How to Help Someone with OCD
Written by Johanna Younce, MA
Obsessive-Compulsive Disorder (OCD) is a really difficult thing to have and experience for yourself, but it is also difficult to care for someone who experiences it. When someone has a diagnosis of any kind, psychological or physical in nature, it is always better to have support from loved ones. If you are reading this because someone you love has OCD, I want to start by thanking you for caring so much. The first step is to do more of what you are doing right now: Seek out information. One excellent source for information on OCD is the International OCD Foundation website (start with https://iocdf.org/about-ocd/). This will help to get a basic sense of what the disorder actually is. This is important because OCD is often misrepresented in media and popular culture, so what many people think they know about OCD may not be completely accurate. As you learn more, it is important to remember that OCD is a complex problem and it looks different for everyone. Some people with OCD have symptoms that most people are aware of, such as fear of germs and washing rituals, but others experience completely different types of obsessions and compulsions. In fact, some people perform compulsive rituals entirely in their minds (for example, repeating phrases over and over in their head). Look for reputable sources to find information, but also ask your loved one about what OCD looks like for them.
Depending on your relationship with your loved one, you may want to help them find a therapist if they don’t already have one, or if their current therapist is not experienced in treating OCD. When looking for a therapist, look for a specialization in OCD or anxiety disorders, and ask whether the therapist is trained in exposure and response prevention (ERP), the gold standard treatment for OCD. For a list of providers at OakHeart that specialize in treating OCD and utilize ERP, visit our OCD specialty page. ERP for OCD is very well-researched and effective. For more information on finding a therapist, see the past blog post "How to Find the Right Therapist for You" by Dr. Katherine Harris.
This next piece can be harder to do. When a loved one experiences great anxiety, our impulse is often to help them get rid of the anxiety by helping them avoid or escape their triggers (feared object or situation). This is super helpful when someone’s anxiety is caused by a truly dangerous thing - when our loved ones are actually in danger, we want to help them and ourselves get to safety. However, when the anxiety is unhealthy and disproportionate to the actual danger involved, we find that these escape and avoidance behaviors actually worsen the problem. When loved ones help the client avoid, we call this “accommodation.” When I work with the families of individuals with OCD, we talk a lot about identifying accommodating behaviors and stopping them. This is often very hard to do, because this makes your loved one more anxious in the short-term, but it is essential to their recovery. It’s similar to when a person struggling with alcoholism begs for alcohol - it’s going to make them feel better in the short-term, but it feeds their problem. We wouldn’t want to give alcohol to an alcoholic, so we also don’t want to give accommodations to our loved ones with OCD.
One of the most common accommodations is reassurance seeking. People with OCD will sometimes seek reassurance from others regarding their fears. If the fear is that they are secretly an evil person, they might ask a parent or partner if they did something wrong or if they are a good person. If they have fears that the house will burn down if the oven isn’t turned off, they may ask someone if they did indeed turn the oven off. It is difficult to do at first, but we as loved ones must learn to stop giving reassurance. If the loved one is in treatment, you can remind them of their treatment goals and tell them (gently) that you will not answer their question. Sometimes I will have the client write down the loved one’s typical response to their reassurance seeking, and the loved one can simply remind them to look at what they wrote the next time that client asks for their reassurance. It feels difficult, and it may go against everything you have been doing for this person for a long time, but finding a way to stop accommodations and communicate your love and support in more fruitful ways will be the best you can do to help your loved one with OCD.
Finally, take care of yourself. Those of us in the helping professions put great emphasis on self-care because we cannot support others well unless we are taken care of. Take care of your body, mind, and spiritual self. Look for support from others.
I believe in you.
If you feel you would benefit from talking with a clinician who specializes in OCD call OakHeart at 630-570-0050 or email us at Contact.OH@oakheartcenter.com.
