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How to be a Therapist When Your Life is Falling Apart

Published on August 17, 2022August 16, 2022 by AkiLeave a comment

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 and Certified Clinical Hypnotherapist practicing at Clear Mind Group in Florida, Georgia, Nevada, New York, and Virginia. Call 954-612-9553 for a consultation. Follow Autumn on Twitter & Facebook.

After a Suicide Attempt – for the Loved Ones

Published on October 13, 2022October 13, 2022 by AkiLeave a comment

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.

After a Suicide Attempt – for the Attempter

Published on October 10, 2022 by AkiLeave a comment

treenage girl suffering with depression in a conversation with therapist or psychologist

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.

Ruminating Recovery

Published on September 9, 2022 by AkiLeave a comment

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.

Ways to Self-Soothe

Published on August 26, 2022 by AkiLeave a comment

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?

Your Needs in the Relationship – an exercise

Published on August 10, 2022August 8, 2022 by AkiLeave a comment

Young African-American couple at odds and bad mood not talking with each other and looking away after heated argument

If you feel that you and your partner are not as connected as you’d prefer, are not headed in the same direction (either short-term or long-term), are not seeing eye-to-eye, or may not be a good continued fit, you may consider this exercise to examine your place in the relationship, your desires, and your goals for the future of the relationship. If you both do the exercise and discuss it, it may lead to increased awareness of your goals; be aware that this may not be a harmonious discussion.

Are your needs being met in your relationship? What are those needs? Some examples may be related to physical needs, emotional needs, and/or spiritual needs. Your topics may vary. Here is a sample outline:

Physical
- Safety
- Intimacy
Emotional
- Safety
  - Financial
  - Boundaries
  - Trust
  - Privacy
- Socialization
- Communication
- Intimacy
- Progress
Spiritual
- Understanding/respect of each other’s beliefs
- Services or celebrations
- Future goals

Here’s an article that fleshes the topics out in more detail.

Why me? and It’s not fair.

Published on August 4, 2022August 5, 2022 by AkiLeave a comment

person walking in rain with red umbrella at night

When a traumatic event happens, most people are left with the question “Why me?” and the feeling of “It’s not fair.” What do you do with those and how do you move beyond the stuck feeling they leave you?

It’s not fair. No, it’s not. Much of real life isn’t fair and this thing is also not fair. There’s no making it fair. There’s no making it right. It was a terrible thing and it doesn’t have to be better or make sense or fit in with an idealized version of reality. Some things just suck and this is one of them. It’s okay that this is how it went down. Fighting the unfairness of it is futile. Allow it to be unfair and you’ll stop coming up against this obstacle.

Why me? No reason, or maybe some reason that isn’t useful to speculate. People do terrible things. Sometimes they’re terrible people, and sometimes not, but done is done. It sucks that it happened to you. Crappy things happen to people all the time and you’re one of the people that had a crappy thing (or series of crappy things) happen to them. Spending your energy trying to solve this is a wasted time.

I get that that this doesn’t sound positive or hopeful. I’m not trying to be a ray of sunshine as I think that’s too far from the truth and wouldn’t be useful anyhow. If you are throwing yourself against these walls and stuck on them, the way past them is through understanding that they don’t have to be fixed to be understood. This is only one piece of the healing, but it’s a crucial piece if its a place where you’re repeatedly finding yourself.

Be Here Now

Published on June 17, 2022 by AkiLeave a comment

Have you been feeling unmoored from your body, your sense of self, or your life? Do you feel adrift, unhinged, untethered, or in need of grounding? Have you been spinning out of control in your thoughts and unable to gain traction?

Try this mantra: “Be here now.” But say it like each word is a sentence: Be. Here. Now.

With each word, do it.

Be. Be in your body. Notice your body, the weight of it, the position it is in, the feeling of any fabric or material on your skin, and any movement of the air.

Here. In this place. Where you are, with anything you can notice around you, eyes open or closed. Engage your senses: see, hear, smell, taste, feel – to notice absolutely anything.

Now. In this moment, the only moment that exists, present as best you can, eliminating thoughts of past and future as best you can right now. It might be difficult and that’s okay; just do your best and reset and reset again if you need to.

What is a Trauma-Informed Therapist?

Published on March 31, 2022March 24, 2022 by AkiLeave a comment

What’s this buzzword “trauma-informed” mean? Trauma-informed means that the therapist has been trained to see client behaviors as symptoms of trauma, instead of as dysfunction.

Why is being trauma-informed useful? Understanding things from a trauma perspective allows a therapist to view the client as a whole person from the angle of trauma, with the behaviors as a function of trauma, as a means to an end, a repeating of negative patterns, a way they adapted to their environment. It allows the therapist to see the client outside of negative labels such as: willful, inappropriate, manipulative, or staff-splitting. This is especially useful for people who have developed personality disorders like borderline personality disorder. Seeing clients differently allows us to act differently and treat the behaviors with more care and usefulness.

Trauma-Informed vs. Trauma Specialist Is a trauma-informed therapist the same as a trauma specialist? No. There has been a big push to get therapists trained in trauma-informed care over the past 5 years or so, which is wonderful. This often consists of a single introductory-level training which may be only a couple of hours. A trauma specialist, by contrast, has been training in trauma-related treatments for at least dozens of hours, generally over many years. Personally, I have trained hundreds of hours over a decade in various trauma-related treatments over a decade.

Overwhelmed? Obsessing? A technique for you.

Published on March 24, 2022March 11, 2022 by AkiLeave a comment

several plants in pots along a sunny windowsill

Zooming in/out

When I am overwhelmed, like thinking about war and climate change and politics, global issues that I have little to no control over, I am zoomed too far out. I’m looking at life through a telescope. I’m needing to change the focus to what is now, here in front of me, that I can change or have control over.

When I’m obsessing, like thinking about day-to-day stressors and my to-do list and all the little pieces that seem to need my attention, I am zoomed too far in. I’m looking at life through a microscope. I’m needing to change the focus to what is now, that I can accomplish and check off, that I can move in the priority if necessary.

I challenge you to change your focus. Notice if you are zoomed too far in or out, and move to a more comfortable middle ground. This is a skill and takes practice, so assume that the lens is going to get out of focus sometimes, and that’s okay, but it is also adjustable and you have the ability to adjust it to be comfortable for you.