The Good, Medium, and Bad days checklist

One truth about both grief and chronic pain (my two areas of expertise) is that some days are good, some days are bad, and some days are neither. Categorizing the days that way isn’t my attempt to judge them, though that’s what it sounds like. Instead, it’s my way of helping my clients figure out how to manage based on what kind of day (or moment) they’re having.

I hear a lot from my clients about whether or not they’re being “productive.” This is a word I hate. You are not a factory that has to churn out a certain amount of parts every day in order to keep functioning. You are a person who sometimes has easy days and sometimes has hard ones. If you are living with chronic pain or suffering a bereavement, you are allowed to not “accomplish” something every minute of every day, or even once every day. Sometimes it’s a struggle to wash your hair or make an important phone call or exercise. It’s ok for even “easy” things to be hard. 

Easy for me to say, right? We get a lot of messages about our worth from a lot of different sources and for most of us, it boils down to this idea of productivity. I can’t undo any of that just by telling you it’s ok to have a bad day. What I can do is offer an alternative to the self-berating some people do when their pain or their grief prevents them from being productive. 

Instead of starting with judgment (“I didn’t do anything today, I’m useless, I wish I had…” etc.), start with making a list. Actually, make three lists: what can I do on a good day? What can I do on a bad day? What can I do on a medium day? A bad day might consist only of eating and drinking and brushing your teeth. A good day might be an endless list of possibilities. There’s no right or wrong, only what you are capable of doing depending on what kind of day you’re having.

This might sound kind of silly but let me explain how it can help. If the only things on the list on a bad day are tasks you’re able to complete, you cannot berate yourself for not doing more. You did the things you were able to do on this particular day. On the flip side, the list of good day activities doesn’t have to be wholly completed on a good day. It can be filled with options: a good day might mean taking a walk with a friend or sitting down to pay bills but it doesn’t have to be both of those. There will be more good days to do more things on the list. 

Changing the way we view ourselves and our worth is not a quick fix; it’s an ongoing practice made of many small habits and tasks. Instead of the usual cycle of self-recrimination, try something new. Make a list. Give yourself grace. Better days will come.

Decision fatigue and grief

One of the perks of being married is that you don’t have to make all the decisions yourself. For most couples, the labor is divided, either out loud or by silent agreement and habit building over the years. It goes beyond who does the dishes and who mows the lawn. It’s also who knows what to do when an appliance needs to be serviced or replaced; who keeps track of the appointments and the birthdays and the finances; who does what in the household. 

When someone is widowed or divorced, they become the sole responsible party in their household. I can’t tell you the number of times I’ve heard, “I don’t know where all the accounts are” or “I don’t know who the electrician is” from my bereaved clients. If you’ve built a life with someone else, chances are you’ve shared the responsibilities. Therefore, finding yourself alone, having to make all the decisions without someone else’s guidance or input, can feel exhausting.  

This is a kind of decision fatigue. Decision fatigue isn’t unique to grief but it is part of it. When the furnace breaks or you’ve forgotten to schedule an annual physical because the other person used to do that stuff, it’s a reminder of who is missing. The bereaved expect the bigger grief landmines: holidays and birthdays, for example. The other moments—the smaller ones, like “my husband always” or “my partner used to”—are less expected. In those moments, your loss may be more keenly felt. When they pile up, one after another, the idea of making yet another decision can feel absolutely paralyzing.

If you find that you’re struggling with decision making during your grief, you’re not alone. Decision fatigue is a normal part of the process but you don’t have to just live with it. This is your gentle reminder to ask for help when you feel overwhelmed. You can’t replace the person who did the things you don’t know how to do (or just don’t want to do); but at least you can tell someone else that you’re struggling and ask them to help you. You will not be stuck here forever; but while you are, let someone lead you out, at least a little.

"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.

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.

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.

When someone we love is suffering

The problem with loving someone—there are many but let’s start with this one—is that sometimes the person you love will suffer. They will have pain or disease or grief or distress and you will not be able to magically take it away from them. Watching someone you love suffer, physically or emotionally, is awful. And yet, it’s part of the whole deal.

Once, after my mom died, I told a colleague, “I just don’t want my brother and my dad to be sad.” I ended up laughing instead of crying because of the way my sweet colleague stared at me and said, “Elizabeth.” It was, in fact, a bonkers thing to say. It was also true. My own grief was hard enough to bear; I couldn’t stand that the people I love were also suffering.

This is a common theme for my clients, whether they are caretakers or bereaved. Their own grief is awful, all-consuming, exhausting; and yet, they cannot bear to think that other people in their life are also having a hard time. Ignoring the grief and pain of others is doable but doesn’t feel great and also can be hurtful to said loved ones. On the other hand, taking on the pain of others also feels awful and doesn’t take anyone’s pain away. So what to do?

The answer, of course, depends: on what kind of day you’re having; on how the relationship usually functions; and on the cues you’re getting from the other person or people. But in general, as I’ve written ad nauseum, our grief is much easier to bear if it’s shared. You are not protecting your loved ones if you deny your grief or theirs. On the contrary, talking about it opens the door gives them permission to grieve with you instead of protecting you.

We don’t want the people we love to suffer but they will; that’s a part of life. And if that’s true, we may as well suffer together.