The loneliness epidemic

I famously hate to be alone. In my adult life, I lived alone for six weeks before convincing an old friend to move from Texas to Baltimore to live with me in my one bedroom apartment. I will insist I need a break from my family, only to wander in to whatever room they’re in a half hour later because I was lonely. All this to say, I know of which I write.

As we get older, our lives tend to get smaller. Children grow up and move away; spouses get sick or die; same with friends. The prevailing issue I hear from my clients, especially those who are widowed, is that they’re simply lonely.

Loneliness, in fact, was cited by the US Surgeon General last year as one of the biggest issue to face older adults, especially post-pandemic. We were already fairly disconnected from each other before the spring of 2020. Those weeks and months before we could safely gather were devastating for most of us but particularly difficult for older people who lived alone or with little informal support. We’re still recovering from those months (years?) and some things have changed permanently. Some people have never recovered from being alone so much.

After all, it’s really hard to have a robust social life when you’re older: you’re retired, the kids are grown and flown, sometimes even the grandchildren have launched into the world. Some folks don’t drive anymore or only drive during the day when there’s no weather. Friends and family have their own health issues that prevent them from visiting. The list goes on.

However! It is not impossible to remedy some of the loneliness. What I mostly hear from people is that “no one calls, no one invites me,” but when we look a little deeper, my client hasn’t made any calls or extended any invitations. Or they got turned down once and gave up. It feels bad to be rejected, even kindly, but what feels worse is to wait around for people to read your mind and know that you want to hear from them.

So: pick up the phone. Send a text or an email or a card (getting actual mail is the best feeling!). The odds are, the person you’re reaching out to is also lonely and will be thrilled to hear from you. It takes a little vulnerability and risk, but you don’t have to be lonely if you don’t want to be. Give it a try.

Setting up therapy for someone else

One of the worst parts of feeling depressed or anxious or grieving is that it’s really hard to do stuff. When you’re not feeling well or like yourself, everything is a chore. Finding a therapist to help you may feel like the last task you could possibly manage. Sometimes, enlisting the help of a trusted friend or family member to do the leg work is exactly what’s needed to get you connected with someone who can help.

At least a third of my referrals come from the friend/adult child/partner of the potential client. I’m grateful when clients have that kind of support and are open to using it. That being said, would this be a blog post if I didn’t add a huge caveat??

Occasionally—though not always—the friend or family member in question wants the client to have a therapist more than the client does. The client may be willing to call me themselves or even set up an initial visit, but their heart really isn’t in it. Sometimes it’s because they honestly don’t need to talk to a therapist; their loved ones are trying to help (or trying to manage their own anxiety) and they want to check the box of THERAPY. This is most often the case with adult children, who have a totally different experience and understanding of therapy than their parents. There’s much less stigma around mental health support for younger generations, which is wonderful! It also can lead people to think that everyone needs a therapist at some point and that just isn’t always the case.

Another good indication that therapy isn’t going to work out when someone besides the client has suggested or arranged it is because said client simply isn’t ready. As I’ve written before, therapy is work. If you aren’t ready to dive deep into some stuff, or being emotionally vulnerable sounds horrific to you, you probably won’t benefit from therapy at this moment. Which is ok! You wouldn’t take an antibiotic if you weren’t sick; you don’t need to go to therapy if you aren’t ready to explore or make a change.

All of that being said—caveat upon caveat!—if someone you love wants you to see a therapist, they usually have a good reason. You may want to give the therapist a call, just to see what they say. Sometimes we need a little push in the right direction. And if it doesn’t work out or you don’t like the therapist or whatever, you don’t have to go back. It’s your choice, even if someone else is doing the administrative work for you.

Your grief in the dark, dreary days of winter

Listen, I am naturally an optimist. I really do see the silver lining the majority of the time. However. Here in Southeastern Pennsylvania, it has been dark and dreary and rainy for what feels like years (I also can be a little dramatic). When the weather is like this, it’s nearly impossible to remember that the days are actually getting longer; that soon we’ll spring forward; that winter actually does not last forever. Don’t get me wrong, all of those counter thoughts can be helpful. After all, nothing hard lasts forever!

