Do you have that pesky voice in your head constantly shutting you down? Maybe you hear it say, “be a man”; “just do better”; “suck it up and deal”; “talking about your feelings makes you weak”; or “dude, no one wants to hear about your problems, just push through”. Seems familiar?
You are not alone. Men across multiple cultures to include the United States of America are constantly told to bottle up their emotions and not talk about their feelings because vulnerability is seen as weakness. This is not only a cultural norm, but something that families instill in young boys growing up, in professional career settings, and in interpersonal relationships throughout our lives. But it’s all bullshit. If you want to know the truth, allowing yourself the space and strength to be vulnerable and discuss what you are going through makes you a man with courage; the courage to help yourself when you need to in a healthy way.
The defining stereotyped image of whats makes someone a “man” includes expectations to use aggression (verbal and/or physical) to solve their problems, suppressing emotions and never talking about their problems, isolating themselves and withdrawing (“because no one wants to hear your problems”), expected to be effortlessly attractive and/or in shape, value sexual conquests over emotional intimacy, homophobia, and be tough/intimidate others to get their way and/or defend themselves.
Because our culture tells us that men should just sit down and shut up about their vulnerabilities, this often leads to self-destructive means of coping in men. Whether that be alcohol and/or substance misuse or abuse; or sabotaging personal and/or professional relationships with terrible communication skills and next to no problem solving abilities.
According to Benita N. Chatmon, PhD, MSN, RN, CNE, “Depression and suicide are ranked as a leading cause of death among men. Six million men are affected by depression in the United States every single year. Men (79% of 38,364) die by suicide at a rate four times higher than women (Mental Health America [MHA], 2020). They also die due to alcohol-related causes at 62,000 in comparison to women at 26,000. Men are also two to three times more likely to misuse drugs than women (Center for Behavioral Health Statistics and Quality, 2017). These statistics are troubling because they reinforce the notion that males are less likely to seek help and more likely than women to turn to dangerous, unhealthy behaviors.” (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7444121/)
So, how can we help challenge the negative stereotypes men are expected to live up to? How do we break the stigma so that men can achieve the felt safety in asking for help from others, whether that be trusted loved ones or professionals?
First, it is essential to normalize the idea of seeking mental health treatment. When we have a medical condition like Diabetes or Hypertension, there’s no shame in going to the doctor and/or dietitian for guidance and/or medication management. So, why should there be shame in seeking out help for issues like Depression, Anxiety, or Trauma? I feel that the reason this happens all too often is that we can’t just look inside the brain anytime we want to see what’s going on from a chemical or physiological standpoint. So, because we can’t physically see and/or measure exactly whats going on or why we feel the way we do, it becomes stigmatized as “a figment of our imagination” or “over-exaggerating”. This is beyond infuriating because mental health concerns are just as legitimate and can potentially become just as, if not more devastating than some medical conditions.
In my career, I’ve seen lives destroyed by Post Traumatic Stress Disorder, Psychosis, Depression, and Anxiety. Although such conditions don’t always lead to debilitation and/or significant decrease in functioning, they sometimes do and this is pathologized by cultural norms in America, especially for men. As noted above, men are expected to sit down and shut up, and not talk about their feelings because…”who cares, just deal and push through”.
In addition to normalizing the idea of seeking help, it is also important to be able to talk with trusted loved ones about what you are going through. Also, find ways to educate yourself about your mental health issues, maybe even do your homework about what condition you’ve been diagnosed with and what to expect in therapy. A wonderful resource for learning more general information about mental health diagnoses and treatments is National Alliance on Mental Illness (NAMI). Please see the link for their main website listed here. https://nami.org/Home. Talk with your mental health provider openly about your diagnosis, what to expect in treatment, and any negative feelings that come with attending therapy. Your therapist is there to help. Try to use the time and calm space in therapy sessions to explore the negative stigmas around men seeking mental health care and how this has affected you and your relationships to yourself, others, and the world. This helps the therapist understand your world and your experience so that they can provide the appropriate tools to help. It is also beneficial to outreach others who are having the same or similar experiences as you; this can build compassion for others and feeling more understood and grounded in knowing that you are not alone.
Men, just know that we all have baggage and you are not broken. You deserve to have the felt safety of seeking mental health care and addressing the concerns you have in a productive and healthy way.
– Jackie Martinez, LMSW (NY), LCSW (NC)
According to a study conducted by the insurance company Lemonade, 7 out of 10 American households have at least one pet. Pets are considered beneficial for mental health, providing companionship, emotional support, and entertainment. Furthermore, as is stated by the National Institutes of Health, pets are also found to improve human health by decreasing cortisol levels, lowering blood pressure, and improving mood.
If you are reading this article, chances are you are grieving the death or absence of a beloved pet, or you have learned your pet is terminal. Maybe there is something else going on. If not, you may be doing research to help someone who is going through such experiences. Whatever your reason for being here right now, I think we can all agree the key importance of pets in our lives cannot be dismissed.
We have all heard (or made) the statement, “that animal got me through a dark, bad time in my life.” I vividly recall my dachshund, Sierra, who I adopted only a few months after the death of my mother. While I knew she could not replace my mother, her unconditional love did help to fill the heavy void within my heart. As a dog with special needs (she was born with microphthalmia, which affected her vision) and me as a human broken by despair, we helped each other. Indeed, Sierra was my best friend.
Sadly, Sierra is no longer here, but I will never forget the bond we shared.
The therapist/writer, Valerie, with Sierra.
When we consider the comfort, joy, and support given to us by pets, it makes sense why losing them can be devastating to our psyches. For some of us, our pets are closer to us than our own family members and friends – and indeed, they are our family members, repairing the wounds we suffered from others. Pets can offer the connection we need to remind ourselves we are loved. Simply think of the last time your dog ran to greet you as you came through the front door or your cat snuggled and purred on your lap.
