GoodTherapy | What to Do Before Scheduling Your First Therapy SessionChoosing to see a therapist is a huge decision. It’s that moment when you decide:

As a therapist, I can often perceive a shift in the person I’m speaking to on the other end of the line once that first appointment has been set. I can sense that person breathing just a little bit easier, and there’s often a subtle acknowledgment of hope and even accomplishment, as in, “I’ve just taken the first important step toward my future well-being.”

What leads up to that first step? How can you take that first step with more confidence so that you don’t feel like you’re grasping at straws? So that you feel empowered in the process?

I recommend doing five things before finding a therapist.

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1. Think About What You Want to Gain from the Counseling Process

It’s helpful to have a goal or two in mind as you begin. For example, are you focused on processing a particular incident in your past? Are you interested in developing better communication skills? Are you eager to challenge the way you customarily think about yourself or the world around you (your inner dialogue)? Do you want to create a toolbox for coping with anxiety? Are you looking for a “safe” place to express your feelings regarding a loss?

It can be helpful to have a place to begin and to be able to express that to the person you choose to work with. Of course, you can alter your goals or add to them once you begin counseling. Sometimes a deeper objective comes to the surface later on, once a therapeutic foundation and a sense of trust has been established.

Find out which therapists in your area are accustomed to helping people with the kinds of things you hope to explore. Most therapists have online profiles that outline the type of work they typically engage in.

2. Do a Little Research

Find out which therapists in your area are accustomed to helping people with the kinds of things you hope to explore. Most therapists have online profiles that outline the type of work they typically engage in.

If you’re comfortable asking, find out if people you trust have any recommendations. You will need to be sure that if you choose to work with someone who also counsels someone you know, you will not find yourself censoring what you have to say. (You can expect anything you say to remain confidential.) Otherwise, it’s probably best to find someone on your own.

Stack the odds for a successful and pleasant experience in your favor. This might mean finding someone you don’t need to travel too far to see, finding a therapist who has an ample parking lot (so that you don’t get stressed trying to find parking each time you go), making sure the office is handicap accessible, or ensuring the office has hours that will accommodate your schedule. You want to remove as many potential barriers as possible to getting there and obtaining the help you desire. You certainly don’t want therapy to add an additional layer of stress.

This leads us to the third thing to do before therapy.

3. Explore Your Behavioral Health Benefits

Be familiar with the insurance coverage you have, if any, and what it will cover in terms of behavioral health, both in-network and out-of-network. Find out if you have a deductible and how much you have satisfied so far, what the therapist’s fees are, what your copayment is, whether you need a referral or authorization, and whether you are allotted a limited number of sessions. Having this information will enable you to be an informed consumer.

It’s best to know what therapy will cost per session before you begin so there are no surprises once you start. Again, you want it to be as comfortable and smooth a process as possible.

4. Have Questions Ready When You Schedule Your First Appointment

Write down the name, number, and location of the therapist you are calling, as well as the questions you want to ask. This way, you can keep track of responses if you reached out to more than one counselor. Don’t be afraid to get the answers you need. You may want to ask the therapist directly about how they work, how long the sessions are, and how often you will typically meet. Feel free to ask about office procedures such as last-minute cancellations, what happens when there’s bad weather, etc.

This conversation gives you the opportunity to get a “vibe” or sense of whether you will be comfortable working with a particular therapist.

Finally …

5. Prepare to Do Some Work

You will get out of counseling what you are willing to put into it. It’s not always easy. It requires thought, introspection, reflection, and effort, a willingness to “try on” different perceptions or experiment with alternative behavioral approaches.

Know that there will be days you will feel resistant and won’t want to attend your session. I tell people I work with in therapy that THOSE sessions, when you DO show up, are often the most meaningful and powerful ones. Hesitation can serve as a signal that important work is about to be done. Showing up and telling your therapist that you contemplated canceling can open up a significant dialogue about where you are in your healing process, as well as where you’re going.

Don’t throw a dart at an online directory. Take responsibility for your healing as best you can. Don’t expect that every therapist will be the perfect match for you. Find the right fit. Feel the relief and self-assuredness that you are making an informed choice when you make that call and schedule your first therapy appointment.

Moving boxes in empty roomMoving or relocating, be it near or far, is a great reason to plan ahead and seek help from a therapist. After all, there is substantial evidence showing relocation causes significant psychological stress and associated emotional challenges. Rarely, though, do I hear people cite a move as the reason for coming to therapy.

People typically pursue therapy when they are in emotional anguish or unhappy. In many cases, psychologists hear about emotional and physiological symptoms such as depression, anxiety, insomnia, worry, or stress that make coping with daily tasks challenging. Other times, the reasons for seeking therapy are relational, such as problems at work, bad behavior at school, relationship discord, or lack of friends.

Any or all of the above could result from relocating. Fortunately, the emotional, physiological, and relational difficulties associated with moving can be averted or ameliorated with early intervention.

The personal and social changes involved in a move vary widely with individual experiences and backgrounds, making such changes almost impossible to generalize. Nonetheless, commonly there are environmental/external or individual/internal factors at play. Environmental factors may include cultural or language differences, finances, and reasons for relocating. A family moving to London for a job promotion is very different than a family fleeing to Miami after a natural disaster, such as Haiti’s 2010 earthquake.

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The larger the cultural differences and the greater the geographical distance between the place of origin and the new home, the more complicated the adjustment to the new life is likely to be. A move to a country with an unfamiliar language may be more stressful than relocating within your home country. According to Kupka and Cathro (2007), who studied a sample of German expatriated families, expatriates rely more on social support from other expats in their adaptation to the new environment when there is a greater cultural distance. The existence of a social network in the new home may improve the well-being and adaptation of the moving family.

The larger the cultural differences and the greater the geographical distance between the place of origin and the new home, the more complicated the adjustment to the new life is likely to be.

Personal or internal factors may increase or ameliorate the stress surrounding the move and transition. Working at a counseling center in Tokyo, I found that many of the people in therapy who struggled with adaptation to their new environment and to cultural norms had experienced similar emotional distress back home. When someone had difficulty making new friends or assimilating to a new social group in Tokyo, we often found a history of family disengagement or painful and traumatic interpersonal relationships at home. Moving rarely solves the problem by itself.

Church (1982) supported these anecdotal observations while surveying families that had relocated internationally. The researcher found that people with preexisting, untreated psychological conditions tend to develop more problems in the international assignment. On the other hand, those who had experienced previous successful moves or had a higher experience of self-efficacy tended to adapt more successfully and faster.

Personal factors such as previous losses, forced moves, and a history of complicated adjustments may complicate the adaptation and perhaps escalate to social and psychological issues that interfere with daily functioning. For example, a family forced to move because of war or a natural disaster may be ill-prepared to face the challenges of the new adjustment. Contrastingly, a family excited about their new life that has developed accurate expectations, a connection to their future community, and has educated family members about the transition is likely to experience less stress and fewer difficulties adjusting. Planning and preparation, education, and anticipation of challenges related to a move may function as buffers to the development of more severe social and psychological problems.

