Election-Induced Anxiety

A mere two days before the 2020 Presidential Election, the anxiety people are experiencing is palpable. Many of my patients have been talking about their fears about the election and what may happen immediately following, with much anticipation of riots and acts of violence and aggression. The news is reporting a significant increase in the number of purchases of firearms. Add to that the fact that we are in the midst of a global pandemic. Cases of COVID-19 are surging as the temperatures are dropping and it is getting darker much earlier as we approach the winter months. People are struggling to keep afloat with devastating numbers of unemployment, work stress, and profound isolation. So many of these stressors are out of our control. Such powerlessness is at the root of our anxieties. When people feel helpless to enact positive changes for themselves, they become fearful.

The antidote to this powerlessness, then, is to practice ways to control the things that are within our power to control. I would be naïve to expect people not to watch the news this week, but perhaps people can choose to limit the amount of time they spend doing so. If the news is contributing to a rise in anxiety, then it would be a good idea to consciously limit one’s exposure to the things that are triggering anxiety. Setting boundaries, in this case time boundaries, is a very empowering act of self-care. There are also a large number of concrete activities that people can do to help manage their anxiety. These often involve changing one’s heart rate either by slowing it down or speeding it up. I teach many patients suffering from anxiety disorders deep breathing exercises that help them take in vastly more air and slow down their breathing. With some patients, we start our sessions with ten minutes of a guided meditation, which can help people focus on the present moment and be more aware of their internal emotions and physical sensations, which may have the added benefit of providing some relaxation. Alternatively, you may choose to speed up your heartrate with any number of cardiovascular exercises. Physical exercise, in addition to keeping your body in good health, can help reduce anxiety. One patient who suffers from anxiety told me that she finds it helpful to focus her attention on activities that she enjoys, such as knitting and trying new recipes. And some people find it helpful to engage in activities that require some type of repetitive motion, such as scrubbing a pan.

FDR famously said, “There is nothing to fear but fear itself.” It seems more and more that politicians and many news sources are intentionally playing on our fears with the thinking that this fear will help them earn votes or make them money. In thinking about all the aggression that exists in the world, it seems to be fear that is at the root. Fear can cause people to act in ways that are almost unimaginable. Often, people aren’t even aware that they have these fears; they may simply be in touch with the anger that is fueling them to behave in dangerous ways. If we look closely, we may uncover deeply buried fears, such as fears of scarcity and fears of mortality. As we head into what is predicted to be a difficult week ahead, I invite you to take a moment to reflect on how you can approach the week by being kind to yourself and considering ways you can stave off feelings of powerlessness by taking charge of the things that are within your power and the ways you can actively manage your anxiety.

The Importance of the Therapeutic Relationship

Until the past several decades, psychotherapists believed they were a blank canvas onto which their patients projected all their unresolved issues from their childhood and their internal relational experiences with their parents. Nowadays, we believe that there is a close, real relationship between the patient and therapist that develops over time and may become the most important agent for change in the patient’s treatment. Both the patient and therapist bring to the relationship their own unconscious past relational patterns that originated in early childhood experiences, often between them and their parents.

It is crucial that the therapist monitor the nuanced interactions and enactments that occur over the course of the therapy. The danger in not paying close attention to the shifts between them and their patients could lead to serious negative consequences, such as repeating unhealthy relational patterns or driving the patient out of treatment. I recently encountered one example of such an enactment in my practice. Twice I mistakenly got the time wrong for one patient and I either had booked someone else during his time slot or I forgot to come to my office to see him. If I wasn’t monitoring the shifts in our relationship, I may have dismissed this as a simple error on my part instead of an interaction between us, and it could have well marked the end of his therapy. Luckily I was aware of how unusual this behavior was, as I have never mistaken a patient’s time slot in my 20 years of practice. This signaled to me that there must be an enactment between us that tells us something essential about the patient’s relational experience in the world. Sure enough, after exploring this together, we discovered his experience of feeling like an afterthought to his parents and friends most of his life. Instead of driving him away from treatment, this enactment elucidated something important about this patient’s relational dynamics and became an essential part of his healing.

I sometimes think that if a patient and I focus on nothing else but the twists and turns in our relationship, we still might be engaged in the vital process of therapeutic action that enables the patient to make long-lasting positive changes to his or her life. This relationship is unique in that I am a part of it, unlike all other relationships that I only hear about through the lens of their point of view. I can help patients come to understand deep-rooted relational patterns and have a positive experience of a relationship that might be unlike any other past or current relationships they have ever experienced. Such a healthy relationship can be a “corrective emotional experience” that can have everlasting changes for the patient.

