Is Anxiety a Problem?

Is anxiety a problem

Is anxiety a problem for you? For me?

Of course, I was reading the New York Times and came across this article about anxiety and it prompted me to think about the feeling of being anxious — which can lead into full-blown anxiety. Anxiety is common — actually I don’t know anyone personally who doesn’t have some level of worry, care and concern over their lives, the state of the world, other people, situations, and more.

If you were to actually sit down and ask somebody, directly, are you anxious about anything in your life or life in general I can’t imagine anyone saying, “no, not at all.” Worry, anxiousness, concern are all basic human emotions and ways of feeling that make us exactly that — human. I think it is how we interact with these feeling states that defines if anxiety is a problem for ourselves or not.

What do you do with the anxious parts of your self? Are you able to listen to what this part of you is saying and put it into perspective, or take a clue that you need to regulate your body and mind to calm both, or take an action that will alleviate your worries and concerns? If so, anxiety is not a problem, but rather something to be mindful of as one part of your feeling state.

Now, if you are having trouble recognizing you are anxious or becoming paralyzed in your life due to feeling anxiety (worry, concern) then it is an emotion that is going to limit your life and how you are living. This is when it is a problem. I would tend to agree with the article referenced above. However, it points to Cognitive Behavioral Therapy (CBT) as the best modality for treatment of anxiety and its symptoms.

CBT seeks to change the way you think about situations so you can alleviate your worry and anxiousness over whatever is causing you anxiety. It is a type of therapy that is often brief and comes with homework to build up skills for reacting differently. It certainly has its place in the canon of treating anxiety, but it is also a type of therapy that insurance companies love — 8-10 sessions and you are cured. Their pocketbooks not needing to pay for anything more.

However, I think of paralyzing anxiety as a symptom of something deeper going on internally within a person. How did you see your caretakers interact with their worries and concerns, were you insecure as a child when your caretakers left you, did you have space to worry and voice your concerns — were these feelings welcomes as a child? Looking at these deeper questions and family of origin patterns can help us take a look at what is driving our anxiety on the surface. Often anxiety that is felt about external things reflects an internalized anxious state that has never been able to be explored — and wants to be heard.

Working with a therapist to uncover these patterns can not only help short-term alleviation of anxiety, but can also shift an internal state where paralyzing insecurity, out of control feelings, and worried states rule the person.

So, there are plenty of options for treatment, but please know if you are worried about someone or something — if you are anxious — to a large degree this is expected as part of being human.

Don’t forget the breath — 4 deep breaths in through the nose and then out through the mouth – can do wonders for any worry.

Therapy for Police

Therapy for Police

For: Tyre Nichols

Although not always required, when candidates apply for the position of police officer, they can be given a psychology screening tool, known as the MMPI, the Minnesota Multiphasic Personality Inventory. One of the purposes of this “test (is) as a screening instrument for certain professions, especially high-risk jobs.” (Cherry, 2022)

When a candidate is screened via the MMP1 and deemed to be qualified to conduct herself and her job within parameters of mental wellness, what accounts for the police officers who misuse their power with the public? We know that systemic racism plays a part, as well as the culture of law enforcement.

However, I believe there is also another element that plays a role in police misuse of their power. This is their own personal story. Although the screening tool takes a snapshot of a potential officer before they are employed in the role, this does not cover what happens when police are on the job, day in and day out, coming up against other people’s traumas in real time, potentially triggering their own stories of trauma. Screening tools that seek to measure aggressive behavior in police at the entry level is not enough to trust and curtail one’s behavior as they do their job each day.

To safeguard a police officer’s mental health and the impact she will have on the community; I suggest that a fundamental requirement for police be to undertake on-going therapy. This can become a part of police reform that people are calling out for in America.

Therapists are highly encouraged to be in their own therapy and/or supervision as a good practice as they work with their patients because trauma, negative emotions, and struggle come up in our on-going work. This is as we sit quietly with our patients taking in their stories and holding it confidentially.

