Category Archives: Uncategorized

“I’m glad to see you.”

It’s twilight in 2021 and I can see.

Seeing in 2021 was simply not supposed to happen for me.

This picture was taken at the dawn of 2016. That’s past me waiting to get a needle jammed in my eye. The treatment was a Hail Mary. It didn’t work.

Yet here I am more than five years later seeing y’all.

Genetic testing has come a long way since I was diagnosed with PXE in 2015. PXE is a genetic tissue disorder that among other things makes sufferers central vision blind by 45 years old more or less. That diagnosis changed my life but that’s a story for another time.

As the years went by I kept seeing, kept seeing, and kept seeing. All this seeing led me to genetic testing that either didn’t exist or I didn’t have access to in 2015. Three rounds of testing and the results are in: no PXE and no idea what I really have. I definitely have something but don’t we all?

Now you know when I say “I’m glad to see you,” as I do in everyone of my #telehealth therapy sessions, why I mean it from the bottom of my heart.

Love y’all,

-c

Filling in the Gaps

Omicron is coming! Omicron is here! 

Anxiety pushes us to make decisions with incomplete information. We instinctively fill in the gaps of any scenario. Remember anxiety is driven by survival first and for most. Anxiety therefore fills in the gaps assuming in all cases that the worst case scenario is all but a certainty. Survival demands it. 

The kicker is that anxiety is almost always wrong. 

Our brains are wired for anxiety. It’s an inheritance from our ancestors that helped us as a species survive to 2021 and beyond. Unfortunately there’s no owners manual for living with an anxious brain so I decided to write one.

The worst case scenario is certainly possible but it isn’t likely. Catastrophe isn’t likely so it absolutely isn’t a certainty. Yet anxiety operates on the assumption of certainty. For our survival. Survival however is far from happiness. Survival is far from thriving. Survival is not your best life.

Given that we have brains wired for survival we can trust ourselves far more than we believe. We will survive. The key to a happy life isn’t about just surviving. It’s about thriving. So, living by default in our minds’ survival settings alone is a recipe for depression. 

Instead of just going through life in the anxious brain base mode consider the worst case as only one option of many. Yes, plan for the worst case scenario. Don’t be naive. Once you have a disaster plan live to thrive trusting that you can handle the worst case. If it happens you can survive and rebuild.

For the worst case scenario with Omicron get vaccinated. Don’t go to large and medium sized events that you don’t really want to go to anyway. COVID’s a great excuse to set the boundaries you’ve always wanted. And do what you really want to do. Live the life that gives you the most and best chances for happiness. You can thrive even in the midst of the 151st wave of this pandemic.

 

Therapy on TV!

Therapy on TV! Depictions of psychotherapy in pop culture are always fun to critique. We get a pretty good one on Showtime’s Yellowjackets. Check it out if you aren’t following along.

*mild spoiler alert*

Checkout episode two to see Shauna and her husband go to sex therapy. We get a pretty accurate portrayal of some (seemingly) vanilla folx trying to get fantasy out of their imaginations and into their bedroom. It feels like a risky proposition and if you stick with it the payoff is pretty good.

Yellowjackets https://g.co/kgs/3D9bSx

 

My Body

I’ll Be Reading My Body

Most mornings I’m up at 3 or 4 AM. I used to stay out until then and now I’m up, scrolling. I always look for stories that pique my therapeutic interests. Recently Emily Ratajkowski’s interview in the Sunday Times and that fit the bill.

It seems that Ms. Ratajkowski has been in the midst of a therapeutic journey. Existential crises don’t just come at midlife. 

Life is complicated. We’re paradoxical. As observers of the world we want all things to be simple and neat. We want good and bad. We want cause and effect. We want explanations that we can easily understand. Meanwhile in our lives we’re a complex mix of history, motives, and defenses in the middle of attempts to be happy. Ms. Ratajkowski seems to bring a lot of her human complexity to her upcoming memoir.

The woman, author, actress, and model talks about her experiences of sexual assault and rape. Ms. Ratajkowski walks her audience through how she thought about herself, her experiences, and her success within a system that is built on her dehumanization. Dehumanization is inextricably linked to trauma and traumatic events. 

Power seems to be another theme of My Body. Power in relationships, careers, and systems is under discussed in most therapy. Power dynamics are quite real. Money and sex are two of the most significant sources of power dynamics in relationships. I grapple them in therapy. Ms. Ratajkowski grapples with them in her new book. I’ll be reading.

My Body by Emily Ratajkowski came out this month: October 2021.