For some people, one of the most painful, difficult decisions they will ever need to make is to allow their beloved pet to be euthanized or “put down.” Euthanasia is frequently the merciful decision if the animal’s prognosis is poor. However, the realization of knowing you made a critical decision regarding your pet’s health and life can result in guilt, thus intensifying the grief process. You may swarm yourself with the “what-if” thoughts, such as, “should I have got a second opinion from another veterinarian?” or “is it at all possible the veterinarian was wrong and more could’ve been done?” or “did my cat even really want to die despite her being so sick?”
Unlike humans, who can help prepare for their demise through completing advanced directives, pets are incapable of making their own decisions. Thus, it is not surprising that devoted pet owners may feel complex emotions about if they did the right thing.
A few years ago, I scheduled for my cats to be spayed. Since this was a routine procedure and my cats were seemingly healthy, I had expected nothing catastrophic to happen. Instead, I figured my cats would be fine, and that I was doing the right thing by helping control the excessive cat overpopulation. Luna recovered well. Tragically, though, my lovely dilute calico Maine Coon mix, Starla, died from the anesthesia. Post-mortem, the veterinarian discovered she had a hereditary form of hypertrophic cardiomyopathy, which is relatively common in the breed. I was devastated, shocked, and angry. I never thought trying to be a responsible pet owner would result in my cat’s untimely death.
In time, I realized Starla likely would’ve died young regardless due to her underlying condition. But in that tsunami of grief, it was difficult for me to think clearly. Rather, I thought there was an injustice.
Like my experience, some pet owners have complicated grief due to an accident that killed their pet. Whether this be a health-related issue like my Starla, or perhaps a beloved dog getting out and run over by a car, or a cat running away, such an unexpected event can complicate the grief process. They may also experience guilt or think they have failed their companion.
Starla as a young kitten, a few months before the veterinary procedure.
A final form of grief over a pet is not due to death at all, but rather in instances that an owner needs to make the difficult decision to rehome their pet. This can be for a myriad of reasons. Perhaps their animal is aggressive and thus unsafe around the children. Maybe someone in the home is ill, requiring much care, and stretching resources thin for the caregiver. Or perhaps the pet owner is experiencing unforeseen circumstances, such as job loss, eviction, or other life-changing events. The person could have become disabled and realized they do not have the ability to care for something dependent on them. Whatever the reason, the person has made the decision to give up their pet.
This type of grief presents its own challenges. Like the other two types, there is guilt, but it can be even more severe because it can be coupled with a sense of betrayal. Furthermore, such owners are also stigmatized by others, such as animal shelters’ social media pages that can portray them to have no justified excuse whatsoever to surrender their animal. This type of loss often is faced in secrecy because the owner is afraid to admit the reason behind what happened, aware they may be shunned for the violation of a social norm.
Whatever the reason for the pet loss, it is loss. It hurts. And it can hurt just like any other loss. Grief is not only for the death or absence of people.
As a grief therapist, I can assure you it is normal to be distraught after the loss of a pet. There have been moments when my clients have confessed that they feel more heartbroken over losing their pet versus significant people in their lives. Some express feeling embarrassed or ashamed, saying things like, “the truth is, I’m sadder about my dog dying than my grandfather, but I know I’m supposed to be sadder about my grandfather.” In response, I challenge them to consider that unlike their grandfather, they lived with their dog. Their dog was never callous toward them, never judgmental, only a loving friend. And thus, of course it makes sense they would feel more grief for their dog.
For some people, pet loss can be the most difficult loss they have ever experienced. It is important for us to normalize this type of grief.
Grief will manifest itself differently depending on the individual. In a family who lost their pet, one person may be angry. Another could be crying nonstop. Still another may seem indifferent. One person may say “she was just a cat” and think about getting another cat right away, while someone else may exclaim, “she was more than ‘just’ a cat; she was my friend, and no, I don’t want another cat!”
All people will progress through their grief journeys at their own pace, facing difficult obstacles and emotions. It is also not a linear process; instead, grief can “go backward” or be experienced more like a web or set of highs and lows. These experiences are normal.
To be of support to someone grieving their pet, simply validate their emotions. Let them know it is okay to feel the way they do.
Remember, too, that other pets in the household can grieve. When Starla died, Luna wandered aimlessly around the home for days to look for her. She seemed to finally realize Starla was not coming home. Since then, I added other cats to the family. Luna tolerates them, but she has never shown the bond with them she had with Starla.
Some individuals do not want or need a support group. For those who would like to feel less alone or are having a hard time coping because they feel their loss is misunderstood, they can benefit from peer support. They can find solace in communicating with others who are going through the same thing. There are many support groups on social media platforms such as Facebook specifically for pet loss.
Yes, it is okay (and encouraged!) to reach out to a therapist to help grieve the loss of a pet and to learn coping skills for effectively managing that loss. As a grief therapist myself who has had my many heavy cries for losing a beloved pet, I will never judge you for talking about this issue to me. And it’s not just me – there’re many therapists out there who would love to work with you through this issue, offering compassion, empathy, and loving support. You are not “weird” for grieving.
For some people, a healthy way to express their grief is to honor their pet through memorials and rituals. Some veterinarians will send a grieving owner a sympathy card along with mold of the animal’s paw print. Meanwhile, some owners may choose to keep their dog’s collar or their cat’s favorite toy. Other owners may find comfort in reading the poem called The Rainbow Bridge, which suggests pets go to a special place in heaven accessible by crossing a rainbow-colored bridge.
Some people may find comfort in burying their animal in their backyard, while others may choose to do so at a pet cemetery. Others may do neither, choosing to keep the cremains, and others may not want any objects to serve as reminders. Again, there is no right or wrong decision here – all that matters is what will help you.
In our hectic daily lives the quality and quantity of our sleep is often overlooked. And this is due to a myriad of reasons including children, work, stress, and interpersonal issues, to name a few. For many, this is even the case in the face of regular reminders about how sleep is connected to our mental health on the news and social media.
So, what exactly does happens when we close our eyes? And how can we improve the quality of the rest we are able to get?
