Evicted.

It’s happening.

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to the woman I called best

I wish you would call me one more time so I could tell you to go fuck yourself.

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a new way to handle infant loss

So dang important. As a hospital social worker I faced this horrible situation way too often – the middle of the night, a groggy chaplain, teams of residents and nurses silently sobbing, the cries of a mother’s grief that don’t even sound human.

There’s no way to ease the pain they’re feeling, the ongoing grief they’ll feel…the going home to a finished nursery or the telling of friends or the baby gifts they won’t get to use. For some reason one of the most vivid images I have is of sitting in the room holding a mom and looking over to the table where this expensive camera sat, waiting to take pictures of a newborn…a toddler…the first day of kindergarten….it was awful.

We try to give the family as much time as they need with their child, with their little family that won’t ever leave this hospital. But this article is right: 2-4 hours often isn’t enough. In fact, the first couple of hours the mother may even refuse to see the child, saying she can’t do it. But most of the time she changes her mind, and we try to anticipate it – keeping the baby in another room until mom is ready. We take footprints even when mom says she doesn’t want to see them, create a memory box just in case. Sometimes family takes it and we hear later that mom/dad were so grateful later on when they had these keepsakes. I love this idea of slowing down, of letting the family have extra time to make decisions. We try to never tell the family there is a time limit, and honestly my families rarely use the whole time we’ve given them….but I think if the staff knew we had extra time we could aid in this slowing down process rather than feel the pressure of the clock and worry that we’d have to tell the family it’s time to physically let the child go.

I love these little suggestions, the colorful blanket or the recording family members. But this….this has changed the way I will handle infant loss forever:

It’s all about taking the time to say hello to their child before saying goodbye.

What a profound and incredible statement. Thank you, Megan, for the work you do and for taking time to share it with us.

Mandy Maneval faced infertility for years. Finally, three years ago, she became pregnant with twins. At a routine ultra sound, she was faced with the news that Aaron was lost at 20 weeks. Her little girl, Abigail (Abby), was healthy.

At 30 weeks, Mandy went into labor. She called her sister, Megan Shellenberger, a nurse at Penn State Milton S. Hershey Medical Center, located in Hershey, Pennsylvania. Megan spends most of her time working in labor and delivery, and she was quick to reassure Mandy that everything would be O.K.

Suspecting that baby Abigail had a heart defect, Mandy came to Penn State Milton S. Hershey Medical Center, the home of a leading neonatal cardiologist. The physicians were able to stop Mandy’s labor, but she would remain an inpatient until delivering Abby at 35 weeks.

Abby was born with two very complex heart defects. So rare, that her doctors described it…

View original post 1,156 more words

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gross.

My coworker just taught me a Buddhist practice to combat what they call “attachment.” I’ve mentioned the concept of attachment before – that we mistake it often for love but it is really a poison in disguise. Attachment to anything – a person, belonging, idea, etc – overtakes our minds and often we obsess over the object of our attachment. For someone like me with clinically obsessive thoughts and a probably-clinical hatred of bodily functions….well, we’ll see how this goes.

ATTACHMENT
Definition: Exaggerated not wanting to be separated from someone or something. (Exact opposite of Aversion) Because the label of “pleasant” is very relative and based upon limited information, Attachment includes an aspect of exaggeration or “projection”.

Near “enemy” (or not to be confused with): Real appreciation, love and compassion.
Opposite: Wanting to be separated from someone or something: aversion.
Main quality: exaggeration of positive qualities, which can only lead to disappointment. Falling in love will usually fit very well in this category. (from View on Buddhism)

The practice my coworker was telling me about, in regards to attachment toward a person, consists of contemplation: sit and mediate on that thing that has such hold over your thoughts. Now think of all of the disgusting, feral aspects of that person. Imagine them without skin. See all of the sinews and blood and guts that make up their body. Think of mucus, of odor, of bowel movements and eye sockets.

I’m not kidding. This is a real practice (it came up because a patient down the hall has a disgusting hacking cough right now) and honestly, I guess I can see how it works. I’d like to know how permanent the images these meditation conjure would be….I don’t want to think of bodily fluids every time his name pops up on my phone. But then again, maybe I do, right?

