Written by: Dr. Alyson Nerenberg,Psy.D., CSAT-S
Last December I had a texting communication with a “friend” who had recently lost her father. She was communicating to me through texts about how painful her grieving process was. I had commiserated with her and said that “I so got it”’ and that I hoped the year 2018 would be better for both of us.
She quickly attacked me and said “you didn’t lose your parent so how could you possibly understand grief?” I then received a barrage of texts about how much deeper her pain was than anything I could possibly understand.
There was a lot that was wrong with this communication. The first and most important point, was that it was done through texts and not through verbal communication where tones of voice and contexts could be understood. The second point was that she was no longer a close friend due to many different circumstances and I should probably not have tried as hard to be empathetic towards her. Thirdly, due to the change in our level of intimacy and my own boundaries, she was not aware of the losses I had suffered throughout the past several years.
This brief and unsuccessful communication led me to think deeply about the process of grieving losses. Do only people who have recently lost loved ones have the right to grieve losses? Also, so many of the tremendous losses we experience are kept hidden away from others.
When someone close to us dies, it is often very public. There is a funeral, a burial and a time when friends and family step up and show support for the surviving family members. Friends may bring meals, send condolence cards and share memories about how their loved family member mattered. These losses are devastating, however both the life of the deceased person and the survivor are acknowledged and honored through the sacred rituals of mourning. Friends often check in and see how the surviving family members are doing for months afterwards. In the healthy grieving process there is a sense of closure, as well as support. This grieving process has been widely discussed and understood both in literature and throughout popular culture.
However, there is another type of grief that is much more hidden and insidious. This is the grief that occurs as we experience significant yet not as easily defined losses. Dr. Pauline Boss coined the term “ambiguous loss” to explain the grief that can be experienced from the loss of a loved one, who is still alive, accompanied by a change or death of the relationship. Dr. Boss initially wrote about this phenomenon to describe the grief that occurs when there is the trauma of a missing child or a loved one who is at war. I believe it can be expanded to describe the situation when there is a betrayal discovered in a marriage and there is a huge disappointment to be grieved. If it is a sexual betrayal, it is devastating and can lead to separation or divorce which can be the “death of the dream of an intact family”. If it is an emotional or financial betrayal it can lead to feeling scared and not safe. Also, addiction often contributes to devastating physical and emotional absences even though the family member may still be alive.
There can also be ambiguous grief suffered when a loved one experiences a significant illness and is not functioning in his or her former state. For example, when a parent has experienced Alzheimer’s and is no longer living like her vibrant self, there is often a tremendous amount of grieving that occurs for the whole family. Additionally, there is the grief that occurs when a child is diagnosed with a learning disability or a significant health condition. Often there is the death of the dream of your expectations for that child. There is also the carried grief you have when a close family member or friend experiences cancer. Sometimes all of this ambiguous grief builds up. You are not sharing it publicly due to honoring your loved one’s wishes. However, it is inside you like frozen grief. You may believe that you do not have the right to feel sad and think that you need to be strong for your family members.
When frozen grief is not spoken about, it often turns into shame and a general sense of feeling deficient. Furthermore, it can be somaticized and felt deeply in your body as aches and pains, as well as a sense of heaviness. Sometimes it can lead to depression and anxiety and a feeling of not wanting to get out of bed in the morning. Frozen grief manifests itself differently in everyone, however one thing is for sure, no one gets out of life unscathed or not touched by grief.em
My own myriad of grief experiences in the winter of 2017, may not have appeared catastrophic to many people, but for me they sure felt overwhelming. Grief is relative, and I felt knocked down by my parents’ aging process, my brother’s diagnosis of bone cancer and his subsequent leg amputation, my son’s learning disability and some additional stressors in my marriage. On top of all that, I was trying to provide support to two close friends with cancer, as well as being a steadying force for my daughters as they dealt with some of the inevitable disappointments that occur during the teenage years. However, to the outside world, or anyone who was friends with me on Facebook, my life looked flawless.