Feelings 101

I occasionally think how backwards it is that we go to school to learn math, reading, and science but we didn’t take classes on feelings or relationships, things that will impact us for the rest of our lives. Many of my patients struggle with identifying and expressing feelings. Often, they grew up learning that certain emotions were “bad,” and they received little to no help from their parents in educating them about affect management. Nowadays, many children are learning in school and at home essential skills to help them identify and regulate their feelings, something of which most adults today could definitely make use.

When working with patients who need help developing a language for their emotions, I encourage them to begin with what I label “primary feelings,” akin to primary colors. They start by learning the basic emotions of anger, sadness, happiness, and fear. Or as some therapists say, “Mad, sad, glad, and scared.” These are the red, blue, and yellow of feelings. If we put each of these feelings on a scale from 1 to 10, with 1 being the mildest degree of the emotion and 10 being the most intense, we can start to differentiate the varying degrees of an emotion. For example, if we have a scale for anger, we put “angry” in the middle at 5. Along the anger scale, we can put feelings such as irritated and annoyed at the low end of the scale - around 2 or 3 - and a feeling such as enraged at a 10, on the high end of the scale. These feelings all are different forms of anger, just to varying intensities of this emotion. On the “happy” scale, with “happy” a 5, we might label a 1 or 2 “satisfied” or “content,” while a 9 or 10 might be “ecstatic” or “exuberant.” Additionally, some feelings are a combination of primary ones. For instance, “hurt” might be a combination of sad and angry. “Surprised” may be a mixture of fear and happiness. When we peruse lists of feelings, we start to see how most labels for feelings can be either a degree of a primary feeling and/or a combination of multiple primary feelings.

The other skill that most patients need help with is differentiating feelings from thoughts and behaviors. If we stick with the core emotion of anger, then anger is the feeling, while slapping is a behavior used to express this feeling, and “I hate you” is a thought that is attached to this core feeling. Most people confuse these and think that “getting angry” is the same as hitting and screaming. We have choice about which behaviors we want to employ to express a feeling; even when it feels “out of control,” we can choose not to hit or scream. We do not have choice about the feeling itself. Feelings are neither good nor bad, they simply “are,” the same way thirst and hunger simply are physiological states. People rarely judge themselves for being thirsty but people often judge themselves for being angry or sad. We cannot choose if we are angry or not, but we can choose how we respond to that anger.

Much of my work with patients around feelings is to educate them about the differences between thoughts, behaviors, and emotions and to help them learn that emotions are not something “bad” they need to run from. I can help them learn various healthy and effective ways to express feelings, in contrast to unhealthy, maladaptive expressions of emotions they may have learned up until now. Most importantly, I help my patients learn that feelings are not something they need to avoid at all costs, but rather essential parts of being human.

Actions Speak Louder Than Words

One of the greatest lessons that I’ve learned which I try to impart upon my patients is that actions speak louder than words every time. This applies whether we are discussing another person in the patient’s life or the patient herself. In other words, one can deceive themselves and others, either intentionally or not, but if we pay attention to an individual’s behavior, we get a much clearer picture of what is really going on. The unconscious is incredibly powerful and one’s behaviors cannot help but betray one’s true sentiments. We can train ourselves to pay more attention and become better attuned to the non-verbal cues that are being expressed.

These non-verbal cues include subtle facial expressions and body postures as well as more obvious behavioral patterns such as perpetual lateness and cancellations, continued inaction, or repeated substance use. I encourage my patients to “turn off the volume” and pay attention to the non-verbal signals they pick up on from others, rather than the words they are being told. One patient who is having problems in her marriage is continually frustrated and upset when her husband says he wants to fight for their relationship but his actions indicate otherwise. This spouse has taken little to no steps to start individual or couples therapy, has not done anything to improve his health through diet and exercise, continues to drink alcohol excessively, and does very little to help out with the household chores. Another patient often arrives for her appointment ten to twenty minutes late or cancels a day before and asks to wait until the following week to meet. Yet another patient consistently arrives for his appointment thirty minutes early yet “forgets” to pay his co-payment every other week. Therapists have learned to track these behavioral patterns, for they provide a wealth of information about the individual’s unconscious motivations.

