So you have a sense that you could benefit from starting therapy, but the whole concept sounds pretty...big. 

Let's break it down so you feel like you know what you're asking for. Let's answer the question: “What do I need”? 

One sweet and simple way to answer this question is to ask yourself this: If I woke up tomorrow and was feeling better, what would be different? How would I know something had changed?

Here are some common responses:

If I woke up tomorrow and was feeling better . . .

. . . I would have more energy.

. . . I would not be obsessing about my relationship.

. . . I would put myself down less and feel more confident.

. . . I wouldn't feel so overwhelmed by my anger (sadness, jealousy, anxiety, etc.)

What comes up for you? 

Maybe you have a few smaller items, or a single glaring one. 

Maybe you're mad or uncomfortable that your attention is being called to things you'd rather not think about. Perhaps you feel hopeful at the prospect of feeling better or different.

Any response is a perfectly fine one. 

Now sit with what you came up with and consider that you've taken yet another step down the road towards getting support. You are clarifying the area on which you'd like to focus.

So let's fill in some more details about the services you seek. These are a few common questions I ask when helping people specify what they're looking for:

1. Do you see yourself talking with a man or a woman, or does it not matter to you?
   
   
2. Are there any other cultural considerations important to you (age, ethnicity, religion, etc.)?
   
   
3. Is convenience important to you – Would you rather see someone close to home or work?
   
   
4. What time of day do you see yourself going to a weekly appointment?
   
   
5. What's your budget and do you plan to use insurance?

(You may notice that I don't include a question about theoretical orientation or what “type” of therapist you want. This is because I believe there's a better way to get at that information, which I will talk about in a future post. I will also post on budget/insurance.)

So, putting it all together, at this point you may have something like this: 

I want to get help with being so hard on myself and never thinking I'm enough. I want to see a female therapist in either the Richmond or Laurel Village area, and don't care about age, ethnicity, or religion. I could go Monday or Wednesday afternoons, and can pay $120/ week using my PPO insurance, which will reimburse me for either an in- or out-of-network provider. 

And just like that, you're ready to start your search. 

You can dive in knowing what you already know, or next up, I'll offer some insight on great starting points.

Yours in wellness, self-care and compassion,

Shana

Have a question or comment? Feel free to share in the comments section.
​Think I may be the right fit for you? Feel free to email me at contact@shanaaverbach.com or call 415-963-3546.

It's the last Monday of January 2016 - the first of the final seven days in which we can still ride the impetus of the new year towards personal growth.

On another day I might have felt like time was moving too quickly (It's the 25th? Seriously?), but today, perhaps because it's the fourth Monday in this generously long month, I feel like this week is a great opportunity. 

I want you to see it that way too. I really want you to see it that way if getting started with therapy is on your list of things-you-know-you'll-benefit-from-but-don't-know-where-to-start. Today I'm talking to you.

Let's all widen the scope of this new year's intention thing and consider that the whole month can be used to decide what we want to cultivate and what habits we may want to put in the not-serving-me-anymore bucket.

My sense is that people are naturally doing just that – thinking about these things, which is terrific in and of itself. It's really something to let into your consciousness that you'd like to hand over some heavy items you've been holding to someone you don't yet know. 

Or even to notice that the ways you've been coping – maybe numbing, overworking, blaming, intellectualizing – are neither sustainable nor satisfying.

Sometimes, though, thinking turns into ruminating or looping and we feel stuck. And one of the quickest ways out of rumination is to step into action.

But what action is the most appropriate for you? It's probably one of these three categories:

1. Those whose task is to clarify what they are seeking.
2. Those whose task is to start their search.
3. Those whose task is to reach out using the information they hold.

Over the next couple weeks, I'm going to walk you through some of this territory in an effort to help you find what you need. 

I will offer some questions to ask yourself that get at specifying what you're looking for. Next up will be multiple ways to search for a therapist, no matter what your budget. And finally, I'll offer support around reaching out, including what to say and what to expect in response.

But for today, what if you locate where you are right now? What category do you fall into? Answering this question may be a bigger step than you even know.

Yours in wellness, self-care and compassion,

Shana
​
​Think I may be the right fit for you? Feel free to email me at contact@shanaaverbach.com or call 415-963-3546.

