If you are challenged with depression, anxiety, social issues, relationship troubles, impulse issues or addiction, DBT skills will help you become healthier, stronger and more capable of coping with your emotions. DBT is a Solution Focused therapy that gets effective results, and quickly!
Up Next: Mindfulness and Interpersonal Effectiveness skills training in Westford, MA starts 11/06/19. Learn more HERE.
Fun fact: when you worry about the past too much, you become depressed; when you obsess about the future, you become anxious. Learning to live in the present moment, aka practicing Mindfulness, can reduce 90% of your depression and anxiety. Yes, you will still need to learn better ways to solve your life’s issues, but if you learn to stay in the present you will be so much more peaceful and useful. Learning Mindfulness skills helps you get there.
If this speaks to you, please visit lisawessan.com and complete the CONTACT FORM. I will contact you within 24 hours to discuss joining our next DBT group or working together individually, whatever you need.
Freedom from the Three Cs: Complaining, Condemning and Criticizing of myself and others.
Freedom from needing approval from family, friends, colleagues, clients.
Freedom from depression, suicidal thoughts, self-harm, and all negative thinking.
Freedom from FOMO! (Fear of Missing Out).
Freedom from the stress of being Here but wanting to be There!
Freedom from all or nothing, black and white, dualistic thinking. Dialectic thinking is a cure for recovering perfectionists, and a lot of OCD, obsessive compulsive, harsh thinking as well.
Freedom from jealousy, envy, lust, longing and cravings.
The only thing I do crave, however, is MORE FREEDOM!
I love feeling useful and peaceful, which is foundational for a life worth living. I also want to feel light and relaxed more of the time.
I want to feel “Serenity in the Storm,” as it is written:
“Serenity is not freedom from the storm, but peace amid the storm.” (unknown author)
Is my life perfect today? Hell no! Far from it! I need to change SO MANY THINGS – I will spare you the burden of listing my ongoing pain, aggravation, losses, frustrations and deep sadnesses – but the good news is that these things are not dominating my consciousness.
I am not a victim anymore. It is no longer possible. I am 100% accountable for my life. I blame no one for my difficult situations and expect no one to save me.
Yes, it’s true, with the help of G-d, Wise Mind, Higher Power, and my Army of Angels, I am the one who I have been waiting for! This is totally a G-d Job…turning my defeats into victories, and my scars into stars. I have finally become bulletproof to the bullies, harsh people, fear and rage around me and within me. As it is written:
“…I have learned to be content whatever the circumstances.I know what it is to be in need, and I know what it is to have plenty. I have learned the secret of being content in any and every situation, whether well fed or hungry, whether living in plenty or in want.I can do all this through him who gives me strength.” (Philippians 4: 11-13)
🌀With the deep healing powers embedded in psychospiritual treatments anything is possible! 🌀
Yes, I’m excited to share this today – my New Normal – after decades of battling with depression, eating disorders, severe mood swings and more.
If you are still struggling, please hear me when I say HAVE HOPE, things will get better if you don’t give up.
Learn and practice your transformative behavioral and spiritual skills (DBT or whatever) knowing that you are making progress and that “This Too Shall Pass.”
If I can heal and be well, it can happen for anyone. I am just another Bozo on the Bus, hastening slowly towards Wholeness and Oneness.
May you have a healthy, peaceful and relaxing fourth of July!
“Everyone experiences ambiguous loss if only from breaking up with someone, or having aging parents or kids leaving home. As we learn from the people who must cope with the more catastrophic situations of ambiguous loss, we learn how to tolerate the ambiguity in our more common losses in everyday life.”
– Pauline Boss, Ph.D.
In my immediate family, several of my nearest and dearest have battled with cancer over the years…both of my paternal grandparents, may they rest in peace, my dear first cousin Stephanie (may she live to be a super centenarian) and my delightful and fierce Aunt Yvette (known as “Auntie”), who is currently receiving hospice care. It has been a long and grueling journey with cancer for all my loved ones.
Sometimes I struggle with feeling powerless, and living so far away from my family in Sarasota, FL. When they lived in New York, it was so much easier to visit. Sadly, I can’t make frequent visits to Sarasota. The only “power” I do have is to send intentional healing and loving energy to my Auntie and family…and to practice radical acceptance so that I will function with some measure of inner peace here in my world.
For a while, my Auntie was in and out of the nursing home while she battled her cancer and other complications from treatment. Her life was severely compromised by her illness. As harsh as this has been is for her, since April 2015, I have also been witnessing how Auntie’s dying process is affecting everyone around her.
My cousins are fraught with anxiety and grief. Others in my family are a hot mess, watching Auntie dying so slowly, not being able to process their feelings and find some relief. Some people get trapped in the “Blame Game,” and are always looking to find ways to defocus their pain by pointing at others.
We are all coping with the ambiguity of Auntie being here, yet not here. She is no longer resembling her true self as we knew her. Sometimes she is delirious, sometimes she is too weak to talk. As her body deteriorates, she is no longer living the full and robust life she once enjoyed.