It is important to remember that no one knows how much grief another is carrying. We all need to be kind and realize that there isn’t a person alive who doesn’t experience significant pain. As a psychologist, I am not immune to grief, however I do have the benefit of knowing how to work through it. During this past year I increased my own selfcare: which included playing a lot of tennis, journaling, reconnecting with close friends, as well as attending a Growth and Transition Weekend Workshop based on the teachings of Elizabeth Kubler Ross. Additionally, I changed my diet and let go of a lot of extraneous commitments, so I would have more time to relax.
For those of you reading this blog post, please know that you are not alone in your grief. If you are struggling with handling your pain and want a safe place to process it, please feel free to contact our practice and connect with a therapist who is skilled at helping assist you cope with losses. We are all in this together and can hold each other up as we move through our darkness into the light.
Sending You All Love and Light,
By: Jessica Feldman, M.S.S., LCSW
As a therapist, treating an eating disorder is complex, multi- faceted, and non- linear. It requires the ability to collaborate with a strong team of both professionals specialized in treating eating disorders as well as the loved ones who are integral to the individual’s recovery. It is this experience and more for an individual who is contemplating seeking treatment or beginning treatment.
An individual in the early stages of recovery may be confused by where to start and whether now is the right time for them to commit themselves to treatment. It is common for individuals to delay seeking help due to distorted comparisons and questioning whether one is “sick enough.” An individual who is initially seeking treatment may be more externally motivated as friends and family begin to notice changes in behavior and/or physicality; and begin to express concern. It may be difficult to reveal the secret of an eating disorder to others due to fear of judgment and loss of control. An individual therapist and support group can provide a non-judgmental space to talk about symptoms and successes.
Therapeutic rapport and trust is frequently challenged and must be attended to throughout treatment as an eating disorder therapist likely is providing conflicting information from all the environmental, physical, intellectual, and emotional sources that are reinforcing the eating disorder. Friends, family and sometimes even other health professionals not specialized in the treatment of eating disorders may be praising weight loss and exercise stamina. Nutrition websites provide convincing information on diets that should be strictly followed and foods that are to be avoided. Media and marketing provide endless messages that maintain core beliefs of not being “good enough.” As a therapist, it is often an uphill battle to fend off myths that are coming from multiple sources.
Eating disorders are compelling and are maintained for a reason. They provide incredible amounts of visible reinforcement in a world that often lacks clarity. They numb individuals who are escaping emotions that are uncomfortable. For many making oneself feel physically empty or filling an emotional void becomes a coping skill for dealing with depression, anxiety, and trauma. It is controllable, measurable, and precise unlike the emotions that are being avoided.
The important work in eating disorders is about addressing the ability to cope with emotions, yet one must be nutritionally nourished first in order for this to occur. Individuals with an eating disorder then must be practicing new behaviors and integrating new information about their health while gaining insight into thoughts and beliefs that have maintained their eating disorder.
As a therapist, we have some real big asks of the individuals brave and insightful enough to start treatment. My hopes for the people that I have the opportunity to work with are that they are able to increase the ability to trust in order to ask for help, to embrace being flawed, and to increase emotional and physical balance in their lives.
By: Alyson Nerenberg, Psy.D., CSAT-S
I wear a chain with a gold coin on it around my neck. The circular coin says Brave, on it. I wear it to remind myself that I am a warrior. I have been brave many times before in my life and I can be strong again in the future, even if I feel afraid.
I remind myself that I was brave when I went to a rigorous graduate school program for my doctorate even though academics did not come easily to me. I was also brave when I decided to have my third child at almost 40 years old. Hell, I was a warrior with that one! I did not want to live my life with any regrets of what “I should have done”, so I bravely went forward. I was brave when my son had learning differences and I had to advocate for his education. I remind myself that I was brave when I taught my daughters to stand up against injustice, even when it made them feel lonely. I was brave when I chose to stay in my marriage despite hurts and disappointments. I am brave each time I open my heart to a new friendship, or make myself vulnerable to an acquaintance that already knows me. I am brave each time I connect deeply with a patient and share myself.
