The word trauma is used in many different contexts, and it has recently been more of a topic of conversation in recent years. When people think of trauma, the typical images that may run through their heads are of war veterans, sexual abuse survivors, or even other kinds of abuse experienced. However, I believe that the population of caregivers as well as loved ones of those who are battling a deadly disease or severe medical conditions experience a trauma that does not get noticed enough. This is what can be termed secondary trauma, when one learns about the traumatic experiences of a loved one. Try painting this picture in your head: sitting in a hospital room beside the hospital bed for days in and days out with no end in sight, having not much to do other than observe your loved one in pain while they are in the hospital or at home, as well as even possibly having to dedicate all your time to care for your loved one.
Unfortunately, my family recently experienced a significant loss. My stepbrother, who was battling cancer since November of 2015, had passed away on Christmas Day. His battle with cancer is one that will never be forgotten by those who surrounded him. My stepmom and dad were his caregivers throughout the whole process. As a mental health counselor, I was keen on observing the impacts his battle with cancer had on them. For the sake of their privacy I won’t divulge, however the countless sleepless nights as well as hospital visits speak for themselves.
What are grief disorders?
Our reactions to bereavement vary from person to person, everyone has their own way in which they react to the loss of a loved one. Grief disorders come into play when an individual is experiencing prolonged as well as complex grief symptoms, these symptoms are typically more challenging for the individual to live with as well as may cause significant impairments to your normal functioning.
Some symptoms that are consistent with complex grief are: excessive irritability, consistent insomnia or sleep difficulties, intrusive thoughts about the loss, feelings of futility, as well as having a strong sense of responsibility for the loss. These are just a few of the symptoms that correlate with complex grief; it should be noted that if you are experiencing these symptoms and if they are lasting more than two months after the loss, it can be a signal of a prolonged grief disorder.
The Impact
It can go without saying that in these kinds of circumstances, we have someone who is ill and may be getting traumatized in the process as well as a caregiver or family member watching all of this play out in front of them, can have a significant impact on how we are perceiving this kind of trauma. I believe that this statement describes the experience of caregivers and loved ones during this time, “for some caregivers and loved ones, watching the death of someone close to them, while making no attempt to stop it, can be excruciating and lead to shock and extreme emotional distress,” (GoodTherapy).
Intrusive thoughts are common when talking about mental health and discussing our emotions. Intrusive thoughts are simply thoughts that enter the mind unwillingly that cause some sense of discomfort, or they can be images or impulsive urges that pass through your mind. In a situation like this, it is common for people to have constant intrusive thoughts about the person who has passed. Those who have a history of addictive behaviors may resort back to old unhealthy habits, and it's even possible for one to develop a fear that is related to the loss in some way (i.e. if the death was caused by a car crash, a fear of driving may develop).
Why is it so complicated?
The history of it all. It’s true, the history that one has with the one who has passed can impact the way that they experience grief. Whether that history is traumatic, joyful, distressful, or filled with unforgettable memories, each has a unique way of causing a domino effect. For example, if the one you have lost was a significant factor in your trauma history it may be difficult for you to wrap your head around how to grieve this individual. Feelings of confusion, conflicting emotions, feeling alone in the grief, as well as feeling guilty for holding negative feelings/thoughts towards who has passed. We see you, and it’s okay to be going through all of these emotions and barriers.
Ultimately, it is up to you to decide how you want to experience grief and how you would like to progress on the path of healing, if needed. Your family may have their own words and ways of going about the loss, but this is not something that needs to be conformed to or feel as though you should be matching the level of emotions of your family members. No. It is your journey. It is your life to drive forward. It is your time to take care of yourself, and if you start questioning the reality of you being able to take care of yourself or if you have hesitations about doing so; just remember how much you have cared for your loved one and pull that energy inwards and direct it towards you.
Grief and loss is unfortunately something that we all come to know all too well. Even with that, it still feels like getting hit with a ton of bricks whenever it happens. Throughout our lives, we make connections, friendships, relationships with people that are not forgotten. It is important not to remember your loved one as they were during their last struggling moments, but to remember them by how they were around you.
Moral injury has been defined as, “In traumatic or unusually stressful circumstances, people may perpetrate, fail to prevent, or witness events that contradict deeply held moral beliefs and expectations” (United States Department of Veteran Affairs).
Essentially, moral injury can occur when someone either engages in or witnesses an event and/or action that goes against their own personal values, ethics, and beliefs. There are two types of acts that can lead to moral injury; acts of commission and acts of omission. Acts of commission refer to actions people take that go against their own morals and/or belief systems. While acts of omission highlight when someone intentionally does not take action on something that leads to an adverse event that goes against their own morals and ethics.
To clarify, an example of an act of commission may be that a military member kills civilians in the midst of performing combat related duties. An act of omission might be a physician not taking someone off of life support despite patient suffering due to the patient's family making the decision to keep the patient on life support.
So why are we talking about this?
Well, oftentimes we tend to associate the term “moral injury” with military personnel and military related tasks/traumas. However, moral injury extends to multiple life experiences in addition to the military experience. For example, those who are in the healthcare and/or mental health care field, first responders, survivors of crime, and survivors of intimate partner violence may also deal with the negative thoughts, feelings, and even potential decrease in functioning related to traumas associated with moral injury.
What types of situations can lead to moral injury?
While we can take an educated guess that engaging in and/or bearing witness to a violent war event is traumatic and will create moral injury in most of us, there are other scenarios in the civilian world that can also inflict moral injury.
For example, during the height of the COVID-19 pandemic, healthcare workers across the world were stretched incredibly thin; working longer hours, having to isolate from their families for extended periods, seeing a high volume of patients, and not always being able to help dying patients see their loved ones one last time before they left this world. The unimaginable stress of working in healthcare at the height of the pandemic led to unavoidable moral injury on various fronts, given there was so much out of our control and so many difficult decisions had to be made. There are even people who blame themselves for others' deaths after unintentionally and/or unknowingly exposing people to the disease, healthcare workers or not.
Then, there are those who are survivors of violent and/or sexual crimes that often suffer with depression, anxiety, social isolation, grief, and resentment towards themselves, others, and the world based on their own traumatic experiences and moral injuries sustained. They might blame themselves for what happened to them, whether that be rape, sex trafficking, or assault. They may know their assailant and still have love and/or affection for them, which creates an internal storm of emotions and confusion.
People who suffer with moral injury often deal with bouts of depression, shame, anger, disgust, distrust, and self loathing. Such feelings can compound with clinical depression, anxiety, or even post traumatic stress disorder that makes moving forward in our lives that much harder. Maybe we notice ourselves to “shut ourselves off” to others, the world, and ourselves…we just can’t trust anything or anyone anymore which creates negative bias that impacts how we live our lives. We feel more isolated because we feel shameful or disgusted by what happened, so we disengage which ultimately fuels the anxiety, anger, sadness, poor sleep, helplessness, and hopelessness that may come with moral injury.
So, what do we do to heal?
Much like any emotional wound, it is important to be able to have the felt safety to talk about our moral injury without being judged. Simple, right? No! Dealing with the dissonance that comes with moral injury is hard enough for the sufferer, but it is discouraging when we think about telling a trusted loved one with fear of being met with “well, why didn’t you just do this?” or “Oh, I would have handled that way differently” or “You could’ve just said no”. Sometimes we may be met with such responses; or, sometimes we may have unconditional love and nonjudgmental support. But we can’t know until we put ourselves out there as a first step in healing. Again, I acknowledge that this is far from easy.