This pain we are all experiencing has a name…it is called Ambiguous Loss. “Ambiguous loss is a loss that occurs without closure or understanding. This kind of loss leaves a person searching for answers, and thus complicates and delays the process of grieving, and often results in unresolved grief.” (Wikipedia)
There are a variety of types of ambiguous loss. One type is when people go missing and the body is never found. For example, a person does not return from a sailing trip, or from a hiking excursion, or war, or they are kidnapped. Their loved ones still feel a lack of closure because the body was not found. “Maybe they will return…” lingers in the mind.
After 9/11, all of us in NYC were processing personal and professional ambiguous loss for all of our New Yorkers who were lost in the pile of bodies that were never recovered.
Another kind of ambiguous loss is when people experience a new emotional boundary that hurts. This happens when people get divorced, or when someone ignores you, stops talking to you, shuts you out of their life. Any kind of break-up creates ambiguous loss, because the person is still here, yet not here. They are alive, but dead to you. This is considered more painful loss than when someone actually dies.
Medical illness and addictions cause ambiguous loss.
Ambiguous loss also occurs when a loved one has Altzheimers or dementia, and they no longer recognize social connections. Similarly, when someone is very ill, such as my Auntie. We have ambiguous loss because the illness is transforming our loved one into someone other than the person we always knew. We are mourning the living remnants of our loved one while she is here…so excruciating and bitter.
When someone is living with an addiction, this too causes their personal relations to deteriorate and they are not fully present for their loved ones. Again, they are here but not here.
I have a friend who had a beautiful daughter in Cambridge, MA, who chose to be homeless. Her daughter was an alcoholic. My friend tried all methods of intervention and help. Nothing worked. My friend suffered with ambiguous loss for so many years. Her daughter was a pianist, absolutely lovely. She died a few years ago, at 35, and it was one of the most heart wrenching tragedies I experienced. My friend is still recovering from this painful loss.
Learning to live a good life with ambiguous loss
I recently listened to a wonderful and insightful podcast interview with ambiguous loss pioneer Pauline Boss, Ph.D., who originally coined the term “ambiguous loss.” Krista Tippett hosts Dr. Boss on her podcast, On Being. You can listen here:
I prefer the unedited versions of Tippett’s interviews, because there are sometimes fascinating nuances that are deleted to make the long form interview fit into an hour. But I’m sure whichever one you listen to will be rewarding💙
One of the ideas I took away from Dr. Boss’ talk was that we will never have complete closure from our ambiguous losses, or from our complicated grief. What we can do is become more adept at processing our negative feelings and difficult thoughts. Dr. Boss has some wonderful suggestions on the process.
Cognitive restructuring, which can be learned, is a big part of the solution. Dr. Boss’ stories and explanations are very helpful in deconstructing the different kinds of ambiguous loss that we all have in our lives.
Even though I learned about ambiguous loss and complicated grief in graduate school, it seems I keep deepening my understanding of it every year. I learn more about ambiguous loss from clients who are struggling with painful divorce, adult children with addictions, my Auntie’s battle with cancer, harsh racial and homophobic incidents and for all the ongoing loss of freedoms in the world that never seems to subside.
Fun fact: Ambiguous loss is clearly part of our psychospiritual journey — for it forces us to grow and move to new levels of compassion and acceptance of things we cannot control. “Lack of power, that is our dilemma,” says Alcoholics Anonymous (Bill W., 1976). Yes, in our culture, we seek to control, cure, fix and manage everyone and everything as much as possible. We don’t like messy endings.
Yet what I have come to know, is that true mastery of life is being able to live in ambiguity with peace, even joy. My life is far from perfect…yet I am more often feeling positive, grateful, uplifted, inspired and anticipating good interventions that will transform it.
If we can learn to live in that “not knowing” place and be peaceful — that is a vast improvement on “hating ambiguity” and perhaps yelling at G-d or the Universe, or twisting into knots over why bad things do happen to good people…again, very messy, so annoying.
The truth is, when it comes to matters of love, there is no closure. As they say at the Grief Toolbox, “Closure is not part of the grieving process, nor is it necessary for healing. A connection formed in love can’t be closed.” Dr. Boss confirmed this with her years of research on ambiguous loss, leading to her forthcoming book on “The Myth of Closure.”
As Dr. Boss discussed in the interview, our Western culture wants neatly packaged endings and for everyone to move on as quickly as possible. There is plenty of ignorant shaming that goes on, as in “Aren’t you over that yet?”
Sadly, our culture does not tolerate ambiguous loss very well at all. It requires more Eastern, dialectical thinking. To be able to say non-binary statements such as “She is alive, but also dead,” “He is not here, but he is possibly still alive,” or “She looks like Auntie, but this is not Auntie anymore,” requires a leap from dualistic thinking to a more dialectical thinking which allows us to embrace opposite beliefs without sinking into a deep depression or disruptive anxiety vortex.
Solution Focused Suggestions
For today, I invite you to learn more about ambiguous loss, and start to apply these non-dualistic, non-binary, dialectical thinking ideas to your situation.
