Thoughts From A Psychotherapist

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  • hands holding

Holding the Hope

Not that long ago I was talking to a friend and they said “sometimes you just look back and think how did I get through that year?” When we are in pain we often just find a way to hunker down and just push through. Eventually there comes a day when we realize things are better, maybe not great but okay again. When we are in that terrible time we often forget that we have been there before and made it to the other side. We are in pain and it feels like we will always be in pain.

As a therapist when I am working with someone who is in that awful time I feel like often much of my job is to hold the hope for them. If I have known them a while I can remind them that they have been on difficult journeys before and they got through them. I can tell them when I see them getting better and that I believe that they will get better. I hold the hope for their recovery when they can’t see it.

Now that isn’t to say another part of my job isn’t to acknowledge the pain that they experiencing. It is always important to not move to quickly to it will get better when someone is suffering. The balance is to both acknowledge the pain and help people believe that things will shift again. A delicate balance to be sure.

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July 27th, 2015|Thoughts From A Psychotherapist|0 Comments
  • Three rocks

How Do We Cope With The Randomness of Life?

I have posted a lot about grief lately. I specialize in working with both grief and trauma and part of the process is dealing with the randomness of life. On any given day everything in our life can change. That sounds so dramatic and of course when it happens it is. One day someone is told they are sick, or pass away, or get into an accident. Of course everything can also change in a positive way with a marriage,  or having a baby or winning the lottery but those are generally less random. We all like to think that we have some control over our lives. If we constantly lived in a state where we acknowledge our lack of control for many of us it can be stressful. We like to believe that if we do the right things then good things will happen. Sometimes it works out that way and sometimes it doesn’t.

So how do we deal with the days that is doesn’t work out the way we want. I have been talking to almost all my clients about finding a mindfulness practice. That can look different for everyone but it is about finding a way to be present in the moment. I have worked really hard on finding my way to my own practice. I will be honest. I have had a hard time committing to it for a long time and then one day I did. Now I have a daily practice. It can look a bit different every day but there is something I do everyday. Then on the days when things aren’t going right I am better able to stay in the moment and cope with what is in front of me and not my fears about what is to come. Of course with being present comes coping with painful emotions. But allowing ourselves to stay present and walk through them is the only true way to heal.



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  • Grief Sign

What I Have Learned About Grief

In recent months grief has been a challenge I have been facing both personally and professionally. It has seemed like so many people I have known have experienced a recent loss. A few things I have learned from this experience

  1. People want to do the right thing and help but many will not be able to. I have watched many people struggle with how to help someone grieving and want to reach out and somehow not be able to. I think fear of doing the wrong thing paralyzes many people from doing anything at all.
  2. Everything you do matters. Every card or text or ride or hug or shared memory makes a difference to the person grieving. They may not be able to articulate it when they receive it but it does matter.
  3. When you extend a sympathy sharing a memory is a wonderful gift. Happy memories are always welcome.
  4. People want to make it better for you-what is more appreciated is if people just acknowledge how bad it is. Grief is hard. There is no getting around it. Yes most people will move on with their lives and may even be happy again but in the beginning it is hard and it hurts. Just acknowledging that is very validating to people.
  5. Some people will surprise you. There are those you will expect to step up that won’t but there will also be unexpected people that come to help you.
  6. Grief is unpredictable. You may be going along okay and then be brought to your knees in sadness. The best you can do is to be aware when it hits you.
  7. There is no way around it. You can only go through it. Our tendency is to want to avoid pain but with grief the only way to move on is to go through the pain. It is hard and often horrible but it does get easier. Grief is always with us it just may become less prominent in our thoughts and actions.



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June 11th, 2015|Thoughts From A Psychotherapist|6 Comments
  • cat sleeping

You can love again-Coping with the Lost of a Pet

Last year my beloved cat was diagnosed with cancer. He was 13. I have had many cats over the years and I have loved them all but this one was was special to me. He was devoted to me. When I found I out he had cancer I was devastated.  We made the decision to do chemo in pill form as the right treatment. Chemo for cats is different than for people as it’s goal is to extend life not save it. My guy lived 9 good months and had no side effects from the chemo. When we lost him I was numb. As a therapist I told myself that grief looks different for everyone but I wondered why I didn’t cry when I lost him.

I worried that I would never again have a cat as special as my Sammy. Fast forward a few months and one day I came home and said ” I need a kitten now!”  We had talked about the timing of adding a new cat. There were some good reasons to wait for a bit. But I just hit the point where I knew I couldn’t wait anymore. The laws of the universe cooperated. We looked online and saw a little girl cat in San Francisco. We got up early the next day and went to SFSPCA with all the paperwork ready. As soon as I saw her I knew. I fell deeply in love with her instantly.