Research also points to forgiveness and self compassion as means of coping and healing from moral injury. How is that done? Well, therapists can help you talk about the event(s) leading to your moral injury followed by discussion of negative beliefs you hold about yourself, others, and/or the world as a result. From there, your therapist can help you find ways to accept the reality of the occurrence and forgive yourself to release the hold of self hatred and condemnation. Your therapist can teach skills to reinforce self compassion, such as learning self empathy and acceptance to lift the burden as well. This work is nowhere near easy, but with time and dedication, the wounds of moral injury can be healed so that you can live your life again.
- Jackie Martinez, LMSW (NY), LCSW (NC)
Ah, the new year. We all think it – “new year, new me!”. We can be so eager to identify one or more resolutions. We always say, “this year is going to be different,” and we start off with a strong motivation until that dreaded crash about three weeks into January.
Some of the most popular resolutions include: exercising more, losing weight, getting organized, living life to the fullest or feeling happy, mastering a new hobby, budgeting, quitting smoking, traveling more, and spending more time with friends and family. While these are all admirable goals in and of themselves, the problem is that they are broad, vague, and unrealistic. For instance, exactly how does one plan to lose weight? Is it realistic to commit to going to the gym every day while having a strict low-carb diet? No. How does someone plan to budget? Does this mean paying for only necessities, and if so, what defines a necessity? Is it fair to say no to a night out with friends because that could break the goal?
The most important factor in making and keeping a resolution is to be realistic, balanced, and fair. No, someone will not lose three dress sizes in one month. No, they will not go to the gym every day. Yes, they will give in to temptation -- they will eat that Boston cream donut in the break room at work. Yes, they will end up buying something “on impulse” simply because they want it.
Now let’s change the “they” in the above paragraphs to “I.” Go back and read the paragraphs again. Reflect on what these sentences mean to you, if anything, when in the first-person.
Do they sound realistic, balanced, and fair? No.
In other words… Be nice to yourself. You are not a failure for a slip-up. You’re human, with your ups and downs, just like everyone else. Imperfection is okay. No one – absolutely no one – is motivated 100% of the time. Even Olympians struggle to maintain motivation. If you'd like additional resources of New Years Resolutions, click here.
Motivation Operates in Cycles
It is normal to experience the highs and lows of motivation. Instead of thinking, “why can’t I be motivated all of the time?” consider that some motivation is far better than none. That episode of motivation, no matter how fleeting it may seem, can still help you achieve your goals. Embrace it.
I used to struggle with not being able to uphold my motivation for long periods. I became frustrated at myself when I was doing something unproductive. Then I realized that the “something unproductive” was the very thing I needed to do to help recharge my emotional battery – to get me to feel inspired to get back on track with my goal.
Motivation operates in cycles, designed with peaks and troughs. It is not linear. Once you can begin to picture those highs and lows of motivation, moving away from the mentality that it is a straight-line to success, you work toward achievement of your goal (or you can at least readjust the goal to be a realistic one!).
The Phases of Motivation
The New Year before my wedding in October, much like so many other brides, I made it one of my resolutions to look a certain way for my wedding. I was determined to lose some of that weight I gained from too many snacks during all-nighters writing papers in graduate school.
I wanted to be reasonable with myself. I knew there was no way I was going to fit into a certain dress size, but I did know I could at least buy a dress in my real size and get it brought in if I lost weight. So, I did that.
I also downloaded Noom, a weight loss app with skills from cognitive behavior therapy (CBT). Daily, Noom drops short tips and suggestions to aid someone as they work toward weight loss. Early in the program, they introduced me to the Motivation Model, which changed my mindset. I began to be much more patient, loving, and kindhearted toward myself, addressing those nagging negative beliefs that were chewing away at me.
Let us use an example. Say you want to save 10% of your paycheck going forward. This is an illustration of what your motivation will look like throughout the journey:
As you can see, the Motivation Model has peaks and troughs; it is not straight nor linear.
The following names of each phase come from the model by Noom. However, keep in mind it applies to all reasons for motivation, not only weight loss. It is a universal model, and I am certain there are other products that have the same model but simply with different names.
Phase 1: The Hype
This is the most exciting phase. This is the phase where you think, “I got this! I am going to achieve these resolutions!” and jump in with a complete, undeniable motivation. This is where you can feel caught in the momentum, determined that their first time saving 10% of your paycheck will be the norm going forward.
This is where you will experience the honeymoon – when motivation is at its most extreme. This is when we have that unstoppable, almost grandiose sense of motivation. We are in a blissful ignorance. We think we need to feel that motivated all the time.
Phase 2: The Plummet
This is the painful, dreaded crash that happens after the honeymoon. This is the part of the cycle where people have a bump in the road, thinking they are a failure, and may fall into an old habit. This is the part where we feel extremely judgmental toward ourselves, thinking we will never be able to get back on track with our resolutions.
This is the part where you did not save 10% of your paycheck. You had a draining day. The boss was hard on you, you got in an argument with your spouse, your child had a temper tantrum. To cope, you went online-shopping and bought some things you wanted but did not need.
You may think the following:
“This sucks. This is way harder than I thought it’d be.”
“Maybe I can’t do this.”
This is all normal! This is okay! It is all part of the journey. Simply acknowledge you had a slip up and continue along.
Trough 1: The Lapse
This is the most difficult part. This is where you will feel at your lowest in your progress with your resolutions. This is where you are most likely to give up, state you will never get better, give in to those negative core beliefs, and just go back to how you used to be.
“This is way harder than I thought it’d be” degenerates into “this is impossible.”
“Maybe I can’t do this” becomes “I won’t do this. I give up.”
This is the time when clients tell their therapists they have given up on their resolutions and goals. They are convinced things cannot get better.
But this phase can and will pass. Just believe in yourself!
To get through this phase, do something. Do something that will help you feel one step closer to your resolutions and goals, even if it is very minimal. If this feels like too much, use a visualization meditation to imagine you have achieved your goal. Visualization can be a powerful psychological trick to boost confidence.
Also, have some gratitude for The Lapse. Sure, it does not feel good being there, but it is not a crisis. It is an opportunity to be introspective, to dive into yourself to figure out what is effective for you when you are not doing well, so you can prepare to do better in the future. It is the time for wisdom.
It gets better.
Phase 3: The Slips and Surges
Phase 3 is the steadier phase, where going at a rabbit’s pace slows down to that of a turtle. You know the saying, “slow and steady wins the race.” In this phase, the highs and lows are easier to tackle. The highs are no longer mountainous like the honeymoon, and the lows are no longer like a great ravine. You will still feel those highs and lows, and yes, they are permanent. But that is exactly to be expected. It is normal.
You will have some days that are better than others. Perhaps one day, your boss says you did an amazing job leading the team project. Maybe that ongoing argument with your spouse is turning more so into manageable disagreements. Maybe your child is learning to use coping skills rather than have meltdowns.
There will be the bad days too, of course. You’re late for work because you got a flat tire – and it is the same day as an important business meeting. Maybe you get a phone call from your child’s teacher because he is having problems in math. Perhaps after weeks of you and your spouse working hard on effective communication, an argument happens again.
This is how motivation operates. It reflects the highs and lows of life – all the good and the bad, the celebrations and the tribulations, the gains and losses.
Once you accept that the slips and surges will happen, you can be mindful. You can think to yourself:
“Today I really will only spend my money on what I need.”
“Honestly, today really was a hard day. It’s okay if I indulge a little bit. But tomorrow I will be back on track.”