Listen to the podcast above, and learn some skills to help process your ambiguous grief.
Perhaps find a good therapist who can help you learn to cope better with your struggles. Good news: coping skills can be learned!
Learn to laugh at the absurdities, paradoxes and incongruities of life (Gavin, 2010; Wessan, 2013).
Practice your Distress Tolerance skills …join a Dialectical Behavior Therapy group. You may then find it easier to work through the painful moments, and allow yourself to live in ambiguity with, dare I say it, some joy!
“If you can recognize and accept your pain without running away from it, you will discover that although pain is there, joy can also be there at the same time.” Thich Nhat Hanh, No Mud, No Lotus
“Grief is the price we pay for love.”
Queen Elizabeth II
(21 April 1926 – 8 September 2022)
“Even when all the experts agree, they may well be mistaken.” ~ Bertrand Russell
“In preparing for battle, I have always found that plans are useless,
but planning is indispensable.” ~ Dwight Eisenhower
“The reverse of truth has a thousand shapes
and a boundless field.” ~ Michel de Montaigne
“Do I contradict myself?
Very well then, I contradict myself,
(I am large, I contain multitudes.)”
~ Walt Whitman, Leaves of Grass
“Whoever is winning at the moment
will always seem to be invincible.” ~ George Orwell
“Family values don’t stop at the Rio Grande.” ~ George W. Bush
“Sometimes you need to get knocked down before you can
really figure out what your fight is.” ~ Chadwick Boseman
What do all these quotes have in common? They are blending opposing beliefs into a non-dualistic framework, which is, for most people, is not easy to hold in the mind without some cognitive dissonance.
One of the reasons I love to teach Dialectical Behavior Therapy Skills (DBT) is to help people move from binary to non-binary thinking. In this way, DBT serves to help people live with massive emotional and cognitive dissonance and yet not have an emotional meltdown (or use self-harm to distract or medicate from the pain of holding the contrasting beliefs).
For example, when you get into the DBT flow of consciousness, you realize that you can both love and hate someone. You realize that on some level, you are amazing, perfect and rocking “as is,” yet you can improve. Yes, you are good enough, yet you can improve! You realize that you are sometimes brilliant, and sometimes really foolish, but still lovable, no matter what. You embrace the FACT that you inevitably will make mistakes, but you are NOT a mistake. You are still awesome, lovable and worthy, no matter what cocka-locka-cuckoo stunt you got into, either consciously or unconsciously. You come to accept that “There is no shame in my game!”
So dialectical thinking helps you get out of the black and white mental trap, the “All or Nothing,” Right or Wrong, Worthy or Unworthy, Perfect or Imperfect name game. Practicing dialectical skills helps relieve so much of your negative inner dialogue, which can potentially lead you down a slippery slope, perhaps causing a spiral into a depression and even self-harming thoughts.
Over time, DBT gently muzzles the harsh inner Critic and lets you move forward with plans to grow, learn, change and improve yourself, your relationships and your life.
DBT makes it so much easier to “Disable the Label” of your diagnosis, gender challenge, financial issue, body image or weight issue and more. For years, I have said that I believe DBT skills will someday soon be taught to everyone by the 3rd grade level…Now Lady Gaga, superstar and mental health advocate, has started a foundation, MENTAL HEALTH FIRST AID to bring DBT Skills Training into all the public schools in the USA. Why? Because after years of suffering, once she learned DBT Skills, she had a dramatic recovery from her mental health issues, and now she is making this possible for everyone.
It is essential that we all move out of this painful and extremely unproductive dualistic perfectionist damnation of ourselves and others! Enough is enough, right? The exquisite radical acceptance that comes from dialectical thinking starts within, and then permeates into our relationships, politics and the world at large.
Yes, it is possible to temporarily hate ourselves for a few minutes for being a bit unconscious or even whacko in the moment, and then with the help of improved self-talk, gently shift back to a more bearable level of acceptance, possibly reach a more comfortable forgiveness level and then back to a more loving baseline. With training, this could be reduced from days/weeks of self-hate to a few minutes…that’s a big win in my practice!
This DBT process uses evidence-based skills culled from the vast Mindfulness research, Interpersonal Effectiveness, Distress Tolerance and Emotion Regulation fields. These skills help people move from being in the extreme of “Emotion Mind” or “Rational Mind” into their “Wise Mind” and function better on every level.
Here are some of the common myths that we deconstruct in our DBT groups:
“Dialectics reminds us of the many paradoxes that are built into our Universe:
The universe is filled with opposing sides/opposing forces. There is always more than one way to see a situation, and more than one way to solve a problem. Yet two things that seem like opposites can both be true.
Everything and every person is connected in some way, in the way that the waves and the ocean are one. It is also believed that the slightest move of the butterfly affects the furthest star.
Change is the only constant. Meaning and truth evolve over time. Each moment is new; reality itself changes with each moment.
