All posts by gabbert2013

About gabbert2013

I have been a psychotherapist for 20+ years. I specialize in Marriage & Family Therapy and addictions. My practice name is Interactions Therapy Center. I've learned a few things over the years and hope you'll find these blogs interesting.

Suicide Prevention

September is National Suicide Prevention Month. All month, mental health advocates, prevention organizations, survivors, allies, and community members unite to promote suicide prevention awareness.

Suicide is the 10th leading cause of death among Americans, and it’s getting worse. From 1999 to 2018, the suicide rate has increased by 35 percent, according to the CDC. People of color have higher rates than other groups, such as American Indian and Native Alaskans, who have the highest suicide rate among all Americans. And there are rising suicide rates among black youth, especially boys. Their suicide rates are increasing faster than any other racial/ethnic group.

Dr. Jonathan Singer, president of the American Association of Suicidology (AAS), makes a distinction between suicidal thoughts, attempts, and deaths. “There is an assumption that there is a linear relationship between suicide ideation, attempts, and deaths, but there’s not.” And not everyone who has suicidal thoughts or attempts has a mental illness. Many people who had attempted or died by suicide did not have a known pre-existing mental health condition at the time of death.

Suicide Prevention Lifeline, suicidepreventionlifeline.org, offers these recommendations:

Ask: Research shows people who are having thoughts of suicide feel relief when someone asks after them in a caring way. Findings suggest acknowledging and talking about suicide may reduce rather than increase suicidal ideation. In a recent workshop that I attended, we were encouraged to normalize suicidal thoughts and ask directly, “It is normal for many people who feel the way you do, to consider suicide. Is this true for you?”

Be There: Individuals are more likely to feel less depressed, less suicidal, less overwhelmed, and more hopeful after speaking to someone who listens without judgment. Give them permission to speak their truth.

Keep Them Safe: Take away access to weapons. Some studies have indicated that when lethal means are made less available or less deadly, suicide rates by that method decline, and frequently suicide rates overall decline.

Help Them Stay Connected: Studies indicate that helping someone at risk create a network of resources and individuals for support and safety can help them take positive action and reduce feelings of hopelessness.

Follow Up: Studies have also shown that brief, low-cost intervention and supportive, ongoing contact may be an important part of suicide prevention, especially for individuals after they have been discharged from hospitals or care services.

I saw an interesting Facebook post on suicide prevention. “It’s suicide prevention month and just a reminder that affordable housing is suicide prevention; livable wages are suicide prevention; universal healthcare is suicide prevention.” The point is that prevention is wider than the individual. Prevention is also addressed on a systemic level.

On the upside, for every one person who dies by suicide, 280 people move past serious thoughts about killing themselves. Of those who attempt suicide and survive, more than 90 percent go on to live out their lives. There is power in communication. Sharing positive stories has a beneficial effect. Studies indicate that the reporting of individual suicidal thoughts following recovery is associated with a decrease in suicide rates. Suicide prevention centers on hope. People need hope to increase their will to live. It is important to share recovery stories.

Cringeworthy Moments

The definition of cringeworthy is something so embarrassing, awkward, or upsetting as to cause one to cringe. Imagine you are having a fine day, going about your business, when you are suddenly hit with a memory, and let out a gasp at the stupidity of the incident. Your body may have an immediate and involuntary physical squirm. That’s a cringe. And that is part of the human experience. None of us get through life without these moments.

It seems that not a day goes by that I don’t recall something that I have said, done, or thought that makes me cringe. How could I have said that? Done that? Or thought that way in the past? The memory may be decades behind us or have happened that day. But no matter how long ago the incident occurred, we still cringe with embarrassment, shame, remorse, and humiliation. How can we be less affected by these intrusive and sometimes painful memories?

I saw a Facebook post that said “If you ever find yourself cringing at something you did in the past, it means you have grown as a person.” This post made me chuckle, but it also gave me a sense of relief over my cringeworthy moments. When the memories return, I can appreciate them as signs of growth. The idea that these memories mark my growth as a person rings true. I have learned from these moments. They have taught me to do things differently.