Break the cycle. New associations. Turn my brain off of that thought and start the process of replacing it….I guess I can replace it with something else altogether once the initial obsession has broken. Maybe…emptiness? I don’t really have this Buddhism thing down…

HANDLING ATTACHMENT

One man can conquer a thousand times thousand men in battle,
but one who conquers himself is the greatest of conquerors.

The Dhammapada

The following antidotes can be applied throughout daily life, but are profound meditation exercises as well.

ANTIDOTE 1 – Observe Yourself: Do I exaggerate positive qualities of things I am attached to, are they really worth all my troubles? Is it really worth to work hard for days, weeks or months to have an hour of fun?

ANTIDOTE 2 – Use Your Inner Wisdom: Discover how exaggerated attachment is and how desire works against oneself. Try to be wiser than the monkey and let go of the candy to be free.

ANTIDOTE 3 – Reflect on the Unsatisfactory Nature of Existence. This is also called the First Noble Truth. How much fun is fun really, and how much is it forgetting the pain? Do desires ever stop or is it an endless job to fulfil them?

ANTIDOTE 4 – Reflect on Impermanence. How important is the person or object: everything will end someday, people die, things break.

ANTIDOTE 5 – Reflect on the Problems of Attachment. Lying in the sun is great, but it quickly leads to sunburn. Eating nice food is great, but it leads to indigestion and obesity. Driving around in big cars is great, but how long do I have to work to enjoy this?

ANTIDOTE 6 – Reflect on bodily attraction (lust for sex). Loving someone is great, but what happens when the “honeymoon-days” are over? But what is the body really? What more is it than a skin bag filled with bones, flesh, disgusting organs and fluids?

ANTIDOTE 7 – Reflect on the Results of Attachment. Greed and craving lead to stealing and all kinds of crime, including war. Addiction to alcohol and drugs are simply forms of strong craving; they destroy the addict and the surroundings. Uncontrolled lust leads to sexual abuse. The feeling of greed, craving and lust in themselves can be easily seen as forms of suffering.

ANTIDOTE 8 – Reflect on Death. What are all objects of attachment worth at “the moment of truth” or death?

ANTIDOTE 9 – Emptiness. The ultimate antidote to attachment and all other negative emotions is the realisation of emptiness.

Hmm.

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Aha! Moments

Neuroscience is now suggesting that in order to change recurring emotional and behavioral patterns, we can’t just talk about change at the cognitive level, we have to evoke an emotional experience that changes patterns in the emotional regions of the brain. Creating these emotional experiences not only triggers profound transformation, but it can also be fun and uplifting for both you and your clients.

Okay, heads up: this entire post is a re-blog from PESIinc., a company that provides continuing education for a variety of professions. I kind of love them, even when they spam me four thousand times a day with courses I might like to take.

10 Ways to Help Stuck Clients Move Forward

posted Nov 24, 2015.

“I know it’s irrational, but I can’t stop the extreme anxiety I feel around people because I’m a 6’3” tall woman and fear they’ll think I’m a freak,” said Natalie, a 35-year old nurse. Though she was comfortable working with patients, was happily married, and had two very close friends, she couldn’t shake the anxiety she felt around colleagues and large groups of people.

“My last therapist taught me relaxation exercises, how to talk back to my negative thoughts, and encouraged me to get out socially with small groups,” Natalie added. “But none of that seems to work. The anxiety just hijacks my brain.”

She’s right. Sometimes, no matter how we try to outsmart it, our emotional brains are primed to override the rational mind with patterns that persist until we intervene with something this feeling brain can understand: a compelling emotional experience that completely changes how we feel, not just how we think.

Orchestrating such felt experiences with your clients is easier than you think. In this post, I’ll share 10 strategies from my book, “The Therapeutic ‘Aha!’” that you can use to engage the emotional brain and help stuck clients move forward.

Strategy #1: Align, Lift, and Lead

Most of us were taught to validate our client’s feelings. However, if you spend too long merely validating your client’s pain, it can amplify negative feelings in the emotional brain. To help your client access positive states of mind, you have to find a way to lift and lead them emotionally. To make this transition, I recommend a language pattern that I call “Align, Lift, and Lead.”

You align with the client by reflecting your understanding of the problem, and then you lift the client by affirming her strengths, and lead her by suggesting her desired response to the situation. Here is how I used this language pattern with Natalie:

 “Natalie, I understand that you’ve had these experiences where you’ve not felt comfortable around large groups of people because you’ve not been sure how they would react to your height. Being a nurse, you’re obviously an empathic person and are probably pretty good at helping people feel at ease. I’m seeing you using these people skills in other social situations, too, realizing that a person’s reaction just tells you something about them, and you can sense how to put them at ease.”

