Mental Health, Therapy General

A regular meeting with one of my students this morning got us looking at two different types of therapist approaches to meeting and getting to work with clients. Both are valid methods of navigating intake and the early stages of information collection, and good to have in the therapist’s toolbox. It might also help clients understand why they click better with some therapists than others, and help them define what they’re looking for if they’re currently shopping for a therapist.

Most of the time people come into therapy because they are dealing with a specific problem, or experiencing a specific set of symptoms even if they don’t yet understand why. During an intake process, they’re meeting the therapist for the first time, which means two things are happening simultaneously:

  • Stranger meets stranger
  • Information changes hands

Establishing Rapport

Many people think of therapy in much the same way as they think of medical doctors: they have a problem, they go tell the professional, the professional gives them something to fix the problem, and hooray they’re cured! (Or at least feeling better.) This is historically the medical model for feeling better, and sometimes leads people to wonder why they can’t get a fix in the same ten minutes it takes a doctor to diagnose a set of patient-reported symptoms. Talk therapy doesn’t always work like that, but some models, like Short-term Solution-focused Therapy, do aim for a similar kind of immediate relief of at least the symptomatic distress.

Therapists are trained to understand what clients come to learn with experience: that perhaps the biggest factor in therapeutic “success” is the rapport established between the client and the therapist. That rapport is all about the relationship these individuals create through the process of sharing space, information, and (hopefully) empathy. Some folks don’t want to take the time to build a relationship, they just want the fastest resolution to their current discomforts so they can go on with their lives. Some people will only allow themselves to open up about experiences once they have established a degree of trust and safety with a therapist. This leads us to approach the work with our clients through either a Problem-centric focus or a Person-centric one.

Problem-centric Focus

This morning I was reflecting with my student on how they are developing their own clinical approaches, drawing on various learning resources through their training. They currently have an intake form they use to guide the first few client conversations that is very focused on gathering information about the problem: the symptoms, their perceived severity and persistence, the level of impairment the client experiences because of them. Only after digging into the details of the problem does the form expand into more general information about the client themselves.

This kind of approach puts the PROBLEM(s) front and centre and focuses the ensuing conversations on those pertinent details. This is a really useful approach if the therapist has only a limited number of sessions (or a one-off situation, as with a walk-in clinic), and needs to understand “where does it hurt the most?” or “where is the client seeking the most relief?” It’s also an effective approach with clients who are focused on fast resolutions and strategies rather than long-term self-development. Reflecting after this morning’s supervisory meeting it occurred to me that this is also probably a useful approach for student and novice therapists who need to determine as early as possible whether the client’s presenting issues are within the therapist’s limited clinical experience and scope of practice.

On the downside, it also presents a bit of a sandtrap to therapists operating from a “just fix it” mindset. The temptation is to label and categorize the problem without digging much into context or broader influencing features in order to go straight to symptom management… and in doing so, perhaps miss a lot of important information about influences on the client’s broader condition. In short: you’ve mitigated the symptoms but potentially done nothing to address or even acknowledge the actual problem.

Person-centric Focus

My own approach to those first client conversations is to get to know a little bit about the client themselves. I’ll ask if they have any previous therapy experience, or what they think therapy as an experience entails. I’ll ask them to tell me a little bit about themselves and tell them a bit about myself in return, though I generally weave any kind of detailed descriptions of how I work into the conversations about their challenges. Especially with people new to psychotherapy, I have less risk of getting lost in trying to describe clinical interventions to someone who has zero idea WTF I’m talking about, no context for what I’m bringing to the table. So I leave that until I can find ways of showing how I might apply what I know directly to their own issues, and let the contextualization do the heavy lifting for us both. I get a good sense this way of how the client talks and how they listen, what kind of language they respond to, and I have a chance to watch and mirror some of their body language (even in virtual meetings). If I can get a basic sense of them in the first few minutes, THEN I’ll ask what’s bringing them in to talk to “someone like me.”

I’m not a doctor; I’m not trying to bulldoze 25 clients a day through my office in ten-minute increments or less; I can take my time and get to know who’s sitting in front of me. (It also helps that I’m personally someone who loves drinking from the information firehose. I often describe my process in those first couple of sessions as gathering all the seemingly random bits of information the client chooses to share, and all the information they don’t even realize they’re sharing via word choices, speech patterns, and body language. I collect it all and sort it out as we go, pairing the client’s information with my observations and clinical experience to come up with working theories I can pitch to a client to see what resonates, and what makes them feel like I’m understanding what they’re sharing.

This type of approach puts the PERSON first and foremost and helps orient the therapist towards the person having difficult experiences before digging into the issues themselves. Focusing on the person is also useful when the client is in emotional distress, if the therapist can use mirrored body language and vocal tones to calm or counterbalance the way the client’s body or voice shifts as they get worked up. It’s not that we ignore the issues so much as we establish that rapport first, a person-to-person connection to put the client more at ease. It helps create some sense of safety (hopefully) for the client to talk about hard things, and to receive compassion and input from the therapist. It’s a style of approach that very much invites the Person into the room, not just the Problem.

The Person-focus approach has its own traps. It’s easy to misread clients who really just want solutions and strategies, if they’re genial enough to engage in the “getting to know you” patter, and in doing so, leave them feeling like you’re not serious, not taking them seriously, or taking to long to get to what they came for. Focus on rapport-building is often a slippery slope for therapists falling into their own biases and risking over-association or over-sympathizing with the client; this is a space in which we run a high risk of transference and countertransference occurring between client and therapist as we try to establish connection and empathy without always having good boundaries right up front.

Not every client is going into a first session with a clear idea of what they want or need from the conversation they’re about to have. Inexperienced clients generally can’t describe what they want from a therapist, other than, “Fix me so I feel better”–the same request they’d make to a mechanic to fix their car so it runs better, or to a doctor so they can feel physically better. Therapists have to develop almost a sixth sense for what live performers call “reading the room”: the ability to suss out a client’s level of (dis)comfort with talking about their issues and asking for guidance or help. Are they here for a quick strategy session, or are they here to unburden for the very first time a lifetime’s worth of relational chaos? (I haven’t yet figured out how to teach reading the room as a therapeutic skillset. It’s just a thing many of us do semi-intuitively.) But once we have that sense we can choose the most effective approach out of the toolbox, and off we go to the races.

