Common Misconceptions About Therapy

By Erica Cramer, LMSW
 

A client recently told me that they were embarrassed to be in therapy. They felt as though being in therapy was a sign of weakness and signified that they could not handle their own problems. After speaking with this client, I reflected on the many misconceptions I have heard about the therapeutic process and who exactly can benefit from speaking to a therapist. In this blog I want to shed light on some of these common misconceptions.

1. Therapy is for "crazy people."

Although there are many stigmas surrounding therapy, we live in a very complicated society where we are inundated with more information than most of us can process. Speaking to a therapist to manage your mental health is similar to working out at the gym to maintain your physical health. Devoting 45 minutes a week to sharing, processing, and analyzing your feelings with a non-judgmental professional is one of the healthiest things you can do for yourself. 

2. People who see therapists have “real problems.”

Everyone has problems and their problems are important to them. Regardless of how “serious” they are by society’s standards, they are serious to you. Whether you are upset about living on the street or chipping a nail, you are entitled to be upset about your problems. They deserve as much time and effort as you are willing to devote to them. Remember, therapists do not have a magic wand and resolving them is a collaborative process between you and your therapist.

3. Therapy is a place where you only discuss negative things. 

Many of my clients come into their session and say they have nothing to talk because "nothing bad happened this week." Another widely held misconception is that therapy sessions have to be negative and upsetting. Therapy is not always about complaining about your problems. It sometimes involves talking about what went well and celebrating your victories. If you acknowledge what you did right, you can replicate it or apply it to other areas of your life. The ultimate purpose of therapy is personal growth and development and that can be accomplished by acknowledging both our successes and failures.

4. People are in therapy for a distinct period of time.

Therapy means different things to different people. Some clients begin working with a therapist for a specific reason and once they have processed that reason they terminate treatment. Other clients pop in and out of therapy throughout their life. They see a therapist when they feel they need to and don't see one when they feel like they don't need to. Other clients go to therapy on a regular basis throughout their life. There is no specific amount of time you need to see a therapist. It is important to touch base with your therapist on a regular basis and ensure that they are giving you what you need from this process. 

5. The therapist is the expert and the client needs to listen to them.

Therapy is a collaborative process. Although therapists are professionally trained, clients are the experts of their lives and always know what is best for themselves. A therapist is supposed to guide clients on the journey to self-discovery not determine what they think is best for them when they do not know what it is like to walk in their shoes.

Erica Cramer is a therapist at Cobb Psychotherapy. If you would to learn more about psychotherapy and how it can support you in reaching your goals, contact Cobb Psychotherapy.

What to do When You're Feeling Overwhelmed

By Bethany Nickerson, LMSW

Lately I have had several clients and many of my friends mention that they are feeling overwhelmed, and I can definitely relate. Between work, chores, family responsibilities, exercising, and trying to still have time for a social life, it's easy to feel like you're always a little behind. Here are a few things I have found that really help me when I feel myself getting anxious and caught up in racing thoughts about everything I need to do:

  1. Do some deep breathing. My favorite is alternate nostril breathing. It helps me to get out of my anxiety brain and back into my wise mind. You can find a great tutorial from The Art of Living.

  2. Move your body. Do some stretching or go for a nice long walk.

  3. Brain Dump. Take a few minutes and write down everything that is bouncing around in your brain. All of your worries, anxieties, and things that you want to get done. Then take a red pen and cross out anything that you have no control over. This will help you focus your time and energy.

  4. Prioritize tasks. Take the remaining things on your list and figure out which tasks are time sensitive. Number things starting with the most critical.

  5. Keep a gratitude journal. Every day write down 3-5 things that went well or things you are grateful for. When you are feeling down or overwhelmed look back in your journal. This is one of my favorite tools as it gives me perspective and helps me to focus on the positive and what I am doing right.

Bethany Nickerson is a therapist at Cobb Psychotherapy. If you would like support in prioritizing and taking care of your mental health, contact Cobb Psychotherapy and see how therapy can help.

What We Can Learn from Elon Musk: Mental Health Awareness in the Business World

By Dan Perlman, LMSW

I truly loathe the use of hyperbole. “Always," “ever," “never,” and “every” are words which undermine our ability think calmly and rationally.  So when I say “No one is ever outside of its grasp and everyone must remain ever vigilant to it, I’m doing this intentionally to bring discomfort and draw focus to the “it,” which in this case is debilitating depression. In light of Elon Musk courageously sharing his personal emotional struggles in August 2018, I hope the value of mental health will continue to grow in awareness and its stigma reduced in the business world. I hope that eventually preventive mental health at work through Employee Assistance Programs (EAP’s) will become ubiquitous to the degree to which exercise and physical health have become accepted and encouraged. 

Elon Musk is a 47 year old man, born in South Africa, three times married with six children, and a resident of three countries, USA, South Africa, and Canada. Musk was severely bullied throughout his childhood and was once hospitalized when a group of boys threw him down a flight of stairs and then beat him until he lost consciousness.  His parents divorced in 1980 when he was 9 and Musk lived mostly with his father in the suburbs, which he now says was "not a good idea." As an adult, Musk has severed relations with his father, he has a half-sister, and half-brother. This summary sounds like he could be a number of my beloved clients with potential attachment issues and early traumas. I’d be on the lookout for coping mechanisms gone awry and some potential anxiety or depression down the road. 

I share this early life bio on Musk because he is one of the greatest entrepreneurs, engineers, and investors of our lifetime.  Elon Musk founded the online payments system PayPal in1998 and selling it to Ebay in 2002 for $1.5 billion.  He then went on to found SpaceX, an aerospace manufacturer and space transport services company, co-founded Tesla, Inc., an electric vehicle and solar panel manufacturer, and inspired the creation of SolarCity, a solar energy services company.  Musk is brilliant and stated that the goals of SpaceX, Tesla, and SolarCity revolve around his vision to change the world and humanity. His goals include reducing global warming through sustainable energy production and consumption, and reducing the "risk of human extinction" by establishing a human colony on Mars. There is clearly nothing beyond his grasp. 

