Partner in Pain: Pain Series Part 8

Hey ya’ll. I was recently reminded that it can feel daunting to enter into a relationship with an individual with a chronic pain condition and I wanted to talk about it. So here we are.

First, a shoutout to the people in pain: You are 100% worthy of love and partnership, diagnoses included.

Now, to the potential and active partners:

The fact that someone is sharing their diagnosis with you is a great start to a possibly great relationship. The risk that the person sharing has taken by being so open with you suggests to me that they are taking this leap with some feeling of security that you will catch them, or at least ask them where the net is so you can run and grab it for them.

What do you do next?

1.     Do your research.

When someone shares their diagnosis, do the work. It’s not the responsibility of the person sharing to fill you in completely.

*Helpful tip, don’t just read the WebMD or Mayo Clinic write ups. While sites like those can be very informational, I find a more humanistic approach is to read or listen to firsthand accounts about the diagnosis from individuals actively living with the condition.

2.     After educating yourself a bit, ask your partner what their experience is like.

Not everyone experiences the same diagnosis in the same way, so it will be helpful to understand what your partner’s unique experience is. Remind them that how and when they communicate that information is on their terms (check earlier blogs on how to communicate about pain). My guess is that both your curiosity and the permission to share as they wish will earn you brownie points 

3.     Learn their do’s and don’ts.

What meds do they prefer in which situations? What foods and drinks help and hurt? Do they prefer ice or heat? What’s their favorite movie to watch, music to listen to, clothing to wear? Do they want you to hold them and tell them a story or do they want to be left alone in a silent, dark room?

4.     Recognize that even with a full medical degree under your belt, if you do not personally live with chronic pain, you will never truly understand what it is like. And that’s okay. You can still be a rockstar support to your partner even without that lived experience.

5.     Be introspective and honest with yourself if this is something you are willing to work at.

If you are an individual who is considering a relationship, actively dating, or long haul committed to a person who has chronic pain, you are not a horrible human for feeling overwhelmed. It is overwhelming to be around pain chronically.

6.     Just don’t take it personally. 

Living in pain is tough stuff and when someone run out of spoons, they don’t have much left themselves, much less you, no offense. But please, feel your feelings and let your partner know if they have been ineffective in their communication. You are not a burden for also having needs in the relationship and it’s your right to be able to share them with your partner and for them to be taken into consideration as well.

7.     Be effective in your communication.

Above is not permission to throw what they said or did in their pain rage back in their faces when they are feeling better. They know what they did and they probably already feel bad about it. Chances are starting a conversation like that when they are finally feeling better isn’t going to be helpful for anyone. Learn one another’s love languages and don’t be afraid to communicate your preferences and boundaries then advocate for both.

Brief intermission while I ask my partner about his recommendations. He is after all the best partner in pain.

1.     Realize that sometimes there’s nothing you can do.

Same bro, same. Hopefully it’s validating to both parties that it is so frustrating that there is not always a “quick fix” to the problem. You can share in those feelings together, and sharing is caring. 

2.     Learn to accept #1.

It’s hard for a person in pain to accept that these sensations might occur for the rest of their lives and it makes sense that their partner might feel a little hopeless about it sometimes too. I say to both parties, acknowledge that right now the typical tools are not working right now. I wouldn’t be so quick to accept that nothing will work because things can change, even moment to moment. Give it a minute and try again or try something new, it might work!

3.     It’s okay to ask questions.

When you are better informed, you are better prepared to proceed as needed.

4.      Know that things take time.

Getting a diagnosis can take time. Finding meds and therapies that work take time. Figuring out the do’s and don’ts as a person in pain and as a partner in pain take time. Adjust expectations accordingly.

5.     Be nice.

Find things your partner likes to do and can do when they’re in pain and offer to do those things with them when they need a distraction (see told you he was good at this)!

So, to the partners in pain out there, thank you. That sentiment sometimes gets lost in the sauce, but we see your efforts and they are so appreciated.

Validation Station: Pain Series Part 7

If you read my last blog (I mean if you haven’t, go go go) you know that I love to use gas in the tank as a metaphor for the amount of energy that we all have to use as needed throughout the day. I mentioned that over time, we can each find and develop skills that are effective in giving us a little extra gas. I’ve also written about pressure. People talk to me about it every day: parents, teachers, peers, all wanting to do and say the right thing to best support their people in need. Throw it back to something I wrote about in March of 2021, validation still remains as relevant as ever and in my thoughtfulness about the topic, I think it’s something worth sharing. A great way to fill up your tank or fill up the tank of others is to go to the Validation Station.

Yes, that sounds silly. Yes, I clearly spend most of my time with kids. Yes, I’ve always loved to rhyme. We done? Great!

Story Time

I’m travelling to Madrid with my husband in a few weeks. Other than one amazing trip planned for us (thanks @Tripscaper) to Costa Rica last November, this feels like the first trip we’ve planned just us two for longer than a few days that is reminiscent of the travel we had together in our late teens, early twenties. One thing is for sure, there will be lots of walking.

Now with time, weather, and all the therapies, my body has been feeling pretty good lately *knocks on wood* Don’t get me wrong, my body still feels pain every day, but we’re averaging 6 or under on the scale. I recently purchased new running shoes and some comfortable flats to break in for the trip and yesterday I walked around my town in the morning and then the mall for a few hours with my sister in the afternoon. Lovely day, no major discomfort. 

I woke up this morning and there’s no exaggeration when I tell you that simply the sheet touching the top of my shin gave me the goosebibbles (if you don’t connect the reference, I insist you stop reading to watch Happy Feet, like right now). No joke, a light fingertip swipe over my shin sent the alarm bells ringing in my brain. Visually, I imagine my brain in chaos like the feelings characters running around screaming at the end of the movie, Inside Out, when the adolescent boy is startled by a *girl! girl! girl!* Haven’t seen that movie either? Ya’ll that’s a good one.

Immediate panic: Oh no, is that a shin splint or a stress fracture?

That may seem overdramatic to some; although, that could be my mean brain judging myself without compassion. What a bully.

But it’s not without reason! Last year, I had physicians debating whether one night of light dancing at a friend’s wedding left me with a stress fracture or a really bad sprain in my foot/ankle. Either way, are you kidding me?!