I am frequently blown away by the courage my patients display each and every single day. Just the fact that they arrive at my office, for the first time, without knowing me at all and trust me with their pain, is actually a huge act of bravery. Especially because so many of them were betrayed by people who were supposed to be there for them no matter what. My patients were often traumatized by parents, partners and friends. The fact that they trust me, the first time that they come in to my office is a huge act of courage and valor. I am often awe-inspired that they let me into their hearts and share the most vulnerable aspects of themselves. I take this trust very seriously and do my best to be worthy of their faith.
We all have moments of self-doubt and fear. The gold pendant that I wear reminds me who I am and what I am capable of overcoming. Being brave is bigger than any obstacle than I will face. It is who I am. I am a risk taker, a warrior and a courageous soul. Join me on our journey as we try our best to be brave as we navigate ourselves through life’s challenges.
By Alyson Nerenberg, Psy.D., CSAT-S
As a psychologist and mother of three children of different ages, I am frequently asked about parenting. Like any parent, I have moments of brilliance when everything I say comes out sounding perfectly, and other moments where my less than higher self emerges and my kids end up rolling their eyes at me. What I have learned about parenting these past 18+ years, is that we all could use a bit of support every now and then. It is in that vein that I would like to share an excerpt from a letter that I wrote to my oldest daughter as she was leaving for college. She is my first child to move away and I wanted to give her some last minute advice/words of wisdom. Please feel free to borrow whatever you would like, modify them or better yet create your own list.
- Wear color. I know that almost every woman that you meet will be wearing black. It is okay to wear color.
- Let guys take you out on dates. I know that many people in your generation will insist that dating does not happen. That is not true. The more efforts the guy is making, the more invested he will be in the relationship. Dating is about making memories and getting to know someone in many different situations.
- You will meet thousands of people in your life. Not everyone is supposed to be a “forever friend”. It is okay to drop relationships where you don’t feel valued. I promise you, there will always be new ones to replace them.
- When a family member needs you, no matter how far away they are, you go.
- Loyalty matters.
- Anything worth having requires hard work.
- Whatever you are doing, do it with heart.
- Find friends that make you laugh so hard that your eyes crinkle up and no sound comes out.
- 90% of life is just showing up. Show up for everything.
- Don’t miss classes in college. You never know who you will meet there.
- Not everything will work out in life the way you want it to, that is okay. Most of life is just adjusting to things that are outside of our control.
- As they say in the great tango scene of the classic movie Scent of a Woman, “If you get tangoed up tango on”.
- Stand up straight, look people in the eyes and let your spirit shine.
- Not everyone you meet will “get you”. That is okay. Find the ones that do and hold on tightly.
- You don’t have to be perfect. Perfect is overrated. Sometimes good enough is sufficient.
- Always remember that you are loved, deeply, completely to the core of your being.
By Katie Dixon, M.S. Ed.
After receiving training in hypnotherapy, I quickly realized that much of my work using this technique would be dispelling myths about what hypnotherapy is not. When I tell people that I am trained as a hypnotherapist, I am met with curiosity, incredulousness, and even trepidation. “Is it mind control?” people ask. “I do not want to be on all fours barking like a dog or clucking like a chicken every time I hear the sound of wind chimes”, they are quick to add. Still others respond as if the key to unlocking a great mystery has been handed to them. There is a willingness to try anything that will free them of unhealthy habits and phobias.
Each of these responses has led me down a path of providing countless explanations about what hypnotherapy is and is not. I am not convinced, however, that my attempts to define hypnotherapy in those moments have been successful. To the contrary, I have found myself grasping for the perfect summation of hypnotherapy for potential clients, loved ones, and curious strangers whose friendliness leads our small talk to the inevitable question of, “What do you do for work?”
