O'Grady Psychology Associates

Psychotherapy, Marriage Counseling, Neuropsychological Assessment

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How to Be Sad

Psychotherapy for depression helps people accept that we can't force happiness.There’s a plethora of information about happiness.

My literature search on this subject yielded over 13,000 scholarly research articles and over one thousand books. Advice about how to be happy floods the internet daily with simplistic listicles and click-bait articles that make it all seem so easy.

But their advice, like telling a sad person to think about all the reasons they shouldn’t be sad, or a depressed person to just get up and exercise, doesn’t work. Thinking about the good things in life can sometimes ameliorate sad feelings, but usually, trying to grasp at happiness when in the grip of a depressed mood leads to failure. And while the research on exercise’s positive effect on depression is robust and persuasive, depressed people lack the drive to work out: that’s what depression means.

These suggestions, though well-meant, amount to telling depressed persons to snap out of it—or it’s their fault. This shames the sufferer, making things worse. And the resulting family strife doesn’t help. Well-intentioned spouses and parents who believe that snapping out of it actually is within a depressed person’s power will eventually succumb to exasperation and resignation.

A recent New York Times article gives suggestions for eliminating negative thinking, and paraphrases  Rick Hanson, author of Hardwiring Happiness: The New Brain Science of Contentment, Calm, and Confidence: ” it might be helpful to ask yourself if you are accomplishing anything by dwelling on your negative thoughts.”

Depressed people have negative thoughts. Understandable. When we’re depressed, we’re likely to feel hopeless, inadequate, and a failure. While practicing controlled breathing and mindfulness even with your eyes open, as the article suggests, will help, how do we get to the point of making these actions regular parts of daily life? When sadness overwhelms, it is often impossible to follow well-meaning suggestions with regularity. Like New Years’ resolutions, these techniques fade quickly.

When Sadness is Normal

Sometimes sadness is normal. Experiencing a range of feelings in reaction to painful life events is understandable; these life stressors would make most of us depressed. When psychologists see a client for a first appointment, we assess mood, its duration, and the severity of distress. Is the client’s symptoms within normal limits given the precipitant for entering therapy, e.g., a marital crisis, job loss, or death of a family member? We would say a client’s feelings are “within normal limits” when they come to therapy with sadness after losing a loved one.

In my own practice, a former client returned to treatment recently because his wife had just died. He spoke of his inability to shake the feelings of loss and sadness. It had only been four weeks, and he asked me if it is normal to feel depressed, and the question that inevitably follows: how long it will last? It’s okay to feel sad—but to someone grieving, the feelings can be so intense that time stands still. Four weeks can feel like four years.

It’s hard to feel deep emotional distress, of course. Indeed, because suffering is part of the human condition, we’ve devised a vast repertoire of ways to avoid experiencing our painful emotions and worrisome thoughts, including self-medicating by substance use, distraction by Facebook and other media outlets, and much more. Americans account for two-thirds of the global market for antidepressants, which also happen to be the most commonly prescribed drugs in the United States. These drugs can play a vital role in helping many people cope with chronic depression, but all too often these medications are over prescribed or prescribed without looking at inner sources of depression.

When Positive Thinking and Life Coaching Make it Worse

Or, life coaches with little training in mood disorders are prescribing positive thinking the way many physicians prescribe mood stabilizers, but even positive thinking strategies are ways to avoid painful feelings. I have seen the disastrous results of life coaches who work remotely from home, charging enormous amounts of money to people desperate for help. Sadly, these coaches have not laid eyes on the people they propose to help. They are unable to see the dangerous weight loss or weight gain or pick up the nuanced suicidal non-verbal communications.

One client I saw judged himself to be a failure after his six-month life-coaching sessions because he was unable to feel better or do the things the coach was suggesting. When I saw him after his failed coaching experience, he was in a deep depression, his sadness palpable. I asked if he was suicidal and he admitted that he was—something his coach had never asked about. Alerting his partner and suggesting hospitalization was imperative. Alarmingly, he had already seen three different psychiatrists and obtained antidepressants from each, and not one of them had inquired about suicidality.

