Can I swear in therapy?

If you’ve ever wondered if you can swear/curse/cuss in your therapy session, I have great news for you: the answer is (mostly) yes!

I’m not suggesting you walk into your therapy session ready to use every foul or vulgar word you’ve ever heard. But there is evidence—actual scientific research!—that cursing can be helpful when we are in pain. Sometimes other adjectives fail us and the only way to explain how we’re feeling—the depths of pain we find ourselves in—is to switch to the four letter words.

Additionally, therapy is not the place to censor yourself. Therapy is meant to be a safe space to say whatever you are thinking, however it gets best expressed. For some people (myself included), cursing is a key component of that expression. Sometimes the only words that can accurately describe our pain are the “bad” ones. As a therapist, it’s a relief to me when my clients drop a swear word here and there because it shows me that they’re comfortable with me. The relationship between my client and me is the most important part of our work together; being able to express yourself naturally, without apology, is key to the foundation of that relationship.

Not everyone needs to express themselves this way, of course. Personally, I grew up with an Irish Catholic mother who could make a sailor blush if she was really on a streak; cursing was normal in my house. As with all therapy-related topics, your mileage may vary. But if you’re in a room with me and you want to explore your feelings by swearing, go nuts. I’ve heard (and said) all the words before. I may even join you.

Doorknob communications

The first time I heard the phrase “doorknob communication” was from a student I supervised. She was a little shaken when she brought it up, having just had a client confess something major to her at the end of their last session together (get it? The therapist’s hand is on the doorknob when suddenly the client says the most important thing). That original blog post still exists but it was time for an update. Now that I’m in private practice, I have a much deeper understanding of what the phrase means, why it happens, and what it feels like for both therapist and client.

Let’s begin at the beginning: my therapy sessions are 45 minutes long. Both the client and I know that from day one. That being said, the first few sessions we have together can run a little longer. Some people come to therapy ready to absolutely spill their guts; that 45 minutes flies by when someone starts talking and can’t stop until they get the entire story out. A new client is often on the brink of something—the depth of their grief; the physical and mental toll of a lengthy illness; the weight of caregiving—making those first few sessions a kind of stream of consciousness. And it’s quite often that it isn’t until around minute 43 that a client gets to the really juicy stuff.

This is partly my fault: once someone starts to get close to an important point or a long-held secret, I really don’t want to cut them off. But when I don’t, I’m left scrambling at minute 46, telling them that while I appreciate we’ve just opened a door, we have to slam it shut again until next week; our time is up.

Extend your session time, I bet you’re thinking. But here’s the thing about the doorknob communication: it happens right before the clinician wraps up the session, no matter how long the session is. When clients do this, they're giving themselves a way out. If they decide they don’t want to deal with whatever it is, they don’t have to; they haven’t left enough time to talk about it. There’s nothing forcing them to come back next week. For some people, they had to tell the thing and then they have to bail out, like they’re on a sinking ship.

But most people do return (one of my clients warmly reminds me every session to write down where we left off so we can continue in that same spot next time, like one long conversation split up into weekly installments). And as they keep returning and the relationship continues to grow, the doorknob communications lessen. It becomes less scary to say the Big Thing(s) to someone you trust.

So if you are just starting out in therapy and you find yourself only getting to the Big Thing(s) at the end of the session, hang in there. As you get to know your therapist, the harder stuff will come up more easily, leaving you more time to dive in. And, best of all, you get to tackle it together, in however much time it takes.

"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.

How to Mark the Anniversary of a Death

I have never found the right word or phrase to describe the date of someone’s death. Anniversary sounds like something to celebrate; death day sounds flippant for some reason. Still, I can’t think of another way to say it so we’re going to stick with anniversary, which is technically what it is: an annual marker of an important date. And anyway, whatever you call it, the date of a loss is important and needs to be acknowledged.

A lot of people hang on to the idea that after that first anniversary passes, they will somehow be on the other side of grief. And although it’s true that time heals, there is no “other side” to grief. Which is not to say it never gets better; of course it does. But it doesn’t end. You don’t get to the other side so much as enter a new phase of grief. During holidays or birthdays or death anniversaries, our grief can grow again. As I've written before you haven’t had a setback when you feel your grief. Rather, you are continuing to experience normal, typical, regular grief. It ebbs and flows, like the tides.

Paths, tides, other sides: forgive my tortured metaphors. Let’s get more concrete: how should you mark the anniversary of a death?