Emotional Intelligence, Life Transitions, Relationships, Self-Development

“I Ate’nt Dead” – Granny Weatherwax (Terry Pratchett)

Hello! Not dead, not retired, and still generally not finding enough time in the week to write blog posts, though it’s not for lack of ideas and themes crossing my plate and prodding thoughts of, “Oooo, I should write up something about that!” (I should write about the rising tide of transphobia, homophobia, and hate in general but that’s too vast and raw a topic to corral into 1500 words or less while also not working myself into a fit of rage at the state of the world these days, so…)

It’s a typical part of my process that blog motivation arises from seeing a particular theme appearing repeatedly in a relatively short period of time in conversations with clients and others. Unsurprisingly, people are constantly changing, and people who engage in change as active, conscious, deliberate choice often follow similar processes–and make similar mistakes. Some conversations therefore come up time and time again, and it’s not that blogging will make them come up any less often, but maybe the ideas and discussions can reach a few extra people before they need a therapist, or at least give them some plausibly-useful structure to apply TO their therapy.

One of the many valuable tools I brought out of years of working in corporate IT that has a crucial place in my therapeutic Change Management Toolbox is the concept of SMART Goals. A very long time ago, I wrote about creating roadmaps to move towards getting your needs met, and I have written about identifying when a plan is or is not a Plan; the missing piece of the puzzle when putting roadmaps into Plans for Change, however, is identifying the success criteria or metrics that define the actual goals for change.

This is a variation on a recurring conversation I have with a lot of clients:

Client: “I want to make this change!”
Therapist: “Wonderful! What is the goal you’re trying to reach?”
Client: “Making this change!”
Therapist: “OK, great! How will you know when you succeed?”
Client: “I… uh, will have made this change!”
(see also: Client: “I’ll know it when I feel better!”
Therapist: But won’t you also feel better if this storm just passes you by like it always does, and things go back to normal like they always do?”
Client: “I… guess?”
Therapist: “Even though nothing will have actually changed…?”
Client: “…”
Therapist: “So ‘feeling better’ is, at least by itself, maybe not a solid metric for success?”
Client: “Damn.”)

Change happens in a lot of different ways and for a lot of different reasons. Most of the time it happens because something isn’t working, and the resulting situation is anywhere from frustrating to painful to dangerous. All organic lifeforms constantly move towards getting their needs met, be it light, air, water, food, or comfort; we just don’t always know when things are changing until we’ve gotten far enough along to notice things are different. At that point we might find ourselves suddenly in a better place–and just as suddenly, we might find ourselves in a worse place.

Managing change effectively, from a project management perspective, requires knowing several things in advance:
A. What do we have to work with (resourcing)?
B. What are we trying to get to (outcomes)?
C. What do we lack/need to move us from A to B (gap analysis)?
(Some Project Managers will add a separate D here: What’s it going to cost? I generally factor cost into the resourcing details as part of establishing a baseline process.)

Once we have answers to these questions, we can generally start assembling the roadmap, and along the way, we want to look at both major goals (endpoints) and minor goals (milestones) that we set for ourselves to help see where we’re making progress and where we’re struggling or need some extra help. Both major and minor goals need to be clearly defined, however, and this is where Change Management as a personal or relational development process often falls apart for people because this kind of goal setting outside a corporate structure seems pretty alien in the hand-wavy, airy-flairy feelies of our relationships. But if we don’t have clearly defined goals and explicit metrics for success, how will we know when we’ve achieved them? How will we even measure progress towards them? How will we communicate them to others around us we may need to be involved in the change process? How will we hold ourselves (or those others who consent to participate) accountable?

We set SMART Goals.

SMART stands for:
Specific: has a clear target in a precise area for improvement (also sometimes Sustainable: a pervasive improvement)
Measurable: has clear indicators (metrics) for improvement
Assignable: has a clear owner consenting to take responsibility for the goal (also sometimes Achievable, but I find that gets covered by the next letter)
Realistic: improvement target that can be reached with the current resources or with resources discovered via the gap analysis
Time-boxed: has a specific timeframe for achieving the milestone or end goal

Admittedly, none of this is likely to spark the sense of feel-good flexibility of some primo handwavy, airy promises for change that lack concrete details. We all love the romanticism of open-ended promises that will magically be fulfilled exactly to our unspoken expectations, don’t we? Isn’t that the entire myth of how “Love Conquers All” in a nutshell??

It aten’t romantic, but I can guarantee it IS effective. The term was apparently first published in 1981, meaning it was in use in some circles well before being codified for public consumption, and it has been a standard approach of project management for more than four decades for many reasons:

  • It’s much easier to communicate expectations
  • Everyone tends to feel much more comfortable when they know not just WHAT to expect, but WHEN
  • It’s much easier to invite participation where we need it (and to communicate expectations explicitly for other participants to provide informed buy-in or consent)
  • It’s much easier to hold ourselves and other consenting participants accountable
  • It’s much easier to measure progress toward SMART goals and milestones, which also means…
  • It’s much easier to adjust course* when we stray from the roadmap and stop meeting milestones and end goals

Change isn’t always easy, but we also don’t need to make it any harder than it has to be. How we set specific goals that are SMART takes some clear idea of what we’re trying to change or move towards and why, as well as some understanding of what we already have as resources and support for those changes, and what we’re going to need to get there from here. That’s the part where some external perspective and wisdom–an experienced friend or family member, a mentor, a therapist–comes in handy, especially when it comes to keeping goals and milestones realistic, and helping with navigating the expectation-setting communications around them.

(*–Someday I swear I need to write something about adapting Agile methodologies to psychotherapy, but that day is definitely NOT TODAY SATAN.)

Communication, Relationships

“No plan survives first contact with the enemy.”
— every military strategist in the history of conflict, ever.

In today’s statement of the blisteringly obvious: relational communications can fall apart in a mind-boggling number of ways. “Mere words” are asked to convey an awful lot of things, from disparate meanings to unspoken intentions to the severe gravitas of emotional expectation.

When relational partners agree that change of some kind is necessary to improve the workings of their relationship, they have to use words to navigate both the agreement that change is necessary (a potentially massive undertaking in and of itself) and to create an understanding of WHAT change will look like. Early on in my practice, I noticed something perplexing: clients would talk amongst themselves and with me about ideas for how things could change, and somewhere down the road a deeply-emotional conflict would often develop from those early conversations. I also noticed this same pattern happening on less intense levels, where a conflict, or at least confusion, would arise from an errant set of expectations shaped out of a previous discussion or negotiation.

“I thought we had a plan.”
“I thought I knew what the plan was.”
“My partner didn’t stick to the plan.”
“I didn’t know there WAS a plan.”