 Then onto the next fear and so it goes: What if I’m still injured for the trip? What’s going to happen with all the walking? I don’t really want to be in pain in Madrid. I don’t want to have to change our plans. Pain has already taken too much from me.

 I’ve moved through a couple steps this morning already and wanted to share. It is short but certainly not simple. These steps don’t always come naturally and take practice.

 Step 1: Don’t hold it in, that stuff is icky and you don’t want that mental gunk inside of you.

 I was texting with said mall sister this morning who happened to be with my Dad (one of said physicians). After scolding me about flats, he helped me convince myself it likely wasn’t a stress fracture. Whew, a little better.

I texted my husband, who no matter how busy I know he is, always responds immediately and sends me a slew of messages only confirming him as my biggest cheerleader, no contest.

Now I’m writing about it, because writing helps me organize my thoughts and feelings; thus, I can better and more easily process everything. Bonus: hopefully sharing helps one or two of you.

Step 2:  VALIDATE

I am recently certified in Pain Reprocessing Therapy, but after a self-assessment, I’m not sure this pain is neuroplastic.

Even if I’m open to the idea that it is and engage in mindfulness and Somatic Tracking, there’s something missing.

Validation.

By skipping over that part, I’m missing an opportunity to talk directly to the negative thoughts that frankly at his point have me feeling pretty upset.

As someone with chronic pain, both structural and non-structural, my body & my brain are more prone to feel pain sensations. So, when I feel a twinge in my shin that some runners shrug off and take for a run, I feel panic and start thinking about all the negative implications of these sensations on my very exciting upcoming plans.

As someone who has known pain and lives it every day, you have to remind yourself that this is contributing to your physical and mental experience in the moment.

Don’t be so hard on yourself. This isn’t dramatics, it’s biology.

It is frustrating to walk around the mall in reviewed and endorsed, comfortable flats and wake up in the morning in significant pain.

 It is scary to think about your future plans being compromised by something that has already impacted your life and decisions so much for so long.

 Ahhhhhhh, taking a deep exhale even as I type these statements. I feel like someone just brushed my hair or put their arm around my shoulder.

Step 3: Now that you’ve affirmed those feelings and opinions, you can reach for those tools that you have accessible to manage them as best you can. See previous blogs for a list of options 

When I was diagnosed with Trigeminal Neuralgia, I found this online community, @GettingonMyNerves5k and the gem of a founder has a tradition of posting “Take What You Need” options on her story. I think it is genius and so soothing and supportive.

With permission from her and validation from my practice partner (see it really works!), I’m going to put a little spin on it and give you a virtual Validation Station, so you can fill up your tank with gas if you are running low. Check out our stories to see which one you connect with most!

Stay tuned because this Pain Psychologist is just getting started…

Let's Talk About the Small Stuff

I would bet that most people have heard the motto: Don’t Sweat the Small Stuff. I fear that somewhere in translation, we all internalized the idea that small stuff does not matter, and we are behaving accordingly. I’m here to scream from the rooftops that SMALL STUFF MATTERS! I’m not standing on this soapbox because I am literally small stuff, measuring in at a mighty 4 feet, 10 inches (and 3/4!)! This comes up a lot in my therapy work with teenagers and when I include the topic in my presentations with James’s Warr;ors, the positive student reception is often noted afterward.

Each of our days is comprised of lots and lots of small stuff. Waking up on time, getting out of bed, washing up, getting dressed, eating a proper breakfast, making it through school/work, daily chores, interactions with teachers/bosses, peers, family, and preparing to do it all over again. Every. Day. If we don’t complete these day-to-day tasks, we’re often met with frustration, maybe from others, maybe from ourselves. There is an expectation that we should all be fully capable of completing each of these tasks in a timely manner, at the desired quality, and if possible, with a smile on our faces.

When we don’t do one or more of these things, we feel terrible, like we’ve failed, and often lose motivation that could propel us forward to some of the upcoming tasks on the agenda. I need ya’ll to take a step back and think about the effort that is required to complete the daily to-do list and what might impact a person’s ability to do so.

Let’s start with the day before: Maybe there was a stressful test or work project due that required more focus and motivation leading up to and more than normal amounts of anxiety during the task. Maybe because you are stressed you aren’t eating as much, or as well. Your sleep schedule might have been thrown off a bit, so you could be extra tired. That stress may have left you irritable, which perhaps caused some frustration between friends. Even just one of these very likely occurrences influences your energy level available to tackle the following day.

Metaphorically, I usually explain it like a tank of gas. Best case scenario, we all wake up with a full tank of gas. But if we have a bad day like mentioned above, you’re probably waking up with a little less gas. Then every little task you manage to complete is more gas out of the tank. For some, it could be the middle of the day when they are running on practically empty. It’s no coincidence that children are often a little riled up and more distractible when they get home from school. They’re running low on gas. Honestly, it applies to adults as well. I know there are days when I get home and my lever is on E.

People with chronic pain/illness may recognize this as the Spoon Theory, which is why many of us adopt the title of “Spoonie.” Similarly, it’s the idea that we all have a certain number of spoons every day that equate to mental and physical energy. When you run out of spoons, you don’t have much left for anything else.

Even if you don’t realize it, many of you already have people, places, and things that can fill your tank a little during the day. Once you figure out who your people are, what settings, foods, movies, songs, comfy clothes, and candle scents work for you, you can make little pit stops and truck-a-long a little further.

You know what else helps fill a tank?

Acknowledgement, recognition, credit, for the small stuff.

Rather than ignore, or much worse, shame a person for the everyday tasks they did not complete, why not praise a person for the everyday tasks they did complete?! If you can use the argument, it should be “no big deal” to change from pajamas to work clothes, brush your teeth, or be polite at the dinner table, then I get to say it should be no big deal to compliment someone for their tiny efforts. Many times, getting that recognition increases motivation (aka fills up the tank) and allows for more ease and less energy exertion to complete other tasks throughout the day that may have felt difficult or nearly impossible without a little extra gas.

We are all not so great at pointing out the positive things we’ve accomplished every day. But, with external reinforcement happening more often around us, our brains are more likely to catch and highlight the small stuff we are checking off our to-do list in a positive way.  It’s a nice reminder to ourselves that we are doing our best and there’s nothing small about that.

