Category Archives: grief

Behind the Scenes

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I’m recently back from the American Academy of Psychotherapists Institute & Conference. It’s always a reliable time of growth and development and this year was no exception. I talk about it frequently because no one else from KC attends this event–and I think it’s the best continuing education I receive. Imagine 12 psychotherapists sitting in a circle for days on end discussing nothing but their feelings and reactions “here and now.” You get the idea! We engage vulnerable self-disclosure and extend both kindness and direct feedback (because YES these are not mutually exclusive). It’s amazing how our lives intersect; wonderful the transference and defense mechanisms we untangle.

We have large group processes as well, and experiential workshops. We built trust and wailed together in grief. We engaged holotropic breath work. We explored internal wounds, aggressor impulses, and options for growth/resolution/integration. Thank you AAP!

Beliefs about Growth & Change

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Here are the nuts and bolts–what I think I know about change and resilience

  • The capacity to fully experience both pleasant and unpleasant experiences is key. A wide Window of Tolerance is healthy.
    • Avoidance and denial are only useful short-term survival strategies. Are you able to fully experience and express your unpleasant experiences in real time? Or the soonest appropriate time? This is what grief processing is all about. If the pain is not honored, it may be waiting in the wings to surprise you and project itself into even more situations down the road. Take your devastation seriously (yet don’t act impulsively). Acceptance and meaning develop out of emotional truth (both pleasant and unpleasant truths).
    • Less discussed is Positive Affect Tolerance. Positive affect tolerance is the ability to fully embrace pleasant experiences (love, joy, success, etc). Many folks harbor unconscious fear when a pleasant experience presents itself because they are bracing themselves from future disappointment and pain. They would rather control their experience than ride the emotional highs and lows. This emotional numbing is an understandable strategy yet ultimately limits internal and external connections.
  • Grief is a part of life. If you want to minimize the expense of therapy in your healing journey, you may want to do some serious grief journaling
  • Identify the emotional longing underneath your disappointments, frustrations, and desires. What are you truly longing for? It may not be in line with your initial words or assumptions. For example, if you’re overtly wanting sex, you might be longing to play, be cherished, or to connect. Once you clearly identify your deep emotional longing, you can generate additional approaches.
  • Congruence is vitality. Congruence means authenticity; we can be respectful without masking. Therapy may be a low-stakes opportunity to increase your genuine self-expression, a key ingredient for both autonomy and intimacy.
  • When magic happens in therapy, it’s usually around a Corrective Emotional Experience. If a client is repeating any unconscious patterns or assumptions, I do my best to respond in a way that is helpful, yet goes off-script from the pattern. Relational dynamics that are experienced earlier in life sometimes become expected, maybe even facilitated, unconsciously. The corrective emotional experience can open doors that may increase relational options outside of therapy. This kind of exploration is a huge part of what makes therapy different from other relationships, like friendships or colleagues.
  • Projections. There are a million things I could say about projections. They can wreck havoc on relationships or, if brought to awareness, can be useful in self-development. Recognizing projections can lead to healthy vulnerability and communication. Everyone makes projection errors. When we recognize projections, we can practice self-compassion and repair.
  • Inner child. Self-parenting is cheesy but real, valid, and often necessary. Neglect is gradually healed by taking the inner child seriously and responding with appropriate, consistent self-care (and community-care if you can find it). Our younger selves can be attended to in the here & now.

Ketamine-Assisted Therapy: Procedures and Safety

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After graduating from the Integrative Psychiatry Institute this May (250 hours of education), I’ll be offering ketamine-assisted psychotherapy, starting in July. I’m supporting other local therapists and their clients, offering brief treatment that augments their current work. A round of ketamine-assisted psychotherapy with me would include:

  • a consultation with you and your primary therapist
  • medical screening with a physician (referral available) who would prescribe you the Rx if indicated
  • Counseling/preparation meeting(s)
  • a 3 hour medicine meeting (the last hour we talk/process)
  • a follow up integration meeting within 2-3 days of the medicine meeting
  • consultation and referral back to the primary therapist and any additional resources
  • additional rounds if indicated

Safety:

