nothing could have been further from the truth.

I adored the occupational therapist, but we saw no clear impact or shifts in behavior from the twice-weekly sessions Dani attended for well over a year. In fact, the meltdowns and inability to cope with daily life seemed to worsen. At one point, my desperation for relief from the relentless meltdowns led me to the bean aisle at a grocery store.

Dani had been deemed a “sensory seeker,” which meant deep pressure was supposed to help regulate her nervous system. One way to provide this at home, the occupational therapist said, was by filling a plastic bin with dry beans and having her sit or lie in it. Perhaps I could’ve purchased the beans in bulk somewhere else, but I was in no condition to think rationally. I reckon I walked out of that store with at least 40 bags of beans.

Later that day, as my husband and I led Dani towards the Bin O’ Beans we’d created, my expectations were high. Maybe, just maybe, these beans would do the trick. Maybe if we plopped her into the Bin a couple of times every day, the meltdowns would stop, and I’d become more regulated, too. Maybe none of us would have to walk on eggshells anymore, and we could be a normal family, and do stuff in the world without being nervous wrecks.

But as Dani sat in the beans, she just looked perplexed. “How about all these beans? Does it feel good to sit in them? Isn’t this fun?” we plied. She smiled shyly, waiting to get out and get on with her life.

The wild goose chase for Answers and Solutions went on for many years. SPD was only the start of the cavalcade of diagnoses she received between the ages of three and 16, including auditory processing disorder, attention deficit disorder, and dyscalculia (or challenges understanding numbers). And then there were the professionals who refused to see anything amiss, like the developmental pediatrician who patronizingly told me when Dani was four, “You just have a high-strung child. We have one too, and she’s an adult doing just fine now.” After that visit, I was shaking with anger. I felt utterly unheard and dismissed as just another “hysterical mother.”

Autistic Meltdowns

Mornings were hell. As soon as I opened my eyes, my body went into fight or flight. I could feel the cortisol coursing through my veins as I braced for the crying, yelling, and kicking that were sure to come from Dani’s room. What made this even more painful was that our younger daughter, Ella, had to start her mornings like this, too.

As an infant and toddler, Dani almost always awoke from sleep dysregulated. To help her through the morning routine, I resorted to capitulation and fawning, offering everything that might be a comfort: juice, food, TV, hugs. Meanwhile, internally, I often felt rage. And sometimes when the fawning and capitulating didn’t work, the rage boiled over and I became a stranger to myself: yelling, slamming doors, scaring everyone around me. Of course, this made Dani’s meltdowns even more intense.

From within the eddy of these toxic cycles, I tried to navigate the Individualized Education Program process Dani now required at school. By second grade, it was clear that the small Catholic school she’d attended couldn’t provide the learning support she needed, so we’d moved her to a local public elementary school. The transition went well through third grade, thanks to supportive administrators and attuned teachers, but by fourth grade, her class had ballooned to more than 35 students. Overwhelmed, she withdrew inward and was often overlooked by her teachers. The noisy classrooms exacerbated her difficulties with math and auditory processing.

I started researching schools that specialized in learning disabilities, and halfway through her fourth-grade year, we enrolled her at a specialized school several hours from our home. Not wanting to uproot the whole family, she and I found a place near the school while my husband and Ella remained in our house. Eventually, realizing the new school was a good fit for Dani, they joined us in this new town, which meant Ella started a new school and my husband commuted several hours to his job, rendering him unavailable two days per week for emergencies, school events, and household tasks.

We were grateful for his job and the relative flexibility if offered, and we were relieved Dani was doing well in a supportive environment, but this way of living was hard on all of us. We all dreaded saying goodbye each week, and I worried about his three-hour drive. The kids would tell me they missed him and ask when he’d be home. I white-knuckled through Dani’s meltdowns on my own.

The Autism Diagnosis

For many years, psychologists told us Dani had features of autism, but they never made the diagnosis. Finally, at age 16, she was diagnosed with autism spectrum disorder. Although it confirmed what I’d always suspected, I was surprised by how angry I felt toward all the professionals who’d been reticent to diagnose her before. If only we’d had this context when she was younger, we could’ve educated ourselves and perhaps taken measures that would’ve helped us all navigate life better. This anger lasted for weeks and then slowly shifted to deep grief.

Dani’s reaction to the diagnosis was mixed. She was relieved to know she wasn’t alone and that her meltdowns made sense. But now that there was context and a name we could apply to her experiences, she wondered if they could be “fixed.” When we tried to give her clarity and let her know that some of her struggles would likely last a lifetime, she seemed to slip into hopelessness and would often comment that she wanted to be neurotypical.

That said, Dani continues to evolve and explore the issue of identity. Since the age of 14, there have been seven name changes and several pronoun changes. Today, Dani identifies as transgender and prefers the pronouns he/him. Though we supported every shift, I sometimes felt grief and frustration over the course of these many transitions. At times, I was afraid to express these emotions, but having now connected with many other moms of trans kids, I understand that the complexity of our emotions makes sense.

Would I Be Easier to Love?

In our current stage of life, I’m holding a shoebox and nervously watching as Dani tries on shoes in a store. He’s trying to loosen the laces on his feet, and I can sense his frustration growing. I’m attuned to even the slightest shift in his body language or tone of voice. He’s 18, and after all these years, I’m hard-wired to do anything I can to prevent a meltdown. Do I stoop down to help with the laces? Do I walk away, give him space, and give him the chance to work out his frustration? Do I wait until the frustration turns into a meltdown, then usher him out of the store?

“It’s so hot in here. I’m getting too hot!” Dani complains.

This situation has all the ingredients to spark a meltdown: loud music, too much visual stimulation, too many shoe options, a crowd of people, growing pressure to make a decision, and the sensory challenge of determining if a shoe fits.

Oh God, are we going to end up leaving without shoes? I wonder. Worse, will this be yet another outing that turns sour, leaving us trying to recover for hours afterward, with him crying hot tears of shame, while I vacillate between compassion and frustration?

I take a few deep breaths and reply, “It is really hot in here. And I bet it’s not easy to focus, with this music and so many choices.”

“Yes!” he nods, seeming relieved that I understand. “That’s exactly right.”

He wears a pair of new shoes out of the store, but after a few hours he announces that they don’t feel right. I let a wave of frustration wash over me and respond, “Sometimes you can spend forever looking for shoes, and you want them to fit so badly, and then when you get home, they don’t work.”

Late that night, Dani comes into my room and explains what was happening earlier that day. “I just get overwhelmed and then can’t find the words to say it,” he says, eyes filling with tears. “And then I go into a lot of negative self-talk.” He pauses for a while. “Mom, would I be easier to love if I was neurotypical?”

His question tears at my heart, leaving me momentarily stunned. Then I look at him and speak the truth: “Dani, you aren’t hard to love. I just see how much you suffer, and I don’t know how to help, and then I feel sad and helpless.”

He thinks for a moment, then says, “Well, you always try hard to come up with solutions and fix things. But what I really need is for you to listen and be there.”

I feel my defenses rising in my throat. I thought I was really doing well with listening and being there! Then, I pause and recognize the truth he’s speaking. “I can definitely do that,” I say.

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My first attempt at therapy, at age 22, was a bust. It was entirely my fault. I lied constantly—to my therapist, but also to myself. I was so invested in my facade of cheerful perfection (“Everything is going great! Thanks for asking!”) that I couldn’t bring myself to admit I was crying all the time.

Ten years and a lot of self-reflection later, I gave therapy another try. At this point, I was working for the American Psychological Association as a science writer, so I was quite the informed consumer. I interviewed several therapists and picked the one I had the best rapport with. She saw through my jokey exterior, and we went through many boxes of tissues in her office.

We didn’t, however, always see eye-to-eye. One day, I accidentally ignored her when we passed on the street. At our next session, she wanted to talk about it, but no matter how much I insisted that I simply hadn’t seen her, she didn’t believe me. “You looked right at me,” she said.

How could I possibly fail to recognize a person I’d spent dozens of hours in intense conversation with? We never resolved this, and I wondered at times if she thought I was playing some sort of strange game with her. But what had seemed weird to my therapist was pretty normal for me. Once, for instance, I thought my boyfriend, Steve, had gone rogue in the grocery store, filling up our cart with junk food and other surprising items. “Since when do you buy generic?” I said, plucking a jar of peanut butter from the cart. His terrified expression alerted me to the fact that this Steve-shaped guy was not, in fact, Steve. I’d been faster to notice the wrong label on a jar of peanut butter than the wrong face on my boyfriend!

Years later, it finally occurred to me that something weird might be going on. Other people don’t make this kind of mistake this often, I thought. I could’ve scheduled a consult with a neurologist, but I’m a science writer, so my first instinct was to start downloading journal articles and emailing neuroscientists. One of them invited me to join a study, and a few months later, I got the verdict: I have a condition called prosopagnosia, colloquially known as faceblindness. My ability to recognize faces is, according to one Harvard scientist, on par with “a mediocre or below-average macaque.”

How did I go so long without realizing I can’t do something that comes naturally to most people? Easy: I didn’t understand how good other people are at recognizing faces. It had never occurred to me to wonder why my brother could recognize our piano teacher wildly out of context, while I couldn’t. If anything, I’d chalked it up to general absent-mindedness.

At 39, I thought I knew myself! What else didn’t I know? As it turns out, a lot. I did more research, joined more studies, and discovered that I’m neurodivergent in a variety of ways. Specifically, I can’t visualize at all, a condition known as aphantasia. Relatedly, I don’t have Proustian “madeleine” moments, where a smell or taste can suddenly transport you to an important moment from your past. My brain only records my experiences semantically, as stories, a condition called severely deficient autobiographical memory (SDAM). People on the opposite side of the mnemonic spectrum remember every mundane moment of their life in vivid sensory detail, a condition known as highly superior episodic memory. Neurotypical people strike a balance between semantic and episodic memory.

Aphantasia and SDAM aren’t disorders: they just describe unusual brain architecture that confers just as many advantages as disadvantages. One area where I, and many people with SDAM and aphantasia, have clear disadvantages is in therapy. To push past my tendency to intellectualize, my second therapist asked me to do visualization exercises—and no matter how hard I tried to squeeze my eyes closed and imagine myself “in a safe place” or “at the beach,” I never saw anything more than the insides of my own eyelids.

So much of therapy involves mental time travel, but while I’ve got some good stories about my past, they are just that: stories, told in words. It’s only a slight exaggeration to say remembering my past feels like reading a biography someone else wrote about me. My therapist was baffled by this phenomenon, and she wondered if my sensory and emotional memories might be repressed. What neither of us realized is that my weird memory isn’t evidence of trauma, it’s just how my brain works.

While I’m rare, I’m certainly not alone. About one in 20 people have aphantasia, and there’s a growing mound of evidence that it’s due to a real brain difference, not just metacognitive errors. If you put a neurotypical person in an fMRI machine and ask them to picture a familiar place, their brain’s occipital lobe lights up. Mine, not so much. Visualizers’ pupils contract in response to imaginary light, while aphants’ do not. And if you ask neurotypical people to read a scary story, they get stressed and sweaty, while my fellow aphants and I remain cool as cucumbers.

The ability to visually recall one’s own past seems to be the key to unlocking old emotions and reinterpreting formative experiences, which is why it’s a central part of many therapy approaches. So how do therapists work with people like me? There’s no official answer yet, as scientists only discovered aphantasia in 2015. I can, however, offer some anecdotal feedback from people who share my neurological disorders and differences.