It is not that people who become therapists are crazy, but by the mere nature of continually being exposed to people’s trauma, we are often led into our own unprocessed anger, openings of our personal traumas, and more. Going to therapy and/or attending consult groups with fellow therapists helps to contain these feelings in an appropriate space that protects both therapists and their patients.

My imagination around police officers is the same. Their work involves unknown circumstances, painful situations, horrific crimes, personal danger and more. Although someone may be screened as non-aggressive for police work, over time it can be a hazard for any police officer to become angry, aggressive, and out of touch with what is and is not appropriate behavior. This, in tandem with having weapons on board, can be a deadly combination as we have seen time and time again in America.

No matter where we come upon these situations, whether in a therapy room or in “here and now” situations, our own stories can become activated. Without any place to process our feelings, we can become a danger to ourselves and to others over time.

For therapists, it can look like not being able to listen well to the other, intruding on our patient’s process, forcing our agenda on another, and more. For police officers, I imagine it can look like the brutality we have seen recently. When police officers cannot even understand what excessive force is, this is a sign that their own “excessive force within” is so great, unregulated, and unprocessed that the unconscious looks for an object, which can often be a person in police work, to take it out on in lieu of any safe place to contain it.

A good practice for police departments across America is to offer personal therapy on a regular basis. Police departments should be mandated to hire mental health professionals who can see each police officer who is actively working with people in the community. Here is a space where police officers can feel safe to speak about what has come up for them, how it may relate to their story, learn ways of diffusing anger, and more.

If police departments want an alternative to individual police therapy, group therapy is also a powerful way for police officers to come together with a mental health professional leading the group to process what they have encountered, how it may be affecting them on deeper levels, and have a safe space to contain it among one another. Further, mental health professionals can be called to listen actively to hear if a particular officer needs personal therapy.

We speak about a change in police culture. I absolutely agree. I think this includes looking at what is going on in the deeper psyche of any individual who is encountering trauma, violence, and unknown situations on a regular basis. As a therapist, we face this every day in a more passive setting. Add in the active setting and it is a recipe for violence, for being out of touch with one’s humanity, for not being embodied enough in self to know how they are bringing themselves to any given situation.

It is not enough to screen police candidates at the entry level. Police officers should be held in ways that support their mental health on a consistent basis with a mental health professional. This type of investment will also support the greater communities they serve. No, a police officer cannot be a mental health professional, but they should be required to have mental health support when they are actively in contact with the communities they serve.

Telehealth Therapy

Telehealth therapy has become the present and future way of conducting therapy sessions ever since the pandemic took hold in March 2020. As a new clinician at that time, I had set up my office and was building my practice in the very way I was trained to do throughout attending school — in-person sessions in a small, containing office where my patients could be with me. I was only 4 months into practicing this traditional way, when a world-wide pandemic came along and shut down society as we knew it.

Although people still needed mental health services, there was then no opportunity to meet in- person. Luckily, we live in a day and age where technology does not hold such boundaries and allowed, through many different on-line video platforms, ways to connect therapists to their patients in real time, on-line, on a regular basis. Although there was resistance in the therapy industry, given how highly valued in-person work has always been, everybody moved to this way of working therapeutically — from the analysts to the behavioral therapists. Everyone went on-line to conduct their sessions.

Now that we can (mostly) say that the pandemic is behind us, mask mandates are still in effect for health-care providers, including mental health therapists. That means that we can meet you in our office, but we still have to have face coverings on — hiding most of the face. Given this constraint and the value I place on seeing my patients’ faces and having them see mine, I have become a full-time telehealth therapist only offering services via video or phone.

Even as I have committed to telehealth counseling, I have also expanded who I serve across America, including New Jersey (where I am based these days), Washington, and Maryland. Being able to serve all people throughout these states also underlies my value of equity of care to all people, not just those living in the city that I reside in. Telehealth has allowed for people to access care from wherever they are and this is one of the values I hold for myself and my practice.

As I have been practicing for almost three years as a telehealth therapist, I also appreciate the convenience it has on my patients’ lives. By and large, people enter into session in a space that they hold a degree of comfort in, have not had to deal with a harried, resource-driven commute to see me, and can seamlessly integrate care of their mental health into their daily life. It is a factor that allows for ease in attending regular weekly sessions with me.