Plan, plan, plan… something about the word was getting lost in translation, somewhere.
In more recent years, I’ve been working with emotional flags as triggers for examining expectations, the often unvoiced aspects of these relational navigations and negotiations. If someone is feeling disappointed, frustrated, annoyed, etc., my first question is always, “What were you EXPECTING?,” then looking at how (or even if) those expectations were communicated upfront. Often the precipitating conversation(s) will have discussed ideas, but the translation between what is an idea and what is The Plantm is generally shown to be where the wheels come off the wagon.

What then is the problem?

When we discuss ideas, especially in a context that has some emotional weight already present, it’s a surprisingly easy thing to attach some of that emotional weight to an idea that we then champion. We put effort into presenting and defending that idea, and if it seems like there’s a sense of support or buy in from our partner in that discussion, then we often presume we have buy-in, and therefore that we have established The Plantm, a locked-in, presumably-mutually-agreed-to set of intentions for forthcoming actions. So imagine now what happens when one person walks away assuming there is The Plantm, and getting emotionally invested in that Plan, and emotionally attached to a specific (probably the desired) outcome of The Plantm… only to find out later that the other person walked away from the same conversation believing that, while they had a great discussion about ideas, that they had NOT established any explicit commitments or even agreements to what next steps might entail.

In short, a plan is NOT A Plantm without that explicit agreement to the intended steps and a clear delineation of who’s taking responsibility for what and a mutual agreement about timelines and success criteria. I know that sounds like an awful lot of work just to make a plan for who’s going to take out the trash every week, or who’s going to drop out of the workforce to take care of a special needs child, or who’s going to have to go to therapy because the relationship needs work. The truth of the matter as I have witnessed it repeatedly over the years (and as I have been guilty of doing in my own relationships), is that a plan is NOT A Plantm just because one partner has started to emotionally invest in a specific outcome. Even a discussion that ends on a generally-sympatico attitude about the topic does not constitute a Plan unless and until there is EXPLICIT buy-in from ALL involved parties as to the details of execution, and that’s where things often fall apart.

“Achieving consensus” does NOT mean “achieving consent”.
“We have an idea” does NOT mean “we have A Plantm.”
“We are in general agreement that this thing needs to happen” does NOT equate with, “We have a detailed set of intentions with clear ownership of who will do what, when, and to what success criteria”. Yet that’s where a lot of relational discussions get hung up. “We are in agreement that this thing needs to happen” will often get taken away by one party to mean, “And now this thing will happen when and how I expect it to.” Except it oftentimes does not happen that way… hence the sense of disappointment, annoyance, irritation, etc. If the relationship has already been plagued by those kinds of feelings, this can read like further proof of the relationship’s unviable status.

When I’m working with relational partners who have been tripping on these kinds of unspoken expectations, we work backwards from the point of recognizing the disappointment. “What were you EXPECTING?” is my first question to the disappointed partner. We have to look at the difference between a general consensus on ideas, a detailed design of steps for actually implementing those ideas, and the actual consent to participate in that implementation process. (In corporate-speak, it’s the exact same process as having a customer come forward with a feature idea, the business teams collaboratively designing the internal development process and budget and scheduling to implement that feature request, then the business and the customer explicitly signing off on a contract for that development process. We all need ideas as a starting point, but ideas alone are a terrible finishing point. We need a structural understanding of what the intentions are and what the process will be, in order to provide informed consent to participate in that process. And we can’t trust that the process will even get started without that explicit, informed consent.

In short, a plan is NOT A Plantm unless and until we have active engagement and consent on all of these items. Anything short of that is a lot of Wishful Thinkingtm with a forecast of heavy Disappointment & Dissatisfactiontm.

So if in your various relationships you find you experience a lot of disappointments around people not executing to plan as expected:

  1. check in on your own expectations; what were you expecting?
  2. had you (or even, how had you) communicated those expectations?
  3. did you and the partner discuss ideas, or did you create a detailed set of executable intentions?
  4. did you both leave the discussion with explicit consent to deliver on this set of intentions, according to mutually established criteria?

If you can answer Yes to all of the above, then you absolutely had A Plantm, and you can both sit down to look at where things went wrong within the process. If you answer No to any or all of the above, then you did NOT have A Plantm, and can start to look at the steps where things didn’t follow the plan-development process to implement changes in what IS being communicated, or how.

(And yes, there is a whole different conversation about managing expectations when one partner’s ability to either communicate OR to deliver on explicitly-negotiated expectations is vastly different from the other partner’s, and how to set realistic expectations accordingly. That’s a topic for another day.)

Mental Health

[Part 1 of this post is here.]

I made the mistake of Googling “How to recover from burnout.”

Seriously, don’t do it. No, really, I —
Well, okay. Don’t say I didn’t warn you.

Now that you’ve done what I did and maybe scrolled through some of the amazing tripe that’s out there as advice, lemme tell you: ignore 98% of it.

One of the reasons I no longer practice something called “Solution-focused Brief Therapy” (SFBT) in spite of it being a highly-touted, evidence-based therapeutic intervention, is because it is at best a bandage solution, meant to deal quickly and (IMO) superficially with potentially significant client issues… all for the purpose of returning them to the workforce as Productive Members of Society as fast as possible, thus minimizing impact to the EMPLOYERS and their INSURERS. I’m not going to call it a scam outright, because it does provide some real, albeit temporary, relief to those who seek it. But it’s not an approach I respect for the simple reason that it’s predominantly used to tape up psychic injuries and send internally-wounded folks often right back into the very teeth of the stressors that are grinding them down in the first place.

And you know what that leads to? Burnout. Bandaids ain’t gonna hold jack-shit when we’re talking about the psychological equivalent of disembowelment. (Why yes, I *DO* have Very Strong Opinions on this topic, why do you ask??)

Workplace burnout is fast becoming the primary reason why employees take stress leave, even though what is likely covered by their insurance (assuming they have the luxury of coverage in the first place) is far below what’s actually required for recovery. From an American Institute of Stress 2022 study:

Workplace stress is one of the largest hurdles you can experience on the job. Stress at work comes in all shapes and sizes, across all types of industries and careers. After extensive research, our data analysis team concluded:

  • 83% of US workers suffer from work-related stress, with 25% saying their job is the number one stressor in their lives.
  • About one million Americans miss work each day because of stress.
  • 76% of US workers report that workplace stress affects their personal relationships.
  • Depression-induced absenteeism costs US businesses $51 billion a year, as well as an additional $26 billion in treatment costs.
  • Middle-aged participants had a 27% increase in the belief that their financial status would be affected by stress in the 2010s compared to the 1990s.
  • More than 50% of workers are not engaged at work as a result of stress, leading to a loss of productivity.
  • Companies spend around 75% of a worker’s annual salary to cover lost productivity or to replace workers.
  • The main causes of workplace stress are workload (39% of workers), interpersonal issues (31%), juggling work and personal life (19%), and job security (6%).