Lia Kvavilasvili, a psychology researcher at the University of Herfordshire, studies what she calls “mind pops”. These are thoughts that seem to come out of nowhere. She finds that memories are often triggered by something in the environment that takes us back to an incident. She also finds that interrupted moments stick with us longer than those that feel completed. For example, if we don’t have an opportunity to explain or correct the initial incident. And, our emotions dictate what our brains decide to hang on to. The stronger the feeling, the stronger the memory. The brain is saying, “Something important happened. Make a strong memory.”

Pam Haag, Ph.D., encourages people to talk out the embarrassing moments. She wrote, “Embracing the cringe—for example, by sharing stories with friends of your biggest relationship failures or gaffes, or your worst professional moments—is a gift to your fellow humans. It sends a message that despite all of the imperfections and mortifications of the human condition, we survive. We’re flawed, and still worthy of care, love, consideration, and attention. This is a more humane, and humanist, way to think about personal failure than to try to spin it, (or) suppress it.”

I propose that any cringeworthy incident that occurred before the age of 21 is to be forgiven. Youth is about learning and making mistakes.

I also propose that anything that we have said, done, or thought that was taught and entrenched in a particular environment or ideology, and from which we had no other knowledge, should be forgiven. We are allowed to change over time.

And, I propose that we reflect on the things that make us cringe. Was anyone hurt? If so, we should make amends. Making amends is freeing.

We can never be free of our past selves, so it would be best to learn to be objective about the past and develop self-acceptance. Embrace your humanness.

What Causes Addiction and Who Will Recover More Easily?

I attended a training recently by Mark Sanders, LCSW, CADC, on best practices in mental health and substance abuse treatment. He raised some interesting points about dependence and recovery.

What makes for a better outcome for those people who have developed substance dependence? I learned that people who have greater resources before the problematic substance use will have greater resources for recovery. People with success before addiction – education, employability skills, healthy family support, and positive group affiliation – will have an easier time of recovery.

Which people will have more difficulty with recovering from addiction? People who slip through the cracks of the helping profession. Some people go back and forth between chemical dependence, mental health, criminal justice, and child welfare systems without recovering. This can also include multiple medical hospitalizations and periods of homelessness. Gabor Mate, M.D. says that drugs don’t cause addiction any more than a deck of cards cause compulsive gambling. There needs to be a pre-existing vulnerability. For some people, the seed of addiction is planted years before they use.

Some people fall through the cracks due to unresolved trauma. Complex trauma includes multiple layers and years of traumatic experiences. These experiences could include neglect, abandonment, unresolved grief, multiple placements, parental substance abuse, adult emotional unavailability, multiple losses, exposure to domestic violence, or other types of abuse.

Illicit drug use is an effective coping tool, until those substances create negative outcomes.

• They numb emotional pain

• They medicate psychiatric symptoms

• They provide constant companionship

• They are predictable

• They provide relief from trauma and abandonment

What can we do to help people along the path to recovery? The first thing we can do is give them hope. We can assist them in finding stable housing, employment, a stable therapeutic relationship, meaningful daily activity, and significant interpersonal relationships, including peer-based support. If we can give them hope and practical assistance, they can more easily recover.

What Causes Addiction and Who Will Recover More Easily?

I attended a training recently by Mark Sanders, LCSW, CADC, on best practices in mental health and substance abuse treatment. He raised some interesting points about dependence and recovery.

What makes for a better outcome for those people who have developed substance dependence? I learned that people who have greater resources before the problematic substance use will have greater resources for recovery. People with success before addiction – education, employability skills, healthy family support, and positive group affiliation – will have an easier time of recovery.