Finally, for me, I have the opportunity to see the expressions on patients’ faces and for them to see my face. Although I am not in the actual room and cannot take in the entirety of a person, I can take in what is being communicated via one’s eyes, in how they are holding their face and reacting to what is going on in the space between us, and I can hear the affect and emotion as tone of voice and facial expressions emerge to tell me something more than the words being spoken. To see another’s face is paramount for me to feel connected to my patients.

If you are curious about the ins and outs of how telehealth therapy works, it’s actually quite simple — a link is sent to you that is HIPAA compliant and you click on it and we are in session together. Pets are welcome too! If you want more details, you can always reach out to me if you are in New Jersey, Washington, or Maryland to learn more.

It’s a new year and my therapy practice is in the new of being fully telehealth — first it happened due to the pandemic and, today, continues due to the legacy of mask mandates still in place. For me, it allows me to serve more people equitably and, at the core, this is what I value most of all.

Pop Up Mental Health Clinics

Pop Up Mental Health Clinic
Pop Up Mental Health Care Clinics

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.

Dear Therapist: Pandemic Nightmares

Pandemic Nightmares
Pandemic Nightmares Are Real!

Dear Therapist,

Ever since this pandemic took over our lives I have been unable to sleep well and, when I do find sleep, I also find nightmares. Seriously, they are disturbing! Is there any way to alleviate these terrifying dreams. It’s gotten to the point where I don’t even want to fall asleep as I am scared of where my dreams will go — death, violence, isolation — this type of imagery is rampant for me. How to get good sleep during this time?

Sincerely, A Terrified Dreamer

This is so common. First, the inability to even get to sleep these days. This happens for a lot of reasons, including not maintaining one’s regular sleep regime, too many screens on too close to trying to sleep, worries and uncertainty on one’s mind — all leading to the inability to let go into an unconscious state and sleep. Which is critical to feeling rested and restored, bright and energetic to greet the next day.

Some tips on getting to sleep during this time include:

  1. Maintain your normal sleep time — when you go to bed and when you get up
  2. Turn off your screen well in advance of bedtime
  3. A better activity is actually reading a real book or working on an old fashioned puzzle with a pencil – activities that can ground
  4. If you have many worries on your mind, writing them down before sleep. In this way they become externalized. You are free to pick those worries back up again the very next morning, but writing them down and letting them breathe for the night outside of you may be helpful
  5. Engage in a ritual that will relax you like a salt bath, gentle stretching or a meditation to calm one’s self.
  6. Direct your dreams! (And this will lead into your nightmares) If there is something on your mind that you want to know about or an answer to, write it down on a piece of paper. Also, as you close your eyes, have this question on your mind and repeat it to yourself again and again. Often, this type of exercise is calling to your internal world to respond with an answer that is not conscious.

I mention this last idea of dream direction to help with the nightmares you are experiencing. All of us are carrying anxiety, worry, and, some of us, even terror over what is unfolding in our daily lives. We speak to it in a myriad of ways while we are awake during the day, and we are also speaking to it in our dreams. Deep down in the places we are not aware of, we are holding these worries and frights and they come out to haunt us in our nightmares.

I hear how terrifying they can be and that they are happening on a continual basis to the point that you do not want to even go to sleep. Engaging in steps #4 and #6 that I have noted above may help you set aside consciously the concerns you are feeling terrorized about as well as direct your mind to focus on something more interesting to you.

It will take some work to actively employ these strategies, but it may very well worth it to find not only sleep, but dreams that answer something on your mind, rather than terrorize you with worries. This is not just you — so many around the globe are being terrorized by their pandemic nightmares — you are not alone. I encourage you to take the steps above to help you sleep through this time of uncertainty that plagues us all.

Dear Therapist: Celebrating Little Victories

Woman celebrates her little victories

Dear Therapist:

I know most people mark the big things in life, work promotions, graduations, anniversaries, birthdays, and more, but I am wondering if it is selfish to celebrate the little victories we may achieve on any given day? I don’t want to be seen as self-involved, but I also want to celebrate this stuff as I go along to mark what’s unfolding in my life.