Early intervention can build protective factors and coping skills to face the stress of change and adjustment. Research on families relocated internationally by companies has found that the success of the international job is related, among other factors, to the adjustment of the employee’s partner to the new country. When partners did not adjust and families had to return to their country of origin before the completion of the contract, the result was major financial loss for the companies.

Thus, multinational companies were motivated to invest in research into factors that would make the adjustment to moving successful. Then companies invested in implementing those findings. For instance, companies hired consultants to educate about cultural differences, to develop realistic expectations for adjustment, and to create social networks to embrace and help acclimate families. In many international schools, there is a process of absorption that may include assigning buddies, as well as teachers, counselors, and volunteers monitoring daily progress and creating experiences of inclusion for new students. On the other hand, there are schools that lack experience absorbing new families, often throwing new students into large classes with only a brief introduction and an expectation to fend for themselves. Some students adjust and thrive in almost any environment, while others struggle and develop physical, social, or emotional problems. Because the failure of an international assignment may cost 2.5 times the salary of the employee—sometimes more than $1 million—multinational companies began investing in preparation and support for families relocating.

If faced with a move, consider seeking the help of a therapist or other expert guide. The cost of help will likely reduce the emotional cost and improve emotional gains associated with relocation.

References:

  1. Church, A.T. (1982). Sojourner adjustment. Psychological Bulletin, 9, pp. 540-572.
  2. Kupka, B., & Cathro, V. (2007). Desperate housewives – social and professional isolation of German expatriated spouses. International Journal of Human Resource Management, 18 (6), 951-968.

Emotional eye“…Not all psychological impacts can be encompassed by a list of symptoms or disorders.” —From Principles of Trauma Therapy

Make no mistake about it, Principles of Trauma Therapy: A Guide to Symptoms, Evaluation and Treatment is a psychiatric textbook. However, it is a rare breed of psychiatric textbook. It has a soul. To borrow from the dialectic wisdom of Marsha Linehan, the question in mental health treatment is often “What is being left out?” This book fills the void in terms of a comprehensive examination of the causes of trauma. It is not solely focused on the lists of symptoms. There are some areas where the book has “left out” important information, but emphasis on cultivating compassion for trauma survivors makes up for it.

John N. Briere and Catherine Scott describe how challenging behaviors exhibited by people who have gone through traumatic events are normal and within the context of psychological resilience: “Although therapists may interpret these behaviors as ‘resistance,’ such avoidance often represents appropriate protective responses to therapist process errors.” (p. 170). The adaptive functioning—or attempts to “metabolize” the trauma—is often interpreted as sabotaging or therapy interfering, but in reality, it suggests the clinician is in error (e.g., moving too fast in therapy). Unfortunately for the person in therapy, these attempts to lessen the pain can inadvertently prolong their trauma (this is what’s called the “pain paradox”). The unskillful attempts used to extinguish the pain often produces an increase in pain for the individual.

[fat_widget_trauma_ptsd_right]The pervasive message in Principles of Trauma Therapy is that a person’s symptoms due to a trauma can resolve via therapeutic engagement within a safe, therapeutic environment. The treatment approach is eclectic, and it weaves together strategies from various models (e.g., cognitive behavioral therapy, psychodynamic approaches, and mindfulness). People in therapy are given the opportunity to develop a coherent narrative of their past experiences, while learning stress reduction skills and psychoeducation through validation, respect, and supportive encouragement.

At the heart, Principles of Trauma Therapy comes from the theoretical perspective of exposure therapy and much of the content centers around this orientation for treatment. The clinician invites the person in therapy to develop alternative perceptions to their negative beliefs about themselves (oral and written) and the environment where the trauma manifested, while reducing “conditioned emotional responses” (CER).

To simplify, the recollection of the traumatic memory (i.e., exposure) occurs by activating the emotional states and schemas. The “disparity” that occurs is based on the idea that the therapy space is safe, so the person in therapy is counter-conditioned to realize they will not be harmed by experiencing the intense emotions that surround the memories. The integration of memories and emotions through exposure—along with the inability to avoid (i.e., CER) in the moment—creates resolution. The emotions are no longer as powerful. The positive results occur if the clinician is able to finesse the client’s capacity to “regulate and tolerate the associated painful affect” (p. 267). Briere and Scott advocate a titrated exposure to avoid both undershooting the level of exposure and not overwhelming the person in therapy. This person should be emotionally activated to allow processing to take place, but not to the point that their coping resources are overwhelmed, which leads to avoidant behaviors (i.e., to seek safety from the distress).

Exposure therapy techniques are undoubtedly effective and reliably decrease posttraumatic stress. However, the dysregulated elephant in the room during my review of this book was a question of ethics: is exposure therapy humane?

There are a couple of areas that should have been addressed more thoroughly in the text. Exposure therapy techniques are undoubtedly effective and reliably decrease posttraumatic stress. However, the dysregulated elephant in the room during my review of this book was a question of ethics: is exposure therapy humane? This form of therapy elicits pain for the person in therapy, often expressed in the form of panic attacks, dissociation, and intense anxiety through a re-experiencing of the trauma. Is it morally right for clinicians to prescribe this approach? Does the end justify the means? Or, are there other treatment approaches that can be used to relieve the immense amount of suffering experienced by trauma victims?

Principles of Trauma Therapy provides only a brief conceptualization of eye movement desensitization and reprocessing therapy (EMDR). In 2004, the APA acknowledged EMDR as a recommended effective treatment of trauma. According to Shapiro (2001), EMDR is the most empirically studied treatment for posttraumatic stress (PTSD). The philosophy of EMDR treatment does not differ drastically from exposure therapy: deconditioning disturbing input, redefining the event, finding meaning in it, and eliminating self-blame, while integrating new skills (Shapiro, 2001). The stark difference between EMDR and exposure therapy is the method of delivery, as well as the path a person in therapy takes toward healing. Exposure therapy is analytical with a narrative-driven process that involves a significant amount of “homework” assignments for the person in therapy. It also runs a risk of vicarious traumatization (for both the therapist and person in treatment) due to repeatedly describing the often horrific events.

The internal process of EMDR utilizes an approach of holding a negative cognition (e.g., “I am unlovable”) paired with what is often an image of the traumatic event (a pre-established target). The person is instructed to focus on the image, negative thoughts, and body sensations while simultaneously engaging in EMDR processing using sets of bilateral stimulation (e.g., eye movements, auditory stimuli, or tactile sensors). They are witnessing in their mind’s eye what surfaces. The clinician does not hear all of the details of the trauma, nor does he or she provide analysis of the experience. Dialogue is at a minimum. It is provided through repeated, brief check-ins between sets of bilateral stimulation; “What comes up now?” or “What did you notice that time?”

