By Andrea Shcramm, MA, LPC
I’ve always been interested in why self-harm occurs when people are struggling with strong negative thoughts and emotions often associated with depression and anxiety. Self-harm can take the form of cutting by using sharp objects, burning or other self-injurious means of inflicting pain and harm. Self-harm is said to be a common practice for managing strong emotional and psychological pain with roughly 20 percent of females and 14 percent of males engaging in self-harming behavior. I’ve often wondered what the science says about self-harm. Here are some interesting facts about self-harm I think will help us understand and respond with compassion when someone we know is struggling with self-harming behavior.
Something interesting about our brain is that both emotional and physical pain are registered in the same area of the brain, the anterior insula, part of the cerebral cortex behind each ear, and the anterior cingulate cortex, a hook-shaped piece of brain tissue towards the front of the brain. People who self-harm because they are overwhelmed with emotional and psychological pain can experience a decrease in their emotional and psychological pain when the physical pain of self-harm goes down after a self-injury. People who self-harm learn that while their emotional pain may peak with self-injury, it recedes on the other side; a kind of washing away of the emotional and psychological pain when the physical pain decreases after injury.
Here are two ways self-harm is reinforced in the brain. Engaging in self-harm can help us feel something when we’re emotionally numb. We are able to experience feelings and emotions through the pain of self-injury. Self-injury can take away painful feelings and emotions when the physical pain of self-injury recedes, and we feel the relief of our emotions going down as our pain goes down.
So how can we help? What do we say? What can we do? What if we have no idea why someone would self-harm themselves? There is a lot of helpful and easy to read information about self-harm online. Taking a little time to orient ourselves to the stories of others and some of the basic research on why people self-harm can help us feel more confident when approaching this behavior with someone we know and love. Express concern and compassion by telling the person you want to help in any way you can. Help the person find their way to counseling and find the right person to talk with about their feelings. We can make ourselves available to people who need to talk by just listening and letting them know we are there to hear them.
Here are two online resources available if we ourselves are uncomfortable engaging in conversation with someone who is self-harming. Maybe we just don’t know what to say or where to start. A good resource is NAMI, The National Alliance on Mental Illness. Crisis Text Line is a website that provides resources, information and texting for support. If you believe someone is seriously injuring themselves by self-harming, call 911.
NAMI The National Alliance on Mental Illness: https://namimissouri.org/
Self-Harm Crisis Text Line: https://www.crisistextline.org/topics/self-harm/
By Allie Lehr, MA, PLMFT
Just a few years ago, I was someone who would fight to the death that “I am not a racist.” Maybe you too have thought to yourself something along the lines of, “I don’t say racist words and I treat everyone the same, so I am not a racist ” or “wow this is a problem, but I can’t do anything about it.” Maybe someone has brought something up to you, and you got defensive and started “othering” (like this is a problem for someone else). If you feel called out right now, you, like most of us, might have some uncomfortable and necessary work to do.
To be honest, it wasn’t until halfway through graduate school that I got called out by a mentor I look up to and became aware of the throne of white privilege, I was sitting on. All of a sudden, it became clear that in order to be the clinician, and human, I wanted to be, I needed to acknowledge my privilege, confront my biases, and decide how I wanted to participate in systems built on oppression and racism.
Our work is far from over. In the mental health field, racial disparities within the system are well documented, especially around misdiagnosis. Black men are four times more likely than white men to be diagnosed with schizophrenia, but far less likely to be diagnosed with post-traumatic stress disorder and mood disorders. BIPOC are also over-represented in the criminal justice system and statistics show over 50% of those incarcerated have mental health concerns. This indicates that instead of receiving treatment for their mental health concerns, BIPOC often end up incarcerated as a result of their symptoms. We also know that mental health care provided in prisons is often offered at a lower standard of care and fails to acknowledge the traumatic conditions and practices in prisons.
Research also suggests that compared to people who are white, black indigenous and people of color (BIPOC) are: less likely to have access to quality mental health services, less likely to seek out services (up to 30%), less likely to receive needed care, more likely to receive poor quality of care, more likely to end services prematurely. In other words, BIPOC are not getting the mental health care they need and deserve.
Anti-racism work is uncomfortable, active and ongoing. It does not end because it isn’t being covered by the media, or you finished reading a book or listening to a podcast. If you have let your work fall to the wayside, I want to encourage you to pick it back up. If you are just now starting, welcome! Here are some of my favorite resources to get started on.