That being said, this is a really difficult time for a lot of my clients.It’s especially difficult for those who are sick or old or grieving (or all three), isolated by those circumstances and the addition of bad weather. The usual self-care suggestions fall flat this time of year. Go outside! It’s disgusting out, no thank you. See friends! People can’t always drive in inclement weather. Or they don’t feel particularly social when they’ve been hanging on to a chest cold for a month. Exercise! Ugh. Don’t even get me started.

I don’t mean to say you should avoid all those things and hibernate for the winter. If you can find the energy and motivation to do that stuff, then you’re in better shape than me! Go forth on the journey. For the rest of us, let me just validate that it’s harder to do the usual self care stuff when the weather is bad, as it has been here. When it’s harder to make ourselves feel better, we can get caught in a shame cycle: “I should be doing X but I don’t feel like it, I’m useless/lazy/awful/whatever.” I’m here to tell you, you are not useless or lazy or whatever other horrid adjective you want to use to describe yourself. You are a normal person having a normal reaction to a very long and dreary time of year.

And if you are grieving, whether it’s the first year or the fifth or the fifteenth, you may find that your grief is heavier than usual. No matter how long it’s been, that is normal. Grief can be exacerbated by any number of things, including but not limited to post-holiday blues, gross winter weather, and increased isolation.

So if you are having a harder than usual time right now and all the usual coping skills are falling flat, I have good news: the days are getting longer. Soon we’re going to spring forward. Winter doesn’t last forever. And neither will this hard time. While it lasts, consider reaching out to someone—a friend, a therapist, some nice strangers on the internet—and let them share the burden. You don’t have to do this alone.

Holiday creep

A colleague of mine recently referred to this time of year as the therapist Olympics. Most of our clients are a little more… unhinged than usual. Rightly so! Days are shorter and colder. Families of origin repeat patterns that range from frustrating to harmful. Sobriety is tested. Finances are tight. Grief is magnified. Caregiving is harder than usual. Basically The Holidays amplifies whatever was already difficult to navigate. While the culture at large insists upon sparkle and glamor and gratitude and consumerism and food and booze in excess, some of us are struggling. 

There are any number of lists out there about how to combat the holiday blues. Of course I agree with most of them: be mindful of how much you're drinking; keep moving your body; make time for yourself, etc. But I also want to add my usual caveat: it's ok to be struggling. In fact, many people are at this time of year. I bet if you admit to someone close to you (or even someone in line at the grocery store honestly) that you aren't filled with joy right now, they would agree. You’re not alone if you’re not feeling sparkly.

If you feel like you are alone in those feelings, it's tempting to self isolate. People are often afraid of spreading their anxiety or sadness to others and instead opt to keep it to themselves. Sometimes time alone does help, and if that helps you, go nuts. But also remember that distress and grief and anxiety are better shared with others. It lightens the load to let someone else know that you aren't filled with the Spirit of the Season. It's ok if holidays are a tough time for you; they’re tough for a lot of us. Take a chance and let someone know you need support. 

(Also make sure you keep your appointment with your therapist).

When to say, "that's not helpful"

The people who love us are (generally) well meaning. They want us to feel well, as a rule, and they often have a good idea of what that looks like. Or, they think they have a good idea. Often when you’re grieving, someone who loves you wants to help you by telling you what they think is a great idea. For instance, “[your loved one] would want you to be happy/live your life/not dwell on the past.” Or, “it’s been six months/a year/so long, it’s time to move on with your life.” They make these pronouncements as if they’ll magically snap you out of your grief and back into the world.

I don’t think I need to tell you, that’s not how grief works.

What I do need to tell you is this: it is ok to tell someone they aren’t helping. You don’t have to be unkind or snappish or rude. You can, however, set a boundary and tell them the truth: “that’s not helpful.”

In a previous post about boundaries, I noted that it can be hard to say something we know the other person doesn’t want to hear. People don’t like to be criticized, especially when they’re sure they’re right. That doesn’t mean that your emotional needs have to go ignored in service of not making someone briefly uncomfortable. In fact, someone who loves you and wants you to be well should be able to hear you tell them “that’s not helpful” without losing their shit about it.

It doesn’t matter how long it’s been since your bereavement or what the deceased would or would not say about how you’re handling it. What matters is that you’re getting real, actual support from the people around you. Sometimes that means telling them what you need–and what you don’t.