And it will also allow you to be more freeing and forgiving toward yourself… “You know, it really is okay if I go out with my friends on Fridays. It’s not going to ruin my goal if I let myself have some fun. If anything, it will probably motivate me to continue my journey.”
Summary
1. Our motivation operates in cycles. We will have highs and lows.
2. Be fair to yourself. Be mindful; reflect on what you can learn during the highs and lows. Know they will all pass.
3. When in a low, do one small thing rather than nothing at all.
So…taking the first step to engage in mental health therapy can be jarring enough, especially when experiencing suicidal thoughts. If you have already taken this step, you should be so proud of yourself because this is a difficult step to take!
Sometimes when we are seeking therapy, we have more on our minds than the day to day stressors and/or desire to vent to a neutral source. Sometimes, we are dealing with suicidal thinking, whether we realize it or not. And this can be quite frightening for some, while it feels fairly normal for others. So as a therapist, when I hear someone say something that may indicate suicidality, it is essential for me to take a closer look at what’s happening.
Also, side note…if anyone in your life makes what you feel may be a suicidal statement, please make sure that you are asking questions, supporting them, and/or getting them connected to the appropriate professionals. Whether it is yourself suffering with suicidal thinking or a loved one, it is best to call the suicide hotline at 988 (press 1 for veterans) and/or call 911 or get to your nearest emergency room in the event that you or a loved one feels unsafe regarding suicidal thinking. Click here for additional resources.
Different Types of Suicidal Thoughts
I want to clarify the different types of suicidal thoughts that can happen for people so we all have a better understanding of varied experiences with suicidal thinking.
Passive Suicidality
First, there is passive suicidal thinking. This type of thought is passive in nature, hence the name. When people have thoughts like this, such statements and/or questions may run across their mind like, “Maybe it would be better for everyone if I weren’t here”; “I wish I were dead”, “I want to die”, “why am I here?” or “I wish I could go to sleep and not wake up”. When people are dealing with passive suicidal thoughts, this tends to mean that there is no plan or intent to harm or kill themselves in place. In therapy, if we as clinicians have determined that you are safe at the time that passive suicidality is discussed, then we discuss creating a safety plan together and talk about safety contacts (trusted people and/or emergency contact) in case one no longer feel safe and they feel they cannot safely utilize their safety plan.
What’s a safety plan?
A safety plan is a tool that is created in a therapy session with one’s therapist for the purpose of having it at their disposal when suicidal thoughts creep back up. A safety plan will prompt one to list out triggers that contribute to suicidal thinking, plan, and/or intent; ways one can remain safe independently (go on a walk, read a book, spend time with a pet); who the trusted people in their lives are and who can be called by client for distraction (not discussing the problem) or for help (discussing the problem); listing out places that bring one a sense of peace and/or distraction, where they can go when feeling upset and/or overwhelmed; listing out emergency contact in safety plan (who can a therapist call in the event thatthere are concerns for safety and client is not reachable); listing out Suicide Crisis Line Phone Number- 988 (press 1 for veterans); list out 911 on safety plan; and list out nearest emergency room closest to client’s home where they may go in the event of a suicidal crisis/emergency.
Active Suicidality
Another kind of suicidal thinking is referred to as active suicidal thinking. With this comes thoughts of not only wanting to die and/or “not be here” anymore, but this has escalated to the point of the sufferer wishing to take their own lives, having formulated a plan and/or has intent to harm or kill themselves. For example, someone may tell you that they are feeling depressed, worthless, and life is no longer worth living. They then go on to say that they are ready to exit this world and plan to jump off of a bridge that very night. When something like this is said, immediate action should be taken. By immediate action, I mean calling the Suicuide Crisis Line and/or 911 or bringing your loved one to the emergency room. There is no tip toeing around this. If someone with active suicidal thinking has a plan and/or intent to harm or kill themselves, they need immediate safety and stabilization. No ifs, ands, or buts about it. They may be upset with you for calling the crisis line, the police, and/or taking them to the emergency room, but this is for their own safety and well being.
Why take action?
Often times, those who survive suicide attempts are grateful they did and are more motivated to start a new chapter in their lives. Suicide is a permanent solution to a temporary problem. Suicidal thoughts are treatable! Therapy can help those who suffer with suicidal thinking to learn healthy coping skills,learn to reframe negative thinking and find news ways to navigate their lives in a way that feels worth while and meaningful.
The Bottom Line
If you tell your therapist that you are suicidal, much more questioning needs to occur first before anything else. So you may get a slew of questions that seem redundant, but they are necessary to have the best grasp on what your clinical and safety needs are at that time. Oftentimes, we as therapists are able to formulate safety plans together and check in on this together regularly. However, there are some times when we need to call 911 and/or get you to an emergency room. Sometimes, this may result in a psychiatric inpatient hospitalization in order to keep you safe and have another treatment team in the hospital evaluate your safety and needs. This is all done in the name of safety and genuine care for our clients. We’d rather you be upset with us and get help than not be here tomorrow.
The concept of psychiatric hospitalizations seems scary to some people, especially if you have never been hospitalized this way before. As someone who used to work in inpatient psychiatric hospitals, I can confidently confirm that the first goal at intake is discharge. Inpatient treatment teams seek to quickly stabilize and get patients out of the hospital safely with plans in place in the community to prevent future hospitalizations.
We as therapists are here to support you no matter what. We just ask because it can save a life. Please see our emergency resources page if you are struggling with suicidal thinking.
I’m a therapist who is transparent about seeking therapy for myself, and who believes both teletherapy and therapy is helpful for almost all people, regardless of the circumstances. Throughout my years, I have undergone my own therapy for different reasons, from wanting support for the trauma I experienced, to learning how to gain the self-esteem needed for me to break free from domestic violence, for simple advice about navigating through transitions, as well as for a means to cope as a caregiver for two parents who both were terminal. Sometimes, too, it felt cathartic just to be able to “vent” to a nonjudgmental, compassionate individual.
Unfortunately, as I’m sure you’ve noticed, it isn’t easy to get a therapist! I’ve had to leave voicemails, emails, and private messages for many local therapists – quite a few who never got back to me, and most who said, “sorry, I’d love to help you but I’m full” without any advice about who I could go to instead. Alternatively, for the therapists who did respond, there were issues with the commute (I require public transportation due to a neurodevelopmental disability) or with timing. For part of my treatment saga, I was also in graduate school and working a full-time job on top of balancing a mandatory field placement, which made it seemingly impossible to fit in self-care for myself.
Talk about irony! I remember it so vividly. I was a social work student learning how to be a therapist, employed at a community mental health agency while also interning at a private practice. I made the time to be there for my clients at the expense of ignoring my own needs. I desperately wanted a therapist of my own, but with the transportation issue, an unforgiving schedule, and the lack of available therapists in the area, how could I?
Then the pandemic happened. The world shut down. Overnight, I had to change meeting with clients face-to-face to going online. I will admit I came with a bias. Years before, during orientation for my social work undergraduate program, a rather old-fashioned professor rambled about why online therapy is a “threat” to the field. Mainly it was that she assumed HIPAA could not be honored or that the relationship was not as “real and organic.” However, now after being exclusively a remote-based therapist since the pandemic to the present, I must admit I respectfully disagree with her. Some of my most intimate, heart-to-heart conversations have been over a video screen. I have shared in my client’s sorrows, hopes, fears, joys, celebrations, and hardships. And I have seen glimpses into the very environment where they spend most of their time – their homes. There is something so powerful, insightful, and raw about seeing one’s home which cannot be captured through the spoken word while in a therapy office. It is truly a privilege to be trusted with seeing the private spaces of my clients, and in turn they get to see mine. Furthermore, teletherapy allows for me to work with anyone if their primary residence is New York State, going far beyond the borders of Suffolk County. This means the people who choose me as their therapist do so because they want to work with me, not because of just location. This arrangement has allowed me to blossom as a specialist in turn, having clients who all fit into my niches (grief/bereavement, complex trauma or C-PTSD, caregiving stress, and/or people with debilitating disease).
