Years before I became a therapist, I began my own therapeutic journey.  My first therapist, Ed, said something so profound I never forgot.  I was depressed and felt hopeless.  I thought about suicide.  I didn’t have a plan or anything, but it surely seemed as a possible option at the time.  Although I felt deep shame about my suicidal fantasies, I knew I needed help, and confessed to him.  I asked if my thoughts were normal - did everyone think about suicide at some point?  Was I crazy?  Ed calmly answered, “Suzanne, if someone has never thought about suicide - they are not paying attention.  Life is hard!” 

I sighed with relief.  I was, at least in that moment, normal.   Well, whatever defines normal - and that’s a whole other blog post.  Ed validated my suicidal thoughts and feelings as being within the normal spectrum of human emotions.  Today, as a practicing psychotherapist, the majority of my patients, at some point, express some suicidal ideation.  That’s the psycho-babble clinical jargon for suicidal thoughts.   According to Swiss psychiatrist C. G. Jung, when someone feels suicidal - they have the right idea!  Yes!  Jung used to tell his patients, in his thick Swiss accent, “Thank God!  You understand now that something needs to die!”  Jung meant that something needs to die psychologically for the patient - not physically.  Suicidal feelings signal something very big within us needs addressed and resolved - not physically killed.  A popular saying by therapists who assist suicidal patients is, “Suicide is a permanent solution to a temporary problem.”  According to SAVE - Suicide Awareness Voices of Education:

• Suicides take the lives of almost 30,000 Americans each year
• Over half of all suicides are completed with a firearm
• For young people, 15-24, suicide is the third leading cause of death
• The highest risk factor for suicide is depression
• 80% of people who seek treatment for depression are treated SUCESSFULLY!

If you or someone you know struggles with suicidal thoughts, please seek immediate medical attention at your local emergency room, call 911, or call: 1-800-273-TALK (8255).  There is HELP.  There is HOPE.  There is HEALING.  

Only the bravest of the brave go to and stay in therapy - the psychological kind.  THERAPY IS HARD WORK for the patient.  Therapy (you know, the counseling kind), requires an enormous emotional and financial commitment.  Then there is that pesky time factor, ideally, the patient should attend 1 session per week - more if they’re in crisis.  Who willingly adds three extra hours of work to their week?  How is it three hours?  Well, on average, the commute alone is about a two hour roundtrip, add in the therapeutic hour - which is actually 50 minutes - and 3 hours are gone!  Therapy is expensive.  Many providers are moving towards private pay because dealing with insurance companies is ridiculously time consuming and not cost-effective for the therapist.  Depending on where you live and the providers credentials, therapy rates may vary from $75.00 - $350.00/hour.  Ouch!   

The emotional expense for the patient is initially pricey.  At first, therapy may seem like a high-cost-low-yield investment.  One of the biggest surprises for the client - therapy doesn’t always feel good right away.  Immediate relief is no guarantee.  Why then, would anyone in their right mind engage in this?  Yes, I know what you’re thinking: ‘Well it they were in their right mind, they wouldn’t need therapy…’  Not so.  I’ve NEVER, never ever, met anyone who could not benefit from some therapy.  I stay in therapy.  We all need a good therapist.  Why?  Because we are all wounded.  Life is hard.  We all have an innate need to be deeply understood.  We all have an innate need to be heard and witnessed and loved.

After several multiple sessions, and depending on their level of functioning, the patient begins to heal.  How?  Because a competent therapist helps the patient identify wounds and traumatic events which contribute towards current dysfunctional behaviors.  This is a process.  It cannot be rushed.  Patients often ask: “I’ve been coming here for 6 weeks?  How come I don’t feel any better?  I actually feel worse!”  Why?  Because it takes years for our psyche to create and maintain defense mechanisms - the emotional blocks we create to avoid feeling pain.  Therapy is like a gentle exfoliation of ‘dead’ or necrotic emotional tissue.  It is hard for the patient to let go of the very structures that have been their emotional glue.  It hurts.  Therefore, the therapist’s role is to facilitate a balance between challenging the patient vs. allowing them freedom to go at their own pace.  A good therapist is constantly negotiating this holding the tensions-of-the-opposites.  Therapy is more like a marathon vs. a sprint. 

Therapy is hard work for the patient - but it is the best investment anyone can make in themselves.  The final dividends are richly fulfilling and yield increased emotional well-being.

