Two Words to Know in Trauma Treatment

We all experience trauma. Our life experiences and resilience levels vary and effect the degree to which trauma impacts us. Untreated, trauma symptoms limit enjoyment of life and productivity.  Common signs of trauma and Post-traumatic Stress Disorder (PTSD) include difficulty regulating emotions, anxiety, an inability to maintain stable or fulfilling relationships, feelings of unreality and/or gaps in memory (dissociative symptoms), depression, anger, nightmares, emotional numbness, unwarranted guilt, sleep problems, substance abuse, eating disorders and paranoia. The senseless acts of fear, hate and violence in Minnesota, Baton Rouge and Dallas this week, along with today’s global and political climate, create despair, grief and uncertainty and exacerbate pre-existing trauma symptoms.

In my practice, I have witnessed the lasting effects of trauma: bullying, addiction in the family, emotional, verbal and physical abuse, accidents, invasive or upsetting medical procedures, sexual assault, neglect, natural disasters, loss, birth trauma, nasty divorces, the lingering effects of 9/11 plus those with multiple accumulated traumas.

A few years ago I began to offer less talk therapy and employ more guided imagery, breath work, meditation and other relaxation techniques with clients who felt “stuck”.  Pleased with the positive response clients reported from mind-body work, I found myself eager to gain an even higher level of expertise.

In 2015 I began studying Somatic Experiencing (SE), a body-oriented approach to healing trauma and other stress disorders. Developed by Dr. Peter A. Levine, it incorporates his 45 years of clinical experience, aspects of stress physiology, psychology, ethology, biology, neuroscience, indigenous healing practices, and medical biophysics.

The SE approach gently increases capacity for difficult bodily sensations and suppressed emotions and helps the body move through and out of the fight, fight or freeze mode caused by trauma. A Somatic Experiencing session can be conducted by a mental health clinician or a body worker, and can be done with or without physical touching.

After almost two years of engaging in SE training, I have had the good fortune to not only practice as therapist, I have also been the lucky recipient of SE while in the client role. The results have reaffirmed the belief I held for this therapeutic form. Multiple talk therapy sessions for a decades-old traumatic car accident had helped me, but not in the same way that SE did. The physical and emotional benefits have been profound.

One of the many aspects of SE I like is that it is well suited to people who don’t like to talk a lot. A skilled SE practitioner may only have a client talk for several minutes before beginning SE, which doesn’t require a verbal narrative from the client. This is very freeing to many who feel self-conscious, who are not verbally adept, or are afraid to tell their story. I have witnessed clients make extensive progress in their healing after a few sessions of SE. Children are also great candidates for SE, as they are often more self-aware of bodily sensations and have had less practice than adults have at intellectualizing their distress. Clients who are already very self-aware and/or have identified very specific treatment goals make tremendous progress with SE.

I became a clinical social worker to reduce suffering and enhancing quality of life for others. I am deeply grateful SE is available not only to my clients but also to the many others around the globe who are survivors of life’s biggest challenges.

For additional reading on the foundations of Somatic Experiencing, I recommend Waking the Tiger: Healing Trauma, by Peter Levine. For more information on Somatic Experiencing and the Foundation for Human Enrichment, visit http://traumahealing.org.

Moms: It’s February: Re-vamp and Refine Your Resolutions

Those of us who make New Year’s resolutions are usually derailed just a few short weeks into the year. If you are in this camp, don’t despair. I will give you six proven tips for getting back on track and staying there.

1. Set goals, not resolutions

Most resolutions fail because they require a big and immediate behavior change: for example, launch web site by February 15, or lose 10 pounds by Spring. Setting goals instead of resolutions gives you flexibility to choose different paths to your goal, and to break them down into manageable steps. For example, rather than simply listing “launch web-site by February 15,” first learn about the steps involved in creating web sites. Step one might be research different web-hosting companies geared to small business. Decide how much time you will devote to the research. Then block your calendar on specific days at specific times to do the research. Step two might be choosing a logo. Decide whether this is something you are good at, or should delegate, and precede accordingly.

2.Give guilt the boot

You deserve success. Moms trying to make strides in a venture or hobby often carry a heavy burden: guilt. Baby boomers and women from traditional families often feel guilty if they are not “all Mom, all the time”. This view is unrealistic and unhelpful. In fact, when your children see you working, they are learning important life skills. Furthermore, if your creative or intellectual side is fulfilled, you will be happier. Research supports what you already know: that when Mom is content, the whole family is happier.

3. Think about what you really want
Write down the goals most meaningful to you.  Start a journal and answer the following:

What do I want to achieve in my business/hobby?

How much time am I willing to devote to it?

How do I see myself in one, three or five years from now?