Thanks to teletherapy, I too got to have my own weekly therapy. After a somber event happened, I needed a therapist to process my emotions. One therapist who replied to me in a timely fashion offered teletherapy to anyone in the state. She offered everything I needed – experience, knowledge, efficiency, she even liked the challenge of having other therapists as her clients! Perfect! Yet best of all, the flexibility of being online allowed me the flexibility I required to remain efficient in my own role as a therapist to the people I serve. It was simple: I only needed to log in to the teleconference platform right before the session start time. This allowed me to never miss a scheduled session, be proactive about my recovery, and let my “therapy time” truly be 45 minutes (rather than adding in commuting time, which of course could be delayed due to an accident or inclement weather!). Plus, this also meant I got to have more time for other commitments in my life.
Still feeling unsure about teletherapy? Here’s some perks.
There are numerous reasons why teletherapy is beneficial. Here are a few in summary.
Privacy (the BIG one!)
Have you ever ran into someone you know while in the waiting room? Worse, was it someone you have difficulty with because you two do not get along? Yep, talk about awkward. Back in high school, I remember being in the waiting room at a therapist’s office when suddenly a girl I knew came in to pick up her younger sibling. She was best friends with a bully who absolutely loved to torment me. Yep… awkward.
Want to hear another unsettling story? That practice was so disorganized with communication that there was always competition for rooms. One time while I was there, one of the therapists came into the waiting room to ask if any of us would be willing to have our session in the kitchen – the public kitchen, where staff and clients alike could come and go to get coffee. Yeah, I’m not kidding. Talk about a HIPAA violation!
Or maybe you have been spared such severe examples, but most of us can relate to at least this experience: Have you ever overheard the entire conversation between the patient and the clinician while at a doctor or therapist’s office? Or have attempts to soundproof the rooms still proven impossible? I’ve been there, too.
Fortunately, with teletherapy you do not need to be concerned about coming across someone you know in the waiting room, parking lot, or restroom. You can schedule your session for a time where you will have optimal privacy and confidentiality, whether that be in your home, your car, or even in your backyard.
Flexibility
Going to a session is easy when you do not have to drive to and from the therapy office! Clients can schedule their session during lunch break, before work or class, during their baby’s naptime or when the toddler is watching Sesame Street, or any other gap. In turn, it allows me to offer a wider schedule to also suit my clients’ needs.
Flexibility is especially important for clients who otherwise would not be able to fit therapy into their schedules at all. For example, for my clients who are caregivers, it would be impossible for them to commit to in-person therapy because they would need to arrange for care for both the session and the commute. However, with teletherapy, they are only “away” from their loved one for 45 minutes, and they also have the option to step away from the computer to care for them, if needed. Or as another example, say the client has a serious medical issue. They can prioritize their doctors’ appointments without having to suffer from a late cancelation fee because chances are, I can fit them into another time slot for that week. This is not always the case for in-person therapists because they tend to have stricter “on the clock” hours.
Accessibility for People with Illness or Disability
Sadly, although therapists tend to think they are sensitive to those with medical issues, this is often not the case. Their hearts may be in the right place, but they simply do not understand why going to an appointment in-person can be a great challenge. It is one thing for an office to be “ADA-friendly” by having an elevator. But what if the elevator fails? What if the parking lot is full of potholes? What if there is no ramp at the entrance or no automatic door? What if the restroom door is very heavy? What if the person needs their caregiver to help ambulate them but the only appointment times available do not work for the caregiver?
What if the person has IBS or Crohn’s disease? Or maybe they are pregnant? The fear of waiting in line for the restroom is a legitimate concern for such people, in addition to the embarrassment that comes with nosy strangers.
If you have limitations due to an illness, disability, or medical procedure, you may be unable to make it into the office, which will hinder treatment during when it is most needed. Teletherapy removes these barriers by allowing you to “log in” from the comfort of your bed.
Continuity of Treatment for College Students
For some youth, their connection with their therapist is one of the healthiest, strongest relationships they have with an adult. They make great progress, tackling the core beliefs or issues or whatever it is that is hurting them… until they must discontinue therapy because they are moving away for college. In the best-case scenario, the therapist may just happen to know another therapist who is in that area and can take on the referral – but that is almost never the reality. Usually, the treatment is terminated, and the client is left floating, just waiting to hopefully get some help through the counseling center at their college. These colleges may not have enough counselors available to assist every student, lack the training needed for issues that go beyond “typical college stuff,” or other limitations.
On the flip side, with teletherapy, college students can keep their therapist, even those going to a college outside of their home state! In my case, I can keep every student who began with me in high school and has since left for a college that is far away. The only requirement is that their primary address must still be in New York, which usually is the case for college students as they tend to “go home” during breaks.
Reduced Wait-Times
In an in-person setting, there may be a considerable wait time to get an appointment with a particular therapist. However, remote-based therapists tend to have more time slots open and allow themselves to be more available. For instance, if someone needs to reschedule a session with me, that is much easier to accommodate because I can log on during a time when I usually do not work. On the other hand, an in-person therapist may only be able to offer times that are bad for the client, or say they are completely unavailable because otherwise they may have to drive to the office for just one session.
Effectiveness (yes, teletherapy is just as good as in-person therapy!)
Evidence-based research supports that teletherapy is highly-effective for most clients, issues, and modalities – and generally, teletherapy is just as useful as in-person therapy. Sometimes it is even more effective since clients may feel more relaxed being in their homes.
It is only a myth that teletherapy is a “diluted” version of in-person therapy. In truth, most modalities (i.e., EMDR, DBT) can be easily adapted to an online version. For instance, there is a website I use for the bilateral stimulation used with my EMDR clients.
For more reasons as to why teletherapy may be the right option for you or your child, click here.
Doesn’t it drive you nuts when people tell you to “calm down” when you’re upset, anxious, panicked, or afraid? It drives me insane. I just think to myself, “Okay great…and how do I accomplish that without putting you through a wall?” Of course I don’t act on such thoughts! But I understand the frustration of feeling stuck in a dark, deep hole of anxiety while the bystanders at the top of the ditch are yelling down to me, “calm down!” or “it’ll be fine!” or “you’re overreacting!”. Which is why grounding techniques can be so beneficial when no one else can.
First, we should go over some basics of what anxiety and panic look like so we can better spot them before we feel completely unraveled in our experience with such symptoms.
Fight or Flight Response
First, quick side note/science lesson…our bodies yield both the Sympathetic and Parasympathetic nervous systems. Housed in the Sympathetic nervous system is our “fight or flight” that prepares us to respond to danger. While fight or flight has always been essential to survival, the body can’t always tell what is a genuine danger versus when we are just emotionally uncomfortable or going through something. The Parasympathetic nervous system helps our bodies restore back to a state of calm when fight or flight is no longer needed. This information is important because it plays a GIGANTIC ROLE in anxiety, panic, as well as other mental health struggles.
