Therapy Costs Too Much! 

​What’s the ROI?
Therapy IS expensive. Period. How would our perspective shift if we were to consider it through the filter of a return on investment (ROI)? What kind of return do we expect for an investment in mental health care? There can be both short and long term gain through personal growth, and yes, that's difficult to measure objectively. It truly is an investment in our future. What type of return do we expect on other investments, and how do we measure results? Lots of questions to ask.

What we privilege reveals what we value
To lend perspective, let’s do some comparative analysis. We can set aside money for vacations, home improvements, or college funds, but we tend to be much more reluctant to spend money for our emotional well being and relationship development. Think of the costs for a new outfit, hair cut, dinner out, concert or sporting event; it can quickly add up. The return on our investment may be short lived, and there's nothing wrong with that as long as we give equal consideration to where all of our money goes.  It is interesting that therapy can land in the column of an unnecessary overpriced luxury, but we may consider cable and internet essential expenses. When we ask where emotional care falls on our list of priorities, we will quickly learn what we privilege and value. 

While most current research on divorce cost statistics are estimated and somewhat subjective, there is a widespread general consensus that the cost of a divorce in the US continues to rise. “Divorce is a big business in the United States. It is in fact a $28 billion-a-year industry with an average cost of about $20,000.” * Now consider the comparative investment in therapy. No, there is no guarantee, but if engaging in therapy is an action oriented step towards personal growth, authenticity, and better relationships, doesn’t that make it worth serious consideration? 

*http://www.divorcestatistics.info/how-much-does-divorce-cost-in-the-usa.html
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​I can’t change who I am. 

​A good mental health clinician doesn’t want to change who you are either! In fact, much of the process value lies in creating a deeper understanding of who we really are, not just who we think we are. It’s about developing a greater acceptance and compassion for our own unique personality; exploring growth opportunities from a more empowered position.

Doing vs. Being
The therapeutic approach is ultimately designed to highlight the difference between identity and behavior. Too often we tie our sense of self to outward action, and there is a huge difference between who we are what we do.

Some of our less than helpful behaviors mute our personality and take us further away from our true self. Successfully engaging in therapy means that we explore and challenge the thoughts, feelings, and behaviors that get in the way of being the person we were created to be.

The path to living a life of authenticity and freedom isn’t easy, but it is worth it. It requires honest observation and a desire to understand and work on what can be changed, and create a healing space for what cannot.

Intellectually we understand mental health care is important and most people profess a desire to lessen the stigma. I have to believe a time will come when our emotional health is viewed in the same light as physical health. Most of us are able to recognize the benefits of preventive health care check-ups, exercise and good nutrition. We might agree in theory that mental health care is important, yet it seems as though it only gets widespread attention when we find ourselves scrambling in response to a loss or tragic event. The spotlight shines brightly on on mental health awareness when we use hindsight to second guess and pass judgement on missed opportunities, and signs we failed to see and act on. 

Confronting Stereotypes
Serious mental illness is not the focus of this piece. However we cannot respond effectively to the larger issue of mental illness if we do not step back and first consider preventive mental health care. Proactively addressing an issue will typically result in greater success than a reactive reply to a crisis. We have to start by confronting the stereotypes  attached to therapy and people who go to therapy. Those who have not done  focused self work with a therapist cannot be expected to fully understand what it offers. In my experience, those who initiate therapy do so to take responsibility and control of their own well being in a way that many do not. 

Change the Mindset
We must stop casting aspersions on therapy. Are you an advocate or an antagonist? Stand up and start the conversation. Today. Now. If we want to normalize and endorse the importance of emotional health we must take responsibility for our role in changing the mindset. We must equip ourselves with information and understanding. We need to bravely step into dialogue, demystify the process, and dispel the misconceptions about mental health care and therapy. If we want to change the perception, we can’t be afraid to talk about it. 

Start a Conversation
In the coming weeks, my hope is to use this blog to initiate conversation about why we don’t go to therapy. Please feel free to share your comments and start talking with friends and family members. We can’t make a difference if we perpetuate the silence. I'll kick things off with a very common concern I hear about therapy, the stigma itself.

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What will people think if they know I’m in therapy?

