Adjusting to seasonal changes and illuminating the mechanics of Seasonal Affective Disorder

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It is almost a visceral reaction: our bodies sense that the days are getting shorter and the nights are getting longer, and we react in the way that feels most natural to us.  The earth’s turning, the seasons changing, and the holidays’ impending arrival can mean excitement and joy for many of us, and it can also bring increased feelings of depression and anxiety.  Therapists and doctors have coined a term for the emotional shifts that occur around the same time every year: Seasonal Affective Disorder (SAD).  This is a relatively new term, and was not defined until 1985.  Most often the symptoms for SAD begin in the fall, continue through the winter months, and then begin to alleviate in the spring as the earth warms up and daylight hours lengthen.  Studies show that SAD has a stronger presence in populations that live further from the equator (when nights may be particularly long), and that it is present in (or reported by?) four times more women than men.  It is also thought that SAD is less invasive when there is snow on the ground.  This is interesting and makes me think that if there is a “reason” for the darker nights (such as – it is snowing/Christmas time), or if there is something to focus on such as holidays celebrations, then there is not as much of a depressive feeling around this time of year.

It’s a positive thing that we can now put a finger on what is felt by 25% of the US population and that we don’t have to blame it on the “wintertime blues”.  We can now get help for the symptoms of SAD, which may be increased feelings of hopelessness or helplessness, fatigue, crying spells, weight gain, or irritability.  A common misperception of SAD is that it occurs only in the wintertime months.  There is a form of SAD that can happen in the summer time (almost a ‘manic’ to the wintertime’s depression), where you may feel overly energetic, and experience periods of restlessness and racing thoughts.  To me, it appears that for many of us the sun’s presence can ignite a new sense of energy in us and its absence can drain the energy right out of us.  This also may link to the increase of suicides in dark and rainy climates and the general census of enthusiasm and openness that bursts from us as spring and summertime arrive.  We have learned that the sun’s presence and the intensity of its light suppresses our body’s production of Melatonin (sleepy time hormones) and helps our internal clock (circadian rhythm) become in sync.

How can we overcome the effects of SAD?  First thing is to know that you are not alone and that it is very possible that the symptoms you are feeling are only temporary.  I would suggest investing in bright, florescent lights and keep them on consistently.  These can take the place of sunlight when it is not present and can help your brain regulate emotions in a healthy manner.  Light treatment is called phototherapy and uses light boxes to synthesize natural light.  It is most effective when used consistently during the winter months.  Increase your social support and social functions during the dark periods of the year.  Make an effort to plan get-togethers with friends and celebrate the many wonderful things about the winter months.  Be aware of the general cycles of your emotions and how they react to changes in sunlight and temperature.  You don’t have to let SAD make you sad! 🙂

Got holiday anxiety? Here are 10 Tips for Coping with Holiday Stress

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Thursday is Thanksgiving — the initial and official marker that the holiday season has arrived.  For many, this holiday brings warmth and love as we are thankful for family and friends.  For others, the holidays may bring grief and sadness as we remember friends and family that were with us last year but are not here this year.  The holidays almost certainly bring some degree of stress to each and every one of us.  Whether it is financial (how am I going to afford gifts for my loved ones this year??), personal (I feel overwhelmed easily and do not handle holiday pressure particularly well), familial (how am I going to spend all holiday with Uncle Steven, when he insulted my religious beliefs last year??), or logistical (how are we going to get two adults, two small children, and all of the gifts, luggage, and baby gear on an airplane in the airport madness??), we all can relate.

So, today in honor of Thanksgiving week, I am going to try to offer some bits of calmness and serenity — and definitely some practicality — as we all try to navigate this wonderful, beautiful, emotional, stressful time of the year.  You know, Christmas is just around the corner!

