Contributed by therapist Katie Gregor, LMHC

For many years, the phrase ‘coming out’ has been predominately used in the LGBTQ community as a euphemism of living openly and authentically as a sexual minority in society. As a member of this community, I want others to know we all have something we want to ‘come out’ about. Sexuality, faith, abusive relationships, changes in mental and physical health, loss, they all impact who we are and how we function in the world. If others knew about these parts of our story, they may be more connected and understanding.  If you are grappling with the decision to ‘come out’ about something in your life to your loved ones here are some thoughts/steps to consider.

Who do I tell- Make a list of all the people in your life and decide who needs to know and who doesn’t. Having this structure may help in reducing the heaviness and overwhelming feelings connected to thinking ‘I have to tell everyone right now’. You also have the choice to not come out to individuals as well. This is your journey, invite only the people in your life that will provide support and space for you to live authentically.

How do I tell people- Face to face, letter or email, video, on the phone or through video services like Facetime and Skype, social media, each option has its pro’s and con’s. Consider your physical and emotional safety as priority one in this step. The power of face to face communication can solidify how important it is for you to share your story with another. However, this powerful connection is not worth risking your safety. Think about how you would want someone to approach you about news like this? Will their reaction (intentionally or unintentionally) stay with you for better or worse? Does sending a letter or video make sense so you can stay safe and give them time to mull over their response and questions? Is social media something you want to use to tell extended family and friends? This option is discouraged when it comes to sharing your authentic self with close family and friends.

What do I say- This is the trickiest part; how do I say what needs to be said with respect to the recipient of the message and to myself? Keep in mind this conversation is the beginning. If you don’t share everything right away or forget something, it’s ok. This is the beginning of a stronger and deeper connection. Tell them highlights of your journey, your process, what your hopes are in being your authentic self, etc. Think about boundaries you want to set in this conversation. Making statements like ‘I know there are questions but, today I want to only share my experiences with you.’ It’s never too early to set boundaries. Consider how you want to end the conversation. Let the person know you want to connect again about this in a couple days, to allow for reflection on both sides.

Now what- Consider what works best for you after experiencing an emotionally intense conversation. Do I need to go home, veg out and snuggle up with a furry pet? Do I need to exercise? Do I need to be with others who are open and accepting of my authentic self? Do I need chocolate? That’s a no brainer! This is where self-care comes into play. How do you celebrate the significant step you just took? This step is just as important as how and what you say. It takes a lot of courage to do what you just did, that deserves recognition and care.

At the end of the day, however you ‘come out’ know, there is no right or wrong way to do so. Listen to your gut and share your story the way that yields the most comfort and confidence for you. Know you are not responsible, nor can you control others reactions. You are only responsible for living and being your authentic self.

Contributed by therapist Kristen Peterson, LISW

Making the decision to begin therapy is a big step.  It’s an investment in your mental health that takes time, money and some vulnerability to talk about the not so fun stuff in life. It’s important to remember that you are the consumer. It’s likely you wouldn’t make a big purchase (house or car) without doing prior research.  The same effort should be made when looking for a therapist.  There are many good clinicians out there; however, it’s not a one size fits all.  You must do some work.

A simple first step is figuring out what kind of person you feel comfortable talking to. We are all naturally drawn to different people. Spend some time thinking about who you think would be the best fit.  Would you prefer a more nurturing person?  Someone who is more straightforward? Do you prefer someone older or younger? Do you prefer male or female?  All these preferences are valid and should be taken into consideration. 

Internet searching therapy clinics can seem rather daunting.  Get referrals from family, friends and social media groups.  They may be able to help guide you in the right direction based on their own experiences.  Look at all potential clinic websites and read therapist bios.  Find out what they specialize in and what population they work most with.  When calling to set up an appointment remember to ask what the therapist’s available hours are, as well as, what insurance they accept.  Often, therapists don’t follow a regular 9-5-hour work week.  It’s helpful to know right away any issues there might be with scheduling or insurance coverage.

