Blog

Midweek Meditation

An invitation to find stillness in the middle of a busy week.

All You Need is Love...Almost

August 28, 2019

This month I will begin Part 1 of a two-part book review of The 5 Love Languages Military Edition. I read the original 5 Love Languages by Dr. Gary Chapman in years past and really enjoyed it. I thought that reading the Military Edition would be particularly useful at this time because I work in proximity to a large military base and thus, interact with a number of veterans and their families on a daily basis, both professionally and personally. It is evident that family life for military service personnel is unique in its challenges due to the potential for long periods of separation the service person must endure from their loved ones. This has an impact not only on the active duty service member who is traveling and/or training, but also on the loved ones who remain at home. I was naturally curious then to learn how one may continue to fill up the “love tank” as Chapman (2013) calls it, despite this barrier. This “love tank” represents the emotional need each of us has to be “filled” with love beginning in childhood. Dr. Chapman’s book is all about how to fill the love tank in your marriage, and, more specifically, how to keep this full in your marriage while involved with the military.

Dr. Chapman identifies 5 love languages that he believes everyone in the world uses whether consciously or unconsciously. These languages include Quality Time, Physical Touch, Words of Affirmation, Acts of Service, and Receiving Gifts. Dr. Chapman insists that these love languages are the means by which we as human beings understand someone imparting love to us and how we, in turn, impart love to others. Dr. Chapman has created quizzes for couples, children, singles, and teens to discover their specific love language. If you would like to know which category you fall into, there is an online quiz available here:

https://www.5lovelanguages.com/quizzes/

I will not focus in this book review on describing these love languages (read the book or check out his website to learn more about these). I would like to instead highlight some concepts that he points out that make a lot of sense to me. Whether or not the love languages resonate with you, Dr. Chapman makes some excellent points in this book that can be generally applied to any marital relationship. He also acknowledges the distinct obstacles that veterans and their spouses face in addressing the marital relationship.

Firstly, the marriage relationship can fulfill a basic human need. Dr. Chapman writes that “At the heart of humankind’s existence is the desire to be intimate and to be loved by another” (p. 26). He suggests that this is why solitary confinement is perceived as the most severe punishment to inflict on a person (p.26). We crave human connection and to experience the feeling of being loved by something outside of ourselves. Perhaps this is part of the reason why military marriages can be so difficult. It would be understandable to lose that sense of intimacy and of feeling loved when your spouse is thousands of miles away with often limited contact for months at a time.

I encourage you, Reader, to consider for this month how this basic human need is being met in your life. Whether you are married, single, military, or civilian, how do you understand and communicate love with others? Are you making an effort to develop this connection with the outside world? What difference does it make to you when you do make this effort? It may be helpful to conduct a self-evaluation and be still.

Chapman, G. & Green, J. (2013). The 5 love languages military edition.

Chicago, IL: Northfield Publishing

The Dog Days of Summer

July 31, 2019

If you live in the South, “Dog Days” is really how one could describe the last few weeks in our climate. The humidity is back and it is taking no prisoners. I hesitate to complain on the Coast due to our typical ocean breeze that makes this heat somewhat more bearable, but it is still fair to say that it has been “hot.” Many of us have been seen running from one air-conditioned oasis to the next in the hope of maintaining some hydration throughout these long summer days. In the middle of my complaints, I would like to stop and consider those who may be suffering from more than just the heat during this time of year.

Not everyone has the ability to enjoy these summer months in the same way as others living in Coastal North Carolina, particularly those of us blessed with central air. I am specifically referencing the homeless population in our state. The homeless rates in North Carolina are truly staggering. According to the United States Interagency Council on Homelessness, 9,268 individuals were estimated to experience homeless on any given day as of January 2018 (Retrieved July 25th, 2019). This number includes 1,163 unsheltered students according to the public school data provided to the U.S. Department of Education during the 2016-2017 school year. I imagine that these numbers have only grown due to the impact of Hurricane Florence on our area in September of last year. This is incredibly disheartening and I am glad that there are agencies out there with individuals working tirelessly to address this issue. After all, how can we ask students to perform if they had to sleep outside last night? There are a number of local organizations working in our area to serve our homeless population:

Share the Table

Website: https://www.sharethetablenc.com/

Assistance Offered: Community Meal, Food Pantry, and Munch Backpack Program

Good Shepherd Center

Website: http://www.goodshepherdwilmington.org/

Assistance Offered: The Day and Night Shelters, On-Site Medical Clinic, Bridge Housing for Veterans, and Soup Kitchen

Vigilant Hope

Website: http://vigilanthope.com/serve-with-us

Assistance Offered: Shower Trailer, Meals, and Urban Garden

I wanted to highlight some unique ways members of our community are working to help those in need, although this list is not exhaustive. There are a number of ways you can get involved to assist your fellow citizens of Coastal Carolina through volunteering, donating, and spreading the word to others who may want to help. First, Reader, I will ask you to be still and consider what you have and how this qualifies you to help those who do not.

