sylvie

May 24, 2018May 24, 2018

Managing Anxiety by Respecting Your Nervous System

Here are things to try if you are feeling anxious. It’s important to notice, as you learn these interventions, how anxious you are so you can calibrate the intervention to your degree and type of anxiety.

Small amount of anxiety= Breathing intervention
If you’re feeling a little anxious, try slowing down your breathing on purpose. This looks like taking a deep breath in through the nose for a count of four, drawing your breath in and letting your belly poof out, then pausing (holding your breath for a couple seconds), then very slowly breathing out through your mouth, pretending you’re breathing through a small straw. (This is a basic mindfulness technique.) Breathing works, but only if you do it in the early phases of getting more anxious. You should aim to breathe for at least three minutes in a row. Use a timer.

Negative thoughts making you anxious=Cognitive Restructuring(CR)
In this scenario, you need to use Cognitive Behavior Techniques to help you rewrite your negative thoughts effectively, so that every time a very negative thought creeps up, you can answer it back with a more positive spin. This too takes practice (and likely won’t help if your anxiety has gotten pretty intense.) Here’s a good quick overview of CR on Psychology Today. Here’s a longer Positive Psychology article covering all the ways humans typically self-sabotage with negative thoughts and several steps you can take.

Slightly larger amount of anxiety=Change setting and go for a walk outside
If you’ve tried breathing and your anxiety isn’t budging, and your anxiety isn’t particularly related to any negative thoughts, try taking a break and going for a quick walk around the block. Walking has been proven to improve people’s moods.

Really anxious=Fight or Flight! (You need to move!)
Next time you have a major surge of anxiety, or a panic attack, remove yourself to safety (if you can) and allow your body to be active. Safety might mean a single stall bathroom in your office building, or going outdoors so you can do jumping jacks, run, jump in place, or whatever movement brings you some form of relief. Follow your nervous system! It knows what it needs. If you’re stuck indoors or in a car, at the very least allow your legs to bounce up and down to release your energy. Your body has mobilized to act, so honor your body’s needs, and give it some safe, healthy action, so the nervous system can return to a resting state.

Basically, the nervous system only has four states: Flight, Fight (both part of the Sympathetic Nervous System–and not within our control) or Freeze (Parasympathetic Nervous System, Dorsal Vagal Complex–not within our control) or be Social (Parasympathetic Nervous System, Ventral Vagal Complex–can be influenced somewhat), let’s work with them!

We tell children to go run and play and spend some energy. I don’t know why we don’t say the same to adults. Same body.

May 15, 2018May 16, 2018

Why is it so hard to say “No” & how to practice

The difficulty of saying “No” has come up again and again with my clients, so I thought I would take a little time to explore what happens to us when we have to choose between “yes” and “no.” Below, you’ll find suggestions on improving your “No” skills.

First, why is “No” so hard to say?

Socialization. Think about it; what are we socialized to say? From the time we are born through a lifetime in the workplace, we are put in situations (with parents, with teachers, with managers) where the only acceptable answer is “Yes.” My sense is that our ability to use “No” gets increasingly compromised over time.
Fear of conflict. Most of us are conflict averse and fear other people’s anger. Most people I’ve met would much rather say “Yes” no matter how uncomfortable, deal with the consequences, and move on than have to explain themselves and potentially get in an argument.
Fear of appearing or becoming selfish. There’s a perception that putting yourself first means you’re selfish, and if you start saying “No,” who knows what you’ll do next, be first at the buffet line?
Fear of hurt feelings. “No” feels much more complicated than “Yes.” We hate to disappoint others, and make them feel bad.
It’s awkward. There’s a lot of reasons why “No” might be appropriate, but it’s awkward to perhaps have to explain what’s happening in our lives.
Knowing you won’t be heard is discouraging. What’s the point in saying “No” when you know that your answer won’t be respected, and you’ll be over-ruled anyway.
Fear of being misperceived as uncooperative or aggressive. There isn’t a lot of education about the distinction between assertive communication and aggressive communication, and the two are often assumed to be the same.
Many of us have trouble expressing our needs and balancing them with the needs of the people we care about.
Venturing into the unknown. Like any new skill set, this one takes time and practice, and can feel a little daunting at first.