Some of my fellow aphants report that they can relive past moments through other senses. They can’t visualize, but they can summon up old sensations, tastes, and sounds. Mental health professionals should also be aware that aphants may lack some of the classic symptoms of mental health problems. An aphant with PTSD, for instance, might have flashbacks that seem more like panic attacks due to the lack of mental images. And an aphant with an eating disorder or OCD won’t experience intrusive visualizations. Instead, they might report inchoate feelings of unease or disgust. For aging aphants, a lack of visual imagination and poor autobiographical memory may be incorrectly seen as evidence of dementia.

As for me, I’m happy to report that my third stab at therapy is going much better than my first two. Early on, my therapist told me to picture my inner child and give her a hug, and I explained that’s something I just can’t do. Saying that out loud was tough for me: I’ll never shake my need to be an A+ client. But now that I and my therapist understand so much about my unusual mind, we can work together to discover effective interventions. One trick we recently happened upon: while I can’t visualize an inner child, I can conjure her up by looking an old photo of myself while hugging a body pillow.

The first time I told my body pillow she was safe and loved, I felt slightly ridiculous, but something inside me shifted when I did. The scared little girl relaxed and melted into my strong adult arms. For the first time, she heard me, and she believed that everything was going to be okay.

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By my early 30s, I’d become pretty skilled at “doing life.” Running the New York office of a bicoastal talent agency, brokering high-value deals, and earning the respect of my peers—check.

Going to grad school to become a therapist and creating a career that aligned with my values—check. Surrounded by awesome, inspiring, drama-free friends—check. Getting high on life (sober) for close to a decade and invested in my own therapeutic life and personal evolution—check. In a passionate, healthy, and reciprocal relationship with a man I deeply loved and building our family with his three teenage boys—check.

For the first time ever, I felt peace and freedom within. My life was both full and wonderful, and I somehow managed to keep all the various balls in the air—that is, until my older sister Jenna found herself in crisis. Then, all my zen went flying out the window.

Jenna had a history of substance abuse and bad romances, but this rough patch was “code red” territory. Ever since she moved in with her abusive, drug addicted a-hole of a boyfriend, she’d been blowing up my phone with SOS calls, eager to relay every detail of his drunken tirades. Their fights had even turned physical. Making matters a million times worse, my beloved sister was completely isolated, living with a jerk in a shack in the woods that had no electricity or running water.

You can understand why my blood pressure spiked every time she called and I’d pick up the phone no matter what I was doing. All that mattered was getting her to safety. I lost sight of my own blessings.

In time, I started to notice a pattern. She’d call with another painful horror story (“he pushed me, he threw me out in a snowstorm, he claimed I flirted with a guy at the liquor store”), and I’d listen, filled with dread and determination. “Let’s figure this out,” I’d say, offering up every single remedy I could think of. “I have a book on escaping abusive relationships that I’ve underlined for you and will arrive in your mailbox tomorrow. I found a great therapist for you. I talked to a lawyer who specializes in domestic violence.” I begged her to leave him and temporarily move in with me. “Please, Jenna—we have room. You can get sober and into therapy, and life will be so much better.” The fix was so simple, according to me. All she had to do was consent.

Every time, she’d thank me for my support and advice, saying, “God, I feel so much better just talking to you. Thank you!” I, on the other hand, did not feel better after our calls. I felt awful. The black cloud of Jenna’s toxic environment transferred into my body, making me want to vomit. My emotional hangover would last two solid days.

Have you ever heard the saying, “Alcoholics don’t have relationships, they take hostages”? Well, if you’ve ever loved one, you know how true that statement is. With Jenna and this impossibly bad situation, I definitely felt like I’d been taken hostage. Soon, it felt like I rarely thought about anything else. I was often distracted, ruminating obsessively about Jenna in my determination to liberate her from hell. I was sometimes so fixed in worry that I might as well have been on a different planet.

Then one day, I hung up with Jenna and felt sadness wash over me. Before I knew it, I was leaning with my back against the refrigerator, sobbing as I slid down to the floor. How could my beautiful, funny, strong sister be caught up with such a monster? Why couldn’t she just accept my help? For the first time, I allowed myself to fully experience the profound sadness and grief over this impossible situation.

Something has to change, I thought.

At my next session with Bev, my badass, truth-telling therapist, I was still very tender and teary, but when I started to speak, frustration, fear, and fury came out. “Bev, I’ve done everything I can think of to help Jenna get out and get help! I’ve sent her money, offered ten thousand escape plans, but she’s not doing anything. What am I going to do?”

I hoped Bev would reply with the answer of how I could fix Jenna’s problems, but instead, she took a long pause. Looking at me with great compassion, she asked, “What makes you think that you know what lessons your sister needs to learn in this lifetime?”

Initially, I rejected the entire premise of Bev’s question. Obviously, anyone with an ounce of common sense could see that my sister didn’t need to learn any lessons by being abused by a drug-addicted POS. “She could learn those lessons while safe with us, hundreds of miles away from this a-hole, in a home with a functional water tank. I think we can all agree on that!” I exclaimed defensively.

Bev looked me in the eye and said calmly, “Actually, Terri, I can’t agree with that. I don’t know what your sister needs to learn. I’m not God.”

My interpretation of Bev’s comment was that it’s impossible for us to know what is right for another person—when we don’t live in their hearts—and it’s self-important and egotistical to presume that we do. This I-know-exactly-what-you-should-be-doing belief can be harmful to our own mental well-being, too, as I was slowly learning.

Bev reminded me of how hard I’d worked over the last decade to build a beautiful, harmonious, and functional life for myself. My sister’s dumpster fire of a situation—or, more precisely, the fact that she would not leave that blazing mess—was threatening my hard-won peace.

“What you really want is for Jenna to get it together, so that your pain can end,” Bev explained.

Wow, I thought. Her wisdom hit me like a freight train of truth. You are not wrong.

This mind-blowing reframe immediately brought my self-image into question. I truly believed that my care and concern for Jenna (and the rest of the world) was born out of selfless, Mother Teresa-style love. It had never even entered my mind that my need for Jenna to get the hell out of Dodge was motivated, at least in part, by my desire for my own pain to end. I tried to wrap my head around this distressing and humbling truth: my need to free her was more about me than I’d realized.

Until this game-changer of a revelation with Bev, I had no clue that what I thought was straight up caring was actually soaked in codependency. For any HFC—someone with an overachieving, I-got-it version of what I call high-functioning codependency—it’s hugely helpful to understand the difference.

I conceived of the term high-functioning codependency to describe the flavor of codependency that I see in the majority of my highly capable therapy clients every day. It was also uncannily familiar, because it was what I experienced for years. I define HFC as behavior that includes being overly invested in the feeling states, the decisions, the outcomes, and the circumstances of the people in your life to the detriment of your own internal peace and emotional and/or financial well-being. HFC relationships can include blurred boundaries and imbalanced effort and power, with the high-functioning codependent often taking responsibility for fulfilling the other person’s needs and trying to control most aspects of the relationship.

High-functioning codependents are often smart, successful, reliable, and accomplished. They don’t identify with being dependent because they are likely doing everything for everyone else. They might have an amazing career, run a household, care for children or aging parents, juggle all the extracurriculars, coordinate the various appointments, and likely life coach their friends through all their problems, too.

Bottom line: the more capable you are, the more codependency doesn’t look like codependency. But if you are over-extending, over-functioning, over-giving, and over-focusing on others—and doing way too much—these behaviors are compromising your inner peace and well-being. Regardless of what we call it, it’s a problem.

And because we are so damn efficient, we make all our overdoing and over-managing look easy-breezy—so no one notices we’re suffering.

Unhealthy Helping

Many HFCs are the lovers, the caregivers, the healers, the resident “moms” and “therapists” wherever we go. If you’re identifying as an HFC, it’s a safe bet that your heart is in the right place, like mine was with Jenna. So, it can be challenging to accept that—despite the best intentions—our codependent actions may be misguided.

Whenever I explore the “codependent versus caring” distinction with clients and students, I inevitably hear, “What’s wrong with being nice?” The answer is—nothing at all. In fact, helper’s high is a legit phenomenon that describes the increased feelings of fulfillment and well-being that arise from lending someone else a hand.

Truly healthy, loving, and appropriate giving can create feel-good vibes all around. However, if you’re chronically giving, doing, and over-functioning from a place of fear in order to dictate outcomes, feel valued, recognized, or even loved, that’s more dysfunctional and codependent than genuine caring. So much of the time, we can see our helping as just being “nice,” but the truth is that there is a tipping point where our compulsion to jump into someone else’s situation may be less about their needs and more about our own.

The concept of unhealthy helping—“helpful” behaviors that are unintentionally unhelpful—was originated by Shawn Meghan Burn, a psychologist, researcher, and the author of Unhealthy Helping: A Psychological Guide to Overcoming Codependence, Enabling, and Other Dysfunctional Giving. In exploring the unintended consequences of dysfunctional giving, Burn writes, “Some types of helping and giving create unhealthy dependencies and reduce others’ self-confidence, competency, and life skills.” So, when we engage in unhealthy helping, we’re making others dependent on us and sending the disempowering message that they don’t have what it takes to handle their own business.

Why do we engage in unhealthy helping behaviors? A lot of my clients over the years have said things like, “I see myself as a helpful person—it’s just who I am,” or, “I like to be needed.” Here’s the thing: If we are pushing our help on someone else, then is it really about them? Or are we doing what we need to feel valuable or okay?

Other people have a right to make mistakes, to fail, to flail, to not be doing the things we think they should be doing. To paraphrase Bev, none of us are God.

Compulsive Reactions

So often, as HFCs, we give and help without pausing to consider if we actually want to be giving or helping in the ways we feel instantly compelled to. We may simply hook our focus on what’s going to help avoid conflict. We are motivated by what we think is best for others, and what’s going to cause us the least amount of short-term stress.

Auto-accommodating. Auto-accommodating is a state of hyper-awareness, where you are acutely dialed into what’s happening around you, unconsciously scanning for ways to ward off conflict or correct problems, even if said conflict or problems have nothing whatsoever to do with you. It’s always being ready to lessen someone’s burden or to help, even without being asked. It’s an unconscious mechanism, so you may not realize how responsible you’re feeling for everything and everyone around you.

Whatever form it takes, acting from unconscious reactions is not acting freely—it’s reacting to whatever might be causing us angst in our environment. Resisting this type of reaction is vital to stopping HFC behaviors in their tracks. When the urge to spring into action is so strong we can’t not do it, that’s a telltale sign that we’re compulsively reacting and not acting from choice.

Anticipatory Planning. Another compulsive and draining behavior is anticipatory planning, or trying to prevent anyone from getting upset by arranging situations just so, ahead of time, leaving no detail untouched.

Years ago, I was planning a couples road trip and one of my girlfriends was in a relationship with a challenging personality. I found myself ruminating over all the ways I could preemptively avoid conflict with this person who had a history of ruining our gatherings with their drama. How could I make them more comfortable and meet all their needs so they wouldn’t instigate problems or torture my friend? That’s called codependent anticipation. It encompasses the anxiety (and fix-it behaviors) that precedes a situation where there might be conflict.