To the mama who is having a hard time, listen close. You ready?

You might feel alone when you are in these exhausting new days of motherhood, which challenge your capacity for everything. You might feel very alone if you are experiencing a flat, depressed mood for weeks, anxious thoughts that keep you from getting that tiny touch of sleep available, and/or that naggy voice telling you that you are doing a bad job, that your baby doesn't like you, that you aren't cut out for this after all.

And you might feel real real alone if you are keeping those experiences to yourself. Because isolation is the breeding ground for unchecked critical self-talk and shame. And of course loneliness.

But YOU ARE NOT ALONE. You are connected to every single woman who came before you and walks beside you in this world. Your maternal experience – the wonderful and the challenging – is shared across humanity. And your suffering -that ache that feels attached to you and only you - is shared as well. Maternal mental health disorders are thought to touch 15-20% of pregnant/postpartum women, and that of course only includes those willing to share their experiences.

And there are people who want to connect with you, to support you through this time.

But if I was just stronger, smarter, . . . If I was just more capable, adaptable. . .If I had a better attitude, diet. . .If I hadn't made this or that decision . . . If I was a different person I wouldn't be having these problems in the first place.

Hold on mama, cause YOU ARE NOT TO BLAME. Your hormones and brain chemistry are on the wildest ride of their lives. Sleep deprivation is considered a form of torture and you've been enduring it for a while now. You may have been raised with the belief that asking for help is weak, or encountered life circumstances that led you to rely solely on yourself. Perhaps you have a partner who doesn't yet know how to be of support. Oh, and you have just carried and delivered a human baby into this world, forever changing life as you knew it.

You're having a hard time not because of who you are, but because of an enormous, intense and complicated constellation of factors. It is so completely not your fault.

But what if I feel this way forever?

You won't. Anxiety is so uncomfortable that 30 seconds seems long. Depression has a heavy quality that gives the perception that time is moving slowly. Worrying about the livelihood of your child for a second feels like a second too long. But it's gonna pass, mama, it will. You gotta tend to you, because WITH HELP YOU WILL BE WELL. The first step is let someone know what's happening for you. Then the options are vast – support groups, therapy, medication, education, accessing your current and building new resources . . . 

You've been doing some heavy lifting. It's time to rest up and let others help hold you. You matter so much sweet mama, even on your darkest days.

"You are not alone. You are not to blame With help you will be well." is the key message shared with women and men around the globe by Postpartum Support International ~ www.postpartum.net. 1.800.944.4773

I was flying high on pride when the dentist's office called to schedule my follow up visit. Several hours earlier, I had gone in for a check-up and cleaning after nearly a decade of avoidance. 

You see, despite the fact that I had a gaping hole in one tooth and obvious discomfort in others, I had let fear guide my judgment–fear of pain, discomfort, a repeat of past experiences, and the anticipation of a shaming conversation called “you need 15 fillings, seven root canals, and what-is-wrong-with-you-that-you-would-let-this-go-so-far”? 

I must have thought I couldn't handle it.

Going in showed me that thought was erroneous. I could absolutely handle it through the discomfort and the tears (yes, I wept, reassured the kind staff, and carried on). It also gave me the opportunity to experience something other than my worst case scenario, which is often the only picture hanging in our minds when fear is in charge of decorating.

Although I did need a lot of work done, it wasn't as bad as I thought it would be. What I didn't even bother fearing is what the receptionist told me after we scheduled my appointment. “For your upcoming visit, your total cost will be $900.” The cost for everything I needed would be close to $2000. 

“Ouch,” I told the woman before confirming that I'd be there (trust me, I scanned my brain for ways to use this as another excuse not to come back).

But I flashed to the moment earlier in the day when I handed over a worn five dollar bill to cover the routine visit. I quickly calculated that I'd be spending $1900 more than 10 years worth of biyearly co-payments for visits that could directly prevent these very issues from coming into existence.

And just like that, I thought “F*#k my fear. I can't afford it.”

I had been trying to take a more gentle, trauma-informed approach to this issue, but as soon as I switched the lens to a monetary one, something shifted in me, and I knew (I know) that I will continue to face this fear. Let's look at a few ways that fear picks our pockets and how we can intervene to lessen our losses.