Principles of Trauma Therapy has an agenda in terms of promoting exposure therapy, but it also offers a holistic array of coping strategies—for both the therapist and the person in therapy—to increase one’s awareness of bodily reactions and ways to create a vocabulary for the feelings that arise. This mindful mentality is more than a subtle emphasis. Empirically validated mindfulness interventions are presented (e.g., acceptance & commitment therapy, dialectical behavior therapy, mindfulness-based stress reduction, and mindfulness-based cognitive therapy) as to disillusion the reader from the spiritual, Buddhist connotation. Clinicians are encouraged to maintain an open awareness to their own mental states (e.g., reduction of reactivity) without judgement, in order to mirror this process for people (e.g., attending to the breath, a here-and-now focus). There are also scripts for new clinicians and comprehensive assessment material that is applicable to anyone in therapy.

Principles of Trauma Therapy has a final, comprehensive directory of trauma-centered psychopharmacological interventions with content relative to psychobiology. This is extremely informative, but one has to question some of the research that was referenced. One concluding statement regarding the efficacy of selective serotonin re-uptake inhibitors (SSRIs) as antidepressant medication gave me pause. It was noted that SSRIs “have been found to be equally effective in reducing symptoms and improving quality of life across most clinical trials” for many diagnoses. The example reference was to a 2000 study comparing monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants and some selective serotonin re-uptake inhibitors (SNRIs) for depression. [1] The citation did not match the broad sweeping claim as the study itself notes “clinically insignificant” differences in efficacy as well as tolerability between SSRIs. [1] Read this section with a grain of salt and consider newer research when determining the efficacy of medication for victims of trauma.

Despite the focus on the individual in this book, the reader is walked through the “victim variables”, “characteristics of the stressor”, and “social response and supports” that affect the outcome for the trauma victim, which forces a cultural vista. Briere and Scott implicitly connect to the fact that our society’s disenfranchised groups of individuals (e.g., people of color and in poverty) are much more susceptible to posttraumatic symptoms.

Trauma is no longer just a micro level problem, but an issue of social justice and equality. The book maps out the generational influences and cyclical effects of trauma. There is an “additive effect” of multiple traumatic events throughout one’s life. For example, a survivor of childhood abuse who has residual effects into adulthood will react with “especially severe, regressed, dissociated, or self-destructive responses to the adult trauma” (p. 22). Earlier treatment interventions are essential to desensitize these reactions to stress.

Briere and Scott provide a stylish blend of the metaphysical and tangible aspects of trauma. They do this with learned experience, academic research, and hope as a means to expose the wide-ranging consequences of trauma. If you are a clinician searching for an in-depth examination of the components, conceptualization, causal mechanisms and treatment of trauma, then Principles of Trauma Therapy is here to the rescue.

References:

  1. Mace, S. and Tayler, D. (2000). Selective serotonin reuptake inhibitors: a review of efficacy and tolerability in depression. Expert Opinion on Pharmacotherapy: 1(5). 917-933.
  2. Briere, John & Scott, Catherine. Principles of Trauma Therapy: A Guide to Symptoms, Evaluation, and Treatment (2nd Edition). SAGE Publications, Inc; Second Edition – DSM-5 Update edition (March 26, 2014).

Woman's hand leaving flower on tombstoneThe phrase “moving on” is common in the grief and loss world, but it isn’t very well understood or, frankly, all that helpful.

What does it mean? What does moving on look like? How does one actually do it?

Unfortunately, there isn’t a clear answer to those questions.

However, there are things it can be helpful to know about “moving on” after the death of a loved one, divorce, or other painful life event.

1. You Are Not Responsible for How Others Feel about Your Grief Process

Typically, it feels like what those around us mean by “moving on” is for us to stop hurting, stop talking about it, stop remembering, stop crying, and just stop grieving. They talk about wishing we would stop dwelling on the hurt and encourage us to just let go and accept what happened.

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The truth is, what they actually want is for us to stop making them uncomfortable about our pain. Let’s face it—being with someone who is in pain and grieving isn’t the easiest of experiences. It’s difficult to watch someone we love hurting so deeply.

But other people’s discomfort with your grief is their business, not yours. You are not responsible for making them feel more comfortable.

2. Moving On Doesn’t Mean Forgetting

I suspect that the primary difficulty many of us have with the phrase “moving on” is that it often feels as if we’re being told to forget our loved one or the relationship we once had.

That’s not what moving on means. Moving on is more about learning to live what I call a both/and life rather than an either/or life. It’s not about grieving or forgetting, happy or sad, black or white. It’s shades of gray.

It’s about learning to live a full and happy life even as you miss and long for what you have lost. It’s about remembering and honoring the one you loved while also embracing the beauty and fullness of the life you still get to live. It’s about the brilliance of your love and the shadow of your loss coexisting in this complex and expansive experience we call living.

Grief and loss are complex, multifaceted, and multilayered. Loss and our experience of grief are integrated into our lives, not things we get rid of.

3. Moving On Doesn’t Mean the End of Grief, Either

Moving on from grief doesn’t mean a static end. It doesn’t mean suddenly we’re done grieving and will never hurt again. Moving on is more about moving forward than being done.

Grief and loss are complex, multifaceted, and multilayered. Loss and our experience of grief are integrated into our lives, not things we get rid of. Grief changes and morphs over time. We get stronger as we carry it, the edges of it round and dull, and with time it begins to take up less space in our lives. It doesn’t simply disappear. Grief can (and will) continue to remind us of our loss throughout our lifetimes, in different ways and at different times.

We move forward with life, embracing the fullness of it, even as our loss becomes part of who we now are.

4. Ultimately, You Get to Define “Moving On” for Yourself

People will have all kinds of advice and well-meaning intentions about how you should move on, when you should do it, and what it should look like. They, however, cannot determine that for you.

There are no timelines or rules to the grieving process. You will move through it at your unique pace and not one minute faster. The process of grieving is unique to each of us. No amount of pressure from others can make us move through our process any faster, not in any kind of healthy way.

Only you can know when you are ready to move forward after your loss. Only you can decide what it means to let go or accept the loss you experienced. Only you can truly decide what it means to move on and move forward.

Whatever that looks like for you, it is perfect and right.

man hugging pillow“Some days you eat the bear, some days the bear eats you.” —Iain Matthews

Sometimes, we get so mired in our thoughts and feelings we forget to see the bigger picture. When that happens, it’s good to look for even the tiniest crack that might open you up to a softened heart or a wider view. That softened heart is not just for others, but toward your own, sweet self.

Paradoxically, this requires both surrender and effort. You must surrender to your truth emotionally, physically, and cognitively, in this moment. Then, make an effort to do what you can to shift gears. If that’s not possible, accept the circumstances and your state of mind, and recognize they won’t last.

When in the throes of an overwhelming emotion such as anger, depression, anxiety, or grief, it may seem as if that’s all there is. Luckily, there is much more to you and your life than the challenge du jour—so much more. Yet, in the midst of jangled nerves and incessant negative thoughts, it’s all too easy to forget everything that is going well. Take a minute and think of everything that is working well for you.

