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What Your Mother Probably Did Not Tell You

What Your Mother Probably Did Not Tell You

I am at that age that can be called middle aged. Which means I have middle aged friends. I also work primarily with women and between discussions with friends and clients I have found most women are sorely under-prepared for the hormonal shifts that occur in middle age. In fact, most women seem to think menopause just happens. You turn 50, your period turns off, you may have hot flashes but that is it. But it is not it. Google mood swings and perimenopause I dare ya.

Perimenopause is that period leading up to menopause where all sorts of things may happen, or not. Menopause is official when you have stopped menstruating for a year. Perimenopause can be the up to 10 years (YES 10 YEARS!!) prior that you have other symptoms. These might include anxiety, tearfulness, bursts of anger, hot flashes, insomnia, breasts that hurt, irregular periods, depression, and many more fun things. What is striking to me in talking to women is how often they just put up with the symptoms. They don’t know what is going on. They feel crazy. They may try and see a doctor but more often than not they are told to either take hormones or just suck it up.

I have found that for most women finding some connection with other women that can normalize the experience for them is a big help. It is also good to find out some information so you can have reasonable expectations. Everyone is different and some women go through the entire experience super smoothly. Most have some bumps along that way. There are all types of herbal supplements and products you can try if you wish (please always do due diligence and research each thoroughly and let your doctors know what you are taking).

The most important thing is to recognize that if you are on an emotional roller coaster it will pass and you are not crazy even if it feels like it in any given moment.

A few books that are highly recommended are below. Please note that these are Amazon affiliate links which means I get a small fee if you purchase through the link. My affiliate disclosure statement is here.

The Wisdom of Menopause by Christiane Northrup M.D. 

This article onIs It Perimenopause” from Prevention online is also short and helpful.


March 22nd, 2017|Thoughts From A Psychotherapist|0 Comments

A Therapist Works Hard To Take Her Own Advice

A Therapist Works Hard To Take Her Own Advice

I often tell my clients that No is a complete sentence. You don’t have to say anything past it. You don’t have to explain your reasons or make someone feel better you can just say no.

Great advice to give not so easy to actually put it into practice. Women in particular can be socialized to have a very hard time saying no. We are also prone to saying “I’m sorry” a lot more than is necessary. It is very hard to shift those behaviors. I fully admit I struggle with this as much as the next person.

Recently someone asked me to do something. I didn’t want to do it. It was a big time commitment and quite honestly I did not want to give up a precious weekend day to do something as a favor to someone. And it was a work sort of a favor not a helping a friend move type of favor. See what I just did there I rationalized my saying no as I write a blog post about it.

Anyway, instead of taking direct route one which was to just say no I first used a delaying tactic and said I had to check on something to make sure I could do the request. After I did that I knew it was a mistake but I followed through and checked out what needed checking and indeed I was capable of doing the project. Easy out gone. Darn it.

Next I procrastinated a few days before responding. Then I asked a friend advice on how to say no diplomatically which essentially means without upsetting the other person or having any consequences. I am a therapist I know this. They gave me advice that I hated about making it a business decision. Then we both agreed I could say it was just about the time commitment, which is actually the true reason. It is hard to just say no without a reason. I wrote and edited the email a few times and then quickly sent it off before I could change my mind.

Good news is that I set my limit. And the other person respected it. It was uncomfortable for me to do it but I have found the more I set boundaries and say no the easier it is to do it. Maybe someday I will do it when the request first comes to me. Maybe it will always be a struggle. The courage is in finding the way to try anyway.

February 17th, 2017|Thoughts From A Psychotherapist|0 Comments

Vulnerability and Empathy

One of my favorite places on the Internet is Humans of New York. A photographer in NY goes around and takes pictures of people and writes a sentence or paragraph of their story. It is full of vulnerability and empathy. The subjects are vulnerable when telling their stories and the photos show such empathy and kindness to the them that it amazes me.

