All Things Freud are New Again

Posted on March 27, 2023 by Lisa Kothari

All things Freud are new again. It’s true.

I was just perusing the New York Times this week and there it was an article titled Not Your Daddy’s Freud. Freud is now a meme, a Tok Tok viral sensation, the inspiration for countless shows about real life therapy. People want to know what goes on in the therapy treatment. What is the secret to Freud and his world?

Apparently, as I read the article, I learned there are record numbers of people studying to be analysts, which has them on the couch for 4-5 sessions per week, and then listening to their control cases for another 4-5 sessions per week. A lot of talking, talking, talking.

People need a place to talk. And to be listened to on a deep level. People want room to process their past, their dreams, their relationships, their inner desires, and more. Overall, society doesn’t have much tolerance for all this psycho-babble, but Freud does. He always did and always will.

People are leaving corporate America and other professional paths to study all this talking and what it means via their own talking and then talking to others about them. People also need to talk about themselves — for long periods of time. They need space to hear themselves, to be validated, to have someone express curiosity over their person and the happenings in their lives.

We, therapists and analysts, also need to talk about ourselves — a lot. To study in a Freudian tradition means those training get to talk and talk and talk too.

Funny how society doesn’t have much time for long talks any longer. It’s all a quick tweet, a social media shout out, a meme, a text, an emoji — the less said the better. No one has time to listen or take time to really hear someone. I am amazed that even newspaper articles state how long it will take you to read it. No time for taking anything much in in detail, let alone another person.

Yes, here is this article. Freud is back and more popular than ever. People need a space to talk — somehow it is the cure for what ails us — as another joins us to hear our story, our pain, our selves come alive. Analytic, depth work can be scary — it doesn’t offer the evidence based treatment of 10 sessions, 10 different thoughts, and you’re cured.

No Freud has each of walk the long road within which is where the pain lies hidden under many protective defensives, traumas, woundings, and more — all that has scaffolded our thoughts and how we bring ourselves to our current lives. As we delve and can bring to voice this pain — slowly through much talking — defenses can shift, memories and pain can be unearthed and more.

Slowly all the talking cures — or at least helps us tolerate what was unknowable as it has been so intolerable.

I practice from this lens within my training. I need to talk, to be heard — and I then return it to my patients who need to talk, to be listened to — it’s these winding roads that lead us to self. Even in this day and age when there is no time to talk — Freud beckons.

Real Self Care

Posted on March 20, 2023 by Lisa Kothari

Real self care — that’s the new title of self care. Apparently, not all self care is equal according to a new book by Dr. Pooja Lakshmin, Real Self-Care: A Transformative Program for Redefining Wellness (Crystals, Cleanses, and Bubble Baths Not Included), and reviewed in the New York Times recently.

Yes, it’s another book on self care. Another thought on how to care for one’s self — this time the real way. I am not sure self care can actually be categorized as real or not real — if one is caring for one’s self then it’s self care. Buy, hey, authors have to have an angle and this is hers.

For Dr. Pooja, it is about aligning one’s self care with one’s values. In this way, yoga, crystals, baths may be just what you need. I think she is seeking to encourage women to think about what they value in their lives and then use these values to care for self. Don’t just take the yoga class because someone has told you it’s a good way to care for your self. Rather, check in with one’s self and ask yourself, “Is stretching in yoga poses a way to actually take care of myself — or not?” If not, then move on.

The author wisely recognizes — as so many of us do — that self care is just another billion dollar industry trying to get their share of the capitalist pie. It’s OK to support the industry as long as it is actually really about your self care — thus the idea of “real self care.”

There is one part of Dr. Pooja’s suggestions that I really liked — her imaginative exercise of thinking about a dinner party you would throw to learn what you values actually are. I never thought of this type of exercise as a way to get at what one values, but I suppose it does. Are you interested in a small gathering or a large one? Is it pot luck or formal? What’s on the menu — take out or something you spent the day cooking? What music are you playing and what games/activities are you throwing into the mix? This is very helpful to see what motivates one in life.