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Now, think of the millions of thoughts and feelings you have had in your life. Some lasted a nanosecond, some longer. Each one came and went. When you are in a negative emotional tornado and it feels as if you are being swept up and carried away, remember: you will land. Sometimes it might be with a huge thud that rattles your bones; other times, it will be gentle. You can’t always control the landing. You can control how kindly you treat yourself in the process, though.

In addition to exercising self-compassion, it’s helpful to cultivate an inner sense of knowing—knowing when to make a Herculean effort to face some demons, and knowing when the best you can do is to keep breathing until the bad experience ends. It will end. Bad things will happen, internally and externally. The more you appreciate the ebb and flow of life, and the less you fight what is, the sooner you may feel a renewed sense of equilibrium and joy.

Trying to control all the variables, beyond a reasonable amount of preparedness, just sets you up for misery. The task is to live this moment, no matter how it appears.

Despite all the evidence to the contrary, there are people who think they should feel happy all the time. The last person who told me he was happy every day died suddenly at age 50 of a massive heart attack. How could anyone be happy 24/7? Only if the person is in denial—of life’s vicissitudes, of his or her ever-changing inner landscape, of everyone else’s ever-changing inner landscapes, of collisions between these landscapes—could that be the case.

Life is messy. Things don’t always go your way. People do what they want, not what you wish they would do. Your body throws curveballs at the most inopportune times. Furnaces shut down when it’s 20 below. People and pets die. You can run out of money. Best friends move far away. Children, too. Trying to control all the variables, beyond a reasonable amount of preparedness, just sets you up for misery. The task is to live this moment, no matter how it appears.

Railing at what is and resisting reality only creates more suffering. Yet, it is supremely difficult to embrace life on life’s terms. Why? Because the ego wants what it wants, exactly as it wants it, all the time. Consciously, few people would say that’s how they think things should work, but unconsciously, where that little child lives, that’s the belief. Otherwise, why would Buddhists and other like-minded philosophers have had to work for millennia to help people think differently?

As helpful as it is to continue practicing unconditional self-acceptance and acceptance of reality, it is equally useful to create a soft landing spot when life feels like it’s tossing you around. Softening your heart to yourself and your experience, with self-compassion, is another way of being in the moment. It’s important to have compassion for the anxious parts of you that don’t know what’s next, for the sad parts that are still grieving, and for the child parts that look to the loving adult within you to watch out for them, even when all you can do is offer a soft inner comforter to cushion the fall.

Creating a soft landing spot takes practice. It consists of first paying attention to what you feel in your body and taking some time to describe those sensations. As this is not a typical human activity, it can feel weird, awkward, and difficult. With practice, it gets easier. Think of it as learning a new language—the language of your body.

Then, check in with your feelings. If you only find one, dig a little deeper. Feelings usually come in clusters. When you have unearthed yours, ask yourself where they came from. Are they remnants from the past? Are they created by current, catastrophizing thoughts? If so, lovingly, patiently work with the parts of you that remember feeling this way before, perhaps in childhood. Give those parts a voice. Let them speak to you. If they are not ready, let them find repose somewhere, either in your heart or somewhere else safe and serene.

Next, listen to your thoughts. If you can write them down, all the better. Are they true? When flooded with negative thoughts, you might believe that’s your reality. It isn’t. It’s simply a temporary state of mind, even if it has existed for a long time. Challenge these unhelpful, possibly habitual, ways of looking at yourself, others, and life. If you use questions, you can answer them and reach a new paradigm.

The most important thing to offer yourself when life is hard and you feel lower than a snake’s wiggle is a feeling of safety. In some ways, all inner work builds toward a greater sense of internal safety.

Couple hugging and holding handsAccording to the Centers for Disease Control and Prevention, in the United States 6.7 million women between the ages of 15 and 55 experience either problems getting pregnant or carrying a pregnancy to term. That is more than 10% of women in this age range. Chances are you or someone you know has experienced or will experience challenges related to fertility.

Infertility often has biological causes, but the emotional effects can be especially devastating for a couple trying to conceive. The National Infertility Association discusses these emotional effects, which may include:

In addition to these symptoms, I have noticed the people I work with in therapy experiencing the following:

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Infertility is traumatic. In addition to depression symptoms, it is quite common that couples experiencing infertility will experience anxiety in response to certain situations or triggers (such as seeing pregnant women, pregnancy tests, babies on TV or in person, etc.). They may experience intense emotion around certain times of the month, particularly the times near ovulation and when a period is due. Going in for fertility treatments may become very triggering and anxiety provoking, particularly if previous interventions failed. Sadness and grieving are common, particularly around holidays and other important life events.

When someone is experiencing infertility, negative beliefs about one’s inadequacy or defectiveness may come up. Both partners may question why their bodies are not functioning like seemingly everyone else’s, especially when those around them are having babies, apparently without any trouble.

If there has been past pregnancy loss, other triggers for anxiety, depression, and intense emotions may come up, including the date a baby was due or times of year associated with the loss. Triggers can seem unrelated or random but still have a profound effect on the emotional reaction of the people going through this difficult situation. For many, infertility feels like riding an emotional roller coaster of anticipation, worry, sadness, grief, and anger.

When someone is experiencing infertility, negative beliefs about one’s inadequacy or defectiveness may come up. Both partners may question why their bodies are not functioning like seemingly everyone else’s, especially when those around them are having babies, apparently without any trouble. People struggling with this issue may question their value and their self-worth can take a major hit, resulting in magnified depression and hopelessness.

The stress and trauma that result from infertility can also have a negative impact on a relationship. Because both partners experience their own challenges in infertility, they may be more prone to snapping at each other, taking things personally, or feeling disconnected.

There are steps people who are experiencing the emotional complications of infertility can take in order to cope and eventually thrive through this major life challenge.

1. Seek Professional Assistance

A mental health professional can help address the symptoms one is likely to encounter when experiencing difficulties related to infertility. Coping skills, trauma work, and couples counseling are just a few of the areas a therapist can help someone to work through to make this difficult path more bearable.

When working with people with infertility issues, I often utilize eye movement desensitization and reprocessing (EMDR) therapy to address negative beliefs about worth and defectiveness. EMDR has also been helpful in addressing and reducing disturbance related to fertility treatments, pregnancy loss, and worries about the future. When trying to get pregnant and while pregnant, stress management is essential in helping the body to be at its best to conceive and carry a baby.

2. Give Yourself a Break from Social Media

Social media can be wonderful, but they can be triggering for someone who is going through infertility. People love to make pregnancy and birth announcements through social media. Someone experiencing infertility may be much more sensitive to these announcements, as they can feel like a reminder of the pain that person is bearing.

If such announcements are triggering, give yourself a break and stay off social media for a while. Work with a therapist to decide when and how you will begin to engage in social media again. Working through some of the trauma and practicing coping skills regularly can help reduce the triggering effect of social media.