United States Interagency Council on Homelessness. (n.d.). North Carolina Homelessness Statistics. Retrieved from: https://www.usich.gov/homelessness-statistics/nc/

Good Grief

June 19, 2019

You may have heard of the 5 stages of grief: denial, anger, bargaining, depression, and acceptance developed by Elisabeth Kübler-Ross (2019). These stages may offer a useful framework for someone coping with a loss as these stages suggest that a grieving individual may experience different feelings and utilize different tools in their processing of this loss. I think it is useful for us to consider that these stages may not be all inclusive, nor do these stages necessarily occur sequentially. I would argue that grief can bring up any number of emotions and that an individual may flow through the process freely, rather than in a prescribed order.

In thinking about the emotional experience of grief, placing boundaries on what we will or will not feel is unhelpful. Adopting a narrow view of what one may feel after a loss may cause the individual to feel guilty or frustrated at themselves for feeling something other than the “typical” emotional experience of grief (i.e. sadness). In reality, someone who is grieving may experience the full range of human emotions! For example, if you have just lost a loved one to terminal cancer, you will likely feel sadness due to your missing them. On the other hand, you may also feel a sense of relief or even happiness because you recognize that this person is no longer suffering from the pain or treatment or their symptoms. Another example of loss that may bring about seemingly opposite emotions would be the loss of expectation. What I mean by this is the individual’s loss of something for which they hoped or expected. Categories may include, but are not limited to, not getting the job you always dreamed of, ending a long-term relationship, or even experiencing infertility. In all of these examples, you had aspirations for your life that did not develop in the way you had anticipated and, because of this change, you may experience grief.

I offer this broad spectrum of potential losses to further suggest that there are no “lesser” losses. Losing a pet for one individual may be as devastating for that person as losing a friend may be for a different individual. When interpreting grief in this way, you do not have to judge yourself for feeling any sadness over your own particular loss, nor do you have to minimize your experience to others. You do not have to say, “I only lost my job” because the reality is, one loss is often convoluted with other losses, so “just losing my job” could mean losing other things including colleague relationships, a sense of purpose, and/or a sense of security.

If grief is so complex, how can it be “good” then? I assert that “good grief” is grief that provides the opportunity for the individual to experience loss in a healthy way. As aforementioned, there are some trends in the grieving process that will resonate with individuals. Observing the stage you are in can be helpful for some in moving forward. For those who do not ascribe to these stages, “good grief” may be experienced differently, but still no less poignantly. Either way, the individual has the ability to reflect on what was significant about this loss and how they may hold onto what is meaningful about this loss. As always, I encourage you, Reader, to consider what you may have lost. I encourage you to process any emotions that may develop for you due to this loss without judgement. I encourage you to be still.

Kübler-Ross, E. (2019). Five stages of grief. Retrieved from: https://grief.com/the-five-stages-of-grief/

Spirituality in Practice

May 15, 2019

I recently provided a continuing education presentation for other Licensed Clinical Social Workers in this area. It was a privilege to be able to discuss a topic that is pertinent to the human experience and, therefore, pertinent to my practice. Spirituality is a topic that can make people uncomfortable. I believe that this largely is due to a misunderstanding of what spirituality means in clinical practice.

The medical community has increasingly adopted the “whole person” perspective in recent years. The whole person perspective addresses symptomology from a holistic point of view. This perspective permits the provider to address illness by examining the whole person including the biological, psychological, and sociological impact on their patients’ lives. In my view, this is liberating for the social worker because we have historically operated from a holistic perspective. That is why case management (connecting our clients to community resources) is always a component of social work. We understand that someone’s symptoms are influenced not simply by the chemical balance in their brain, but also by their physical well-being and social supports, or lack thereof. If we isolate our work to one symptom, we are missing out on opportunities to address the other issues that will work to exacerbate or improve our client’s prognosis. Hence, if we are thinking about treating the whole person, we must consider all of our client’s needs and strengths whether these are related to biological, psychological, sociological, or even spiritual care.

