There is currently much going on in my life, not more or less than others, but enough to preoccupy me and distract from this writing. This, along with friends who are struggling, led me to contemplate how I have shown up for and in turn how I have felt supported and nurtured by others. So, I am asking the question what are we really meaning when we say, “I support you, I will be thinking of you, I will be praying for you, I will send good energy your way,” etc.? I have said each of these things at some point to various people and heard them shared with me.
Mostly, when I hear these phrases I appreciate the sentiment, say thank you and we both move on. I must admit, however, there are other times, like now, when I have a longing for something more. As I reflect on what this “more” would include, I concluded: asking how I am doing when you have time to listen – asking if I would like a hug and holding on until the tension leaves and/or the tears come (this may take some time with my wife and male friends) – empathizing while challenging me to consider where growth is waiting for me – and the tangibles of “let’s take a walk,” “I would like to come over and bring dinner,” and at times “maybe we should do something different right now like play a game, go watch a movie,” etc.
My wife has always been good about putting her desire to support others into action. As I am writing this, she is writing notes to people in our lives. Even more profound are we willing to do this with those different from us whether the difference is reflected in homelessness, race, or non-normative sexuality or gender? This is my ongoing desire to work with what I would appreciate from others and take action to show up with the time to engage and ask what they need, with the intention of following through. How valued and inspired each of us would feel if we moved beyond loving intentions to loving actions. To all those who have taken time with me, thank you, I am a more fulfilled person for it.
A Look Inside the PCS Intensive Treatment Program and Why We Do What We Do
Welcome to PCS! This issue was born from the realization we perhaps had never provided an overall glimpse into the PCS Intensive Treatment Program (ITP).
The PCS Individual Intensive Program is an intensive, trauma-focused program that concentrates on the client’s individual needs providing 65 hours of engagement. Clients will participate in a rich mixture of individual and group processing from Saturday at noon to the following Saturday at noon.
The hallmark of our program is ITP clients spend over half their time in individual sessions (i.e. 34 hours) typically with a team of 5 to 6 different therapist each bringing their unique personality, style, and skills to the process. This creates an incredible diversity of experiences in a client’s path toward their goals. Additional meetings with a Dietician, our Medical Director, and Psychiatrist create an enlightening and influential treatment system.
The groups are mixed-gender and incorporate individuals and couples presenting with varies issues. You can read a description of each group personally written by its facilitator. Please note we once again welcome non- intensive clients to these in person groups with a therapist referral.
We endeavor from the beginning to the completion of the program to fully engage with clients as they process through their most challenging issues. As always, we welcome questions and feedback as we continue to improve our program.
Pre-screening
We are not for everyone. There is a prescreening process to determine if a client may be right for our program. This includes collecting detailed information from the potential client and phone conversations with one of our therapists between the potential client and primary therapist. We work as a team at PCS and involvement of the primary therapist and sometimes psychiatrist is key to success. Intensive clients must be working with a therapist at home in order to attend.
A PCS Intensive works for those who are:
Highly motivated and want to jump-start their therapeutic process and utilize a program where sessions build off one another, creating a greater possibility of transformational change.
“Stuck” and desire a safe place to face their fear of what change will mean in their life, fear of the unknown.
Making some progress in weekly or bi-weekly therapy, but not the broader changes they are looking for.
Busy with work and home and find it difficult to keep consistent weekly or bi-weekly appointments and would prefer a shorter, but more intensive span of time to create movement.
Experiencing an intense current crisis and struggle to manage daily living, needing a space to stabilize and strengthen in grounding and coping skills.
Making some gains in recovery, but still experience relapses due to their need to process the deeper causal roots to their problematic or addictive behaviors.
A PCS Intensive does NOT work for those who are:
Signing up because someone else in their life is making them do it, and they otherwise would stay home.
Pointing the finger in defensiveness and blame, struggling to face what makes them difficult to those around them.
Using the intensive as a checklist, and uninterested in making genuine changes.
Resist transparency and are not ready to tell the truth.
Experiencing severe mental illness, including auditory hallucinations, extreme paranoia or delusional thoughts.
Actively suicidal or homicidal.
Continuing to act out or use substances.
Assessment
Intensive clients are provided with a battery of online assessments several weeks prior to beginning their program. Because the client is completing these on their own schedule and before they arrive, it offers more therapy time upon arrival. It is also more comfortable for the client to complete these at home.
We offer assessments specifically designed for each client’s program and treatment plan. All of this information is provided to the client’s primary therapist in a report sent after the client has returned home.
When the client arrives they will also meet with a dietitian to discuss a variety of nutritionally related topics. Physical health and well being is very important to mental health as well.
The sessions with our medical director and psychiatrist generally take place early in the program so that the information can be shared with his or her team. This information is also included in our final report to the referring therapist.
Workshop
The PCS Intensive is a weekly offering built around “The Murray Method,” developed by Marilyn Murray in the early 1980’s. Clients begin the process on a Saturday, with Marilyn’s workshop and explore “The Scindo (Latin for “split”) Syndrome,” looking at how adverse childhood events cause “survivor” parts to develop, who try to cope and manage their powerless and painful circumstances, the Circles of Intimacy, helping to organize a hierarchy of healthy intimate connections, and lastly, the Trauma Egg, a document the client creates that chronicles difficult traumatic life events, so the client can understand patterns in negative internalized messages and coping styles.
The concluding workshop provides an opportunity for each person to review and share insights and their commitment to personal health. Clients state these two “book-end” sessions offer a special opportunity for initiation and closure with their group.
Everything you ever wanted to know about PCS Group Therapy
Emotional Regulation
When we experience trauma, addiction or attachment issues, we often struggle with emotional regulation, tolerance and resiliency. We are taught (and sometimes not) about emotion from our caregivers. How was emotion modeled in your family? Was it over the top? Was it dismissed? Was there room for you to have an emotional experience? Did someone else take up too much emotional space? We are social animals with nervous systems designed to co-regulate with those around us. What did your nervous system “learn” about trust and safety?
“Psychodrama —meaning “psyche in action”—is an experiential group that helps us explore our inner and outer worlds through action vs talking. Through enactment, participants explore issues and concerns in a safe environment with the help of the group. The goal of psychodrama helps participants discover their inner truth, express emotions freely and establish authentic interactions with others.” (paraphrased from Karen Carnabucci’s Practical Psychodrama).
Equine-Assisted Therapy
Our Equine-Assisted Psychotherapy (EAP) group meets offsite for 2 hours. In our fast paced world it can be difficult to slow down and be present. Due to their size, the horses will organically help you to slow down, be mindful, and present. The activities will engage you intellectually, emotionally, socially and physically. The horses become a canvas onto which you project your reality. By becoming aware of both your non-interpretive observation and the story that follows, you become better informed about yourself and how you move through your world. Through this organic process you will begin, or deepen, your journey of self-discovery and awareness. You will be invited to consider new ways of being in, and engaging with, the world.
Communication is at the core of our daily living, and the higher the stakes in terms of relationship, the greater the chance we can inadvertently dance into the “Demon Dialogues”. Whether we are talking about a significant other, close family member or close friend, the tendency can be to either go into a fight response (“Attack-Attack/Find the Bad Guy”), a fight/flight response (“The Protest Polka”) or a freeze response (“Freeze/Flee”). We end up “amygdala-hijacked”, deep into our “reptilian brain”, and find it difficult to get grounded and engage in a “Wise-Minded” exchange.
Using the Awareness Wheel and Listening Cycle, this group assists in helping clients get out the “Demon Dialogue Dance” through the encouragement of vulnerability, assertiveness, curiosity, validation and empathy.
Offense Cycle
This group focuses on the offense cycle (also called an intimacy-blocking cycle) and the clarification process. We all engage in some form of maladaptive behavior that contributes to a lack of intimacy with self and others. This group is designed to help identify our offensive behaviors in order to break the cycle and set the stage for healthy intervention. Participants will be encouraged to recognize what is under the surface and how their behaviors impact others.
Borders and Boundaries
This group is designed to educate, encourage, and empower you to establish and maintain healthy boundaries. It will support you in exploring the ways you treat yourself, they ways you treat others, and the ways you allow others to treat you. Setting boundaries is an important part of establishing our identity, engaging in healthy relationships, and is a crucial aspect of mental health and well being. In setting boundaries, we are prioritizing ourselves and what we need.
Mindfulness
Mindfulness and meditation are vital components within recovery and healing. We are not only our thinking, we are the awareness behind the thinking and experience of our life. Deepening one’s relationship with this awareness and self is vastly improved when engaging in daily mindfulness or meditation. Mindfulness group will address how and why meditation and mindfulness are necessary aspects integrating one’s healing experience.
