Veterans Mental Health
By Andrea Schramm, MA, LPC
​
I’ve been thinking about this month’s topic for our November blog as this month, the month of November, is when we honor and celebrate our Veterans who have given so much to all of us through their service to our country, many have given their lives both in and out of conflict. It’s a huge topic.
​
I am not a Veteran so my experience is uniquely civilian in scope. I am the wife of a prior Senior Master Sergeant and 25-year Veteran of the United States Navy and Air National Guard and the mom of a prior Sergeant in the United States Marine Corps. It is from these roles I have come to understand the significant and unique differences between our experience as civilians and those who have served in our military.
I remember when my son returned from serving in the Marine Corps and despite having been in constant contact with him, visiting him at Camp Pendleton may times and meeting his close buddies in the Corps, I realized I struggled to understand the unique experience he had while in the Marine Corps.

Each of us is unique in our experience and although may be common with those close to us, they are our own and this can feel isolating even amongst those we shared our experiences with. One thing I learned which I found helpful is the core purpose of those serving across our military branches is the goal of “Mission Ready.” Our service members train constantly and this is the single experience they have with each other outside of what is uniquely their own. Their training is constant in support of their ability to be ready to engage at any moment with their mission in our defense. It is also a mind set each and every service member internalizes. In order for our service members to do their unique job, they must be mission ready at all times. The United Nations offers this guide for Mission Readiness and Stress Management. I encourage you to take a look at the process of deployment for our service members whether in training missions or in combat missions.

https://www.un.org/Depts/OHRM/stress.htm

How can we support and understand the mental health needs of our service members and Veterans? I can offer a few experiences of my own having had to adapt to something I had no knowledge of myself.
We can be active participants in helping our Veterans stay in touch with those they have served with. Watching how incredibly important it has been to maintain contact with those they have served with within my own home, this is a significant investment in our Veterans mental health and well-being. If you know a Veteran, take the time to ask them about their buddies they have served with and encourage them to remain in touch. This is an incredibly significant support for our Veterans. Consider involvement with an organization such as Make the Connection that connects Veterans and families through their experiences.

 https://www.maketheconnection.net/family-friends/

We can ask to hear and listen to our Veterans stories. Not all Veterans want to share their experiences, however, we can still ask and tell them we want to know about their experience serving in our military. Tell them how important they are to you and how much you want to share in their experience. Talking about something can be very helpful for a person’s mental well-being and fosters the very important connection between those who have served and their families and the greater community in which they live. 

Listening to Understand
By Allie Lehr, MA, PLMFT
​
​Have you ever been in a “discussion” with someone (a partner, a parent, a sibling or friend) where you feel like you are both talking and listening, yet you are still going around in circles? You are both actively trying to listen and share your perspective, but you are both left feeling unheard and frustrated. As humans, we all want to feel seen and heard.
 
Whether I am working with couples, families, or friends, this is one of the most common communication patterns I see.  The reason this pattern is so frustrating is because both parties are listening, but they are listening to defend their point, rather than listening to hear and understand the other person. Listening to understand the other person’s point can feel really scary because we believe if we don’t share our point right away, it won’t be heard. The irony is, when we feel heard and validated, we are much more open to hearing the other side than when we are shut down.
 
Below is an example of *discussion* my fiancé and I frequently have and two ways it has gone:
 
Listening to Defend:
Zach: I told you the dishwasher was clean 2 days ago. Why haven’t you unloaded it?
Allie: Gosh why are you always nagging me? I’ve been really busy with work an haven’t had two second to myself. I don’t understand why you can’t just do it if it bugs you so much.
Zach: Are you kidding me? I do so much in this house. You don’t appreciate me. I asked you to do one thing,
Allie: I do a lot too. You never notice anything I do. You just criticize me.
Insert the rest of a fight here.
 
Listening to Hear:
Zach: Can you please unload the dishwasher? I told you it was clean 2 days ago and it’s really frustrating that it hasn’t been done.
Allie: I am sorry it’s been frustrating. I have been really overwhelmed with work and keep forgetting.
Zach: You have definitely been busy and it makes sense that you’ve been forgetting. What can I do to help remind you when you are busy so that I don’t feel frustrated and you don’t feel nagged.
Allie: Let’s get a magnet that tells me if it’s clean or dirty to help me keep track. I will work on getting it done within a day. Does that work?
Zach: Thanks for making the effort. I think I can live with that.
 