I’d venture to guess that everyone has, at one point or another, not gotten enough rest and felt irritable or had trouble concentrating. And this universal experience is really indicative of the larger impact that rest has on our lives. Sleep is a biological function that impacts our hormones, immune system, and metabolism. Likewise, sleep impacts us neurologically in regard to our mood, cognition, and attention. And the list goes on for both as research and science around sleep improves.
In regards to mental health, we know that many diagnoses, like depression, anxiety, and PTSD have symptoms that relate to sleep disturbances. For instance, studies show people who are suffering from depression may find it hard to fall asleep. Some people with anxiety may report similar issues with insomnia, if they find themselves worrying while in bed. PTSD can be associated with anxiety and nightmares that impact the quality and quantity of sleep hours. Likewise, studies have shown that symptoms of mania and psychosis can emerge due to sleep deprivation.
This is all to say, getting an appropriate amount of shut-eye, without interruption, on a regular basis, may be significantly helpful in deterring the onset of mental health symptoms.
So, the science is there, but it doesn’t change the fact that life happens. What can we do?
These are just some general tips to help improve your routine. In some cases, medication or medical intervention, like a CPAP machine, may be necessary. Be sure to visit your primary care doctor on a regular basis to inform them of concerns regarding your sleep. For example, if you wake up in the middle of night, struggle falling asleep, or if someone is concerned about your breathing while you’re sleeping.
As previously mentioned, sleep disturbances can be a consequence of a mental health diagnosis. If you feel you are overwhelmed, struggling with your mental health, or just need someone to talk to, you can reach a qualified clinician at Suffolk Family Therapy and schedule an intake appointment at your earliest convenience. To do so, call 631-503-1539 or visit our website.
– Nicholas Costa, Social Work Intern with Hunter College
Have you ever felt like when you try to explain something out loud, the pieces aren’t all coming together like you thought…but when you write things out, it makes so much sense?! Or maybe you’ve noticed that fiercely scribbling out your upsetting feelings on paper to get it out of your head brings such a huge sense of relief, just to vent out the intensity for a second. Lots of people experience this relief and sense of calm with the powerful tool of journaling. It is a great way to organize our thoughts a bit better and use writing to cope with our feelings.
The many benefits of journaling to address our thoughts and feelings include the relief that follows laying out our thoughts on paper; tracking our emotions, triggers, and physical symptoms related to our thinking patterns; figuring out and processing what is helpful or not in our coping; and thinking at our writing pace so that we can slow any racing thoughts so they are more manageable.
Journaling is an amazing tool to help us learn more about ourselves that we didn’t realize. We often feel that we know ourselves well enough and don’t need writing to figure it out. However, if we try journaling, we may find that it increases our insights into ourselves and how our thinking influences our feelings, behavior, and overall functioning in our lives. Sometimes, people find that journals with prompting questions and/or tasks help guide them in a positive direction in their journaling practice. Some ways to do this could be with Cognitive Behavioral Therapy (CBT) thought challenging, practicing gratitude exercises; mindfulness exercises; creating task/goals lists-breaking down large goals into smaller and more manageable ones; or tracking physical symptoms related to our emotional experience. Journaling not only helps with self reflection, but it boosts our sense of self efficacy, and shows us that we can take some control back in our lives.
Over time, I have seen that journaling using prompts based in Cognitive Behavioral Therapy have been especially effective as it gives a new perspective on how to view and analyze different situations that are upsetting to us. Some prompts you may notice are helping us to highlight the negative thought and situation that may have contributed to it, thinking about whether this is emotions based or reality based thinking, finding new ways to view the situation and/or thinking about what we might tell a loved one if they were faced with similar thinking and/or circumstances. This method helps to reduce or even extinguish upsetting thoughts and/or feelings so that they don’t rule our existence.
It is recommended to journal with the guidance of a professional if you feel like your journaling often takes you to a dark place, whether that be becoming more stuck in thoughts related to depression, anxiety, or trauma without any relief or benefit to journaling. I say this because some people may ruminate over the negative thoughts recorded and this is not useful. Some ways to manage this could be writing out the negative thoughts and then throwing out the page, burning it, or shredding it, whatever fits with how you feel. Avoid journaling about trauma independent of a professional. The reason I say this is because recording traumatic events and/or issues related to the trauma(s) can ultimately increase distressing thoughts and feelings, leading to potential decompensation in our emotional regulation and functioning.
There are many structured journals with amazing prompts that can be found online that I highly recommend. One is called “Worry for Nothing: A Discreet, Guided Anxiety Journal | Journal with Prompt to Calm Anxiety & Improve Mental Health | Promotes Stress Relief & Self Care”. See link for additional information ( https://a.co/d/fuNxlkB). Using such a tool with the guidance of your therapist can help increase your own insights and help your therapist understand you better as a person and how they can help solidify your emotional coping artillery.
In closing, journaling can be utilized as an incredibly effective tool to help us identify and manage our thoughts and emotions. I prefer the journals with specific prompting questions to guide me along in my wellness journey; but of course, everyone has a different preference and that is okay. As long as you are taking note of your negative thoughts and feelings to help shift them to a more positive and empowering place, this is the true benefit of journaling and its power.
– Jackie Martinez, LMSW (NY), LCSW (NC)
For years, the acronym ‘OCD’ has been widely misused by people to describe their organizational skills or how neat they keep all of their belongings. To be technical, Obsessive Compulsive Disorder (OCD) should be defined as the presence of obsessions as well as compulsions. Obsessions being characterized by “recurrent & persistent thoughts, urges, or images that are experienced as intrusive or unwanted..” and compulsions being characterized by “repetitive behaviors or mental acts that that an individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly,” (APA, 2022). What I hope to voice is that OCD is not something that is a personality trait, it is a mental health disorder as it states in its name.