Compulsivity
Each of us experiences some form of out-of-control behavior, even if it is reflected in our over-control. In this mixed gender group space is created to share your story of addictive, compulsive, and/or out of control behavior. Each participant is encouraged to openly discuss those things hidden from others. The process of directly confronting our secrets often provides opportunity for reducing shame.
Spirituality
This group gives us the opportunity to share diverse experiences of faith and unfaith in an experiential or discussion format that maximizes the integration of spirituality and therapy. It allows everyone to share lifestyle choices, inspirations and values in a welcoming setting to provide strength or renewed strength to all.
Courageous Living
Courageous living is dedicated to increasing your ability to live your life as a healthy adult. This group works on reducing shame and finding the courage it takes to be accepting and loving of ourselves. In so doing, we will also be able to accept and love the important people in our lives and build emotionally intimate relationships.
Anger & Forgiveness
The Anger/Forgiveness group focuses on three inter-related topics; anger, apology and forgiveness. Through videos, discussion, experiential exercises/interactions and group handouts, participants learn more about the important role that anger plays in our lives (protection) and how to manage this powerful emotion.
A mixed gender group focusing less on claiming the label of codependency, but more on recognizing our learned behavior of ignoring or minimizing our own needs to focus on others. Emphasis is placed on affirming self and identifying self-care. The group provides each member an opportunity to check in and provide feedback to one another in an open forum.
Healthy Balance
In this group, we explore more in-depth Marilyn Murray’s model for how we respond to challenging events in our lives, as well as how we can design our lives as a Healthy Balanced Person. As children, we develop different “parts” of ourselves as we learn to adapt to our world. By noticing and nurturing these “parts,” we can help ourselves meet our needs today in healthy ways as mature adults. We also explore unhealthy strategies and ways of coping with our unmet needs that are often destructive, both to others and ourselves. Lastly, this group reviews homework assignments that are due for the Concluding Workshop at the end of the intensive therapy program.
Power of Positivity and Play
The “P3” (the power of positivity and play) group is based on principles of positive psychology including the importance of recognizing and integrating core gifts/strengths and values in to one’s day to day life and relationships. The importance of positivity and play as sources of fulfillment, well-being and overall balance in life are emphasized. Group members engage in interactions in which they share and celebrate “their awesomeness” (successes, traits, talents/skills, etc.).
Relationship Enhancement Group is a psychoeducational group aiming to provide an introduction to attachment theory, the basis for Emotionally Focused Therapy (EFT). With this information, group members should be able to identify their attachment styles and give thought to ways in which their attachment styles work together with their partner’s to create their negative cycle of interaction.
Wrap Up Group
This group offers an experiential activity for Intensive Program participants to express gratitude to their fellow group members and reflect on their own progress. This group also includes a review of financial packets and program information, follow-up sessions, and other pertinent matters. Clients are provided an opportunity to share in depth feedback about their intensive experience.
Follow Up
Each intensive client has a follow up video session scheduled with their case manager (and often their referring therapist) to discuss the client’s continued progress. This session also allows the client to let his therapy team know about any issues since arriving home.
Have you ever wondered about the best path to help a young adult through therapy? Our young adult program is offered twice a year and is specifically designed for single persons age 18-25. Our next young adult week is December 18-23, 2022. This program fills quickly and often has a wait list.
We also offer family intensive programs. Families of 6 or more may attend our intensive program together. The week will be reserved for you and your family members offering individual, couples and group therapy as needed by each family member.
The hope is that we, as children, outlive our parents. That our parents live a long and rewarding life before they die. But what happens when this isn’t the case? What happens when our parents die young? What happens when we lose both of our parents and we aren’t quite ready to be the adultest adult in the room yet? This blog addresses things I wish I would have known being in the Young Adult Orphan Club along with some things that I have found to be helpful.
Both of my parents passed away in their early-mid 60s. Wham, I was suddenly very alone by the age of 40. I entered a special club that I had no idea existed nor did I want the honor of joining. My parents still had places they wanted to visit, grandchildren they wanted to watch grow up, traditions they wanted to pass on, relationships they wanted to enjoy, work that needed to be done, and quilts that needed to be created. There was a sense of being robbed, the “no fair” siren was screaming, and I was lost.
Grief. What a term, right? That thing that we all go through, multiple times in life, yet each time is unique and different in its own right. The waves carry us into a numbed daze, knock us over, and even provide a salve to our aching heart. Sometimes it was hard to breathe and in other moments, time lapsed without any sort of awareness. Each “task” that needed to be completed was painful and carried a sense of finality. It was raw and I couldn’t help wishing that I had been more prepared. Because when we know what to expect, it hurts less… right?
Here are some things that I wish I would have known…
Holidays, birthdays, and anniversary’s = yep they suck. There is a sense of not wanting to participate or forget the day is supposed to be “special.” However, there is also a pull to ensure that family traditions and my folks legacy remains. The memories come flooding back, the pain that they aren’t here is heavy, and it’s also a time to honor what they have given me. One word comes to mind, torn. What helped me = I took a break from holidays and traditions. I started to add in somethings that felt “safe” and was able to go at my own pace. I allowed myself time to cry and take breaks from the day as needed. .
Despising certain words and phrases. We never know what to say in times of grief, so sometimes what we think might help actually backfires. I experienced so much anger towards people who were trying to provide comfort but I felt they just didn’t get it. Hearing “with time, things will get better”, “I can’t even imagine,” “they are in your heart, keep their memory alive,” and even the Bob Marley quote that I adored “You never know how strong you are until being strong is all you have left” became massive triggers for me. I didn’t know how to respond so I isolated. What helped me = I started telling myself the things that I was needing to hear. I found phrases that worked for me. I told my support system my phrases.
Others are grieving too, in their own way. I wasn’t prepared for being a reminder to my mom’s siblings and friends that she’s gone. People that I was hoping to find comfort with, weren’t able to give me that support. Partly because they were grieving, partly because I was grieving, and partly because it just hurts all the way around. It was easy to isolate and turn off the world. What helped me = I turned to others within this club to provide support and understanding. I tried to not take things personal. I got really good at deep breathing exercises
Life milestones and highlights aren’t the same. The dreams of having a parent walk you down the aisle, see you walk across that graduation stage, watch your children grow up, and taking those family trips to faraway lands will not happen as we had hoped. Going to weddings, funerals, birthday parties, retirement parties, etc. can cause a windfall of emotions. Taking a trip to the restroom when the father daughter dance happens and even minimizing your accomplishments can occur. Some may see this as running away from the pain, I see it as a protective factor to help us be present when we can. It’s okay to not be okay. What helped me = I talked to my parents and envisioned them watching my accomplishments. I purchased gifts for myself in their memory. I sent cards for events when I wasn’t ready to attend yet. I told my support system and they walked beside me.
“I wish I would have taken the time” moments will happen on a regular basis. Wishing to have conversations that we can’t have now, gain a better understanding of family history, learn how to quilt/wood work, master the family recipes, learn the adulting tricks, and take those trips we always said we would. The missed opportunities can be haunting and yet there are times I’m able to channel my folks and fix the garbage disposal or remind myself “the trick to cooking is to just let it sit.” What helped me = Every time I found myself in the ‘I wish’ loop, I would remind myself of something I had learned/experienced. Sometimes I even completed the task for added measure. I started paying more attention when family members would reminisce. I asked people to tell me about my folks as a kid. I made family dishes and started to experiment with making them my own.
There are so many more bullet points I could add to this topic and in all honestly, even in this club, we all grieve differently. I’m a firm believer that our grief doesn’t shrink over time, it’s more about how we grow around our grief. Yes, some days are much easier than others. Yes, I am thankful for the time and memories I have with my parents. Yes, my love for them has not changed. AND yes, it still hurts. Anne Lamott wrote it best, “It’s like having a broken leg that never heals perfectly that still hurts when it’s cold, but you learn to dance with a limp.”
I have worked at a children’s hospital in their inpatient psychiatric unit for over four years now. To this day, one of the most visceral images I have from my time there is of spaghetti with spoons.
I mean it makes no sense. You give a kid that has a very small window of tolerance a plate of noodles and two spoons. The thought of navigating that as an adult makes me angry. And yet, somehow, they all find a way to manage.
Some will painstakingly cut the noodles up until they have a makeshift soup to spoon from their plates. Others use a two-spoon approach, similar to chopsticks. And then of course there are the ones that use their hands—dangling the long noodles high in the air and catching them like a fish would take bait. It’s incredible, really, to watch them make do. Against all odds, they manage to find a way to fuel their bodies and fill their stomachs. To survive.
I think many of us have been given a plate of spaghetti with two spoons. And like the kids I work with, we’ve found ways to get by.
