Avoidance and Attendance: Advocating for yourself

It’s that time of year. The time where you might feel the urge to disengage from therapy in response to the season, holidays, or stress.  The time when you may need an appointment the most in order to support you through trauma, family conflict, isolation, and loneliness. For some, the crises seem to intensify during the holidays. Perhaps you are experiencing depression symptoms due to the winter weather or maybe you are battling loneliness in spending the holidays away from your loved ones. Perhaps you are attempting to navigate the unwanted memories of trauma during your family’s holiday dinner or are experiencing high anxiety because of money stress and holiday shopping. You on your journey to sobriety and anticipate having to navigate holiday parties around family and friends where temptation may lead to relapse. Combine these stressful situations with your ability to cope and you may feel you can engage in therapy fully to receive support, or in some cases, desire to disengage in response to the overwhelming feeling of all that is weighing you down. It can feel like a balancing act to engage your supports when feeling stressed, but rest assured, it can be an empowering experience to engage in through the holiday season in support of your personal and relationship goals.

Avoiding Appointments

The more easily measured type of avoidance when overwhelmed is a change in attendance in your scheduled sessions. Perhaps you find yourself canceling sessions when in the past, you’ve been consistent in attending each week. Or maybe you find yourself cancelling last minute due to feeling like you need to use that time or money for another task? How do you explore your needs when you haven’t been able to justify spending the time or money on your own mental health? Depending on how your therapist structures sessions, you may want to consider advocating for yourself in exploring the following:

• Completing a phone call with your therapist to communicate what is going on in your world and attempt to re-engage in sessions to support managing your stress.

• Engaging in a phone session instead of a face-to-face to explore and address present stressors if you are unable to attend in person.

• Identifying a different appointment time that encourages attendance such as an early morning before work or later evening if appropriate and depending on if your therapist has openings at those times.

• Identifying biweekly or monthly sessions for the holiday season to account for financial constraints and time management.

• Reviewing your attendance contract with your therapist to explore opportunities and restrictions, such as possibly placing scheduled appointments on hold and resuming at a later time if appropriate.

Emotionally checking out

The hope is that with ongoing rapport, the conversations with your therapist above can support you with healthy communication and accountability when experiencing increased distress. Your relationship with your therapist, or rapport, becomes even more important when you find yourself engaged by your therapist around a lack of emotional participation in session. Perhaps you begin to notice that you struggle to arrive on time to your scheduled appointments, jumping into sessions with details unrelated to yourself or changing subjects rapidly throughout the scheduled time. Or maybe you remain surface-level in your processing, not dropping down into emotions and deeper meaning in session because you are avoiding the stress or have worries that it will become unbearable when talking about it. With healthy communication, you can name what’s going on for you and process the outcomes with your therapist. Here are some examples of how you might start the conversation:

• In response to running late: “I’m struggling to get here on time and it feels rushed lately, like we have to fit it all in. Can I talk to you more about what that’s like for me?”

• In response to staying surface-level: “I have to admit, it’s easier to talk about the lighter things than the deeper, more stressful stuff. I think I’m worried that if we talk about it, it will just make me feel worse.”

• To encourage connection: “I feel very disconnected from my body, like my head is fuzzy and floating and I just want to be numb rather than this stressed all the time. Can you help me feel more like myself?”

• To encourage feedback: “I’m needing something different in our sessions to help me. Can I talk to you more about that?”

• To name fears: “I’m afraid that if we talk about these things, I won’t be able to function or get things done afterwards,” or “I’m reluctant to talk about this now because we won’t have our next appointment until after the holiday.”

Any of these statements can lead to a supportive conversation with your therapist to further identify and explore your needs. These sessions can prove to be some of the most impactful and fruitful in not only holding space for emotion and processing of stress, but also supporting vulnerability and self-advocacy in exploring how you can engage all of your supports in ways that feel beneficial to you.

Hear me

Vulnerability is hard. Yet for many of us, the power of being seen, heard, and understood makes engaging in vulnerability worthwhile. Your therapist, engaging you from a place of compassion and empathy, can better understand your needs when you speak of them. Your therapist can offer a neutral curiosity with ongoing optimism conveys the message that, together, you can find relief. Whether it be concrete tools for coping or holding space for your emotions, your therapist can create a safety net to address any fear, guilt, or shame you may be harboring in these moments of distress. Engaging in holiday travel, consider your therapy sessions a roadmap to relief! With direction and insight, you can address avoidance and attendance from an authentic, supportive place to best serve you during the hustle and bustle of the holiday season.