I was invited to speak to a group this past week.  I spoke about SIB, Self-Injurious Behavior, aka, ‘cutting’.  I gave the attendees my four-page handout citing facts and stats regarding definitions, gender and racial differences, typical age groups, and various scientific theories.  I enjoy presenting and sharing my knowledge.

Then, a middle-aged man with a wave of steel-colored hair looked up over his metal-frame glasses and asked:  “You said you have fairly good success with helping cutters.  What do you attribute that to?”  I readily responded:  “Therapeutic brilliance never cures the client.  But love does.” 

Out of all the data I presented to this educated group, and all of my care in looking professional, speaking well, and emulating speakers that I’ve admired - this statement alone seemed to win their confidence in me.  I saw people nod.  This moment of my pure authenticity resonated as their truth.  What qualities does a good therapist possess?  Yes, the obvious is needed.  A good therapist needs to have a solid theoretical framework, based on data and research, from which they operate.  Most therapists that I know, are eclectic and integrate a variety of techniques such as experiential with humanistic, and dose of cognitive-behavioral therapy to assist their clients.  This is good.  This works.  But, in my experience, when the client experiences genuine lovingness from the therapist - this hastens the healing process.  Carl Rogers referred to this as ‘unconditional positive regard.’  

When we feel safe, contained, valued, deeply understood and loved by the therapist - we are able to allow ourselves to be vulnerable and emotionally exposed, knowing that whatever we bring into the therapeutic setting is OK.  This is what helps us heal.  Love.                

Relationships require emotional energy.  The energy is seldom in perfect balance.  Sometimes one person is ’extra expensive’ - requiring a lot of emotional currency.  Perhaps a friend or lover or significant other needs to make hefty withdrawals - maybe they are in crisis, or depressed (from either neuro-chemical or situational causes), or just plain life happens and they need to withdrawal some emotional currency - the energy from the relationship you’ve built.  What does that look like?  Oftentimes, patience. 

 Sometimes the person in need of emotional currency needs to verbalize their conflict, or maybe they need to emotionally isolate.  One may choose to give the emotional currency or state feel like the joint account has  ’insufficient funds’.  The later is a tough one.

When one person repeatedly makes deposits to the relationship and the other makes withdrawals, the account becomes drained.  For a healthy emotional account, both people must contribute to joint deposits.  A healthy balance allows both partners to make deposits and withdrawals.

Visit msnbc.com for Breaking News, World News, and News about the Economy

By:  Suzanne Maiden, M.A.

I was pleasantly surprised to see the Today Show with Dr. Nancy Snyderman and the Editor in Chief, Ann Shoket, of Seventeen Magazine, discuss cutting behaviors in young women.  ‘Cutting’ is the layperson word for Self -Injurious Behaviors (SIB).  Why would I be happy to hear this touchy topic be talked about on mainstream T.V?  Because cutters and why they cut are grossly misunderstood.  I wrote my graduate thesis on SIB.   Many medical personnel and mental health professionals find cutters’ behaviors troubling, treatment-resistant, and plain disgusting.  As a practicing Family Therapist I have successfully treated many cutters.  I appreciate your bringing awareness to this issue.  I would like to offer just a bit more insight based on my experience.

Katie Stewart bravely shared her painfully private struggle with the Today Show .  In many ways, she represents the various women with whom I have worked – bright, beautiful, and the seemingly a “great kid”.   Unless one would see their scars, cutters do not fit an easily identifiable profile.  Outwardly, they present as very together.  Inwardly, they battle demons.  Most want to quit.  Many report extreme shame and guilt over their irresistible urge to self-injure and go to great lengths to hide their scars.  But why?  Why does anyone self-injure?  There are multiple hypothesis as to why people self injure to include:  1) non-validating environment, 2) poor attachment in childhood, 3) addicted to their own opiate release system, and 4) history of sexual abuse. 

The data strongly support the positive correlation between sexual abuse and future SIB.  Not every person who has been sexually abused will end up self-injuring.  Conversely, not every person who engages in self-injury has a positive history for sexual abuse.  However, in my personal experience, the majority of my clients who self-injure do report a positive history of prior sexual abuse. 

What’s sexual abuse have to do with self-injury?  The cutters who do have a positive history for sexual abuse frequently report that self-injury is the only way they know to access their pain – or express it.  Ironically, many self-injurers do not feel pain while actively self-injuring.  Why?  Because sexual abuse survivors tend to be very adept at the ability to dissociate.  That is, when sexual abuse occurs, the victim often mentally “checks out”.  This ability helps the victim endure the abuse when they cannot physically escape.  Many cutters report they are in a dissociative state when they self-injure and many do not realize the extent of tissue trauma until they “come back” mentally. 