His boundless vision made it newsworthy when he shared this summer that he suffers from issues of depression which affect his everyday life.  This contained a special message to me because many executives fear such an admission is tantamount to a loss of credibility, and as CEO there’s a constant managing of public Image.  His reality, he said, is a mix of “great highs, terrible lows and unrelenting stress” as a result of his battles with mental health. While some believe seeking treatment makes them look weak, Musk turns things on their head by sharing unabashedly to the entire world at once via the New York Times and Twitter. While he knows that telling the word will not obviate him from the pain to come, my hope is this will lead to the opportunity to process, grow, and move forward.  Perhaps he went public to help others avert their own depression? Perhaps to normalize the idea of depression?  Either way, shares in his company traded down 5% that day (TSLA $305.50-29.95) losing $5 billion in market capitalization and have since remained flat. After rising 750% since 2013 to a capitalization of $50 billion, Musk is currently worth $20 billion making him the 46th wealthiest person in the world. It will now be an interesting social experiment to see how Musk, his company, and the acceptance of metal health into the workplace EAP’s move forward. 

With one of our greatest thinkers putting himself out there the business world must now recognize we all possess a limit beyond which anxiety and depression await to pounce.  We all (hyperbole intended) must face the reality that we’re all in fact vulnerable. So yes, I use hyperbole repeatedly in this very dangerous space for emphasis because everyone must remain ever vigilant in recognizing the signs and pathways toward depression in order to fight it off. We must remain ever mindful of the need for preventive therapy and the need to normalize its use to preserve and protect our mental health no matter how big our dreams or successes.

References:

Dan Perlman is a therapist at Cobb Psychotherapy LCSW. If you would like support in exploring and managing emotions, visit cobbpsychotherapy.com to learn more about how therapy can help.

The Dark Side of "Wellness"

By Rosie Barton, LMSW

These days the buzz word on the street, in advertisements, blogs, and seemingly every app on our phone is the term "wellness." We’re constantly inundated with messages about whole foods, eating clean, cleanses, and organic beauty products. Although wellness is touted as the answer to all of our mental and physical woes, at its core it’s just another damaging manifestation of the diet and fitness industry. 

The diet industry is insidious — it sneakily inserts itself into our lives in the form of smoothie bowls on Instagram, athleisure designed to take you from that thirty-five dollar spin class straight to brunch, and bloggers advocating for everything from carb-free diets to activated charcoal. We’re told that if we simply strive enough and have the right products, we too can achieve total mind and body wellness. 

Beneath the glamour and purity of these manufactured social media posts is the dark side of obsession, guilt, shame, and deprivation. The more we attribute our moral “goodness” to what we put into our bodies, the more we’re primed to feel inadequate when we can’t live up to those impossibly high standards. The wellness industry wants you to believe that wellness is indeed a state at which you can arrive. You can (you should! You must!) “live your truth,” and “be your best self.” 

These messages inflict tremendous damage because they make us feel as if we aren’t already good enough just as we are. We’re left striving and exhausted, more preoccupied with ridding our body of toxins than getting curious about how we actually feel. The more we seek balance from something external to ourselves, the more elusive it becomes. When we rely on bone broth or juice cleanses to make us feel wholesome, inevitably we will be left with a persistent sense of emptiness or lack. 

People may come to therapy holding the belief that they somehow don’t measure up to others. It seems as if everyone else has figured out this whole happiness and self-love thing, and they’re the only ones left depressed and inadequate. Wellness no longer feels so "well" to a fitness instructor who believes she’s a fraud because her clients look up to her as the epitome of health, meanwhile she’s unable to eat a piece of pizza with her friends. Wellness is draining to the man who spends hours each evening cooking chicken breasts and portioning out baby carrots into ziploc bags to ensure he has enough food for his paleo diet at work. It’s even worse when he feels crushed by guilt and shame for “cheating” with a piece of cake at a party. Pursuing wellness is often disguised as self-improvement, but when that’s combined with traits such as perfectionism and low self-esteem, the spiral into self-loathing can be swift. 

What the wellness industry fails to acknowledge is the degree of suffering inherent in living a life in which your self-concept is defined by a diet, fitness regimen, or the financial means to buy expensive supplements and beauty products. The wellness industry is booming because it’s designed to make us believe that the right products, classes, and superfoods will finally help us arrive at our best selves. It’s time to push back against these messages and recognize the wellness industry for what it is — another way that men and women are urged to participate in rampant consumerism in order to rectify their perceived shortcomings. This isn’t self-improvement or self-care—and it certainly isn’t wellness either. 

Rosie Barton is a therapist at Cobb Psychotherapy LCSW. If you would like support in exploring and managing emotions, visit cobbpsychotherapy.com to learn more about how therapy can help.

Strategies for Coping With Mild Social Anxiety

By Kristen Quinones, LMSW

It’s common to get some nervous jitters in social settings. Whether it’s attending your first day of classes, starting a new job, going to your high school reunion, or attending a wedding where you don’t know anyone, there are plenty of common situations you may find yourself in where you’ll feel a little awkward or uncomfortable.

My favorite way to think about anxiety is this: anxiety is a feeling and it is internal. Therefore, our best tool to combat it must also be internal. So what does that mean? Positive self talk! Positive self talk does not always mean telling yourself something overly optimistic and unbelievable. Positive self talk consists of reminding yourself of what is normal, human, possible, and realistic.

First and foremost, try to normalize your feelings to yourself. Remember, most people in your shoes would also feel a bit anxious in this situation, and some other people in the room may be experiencing these same feelings simultaneously! Anxiety is not rare. People hide it quite well. There is often a chance that whoever you are making small talk with is also overthinking their questions and worrying about running out of things to say. So literally say to yourself, “Some people here may be experiencing what I am feeling on some level. This is normal. It will take us all time to become more comfortable. There is a chance this is not just me. I can get through this. I will take it one conversation at a time.”

Second, plan. It can help to plan conversation topics ahead of time and use open ended questions. How do you know the bride and groom? Have you been to a lot of weddings recently? How do they compare? Are you from the area? What was it like growing up here? What made you decide to pick this major? What do you love most about your line of work? How did you spend your summer? What are your top five favorite shows on Netflix right now?

Third, practice self care. Give yourself some credit and some breaks if you need to! Step away to the restroom, step outside, grab a glass of water, call a loved one. If you need a break allow yourself to take it. You can always excuse yourself in a situation to take care of yourself. Treating yourself to something special afterwards is also a great motivator to confront your social anxiety and practice self care.

Kristen Quinones is a therapist at Cobb Psychotherapy. If you would like support in prioritizing and taking care of your mental health, contact Cobb Psychotherapy and see how therapy can help.