On that same note, I also hear, "people will think I’m weak if I can’t fix my problems on my own". It was Albert Einstein who said “We can’t solve problems using the same kind of thinking we used when we created them”.  It's amazing how we can make universal logic situational!

How many areas of our life are we considered weak if we seek to expand our understanding and knowledge base? How about if we need expertise? Are we ashamed to admit we hire accountants to help us with our taxes, personal trainers for fitness, doctors, lawyers, hair stylists, tutors, mechanics, computer techs? We can justify contracting virtually any other service provider without shame. For some reason, personal issues fall into a unique category of exception, as if we shouldn’t need to engage someone to help us with emotional challenges. How do we overtly or covertly feed into this way of thinking?

If we are stuck and not getting much traction in dealing with an emotional or relational problem, it should show strength of character to seek the support of someone trained in that area to help us. It should not induce shame or secrecy. We encourage others to ask for help, but do we take our own advice? Are you an advocate or a silent participant? If you want to be part of the solution but don't know what you can do, just start a conversation, you never know who you may be helping!

Anxiety shows up in some form or another for all of us. Anxiety is not the same as an anxiety disorder. As with any upward trending mental health condition, it can become whitewashed and we can  confuse day to day stress with an actual anxiety disorder. Anxiety is an innate survival instinct connected to the threat detection system in our brain. It serves an important function as it alerts us to potential dangers in our environment and keeps us safe. It is only classified as a disorder when anxiety kicks into overdrive and it becomes unhelpful and interferes with our ability to function normally. Defining the optimal level of anxiety is the challenge. We all have a unique response to differing levels of anxiety and to different stressors. Begin by asking yourself if your anxiety get’s in the way of everyday activities? Does it keep you from doing things you should do or want to do? Do you find yourself doing things targeted specifically on reducing your anxiety?
 
Sometimes it drives us to plan and manage and control our world so we can feel prepared for whatever comes our way. Invariably, the result is not what we hope for. We may avoid situations, people, or events. We may disconnect and shut out anything we deem as a potential threat and live in a hyper-vigilant state that leaves us unsatisfied, isolated, and frustrated. It is exhausting to live in fearful anticipation; waiting for the next worst thing to happen. The question we need to ask ourselves is how much time do we spend feeling anxious or responding to our worry? How much of our time and peace of mind do we hand over to our fears leaving us feeling helpless and stuck? 

We privilege discomfort and pain over more tolerable emotions, so we are more sensitive to the feelings connected to anxiety. As a result, we tend to label anxiety as “bad”. The anxiety is not the bad guy in our story, it is our response to anxiety that causes suffering. Symptoms can look like excessive worry and an inability to control worry, avoidance behaviors, and intrusive thoughts. There are also physical manifestations* that include feeling restlessness or feeling keyed up or on edge, being easily fatigued, difficulty concentrating or mind going blank, irritability, muscle tension, sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep) (Source: DSM-5). If any of those things get in the way of your day-to-day life, you may be struggling with anxiety or an associated disorder. 

Anxiety disorders are the most common mental illness in the U.S. today, affecting 40 million adults in the United States age 18 and older, or 18% of the population. (Source: National Institute of Mental Health) Because the prevalence is so high, you will find endless sources of self help, “fixes”, self proclaimed “experts” and “professionals” who prey on those who are suffering and looking for help. Beware of anyone or anything that claims guaranteed results. We cannot remove anxiety from our lives or seek a "cure", but with hard work we can learn to manage the symptoms of the disorder. Dealing with excessive anxiety can feel like a life sentence. People can label themselves and say, "I'm just a worrier", believing it is a personality trait they are destined to carry, but it doesn't have to be your defining story! If you decide to seek help, look for credentials. Check for academic degrees, professional and/or state licenses, association affiliations, and any evidence of experience and expertise. In addition to the level of qualification, your comfort level with your therapist is always a key factor in your ability to fully engage and see positive results in the process. Choose carefully to find a good fit, you will be glad you did! 

*To address any potential underlying health condition(s), always be sure to consult your primary care physician to discuss any physical symptoms you may be experiencing.