I caution my patients not to interpret the behaviors of others. We may hypothesize about what the non-verbal behavior tells us, but we are not mind-readers and we cannot know with certainty the meaning of these behaviors. For instance, the patient who is consistently late for her appointments may be unconsciously expressing anger toward me and/or may be acting on her fears about accessing painful emotions in therapy by attempting to regulate the amount of contact we have to ensure that she not come in contact with these feelings.

Interpreting another’s behavior can lead to confusion, anger, and faulty assumptions; simply paying attention to what the patterns of behavior are is safer, as it is almost always non-disputable. If I point out to the female patient above that she frequently arrives to her sessions late or cancels her therapy appointments, this data is merely observable fact that is indisputable. If I interpret the meaning of this behavior as an expression of the patient’s anger toward me, then I have crossed into the murky territory of attempting to guess the reasons for her behavior. The patient may disagree with my interpretation and a therapeutic rift may occur or my deductions may be incorrect. I caution my patients to stick to the observable behaviors without interpreting the meaning of said behaviors. By strengthening our ability to “mute” another’s words and tune into behaviors, we can develop our ability to accurately pay attention to the incredibly powerful non-verbal communications that are being expressed before our eyes.

The Role of Meditation Practice In Psychotherapy

In recent years I have begun implementing meditation practice during the first ten minutes of a session with some of my patients. The choice whether to meditate or not is always at the discretion of the patient. The purpose of such practice is to help bring awareness to one’s internal world in the present moment. This encompasses improving one’s attunement to emotions and physical sensations that can be detected in the body. I have found that many people are initially uncomfortable being with themselves in the here-and-now, and thus they flee being in the present and resort to living in the past or future, allowing their thoughts to distract them from what is right before them.

Most people do not need my help accessing their thoughts; they can fairly readily identify what they are thinking. It can be a different matter when they are trying to identify what they are feeling. When an emotion is intensely felt, it is likelier that the individual will notice it and be able to describe it. One is more apt to recognize that she is enraged than to recognize that she is mildly annoyed. But if we believe that all people have thoughts, feelings, and physical sensations at every moment, whether we are aware of it or not, then we can begin to see how difficult it can be for many people to access feelings when felt to a lesser degree. This concept that people have thoughts, feelings, and physical sensations at every moment is similar to breathing. Once an individual is encouraged to focus on his breathing, he usually can do so easily. We are all breathing at every moment but often we are not paying attention to our breathing. The same applies for thoughts, feelings, and physical sensations. Some people may find identifying and accessing physical sensations challenging. Still more may struggle to identify and stay with their feelings. Trauma survivors in particular may struggle in this way, given that one of the ways they learned to cope with the trauma they experienced was to numb themselves and dissociate from their internal world. This serves a protective function. As adults many of these individuals have difficulty knowing what they are experiencing when it comes to emotions and physical sensations.

Meditation seems to assist people in building their awareness of what is happening internally. Furthermore, it can help people learn to stay in the present moment and tolerate inhabiting their own internal world without feeling threatened by unpleasant emotions. I’ve witnessed people who initially had trouble sitting still because they were so anxious learn to relax into a ten minute meditation practice and open themselves up to the present. With most patients we start and end the meditation practice with four deep breathing inhalations and exhalations. This seems to help people relax and prepare themselves for the meditation. During the meditation itself, patients are instructed to focus on something simple, such as their breath, that they can keep returning to when their minds start to wander. They simply can notice and be curious about the thought that distracted them and then return to their breathing. With some patients, it is preferred to scan the body from head to toe during the meditation as a way to tune into what is happening internally. By conducting a body scan, one might become aware of tension and other physical sensations that are being held in various body parts. Another option is to draw one’s awareness to the sounds around them, both near and far. I invite my patients to focus on their breathing or to do a body scan, however, because these are ways to increase awareness of one’s internal space, whereas sound brings the individual to something that exists outside of them. Over time, most patients tell me that they have found that the meditation helps them be more aware of what is going on inside them, both with emotions and with physical sensations, and these skills can transfer to the their lives apart from the meditation. For the purpose of developing these skills during psychotherapy, I find that the term “awareness building” rather than “meditation” may be a better fit. People can get confused by what is meant by meditation practice. When we agree that we are working on improving their awareness of their feelings and body sensations, they can best understand how such practice can be of value to them. After the ten minutes, I find it useful to briefly discuss how the patient experienced the exercise and what she became aware of during the time. I also attend to whether starting with this practice has a positive shift for the remainder of the session and can help the patient feel more present and connected to me while engaged in the therapeutic endeavor.