If the thought of starting therapy gives you some butterflies rest assure that it’s completely normal.  You are basically meeting a stranger with the intention of sharing your life story … the good, the bad and the ugly.  Where do you even begin?!  Do you start with the fight you had with your partner ten minutes prior to your session, or do you take it back to middle school drama?  Find comfort in knowing that a (skilled) therapist knows you will be nervous and will guide the conversation, so you don’t feel like a chicken with your head cut off.  The first session is a great time to express any concerns or fears you might have.  Therapy is a team effort and you are the captain of the team – don’t hesitate to say what’s on your mind. 

The first couple sessions will quickly reveal if you feel a genuine connection.  However, it’s important to invest enough time to get past initial fears and preconceived notions.  Once that subsides and you realize something is missing it’s okay to look for services elsewhere.  If you aren’t feeling a connection, you will never fully open up, which will hinder your progress.   Remember that therapists can read body language, not minds.  If you disagree with the path your treatment is going down or feel like you aren’t being fully heard speak up!  You will not offend or hurt feelings.

The bottom line is therapy works and can be a powerful tool used to heal and improve one’s quality of life.  Studies show that if a person feels genuinely connected to their therapist success and personal growth is much higher.  Hopefully this provides some encouragement to take the next step in finding a therapist that will join you in healing.   You deserve it!

Contributed by therapist Trisha Broihahn, LMSW

It’s something I ask my clients almost every session. “What do you do to take care of yourself?” To many, taking care of themselves is an unfamiliar concept. We’re always giving of ourselves to others. We like to put other’s needs before our own. We think about how we affect people before we think about how it affects ourselves. I see this all the time with my clients. “Did you really want to pick up the extra hours at work?” “No, but I didn’t want to make anyone upset.” We rarely take time to stop and explore how we are really feeling; tired, overwhelmed, burnt-out, foggy, drained, depressed. We push ourselves to meet the expectations of others.
So why is this a problem? Why is putting yourself second a big deal? One way to think about it is like a bucket full of water. We each have a bucket and when we constantly give to others, our water slowly lowers. We give, give, give, and in return, do nothing to replenish our buckets of water. If we are not being filled at the same time, eventually our water will run out. We will be drained. Being drained of emotional and physical energy presents itself in various ways; irritability, exhaustion, mental fog, depression, lack of focus, emotional reactivity. Anything sound familiar? Yes, it’s important and sometimes necessary to take care of others, but it is also just as important to take care of ourselves.
So, what do you do? How do you start to focus on yourself when you have put others first for as long as you remember? Here are some steps…

1. Self-reflection: Take time and do a self-care inventory. You can find these online. If you’d rather do it on your own, take time to reflect on the following questions:

• What do I do just for me?
• When do I have alone time?
• What are my passions and interests in life?
• How many hours of sleep am I getting?
• What kind of food and drinks am I fueling my body with?
• Am I satisfied with my spiritual and social life?
• How am I truly feeling? Am I stressed, tired, angry, sad?
• How is my mental health?
• What brings me happiness?

1. Compare: Compare your answers to what is truly happening in your life. Look at each of your days; 24 hours each. How are you spending each hour? What percent of the day are you doing things for others versus yourself? How often are you doing things you love and are passionate about?
2. Create change: Make goals of how you are going to incorporate self-care into your schedule. Start small so you don’t feel overwhelmed, but remember self-care needs to be a priority. Write it in your schedule, just like you would an appointment. Sometimes taking time for ourselves feels unnatural, but with time you’ll feel more comfortable and begin to notice the benefits.

What is considered self-care? Lots of things! Consider the following ideas:
Taking a nap, taking a bath, journaling, listening to relaxing music, mindfulness, yoga, meditation, taking a walk or going for a run, exercising, art, getting your nails done, sitting outside, reading, dancing, getting a massage, writing a letter, going to the movies, watching funny videos, taking a mental health day, taking a vacation or small trip, going to therapy, joining a support group, relaxing in the sun, doing a hobby, visiting a friend, playing with an animal, setting boundaries, saying no. Anything to refill your bucket. You cannot fill up other’s buckets if yours is empty. You are just as important.