Another example from my practice is that of a woman who saw a life coach because she hated her job. They talked about the need to follow her bliss and sever ties with her employer. She took this advice, quit her job, and when her unemployment ended, she was unable to find another job. Despondent, she came to therapy to help sort out her feelings about her life and to find a way to understand why she was unhappy at her former job. She needed to understand her role in how she was sabotaging herself. She took the long road to what ultimately brought her fullness and acceptance of life and work.

Accepting Suffering as Unavoidable

Suffering can’t be avoided. (In Buddhism, it’s the first Noble Truth.) But allowing ourselves to express sadness and to accept deep pain will eventually allow these feelings to dissipate; blocking emotions only deepens problems. Also, giving ourselves time to settle into feeling allows us to recognize that they ebb and flow. Through this, we can accept that while old age and death are inevitable, and feeling sad is part of living, suffering is impermanent. By being able to sit with emotions and not get caught up in either rumination or anxious fretting, we develop a steadiness of mind. Meditation works by settling our turbulent thoughts and emotions so that we can titrate them into tolerable moments.

What works

When sadness becomes major depression, positive thinking (and related approaches, such as life coaching) are like putting a Band-Aid on a gushing wound. Facing our pain, learning to bear our suffering, and then doing the deep inner work of understanding our role in our troubles is a way out. It is often slow and filled with obstacles. Here are some steps in the process:

  1. Become aware of subtle emotions as you experience them. By becoming aware of emotions as you feel them, rather than pushing them away, you will be better able to use them to employ coping strategies.

 

  1. When emotions become intense, know that feelings don’t stay that way forever. All emotions are transient. Practices such as regular meditation help us not just to become aware of feeling but also not to indulge them.

 

  1. Remember that subtle change is hard to see. A broken bone mends slowly; in the early stages, healing is hardly noticeable on an X-ray.

 

  1. Look deeply at ourselves and the role we play in our mood. Doing so opens what is within, leading to understanding and insight.

 

  1. Take into account what precipitates depression. Learning to tolerate understandable sadness and some depression helps normalize what we are experiencing. All emotions have a role to play in living well; we must accept and not disown our most difficult feelings.

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Psychologists Need Self-Care Too

Self-care and ethics for psychologistsWho Helps the Helper?

Self-care and Professional Ethics

Most psychologists get into this profession because we get deep satisfaction from helping people. But who helps the helpers?

What about us, anyway? We sit for hour after hour, year after year, listening to our patients’ troubles. We help them make sense of what brings them to our office. We help them deepen their understanding of themselves, working with them to bring meaning and healing. But as psychologists, our training is not very conducive to our taking care of ourselves. The doctorate alone requires years of study, often at great expense, to say nothing of the 3,000 hours of unpaid or poorly pay internships, post-docs, and fellowships. It doesn’t end there; paying back debt and building a practice all take a toll on our self-care.

And of course, while dealing with these stresses, we must be effective and ethical therapists, even when clients may be testing our limits, perplexing us, or causing us worry.

A therapist’s most valuable tool is the therapist’s own self. We need to model a healthy self to our patients, and this is where self-care comes in. In fact, self-care is an ethical obligation to maintain our competence as psychologists. Caring for ourselves as well as others is an inherently integrated and reciprocal process. When we “more readily realize the false demarcations between ourselves and our clients, self-care becomes both an ethical imperative, and a humanistic one.”

So as a therapist, don’t forget to ask “What about me?” Issues that can challenge self-care include:

  • Balancing our own and clients’ needs
  • Countertransference reactions such as envy or erotic feelings
  • Confidentiality

For example, let’s take envy, a problem that can loom large in this time of widening income inequality or for any therapist working with wealthier patients. No one likes to admit to these feelings, but denial is never a good strategy.

