Just Chillin' in the Freezer

     Panic attacks are weird and traumatic and unpredictable, aren't they? I used to have them almost daily, and I still have them occasionally, even after my time in therapy. It seems like, even today after a lifelong battle with them, that I still sort of scramble to remember coping techniques sometimes, particularly if a panic attack just comes on quickly, with no warning, like the times I've been woken up by a panic attack at night from a sound sleep.

    As someone who lives with panic disorder, I've spent plenty of time trying to avoid having a panic attack in the first place or trying to stop a panic attack before it spirals out of control. In the early days, I did everything from standing on one foot to watch TV to practicing a British accent just so the space where the panic lived in my mind might be filled up enough with other things that I wouldn't have room left for the panic to occur. Then once I started therapy, I would do meditation and relaxation breathing, yoga, and other helpful things. Since panic disorder is so unpredictable, sometimes those coping techniques work, but sometimes they don't. I'm sure all of us living with panic disorder have been there, right? We do everything we can think of, but the panic attack still comes barreling at us like a train at full speed.

    Instead of going straight for a hard brain reset (if I'm not sobbing yet), I can do one more thing that always seems to work. I go stick my face in my freezer for a couple of minutes, and then I do some relaxation breathing while I've got my head stuck in there. If it doesn't drop my anxiety to a completely manageable level, it at least stops the panic attack. I know that sounds weird, but it works. (I also read online about someone who would hold an ice cube in their mouth to stop a panic attack, too. Holding an ice cube in your hand is supposed to work as well, but I find that putting my face in my freezer works best for me.)

    Here's why something like this tends to work: When you have a panic attack, all of your focus is turned inward. You're only aware of your mind racing and your heart racing and how you might feel like you can't breathe. You're also probably monitoring for any other symptoms associated with a panic attack. When you go stick your face in your freezer, you're shifting your focus from internal (where the panic attack symptoms are) to external (where you're suddenly feeling the cold air on your face and breathing it in). Shifting your focus from internal to external like this is a way to bring yourself out of the panic apace and back into the current reality. Also, the relaxation breathing is a way to trick your brain into thinking things are calm instead of in overdrive and out of whack. 

    I'll end with this: Life with panic disorder can be unpredictable, to say the least. Sometimes the usual coping techniques don't work, or if the panic attack comes on quickly, we can be left scrambling to remember anything we learned about how to manage moments like these. Something that shifts your focus from internal to external is ideal, like (for me) sticking your face in your freezer for just a couple of minutes, to stop a panic attack. 

Your Therapist is Not Your Friend

     I recently had someone tell me that they think of their therapist as their friend. This person told me that they felt like their weekly therapy appointments were just two friends hanging out and chatting about stuff. This person also thought the therapy they received from this therapist wasn't helping them, but, since they thought of the therapist as their friend, they didn't want to find a new, more helpful therapist. This situation is not a good one, my friends. This is not how a client-therapist relationship should look or feel.

    Your therapist is not your friend. Your therapist is not supposed to be your friend. Forgive me if that sounds harsh. A client-therapist relationship is like a business partnership. The client and the therapist are the business partners, with the therapist as the "senior partner", there to guide the newer, more inexperienced business partner (AKA the client) through the business venture of rewiring their brain and healing their trauma. Like with most business partners, there are certain boundaries that are defined from the beginning by the client and the therapist when they agree to work together. (A therapist usually defines the parameters of the client-therapist relationship and the expectations for the process during the in-take appointment.) If you ever feel like your therapist is your friend more than you feel like your therapist is a mental health professional providing a needed service, the boundaries have become blurred or weren't enforced properly, and this is not good for the therapeutic process.

    When your therapist becomes your friend instead of your mental health counselor, the whole therapeutic process can fall apart. Think about how you interact with your friends. You might hide things from them or lie to them to avoid having them think or feel differently about you. You're also likely to ignore help your friends try to give you, or if they tell you that certain behaviors are becoming a problem. You can't do those things with your therapist. You have to tell your therapist everything, and you have to put in the work outside the sessions that they expect of you or therapy won't work.

    Your therapist also has a duty to remain objective when it comes to treatment. If your client-therapist relationship has turned into more of a friend-friend relationship, it can become difficult for the therapist to remain objective and for the client to place their trust in the therapist's ability to treat them adequately. (Note: if a therapist has lost the ability to be objective with their client, it's unethical for them to treat that client any longer.)

    I hold my therapist in high regard, and I trust her with my life. I enjoy the way she has worked with me for the past five years. However, I know she isn't my friend. She is a professional, much like my primary care physician, that I am paying to provide a service that contributes to my overall well-being. We have boundaries. My therapist is a warm and caring individual, and I truly believe that she cares about me as a person. However, my appointments never feel like we're just two gals chillin' over a nice cup of tea. My appointments feel more like business meetings. I'm not making idle chit-chat or asking her about her life during my hour session, and she doesn't share details about her life with me. We work during my appointment to change the way I function and interact with my mental health condition. We meet with a thing to accomplish and an end-result visible on the horizon.

    I'll end with this: It might seem weird to think of the person you share your most troubling experiences with as "not your friend", but your mental health counselor is not your friend. It should never feel like your therapist is your friend, or like your counseling appointments are just two friends hanging out. If that happens you need to address the issue and possibly find a new therapist that can provide objective and professional treatment.

Should I Tell My Therapist?

