Mental Health during Covid19
In what ways is the current moment -- between the pandemic and the stay-at-home orders -- more exacting on mental health?
These days, the feeling of uncertainty is weighing on us all. People are understandably feeling anxious, worried, and concerned about the coronavirus. Fear for our health and the health of our loved ones, neighbors, and fellow humans around the world is justified. Additionally, the stress experienced as a result of unemployment, loss of social supports, and an extended stay at home is challenging our mental wellbeing.
Anxiety is normal right now, but when it starts disrupting your ability to manage daily life or sleep, you need to learn new strategies to take care of yourself.
What are some common reactions to this stress?
Common physiological responses to stress may include tense muscles, clenched jaw, difficulty sleeping, upset stomach, low energy, and feeling “foggy”. Behavioral responses to stress may include compulsively watching the news, blaming others, increased dependence on alcohol or other substances, spreading conspiracy theories, and ignoring public health recommendations. Cognitive responses to stress may include difficulty sustaining focus, forgetfulness. Emotional responses may include sadness, crying, irritability, anger, frustration, and fear. All of these responses are normal so long as they don’t take over or limit your ability to function overall.
Healthy functioning is not the absence of stress. Healthy functioning is the ability to recognize signs of stress and the ability to behave in ways that help us feel better. This may include reducing media exposure, expressing (not suppressing) emotions (it’s okay to cry!), and staying active (hobbies like cooking, gardening, and exercise, etc.)
Symptoms to watch for include feelings of hopelessness, intense emotions that are hard to manage, impaired daily function, anxiety that leaves you feeling out of control or hypervigilant. If you experience these symptoms, contact your healthcare provider.
In your experience, do certain groups of people -- at-risk individuals, for example, or perhaps children -- react more strongly to the stress of the coronavirus?
People who already suffer from pre-existing medical conditions or have existing mental health issues like depression and anxiety are most vulnerable to additional stress during this time. It’s also important to note that people in unsafe and unhealthy living situations with reduced ability to remove themselves from harm are also more at-risk at this time. These may include victims of violence in the household, people who depend on social services that may have been interrupted, and those in the LGBTQ+ community who are in non-affirming environments. Please refer to the resources below for hotline information.
What are your tips for coping with the stress of the coronavirus? What does "self-care" mean to you as a mental health professional?
Self-care is the effort we make to know and support ourselves and then living that awareness out in the world. Self-care includes doing the work of healing from unprocessed traumas or grief so that you are not stuck living in your past and learning how to establish and maintain appropriate boundaries in order to have healthy, functional relationships.
However, during this pandemic it is important to recognize that self-care begins with ensuring that your basic needs are met: eating well, getting enough sleep, and spending time outside to the extent that it’s safe and possible. We are so fortunate here in Maine to be able to be outside while respecting six-foot distancing.
To reduce your stress levels, one of the most important things you can do is to calm your nervous system. Focusing on your breath helps. The following tool is one I use often with patients.
Sit in a comfortable position. Relax your eyes close and rest your hands on your legs or in whatever way feels comfortable to you. Slowly begin taking a deep breath in, pushing your lower abdomen out with air, bringing oxygen to the bottom of your lungs. As you breathe in, notice your belly expanding. On your exhale, release your breath slowly (for a few counts longer than your inhale). Breathe in and breath out slowly, for 6-10 mindful breaths, allowing your body to relax and your mind to become calm. And finally, when you’re ready, come back to the room and notice how you feel. If you feel better, practice this as throughout your day and before bed.
More generally, when coping with stress from the coronavirus, seek support by reaching out to friends or healthcare provider and stay up-to-date on managing any medications with medical providers.
Maine has started lifting some restrictions on stay-at-home orders. The CDC also says that coming out of quarantine will come with its own mix of emotions. What do you recommend for people dealing with the fear, guilt, or anger associated with restrictions being lifted?
The truth, exposed by the coronavirus, is that our lives are always changing and that massive changes can occur within moments, let alone days and weeks. This is a time of accelerated change on a mass scale and the opportunity to do things better.
Humans are resilient and we are capable of adapting to adversity. Building resilience is like strengthening a muscle; it requires time and dedication. Developing resilience is a process of strengthening connection, learning to cope with stress, adjusting your thought process, fostering physical wellness. As we open up and come out of quarantine, we are going to need to care for the vulnerabilities in our communities and the people who have suffered tremendously during this time. Try to be compassionate and remember the way you’ve dealt with the last several weeks isn’t necessarily how your partner, children, neighbors, or strangers have dealt with it. It is okay to feel fear, guilt, and anger. It is not okay to take those feelings out on other people.