Fear. Looking back, it’s kind of remarkable how much energy I was putting toward my sister Jenna’s situation when I also had a full-time job, a newish relationship, and three step kids who definitely needed my time and attention. But my compulsive behavior came from the sheer terror that something more terrible might happen to my sister. My actions were more a desperate bid for control than a healthy expression of my free will to help. But it was also so darn sneaky I couldn’t even see it.

Over the years, I’ve treated and encountered many women at the end of their rope, experiencing exhaustion and other physical conditions, like autoimmune disorders, TMJ, irritable bowel syndrome, and burnout. Nearly all were blind to their compulsive behaviors and sought help to address either their stress-related physical symptoms or a loved one’s dire pain. It often took time for them to gain awareness around their emotional pain.

Auto-Advice Giving. The moment someone in your orbit so much as hints at a problem, do you find yourself naturally turning your mental dial to the “fix it” channel and offering grade-A, but unsolicited, advice? This behavior is what I call auto-advice giving, a common HFC move. To avoid our unease with someone else’s discomfort, we whip out strategies, doctor referrals, sage bits of research-backed advice, and relevant personal anecdotes. Our well of sound solutions runs deep.

But let’s consider the following hypothetical example: a colleague confides in you because she’s just had a fight with her partner over their future. He wants kids, she doesn’t. Instead of listening to her with an open, compassionate ear, you mentally gather your ideas, thoughts, and judgments about what’s right for her. As she’s about to dissolve into tears, you come up with a plan, “Here’s the name of a great couple’s therapist. Grab a copy of The Baby Decision.”

We may not realize it, but when we’re automatically citing from the-world-according-to-me, we’re missing out on some of the richest parts of human interaction, which is the give and take of sharing and listening. In this example, you’re seeing your colleague through a reactionary, must help lens tinged with your own desires and life experiences. Your colleague is not recognized for her strength or who she might become as a result of her struggle. And you’ve defaulted to a familiar utilitarian role where your value is only as good as what you can do for others. The real connection can get lost in that stream of excellent advice.

To be clear, this doesn’t mean you should never ever again share your thoughts or opinions with the folks in your life. It means you can learn to do so mindfully and with respect for the other person’s autonomy.

When most HFCs start to look under the hood and see that their behaviors are not always motivated only by lovingkindness, it can feel mortifying. But as an HFC in recovery, I can sincerely say that it’s better to raise your self-awareness and risk this (temporary) discomfort than to stay in a pattern of behaviors and relating that is stealing your precious peace, time, and well-being. You don’t have to be perfect; you just have to be willing to unlearn the disordered behavioral patterns that are not optimal for the life you deserve. 

***

Adapted from Too Much: A Guide to Breaking the Cycle of High-Functioning Codependency by Terri Cole (October 2024) Reprinted with permission from the publisher, Sounds True.

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Listening with an open heart is the ultimate spiritual act. It’s one of the greatest gifts we can give to others and ultimately to ourselves. Our capacity for kindness, compassion, connection, and emotional presence, even in the face of criticism and great differences, will rise or fall in direct proportion to our capacity to listen well.

I was taught in a graduate school class that listening is a passive process, but this is not so. It’s an active process, one that comes less naturally than talking. A good listener does more than just sit there and make empathic grunts.

True listening requires us to quiet our mind, open our heart, and ask questions to better understand what the other person is saying. It also requires that we stop ourselves from interrupting and saying things that leave the listener feeling unheard or cut short. It requires us to get past our defensiveness when someone is saying things that we don’t want to hear, and to instead allow their voice and pain to affect and influence us. And it requires that we know when we’re not able to listen well and say, not now, or not in this way.

No words capture the quality of pure attention that occurs when we listen best, when we are fully emotionally present without judgment or distraction, when we are open and receptive to what the other person is saying without having to change, fix, correct, or advise, when we are there with that person and nowhere else. We’re all capable of much deeper levels of listening than we may ever realize, a lesson I learned when I least expected it, taking me by surprise.

I was participating in a seminar on transformation and spiritual growth, held in the Arizona desert and led by an extraordinary teacher, the late Carolyn Conger. The experience concluded with a solo retreat in the desert where we spent two days fasting and practicing total silence. Afterward, as we gathered together, one woman shared her profound sense of aloneness and despair during the experience. As she spoke, I felt fully present with her and with the others in the group in a way I’d never experienced before. Compassion, connection, detachment, and appreciation for the sacred came together in this pure moment of listening and unconditional love. We have only to experience something once to know of its possibility.

In everyday living, of course, we give and receive a fair amount of divided and partial attention. This is a natural way to move through the day. When it matters, however, the challenge is to shift out of a distracted or defensive mode and summon a different quality of emotional presence. As with meditation or yoga, wholehearted listening requires, well . . . practice. Yet the reality is that most of us are far more motivated to improve our talking skills than to attend to the other half of the conversational equation. Sometimes, however, the Universe may send us a painful lesson that sparks our motivation to listen better.

Consider my friend Audrey, who’s a wonderful storyteller. The only child of doting, ambitious parents, she was rewarded, if not glorified, for her talent with words, her precocity, the way she could entertain and impress her parents’ friends and other adults. She carried this behavior unmodified into her own adulthood. When another person would tell a story, she often grabbed the first empty space by saying, “That reminds me of something that happened to me,” or she’d just jump in to tell a story about her incredible trip to Paris or her near-death experience hailing a cab in Chicago. People were impressed, but I suspect they also felt the absence of a deep, mutually enhancing connection. It’s a terribly lonely feeling when you share something painful or intimate and the other person says, “I know just how you feel,” and off they go with a story of their own.

A turning point came when a group of friends were having dinner together and a man named Stanley was asked about his daughter’s recent diagnosis of ovarian cancer. Not too long after he began speaking, Audrey turned the conversation to her own experience with a serious health scare when she was in college. A few minutes into her story, Stanley suddenly started sobbing. He collected himself at once and offered a simple apology. “I’m sorry, Audrey,” he said softly. “I didn’t mean to interrupt. I just can’t listen to this right now. I’m too frightened about my daughter.”

Of course, Stanley had no reason to apologize, and Audrey knew that. She felt ashamed of her insensitivity. This painful event led her to a new level of insight and capacity for self-observation. Audrey told me that Stanley’s tears made her feel like the Wizard of Oz when Toto pulled the curtain off its track and exposed a big phony. But what Stanley had exposed, really, was the fact that Audrey was an ordinary, flawed, uncertain human being, like the rest of us.

Audrey decided to practice listening. She experimented with entering conversations with the intention to only listen, which meant staying curious and asking questions that allowed her to better understand the other person’s experience without quickly turning the conversation to herself. Obviously, Audrey didn’t change her habitual conversational style with one gigantic act of will. But over time, her commitment to a “listening practice” led her to a greater sense of ease being among people, more connectedness, less judgment, less need to display her “exceptionalism,” and more awareness of how her words and the quality of her attention affected others. She became a kinder, more open-hearted person, more compassionate toward others and toward herself.

It’s widely recognized that listening to our inner dialogue, as with meditation or mindfulness, is a practice integral to many spiritual traditions, while the practice of listening to others might be glibly viewed as acquiring new communication skills. Yet both paths are inextricably interwoven and circularly entwined. Just as the practice of being present and attentive to our own thoughts and feelings can serve as a bridge to deeper empathic engagement with others, it works the other way around as well.

For as long as we’re human, we’ll have difficulty listening to people say what we don’t want to hear. Wholehearted listening is challenging enough with the “easy” people in our lives, or with those who matter most. I’m only partly joking when I suggest to my colleagues that listening-deficit disorder should be added to the DSM. We all have LDD under stress. But when defensive listening is our habit and our practice, we cause great pain to ourselves, to others, and to the web of interconnectedness in the world we live in.

How we listen shapes whether we become larger or smaller selves, whether we enhance or diminish others, whether we connect deeply in relationships or fail to, whether we shrink or expand the possibilities for loving kindness and a recognition of the shared humanity that connects us all. If only our wish to understand the other person were as great as our passion to be understood. It takes a grand leap of imagination to even begin to imagine what such a world might look like.

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Once upon a time, there was a therapist, a teenage boy, and a very long hour.

This particular boy slumps in the maroon armchair, nearly supine, staring at the window. Outside, three boys whizz by on skateboards, hooting. Hard plastic wheels rumble over sidewalk cracks.

“So, tell me about your day at school,” the therapist asks. “What’s your favorite class?”

Every so often, the boy can raise his eyes to the ceiling, see cracks in the yellow paint, and pretend not to hear. That’s one minute. Then he imagines he’s somewhere else. Maybe playing frisbee with a friend, if he had a friend, or one of his brothers. Two minutes down, 48 to go.

“I’d like to know what happened today,” the therapist says. It sounds like pleading. “What’s going on at home? What are you feeling? Are you sad?”

In seventh grade, my life entered a terrible new era. Boys and girls were separated in physical education class. Mr. Gardner, mustachioed, broad-shouldered, gray hair closely shorn, terrifying, walked up and down the line of boys, clipboard in hand, eyeing us in our oversized white t-shirts and black shorts, our pathetic middle-school inadequacy.

At 13, I was smaller than the others. My voice was so high-pitched, I tried not to say anything. When Mr. Gardner called my last name, I raised my hand. Not seeing me, he yelled again, “Scott?!?” When I answered, “Here!” the other boys snickered at my attempt to lower my voice.

It was wrestling season. For a grade, Mr. Gardner required each boy to face off against another. When he called my name, the crowd of boys hooted. Stomach reeling, I moved into the circle. Then he hollered: “Eugene!” One overweight boy stepped forward, his face flushed, the epicenter of all dread in the universe. The rest of the class encircled us, laughing at the contrast. Eugene was huge. I was short and slight. How could the coach think we were well-matched?

“You can do this,” he said. “Have some fun!”

My mind swirled with notions of arm bars and single-leg take downs and half-nelson pins. Eugene was too big for me to put my arms around, so I got on all fours. He wrapped one arm around my chest; the other gripped my skinny bicep. His heart thumped against my back. His face was damp, and he dripped sweat on me.

Mr. Gardner blew a whistle. “Go!” The boys thumped the mat with their hands, an earthquake of humiliation. I don’t know what happened next, since Eugene was behind me, but it seemed he collapsed on top of me, pinning me under a mountain of flesh.

“Get out from under him!”

I could barely breathe, let alone move. Within seconds, Eugene won. The coach pulled his hand into the air. Eugene’s face turned pink, relieved.

I wanted this nightmare of being a boy to be over. Back in the locker room, there was nowhere to hide in the echoey shower room full of naked boys. Everyone seemed to have new hair in places I didn’t. I caught a glimpse of Eugene: huge fleshy stomach, shy smile. Even he had hair between his legs. I fumbled getting dressed.

“If you don’t take a shower, I’ll mark you down,” Mr. Gardner said behind me. I pretended I didn’t hear him and bolted. “I’m marking you down,” he called.

Though it wasn’t lunch yet, I walked out of school and ran to the apartment I shared with my mother and two brothers. She’d separated from my father, who’d disappeared a few months earlier without explanation. No one else was home. In my bedroom, I huddled under the bedsheets with a flashlight and a book. Over and over, I read the same books: Laura Ingalls Wilder’s Little House series, Louisa May Alcott’s Little Women and Little Men, E.B. White’s Charlotte’s Web. My criteria for a good book were simple: there had to be a family with two parents, a soft-spoken father with opinions about meeting adversity, and mostly girl characters. There could be nothing about the rules of being a boy.