And this can especially be a problem if we feel stalled in our own lives. We’re in the trenches; meanwhile, we’re helping others live fuller lives. They write books, get fit, flourish. Good for them—but here we sit, with unfinished books, unexercised bodies, unexplored possibilities.

Here’s an example from practice.  I had a patient with a lucrative professional job who came to me for anxiety. His wife was leading one of my dream lives, an unlived life: owning, showing, and riding horses.  I thought “Damn, she is lucky.” I felt impatient with his problems and had to stop myself from telling him his wife should get a job. Because we have lots of training in recognizing when our reactions are countertransference, I was able to see my envy at the moment so as not to let it interfere with my client’s process.

Or again, I authorized a patient’s disability leave. He got four months of paid time off, lost 20 pounds, got a personal trainer, went on a luxurious retreat, and returned looking 15 years younger. Good for him again, but I was seeing 30 patients a week and couldn’t help contrasting my responsibilities with his fortune. For those of us in private practice, taking time off is tricky. We lose income, and our clients may have a hard time without the continuity of their therapy.

When our patients improve and surpass us, how do we deal with that? That’s our goal, after all, to help them attain full lives and be the best selves they can. It’s not their fault we haven’t achieved the same goals. We must move forward in our own lives if we’re going to maintain ethical principles and standards.

Another challenge can be secrecy. Keeping patients’ secrets is an ethical imperative, but not always easy. A very famous person came to me for something highly scandalous, something I was dying to tell—but even married to a psychologist, I could only mention broad strokes, no name, and no juicy details. It’d be a great story to tell at parties, but I have to keep all such secrets locked in a vault. It’s a peculiar situation to know more about the inner world of a very famous person than anyone else and not be able to tell a soul, but as an ethical psychologist, I can’t.

Heal Thyself, Know Thyself

The arduous, never-ending self-scrutiny and inner work required by our profession is like no other. Gaining deep intimacy with our clients requires us to be just as deeply familiar with our own feelings. As therapists, we’re already familiar with the value of therapeutic lifestyle changes in areas like exercise, nutrition, rest and relaxation, maintaining good relationships, and service to others. We recommend these to our clients, so we should also practice them ourselves, along with helpful interventions like apps to help monitor diet, movement, and sleep. To that list, we should add personal therapy and development for ourselves, not just clients.

This is because our work depends on the personal/professional therapeutic bond. In turn, this largely reflects and depends on the therapist’s interpersonal skills and capacities, which must be developed in the therapist’s personal growth. The link between ethics and self-care is professional competence, which is necessary to protect our patients. Clients’ experiences of the therapeutic relationship—the respective interpersonal capacities of the client and therapist—are among the strongest predictors of outcome in psychotherapy. Those of us who are reluctant to practice self-care techniques should remember that we are decreasing our competence as therapists.

More information on these principles can be found in the American Psychological Association’s “Ethical Principles of Psychologists and Code of Conduct.”

Taking care of ourselves

When we say we’re not taking care of ourselves, what does that mean? Examples include overbooking or double-booking clients and working late; taking no breaks; being distracted, impatient, or bored; giving clients the same exercise as last week; talking about your problems instead of the client’s; or falling asleep. As you can see, these actions affect clients as well as ourselves. If we’re not getting our needs met, we may look to our clients to meet them, a violation of their boundaries.

Occupational hazards

In our jobs, occupational hazards include isolation, demands on body and psyche, frustration, and never-ending self-scrutiny. Burnout, compassion fatigue, secondary traumatic stress, suicidal patients or our own suicidal feelings, depression, anxiety, boredom, conflicts with co-workers, practice logistics, insurance company hassle, money problems, personal losses—these can all add to professional stress. To cope, we need inner strength, self-soothing skills, and awareness of our own strengths and vulnerabilities.

