Making meaning of your wounds

This blog post was inspired by this Video. Worth the watch...


This speaker was talking about cancer and about how we process and making meaning of the challenges in our lives. This speaker is a chaplain by training, but also went through her own experience with cancer, and spoke about how we can either learn from our challenges, or become defined by them.

In my counseling practice, I see this happen frequently. People get stuck in the process of wading through the mud of the horrible things that have happened in their lives, and trying to move forward, but feel powerless to do so. And some have an unwillingness to do so.

In the video, the speaker talks about her training as a chaplain, and learning "The Three C's: comfort, clarify and challenge (or confront)". She uses examples for how this applies to her work, and it occurred to me that this is exactly what is done, or should be done, in the therapy process.

Comfort
Our clients are in pain, both physically and emotionally at times, and need us as a source of comfort. Often that comfort comes in the form of giving them a space to talk, vent, cry, yell and purge their pain to someone who is non-judgmental, and a neutral person. As therapists, we have an obligation to provide this. Many are stuck because they feel they have nobody else in their life who can comfort them, or people just don't know how. Or perhaps they have exhausted the people in their lives. This is a great first step to connecting and building trust in therapy, and in healing for the client.

Clarify
Things get harder here. We have to work through the client's experience, and either clarify for ourselves, or help them better see how things really are. Sometimes they are stuck in the perception of their story, or how others see them. Helping them learn how to fact check can be very powerful and healing. It can help them feel understood, and help them take the first step in finding meaning of their experience.

Challenge/Confront
The speaker admits that this is the hard part. And it is also a part where many therapists either don't get to- because clients discontinue therapy- or they don't feel comfortable with this part, so never do it full with the client. And this is a disservice to clients. How many of us therapists have heard stories from clients about previous therapy, where all they got was "smile, nod, and 'tell me how that feels'"? This is not thoroughly helping our clients heal.
But confrontation is hard. It means taking a risk- that your client might get angry with you. That your client may not come back. And perhaps your client isn't ready for this phase yet, but if you don't get to this point, your client will likely never learn how to define him or herself as anything other than a victim.

One of my favorite books ever is "Man's Search for Meaning" by Viktor Frankl, who was a Holocaust survivor. He talks about this same process- how in order to heal, and be resilient, we must make meaning of our traumas. Therapists- you can be such a powerful part of this journey. And clients- you can achieve true healing and find a way to define yourself in other ways than your trauma. Because you are so much more, and you deserve it!

Old Wounds

As a marriage therapist, one of the biggest reasons couples present for counseling is because they say they want to fight less, and learn how to fight fairly. Many times, they think the solution is just about communication- reducing black/white/all/nothing statements, namecalling, stonewalling... all that good stuff. And while that is important, a bigger part of therapy that will result in deeper connections and healing is uncovering what is beneath the scars, and being vulnerable with each other about those old wounds.

Think back to your common conflicts in your relationships. Really observe what happens- like creating a flowchart in your mind. Where is the breakdown? What is the moment when all hell breaks loose? That is generally where an old wound has been triggered. That is where people will engage in negative behaviors, or shut down. When something from the past, whether childhood or previous relationships, or both, has been reopened. All of your insecurities, worries,

and fears come bleeding out, and you don't know how to stop it.

How to break this painful cycle? Here are some techniques that I have found helpful in my practice:

• When you are both hurting, picture your partner as a child. When old wounds are sliced back open, we emotionally become a much younger age. In fact, many survivors of trauma find themselves stuck at the age they were originally wounded. Instead of holding on to that anger, attempt to connect with the vulnerability that your partner is showing, even in what is sometimes very ugly behavior. This visualization can often result in a much-needed emotional break for you both to regroup and reconnect in a better way. (Note: This does not apply to abusive behavior. If your partner, male or female, is harming you physically, emotionally, or sexually, that is a different topic, and one that requires seeking professional help). 
• Sit down with your partner and make a timeline of the events in your lives that have wounded each of you. This will help you both see where you are vulnerable, and will help you be more aware of what to keep in mind when needing to have emotional conversations or conflict. Share each others events, and help your partner understand why this hurts you- even if it doesn't make sense, or seem logical. When we are in conflict, we are rarely logical. 
• In conjunction with the timeline exercise, have a discussion about each of your families of origin. Talk about events, how conflict was handled (or not handled), how emotions were expressed, if there were emotions that were not allowed to be expressed, abusive behaviors, and other topics that you feel have shaped you. 
• Read the book "Hold Me Tight" by Sue Johnson. It is just SO good, and all about attachment in relationships. It helps couples stick together when they want to push each other away. Enough said.