We find ways to cope. We avoid things that make us feel uncomfortable and small. We become dependent on our loved ones or shut them out completely. To be fair, these strategies often work. They may even work for years or decades.
The thing is, it’s very easy to get stuck using these strategies. Why change it if it works? Why try something new and risk failure?
How could someone suggest that we’re eating the spaghetti wrong?
Therapy is a lot like trying to eat spaghetti with a fork for the first time. It’s new. It’s unfamiliar. It challenges so many of the things that we have known to be true.
Learning to use the fork—or beginning a therapeutic relationship—takes courage. It takes humility. It is by no means an easy thing to do. However, learning a better way to navigate our lives is a worthwhile endeavor. There may be giant plate of spaghetti in front of you, but you don’t have to suffer through it. In fact, the best way to eat spaghetti is by taking a spoon and a fork, together, and using them in tandem.
How Instant Gratification Influences the Brain & Deteriorates Recovery
The saying, “good things come to those who wait” has become harder to employ.
Patience was long considered a virtue, but it seems more like an anachronism today.
In today’s world we have access to fast everything—information, food, technology, entertainment, comfort, prescriptions, sex, etc.
Don’t know the spelling of a word? Use Siri or Google it. Feeling hungry but are too tired to cook dinner? Postmates it. Feeling lonely? Launch Tinder and start swiping right. Forgot it is your friend’s birthday tomorrow? Get a gift delivered that day with Amazon.
Instant gratification refers to the experience of satisfaction or receipt of reward as soon as a response is made. Simply stated, instant gratification is the act of receiving a reward and/or pleasure without having to wait.
At the heart of instant gratification is one of the most basic drives inherent in humans—the tendency to see pleasure and avoid pain. Having our desires quickly met is not necessarily a bad thing.
So what’s so bad about instant gratification?
For starters, having an over-reliance on certain instant gratification-fueled impulsive behaviors can create changes in our brains. The repeated exposure to instant gratification disrupts the balance of benefits versus risks in delay of receiving an available reward.
A study at Harvard observed two groups of participants consuming chocolate. Group A indulged in the chocolate while Group B had no access to the chocolate. After the study, both groups were given chocolate and Group B reported higher happiness, savored the taste more, and was in a better mood afterwards. This study shows what people think will make them happy isn’t always what will and that you can have too much of a good thing.
If we experience more pleasure and happiness through delayed gratification, why is it so difficult to choose delayed over instant?
Our brains are constantly changing in response to our actions and behaviors. For instance, if the desire is to lose weight we may impulsively purchase the newest trending diet pill that advertises “Lose 20 pounds in 2 weeks!” rather than going for a walk every morning. Each time this compulsion for instant gratification is acted on, our brain pathways for those actions are reinforced and strengthened, making it easier to fall into the same patterns the next time around and harder to break the cycle.
The start of the cycle may look like having a drink one night after a long day at work to then finding any minor inconvenience the next day in order to justify drinking again the next night.
Getting caught up in the instant gratification cycle can make you susceptible to addictions, jealousy, anger, and impulsive behavior. It also often leads to increased stress, anxiety, and feeling overwhelmed.
As it pertains to instant gratification harming our recovery, research has found that individuals with mental health issues are less likely to wait for things they find pleasurable. For example, if symptoms of depression are present, there is an impact on how the brain processes things – particularly our prefrontal cortex which deals with decision making, problem solving, and memory.
As the struggling person goes straight to self-soothing behaviors to give themselves a quick boost, they may neglect their basic needs as a result, harming their recovery.
Looking at Maslow’s hierarchy of needs, we see how vital meeting our physiological needs (like food, sleep, and shelter) is. These needs sit at the bottom of the pyramid, and if the physiological isn’t addressed first, safety, belonging, esteem, and self-actualization fall by the wayside.
In addition, researchers have found that the ability to delay gratification is not just an important part of goal achievement, it might also have a major impact on long-term life success and overall well-being.
So, next time you notice yourself falling into the compulsion cycle for instant gratification, pause and assess your needs rather than act. Rather than rushing to a psychiatrist to get a prescription for ADHD medication, ask yourself: “Am I getting enough sleep?” Instead of going straight to the fridge to pop open wine after work, ask yourself: “Would going for a walk or taking some deep breaths help me destress?”
Over the past few years COVID-19 has had global impact. While many aspects of daily living have returned to their “new normal”, COVID continues to leave plenty of challenges outside of the actual virus. Working with children, adolescents and young adults has given me unique insight into the ongoing struggles of these populations. Here are a few of the most common challenges I see presenting in the therapy room and some ways parents and caregivers can help.
Social Struggles
From quarantines, to stay at home orders to social distancing, most young people experienced increased separation from their peers during key social development stages. This can lead to feelings of isolation, loneliness and difficulties establishing new relationships.
How it shows up in the therapy room
Reports of…
feeling lonely
not having friends
uncertainty of how to make friends
What parents and care givers can do to help
Spend meaningful time with your child
Consider opportunities to expose your child to other kids (sports, clubs, community events)
Talk to your child about how to make new friends, consider role playing or using toys to act out an interaction
Set up play dates
Check with your child’s school for resources they use to support social and emotional learning
Academic or Learning Difficulties
The COVID-19 pandemic brought significant challenges to schools and educators leaving them to figure out how to continue providing education to students who were no longer in a physical classroom. Many schools utilized remote learning and hybrid methods with little preparation. Educators did their best AND many students struggled with the inconsistent methods of teaching during these years.
How it shows up in the therapy room
Reports of…
feeling behind academically
difficulty adjusting to new routines
increased low mood
difficulty concentrating
What parents and care givers can do to help
Talk to your child’s school and teachers to get an idea of how your child is doing in the classroom
Help kids to create routines around schoolwork
Express interested and engage with the topics your kid is learning
Listen, validate, and express empathy when children report difficult feelings
Mood Difficulties
The pandemic brough about unprecedented times across the globe. Children often look to their surrounding environment (parents, caregivers, peers, school, etc.) for reassurance when big feelings arise. With the uncertainty that COVID-19 brought, many of the typical reassurances were not available. Fear of the unknown was a common experience of both adults and children alike.
How it shows up in the therapy room
Reports of…
feeling stress and overwhelm
difficulty dealing in uncertainty or ambiguity
anxiety or fears (ranging from social fears, health-related anxiety, fear of loss, and general unease)
sadness, low mood, depressed feeling
What parents and care givers can do to help
Listen to your child and validate their difficult feelings
Share your own feelings (in age-appropriate ways)
Practice naming emotions as a family
Identify ways to cope with big emotions and practice them with your child
Seek additional support (counseling, therapy) if needed
Missed social or life milestones
COVID-19 caused so many cancellations – weddings, graduations, prom, trick or treating, birthdays, first days of kindergarten, first days of college, etc. There is no doubt your child missed out of some sort of milestone due to the pandemic. Grief over missed experiences was a regular occurrence in the past few years and can be difficult to navigate for those in their formative years,
How it shows up in the therapy room
Reports of…
sadness or grief around lost opportunities
difficulties “launching” or moving to the next stage of life
regression into younger age or stage related behaviors
What parents and care givers can do to help
Ask your child if there is anything they feel they missed
Get creative with how to commemorate special milestones in a new way
Talk about what it means to transition from one stage to the next and find ways your child can practice their transition
I doubt we have seen the last impacts of COVID-19 and it is important to remember how this pandemic has uniquely impacted our children and their development. As a mother myself, I know how stressful it has been to navigate parenting throughout the pandemic. You are not alone. If you have concerns about your child or their development talk to your pediatrician, your child’s school, or counselor.
Emotions can be interesting… Fleeting yet intense, confusing yet our best teachers. When we are in tune with them they can be helpful, and when we are not we might miss something important or feel out of control. If you know me, I could get an award for compartmentalizing and avoiding emotions and, quite frankly, I’ve prided myself on this. I historically have a habit of treating feelings like something on my to-do list. My thought process is often, “I don’t have time right now to feel that” and I often do not come back to it. I have been challenging myself on this recently and that is partly why I write this to hold myself more accountable. What I have found as the antidote to my compartmentalization and avoidance is the simple concept of slowing down. It’s so important yet our daily lives seem to move so fast around us that it is easy to get caught up and run from what our emotions are trying to tell us. As we slow down and give ourselves the chance to sit with and truly be with our emotions, we can, with time learn to not fear and run from them. Once I slowed down enough recently to recognize it, I learned my anxiety has been begging me to slow down and I have even gotten some relief now that I have listened. Funny how that works, right? While I know this is easier said than done and all our stories are complex and dynamic, I invite you to join me in slowing down today. Maybe we can slow down enough together that we will not miss what our best teachers are trying to tell us.