Restorative Yoga to Relax and Unwind

By Bethany Nickerson, LMSW

I took my first yoga class during my freshman year of undergrad. My mom had been doing it for a few years and kept telling me that she thought I should give it a try. She was right. I loved it. I have always been a pretty anxious person and yoga was a great way for me to get back into the present moment. I really liked how each movement was joined to my breath and found that the combination of the two was very calming. I continued to take yoga each semester and completed a teacher training. I taught yoga for several years and it was wonderful to share something that I love so much with other people. That being said, going to a yoga class can feel intimidating. Clients often tell me that they don’t have time or they worry that they will “do it wrong” and feel embarrassed. One of the best things about yoga is that it is totally doable on your own at home. Lately I’ve been ending my day with a short restorative practice to help me unwind and stretch my body. Here are a few of my favorite parts of that practice:

 Source: https://www.wikihow.com/Do-the-Crescent-Moon-Pose-in-Yoga

Source: https://www.wikihow.com/Do-the-Crescent-Moon-Pose-in-Yoga

1. Crescent moon

How: Reach your arm up over your head, interlace your fingers and let your first fingers point straight up. Inhale and lengthen your spine, on the exhale lean to the right. Take a few breaths here and feel the stretch through your side body. Then on an inhale bring yourself back to center. Repeat on the left side.

Why: Opens and stretches the sides of your body and improves core strength.

 

2. Forward fold

How: Inhale and reach your hands up, extending them all the way up towards the ceiling. On the exhale come all the way forward. Take a few breaths here. On an inhale roll back up to standing, one vertebra at a time.

Why: Keeps your spine strong and flexible. Calms the mind and soothes your nerves.

Modifications: Don’t worry if you can’t reach the floor. You can rest your hand on your knees or place them on a stack of books or a chair.

 

3. Goddess

How: Sit down on the floor and either cross your legs (like the picture) or put the soles of your feet together in front of you. Inhale and lengthen your spine, imagine a string running from the top of your head to the ceiling. On your exhale roll your shoulders down your back and place your hands on your knees. If you want more of a stretch reach forward (bending at the hips) over your legs and walk your hands over to the right. Repeat on the left.

Why: Opens your hips and is a great way to ground yourself (feeling your sits bones on the floor).

Modifications: If your hips are tight try sitting on the edge of a folded blanket.

 

4. Legs up the wall

How: Slide right up against where the wall meets the floor and swing your legs up the wall. Scoot forward until your tail bone touches the wall. Lay back and picture breathing your spine back into the floor. Stretch your arms out like a T. Take several breaths here and pay attention to what you feel as you take deep inhales and long exhales.

Why: Increases circulation and promotes relaxation. Stretches hamstrings and lower back. Great for people who spend a lot of time sitting throughout the day.

Modifications: Feel free to use a firm blanket under your hips or to support your back. If you can’t completely straighten your knees that's okay! Just meet yourself where you are and don’t worry about doing it perfectly.

Remember that the point of practicing yoga isn’t to do the poses perfectly or to make yourself achieve a certain “level” of flexibility. It's all about being kind to yourself and spending time connecting to your body.

Bethany Nickerson is a therapist at Cobb Psychotherapy. If you would like support in prioritizing and taking care of your mental health, contact Cobb Psychotherapy and see how therapy can help.

Book Review: Disarming the Narcissist

By Alisha Bennett, LMSW

Disarming the Narcissist, 2nd Edition, by Wendy T. Behary was recently recommended to me after I expressed difficulty with people in my life who demonstrate narcissistic qualities.  I know I am not alone in this struggle as I’ve heard clients, friends, and family talk about people in their lives who seem self-centered, or have narcissistic traits. If you do find yourself feeling frustrated over and over again with people in your lives who seem self-absorbed, self-centered, or seem to always be putting themselves first, I highly recommend this book. Not only does it help to understand the classic narcissist or self-centered person, but it also helps to define other forms of narcissism that can often go unnoticed.

Part of Behary’s approach is about finding some empathy for the narcissist in your life, which initially was a little off-putting for me. She acknowledges this discomfort in the book and talks about the flak she received from friends and colleagues about this. Then I remembered that I do similar work with clients when I support them in coming to an understanding of what makes the people in their lives the way they are. The next step with clients is working on acceptance and then boundary setting.

Behary begins by stating that the book is: "intended to help those who are trying to deal with a narcissistic person. It will define and illustrate different types of narcissism, offer explanations for why and how narcissism develops as part of a person’s personality, and provide guidance and tools for effectively surviving and even thriving in relationships with these challenging folks. It will also help you identify your own life patterns and personal life.” 

The book did exactly what it was intended to do. It helped me to gain a better understanding of why the narcissists in my life are the way they are. It helped me to develop some empathy for them and give meaning to why they have become who they are today. I have been able think more about their life experiences and keep this in mind when interacting with them. It has helped me to see them through a different lens, rather than just feeling angry and annoyed.

Behary also provides practical and quick exercises to identify the narcissists in your life, and then provides strategies on how to deal with them. Change can be difficult for all of us, but it can start with learning how to set boundaries for ourselves and feel more confident in the knowledge that we don’t deserve to be treated poorly or made to feel bad about ourselves by others. We can have more empathy, reframe our thinking, have a level of acceptance, set boundaries, and stick up for ourselves and our needs. 

References: 
Disarming the Narcissist: Surviving and Thriving with the Self-Absorbed by Wendy Behary

Alisha Bennett is a therapist at Cobb Psychotherapy. If you would like support in prioritizing and taking care of your mental health, contact Cobb Psychotherapy and see how therapy can help.

Why Compare?

By Cherise White, LMSW

It starts when we are young and become more aware of ourselves and begin to notice how we are similar and different from others. It’s normal to compare and see how you may line up to others in various aspects of one’s self and life. However, comparison can also be a trigger for negative thinking and foster a never-ending web of negative self-beliefs. It can be stressful once you gain awareness that you have a tendency to compare yourself to others, but this stress combined with the feeling of not being able to stop comparing can impact one’s mental health. 

Sure, we learn by comparing ourselves. Even in learning environments we are often ranked and compared to others taking an exam, by GPA, or when completing tasks. However, comparison in general can lead to increased stress and low-self-esteem. It could cause a person to feel like they will never be good enough or measure up. 

 Source: https://www.criticalcactus.com/wp-content/uploads/2014/09/JIDDU-KRISHNAMURTI-Don%E2%80%99t-compare-yourself-to-others.jpg

Source: https://www.criticalcactus.com/wp-content/uploads/2014/09/JIDDU-KRISHNAMURTI-Don%E2%80%99t-compare-yourself-to-others.jpg

Tips For Dealing with Comparison

  • It could be helpful to ask yourself, what am I comparing myself to? What does this comparison do for me? How is it impacting me? What specifically is it I have interest in and how may I go about achieving it? 
  • Another possibility is to challenge yourself to scan your environment and discover what it is you are seeking. Are you wishing you would be more ambitious, skinnier, wealthier, healthier, more attractive, bolder, more outgoing, braver, more adventurous? Discover what the thing is and develop goals to help you begin to achieve it. Turn your comparison and wanting of what you are missing into action. 
  • Lastly, when we compare and work towards becoming what we see in others we have the potential to lose ourselves. Try creating and blending various elements from your discovery to develop your uniqueness. It is much more challenging to not compare and stand out than to emulate.