“You are as amazing as you let yourself be. Let me repeat that, you are as amazing as you let yourself be.” Elizabeth Alraune

Making Meaning of the Dance: A Journey Through the Couple Cycle

“From the cradle to the grave, humans desire a certain someone who will look out for them, notice and value them, soothe their wounds, reassure them in life’s difficult places, and hold them in the dark.”
The practice of Emotionally focused Couple Therapy: Creating Connection by Sue M. Johnson

The Tango, The Charleston, The Swing, and The Cha-Cha. Yes, I know these are famous dances, but I would like to talk about another kind of dance. Within a relationship we all long to move toward our partner. To sway in the rhythm of passion, and desire. We long to feel the power of true connection that comes with being able to say “I need”, and get a loving and empathetic response in return. The dance I’m speaking of is the common relational exchange called the Emotionally-focused Couples Therapy Cycle. Emotionally-Focused Therapy or EFT as it is commonly referred to was the forward and remarkable thinking of Dr. Sue Johnson. In the 1980’s very little in therapy was being done to explore the scientific concept of adult attachment, which is a stark contrast to this same time period when so much emphasis was being placed on the continued study of childhood attachment theories and models. As Sue begun to delve into the attachment science, she began to see a potentially incredible model that could not only address attachment injuries both from childhood, and adulthood, but could systematically uncover relationship fractures, and invoke new and lasting connections. According to the ICEEFT website using the EFT model leads to couples being to move from distress to recovery 70-75% while 90% of couples showed significant improvements.

So how does this beautiful, and empirically proven model work? Well then, let’s begin!!

EFT is made-up of 3 stages i.e; Assessment and Cycle De-escalation, changing interaction patterns, and creating new bonds, and consolidation, and integration.

STAGE 1: ASSESSMENT AND CYCLE DE-ESCALATION

1. Ascertain primary concerns, and set couples goals. Then, explore relational history.

2. Interactions, and patterns are explored, and delineated. Therapist supports and assists in seeing historical interplays that have negatively impacted the coupling.

3. Partners comprehend attachment-related emotions. Couple first acknowledges covered emotions, and feelings, and discuss those emotions, feelings, and behaviors with their partner.

4. Couple and therapist with analyze cycle, triggers, and behavior output which results in two defined roles which are pursuer, and withdrawer. Therapist will also be mindful to notice, and name triggers present in the cycle.

STAGE 2: CHANGING INTERACTIONAL POSITIONS AND CREATING NEW BONDING EVENTS

1. Space is created for transparency in order to state attachment needs, for which partner had not received in the past, which cause bond fracture.

2. Couple develops the ability to compassionately respond to identified needs, and begin to accept the hurt, longing, and emotions that have been impacted by their partner.

3. As cycle awareness increases, and new cycle, and interactional goals are practiced new conversations and interactions present themselves, which increases likelihood of bonding experiences.

STAGE 3: CONSOLIDATION/ INTEGRATION

1. Couple integrates techniques, communication, and transparency, as they discuss the old cycle, and practice the new one. Practice is done outside the sessions in their own environment that exposes them to their domain that has been a potential trigger. Work with the therapist explores issues that came from those practices, and post conversations.

2. With heightened awareness of skills, and deeper bonds couple and therapist focus on the celebrating efforts, and future methods to enhance new found rituals. To safeguard couples success, and decrease history of emotional breaks safety risks are addressed and prepared for.

Real-life example:

In an EFT therapy session, a wife pursues her avoidant and emotionally absent husband. Her protest becomes a sense of loneliness, abandonment, and sadness that she no longer feels connected to her spouse. In the past she felt that she was assertive, and asking for her needs to be met, by demanding, yelling, screaming, and sometimes becoming violent. Over a period of time, her protests turn to withdrawal, as her pleads go unanswered, and she is tired of getting so big to be seen, but yet still remains invisible. “I want to be wanted, loved, and cherished”, so please stop avoiding me, walking away, and pretending that my yelling doesn’t mean more.

Her husband’s stark hallow shell, becomes empty, but rumbles underneath as a fire, and a quiet storm brews behind a cold and distant face. The separation turns from heartbreak to fury, as he doesn’t understand why his wife hates him so much and just wants to yell at him all the time. “I walk away because it hurts”! “I leave because my space no longer feels safe, and threatens any bit of quiet we have left”. “Why can’t you just see, that you are tearing us a part”.

