Category Archives: psychotherapy

So … Where Do Those Characters Come From?

Every author hears that question. Probably more so, it’s what people wonder when a therapist starts writing fiction. Friends, family and, possibly, clients and colleagues, wonder whose secrets I have mined to create the characters in my books.

Well, with the first novel in the series out there (Falling Feathers) and a second expected out before year’s end (Never Just One), two more in the queue for 2026 and one in development for 2027, I am happy to take on that question directly.

The fact of it is, unfortunately, that I am tucked into each of these characters.

I am Alex, the put-everyone-else-first person until the stress gets to critical mass and then she must say, No, that’s enough.

I am Joe, who can get so excited about a topic of interest to me, that I can turn any dialogue into an awkward monologue/college lecture.

I am Sandy, who wants to save the world, and probably needs to stop talking about how much better the organic produce is. But it really is better, that’s the thing.

I am Beth, who thinks if I just work a little harder, I can fix any situation.

I am Gloria, who thinks she knows best what everyone else should do. Period.

I am Bob, who smiles and nods at others’ advice and then wanders off to do what I please.

Even the characters I dislike have pieces of me. That’s the way it goes. Writing fiction is like a long and brutal examination of conscience, thrown out there for other people’s enjoyment.

To the extent any reader feels a flash of recognition – well, hello, friend! Looks like we have something in common. I hope you enjoy the books.

Believe that there is more to you

It is a sad and common theme.

A person is struggling: with an addiction, or obsessions and compulsions, or moral injury, or the impact of trauma, and has come to a place where the sense of self has been entirely subsumed by the problem and its pain.

The definition of self becomes “the addiction,” or “the monster who did (whatever has led to moral injury)” or “the mental disorder diagnosis.”

And, of course, as a therapist, I believe it is critical to address mental health troubles with the best of the science we have, with the particular approaches suited, as discerned ongoing, with the specific needs of that client.

But I also believe that a parallel need is extant and urgent: the need for this person, who is suffering, to come back to an awareness of self as a deeply beloved child of God. Not generically loved, like we may say that we “love” some food or activity or type of animal – but particular, personal, and intense.  Women who, like me, have been blessed to give birth will recall that wild wave of emotion that engulfs us when we meet that little person face-to-face after the peculiar intimacy of pregnancy. It makes us irrationally jealous of everyone and anyone; what mother doesn’t remember resenting the nurses and physicians who separated us from the baby long enough to do the general assessments and necessary care? Well, that is a reflection God’s love for each person.

If a person who is suffering is willing to enter into, and do, the hard work of therapy, which will include lifestyle changes and “homework,” and also becomes open to reconsidering his or her existence as a deeply loved person, someone who is more than the addiction, or bad choices, or terrifying memories, or intrusive thoughts and painful compulsions, then true and deep healing can happen.  This is what I would wish for every person struggling with emotional wounds.

My Grief Support Group

On October 1, the next offering of GriefShare will begin at St. Matthew Catholic Church. This marks my 15th round of GriefShare at St. Matthew’s, on top of a long history of grief support volunteerism prior to starting at St. Matthew in 2018. GriefShare at St. Matthew’s is free, although we do ask for a donation to cover the cost of the workbook provided to each participant.

GriefShare is a 13-week program, but with the breaks for Thanksgiving and Christmas, this offering will wrap up in late January, which I find useful – we surround the difficult weeks of the holidays but are well into the program, and, we hope, some extra support and encouragement for grief during especially challenging periods.

The last session began in February and ran through May – a difficult one for me, as my father passed in January 2025, the day before the October 2024-January 2025 GriefShare program ended. I was more than a little raw and definitely not my best self for the participants this past spring. I apologized along the way but it doesn’t make up for the fact that I was not on my A-game for people who needed me. I hope to do better this time around.

Generally, the guidance for grief support groups is to wait three months. For some people, it takes longer. Some people jump in sooner simply because waiting until another group starts seems too long. Every person is unique and so is their grief, the person they are grieving, and their history of losses, and these factors impact how we each grieve. Some people come to grief counseling years after the loss, when the demands of the aftermath of loss have slowed down. There is no timeline on grief.

GriefShare programs have a standard format: some check-in and chat time; a 30-minute video that addresses a particular aspect of the grief experience; and discussion time on that topic. The aforementioned workbook is for personal use between sessions, with daily readings and activities focused on each week’s topic. Speaking in the group is entirely optional – no one should feel pressured to speak. If you come and are unable to speak, please do not feel badly; your presence is important and valuable even if you don’t say a word. Simply by being present to one another, we give witness and support to the fact that we do, in fact, grieve the people we love. It doesn’t go away just because the world seems to have moved on.