It is actually believed that OCD can be dated back to the 14th century. Researchers believe that some religious depictions and works depicted signs of OCD-like behaviors. Of course, the term OCD was not around during this time and it was referenced as scrupulosity (a term to reference fear of sins and compulsions to be devoted). During the 19th century, a time when psychology as well as medical advances were being made, French psychologists attempted to understand what they came to know as compulsions and obsessions by separating them into different categories. These conditions include that of phobias, panic disorders, as well as manic behaviors.
What we have come to know now within the world of psychology, is that there really is no particular cause for OCD. There are current theories that state that biological, environmental, as well as learned behaviors can trigger the onset of OCD behaviors. However, what we do know is that those who have OCD have a larger sense of responsibility to tend to their intrusive thoughts as well as may misinterpret these intrusive thoughts. This sense of responsibility and repetitive behaviors lead to the obsessive thoughts regarding the stressor, leading the individual to engage in compulsive behaviors to rid themselves of the intrusive thoughts.
Obsessive-compulsive and related disorders is now its own section within the DSM. OCD used to be categorized as an anxiety disorder, however with the recent DSM-V edition it has been separated into its own section for obsessive-compulsive and related disorders. There are several disorders that fall under this category: Obsessive Compulsive Disorder, Body Dysmorphic Disorder, Hoarding Disorder, Trichotillomania, Substance/Medication Induced OCD, Excoriation Disorder, as well as Other/Unspecified Obsessive-Compulsive disorders.
Body Dysmorphic Disorder occurs when an individual has a preoccupation with perceived flaws or defects in their appearance. Any part of the body can be the area of concern for the individual; even if these flaws are not observable to anyone else. Because of the obsession over these perceived flaws, the individual likely will engage in compulsive behaviors in order to keep themselves in check.
Hoarding Disorder is probably one that you may know well due to TV shows like Hoarding: Buried Alive, I came to know it because of my grandparents. My grandparents were excessive hoarders, with their house being filled with countless knick-knacks, books, clothes, and even hundreds of mason jars. After my grandparents passed, it was up to my family to clean out their house and that was a project! After, most likely, 10 full dumpsters and a week of work we were able to clean out the house that they once lived in. Hoarding is the characteristic that an individual has a hard time letting go of items, regardless of their perceived and actual value. The difficulty that comes with letting go and releasing these items is the aesthetic and/or sentimental value that the item may have. Even though my grandparents were victims of hoarding, we were able to donate many things from the house we were able to salvage.
Trichotillomania is a disorder where the individual compulsively pulls hair out from any part of the body. The distress that can be experienced by those with a hair-pulling disorder is one that can be described as shame, embarrassment, or even just feeling as though they have lost control. Hair-pulling may bring one gratification and satisfaction with each pull of a hair. Whereas, excoriation is the picking of the skin. Individuals who actively pick at their skin throughout the day, may experience similar emotions and feelings; feeling embarrassed, ashamed, as well as loss of control. The preoccupation with the intrusive thoughts of wanting to pick at your skin, or the struggle to fight the urge to not pick off a healing scab can leads to the compulsive behavior of removing that part of their skin.
Still think that OCD is just a cliche personality trait?
There are ways to live with symptoms falling under the umbrella of obsessive-compulsive related disorders. A common modality that is used is Cognitive Behavioral Therapy, which is oftentimes used for many mental health concerns in therapy today. For a brief explanation of CBT, it essentially involves regular talk therapy about problems causing distress in the here and now. One of the key targets for CBT are intrusive thoughts, which we can also call OCD obsessive thoughts and need to act on compulsions as intrusive thoughts. Unfortunately, intrusive thoughts are something that cannot be completely eliminated because intrusive thoughts are simply unwanted or distressing thoughts, urges, or impulses.
Additionally, there is an approach termed Exposure & Response Prevention that is specifically geared towards challenging one’s fears, obsessions, and compulsions. The idea of ERP is not to scare the individual, but to allow the individual to confront their fears in a comfortable setting that does not cause further distress. A major part of ERP is for the individual to be confronting these fears, but minus the act of the compulsions to “make it right.” Similar to regular talk therapy, with ERP the initial targets are small and are ones that don’t cause too much distress. This is because it is easier to challenge minute fears and be able to comprehend your ability to overcome them when first starting out.
Let’s say that your fear is that everything around you is covered in germs and you are fearful that these germs will cause you to become infected or die. Here is an example of what can be done to challenge and confront these fears over the course of treatment. Also notice that these steps are broken down into simple achievable steps, as to not be pushing the fear too far.
With each step being broken down and with each step gradually working up the fear ladder, an individual can become confident with facing their fears. However, it should also be stated that the person seeking treatment determines their hierarchy of fears and what they feel comfortable confronting and in what order.
OCD can be a debilitating illness, although it doesn’t have to stay that way. OCD is not making sure your desk is organized, or your kitchen is always clean. It’s more so about what these obsessions and compulsions do to you and how they impact you. Also, OCD is not the only disorder that comes with this family sized pack of obsessions and compulsions. If you feel like you’re struggling with any of these, there is a way to regain control. Obsessions and compulsions will not write your life story.
At the start of any romantic relationship, everything is fresh, new, and exciting. We tend to idealize the person we are dating, feeling that they can do no wrong and would never do anything to hurt us, ever! Sound familiar? It’s because these feelings get the best of us and many times, these idealized traits can very well be true (with hints of reality that we won’t always agree and/or be “lovey-dovey” 24/7). However, sometimes we may start to notice that we have polar opposite experiences in our relationship, depending on the day…never knowing what’s to come. We have some days where we are honeymooning followed by days of emotional turmoil. When we start seeing this pattern continue over time in the relationship, it’s time to start thinking about whether we may be dealing with a partner who is emotionally manipulating you, whether they even realize what they’re doing or not.