The Collective PTSD of a Nation

Since the Presidential election of 2016 - even prior to it - there has been a spike in the number of patients who are reporting experiences of anxiety, powerlessness, restlessness, fear, difficulty sleeping, and being more scattered and disoriented than they previously have known themselves to be. This is particularly jarring when their sense of self is shattered and they are exhibiting symptoms that have not materialized before in their adulthood. Still more concerning is when, given the changes in health insurance in recent years, patients can no longer afford their deductibles and therefore opt to discontinue treatment at a time when they might most need to be coming in.

Not long ago I attended a seminar in which the speaker addressed how in ways not previously seen to this extent or magnitude, people seem to be responding to a collective trauma brought on by our current political climate. Clinicians, in addition to our patients, are struggling to manage their own levels of anxiety and powerlessness. Many of the people in our country show a complete dismissal or disinterest in facts, choosing instead the ease of not having to think for themselves and diminishing their personal fears by taking comfort in entrusting those in authority who are disseminating lies and "fake news." On a national (if not global) level, this is incredibly terrifying. Many of us are reeling from the continual onslaught of political egregiousness. This constant bombardment of one horrific incident after another is a form of trauma and the very thing that can disrupt us to such an extent that we are left in the position of having to always be in a reactionary stance, having to brace ourselves for further trauma.

For people who have a history of trauma in their childhood and adolescence, the current political landscape is all the more fraught. It is like walking through a landmine that presents us with ongoing triggers which reawaken those early traumas which may be deeply entrenched. One might react internally in much the way they did when they were young, defenseless children. 

I encourage patients to limit their exposure to the news if it is interfering with their ability to function. Given that it may be crucial to have a safe relationship such as the one that can develop in a therapeutic relationship, I think it is important to work together to figure out how people can continue coming in if their insurance is the barrier that is preventing them from seeking the help they require. Having a support system and appropriate self-care is of the utmost importance for both patients and clinicians during this highly chaotic time. 

Suicide Survivors Part Two: The Parallel Process

In my last blog post, I addressed the topic of suicide survivors, i.e. people who are impacted by the loss of an individual who has taken his or her life. In light of the recent news of the suicides of celebrities who are in the public spotlight, I wish to follow up on my last post by focusing on the issue of "parallel process."

One of the common themes that most survivors will speak about is how powerless they feel in the wake of such a tragic event. Often they feel guilty that they were not able to do more to prevent the suicide. In the presence of the survivor's grief, others can feel powerless as well, not knowing how to best provide support or comfort to the survivor. They may feel compelled to help but are not sure how. I believe that in this particular circumstance, this response differs from other types of losses. We frequently can find ourselves in situations where friends, family members, and colleagues are impacted by the death of someone close to them. Many people have experienced these types of losses themselves and/or have witnessed others who are in mourning.  Yet this may not be as frequent when it comes to suicide. Especially if the person has never experienced a suicide or known a suicide survivor, they can feel ill-equipped to know how to respond.

In psychological terms, we can refer to this experience of helplessness or powerlessness as a "parallel process." It is often the case that the people left behind can experience in themselves a parallel experience to the person who took his or her life, namely that of feeling powerless. We can imagine that the person who saw no alternative to suicide must have felt incredibly helpless, powerless to do anything to improve their situation and feeling utterly hopeless that things can get better. Many of these people have tried multiple things to alleviate their symptoms, such as therapy, medication, meditation, yoga, body work, nutrition and exercise. At the end of the day, none of these things have alleviated the depression, shame, negative sense of self, and other feelings underlying their suicidal ideation and intent.

When others are caught in a parallel process, feeling powerless ourselves, our instinct is often to try to "fix it," to find solutions for the people who are grieving. This stems from the discomfort they have tolerating their own profound sense of powerlessness. I encourage people to sit with this discomfort. Sometimes the most we can do is to simply offer support, communicate that we are thinking about the person who is grief-stricken, and let them know that we care about them. Depending on the specific situation, we may spend time with the survivor, bring them food, and check in with them. It's different for each person. To ask the survivor what would help them can even feel like too much for them; it puts the burden on them to have to respond or even know what they need. Our intentions are coming from a place of a sincere wish to help. It's good to remind ourselves that sometimes just the simple things are a form of help. 

Someone once told me that hearing a friend say, "I'm thinking of you" felt a lot better than if the person asks them, "How are you doing?" or "How can I be helpful to you?" A simple "I'm thinking of you" conveys that you care without requiring anything in return.  