Maybe the real torpedo came, weeks before the wrestling match, on that first day when students were assigned lockers. It was my first year at Cockeysville Middle School, in the suburbs of Baltimore, Maryland. I fumbled with the dial of my locker and jerked the handle. “Darn it.” I only had a few minutes before the bell. Day one of middle school and I already hated it.

Mitchell McGuire’s locker was two doors down. “They’re tricky,” he said, his face covered with blond scruff. “I can help. Tell me your number.” A foot taller than me, he looked like a man, yet we were the same age. He turned the dial as I told him, and it popped open, and I dumped half my textbooks in it. Then he stood there, waiting.

“We need to get to class,” I said. “The bell’s gonna ring.”

“Do you want to go get high?” he asked. “We can go behind the bleachers.”

“What?”

“I have grass,” he whispered.

It had never occurred to me that I was old enough or bold enough to skip class or smoke grass. I trembled and shook my head. “You shouldn’t smoke grass,” I said. “It’s illegal. You shouldn’t skip class either. You’ll get in trouble.”

Mitchell’s eyes narrowed. “Forget I asked,” he said. “I’ll go by myself.”

A middle-school reputation is a fragile thing, easy to tank.

A few days later, when I opened my locker, it was filled with shaving cream. My books were covered with white foam. I didn’t know what to do. It was impossible to get them clean, though I scrubbed furiously with toilet paper from the boys’ bathroom. The word hate wasn’t strong enough to describe how I felt about middle school.

Though I was 20 minutes late, the art teacher, Mrs. Dennis, smiled and told me to get my project from the shelf. We were painting faces on old shoes covered with papier-mâché. Mine had a frowning clown face with far-apart eyes, crazily dilated, as if he’d just murdered someone. I dreaded sitting in her class almost as much as physical education. Some of the same boys were there, lobbing spit balls when Mrs. Dennis wasn’t looking. The word they used to taunt me, bigger and louder and more powerful when said for the class to hear, was always the same:

Faggot.

I dipped my brush in black paint and tried to concentrate on my clown’s murderous eyes. No one had ever explained this word to me. I suspected it meant homosexual, a vague idea shivering in a haze of otherness. But who would I ask?

Mitchell called out, “Why are your hands so sticky, faggot?”

A girl yelled, “Ew gross, Mitchell!”

“You’re pathetic,” he said to me. “You better watch yourself after school, little boy.”

I wanted to run home.

Faggot, faggot, faggot. Each time someone said the word, it felt like a violent bee sting. There’s-something-despicable-about-you. You-do-not-belong-here. Disappear.

I wanted the day to end.

Later that afternoon, as I began to walk home, Mitchell jumped from a nearby bush and punched me in the jaw. I was so shocked that I barely felt the blow, but later that evening my jaw began to ache. The jagged shards of the day reassembled, and I recalled Mitchell’s 13-year-old face, which looked so much older, when he leaned in to punch me: his angry squinting eyes, the set of his rectangular jaw, the wisps of whiskers on the chin, and the burning cigarette clenched in his lips, so close to my own face that I worried the hot ash would fall on my polo shirt. Then he’d said the word: Faggot.

For the next few weeks, my mother let me stay home, accommodating my complaints of stomach pains and headaches. I researched and discovered that I could miss 45 school days a year and still pass to the next grade.

Then, after 10 days absent from school, the school secretary called my mother and asked us to meet with the vice principal. His office was a foreign territory, reserved for kids in trouble. In my whole life, I’d never gotten into trouble. The vice principal was a grandfatherly figure, in a white shirt and a navy-blue tie. He had wrinkles obscuring his eyes and gray tufts coming out of his ears. “Wayne’s missing a lot of school,” he informed my mother.

In a quiet voice I explained, “I can stay home for 45 school days and still pass to the next grade.”

He frowned and shook his head vigorously. I couldn’t hear everything he said because it was now shockingly clear that I was the kid in trouble. He commanded my mother: “You need to get him to go to school. No matter what.”

My mother pursed her lips. She wore a mint green pant suit with a scarf patterned with purple flowers. She was a realtor in 1978, a brutal economy that no amount of hustle could match.

“I can keep up with my homework,” I whispered to her as we left his office. “Why does it matter if I’m in the building, if I get good grades?”

After our talk with the vice principal, we stopped by the office of the school counselor, as directed, to see if he could help with school avoidance. His navy-blue tie pinched his neck, as if it was choking him. He had more to say than the vice principal, but he talked to me. “If you get picked on, you need to fight back. If you fight back, they will leave you alone.”

I stared at him. This seemed impossible.

“They smell fear,” he said, “so you must get rid of your fear.” He had a gentle fatherly tone when he gave these awful directives. “If you think you’re going to cry,” he continued, “come to my office. You must not let them see you cry.”

I said nothing. Neither did my mother. She was worried about taking time away from showing houses. I knew she was worried about rent. Neither of us knew what to say to these men in their crisp, ironed shirts with perfectly knotted ties. When we got to the car, she sighed. “Assholes,” she muttered.

As a working parent with three boys—13, 12, and 10—she didn’t know what else to do with my complaints of physical ailments, except to keep me home. She couldn’t argue with the vice principal and the counselor, she said, but she didn’t have to listen to them either. She brought me to our pediatrician. Wearing a white coat over a pale blue shirt, he listened with what looked like either patience or suspicion, then cut a deal: he’d write a medical excuse for me to get out of physical education class, the nexus of my anguish, on the condition that I attend school every day, no excuses, and go to therapy. He wanted me to see a male therapist. “He needs a man’s influence,” the doctor told my mother. “You can’t coddle him.”

Neither the vice principal, nor the school counselor, nor the physical education teacher agreed with this medical excuse—this endorsement of sissyness—but he was a doctor. Other than my mother, who secretly thought my staying home was the only safe solution in a dangerous school, all the men watching us seemed to believe that the problem was me: my habit of crying when teased; my fear of being chased and shoved and punched in the locker room; my anxiety about jeering and name-calling in home room and art class and the gymnasium. And it was impossible not to notice all of them seemed to be throwing adult men at me as an antidote. Everyone seemed to want to cure me of my fatherless state. But all the substitute fathers who came onto my path made me feel like I had a gruesome disease.

Once a week, my mother dropped me off at the therapist’s office. My body resisting the give of the armchair, I sat across from Howard and stared. He had a brown beard, glasses that didn’t obscure the warmth in his eyes, a round face, and a paunch that seemed to suggest he was comfortable with himself. Sometimes he wore a plaid flannel shirt, reds and blues with threads of gold. He asked questions in a gentle voice. He wanted to understand what was making me unhappy, but still he had that voice and that big man’s beard. Though he had done nothing to me, I couldn’t forgive him.

Howard asked question after question, nudging to see if I’d say more. I responded with single words—the fewer syllables, the better—and grunts. He cajoled me to play games of checkers and Uno and Monopoly, games that sat in tattered boxes on a shelf. He tried to engage me over a game of pool in the group room of the Community Mental Health Center. I refused to talk. He praised me when I broke apart the triangle of colored balls. “Excellent shot!” If he ever felt irritation, he never showed it. When nothing worked, we sat across from each other in silence.

It’s not easy to be silent for an hour, sitting across from someone who’s waiting for you to speak, but with determination it can be done.

Week after week, as I endured middle school, Howard looked at me and I looked away. Except when I glanced back to confirm he was still looking at me.

While Howard did have the beard, and the paunch, and the flannel shirt, he didn’t direct me to do anything. He offered no advice or guidance or reminders of the rules of being a boy. He asked questions or he waited for me to speak. When I glared, he smiled at me with his brown eyes.

Sitting across from him, I was steadfast in my resolve. My throat tightened. My brain shut down. There was a rolling in my stomach, a constant pressure behind my eyes. The words to name the problem were far beyond my ken: contempt, aggression, hatred, homophobia. I only knew I needed to hide from the forces they represented. Words I did know—chase, punch, faggot, cocksucker—were wrapped in humiliations which only became bigger in the retelling. Silence can be powerful that way, a kind of refusal and strength.

“I have a question for you,” Howard said one afternoon.

I stared, unwilling to give him any encouragement.

“Do you know what a ‘faggot’ is?” he asked as if it was any ordinary word.

My face burned. I looked away but couldn’t escape his gaze. How did he know? I wondered. Was I somehow marked?

“You’ve heard that word at school,” Howard offered, his hands folded in his lap. “Many teenage boys use it as a curse word.”

Before I could stop myself, a word escaped from my body: “Yes.” Howard was seeing parts of me, my humiliations, that I didn’t want to reveal.

“Do you know what it means?”

I shook my head. I wanted our time to be over. I wanted to be in the car with my mother driving home as she sang along to Carly Simon and Aretha Franklin on the radio.

“It’s a cruel word for a male homosexual,” he said in a weary, matter-of-fact voice. “A man who is attracted to other men. It’s used to make them feel badly about themselves. But there’s nothing wrong with being gay, Wayne. It’s just another form of love.”

A few days later, as I hurried home from school, three boys emerged from behind the same hedges carved into sharp angles. They were smoking cigarettes. Two of them were from physical education class. The other was Mitchell. When I tried to charge past them, they blocked me.

“Where’re you going?” Mitchell asked. The cigarette smoke made my eyes sting.

There were three of them. It seemed so unfair. “Leave me alone,” I said, voice softer than a whisper.

Mitchell shoved me. Another boy punched me in the stomach: the air left my body, and my butt hit the ground. For a moment I sat stunned, trapped. After a day of loneliness and invisibility at school, it was too much. They towered over me. They talked over each other: “You’re a faggot, you know that?” “We’re going to beat the shit out of you.” “Just like Eugene did.” They laughed, hard.

“Boys, what are you doing?” shouted a teacher. She started walking over to us.

When the bullies turned to look, I took my cue and bolted.

“Wait a minute,” she called. “Tell me what happened!”

But I’d gotten away again.

Later that afternoon, I sat across from Howard, trying to hold back. But my resolve broke. I couldn’t control the hot tears running down my cheeks. I cried and cried and cried like there was no end to the sadness, like I was all of sadness, like there was no boundary between my body and the expansive misery of the universe. Howard nodded and he passed me tissues. His eyes grew moist.

I didn’t say any words but I cried for the whole hour. Howard looked at me with a sad helplessness, as if we were stuck together in the same awful situation. He only said one thing, as the session came to a close: “It must be very hard, Wayne.”

My mother was waiting in the car outside. Without a word I left.

Remembering that silent time in his office, it strikes me that he taught me something about fathering, but it didn’t look anything like the makeshift fathering being pushed on me from all sides, so it was unrecognizable, strange. Fathering can come from a quiet, humble place.

For the three years I was a mandated therapy client, I never had a real conversation with Howard. I was stubborn and unforgiving, of him and all the father substitutes—of everyone who couldn’t see that I was mad there even had to be a substitute. To the men scrutinizing my situation, even to Howard, there was never any sign that I improved. For most of high school, I never returned to physical education class. Every year, my mother insisted that the pediatrician write a medical excuse. “He’s still seeing a male therapist?” the pediatrician would ask without looking up. I remained a sensitive boy, quick to cry, fearful of brutality, maybe a touch more compassionate than average. Not such an awful fate in the long run.