She has grown, learned, and observed the hurt, and pain that both her and her partner are experiencing. This shared pain has given her a new perspective, and has gotten her closer to a man that she felt was lost. She has discovered that she can still be seen as she quiets the storm of her own pain, and brings her partner closer and shows him that loneliness that brought her right to the edge. He has found the passion, and strength to expose his vulnerability and deep need to be loved, and comforted without fear. His transformation travels from “you don’t care, and your cruelty is just too much”, to “this is really hard, for me, but I want to trust this feeling”. “Please be with me, and make me feel safe within this relationship”.

New cycles of closeness contact interactions appear and dissipate previously established cycles, criticize-defend or pursue-withdraw, withdrawer reengagement, or pursuer softening. As the partners experience the cycles together in safety and empathy these behaviors are reinforces, which leads to a positive and permanent change. Space for healing, and a new sense of having a brand-new safe haven sparks connectedness, and fulfillment previously missing.

“EFT can be thought of as a postmodern therapy in that EFT therapists help clients deconstruct problems and responses by bringing marginalized aspects of reality into focus, probing for the not-yet spoken, and integrating elements of a couple’s reality that have gone un-storied.”
Becoming an Emotionally focused Couple Therapist: The workbook by Susan M. Johnson

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Guest post written by Jamie Benson MFT-C, M.Ed, EFCT

Jamie Benson MAMFT, MFT-C, EFCT, M.Ed has been providing therapeutic services to Denver area children, adults, couples and families since 2015. She holds a Master’s Degree in Marriage, Couples, and Family therapy, as well as a Masters Degree in Education with an emphasis on Applied Behavior Analysis. Jamie currently works at Allhealth Network in Littleton Colorado and her work is centered around at-risk populations, including human trafficking, homelessness, human services, PO/probation, and substance abuse.

Holding Space for Horror, Hurt, and Healing

Have you ever felt the sensation of déjà vu? The gut feeling that you’ve been here before and thus can’t escape this surreal feeling, like you’re floating, your stomach is full of rocks, and there’s a ringing in your ears? For many of us, February 14, 2018 was a day of déjà vu in its worst form, reliving the trauma and horror of another mass shooting.

For me personally, the sudden anger, sadness, grief, and avoidance that came to the surface were the very same that I experienced after the Aurora Theater Shooting on July 20, 2012.  For others, it felt like Columbine on April 20, 1999.  Many people around the world are affected by the loss and violence surrounding a mass shooting and so many of us want answers. As therapists, we hold space for the questions and the grief, providing a safe environment for processing of loss, fear, and desire to understand. As trauma therapists in particular, we encourage clients to explore fears and needs in order to feel heard, and possibly, to begin the healing process again. And yet there are days we struggle with balance, the effort of holding space for others as well as holding space for ourselves.  If we are completely honest, it may even feel easier to hold space for others rather than think and feel our own emotions.

Professionally, it didn’t occur to me that Aurora would stay with me in my practice, year after year. July 2012 was supposed to be a month of celebration as our cohort had graduated and were seeking our first jobs as therapists. We had bonded in role plays, through projects, on adventures, and with humor. Survived internships, passed exams, and grew as individuals. Aurora would prove to impact the cohort quite rapidly when we found out four of our own peers were present and involved in the violence that took place. It took all day to get answers about their safety, and when we finally did receive word, we came together to grieve the loss of one of our own and trauma to three others. You may know him as the hero who took a bullet for the woman he loved, shielding her from the chaos in the theater. His actions show his character and the person he was in this world. There is so much I could say, but know that he was loved by many and brought humor and lively spirit to otherwise heavy work. We grieved together over the weeks that followed, knowing the impact would go beyond our cohort and be felt around the world.  Before we could blink, the cohort was scattering rapidly, almost like a driving force was pushing us away from one another, and away from the reminders of what we’d lost. It became easier to avoid and attend to others, to embrace their pain and needs for healing by throwing ourselves into the therapeutic work, perhaps hoping to heal ourselves in the process.

And yet with each new tragedy, full of images, horror, and tears, we are transported back to our own dark times. Perhaps triggered to the point of needing breaks, tracking our own emotions, and holding boundaries with our clients to stay present in their grief. Grappling with whether to share our pain with clients out of connection and compassion or decide to lock it away for another, more private time.