To Text or Not to Text? Pain Series Part 6

Oh, hey!  It has been a few months since my last blog post in a series focused mostly on communication: how to talk, how to listen, and why it’s all so important.  I want to dedicate today’s post to the times when people in pain are quiet.  I know in the past I have encouraged readers to respect requests from others for privacy about certain topics, while also encouraging people to share those experiences they are holding most private in an effort to feel supported.  I’m talking more about the times when someone notices that they haven’t heard from a friend in a while or are feeling that conversations with that person are one-sided.  The goal?  Hopefully to validate those in pain and those in their lives that are feeling some sort of way about their communication with the aforementioned individuals.

I think I have pretty good manners and I’d like to think I’m well versed in interpersonal etiquette.  I also highly value “my people” and know that reciprocity in communication is an important part of my relationships with them.  But even though I know that if someone texts me, I should text back or if I’m thinking of someone, it’s nice to let them know, sometimes I literally just do not have what it takes.  And I get it, “all it takes is one text,” but there is so much that can be wrapped up in one simple message. I’m exhausted just thinking about it.    

Reaching out to someone after a while might warrant a well-meaning but snarky response:

·       Hey, where ya been stranger?

·       Finally!  I’ve been wondering where you were.

If a person is already in pain, whether it’s emotional and/or physical, a response like that is salt in the proverbial wound.  Even if it is pretty clear it’s a joke, they still might be left wondering how much truth was behind the response.

The person receiving the text might take advantage of the window and try to engage in full-blown conversation:

·       Fill me in on everything!

·       I have to tell you about x, y & z!

It is important to remember that the texter might have been in a place to say “hey,” but that might be the extent of what they have to offer someone.  Remember, each person only wakes up with so much energy to tackle the day-to-day stuff (chronic pain warriors sometimes refer to this energy as Spoons).  Pain of any sort takes up a lot of that energy and a full-blown convo may not be on the agenda in terms of Spoon budgeting for the day.

Let’s say a person has saved up some Spoons and is in a place where they are ready to connect with someone and really catch up.  The text is sent…and there’s no response.  Hopefully this isn’t a full ghosting incident, but rather the person is just busy and texts back later.  The problem?  Later wasn’t part of the plan and the person who initiated the chat might not be as ready for the conversation later as they were earlier. 

To the people stressing about how long it’s been since they’ve reached out, wondering if their people are upset, hoping no one has noticed and it’s not that big a deal, I say this:

·       Cut yourself some slack.  You are going through it, and ultimately you are the expert on how to get yourself through as unscathed as possible. 

·       Don’t be stubborn.  No one should be going through tough stuff on their own. 

·       Reach out to your people.  You chose them for a reason. Give them a chance to remind you why.

·       You can’t read your friends’ minds, so you can’t just assume they are upset with you, or that the conversation won’t go well.  The only way to find out how they feel and what’s the deal with your friendship is to say hey.

Now on the other hand, I get that it can be upsetting to feel ignored or wonder if you are valued as much as you value another when they are not acknowledging memorable events in your life or even simply checking in.  Totally valid!  I’d just like to provide a little perspective…

Take birthdays, for example.  They are a big deal to a lot of people, celebrated in different ways throughout the lifetime.  You’ve got parties and cake from the time you are a literal infant to middle/high school displays of popularity (what you guys didn’t have contests about who could accrue the most balloons on their special day too?!).  With social media, do you even love the person if you don’t create a collage and publicly display your best wishes and affection for them on their big day?

The answer is yes, let that resonate with you. 

I have a master calendar of birthdays because despite my excellent memory (self-declared after undergoing numerous assessments in my Neuropsych Class in Grad School) I cannot for the life of me keep track of all my family and friends’ birthdays.  Even so, I have still let an important birthday pass by without acknowledgement because checking the master calendar falls low on my list of things to do on any given day.  Honestly, on a tough day, I am not always sure of the actual date.  Even the day of the week can lose importance when a person is literally trying to make it until “tomorrow,” no matter where in the week tomorrow happens to be. 

I’m going to let you in on a little secret…this is totally normal!  Don’t get down on yourself if you lose track of time or miss something, it happens to everyone.  It’s important to be compassionate with yourself and others because you never quite know what someone else is going through. 

Just because someone isn’t reaching out to tell you they smiled thinking about how much fun they had as coworkers or how cute the endless videos of your toddler they are watching are doesn’t mean those things aren’t happening and that they don’t love you and miss you. 

To those waiting in silence wondering what’s up with the unread text messages, or worse the read messages that have gone unaddressed, a friendly reminder:

·       Everyone gets overwhelmed with something at one time or another. 

·       Be patient with your people. 

·       When your patience has run thin, and it will, because that’s real life, gently reach out to let them know you miss them and want to dedicate some time to reconnect. 

·       Again, telepathy is hard to come by, so you can’t expect anyone to change their behavior based on a feeling you have unless you tell them what’s going on and how you’d like circumstances to change.

Moral of the story: Send the text.  Doesn’t matter what side of the conversation you are on.  Honestly, it doesn’t even have to be words…have you seen the Memes that are out there nowadays? HA!

Why a Series on Physical Pain for a Mental Health Blog? Pain Series Part 5

I’ve asked myself this a few times while writing this series.  The thing is, there is such an emotional component to physical pain.  I mean, there is a whole field of psychology committed to researching, discussing, and improving the brain-gut connection. 

So, it only seems fitting that the underbelly of psychology is a perfect place to start.  It can sometimes be a chicken or the egg situation, right?  My stomach hurts and now I’m worrying about it versus I am worrying and now my stomach hurts.  Then my favorite rollercoaster ride: I am worried about my stomach aches, so it is hurting either way.  Stomach aches and other related physical aches (i.e., headaches, body aches, etc.) are not only connected to anxiety, but can be related to depression, anger, and/or stress in general. 

Ya’ll know one of my first lines of defense is tapping into those five senses.  However, the things I reach for when I’m not feeling well are specific to my physical experience when compared to what I might grab if I’m feeling mentally stressed. 