Here are Kate’s Ten Tips for Surviving the Holiday Season (and hopefully these tips can help you cope with many overwhelming periods or feelings):

1.) Try to prepare yourself for events/people/feelings that may be difficult for you.  Are you aware of what digs at you? If you know that money is one of the biggest reasons you stress over the holidays, you can prepare for this in advance by saving money or budgeting exactly what you know you can spend.  Same thing goes for other triggers: is it being with the whole family that is overwhelming? seeing in-laws? having to prepare a huge Thanksgiving dinner at your house (which means cleaning, organizing, sorting….not to mention cooking!)? How about trying to manage the first Thanksgiving without your grandmother, who passed away after the holidays last year?  Even if you have no idea how to handle these intense feelings, just defining what they may be (it helps to write them down) can give you a sense of power and control over them and set you on your way to finding solutions.

2.) Schedule self-care time.  The holidays come fast and they come intensely.  There is no such thing as “halfway” doing the holidays.  So this means that you will not be able to “halfway” do it when it comes to self-care.  Many of us (me included) have a difficult time scheduling time for ourselves to do the things we love and the things that relax us.  Never is there more important of a time to schedule a massage, see a favorite movie, or take a long walk with your dog than the holidays.  Take care of YOU!

3.) Voice your feelings and needs.  So often when we feel overwhelmed, we might feel as if the only solution is to retreat inside of ourselves and try to hide. Or we may feel our emotions explode out of us, but not in the way we intended.  If we can speak up to ourselves and others about what we feel and need, we can take the next step towards getting those needs met.

4.) Make a list.  I love making to-do lists.  It can ease my anxiety if I see what I need to do written down.  You might have several lists: gifts to buy, arrangements to schedule, events to attend.  Put them up on your wall so that you can see them and know what to expect — and by when.

5.) Ask for help.  Reaching out to a partner, friend, parent, or therapist can relieve some of the intensity of holiday stress.  We all need support during busy times and the holidays are definitely no exception.

6.) Learn to say no.  Often times we get so overscheduled during the holidays, that there is no time left to enjoy them.  You don’t have to do everything.  You don’t have to be everything! If you are exhausted and feel like a night in, then speak up and say so – and don’t feel guilty about doing so.  Your friends and loved ones will admire your efforts at listening to your inner voice.

7.) Treat yourself.  One of the most stressful things about the holidays (in my opinion) is the emphasis on “so much food, drinks, and treats — how will I ever keep it in check?”  I encourage you to give that little voice in your head a swift kick out the door and to let yourself have some eggnog if you want some.  There is so much delicious food this time of year, and so many family members and friends to share it with, — would you want the negative voice to ruin that for you? I know this is harder than it seems.  Don’t take it to either extreme, but I think that allowing yourself to enjoy every part of the season will be worth it.  You don’t get the chance to have gingerbread men with your nieces again for a whole year 🙂

8.) Search out the free and fun activities!  If finances are a big part of your holiday stress (and I think we all can empathize on this one), focus your holiday fun on free activities and events in your area.  There are always lights displays that you can admire, carols you can lend an ear to, or hills that you can sled down.  One of the highlights of the holiday season is all of the opportunities it brings, and there is something for everyone. I suggest scoping out your local newspaper for ideas.  Making crafts with family members is a meaningful and cost-effective activity that heaps unlimited rewards.

9.) Try to remind yourself what the holidays are really about.  Whether you celebrate Christmas, Hanukkah, Kwanzaa, or other cultural holidays, it can be all too easy for us to get caught up in the frenzy of gift-buying and traveling and forget what we are truly celebrating.  Think about what the holidays represent to you, how you would like to celebrate that meaning, and try to plan activities that will create special holiday memories for you and your loved ones.

10.) Cuddle with a loved one.  I may be biased because I am an animal lover, but I feel as if there is no better way to calm down than to hug or cuddle someone you love.  No matter if it is animal or human, a special companion can help you to relax and unwind from the fast-paced holiday craziness and help you to appreciate this beautiful time of year (see #9).  Go ice skating with an out-0f-town friend, drink hot chocolate with your partner by the fireplace, decorate your Christmas tree to the tunes of holiday music with your sister, or watch Frosty the Snowman under a blanket with your dog.