So when we have anxiety, there is constant worry that we can’t seem to shake most of the time in addition to maybe feeling restless, on edge, having a hard time focusing, feeling more irritable, physically tense, having a tough time sleeping and feeling easily fatigued quite a bit. I go through this myself and I can tell you firsthand that ignoring these symptoms will lead to feelings of anger and irritability, scatteredness, constant exhaustion, and like every little thing is an insurmountable task which will negatively affect your life across the board. Trust me, I know.
What is Panic?
Panic is a bit different and more intense than your typical anxiety monster impeding on your day to day life. With panic, we actually feel like we’re having a heart attack or like we’re going to die! That’s right…there are instances when people have had to go to the Emergency Room because they thought they were having a medical emergency. Completely understandable given the symptoms of panic. If we look at symptoms of panic that include accelerated heart rate/palpitations, sweating, trembling/shaking, shortness of breath, feelings of choking, chest pain/tightness/discomfort, chills or heat sensations, numbness or tingling, feeling detached from ourselves or reality, fearing we are losing control, and fears of dying….it’s no wonder people may want to seek out a medical professional real quick.
While I have never experienced a panic attack myself…I am willing to bet that if I ever do, I’m getting my butt straight to the Emergency Room because as humans, what are we supposed to think when all of that is going on without any clear medical explanation? I highly encourage anyone experiencing such symptoms, especially if this has never happened before, to seek medical attention immediately and rule out medical concerns before chalking this all up to panic!
However, once we rule out medical concerns and have an understanding of panic symptoms, we can better manage them without seeking unnecessary medical attention or escalating our anxiety/panic due to fear of the unknown. It is essential to understand that panic attacks are just that, panic. They cannot physically harm you and they tend to last about 10 minutes (while I’m sure it feels like forever!). So, we have to remember that it will pass and getting comfortable with discomfort is one of the first steps to getting through panic attacks. I’m sure that’s obnoxious to hear, but it’s true.
Much of the time, what I’ve caught myself doing to alleviate my own generalized anxiety is to avoid, avoid, avoid. Whether it be avoiding a deadline or an uncomfortable conversation, dodging obligations/tasks all together feels good in the moment, for sure. While my education tells me that avoiding my anxiety like the plague only makes things worse, I admittedly engage in this behavior. And trust me, the education is correct…avoidance only feeds the anxiety monster that lurks beneath.
So what are we to do when anxiety and panic strike?
Well, a form of coping called grounding skills seems to help many, including myself, to feel more centered in the present moment and ultimately activate my parasympathetic nervous system (that’s what we want). With grounding, we are essentially turning our attention to the present moment so that we can ultimately feel more calm and address potentially anxious triggers.
In grounding, we use our five senses to return to the present moment when feeling overwhelmed and like everything is on top of us. Grounding equips us with several skills to utilize healthy detachment from emotional pain with use of distraction until we feel ready to return to any given problem. The following 5 skills that I will list below can be used any time, in any place, and can be completely discreet. There are many more ways of grounding that will not be covered here but I encourage you to explore ways of grounding with your therapist to find the right fit for you.
The 5-4-3-2-1 Technique:
This skill invites us to observe 5 things we can see, 4 things we can feel, 3 things we can hear, 2 things we can smell, and 1 thing we can taste. For example, if I am feeling overwhelmed I will stop and look around me, engaging in this technique to focus on something aside from my stressor for a few minutes until I can collect myself and face my problems with my head screwed on right.
Body Awareness Technique:
Here, we are encouraged to focus our attention on sensations in the body and feeling of calm after the exercise is over. Below, you will find an example cited from Therapistaid.com.
- “Take 5 long, deep breaths through your nose, and exhale through puckered lips.
- Place both feet flat on the floor. Wiggle your toes. Curl and uncurl your toes several times. Spend a moment noticing the sensations in your feet.
- Stomp your feet on the ground several times. Pay attention to the sensations in your feet and legs as you make contact with the ground.
- Clench your hands into fists, then release the tension. Repeat this 10 times.
- Press your palms together. Press them harder and hold this pose for 15 seconds. Pay attention to the feeling of tension in your hands and arms.
- Rub your palms together briskly. Notice and sound and the feeling of warmth.
- Reach your hands over your head like you’re trying to reach the sky. Stretch like this for 5 seconds. Bring your arms down and let them relax at your sides.
- Take 5 more deep breaths and notice the feeling of calm in your body.”
Grounding Statements:
When having anxiety or panic, a way to cultivate acceptance of discomfort and better managing symptoms, we can be kind to ourselves. Does it seem ridiculous? Maybe… but it can work! Focusing on positive words you say to yourself over and over in the midst of anxiety or panic can help you remember that you are strong, resilient, and can overcome difficult things in this life. Some examples of what you might say to yourself would be, “This is uncomfortable but I can accept it”, “I will let my body do its thing and it will pass”, “I survived this before and can do it again”, “this isn’t dangerous”, “no need to push myself, I can take a small step forward as I choose”, “these are just thoughts, not reality”, or “don’t worry, be happy”.
Diaphragmatic Breathing:
I’m sure mostly everyone has heard of some form of deep breathing and I often hear clients tell me, “this doesn’t work for me”. Upon closer inspection, I find that people may try this once or twice, and when it's not instantly working, they chuck it out the window. However, this form of deep breathing should be given a fair shot! Let me explain a bit more about how to engage in this skill, then I’ll explain why I feel so strongly that deep breathing really needs to be given a chance.
So, how do we do this one? We put one hand on our chest and the other on our belly. Then, we inhale slowly through our nose, hold briefly, and exhale through our mouth. Some follow a formula of 4-6-4; ie. inhale 4 seconds, hold 6 seconds, exhale 4 seconds). Adjust to your comfort level. Make sure that upon breathing in, your belly is expanding out. Notice how your belly expands and falls with each breath. It is recommended to engage in this skill for at least 2-5 minutes daily.
The reason deep breathing works is because it levels out the oxygen and carbon dioxide in your blood. When you have anxious breathing, your oxygen and carbon dioxide levels are uneven, leading to the physical manifestation of anxiety that we talked about earlier. So to help activate the parasympathetic nervous system (the one we want) and ease the physical parts of anxiety, diaphragmatic breathing is a great one to try. Let me know how it goes!
Using Sense of Smell for Grounding:
It has been found that in anxiety as well as trauma, the sense of smell is largely connected to the emotional part of our brains. If you think about it, maybe something that smells oddly familiar to you but you can’t put your finger on it brings a sense of comfort and calm. I know for me, whenever I smell anything that resembles Thanksgiving dinner, I have a sense of ease thinking back to fun childhood memories, enjoying my grandmother’s cooking for Thanksgiving dinner. Her food is always on point!
So when we are feeling anxious and/or triggered in any way, we can use sense of smell to quickly return to the present moment. Ideas that some of my clients have found helpful over time is to keep a perfume and/or cologne soaked handkerchief on them, an essential oil bottle on them, or maybe a favorite kitchen spice. Candles and/or wax warmers at home can also bring a sense of peace and calm using pleasant scents.
While anxiety can sometimes make us feel like we’re in a moving car with no driver, there are ways we can safely get back into the driver’s seat and navigate our symptoms safely, securely, and happily. Your therapist can help you navigate these tools and find out what may be the best suited for you and your needs. Anxiety will not get the best of us!
For some people dealing with the death, illness, or absence of a *significant person, the holidays can be a time of mixed emotions like sadness, guilt, grief, as well as hopelessness. On one hand, we are expected to be festive and merry; on the other, we are reminded that person is no longer here or in the capacity they once were. It can be exhaustive to cope or grieve. Unlike an anniversary or birthday, where the day itself can be dreadful but otherwise there are limited triggers about it, the holiday season is different. The sights, sounds, activities, and gatherings go on for weeks.
