Any divorcing parent knows that one of the hardest parts of a marital ending is feeling forced to stay connected to someone you don’t particularly want to see or spend time with. Not all co-parenting situations are toxic—in fact, many couples find parenting is easier after they have separated—but the adjustment to parenting separately can be tricky for anyone.

Children can be one of the biggest stressors on a marriage, and even when that marriage ends, the co-parenting relationship maintains its own level of stress. Once your custody has been set, you may be faced with all sorts of issues and circumstances that challenge you to reflect on your parenting strategies. Among your considerations: how best to cope with your ex as you figure out what this new relationship means and how it’s supposed to go.

Productive co-parenting isn’t about following any particular formula. Each couple has their own unique dynamic, story, and situation that needs to be worked out in a way that serves the context of that family. However, there are techniques, strategies, and practices that can improve both the co-parenting dynamic and each partner’s experience of that relationship.

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In my work with divorce, my focus is almost always on what each individual can work on within themselves. I encourage couples and individuals to refrain from trying to change or control their partners, and to focus on their own thoughts, feelings, and behaviors instead. Based on that philosophy, here are five strategies you can use to improve your co-parenting relationship that are completely within your control.

1. Use Empathy and Your Child’s Perspective

Having compassion for an ex can be hard when there has been betrayal, hurt, or rejection, but this is an essential component to co-parenting well. Seeing the situation through your child’s eyes will help you drop down into your heart, and it may give you a different perspective as you deal with your ex. Children simply want to feel loved, safe, and to spend time with their parents, so if you can make your main intention to help them in these respects, you’ll be co-parenting from a compassionate place. As you co-parent, remember it’s more about your child than you, and stepping into that place of empathy will be a good reminder. No matter how much you struggle with your ex, your children are always the priority.

2. Set Clear Boundaries and Maintain Structure

From the minute your marriage ended, your marital relationship shifted into something different, but you may still be engaging in old dynamics. Many of the ways you interacted with your ex in marriage are no longer appropriate or necessary, and a lack of good boundaries may make it even harder to transition into a new way of relating. Becoming clear about what works for you as you move forward untangling the relationship may help you set healthy boundaries. This includes how your children are picked up, whether your ex has a key to the house, and what kind of contact there is when you have the kids. Your boundaries may be violated, but it’s still important to communicate them.

3. Relinquish Control and Accept What’s Happening

There may be things you don’t approve of when it comes to your ex’s parenting style, or how they spend time with the kids. You may also feel differently about introducing a new partner or dating when it comes to parenting time. The reality is that more often than not you have no say over how your ex decides to live. Unless the situation is dangerous or neglectful, you need to learn to accept and let go of your need to control what happens in your absence. Instead of trying to control or change what’s happening, learn to let go, accept, and work with it as best you can. This is one of the hardest consequences of co-parenting, but also the one thing that can really reduce unnecessary stress.

4. Maintain Your Values and Live from Integrity

No matter how frustrated or annoyed you feel about co-parenting with your ex, maintaining your integrity and sticking to your values is essential. It’s easy to get pulled into ugly dynamics or engage in bad behavior when your buttons are pushed, but keeping your cool and staying true to yourself will feel better than reacting. It can help to make a list of the traits and qualities you want to uphold as you co-parent. These might include patience, kindness, respect, and/or grace. These are hard to stick to when you are dealing with someone who doesn’t have the same agenda, but rising above and taking the high road will be better for you and your kids.

5. Enjoy Your Time Off

Many parents spend the whole time they don’t have their children worrying and waiting for them to come back. It’s hard to not see your children half the time, but this alone time can be considered a silver lining. The more you take care of yourself by using that time to reboot and replenish, the better you’ll be for your children when you have them. Try practicing self-care, spending time with friends, exercising, or just having quiet time. All of these forms of self-support may lead to a greater sense of happiness, and you’ll have more space for caregiving and for dealing with your ex.

Learning to co-parent well is a growth-promoting process. You gain skills in negotiating, compromising, as well as stretching your internal capacities for compassion, patience, and empathy. All aspects of divorce can be used to transform the self, so making co-parenting another arena for becoming a better person may shift your focus and intention as you manage this challenging part of the process.

Author’s note: A caveat before we get into the substance of this article: couples counseling with a skilled therapist can greatly help couples in which one partner has the symptoms or diagnosis of autism spectrum (ASD)/high-functioning autism. This article describes the path followed by many women whose husbands are not diagnosed and who did not have successful couples counseling support to help them understand their differences. I write here about heterosexual married couples because these are the couples I see most frequently in my practice, where most often it is the man who exhibits the characteristics of ASD. This is not meant to imply only heterosexual couples face these issues or only men can have problematic ASD.

When a neurotypical woman is married to a man who has the behaviors associated with autism spectrum (ASD), several things typically occur. Over the course of her marriage, she experiences herself as gradually disappearing. In the place of her former self emerges a person she barely recognizes. She is so lonely. So hurt. So … angry. She feels isolated, as her social connections have gradually diminished. She feels misunderstood by everyone who knows her, so she has learned not to talk about her “problems.” She starts to feels crazy. She also feels guilty, because her husband is a good man.

This result can be seen in the following modified example from my psychotherapy practice:

A woman in her mid-50s came in for her first appointment. She seemed unsure of herself, eyes downcast, behaving as many women do when they first arrive. I recognized the familiar look of bewilderment, explained by others before her as wondering whether they are going to make sense when they begin to speak, of whether I will view them as whiners, or whether they may be wasting my time.

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Before taking a seat, she handed me her curriculum vitae. Many pages long, it was heavy in my hand.

“This is who I used to be,” she said.

At a glance, I could see that among other things this woman had successfully argued a case in front of the U.S. Supreme Court. Sinking into the chair in my office, however, she appeared too meek to look me in the eye as her tears began to form.

“I think my husband has Asperger’s. I don’t know, though. Maybe it’s me. Maybe there’s something wrong with me,” she said. “We have been married for 20 years. I don’t mean to say anything bad about him. He’s a good man. But I need a divorce. And my children think I’m a crazy person.”

Then the tears came in earnest.

“It’s such a relief to be here. People don’t believe me. I stopped talking about this a long time ago.”

I have seen this many times. On one occasion, a woman told me, “My husband has Asperger’s.” Then she began to cry, could not stop, seemed uncomfortable for not being able to compose herself, and left the office without uttering another word.

There are women who work with me for several months and can still feel blindsided when something comes up at home that they misinterpret from a neurotypical (NT) perspective instead of considering the implications of ASD. They continue to be surprised at the gap between themselves and their husbands. The pain they feel when they recognize this gap catches them like a stab to the stomach.

What has happened to these women? It’s difficult to see the process while it is going on, just as it is difficult to see the effects of water drops on granite minute by minute. But changes that are negligible day to day are incontrovertible over the long term. With time, granite that once held the characteristics of a unique natural form is visibly reduced to a smooth, monolithic surface.

What has happened to these women? It’s difficult to see the process while it is going on, just as it is difficult to see the effects of water drops on granite minute by minute. But changes that are negligible day to day are incontrovertible over the long term. With time, granite that once held the characteristics of a unique natural form is visibly reduced to a smooth, monolithic surface.

Instead of drops of water, women married to men on the spectrum are struck by pain from unrelenting moments of being reflected inaccurately in the place they look most often for reassurance: the eyes of their husbands. And over time, they begin to interpret what is reflected to them as a reliable representation. They try to alter their own perspective, their own aspirations, their hopes and dreams, to bring them into line so they are consistent with the way their husbands treat them. The lonely process of love and guilt and shame rips them apart.

It starts like this: a man on the spectrum (most often undiagnosed) marries a woman for all the qualities he admires, but once the wedding is over, those very qualities become the things that spark the most unsettling experiences for him. She is outgoing socially, has interesting things to talk about, and is engaged in intriguing professional activities. She is well-regarded, confident, and kind.

For her part, she finds his thoughtful attention and his stability comforting. She is also drawn to what she takes to be his reticence. She admires his ability to maintain his focus so intently and to be so successful in his work.

To a man on the spectrum, however, living with a person who has these qualities may be predictably uncomfortable. Where he seeks equilibrium in order to feel he understands the world around him, she seeks—and represents—novelty, as a result of the very curiosity that made her the woman he initially admired.

His constant anxiety related to living in what feels like an alien culture is soothed by predictability. This would be facilitated by the presence of a partner who complies with his view of reality. This is not because he sets out to manipulate her. It is because his fundamental concepts are threatened by hers. His anxiety grows with his fear of doing “something wrong” because he is never quite confident about what the “right thing to do” might be.

From her perspective, his thoughtful attention may have disappeared the very day of the wedding. He quickly became self-involved and aloof. The stability she admired slowly shows itself to be profound inflexibility. The reticence does not point to the underlying wisdom she assumed was present; she now sees that it comes from his not knowing what to do or say. And his inability to focus on her has come to mean she exists outside his field of interest, where he is apparently content to relegate her.

Mommy’s Birthday Doesn’t Matter

We can look at birthdays to explore the dynamics common to interactions between partners in an ASD/NT couple. When he does not acknowledge her birthday, and she asserts that his behavior has upset her, he may respond that he did not mean to upset her; therefore, she shouldn’t be upset. Or he might tell her that because birthdays come once year and everyone has them, they are no big deal and she should stop making such a big deal about them. Or he could tell her they celebrated her birthday last year. Or that birthdays are for children. In other words, he may hold her to the same idea regarding birthdays he holds himself. He may criticize her to the degree that her feelings about birthdays differ from his. He will miss her distress.