Happy Holidays to everyone!

An unconditional love: the healing powers of animal-assisted therapy

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We have all experienced the emotional, sentimental, and almost gravitational pull of an animal’s touch.  Whether it is playing tug with your dog with his favorite rope toy, cuddling with your cat on the couch — even watching an elephant pull her daughter out of a mud pit in Africa on a television show…animals have a special healing power that transcends any sort of boundary.  More and more mental health professionals are incorporating Animal Assisted Therapy (AAT) in their practices, to phenomenal results.  AAT is designed to improve the cognitive, social, emotional and physical functioning of a client — and the animal presence is so simply soothing.  Often referred to as “comfort animals”, a wide variety of animals such as dogs, dolphins, birds, rabbits and even lizards are used to help clients heal from emotional and physical difficulties that may be too painful to talk about.  AAT is often used with horses, in a special type of AAT called Equine-Assisted Psychotherapy (EAP).

The divide between the human and animal worlds is much less separating than we might have believed.  There is a wisdom and power that animals hold, and when interacting with humans they can soften feelings and problems that their human might have felt were all too overwhelming.  I think one of the most magical aspects of the human-animal connection is the unspoken language that can be shared between them, fostering a trust and affection that never wavers.  Some might argue that animals “know what their human is anticipating and thinking without needing to be told”, says a noted psychotherapist in the Denver area.  This therapist talks about a client she had, a family whose beloved dog was getting sick, her health deteriorating rapidly as the days went by.  The family members were scattered throughout the state, and were not all together as the dog’s condition was worsening.  As the family gathered to try to determine the best option for the dog’s care, the dog passed away on the lap of one of the daughters.  It was almost like the dog “waited until everyone was there, and then passed on in a space where she felt most comfortable and loved — in her home of 12 years, not a hospital”.  The therapist recounted that the family felt the dog’s strong presence in the room as she passed, almost as if she was telling them all that it would be okay to let her die.  One of the most significant things about this story is the way it impacted the family; they came together in grief and happiness as they buried the dog and traded stories about how she impacted each of their lives.  Her life healed theirs.

Many therapists and treatment centers are developing Animal-Assisted therapy programs in the Denver area — and it is so amazing how all parties (human or otherwise) are significantly benefited by the therapy!  The Mental Health Center of Denver, in conjuction with the Denver Dumb Friends League, runs BARK (Behavior Reduction in Kids), a program in which kids can help train dogs up for adoption and in return work with the dogs to learn coping skills for emotional distress and regulation.  The Animal Assisted Therapy Program of Colorado has psychotherapists who work with trained animal partners to accomplish therapeutic goals in cost-effective and timely manners.  Kerry Borcherding, a psychotherapist in Boulder, works with clients to enhance centeredness and grounding, build trust and intimacy, improve breath and body awareness, and other goals — all while on the back of a horse! She also facilitates horseback yoga, which helps heal the body as well as the mind.

Whether you are seeking professional help to work on mental health issues, or if you are an animal lover who spends time and energy connecting with your animal companions, you can be gifted by the healing presence of an animal.  You probably already have — who can forget the noble and kind nudges of Lassie’s nose?  Research has shown that petting an animal automatically reduces the levels of stress hormones running through your body — and the more love and attention that you reap on your animal companion, you will receive exponential amounts of devotion in return.  There is nothing quite like the unconditional love of an animal and I believe that we all have lots to learn from them.  Where else will you be accepted just as you are?  Who else will welcome you — NO MATTER WHAT — with a nonjudmental, excited, and eager presence the moment you step through the door? We all may make our best efforts to offer this type of love to our partners, friends, and family members (and might often be able to give it), but no one can drop everything else and lavish you with adoration the way that an animal can.