3. Acknowledge and Feel Your Feelings

Emotions are meant to be felt. One of the main jobs of an emotion is to alert us that we need to pay attention to something. Emotions can do what they are supposed to do only if we are willing to acknowledge and feel them.

The human body and brain are very good at working through difficult material when we stop avoiding emotions and allow ourselves to feel fully. A therapist can help with learning to tolerate and regulate emotions.

4. Celebrate and Enjoy the Little Things

Infertility can consume your life. From your thoughts to your time to your emotions and your relationship, it seems that there is not an area that infertility does not impact.

With your partner, find reasons to celebrate life. Engage in fun activities that you wouldn’t or won’t be able to do while pregnant or with a newborn. Try to soak up the moments of joy, calm, and fun as they come up. Seek out new hobbies or activities you have wanted to try. It is important to find joy and meaning in life, even when you are going through a difficult time.

References:

  1. Centers for Disease Control and Prevention (2006-2010). FastStats: Infertility. Retrieved from http://www.cdc.gov/nchs/fastats/fertile.htm
  2. Dunkel-Schetter, C., & Lobel, M. (1991). Psychological reactions to infertility. In A. L. Stanton and C. A. Dunkel-Schetter (Eds.), Infertility: Perspectives from stress and coping research (pp. 29-57). New York: Plenum.
  3. The National Infertility Association (2014). Emotional aspects of infertility. Retrieved from http://www.resolve.org/support/Managing-Infertility-Stress/emotional-aspects.html

Side view of mother and childParents in previous generations used to parent with one central theme in mind: obedience. It didn’t matter how you felt, what you thought, or what you wanted. As a child, you simply did what you were told.

As the concepts of emotional development and self-expression in children began to give kids more of a more prominent voice, we should ask, what are we doing with that voice now?

I believe parenting is entering a new generation where emotions are dictating our every move. Some examples you might recognize include:

These are some of the trends that we are seeing now, and they can be detrimental to a child’s growth. Some children are not learning to put their emotions aside. Their moods are driving their behavior, motivations, and how they treat others. If they don’t “feel” like doing something, they won’t do it. If they are angry, they lash out. Children’s emotions are officially taking over, and I don’t necessarily think that was the goal when the exercise of self-expression for children was first encouraged.

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The Repercussions of ‘Emotions-First’ Parenting

Too often, the way seems to be to point the finger at something or someone else, then later wonder why so many children grow up and have difficulties with jobs or relationships. As parents, it’s often easier to point the finger at people such as teachers and accuse them of failing to do their jobs instead of helping your children adjust to an imperfect world. Children whose parents put their emotions first are navigating the world through a happiness lens, and if they are not happy, they are likely not engaging. The process of life becomes looking outward versus inward, and children may become experts at finding other people’s flaws but in the process lose the ability to process their own.

Children are learning that their moods dictate what they should do, and not the other way around. As a result, they may stop doing things when they become harder, and they may avoid social circles and relationships that don’t make them happy all the time. This can also manifest as less motivation to take risks or put themselves out there because of discomfort.

The Road Is Often Paved with Good Intentions

Where do we go from here? Most parents mean well and deeply want their children to be happy, but we as parents need to start making some serious changes. Here are 11 ways we can take our children’s emotions into account while also being the best parents we can be:

  1. If you are accepting your child’s emotions, this includes all emotions. It does not mean creating an “always make you happy” situation. You have to allow your children to process their emotions when things aren’t going their way, which will help them build resilience.
  2. Behavior and feelings are different. Your children are allowed to FEEL however they do. This does not give them a pass to BEHAVE however they want. Hold children responsible for their behavior and let them know that they have a choice in how they manage their feelings.
  3. Promote looking inward, self-regulating, and taking responsibility. Today they may have the worst math teacher on the planet, but someday your children may have the worst boss in the world. In either situation, they must learn to cope.
  4. If we cannot accept when our children are anything but happy, we are setting them up for a race they will never win.
  5. Consider using consequences instead of reward systems. Reward systems are unrealistic and confusing to children, and they do not work long-term. Consequences help develop consequential thinking, which is key to self-regulation and thinking beyond the present moment.
  6. If your child screams at you and you give in, you are teaching him or her that emotions rule. Show your child that behavior rules by remaining calm and shifting your stance only when he or she makes better choices.
  7. Allow your child to feel emotions. Sit with him or her. Explore instead of fix. Process instead of numb. Trust in your child and he or she will trust in themselves.
  8. Reframe discomfort as growth. Teach your child essential skills for coping or consider finding a therapist to help him or her learn and utilize coping skills.
  9. Let your child make mistakes, take risks, and mess up. Natural consequences are sometimes the best consequences.
  10. Put boundaries on anxiety and anger. Anxiety is at the root of many behavior issues we see, and we too often allow children to behave disastrously because of it. Anxiety is an intense emotional response and it needs boundaries.
  11. Process your own emotions. If you are unable to feel your own range of emotions, it’s going to be very difficult to be with your child as he or she is feeling his or her own. Practice sitting with your child and remind yourself that it is OK that he or she is feeling.

Parenting is by far the most difficult job, and there is no one way to do it perfectly. You will mess up, you will face all sorts of emotions, and that’s OK. It can become a beautiful model for your children to follow. The best thing we can give ourselves and to our children is the ability to self-reflect, change, and grow. Teach them to look inward instead of outward for happiness, what it means to work hard for something despite discomfort, and how to take risks doing what they love.

It is an incredibly important milestone for civilization as a whole that we are allowing our children to have a say and to express themselves. Now, however, we must do the hard work of teaching them what to do with the emotions they are expressing.

people emerging from shadowsRachel Dolezal, a Caucasian woman, has dominated recent news with her assertion that she identifies as black. Like many people, I was initially perplexed about why someone would choose to identify with an oppressed culture. What benefit is there to choosing to belong to a group of people who have been marginalized?

When people have difficult and character-forming experiences, they generally want them to be witnessed, honored, and respected. People with visible identities, as race typically is, naturally have this validating experience. For many people, parts of their identities and the way they understand themselves come from the struggles and challenges they have endured.

Poverty is a prime example. Though we may not consciously consider poverty an identity, for many people it is one. Many people who experience poverty have a shared experience of not having enough, being judged, and being marginalized. Poverty informs how people experience and interpret the world.

I worked with a 48-year-old woman—I’ll call her Nina—who consistently spoke of “being poor.” For most of her childhood, her family struggled financially and did not have their basic needs of food, shelter, and clothing met on a regular basis. When she was 14, her family’s situation changed. Her mother got a well-paying job, they bought a home, and they had financial security, as is true to this day.

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As a grown woman, Nina continued to refer to herself as poor, though she factually had not experienced poverty for 34 years. Nina’s earlier experience of living in poverty was so defining that it became part of her identity.

This phenomenon is also true for internal experiences. Consider people who have experienced, say, addiction or depression. “I’m an addict” and “I’m a depressed person” are phrases that I have heard many times. People often define their entire being by a challenging part of themselves, when in reality it is one of many aspects and identities that comprise who they are.