For example, when I might normally reach for something sour or spicy to distract my tastebuds when I’m overwhelmed emotionally, I always make sure I have something minty (hard candy, gum, tea, the works) when my stomach is upset.  I’m also a big fan of ginger, especially candied ginger when I’m not feeling good.  I have certain pajamas, preferred blankets, and specific kinds of music and movies I like to utilize when I’m physically sick.  There are even certain parts of my house I like to lounge when I’m feeling badly.  If you’ve read Blog #4, you know I firmly believe that the body creates associations between our physical and mental state and the places we’re having those experiences.  Even though there’s nothing I want more than to curl up in bed and stay there when I’m feeling ill (and don’t get me wrong, I do do that sometimes), I’ll try and lie on a separate couch outside of my room.

When I’m experiencing a pain flare up, it’s a similar process.  I have certain places and tools I use to decompress, distract myself, and eventually move through the experience.  One big thing I have learned from chronic pain is that it is not just a physical experience but creeps into your emotional state as well.  The resulting intrusive thoughts and anxiety can be debilitating.   

Waking up in pain is not a great way to start your day, almost worse is waking up feeling okay but tip toeing around your actual life waiting for the other shoe to drop.  Even if you have a relatively pain-free day, at least part of you is in some way affected by the fear:

·       Will it last?

·       If it doesn’t, will the pain be the same? 

·       Will the normal tools work? 

·       Did I pack everything I might need?

·       Should I tell someone if I’m hurting?

·       If I do, will they believe me?

·       When’s the next appointment with the doctor to make sure everything is managed appropriately? 

All day, every day.  Nighttime is both a blessing and a curse, knowing that sleep might be the one, safe space where you know aside from normal tossing and turning you will be relatively free of pain, your body and your brain in recovery mode.  But there are still those lingering worries about what it is going

to be like tomorrow.  You develop a distrust of your mind/body.  If something new happens:

·       Is this just another version of what I’ve already experienced?

·       Is this something new?

·       Is this a side effect?

·       Should I make another doctor’s appointment?

·       Will they believe me?

·       Is this getting annoying for those around me?

How might this distrust affect your average person’s everyday life?  Well for those that know me, they know that I have a bunch of ear piercings and a couple tattoos.  I have had ideas of new piercings or new tattoos and prior to my pain, my biggest decision was of what and where?  But because I don’t really trust my body anymore, I can’t be certain it has what it takes to fight off infections and keep me safe.  Fear not readers, there is always a way to figure out how to achieve your goals (generally speaking, of course)!  Not going anywhere near a Tattoo/Piercing Shop anytime soon?  No problem.  I have a few websites I order temporary tattoos from where I can be creative with pictures and placements without worry.  My family even jumped on the bandwagon and got me some really cool ear cuffs (just my existing lobe piercing necessary) so I could get creative and feel more edgy rather than on edge. 

For me, this distrust has also provided me with personal insight into all of my kiddos’ lives who physically experience their emotional stress. For example, one of the primary criteria for Panic Disorder is “persistent concern or worry about additional panic attacks or their consequences (e.g., losing control, having a heart attacks, “going crazy”).” 

How stressful to first have even experienced something so emotionally and often times physically taxing in the first place, but then to constantly be thinking about the fear of if and when it will happen again.  Living with chronic intrusive ideation or experiencing chronic pain, not only impacts your thoughts but your own nervous system’s natural response to the world, in danger or not. 

I encourage my clients to use their Fitbits, Apple Watches, or good ole fashioned fingers to track their resting and active heart rate, because sometimes the body can trick the brain into thinking they are in more danger than they are.  Rapid heart rate (or feeling as though your heartbeat has increased) is a common side effect of worry and panic.  Knowing your resting heart rate and having access to your active rate can be used to check those worries about your physical responses to stress and tell yourself that even though it feels like your heart is beating out of your chest, it’s really not much faster than your resting rate.  You are safer than you think, but that does not diminish the physical experience or the overall toll that this whole process takes on your mind and body. 

This week was a toughie pain-wise and after what seemed like non-stop brain chatter, I thought, “What if I feel this way forever?”  That really got to me because I take on this pressure to “handle” both the physical and mental components of this particular experience and I was feeling down on myself for even allowing such a negative idea to make its way into my mind. 

How could I be so pessimistic?  I’ve worked hard to get where I am professionally, I don’t want to “let my pain win” and forego some opportunities because it’s going to be hard on my body.  I can’t give up! 

But I’m not giving up.  There’s such pressure to get a handle on all of this.  Pressure from others, but also from myself.  I mean, I’m a Psychologist with over a decade of school, training, and experience learning how the brain works, how it interacts with the body, and how to effectively talk about it all in an effort to manage it successfully.  I, as many of my clients have reported to me, feel a sense of failure when this mental game rears its ugly head because others may assume, or actively remind us that if those negative thoughts still exist, we must not be working hard enough.  Trust me ya’ll, we’re doing the work.  I remind clients every single day that even if therapy is a complete success, they’ve developed insight into their experience, and are implementing the skills they’ve learned work best for them, those negative thoughts will never fully disappear.  They exist and unfortunately we have very little control of when and where they decide to pop up.  Fortunately, we have lots of control on what to do once they do.

What did I do?  

I let those thoughts come to the surface, because keeping them inside never works out for me.  I cried a little.  I went for a run.  I made a dairy-free personal pizza (Thanks Daily Harvest!).  I acknowledged the realizations I had above.  I made a promise to myself that even if the feeling had passed or I just didn’t want to remain/put myself back in this space later, I would tell my husband about all the feelings and then decided it was important to put them down here.  Maybe just as an exercise in getting it off my chest, but hopefully more in an effort to remind you that you aren’t alone in these thoughts and it’s okay to be sad.  Today requires enough energy, no use in giving tomorrow or next year or 10 years from now much of it, because honestly, I, like all of you, have no idea what’s going to happen so it wouldn’t be the best use of my time to judge myself for the negative thoughts I have about myself in the future. 

In signing off today, I don’t want to place any additional pressure on you to sit in a “bad” day or do whatever it takes to have a “good” day.  I’m just going to quote The Odd Life of Timothy Green:

Have the day you have!

Picking a Provider: Pain Series Part 4

Have you had a chance to start sharing your story, curating your schpiel, feeling understood and supported by family and friends around you? 

Perhaps you already have a full network of providers (read: PCP, multiple pain management specialists, a PT, GI, neurologist, rheumatologist, acupuncturist, therapist, etc.)?