Suicide Survivors

The term "suicide survivor" is unfamiliar to most people. They assume it refers to people who have attempted suicide themselves; in fact, it refers to people who have lost someone to suicide. Whether it is a family member, partner, friend, patient or colleague, losing someone to suicide is incredibly challenging to those who are left behind to grieve. It is a far more complicated type of death that may take a longer time to grieve and can stir up a variety of feelings such as sadness, shock, anger, and guilt. Many survivors feel very isolated, experiencing that those around them cannot understand what they are going through. Also, there is a stigma attached to suicide that often causes people to keep this information a secret. 

Working with suicide survivors is one area I specialize in, although many patients come to me for other reasons and it often isn't until much later in their treatment that I learn they've lost someone to suicide. The impact of this loss can be tremendous. We need to take into consideration the specific relationship to the patient. Losing a friend or sibling is quite different than losing a parent. Losing someone the patient had a close, loving attachment to is different than losing someone where the bond was more fraught. We also want to pay attention to the method of suicide and the patient's unique experience around the death. For instance, the trauma of a survivor who witnessed or discovered the person who committed suicide varies from that of those who were distanced from this immediate visual and auditory trauma. The experience of someone who had a loved one who had previous attempts or threatened suicide for years varies from that of the patient who was completely caught off guard by the loss of one whose death was spontaneous or unexpected. A health care provider who loses a patient to suicide may experience a particular type of guilt, as their colleagues or the institution they work for may consciously or unconsciously fault them for the death. 

As you might imagine, this is a very complex topic that has so many variables that one may have never even considered. In working with survivors, I try hard to not make any assumptions about their experiences. I allow for the space and time for them to tell their story and express their feelings about their loss. Many of my patients have described how I am the first person they talked to at length about their loss because of their shame and their experience of feeling misunderstood by others. I sometimes will encourage survivors to seek out a support group where they can hear other survivors tell their stories so that they can feel less alone with their grief. 

One good resource for more information is The American Foundation for Suicide Prevention, which has information that can be useful for suicide survivors: https://afsp.org/ 

Couples Counseling From a Psychodynamic Framework

I often reflect on how the skills we need to navigate our lives through adulthood were not taught to us in school. Most of us did not get taught how to identify and express feelings. We didn't take classes in how to nurture healthy relationships and how to sustain these throughout one's lifetime. While a great deal of effort may be given to one's career, an equal amount of effort might be missing when it comes to the relationships that we consider most important.

When the issues that bring people into treatment seem to center on their primary relationship, then couples counseling may be warranted as the preferred treatment modality. Unlike individual therapy where we delve into a patient's psyche to understand how one's unconscious processes inform current behaviors, in couples counseling the couple is the patient and the focus of our work shifts to attending to how the partners communicate, manage conflict, and show empathy for each other. Often my role is to teach specific skills along these lines. I might help them learn active listening and empathy skills. Perhaps I may teach effective ways to deescalate fights and constructively handle arguments. I may encourage partners to talk to each other and not simply to me so they can practice communication, thus bringing their relational issues directly into the room so that I can observe and intervene as needed. As the therapist, I am in the unique position of watching how they interact and I can pay attention to the moment to moment shifts in their conversation to see where they might get stuck or how conflict escalates. 

As a psychodynamic therapist, I also place importance on understanding each person's individual history and how these intersect in their relationship. It is not arbitrary when two people find each other and embark on a journey to form and maintain a relationship. Each person brings to the table their individual relational dynamics that they learned as far back as childhood. Often people reenact in their current relationship patterns that they experienced in their parents' relationship or in their own relationships to their parents. These relational patterns continue to get repeated and played out in their subsequent relationships throughout life. When we can identify these relational patterns and how they are reenacted, then we can set about to shift these in healthier directions. When we come to understand how each individual is triggered by their partner and how that may be connected to experiences they had in childhood and adolescence, it helps each person develop a deeper understanding of their partner, an awareness of how their own behavior is impacting their partner, and the potential for greater emotional intimacy. 

Relational patterns tend to get passed from generation to generation until someone takes the initiative to work through these in the context of psychotherapy. One can imagine how complicated this can be when each member of a couple is bringing to the relationship specific patterns that can be traced back to their own early relationships and those of the generations that came before. So a husband's behavior may trigger his wife in ways that are similar to how one of her parents triggered her or similar to how her parents and grandparents related to each other, and the same can be true for how the husband experiences his wife's behaviors. Usually these patterns aren't easily identifiable at the start of couples counseling, but over time, with the help of a trained therapist, they can be elucidated and worked on. The hope is that by working together in this way, each partner can come to experience a more rewarding and intimate coupling into the future. 

