Category Archives: mental health

Reminders and Changes

Sunday was my mother’s birthday. At least it would have been, if she were still living.  She died in 2008 when she was 88 years old.  It is strange to be the oldest generation now in the family, something we babyboomers never really anticipated.  Maybe no generation expects to get to a time when they are the elders. Not many of us have parents, aunts, or uncles any more, even if we’re from families known for longevity.

When I think of my mother, I am reminded that many theories within the world of mental health look to mothers as the source of our health or illness. I remember my mother-in-law resisting the idea that my husband (her son) would benefit from seeing a therapist. “They all just blame the mother,” she said.  And I believe she worried that someone she never met would blame her for her son’s depression.  My mother, on the other hand, took that fear and wrapped it around her like a Kevlar jacket, preventing any inkling of contribution to anyone’s unhappiness from penetrating the shell. Once when I asked why she said such mean things about people (she had referred to a family member as a fat cow), she replied, “Because I can, and I like it.” She subscribed to the “every man for himself” theory of child rearing – even if that “man” were a toddler.   She was energetic, hard-working,  and very capable of being the center of attention.  There never was a power struggle she could walk away from. It wasn’t until I was much older and experienced  that I realized she was trying to as hard as she could to establish her place in this world.  She hated asking for help. In her experience, assistance always came with a package of shame, tied up in many strings. Asking for help meant she had failed. The person providing assistance would always know this, and could use it to maintain superiority over her.  Sometimes that person was my father: sometimes it was her father.

I believe it is true that much of our emotional development is influenced by the people who raise us, or abandon us. It is also influenced by our genetic composition, as continued DNA and gene studies show. The general circumstances of the times when we are children affect us, as witnessed by those of us raised by survivors of the Great Depression. Even the trauma of our parents or grandparents can influence the way we view the world and our place in it, as seen in families where there were survivors of the Holocaust, or colonization of the Native American, or veterans of combat.

Families and other communities create a culture that defines normalcy for its children.  Only as they explore other worlds, do developing minds and identities see alternatives.  The exposure doesn’t require travel. Those other worlds might be found at school, with friend’s families, at the elderly neighbor’s home, in books, movies, and other media.  I have always believed that my opportunity to spend extended time with my older cousin’s family allowed me to see a marriage relationship so different from my parents’, that I no longer saw theirs as the “normal,” and could have options in my relationship repertoire. I believe teachers have provided children exposure to adult-child relationships vastly different from parental ones.  I have been saddened by the increasing restrictions on teacher-child interactions resulting from reactions to isolated abuse, and to funding driven emphasis on the rote aspects of learning over the social development activities. Today’s children seem to have a group of trainers – school, soccer, piano, gymnastics. I wish there were more adult friends, teachers, and mentors.

I wanted to be a therapist so I could be a mentor, a guide, a helper to persons looking for alternatives to how they were living their emotional life.  Feeling better is much more than just changing the path you are on. It is really helpful to have an idea of where you want to go. In Alice in Wonderland, Alice asks the Cheshire Cat to help her find her wayThe cat replies, “Well, that depends on where you want to get to.”  Alice responds,” Oh it really doesn’t matter, as long…(as it isn’t here).” The cat’s answer? ” Then it really doesn’t matter which way you go.”  Think about what you would like the new place to be. How would you feel?  What behaviors would be different?  How would your self-talk change?  How would your relationships  be different?  With a therapist you can head toward that new place with support and guidance.   Change happens.

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Filed under childhood trauma, counseling, emotional healing, healing, mental health, Penny Milczewski, relationship, therapist, therapy

Redefining Normal

Thinking back on my experiences as a seeker of care and a provider, I remember two big misconceptions.  “Everyone experiences what I do,” and “No one understands what I’ve been through.”  While these statements may seem to appear opposites, they easily co-exist in the belief systems of people experiencing emotional distress.  Since I grew up in an alcoholic family, I have easily identified with the movement from the 70’s and 80’s focusing on Adult Children of Alcoholics: identifying the family system, the cognitive adaptations that help your world make sense, and the internal belief systems that rise from families where there is role confusion, denial,unpredictability, and secrecy.

