How I'm Remaining Sane as a Psychotherapist During the Corona Virus Pandemic

It’s the eve of a new week. Another week of drudgery with no end in sight. I hear the anxiety, loneliness, frustration; and fear in my patients’ voices and they often ask me, “How are you? What are you doing?”

Patients never ask me these things, it’s an unwritten but assumed law that therapists don’t talk about themselves. It muddies the water. I become real and that might stymie the growth we are both so hoping for. If patients know the details of my life then they may spend their time in therapy saying things they might think I want to hear. For example, if I say I have a dog (I don’t), then they may talk about how much they love their dog in order to please me, and then the therapy turns around from being about them to being about me. Therapy is the one place where it is ALL about you, and that’s part of the beauty of therapy.

So, what has changed? EVERYTHING has changed. I was wondering what they wanted to hear me say and I think this is it:

We are in uncharted territory. We don’t know one day to the next when this will end and if we are doing the right things to protect ourselves. We hear accurate and inaccurate news and have to parse what is what. No more schedules, no more predictability, mostly just fear. Perhaps patients are looking to me not just for answers, which of course I don’t have, but for a model of how to get through this nightmare, and also comfort in a most uncomfortable time.

I have no bag of tricks; I wish I did. This is what I am doing to remain sane:

1. I have a general schedule for every day starting with three things that I am grateful for in the morning. I like this because it not only encourages gratitude but it also helps me focus on the everyday instead of starting my day with the Big Awful Picture. 

2. I turn on the news. Twice only during the day, once in the morning and once in the evening, with an occasional listen to Governor Cuomo.

3. I get up slowly because I end work late into the evening. 

4. Work. I FaceTime, WhatsApp, Zoom, or have phone sessions with my patients throughout the week. 

5. I include building my business - my online course and website - every day. I do something every weekday to learn how to improve what I love, and that is helping women who are at a crossroads in their lives. I do this because it helps me envision the future.

6. I try to exercise on my bike daily.

7. I talk with my girls daily- we call ourselves Fab5 - women I’ve known since adolescence. This is where I can be silly, sad, ridiculous, and where I receive more than I give.

8. I connect with my kids and grandkids - this is my life's blood.

9. I binge watch or I watch oldies on TV, Netflix, Hulu or Amazon Prime.

10. Last, I write in my journal and end with 3 things that I am grateful for that day.

Let’s talk about tanking. Weekends are where I go rogue. The sabbath, Saturday, gives me certain boundaries. Within those boundaries comes a lot of time for reflection and thought. That can be good, and in these times, sometimes that is not so good. I pray, and that makes me feel better. As it is a boundaried time, I am blessed with an enforced time when I am NOT hearing or looking at the news, which is awesome. Corona virus doesn’t exist from Friday at sundown to Saturday at sunset (not including in my imagination and in my worries, of course!). 

Here’s where I tank; I have NOTHING to read! Anyone who might come to my home might think I am nuts for saying that. I have many, many books. But I’ve either read them or they are educational books, and that’s not what I want these days. I want to escape with a well written novel. 

Here’s where I also tank; I am worried about the world, I am worried about first responders, I worry about retired health care workers going straight into danger’s way. I worry about my family, I worry about everyone’s families, I worry about my patients.

However,  I don’t want those feelings to go away because that’s what makes me human.

Here’s where I am NOT worried: 

1. I’m not worried about those days that I do nothing “productive”

2. I’m not worried about self-improvement

3. I’m not worried if my house is messy or I haven’t done laundry

So, to recap:

1. Schedule and gratitude

2. Limited news AND no news from social media!

3. Ease into the day if you can. If you have kids at home, let them do that as well, you in your place, and them in theirs (that could well be in front of the TV)

4. Some of you have work for the whole day. Take scheduled breaks and mix it up a little. If you have kids who are in remote school AND you are working remotely, good luck! Just remember, they may be as frustrated as you so give yourself some times out when you feel you need it. One great way, if you’re ready to explode, is to take a short shower - with the added benefit that you can scream in the shower if need be.