How would you answer these questions? For me, I tend to like more people than less, I love to set a table or make a pretty table for the group, I mix in store bought foods with easy-to-cook dishes (I want to have fun too!). If children are there, I love to have games for them to play or at least give them my Labrador who loves to play with kids. Oh, and i love a good party favor.

How does this translate into real self care?

It seems to me that I value sharing time that is fun and creative with people whom I am close to of all ages. If I choose to spend time in this way then I am caring for myself. Makes sense to me as a way to get at what real self care looks like.

Of course, it’s not the only way and if you feel good about spending your money in the self care industry that is fine too. When it comes to self care, follow your bliss, and make the time to do so on a regular basis.

To Be Selfish — or Not?

Posted on February 27, 2023 by Lisa Kothari

To be selfish — or not? That is the question.

I am always reading the news and find myself stumbling upon articles around mental health, which, of course, catch my attention. This week it was an article in the Times about The Benefits of Wise Selfishness. I had to laugh out loud as I read how the article had to spin selfishness (something our society judges as a bad thing) into something that is OK to be these days. Actually necessary.

I tend to agree with this article, but I wouldn’t call it “wise” but rather absolutely necessary and critical to our own mental health. And it is mind boggling to me that people feel that it is wrong to think about themselves and hold their interests in mind. Like everything, just because we are thinking about ourselves does not mean we can’t also think about the other.

If you think about it, in the airplanes, during the safety instructions, parents are always told to put on their own oxygen mask on before putting it on their child. Intuitively, we must be cared for before we can offer care to another — even our own child in this case!

It is important that we hold ourselves in minds throughout our days that make up our lives. That we are living out of alignment with who we are, our values, our bliss, our boundaries, and more. It may sound selfish, but I don’t see it that way, I would actually argue if we cannot hold ourselves in mind and take care of our desires, needs, and wants we really cannot extend that to another in an authentic and true way. When we turn our backs on our own selves to be selfless there is something inauthentic about how we are doing for others — rather than it springing forth from a full well of ourselves, it is motivated by a turning away from ourselves to sink into the other, perhaps putting their needs above our own.

This is then applauded by society. This type of person is so selfless and does for others with asking for nothing in return for themselves. What exactly is going on here is where my mind goes? Why is it so difficult for the person to be with herself and be there for one’s self? Often the message is you are selfish and bad for thinking about yourself.

Ah, selfish, selfless — such judgements on people and situations which we hardly know the truth of it at all. It isn’t wise to be selfish and it isn’t unwise to be selfless. We love to organize our minds with things being all good or all bad. The truth is holding yourself in mind is mentally healthy and then allows for us to be there for others that are authentic and true to who we are as we are also held in mind alongside the others we are holding in mind. This can be in parallel and does not need to be an “either/or” situation.

Let’s all practice remembering ourselves first as a basic tenet of good mental health. From there, it’s up to you how you would like to do or not do for others. Selfish, selfless — it’s time to drop these judgments.

Word Games

Posted on February 13, 2023 by Lisa Kothari

Word games — do you play them? It used to be games like Scrabble and the NYT Crossword Puzzle — but now there are many more options. It seems like the game Wordle has made us all a fan of word games. Well, that one is quick, even if not always easy, and provides quick satisfaction of being competent in knowing your 5-letter words.

I was never big into word games, but I can see how they keep one’s mind sharp, provide an interesting distraction to calm one’s mind, and can be entertaining during an otherwise boring day. People have taken to sharing their results on social media as well. People comment on how hard or easy it was for them as well — without giving away the answer. (This all has to do with Wordle, of course.)

Recently, I have heard some people say they are using word games as a distraction away from their problems to the point that they cannot focus on what they really “should be focusing on” — often something that is a difficult change process. They see the word game as taking them away from the issues they have at hand, rather than helping. Of course, word games offer a calming and interesting distraction and can often be grounding during a time of personal upheaval.