OCD and “Unacceptable” Intrusive Thoughts : You are Not Alone
Written by Johanna Younce, MA
When most people think about Obsessive-Compulsive Disorder (OCD), they think of the stereotypical symptoms: needing everything to be perfectly organized or “just right” and fear of contamination. While these are valid and common presentations of OCD, there are other types of symptoms that are less often discussed. One of these symptom types is the fear of unacceptable thoughts or repugnant obsessions, which feel incredibly scary and threatening to people with OCD. This type of OCD can cause an immense amount of shame and fear, and I believe we need to discuss it more openly to decrease the shame and give less power to these thoughts.
What does “unacceptable thoughts” mean? This type of OCD involves sexual, aggressive, and religious/moral obsessions. These obsessions involve very taboo thoughts that are hard to talk about, even with people who we are closest to. Many people with OCD have these unwanted, intrusive thoughts and think they are the only ones. However, research has shown that about 94% of people experience intrusive thoughts. That’s almost everyone! Almost every single person has intrusive thoughts from time to time. It is extremely common; People just don’t talk about it because it is so taboo and uncomfortable.
So, wait, if so many people have intrusive thoughts, why do only some people have OCD? Thank you for asking; That is an excellent question. The difference is that people with OCD place an enormous amount of meaning on and responsibility for these thoughts. In other words, they interpret the thoughts differently. When most people experience unacceptable intrusive thoughts, they brush them off and recognize them as random and meaningless. People with OCD often think that having the thoughts must mean that they are terrible, awful people. But this simply isn’t true! The fact is, we cannot control what thoughts come into our heads, and sometimes the thoughts are taboo and uncomfortable, and that is ok. The same goes for dreams: Having a dream about something does not mean it is something you want to happen.
To further the cause of normalizing unacceptable intrusive thoughts, let me share some thoughts (in the form of either words or images) that I have had or have heard from others:
Reading this list may have made you uncomfortable. You may have even found yourself judging either yourself or others for having these thoughts. The important thing here to remember is that these thoughts are intrusive, meaning they come into your mind without intending them, and they are unwanted, meaning they are not fantasies or desired outcomes. Just having these thoughts pop into your mind does not mean that you want them there and that you like to think about them. Fantasies are things that you enjoy thinking about (and every part of you enjoys it; there is not one part that feels anxious or thinks it is wrong). My random thought of myself driving off the highway this morning is meaningless and it does not worry me because I know that thoughts are just thoughts.
I hope this has helped you feel less alone in your more taboo thoughts or dreams. Almost everyone has them, and they are not meaningful. You are not alone, and you are not an evil person.
Remember, thoughts are just thoughts.
To hear more about one individual’s experience with unacceptable obsessive thoughts, check out NPR’s Invisibilia Podcast’s Season 1, Episode 1: “The Secret History of Thoughts.” To learn more about intrusive thoughts and OCD, visit the International OCD Foundation website.
If you feel you would benefit from talking with a clinician who specializes in OCD call OakHeart at 630-570-0050 or email us at Contact.OH@oakheartcenter.com.
Dealing with Political and Societal Uncertainty
Written by Hillary Gorin, PhD, LCP
Regardless of your political views, your understanding of the impact of COVID-19, or your beliefs about societal injustices, nearly every U.S. citizen is experiencing stress, uncertainty, and worry. Worry is an important cognitive function, as it helps humans solve problems effectively, plan for the future, and remain motivated. We may worry about solvable problems and, at other times, unsolvable problems. When we worry about solvable problems, we often find a solution and can put the concerns behind us. However, when we worry about unsolvable problems or problems that extend beyond our control, we can find it difficult to know what to do with the uncertainty. With an immense desire to solve an unsolvable problem, we can fall into what I like to call the ‘worry cycle’ or the ‘hamster wheel of worry.’ Our minds go around and around, searching for answers we cannot seem to find. So, how do you get off this hamster wheel? How do you accept uncertainty, particularly during these times of social unrest, political turmoil, and a terrifying pandemic?