Of course, it can be very difficult to tell if you have a manipulative partner and even more difficult to admit this to ourselves once we see all the clear signs that this could be true. Oftentimes, we may see that our partners are incredibly loving, affectionate, and make us feel like we are the most important thing on this planet. It’s a wonderful feeling, something to be cherished, and oftentimes we become addicted to the feelings of elation that come with this affection from our partner. Then, maybe there’s some kind of disagreement where we are then ignored, avoided, and made to feel that we are a burden. Often, we are made to feel that we are in the wrong, confused, or not paying enough attention. The constant cycle of honeymoon phases followed by conflicts, anger and confusion makes it difficult to know whether we are genuinely in the wrong or if we are being manipulated.
There are many signs of manipulation that one can show if we know what to look for in our interactions with not just our romantic partners, but anyone in our lives. Here, we will go over just a few of the big manipulating skills that we often see in romantic relationships that maybe you’ve noticed too.
First, there’s gaslighting. Do you ever notice that you become more confused and feel like you’re losing your mind in your relationship? Your partner may make you doubt yourself constantly and that you are always in the wrong. An example may be that your version of events often differs from theirs and they make you believe that you are confused or maybe even accuse you of lying and/or being manipulative.
Another tactic is called stonewalling. When your partner and yourself have a disagreement, do you find that you are then being ignored and avoided for several hours, maybe even a day or two? This is called stonewalling and manipulators use this tactic to make you feel emotionally isolated, it’s all your fault, and that you are the problem.
Also, you may notice that there are ever changing and unclear boundaries in your relationship. Manipulators will often change the rules and flip the script on you to fit their own agenda. They are flexible in the way they represent themselves to you and others around them to ultimately get what they want from whoever they can, which would mean manipulating a lot of people throughout their lives.
Do you notice that you are always painted to be the monster while your partner is the victim to your constant wrongdoings? Maybe your partner is always saying that they are being wronged somehow without having any willingness to look at their own behaviors. Maybe they are unwilling to reflect on how their actions may impact your relationship. They want sympathy and the best way to get it is to make you feel bad and that this is all your fault. An example may be that your partner tells you that they are drinking excessively because of the stress you bring them.
Maybe you have also noticed that there are elements of blaming language and sarcasm interwoven into your regular interactions with your partner, whether they are positive, negative, or neutral conversations. When manipulative partners use sarcasm and/or blaming language, they may downplay your problems, feelings, and make you feel like you are just being dramatic and/or overreacting. They may even make a joke of the issues and your feelings. Infuriating, right?
If you determine that your partner is manipulating you, it is essential to first develop and solidify strong boundaries for yourself. Talk with your partner about some of the behaviors you notice from them in a calm and neutral manner. Do not use blaming language and avoid any angry tones or raising your voice. Knowing what your own values and expectations are in your relationship will help you hold boundaries and immediately address any manipulative behavior as they happen.
When one partner notices emotional manipulation, they are hurt but still in love and often will look into anything they can to remedy the relationship. They may ask, would couples counseling help? Well, it could potentially help, but not always. A couples counselor could help to highlight behaviors from both parties in a relationship that may be maladaptive and contributing to emotional tensions and conflicts. Afterwards, they would likely discuss conflict resolution skills to promote transparency and constant constructive communication between both parties. Sometimes if the manipulative partner is not willing to acknowledge their behaviors and how they impact the relationship, individual counseling may be recommended. However, manipulators are not always willing to make change because their manipulating ways work to their benefit, so why change? Often in these circumstances, couples counseling could be beneficial in that the ever-rising conflicts are highlighted so that the manipulated partner may gain additional insight and strength to leave this toxic relationship.
If you feel you are in a relationship with a partner who is emotionally manipulating you, talking to someone about what’s going on, whether it be a therapist or trusted loved one, this can help you have additional objective insight into what is happening so you can make the best choice regarding next steps for your own wellness and what next steps you’d like to take in your romantic relationship. Much easier said than done, but you can do it. You have the strength, wisdom, and resilience. You’ve got this.
– Jackie Martinez, LMSW (NY), LCSW (NC)
The word trauma is used in many different contexts, and it has recently been more of a topic of conversation in recent years. When people think of trauma, the typical images that may run through their heads are of war veterans, sexual abuse survivors, or even other kinds of abuse experienced. However, I believe that the population of caregivers as well as loved ones of those who are battling a deadly disease or severe medical conditions experience a trauma that does not get noticed enough. This is what can be termed secondary trauma, when one learns about the traumatic experiences of a loved one. Try painting this picture in your head: sitting in a hospital room beside the hospital bed for days in and days out with no end in sight, having not much to do other than observe your loved one in pain while they are in the hospital or at home, as well as even possibly having to dedicate all your time to care for your loved one.
Unfortunately, my family recently experienced a significant loss. My stepbrother, who was battling cancer since November of 2015, had passed away on Christmas Day. His battle with cancer is one that will never be forgotten by those who surrounded him. My stepmom and dad were his caregivers throughout the whole process. As a mental health counselor, I was keen on observing the impacts his battle with cancer had on them. For the sake of their privacy I won’t divulge, however the countless sleepless nights as well as hospital visits speak for themselves.
Our reactions to bereavement vary from person to person, everyone has their own way in which they react to the loss of a loved one. Grief disorders come into play when an individual is experiencing prolonged as well as complex grief symptoms, these symptoms are typically more challenging for the individual to live with as well as may cause significant impairments to your normal functioning.
Some symptoms that are consistent with complex grief are: excessive irritability, consistent insomnia or sleep difficulties, intrusive thoughts about the loss, feelings of futility, as well as having a strong sense of responsibility for the loss. These are just a few of the symptoms that correlate with complex grief; it should be noted that if you are experiencing these symptoms and if they are lasting more than two months after the loss, it can be a signal of a prolonged grief disorder.
It can go without saying that in these kinds of circumstances, we have someone who is ill and may be getting traumatized in the process as well as a caregiver or family member watching all of this play out in front of them, can have a significant impact on how we are perceiving this kind of trauma. I believe that this statement describes the experience of caregivers and loved ones during this time, “for some caregivers and loved ones, watching the death of someone close to them, while making no attempt to stop it, can be excruciating and lead to shock and extreme emotional distress,” (GoodTherapy).