Resources:
National Suicide Prevention Lifeline: If you’re feeling suicidal, please call
1-800-273-TALK (8255)
Toll-Free (español): 1-888-628-9454
TTY: 1-800-799-4TTY (4889)
NAMI - Text NAMI to 741-741 to connect with a trained crisis counselor to receive free, 24/7 crisis support via text message
National Domestic Violence Hotline –Isolated at home in an abusive situation and need help? Call 800-799-SAFE (7233)
National Sexual Assault Hotline – Call 800-656-HOPE (4673) or chat by visiting: https://hotline.rainn.org/online
How to help your children while sheltering-in-place
What tips do you have for parents to help manage their children's stress in light of the coronavirus?
Signs of stress in children and teens include psychosomatic complaints (headaches, stomachaches, muscle aches), sleep disturbance (difficulty falling or staying asleep), nightmares or night terrors, irritability, regressed behavior (including bedwetting), acting out (teens), anger (teens), avoiding schoolwork, excessive worry or sadness, aggressive behavior, use of alcohol, tobacco, or other drugs (teens), and changes in eating habits. Reaching out to your pediatrician or to a mental health therapist is important if your child is experiencing intense symptoms related to stress.
Parents can support their children by managing their own anxiety, making time to laugh and play, making routines for family exercise, and trying to keep things upbeat. The good news is that the things kids need are the same things that adults need. If we can shift from feeling like we need to manage our children to learning to co-exist alongside our children, we will have a higher chance of caring for both our own needs and the needs of our children. This goes against a current parenting trend known as “helicopter parenting.” Of course, this is more challenging with younger children and in families where there is not another adult to help. This is not business as usual. Check your expectations to see if they are realistic and connect with other parents who empathize with the current situation.
For parents with children who have behavioral health needs, G.E.A.R. Parent Network is a great resource. Through parent-to-parent sharing of experiences and knowledge, G.E.A.R. Parent Network empowers parents of children with behavioral health needs to build on their family’s strengths and to advocate for their family’s needs. G.E.A.R. can be reached by phone at 1-800-264-9224
Living with Grief
Therapy can help with feelings of grief, conflict, and stress that arise in the midst of transitions. Living through transition and loss provides an opportunity to learn how to connect more deeply to ourselves and to the loved ones around us. Loss is part of life and we each experience many losses throughout our lifetime. For example: moving, retirement, death, loss of physical ability, children leaving home, changes in employment, marriage, and divorce. In my practice we take the time to tend to the loss.
People experiencing loss of a child, death of a family from sudden trauma or prolonged terminal illness can greatly benefit from working with a skilled therapist. I have worked with families, couples, and individuals in the midst of profound loss. This work has lead me to explore treatment modalities for complicated grief which I would be happy to discuss with you.
In the space surrounding loss there is an opportunity to strengthen our resilience. Feeling stuck in the raw grief, anger, despair is where most people are when they begin therapy. Together, with guidance, we journey along this path supporting you in taking time to process, to feel, and to heal.
Turning Toward Wonder
Written for and shared with the Camp Dudley community in Westport, New York on August 4, 2019.
Video: Katharine speaking at Camp Dudley’s chapel service.
Turning Towards Wonder
Good morning. What a pleasure it is to join you here at Camp Dudley - in this beautiful chapel among friends.
Earlier this summer, our family adopted a puppy.
Who here has a pet at home waiting to see them after camp? Some hands, I had a feeling a few of you would. Oh, those reunions are sweet.
We named our puppy Casco as in Casco Bay, which is the bay along the coast of Maine where my husband and I grew-up. Our Casco is a sweet boy- and all puppy. He is has a grey coat and grey puppy eyes. He wants to be around us all the time- right under foot. His favorite thing to chew on right now is a piece of moose antler and his favorite stuffed toy is an owl - one of those ones with a squeaker in it.
I had forgotten how curious puppies are, but was soon reminded when I began to take him on walks. He ambles along, sniffing…until he hears or sees something and stops suddenly. In our neighborhood along Maple Street it is often birds squawking, a motorcycle driving past us, or the scurrying of a squirrel up a tree that gets his attention.
When this happen, he pauses, and he observes. His body becomes still- one paw slightly forward and his eyes and ears attentively turned toward whatever he has noticed.
This too is true of human babies. Think of a baby or a toddler in your life: maybe a younger sibling or a cousin or a family friend. Remember for a moment what these young children are like.
For me, one of the greatest gifts in becoming a mother was the opportunity to see the world anew through the eyes of my children. Eli and Jasper became my teachers, as I re-learned how to notice the subtle mystery of life that always surrounds us. Together we would walk most afternoons to pass the time. As my kids bent down to inspect the ants on the sidewalk, I too, noticed the ants. As they dragged their hands through a puddle, I too, slowed down to watch the swirling movement.
