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Suicide Prevention

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September is National Suicide Prevention Month.

Whenever I think about suicide, what it means to me, how I feel about it, the word that always comes to mind is shame. I don’t think you can talk about suicide without talking about shame. I have been heavily immersed in Brene Brown’s research work on shame and vulnerability and the more I learn about it, the more open my eyes are to seeing it everywhere I go. Everyone I have ever known that has struggled with suicidal thoughts or gestures is shrouded in shame for one reason or another—they don’t feel good enough, worthy enough, pretty enough, smart enough, together enough…they feel too broken, undeserving of help or hope, and lost in a sea of “if only’s.”

The thing that strikes me in reading Brene Brown’s work and in applying this to my understanding of suicide, is just how preventable it is. I have always known and believed that, but understanding the role shame plays in it has shed new light on the word prevention. I think of someone who is suicidal as someone who has been walking a path of shame for weeks, months, sometimes years, all leading to feeling suicidal. The path is long and winding and with many stops along the way. Many chances for hope. Many chances for someone to reach out and offer a different path. So why? Why do we lose over 40,000 Americans to suicide each year?* Why is there a suicide attempt every 12.95 minutes?* Why are there approximately 1 MILLION suicide attempts made annually?*

Because of shame. Because of our lack of understanding of shame. Because of our fear of talking about shame.

We are infiltrated on a daily basis by messages of perfection, messages that encourage shame and discourage self discovery. We are plagued by the disease of comparing ourselves to others and constantly feeling not good enough. We think in terms of social media Likes and want to make sure we present our best looking, happiest, and most connected selves on Facebook, Instagram, and twitter. I have clients as young as 14 coming into my office completely depressed and hopeless because of something someone at school posted on Twitter, because their friends get more Likes than them, because someone made fun of their profile picture. The world has become so completely technologically connected that we have lost touch with what actual connection means. When I go to the store, or for a walk, or to get gas, I am always struck by what people are doing while they are waiting or walking or standing. They are on their phones. Not looking up. Not engaging. Not connecting to the world around them. How on earth can we be our most authentic selves if we are only putting what we think is our most “perfect” self out into the world via social media? That’s a lot of pressure. And it is incredibly lonely.

Bene Brown writes in The Gifts of Imperfection, “Our sense of worthiness—that critically important piece that gives us access to love and belonging—lives inside of our story.” Our story can be found in our imperfections and our vulnerabilities. If we don’t own our story, we flounder. We float around looking for something to grab onto to give us a sense of purpose and belonging. Without it the path of shame and not being enough becomes a path leading to hopelessness, helplessness, and feelings of not wanting to exist any more.

Suicide prevention month should be about putting down our devices and connecting with the people in our lives. Really connecting. That means sharing our stories, embracing our imperfections, and allowing the light to wash out the darkness that is shame.

If you or someone you know is struggling please call us. We can help. And you are not alone.

*Source: American Foundation for Suicide Prevention

Resources:

Depression and Mutual Need

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“We are all in this together and there is no therapist and no person immune to the inherent tragedies of existence”.

I read this passage from Irvin Yalom’s Book titled The Gift of Therapy and it touched something within me deeply. It was the reason I began my career in social work. The reason was to reach people, to join together to help create change and to help ease some of the burden that lies in being human. A passion was ignited within me at a young age to reach people in all walks of life and to do so in a meaningful and honest way. The truth about being a therapist is that it is not selfless work. There is little in this world that is. Being a therapist is a calling and therefore fills a deep need within those of us who do the work each day. It fills a need to connect and a need to help facilitate change. Just as joy and laughter are a beautiful part of life, so is suffering. Most of us need support on our journey to figuring out what to do with that suffering. I am not immune to that suffering, in fact it is because I have been touched by it that I am where I am today and am able to do the work that I do. The things I am reading in the news every day, the stories I am hearing from people in my community, all speak to the fact that while the dialogue about mental health is catching, it needs constant fuel to ensure that it doesn’t burn out. It is this dialogue that will save lives if we keep it going. But we must keep it going.