She has been with us for 2 weeks now and we are working on integrating her with the other cats. She has a bold little personality and is a super-duper lap cat. I didn’t think I could love a cat as much as Sammy but I do. It’s different and it doesn’t take away from the love I had from him-in fact I think it is because of him that I love her so much. She is filling a hole I had in my heart. It is hard to be sad when there is a kitten in the house.

Everyone experiences grief differently. Not everyone will get another pet. But for me having a new little girl has helped me heal from the loss of my boy.

  • Invisible Disabilities Word Cloud

4 Ways To Support Those with Invisible Illnesses

I recently wrote a blog post about the “Spoon Theory”.  That is a way for people with disabilities to explain how they allocate their energy during each day. I got a lot of positive feedback on that post and wanted to further expand it to ways to support people with invisible disabilities.

1. Never say “But you look fine.”. You may mean it as a compliment but to a person struggling in pain in can be instead construed as invalidating. Looking okay to the world and feeling okay in side are two very different things.

2. Offer advice judiciously. Everyone has access to Google. That means whatever diet or exercise plan that, you have read about that cures these illnesses the person with it has read also. Healthy living is good for everyone, but most of these illnesses do not have a cure. Hearing about such things can again come across as a judgment. The person hears that if they had only done this thing they would be okay. This is something they have thought about and they are trying to live the best they can so be careful with the advice.

3. Be flexible. When you are living in chronic pain or with fatigue you don’t know how you will feel day to day and sometimes minute to minute. It is hard to make plans that way and many people just stop doing it because they don’t want to cancel at the last minute. Let people know that you are okay with being flexible in regards to the plans. If they can’t go out offer to come over to their house. It can feel very isolating to live with an invisible disability so any way you can connect with people is great.

4. Ask them. What you can do for them or what they need. Many people can be prideful about asking for help but if they know you mean it maybe then they can ask for things. Ask them what is hard in particular and see if there is something you can do to help.


  • Man meditating

Meditation In Practice Continues

Not to long ago I wrote a blog piece about my struggles with keeping a regular meditation practice.  A friend recently recommended the book Full Catastrophe Living to me. This book is one by Jon Kabat-Zinn who is a founder of Mindfulness Based Stress Reduction Programs. In class form this consists of 8 2.5 hour classes plus one full Saturday class. You have to commit to meditation 45 minutes a day while in the program. In fact, there is some recent research that doing this program can change your brain in the 8 week period.

My first reaction to looking at dong the home program was “No Way!” I If you are didn’t think I could do 45 minutes a day of meditation. But I tried it. I am now starting week 3 of the program where you can add Mindful Yoga to your routine if you are able. I have to say that since I have been doing this I have felt really good. I have also found myself looking forward to doing my 45 minute meditation every day. It is hard no doubt. Right now I am doing the Body Scan Meditation which is focusing on one part of your body at a time. I have to redirect my thoughts about every 5 seconds or so it seems. But I do it and I feel like it is making a difference. Interestingly enough I have been more engaged in doing the longer meditation daily than I ever was in the shorter ones I did previously. I know I can keep up on the practice for the 8 weeks it is structured for and I hope I can keep it up as an ongoing practice beyond that. I have read so much research recently on how meditation can improve both physical and mental well being that it seems really important to add this to my day.

If you are interested here is a resource to get the meditations for free. And here you can find more information on MBSR and buy Jon Kabat-Zinn’s cds for the program.

I would love to hear from you more about how you try and integrate mindfulness into your day.











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  • Spoon

The Spoon Theory-How to Understand Those With Invisible Illnesses

Christine Miserandino who has Lupus came up with the Spoon Theory” to explain what it is like living with a chronic illness. This explanation is now used by people who have so called “invisible illnesses” to explain to others what their days are like. Many people with depression, autoimmune disorders, and other chronic illnesses may not look sick to an outsider. That is generally because they don’t want you to know they are sick, they are trying to live their lives as normally as possible, or they may not want to hear or respond to comments that can make them feel bad.

Then comes a time when they can’t do something because they just don’t have the spoons left. Sometimes they experience others thinking they are exaggerating their symptoms and they feel unseen and misunderstood. The spoon theory is a way of trying to explain to someone kindly what it is like to have to think about every action they take in a day in order to make sure that they can get through their day. Or to be planning things well and just find out that today for some random reason you have less spoons than normal.