I suggest we all take a moment to think about what we can learn from our devoted animal friends, and to pet them, talk to them, and lavish them with love as much as we can.  You know they will do the same for us until the day that they die (and after).  You probably will feel calmer, more rested, and happier than you did before you started petting that cute and furry little being!

A personal and clinical reaction to the documentary “What’s Eating You?”

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As an eating disorder therapist, I have taken a keen interest in E!’s six-part documentary “What’s Eating You“, airing on Wednesday evenings.  This series features two individuals each week and follows them for an hour through their decision to seek treatment, some inside looks at therapy sessions, and efforts they are taking towards recovery from an eating disorder.  I have found the series fascinating, and very real — featuring a range of people who are affected by eating disorders and not just the “stereotypical” upper middle class white young woman.  The subjects have been male, female, married, parents, and have been a variety of ethnicities. 

I have to admit that when I first heard about the series, I worried that it would be the type of show that glamorizes and shines lights on EDs in ways that are not prone to recovery– but perhaps prone to “giving ideas” to viewers.  This was a common reaction amongst other blogs and therapists with whom I have consulted about the series.  A popular blog wonders if the series is giving an incomplete  or overly simplified picture of what an eating disorder is, and what treatment and recovery can look like.  I have to say that I appreciated that each client was not “recovered” by the end of the episode (two new people are featured each week), and that the sometimes years-long struggle to find peace and healing was depicted for the most part, realistically.  Other positive aspects of the show include involving the families in treatment (imperative!), visiting doctors and nutritionists, and showing the high probability of relapse and ambivalence in recovery.

Other factors of the show worry me.  I am viewing this from both a personal and clinical perspective.  As a human being, is it healthy for me to watch a show that reveals what eating disorders do to impact relationships, physical health, self esteem, and families?  Is it encouraging me to not go down that road and to be grateful for my own health, or is it putting (perhaps subconscious) ideas in my head about what I could do to lose weight and “fit in” and “be popular”, if that is what I’m longing for? 

For years there has been talk about the Pro-ED websites, which give susceptible men and women ideas for how to “successfully” develp an ED.  I am going to write a whole blog post about those sites next week — but is there any commonality to tv shows that depict what EDs are truly about?  You could argue that What’s Eating You is aimed to help folks get resources if they are going through similar issues, but I could very easily see someone watching the show who is fragile, depressed, and lonely, and they might feel like this “coping mechanism” could free them from their pain.

I have watched all five episodes that have aired so far, and have noted the different treatment approaches by each of the therapists featured on the show.  Some adovcate for inpatient treatment, some recommend an outpatient philosophy.  This is true of therapists in every city in the country — we all have different ideas and reasoning about what is best for our clients.  Consulting doctors, psychiatrists, and nutritionists is essential, of course.  Yet viewing the choices that the therapist make and that the clients make causes me to wonder (again): what is the best treatment for an eating disorder? 

The sixth and final episode is set to air this Wednesday, and the previews of it terrify me.  I have not seen it yet so I cannot judge, but it appears that the episode is about people who have learned their ED behaviors from their mothers — and in line, blaming the mothers for the devestation of the ED in their lives.  This is the WORST message to send to viewers, because an assumption that mothers cause EDs already exists and this may exacberate it.   From a clinical approach, this is a negative message to send to all families and individuals affected by eating disorders and proves to worsen the epidemic, not lessen it.

Final note:  After watching last week’s episode, I was left with many conflicting feelings.  This may be because I have so much knowledge about EDs, but it also may be because the episode was very emotional and triggering.  I encourage anyone who may have emotions stirred up by this show (even if they can’t quite put a finger on what they are or mean) to talk to someone — a friend, family member, therapist.  That may be one of the best results of the show.

The many faces, spaces, and paces of grief and loss

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We have all endured some type of loss.  Some of us, multitudes of loss.  Mine might be a completely different type of loss than yours, and I may feel it most in my aches and pains, while you feel it in mood swings and emotional responses.  There are thousands – millions – of losses that we all endure each and every day and not one person on this planet has not known what it feels like to lose someone or something that they hold dear.  With all of this commonality — though it has diverse strands — why can’t we connect easier over our grief?

