Talk Therapy-More Than Just the Talk

6/27/2019

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I sat quietly while my young client composed a letter to one of her guardians.  She wasn’t sure how to express certain emotions to him directly so I suggested she try to write it out.  We brainstormed a little together as she listed several bullet points that she wanted to include in the letter and then she began writing. I sat in my ‘therapist chair’ and let her write. A few times she asked about spelling, but mostly she sat for several minutes and wrote.
 
I have spent many hours in session with my clients doing things other than talking.  Young children, especially, need diversion from staring at me while I try to assess their mental health.  I have toys, coloring books, art supplies and games in my office.   As a young therapist, I was confused about how playing a game of checkers could be therapeutic.  A wise mentor taught me that we can learn so much about a person by how he operates in the world.   Can he take turns?  How does she do with winning? Losing?  Does he play fair?  Does she get angry and toss the board over?   In playing the game, my goal is to  explore with the client what is triggering his maladaptive behaviors and see if, by talking it through, he can learn to be more mindful about his choices when he is losing a game to a peer in his real world.
 
Coloring is a wonderful activity that coincides with  talking.  Sometimes I will suggest a directive like “draw your family eating dinner”, and sometimes it is free flow coloring as we discuss difficult feelings.  Often, I will color as well, to join with the client (and avoid from feeling like I am staring at them), but my doodles are barely intelligible because, of course, I am tracking the client and his emotional lability rather than creating an artistic masterpiece.  (One very savvy teen insisted that we play chess week after week.  I told her that I could barely manage chess using all of my faculties, certainly not while facilitating a therapy session.  Needless to say, she beat me ever time!)
 
I have also worked with older teens on college essays,
home-school assignments and resume’s .  I was hesitant at first to spend valuable therapy time on a task that should be easily completed at home.  But, with these anxious kids, this was the best way to practice these challenging life skills in a safe environment.  I had a great rapport with each of these clients, so they trusted me to hear their work and gently guide them.  I am also NOT their parent.  Each of these projects could have devolved into angry yelling matches with a parent, but within the therapy session, it was calm, productive, and, by golly, completed! (Providing a most pleasurable relief to each parent who could then avoid the messiness at home).
 
The therapeutic relationship is most crucial in the therapy session.  The success of these less-verbal activities only occurs when a good rapport has been established;  both young and older kids learn that they can trust me to show their true selves be it feeling under confident while drawing or sharing their most personal selves in their writing

Teens and Chronic Illness

5/30/2019

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​I have worked with many teens that have some form of chronic physical illness. Coping with a chronic illness can trigger mental health struggles and can also be an additional stress for someone who is already struggling with depression or anxiety.

The many chronic illnesses that I have come across in my practice include type 1 diabetes, cancer, POTS, chronic stomach ailments such as IBS and gastroparesis, migraines, and menstrual disorders. There are many others, my clients have happened to suffered from the list above.

These kids have a lot on their plates. Some of the illnesses are straightforward and often have quick diagnoses. Others may involve months or years of symptoms, doctor appointments, and medical tests and still an answer is hard to come by. Whatever the case, the teen is not well and can have pain, feel sickly or both.

These students often have increased absences, or might not be able to attend school at all. Often times the school does not understand and may penalize the student. There are other times when the school tries to work with the student, but it is still difficult to learn and keep up with assignments when the student has erratic attendance and does not feel well. Some teachers will send home missed work, but some fail to understand that the student is unwell. Even if the assignment is accessible to the student, he may feel too sick to concentrate and do his best work, which will, nevertheless, be graded and placed on his permanent record.

Some school systems will provide Home Bound instruction for a student who is physically unable to attend school for a long stretch of time. A teacher is sent to the home to provide lessons that have been submitted by the classroom teacher. In many cases this is a simple solution. I have heard about students where it didn’t work so well. One student was taking AP Chemistry and the only teacher that was available for Home Bound taught biology. The teacher spent the hour with the student trying to learn AP Chemistry from online videos so she could then try to teach it to the student. Needless to say, it was not a good fit and the student’s learning and grade suffered.

Input depression and anxiety. “I’ll never get back to school”. “I am missing so much”. “How will I ever have a decent transcript to apply to college?” “I miss my friends”. “ I am missing out on so much!” “I feel awful and I can’t get better”.