Change is transactional. What we do influences our environment and other people in it. The environment and other people influence us.” (Linehan, 2015)
For today, I challenge you to start letting go of your dualistic mind traps, end all “Compare and Despair” drama and gently start to shift into a more compassionate, empathetic and dialectical mindset that will allow yourself and others to be good enough around you, as is, while you are all improving. Here’s the emotional math: less judging, more inner peace. Simple, but not easy!
Onward and Upward🌀
Lisa Wessan
Reference:
Linehan, M. (2015). DBT Skills Training Handouts and Worksheets. Second edition. New York: Guildford Press. Page 150.
There’s a lot to be grateful for this season, and I’m grateful for the never ending Light that goes to any length to reach us…
I appreciate this verse from Leonard Cohen, that when you are having a breakdown , aka cracking up, you are actually have a breakthrough. Those cracks allow us to grow, learn and transform.
No cracks, no wisdom. It’s all part of the mysterious dialectical personal growth process we engage in as living beings. We are not aiming for perfection, but we are aiming for wholeness.
I hope this message finds you in good health, moving towards wholeness, having more breakthroughs than breakdowns!
Happy, healthy, spirit of Thanksgiving and holiday season,
Open Enrollment Period for Adult DBT Skills Group ends 1/3/19. This next semester we cover Mindfulness and Interpersonal Effectiveness. Learn more HERE.
For some people, the holidays are a very joyful and exciting time of year. More parties, celebrations, shopping and gift exchanges coupled with lots of social stimulation. It’s all good…for them.
But for others, who feel painful pressure to have “forced fun” and may not have strong intimate connections, lack financial resources, struggle with illness or addiction, these times are fraught with deep loneliness and uncomfortable feelings of “Compare and Despair” (Wessan, 2011). For this group, we are entering “The Red Zone.”
The Red Zone runs through Thanksgiving, Christmas and New Year’s Eve…and perhaps for many Valentine’s Day is also included in this over stimulating, emotionally charged, addiction riddled time of year.
When I was younger, single and living alone in New York City, I experienced the holidays as my Red Zone. I loved my circle of friends, but many of them were married or had moved far away. They were not available for the holidays. I found my loneliness was most acute during this time of year.
As part of my coping with loneliness, for many years I went away for New Year’s weekend to Pumpkin Hollow Retreat Center, in Craryville, NY. Pumpkin Hollow is a beautiful place, with magical trails on lush Berkshire hills and a thoughtful and sensitive staff. They used to facilitate a wonderful Silent Retreat over New Year’s weekend (I noticed now they have one in late January and May).
There were moonlit walks in the woods, we ate delicious gourmet organic vegetarian meals , danced around a huge campfire, hugged trees and meditated together in the silence. The facilitators artfully helped us work through all the activities in silence, and I remember every year being amazed at how little language I really needed to get by and still feel peaceful and content.
For me, it was a relaxing and restorative weekend in the Berkshires, but I also I had to process some difficult feelings.
Forgiveness 101
Being in the Silence can be a powerful cleanse, as so many distractions are removed. The Silence gives us time to deeply work through some acceptance and forgiveness issues, serving as a “Mental Laxative,” as Iyanla Vanzant is known to say (Vanzant, 2013). This is a perfect time to take a moral inventory of ourselves, and notice where we need to improve.
Moral inventories vary, but at their core, we make a list of the people we have harmed, consciously or unconsciously. Then we make a list of the ways we hurt ourselves, consciously or unconsciously. Finally, we make a list of our fears and regrets. (The only way to do a moral inventory wrong is to not do it at all.)
All of this then requires a deep and thorough forgiveness practice, ultimately letting go of all of it. Then it is done. We have a fresh start.
You can use this Forgiveness Prayer to help you get started. Practice Suggestion: Read it into your Smart Phone’s Voice Memo app (or tape recorder) very slowly. Pause 5-10 seconds between each line. Save it, and then play it back to yourself with your eyes closed, allowing yourself to feel it deeply. As faces and names to forgive bubble up in your consciousness, you can make a note of them to add to your lists.
For all those we have harmed, knowingly or unknowingly, we are truly sorry. Forgive us and set us free. For all those who have harmed us, knowingly or unknowingly, we forgive them and we set them free. And for the harm we have done to ourselves, knowingly or unknowingly, we are truly sorry. We forgive ourselves and we set ourselves free. ~ Author Unknown ~
Afterwards, we may also need to talk to a few people and apologize for our behavior (or in some cases neglect). Hard Fact: In order to really feel healthy, whole, clean and strong inside, it is essential to give our inner emotional pipes a good Roto-Rooter cleaning by resolving any awkward or tender hurts. Apologies and amends need to be in the process. Fun Fact: Asking for forgiveness is the final piece in our quest for inner calm, or should I say, the Final Peace?!!
But you don’t have to go away for a whole weekend to give yourself an effective Mental Laxative…you can carve out some time each day, or each week, to sit quietly and review your life to forgive the imperfect moments. What worked well? What did not go so well? Whom did you judge too harshly? Even taking a brief inventory of your emotional interior will have huge pay offs in the long run.