4. Prioritize and break goals down into small steps

The other obstacle most moms face is finding the time and energy for their many responsibilities. Most of us over-estimate how much we can accomplish in a day. I highly recommend writing down all the tasks you accomplish in a week, or even a full month. Get a calendar that includes 15-minute increments. Fill in every task, no matter how menial and repetitive: sleeping, driving time, doctor appointments, etc.  This is an important way to learn how much time you truly have to devote to your pursuits of choice. You will then be able to better predict how many weeks or months it will take to achieve the “small steps” of your goals. You might decide to delegate some of the household tasks. Break down business goals into weekly, monthly, quarterly and annual increments.

5. Review and revise
Review and update your goals regularly. Fine tune them, or devise new ones. Figure out which obstacles are hindering you, and determine what you need to do to overcome them.

6. Be patient with yourself and others

Expect roadblocks: technology will fail, competition will crop up, and your children will need your guidance. Breathe, visualize yourself achieving your goal, and be patient.

You will achieve your goals, but never exactly the way you expected, and that’s OK!

Not Feeling Festive? Get Your Zzzzzzzzzzzs

I am re-posting a timely blog in hopes it may help you if you missed it 5 years ago...

Good sleep is not only important to your physical health, it is also key to a good mood. Getting plenty of sleep during this busy season is difficult, for sure.  However, it is essential. The holidays put extra emotional and physical demands on us, and sleep helps us bounce back, maintain perspective, and stay healthy.

Not only is the quantity of your sleep important, the quality of your sleep is, too. Sleep quality can be enhanced in many ways: a cool but not cold room temperature, a very dark bedroom, a comfortable bed without pets or children hogging the bed. Those of us who have reached - ahem - "middle age" have biological factors that make our sleep less sound than it used to be, and may need to take extra steps to insure a good night's sleep.

The first suggestions I make to clients who are frustrated by poor sleep are:

• eliminate afternoon caffeine
• limit alcohol to one (women) or two  (men) drinks
• try deep breathing or alternate nostril breathing* when you can't sleep
• turn off all electronics, including the TV, an hour before bed
• keep a small journal or pad near your bed, and write down any thoughts or chores that are nagging at you
• no vigorous exercise closer than three hours to bed time

If you have made these changes and are still having problems falling asleep or staying asleep, or usually feel grouchy or tired in the morning, it is probably time to get some help. I find clients often hesitate to see an internist or psychiatrist to discuss medical interventions for insomnia. However, I urge them to do so, as I have witnessed tremendous improvement in mood and stamina in those who have sought treatment.

Sleep can make the difference between a good day and a bad one

There are natural sleep remedies that are effective for many people. There are also several sleep medications that have been developed in the last decade that at the right dose do not leave people feeling groggy or "hungover".  I  prefer environmental and natural sleep interventions. However, the effect of sleep on quality of life is so profound that medication should be considered if other interventions fail to help.

If the shopping and wrapping are feeling more like torture than fun, crawl into bed early tonight and take a long winter's nap.

Wishing you more "ho ho ho's" and less stress;  good health, and peace this holiday season.

Be well,

Laura

For more information on alternate nostril breathing, go to: http://www.holisticonline.com/yoga/hol_yoga_breathing-ex-nadisodh.htm

FIVE CONVERSATIONS BEFORE “I DO!”

I want to share this excellent article by Lane Marmon, who had a career as a family law lawyer and is currently a director at HHG, a financial management company in Darien, CT.  I counsel many people who are unhappy with their money habits and/or with the negative impact disagreements about money have on their relationship. Lane's tips are excellent. I hope you find them helpful.

FIVE CONVERSATIONS BEFORE "I DO!"

Congratulations! You are engaged and have started planning your dream wedding. You have considered who should be in your wedding party, what music will be played and where the special day will take place. However, marriage is a big step and having a serious discussion about finances with your soon to be spouse is important. Therefore, it is shocking that most people generally do not discuss finances and household responsibilities before saying “I do”.  

Below are five recommended topics of conversation for you and your future spouse to discuss.

Share your spending habits:

When it comes to spending, you need to be honest with your spouse about your habits.If you are honest with each other, you are more likely to work together to reach your goals in a trusting relationship. However, if you are dishonest, you may find yourself hiding your credit card charges or arguing over the balance of the checking account. You should consider that there may be a reason why your spouse pinches every penny or spends every dime. Having a conversation about a habit can lead to a stronger and more thoughtful relationship. In addition, it enables you to set realistic goals with your spouse about saving and spending.

Transparency:

Having a mysterious credit history is not a turn-on.  In fact it can be a turn-off. Your soon to be spouse may have a prestigious high-paying job in New York City but, he may also have hundreds of thousands of dollars of student loan debt. Having debt does not necessarily need to be a deal breaker for you.  However, it will help you to set realistic saving goals. 

