Therapy during COVID-19 (part 2)

While we may need to stay six feet or farther away from each other physically right now, we also need to find ways to come closer together socially, emotionally, and spiritually. That starts with keeping your mind and heart healthy, so that you are available to connect with and help those around you. 

We all have traits, quirks, defenses, anxiety symptoms that get in the way of connecting. Maybe you experience self-conscious thoughts that prevent you from being fully present when someone is talking to you. Or fear of vulnerability that makes you shove your thoughts and feelings into a box. Each of these things is like a layer in between you and other people. The layers can build up to a thick, tall wall that makes you feel alone even in the presence (digital or face-to-face) of others. 

In stressful times, these defenses can get stronger and make it even harder to feel connected, even when connection is what we need most of all. 

Therapy right now can be a place to talk about how stressful the outside world is. But it can also be a place to look inward and identify what your layers are, and figure out how to peel them back. Use this time to explore your inner world, get to know your layers. Learn more about how to be present with yourself and available for contact with others. Practice giving yourself permission to enjoy what’s happening in this moment without worrying if you are “doing it right” (whatever “it” is). Learn to speak without a censor or filter editing every word. 

You can figure out how to get through this with your mental and emotional health not just intact but improved. Therapy can help with peeling back those layers and being your authentic self right now. And since you are stuck with yourself a lot now, you might as well learn how to enjoy your own company.

Therapy during COVID-19 (part 1)

These are stressful and uncertain times for all of us. 

When you think of going to therapy right now, the first thing that comes to mind is probably getting support for the anxiety and fear that is all around us now. And that is definitely true — therapy can be a space to talk about what’s stressing you out and your fears about the future. But these uniquely stressful conditions are also weirdly creating a near-perfect environment for some people to dive into deep self-reflection, healing old wounds or conflicts, and investing in personal growth. 

Let’s start with the slower pace of life right now. You probably have more time on your hands than you are used to, with no commute, no in-person social obligations, and limiting your trips out into the world. Just having more time alone can make space for self-reflection. In addition to more time, we’re also experiencing a shift into a more thoughtful, intentional way of life. Things we used to do mindlessly — like coming in the door and tossing our keys somewhere — have now become mini mindful rituals where we have to pay attention to what we are doing in order to remember new routines and build new habits. We think carefully about what supplies we need so we can get it all in one trip. We pause to wipe down surfaces and wash hands thoroughly. We have to be more present in the moment and less distracted by multi-tasking. 

These changes can be the building blocks for a deeper kind of mindfulness and self-reflection. You can use those 20 seconds of hand-washing to do a scan of your internal experience: what are my emotions right now? How is my body feeling? Eyes getting tired from a week of binge-watching TV? Give them a break by writing long-hand in a journal. At a loss for what to write? Consider these prompts:

*Many aspects of life feel “on pause” right now. If you could decide what the world would look like when we hit “play” again, what would your ideal world be like? This can help you explore your values and desires. 

*Name five people in your life for whom you are grateful. What do you love about them? Now consider what is challenging in each of those relationships. Are any of those challenges or problems ones you want to heal? What stops you from offering apologies or asking for them in these most important relationships? 

*What did you learn about coping with stress from your family of origin? What are the ways you’ve developed on your own to cope with tough times? Are there coping tools you got from your family that you want to keep, or let go of? What other habits, beliefs, values did you get from your family that you want to hold on to, and what do you want to let go of? 

*What are you the things you are enjoying or valuing about this time of slowing down and staying at home? What do you want to take with you when the pace of life picks back up again?

This time of crisis does not have to be a time of holding in place, just getting by. You can use this time to invest in yourself and your growth. You can use this time to identify what is important and valuable to you, what you want to choose to build or maintain and what you want to let go. Whether you do this through journaling, art, therapy, or a combination of methods, give yourself permission to use some of this time to get below the surface anxieties and feed your soul.