The medical community has developed a term pertinent to addressing a client’s spiritual needs called spiritual distress. Spiritual distress is defined as the impaired ability to experience and integrate meaning and purpose in life through connectedness with self, others, art, music, literature, nature, and/or a power greater than oneself (Alegre, Artmed 2010). There are a number of clients who could meet criteria for this diagnosis because I believe that this definition ascribes to the human experience. Finding meaning, purpose, and setting goals is the primary objective at the beginning of any treatment experience. It is not my responsibility to define goals for my clients. It is my role to help my client identify what is meaningful to them and how to apply this practically to their world often through examination of the self, others, art, music, literature, nature, and/or a power greater than oneself. It follows then that it would be useful for me to adapt my practice to include elements pertinent to addressing my client’s spiritual needs in order to operate from a holistic perspective. This will yield better results for me as a professional and for my clients as this approach will allow the client’s needs and purpose to direct treatment. One remaining challenge is to explore how to incorporate this into practice.

The English "spirit" derives from the Latin "spiritus" meaning “breath.” This implies that, historically, simply observing the breath could mean observing the spirit. Utilizing this definition, I practice spirituality with my clients on a daily basis as being mindful of one’s breath is an effective tool for everyone despite their specific diagnosis.

Reader, I would encourage you to begin here. Begin by observing your breath and consider how this observation may yield the opportunity for you to observe your spirit. As always, in order to do this, it will first be necessary to be still .

spirit. 2011. In Merriam-Webster.com.

Retrieved May 15, 2019 from https://www.merriam- webster.com/dictionary/spirit

NANDA Internacional . Diagnósticos de enfermagem: definições e classificação, 2009-2011. Porto Alegre (RS): Artmed; 2010. P. 452

4/23/2019

Progress is Progress

April 24, 2019

I think it could be useful to examine this thought and apply it to our modern day, fast paced, instant gratification world. I am technically a Millennial and so I am pointing out my own generation’s perceived flaws, however, I would argue that the desire to “have it now” and “upgraded” does not rest solely on my cohort’s shoulders. That’s right. I am invoking the other Millennial Right: I refuse to take responsibility. At least, I refuse to take full responsibility.

The implications of “progress is progress” can be applied directly to mental health treatment. It is natural for people to want immediate, BIG results in therapy. When people begin treatment, they may be in painful circumstances or coping with the aftermath of an earlier experience. It follows then that they would want to attend 1, 2, or maybe even 3 sessions and desire to see symptom reduction. I validate this desire and I also think it is useful to observe that complex symptomology is often complex to resolve. I realize that I ask my clients to make changes to behaviors that they have been engaged in for months or perhaps even years. Behaviors that have been engaged in for years do not change overnight. They may not even change over a month. As I have discussed in earlier posts, the first 2 sessions of most treatment experiences are largely paperwork and historical accounts, so how much change could one realistically make in that abbreviated time period?

It would be helpful then for us to consider how we are measuring success. I think that one can see immediate results in therapy, yet it is useful to recognize that these results may not be delivered to you in IMAX proportions. The results may be small and may develop more slowly than we would like. It would be useful to examine your changes with the understanding that you have just begun the process. You are asking yourself to change things to which you have become accustomed, and you are human. Humans make mistakes. If you did everything exactly right the first time and in that exact manner every time after that, you would be a robot and the robots already have enough power as it is. You can give yourself permission then to be human and give yourself the grace to make mistakes and take as much time as you need to run your race.

Let us consider your journey. If your goal is to learn how to communicate better with your partner and you go one whole day without arguing, you have made progress! If your goal is to get more tasks done at work and you stay away from social media for an entire hour, you have made progress! If you continue to make these progressions, slow or small though they may seem, you will eventually complete your journey. This is a relief because there is likely another journey awaiting you on the other side. I invite you, Reader, to reconsider what is progress for you. I encourage you to consider that you are human and you will change when you change. Even smart phones have to be charged periodically to keep working, so how much more do you deserve a break, a time to recharge, a time to be still?

Out of the Darkness

March 27, 2019

I would like to take a moment to consider what our communities are doing to improve thewell-being of all. Out of the Darkness Walks occur all over the country on a yearly basis and are hosted by the American Foundation for Suicide Prevention (https://afsp.donordrive.com/index.cfm?eventGroupID=9AA117B3-F522-BB6D-359D1AA2D75A7958&fuseaction=cms.page&id=1196). I recently attended a training given by AFSP about suicide prevention and it was a powerful presentation. Surf City had its own Out of the Darkness Community Walk on March 24, 2019 at 1 p.m. in Soundside Park. It was truly touching to see so many of our neighbors joining together to support one another. You can find out more about the local walk here: https://www.facebook.com/Surf-City-NC-Out-of-the-Darkness-Campus-Walk-for-Suicide-Prevention-1862305157337857/?ref=bookmarks.