Reframing her problem in this way helped Natalie feel more socially competent and encouraged.

Strategy #2: Visualize the Desired Response

Because the emotional brain learns better through metaphor and imagery than it does through words, another strategy you can use is to have your client visualize her desired response. I suggested Natalie visualize herself successfully navigating a social situation and imagine feeling curious, secure, and calm. Then, I asked her to imagine something in nature that could represent her mind working this way. Natalie smiled and said, “Muir Woods with the redwood trees.” Visualizing the peacefulness of the tall trees in this forest helped her feel calmer and gave her a sense of belonging.

Strategy #3: Identify Inspiring Goals

Instead of setting dry, lifeless goals like, “Client will practice relaxation skills and talk to two new people per week,” explore potential goals that have real value and meaning for your client.

When I explored inspiring goals with Natalie, she began talking about her desire to have lunch with a group of colleagues. They’d been inviting her to lunch for several weeks, and she liked the idea of connecting with fellow nurses. Targeting a small group of people she wanted to be around felt more intriguing and doable to her and less like a task.

Strategy #4: Locate the Root of an Emotional Conflict

Even though Natalie felt encouraged by this goal, she still felt a knot in her stomach at the thought of going out to lunch with these colleagues. I asked Natalie to follow the sensations in her stomach back to the first time she could remember having a similar feeling. Her eyes widened as she recalled being teased during lunchtime in middle school by a group of kids who called her names like “Amazon” and “Sasquatch.”

She had coped by avoiding the school cafeteria and doing her homework in the library during lunch. As a result, she avoided her bullying classmates and was praised by her teachers for being studious. Natalie gasped as she realized she was doing the same thing at her job­—skipping lunch with peers to avoid fears of being ridiculed and getting praised by her boss for being so dedicated.

Once Natalie made this connection, she understood her emotional brain had simply continued the pattern because it had been adaptive for her in the past.

Strategy #5: Reverse Traumatic Memories

Natalie was excited to have made this connection, but just having cognitive insight into the cause of her social anxiety didn’t change it. In fact, recent neuroscience discoveries have shown us that in order for the emotional brain to change a response that was once adaptive, we have to recall the old memory while eliciting a new experience that invalidates the beliefs that got attached to the disturbing memory.

Strategy #6: Change Beliefs With Imagery and Metaphor

To change Natalie’s negative self-concept, we revisited her imagery of the redwood tree­—tall, beautiful, and majestic. I suggested she imagine the smaller trees laughing at the redwoods for being so tall and see the absurdity of it. Imagining this scene made Natalie laugh and realize every tree had its natural place in the world, and so did she.

Strategy # 7: Conjure Up Compelling Stories

Another way you can reverse the meaning of a traumatic event is to have your client finish her story with a new ending. For instance, she can finish it with a later moment in her life when she was out of danger, in a better situation, or felt competent or empowered.

The first time Natalie told her story about being bullied at school, she ended the story with an incident where a boy asked her to dance, then brought out a chair to the dance floor and stood on it so he could be as tall as she was. Everyone laughed, which made Natalie cry.

When I prompted her to consider a new ending to this story, she said, “Well I’ve been happily married for 15 years, and my husband said he was attracted to me because I was tall. He thought I looked like a graceful dancer.” She smiled and realized that ending her story this way suddenly caused the experiences she had with the boys in her youth to seem trivial.

Strategy #8: Prime With Play and Humor

Using play and humor are also great ways to dissipate anxiety and trigger new perspectives on events. Natalie and I acted out a role-play in which I let her play a woman with a snobby attitude teasing her while I played Natalie. She began the role-play by wrinkling her nose and saying,

“Who invited you to lunch with us, Amazon lady?”

I answered by simply saying, “Linda invited me.”

“Well I hope you don’t think I can be seen walking next to you, Sasquatch,” Natalie continued. And you should really consider doing something different with your hair.”

I smiled and replied, “Oh, what a shame. I fixed my hair this way just for you.”

Natalie laughed and we continued the role-play for a few more minutes. Letting Natalie play the character she feared reduced her anxiety because she realized how insecure a person would have to be to make such insensitive comments.