These are all real and difficult concerns for anyone, but especially for this adolescent population whose identity is very much about peer experiences. Some teens slip into a depression as the illness continues; they feel worse physically and become more isolated socially. Their peers are moving forward, both academically and socially and it is hard to watch from your sick bed at home. It is particularly hard now when every move that any teen makes is shared on social media.

Parents of these teens are also impacted by their child’s chronic illness. They are worried about their child and obsessively seek medical answers. They miss work for doctor’s appointments and to care for their sick teen and often have little energy to regroup and plan any self-care.

I would not wish this on any family. It is draining, scary and expensive. I have one client who struggled terribly as a teen, but has returned as a young adult with less physical ailments and more resilience to go forward in her life. That fills me with joy, but I know that is not the case for all. Some illnesses are life long and can make quite a dent in one’s quality of life.

Pressure

4/30/2019

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Pressure – I can’t get the Billy Joel song out of my head
“All grown up and no place to go. Psych 1 Psych 2 What do you know?.....I’ll tell you what it means PRESSURE”.

Daily I am sitting with kids, teens, college students and yes, adults, too, that are drowning in a pool of pressure. Grades and schedules and internships and jobs and money, bills and debt. Mr. Joel could write several more versus of his song based alone on woes from my clientele.

I’ve been on the sidelines of many college students looking for summer internships or full time jobs, if they are graduating, and have witnessed the pressure building in their souls. Pressure to have the right position with the right company making the right salary. Sadly, this is after they have basically been under pressure most of their lives; high school grades to get into the right colleges and then college grades to get the right employment (and, of course, don’t forget about graduate school).

Is it all too much? I don’t think I could do enough deep breathing in my office to quell the societal pressure that so many of us are feeling.

How do we handle it? The truth is, relaxation techniques like deep breathing in my office can help with building pressure, as can taking a good look at perspective. Our students often believe that there is one right college and one right job for them. After having spent decades on this earth, I now know that there are many many options for each of these anxious over achievers.

What if the right fit isn’t the most prestigious? Maybe someone can get a great education and make lifelong friends from their second, or even third choice university. And, often the best jobs are with good people and mentors, even if they aren’t Wall Street companies (we see how well that did for some).

It is true, there is an abundance of pressure floating around the halls of our schools and workspaces; but I truly do believe that a worthwhile education and career can occur from readjusting expectations and looking for the best fit rather than the best fancy name

Healthy Minds

4/8/2019

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      I have been a private provider contractor for Healthy Minds Fairfax for about two years.  Healthy Minds works to improve access to mental health services throughout the county.  
    The local high schools and middle school contact me when they have a student who needs mental health services, but doesn't have insurance and/or adequate funds to pay for therapy.  I then contact the family who is entitled to attend eight sessions with me free of charge to them.  
     It has been so rewarding working with these families and students.  Many of the parents speak  little English.  We have enjoyed many a laugh as I attempt to communicate with them from my very limited Spanish abilities.  You would be surprised how well it works and what genuine bonds I am creating with the parents via our minimal shared language.  Healthy Minds does have a contract with translators which I use on occasion, particularly when I need extensive historical narrative from the parent or their is a serious mental health challenge that requires in depth dialogue.
      Most of the clinical work is done with the student.  They report depression or anxiety about their personal, home or school lives.  These teens have fewer resources than many of my other clients and encourage me to tap into other areas of my expertise.  I have found myself putting on my social worker hat and using  casemanagement skills more frequently with my Health Minds clients.  I have coordinated with school social workers, provided some transport to clients, made a home visit and accessed a free bicycle for a client who needed transportation to his job.  
    Other than the concrete ways I have helped these clients, I am also working with them on basic core beliefs that may not have been given to them at home.   "You are worthy and deserving of love" seems to be a common theme that many of my clients have struggled with, but particularly these beautiful souls referred by Healthy Minds.   
     It can be really difficult to start believing in yourself as a teen.  Many of these kids have not known their own worth, being told they are a "slut" or "useless", or sometimes, even more painful, simply ignored.   In my office I see them, I hear them and, for some, this reality is completely foreign.  They often don't know what to do when I emphasize their importance in the world.  Instilling confidence and worth can be seem so simple, yet when you have been taught the opposite, it can be very tricky to reverse.
     After the eight sessions I work to ensure that the teens are in good mental health. Often they are and we terminate without a need for further services.   Sometimes Healthy Minds can grant a few more sessions to solidify the work that has been done.  We also reach into the community to find other services that can help meet these clients' needs.
    This piece of my work has been unbelievably rewarding. Some of these kids have never had anyone to talk to;  my ability to listen and believe in them can make an everlasting impact and for that I am so grateful.
   For more information on Healthy Minds see the video below. Make sure to notice the great acting job of the therapist used for the video.    ​https://www.fairfaxcounty.gov/cableconsumer/node/1439

Suicide in the Spring- does that make sense?

