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(*trigger warning: domestic violence and sexual abuse)

The statistics on trauma are staggering to say the least. According to the National Counsel 70% of US adults have experienced a traumatic event in their lifetime. That’s more than 200 million people. With numbers like this it’s easy to see that more of us have experiences with trauma than those of us who haven’t.

But what is trauma exactly? Trauma occurs when a person is overwhelmed by events or circumstances and responds with intense fear, horror and helplessness. Extreme stress in these terms can negatively impact a persons ability to cope.

For women it’s especially difficult. Women are victims of violent crimes at extreme rates. In fact, in the US a woman is beaten every 15 seconds. A forcible rape occurs every 6 minutes.

As a society we work very hard to distract ourselves from problems through entertainment and social media but what about those who don’t get the luxury? With the majority of the population having had some kind of trauma exposure there is a greater need to have a larger discussion about trauma.

First, we need to de-stigmatize it. Many people (women especially) don’t come forward after periods of violence because of the fear of not being believed, the fear of retribution, or the guilt and shame that occurs as the victim of violence. In terms of traumatic events themselves, these can sometimes be complex. What if there wasn’t a distinct incident but a constant environment of neglect in childhood. What if it wasn’t a challenging childhood, what if it was an unhealthy relationship with emotional manipulation and gaslighting. Many trauma survivors question the validity of their experiences because it doesn’t “look” like what they think trauma “should” look like.

No matter the event, if you have had experiences that cause overwhelming stress, nightmares, flashbacks, periods of dissociation, anxiety or depression – consider seeking help. You’re not alone.

When we are kids we love attention. We love when people play with us, and we don’t mind shouting our accomplishments at the dinner table even if that accomplishment was using the big-kid toilet that day. When we’re kids we have the benefit of innoncence and our worlds are small. As we age we learn that the world is a vast place…and maybe I was good at this one thing but, look, this person is…better?

These are jarring moments and they typically reach a crescendo in the teen years where embarassment is almost always lethal and a zit has you calling out of school for a week. It doesn’t always get better in adulthood either. We learn to hide it better, and maybe hide that blemish under makeup and still make it to work on time but those feelings of self-doubt and uncertainty still ruminate in us adults.

We look to others and see what they have, do and are and we look at ourselves and we see things that to us ‘lack’. She’s got a higher paying job than I do, he’s got a wife that plays video games with him, they just bought a house, had a kid, lost weight. The list goes on.

Comparison to some extent is normal. It’s motivating to some degree and a little bit can be healthy. When it becomes paralyzing, that’s when help is needed. When those thoughts of “I’m not good enough.” start invading your everyday self-talk and you start believing it, we get into shaky territory. Maybe self-doubts have been part of your nature for as long as you can remember, perhaps negative life experiences have resulted in some negative core beliefs that have been running the show behind the scenes for far too long. If that’s the case a deep dive into what’s driving the boat can do a world of good in improving those feelings of low-worth and low self-esteem.

So whether it’s wishing you could change one aspect of your life, or wanting to change it all, each one of us can do work. Maybe that means taking a social media fast, maybe it means being more open about your feelings, maybe it means taking that yoga class you’ve been meaning to go to. Whatever it is, know that you have the power to address it and when that’s not enough know that you can always reach out to loved ones, friends or a therapist.

If mood disorders had PR agents then depression needs to fire theirs. Popular media and even commercials for medications that treat depression seem to stick to the stereotyped version that’s been touted for years. You know the type: a person with a rain cloud over them, someone sleeping in bed all day with the lights out, another person wearing baggy black clothing and pulling shades closed to a sunny day outside like they’re nosferatu.

While at times depression CAN feel like this – it does a disservice to the complex ways this set of emotional struggles affects people. What about irritability and anger? What about forgetfulness? What about anxiety? These also come with depression but are seldom talked about. Instead it’s easier to picture Eyore and be done with it.

But depression comes in all shapes and sizes. Often times it comes with a pinch of anxiety too that leads to a painful loop of being anxious about your depression, then getting depressed because you’re anxious. A merry-go-round ride you never asked to be on…

Clinical depression may be situational as when a traumatic life event occurs, or it may be biological. We don’t only get our hair, skin color and body type from our parents – we get their emotional makeup too – thanks, mom and dad!

Biological explanations usually go something like: depression is not your ‘fault’ but is just a chemical imbalance in your brain that causes a mismatch in the feel good hormones vs. the not-so-feel good hormones which makes it harder to feel happy. This, clearly, is paraphrased.