Eight Tips to Make the Most of Online Therapy

Here in San Francisco, we’ve all been “sheltering in place” for at least a week now. We’re trying to settle into the new normal, even as we also expect that things will keep changing and creating a constantly evolving sense of normal. 

Part of that change has been a switch from in-person therapy to online sessions, for me and for every therapist I know. While I’ve had some experience with this mode of working, it’s new to a lot of people and some folks have been encountering some bumps during this adjustment period. With that in mind, here are some tips that could help you make the most out of your video therapy sessions:  

1. Give it a chance. Some people have a knee-jerk reaction to video and shut down the option before giving it a try. Since we’re all stuck with this for at least a couple more weeks (but probably longer), you owe it to yourself to give it a try before writing off the possibility of therapy altogether. 

2. Find a private spot. Negotiate with your roommates for 45 minutes of privacy and relative quiet. Time your session with your spouse’s ability to take the kids for a walk. Put a sign on your door to remind folks not to knock for the next hour. Whatever you can do to make sure you feel safe that you won’t be interrupted and can really dive into the material that matters to you. 

3. Do a test run. If the platform your therapist is using is new to you, spend a few minutes before session checking it out and doing any trouble shooting necessary. Many platforms give the option of doing a test call or checking your video and audio connections and your internet speed to make sure you are in good working order technologically. 

4. Have a “plan B.” If the video call is glitchy or delayed, have a plan in mind or an agreement with your therapist about a back-up (phone, a different platform, etc) so you don’t have to use session time figuring that out. 

5. Negotiate wifi. If multiple people in your house are using internet at once and that’s making it hard to have a smooth session, see if people can stay off streaming services for the hour of your call. 

6. Silence. Take a moment to silence devices you don’t need, turn off phone or laptop notifications that will distract you, close browser tabs, etc. When the session is going, maximize your video screen so you can’t see other programs, apps, or browser tabs. Support yourself in staying focused on just your therapy session. 

7. Create a pre-session ritual. Once you have all your technology and privacy needs taken care of, try to take a few moments to get yourself centered and into a therapy headspace. Take a few deep breaths, experience the quiet, review your journal for the week, think about how you want to use your session time. 

8. Revisit your goals. While you might feel compelled to talk about your COVID19 anxiety for some or even most of your session, you don’t necessarily have to pause your longer-term therapy goals during this time. The slower pace of life, the extra time now that you are doing less, the global focus on individual and communal health — these conditions can actually create an environment for some deep therapy work to thrive, even on video!

The problem with text therapy

You’ve probably seen the ads for Talkspace, Betterhelp, and other digital therapy services meant to “disrupt” the therapy world. Maybe they even sound good to you — a bargain price, and access to your therapist whenever you want instead of at a set appointment time each week.

But with anything, there’s a shadow side, a catch. There are a lot of problems with these services, including issues with privacy and confidentiality for clients, and serious concerns around professional ethics and compensation for therapists. On top of all that, I seriously question whether any effective therapy or personal growth work can happen via text.

 

Getting Out of Your Comfort Zone

Text therapy probably sounds pretty comforting, easy. Less intense and nerve-wracking than face-to-face interactions. You don’t have to make eye contact. You can just stop responding for a while if you feel overwhelmed or annoyed or done. You don’t have to see the impact your words, tone, or energy have on another human being. All the same reasons you probably prefer to text friends or romantic partners instead of talking on the phone or seeing them in person. It’s easy, and you don’t have to get outside your comfort zone.

The thing is, therapy is meant to a place to grow, heal, and change. And by definition, you can’t do that if you stay in your comfort zone. If therapy is easy, comfortable, and allows you to wiggle out of uncomfortable feelings and situations, then you aren’t getting what you need out of the process.

Therapy isn’t meant to be horribly uncomfortable either. There’s a productive window, just outside your comfort zone but before you get flooded with anxiety and become unable to think. Negotiating that place with your therapist is part of the process, part of the important job of getting to know yourself better, knowing when you are getting overwhelmed and how to calm yourself down. This is a very useful skill to have in life, in job interviews, talking to strangers at parties, and a million other situations. If you are always avoiding getting uncomfortable, you never learn how to do this. You stay stuck.