How to be an Anti-racist by Ibram X. Kendi
I’m Still Here: Black Dignity in a World Made for Whiteness by Austin Channing Brown
The New Jim Crow by Michelle Alexander
They Can’t Kill Us All: The Story of Black Lives Matter by Wesley Lowery
Just Mercy: by Bryan Stevenson
Me and White Supremacy by Layla Saad
So you Want to Talk about Race by Ijeoma Oluo
Websites and Articles
By: Ken Barrett, MSW, LCSW
I have thought painstakingly about how therapists can manage the Covid-19 Pandemic. First of all, during the course of the therapeutic hour it’s a safe assumption the topic of Covid-19 will come up in discussion. I think it’s ok to be open about how you experience Covid-19 in terms of your own challenges as a human being. The depth and breadth of your sharing is probably worth exploring. In the event you’ve had moderate to severely painful experiences with Covid-19 as it relates to family and friends this is pause for thought. I think sharing generalizations about your experience with Covid-19 is warranted in therapy with your clients. On the other hand, if the experiences you’ve had with Covid-19 are emotionally charged you may need to modify to a great extent how much you share with clients. Lastly, when sharing with clients who are highly anxious and prone to panic it’s a good idea to limit sharing in general unless they are really doing well in managing their symptoms.
Countertransference is a concept I want to briefly touch on in this blog. The concept I speak of is when you become emotionally entangled with your clients. I believe as therapists we will invariably suppress our own pain some of the time in order to make a clear mental path for our client’s therapeutic process. If you are having an excess of countertransference in sessions about Covid-19 it would be good to process this with your supervisor in order to reach clarity about it. We are not machines, and it’s essential we reach out for help when feeling flooded, burned out and under unusually high stress.
The last part I want to share revolves around working as much as possible to gain a sense of taking control of your life. Obviously, monetary gain, satisfaction of helping people and reinforcing job security have direct benefit to a therapist. Beware of burying yourself in work to avoid or not cope with your own life. We get one life to live and balance is of the utmost importance as a therapist. Take time out to do things you like such as exercise, reading, extra rest and quality time with your friends, partner and children.
By Jennifer Eulberg MA, LPC
Courage is most often represented in actions taken rather than those not taken. There are many important examples of courage from first responders and soldiers for example. While those examples and others like it are true, there are plenty of “quiet” acts that describe courage as well.
For some in our society it takes bravery to just live their lives, to make it through. For some it takes strength and bravery to live, to say no to suicidal thoughts, to say no to indignities, to say no to those with more power. Courage is found in the child that doesn’t succumb to peer pressure but follows his/her/their own path.
Acts of courage aren’t always “pretty” or successful in looking “good”. It can also look quiet, peaceful, it can fail to achieve its goal. Courage can look tearful, embarrassing, difficult, ugly, and hard. There might not be cheering, applause, or gratitude. Courage doesn’t always look decisive, strong, and big. It is also in the unsure, the timid, and the small spaces.
Remember, too, courage doesn’t have to be a solo activity. Asking for help is also brave. Our strength can grow as we inspire others and they inspire us in return. Perhaps this can serve as a reminder to yourself of all the acts of courage you have taken in your life.
At one time it was an act of courage for me to volunteer to write this blog. Today, I am embracing courage in a different way as I pass the baton to someone else. I’m so happy I have been able to contribute to Sandhill in this way and hopefully to my readers. Thank you to everyone who has read, shared, and liked. A closing “cheers” to recognizing all types of courage. I hope you find yours.
By Jennifer Eulberg, MA, LPC
I believe in you—and here’s why:
I’ve spent many years of my life not believing in myself. While it could be argued that I looked great “on paper”, I experienced my life through lenses of trauma, doubt, depression, and anxiety. I did everything I could to set myself for “one day” but not believing much that “one day” would happen. I felt summed up by friends who noted, “You’re good at school!” but didn’t really categorize me as “intelligent”. It became another self-deprecating joke I encouraged about myself. I took it on and labelled myself as a “school robot—beep boop beep”. I sacrificed many things to “make sure” I would have a decent future, but I was barely living the right now. I look back on my life and see large, sweeping periods of not much. I certainly FELT those years. I used to consider so much of this as a waste of time. However, I see now how much I learned and grew—becoming who I am now.
