My Experience With GriefWritten by Katie Cockrell, MSW, LCSW
My name is Katie and I am a Licensed Clinical Social Worker. In my years of clinical practice so far, I have seen, treated, supported and helped individuals struggling with many different obstacles. Among the challenges that I have provided treatment for, I have always felt that grief and loss is one of the most difficult things to treat. I say this for many reasons. For the longest time, I had never experienced death or a form of loss that I felt had really impacted me personally. I have experienced the death of extended family members, friends and pets. I have also experienced other forms of loss such as, the loss of a relationship, friendship, divorce in the family, moving, losing jobs, and financial loss. Secretly, I had always felt that my experience with grief and loss never seemed to quite impact me in the ways I had seen it impact my clients. At the time, I had felt that none of my experiences with grief or loss seemed "valid". My experiences did not seem to deepen my empathy and understanding of grief and loss. At least not in the same way for those who have PERSONALLY been affected by grief. My client's seem to discuss their feelings of grief and loss in ways that logically I could understand, but not emotionally. I recognized that I had never felt the impact of grief and loss to the degree in which my client's described. It appeared to me that my clients were experiencing very intense feelings. Some found it so intense, that it seemed difficult for them to comprehend, understand, and process it. I felt so ignorant in my experience and truly not qualified enough to provide help and support in the ways I thought I should. Then...I had my experience. I experienced grief. I experienced thoughts and feelings that were so strong, so intense and so overpowering, that my entire life seemed to fall apart. I want to TALK about grief. Certain thoughts and feelings that I experienced in my journey through grief, really stand out to me. I want to take a moment to be very transparent and openly discuss the ways in which I felt I was impacted by grief. Some of the things that I have experienced are very difficult to talk about, let alone be honest about. I have felt guilt, shame and disgust in myself in regard to parts of my grief journey. Honestly I feel that some of the things I am going to discuss may be viewed by some, as potentially "negative" or too "taboo" to discuss out loud, especially coming from the viewpoint of a clinician. Commonly, when one seeks guidance for issues related to grief and loss, they are introduced to the concept of the "grieving process" or "stages of grief". As a clinician, I highly support education on the grieving process and the stages. I feel that these are wonderful tools to help guide and aid the healing process. However, I feel that there are specific thoughts and feelings that one can experience that could be deemed by others as too "heavy" or "controversial” due to the nature of these thoughts or emotions. I feel that we still live in a society where death is not often discussed, and therefore should not be discussed. If it’s discussed, then one should use "appropriate dialogue" when discussing it and unfortunately, since this "negative" viewpoint of grief still exists, many do not want to talk about it or admit to experiencing difficulties when grieving. As a clinician, I view this as very problematic. My hope is that by sharing my experience, I can help start a new conversation about the grieving process and normalize all the thoughts, feelings and experiences that one goes through when facing grief and loss no matter how "big", "small" or “intense” they are. On February 9th, 2018, my life was permanently changed. I remember that day perfectly. I remember what I was doing, where I was, what I was thinking, what I had planned and who I had spoken to. I was in the middle of preparing dinner for some friends that evening. Plans changed that day, when a police officer came to my door to tell me that my twin sister, Lauren, had been killed in a car accident. Everything seemed to stop at this point. I couldn't make sense of it and I didn't understand it. Little did I know that my life, my perception, my views, goals and dreams would no longer be the same. I am going to highlight four “reactions” that I personally experience when grieving, that I feel fit into the "controversial" category. I am also going to provide ways to work through the various reactions, responses, and emotions experienced during the grieving process. Fear When I think of my personal journey through grief, the first word that comes to mind is "fear". Fear showed up for me in many different ways. What stands out to me the most about my feelings of fear was the moment I was able to see Lauren for the last time. My family decided to have her cremated, and we were able to view her as a final goodbye. Not only was this experience horribly sad, uncomfortable, confusing and honestly traumatizing, but I remember feeling very afraid. I was afraid to see her body. I was afraid to look at her. I kept thinking that her eyes would shoot open, like a scene from a horror movie. I remember feeling very embarrassed by this reaction and felt a lot of shame. How could I be afraid of my own sister!? Was I allowed to feel this way? I felt that I could never be honest about this experience and that I would be judged. Stereotypically, I think many view the "final goodbye" as a peaceful experience, not one that evokes fear. I felt very guilty in admitting this to myself, friends and family because in my mind it made me feel like I didn't love Lauren since I was afraid of her. Change in Identity and Purpose After losing my twin, I remember waking upone morning feeling like my life no longer made sense. I felt that my identity had been stolen from me and that I no longer had a purpose. I did not know who I was anymore, nor did my identity as "Katie" seem to make sense. When Lauren was alive, I remember working very hard to establish a different identity for myself. Let the world know and understand that I was my own person in every type of way. But the only thing I wanted at that moment was to be a "twin" again. My entire life I was a part of this duo. My person and my counterpart was suddenly gone and there was nothing I could do about it. My life had always included my sister and so would my future. Anything that held significance in my life, was supposed to include her and this was no longer possible. Was I allowed to acknowledge the fact that I was still a twin, even if my twin was dead? Did I have permission to do this? It felt like I was breaking the "rules" or something. I wasn't allowed to be a twin anymore unless my twin was alive. How could I go on as "Katie" if Lauren no longer existed? Thoughts of Suicide I think this area is the most difficult for me to acknowledge. I think as clinicians, we understand that suicidal thoughts can come up and be a part of the grieving process for many reasons. Nothing prepared me for the ways that I experienced this. I was extremely suicidal. My twin was gone, which meant my life no longer had meaning. Life as I knew it and understood it, was no longer mine. Life did not feel real anymore. All I could see and feel was complete and total emptiness. These thoughts became so overwhelming at times, that I couldn't think, focus or breathe. These thoughts became my new purpose, my source of comfort, my support and my future. In my mind, since I did not exist without Lauren, why exist at all? I needed to be where she was, even if it would cost me my life. Loss of Control I remember feeling very out of control after Lauren died and this feeling seemed to last for a long time. I felt as if I was "out of my body" and did not feel present in my own body, mind and life. I began to experience emotions that I had either never experienced before or at an intensity I had never experienced before. My experience with anger had changed in ways that felt very unfamiliar, uncomfortable and shameful. I was irritable most of the time and I noticed that my tolerance level and patience level became non-existent. Up until Lauren's death, I was never quick to anger and did not experience anger too often. I had always prided myself in my ability to have a tremendous amount of patience, and a high tolerance for stress. Now I had no patience, felt very stressed, anxious, angry, frustrated and irritated all the time. I felt shame toward this. I noticed that I was acting out toward the people I loved and it made me feel horrible about myself. It was very difficult to process at times. I hated myself. I felt very disconnected from reality. I seemed to experience my life in a fog. I found myself regularly dissociating, daydreaming and fantasizing about things that were very irrational. I became obsessed with the idea that Lauren was still alive. I would regularly experience two distinct thoughts that seemed to co-exist at the same time: One part of my brain could rationalize Lauren's death. I knew logically she was gone. At the same time, I experienced a complete opposite thought that suggested Lauren was very much alive and that her death never happened. I could not accept Lauren's death. It was too powerful, too intense and carried too much pain. What Now? What does one do if they experience these emotions and reactions to grief or loss? How does one begin to heal? First and foremost, I want to acknowledge that these responses to grief and loss are very NORMAL and very REAL. I cannot stress this enough. While the reactions may feel completely uncomfortable and totally unreal, these reactions are common. Grief is a very abnormal process that is extremely complicated. It leaves one without answers and practical solutions. It robs one of peace, happiness, and at times all understanding of what "life" is. Grief takes time to process and so does healing. It may mean experiencing the same emotions over and over again, experiencing the same thoughts, and working through difficult reactions multiple times. I find that the hard part of this process is the factor of “time”. There is no exact timeline in which one feels more "comfortable" in their grief. This looks different for all. We cannot wish the thoughts and feelings away, we cannot avoid it, we NEED to ALLOW ourselves to go through it. Go Through It Talk. Please TALK about it! Talk about all of it and don't stop! Choose someone that you feel safe with. Someone you can trust and can be completely vulnerable with. Someone that will support you, understand you, show you love, kindness and empathy. This can be a family member, friend, pastor, teacher or therapist. Try a support group. Group work can be very difficult at times, especially when discussing something so personal. However, it can also be very empowering and healing. Being around others who share this journey can really help normalize the experience. Create a routine/engage in some serious self-care: It is very important to continue engaging in life. While I understand that life may never be normal again, continuing to live life and experience life is crucial. Doing things that are mindless, fun, funny and active are a great distraction. Keeping up regularly with hygiene, eating and sleeping are a must during this time. Adjusting expectations of how one continues to take care of themselves and live their lives while healing is completely acceptable and encouraged. Patience with yourself and others is the key here. Address/speak out/take action regarding suicide! Please, if you are experiencing suicidal thoughts, feelings or actions to any degree, seek out support and help immediately. It is very important that your support system(s) are aware that you may be experiencing these thoughts and feelings. If you are without support, Please contact 911, go to your nearest emergency room or contact the suicide hotline (1-800-273-8255) if you feel that your are in any type of danger. Keep in mind We are not alone in this difficult time. Grief is a very strange and complex journey. Healing is very possible and it will happen. All forms of grief and loss are legitimate and real. Never let anyone say that your grief is "less than" because your grief is different from theirs. Allow yourself to heal in your own way and in your own time. Allow yourself to seek out the appropriate support and give yourself permission to talk and NEVER STOP TALKING. If you or someone you know is struggling with grief, I encourage you to reach out for help. You can talk with one of our grief and bereavement specialists at OakHeart by calling (630) 570-0050 or emailing Contact.OH@OakHeartCenter.com. HOW TO FIND THE RIGHT THERAPIST FOR YOUWritten by Dr. Kat Harris