 

Cherise White is a therapist at Cobb Psychotherapy. If you would like support in prioritizing and taking care of your mental health, contact Cobb Psychotherapy and see how therapy can help.

How Social Media Negatively Affects Our Mental Health

By Heather Matzkowitz, LMSW

Facebook, Instagram, Twitter — these are all incredible platforms that help us connect with others, discuss important topics, and express our creativity. However, multiple studies have shown that spending ample time on social media is linked to higher rates of anxiety and depression.

I was watching a Ted Talk titled, ‘Is Social Media Hurting Your Mental Health?’ in which Bailey Parnell discusses the four most common stressors on social media. The first is that we are seeing a collection of the happiest moments. Steven Furtick said it perfectly: “We struggle with insecurity because we compare our behind-the-scenes with everyone else's highlight reel.” The second is social currency, which is all of the likes, comments, and shares that you receive on social media. With every like you receive, you experience a rush in dopamine, the feel good chemical. We all know someone (or have been someone) who has taken down a photograph because it did not get as many likes as you were hoping it would. The third, is fear of missing out (aka ‘FOMO’). This is a social anxiety linked to the fear that you’re missing something important. The fourth is online harassment. Forty percent of adults online have experienced harassment. Harassment can take many different forms and occur at varying levels.  So what can we do about it?!

Well, the simple answer would be to cut out social media altogether. But let’s be honest, this is unrealistic. Recognizing a problem is one of the first steps towards fixing it. Parnell talks about the importance of being able to identify when one of the four aforementioned social media stressors is happening to you. Ask yourself questions like, ‘Did that Facebook post make me feel better or worse?’ or  ‘How many times do I check likes?’ If you’re not content with the way these answers makes you feel then move on to create a better online experience for yourself. This could mean unfollowing a friend who posts things that are triggering for you, or deleting a celebrity from Instagram who you find you’re often comparing yourself to. Social media has the power to bring you down or make you feel lifted up. Make sure that you’re doing the correct things for yourself so that you’re feeling the latter. 

Heather Matzkowitz is a therapist at Cobb Psychotherapy. If you would like support in prioritizing and taking care of your mental health, contact Cobb Psychotherapy and see how therapy can help.

Sleep and Mental Health: 3 Tips for a Good Night’s Rest

By Allie Lewin, LMSW

I was recently asked about the effects of sleep on mental health for an article on HelloGiggles and realized that while it’s common knowledge that getting enough sleep is important for one’s physical health, how sleep affects mental health is not widely understood. In fact, living in a busy city like Manhattan, often it seems not getting enough sleep is worn like badge of honor, somehow proving you are working hard and sacrificing rest for productivity and success. However, the reality is, in order to be truly successful both at work and in your personal life, getting enough sleep is paramount, especially if you are prone to symptoms of anxiety, depression, and other mental health issues.

Studies consistently show that lack of sleep affects mental health on multiple levels as it increases stress, anxiety, irritability, depression, and anger. When we lack sleep, we feel tired and lethargic. As a result, we are less likely to engage in social interactions, exercise, and take part in other activities that provide us with a sense of connection, pleasure, and accomplishment. In addition, lacking physical and mental energy, we are less likely to follow through with goals we set for ourselves, whether it’s making it to the gym that day, completing an errand, or working on an extra-curricular project. These perceived mini-failures ultimately influence how we see ourselves as well as how we view our ability to function in the world. Lack of social connection and follow through with activities that provide a sense of pleasure and mastery leads to increased negative thoughts and beliefs about ourselves, our present lives, and our future that produces feelings associated with depression and anxiety. 

Chronic lack of sleep directly affects multiple parts of the brain including the prefrontal cortex, in charge of reasoning and decision-making, as well as the amygdala, associated with the fear response. This impact on the prefrontal cortex can mean that when a person is chronically sleep deprived, their ability to make sense of interactions and experiences in helpful, realistic ways is impaired. As a result, a person may perceive potentially ambiguous and even positive situations in ways that elicit exaggerated feelings of sadness, hopelessness, guilt, and fear (emotions found in depression and anxiety). In addition, the effect on decision-making capability means the person is more likely to behave in ways that amplify these negative states of mind. When a person is chronically sleep deprived, the amygdala becomes more active. This leads to an increase in cortisol levels, triggering the fight or flight response, which produces symptoms of anxiety. Cortisol has a stimulating effect so this increase in production makes you feel more alert, which interferes with your brain’s ability to slow down and rest. All this suggests that not getting enough sleep increases anxiety and heightened anxiety impedes ability to sleep! 

So what can you do to get better sleep and alleviate additional anxiety, depression, and irritability? Here are a few tips: 

  1. Resist the urge for that afternoon cup of coffee
    According to the American Academy of Sleep Medicine, the half life for caffeine is 3-5 hours, which means it takes your body anywhere between 3 to 5 hours to eliminate half of the substance. The remaining caffeine can stay in your body for much longer, and as a result, can drastically interfere with your ability to fall and stay asleep if consumed too late in the day. So if being well rested is a priority for you, drinking coffee, soda, or caffeinated tea in the afternoon is probably not a great idea. If you are looking for an afternoon pick-me-up, opt for a green juice or try fitting in a lunchtime workout class. 
     
  2. Make mental checklists well before bed
    People with anxiety or just a busy mind tend to have difficulty falling sleep. Sometimes laying in bed is the first time throughout the day when attention and energy is not being directed to something specific (other than attempting to sleep) and our brains begin to wander, processing the events of the day, and preparing for the next. This can lead to rumination and mental checklists that interfere with falling asleep. Try to set aside time well before bed for this mental processing and preparation. By giving your brain permission to process and plan in advance of bedtime, you will be putting yourself in a position more likely to enable sleep. 
     