In the second example, we are working together to come to a conclusion and hear why the other person is frustrated. When I felt validated in how hard I was working, it was easier to understand his frustration. When he felt validated, in his frustration he was able to have empathy for me.  We both still got our points across, but were able to do it in a much kinder way.
 
Next time you feel yourself going around in circles, ask yourself if you are listening to defend. If you are, try to repeat back what they said and validate before you share your perspective. Who knows, maybe you will both get to feel heard.

Suicide Prevention Month: How to have a conversation and keep yourself or someone else safe. #BEThe1to
By Andrea Schramm, MA, LPC

September is National Suicide Prevention month. Here is some information on how to recognize and support yourself or someone else if you or someone else may be thinking about or contemplating suicide. How do we know what another person is feeling? What might we hear in conversation or see in their behavior?

Feelings of hopelessness and an inability to see one’s self through a problem can distort a person’s view of their situation and lead to feeling there is no way out of what is troubling them. An increase in isolation and disengagement from normal activities of interest can also indicate a person is struggling with feeling worthless or hopeless. People will often think, “I can’t live with this anymore, I would be better off not here anymore, this is so painful” or “I am the cause of other’s problems, and they would be better off if I wasn’t here.” If you or someone you know is experiencing these thoughts, a safety plan can help support efforts to redirect suicidal thoughts. Safety plans include who you will reach out to when you feel suicidal, ways you can redirect your thoughts and change your view by engaging in activities and who your support people are when you feel hopeless or have suicidal thoughts. It is important to listen for and respond to thoughts and feelings of hopelessness, worthlessness and feeling trapped with no identifiable way out of what is troubling you or someone else.

How can we listen and recognize when someone close to us is have suicidal thoughts? Don’t be afraid to: ASK if you suspect someone might be considering suicide. Listen for those feelings of not being able to solve their problem, feeling hopeless, worthless, and stuck. People can experience feelings of relief when asked about their troubling thoughts.

BE THERE. Don’t engage in problem solving or minimize their problem and resist giving advice, listen without judgement, as this approach can increase hopefulness and decrease suicidal thoughts.
KEEP THEM SAFE. Reduce any lethal means such as firearms or medications as this can reduce suicide attempts.
HELP THEM STAY CONNECTED. Help them create a simple safety plan with people they can reach out to, places they can redirect their feelings in positive ways and things they can focus on to experience positive feelings and hopefulness.
FOLLOW UP with the person as this basic level of ongoing support can be an important part of suicide prevention.
LEARN MORE. Here is a link to the 5 action steps to helping someone who may be suicidal. https://www.bethe1to.com/bethe1to-steps-evidence/
​
Let’s all have a conversation about Suicide Prevention.

Transitioning Back to School
By Andrea Schramm, MA, LPC

Whether you are beginning school for the first time as a new kindergartner or heading off to a new role as an adult learner, going back to school is one big transition. Like all transitions, it’s change. Change from what was, summer vacation, life as it is, to new opportunities, change can feel uncomfortable or be downright hard to make. Change as a transition often involves some of the unknown. Will I know anyone in my class? Will I have anyone I like to sit with during lunch? Will my PE teacher be a nice person and understand I hate running? Will I be able to get to my own class on time after getting the kids off to school?
​
Change involves energy. Positive change like making a new friend who likes the same books as I do and read the same ones over the summer can create energy, fueling us to do more and increase our motivation to keep growing and expand on what we are doing. Having a negative experience with change can have the opposite affect and zap our energy like finding out we have nobody we know in our lunch hour. This experience with change can decrease our energy and our motivation.

Positive change through transition can feel awesome. How do we keep this going on the inside? Something like this way of thinking can help us stay motivated through change; how we think about something affects how we feel about it. Keeping our thoughts neutral to positive protects us from the energy zapping negative thoughts that make change and transitions difficult. Positive thoughts protect our energy and can increase our motivation resulting in more positive experiences.

What does this look like in practice? Here are some self-care ideas: taking a brief walk, taking a shower, reading a magazine or book for a few minutes. Engage in down time doing something we like: watching content we enjoy to decompress, talking with friends and family. Protecting what gets our attention (this is mindfulness): staying in the moment and not dwelling on the past or worrying about the future. Resist over committing and inviting stress and negative thoughts into your daily experiences.

What do we do when negative thoughts bring us down, change our feelings and make change difficult if not anxiety provoking? Make a list of your negative thoughts and an opposing positive thought to go along. Changing negative thoughts to neutral/positive thoughts is something we learn as our negative thoughts are often part of our brain’s job of protecting us and keeping us safe.

