You Are A Gift

iStock_000018620938_Medium-500x333Earlier today I was speaking with a fifteen year old girl in our juvenile detention center. She is experiencing depression and is 6 weeks postpartum so I was concerned about her. As we talked, I started to understand some of the sources of her depression.

During our session, she revealed that her mother also gave birth to her when she was fifteen and that her biological father has been in prison since she was three years old. Her mother is currently married to a verbally and physically abuse man that she feels her mother places before her in order of importance, attention and affection.

As this young lady and I talked, she described how she grew up feeling like a burden to her young, single mother and how after her mother had other children and multiple boyfriends, she was always made to feel like she was “in the way”.

It became very apparent that this young woman, consciously or unconsciously, had a baby at fifteen years old, partly so that she could have someone in her life that didn’t make her feel like a burden, but gave her the unconditional love she has been yearning for. However, due to her own psychological damage, she now sees her 6 week old baby as a burden and if she doesn’t learn to change the way she views herself, she will pass on that damage to her child.

What I discussed with her this morning and will try to instill in her is this:

We are the greatest gifts we can ever give ourselves. We are also gifts to other people and the Universe. Our children, if we have any, are also gifts.

Too many people grew up being made to feel, even as children, that they were a burden. Maybe they were born to parents who themselves were brought up in painful situations where they did not truly know how to love and appreciate others.

Maybe their parents conceived them as a resolution  to fixing a broken relationship or “save” a troubled marriage. Maybe their parent expects them to be their caretaker, or they were simple born during a difficult time of their parents lives and they were never able to be truly enjoyed, loved, appreciated and viewed as precious gifts as children.

Many of us have grown up never feeling truly accepted and carrying these feelings on unconscious and conscious levels that we were and are a burden.

This is how people can fall into a deep depression or become suicidal, thinking that the World would be better off without them.

This type of thinking is what keeps people from truly connecting with other people on any level or truly enjoying life.

Because of this they end up beating themselves up all the time with negative self-talk, not appreciating themselves, walking around apologizing for themselves, feeling like other people know better and are better than them.

For those of us who have received this terrible message growing up, it’s time to change it.

You are not a mistake. You are not here by accident. You are here because we are supposed to be here.

Our lives have purpose and intention.

We don’t have to apologize for being here or for being ourselves. We don’t have to beat ourselves up over our past mistakes or experiences that have helped create who we are now. We don’t have to be ashamed, apologetic or doubt the beauty that is our unique selves.

We are not a burden and if our parents are the ones who tried to put that on us, it’s time to recognize that it is their issue and not ours. We don’t have to carry that with us. We can let it go.

We are precious gifts and today we will start treating ourselves as gifts to others, the Universe and especially ourselves.

We All Need To Practice Emotional First Aid

istock0000179371As a mental health professional, I have found myself spending a lot of time trying to convince people that they need to take care of themselves mentally and emotionally. Meaning, I run into people who are working two jobs, taking care of their family and everyone else around them, but are letting themselves go mentally and are getting sicker and sicker over time.

Or, I meet someone who is obviously not dealing with various issues in their lives, probably hoping that ignoring them will make them go away, but all the while they are growing emotionally unhealthy.

It reminds me of when a parent would bring a child in to see me for therapy and it would become apparent pretty quickly that it’s the parent that needs therapy, not the the child. Many times the parent would like at me as if I was crazy. They couldn’t see that their own neurotic behavior, substance abuse or even past childhood issues are creating the “problem” they are prescribing to their child.

It’s easy to tell when someone is physically not doing well, but it’s not always easy to tell when someone isn’t mentally doing well, especially when it comes to everyday things like anxiety, depression and self-esteem. Things we all deal with from time to time.

I have a sister who at one point was working a very demanding job, raising a challenging teenager on her own,  volunteering her sparse free time to multiple organizations and if that wasn’t enough, she was trying to help every friend that called and needed something from her.

On the outside she looked ambitious, energetic, like a true type A-personality. On the inside she was feeling overwhelmed, flustered and fragile.

One night, while having dinner with our family which should have been relaxing, seemingly out of the blue she had what some would call a nervous breakdown. She started crying, hyperventilating and felt as though she was going to lose control of her mind. I could look at her and tell she was having a classic panic attack, but she was too far gone to hear me and was convinced she needed medical attention.

