Category:

therapy

Grief In Repeat

{Upland, California}

Upon driving into my garage coming home from work this evening, I suddenly burst into tears as the garage door slowly closed behind me. I haven’t felt like myself at all this past week. I tried my hardest to discern the reason for my melancholic mood and pinpointed a series of events that occurred after the subject of death was brought up during my therapy session this past weekend. The subject of terminal illness and inevitable death is never an easy one, even as a physician who had to pronounce deaths in the hospital wards and was educated on how to talk to patients about advance directives (Do Not Resuscitate/DNR), hospice, etc. We all have triggers that may occur randomly during our day that may unleash suppressed feelings that go deeper beyond whatever triggered us in that present moment. A patient once told me that hamburgers made her sad because her deceased father cooked them all the time at family gatherings. For others, something as simple as a hamburger triggering profound emotions may sound ridiculous, but we must be empathetic to each individual because none of us know of the history, context, or meaning that a symbol (such as hamburgers) provided in a person’s life.

My initial trigger was watching the movie Furious 7 last week. Now, I know that millions of devoted Paul Walker fans (including myself) were profoundly impacted by his tragic death, but the uncontrollable amount of tears that I shed was far too disproportionate to the mild attachment I had for the actor. Since everyone I knew who watched the movie admitted to shedding tears, I didn’t think much of my emotional response at the time. But, during my group therapy session, I was extremely angered about an unrelated topic, and again, I couldn’t figure out the reason why. Leaving my therapy session in a pissed off mood, I contemplated quitting group because I didn’t want to be a part of anything that made me feel angry and unsupported. I looked at my phone and started scrolling Instagram to distract myself from my emotions, and stopped incessantly scrolling once I came across the picture below, which my sister posted for National Siblings Day with the following caption:

It was always the four of us. Although we’re all grown up with separate lives, we will always have the same love for each other, and share the same values that our Lola and Lolo (Grandma & Grandpa) taught us. My latepost In honor of ‪‎siblings Day 4/10 and my lolo’s birthday 4/7. I love you all. I miss you Lolo & Lola.

Last week was my grandfather’s birthday. The theme of losing such a devoted and integral part of a family is the theme that resonated most with me about the movie. And watching the ending somehow re-opened the wound in my heart that I experienced when I first received news that my grandfather passed away from cancer thirteen years ago. I continue to re-experience feelings of grief each year around his birthday and this year is no exception. I wrote about my grandfather’s influence and my difficulties coping with losing him in previous blogposts (here, here & here). Last week, a few of my patients discussed their own grief, which is always a hard subject to process. I always do my best to provide them with as much support as possible because I know what it’s like to feel isolated, angered, and confused by a complex mixture of emotions.

I used to want to believe that “time heals all wounds,” but one of my inspiring readers modified my perspective of the statement to make it more accurate: time may help make the grief a bit more tolerable. Grief never goes away, but rather is re-experienced in different, sometimes confusing ways. But, just like the goal of the movie, I try to shift my focus from sadness to embracing my grandfather’s strength and legacy. I can already feel the wound close a tiny bit as it starts to repair itself yet again.

April 15, 2015 16 comments

Personal therapy

Let Go

written by freudandfashion

{Ventura, California}

Several of my readers know how much I struggle with self-care and criticize myself on days that I feel less productive (I wrote about the subject here, here, and here). I’m starting to let go of the guilty, judgmental thoughts, which I’m sure are ingrained in the minds of many others like myself who’ve spent most of their lives incessantly working towards a degree and busy career. Last month, I disclosed to one of my patients that I sometimes sit on the couch and watch tv for hours on days I feel exhausted and overwhelmed. I regretted telling her the information because I realized my attempt to make her feel less guilty about doing a similar “lazy” regimen was really an attempt to validate my own actions of simply resting on my days off. I realized how much I still need to work on letting go. I need to let go of the pressures, demands, guilt, and self-criticism.

Well, I’m happy to report that I went to the beach this week, strolled, and stared out at the water as the surfers rode the waves. The thought of rushing home to answer emails popped up in my head a few times, but I surprisingly allowed myself to let the thoughts go. I’ve been working on this process of self-care for years, but I’m making progress. And that’s all that matters (no self-criticism involved).

What activities of self-care did you incorporate this week? I hope you all have a wonderful, relaxing weekend!

April 10, 2015 12 comments

Personal therapy

Numb

written by freudandfashion

I honestly didn’t want to write a blogpost today. The main reason being that I’m not in a peppy mood, but why should blogging only be about happy thoughts when reality is that human beings experience a full range of emotions?