How to strengthen your “No”:

First, practice checking-in with yourself when you are asked a question. Regardless of your actual answer, what does that quiet inner voice really think?
Second, slow down your decision-making process. According to Forbes, Warren Buffett says, “We need to learn the slow ‘yes’ and the quick ‘no.’” Give yourself time to really think about the ask.
Take some time to journal daily about your Yeses and your Nos. Understand your primary motivations in agreeing. Do you notice any trends?
Think it through past the initial discomfort. Can you revisit one of your “Yes” decisions and play out what would have happened if you had said “No”? If you had said “No” what would have happened to you, and what would have happened to the person who asked? Would your relationship have endured? How much damage would have really occurred? Where would you be today?
Assume others are resilient (just like you). Most of the time, we weather challenges much better than we would ever have anticipated.
Read up on the differences between assertive and aggressive communication (see below).
Conduct experiments–start practicing saying “No” instead of “Yes,” with very small, simple asks, just to get used to saying the word out loud. After each “No,” reflect on the experience and its fallout. Was it easier or harder than you thought, and why? (This is a classic cognitive behavior therapy approach.)
Create a ladder of progressively harder “No” experiences. Come up with the easiest “No” you might be able to say to a stranger, and then come up with progressively slightly harder “No” experiments. It might start with saying “No” to an offer of a beverage. It might progress over time to saying “No” to a friend over some minor request. It might end with saying “No” to a family member or a partner over a slightly more important request. (This is a behavioral approach: to let you experience a change in behavior, and help you realize it’s not as hard as you thought.)

No takes practice. But it’s a skill we all can improve in.

(This is my first take on the subject of “No,” but I’ll be looking on the web for other perspectives and adding them in over time. And one aside: At first glance [and google search] there’s a lot more coverage of the importance in business of learning to say “No” than there is discussion of it in our private lives. )

Here are some other takes on the topic:

“Why Is It Hard to Say “No” and How Can You Get Better At It?” from Psychology Today

“Why Is It So Hard for Me to Say No?” from GoodTherapy.org

“6 Quotes To Help You Understand Why It’s Important To Say No” from Forbes

“Why Is it So Hard to Say ‘No’?” a video from the Wall Street Journal

“This Is Why It’s So Hard to Say No” from Real Simple

Some takes on assertive communication:

“How to Be Assertive, Not Aggressive” in the workplace, from Psychology Today

“The Four Basic Styles of Communication” from the UK Violence Intervention and Prevention Center

“Assertive versus Aggressive Communication” in business, from NJ.com

February 19, 2018

One Hour Get To Know Me Session

For those who would like to meet with me for an hour so we can get to know each other, but aren’t ready to commit to a full two-hour intake process, I propose the One Hour Get To Know Me Session. We’ll keep the paperwork to a minimum and focus on getting to know each other. Sliding Scale $120-$60.

February 19, 2018

Making Therapy More Affordable

My new sliding scale is from $120 to $60 per session, based on what you can afford, so that we can work together weekly.

I’ve been thinking a lot about how to make therapy more affordable. If you have insurance, since I am an out of network provider, you have to wait for your receipt to be reimbursed. I’d like to have an hourly rate that makes that wait for reimbursement tolerable. I remain committed to finding a fee that you can afford on a weekly basis.

July 20, 2017July 21, 2017

Article: Science and the Many Paths to Healing

I love good science. I particularly love science when it gives me language and a good theoretical framework to support understanding of observable phenomena–and offers new paths to understanding. I’m so pleased I live in an age where brain/mind science and nervous system functioning are being so thoughtfully studied. It’s starting to provide some empirical evidence for stuff that, in other decades, might have seemed witchy or intuitive or wacky. Science tends to take a while to catch up to certain kinds of pre-existing wisdom, and then takes the credit for inventing concepts that were known within wisdoms outside of mainstream medicine/science. One quick example off the top of my head–Cognitive Behavior Therapy is just a fancy name for certain kinds of ancient Greek philosophy and Buddhist mindfulness practices.