I don’t know that I ever really did too much of that on purpose, though. I have always tended to be more of a reflector on what has already occurred, working to adapt a way to live with the past. I absolutely went to therapy, many times. Each time helped in different ways. Again, DURING those times I felt and thought myself an absolute mess. I often couldn’t see how what counselors told me could possibly be done. I saw barrier after barrier. I still often look at self-help books cynically. Usually written by someone that has conclusions to a struggle, I wonder how someone in the struggle sees anything but what I did—something so far from where I am/was to give it much credence.
My life, including my own therapy experiences, has greatly influenced what I do with clients. As counselors, we strive to meet the client where they are—not where they can get. I see this as one of the most powerful tools in a therapist’s toolbox. I’ve seen the impact this has on my ability to help people.
From that starting place, wherever that is, I have seen people’s ability to growth and make positive changes. On reflection, I never made it anywhere without first grappling with where I was first. I struggled immensely with years of disbelief it could get better, then years of seeing how it might get better, but only to a point. Now I have had several years of it being better to the point I can actually have visions of something even better!
This is why I believe in you. I believe in people. I believe because I lived it and currently have the honor to see my client’s doing the work to get there too.
So, am I trying to convince you to believe in yourself? Actually, I’m not. I get that it might not be possible where you are. I had loads of people believing in me, but it didn’t matter until I got there myself. I’m hoping by sharing all of this and stating my belief in you, that you might make a step toward the many, many steps toward, maybe, if only, someday, you MIGHT believe in yourself too.
By Jennifer Eulberg, MA, LPC
With everything going on in our outside worlds, I thought this month’s focus could be on connecting with one’s self. When I find things are overwhelming for myself or a client; I enlist some “go-to” concepts such as the following to help reconnect to “the authentic self”:
Resilience in Adolescence
By Mikah Solanies, MA, LPC
Resilience is defined as the process of adapting well in the face of adversity, trauma, tragedy, threats or significant sources of stress. The stressors can come from places such as family and relationship problems, serious health problems, or workplace and educational stressors. Just like building materials are tested for their ability to be strong and flexible, the resilience of a person is often judged by their ability to bounce back from a difficult situation.
The importance of resilience lies in its incredible ability to impact a person’s life. Low mental resilience can lead to irritability, social isolation, unhealthy dependence on others, difficulty sleeping, overreaction to daily stressors and increased crying or feelings of sadness. Low resilience can also lead to negative thought patterns that erode away at self-esteem and hope. Helping Teens recognize what are called “Cognitive Distortions” in their thinking can prepare them to combat them and include “All or Nothing Thinking”, “Catastrophizing” and “Jumping to Conclusions”.
Cognitive Distortions are simply ways that the mind convinces us of something that isn't really true. These inaccurate thoughts are usually used to reinforce negative thinking or emotions. The Cognitive Distortions sound rational and accurate, but really only serve to keep them feeling bad about themselves.
Parents can help eliminate the Cognitive Distortions by using their names and then encouraging the Teen to identify them whenever they are heard. Parents can also assist their Teens by encouraging the objective evaluation of an emotion or thought against real life. Parents can help the teen remember times that they overcame difficult situations so that the teen can feel an increased sense of confidence for future tasks.
Low mental resilience requires coaching to redirect negative thought patterns into purpose and productivity. Once small goals are achieved, some of the negative thinking will subside. Hope in their ability to achieve the life that they design begins to appear.
Spend some time with your Teen discussing their perceptions of the following quotes about making life choices:
“May your choices reflect your hopes, not your fears” - Nelson Mandela
“When you have a choice and don’t make it, that in itself is a choice” - William James
By Jennifer Eulberg, MA, LPC
For this once again planned pre-pandemic blog topic, I would like to start with a “Thank You”. I’m thankful for my clients and all of those individuals willing to take a look inside themselves and work toward better understanding of themselves, others, and the world around us. Engaging in therapy is not easy. It certainly isn’t a weakness! Doing the work of internal investigation, confronting traumas, challenging brain patterns, and sharing your most personal thoughts takes incredible strength. I thank my clients for the honor and trust of being a part of their journeys.
To this end, I would like to go a different way than I perhaps normally would with “explore”. While it is often the realm of my work to help clients explore their inner worlds as well as their closest relationships, I have to admit many of us are a bit sick of that concentrated, and lately unrelenting, journey. The possible explorations outward and into the community is a place of mixed messages, mixed opinions, and frankly, mixed levels of restrictions. So then, where to explore?
This question led to my immense gratitude of those who share their stories with me and the world. While this sharing is built into my work as a therapist, it is an available and abundant resource for all of us. Whether you have a large network of friends and/or family or not, we all have unprecedented access to stories of others. Available access points to such journeys can be found in (but not limited to) the following: podcasts, vlogs, blogs, posts, and good old-fashioned memoirs and biographies.