5. Business comes next for me but for you it can be a scheduled anything that you love: art, reading, meditating, learning, projects of any sort. In fact, I’m learning to play the harmonica via YouTube! We’ll see where that goes…

6. Exercise, exercise, exercise. Just take a 6 ft. away from other pedestrians walk if the weather cooperates.

7. Social connection isn’t a luxury, it's a necessity. Reach out, not just with texts but with actual phone conversations. We did a Zoom conference and it was hysterical.

8. Family - take care of them by checking in and let them take care of you. We need each other at this time. I would add volunteering in any way you can, even via the internet. There are many opportunities and it’s good to look beyond ourselves and our four walls.

9. Escape! It’s OK, it's healthy here.

10. An end of the day recap is so important. Sometimes our days bleed one into the other. Writing helps us focus and see that we’re getting through this. It helps us know what works and what doesn’t work. And last, it is a witness to the horror we are going through now. Getting through the day makes us heroes. This is hard and we are doing it. Some days are throw away days; that’s normal. If you’re having an especially hard time or want to be heard in a non-judgmental, accepting way, then reach out to your psychotherapist. We are all working remotely. If you don’t have one, then you can look at Psychology Today and find one that appeals to you.

Nothing is perfect; our days won’t be either. What I find important is looking at each day as its own entity. In other words, looking for a date when this will end might be an exercise in futility. No one knows. But, we can try. I try to look at each day as its own. That last check in the evening says to me that I did the best I could today.

Are You a Woman Feeling Stuck? Here's a Way to Fly

ARE YOU A WOMAN FEELING STUCK? HERE’S A WAY TO FLY

I came across an allegory that blew me away. A philosopher named Wittgenstein wrote about the perils of a fly in a jar. It goes like this: Wittgenstein said that his aim as a philosopher was ’to show the fly the way out of the bottle’. The fly flies into the bottle perhaps thinking it will find a morsel to eat, upon finding the futility at the bottom of the bottle he flings his body against the sides of the bottle  over and over in order to be free until, in utter exhaustion, he falls to the bottom of the bottle in complete despair. What did the fly forget? The one thing the fly forgot was, to look up!

How often do we forget to look up? We become mired in the roles we play and  we feel stuck, so stuck that we can’t see the way out, we simply don’t look up.

Sheila sits across from me, she appears forlorn.  There is a pallor to her face, she is plain looking and her speaking is without inflection, in fact, there is a sadness in her eyes. She looks like she needs someone to pluck her from her life and put her in a happy place and I wonder if I, as a therapist,  can quell the urge to save her. 

She says to me in utter confusion that she doesn’t know why she is unhappy.

“I don’t know why I’m here, I just feel sad, there is an empty feeling inside of me.” She looks as if she has given me a present, and I wonder if she wants me to fix it for her,  she doesn’t elaborate. I ask, “What made you come in now? what happened right before you decided to look for a therapist?”. She begins to tell me how great her life is. “I have four children all launched, they have partners and careers. I have grandchildren whom I love so much that I just can’t get enough of them. I would do anything for them. My husband has a lot of money so I could do whatever I want, if I knew what that was. I just don’t know what I want to do, and I don’t know why I’m so sad.”

 Sheila feels like she has a good life, good children, dutiful husband, the means whereby she doesn’t need to work, and she can travel as much as she likes. Sounds great but a very sad woman is still sitting across from me. As we unpack the flotsam and jetsam of her life a new picture emerges. She has a husband who is needy, he only takes, he is awkward and focused on golf and the next golf trip. Sheila’s children have been raised, they have left the home, she is dissatisfied with her marriage, and now,  she looks in the mirror and sees nothing, who is she.