It is not a bad thing to use word games as an object that takes one away from the worries/changes/anxiety and more at hand. I often see it as a part of one’s change process. Distracting one’s self from always holding the worry in mind feels important. It allows unconscious parts of ourselves to step in and be with the issues at hand. Our mind is turned off from the worry and directed elsewhere which allows for more space to open up and work things out.

I notice how hard people are on themselves for taking pleasure — often for long periods of time — in something like word games. Relax. Word games may not only serve as a puzzle for you to solve, but also a place for other parts of yourself to work out your own puzzle you may be in. Distractions can be very helpful in this way.

There are many distractions out there. If you are choosing a word puzzle, chances are your mind is sharp, you seek to feel competent in an everyday puzzle, and (often unknown to self) are trusting that other parts of your self are working out your own personal puzzle.

Even I Wordle — every now and again.

How to Worry Nonsense

Posted on January 23, 2023 by Lisa Kothari

How to worry nonsense seems to be in the papers this January. It’s no surprise given the bent of most articles this time of year is how to be “better” both physically and mentally. However, I was shocked to see the headline in this Washington Post article, Don’t Try to Worry Less. Worry Smarter” The title sounds good in theory, i.e. worry!, but just do it in a way that is better for you — smarter for you.

All I got from this title was now you are worrying wrong. Ugh! Must there be so much judgement even on our worries?

The article is filled with lots of tips and tricks to acknowledge your worries, i.e. find it in your body, problem solve, and then let go. Oh so simple. If we could do any of these things, would any of us be worried? Probably not according to this article.

Worry is more than what is going on in your mind at the time. Often worries are deeply embedded in earlier experiences where we were left alone, let down, our expectations were not met, the worst happened, and more. When the events, people, or whatever comes up in our here and now and we “worry” it is often calling back to these earlier woundings and hurts.

That is why it is almost impossible to worry smarter.

How about using our worries as a place to get to know ourselves better. Inviting the worry in and letting it breathe. It certainly has something to tell us about our present concerns and where we have come from. If we can tolerate looking at ourselves from this lens, our worries can lead us to know ourselves in deeper ways.

It’s not always about being smarter and better by letting go and getting rid of the (what has been deemed) “bad” stuff. Sometimes it’s about tolerating our worries and anxieties, allowing them space to breathe, so we can then hear what they are trying to say and learn more about ourselves.

My two cents.

The Mental Schema of the Unvaccinated

Posted on November 15, 2021 by Lisa Kothari

I recently got my booster to protect myself from COVID — this marks my third shot in one year. As soon as the vaccination came out, I wanted it — badly. I had all the things that you probably have been suffering from — tired of the masks, tired of staying indoors, tired of regular life being interrupted — in short, pandemic fatigue! I felt grateful that science was so good that within a year, major pharmaceutical companies had come up with vaccination shots that could protect me and others — and would ultimately put the pandemic to rest.

Why then is the pandemic still raging even as people lose interest? Because so many people have chosen to not get vaccinated. Now, what are the reasons? It ranges anywhere from not wanting to be controlled by the government, to not believing in science, to not being told what to do, to straight out denial that a pandemic even exists. Also, people believe they are strong enough to overcome it if they do contract COVID.

My carpet cleaner recently came into my home — no mask and no vaccination on board. When I asked him why — and went on to give him a piece of my mind — he said his body was strong enough to handle it. Based on what? Do any of these people realize they have been vaccinated since they entered public schools? Someone in their family took them to get their shots so they could attend school — otherwise, who knows if they would still be living? People take for granted what their elders did for them — somehow abiding by public health protocols is not for the strong in body.

There is a felt sense among the unvaccinated that they do not want to be told what to do by the government or anyone else. There is a particular mental schema that askews being told what to do by anyone for anything. I knew someone years ago who always stated he hated being told what to do by his parents — he wants to make his own decisions. He made the umbrella statement that no one wants to be told what to do. I know my friend came from a strict upbringing with caretakers who gave him very little room to make any decisions for himself.