Epistemic trust is a term with which many may be unfamiliar. It began as a term used in sociology before being adopted into the vernacular of psychologists in more recent years. The most basic definition is “one’s trust in communicated knowledge.” However, it can be more specifically described as “the capacity of the individual to consider the knowledge that is conveyed by others as significant, relevant to the self, and generalizable to other contexts” (Campbell, 2021). This communication can be in many forms, such as spoken words, non-verbal communication cues like body language, or reinforced messages communicated across a lifetime. The development of epistemic trust begins early in life as we interact and learn from those around us and is continually refined throughout our lives to adapt to our social environments.
Most of the psychological research studies on epistemic trust focus on personality disorders, specifically borderline personality disorder (Fonagy et al., 2015). However, more recent studies are considering epistemic trust as it relates to other kinds of psychopathology, and its implications for belief in conspiracy theories has even been considered (Tanzer et al., 2021). Unfortunately, due to the novelty of this concept in psychological studies, there is a shortage of available research to explore this topic further, especially in trauma-related areas. However, the recent development and validation of a questionnaire to measure an individual’s level of epistemic trust, mistrust, and credulity can aid in this area. This questionnaire allows for a closer and more standardized look at individuals’ epistemic trust and can be incorporated easily into future research (Campbell et al., 2021).
Considering epistemic trust and how it pertains to clients can also be useful in the treatment planning process. For example, one study highlighted that individuals diagnosed with personality disorders who had an elevated level of epistemic mistrust had poorer outcomes from their therapy experiences (Knapen et al., 2020). This may be the case for many that enter therapy with complex trauma backgrounds or other conditions that have reinforced a distrust in communication from others. This opinion can be supported by the argument that “epistemic trust may be the final common pathway through which aversive relational experiences in the past result in interpersonal dysfunctioning, which in turn result in dysfunctional therapeutic relationships, rendering it difficult for patients to trust whatever is offered to learn in therapy” (Knapen et al., 2022).
Little research has been done on achieving the restoration of epistemic trust, but it is believed that therapeutic interventions may be the most beneficial (Kamphuis & Finn, 2019). To date, there has been no known study that aims to investigate the relationship between trauma-focused therapy and restoration of epistemic trust. Such a study may prove to be a critical piece to understanding how epistemic trust impacts this population of therapy clients and whether trauma-focused therapy is an effective tool in the restoration of epistemic trust. As this concept continues to gain interest, we can expect a wealth of exciting developments in this area that will ultimately lead to improved therapeutic outcomes for clients everywhere.
References
Campbell, C., Tanzer, M., Saunders, R., Booker, T., Allison, E., Li, E., O’Dowda, C., Luyten, P., & Fonagy, P. (2021). Development and validation of a self-report measure of epistemic trust. PLOS ONE, 16(4), e0250264. https://doi.org/10.1371/journal.pone.0250264
Fonagy, P., Luyten, P., & Allison, E. (2015). Epistemic Petrification and the Restoration of Epistemic Trust: A New Conceptualization of Borderline Personality Disorder and Its Psychosocial Treatment. Journal of Personality Disorders, 29(5), 575–609. https://doi.org/10.1521/pedi.2015.29.5.575
Kamphuis, J. H., & Finn, S. E. (2019). Therapeutic Assessment in Personality Disorders: Toward the Restoration of Epistemic Trust. Journal of Personality Assessment, 101(6), 662–674. https://doi.org/10.1080/00223891.2018.1476360
Knapen, S., Hutsebaut, J., van Diemen, R., & Beekman, A. (2020). Epistemic Trust as a Psycho-marker for Outcome in Psychosocial Interventions. Journal of Infant, Child, and Adolescent Psychotherapy, 19(4), 417–426. https://doi.org/10.1080/15289168.2020.1812322
Knapen, S., van Diemen, R., Hutsebaut, J., Fonagy, P., & Beekman, A. (2022). Defining the Concept and Clinical Features of Epistemic Trust: A Delphi study. Journal of Nervous & Mental Disease, 210(4), 312–314. https://doi.org/10.1097/NMD.0000000000001446
Tanzer, M., Campbell, C., Saunders, R., Luyten, P., Booker, T., & Fonagy, P. (2021). Acquiring knowledge: Epistemic trust in the age of fake news [Preprint]. PsyArXiv. https://doi.org/10.31234/osf.io/g2b6k
Making the decision about who is going to be responsible for what within the context of your family system can already be a tricky task to navigate. Throw a baby into the mix—this becomes even more complicated. For most, having a baby means taking on a whole list of new responsibilities while maintaining the responsibilities you’ve had all along. Whether you’re talking about who is going to do the grocery shopping, to work outside the home, or to get up in the middle of the night when your baby wakes up, it’s important to make at least some of these decisions on the front end so as to ensure that both you and your partner feel a sense of partnership and equality. If this is not done ahead of time, or at the very least discussed intentionally once your baby arrives, you set yourselves up for what I like to call, defaulting. Defaulting is a fairly common occurrence where one parent, we’ll call them “Parent B“ (generally the parent who IS NOT primarily responsible for feeding) tends to make the assumption that the other parent, “Parent A” (generally the parent who IS primarily responsible for feeding), has whatever the task is on hand covered. This is not done from a place of mal intent but from a place of Parent B’s lack of awareness.
The reality is, parenting has a steep learning curve where most develop a system on the go. Parent A completes tasks because they simply have to be done and Parent B often falls short in stepping up to the plate because it seems as though Parent A has it under control. The result: a big ball of resentment. While I am talking about the importance of delegating the big responsibilities, I’m also talking here about the importance of discussing the seemingly smaller ones. These are the ones that tend to be overlooked and as a result, add up over time. Responsibilities like who is going to sit next to your baby at dinnertime, who is going to carry your baby up the stairs when you get home, and who jumps out of bed to pop the pacifier back in at night are just a few examples of such seemingly small tasks that when one parent finds themselves having to perform each and every time, can lead that parent to wonder whether they are in this alone. So moral of the story, sit down with your partner before your baby is born and regularly thereafter. Discuss potential tasks and who will take primary responsibility for performing them. Regularly check in after your baby is born to assess for new tasks that are likely to pop up and your partner’s willingness to continue performing tasks they have previously committed to. Most importantly, whether you are Parent A or B, please take note of all the big and little things your counterpart does on a daily basis and ask if they could use a hand or a swap out from time to time. Don’t just assume that your partner will do whatever needs to be done and even if a particular task has been clearly designated your partner’s responsibility, regularly express appreciation and gratitude to them for what they are doing. At the end of the day, whether you are Parent A or B, doing these few simple things will likely result in your partner feeling more appreciated and seen.
Please excuse me, I am asking for a moment of your time. This seems presumptuous for someone who has spent most of his adult life “never” having enough time. I know it seems overstated but trust me I never have enough time. It seems a chronic condition – no matter how far ahead, in short order falling behind circles back. Certainly, a tendency to say yes (do not want to disappoint anyone) and an ongoing difficulty to pronounce the word “no” (do not want to hurt another’s feelings) contribute to my ailment. Additionally, there is the ongoing distortion if I get this or that completed the illusive experience of calm and peace are waiting for me.
It seems I may fear peace and calm. Perhaps these fears partly explain working the ridiculous hours I have – maybe I could “buy” more time. Truth be told it has more likely served to shorten my time on this earth. Sure, there are moments of boredom and perhaps even periods of depression where life moves more slowly and yet I always return to the belief I am running out of time. One contribution to this chronic stressor is the belief I can do just one more thing. Of course, this has served to frustrate those around me as I have developed a consistent arriving 5 to 15 minutes late, because there was one more thing I knew I could squeeze in before leaving – “to save the time of doing it later.” This is the dilemma of never having enough time, if you avoid doing it now, you have to make time for it later.
This at times leads to never getting around to something, “there is not enough time,” which provides the wonderful excuse – “I did not have enough time.” There is a certain level of anxiety and stress this game with time creates. Yet it is this very experience of stress which drives me. I live life with intensity, rushing to accomplish, and yet looking as calm as a cucumber (although I have no earthly idea if cucumbers are emotionally calm and cool). I certainly would have written about this chronic condition earlier if I had enough time… As it turns out moving into my 60’s, there is a certain truth to this statement, “at 61 I am running out of time.”
Age has also promoted greater reflection, something you typically do not take time for when you are constantly “short on time.” I believe the truth is there has always been enough time, I just did not believe there was enough time for me (i.e., childhood belief). It must be time then to let go and grieve this relationship I have developed with time and move toward acceptance there has always been enough time. Acceptance in the reality I am not what I accomplish, rather I am an individual deserving of time to slow and just be. I could write more, but…well, you guessed it, I am out of time.
