"I don't want to kill myself but..."

It’s important to talk about suicidality but it’s also incredibly hard. For people who are suffering, there’s a lot of fear about admitting they may be even vaguely thinking about suicide. They’re afraid talking about it out loud will lead to a traumatic hospitalization or cops banging on the door. Afraid that admitting they’re struggling in this way will lead to dismissal or anger or a big reaction that they can’t handle. And afraid that if they say the words out loud, they’ll be more likely to act on them.

The truth is, talking openly about suicidality does not lead to suicide. Talking about it is actually a protective factor. Protective factors are just what they sound like: the parts (and people and pets) of our lives that keep us safe. Talking out loud about suicide does not cause suicide; research shows it actually can decrease the risk that someone will complete. Still, talking about it is extremely tough. Most people want to avoid bringing it up, especially if the thoughts are just… thoughts.

What I mean is that for many people, their suicidal thoughts are not active. They don’t intend to harm themselves. They don’t have a plan to die. They have protective factors: a pet that needs them; a family who would be devastated; a religious background. But they are suffering. They have thoughts about closing their eyes at night and not waking up in the morning. They wonder what would happen if they were in a serious accident. This is called passive suicidality and even if it doesn’t necessarily mean someone will become actively suicidal, it still bears discussing. It is a sign that more support is needed.

Being honest about your passive suicidality is a good thing to do. Even if you think you would never actually hurt yourself; even if the thoughts are just passing and not intrusive; you deserve support. Help is out there. Don’t wait to call someone.

Your therapist believes in you

At our lowest moments, it’s hard to believe we will ever feel better. This is especially true when we get hit by a giant wave of grief. Long-time readers of this blog will remember the ocean metaphor: your grief is like ocean waves. You can be standing at the edge of the ocean for a long time with only little waves at your feet and then suddenly a major one comes and knocks you over. You didn’t see it coming so it knocks you to the ground with its force, or swallows you up. Temporarily. The ocean is not always giant, knock-down waves, right? Likewise, your grief will not always swallow you with its magnitude.

That’s easy to forget though, especially when you’re experiencing a big wave. This is where your therapist really comes in handy, especially if you’ve been seeing each other for awhile. You may not remember being here before, but I do. I also remember that you didn’t stay here forever. I remember that we got through the last wave and I believe we’ll get through the next one, even if you don’t.

Hope is hard to reach for when you’re struggling. But it’s also why I’m still a therapist. I really do believe that people can get better, that things will not always feel so incredibly difficult. The great thing about therapy is, you’re not alone, especially in those very bad times. We’ve been here before; we’ll find the way out again, together.

When does therapy end?

In my very first social work class in college, our professor taught us that termination begins during the first session. It shouldn't be a surprise to anyone when the relationship between social worker and client ends; it should be an ongoing conversation from day one. Sounds reasonable, right? After all, the relationship–whether it’s traditional therapy or case management or some other social worker/client situation–is finite. There is a goal that both parties are trying to achieve together. It’s not going to go on forever.

In real life, I don’t necessarily start talking termination in the first session (with apologies to that favorite professor of mine!). I have my reasons. First, for a lot of my clients, starting therapy is a giant step that they’ve often taken only reluctantly. Before they even start they’re looking for a way out. Talking about termination when they’ve just screwed up the courage to begin therapy may be enough to tip them over the edge into quitting.

Also, endings are hard. Ending a relationship whose major purpose is to dig deep into some very personal, vulnerable, and sometimes scary stuff feels even harder. Some people choose not to terminate in the traditional way (including me! Full disclosure, I have absolutely terminated via voicemail. I just wasn’t ready and I didn’t want to talk about it so I took the easy way out). I’ve also had clients feel really anxious about terminating and instead prefer a slow fadeout: first a session every two weeks, then every month, then… See you later? 

In fact, that’s a way to make termination much less frightening: you can always come back. I’ll be here. And if you’re nervous about starting therapy, maybe knowing there’s a time to end it will help. It’s one session at a time. You can start–and stop–whenever you’re ready. 

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.

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.

When grief is bittersweet

I took my daughters on a walk in the woods the other day and happened upon some birds taking a bath in a stream. My very first thought was, “I have to call Mom.” Almost simultaneously, I remembered that I can’t call her; she’s been dead for more than seven years.

But she popped into my head in that moment because she used to tell this story about me waiting next to my grandparents’ birdbath to see the birds. There’s even a picture to commemorate the story: three year old me in a pink winter coat, staring determinedly at the (very empty) birdbath. My mom told me how they tried to convince me that I was too close and the birds wouldn’t come but I waited and waited anyway. She loved telling that story. So when I came upon those robins bathing in the stream while I walked with my own children, I was seized with the desire to call my mother to tell her, I finally managed to catch the birds in the act.

It was sad, obviously, to realize I couldn’t actually call her. But what a lovely moment, to forget for just a split second—to have her be so alive to me still.