1. My dentist example mirrors many others in the medical domain. While they don't always talk about it openly, often people avoid the doctor—whether dodging routine visits, ducking blood tests, or not being honest about symptoms—for fear of what they will learn. The worst case scenario motif in this case usually involves an incurable disease.

Sometimes this avoidance will be okay; The symptoms are innocuous, the person is generally healthy. Other times issues will exist and grow and cost more than they would have if they had been addressed earlier. At its very worst, this type of fear can bring us to the place where it's too late for a medical intervention.

What can you do instead? Hang out in the worst case scenario gallery. Ask yourself what you would do if your worst fear came true. What would be your plan to deal with it? Who would be your support system?

Or think of a time when you had to adjust to something difficult. How did you do it? We often forget just how adaptable we are. Positive psychologists, who focus on human strengths, continually find that people underestimate their ability to get used to things.

Now that you've conjured up images of effectively coping, see if it's easier to take the first step. (And here's a big bonus: When you do show up, there's a good chance the worst case situation won't be there.)

2. Fear blocks us from taking the risks often required to earn more money. Think of the promotion you won't go for or the more appealing and lucrative career change that is too daunting to let in to your consciousness. Think of the inner voice of fear saying things like “I won't get it, why even bother.” Or, “There are other people far more qualified than me.” 

But what if either of these changes would bring you $5000 to $20,000 more per year, or more, and you've been avoiding these changes for a a mere three years? I don't know about you, but I can think of plenty of things to do with an additional $15,000 to $60,000, annually.

So how can you stand up to that voice? Think of all the ways that you do qualify. Scroll back and think of every piece of positive feedback that's ever come your way, whether you believed it at the time or not. 

Think of specific examples of work you have done that stands out. Write these things down and see if your “evidence” is enough to suade you to reconsider your stance.

Alternately, recall the times that people who are not, in your view, very adept, but are outwardly confident got the promotion, got the raise. This feels a bit immature as I write it, but it also feels extremely true and important. Regardless of skill level, the people who are willing to go for things are always in a better position to get them, plain and simple. Wouldn't you be doing a service to everyone to plug in your concrete examples of skilled goodness into the next level of work?

If you truly are left with the feeling that you aren't ready—that it isn't fear, but a simple truth—take the steps to prepare you for the next time an opportunity arises (e.g., take a class, find a mentor, etc.).

3. Fear leads us to purchase things we may not need. Think car rentals where we purchase insurance even though we are already insured. Think baby product industry where the edge of informed parenting is on a slippery slope down which you can fall into a pit of purchases you don't need—from buying every single book on parenting you see to insisting on the Cadillac of strollers instead of the perfectly good Toyota.

The latter example can also be seen in other phase-of-life purchases made because we want to keep up with what society says we should be doing. Think purchasing a house or car that you cannot actually afford.

I know this is quite a spectrum of stuff that may range from 25 to hundreds of thousands of dollars. And I should add that there is nothing intrinsically wrong with wanting any of these things. But what they all have in common is the in-the-moment perception that we must have them, or else _____________. No matter what you put in that blank space, it is likely a statement about fear.

So how can you buy some time? Do just that. Do whatever research you need to do before you get in the car rental line, the real estate office, or the baby registry zone. Get an idea about what you truly need, based on your values, your budget, and your bigger picture timeline. 

Talk to people you know and trust before those who are in a position to sell you something. And when you are before the sellers take all the time you need to ask clarifying questions. And don't forget one of the first words you ever learned: “No.”

I've been back to the dentist twice since that initial visit and it's amazing how my comfort level grows each time. The cost is a bummer, but I know it's finite. It's like the decision to seek support in any way. I'm not only investing in my health, but in my ability to change how I show up to different situations. And that to me is priceless. 

I met a colleague for a walk several weeks back and when she suggested a hilly route, I paused (yes, the thought of an incline made me hesitate) and said, “Yeah, let's do it. I haven't been exercising lately.” Then she paused, and in a lighthearted way that didn't quite sound like the appropriate accusation that it was, exclaimed “I just read your blog post about exercise today.” “I know I know I know, it hasn't been that long,” I quickly inserted (it had been a week). “I just haven't been getting in as much as I would like.”