Strategy #9: Rouse With Rhythm and Music

Music can influence mood and neurochemistry, and it can entrain the brain to calmer states. One activity many clients enjoy is creating a playlist of tunes that evoke desired responses. Natalie started her playlist with “Creep” by Radiohead, which reflected her fears of being a social reject. Then we added “Everyday People,” by Sly and the Family Stone, which was more upbeat and affirmed that humans come in different colors, shapes, and sizes. Natalie ended her playlist with “Can’t Keep a Good Woman Down,” by Mary J. Blige, which helped her feel empowered.

Strategy #10: Integrate Mindful Movement

Movement can also engender desired states of mind. Dancing to her playlist helped Natalie shake off anticipatory anxiety, but I also suggested she could place her hand on her abdomen to calm her stomach and invoke a sense of self-compassion. She practiced this gesture while she slowed her breathing and imagined the beautiful redwood trees. Over the next several weeks, Natalie reported that her anxiety completely dissipated and she was able to comfortably enjoy lunch with her co-workers and other social situations.

Closing Thoughts

Neuroscience is now suggesting that in order to change recurring emotional and behavioral patterns, we can’t just talk about change at the cognitive level, we have to evoke an emotional experience that changes patterns in the emotional regions of the brain. Creating these emotional experiences not only triggers profound transformation, but it can also be fun and uplifting for both you and your clients.

I hope this post has given you ideas for new techniques you can use, and that it leads to many “Aha!” moments for you and your clients.

Courtney Armstrong, LPC, MHSP, is a licensed professional counselor in Chattanooga, Tenn., and the author of “The Therapeutic ‘Aha!’: 10 Strategies for Getting Your Clients Unstuck.” She also offers training and free resources for therapists at her website: www.courtneyarmstrong.net.

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financial intimacy: a reblog + thoughts

Once we got engaged and the ring sat on my finger, it seemed that problems were not always handled effectively. One of us was compromising to the point we were dismissing potential landmines so that we could get married. It was about the wedding and getting through to that day so we could live blissfully ever after.

I would also add to this article from Be Like Water that financial collaboration and intimacy is unbelievably important even after accounts become joined, credit cards become shared, and incomes are combined. After my own divorce ended in a financial disaster for me, I have found that many, MANY people share my story. We trusted each other, we were both financially independent and secure when we entered into our marriage, and we were open with each other about every piece of debt, loans, open credit, etc. BUT that trust led to my own downfall – I didn’t keep checking our accounts, didn’t look at bills or make sure they were paid, didn’t check my credit or look at our taxes. We tried doing our budget together but since we both had such different ways of doing the physical budget (I like pen and paper, he liked Excel – my Excel spreadsheet went from top to bottom, his went from left to right) that I eventually entrusted the whole process to him. Like I said, we were both capable adults who had spent years in charge of our own finances – I thought I had no reason to double check everything.

So eventually I had no idea that our bills weren’t paid or our debts grew. I didn’t know he lost his job until the pharmacy told me I no longer had insurance. I thought we were fine. I knew we were on a budget, sure, but we still went out to eat with our friends and bought new things when we wanted them.

I didn’t realize our “$200” car repair actually cost us $2,000. I didn’t know that he added himself to an old credit card of mine and charged thousands of dollars to it. I didn’t know he spend hundreds of dollars buying everyone rounds of drinks at the bar each night.

I had already left him by the time I discovered all of the debt. I had no money to pay anything; my paycheck went into our joint account for which I didn’t even know the log-ins or passwords.

So my advice is this: even if you don’t check often, make sure you CAN check. I speak about this with all of my friends, clients…heck even friends of friends I’ve just met. People who say, “oh I’m bad with money, I just let [my partner] handle everything.” Or “he/she has me on a budget because I just don’t pay attention to that stuff.”  Make a note to check your accounts,  at least every quarter. I’m not accusing your partner of fraud or anything, I’m suggesting that he or she may get into a bind and think “well, I’ll pay the savings account back next month” or “I want her to have a good Christmas, I’ll put this on the credit card.”

If I had known how stretched we were financially I would have stopped spending money! I’m sure pride and depression and alcohol and the fear that he was losing me all contributed to my ex-husband not telling me what was going on. When I finally did leave I had no idea the mess that we were in financially.