Intrusive thoughts are common when talking about mental health and discussing our emotions. Intrusive thoughts are simply thoughts that enter the mind unwillingly that cause some sense of discomfort, or they can be images or impulsive urges that pass through your mind. In a situation like this, it is common for people to have constant intrusive thoughts about the person who has passed. Those who have a history of addictive behaviors may resort back to old unhealthy habits, and it’s even possible for one to develop a fear that is related to the loss in some way (i.e. if the death was caused by a car crash, a fear of driving may develop).
The history of it all. It’s true, the history that one has with the one who has passed can impact the way that they experience grief. Whether that history is traumatic, joyful, distressful, or filled with unforgettable memories, each has a unique way of causing a domino effect. For example, if the one you have lost was a significant factor in your trauma history it may be difficult for you to wrap your head around how to grieve this individual. Feelings of confusion, conflicting emotions, feeling alone in the grief, as well as feeling guilty for holding negative feelings/thoughts towards who has passed. We see you, and it’s okay to be going through all of these emotions and barriers.
Ultimately, it is up to you to decide how you want to experience grief and how you would like to progress on the path of healing, if needed. Your family may have their own words and ways of going about the loss, but this is not something that needs to be conformed to or feel as though you should be matching the level of emotions of your family members. No. It is your journey. It is your life to drive forward. It is your time to take care of yourself, and if you start questioning the reality of you being able to take care of yourself or if you have hesitations about doing so; just remember how much you have cared for your loved one and pull that energy inwards and direct it towards you.
Grief and loss is unfortunately something that we all come to know all too well. Even with that, it still feels like getting hit with a ton of bricks whenever it happens. Throughout our lives, we make connections, friendships, relationships with people that are not forgotten. It is important not to remember your loved one as they were during their last struggling moments, but to remember them by how they were around you.
Moral injury has been defined as, “In traumatic or unusually stressful circumstances, people may perpetrate, fail to prevent, or witness events that contradict deeply held moral beliefs and expectations” (United States Department of Veteran Affairs).
Essentially, moral injury can occur when someone either engages in or witnesses an event and/or action that goes against their own personal values, ethics, and beliefs. There are two types of acts that can lead to moral injury; acts of commission and acts of omission. Acts of commission refer to actions people take that go against their own morals and/or belief systems. While acts of omission highlight when someone intentionally does not take action on something that leads to an adverse event that goes against their own morals and ethics.
To clarify, an example of an act of commission may be that a military member kills civilians in the midst of performing combat related duties. An act of omission might be a physician not taking someone off of life support despite patient suffering due to the patient’s family making the decision to keep the patient on life support.
Well, oftentimes we tend to associate the term “moral injury” with military personnel and military related tasks/traumas. However, moral injury extends to multiple life experiences in addition to the military experience. For example, those who are in the healthcare and/or mental health care field, first responders, survivors of crime, and survivors of intimate partner violence may also deal with the negative thoughts, feelings, and even potential decrease in functioning related to traumas associated with moral injury.
While we can take an educated guess that engaging in and/or bearing witness to a violent war event is traumatic and will create moral injury in most of us, there are other scenarios in the civilian world that can also inflict moral injury.
For example, during the height of the COVID-19 pandemic, healthcare workers across the world were stretched incredibly thin; working longer hours, having to isolate from their families for extended periods, seeing a high volume of patients, and not always being able to help dying patients see their loved ones one last time before they left this world. The unimaginable stress of working in healthcare at the height of the pandemic led to unavoidable moral injury on various fronts, given there was so much out of our control and so many difficult decisions had to be made. There are even people who blame themselves for others’ deaths after unintentionally and/or unknowingly exposing people to the disease, healthcare workers or not.
Then, there are those who are survivors of violent and/or sexual crimes that often suffer with depression, anxiety, social isolation, grief, and resentment towards themselves, others, and the world based on their own traumatic experiences and moral injuries sustained. They might blame themselves for what happened to them, whether that be rape, sex trafficking, or assault. They may know their assailant and still have love and/or affection for them, which creates an internal storm of emotions and confusion.
People who suffer with moral injury often deal with bouts of depression, shame, anger, disgust, distrust, and self loathing. Such feelings can compound with clinical depression, anxiety, or even post traumatic stress disorder that makes moving forward in our lives that much harder. Maybe we notice ourselves to “shut ourselves off” to others, the world, and ourselves…we just can’t trust anything or anyone anymore which creates negative bias that impacts how we live our lives. We feel more isolated because we feel shameful or disgusted by what happened, so we disengage which ultimately fuels the anxiety, anger, sadness, poor sleep, helplessness, and hopelessness that may come with moral injury.
Much like any emotional wound, it is important to be able to have the felt safety to talk about our moral injury without being judged. Simple, right? No! Dealing with the dissonance that comes with moral injury is hard enough for the sufferer, but it is discouraging when we think about telling a trusted loved one with fear of being met with “well, why didn’t you just do this?” or “Oh, I would have handled that way differently” or “You could’ve just said no”. Sometimes we may be met with such responses; or, sometimes we may have unconditional love and nonjudgmental support. But we can’t know until we put ourselves out there as a first step in healing. Again, I acknowledge that this is far from easy.
Research also points to forgiveness and self compassion as means of coping and healing from moral injury. How is that done? Well, therapists can help you talk about the event(s) leading to your moral injury followed by discussion of negative beliefs you hold about yourself, others, and/or the world as a result. From there, your therapist can help you find ways to accept the reality of the occurrence and forgive yourself to release the hold of self hatred and condemnation. Your therapist can teach skills to reinforce self compassion, such as learning self empathy and acceptance to lift the burden as well. This work is nowhere near easy, but with time and dedication, the wounds of moral injury can be healed so that you can live your life again.
– Jackie Martinez, LMSW (NY), LCSW (NC)
Ah, the new year. We all think it – “new year, new me!”. We can be so eager to identify one or more resolutions. We always say, “this year is going to be different,” and we start off with a strong motivation until that dreaded crash about three weeks into January.