Maybe you are just now feeling ready to share your story with providers and don’t know where to start?

This is for the latter group and it warrants a full blog post because it can be quite the overwhelming process.  I mean, there have been times I have found myself lost, frustrated, and waiting months to be seen only to be ignored while in the room and rushed out in a few minutes time.

I also want to preface this by clearly communicating that I think providers of all backgrounds are smart, well-intentioned individuals and while I am borderline in love with some of my providers (I hope you know who you are), I feel like I take something positive from even my less-than-stellar experiences because they help push me to advocate for what I feel and what I want, a trait I think I can take with me for the rest of my life.  I also want to open up the possibility that Western medicine providers aren’t the only ones with answers.  Explore Eastern practitioners and see how you respond to their treatment plans.  You don’t have to choose one over the other.  I proudly subscribe to both approaches to wellness and find the most relief using a combination.

Some tips to find and connect with a provider:

1.       If you have a provider of any specialty already, ask them if they have a referral source.  Chances are, the people your trustworthy provider will connect you to will be trustworthy as well.  If not, hopefully your comfort level with that original provider will give you the chutzpah to report back that the referral did not work out and they should think twice before referring to that provider again.

2.       If you don’t necessarily have a trusted provider, start looking within the network you currently use.  Locally we have Caremount and Healthquest, in addition to many individual primary care providers. I have providers sprinkled everywhere and it can be difficult for your different providers to have access to the records and findings of your other providers, which is always nice so that they can work to best understand the big picture. 

3.       Two websites (there are more) to look specifically for mental health providers are Psychology Today and TherapyDen, where you can also type in your zip code and some key words and a variety of pages will come up where therapists post their pictures and a little bit about themselves and their work.

4.       Insurance company websites usually have an option where you can type in your zip code and type of provider you want and they’ll provide you with a local list of in-network options.  Unfortunately, not all providers are in-network and will have to be paid out of pocket.  I highly recommend calling your insurance company to ask about their reimbursement policies because many times there will be an option for you to receive at least partial reimbursement for services completed if you submit a receipt afterward.

5.       I know many providers have options now to book online, which can be the preferred method for individuals trying to schedule something.  Keep in mind, providers might also have some extra availability for individuals who call on the phone looking for an appointment.  So, don’t give up if you see a gray-ed out calendar with no openings.  Give them a call and see if you can get it that way.

Hallelujah you found a provider and you are about to have your first appointment! 

How to best prepare:

1.       Write down on paper, computer or on your phone details of when you started experiencing symptoms, how they change, and if you have any insight into what helps and what makes it worse.

2.       If you don’t have as much experience sharing your story with those around you, maybe practice the schpiel that you’ve prepared for the provider with a trusted family member or friend, maybe even someone who has watched you go through the experience and can remind you of things you may have forgotten to include.

3.       Manage your expectations, a hard lesson I learned along the way.  I used to walk into appointments feeling so relieved that I somehow survived the pain and would leave knowing exactly what was happening to me and with a treatment to be started immediately that would work 100%.  I now understand that is not at-all a reality-based expectation and have reframed my hopes accordingly.  10/10 recommend!

4.       To that end, have someone(s) who knows you are going to these appointments and what day/time they are occurring.  This is good for two reasons.  First is that they can and should text you the day before or day of to check in or wish you luck, which feels really nice.  Second, people can be prepared to hold space for your updates *cough cough, tears* about how the appointment went.

Now, you’re in the office, talking to the provider, answering their questions, and moving forward with next steps. 

How to advocate for yourself:

1.       It can be overwhelming being in an office with someone you don’t really know divulging really personal information.  Maybe you didn’t write down questions you wanted to make sure you asked or you forgot them as you were running out of the house.  I’m a big fan of having someone (i.e.,  Mr. Dr. Arnoff) with me (even if it’s on facetime, thanks COVID) to remind me of things I wanted covered during the appointment.

2.       If there’s a recommendation you’re not as comfortable with, express your concerns.  I have had some side effects to certain medications before and when it was brought up as a preferred treatment I would just accept that to be best practice and didn’t say anything.  Turns out, there’s more than one treatment plan that can be used to address a singular thing.  No need to suffer, you’re going through enough.  Speak up and see if there are other options that would make you feel more comfortable.

3.       Something I say to the parents of my young clients is “I might be the expert in childhood X, but you are the expert on your child.”  Same is true for you and your body, no matter what is bothering you.  These providers are experts on the human body, but you are the expert on your body.  If someone doubts, downplays, or down right ignores you when you tell them what you’re feeling, they are not the right provider for you (and would likely benefit from a Psych 101 lesson on empathy.  Please refer them to BFF Therapy and we’ll make space for them :-)

After the appointment:

1.       If it goes well, YAY!  Jump for joy, call your people, take a deep breath, buy yourself a treat, you freakin’ deserve it.  If it did not go the way you hoped, let it all out.  Also buy yourself a treat (sweet tooth, sorry not sorry), cry, scream, punch your pillow, go for a run, take the nap (follow Bbear_DontCare on Instagram for napping puppy pictures that will change your life).  Your body is already holding so much physical/emotional pain, it doesn’t need more.  You might be feeling isolated in your frustration, but I bet you will find that those you share your experience with will be equally frustrated on your behalf.  It’ll feel nice, trust me. 

2.       If you don’t feel comfortable for any reason with your provider after your 1st, 10th, or 100th appointment, it is your right to A) share what’s bothering you with them and/or B) find a new provider that is a better fit without explanation.  I know it can feel like you are taking four steps backward, having to start from the beginning, waiting for what seems like forever for a new appointment, but it will feel just as long and frustrating to stick with the provider that isn’t doing it for you.

Do not allow anyone to make you feel like any of your pain is your fault and that you are not doing the very best you can to feel better. 

Last tip: KEEP GOING.  I understand the feeling that comes with leaving with minimal to no validation, a follow up appointment that you have to wait three months for, and two other specialists you need to do this with all over again.  But remember, you somehow made it to this appointment, you will make it to the rest of them.  It’s encouraging to also have providers you still get giddy about when you see their name in your calendar.  You know you’ll be able to share every weird, personal, perhaps mortifying detail of your time between appointments with them, tears or jokes and all (whatever helps you feel better).  You practically skip out of those appointments because they remind you that even if you don’t have all the answers now, you will figure it out, you will be okay.