  3. Rid yourself of technology at least 30 min before sleep
    Engaging in technology, including your phone, computer, or TV right before bed is one way to set yourself up for a poor night of sleep. The blue light emitted by such technology decreases production of the hormone melatonin, which makes it harder to fall and stay asleep. In addition to a decrease in melatonin, engaging with such media before bed sends signals to your brain that it still needs to do work and as a result interferes with it’s ability to slow down and initiate sleep. To ensure you’re giving yourself the best chance at getting a good night of rest, give yourself an hour before bed to start winding down. Instead of reaching for your phone or sending that last email, try doing some light reading, listening to a podcast, or using a guided meditation/relaxation exercise. 

Allie Lewin is a therapist at Cobb Psychotherapy. If you would like support in prioritizing and taking care of your mental health, contact Cobb Psychotherapy and see how therapy can help.

Understanding Obsessive Compulsive Disorder (OCD)

By Salina Grilli, LMSW

 “Oh that’s just my OCD.” – A friend commenting on how organized she is. 

Obsessive Compulsive Disorder (OCD) is one of the most commonly misunderstood mental illnesses. It is often associated with organization and cleanliness. However, OCD is a complex disorder that is more than just ‘cleaning’ and ‘organization.’

What is Obsessive Compulsive Disorder (OCD)?
OCD is a neurobiological disorder that is characterized by intrusive and recurring thoughts, feelings and/or sensations (obsessions), accompanied by behaviors that are used to minimize discomfort and ‘undo’ the obsessive thought (compulsions). 

What is it like to suffer from OCD?
Imagine this scenario: You’re home with your spouse cooking dinner one night. As you chop up the vegetables, you have an image pop into your head where you grab the steak knife from the counter and start stabbing your spouse. 

Individuals without OCD might say to themselves, “Weird, I must be watching too many true crime shows, maybe I should cut back,” and then return to cooking. 

For individuals with OCD, intrusive thoughts are much harder to let go of. You might think, “What if I’m actually a murderer? I might lose control one day and kill my spouse.” Since this is incongruent with your values, you feel anxious and panicked. To reduce your anxiety, you might engage in a compulsive behavior (for example, repeating the word ‘peace’ to yourself 10 times). This provides you with temporary relief. When the thought comes back, you feel more anxious and have to repeat the word ‘peace’ 10 times. As these intrusive thoughts reoccur you find yourself trapped in the OCD cycle:

 

So, how do I know if I have OCD?
Everyone experiences intrusive thoughts, but for individuals with OCD these intrusive thoughts are almost impossible to ‘let go,’ and their thoughts become debilitating.  In order to be diagnosed as having OCD, obsessions and compulsions must cause significant impairments in functioning and/or take up a substantial amount of time (at least one hour per day). If you find yourself fitting into one of those categories, it might be helpful to speak to a therapist to assess whether you have OCD. 

What are common obsessions?

  • Contamination
    • Examples: germs, bodily fluids/waste, toxins/chemicals
  • Fear of Losing Control
    • Example: Fear of harming your children. 
  • Responsibility for harm or mistakes
    • Example: Fear of being responsible for a fire or car accident.
  • Order/symmetry 
    • Example: Fixation with ending on even numbers.  
  • Obsessions concerning violence, sex, morality and religion
    • Example: Hurting a family member

What are common compulsions?

  • Checking
  • Decontamination
  • Ordering/arranging
  • Repeating actions
  • Reassurance seeking rituals

What are the best treatments for OCD?
The most effective treatment for OCD is a combination of Exposure and Response Prevention (ERP). Exposure and Response Prevention is a subset of Cognitive Behavioral Therapy (CBT) that exposes individuals with OCD to their intrusive thoughts, images, and sensations (obsessions) without using anxiety-reducing techniques (compulsions). 

The purpose of exposure therapy is to reduce the anxiety associated with the feared thought/image/sensation. This is accomplished through exposures that help an individual recognize that their thoughts are irrational. 

ERP is often paired with Cognitive Behavioral Therapy (CBT), which focuses on understanding and changing unhelpful thoughts, behaviors and emotions that reinforce the OCD cycle.

How effective is treatment for OCD?
According to Stanford Medicine's Department of Psychiatry approximately 65-75% of individuals who complete ERP therapy maintain improvements 6 months and 3 years after the intervention.

References: 
Abramowitz, Jonathan S. Getting over OCD a 10-Step Workbook for Taking Back Your Life. The Guilford Press, 2018.

Salina Grilli is a therapist at Cobb Psychotherapy. If you would like support in prioritizing and taking care of your mental health, contact Cobb Psychotherapy and see how therapy can help.

How to Develop an Attitude of Gratitude

By Shaudi Adel, LMSW

As we try to stay cool during this heatwave in the city, I find myself complaining about the heat and humidity outdoors, and sometimes even the chilly, highly air-conditioned office I work in! The sad part is that only four months ago I was complaining about the longest winter I’ve ever experienced, and how I would basically do anything to feel the summer heat!

As you can probably tell, I have let the mindless complaints flow. I have forgotten to practice gratitude for the present moment and the positive experiences I am having during the temporary summer season (before winter strikes again!). If we are not finding moments to count our blessings or see the positive in a situation, we are sure to fall into a pattern of seeking out the negative in experiences, which takes a toll on our mental health. Here are some easy ways to develop an attitude of gratitude:

1.    Keep a gratitude journal and commit to write down 3-5 things you are grateful for at the end of the day. This technique is an easy one to implement in your wind-down routine before bed. Keeping the list simple with only 3-5 items can be an easy way to make gratitude a daily habit.

2.    When you’re outside, find something you are grateful for with one or more of your senses. For example, take a look around and identify something you are grateful to see. For me, I will make it a point to walk through Bryant Park on my way home from work in the evenings—it’s a fun way for me to practice gratitude of the greenery and the summer vibes! 

3.    Complete a gratitude meditation at the start of your day. A gratitude meditation is just a technical term for taking a predetermined amount of time to reflect on the people and things in your life you are grateful for. You can pair it with some deep breaths with your eyes closed if you’d like. Also, a quick online search can connect you to multiple gratitude meditation scripts or, if you prefer, you can find audio files to play that will guide you through a script.

The research is clear — adopting an attitude of gratitude is good for improving your mental and physical health, building self-esteem, lowering depression, and enhancing resiliency from trauma (Morin, 2015). Try to incorporate some gratitude into your day and allow yourself to experience the benefits of [literally] changing your brain through this simple behavior.

References:
Morin, A. (2015, April 3). 7 Scientifically Proven Benefits of Gratitude. Retrieved from https://www.psychologytoday.com/us/blog/what-mentally-strong-people-dont-do/201504/7-scientifically-proven-benefits-gratitude

Shaudi Adel is a therapist at Cobb Psychotherapy. If you would like support in prioritizing and taking care of your mental health, contact Cobb Psychotherapy and see how therapy can help.