Many may think, ‘I will just reassure myself!’ or ‘Everything is going to be fine.’ Alternatively, many try to distract from or avoid the worry. For some, this strategy may be effective. For others, the worry persists, early in the morning, late in the evening, while watching the presidential debate, while scrolling through social media, while reading about COVID-19, while obsessively searching for polling predictions. The worry persists, even though you say, “Hey brain, everything is just fine.”
Why don’t our brains listen to this self-reassurance? Why is it challenging for some, especially now, to believe that everything will be ok? Because the reality is, many of us have never faced risks/ threats of this magnitude before. These current threats are present and lingering in the background every day. Compared to various other points in our lives, the political unrest and looming pandemic have increased the chances that something bad could happen to us. Thus, no matter how hard we try to find evidence against our worries, we can’t find clear evidence that disproves our worry completely. So, worries propel through our minds, such as, ‘What if my loved one gets COVID? What if I lose my job? What if that candidate becomes president? What if social injustice persists?’ These are all possible, scary outcomes due to current, omnipresent stressors.
So, if reassurance and looking for evidence that everything will be ok does not work, how do we get these catastrophic thoughts out of our heads? One possibility is a technique called decatastrophizing. Decatastrophizing involves considering whether or not you could find ways to cope in the face of a feared outcome (Zinbarg et al., 2006). This technique assists us with changing our thinking from, ‘I could never cope if that happened’ to ‘This would be difficult, but I would find a way to cope.’ This could appear as asking yourself, ‘Will I survive this election?” The answer is – yes, you will, even if things don’t go the way you are hoping. Asking, ‘Will I survive this’ helps us see that the threat we are facing is not as imminent as it feels. In other words, we are not in imminent danger all the time, despite how these political, societal, and health crises may make us feel.
So why does your brain make you feel like you are facing an imminent risk while watching a debate from the comfort of your couch? Studies suggest that the area of the brain involved in detecting threat, the amygdala, is triggered by certain thoughts, certain worries, and uncertainty (Hilbert et al., 2014). Decatastrophizing can be an initial step to telling that part of the brain that it can settle down. Instead of telling ourselves, ‘I will never manage to live through this,’ we can say, ‘I don’t like the world right now but I will probably be able to find a way to live in it.’
The next important step can be considering how you would actually cope with certain feared outcomes. This can be accomplished by considering what specific coping strategies could help you manage the situation. For example, if you lose your job, what steps would you take to manage it? For some, a coping strategy could be updating your resume and looking for job opportunities.
Of course, this thought of losing your job will undoubtedly bring up anxiety, which brings me to another suggestion that I propose for most of my patients: The more we can start to accept uncertainty and sit with it, the less we will be propelled to continue running on the hamster wheel of worry. Sitting with anxiety is challenging and specific techniques are best applied with the assistance of a licensed mental health professional. However, beginning to allow yourself to feel anxiety, to ride the wave, and to let it come up and come down is important for everyone because we must see that we can tolerate anxiety, that it won’t last forever, and that we do not need to fear this emotion. Instead, anxiety/ fear is a critical emotion that keeps us alive. In life threatening situations, these emotions tell us when we are in danger. For example, many people experience anxiety and fear when they stand too close to the edge of a mountain. This anxiety/fear is normal and adaptive to keep us alive, as it prompts us to take a step back! However, sometimes we have this anxiety/fear in situations that are not life threatening, as our brains are mistakenly telling us that our lives are at risk. When there is nothing to act on immediately and when the worry is unsolvable, sitting with the anxiety and accepting that one person cannot eliminate our current health crisis or our political and social unrest, is important. Sitting with anxiety can be as simple as accepting the possibility of your feared outcome occurring. It may or it may not come true.