For the Listener: Pain Series Part 3

If you’ve been keeping updated with our pain series, you may have someone in mind that you have been worried about, maybe someone who’s given you a peek into their struggles managing pain, or maybe someone has recently opened up to you about some of their painful thoughts or feelings.  Like many others in similar situations, a common question that pops up is “Now what?”

A pretty normal urge that sometimes follows someone opening up about their tough stuff would be to get all the deets.  I get it and I love to ask questions as much as the next person, but this is not necessarily the time to be information-greedy.  Don’t get me wrong, some people find it most helpful to share all of their “story,” but it’s case-by-case, and it is best to let the person sharing take the lead.  In an effort to prepare you as best I can, I think there are a few good ways to approach the conversation.

If you are left wanting more, you can ask the person sharing if they feel comfortable with you asking them more about their experience.  If they say yes, let them know/remind them often that if at any point during the conversation they are feeling drained, you can talk about something else or simply end the call/text and chat again later, no problem.  This is on their terms, not yours.

They are likely going to be feeling out your preferences and your responses throughout the conversation and may forget to check-in with themselves about how they are feeling.  Recently, I had a conversation with an old friend who wasn’t up-to-date on my pain stuff and I was giving her “the schpiel” (if you know, you know).  After I finished, she asked how I was feeling having just shared all that information and I realized 1). Since I was physically feeling okay in that moment, I hadn’t checked in with myself about how I was doing emotionally re-living some of my not-so-fun recent past and 2). It felt so nice to be asked that question!  It was like validation I wasn’t hoping for or expecting that communicated that the person truly cared about my overall well-being and that it wasn’t silly to sometimes find myself stuck in the pain, because it was tough enough for someone on the outside who hadn’t personally experienced it stop and ask how I was doing just talking about it.

*Quick note to prep “a listener:” While you are listening, give nonverbal cues often (if they can see you) like nodding and leaning forward, say things as small as “mm hmm” or “okay” frequently, all to show that you are engaged and following their story without projecting anything specific onto it or them.  Chances are the person is working hard to methodically share their experience (the schpiel) without too much emotion as to not overwhelm you or themselves, so responding with things like “WHOA” or “OH MAN THAT STINKS” may not be as helpful (classic play therapy rule of thumb!).  If you are a more advanced active listener, you can try and use the words (or something in the same wheelhouse) they used to describe the experience and repeat it back to them.

Example (Sharer): “I had to go from provider to provider and no one would take me seriously and I was hurting the whole time and just ugh.”

(Listener): Ugh, that sounds like it was really frustrating.

I’m telling you, works like magic every time. 

Keep in mind that by asking if you can have more information, they could say no, and you need to be prepared to honor their feelings on the matter right then and there.  If they say no, you can ask what might be helpful for them in the moment: a new topic, a funny distraction, listening to music together without much talking, switching from talking to texting (helps me sometimes, especially when I’m physically hurting), or maybe resuming the conversation at a later time. 

I cannot stress this enough: Validate them either way.  If they gave you all the details, let them know that it must be so *tough, *frustrating, *any feeling they mentioned or you got from them during their story, to go through or be going through X.  Then thank them for sharing what they did and let them know you are always available to support them in whatever way they need.

If you are experiencing chronic pain, whether it’s nerve pain or everyday intrusive ideation, here are some of the Instagram accounts I follow to feel less alone and also laugh (the combination of both really hits my sweet spot)…I would highly recommend @chronicillnesshumor, @chronicallycranky, and @how.u.feeling.  If you are not currently experiencing any physical or emotional pain, I am so genuinely happy for you and encourage you to take advantage of every moment. 

I bet everyone knows someone that is in some sort of pain, so in order to prepare for these tough conversations you can also check out these accounts to get some quick insight into how it feels to hurt, framed with humor to make everyone more comfortable.  You might even be able to recommend the accounts to someone in pain that might not be aware of the resource.  Look at you, so knowledgeable, so empathic, so helpful – why haven’t they reached out to you sooner?!  For the person communicating, a positive experience sharing pain causes a ripple effect of endorphins.  For me, it’s a reminder that the voices in my head that kept me quiet and struggling alone are complete fiction because these conversations can go well and people will be receptive, and you will feel better.  Who knows, it could ripple all the way to a blog series about experiencing, managing, and sharing pain with the whole internet (hypothetically speaking, of course)!

Sharing is Caring : Pain Series Part 2

Hey again, Dr. J here.  I know when I hear the words sharing is caring, I’m usually thinking that the caring is for others.  However, when it comes to sharing tough thoughts, feelings, and lived experiences…I think it is very much about self-care.  As I mentioned in my last blog, pain is experienced in different ways by everyone and is most definitely not something you should be carrying on your own.  So how do you share these experiences with someone else?

The prep:  If you are feeling ready to share your thoughts, feelings, or experiences of pain with someone else, I always suggest getting it out there first.  Then you can check-in with yourself on how it feels to talk about these topics, what judgements you might have yourself, and what parts might be more difficult to share.  There is not just one “right” way to do this.  You can handwrite it, type it, even record yourself talking about it on your phone’s voice memo app.  Once you do, reading or listening back can be quite cathartic.  Once you’re done, you can also just store it somewhere hidden, rip it up, throw it out, delete it off your phone, whatever works for you.  If you want to make sure there isn’t a record of the story at all, blast some music, get in the shower, and talk about it aloud to yourself while feeling the benefits of the warm water and nice smelling soap! 

Don’t forget, this is your show.  Just as we’ve previously discussed having permission to feel (see Blog #5) it is your right to set boundaries.  Now, boundaries can be tricky for some people, especially if they aren’t used to others imposing them.  But you got 99 problems and this ain’t one.  It is something to think about before you have a sharing conversation with someone so that you are aware of your personal boundaries before, during, and after the talk.  This way, you can clearly communicate them to others without having to use too much energy or brain space.  I’ll give you a few personal examples:

The pre-personal boundary – Planning for the conversation: “I’m available on Sunday afternoon to talk and would love to plan on chatting then.  I’ll let you know Sunday morning how I’m feeling and if I need the conversation to happen over text or just reschedule for another day so I have the day to rest.”