GriefShare is a Christian program – there are references to scripture throughout – but all are welcome. For our Jewish brothers and sisters, most of the Scripture is drawn from Hebrew Scriptures. Not surprising, Job and the Psalms are probably most referenced!

To find a GriefShare group near you, go to www.griefshare.org and search by your zip code.

Please share this information with anyone you know who might need it. Even better – offer to go a time or two with a grieving friend who needs the support and encouragement to take that first, scary step to go to a group. It will be a couple of hours of pure, loving gift to someone who needs it.

Riding the Rapids

We recently spent a few days hiking up mountains, camping and white-water rafting in Wyoming and Montana, because isn’t that what people who are afraid of heights (me) and can’t swim (yeah, me, again) do for fun? And it was fun. It’s good to push out of the comfort zone.

Most parents and the other adults who care for and work with children are quite serious about helping them get out of their supposed comfort zones and into a healthier lifestyle. Recently, I was speaking to a group of adults about the topic, “Raising Mentally Healthy Children.” We spent our time focused on what we can do.

One problem that arises in these conversations – whether in a group, one-on-one, or with a family, is that making time for change seems impossible. The days are packed, and nothing on the schedule seems negotiable. Yet, in reality, what’s not negotiable is what humans need to be healthy and thriving.

What most kids need, and what we need, too, is more appropriately divvied-up time. For example, children and teens benefit from a solid two hours or more of physical activity every day. They need time outdoors, in nature, for their immune systems, Vitamin D, circadian rhythms and even their eyesight development. The near-and-far variation in focus that being outdoors elicits promotes healthy eyesight in young children; kids are supposed to go from crouching down to study a beetle to peering across the field to see if that’s a hawk in the tree and then taking off running to make sure. Optimally, they’re outside for at least two or so hours every day – more on weekends.

Kids need enough sleep – probably 9 or 10 hours a night, with an absence of screens. Recent research links high levels of artificial light at night (ALAN) with increased rates of cancer due to disruption of the circadian rhythm. An immediate risk with insufficient sleep is the attention system. Sleep-deprived people are irritable, inattentive, forgetful, disorganized and generally not fun to be around. Sleep-deprived drivers test as impaired, much like those with alcohol and/or drugs in their system. Think about inexperienced and sleep-deprived teenagers driving to and from school and work, often in the dark.

Kids, and we adults, need unstructured time. Most of the adults present had a creative hobby or two, and we all agreed that it takes time to shift gears into that hobby. It’s hard to walk in the door after work and immediately pick up a paintbrush, or guitar, or journal, or woodworking tools, and be in flow. The segue into creativity requires a sort of almost boring downtime – something many adults and children avoid compulsively through electronics. 

I can’t tell people what sacrifices have to be made for their family to have a healthier life. It varies from family to family, and it is never easy. It might be simple or quite complex, but it is never easy. However – after the white-water part, when you aren’t on nature’s roller coaster, there are always some smooth, easy times ahead. Thank you to all the parents who go for it – who strive to be sure their children to have the range of experiences they need to grow up resilient, curious and confident.

Ouch! Hey! and, Yay!

It can be hard for parents to make the changes they see would be best for their families. Every good idea seems like a Sisyphean struggle.

Sometimes it’s useful to start very small. Let’s begin with a short, very simplified review of behavior modification from Psych 101. We’ve got positive reinforcement (YAY), negative reinforcement (also YAY) and punishment by application – life does something to you (OUCH), or withdrawal, when life takes something away (HEY!).

Let’s say it is noonish on a pleasant day, I have a break, and decide to take a walk outside. I will enjoy the breeze, the birds singing, a chance to move and clear my head. I will come back to the desk feeling invigorated. I have been positively reinforced. I did an action, or stopped an action, that resulted in something good (my uplifted mood).

A few hours later, it will be about 3 PM and I may have the beginning of a headache. I glance at my water bottle and realize I am way behind on fluids, so I drink a few glugs of water. In short order, the headache dissipates. I have been negatively reinforced: I did a desirable action, and something bad went away.

Punishment, on the other hand, is entirely different. If, feeling a bit bored, I decide to scroll through the news of the day, I might feel depressed and then realize I have wasted my break reading bad news (HEY!).  Or, I may notice the beginnings of a headache and, instead of a drink of water, start with a few chunks of delicious, smooth dark chocolate and then (OUCH) my headache may well get worse.