I think it is a good way of trying to put yourself in someone’s shoes so you can understand. No one who hasn’t experienced chronic fatigue and/or pain can understand that experience fully.  That is actually a good thing. No one who counts spoons wants others to have to do the same. But if you know someone with one of these illnesses the spoon theory can give you some perspective so that perhaps you can look at them a little differently and in a more understanding way.











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  • Lady Meditating

How I Nagged Myself into Regular (almost) Meditation

As a therapist I try to practice what I recommend to clients. As a human I struggle with these habits as much as anyone. I try to meditate every morning. Just a few minutes. I have apps on my Iphone that I use. The current one is Stop, Breathe, Think which evaluates how you are and then recommends three different meditations. Still I just wasn’t doing it every day. I would do it for a day or two  then miss. I was frustrated because it is just 10 minutes a day, how could I not get this in my day? I know how valuable that daily meditation is to a persons health and well being.

So I set up a self nag. I put a reminder into my Iphone and set it to go off at 8am everyday reminding me to meditate. If I don’t check it off it will continue reminding me all day long. So if I don’t find the time in the morning I come back to it in the evening. And while I am still not perfect in my practice I find that the reminder has increased the days I do find the time to meditate.

Everyone has to find the meditation technique that works for them. For me using a app that talks me through the meditation and reminding myself until I actually do it is what works for me. I would love to hear from you what you do to keep yourself committed to your mindfulness practice.

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  • Head Picture

Why You Can’t Get A Therapist on Your Insurance Plan

I get an average of five calls a week for people who want me to see them and have Insurance X. I can’t take most of these people and often they ask me for a referral. I have to say I don’t have one. I have no therapist on Insurance X I can refer to. What I don’t get into with them is why. Insurance X hasn’t taken new providers in my area for at least ten years. In fact, when I applied to get on them they turned me down several times. I actually got on their panel when they took over Insurance W and just absorbed all of their providers. didn’t even know I was on their referral list until I started getting phone calls from prospective clients.Insurance X maintains that they have an adequate number of providers in their network and therefore will not accept new providers. Now the people that call me and say I am literally the 20th person they have called (and that is not an exaggeration) would probably beg to differ.

The second issue with Insurance X is that they have not given a raise to providers for at least ten years and I have heard it has been more like twenty or more years. Their rates are at least 10% under other companies rates. As a therapist we can only see a certain number of clients a week and remain effective. We can’t just add more clients to make more money and do good ethical work. So if the opportunity exists for a provider to take clients with Insurance Z that pays more which clients do you think they will accept first?

In fact last year one of the providers sent out contracts with a provision buried in it where providers would accept rates 30% lower than the already low rates. I actually almost missed that provision and the ability to opt out of that plan. This year I dropped two of the plans I am on and I am moving towards getting off of Insurance X. I am one of the only area providers that takes this insurance and has the expertise in gender identity and is also EMDR trained. I want to work with people that want to use their insurance for their treatment. I recognize that out of pocket therapy services are pretty costly. But I can’t work until retirement without any increase in my income.

This is the dilemma that psychotherapists that take insurance face. In my area there are a substantial number of providers that refuse to take insurance. They will provide a superbill for clients to submit and then fight out with their plans. Insurance X has a higher deductible for members that use providers out of network so essentially that means unless you have high medical bills you have no out of network coverage. My guess is that this dilemma with insurance affects other providers as well which is why your doctors visits now are only ten minutes. They compensate by adding more patients. We can’t.

So if you have experienced the inability to find a provider that is on your plan perhaps this is why. I encourage people to complain to their state managed care departments, their HR departments, and the insurance companies. Until people say no more the companies will continue to do what they can to keep their profit margins.


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October 25th, 2014|Thoughts From A Psychotherapist|5 Comments
  • man in a hurry

Hurry Up-There Will Be No Relaxing Here

Here I am at home mid day and what have I done? Ate lunch, prepped dinner, and am now writing my blog posts. I am fortunate to have a job that sometimes allows me random daytime hours off. However, I will confess that during that time I have difficulty relaxing. It is a beautiful day out. I have many books to read yet I made my choice to work. Why? I feel guilty about having this time, somehow it just seems wrong. It is one thing if I had work I had to do but I don’t. I could have continued to procrastinate on writing my blog post for this month. But I have bought into the cultural values about time and wasting time. Which is flat out silly. How can it ever be said that enjoying yourself is a waste of time?

I admit to be being a work in progress. I am listening to the ballgame as I type (Go A’s!) and after I finish this post I promise to go sit on the front porch with a book. I wish I was at the point where I could have relaxed the entire three hours I have off but I am happy to at least go have some fun for an hour. Because life is to short to spend it busy.

I challenge my readers to find some time in the next week to goof off. I myself will promise to do this again next week. Practice makes perfect.

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