We Are Really All Alone

Many times I will see a patient who is afraid to be alone. It can become difficult to spend time alone following a divorce or a breakup. It’s not unusual for my patient to stay in a long term marriage or relationship because the fear of being alone becomes too much to bear. So she stays rather than leave and experience the pain of the breakup. As we get older we also see our chances of meeting new partners or friends as less likely and so we may also stay out of fear of being alone. The feeling of “not being alone” is kind of an illusion. For example “being in a relationship” with someone who is drinking too much is actually pretty close to being alone. The drinker is not emotionally available. So in essence we are alone. It goes for any situation in which the other person is addicted to a substance whether it be work, alcohol or exercise to name a few.

Do not enter

Being alone has shown up markedly since the pandemic started. I recently had to have a medical procedure in the hospital. I was not allowed to bring anyone with me. I had my “driver” bring me and pick me up. I sat by myself in the procedure area. After the nurse finished up her part with me I sat for the entire time alone. The whole thing took two hours, but it was very different from years past when I have had other procedures. I had come all prepared with a book and my ear buds but I found myself thinking about how alone we really are in this world.

Only Ticketed Passengers May Enter the Boarding area

The first time I really knew we are alone was after my father’s death as I watched them carry him out from the synagogue in his pine casket. Observant Jews, which my parent’s were emphasize modesty and simplicity. Rabbi Simeon ben Gamliel II started the tradition in the second century C.E. I realized in that moment , as he was being carried to his resting place, that he was leaving by himself. It was then I knew that we are all really alone. We come into this world alone and we leave the same way. 

Leaving on  a jet Plane

I always think of the song by the Peter, Paul and Mary., “Leaving On a Jet Plane.” For some reason the lyrics seem to fit. She sings of having to go.  She knows she must leave. She hasn’t left yet but she already feels alone.  It’s also about letting go.  We have to let go to move forward. There really is no other way.  Sometimes it means being alone for a while.  But the real growth can only happen when we embrace our fears rather than avoid them.

Swimming in the Deep End takes Courage

So how does  my patient get over her fear of being afraid to be alone? We must  look together and be curious about why this particular fear has become so embedded in her psyche. I tell my patient she must go deep inside and she will find her answer. I usually get back, “what do you mean go deep inside?” I mean go as far as you can with writing, visual imagery, paint or whatever else creatively will help her find the answer.

Thin Privilege

In recent times we are learning how certain groups are afforded more rights or privilege than others. As someone who grew up fat most of my life except for about ten years in medical school and residency, I know what it is like to be treated differently from thin people. I was also not a fat child or teen, but I ALWAYS felt like I could be thinner. I don’t think I know any women in or out of my practice that at sometime was not unhappy with her body. I see more women than men in my practice who are dieting or using extreme forms of exercise to maintain thinness. However, lately I see more men trying for that twenty something body well into midlife. Today’s discussion is not about trying to convince you that diets fail in 98% of people.  It is about how badly fat people are treated. It is also about the privilege I see afforded to thin people.

Seatbelt extenders are shameful

On airplanes seats are designed for thin people. At one time a major airline was requiring fat people to purchase two seats. I thought this was odd because up until age two a child can sit in a seat with the parent for free. Yet if you have an extra 20 pounds of fat you will need to purchase the extra room. What’s even more humiliating is having to ask for the seatbelt extender. You might fit in the seat but to safely sit there you will have to ask the flight attendant for the seatbelt extender. Why would anyone design a seat like that? Cars are not designed for seatbelt extenders. If you are a woman shopping for clothing in the plus size category, you will also  know that ten dollars gets added on for those sizes. As someone who sews, I highly doubt an additional ten dollars worth of fabric was used to make the garment and sewing a seam is sewing a seam.

Dieting makes us feel bad

Some of the most accomplished women in my practice “feel like failures” if their bodies have gained back the weight they worked so hard to lose. It is usually a repetitive cycle, they lose, they gain, they lose and gain time and time again. They only see that failure rather than their accomplishments as good friends, mother’s, doctors, lawyers, nurses etc. My job is not to stand in their way if they truly wish to diet to try to be thin. I am there to understand it with them. Why do they hate their bodies so much? What started the war with their bodies? Was it a mother who was always dieting? Was it something they learned?  Did a doctor tell them to lose weight?

It’s time stop hating Fat people

I am learning more about white privilege these days. I will admit I was unaware of how lucky I was to be afforded things others were not. I am now far more conscious of what I need to do to stop it in myself and my community. I know the time is also here to stop thin privilege as well. I am tired of seeing fat people ridiculed, passed over for jobs, labeled as lazy or unfit. It’s time to stop hating fat people.

