Therapy as a “Creative Storm”

“So do you have experience with this?”

Quite a few people who want to begin therapy ask me this. Of course, this is a perfectly reasonable question, but I still usually find myself searching for a good response. The answer should be easy. My specialization as a therapist is the treatment of anxiety and my subspecialty is OCD therapy. creative-storm-300x175Many people, therefore, contact me because they are struggling with one of these issues or both. Of course, I have experience as well as training and skills working with people on these matters, so I could just say “Yes” with confidence and conviction.

It took me a bit to get to the bottom of my own hesitation, but eventually I realized where it stemmed from…Continue reading in “Psyched in San Francisco” Magazine

Physician-Assisted Suicide, The Freedom of Ambivalence, and Why Our Heads are Round

I grew up with the saying “The head is round so that the thoughts can change direction.” When the debate around legislation permitting physician-assisted suicide in California hit the news lately, I was reminded of this saying when I examined my own thoughts and opinions around this law. Urusla-ambivalence-300x200As a member of the disability community, I am engulfed in the discussion around its implications for disabled lives. I wrote against proposed assisted suicide laws from a disability activist position when I lived in Europe and they were introduced there. The nightmares Jack Kevorkian and Peter Singer created are still powerful and the concern over a law that could ever be used to suggest from the outside that anybody’s life is unbearable (or less worthy, or too expensive) and should therefore be ended prematurely is well justified by history.

But then I was diagnosed with cancer some years ago… (Continue to read in Psyched in San Francisco Magazine)


Legs dangling off a high building“So, first of all, let me assert my firm belief that the only thing we have to fear is fear itself.”

FDR’s famous line from his first inaugural address used to strike me as a universal truth. He describes fear as “nameless, unreasoning, unjustified terror which paralyzes needed efforts to convert retreat into advance.” I have interpreted this line as a call to be brave, to take on life fully, make  the best of a difficult situation and count one’s blessings while doing so. The encouragement and sense of bravado inherent in FDR’s speech still strikes a strong cord in me… (Continue to read at Psyched in San Francisco Magazine)

Forgiveness: What and How

Hands letting go of sandWhat does forgiveness really mean?  It comes up in therapy a lot but the concept is so unclear for many of us. I have devoted hours pondering the meaning of this elusive concept. Forgiveness describes a conscious act on the part of the person forgiving and a human gift received by the person who is in need of forgiveness. And forgiveness is a close partner to intensely painful feelings and memories of things that have happened in the past.  In truth “to forgive is not to forget” so how does transformation of the past pain and damaged relationship happen?… (Continue to read at Psyched in San Francisco Magazine)

The Truth in Hierarchies

purple flowersWhat is your position in some of the hierarchies of your life? Are you a manager, do you have a boss, are you an employer, an employee, a parent, somebody of wealth, somebody with little means, do you see yourself at the fringes of society or among the movers and shakers? Hierarchies are everywhere. They structure our life on this planet in so many ways that we tend to lose track on how they impact our sense of self and well being. We create practical and more or less innocent hierarchies such as among our favorite foods or colors, but we also attach our worth as human beings to the hierarchies we find ourselves in. Hierarchies are arrangements of power and whether we experience being at the top, the bottom or somewhere in the middle of a human hierarchy we tend to internalize the level of power (or powerlessness) that comes with this position. Continue reading

Obsession Balloon and Bad Feeling Monster

Today I want to share a tool I have created to explain the mechanisms of Obsessive Compulsive Disorder (OCD) to children who are struggling with it. I work with a mindfulness based version of Exposure and Response Prevention. In mindfulness practice I find it helpful to imagine one’s own awareness as a wide open blue sky. Thoughts and images pop up and pass through this sky like planes, clouds, balloons and other flying objects. They can appear big and loud and strong but they inevitably become smaller and finally disappear out of sight. From the perspective of the wide open blue sky they may rough up things for a bit but they don’t change the sky. If we can treat the thoughts and images our mind creates with non-judgmental awareness, look at them, appreciate the feeling that comes with them and then let it drift away, we can become “unstuck” and our emotional pain can diminish. When we practice mindfulness we can learn to accept our inner experiences without avoidance. I will write more about this later and this book about “Acceptance and Commitment Therapy” (ACT) is a fantastic introduction, “Get out of Your Mind and into Your Life: The New Acceptance and Commitment Therapy,” by Stephen C. Hayes, PhD.