Have a plan for returning to school. Wear comfortable clothes you feel good in. Bring something to keep you hydrated, have a favorite “something” in your backpack or locker to keep you oriented emotionally and present. Learn to recognize negative emotional reactions and consider taking a few deep breathes when you feel them. Learn to practice good sleep/wake behaviors as you move through the transition and change of going back to school.

Most of all, try to have fun! Change is a constant part of our lives and something we will always go through as we grow and change ourselves. Learn to take deep breathes and tell yourself it will be okay when change seems hard to overcome. You can do it!

Planes, Trains, & Automobiles - Self-Care Tips for Travel during Covid-19
By Andrea Schramm, MA, LPC 

​During this Covid-19 pandemic one of the biggest changes in our life has been the ability to just pick up and go places. Whether you prefer a jet setting to faraway places or simply getting out and about in your own neighborhood or community, restrictions, mandates, and the need to protect each other and our own health and well-being has made travel unavailable, dangerous, or inconvenient.

Whether you have plans to hit the runway, ride the rails or simply explore your local community by car, bike or on foot, here are some basic tips to get you out and about.

Plan ahead:
If you haven’t flown recently, take a few minutes to familiarize yourself with your airline’s rules and regulations on mask wearing. This information is readily available on their website. Most airlines require masks worn during the entire flight upon boarding and after exiting the plane. Terminals and shuttles may also require masks to be worn for the duration of your travel or while in the terminal. This can result in having to wear a mask for an extended period of time across the duration of your trip. Amtrak also requires masks to be worn at all times while traveling by train. Plan your trip by car and consider using an app for trip planning such as TripIt to stay informed on the road. Depending on your local neighborhood and community, mask restrictions may be lower or not at all and outdoor spaces which allow for social distancing may be a great choice for traveling away from home.

Plan for waiting or restricted access to amenities:
Bring snacks and drinks to stay hydrated while traveling. Traveling by plane or train could be more stressful during the pandemic than in past times. Restaurants can have limited access or be closed all together. Wait times may be excessive.

Managing anxiety associated with travel:
Consider comfortable and familiar clothing you will feel relaxed wearing. Bring a favorite book, magazine, and snack food. Basically, bring the comforts of home along as best you can. Your favorite stuffy can share your boarding pass and provide emotional support and soothing. Take deep breathes when you feel anxious. Stay in touch with family and friends for support. Bring your favorite playlist to soothe your nerves during long waits, long periods of time wearing your mask, and the unknown of pandemic travel.

Plan to have fun where ever you go or however you get there! Travel can be fun, exciting and bring us to restful and regenerative places and experiences. Travel is beneficial to your mental health in a number of important ways. Getting away can help you relieve the stress of daily life and let you relax your mind and experience calm. Regular get-aways can have lasting positive benefits to your mental health for weeks after you have returned home. Vacations can improve your mental power by giving your brain a rest. We can increase our empathy when we go places we have never been before and have new and different experiences.

​So, feel better in a plane, on a train, or in the family car on the way to the park. With a bit of planning, travel is still a huge benefit even during a pandemic. Find your fit and pack your bags!

Pride Is A Verb
By Angela Summers, MA, LPC
 
A couple of weeks ago the rainbows started to pop, and it seemed like every commercial was trying to sell me something using actors portraying non-heterosexual couples. I scream for my wife to come look when LGBTQ+ people are depicted in commercials. We literally pause and rewind to watch them. So what is this feeling inside? What is this dead spot around the edge that turns to rage as I move in closer? Why does every slogan, every good intention, every product wrapped in a rainbow make my chest tighten, and my jaw clench?   
 
I practice this for a living- reminding others and myself to notice what is happening in our bodies, name the sensations and any emotional quality, ask the part if it has any information for us.  And still sometimes I walk around a couple of weeks being annoyed I feel a particular way when I “should” be feeling something else.  Anger is uncomfortable AND it often knows the way to the places that need our attention, the places that are hurting. 
 
Every LGBTQIA+ person we meet is carrying heartache from direct and collective experiences of harm inflicted when individuals, families, cultures, governments, religions, or other institutions invalidate, pathologize (looking at us mental health community), demonize, criminalize, shame, discriminate, torture, and murder based on LGBTQIA+ identity.  A rainbow band-aid does not make the bleeding stop. It is only through acknowledging how we, systems, and institutions are causing harm, immediately followed by corrective action that has any chance.  For those that are already lost through hate crimes and suicides, nothing brings them back.    
 