Contributed by therapist Diana Bonus

Have you ever noticed that you can’t spell the word challenge without change?  Sometimes the purpose of a challenge is to dispute, to question formally, or to call out to duel.  When thought about in those terms, the end result is likely some sort of change, or a compromise, at the very least.  When thinking about a New Year’s resolution, do you think challenge or change?  According to Merriam-Webster, some synonyms for resolution include tenacity, courage, and spirit.  Challenge or change doesn’t necessarily fit the definition of resolution, however, rarely does lasting change occur without tenacity and spirit, and often times we need courage to even get started. 
Many times, the New Year rolls around and we list our resolutions: lose weight, exercise more, eat healthier, drink more water, spend less, limit screen time, get more/better sleep, etc.  We start out in a flurry of spirit, vowing to make this year better than the last, and by January 12, we are so tired, hungry, worn out, and frustrated, we throw our hands in the air, say “we gave it our best,” and resolve to not let the guilt bother us.  Sound familiar?
One school of thought is that it takes 21 days to create a habit.  Recent research shows that it’s actually more like 66 days.  No wonder we have difficulty attaining our New Year’s resolutions!  What if lasting resolution, lasting change was actually attainable?  What if lasting resolution and change didn’t require a steel mindset and an all or nothing approach?  What if the only challenge was to identify the first step?  That’s right, the first step. 
If your New Year’s resolution is to get more sleep, start by going to bed 15 minutes earlier.  When this has become a habit (in 66 days), go to bed 15 minutes earlier.  If your New Year’s resolution is to spend less, buy one less coffee a week for 9 weeks (approximately 66 days) and then stop buying coffee another morning or bring your lunch one day a week.  When you institute 1 small change at a time, over time, it becomes habit, is easier to maintain, brings you closer to your goal, and is truly successful!  New Year’s resolution attained?  Maybe not yet. Change occurring?  Definitely! 
So I ask you now, are you up for the challenge?  Can you spell the word challenge without change?

Contributed by Julie Hewitt, therapist

The holidays are upon us. We are slammed with commercials, movies and advertisements telling us to do more, be more and buy more. Did you make the perfect meal including napkin rings and personalized name cards? Did you stand in line for three hours to make sure you got the hottest toy this season for the cheapest price? Are you working out daily to avoid gaining those pesky extra pounds? Did you remember to buy and wrap a gift for your cousin, co-worker, brother’s new girlfriend and the mailman? Are you exhausted just reading this list but realize it’s horrifyingly accurate?
 
If so, it’s okay! You’re not alone!
 
Take a deep breath and think about what’s important this holiday season. It isn’t napkin rings, name cards or Cyber Monday deals, is it? It’s in the small things like fresh white snow, hot cups of cocoa and most importantly, how we treat each other.
 
All too often we lose sight of our values during the season trying to show everyone how happy, organized and ‘in the spirit’ we are. The reality is that we are forgetting what it means to be joyful and spread that joy to others. Instead of running a million miles a second, I’d like for you to stop and spread joy in small ways. Say ‘thank you’ to the mailman with a warm smile. Call your friend that lives across country to let her know you were thinking of her. Read an extra bedtime story to your child even though it’s past their bedtime. Have that extra sugar cookie. Be the warmth and light this holiday season.

Cheers,

Julie H

Contributed by Shana Boger, Therapy Intern

The holidays are upon us, and so is Christmas cheer. Or at least it should be, right? The commercialism of the holiday season (not to mention the growing list of Hallmark Christmas movies that are on all month) make us excited for Christmas, but they also create an expectation in our minds. Expectations of the experience and, more importantly, expectations of ourselves. That said, the holidays can also be stressful. How many of us are hosting a holiday party and meal? How long are our holiday shopping lists? Who will all be at the family Christmas party, and how do we ensure that everyone gets along? Hoping for that holiday bonus so you can afford everything on your shopping list? The stress of the holidays can often fog our minds to an extent that we don’t even allow ourselves to enjoy the holidays.
 
I’m noticing this in myself more and more as I grow older, but I most clearly see it in my own mother. My mother is a busy, dedicated woman, and has always been the one to make the holiday meal (which begins months in advance by making a list of all the foods she needs to make, followed by a shopping list, etc.) When the holiday arrives, everything is wonderful. The food is delicious, the tree is lit up beautifully, the stockings are hung just right, and the gifts are wrapped and meticulously placed under the tree. But where is my mother while we’re eating the delicious food? In the kitchen, cleaning up the counters and helping others make their plates. Where is she when we’re opening gifts? Picking up all the wrapping paper we’ve thrown to the side in excitement. She is always thinking about what task needs to be done next in order for things to go smoothly. I know my mother enjoys her role on the holidays, but I also know that stress often overshadows our own excitement of the holidays and, the more I grow into adulthood, the more I feel myself becoming stressed about the holiday season.
 