Eventually, I became a father of two sons, also late bloomers with smaller-than-average bodies; then a psychotherapist, like Howard, who would have his own experiences of sitting across an office from teenagers with hard expressions, begrudgingly accepting the one hour they get when no one tries to change them.

I’d become a man who longs to send out a message into the universe, that mostly brutal place with its occasional pockets of human kindness. I want to say to Howard: “A long time ago, it was you, your quiet humility, who saved a misfit boy. But I didn’t know it at the time, and you would never see it.” I wish that I could tell him: “You waited, never knowing if there would be a return on that investment of patience.” But I don’t know where he is, or if he is still alive.

Instead, I sit in my office, the bookshelves stacked with board games and decks of cards, with a boy who doesn’t want to play and doesn’t want to speak. I take another breath. I ask another question. I watch him and I wait.

The post The Silent Treatment appeared first on Psychotherapy Networker.

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April 19, 2024

The clang and bleep, clatter and whine of the MRI assaults my ears despite the ear plugs. I’ve been in the machine for an hour and a half because they’re doing two different kinds of scans, one on my spine, and the other on the cancer site on my leg. I’ve already had CT scans on my lungs and abdomen. I’m glad I took an Ativan this morning because lying motionless for this long is difficult. It’s hard not to feel like a corpse.

This test day has been circled on my calendar since back in February, before I started the radiation. The results will reveal the course of my cancer and how I’ll be treated medically. In 10 days, if it hasn’t spread, I’ll have surgery to remove whatever cancer survived the radiation in my thigh sarcoma. If the cancer has metastasized, they won’t bother with the leg surgery. Instead, they’ll move on to a challenging form of chemo which I’ll be on until it doesn’t work anymore or until I can’t handle the impact—possibly two or three years down the road.

If I’m lucky enough to get clean scans and then the surgery, I have a reasonable shot at 5 to 10 years more. In which case, since I’m 78, I may get to die from something else. And that would be the good news.

Forty years ago, when our kids were little, I prevailed on my beloved wife Kate to spend our summer vacations on The Crow, my beloved boat, off the coasts of Maine, Nova Scotia, and Newfoundland.

Being on a schedule meant that we sailed in good weather and bad. And sometimes, it was very bad. Kate didn’t grow up sailing and would get flooded with anxiety when the winds howled, the waves crashed, and the rain drove down.

“We’re all going to die,” she’d wail. It was meant as a joke, sort of. She was really scared. But here’s the news: we are all going to die. At my age, I should’ve made some peace with this, but it’s still shocking. And now, with this new cancer, death has become more imminent and concrete.

May 2, 2024

Hopefully, to a casual onlooker, I just look like an old man trying to find something in his car. In reality, I’m peeing between my shoes and the car because I couldn’t get the walker out and make it to the pharmacy restroom in time. Kate has gone in to get the pain meds. I feel utterly humiliated.

I’m headed home from surgery filled with narcotics and hoping to make it into my bed. And then, to not make a mess in it.

I did get four clean scans this time. Two days ago, I had my leg cut open and the remaining cancer gouged out. And now, I’ll be on three weeks of bedrest because the tissue they operated on is fragile and there’s a big hole in my lower thigh where they had to take out not only the cancer but a chunk of thigh muscle surrounding it. Recovery will be long and hard. And that’s all really good news.

June 8, 2024

I’m on the porch at dawn. Early morning fog. Third anniversary of my new-cup-of-coffee-by-myself birthday ritual.

I’m recovering well from my surgery, but it turns out I had a high-grade tumor, which means the odds of recurrence are worse than I thought. I’m looking at a 50-50 chance of cancer and chemo till death. Next scans in August.

I look out at the mist enshrouding our meadow and the woods beyond. The shapes of trees and branches are appearing and then disappearing like ghosts.

I’d begun to be dissociative by the age of six, having learned to skillfully maneuver my way through the dangers of my family and other people by appearing to be a happy-go-lucky boy with an effervescent smile. I came across as fearless and mellow, and this made me the lucky favorite in a family affected by suicide, addictions, and mental illness. Oddly enough, I led a rather charmed life, and I carried into my adulthood with reckless abandon.

It was my fearlessness that allowed me to sail across the Atlantic Ocean alone at the age of 36. I was never afraid of dying: not because I didn’t know the great risk, I just didn’t care. This was also the case when I had my stage four non-Hodgkins lymphoma with only a small chance of survival. What some people perceived as my bravery was me not really giving a shit if my time was up.

Now, decades later, I do care. I’m no longer the slightest bit dissociated or in denial: I’m terrified of dying. My terror is what the kids call FOMO, or fear of missing out. I likely won’t make my grandson’s high school graduation. My two new little granddaughters might not even remember me. I hate the idea of not being part of it all anymore.

I’m 79 today and still shocked that I’m surprised my time on the planet is, by definition, limited, even without the cancer. I’m so not ready. Knowing that each day is a step closer to the last is hard. So is wondering how many more birthdays do I have left?

It’s odd that we all know we’re going to die, every single one of us, by the time we’re seven or eight. And yet somehow that truth gets parked safely away somewhere until you near the end and realize you’re living on borrowed time.

Kate calls out from the kitchen, “Ready, for your breakfast, sweetie?”

I come in off the porch and sit down to a plate of my favorite blueberry pancakes.

“Explain to me again why I spent decades in therapy learning how to connect to my feelings of vulnerability?” I say.

August 10, 2024

Holy cow! I got clean scans. No sign of cancer anywhere. But I’m not handling the good news well. First, I’m on a manic high and then suddenly an angry, agitated part of me shows up. When my brother, Jim, says that he knew it was going to be fine, I shout at him, “That’s bullshit! The odds were 50-50. Are you saying I was catastrophizing? Fuck you!”

Kate tries to help, but I just bark at her, drink too much, and eat a pint of ice cream. Finally, I know what I have to do and play Leonard Cohen’s version of “Hallelujah.”

The tears come, and I weep and weep.

September 1, 2024

I’ve finally settled into the idea that I might live a while longer. And I’ve rediscovered some gratitude and even a measure of joy. And yet, the truth still looms on the horizon: my finish line is in view.

I can’t tell you how much it’s meant to me to be writing to you—whomever you are—over these past nine months. I’m blessed with a loving family and lots of good friends, but somehow writing down my fears and tears and sharing them with you has filled my heart to bursting. Sharing my story makes life less lonely.

Because all we really have is each other—for the precious time that we’re here.

The post A Diary of Precious Time appeared first on Psychotherapy Networker.

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A therapist, a client, and a comedian walk into a bar. This might sound like the start of a hilarious joke, but for therapist David Granirer, it’s just another Saturday night. Granirer isn’t any ordinary clinician. As the founder of Stand Up for Mental Health, as well as a skilled comedian, he’s spent the last two decades helping aspiring stand-up comics—many in therapy—not only hone their craft, but alchemize their personal stories about mental health into performances that are empowering, destigmatizing, and often hilarious!

Since creating the program, Granirer has partnered with a range of mental health organizations that connect him with these comics-to-be, singlehandedly training over 700 stand-up comedians and coordinating over 500 shows in more than 50 cities across the United States, Canada, and Australia. Beyond clubs or theaters, they’ve taken their acts to workplaces, boardrooms, college campuses, and even military sites.

When I managed to pin Granirer down for an interview, he was on his way to do a gig for 900 crisis line workers at crisis con, an annual conference in Arizona. Over the next 45 minutes (Granirer promised not to bill me) we talked about his comedy origins, what training comedians and helping clients have in common, and how comedy belongs in the therapy room.

***

Chris Lyford: Blending comedy with mental health is such an interesting concept. Where did this all begin?

David Granirer: Technically, it began when I was a teenager. I’d been a guitar player, and when I developed problems in my wrists and could no longer play, I plunged into a horrific, awful depression that, combined with bipolar disorder, culminated in me attempting suicide. After getting help, I thought, I’ve got to do something constructive with my life, so I started volunteering at the crisis line where my dad and brother had volunteered after my suicide attempt. It turned out I was really good at it, and eventually they hired me as a trainer, and I continued to work there for 10 years.

Before the suicide attempt, I was known as a bit of a class clown. But my depression had caused me to lose my confidence and humor. It was only once I started getting treatment that I tried getting it back. I was in my early 30s, getting trained as a counselor, and my training center was right around the corner from a comedy club called Punchline. So after I’d finish class, I’d walk over and watch amateur hour at the comedy club. After a couple visits, I decided to try it out for myself.

CL: What was that like?

Granirer: To be honest, the first time I did stand-up, I was horrible! I did five minutes, and I completely bombed. There was dead silence afterward. It felt like the longest couple minutes of my life. I thought, I’m never going back! But then I decided to take a comedy course, and the next time I got onstage, I was prepared. I knew what I was doing. The club was packed with my friends and supporters, and it was an amazing experience. That’s when I knew I had to stick with it.

Soon, I began talking about my mental health issues in my routine. But back then, there wasn’t a lot of precedent for talking about mental health in this way, and stand-up became a process of trial and error, where I had to ask myself, Do I feel safe doing this?

I found that not only did I feel safe joking about my mental health onstage, but people would come up to me after shows and say things like, “Oh, I can totally relate to that!” or “I’ve been suicidal” or, “I feel depressed.” I was getting a lot of great feedback, and having some really wonderful conversations.

CL: That’s amazing. So how did Stand Up for Mental Health come about?

Granirer: After a couple years of doing stand-up, I was asked to teach a stand-up comedy course at one of my local community colleges. The course had nothing to do with mental health, but students would often tell me how transformative it was for them for get up and stage and talk about themselves and their problems. It was powerful for them and for the audience. So I had a good feeling that a program like Stand Up for mental Health would be transformative for people.

In 2004, I started putting out some feelers and found a handful of people who were interested in joining. Truthfully, I wasn’t sure how our first show would go, but we got a standing ovation. And so many of the comics told me how incredible they felt about succeeding in something like that. They say that public speaking is the hardest thing in the world. But stand-up comedy is a whole other ballgame. You have to get laughs every 10 or 15 seconds, and they were doing it! They’d all been told things like, “You can’t do this,” or “Be really careful about that,” and they knocked it out of the park.

CL: How do you go about training the comics? What’s that like?

Granirer: The program is a six- or 12-week virtual class, but I also do individual coaching. At the end of the training, I fly in to do a live show with the comics, usually at a theater or club. Of course, participants have to self-select, because it would be incredibly damaging if this was part of some kind of mandated treatment program. You can’t just tell someone, ”Okay, now we’re doing stand-up comedy.” So I teach people who want to do comedy all the nuts and bolts of stand-up: the formulas, tips, and techniques. My guarantee is that I’ll do whatever it takes to help them succeed. If they need time to practice outside of class, no matter how much, I’ll spend that time with them.

I don’t call the students in my course, clients or patients. I call them comics. That’s huge for people who’ve been in the system for a long time. They no longer have to think of themselves a perpetual client. Now, all of a sudden, they’re a comic, and I treat them just like I would any other comic.

I once had a student who told me about a manic episode he’d had five years earlier, where he took off all his clothes at a Walmart and ran around naked. As a counselor, I’m trained to say, “Whoa, that sounds really problematic. Let’s talk about your feelings.” But as a comic, I’m like, “Whoa, that’s hilarious! I can’t wait to see that in your act!” And suddenly, there’s a cognitive shift. All of that horrible stuff you’ve been through just becomes great material. Now, you can talk about all that stuff you’ve been hiding—and it changes the way it sits in your soul.