The point of this little meander through intro psych lessons is that, when making changes, maybe it will progress better if you find ways to start with positive and negative reinforcement rather than what will seem like punishments.

For example, let’s say you think that at least one weekend afternoon of family time without devices would be a good start. Teens and even younger children may not agree. Wrestling their phones and tablets away is feasible, but they will consider this HEY!, and their resulting dopamine withdrawal symptoms to be OUCH for them; their miserable behavior may be a big OUCH for you.  But if a family activity inherently means no devices and then everyone has fun, we now have a big YAY in place the OUCH and HEY! What might that include?

Being outdoors in nature, where devices may not work properly anyway. A movie outing. A museum that requires devices be silent and away. Physical activities. Someplace where there is no phone or internet signal. Or just take a deep breath and impose device-off mode around a slice of a day and spend it in actively doing things that would not be improved by device distractions. Have fun. Don’t lecture about how fun it was (that’s an OUCH). If your kid mentions it was pretty fun, you can agree and take that as YAY – an invitation to repeat as possible.

Hard Changes

Most of us have some changes to make. And most changes are not so easy. That’s why people postpone them, or poke at the edges, or just pretend the problem will go away by itself. Sometimes people convince themselves there isn’t even a problem, really; that it just depends how you look at it. Maybe so. But maybe there’s something that needs changing.

Let’s say you have a teenage child, or a child approaching the teens. S/he is cranky, sullen, uncooperative with chores, sulks during family meals and resists being on time for school and other appointments. S/he wants to spend time alone, in the bedroom, with electronics. The child is depressed and/or anxious and/or obsessive and/or perpetually angry. You know the situation will change, one way or the other. Everything changes. If you do nothing, you are gambling that your child will continue down this road and somehow, at 18 or 19 or 20, wake up, shake themselves off like a wet Golden Retriever and come out of their bedroom, smile and say, “Wow! How could I have been so wrong?!”

Yeah, I doubt it, too.

If you have this situation and need to take it on, it can be hard to know where to start. Here’s a suggestion: if the situation is not a crisis, then the most practical first step may be to start with yourself.

You will have to change. Perhaps you have to start the change process by being sure that all the adults in the house are on the same page in your expectations. Perhaps you need to get yourself on the right path.

You go first. You get enough fresh air, and time in nature, and sleep, and healthy nutrition, and balanced physical activity. You strive to do interesting and challenging things in what little free time you have. You will, quite naturally and incidentally, spend less passive screen time. You’ll be leading from strength rather than being a target for adolescents’ favorite criticism: that we adults are hypocrites. You’ll be in a much better stance to steer positive changes for your tween or teen.  

It’s Just an Experiment

You know how it is. You want to make a change. Something needs to change. Maybe the kitchen needs organizing, or you need to sleep better, or be less stressed…whatever it may be. You want to get it “right.” And that’s where the freeze happens. “Right.  It has to be right.”

But what if there’s no way to know what is right for you without experimenting?

For all the chatter the past few years about science, and following science, there seems to be a misunderstanding of what science is. Science is more of a verb that a noun. It has more in common with, Hey, let’s try THIS and see what happens, than with learning a few things and deciding that’s it – that’s all there is to know.  You can see the difference in real time when SpaceX runs another experiment with the super heavy and the personnel there are excited about how much they’re learning and thus able to improve, while some people in the press call it a “failure.”  No, “failure” would be not doing or, having done, failing to study and learn. That’s failure.

At an individual level, let’s say you decide to take guitar lessons. You have no idea how to do anything with a guitar, but it’s been a long-time dream. Unless you are younger than five, you surely wouldn’t pick up the guitar, strum at it, and wonder why you didn’t sound like Carlos or Angus or Eric or Brian or whomever. You would have to spend many hours, experiment after experiment, building and reinforcing the new neural connections and fine motor skills that lead to the ability to play guitar. You would not call the outcome after the first, or tenth, or thirtieth, lesson a “failure,” properly, unless you gave up in impatient disgust and stuck the guitar in the closet, where it will peek at you through the clothes hanging in front of it and reproach your surrender until you sigh and try again or give the guitar away.

If you are looking at making a change, and feeling stuck, reframe what you are doing as experimenting.  Move the coffee mugs to that cabinet, over there, closer to the coffee maker, and see how you like it.  Buy a battery-operated alarm clock and leave your phone in the kitchen overnight for a few weeks and see what happens. Try turning screens off during meals, or leaving the audio off in the car, for a month or so.