The very evening I wrote about mindful cooking, I botched some roasted veggies due to basic inattention and I may or may not have checked my email in the time it took for my sausage to grill.

And yesterday I ran into a lovely woman I haven't seen in forever and one of the first things she said was that she'd been keeping up with my blog and that she was finding it helpful, to which I responded “Oh-thank-you-so-much-I-totally-haven't-been-taking-my-own-advice-I'm-about-to-write-a-post-about-hypocrisy.”

Clearly accountability is on my mind. This is good.

See, the thing about caring for others in any way is that you must check to see if you are holding yourself to the same expectation and hopes as those for whom you provide support. Plain and simple.

Sometimes the misalignment is obvious. 10 years ago I was a coordinator for a mentoring program for children and adolescents. I worked in a building in the Tenderloin that had a youth center on the first floor with windows facing the street. There were always youth inside playing pool, doing homework, or just hanging out.

I was a smoker then and on one of my first days went outside for a cigarette. I didn't feel right about standing in front of the youth center smoking, so I walked around the block and tried to enjoy a short cigarette break. What I found during the five minutes I had left was that I was standing on a street with drug deals to my right and people nodding off to my left. It was hot and the air smelled of urine. I had a moment of clarity. If I don't want these kids to smoke and if I don't want them to see me smoking to the degree that I'll hang out in the middle of THIS, maybe I should stop smoking. So I did.

But sometimes the mismatching of norms for self-versus-other is more subtle. I know a lot of therapists who simply speak unkindly to themselves, leaving the voice of the self-critic to her own devices. There are those who fill their time to the brim while preaching time management, and those who self-medicate with substances, food, and/or harmful behaviors while exploring healthy decision-making with clients. Occasionally I'll meet a therapist or social worker who still has never been to therapy.

If this sounds familiar to you, congratulations. Why? Because every moment of recognition is a potential moment of intervention, and there's no time like the present.

Check out this Wellness Tool for a simple way to start.

And while I've been speaking to those in the helping profession, this same concept is true for everyone. We're all prone to put ourselves last at times or to not live by the lessons we expect others to learn from. (Anyone who has the pleasure of parenting a teenager knows that you can't really get away with this without the hypocrisy police being called. Save them the pleasure.) 

So I stand here in all my glorious confessions to take an unhypocritical oath and I invite YOU to join me. 

The fact that there are three entirely different popular songs entitled “Beautiful Disaster,” two called “Beautiful Mess,” and one “Beauty in the Breakdown” makes me think that pop culture is into the concept of capturing the power and beauty in moments of messy despair.

These are times we wouldn't necessarily want to relive, wouldn't speak of in a job interview, or think of as role model moments. But I have discovered that they are pivotal parts of life, as in something is different and better in the moments or phases after. Presenting to graduate students in the very same counseling program I attended a few days ago reminded me of one of my beautiful disasters, an honest, messy moment in Tulum, Mexico several years ago.

I had just finished graduate school, ending two of the most emotionally taxing years of my life. For those who don't know, a large part of graduate training in counseling/psychology involves thinking about, processing, and writing about your individual, family, and relationship experiences. For those of us who choose to do this full time in public institutions, this means sitting with clients very shortly after opening your first “How To Be A Counselor” book and starting your first of many personal reflections.

Now, being a human being, and arguably one who comfortably hangs out in my head, and even one who had several years of therapy under my belt, I, like most people who want to feel normal and okay more often than not, tried not to think about family dynamics on a regular basis, nor traumas, nor relationship issues. 

Graduate school got in the way of that. 

Conjuring up these subjects was an absolute requirement. From Group Work to Human Sexuality, every subject was subjected to personal scrutiny. And just to remove any semblance of subtlety from the experience, I, in true San Francisco form, lived in my parents' in-law during this two year trek. In any given week, it wouldn't be a stretch to delve into an old wound with my mother and then split an omelette the next morning.

When I wasn't in the swampland of reflection, I was sitting with clients, trying to plug skills from professors and books into human relationships. I had to listen to recordings of sessions and code my interventions, hear my own voice (which, all self-love aside, I don't even like the sound of in a voicemail), and critique my work. The self I walked in with was shoved aside for the self I was supposed to be becoming. Even when things were going well, it was difficult for me to feel like I was doing things right.

