I am a Board Certified LCSW in San Diego, California. I have worked in the field of mental health for over 20 years and have a private practice specializing in anxiety, depression, and interpersonal relationships.
I recently inherited a coping skills group for adults that suffer from mental illness. The group has been formed of individuals that have been recently diagnosed. They are struggling with accepting how their symptoms impair their daily functioning and how their diagnosis influences their self-perception.
I have found the verbal processing of emotion has been helpful, but many are resistant to engage due to their defense mechanisms. A strategy that I have found to be effective in both providing a comfortable space to let their guard down and express their emotions is through artwork.
This week, my clients were tasked to sketch a picture of their old and new selves. They were instructed to fold a piece of paper in half to draw an empty face in the center of the page. On the left side of the paper inside the face, using crayons, oil pastels, or markers they were to draw who they were before they were diagnosed with their illness. On the right side of the face, they were tasked to draw who they currently are or who they want to be.
As with all my art activities, once the instructions are provided and a brief moment of deep breathing is completed as a group, the activity is practiced in silence with soft relaxing music playing in the background. This provides an opportunity to practice mindfulness, focusing on the present moment, non judgmentally.
Once the art activity was completed, the group shared what the process was like for them. There were diverse responses that ranged from relaxing to disturbing. Once their feelings were validated, each person shared their project to include what lessons they were taking away regarding their mental health journey, as well as from the exercise.
What was this experience like for you?
What emotions surfaced? How do you know, (i.e. your body’s sensations, your thoughts)?
What were you thinking when you drew your old self?
What did you notice about yourself?
Was this easy or difficult? How did you tolerate it?
What were you thinking when you drew your present self/future self?
What were your reasons for choosing one over the other?
What did you notice about yourself when you were drawing?
What do you think about yourself now?
When you hear other people sharing their experiences, how does this influence how you think about yourself?
What are you planning on doing with the drawing?
How can you honor both your old self and new self with purpose and pride?, (i.e. helpful self-talk, forgiveness, radical acceptance, continuing to seek answers/help)?
What advice would you give your old/current/future self?
*An additional way of using this activity is by assigning participants to draw on the left side of the face what they hide from others about who they are or how they feel on the inside. On the right of the face, have them draw what they want others to see.
Being aware of your needs and educating those around you what they are is not easy. Many have learned growing up that their feelings and needs are not important. When ignored for too long, feelings and needs become difficult to recognize and negative emotions and acting out behavior eventually develop.
Use Your Words
Self awareness of one’s own feelings and needs are critical for problem solving, communication, and healing. For example, when one is mindful they are feeling scared and their need is to be reassured, the person will be more effective in letting others know how to help them feel better. Having the language to say, “I am scared, I need your reassurance” also guarantees a higher likelihood of having one’s needs met by a trusted support than being silent and withdrawing.
In an effort to ensure my client’s needs are being met in therapy, and to keep the therapeutic session in a purposeful direction, I follow my initial question of how they have been feeling with the inquiry of what their needs are for the day’s session. I selfishly use the therapy needs menu as a guide for my interventions and will reference their need throughout the discussion ensuring we are both on track to addressing their need.
Group Therapy Needs
My favorite use of the therapy needs menu is in group therapy. At the beginning of every group, I check in with each client and ask them to briefly share what they are thinking, feeling, and what their group needs are.
Many will share one need and some share all the needs on the page. Their announcement provides the opportunity for the client to identify and educate everyone what their need is this day. It also facilitates perspective taking and group problem solving, as group members tend to work together prioritizing the subsequent discussions.
Posting the menu of individual and group therapy needs in my office space provides a helpful visual prompt for both of us. Overall, my goals are to have my clients disclose their feelings and their needs to address and to eventually generalize this practice with their trusted supports.
As in life, not all sessions end with one’s needs being met. It will be helpful to end each conversation with the inquiry if they had been met. Should my clients remain to have an unmet need, I encourage ongoing self-care to address their need throughout the week, as well as the plan to revisit their need at the next session.
Regardless of our age, positive friendships bring joy, a sense of connection, entertainment, stress relief, improved mood, and self-confidence. The benefits of healthy friendships are so significant to our well-being that daily social interactions are recommended, and a common homework assignment that I prescribe.
We are hardwired for human connection and as a result, we do not thrive emotionally when friendship conflicts arise. In fact, we can be thrown greatly off course and become toxic and self-destructive when we sense a threat to our friendships. This is when we will commonly see “drama” like behaviors, such as gossiping and excluding. Ironically, these are maladaptive attempts to rescue the friendship.