The key is awareness. Learn what your old wounds are, and be honest- not just with yourself, but with your partner. Take a chance to let him know what has happened that has contributed to that response. This is when true healing can begin. 

Not what I envisioned... Part 1

When I was inspired by this topic, I realized that I could take this post in two different directions. And since I am not a professional writer, I decided it would make more sense to my readers for me to break this subject up into two different blog posts.

With my specialty in perinatal mental health, I work with many people who feel shame about their emotions as they navigate new parenthood. Women especially grow up with an image in their heads about what being a mom was going to look like. They envisioned being blissfully pregnant, then having an unmedicated, vaginal birth, followed by a beautiful mother/baby bond that nobody could break. They would hold their baby and attend to every need, knowing exactly what to do.

I have never met anyone who actually had this experience. Have you?

Processing this involves grieving, which means stepping outside of your shame and embarrassment, and learning to accept that you will not get your dreamed of parenthood experience. And that this is OK. Normal, for lack of a better word. There are three main tasks involved in this process, although not everyone will go through these at the same rate, time, and even order. It is also helpful to note that if your partner has his/her emotions about becoming a new parent, s/he may not feel the same way that you do. And this is OK. Talk about it anyways.

Task 1: Getting angry. Many people are raised to feel that anger is not acceptable. You "shouldn't" feel this way, or anger is bad. Anger is not the problem. And anger is fueled by fear and anxiety. So take some time- a day, a week, a month- to understand your anger rather than judge it. Are you angry that you were robbed of your envisioned experience? Are you angry at someone in your life who contributed to this? Let yourself feel that. Journal about it. Write therapeutic letters to the people who you feel have wronged you, or to yourself (note: do NOT send these letters, at least not right now!). Talk about it with a trusted person or therapist. Just don't keep it locked inside, stuffed down by shame.

Task 2: Allowing sadness in. This is another toughie for people. Sadness is often associated with depression, when really- sadness is a normal human emotion. Many men, especially, don't know how to express sadness, as they are raised to believe that it is not OK for boys to cry. Women tend to be more comfortable with sadness, but may feel guilty that they feel sad about their experience- they "should" just be happy that they have a healthy baby now. But reality is, that this is a process, and the more you fight sadness, the longer it will take. So feel it- again, journaling and letter writing can be helpful. Crying to a trusted friend or family member or therapist can also be helpful. Don't resist.

Task 3: Acceptance. First, we must define acceptance. Acceptance does not mean that you are happy with the way things went or turned out. It just means that you accept it. It is what it is. And you may have moments of feeling sad or angry at times, but you find that these are fewer and far between. You don't feel guilty for your feelings any longer. You have a new meaning for your experience, and some people use this meaning to help others.

There is no timeline for these tasks, and they will go more smoothly if you don't fight them. We are all a work in progress!

If you have recently had a baby, and you are finding it overwhelming to parent, help is available! My, and several other MN resources, information are all part of Pregnancy and Postpartum Support MN. See the resource list at www.ppsupportmn.org, or call the PPSM Helpline at 612/787-7776. You are not alone!

What about dad's village?

I have spent a lot of time this past month focused on maternal mental health. We had the Daisy Dash 5K (our annual fundraiser for PPSM) mid-May, a screening of a documentary on maternal mental health, Dark Side of the Full Moon, and today, spent the day at the Beyond the Baby Blues conference.
When people discuss perinatal mental health, much of the focus is on moms. This is definitely important, as statistics show that 1 in 5 moms will struggle with some form of perinatal mood or anxiety disorder. The numbers may be even higher.

But did you know... dads can also get postpartum depression (PPD)? Depending on which site you are looking at, stats are roughly 1 in 10 dads. That is way more than many people realize, and WAY more than we are talking about.

Why is this?

Men with depression look very different from women with depression. Men are not weepy, sad, or talking about their feelings (in general). They tend to become withdrawn and easy to anger, and pour themselves into their jobs, hobbies, and, sometimes, substances (alcohol or drugs). The odds of depression increase further if the dad has ever experienced depression in the past, and if his partner is depressed.

We need to talk about this. Dads need a "village" too. But their village may look very different, so it's important to recognize this.