As a result, she doesn’t have the opportunity to celebrate her birthday, something which is generally understood as a common social convention in our culture. She also feels rejected by her husband over the belief her birthday is worth noting in the first place. She asks herself why such a little thing as a birthday seems so important to her. She wonders whether she is being juvenile, as he suggested. She sees he doesn’t care one way or another about celebrating his own birthday, after all.

She decides he is more mature than she is and attempts to comply with this idea of “maturity” by trying to ignore her own birthday. It doesn’t work. All her friends and family members mark their birthdays in some way. She sometimes has to explain to them why hers was overlooked. On occasion, she makes up stories about her birthday so people won’t feel sorry for her. She feels rejected, as well as foolish for being immature.

Overall, she is sad and lonely, still wondering why she can’t seem to make a point on her own behalf that she’d enjoy at least a card acknowledging her birthday, even though birthdays may not be important to him. But over time, she has learned further discussion is hopeless on a subject like this. She won’t say anything else about her birthday. She has learned such a conversation isn’t a discussion at all. It feels more like a pedantic correction of yet another one of her stupid ideas. And it will leave her upset, possibly in tears, with nowhere to go but inside.

She continues to celebrate his birthday. She makes certain the children’s birthdays are acknowledged and celebrated. She is now operating from the notion that her own birthday is a nonevent. It does not get mentioned because she does not bring it up. Her children, even though they are young, are noticing mommy’s birthday doesn’t matter, however. Daddy’s does. Theirs do. Mommy’s doesn’t. They do not understand it is Mommy herself—and without help from Daddy—who makes all the other birthdays happen. By complying with her husband’s view of things, however, in order to avoid the pain of being criticized about it once again, she has taught her own children that Mommy’s birthday doesn’t matter.

It is fair to wonder why a woman can’t decide to celebrate her own birthday on her own terms, regardless of what her husband thinks about it. In most cases, this would be a valid point. When ASD is present, though, the calculus is different. She can celebrate. She can bake a cake. She can buy herself flowers and even make reservations to go to dinner that evening. If she does, however, her husband’s attitude will be clear to her and to the children, whether he says anything with actual words or keeps his silence. It will be obvious to all concerned that he does not approve. He will comply to a minimum degree. He will participate begrudgingly. He will damn with faint praise. He will stonewall, which means he will say nothing at all, when she suggests (even mildly) that he participate. She has become accustomed to his stonewalling, which Dr. John Gottman, relationship expert, believes can kill a relationship because it denies communication and denies opportunity for the relationship to grow.

The Children Are Watching

The children are watching everything, interpreting it from their limited perspective and understanding. Mommy isn’t thinking of this at the time. She is not thinking the children learn how to treat their mother by observing the way their father treats her. She is operating on the assumption her children know her and love her and they see she is a good person. She is unaware that negative lifelong attitudes toward her are being formed in the young minds of the children she loves so dearly, and that these attitudes can come at her later to hurt her every bit as much as the behaviors she suffered from her husband, their father—the very behaviors that instilled these attitudes in the children in the first place. She is not thinking about the fact the children will likely remain unware they hold these subconscious notions regarding their mother, regarding how to treat her, regarding what she “deserves.” They watched how their father treated her. They learned. As adults, they may ignore their mother’s feelings and question her judgment, just the way Daddy does.

She is also unaware that in doing all the work and providing all the energy toward celebrating Daddy’s birthdays and the children’s birthdays, she is showing the children one more example of taking on both roles, Mommy and Daddy. She does it because it is important to her, for example, that the children’s birthdays are celebrated. She wants them to have fun. She wants them to have one special day a year that is all about them. She sees this as normal.

Daddy doesn’t agree, so he doesn’t participate.

Mommy does it all, from the planning to the present buying to the cake decorating, at home or at the bakery. She chats with all the parents who bring their own children to celebrate. She cleans up after the party. She is exhausted. She says so. Her husband may respond by saying, “Well, you’re the one who had to have this big party! You asked for it.” He may not help with the cleanup because, well, it was “her idea to have the party.”

The children are watching as Mommy cleans up and Daddy retreats to his study. If they get wild or misbehave, a distinct possibility after having the house full of friends and their tummies full of birthday cake and ice cream, it will be Mommy who has to enter the fray and settle things down. If she’s tired and feeling lonely and rejected by her husband, she is at her least resilient point, and she can snap unintentionally at the children. She looks like the bad guy, the parent who is “always angry.” This is how it may seem to small children.

The children are also susceptible to misunderstanding another basic fact they observe regularly. They see Mommy being strong. They see her as the one in charge of all the daily life of the family, and of all the extras (such as birthday parties, ballet lessons, soccer games, play dates), and they wonder where Daddy is. Because the reality of the situation is impenetrable and inaccessible to the children, they may create their own narratives. They may believe Daddy is a good man, yet Mommy seems to want to do everything. They determine this is because Mommy has pushed Daddy aside in order to control everything herself. Mommy doesn’t let Daddy help. Poor Daddy! Mommy is really mean.

Time to Make a Change

The years go by. The children go off to college, graduate, create their own lives. Mom couldn’t be more proud of the young people they have become. She decides she can no longer survive the relationship with her husband, however. It is not unusual for women to leave these marriages once the children are at least in high school, but often the marker is when they leave the house for college. This is not an easy decision for a woman. In fact, it is brutal. And it often makes no sense to anyone who is looking in at the marriage from the outside, including the couple’s children. She must give up everything in order to save her sanity. Yes, it has come to that.

This woman has lost a partner, lost a marriage. She has also lost her dreams, her hopes. She has lost her fundamental sense of who she is. She has to mourn these losses. She then has to heal. And she has to re-create herself.

The woman by this time may have few friends, few confidants. She has learned to refrain from discussing her marriage difficulties, because the friends she has have always seen her husband as such a “nice guy” and because he is undeniably a good provider. She stopped trying to talk about it because she got tired of hearing “all marriages have problems,” she is “expecting him to meet all her needs, which is impossible for any one person to do,” and she is “misinterpreting things.”

When she finally does go through a divorce, she discovers it will take her years to sort things out. She will think she is doing well immediately afterward because it feels so good to be free from the constant state of stress and criticism. This can be exhilarating. But gradually, she learns it is a phase. And it reveals a miscomprehension of how much healing she really has to do. During this time, before she reestablishes her new self, she may do things that seem rational and make decisions that seem logical. However, it is in looking back from a vantage point of several years after her divorce that she is likely to begin seeing just how separated from her true being she was during these years of healing, and of how much more healing she had to do, and still faces.

This woman has lost a partner, lost a marriage. She has also lost her dreams, her hopes. She has lost her fundamental sense of who she is. She has to mourn these losses. She then has to heal. And she has to re-create herself. It can take a decade or more to sort these things out and to become strong on her own. If she enters into a relationship with another man before she gets her bearings, she is likely to face additional confusion until the dust settles. This is not to be dismissed as the normal post-divorce phase of a woman’s life. It is an epic battle for reconstruction.

A No-Win Situation

By this time, the children see her differently. She is the woman who did not deserve to have birthday parties, remember. She is the woman who appeared to have pushed their father aside, so he was unable to be part of their daily lives. She appeared to have been the one who rejected him, and who instead of involving him in their lives, inserted her own agenda and goals. She is the one who spent all the money, because she had to manage everything and make all the decisions without her husband’s input. She is the one, most importantly, who broke up the family. Her selfishness caused the divorce, and the children were left to sort it all out.

Dad is the victim. Mom is the witch.

Mom has given her life to be both mother and father to the children because their father, on the autism spectrum but undiagnosed, was incapable of being involved emotionally and practically in the daily lives of their young family. Patterns were established. Mom continued to give. She finally left the marriage for her own sanity. She loses her marriage, her husband, her intact family. She appears to be the agent of the demise of the family, but she is not, because in running from abuse (regardless of the fact it was not necessarily intentional), she is running from a burning building in order to save her life. A fire set by intent, an accidental fire—what’s the difference to the person inside the house who must flee if she wants to live?

The woman loses again when she begins to understand her children treat her the way their father always treated her. They don’t respect her. They keep their distance. They blame her for everything they ever felt was wrong in the house when they were growing up.

The woman coming out of an ASD/NT marriage loses twice. She loses her husband and she loses when her children treat her the way their father treated her.

And to attempt to tell her story to her children is wrought with landmines invisible to her and unimaginable to the children. She feels she cannot convey the reality to them, regardless of her attempts. And even after all these years, she does not want to disparage their father, because she understands ASD is not his fault. She still treads carefully, even though he is unlikely to extend the same grace toward her. The children do not see this. Too much time has gone by. Too many patterns are set. They see only criticism of their father if she mentions she had to heal, or that she had to rediscover who she was after the divorce, or that she may have made decisions in the early years following the divorce that were not ultimately consistent with the person she now knows herself to be. She is, once again, judged and criticized—this time by the very children she exhausted herself to nurture.

If she is fortunate, she has found a good therapist along the way. She has had the opportunity to talk without feeling crazy. She has cried the bulk of her tears, though they still come when she thinks of her children, of how she loves them, of how unfair this has been to them, to her, to her former husband.

She has herself. She has friends. If she is fortunate, she has learned to re-create herself in such a way she has a career or an involvement in the community that allows her to experience herself in her competence and to be acknowledged by others as a person worthy of attention, worthy of friendship, even worthy of a birthday party.