All this to say that I’m increasingly trusting the heart, the soul and the body, as well as each person’s creativity, to assist in the mind’s healing process. And also, that while we like to call it psychotherapy and talk about the mind and the unconscious, maybe the mind and the unconscious are fancy constructs (or other types of symbolic language) for heart, soul and body striving together towards unity and self understanding.

Or as my partner would put it, based on a recent Radiolab, if we knew enough about individual biology, we would be able to anticipate 100% of what a person would do (and there is no free will). I see free will working daily in therapy: I think the process of making changes away from your baseline–which is the whole project of psychotherapy–is free will at work. In sciency words: the system trying to re-regulate.

I actually think the biology argument is a silly way of thinking because 1) it’s a tautology–of course everything is a biochemical process at a certain level and yes, the right number of identifiable variables would yield predictive modeling of all human behavior (thank you Asimov for calling that one ahead of time). 2) That’s just one language for describing phenomena. The same way that I prefer to think and speak of traumatized nervous systems that are highly reactive instead of labeling language like a possible diagnosis of “Borderline Personality Disorder.” Both describe similar observable behavioral and physical activation phenomena. However, I much prefer the nervous system science version because it starts to de-stigmatize the experience of those that struggle with their lived experience.

I know I’ve wandered a bit off the map, but I wanted to share what has been on my mind. Here’s my point, or points.

There’s very strong evidence of a powerful placebo effect for therapies people believe in–regardless of the therapy–with patients being able to assess a reportable decrease in physical symptoms (with more complicated questions about the biochemical basis of these reported experiences of healing. Here’s a fun article about a researcher on placebos at Harvard). This means that for some people a Chakra healer, or a crystal energy healer, or a tribal healer will transform their lives.

This belief in a healing system also helps predict whether psychotherapy will be of assistance to our clients. On a certain level psychotherapists are asking clients, “do you want to believe that I can help you?” The answer should be “yes” and that will help shape what psychologists call “the therapeutic alliance” according to the American Psychological Association‘s Education Directorate (fun name, right?).

If you think Chakra work is going to be integral to your healing process, you better work with a therapist that agrees with you. <<[Also, here’s a book that you would like.] Also, I am a therapist that agrees with you.

I’m writing this in support of those who wish to find healing in other domains, or in addition to the experience of psychotherapy. Humans are complex, and the healing experiences we will need to move beyond or integrate damaging life experiences will vary as our own understanding of how we function expands or alters. In my case, my belief system was challenged in a wonderful way by deep healing through craniosacral therapy and I wrote about it here. (Here’s an article about the benefits of the therapy while you receive the therapy.)

I’m becoming a nervous system/brain structure nerd.

Other fun texts:

Think religion should be in the mix? Here’s a fun article about “spiritual intelligence” helping Iranian teens deal with depression and anxiety.
Reiki? (Article from PsychCentral)

July 18, 2017July 18, 2017

The lack of (English) language for existential unease

I was reflecting today with a client on the general lack of language in our culture for discussing the deep discomfort of depression, and its many shades of anguish. There’s not a lot of room, culturally speaking, for recognizing and caregiving for negative self states in either ourselves or our friends. American culture, to make a broad generalization, is all about “can-do” optimism, “pull-yourself up by the bootstraps”, “where there’s life there’s hope” and any number of other pithy sayings that don’t do much for reflecting the nuances of our life experience as humans.

I shared with my client that one of my favorite French expressions is having “le cafard” — which very literally means to have “the cockroach.” It’s used to express struggling with a depressed moment, so I translate it as “having the cockroach of the soul.” [If you refer to online dictionaries, they simplify the meaning and just say it translates to “I’m feeling down” which kind of misses some of the beauty.] It’s totally socially acceptable, in France, when someone you know asks you how you’re doing casually, for you to answer honestly: I have the cockroach.