There is currently much going on in my life, not more or less than others, but enough to preoccupy me and distract from this writing. This, along with friends who are struggling, led me to contemplate how I have shown up for and in turn how I have felt supported and nurtured by others. So, I am asking the question what are we really meaning when we say, “I support you, I will be thinking of you, I will be praying for you, I will send good energy your way,” etc.? I have said each of these things at some point to various people and heard them shared with me.
Mostly, when I hear these phrases I appreciate the sentiment, say thank you and we both move on. I must admit, however, there are other times, like now, when I have a longing for something more. As I reflect on what this “more” would include, I concluded: asking how I am doing when you have time to listen – asking if I would like a hug and holding on until the tension leaves and/or the tears come (this may take some time with my wife and male friends) – empathizing while challenging me to consider where growth is waiting for me – and the tangibles of “let’s take a walk,” “I would like to come over and bring dinner,” and at times “maybe we should do something different right now like play a game, go watch a movie,” etc.
My wife has always been good about putting her desire to support others into action. As I am writing this, she is writing notes to people in our lives. Even more profound are we willing to do this with those different from us whether the difference is reflected in homelessness, race, or non-normative sexuality or gender? This is my ongoing desire to work with what I would appreciate from others and take action to show up with the time to engage and ask what they need, with the intention of following through. How valued and inspired each of us would feel if we moved beyond loving intentions to loving actions. To all those who have taken time with me, thank you, I am a more fulfilled person for it.
A Look Inside the PCS Intensive Treatment Program and Why We Do What We Do
Welcome to PCS! This issue was born from the realization we perhaps had never provided an overall glimpse into the PCS Intensive Treatment Program (ITP).
The PCS Individual Intensive Program is an intensive, trauma-focused program that concentrates on the client’s individual needs providing 65 hours of engagement. Clients will participate in a rich mixture of individual and group processing from Saturday at noon to the following Saturday at noon.
The hallmark of our program is ITP clients spend over half their time in individual sessions (i.e. 34 hours) typically with a team of 5 to 6 different therapist each bringing their unique personality, style, and skills to the process. This creates an incredible diversity of experiences in a client’s path toward their goals. Additional meetings with a Dietician, our Medical Director, and Psychiatrist create an enlightening and influential treatment system.
The groups are mixed-gender and incorporate individuals and couples presenting with varies issues. You can read a description of each group personally written by its facilitator. Please note we once again welcome non- intensive clients to these in person groups with a therapist referral.
We endeavor from the beginning to the completion of the program to fully engage with clients as they process through their most challenging issues. As always, we welcome questions and feedback as we continue to improve our program.
Pre-screening
We are not for everyone. There is a prescreening process to determine if a client may be right for our program. This includes collecting detailed information from the potential client and phone conversations with one of our therapists between the potential client and primary therapist. We work as a team at PCS and involvement of the primary therapist and sometimes psychiatrist is key to success. Intensive clients must be working with a therapist at home in order to attend.
A PCS Intensive works for those who are:
Highly motivated and want to jump-start their therapeutic process and utilize a program where sessions build off one another, creating a greater possibility of transformational change.
“Stuck” and desire a safe place to face their fear of what change will mean in their life, fear of the unknown.
Making some progress in weekly or bi-weekly therapy, but not the broader changes they are looking for.
Busy with work and home and find it difficult to keep consistent weekly or bi-weekly appointments and would prefer a shorter, but more intensive span of time to create movement.
Experiencing an intense current crisis and struggle to manage daily living, needing a space to stabilize and strengthen in grounding and coping skills.
Making some gains in recovery, but still experience relapses due to their need to process the deeper causal roots to their problematic or addictive behaviors.
A PCS Intensive does NOT work for those who are:
Signing up because someone else in their life is making them do it, and they otherwise would stay home.
Pointing the finger in defensiveness and blame, struggling to face what makes them difficult to those around them.
Using the intensive as a checklist, and uninterested in making genuine changes.
Resist transparency and are not ready to tell the truth.
Experiencing severe mental illness, including auditory hallucinations, extreme paranoia or delusional thoughts.
Actively suicidal or homicidal.
Continuing to act out or use substances.
Assessment
Intensive clients are provided with a battery of online assessments several weeks prior to beginning their program. Because the client is completing these on their own schedule and before they arrive, it offers more therapy time upon arrival. It is also more comfortable for the client to complete these at home.
We offer assessments specifically designed for each client’s program and treatment plan. All of this information is provided to the client’s primary therapist in a report sent after the client has returned home.
When the client arrives they will also meet with a dietitian to discuss a variety of nutritionally related topics. Physical health and well being is very important to mental health as well.
The sessions with our medical director and psychiatrist generally take place early in the program so that the information can be shared with his or her team. This information is also included in our final report to the referring therapist.
Workshop
The PCS Intensive is a weekly offering built around “The Murray Method,” developed by Marilyn Murray in the early 1980’s. Clients begin the process on a Saturday, with Marilyn’s workshop and explore “The Scindo (Latin for “split”) Syndrome,” looking at how adverse childhood events cause “survivor” parts to develop, who try to cope and manage their powerless and painful circumstances, the Circles of Intimacy, helping to organize a hierarchy of healthy intimate connections, and lastly, the Trauma Egg, a document the client creates that chronicles difficult traumatic life events, so the client can understand patterns in negative internalized messages and coping styles.
The concluding workshop provides an opportunity for each person to review and share insights and their commitment to personal health. Clients state these two “book-end” sessions offer a special opportunity for initiation and closure with their group.
Everything you ever wanted to know about PCS Group Therapy
Emotional Regulation
When we experience trauma, addiction or attachment issues, we often struggle with emotional regulation, tolerance and resiliency. We are taught (and sometimes not) about emotion from our caregivers. How was emotion modeled in your family? Was it over the top? Was it dismissed? Was there room for you to have an emotional experience? Did someone else take up too much emotional space? We are social animals with nervous systems designed to co-regulate with those around us. What did your nervous system “learn” about trust and safety?
“Psychodrama —meaning “psyche in action”—is an experiential group that helps us explore our inner and outer worlds through action vs talking. Through enactment, participants explore issues and concerns in a safe environment with the help of the group. The goal of psychodrama helps participants discover their inner truth, express emotions freely and establish authentic interactions with others.” (paraphrased from Karen Carnabucci’s Practical Psychodrama).
Equine-Assisted Therapy
Our Equine-Assisted Psychotherapy (EAP) group meets offsite for 2 hours. In our fast paced world it can be difficult to slow down and be present. Due to their size, the horses will organically help you to slow down, be mindful, and present. The activities will engage you intellectually, emotionally, socially and physically. The horses become a canvas onto which you project your reality. By becoming aware of both your non-interpretive observation and the story that follows, you become better informed about yourself and how you move through your world. Through this organic process you will begin, or deepen, your journey of self-discovery and awareness. You will be invited to consider new ways of being in, and engaging with, the world.
Communication is at the core of our daily living, and the higher the stakes in terms of relationship, the greater the chance we can inadvertently dance into the “Demon Dialogues”. Whether we are talking about a significant other, close family member or close friend, the tendency can be to either go into a fight response (“Attack-Attack/Find the Bad Guy”), a fight/flight response (“The Protest Polka”) or a freeze response (“Freeze/Flee”). We end up “amygdala-hijacked”, deep into our “reptilian brain”, and find it difficult to get grounded and engage in a “Wise-Minded” exchange.
Using the Awareness Wheel and Listening Cycle, this group assists in helping clients get out the “Demon Dialogue Dance” through the encouragement of vulnerability, assertiveness, curiosity, validation and empathy.
Offense Cycle
This group focuses on the offense cycle (also called an intimacy-blocking cycle) and the clarification process. We all engage in some form of maladaptive behavior that contributes to a lack of intimacy with self and others. This group is designed to help identify our offensive behaviors in order to break the cycle and set the stage for healthy intervention. Participants will be encouraged to recognize what is under the surface and how their behaviors impact others.
Borders and Boundaries
This group is designed to educate, encourage, and empower you to establish and maintain healthy boundaries. It will support you in exploring the ways you treat yourself, they ways you treat others, and the ways you allow others to treat you. Setting boundaries is an important part of establishing our identity, engaging in healthy relationships, and is a crucial aspect of mental health and well being. In setting boundaries, we are prioritizing ourselves and what we need.
Mindfulness
Mindfulness and meditation are vital components within recovery and healing. We are not only our thinking, we are the awareness behind the thinking and experience of our life. Deepening one’s relationship with this awareness and self is vastly improved when engaging in daily mindfulness or meditation. Mindfulness group will address how and why meditation and mindfulness are necessary aspects integrating one’s healing experience.