Finding the right therapist is not always as easy as it should be. I’ve talked with many people looking for a therapist who feel overwhelmed at the prospect and don’t know where to start. Or they have already started but their searches have provided an overwhelming array of options. Or alternatively, very few options that fit their needs. Then they find someone who seems like a good fit, call or email the therapist to set up an appointment, only to find out that the therapist either doesn’t accept their insurance, doesn’t have availability that matches, or isn’t accepting new clients at all. Making the decision to see a therapist is a brave one, and it’s unfortunate that the task can sometimes be daunting. My hope is to outline a few considerations to help make the task easier. Finding the “right” therapist can be so rewarding in so many ways and worth the work to find one. License Types and Degree Types What are all of those letters after a person’s name? In short, the letters often indicate one of three things: degree type, license type, and additional certifications. For example, someone with the letters MA, LCPC, CADC after their name is someone with a Master of Arts degree (MA), licensed as a Licensed Clinical Professional Counselor (LCPC) and are certified as a Certified Alcohol and Drug Counselor. There are many types of degrees in the field of mental health (e.g., PhD, PsyD, MA, MSW) in various areas of study (e.g,. Psychology, Counseling, Social Work, Marriage and Family Therapy). And there are many different licenses (e.g., Licenced Clinical Psychologists, Licensed Clinical Social Worker, Licenced Professional Counselor) that vary across states, with some denoting full licensure and some denoting partial licensure (still requiring supervision). And there are even more kinds of certifications, some that come with additional letters after the person’s name, and some that don't. At the end of the day, what I believe is most important is not so much the letters after someone’s name, but what the therapist’s competency level is in the areas which they claim to treat, their professional value system, and the therapist-client relationship. Where to Start Looking Where to even start? Here are some ideas: Therapist directories specifically designed to help consumer’s find counselors. Examples of these include Psychology Today, Theravive, and Good Therapy to name a few. Most of these directories allow you to filter out options to best match your needs such as finding a therapist who accepts your insurance or who claims to specialize in what you need help with. Specific mental health organizations also have their own internal therapist directories that can be an excellent way of finding therapists who specialize in treating your symptoms. For example, the International OCD Foundation and the Anxiety and Depression Association of America both have therapist directories to help people with symptoms of OCD and Anxiety ind specialists. If you have insurance, you can also contact your insurance provider or go on your insurance provider finder website page to obtain a list of providers in your area who accept your insurance. Asking a friend or family member for counselor’s whom they would recommend is another great place to start. Navigating Insurance and/or Affordable Therapy Navigating insurance alone can feel like you need a direction manual. Here are some basic things to consider: If you have insurance, you will likely want to find a therapist who is “in-network” with your insurance company. This means that they officially contract with that insurance company and have negotiated rates with that insurance company. That way you can pay “in-network” rates for co-insurance/co-pays/deductibles rather than out-of-network co-insurance/co-pays/deductibles which can often be significantly more expensive. Check your personal contract with your insurance provider to determine what your in-network and out-of-network responsibilities are as the client. A co-pay means you are paying a set amount (e.g., $20) per session and the insurance company is paying the rest of what your therapist bills. A co-insurance means you pay a certain percentage (e.g., 20%) of the contracted rate for a therapy session and the insurance company pays for the rest. A deductible refers to the amount of money you have to pay out-of-pocket before your co-pays/co-insurance kicks in. Deductibles can range greatly and can be anywhere from $0 to thousands of dollars. Until your deductible is met, you have to pay 100% of the therapist’s session fees. Not all therapist’s will be in-network with all kinds of insurance companies. In fact, some therapist’s choose to only be in network with one or two companies. PPO’s do not usually require a physician’s referral for therapy sessions to be covered but may require pre-authorization depending on the service. Most therapist’s are in network with PPO’s. HMO’s require a physician’s referral for therapy sessions and fewer outpatient therapists tend to be in network with HMO’s. If you have an HMO it would likely be easiest to contact your insurance company and ask for a list of therapist’s in your area whom they will cover. If you don’t have insurance, community organizations such as community mental health centers, and sometimes private practices, have sliding scale options. Training clinics are also a good place to try because they often offer sliding scale fees. Open Path is an organization that can be a good start to find a therapist if you need a sliding scale as well. Finding a Specialist Do I need a specialist? In short, it depends on a number of factors. These factors include severity of symptoms, symptom presentation, and prevalence of the disorder. For example, I would recommend that someone with OCD find someone who specializes in the treatment of OCD. Particularly using a form of therapy called Exposure and Response