Soon afterwards she was diagnosed with an anxiety disorder and was told to cut back on the million and one things she did in her day to day life to take care of other people and to start taking care of her own mental health, something many of us don’t do enough of.

Sometimes I even catch myself too caught up in work, life and everything else and before I realize it I am dealing with some type of anxiety, insecurity or dysthmia. I have to slow down, stop myself and figure out a) where is it coming from and b) how do I take care of it. Often times for me the solution is simple awareness and acknowledgement that something is bothering me. Other times it takes journaling, reading something inspirational or processing my feelings with someone I trust. I’m usually that person for everyone, but sometimes I need someone to be that person for me.

It doesn’t always have to be something major and it doesn’t always take a therapist, but sometimes it does. Sometimes it’s simple mindfulness, meditation, or getting out and having some fun, but many of us have no real idea of what it means to administer emotional first aid to ourselves which is why I included this Ted Talk by Guy Winch: Why We All Need To Practice Emotional First Aid

Being A Psychotherapist: Things School and Books Can’t Really Prepare You For Part Two: Suicidal Clients

Another thing school and books can’t really prepare you for are suicidal clients. Sure they cover the subject of suicide in graduate school, but the training of dealing with suicidal patients is usually very brief. There are many great books on working with suicidal clients and I have read a few, but I don’t think anything can really prepare you for sitting face to face with and working with a suicidal patient.

From my experiences, there are many types of suicidal clients and they all have to be taken seriously.

There’s the client who doesn’t really want to commit suicide, but they like to self-injure and that self-injurious behavior may lead to an accidental suicide. These are often the most common types of clients, often called “cutters” and they tend to be the most frustrating since a lot of them have cluster b type personality disorders such as borderline personality disorder.

When I worked in a high school I had a whole group full of students who self-injured and ended up involuntarily hospitalizing at least one every month because while they said they weren’t suicidal, they were definitely at times flirting with death.

This picture was taken of one of my former students who likes to cut. The next day she had twice as many cuts on her arm and I was forced to involuntarily hospitalize her.
This picture was taken of one of my former students who likes to cut. The next day she had twice as many cuts on her arm and I was forced to involuntarily hospitalize her.

There’s also the suicidal client who is extremely depressed or emotionally unstable and talks about death and suicide a lot. They typically don’t self-injure and have never tried to commit suicide and don’t think they ever would, but they talk about it so often and their emotional pain is so deep that when they leave your office you often wonder if this will be the last time you ever see them.

These type of clients can also be very stressful to deal with. Often when I have had clients like this I found myself worrying about them when I wasn’t even at work, when I was on vacation,  when they didn’t show up for an appointment and sometimes I even dreamt about them.

One patient in particular was diagnosed with a terminal disease and she didn’t want to die a slow death. She didn’t think she would kill herself, but all she talked about was death and dying and her depression was so deep that it was hard to not be concerned about her when she missed an appointment. Eventually I had to hospitalize her after one particularly draining and emotional session when she couldn’t promise me she wasn’t going to go home and try to kill herself. Everything inside of me was screaming she would. She was angry that I hospitalized her against her will, but told me in later sessions that she had every intent of going home and killing herself that day and thanked me.

Another type of suicidal client is the one who never talks about suicide. Some are impulsive, but many just keep their thoughts and feelings buried deep inside.  They may never even tell anyone that they are in pain. They just attempt or commit suicide without any real warning signs. These clients take not only you by surprise, but everyone else in their lives too.

I once worked with a student for two years dealing with the grief of a parent and then one day he gave me a card thanking me for helping him. It was our last session, he was doing great. Less than a week later I got a call from his family telling me he had attempted suicide and was in critical condition at a local hospital. I was stunned. I rushed to the hospital and nearly broke down in tears as I looked down at his lifeless body. I kept replaying our last sessions together, our last interactions, his last words to me, trying to figure out what did I miss. Thank goodness he came out of his comatose state after a few days and I was grateful that he not only lived, but that I had the opportunity to process his suicide attempt with him. I didn’t miss anything. He had suddenly decided he didn’t want to live any more and wanted to be with his deceased parent.

A couple of years before that I had been part of a crisis team that was sent to two different schools after two students had killed themselves apparently out of the blue. One was a popular jock that killed himself and stunned the whole community because no one, not even his closes friends knew that he was in so much emotional and psychological pain. His friends, family and even school staff members were blaming themselves for not seeing signs that weren’t even there.