Amazon.com: My Body: 9781250817860: Ratajkowski, Emily: Books

 

Cutting Ourselves with William’s Razor

We have William of Ockham to thank for the problem solving maxim Occam’s razor. According to William the simplest explanation is often the best. I like the idea. We all do. We crave simplicity. Complexity is hard. And that’s how we cut ourselves by oversimplifying complex situations.

Occam’s razor that gives us tacit permission to ignore complexity and jump to a conclusion has the potential to hurt as much as help. I was reading the New York Times Daily newsletter the other morning, an almost regular habit, and the lead story got me thinking about William’s razor. The topic was inflation. The author Neil Irwin tries valiantly to explain to us his audience why stuff costs more now. The answer, we’ll it’s complicated. Occam’s razor? It need not apply. 

My work with relationships is similar. When a bomb goes off in our lives we instinctively want simple solutions. Who’s to blame? Can my marriage be saved? Why did he cheat? Should I stay or go? We want the simplest possible explanation. That instinct indeed that overwhelming desire for simple answers to a complex question hurts more than it helps. In crisis we tend to cut ourselves with William’s razor.

In complex systems like federal monetary policy, the Kyle Rittenhouse trial, and our relationships there are many variables that come together to cause our current circumstance. It’s frustrating because we can’t simply blame our husbands or our President and hope that none alone will solve our problems. Nope. It doesn’t work. Simplicity is not effective in complex situations. So what’s the alternative?

Complex situations have many variables that all coalesce within a given context. Change just one of your variables, change your context and you’ll have a new outcome. Change just one thing and it will be different. Change many things and things will be very different. We can’t control the outcome. The difficulty of that is a story for a different day. We can’t control the outcome of our relationships but we can absolutely change them. So if you know things as they are don’t work for you. Let’s do something different and see what happens.

https://www.nytimes.com/newsletters/morning-briefing

 

Running Toward Instead of Running Away

Running toward something is so different than running from something.

I’ve run, spun, and stairmastered from things for decades. Exercise is a fabulous antidepressant. I know from experience. I ran from sadness. I ran from SSRI weight gain. I ran from anxiety. 

We humans have a long history of running from dangerous things. It’s important to do. Vital.

We can and should run from distress. We get to run from burnout. Run from heart disease, high blood pressure, and type 2 diabetes.

What about running toward though? It feels totally different! 

I’ve only been running toward accomplishments for less than a year. It feels exciting and that’s completely different. 

Motivation out of fear feels like pressure. Maybe running toward a finish line is motivation for something we want. Motivation out of desire? I’m not sure but I know I’m excited. Gotta geaux!

 

Motives Matter

It’s a hallmark in criminal procedurals for detectives and prosecutors to determine if a suspect had motive for a crime. I think of motive as trying to guess the “why” someone did something. It’s something that I spend a lot of time wondering about with clients who are in stay or go situations in their relationships.

In relationships, our partners have their motives and we have ours. My experience is that we spend most of our time, energy, curiosity, and anxiety wondering about their motives. It’s far more difficult but ultimately more fruitful to invest in understanding our own motives in our relationships.

Why do I stay? Why do I want to go? What are my needs? Are my expectations too high or too low? What am I afraid of? Do I give too much too easily? These are just some of the questions that we might ask ourselves when we’re facing a stay or go decision in our relationship.

Thought about our partners’ motives are not totally useless. It’s especially worthwhile to examine and clearly see the evidence of our partners’ behavior.

Do they act maliciously or not? Do they act mostly or only out of self interest? Do they treat you the way you want to be treated, mostly? Be honest about your experience with them. It matters.

Invest the most in understanding yourself, however. See your partners clearly. If you need it help is available.

In Case of Emergency Call 911?

When I was a young therapist in training I was taught to call 911 if a client was in danger. In other words if a client was suicidal I was trained to call the Houston Police Department. To this day I hear therapists with outgoing voicemail message like the one I had in the 2000s.

This is Christopher. You’ve reached my voicemail. Please leave a message and I’ll return your call within 24 hours. If this is an emergency or if you feel suicidal please hang up and call 911.

I had some version of that voicemail message for years without much thought. I’m rethinking it now.

What if calling 911 isn’t helpful for mental health crises? What if calling 911 for mental health crises is dangerous?

What’s a better option for us therapists? What’s a better option for our clients when they’re in crisis?

On Chronic Pain

I’ve lived along side chronic pain suffers for about 20 years. I’ve had it myself. Chronic pain is a matter of time not sensation. The Mayo Clinic describes pain as chronic if it lasts 12 weeks or more. Chronic pain can be steady. It can be intermittent. The pain might ache, it might burn, it might throb, it might be dull, it might be sharp but if it lasts for three months or more it’s chronic.