This holiday season, I want to offer a different way of approaching the holidays. And so I’ve thought to myself – how do we reduce the stress of the holidays? It all comes back to self-care. Here are some simple, yet effective forms of self-care and stress reduction:
 

• Practicing mindfulness and being in the present moment
• Allowing yourself some quiet time, away from the hustle and bustle
• Setting boundaries for your own emotional well-being
• Slowing down! (Mindfulness helps with this, as does quiet time)
• Allowing yourself to smile/laugh!

 
Beyond the few tips that I’ve mentioned here, I also want us to think about the small things that we truly enjoy about the holidays and allow ourselves those things! For me personally, it’s grabbing a Christmas cookie and a cup of hot chocolate, snuggling in with my dog under a cozy blanket on the couch, and watching the Grinch. It is different for all of us. So grab that fa-la-latte from Caribou Coffee. Sit and admire your hard work of decorating the Christmas tree. Go outside and get that fresh air and moment away from your not-so-favorite uncle. Hum or sing your favorite Christmas carol. Whatever it is that makes the holidays less stressful and more enjoyable, do it! After all, the holidays only come around once a year.

A a clinician: Starting with a timeline of events can help you determine where the client has been and what negative beliefs are impeding their happiness and fullness of life. 

We want to find what is a maladaptive response to things that happen in life and help them become more adaptive. This is what helps people to function well. Sort of 'updating the circuits' if you will. EMDR can help you update them after you find them. 

The following is based on my experiences as a clinician. 

Start with a question like: "What is the earliest memory you have?"  An example may be something like: "I went to the hospital because I fell off the bed. I had a broken clavicle. It happened when I was 3 years old. I remember my mom being upset and it hurt a lot and I had to have my arm strapped down. I hated it. I wanted them to let my arm out but they wouldn't. My parents fought about it and it got pretty nasty. They were both mad all the time." 

This type of answer will tell you as the clinician to look for the 'I'm not safe' 'I am trapped' and/or 'I am vulnerable' negative belief, there may be other beliefs like 'I'm not important,' 'I am invisible', or 'I am not worthy',  because of the fighting going on that as a 3 year old the person believes is about him/her. 

This client could have problems with relationships, hospitals/doctors, having someone grab their arm or feeling trapped when in certain physical positions, they may have dreams about falling off of things and have general feelings of low self worth. 

Continue to get event after event and you will begin to see themes for them. You may find several times when they tried to do something and it wasn't well received or they had a couple of bad job experiences. Cluster those events as negative belief systems. 
 
Our worth is dictated to us by how our first relationships treat us. At 3 years old, it is a time when we are learning our separateness from our parents and our ability to do things. It is Erikson's 3rd stage, called Initiative vs. Guilt. We are drawn in this stage to look for things we can do on our own, start something (and finishing with help) and feel good about it. When we are told no repeatedly for trying to do things, or unable to do so, we often feel bad about ourselves.

So, this seemingly small incident can make us download one or more negative belief into our neuro-pathways. All negative beliefs make us desperately want find reasons they are not true. However, our brains see more of when that negative belief IS true. Things we see validates that negative belief, over and over again through our life. It makes it difficult to rid ourselves of that negative belief and we respond to it maladaptively over and over again. A reaction if you will to keep ourselves safe. Our brains don't know the difference between a physical danger and an emotional danger.

So, when that same person has an argument with someone they love, the old networks fire off and we have the same reactivity as when we were young. They may have a shut down, fighting or avoidance response related to all this old content that comes rushing back to them when 'triggered' to remember these things. 

This is a simplistic view, but from the age of 3 to 30, one can have several of these types of reactions and 'triggers' which makes it more and more likely that the next thing that happens to them will have the same response. These responses are maladaptive now, but they were adaptive when the person was 3 years old. It is like, the brain finds what works and sort of etches it in and uses the same response over and over again because it worked once. It is like gambling... that rush with the win prompts the next bet. 

Our job as the clinician is to find the negative belief that hurts their ability to respond adaptively and help them update that neuropathway. 