While scientifically speaking this is mostly true, and people mean well to get you to see it’s not your ‘fault’ – it still can leave one to feel like “Oh, well then I’m just messed up then.” That’s not a great feeling either… The flaws in this explanation are evident.

There’s a better way, I think, to understand this complex disease. If you think about it, we are all, every one of us, endowed with a certain chemical makeup. Mine, to be brief, makes me brunette, with curly hair, dark skin and sensitive to dairy. In order to cope with my dairy sensitivity, I have to avoid milk and cheese. If I don’t – I will pay in some not so nice ways. So, to make my life easier I manage my diet to avoid pain and discomfort. I also have predispositions to anxiety and stress due to long histories of PTSD in my family from war-torn countries, discrimination, and the struggles of my immigrant father and grandparents. What this means is that I need to manage my behaviors to monitor the stressors in my life and take appropriate actions and steps to manage anxiety in my own life. That is my lot, we all have one.

When it comes to depression, regardless if it is genetic chemicals driving the moods or traumatic experiences – that is your lot, again, we all have one. But there are ways to manage. If you have diabetes, you manage the disease through diet, medication, and not eating a bowl of sugar for lunch. If you have an allergy to bees, you most likely are not a professional beekeeper. If you have depression, you should be educating yourself on the disease, on your makeup, and how to prepare yourself in the best ways to manage.

Having depression does not mean you are broken or flawed. You do however have a tough journey and in no way is it your fault, but with professional help you can start your educational journey to lead you to better techniques for more control over the beautiful life that you have been given.

We all have moments where we feel anxious and overwhelmed. The demands of our daily life ensure that. Moments of anxiety are not signs of weakness – they’re signs of our humanness! But what is anxiety exactly? Periods, or episodes of anxiety are short bursts of worry or nervousness that are situational in nature. These situations may be butterfly’s before an interview, a rapid heart beat before a first date or fears that a medical test may bring bad news. These bouts of worry will typically subside after the event or once the situation is resolved.

What about chronic or clinical anxiety? This is when excessive worry presents itself persistantly and seems difficult to shake. The worries may be based in real situations but the magnitude of the emotional discomfort makes every day tasks difficult. Relationships may become strained, and thoughts are taken hostage by the persistent fear that something will or has gone wrong. Even when the situation passes, the anxiety remains. Even if there is not a specific situation that is causing the worry – you sense this air of dread that makes it hard to see what’s real.

Both types are frustrating. Friends may tell you – “just don’t worry” or “you’re overthinking things, it’s fine” and though they may mean well, it can leave you feeling more frustrated than before. Of course if you could “just not worry” then…you would.

A grand mystery really, if only you could see things the same way these friends did, if only you could “snap out of it” and participate in the same life that they seem to be enjoying carefree! But where’s the door to that life, where’s the invitation?

Whether you’re struggling with chronic anxiety or stress from a bumpy patch in life there are ways to change things. You don’t have to keep living in the fog and you may be able to find that door to a new life after all.

You know the feeling. Too many things to do, not enough time. You’ve got several emails from your boss that you have to return, your dog just made a mess on the carpet and you only have 2 hours to make a dish for that potluck tonight that you are kicking yourself for signing up for. Every day stress comes in all shapes and sizes and not one of us is immune.

For the average human in todays society we’ve slowly slid into our fast paced lives with no “off” button and minimal disconnection from the demands around us. Even when we aren’t tweeting, instagraming, posting, texting or returning an email we feel like we *should* be doing *something* to stay *productive*. These subconscious demands on our time and minds leaves little room for the rest that our organic bodies and minds need to keep us healthy.

In some ways, we have to accept the world that we’re part of and in other ways we need to push back a little. When we push back and it doesn’t seem like the chaos wants to budge we may be facing another issue.

I’ve heard it said that everyone in this generation has some form of anxiety and while it may be true that we all experience episodes of acute stress and anxiety, chronic anxiety is different. The anxiety of the demands of our every-day will ebb and flow. You find the strength to put down the phone, take a bath, walk on the beach and you experience the calm of a mind at ease. This may not be all the time, but when not struggling from chronic anxiety you can sense when these times are needed and you know how to put up the boundaries to allow you the space. This is how one “ebbs” the “flow” of the every-day stress.

Chronic anxiety is like a raging river. You may try to dam up the current but the water rushes over you pushing you down. You try putting up a boundary again and again but each time you find yourself with a mouth full of water. You know “what” to do and you know “how” to do it but something just isn’t falling in to place to get you to that place of rest. This feeling is more in the territory chronic anxiety.