Note: I use the term “significant person” rather than “loved one” in recognition that grief is complex. Not all people had loving, supportive relationships with the person who died, but regardless that relationship was still of profound importance. “Significant person” is thus an inclusive term.
Unquestionably, some holidays during other times of the year can be bittersweet, such as Mother’s Day or Easter. Yet as a culture, the holiday season seems to be the most profound in its importance for its emphasis on family gatherings. Thus, it is not surprising that for many people Thanksgiving through New Year’s Day can be especially hard.
The Grieving Grinch
A long time ago, I was close to someone who detested Christmas. He was a classic Grinch. From around September and onward, he would be triggered by reminders. It could not be avoided – every store was already getting decked out with Christmas decorations and toys to sell. By the end of October or perhaps early November, Mariah Carey was already bleating over the speakers at every store. This despair from September through January went on for years, with me making every effort to try to make the months more tolerable for him. Eventually, though, I realized he was too caught up in his grief. I told him that he has no control over the holiday season; that he must radically accept it will come every year no matter what, and that the more he fought against it the more it would breed misery for him. I encouraged him to instead honor his losses, truly grieve, but to still try to enjoy other aspects of the season. He insisted he wanted to avoid it. I asked him to consider, “how exactly would you avoid Christmas?” and he said he would lock himself in his room. My response: “Which would mean you would need to sleep for months. You wouldn’t be able to turn on the TV, go on the internet, listen to the radio, really… anything. Because the point is that no matter how much you try to ignore Christmas, it will come anyway.” I don’t know why, but somehow that dry, matter-of-fact response got him to begin thinking differently – he finally stopped fighting the “hatred” which in truth was grief. He was avoiding his grief.
Grief Coping Strategies
While by no means a complete list, the following are tips you may use to help you get through the holiday season if caught in grief.
Skip the holidays – but with a plan
Yeah, I know. I just got done writing about that person where I gave him the exact opposite advice. Hear me out.
The holidays are stressful enough. Compounded with grief, they can feel downright unbearable. The traditions, shopping, cooking, family, parties… all of it can feel tiring even when thinking about it. I want you to know it is okay to skip the holiday season. You may face backlash for saying no to Thanksgiving dinner, but your self-care comes first.
Remember these points before canceling your holiday season:
1) The holidays will come again. This year you may not have the energy to deal with the holidays, but next year may be different. At that time, you may feel ready to engage again. Do not think you have to be in a rut each year. That is unfair to you.
2) Ask yourself, “am I skipping the holidays to help myself or just to avoid the pain?”. If you need to, take your pen to paper to come to this answer. You may truly want to skip the holidays, or maybe you are feeling pressured by others (family, society, etc.) to celebrate.
Additionally, ask yourself if you are prioritizing your self-care versus having avoidance. In psychology, avoidance coping is a maladaptive coping mechanism (in other words, an unbeneficial or unhelpful technique) that means to avoid processing the thoughts, feelings, and stressors associated with an issue. In grief, this can mean you are refusing to process the loss of the significant person, procrastinating things that need to be done that remind you of the person, or being in denial of emotions you are feeling. While this seems helpful in the present moment, it only intensifies the anxiety. It festers like an untreated wound.
3) Decide what you will do for the holidays, rather than only what you will not do. Remember that if you say no to going to dinner at Uncle Joe’s house, ultimately the rest of the family will be there. Then what? What is your plan? Before that day springs up on you, plan accordingly. If your idea of self-care is to binge-watch Cobra Kai in your bedroom on Thanksgiving, do so! But do not wait until the holiday arrives to try to plan as that may increase your negative emotions; you may make yourself feel unintentionally worse.
4) You may have regret or sadness if you skipped the holiday. On that day, you may go on social media only to notice the get-together at Uncle Joe’s house looked fun. Maybe there is a funny video of your younger cousin making a snide comment on TikTok. Maybe your sister posted a Facebook video of your three-year-old nephew unwrapping presents with a big smile. Ask yourself if it is worth you skipping the holiday or instead if you may find happiness in being with others.
Did you watch A Muppet Family Christmas special when you were younger? If so, remember when Fozzie Bear and his friends drove to Fozzie’s mother’s house with the intention of spending Christmas with her, only to find out she rented out the home to a man and his dog who wanted to avoid everyone for Christmas while she ran off to Malibu? Although the man was upset at first that his holiday did not go as planned, he ended up having an even better time because he allowed himself to join in the festivities.
5) Or you may have an even better day if you put yourself first! In that same special, Fozzie Bear’s mother was having the time of her life on the beach in Malibu.
Do not make comparisons
It is tempting to see other individuals or families enjoying festivities and comparing their experiences to your grief. You may feel worse, like you “should” feel merry.
It is important to remember that even under the best of circumstances, the holidays are stressful for most people and families. The sappy, magical events shown on television and captured in greeting cards are rarely the reality. For instance, you do not know if the hostess of the dinner was in a vicious argument with her spouse only minutes before the guests arrived, only to hide it all behind a beaming smile. You do not know if the parents are struggling to buy presents for their children. Instead, think about what you do have – you may feel more gracious!
Extend yourself to others
If you have the time, consider volunteering your time to someone who needs the extra support (Long Island Volunteer Opportunities). This could be spending the holidays at a hospice, nursing home, hospital, soup kitchen, or shelter. Your love and support toward a stranger may make their holiday memorable and bright, while benefiting your own mental health by taking your focus off the grief. Volunteering is very helpful in the healing process of grief!
Alternatively, reach out to a family member or friend who may need some help right now.
Remember that the anticipation can be worse than the day
In my work as a grief therapist and as someone who has experienced significant losses, I have noticed the phenomenon of anticipation being worse than the holiday itself. My hypothesis is that by experiencing the surge of emotions beforehand, we are thereby allowing ourselves to think the day itself will be awful, which will make us feel better when that day arrives, and we find we are okay. In essence, it is making us “cope ahead” by going through the storm beforehand.
Find support
You may reach out to friends and family for emotional support with your grief, but are worried about doing so because they may be preoccupied with the holiday season. Consider joining a grief support group.
Let yourself feel your emotions
Your emotions are valid. Do not think you must feel happy because it is the holidays or otherwise there is something “wrong” with you. If you feel angry, let yourself vent. If you feel sadness, allow the tears to flow. If you feel lonely, reach out to a friend.
Ask for help
We as a culture tend to be cautious of asking those who are grieving if they need help. We may assume it would be an unwanted reminder or we simply do not know what to say. Other times we may think that the bereaved are doing okay.
Please speak up if you need help from a friend, neighbor, or family member. Perhaps that entrusting someone else to make a particular favorite dish, cleaning up the house, or getting some other tasks done. People tend to feel satisfaction when they know they are caring for someone they love.
Other ideas
Are you looking for more ideas for coping through the holiday season? If so, go here.
After a long day, rushing to get your work done, put dinner on the table, and solve the crises everyone runs to you for, you finally get a moment of peace while laying down to sleep. Unfortunately, for many of us, this time can be full of distressing thoughts including memories of the past, fears for the future, and analysis of ourselves. Some even find themselves unable to fall asleep due to these ruminations, making their next day even more tiresome.
Why Do I Overthink at Night?