The other student apparently killed himself on impulse in the midst of an angry dispute with his girlfriend. He told her he was going to hang himself. She didn’t believe him, but that’s exactly what he did. He had no history of being suicidal and no one saw it coming.

In my nearly 8 year career as a psychotherapist I’ve dealt with hundreds of suicidal clients. My main job right now is interacting with inmates who have been flagged as suicidal. Luckily I have not had one client commit suicide although I have had a few who have made serious suicide attempts landing them in the emergency room.

Studies suggest that:

  • 1 in 4 interns/trainees will have a patient who attempts suicide at some point during their training and 1 in 9 will experience a completed patient’s suicide.
  • 25% of psychologists and 50% of psychiatrists will experience a patient’s suicide.
  • 1 in 6 psychiatric patients who die by suicide die in active treatment with a healthcare provider.
  • Approximately 50% of those who die by suicide in America will have seen a mental health provider at some time in their life.
  • Work with suicidal patients is considered the most stressful of all clinical endeavors. One third of psychotherapists who experienced a patient’s suicide subsequently suffer from severe emotional distress. Several factors may contribute to such severe distress including failure to hospitalize a suicidal patient who then died; a treatment decision that the therapist may feel contributed to the suicide; negative reactions from the therapist’s institution; and the fear of a lawsuit by the patient’s relatives.
  • 25 % of family members of suicidal patients take legal actions against the patient’s mental health treatment team.

As a coincidence, just as I was finishing this post I was informed that an inmate just purposely swallowed 18 Ativan pills in an attempted suicide and is being rushed to the hospital.

Being A Psychotherapist: Things School and Books Can’t Really Prepare You For Part One: Mental Fatique

iStock_000024633998Medium-744x418To be a psychotherapist takes years of school and a lot of reading and writing about various aspects of human behavior. Many students fresh out of school with not much patient contact or real therapeutic hours under their belt, think that they fully know what it is like to be a therapist. They don’t. While school and books definitely prepare you for sounding like a trained therapist, nothing but real experience and hundreds of hours of patient contact, can prepare you for even the basics of what it’s like to be a therapist.

Many people who see me doing my job say, “I want to do that” and I never discourage them. I just tell them that if they are doing it from their hearts then they should pursue it. If they are doing it because they think it pays well, then they should seek another career. If they are doing it because it looks easy, then they should definitely seek another career. Even students who have spent years in undergrad and then graduate school are disillusioned and thus disappointed when they actually start seeing clients of their own. A few, those meant to truly be in the field, will love it, even when it’s frustrating. Others will hate it, but stay because they’ve fooled themselves to believe they are supposed to be therapist, and most end up becoming very bad therapists… or program directors. A large portion will leave the field altogether and seek employment that is more fulfilling and they should.

So what are the things that school and books can’t prepare you for when it comes to being a psychotherapist? Well I will cover one topic every now and then instead of trying to cram a top 10 list, but we’ll start with mental fatigue.

Being a psychotherapist is exhausting. Sure it’s not the same as lifting bricks all day, but it’s a different kind of exhaustion. People will say, all you do is sit and listen all day, how can that be exhausting. Well actively listening, being thoughtful, sustaining alertness, using your memory and paying attention to someone for 50 minute stretches throughout the day is very draining. Not to mention the stories you hear and have to process. Stories that are sometimes so sad that you have to hold yourself back from tears, or stories that trigger counter-transference issues because they remind you of some part of your own life.

There is also other things that make it taxing such as doing notes, scheduling, dealing with insurance companies and billing. There’s also that part about managing risks, having to figure out how much of a risk someone is to themselves or others. My main job right now is assessing suicidality in inmates who have exhibited a risk for suicide. It can become very stressful.

On top of that, sometimes your friends and even strangers who meet you and find out you’re a psychotherapist will treat you differently.

Strangers will either be fascinated and want to tell you about their problems, or a “friends”, or they will not talk much out of fear that you are always analyzing people. We do know how to turn it off, well at least turn it down. Your friends will most likely have you as their default free therapist, yet will not offer you much advice/help since “you’re a therapist, you should be able to figure out your own problems.” Oh, I’ve heard that too many times.