In therapy, there’s space to process both. Therapy for every-day stress may be less intensive and focus on those boundary making skills and work on reorganizing a life so as to have more moments of calm. Therapy for chronic anxiety has the potential to truly change your life. Chronic anxiety has effects on all aspects of your health and relationships. Learning about the intricacies, and what chronic anxiety for you specifically looks like are some of the first steps towards healing and change.

Life is full of wonderful moments for us to take in, but it’s hard to breath when you’re under water. But the good news is that there’s help, whenever you’re ready to ask.

Therapy looks different depending on who is coming. In this post I will briefly explain the differences in individual sessions, family sessions, and couples sessions.

• Individual: Individual therapy sessions are just you and the therapist. It’s one-on-one and the whole hour is devoted to speaking about things that are impacting your life personally. While your issues may stem from family members, a relationship or a child, those people (typically) will not be present for your sessions or take part in any way. There are of course exceptions and at times it can be helpful for one or two sessions to invite another party into your session but for the most part this is time to just work on you.

• Family sessions: In family counseling the whole family unit is the ‘client’. While each individual brings their own complexities to the table, how those complexities are addressed in the context of family is the focus. Sessions may, at times, be run individually but the goal is always to treat the family. Individual sessions, if any, are meant to find how that can be done.

• Couples sessions: Just as in family sessions, in couples therapy the couple is the ‘client’. Often times partners will come into couples counseling looking to have the therapist pick sides and prove that one or the other is right/wrong. This is very common and when a relationship is in crisis it’s natural to seek allies. However, couples therapy does not further drive wedges or vindicate one over the other. The client is the two together, and thus the sessions are meant to increase harmony, connection and discover where the connection is fracturing. A couples therapist (at least a good one) is not a secret keeper, is not a side picker, and will not create further distance.

You know you want to go to therapy and you go to the all powerful Google to search one out in your area. Maybe you’ve come across a site dedicated to therapists advertising themselves, maybe you’ve gone through your insurance providers website to see who is in your network, great! You have a whole list of therapists so picking one should be easy. But what are all these letters? They all have some kind of letters after their name…most either have an MS or ED? What about RMHCI, LMHC, MFT, LCSW, LPC?! In no way is this list exhaustive but below is a short guide to what some of these credentials mean.

MS: Master of Science. This means that the individual has at least a graduate level of training from a university and has obtained their masters degree with a focus applied to scientific or technical degrees.

MA: Master of Arts. Again, this means that the individual has at least a graduate level of training from a university and has obtained their masters degree with a focus applied to humanities and the arts degrees.

M Ed: Master of Education. Again…this means that the individual has at least a graduate level of training from a university and has obtained their masters degree. An M.Ed. program is research-based in that consideration of educationally relevant research constitutes a major focus of study and students are normally required to take a number of research-relevant courses (e.g., statistics courses).

LMHC/LPC: Licensed Mental Health Counselor/Licensed Professional Counselor. This individual has completed their masters degree including pre-graduate practicum providing counseling services, has completed at minimum 2 years of post-graduate work providing therapy under supervision from a qualified supervisor, has passed their national examination for their license, and has completed additional mandatory coursework for their state. LMHC’s focus solely on the mental health of their patients

RMHCI: Registered Mental Health Counselor Intern. RHMCI’s are able to practice on their own but are not yet licensed therapists. They have completed their masters degree programs and are registered with the state as interns. They either have not yet completed their mandatory 2 years post graduate work, their national exam or their number of clinical practicum hours to receive licensure. They may still practice therapy but under the supervision of a Licensed Qualified Supervisor who oversee’s their services. RMHCI’s are limited in the scope of services they can provide without supervision but are otherwise well trained, depending on their years out of school.

LCSW: Licensed Clinical Social Worker. This individual has completed their masters degree including pre-graduate practicum providing counseling services,, has completed at minimum 2 years of post-graduate work providing therapy under supervision from a qualified supervisor, has passed their national examination for their license, and has completed additional mandatory coursework for their state. LCSW’s focus on the mental health of their patients, but also do considerable work to help underserved populations access resources that may not be able to access on their own. LCSW’s may also be employed in hospitals and palliative care to help families with end of life decisions and resources/referrals for long term living care.