And people will welcome you sharing the cockroach state of affairs in your soul. They’ll usually answer in kind, something along the lines of “I recently had the cockroach when X happened. It took a while for me to get over it.

In France, no one thinks any less of someone dealing with the cockroach of the soul. It’s understood as a passing state of affairs, that challenges your wellbeing, but with proper care, hot tea or coffee, and long conversations with loved ones, can be overcome in the course of time.

[I’ll concede that the cockroach state generally doesn’t correspond with crippling clinical depression or the inability to leave the bed or shower. However, I think the space for having open conversations about the struggle of life leaves more room for seeking support from your community when the downward slide starts to happen.]

I wish this somewhat pragmatic, somewhat more welcoming approach to the ups and downs of life were more commonplace in our U.S. culture, and that the requirement that we be sunny could abate somewhat. I think we would all be healthier for it. Certainly expecting acceptance when we shared our vulnerable moments with our friends might be a game changer for some.

July 15, 2017July 15, 2017

Treating the Whole Person In Psychotherapy

I’ve been really happy with some of the work I’ve been doing with clients lately and the frameworks I’m using in psychotherapy. I’m realizing that I have a really nice toolbox to work with a variety of different aspects of the human experience. As someone who only feels comfortable when I feel I’ve reached a level of mastery, and someone interested in continuous learning and growth, I’m feeling very lucky about having become a psychotherapist at this particular time in the field.

We’re able to do a lot of really interesting connecting the dots between psychotherapy, the human experience and brain (and other) science–for example Siegel’s notion of interpersonal neurobiology (which makes intuitive and professional sense to me) For example, we already knew that people who have experienced trauma have challenges relating to regulating their nervous systems, and the nervous system’s impacts on their experiences of their brains and bodies. But, more and more, we know why, and we also know ways of providing significant healing experiences at a client’s pace. I’m thinking primarily here of both Brainspotting and Somatic Experiencing, each of which offer approaches that don’t rely on a patient’s ability to communicate using words.

This is a relief for me as a therapist, because I believe that knowledge/feelings/memories are sometimes stored in the brain and body in ways we can’t access with language and conscious thought. We can now do work directly with the nervous system via the body, and with memories via the visual field and the brain/mind. I deeply believe (based on my own life experience, and my experience as a clinician of observing my clients’ bodies during therapy) that as we work to integrate all knowledge about self-regulation and reworking negative experiences, therapists will increasingly treat the whole person. Bringing the unconscious into light and discussing drives, motives and past experiences is necessary and important work, but only part of the puzzle.

I’m really happy to say that I feel increasingly comfortable working with the following different aspects of people’s human experience to help clients. In my case this includes using some of the following approaches/strategies to inform my work:

For concrete assistance with improving client behavioral strategies and negative thinking: CBT.
For reducing overall distress/anxiety: Deep breathing, relaxation methods like progressive muscle relaxation and mindfulness exercises.
For insight: Object relations theory, narrative therapy, relational therapy.
For traumatic memories: Brainspotting.
For difficult body sensations: Sensorimotor Experiencing.
For understanding motivation for changing challenging behaviors/managing ambivalence: Motivational Interviewing.

I’m also a feminist therapist, and I use critical race theory to understand the more damaging aspects of how power works and replicates itself in our society’s functioning. These are also tools for considering the language we use to discuss the “isms” that permeate our lives.

There’s more, but this is a good start. In short, I believe in treating the whole person and helping people develop better coping strategies, experience more positivity in their lives, gain greater peace with their thoughts and bodies, and (of course) gain insights around patterns in their lives and how those patterns were inspired by history and personality.