We all grieve in different ways….and we may not know our grief process until we experience a loss.  Many people in mourning grieve in healthy and healing ways.  Some of us close in on ourselves in protection; others yearn for open connection and community.  Some of us shut down in hopelessness and depression; others lash out at loved ones with anxiety.  Some of the most ineffective grief patterns….those folks who may not know what they are feeling or believe that they can feel better….can turn to violence against themselves or others in an effort to numb the pain.

A friend of mine, a bright and inspirational woman who was only 29 and pregnant when she was diagnosed with breast cancer, died last summer.  This was an enormous shock to everyone who knew her.  How do you deal with that kind of news?   As the disease spread rapidly and viciously and took her life, just as she was starting out an exciting new phase of first-time motherhood.  I cannot even imagine the loss that her husband, family, and newborn child have felt, and I know that I was shaken down to my very core by the unfairness and devastation of the event.  To have the life of a beautiful, kind, and intelligent young woman (who was also just beginning her career as a counselor) taken away is an especially tragic loss, and the experience of it taught me a lot about myself.  While nothing can take away from the tragedy of her illness, there was a ray of light in the process of coping with her situation, as people all across the country rallied to raise money, send love, and show their faith in her every step of the way.  My friend knew how much she was loved.  This was a gift!

A loss brought so many people together, and we are now helping each other grieve.  This is the type of grief and loss that can have a silver lining, as community is formed in an effort to cope.  Unfortunately, loss can have the opposite effect on some people, and it can actually divide families, foster anger and resentment, and result in further tragedy.

Loss can be defined in every color of the rainbow.  Loss can encompass the death, illness, or other type of sudden change of a loved one — human or animal.  Loss can be felt around the ending of a relationship or a job or a house.  Loss can come at the change of a situation, such as moving to another state or shifting an emotional response.  Loss does not need to be specific to a person, place, or thing — which makes it both easy and hard to define!  What I am trying to relate is that everyone defines loss in his or her own way, and grieves for that loss in his or her own personal fashion.  There is no “time limit” on grieving (though the DSM might want to convince you otherwise).  There is no “right way” to mourn.

Many professionals have developed models that define stages of grief, such as Elizabeth Kubler-Ross’ model from her book On Death and Dying. This can be helpful and define some structure for mourners who are looking for guidance in uncovering their feelings.  Kubler-Ross describes the five stages of grief as: Denial, Anger, Bargaining, Depression, and Acceptance.  I have used this model in my work and have seen it be effective in helping clients define their own personal grief processes within the larger structure of the model.  There are many such ideas about methods and stages of grieving, and if you find that this is an area which may be relevant for you, I encourage you to research them.

I have witnessed some clients shut in and dwell in solitude for a bit as they grieve; I have seen other folks reach out for support as they mourn; I have also seen many combinations of methods of coping.  There is no paint-by-number answer to getting through one of the toughest things we will experience: losing a loved one, a special relationship, a lifelong dream.  We are all unique individuals and we all cope in our own personal ways.  I caution that destructive tendencies (addiction, substance abuse) can feel like effective coping mechanisms, but if they are used to extreme the loss only intensifies.  If depression or anxiety take over and daily functioning is becoming more and more challenging and exhausting, I encourage you to seek professional help.  Remember: you are not alone and you will get through this!  It will get better.

A thank you and a recap of Kate Daigle Counseling, LLC Open House!

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Kate Daigle Counseling had its Open House yesterday, November 7th, and it was a invigorating and rewarding day for the practice!  I want to extend a personal thank-you to all that attended and showed support.

Here are a few pictures from the event:

Kate and her friend Roger

Friends and family checking out Kate Daigle Counseling’s brochures…

So grateful for all of the support!