Ketamine therapy is not for everyone. I have seen it effective for treatment-resistant depression and obsessive-compulsive disorder. Manic or hypomanic states, personality disorders, and/or a history of psychosis contraindicate ketamine. Ketamine involves altered states of consciousness that can increase client vulnerability and projection. I’ve heard of misuses. For the safety of everyone:

  • I follow best practices in the field (from my clinical training as well as the Big Tent community and the Jules Evans substack)
  • medicine meetings are videotaped and securely stored according to HIPAA protocols
  • I do not touch clients
  • there is no communication between client and therapist between meetings, except to schedule meetings, or in case of an extreme emergency
  • clients are welcome to bring a calm, quiet support person observe medicine meetings
  • All ketamine treatments are conjunct with psychotherapy (this is not necessarily true of IV clinics or “underground” practitioners)

I’d be happy to answer any questions! julia@juliacounseling.com

Healing Body Memory of Trauma

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I took a recent training with Yudit Maros called “Brief, Solution-Oriented Trauma Resolution.” This training specifically focused on troubling sensations in the body that may periodically resurface after the trauma. The BSOTR protocol helps a client attend to and correct the aftershock disturbances in the nervous system and one’s negative self-identity. Here are the most basic steps:

First, the therapist helps the client identify and practice a resource state called grounding. I can guide you through a visualization exercise that depersonalizes the pain and provides more comforting imagery, which tends to regulate the nervous system. We identify and develop comfortable imagery that helps you reset. Then, I ask you to scan your life history for anything that feels pleasurable and safe. We detail key components of the experience and you practice re-experiencing the positive experience and people. Later, we scan your life history again for an unpleasant or traumatic experience. I interview about what you would have preferred to experience. Then, I facilitate your current, grounded self attending to and taking care of your younger, distressed self through a series of self-care invitations, visualizations, and self-dialogue. When it appears that you have been a loving guide to your younger self and you have nothing left unattended about the chosen difficult experience, I invite you back to the here and now of the therapy room.

If you are interested in experiencing this BSOTR process or have any questions, please let me know.

Shame Shields

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I took a webinar with Brene Brown called Shame Shields. Dr. Brown is mostly known for her research on shame, worthiness, and healthy vulnerability. Her research reveals these core tenants about shame:

  • We all have it
  • No one wants to talk about it
  • The less you talk about it, the more you have it
Shame and addiction are interlinked. Addictive behaviors are an attempt to numb, or shield the shame. However, their effectiveness is short-lived and the shame resumes.
Dr. Brown, and separately–researchers at Wellesley College Stone Center–discovered there main subtypes of these shame shields:
  • Moving away — Avoiding, leaving the room, spacing out, daydreaming, distraction
  • Moving towards — Hyper-appeasing, over-flattery, buttering up, sucking up
  • Moving against — Attacking other people, inducing shame in other people
All three shields are an attempt to deflect shame away from the person. Here’s Dr. Brown’s recommended alternatives for shame resilience:
     1) Recognize triggers
     2) Reality check messages
     3) Reach out
     4) Speaking shame
I know these four prescriptions are easier said than done so I am happy to help be a part of the process.

Why do People Sexually Harass?

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It’s almost a daily headline the last couple months: Prominent Man Investigated for Sexual Harassment.

Outside the context of each specific accusation, many people are asking: Why do People Sexually Harass? I will attempt to answer that question. It’s NOT a commentary about specific cases, but a broader analysis. I’m not sure whether other researchers & theorists have arrived at the same hypotheses. Mine are a result of my broad professional experience and critical thinking. I have not done a lit review on the matter (although it’s on my to do list). Without further delay, here are my theories:

  • Narcissism: the hallmark of narcissism is a lack of empathy or regard for others’ safety, feelings, and/or independence. Sometimes this deficit comes from unprocessed shame (i.e. the person is not dealing with their own issues so they distract themselves by gaining influence over others). A narcissist also copes by pursuing pleasure, in this case, sexual gratification or interpersonal dominance.
  • Unclear sense of self: Similarly, some people confuse what they want by projecting it on to others. Rather than own and disclose their desire in a straightforward manner, a sexual assaulter may justify their actions by claiming that the other person wanted the behavior. Lots of unhealthy mind reading. Victims are often criticized & burdened for not speaking up. Unfortunately, less discussed is the lack of openness and honesty from the sexual harasser. Sexual harassers are frequently dishonest with their own intentions.
    • Blurred boundaries at workplaces: People who struggle to separate their personal life from their professional life are not skilled at understanding themselves separate from their immediate context. They are at risk for blurring other boundaries, between themselves and other people.
    • Compartmentalization: The flip side of the coin is compartmentalization. Sexual harassers may locate the harassment experience into a corner of their awareness, sealed off from the rest of reality. Effectively, compartmentalization is a type of denial, or delusional boundary formation.
  • Lack of Comprehensive Sexual Education: An absence of healthy sexual discussions produces ignorance and assumptions. Many people associate ALL sexuality with secrecy and shame. Secrecy and shame are the building blocks of sexual abuse. Or, a person can be so sexually permissive that they do not acknowledge the difference between harmful sexualization (imposing on others) vs mutual sexual pleasure. Comprehensive sexual education facilitates self-awareness & dialogue about the healthy diversity of sexual desire and healthy approaches to it. In consensual exchanges, each person is empowered to identify their sexual and non-sexual desires. If there is a conflict, safety is prioritized. For people who missed the boat, I will make another blog post about specific resources for healthy sexual dialogue.
  • Objectification: “noun. The action of degrading someone to the status of a mere object.” People may reduce other people to sexual targets rather than incorporating their other qualities, e.g. creativity, sensitivity, vulnerability, intelligence, etc.
  • Body Privilege: This phenomenon comes in at least two forms.
    • Male privilege: As a general category, men are granted more social license to impose their sexuality as part of their inherited gender script. Dominant social dynamics teach women to be passive receivers. It doesn’t have to be this way–yet this tradition is enforced by many formal and informal social mechanisms.
    • Attractive People: People who are socially-evaluated as attractive may internalize the message that their body is their main source of worth and connection. They may over-rely on physicality in order to deal with loneliness. This dynamic can be described as self-objectification (see objectification, above).

If you would like to discuss these ideas in more detail or conduct an internal exploration, feel free to contact me.

Science of Trust

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I took a webinar with John Gottman of the Gottman Institute called “The Science of Trust.” Perhaps Gottman is most famous for his “four horsemen of the apocalypse” theory–that contempt, stonewalling, criticism, and defensiveness poison intimate relationships–and that the long-term success of a partnership can be calculated according to the frequency of these problematic dynamics. This particular webinar about trust explored active, healthy alternatives to repair interpersonal wounds.

Essentially, cognitively-based repairs (appeals to reason, logic, and problem-solving) aren’t as effective within intimate relationships as emotionally-based repairs. For example, empathy, self-disclosure, and investing extra attention/participation into the partnership all work at the emotional level. Emotional interventions help relax someone in distress, thereby encouraging them to make any decisions outside of duress. Within an intimate relationship, logic and “fixing” other’s problems can be experienced as dismissive, shallow, or intrusive.

Many people are not taught intimacy skills–it’s not a formal study in primary school. Some of us learn from family and community role models–other people don’t have this access or experience.

After an interpersonal or developmental trauma, a person is likely to experience hypervigilance–fight/flight responses–and/or avoidance–flight/freeze responses, even within more moderate conflicts. Effective conflict resolution within a healthy relationship requires active participation, deliberation, and transparency from all involved parties. Often, a partner can facilitate a step down the scale of hypervigilance. Gottman and others use the acronym ATTUNE to describe this stance in more detail: awareness, turning towards, tolerance, understanding, non-defensive responding, and empathy. For a great video on empathy, click here: Brene Brown on Empathy.

Does this mean everything has to be hearts, puppies, and sunshine? NO! If people interrupt their conflict or trauma processing, something like the Zeigarnik Effect is likely to happen–people will remember (often at inopportune times) experiences they haven’t ATTUNED to in a healthy relationship. If we haven’t ATTUNED to a partner’s distress, we are most likely telling a negative fictional story about our partner’s abilities.

People who avoid relational conflict have a tendency toward infidelity and and other betrayals, which likely create more (internal) conflict and avoidance.  People who address conflict also practice relaxation and co-construct viable creative solutions, over time, with additional input & information.