CL: In a way, it sounds like something you might do in therapy. You’re reframing.

Granirer: There’s something very therapeutic about it. In therapy, you get to tell your stories to another person and be witnessed. In this program, you get to tell your stories to a room full of people, and afterward they’ll applaud you and come up to you and say, “Wow, that was great!” And you begin to think, Huh, I’m not such a bad persona after all! People can really relate to me!

It’s also worth noting that these comics are great role models, and this kind of comedy is really empowering for our audience. It gives people courage and empowers them to talk about their own mental health.

CL: I’m itching to hear some of their jokes! What are some favorites you’ve heard over the years?

Granirer: One of our recent comics had this great joke. He said, “I’ve been in and out of psych wards all my life, and my dad told me, ‘In order to do great things, you have to be committed!’”

I also have some of my own that I really like. One of my favorites is this: I’ve found this great new drug for overcoming depression. It’s called winning the lottery! But seriously, I think the government should get a group of depressed people together and give them each a million dollars and see what it does for their mood. In the interest of science, I’m offering to go first. But with my luck, I’ll wind up in the placebo group!

I have another: So many people are afraid to use the word suicide. I once had a friend say to me, “But David, if I use that word, It’ll give you ideas!” And I said “Listen, man. I’ve used the words mow the lawn with my son every day for the last eight years, and it never gave him any ideas.”

One more: Sometimes my wife and I like to role-play to spice things up. One night she said, “David, who do you want me to be?” I told her, “A client who doesn’t speak!” And she said, “Nice try. I’ll be a client who doesn’t pay. But really, who do you want me to be?” So I told her, “I want you to be my psychiatrist. Ohhh, cancel my session! Up my Zoloft! I’ve been a baaaad boy, tell me I’m noncompliant!”

Lyford: I love it! What’s the audience reaction like?

Granirer: When people come to see us, they know what they’re getting. Many of our audience members have mental health issues and addictions—and they’ll often bring their families and friends, or their therapists, or their psychiatrists.

And since our audience knows what we do and wants to hear what we have to say, the reaction is incredibly positive. We get a ton of laughs. I think the best compliment I ever heard from an audience member was, “Hey, that guy with schizophrenia was hilarious!” I love that. How often do you hear schizophrenia and hilarious in the same sentence?

These kinds of reactions are an incredible confidence-booster for the comics, too. Getting applause and laughs and people coming up afterward to say how great they were—it really lessens the internal stigma they’ve had about their conditions.

Lyford: I’d imagine doing this has been transformative for you too, professionally and personally.

Granirer: I love the process of making people into stars. I love watching someone come into the class and start off really scared, thinking they’re going to fail, and then a couple weeks later getting onstage and killing it. So in a sense, I guess it’s like being a therapist! You see your clients go on to all sorts of amazing things. It’s been incredibly rewarding to watch them grow.

More personally, doing this has given me a real sense of freedom. When I started out, I had a lot of internalized stigma, too. I used to feel really embarrassed about my suicide attempt, and now I talk about it in my act.

Lyford: I’m sure a lot of clinicians will be curious about bringing humor into their therapy sessions. Can it be done?

Granirer: Definitely! It needs to be done respectfully, of course. It’s less about telling jokes and more about helping the client use their sense of humor, helping them find the comedic moments in their own life. Sometimes a client will say something like, “There’s a part of me that’s really negative,” and I’ll ask, “If that part of you was a cartoon character, what would that cartoon character look like?” At that point it starts to become absurd, and I think absurdity is the key to a lot of great humor.

***

For more information about Granirer’s work and Stand Up for Mental Health, visit standupformentalhealth.com.

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Funerals have a way of bringing out the oddest of feelings, and my Grandma Chin’s was no exception. The day was picturesque. The sun shone brightly, and a gentle breeze blew through the trees, rustling the leaves. It was the kind of weather you’d want for a picnic, not necessarily saying goodbye to a loved one. Yet there we were—just eight members of my immediate family—attending this modest gathering.

I suspected that no one outside our immediate family knew that Grandma Chin—my grandmother on my mother’s side—had passed away. In Chinese culture, death is often shrouded in a veil of silence, as if uttering its name might somehow summon it closer. Growing up, I never quite understood this culture of secret-keeping, but over the years, I’ve learned to see through the silence, to find meaning in tones, gestures, and things left unsaid.

The two cars carrying our small family wound though the cemetery, finally arriving at a spot where a few groundskeepers stood quietly beside a freshly dug plot. A chocolate lab sat at their side, a quiet contrast to the solemnity of the moment, next to the open earth waiting for Grandma Chin’s casket. There were no flowers or photos—befitting for a woman who’d lived most of her later life hidden from view. In all the decades I’d known her, I’d never seen Grandma Chin with friends, or heard about anyone stopping by her house for tea.

Standing in silence among all the tombstones, it felt as if we’d stepped into some sort of library, surrounded by people’s stories we’d never read. As I struggled to compose the story of Grandma Chin in my head, I realized just how much of it was a mystery to me. There was so much I’d never bothered to ask about, and now, would never know.

As I reflected on Grandma Chin’s solitary life, I couldn’t help but think about the loneliness I’d felt as a child. Growing up in rural Virginia as the bicultural daughter of immigrants had been difficult. I’d often felt like I was living on the fringes, much like Grandma Chin. My parents had embraced their Americanness with pride, seeing it as not only a means of safety but also, I believe, as a way of reinventing themselves and healing from generational trauma. For them, being American was the great equalizer, the key to a new future.

But I’d struggled—and questioned my own identity—when my classmates had bullied me or asked me what I was. “Tell them you’re Asian-Caucasian,” my parents would advise. I didn’t even really know what that meant—and neither did the kids bullying me. I knew how much my parents and grandparents had sacrificed for us to be here. So I kept quiet about my confusion and sense of shame. I wanted to protect their feelings, to avoid burdening them with my pain or making them feel like all their hard work had been for nothing.

As the years passed, I turned the same questions over and over in my head: Who am I? Where do I belong? And now, standing at Grandma Chin’s grave, those questions came rushing back. I wanted to feel sad, but Grandma Chin and I had never been close. Not only had she barely spoken any English, but she’d lived several states away, so our interactions had been minimal. What might it have been like, I wondered, to have an emotional bond with someone whose influence was deeply woven into the fabric of my family’s history?

My few memories of Grandma Chin are faded snapshots. Mostly, I remember the disparaging comments she’d make about my body and eating habits over dim sum. My younger brother had an adventurous appetite, diving into all types of Cantonese cuisine, but I was pickier. “Eat! Eat!” Grandma Chin would say, piling more food onto my plate—a gesture of both affection and insistence. I knew it was her way of showing care, but it only made me feel more misunderstood—especially when she’d turn to my mother with a look that seemed to say, What’s wrong with her? She’s not like us Chins.

Now, I glanced over at my mother, standing opposite Grandma Chin’s plot, and felt a wave of sadness, mixed with relief. For years, she’d borne the brunt of Grandma Chin’s unpredictable moods. I’d never seen it firsthand, but my mother had told me stories that painted a troubling picture of her childhood: one filled with physical abuse, emotional neglect, fear, and pain, especially as she’d taken on responsibilities far too great for her age, caring not only for herself but for her two younger brothers as well.

There were no “good old days” in these stories: just the raw, unfiltered reality of a poor immigrant family. My mother’s difficult upbringing had shaped her into an incredibly independent, formidable woman, but it had also taught her to suffer in silence. Sometimes, she’d begin to share stories from childhood, then stop abruptly. “Never mind,” she’d say, tears gathering in her eyes. “You don’t want to know about that. It was awful.”

We continued to stand silently as Grandma Chin’s casket was placed in front of us. Nobody, it seemed, knew what to say about a woman who’d been so difficult to love.

After a minute or two, my uncle cleared his throat and took a rosary out of his pocket, launching into the first Hail Mary. His voice was steady, but devoid of warmth. My aunt nodded along silently while my cousin fidgeted, clearly uncomfortable. My mother mouthed the prayer, and my brother and I exchanged sidelong glances.

After he’d finished, my other uncle took a nearby bouquet of roses and passed a single bloom to each of us. One by one, we placed a flower on top of Grandma Chin’s casket. My mother gestured to the groundskeepers, who began to lower it into the soil. I wondered what they must’ve thought of us, dry-eyed and silent.

As the casket slowly descended, I was struck by a sharp pang of regret as my thoughts drifted back to a moment in my childhood when I’d stubbornly declared to my parents that I refused to attend Chinese school. I had longed to fit in with the neighborhood kids and was desperate to escape the constant reminder of my differences. Now, I wished I’d embraced the language, the customs, and the bonds that connected me to Grandma Chin. I’d let my fear hold me back.

Perhaps Grandma Chin had felt afraid, too, when she left my aunt in China and stepped off a boat in New York City, more than 60 years ago. She was young, newly married, and facing the daunting challenge of adapting to life in a place she’d never known. Just a few years later, she’d be managing a laundromat, then later, a Chinese restaurant, all while raising my mother and her siblings, with no friends to drink tea, gossip, and play mahjong with. It must’ve been lonely, I thought. Or had she grown accustomed to the solitude?

My mother’s voice broke my reverie. “Ready to eat?” she said, flashing a thin smile. “I know a place with great paella.”

As we walked back toward our cars, I realized that perhaps the distance between me and Grandma Chin hadn’t been due to a language barrier, or because we lived far apart. Maybe, all this time, my mother had been shielding me from the person who’d made her childhood so painful. I reached out and gently rubbed her back, trying to both comfort and steady her. Our eyes met, and we exchanged a soft smile.

In the days that followed, I found myself replaying the funeral in my mind: the stoic prayers, the quiet procession of roses, and the stories that remained unspoken. As I processed these things, I realized the grief I felt wasn’t just for my grandmother; it was for my mother—and for myself.

While the question of where I belong doesn’t haunt me like it used to, I still find myself struggling to piece together the fragments of my identity. Although I don’t know all the details, my family’s narrative of survival and adaptation has shaped me in ways I’m only beginning to grasp. And I recognize that my journey, like theirs, is one of resilience. As I continue to carve my own path, I hope to honor the rich complexity of who I am.

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It’s 7 p.m. on a Thursday evening, and I’m at an intersection, jogging in place. Typically, urban dance music motivates me to exercise, but I’m not in the mood for music. I’m in the mood for wise words, which I’m hoping a podcast called Wiser Than Me will provide.

Earlier in the day, my doctor informed me that my breast biopsy had come back positive, and I have something called ductal carcinoma in situ—a precancerous condition that required surgery and possibly radiation. The news has unsettled me. I’m disoriented and my body feels strange—like it belongs to someone else. All of a sudden, the familiar identities of writer, spouse, mother, and therapist don’t fit. I’m a person with cancer, now.

Soon, I’ll need to call or text friends and family members, have emotional exchanges, answer questions, schedule an MRI appointment—but not yet. The thought of putting my news into words gives me vertigo. The problem with sharing something scary with other people is that it makes the scary thing true. As long as I can keep it to myself, then it might still be a mistake—a false positive. Plus, I can’t imagine talking about what’s happening, how I’m feeling, or what I’m going to do about it. How would I begin? “I’m scared of dying”? That’s not an ice-breaker—it’s a conversation killer. What I can do, though, is go for a three-mile run around my neighborhood. I can listen to a podcast.