Compulsivity
Each of us experiences some form of out-of-control behavior, even if it is reflected in our over-control. In this mixed gender group space is created to share your story of addictive, compulsive, and/or out of control behavior. Each participant is encouraged to openly discuss those things hidden from others. The process of directly confronting our secrets often provides opportunity for reducing shame.
Spirituality
This group gives us the opportunity to share diverse experiences of faith and unfaith in an experiential or discussion format that maximizes the integration of spirituality and therapy. It allows everyone to share lifestyle choices, inspirations and values in a welcoming setting to provide strength or renewed strength to all.
Courageous Living
Courageous living is dedicated to increasing your ability to live your life as a healthy adult. This group works on reducing shame and finding the courage it takes to be accepting and loving of ourselves. In so doing, we will also be able to accept and love the important people in our lives and build emotionally intimate relationships.
Anger & Forgiveness
The Anger/Forgiveness group focuses on three inter-related topics; anger, apology and forgiveness. Through videos, discussion, experiential exercises/interactions and group handouts, participants learn more about the important role that anger plays in our lives (protection) and how to manage this powerful emotion.
A mixed gender group focusing less on claiming the label of codependency, but more on recognizing our learned behavior of ignoring or minimizing our own needs to focus on others. Emphasis is placed on affirming self and identifying self-care. The group provides each member an opportunity to check in and provide feedback to one another in an open forum.
Healthy Balance
In this group, we explore more in-depth Marilyn Murray’s model for how we respond to challenging events in our lives, as well as how we can design our lives as a Healthy Balanced Person. As children, we develop different “parts” of ourselves as we learn to adapt to our world. By noticing and nurturing these “parts,” we can help ourselves meet our needs today in healthy ways as mature adults. We also explore unhealthy strategies and ways of coping with our unmet needs that are often destructive, both to others and ourselves. Lastly, this group reviews homework assignments that are due for the Concluding Workshop at the end of the intensive therapy program.
Power of Positivity and Play
The “P3” (the power of positivity and play) group is based on principles of positive psychology including the importance of recognizing and integrating core gifts/strengths and values in to one’s day to day life and relationships. The importance of positivity and play as sources of fulfillment, well-being and overall balance in life are emphasized. Group members engage in interactions in which they share and celebrate “their awesomeness” (successes, traits, talents/skills, etc.).
Relationship Enhancement Group is a psychoeducational group aiming to provide an introduction to attachment theory, the basis for Emotionally Focused Therapy (EFT). With this information, group members should be able to identify their attachment styles and give thought to ways in which their attachment styles work together with their partner’s to create their negative cycle of interaction.
Wrap Up Group
This group offers an experiential activity for Intensive Program participants to express gratitude to their fellow group members and reflect on their own progress. This group also includes a review of financial packets and program information, follow-up sessions, and other pertinent matters. Clients are provided an opportunity to share in depth feedback about their intensive experience.
Follow Up
Each intensive client has a follow up video session scheduled with their case manager (and often their referring therapist) to discuss the client’s continued progress. This session also allows the client to let his therapy team know about any issues since arriving home.
Have you ever wondered about the best path to help a young adult through therapy? Our young adult program is offered twice a year and is specifically designed for single persons age 18-25. Our next young adult week is December 18-23, 2022. This program fills quickly and often has a wait list.
We also offer family intensive programs. Families of 6 or more may attend our intensive program together. The week will be reserved for you and your family members offering individual, couples and group therapy as needed by each family member.
The hope is that we, as children, outlive our parents. That our parents live a long and rewarding life before they die. But what happens when this isn’t the case? What happens when our parents die young? What happens when we lose both of our parents and we aren’t quite ready to be the adultest adult in the room yet? This blog addresses things I wish I would have known being in the Young Adult Orphan Club along with some things that I have found to be helpful.
Both of my parents passed away in their early-mid 60s. Wham, I was suddenly very alone by the age of 40. I entered a special club that I had no idea existed nor did I want the honor of joining. My parents still had places they wanted to visit, grandchildren they wanted to watch grow up, traditions they wanted to pass on, relationships they wanted to enjoy, work that needed to be done, and quilts that needed to be created. There was a sense of being robbed, the “no fair” siren was screaming, and I was lost.
Grief. What a term, right? That thing that we all go through, multiple times in life, yet each time is unique and different in its own right. The waves carry us into a numbed daze, knock us over, and even provide a salve to our aching heart. Sometimes it was hard to breathe and in other moments, time lapsed without any sort of awareness. Each “task” that needed to be completed was painful and carried a sense of finality. It was raw and I couldn’t help wishing that I had been more prepared. Because when we know what to expect, it hurts less… right?
Here are some things that I wish I would have known…
Holidays, birthdays, and anniversary’s = yep they suck. There is a sense of not wanting to participate or forget the day is supposed to be “special.” However, there is also a pull to ensure that family traditions and my folks legacy remains. The memories come flooding back, the pain that they aren’t here is heavy, and it’s also a time to honor what they have given me. One word comes to mind, torn. What helped me = I took a break from holidays and traditions. I started to add in somethings that felt “safe” and was able to go at my own pace. I allowed myself time to cry and take breaks from the day as needed. .
Despising certain words and phrases. We never know what to say in times of grief, so sometimes what we think might help actually backfires. I experienced so much anger towards people who were trying to provide comfort but I felt they just didn’t get it. Hearing “with time, things will get better”, “I can’t even imagine,” “they are in your heart, keep their memory alive,” and even the Bob Marley quote that I adored “You never know how strong you are until being strong is all you have left” became massive triggers for me. I didn’t know how to respond so I isolated. What helped me = I started telling myself the things that I was needing to hear. I found phrases that worked for me. I told my support system my phrases.
Others are grieving too, in their own way. I wasn’t prepared for being a reminder to my mom’s siblings and friends that she’s gone. People that I was hoping to find comfort with, weren’t able to give me that support. Partly because they were grieving, partly because I was grieving, and partly because it just hurts all the way around. It was easy to isolate and turn off the world. What helped me = I turned to others within this club to provide support and understanding. I tried to not take things personal. I got really good at deep breathing exercises
Life milestones and highlights aren’t the same. The dreams of having a parent walk you down the aisle, see you walk across that graduation stage, watch your children grow up, and taking those family trips to faraway lands will not happen as we had hoped. Going to weddings, funerals, birthday parties, retirement parties, etc. can cause a windfall of emotions. Taking a trip to the restroom when the father daughter dance happens and even minimizing your accomplishments can occur. Some may see this as running away from the pain, I see it as a protective factor to help us be present when we can. It’s okay to not be okay. What helped me = I talked to my parents and envisioned them watching my accomplishments. I purchased gifts for myself in their memory. I sent cards for events when I wasn’t ready to attend yet. I told my support system and they walked beside me.
“I wish I would have taken the time” moments will happen on a regular basis. Wishing to have conversations that we can’t have now, gain a better understanding of family history, learn how to quilt/wood work, master the family recipes, learn the adulting tricks, and take those trips we always said we would. The missed opportunities can be haunting and yet there are times I’m able to channel my folks and fix the garbage disposal or remind myself “the trick to cooking is to just let it sit.” What helped me = Every time I found myself in the ‘I wish’ loop, I would remind myself of something I had learned/experienced. Sometimes I even completed the task for added measure. I started paying more attention when family members would reminisce. I asked people to tell me about my folks as a kid. I made family dishes and started to experiment with making them my own.
There are so many more bullet points I could add to this topic and in all honestly, even in this club, we all grieve differently. I’m a firm believer that our grief doesn’t shrink over time, it’s more about how we grow around our grief. Yes, some days are much easier than others. Yes, I am thankful for the time and memories I have with my parents. Yes, my love for them has not changed. AND yes, it still hurts. Anne Lamott wrote it best, “It’s like having a broken leg that never heals perfectly that still hurts when it’s cold, but you learn to dance with a limp.”
I have worked at a children’s hospital in their inpatient psychiatric unit for over four years now. To this day, one of the most visceral images I have from my time there is of spaghetti with spoons.
I mean it makes no sense. You give a kid that has a very small window of tolerance a plate of noodles and two spoons. The thought of navigating that as an adult makes me angry. And yet, somehow, they all find a way to manage.
Some will painstakingly cut the noodles up until they have a makeshift soup to spoon from their plates. Others use a two-spoon approach, similar to chopsticks. And then of course there are the ones that use their hands—dangling the long noodles high in the air and catching them like a fish would take bait. It’s incredible, really, to watch them make do. Against all odds, they manage to find a way to fuel their bodies and fill their stomachs. To survive.
I think many of us have been given a plate of spaghetti with two spoons. And like the kids I work with, we’ve found ways to get by.
