Contributed by Tonya Jansen, LMHCP

Within my practice, I often have clients who minimize their traumatic experiences when comparing themselves to people they read about in the news headlines.  It is always dangerous to compare ourselves to others because we will never be the best or the worst in a subjective category, but it is particularly detrimental when it comes to trauma.  And there are two reasons why:

1. There are “little T’s” and “big T’s”
2. Trauma is cumulative

“Big T’s” are often considered rape, incest, and assaults, where life-threatening injuries are reasonably assumed.  “Little T’s” are more commonly non-life threatening injuries, bullying, harassment, emotional abuse, and attachment wounds.  “Big T’s” are less common and contribute to feelings of isolation, whereas “Little T’s” are more common and may occur repeatedly throughout a person’s life.  If we compare rape to a single episode of bullying on a schoolyard playground, a majority of the population would agree that the rape would be far more traumatic than the playground example.  This is why the second point is so important to understand.

Research has demonstrated that trauma is cumulative.  This means that repeated exposures to “Little T” traumas can have significantly greater symptoms over a person’s lifetime.  Any trauma as a single incident is less likely to cause chronic mental health issues than repeated negative experiences.  In short, one “Big T” may have the same mental health impact as multiple “Little Ts”.  A “Little T” trauma may have more impact upon an individual than a trauma that occurred years earlier.   Failing to address the emotional suffering of any traumatic event may lead to cumulative damage over time.  Older people are naturally more likely to have a history of “Little T” trauma because they have lived longer, therefore creating more vulnerability to trauma-related symptoms.  Trauma exposure has a cumulative effect on anxiety, depression, suicidality, psychosis, dissociation and other trauma symptoms. 
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Let’s put together an example of this. If you have experienced an absent parent, bullying at work or school, and serious illness in life, it is valid to connect your mental illness struggles with your life experiences.  You cannot set your experiences beside another person’s trauma and determine which person is more “worthy” of trauma-related symptoms or therapy.  Minimizing the emotional suffering of any event does not remove the cumulative damage that occurs over time.  Your story matters.  

One of the most memorable classes that I took as an undergrad was about grief and loss. Every week, a guest speaker came to class to share a personal story of a time they were impacted by the death of a loved one. The story that stuck with me was that of a mother who lost her son, Ben. It was the kindness from those around her, even complete strangers, that helped her through such a heavy loss. The kindness she received motivated her to start a non-profit, Ben’s Bells, dedicated to teaching individuals and communities about the positive impacts of intentional kindness and to inspire people to practice kindness as a way of life. Ben’s Bells motto, “be kind,” is scattered around Tucson, AZ where the non-profit began, and I’ve kept that with me ever since I first heard Jeannette tell her story. You can read all about Ben’s Bells here: https://bensbells.org/

As one of MOSAIC FAMILY’s administrative assistants, I strive to be kind to every single person that calls and to every single client that walks in our door. Why? Unfortunately, I’d like to say that people need our services during the best days of their lives but that is just not the case. The person on the other line may have been trying to call to schedule an appointment for weeks but were having anxiety about doing so or just didn’t have the energy to. The person walking into our office for the first may have just lost their mother, their spouse, or their son. Now a days, all we hear about on the news, radio, social media, are stories of people hurting one another. Recently, I decided to step back from social media applications because of this. I decided to be kind to myself. Now, that I am not staring at my phone so often, I can focus on being kind to others in the smallest of ways. How? I can say “good morning” to others in the elevator and hallway as I head to the office, I can help an elderly couple understand how to use the pop machine if they are struggling while I’m out to lunch, I can send a funny picture to a friend I haven’t spoken to in a while. 

The smallest of gestures can go a long way. Research tells us that kindness benefits our physical and mental health, and that recognizing kindness in others increases a person's happiness and satisfaction. Focusing on being intentionally kind in our interactions can also improve our ability to connect with others. I believe that we need more of that now, personal connection, beyond a phone or laptop screen.
So go ahead, hold the door open for someone, let the person with one item go ahead of you at the check-out line, be kind to the barista who may not have gotten your order correct because it was her first day on the job.
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Kindness is free, sprinkle it everywhere. 

It’s a very simple question but oh how deep the effects of having a support system. Imagine taking the world on your shoulders and not having anyone else to share the load with. It can be the difference between positive mental health and negative mental health. When the stressors of daily life compound, a person needs an outlet or a place they can unload some of those stressors. While it is wonderful that many people meet with their therapists, all too often this is a one-hour meeting out of an entire week that consists of 168 hours. Take that and look at it on a grander scale and an average person that gets to meet with their therapist once a week, meets with that therapist for 4 – 5 hours a month that consists of 720 -744 hours. Out of a year, that person would meet with their therapist 52 hours, while the year would consist of 8,760 hours. That is far too much time to not have someplace else to lay one’s troubles and cares.

You might ask, how do I go about building a good support system. Members of your support system can come from all walks of life. They can be individuals with different races, ethnicities, religions, and much more diversity. A support system can consist of family members, friends, coworkers, or teachers, and can give a person a place where all the frustrations of the days, weeks, months, or even years, can be offloaded. A support system should consist of anyone that a person feels comfortable sharing very personal things with.  Look for individuals with whom you feel you could discuss anything at all without the other person judging you. Have an open and honest conversation with that person about your need to be able to share very stressful and personal things. Having nonjudgmental people in your support system is of the utmost importance. These types of individuals can help you to offload the weight of the world in an environment where it feels safe to offload whatever stressors, difficulties, troubles, and traumas you have had to endure. Also look for shared interests and experiences. An example might be finding another mom who is also going through the stress of raising young children, or a coworker who has shared with you how difficult it has been to meet the current quota. Dig beneath the negative thinking, find the courage, and just reach out. You will be pleasantly surprised how many people want to be there for you and to help you through whatever difficulties you are going through.

Many people worry about sharing their troubles with another individual, as they worry that the other person might find them a burden. I invite you to think back to a time you had to care for a loved one who desperately needed your care, compassion, and helping hands, heart, and mind. There is a very big chance that you felt very good for getting to be there for another person who desperately needed your help, as they did not have the ability themselves to provide the comfort, caring, and compassion that you provided for themselves. Mental illness will often cause a person’s mind to send messages such as stay away from other people, they don’t know at all, what its like to be in your shoes. It is often at these times that a person can make the greatest progress in defeating negative thoughts like these by doing the opposite of what the thought is telling you. If the thought tells you to isolate, find some friends to hang out with. If the thoughts tell you not to talk to anyone else, find that nonjudgmental ear to tell your troubles too. If the thoughts tell you to stay in bed and sleep longer than is needed, get up and do something, make some goals and try to accomplish them. If thoughts tell you to draw the curtains and veg out in front of the TV, binge watching Netflix, get outside and take a walk with a friend or enjoy the sounds of nature by yourself.

The most important thing of all is finding the courage to reach out. There is a world of people out there just wanting to help you through the stresses and difficulties you experience. Use your best judgement and find people who you feel safe with. In today’s modern, technological world, a new friend and confidant can be just a phone call away. Look at yourself like a builder would look at a home. No good structure would feel safe and secure without proper supports in place. No good structure would be able to withstand harsh weather and stresses without proper supports in place. Do yourself a favor and decide today that you are going to put those proper supports in place.

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!