Some of the most popular resolutions include: exercising more, losing weight, getting organized, living life to the fullest or feeling happy, mastering a new hobby, budgeting, quitting smoking, traveling more, and spending more time with friends and family. While these are all admirable goals in and of themselves, the problem is that they are broad, vague, and unrealistic. For instance, exactly how does one plan to lose weight? Is it realistic to commit to going to the gym every day while having a strict low-carb diet? No. How does someone plan to budget? Does this mean paying for only necessities, and if so, what defines a necessity? Is it fair to say no to a night out with friends because that could break the goal?
The most important factor in making and keeping a resolution is to be realistic, balanced, and fair. No, someone will not lose three dress sizes in one month. No, they will not go to the gym every day. Yes, they will give in to temptation — they will eat that Boston cream donut in the break room at work. Yes, they will end up buying something “on impulse” simply because they want it.
Now let’s change the “they” in the above paragraphs to “I.” Go back and read the paragraphs again. Reflect on what these sentences mean to you, if anything, when in the first-person.
Do they sound realistic, balanced, and fair? No.
In other words… Be nice to yourself. You are not a failure for a slip-up. You’re human, with your ups and downs, just like everyone else. Imperfection is okay. No one – absolutely no one – is motivated 100% of the time. Even Olympians struggle to maintain motivation. If you’d like additional resources of New Years Resolutions, click here.
It is normal to experience the highs and lows of motivation. Instead of thinking, “why can’t I be motivated all of the time?” consider that some motivation is far better than none. That episode of motivation, no matter how fleeting it may seem, can still help you achieve your goals. Embrace it.
I used to struggle with not being able to uphold my motivation for long periods. I became frustrated at myself when I was doing something unproductive. Then I realized that the “something unproductive” was the very thing I needed to do to help recharge my emotional battery – to get me to feel inspired to get back on track with my goal.
Motivation operates in cycles, designed with peaks and troughs. It is not linear. Once you can begin to picture those highs and lows of motivation, moving away from the mentality that it is a straight-line to success, you work toward achievement of your goal (or you can at least readjust the goal to be a realistic one!).
The New Year before my wedding in October, much like so many other brides, I made it one of my resolutions to look a certain way for my wedding. I was determined to lose some of that weight I gained from too many snacks during all-nighters writing papers in graduate school.
I wanted to be reasonable with myself. I knew there was no way I was going to fit into a certain dress size, but I did know I could at least buy a dress in my real size and get it brought in if I lost weight. So, I did that.
I also downloaded Noom, a weight loss app with skills from cognitive behavior therapy (CBT). Daily, Noom drops short tips and suggestions to aid someone as they work toward weight loss. Early in the program, they introduced me to the Motivation Model, which changed my mindset. I began to be much more patient, loving, and kindhearted toward myself, addressing those nagging negative beliefs that were chewing away at me.
Let us use an example. Say you want to save 10% of your paycheck going forward. This is an illustration of what your motivation will look like throughout the journey:
As you can see, the Motivation Model has peaks and troughs; it is not straight nor linear.
The following names of each phase come from the model by Noom. However, keep in mind it applies to all reasons for motivation, not only weight loss. It is a universal model, and I am certain there are other products that have the same model but simply with different names.
This is the most exciting phase. This is the phase where you think, “I got this! I am going to achieve these resolutions!” and jump in with a complete, undeniable motivation. This is where you can feel caught in the momentum, determined that their first time saving 10% of your paycheck will be the norm going forward.
This is where you will experience the honeymoon – when motivation is at its most extreme. This is when we have that unstoppable, almost grandiose sense of motivation. We are in a blissful ignorance. We think we need to feel that motivated all the time.
This is the painful, dreaded crash that happens after the honeymoon. This is the part of the cycle where people have a bump in the road, thinking they are a failure, and may fall into an old habit. This is the part where we feel extremely judgmental toward ourselves, thinking we will never be able to get back on track with our resolutions.
This is the part where you did not save 10% of your paycheck. You had a draining day. The boss was hard on you, you got in an argument with your spouse, your child had a temper tantrum. To cope, you went online-shopping and bought some things you wanted but did not need.
You may think the following:
“This sucks. This is way harder than I thought it’d be.”
“Maybe I can’t do this.”
This is all normal! This is okay! It is all part of the journey. Simply acknowledge you had a slip up and continue along.
This is the most difficult part. This is where you will feel at your lowest in your progress with your resolutions. This is where you are most likely to give up, state you will never get better, give in to those negative core beliefs, and just go back to how you used to be.
“This is way harder than I thought it’d be” degenerates into “this is impossible.”
“Maybe I can’t do this” becomes “I won’t do this. I give up.”
This is the time when clients tell their therapists they have given up on their resolutions and goals. They are convinced things cannot get better.
But this phase can and will pass. Just believe in yourself!
To get through this phase, do something. Do something that will help you feel one step closer to your resolutions and goals, even if it is very minimal. If this feels like too much, use a visualization meditation to imagine you have achieved your goal. Visualization can be a powerful psychological trick to boost confidence.
Also, have some gratitude for The Lapse. Sure, it does not feel good being there, but it is not a crisis. It is an opportunity to be introspective, to dive into yourself to figure out what is effective for you when you are not doing well, so you can prepare to do better in the future. It is the time for wisdom.
It gets better.
Phase 3 is the steadier phase, where going at a rabbit’s pace slows down to that of a turtle. You know the saying, “slow and steady wins the race.” In this phase, the highs and lows are easier to tackle. The highs are no longer mountainous like the honeymoon, and the lows are no longer like a great ravine. You will still feel those highs and lows, and yes, they are permanent. But that is exactly to be expected. It is normal.
You will have some days that are better than others. Perhaps one day, your boss says you did an amazing job leading the team project. Maybe that ongoing argument with your spouse is turning more so into manageable disagreements. Maybe your child is learning to use coping skills rather than have meltdowns.