Whatever direction you decide in your own grief, know that your efforts to help others through connection and compassion go a long way in recovering from these tragedies. Let us be gentle with ourselves as we are with our clients. Let us acknowledge the hurt and remain open to the healing. Let us recognize the avoidance of pain and the safety needed to face it. And let us hold space when words cannot capture what is felt rather than said.  Only when being true to ourselves and embracing vulnerability can we truly support healing.

In loving memory of Alexander C. Teves

Avoidance and Attendance: How to Address Each in Therapy

It’s that time of year. The time where certain clients disengage from therapy in response to the season, holidays, or stress, and the time when others need appointments the most in order to support them through trauma, family conflict, isolation, and loneliness. When working for an agency, the crises seemed to intensify during the holidays. First it was the client diagnosed with Bipolar Disorder experiencing depression symptoms due to the winter weather. Then the client with trauma from sexual assault having to see their perpetrator at the family holiday dinner. Or the single client with no access to family experiencing increased suicidal ideation in response to spending the holidays alone. Or the client with high anxiety becoming stressed about money and gifts for their family, losing sleep and snapping at their kids. And finally, the client sober from alcohol for three months having to navigate holiday parties around family and friends where temptation may lead to relapse. Combine these factors with a client’s distress tolerance and they could engage in therapy fully to receive support, or in some cases, disengage in response to their symptoms. As helping professionals, how do we balance the variety of client needs with consistency, empathy, and grace?

Lack of physical attendance

The more easily measured is a change in physical attendance in your scheduled sessions. Perhaps the client starts to cancel sessions when they’ve been consistent in attending each week in the past. How do you explore their needs when you haven’t been able to see them in the office for several weeks now? Depending on how they are engaging you to cancel the appointments, you may offer a couple of ideas in response to their distress:

• Completing a phone call to gauge what is going on in their world and attempting to re-engage them in sessions to support symptom management.
• Offering a phone session rather than a face-to-face to explore and address present stressors if they are unable to attend.
• Identifying a different appointment time that allows physical attendance such as an early morning or later evening if appropriate.
• Redirecting text messages of distress by offering an appointment to discuss and support them.
• Reviewing their attendance contract with them to determine how they’d like to proceed, including possibly placing scheduled appointments on hold and resuming at a later time if appropriate.

Lack of emotional attendance

The hope is that with ongoing rapport, the conversations above can demonstrate healthy communication, accountability, and boundaries with a client experiencing increased distress. Rapport becomes even more important when engaging a client around a lack of emotional attendance or participation in session. Perhaps you begin to notice that the client arrives late every week, jumping into sessions with surface-level details or changing subjects rapidly throughout the scheduled time. Or maybe they remain at head-level in their processing, not dropping down into emotions and deeper meaning in session with you. With healthy rapport, you as their support can gently name the behaviors you are seeing in the room to encourage a healthy conversation about their avoidance. Here are some examples of how you might approach them in a compassionate way:

• In response to their running late: “I’m noticing how rushed it feels lately coming into our sessions and feeling like we have to fit it all in. Can you tell me more about what that’s like for you?”
• In response to staying in their head: “I’m noticing you are very much in your head today when it comes to describing how you feel, can I ask you to pause a moment and share with me what’s happening in your body right now?”
• To encourage reflection: “I feel like you are very far away in this session even though we are sitting across from one another, what does it feel like for you?”
• To encourage feedback: “I’m hearing that you have a lot on your plate right now. What can I do to help you best in this moment?”

Any of these gentle inquiries can lead to a tenderness and connection to emotion as well as an access point for clients to identify and explore their needs. These sessions can prove to be some of the most impactful and fruitful in not only holding space for emotion and modeling what it looks like to communicate needs, but also supporting vulnerability and self-advocacy in the client as to how they can engage their supports.

I hear you

As a therapeutic support, engaging clients from a place of compassion and empathy can be powerful to their experience. Balancing a neutral curiosity with ongoing optimism that, together we can find relief, can be empowering for the client. By starting with gentle reflection and gaining better understanding of their emotional response to stressors in their life, we can then encourage exploration and practice of positive coping. Whether it be concrete tools for coping or holding space for their emotions, we are creating a safety net to address any fear, guilt, or shame they may be harboring around their functioning in these moments of distress. Like any roadmap, with direction and insight, we can address avoidance and attendance from an authentic, supportive place to best help our clients in navigating their world.

“If we can share our story with someone who responds with empathy and understanding, shame can’t survive.” Brene Brown in Daring Greatly: How the Courage to be Vulnerable Transforms the Way We Live, Love, Parent, and Lead.