Here are some ideas for dads who are struggling postpartum, and really need an outlet for that:

• Self care is important. Aside from sleeping as well as possible, and eating, other things like exercise and time for yourself are key. Is it harder with an infant? Yes. But not impossible. If your partner is struggling too, have a discussion about how you are both going to take care of yourselves. It would benefit you to work out a plan or schedule for this. It may also be necessary to enlist help of others- such as friends or family members who can come be with your partner, so that you do not feel guilty taking time to go to the gym or going out with friends. It may mean asking someone to take the baby for an hour or two so you can go have a date with your significant other. 
• Support... while there is definitely a shortage of men's mental health resources, especially postpartum, it is not impossible to find. Below, I will list some specific resources geared towards men, some specifically for depression, but others just more about the challenges of being a dad. Feeling at times like you don't know what you're doing. Feeling like you aren't sure what to do with a newborn who eats, sleeps, cries and poops. Wondering what happened to your partner.... while men tend to not talk about feelings, it is OK to share your story and speak your truth. 
• Professional help may be a good idea. In my practice, it seems that men have an easier time accepting the idea of taking medication for depression versus going to therapy. AND THIS IS PERFECTLY FINE. If you have felt depressed, down, hopeless, angry, or having thoughts of running away or harming yourself, medication may be an option to explore. If you do decide you would like to talk with someone, whether that is therapy or a support group, it is really important to find someone who is trained in perinatal mental health or understands male depression. Resources like Postpartum Support International, and in Minnesota, Pregnancy and Postpartum Support MN, are great places to look to find people who will get it. It is hard to open up to a stranger about what is supposed to be the greatest event of your life, so make sure you have someone who understands. It is also an option to attend some sessions with your partner. If she is going to therapy, ask if you can come along sometime. She will probably LOVE that, and it is very helpful as a therapist to get both perspectives, and for me to assess depression or anxiety in both members of the couple. 

Dads are SO important. Your relationship with your baby matters too!

Resources:

http://www.postpartummen.com/

PSI: http://www.postpartum.net/family/tips-for-postpartum-dads-and-partners/

Locally (in Minnesota):

PPSM: http://www.ppsupportmn.org/

FaceIt Foundation: http://www.faceitfoundation.org/

Dads groups can be hit or miss. But some places to check are http://www.meetup.com/ and Facebook. PSI also has phone chats for men, and PPSM has a free HelpLine for all new parents and their providers who are in need of resources and support. 

Books:

The Postpartum Husband by Karen Kleiman

I Don't Want to Talk About it by Terry Real

P.S-- there are NO books specifically for dads with PPD!!!

Mothers Day is great... except when it's not

Don't get me wrong. I LOVE Mothers Day. One of two days of the whole year that is just for me. However, there was a time when Mothers Day was one of the worst days of the year- when I was going through infertility. Since that experience, I work hard to be mindful that Mothers Day can be very painful to some. 

In my practice, as a therapist who specializes in perinatal mental health, there are three common categories of women that Mothers Day is hard for (and some men too!). 

1. Women going through infertility (and their partners)

About 12% of women (1 in 8) and couples struggle to get pregnant. It makes sense that a day that celebrates being a mom can be difficult for these people. We need to be aware of how painful it can be for a woman who so desperately wants to be a mom cannot escape that our culture defines success as a woman as being a mom. You can't escape it, especially around this time of year. Go to Target, and right when you walk in the door is the HUGE sign above the card display for Mother's Day. Commercials on TV. Pregnant women with their bellies and young babies going out on walks, as the weather warms. I remember wanting to just stay in bed with a blanket over my head for the month of May. But we have to live. So, if you know someone in your life who is struggling to get pregnant, make sure you acknowledge that Mothers Day is hard for them. Offer to get together and do something fun anyways. Or let her talk, cry, yell about how unfair it all is. And if you or your partner are struggling, it is OK to let people know you are sad. It is OK to be sad for you and happy for the women in your life who are mothers. 

2. Women who have had a pregnancy or infant loss (and their partners)

Here are some statistics from www.hiringforhope.org:

• 90,000 children die annually in the United States before their first birthday.
• Nearly 2,500 babies are lost/year in the United States due to S.I.D.S.
• Nearly 30,000 babies a year are born stillborn. The number of stillbirths that occur worldwide jumps to more than 4.5 million/year.
• More babies die as a result of stillbirth than all other causes of infant death combined.
• Stillbirth occurs ten times more frequently than S.I.D.S.
• 15-20% of all clinically recognized pregnancies end in miscarriage each year.

This means that it is very likely that you have experienced or know someone who has had a miscarriage or lost a baby. For the same kinds of reasons mentioned with infertility, pregnancy and infant loss is invisible. You can't tell just by looking at someone if they don't have kids by choice or not. And there is still a lot of misinformation and ignorance that some people don't consider miscarriage "a baby", or if a family has had other children, the one that was lost is forgotten. But moms don't forget. Moms remember every year how old that child would have been. Or how differently their family would have looked if that child had survived. So again, be kind, because we don't know what anyone's story is. But if you DO know someone, remembering that baby to them can be so so kind. Tell them Happy Mothers Day. Validate their sadness. And if you are a partner, talk with her about how she wants to acknowledge Mothers Day. Please don't ignore it or pretend it's not happening. 