Someone asked me the other day if depression is for life. “Is it like addiction? Once you have it, you have it forever?” Depression is often at the forefront of our discussions regarding mental health. The reason is clear: it is so prevalent and relevant. While this is encouraging in that it means the dialogue is opening up surrounding the subject, it is often not being used correctly which is problematic for those suffering from depression. “I’m depressed. It’s just who I am.” Believe it or not I have heard this more than once. My question is always, “what does that mean to you, what is depression to you?” It is shocking how frequently the response is: “I’m not sure”. The word has become a catch all for things not going well in our lives. When this is tied to the stigma that is still woven throughout our society surrounding depression, it creates even more unrest in someone believing themselves to be depressed. The belief is I am depressed therefore I am broken. I can instantly feel the hope drain from the person sitting in front of me as they share this with me. But depression, like all mental health issues, is far from hopeless. Being broken is part of being human, we are born broken and it isn’t until death that we become free from the brokenness. Feeling sad is not depression. We all feel sad sometimes. It is one of our most natural and human emotions. Depression goes deeper than sadness. Depression resides in ones mind and heart like a beast, robbing the world of beauty, light, joy, and hope. The less we talk about it, the greater it grows, the longer it lingers, the more painful it becomes.

Jamie Tworkowski writes in his book If You Feel Too Much, “We all have our past. We all have our pain. We will all know ghosts from time to time. But if our life is like a building, then we should open our doors to let some people see inside. Into our darkest places, into those rooms that hold our fears and dreams.” Depression whispers to stay silent, to stifle your story, to not ask for help. The courage comes in doing the opposite. When I am asked what I do and the type of people I see, my initial reaction is to always respond by saying, “I see people like you. And I listen to their stories.” I am a therapist, but first and foremost I am also a human with my own story and my own pain and my own places that are broken. In the beginning I thought that made me less worthy of helping, listening, supporting, but I know now it actually makes me more capable. Living honestly is one of the greatest challenges we are faced with on a daily basis. We ignore our pain, we push away our discomfort, we hide from depression and anxiety and feelings of insecurity. It is when we step into the light, when we honor the broken parts of ourselves as much as the strong parts, that we become whole. Only then are we able to find true connection, true healing, and true peace.

Mutual need is a concept that rings true not only in my work as a therapist but also in my work as a human. It is when we free ourselves from the fear of being in pain, the fear of being broken, the fear of facing our demons, that we begin to see clearly. We are all in pain at some point in our lives. If we join together in that, the pain lessens, the burden lightens, and the darkness wanes.

The Importance of Validation in Relationships

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I remember when I was a teenager how frequently I felt misunderstood. It was a time in life filled with emotions and unknowns and I was bursting at the seams to “figure it all out”. Looking back I see clearly now that what I was really looking for was just to be understood, to have someone listen to me and say, “I hear what you are saying”. So many of us get stuck emotionally at different times in life and it is easy to revert back to a young place and a young feeling of wanting to be heard and needing to be understood. How many times have you talked to a friend, acquaintance, or family member and had them offer advice or had them tell you their story in response to yours? It can leave you feeling angry and even more confused than when you started out. The reason being, you weren’t looking for a solution. Most of us understand that it is up to us to solve our problems. What we are looking for in connection, in relationships, in life, is just to have someone listen and validate what we are feeling.

This holds true in therapy as it does in the rest of our intimate relationships. People come to me to share their story . Whether these stories are heartbreaking, tragic, pathological, or just about a bad day, it is not up to me to place judgment on them. It is up to me to not only hear the story but hear the emotion behind the story. What most of my patients are looking for, whether it be because they have been starved of it their entire lives, or because they just need to hear it coming from an unbiased and professional perspective, is validation. I see you. I hear you. I understand the difficulty of the emotions you are experiencing right now.

I was eating dinner at a restaurant the other night with my husband. In the midst of our dinner I couldn’t help but overhear the conversation two women eating near us were having. One said to the other “I just don’t understand why she wouldn’t just end it, it’s ridiculous. All she does is complain about him but she doesn’t do anything to change it!” My interpretation of this is that one of these women’s friends is in an unhealthy relationship that she talks about often to her girlfriends yet she does nothing to change her situation. This story sounds familiar to so many of us. The question can always be asked in a situation like this: is that friend talking to her girlfriends about her relationship for them to change it or just to have them hear what she is saying and to hear what she is feeling? The latter is always true. Understanding that we as humans need to be emotionally validated comes with another important lesson, we all have stages of motivation to change that we go through. This unknown woman in the unhealthy relationship that just “won’t end it” is clearly not ready to end it. I don’t know this woman, I don’t know the relationship, but I can guarantee this is the case. She is emotionally stuck. While it is easy for an outsider to judge this and look at her as being “crazy” for not ending it, if we validate her feelings and understand she isn’t ready to end it yet, we might provide her with exactly what she is looking for.