3/27/2019

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The irony of the above quote, it's author and what I am about to say is not lost on me.
Did you know that suicide occurs most often in the spring? This felt counterintuitive to me when I first learned it, but as I put more thought into the rationale, it began to make more sense. Follow along as I explain.
Another long, cold, winter is about to be put to bed. Dark. Snowy, Gray. There has been little sunlight and too much dark, indoor time. Many people start talking about spring in February, there is that whole groundhog thing and people are tired of boots and puffer coats. There is the illusion that spring and light and warmth can make things better. And, for many, it does.
Kids play outside more and can really release their pent up energy. Teens are working hard at their spring sports and often have a new lease on life. Adults, too, are gardening, walking, playing, even chatting with neighbors, or having happy hour on the cul de sac. The tease of summer, no school, beaches and vacation is around the corner and many people have a lighter step, but this is not the case for all.
It is not uncommon to feel low during the dark winter months. With the shorter days, people are grumpy and grow weary of feeling cooped up inside. They are eager for the light to shine more and the warmth to give some relief from the cold winter chill. Those who suffer from Seasonal Affective Disorder begin to heal when the days are longer and they can soak up the Vitamin D that their body so craves.
Not everyone gets the bounce back in their step when April rolls around. and the daffodils begin to push through the freshly laid mulch. There are many who suffer from dark depression who hope to feel lifted in the spring. And they don't. They see others cheering up and sloughing off their winter blues. And they aren't.
​ This can be a dangerous time for some. People with deep depression often believe that their situations will improve as spring comes, but continue to suffer with the heavy, painful burden of depression. When it doesn't lift as they had hoped or predicted come spring, some turn towards suicide as what they see to be their only option. The rebirth that occurs during the spring can make a very depressed person feel even more hopeless.
If you have struggled these past few months or know someone who is struggling, it can get better. The right medication and good talk therapy can truly make a difference for someone who feels like they are at their bottom. The National Suicide Prevention Hotline is an excellent resource for anyone that is feeling desperate, or who just wants to talk or ask some questions. Please don't hesitate to call them, a trusted friend or a therapist if the heavy feelings are weighing you down..
The happy festive quote above was written by Robin Williams who died by suicide in 2014. The message is strong and peppy, and yet, what we now know about his life, depression and, ultimate death makes me pause when reading it. I encourage you to embrace all sorts of joy and party it up this spring with the beautiful nature in our world, but if the depression does not lift, or gets worse, take care of yourself and seek out help

Rowan Tree

3/18/2019

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    Have you heard about the coolest new place in town? It's called Rowan Tree which is a women-centered coworking space.   I don't need actual office space as I have my beautiful office 3 minutes away from Rowan Tree.  What I am enjoying as a community member at Rowan Tree is the "cogrowth" piece of the Rowan Tree mosaic.  That is the part where woman collaborate and connect and it has been a rich addition to my life both personally and professionally.
     I walk into the 'Tree' as I keep calling it and feel like I am Norm walking into Cheers; everyone knows my name, gives me a big hello and, at many events, will even offer me a glass of wine.
     Rowan Tree opened in December and I have been to a cogrowth event almost weekly;  I have done a painting class, a card making workshop, I have been to a documentary viewing followed by discussion, a vision board workshop and several business development presentations.  There is so much happening that I just can't make it to all of the Rowgramming.  They also offer yoga twice a week, short massages once a month and ever-flowing (good) coffee and tea from local shops.
    What does this have to do with a therapy practice?  My motto is "a happy Laurie makes for darn good therapy".  The more I adhere to self-care, be it mental, physical or emotional, the better I am with my clients.  When I am at peace, I am listening deeper and supporting better.  As I instruct all of my clients, we have to take care of ourselves  so that we can be available for others.
        The co-founders, Amy Dagliano and Kate Viggiano Janich, have created a beautiful space with fantastic people.  They have thought of everything; quiet space, social space, meeting space, eating space, lactation space.  Cozy couches, proper tables for working, beautiful decor and even a phone holder in the bathroom.          
    Amy and Kate are not just running the space, they have become my friends;  we check in, share ideas and just laugh.  I have found that all of the members are warm and friendly and  have quickly met many new people.  Meeting so many smart and talented  local women running their own businesses has been truly inspiring.
      If you can't find me at the 457 on Carlisle, peek on over at Rowan Tree, you will probably find me trying to work there, but really just having a warm, fuzzy playdate.