The reason I bring this up is that it feels like we have become completely incapable of listening and hearing each other. In conversations everyone seems to focus on their next point in an argument that will never be won. So how has it become that we have become culturally unable to listen? That answer may be beyond me but what I do think it that listening requires both vulnerability and empathy. In order to engage in a true conversation we have to be vulnerable and we need the other person to respond with empathy. Empathy doesn’t mean you have to agree with what anyone says but it does mean you have to hear his or her feeling underneath and respond to it. When we have a conversation in which we are vulnerable and the other person responds with something other than empathy we often become defensive or even angry. They respond in kind and an argument ensues.

I am not sure how we move forward in communicating with vulnerability and empathy with those that differ from us so much. It is hard to be vulnerable when you feel like you are going to be attacked. I suspect that is the reason that many of us right now are in our safe places where we only converse with those who are like-minded. And that is okay. We need to feel safe. But perhaps when we push out of our safe places instead of having a discussion about current events we can ask the other person about themselves. What is their story? What are their fears and their goals and desires? Maybe if we can find a way to connect with them on that level then at some point in the future other conversations can happen. Maybe not. I admit to fluctuating between saying stay safe and try to connect with other that are different from you. I think that there is room for both.

What I do know is that when we can listen it makes a difference. And listening to people’s stories always matters.

December 19th, 2016|connection, Thoughts From A Psychotherapist|0 Comments

Transgender Rights and Resources

Transgender Rights and Resources

Since the election, a lot of concerns have been coming up for the transgender people. I have put together some resources and information below so that you can have the best possible information when you make any decisions. Obviously right now we do not know anything for sure. I don’t want to perpetuate panic but at the same time, people need information on the best ways to protect themselves. Everyone needs to make the decision that is best for them in their own circumstances.

I am going to focus on the practical concerns of documents and health insurance.

Please feel free to comment or email me if you have anything to add to this post.



In California, the go to for information on legal documents is The Transgender Law Center. Here is the link to their page with detailed information about this topic. Here is their extensive guide.

Here is my quick summary:

California State-Documents

In 2013 Governor Jerry Brown signed AB 1121 which made it easier to get documents changed in CA. Full implementation occurred in July 2014. So with the same Governor in office and statements issued both from him and the Legislature that assert that they will protect Californians, at this time there is no indication that this law will change and you should still be able to change your name and gender in CA fairly easily.

It is important to note that you do not currently need a court ordered gender change to change your California driver’s license, social security card, or U.S. passport. You also no longer need a court order to have a new California birth certificate issued reflecting a change of gender.

You DO need a court order for a change of name.


Documents-Other States

For information on other states and their rules, The National Center For Transgender Equality has an awesome site here. You can click on any state to get additional information including some local advocacy partners.

In states with Republican Governors, there may be a backlash against gains for transgender people and those laws may be at risk so please check in with your local transgender advocacy projects.


Federal Documents

Social security cards and passports are Federal documents and as such may have more risk for change.


Social Security Cards

National Center For Transgender Equality also has a great fact sheet on changing your gender for Social Security. Right now it is considered a relatively easy process but we have no idea at this time if this might change and become more challenging in the future so if this is an important change for you, it should be done as soon as possible.



In 2010 the State Department updated its policy to make it easy for transgender people to obtain a passport that has their correct name and gender identity. This may be an area that is targeted and changed moving forward.

If you believe you may want to leave the country at some point this is a very important process to complete as soon as possible.

Here is information from the National Center for Transgender Equality on passports.


Health Insurance-California

The California Department of Managed Health Care (DMHC) has ordered California’s health plans to remove blanket exclusions of coverage based on gender identity or gender expression. This was done to comply with the California Insurance Gender Nondiscrimination Act, passed in 2005. These rules did not apply to self-insured plans. Many larger businesses have “self-insured” plans governed by ERISA, a federal law that preempts state nondiscrimination protections.

Essentially what this means is that those who got transgender health coverage added because of the Affordable Care Act (ACA) risk losing it if the ACA is repealed.

However, many in California will continue to have transgender health care coverage under private insurance plans.

With Medi-Cal is more complicated. Many people got on Medi-Cal through the Medicaid expansion in the ACA. Many others also got private health insurance because of the ACA subsidies to buy private insurance. Those aspects are at risk if the ACA is repealed. So people will lose their entire health care plans not just transgender-specific aspects.

