3 AM hits different. No distractions. Just you, the ceiling, and the weight of everything that’s gone wrong—failed ventures, empty accounts, broken confidence. This is where most people quit. But this? This is where comebacks… More
How to be a Therapist When Your Life is Falling Apart
You are a human being in the real world and sometimes your life, like a taco, is going to fall apart. You still have a job to do. Some jobs are easier than others when heavy things are going on. Therapy isn’t one of them. You can take a sabbatical, maybe, cancel your clients for a day or two, or a week, but probably not much longer than that. Or you can keep working and get by. What to do is a very personal choice and depends on many factors that you will have to weigh. You might seek supervision about transferring your caseload while things settle down or how to proceed.
Doing the minimum Get up, take a shower, and get dressed. You can do the minimum if you have to for now. That may mean not shaving, not dressing well, or not styling your hair. It’s alright to do what you can. Even the minimum can be a lot sometimes. Go easy with yourself.
Being there for your clients when you don’t have anything to give Therapy is part conversation, part technique, part education, and part entertainment. When you’re depleted in your personal life, you may not feel able to do those things. Just show up. When the part of conversation that is yours drags, use silence; you didn’t choose to be a clown and don’t have to entertain all the time.
What do I say? But what if my clients notice I’m not myself, not cheerful, not energetic? Own it. Use it as a teaching moment to say “we’re all going through stuff and we all get by sometimes, even me, even you.” Let it be okay to not be okay all the time. Demonstrate the principles you teach. I also like the analogy “Sometimes I’m at 100% and I can give 100%, but sometimes I’m at 30% and that’s what I can give.”
How much to share Keep it to yourself to be ethical and process your stuff in your time. Use a blanket statement like “I’m just going through some things right now” or “things are just rough right now.” You don’t have to reassure your clients that you’re fine if you’re not, promise them you’ll be alright if you’re not sure you will be, or worry them unnecessarily. You also don’t want them guessing about your personal life, prying, or following up on your issues – that’s your job for them, after all.
Get therapy Don’t hesitate to get yourself therapy. Find one who is a good fit for your needs. Process your stuff. Do your homework. Be a good patient. It’s okay if you just cry the whole time. Sometimes just thinking about my therapy appointment coming up makes me cry because I’m holding it together the rest of the time until then. If you can’t cry in therapy, I don’t know where you can. Express any countertransference as it comes up.
Self care Oh boy is this a hard one! Sleep, eat decently, journal, get some gentle movement in like a walk, and drink water. Oh, and socialize and do your hobbies. You know, all that stuff you tell your clients about. I know you don’t want to and feel like you can’t; do what you can, then do a little more. Oh, I know how hard it is but you have to in order to have a chance at getting out of The Pit, and you need out. Even spending one minute on a self care activity can be progress, so mark that progress and go forward.
Referring out and consultation If there are certain topics that are too close to home right now (relationship issues, parenting issues, whatever the thing may be) or certain populations you cannot deal with right now, stop taking those new cases and refer out your existing similar cases. It’s the ethical thing to do, to let them continue their treatment with someone who has the capacity for them if you currently do not. Unsure how to do this or to whom to send them? Seek consultation. Ask your peers for recommendations on how to handle things that are sensitive for now. Consider taking a sabbatical if it’s possible for you to take a leave for awhile while you get things sorted out. Tell your clients only the brief statement you prepare in advance that does not inure them, like “I’m stepping away from my practice for now and am uncertain when I will return, but am providing you with 3 capable therapists to choose from that work with your needs and insurance. I’m emailing your their contact information and a link to their websites so you can decide who to work with.” Consultation can help you set up referrals and a statement like this. It probably won’t feel good to do, but having done it will feel like relief and will minimize countertransference.
Know that this, too, will pass. What is happening is hard, but you will persevere. You have survived every bad day so far. Keep going. Be gentle with yourself.
Autumn Hahn is a Licensed Mental Health Counselor, Licensed Clinical Professional Counselor, and Certified Clinical Hypnotherapist practicing at Clear Mind Group in Florida, Georgia, Idaho, Nevada, New York, and Virginia. Call 407-494-5280 for a consultation. Follow Clear Mind Group on Twitter & Facebook.
Fall Behind for Better Habits
Have you been wanting to have a more structured day, create a different routine, or add in something you can’t find time for, like regular exercise? Me too. I’m using Daylight Savings Time to kick that off, and you can, too.