One more Mental Laxative Practice Suggestion: set a timer for 10 minutes. Do as much of your list making as you can in that time, and then stop. It will be enough. Do this on a weekly basis, or more frequently if you are ready. Ten minutes of taking a Mental Laxative twice a week is a great beginning, perhaps once over the weekend and once during the week? Do what feels right for you.
As you progress, this could ideally become a daily activity…and who would you be if you had no resentments, anger, unresolved grief and rage? You would bloom on in a whole new way.
In addition, I believe that holding onto negative thoughts and unresolved anger, resentment, fear and grief will fester within, and eventually manifest into some kind of physical illness and/or mood disorder. We need to keep all of our pipes clean! Digestive pipes and emotional pipes, which actually work together in the big picture.
As the hallowed halls of the Mindfulness research and Functional Medicine have taught us, every thought becomes a chemical reaction in our bodies. Please note, the Mind-Body connection is not philosophical, theoretical or conjectured. It is grounded in science (Turner, 2014).
We need to be aware of this and carve out the time to release and let go of our negative and stinking thinking. If we don’t, it will just putrefy within, and poison our relationships as well.
What is Reflective Listening?
Being heard is so close to being loved, that for the average person they are almost indistinguishable. – David Augsburger
Another worthwhile activity to do if you find yourself being in the Red Zone now is to volunteer your time, talent and special treasure in places that will appreciate you.
Before I became a therapist, I used to volunteer at a Suicide Hotline called HELPLINE, at the Marble Collegiate Church in New York, which for me, was an exhilarating service. It was founded by the late, great Reverend Norman Vincent Peale, may he rest in peace. (There is also an excellent Blanton-Peale counseling center located at Marble, with wonderful psychospiritual therapists on staff, see reference below).
Most Hotlines have a fascinating and useful training program which enhances all human relationships. I first learned the power of Reflective Listening in my 10-week HELPLINE training, and it transformed my life.
Reflective Listening is being able to let someone else talk and just be present for them, listening quietly. When they pause, then you reflect back the essence of what they have just said. This feels very soothing and loving to the agitated talker. The person feels so validated by your Reflective Listening, it is often enough to help them get “off the ledge.” Listening is a form of loving each other that soothes, heals and restores us.
Learning Reflective Listening was the bulk of my HELPLINE training, plus there was also a lot to learn about making referrals and gaining trust.
Coming from a culture of chronic interrupters and non-listeners, I had learned some ineffective communication habits over the years, which I continue to strive to improve. The impulse to speak out and interrupt is fierce, but knowing that it compromises relationships and hurts people helps me to zip my lip, as best as I can. For today, I remain a humble work in progress, that’s for sure.
My hope for the future is that the Hotline’s training program is something that will be taught to all humans by the sixth grade. Similar to the skills learned in Dialectical Behavior Therapy (DBT, which should also be part of elementary school education) during training we learned about interpersonal effectiveness, mindfulness, distress tolerance and emotion regulation. These skills give us the foundation for better emotional balance, and allow us to be more present for others’ pain and suffering, as well as our own.
Ask yourself the magical question, “How can I be useful today?”
I understand that a Hotline gig may not be your cup of tea. Volunteering at a soup kitchen, animal shelter, nursing home, botanical garden, museum, Indivisible, MoveOn or anywhere can also be very uplifting during the Red Zone.
Nursing homes always need a river of volunteers to help with feeding, reading, translation services and transporting non-ambulatory residents . I learned this when I was in graduate school, as one of my internships was at the Jewish Home and Hospital for the Aged in the Bronx. I was facilitating several therapy groups each week, but there was a huge volunteer staff that coordinated all these helpful tasks for the residents. I was so impressed with the volunteers’ compassion and zeal to help these nursing home residents.
Yes, there is a time for self care, and then sometimes it is better to focus on others’ needs more than your own, to take a break from the painful ME-ME-ME inner dialogue you might be having.
Transparency is Healing
Finally, being in the Red Zone totally in secret is just exhausting and no fun. Be honest and authentic about your feelings — transparency is healing — and see who matches your energy. You might find a few people who also feel put upon and even hate the holidays — great — these will be your Red Zone buddies and comrades in getting through the muck of the season.
Make it a point, however, to be victorious together, e.g.”let’s stay sober and clean through this nightmare,” or “This too shall pass. How can we be useful today?” or “Let’s go for a hike and get away from the shopping madness.” Complaining is draining, so it’s important to find ways to support each other to rise above the chaos of the season.
Being able to laugh about it, the complete absurdity and paradox of Christmas especially, is so refreshing. Whenever I see huge displays of gifts and glittery objects everywhere tempting us to buy-buy-buy, I chuckle to myself and think “What would Jesus say about all this? Would He be happy with this display?” Yikes.
I’m not judging, nay, nay, I actually love the glittery Hand of G-d in all of this (Wessan, 2012). But you know the commercialization of Christmas becomes excessive and downright irritating at times — so I like to take a step back and think about the real reason for the season…our awesome connectivity, celebrating our Oneness, and the mystery of the Numinous in our lives.