Positives experiences are things the brain doesn't spend as much time on cataloging because we are wired for health and safety, so we find the negatives first!

Getting a second positive timeline of events can help to build resiliency and show the person they have good things in their lives.  When you do both at the same time, you can reduce the activation of negative emotion substantially and not let the person leave your office with too much emotion. Keeping them in the window of tolerance. 

Have them tell you about happy events that give them positive memories and feelings. Have them bring up the positive emotion, find it in their body and assign a positive belief to that specific memory or event. Then have them tap in (tapping their heels or hands on knees, alternatingly for a count of 6 or so, don't actually count) or meditate with breathing on the positives that those memories give them. This can substantially help them to function better during your treatment and help them feel more in control of their emotions during treatment. 

There is much more to this, but these are two basic things you can use to help guide your therapy, (making a plan) and prepare them for therapy.

Hope to see you in Consultation!

In Every stable relationship the following pillars are present


Basic pillars 

1) An Openness that allows each person to Validate the other's experiences and feelings.
2) Show Empathy in their understanding of how difficult some things are for the other person.
3) Feeling safe to be Vulnerable in the presence of their partner will help the couple to,
4)  Trust their partner and see they both want a good outcome.
5) Bring these all together to form an increased Intimacy that allows a couple to move forward in healing their hurts and forgive the other.
6) A new Respect in the relationship will occur as a result of the all of this work so far. 
7) Communication, behaviors and beliefs in the 'space between' will be positive and collaborative Problem Solving will happen easier in the relationship, securing a positive future.

Some couples have never been truly intimate with each other. They need to know they have the capacity to be vulnerable enough with each other and they have experienced this ability in the past.

Most people have negative beliefs that keep them from having empathy for themselves and others. Some have a negative belief of self that they are somehow unworthy. This belief hurts their ability to see the worth in others and believe that their partners can find worth in them. Helping them to find some empathy for self, will help them find empathy in their partner. 

Empathy comes with validation of each other's perspectives. The therapist must model this, validate, validate, validate! Then help them see the child inside. Tying the past to the present, through the AIP lens is imperative in helping the client their current responses to things are very much rooted in the past. This will help them connect to themselves, so they can connect to their partners. Extra benefit... the partner sees this happening and is often able to see that child inside and give them empathy. This starts the healing in a real way. It provides a little distance to the emotional cycle and helps them to see their responses and their partner's responses as being the child's hurt feelings that are still present. 
           To be continued...

EMDR Resourcing for Couples - Early Stages of Therapy

This is only a small part of the process but the technique can be used as a stand alone resource intervention, integrated into your normal practice.

Many couples come in very angry at each other and unable to communicate in a constructive way. Both feeling misunderstood, needing a validated connection with their partner. These are symptoms of attachment deficits. Our goal is to help heal these deficits.

You may notice that one part of the couple will avoid, while the other will pursue, or conversely they may both pursue or both avoid each other and the issues that cause the wounds. These dynamics must be taken into consideration. This is a re-enactment of their own attachment cycles. 

I have found in my work with couples, there are several things that need to happen for them to be on the same page, for both to want to engage in a way that will be more conducive to healing their wounds. Although this is an intensely personal process for the individual, there is another level of vulnerability when they are together. I attempt to help them find that safe space, the in between, where they can see the other with deeper connection.  Our client is the relationship. To get to the heart of the connection, each person must identify their own vulnerabilities, empathize with the other and a desire to forgive. 

Before I begin, I discuss their intentions individually to make sure they both have the goal of staying in the relationship and will do the work it takes to be successful. I theneducate them on how the wounds in their relationship are symptoms of old trauma or bad experiences from both partners that has been brought into the relationship, into the 'space between'. I help them understand how trauma affects the brain and how their neuropathways are 'frozen' by repeated 'validation of the negative belief' throughout life experiences. I discuss how that effects their behaviors and emotions in and about the relationship. I explain to them how EMDR can help to reduce the interpersonal negative effects of those events.