Usually, I get up at 9 (I’m not a morning person), pee, wash my face, feed the cats, eat, and get ready for work. Now that we did “fall behind” last weekend, my body is used to getting up at what was 9am, and is now 8am. I took advantage of that last night by preparing for this morning; I set my alarm for 8. I spent about a half hour “wasting time” laying in bed, waking slowly, petting a cat, then got up and started my day. By 9, I was in exercise clothes and leaving my house. I went for a little walk, listened to a podcase, and was home by 930 (also have a phone alarm set so I’ll get home in time), to shower, eat, and get ready for work. Thankfully, I have no commute.
There was nothing difficult about that. I don’t believe resolutions have to start with the New Year, and you can make a change any time. Use what is convenient, like not shifting your sleep schedule, to start where you are at.
Autumn Hahn is a Licensed Mental Health Counselor, Licensed Clinical Professional Counselor, and Certified Clinical Hypnotherapist practicing at Clear Mind Group in Florida, Georgia, Idaho, Nevada, New York, and Virginia. Call 407-494-5280 for a consultation. Follow Clear Mind Group on Twitter & Facebook.
What are triggers?
A piece of jargon that gets gets wrong (wrongly?) is “trigger warning.” Triggers are things that remind the nervous system of a negative past event. The system responds as if the bad thing is happening, and this can be confusing, because the logical and rational mind knows the bad thing is not happening, but the subconscious part says “similar is same” and responds. This happens to protect us from further harm.
It is impossible to warn that something is a trigger as one has no idea what will trigger a person if they have not disclosed their triggers. A trigger can be a scene, like rape or war, or someone’s appearance, the way the light hits an object, the way a person moves, speaks, holds their head, or walks. These triggers may be unknown even to the triggered person because it’s happening that deeply.
Content, by contrast, is a scene that may be a trigger to big groups of people, like war or rape, violence, gore, vehicular crashes, or animal cruelty. So content can be triggering, but is not necessarily so.
I like that people use content warnings. I’m a person who likes horror movies, but I don’t like gore, animal cruelty, or gratuitous violence. None of these things, however, are trauma triggers to me; I just dislike them. I like that people are trying to do well by others by labeling things with warnings and I appreciate the efforts. I do, however, want to provide some additional education that you’re not doing the thing you intend with that particular label.
TL;DR: Trigger warnings are impractical, but content warnings are useful.
Autumn Hahn is a Licensed Mental Health Counselor, Licensed Clinical Professional Counselor, and Certified Clinical Hypnotherapist practicing at Clear Mind Group in Florida, Georgia, Idaho, Nevada, New York, and Virginia. Call 407-494-5280 for a consultation. Follow Clear Mind Group on Twitter & Facebook.
Florida’s 2023 Bills Relevant to Counseling and Transgender Persons
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Mother’s Day, Father’s Day, Arbor Day
Holidays are conflicted for many people. Mother’s Day and Father’s Day, in particular, are especially hard because of the complicated relationships we often have with our parents, our children, our grandparents, and the history of those days. It can be painful to see commercials celebrating seemingly perfect parent-child relationships, receive texts and calls, and feel obligated to see family.
Here’s the solution: Treat these days like Arbor Day. You know, Arbor Day, when you’re supposed to…worship trees like a druid? Plant trees? I don’t know. But we never even notice it passing on the calendar. Let this be that. Take those texts in like “Happy Arbor Day!” and those invitations like “Let’s celebrate Arbor Day together” oh, no thanks. Switch the words in your head and eliminate some of the heaviness.
Autumn Hahn is a Licensed Mental Health Counselor, Licensed Clinical Professional Counselor, and Certified Clinical Hypnotherapist practicing at Clear Mind Group in Florida, Georgia, Idaho, Nevada, New York, and Virginia. Call 407-494-5280 for a consultation. Follow Clear Mind Group on Twitter & Facebook.
Being Transgender is More than Preference
There can be a strong adherence to the old way of thinking when it comes to gender being binary, and the social trend of transgender people expressing their gender through hormone replacement therapy (HRT), surgeries, living as their preferred gender, and use of pronouns that more accurately fit their gender. Not only do we see this in transgender people, but also non-binary, gender-queer, and intersex people. What are all these terms? Is it relevant that we allow, or encourage, someone to follow their preference? The short answer is “yes.” And maybe it would sway you to know that it is much more complicated than binary gender and preference.
Gender is not sexuality. When it comes to discussing any of these gender issues, I want to be clear that we are not simultaneously discussing sexuality. Any person of any gender can be any sexuality, so these are two separate issues. This article will not address sexuality as to help keep the issue clear.
