Phases of Healing

Tanya Ruckstuhl LICSW

Back in the late 60’s, Swiss psychiatrist and kick ass trail blazer Elisabeth Kubler Ross developed the five stages of grief through her work with terminally ill patients coming to terms with their own death. Those phases have since been applied to everything from death to divorce to disappointment. The five phases are: denial, anger, bargaining, depression and acceptance. This framework for sorrow helps normalize and make some sense of the pain of loss.

In my work with trauma survivors, I’ve also noticed recurring patterns of healing.  The first phase is Rigidity and Anger. These are folks who need things just exactly so in their lives. They are often highly productive but not personable. Trauma survivors in this phase usually have more projects than friendships. They are usually workaholics because they don’t trust anyone else’s contributions. They often drop out of therapy because they are not ready for the vulnerability of being seen or having any part of their thinking or behavior challenged.

When the strategy of avoiding feeling by staying busy no longer works due to exhaustion or becoming healthy enough to start feeling the pain left by childhood trauma, trauma survivors enter the Anxiety Free Fall phase. In Anxiety Free Fall there is tremendous fear about future events, personal safety, loved ones, medical and economic vulnerability. They are downright creative in coming up with things to worry about!  They face a constant feeling of looming and inescapable disaster. People in anxiety free fall often seek therapy to relieve the discomfort from finally feeling.

Then comes the hardest phase: Shame and Self-Hatred. Just as rigidity/anger functions as an armor protecting survivors from the anxiety free fall, anxiety is a distraction (ironically a protection) against the underlying pattern of shame and self-hatred.

Why do abused or neglected children learn to hate themselves? First, let’s look at the world at large. Unlike an American courtroom where you are innocent until proven guilty, in the world at large you (and me, and everyone) are irrelevant until proven useful, or interesting, or attractive in some way. Strangers might care about others from of the goodness of their hearts, out of general care for the welfare of our fellow wo(man), but these strangers don’t actually know you enough to care about you personally. The focus of our caring starts with those we know the best, and moves out in concentric circles of distance. We feel the most investment in the wellbeing of those who we personally feel connected to.

This pattern of tribalism is okay as long as everyone is born into a household where they are flat out adored just for showing up on the planet. In a reasonably healthy family, each and every baby is the best thing that ever existed. Every child is a source of delight and wonder. This experience of being precious, worthy, special, smart and beautiful in one’s family is the counterbalance to the world at large, which says “you don’t matter until you prove your value.”

In families that are deeply unhealthy, babies are not adored. Children are a burden. And they are told this in a number of ways: rough handling, resentful or bored facial expressions, lack of touch, ignoring, screaming, pinching, hitting, etc.

An un-adored baby in a world of prove-your-worth is filled with a sense of emptiness and insecurity. There’s no tap root of knowing “I’m special” inside that person to counterbalance the world’s apathy.

That’s the bad news. The good news is that we can all move towards the phase of Healing. Just as the deepest wounds are inflicted relationally–by the very people who are supposed to take care of us–the deepest healing also comes this way. In a healthy love relationship, people develop a sense of personal value. They discover that they matter to another person, and that allows them to matter to themselves. This is a slow process because it’s a total change in personal identity.  Evidence of healing is both internal and behavioral:  they take less dangerous risks but more emotional risks. They take breaks from work, protect time to sleep, eat vegetables.  As they discover that they are lovable even while being imperfect, they stop hyper focusing on their own and other people’s flaws. (Which reminds me of the perfect bumper sticker I saw this week: “Proud parent of a great kid who can occasionally be an asshole and that’s okay”)

In a healthy relationship—which can be love, friendship, therapy or any combination of the three–we can reprogram our sense of value from “nothing” to “special.” Not everyone will feel this way about us. In fact, most of them won’t give us a second thought. Because they don’t know us well enough to have an opinion.  Pop culture aside, we cannot and do not need to impress everyone. We just need to *adore* ourselves, and hopefully, have a few other folks in our lives who join our fan club, as we also join theirs.

What To Do When There’s Nothing To Do

by Tanya Ruckstuhl LICSW

Photo by Artem Beliaikin on Pexels.com

Here in Washington state, our governor just clamped down restrictions to slow the spread of the Corona virus and prevent deaths. In this strange time, we must minimize contact with the outside world. Our winter rituals have changed. No longer do we gather in extended family and friend groups around a table filled with communal food. No longer do we lighten the dark, chilly days with the warmth of our tribe.

Collectively we are in the wilderness, looking for ways to find comfort and remember: even the longest winter ends.  And then comes spring. We are left hoping. Hoping a decent vaccine will be made. Hoping our world will return to some semblance of safe-enough. Hoping to return to our offices and schools. Hoping we can once again take up our petty concerns and stop tracking projected body counts.

When my twins were born, premature and medically fragile, I looked forward to the day I could get mad at them for stupid things: leaving socks on the floor, refusing broccoli.  Trivial annoyance meant they were safe, and I longed to be free of the terror of their deaths.  (I got my wish. So. Many. Piles. Of. Objects…So. Much. Food. Pickiness.)