We find ways to cope. We avoid things that make us feel uncomfortable and small. We become dependent on our loved ones or shut them out completely. To be fair, these strategies often work. They may even work for years or decades.
The thing is, it’s very easy to get stuck using these strategies. Why change it if it works? Why try something new and risk failure?
How could someone suggest that we’re eating the spaghetti wrong?
Therapy is a lot like trying to eat spaghetti with a fork for the first time. It’s new. It’s unfamiliar. It challenges so many of the things that we have known to be true.
Learning to use the fork—or beginning a therapeutic relationship—takes courage. It takes humility. It is by no means an easy thing to do. However, learning a better way to navigate our lives is a worthwhile endeavor. There may be giant plate of spaghetti in front of you, but you don’t have to suffer through it. In fact, the best way to eat spaghetti is by taking a spoon and a fork, together, and using them in tandem.
How Instant Gratification Influences the Brain & Deteriorates Recovery
The saying, “good things come to those who wait” has become harder to employ.
Patience was long considered a virtue, but it seems more like an anachronism today.
In today’s world we have access to fast everything—information, food, technology, entertainment, comfort, prescriptions, sex, etc.
Don’t know the spelling of a word? Use Siri or Google it. Feeling hungry but are too tired to cook dinner? Postmates it. Feeling lonely? Launch Tinder and start swiping right. Forgot it is your friend’s birthday tomorrow? Get a gift delivered that day with Amazon.
Instant gratification refers to the experience of satisfaction or receipt of reward as soon as a response is made. Simply stated, instant gratification is the act of receiving a reward and/or pleasure without having to wait.
At the heart of instant gratification is one of the most basic drives inherent in humans—the tendency to see pleasure and avoid pain. Having our desires quickly met is not necessarily a bad thing.
So what’s so bad about instant gratification?
For starters, having an over-reliance on certain instant gratification-fueled impulsive behaviors can create changes in our brains. The repeated exposure to instant gratification disrupts the balance of benefits versus risks in delay of receiving an available reward.
A study at Harvard observed two groups of participants consuming chocolate. Group A indulged in the chocolate while Group B had no access to the chocolate. After the study, both groups were given chocolate and Group B reported higher happiness, savored the taste more, and was in a better mood afterwards. This study shows what people think will make them happy isn’t always what will and that you can have too much of a good thing.
If we experience more pleasure and happiness through delayed gratification, why is it so difficult to choose delayed over instant?
Our brains are constantly changing in response to our actions and behaviors. For instance, if the desire is to lose weight we may impulsively purchase the newest trending diet pill that advertises “Lose 20 pounds in 2 weeks!” rather than going for a walk every morning. Each time this compulsion for instant gratification is acted on, our brain pathways for those actions are reinforced and strengthened, making it easier to fall into the same patterns the next time around and harder to break the cycle.
The start of the cycle may look like having a drink one night after a long day at work to then finding any minor inconvenience the next day in order to justify drinking again the next night.
Getting caught up in the instant gratification cycle can make you susceptible to addictions, jealousy, anger, and impulsive behavior. It also often leads to increased stress, anxiety, and feeling overwhelmed.
As it pertains to instant gratification harming our recovery, research has found that individuals with mental health issues are less likely to wait for things they find pleasurable. For example, if symptoms of depression are present, there is an impact on how the brain processes things – particularly our prefrontal cortex which deals with decision making, problem solving, and memory.
As the struggling person goes straight to self-soothing behaviors to give themselves a quick boost, they may neglect their basic needs as a result, harming their recovery.
Looking at Maslow’s hierarchy of needs, we see how vital meeting our physiological needs (like food, sleep, and shelter) is. These needs sit at the bottom of the pyramid, and if the physiological isn’t addressed first, safety, belonging, esteem, and self-actualization fall by the wayside.
In addition, researchers have found that the ability to delay gratification is not just an important part of goal achievement, it might also have a major impact on long-term life success and overall well-being.
So, next time you notice yourself falling into the compulsion cycle for instant gratification, pause and assess your needs rather than act. Rather than rushing to a psychiatrist to get a prescription for ADHD medication, ask yourself: “Am I getting enough sleep?” Instead of going straight to the fridge to pop open wine after work, ask yourself: “Would going for a walk or taking some deep breaths help me destress?”
Over the past few years COVID-19 has had global impact. While many aspects of daily living have returned to their “new normal”, COVID continues to leave plenty of challenges outside of the actual virus. Working with children, adolescents and young adults has given me unique insight into the ongoing struggles of these populations. Here are a few of the most common challenges I see presenting in the therapy room and some ways parents and caregivers can help.
Social Struggles
From quarantines, to stay at home orders to social distancing, most young people experienced increased separation from their peers during key social development stages. This can lead to feelings of isolation, loneliness and difficulties establishing new relationships.
How it shows up in the therapy room
Reports of…
feeling lonely
not having friends
uncertainty of how to make friends
What parents and care givers can do to help
Spend meaningful time with your child
Consider opportunities to expose your child to other kids (sports, clubs, community events)
Talk to your child about how to make new friends, consider role playing or using toys to act out an interaction
Set up play dates
Check with your child’s school for resources they use to support social and emotional learning
Academic or Learning Difficulties
The COVID-19 pandemic brought significant challenges to schools and educators leaving them to figure out how to continue providing education to students who were no longer in a physical classroom. Many schools utilized remote learning and hybrid methods with little preparation. Educators did their best AND many students struggled with the inconsistent methods of teaching during these years.
How it shows up in the therapy room
Reports of…
feeling behind academically
difficulty adjusting to new routines
increased low mood
difficulty concentrating
What parents and care givers can do to help
Talk to your child’s school and teachers to get an idea of how your child is doing in the classroom
Help kids to create routines around schoolwork
Express interested and engage with the topics your kid is learning
Listen, validate, and express empathy when children report difficult feelings
Mood Difficulties
The pandemic brough about unprecedented times across the globe. Children often look to their surrounding environment (parents, caregivers, peers, school, etc.) for reassurance when big feelings arise. With the uncertainty that COVID-19 brought, many of the typical reassurances were not available. Fear of the unknown was a common experience of both adults and children alike.
How it shows up in the therapy room
Reports of…
feeling stress and overwhelm
difficulty dealing in uncertainty or ambiguity
anxiety or fears (ranging from social fears, health-related anxiety, fear of loss, and general unease)
sadness, low mood, depressed feeling
What parents and care givers can do to help
Listen to your child and validate their difficult feelings
Share your own feelings (in age-appropriate ways)
Practice naming emotions as a family
Identify ways to cope with big emotions and practice them with your child
Seek additional support (counseling, therapy) if needed
Missed social or life milestones
COVID-19 caused so many cancellations – weddings, graduations, prom, trick or treating, birthdays, first days of kindergarten, first days of college, etc. There is no doubt your child missed out of some sort of milestone due to the pandemic. Grief over missed experiences was a regular occurrence in the past few years and can be difficult to navigate for those in their formative years,
How it shows up in the therapy room
Reports of…
sadness or grief around lost opportunities
difficulties “launching” or moving to the next stage of life
regression into younger age or stage related behaviors
What parents and care givers can do to help
Ask your child if there is anything they feel they missed
Get creative with how to commemorate special milestones in a new way
Talk about what it means to transition from one stage to the next and find ways your child can practice their transition
I doubt we have seen the last impacts of COVID-19 and it is important to remember how this pandemic has uniquely impacted our children and their development. As a mother myself, I know how stressful it has been to navigate parenting throughout the pandemic. You are not alone. If you have concerns about your child or their development talk to your pediatrician, your child’s school, or counselor.
Emotions can be interesting… Fleeting yet intense, confusing yet our best teachers. When we are in tune with them they can be helpful, and when we are not we might miss something important or feel out of control. If you know me, I could get an award for compartmentalizing and avoiding emotions and, quite frankly, I’ve prided myself on this. I historically have a habit of treating feelings like something on my to-do list. My thought process is often, “I don’t have time right now to feel that” and I often do not come back to it. I have been challenging myself on this recently and that is partly why I write this to hold myself more accountable. What I have found as the antidote to my compartmentalization and avoidance is the simple concept of slowing down. It’s so important yet our daily lives seem to move so fast around us that it is easy to get caught up and run from what our emotions are trying to tell us. As we slow down and give ourselves the chance to sit with and truly be with our emotions, we can, with time learn to not fear and run from them. Once I slowed down enough recently to recognize it, I learned my anxiety has been begging me to slow down and I have even gotten some relief now that I have listened. Funny how that works, right? While I know this is easier said than done and all our stories are complex and dynamic, I invite you to join me in slowing down today. Maybe we can slow down enough together that we will not miss what our best teachers are trying to tell us.