Which people will have more difficulty with recovering from addiction? People who slip through the cracks of the helping profession. Some people go back and forth between chemical dependence, mental health, criminal justice, and child welfare systems without recovering. This can also include multiple medical hospitalizations and periods of homelessness. Gabor Mate, M.D. says that drugs don’t cause addiction any more than a deck of cards cause compulsive gambling. There needs to be a pre-existing vulnerability. For some people, the seed of addiction is planted years before they use.

Some people fall through the cracks due to unresolved trauma. Complex trauma includes multiple layers and years of traumatic experiences. These experiences could include neglect, abandonment, unresolved grief, multiple placements, parental substance abuse, adult emotional unavailability, multiple losses, exposure to domestic violence, or other types of abuse.

Illicit drug use is an effective coping tool, until those substances create negative outcomes.

• They numb emotional pain

• They medicate psychiatric symptoms

• They provide constant companionship

• They are predictable

• They provide relief from trauma and abandonment

What can we do to help people along the path to recovery? The first thing we can do is give them hope. We can assist them in finding stable housing, employment, a stable therapeutic relationship, meaningful daily activity, and significant interpersonal relationships, including peer-based support. If we can give them hope and practical assistance, they can more easily recover.

What’s Your Private and Public Face?

Personally, I want our political and religious leaders to aspire to be ethical, trustworthy, and decent individuals who will make every effort to be a servant of the public. Leaders are held to a higher standard of personal behavior when they seek public offices with civic and leadership responsibilities. Unfortunately, many leaders fall short of this expectation, particularly when their private-self is made public. Those of us who are not in the public eye also have private and public personas.

You may have read of Jerry Falwell Jr’s leave of absence from the Christian institution Liberty University, at the request of the board. The board asked him to take an indefinite leave of absence as the president and chancellor of the university following a questionable photo that was posted to Instagram. The photo shows Falwell with his pants unzipped and his arm around a young woman. Falwell defended himself by saying “It was all in good fun.” Many people believe the photo to be hypocritical and indecent, which is contrary to the school’s strong moral code of ethics.

Although our personality is relatively fixed, personalities are multifaceted. When at home we can let our guard down and express ourselves freely with immediate family members and trusted friends. Yet in public, we choose carefully how and what to reveal. It is normal and healthy to adapt to our environment and its expectations of us. We may speak differently when in the presence of our spouse, children, friends, co-workers, or our boss. We certainly should watch our behavior and speech when in the presence of cameras. We have aspects of ourselves that we do not like and try to hide from everyone, and perhaps even from ourselves.

How much of ourselves should we reveal in personal relationships? Self-disclosure is necessary to build close relationships. As relationships grow closer, so does the amount of self-disclosure. People tend to share more when others share first. How we share, what we share, and when we share it are all factors that will influence our relationships. We will need feedback to determine whether we’ve shared too much.

In Japan, “Honne” is a person’s true feelings and desires. And “Tatemae” is the behavior and opinions one displays in public. According to Wikipedia, Honne may be contrary to what is expected by society or what is required according to one’s position and circumstances, and they are often kept hidden, except with one’s closest friends. Tatemae is what is expected by society and required according to one’s position and circumstances, and these may or may not match one’s Honne. In fact, there’s a quote attributed to the Japanese that there are three faces: “The first face, you show to the world. The second face, you show to your close friends and your family. The third face, you never show anyone. It is the truest reflection of who you are.” Each face reveals a different aspect of your character.

I encourage the use of self-reflection to better know yourself. What is your public face? What do you reveal to your family and closest friends? And finally, what character traits do you hide from others, even yourself?

Making Impossible Decisions

With a new school year beginning during the Covid19 pandemic, parents are caught in a dilemma. Should I send my child to school or keep them home? One mother said, “I can’t get past the guilt. Guilt if I’m not letting my kids connect with other kids, vs. guilt that I send them and they get sick and have long-term health consequences. Parents are wired to be protective, but they wonder if it’s better to protect their academic and socialization needs, or their medical health.

Some decisions are easy. A simple pros and cons list will help you formulate an easy decision. Research shows that applying a reasoning process, like a pros and cons list, is the best way to make relatively simple decisions.