Talking about suicide is not easy, however, easy things are not always worth discussing anyway. The statistics on suicide are astounding and perhaps more so when we think about the fact that these statistics represent actual human lives. Each person lost to suicide represents an even larger group of human lives. Family, friends, coworkers, neighbors, physicians, first responders, military, and many more are all affected by this issue and yet, we find it difficult to even discuss. I wonder why this is.

It is possible that suicide is difficult to discuss because we fear it. There is still much judgment that surrounds the notion of suicide and those who are driven to consider this as an option. I think we forget, or worse, disregard, the fact that these individuals are, in fact, driven to consider this as an option. They are not motivated to consider this due to some moral failing or intellectual shortcoming. Quite the opposite, individuals who consider suicide are responding to incredible physical, emotional, and/or spiritual pain. I believe that we must discuss suicide, or we are allowing this fear to overpower us.

If you are unsure how to get started, you are not alone. I think the first step as always is to first consider your own personal beliefs about suicide. What are your fears? What are your barriers to doing something? Of course, this will require some introspection, some consideration, and there is certainly an opportunity to be still. In this case, however, I do not encourage you to remain still. I encourage you to consider what is needed, communicate with others, and tell your fears to be still.

Food for Thought

February 20, 2019

Food is one of my favorite topics because it is so integral to my culture. Hah! It is only as important as we make it, right? Although, I will acknowledge that I live in the South and, therefore, food has played a significant role in my life. What do you do when someone has a baby? You bring them a casserole. What do you when someone is grieving? You bring them a casserole. What do you do when someone invites you into their home? You eat their casserole and bring a dessert with you to share. Quite often I hear, “I eat my feelings.” The thing is, this is at least partially true.

What do many of us do when we are sad? We seek comfort. Occasionally, we seek this comfort in food. Macaroni and cheese, brownies, deep fried butter…well, if we are sad and at the state fair, we will eat fried butter. Still, I think we can all admit that we have sought out extra carbs in an effort to dispel feelings of sadness, loneliness, anxiety, frustration, etc., at some point in our lives. I wonder, however, if we have ever considered what this food is actually doing for us. Is there a way to utilize what we eat to make a difference in our mood? Naturally, there is.

What we eat has great meaning for me not only culturally, but also biologically. I am certainly no nutritionist, but I do know that what we put in our gut has an impact on the rest of our experience. Let me introduce you to a little neurotransmitter called serotonin. Serotonin is associated with the regulation of a number of our bodily processes including sleep, appetite, and even mood. Serotonin does not only operate in our brain, as you might think. Serotonin travels back and forth between our brain and our gut because 90% of our serotonin receptors (the part of our body that collects and uses this regulating master) are located in our gut (Naidoo, 2018). Thus, if something is imbalanced in our gut, our serotonin could also be at risk for being out of balance. This could then cause adverse reactions in our sleep, appetite, and our mood. In this way, we actually eat our feelings on a daily basis.

Perhaps it would be useful then, Reader, to consider what you are consuming and monitor how this may be affecting your emotional health. It may be helpful to consult your primary care physician, or even a nutritionist regarding your body’s nutritional needs. You may also choose to peruse some of the literature from educational institutions applying to nutritional psychiatry (https://nutrition.org/food-and-mood-what-is-nutritional-psychiatry/). I will prompt you first to turn inward and ask yourself: what is the food I am ingesting doing to improve my physical, emotional, and mental wellbeing? Are these brownies really going to alleviate my sadness, or would it be useful to pair this comfort food with a food that could help to balance my gut and likewise, my mood? I would never ask you to turn away from the brownie completely because I do not intend to do that myself. I will ask that you take a moment to observe your food, observe your needs, and be still.

Naidoo, U. (2018, December 7). Gut feelings: how food affects your mood. Retrieved from https://www.health.harvard.edu/blog/gut-feelings-how-food-affects-your-mood-2018120715548 You

Self-Care. DO Care.

February 13, 2019

Self-care is a concept occasionally overused and misunderstood. The operational definition of self-care I will employ is a multidimensional concept that includes everything from hygiene to increasing socioemotional wellbeing. I would like to take a moment to recognize the utility of self-care not in spite of the holiday tomorrow, but because of the holiday tomorrow.