CA law does still require coverage of transgender health but it could get more challenging if cities lose funding for public health.


Health Insurance-Other States

If the Affordable Care Act is repealed then Rule 1557, which removed trans health exclusions federally, will be gone. If you live in a state that did not protect transgender health care prior to the ACA there is every reason to believe that coverage can be gone by the beginning of 2018. Also, those who got coverage through the Medicaid expansion will also most likely lose their healthcare coverage if/when ACA is repealed. And we know repeal of the ACA is the top of the list of legislative goals for the Republicans. The other scenario I have heard is that Medicaid expansion may stay but become much more restrictive depending on the state. Vice President Elect Pence did do a Medicaid expansion in his state so we just don’t know how this will play out.



Resources for Further information

Transgender Legal Services Network

Transgender Law Center-CA Specific

Southern Poverty Law Center is collecting reports of incidents of violence and intimidation. They advise reporting to local police first but they are tracking the violence. The link to that is here

Trans Lifeline

US: (877) 565-8860 Canada: (877) 330-6366

Trans Lifeline is a non-profit dedicated to the well-being of transgender people. It is a hotline staffed by transgender people for transgender people.

Lambda Legal resource guide on Documents

CA Courts Site Reference for further CA legal document questions.

Post Election Trauma is Real

We have ended the ugliest election in US history by electing a man who has called Mexicans rapists, said women should not have the right to choose, said gays should not have the right to marry, and that Muslims should have to register if they live in this country. Many people think therapists should not speak out about politics. This therapist begs to differ. I am not speaking out against a party. I am speaking out against a clear and present danger to many in this country. I will not be silent when a White Supremacist is appointed to a job next to the president.

As many in the LGBT community know there was long a slogan that Silence Equals Death. Many of us wore pink triangles to represent the LGBT people killed in the Holocaust. Sadly I fear we are again in a time where silence could equal death and I will not be silenced while people in this country are being persecuted.

I recognize that for many people, including the people I work with, are scared. They are traumatized. They do not know what to do or how to handle this. As a therapist, I have no easy answers. We each have to find our own way to cope with this pain. What I can say is that I will be here to listen. I will be here to help you with the trauma you are experiencing and the fear you are facing. I commit to providing a safe space and I commit that outside of my office I am going to be doing everything I can to protect people in this country.

November 14th, 2016|trauma|2 Comments

Personal Connection is How We Will Heal From This Election

Personal Connection is How We Will Heal From This Election

Wow. Honestly I feel like that is all I can say right now is wow. Everywhere I go people are talking about this election. People are really angry and people are really scared. It seems to me that the media is fanning the fuel of anger right now and social media can take it over the top. I certainly don’t want to minimize people’s anger and the reasons behind it but I am concerned about how it will permeate into other aspects of our lives and how we will somehow all move forward after this election is over.

I feel sad that this is what American Politics has come to. It used to be that we all had our parties and we supported them and hoped they won but we had some respect for those on the other side of the aisle. This has been falling to the wayside for the last eight years and has reached a critical point right now. I have heard multiple friends say they don’t want their children around people that support certain candidates. Relationships are becoming acrimonious or even ending.

Prior to this election politics and elections were rarely discussed in my counseling room. Now it is talked about all the time. I hear fear and anger there too. And I don’t have answers to that. All I can do myself and advise others to do is to take care of yourself the best you can. For different people that may be different things like not watching news, or limiting contact with people that support the other candidate, or becoming active in the campaign you support. But people feel helpless and that is a very challenging place to be.

Now I digress for a moment (hang in there I will make my point) but yesterday during a break in my work I wandered over to the bookstore. It is dangerous for me to have an office near a bookstore but it is also a place I like to wander. It calms me. As I perused the books an older gentleman came into the aisle and was grumbling about not finding the book he was looking for. I will be honest in the past, as an introvert I probably just would have nodded politely and moved on. But I have been pushing myself to try and connect more when opportunities arise. This gentlemen then mentioned the author he was looking for and I said oh you find him over in the fiction and literature section not here, because I read him too and that’s where I found him. He wandered off and then returned having found his book. We then compared notes on that series and then several others we both enjoy. He told me he was 92 and about the challenges of aging. He told me how old his kids were and I joked I could be one of his grand kids. He then told me about his grand kids and great grand kids. We continued to talk as we went to pay and he told me about his service in WWII. It was a very enjoyable interaction for me and I hope for him.