This is what I mean when I describe grief as bittersweet. The long, winding road of bereavement is filled with these moments: listening to a song that reminds you of your person; finding their handwriting in an old card; hearing a story you’d forgotten or never known about them. It’s sad, of course, but it’s lovely too, that the person you lost is still with you.

Grief isn’t all sharp edges and painful black holes—though those are part of it. It can also be a gift. Let it be. Let your heart feel full, even if it hurts. Find the sweetness in your grief.

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

Therapy is work

Sometimes people aren’t ready for therapy. They think they are. They make the phone call, schedule the appointment, show up and answer the first session questions. But then, when the work really begins, it turns out they’re just not ready to do it.

I confess, I have sometimes been one of these people who thought I was ready and then… wasn’t. I have walked into a therapy session, confident in my ability to get down to business, and then discovered it’s actually really hard. And I didn’t always have the bandwidth to do the hard stuff.

There’s no shame in that. It’s just a fact: if you aren’t ready to really look at yourself and do some work with what you find, you aren’t ready to be in therapy.

Notice I wrote that the work is “on yourself.” This is an important distinction: some people come to therapy because they want to change someone else. They want their marriage to get better, their mother to apologize, their best friend to commit to something important. But that’s not what therapy is for. You are the person in the room. You are the one who has to look at your own stuff and figure out what to do with it.

There are a lot of reasons not to commit to that; it’s expensive, it’s time consuming, it’s emotionally taxing. And yet, when you are ready, when you have the time and the resources and the mental and emotional space, it can be life changing. So if you aren’t ready now, take heart: you will be one day. And when you are, you are going to do great work.

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.

How to talk to someone who is grieving

The prevailing reaction from people when I tell them what I do for a living is, “ugh, how do you do that?” Which, I get: listening to people talk about their grief all day sounds like it would be depressing. It certainly can be at times. But it’s also an honor to hear people’s love stories, which is what grief pretty much amounts to: ongoing love for someone who has left us.

That being said, I realize not everyone feels the same comfort when talking about death, grief, and loss. So if you aren’t a grief therapist, what on earth are you supposed to say to someone who is grieving?

First, let me release you from the idea that you are capable of curing someone else’s grief. You are not. Grief does not have a cure, nor does it have an expiration date. This is not to say you should throw up your hands in despair and ignore someone else’s grief entirely. Rather, I want you to let go of the idea that you are responsible for fixing someone’s grief by knowing the exact right words to use on them. There are no exact right words.

There are, however, some less right words. By this, I mostly mean stay away from cliches like “she’s in a better place” or “it’ll be ok.” I know those phrases are tempting to use; they’ve become cliche for a reason after all. But that doesn’t mean they’re particularly helpful. You may sincerely believe in your heart that someone is “in a better place” but you don’t have to say that out loud to the bereaved. Likewise, you don’t have to say that “everything is going to be ok” or that “they wouldn’t want you to be sad.” Again, those things may be true but they aren’t useful to someone who is grieving a loss.

What is useful for grievers is to be truly heard. This means listening without trying to come up with an answer. You aren’t fully listening if part of your brain is working on a response. There’s also no rush to reply immediately with a profound and heartfelt speech. “That sounds so hard,” is enough. Or, “I wish you didn’t have to go through this.” Both of those statements convey that you hear what the bereaved is saying and that you aren’t going to try to convince them of anything. You’re just going to let them be sad. And if they’ve said something that you really don’t know how to respond to, admit that! “I don’t know what to say” or “I don’t know how to help” are both completely reasonable responses to someone’s grief. Sometimes there are no words.

That doesn’t mean we are powerless to help. When someone is grieving, even if you can’t think of the right thing to say, you can sit beside them and help shoulder their burden for a little while. That, I think, is far better than talking.

Therapists don't give advice

I love advice columns. I always have; even as a kid, they were my favorite part of any magazine. My Google tiles are mostly suggestions for Dear Amy and Dear Abby and Dear Prudence. I have a subscription to the Savage Love newsletter. I am addicted. I love that the problems are concise and (mostly) straight forward and that the answers are the same: here’s what to do!

But as a therapist, I don’t get to give advice. Don’t get me wrong, it’s sometimes tempting to just tell someone what to do. As your therapist, I have the benefit of objectivity; you may not know why you’re having such a hard time but it’s usually rather clear to me. I’m able to clarify and reflect back what you’ve told me so that you can decide how you want to move forward. It’s not advice but a different perspective.

This difference can be a tough distinction for clients to make. Often at the end of a session, my client asks, “so do you have any advice for me?” Of course the short answer is yes! I have very strong opinions about many things! As I said, the temptation to tell my clients what to do is sometimes very powerful. But advice is often best for the person giving it, not the one who receives it. Tempting as it may be, as right as I think I am, therapy is not like an advice column. The goal of therapy is to help my clients come to their own conclusions and make their own path.

You may not get advice in therapy but I think what you end up with is even better: trust in yourself to figure out how to change or move forward or let go. You know the answer; you just need someone to help you see it. Even Dear Abby agrees.