Finding the Right Therapist (Anywhere)

Seattle is a lovely vibrant city, with the requisite attractions like the Space Needle, Pike Place Market, and the Troll under the bridge. It’s also very hustle bustle and, some say, is known for a phenomenon called the Seattle Freeze. The Seattle Freeze is a belief that Seattleites are closed to newcomers; it’s difficult to make friends and get close to people here. If you experience loneliness, isolation, or sadness, you may benefit from working with a counselor in Seattle. Seattle has many counselors, psychotherapists, and life coaches, each with different fields of expertise. You could search on Google or ask your doctor or a friend for a recommendation. All of these are useful ways to locate a counselor that might fit your needs. Now what?The next step is scheduling a consultation with a therapist you’re interested in working with.

The consultation is often via phone conversation, although some therapists prefer to meet in person. You can expect to tell a bit about yourself. What motivated you to seek counseling now, have you ever had therapy before, why, and how did it help? What are you seeking help with? What would you like to be different to improve your situation? Have you experienced this issue before and how did you resolve it? What would you like your life to look like in 3, 6, 12 months? This helps the counselor and you envision possible therapy goals.

Then the counselor will explain a bit about how therapy works; discuss frequency of sessions for continuity of care. She’ll describe the process of setting long-term goals and short-term objectives, and explain the process for checking outcomes. Outcomes show progress, what’s working, and what might need to be changed up. Therapists generally check outcomes quarterly, to make sure the progress is flowing along the way you want it to.

She may talk with you about benefits and drawbacks to a diagnosis and possible therapeutic methods shown to benefit specific issues, like Cognitive Behavioral Therapy’s help for depression, motivational interviewing’s help for addictions, and Eye Movement Desensitization and Reprocessing Therapy’s benefit for anxiety, trauma, and phobias.

At this point, you both get to check in with yourselves and see how you think you’d feel working together. Does she listen more than she talks? Do you feel heard and understood? Do you have confidence that she can help? Do you feel like you can connect with her? If the answer to these questions is no, it may be time to seek another counselor.

If you can answer these questions with a confident yes, you can assume this is the therapist for you. At this time in the consultation, one of you, usually the therapist, brings up the topic of money. If you don’t connect, or this therapist specializes in other areas than your issue, it doesn’t matter if the fee is $20 a session. $20 a session gets very expensive when it goes on for years and years.

The therapist then tells you her fee, whether and which insurance she takes, when payment is due, and how/if you can be reimbursed. If your insurance pays out of network, you would likely pay for sessions and your insurance will reimburse you, minus your copay. If you participate in your employer’s flex care spending plan for medical costs, it will likely reimburse you for all therapy expenses, although you need to check your plan.

If all goes as you wish, you two will schedule your first session. You can relax; you already know you’ve got the right therapist for you. Now you can dig right in and start feeling better. And as always, I'm here. You can reach me in Seattle at Balance InSight, 206-790-7270.

Thanks for reading, and be well.

~ Robin

To Hide or to Run: Tools to Help with Decision Making in a World with Too Many Choices

Did you ever play hide and seek, outside in the neighborhood, after dark? My cousins were the best at surrounding the good hiding spaces, causing me to freeze, leaning toward the corner of the garage – nope, Kathy’s there, leaning toward the cave under the stairs – nope Pam’s there. As a child I’d think: what’s keeping me from just grabbing a spot and hiding? Well here it is: to make one choice was to leave behind other, possibly better options. Worse, the number of hiding spots felt infinite, so any one choice eliminated an infinite number of potentially better choices. Now, don’t get me wrong, I know the difference between hiding spots at age 8 and where to move, where to work, whether to have children, who to reach out to at age 30 or 40 or 50.

Some people list pros and cons on a T-chart. That’s one way as long as the items on each side have equal weight and value. I tend to pick apart the items into smaller parts, taking lots of time making sure the smaller items are relatively equal.

Some people research and gather information from the internet, friends, and professionals, mull it all about and synthesize things into the one best choice. I try this one often. If nothing else, I enjoy learning more about possibilities. That said, I have a hard time making an actual decision.

Another thing I try is flipping a coin. Even for major decisions. Wait, hear me out. Say, for example I am trying to decide whether to move to Hawaii or stay in Oregon. I researched in a huge way, read books about the different islands, talked to friends I trust, and made a lengthy list of pros (all about beaches and sunshine) and cons (many more – pet quarantine, leaving jobs, no family or friends there, etc.).