But other decisions are complex and stressful. If no choice is clearly better than another, and you are forced to choose between the lesser of two evils, then you are faced with an impossible decision. And,  if that choice will directly affect the welfare of your child, you cannot feel satisfaction about either choice. Unfortunately, you have to accept the fact that there is no sure proof answer.

Sometimes we can get caught in our heads analyzing the decision to the point of paralysis. If we have exhausted the research and still can’t decide, then it may be time to apply emotions. What are your emotions and body telling you? Pay attention to your feelings and body sensations. Do you feel lighter and more relaxed with a particular choice, or does it make you feel more tense?

It is not fair to pass this important decision to someone else. However, talking it out with others might bring clarity. Other people may reflect back what they hear and might help you articulate and clarify your thoughts.

Once a decision is made, reinforce your hard choice by citing the reasons why that choice is right for you. Your situation is unique based upon personal resources and your community. Know that you made the decision based upon the information you had at that moment in time.

Take heart in knowing that every decision you make can be temporary. You can change course based upon evolving information. What is the infection rate in your community? Is it slowing or getting worse? How prepared is the school? Do they have enough space, teachers, personal protective equipment? Do they have a solid plan to safeguard the bus, the lunchroom, and the classroom? Can they enforce social distancing for children?

Once you’ve made a decision, don’t dwell on the possible outcomes of the choice you didn’t make. The “what if” game is counterproductive. Most of us are not psychic and can’t know the future. At some point, you have to trust yourself and commit to your decision until you are faced with new evidence and information. You have the right to change your mind.

Learn to live with a certain amount of fear. Fear is an indicator that we care deeply, and we’re facing the unknown. You are certainly not alone with fear during this COVID pandemic. Let your fear prompt you to utilize safety measures.

Someone’s Gotta Say It, “Get Your Will In Order”

As of the date of writing this column, July 19, 2020, the U.S. has 3,698,161 confirmed Covid19 cases and 139,659 deaths, according to the CDC. We don’t know if illness or death is just around the corner for us. And yet, according to a 2019 survey by Caring.com, 57 percent of U.S. adults do not currently have a will or living trust. At the beginning of the coronavirus outbreak, we thought that older people were more at risk for Covid-19 infection. But now, especially in states where Covid-19 cases have been rising in June and July, the median age has been dropping. 20- to 40-year-olds are now the highest age bracket to become infected. The percentage of millennials who have a will or living trust is exceptionally low. Only 1 in 5 of 18-34-year-olds have an estate plan in place.

At the start of this Covid19 pandemic, online companies that help you create your own will, saw an explosion in new customers. Boston-based Gentreo saw a 143% week-over-week increase in people filling out wills, according to the company, while San Diego’s Trust & Will saw a 50% uptick in customers.

We may have saved money for old age and hope that the people we love will make sound decisions on our behalf. But most of us have not fully prepared. Our family and friends should know our end-of-life wishes, and we should have the necessary paperwork to back-up those wishes.

End of life planning can seem morose, depressing, and maybe scary. We don’t want to think about our mortality. We procrastinate, we don’t believe we have enough assets to make it worthwhile, we believe it is expensive to create a will, or we just don’t know where to start. However, we need to have more conversations about our end of life preferences before it’s too late.

Wise people will have prepared a living will, also called an advanced directive, regarding their end of life wishes rather than leaving it to the doctors or family members to guess. If we are wise, we will also have declared a power of attorney for who will make decisions for us in the case of an emergency. For help with a living will, I recommend a tool called “Five Wishes” that can be accessed through http://www.agingwithdignity.org. And, I strongly recommend you read Understanding Healthcare Decisions at the End of Life at nia.nih.gov. This guide includes questions to ask your doctor and medical staff, practical advice on issues you may face, family involvement, working with medical staff, and more.

We will certainly die. Perhaps of Covid19, and perhaps not. Creating a will can provide some peace of mind in all this COVID chaos.