Welcome Back to Me and Hello to Dr. PP

3/11/2019

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    I have been on, well, shall we say, a little blog sabbatical? I've been writing in other places and working joyfully at my practice, but I thought, why not return to to a spot that provides me with a place to express myself and maybe even, help a soul or two  with a tidbit of something, helpful?
    I've been working with many many teens and learning so much from them.  Other than the most trendy fashion, the ins and outs of juuling and how to break down a meme, I learn so much from their sharing.  If this, aging-like-a-fine-wine, therapist knew today what she has learned from her insightful and brilliant young clients, the early 80's would have gone a lot smoother in her world.
  One thing I am learning from these teens is the beauty of being more open and transparent.   I love how so many of my clients are sharing; they say it like it is.  They talk about body issues, bodily fluids and sexuality with an open, freer sense than I remember discussing in the 80's.  It's quite refreshing.  
   I recently learned from one of my teens that there is a show called Dr. Pimple Popper. (I just googled it to make sure I was spelling it right and it popped (no pun intended) right up on the google search. I am clearly late to the game).  I remember feeling embarrassed about pimples, not really discussing them, and if the need occurred, quietly popping them in the bathroom.   These teens are talking and popping and sharing and I find it beautiful. There is less shame and more openness and I believe that it helps these developing young adults to connect better with one another and have a better understanding of themselves.
   This brings up another topic which I will save for another post, the idea of teen connections.    They are all about the phone and the screen and not talking directly to anyone,  but instead texting all of the time, which I do agree has impacted their communications.  But, what I have seen is that there is a level  of connecting amongst teens that is raw and exposed and, honestly, very healthy.
   I can tell from the way they talk to me.  They are often very open and share very comfortably.   They also tell me about conversations that they have had with their friends, and again, it shows a nice openness that makes for strong and close relationships.  These teens talk about their struggles, their sexuality, their vulnerability far better than many adults I know.
   Do they go too far? I don't know. Some may think so; some may not want to know about every pimple, hook-up or suicidal ideation.  I encourage the openness, in an appropriate way of course,  and encourage my clients to keep sharing and connecting with their peers.
    There is more to be said on this subject, but for now I am going to check out Dr. Pimple Popper.....or maybe not.

Yoga Works

1/12/2015

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I have been spending a lot of time at my beloved Beloved Yoga studio recently. A true enticer for me of late has been the warm toasty yoga room on these very cold mornings. I have been doing yoga on and off for a decade; this spring I started up again and I always wonder "why would I ever stop?"

The teachers are fabulous; they are so well educated and proficient at their skill. I have learned so much about the body, the mind, my own strength and potential. I love realizing how I struggled with a certain pose back in the summer that comes so easily to me now and seeing how my endurance has really improved from these months of practicing yoga.

The typical class is ninety minutes. The teachers often give a message in the beginning of class about balance, being in the present or any number of possibilities essential to both being on the yoga mat and living our daily lives. We then warm up, progress into a pretty intense flow workout where I love to really get my sweat on. The class then cools down a bit where we do a variety of still poses and balances. At the end we settle in to shavasana where we lie still for about five minutes and relax.

This 'relax' thing is harder than one might think. When they say relax, they really mean relax; not plan your grocery list, itemize your work to-do tasks or think about calling your mother-in-law. One of my favorite teachers encouraged me to try to feel my heart beat while in this pose. When I am struggling to still my mind, I often focus on his suggestion and am able to slow down and focus on, well, just nothing, which is the intended goal.

As I get in my car to drive home, I always feel really great. Each muscle has had a chance to be stretched or worked so my whole body feels wrung out. And, my mind is always usually perfectly still and calm as well (last week during shavasana, I did have a panic moment when I remembered that my quarterly taxes were due, but otherwise, I tend to achieve a very calm state).

One day the week before Christmas I had gone to one of my favorite morning classes before a client. I rushed home, showered and got to the office while still maintaining my post-yoga calm.

My client arrived in the throes of the pre-Christmas frenzy. There was talk of wrapping and shopping and cooking and extended family. She was feeling anxious and stirred up and I listened. I was still and slow, I responded calmly and from a very grounded spot. As the session progressed, my client began to slow down. She became more calm and peaceful; her speaking slowed and her anxiety decreased.