The Relational Nature of Shame

In the play (and movie) Proof, the character Hal asks, "How embarrassing is it if I say last night was wonderful?," to which Catherine responds, "It's only embarrassing if I don't agree." This is a great example of illustrating how shame is relational in nature. As Catherine points out, Hal's question might have been met with a variety of reactions. If Catherine were to respond, for instance, by saying she wishes it hadn't happened, Hal might experience shame about what he said and may even regret that they spent the night together. But Catherine agrees with him, they kiss, and he is elated. Without our even realizing it, our experiences of shame are often closely tied to other people's reactions. The key component to hold onto from this illustration is that one may say or do the exact same thing yet have a completely different self-experience based on the reaction of the other.

From a very early age, children may develop positive or negative self-experiences based on how the people closest to them (parents, siblings, peers, teachers) respond to them. If a young boy is expressing excitement and vitality about what he is doing, for instance, his father might respond by mirroring the boy's enthusiasm and encouraging him to engage in the activity. This could lead to the boy developing a healthy sense of himself and his own agency in the world. If the father, on the other hand, were to respond by telling the boy to knock it off, then the boy is likely to believe that what he was doing displeases his father and is wrong. Often, the reaction of the other is much subtler. In this example, the father might simply give a lukewarm response, ignore the boy, or register discomfort on his face. These more nuanced, less apparent reactions can be incredibly impressionable on a child's sense of self. Even if it is not conscious, the boy might come to learn that expressing his vitality is something to be ashamed of, and this might continue to be confirmed by subsequent, similar experiences. Once the boy reaches adolescence and adulthood, a lifetime of such experiences may have led him to squelch his own excitement and dampen his vitality.

I find that by helping patients understand how closely linked their shame is to the reactions of others, it helps them to shift how they view their past experiences. Others' reactions could lead either to greater acceptance or greater shame about the part of self in question. If a female patient comes to learn that her shame about her appearance is tied to comments and reactions she has gotten from other people throughout her life and to images that our society has held up as an ideal, she might begin to reevaluate her own beliefs and self-perception. In this way, having the awareness of just how powerful is the relational nature of shame, one might be better positioned to change one's own deeply held views and challenge distorted beliefs about oneself. 

Mourning Losses

When we think about mourning losses we usually think of grieving a loved one who died or perhaps grieving the end of a relationship. Yet, much of the work of psychotherapy involves mourning losses that are less transparent - losses that can be traced back to childhood. This is the type of mourning that I wish to address in this blog post.

Most adult behavior has its origins in our early childhood experiences. We may unconsciously cling to relational patterns and beliefs that stem from the earliest years of our lives. Oftentimes, the reason we do this is to avoid incredibly painful feelings that may arise and engulf us when we allow ourselves to fully access these experiences. To recognize that one's parent was never able to love and accept them unconditionally, that this parent may never apologize for abuse or injuries they've inflicted, that the parent may never change and one may never have the mother or father they have always longed for and needed, that they will never be truly vindicated for the traumas they have endured - to come to terms with such losses is to open oneself up to tremendous grief. People may spend the majority of their lives engaging in all sorts of behaviors that are attempts to stave off such mourning.

Continued avoidance of mourning unresolved losses from our past comes at a devastating cost. People may suffer from depression, anxiety, and any number of other mental illnesses. They may experience chronic pain and health concerns, abuse substances, repeat unhealthy relationship patterns, and find themselves having ongoing difficulties at work and in their social lives. Even worse, they may inflict the same injuries that they suffered onto their partners and children. 

We can understand how not allowing oneself to mourn the death of a loved one can impede one's healing; we may allow ourselves and encourage others to take whatever time is needed to fully grieve, being gentle in the knowing that mourning can take various forms and evoke a gamut of emotions.  The same concept applies to mourning losses that are much more deeply buried. If working through these losses in therapy didn't have the potential to help an individual achieve greater self-awareness, profound healing, more satisfying relationships and one's personal life goals, then there would be absolutely no good reason to ask our patients to undergo a process which has the potential to stir up such pain. Still, I know of no other way to make long-lasting fundamental positive change. There's a corny saying in the business (alright, there are several) that you have to go through it to get through it. I think this expression is rather apt when it comes to this topic of mourning losses from one's childhood.