Another reason is the magnitude of working through the bittersweet feelings of existence together and being brave enough to peacefully co-exist in this tumultuous world. We can acknowledge the dialectical paradox, that sometimes we want to live and sometimes we don’t, but we choose life anyway. We need to be courageous during this time, knowing that we are struggling in the Red Zone while “everyone else” seems to be having the best time ever.
In Conclusion
For this holiday season, The Red Zone, I encourage you to try something different:
Experiment with a daily or weekly Mental Laxative experience, or go away on a retreat for more in depth forgiveness work.
Volunteer somewhere that will give you a chance to focus on someone else, take a break from “Poor me, Poor Me, Pour me a drink” thinking.
Give honesty a chance, come clean and tell a few people how you really feel. Defrost some of that hidden grief, rage, loss, loneliness, “Compare and Despair” and all the inner stressful thinking that puts a damper on your days.
I promise if you follow some of these suggestions you will feel lighter, brighter and perhaps, dare I say it, even more peaceful during this relentless Red Zone.
Good health is wealth, go for it!
References
Dialectical Behavior Therapy Skills (DBT). This is a four part psychoeducation program that covers Mindfulness, Emotion Regulation, Distress Tolerance and Interpersonal Effectiveness. It takes one year to complete the curriculum.
Turner, K. (2014). Radical Remission: Surviving Cancer Against All Odds. New York: Harper Collins.
Vanzant, I. (2013). Forgiveness: 21 Days to Forgive Everyone for Everything. Carlsbad, CA: Smiley Books.
Blanton-Peale Institute and CounselingCenter, New York, NY, for individual, family and couples counseling. Accepts most insurance. Highly recommended for quality psychospiritual therapy. Founder: the late great Reverend Norman Vincent Peale.
Pumpkin Hollow Retreat Center, Craryville, NY. Owned and operated by the Theosophical Society. Organic vegetarian food served from their own farm, non-dogmatic, beautiful retreat center. Highly recommend, especially the retreats on Therapeutic Touch, and the Silent Retreat.
The full scope of Interpersonal Effectiveness focuses on improving communication, learning to set healthy boundaries, learning to validate self and others, gaining confidence in asking for what you want, enrolling others to help you in your dreams and goals, and letting go of toxic relationships.
Below is a sample of one of my lesson plans for Interpersonal Effectiveness. (This is one segment from 14 classes on this topic.)
Preventing Compassion Fatigue
It can very often be difficult to say no to people who make demands of us, and if we say no, we can get caught up in self-critical thoughts leading us to feel guilty. To avoid feeling guilty, we just keep on saying “yes” to every request.
Someone asks us to do something:
We can learn ways of saying “No” that don’t lead us to think self-critically or feel guilty. For example:
I’m sorry but I really can’t take on anything else at the moment.
I’m quite busy right now. Perhaps another time.
I’d like to help you out, but I just don’t feel up to it at the moment.
Thank you for asking me. You’re a nice person, but I don’t want to go out with you.
I don’t need a new roof (double glazing, vacuum cleaner etc). I’m happy with what I have thank you.
If the person seems to have trouble accepting your “No,” then just keep repeating yourself, over and over if necessary. Be a BROKEN RECORD! Practice what one of my students calls Polite Perseverance…You might have to add the word “No” to the beginning of those statements, perhaps with some emphasis on that word. For example:
No. I’m sorry but I really can’t at the moment.
Be wary of those self-critical thoughts afterwards. Practice challenging and/or dismissing them, by telling yourself:
I explained to them why I couldn’t do it.
It’s not my responsibility.
It would only end up upsetting me if I agreed to it – this is best for me. If I feel less tired and not resentful, then I might be a better position to help them out next time.
They’re just thoughts – I don’t need to pay them any attention (then put your focus of attention on something else).
The following dialectic affirmations about control and esteem can be helpful for finding that balance.
I cannot control some things but I am not helpless.
I cannot control other people but I am not helpless.
I am not responsible for those things I cannot control.
I accept those things in myself that I cannot change.
I can make positive choices for myself.
My strengths and abilities deserve my appreciation. Appreciate those abilities you have.
Create your own affirmations by completing the following sentences:
I am not powerless, I can ___________________________________________________
I have the right to refuse ___________________________________________________
I am not helpless, I can _____________________________________________________
I deserve to _________________________________________________________________
Remember, a wise person once said “Repetition is the mother of skill…” so aim to repeat these phrases at least twice a day, with focused energy, enthusiasm and passion!
It takes one year to complete the DBT Program. During the year, we cover these modules:
DBT Core Mindfulness [focusing skills]
Distress Tolerance [crisis survival skills]
Emotion Regulation [de‐escalation skills]
Interpersonal Effectiveness [‘people skills’]
During class, we explore the act of saying “No” and turn these into powerful “Moves” to help you build new neural networks in your brain. We combine neurology, physiology and cognitive restructuring to do this, and sometimes add music and dancing to ramp up our energy. This helps you develop a fresh new response more easily and will become your “new normal” response to people’s inappropriate or untimely requests.