Many ask me, ‘Why doesn’t avoidance/ distraction work? Isn’t that what we learn at an early age?’ Yes, distraction and avoidance are useful, at times, particularly when our anxiety is in the low to moderate range. When we are feeling slightly worried or anxious, watching a funny movie, participating in relaxing activities, or taking a walk tends to help reduce our physical and psychological tension. However, when our anxiety becomes too high, our amygdala, or that threat detector in our brain, is on high alert. This threat detector acts quickly and efficiently, without much input from logical thinking or what are considered, ‘executive functions’ (LeDoux, 2000). Why? Because, in the face of a threat, we need to act quickly. We do not have time to think. Imagine if you are in the woods and you see a bear on the trail! Your first reaction will be fight, flight (run away), or freeze (hide and hope that you are not seen). You likely will not be able to think through the situation logically. In these situations, our amygdala or ‘emotional brain’ holds our ‘thinking/ cognitive brain’ hostage so that we can act on instinct, automatically (Okon-Singer et al., 2015)! So, when politics, health crises, and societal unrest trigger high levels of anxiety, our brain tells us to fight, flight, or freeze. When you tell it to ‘calm down,’ ‘chill out,’ ‘distract yourself,’ ‘Look at all the evidence you will be fine,’ our amygdala tells us ‘NO WAY!’ It believes it still has work to do to keep us safe.
Thus, I will again emphasize the importance of sitting with anxiety when we can, or with the help of a licensed mental health professional when we cannot. We need to let the anxiety peak and come down so that our logical, thinking brain can take back control! ‘Sit with it’ is a phrase my patients hear often because if you don’t sit with the anxiety and see that you will survive it, see you will cope with it, and see that it will not last forever, the ‘hamster wheel of worry’ can become very exhausting and self-doubt can grow. It is possible that your fears will come true. However, I am confident that you will find a way to survive and to cope with whatever comes your way.
If you're feeling like you need a little more help navigating through worry call or email us today to schedule an appointment to speak with a clinician. Take a look at our provider page for a full list on all clinicians that treat anxiety disorders.
Hillbert, K., Lueken, U., & Beesdo-Baum, K. (2014). Neural structures, functioning and
connectivity in generalized anxiety disorder and interaction with neuroendocrine systems:
A systematic review. Journal of Affective Disorder, 158, 114-126. http://dx.doi.org/10.1016/j.jad.2014.01.022
LeDoux, J. E. (2000). Emotion circuits in the brain. Annual Review of Neuroscience, 23(1),
Zinbarg, R. E., Craske, M. G., & Barlow, D. H. (2006). Mastery of Your Anxiety and Worry:
Therapist Guide (2nd ed.). New York, NY: Oxford University Press.
The Healing Power of Creativity
Written by Pam Heilman, PsyD, LCP
This year has undoubtedly been one of the most stressful, scary, challenging times for many individuals. As a trained psychologist, I frequently discuss the importance of self-care with clients and my colleagues. Self-care refers to any act in which you are taking care of yourself. This can include tending to your basic needs: showering, brushing your teeth, exercising, eating healthy meals, attending therapy, taking medication as prescribed, and getting regular physicals. Self-care also consists of engaging in activities that bring you relaxation or joy: meditation, spending time in nature, taking a hot bath, having a spa day, listening to music or podcasts, singing, or snuggling with your pet.
One aspect of self-care I regularly explore with clients is engaging in creativity. Have you ever found yourself so interested or engrossed in a particular activity that you lost track of time and became extremely focused on the task at hand? This is what Mihaly Csikszentamihalyi, one of the founders of Positive Psychology, would refer to as “flow” in his 1990 book, Flow, the Psychology of Optimal Experience.
As Csikzentamihalyi described it, flow is “a state in which people are so involved in an activity that nothing else seems to matter; the experience is so enjoyable that people will continue to do it even at great cost for the sheer sake of doing it.” Many people refer to this as being “in the zone” which happens when there is a balance between challenge and skill level. So, what are some of the reasons that flow might be so helpful? According to Arne Dietrich (2004), flow has been associated with decreased activity in the prefrontal cortex (in Oppland, 2020). This is the area of the brain that is responsible for executive function, or organization of thoughts and actions in accordance with internal goals. As Dietrich (2004) suggests, this temporary inactivation may trigger feelings of distortion of time and loss of self-consciousness (in Oppland, 2020).