That’s a pretty bleak picture, and I suspect the Canadian numbers correlate relatively closely. Under Canadian employment law, “if you are a full-time employee with a work week of 37.5 hours, you earn sick leave at the rate of 9.375 hours each month for which you receive 75 hours pay. Sick leave is prorated if you are a part-time employee.” Under the Ontario Employment Standards Act, “Most employees have the right to take up to three days of unpaid job-protected leave each calendar year due to a personal illness, injury or medical emergency. This is known as sick leave.” Good to see in print that even our federal and provincial governance can’t agree on how to effectively manage sick leave, which is what employees are requesting when they are asking for stress leave. THREE DAYS??? Oy.

Unsurprisingly, many people start with the same assumptions about a stress leave that they might take into a vacation break: it’s time away from work, I’ll feel so invigorated, I’ll get so many non-work projects accomplished, I’ll make such great use of my now-free time! I’ll find a new job! But even a couple of weeks into a leave, they find they often Just Can’t Even, and that’s when they often wind up in my office, or offices like mine. They’re wondering where their motivation went, and why can’t they seem to feel any better even with the time they’ve already taken off.

Burnout is a state that affects us on every level: physically, emotionally, mentally, and relationally. That means recovering from burnout needs targeted recovery processes (note the multiple there) aimed at each and every one of those aspects. And because burnout is often the product of long exposure to the stressORS that have ground us down to mush, it operates very much like a long-term illness. We’ve been “sick” for a very long time, even if we didn’t realize it until that sickness brought our functionality to a crashing, crushing halt. Ergo, we’re not going to “fix” it with a weekend of sleep, a two-week vacation, or even a two-month stress leave. We just can’t. THAT’S NOT HOW BURNOUT WORKS. (And yet, that’s what employers and insurers want us to believe because it benefits them, or they believe it does, to have their employees back in the trenches as fast as possible, recovered or not. They want the bandaids, because then they don’t have to fix their own destructive, systemic issues that create the stressors in the first place.)

So then, how DOES one recover from burnout, if at all??

The first step is recognizing the difference between the stressors, and the stress. Stress is what you experience as a result of a variety of factors (the stressors) having an ugly, corrosive impact on your quality of life.

“Stressors are what activate the stress response in your body. They can be anything you see, hear, smell, touch, taste, or imagine could do you harm. There are external stressors: work, money, family, time, cultural norms and expectations, experiences of discrimination, and so on. And there are less tangible, internal stressors: self-criticism, body image, identity, memories, and The Future. In different ways and to different degrees, all of these things may be interpreted by your body as potential threats.
Stress is the neurological and physiological shift that happens in your body when you encounter one of these threats. It’s an evolutionarily adaptive response that helps us cope with things […] [I]t activates a generic “stress response,” a cascade of neurological and hormonal activity that initiates physiological changes to help you survive[.] Your entire body and mind change in response to the perceived threat.” (Nagoski & Nagoski, “Burnout: The Secret to Unlocking the Stress Cycle,” Ballantine Books, 2019)

Burnout, therefore, is the result of living within the cascading effects of that threat-response pattern over the long term. And as a long-term issue, the recovery is also going to be a long-term process. How long? Well, that depends on too many factors to have a standard formula, but from my perspective, what I’m seeing is that the deeper the burnout, the longer the recovery will take.

I have come to liken what’s actually required for recovery as being akin to what happens when a serious athlete, like a marathon runner, breaks a leg.

At the point of the break, the marathoner does NOT think, “Hey! Now I can go and run all those OTHER races I’ve been meaning to get to for months/years!” No, the marathoner is going to be KEENLY aware of the damage and the pain… something burnout victims are notoriously bad at acknowledging (something, something, frogs in pots of slowly-heating water, something…). In a best-case scenario, the marathoner can get off the course and into help and safety immediately. Sometimes the break happens and the marathoner is going to have to continue on for a while before escape to treatment can happen, which means the pain will be inescapable once realized, and the damage might get worse before it has a chance to get better. Obviously, we want systems that support the former, but all too often we’re trapped in systems that enforce the latter.

Once the marathoner is off the course, then we’re into a healing process that looks a lot like this, and this model is what I’m now using with my burnout clients:

  1. First things first, the break needs a chance to actually heal: knitting bone and soft tissue back together, sometimes with professional intervention, but mostly just letting the brain and body do what they need to do to put broken pieces back together. THERE IS ABSOLUTELY ZERO LOAD-BEARING ACTIVITY AT THIS POINT. There can’t be; the broken bones won’t tolerate it. There’s a lot of rest. This stage usually takes several weeks for both bone breaks and for burnout.
  2. Then, once the bone has knit and the soft-tissue damage or inflammation has largely receded, THEN AND ONLY THEN will a doctor give the okay to start physiotherapy and rehabilitation. This is the stage in which the marathoner is trying to teach new tissue how to do basic things like move and flex, and integrate with the existing tissue. Agin, not a lot of load-bearing activity here. In burnout terms, this is the stage in which people start to do basic functions in their own lives, like tend to personal care or basic relational interactions. They might start THINKING about whether or not to update their resume, but they’re generally in no great energetic state to put their best selves forward in interviews. This stage can take literally MONTHS for both the marathoner and the burnout client.
  3. After that, and only once the medical and phsyio supports sign off, can the marathoner even THINK about starting to move like normal. They’re certainly not in a state to go back to running, but they might be able to take a walk to the end of the block and back. They’ll eventually work up to making it a sloppy shuffling runwalk, and be constantly monitoring the new tissue for pain or other signs of damage. THIS is also a stage that can take months to progress through, and this is the stage where both athletes and burnouts are likely to push too hard too fast, and experience inevitable setbacks when the recovery process proves unequal to the desire to just get on with things.
  4. When there’s a generally-consistent ABSENCE OF SYMPTOMS related the break/burnout for period of time approved by the support system (NOT the recovering individual), THEN AND ONLY THEN is the individual at the state where they can BEGIN to start retraining their body to work back up to a level of pre-break functional capacity. This is NOT the stage at which the marathoner goes and runs a 26-mile race. This is when they start actually running to see how far they can get, or they start for endurance but take it at a quarter-speed. This is when the burnout client MIGHT return to work one or two days a week on light duty.
  5. From there we collectively eyeball a “return to full-function” target but maintain a consistent and careful watch on how the recovering individual does with resumption of the load-bearing factors.