Postscript: This article is a composite of what I have seen in my practice over the years among neurotypical women who have emerged from marriages with men who exhibit the behaviors consistent with a diagnosis of autism spectrum disorder (formerly called Asperger’s syndrome, high functioning autism). As a psychotherapist, I work with ASD/NT couples. I work with individuals affected by ASD. I work with women who are or were married to men with ASD. My role can be described as that of an ASD/NT translator, essentially, and my goal is to help both partners understand the world as seen from the other. By writing this, I do not mean to disparage or judge anyone. This article reflects my experience as a therapist, and I offer it here in this form to help women understand that their experiences are valid as well as to help their friends and family members understand what these women have been struggling with—and what they may well continue to struggle with for some time to come.

References:

1. Gottman, J. (2015). The Seven Principles for Making Marriage Work: A Practical Guide from the Country’s Foremost Relationship Expert. New York, NY: Harmony Books.
2. Silverman, S. (2015). NeuroTribes: The Legacy of Autism and the Future of Neurodiversity. New York, NY: Avery Publishing.

Do you know what type of therapist you are seeing or are about to see? Not all therapists are the same—they have different perspectives and training. Therapists need to know what motivates their work, what they hope to accomplish professionally, and how they want to serve people in therapy. Many therapists struggle with questions such as, “What’s my niche?” or, “How, exactly, should I help this person?” Most of us come into the field wanting to help and make a difference in people’s lives; orienting ourselves professionally can help us achieve this goal.

As a person in therapy, you may expect your therapist to know exactly what they’re doing, but this is not always the case. Some degree of uncertainty and self-doubt is common and natural among therapists. However, it can become problematic when they fall back on outdated training, integrate interventions that are incompatible, or serve populations with which they have no expertise or knowledge. This can confuse both the person in therapy and the professional.

I have struggled with lack of direction in my own practice, and I have learned to view my work as a therapist from a different, more realistic angle. After working in the field and developing my professional identity, I came to understand there are four important components that describe the style of every therapist. People seeking therapy might benefit from learning about these and being prepared to ask questions when searching for a therapist.

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1. The Therapeutic Philosophy/Approach

It can be helpful for therapists to understand how their worldviews inform their therapy. As a result of their training and experience, they may automatically and unconsciously perceive people in therapy and their work with them in a specific way. As they begin to notice what makes them feel more competent in their work, therapists can become confident about the interventions they use and can identify a clear pattern in their clinical practice.

For instance, therapists who find they are interested in understanding people’s thinking patterns and processes, and adopt a deliberate intervention to redirect these, are usually approaching their work from a cognitive or cognitive behavioral angle. This may not make a lot of sense for people in therapy; however, it is the therapist’s responsibility to be informed and aware of therapeutic philosophy, or at least aspire to this level of professional self-awareness.

You may sometimes hear therapists referring to themselves as “eclectic.” This is common in the field of psychotherapy, and it means they integrate multiple therapeutic approaches, or perhaps use specific techniques borrowed from different models. Although this can be a valid lens from which to conduct therapy, it can also create confusion, diminish the efficacy of evidence-based practices, and distort the objectives of therapy. There are eclectic therapists who truly believe their best work comes from borrowing from different approaches, and then there are “eclectic” therapists who fail to take the time to develop expertise in any one approach.

It is not always easy to distinguish between these two types of eclectic therapists, but it’s important for a person seeking therapy to know the difference. Many therapeutic approaches or models are similar, but they are different enough that therapists may want to be deliberate and specific about their worldview.

2. The Delivery

You may notice therapists often identify with a delivery that matches the model they use. A therapist whose therapeutic philosophy is cognitive behavioral will frequently describe their delivery with people in therapy as “directive.” Specific therapeutic models suggest therapists who use their model should always have a particular way of conducting their sessions.

One of the most common complaints from people in therapy is that therapists act like robots—they aren’t being themselves, or they don’t connect. I believe this is a result of forcing an unnatural delivery in therapy sessions.

I think this is unrealistic. The delivery is about the way therapists communicate with someone in therapy, how they translate the information, and how they choose to convey their messages. A therapist who identifies with a cognitive behavioral philosophy, who tries to exhibit a “directive” delivery as the cognitive behavioral model suggests, but whose personality and natural presentation are more soothing or indirect, is simply not being truthful.

One of the most common complaints from people in therapy is that therapists act like robots—they aren’t being themselves, or they don’t connect. I believe this is a result of forcing an unnatural delivery in therapy sessions. The delivery should match the therapist’s personality, not necessarily the therapeutic approach or philosophy. People pick up on these things.

As most therapists know, one of the most important factors in therapy is the relationship between the therapist and the person in therapy. How can there be a genuine relationship if the therapist is trying to be someone else? I suggest therapists simply be themselves. This is likely to be the easiest part of their clinical work. Therapists can adopt a variety of delivery styles: directive, soothing, indirect, challenging, curious, humorous, reflective, supportive, intellectual, or a combination of these. I don’t think it should be about trying to match the model, but about who the therapist truly is.

3. Skill Level

To have a big influence on another person’s life, therapists should make sure their skills are strong, sharp, and up to the challenge. When I say skills, I am not referring to experience or age of the therapist. Skill level involves the preparation, commitment, and willingness to become a better therapist. A therapist should never assume they know it all, or that they should know it all. This can be a terrible trap and one that can make people in therapy feel like they are wasting their time.

Most licensed therapists are required to participate in continuing education as required by the agency or organization that regulates their credentials. Some therapists may attend any training just to get the hours they need to renew their license, while others may research and attend training that specifically target their personal needs and contributes to their professional development.

For example, if you have a therapist who specializes in treating young girls experiencing an eating disorder who attends a training on substance abuse in middle-aged men, you may want to ask why. Your therapist may have a perfectly sound reason for this, but sometimes the reason is license renewal. An important exception to this is when therapists are curious about new modalities, or when they truly don’t know yet what their niche will be. Most therapists are quite comfortable sharing their recent training and education with people seeking therapy. This is not part of the mandatory disclosure statement, but I think it should be.

4. Awareness of Readiness to Help

Is your therapist ready to help you attain your goals? Sadly, some are not, even if they really want to help. Readiness to help can include preparation, skill level, delivery style, and even therapeutic philosophy—but it’s more than that. Therapists need to be self-aware regarding how helpful they can be within the therapeutic context. Does your therapist have the tools to navigate vicarious trauma? Have they lost their passion for therapy? Are they burned out?

Naturally, this work is difficult. Therapists are exposed to painful stories every day, all day long. This can take a toll on a therapist’s ability to perform on the job in the long run. Burnout can influence a therapist’s self-perceptions about their ability to help. When this happens, your therapist may not be ready to help, or they may be completely unaware of this and continue to do clinical work. (They also have bills to pay.)

The good news is there is hope. Therapists are used to hearing about something called “self-care,” which is necessary to maintain a healthy balance between personal and professional lives. When therapists neglect this area of their work (yes, self-care should be part of the work), they may be unaware or even in denial about the effects of their work on their emotional well-being. This in turn can affect the quality of the service they provide.

Burnout is a real thing in this field. Many therapists who work in community mental health, residential services, in-home therapy, or hospitals run the risk of becoming burned out. It is important to recognize the signs and take immediate action. You want your therapist to love what they do for a job. If they don’t, take your business elsewhere.

I have been (and am) a person in therapy myself, just like many other therapists. I don’t want my therapist, the person who is supposed to help guide me through my journey, to be unaware of where their philosophy and passion lie, to pretend to be someone else, to lack the necessary skills or education to help me overcome my challenges, or to be burned out to the point of not being helpful at all.

I will conclude with sharing the four characteristics that shape my own therapeutic identity. My therapeutic philosophy is narrative therapy, an approach that views the problem external to the person, who is the expert of their own experience, able to retell their stories in their own voice. My delivery includes some traits usually connected to narrative, such as curiosity and respect, but I am also direct, which is often associated with therapeutic models very different from narrative. As for my skill level, well, I’ll let that speak for itself. Lastly, my awareness of my readiness to help is strong because I have made it an important part of my work to practice self-care and to not allow the difficulties of this field diminish the passion that drove me to this work in the first place.

Earlier this year, the Powerball jackpot soared to $1.5 billion dollars. Ticket sales went through the roof. People who never played the lottery before were suddenly buying handfuls of tickets. According to psychologists, this is likely rooted in an innate fear of missing out.

FOMO, an acronym for “Fear of Missing Out” has become a popular internet term in the last few years. It was even added to the Oxford English Dictionary in 2013. FOMO is defined as the feeling of anxiety or apprehension over the possibility of not being included in an exciting event happening elsewhere that others are experiencing.

The term may be new, but the feeling itself is not. People tend to wonder if the grass might be greener on the other side. There’s always the question of whether someone out there is living a better life, making more money, or finding more opportunities. In the digital age, when social media and smartphones have the potential to make us more preoccupied with others’ lives than ever before, FOMO can become a serious problem for some people.

Where FOMO Comes From

The term FOMO was originally popularized by entrepreneur Caterina Fake. FOMO is a modern-day form of “keeping up with the Joneses.” Where people were once trying to keep up with a handful of neighbors, they’re now trying to keep up with hundreds, even thousands of social media friends and followers.

Social media has its good points. It can help people stay connected to friends and family around the globe, but it can also create serious feelings of anxiety, inferiority, and depression for some. People look to social media to feel more connected, but in many ways, it can make people feel more disconnected.

[fat_widget_right]It is not clear to researchers whether social media is responsible for creating feelings of FOMO or if it simply makes it easier for people to indulge in those feelings. The latter is more likely, as humans have dealt with emotions such as envy and regret since the beginning of time. Looking at others’ lives on social media for hours each day can exaggerate those emotions.

Research has linked FOMO to feeling disconnected from others and discontent with one’s own life. According to a 2013 study published in Computers in Human Behavior, people with a high degree of FOMO feel less competent, less autonomous, and less connected in their daily lives than the average person. People with strong feelings of FOMO also reported using social media more often, suggesting social media may be a significant contributing factor to their anxiety.