Perhaps the idea of flow has been catching on in more recent years. Many local businesses such as Pinot’s Palette, Chilled Palette, Bleu Palette, Board and Brush, Arts on Fire, and Color Me Mine have become popular for gathering with friends or for a date night. Businesses like these offer workshops where you can learn how to paint on a canvas, paint pottery, or even stain and paint a bench or wooden sign to decorate your home.
As a psychologist I like to practice what I preach. I had my first experience with painting acrylic on canvas several years ago with a group of friends at Pinot’s Palette. I was surprised by the amount of joy I experienced that night. Ever since then, I began attending more workshops and tried different types of projects. During the quarantine, I stocked up on painting supplies (acrylic paints, canvases, an easel, and brushes) from Michael’s. I began trying to set aside time every week to paint something new. In spite of the increased stressors during this difficult time, I have found my painting to be an amazing source of comfort and pride. I’m working on my skill level but what is more important to me is that I can create something with a blank canvas and just a few tools. I make myself a nice cup of coffee, put on some of my favorite music, have my basset hound close by, and I am content.
My hope is that I can help my clients to find something that gives them a sense of passion or purpose to help them get into their “flow” state of mind. It doesn’t have to involve creating art. This can be anything that you are so interested in that you are able to focus solely on the task and lose yourself in the moment. Think writing, playing an instrument, gardening, yoga, working with tools, putting together a jigsaw puzzle, doing crossword puzzles or sudoku. Feel free to try different things to see what you like. It took me quite some time to stumble upon painting but I am so glad I was willing to try different activities to get there. I’d like to share some of the artwork I have done in recent months. These pieces are filled with imperfections but they are mine and I am proud of them.
“The desire to create is one of the deepest yearnings of the human soul.” ~ Dieter F. Uchtdorf
If you'd like to schedule an appointment with one of our clinicians call (630) 570-0050 or email Contact.OH@OakHeartCenter.com.
For more blogs on self-care written by OakHeart clinicians, read Surviving Social Distancing or Practice Self-Care.
Csikszentmihalyi, Mihaly. Flow: The Psychology of Optimal Experience. New York: Harper & Row, 1990
Oppland, M. (2020, January 9). 8 Ways to Create Flow according to Mihaly Csikszentmihalyi. Positive Psychology.com. Retrieved from: https://positivepsychology.com/mihaly-csikszentmihalyi-father-of-flow/
Written by Brittany Male, LCSW, CADC
This is a stressful time for so many of us. Between social distancing, changes at work, a new and unique start to the school year, and the political climate, we’re all navigating through a lot of stressors. The stress that we feel, impacts those around us, including our partners. If you or your partner have been struggling to communicate in a productive way, take a moment to read these tips for fighting fair that you can start practicing today.
I’m hopeful that you are able to utilize these tips the next time you find yourself in a conflict with your partner or anyone in your life. Again, if you’re finding that you need more support, call (630) 570-0050 or email Contact.OH@OakHeartCenter.com to schedule an appointment with one of our clinicians. Relationships can be challenging, especially when there are so many external stressors that are out of our control. The key is knowing that you’re not alone and you can utilize help.
You've got this.
Coping vs. Avoiding
Written by Megan Allegretti
2020 has been a year to remember! Maybe not for the reasons we initially set out to remember - but one we will never forget. Think back to January and what plans or resolutions you had set for yourself. Was learning how to manage when your life gets flipped, turned upside down one of them? I am going to say with confidence that most of us had no idea what this year would look like. So, I wanted to start by congratulating you on doing what you needed to do to get through! The object of this post is not to make us feel bad about what we are doing or not doing, but rather increase our intentionality in the behaviors we are using. By being aware, we can see if we are in fact coping or avoiding a situation, and then observe to see if our actions are serving us well, or maybe not so much.