July 13, 2017July 13, 2017

Article: Recovering from being too sensitive

Have you ever been told “You’re too sensitive?” or maybe told that your emotional reactions were “too much?”. According to Dr. Elaine Aron, this experience is fairly common for children and adults–about 20% of the population experiences life as a Highly Sensitive Person. One of defining features of being “sensitive” is that you might have strong reactions to both sensory and social stimulation. You might need more rest or time to care for yourself. It might take you more time to make sense of your experiences. I find this theory fascinating, because it overlays nicely with the work being done through the Somatic Experiencing Trauma Institute.

There’s already some research confirming that Highly Sensitive People (HSPs) feel emotions more deeply–“that awareness and responsiveness are fundamental features of SPS”–meaning that HSPs will pick up more readily on emotional cues from others, and they will also respond to the emotions they pick up from others more intensely. My professional estimation, based on my clinical experience, (I’m just starting to look into the research findings), is that Highly Sensitive People have a more highly responsive nervous system overall. They take criticism and life experiences to heart, and experience emotion within their bodies much more readily than others. But if they can survive the experience of living in their responsive, compassionate minds and bodies, HSPs can do great things in the world. I particularly like this article from Entrepreneur Magazine.

Here’s another preliminary clinical formulation based on my client population, because they are so exquisitely attuned, unfortunately, HSPs often have challenging childhoods, and difficult teen years, which can impact their overall functioning by the time they are adults. The good news is that the world of psychology is increasingly finding great new strategies for helping those who are highly sensitive calm their nervous systems, through mindfulness strategies, and by incorporating knowledge gained through the polyvagal theory, for example.

So if you feel that your sensitivity has made life more challenging for you than for others, you’re on to something. And if you’re ready to get some support and find a more comfortable way of being in the world, please know that strategies do exist (I’m very interested both in Somatic Experiencing and in Brainspotting) and that I’m ready to do that work with you.

(One of the most exciting aspects of being a therapist is when different concepts come together and suddenly the puzzle pieces fall into place in a meaningful way and you find powerful new language–I’m so excited by this line of inquiry.)

June 19, 2017June 19, 2017

Article: Creating Meaning & Healing Personal Rituals

Is there something you want to celebrate, mourn, think about communally, or notice in your life, but aren’t sure how to go about it? (Lots of meaningful life events go unacknowledged by us and our communities because they don’t fall within the valued and acknowledged cultural rites of passage.) This could be a change in relationship or career status, the diagnosis of a health condition, the loss of a friend or family member, or coming to terms with new understanding about your life’s course. If your usual strategies don’t feel quite sufficient, develop a personal ritual (regardless of your religious or atheist upbringing). Here’s how.

The dictionary definitions of ritual all include two parts and I’m going to add a third:

Acts that have meaning
Carried out in prescribed order
With the right people present (my addition)

Steps to create a ritual?

Acts

This is the biggest piece of the equation. It imbues common activities with intention and power. What do you like to do? Which activities have meaning for you? Let’s say you wanted to mourn someone’s death, or the loss of a relationship. You could engage in acts of remembrance: recognize the many gifts of the relationship, what wisdom was passed down, what now lives in you because of your contact with this person. You could do this remembering by journaling, sharing pictures, playing a song, reading a meaningful poem or passage from a book, telling jokes, or sharing correspondence. You could summon friends and ask them to bring an object from a lost relationship. You could tell them to only bring snacks, or French food, or ice cream, because that is the food you associate with that relationship. Are you letting go or bringing something into your life? You could burn a candle, light some incense, mark an object.

Order

It’s important to have an opening and an ending in each ritual. Do you want the experience to be more active (say, involving dancing), or quieting–encouraging reflection, and maybe solitude? Do you want to move through different forms of celebration and remembrance? What three activities (or more) would be fun to do with the people with whom you will share this ritual?

The Right People

Do you want to do this alone, with a couple friends, or with a larger group? Which people in your life have the capacity to be playful, creative, thoughtful, quiet, or funny in the ways you’ll need to carry out your ritual? Think carefully about who would understand your need to engage in this activity. Consider what kind of support you’ll need and who is best suited to be that support through the ritual. Pick a day and time and invite those people over.