Megan MacCutcheon, LPC, has noticed the negative effects of social media in people who are seeking to improve their self-esteem through therapy.

“In my workshops, participants often begin a conversation around social media and how it affects their self-esteem and the ability to feel satisfied in their own lives,” MacCutcheon said. “They see all these pictures and status updates on Facebook and develop a fear that they are missing out on the happiness, success, perfect families, and exciting experiences that everyone else seems to have.”

For those looking to improve their self-esteem and increase satisfaction in their own lives, here are some tips for overcoming FOMO.

Embrace the JOMO (Joy of Missing Out)

JOMO, or “Joy of Missing Out” is a counter-term created by entrepreneur Anil Dash. While people with FOMO may second-guess their choices and wonder if they could be having more fun elsewhere, people with JOMO embrace the choices they have made and find joy in the present situation.

Millions of amazing events take place in the world at any given moment. It is impossible to be everywhere at once. Rather than worrying about what you may or may not be missing out on, try making the choice that is best for you and owning that decision. Find happiness in what you’re doing, and remind yourself why you made the choice in the first place.

Limit Your Social Media Intake

FOMO might be an age-old problem, but social media can add fuel to the fire. If you find social media is making you feel envious of others’ lives or unsatisfied with your own, try limiting your time on social media websites such as Facebook, Instagram, and Twitter. Many people have become addicted to knowing what is happening in others’ lives. They end up neglecting their own lives, staring into a screen instead of being fully present in the moment.

Try giving yourself a set amount of time to check social media each day. Applications such as StayFocusd, Anti-Social, and Self-Control can block or limit time on social media and other distracting websites. You can also stop notifications from appearing on your phone so you are only engaging with social media when you are actively logged on.

Go to a Digital Detox Camp

FOMO is a modern day form of “keeping up with the Joneses.” Where people were once trying to keep up with a handful of neighbors, they’re now trying to keep up with hundreds and even thousands of social media friends and followers.If limiting time on social media doesn’t seem like enough, sometimes a full hibernation may be helpful. Some people choose to take a few weeks or even months off from social media to spend time with their real-life friends and family and focus on the present moment.

Some may choose to go on a camping or hiking trip to unplug. Others may find it more difficult to put their phones down, so they choose to attend a digital detox camp. Camp Grounded, located in Northern California, is one such digital detox camp. Adult campers willingly give up their phones for a few days, leaving the work jargon at home and participating in activities such as campfires, yoga, meditation, swimming, archery, and stargazing, among others.

Remind Yourself Social Media Is Airbrushed

Remember what is posted on social media is usually not what it seems. Just like the photos of models in magazines are airbrushed, people don’t typically post the whole truth on social media. Instead, people typically only post their best selfies and are more likely to share a photo of an exciting adventure rather than a rant about any difficulty they may be having. Remember, no matter how perfect or interesting a person’s life seems, everyone has bad days.

Be Grateful

Cultivating an attitude of gratitude can help combat anxious and envious feelings. Research has shown simply writing down a few things you’re grateful for each day can help increase your overall life satisfaction. Further positive psychology research links gratitude to greater feelings of happiness and well-being. The next time you’re feeling envious of what someone else has, try redirecting your focus to the positive aspects of your own life. You may start to feel better.

Practice Meditation

Meditation can help you become more mindful of your thoughts and feelings and how they affect your life. Taking a few minutes to meditate each day can help clear your mind and reduce anxiety.

Change Your Thoughts

According to psychologists, FOMO can actually be a form of cognitive distortion. Cognitive distortions are irrational thought patterns—such as believing your friends don’t like you if you weren’t invited to a recent event—that can lead to depression and other mental health conditions. Cognitive behavioral therapy techniques can help people learn to spot cognitive distortions when they occur and transform them into more positive and constructive thoughts.

Unplugging from technology, redirecting your thoughts, and seeking help from a qualified mental health professional are all ways you can stop worrying about what you’re missing out on and start feeling confident in the way you choose to spend your time.

References:

1. Burkeman, O. (2014, October 17). This column will change your life: The joy of missing out. The Guardian. Retrieved from http://www.theguardian.com/lifeandstyle/2014/oct/17/joy-of-missing-out-oliver-burkeman
2. Hinds, H. (2016, January 13). Fear of missing out fuels pressure to play Powerball. Retrieved from http://www.fox13news.com/consumer/74215255-story
3. Huet, E. (2014, June 20). Camp Grounded: Where people pay $525 to have their smartphones taken away from them. Retrieved from http://www.forbes.com/sites/ellenhuet/2014/06/20/camp-grounded-digital-detox/#732df78c688a
4. Giving thanks can make you happier. (2011). Harvard Health. Retrieved from http://www.health.harvard.edu/healthbeat/giving-thanks-can-make-you-happier
5. Glei, J. K. (2010). 10 online tools for better attention and focus. Retrieved from http://99u.com/articles/6969/10-online-tools-for-better-attention-focus
6. Pappas, S. (2013, May 14). Life satisfaction linked with fear of missing out. Huffington Post. Retrieved from http://www.huffingtonpost.com/2013/05/14/fear-of-missing-out-life-dissatisfaction-fomo_n_3275349.html
7. White, J. (2013, July 8). Research finds links between social media and the ‘fear of missing out.’ The Washington Post. Retrieved from https://www.washingtonpost.com/national/health-science/research-finds-link-between-social-media-and-the-fear-of-missing-out/2013/07/08/b2cc7ddc-e287-11e2-a11e-c2ea876a8f30_story.html

If you’ve watched television in the last few years, you’ve likely come across a reality show about hoarding. Rather than truly educating the public on the condition, reality TV tends to dramatize the issue, spread misinformation, and increase stigma.

Hoarding reality shows can be misleading, as they often showcase only the most extreme cases of hoarding. Hoarding is a broad term that covers a vast range of circumstances. For example, a person with a hoarding problem may have difficulty getting rid of possessions but still have far less clutter than the individuals seen on TV.

An estimated 15 million people in the United States experience hoarding issues. Hoarding is a serious condition that can have devastating physical, emotional, social, financial, and legal effects on the individual and surrounding loved ones.

It’s time to bust the stigma and tell the truth. Here are seven common myths about hoarding.

1. Hoarding Is Just Another Name for OCD

Hoarding is a complex mental condition characterized by collecting too many items, an inability to let go of possessions, and trouble with organization. Until recently, hoarding was considered by mental health professionals as a form of obsessive compulsion (OCD).

While hoarding seems to be related to OCD, a vast percentage of individuals with hoarding problems do not exhibit other OCD symptoms. Even though some experts consider it a subtype of OCD, typical treatment plans have not been shown to be effective at treating the symptoms of hoarding.

2. Hoarding Is the Same Thing as Being Disorganized

[fat_widget_right]While being disorganized can be a problem itself, it is not as severe as hoarding. The major difference between someone who is hoarding and someone who is messy is hoarding can make it difficult for the person to function. People may accumulate so many items they can no longer sit on the sofa or use the stove. A person who hoards is often unable to get rid of such items even when they are no longer useful or they interfere with daily living. A messy person is usually able to let things go when necessary.

Hoarding is far more serious than being disorganized. Compulsive hoarding can affect a person’s ability to maintain relationships, keep a job, and take care of personal and household needs.

3. Cleaning Will Immediately Solve the Problem

Simply attempting to clean up a cluttered space without addressing the underlying issue typically fails to solve the problem. People may spend hours of time and thousands of dollars to clean out a space only to have the person relapse and start accumulating more stuff in just a few months.

Those whose homes are cleaned out without their permission also may experience extreme distress, complicating the issue. To completely stop hoarding, a holistic treatment plan may be more effective.

4. Hoarders Are Lazy, Dirty, and Unmotivated

Stereotyping people with a hoarding condition as dirty or lazy is an unfair stigma. People who hoard may have cognitive deficits in the brain, impairing their ability to make decisions as well as to keep things organized. Studies have also shown there may be a genetic component to hoarding problems.

Rather than being stigmatized, what people with a hoarding condition really need from others is compassion, empathy, and support.Assuming a person who hoards is also dirty adds to the stigma surrounding a hoarding condition. The term hoarding most often refers to the accumulation of objects and clutter rather than dirt. It is common for a person who hoards to keep a clean house despite the clutter.

Hoarding is also common after a major loss when a person is unable to cope with grief in a healthy way. People who hoard are not lazy; they are just less capable than the average person at carrying out tasks and making decisions. Rather than being stigmatized, what people with a hoarding condition really need from others is compassion, empathy, and support.

5. Hoarders Are Collectors

Hoarding and collecting are two different things. Collectors tend to keep their items organized and proudly on display for others to see. People who hoard will rarely display their possessions, usually keeping their belongings in complete disarray. They often feel embarrassment and shame when others see their mess.

Hoarding also differs from collecting because it often prevents normal usage of the home. For example, a person’s kitchen appliances may no longer be accessible as a result of clutter.

6. Hoarders Can’t Stop Hoarding

Though it can be difficult for an affected person to stop hoarding, compulsive hoarding can be treated. Medication has not been shown to be effective against hoarding, though it may help alleviate some of the symptoms associated with it such as depression and anxiety.

Long-term therapy can effectively treat hoarding when combined with adequate education and support. Hoarding generally requires a holistic and comprehensive treatment program that addresses all aspects of a person’s life.

7. Hoarding Can Be Treated by a Single Medical Professional

Hoarding is a multi-faceted issue and typically requires a team of professionals to effectively treat the problem. Some professionals that may be involved in the treatment process include psychiatrists, therapists, counselors, professional organizers, building inspectors, and landlords, among others. These teams are often referred to as task forces, and approximately 75 cities currently have them in place to help those in the community who are struggling with hoarding.