Even when we’re well aware of the damages we’ve suffered, we can fall into the mistake of projecting all such woundedness onto patients, and claiming the role of healer—and healed—for ourselves. Self-knowledge helps prevent this trap. It’s also important to seek peer support through professional groups and other networks, social support from friends, and develop coping methods like cultivating humor and a positive attitude.

Occupational Privileges

 As psychologists, we live a life of service. We are always growing and our work protects us from stagnation. As Irvin Yalom states in his book The Gift of Therapy, we daily transcend our personal wishes and turn our gaze toward the needs and growth of the other. We take pleasure in the growth of our patients and also in the ripple effect–the salutary influence our patients have upon those whom they though in life.   Viewed the right way, the very stresses of our job help prevent stagnation. Continual growth and self-examination help us to see the world, ourselves, and our patients for what they are, making us better able to help—which is what brought us into this field in the first place.

The result of my exploration on this topic is that I am taking a sabbatical during the month of January. I plan to write, read, and spend more time deepening my self-care.

References

In pursuit of wellness: The self-care imperative. Barnett, J. E., Baker, E. K., Elman, N. S., & Schoener, G. R. (2007). Professional Psychology: Research and Practice, 38(6), 603–612. http://doi.org/10.1037/0735-7028.38.6.603

What Therapists Don’t Talk About and Why: Understanding taboos that hurt us and our clients.  Kenneth S. Pope, PhD, Janet L. Sonne, PhD, and Beverly Greene, PhD Second Edition, APA Books, second edition, 2006.

Ethics, self-care and well-being for psychologists:  Reenvisioning the stress-distress continuum. Wise, E. H., Hersh, M. A., & Gibson, C. M. (2012). Professional Psychology: Research and Practice, 43(5), 487–494. http://doi.org/10.1037/a0029446

Ethical principles of psychologists and code of conduct. The American Psychologist, 57(12), 1060–1073. http://doi.org/10.1037/0003-066X.57.12.1060

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Implacable Grandeur: Mindfulness and Change

Learning to appreciate what you have.

If there is a sin against life, it consists perhaps not so much in despairing of life as in hoping for another life and in eluding the implacable grandeur of this life.                 Albert Camus

Much of the human experience is determined by chance—factors completely outside our control.

My father, who died of prostate cancer at the age of fifty-six, had two copies of the BRCA2 gene, one healthy and one defective. The defective BRCA2 gene greatly increases the chances of developing hereditary breast, ovarian, or prostate cancer (HBOC). My brother and I each had a 50/50 chance of getting that mutated gene. As it turns out, my brother got the broken gene, and I got the healthy one.  I was lucky; I don’t have to face that increased cancer risk, and neither do my two daughters. But my brother is now fighting HBOC prostate cancer.

Surgery and treatments will hopefully keep the cancer from spreading beyond where it has already taken up residence in his body. My brother and I talked for a long time after we got the genetic news. I felt something akin to survivor guilt—why did I escape hereditary cancer while my brother was saddled with it?

Like many siblings, we had been competitive in our younger years; I worried that he would feel envy, but in fact, he congratulated me. My brother was genuinely happy for me. For anyone in that position, being able to feel glad for another in the face of your own difficult outcome takes maturity, wisdom, and a generous spirit.

Finding out that I do not carry the genetic alteration BRCA2 was a great relief. I’d had such an outpouring of kind thoughts from so many people while waiting for the results that I almost feel guilty for not having the mutation. I had this crazy thought that those who expressed love and support would think “Why was she such a drama queen bothering us with this when she only had a 50% chance?”

Some might wonder why I chose to be so transparent, especially when psychotherapists normally aren’t self-disclosing. On further reflection, I believe that transparency facilitates integration. That means that you’re working toward a more unified sense of self, rather than compartmentalizing or walling off different facets of your personality.