Change is uncomfortable and can be painful and challenging. We cannot expect people to change overnight, and we cannot expect it to be easy. Often times change pertaining to difficult emotional relationships and situations in life means untangling patterns and behaviors that have been present for ones’ entire life. That takes time, patience, motivation, and professional help. When your car needs a repair to run properly you don’t think twice in taking it to an auto mechanic. The same should be true when you need an emotional tuneup. None of us are free from the need for help every once in a while in getting unstuck.

The next time someone you love is talking to you, practice active listening and validation. Active listening means not only hearing the words the person is saying but also recognizing the feelings that come with those words. When they are finished, fight the urge to give them advice or to relate what they have said to something you have been through. Validate what they are saying, allow them the space to be supported by your understanding, and then if you feel you have something to offer–ask if they are open to hearing it before you speak. If you practice this in your relationships I promise they will become richer. And while you will be giving more, you will also end up getting much, much more.

Self Harm as a Way of Coping with Buried Rage

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Self harm, also known as self injurious behavior, is a topic that frightens many and is not talked about enough, particularly when discussing young adults and adolescents. Self harm manifests in many ways including cutting, burning, scratching, hitting, punching, head banging, sticking objects into the skin, or even swallowing dangerous substances. Some common misconceptions about self harm are that the people who do it want to die, they are trying to get attention, or they are dangerous. While finding out someone you love is engaging in self destructive behavior can be devastating and frightening, there is hope. Self harm usually is not a suicidal gesture. Those struggling with this behavior are seeking to escape the intense emotions they are experiencing. This seems like an oxymoron to many people. Why would someone want to inflict physical pain to avoid emotional pain? The truth is that self harming behaviors actually provide a temporary sense of relief due to the endorphins that are released in the body after cutting, burning, or other self injurious behavior. When our bodies are injured the natural biological response is for the body to release chemical endorphins. This creates a feeling of calm and temporarily soothes a hurting soul. The problem is that this temporary relief does not last very long and in fact creates even more emotional pain. It doesn’t address the underlying issue.

The first response I have to someone who is engaging in self injurious behavior is to find out what feelings they are trying to escape from. It is imperative that therapeutic work is done to get to the core of what they are self soothing. What happened in the past that is so painful and emotionally scarring that the only relief comes from hurting oneself physically? Generally the answer always comes back to buried rage. We learn at an early age that anger is socially unacceptable. Anger equates to fighting, violence, pain, suffering, even death. The misconception is that anger equals action. This is entirely untrue. Anger is a feeling just like any other. Even more important is the understanding that anger is a secondary emotion. It stems from some other feeling first such as hurt, pain, vulnerability, betrayal, loss, etc. In order to understand the rage we need to look back and discover where it was born. There is too much of what I call “bandaid therapy” in treatment these days. Learning new behaviors and practicing different coping skills accompanied by self esteem boosters and thought changing cognitive work. These practices are not entirely ineffective, but they lack the long term results that one hopes to get when they seek professional support for emotional difficulties. Learning new skills is incredibly beneficial after the core issue is understood and addressed. In order to see lasting change, one has to look deep into the psyche to uncover where the damage started and then begin to unravel it and heal old wounds. The therapeutic relationship is the perfect place to start doing just that.

My approach to self harm is to first create a trusting and solid therapeutic relationship in which to build a foundation for wellness. Once this is accomplished we will begin to uncover what has been buried so that we can begin to heal old wounds. The message anyone who self harms needs to hear is that they do not deserve to suffer any more than they already have. In therapy peace and understanding can be found that eliminates the need to self soothe through self harm.