I will acknowledge that the modern celebration of Valentine’s Day seems mostly like a ploy for people to expect more gifts from others. In some ways, this is true. Do we really need a stuffed bear holding a heart from our loved one to know that they care? Not necessarily. Still, I think it is helpful for us to consider self-care today for the impact it has on ourselves and others.

I consider self-care as having physical, mental, spiritual, professional, emotional, and relational aspects. Physical self-care includes the traditional practices of hygiene and attending a physician for ailments, but it can also include exercise, eating well, and maintaining a healthy sleep schedule. Professional self-care includes setting appropriate boundaries with coworkers, taking regular vacations, in addition to leaving work at work. That’s right! When you leave your place of business, you can make a concerted effort to STOP working. You can tell your supervisor I said so.

Mental, spiritual, and emotional self-care are often grouped together as one aspect of self-care. I like to separate these into different categories as the activities associated with each of these and the benefits you receive from engaging in these activities are unique. Mental self-care activities can include seeing a therapist or taking a course in an area of professional or personal interest. On the other hand, spiritual self-care could include practicing mindfulness, attending a religious activity, or being out in nature. Finally, emotional self-care is going to appeal to specific feelings you have or desire to have. One might watch a funny movie, read a thought provoking book, or journal about an issue for which they are seeking clarity. There can be overlap in all of these categories, however, they still each serve a specific function in our overall wellbeing and hence deserve special mention.

You may not have heard of relational self-care. Nevertheless, I think observing our relational self-care is essential because this is a mutually beneficial practice. By establishing clear boundaries, maintaining contact with loved ones living far away, and, yes, by buying your loved one a stuffed bear, you are practicing relational self-care. You are making the choice to invest in someone else and this not only benefits you, but also the other person. They see that they are cared for by someone else and are likely to reflect this care back to you. What a healthy cycle?

So, I encourage you, Reader, to consider how you are caring for yourself and others today. If you do not have any one in particular to whom you would give a little stuffed bear, perhaps there are other people that need to see your relational self-care today. Maybe it would be useful for you to practice relational self-care with a stranger. Open a door for someone, smile at your mailperson, or say “thank you” to your wait staff at lunch. Of course, to notice who needs your care and observe the care you receive in return, you may need to be still.

Community Is Not Just A T.V. Show

February 6, 2019

Yes, it is true. I have seen all of Community that was aired prior to the show’s move to Hulu. There were laughs. There was confusion. And there was also truth. Part of what intrigued me about this show was the concept of community and how it can be found in unlikely places. I think community is one of the most important parts of healing and also of the human experience. We are designed to be in community with other people. When we are deprived of community, we may have difficulty reaching our full potential. I make this assertion based on anecdotal evidence I have witnessed and experienced firsthand.

Having a community can provide purpose for our lives. For instance, if my community includes my immediate family, my purpose can be to protect and care for my family. This gives me a focus, separate from my own needs, to tend to and work for on a daily basis. This is naturally a reciprocal relationship, as this small community (my immediate family) is also available to focus on my needs. And I can hear the parents now, “My kids can’t fulfill my needs. That’s not their job.” I agree perfectly. A child is not responsible for the needs of an adult. Still, by virtue of their presence in your life, they are fulfilling your needs. Kids are smarter than we are. They often observe things we miss and if mom or dad needs them to pick up their toys for the house to feel calmer (and to not step on that Lego again!), that is the child’s responsibility. In this way, community gives us purpose and fulfills our purpose.

Community can also provide us with protection. Another example of community includes friendships. If we are actively participating in friendship with another person, they will come to know our presentation (i.e. habits, appearance, temperament). If there is a change in our presentation, our closest friend will be some of the first people to note this change. This friend could then remark on the change and offer means for helping to correct this change should it be unfavorable. This friend could help to get us to doctor appointments, check in with us about medication compliance, and provide a meal for us, in addition to offering other forms of support until we are back to our typical presentation.

A final product of community is the opportunity community gives us to reflect. The people that we choose to surround ourselves with typically reflect what we think of ourselves or who we wish to be. Special interest groups like religious affiliations, professional outlets, or even gyms target specific talents we have and pursuits in which we desire to endeavor. If we take a moment to observe the communities we are involved in, we have the potential to learn a lot about ourselves. This leads me to some questions for you, Reader.

In what kind of community do you find yourself? What purpose does this give you? What is this community giving back? What does this community say about you and who you desire to be? As always, I encourage you, Reader, to take time and consider. Take time to be still.

Stigma. Dogma. Bushwa.