If you or a loved one are struggling with hoarding problems, it may be helpful to talk to a therapist or other mental health professional who specializes in hoarding.

References:

1. Baker, J., Bergren, M. G., Frost, J., Sanchez, L., Andreasen, T., & Bratiotis, C. (2014). Beyond the Sensationalism: Professional Responses to Hoarding Disorder in the Omaha Community. Retrieved from http://www.unomaha.edu/news/2014/04/hoardingwhitepaper.pdf
2. Bratiotis, C., Otte, S., et. al. (2014) Hoarding Fact Sheet. International OCD Foundation. Retrieved from https://iocdf.org/wp-content/uploads/2014/10/Hoarding-Fact-Sheet.pdf
3. Dailey, S. G. (2013, February) Hoarding: A Complex Issue Needing Community Support. Age Wise: King County. Retrieved from http://www.agewisekingcounty.org/en/125/1/449/Hoarding-A-Complex-Issue-Needing-Community-Support.htm
4. Samuels, J., Shugart, Y., et al. (2007, March). Significant linkage to compulsive hoarding on chromosome 14 in families with obsessive-compulsive disorder: results from the OCD Collaborative Genetics Study. American Journal of Psychiatry, 164(3): 493-9. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/17329475
5. Treneva, R. (2005, August 3). Hoarding: Myths and Misconceptions. Insight Bulletin. Retrieved from http://insightbulletin.com/hoarding-myths-and-misconceptions/
6. Webley, K. (2010, April 26). Hoarding: How Collecting Stuff Can Destroy Your Life. Retrieved from http://content.time.com/time/nation/article/0,8599,1984444,00.html

When I work with people who have difficulty expressing what they want and need, especially to their significant others, it is apparent feelings about hurting the other can create a fierce resistance to the authentic expression of self. As a therapist, my job is to find a way to help people navigate between consideration of the other’s feelings and honoring their own wishes and desires.

For some, realizing they have wounded someone they care about, even unintentionally, can cause painful regret and self-attack. Frequently, I find I must help people accept that they can and sometimes should choose to express themselves knowing it might hurt someone they love. My challenge is how to help someone accept that hurting and being hurt comes with the territory of love and relationships.

Identification with the Other

Mark, who has been married to Cynthia for five years, talks about how much he loves his wife and how difficult it is to make choices for himself when she disapproves of those choices: “Cynthia is such a strong person. She always seems to know what she wants and what is right for us. I wanted to take a relaxing beach vacation since work has been so crazy, but she insisted we do something more interesting. When I tried to push and said how tired I was, she started to cry and told me I should know how much she hates the beach and how it hurt her feelings that I would even suggest it. I felt really terrible and mean. She’s right: I should never have brought it up.”

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Mark and I explored his reaction to Cynthia and his feelings of guilt and cold-heartedness for not recognizing he would hurt her by expressing his wishes. Mark found it difficult to consider that he hadn’t done something unforgivable. He was consumed with self-loathing and seemed devastated as he put his head in his hands and told me: “I always feel like the world’s worst person when I hurt her so badly. It shakes me up and I hate myself.”

Mark was not aware of how he identifies with Cynthia’s feelings and experiences her pain as if it were his own: “I know just how she feels when I do that to her. I’ve felt that so many times in my life, especially when my older sisters would be mean to me. I never want to make anyone, especially the woman I love, feel so awful.”

His recounting of his experiences with his sisters led us to focus on how Mark identifies with Cynthia and assumes her hurt feels exactly like his hurts of so many years ago, inflicted with malice. I asked Mark if he could imagine not feeling so viscerally that he had hurt her and instead feel sad or sorry for his behavior. I pointed out, “You identify with Cynthia and experience her pain as if it were your own. It seems difficult to step back a little and just feel badly that your wishes hurt her and be concerned, rather than taking on and experiencing her feelings. Identifying this way makes it very difficult to allow yourself to be free to express your needs and cope with your impact. You also end up attacking yourself and feeling like a bad person when it feels like you have so seriously wounded your wife.”

Mark acknowledged he often felt paralyzed to express his wishes but found it confusing to consider he could have a choice and not identify with Cynthia. I introduced the idea of empathy to Mark as an alternative to identification. We have begun to work on what it would mean and how it would feel to be empathic (being compassionate and sensitive to feelings without having the feelings) rather than identifying. This is not yet a distinction Mark can easily understand, and we continue to work on this. We will also continue our exploration of how Mark develops his identification reaction when a significant other is hurting.

Early Family Communications About Hurt and Hurting

Some children grow up in families where parents communicate that any negative impact the child makes on the parent will not be tolerated. This means the child cannot disagree, create conflict, or express any thoughts or feelings which negatively affect the parent. Under these circumstances, the parent’s response when they feel the child has hurt them is typically a communication that the child has inflicted pain and suffering on the parent. This is frequently experienced by the child as a sign of the child’s “badness.”

When a child’s early experience is that they have the power to inflict such hurt and distress on a parent, they are likely to take on that “bad person” feeling. Thus, feelings of shame, anxiety, and worries about being destructive can become part of the child’s identity. The degree to which this is felt and internalized may depend on where on the continuum of possible responses the parent’s reaction falls. The parent’s negative responses may range from a quiet and subtle withdrawal of love or connection, to guilt- and fear-inducing accusations of “you hurt me” or “you’re mean,” to aggressive physical punishment.

This kind of negative emotional response from a parent may severely interfere with the child’s ability to develop a positive sense of self and impair the capacity to assert their wishes and desires to others. The expression of any sense of agency can create anxiety about the risk of negatively impacting the other, along with worry they are doomed to experience the feelings that have come to be part of the “bad person” identity.

Part of the work for these people in therapy is to get comfortable with being hurt and hurting as a normal component of relationships. This doesn’t mean one shouldn’t feel badly or sorry when they inflict hurt. It does mean it is necessary to address old responses of feeling devastated (identification) when a loved one is hurting, as well as the “bad person” feelings of shame and self-hate.

Jana, 29, was very angry in her session with me as she recounted a memory when she was 5 or 6: “My parents divorced, and my father left me and my younger brother with my mother. I was sad all the time and scared. My mother went to work, and we had a babysitter. I remember pulling on my mother and crying, ‘Don’t go, don’t go.’ I was beside myself. She told me to stop it, that I was making her feel bad and hurting her feelings. I’m not absolutely sure she said this to me, but I think she said something like it was mean of me to make her feel like a bad mother. I think she said that a lot. She hasn’t changed. She’s the mean one. That icy cold voice comes out of her even now when I’m upset about something or need something from her.”

I remarked, “You seem angry at her now. How did you express anger growing up?”

Jana sighed, “I am angry now. But I could never let myself get angry at her when I was growing up. I couldn’t really let myself feel angry feelings toward her until a few years ago, after I started to work with you. I was always the bad one; I felt I was always hurting her. I especially remember hurting her if I didn’t say the right thing to my grandparents. I absolutely remember her telling me I was mean to make her look like a bad daughter because of something I said or didn’t say to my grandparents. I don’t know what she wanted. It was so unpredictable. I remember this awful feeling in my stomach, like I was going to throw up. For so many years, I felt like a disgusting person.”

Jana has increasingly been able to understand her child self was not to blame for her mother’s hurt feelings and that her behaviors were not bad or mean, even if her mother experienced them that way. She is now better able to be angry with her mother and recognizes her overwhelming feelings of shame and anxieties about her impact on others are related to her early experiences.

Nevertheless, she has not been able to give up the wish for her mother to affirm her goodness. She continues to struggle to maintain a more positive sense of herself and disavow the “bad person” feelings. Contact with her mother is her biggest challenge to accepting her goodness and shedding her sense of herself as a disgusting person. Fortunately, Jana’s awareness of her situation, and her commitment to herself to grow an identity in which she can comfortably express who she is, is powerful motivation to keep growing.

For Jana and Mark, there is a strong drive to suppress their thoughts and feelings rather than risk “bad person” feelings and/or their own pain should they hurt a significant other. For any person who has to fight “bad person” feelings, it becomes necessary to loosen the hold on the idea that the other’s hurt is the consequence of their behavior and/or badness. Rather, they need to recognize that the other’s feelings of being hurt don’t always correspond to having been treated in a hurtful manner.

It may sound glib to say “hurt happens,” but it does. This doesn’t mean behavior isn’t sometimes intentional and meant to hurt and destroy. However, when I think about the people I help and their early experiences in their families, they were not helped to be comfortable with their nondestructive or non-mean behavior if the other felt impacted in hurtful ways. (I am not addressing hurtful behavior when it was intentional.) Part of the work for these people in therapy is to get comfortable with being hurt and hurting as a normal component of relationships. This doesn’t mean one shouldn’t feel badly or sorry when they inflict hurt. It does mean it is necessary to address old responses of feeling devastated (identification) when a loved one is hurting, as well as the “bad person” feelings of shame and self-hate. These old responses do not serve the individual’s needs for self-esteem, agency, and authenticity.

Note: To protect privacy, names in the preceding article have been changed and the dialogues described are a composite.

It is love or is it lust? Many have asked this question at some point, struggling to make a distinction between the two. According to recent science, the answer lies in the eyes.

“The eyes are the windows to the soul” is a popular phrase, and science has revealed the truth of this poetic line. Researchers have found eye movement alone can distinguish the feelings of love from lust.