Coping is a big buzz word currently, particularly in the COVID-19 world of uncertainty. In the context of this article a coping skill will be defined as techniques that an individual applies to manage difficult emotions. Coping is different from avoidance. They look so similar! Both reduce distress, but there is a curtail difference- avoidance does not address why you are feeling the way you are. Instead it pushes the uncomfortable feeling away or deep down. This might be rewarding in the short term, because there is a good chance you will feel better by not engaging in whatever thought or behavior that triggered the distressing emotion. But by not confronting the situation or avoiding it, that emotion will find a way to come back out. Often it will leak out when you are least expecting it.
For all of my metaphor learners out there, this one's for you! Say you have a beach ball and you try to shove it down as far as it can go underwater. You can hold it there for some time but eventually your body gets tired, and it comes shooting out of the water with explosive force. This looks a lot different than holding the beach ball where it is at, instead of shoving it down, and then slowly bringing the ball back to the surface. This way you have more control over when you do want to bring the emotions back up to be addressed. That is the difference between avoiding and coping. The following tips are aimed at helping draw our awareness to our behaviors and choosing them with more intention.
We are all doing our best given the current state of our environment. The above tips are designed to help you identify if your difficult emotions are being coped with or not addressed. This is all subjective too! The beauty of human nature is there are many factors that influence our thoughts, emotions and behaviors. The goal is to bring awareness to the unique behaviors being used when our thoughts and emotions are distressing. The practice of using coping skills over avoidance may create some discomfort in the short term but it is allowing you more regulation of your emotions in the long term.
Stay safe, and know you are enough.
A 2020 REMOTE LEARNING SURVIVAL GUIDE: PRACTICAL TIPS FOR SUCCESS
Written by Katie Sheehan, MSW
Across Illinois, many schools are beginning, or have begun their first few weeks of full remote instruction. With this, comes the potential for overwhelming uncertainty. Will they adjust? What is my role as a parent? Am I doing too little? Am I doing too much? Below are a few suggestions to ease the possible uncertainty as we move forward.
1. Maintain normalcy in the areas that you can.
If back to school usually means school supply shopping or a new outfit, it can still mean that! Work to change the definition of a school supply. Get creative! Maybe this means blue light filtering glasses, new ear buds, or a back support pillow.
2. Weekends still should = FUN.
Across the country people have been reporting the phenomenon of days running together or time not feeling concrete. It has become increasingly difficult to tell weekdays from weekends. But weekends are a necessary time for rest, relaxation, and most importantly, fun. Try to encourage activities such as socially distanced gatherings, renting the latest movies to your living room, or family game night.
3. Monitor for changes in mood or behavior.
Things to look out for may include irritability, changes in sleep or appetite, lower energy levels, isolating from friends or family, or loss of pleasure in interests or hobbies. While one or two of these changes occurring infrequently, may be a typical response, more severe changes may indicate difficulty adjusting, and an increased need for support. If you're concerned, and would like more information regarding depression and anxiety disorders that may be triggered or exacerbated by the beginning of this unique school year, get more information on our website by following the highlighted links above.
4. Validate their feelings.
Many students may hyper-focus on the unfairness of the situation. Especially those who are missing out on milestone years, such as their freshman year, or their senior year. They may be feeling a profound sense of loss for an experience that they have looked forward to, or fantasized about for years. It may be difficult for them to verbalize in ways other than “It’s just not fair.” Steer away from accidental invalidations such as “at least we’re healthy,” or “it could be worse.” While true, this is not helpful for someone navigating emotional pain. Practice leaning into their feelings and trying out something like “I know this is unfair, and I’m so proud of your resilience.” If you're needing a little more guidance take a look at our previous blog on supporting someone when they're struggling.