January 30, 2019

I would like to briefly address the stigma that surrounds mental illness and seeking mental health services. I recognize that this is a difficult subject to tackle and that there are more intelligent and educated individuals working to address this same issue and yet, it is something I would like to process as well. I would first like to give credit to individuals and organizations that have striven to alleviate the impact of the stigma surrounding mental health services. There are advocates around the world who attempt to provide support to those seeking mental health services through resources and education to the general public. Perhaps the most well known of these is NAMI. I appreciate what these organizations do to help those in my profession and our clients.

Despite all of the strides we have made, however, there remains a stigma attached to mental health issues and those who would seek to ameliorate these concerns. It surprises me that I still have people suggest to me that they “could probably use therapy, but I’m not crazy.” The implications of this sentiment, even when spoken in jest, are that we as human beings continue to hold onto negative connotations associated with mental health diagnoses and services. We still think on a subconscious level that, “if you are going to a therapist, there must be something wrong with you.” This is, of course, the most benign assumption someone makes about an individual with a mental illness. Unfortunately, we also may still believe that someone with mental health issues is inherently more dangerous than others. This is counterintuitive.

Someone who is diagnosed with mental illness and actively seeking treatment is less likely to be dangerous than previously purported. This is only logical. This individual may better recognize their personal needs and is working towards meeting these needs. Furthermore, someone who is regularly participating in treatment is being monitored by a mental health professional. This person would then likely have more accountability and resources than someone not participating in treatment. I am not surprised that the research agrees with this logic. According to mentalhealth.gov, an individual diagnosed with severe mental illness is 10 times more likely to be the victim of a violent crime than the general population. In other words, someone diagnosed with a mental illness is more likely to be perpetrated on than are others not diagnosed with mental illness.

I am not sure where this stigma comes from, but I think it could be related to antiquated religious dogma that permeates our culture. Some religious tradition previously held that disorders or diseases of the body were related to moral failings on the part of the patient. Thanks to education on the development and spread of disease, these ideas have been largely dispelled in Western culture. Indeed, I do not think that someone would think less of an individual who had been diagnosed with Breast Cancer or Degenerative Disk Disease. We would not assume that they developed these health issues due to “weakness” or another personal failing. So, why would we attribute these qualities to someone with a mental illness? Why do we feel that it is necessary to point out that “we are not crazy” when we note increased depression or anxiety during a period in our lives? I encourage you, Reader, to take a moment and examine your own bias. Consider what you may be subconsciously applying to the notion of therapeutic services and those who seek this resource. Maybe next time you notice these assumptions arise, rather than discrediting those who seek services as “crazy,” you will instead take the opportunity not to judge, but to be still .

U.S. Department of Health and Human Services (2018, August 29). Mental Health Myths and Facts. Retrieved from https://www.mentalhealth.gov/basics/mental-health-myths-facts

Third Time’s a Charm

January 23, 2019

Perhaps I don’t mean “a charm.” I do believe, however, that the third time is the chance. I am referring to the chance offered during a third meeting with a therapist. I have been told on more than occasion that my clients’ third session with me is “their favorite” or “the most helpful” at the beginning of treatment. This is likely true for a couple of reasons.

By the third session, a real therapeutic relationship has begun to develop. I am getting to know my client, better understanding their personality and interpretation in addition to their communication style. My client is also getting to know me. My client can get an idea of my therapeutic style and my client will begin to get a sample of my therapeutic skills through conversation as well as homework assignments I give to them (that’s right, I give homework but, unlike with school, you really do get an “A” for effort).

A second reason for the third session being the most enjoyable at the onset of treatment is because this is the first real opportunity my client and I have to experience “real” therapy. This is the session in which we both do we what is often imagined as a typical therapy session. My client talks about issues concerning them presently and I offer feedback. We both discuss my client’s needs and tangible means for addressing these needs. This is the first opportunity to have a typical therapy session due to the structure of psychotherapy.

It is common practice for mental health services to follow some version of the following structure: Intake, Treatment Plan, Psychotherapy, Discharge. Depending upon your provider or practice, there can be some variance in this sequence, but this is a basic outline of therapy services. The first appointment in my practice is always the Intake.