Starting a Private Practice in a Post-Sandy Hook World

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My husband and I always knew we would settle in Newtown, Connecticut. After our years spent savoring every second of our overpriced New York City lifestyle, complete with a tiny shoebox apartment, we knew it was time to invest and make a commitment. Our future, if we were lucky enough to acquire it, always included a house with a big yard, marriage, and kids. My future also always included starting a private therapy practice. In our minds this future was always pulling us in the direction of Newtown. The choice was easy as my husband graduated from Newtown High School and his parents, my in-laws, still reside here. We were drawn in by the beautiful colonial houses, the iconic flagpole, the General Store sandwiches, friendliness of the residents, and the peace and quiet that comes with settling here. Three months before officially beginning our house hunt, December 14, 2012 happened. The world came to a screeching halt. I’ll never forget reading my husband’s text message multiple times and not believing his words to be true: “There was a school shooting in Newtown.”  Suddenly the town that had provided us with a peaceful escape from our NYC life, and that we had come to call home before even having a permanent address here, was all over the news. Just as it was for everyone and anyone who knows this town, it was completely surreal and horrifying.

What shocked us in the months following that day was that we were asked more than once if we were still planning on moving to Newtown. Our answer was always the same, “of course.” Where else would we go? While there was no denying that there was a heaviness that had washed over the town, what was more palpable was the incredible outpouring of love. It came from within, but it also came from all over the world. Love is louder than hate. People all over the world proved that and are still proving that every day. Of course we were still moving to Newtown. In the face of this great tragedy all of the reasons we loved this town were reaffirmed. When I envisioned opening my private practice did I dream of it being in a town shattered by such indescribable trauma? No, of course not. How can anyone imagine the unimaginable? But again, when asked if this was still my plan after having my son in 2014 and leaving my job at an inpatient treatment center for those suffering from substance abuse and mental health issues, the answer was always, “yes, of course.”

The need for quality mental health services is greater than it ever has been in our country. That is the conversation that needs to be had and heard in every fabric of our lives. The conversation needs to move from one of “mental illness” to one of “mental health”. The term I always saw at the core of my practice was “wellness”—wellness in mind, wellness in body, and wellness in spirit. After having a baby and realizing my life was in the greatest transitional shift I’ve ever experienced, I was further drawn to this practice rather than pushed away from it.

Becoming a mom doesn’t happen gradually as any mom will tell you. It happens in an instant and all at once. While what being a mom means to us changes and evolves throughout our lives, the instinctive feeling of unconditional love comes the minute your children are born. Becoming a mom has made me more passionate about everything I already felt deeply for. Our children are our future. While this seems obvious, it also seems to be the one true innocence in our culture that is suddenly being taken advantage of. Our children are in danger—and it’s not the kind of danger one normally fears. It’s the kind that grows in the mind of an unhealthy person and knows no boundaries. It’s the kind of danger that lies in the ignorance of what mental health is and how we can care for those struggling to find it and hold onto it. It’s the kind of danger that sits quietly in the house down the street or next to us in the grocery store, alone and afraid. In protecting our children we need to be open to looking at ourselves and recognizing when we need a tune up. We need to be role models of mental health so that generations to come watch as we change the conversation. This needs to happen in every facet of our lives, in our relationships with family, friends, coworkers, and neighbors.

Making the decision to seek therapy is an incredibly humbling decision and takes immense courage. Psychotherapy has gotten a bad rap over the years, but we are in the midst of an incredibly altering era for mental health. The difference is in understanding what therapy is. It isn’t just about diagnosing someone, labeling them, or focusing on what is “wrong” with them. It is about building on strengths that are already present, uncovering coping mechanisms to allow a person to heal and thrive even in times of struggle. It is about connecting a person to the right resources to be successful in their lives. Therapy can support you in learning how your feelings affect everything you do. So many suffering and in pain are searching for an answer or a cure. Psychotherapy offers more than that. Psychotherapy is the key to unlocking all of the parts of ourselves that end up buried by everyday stress, trauma, pressure, and sorrow. Psychotherapy allows one to move past just surviving and encourages thriving.

The dream of starting a private practice wasn’t born when the Sandy Hook tragedy happened. It was born well before that as I sat completely entranced by my professors at NYU as they spoke of change, equality, and what happens in the absence of love and self-awareness. Newtown Family Therapy came to fruition in a similar fashion as did my becoming a mother—all at once and without a rulebook, backed by passion, commitment, hope, and love.

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