For example, an individual who accumulated thousands of dollars in credit card debt and has a diminished credit score, may influence a spouse’s ability to purchase a house. Together, you and your spouse can repair credit damage and pay off debts.  However, it is hard to repair something that you do not know is damaged.  The key is transparency. 

Discuss how you are combining your finances:

Each relationship is different. Understanding how each spouse’s income is going to be treated and how the expenses are going to be paid varies from couple to couple.  Some couples merge all their income and expenses, others keep everything separate. Whereas, others follow a hybrid model of keeping some income and expenses joint and others separate. Once you have decided how the income and expenses are going to be handled, one spouse needs to take the lead on managing them and monitoring the monthly cash flow. 

Often times the spouse who is monitoring the cash flow is seen as the spouse with more financial control and knowledge. However, with honest conversations about expenses, both spouses can feel equally involved in the decision making process.

Define your financial goals:

Everyone has a financial goal. Perhaps it is to save up for a new set of golf clubs or a small starter home. On the other hand, it may be to be a stay-at-home parent. Whatever it may be, you should share those goals with your future spouse. You will receive a greater understanding of your spouse’s desires and it will help develop a serious discussion about the reality of those goals. 

Financial Advisor:

Having a financial advisor to provide knowledge, resources and insight is exceedingly helpful when developing a financial plan. You want to pick a financial advisor who is honest and makes you feel comfortable. Your advisor will work with you to develop your financial goals, plans surrounding a major life event and tax strategies, among other things. It is never too early to pick a financial advisor, since you want to develop a long-lasting relationship with an individual who understands you as a couple and your future plans.

By having these serious conversations about finances, you are building a healthier and stronger relationship with your spouse. 

[1] This is from a study conducted using longitudinal data from more than 4,500 couples as part of the National Survey of Families & Households.

Nine Decades of Inspiration for Happy Living

As a clinical social worker, I support people as they fine-tune the art of living happily. Much has been written about personality types and lifestyles that contribute to a happy life. Although there seems to be little useful data on what factors definitively help us live enjoyable lives, we know when we are in the presence of inspiring people who manage to do just that.

For the past eight years I had the pleasure and honor of knowing a woman who I consider an amazing mentor on this topic. Ruth, until September of this year, lived with her pet rabbit in a one bedroom pre-war apartment in mid-town Manhattan. She was the loving mother of my life partner, Jon. Although in failing health the last two years, she insisted on maintaining both her lifestyle and her independence and remained upbeat and engaging until she died.

Since Ruth passed away –one month shy of her 94^th birthday- Jon and I have received many comforting and informative condolences from those who knew and loved her.  The comments have touched upon Ruth’s following qualities:

Curiosity  Ruth loved to learn. A college graduate who served as an officer in the Coast Guard during WWII, she was an avid traveller and reader who loved to learn about other cultures and animals. She enjoyed the Sunday NY Times crossword puzzle which she completed in ink, not pencil. She was an accomplished cook who prepared gourmet meals of many cultures in a galley kitchen. 

Creativity and Persistence  Ruth worked hard for years in her role as a creative director for several different major advertising agencies on Madison Avenue. In an era when female executives were few and far between, many of her national campaigns were award- winning. A single mother, she did more than raise Jon; she regularly made it a priority to expose him to new cultures and experiences through travel. She also used her abundant creativity to parent Jon. She once made him hold a banana during the entire two and a half hour ferry and train trip from Fire Island to Manhattan because despite her instruction not to do so, he had threw a banana overboard from the Fire Island ferry.

Loyalty Ruth loved her family, friends and pets unequivocally. She did not judge, gossip or disparage others. She zealously defended those that she loved and counseled patience and compromise during disagreements among family or friends.

Adventurousness

When Ruth retired from Madison Avenue, she joined the Peace Corps. At age 68, she travelled to Lesotho and taught English for two years. She rarely talked about the bugs and rats that were at her camp there; instead we heard stories about her amazing fellow volunteers and the people and animals of Africa.  In her seventies, Ruth decided to learn how to dance the Tango, and did so up until her late eighties. Besides traveling extensively in Africa, Europe, and Asia, Ruth went fishing in Alaska and made it the Great Wall of China for her 90^th birthday.

Activity

Like most Manhattanites, Ruth walked everywhere. She thought nothing of walking 30 blocks to shop at the flea market or buy groceries. Up until recent years, she refused to take a taxi unless her destination was in another corner of the city. In her eighties, she resumed tango dancing soon after a hip replacement surgery.

Sense of Fun and Sociability

Ruth loved to play games, cards and entertain. She had bags of party accessories: hats, boas, masks, glow sticks, multiple decks of cards and drawers full of colorful candles and tableware. Jon and I were loathe to miss her annual St. Patrick’s Day party or annual Easter egg hunt. Her living room was painted fuchsia and her kitchen had black chalkboard walls that her many friends had filled with drawings and words of affection.