When you do not talk about your inner life, you have few ways to compare it to others’. I remember in my 20’s having an eye exam that showed I was very far-sighted. The doctor asked me if I had experienced seeing double when trying to read. My response was, “Of course, I do. Whenever I get tired. Doesn’t everybody?” Or in my late 30’s when the dentist asked in a standard survey, “How frequently did I have headaches?” then responded with concern when I answered 5-7 days/week. “How had I gone so long without being concerned about it?”  I thought it was “normal.” Today I look back  with gratitude that someone asked a question in a way that I could respond, which resulted in recognizing that I could have a different experience than  I had.  It wasn’t normal, everyone did not experience it the way I did, and it wasn’t necessary that I struggle with it either.

The flip side (and yet companion) of defining your personal experience as normal, is seeing yourself as abnormal – the only person who feels this way or has had this experience. Part of the benefit of the Adult Children of Alcoholics (ACOA) movement, pioneered by people like John Bradshaw, Claudia Black, Jane Middleton-Moz, and Timmen Cermak,** was that it described a developmental process and set of beliefs that large groups of people had previously identified as individually unique to them. In the same way, group therapy is often the most helpful with persons having similar trauma experiences, because the individuals see that others have had very similar feelings,  emotional or physiological responses, and common self-talk,  generated from the common experience and not from a personal deficiency or inability to cope. This exposure  to others who share your difficulties “normalizes” the experience and the person’s response, and confronts the internal view that one is somehow “not doing it right.”

Now with all that said, don’t be too concerned about “Being Normal.”  A recent post by a friend said something like, “Normal is just a setting on your washing machine.”   And when you see a therapist or counselor, and they somehow start to describe fairly accurately how you might be feeling, or thinking, or experiencing something; don’t be alarmed.  They are not reading your mind. They are discussing common experiences of many persons in similar circumstances. Experiences you might learn from.Experiences that may be common, predictable, understandable, and human… that’s normal.

** These writers were important to me.  I have not tried to be inclusive here.There are many contributors to the ACOA knowledge base and treatment approaches.

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Remember, this forum is not intended to be therapy.  I have no way to view your body language, hear your tone of voice, or see your emotional expressions.  These are essential to effective communication and great tools for the therapist (and for the consumer when reversed.) I will attempt to be as helpful as I can. I will refer you the best I can to needed services. Even though I will not be your therapist, I am a health care professional bound by law and ethics to act to protect persons from harm. I am required to report my concerns of  harm to self or others, and suspected abuse of children and vulnerable adults.  I am located and providing these services in Washington State.

Again, I am open to communicating directly with you here.  If you have questions or concerns, please leave a comment. I will attempt to address the content if I can.

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Filed under childhood trauma, emotional healing, healing, mental health, Penny Milczewski, psychotherapy, relationship, therapy, Uncategorized

Therapy: What it is and What it isn’t

Whether you call the process Therapy or Counseling, there are many misconceptions about it. I don’t pretend to know all the issues, but there are several I have run across – as a seeker and as a provider.

Your therapist cannot “fix” you. First, this assumes you need fixing, and secondly, it assumes the repair work is completed by someone else.  Healing from loss or trauma is a process that you take on.  Changing  behaviors that create barriers to your happiness takes a process of awareness and practice. In therapy, you choose a guide to assist you with the processes. Remember, the answers are within you and your therapist helps you find them – your solutions, not theirs. As you engage in a relationship with your provider, your patterns of interacting with others rise to the surface. So do the relationship behaviors of the provider (more about that in another post).

Your therapist is not your friend.  You are not paying for friendship. This seems to be an accusation that comes from others who for reasons of their own, need to discourage your healing experience. Your relationship with your provider has specific boundaries regarding when and where you meet, and has a specific purpose – to guide you in identifying and achieving your emotional  or relationship goals, or to relieve your symptoms of distress. Friendships are reciprocal in a way that counseling relationships are not.  Both parties have roles, but they are not the same as friends.  Don’t call your therapist for a ride after dropping your car off at the dealer’s, and don’t expect to be invited to their summer barbecue.