The short answer is: however you like.

The longer answer is: it depends.

It depends on what will make you feel… not better, but comforted. What will make you feel that the day can pass without you white-knuckling through it? For some, the routine of every other day is paramount. I’m not recommending you ignore the day, but if it brings comfort and solace to get up and do your normal stuff, then that’s what you should do. For others, the day needs to be honored and ritualized and marked somehow. In my family, one of us texts the group chat with the number of years that have passed. It’s a small thing, but it helps to remember that we have suffered our losses together; that we are not alone in our grief. It’s a ritual, albeit a small one.

That’s the thing about rituals: they don’t have to be epic. You can choose to mark the day in a small, quiet, safe way. In fact, that may be the only way you can mark it. You can also choose something big and loud and intense. Your mileage may vary, as they say on the internet.

What’s important is that you figure out what works for you. There are no rules to grief and there are no rules about how to mark a death day. But I encourage you to mark it in some way: to write a note, share a photo, text or call someone you love who remembers. Tell a favorite story, take a walk in the woods, speak out loud to your person. Perform an act of service, sing a song, cry in public or in private. Find the thing that makes the day go by. Because it will go by. More days will come, some better and some worse. And on the worse days, I encourage you to lean in; let yourself feel. The only way out is through.

Talking to kids about death

I grew up in a house of death.

Which is not to say it was a sad or morbid place. On the contrary, my childhood was full of joy and happiness. I only mean that talking about death and grief was normal in my house. This was partly because my dad is a doctor, from a family of doctors. And it was partly because my mom had lost her father very young and she kept him alive for us with stories and memories. Later, our family suffered more tragic loss—a blog post for another time—and so talking about death and grief and loss doesn’t really stress me out. On the contrary, it feels like a natural part of conversation.

It turns out that this isn’t typical for everyone. I can tell because of the way people’s faces contort when I casually start talking about death and dying. It kind of freaks them out. And if adults are so freaked out or uncomfortable talking about death, it stands to reason kids would be as well.

But the thing is, kids are remarkably unphased by death. There are a few reasons for that. First, most of early childhood is a time of pure self-centeredness; kids can only understand the world and its events by how they are directly affected. (I don’t mean this derisively; it’s an appropriate developmental step). Second, and I would argue most importantly, kids take their cues from the other people around them. They don’t always listen to our words (as any parent can attest) but they do often mimic what they see us do. How we model big emotions—and grief is a big one—means more than the words we use to describe it.

We do also need words, of course. There’s a tendency to talk around the mystery of death, to use flowery metaphors instead of using the real words: dying, death, dead. Euphemisms may feel safer but they can be confusing and misleading. Shrouding death in secrecy like this isn’t fair to kids. We don’t have to tell them everything but we have to tell them something. We have to use the words: this person that we love, their body died. And listen, there will be follow up questions; namely “why?” (The whys are endless). And also, how? And—this one can be really tough—what happens when we die?

I know that all sounds intense. There’s a fear that of scaring kids or making them sad. But death is generally sad! Part of our job is to show kids how to handle big feelings. Basically, kids need to see that it is ok to discuss death and it is ok to grieve. I give you permission to cry in front of your kids; to say “I miss our person;” to explain that bodies die and to offer them a space to ask questions about that.

Talking to kids about big stuff—and death is one of the biggest—can be daunting. But I assure you, you won’t scar them for life by being honest and clear. You don’t have to make your home a house of death (not everyone is as cool as my family or origin). Start with the basics, don’t over explain, and most of all, let there be space to have big, tough feelings. For yourself, too.

The 6 month grief slump

“Shouldn’t I be further along now?”

This is a common question from the bereaved: however much time has passed, they wonder if it’s been long enough. The implied concern is, am I moving in the right direction? Will I get out of this? There is a fear of being forever stuck in the beginning, acute phase of grief. Additionally, there is a general idea that grief is a path you walk from the beginning (your loss) to the end (feeling “better”). But grief isn’t a straight line; it’s ocean waves. It’s peaks and valleys. It’s never gone; it only changes, from sometimes sharp to sometimes dull. And sometimes the wave or the valley or the sharpness can be unpredictable.

