Help for Healing

Bitter & Sweet, living daily with grief


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Mental Wellness vs. Mental Illness

I think mental health is on a continuum, and every one of us fits on it somewhere. This is one of those topics where we talk in divisions and categories, but in reality the lines are not that concrete. The lines are helpful to discuss issues with each other, but in real life? It can be very hard to distinguish between them.

I am in private practice. Most of the time, my clients consist of people like me. I am functioning, capable, and relatively healthy. I struggle with depression, but overall I manage well. I see a counselor and plan to for the remainder of my life. I don’t always NEED counseling, but I benefit from it. I like having someone to bounce things off of. My clients are generally in the same “category” – they don’t necessarily NEED counseling to function, but choose it because it is helpful.

Oddly enough, I had never thought of a simpler way to express that idea but recently I was meeting with a UB student. There are med students who have the option to choose an elective called “Spirituality and Health” or something like that. These students meet one on one with several key people in our community to get several different perspectives of how spirituality affects our health. I am one of the panelists the students see. Recently I was meeting with one rather delightful student who happened to want to go to into psychiatry. It was a double connection with me, being in the mental health field.

Anyhow, she said she had read about the term “mental wellness.” She’s a good student so she wanted me to be sure and say she didn’t get credit for coming up with the term herself. I loved it. That’s it. People like me are pursuing MENTAL WELLNESS. People like me are helping other people pursue mental wellness.

I got an extremely huge education this week about mental illness. I spoke with some higher-ups and got a big clarification about hospitals like ECMC and what their goals and purposes are. The statistics I got were staggering. The amount of people a facility evaluates and the amount of patients that are actually admitted presents an incredibly huge gap. The hospital is only equipped to see the very sickest of the sickest. They just can’t meet the needs that the larger majority of people in need represent. My question is, then where do we tell our clients to go?

There isn’t a good answer. I am currently looking into some partial programs to educate myself further. It’s a huge problem. It’s what I encountered last year with my daughter. It’s what I encountered last week with my client. It’s what virtually all of my colleagues struggle with. What is there for those people who don’t fit into the “mental wellness” category? They really aren’t functioning well. Counseling and outpatient psychiatry isn’t enough. But they aren’t completely mentally ill either. They aren’t talking about aliens in their stomachs or wielding dangerous weapons around and a serious threat 98% of the time. There just isn’t much in place for them. There just isn’t. And it’s heart-breaking. I feel like I’m watching a disaster in the making. Worst case scenario is people continue to worsen and end up being in the “sickest of the sickest” category. Perhaps it could be prevented if they would get the proper help. Best case scenario is they don’t worsen, but live a life with almost zero quality. That pretty much sucks too.

Not sure what the answer is. I do know I will keep looking and fighting and arguing and trying. It’s time-consuming and non-rewarding most of the time, but I know of no other way. So if you are one of those support people in my life, be patient when I need to talk and vent and talk and vent. You need someone to put a pillow on the wall sometimes when you are banging your head into it. But I would rather do that than give up or become so disenchanted or jaded that I just give up. My daughter deserves better than that. So does my client.


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The Extra Mile- Is It Worth It?

Henri Nouwen said the following:

“Do not hesitate to love and to love deeply. You might be afraid of the pain that deep love can cause. When those you love deeply reject you, leave you, or die, your heart will be broken. But that should not hold you back from loving deeply. The pain that comes from deep love makes your love ever more fruitful. It is like a plow that breaks the ground to allow the seed to take root and grow into a strong plant… Yes, as you love deeply the ground of your heart will be broken more and more, but you will rejoice in the abundance of the fruit it will bear.”

This has always been my philosophy. I may not have been able to articulate it as such, but I think it is the way I have usually lived and conducted my life. Several years ago when I was introduced to the Eneagram and discovered I was personality type number four, I was given another layer of understanding. Fours will take agony over nothing because it makes you feel alive and not invisible. I had more words to articulate my personality and philosophy.

The last couple of years though, I find myself questioning whether or not I want to continue to make decisions based on the “better to have loved and lost than never to have loved at all” theory. I’m not talking only about romantic relationships, but the way I have approached every aspect of my life. Give with all my heart because that is who I am. That is how I am wired.

Truth is, I love living my life that way. I’m actually proud of it. I got the extra proverbial mile. Okay, let’s face it, I go thousands of extra miles, as a mom, step-mom, therapist, family member, friend. When I was very young, I remember my mom saying that I give so much of myself, which is fine until I expect others to give back the same. When they don’t I get crushed. She understood me from the very beginning. And it’s the line in Henri Nouwen’s quote about being rejected, abandoned, or left by death that gets to me. I love giving passionately. That is, until it hurts. Then I question the whole way I conduct my life.

In my practice, I have often gone beyond the normal expectations. I will do a home visit if someone has lost their license, has a bad back, or suffered a particularly difficult trauma. I have given several free sessions for different circumstances. I have attended weddings, funerals and other meaningful events when requested to do so. I don’t charge for those extra phone calls between sessions or for letters to be written. And I do it because I want to. I do it because it is how my heart beats. Then I do something- less than perfect, or not what is anticipated, or whatever it may be, and the client gets angry or upset, and drops out of therapy. It may or may not be accompanied by a torrent of harsh words. I know professionally that this happens. But regardless of any intellectual knowledge I have, it still knocks the wind out of me. Years of going out of my way and doing all the extras are forgotten because one ounce of upset negates several tons of love and compassion.