Bringing It All Together

I’m going to share two quick examples of rituals I have previously created and used.

When I was in college, I would mark the end of each semester (meaning the day I finished all my final exams) by taking the dried flowers that I had collected in my bedroom over the course of the semester and throwing them into a rushing river nearby. I would then go to the movies to know I was in celebratory mode (once I got to see Rocky and it felt particularly fitting), and then meet friends for one exhausted drink at a bar.

When I lost my French grandmother a couple of years ago, I was unable to travel back to France for her funeral. So I created a ritual of remembrance and invited friends over. I picked out music that made me think of her. I served some French food. I shared a poem read by Billy Collins that I thought she might appreciate. I showed pictures of her and her home, and my recent visits. I asked everyone present to bring an item that reminded them of their grandparents, and to be prepared to share a story about their grandparents. About 15 people came, and we told stories, and it was a very moving afternoon. Making time for this community ritual helped create some closure–I knew I had honored my grandmother’s memory, had marked the moment and created a new memory.

Why? I wrote this article because I often have conversations with clients where something important has happened to them, but it doesn’t fall within the bounds of activities that are typically commemorated through ritual. This doesn’t mean that a meaningful ritual can’t be created, and I encourage them to do so.

May 8, 2017

Article: Aligning Time and Values

One way to feel greater meaning in your life is to consider what your priorities are, and where you want to spend your time and effort.

The first question you should ask yourself is: What parts of your life to do you want to focus on and grow at this time?

The second big question is: Is the way you are spending time aligned with your wishes and priorities?

The third question is: What future are you building? What seeds are you sowing and what will you reap in 5 or ten years from today’s efforts? Are you moving in the direction of your dreams? (These questions I learned from my mentor: Caroline “Alex” Robboy at the Center for Growth.)

There’s an easy way to assess the first and second questions. It involves creating two homemade pie charts. One for the way you wish you spent your time. One for the way you actually spend your time.

First, write down in a list the parts of your life you care most about (for example: family, friends, career, travel, culinary adventure), then write down things you have to do or are very likely to do (for example: work, sleep, chores, gym time, goofing off with your phone, watching tv).
How many hours a week would you ideally like to spend on each of these categories? Write the ideal number of hours you would like to spend on each of these parts of your life next to each category.
Copy your list of the parts of your life a second time. Then either formally track your time for a week, or guess approximately how many hours a week you actually spend in each category.
Then you do some math. (Here’s a quick model to make it easy). Start with how you actually use your time. For example, there are 168 hours in a week (7X24). If you typically sleep 7 hours a night, that means 7 hours of sleep nightly multiplied by 7 nights a week (7×7)=49 hours a week of sleep. 49 hours a week of sleep divided by 168 hours in a week (49/168)=0.29 or 29% of your week spent sleeping. You can do this for every category. Tip: 25% (or a quarter of your week) is the pie divided in four slices. You can then hand draw your Actual Time Used pie chart, making the slices approximately bigger or smaller than 25%. (Do this process again to build a Desired Time Use pie chart.)

Compare your Actual Time Used pie chart with your Desired Time Use pie chart. Are there any differences? Any places you could cut back? (Less YouTube time, perhaps?) Any places you should increase your time spent? You might be doing the best you can with a lot of different constraints and obligations. However, might you be over-committed? Is every volunteer activity absolutely necessary? Can you reduce any of your commitments. Can you set aside a goal and pick it up again in six months? (In my case, I try to limit the number of therapy-related activities to one or less per weekend.)

This sort of approach is often used in business literature, but I think it clearly applies to exploring our personal values and priorities as well, and making sense of our life in the broadest sense, and maybe changing how we define success. We’re all constantly moving through both time and space, but I believe we get the most satisfaction when we’re using our time with intent and consideration for our authentic self (the person you allow yourself to be when you do what you love or spend time with people who bring you joy.) Whether you get joy from quiet time alone, or from busy time with friends, give yourself the gift of joy.

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