• Every tried hard to find a therapist only to discover that no one is taking new patients?
• Ever had a therapist tell you they would like to treat you but your insurance company is too difficult to work with?
• Maybe an insurance company has tried to shut down the number of sessions you can have?

It's been awhile since I have written, but I have been working hard behind the scenes with colleagues on ensuring full access to mental health care for all Oregonians.  These days, focusing on the state level can be the most empowering way to work for our rights.  I have been part of a group, the Oregon Independent Mental Health Providers (OIMHP) that has crafted a bill and lobbied the Oregon state legislature to enforce compliance with mental health parity laws.  We have had parity laws on the books since 2005 but insurance companies have been able to get around those laws, squeezing providers which then closes down access for consumers.  Parity laws say that insurers must treat mental health care the same way they treat physical health care.  Our lobbyist has worked hard in Salem and now it looks like we may just pass our law, Senate Bill 860.  Please take a look at the following powerful article by the president of the Oregon Senate, Peter Courtney.  He is a passionate advocate for our bill so success for equality in mental health may be within reach...!

www.oregonlive.com/opinion/index.ssf/2017/05/mental_health_is_important_jus.html#incart_river_home

2017 has started off with a bang.  So much to read, to do, to worry about, to recover from.  The good news is that our brains really appreciate a challenge.  The human brain sees novelty, change and hard work as the very best nutrition it can get.  These activities stimulate neurons to fire and grow, they promote synaptic development that enriches our cortical structures.  So while it may seem daunting right now to apply ourselves to change, our brains are poised to appreciate our efforts.  

It can be easy to feel like what we are doing to support change in ourselves and in our society is just a drop in the bucket, never enough.  But social activists promise that consistent small efforts are the only things that have ever led to social change. 5 minutes a day of activism, or one task a week, can help us feel like we are fighting the good fight for peace and equality.  

On the brain level, our neural architecture is extraordinarily responsive.  This means that one small change can lead to a cascade toward health.  If you have ever felt a whole lot better by doing just one thing for yourself that you have been meaning to do, this is not an illusion!  So if we let ourselves do just one thing, instead of shaming ourselves that it isn't enough, our brains will gobble up this change and it will lead to other changes in an organic way.  Whether that means doing that bit of exercise you have been wanting to do, or cooking one healthy dish you like, or reaching out to a person in your life that you have meaning to contact, these changes will naturally increase incentive to follow through with other goals for self-care. 

Brain empowerment can be making a change on the micro level that will lead to macro level changes for you and yours.

I want to say something hopeful to anyone who may read this post.  I want to wish them a measure of joy and peace during the holidays, however they celebrate or get through.  I know it's crucial that we see what is around us while taking the best care of ourselves and others that we can.  I hope you have time to rest and reflect, relax and recuperate from 2016.  I trust that 2017 will give us many chances to apply ourselves again in work and love.

It's an interesting time to be a psychotherapist, especially coming from a background in social work.  Social workers believe that you cannot separate the person from their environment, that the way to support people in their daily lives must always include looking at their family environments, their communities, their society.  (It's been a dream of mine that my practice would include my patients bringing in the people in their lives, so the whole system can get help to feel better and meet their goals.  I am grateful that people are starting to bring the ones they love to the therapy room.)

I am trying to figure out how best to help people who feel that the foundations of a civilized society are not supporting them.  From the fear of their health insurance or disability benefits being threatened, to the terror of being harassed and rejected for not being part of mainstream dominant culture, I am meeting daily with people who are really scared about the state of our country.  It is painful to sit with their realistic concerns.

I also see some people who have connections to the Trump voter, who are struggling to make their lives and family relationships better and don't know how.

What can psychotherapy provide at a time like this?  At its best, therapy is a process of making reality more and more tolerable for the humans who live it.  The idea is that the more we can directly cope with the facts in front of us, the less energy we will spend hiding from what we know.  Masking things from ourselves takes a lot out of us, it makes us feel anxious and depressed, it makes drugs and alcohol really seductive.

So I am slogging on, hoping that by talking openly about the political realities of our day and the way they connect to our daily lives, we can feel a little less alienated, a little less confused.  I hope you have a place where you can talk about your ideas and fears and get a little more clarity when you do.

Sometimes you gotta take the leap.  I have moved down the hall in the Jeffrey Center to a new office, suite #435.  It's bigger than my old space and has some great features like a private waiting room and exit door because we don't always want to see people right after a good therapy session.  There are four working windows that face the west hills.  These windows that open are one of my favorite parts of being in a vintage medical arts building downtown.  I am told by the therapist who was in here before that there is a Pacific Northwest cloud show that can blow your mind.

All these details are great, and a big part of why I moved, but the real impetus was the urge to keep growing, even when there is fear.  I want people to have enough space in my office to fully engage in group therapy.  There is nothing like being in a room with 8-10 other working brains, hearts, guts, histories, ideas, humor and dreams to evolve.  The sheer multiplicity of factors renders group into its own animal.  My favorite quote about group comes from the great Louis Ormont, "All of life passes through the needle's eye of group experience."