For a lot of grievers, the six month slump is one of the unpredictable times. The first round of holidays after a death or the first birthday without someone are expected to be tough. But around 6 months, a lot of people are shocked by a sudden wave of grief. It feels like a setback. For awhile there, they were feeling like things were getting back to normal: the funeral is over, they’re back to a routine, they are beginning to see what their new life is like. When their grief confronts them again, it is destabilizing. They feel they’ve gotten off track somehow.

But grief is not on a track, or a timeline, or a calendar. It is an experience that changes over time. We learn how to grow around and with our grief instead of trying to get away from it. The six month slump isn’t going backwards; it’s part of the process. Remember, you’ve been here before and you know the only way out is through.

Using Emotional Intelligence to Thrive

Earlier this week, I had the pleasure of presenting to a group of professional women about emotional intelligence. They had chosen the topic and while it’s not my typical area of expertise, the idea interests me. At its core, emotional intelligence is about examining how we understand and interpret our feelings, our motivation, our interpersonal interactions. I think this is one of our lifelong jobs as human beings: to grow through self reflection and introspection.

So how does that growth occur? First, we need to have a basic understanding of how much emotional intelligence we already possess. As with all psychological concepts, there’s some debate in the psychological community about how measurable EI is. (There’s debate in the community about literally everything, to be fair). That being said, it’s pretty well accepted that emotional intelligence can be higher or lower depending on a number of factors: empathy, for instance, as well as motivation, social and self awareness, and self regulation. There are tests you can take online to get a feel for where you land in each of those aspects. Or you can take a moment and just consider: how well do you know yourself?

The reality is, honest self assessment can be tough. We all want to believe we’re naturally empathetic and intuitive, etc. But actually looking inward takes a little more work and a lot more humility than a standard, “how nice a person do you think you are?”. It takes effort to honestly face yourself and ask, how empathetic am I? How much do I let my emotions dictate my actions? What would others say about me?

A lot of my work as a therapist is encouraging people not to be so hard on themselves for having difficult feelings. So don’t get me wrong: this shouldn’t be an exercise in self flagellation. Rather, I want to encourage you to consider measuring your EI as one more way to grow. It’s all grist for the mill, as my brilliant clinical supervisor told me recently. How we understand and manage our emotions impacts our lives in numerous ways, big and small.

And if you aren’t ready to look further right this minute, you have permission to leave it alone until you are. Part of being emotionally intelligent is setting limits, even (especially) with yourself. When you are ready, I encourage you to investigate with curiosity and empathy. The path to growth doesn’t need to be all thorns. Celebrate the parts of yourself that bring and spread joy and tend to the parts that want to grow with love and compassion.

Why a home visit?

Mental health care looks a lot different these days then it did decades ago (though some things are frustratingly the same but that’s a post for a different day). For people my age and younger, it’s pretty acceptable to see a therapist, online or in real life. In fact, over the past two years, more people than ever have sought out mental healthcare. Not only that, they’re vocal about it. Which is wonderful! Mental wellness should be for everyone; there's no shame in caring for yourself that way.

But for the majority of my clients, who are from an older generation, therapy is still something to be whispered about, not shouted. Many of my clients have never spoken to a therapist before. As a result, they’re a little overwhelmed by sitting down with a stranger to spill their deep, dark secrets.

This is where the home visit really shines.

There is a natural power imbalance between a therapist and a client, no matter how we both may want to pretend we’re on equal ground. The client is in a vulnerable position, about to answer some really personal and difficult questions; the therapist holds a lot of power in that situation. But when I enter your home, I am first and foremost your guest. This evens the playing field immensely. In your private, comfortable space, I am a visitor and you get to make the rules.

For many of my clients, meeting at home helps them open up faster. There are literal objects to point at when they begin to feel stuck, for instance: a wedding photo or a trinket from a long ago vacation. There is the comfort of being in your own safe space as we begin the hard work of feeling better.

So while it may seem strange to some that I don’t have a physical office, others are relieved to hear that they don’t have to go anywhere; I’ll come to you in the place you feel most comfortable. The only expectation is that I’ll show up, we’ll sit down, and you get to talk. How easy is that?

Carrying the weight of grief

Grief brings its own kind of exhaustion. Clients often tell me that they think they’re getting enough sleep—they’re going to bed at a reasonable hour and sleeping through until the morning, minus the usual up-to-pee-at-3-in-the-morning—and yet they still feel tired all the time. Why is that, they want to know? Often it’s the weight of their grief, holding them down even as they try to move through the day.