This appointment involves the client signing the myriad of paperwork that they would complete at any provider’s practice (i.e. demographics, insurance information, signing away your inheritance, etc.). This appointment also includes the biopsychosocial assessment. The biopsychsocial assessment is exactly what it sounds like. I will ask my client multiple questions related to their biological, psychological, and social history to get a comprehensive understanding of what brought them to my office. These questions will inevitably include family history/dynamics, medical concerns, mental health symptoms, among other facets of my client’s experience. This appointment can sometimes be difficult for the client because I am asking them to reflect upon their life experiences and what brought them to my office. In some cases, I am asking people to retell some of the most difficult times in their lives and this may be uncomfortable or even painful for some clients. Nonetheless, this appointment is essential in the therapeutic process. If we do not look at where you have been, how will we know where to go together?

The second appointment is the Treatment Plan. This appointment is where I review with my client their symptoms and my client’s specific goals for addressing these symptoms. I like to set measurable goals for my clients and I like to review this plan frequently to ensure that we are meeting my client’s goals in a reasonable time frame. For instance, if you would like to make more friends, how will you accomplish this? Is it a reasonable goal to state that you will participate in more activities to meet new people in the next month? Or, would you like to learn and implement better communication skills in the next two weeks? Or both? Here again, developing a treatment plan is not usually what one pictures when they think of a therapy session. This session is nevertheless a necessary component in the process of treatment. My client and I must establish goals in order to clearly identify what we will work on together and so that we can celebrate together when these goals are accomplished.

Therefore, there are a multitude of reasons why the third session is so well enjoyed at the beginning of treatment. My client has chosen to trust me with their life’s story during the Intake session and has invited me along their journey for healing by developing a treatment plan with me to improve their wellbeing. This is a privilege I highly value and this is likely why the third session is also my favorite. The good news is that treatment can continue to improve as long as my clients continue to trust the process, trust me, and trust themselves. So, Reader, I encourage you to not get discouraged if your first two appointments are not exactly what you imagined for treatment. I encourage you to be honest and be patient as we begin our work together. I encourage you to give yourself the chance to experience the process. I encourage to be still.

Meditate or Medicate?

January 16, 2019

I am occasionally asked the question: “Do I need medication and therapy, or just therapy?” It is first important to clarify that I am a Licensed Clinical Social Worker. I have no medical license and thus cannot legally make a recommendation for pharmacological treatment. I would have to refer you to a provider who could make this determination. It is secondly important to clarify that I am not you and, therefore, it would be inappropriate for me to abjectly deny that you will ever need or not need to do anything in addressing your symptoms.

I think we sometimes rely too much on the “expert” of whatever service we are utilizing to make our decisions for our care when, ultimately, the choice is ours. I emphasize that I include myself in this “we.” Once you have identified a provider whose opinion and practice you trust, it easy to simply follow orders without asking any questions. After all, this person went to school for this and has been trained to do this. Who am I to question that authority? Nonetheless, a quality I respect in other health care providers is when they clearly explain their knowledge of a particular treatment and then redirect me to make my own informed decision.

All we as providers can do is make recommendations and provide education surrounding your symptoms and what evidence suggests is the most effective treatment regimen. However, each individual is so vastly different, there is no one-size-fits all program. I cannot and would not suggest that your experience is going to be exactly like anyone else’s, nor that you will respond to one treatment in the exact same way as someone else. The good news is that research is so readily accessible to us, we can inform ourselves of the options. With the click of a button, we can assemble thousands of articles surrounding different diagnoses and treatments. It is useful to sift through this wealth of information to find trusted sources of education and then discuss this with your provider to determine the best course of action. If your provider does not have the training for a particular treatment that resonates with you, you have the opportunity to educate your provider, or, to seek out a provider with this training.

Once you have educated yourself on a treatment and begun the regimen, your responsibility is not yet fulfilled. It is further your responsibility to monitor your response to this treatment. Recognizing that everyone responds differently to different treatments, it is imperative that you observe your body’s reaction to a change and to report these observations to your provider so that they can adjust your regimen as necessary. In this way, you will be an active participant in your own treatment. I believe this action is essential is improving quality of life. So, I invite you, Reader, to ask yourself “Do I need to medicate, meditate, or both?”

You don't have to hesitate. Meditate.

January 9, 2019

I incorporate meditation as a part of my daily routine personally and professionally. I use meditations with my clients on a regular basis and some people express resistance when I initially suggest this skill. I get responses like:

“I have never been able to not think about anything.”

“I don’t have time to meditate.”

“I can’t meditate.”

I think the primary issue here is that we do not understand what it means to meditate. It is useful, therefore, to consult an expert on semantics. Merriam-Webster defines the word “meditate” as an intransitive verb meaning:

1) to engage in contemplation or reflection

2) to engage in mental exercise (such as concentration on one’s breathing or repetition of a mantra) for the purpose of reaching a heightened level of spiritual awareness.