Please call me now and let's do group!

I have been in the field long enough now that I frequently get to experience the deep gratification that comes from watching someone really grow.  It's always a good feeling to support people as they move out of crisis, to see them begin to care for themselves, and then there's this next step.  They start to deepen in their commitment to themselves.  I am in a privileged position where I get to be part of the small, concrete, hard steps, the intermittent epiphany, the occasional return to the discouraging slog, and then, suddenly, the exhilarating thrill of swift and sure progress.  To watch people experience more freedom, to sit with them when they allow themselves to feel much deserved pride, to be part of their authentic growth, this is a great benefit of my position.  

I have been thinking a lot about difference.  Since Orlando, and all the terror since.  Since childhood, and all the terror since.  There seems to be something so fundamentally threatening to us humans about the simple reality that people are different.  In many ways, in every way.  We think differently, we feel differently, we look different.  Our brains are different, our guts are different, our bodies are different.  We each have our own subjective reality that is informed by the infinite variations in our genetics and our experience.  

I know we need to connect, more than anything.  But I am struggling to understand why we seem to require sameness to be close.  When we first meet, it's so exciting to cross the distance of difference.  We thrill to discover the ways we are the same in a sea of uniqueness.  And then when we start to know each other and be known, we start the process.  We pick at each other.  We pressure each other to agree.  We threaten to go away.

Some people require sameness right from the get go.  There is no pleasure in difference, no curiosity, just threat. 

What are we afraid of?  Is it really difference?  Is it maybe the painful reality of our separation from each other?  Would we rather hurt each other than tolerate the uncertainty that comes with being human?  What do you think?

It's good to get to the weekend sometimes.  Maybe the weather is fine and we can eat something nice with someone fun.  We can make jokes with strangers and appreciate the easy connection.  Or maybe we can be all alone, or with the dog, and full of the keenness of our own thoughts.  Perhaps we can look forward to something we have planned and trust that it will take place.  We can allow ourselves to feel safe, sometimes, even when the world can be very treacherous.

It's tough for people to stay in therapy.  There are many pressures to stop as soon as the crisis has passed.  People feel, "I shouldn't need this as a crutch."  Maybe other people ask them, "How long are you going to keep going?  Shouldn't you stop now that things are alright?"  Sometimes there is pressure from insurance companies to only do a limited number of visits.  There is still stigma in our society about mental health as a medical condition that requires ongoing management, just like any aspect of our physical health.  

The brain is a physical organ that requires care.  We have to take care of our other organs, our lungs, our hearts, our skin, our digestive system.  Why is there pressure to neglect what is arguably the most critical organ we possess?  It takes a long time for our brains to get wired with particular patterns of feeling and behavior.  Most people don't start therapy until adulthood, and at that point there are literally trillions of neural connections that are driving how we care for ourselves, or don't.  Add to that the default brain wiring of the people in our lives, and you have a complicated structure that takes time to study, explore, undo and redo.  It's hard to let go of some of the ways we are used to thinking and behaving.  Fast change is exciting sometimes, but is also notoriously short-lived.  Slower change over time is more durable.

So if you feel like, "Enough already!  I should be over this!" ask yourself:  What could happen in my life if I gave myself enough time to make changes at a pace that wasn't too scary for me?  What if I kept going to therapy after the worst had passed?  If I keep going when I feel better, could I feel better still?  

If change feels like it is just too hard to make, what would happen if I stuck with treatment?

Sitting in a therapist's chair provides an interesting perspective on relationship conflicts.  When we are knee deep in a difficult relationship, it is hard to see clearly what is going on.  It is easy to become confused about who is responsible for what, about what has been done to who, about how best to react in a conflict.  I watch people struggle with self-doubt as they try to have an expectation that they will be treated well by their partner, or their parent, but find that their daily experience with that person is not one of good treatment.  Depending on what we have been through in life, we may have a really hard time standing up for ourselves.  It becomes easy to accept blame from someone else when in fact, the other person is not being truly accountable for their own behavior.

​The people who come into therapy tend to be people who set a high standard for themselves.  They want to take responsibility for the way the act, for their own foibles, for the goals they have in relationship.  Unfortunately there are people in the world who don't have the same feelings about their own behavior.  They are willing to allow other people to take more responsibility than they should for what happens between two people.  It can be very painful when you love someone who doesn't take their fair share in relationship with you.  At best, you might blame yourself and keep working for improvement and be scratching your head about why your relationship isn't getting better.  At worst, you might accept the blame and feel like you are a bad person.  Or you might become accustomed to bad treatment, you might get used to a life where you are being used or controlled by someone else.  From where I sit, it becomes clear when someone is not willing to engage in a reciprocal relationship.  I try to help people sort out this painful dilemma:  what do you do when being in the relationship causes you great pain but you feel scared to death when you think of changing it?