Saying Goodbye to Summer

By Erica Cramer, LMSW

For most people, summer is their favorite season. The warm weather often inspires people to try different things, meet new people, and travel to interesting places. Despite the many positive aspects of summer, it also presents challenges regarding boundaries and self-care. Some people struggle declining a beach trip they cannot afford or don't give themselves enough time in their apartment decompressing. To make the most out of the last weeks of summer, I suggest the following:

  1. Find time to relax. Things in the city are much quieter and work is often less busy over the summer months. Take advantage of summer Fridays or uncrowded streets on the weekends. Do things that you enjoy but usually do not have time to do. See the museum exhibition you always wanted to see or have lunch outdoors with a friend.
     
  2. Learn to say “no.” Just because the weather is warmer, it does not mean you can do everything. If someone asks you to do something and you do not want to it, simply say no. Sometimes it is best to say why you are declining an invitation first and then actually decline it. Also, if you would like to spend time with that person you can think of an alternative option that you would prefer to do instead.
     
  3. Take advantage of the outdoors. Nature can be extremely therapeutic (especially when you live in a city known as “the concrete jungle”). Whether you prefer taking a walk in a park or escaping the city for the day, both options can prove beneficial to your mental wellbeing. Seeing different scenery can help you reflect and see things from a different perspective.
     
  4. Know your limits. Everyone needs to do different things to take proper care of their mental and physical health. Know what you need to do to feel good about yourself and ensure that you set aside time to do it.
     
  5. Clean your surroundings. Summer is a good time to get organized and get rid of unnecessary things. Take advantage of downtime in the office to clean your desk or a relaxing weekend at home to clean your apartment. Although cleaning can sometimes be annoying, you will likely feel better after it is done.

Erica Cramer is a therapist at Cobb Psychotherapy. If you would like support in prioritizing and taking care of your mental health, contact Cobb Psychotherapy and see how therapy can help.

Mind Full or Mindful?

By Amy Brightman, LCSW

After attending a week long intensive training in upstate New York last week with spotty cell phone service and plenty of time with nature, I realized I spend a lot of time up in my head and only small moments actually feeling my feet on the ground. Like a true New Yorker, not being “plugged in” and the absence of sirens and horns while I slept felt a little eerie. But after a few days, I started to settle in and really feel what it is like to breathe, walk, and be in the present moment.

It was uncomfortable: I started to recognize how my mind wanders, how I judge things, and what my body actually feels like. And, it was liberating: time didn’t seem to run away from me so fast, I actually saw all the nature around me (even on the rainy days), and I felt more aware of my needs. Everything started to feel like a natural schedule rather than an imposed schedule. And then, poof, I came back to New York City. I went right back to my autopilot mode. So, it got me thinking: how do I accomplish being in the here and now in a life that is so focused on what’s next? And, boy, do I need to practice what I preach!

I’ve been reading Jon Kabat-Zinn’s Wherever You Go, There You Are, and for those who want an introduction into mindfulness, I recommend reading it. Kabat-Zinn lays out mindfulness meditation in a simple way, making it not too intimidating for those who want to start cultivating their own practice. In his book, he gives recommendations for practicing mindfulness in everyday life. It got me thinking about my own practice and ways to ground myself, to actually put roots in the ground, even if it’s just for five seconds. Here’s what I’ve been working on:

  1. Just pause and think “right now.” Kabat-Zinn talks about using “this is it.” Find a word or a phrase that works for you. Use it as a signal to stop and plunk yourself into the moment you’re in right then and there.

  2. Feel the weight of your body in your chair or the concrete under your shoes as you walk.

  3. Take 10 deep breaths. Feel your belly rise and fall. Notice the sensation of breathing.

  4. Close your eyes and recognize how you feel today. How are you feeling emotionally? How do you know you feel this way?

  5. Name five things that you see, four things that you feel, three things that you hear, two things that you smell, and one thing that you taste in that very moment.

These are all pretty quick things I can do any moment in my day, but mindfulness is a practice because it requires practice. Some days mindfulness comes a little easier to me and other days it feels very challenging. As I continue to add to my list to develop my own practice, I encourage everyone to start their own lists. You can even make commitment to limit distractions - I’ve been keeping my phone in another room when I’m home. Over time, I hope to develop more awareness, acceptance, and appreciation of my here and now and I hope you can do the same. Begin by asking yourself: Am I being mind full or mindful?

 Amy Brightman is a therapist at Cobb Psychotherapy. If you would like support in prioritizing and taking care of your mental health, contact Cobb Psychotherapy and see how therapy can help.

Common Cognitive Distortions and How to Fight Them

By Kaylen Hagadorn, LCSW

Most of us experience cognitive distortions, which are thoughts that convince us of something that’s not true. We think they are rational, but really they just continue to make us feel bad about ourselves. 

Some common cognitive distortions are:

  • All or Nothing Thinking: Things are either black or white. We are either perfect or a failure. There is no middle ground.
     
  • Overgeneralization: Coming to a conclusion based on one incident or piece of evidence. One upsetting event may be seen as part of a pattern of never-ending defeat.
     
  • Filtering: We magnify negative details of situations while filtering out all positive aspects. A person might dwell on a single unpleasant detail so intensely that their vision of reality becomes distorted.
     
  • Catastrophizing: Expecting disaster to strike no matter what.
     
  • Jumping to Conclusions: Assuming we know how people are feeling and why without them telling us so. 
     
  • Personalization: Believing everything others say or do is a direct, personal reaction to us. Assigning blame to ourselves for an external event we were not responsible for. 
     
  • Emotional Reasoning: We assume that what we feel must be the truth.
     
  • Should Statements: We have rules about how we and others should behave and feel guilty or frustrated when they are violated.
     
  • Control Fallacies: If we see ourselves as externally controlled, we are victims of fate. If we see ourselves as internally controlled, we are responsible for the pain and happiness of everyone around us. 
     
  • Blame: We hold others responsible for our pain, or we blame ourselves for every problem. There is no middle ground.

Ways to fight cognitive distortions:

  1. Identify Them: Make a list of these thoughts that cause us to feel bad about ourselves so we can examine them later.
     
  2. Examine the Evidence: Find evidence that contradicts these thoughts. If we are self-critical, find examples of times we were successful.
     
  3. Double Standard Method: Rather than harsh self-talk, talk to ourselves in the compassionate way we may talk to a friend in a similar situation.
     