Pride was born out of the necessity of LGBTQIA+ people to protect their lives, create safe spaces, and secure basic human rights.  Pride is dismantling oppressive systems that have and continue to terrorize LGBTQIA+ people. Pride is seeking the liberation of all LGBTQIA+ people along with every oppressed and marginalized group of people because LGBTQIA+ people are also part of those groups (and it is just the right thing to do).  Pride is actively unearthing the ways in which LGBTQIA+ people and their history, struggles, and contributions were and continue to be erased.  Pride is asserting there is no wrong or right way to be non-heterosexual, trans, non-binary, or queer as these false narratives further oppression.  Pride is searching for any place you have internalized harmful messages about yourself or any member of the LGBTQIA+ community and choosing to do the work to be a safe person.  Pride is caring for ourselves because self-preservation is an act of political warfare, thank you, Audre Lorde. Pride is radical self-love, thank you, Sonya Renee Taylor, and a love for ALL those in the LGBTQIA+ community.  Pride is knowing none of this happens without BIPOC, especially Trans Women of Color, who despite being the most targeted because of the intersectionality of their identities, have and continue to show up in ways no one else can nor dares to.  Thank you. Thank you. Thank you.
 
When we are having all the feels, may we make time to be with them, listen deeply, and receive their offerings. When we are hurting, may our truest selves and community reconnect us to our inherent worthiness, our healing, our Pride. When we are celebrating, may we honor those who came before us, embody the radicalness of our joy, and fiercely fight to make it safe for all to come out.
 
Happy Pride

Resources for education & support:
https://www.stlmetrotrans.org/
https://www.growingamericanyouth.org/
https://www.pflagstl.org/who-we-are/
https://promoonline.org/about/sage-of-promo-fund/

Mental Health Awareness Month
By Andrea Schramm, MA, LPC

​The month of May is Mental Health Awareness Month and two of the most prominent organizations, Mental Health America and National Alliance on Mental Illness have wonderful tools for living with and sharing with each other the importance of our mental health.

This year Mental Health America is recognizing Mental Health Awareness Month with their “Tools 2 Thrive” downloadable toolkit which contains all kinds of wonderful tools for engaging organizationally, socially and individually with the importance of our mental health. Check out the Fast Facts and Tips for Success in this amazing toolkit! https://mhanational.org/mental-health-month-2021-toolkit-download.
​
National Alliance on Mental Illness has identified the month of May with the words “You Are Not Alone” and the opportunity for each of us to tell our own unique experience with mental health through video, picture or story. What a wonderful way for all of us to connect on the topic of our mental health and well-being! https://notalone.nami.org/

Remember we all come into this world with the best of intentions and do the best we know how. Our mental health is a fluid concept and mental illness is an experience many, if not all of us will have at some place across our life span. Treat each other and yourself with kindness and learn to accept yourself and others where we are. We are all on a journey through life and all our roads are different and unique to each of us. Practice keeping curiosity in your mind for times when your own thoughts and feelings and the actions of others are challenging. Consider exploring the tools provided above as an investment of your time and attention on the subject of your mental health and the mental health of those you know and love. If you think you need support for your mental health, reach out to your primary care physician, counseling services or a trusted friend or family member for support. If you are experiencing suicidal ideations or feeling worthless, please call the National Suicide Prevention Lifeline at 800-273-8255.

Parental Burnout:  A tribute to single parent mothers and fathers who get burned out!
By Ken Barrett, MSW, LCSW

The typical parent is likely to get “burn out” which is not to be mistaken with compassion fatigue.  Burnout as a parent causes exhaustion, feeling overwhelmed, emotional distancing from one’s children and a sense of being an ineffective parent. (Psychology Today, Posted September 2019)

Let’s take for example, single mothers who are statistically by far the largest demographic of single parents.   We are in a Pandemic and the amount of time at home has significantly increased putting an immense amount of pressure on single parents who are mothers in overwhelming numbers. I would be remiss in not mentioning men also are single parents and will be considered in this discussion not as an afterthought but as a key part of their children’s life.  Based on the Census, 2020 first results single parent mothers make up 23% of all mothers parenting children under 18 years of age who live without a partner. In addition, 6% of fathers live without a partner and parent children under 18 is also significant (Census 2020, first results).
    