Other pictures of the office can be found on all of the pages of Kate Daigle Counseling’s website.

Upcoming events with Kate Daigle Counseling:

-Blog post topics: Surviving the emotional roller coaster of the holidays; PTSD, mental health and War Veterans; the implications of the FREED Act; helping children of divorce cope; the mystery and debates over Autism; the healing presence of animals in therapy; radical acceptance; the stages of grief; men and eating disorders; unlocking the reasons that drive self-harming behaviors; and many more! Please write to me with new ideas that you would like me to write about in my blogs.

-COMING IN DECEMBER! Body-centered therapy group, held weekly at the office of Kate Daigle Counseling.  More information about this will be coming out VERY soon so please keep your eyes open!

-Seminars in schools, recreation centers, and with parent groups: Kate offers talks about the symptoms of eating disorders, some of the causes, and how you can help a child/parent/friend/family member who might be dealing with an eating disorder or other form of emotionally destructive eating pattern.

Thank you for your support of Kate Daigle Counseling!!

Extending a hand to male survivors of childhood sexual abuse

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Females are not the only victims of childhood sexual abuse, and now is the time to embrace males who are survivors and who are coming forward in their healing journey.  The trauma that hundreds to thousands of young males endure has been in the shadows and only recently have support groups and researchers begun to focus treatment on this population.  Why?  This is a complicated question, but some of the answers may be found in the messages sent to men about masculinity and what it “means to be a man”.  It might be thought that to be vulnerable and victimized is not a “manly thing” and therefore should not be exposed.

A blog that I was reading talks extensively about the pressures put upon men in this society. Cultural standards (in the United States, and in other countries such as Mexico and the United Kingdom) dictate that a man must “prove his masculinity” consistently throughout his life because he is supposed to be the “protector, strong, devoid of soft and feminine emotions, and overall a stoic presence”.  This brings up images of John Wayne and the Marlboro Man – a man you can trust to keep you safe.  If this man’s own personal safety and boundaries are violated, is he “still a protector, still a man??”  This masculine drive is referred to as machismo in the Mexican American culture.  I also reflect on bullying and the way that bullies can make you feel like you are not “okay as you are — whether that is a man that is not manly enough”….and also makes me wonder what the bullies are protecting about themselves in their mission to tell others that there is something wrong with them.

A man who is sexually assaulted or who is a victim of incest may feel that his masculinity is at stake and may question his sexuality.  This can lead to denial and other defense mechanisms to protect their “abominable secret – that they were not strong enough to be the man they should be”.  The truth is that there is NOTHING to be ashamed about and that addressing these issues in no way makes the survivor “less of a man”.  Studies have shown that men who were abused might take on one (or several) of three roles: 1) Perpetrator – he feels he must victimize others in order to protect himself from more pain and hurt; 2) Victim – he believes he will always be a victim and that he does not have the power to openly heal his wounds, or that he “shouldn’t try”; 3) Protector – he might feel that every child is at risk for being abused and will go out of his way to make children safe.

I have deep and insurmountable respect for Tyler Perry, an actor, writer and director who recently revealed a horrendous personal history of childhood abuse at the hands of his father.  He is making his story public and opening a door for thousands of other adult males to feel safe and free to talk about their own trauma.  Tyler went on Oprah’s show to process this devastating aspect in his life, and tomorrow he will return to her show to support 200 adult men who were molested as children and who are now (many of them for the first time) disclosing their history on national television. I am in awe of the bravery and courage of Tyler and the men coming on the show, men who are comfortable and willing to show that they can be survivors of childhood sexual abuse and still be strong men.  Tyler is a hero for adult male survivors everywhere, and I know that there are hundreds of other heros, heros who have moved forward in their lives and made a difference in the world through advocating for sexual abuse survivors.

I think that openness and sensitivity are truly honorable marks of both femininity and masculinity and that the more that our culture opens up to diverse types of people (whether in terms of sexuality, personality, ethnicity, backgrounds, etc), the more peace and healing will come to our community as a whole.