Our nighttime thoughts are often a reflection of our daily lives. To a degree, thinking at night is our mind’s attempt to reflect, adapt, and prepare for challenges to come. What this means is that if our days are full of stress then our minds will try to anticipate future stress and prepare us for that stress in our only moment of respite.
Some people find that giving themselves a time, during their waking hours, to feel their stresses and accept them, have less of a tendency to think of these thoughts later on. This can be a difficult task to do, but a number of clinicians at Long Island EMDR can be there to help you get started. Learn about them here.
Overthinking Affecting Sleep
People who suffer from overwhelming life stress, anxiety, depression, and associated insomnia will often say that their unwanted thoughts make it harder for them to get to sleep each night. This insomnia can lead to decreased work or academic performance, depleted mood, low energy and fatigue, or many other functional impacts.
How to Focus on Trying to Sleep
As silly as it may seem: count sheep. More specifically, there is research that suggests repeating a word or phrase at specific rates (usually 3-4 repetitions a second) can impact our brain’s ability to think of other thoughts. This is called articulatory suppression. This phrase should be neutral so that it doesn’t trigger thoughts of other things to come to mind. Some people find syllables or articles (“the”, “an,” or “a”) as helpful choices.
Others find imagery to be exceptionally helpful in maintaining sleep and getting to sleep. Try this exercise: in your mind, craft a story around yourself doing something that you enjoy most. Do your best to picture the details: sights, sounds, smells, or tastes. By practicing this imagery, you are training your brain to use your imagination to distract yourself from your thoughts. If those intrusive thoughts come to mind, accept that they are there, and push them aside as you author your tale.
Remember, this is a learned skill. It may not come naturally and it may not work the first few tries.
Other things that you may be able to do to focus on your sleep include:
- Staying off of your electronics at least 30 minutes before bedtime.
- Not utilizing your sleep space for non-intimacy or non-sleep-related activities throughout the day.
- Eliminating caffeine or other stimulating substances.
- If you struggle to fall asleep within an hour and a half, get up and do something for 15 minutes. Then try again.
- Exercise in the day to drain excess energy.
What to do to Control Thoughts
Our brains are very much like a river: the water represents our thoughts and the land represents our mind. If we can place ourselves firmly in the river, and not get carried away with the current, then we can improve our wellbeing. For some, the current, or our intrusive overthinking, will carry us into anxiety, depression, and other negative mental places. So, we look to take some control back and stand up.
Some brief activities can help us to control our thoughts and thus improve our nighttime routines.
- Mindfulness meditation.
- Breathing exercises.
- Positive affirmations and rejection of self-judgements.
- Taking a meaningful break from daily stress.
- Identify what causes unwanted thoughts and our focus on them.
- Journal your thoughts and feelings.
- Talk with your therapist about Mindfulness and Acceptance based Cognitive Behavioral Therapy.
Losing a parent is a life-changing, profound experience that almost everyone will go through at least once. In fact, the death of a parent is one of the most common types of death, and as a society, we expect we will outlive our parents. As a result, while the grief that accompanies the death of a parent can quickly be recognized with the inundation of flowers and sympathy cards, this commonality seems to minimize the loss and makes us think we should “get over” it soon. The truth is, it can still be a tremendous loss – and this sense of “get over it” can make the healing even more difficult because it comes with guilt.
While the death of a parent regardless of one’s age is universally a colossal experience, the death of a mother or father as a young adult can be even more devastating because it is compounded with unique obstacles. For instance, there are milestones that the parent is expected to be present for, such as college graduations or weddings, and it can seem impossible for anyone else to fill that space. Plus, for young adults, this type of loss can be especially difficult because they are on the cusp of dependence versus independence. While they strive to depend on themselves, they still may turn to their parents for financial assistance, emotional support, or the wisdom of lived experience.
And we know this much: When a parent dies suddenly or expectedly, there is an absence – an emptiness, perhaps – that arrives with the realization someone so significant is gone. Regardless of the relationship dynamics, whether it was balanced and warm versus chaotic or cold, the death will have a huge impact.
Some beliefs among young adults who have dealt with the death of one or both parents
“I feel so alone and misunderstood.”
“My best friend says she ‘get its’ because she lost her grandma. But I lost my mom. It’s just not the same.”
“I will never feel loved that way again.”
“Everyone is telling me I need to ‘get over it’ and start living my life. But how am I supposed to move forward knowing I’ll never hear Mom’s voice ever again?”
“Dad’s gone. Who is going to walk me down the aisle?”
“I’m so sick and tired of my friends complaining about their silly problems! They have no idea what it’s like to be in this much pain!”
“I’ve always wanted to be a mother. I wanted so desperately to have a family of my own. Now that I’m pregnant, I should feel excited. But instead, I’m just thinking about that my baby will grow up without grandparents.”
“Thanksgiving is going to be weird this year. Dad always sat at the head of the table. He always carved the turkey. He always said grace. I just don’t even want to go.”
“Mom has been an absolute mess ever since Dad’s been gone. I want to help her, but she doesn’t seem to care that I’m hurting too. It feels like she’s gone too even though she’s here.”
“They say they’re ‘here for me’ but they’re not. No one wants to talk about Dad anymore now that the funeral’s over. If I say something, I’ll sound negative.”
“My friends have told me I need to start ‘living my life’ again. They’re sick of me being so mopey and depressed. I’ve noticed they’re pulling away from me. Now I feel like I’ve not only lost my parents, but even my own friends, the same people who said they’ll always be there for me no matter what.”
“I hate to admit it… I feel guilty saying it… but yeah, I’m jealous of my friends. While they’re looking forward to happy things like getting married or graduation, I’m taking care of my mother who is terminal. She’s going to die and that’s that.”
“It pisses me off when people tell me ‘She’s in a better place now.’ It invalidates how I’m feeling.”
The adult orphan syndrome following the death of a parent
For most people, they have known their parent(s) longer than anyone else in their lives. Whether the relationship was positive or negative, or there were additional issues like separation, parents still shape their children.
The identity of “son” or “daughter” is the first identity upon us all. Most people were cared for by their parents as they grew up, even if not done well, and their parents witnessed all the obstacles along the way – seeing all the rises and falls, all the happiness and despair, all the pulling in and pushing away for guidance.
By adulthood, we have formed far more identities while carrying over some from childhood. Yet the age never matters – we continue to be a son or daughter, the role carried from since the beginning.
To lose a parent thus brings about a role loss. When I lost both of my parents, I realized my first role – “I am a daughter” – was destroyed too. And my first sense of constancy, of a promise something will always endure, had died too. We all seem to realize we will likely outlive our parents, but the idea of them dying is so often shaken off until it happens. We see the relationship as permanent as the sun rising with every dawn.
Losing a parent in adulthood can bring about complicated emotions, one of them being abandonment. Even people who are very independent from their parents can still feel abandoned because the sense of constancy has been disrupted.
For young adults who were the main caregiver for an aging, disabled, or ill parent, the grief can be exacerbated since two roles are now lost: the role of being one’s child but also serving as their “parent.” It may also mean having to adopt new roles in the family going forward, such as needing to help the surviving parent with paying bills because they feel overwhelmed and that was always done by their spouse.
All of these issues are recognized by some researchers as what they call “adult orphan syndrome” in that the feelings of abandonment, confusion, role changes, lack of support, and idea of being alone are universal regardless of age. For some, the idea of being an orphan as an adult may sound insensitive to children who are orphaned, but it is not meant to compare or dull that pain – only meant to show that the feelings and complications can still exist.