Since I changed careers in 1999, morphing from science journalist to therapist, I feel as if I have given birth to three clinical children in this journey…
First, I delivered Therapeutic Laughter for Caregivers (and others) in New York City, which emerged as keynotes, workshops and seminars. I still enjoy presenting these programs which also include Team Building with Laughter, the Let Go and Lighten Up program and LaughAnanda (laughter meditation). Each program serves a different sector, for corporate, medical/healthcare, educational, non-profit, and spiritual organizations.
Second, after a long gestational study period, I delivered Dialectical Behavior Therapy Skills Groups (DBT) two years ago and currently facilitate two DBT groups in my office in Westford, MA, one daytime and evening group.
Third, and brand new as of June 2017, Walk and Talk Therapy (WATT) was born. I am very excited about the progress and results my clients are experiencing during WATT.
Over the past several years, every time I read about exercising with clients, I was more intrigued…yes, there is solid science and empirically verified research on the benefits of WATT.
In brief, the motion of walking stimulates the bicameral brain and increases activity between the left and right hemispheres. This allows people to access more complex feelings and memories, and have the ability to process the sadness, grief or trauma even more effectively while walking. While walking, everything is flowing, and the negative or heavily charged energy from the traumatic memories can discharge quicker. (I’m in the process of writing an article on a few of my clients who have had dramatic shifts and turnarounds on these walks.)
RISK MANAGEMENT
I have my clients sign an Indemnity Agreement prior to the WATT, and we discuss the possible challenges that may occur, such as tripping on a rock, or falling for some reason. For some, this often leads to a lively discussion of their previous adventures and how confident they are in their walking ability. “Walking around a lake? This is nothing, a piece of cake!” they say. For others, the prospect of walking for two miles is daunting, but they understand they can do as much or little of the walk as they want. We have a choice of several benches for resting along the way with stunning views of the lake.
If you are considering WATT, I strongly recommend it. As the Scottish-American naturalist John Muir once said, “In every walk with nature one receives far more than he seeks.”
This goal of this article is to provide insight into the “back office” of behavioral health care practitioners, especially for our patients, and the administrators who work with us.
Even though I tell new patients that they need to allow for some “wiggle room” at the top of their session and at the end of their 45-50 minute therapeutic hour, there are always some who are hurt and upset when I am not perfectly punctual, and that would be for anywhere from five to 10 minutes. I am writing this article for them… and my fellow behavioral health care practitioners, who may appreciate this illustration of what goes on while our patients are waiting for us.
One factor to keep in mind is that there are many different opinions on the “therapeutic hour.” Most insurance companies reimburse for a 45 minute session, a unit of time that they deem is appropriate for treatment. There is an ongoing debate on this matter.1
My patients know that they will get their full time here, whether we start at 2 PM or 2:10 PM. Most of the people I work with have no problem if I am a few minutes past the hour. They understand the ebb and flow of a behavioral health care facility, or they are conditioned to wait from previous appointments with other practitioners. There are just a handful of people that are in more pain in the Waiting Room, and this article will hopefully soothe their concerns.
What do therapists typically do in that 10-15 minute gap between patients? We are usually reviewing or writing notes, returning phone calls, making appointments, visiting the restroom, and perhaps eating lunch, dinner or some kind of metabolic adjustment.
Then we have the Unavoidable Delays which occur during these gaps:
Delay #1: Collateral calls between sessions. What is a collateral call? That’s when we return urgent calls to your doctors, nurse practitioners, teachers, guidance counselors, lawyers, judges, concerned family members or call your insurance company.
For example, when I have a patient in the hospital, and her doctor wants to talk to me, he leaves a message in the morning “Please call me today as soon as you can before 1 PM.” So what happens at 10:50 AM or 11:50 AM when I am returning his call during a 10 minute gap? I call the doctor, and then his secretary tells me to “Please hold while I page him.” I can be on hold for more than 10 minutes at times — waiting to find out how our mutual patient is doing. Naturally I am concerned for my hospitalized patient’s well being and may also need to respond to the doctor’s questions. Plus, Medical Release forms may need to be signed and faxed so that we can speak without violating the HIPAA Privacy Rule2.
Am I concerned about you being in the Waiting Room? Yes, I regret when this happens. But to remedy this challenge, when I have a collateral call to place — which may guarantee a delay — I immediately send you a “Courtesy Notice” via text. I let you know that I am being detained, and that we will most likely meet closer to 11:15 AM, or 12:15 PM, or whatever is 15 minutes past your original appointment. I am always doing the best I can, given the urgent and timely nature of these collateral calls.
I am honoring your time as much as I possibly can, and I deeply care that you are waiting, but I also need to make these calls between seeing patients in my office. You need to know that I am not thoughtless, careless or indifferent to your waiting time. That would be an extremely false assumption.
Delay #2: Longer sessions. Sometimes a client is delving into a very difficult thought or memory, and is having a breakthrough at the 43rd minute of the 45 minute hour, often referred to as “Doorknob Therapy.”3. Do I stop the client at the stroke of 45 minutes and say, “Sorry, we will pick this up next week.” No, I allow them to finish their thought, or complete their process, especially when they are releasing a traumatic memory or having a major breakthrough or insight. Again, it’s just a few extra minutes past their usual time.