Love or Lust: The Eyes Tell All

During a study by University of Chicago researchers, participants’ eye patterns were monitored while looking at a stranger’s photo. According to the results, a person who sees someone as a potential romantic partner would look at the person’s face, whereas a person who is feeling lust or sexual desire is more likely to look at the person’s body.

Other scientific studies have shown the brain regions involved in feelings of love are different from those involved in feelings of lust. Eye movement data proved different eye movements occur when a person views a photo of romantic love, such as a picture of a couple holding hands, versus a photo of an attractive person.

The Neurophysiology of Love and Lust

[fat_widget_right]Though love and lust are interrelated, they are coordinated by different emotional systems and neural processes in the brain. Lust is ruled by the sex drive, which is processed in the endocrine and reproductive system, driven by testosterone and estrogen.

Physical attraction plays a role in feelings of lust and falling in love. Attraction is driven by the reproductive instinct and is subject to hormonal reactions as well as the release of neurotransmitters such as dopamine and norepinephrine.

After someone has fallen in passionate love, the initial excitement and passion may fade over time as the dopamine levels associated with novelty begin to level out. At this point, the love may grow into companionate love. This type of love is associated with bonding hormones, such as oxytocin and vasopressin.

Distinguishing Between Lust and Love

Although science indicates love and lust are distinct even on a physiological and neurological level, it may not make distinguishing between the two any easier for those under the charms of lust and romantic love. Differentiating between the two can be a challenge, as the feelings often occur simultaneously and both have the ability to cloud judgment. So how can you tell the difference?

Lust is purely physical attraction. It is an altered state of consciousness biologically driven by the instinct to procreate. It can be incredibly powerful and can at times surpass logic and reason. Lust is initiated by pheromones, chemicals secreted in sweat that reveal information about genetics and influence behavior. When you experience physical attraction and sexual desire for another, it is the result of bodily awareness of a good genetic match for creating offspring. Lust knows nothing about long-term compatibility or companionship.

Love is also an attraction, but it goes beyond a physiological impulse. Love is not immediate; rather, it grows over time. When you meet someone you fall in love with, it may start out as lust and grow into infatuation, which is what we commonly associate with romantic love.

Love is also an attraction, but it goes beyond a physiological impulse. Love is not immediate, but rather grows over time.When you become infatuated with another, you may begin to see through rose-colored glasses, putting the person on a pedestal and ignoring any flaws. Infatuation can become obsessive, leading someone to experience the “can’t eat, can’t sleep” phenomenon often associated with falling in love.

Scientific studies have shown the brain in love looks a lot like the brain on cocaine, with high dopamine levels and lowered serotonin. Eventually, the exciting feelings fade as the novelty of the relationship wears off and you are no longer under the lover’s haze. It is often at this stage when people begin to see their partner clearly without projections, and flaws start to become apparent. Lovers either realize they are not compatible and part shortly after infatuation fades or they commit to the relationship and develop companionate love for one another.

Lust and infatuation require little commitment or effort, whereas love generally requires a high degree of both. A successful loving relationship requires honesty, communication, compassion, respect, and trust. Love is most often built on a strong mutual foundation. Love usually involves personal sacrifice. When you’re in love, you shift from “me-thinking” to “we-thinking.” It is the willingness to consider another’s well-being in the same way you would your own.

References:

1. Blair, L. (2010, July 14). Mistaking lust for love. The Guardian. Retrieved from http://www.theguardian.com/lifeandstyle/2010/jul/14/mistaking-lust-for-love
2. Fisher, H. E. (2000, January 1). Brains do it: Lust, Attraction, and Attachment. The Dana Foundation. Retrieved from http://www.dana.org/Cerebrum/Default.aspx?id=39351
3. Ingmire, J. (2014, July 17). Eye movements reveal difference between love and lust. UChicago News. Retrieved from http://news.uchicago.edu/article/2014/07/17/eye-movements-reveal-difference-between-love-and-lust
4. Lahat, I. (2014, July 9). The Brain Looks the Same When We’re in Love or High on Cocaine. Business Insider. Retrieved from http://www.businessinsider.com/the-brain-looks-the-same-high-on-love-or-cocaine-2014-7

Sexually compulsive behavior is easy to joke about. We’ve seen an endless array of politicians and celebrities claim they’re “sex addicts.” Some of them legitimately are addicted to sex, while others seem to be using this as an excuse for their behavior. It makes some question if these people (mostly men) simply are letting their high libidos take over. Is this a legitimate issue?

Yes.

As a sex therapist and sex addiction therapist, I find many people have little understanding about this serious issue. Sex addiction can decimate relationships that appear happy. It can create a level of disconnection that is difficult to recover from. And the betrayal and trauma associated with this can be extremely challenging to overcome.

When people ask what I do, I get a variety of responses. One of the most common replies I get is, “I wish I was a sex addict.” I have to maintain my composure when I hear this. I want to admonish this ignorant and sarcastic commentary with a heavy dose of reality. There’s nothing admirable or desirable about addictive sexual behavior. I typically refrain from responding with a harsh tone, remembering the idea of “being addicted to sex” can appear like nothing more than a high sex drive. However, sex addiction is more complicated than having a high libido.

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Sex addiction isn’t about having a lot of sex. Although some people addicted to sex do have many sexual encounters, many have the opposite. They struggle with finding sex that is pleasurable or satisfying. Some avoid certain sexual behaviors, only to obsessively engage in another type of behavior. Others have a subconscious desire to connect, but fear the vulnerability of such connection.

Overall, relationships, trust, and intimacy become imbalanced. Sadly, this imbalance is often disguised under the typical chaos of work and family life, until it becomes undeniably traumatic.

What can make this even worse is that this behavior is often buried under a series of secrets and lies. Many partners of people addicted to sex are completely blindsided by a discovery of a series of behaviors. This is often a crushing blow to the partner, and a shaming experience for the one who is out of control. Families can be torn apart by this.

Many who are dealing with sex addiction also describe their lives as quite lonely. The sex isn’t necessarily fun or even enjoyable. They love their families and they hate that they’re lying to them. They just don’t know a way out.

Many who are dealing with sex addiction also describe their lives as quite lonely. The sex isn’t necessarily fun or even enjoyable. They love their families and hate that they’re lying to them. They just don’t know a way out.

Week after week, I hear the painful stories of people whose sexual behavior is out of control. Whether it’s a personal story or a story about their relationships, the pain caused by sex addiction is no laughing matter. This is why I puff up with frustration when people make light of or oversimplify what sexual addiction is. It’s not easy to treat or process through. And when it’s made out to be a silly punch line, it can increase the shame for those who are struggling with this issue.

Sex addiction is numbing behavior that takes on another level of compulsivity. All of us numb to some extent. Numbing is a minor level of dissociation. However, people addicted to sex take this numbing to a whole different level of disconnection. This can become so prevalent that work and relationships can be at risk.

For those dealing with this serious issue, support groups, such as 12-step groups, can help. However, they often need another layer of support. Therapy can help with building solid plans for recovery in a way that helps people stay in alignment with their values system. It can help people with sex addiction grow so they can reduce their levels of shame, reconnect with their families, and reach life goals.

We make decisions every day, throughout the day. In fact, we make so many decisions we often don’t even see them as decisions. Decisions we’ve made over and over eventually turn into habits. Although we often think of habits as bad, it’s important to see them as a set of decisions that simply don’t need much, if any, conscious thought to perform them. Brush our teeth. Put on our shoes. Eat breakfast or skip it. All of these mundane tasks are still choices, still decisions we make.

All too often, we make decisions based on faulty information, peer pressure, and impulsivity. In this article, I’d like to highlight some red-flag behaviors that increase our chances of feeling regret about our decisions. I’ll also offer some suggestions on how to avoid these red flags.

Red Flag: Decisions Based on Other People’s Wishes

Literally from birth, we find ourselves surrounded by other people and their wants, expectations, and fears. We come into this world already shadowed by built-up beliefs about how we should be, according to cultural and socioeconomic factors, parental expectations, our gender, and on and on. It’s no wonder we often feel pressured to be and do other than what resonates with our truth.

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Because of the pressure to fit in and to please, we can find ourselves making decisions that don’t align with our highest good. From small decisions, like drinking at the party, to life-altering decisions, like getting married, our surroundings impact what we choose to pursue. When we make decisions from the fear of being judged and/or rejected, we doom ourselves to this people-pleasing brand of decision making.

So apart from moving to the woods and shunning society, how do we combat this monstrous impact on our decision making? We begin by reframing the nature of making decisions. At their core, decisions express our humanness. They express the gift of our free will. Although we are definitely animals, we are a unique form of animal with the option to move beyond our limitations.

Moving into a place where we make decisions based on our own wants and wishes requires us to know ourselves. Not possessing intimate knowledge of our core value system inevitably leads to a “follow the herd” mentality. This ultimately leads to frustration and resentment.

A simple exercise to acquaint yourself with your values is to simply ask the following questions about everything you choose. (Yes, everything.)

• What do I like about this?
• Does this thing support my growth?
• If no one were around to influence me, would I still want to do this?

These questions will be answered by your bodymind through other thoughts, images, and emotions. Listening to them will steer you straight.

Red Flag: Making Impulsive Decisions

Impulsive decision making often gets viewed as wrong or bad because impulsive behavior is seen as “emotional.” Once again, we have society’s misunderstandings about emotion dismissing the importance of emotion in our lives. We can view impulsive decision making from two angles.

We must learn to fully connect with our emotions. Feeling them fully without comment allows the energetic charge to run its course. After the intensity of the emotion subsides, calm, creative problem-solving can occur.

The first angle involves making a decision while feeling an intense emotion. When we are intensely feeling emotions, we don’t have access to our prefrontal cortex, the part of the brain designed for effective problem solving. When we make decisions from an emotionally intense place, we basically tell ourselves whatever emotion we currently feel has complete sway over our wants and needs.