When a friendship is salvageable, for example, the friendship is meeting one’s emotional needs the majority of the time, assertiveness training, conflict resolution, boundary education, and the processing of feelings are my go-to interventions for friendship healing. When the discussion leads more toward’s one’s frequent heartbreak, consistent emotional discomfort, or one’s boundaries being violated, this is when we begin discussing the time for a friendship breakup versus a friendship make up.
The emotional recovery of a friendship break up can take months to heal from, and if complications from older friendship wounds are present the grief process can take even longer. Examples of friendship grief reactions range from avoiding all contact, vengeful fantasies and behaviors, and collecting new and old friends to side in one’s favor.
Friendship Grief First Aide
Proven strategies to grieve a friendship that alternatively promotes an easier recovery, prideful behaviors, and improve self-confidence include the following:
Write a handwritten goodbye letter. Do not pay attention to grammar, spelling, or formatting. Freely write what comes to your mind, including how you feel, why you feel the way you do, what you don’t understand, what you want, and how you plan to move forward. Put the unstamped letter in the mail, the trash, or a shredder when you are finished. Repeat this ritual when emotions linger.
Set boundaries. In an effort of making sense of the pain, we can obsess about the loss and villanize our ex-friend when talking about them. Stay away from writing on social media and make a choice of the few people you will share your feelings and experiences with. Be mindful of how others may react to your negative comments and how others may perceive you. When venting, focus primarily on your feelings and your responsibility.
Share only the facts. Adjectives and judgments about others tend to heighten our emotions. To protect your feelings from escalating, when talking about your ex-friend, stick with the truth and limit language that is exaggerated or abusive.
Have a backup plan. Be prepared that you may be blindsided by others approaching you with questions about what happened. You may also run into your ex-friend unexpectedly. Have a plan in place for what you want others to know and how you want to pridefully respond if you see your ex-friend in public.
Create a friendship shopping list. Make a list of what you want in a friend, how you want to be treated, and what the consequences will be if your needs are not met.
Write a friendship inventory. Make a list of what makes you a good friend, how you can improve, and commitments you will make to be a better friend as a result of this experience. Read the list often to remind yourself of the strengths you provide your other friendships.
Take care of yourself. Regularly involve yourself in activities that make you happy, such as drawing, being outside, playing an instrument, exercise, or listening to music. When feeling down, commit to having fun and surrounding yourself with those that care about you.
Get social. Invest your time in your old friendships by reaching out and inviting them to go do something enjoyable. Also, include yourself in activities that expose yourself to making new friendships. Be courageous and introduce yourself and find common interests. Remember, everyone wears an invisible signs that says, “include me.”
Journal. Writing down your feelings is one of the most therapeutic exercises you can engage in. When your mind wanders on old memories or you get preoccupied with fantasies of reunifying with your friend, journal your feelings and write down a list of reasons you broke up and compare it to your friendship shopping list.
Be your own therapist. Friendships don’t always last. Remind yourself that this is normal and it is common to outgrow friendships. Validate your feelings, don’t judge yourself, and engage in activities that make you feel good about yourself, such as volunteer work or kindness acts.
It is now officially the holiday season, which means it is time to begin decorating, purchasing greeting cards and gifts, and scheduling visits with family and friends. Not to mention, it is the time of year to be jolly and grateful for our blessings. This is of course according to our cultural traditions, family expectations, and the media’s messages.
There is a lot of pressure on everyone to actively participate in celebrations and embrace the moments with joy. But, when you have lost a loved one to a death, having holiday spirit is the last thing on your mind.
Whether the death was 5 years ago or 5 days ago, memories of previous holidays with your loved one are regularly triggered and old grief commonly resurfaces. So, it’s not surprising others may be depressed during the holidays when you combine grief and the social pressures to be joyful.
Fantasies of loved ones returning, resentment of others having perceived fun, and anger that loved ones are not here are common thoughts that also complicate emotional reactions and drive isolation and avoidance.
Although everyone’s healing has a different pace, acknowledging that it is normal to feel grief during the holidays helps bring comfort and decreases feelings of shame.
A helpful way of managing intense emotions during the holiday season is being proactive and coming up with a self-care plan. This helps armor those grieving with strategies to cope with planned and unplanned holiday experiences. I use the Holiday Grief Self-Care Plan template as a guide, but you can also use a blank piece of paper with the following directions:
Start by making a list of holiday expectations, anticipated negative possibilities, unwanted individual encounters, and uncomfortable feelings.