Cutters are often the modern day lepers of emergency rooms and therapists’ office.  Nobody wants to deal with them and their self destructive acts.  However, their wounds are the physical manifestation of their internal suffering.  If they knew how to access their pain in a healthier way – many would.  Thank you TODAY Show and Seventeen Magazine for bringing this dark phenomenon into the light.          

Then, I started texting.  I get it now!  Texting is convenient when a phone call is  impractical.  You can text anytime -  day or middle of the night, not so with a phone call.  Texting is a great way to send a quick message without having an extended phone conversation.  And, for whatever cheap thrill I derive, it’s just fun.  Texting is like getting a cool letter in the mail, or an anticipated email or post on facebook.

Now, the bad side.  Texting, while fun, can be hazardous to relationships.  Because there is a LOT of room for misinterpretation.  Subtle nuances don’t come across clearly.  Typos and abbreviations can lead to general confusion for the recipient.  While texting is fun and sometimes necessary, it can create more communication problems.          

Groups, predictably, psychologically collapse to the lowest denominator of the group member - this is certainly true in family systems.  The most neurotic family member calls the shots for the entire family.  The family acquieses to the needs of the sickest family member.  Groups frequently mimic familial dynamics.

It fascinates me when a group will bully or slam or make fun of or criticize or laugh at another.  This is an example of when the group slips to the lowest denominator of the dominant and twisted person.  I feel ashamed when I’m with a group and this occurs.  I do recognize the distinction between teasing verses unkindness or cruelty.  I have gotten into heated arguments when I’ve been in this situation - when someone is intentionally and cruelly critiquing another.  I give credit to my mother. 

My mother is innately kind.  My first lesson in not participating in the group think and laughing at others was when I was in third grade.  We lived in Stow, OH.  A girl in my class Bonita, was larger than the rest of us and mentally impaired.  Chronologically, Bonita belonged in 5th grade, but her mental lethargy required her to be placed with my third grade class.  Bonita loved physical affection.  She ran up to anyone and tried to kiss them.  Well, this caused quite the stir on our playground.  Everybody ran away when Bonita approached with her body crushing hugs and drowning wet kisses.  Children laughed and sneered and made fun of Bonita.  I felt great compassion for her.  Most of the time, I allowed her to kiss me on the cheek, and agreed to push her on the swing.  The other kids made fun of me for befriending Bonita.  I didn’t care.  I even tried to physically defend her against the class bullies.  This was difficult for me because although I was tall, I was very skinny and didn’t have any physical strength to back up my verbal threats.  Most of the time, I got the bullies to leave Bonita alone.  I couldn’t stand anyone hurting her either physically or emotionally.

Several years later, we lived in Williamsville, NY.  My mother was driving and we came to a 4-way stop sign.  I impulsively stuck my tongue out at the opposite car.  I was about 11 years-old, and I cannot remember why I did such a thing.  My mother turned and slapped me hard across my face.  I was shocked.  She told me that I had no idea who could be in that car and they may interpret my behavior as cruel mockery.  Between Bonita and my mother’s hard slap, I got it. 

I am extremely sensitive to laughing or mocking or making fun of another.  I don’t do it.  Laughing at others with intentional malice is cruel.  It’s a small person who engages in the behavior.  I am so glad I have surrounded myself with the kindest of friends.    

My therapist said today:  “Christmas is a diabolical system in America…. We have lost our way.”  Whoa.  I’d never heard those two words, ‘Christmas’ and ‘diabolical’ used together before.  Let me explain.

I began our session saying that I felt discombobulated during this Christmas season.  I love the idea of Christmas.  I love the idea of giving to others to our fullest capacity without expectation of return.  I love my increased intense feeling of connection to the Divine.  I love the collective celebration of the miracle of Christ.  It is beautiful.  But I wasn’t feeling the love this season.

Instead, I couldn’t wait for it all to be over.  I  disliked fighting the traffic and shortness in others, whether is be sales people or customers.  And of course family complexes and neurosis glibly come trotting out in full expression.  Nothing about my experience felt reverent or restorative or remotely holy.