Sincerely, One Moment Away From Celebrating the Little Victories

Glad you wrote in! It’s funny how down society is on noticing the little victories of our lives and celebrating them along the way. We somehow receive the message that life is not to be marked and celebrated, except for those very big milestones, i.e. marriage, having children, work promotions, a new home, an anniversary, a Birthday and, of course, the holidays.

Outside of those parameters, life is considered ordinary time. As adults, we are given the message that we must bear the ordinary days and be “OK” without anything special happening. If we are constantly celebrating, then how will there be anything special about the big moments. Rather, keep these to yourself and don’t make a big deal.

Sort of feels like these are our Puritanical roots. Head down, do good work, don’t cause any ripples – good, bad, or otherwise — and pass on calling any attention to yourself. I say a loud and strong, “No!” to this way of living.

I think any day one has good health — ie you wake up and are not in any type of pain — that is a victory day. Do you know how many people wish they woke up to a pain free physical life? We should celebrate at the start of each day when we are healthy.

All through our ordinary days, extraordinary people, events, and kindnesses unfold and they should be celebrated and noticed. In that same spirit, many small victories are won in a day that should be marked. Some of these could include:

  • Your child is toilet trained
  • The dog no longer chews the carpet and house to bits
  • You tried a new food and enjoyed it
  • You got a rebate
  • The service call you had to make had you waiting on hold for less than a minute
  • A beloved item is returned to you
  • A presentation you deliver packs a punch and people really appreciated it
  • You got to sleep with no problem
  • You found time to make dinner
  • A letter arrives with the news you’ve been waiting to hear

Goodness! Our little victories that we experience each day are not to be discounted, but celebrated. It may feel strange given the societal norms to not make such a big deal of any number of little things. Still, to get through the ordinary time, not only should you mark your own little victories, but others as well.

Let’s start a movement!

The Therapeutic Alliance

The therapeutic alliance is a key component to good therapy.
Therapy Offers a Chance for an Alliance!

When I was in graduate school, we were often taught about the “therapeutic alliance.” That feeling the therapist extends to a client to let them know we are aligned with them and their needs, desires, hopes, fears, and anything else he is bringing into the therapy room. I am struck by how clinician-focused this term is when therapists-in-training are taught about it in school.

Yes, the therapist must align and become an ally to one who is seeking therapy, but even more important is for the client to feel an alliance with his therapist. I believe school teaches practitioners that this will happen naturally for the client if we align ourselves with them and, yet, I feel that a client must gauge for themselves if someone if therapeutically attuning to him.

How can you even know if a therapist is forming an alliance with you? And what if the therapist is doing all the right things, but it just doesn’t feel right to you?

Aha! Those are the important questions to keep in mind when creating a new relationship with a therapist. We have been taught how to form an alliance with you, but I don’t think there is much thought given to educating the public who seek therapy regarding whether someone is a good fit or not for you.

My number one suggestion to you is to gain an intuitive sense about what you are looking for in a clinician. Do you want someone direct or perhaps indirect? Do you want someone to stay silent or do you really need to have the person responding to you throughout the session? Are you interested in learning new coping skills or are you there to take a deep dive into old patterns? Depending on your answers to these types of questions, you can observe if the therapist sitting in front of you is going to form an alliance that is supportive of you and your unique self.

There is no one therapist who can meet everyone’s needs and desires. That is not even the point. As much as you the client are unique, so too are the therapists. We have been taught a particular set of skills to align with you, but it is general and not specific to any one person. The magic is when you find a therapist who does align with what you need and who you are that can make the work be wholly attuned to you.

And what if we are doing everything that seems like we are a good match and alliance for you, but you are still not feeling it? It’s completely OK to be honest about it not being the right match for you. We are always trying our best to match and align with you, and we also know it doesn’t always happen. Find your voice and say as much.

The therapeutic alliance is a must and is a golden space when we align from both sides — the Clinician and Client sides.