What is a transgender person? Did I say that right? A person who is transgender is a person who was born into a body that is not the one that feels right and true to them. (If you are a person who is not transgender, you are cisgender.) Some people take action to make their body conform to the one that they feel they should have gotten. This can be done through HRT (hormones that change the endocrine system’s response), surgery, or dressing differently. They may also use different pronouns than those they were assigned. These people are either assigned male at birth (AMAB) and feel that is incorrect, or assigned female at birth (AFAB) and feel that is incorrect. If they desire to change their gender, modern technology and science allows that to happen to varying extents depending on when they start hormonal treatments. Starting treatment before puberty can help a person to “pass,” or look more like, their chosen gender by not having gone through the puberty of the body they were assigned. This matter is currently being hotly debated and voted on in politics by people who often don’t even bother to read the bills they are voting on. Some people who are transgender do not go on HRT because of medical conditions, an adverse reaction once starting them, fear of the physical ramifications (for instance, going on testosterone can increase the odds of certain cancers), fear of having to stop them once started (due to the political climate and little research into what will happen in those cases), or other more personal reasons. Some people who do or do not go on HRT choose not to have some or all of the gender-affirming surgeries as they are averse to the risks of elective surgery, are okay with some parts of their body remaining as they are, or for other more personal reasons. It is absolutely relevant that we allow transgender people to have the sorts of treatments they desire in order to stave off body dysmorphia – a feeling that the body, or parts of the body, are not a fit – as this is a source of depression, a reason for many suicide attempts, and just a terrible way to feel about one’s self.
Okay, so that’s transgender. What about non-binary and gender-queer? I thought that was a slur? A person who feels they are sometimes more masculine or more feminine, and changes things about themselves (their clothing, walk, style, etc.) on the fly can be considered to be gender-queer, meaning changeable from time to time – as frequently as several times a day and as infrequently as several times per month. Even cisgender people will say they may feel more masculine or feminine at times, although it is not as culturally acceptable for cisgender men to assert this in public due to toxic masculinity. Yes, queer can be a slur, when it refers to someone’s sexuality, and you should not assume that label of someone else, but if they say it of themselves, assume it means “flexible” or “fluid.” You may also hear the term “gender fluid” used interchangeably with “gender-queer.” However, a person who is non-binary considers themselves to be neither feminine nor masculine, but somewhere in between They may be more androgynous in nature, but not necessarily outwardly so, as it may be how they define themselves, while conforming to a more typical presentation.
Okay, that was a lot. I’m afraid to ask what intersex is. Ah, but ask, because asking is how we learn! “Intersex is an umbrella term used to describe a wide range of natural variations that affect genitals, gonads, hormones, chromosomes, or reproductive organs. Sometimes these characteristics are visible at birth, sometimes they appear at puberty, and sometimes they are not physically apparent at all.” Its intersex awareness day – here are 5 myths we need to shatter. Amnesty International. (2022, November 28). Retrieved March 28, 2023, from https://www.amnesty.org/en/latest/news/2018/10/its-intersex-awareness-day-here-are-5-myths-we-need-to-shatter/
It used to be, and likely still remains, that intersex children had their gender chosen by the doctor who delivered them and surgeries were recommended to the parents to make the body conform to what the doctor thought was most probable or most aesthetically pleasing. But it’s so much more complicated than that! Take for example, Persistent Mullerian Duct Syndrome (PMDS), a rare disease that occurs in cisgender men who have normal-looking and functioning genitalia, but also develop ovaries, and are only diagnosed when something goes wrong, requiring a scan. U.S. National Library of Medicine. (n.d.). Persistent müllerian duct syndrome: Medlineplus Genetics. MedlinePlus. Retrieved March 28, 2023, from https://medlineplus.gov/genetics/condition/persistent-mullerian-duct-syndrome/ Learn more about intersex by viewing the video Intersexion.
ALL of those variations fall under the transgender label or umbrella in the LGBTQIA+ community (it’s the T part).
How much of a person’s preference that isn’t mine applies to me? You can be an ally by: using a person’s preferred pronouns – that’s a small ask – “I prefer to called she/her,” but putting your own pronouns on work/school documents like next to your name on an email signature or on Zoom. By the way, a person who is non-binary or gender-queer might go by “they/them, so you don’t have to ask their designation on a particular day, just call them by their name or refer to them as they. The use of the singular “they” is not grammatically incorrect, as stated by the APA style guidelines, it simply fell out of fashion for awhile, but language is living, and always changing and evolving.
But it’s a choice, right? Probably not. More and more research is showing that there are distinct differences between the physical brains of transgender people and the bodies they were assigned, so the brains of a person’s preferred gender more closely aligns with those of their cisgendered counterparts. Here is a study from 2008, another from 2018, another from 2013, and I’m certain more will be forthcoming as technology continues to progress and there are more transgender people of all ages to study. There seems to be something about physiology that leads to the brain being in the wrong body; that’s not a choice!