I’m no somatic therapy expert but it’s widely accepted that our feelings show up in our bodies. It’s no coincidence that we describe being “gutted” or “broken-hearted” when something upsetting happens; we often feel emotional pain in a physical way. We cannot disconnect our minds and our bodies, no matter how we sometimes try.

Just like any other heartbreak, grief can show up physically: as exhaustion for instance, or a general achiness throughout the body. Sometimes you may cry so hard you become short of breath for a minute. We cannot ignore the physical pain and weight that grief exerts on us. So if you feel tired, headachy, occasionally short of breath, certainly check in with your primary doctor first. But after you get the all-clear, spend some time considering: is carrying the weight of your grief hurting you?

This is not to say you’re doing grief wrong. All the ways you grief manifests are normal, if awful. Rather, I hope you take away that if you are suffering, you are not alone. No one can take your pain away from you but others are willing to help you carry it. There is no burden you have to shoulder alone, even (especially) your grief. This is your invitation to reach out—to a friend, a lover, a stranger, a therapist—and let someone else share the weight with you.

"The second year is harder" and other difficult truths about grief

I’ve written before about grief not having an end date. It’s a nebulous, unpredictable process. That’s because each of us experiences grief in different ways and on different timelines. That being said, we can expect certain periods to be universally hard during the bereavement process: the first birthday of your lost loved one, for instance, or the first holiday season. After a death (or a divorce or another kind of ending), there is a whole year of firsts to wade through. That first year can feel full of landmines—but also full of the comforts of reminiscing and tradition-keeping. There can be some sweetness in our loss, some celebrating of the birthday or the holiday, a heavy reliance on really marking the tough days. And there is a kind of relief in getting through that first long year.

Then the second year hits.

You would think the second year would be easier. And in some ways it is; time does heal, after all. But in other ways, the second year is a reminder of the finality of your loss. People prepare for that first year to be difficult but they aren’t necessarily prepared for the second year to hit so hard.

This sounds like bad news. But remember, your grieving process is not something to get over. Grief is a reminder of how deeply we loved someone; that love doesn’t just disappear. This holiday season, whether it’s your first or second or tenth with someone missing, don’t hide from your grief. Take some time to honor your losses—in big ways or small, whatever feels natural to you. And remember, you don’t have to do it alone.

Happiest holidays to you, even if they are a little tougher this year.

What if I want to know about my therapist?

Once, during a job interview, the interviewer asked to describe my boundaries with clients. A pretty vague question, right? Like, it depends! But seeing as how I was in an interview for a job I wanted (and eventually got, thank you very much), I played along and responded: I answer the questions my clients ask me (within reason).

Because here is the thing: when you are sitting across from me in that first session, I want to know some pretty deep stuff right off the bat. For instance, do you drink alcohol? Use drugs? Are you religious? Have you ever tried to hurt yourself or someone else? Not exactly cocktail party conversation. So if a client has a question for me (like how old am I or how many kids do I have, etc.), I’m more than willing to answer.

Some things about me are already clear: I wear a wedding ring, for instance. I’m fairly young. I’m a woman. I’m white. For some therapists, this is about as much information as clients are allowed to know. There are different schools of thought and none of them are wrong; in some ways, it’s a personal preference. There are good reasons for a therapist to not spend a lot of time talking about herself. For one thing, that’s not why you’re paying me; we’re here to talk about you, my friend. For another, some clients use this tactic to deflect and avoid the stuff they need to talk about. But I think, especially in the rapport building phase of therapy, it’s normal for a client to wonder, who is this person I’m telling all my secrets to?

So ask away! If I don’t want to answer, I won’t. Part of this process is developing a relationship and setting boundaries within it. I’m happy to tell you that I have two kids and a little dog and a husband. I’m happy to tell you that I’m in therapy myself, and that it helps me be a better therapist for you. I’m happy too, to talk about why you want to know about me instead of telling me about you. Like I said last time, almost nothing is off limits. This is a road we walk together. So tell me, what do you want to know?

You can say (almost) anything to your therapist

This week, in my series about what to expect from therapy, I want to dive into what may be off limits to talk about with your therapist. The short answer is, pretty much nothing!

There are exceptions to this of course: if your therapist thinks you’re going to hurt yourself or someone else, or that you already have harmed someone, they’re obligated to do something with that information. But otherwise, you get to say whatever you want. You don’t have to be on your best behavior when you’re talking to your therapist. Therapy is a relationship but it’s not a friendship or a conversation at a cocktail party; you don’t have to come armed with your best stories or convince anyone of how delightful you are. In fact, once some trust is established, you can be on your worst behavior if you so choose. In therapy, you get to explore the darkest and meanest parts of yourself. It’s safe there.