For people who struggle with OCD certain intrusive, repetitive, negative thoughts and images (obsessions) create intense feelings of anxiety. To relieve these feelings they tend to engage in concrete or mental rituals. The way our mind tends to work, however, when an anxiety provoking thought gets negatively reinforced via a response (a compulsion) it comes back bigger and stronger. To explain this mechanism to children I have created these images:

1st page obsession balloon  Copy of 1st page obsession balloon

Children can write one of their obsessions into the first balloon and can fill some of the other flying objects with thoughts that are not coupled with anxiety for them. They can then also fill in a compulsion they use to feed the “Bad Feeling Monster.” On the second page they can see how the monster and the balloon have grown and are still right in front of them while the other “thoughts” have moved away and are leaving their “sky of awareness.”

Let me know if you find this tool helpful!

A Strange Ode to a Weird Friend

Mirrored IamgeYou make my skin crawl when I hear a noise in the night

You send jitters down my spine when I climb to scary heights

You make me run, run, run…

Forward, don’t look back, never rest!

You remind me I have a heart that can beat out of my chest

You come to me in the night with memories and visions, a punch to the gut

And then you push me out of the gates with incredible speed.

Fight or flight! Freeze or death! You keep me going, my weird friend, my racing breath, forward, don’t look back, never stay, never rest…

In this short poem I was trying to touch on some of the contradictory aspects our experience of anxiety can contain. While it originates in our basic survival mechanism of “fight, flight or freeze,” our emotional makeup as humans that comes with the knowledge of our own mortality, a keen memory and a sense of imagination of the future can transform it into a force that works against us. I sometimes describe this aspect of anxiety as an “emotional and mental autoimmune condition.” Like our immune system, anxiety is there to let us survive but it can turn into an enemy. When we experience the detrimental effects of overbearing anxiety, we tend to lose touch with not only its truly protective aspects but also with its potential as a driving force. I will certainly write more about this in future posts but would love to hear more from you about your thoughts and reflections on anxiety.

The Roles We Play

RolesSome people love acting on stage or in films. They loan their body and imagination to a fictional character and make us believe in its existence. We are moved to tears or break into heartfelt laughter at their performance and experience their adventures vicariously for a while. I have not done much of this kind of acting, apart from being a ghost in a school play, but I admire actors and their skills. Before I became a therapist I was a professional fiction writer and have created characters on page, which requires imagining the feelings of somebody not yourself and bringing their thoughts and actions to life in a believable way. So when I learned about role theory during my clinical social work training, I was naturally drawn to this way of describing how we interact in society.

Let’s think about the many roles we take on every day. Continue reading

Praise Our Chosen Family!

What a wonderful article. It puts in words exactly how I feel about my chosen family as well.

Counseling TidBits

From “On Being” with Krista Tippett

In Praise of Chosen Family


Kate is one of the first friends that I feel like I actually chose. I’d see her walking around campus, her thick, dark hair curling up around her headphones, her head bobbing. She was a DJ at the college radio station. She was in my human rights class with the ancient and erudite Professor Juviler.

She sat with a group of girls in the cafeteria who exuded a bravado that I craved as I sat with my calorie-counting crew. I admired her from a safe distance for a while, suspicious that I was probably too earnest for her. Then, one day, with my adolescent esteem on some erratic upswing, I decided to email her. I told her that she was amazing and that…

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Let’s Make Personal Space

personal spaceA little while ago an amazing poem by a 6-year-old boy circulated on the internet. It is charming for its misspelled words and the last two lines convey this beautiful image, “We danst to the mozik/We made personal space” (spelling as in the original).

These lines so perfectly capture the idea of this small area of space around us that moves with us when we move and whose size depends on the situation we find ourselves in. This physical personal space is something we are unconsciously always aware of and we learn to sense and respect other people’s personal space as well. Continue reading