When I explored my dissatisfaction with my therapist, Barry, he replied: “Your feelings are accurate because Christmas is a diabolical system in America.”  What?  Barry continued and said, ”Unfortunately, Christmas in America has become an extroverted experience.”  How?  Because many of us are outward and excessive during this time.  Our social calendars are often overbooked with parties, some we actually complain about feeling obligated to attend.  We loose our focus and the point of togetherness.  The Sacred, Soul, the Divine, God feels mysteriously absent.  We consume too much food and often too much alcohol.  We wake up hungover and extra pounds on the bathroom scale as evidence of our gluttony.  We purchase presents out of obligation instead of heartfelt love.

Christmas is a time for reflection and a recapitulation of our connectedness to all that Is.  Christmas is the season to increase our commune with God.  Of course, we can collectively celebrate and honor this event.  But the way in which many of us do somehow and sadly feels vacant of the Sacred.  I long for something deeper and more meaningful.   

Christmas is about the miracle of light; it’s about the miracle of Christ’s light in the midst of darkness.  This is something to celebrate, but in a much more introverted and reverent manner.  One of the loveliest Christmases I experienced was in Venice.

I was active duty Air Force and stationed at RAF Bentwaters, England.  My girlfriend, Paula, invited me to spend Christmas with her and her family in Venice.  I vividly remembering walking the streets on Christmas Eve and the excitement, merriment and joy from others exuded everywhere.  The dinner we ate felt more about the anticipation and sanctity of Christ’s birth than the menu.  The gourmet cuisine was to honor the blessed gift.  The message of the Divine seemed ever present.  This was two decades ago, and perhaps things have changed.  I hope they have not sadly followed our excessive commercialism.  

I am aware that this post may sound Anti-American.  Not so.  I love my country.  I feel blessed to be an American.  I proudly served 5 years Active Duty Air Force.  I get tears when I stand for our National Anthem or see our flag boldly blowing in the wind.  

My disappointment in Christmas just left me to examine what is the missing piece.  I agree with my therapist: Christmas in America has become a diabolic system contaminated with commercial excessiveness.  We mistakenly regard Christmas as an extroverted event.  In small doses and when done with meaning, this is fine.  But, we have become gluttonous consumers and slaves to commercialism.  If we want a deeper experience, if we seek to access the essence of the Divine, then we need to reorient our stance inward.       

As a Family Therapist one question frequently asked is: “How do I find a good therapist?” Below are 5 basic components to consider:

I. Word of Mouth is still one of the best ways to find a skilled therapist. If you’re resistant to asking a friend, consider calling the following to ask for referrals:

* Primary Care Physician/Doctor’s Office
* Local church (call several)
* Hospice or Funeral Home (if grief related)
* Local Hospital Mental Health Unit
* School Guidance Counselor (s)
* Community Mental Health Center (often listed in the front of your phone book)
* EAP (employee assisstance program)

II. The First Call – What to Ask?

* What are your clinical specialties?
* What population do you enjoy working with most?
* Do you accept insurance? Will you consider a sliding scale?
* Do you have access to a competent psychiatrist if medications may be needed?
* Average length of treatment?
* Are you in therapy? Have you ever been?
Most therapists have the academic training to treat the full spectrum of mental health issues. However, as therapists we have our clinical strengths. For example, one of my areas of expertise is SIB (self-injurious behavior) or ‘cutters.’ Many therapists dislike working with this population for various reasons. I can work with cutters all day long. Don’t be afraid to ask. The last question surprises people. You want your therapist to have actively spent time working on their issues before they help you work on yours. I stay in therapy because I need a great therapist for me to be a good therapist. It’s like Tiger Woods continuing to take golf lessons – it keeps him on top of his game.

III. The First Appointment – What to Expect:

* You want the therapist to take a thorough history. Yes, I know, you or your loved one may be in crisis and you finally make it to the therapist’s office; you’ve got a lot to say. You don’t want to spend part of your 50 minutes by answering a lot of questions. But a thorough history potentially eliminates big future ‘uh oh’s’ and errors.  It’s imperative to your best treatment.  Nearly every time I compromise on initial history taking - I regret it because I inevitably miss a big piece of information that perhaps my client did not think was a big deal - but was key for correct diagnosis and treatment.
* Be honest about all medication use, especially recreational drugs to include alcohol.
* Make sure you understand confidentiality policies. Therapists are mandated reporters. Loosely, a mandated reporter is legally obliged to report suicidal/homicidal threats and physical/sexual abuse. This does NOT mean that if the client mentions suicidal/homicidal thoughts that they will be reported. Only, if the client presents imminent danger to self or others, then therapist must take appropriate action.