 

Words Are Only Part of the Picture

Text makes it hard for you to do your work, and makes it hard for us therapists to do our work too. Text is a very limited form of communication. As a therapist, I am looking at ALL the ways you communicate with me, not just the words you choose. I’m listening to your tone of voice, the pace at which you are speaking, the energy behind your voice. I’m paying attention to your body language, eye contact, and the way you gesture and move. I put all this together to form a complete picture of what’s going on for you in every given moment.

I can’t tell you how many times someone’s words said something very different than their body was saying, and being able to call my client’s attention to that and explore leads to huge breakthroughs and changes. That can’t happen over text. The truth is, therapists need to actually see your body language, hear your tone of voice, to be able to diagnose you and to provide effective treatment.

 

A Time and a Place

Without a doubt, for some people in some situations text “therapy” can be a good thing. If you are unable to access any other form of mental health care for instance, or if you truly are only looking for someone to just listen. Peer support text programs provide a wonderful service, a way to be understood and feel less alone.

But if you are actually looking to address real mental health concerns (for example, depression, anxiety, or disordered relationships to food, drugs, sex, etc.), text therapy is not going to cut it. And if you are looking to actually push yourself to grow as a person, change unhealthy patterns in your relationships, work, and life, texting someone is not going to do the trick. Texting is easy, and easy does not bring about change.

“OMG I’m such a perfectionist!”

If you have ever uttered this humble brag, or heard your teen child or student say it, check out my guest appearance on The College Prep Podcast to learn why this is not a good thing.

Tune in to hear more about:

  • What perfectionism is and isn’t
  • What the underly beliefs are that provide the root of perfectionism
  • What behaviors are signs of unhealthy perfectionism, and
  • What teens and parents (and everyone!) can do about perfectionist tendencies, including when to address the behaviors versus the underlying beliefs

163: Why Perfectionism in Teens Is Not Always Healthy

Feeling more stressed than usual? You’re not imagining it.

If you’ve been feeling stressed, tense, overwhelmed these past months, you are not alone. A recent survey by American Psychological Association found that Americans are more stressed than we’ve been — or at least since this survey started in 2007. The current political situation, the near-constant news updates, conflicts on social media, and the fear and uncertainty about the future have all created a sea of stress… and some of us are barely keeping our heads above water.

This stress can hit in a lot of different ways. Perfectionist types — prone to obsessive thinking, self-criticism, and anxiety — tend to feel it in the following ways.

 

Problem: Obsessing

If you are prone to anxious ruminating, politics can become one more thing stuck in your brain. You can find yourself obsessively consuming news or social media, and endlessly thinking, thinking, thinking about what’s happening or what might happen next. In the sea of stress, these intrusive thoughts are like a rip tide that can pull you under, and you find yourself unable to focus on anything else or get to sleep.

Solution: Limit news and social media. Set a schedule for when you can read or watch and when you can’t, and stick to it. Use an app to lock yourself out of your phone if you worry you can’t hold yourself to it. Come up with three things you can read, watch, do, or think about instead — things that have nothing to do with politics. Keep a book of short stories on hand, watch an old tv show, plan inventive dishes to cook for friends.

 

Problem: Feeling powerless

Perfectionists often struggle with self-criticism or feeling “not good enough.” When that combines with politics — especially political activism — the result can sometimes be a sense of powerlessness. No matter how many calls you make or marches you attend, your inner perfectionist voice tells you it’s not enough. You beat yourself up for not doing enough, not being effective enough. Your inner perfectionist might think this criticism is the only way to motivate you to stay active, but in reality, feeling terrible about yourself leads to burnout and apathy.  