Throughout this, the burnout client, like the marathoner, is hopefully working on adaptive skills to better balance the stressors that created the state of collapse in the first place. This may involve being honest with themselves about what they can and can’t handle; this may involve needing to do different work on managing stressful relationships. This may require changing jobs, or dealing differently with health issues. Some of these factors CANNOT be addressed by quick-fix bandaid solutions, and the entire recovery process is NOT a short-term affair. Burnout can literally take YEARS to recover fully; that part is defined mostly by the client’s ability to adopt and sustain more effective capacity-management strategies, not just “coping” strategies.

Clients don’t like hearing that they could be recovering from burnout for a long time; most people don’t like the notion of being compromised, because it will mean having to change how they live, how they behave, and how they view their own capability, differently for the duration. Employers don’t want to hear that they may be paying full or partial salaries for absent employees for months on end, and insurers put out so many hoops and challenges to those applying for stress leave that it makes it hard to onside medical and mental health professionals who are required to provide corroborating evidence of the client’s mental state for the duration.

I get it. It’s hard. So is being laid up with a broken leg when you’d rather be out running the Boston Marathon or through-hiking the Appalachian Trail. But the point at which you’re willing to acknowledge that something is broken is NOT the point to simply switch gears/stressors and keep applying load to something that has been broken down by bearing too MUCH load for too long.

Heal first. Then start to retrain or add adaptive skills. THEN start to work back up to load-bearing functionality. THEN re-assess that capacity, and make whatever changes will be necessary to maintain yourself at non-breaking levels.

It’s a slow process, but so far, it’s the only one I have seen work, and I’ve been looking at the issues of burnout for a really, really long time.

Mental Health, Uncategorized

In 2019 (when I started the original draft of this post), the World Health Organization released an updated classification for burnout as an “occupational phenomenon”:

28 MAY 2019 – Burn-out is included in the 11th Revision of the International Classification of Diseases (ICD-11) as an occupational phenomenon. It is not classified as a medical condition.

It is described in the chapter: ‘Factors influencing health status or contact with health services’ — which includes reasons for which people contact health services but that are not classed as illnesses or health conditions.

Burn-out is defined in ICD-11 as follows:

“Burn-out is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions:

  • feelings of energy depletion or exhaustion;
  • increased mental distance from one?s job, or feelings of negativism or cynicism related to one’s job; and
  • reduced professional efficacy.

Burn-out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.”

Burn-out was also included in ICD-10, in the same category as in ICD-11, but the definition is now more detailed.

The World Health Organization is about to embark on the development of evidence-based guidelines on mental well-being in the workplace.

This blog has looked at the issues of burnout many times before (here, here, here). On a personal as well as a professional level–across TWO career fields, no less–I am intimately familiar with what WHO somewhat blithely labels as “chronic workplace stress that has not been successfully managed”.

On one hand, I applaud WHO for putting their eyes on this issue as their attention can have repercussions on a global level. On the other hand, when North American culture seems hell-bent on stripping everyone but the richest of their rights, it means the workload of making things function as the entitled expect, continues to be the only kind of trickle-down effect to land on the common worker. And at the end of the day, people who fear for their jobs are increasingly UNLIKELY to raise concerns and issues about stressors in the workplace that affect their engagement and efficiency, as well as their overall mental health and safety.

This isn’t an issue I know how to solve. Especially since I left IT, this is a discussion I have had with a very great many of my clients who work in IT specifically. This runs the gamut from trench-level workers in support call centres to the content developers (programmers/testers/designers/writers) to system architects, team leads, managers and corporate braintrust-level employees, to HR agents and executives, to C-Suite bosses. Burnout is pervasive in the high-tech industry at levels I have never seen from any other field, with the possible exception of teachers. Stress-induced sick leaves are rampant in IT, judging by my own clientele in two practices, and what I know of the types of clients coming to see many of my colleagues.

Burnout, as “chronic workplace stress that has not been successfully managed” means that several issues are coming to a head in the workplace:

  • unrealistic performance expectations (individual or across the corporate board)
  • demands and pressures that exceed regular working hours and bleed across employees’ private lives
  • artificial pressure to advance and/or transfer around the company for a breadth of experience or “to avoid stagnation” (Google in particular is notoriously heinous for this practice) regardless of the individual’s preference or capacity
  • lacking or insufficient support for employee mental health and balance with life outside of work
  • HR solutions and EAPS that are constrained to get employees back to work as quickly as possible, which always ends up working in favour of the corporations, not the employees
  • corporate practices that reward employees for making sacrifices that then normalize the culture of sacrifice

Organizations like WHO can legitimize the workplace effects of unmanaged stress, but this does nothing in truth to change the sales and management styles of businesses intent of maximizing a profit line no matter how badly they chew through human resources to do so. Looking at resources online dedicated to offering suggestions on retaining talent, I see some common themes:

1. Start with recruiting “the right people” who will “stay the course” (read: “people who won’t complain about getting hired for a 40hr work week who are then regularly asked to work 80+hr weeks).

2. Pay them well, offer bonuses and a good benefits package (read: if you give them enough money, they’ll theoretically never notice they’re missing their children’s childhoods, or their own romantic partnerships, or even sleep).

3. Offer them opportunities for advancement (read: because nothing makes people work harder than giving them goals that they can burn themselves out trying to achieve for the reward of yet more work and stress and burnout…).

4. Flexible work schedules, and a great corporate culture (read: give them all the comforts of home so they don’t miss actually going home quite so much). — edit to add: we did see an enormous shift downward in stress levels for much of the workforce who adapted to working from home during the pandemic, many of whom are not reacting well to corporate pressures to return to the office even part-time as of mid-to-late-2022.

5. Offer praise and affirmation (read: pleasant words on the way to self-sacrifice as a reward for setting oneself on fire make EVERYTHING SO MUCH BETTER, YO).

Okay, so I admit the bias here is exceptionally cynical, but I come by it honestly. These were cultures in which *I* came of age, and these are corporate practices I now watch consume my friends and clients and loved ones on a daily basis. But can anyone else spot what’s missing from these kinds of lists? When we talk about retaining good employees, can you see the glaring hole where the best answers of all should be?