Thankfully, having the opportunity to write this blog has provided me an opportunity to collect my thoughts on the subject of hypnotherapy. My hope is to clarify what one can expect in a hypnotherapy session and to highlight the benefits of hypnotherapy for treating many of the issues that lead people to seek the help of a mental health practitioner. Hypnotherapy can be used in conjunction with numerous other modalities and can often be sufficient for treatment in and of itself. I personally draw from various techniques to meet the needs of each client. Some areas that hypnotherapy has proven to be particularly effective are in the treatment of anxiety, depression, phobias, compulsive behaviors, addiction, pain management, self-esteem issues, and trauma. Interestingly, hypnotherapy is particularly helpful in healing the inner child after trauma. In this instance, hypnotherapy involves age regressions which can bring the client to a vivid memory in order that it might be healed. For some clients, this process can happen very quickly and for others may occur after numerous sessions. Clients who have experience with EMDR (Eye Movement Desensitization and Reprocessing Therapy), may have a comparable experience in hypnotherapy in terms of how quickly they are able to create distance from past negative experiences and behaviors.
The primary aim of hypnotherapy is to replace automatic negative thought responses and behaviors with healthier, more positive ways of thinking and being. Initial sessions are focused on gathering some background information about the current challenges a client is facing.
Once problems have been identified and goals for treatment have been established, the client will be introduced to relaxation techniques followed by a hypnotherapy session. There are several methods for inducing hypnosis. I often begin induction into hypnosis with a very relaxing guided meditation. This allows clients to gain deeper access to the subconscious mind. Clients are fully awake and conscious while in hypnosis. They have complete recollection of everything that comes up or is shared during a hypnotherapy session.
The purpose of hypnosis is simply to allow clients to approach their treatment from a deeply relaxed state. People often express that it would be impossible to hypnotize them because they may be skeptical, stubborn, or unwilling to allow the process to happen. In truth, anyone and everyone can be hypnotized. Consider the fact that most of us are hypnotized daily without even realizing it. For example, when we see a tantalizing commercial for a delicious specialty sandwich while getting ready for work only to find that later in the day find we have an nagging craving that none other than that specific sandwich can satisfy, we are experiencing the power of suggestion. This is a form of hypnosis. When we are thinking deeply while driving and miss our exit, we are in a hypnotic state. We are fully conscious and fully awake, yet accessing deeper thinking at the same time. Clients who present with severe anxiety, PTSD or any kind of phobia may find that they are in a constant state of hypervigilance. This in and of itself can be a obstacle in therapy and can lead the process of healing and change to take longer. By bringing such clients into a more relaxed state, their subconscious mind is more open to the power of suggestion and, therefore, can begin to heal more quickly after fewer sessions. The benefits of hypnotherapy for treating addictions and compulsions have been proven to decrease or cease the unwanted behaviors in a short amount of time.
The subconscious mind is undeniably powerful. This is where we store our memories as well as deeply rooted beliefs about ourselves and the world around us. Many of these beliefs developed when we were too young to discern or challenge the validity of disempowering thoughts. Early experiences in school and within our own families can lay the foundation for the way we live and make choices as adults. Much of this we are simply unaware of until we reach a place of recognizing that something is no longer serving us well. It is often in an attempt to understand our own negative beliefs and behaviors that we seek the help of a therapist. Traditional talk therapy is proven to be effective in treating all of the issues previously mentioned. Hypnotherapy is like taking the direct route to healing instead of winding through the back roads. The paths are heading to the same place and get there eventually, but hypnotherapy provides a fast track to healing and change.
Still skeptical? Schedule a session and come experience hypnotherapy for yourself. I promise you will not leave the office clucking like a chicken at the sound of wind chimes. You may just leave with a deeper understanding of what has been motivating you and a newfound desire to change old habits for the better.
by Kristina Ferrari, M. S.Ed.
Recently I stumbled upon the anthem for anxiety, or what I would imagine anxiety would sound like if it had its own soundtrack. There was a rapidly increasing beat, a deafening pulsing sound felt throughout the body, a less than kind voice barking orders and formulating its own reality. This tune even came complete with a countdown to what could best be described as impending doom. Now, it’s safe to say that this same song could be experienced by others in a far different way, even motivating perhaps. But that was not my experience. My experience, rather my reality at the time, was all negative.