But I’m unlikely to ever meet a transgender person, right? You probably have. Have you ever met a redhead? Intersex people are more common than redheads, you just don’t see it like you do hair color. This study from 2016 discusses the prevalence of transgender populations, and this one from 2002 discusses the prevalence of intersex populations.
After a Suicide Attempt – for the Loved Ones
You care about someone who recently attempted suicide. What is your role now? How can you be supportive, helpful, and useful to them? Should you pretend it never happened, or follow up? Will talking about it make them more likely to try again? These are difficult waters to know how to navigate.
They’re experiencing a lot of feelings right now, and may not be able to ask for – or know – what they need. They may feel like a burden to others and feel unable or unwilling to ask for what they need. To get another perspective, here is an article for the attempter.
Be available as much as you can, and check in. The rate at which to do this depends on your existing relationship. Do what feels comfortable, and maybe 1/2 a step more. You are not expected to have a perfect solution or fix anything. Ask how they’re feeling, sleeping, eating, and what they’re thinking. Skip the platitudes like “everything happens for a reason” and “there must be a purpose you’re still here” as they feel hollow to receive and don’t create lasting change or connection.
Sort out your own feelings by talking to a therapist of your own, the family support staff at the hospital or agency where your loved one is being seen, or a trusted friend who will keep confidential what has happened. You can still lean on your loved one, but they can only give you back so much right now as they deal with their own stuff, so keep your portion lighter than theirs for the time being, but don’t withdraw, either, or be afraid to talk about some of your struggles. They likely don’t want interactions to feel phony, surface, or like others cannot be themselves – this can lead to guilt. If you have guilt, sort through it knowing that a person has to be at a personal low in order to make an attempt, and your part in that, if any, was only a part, and there are more pieces that created the depth of pain. Despite your curiosity, do your best to avoid asking them why they made the attempt as expressing the level of pain it took to try to escape it may be impossible to verbalize; do encourage them to discuss it in therapy, though any decent therapist will be exploring this.
Ask what you can do to help. This could be: making some meals and dropping them off to be heated up later, helping them get clothing or makeup to cover the healing wound, just sitting together, or checking in on them by text daily. Sometimes they want to be left alone, and if it is safe to do so, respect that request, and make the offer. Make plans for the future, something to look forward to – a restaurant you haven’t tried yet, a return to a fun activity, a small trip.
It’s okay to ask if they feel suicidal, or are having thoughts, urges, or a plan to kill themselves. Of course, making that every interaction would be annoying to anyone, but asking does not increase suicidality. You could also ask what the plan is if those feelings/thoughts return, and have a ready plan in place (mobile crisis unit, hospital, psychiatrist, therapist, who they will tell, if not you). It is relevant to know that suicidal thoughts are just thoughts, but urges and plans are more serious and safety actions can be mobilized at those later steps.
Be patient with them and with yourself as you each work through this. This part is going to suck for everyone. You’re enduring it together so you can all get through it.
Autumn Hahn is a Licensed Mental Health Counselor, Licensed Clinical Professional Counselor, and Certified Clinical Hypnotherapist practicing at Clear Mind Group in Florida, Georgia, Idaho, Nevada, New York, and Virginia. Call 407-494-5280 for a consultation. Follow Clear Mind Group on Twitter & Facebook.
After a Suicide Attempt – for the Attempter
You’ve been in a low point and it took you as far as you could go, so far that you felt ending things was the only way to get out of your misery. And it didn’t work. Maybe you were intercepted or your method wasn’t effective or executed in the right way. You’re going to have a lot of feelings interspersed with feeling nothing at all. This is normal, if anything can feel normal right now.
You might feel anger at your choices, your method, those who intervened, or God. You might feel worthless for failure at the attempt that was unsuccessful. You might feel just as (or more) sad, lonely, or depressed than you did before the attempt. You might feel guilty over the fallout to your loved ones, or inability to provide. You might feel numb, hollow, or empty – this one is especially tough as it is a protective factor, but means you cannot absorb any good feelings being sent your way during these times. Whatever you’re feeling, it’s okay. If you’re feeling something, that’s positive. Here’s the thing to note: feelings change. If you can feel this, you can feel something positive – maybe not today, but there can be hope. You’ve felt good feelings before, even if not recently, and you can feel good feelings again.