In Defense of Denial

Like most therapists, I'm a big proponent of feeling your feelings. (In fact, if you’ve met me in real life, you’re probably well aware of this, as I share every feeling at every moment). Experiencing your emotions (namely the tough ones) is a key part of good mental and emotional health. After all, ignoring your feelings doesn’t make them go away. In fact, your feelings don’t care that you don’t want to deal with them; they will find a way to make themselves known.

All that being said, sometimes denying our feelings, for a little while, is a necessary coping mechanism. Remember Kubler-Ross and her stages of grief? The first stage is denial. You know, “this can’t be happening, there has to be some mistake.” There’s a good reason we start there when hit with bad news: some experiences are just too hard to process all at once. Instead, we sometimes have to pretend they’re not happening until we’re ready to handle them.

Notice that last sentence: denial needs to be a temporary response. At some point, you do have to acknowledge what’s happening, be it a poor prognosis or a financial crisis or a death. You can’t ignore your circumstances forever. But you can sort of ignore them temporarily. Our brains are not made to withstand constant distress. Denial exists so that we can continue to function while bad things are happening to us.

So if you need, for a little while, to live in the land of Denial, be my guest. It can be a really pleasant and helpful place to visit. Just make sure you aren’t there to stay; those feelings you’re avoiding won’t stay hidden forever. Better for you to the be the one who decides how to deal with them.

Caring for yourself as you grieve

It is easy to list for ourselves all the things we didn’t start or finish in any given day. “I should have called my sister/run a load of laundry/exercised today;” the list is endless. When we are grieving or in a depression or having big anxiety, the list also comes with some serious self-judgment: what is wrong with me? Why can’t I do anything?

In those moments, I invite you to remember that there are very few things you must do every day. You have a set of basic needs: food, water, and shelter. If you’re really feeling ambitious, you can add personal care (showering, brushing your teeth) and socialization (as much of it as you can handle; even just texting someone hello is good enough here). On days when your emotions are heavy, when you are weighed down by grief or pain, you do not have to accomplish anything except very basic self care.

Self care conjures up images of bubble baths and good chocolate. That’s lovely but it’s not what I’m talking about. I’m talking about some Maslow’s hierarchy of needs stuff. Remember your intro to sociology class? I shall refresh your memory, just in case:

See how those physiological and safety needs are at the bottom? That’s because you can’t reach the other levels without first meeting the basic needs. It’s easy to get lost in the weeds, especially when we are not well. Instead of berating yourself for not doing enough, look at what you can do: get out of bed; feed and water your body; try to connect with another human being or a pet or a plant or a book. Focus on what you need to stay alive. Everything else can be done tomorrow.

Try breathing through it

Imagine you’ve stubbed your toe, or banged your shin on the coffee table. When that pain hits, you suck in your breath and hold it for a second. Your brain has sent a signal to your body that you are in danger. You freeze.

Now imagine the way you exhale after that moment of intake: slowly and steadily, right? When you breathe that way, the pain subsides a little. Breathing is the best way to remind your body that it is safe. But when we’re in pain–be it physical or emotional pain–we don’t necessarily remember that. Our lizard brains can only report DANGER and so we hold our breath. How can we make the change and remember to breathe when we are suffering? Only with practice.

Here I should tell you that I am not good at practicing this in my real life. I won’t pretend here that I am an expert in mindfulness or even deep breathing. Just like doctors make for bad patients, therapists are not always beacons of mental health ourselves. But that kind of work–being mindful, and present in your body, and taking deep breaths when you are dysregulated–is a practice. That means you don’t have to do it perfectly or even all the time. It means you can practice doing it as you are able. It can be a process made up of small changes; you don’t have to become Zen Master You. The goal here is just to try it out.

So the next time you are in pain–a stubbed toe or a broken heart–take some deep breaths. Remind your body that you are safe. See how it feels. And if you don’t do it perfectly, or every time, it doesn’t matter. What matters is the practice of it. What matters is caring for yourself.

Find the light

It has been literally quite dark the past few days here in the Philly suburbs. Between the rain and the time of year, the sun feels like a distant memory at the moment. However! It is also the holiday season, which means there is (other) light everywhere. There are intricate light displays on homes and businesses. There are sparkles and sequins in shop windows. There can be candlelight. There is brightness to combat the dark.