It happened quite randomly and without any intention on my end. I was in the middle of my daily workout when a song from that week’s playlist began. It’s important to note that this particular exercise regimen changes every seven days. As this was the first day of the new week, each physical task — and accompanying musical selection — was new to me. As the song began I could instantly feel a sense of discomfort in my body that was unrelated to the physicality of the workout. Tension in my chest, cloudiness of my thoughts, followed quickly by a hyper focus on both how much I disliked the song and how powerless I was to change my experience. I recall these very specific words entering my mind… “Great, I have to suffer through this for a week.” Suffer. Because when we’re in an anxious state we often fail to see all the alternatives available to us.
This is one of the main problems anxiety creates. It removes, or rather it pushes out, alternative ways of thinking. Anxiety is a bully, and like a bully it takes ‘a’ truth and turns it into ‘the’ truth. It’s the modus operandi of anxiety. One fearful thought, one worry or questioning or wonder or second guessing, is turned into an absolute. It’s the “if this, then that” reality, except the issue is it’s not actually real. It’s not ‘the’ truth, a universally known, accepted and definitive outcome. It’s anxiety’s truth — and anxiety’s truth is whatever anxiety wants it to be. This could happen (it’s technically feasible), becomes this will happen (it’s a foregone conclusion). Anxiety’s power is in its ability to shut down the parts of our mind that might see things more clearly, might offer up other possibilities, could navigate us to safer emotional spaces even if the thing we fear does actually occur. Because it’s not the initial voice that highlights a potentially negative experience or outcome that’s the problem. That voice, when operating without the bully, is actually quite helpful. We may tweak or alter our approach to things based on that voice. We may even elect not to engage in particular ways because that voice opens the door for more pragmatic thinking if we are lost in a purely emotional response. That voice is the good guy and is an integral part of healthy mental state. But let’s not confuse that voice with the bully, who slyly and stealthily sneaks in and takes over.
Imagine you’re in a safe space. Let’s say a room, for the purposes of this exercise. It’s a room where you are comfortable and feel a sense of ease and contentment. Nothing bad is happening in this moment. You are safe. And then there’s a knock at the door. You naturally call for whoever is on the other side to enter, continuing to do whatever it is that you were doing, because this doesn’t require your full attention. The person tells you in a soft and measured tone that the room you’re in feels a bit warm. “Ok,” you think, “yes, perhaps I do feel a bit warm.” And then, without your knowledge or consent, when you have turned your full attention back to the initial activity, that person is pushed out the room and the bully sneaks in the open door. He looks a lot like the first person, he even sounds a bit like him. At first, that is. No, this doesn’t feel quite right, but he’s hard to ignore because now he’s getting louder and more worried and he appears to be very certain. As it turns out, the room you’re in is on fire. That’s why it’s hot. This is what he’s telling you. You don’t see any flames or hear sounds of desperation from anyone else in the house, but wow it IS hot in there now. All you can focus on is this threat and the only access you have to “help” is this person. So, you listen…to everything he says, and you do as your told.
That was me and the song was my room on fire. I had to suffer through it because the bully told me that was what I had to do. Bullies create and maintain their power not only through fear, but also through attention. Through a massive amount of mental energy that is spent trying to avoid them, worrying about coming into contact with them or what they might do next, actively trying to appease them, or attempting to make ourselves so small we can no longer be seen by them…or anyone else for that matter. It’s that mental energy — all those resources that go to “protection” — that actually keep us from seeing reality. That ultimately rob us from safety, in an emotional, and sometimes physical sense.