It is interesting, too, that this type of loss has no such word in English. An orphan literally means a child whose parents are dead. A widow is a woman who lost her spouse; a widower a man who lost his spouse. Yet why not a word for those who lost a parent in adulthood?
Challenges faced by young adults experiencing parent loss
Although parent loss can be painful at any age, there are differences that are driven by our age brackets.
First of all, most young adults have parents who are alive and likely well. They may be mostly independent, but they know they can still rely on their parents when needed (obviously there are exceptions, but I am speaking in general). They and their friends will be “going home” for the holidays during college breaks to stay with their parents. They know their parents will be there at their commencement ceremonies, sharing in their joy for their successes. They excitingly call their parents when they get engaged, wanting them to be the very first people to know. Then during the engagement months, their parents are involved too, with the mother helping with choosing the dress and adorning her daughter on her wedding day, and the father walking her down the aisle. Parents, too, are also usually the first to learn when their child and the child’s partner are expecting a baby. And they are there for the baptism or other ceremonies, there for the birthday parties, the holidays, for help with childcare.
While these above milestones can still occur despite the death of one or both parents, it feels different. I will honestly admit I skipped my commencement ceremonies from college and graduate school (the pandemic did postpone the latter ceremony by a year, but regardless, I still did not go even when it was happening). I did not want to be “that person” who was there without their parents, that adult orphan. And while I was proud of myself, having been summa cum laude both times, I did not feel there were others to share in that sense of accomplishment.
I can also say that among my friends and family members, most of them do not understand what I have gone through as a parentless young adult. That is not subjective; it is factual. Some are fortunate to still have their parents. Others have lost their parents, but that was not until their mothers and fathers were in their geriatric years. My grandmother died at the advanced age of 93, an age considered a “life well lived.” My mother died at 57. While the adult orphan syndrome happens at any age, and pain is pain, it still does not feel the same. There is the lingering thought, “she should be here.”
Healing from parent loss as a young adult
The goal of bereavement therapy is not to “get back to normal.” That is impossible, for life has forever changed due to the death of the parent. The idea of having to “move on” is counterproductive, and in fact can make someone feel worse because they are burying the emotions they need to process. Instead, the goal after such a loss is to learn to redefine one’s life and to feel fulfilled despite the loss. It also not only the loss itself that must be explored, but also the update in roles, the severance of expectations, and all other things that come with death.
Losing one’s parent can unearth disturbing thoughts. It can make someone question their own mortality with the realization they too will die someday. They may think things like, “since Dad died at 45, that means I’ll die at 45 too” even if they realize that is irrational. Additionally, it can make one reflect on the importance of other relationships in their lives. One person may become closer to their siblings or friends, while others may distance themselves, and still others may decide to focus solely on their spouses and their children.
Such a loss can also be an inspiration to make newfound changes in one’s life – some for the better. For me, I was smacked with the realization of, “I must rely on myself. I am an adult” the moment my father died. This realization did not strike me when I moved out at age 19 to live across the country. It did not fall upon me on my wedding day. Hell, it did not even come up during the discussions with my husband about starting our own family. No, it really took him dying for me to have this fricken’ epiphany. Only a month after his death, I was on job interviews to have greater opportunities. Right now on the weekends, I am house-hunting with my husband rather than doing the same ol’, some ol’ things we did with our friends. We are trying to conceive.
I was already following a plant-based and low-alcohol lifestyle, but after my father died, I made the full commitment to being healthy. I make selective, nutritious choices, and I do not drink at all. A healthy lifestyle is my priority now, my sworn vow to myself, because I don’t want to die the way my parents did if I can help it. I want to live. One profound effect of the loss of one or both parents is the opportunity for positive changes.
The next step
Long Island EMDR recognizes the aftermath of a death is a significant, life-altering process. Some of our clinicians specialize in grief and bereavement, including having specialized training in this important field. We offer individual therapy and group therapy for this topic. In fact, we are even starting a group called Millennials in Mourning, which is specifically for Millennials and older Zoomers who have experienced parental loss. It will be led by me, Valerie Smith!
Reach out today to learn how we can help you navigate through this challenge while building a brighter future.
About the author, Valerie Smith, LMSW
Valerie Smith, LMSW, CFTG, is a therapist, social worker, and certified forest therapy guide at Long Island EMDR under the supervision of our clinical director, Jamie Vollmoeller, LCSW. Valerie possesses a bachelor and master’s degree in social work from Adelphi University and Fordham University, both from which she graduated summa cum laude. Valerie is also a certified forest therapy guide through the Association of Nature and Forest Therapy (ANFT), where she trained in the Rocky Mountains to master sensory-based, mindful activities through a biophilic perspective. Valerie is passionate about the health benefits of a plant-based diet as well as holistic wellness. Valerie is trained in EMDR and TF-CBT, with experience in DBT-informed skills. She focuses her treatment on adolescent girls and young women with C-PTSD and PTSD. Additionally, she helps people with life-threatening disease and their caregivers. Finally, she works alongside those experiencing grief and bereavement, especially young adults who lost one or both of their parents/guardians.
Everyone ruminates. Whether it’s thinking about something we said to someone, something we did wrong, or some recent event that is stuck in our mind. Ruminating thoughts can be defined as repetitive and recurrent, negative, thinking about past experiences and emotions (Michael, et al., 2007). However, while everyone experiences ruminating thoughts at some point in their life, for some, rumination can be distressing, difficult to stop, and can lead to dysfunction in their day-to-day lives.
Why do we ruminate?
When we think about ruminating, it’s important to acknowledge that it often comes from an effort to cope with distress. For instance, analyzing an experience can better prepare us to encounter a similar experience in the future. Or it can help us mend some relationships that were negatively impacted by an event in the past. But, when these thoughts aren’t leading to any productive change we can see individuals obsess over these thoughts, become anxious and depressed, isolate, or begin using / increasing their use of mind-altering substances.
Types of ruminating thoughts?
Ruminating thoughts can be very diverse. For some, they may ruminate about their hands being dirty and that they may get sick. Others may ruminate about suicidal thoughts, including existential themes about the meaning of life. Some may continually think about a traumatic experience, like an assault or some form of abuse. As well, some of these ruminating thoughts may be untrue distortions of events. For example, repeatedly thinking about being sexually assaulted may come with false thoughts that the victim somehow provoked their assailant or deserved to be assaulted.
Are my ruminating thoughts true?
Our experiences mold our self-esteem, or the way we perceive our behaviors, abilities and traits. A traumatic experience can leave individuals with warped perceptions of themselves that can have a detrimental effect on their day-to-day lives. Especially the formation of a negative self-esteem, or negative self-concept, is associated with feeling disempowered, hopeless, and helpless. Ruminating on these experiences, or even these self-beliefs, has been shown to exacerbate and prolong negative moods, and hinder social interaction and problem-solving skills (Wang, et. al, 2018).
Are ruminating thoughts part of a diagnosis?
Ruminating thoughts can be associated with a number of mental health diagnoses, including:
● Depression
● General and social anxiety
● Substance abuse disorder
● Bulimia
● Binge eating disorder
● Obsessive-compulsive disorder
● Post-traumatic stress disorder
● Personality disorders, like borderline personality disorder
There is hope!
Ruminating thoughts are treatable and manageable. Treatment often aims to interrupt the thought processes and improve coping skills to replace rumination. Some individuals find relief from medication management, cognitive-behavioral therapies, and mindfulness techniques.
If you experience ruminating thoughts and are looking for a way to move forward, please call our office and schedule an appointment. Our licensed clinicians and therapists on staff would be more than happy to work with you.