It can be exhausting because being a therapist, once you’ve done it long enough, becomes who you are. You don’t leave it behind at 5pm, even when you think you do. It’s always there with you and if you aren’t careful and don’t take care of yourself, it will drain you.

The link below is to a very well written article that details some of the hardest and most exhausting parts about being a therapist.

The One Thing Every Psychotherapist’s Partner Doesn’t Get.

Family Shares UPenn Student’s Suicide Note

Suicide affects thousands of families each year. Last year, many people were shocked to hear about Madison Holleran’s suicide. She was a beautiful, intelligent college freshman, but like many college students, she was having difficulty adjusting. Her suicide took her family by surprise and if you read her suicide note, it appeared to have taken her somewhat by surprise as well.

I’ve read a number of books on suicide and have unfortunately read a number of suicide notes during my career as a psychotherapist.

Reading suicide notes, especially from people who have completed suicides, can help us understand what that person was going through at that time and may be able to help us prevent other suicides.

Many times families and friends have no real ideal of the internal struggles and emotional pain that suicidal people are dealing with.

Madisons’ family recently released her suicide note to the public. If you’d like to read it, it gives a brief but heart wrenching account inside of Madisons’ mental and emotional state.

Family Shares UPenn Student’s Suicide Note – FOX 29 News Philadelphia | WTXF-TV.

Emotional Vampires: How To Spot Them And How To Deal With Them

ed6568492c7ad5b402e59e8e9a09fe20-d55q1a1I am personally very sensitive to other peoples energy. Meaning, if I am in a room where everyone is sad, I can feel that sadness and even myself start to become sad. The same is true if the energy and emotion are happy or angry. I often get taken out of my element when I get around someone whose energy is different than mine. Meaning, I can come home happy and immediately become down if my partner is down because she had a bad day. It’s something that is my personal challenge to work on, but many of us are like that.

We realize that while some people are very positive and they often help improve our mood and energy, others are just the opposite, they are very negative and suck us dry of any happiness, positivity, peace and joy. A popular term for these type of individuals today is emotional vampires.  Some emotional vampires we know right away because they immediately drain us of emotional and physical energy as soon as they come around. Others are much more discreet and make remarks that leave us feeling bad and doubtful about ourselves such as  “You’re just not as smart as your brother” or “You’re always taking things personal”.

There are different types of emotional vampires and here I’ll list them and give you some tips on how to deal with each type you may encounter.

The Narcissistic Vampire

This vampire is all about themselves and everything is always about them. They are conceited, grandiose, entitled, want all the attention and admiration and believe that they are ultra-important. They lack empathy and have a very short fuse when it comes to giving love to others. Even when they do show favor to others, they will quickly withdraw it if things aren’t done their way, then they become very hurtful and punishing.

One way to combat this type of vampire is by keeping things in perspective by realizing that these type of people are very limited emotionally. If you expect more from them, you will just be disappointed over and over again. Falling in love with them is just setting you up for heart ache because they do not know how to be selfless or love unconditionally. If you depend on them for your self-worth you will only be crushed.

If you must deal with this type of person, the best way to handle them is by showing them how something will be in their best benefit. They are very selfish people and are happiest when they believe they are benefiting the most out of a situation.  This type of person is in my opinion the second most draining.

The Victim Vampire

This type of vampire is always crying “poor me”. They hate to take responsibility for their own actions. They believe that everything and everyone is against them which they believe is why they are unhappy. They fail to see, or want to see, their role in causing their own unhappiness. They will blame everything and everyone but themselves. These type of  vampires are most draining when you try to help them, but never can.

For this type of vampire you have to set limits and boundaries for self-care. Tell them you can only listen for a few minutes because you are busy, otherwise they will drain you quickly.

The Controlling Vampire

This vampire is always trying to control others by telling them now only what they should do, but also how they should feel. The way they do this is sometimes obvious, other times it’s less obvious because they try to control you by invalidating your emotions if they don’t believe you should feel that way. These are the type of people who always know what’s best for you and don’t have a problem telling you. In the end you end up not feeling good about yourself, feeling demeaned and belittled.

With this vampire you have to be assertive and confident. Pick your battles wisely with them and don’t try to control or “fix” them, that will only set them off. Be assertive on the things that matter and let some of the smaller things go.