The antidote to all this, the way out, is first to simply pause. To press the big STOP button in your mind and cut off the fuel supply of the bully who feeds on attention. And then we have some space free to question that foreboding voice, to put these thoughts back in the hands of our authentic self. The one that can see things from a more holistic perspective, a 360-degree view. If we place ourselves back in that room, we might notice that it’s now the middle of a hot summer’s day and the sun is beaming though the window directly onto us. Or, we might remember that we had felt a bit chilly earlier due to the air conditioning and covered ourselves in a thick heavy blanket. Yes, we are feeling warm. No, the room is not on fire. Both things can be true. Once we are able to see things as they are, a whole host of options opens up for us. Close the blinds, remove the blanket, turn on a fan, leave the room. They all require some degree of effort, we can’t simply sit as we are not feel warm anymore. But none of them contain catastrophe, because none of them are predicated on a falsehood that the room is on fire.
That song, the anthem for anxiety, the one I had to suffer through for a week…turns out I had lots of options open to me once I recognized that voice for what it was — a bully. I stopped those negative thoughts by simply telling myself…STOP. Then I had the mental energy and space to see so many alternatives. And quickly they came to me, in a kind and calm voice so unlike that bully. I could mute the sound during that portion of the workout, play a different tune from my phone, create my own playlist for the week with songs I found motivating and enjoyable. I could even work to access a different emotional response from the song. After all, someone put a lot of effort into creating that piece and the fact that it was selected for inclusion would suggest that others appreciated it in a way I hadn’t yet experienced. Again, none of these options were without effort on my end. That song was not going to magically disappear from my weekly workout. It may even show up again next week or at some point I cannot predict in the future. But what I can control, what I can change, is my experience of it. That’s the thing we all have available to us at all times. The bully doesn’t want you to see that, so he creates a lot of noise to distract you, but as with all bullies he is thin skinned and weak. And his power is false. He’s a bad actor. I didn’t have to suffer through that song, I had options. And I took them. You can too.
by Dr. Alyson Nerenberg, Psy.D., CSAT-S
After 26 years of practice, I am finally writing a blog….. The reason for my long overdue post is that I have been very busy living my own beautiful/messy life and have not gotten around to writing about it, until now! By way of background, I currently juggle: a husband, three kids between the ages of seven and eighteen years old and a white fluffy dog. Additionally, I own a private practice that consists of myself and five other incredible psychotherapists, as well as a bookkeeper/office manager who keeps us all organized. On the good days, everything runs smoothly and I am filled with gratitude to do what I love and still manage to be there for my family. On the difficult days, I am managing life’s chaos the best way I can using spirituality, a positive approach and a sense of humor.
I am aspiring for this blog to be a genuine place to share some of my insights, wisdom and my down to earth way of treating obstacles. I do not claim to have all the answers, but I have learned quite a bit over the past two and a half decades of counseling patients, along with my own humbling experiences being a parent, wife and family member. Additionally, I am hoping this blog will provide an opportunity to spotlight the voices of the powerful men and women who work as psychotherapists in my practice.
In describing my approach as a psychologist, I do not believe in working from a distance, but instead bringing my whole self into the room in order to be both genuinely accessible and open. I wholeheartedly invest in the people who I work with and am very loyal, as well as care deeply about my patients.
Two of my best attributes as a therapist are my ability to be both honest and authentic. Along those lines, I need to share that one of my fears in developing a blog is that I will not have the time to update it frequently. I guess it will be my own opportunity to practice what I preach. I am frequently quoted by my patients as saying “90 percent of life is just showing up”. This blog will be my opportunity to just “show up” in a written form.
I also frequently quote the 12 Step saying that we need to “make progress, not perfection”. As a person who struggles with her own sense of perfectionism, it is okay to just have a “perfectly imperfect” blog. The psychoanalyst Donald Winnicott describes the “good enough” mother and explains that for a child to grow he doesn’t need a parent who is perfectly attuned to him at all times. Instead, he just needs a parent who is showing up, doing her best and meeting most of the child’s emotional needs. I have adapted this term to apply to the “good enough” student/therapist/blog site.
For my readers who are joining me on this blogging journey, I promise you it will be a “work in progress” but never boring and worth the ride!
Wishing you peace, love and compassion, Alyson Nerenberg, Psy. D.