In the end I flipped a coin. Heads, we’d live on an island; tails, we’d stay in Oregon. Now this is the beauty of coin flips: it’s a coin, not a judge or The Price Is Right. I flipped tails. My reaction was on of disappointment, sadness, “why not’s,” and “but I want to’s.” Coin flipping lets me gauge my reaction to the coin outcome and my decision becomes clear.

Another decision making tool I use, especially for decisions with more than two options, is eeny meeny miney moe. Yes, the childhood game. There are a couple of ways to do this. I like to touch a photo of each option or have some item that symbolizes each option and touch them as I go around, one touch and one word for each option.

• Eeny (go to Hawaii this year), meeny (stay in Oregon), miney (move to Hawaii after retirement), moe (move to Florida instead),

• catcha (go to Hawaii this year), piggy (stay in Oregon), by the (move to Hawaii after retirement), toe (move to Florida instead),

• if he (go to Hawaii this year), hollers (stay in Oregon), let him (move to Hawaii after retirement), go (move to Florida instead),

• Eeny (go to Hawaii this year), meeny (stay in Oregon), miney (move to Hawaii after retirement), moe (move to Florida instead).

If I land on Florida and I don’t want to move there, I toss that out and start again with just 3 choices. If I want Florida in, I cheat and decide that means I win and get to go to Florida. Either way I’m tricking my brain into making decisions.

Decisional Balance

For a broader, deeper, and visually relevant decision making method, I like the Decisional Balance Activity. It’s a grid that works a bit like the T-chart, but it includes scales of how important the choice (change) is and how certain you are that you can make the choice (change). It looks something like the graphic (click to enlarge, and thank you Miller and Rollnick).

How do you make decisions? Try one of these and let me know what works for you. Add others if you have ‘em. Thanks! We all need a little help with choices.

The Impermanence of Both Sides of the Pain/Joy Coin

I recently returned from a silent meditation retreat – a place of painful and joyous insights. It was held in a peaceful place, in the middle of nowhere, amidst deer and wolves, caterpillars and snakes. In an effort to force myself to get up and stay up for early morning 4:30 am meditation, I volunteered to ring the morning gong each day.

I set my travel alarm for 3:50 and dressed silently by the light of the little wooden lamp, wrapping scarves around my neck and head – it’s cold in the dark in the woods. My job was to walk outside under the awnings around the women’s dorms, hitting the wooden mallet on the heavy – brass, I think – gong, making it spin and sending vibrations of sound in all directions signaling 4 am wakeup and 4:20 “get yourself to the meditation hall,” for women meditation students.

By 4:30, I was wide awake for morning meditation and took my assigned cushioned spot in the meditation hall. Seated in silence, unmoving, scanning my body for vibrations, my feet would go to sleep. The tingling turned to electric shocks as I worked to notice the sensation, wonder about it, without judgement, and then move on to each area of my body, piece by piece. Working my way up, my back screamed in silence. Notice, wonder, no craving, no aversion, anicca, anicca, anicca* – the law of impermanence.

Meditation continued, alternating with meals and breaks, until 9:30 at night, for ten difficult and wondrous days.

During meals and breaks, I thought. In my head without distraction can be a scary place to live, and so I tried to notice, wonder, and practice anicca with my thoughts. I had painful thoughts of childhood traumas, joyous thoughts of future life plans, and tender fearful thoughts of the impending loss of my dear friend, his third bout with cancer, third type, ever growing. And I cried. Often. In silence. Walking the mowed paths in the meadow and looking out at deer during teatime. Why did he do that? I got this! Why must she go and leave all her children?

I made decisions, changed decisions, and meditated on it.

I must confront my father for his sins against me; I must not confront my father, he can hurt me in other ways now; I am not a traumatized child anymore and my existence no longer depends on the whims of my father.

I must continue my agency job healing moods and personalities; I must leave my job to support myself; I will continue my work, my life's mission, in my own office.

My friend will die; my friend might live with this treatment and that intervention; my friend’s body is dying and I will hold his family in my heart and his soul in my hands.

And then, I meditated some more.

The last night of the retreat was a buffer between the isolation and noble silence of meditation and the hustle bustle noise of the outside world. Talking was allowed everywhere except in the meditation hall. I stayed up late in deep discussion with other women I felt silently bonded to. And then the pain/joy coin hit me in my gut: life is pain and life is joy. Physical aching electrical pain and horror-invoking mental pain and the heart ripping pain of grief. Subtle pinpoint vibration joy and emancipating courageous “I got away” joy and hopeful life without end joy.