Helpful Anxiety Resource Links:

• Anxiety and Depression Association of America
• National Alliance on Mental Illness
• National Institute of Mental Health

“It isn’t what happens to us that causes us to suffer; it’s what we say to ourselves about what happens.” ~Pema Chodron

This is the second part of a two part blog post on relational endings and working through

How frustrating is it to hear that to heal from pain, we have to sit in it? If you’re anything like most people, the prospect of “working through” feels as comforting as chewing on aluminum foil. Who wants to knowingly call up all of the emotions that have been shoved into a deep compartment labeled “do not enter under penalty of emotional meltdown”? Perhaps you are the type who never put the emotion aside and you are riding an endless wave of feeling overload that you call grief. Or maybe you find the one emotion you are most comfortable with and you filter your entire grieving process through that one feeling and call it good. Some of us want to treat grief like ordering a meal at a restaurant “OK, I’ll start with a small plate of denial, I’ll take my anger rare, with a side of bargaining, and I’m too full for depression so I’ll finish up with a cup of acceptance.” Check please! Done and done! These may be tongue in cheek analogies, and the truth of the matter is that most of us don’t even understand what it means to work through complex emotion or grief. 

This is where we can get stuck. We may fail to validate the depth of our pain or we may get swallowed by it. We may fixate on our role or refuse to take any ownership at all. We can’t dismiss the importance of working through the pain before we can get past it. Dismissing the process discounts our experience leaving little room for accountability and self compassion. There is no one recipe for relief, and every path is different. To find the road that’s best for you it is often helpful to get curious. Spend some time journaling and reflecting. If you are thinking about the relationship specifically, what did it offer you? What did you learn? What was challenging? How did it make you feel? When was it good and when did you struggle? What did YOU bring to the table? Every relationship provides us with an opportunity to reflect on the gifts we offer to those we are in connection with as well as revealing our opportunities for growth and change. No experience is wasted if we are able to stop and reflect, honestly. 

Consider using mindfulness and self compassion as you contemplate what it means to work through. Mindfulness is when we purposefully pay attention, in the present moment, without judgement. Why mindfulness works hand in hand with self compassion is that we often struggle with that last piece… "without judgement". Self compassion requires that we recognize our own suffering. Often times we opt for self judgement over compassion because we feel internal and external pressure to be strong, move past, and tough it out! In the process we shame ourselves for feeling the pain instead of acknowledging our suffering as real. When we can mindfully explore our relationships, our experiences, and our suffering, we can learn a great deal from our reflections. If we don’t assess what’s going on inside of us, we can repress or project our suffering instead of owning it. We may find ourselves back on the same hamster wheel recreating the same pattern in the next relationship. 

Beyond reflection, we need to consider what it means to let something go. While an overused and often misunderstood concept, when it comes to emotional health, letting go is critical to our ability to work through and move forward. It isn’t about denying the situation or the impact, but radical acceptance of the experience in its entirety; pain and all. Jon Kabat-Zinn, the author of Wherever you go, there you are: Mindfulness meditation in everyday life describes it this way “To let go means to give up coercing, resisting, or struggling, in exchange for something more powerful and wholesome which comes out of allowing things to be as they are without getting caught up in your attraction to or rejection of them. We hold on with our minds. We catch ourselves, get stuck ourselves, by holding, often desperately, to narrow views, to self serving hopes and wishes.” Pema Chodron, an American Buddhist nun talks about letting go of our suffering with a simple analogy of being knocked down by a wave. We can lie there, not get up, and eventually drown, or we can get up and keep moving forward. We fail better. We will get knocked down again, but the more we get up, the smaller the waves become if we keep moving forward. Chodron says “We think that the point is to pass the test or overcome the problem, but the truth is that things don't really get solved. They come together and they fall apart. Then they come together again and fall apart again. It's just like that. The healing comes from letting there be room for all of this to happen: room for grief, for relief, for misery, for joy.”  

The confusion about what it means to work through our emotional experience has shrouded the concept in mystery. It’s as if there is a code to decipher and a secret set of instructions we didn’t get. When we are able to work through, it isn’t a realm of enlightenment where we no longer encounter adversity, we simply begin to understand that when we do suffer, the pain creates fertile soil to grow instead of stagnate. If you find yourself journeying through a breakup and it feels like trudging through quicksand, know that you aren’t alone! We all walk through places of pain and loss that leave us confused, hurting, and lonely. Our tendency may be to isolate in an attempt to prevent this kind of hurt from happening again, but this is the place we need to recognize the commonness of our connection. The literal meaning of compassion is “to suffer WITH” (Neff, 2011). The “with” guides us to understanding that these are the experiences that most connect us to other people because of the commonality of suffering. Instead of focusing on feeling isolated, alone, and inadequate, know that we all suffer, we all experience pain. Be courageous, compassionate, and boldly break the cycle to create something different! If you need a kick start or feel as if you can’t get “un-stuck” on your own, it may be helpful to speak with a professional, someone who is trained in emotion and relationships to walk with you through this process.