As our boys grew stronger and could cover more miles, our family discovered a favorite camping spot along Icicle Creek back in Washington State where we lived. I’ll never forget one camping trip, we wandered along the trails and down to the river bank. Ben, Eli, Jasper and I (without saying much) agreed upon which of the huge, flat rocks we would make our way down to. The river was so powerful in its force - crashing along the river bed- that it was not worth trying to talk over it. It was simply too hard to hear one another. So we sat silently- picking at the crooks between the rocks, touching the surfaces (smooth and course), but more or less just taking in the power and the beauty of that place.
Now, I don’t know how to explain scientifically what I felt, but as we climbed the bank and walked back along the wooded trails I felt like the very atoms of my body had been rearranged. I felt a calmness and settling within myself and as I looked at my kids and husband, I suspected they too had experienced some physical shift. Not to share too much, but we had all been a little grumpy when we started out on that walk and now, after having our atoms scrambled by the intensity of the water rushing past us, we seemed to float along the trail - open to the wonder of the beauty surrounding us in those woods. There was a sense of ease.
Perhaps some of you know what I am talking about. Maybe it wasn’t beside a raging river and probably not in Washington State for you, but perhaps:
—looking up at the Dudley dome - at all those stars
—feeling an arrow fly off your bow toward the target
—grasping the mainsheet while under sail in Lake Champlain
— or feeling clay ooze and shift between your fingers as you shape your pot on the wheel in Brodie…
Perhaps, you have experienced one of these moments.
These moments of noticing when everything else in your head and everything else around you, falls away- and you are transfixed by something out of the ordinary.
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In today’s gospel story, Moses is out minding his business, tending a flock of sheep. He stops short when he sees a bush in flames - not on fire, but brilliant with unconsuming flame. Moses decides toturn towards it- to see this great sight. The Lord responds with excitement, Moses, Moses. Here I am.
Now when Moses set out with the sheep that morning, he was not expecting this. He was working- he was in his routine. I’m sure he had worries, fears, and other thoughts that occupied him. But as he walked, he noticed the bush and he turned towards it much like my puppy Casco stops in his tracks to take another look.
Moses, stops in his tracks - he pauses, he makes the choice to turn toward the sight, and in doing so- in making that choice to notice - to see what is before him- he is given the gift of seeing something that becomes something out of the ordinary. A sight that holds within it mystery- and in the teachings of Christianity, Judaism, and Islam (of which this is a common story)…what Moses sees is later interpreted to be God, Yaweh, Allah.
Now Moses wasn’t the only person to walk past this bush. There were certainly other people out walking along the hillside. But the reason we retell this story of Moses is because of his reaction- his response. Where others walked by, barely glancing up, too consumed in their own routine or thoughts, Moses interrupts his thoughts and notices the sight before him. This ability to see what is around us (for Moses the bush), and the willingness to turn toward the mystery of life (again for Moses, God saying “here I am”) is what I am here to talk about with you this morning. It is a story of turning toward wonder.
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I am by training a clinical therapist - kind of like a guidance counselor- and in my practice work with people of all ages. Twice a week I spend the day in our local school. I work with kids who are anxious, sad, or angry. I help them develop strategies to get through the day and to compete their tasks. I have learned from these kids that there are so many pressures - pressure to do well in school - making the honor role, keeping up with friends on social media, having the right clothes or phone, making the best teams, being the best musician, it goes on and on. And at home, being part of a family has its challenges: getting along with siblings, living up to your parents’ expectations, working through the moments when someone is angry or sad- depressed or anxious. And some of you, as did I, deal with terminal illness, death, divorce, addiction and other deep pains. There is room for you here- I see you.
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Living the Dudley motto, “the other fellow first”, begins by seeing those around us. When we allow ourselves to see and to be seen we engage in the mystery of life. When we live “the other fellow first” we pause and turn toward one another and ourselves. Your time at Camp Dudley is an opportunity to pause and to notice what is around you. This is a supportive place that recognizes and honors the value in doing so. You have leaders and staff sharing their stories in vespers and during chapel talks. You have reflected and grown with your cabin mates. This summer you’ve had the opportunity to practice pausing – noticing- and flecting with your leaders. Pay attention, these tools will serve you.
And then when the summer is over, I hope you walk boldly back into your lives at home and at school present to what surrounds you and what is within you.
In those moments when you feel pressure, even from those who love you, — pause — and notice what is around you. Turn toward wonder, like Moses with the burning bush, like Casco the puppy with the scurrying squirrel.