My all-too-short time with Ruth inspires me to impart to my children and clients the importance of pursuing lifelong learning, authentic connection, fun, adventure, and living with curiosity and creativity. Although we can’t avoid the obstacles and illness that life inevitably throws our way, we can certainly follow Ruth’s example and invite more joy into our lives.

Four Steps for Crushing Relationship Conflict

As a mental health practitioner, I often help others sort out conflicts and crises. Over the years I have learned that there are specific skills that help people navigate their relationships in a more loving and productive manner.

The next time you have a disagreement, try these tools before you re-engage:

1. RESET

We are victims of age-old wiring. When we feel threatened, we have a primitive instinct to fight, flee, or freeze; or a combination platter of the three reactions. Take whatever time you need to restore your normal heart rate and breathing patterns. Deep breathing, stretching, time with a pet, a walk around the block, and time outside in a garden or the woods can all be helpful.

2. REVIEW
Ask yourself what your role was in the argument. Did you stoop to name-calling, blaming, or shaming? Did you yell? These common tactics used in arguments are not productive. Did you bring up hurts or incidents from the past? Fair fighting requires a focus on the present and using "I" statements ("I worry when you come home an hour after you told me you would",  not "You are always late"). Were you looking to blow off steam after a bad day? We often save our worst for those we love. Be mindful of this tendency- it erodes the warmth in a relationship. Are you currently under major stress? When chronically stressed, we have a lower threshold for upset and may argue more frequently.

3. REGROUP
Next, try to identify what the biggest issue is that you hope to change or bring awareness to.  Did the disagreement start over differences in emotional styles? Did it start over a difference of opinion in parenting or money? Is this an old, recurring fight? Identifying what the argument is really about may help you sort if out.

4. RETRY
Calmer heads will prevail if you wait to talk again only when all parties are ready (although perpetually refusing to talk after a day or so has passed is unhealthy).  Be aware of the volume of your voice. I have noticed that when someone is consistently loud, a pattern can be set up whereby the quieter person shuts down regardless of the content. Also, listen intently and try paraphrasing what your loved one says. This technique gives you time to absorb and clarify the message before you respond.

 If you continue to feel frustrated, unheard, or hurt, you may want to seek out a counselor or therapist.
Sometimes an objective professional can spot unhelpful dynamics and share insights and tools to help you get the warmth back in your relationships.

UNDERSTANDING THE REAL COSTS OF DELAYING MENTAL HEALTH TREATMENT

One of the many reasons I love my work is that I have the honor and pleasure of seeing most of my clients get better. Do I have special skills that other mental health clinicians do not? No, my work simply mirrors the statistics on the efficacy of mental health treatment. Research shows that therapy is effective at least 80 percent of the time.

Since therapy usually helps, and no one wants to suffer, why are we our own worst enemies when it comes to getting help? Our tough inner critic tells us "you should be able to snap yourself out of this", or "you don't have it so bad, think about what Mary next door has been through", or "you need to help the kids, you're not as important." My wish for folks suffering from mental health challenges or family struggles is that they view mental health treatment as a tool that can help them move towards their future, not as a failure and a last resort.

Recently I have noticed an increase in the length of time clients are waiting to get themselves or their kids to treatment. My colleagues have shared the same observation with me. There are good reasons: financial challenges, increasingly spartan or absent insurance coverage, busy family schedules, and the still present stigma in our culture towards mental health treatment. The problem with delayed treatment is that it increases the likelihood of the development of a second mental health challenge, a substance abuse problem, and physical illness.

Not only does the client get worse if not getting help, but family members and co-workers are also sorely tested by caring for or working with a depressed, highly anxious, bi-polar or substance-involved individual. Many times the people that end up in my office have anxiety or depression that has been triggered by living or working with someone who has not sought help for their own challenges. Delays in getting help often leads to multiple family members in crisis. Jobs are lost, marriages fail, and academic careers stall.

The decision to see a therapist does not bind you to a never-ending series of weekly appointments. One of the important roles a trained therapist plays for you or your child is "assessment".  We evaluate a client's functioning in their environment: home, school, work, relationships, and community. We work with clients to collect data by interview, observation, surveys and test (psychologists) instruments. Thanks to the assessment process, clients can decide whether to enter the "therapy or treatment" phase of mental health treatment after gaining an understanding of their diagnosis and treatment options. After the assessment, I may recommend that a client meet with a psychiatrist, nutritionist, career counselor or life coach. Sometimes I work with parents to help them sort through parenting challenges without ever seeing the child.

The bottom line is that there may be much to gain by investing in a few visits. Unfortunately, waiting until you or your child are too sad to get out of bed in the morning, or your daily glass of wine has turned into a daily bottle, will likely cost more time and more money, and more importantly, needless suffering.