Fat women hate Fat women too

I know I have had patients leave my practice because of my being overweight. Oddly the women who seemed upset with me were not the thin ones. It was the women who had body’s similar to mine. They wanted to see me as bad because I wouldn’t join them in hating their bodies. Thankfully through my own therapy I found a therapist who helped me stop the war with my own body. Each day I am grateful this body lets me dance, ride a bike, garden or walk. We must stop giving so much privilege to any group. For today I will think about ways I  might still conform to thin privilege, to be “the good fat person.” I would ask you to think about it too.

Mad feels better than Sad, but does it?

Yesterday I lost one of the my first chickens. She was my Buff Orpington known affectionately as Nancy Drew. On Wednesday I saw that she was not doing well. In chicken farming, that usually means the end is near. Chickens do not let you know they are sick until it is too late. They hide their illness. I have learned not to feel bad anymore and that by the time I know, there is little I can do. I let myself feel sad rather than avoid the feelings. She was a good chicken who provided me with hours of joy and many, many eggs  Although she stopped laying a few years ago I felt she earned the right to stay for the duration of her life. I do not enjoy the painful feelings that come when we lose an animal, but it is inevitable as we usually outlive them. I also know that we humans as a group tend to hide or mask feelings a lot of the time.  For example, it is far more ladylike to look anxious than angry.

Therapists make mistakes too

 

Last week I continued to listen to a podcast of three jungian analysts. It is called “This Jungian Life.”  It helped me personally get through the pandemic. I would listen to them pretty much every night. I found myself feeling connected to them. It was very comforting.  Last week they spoke of all the anger around the country and that they felt that it was more related to how sad everyone is actually feeling about the current state of affairs. I felt they were exactly right about what is going on.  That is that “we would rather feel mad than sad.” Feeling mad is so much easier than allowing ourselves to feel sad.  Like when we leave a job or relationship, it’s easier to go when we feel mad vs. sad.  When I have a patient who is angry at me or  seems  mad, I will often ask to see if something I did made them feel upset. I make mistakes all the time.I am human. I readily own that I will NEVER be a perfect therapist. However, therapy is a relationship that is to be learned from. It is not only my patient who learns. I try not to beat myself up when I make mistakes, but I know I can feel badly when they happen. A mistake could mean me not offering empathy at the right moment, or letting my own feelings into the session.

Mean is the new normal

Outside my office I am disheartened to see the personal attacks on people for having differing opinions than one’s own. I have made a conscious choice to leave some forms of social media when it seems too personal. I wish we could all be kinder to one another and allow for differing opinions. Yesterday I was watching a conversation on social media. There were differing opinions. I watched one poster start a personal attack on the other poster for simply having a different view. I understand this comes from fear and sadness, but it seems endemic. That it seems to have become acceptable to lash out at people with differing views. I think the lack of dealing with that which makes us sad has infected social media. It has become a platform of meanness and “having to be right.” What might happen if we dealt with the sadness? I suspect those angry misguided feelings would evaporate. 

I will leave you today with a picture of Nancy Drew. She is the yellow one. She will always live on in my heart.

It Wasn’t The Fish

“One thing about which fish know exactly nothing is water, since they have no anti-environment which would enable them to perceive the element they live in.” ― Marshall McLuhan, War & Peace in the Global Village (1968)

Many times in life we can be so heavily immersed in something that we miss what is actually happening around us. What I mean by this is if I am so involved in a movement or cause that I may fail to see my own short comings or how I too am like what I seem to be fighting for or against. The bigger question is “what is it I am fighting against inside of me?” “What am I afraid I might be?” Sometimes those short comings can look opposite of what I am fighting for but in essence opposites are just different sides of the same coin. For example, the opposite of love is not hate. It is indifference. Hate is a very strong attachment to the previous loved object. So instead of actually letting go of the relationship or person, I am still holding on very tightly but in a negative way. This happens frequently in contentious divorces. If one or both parties “hate” each other they may fight for years in court. This does nothing more than keep the two very negatively attached. Or years later one or both parties is still unwilling to let go by keeping past grievances alive.

Can I get a side of Masochism, please?

So if I am a fish swimming in the water and I have nothing to compare the water to, I don’t really know that I am swimming in water. When my patient grows up in a family where she is told she is loved but family members are also mean to her, this becomes her “normal.” My patient then learns love comes with pain. Going forward, her adult relationships resemble this family pattern  She becomes masochistic.  Unbeknownst to her she picks very sadistic partners. That being loved in such a painful way is the norm. Ah, if someone really loves her then of course they would treat her badly!