Solution: Set realistic expectations, and find a sense of fulfilment and satisfaction in whatever actions you take. There are a hundred organizations to support, dozens of calls to make, and an impossible number of events to attend. Decide for yourself what is actually realistic, what you can manage. When you accomplish your task for the day or the week, take a moment to feel some satisfaction and pride about what you did. I don’t mean feel full of yourself or think you are saving the world by calling your senator — I mean letting yourself get energized by feeling effective and engaged in something you care about.

 

Problem: Overwhelm

If you are sensitive or anxious in general, swimming in the sea of stress is even more exhausting for you than for others. There may not even be specific thoughts running through your head, you may just feel drained by the atmosphere of anxiety around you. The feeling of overwhelm can easily lead to collapse, giving up, or feeling depressed.

Solution: Engage in self care. Know what recharges you and make space for that in your life, so you have energy for action too.

What’s the Point of Feeling Emotions?

What’s the point of feeling emotions? Especially ones you might find difficult, distasteful, even scary. You might be thinking, “I don’t want to wallow in sadness,” or “I don’t want to get stuck in anger and not get out of it.” We have a lot of fears about emotions, and spend a lot of time trying to dodge, distract, or avoid feeling things that we’re worried will overwhelm or harm us.

Emotions serve an important purpose. There’s a reason they’ve stuck around through the process of human evolution. Emotions tell us when and how to act — to run from danger, stand up for yourself, connect in grief.

There’s an important distinction here, between core emotions — which bring us this wisdom about the world and how we want to respond to it — and defensive emotions — which take us down a rabbit hole of anxiety or feeling stuck.

Likely you’ve experienced this with a good cry… You feel hurt or sad, tears come and then stop, you reach out to a loved one to connect, you exhale a big sigh and feel a little lighter, relieved. You might not be done with your grief or hurt — another wave or waves might come later. But for the moment you feel complete and are ready to move on to a new experience — maybe a moment of laughter or joy, maybe peace and calm. That’s an experience of core emotion.

Contrast that with a time you felt stuck in your emotions… Maybe you are trying really hard not to feel sad, but you can’t really get rid of it. It is always nipping at the edges of your awareness, and as a result you feel down all the time or maybe even slip into a depressive episode. Maybe you are trying to suppress your anger, and then you end up feeling low-grade irritation constantly until you snap and explode.

Another common experience of defensive emotion is when you cover up what you are really feeling with something that’s easier for you to express. For some people this might be feeling hurt or sad, and covering it up with anger (“whatever, I didn’t like her anyway, she’s awful”). Other people might feel uncomfortable with anger and mask it with sadness (“He stood me up and I feel like such a loser, I suck”).

So how can you tell the difference?

Core Emotions

  • Embodied – there is a physical experience of the emotion (muscle tension, tightness, lump in throat)
  • Relatively short – last seconds or minutes generally
  • Movement – they rise and fall
  • Relief or sense of difference at the end

Defensive Emotions

  • Stuck in your head, racing thoughts
  • Persistent – don’t seem to come to an end
  • Ruminating – thoughts that run in loops, endlessly repeating
  • Stuck – don’t change over time or end

If you notice you are feeling defensive emotions, try sitting still for a moment. Ask yourself, are there any other emotions I am feeling other than this stuck one? Is there hurt under this irritation? See if there is some real grief, hurt, sadness that needs a moment of feeling. Or is there anger that wants to fuel effective action on your behalf? See what it is like to make some space for core emotions.

So what is the point of feeling emotions? The point is to get in touch with your internal compass that is telling you when to run, fight, connect, breathe. To connect to yourself and to others, to feel alive and resilient and in motion, rather than constricted, overwhelmed and stuck.

It’s OK to Be Angry and Sad Right Now

Emotions are running high post-election. You may be feeling disappointed, shocked, scared, angry, or saddened by the results on November 8.

If you’re like me, you’ve heard a lot of well-meaning people trying to talk you out of your emotions. I’ve been told I need to stop feeling sad, or that being angry won’t help. I’ve been encouraged to wait and see, that “it’ll be OK.”