“ What happens if you don't arrange for your parents trip what happens if they call a travel agent?  ‘They will continue to call me until I actually do it, they don't believe in doing things themselves, they believe that I should take care of them. It's always been that way.’ 

 I respond, ” Your father is a lawyer, and your mother runs a household, I'm confused, it seems like they should have some basic abilities”. She states in a matter- of- fact way,” Well, when we were children we had to be in our rooms by 7:00PM  all the way through the age 16. She (her mother) wanted no part of us. She didn't want to take care of us she wanted her own life she didn't want us to interfere with her. If my sister cried I was supposed to take care of her ,my mother was not going to come to the room .” I am shocked. “ It sounds like a huge responsibility for a child and it doesn't sound like you felt very taken care of. I guess that's where you started to learn how to nurture people other than yourself, you put yourself at the bottom of the list.” 

“So, you raised yourself, and your sister, and then you married someone who wanted to be babied.” She responded, “Wow, yes. He also expected me to go on trips with him and it didn't make a difference to him that we had four kids, I was supposed to drop everything and go with him golfing, mind you, I hate golf !”.

 I wonder how she gets her needs met, “What would happen if you would say “no”, I have other things to take care of, I need to take care of the kids, or just, I don't want to go? “. No response, a change of subject.

Sheila appears paralyzed without knowing how to break free, she doesn’t even know that she is paralyzed. Women have been told to be givers, it’s natural and can be quite beautiful. What is missing in that message is that women can give to themselves while they nurture others. Not only that, but a woman can just nurture herself if she likes. Thus, the mirror. They look into the mirror and if they aren’t giving then what do they see? Whom do they see? Who are you?  

Sheila has parents who are dependent and demanding, and they have been that way her whole life. She has a mentally ill sister. Her parents abdicated the job of parenthood and gave that role to Sheila, and she filled that role with poise being the good daughter that she is. She made sure her sister was dressed appropriately, that she ate healthful food, and that she had friends. When her sister got older Sheila made sure her sister was financially taken care of. 

Sheila is surrounded by takers and so, she has defined herself as a giver and if we take that away, what then is she?

There is a misnomer, empty nest syndrome refers more to the father than the mother. We were all led to believe, by the media primarily, that when our kids leave the house we fall apart. Studies show that fathers are more upset when the kids leave the house than their wives. Women are upset for a very short while and then say, “goodbye.”  No more laundry, no more short order cook, no more trying to make everyone happy, she IS alone and free, BUT... This freedom, this happiness eludes some women. Why wouldn’t a mother be at least relieved when she is no longer at the beck and call of her children? This is the trouble Sheila is finding herself in. She has wrapped herself up into everyone else but herself.

 The woman who never nurtured herself before the kids left home, the woman who most likely does not have a career she loves, she is perhaps not in a loving relationship, this woman is missing something in her life. She doesn’t know how to get that thing she doesn’t have a name for, she is confused because she doesn't know what it feels like. Maybe she never felt it, or maybe she can’t remember it, or maybe she has changed. She doesn’t know what she’s looking for.

 What she does know? She knows she is unhappy, and she doesn’t know who she is.

Sheila began to see her outline in the mirror. 

Sheila and I started chipping away at the neediness of others. She slowly negotiated boundaries with her sibling. She told her sister that they would speak on the phone on Mondays and Wednesdays at 7:00pm, and that they would have a special day together one Sunday a month. She painstakingly created  boundaries for herself with her parents. She said to them point blank that she was not responsible for her sister and that they were, they needed to step up. As Sheila only checked up on her sister twice a week, something wonderful happened. Sheila spent more meaningful time with her without the heaviness of the day to day strain. 

Sheila began to remember what she loved a long time ago.

Sheila loved ceramics. Sheila loved solitude, Sheila loved getting together with friends. Sheila loved walking in the park. She tried not to marry her happiness to the mood of her husbands’, if he was unhappy, she didn’t need to be, she could go about her day and find her own happiness. She tried to negotiate what she wanted to do with him and what she really didn’t like, and Sheila really really didn’t like golf!