IV. Trust Your Gut – But Don’t Quit Prematurely

* Trust your gut whether the therapist is a good fit; BUT, give a new therapist 6 sessions before you bail. Rapport takes some time.
* It’s important that you like the therapist as a person; this doesn’t mean that you agree with everything they say, I guarantee you won’t, that’s OK
* It’s important that you feel confident in their ability
* It’s important that you experience the therapist as genuine, compassionate, sensitive, and non-judgmental of whatever you bring into the session

V. A Good Therapist Can Change Your Life:

The therapeutic relationship is one of the most intimate relationships you will ever know because it is supposed to be a safe haven to explore your inner world and deepest thoughts. It is completely about you - the client. Reciprocity does not, nor should it, exist. That is, the therapist is always in service of the client.

Lastly, the therapeutic role is to assist the client in exploring healthy life choices and identify barriers which may inhibit that process. Therapy can be one of the most growth-enhancing and healing events anyone can ever experience. Make that call.

By: Suzanne Maiden

It’s nearly the New Year and I traditionally like to tidy up lose ends.  I am naturally organized, except for lately, things (papers, study materials, academic books etc.) seem to stack up like snowfall during a winter storm.  I like a structured environment to perform at my optimum; I’m not neurotic but I focus better.  So in that effort - well to get it together for the New Year, I’m going through my emails… 

I’m sorting through my 1234 emails.  I found some feedback from listeners.  Any feedback I receive I am grateful.  Even negative feedback lets me know that someone is out there in podcast land and listening.  It stokes my motivation to keep pushing through the pain-in-the-booty factor to produce shows.  Thanks to each and everyone of you who contribute to any of the three shows I do:  1)  http://www.InsytWorks.com, 2) http://TheDivaCast.com, and of course 3) http://www.DearZanny.com.  Below are some comments from listeners:     

Hi Robin and Susan,

I just listened to your InsytWorks podcast on the subject of Elliot Spitzer and prostitution. You and Susan are remarkably talented. Please don’t misinterpret this, but if Loren Michaels (the produce of Saturday Night Live) got wind of you two, you’d be able to buy your own airliner! Again, I am not being condescending in any sense, I think you guys are incredibly articulate and passionate about your subject matter and I can also appreciate the seriousness of the topic. I happen to love satire, however, and I found quite a bit of humor in your exchange. Susan is remarkably bright and witty. I enjoyed it very much and again, I hope you don’t take offense to my comments. I also hope that Susan is fairing well with her cancer. All the best, Tom

********************************************************************

Hi Suzanne!  I discovered your show a few months ago and am totally caught up on all of your episodes now.  Thanks to you and your husband for putting it out.  I am a counselor on a long maternity leave (I had two babies close together, so I am taking 2 years off to enjoy babyhood).  I come from a very cognitive-behavioral background, so your show is stretching my mind.  I really enjoyed your topical discussions of grief and self-mutilation.  My suggestion is this:  I would love to hear more topical discussions from a depth perspective (ex - domestic violence explained from a depth psych perspective).  Thanks for all you both do.  Oh - I am also a huge fan of the Diva Cast (even though I am only 28).  It is very encouraging to hear ladies in a life stage ahead of me with so much zest for life and career.  It reminds me that there is life again after babies.  
Much appreciation for what you do - Katherine from McKinney, TX

********************************************************************

Note from Mama Whyte!: I Love all of your podcasts!  I listen to them religiously!
You are such an amazing girl, and a true diva
~ Chrissy

********************************************************************

Dear Suzanne & Robin,First I want to say I’ve become such a fan of your podcasts.  I listen to TheDivaCast, Insyt Works, and now Dear Zanny!  Of course I also listen to Carrie’s Words to Mouth.  I am listening to an old Insyt podcast on Being Loving.  Suzanne, I was so surprised to hear that someone would ever think you are being superficial or that you may need to win them over.  I’ve always been drawn to the authenticity and wisdom of what you share.  It was so helpful to me today to hear you say that when you are being loving and someone can still have a strong or visceral reaction directed at you.  I can completely identify with that.  Anyway, all that to say what you said today really resonated with me.  Thank you!Oh, also I will be going on the Manic Mommies Cruise (feeling like a bit of a podcast stalker now - please do not misinterpret -I have a very long commute and you all keep me entertained!)  Kindest regards, Angela