My current emotion = numb. I participated in a suicide debriefing at work today, which is a meeting where we review a recent suicide, process grief, and provide support for staff members involved. I have been open about my feelings surrounding patient loss (here, here, and here), and experiencing this sort of numbness is somewhat new to me. The intellectual part of me feels inclined to look up research articles to find meaning behind this numbness, however the emotional side of me lacks motivation to perform the work. We may sometimes experience a mixture of confusing, unfamiliar emotions, which may contrast from what one might perceive to be normal or expected. But that leads to criticism for feeling a certain way. How nice would it be to have freedom to be yourself and feel a certain emotion without being judged?

Yesterday, one of my newer patients wanted me to tell her where her anxiety is coming from and I replied, “I’m actually not sure, but perhaps you have an idea what might be triggering it?” My patients often expect me to identify the reason behind a specific emotion, but I find it difficult to formulate my thoughts without the patient’s own input. If I switched roles right now and sat in the patient chair and the psychiatrist asked me where I think my numbness is coming from, I’d say “I feel too overwhelmed and there’s no room for extra stress in my life.” (Then, the light bulb goes off in my head). I have too much going on in my mind and don’t have the reserve to tolerate more emotions at this current moment. Hence, feeling numb. Now that I think about it, feeling numb isn’t much different from the hours I spent watching House of Cards last night (Note: it’s out of character for me to watch that much tv on a regular basis). Either way, I am trying to avoid some unsettling feeling that I’m not quite ready to process. However, I’m bracing myself because I know the time to process the difficult emotions will eventually come. Until then, I still have two more seasons to watch.

March 5, 2015 20 comments

Psychiatry therapy

Therapy Pet-Friendly Guide

written by freudandfashion

I learned about the concept of service dogs early on since my dear aunt has a guide dog (which I featured in one of my blog posts here). In my practice, I am often asked about the process of making a beloved pet an emotional support animal (ESA) or a psychiatric service animal (PSA), so I thought it might be helpful to share info for those who are interested. And as a side note, it wasn’t until I wrote this post that I realized the differences in nomenclature, for “therapy dog” (a dog trained to provide comfort to people in hospitals, nursing homes, and other institutions where their services are needed) certification has its own set of guidelines that you can refer to here. Therefore, for the sake of this post, I will limit my discussion to PSA and ESA.

Psychiatric Service Animal (PSA):

The 2010 Americans with Disabilities Act (ADA) regulations define “service animals” as dogs that are individually trained to do work or perform tasks for people with disabilities.
- a dog trained to perform tasks that benefit a person with psychiatric disabilities = a “psychiatric service animal”
  - examples: calming a person with PTSD during an anxiety attack, reminding individuals to take medications
- Miniature horses may also be included under this definition, however, there are four assessment factors that facilities may use to determine whether or not miniature horses are permitted
How do you get your dog to qualify as a service animal?
- In my research, I was surprised to find that registration for a service dog is not required, nor are special vests, tags, or harnesses required to be worn (though many utilize these as a way of identifying them).
- Almost anyone can train a service animal. In order to be protected under federal and state law (I know this to be true in California, but please check with your respective states), the only requirement is that the dog must be individually trained to benefit the person with the disability (Bronk v. Ineichen). Otherwise, if the owner fails to demonstrate their dog’s ability to perform the trained task, it is considered a crime of misrepresentation.

Emotional Support Animal (ESA):

An ESA is any type of animal (not just limited to dogs) that can provide comfort to a person with a psychiatric disability. Training to perform a specific task is not required [1].
ESAs are not protected the same way that service animals are protected when it comes to access to public places (restaurants, buildings, etc).
Will your ESA be allowed to stay in your home even if your housing complex has a “No Pets” policy?
- The answer is generally yes, however, the details are a bit more complex so I suggest checking out the answer to this question here starting on page 5.
What is required for your pet to qualify as an ESA?
- As mentioned above, the animal must provide comfort as therapeutic benefit for a verifiable disability.
- For situations pertaining to housing or travel, a note from a physician, therapist, or other qualified medical professional should indicate the animal’s provided benefit for the person’s disability.

Helpful Resources:

I like to print out information for my patients, so I bookmarked the following link from Disability Rights California (still quite useful even if you live in a different state) as it provides simplified, yet comprehensive information on the topic: Psychiatric Service and Emotional Support Animals.

For physicians, mental health clinicians, and other qualified medical professionals, the link above also includes useful sample letters to use as a guide when writing notes for your patients.