Sheila began to emerge and began to realize that she had the ability to create her own life, and the same way she shrank herself to help others by following an old trajectory, one that said what she wanted didn’t count,  she could detour and eke out a new path.

So the fly. We fly around and bang against the walls of the jar because we feel that what we want comes last or is unimportant and so, we never feel that things can change. We can’t imagine change. So simple, we need to look up, we need to see the possible.  We forgot to imagine that our lives can grow and that we are not stuck like the fly. There is an opening in the jar, waiting for us, WE CAN FLY!

This is how you might begin to see  your outline in the mirror. 

       4 Beginning Steps to Finding Yourself 

1. The first important step is to account for  how  

        much time you spend on yourself and how much time you   

        spend on others? Can you let go of anything?  

        No one is indispensable! 

 2.  Next, this is very hard, chip away at extra time consuming,              

        mindless activities that you don’t enjoy. An example of that  

        might be, asking your parent, child, or spouse, to Uber              

        wherever they want to go instead of being their  

        chauffeur. Another example; making lunch for the kids, after 

        a certain age they can do it for themselves. That is a 

        particular win-win situation. You free up some time and they 

        learn how to take care of themselves.

3.     While you are doing this, find joy in the every-day; did you   

        enjoy your coffee in the morning?  is the sun shining?  did 

        you love talking to your friend? Make a list of those items,

        nothing is too small or insignificant.

4.    Get to know yourself in a mindful way.You can do this by     

       identifying your feelings in the moment.  It’s a journey. These

       are all beginning steps.

He who Kisses the Joy as it Flies

I just came across a beautiful poem by William Blake. In his poem called “Eternity,” he writes:

“He who binds to himself a joy 

Does the winged life destroy; 

He who kisses the joy as it flies 

Lives in eternity's sun rise.”

“He who kisses the joy as it flies” implies to me that when we cathect to something or someone, when we glom on and hold tight, we can’t let them fly. We hold them back, and even more, we hold ourselves back. Being stagnant, not growing is moving backward. We become encased in fear and anxiety. We feel the only way to be happy is this way, or with this person. Such a mindset shrinks us, it makes us small, it feels claustrophobic.

When we kiss the joy as it flies, we embrace mindfulness, we catch the moment and seize it. We love it for being in our lives even for just a moment. I feel it when the sun shines, or a beautiful view. Today I relate it to my father. He is ill and in much pain. I try and hold on to the moment he is lucid, I cling to just a smile, an “I love you.” Notice I used the words “cling” and “hold on,” because our nature is to have that joy, hold on tight and never let go. I don’t know what the next minute will hold, but in that minute, Ahhhhh, I kiss my father and the joy that is flying.

El Condor Pasa, Flying, and New Years

It’s that time again. Time for resolutions, new beginnings. Hope, infinite possibilities. Time to fly.

 I don’t know how to fly, and I am afraid of heights. Up and down, this is how I feel when approaching the possibility of growth and change. I can do it, I can’t do it. It’s too much, it’s not enough…enough to make my head spin. I don’t want to set myself up to fail, I mean, that is what New Years resolutions are anyway, right?

There are so many things I want to change in my life, where do I start? and now here’s where my evil eye, doubting Thomas, doomsayer chimes in and says “I will never succeed, I shouldn’t even try, it never works.” So the big question, why should I try?

On the other hand, I want to be a growing person, I want to do more, I want to be more, I want to accomplish more. This can’t possibly be it, I know there is more. Static is not an option, static is the equivalent to stuck. And I know what stuck means, it does NOT mean staying still, it means regressing, going backwards, that is not in my DNA.