I also teach them the technicalities of EMDR work and how to 'walk it through' or 'tap it in'. I show them the feet as I walk through as I sit. I also demonstrate tapping on my knees and say "just tap like this, not too fast, between 6 and 12 times, not too many, but don't count". I find it helps them to be able to have dual attention for the resource. I also work with them on their own individual calm place, conflict free place in nature. It is imperative that the individual have skills to self calm and regulate. 
​
Couples must BOTH want to save their relationship and be committed to each other to work it out. Identify the commitment to the process. That is the beginning of the healing. Then you work on their ability to be INTIMATE with each other in a sense of human connection.
Validation, Empathy, Vulnerability all work toward an Intimate, connected relationship. 

Here is one thing you can do to help the enhance the positives of the shared space, between them. 

Teaching  how to formulate a SHARED Conflict Free Image of Togetherness is one step to help remind them they are on the same page.

The following is written from the therapist perspective, with narrator comments in parentheses. 

Therapist: Have you ever been on a trip or had a shared experience where you experienced a really good connection? Have them explain this experience.
                         (I often get answers like, honeymoon, trip without the kids, camping, road trip. All places where freedom is the feeling, reduced responsibilities etc.  Their perceptions are their own, it doesn't matter if they have the same part of that memory or one of them have a different one. They just have to use that experience to help them realize their closeness.)

Therapist: Bring up that experience, what is the temperature, what sounds are associated with the experience, smells, how are you holding yourself? Where are you in proximity to your spouse, remember those good feelings you shared at that time. Bring this up and amplify the picture, make it brighter and more intense, when you get a good sense of that closeness tap it in. (Have them tap it in or walk it through, you can have them to this together or tap for each other if appropriate). 
​
Debriefing the experience: 
Therapist: What came up for you as you were re-experiencing that time together? Share what was the best part for you (each client shares). Remember that it doesn't matter if you have different 'best parts', both of your perceptions are valid and cause good feelings toward the relationship. 

Give them this as homework on a daily basis, spending time remembering the positives of how they felt with each other. 

If you'd like to learn more, I will be presenting a full day on October 2, 2017 in Sioux City. Go to www.EMDRandBeyond.com to get more information or to have me come see you! 

I have studied many different approaches to working with couples/families. All of my comments come from studies and experience working with couples/families. Some of the more current studies for couples was in Emotion Focused Therapy. Many of the EMDR references come from my original EMDR relationship focused training by Laurel Parnell and subsequent belief focused EMDR training by Roy Kiessling. As most therapists accumulate knowledge and don't remember where it was learned, so do I. This is an attempt to give credit to those who came before me and have shown how well they do their work.  

     It's hard to remember to be grateful all the time. But when we can, it is a very satisfying feeling. 
True gratitude doesn't come from saying 'thank you' rotely, or saying we appreciate something. 
But, being grateful for something is an action. An acknowledgement of what you are happy that you have. 
     The dictionary says that 'Grateful' is a feeling or showing an appreciation of kindness; thankfulness. 
What are you grateful for? 
     Sometimes it is difficult to articulate, or show our feelings of thankfulness and appreciation. Sometimes it is easy. If you know the person. But how often do we express gratitude or thankfulness to others that you don't really know. Those that have an impact on your life even if just a small one. The person who goes out of their way to make sure your coffee is just right. The person who complimented you on something of small importance. That random person who opens the door for you or the greeter at the grocery store? These people make a difference if you stop to think about it. Problematically, they become part of the wallpaper of life. We don't notice these things because we are busy, rushed or just simply not focused on being where we are in the moment. 
     What would it take to be here, in the moment... from moment to moment and show simple gratitude? 
Do you notice gratitude when you feel it?
     I have this overwhelming feeling of gratitude when I look outside and see a beautiful landscape or sunset. Cliche maybe. But it is true. It fills my heart with wonder and thankfulness that I have the opportunity to see such beauty. I have had many experiences like that in my life. I try to take pictures of those things, but they never seem to do those views justice. 
     I have also had the opportunity of  spending special time with family and friends. I have such a great warmth when I look out at the scene of those that I love and can't help but feel gratitude for the time we are spending together in that moment. 
     When I go back to my life, I begin to loose my focus on gratitude that shortly before filled me up. I wonder why that happens? 
     I would love to hold on to that feeling all the time. I will look to see what it will take to do so in my future. 
     What will you do to hold onto that wonderful feeling of deep gratitude that has the power to fill your heart?