You don’t have to celebrate a religious holiday this time of year to bask in the glow. Light can be found and celebrated without having to subscribe to Christmas or Hanukkah. It can be found in being with others; in volunteering your time or money (if you have it to give); in window shopping; in fancy light displays or wandering through your neighborhood. In the cold, wet winter—when it is mostly dark and often difficult because of grief or family or winter blues or any number of other things—I want to remind you that you deserve some light. If you can’t find it, create it. If that’s beyond you right now, ask someone else to help. And remember, darkness passes.

Have a joyful holiday season—and if that’s beyond you as well, just get through it. Wishing you all light and lightness as we enter the new year.

Creative ways to explore your grief

People who are grieving often ask, "what should I be doing?" Usually I reject the premise of the question: there's nothing to do except experience your grief. You have to feel your feelings, even (especially) the hard ones.

That being said, I do appreciate the idea that there should be an action that accompanies grief, something to help move through it. There are any number of options in that vein. What follows here is a (small and not at all comprehensive) list of creative ways to experience and honor your grief. If they make you feel weird or too silly, don’t do them! But let me encourage you to consider doing something a little different (and maybe a little weird) in order to give your grief the attention it deserves.

1. Write a letter to your person. It can be about whatever you want: a list of things you miss about them; an update about the family; a rehashing of an old argument. You can write as much or as little as you want. You can burn it after it's done or tuck it away or share it with others. The object here is to connect with the person you love and miss, keeping a part of them alive for yourself.

2. Tend to a plant. I say "a plant" because I have a black thumb, not a green one, so an entire garden feels off-putting to me personally. But maybe gardening is your thing! Take your grief there. Tend to the living, green things; put your hands in the dirt. Talk to the flowers.

3. Write a song or a poem or a haiku or paint a picture. It doesn't have to be Pulitzer or museum-worthy. It doesn't have to be shared with anyone else, though it can be. Again, the only objective is to take some intentional time with your loss and find what’s beautiful in it.

4. Make a shrine. (This is my personal favorite). It can look any way you want. It can be tucked away in a corner or right in the doorway of your home. It can have pictures and ticket stubs or candles and symbols. Spend some time building it and looking at it so you can honor the memory of this person that you love so much. It’s a gift for you both.

Remember, in grief there is no way out but through. You may as well find a way to make the journey a little more interesting. And if you’re feeling particularly brave, share what you’ve created. I, for one, would love to see it.

Grief can be complicated

For many of us, grief is straightforward: we feel sorrow and sadness and our loved ones can understand our mourning process. For other people, it’s much more complicated than that. If there are past traumas, if you were estranged from the person who died, if the relationship was challenging or abusive, your bereavement is not a straightforward period of sorrow and sadness. And because your grief isn’t typical, it can feel isolating and confusing.

It isn’t easy to talk about this kind of complicated grief with others, even those who know you well. That old adage, “don’t speak ill of the dead” is deeply ingrained in us. When someone dies, it’s tempting to only view them fondly and warmly; they can’t defend themselves from criticism anymore so the default is to not criticize. But death does not make saints of everyone. Sometimes people are abusive or addicted or they made mostly bad choices, or they were barely present at all. Then, when they die, it’s difficult to find the right words to explain your grief.

The good news is, you don’t have to explain your grief (or lack thereof) to anyone. You don’t have to be sad about someone’s death if ultimately their death is a relief to you. Instead, your grief can be about what you never had from that person, and what they will never be able to repair for you. You can decide how you want to forgive them—if that’s what you want. You can decide how to move forward and how to mourn. Your loss is your own. Your grief is your own. Other people don’t have to understand it or accept it.

Photo by Ian Stauffer on Unsplash

Say no: Setting boundaries when you're grieving

Therapists love to talk about boundaries and I am no exception. Boundaries are wonderful! There are so few things we can control in our lives; setting limits with others is one of them. That being said, knowing we can make our own rules in this way is easier than actually doing it.

Setting boundaries can be frustrating, to say the least. That’s because most frequently, the response you get from others when you set a limit with them is not ideal. It is not, “oh, thank you for telling me! I will honor your request with good humor!” Instead, setting a boundary or a limit with someone in your life often leads to hurt feelings and frustration. Asking someone to give you space or not bring up a certain topic or whatever can be difficult for a number of reasons: you’ve never said no before; or the situation has been the same for so long, it seems weird to suddenly ask for a change. Likewise, the person who is being asked to step back or stop a behavior often feels defensive: what’s wrong with the way things are? Why are you suddenly changing the game on me?