A couple of weeks ago, I saw an Instagram reel of Julia Louis-Dreyfus—of Seinfeld and Veep fame—giving an acceptance speech at the 2024 Webby Awards after Wiser Than Me was selected for Best New Podcast. She holds a trophy, leans toward a mic, and proclaims, with perfect comic timing, “Listen to old women, motherfuckers!” That’s what tipped me off to her latest creative venture, in which she interviews accomplished women who’ve lived a long time and gotten wise from their experiences.

I’ve always known older women are a national resource, one that’s widely underappreciated and underpaid. In every field, in every culture, throughout history, older women have always been unsung spiritual leaders, social change agents, community activists, shamans, healers, nurturers, and public servants. In a youth-and-beauty-obsessed culture, “Listen to old women, motherfuckers” should be a perennial crie de couer. This evening, for me, it’s more than that. It’s personal. I need to hear older women talk about crises they’ve faced and overcome.

In the podcast, Julia Louis-Dreyfus has interviewed dozens of accomplished older women like actress and comedian Carol Burnett, fashion designer Diane von Furstenberg, blues singer Darlene Love, The Joy Luck Club author Amy Tan, and feminist icon Gloria Steinem. When she and her guests talk to each other, they generate a free-floating sense of shared sisterhood—like an all-girls slumber party for women aged 50 to 90. There’s an intimate, conversational flow to the episodes, and it’s easy to forget I’m listening to a recording as I run down a street. I commiserate, wince, laugh.

This evening, I choose an episode with writer Anne Lamott, who’s 70.

Lamott and Louis-Dreyfus talk about aging and different parts of their bodies hurting. Then Lamott says, “By a certain age, we’ve all had unsurvivable losses, right? And I know how you come through them. I know what helps, and I know what doesn’t. Platitudes and nice little Christian bumper stickers don’t help. What works is that you show up, and you sit with a person, and you’re willing to feel like shit with them, and you don’t try to get them to feel any better than they do for as long as it takes.”

This, I realize, is what I’ve tried to get better at as a therapist for most of my career—the art of feeling like shit with people—particularly when my clients are in the white-hot center of a frightening situation, like the one I’m facing now. I’ve always tried to settle into the shared emotional experience of another person’s pain without losing myself in it, but also without jumping to fix it. Just sharing a shitty feeling with someone you trust can be incredibly healing. But it’s hard to share shitty feelings. It’s natural to want to get rid of them, in yourself and others. Right now, listening to older women discuss love, regret, illness, aging, ambition, sex, and death is my way of being with my own shitty feelings.

Now and then, I’ve wished Louis-Dreyfus pushed her guests to go a little deeper with their answers than they do, but then I’ve reminded myself she isn’t a clinician in session intervening with a client. She’s riffing, chatting, and drawing people out. It’s entertainment. There’s joy in quirky, funny moments—like when 82-year-old Isabel Allende, bestselling Chilean-American author of House of Spirits, talks about eating marijuana-infused, chocolate-covered blueberries before getting frisky with her younger husband. There’s tenderness in sad moments—like when 90-year-old actress and political activist Jane Fonda, who starred in films like On Golden Pond—admits to regretting the kind of mother she was. Burdened as women are by outsized societal expectations, what mom can’t relate to that?

I’ve reached the top of a steep hill and rounded a corner. Finally, I feel a little lighter. The endorphins are kicking in. White panicles on a crepe myrtle tree by a local Dunkin’ Donuts have exploded into bloom. For a moment, I marvel at the pleasure of swinging my arms, lifting and lowering my legs, and feeling the sidewalk slap my feet in a way that carries me forward through space. A benefit of fearing death is appreciating life.

Lamott and Louis-Dreyfus talk about how difficult it can be to write a book—an assessment I agree with, having written a few self-help books over the course of my career. Lamott says E.L. Doctorow—the novelist and professor who wrote Ragtime—compared the book-writing process to driving at night with the headlights on: “You can only see a little ways in front of you, but you can make the whole journey that way.” I stop mid-sidewalk, tap the arrow that rewinds the episode, and listen again. It doesn’t just apply to book-writing, I realize. It applies to everything. Do we ever see more than just a little ways in front of us? I don’t think so, although our mind is good at tricking us into thinking we can plan out our entire future. So maybe I can refocus on looking just a little ways ahead of me now. Maybe I can make my whole upcoming cancer journey that way, whatever ends up happening.

“If you could go back in time,” Louis-Dreyfus asks Lamott, “is there something you’d tell yourself at age 21?”I’ve heard her ask other guests this same question. Jane Fonda’s answer was: “No is a complete sentence.” Gloria Steinem’s was: “It’s going to be all right.” Isabel Allende’s was: “Be compassionate with yourself.” My favorite was author Fran Lebowitz’s. She said: “At 21, I’d tell myself, ‘Whatever you do, don’t buy that first apartment.’” Now it’s Lamott’s turn to answer. She says, “I’d tell myself, you are so beautiful as is.” Of course she’s right. All of us are. We just don’t always see ourselves clearly.

The podcast ends with Louis-Dreyfus ringing up her 90-year-old mom. Endearingly, at age fifty-five, she still calls her “mommy.” The two review highlights from the episode, one of which, Louis-Dreyfus shares, is WAIT, an acronym for “Why am I talking” that helps Lamott resist the compulsion to tell her grown son how to live his life. I remove my AirPods, slip them into my pocket, and walk up the front steps of my house. Am I wiser having listened to all that? Probably not. But I’m in my body again, and that’s a good thing.

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I was in a restaurant recently and noticed a family of four sitting down for a meal. They looked like an ordinary family.

As the daughter and son perused the menu, the mom said hesitantly, “The fettuccine alfredo might be good.” I noticed the husband roll his eyes. “There she goes with her fake Italian accent,” he sneered. The son smiled sheepishly, and the tweenish daughter raised her menu higher in front of her face like a shield.

To many people, this moment might have seemed insignificant. All families tease each other, right? Maybe. But these kinds of moments can be indicative of a larger, destructive dynamic known as coercive control, a term coined in 1982 by social worker Susan Schechter, one of the first to acknowledge the intersection of child abuse and domestic abuse. In 2007, the term was propelled into the cultural lexicon by sociologist and forensic social worker Evan Stark with his seminal book Coercive Control: How Men Entrap Women in Personal Life. Though he defined it as a gendered oppression that plays out due to patriarchal norms, men can certainly be victims, as can anyone who identifies as male or nonbinary. On a societal level, coercive control underlies the oppressive dynamics used against all marginalized populations, like LGBTQ+ folks and people of color. But on an individual level, behind closed doors, current research shows that women and children suffer in coercively controlled relationships most often.

How can coercive control be such a big issue to address today, when so many people value and seek to form healthy, equitable partnerships? Because it’s like a slow, insidious burn you can’t see coming. A pattern of devaluation that takes place over time, in various forms, it’s often minimized, dismissed, or even normalized as a common relationship challenge. The truth is, coercive controllers don’t wear signs that say, “Hi, I’m an abuser.” They’re ordinary neighbors, plumbers, artists, coworkers, community activists, counselors, legislators, CEOs, lawyers, movie buffs, musicians, government officials, and teachers. Many even call themselves feminists.

The common thread is that at their core, coercive controllers can’t stand feeling vulnerable. Sadly, most didn’t grow up with a secure attachment to a primary caretaker and feel deeply insecure. They’re burdened with intense shame, often due to their own childhood trauma, and work diligently to hide their shortcomings by ensuring they’re more powerful than those around them—which is easily accomplished by diminishing others. While they can perpetrate this dynamic anywhere, it plays out most often in their intimate relationships, where they can be most powerful and don’t have to perform up to society’s standards, either overtly or covertly.

In countless, subtle ways, they inflict psychological abuse through intimidation, gaslighting, and isolation. Sometimes financial, legal, and sexual abuse come into play. At times—but not always—there may be physical violence. But to me, having worked my entire career helping victims of domestic abuse, it’s most heartbreaking when coercive controllers use children as weapons against mothers, damaging a parent–child bond to harm a partner.

Coercive controllers are drawn to people who are unwittingly easier to exploit than others, no matter how confident and secure they may be: I call them “perfect prey.” These people tend to score high in agreeableness and conscientiousness on the Big Five personality test. They’re often willing to accommodate other people—something coercive controllers use to their advantage. They’re loyal and forgiving. They have a hard time believing someone they love and trust, or raised children with, could have malicious intent. Unfortunately, many institutions don’t believe it either. Research shows that when victims present their experiences of abuse to family courts, they’re disbelieved up to 55 percent of the time, and when they disclose abuse of their children by a coercive controller, they’re disbelieved 73 percent of the time for physical abuse and 85 percent of the time for sexual abuse.

I’ve advocated for victims of coercive control—also known as domestic abuse—for decades, beginning at age 19, when I volunteered in an agency focused on helping domestic abuse and sexual assault victims. At 23, I began working in child welfare and saw how often domestic abuse and child abuse intersect. Even so, I didn’t recognize the gaslighting, manipulation, isolation, and intimidation in my own partnership as domestic abuse, because I was still gauging what was and wasn’t abuse by the parameters of the violent-incident model. Now, I understand that coercive control is the underpinning of all abuse, physical or not—it’s about exerting power and control over another.

When I finally got out of my 27-year marriage, I started a long process of healing myself as a person and a parent, one that led me to create a trauma-informed program to support protective parents—adult victims of coercive control striving to shield their children from harm as they work toward clarity and freedom. Since it started, in 2022, hundreds of protective parents from all over the world have sought me out, including therapists who either need my help or want to be of help—sometimes both.

I Was His Everything

I was raised in a tight-knit family with traditional values. My parents were life partners who modeled kindness and love toward one another, and as a result, I didn’t even know what abuse looked like. My parents believed that only “bad” people did “bad” things—something I grew up believing, too. But the reality is, the world is full of people who are Dr. Jekyll and Mr. Hyde—and one day, when I went for a jog with my brother at age 16, I met one of them. A young man waved at us as we ran past his porch, and I was intrigued. A few days later, I saw him again. “I’ve been watching you run by,” he called out. “Will you go out with me?” I’d never been pursued by a boy before, and it felt good.

My parents didn’t approve of my new romantic interest—they thought we were getting too close too fast and preferred I not date at all—but they never imagined the relationship had the potential to become abusive. Neither did I. Back then, I thought the intense, exciting highs and lows I experienced with this young man were what true love felt like. I now know the extreme declarations of affection he interspersed between more coercive behaviors were his version of love bombing, a common way abusers gain more control by confusing victims.

My partner often told me I meant everything to him, that I was his soulmate. Sometimes he became angry if I was too busy to see him or had plans with friends. He’d claim he was worried about me and missed me; then he’d grill me with questions. Had anyone hit on me? Who did I sit next to in the movie theater? Had I seen any old friends at the reunion?

Eventually, we married and had two children. The arrival of children in a coercively controlling relationship adds a complicated abuse accelerant. Many coercive controllers resent the children for funneling attention away from them and end up ramping up the abuse of their partner because of it. Abusers become authoritarian parents. Their omnipotence is felt throughout the home, leaving everyone unable to express their fear because there’s no room for negotiation. Some abusers, like my partner, aren’t overtly authoritarian: they’re permissive and even work hard to portray themselves as family heroes. Either way, the children always know who holds the power.