Start the experiment, and then pay attention. That’s a critical part of an experiment. What happens in the absence of the old behavior? What seems better? What’s harder? What is your theory on why it’s better or worse? Can you build another little experiment – not a long-term commitment – on this one? It’s an experiment, for goodness’ sake, not a marriage.  That is science, and that is a way to get unstuck, make changes and work around any lurking perfectionism.

Not another horrible day

A different day, another awful situation. 

A child, or teen, or young adult has been struggling with emotional turmoil and is tumbling into danger. They confide in a friend, or maybe a few friends.

They may have “met” someone in an online chat and now this person is their “boyfriend” or “girlfriend,” and they are planning to run way to meet this person.

Perhaps the young person has been “sexting” with someone they know personally, or “met” online, and now are being threatened with “sextortion,” that the images of them will be spread around, unless they meet some demand. This has recently led to many teen and young adult suicides.

Perhaps the young person shares that they are a victim of abuse.

Or, perhaps they stumbled upon, or were led to, the terrible misinformation that hurting oneself is a useful way to cope with painful feelings. The young person proceeds to experiment with self-harm, and posts online about it.

So-called friends hear the plan, listen to the horrible stories, or see the images of scratches, cuts or burns, and fail to turn to an adult for guidance.

Every parent I’ve ever spoken to is under the impression that their child would, of course, come to them if a friend were in grave danger. And sometimes that is true, but an awful lot of the time – in almost any of these kinds of incidents I’ve ever encountered in clinical practice or consulted on, as it happens – that was not the case. The case was, almost every time, that other young people knew about the plan to run away, or the abuse, or the self-harm, and did not seek the guidance of an adult.

Sometimes these “friends” have an unflagging alliance, suddenly, to keeping promises (unlike the promises they have made to you, dear parent, about everything from cleaning their room to homework being done well to treating your automobile with respect). Sometimes they believe they are better equipped to help than an adult would be, although they cannot arrest an abuser, drive someone to the emergency room or help them connect with a mental health professional for counseling, and their capacity to manage extreme distress is probably not much better than the troubled friend’s skills. Sometimes they dread social disapproval for breaking the rule that you keep adults out of it, whether the “it” is someone self-harming, or sharing that they are a victim of abuse, or are planning to run away from home to meet up with the “boyfriend” they “met” online.

I urge you to have frequent, open conversations about these topics with your young people. Make them age appropriate; be calm and encouraging. If you are too stressed out, you may be misread as “angry.” Remember that adolescents go through a stage where their brain interprets almost every non-happy facial expression as “angry.” If that happens, the conversation will probably be a complete failure.

Be calm, be matter-of-fact, and be sincere. Ask questions, too:

How do the people you know handle things like a friend telling them this kind of stuff?

If this was your friend, what would you do?

If it were (fill in the blank for some close friend or family member), what would you want their friends to do in this type of situation?

Why do you think people are reluctant to ask adults for help with this?

What would make an adult seem safe to go to with this problem?

Don’t lecture; have the conversation. It may be a conversation that occurs for a few minutes at a time over an extended period. That’s okay; sometimes a few sentence and letting it simmer is what’s necessary.  

You may, without knowing it, be setting the groundwork to save a life.

Boundaries, Fences and the Berlin Wall

My cousin George died a few years ago, still with Soviet bullet fragments in one leg from his part in helping people escape from East Germany to the west. He had been a young man seemingly allergic to caution and willing to risk death to help others through what was intended to be an implacable barrier, the old Berlin Wall.

There are walls, and fences, and boundaries. The fences around our back yard allow bunnies to slip from one yard to the next. Yesterday, a squirrel chased a small bunny – not much bigger than said squirrel. The bunny escaped under the fence; the squirrel scurried up the fence to be sure the bunny was banished to the neighbor’s yard. The bunny, meanwhile, scampered right back into our yard. Up above, the squirrel looked left and right for the bunny. They had, apparently, an issue with boundaries.

Boundaries.  Twenty-plus years ago, boundaries were discussed most often in therapy, helping clients, often victims of emotional, physical and/or sexual abuse, learn how to put up practical, realistic limits for interactions with others. As the topic became more commonly known, wise writers and speakers (Brene Brown, for example) provided practical and inspiring information about developing and maintaining these healthy limits.

Like anything else, though, something good can be misused.

Medications that are essential to reduce some pain for someone in the final stages of cancer kill non-patients via drug abuse.