When politicians came along and said, “Liberate yourselves and say no to mandatory vaccination” I can imagine that many people who, like my friend, do not like being told what to do, resonated with this message and now are the ones crashing school board meetings, protesting, booing anyone who speaks up about getting vaccinated and more. It’s all a lot of drama that gets going in rebellion to not being told what to do — unfortunately, in this case, not getting vaccinated can lead to death of self and others.

Yet, many people would rather die than be told what to do by anybody. These same people did as they were told at the age of 5 and got their shots to enter kindergarten. It all feels a little insane that people think their own body itself has gotten along without disease on its own.

For me, the little jab took about a second. The side effects were nominal at best. I know I am protected and I am helping protect others in my community. Millions have been vaccinated and the vast vast majority are safe and healthy afterwards. There is no excuse to not be vaccinated at this point. It’s time people got over rebelling against being told what to do and start working with what is not only logical but also absolutely the right thing to do for self and neighbor. We want a right to life — then it is a responsibility we care for.

In this case, it’s a one second jab — three times. No excuses. None.

Pop Up Mental Health Clinics

Posted on May 12, 2021 by Lisa Kothari

A pop up mental health clinic? Never heard of it? Nor had I until recently when I read an article on how pharmacies are getting into the game of mental health care. Soon, it seems, we will all be able to roll up to our local pharmacy and not only pick up our prescriptions, but see a therapist on site as well.

As a therapist myself I wondered what does this mean for not only me as a provider, but also for the patient. Certainly the pandemic over this past year has taught all of us that access to mental health care is not only necessary for everyone, but also needs to be accessible with few barriers to receiving treatment. In terms of access, rolling up to your pharmacy and having access to a therapist on the spot feels like this need is being met.

However, I have my questions. Therapy is broad with many therapists offering a range of different types of care for many different types of symptoms and upset. From anxiety to depression to severe illness such as schizophrenia, therapists treat people suffering from all of these and much much more. Given this broad range of mental health ailments, most therapists specialize in an area. The specialization comes from study, their experiences, and their interests. When someone is looking for a therapist, they are often trying to find someone who matches what their needs are.

Walking into a pharmacy, I wonder how people will be matched up. Will it run like a crisis line where whomever walks in gets the next available therapist and the meeting is for the therapy hour (45 to 50 minutes) and then the person gets up and walks away and hopefully feels better with no charge or is it going to operate like a low fee clinic, charging a low fee, and patients have a choice of whom they see and have the option of returning and seeing the therapist on a regular basis?

I also wonder will pharmacies tie people to a therapist based on their prescriptions. Let’s say someone is picking up an anti-anxiety medication and the pharmacy staff not only gives the patients their script, but also the names of therapists in their clinic that they encourage you to see alongside taking your medication. The flip side of this is a therapist who sees someone for anxiety and then sends them to an in-house medical doctor who then prescribes anti-anxiety meds that get filled right at the counter. Convenient one-stop mental health help.

Those two points, i.e. that therapists seeing patients in such pop up mental health clinics, actually have the experience to support whom they are seeing in the pharmacy and that this is not just a grab to prescribe more meds to the public, are the places where I feel concern. This article does not disclose the details of these plans, just to say this fad is coming our way.

The article lists out questions that patients should hold in mind when they meet a therapist, but, truth be told, when people want to talk to somebody such questions often go out the window as their distress is so keen, it is difficult to hold in mind who is this therapist and do I feel comfortable with her? It is then on the therapist to hold on to their minds to decide if they can serve a potential patient or not. If a therapist does not think she can, does she have the ability to not take someone on? In community mental health, that choice is often not there for the clinicians, but will it be in corporate America?

Mental health is serious and corporate America is seeing it as its own power play and grab. Ethically one needs to safe guard themselves from a fast food approach to mental health care. Yes, something is better than nothing, but sometimes fast therapy does little to change anything.

As a practicing therapist in Capitol Hill, Seattle, I believe mental health care should be available to all, but in a responsible way. There are low-cost clinics and websites where Clinicians offer their services at a deep sliding scale. Finding this type of therapist for a long-term relationship feels important as the therapist can then track alongside you your progress, setbacks, and provide a containing space that is ongoing and built on trust. I believe in this type of approach for the work we do together.