  4. Think in Shades of Gray: Be open to considering experiences as partial successes rather than just successes or failures.
     
  5. Survey Method: Check with others to see if their perceptions of situations are the same as ours.
     
  6. Re-attribution: Identify external factors that may have contributed to problems we have been blaming ourselves for. Rather than focusing on blame, focus on coping.
     
  7. Cost-Benefit Analysis: List advantages and disadvantages of feelings/thoughts/behaviors. This can help us identify what we may be gaining from distorted thinking.

Kaylen Hagadorn is a therapist at Cobb Psychotherapy. If you would like support in prioritizing and taking care of your mental health, contact Cobb Psychotherapy and see how therapy can help.

What Does Self-Care Look Like For You?

By Salina Grilli, LMSW

Self-care has taken off in the wellness community with articles, bloggers, and even influencers asserting the myriad of benefits that come from simply slowing down and taking time to connect with oneself. 

But what does self-care actually mean? When I talk about the importance of self-care with my clients, I often find it difficult to describe what exactly self-care means. Isn’t it self-explanatory? If you were to look at the definition of self-care, it essentially boils down to making a conscious effort to take care of your basic needs. 

What I have found, however, is that self-care means something different for every person. For example, think about a Mom with three young children. Self-care for her might simply mean taking a shower every night and fueling her body with nutritious foods that give her energy.  For a 20-something work-a-holic, self-care might mean taking a quick 10-minute break during the day to de-stress.

Point being, what your bestie swears cured her anxiety, might not be helpful for you. Establishing a self-care routine and finding what works for you will take time and practice. Here are some ideas to begin integrating self-care into your life:

  • Take a long, warm shower before bed.
    • If you are feeling adventurous, try incorporating essential oil or a scented body-wash into your routine.  Focus on finding a scent that you find soothing and relaxing. Lavender, rose, jasmine, and chamomile can be especially calming.   
  • Light a candle when you get home from work.
  • Mindfully take a few minutes to take some deep breaths (Check out our therapist Amy Brightman's blog post on how deep, calming breaths can be used to reduce stress and anxiety).
  • Sneak out on your lunch break and go for a short (or even long) walk. 
    • Maybe venture down a new block and see if you can notice something you’ve never seen. The city is full of wonderful surprises. 
  • Get a monthly (or even weekly) massage.
  • Keep a gratitude journal
    • Write down three things that you are grateful for every night before going to bed. This can range from your parents being in good health or being thankful for your favorite barista.
 (Photo taken from  Chelsea   Baker ) 

(Photo taken from Chelsea Baker

Salina Grilli is a therapist at Cobb Psychotherapy. If you would like support in prioritizing and taking care of your mental health, contact Cobb Psychotherapy and see how therapy can help.

Building a Social Support Network

By Amy Brightman, LCSW

Establishing healthy social supports is an important component of overall wellness because it enables you to manage stress more effectively.  Social supports provide physical and emotional comfort and allow you to connect with a community, which offers a sense of being cared for and valued. Social supports can take many forms—emotional, practical, informational, and intellectual—and vary from person to person. There will be people in your life you can turn to when you need to talk to someone, when you need a ride to the airport, or when you need to understand something. 

Living in a large city like New York City, despite busy schedules and the constant crowds of people, can often feel very lonely.  Maybe you are new to the city, friends may have moved away, or perhaps you are in a new stage of life. This and many other factors can make it difficult to feel connected to others. 

One thing I always focus on in therapy is: “Who are your supports?” and “What are your supports?” If you understand the “whos”’ and “whats” of your support network, you are less vulnerable to depression, stress, and loneliness. So, how do you improve your social support network? Consider some of these suggestions:

  1. Take advantage of opportunity: Don’t hold back from putting yourself out there. If you’re invited to a networking event, give it a try. If you're free on Wednesday evenings,  try volunteering. You never know who you will meet or what you will enjoy.
  2. Schedule in advance: Make plans with your established supports regularly. Try putting a monthly dinner on the schedule with your friend. Not only is it is nice to look forward to plans, but it's better when you’re not only seeing each other when things are stressful.
  3. Out with the old, in with the new: Let go of unhealthy relationships and join something new like online dating websites, meetup.com, or book clubs. Understand your boundaries and what is healthy for you, and limit negative relationships that take a toll on your wellness. 
  4. Don’t give up: It takes time to meet new people, make new friends, and find new interests, so be patient when developing connections.  Having supports is an ongoing process, and establishing a trusting relationship doesn’t happen over night.

While putting yourself out there or finding the time in your busy schedule to make plans may be difficult, you are building and maintaining connections that will support you in the long term. 

Amy Brightman is a therapist at Cobb Psychotherapy. If you would like support in prioritizing and taking care of your mental health, contact Cobb Psychotherapy and see how therapy can help.

Man’s Search for Meaning

By Cherise White, LMSW

In his book, Man’s Search for Meaning, Viktor Frankl claims that future orientation is a way to self-preservation in extremely harsh conditions. This premise highlights the strength of the mind-body connection. Following the focus of the mind and its functioning, Frankl states, “emotion, which is suffering, ceases to be suffering as soon as we form a clear and precise picture of it.” This sounds like he is referencing what we know to be a component of mindfulness. This clarity can be found through awareness and acceptance of one’s emotions, thoughts, or sensations. Even though mindfulness as described by Bishop et al. (2004) is more about being present and in the moment than focusing on acceptance and awareness, these elements are still a part of the general perception of mindfulness as presented by Marsha Linehan in Dialectical Behavioral Therapy. 

Frankl also discussed the connection between the psychological and physiological parts of a human. He shed light on the relationship between immunity and the state of mind, courage, and hope. The physiological and psychological parts of a human were also discussed in Wager et al’s (2004) study on the anticipation and experience of pain. They highlight how pain is a psychological experience but that it has great effects on the physiological part of a human body. The same connection is discussed in Gross’s (1998) experiment on emotion regulation. Even when emotion regulation strategies such as suppression and reappraisal are used, there is still the potential for physiological effects as displayed in his findings. Therefore Frankl, from observation and experience, honed in on something research has now proven, that there is a strong link between the physiological state and the psychological state, cognition, and mind of a person.