Please don’t try to do this in isolation. Maybe you can, but you don’t have to, and it’s too hard to try. When everything else is already so hard, let this part be easier. There’s hospitals for inpatient help if you need to be monitored for additional attempts and need round-the-clock care (search “psychiatric receiving hospital near me” and read the reviews to choose one), outpatient services like therapy (there’s different levels of therapy like weekly or multiple times per week, in person and online) and psychiatry. Psychiatrists prescribe medications, and it’d probably be good to look into this as your chemicals are likely lacking in one direction or another and need servicing like your car needs proper gas. I’d advise you to tell one person close to you about your attempt. Maybe someone already knows, or multiple people do. It’s okay to share as much as you’re comfortable with with these people and half your burden. Therapy is a great outlet for this, in addition, but do lean on your loved ones as they want to help you through this.
How do you get back to living? Do you just pretend everything’s fine? That’s too much effort. Be where you are. Take a break as much as you can. Step back in gently. Do a bit of work. Do a bit of hygiene. Do a bit of housework. The stuff that makes life feel normal, do some of it. If the house is still a mess, that’s okay, too. But spending 5 or 15 minutes doing the dishes or making a dentist appointment is what life is, that little stuff. And by gently, I mean even if you spend 15 minutes washing the same dish while zoned out, that’s okay. It’s still one dish down. Sometimes you have to plod along, and this is that transition point. Get by and get through.
Autumn Hahn is a Licensed Mental Health Counselor, Licensed Clinical Professional Counselor, and Certified Clinical Hypnotherapist practicing at Clear Mind Group in Florida, Georgia, Idaho, Nevada, New York, and Virginia. Call 407-494-5280 for a consultation. Follow Clear Mind Group on Twitter & Facebook.
Ruminating Recovery
Is there an issue in your life that has become the focus? Does it consume all your energy and thoughts, even when you’re otherwise occupied? Does it feel like intrusive thoughts about the same thing all the time? You’re likely ruminating.
I’ve described ruminating as “sitting in a dirty puddle with a wet butt.” It doesn’t feel good. You don’t want it, but you keep doing it. I’m here to offer you a hand up and out of the puddle, to get dry again, to feel better, to reclaim your energy. You must place your mind and face in the direction you wish to be going in order to do it differently. This is an active process and a conscious act.
Ruminating is thinking of something negative that makes you feel bad. It’s all-consuming and colors the rest of your day and life with a grey-wash.
How do I stop ruminating? Read this article. Then keep making the conscious decision to stop. Like any practice, it starts out hard and gets easier as you go. You may consider starting therapy (or discussing this with your existing therapist) to help you reframe, break bad habits, have support, or think differently during this process.
You might also like a mantra to support you in not engaging in rumination. I like “It is done. Make good choices.” Dr. Greenberg uses “Stop doing the math.” Pick a short statement that makes sense to you and your situation.
Autumn Hahn is a Licensed Mental Health Counselor, Licensed Clinical Professional Counselor, and Certified Clinical Hypnotherapist practicing at Clear Mind Group in Florida, Georgia, Idaho, Nevada, New York, and Virginia. Call 407-494-5280 for a consultation. Follow Clear Mind Group on Twitter & Facebook.
Ways to Self-Soothe
You’re having a bad day due to anxiety, depression, or just the general stress of being a human on this modern earth. You want ways to calm yourself when the things you know to try aren’t successful. Try these:
Pet an animal, real or stuffed, or a soft blanket, or a cozy sweater.
Sip a warm beverage, any that you enjoy (but you might skip the caffeine) like cocoa, tea, or coffee. You don’t have to follow Big Bang Theory’s protocol.
Take a warm shower or soak in the tub. Bonus if you have bubbles or something to add a pleasant scent. You don’t have to cleanse if you’re already clean, but bringing your core temperature up can be helpful.
Write or do art. Getting your emotions out of your body and onto the page can release pent up feelings. What you write/create makes no difference as it’s about expression, not creating something wonderful right now.
Move your body gently and briefly is fine. Take a walk around the block, dance to one song, check out some tai chi, or whatever you like best.
Massage your muscles by rolling your neck, using a foam roller, or rubbing your body with your hands.
Spend time in nature by visiting a local park, or even sitting on your porch and looking at the plants and creatures nearby.
What other tips do you enjoy that I haven’t listed?
Autumn Hahn is a Licensed Mental Health Counselor, Licensed Clinical Professional Counselor, and Certified Clinical Hypnotherapist practicing at Clear Mind Group in Florida, Georgia, Idaho, Nevada, New York, and Virginia. Call 407-494-5280 for a consultation. Follow Clear Mind Group on Twitter & Facebook.
Short-Term Therapy 