Next, create a list of action plans that match these scenarios to review and practice before the holiday. For example, if one anticipates seeing their Grandfather on Thanksgiving will bring a flood of grief from reminders of losing their Grandmother, create a list of self-care strategies that will be implemented when in this moment.
Include families to participate in the writing and reading of the list. Invite the discussion of creating new holiday traditions, experiences to mourn their loved one, and ways the family members may be of support during more vulnerable times.
Use the list for ongoing discussion, practice of role plays, visualization, and mental rehearsing.
Thanksgiving is a child therapist’s ideal holiday. The month offers the opportunity to introduce to our children the practice of gratitude. As research has suggested, this important act aides in improved wellness and life satisfaction for all ages.
The Giving Tree
It is important to me to teach my children this important life skill. So, once the Halloween decorations are put away, I introduce the concept of gratitude by reading the story, “The Giving Tree.”
I invite the conversation of The Tree giving his friendship gestures to the boy in exchange for the tree’s happiness.
I explain to the children their ability to also improve their own happiness by engaging in kindness acts and being mindful of what in their life makes them grateful.
My Giving Tree Craft
I have the children then create their own personal giving tree with examples of what they are grateful for, how they show gratitude to others, and/or kindness acts they commit to practicing throughout the month. Once their giving tree is complete, the children share their personal examples. They are encouraged to gift their tree to someone special or display in a location where reminders of self-care will be helpful.
1 paper bag
Green construction paper
Sharpie or markers
Optional: Paper, Tape, Glue, Ruler
Start by cutting 3 inches off the top of a paper bag and then cut 3 inches of strips from the top of the bag. Flatten the bag before you write, “My Giving Tree” on the front of the bag.
Next, take out your green construction paper and cut 3-inch strips on the right side. Use a marker to write what you are grateful for or how you show kindness on each strip. Use as many separate pages of green paper as you need.
Then, place the construction paper inside the bag with the left side facing down. Gently squeeze the neck of the tree and tug the green strips in between the brown paper bag strips.
One could argue that child therapy is similar to veterinary medicine in that the underlying problem is often a guessing game. Similar to pets, young and immature children do not have the verbal skills to share their internal experiences. It is not likely for a child to enter your counseling office or classroom with the insight of why they are there, what they are feeling, and what they need. Their self-awareness is limited, and their ability to articulate their needs is often obsolete.
Just as your dog may chew up the couch when you leave for work, or your cat may urinate outside of the litter box when a new kitten is brought home, children will show their distress through their behaviors.
It is easy to get distracted by attitudes, manipulation, lying, defiance, and stealing, as our immediate reaction is to discipline and teach respect. However, if we only focus on repairing the negative behaviors, we neglect to see that these behaviors may be signs something is seriously wrong.
When I receive calls from parents pleading for help because their child has “anger issues,” and is exhibiting “out of control behavior,” my automatic response is to assess for anxiety, social changes, trauma, and depression. It would only be a band-aid strategy if I just focused on teaching anger management skills without exploring what is causing the anger. Once the trigger to the behavior is identified, the real treatment can begin.
Behavioral Signs of Child Distress
Below are a few not-so-obvious, but still significant behavioral signs of distress. Use the bullet-pointed clues as excuses to assess for underlying issues, such as anxiety, depression, and social problems to further explore and remedy.
Anxiety Behavior Signs:
Trouble staying asleep
Depression Behavior Signs:
Drop in academic performance
Talking less than normal
Neglecting important or typically preferred activities
Teach assertiveness skills to defend children against a real bully. Proactively create a safety plan that includes ways to respond to a bully, trusted supports to seek out, and safe locations to move towards. Once the bully safety plan is completed, consistently rehearse it until it becomes second nature.
Power Up: Avoid being alone. Ask for help and physically surround yourself with friends or same-aged peers.
Look Brave: Be mindful of your body language. Holding your body in an upright position shows confidence. Keep your head high, your eyes forward, shoulders back, chest pumped out, and hands on hips.
Assert Yourself: When approached by a bully, say something that shows you are not bothered by them. Bullies like to provoke our reactions. Using a calm, firm
tone of voice and a clever comeback shows the bully you do not care and will not tolerate being bullied.
Near an Adult: Ask for help. When appropriate, physically surround yourself with an adult before, during, and after a bully encounter. They will help problem solve.
Step Away: When approached by a bully, do not feel the need to entertain their attention. Show you don’t care and walk away to a safe area that is surrounded by peers and adults. Classrooms and offices are best. Avoid the bathrooms or other areas that are closed in or empty.