     This is a question that I get asked quite often by my fellow therapy-seekers. They will usually tell me about their problems, stresses,  the new or most bothersome symptoms of their mental health condition, or a mistake or bad decision they may have recently made, as friends do. Then they'll ask me, "Do you think I should tell my therapist about this?" My answer is always, "YES. TELL THEM."

    I completely understand how this can be an uncomfortable thing, but if you're in therapy, you are ABSOLUTELY supposed to tell your therapist everything. If it's good, bad, ugly, embarrassing, shameful, scary to talk about, and everything in between, you're supposed to talk to your therapist about it. Even if you think they'll be mad at you, (spoiler: they won't be mad at you), tell them. Even if you think they won't like it or understand it, tell them anyway. Even if you're sure they won't able to help you, tell them everything anyway. If you're asking yourself or anyone else, "Should I tell my therapist about this?" the answer is yes, you definitely should. That's the only way therapy will actually be helpful.

      When I had my intake appointment with my first therapist, I almost didn't tell her about my intrusive thoughts. I was afraid that she would either think I needed to be institutionalized (they don't really even do that anymore) or that she'd confirm my worst fear, that I was actually possessed and she couldn't help me. Then I realized that if she didn't know, that I wouldn't even be in therapy for the one thing that was causing all of my other symptoms, so therapy wouldn't actually help me at all. So, I told her, and I was absolutely terrified as I told her. She said she could still help me, and because I was honest, I finally got the help that I so desperately needed. Because I had told her EVERYTHING, I had taken my first step in the healing process.

    Being completely open and completely honest with your therapist is the only way that the therapeutic process is going to work. If you keep anything hidden or don't talk about ALL of your feelings, then how are you going to process everything that you need to process in order to heal from it? You have to be willing to let your therapist see all the "broken" bits, all the bits that you don't like, everything that feels weird. You're therapist needs to see all of that so they can see the "whole picture" of you, your illness/trauma, your thoughts and beliefs, your feelings, and your life so they can see how best to help you figure out how to help yourself.

    I'll end with this: I know it can be terrifying to think about telling someone, even a therapist, all of the things you think are strange about your mind, all the things that you feel ashamed of, and/or all the things you think make you "broken". But...the only way that the therapeutic process works and helps you heal from your trauma is if you're completely open and honest. If you think for even one second, "Should I tell my therapist about this?" The answer is YES, TELL YOUR THERAPIST.

The Big Misconception

     I know, it seems like I'm always mentioning how the symptoms of mental illness come and go over time. That's one way in which mental illness is a little bit predictable, because we know that life with a mental health condition will require more effort on some days than on other days. One thing that I haven't talked about, though, is how those symptoms can change over time.

    One common misconception about mental illness is that people experience the same symptoms of their mental health condition over and over again. That's not usually the case. If it was, those of us with a mental health condition wouldn't really need ongoing therapy once we learned how to manage the symptoms for which we went to therapy in the first place.

    The reality of living with a mental illness is that symptoms change from time to time. Sure, some symptoms can go away or lessen to the point that we might barely notice them. But...new mental and physical symptoms can also occur at any time. New triggers can emerge. New intrusive thought can suddenly filter into or take the place of old intrusive thoughts. (So far, the content of my intrusive thoughts has changed four times during my wellness journey.) This can happen through no fault of our own. It just happens sometimes, and then we're left trying to figure out how to manage this new piece of the puzzle that appeared after we already thought our puzzle was put together.

    The other piece of that misconception is that everything will be fine as long as the person is on their medication, and their mental illness will continuously be "better" with the medication. Medications can stop working. Dosages need adjusting sometimes, or the medications may need to be taken at different times of the day or night if it's helping less than before. Sometimes the medication can cause a new set of symptoms (as it happened in my case), and then a new medication may need to be added to treat the new symptoms. Sometimes medications need to be changed altogether, and then the person experiences a spike in symptoms as they wait the two to eight weeks for the new medication or combination of medications to become effective.

    This two-part misconception can add to the idea that I talked about last week, that people that live with a mental illness are "unstable" as a permanent state of existence. It can also make it seem like the person is suddenly getting worse or maybe not trying as hard to stay on top of their mental health. That isn't accurate, though. Just because new symptoms emerge or medications need adjusting or changing doesn't mean someone is getting worse or not trying hard enough. It just means things have changed, and now we have to learn how to cope with these changes that we didn't expect, which can feel like starting the whole journey over again sometimes, depending on how severe the new symptoms are.

    Mental illness is extremely unpredictable that way. Every person won't experience the same symptoms or the same symptoms in the same order. The medications for a specific condition won't work for every single person with that condition, and so it's trial and error until the right medications can be figured out by the healthcare team. My point is that mental illness doesn't look or feel the same for everyone. Mental illness may not even look or feel the same week to week for one person. That doesn't mean that one person is "worse" or more "unstable" than the other. It just means their brains are different.

    I'll end with this: People don't just keep experiencing the same symptoms of their mental health condition over and over again. Symptoms and triggers can change over time, even though someone is going to weekly therapy and taking their medication(s). Mental illness is unpredictable in that way. Medications won't always cause continuous symptom improvement either, because medications can stop working, or the dosage may need adjusting from time to time. These changes don't necessarily mean that someone is becoming "unstable", getting worse, or not trying as hard as before to be well. It just means they may have been thrown a curve ball, and now they need the time to adjust to this new situation.