At the end she said "and this is why I scheduled a pre-Christmas Laurie appointment" (she may have even blurted out "you are a genius" at one point)(to which I just laughed and thanked the yoga teacher).

After the session, us both feeling very peaceful, I shared my "genius" with her.

I told her about my yoga class and my enhanced calm during this particular therapy session. I have known her for years; her sessions are generally on a different day when yoga is not part of my morning. We were both aware and impressed with how the yoga effected not just my state of being, but also my therapy presence and ultimately her state of being.

I have been very conscious of this in my subsequent sessions with all of my clients. I am really aware of channeling this inner yoga calm into the therapy room. What an amazing tool and quite the testament to mindfulness and the calm that is yoga; it does work!

The Pain and The Ache

7/28/2014

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Who remembers when I was going to physical therapy? My wonderful physical therapist, Andre Heletsi, healed my pains and tingles like a champ.

Andre has now opened Missing Link Physical Therapy in Loudon County. It is a unique physical therapy practice that addresses not only traditional physical therapy needs, but also those of athletes and dancers. The team includes physical therapists, personal trainers, massage therapists and a performing arts specialist. Their philosophy is to provide an in-depth assessment and treatment of their patients. Missing Link is a fee-for-service practice so that each patient receives more personal time and attention with their therapist than at an insurance based clinic. Andre's vision is to treat the whole patient - mind, body and soul.

That is where I come in. Andre has invited me to help with the mental health piece. He and I have talked at length about the mind-body connection and how intertwined they are. He is viscerally aware when his patients' physical ailments go beyond the body. Often trauma and stress can contribute to a chronic pain issue or to prolonged recovery from surgery or an injury.

My daughter was asking how my work and his were connected. I explained to her that "he can take away their pain" and she finished my sentence beautifully with "but not all of their ache."

I am currently creating a workshop for Mind Link Physical Therapy; I plan to facilitate a discussion on the tools we can all implement to decrease both our pain and our ache. The date has yet to be decided (which is fine since the workshop is still in its early stages)(get to work, Laurie!), but it will be a free event at the beautiful Mind Link Physical Therapy facility.

I promise to keep you posted.

My Inside vs. Your Outside

6/18/2014

105 Comments

A client's mom recently asked me what I see as the biggest challenge for teens. I thought about all of the work I have done with so many different teens and answered based on what is most commonly discussed in my sessions. As teens walk through the hallways of their high schools they encounter hundreds of peers at each class passing and scrutinize the clothes, hair and bodies of their classmates. These teens see what appears to be 'put together' kids who look happy, confident and surrounded by friends and compare this image to their own inner struggles of anxiety, depression and low self-worth.

I remind my clients time and time again that they are comparing what they feel on the inside to what they see on others' outsides. A teen who is feeling insecure and shy sees a bubbly group of kids walk by and assumes that the bubbly girls are happy and 'perfect'. What the insecure teen doesn't know is that Ms. Bubbly's parents may be getting divorced, she may be failing in school or she may have an eating disorder. Another piece of this puzzle is that as low as the insecure teen may feel, Ms. Bubbly might look at her and think that she has it all together and is stress free.

One never knows what is going on inside of another person or what happens behind the closed doors of what appears to be the perfect home. Too often we assume based on what we perceive to be someone's happiness, and so many times we have assumed wrong.

I have clients tell me that they work really hard to look "happy" at school so that people won't know that they are suffering. I ask if they share their sadness or problems with their friends and most of the time they say that they don't; they don't want people to know, they don't want to burden their friends or it is just easier to not discuss their pain. I'm grateful that these kids are able to open up to me (or rather break the silence after gentle therapeutic coercion; they rarely want to talk to me either). I do wish they had others with whom they felt safe about disclosing their personal challenges.

I have yet to meet the 'perfect' person. I share this with my clients regularly and the notion that everyone has challenges and bad days. It is true that some suffer more than others, but there is no one that is issue- free. Often I use the word "human" when trying to impress upon my clients that no one is perfect. We are all human; we hurt, we laugh, we grieve and we celebrate.

I must say, we grown-ups often fall into the same patterns of comparing our insides with others' outsides. That one has a nice car, great kids or perfect vacations; not so true. Just like with the teens, we adults are not always aware of the struggles that our peers endure. If you or your teen falls into the "compare and despair" habit, try to remember that things aren't always as they appear.