The reason I share this story (told you I would return to the point) is that it helped me recognize that human connection is what we continue to really need. I don’t know who that man is going to vote for but I do know we like the same books and I enjoyed talking to him. It actually made my day. I think as we move forward post election it is important to remember this. We can still almost always find ways to connect with others, even those we disagree with. And the healing will only happen if we try and do that and try to both connect and really listen. Try to hold on to that as we move towards November 8th and beyond.





Copyright: allegretto / 123RF Stock Photo

October 11th, 2016|connection, Thoughts From A Psychotherapist|0 Comments

The Blame Game-Can We Find Empathy?

In the chaos that has been the last few weeks in the world a few friends posted the following quote by Brené Brown.

“I woke up this morning looking for someone to blame. Someone to hate. Someone who I could make the single target of my fear about the officers killed in Dallas and the killing of Alton Sterling and Philando Castile. It was such a desperate feeling to want to discharge the uncertainty and scarcity. Then it dawned on me that this is the exact drive that fueled what’s happening right now.

Instead of feeling hurt we act out our hurt. Rather than acknowledging our pain, we inflict it on others. Neither hate nor blame will lead to the justice and peace that we all want – it will only move us further apart. But we can’t forget that hate and blame are seductive. Anger is easier than grief. Blame is easier than real accountability. When we choose instant relief in the form of rage, we’re in many ways choosing permanent grief for the world.”

I feel like I am just watching people further polarize and blame each other for what is going on in the world right now. Not just with the shootings recently but the parents whose son got into the gorilla cage and every other incident like that. People say if the person driving the car listened to police he would not have been shot. If the parents at the zoo had watched their son better he would not have gotten into the enclosure. I get it. We want to say those situations happened to “those people” because of something they did. That means in the same situation we are safe because of course we would listen to the police and watch our children more closely. Right now we seem incapable of looking at events with any type of complexity and/or empathy but instead rush to judgment. That may make use feel better and safer but it does nothing to address what is going on in this country right now.

This post is not going to delve into the deep racial divide that is in our country right now. It is beyond me to write something to address that. What I do want to address is the blaming and the lack of empathy. It is harder to try and put ourselves in the shoes of another person. It is hard to make ourselves vulnerable to listening to others stories. But I do not think we as a society can heal and move on until we can allow ourselves to be that vulnerable.

I do believe that most of us want a just world where bad things don’t happen. But that is the world we live in. Take a moment with each situation and try really really try to put yourself in the shoes of the person it happened to. Let yourself feel for a minute what that might be like for them. Have some empathy. It is hard really hard sometimes to do this but if we can all try and find our way to be a bit less judgmental and a bit more compassionate maybe we can all work on healing the hurts that are separating us.


July 11th, 2016|Thoughts From A Psychotherapist|0 Comments

It was a hard week to be a LBGT therapist

It was a hard week to be a LBGT therapist

I woke up Sunday morning and sat with my coffee and Ipad as is my morning routine. I immediately realized something horrible had happened. So on came the news. I was quickly in tears. Not just another mass shooting but one that specifically targeted both the LGBT and Latino communities. I watched the news until I was coaxed to turn off. I have checked in on the stories of the victims all week long. Each story breaks my heart. It has affected me deeply.

I understand that all people are hurt, angry, confused etc. about this shooting. But for LGBT people it is very very personal. We have all always known that on some level we aren’t safe. Many of us have experienced a variety of different anti-gay actions from name calling, to bullying, to murder. We have all been fearful of being who we are in public settings. For those of us of a certain age we all came out to some extent in a bar. The bars were where you were safe. Where you could dress like you wanted, kiss whom you wanted, and sigh a deep breathe knowing you did not have to pretend to be something that you were not. The bars were the safe place, for some in certain communities the only safe place for them. That has now been torn away.