Delay #3: Engrossed listening, not watching the clock. The good news and the less good news…I am listening to your story, you have my full attention, and I do not watch the clock every minute. I sometimes lose track of time while I am deeply concentrating on your words, and what is happening with you. This is a natural hazard of working in this field4. Yes, there are ways to keep track of the time despite the process of intensive reflective listening, putting together symbolic themes and meaningful interpretations for you.
Possible solutions for Delay #3: How would you feel if I set a timer for 43 Minutes? Would you mind if a chime went off right before your time was up? That is one solution for this delay. Other solutions involve keeping one eye on the clock and thereby removing myself from total immersion in your story. When I go over the hour due to engrossed listening, it is rarely more than 5 or 10 minutes. Yet this does anger some patients in the Waiting Room who feel miffed that I am a few minutes past their appointment time.
Delay #4: Clinical meetings off-site. Sometimes I perform home visits for my elderly patients, or teens without wheels. Traveling from another location, where I was in a clinical meeting that ran later than expected, could cause a small delay. Again, when I see that coming, I send a text with a Courtesy Notice. During home visits, sometimes there are extra complications, or equipment needs to be ordered, and urgent paperwork needs to be processed which takes a bit longer. This is all part of the unavoidable delay caused by this off-site work.
In Conclusion
It remains questionable as to whether the 45-50 minute hour can be effective when processing deep trauma and chronic grief. I do the best I can during this standardized treatment window, but you need to know that there are methods and techniques which do require longer time for maximum benefit, including Dialectical Behavior Therapy (DBT), Eye Movement Desensitization and Reprocessing (EMDR), Hypnotherapy and other trauma treatments. These do not always fit into the 45-50 minute hour5.
In sum, this work occurs in a non-linear, sometimes timeless space that cannot always be boxed into a precise unit of time if the practitioner is working with true empathy, compassion and a commitment to excellence6.
So the next time you are sitting in the Waiting Room, I hope you consider that one of these four delays are probably happening and that’s why you are waiting, hopefully patiently.
Suggestion: It would be an excellent use of your time to make a list of topics that you want to discuss with your therapist, or sit quietly with your eyes closed and scan your body and mind for what you are feeling in the moment, to get in touch with your inner world in the Waiting Room. This will contribute to your having a more effective and successful quality of session and therefore you will be using your time with deeper purpose and meaning in the Waiting Room. You could also write your check for your fee or copayment while you wait, also a good use of those minutes. [Please refer to my article on “The Art of Waiting,” for your enjoyment and better understanding of this issue7.]
Finally, this is an important issue to discuss with your therapist. Chances are if you are impatient in the Waiting Room, you are impatient everywhere. You are not behaving this way only at this time. It’s how you roll, your Modus Operandi.You may also discover that you are avoiding dealing with your painful issues and interpersonal conflicts by hyper-focusing on the 10 minutes you are waiting.
You may be triggered by this short wait, and it is bringing up important tender golden threads from your childhood when you were neglected or kept waiting by a harsh relative. But being condemning, critical and complaining of your therapist’s time delay will not help you in dealing with your inner troubles and your personal transformation process unless you discuss it openly with your therapist. Ultimately, railing about your therapist’s time delay to your friends will just keep you feeling like a victim, and you will stay stuck right where you are until you process this out with your therapist.
We are your Practice Human. In the best of all possible therapeutic relationships, you will feel safe enough to say anything to us, tell us exactly how you feel, what you think, and how frustrated you are with your waiting experience (or any other issue you are having with therapy). This is all very useful and helpful in your journey towards wholeness. When you practice improving your communication with us, you increase your interpersonal effectiveness in the world. I always tell my people “This is the Huddle! You come in here to defrost painful feelings, get some relief, regroup, strategize, learn some new skills, tools and methods, and then go out and practice. The real work is done out in your life.”
If waiting for your therapist continues to be a huge issue for you, speak to your therapist about getting treatment for practicing Radical Acceptance8. Or if none of this fits for you, then just get a referral to see a different therapist.
At the end of the day, you are always 100% accountable for your life. As the captain of your ship, you can always sail on to the next safe harbor.
4. Lazarus, A. (1997). Brief But Comprehensive Psychotherapy: The Multimodal Way. New York: Springer Publishing Company.
5. Ibid.
6. For this reason, some of my patients have double sessions, where we can do accelerated work and have the advantage of a 90 or 100 minute session to cover a broad reach of material successfully.
8. Brach, T. (2004). Radical Acceptance: Embracing Your Life With the Heart of a Buddha. Bantam Dell: New York, New York.[There are many sources for learning about Radical Acceptance, and it’s also included in the Distress Tolerance module of Dialectical Behavior Therapy. Tara Brach’s book is a wonderful source for delving deep into the process of learning to accept reality and find peace with the imperfections of your life.]
The Lighter Side of Transformation 