When used as a transitive verb, Merriam-Webster defines meditate as follows:

1) to focus one’s thoughts on: reflect on or ponder over

2) to plan or project in the mind: intend, purpose

I am not ashamed to admit that my mental cobwebs have long ago grown over understanding of the distinction between an intransitive verb and a transitive verb (my apologies to my 8th grade Language Arts teacher, you did your best). However, I do not believe that recognizing this part of speech is vital to our understanding these definitions.

I was not surprised to discover that locating the definition of meditate debunked each of the resistant replies I have received against meditating in session. Firstly, the presumption that meditating means to “not think about anything” is in direct violation of definition 1 for either usage. The act of engaging in “contemplation” or “to focus one’s thoughts on” suggests that meditating includes considering, or “pondering” concepts, not “keeping your mind blank” as one may believe.

The second argument, that one does not “have time” to meditate also does not hold up against the definition provided by Merriam-Webster. The definition referring to “intend, purpose” informs us that meditation is an opportunity to explore our intentions or our purpose. If one does not consider purpose on a daily basis, what is it that we are spending all our time doing? Is every act an aimless exercise meant to fill space and time? Does what you do and say every day have a rationale? Is it important to consider that rationale, whether to motivate you to continue in your endeavors? Or, if you find that your activities do not coincide with your intention or purpose, does it make sense to ponder an alternative?

Lastly, the claim that “I can’t meditate” is counterintuitive. Our definition does not describe a specific structure for meditation. The examples included here liken meditation to “concentration on one’s breathing or repetition of a mantra.” If you are telling me that you cannot breathe during the day, we have bigger issues and you may need to consult a physician. Therefore, there appears to be more freedom in the concept of meditation. Indeed, meditation is not about rigidly following a program developed by an expert. It is not about “doing it right.”

This sense of freedom is what I love so much about meditation. This means that meditation is what you need it to be. Meditation can be a reflection of what you did today. Mediation can also be a creation of intention for your day and the possibilities for your intention are endless. Meditation in its most simple and, I think most powerful form, can also be to just breathe. So, this is what I challenge you to do today. If you are willing, Reader, I encourage you to consider, ponder, or meditate on what it means to simply breathe. To be still.

References

Meditate.2011. In Merriam-Webster.com.

Retrieved January 7, 2019, from https://www.merriam- webster.com/dictionary/meditate

What Still Waters Means to Me

January 2, 2019

Hello and welcome to my first ever blog entry! If you are looking for expertise or technology savvy, you may not want to start here. There are plenty of other bloggers out there whose technological knowledge far exceeds my own. On the other hand, if you are considering exploring new ideas or simply interested in taking a midweek break, you have come to the right place! I hope for this blog to be an invitation for you as the reader to ponder, think about, or (you guessed it) meditate on what it means to be still in the midst of a chaotic world. I will offer thoughts about mindfulness and other topics pertinent to my practice and its practical application. This blog is likewise an invitation for me to practice what I preach and slow down long enough to mindfully and purposefully observe the present in an effort to grow and connect with myself and others. Will this blog be perfect? Absolutely not. Will this blog be thoughtful? Absolutely yes. So, without further ado, let us meditate on still waters.

When you think of still waters, what images come to your mind? Perhaps, like me, your mind recalls any number of beautiful beach scenes we on the coast are privileged to witness on any given day. You may imagine low tide at the end of a clear and warm day. You may see the water and note how it reflects the colors of the sunset. For our night owls, you may imagine the water and how it captures the moon and stars in the sky. Finally, for the morning people (I respect you, but I do not understand you), you may see the sunrise as it splits the horizons and melts into the water beneath. You could observe the life living in the waters. Maybe you see birds floating serenely on the surface, or the fish swimming in schools beneath the surface. When the water is still, you may even be able to find a shell nestled in the sand.

In all of these images, we recognize two themes: reflection and peace. I would suggest that this is the importance of stillness. If the waters never grew still, even for just a moment, we would never get to see the sky's beauty reflected. Furthermore, if the waters did not still, the birds could not rest and the school of fish may lose track of a few of its students. I have the same belief about human beings. By not taking the time to reflect, to even be still, what beauty are we missing? How can we experience peace when we are always in motion? What gift might we never discover because we did not observe the quiet waters? I encourage you, reader, as I encourage myself, to simply take a moment. Notice the beauty around you. Allow yourself to experience peace. Observe the gifts nestled in the quiet. Be still.

(910) 622-3418