Therapy is deeper work

Therapy is not to make us feel better and to have the therapist cheerlead away the problems. It is a process of discovery. It is learning to immerse ourselves in a discovery process. Lawyers use discovery to get at the truth. In therapy it’s kind of the same thing. Finding our truth is the way out of the dark and frequently murky water.

Fat Phobia

I am fat. I have been fat since I was in fourth grade. I got very thin in medical school mostly from not eating and dieting. The trouble was I could not keep the weight off. I felt like a failure when I gained back the weight. I weighed a whopping 142 pounds! Over the years and through my own therapy I realized I had to love the body that I had. That I was never going to be thin and that my constant rejection of my body would show up in other ways.

Weight Loss Rarely Lasts

What didn’t help was when my doctors would ask me, “have you ever thought about losing weight?” Are you kidding me?! I don’t know any overweight woman who has not thought about losing weight! Even the thin ones want to be thinner! I don’t know any woman who is truly in love with her body. In my practice so many women reject themselves and their bodies. I am also seeing it more now with men than I had in the past. There seems to be an association with thinness and happiness. Most of the doctors I see for any thing will typically counsel me at the end about weight loss. Thankfully, I have learned to tune it out. I know that weight loss only leads to weight gain and usually we add more back each time. I also know that after five years only 2% can keep the weight off. That is the same statistic as surviving pancreatic cancer. Why would I accept a prescription that has a 98% failure rate? A few years ago I had foot pain from what was diagnosed as a “stress reaction.”. The orthopedist told me I would likely improve if I lost weight. Well, that didn’t happen and HUZZAH my foot got better on it’s own. Guess that blew his theory out of the water.

Attacking our bodies is bad for our health

I am not going to pretend that my own negative feelings never come up now and again. What I must do is take on the battle of rejecting myself. This is what I teach my patients. It’s more about attacking myself rather than the actual struggle. When we reject our bodies it can show up as physical illness. It may show up as Lupus or another autoimmune disorder. Which by definition is the body attacking itself. I will teach my patient not to reject herself. Hopefully she will listen rather than believe I am “not on her side.”

Chickens are the best

This is a picture I would have hesitated to post many years ago because it does not depict a flattering image of myself, BUT this is who I am. I am fat and I love my chickens!  

Face to Face, the Sequel

online counseling session

I haven’t written in a while and I know it is long overdue. I am feeling back to my “new normal.” I play my flute, exercise, garden when the weather permits and talk virtually or by phone with friends. During this time it is important to maintain some sense of structure and connectedness. My practice is entirely Telehealth. I have even met with new patients that way which is quite different than I would have ever done it in the past. Most of my patients are finding it OK. Only a handful have not.

 

Psychotherapy is not Crisis Management

This morning I read an article in the local paper. It is not my first source of daily news but it gets delivered online so I took a look. There, on the front page was an article about therapy. I read it and I found don’t agree with much of what was being said. Sure there was an occasional valid point being made, but my practice is much different from the ones’ being described in the article. I have always felt I practice quite differently from my peers. I believe in depth psychotherapy and my work is not crisis or symptom management driven. My practice certainly has seen an uptick but not due to the pandemic. Talking about the pandemic was surely on the agenda in the beginning of all this but most of my psychotherapy patients continue to work on the very issues that brought them in the first place.

Feelings, whoa Whoa Feelings

One question that is now coming up for some and also for me is when do we go back to face to face meetings? The simple answer is I don’t know. But if I look more deeply at that question, it can mean my patient is missing seeing me.  It can mean she wants to feel more connected in my office space.  I will explore her feelings around this and see if we can get to the heart of what she is feeling. The work I do is always about  feelings.

The Ugly Duckling Strikes Again

I have always felt I was a bit different from my Psychiatrist peers. I used to wonder if that was a bad thing not quite fitting in. When Psychiatrists wanted to become more biological, I was still more in favor of psychotherapy over prescribing. In the fairy tale, The Ugly Ducking, the beautiful swan just needs to grow into herself and find her truth. My truth has always stayed the same. My new truth is Telehealth works. I will stay with this as long as I need to to keep myself and my patients safe. I will deal with my patient’s feelings as they arise the same as I would doing face to face. I do believe we will be back working physically  face to face again. I just don’t know when.

online counseling session

Abandoning Therapy

I am glad to be writing about something other than COVID 19. I feel like my practice is cruising along at the usual pace. I am  still using a Telehealth platform.  Each week I still see the same number of patients. I have had a few people drop out but I don’t think it is due to the pandemic. Sometimes the clues are there. They were never fully in therapy. I probably should have done a better job pointing that out. As a therapist I have to look at my own hesitation to do so. What was I avoiding by not saying something about the irregularity of our work?  Frequently a patient will blame it on erratic schedules, but I know most of my patients come the same time each week despite having unpredictable schedules. Not coming to therapy or not making it a priority is what we call resistance. It is a psychological term that other wise means to avoid. Sometimes patients come in to therapy if their love relationship is failing or a mother and son have stopped talking. They think the therapist will cure the ailment much like a doctor treating a virus. I cannot make someone’s relationship or marriage better. I cannot help a mother and son to start talking again. What I can do is listen and empathize with how hard what they’re dealing with has become. I encourage them to look at themselves and their own behaviors in the relationship which hopefully leads to deeper work.