Still, it feels risky to open up to someone, even a professional. On the one hand, you’re seeking out therapy because you need to talk to someone and presumably, you’re ready to do just that: talk. On the other hand, there may be a fear that you’ll say something so dark, your therapist just won’t like you anymore. Generally, we want people to like us; we’re only human. So it can be difficult to drop the social niceties we’re practiced at performing. For instance, hearing “how are you?” from your therapist is different than hearing the same question from a co-worker. And yet, for many of us, the automatic answer is the one that comes out: “Fine, thanks, how are you?”

This isn’t to say you can’t be nice to your therapist. Believe me, we’re happy to be asked how we are, even if we won’t tell you the actual answer. I’m only saying that in that therapy session, you are released from surface-level social stuff. You can talk about whatever you want.

Which brings me to another caveat: you can also NOT talk about whatever you want. You don’t have to recount every dark thought that has ever entered your mind. You don’t have to review every embarrassing moment or delve into something that feels too tricky to explore. In that session, you get to decide where to begin and where to stop. When your therapist asks how you’re doing, you can tell the truth. And if the conversation starts to go somewhere you aren’t ready to go, you can say no. You don’t have to worry; you can say (almost) anything to your therapist.

When your body betrays you

Last week, I wrote about grief. I was mostly referring to the grief we experience when someone we love dies. But there are losses throughout our life cycle that don’t necessarily have to do with death.

For the majority of my career, I’ve worked with people experiencing life-changing and often chronic illness. The prognosis doesn’t have to be terminal for the symptoms of being ill—of having a body that doesn’t do what it used to do—to be devastating and isolating. Your friends and family can’t understand what you are experiencing. It’s difficult to explain pain or fatigue or some other unquantifiable symptom to someone whose body is not sick. In a misguided attempt to help, these family members and friends may tell you that your situation isn’t as bad as it could be; that you just have to push yourself harder; that you need a second, third, fourth opinion.

Their hearts are in the right place. They’re hoping that the power of positive thinking will do the trick and cure you. But not everyone is helped by the relentless positive thinking memes that social media throws at us: believe you’ll get better and you will! Trust your body! Mind over matter! Et ceterra, et ceterra, until you start to doubt your own feelings. Among these feelings, of course, is the grief of what you have lost.

Because although you are still here, your body has betrayed you. Illness takes from us. Maybe you aren’t able to exercise anymore, or even get on the floor with your kids or grandkids. Maybe you can’t drive anymore. Or your brain fog is making it hard to concentrate at work or school or in social situations. Those are big losses to bear by yourself.

Therapy is not going to cure your illness. Further, your therapist will not be able to tell you how long you’ll be sick or if any of what you’ve lost will be returned to you. Your therapist can’t tell you that everything is going to be ok. What therapy can do is meet you where you are. You can grieve. Then you can start to rethink and rebuild your life. Then grieve some more and then rebuild some more… You can be hopeless and hopeful both at once. And you do not have to walk this path alone.

Where do we start?

How does therapy… start?

Some people come to therapy fully ready to spill: they’re like a pot of water ready to boil over. Those first two or three sessions are just full of words and feelings and sometimes tears. That’s been my personal therapy experience and it’s one I really understand: talk until you can’t talk anymore and then we can figure out where to go next.

But not everyone is like me (thank God). Some people enter therapy reluctantly or cautiously; they are not in fact ready to spill their guts to a stranger. It’s not that they don’t know why they came, it’s more that they don’t know how or where to begin. Or they start and then get stuck. Or—and this one is the toughest for me as a clinician—they want an immediate answer.

There’s good news and there’s bad news, here. The bad news is, I do not possess a magic wand. I can’t make sisters or lovers or children behave better; I can’t bring back a loved one from the dead; I can’t give you a secret code that will make your anxiety disappear into thin air. But—and here’s the good news I promised!—there are going to be answers. We can find them together, by sifting through the past and the present. We can find a way to set boundaries with the misbehaving family members; memorialize the dead loved one; understand and quell the anxious thoughts that plague you. In short, we can start wherever you are that particular day, that particular moment, and see where we end up. We just have to start.