Mother’s Day is coming up so be thankful for what our mothers contributed and contribute to our lives especially those who parent and parented alone. The obstacles single parent mother’s face is insurmountable.  Overcoming sexism, shattering the glass ceiling all while trying to be healthy parents to their offspring.   Can you imagine why it would be easy to give up given the context that presents itself to women-mothers across the globe. My contention is that there were many times my mother could have been broken.  She was ahead of her times given all three of her sons did laundry by the time we were early teens, knew how to cook at an early age and learned empathy at a young age for our mother’s challenges.

I have compiled a list of coping strategies for parental burnout (zerotothree.org):
Remember it is ok to drop some of the balls; share the workload; do something special for yourself; be present with others; give yourself and your child credit; focus on the problem and what it might be telling you.

Tips for managing teens to avoid burnout: (yourteenmag.com Neil Brown, LCSW):
Eliminate control battles. Be clear with your teen and yourself what your expectations of her are in a civilized tone. ‘Be sure that the change of behavior belongs to the teen. Be patient with your teen.  Remember all their qualities and what you love about them and communicate that to them.   Use privileges to motivate your child to do the right thing.  Try not to overfocus on punishment but rather reward behavior you have agreed upon with your teen is culturally acceptable.

Have a regularly enforced tech policy in your home. Tech devices should be unavailable at meals and an hour before bedtime.

​Get parenting support.  If you have friends and family who gives unconditional acceptance and good  listeners then engaging them would be productive.  Do not enlist people who have a tendency to be overly critical.

Make time for yourself.  Me-time is essential to surviving the rigors of parenting.  If you paint, find time to paint a picture.  If exercise is your thing find time to fit this into your schedule. 

If feasible make sure your work environment meets your parenting needs. Try to get your employer to allow you to work a flexible enough schedule to meet your child’s needs.

A short poem about a single parent:
I think and think about how mom found the energy of heart to love so strong.
Tucking me in bed at night and tending to me in the morning.
Certain is she to approve of me in terms of development and disapprove of impulsive fight and flight.
Always there like a solid tree but she like me needs sun, water, air and rest.  

By Allie Lehr, MA, PLMFT
​
​I began my journey in therapy at the age of 12. I loved my therapist. As a middle schooler, I wasn’t excited by much, but I remember bragging to my friends about getting to talk to a “cool adult” about all my problems. I looked forward to therapy and I saw her through high school and until I moved out of state for college.

Halfway through my first year in college, I went into treatment for an eating disorder. I was assigned a therapist who worked at the treatment center and saw her weekly. I began to hate therapy. I found any excuse to avoid going and after every session I remember feeling awful. She was perfectly nice and other people seemed to like her, so I thought maybe there was something wrong with me, so I stuck it out. Eventually, I got out of treatment and went to a different therapist that was *strongly recommended* by the treatment center. I saw my next therapist off and on for about 3 years. She was fine, and I made progress in my eating disorder recovery and with my relationship with food, but I still felt like something was missing.

After undergrad, I moved to St. Louis and started my graduate program. It became clear pretty quickly that I needed to find a therapist to help me deal with the anxiety and stress of grad school. I found someone who gave me the same feeling as my therapist from college and after about 3 sessions I ghosted her. At this point I had given up on therapy, which I know is ironic considering I was in school to become a therapist, but someone recommended their therapist and I thought I would give it one last shot.

I reluctantly walked into her office, expecting to ghost her like I did the one before that, but immediately something was different. After a couple sessions, I had the same feelings of motivation and enthusiasm for change I had with my therapist from high school. Let me make it clear, therapy was hard. My therapist pushed me, and sometimes I didn’t want to go, but I finally felt safe and understood.

As a therapist now, I always tell clients that our relationship and connection is the most important part of therapy. Research shows the relationship is the single most predictive factor for success in therapy and I see that to be true every day in my practice.
​
If you have gotten this far, you are probably thinking “cool story bro but are you going to help me find a good therapist?” My answer is: sort of. To be honest, a lot of finding the right therapist is trial and error, but there are some questions you can ask yourself and the therapist that may set you up for success.

Questions to ask yourself:

• What am I hoping to get out of therapy?
• Do I care about my therapist’s gender?
• What qualities am I looking for in a therapist?
• If you have been to therapy before…
  • What did you like?
  • What didn’t you like?

Questions to ask the therapist:

• Have you worked with individuals experiencing similar concerns?
• What is your background?
• How do you think therapy can help me?
• What is your approach to therapy?

 The bottom line is therapy is effective, especially if you have a good relationship. If there was something that your therapist did or said that made you feel uncomfortable, talk to them. If you don’t think it’s the right fit, talk to them! Odds are they can help point you in the right direction of someone who is. 

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/