The Splitter or Borderline Personality Vampire

Dealing with someone who has borderline personality disorder in itself is a taunting task. These type of vampires are always in black and white relationships, there is no gray areas. You are either good or bad therefore the relationship you will have with them will always be love and hate relationship. One day they worship you, but do something wrong and the next day you are totally worthless. They are very emotionally damaged people and often feel numb unless they are angry, and that’s when they feel alive. These type of vampire will keep you on a continuous emotional roller-coaster which is not only emotionally draining, but they can make you feel like you’re going to lose  your mind trying to deal with them and walking on eggshells to avoid conflict.

With these type of vampire you have to not allow them to suck you in and get as angry and upset as they are. You have to protect your emotions, stay calm, don’t over-react when they come looking for a fight. Believe it or not, these vampires respond best to structure and knowing where the limits are. If they start to get angry and out of control, tell them that you are going to walk away until they calm down. They won’t like it, but in the end this type of response is best for you and them. They will come to know their limits. They are also good at pitting people against each other and dividing friendships and families which is why it’s also important to not take sides when one tries to pit you against others, especially family and friends. These people in my opinion are the most draining because of their unpredictable, yet predictable nature.

We all know some emotional vampires and to be emotionally free, we have to learn how to deal with them.

For more information on emotional vampires check out “Emotional Freedom: Liberate Yourself From Negative Emotions and Transform Your Life.” by Dr. Judith Orloff and “Emotional Vampires: Dealing With People Who Drain You Dry.” by Dr. Albert Bernstein

What We Can Learn From The Dying

dying-wife-istockI’ve read a lot of books and information about death, grief and suicide. Those books have been both some of the most depressing and uplifting books I have ever read. Some of the most interesting books have been on people who were terminally ill like a book written by Bronnie Ware called The Five Regrets of the Dying.

We can learn a lot from the regrets of the  dying as regrets can give us insight if we look at them as things we can change so that hopefully we won’t have the same regrets. Here we’ll talk about the top five regrets of the dying as mentioned in The Five Regret.

  1. I wish I’d had the courage to live a life true to myself, not the life others expected of me: Many of us live lives that are inauthentic to who we really are and what we really want. It’s hard not to when we have been bombarded since birth by our parents and later by society about who we should be and what we should want, even when it contradicts our true desires. Even more disturbing is that many of us have been so brainwashed that we don’t even know when we are living inauthentic and think that the thoughts and goals that have been inserted inside of our minds by culture, society and family, are really our own when in fact they may be keeping us from living authentically. Something we can work on is recognizing this and attempting to live a life that is more inline with our true desires and goals.
  2. I wish I hadn’t worked so hard: We are taught that we are supposed to work hard and as a matter of fact, many people enjoy working hard, but many use working hard to escape dealing with other issues or work hard because it is what is expected of them. However, most people who are dying wished they would have spent more time doing things that nourished them, such as hobbies or spending time with friends and family, instead of working and collecting material items that now serve them little to no purpose. Sometimes we must work hard in order to pay the bills and “free time” doesn’t seem like an option, but we still have to find the time to do things that will serve us better spiritually.
  3. I wish I had the courage to express my feelings: How many times do we hold our tongues and not say the things we really want to say to family, friends, etc? We end up becoming passive and not assertive in order to save face or avoid a potential argument. Furthermore, a lot of people have trouble expressing love and affection and miss out on opportunities to let others know how they truly feel about them. In order for us to live a life with less regrets, we have to live a more authentic life where we are not only in touch with our true feelings,  but are able to express them.
  4. I wish I had stayed in touch with my friends: It’s easy with the pressures of life and how fast paced  things can be, to lose touch with our friends, but having healthy, nurturing relationships adds to the overall happiness and quality of life. Maybe today you can find a way to start re-connecting with good and healthy people that will help bring joy to your life.
  5. I wish I had let myself be happier: In the book Five Regrets of the Dying, most people didn’t realize until they were dying that happiness is a choice. Sure things happen to us, many that are out of our control, but we still choose how to deal with that situation and how we will let it affect us. We can start becoming more aware and make more  conscious decisions about how to deal and respond to those situations instead of allowing them to bring us down, make us angry or throw us for a loop.

The good thing about other peoples mistakes and regrets is that we can learn from them and hopefully not end up having the same regrets. We can all start today by looking over this list and incorporating our own so that we can live a happier, more authentic life.