Where in the conversation regarding burnout and retention are the discussions about governance responsibilities? Where is “more effective project/product management” that avoids the common practice of overselling features that cannot effectively be designed, developed, tested, documented, packaged and deployed in a realistic timeframe? Where is the discussion about mitigating the profit craving so that we reduce the factors that produce burnout in the first place, and avoid paying stress leave in favour of making it easier for employees to stay happily at their jobs? Where is the improvement in management that better controls customer-driven scope-creep under project deadlines?

In FantasyLand, for the most part. That’s where. And more and more people are “coming down with” symptoms of stress, fatigue, anhedonia; comorbid diagnoses of depression and anxiety increase exponentially in my clientele every year, even before the pandemic sent those numbers spiralling out into chaos. People take insufficient downtime through the work weeks because they feel they can’t repent of their busy-ness, and when they do take time off as vacation or stress leave, they rarely do what’s needed to recover (more on that in Part 2). Part of recovering from burnout across the board is going to require the corporate culture that engenders the stress to begin with, to take a long, hard look at its own culpability, and step up to change expectations and management styles. That isn’t going to happen in my lifetime, I suspect; stress is built into the very nature of a build-and-deploy, feast-or-famine cycle of software development.

So if we cannot remove or significantly redesign the stressORS, how then do we begin to reframe our understanding of healing from the stress itself? For that, we go to Part 2 of this discussion. Please stand by! 🙂

Uncategorized

I am the very model of a modern psychotherapist,
I’ve information needed for subverting mental terrorists;
|I interrupt and help reframe dysregulated mentalists
From Cognitive Behaviours to programming neural linguistics.

I’m very good with differentiated personalities,
And integrating all your Parts with their irregularities;
I quote in Family Origins talk all Bowen’s sensibilities,
With many thoughts about defensive boundary capabilities!

I weed out histrionics from the conflict-laden narcissists,
And encourage voices raised by sublimated angry feminists.
Anxiety and depression both remain my daily nemeses;
But I am here for all so bring your sorrows to my office, please!

(Just not until after the New Year, I’m on vacation Dec 17-Jan 5.)

Uncategorized

My life looks both very different, and not really all that different, depending on whether you’re on the outside looking in or vice versa. Year Two of the Pandemic, Day 71 sees me half-vaccinated and waiting for a second Pfizer dose in early July; still working with heavy client traffic in both practices, still doing multi-day intensive training courses whenever I can afford them, still pursuing new professional certifications to help support my clients, still working with supervisees and trying to keep them, clients, colleagues, and myself, as sane as possible while COVID-19 ravages on and on. South of the border the CDC has removed the mask mandate for fully-vaccinated persons while Ontario extends its third lockdown and border closures into June. A new Indian variant of the coronavirus is making its way into North America and challenging what we were told would be okay with delaying secondary vax doses.

I work, I sleep, I pander to the cats. These parts of my life look the same. I haven’t left my house much in the past fifteen months; that part is new. And as much as I miss travelling and visiting friends, I really enjoy being able to sleep in as late as I want EVERY weekend. I have embraced grocery delivery services and Skip The Dishes and now boxed meal plan services like I was born to them (though the boxed meal plan service is largely to counter my increasing reliance on Skip to feed me). And with the completion of the backyard project I started in the First COVID Summer, I feel like I have joined a Sooper Sekrit Club of outdoorsy folks that I’ve been envying for their outdoor spaces for years.

In the past fifteen months it has also become apparent that I now have only two modes: On, which is reserved exclusively for work, and Off, which is what happens once I am done for the day. It’s been a learning curve to adapt, but I’ve had 15 months to get used to the idea that Off is a necessary state no matter what anyone else says. It’s not lazy or unambitious or disorganized. It’s the point at which my brain has to switch gears or I will get zero rest and speed myself right into the hell that is BURNOUT. It’s hard on relationships but critically important for survival as a therapist and as a human.

COVID has done a couple of very important things for me. (1) The love I have for the backyard space that didn’t exist a year ago knows no bounds, and when I need to turn my brain Off, that’s my favourite place to do so. I have embraced Off, you see, as Respite Time. I don’t need to Do anything, or Attend to anyone; I don’t need to be “on”. The critters in the backyard who have come to accept me as a safe presence who also dispenses food means they accept me (warily) on their terms, though I get scolded if I go out without peanuts. (2) The work that had already begun on learning to live with depression has really hit home in accepting that not only can I NOT do everything on my own, but I don’t even have to TRY. All of my clients might be delighted to know that I’ve finally gotten as hardcore about calling out my own “shoulds” as I have been about calling out theirs. No, I should NOT singlehandedly be able to run an entire household, balance a budget, manage two practices, maintain the outside property, and keep myself fed. Farming out food delivery was a good energy-saving strategy but to go one step further and farm out meal PREP and PLANNING is simply brilliant. Someone else mows my lawns every two weeks. Once I can afford it and am willing to have live human beings in my house again, I’m going to hire cleaners as often as I can manage. These are options that go beyond “privilege” and well into the realms of “luxury”, and I am keenly aware of that. I also don’t have a village to support me in these things, but I do have some financial latitude that can take these tasks off my plate and free up the mental and energetic real estate I need to keep doing the work that I do. That’s prioritization and a set of choices I can live with, and will so long as I can afford them.

Having recently read Emily and Amelia Nagoski’s book, “Burnout,” I am keenly aware of the price demanded of caregivers for the work that we do, and the excessive cultural messaging to “get back in line” when we try to break the patterns imposed upon us. COVID took away most of the things I do to recharge and respite myself, so I’ve had 15 months to look inward at what best balances the demands of the work; the answers have been both surprising and emboldening. Almost every one of them would qualify me as “selfish” for putting my self-care first. But it’s been critical to getting through this year-and-still-ongoing trauma, and will remain so for some time to come, I’m sure.

I have nothing but mad respect for my fellow caregivers who ARE managing all their SHOULDs and then some (my heart goes out to the parents who have also had to become teachers this year, many on top of also running households AND being full-time career people to boot). I don’t know how y’all are doing it without setting the world on fire when I can’t even handle pants most days–well, not entirely true; I do know many of you simply AREN’T handling it well at all. I have those conversations with you day after day after day in my virtual office, so I know the truth. I’ve already been proselytizing “Burnout” up and down my social media channels and thrusting it virtually into clients’ hands, and I will likely continue to do so until we claw our way out of this pandemic into whatever the world looks like on the other side. I want women to realize they’ve been suckered and conned into playing a game that’s been rigged against us since the outset, and at the end of the day, letting go of the belief that we have to be ON for others all the time with no shame-free thought of respite for ourselves is the cruellest form of gaslighting we’ll ever experience.