And now, I meditate some more.

*Anicca is pronounced uh-nee-cha, and means impermanence in Pali. The law of impermanence says that pain and suffering, like joy and happiness, are impermanent.

If you've experienced grief, loss, trauma, or pain, you can feel better. I'm here. You can call me to schedule a consultation, where we'll talk a bit, give you some hope, and see if maybe you want a little more help.

EMD What? FAQs about EMDR

Eye Movement Desensitization and Reprocessing Therapy (EMDR) is one of the great counseling techniques (stay tuned for others) to lessen the triggers and flooding that come with anxiety. It works on the stuck memories that come out with physical sensations when we are confronted with smells, sights, people, places, or sounds that are similar to trauma, pain, or fear we experienced in the past. For example, if you’ve experienced sexual assault that started when you were sleeping, by a man with alcohol and cigarettes on his breath, you might start sweating or crying when you smell the combination of cigarette smoke and alcohol. You might start hyperventilating or having chest pain when you are woken up from a deep sleep. You might need to sleep with the lights on, or in your living room, or not much at all.

Triggers

The smoke, alcohol, darkness, being woken up, or sleep itself, are triggers that flood the brain with chemicals that put us into fight, flight, or most commonly, freeze mode.

We feel immobilized and experience panic, perspiration, inability to catch our breath, chest pain, tingling sensations in our hands or feet, lightheadedness, nausea, or headaches. We might get a flush of being extremely hot or cold, blacking out, and even a sensation of either watching ourselves from outside our bodies or of not being present in that time and space at all (this last one is called dissociation and I’ll post more about it later).

Protection

These physical sensations, interestingly, are our brain and body’s way of protecting us from danger. Our brain was so overwhelmed by the danger and trauma of the assault that it goes into protection mode to make sure to keep us from getting assaulted again – it warns us if any aspect of the assault is present now to tell us to get away and get safe.

When you think about it that way, our brains are pretty amazing, right? The problem comes when the brain’s attempt to protect us isn’t helpful, like when we are not in danger of assault but the brain thinks we might be, so we can’t be around certain smells or sights or places without experiencing the physical and immobilizing symptoms I talked about above.

While our brains are terrific at protecting us, that protection, when we don’t need it, gets in the way of us living life and doing things we want to do.

Enter EMDR Therapy

EMDR is a technique that I use, to help your brain recognize that sleep doesn’t necessarily lead to assault, nor does darkness, or the smells of cigarette smoke and beer.

EMDR uses something called bilateral stimulation – stimulating both sides of the brain – to get the emotional feeling side synced up with the logical thinking side. Integrating the two sides around the trauma helps the brain reprocess the traumatic event and move it from a current trauma to a past trauma, thereby lessening the physical triggers and panic in the present.

Sounds like such a relief, right? It certainly can be. EMDR does not make the memories go away, but it does lessen and dilute the symptoms related to the assault – or car wreck, dental visit, humiliating or fearful event, loss, death of a loved one, combat, dog bite, or, or, or, you get the idea.

Like all EMDR trained therapists, I've gone through rigorous training over an extended period, many hours of practice, and consultation with a certified EMDR supervisor, to make sure it's the best and most effective treatment for the issue/s you want to work on. Just like psychotherapy – longer, deeper, talk therapy – is not right for every person or even every issue of the same person, the same holds true for EMDR.

If you experience symptoms such as panic, tingling hands or feet, anxiety, nausea, avoidance of places, smells, sounds, or people, or a sensation of not being present, ask me about EMDR and whether it might be helpful for you. Request your free consultation here.

Note: If you are involved in a lawsuit, or if you plan to be involved in a lawsuit, related to the original trauma, please contact your lawyer to determine whether it is advisable to keep your triggers intact until the legal issue is resolved.

How to celebrate Father’s Day when your father is undeserving

With Father's Day right around the corner, here is a repost of blog on how to manage the holiday with a, shall we say, less than loving father. Celebrating YOU!