I will be sure to tune in tomorrow to Oprah, and hope you do too.  More resources and information about male survivors of childhood sexual abuse can be found at:  www.malesurvivor.org and www.wingsfound.org.

Working with clients with somatic symptoms: how can we be effective?

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First of all, what are somatoform disorders?  This is a topic that was roughly covered in my training but that I have not seen often as presenting issues in clients, but I feel it is important to raise awareness about these issues.  Somatoform disorders are defined as “physical symptoms that seems as if they are a part of a general medical condition, other mental disorder, or substance is present.  It is thought that psychological and mental issues are translated into presenting as physical medical problems or complaints.  This type of disorder is typically first found in a medical setting, as clients come in initially complaining of physical distress.

Somatoform disorders are categorized into several types: Somatization disorder (or Briquet’s Disorder); Pain disorder (complaining of pain, seen most often in the older generation); Conversion disorder (the client’s sense of mobility is impaired with no real cause other than stress); Hypochondriasis (marked by fear of sickness or injury and a lack of assurance that they are okay); Body Dysmorphic Disorder (fear of or irrational exaggeration of a certain part or parts of a body — this is often tied with eating disordered symptoms); and Somatoform Disorder Not Otherwise Specified.  Given these differing types, it appears that the factors that qualify a Somatic Disorder can vary widely and do not necessarily fit into neat categories (as is the case with many types of mental issues).  It seems that the underlying factor for many of these types is a projection of mental distress onto the body, with it manifesting in physical symptoms.  As mentioned earlier, clients often first present at doctor’s offices, because this chronic hip pain must be a purely physical ailment.  However, if the doctor tries varying treatment approaches and the pain still remains, the client might be referred to a mental health counselor.  I have known counselors who meet such clients, and they have related that sometimes the clients do not see a reason for therapy — the issue is IN HER HIP! NOT HER HEAD!  This makes for a careful assessment on the part of the therapist, and patience and dedication by both parties.  It is amazing when clients suddenly feel less pain in their shoulders or an improvement in their chronic headaches as they work with a therapist to address stress-related mental health concerns.

I once had a client who was dealing with an eating disorder and she told me about experiencing chest pains and a tingly feeling in her left hand.  She went to the doctor (without disclosing her eating disorder) and he took an EKG, did full-body x-rays, prescribed Vicodin, and read her vitals — all to find that she was perfectly healthy (as healthy as you can be with a serious ED).  He could have referred her to a mental health counselor, but he did not (she found her way to me anyway)…though he did talk to her about stressors in her life.  As I worked with this client and her eating disorder got better, she experienced less and less of the chest pains and tingly feeling in her arms.  Were those symptoms part of a somatic issue or were they the effect of an ED?  Obviously, her body was stressed by the medical effects of the ED and could have presented that stress in the form of chest pains and arm tingling…but the doctor could not find anything to put his finger on in terms of diagnosing the physical issues, so is it purely mental distress projected upon the body in the way that somatic disorders do?

Somatic symptoms can be challenging for therapists as well as doctors because the client might not know (or want to talk about, in the case of the ED) why this is occuring and it could take leg work on the part of all parties to get to the deeper issues.  Somatic Experiencing is a type of therapy designed to help relieve and resolve the symptoms of Post-Traumatic Stress Disorder (PTSD) and other mental and physical trauma-related health problems by focusing on the client’s somatic symptoms.  Clients who have suffered trauma or abuse can exhibit somatic symptoms as a way to express the pain of the trauma in a physical capacity.  Dr. Peter Levine’s book Waking the Tiger talks extensively about Dr. Levine’s observations of wild animals and how they cope and recover from physical traumas.  Therapists using this approach work with the mind and the body to regulate the autonomic nervous system, defining the ways the mind affects the body and vice versa, and healing those connections.