The second angle surprisingly encompasses the exact opposite—not feeling our emotions at all. When we suppress our true emotions, we cut off access to our self-appraisal regarding a particular situation. Put differently, we sever a relationship to our values. Being disconnected in this way leaves us vulnerable to making those impulsive decisions that don’t align with our growth and truth.

The solution to both of these predicaments involves the same process. We must learn to fully connect with our emotions. Feeling them fully without comment allows the energetic charge to run its course. After the intensity of the emotion subsides, calm, creative problem-solving can occur. We can learn to regulate our emotions through numerous ways. Dialectical behavior therapy works wonders here, as do mind-body exercises such as tai chi, qigong, yoga, and other breathwork practices.

Red Flag: Believing Our Mental Stories

I could write volumes about this issue alone. Most of us, most of the time, are thinking. That wouldn’t be so bad if our thoughts were grounded in reality. Sadly, our thoughts, especially intense and obsessive thinking, rarely are. We make bad decisions all the time simply because we believe something to be true that isn’t.

I call this habit “storytelling.” It’s a handy way of looking at our string of thoughts. Storytelling occurs as we “once upon a time” our lives, filling in loads of made-up information to fill in the gaps between aspects of reality we really don’t know or don’t have access to. Storytelling occurs most frequently in relation to the future. So many of us hate uncertainty. Rather than learning to accept the limits of our knowing, we tell stories in an attempt to self-soothe. Anxiety is usually the result.

Reality testing is a tried-and-true cognitive behavioral technique used in therapy to help us break away from acting upon our untrue but intensely believed thoughts. In reality testing, we ask the simple question, “How do I know this thought is true?” We are then tasked with the quest of seeking external proof that our thoughts accurately reflect reality. This involves behaving differently, taking risks, and assertively communicating our thoughts, needs, and desires to others.

Being mindful of the red flags mentioned above, as well as practicing the steps discussed, can lead to an increased sense of ease and confidence in your decision-making and problem-solving capabilities.

As adults, we don’t typically have tantrums. We don’t throw ourselves on the floor crying and screaming. We can, however, act out when we don’t have a space to honestly express our feelings.

Many people enter therapy with the intention of learning to control their stress. This is often preceded by verbal warnings at work telling them their stress is too visible.

Crying is a big one. Getting angry is another.

Once, a person shared with me that his latest performance evaluation advised him to “find a better way to hide your stress.” Not “decrease your stress.” Not “maybe this job is too difficult and we’re pushing you too hard.” Not “maybe you’re being treated poorly here.”

No, they wanted him to hide his stress better so as not to see it. They didn’t want to deal with his emotions.

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I can understand this, to some extent, from an employer’s perspective. It’s hard to work in an atmosphere where someone is crying all the time. Certainly, it’s a challenge to focus on work if someone is screaming and pounding on their desk.

But office or workplace culture often sends mixed, even hypocritical, messages. In many workplaces, when a boss is stressed it’s perfectly acceptable to berate a subordinate, even in front of other employees. Expressions of the boss’ stress are allowed. Anyone else who gets upset or looks frazzled, though—that’s not okay. Giving back anger to a boss who is giving it to you? That’s a big no-no.

Some people can take their stress out on others, but most can’t.

So what to do?

Allow Yourself to Have Your Feelings

It’s important to understand that where there’s a crying jag or aggressive streak, there’s usually a buildup of attempts to push those feelings away by squelching or stuffing them. When those feelings come rushing out, it often follows days, maybe weeks, of holding them in.

When you fully express your feelings in the safe confines of your therapist’s office, you don’t have to do it in your boss’ office. You learn to modulate, but not squelch.

You can learn techniques to hide your feelings, but they’re going to come out somewhere, sometime. They’re going to pop out when you go home and are short with your kids, snap at your partner, or yell at the barista for not giving you the correct change. Maybe you’ll notice your body responds with muscle tension, headaches, or by getting sick.

That can happen with unexpressed feelings.

In session, a person will tell me the story of what’s been happening at work. I’ll hear about various incidents, but the feelings they inspire still might not be fully expressed.

It’s an interesting phenomenon, people in therapy continuing to not express their feelings.

Here’s the thing, though: When you fully express your feelings in the safe confines of your therapist’s office, you don’t have to do it in your boss’ office. You learn to modulate, but not squelch.

Express Feelings Where It’s Safe to Do So

Ever see the kid who’s an angel at school but has big tantrums at home? Ever witnessed how exhausted, yet fully soothed, that child becomes because they were able to show their “worst self” to someone safe and trusted, who acknowledged and empathized with their pain, who didn’t punish them, who comforted them when they were done?

It might seem paradoxical, but having tantrums at home can allow the child to have a higher frustration tolerance at school. The child knows they can express those feelings in a safe environment and, perhaps, explore the meanings behind the feelings with the parents.

You’re Not Too Emotional

The same concept applies with adults and therapy. Regardless of age, we all need to express our feelings somewhere, sometime, to keep them from coming out in destructive ways. Expressing strong feelings in therapy means you don’t have to release them to such a large extent at work.

Many people worry that if they deeply feel their feelings, there’ll be no turning back. If they turn on the tap, will they be able to turn it off? But like the child who feels safe having a tantrum at home and has no behavioral problems at school, we can learn to tolerate difficult feelings as they arise and express them fully in safe spaces.

We learn that feelings come and go. We learn to hold our partners when they cry. We learn to sit with our buddies when they’re depressed. We’re not too emotional. We just spend too much time trying to hold in emotions instead of listening to them.

For many, anxiety is the enemy. It can make you feel nervous and afraid and can prevent you from taking actions that will move you forward in life. People often look at anxiety as something they need to get rid of or prevent, but what if that isn’t the case? Would your relationship to anxiety change if you could look at is as a friend rather than an enemy?

Anxiety itself may not be the problem; not knowing what to do with it may be the main issue. Anxiety is the body’s natural response to stress. If you can accept that some anxiety is inevitable, you may be able to learn how to work with it instead of against it.

Here are seven creative ways to turn anxiety into productivity.

1. Use the Adrenaline

Anxiety gives you adrenaline. Stimulants such as caffeine and nicotine can cause physical symptoms similar to anxiety symptoms in the body by increasing heart rate and constricting the blood vessels. Coffee is a popular productivity booster for this reason. If you’re feeling anxious about an upcoming project, speech, or other task, try utilizing the extra energy to help improve performance and increase productivity.

Many sports psychologists and coaches generally want their athletes to be a little anxious rather than relaxed right before a game. Researchers say there is a “sweet spot”—a moderate amount of anxiety that actually helps people perform better by keeping them on their toes. Studies have shown learning increases when stress hormones are slightly elevated. The Yerkes-Dodson curve—originally developed by Harvard psychologists Robert Yerkes and John Dodson in 1908—illustrates how arousal enhances performance up to a certain point, but too much anxiety may hinder performance.

2. Reframe Your Anxiety

Anxiety is not always a negative thing. Telling yourself anxiety is bad and trying to avoid it may end up making the problem worse. Rather than saying “I’m so nervous,” try saying “I’m so excited” instead.

Anxiety is the body’s natural response to stress. If you can accept that some anxiety is inevitable, you may be able to learn how to work with it instead of against it.A research study conducted at Harvard Business School found saying “I am excited” out loud can improve performance. In order to increase anxiety levels during the study, Dr. Alison Woods Brooks told students their persuasive speeches would be recorded. Before delivering the speech, students were instructed to say “I am excited” or “I am calm” out loud to themselves.

Those who said “I am excited” gave longer speeches that were more competent, relaxed, and persuasive than those who said “I am calm.”

Because anxiety and excitement are both emotional states characterized by high arousal, Dr. Woods suggests it may be easier to reframe symptoms of anxiety as excitement rather than trying to be calm. When you’re feeling anxious, you often focus on potential threats. In these situations, it is more productive to try to reframe the situation and focus on potential opportunities instead of threats.

3. Accept that Anxiety May Be Inevitable

Some situations or tasks may always give you some amount of anxiety. Rather than trying to avoid these tasks or diminish the emotion, it may be best just to accept the feeling as part of the experience.

The more you view anxiety as routine and normal, the less power it can have over you. Even successful people experience fear. They just choose to find a way to persevere in spite of it. Try to remember that anxiety and fear are natural reactions. If you’re able to, choose to focus on the task in front of you rather than the fear related to it.

4. Channel the Anxiety into Motivation

[fat_widget_anxiety_left]Find your anxiety sweet spot and channel it into motivation. Research shows most people have an anxiety sweet spot where they have enough anxiety to feel alert, but not enough to feel debilitated. In this state, anxiety can be an excellent motivator. For example, if you’re worried about theft, you might lock your doors. If you’re concerned about your health, you might visit a doctor. Whatever the worry, the surrounding anxiety can often push you to do something about it.

Anxiety often results from some sort of apprehension about the future. Perhaps you’re worrying about the outcome of something you really care about. Remind yourself why it matters to you in the first place, and let that drive you forward. Anxiety has the ability to make you more alert, focused, and productive, and you have the ability to use that to your advantage.

5. Distinguish Productive Worry from Unproductive Worry

Anxiety can be either productive or unproductive. Unproductive anxiety usually amounts to worrying about things that are out of your control and may lead to an anxiety attack. If you can’t do anything to change the situation, you might be wasting your time and energy by worrying about it.

On the contrary, productive anxiety generally amounts to worry about things you do have the power to change. If you are worried about a presentation you have to give to your boss, you can acknowledge your anxiety and take the steps necessary to help you be best prepared for the presentation.