In Man’s Search for Meaning, Frankl also calls for a change in attitude toward life. He states that one has to take responsibility in searching for an answer to one’s problems.  To an extent it seems Abramson et al.’s (1978) theme of learned helplessness could come into play. With the harsh conditions and circumstances the men faced in the concentration camps, many fell victim to learned helplessness and took on a perspective of a larger external locus of control. To combat ultimately being overtaken by helplessness, Frankl employed a number of emotion regulation strategies. He used both reappraisal and suppression (Gross, 1998). He also used cognitive strategies such as distraction (focusing on his wife and the everlasting feeling of love). At other times it appears he used mindfulness (find solitude for about five minutes) and visualization (“I dreamed longingly, and my thoughts wandered …in the direction of my home”) as coping mechanisms. 

Overall, Frankl underlined the idea of mind and body all throughout the novel as he presented the struggle for the prisoners to remain men and not objects, to implement mental toughness and remain hopeful, and for the men to employ cognitive strategies that could promote self-preservation in the midst of ambiguity of them ever being free. 

References

  • Abramson, L. T., Seligman, M. E. P., & Teasdale, J. D. (1978). Learned helplessness in humans: Critique and reformulation. Journal of Abnormal Psychology, 87, 49-74.
  • Bishop, S. R., Lau, M. , Shapiro, S. , Carlson, L. , Anderson, N. D., Carmody, J. , Segal, Z. V., Abbey, S. , Speca, M. , Velting, D. and Devins, G. (2004), Mindfulness: A Proposed Operational Definition. Clinical Psychology: Science and Practice, 11: 230-241. doi:10.1093/clipsy.bph077
  • Frankl, V. E. (2006). Man's search for meaning. Boston: Beacon Press.
  • Gross, J. J. (2002), Emotion regulation: Affective, cognitive, and social consequences. Psychophysiology, 39: 281-291. doi:10.1017/S0048577201393198
  • Linehan, M., M., (2014). DBT Training Manual. New York, NY: The Guilford Press. 
  • Wager, T. D., Rilling, J. K., Smith, E. E., Sokolik, A., Casey, K. L., Davidson, R. J., Kossyn, S. M., Rose, R. M., & Cohen, J. D. (2014). Placebo-Induced Changes in fMRI in the Anticipation and Experience of Pain. SCIENCE, 20, 1162-1167

Cherise White is a therapist at Cobb Psychotherapy. If you would like support in prioritizing and taking care of your mental health, contact Cobb Psychotherapy and see how therapy can help.

Ambivalence in Eating Disorder Recovery

By Rosie Barton, LMSW

The decision to recover from an eating disorder is a challenging one, often fraught with feelings of uncertainty, ambivalence, grief, and fear. For many suffering with an eating disorder, the behaviors can feel like a security blanket and the disorder itself can become part of your identity. While most people seeking recovery are able to connect with reasons that their lives would be better without the disorder—more energy, healthier relationships, fewer distracting thoughts—the actual process of letting it go can be painful. 

Often times in the early stages of recovery, clients are tempted to run back to the familiar arms of their eating disorder. It provides them a sense of distraction and purpose in a world that can feel too overwhelming. I often describe the early stages of recovery through a metaphor. The person attempting to recover is stuck on a tiny raft in the middle of a stormy sea. They can see land and safety in the distance, but it will take a lot of courage to abandon the raft and begin swimming towards it. As they begin swimming, they get stung by jellyfish and the waves crash over their head, making them doubt their ability to make it to land. So they retreat back to the comfort of the raft, still longing for the safety and connection on the land within sight. 

When someone with a restrictive eating disorder begins to follow a meal plan regularly, feelings of guilt and anxiety can become deafening. Making healthy choices goes against everything that the eating disorder tells them to do. So they go back to restriction and the eating disorder behaviors that have been so comforting in the past. They are back on that little raft.

Recovery is very rarely a linear process. Usually someone will go swimming to shore, get scared or overwhelmed, and return to the raft. Eventually, through supportive therapists, friends, family, and their own courage, they will once again be willing and motivated to try and reach the shore. This is a natural part of recovery, and I always encourage clients to acknowledge their desire to return to the eating disorder. What is so compelling about it? How will you feel better if you relapse? Only through exploring this ambivalence can one begin to mourn the loss of the eating disorder and all that it has provided. 

So what do you do when you are swimming to shore and want to go back to the comfort of the eating disorder? To begin with, it’s important to share these feelings and fears with someone you trust. Suffering and fighting alone will only give power to the eating disorder. Part of recovery is the ability to have faith in your treatment team over faith in the eating disorder. It means following a meal plan, despite the urge to compensate for a binge or skip a meal. The more often you can make choices that align with your recovery, despite how scary the unfamiliar waters feel, the closer you will get to believing that the isolated raft isn’t going to save you after all. There might be safety there in an immediate sense, but lasting peace and connection can only be found through braving the journey to shore. And remember- you don’t have to go it alone. 

Rosie Barton is a therapist at Cobb Psychotherapy. If you would like support in prioritizing and taking care of your mental health, contact Cobb Psychotherapy and see how therapy can help.

The Three-Stage Model of Trauma Recovery

By Bethany Nickerson, LMSW

I work with many clients who have experienced trauma. Beginning the healing process can feel uncomfortable and overwhelming for clients because it is not a linear process. Not being able to know exactly how things will unfold can be distressing for both therapists and clients. It can be helpful to have a bit of a “road map” even if that road isn’t perfectly straight or flat. I love the three stage model Judith Herman outlined in her book Trauma and Recovery because it allows for a lot of customization and takes a very holistic approach.

  1. Stabilization: This phase is all about setting goals, establishing a treatment plan, and developing skills. The therapist will help the client to establish safety in their body and tap into their inner strengths. The client and therapist will assess for disassociation and work on recognizing the difference between being disassociated and being fully present. There are many different ways to help clients address their disassociation. The therapist provides psychoeducation about trauma and how it impacts the body and mind. This is typically very validating for the client because trauma responses can feel isolating and confusing.

  2. Reprocessing: During this phase treatment will focus on memories that are typically intensely distressing and disruptive to clients' lives. This can be done through: desensitization, grief work around unwanted or abusive experiences and how they impact functioning, mourning or working through grief about good experiences that one did not have, but that all children deserve, and/or re-parenting (which is encouraging the developed brain to care-take the developing brain). EMDR is a great tool to use during this phase.

  3. Reconnection: The final phase is centered on reconnecting with people, meaningful activities, and other aspects of life. Sometimes this will include peer led communities/groups, exploring identity components, learning to explore outside the client's comfort zone, and finding hobbies.

Herman, J. L. (1997). Trauma and Recovery. New York: BasicBooks.

Bethany Nickerson is a therapist at Cobb Psychotherapy. If you would like support in prioritizing and taking care of your mental health, contact Cobb Psychotherapy and see how therapy can help.