Right now, it’s easy to get lost in the isolation. What month, day, time is it? It’s difficult to navigate our options going out: which stores, counties, states are “open”? Do I feel safe going out?
To me, it is a wonderful feeling of connectedness to our larger humanity to explore the worlds of others. If you happen to feel stir crazy with the staying in and/or if you are unsettled regarding where, when, and how to go out, I encourage you to explore the ways you can connect with others through hearing, reading, listening, or watching their stories.
May is Mental Health Awareness Month! If you, or someone you know, are struggling, please reach out. Tell someone YOUR story. Please know mental health therapists everywhere are here to help! If you are interested in speaking to someone at Sandhill Counseling, please reach out to our intake coordinator at 636-379-1779.
How to Remain Connected to Loved Ones
Living in a Long-Term Care Facility
By Geoffrey Schaefer, MSW, LCSW
During this COVID-19 pandemic, many loved ones are currently isolated from their families. With stay at home orders and social distancing guidelines, most of us are feeling, bored, isolated and disconnected. But for those elderly who reside in Long-Term Care (LTC) Facilities, they are really feeling the pinch of isolation and loneliness.
Here are a few my thoughts on breaking down the barriers of social isolation in LTC facilities:
During COVID-19 pandemic, we all can be creative with how we can be social. For those living in an LTC, socialization is an important part of their well-being. We all in our community must help each other during this unprecedented time. Through helping and caring for each other, we will get through this!
I will finish with this thought:
“At times our own light goes out and is rekindled by a spark from another person. Each of us has cause to think, with deep gratitude, of those who have lighted the flame within us.”
— Albert Schweitzer
By Jennifer Eulberg, MA, LPC
One of my colleagues sent this meme my way recently. I’m sure it’s familiar to many.
As I have contemplated this blog topic of “enough” (planned pre-pandemic), I have struggled with the certainty that nothing I can write in a few short paragraphs could ever be enough to address what we are all experiencing. Instead, I’m going to share my own sense of vulnerability and what I’m doing with it.
Frankly, I’m unsure. I’m back and forth. I feel just fine for a while and then sadness strikes. I’m providing support for others while experiencing self-doubt. Guilt comes in. I’m really tired. My thoughts and actions are unorganized. I’m eating so many carbs and chocolate, definitely chocolate. I move from being inspired to thoughts of “why bother?” I want nothing to do with news and then I go down the rabbit hole.
I also find myself laughing. Sometimes because it all starts to feel ridiculous, sometimes because it seems like a way to keep sadness at bay, and sometimes because I’m enjoying myself. That’s okay, right? If I’ve given you the impression I’m a typical human being – imperfect, confused, struggling, coping, and living – I’m glad. Leaning in to my human-ness is basically my “brand”. It’s the thing I’ve realized might be my biggest strength personally and professionally. I truly believe in authentic selves and connection through (appropriate) vulnerability.
I don’t think I’ve ever felt so in tune with the kind of counseling I do. I am simultaneously living the experience and feeling the feelings my clients are. I’m also giving myself the same encouragement and support. First—always first—is validation. I encourage you to validate your emotions. Realize there isn’t a right or wrong way to feel. Scared, worried, frustrated, sad, anxious, grieving, they are all valid. I feel those feelings and more, but then I take another step. I remind myself how many difficult situations I’ve survived. I remember what helped me get through. I think of the gratitude I have for my family, friends, and colleagues. I remind myself of times when I was sure I couldn’t possibly have all I needed, and yet, somehow, what I had BECAME enough. I stretched, and feared breaking, but instead I grew.
Don’t get me wrong, this thinking is on the best days at the best moments. It comes and goes, being broken up by those large quantities of chocolate, naps, mindless television, and frankly, some whining and complaining. Today was a better day, less chocolate, more focus on what I can do and less on what I can’t. I wish you all the best in your endeavors, especially in your practice to validate yourself. Whatever you do, it is ENOUGH.
JENNIFER EULBERG, MA, LPC
Welcome Jennifer, our new blogger!
Jennifer is a counselor at Sandhill who specializes in depression, self-esteem, and grief & loss. Get to know Jennifer as she shares her perspectives on life, contemplates value themes, and offers gentle encouragement.
THANK YOU to Stefanie Pisarkiewicz, LPC for her blog contributions from November 2014 - February 2019!
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