Notes:

See Majors v. Housing Authority of the County of Dekalb (5th Cir. 1981); Housing Authority of the City of New London v. Tarrant, (Conn. Super. Ct. Jan. 14, 1997); Whittier Terrace v. Hampshire (Mass. App. Ct. 1989); Durkee v. Staszak (N.Y.App.Div. 1996); Crossroads Apartments v. LeBoo (City Court of Rochester, N.Y. 1991)

February 26, 2015 9 comments

Psychiatry therapy

Shock and Denial

written by freudandfashion

I review the 5 Stages of Grief with my patients all the time. Yet, no matter how many times I review them, nor how many patients or people I lose in my life, experiencing these stages never gets easier nor avoidable.

Stages of Grief:

Shock/Denial
Depression/Sadness
Anger
Bargaining
Acceptance

The following was written last week:

Today, I shall focus on shock/denial. Why focus on the shock/denial stage? I received a call from the medical examiner (aka coroner) today. I hold my breath each time I answer my office phone in fear that the medical examiner’s office is on the other line. The worst sentence to hear upon answering the phone is “Hi doctor, this is (insert name here) from the medical examiner’s office.”

My biggest fear became a reality today, yet again.

Currently, I am in the shock/denial phase and I’m coping by intellectualizing (a defense mechanism that many of my colleagues employ to deal with difficult news; mostly because I’m more comfortable processing the loss clinically rather than emotionally at this point, hence, the reason I am focusing on writing a blog post that teaches the stages of grief), carrying on with work, and going about my day, with the occasional few tears and blank stares when I have downtime. These moments of sadness are periods that I try to avoid, especially after glancing at my fully-booked patient schedule. According to the medical examiner, “cause of death is not known, the toxicology results are still pending.”

Each and every one of us go through this phase when we experience loss. I blogged about the subject of grief recently when I lost a patient to suicide two months ago. I am aware that my demeanor is currently “off” because I’m quite tense and impatient right now as well. I might be going through the motions of a regular day, but in no way am I taking this loss lightly. I know the anger stage will approach soon. For me, the worst stage is sadness/depression because I generally want to isolate and hide.

The following was written today:

One week has passed since hearing the tragic news about my patient. I enter the clinic, greet my usual “good morning” as I observe everyone going about their busy day as normal. I enter my office and suddenly have a desire to punch my computer as it takes forever to reboot. I settle for slamming my palm against the keyboard instead. Note that this is my usual morning routine, minus the angry/”I wanna punch something” part. The anger stage is here.

I see my first few patients and notice a decline in my usual empathetic statements, my mind drifts more frequently, however, I remain fully aware of my thoughts and am able to re-focus. The 20 minutes that I have with each of them is their designated time and I must not let my grief impact any medical decision. I take my lunch break and run into one of the therapists, who was also involved in my deceased patient’s care. I decide to open up about the struggle I’m having today, in hopes that we can provide comfort and support each other during this difficult time. Instead, I get a remark that pisses me the hell off, or at least that’s how I interpreted her curt comment. I essentially wanted to tell her she was an insensitive idiot and to f*** off, but I held my composure. I normally wouldn’t be bothered by such a comment, but I’m clearly more irritable than usual. I let it go and tried to have compassion for her especially since she might be grieving as well, or thought that perhaps she’s a cold witch and doesn’t care, then thought that perhaps I misinterpreted her comment. Perhaps I feel that nobody understands, and maybe no words can make me feel better at this moment anyway.

February 5, 2015 23 comments

Personal therapy

Sticking To It

written by freudandfashion

{midweek hike in Malibu Creek State Park}

My “Monday Motivation” consists of posting my continued efforts to maintain my New Year’s goals for 2015. I truly appreciate all of you because you’re part of my support system — you’re helping me hold myself accountable to stick with these goals! I can’t emphasize enough how important self-care is to maintain a sense of well-being, which is the reason my last few posts have been dedicated to the topic. Most of my patients struggle with the same issue, which leads to burnout, increased stress, uncontrolled anxiety, worsened health, and much more. The photos in my post are proof of my activities from last week, and serve as my motivation to continue this week. If you’d like to join me in my efforts to prioritize self-care, would love for you to share how you’ve been doing so thus far!

{Took a REAL lunch break & caught up with celeb gossip and world news}/ {went to two amazing yoga classes, even though I was initially too lazy to go and wanted to back out (pic taken before class)}

{Took a stroll on the beach of Playa Del Rey after my weekend therapy session}

January 27, 2015 11 comments

therapy

Restful Week

written by freudandfashion

Have you ever felt guilty about having an unproductive week? That’s how I initially felt regarding this week, but in retrospect, I believe it was necessary to take it easy.