Protests and Marches Are Not Enough

I saw a Facebook post that said, “I wonder why we did not fix this racial issue when we had a black president for 8 years?” This social media post was presumably a response to recent Black Lives Matter protests. My response was to suggest that 400 years of systemic racism can’t change in 8 years. Wouldn’t it be great if protests on a grand scale initiated long term systemic change? Unfortunately, drawing attention to societal problems does not fix them. Personally, I get discouraged. How much is really changed?

The 1960’s civil rights movement did not ameliorate racism. The Me Too movement has not stopped sexual harassment and sexual abuse. The Peoples’ Climate March in September 2014 was the largest and most diverse climate mobilization on record, and yet, we continue to experience global warming and increasing natural disasters. The Women’s March was a worldwide protest on January 21, 2017. It was the largest single-day protest in U.S. history. And yet, in the United States, the average female’s unadjusted annual salary is approximately 78% of that of the average male. A moment in time, a day, or a period in history does not, in itself, cause long term change.

It is human nature to return to our set point or comfort zone. Despite raised awareness and good intentions, we fall back to prior behavior. The rate of relapses among people who set goals is high. Perpetrators of domestic violence are reported to be violence-free up to three years after treatment. Figures vary on substance addictions, but approximately 40-60% will relapse. 97% of dieters regain what they lost within 3-5 years. Medication non-adherence leads to worsening of disease, death, and increased health care costs.

Here’s what doesn’t work for systemic change:

Intentions alone are not sufficient to sustain change. Excitement fades.

Negative emotions such as shame doesn’t produce change. We all experience negative emotions such as regret, shame, fear, and guilt. But negative emotions are the least effective change strategies. For example, scolding a heavy drinker won’t cause them to stop drinking.

Information is not sufficient. Information is only as useful as what you do with it. You can know something and still do nothing. Well-intentioned advice does not produce motivation for change.

Even with compromise, people tend to go back to their set points.

So, if the question is, “Can people change?” The answer is yes, and no. We can change our individual habits and behaviors and never address societal change. Change is rarely just one thing; it’s a lot of connected things and sustained change doesn’t happen without a consideration of broad implications.

So what does work for systemic change? Systemic change happens on a policy and procedural basis. Individual change is insufficient for systemic change. Systemic racism, sexism, and other isms are broader than individual people and require policy and procedural change.

For example, perpetrators of domestic violence do not enter treatment because they have a change of heart. Abusers who demonstrate significant change are externally motivated to change, rather than internally motivated. External motivators may come from a spouse who will leave them if they don’t change, or the threat of jail. Internal motivators such as remorse do not lead to lasting change. Remaining abusive is easier than changing, and more rewarding for the abusers.

Although I can become discouraged about racism, sexism, etc., I support community and political efforts for change. Participating in elections is one of the key freedoms of American life. Many people in countries around the world do not have the same freedom, nor did many Americans in centuries past. No matter what you believe or whom you support, it is important to exercise your rights. Continue to march, protest, and raise awareness. But be sure to vote and work toward systemic change.

It’s Not About Intention, It’s About Impact

Author Robin DiAngelo of White Fragility, Why It’s So Hard for White People to Talk About Racism, challenges the assumption that racism has to be intentional. Most people feel good intentions exempt them from accountability. She calls for white people to examine their bias and its impact on people of color, not their intentions. This holds true for most offenses, whether it is racism, sexism, or other isms, including interpersonal conflicts.

As a couple’s counselor, I meet people who have been hurt by betrayal, abuse or neglect. Yet, they come to therapy with hopes of healing and reconciliation. The person who caused their partner’s pain generally wants their partner to know that they did not intend to cause pain. “I never meant any harm; I would never want to hurt you.” They are not monsters who deliberately inflict pain. Establishing good intention is a beginning, but is not sufficient to heal broken relationships.

