Category Archives: anxiety

Beliefs about Growth & Change

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Here are the nuts and bolts–what I think I know about change and resilience

  • The capacity to fully experience both pleasant and unpleasant experiences is key. A wide Window of Tolerance is healthy.
    • Avoidance and denial are only useful short-term survival strategies. Are you able to fully experience and express your unpleasant experiences in real time? Or the soonest appropriate time? This is what grief processing is all about. Grief work is not about recurring thought-cycles from the past; however, it includes honoring the deep emotional truth you feel presently. If the pain is not honored, it may be waiting in the wings to surprise you and project itself into even more situations down the road. Take your devastation seriously (yet don’t act impulsively). Acceptance and meaning develop out of emotional truth (both pleasant and unpleasant truths).
    • Less discussed is Positive Affect Tolerance. Positive affect tolerance is the ability to fully embrace pleasant experiences (love, joy, success, etc). Many folks harbor unconscious fear when a pleasant experience presents itself because they are bracing themselves from future disappointment and pain. They would rather control their experience than ride the emotional highs and lows. This emotional numbing is an understandable strategy yet ultimately limits internal and external connections.
  • Grief is a part of life. If you want to possibly skip the expense of therapy in your healing journey, you may want a grief processing strategy. Here’s one option and another
  • Identify the emotional longing underneath your disappointments, frustrations, and desires. What are you truly longing for? It may not be in line with your initial words or assumptions. For example, if you’re overtly wanting sex, you might be longing to play, be cherished, or to connect. Once you clearly identify your deep emotional longing, you can generate additional approaches.
  • When magic happens in therapy, it’s usually around a Corrective Emotional Experience. If a client is repeating any unconscious patterns, assumptions, and solicitations, I do my best to respond in a way that is helpful, yet goes off-script from the pattern. Relational dynamics that are experienced earlier in life sometimes become expected, maybe even facilitated, unconsciously. The corrective emotional experience can open doors that may increase relational options outside of therapy. This kind of exploration is a huge part of what makes therapy different from other relationships, like friendships or colleagues.
  • Projections. There are a million things I could say about projections. They can wreck havoc on relationships or, if brought to awareness, can be useful in self-development. Recognizing projections can lead to healthy vulnerability and communication. Everyone makes projection errors. When we recognize projections, we can practice self-compassion and repair.
  • Inner child. Self-parenting is cheesy but real, valid, and often necessary. Neglect is gradually healed by taking the inner child seriously and responding with appropriate, consistent self-care (and community-care if you can find it). Our younger selves can be attended to in the here & now.

2022 & 2023 Continuing Education

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Here’s a quick list of my studies the last couple years…I love my job!

(My year with the Integrative Psychiatry Institute is included in prior posts, skipping it here)

SUPERVISION

  • Clinical Supervision: Ethics & Effective Practice*
  • Ethical Frameworks for Multiple (Dual) Relationships

SEXUALITY

  • Issues & Clinical Implications around BDSM/Kink and Non-Suicidal Self-Injury*
  • Sex & Consent in Contemporary Youth Culture
  • Minimizing STI Stigma with Inclusive Education
  • Building Queer Families: Conception, Emotional & Legal Issues, and Resources^
  • Sex Positivity: what it is and isn’t
  • Decolonizing Mental Health & Sexuality through Irreverent Comedy
  • Sex after Sexual Assault
  • Pelvic Floor Health and Vitality: from Pain to Pleasure*
  • Trauma-Informed Assessment of LGBTQ+ Youth^
  • Emerging Trans: Therapists’ Role in Supporting TNB Young People^
  • LGBTQ+ Older Adults: Strategies and Recommendations^
  • Non-Monogamy/Polyamory Panel^
  • Rewiring Trauma through Kink^
  • Age Play Theory
  • Gender-Affirming Letter Writing for Clinicians^
  • Play Therapy with LGBTQ+ Youth: Caring for the Child, Collaborating with the Parent^

EMDR

  • Easy Ego State Interventions*
  • EMDR & Mindfulness*

OTHER

  • Ethics of Self-Disclosure
  • Suicide Prevention
  • Grief & Bereavement in LGBTQ+ Communities^
  • Borders & Walls: Facing the Other*
  • Differential Diagnosis with DSM 5*

*Longer events, ranging from 4 hours through 4 days

^Events I volunteer organized speakers for the Queer Affirming Therapists Guild

Ketamine-Assisted Therapy: Procedures, Safety, and Science

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I graduated from the Integrative Psychiatry Institute this May! 250 hours of education in psychedelic-assisted therapy was time well-spent.