The actual rigidity of professional boundaries is affected by many things, including the size of community you live in. Living in Seattle, you might never even see your provider out of the office. If you do, they might not acknowledge you unless you have indicated a connection first.  In a much smaller community, you may interact frequently, sharing the kids’ soccer field, the grocery store, church, or even social groups. Not acknowledging you in public in this setting might be viewed as “snubbing.” How you prefer to deal with these situations will probably be a session discussion topic. Whether in a small or large community, you have the right to have your professional relationship kept confidential if that is what you prefer. No matter the setting, sexual relationships and providers using the therapy relationship for personal gain are never appropriate.

When I say that your counselor is not your friend, I don’t mean they do not care about you. It is a relationship and a collaboration. My experience is that providers share consumers’ successes and concerns.  Depending on treatment orientation, your therapist may have accepted the responsibility of modeling nurturing behaviors such as acceptance, encouragement, and responsiveness. They expect to care about you.

Paying for assistance does not reduce its value. You have chosen to engage in a relationship with a specific purpose. For the provider, this specific purpose is a professional service. You are paying for the education, training, and experience of your provider, as you would a doctor, mechanic, or plumber. Remember, in this process, you are the buyer and you have a right to choose the service you get. You are not obligated to “stick it out” if  you are unhappy with the provider or the process. Ask for what you need.  There is nothing wrong with looking for  a provider and a methodology that works for you, or with changing providers and methodologies after you have started.

The credentials of your provider do not indicate relative competency or quality of care. There are several paths into the profession of psychotherapy.  These include several master’s level degrees, nurse practitioners, PhD’s and MD’s. Other than the ability to prescribe medications, Psychiatrists (MD’s with specialized training) and Psychiatric Nurse Practitioners (Registered Nurses with specialized training and experience) do not necessarily have more counseling expertise. Many have less counseling /talk therapy training than the others.  Clinical psychologists in Washington State have to have academic doctoral degrees and pass a licensing exam. Some states allow folks with Master’s degrees to be licensed as psychologists, and some states permit psychologists limited prescribing authority.  Psychologists also do not necessarily have more counseling training or experience.  They are often valued for their testing and assessment credentials.  Master’s level degrees in social work, psychology, and counseling also offer entry into counseling.  If you are looking for a therapist, explore their training and experience in the areas of concern you have. Above all, ask yourself after an interaction, ” Is this someone I could work with?”

Sometimes, the most difficult aspect of participating in therapy is the reactions of the people closest to you: The mother who believes she will be blamed for all your sorrows; The friend who wants your time and attention; The spouse who is afraid your therapist will tell you to leave your marriage; or the person who thinks you should just “buck up.”

The goal of therapy is positive change. Change is difficult for most people  – even good change, so there may resistance on your part and from the people around you. Try to be accepting and patient with yourself and with them.

This is a journey of self discovery and healing.

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Remember, this forum is not intended to be therapy.  I have no way to view your body language, hear your tone of voice, or see your emotional expressions.  These are essential to effective communication and great tools for the therapist (and for the consumer when reversed.) I will attempt to be as helpful as I can. I will refer you the best I can to needed services. Even though I will not be your therapist, I am a health care professional bound by law and ethics to act to protect persons from harm. I am required to report my concerns of  harm to self or others, and suspected abuse of children and vulnerable adults.  I am located and providing these services in Washington State.

Again, I am open to communicating directly with you here.  If you have questions or concerns, please leave a comment. I will attempt to address the content if I can.

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Filed under counseling, emotional healing, healing, mental health, Penny Milczewski, psychotherapy, relationship, therapist, therapy

Toe in the Water

As a child living in the Pacific Northwest along the cold waters of Puget Sound, I learned to swim.  I had two primary sites for learning: Quartermaster Harbor on Vashon Island, and a big cement swimming pool filled with mountain spring well water at my Grandparents’ in Tacoma.  It wasn’t until I started teaching boating safety classes that I realized that nearly my entire childhood swimming experience was conducted in the early stages of hyperthermia – blue lips, chattering teeth, progressing to numbness in the feet and full body shivers. It was very difficult to ease into the water slowly.  Everyone seemed to endorse the plunge approach. Anyone testing the water with their toe or attempting to enter a pool using the ladder or steps was considered cowardly and unlikely to ever complete the task.