But life is always changing (which is out of our control) and we need to be able to make changes that suit us (which is in our control). This is especially true when we are grieving.

Grief is exhausting. It takes up so much of our energy, mentally, physically, and emotionally. In a grieving period, we need to be able to tell others (who may be well meaning) what we need. Most often, what we need during our grief is to say no.

I don’t mean you should hide away in a cave until you feel better (though there may be days when that sounds appealing). Rather, I mean you don’t have to go on as if everything is normal. It isn’t, for you. Your life has changed and you need time to adjust and figure out how you want to move forward. People in your life may not understand this; they may want you to show up in the ways you used to, at work, in your family, in your social life. I’m giving you permission to sometimes say no, without guilt. Your grief deserves your full attention. You deserve to honor it by asking for what you need.

Grief before loss: Anticipatory grief

Most of the time, we think about grief in terms of a death loss. After a death, your grief may be all consuming but it’s also clear: someone you love is physically gone and their absence is painful. But sometimes we lose someone before their body dies. That grief—the more ambiguous, murky loss of loving someone who leaves us by degrees—is called anticipatory grief.

Just as it sounds, it’s the anticipation of a loss before the loss itself. Perhaps the person you love is still physically present but they’ve had a major change in their functioning. I don’t just mean dementia, although that has its own devastation. It can also be that your loved one has cancer or ALS or some other illness that is changing their mind and body over months or years. It can be that you’ve lost the person you knew to their addiction or a traumatic brain injury that’s changed their personality. The person you love is technically alive but they aren’t themselves anymore.

In some ways, anticipatory grief is even more difficult to deal with than the grief that follows a death. When someone dies, there is a clear date to point to as the “beginning” of your grief. There are milestones to mark: one month without them, six months, a year. When your loved one slowly leaves you, it’s harder to name your grief and figure out how to cope with it.

That naming is the first step. Acknowledging anticipatory grief will help you move through it. Remember, we don’t “get over” grief, no matter what kind it is; instead we learn to grow around it. Rather than trying to ignore it or avoid it, speak it aloud; share it with others; carve out the space and time to honor it. Anticipatory grief is normal, even if it’s hard to wrap your mind around, and it deserves your attention. Reach out for support; you don’t have to do this alone.

"I don't know what to say in therapy."

Let me begin with a small personal confession: this is the longest I’ve ever attended therapy as a client.

Maybe that doesn’t seem like such a big deal. But as someone who has made a living explaining why everyone should attend therapy actually, it feels mildly embarrassing, like forgetting the name of an acquaintance at a cocktail party. “Therapy is wonderful!” I’ve told people over and over for more than a decade while also not actually going myself for longer than 3-5 sessions. I’m a hypocrite, is what I’m saying.

I’m confessing my hypocrisy because I suspect a lot of people are like me: an acute crisis or some other event occurs that leads them to a therapist. They attend anywhere from one to maybe even ten sessions. The crisis passes; things get a little better. And they think, “well, I guess there’s nothing else to talk about.” So they stop seeing their therapist.

I hear this from clients sometimes: “I don’t know what else to say.” Or, “I don’t know what to talk about today.” Or, my least favorite, “what do you want me to talk about?” At that last one, I usually smile and reply, “that’s up to you.” I imagine my clients are not fond of this response but it’s the truth! I can’t see inside your brain. You have to tell me what’s in there that you want to explore.

All that being said, I get it: sometimes I struggle with what to say to my own therapist. She asks me how I am and I say, “I’m good!” and then immediately wonder if that means I should stop going to therapy. The crisis that brought me back to the proverbial couch almost a year ago has passed; I am good. But that doesn’t mean there’s no more work to be done.

The other week, when I really did feel ok, I felt myself about to say those dreaded words “I don’t know what to talk about today.” Instead, I told my therapist that sometimes I’m afraid that I won’t have anything to say and she’ll tell me I don’t have to come back. She laughed (kindly but still, she did laugh because it was ridiculous). She assured me that she wouldn’t say such a thing. And that was all I needed to find a new place to begin. The storm that brought me in has passed but now is the perfect time to do some deeper mining: when I feel well enough to really explore the deeper stuff.

So if you find yourself in therapy at a loss for words, that’s ok. In fact, it’s good! It may be the beginning of a new phase of your work in that space. Hang in through the lull and you may find you can feel even better.