Epistemic trust is a term with which many may be unfamiliar. It began as a term used in sociology before being adopted into the vernacular of psychologists in more recent years. The most basic definition is “one’s trust in communicated knowledge.” However, it can be more specifically described as “the capacity of the individual to consider the knowledge that is conveyed by others as significant, relevant to the self, and generalizable to other contexts” (Campbell, 2021). This communication can be in many forms, such as spoken words, non-verbal communication cues like body language, or reinforced messages communicated across a lifetime. The development of epistemic trust begins early in life as we interact and learn from those around us and is continually refined throughout our lives to adapt to our social environments.
Most of the psychological research studies on epistemic trust focus on personality disorders, specifically borderline personality disorder (Fonagy et al., 2015). However, more recent studies are considering epistemic trust as it relates to other kinds of psychopathology, and its implications for belief in conspiracy theories has even been considered (Tanzer et al., 2021). Unfortunately, due to the novelty of this concept in psychological studies, there is a shortage of available research to explore this topic further, especially in trauma-related areas. However, the recent development and validation of a questionnaire to measure an individual’s level of epistemic trust, mistrust, and credulity can aid in this area. This questionnaire allows for a closer and more standardized look at individuals’ epistemic trust and can be incorporated easily into future research (Campbell et al., 2021).
Considering epistemic trust and how it pertains to clients can also be useful in the treatment planning process. For example, one study highlighted that individuals diagnosed with personality disorders who had an elevated level of epistemic mistrust had poorer outcomes from their therapy experiences (Knapen et al., 2020). This may be the case for many that enter therapy with complex trauma backgrounds or other conditions that have reinforced a distrust in communication from others. This opinion can be supported by the argument that “epistemic trust may be the final common pathway through which aversive relational experiences in the past result in interpersonal dysfunctioning, which in turn result in dysfunctional therapeutic relationships, rendering it difficult for patients to trust whatever is offered to learn in therapy” (Knapen et al., 2022).
Little research has been done on achieving the restoration of epistemic trust, but it is believed that therapeutic interventions may be the most beneficial (Kamphuis & Finn, 2019). To date, there has been no known study that aims to investigate the relationship between trauma-focused therapy and restoration of epistemic trust. Such a study may prove to be a critical piece to understanding how epistemic trust impacts this population of therapy clients and whether trauma-focused therapy is an effective tool in the restoration of epistemic trust. As this concept continues to gain interest, we can expect a wealth of exciting developments in this area that will ultimately lead to improved therapeutic outcomes for clients everywhere.
References
Campbell, C., Tanzer, M., Saunders, R., Booker, T., Allison, E., Li, E., O’Dowda, C., Luyten, P., & Fonagy, P. (2021). Development and validation of a self-report measure of epistemic trust. PLOS ONE, 16(4), e0250264. https://doi.org/10.1371/journal.pone.0250264
Fonagy, P., Luyten, P., & Allison, E. (2015). Epistemic Petrification and the Restoration of Epistemic Trust: A New Conceptualization of Borderline Personality Disorder and Its Psychosocial Treatment. Journal of Personality Disorders, 29(5), 575–609. https://doi.org/10.1521/pedi.2015.29.5.575
Kamphuis, J. H., & Finn, S. E. (2019). Therapeutic Assessment in Personality Disorders: Toward the Restoration of Epistemic Trust. Journal of Personality Assessment, 101(6), 662–674. https://doi.org/10.1080/00223891.2018.1476360
Knapen, S., Hutsebaut, J., van Diemen, R., & Beekman, A. (2020). Epistemic Trust as a Psycho-marker for Outcome in Psychosocial Interventions. Journal of Infant, Child, and Adolescent Psychotherapy, 19(4), 417–426. https://doi.org/10.1080/15289168.2020.1812322
Knapen, S., van Diemen, R., Hutsebaut, J., Fonagy, P., & Beekman, A. (2022). Defining the Concept and Clinical Features of Epistemic Trust: A Delphi study. Journal of Nervous & Mental Disease, 210(4), 312–314. https://doi.org/10.1097/NMD.0000000000001446
Tanzer, M., Campbell, C., Saunders, R., Luyten, P., Booker, T., & Fonagy, P. (2021). Acquiring knowledge: Epistemic trust in the age of fake news [Preprint]. PsyArXiv. https://doi.org/10.31234/osf.io/g2b6k
Making the decision about who is going to be responsible for what within the context of your family system can already be a tricky task to navigate. Throw a baby into the mix—this becomes even more complicated. For most, having a baby means taking on a whole list of new responsibilities while maintaining the responsibilities you’ve had all along. Whether you’re talking about who is going to do the grocery shopping, to work outside the home, or to get up in the middle of the night when your baby wakes up, it’s important to make at least some of these decisions on the front end so as to ensure that both you and your partner feel a sense of partnership and equality. If this is not done ahead of time, or at the very least discussed intentionally once your baby arrives, you set yourselves up for what I like to call, defaulting. Defaulting is a fairly common occurrence where one parent, we’ll call them “Parent B“ (generally the parent who IS NOT primarily responsible for feeding) tends to make the assumption that the other parent, “Parent A” (generally the parent who IS primarily responsible for feeding), has whatever the task is on hand covered. This is not done from a place of mal intent but from a place of Parent B’s lack of awareness.
The reality is, parenting has a steep learning curve where most develop a system on the go. Parent A completes tasks because they simply have to be done and Parent B often falls short in stepping up to the plate because it seems as though Parent A has it under control. The result: a big ball of resentment. While I am talking about the importance of delegating the big responsibilities, I’m also talking here about the importance of discussing the seemingly smaller ones. These are the ones that tend to be overlooked and as a result, add up over time. Responsibilities like who is going to sit next to your baby at dinnertime, who is going to carry your baby up the stairs when you get home, and who jumps out of bed to pop the pacifier back in at night are just a few examples of such seemingly small tasks that when one parent finds themselves having to perform each and every time, can lead that parent to wonder whether they are in this alone. So moral of the story, sit down with your partner before your baby is born and regularly thereafter. Discuss potential tasks and who will take primary responsibility for performing them. Regularly check in after your baby is born to assess for new tasks that are likely to pop up and your partner’s willingness to continue performing tasks they have previously committed to. Most importantly, whether you are Parent A or B, please take note of all the big and little things your counterpart does on a daily basis and ask if they could use a hand or a swap out from time to time. Don’t just assume that your partner will do whatever needs to be done and even if a particular task has been clearly designated your partner’s responsibility, regularly express appreciation and gratitude to them for what they are doing. At the end of the day, whether you are Parent A or B, doing these few simple things will likely result in your partner feeling more appreciated and seen.
Please excuse me, I am asking for a moment of your time. This seems presumptuous for someone who has spent most of his adult life “never” having enough time. I know it seems overstated but trust me I never have enough time. It seems a chronic condition – no matter how far ahead, in short order falling behind circles back. Certainly, a tendency to say yes (do not want to disappoint anyone) and an ongoing difficulty to pronounce the word “no” (do not want to hurt another’s feelings) contribute to my ailment. Additionally, there is the ongoing distortion if I get this or that completed the illusive experience of calm and peace are waiting for me.
It seems I may fear peace and calm. Perhaps these fears partly explain working the ridiculous hours I have – maybe I could “buy” more time. Truth be told it has more likely served to shorten my time on this earth. Sure, there are moments of boredom and perhaps even periods of depression where life moves more slowly and yet I always return to the belief I am running out of time. One contribution to this chronic stressor is the belief I can do just one more thing. Of course, this has served to frustrate those around me as I have developed a consistent arriving 5 to 15 minutes late, because there was one more thing I knew I could squeeze in before leaving – “to save the time of doing it later.” This is the dilemma of never having enough time, if you avoid doing it now, you have to make time for it later.
This at times leads to never getting around to something, “there is not enough time,” which provides the wonderful excuse – “I did not have enough time.” There is a certain level of anxiety and stress this game with time creates. Yet it is this very experience of stress which drives me. I live life with intensity, rushing to accomplish, and yet looking as calm as a cucumber (although I have no earthly idea if cucumbers are emotionally calm and cool). I certainly would have written about this chronic condition earlier if I had enough time… As it turns out moving into my 60’s, there is a certain truth to this statement, “at 61 I am running out of time.”
Age has also promoted greater reflection, something you typically do not take time for when you are constantly “short on time.” I believe the truth is there has always been enough time, I just did not believe there was enough time for me (i.e., childhood belief). It must be time then to let go and grieve this relationship I have developed with time and move toward acceptance there has always been enough time. Acceptance in the reality I am not what I accomplish, rather I am an individual deserving of time to slow and just be. I could write more, but…well, you guessed it, I am out of time.
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