It took 15 months of a global pandemic for me to get free of that belief (and guilt), to be perfectly okay with what the house looks like on the outside when I don’t do all my dishes regularly, or only have the lawn guy come by every TWO weeks. It’s been a relief, frankly to have the pandemic as a platform on which to let all those old expectations and assumptions about what I thought I HAD to do as an adult, go. Simply… go. I’d really be just fine, I think, working and living this way indefinitely, though preferably without the threat of a killer disease hanging over all our heads. I still love my work, love my clients, love my home (inside and out), but I have also learned a great deal about how I had been relating to a lot of these things in some pretty unhealthy ways.

On the outside, the pandemic has meant being locked down, locked in, stuck on pause. But it has also meant being able to turn inward, slow down or pause, re-examine a great many things we’ve just been too busy to stop and contemplate before now. My clients have been learning that; hell, I’ve been teaching them that.

Guess it was only a matter of time before that lesson finally came home to roost in the therapist’s house too.

Community, Current Events, Grief, Practice News

https://erbgood.com/tribute/details/15465/Gloria-Taylor/obituary.html

The psychotherapy community just lost one of its best. More personally, I just lost my own therapist of twenty years. Most importantly, if there’s one person I can point to as a guiding light for everything I have become in the past two decades, it was Gloria.

I had already been her client for seven years, through one relationship and into my then-marriage, when I walked into her office on 7 Willow Street in Waterloo and asked, “If I wanted to do what you do for a living, how do I get from here to there?”. It was Gloria who talked me into the Master of Theological Studies at Wilfrid Laurier University’s adjunct Waterloo Lutheran Seminary. I balked at the “seminary” part initially, but a chance to actually work with Gloria in her capacity as the instructor of the Family of Origins course proved an extremely powerful lure. And frankly, the Seminary itself proved to be the best possible place to go for a lot of reasons I’ll cover some other time. So Gloria became not only my therapist but also a teacher and mentor. Teaching how to navigate and reframe and unpack family of origin mysteries was only one of her many gifts to me and other students. I regret now never having had the opportunity to take one of her Mastery courses while she was still leading them, but what she taught me — not just in that class but over the course of twenty years of great patience as my therapist — is material that I use every day of my life now.

Gloria is the reason I became a therapist. The ways in which she helped me unravel and reknit parts of myself were a form of serious magic that I wanted to understand, and more, to practice as she did. We both came into this field as a midlife career change, and more than anything else, that showed me that what she could do was within my reach. Grad school, private practice, the slow transition out of my old career, facing the personal travails of that transition, finally getting grounded, and eventually having enough professional cred to land the position at Bliss Counselling… all of this is a testament to everything Gloria taught me, and everything she modelled for me in our own conversations.

She’s the reason I’ve now written a number of letters of recommendation for my own clients as they apply to the same program I did. She’s the reason I also became a supervisor of students and qualifying psychotherapists. She nurtured and encouraged my aspirations; it behooves me to continue that circle onto the next generations who follow and pay forward the many great gifts she shared with me.

A month and a half ago, Bliss Counselling moved into that building at 7 Willow Street in uptown Waterloo. As soon as I heard the new address, I emailed Gloria to tell her the news; she laughed at the circle completing itself in new and interesting ways. “That’s just wild,” she said. I had meant to ask about appointments at that time but forgot; I know now she wouldn’t have been in any condition to work and had actually FINALLY retired for real. A couple of weeks ago, I sat in what had been Gloria’s office when I started seeing her. That evening, I wrote,

20 (or 21) years ago, I walked into the second-story corner office at 7 Willow Street. I sat in one of the chairs under the east windows; I never really thought about why I never sat on the sofa on the opposite wall. The chair and the desk along the south wall were clearly where The Therapist sat. And there she sat, the terrifying authority who was obviously going to tell me everything that was wrong with me/us/our relationship/our lives. It was one of the most frightening experiences of my adult life, frankly.

Today I walked into that very same second-story corner office, and for the very first time, I sat in the chair by the desk along the south wall. Different chair, different desk, but… this is clearly still where The Therapist sits. Only now The Therapist is -me-, 20 (or 21) years and a whole lifetime different from the woman who sat first in the chair under the window feeling terrified. And the young woman sitting today on the sofa that is now under the windows is herself the NEXT generation of therapists, although she already knows it whereas I had NO clue.

If there is a word for this feeling, I surely do not know what it might be.

Yesterday a friend who was also a client of Gloria’s messaged me to ask for help in finding a new therapist; that was the first word I had that things had gone as far for Gloria as they were going to go. I immediately sent her my own email yesterday to touch base and say thank you, but I absolutely doubt she will have received it, given… everything. My greatest hope is that somehow Gloria knew how many lives she touched, how many she helped reframe, rekindle, rebuild. Clients, students, the “baby therapists” she supervised, the Marriage & Family Therapists she mentored and guided through AAMFT, the many people who took her Mastery courses over the years to discover themselves–no-one ever seemed to walk away from Gloria without the seeds of change implanted in their minds.

My heart goes out to her family, who thankfully had the chance to be with her in whatever ways they could be when she went out by her own choice with medical assistance in dying (MAID). That’s absolutely Gloria, right to the very end. Her daughter Dawne shared a photo of Gloria in her last moments, and I agree with Dawn 200% — all I see is the beauty that was Gloria.

Photo courtesy Dawne Taylor-Gilders

Goodbye, Gloria. I’ll do my best to live up to that legacy you’re leaving behind.

Article links, Current Events, Self-care

Hoooo-nelly… We’re still here. And we’re going to be here a long while yet (she says, eyeballing the again-rising numbers in Ontario and the ongoing dumpster fire that is COVID responses and shenanigans one month from a presidential election south of the border). And winter is coming — insert ubiquitous Game of Thrones graphic here — and shit’s about to get very, very complicated. (Not that COVID wasn’t already complicating everything, so I’m not really sure how much worse it can get… no. I really shouldn’t invite that kind of chaos. It can ALWAYS get worse.)