But I honestly take some of the blame for our financial burden. By being lazy and stubborn (“fine! If your way is so much better, you can just do it!”), I put the entire responsibility on him. We should have been a team when it came to budgeting and spending. 

I am positive he thought he was doing the right thing to try to make me happy. Maybe at the end some of his spending was spiteful, but I am 100% it didn’t start out that way.

Pay attention. Be a team. And – I say this with the experience of many, many people I’ve met – protect yourself. I promise you, ALL of us at one point said, “that will never be me. My partner would never do that to me.” Please be safer and not sorry.

__

PS: Shout out to the many, many people who have helped me survive (literally) since that time. From the one buying me mac & cheese and SunChips in bulk at Costco (lived on that for months), to the one who let me live in her guest room for free, to the ones taking me out or to shows or to dinner, to the one replacing the broken things and sending me beauty for no reason other than believing I should have it. I may be living paycheck to paycheck, but I wouldn’t be here at all if it weren’t for the incredible people who have picked me up along the way. Which is a whole different blog: can we be friends with the people who save us? 

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Cheers for EDNOS!

What’s worse, an eating disorder lacking a clear label can deter people from help. “Often people with eating disorders of any type really minimize it” – name or no name, DeNicola says.

That tendency can be even greater when the condition’s identity is elusive, Kracov says. “When you don’t fit into those categories it’s really easy to say, ‘That’s not me. This isn’t a problem,’ when really, you’re still thinking about food all of the time – it’s taking over your life,” she says.

Read more about it here (from February 2015): When Your Eating Disorder Doesn’t Have a Name.

What’s really interesting to me is that I began eating again during my study abroad in Argentina (a girl in the above article re-discovered food in German). I’m interested to know how we can create experiences like that for people with disordered eating who don’t have the opportunities that we did.

And the thesis develops…

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Loathing

I hate myself. I realize that’s a common theme with me these days, but today I can’t stop crying about how awful I am. This woman on the train was howling, that awful guttural cry you make when something is horribly wrong. The problem is, it’s rush hour and super crowded and no one wants to look at each other must less interact. And we are used to it, these noises of the emotionally disturbed, the begging for money, the cursing at us when we don’t respond. And I figured, there’s nothing I can do. I saw a woman slip this woman money Grandma-style; the two had clearly interacted before I boarded the train. At the next stop after I got on another man told her, “you have to get off here, honey, this is where you crossover.” He had also spoken with her before my stop. But before I saw these people I debated fiercely with myself whether or not to bend down and ask her what was wrong, what can I do? Or just offer comfort. Or anything. But I didn’t. No one has ever ‘bent down’ for me in the train or on the streets when I’ve been upset. Not that I would want them to, really – regardless, I followed the NYC protocol and just read my book as if nothing happened.

I didn’t even offer a fucking Kleenex. The ONE thing someone has done for  me that changed my entire life, and I didn’t even pull the pack of Kleenex from my bag and hand it to her.

Who. Does. That. Who sees such an obvious parallel and doesn’t respond?

Once the woman left the train a man asked the aforementioned Samaritan if the woman was okay. The man said, “No.” And he followed up with, “She’s had one of those nights.”

And all I could think of was that she’s been sexually assaulted. Maybe that’s not true, but I’m obsessing over it. My passion, my patients, the ones I sit with for 24 hours without overtime pay if they need me, and I didn’t even ask what was wrong. Or offer a Kleenex.

I almost got off at the next stop and went back, but it was such a far away stop that I figured she’d be on the next train by then. But what if she wasn’t? I was too late for work to go back and check?

I am LOATHING myself. I feel dirty and disgusting and ashamed. I feel like this will come back to me in the worst way. I feel like I deserve it.

Not even. A damn. Kleenex.

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faking it.

When we have a skill or talent that has come naturally we tend to discount its value.

Why is that? Well, we often hesitate to believe that what’s natural, maybe even easy for us, can offer any value to the world. In fact, the very act of being really good at something can lead us to discount its value.

Great article on the Impostor Syndrome in the NY Times. The way I’ve always dealt with – the way I tell all of my friends/clients/patients to deal with it – is that literally everyone feels this way. Everyone I know who isn’t a sociopath feels like they are faking it. So what is even the point of feeling that way? No one is looking to find you out. Just because it’s easy for you doesn’t make it less valuable. And lastly, as always, what’s the worst that could happen?

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Why

don’t you like him?

 

I don’t know.

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