Gina Waltmire, LMFT
Gina is a licensed marriage and family therapist practicing in Overland Park, KS

References:
Chödrön, P. (2000). When things fall apart: Heart advice for difficult times. Boston: Shambhala.
Kabat-Zinn, J. (1994). Wherever you go, there you are: Mindfulness meditation in everyday life. New York: Hyperion.
Neff, K. (2011). Self -Compassion: The proven power of being kind to yourself. New York: HarperCollins.

​Other helpful resources and links:
http://www.huffingtonpost.com/kristin-neff/self-compassion_b_1889880.html
https://www.lionsroar.com/how-to-move-forward-once-youve-hit-bottom/

I spend a lot of time with clients who are bravely walking through change. The goal of our work is always to promote healing; individually and relationally. Some relationships can be strengthened and improved, while others must end before healing can begin. 

​Endings, goodbyes, transitions. How many of us think of these words and are filled with eager anticipation and excitement? Easy answer, right? Not many of us would say that our first thought is “Awesome! I can’t wait to plunge headlong into my next farewell!” It’s human nature to have a sense of foreboding when it comes to any ending, whether planned or unexpected. Despite the understanding that the only certainty we have in this life is change, many of us would rather not step into it willingly. We may find that we cling to the familiar, be it in jobs, people, or places because “sameness” provides a sense of predictable security. So what do we do when change is forced upon us or necessary for our individual or collective well being?

One of the most painful changes we will experience is the end of a relationship. When death is not the cause of the ending, we all wrestle with the implication of one word, choice. Choice adds a layer of complexity when contemplating the fate of a relationship. Even if the decision to part ways is mutual, the emotional and logistical implications seldom look like a Hollywood movie ending. We are flooded with questions of whether or not the ending is permanent or temporary. "Should I hold out hope or move on?" Choice creates uncertainty about finality. Our work is about finding a place of acceptance in what today holds, regardless of the pull of the past or the anticipation of the future.

An important consideration for all caring human beings is that endings are painful, no matter what side you find yourself on. People are often surprised that suffering is not rank ordered; the end of a romantic relationship is not necessarily more painful than the end of a close friendship, nor is a cutoff between siblings less painful than the estrangement between a parent and child. Confusion is a common theme we wrestle with. We may bury ourselves in second guessing, rumination, endless questions of “why”, what if, and lots of hurt. We look for a place to put our pain so we can make sense of it in our head when our heart feels such sorrow. We are desperate to cling to anything that helps us eradicate the source of our suffering.

Which Side of the Fence am I on?
Let’s first consider the person who does not choose to end the relationship. When the choice is made for us we can feel rejected, abandoned and not good enough. There are usually layers of feelings, and just when we think we’ve processed through one set of emotions, new ones come knocking. We can vacillate between anger, sadness, betrayal, loneliness, isolation, etc. Our self worth can take a nose dive as we assess our role in the split and imply a direct connection to our personal value. We may want to blame - either ourselves or the person who ended it. We may feel like a victim, fixating on what was done to us. We may question the relationship in its entirety when it feels as if all we are left with is the hurt. There is no way around the fact that it is just plain hard when someone chooses to leave us.

Then there is the person who initiates the break. If we are trapped in resentment or anger, we may find it’s all about blame. Our focus can get stuck and all we see are the actions or behaviors of the other person, "They gave me no choice - I had to leave". On the other hand, if we take full ownership of our decision to step away from a relationship we can feel like the villain. We may find ourselves mired in guilt, remorse, and uncertainty. It can feel as if making a break suddenly means that we are no longer compassionate and we fear being seen as uncaring and unkind. We may save the most hurtful descriptions for ourselves because we struggle to see the rationale beyond the pain induced by the breakup itself. We fail to embrace the grief because we would rather hold the guilt. As the initiator, we withhold permission to experience the impact of the loss since we chose the path. We refuse to let ourselves off the hook, and we can’t properly move on until we acknowledge where we’ve been.