I use my own personal experiences, as well as the insights from my work, as a foundation for growth and self-discovery leading to greater authenticity. As we get older, we learn that being authentic feels better. I’m glad that despite my self-doubt, I opened up about that threat. By doing so, and by being present to either outcome, I learned a lot.

What I learned is the stuff of aphorisms, platitudes, teaching stories, parables, and fairy tales from all faith traditions: How to appreciate your life before you see it vanish, how to find meaning in daily challenges, and beauty in the smallest things. My wish now is to savor my sense of gratitude and good fortune and relish my current good health.

I was lucky. But the truth is, no one gets to a certain point and then lives happily ever after. Most of life is a matter of contending with problems, hardships, and unexpected turn of events. Periods of placid security are the exception rather than the rule.

Life is change. It’s our nature to want to hold onto things, always grasping to make things safe and predictable. But the wisdom of the Buddha teaches us that we will never succeed: Because life is constant change, attachment causes suffering. The only way to achieve true peace is through accepting that life is dynamic, not static. As Epictetus wrote, “It is not events that disturb the minds of men, but the view they take of them.”

But this doesn’t require superhuman serenity. I believe that we all have an instinct for wholeness at the core of our being. One way of looking at this yearning is as an archetypal urge of the Self, an archaic memory that may have been present in the lives and generations before us.

Growing with difficulties and changes.The Next Blade of Grass

“As a caterpillar, having come to the end of one blade of grass, draws itself together and reaches out for the next, so the Self, having come to the end of one life and dispelled all ignorance, gathers in his faculties and reaches out from the old body to a new.”  [IV.4.3] (Easwaran, Eknath. The Upanishads. Nilgiri Press, iBooks, 2007.)

Like the caterpillar, we draw ourselves together when one phase of life ends and stretch to reach for our next landing place—a new way of being in life, despite the inevitable changes that chance throws in our path.

We all possess that ability to draw ourselves together, collecting what we have learned from our experiences (a difficult situation, an insight during mediation, inner work in psychotherapy) and stretching out for the next blade of grass, the next place of sustenance. In this way, we grow, progressing slowly and deliberately from one place to the next.

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Accepting Life’s Turbulence: Fasten Your Seatbelt

Life brings ups and downs and finding a way through the stormy turbulence takes courage and grace.
Thunder Cloud from 37,000 ft

This dramatic cumulonimbus was captured at 37,000 feet over the Rocky Mountains in Colorado. Pilots know to avoid going near these thunderclouds, charting a course around them for the comfort of passengers and safety of the aircraft. Even coming close will cause turbulence—the jet trembles and shakes, often violently.

Pilots rate turbulence as mild, medium, or severe. Thankfully, excellent communication between pilots means that patches of bumpy air can be predicted well ahead of time and avoided by changing elevation or course. But sometimes turbulence is unavoidable. In that situation, fearful flyers grip armrests, pop benzodiazepines, and turn up the volume on their headsets. Eventually the air smooths out, and everyone releases their breath…and their grips.

Staying Steady During Turbulent Times

Jet travel is a great metaphor for life. Sometimes the bumpy moments are so extreme that there’s nothing you can do but sit with it and hope you don’t have to pee. But sitting with the rocky ups and downs of life isn’t always easy.

When a pilot acquaintance asked me how to survive the turbulence of his current marriage problems, I asked him what he tells his passengers to do when the flight encounters a rough patch.

He said, “I tell them to fasten their seat belts.” We have all heard the familiar words, “The captain has turned on the seat belt sign. Please return to your seats and fasten your seatbelts.” Now, I confess I sometimes use this moment to zip down the now suddenly empty aisle to use the lavatory (but only in mild turbulence.)  But basically, in bad weather you need to stay seated and wait it out.

I enjoy flying, but that wasn’t always true. I was a fearful flyer for about six years. I wasn’t phobic, I didn’t avoid flying or have panic attacks, but I was alert to every squeal of the engine, movement of the wing flaps, or ring of a cabin bell,. During euphemistically described moments of “bumpy air,” I would glance up at the flight attendants’ faces to see if they were showing signs of concern.