So there were two years of up to 14 hour days, three hour seminars followed by three hours more, lots of critical thinking, lots of critical thinking, plans to quit and run away, insights, family tension, tension in general, taxed relationships, new relationships, many hours in rooms full of many therapists-in-training, and a 50 page culminating paper. 

By the time I got to Mexico my shoulders had inched up a half a foot towards my ears.

Arriving midday, I stepped out of the cab into the moist air, feeling my curls swell on impact. I was escorted down a short path to my new "home." I put my luggage down, stood in the stillness of my room—a cabana just off the beach—inhaled this humid new place and felt so instantly, thankfully far away.

Human interaction during the first part of the trip was reserved solely for ordering food. I spent hours in silence watching my thoughts go by, observing my judgments and defenses trying to find a space at my table and giggling as I saw that there was no room for them. Alone and amused, I decided to start in on the daily yoga offerings.

I entered a spacious cabana, where 10 or so other people sat silently awaiting the start of class. The instructor flowed in, got right to it. We chanted Om, grounded our feet down, and started a never ending series of sun salutations. We opened our hearts, our crowns, our hips, our thighs.

It hurt.

Out poured the aching in my heart for the times I hadn't been able to give or receive love, and for the ache of others' hearts I had added to my own. Out came the tension in my head tied to war that was waged on my thinking brain, my executive function overload. Out came the pain of tightness, of trauma, that had locked its way into my body. And out came the shaky strength of the beams that had carried me forward despite myself. I wept openly with pain, and sweat out the toxicity of too much hurt and not enough self compassion.

90 rigorous minutes later it stopped.

We layed on our backs in Savasana—corpse pose—for 10 minutes, my entire body pulsing slower and slower. We were then instructed to keep our eyes closed while transitioning to a seated position to start alternate nostril breathing, a technique that was new to me. The instructor described where to place our hands, this finger on your third eye, these two covering one nostril, this one then covering the other.

I was confused, tears still sneaking out of my eyes, but present. My eyes trembled as I struggled to keep them closed and I noticed that amidst the heat and the heavy emotions my nose had started to run. I kept my eyes stretched across my wet face as I was being instructed. My body shook.

Sweat, tears, and snot commingled as my breath at-last found a steady rhythm. I was getting it. I hint of pride and relaxation passed through as we came to the end of the exercise. We were asked to bring our hands into prayer and bow. 

Namaste. 

I bowed low, flexible from the heat, sat back up and opened my eyes to see not the eyes of the instructor, nor the faces of my classmates, but the back of the room.

I looked for the familiar feelings of self-criticism and embarrassment, but they were nowhere to be found.

I had misunderstood, gone the wrong direction, done the exercise completely wrong. I had cried through the majority of the class. I was the craziest shade of red and soaking wet with sweat. And yet I felt lighter than I had in two years, my head held high. I had surrendered to my messy pain, and left the battle, gross and proud as could be.

San Francisco is vibrating with the energy of human rights supporters. Two days ago thousands marched for same-sex marriage equality here, and a quick search tells me smaller marches took place around the globe.

Then there's the cyberworld, which is visually showing its support with various images and symbols. It's pretty moving. 

I would say that actively supporting something you believe in is a Wellness Tool in and of itself. Between building community, fostering connection, and working towards something bigger and better for current and future generations, the enriching qualities of such movements are vast.

But people's inclination to show support and to empathize with those with fewer rights than themselves also got me thinking about one of my favorite forms of meditation, called Metta, which translates to loving-kindness. It involves first bringing loving-kindness to yourself, and then sending it to other(s). Below is a snapshot (a more thorough guide can be found through the Metta Institute website), followed by a 30-minute guided video:

1. Find a comfortable position in a quiet space. Take a few deep breaths and invite your mind to be still.
2. Repeat silently to yourself, "May I be happy. May I be well. May I be safe. May I be peaceful and at ease."
3. Call to mind a person in your life (it's easier to start with someone who you care for and/or cares for you) and repeat silently to yourself, "May you be happy. May you be well. May you be safe. May you be peaceful and at ease."
4. (Optional) Repeat with other people, including those who are more difficult for you to appreciate.
5. Simply notice how it feels to invite these thoughts to yourself and to send them to others. Enjoy!