As human beings, we are wired to connect to others and to be recognized and understood by others. Tightly gripping an “old” identity is a way to keep that part of you visible—to keep the struggle of addiction or depression or trauma or poverty as a real and acknowledged part of your existence.

Being depressed is not all of a person. It is an experience, albeit it an unpleasant one. People who are depressed are also parents and friends and colleagues. There are many other pieces to who they are in addition to their depression. However, unlike depression, being a parent is visible. Being a colleague is visible. People see and understand these roles and identities and, in turn, validate them.

What happens when life circumstances shift and their current experiences no longer fit their description of themselves? Though Nina no longer lives in poverty and has not for more time than she has, she still very strongly identifies with being “poor.” When someone is no longer depressed, does he or she still say, “I’m a depressed person”? Many people do. They become so used to understanding themselves one way that it becomes the dominant narrative of their life, even when it no longer fits the circumstances.

As human beings, we are wired to connect to others and to be recognized and understood by others. Tightly gripping an “old” identity is a way to keep that part of you visible—to keep the struggle of addiction or depression or trauma or poverty as a real and acknowledged part of your existence.

But you can release parts and identities that no longer fit while still having them as part of you and your story.

Narrative therapy is a technique that allows people to share and tell the stories of their lives. It makes visible what is invisible. The struggles, challenges, and resilience that you have developed during your lifetime are part of your story. The ways we self-identify at one point in our lives may be different than at another point, and both identities can be true. Narrative therapy helps to weave together these many different aspects of life into a multifaceted story. It gives us the richness and fullness of our experiences as people rather than limiting us to one way of being. It helps us understand that we are not only our race or gender or depression or addiction. Instead, those aspects are pieces of a changing, evolving, and larger picture of who we are.

Young african american woman taking notes for her studyWhile symptoms of inattention and hyperactivity tend to be prominent in any discussion about ADHD, difficulty beginning tasks is another major issue for many individuals with the condition. In fact, in some cases, difficulty initiating tasks is a more visible symptom of attention-deficit hyperactivity than difficulties focusing or sitting still.

Here are four strategies to help facilitate task initiation:

  1. Break down large tasks into parts. Create a schedule of when you will do each part or set a deadline for when each part should be completed. For some individuals, an hour-by-hour breakdown of their day that notes when specific tasks should be completed is the best way to ensure that they get completed. For other individuals, having to follow an hour-by-hour schedule may seem daunting and annoying. Thus, one modification of this strategy is to estimate how long each scheduled task will take and list each part of the task on a piece of paper with the time needed to complete the parts. One can begin tasks at his or her leisure as long as sufficient time is allowed to complete what is needed. This method may be more difficult to follow through on, but having a moderate amount of structure sometimes is enough to initiate completion.
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  2. Set up motivators that encourage you to complete tasks. For homework or household tasks, forgo watching a television show, playing video games, or doing something else of interest until a specific task is completed. If the task requires running an errand, identify a small reward to motivate you to complete the errand. For instance, if you have to go to the library, tell yourself that if you go, you can treat yourself to frozen yogurt.
  3. Work in an environment consistently associated with work. The setting in which you complete homework or other tasks is important. If completing tasks requiring sustained focus, make sure you are working in a quiet area. Ideally, if you can complete tasks in an area that you use only for this type of work, you can train yourself to focus better knowing that when in that area, you are supposed to be working. If you were to try to complete homework while sitting in front of the television in the family room, chances are you’d be more focused on turning on the TV than working.
  4. Reduce distractions. Switch your cell phone to silent mode, turn it off, or put it in another room. Being tempted to check email, text, open a notification from an app, and so forth will draw your attention away from the task at hand. All the time you take to check your phone and get back on task is wasted time, and it adds up to quite a bit of time if working for a few hours or more.

In general, if beginning tasks is difficult for you, look at what things stop you or get in the way. Are there specific distractions? Is there boredom with the task at hand? Do you have trouble understanding the directions? Something else?

Identifying the causes of your task initiation difficulty and developing behavioral strategies to make it easier to begin tasks will likely lead to greater success with task completion.

Mother with her daughterThe refrain is familiar. Frazzled parents enter my office and are at a loss as to how to handle the intense emotions of their child. “He goes from zero to 60 in no time flat,” they report. Sometimes the child is lashing out in anger, sometimes he or she is overcome with sadness. The overall effect is that the parents are left confused about how to help the child put on the brakes when emotions take control.

Let’s look at a case of a child we’ll call Justin (not his real name). Justin, a third-grade student, has always had trouble managing intense anger. He often loses his temper with his younger brother, resorting to screaming, hitting, or saying very mean things (i.e. “I hope you die!”). He sometimes makes hissing noises at his parents when he becomes so angry that he can’t express his feelings in words. Other times, he attempts to escape the situation by leaving the house or hiding.

Justin’s parents never know exactly what will set him off, so they find themselves walking on eggshells in their own home. The types of events that may trigger an emotional reaction for Justin are often minor and seem out of proportion. Chores, homework, and other daily activities can ruin an entire day, and the family sometimes feels compelled to leave social events due to his behavior.

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His parents simply want Justin to be resilient enough to handle the obstacles he faces in his daily life. They know his behavior has, at times, impacted his peer relationships, and although Justin desires more friendships, he has a difficult time establishing and maintaining them because of his anger outbursts.

When Justin comes to counseling sessions, we spend a lot of time exploring these events and searching for more appropriate coping skills. As Justin has progressed through counseling, he has made strides to recognize that his intense emotional reactions are causing more problems than they are solving. We work on relaxation and realistic reframing of negative thoughts to help get through these events.

As we worked through these types of experiences, a pattern began to emerge that I have frequently seen with others.

Finding the first emotion is a skill that is beneficial for both children and adults. Parents can help to coach their children through this process as well.

When Justin had an angry outburst because he was going to have to share his post-baseball game ice cream with his brother, he was already in a poor mood because his team had lost the game and he had struck out. Was this outburst really about having to share his ice cream?

After having a tantrum at home because he would not be allowed to play with his neighborhood friend due to other family commitments that day, his teacher sent an email sharing that Justin had been upset at school about an argument with that friend. Was the meltdown related to the fact the family had other plans and he wasn’t getting his way?

Being asked to put his homework away after spending over an hour on a writing assignment caused a major incident with books being thrown, name-calling, and Justin being carried to his room because he was unable to calm himself. Was the incident caused by being asked to transition from homework to dinner time?

In each of these situations, there was a preceding event that triggered some uncomfortable emotions in Justin. He felt embarrassed by his performance during the baseball game; he was worried about the impact of the argument with his friend; and he was frustrated by the writing assignment that he felt had to be “just right.” It is easy to mistake the reaction as the stubborn response of an obstinate child.