Being mindful won’t make the pressures go away completely. Being mindful won’t take away sadness, fear or anger, but I believe it will give you some wiggle room. Just enough wiggle room in which you can connect to your breath and in doing so connect to your courage, your wisdom, and your spirit.
You have what it takes- wonder is already, always present- within you – and around you. Turn toward it.
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For Longing
by John O’Donohue
Blessed be the longing that brought you here
And quickens your soul with wonder.
May you have the courage to listen to the voice of desire
That disturbs you when you have settled for something safe.
May you have the wisdom to enter generously into your own unease
To discover the new direction your longing wants you to take.
May the forms of your belonging–in love, creativity, and friendship–
Be equal to the grandeur and the call of your soul.
May the one you long for- long for you.
May your dreams gradually reveal the destination of your desire.
May a secret Providence guide your thought and nurture your feeling.
May your mind inhabit your life with the sureness with which
your body inhabits the world.
May your heart never be haunted by ghost-structures of old damage.
May you come to accept your longing as divine urgency.
May you know the urgency with which God longs for you.
Walking while Talking
I began walking while talking with client as an opportunity to get some fresh air…need I say more? Over the course of my career, I have worked in wilderness therapy, alternative dispute resolution and education. Based on these experiences and the various settings in which I practice, I have observed the benefits of physical movement and time spent in the outdoors on overall well-being. Getting our blood and conversation flowing and being out in nature are all catalysts for feeling our best.
Health and well-being are the foundations of my personal life practice, and the focus of my ongoing growth and learning. I do not ask clients to engage in treatment modalities I do not practice myself. I continually collaborate with other professionals in the health and wellness communities around me.
The exploration of the mind-body connection and various healing modalities within both my personal and professional life have provided me with an in-depth understanding of the interplay between physical, emotional, mental and spiritual health and happiness.
The idea comes from somatic based therapeutic practices that recognize that we are creatures of movement. Our brains, circulatory, hormonal, and nervous systems rely on movement to function optimally. The idea of purposeful movement is as old as our human tendency to overthink things. The integration of our physical, emotional and spiritual experience is essential for cultivating resilience. A key part of the human experience is learning to cope with the adversity of imperfection, dis-ease, grief, and uncertainty. Exploring physical movement enables us to observe our mental state with greater clarity.
My practice is pretty fluid, and walking is one option for my clients on any given day. Sometimes there are benefits to making a cup of tea and sitting still. At other times, it is helpful to draw or write, which is best done in my office.
Research supports the use of exercise to reduce stress, improve sleep, and to support overall mood management. Movement supports our well-being by releasing endorphins leading to improved moods. Exercise is often part of self-care or self-soothing skills that I recommend to my clients. The opportunity to walk together helps to reinforce and integrate in-session and outside-of-session behavior.
Time spent outside is another incredible benefit of this practice. Exposure to the elements grounds us. The use of our senses reconnects us with our creativity and resiliency. Being surrounded by the rugged beauty of Maine provides us with ample opportunity to explore what is going on within us.
Some clients are more comfortable talking while walking side-by-side than they would be sitting in a chair across from me. While there is transformative power in being uncomfortable, as you might experience in a backwoods wilderness program, my practice maintains my client’s comfort. I invite my client to set the pace.
Walk-Talk therapy is a mindfulness practice that encourages steady breathing, relieves physical tension, and improves circulation. Mental benefits of this practice include improved brain health, stress reduction, and a decreased intensity of negative thought patterns. In all of these ways we see that therapy is enhanced when we are moving outside.
No, all sorts of people choose to walk and talk. Some clients work with me for a while before choosing to explore this option, while others seek me out specifically for this treatment modality.
Clients of all ages utilize this form of therapy. Teens and young adults dealing with ADHD or anxiety use physical movement to balance mental activity. They express increased insight and decreased feelings of restlessness. Parents of young children, with their child in a backpack or stroller, find an opportunity for self-care that otherwise seems improbable. Individuals dealing with trauma or depression benefit from the bilateral movement. Clients of all ages who live with insomnia and body-image issues are supported by this therapy.
Initial meetings with clients take place in my office to briefly complete intake paperwork and an assessment. Otherwise, I tend to write my notes after each session and I accept payment through a mobile app, so there is very little in my office on which I rely. That said, I have a beautiful space and I work alongside wonderful colleagues.
With regard to confidentiality, I discuss with my clients pausing conversation until we are out of earshot of other people. I find my strong sense of professional and ethical boundaries are central in helping my clients feel safe. This is the foundation of our work together.