3. Those who have lost their own mother, or have a poor relationship with their mother 

Stepping outside our own feelings of Mothers Day, about if we are a mom or not, and remember that we all have a mom somewhere. Some of our moms have died. Some of our moms are cut out of our lives for numerous reasons. And some of us still have our mom with us, but the relationship is very complicated and makes Mothers Day a challenge. 

If you have lost your mom, the first Mothers Day will be particularly difficult. Think about how you would like to spend this day, and honor your mom. Share this with your partner or a close friend. Don't go through it alone. 

If you have relationship challenges, make a plan. Do you need your partner or a close friend to take you out and keep you distracted? Let you share your emotions about it? And if you do still see your mom on Mothers Day, set very clear boundaries. It is OK to limit the amount of time that you spend with your mom. It is OK to feel sad, hurt, angry, or frustrated (or all of the above) that you don't get a happy Mothers Day with your mom. Try to plan something to do afterwards to vent and debrief. 

This post is not intended to take away from the joy that Mothers Day brings. If you are a mom, you are to be celebrated. Just know that it is a very emotional day for many people, and to be kind, because we never know what people's story is. 

Best Books of 2014... In my opinion

Happy new year! I'd like to start off the year by recapping a list of self-help books and memoirs that I found very readable this past year. Some of them are serious, some of them are funny. Note: this is only MY opinion, and in no particular order...

Self help

"Just Tell Me What to Say" by Betsy Brown Braun is a nice quick read on very common parenting concerns about discipline, friendship issues, sexuality, and conflict resolution. It gives readers a script for ways to navigate these difficult issues. It is geared towards those who have kids in the preschool through high school ages. This book would also be helpful for anyone in a profession that works with kids this age. One of the easier reads that tackles difficult parenting conversations.

"Change your Brain, Change your Body" by Daniel Amen, MD  This is not the first book I have read of this authors, nor will it be the last. What I love about his books is he is a advocate for people who choose treatments of all different modalities. He talks about Western medications, but also eastern integrative medicine, such as homeopathic treatments and supplements. He also emphasizes the importance of good old self care: sleep, diet, exercise. He also includes nifty brain scans that show the science behind his research, and how it literally can change the structure of your brain. He includes wonderful mental health information as well as other physical ailments.

"The Secret of the Shadow: The Power of Owning your Whole Story" by Debbie Ford This is not a new book, but one I finally just got around to reading this past year. I fell in love with one of Ford's previous books, and had to read this one as well. I like this one better. It takes the information from some of her other books and makes it more about using it to improve your current and future life. This book will help people who struggle with low self-worth and self-esteem. Through guided exercises, you will learn to like yourself better, and except that even if bad things have happened to you, you are still a great person.

"The Gifts of Imperfection" by Brene Brown This is another wonderful read about self-esteem. In a culture that values perfection, we need to learn how to handle the reality that we are not perfect. But how do we embrace that? This book walks you through Brown's ideas of how to do that in a simple straightforward way. If you would like to get a flavor of brown before buying, she also has a video on TED about shame and imperfection.

Memoirs

"Dad is Fat" by Jim Gaffigan Not only is Jim Gaffigan hilarious, but he is also the father of five very young children. This memoir is filled with short essays about his experience as a dad and son are laugh out loud funny. This would make a wonderful gift, not only for dads in your life, but for anybody who appreciates parenting humor.

"Battle Hymn of the Tiger Mother" by Amy Chua A controversial read, I really liked that the tone of this book was not about "this is how you should parent" but about how she did follow the cultural mores of her family's parenting style, and how it went wrong in some ways. She also shares the challenges of having a blended cultural marriage, and how they made that work. It is a good breed that makes you think about your own parenting style and about how the American culture can be a challenge for people living here from other cultures.

"How Starbucks Saved My Life" by Michael Gates Gill Okay, I'll admit it: the reason I picked up this book was all about being addicted to Starbucks coffee. However, I was pleasantly surprised by this memoir written by a man who basically loses everything. He was raised in a wealthy family, and had a very wealthy lifestyle until the market crashed. I won't give anything away, however I will say that what I loved about this memoir is that it shows that people can be happy without all of the material things that are culture tells us we "need". He makes a very difficult new start and is inspirational. PS. It's also not a very long book, so good for even those who do not like to read.

Motherhood Comes Naturally, and Other Vicious Lies" Jill Smokler  As someone who works with postpartum moms, I am always looking for books that talk about motherhood in a realistic way. Smokler, founder of the blog Scary Mommy published this book a very funny essays about the realities of motherhood. If you are looking for a gift for a new mom, or you are a new mom yourself, pick it up on a bad day and just read one essay. It's a great reminder that motherhood does not come naturally.

Happy reading!