I’ll be offering ketamine-assisted psychotherapy, starting in July. In addition to treating my own clients, I’m supporting other local therapists and their clients, offering brief treatment that augments their current work. A round of ketamine-assisted psychotherapy with me would include:

  • consultation with the primary therapist
  • preparation meeting(s) with the client
  • a 3 hour medicine meeting (the last hour we talk/process)
  • a follow up integration meeting (client creates a plan that applies our treatment to broader mental health concerns)
  • consultation and referral back to the primary therapist and any additional resources

Safety:

Ketamine involves altered states of consciousness that can increase client vulnerability, client or therapist projection, and risk of blurred boundaries. I heard some horror stories on the Cover Story podcast. For the safety of everyone,

  • medicine meetings are videotaped and securely stored according to HIPAA protocols
  • I’m not offering therapeutic touch. I’m trained in therapeutic touch but not offering it. We can identify several grounding substitutes
  • there is no communication between client and therapist between meetings, except to schedule meetings, or in case of an extreme emergency (this is true for non-ketamine clients as well)
  • clients are welcome to bring a calm, quiet support person observe medicine meetings

Mechanism of Action:

If you’d like to know about the science of ketamine, it’s mechanisms of action, and research studies, neuroscientist Dr. Andrew Huberman can help! https://www.hubermanlab.com/episode/ketamine-benefits-and-risks-for-depression-ptsd-and-neuroplasticity

I’d be happy to answer any questions! julia@juliacounseling.com

Dare to Lead

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I’ve been enjoying Brene Brown’s new book Dare to Lead and decided 2019 is my Year of Leadership 🙂  I previously resisted being a leader because I’ve seen poor examples. I overlooked many positive examples of leadership. The DTL workbook helps self-assess leadership skills and is giving me courage to make more leadership contributions.

 

On Fire

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I’ve been reading Woman on Fire: 9 Elements to Wake up your Erotic Energy, Personal Power, and Sexual Intelligence. The 9 elements are: Voice, Release, Emotion, Body, Desire, Permission, Play, Home, and Fire. Amy Jo Goddard offers worksheets and exercises in each chapter to help individual women explore their sexual stories while identifying any stuck-ness, growth edges, preferred experiences, and experiments. I may refer to some of Goddard’s activities and resources as tools to bolster therapy.

Body Image and Sexuality

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Positive sexual experience can be a great way to feel gratitude for one’s own body. Unfortunately, many people’s negative body image interferes with their ability to be truly present with themselves and inhibits their pleasure. Dr. Emily Nagoski identifies some concrete practices to build self-love at the end of her TED Talk: Confidence and Joy are the Keys to a Great Sex Life. Over the last couple weeks, I have been reading her book Come as You Are.

Erotic, Non-Sexual Experience!

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I returned from another week of sex education. I took courses titled the Exceptional Sex Therapist (3 days); Resolving Trauma Through Somatic Experiencing, and Sexuality & Culture. Surprisingly, my favorite course was Introduction to Tantra. Before this course I thought Tanta was having sex for 24 hours at a time, which seemed kind of like a waste of time, honestly. I learned, instead, that tantra is a way of experiencing the eroticism in everyday life, sometimes without any specifically sexual encounters. Tantra is welcoming inter-connection while maintaining a primary connection with oneself. Eroticism bigger than sex—sensory and intellectual pleasure of many types and more of an attitude than particular events. Since March 17th, I keep going back to the 8 Principles of Tantra so I will briefly describe them here.

  • Everything is an Experiment: Beginners mind, openness to experience, observation, willingness to gather data
  • As Within, so Without: what happens in the world affects our individual experience; we need to prioritize and reset our bodies; we can offer our balance to the world
  • Tapas and Spanda: in a concrete visual form, these are the eyes in the yin and yang that reflect the healthy healthy “masculine” energy within “feminine” energy and the healthy “feminine” energy within “masculine” energy. The tapas is about patient, non-attached willpower and the spanda is about a sense of wonderment, thrill, and joy.
  • Inner Marriage: the healthy interconnection of dual, or contrasting energies within oneself. A well-integrated person is able to be consistently present in the world.
  • Multiple Realms of Consciousness: everyday waking consciousness, mythical consciousness (symbols, projections), magical consciousness (big energy, transformation), and integral consciousness (all levels of consciousness simultaneous)
  • Ascending and Descending Currents: chakras
  • Transformational Healing Power of Pleasure: this may be my favorite principle–that pleasure can heal! As a trauma therapist and human being, I know that people can get stuck in trauma, vigilance, and guardedness. True pleasure is the opposite! True pleasure can restore our bodies and clear our minds. While sometimes pleasure can invite trauma processing (for example, someone can remember a painful event while laying on the beach) it also provides a welcome, stabilizing context for healing. It’s important to differentiate impulse and addictions from pleasure.
  • Love: love, like pleasure, heals. It also connects people and connects humans to their surroundings.