*Quick interruption here because as I was typing to rest even I felt it in my gut, so I’m wondering if someone else is feeling the same way.  I know the pressure to be constantly doing things (see Blog #8) is a weight we all carry and that the idea of rest is often looked at as lazy or a waste of precious productive time.  Well, I’m sticking it to the man (see Blog #1) and trying really hard to listen to my thoughts and my body when it needs to recharge and I encourage you to do the same! 

Okay, you have made it to the middle of the conversation – woo hoo, you are doing great!  Keep going (or as you’ll soon read, stop whenever you want)!

The during-personal boundary:  Let’s say you are sharing and all the sudden you get the message from yourself that it’s too much right now OR someone starts asking you questions you aren’t feeling ready to answer in that moment.  You could start your response with statements like:

·       Hey, I’m feeling pretty drained…

·       Talking about this always takes it out of me…

·       I appreciate your interest in the details…

And finish your response with statements like:

·       …so/but I’m going to talk about something else now so I can still enjoy your company.

·       …so/but I’m going to go relax for a bit outside/on the couch, I’ll text you sometime soon. 

*Quick interruption #2 here because as I was finishing the last response, I was thinking, I should end it with “I’ll text you later.”  While I still think that “later” is a fairly vague time frame, some people might read and understand that as later that day.  You don’t need any pressure to chat any time you aren’t feeling up to it and you surely do not need to be overthinking their reception and now expectation of when you are going to reach out again much less the aftermath of a miscommunication that leaves you feeling bad when that night has come and gone and you didn’t text them.  Leave it open, give yourself options.  

Here is your friendly reminder that you don’t owe anyone an explanation.  I was just watching a clip of an Elizabeth Olsen interview when she mentioned that one of their family mottos is No is a complete sentence.  How refreshing, timely, and needed.  While the difficulties of using that single word to establish a boundary warrants its own post, I just wanted to acknowledge that no is a perfectly acceptable answer to use if you do not want to engage in further conversation, or conversation at all for that matter.

The after-personal boundary – After the conversation:  This is honestly a little bit of everything I’ve already mentioned.  If you’ve finished what you’ve prepared to say and want to answer questions, let them know.  If you’ve finished and you want to keep talking about something different, let them know.  If you’ve finished and want to go, let them know.

Now, this paragraph is tough to write because I don’t want to ever discourage anyone from talking about their tough stuff, but I’m all about transparency so…sometimes you might leave the conversation not feeling the way you hoped you would (i.e., relieved, supported, understood, happier, etc.).  For some, having these conversations might lead to that physical or mental deep breath kind of feeling, for others the listener may not have made this the most helpful conversation.  Every sharer and every listener are different, so if you try and it doesn’t feel like a success, I’m going to be a little pushy and encourage you try again, after you’ve taken whatever time and steps you need to get back to a place you feel comfortable to do so. 

Take home message: You are doing great and just because you have these tips does not mean that you have a timeline within which you follow through on sharing your story.  Stay tuned for next week’s blog where we will provide tips for the listener to facilitate the most successful share possible.  If you have any questions or comments related to any of our blogs or have ideas for areas to expand upon within this series, or any other topic, feel free to leave a comment or reach out to us on social media @bfftherapy

Working Up the Nerve to Talk About Your Pain: Pain Series Part 1

While we’ve been trying not to surrender to internal and external pressures out there (read our last blog post to learn more); we’re not perfect, we’re just like everyone else…a work in progress.  A thought that has been rolling around up there like clothes on a repeat cycle is the responsibility (read: obligation) we at BFF Therapy often feel to share our experiences, thoughts, and feelings, but only in a way that is perceived as helpful to who we hope is reading (i.e., kids, teens, young adults, parents, aw who are we kidding: humans! Although, you know we are fans of furry friends and are not objecting to the possibility of extra-terrestrial life that enjoys a good blog).  We don’t want it to seem like we use our outlets as personal venting opportunities or just make things about us.  I think at least for me (oh hey, Dr. J here), with this platform I just want to be the best role model I can be. 

I do try in session from my very first meeting with a new client to be completely myself in hopes that my kiddos really feel comfortable to do the same.  For example, I try and be a little goofy, make clear that I won’t always have all the answers, and remind them that the answer “I don’t know” is a totally acceptable response in therapy (no pressure, remember?).  But being comfortable to be completely yourself ISN’T always that easy. 

There are some things about my life and my experience that I don’t openly share in session because after all, it’s not about me.  But there have been things, especially over the past year or two that I have also kept from the people closest to me in my life.  Soooo, in an attempt to be a better role model, I want to talk a bit about some of my experiences with pain. You see, pain comes in many different forms; although, the overlap of physical and mental/emotional pain is real and will definitely be a separate blog post.  I want my clients to know that even if the idea of sharing your experience is uncomfortable and if there is also a voice in your head that says things like “it’s not that bad,” “other people have it worse,” or “I don’t want to seem like I’m always complaining,” your pain is valid and you shouldn’t have to carry it alone. 

I am not here to place blame on any one system specifically regarding the discomfort that comes with the idea of, much less the actual sharing of a person’s experience with pain.  It also feels like with this post, I am in some ways placing pressure on people, kids especially, to simply overcome their fears in this area and be vulnerable by sharing their pain.  Note, it has taken me over 30 years and lots of constant encouragement from some very special people (you know who you are) to get to this place, so why not share my can-you-call-it-wisdom? in the hopes that maybe by having/being a model and opening up the conversation about it, sharing experiences of pain becomes less stigmatized, more normalized, and easier for people to talk about, listen to, and support. 

Think about it: we are given the message from super early on that feeling pain or expressing discomfort is not something to attend to or to stop for.  When toddlers fall, we exclaim, YOU’RE OKAY!  Now please do not come for me, I’m a Child Psychologist and I know the theory and potential benefits of taking a scared little one and letting them know that they are/will be alright if they scared themselves after tripping over their own feet.  On the other hand, they are getting the message that whatever feelings they are having in that moment should be shushed and activity should continue immediately as though nothing happened.

I’m even guilty of perpetuating this in my own practice!  I once had a little sign in my office that said CHOOSE HAPPY! until one of my teens reminded me how ridiculous and frustrating the message was because she was not choosing to be sad and if she could simply choose to be happy with a snap of her finger, she would.   