5. Practice patience and compassion.
Grades may slip. Pajama pants may replace jeans. Suppress the urge to come down hard on them. Try to solve the problem collaboratively. Remember that in 10 years your child will look back and remember this time full of fear and uncertainty. They will remember how hard it was to go from classroom instruction and seeing their friends in-person everyday, to their worlds existing through a screen. This is your opportunity to show them grace, understanding, patience, and compassion.
If you are still finding that you or your children are struggling with the adjustment to the changes that this new school year is bringing, I encourage you to reach out for help. You can schedule an appointment with on of our clinicians at OakHeart by calling (630) 570-0050 or by emailing Contact.OH@OakHeartCenter.com.
My Experience With Grief
Written 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.
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 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 YOU
Written 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.
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.
Giving Yourself Permission
Written by Brittany Male MSW, LCSW, CADC
I can’t count how many times I have said, “Give yourself permission…”, to a client during a session recently.
Give yourself permission to be angry.
Give yourself permission to be sad.
Give yourself permission to be disappointed, frustrated, annoyed, fearful, resistant, confused, or even UNPRODUCTIVE.
I’m noticing that a lot of us are having difficulty making the adjustments necessary due to the changes in our world. A lot of us didn’t want to skip a beat when the stay-home-orders were initially put in place.
Things are not as they were. At least not for now.
We must adapt to this change instead of trying to force the previous routines, schedules, and expectations on ourselves and others. Follow the steps below to better identify what your needs are and give yourself permission to meet those needs.
Be mindful of the emotions you're experiencing that are causing distress.
Mindfulness is a buzzword right now - and rightfully so. That said, it is also not as complicated as it may seem so don’t be intimidated. Simply identify the emotion you’re experiencing and explore how it is influencing you in this moment. Could I be called a therapist if I didn’t include an emotions list for you to utilize? Next, think about where you are physically feeling this emotion, if anywhere. If you visually were to represent this emotion, what would it look like in color, size, texture. These are all questions that can help you more mindfully define your emotions.
Explore what is contributing to that feeling.
Ask yourself questions like: Have I felt this way in the past? Are there any other emotions that I’m experiencing underneath or alongside this emotion? Oftentimes we can experience multiple emotions at the same time and it can be helpful to figure out what we need when we identify them. Are other people’s behaviors contributing to this feeling or is it self-imposed?
Explore your needs in the moment.
If you don’t already have a list of coping or self-care techniques/activities/tools that you utilize, take time now to reflect on what those things could be. It is helpful to have this list already prepared ahead of time so that when you are feeling overwhelmed with a distressing emotion you do not have to think of what may help and can instead simply look at the list. For me, some examples of things on my list include lighting a candle, opening a window or curtain, putting on some music, and doing something that brings me joy.
Another important thing is that what may have been on your list previously may not be on your list currently due to the restrictions or because your needs have changed along with the times. While previously I would have included “getting out of the house” and “spending time with friends or family” as on my list, currently there are limitations to that. Additionally, I have identified that I have adjusted the shows and movies that I am interested in watching. Instead of movies filled with deep meaning and drama, I prefer light hearted and feel good movies and shows. There is enough intensity in real life right now.
Give yourself permission to make the adjustment and take care of your needs.
Although it may seem strange, I encourage clients to actually say the words, “I give myself permission to...” as a means of accountability to follow through.
After you’ve identified how you’re feeling and exploring what your needs are in the moment, it’s action time to give yourself the permission to give yourself what you need. Now more than ever, we need to continue to take care of ourselves, to say no when we need to, to adjust our expectations, to make changes in our routines and schedules, and to rest.
If you find that you’re needing more help trying to navigate through the current changes in our world, don’t hesitate to schedule an appointment with a therapist. Our therapists are currently accepting intakes via Telehealth. You can find out more information by visiting our website www.OakHeartCenter.com or calling (630) 570-0500.