But I’m here as a therapist to tell you to ignore all that. Your feelings are valid, understandable. And they are important! Core emotions* have what we therapists call “adaptive action tendencies” attached to them. That means that an authentic emotion, one that is coming from your gut, is propelling you to DO something. Grief and sadness urge you to connect to loved ones. Anger energizes you to take action to help yourself. Fear motivates you to fight or flee. Emotions have stuck around through evolution because they serve a purpose. They tell us when and how to act. Sure our thoughts do this too, but emotions bring different information and urges (and also work a heck of a lot faster than thoughts, which is especially important in life-or-death situations).

So listen to your feelings, and what they are telling you. Do you need connection? Do you need to take action? Do you need to do something to protect yourself or your family? Engage your brain, your thoughts, to figure out what to do with the messages your emotions are sending. Think about what friends are the right ones to reach out to, or where you can connect with community for comfort. Engage in activism. Do you need to call or write your government representatives to express opinions, volunteer for an advocacy group, participate in a protest, or make a donation?

A caveat – our emotions are useful only when they are regulated and manageable. When your emotions get so intense that you are overwhelmed by them, it gets really hard to make wise choices about what to do next. When you’re overwhelmed, you may collapse, panic, or sprint into action in ways that aren’t effective or at a pace that leads to burnout. So if you are overwhelmed, take a minute to regulate. Try some mindfulness and resilience tools. Talk to a therapist.  Get some exercise. Once you are back in a place where you can feel your emotions and think at the same time, you are ready to start listening to your emotions again.

So feel your feelings. You can’t really stop yourself from feeling anyway, so you might as well accept your emotions and find the strength and wisdom in them.

* Core emotions are your true, authentic emotions, the ones coming from your gut and giving you wisdom. As opposed to “defensive emotions” which are cover-ups… like when you snap at someone in anger but underneath you are really hurt or sad. 

Procrastination vs. Resilience

My new book, The Perfectionism Workbook for Teens, is available now! To celebrate, I am running a five-part series highlighting some concepts from the book. I’ll talk about some different ways perfectionists struggle, and offer some tools for change. (By the way, although my book is technically aimed at teens, a lot of the tools work for adults too, and these blogs posts will focus on ideas for grownups.) This is the last week! I have procrastinated writing this post until the last minute, because it is about procrastination.

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When faced with a challenging project or daunting task, perfectionists want to envision an unobstructed path towards certain victory. You want to imagine every step of the plan, anticipate every possible challenge and how to overcome it, and clearly see a “perfect” outcome before you start taking any action.

This can lead to a common perfectionist habit: procrastination. You put off getting started on that important project, because we haven’t completely thought it through yet. You have it on your to-do list to get started this afternoon, but then your inner perfectionist says, “Do a little more research first,” or that part might anxiously wonder, “What are you gonna do if X happens?” And then you’re back to the planning and preparing, putting off getting started for another day. Or week. Or year.

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Six Steps to Death

My new book, The Perfectionism Workbook for Teens, is available now! To celebrate, I am running a five-part series highlighting some concepts from the book. I’ll talk about some different ways perfectionists struggle, and offer some tools for change. (By the way, although my book is technically aimed at teens, a lot of the tools work for adults too, and these blogs posts will focus on ideas for grownups.) This week’s post is about catastrophizing.

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Catastrophizing is one of those things that can stop you before you get started, take a perfectly good idea or ambition and make it vanish into thin air. What happens is this: you notice a desire to say, write a blog post. Immediately your inner perfectionist starts weighing in with its worries and predictions… you don’t have anything original to say… your writing isn’t good enough… you’ll embarrass yourself… no clients are going to call after reading this crap… your career with wither away… you won’t be able to pay your bills… you’ll end up penniless and alone. Now feeling anxious and hopeless, you close your laptop and walk away. No blog post ever gets written.

What the hell just happened?

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