There will be the bad days too, of course. You’re late for work because you got a flat tire – and it is the same day as an important business meeting. Maybe you get a phone call from your child’s teacher because he is having problems in math. Perhaps after weeks of you and your spouse working hard on effective communication, an argument happens again.
This is how motivation operates. It reflects the highs and lows of life – all the good and the bad, the celebrations and the tribulations, the gains and losses.
Once you accept that the slips and surges will happen, you can be mindful. You can think to yourself:
“Today I really will only spend my money on what I need.”
“Honestly, today really was a hard day. It’s okay if I indulge a little bit. But tomorrow I will be back on track.”
And it will also allow you to be more freeing and forgiving toward yourself… “You know, it really is okay if I go out with my friends on Fridays. It’s not going to ruin my goal if I let myself have some fun. If anything, it will probably motivate me to continue my journey.”
1. Our motivation operates in cycles. We will have highs and lows.
2. Be fair to yourself. Be mindful; reflect on what you can learn during the highs and lows. Know they will all pass.
3. When in a low, do one small thing rather than nothing at all.
So…taking the first step to engage in mental health therapy can be jarring enough, especially when experiencing suicidal thoughts. If you have already taken this step, you should be so proud of yourself because this is a difficult step to take!
Sometimes when we are seeking therapy, we have more on our minds than the day to day stressors and/or desire to vent to a neutral source. Sometimes, we are dealing with suicidal thinking, whether we realize it or not. And this can be quite frightening for some, while it feels fairly normal for others. So as a therapist, when I hear someone say something that may indicate suicidality, it is essential for me to take a closer look at what’s happening.
Also, side note…if anyone in your life makes what you feel may be a suicidal statement, please make sure that you are asking questions, supporting them, and/or getting them connected to the appropriate professionals. Whether it is yourself suffering with suicidal thinking or a loved one, it is best to call the suicide hotline at 988 (press 1 for veterans) and/or call 911 or get to your nearest emergency room in the event that you or a loved one feels unsafe regarding suicidal thinking. Click here for additional resources.
I want to clarify the different types of suicidal thoughts that can happen for people so we all have a better understanding of varied experiences with suicidal thinking.
First, there is passive suicidal thinking. This type of thought is passive in nature, hence the name. When people have thoughts like this, such statements and/or questions may run across their mind like, “Maybe it would be better for everyone if I weren’t here”; “I wish I were dead”, “I want to die”, “why am I here?” or “I wish I could go to sleep and not wake up”. When people are dealing with passive suicidal thoughts, this tends to mean that there is no plan or intent to harm or kill themselves in place. In therapy, if we as clinicians have determined that you are safe at the time that passive suicidality is discussed, then we discuss creating a safety plan together and talk about safety contacts (trusted people and/or emergency contact) in case one no longer feel safe and they feel they cannot safely utilize their safety plan.
A safety plan is a tool that is created in a therapy session with one’s therapist for the purpose of having it at their disposal when suicidal thoughts creep back up. A safety plan will prompt one to list out triggers that contribute to suicidal thinking, plan, and/or intent; ways one can remain safe independently (go on a walk, read a book, spend time with a pet); who the trusted people in their lives are and who can be called by client for distraction (not discussing the problem) or for help (discussing the problem); listing out places that bring one a sense of peace and/or distraction, where they can go when feeling upset and/or overwhelmed; listing out emergency contact in safety plan (who can a therapist call in the event thatthere are concerns for safety and client is not reachable); listing out Suicide Crisis Line Phone Number- 988 (press 1 for veterans); list out 911 on safety plan; and list out nearest emergency room closest to client’s home where they may go in the event of a suicidal crisis/emergency.
Another kind of suicidal thinking is referred to as active suicidal thinking. With this comes thoughts of not only wanting to die and/or “not be here” anymore, but this has escalated to the point of the sufferer wishing to take their own lives, having formulated a plan and/or has intent to harm or kill themselves. For example, someone may tell you that they are feeling depressed, worthless, and life is no longer worth living. They then go on to say that they are ready to exit this world and plan to jump off of a bridge that very night. When something like this is said, immediate action should be taken. By immediate action, I mean calling the Suicuide Crisis Line and/or 911 or bringing your loved one to the emergency room. There is no tip toeing around this. If someone with active suicidal thinking has a plan and/or intent to harm or kill themselves, they need immediate safety and stabilization. No ifs, ands, or buts about it. They may be upset with you for calling the crisis line, the police, and/or taking them to the emergency room, but this is for their own safety and well being.
Often times, those who survive suicide attempts are grateful they did and are more motivated to start a new chapter in their lives. Suicide is a permanent solution to a temporary problem. Suicidal thoughts are treatable! Therapy can help those who suffer with suicidal thinking to learn healthy coping skills,learn to reframe negative thinking and find news ways to navigate their lives in a way that feels worth while and meaningful.
If you tell your therapist that you are suicidal, much more questioning needs to occur first before anything else. So you may get a slew of questions that seem redundant, but they are necessary to have the best grasp on what your clinical and safety needs are at that time. Oftentimes, we as therapists are able to formulate safety plans together and check in on this together regularly. However, there are some times when we need to call 911 and/or get you to an emergency room. Sometimes, this may result in a psychiatric inpatient hospitalization in order to keep you safe and have another treatment team in the hospital evaluate your safety and needs. This is all done in the name of safety and genuine care for our clients. We’d rather you be upset with us and get help than not be here tomorrow.
The concept of psychiatric hospitalizations seems scary to some people, especially if you have never been hospitalized this way before. As someone who used to work in inpatient psychiatric hospitals, I can confidently confirm that the first goal at intake is discharge. Inpatient treatment teams seek to quickly stabilize and get patients out of the hospital safely with plans in place in the community to prevent future hospitalizations.
We as therapists are here to support you no matter what. We just ask because it can save a life. Please see our emergency resources page if you are struggling with suicidal thinking.