To be easier on myself (which is difficult for a self-critical person like me), I had to keep in mind two of my goals for 2015 (which I discussed in my previous post):

be mindful
be aware of my need for self-care

I felt ill this week and wanted to sleep most of the days, and therefore, couldn’t complete most of my tasks. However, I needed to listen to my body and its need for rest and recovery, whereas in the past, I’d push myself to go to the gym and stay up late until I completed everything on my to-do list. I also had insightful, yet emotionally-draining group and individual psychotherapy sessions, which resulted in me not wanting to write a blog post due to how much thought and psychological overtones I put into my posts. Yet, this is a pattern that has occurred in the past since I first started blogging in 2010, which resulted in large gaps between posts. I am trying to avoid those large gaps this time around and want to let you all know of the reason I’m late with this weekly posting.

What made me feel better was reading statements such as “it’s okay to not be okay,” which is definitely true, however, society makes you feel as if you have to be running on all cylinders ALL OF THE TIME. Which is fine, as long as you take necessary breaks and don’t wear yourself out. However, we are all human, and I often try to help my patients overcome barriers towards being less judgmental on themselves.

As you can see, I’m trying to take my own advice 🙂

January 18, 2015 7 comments

Psychiatry therapy

Mind Over Meds

written by freudandfashion

{Claremont, California}

Some of you may have noticed that although I am a psychiatrist, I rarely comment nor write about my thoughts on psychiatric medications in my blog. I did write a post as a resident physician-in-training in 2010 titled Pill Pusher, which briefly describes my general approach to simplify, minimize, and streamline medication regimens to the least amount of meds needed to provide symptom relief. In some cases, I have successfully worked with my patients to wean off and discontinue all of their psychiatric medications, though the process requires much patience, toleration of uncomfortable withdrawal symptoms, and numerous non-medication approaches to maintain stability off of meds. And most importantly, I believe a trusting doctor-patient relationship is needed to provide education of potential withdrawal symptoms, encouragement to push forward, and processing fears that may arise from being off medications for the first time in years.

Now, please do not mistake me for a protester against pharmaceuticals — I witness the positive impact that medications can have on enhancing the quality of life of my patients on a daily basis. However, I do not attribute the improvements primarily to medications. My treatment plans generally promote the development of insight and self-awareness of mood patterns, anxiety triggers, etc, and oftentimes explore how past suppressed emotions may contribute to current symptoms, all of which are topics I aim to emphasize in my blog. Medications may stop working or provide temporary relief, but knowledge of one’s self can last a lifetime.

Photos by Marlon Santos

December 20, 2014 2 comments

therapy

Thanksgiving Weekend

written by freudandfashion

{Fairfield, CA}

For Thanksgiving weekend, I could say I’m thankful for my family, job, friends, etc, though I’m thankful for these things every single day. This weekend, I’m especially thankful for the breakthroughs and insights I’ve had through therapy and life experiences I encountered this year, which have made me become more self-aware, mindful of my actions, confident in my strengths, accepting of my weaknesses, and appreciative of the many facets that make me who I am.

Hope you all had a wonderful Thanksgiving and enjoy the rest of your weekend!

November 28, 2014 0 comment

therapy

Fight the Blues

written by freudandfashion

{Emerald Bay, South Lake Tahoe}

I’ve written about the subject of laziness several times in my blog (here, here, and here), and this week has been exceptionally rough to get through. I attribute my dysphoria to a combination of factors: mental exhaustion (struggling with recent loss that I wrote about here, weekly sessions with my therapist exploring the origins of my overwhelmingly self-critical tendencies), the weather changes (hello, hibernation mode), and the upcoming holidays. Rather than writing a deeply emotional post, I felt it would be appropriate given my current mood to instead write about 3 things I did this week to combat the seasonal blues. I may be a psychiatrist who inherently gives advice, but I seriously learn a lot from my patients and others. Would love to hear about any techniques you apply to prevent from feeling down this time of year as well!

1. Write a simple to-do list. I used to be overly-ambitious with my lists, but that just left me feeling worse and unaccomplished if I couldn’t get everything done. This week, I listed 3 mandatory responsibilities plus a few smaller, easier tasks (yes, I even listed getting the mail as a task and felt great when I checked it off my list!).

2. Get moving. Though the couch and Netflix seem far more appealing than going to the gym, I struck a balance by going out for a quick jog. Even a 15 minute run helped provide some exercise and made me feel less isolated.

3. Schedule an activity with a friend..and don’t flake! When I have something planned, I hold myself more accountable and am less likely to cancel, especially if it’s with a friend. Even something as simple as putting on makeup for an outing made me feel more like my usual self again.

Thought of the Day: What different techniques do you utilize and find helpful?

November 20, 2014 8 comments

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