We’ve cruised over the six-month mark in this current pandemic, and it is taking its god-awful toll on all of us in some way or another. Not too long ago, someone pointed me to this amazing description of “the six month wall” by University of Toronto prof Dr. Aisha Ahmad. For those who prefer not to scroll through Twitter stories, she encapsulated her thoughts in this article, and there’s a decent Forbes article exploring her ideas. Dr. Ahmad’s experience working in disaster relief is, I think, a good parallel for what it’s like for many of us struggling to find footing and balance under the weight of an ongoing pandemic, albeit one a growing number seem inclined to ignore as a threat. She provides a very balanced look at both how tough getting over the six month wall can be and also what has worked to help keep forging ahead when we hit those difficult slumps and ruts.

The idea that in an ongoing, persistent crisis state, we’re all going to hit a slump in our struggles against that state just makes sense. Some people have been struggling with the fear of infection and illness since COVID first started spreading in North America; some are less worried about the virus itself and more concerned about the short- and long-term impacts of protracted social distancing. Others might be most impacted by grief and grieving those they cannot get to under quarantine restrictions and travel embargoes. Long story short, for one reason or another (or many reasons all at once), a great many of us have hit an exhaustion point. We’ve been struggling to adapt to this new scenario in all its implications since March; it’s been at best a challenge and at worst an utter shitshow. We’re breaking down mentally and emotionally stalling out.

As she points out, most of us have already adapted to some degrees of the “new normal”, but winter is going to require us to adapt again to the new challenges of COVID resurgence WITHOUT the benefit of warming weather and outdoor escape options. That we’re hitting the six month wall now, as those seasonal implications begin to really hit home for many, is doubly harsh. I don’t about other mental health workers, but I don’t even know how to predict what my work is going to look like come the holidays under COVID, and the aftermath heading into deep winter. I can’t imagine it’s going to be pretty. Humans are naturally adaptable on an evolutionary scale of things, but a lot of us don’t actually enjoy change when the necessity of it is thrust upon us by factors beyond our control (personally, I get grumpy about change even when it IS 100% in my control, so… there’s that.)

“[T]he wall is real and normal. And frankly, it’s not productive to try to ram your head through it. It will break naturally in about 4-6 weeks if you ride it out.” – Dr. Aisha Ahmad

Aye, there’s the rub… riding this slump out for another four to six WEEKS.

A later Tweet by Dr. Ahmad explores a little more deeply her concept of mental “shore leave” plan to help make it over the six month wall:

Mental shore leave means a psychic retreat. So my task is to get creative about where I can create respite in my life today, just as it is. It also means looking hard at where I can set boundaries, and cut out negativity & noise. The goal is simple: optimize rest and joy. /4

A key factor will be ensuring that my shore leave plan does not depend on anything staying open. If my strategy is about going to a gym or bookstore, it will be vulnerable to collapse. I need my respite to be absolutely untouchable. /5

On the whole, I am deeply onboard with this idea. The idea that we’re allowed to put down the load of “life in wildly-uncertain times” is seductive, if only because sometimes *I* just want someone to give me permission to stop worrying about things for an hour or two. Even half an hour! My only caveat is that, as presented, there is no allowance for those who have spent the last six months sliding down into depressive cycles that make adding ANY extra efforts to their day a difficult challenge, even respite time. As a therapist, in the past week, I’ve been shaping those conversations with clients in this slump as exploring their definitions of “respite”. For some, it has meant finding ways to increase literal rest or looking for ways to reshare/rebalance some of their workloads to provide relief from at least SOME of their stressors. For others, it has meant the deliberate, temporary delay of dealing with all manner of issues and circumstances that might be a lower priority than basics of safety and survival. For many on the depressive spiral, myself included, it has been a discussion about allowing ourselves a respite from some of the less-important things we believe we SHOULD be doing, and giving ourselves permission to make rest and recovery our highest priority as much as our circumstances permit.

The pandemic may be unrelenting, but how we engage with it need not be. I like Dr. Ahmad’s notion of respite breaks, but I would prefer seeing a more grounded approach in introducing that notion to our struggling clients especially. Most importantly, I really appreciated seeing someone outside of the therapeutic/mental health field validating and echoing what I’ve been noticing lately in discussions with my own clients… and experiencing in my own head. The wall is real, the slump is not exactly short-term but it IS temporary, and we DO have options for disengaging from it for whatever periods of time we can muster for respite.

I might just get myself and my clients through the next 4-6 weeks, then, given all of that.

Current Events, Life Transitions, Mental Health

So there we were, six months into a pandemic, trying to pretend the world was getting back to “normal” in spite of COVID numbers slowly creeping back up in the wrong direction, a race war brewing, backlash against militarized and violent policing growing, an American election fiasco in the making, questionable political decisions on our own side of the border…

No, wait. Not “were”. ARE. Here we *ARE*.

Today in Ontario, many schools reopened their doors to returning students without a clear plan on how to manage classrooms under pandemic conditions. Parents, teachers, and school staff alike have been dreading this moment since things closed down in March; next to actual lockdown adjustment crises, that’s been the second or third most common issues walking into my (virtual) office for the last month or so. Even for those of us without kids but with an excellent understanding of science basics, there’s a sense of a timer ticking, and this year it’s not just about the surge of the usual colds and health issues that come from children playing together as children do. It’s all the OTHER infection vectors that are now in play.

And yes, we’re concerned. We’re concerned about how best to continue to support our clients and our communities while keeping ourselves, our colleagues and office staff, our offices, and yes, our clients and everyone to whom YOU are connected, as safe as we can. We’re still being advised by our governing colleges to avoid returning to in-person sessions for the foreseeable future, so virtual meetings continue. Six months into things, we’re still not back to normal operations, nor will we be any time soon.

Our clients continue to be graciously understanding for the most part, but they’re as frustrated as we are. We’re still helping folkx navigate a world where jobs are still disappearing as businesses falter, where pandemic/lockdown fatigue and social distancing remain considerable barriers to mental health, where “Zoom fatigue” and the normalization of working from home creates a whole new set of challenges to work/life balance routines. We’re trying to figure out how best to help our seasonally-affected clients prepare for the autumn and winter in the absence of most of their normal social options. And we’re trying our best to make sure we as therapists don’t succumb to this tidal bore ourselves.

All of which to say, six months on, we’re still here, still working, still doing our best to support where we can, validate and commiserate where we can, change what we can, offer what hope and perspective we can… And we know that some days, many days even, will be harder than others. We can’t make any of this go any faster, we can’t predict what life will look like in The After, and we don’t always know what will make it easier to get from Here to There either. But we’re in the mud with everyone else, and we get it.

Stay strong, stay safe. As the clich? says, especially at this point, “The only way out is THROUGH.”