RCSWI: Registered Clinical Social Work Intern. RCSWI’s are able to practice on their own but are not yet licensed therapists. They have completed their masters degree programs and are registered with the state as interns. They either have not yet completed their mandatory 2 years post graduate work, their national exam or their number of clinical practicum hours to receive licensure. They may still practice therapy but under the supervision of a Licensed Qualified Supervisor who oversee’s their services. RCSWI’s are limited in the scope of services they can provide without supervision but are otherwise well trained, depending on their years out of school.

LMFT: Licensed Marriage and Family Therapist. This individual has completed their masters degree including pre-graduate practicum for their field as well as LMHC and LCSWs. However, depending on the state requirements coursework may be less in depth and the requirements lower than for LMHCs and LCSWs. For example, in the state of Florida practicum requirements for LMFT’s are only 180 hours compared to 1,000 for LMHCs, and educational hour requirements are almost half that for LMHC and LCSWs. Additionally, LMHC’s and LCSW’s may earn dual licensure as an LMFT after they have been practicing for 3 years and may take the exam to also add LMFT to their expertise. This is not reciprocal for LMFT’s, however. This may be due to the speciality nature of this degree as it focuses mostly on helping those with marital problems and family relationship dynamic issues. They view things from a social and relational context, which see’s each individual in a family unit as affecting the other which can have a profound impact on our behavior and mental well-being.

RMFTI: Registered Marriage and Family Therapist Intern. RMFTI’s are able to practice on their own but are not yet licensed therapists. They have completed their masters degree programs and are registered with the state as interns. They either have not yet completed their mandatory 2 years post graduate work, their national exam or their number of clinical practicum hours to receive licensure. They may still practice therapy but under the supervision of a Licensed Qualified Supervisor who oversee’s their services. RMFTI’s are limited in the scope of services they can provide without supervision but are otherwise well trained, depending on their years out of school.

Therapists love their alphabet soup. When looking for a therapist you may have come across terms and acronyms that don’t make sense. CBT, TF-CBT, ACT, DBT, EMDR,…is it so hard to type out the full words?! In this post I’m going to define some common therapy modalities/approaches that your therapist may use. This is not an exhaustive list, but a list of some more common types that you may not be familiar with.

• First, What is a Therapy Modality/Approach?

This simply means the approach your therapist takes when they think about how their clients can best heal. Some therapists are purists and pick one and stick to it. Some are flexible and tailor their approaches to what best suits a clients need. Below you’ll find various models that you might hear in therapy.

• Cognitive Behavioral Therapy (CBT): a mode of treatment that focuses on how a persons thoughts, feelings and behaviors interact and influence each other. Much of this therapy works to identify unhelpful thinking patterns, reframe those into more helpful thinking patterns and thus improve behavior outcomes. This type of therapy is more works based with worksheets, homework and charting with the goal of spurring on behavior change. This type of therapy is not talk based where you verbally process your problems to gain healing through insight.

• Trauma Focused – Cognitive Behavioral Therapy (TF-CBT): a mode of treatment that is a variation of the above type, but with the addition of heavy building of coping skills, education about trauma, and the addition of a “trauma narrative” (writing out what happened to you) to process the event and reduce the involuntary reoccurrence of traumatic memories and symptoms of the traumatic episode.

• Acceptance Commitment Therapy (ACT): uses acceptance and mindfulness strategies mixed in different ways with commitment and behavior-change strategies, to increase psychological flexibility. With this approach people work to accept the things about their lives they cannot change, and in that acceptance, peace can begin. Commitment is used to take the acceptance to the next step and make choices to change behaviors that cause unhelpful stress.

• Mindfulness: this approach uses your powers of observation, deep breathing, meditation and acceptance to bring awareness to our thoughts. Awareness, education, deep breathing and meditation make up the majority of this approach.

• Dialectical Behavior Therapy (DBT): the term “dialectical” comes from the idea that bringing together two opposites in therapy — acceptance and change — brings better results than either one alone. (WebMD) . In DBT much work is done on critically looking at behaviors that are unhelpful and linking those behaviors to thoughts and feelings that may contribute to it. This type of therapy is “works” intensive and does not rely heavily on talk therapy for comfort. The results are lasting behavior change and increased understanding of why unhelpful behaviors are occurring.