Ugh, I am totally still procrastinating the sharing of my own stuff, but I never said this was going to be easy!  Look forward to sarcasm and movie references because that’s how I make hard things feel easier.  There is no right way to talk about tough stuff and it is not your responsibility to manage the emotions of others, so share your feelings and experiences however is best for you.

Many people that know me personally know that I have had a bad back for over a decade.  This has come with all kinds of fun side-effects, but most enjoyable is the chronic nerve pain hip-to-toe on both sides of my body.  You would think the waist down would be it, but over the past year and a half, there were new, little lightning bolts striking the nerves in my arms and hands too.  But wait, there’s more!  Over the past few months, this pain has traveled to my face.  We are talking head-to-toe!  I literally feel like the Girl on Fire in my body’s own personal version of the Hunger Games.  This is in conjunction with a bad gut, which is a discussion for another day.  The plan is that this blog is the start of many conversations and posts about how therapists are physically impacted by the work that we do, how the medical system has its flaws, and how verbal invalidation can hurt more than any nerve pain I’ve personally experienced and I just used the words fire and lightning.

Big goals, small steps.

Step One: Friendly reminder that pain is a human experience and is valid (CHECK!)

Step Two:  Acknowledge that talking about pain is tough and then talk about it anyway (CHECK!)

Step Three:  Discuss ways to respond to someone who then asks you how you are doing/feeling (Keep Scrolling!)

Once you get those voices in your head telling you not to talk about your pain to quiet down or go to another room, I bet the people that matter will check in on you more often because you are awesome and you are loved! 

I know it is so much easier to say, “I’m fine” or “Better!” when someone asks how you are doing or feeling.  I do it often.  But then I feel bad that I kind of lied.  Plus, pain is all relative.  Technically, if I was at a 10 yesterday, but today I’m at an 8, I am feeling better, but I am most definitely not fine. 

Here are a few examples of how to respond instead:

1). We can experience more than one feeling at the same time.  Something you might say is, “I’m not physically feeling great, but I’m glad to hear from you!” 

2).  Don’t be afraid to communicate your needs.  You know yourself best and can’t really be frustrated with someone’s response if you are not being honest with them about what you need.  You could say, “I’m actually hurting today and am so perfectly distracted by this Netflix series so can we talk later?”

3).  Fun fact: You don’t owe anyone an immediate response!  If you aren’t feeling up to checking or responding to calls or texts, you snuggle up with your puppy in your pajamas in your comfy bed, soak in that hot Epsom bath, or listen to a podcast if you think taking a walk will make you feel better, guilt free.

Keep in mind, what I shared today about my personal experience was focused on physical pain.  But as I was writing and re-reading this, I was interchanging the words physical and emotional, and you can read it with either or go wild and try both!

If you are experiencing pain in any way, shape, or form, imagine me opening my arms for a big air hug!  If you’ve made it to the end of the blog and feel a little overwhelmed by some of the steps above, don’t fret!  You have already completed a couple steps by reading this and considering the concept that by sharing your pain, you are not necessarily placing a burden on someone else, but you are starting to lift the burden off yourself.  Congrats on getting this far and stay tuned for more conversations + tips about feeling and sharing your pain. 

U N D E R P R E S S U R E!

Hello again, Dr. J here.  I feel like I should reintroduce myself because it has been a while.  I spend my time supporting kids ages 6-25ish and their parents through my private therapy practice, testing, presenting, and being involved in organizations where the sole purpose is to support local youth.  I love tap dancing, traveling, hanging with my husband + my dog, and laughing with my friends, among other things.  I don’t have to tell you times have been tough; we’ve all felt it in some way or another.  My involvement with certain jobs has changed, the decision sometimes by choice and other times totally out of my control.  With change has come some extra time. 

A positive reframe I might throw out in session would be:

With extra time comes the opportunity for you to do something you have wanted to do but didn’t have the time for!

Sounds great, but unfortunately, comes with a bit of pressure (even therapists aren’t perfect).  Pressure to fill that “free time” with something else, which as I’ve noted before in my Me-Time blog, is not always necessary or helpful.  There should be no pressure to fill a full plate with something extra just because you removed something else.

In therapy, transparency is something you can expect from me always so: I’ve been working on a few writing projects and just did not have the time to fully commit to any of them.  I finally feel like I’m ready to add something new to my plate, but I’ve been met with a new obstacle, a different kind of pressure!

A pressure to just knock out these complete masterpieces of original ideas that are publish-ready and will be on my list of greatest hits.  That pressure has motivated me to sit in front of my computer with a word document open but has left me with quite a writer’s block and therefore, not a ton of progress.

While taking a social media break today, I saw a story that reminded me to start small and then repeat.  Brilliant!  Something that now reading again makes me go, Duh!  It was what I needed to sit down and actually write something that I planned to share…this. 

Now, enough about me.  I know my clients and their families are feeling pressure too.  Pressure to have it all together at home, at school, be social but distanced, and keep the mood even keeled.  Kids (adults too) have their own internal pressure, but also report perceived external pressure.  I find myself constantly reframing parents’ or teachers’ “hovering” or “pushing” as their attempt to support the client, almost always stemming from a positive place.

I’m here to share this social media wisdom in hopes that when you find yourself somewhat settled into your new normal and you are feeling ready to add something to your plate, you start by doing one school worksheet, walking one lap, writing one paragraph.  You do it today and you repeat tomorrow.  Feel free to break it up into smaller steps or if you are feeling wild, take it a step further, no pressure.   

Of course, as a self-proclaimed five senses fanatic (you didn’t forget how much I love alliteration, did you?) I recommend you ground yourself and surround yourself with tools to help relax during the process.  I, for example, listened to Under Pressure by Queen and David Bowie and then watched the clip of Happy Feet 2 (tap dancer, remember) where this song and one single step basically save the day!  I can feel the support of the pillow behind my back and can taste the delicious tea I made before writing.  I have a colorful light in my office and can see a soothing, blue glow on the walls all around me. 

So, check your plate, add something only if you feel ready, and prepare your space to be as supportive as possible when you take that first, small step.

Whatever you decide to do, as the brave Will the Krill from Happy Feet Two says, I hope it brings out your happy.