The US census bureau reports the US population to be about 328.2 million people. The Mayo Clinic says there are about 3 million reported cases of chronic pain in the US each year. Less than one percent of the population sounds pretty good if you’re not one of those cases and you’re not a person who loves one of those people reporting their cases. When chronic pain has affected your life less than one percent of the population seems like a woefully underreported number. By contrast Wikipedia’s entry on “Opioid Epidemic” says in the 1990’s 100 million US citizens were affected by chronic pain. Whatever the current numbers are their big enough to warrant 5120 active research studies on chronic pain as of today. At least better help might be on the way.

Nothing activates my ready, fire, aim response more than the pain of people I care about. I see it, I feel it, sorta, through empathy pain, and I want to fix it. “Feel bad? Take a pill.” I think. Thanks for that thought I say to my American mind. That cognitive knee jerk reaction is a good reminder that my first thoughts are often not my best thoughts. When it comes to living around chronic pain I’ve made more than a few mistakes. 

Most want pain to go away. Whether it’s our pain or our loved one’s pain we just want it gone. When the mind/body connection is working well pain is a signal our bodies send to our brains that something is wrong. Something is wrong and immediate attention is needed. Ideally once the message is received and the right attention is given the signal stops. With chronic pain, however, the signal keeps blaring.

When the pain signals won’t stop the best next step is to go back and find the cause. Get the best most specific diagnosis that you can.

Amateur tip: Don’t passively accept the first diagnosis you get as the best diagnosis. Get second, third, and forth opinions. Get to the right specialists.

I’ve know football players whose chronic pain started with repeated collisions that seem like car crashes. I’ve seen rheumatic diseases up close and personal. Arthritis and joint dysfunction can cause chronic pain. Cancer can do it. Infections can cause chronic pain so can nerve disorders. There are as many causes as there are potential treatments. A good diagnosis provides a path to the right treatments.

Amateur tip: If your chronic pain is localized go to the best specialist in that body part that you can find. If the chronic pain is generalized go to the best rheumatologist you can find.

Pro tip: If you’re having chronic genital pain get a consultation from San Diego Sexual Medicine.

Treatment for chronic pain has come under great and appropriate scrutiny given the over prescribing of opioid medications in the United States for the last 25 years.

Amateur tip:: For a heartbreaking illustration of this disaster check out The Pharmacist on Netflix.

What can we do about chronic pain besides taking a pill? There has been some evidence that shows chronic pain suffers have lower levels of endorphins in their spinal fluid than non-suffers. Acupuncture and electroacupuncture increase endorphins in that same fluid.

I’ve bought more than one TENS unit in my life. These help some episodes of nerve pain and low-endorphin levels.

There are medications that are not opioids that can help. For more information call your friendly neighborhood rheumatologist. Humira is a drug that treats chronic pain among other things and in 2018 alone the drug brought in $13.7B (that’s billion) of revenue for AbbVie.

The supplemental treatment that’s caught my eye is a specific protocol of psychotherapy – CBT-CP – or cognitive behavioral therapy for chronic pain. Cognitive behavioral therapy is a type of psychotherapy that focuses on changing our actions and our thinking so that we can influence our feelings. It’s been around since the 1960s and is one of the approaches to psychotherapy that has a lot of evidence to prove that it works. CBT works well for a lot of people with depression. CBT works well for a lot of people with anxiety so it doesn’t surprise me that CBT has been applied to people carrying the burden of chronic pain.

The protocol that I found is a manualized treatment which means in part that there’s a book telling therapists how to do it. Manualized treatments are also in theory easily replecated so that their outcomes can be more easily quantified, studied, and published. I have my reservations about this whole trend in psychotherapy. That said I’m glad to have the manual because I’m going to use this in my practice next month. The more I figure out the more I’ll share.

Love y’all,

– c

Pro Tip: If you can’t find a provider to help your client then be that provider that can help your client.

Longevity Alone Is A Terrible Measure of Happiness

I can’t decide if this is more about relationships or sexual experiences so take your pick.

Relationship satisfaction is an underrated measure of what makes for a “good relationship” and tenure is overrated. I’ve known a few married couples who get lots of praise for hitting milestone anniversaries: 30, 40, 50 years and I inevitably wonder how happy those decades have been?

Eli Finkel wrote of our era of marriage in his book The All or Nothing Marriage. Marriages that have longevity in this era must have high relationship satisfaction too. Otherwise we leave. Have all the reactions to that which you need. The trend remains.

Today we will not stay forever in situations that aren’t contributing to our growth as human beings. I see it all the time in people coming to my practice with stay or go decisions.

If you’re facing a stay or go decision there’s your work.