• Eye Movement Destabilization and Reprocessing (EMDR): [From the EMDR institute at emdr.com] “EMDR (Eye Movement Desensitization and Reprocessing) is a psychotherapy that enables people to heal from the symptoms and emotional distress that are the result of disturbing life experiences.  Repeated studies show that by using EMDR therapy people can experience the benefits of psychotherapy that once took years to make a difference. It is widely assumed that severe emotional pain requires a long time to heal.  EMDR therapy shows that the mind can in fact heal from psychological trauma much as the body recovers from physical trauma.  When you cut your hand, your body works to close the wound.  If a foreign object or repeated injury irritates the wound, it festers and causes pain.  Once the block is removed, healing resumes.  EMDR therapy demonstrates that a similar sequence of events occurs with mental processes.  The brain’s information processing system naturally moves toward mental health.  If the system is blocked or imbalanced by the impact of a disturbing event, the emotional wound festers and can cause intense suffering.  Once the block is removed, healing resumes.  Using the detailed protocols and procedures learned in EMDR therapy training sessions, clinicians help clients activate their natural healing processes”….”EMDR therapy is an eight-phase treatment.  Eye movements (or other bilateral stimulation) are used during one part of the session.  After the clinician has determined which memory to target first, he asks the client to hold different aspects of that event or thought in mind and to use his eyes to track the therapist’s hand as it moves back and forth across the client’s field of vision.  As this happens, for reasons believed by a Harvard researcher to be connected with the biological mechanisms involved in Rapid Eye Movement (REM) sleep, internal associations arise and the clients begin to process the memory and disturbing feelings. In successful EMDR therapy, the meaning of painful events is transformed on an emotional level.”

• Solution-Focused Therapy: this type of therapy focuses on the problems that you describe and works to find the solutions that work for you. There are tangible goals, markers for those goals, and measurable objectives that are formed to help therapist and client stay on track to meet the goals that the client lays out. As in all therapy, the client sets the pace and describes what they want changed in their life and works in collaboration with the therapist to shape what solutions can look like.

• Insight Therapy: this is a form of talk therapy that focuses less on measurable objectives and more on processing the ebbs and flows of your present and past. Your life brought you to where you are and there may be questions that formed along the way. In talk therapy, it is just that – you talk. You and your therapist discuss situations in your life, that you decide to bring up, in an effort to allow you to gain more understanding of your self.

“Although the world is full of suffering, it is also full of the overcoming of it.”

Helen Keller

Life will always present challenges. This is a given. Often times with experience and grit we can overcome them and move on. Often times the burden of the situation becomes too much. We know the ‘right’ answer, we know what we ‘should’ do, but sometimes that is not enough.

• But how can therapy help me?

Therapy is not a magic wand to wave over your problems and make them go away. What therapy is is a tool and a treatment.

If you were to plan to hang a picture on the wall of your home, it would help to have a hammer. Sure, you can probably, over time and with much effort push a nail into the wall using only your hands but you risk unnecessary pain and time in the process.

If you were break your arm, it would help to go to the hospital to get a cast. Sure, you can probably skip the hospital and let the broken bone set as it is, but you risk additional pain and a long lasting injury that may never fully heal.

Just as a hammer can make a job easy and a cast can heal what is broken, therapy is a tool for the emotional and mental challenges that we face.

• But how can a therapist help me?

Therapists are only human. They have the same problems, fears and vulnerabilites as you do. What is different is the training.

I like to explain it to my clients like this: I went through the schooling, took the tests, wrote the papers, did the research and put in the years of concerted dedication to learning the best techniques and methods to handle life’s challenges – so that you don’t have to.

When I meet with you I can parse out what is relevant vs. what is not for your specific situation. I can give you the cliff-notes, the abbreviated take, the bullet points without you loosing any of the value. I’ve explored the whole ice-burg but you only have to scale the tip. I read the book so you get to watch the movie. We are a living shortcut for you, a work around to get you where you need to be. We are glad to do it. We want to do it. We have the knowledge and power to help, let us.

Asking for help is difficult. Asking a stranger for help may seem kind of crazy. When we first talk I just want to hear from you, from where you are, and what you are looking for. Maybe you are not sure what that is…in that case we can talk about those questions and find an answer together.

On my sites contact page you will find a HIPAA secure form where you can introduce yourself and tell me what you are thinking. Don’t worry about putting all your concerns or worry about leaving anything out. This is truly just a – “Hey, I think I want to try this out – ” kind of thing, where you let me know how you think I can help. More time for other information will come.

After you send it, I’ll reach out to you via secure messaging or phone. I’ll introduce myself and ask some more clarifying questions to make sure I can help you in the ways you’re looking for help. If we find that I’m not the right person right now, I’ll help point you in the direction of someone who can.

If you feel comfortable scheduling an appointment during this call, we will do that then and that’s it. Low stakes, no commitments. Our first conversation will be just that – a conversation.

If you feel like now is the time, please please please, do reach out.