Good Cop, Bad Cop

Most people thought my partner was an amazing father. He was enamored of our children and became laser-focused on receiving their love and affection. His role was to have fun with the kids. In turn, I was relegated, in his eyes, to the role of homemaker and caretaker.

It was hard to explain to people what was happening as I became marginalized. He has no time for me didn’t quite capture it. Neither did He won’t go on a date with me. When I tried to explain what was happening to a concerned friend or relative, it felt like I was complaining. He told me I was selfish for wanting time with him and being focused on improving our relationship. But he wasn’t the only one gaslighting me. Following his lead, I gaslit myself into believing I was the problem.

As with many victims of coercive control, my sense of isolation grew as my vulnerabilities were repeatedly used against me. At first, my partner criticized my friends and family subtly, but later, he did so more aggressively. I saw them less and less. Part of me was afraid that if I shared how unhappy I was with people close to me, I’d be told I was making a big deal over nothing or that it was my fault. I learned it was best to fit in my time with friends and family when he wasn’t around, since it created less tension between us. Now, I see his criticism and judgment of them functioned as an isolation tactic. He was undermining my support network.

In public, my husband would bring things up I’d shared with him in private—my feelings of anxiety, or the fact that one of my children didn’t want to go to the movies with me. “Well, Christine and our daughter have a rough relationship,” he’d tell people. All the while he was the one indoctrinating our children to view me as unstable and unsafe. I liken it to being in a cult where children align with their oppressor.

He used our children to fulfill his needs. They were his children. He felt possessive of them and shrouded his competitiveness in humor and mockery. “You know mom, she’s way too serious,” he’d laugh, or he’d nudge them and say, “Mom likes weird books and music, right?” It was hard to speak up because then I was told I was overly sensitive. I felt powerless to create boundaries in the home, particularly as the children grew older. He was permissive, leaving me alone to encourage responsibility, set limits, and enforce consequences when tasks and schoolwork weren’t completed. He was the indulgent, fun parent—the one who allowed them to have endless screen time and junk food. All he asked for in return was that they like him better than me and make their preference clear.

Sure, our children adored him, but when they were up at night because they were scared or ill, I was the one who took care of them. He was always too tired. He grew easily frustrated if I asked for support or pointed out his counterparenting. I learned that saying nothing was easier than confronting him. Silencing me empowered him. I’d always conceived of abuse through the violent-incident model, and because I didn’t have cuts or bruises, I believed I was the problem. But in coercively controlling dynamics, abuse is often a death by a thousand cuts.

I felt the destructive impact of our family situation most with my children. By the time they were tweens, they’d figured out that their father would provide them with as much freedom as they wanted and require significantly less accountability than I did. Many coercive controllers use this strategy, before and after separation. They lure their children in just as they did their adult victim. The trauma bond occurs with everyone in the family system. My children learned I was disempowered in my own home, aligned with the parent who had more power, and gave him what he wanted. His conditional love left them in a compromised state, confused and torn.

In the Wolf’s Den

Children align with an abusive parent because they don’t want to lose that parent’s conditional love, and they’ve seen how the protective parent is treated when expectations aren’t met. When they’re also told that the protective parent isn’t safe or trustworthy, they question that parent’s love, too. It’s a betrayal trauma that few speak of or understand, one that leaves them in a similar state as the protective parent: walking on eggshells, feeling insecure, and unable to be their authentic selves. Sadly, protective parents are often so overwrought from the psychological warfare in their home that this dynamic isn’t clear to them, even when it’s happening under their own noses.

My abuser masked his gaslighting of the children as care and worry. When the children were 9 and 10, I found out he was having an affair, and I took them to my parent’s home for the weekend. My husband begged me to come back, promising to go to therapy. His promises were interspersed with statements like, “I’ll have you arrested for kidnapping” and “The children will never stay with you again.” But I wanted to believe we could heal, so I returned. Years later, I learned from my daughter that on the day we came back, when I left to teach my college social work class, their father told them I was the cheater, not him, and that I couldn’t be trusted. “I’m worried about your mom,” he said. “If she’d just take her medication, we’d all be okay.”

As happens with so many children, mine were robbed of their sense of agency and the ability to think critically about the dynamics they were witnessing. I believe most abusers set up their relationship with children in this manner from the beginning. On my social media channels, I openly share my conviction that coercive controllers strategically sow the seeds of doubt and division between family members from day one. People who’ve never been in coercively controlling dynamics may dismiss this idea, but survivors in my parenting groups say this day-one experience aligns with what they’ve been through.

Small, innocuous comments may not seem harmful in isolation, but a pattern of diminishing one parent is a pattern of domination, which fosters a situation where children feel insecurely attached to both parents. This gives the abusive parent the ability to coerce and control the children, weaponizing them against the protective parent. My own children later shared that their father used to tell them I loved one of them more than the other, while offering examples to prove his point. These statements functioned as another tactic toward the malicious fracturing of our attachment.

In private, my partner frequently reminded me of all the ways I was incompetent. His constant criticisms became the norm. But as with most victims, I did my best to focus on his positive traits as a father. Motherhood and family mattered greatly to me—which made me vulnerable. If I was brazen enough to ask him for anything—emotionally, physically, sexually—he told me I was needy and demanding. When so little appreciation, kindness, consideration, or respect is transmitted from abuser to victim, any time something good comes along, no matter how small, the trauma bond is strengthened. The abuser’s goal is to be able to give less, and they condition victims to require less. “If you’d just relax,” he’d say, “I’d make time to be with you.”

But how could I relax when I was shouldering most of our family’s financial responsibilities? I worked a full-time job, taught extra courses on the side to maintain our standard of living, and eventually opened a private practice as a therapist, while he put less and less of his earnings into our shared bank account. Every time I raised concerns about feeling overwhelmed, he stonewalled me, or the discussion devolved into an argument. If I said I was feeling sad or hurt because of something he’d said or done, he denied wrongdoing and twisted the reality of the situation in ways that cast him as the victim of my “unstable” moods. He was adept at a common abuser’s tactic: DARVO, an acronym for deny, attack, reverse victim and offender. This term was coined by psychology researcher Jennifer Freyd in 1997 to describe how abusers deflect blame.

At the time, the tactic had its desired effect. I doubted myself and tried harder. I saw four different therapists who never questioned the dynamics of my relationship. More than once, I was told to be flexible and accommodating—some of the worst advice you can give victims of coercive control, who are often overly accommodating and need help being less so. Empowering clients to have agency, even as they focus on maintaining safety, should be therapists’ number-one goal. What I really needed was someone who’d help me recognize that I was in an emotionally abusive relationship, someone who’d help me recognize that I had to leave so my children could see me outside of that relationship, so I could repair my relationship with them.

When I filed for divorce for the second time, my partner threatened to separate me from the children. Perhaps sensing my resolve was stronger than usual, his pleas were interspersed with emails—over 3,000 of them—laden with verbal assaults and threats describing everything I’d lose if I left. “Your children will never want to be with you.” “Everyone will know who you really are.” A few emails told me I was his soulmate and begged me to return. Had the post-separation abuse not been so bad, I might have gone back to him.

Abusers are so overwhelmed with fear of abandonment and feelings of shame that they can’t let go of the victim. If the victim disengages, they usually become hell-bent on exacting revenge. I’ve seen this happen with surprising regularity to the protective parents I work with. Even after I left my husband, it took years for me to acknowledge the insidious abuse of being mocked, demeaned, and undermined daily by statements like, “Too bad mom likes her own family more than our family” and “I wish mom would go to more therapy so she’d be less anxious.”

Years of criticism and negative feedback can erode a person’s sense of agency and self-trust. My work with survivors, regardless of whether they stay in the relationship or try to escape, focuses first on validating their experiences so they can begin to regain trust in themselves and their own intuition. I tell them they have every right to feel anxious and overwhelmed. Then, I guide them toward understanding their trauma bond, and that which may have befallen their children.

Coercive control is as old as time. Individuals and groups in positions of power have always used their victim’s vulnerabilities against them. It’s a liberty crime. But as therapists, if we can better discern when one person has been exerting power and control over another—and have the courage to name it for what it is—we can help survivors grieve losses, heal, and fortify a fractured attachment with their children.

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I wasn’t intentionally heteronormative with Adi, but in explaining how babies are born, I made the false assumption he’d end up only being sexual with girls, and this was most relevant to his future. In my defense, Adi seemed to prefer girls then and often spoke of his “wife-to-be,” so I assumed, at my peril, he was straight.

Then, at about age 14, Adi went to camp and came home saying he thought he might be bisexual. I nodded warmly, as if he’d told me something utterly benign, like he preferred chocolate chip ice cream to mint. But I also told myself perhaps he didn’t really know. With his generation, kids almost had to be gender- and sexuality-questioning to be cool, right? Maybe he was just mirroring what was happening around him.

I’m comfortable with gender fluidity, but it still caught me off guard when Adi kept shifting. He changed his name to “Jules.” Everyone pronounced Adi wrong anyway, accenting the first syllable, so I went along with it. I loved the name Adi—Hebrew for “jewel”—but I tried to keep my disappointment to myself and act cool and accepting.

Soon, Jules had a couple girlfriends. Then, he announced he was pansexual. Technically, that means you are, or may be, attracted to people of all genders. Silently, I thought, Fine, whatever. That’s just a nice word for doing whatever you want with whomever you want. Most recently, Jules announced he wanted to change his pronouns to they/them. They are now nonbinary: not trans, not changing genders per se, just neither he nor she.

“Some days I wake up feeling feminine,” they told me. “Other days, more masculine. It’s a relief to be who I am. Looking back, I see so many signs of my nonbinary self. It’s freeing to be me.”

I know it’s my job to accept all these changes, and frankly my career background alone should’ve made me into a poster parent for these expansive, modern gender definitions, but I screw up a lot…  And more than once, Jules has snapped at me for saying something inappropriate and unaccepting, like, “We need more good men. You not identifying as a man is a loss for me!”

***

Recently, fidgeting with a rainbow flag container on their keychain that housed a bright blue condom, they asked me, “Did you tell Jamie…”—an acquaintance of mine, who was scheduled to go on a bike ride with Jules —“that I’m nonbinary?”

“Yeah,” I said. I sometimes explain Jules’s pronouns in advance, mostly to save them the trouble. Other times, it seems like their story to share.

“You don’t have to tell people,” Jules said.

“You’ve said you want me to tell; now you say I don’t have to? What exactly am I supposed to do?” I tried to hide my exasperation, but it was coming through.

Jules nodded gently. When they aren’t irritated with me for messing up pronouns, they can be quite compassionate about the whole thing. “Okay, okay, I get your frustration,” they said. “Tell them if you want to. You can say that I’m ‘nonbinary but very male-presenting.’”

I clenched my teeth, glowering at the broccoli I was chopping. Could you just dictate a voice memo I can play when people ask questions? I wanted to blurt out.  Instead, I stayed silent. As much as I moan about keeping up with Jules’s gender/sexual/romantic changes, they have my heart, and I try to get it right.

Many of us parenting this generation, with its embrace of sexual and gender identity fluidity, haven’t been equipped with the cultural scripts parents of heteronormative kids had at their disposal in generations past. In some ways, what’s being asked of us feels remarkable, but mostly it isn’t remarkable at all. It’s simply a matter of ordinary good parenting, which means accepting kids for who they are, no matter who that is, with compassion, care, and curiosity.

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