6. Decatastrophize Your Anxiety

Anxiety often stems from fear. Try to decatastrophize your anxiety by asking yourself what it is you are truly afraid of.

What is the worst possible outcome, and what are the odds of that actually occurring? When you realize even the worst outcome isn’t as bad as it may seem in your head, your anxiety may start to decrease.

7. Practice Centering

Centering is a pre-performance technique originally designed by sports psychologist Dr. Robert Nideffer in the 1970s. Centering is a 7-step process that can help you quiet the mind, focus, and gain poise.

• Step 1: Choose a focal point. Select a focal point that is below eye level to minimize distractions.

• Step 2: Set a clear intention. Your intention is your goal. What task are you planning on doing in spite of your anxiety? Whether it is a performance, work task, or creative project, clearly state your intention in positive language.

• Step 3: Breathe mindfully. Use diaphragmatic breathing to calm the body and deactivate the body’s fight or flight response.

• Step 4: Scan and release tension. When you engage in more negative thinking, the muscles in the body have a tendency to tighten. Scan the body slowly for tension, relaxing the muscles one by one.

• Step 5: Find your center. In many Eastern philosophies and traditions, it is believed the body has a specific location where the center of a person’s energy rests. By finding your center, you may begin to feel more grounded, calm, and self-assured.

• Step 6: Visualize success. Visualize yourself accomplishing your intended goal. Activate the right brain by imagining what it would look like, feel like, and smell like to achieve your desired results.

• Step 7: Direct your energy appropriately. By the time you reach the last step, you are more likely to be calm enough to channel the energy appropriately. Rather than trying to rid yourself of the anxiety completely, you can use it as inspiration.

Anxiety can be both normal and healthy in small amounts. If it becomes debilitating and is negatively impacting your life, a qualified therapist may be able to help you learn how to deal with anxiety.

References:

1. Beck, M. (2012, June 18). Anxiety can bring out the best: researchers prescribe just enough stress to ace life’s tests; too little is lazy. Wall Street Journal. Retrieved from http://www.wsj.com/articles/SB10001424052702303836404577474451463041994
2. Kageyama, N. How to make performance anxiety an asset instead of a liability. Bulletproof Musician. Retrieved from http://www.bulletproofmusician.com/how-to-make-performance-anxiety-an-asset-instead-of-a-liability/
3. MacGill, M. (2013, December 28). ‘Work with anxiety’ rather than seek calm to improve performance. Medical News Today. Retrieved from http://www.medicalnewstoday.com/articles/270641.php
4. Nisen, M. (2013, February 19). How productive people turn anxiety and fear into an advantage. Business Insider. Retrieved from http://www.businessinsider.com/how-productive-people-turn-anxiety-and-fear-into-an-advantage-2013-2
5. Porter, J. (2014, October 21). How to turn your anxiety into a productivity booster. Fast Company. Retrieved from http://www.fastcompany.com/3037338/how-to-be-a-success-at-everything/how-to-turn-your-anxiety-into-a-productivity-booster

Editor’s note: This article contains mentions of suicide. Details have been altered to protect client privacy.

Bill promised not to kill himself, as long as he could continue to see me. Despite his severe depression, this 67-year-old Vietnam veteran showed up at my office each week at 1 p.m. on Tuesday wearing the same stained beige t-shirt, torn jeans, and a faded baseball cap with the words United States Air Force embroidered boldly across it. His sour body odor choked the room as I listened to the horror of his nightmares and gauged the degree to which he wanted to kill himself that day. The hour before he arrived, I spent readying myself for his whirlpool of despair and avoiding the obvious fact that this person wasn’t getting better. In my 20 years as a psychotherapist, I had never encountered someone in therapy who worried me as much as Bill.

I was his third therapist. Before he reached me, Bill had already spent years in weekly therapy at our facility. His previous therapist ended treatment because he believed Bill was “not interested in getting better.” Still, I was optimistic that I could help this stubborn, but fragile, man. Bill reinforced my aspirations at first by leaving our sessions lighter. His depression soon reappeared, however, like a disturbed old friend who comes for a visit, somehow moves in, and requires a police escort to leave. But no matter how depressed Bill felt, he would always make it a point to end our sessions with, “I really appreciate our work together, and thank you for your time.” This gave me hope.

[fat_widget_right]Bill was angry, bitter, and resentful about many things. At the top of his list was his sister, Kate. What likely started as sibling rivalry in childhood simmered into a putrid sludge of jealousy, betrayal, and abandonment so thick that Bill’s irritable bowel syndrome flared up whenever his sister’s number flashed across his cell phone. Unfortunately, Kate was the only other consistent person in Bill’s life.

The only way I seemed to get through Bill’s anger was to connect with him as a person, not as a therapist. Whenever I strayed from my clinical persona and mentioned that I enjoyed a certain book or movie, he came alive. Bill would recommend certain books or DVDs and loan them to me like a devoted uncle. These exchanges touched my heart and showed me the thoughtful and caring man below his embittered exterior.

Over the first four years of our work, I came to recognize that Bill might be getting worse. There were ups and downs, but the downs came more quickly and stayed longer. His melancholy started to weigh me down, too. I began to feel burdened by our sessions and had trouble tolerating his misery. I knew it was my professional responsibility to work through my resistance, but I struggled. At times, his pain was almost too much to bear.

Somewhere around the middle of his fifth year of treatment, Bill blurted out that he found a “foolproof” suicide method on the Internet. His eyes twinkled as he shared that the suicide would mimic some other form of death.

Somewhere around the middle of his fifth year of treatment, Bill blurted out that he found a “foolproof” suicide method on the Internet. His eyes twinkled as he shared that the suicide would mimic some other form of death. “No one would ever know,” he mouthed his excitement. His demeanor frightened me so much I changed the subject. Later, once we had both calmed down, I asked him to tell me more about this method, but he had moved on. “I don’t want to talk about it,” he insisted. So, I assessed him once again for suicide risk. No, he reminded me, he wouldn’t kill himself as long as he could continue to see me.

After that, I started to question whether I’d be able to keep Bill alive. The gravity of my increasingly impossible duty sat on top of me in session, as I drove home, and at night while in bed. I felt so powerless. The truth was, I couldn’t secure Bill’s safety unless he verbalized intent to kill himself—only then could I hospitalize him. Bill knew this. He knew exactly what words would have him locked up in the psych ward, and he carefully avoided them. He had been hospitalized once before, a number of years ago, and wished never to return.

A few months later, Bill came to session particularly upset. He was being evicted from his flat where he’d lived for the past 30 years. His landlords had sold the property. Bill decided he was going to fight it. His determination seemed to embolden both of us for a few weeks. Bill secured a lawyer and showed up to session bathed and wearing clean clothes. I began to believe that if we could win this fight we might finally lift his depression. As it became clearer that Bill would be forced to leave, I changed course. Not Bill, though.

Bill started missing sessions. At first, I was secretly relieved that I didn’t have to spend the hour arguing with him about finding a new place to live. These disputes wore me out. But I was also worried about him, so after a couple of cancelled appointments I insisted he come back in. Things were not going well at all. Eviction was imminent. As a last resort, Bill had called his sister to ask if he could “crash” for a couple of weeks. Kate refused.

Bill sobbed in my office. I felt crushed, too, as I assessed for suicide and he promised, as always, not to hurt himself. His mood improved as we talked over his situation, and he felt supported. Toward the end of session, he promised to see a doctor about his IBS and attend a stress management group before our next meeting.

When I arrived at work the following Tuesday, I had a voicemail waiting for me from the site manager of our clinic. Bill’s sister, Kate, had contacted him. She hadn’t heard from Bill on her 40^th anniversary and found this strange. Nor was he answering his phone. Kate decided to call the police to check Bill’s apartment, where they found him found him on the bathroom floor, dead. The message ended by informing me Bill’s body would be sent for an autopsy to rule out suicide.

I cherished Bill and felt honored by his trust. Then I remembered the words he had used about a year ago—“foolproof suicide.” My grief turned to panic as I began to question whether he killed himself or not, and if so, could I have prevented it?

I locked the door to my office, put my head on my desk, and wept. I was devastated. I cherished Bill and felt honored by his trust. Then I remembered the words he had used about a year ago—“foolproof suicide.” My grief turned to panic as I began to question whether he killed himself or not, and if so, could I have prevented it? Why hadn’t I pressed him more for details? My thoughts jumped down that dark black hole, until I remembered I could only take Bill at his word. He had promised not to kill himself that day, as well as the gazillion other days I had asked him.

The coroner’s report came back a month later. It determined the cause of death to be a myocardial infarction—heart attack. I was relieved. Bill’s death was due to natural causes. But to this day, I still wonder if he may have used the “foolproof suicide” plan. He had come to the end of his road: he was elderly, physically impaired, soon to be homeless, and completely alone. His last remaining pleasure might have been to make sure he would ruin his sister’s anniversary each year by dying on the same day. Yet I can’t be fully certain. If he had taken any actions to bring about his death, they left no trace.

Bill’s death had me asking some very painful questions. Was there more I could have done? Was the therapy unsuccessful? And, most damning—was I to blame for his demise? Thankfully, the uncertainty around his death left many of these questions unanswerable and spared me from the agony I would have felt had I known for certain that he committed suicide under my care. In the end, after I tried so hard to protect Bill, he in his death may have, in fact, protected me. I will never know for sure, and I’m pretty certain that Bill intended it that way.

Susan Oren is a clinical psychologist who has been treating clients and training psychology pre-doctoral interns for over 25 years. Her writing has appeared in professional journals and books as well as in the Huffington Post and three anthologies.