Relationships are an investment; emotionally and mentally. The book Necessary Endings by Dr. Henry Cloud describes the investment as the energy we pour into the relationship. In order to move on, we must take energy out of the relationship, and to do that we must grieve. We must feel the feelings we are experiencing and acknowledge the reality of the ending (Cloud, 2010). Most of us want to skip this process; we want to force fit a fix, offload our hurt externally, or we want to downplay the significance of the situation, swallow the emotions and jump forward past the grief. Unfortunately we can't bypass this process and we will find that unprocessed grief can weigh us down for weeks, months, or years.

This is where we can advocate for our own healing with intentionality and compassion. This is where we have choice to create something different for ourselves, our current relationships and our future. Not an easy prospect when choosing the healing path requires that we look at our pain and hold the reality of our circumstance in the present moment. It is the most authentic response we can choose as it helps us to honor our emotion and our experience with honesty and integrity.

Check back soon for part 2 of this post as we explore the process of grieving and working through.

References:
Henry Cloud. (2011). Necessary Endings: The Employees, Businesses, and Relationships That All of Us Have to Give Up in Order to Move Forward. HarperCollins.

NOTE: This post is not intended to provide the reader with advice about how to handle their specific situation. If a relationship contains any elements of coercion or violence, personal safety should always be the foremost concern. If you or someone you love is in an abusive relationship, talk to someone who can provide help and guidance: http://www.thehotline.org To find a local domestic violence agency near you call 1-800-799-SAFE (7233).

​There is a power in bearing witness to unfiltered truth and raw experience. It can also result in uncomfortable vulnerability, even when the story is not our own. Just being close to such unguarded candor opens the door to introspection. If we’re brave enough, we step forward to view our own barometers of self acceptance and authenticity. After reading Love Warrior by Glennon Doyle Melton, I felt as if I’d been given permission to peek behind the curtain of my own inner realm with timid apprehension. The point isn't to compare the similarity of our stories. It's that you can’t help but trip over feelings that mirror our own experience simply because she reaches a place of brutal honesty about all that we are afraid to reveal about our own self limiting beliefs, regardless of what those beliefs may be. Is this a story of our collective truth? How much do we skim the surface of life and experience; afraid to look in the mirror long enough to recognize how much or little of ourselves we truly reveal? More than a limited view; the truth often speaks of our discomfort in seeing just how much we really hide from ourselves. 

We all recognize an undercurrent of collaborative inauthenticity any time we work to maintain outward appearances. The image we portray outwardly often stands in stark contrast to the story we tell ourselves about who we really are. Ironically we may find that we share a deep connection in our silence. These societal and self imposed rules of engagement create fear of how we appear to others. Fear that our inner dialogue translates into not being a good enough parent or friend or child. Fear that we don’t love as we should. Fear that we aren’t smart enough, thin enough, attractive enough or brave enough. Fear that deep down we are unworthy of love and acceptance. Fear that tells us if anyone really understood the thoughts and feelings we push into the darkest corners of our heart and mind, we would be ostracized even more than we already isolate ourselves.
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Because we are so strictly governed by cultural and societal rules, we force ourselves to choose between competing values of appropriateness and authenticity. We choose between our gifts and our goals, and if we aren’t careful we find ourself living a life structured and prioritized solely by what we should do and who we should be. In turn, we dim the light meant to illuminate who we truly are. That doesn’t presume we abandon our responsibility or moral compass in favor of a life of self indulgence. We are constantly being sold the idea that if we chase the image of the American dream; money, sex, career, then we can achieve the end goal of “stuff” that will make us happy and fulfilled. It is the conflicting pursuit of “doing” over “being” that has us numb and distract and self medicate to quiet the voice that says we aren’t good enough to achieve the unattainable goals we have been force-fed. We need the occasional reality check that has us stop, check in, and ask ourselves, “what am I chasing, and is it in line with my foundational values?”. The honesty, vulnerability and authenticity required to question the the path we travel requires courage. This self exploration exposes us to potential pain and rejection, but also creates a path for growth, healing, and deep connection. You are worth the risk!