Prevention. Why? Because research has demonstrated that this is the gold-standard treatment for this disorder and not all therapists have training in this treatment or in treating OCD. Someone with mild depression on the other hand may not need to find a specialist because the majority of therapists have training and experience treating at least mild to moderate depression. What makes a specialist? I have always suggested that what makes a specialist is someone who has the following four pillars of specialty practice: Formal Training, Supervision and/or Intensive Consultation, Experience, and Continued Education. Formal training can include graduate school training, internship or postdoctoral training, trainings at conferences and other intensive trainings. Supervision and/or Intensive Consultation means that the person has received supervision or consultation from another professional who is already a specialist in the area. Experience means that the therapist has seen a large enough number of cases to have had the opportunity to refine skills, learn from their experiences (preferably under supervision or consultation), and develop nuanced approaches for a variety of presentations. Finally, continued education means that the therapist is passionate enough about their speciality that they want to continue to learn and grow. This may mean that they seek out up-to-date research, regularly attend conferences and trainings, are members of speciality interest groups, etc. We're grateful at OakHeart to have specialists in several areas including OCD, Panic Disorder and Agoraphobia, Substance Abuse, Eating Disorders, Grief and Bereavement, Trauma, LGBTQ Related Issues, and many more. It is impossible for a therapist to specialize in everything. Therapists who list 20 “specialties” under their profiles or in their bios are likely not specialists in all they claim to be. It’s 100% OK to reach out to a prospective therapist by email or phone and ask a few questions to ascertain whether they would be a good match for you, including whether they meet some basic qualifications for claiming to be a specialist in a given area. If a therapist makes you feel badly for asking questions then they might not be the best match for you in the first place. Here is an example list of questions for someone interested in finding an OCD therapist authored by the International OCD Foundation: https://iocdf.org/ocd-finding-help/how-to-find-the-right-therapist/ Levels of Care Another consideration is that there are varying levels of care. Many people think of two things when they think of therapy: traditional outpatient therapy, where you meet one-on-one with a therapist, or inpatient therapy where you are locked on the unit for safety reasons. However, there are actually several in-between options that may be a good match for your needs depending on the “dose” of treatment you need. The more severe the symptoms, the more likely a higher level of care will be indicated to best help you get better. Outpatient: This is the most traditional level of care and will fit most people’s needs. Usually in this setting you see a therapist once or twice a week for between 40-53 minutes. Intensive Outpatient Programs (IOP): At this level of care, client’s would attend a therapy program anywhere between 3-4 hours a day. The therapy program might include group therapy, psychoeducation presentations, meetings with an individual therapy, meetings with a psychiatrist, and an experiential component (e.g, music therapy). At this level of care you go home at the end of the day and your participation is voluntary. Partial Hospital Programs (PHP): This level of care is very similar to an IOP settings (and most of the time client’s start in a PHP and then “step down” to an IOP setting within the same location and program. With this level of care a client might attend anywhere between 5 and 6 hours a day and have additional components such as family therapy. At this level of care you go home at the end of the day and your participation is voluntary. Residential Treatment: This level of care is similar to PHP programming; however, the client’s sleep on a unit in the program and programming might last a little longer throughout the day. At this level of care you don’t go home at the end of the day and your participation is voluntary. Inpatient: This level of care is reserved for situations where a client’s symptoms are severe enough that the person’s safety or ability to function are at risk, and therefore the person needs to be closely monitored. This is a short-term treatment, and the person is usually “stepped down” to a PHP/IOP program as soon as possible. At this level of care you don’t go home at the end of the day and a person's ability to end treatment is sometimes partially determined by the attending physicians. Final Thoughts It might be helpful to be open to the possibility that you might need to meet with more than one therapist before finding a good match. My heart breaks when I meet a client for the first time and they inform me that they tried finding help a decade ago but gave up after a meeting with a therapist didn’t go as they had hoped (and there can be many reasons for this). I think of the decade lost and what could have been if they had met the “right” therapist for their needs. There are many factors that go into whether a therapist is a good match, but some of the ones that stand out most to me are whether you feel safe, whether you feel understood and heard, and whether the therapist demonstrates some level of competence in diagnosing and treating your symptoms. Finding a therapist in some areas of the county can be considerably more difficult than other areas. Especially if someone is looking for a particular specialist or another important variable. Telehealth might be a good option for individuals with limited options in their communities. There is a therapist for you! And there are treatments that work! Best wishes on your journey! For more information on the therapeutic services that OakHeart offers, call and speak with her intake specialist at (630) 570-0050 or email us at Contact.OH@OakHeartCenter.com. |
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