I respond to the opportunities and challenges of each season as they arise. This aspect of my practice reflects the work I do in session with my clients to promote flexibility in response to change. This flexibility is a skill that promotes resilience. Walking on icy and snow-covered sidewalks can be a challenge during the winter months. However, there are options that make it more feasible. One opportunity is cross-country skiing. During some beautiful skis this winter I realized, with help from a friend, that incorporating winter movement into my practice is of interest to me. Winter is a particularly difficult time for my clients, and I see the need to be creative in how I adapt my practice to best support them. It is up to me as the practitioner to be creative and flexible enough in my practice to accommodate these options.
One of my favorite quotes by Pema Chödrön: “True compassion does not come from wanting to help out those less fortunate than ourselves, but from realizing our kinship with all beings.” Together we create compassionate communities and in turn support well-being for all.
Parenting Through Transition to Middle School
Why is the transition from elementary school to middle school tough for a lot of kids? Is it because they are all starting puberty, peer pressure, the change? A mix of everything?
Pre-adolescence is a time of immense physical, cognitive, social, and emotional development. This is potentially a wonderful phase full of blindly robust confidence, total adherence to all things peer-related, and sweet sensitivity. However, as a culture, we do not readily appreciate the perfectly imperfect experience of our tweens. In my practice with parents, we explore internalized messages of worth from their teen years that make it difficult to parent from a place of clear head and heart.
To this end, I recommend the work of Dan Seigel and his book entitled “Brainstorm.” He outlines a new conceptualization of adolescence that includes four aspects for healthy development, “emotional spark, social engagement, novelty-seeking, and creative exploration.” Seigel challenges adults to assess the presence or absence of these four qualities in our own lives and wonders if our life satisfaction influences our ability to parent our teens and tweens.
Video: Dan Seigel "Essence of Adolescence"
Physically, girls are beginning puberty at the early end of this timeframe (around 9-12) and boys following (around 11-13). You may notice your child becoming more aware of their body and perhaps self-conscious. Tweens need real answers to their questions about puberty and real information about their bodies. A great resource is a book entitled, “Will Puberty Last My Whole Life?” by Metzger and Lehman.
Cognitively kids are shifting from being completely self-absorbed to becoming aware of the world around them. What was once carefree existence becomes a cautious existence where they perceive everyone to be watching and judging them. Tweens are also expected to manage their learning in new ways in middle school, which is a stretch for most kids. They need to learn how to work with multiple teachers, assignments, and other educational responsibilities.
Socially and emotionally pre-adolescents are exploring their self-identity, gender roles, social cliques, and a growing desire for independence. Anxiety about the transition to a new, usually larger, school and growing student body are sources of anxiety for tweens as they enter middle school.
What are some signs parents can look for to make sure their child is or isn't adjusting well?
I encourage parents to look beyond the struggling grades, resisting of school, misbehavior or a bad attitude to see what their child may be experiencing. Teens and tweens I see in my practice are dealing with divorce, blended families, sports pressures, giftedness, bullying, identity formation, anxiety, and learning emotional intelligence. If you are concerned about your child, talk with their teachers, get to know the parents of their friends, ask them what’s difficult, and seek professional support from a therapist when you need help.
How can parents support their children if they are struggling?
Parents of young teens are figuring out how to stay connected to their kids despite apparent rejection. In my practice, I remind parents that their child’s assertion of self (i.e. actions and choices not in accordance with family values) is developmentally appropriate. Children need parental love, support, and trust as they explore who they are becoming in this world.
For our younger teens, this journey has begun. As kids enter middle school support and guidance is less about control and more about experiencing a modicum of success and failure in their decision making. Over the course of a few years, this experience better enables them to handle more complicated situations and choices as they are presented.
Keep your child close especially in these early years. Ask your child what they are interested in and follow their lead. Find ways to spend time together as a family by playing games, exploring local trails or beaches, learn new skills together such as horseback riding or archery, cook and eat meals together.
Listen by asking open-ended questions such as “Who did you work with today?” “What shows are you watching?” “What’s the most embarrassing thing I do?” “What was the funniest thing that happened today?” Remember this journey through adolescence is about self-discovery.
Trust your child has internalized the values you offered in those early years…being honest, caring, considerate etc. Be curious about how they see themselves and understand the world around them.
Model confidence by taking care of yourself and choosing to authentically relate to people and situations around you. Model feeling good about your body’s abilities, which promotes positive self-image and confidence. Your pre-teen wants to fit in and is looking for examples of how you do that.
Explore your interests and attend to the non-parent parts of yourself.
Don’t feel rejected remember it is developmentally appropriate for your child to turn away from you.