I wasn’t afraid of heights or of being in an enclosed space—my fear was simply of crashing. Kaput, end of life, and the imagined 60 seconds of sheer terror I expected to feel going headlong into death.

We have no control over death. Once I came to terms with accepting that I could die in a plane crash, I became less afraid. It wasn’t that I was convinced by statistics showing how rare such deaths are; fearful flyers are rarely comforted by the statistics. Acceptance, in contrast, goes a long way in dealing with the bumps we encounter in life.

I found out this week that I have a 50/50 chance of having the genetic mutation associated with hereditary breast and ovarian cancer (HBOC). My family on both sides has had lots of cancer. But through advanced genetic testing, I now know that my family members have the BRCA2 mutation going back three generations. As I await the results of my blood test, I am again reminded of our lack of control. For me, it’s the toss of a coin: I either have it or I don’t. If I do, I have an 85% chance of developing breast cancer and lower risk of other cancers (ovarian, pancreatic, melanoma, and stomach). I am not comforted by those odds.

Flying has infinitely better odds. But after a week of emotional turbulence, I will meet my fate with HBOC with as much grace as I can muster. It hasn’t been an easy week, to be sure, veering between certainty of bad results and certainty of escape. So while I wait and hope that I end up on the happier side of the 50-50 split, I will fasten my seatbelt and try to steer as safe a course through the thunderstorm as I can, with all the support I’ve gathered over the years: family, friendship, work that I love, and resources (such as FORCE). Coping skills, like seat belts, keep us safe. While we generally don’t enjoy restraints, a seatbelt helps to contain our emotions so they are less likely to overwhelm.

I am reminded, once again, of a lesson taught by Thich Nhat Hanh: “When we have a toothache, we know that not having a toothache is a wonderful thing.” (Peace Is Every Step: The Path of Mindfulness in Everyday Life, 1992, p. 38). Finding comfort in the face of difficulty is possible—by riding out the painful moments and trusting that the next moment contains a potential fullness, some simple pleasure waiting to be noticed. So when the seatbelt sign is again turned off,  you are free to move about the cabin. Add take a deep breath.

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Psychotherapy: A Safe and Sheltered Space

Psychotherapy is a safe place to explore what is causing you pain and how to cope.One size does not fit all when it comes to finding a good therapist. Many variables influence the extent to which people get better, solve problems, and grow. While empirical support is important in choosing what treatment to provide, psychotherapists shouldn’t stick rigidly to what studies suggest; instead, they should work from the position of evidence-informed practice. This allows for treatments that respond to what clients bring to therapy—their unique histories, temperaments, and narratives. Sometimes what may be most helpful in the therapy is intangible and unmeasurable by any study. In research, these are referred to as non-specific effects. These are uncontrollable factors: the usually small, barely noticed interactions that create an unexpected effect in the subject. In other words, they are not a part of the research experiment.

In Irvin Yalom’s book Existential Psychotherapy, he describes how, during a cooking class, he wondered why the instructor’s meal always tasted better than any of the his attempts at the same recipe. He learned why after catching the teacher’s assistant throwing fistfuls of various spices in the dish before putting it in the oven. This story has stayed with me since reading it in the early years of graduate school. The crucial ingredients—the “throw-ins”— of good therapy may be unquantifiable, and untaught; even the therapist may be unaware of them.

In a previous post I wrote about love as part of the therapy. Love is a challenging factor to study because it is difficult to quantify and because love overlaps significantly with other emotional reactions such as respect, compassion and empathy, and curiosity.

What is the art of therapy? Sometimes it is as simple as being really present with clients during their pain. Being present means not interrupting, giving advice, or falling asleep, but instead staying tuned to a client’s process. As in meditation, a therapist who notices his or her mind wandering should first notice where it has gone (and if there is anything in that mental tangent that could provide meaning about the client’s situation) and second, return that attention to the client.