Some folks look at therapy or counseling in the same way (All or nothing), and that approach probably keeps many from ever being able to truly use the process in a way that helps them.  It is okay to stick your toe in, and decide whether to proceed a little more or withdraw. No one has to leap in or be in the deep end rather than the shallow.   The process of working on your own emotional wellness, of relieving your distress, needs to be at your pace, and in an emotional environment that is safe.  A therapist that takes on the role of the bully, and throws you in the deep-end to sink or swim is not honoring you.  You might survive, but you are unlikely to continue to use the techniques you employed, at least use them with pleasure and confidence.

Just as our emotional distress is highly unique and personal, so is our path to recovery. There is no single approach, technique, method, or set of exercises that is helpful to everyone. It is okay to try different therapies. There will be a therapist that can help, but it might not be the first one you meet. Try not to assess your potential for recovery based on a poor experience.

Today there are all kinds of ways to explore therapy approaches: audio books, videos, U-Tube, reading, attending public presentations, workshops, health fairs, and many more.  It is okay to shop. I believe (and there is research to support) that the key element in a successful counseling /therapy experience is the relationship between the therapist and the client. (Please substitute whatever word you feel comfortable with to describe the person seeking therapy – patient, client, consumer, seeker, student – the words used seem to vary based primarily on provider experience and training.) After years in social services, I referred to the people I worked with as clients, then after 10 years in a medical clinic, I found myself referring to them as patients. Mental Health Advocates seem to prefer consumer. I will probably shift among the various titles as I write.  The key point is that you – the seeker of service – are the one in control of the relationship, not the provider. You (or your insurance, employer, or taxes) are paying for a service. And within your provider’s boundaries, you are entitled to manage the level of intensity, the frequency, the content, and the direction of your care.

Identifying and challenging your fears, doubts, pain or sorrow is not easy. You won’t necessarily be comfortable all the time, but it is essential that you trust you will be safe, and that you can stop or slow down  when you feel overwhelmed.

There are also online options for testing the water.  Visit blogs or websites that have questions and answers with therapists.  This is not therapy, but you can get a feel for how different people approach identifying problems and solutions.  In some cases, there may even be an opportunity to transition into a therapy relationship with the person.  Remember, it is your treatment. You can approach it in the way that fits you. You will need to stretch your comfort zone at times for growth to occur, but you can also approach slowly and move in a little at a time.

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Remember, this forum is not intended to be therapy.  I have no way to view your body language, hear your tone of voice, or see if your words and your displayed emotions are matching.  These are essential to effective communication and great tools for the therapist (and for the consumer when reversed.) I will attempt to be as helpful as I can. I will refer you the best I can to needed services. Even though I will not be your therapist, I am a health care professional bound by law and ethics to act to protect persons from harm. I am required to report my concerns of  harm to self or others, and suspected abuse of children and vulnerable adults.  I am located and providing these services in Washington State.

Again, I am open to communicating directly with you through this forum.  If you have questions or concerns, please leave a comment. I will attempt to address them if I can.

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Filed under counseling, emotional healing, healing, mental health, psychotherapy, therapy, Uncategorized

Where to begin?

I suppose everyone starts off similarly. Sometimes taking the first step (leap?) is the hardest thing.  That may be a common theme in this blog, because seeking psychotherapy to help with sadness, anxiety, relationships, trauma, big decisions, or general unhappiness with your life is often hard to start.  So is  shaping and building a therapy practice. That will be my primary focus: the process of healing through psychotherapy, written for the consumer and the provider.