By working with Justin to trace back the events to the true trigger, it became clear that he experiences uncomfortable emotions and struggles to verbalize them and process them independently. This results the discomfort building and eventually exploding as anger, directed at anybody who may be nearby. Through therapy, Justin continues to work on identifying the first uncomfortable emotion and finding ways to reduce the resulting anxiety before it builds to the point that he acts out in anger.

Finding the first emotion is a skill that is beneficial for both children and adults. Parents can help to coach their children through this process as well. Here are some steps to help you get started with identifying the first emotion:

Couple walking in the fog

Coping with an affair is one of the greatest challenges a couple might face. Some people choose not to try to cope and instead leave the relationship feeling devastated by unprocessed anger and hurt. Others choose to stay and find answers, potentially leading to reconnection and rediscovery.

Recent research indicates that lifetime rates of infidelity in the United States range from roughly 22% for men and 13% for women, with anywhere from 20% to 40% of couples worldwide admitting to having engaged in an affair during their lifetime. When a person finds out that his or her partner has strayed, feelings of betrayal, confusion, and abandonment may cast a painful shadow over everyday life. It takes time to reestablish trust. If both partners are committed to making the relationship work, it is possible to make a full recovery from an affair.

Research shows that approximately 60% to 75% of couples stay together after discovering an affair, and recent studies demonstrate that structured therapeutic approaches can be globally more effective in facilitating affair recovery, notably in the areas of trust, conflict management, relational satisfaction, and quality of sex.

As a couples therapist, I’ve watched couples go through a five-step process while working through this difficult time. Results show that structured therapeutic methods are globally more effective in facilitating affair recovery than treatment-as-usual approaches. But to fully heal, you and your partner must go through each step together.

At each step, you will peel back the layers of your relationship, discussing what happened leading up to the affair. As you dig in deeper, you may realize that there were issues in the relationship and individually that contributed to the affair. Keeping these issues in mind will guide you as you address the real sources of the problems.

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couple growing apart

Use each step below to guide your discovery of the true sources of problems in your relationship. The steps do not necessarily happen in order. However, each one is necessary and fundamental to the healing and rebuilding of your life together.

1. Apologies and Forgiveness

Before you can move forward, both people need to make the choice to remain in the relationship and work through things. It won’t be easy. It is imperative that the person who had the affair apologizes, and that the offended partner offers forgiveness.

The person who had the affair must offer a genuine, heartfelt apology. The apology must acknowledge the hurt and pain the other person is feeling. He or she must openly express empathy for the myriad emotions the other person is experiencing.

The person who was cheated on must forgive the affair. Research on forgiveness after infidelity shows that solidarity-oriented personality and perceived partner’s reconciliation motivation facilitate benign attributions and empathy, then facilitate higher levels of decisional forgiveness, which promotes emotional forgiveness. It’s this forgiveness that will allow reconnection to happen.

2. Commitment and Communication

Both partners must feel committed to each other. This commitment is significant as you move through the healing process.

Broken love and photograph

Demonstrate your commitment of patience and time by listening to and openly communicating the “how” and “why” of the affair. Reassure each other that you will figure out how your relationship got to this point.

The goal is to discover the underlying factors and triggers that contributed to the affair. Some couples find the affair was a symptom of growing apart. Others find the affair stemmed from feeling disconnected and distant. Research reveals similarities among partners in recovery: frequent and quality communication, mechanisms for rebuilding safety and trust, and the importance of forgiveness, though partners’ experiences varied regarding responses to needs for comfort, their sexual relationship, and responding to reminders. Regardless of the reason, open communication and commitment to each other is necessary for getting to the root of what caused the affair.

3. Mourning the Affair

Grief and sadness are natural feelings after an affair. Experiencing and expressing the pile of emotions you’re going through is part of the healing process.

Allow the offended partner to express these feelings of betrayal and the emotional impact of the affair.

Key Insight: Nathanael Schlect, Licensed Associate Counselor “In the aftermath of betrayal, anger is often protective. It can create emotional distance when vulnerability feels too risky.”

Through all the pain and emotion, both partners will eventually need to take ownership of the underlying issues that caused the affair.

couple holding hands

4. Awakening and Rebuilding Trust

Through all the pain and emotion, both partners will eventually need to take ownership of the underlying issues that caused the affair. In this stage, you will both awaken and recognize that the affair was a symptom of a problem, or problems, in the relationship.

As you work on repairing the underlying issues, you will rebuild trust and create a new sense of security and safety. Recent systematic research identifies five key themes for trust repair: proactive transparency, active monitoring, remorse and accountability, shared activities, and clear communication of reasons for the betrayal. Feelings that were never expressed may float to the surface. Issues that were never discussed will become a new part of the relationship.

Key Insight: Nathanael Schlect, Licensed Associate Counselor “Healing after infidelity isn’t about eliminating anger. It’s about slowing the intensity enough that grief, fear, and longing can be expressed safely.”

It’s during this stage that physical intimacy may be rekindled and emotional intimacy restored. The offended partner must feel reassured that he or she is still attractive and desirable to the partner who had the affair.

5. Reconnection and Acceptance

As you move into a stage of acceptance, the period of mourning your old relationship comes to a close. You’re ready to reconnect and rebuild your new relationship by learning from your mistakes. You’re ready to leave behind the relationship that once was, and to create a happy, new future together.

Clinical studies show that about 70% of couples report greater marital satisfaction post-therapy than they had pre-affair, having used the crisis as a catalyst to improve communication and closeness. It’s hard to recover from an affair, but with a lot of work, commitment, and dedication, your relationship can grow as a result of the experience. Once you’re able to move past the hurt and pain, you will have a solid, more evolved partnership. The work is well worth it, and partnering with a therapist is a great place to start.

Studies demonstrate that couples with a history of extramarital affairs show significant improvements during therapy leading to increased marital satisfaction, reduced psychological trauma symptoms, and forgiveness in the uninvolved partner, with many couples able to sustain these gains and preserve the integrity of their relationships.

References:

  1. Abrahamson, I., Hussain, R., Khan, A., & Schofield, M. J. (2012). What helps couples rebuild their relationship after infidelity? Journal of Family Issues, 33(11), 1494-1519.
  2. Giacobbi, E., et al. (2025). Unpacking trust repair in couples: A systematic literature review. Journal of Family Therapy, Published online January 5, 2025. https://doi.org/10.1111/1467-6427.12483
  3. Irvine, T. J., Peluso, P. R., Benson, K., Cole, C., Cole, D., Gottman, J. M., & Gottman, J. S. (2024). A pilot study examining the effectiveness of Gottman method couples therapy over treatment-as-usual approaches for treating couples dealing with infidelity. The Family Journal, 32(1), 81-94.
  4. Nickerson, K., et al. (2023). Relationship satisfaction and forgiveness following infidelity: A longitudinal study. Journal of Marriage and Family Therapy, 45(3), 234-251.
  5. Smith, J., & Taylor, M. (2021). Intrapersonal and interpersonal facilitators of forgiveness following spousal infidelity: A stress and coping perspective. PubMed. https://pubmed.ncbi.nlm.nih.gov/31347701/
  6. Weiser, D. A., Shrout, M. R., Thomas, A. V., Edwards, A. L., & Pickens, J. C. (2023). Two decades of infidelity research through an intersectional lens. Journal of Social and Personal Relationships, 40(2), 412-438.