Entire genres of horror movies revolve around practical items used as devices of mayhem.

And the important psychological concept of boundaries – that we are each distinct beings and have a right to dignity and mutual respect ¬ is weaponized, like so much else in therapy, by far too many people.

As an example, consider the meme that “No is a complete sentence.”  That’s fine, as far it goes. But how often is that level of curtness warranted?

Husband: “Would you like to go out for ice cream?”

Lori: “No.”

Okay, for one thing, unless I am on a medically required pre-surg fast I wouldn’t ever say no to ice cream, so it’s ludicrous on that count. Secondly, it’s just rude. “No.” Better: no, thank you; tomorrow would be better, or, No, not this instant; could we go after I finish this paperwork?

No is a complete sentence, and optimally a loud one, when someone behaves inappropriately – then drawing attention to the need to stop an encroachment makes “NO! NO! NO!” a complete paragraph.

But the magical complete “No” is the least of my concerns. What happens more is the application of “I’m setting a boundary” when the person (usually a gaslighting partner or manipulative family member) really means, I’ve decided to be mean to you and I am using the magic hall pass word of boundary to get away with it. It’s totally legitimate to set a boundary. Yet, when used to justify inconsiderate behavior, it becomes a useful tool gone bad, a well-oiled emotional chainsaw in the wrong hands.

Of course, there are many people who refuse to accept reasonable boundaries.

For example, the fact, grandparents, that your (and my) fantasy of grandparent-life looked one way does not impose that script on our adult children. Whether we like it or not, they largely write that script and we can be enthusiastic about our roles, or be miserable grumbles and find ourselves little more than walk-ons.

Adult children who are not financially dependent on you do not need your unsolicited guidance on what they should be doing with their money. That conversation reasonably happens when they breach their “I’m a grownup boundary” by asking for money. They have, at that point, called you up from the Parent Reserves to Active Duty, and at that point you can ask questions, like, exactly what are they proposing to “pay off” with your IRA distribution for the entire year? Counter their complaints about boundaries that they are the ones opening that door.

When someone brings up the boundary word, it is time to breathe, ask some clarifying questions, and then take some time to reflect.

Does this feel like gameplaying – do the “boundaries” in this relationship keep shifting like quicksand?

Can you discern the difference between your disappointment and actual manipulation and meanness?

Does this sound as if the person is using psychological terminology to justify distancing from family? Is it possible that there are factors you don’t know about, or don’t sufficiently understand, that make this reasonable to them and for them at this time? This is entirely separate from you being disappointed.  Example: if big family holidays include family members who have been cruel, or abusive, or harshly critical, or have bullying senses of “humor” towards this person, the person placing a boundary up is acting in reasonable self-interest.

Usually, in the short term, the uncomfortable fact is that you can’t change the situation; you must figure out how to adapt. Pushing against the decision will, inadvertently, reinforce the decision; your arguments, tears and complaints will be interpreted as more evidence of disrespect for their asserted interpersonal boundaries – whether they are emotional boundaries, actual physical distance, or the dire separation equivalent to the old Berlin Wall.

Why didn’t you call me?

The Mystery of the Missing Phone Call

If you leave voicemail and I do not call you back, odds are it is because the voicemail did not come through, or, as sometimes happens due to cell phones, it was impossible to understand.  During 2024, there was a week in the autumn in which my cell phone record clearly shows no phone calls and yet later, several people complained about having called and receiving no call back. Their number popped up showing they’d called during the week in question, but the cell phone call logs of that week showed no such call. These things happen; it is regrettable and out of your, and my, control. If there is no call in a day or so during the business week, please call again! 

If you email me and ask me to call you, I will email back and invite you to call me. Sometimes people find this annoying or avoidant. I have two reasons for this.

First, I cannot be sure that whomever is emailing (or texting) is the person in question. That is why we therapists have requests about not sending confidential information by text or email.  Believe it or not, several times in my over quarter-century in practice, people have left voicemail or email with a name and number that was not their own. They had decided that “Alex” was in need of a therapist. In their imagination, leaving unsuspecting me a message to call “Alex” was a way to have “Alex” unexpectedly encounter a real, live therapist and jump at the chance to make an appointment. This is not how it ends up, believe me. On occasion, people have called and directly requested that I call some family member or friend, and I decline. I appreciate the honesty in the latter case, but it is still inappropriate.

Secondly, I cannot be sure that I will be calling when it is safe and private.

Thanks for calling!