~ Robin

We all have less than perfect parents. We, ourselves, are less than perfect parents. Maybe we are involved in our children’s education and attend all school and sporting events. We also get frustrated, exasperated, and act out. We yell too often, expect too much, or are inconsistent with rules and our child’s behavior. Less than perfect is good enough. Well-respected developmental theorist Donald Winnicott states that within a secure relationship, being a good enough mother (later changed to include fathers and other caregivers), one who is less than perfect, actually facilitates children’s learning independence, forgiveness, self-reliance, and an understanding of the dependability of love. Less than perfect does not equal undeserving of the title. In my mind, undeserving covers parents who rape or sexually assault their children, subject them to horror or horrific neglect or abuse, sell or give their (the children’s) bodies to others. I’m not talking about a parent who makes a mistake. I’m referring to parents who take pleasure in harming their children’s minds, souls, and bodies.

Father’s Day is coming and, as with many holidays, we are asked to celebrate someone, to thank them, to acknowledge their gifts of love, time, and care we received from them. We are enculturated to believe family is family, the bond is unbreakable, and we’re always there for one another. We grow up hearing we must respect our parents – they raised us after all. We owe them. However, the truth is some families don’t fit the description of a loving bonded unit. In some families the children aren’t or weren’t protected, loved, or cared for. What then? You’ve survived your childhood; must you now celebrate those whom you survived in spite of?

The short answer is NO. There are other, greatly deserving, loving people you can celebrate. There are other ways to get through days of obligatory adoration of individuals who are not present or ought not be celebrated. The first thing to do is make a plan. Make choices. Consciously choose. Otherwise, you may find yourself saddened, disappointed, and isolating. A better way is to make a plan.

• Choose who to celebrate The father in Father’s Day need not be your father. Is there a father figure you love, maybe an uncle or family friend who nurtured you? If you have children, their father can be celebrated. Do you have a father-in-law who treats you well? A brother with children? A friend’s father? What about you? As a mother, are you also the de facto father to your children? Are you a parent of a pet?

• Choose to honor yourself It’s also alright to simply honor yourself, your growth, and your existence in the world today. Honor the child you, growing into the woman you. Honor your strength, resiliency, and sassiness. Honor your grief, what wasn’t, what should have been. Sit with you, and the sadness that was or is, and the spark of hope that can be. But mostly honor you.

• Choose how to celebrate There are many ways to celebrate. Sending a card or flowers, having a meal together, or throwing a party are just a few. Spending time in nature, or a picnic on the living room floor, in the park, or at the beach. For those without young children, an evening of dinner and a movie or a club might be fun. It doesn’t matter what you do, so long as you plan to do something. If you are alone, that something can be a sappy movie and a big bowl of popcorn laying on your bed. The most important thing is to have a plan.

• Choose to revel and reflect that you celebrated in a way that is meaningful for you Try to spend some time praising your creativity and resourcefulness at managing a difficult holiday. Meditate on your survival abilities and inner spunk that got you where you are today. Find joy in something, anything that nurtures your spirit today. You made it! You’re the you you are today, because you made it. You are deserving of all that is good. And if you don’t believe it, and can’t possibly tell yourself that truth, find someone who believes it enough for both of you. A friend, sibling, or partner. Or seek out a therapist, to help you believe in you and find your joy.

And as always, I'm here. You can reach me in Issaquah at Balance InSight, 206-790-7270.

Thanks for reading, and be well. ~ Robin

Want to find the real you? The you before your trauma?

"We are affected by our past, but we are not prisoners of our pasts."   ~Robin Custer, MSW, LICSWA When we have trauma, whether from violence, car crashes, phobias, a death, relocation, foster families, alcoholism, loving parents who were just absent, we can feel stuck, mentally, at the age the trauma first occurred. While we can't go back and redo our childhoods, we CAN use tools help get unstuck. One simple technique you can do at home is to write with your right (or dominant) hand on one side of an open notebook. Write to your early you. Maybe you want to ask your young you what they needed but didn't get. Other examples are:

• Who helped you when you needed it at 4, or 5 or 6?

• What did you play with and where did you go that you wished you could do / go again?

• What did you need that I (your older you) can give you?

• Would it help if I held you close and took care of you now?

Then, using your left (or nondominant hand) let your thoughts flow freely onto the other page in the notebook. Let your little you answer back. You might get responses like:

• Auntie Jane tried to help me. I always loved Auntie Jane.

• I played cars in the back yard, far away from the sounds of fighting.

You get the idea. It's simple but perhaps not easy. Try this and let me know what you come up with robin@balanceinsight.com