I just heard El Condor Pasa by Simon and Garfinkel on Spotify and I had an epiphany, read the lyrics:

I'd rather be a sparrow than a snail

Yes I would, if I could, I surely would

I'd rather be a hammer than a nail

Yes I would, if I only could, I surely would

Away, I'd rather sail away

Like a swan that's here and gone

A man gets tied up to the ground

He gives the world it's saddest sound

Its saddest sound

I'd rather be a forest than a street

Yes I would, if I could, I surely would

I'd rather feel the earth beneath my feet

Yes I would, if I only could, I surely would

Wow! brilliant! I want to fly like that sparrow, I want to be the master of my destiny, I want to be that hammer. I also want to be grounded and feel the earth beneath my feet. I think this is my answer, for today. I know life is dynamic and I will change and grow, and with that have new questions and challenges.

So here it is. A sparrow starts from somewhere, the ground, a tree, and it ascends, it takes time, it is a trip. The hammer uses fortitude and patience banging away. Sailing, that is a trip not a destination. I will take this new years and start my trip. I will not trip myself up and only think of the end results as the late great Harry Chapin says:” it’s got to be the going not the getting there that’s good.”  I will start, and I will take it slowly and I will be in the moment and try to enjoy the flight.

So this is the takeaway. Have dreams and resolutions, work towards a goal, be excited. Do it one foot in front of the other and enjoy your trip because every step counts.

How to feel better in winter months - here's what you do

The leaves that turned from luscious green to red, orange, yellow, and finally brown are now meeting their death on grass that was once verdant with the promise of renewal and life itself.

It never fails that year after year when Autumn pushes its’ way in, negating summer, I am faced with patients who are depressed in my practice.

Who can blame them?

 The good news is that most of the time it is not clinical depression, but it is what is often referred to as Seasonal Affective Disorder, commonly known as SAD.

How to feel better in winter months - here’s what you do:

According to Christiane Northrup M.D., a noted physician and disseminator of women's health information, exposing yourself to a full spectrum light bulb helps; indeed, and that using a full spectrum light for about six hours a day is the equivalent to 30 minutes of sunlight. The absence of sunlight is the problem, it is what brings on those awful feelings of sadness, lethargy, and that overall bleak mood that makes you not want to get out of bed all day.

1. To that end, open the blinds, turn all the lights on when you get home, make your room bright and cheerful. Treat yourself like you are a magnet to the sun and attach yourself any which way you can.

2. Take walks during the day. Exercise, after all,  is always good, as it helps to increase your exposure to light, it gets that adrenaline going, and last of course, exercise helps you feel good about yourself, which is a wonderful goal in and of itself.

3. Take care of yourself. Your instincts might tell you to hibernate, and while I love a little hibernation, it is not good on a regular basis. Force yourself to get out of the house. Seeing people, and feeling alive while nature is dormant is a wonderful antidote.

4. Turn on music when you get home and sing at the top of your lungs or, try a quieter route. Meditation is a wonderful tool to get you in that mindful place where things are not ALL good or ALL bad.

5. Of course it must be said that going to therapy is a good idea. Your therapist can help identify when your mood changes, for example, and give you specific ideas as well as identify anxieties that may occur, help change negative thought patterns, manage stress, and help you cope with whatever is making you feel worse.

For me, there is always John Denver and Brahms.

It Is What It Is

October 14, 2015

It is what it is, acceptance or giving up

I love saying “it is what it is.”  It is shorthand for acceptance, their is nothing more you can do and so, learn to give up, gracefully of course. Then I heard someone say, “I hate the saying, what does it mean ? ’it is what it is, that is not the way it is supposed to be.” What does she mean?

When do we give up? When is it OK to say enough? Does giving up mean you are a loser? a negative person? one with no hope? I find myself thinking about that sayingwhen a patient might be hitting their head against a wall. What scenario might that be? 