Or perhaps it is my family. As a step-mom, I vowed on my wedding day to seek to love my non-biological children as much as any biological children I had. I know there is a difference, but my goal was to minimize that difference as much as was in my power to do so. And anyone that knows me, knows I have kept that vow. Of course I’ve made mistakes and I’m far from perfect. But I have been there. I have sacrificed and interrupted my life innumerable times. I have given on some occasions, far more than any biological family members have given them. I have opened up my home dozens and dozens of times to my husband’s FORMER wife and her family over and over again in order to make things comfortable for the kids. And I don’t mind… that is, until I get hurt or attacked or whatever. Then I wonder if I should make different choices.

I could go on and on but you get the point. I am challenged all the time by my professional peers, counselors that care about me, friends that love me- that perhaps I need to not always go that extra mile. Disappointment and hurt are part of the human condition and are inevitable. But is it possible that it might hurt a little less if I haven’t gone so far beyond the call of duty when it happens?

I don’t have any answers. I just keep wondering and thinking and wondering and thinking about it. But part of me also wonders if it is a futile exercise. The bottom line is, I don’t know if I am capable of living any other way. Sure, we can tweak things a bit, but overall? I’m not sure I know how to relate to the world in any other way but the intense way in which I do. I can provide evidence of ways that I have been a bit more self-protective and held back a bit so as to learn from the lessons I have encountered in my life. But overall? I will probably always love deeply like Henri Nouwen says.

I have met a few people who have chosen NOT to allow themselves to love deeply. They will not risk it. They just won’t. I adore them, but know I will be kept at a certain distance. It makes me sad, but then I have to admit, they seem happier than I am on a consistent basis. They are more alone, but they also don’t experience the aggravation and hurt as often. If I am totally honest, part of me is even envious of them. I wish I could distance myself and protect myself more.

Again, I’ve made some progress. I’m slowly, slowly learning how to be slightly more judicious in how I put myself out there. But the bottom line is, you never know when you invest how it is going to end. Just like with being an advocate, you don’t know when you will be successful so you just have to keep trying. And I will keep trying to take better care of myself, but in the big picture, I will probably keep loving deeply and keep praying for that fruit to show itself. Sometimes I just need a different perspective to see the fruit that is there, but sometimes there just isn’t any there to see. Somehow, I will seek to love deeply, but maybe more smartly too.


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More Purpose

Last week I wrote about purpose. This week on Facebook I posted a quote from my psychology magazine. Today I noticed that the headline of the article reads “Fulfillment of Purpose.” Hmmm…

I am going to repost that quote and add another from the same article by Mark Hubble, Francoise Mathieu, and Scott Miller. The article is talking about the purpose of therapists. “In the end, we don’t fulfill our purpose by providing caring, empathy, and compassion, no matter how lovingly extended. We do fulfill our purpose, however, when we consistently engage in the kinds of therapeutic practices that objectively promote the client’s improvement. Further, genuinely and demonstrably helping people improve is the entire point of therapy and, in the end, the best of all ways to show that we really, deeply care.”

I had mixed feelings when I read this. Often times I am amazed by the way my personal life dovetails with what is going on in my professional life. This is one of those times that as I read those words, I can’t separate how I feel as a therapist, with how I feel as a client myself, or how I feel as a human being in general.

The ultimate goal is progress, change, growth. When I run groups, I stress that. We are here to support each other, but if we aren’t working toward change, then you are paying for a bitch session. Come and spill your guts, get validated, but then let’s talk about how to move forward.

When that happens (i.e. we have an “aha” moment and actually move forward) in therapy or in life, it is very gratifying and satisfying. Knowing that things actually “work” is a great experience. But what about when we are stuck? And what if that statement is even wrong? Being “stuck” implies that you should be moving forward. What if we are just meant to be where we are? What if right now is as good as it gets? There also seems to be wisdom in that Eastern thought of contentment exactly where you are.

I recently had a talk with one of my clients about this before I read the article. I’ve been seeing her over ten years. I’ve been seeing her husband less than that, but still for several years. They were having one of those repetitive arguments where they both had good points. He said, “We’ve been talking about this for years.” She looked at me, shrugged her shoulders, and said, “I got nothing.”

I was listening to them, thinking the exact same thoughts. They both have good points. I don’t know that they can/will change. I have no idea how to help them past this one. (Wasn’t a life-changing argument, just one of those annoying living with each other things.) I looked at them, shrugged my shoulders, and said, “I got nothing either.”

And they pay me!

Later, she and I were talking in her individual session. It was one of those conversations about angst and the circular problems of life. You do everything you can, but fundamentally things don’t change. I could totally identify with her. I said that sometimes I feel like I would do her a better service if I referred her to someone new who had more wise things to say other than validate her frustrations. She emphatically told me that she would end up walking away from a therapist like that. One of the reasons she has continued all these years, is because I am genuine and real, and she feels like I really get it.

I’ve been seeing my therapist for 15 years. People ask me sometimes if I should change it up. I guess what I’ve concluded is that even if my life doesn’t radically change, I feel good for that 50 minutes I am there. He knows me inside and out. He challenges me and tells me things that are hard to hear sometimes. But overall, it just feels better to have a compassionate ear.

All that flies in the face of what that article says. I guess I don’t fully agree or disagree. I think ONE of the purposes of therapy IS to deliver compassionate care. But another very important purpose is to help people change and grow. I guess that is the bigger purpose. Perhaps the steps to get there require the caring.

In my own life, and my professional life, my purpose is to grow and change, by providing compassion and love. And when the change is slow or non-existent, and I am left with people who care, I prefer not to think of that is failure. Sometimes that is as good as it gets. And if you truly have that love and understanding, that is pretty damn good.