A safe and sheltered space

In ancient times a holy person who would descend into what was called an incubation chamber—a dark underground space—with someone in turmoil or grieving. They would remain together in the darkened underground space for three days. This practice illustrates how healing  comes through being present with feelings. When someone is suffering, the willingness to go into the dark with them as they express and move through their feelings is a large part of what we do as therapists. When suffering people can take what’s vague and private, locked inside their heads, and speak out loud the unspeakable, they can gain a depth of understanding and new self-compassion.

The popular 2015 Pixar film Inside Out shows how this works. Riley, the young protagonist must endure her family’s cross-country move, which takes her away from her friends, her home, and her beloved hockey team. Believing she must be perfectly mature, she suppresses her sadness. Five personified emotions–Joy, Sadness, Anger, Disgust, and Fear –live in her head and influence her actions and memories. The dominant voice is Joy, because being happy and not expressing our negative feelings is socially rewarded. But all emotions have a role to play in living well. When Riley tries to silence Sadness, she becomes numb to all feeling, including Joy, and pandemonium ensues. It’s only when Riley can fully acknowledge the sadness in her life that she can also remember the tender, loving moments. Therapy patients must similarly accept and not disown their most difficult feelings.

Good treatment isn’t always easily available. Many therapies lend themselves to apps and downloadable protocols, making these treatments more accessible for people who are unable to find (or afford) a good-fit therapist. Videoconferencing, mobile applications, g-chats, and web- or text-based therapy have a place, and can be powerful ways to change behavior and improve symptoms, especially for those who feel shy or stigmatized about talking to a therapist. But with something gained, sometimes something is also lost with techniques that avoid human interaction and relationship.

What’s missing are the powerful nonverbal communications that shed so much light on the intangibles of what might be contributing to a person’s issues. A blush, an eye-roll, a tear welling up; the fidgeting of someone with a secret, the nervous giggle or shy smile—these nuanced communications can speak in ways where texting is mute. Staying safely in front of a screen provides shelter, to be sure, but possibly also a place to hide.

To illustrate the importance of face-to-face therapy, there’s the example of my former client who returned to therapy after a seven-year break. He told me his physician kept increasing his antidepressant dosage, but he was getting worse, not better. After sitting with him for close to an hour, listening to the many stresses he described, I gently inquired about his subtle, yet noticeable twitching. His movements were suggestive of a genetic disorder and not merely anxious fidgeting. He immediately told me “My biological father [he was adopted at birth] was really strange before he died. He moved and twitched all the time—I haven’t thought about it in years but I know he had something wrong.”

At the conclusion of our session, he promised me that he would contact his cousin and find out the name of his father’s condition. I suspected it was Huntington’s disease, a rare genetic disorder. When he emailed me the confirmation, I was able to suggest genetic counseling and testing.

So what appeared to be depression and anxiety—and was being treated as such—was in fact a neurobiological condition. While the news was not good, he could be treated by the right physician for his condition and not keep taking medication that only made him feel worse.

The opportunity to look at your darkness with someone who respects you and your process can allow you to speak the unspeakable, giving room to the ineffable—those moments of awe that come only when we let the full range of who we are be seen and known.

Rumi stated it well in his mystical poem “A Garden Beyond Paradise”:

Everything you see has its roots in the unseen world.

The forms may change, yet the essence remains the same.

Every wonderful sight will vanish; every sweet word will fade,

But do not be disheartened,

The source they come from is eternal, growing,

Branching out, giving new life and new joy.

Why do you weep?

The source is within you

And this whole world is springing up from it.

 The joy of which he wrote cannot spring forth without awareness that it will also fade. Trust that the source of life is in sitting with and sharing the difficult parts of ourselves in a safe and sheltered space.