 

Healing Body Memory of Trauma

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I took a recent training with Yudit Maros called “Brief, Solution-Oriented Trauma Resolution.” This training specifically focused on troubling sensations in the body that may periodically resurface after the trauma. The BSOTR protocol helps a client attend to and correct the aftershock disturbances in the nervous system and one’s negative self-identity. Here are the most basic steps:

First, the therapist helps the client identify and practice a resource state called grounding. I can guide you through a visualization exercise that depersonalizes the pain and provides more comforting imagery, which tends to regulate the nervous system. We identify and develop comfortable imagery that helps you reset. Then, I ask you to scan your life history for anything that feels pleasurable and safe. We detail key components of the experience and you practice re-experiencing the positive experience and people. Later, we scan your life history again for an unpleasant or traumatic experience. I interview about what you would have preferred to experience. Then, I facilitate your current, grounded self attending to and taking care of your younger, distressed self through a series of self-care invitations, visualizations, and self-dialogue. When it appears that you have been a loving guide to your younger self and you have nothing left unattended about the chosen difficult experience, I invite you back to the here and now of the therapy room.

If you are interested in experiencing this BSOTR process or have any questions, please let me know.

Shame Shields

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I took a webinar with Brene Brown called Shame Shields. Dr. Brown is mostly known for her research on shame, worthiness, and healthy vulnerability. Her research reveals these core tenants about shame:

  • We all have it
  • No one wants to talk about it
  • The less you talk about it, the more you have it
Shame and addiction are interlinked. Addictive behaviors are an attempt to numb, or shield the shame. However, their effectiveness is short-lived and the shame resumes.
Dr. Brown, and separately–researchers at Wellesley College Stone Center–discovered there main subtypes of these shame shields:
  • Moving away — Avoiding, leaving the room, spacing out, daydreaming, distraction
  • Moving towards — Hyper-appeasing, over-flattery, buttering up, sucking up
  • Moving against — Attacking other people, inducing shame in other people
All three shields are an attempt to deflect shame away from the person. Here’s Dr. Brown’s recommended alternatives for shame resilience:
     1) Recognize triggers
     2) Reality check messages
     3) Reach out
     4) Speaking shame
I know these four prescriptions are easier said than done so I am happy to help be a part of the process.

Why do People Sexually Harass?

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It’s almost a daily headline the last couple months: Prominent Man Investigated for Sexual Harassment.

Outside the context of each specific accusation, many people are asking: Why do People Sexually Harass? I will attempt to answer that question. It’s NOT a commentary about specific cases, but a broader analysis. I’m not sure whether other researchers & theorists have arrived at the same hypotheses. Mine are a result of my broad professional experience and critical thinking. I have not done a lit review on the matter (although it’s on my to do list). Without further delay, here are my theories:

  • Narcissism: the hallmark of narcissism is a lack of empathy or regard for others’ safety, feelings, and/or independence. Sometimes this deficit comes from unprocessed shame (i.e. the person is not dealing with their own issues so they distract themselves by gaining influence over others). A narcissist also copes by pursuing pleasure, in this case, sexual gratification or interpersonal dominance.
  • Unclear sense of self: Similarly, some people confuse what they want by projecting it on to others. Rather than own and disclose their desire in a straightforward manner, a sexual assaulter may justify their actions by claiming that the other person wanted the behavior. Lots of unhealthy mind reading. Victims are often criticized & burdened for not speaking up. Unfortunately, less discussed is the lack of openness and honesty from the sexual harasser. Sexual harassers are frequently dishonest with their own intentions.
    • Blurred boundaries at workplaces: People who struggle to separate their personal life from their professional life are not skilled at understanding themselves separate from their immediate context. They are at risk for blurring other boundaries, between themselves and other people.
    • Compartmentalization: The flip side of the coin is compartmentalization. Sexual harassers may locate the harassment experience into a corner of their awareness, sealed off from the rest of reality. Effectively, compartmentalization is a type of denial, or delusional boundary formation.
  • Lack of Comprehensive Sexual Education: An absence of healthy sexual discussions produces ignorance and assumptions. Many people associate ALL sexuality with secrecy and shame. Secrecy and shame are the building blocks of sexual abuse. Or, a person can be so sexually permissive that they do not acknowledge the difference between harmful sexualization (imposing on others) vs mutual sexual pleasure. Comprehensive sexual education facilitates self-awareness & dialogue about the healthy diversity of sexual desire and healthy approaches to it. In consensual exchanges, each person is empowered to identify their sexual and non-sexual desires. If there is a conflict, safety is prioritized. For people who missed the boat, I will make another blog post about specific resources for healthy sexual dialogue.
  • Objectification: “noun. The action of degrading someone to the status of a mere object.” People may reduce other people to sexual targets rather than incorporating their other qualities, e.g. creativity, sensitivity, vulnerability, intelligence, etc.
  • Body Privilege: This phenomenon comes in at least two forms.
    • Male privilege: As a general category, men are granted more social license to impose their sexuality as part of their inherited gender script. Dominant social dynamics teach women to be passive receivers. It doesn’t have to be this way–yet this tradition is enforced by many formal and informal social mechanisms.
    • Attractive People: People who are socially-evaluated as attractive may internalize the message that their body is their main source of worth and connection. They may over-rely on physicality in order to deal with loneliness. This dynamic can be described as self-objectification (see objectification, above).

If you would like to discuss these ideas in more detail or conduct an internal exploration, feel free to contact me.