Caught in the sunAndrea woke up feeling great and full of energy. She grabbed a bagel and a coffee on her way to the bus station and ate it on the bus to work. She arrived on time and proceeded to the conference room for an early meeting with her team. During the meeting, Andrea noticed her boss giving her what she perceived as a disapproving look, and became deflated as a result. All her energy was suddenly gone, and an inner voice began telling her an all-too-familiar message: “What did you do this time?” “The fact that your boss is looking at you like that means she’s heavily disappointed in your mediocre way of working!” “If you keep cutting corners, you’re going to lose your job!”

Meet Andrea’s inner critic: the voice that comments on her experience, criticizing her and describing how (awful) things supposedly are, regardless of the actual circumstances.

The inner critic is composed of ideas, beliefs, emotions, thoughts, and voices that try to manage our experience by telling us when we’re doing something right or wrong. We acquire this internalized structure as young children, and it continues to develop throughout our lives. It was initially shaped through our interaction with our environment. As young children, we are completely dependent on our caregivers. Even if they are for the most part responsive and attuned, they don’t always respond to us in ways that support our needs. Depending on their own conditioning, they try to shape us in ways that conform to their perception of reality.

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This can happen in many ways, such as punishment when we don’t behave the way they want us to, or reinforcement when we behave the way they do want us to. This shaping also happens subtly, from simple looks of disapproval or the opposite. Since we are totally dependent on their care, we begin to repress our aliveness and dynamism in order to adapt to how they expect us to behave—avoiding behaviors or expressions that will trigger punishment or disapproval, and doing what will bring their approval. Eventually, we end up internalizing our caregiver’s punishment-and-reward system, and it begins to limit both our worldview and our range of action. In a way, the inner critic is an inner police force that holds in check anything that deviates from our habitual, known patterns of experience and action.

Our caregivers aren’t the only ones influencing the development of the inner critic. Our schools, the environment around us, society, and basically any external input will contribute to creating this inner structure.

It’s important to point out that depending on our upbringing, our inner critic can be very harsh and painful or subtle and harder to notice. However, pretty much everyone has an inner critic that limits his or her expression in the world. In order to grow and develop, we must learn to work with this inner structure.

Breaking Out of Your Comfort Zone

One way of defining “inner work” is understanding and dissolving the internal structures that obstruct our perception of reality. This way of seeing is a direct threat to our conditioned sense of self and sense of reality, so the inner critic, understandably, is going to do everything and anything in its power to discourage us to continue pursuing our work.

Therefore, one of the first structures we must understand and work with is the inner critic. As long as we have an inner voice criticizing us or scaring us about going deeper into ourselves, it will be difficult to progress.

Identifying the Inner Critic’s Triggers

There is no formula for working with the inner critic. Each person’s process is unique, and different techniques may work differently for different people.

Any time you feel guilt, the inner critic is playing its part. There’s a difference between feeling guilt and feeling remorse. The latter is a genuine feeling of pain about the consequences of one’s actions. Guilt, on the other hand, is a self-defeating pattern of making yourself “bad” as a consequence of doing something perceived as wrong. Many times when we feel guilty there is also genuine remorse, and there may be an objective aspect of your behavior to recognize in the situation, but the extra layer of “I am bad for such-and-such” is just plain inner critic impeding us from growing.

Other times, the inner critic lurks when we’re about to embark on a new venture and we feel afraid. It can show up as a critical voice, saying, “You can’t do this” or “Who are you trying to fool?” It can also say, “This is dangerous, don’t even try it!” No matter what it says, the point is it attempts to keep us from engaging in the new endeavor. Identifying the triggers of your inner critic is key to the growth process.

The inner critic is composed of ideas, beliefs, emotions, thoughts, and voices that try to manage our experience by telling us when we’re doing something right or wrong. We acquire this internalized structure as young children, and it continues to develop throughout our lives.

Developing an Awareness Practice

The next step in working with the inner critic consists of learning how to identify its different voices. It can show up with a subtle, seductive voice, as an outright nasty attack, or something in between. By developing presence of mind through mindfulness meditation or other awareness practices, we can begin to notice when it’s lurking. The more identified we are with it, the harder it will be to notice when it is in action. By having a solid foundational awareness practice, in time you’ll be able to discern the inner critic in action.

One of the great benefits of mindfulness is that it allows us to observe our inner phenomena without identifying with them, so by being mindful of our thinking, feeling, and body sensations, we begin to see the different ways the inner critic shows up. Working with the inner critic is a lifelong endeavor, and as we progress on the path, we work with subtler and subtler ways in which the inner critic tries to sabotage our development.

Disidentifying from the Inner Critic

When we recognize that we have been attacked by the inner critic, we can experiment by switching our internal voice to the second person: “You are such-and-such!” This can be powerful in revealing the impact the voice is having. I have seen people in therapy begin to notice how harsh and brutal the energy is when they try this. Learning to see the inner critic as an external attack coming toward us, as opposed to being completely identified with it, is essential to neutralizing its power.

Using the Power of Anger to Regain Our Strength

The energy that fuels the inner critic is our own inherent aliveness and strength that’s being hijacked and used against us. At times, the criticism we give ourselves can be harsh and aggressive, and may require a strong defense.

Once we identify an attack and regard it as coming from the outside, we can experiment defending with a strong stand against the attack. Anything from a karate chop in the air to a simple “Get off my back!” with the right tone can be effective; it’s important to experiment and find what works for you. The purpose here is to reclaim our strength, so the energy, tone, and way we do this can be very different from person to person.

Effectively Using Compassion

Sometimes a forceful defense may not be effective, and a more gentle approach may be what’s needed. Simply getting in touch with the pain the attack produces in us and feeling compassion for our suffering can be a powerful way to disarm the critic. When the full force of self-compassion is present, any shred of attack will likely melt away.

Having an Ally Is a Must

Inner work isn’t easy, and navigating our inner landscape can be very confusing, so having an ally in the form of a therapist, teacher, or coach is imperative when going into the deeper aspects of working with the inner critic. Although each of the strategies mentioned above is helpful in giving you space from the critic, for deeper work you must also develop an embodied, contextual understanding of its origins, its impact, its phenomenology as a structure, and its energy. This requires a commitment to going into places inside of us that are old, hidden, and scary. It is difficult to do this alone, so the help of a compassionate therapist or other professional will make your work easier.

Important Notice

GoodTherapy is not intended to be a substitute for professional advice, diagnosis, medical treatment, or therapy. Always seek the advice of your physician or qualified mental health provider with any questions you may have regarding any mental health symptom or medical condition. Never disregard professional psychological or medical advice nor delay in seeking professional advice or treatment because of something you have read on GoodTherapy.