Women and Men Behave very Differently

Frequently I will be seeing someone and I might suggest they consider couples therapy as well. It’s a gamble when I do that. In couples therapy the relationship is the patient. Sometimes because the patient thinks if the relationship gets better than the therapy need not take place. Nothing could be further from the truth. Unfortunately, I see this more often with women than with men. Women as a group carry much of the responsibility of relationships working out than men. Women socially tend to define themselves by their relationships. Men usually define themselves by their work.

Leaving Before the Therapy is Finished

When people leave therapy without discussing it, I usually see a pattern. One pattern is not wanting to schedule an appointment until they know something about their work schedule. My hope is that they come back in and then I can point out the behavior of leaving. Sometimes they will tell me that is true and other times they might deny it and actually may not be aware of it themselves. Either way, staying put (as we all know currently) is really hard sometimes. If the self work was left unfinished then the problems will come back. I might get a call to resume or they might start seeing someone else. Either way is OK with me. My hope with all my patients is they end up with the lives they want.

 

Waves of Emotions

During these uncertain times it is not unusual for my patients to feel different emotions in very short periods of time. I hear mostly of anxiety. However, I also hear of sadness and feelings of loss and grief. Even as my patients stay healthy physically the emotional toll the COVID-19 Pandemic has inflicted is quite high. We mourn for the people who have died. We mourn for the families who have been inflicted with economic hardship. I know some of my patients will sail through this seemingly unaffected and others who will be deeply affected for a long time. Each patient is dealing with this differently. I have to listen and meet my patient wherever she is.

Create your  immediate future

Dealing with different emotions can be scary and exhausting. Because the future is so uncertain it is important to create the future we need in this moment. If there is a picture that needs to be painted get out the paints and start painting. If that yarn has been sitting in the bag since it was purchased get those needles going. If there is a book you have been wanting to write start writing. If my patient is feeling helpless she can take back some control. Life will feel less helpless if she can determine even the immediate future.

Staying Connected Matters

I am seeing all of my patients each week via Telehealth. I am happy that the hour they come we can stay connected. Staying connected is so important right now. If you are not already in therapy, it can start now. If you feel alone it can help you feel that someone is there for you week after week.  Relationships are what will help us get through this emotionally.

I’m your Venus

 Take good care of yourselves. On another note, if you look at the evening sky in Portland, Maine Venus is very bright tonight. I think this is symbolic for the brightness that needs to shine over all of us right now. Be well, stay safe and stay home!

Stay Calm and Keep Your Distance

I made the difficult decision to increase social distancing in my private practice. As a whole, we must do this to flatten the curve of new infections from the coronavirus. Right now, if we don’t our health care system and workers will be over whelmed. I felt I needed to do my part and have moved my practice to a HIPPA compliant video tele-health platform. If this creates a hardship for anyone in my practice I am asking you to call me and we will come up with an alternative plan. My hope is this will be short and we will resume our face to face meetings once things have settled down.

Worrying Increases Cortisol Levels

Staying calm is something you can do to boost your immune system.  Stress and anxiety increase cortisol levels and is not good for our immune systems.  Good self care is very important right now.  Meditate, knit, bake, paint or watch movies. If you can, stay connected with loved ones.  If watching the news heightens your anxiety-turn it off!  Stay calm and wash your hands!

 

COVID-19 Guidelines for Established Patients

Today at around 3:45 p.m. President Trump declared a national emergency. He has restricted any laws that would not allow me to provide Tele-Psychiatry to all of my patients. I am currently giving my patients the choice to see me via HIPPA COMPLIANT video platforms. If patients still want to come to the office they may  only come  if they do not have any of the following symptoms: fever, cough, runny nose, difficulty breathing.  They may also not come  if they believe they have been exposed to the Coronavirus within the last 14 days. I will continue to  reassess the situation over the next two days to determine if I will move to Tele-Psychiatry entirely.

This is not Fake News

 

This is very big news and thankfully it lets me continue to provide the best care to my patients during this very difficult time.  If you are a current patient and have any questions or concerns, or are unsure if you should come to the office,  please call me or contact me via the contact page

Stay Tuned!