Gay rights and to a lesser extent transgender rights have progressed enormously in the twenty plus years since I came out. We can now get married and in a lot of places can hold hands freely. At the same time our jobs are not protected in many states. Gender Non-Conforming and Transgender people continue to be harassed and hurt for going to the bathroom. The recent bathroom wars have caused many in the community to become fearful again. This horrible tragedy has exacerbated that fear.

I had more than one person tell me this week that this tragedy told them that people still want them dead. That is what LGBT people are holding this week. That some people want them dead. It makes me sad beyond belief.

As a therapist my job is to support my clients to help them work through their feelings. This week I had to do that as I held my own grief, anger, and sadness. What I could do was be with each of them as they had their feelings and be honest at the times when I had my own feelings about this horror.

I don’t know how we will all carry this moving forward. But this week as hard as it was to be a LGBT therapist there was nothing else I would have rather been doing.


June 16th, 2016|grief, LGBT|2 Comments

Being Kind and Not Posting it on Facebook

Many of you will have heard about the horrific rape case that happened at Stanford. An unconscious woman was raped, two men came along and saw it happening, stopped it, and captured the rapist. The rapist was then convicted and got only six months. There is much to be upset about in this case. However, what I am choosing to focus on are those two men who made such a difference in that victim’s life. If they had not stopped to help the violence could have been worse and she may never have known what happened to her and the perpetrator may never have been caught. Because they saw something that looked wrong to them they stepped up and got involved and saved this woman from further trauma. The only reason there was a conviction in this case is because of these two young men.

What I admire even more than their willingness to get involved is that they have subsequently declined their 15 minutes of fame. There is very little about them on the Internet and they have refused to make statements overall. Afterall the Chewbacca Lady got to be on the morning shows so I am quite sure these young men could have had their moment too if they had chosen that. The only thing they have said was in response to the victims statement.

“Jonsson, one of the men posted the victim’s letter on his Facebook page Tuesday, thanking friends and strangers for all the “encouragement and support” over the past few months. He said he would not publicly comment on the process or outcome of the trial, but asked everyone to read her letter. “To me it is unique in its form,” he wrote, “and comes as close as you can possibly get to putting words on an experience that words cannot describe.”(From Buzz Feed)

I often think about all the good deeds I have seen posted on Facebook. I wonder how many of them are true and how many of them would have still happened if the person did not have the opportunity to post their goodness for all the world to see. These men did the right thing and their names are only public because of their testimony in the court case.

Don’t get me wrong I like seeing the good things people do for each other. In today’s world with so much gloom and doom on the Internet it is always nice to read a feel good story. But at the same time I wish people would be kind just because it is right. Not for praise or rewards but because our world needs lots of kindness. I hope these men can inspire us all to do be kind and to get involved when the situation calls for it, even when it is hard.



Photo Copyright: iguanasbear / 123RF Stock Photo

June 7th, 2016|Thoughts From A Psychotherapist|0 Comments

The Value of Connection

The Value of Connection

The other day in between clients I ran over to the bank. As I was walking back to the office I heard a lady yelling hey at me. I admit I was tempted to ignore her but I turned and acknowledged her. She gestured me over and then started complimenting me. She admired different aspects of my outfit (which honestly wasn’t all of that IMO). But she was so genuine and happy. I chatted with her a few minutes and then went on my way. As I was leaving she grabbed my hand and said, “Keep wearing paisley”. It was such a Bay Area moment for me. I went back to work with a big small on my face.

I was born and raised in NJ. That means you grow up with a certain attitude and you move fast. I recently complained to a friend about how rude New Yorkers were after a recent visit there. I said, “they never say hi and they always try to run you over”. She replied, “ When you first moved to CA you used to complain about people talking to you everywhere, you thought it strange.” She was right. I often complained about that when I moved out here all that talking was slowing me down. Now I try to get in the grocery lane of the checker who also likes the Oakland A’s so we can catch up on what the team is doing wrong this year.

It is good to recognize that for me right now I like the slower pace and the random conversations that happen where I live. These connections actually feed me and they make me feel seen. In the world right now we seem to often forget about the value of connection. It is what makes us have joy. That is the place to spend time, rather than think it is a waste of time.