Before we tackle the many aspects of these concerns, I want to let you know a little more about me and what I hope this blog will be.  This is not a therapy-client relationship.  You and I do not have the privacy nor containment that a therapy relationship usually requires.  I hope to identify and address common concerns, hopes, and fears that seekers bring to the search for a helper. For the content to be more meaningful to my readers, I intend to disclose more personal information than you would usually see in a therapy relationship.  I hope this disclosure will assist in understanding the complexities of the therapeutic relationship.  I also want other therapists to see examples of how our own histories and personalities affect the context of our services. So for the record, I am neither your therapist nor your clinical supervisor. I hope I can be a guide, an advisor, and a supporter in whatever journey to healing you take.  I am glad to address specific issues if I can, so feel free to ask questions or make comments.  Published comments will be managed to prevent inappropriate content being posted.

I am a baby boomer – class of ’46. I recently retired from a therapy practice in a Native American Tribal Health Clinic.  I had a private practice for 20 years, and worked in a community where I was well-known and in one with no contacts at all.   My primary emphasis was trauma and attachment issues for adults and children.  My favorite clients were 4 – 5 year-old boys (They are so “in the moment”), but I thrived on a mix of children and adults, and grew to appreciate the complexities of Gay and lesbian relationships, childhood trauma, traumatic injury recovery, chronic  treatment-resistant depression and anxiety.  I supported my practice in lean times working in family courts providing Guardian ad Litem and parent-child evaluations. Before starting my private practice in 1985, I  worked 16 years in Washington State’s social service programs. Before moving into children’s services program development and administration, I worked as a juvenile parole counselor,  child protective service caseworker, child welfare/ foster care caseworker, foster home recruiter and licensor. The last 10 years with the Department of Social and Health Services, I worked in policy development and administration, leaving as the DSHS Deputy Regional Administrator in central Washington. Although I worked for the same agency 16  years, I held a variety of jobs. I like change and challenge. I don’t usually like surprises.

Raised in a chaotic family of 5 children born within 6 years and two alcoholic parents, I developed a passion for rules, regulations, and predictability. I have worked hard to incorporate and enjoy spontaneity. While I still have difficulty going against the directional arrows in a vacant parking lot, I am much more at ease with hanging loose and having fun.  I am fiercely competitive in games, but a stickler for playing by the rules. Deep down, I want everything to make sense and am frequently frustrated by the “craziness” of organizational and governmental politics. I find the older I get, the grumpier I am about things that bother me.

At the same time, I am warm and generous.  I can be funny and fun to be with. I love to read, to laugh, and to be on the water – boating, kayaking, or dock-sitting. I love the lush greenery and vast seas of western Washington’s marine climate, but miss the blue skies, summer heat, and winter snow of central Washington. I am creative and express this with sculpting, gardening, ideas, and words.

When it comes to mental health care, I am a believer that the individual has within them the keys to healing their pain and distress; that therapists serve as guides – not directors. I believe emotional healing is a journey, and while therapists may have been on many journeys before, each path is unique and must be carved out by the individual.  The therapist brings experience in survival and, like any skilled guide, has tools to assist. But they cannot lead the way because they do not know the path. I also believe that there is no single path, no “right” answer for any given personal goal.  All paths will lead to healing. Some choices make those paths much longer and more difficult, but they all offer a way to emotional health.

So that’s my story in a big nutshell.  What I hope to do here is to guide you in addressing your distress; to help you make a connection with a therapist if that’s what you are seeking: to share my experience in life and therapy in ways that might be helpful to both seekers and providers of therapy; and to figure out how this incredible mode of electronic communication can benefit the process.

Remember, this forum is not intended to be therapy.  I have no way to view your body language, hear your tone of voice, or see if your words and your displayed emotions are matching.  These are essential to effective communication and great tools for the therapist (and for the consumer when reversed.) I will attempt to be as helpful as I can. I will refer you the best I can to needed services. Even though I will not be your therapist, I am a health care professional bound by law and ethics to act to protect persons from harm. I will be required to report my concerns of  harm to self or others, and suspected abuse of children and vulnerable adults.  I am located and providing these services in Washington State.

Again, I am open to communicating directly with you through this forum.  If you have questions or concerns, please let me know. I will attempt to address them if I can.

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Filed under healing, mental health, psychotherapy