Somatoform disorders can present when a client has experienced trauma, abuse, or devastation (such as a natural disaster) and may not know how to safely express the feelings they have inside.  Perhaps they do not even realize they have those feelings and their bodies relocate the pain to a physical sensation, which might be more natural to experience.  Some cultures, such as Southeast Asian cultures, often present with somatic symptoms to their doctors, who then refer them to therapists.  It is essential that counselors recognize the signs of Somatoform disorders and become knowledgeable about the populations and situations in which they most commonly are seen.

Removing the problem from the relationship: narrative couples therapy

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I was excited to find a blog post that focused on how couples can benefit from narrative therapy.  I have always been intrigued by narrative therapy and use it often in my practice, but my couples therapy training had never specifically touched on how to integrate this post-modern approach with relationship work.  Narrative therapy is an innovative and collaborative therapeutic approach that is intrigued by the stories of people’s lives.  It focuses on understanding how the stories our lives lead are based on influences from society, culture and politics and how these factors can create problems in relationships with ourselves and others.  Integrating the postmodern approach of “there is no objective truth”, narrative therapy believes that our lives are built of many stories that interact with each other and form a network of experiences and memories.  In individual and family therapy, I might work with a client on “rewriting her life story”, either literally or figuratively, so that she feels she has the power to direct her life in a healthier, more peaceful route.

Narrative therapy also uses the technique of “externalizing the problem”, which is a way of removing the problem from within ourselves and seeing it as a separate thing that influences us and interacts with us in ways we might not even realize.  I find this to be one of the most dynamic and healing aspects of narrative therapy: how many of us feel as if we are the problem?  As if it is a part of us that we cannot do anything about and it therefore gains control and makes us miserable? I sure know the feeling.  In relationships, each partner’s life stories interacting with each other, multiplying the complexity and depth of the ways that each partner has chosen to live his or her life thus far.  How does your story impact the way you relate to your partner?  For example, if your family struggled with financial security for many years of your young life and you survived by learning how to budget and live modestly, you might have a story that is written about survival, responsibility with money, and thinking very hard about each decision you make.  Your partner may have had a completely different background and his life story may never had the chapter of needing to learn how to manage money in a careful manner.  These backgrounds, ingrained in us, might navigate the ways that we talk to our adult partners about money.  Using narrative approaches, the couple could explore the influences of society and culture on money management as they grew up, and they could collaborate to write a new story on how they would like to approach money management as a couple.

Often times, couples come to therapy focused on a problem.  They have already “tried everything” and therapy is a last gasp at saving the relationship.  A popular marriage therapy blog offers a very honest account from the perspective of one partner as the couple enters marriage therapy at this stage.  Using narrative therapy to externalize the problem can be a very powerful intervention that makes the blame game completely disappear.  Through exploring the couple’s story, I learn what the underlying issue is (*note: this is not often the first thing they present with.  Couples often present with issues surrounding sex, money, in-laws, and parenting responsibilities and it takes a lot of work to find the raw feelings that lie underneath these).  Perhaps the couple presents with issues of jealousy and dishonesty in being accountable to their partner.  After exploring for a session or two, I am able to fish out that each partner is feeling lonely in the relationship.  By removing “lonely” and using it as a separate entity in their relationship, both partners can see it as something they do not own and thus do not need to feel guilty or ashamed about.  I might ask them “how is loneliness affecting your ability to relate to one another on an intimate level?”.  Or “in what was does jealousy harm the relationship?”.  And, further down the line, we could work on figuring out “What steps can you take as a couple to lessen the powerful and dangerous effects of ‘withdrawal’ on your relationship?”

This is just a taste of some of the interesting facets of narrative therapy, as I begin to dabble in ways that it can effectively help couples heal wounds and start writing new and liberating life stories together.  When we are able to feel that we are not the problem, that we do not own it and it is not a deficit of ours or our relationship’s, I think that partners can start to adopt a solution focused outlook instead of a toxic problem-infused mentality.