I have a middle aged patient, well read, articulate, good relationships with friends but, very stagnant in areas regarding her mother. Her mother, at 85 still has the power to knock my patient out, igniting anger that can last for weeks. It makes no difference that the lady is old, that she is cruel, that anyone can objectively see that this mother is self centered and uncaring. When the mother says something, it borders on the absurd, one can’t take her seriously because she is so blatantly living in her own made up world where she alone exists. I see this, my patient sees this yet, she spends a lot of time fabricating all sorts of things she can say in retaliation to her mother. Can I be so heartless as to say, it is what it is?

This mother will never change, nor does she want to. The world revolves around her and she has little capacity for empathy towards her daughter. Yet, the daughter goes over figuratively, bends down and tells her mother to give her a smack in her behind. How can this stop? It is what it is the mother isn’t changing but the daughter can. The daughter is working towards understanding that if she wants to zing her with the perfect quip it will not make a difference whatsoever towards the mother. What will be accomplished? maybe some relief that she can finally talk back to her mother. I don’t know. What I do know is that my patient is not rendered hopeless in this relationship, their is hope.

In the book The Power of Hope (full disclosure, it is written by my father Maurice Lamm), the author writes when someone is dyinghope does not have to be distinguished, it is repurposed and redirected. One may not have hope that the dying person will live but, one can hope their pain is under control. One can hope their loved one has a good day, hour, minute. One can put effort into easing the dying persons last days. It is what it is, with a caveat.

My patient can throw up her hands, perfectly understandable, she can also work it through and take back some of that power her mother has and by doing that say, “it is what it is.”

Empathy

Empathy

It is propitious that I begin my blog about empathy. Empathy, often synonymous with sympathy , though untrue, is a catchword for feeling someone’s pain. Empathy is popularly defined as,  the ability to understandand share the feelings of another. Sympathy is defined as feelings of pity and sorrow for someone’s misfortune. The first being in the proverbial “shoes of another,” and the other, seeing the shoes, and feeling sad.

Therapists learn about empathy upon entering the building on the first day of graduate school. it would be hard to be an effective therapist without understanding and feeling someone’s pain. I believe that is correct. When I sit acrossfrom a patient, they need to know that I get it, not just in my head but in my heart, as much as I can. It helps me to understand and helps them to feel that they are “gotten.”

When I first started being a therapist I might be on line at Starbucks and if I overheard a conversation about someone's children who were going through some difficulty, or a tough relationship breakup, or any kind of distress, anxiety, and the list goes on, I became sad.I wanted to fix it. It consumed me , all of a sudden I heard sorrow and distress wherever I went. Of course it existed before, but my empathy radar was on and fast becoming raw.  Colleagues, professors, professionals all toldl me I would get used to it. 

Should I? Is that good? is that what I want? Does that mean I will become cold and callous? Can I still be a good therapist if I get used to it?

A man named Paul Bloom has been in the news lately. He is a professor of psychology and cognitive science at Yale University. According to Bloom, empathy is, “narrow -minded, parochial, and innumerate.”

“… Instead of assuming that we can know what it is like to be them, we should focus more on listening to what they have to say. This isn’t perfect — people sometimes lie, or are confused, or deluded — but it’s by far the best method of figuring out the needs, desires and histories of people who are different from us. It also shows more respect than a clumsy attempt to get into their skins; I agree with the essayist Leslie Jamison, who describes empathy as “perched precariously between gift and invasion.”

He touches on something for me. When a patient is in pain and crying, do they want me to cry with them? and then who comforts whom? I’m not saying that sometimes a therapist has to throw caution to the wind and be in the moment but, how can I engage with you if you are worried about me? if I am worried about me? It is the patients session, not mine.

That “therapeutic distance,” enables me to see you, in that moment, and while I see you to experience you with a modicum of neutrality and distance otherwise, I am your mother.

So, can I say I can stand in a line and shrug off someones’ pain when overheard? not so much. Sometimes I can intercede, sometimes I can put some perspective on it, after all I don’t know the whole narrative, only the story the person is presenting. And sometimes, I can just walk away, sad.

What do you think?