Many people believe that if our intentions are good, then the impact of our behavior should not count. “I did not mean to do that, so therefore, you know, get over it.” Not so easy. The offender has to be held accountable for the impact to their partner. Speaking about intention can be an attempt to deflect criticism. It turns the conversation away from the painful impact, thereby minimizing the consequences of their actions.

A better response is, “I did not mean to do that, and I would never have wanted to do that, but I see that I have indeed done that, and for that I apologize. Where can we go from here?”

In Janis Abrahms Spring’s book, How Can I Forgive You?, she lists seven guidelines in making a good apology:

  1. Take responsibility for the damage you caused. For your apology to take hold, you must acknowledge your role.
  2. Make your apology personal. It’s not just an admission that, “I did something wrong”, but an admission that “I wronged you. I did this to you.”
  3. Make your apology specific. You don’t just say, “I’m sorry.” You say exactly what you are sorry for.
  4. Make your apology deep. If you want to be forgiven, you admit the whole wretched truth of what you did, naming the unflattering truth about yourself.
  5. Make your apology heartfelt. Your remorse must be real, profound and enduring, not self-serving, to rid yourself of guilt.
  6. Make your apology clean, straightforward and uncomplicated. No “buts” or defenses.
  7. Apologize repeatedly for serious injuries. A single apology may not be sufficient to restore your good standing.

Robin DiAngelo would add,

8.    Examine your bias and its impact. Work to right the personal and systemic impact of your actions.

Are You Harboring Thoughts of Revenge?

I happened to see a powerful video in the midst of Black Lives Matter protests. It made me ponder on the role of revenge. Kimberly Latrice Jones was extremely angry and made this statement. “They are lucky that what black people are looking for is equality and not revenge.”

The desire to seek revenge for mistreatment is universal. It has been said that revenge is sweet. But is it? And if you harbor a desire for revenge, what does it say about your character?

The definition of revenge is to inflict hurt or harm on someone for an injury or wrong. A thirst for sweet revenge can last a lifetime. But it turns out that revenge is not so sweet after the first rush of brain activity. Behavioral scientists found that instead of satisfying anger, revenge can prolong the unpleasantness of the original offense. And revenge can institute a cycle of retaliation, fueling additional hostility and aggression. Revenge does not dissolve the anger caused by the original offense.

Certain groups and societies are more prone to seek revenge because there’s just no other way to obtain justice. There is no recourse to law and they have to rely on their own retaliatory methods. Black Lives Matter protests are an outcome of black Americans belief that the criminal justice system fails them.

What is your expectation for the emotional benefits that will come of revenge? If you are seeking catharsis through revenge, you will likely be disappointed. Kevin Carlsmith, a social psychologist, concluded from his studies that people erroneously believe revenge will make them feel better and help them gain closure. In actuality, punishers ruminate on their deed and feel worse than those who don’t take revenge.

There are a couple of ways that revenge can be sweet. It is satisfying if the offender makes a direct connection between the retaliation and the initial offense – in other words, if the person who did the wrong gets that what they did was wrong, and why it was wrong. Put another way, revenge is only satisfying when an offender understands why the act of vengeance has occurred. They need a message of understanding. For example, “We white Americans understand that systemic racism has hurt you and caused your pain”. Unacknowledged revenge feels no better than none at all. It is the offender’s recognition of their wrongdoing that makes revenge sweet. Revenge is also sweet if the revenge prevents future offenses.

Everyone is slighted from time to time. But why do some people seek revenge and others don’t? Studies have found that people who are more vengeful tend to be those who are motivated by power, authority, and the desire for status. Those people tend to be less forgiving and benevolent. Another study indicates that sadism is the dominant personality trait that explains why certain people are more likely than others to seek vengeance. The person who seeks revenge is a person who tends to enjoy it.

In summary, examine your desire for revenge. What do you expect the outcome to be? Is it your only recourse for justice? Is your motivation pure? Consider forgiveness. It can enable you to suppress the desire for revenge and help you to move on.