Yet! I won’t be surprised to walk into a pharmacy next time and see a line of therapists waiting to see you and me.

Mental Health Crisis in America

Posted on May 11, 2020 by Lisa Kothari

I read an interesting article the other day in the Washington Post regarding how the current COVID-19 pandemic is pushing America to the brink of a mental health crisis. I cannot even believe it has taken a severe public health crisis like this one for the media to begin to pick up on how difficult it is for Americans to find and receive quality mental health care today.

Sitting from the vantage point of a therapist, I know this to be true for many reasons. While most articles, like the one in the Post above, focus on access to mental health care, there is something else one has to first realize. Access to mental health care starts with clinicians who are in training to work in the field and serve people in need of mental health services.

It is an unfortunate truth and one not often discussed in the media that to do the work of a therapist, or, as the traditional license is called, a Licensed Mental Health Counselor, is a costly and time-consuming journey. One cannot clinically practice one-on-one therapy with individuals without holding a Master’s Degree in counseling, social work, or marriage and family work. This type of degree takes 3-5 years to complete with significant amounts of debt taken on to complete the degree, upwards and over $100,000.

Along this journey, graduate students in training are called to do an internship with a significant number of clinical hours and supervision time spent in order to earn one’s degree. Although a person may have at least 2-3 years of training experience in school, one’s internship is unpaid. People must find paid jobs as they juggle their internship demands.

This is where it strikes me that the mental health system is failing at its core. Community Mental Health Agencies that serve the poor and mentally unwell, a segment of the population that would have very little access to mental health services, are staffed with interns from graduate schools who are seeing these people for free. The core of the mental health services offered to thousands of Americans is valued at an intern level who earn nothing.

From there, graduate students leave school and are permitted their first license. Where I live it is an Associate’s license, which means you have the ability to see patients, but you must be supervised for a set amount of hours as you work toward full licensure, which is additional hours. Often Associate Mental Health Counselors use this period of time to take clinician positions in mental health agencies. Now they are no longer serving for free, but for $17 to $23 per hour. The average case load for a new Clinician is upwards to 100 clients. Then add in the math of $100,000 of student loan debt.

It is from this vantage point that I see our mental health system failing in America. From the start, when people seek to train to become a mental health clinician, no value is given to the skills that they are learning and employing to help people with their mental health needs. From weighting people down with student loan debt, to not providing any value to the intern seeing clients, and then providing a very low income to the new clinician with a caseload that no one can keep up with — not only are the clinicians burned out, but the system is overwrought with little to no support for people who need tremendous care.

What happens after one has completed her Associate’s license requirements and you are now a fully licensed therapist? Unfortunately, most clinicians leave Community Mental Health and set up their own private practice. Even if the clinician charges a reduced fee, it is often three times the amount one was earning at the mental health agencies. It is unfortunate that the very poor and mentally unwell people in America are left to be churned through by clinicians who are in some training phase of their career burning out without proper care, support, or caseload numbers.

Insurance also plays a roll in the inequity of the Mental Health system in America. Are you in network and, if you are, your patients may benefit, but the Clinician will likely make very little money for their services when all is said and done. If you are out of network, then the Clinician works with the patient to determine the fee. A patient may submit a receipt to their insurance company which may provide them with a portion of the fee they have paid. In this way, the patient has to decide what can they afford given the insurance company will only be reimbursing some of the full fee and that is often after deductibles are met.

All of this to say that when we look at the mental health crisis in America, we need to critically think about how we value our clinicians in training as well as how we value the services provided to the mentally unwell, especially those accessing care through the community mental health agencies. It begins with both parties being valued and supported in terms of money and care.

Until this happens, the system is on crumbling crutches which is going to further lead to the black hole of inadequate care, funding, and a lack of people to serve during crisis such as the one we are in currently.

Lisa Kothari Counseling

Tag Archives: Mental Health