We don’t think about irritation as evidence of good luck, but guess what people in real crisis are not doing? They are not thinking about who owes them a text back or how many weeds in their own yard came from the neighbor’s non-gardening.

There are some deep healing opportunities within this Covid restriction time. We live in a cornucopia of distractions: the news, Netflix, pasta, Paris, Amazon, beer, books, pot, porn, gambling, virtual farming, cat collecting, this world offers distraction 24/7.

With Covid getting worse, some of those distractions are no longer available. Loss of distractions is uncomfortable at first. What do we do with ourselves? With our time? We can comfort ourselves by doubling down on the ones that are still in our grasp. Numbing out with food and television was already a national pastime before Covid, and it’s only become more common.

Or we can try something else. With the television off and phone down, there is an opportunity to sit alone in the company of our own consciousness. Try this. Take stock of what you notice, feel, and think.

In this moment I’m sitting in my sweet little backyard office. The space heater is noisy. The amber light bulbs above my desk cast a weak ring of light. It’s still dark out, and the shapes of the tree branches shade the sky. I’m tired but also proud of myself for waking up early. I’ve been wrestling with non-writing, trying and failing to become more productive. I wish I craved writing like I crave coffee. But I don’t. I regret this.

If you want to grow emotionally, to be more resilient and kinder there is a simple way. All we have to do, in any given moment, is to notice and then tolerate whatever feelings arise. The good feeling ones and the bad feeling ones have this in common: They won’t last forever. A moment of irritation will turn into a moment of gratitude and then we might feel hungry. Or bored. Or overwhelmed. Or sad. Or playful. Or focused. Or inspired.

Today I’m going to try and tolerate feelings, one moment at a time.

The Right Amount of Responsibility

By Tanya Ruckstuhl LICSW

Many of the good people I see had really rough childhoods. Their psychological diagnosis is Post Traumatic Stress Disorder, or PTSD.  PTSD usually manifests in symptoms such as flashbacks, pervasive anxiety, an exaggerated startle response, dislike of surprises, controlling behavior and a sense of coming danger, as if they are always bracing for the other shoe to drop. The public has heard of PTSD, so the label provides trauma survivors an explanation of some of their behaviors and struggles.

But today, I want to go deeper into the effects of trauma. Let’s talk about self-blame. First, some basic developmental information: all kids think their parents are gods. Because the adults taking care of them have so much more power, life experience, understanding and agency then they do, children believe they control the world. And in a small way they do: they control (most of) the child’s world. I remember having a conversation with my son when he was four years old.

“Mommy, I want you to make it stop raining.”

“I can’t do that. I can’t control the weather.”

“Mommy just give it your best.”

“Sweetie. I can’t make it start or stop raining.”

“You can! You’re not even trying!” (starts crying in frustration).

Children believe their caretakers know everything and can do anything. Parents are the absolute compass for children, ever pointing in the “right” direction. So, when caretakers beat them, ignore them or sexually abuse them, the children blame themselves for causing it to happen. They think “it’s because I’m bad.”

And the perpetrators of abuse also add to this mistaken belief. They say things like,

                “You were asking for it.”

                “It’s your fault.”

                “You’re more trouble than you’re worth.”

Self-blame is a perfectly reasonable survival mechanism for a young and dependent creature living in a dangerous family. It keeps the world in order. Parents remain gods. It allows them to believe change is possible: if this happens because I’m bad, well I can always change. Self-blame protects abused/neglected children from despair. It keeps them submissive and obedient to their parent/abusers, so more likely to survive and get some emotional needs met. In a dangerous childhood, self-blame makes a ton of sense.

News flash: it’s false. It never was and never could be the child’s fault that they are abused or ignored.  Even though this belief system helped children survive lousy childhoods, it’s toxic to maintain in adulthood. Self-blame keeps trauma survivors committed to partners who are dishonest or unreliable, or who consistently berate and devalue them.  It keeps them working long hours for withholding bosses.  It makes it extremely difficult for them to set boundaries and follow through with consequences when other people trounce those boundaries. Self-blame is a false belief that needs to be grown out of, as soon as safety is attainable.

On the other end of the problematic coping style, there are those who refuse to take personal responsibility. Entitlement issues are also forged in childhood. Parents who don’t feel proud of themselves convey a religious-type worship of external accomplishments and accolades to their children. These kids grow up thinking they must become Nobel laureates or supermodels or Russel Wilson in order to be lovable. Because the mark of acceptability is so lofty, they never make it.  Then they feel inferior, and hide it by pretending to be blameless and perfect. Because that is what they had to pretend to be in order to feel approved of as a child.

When entitled folks screw up, they can’t take responsibility.  This is a problem because accepting reasonable responsibility is just as important as not taking over-responsibility.

It means admitting mistakes, apologizing WIITHOUT qualification, and understanding that one’s own comfort and convenience is of equal value to others. It means playing by the rules and not thinking of oneself as special or deserving extra cookies.  People who cannot take personal responsibility often partner with…. those who take too much!  It’s a perfect, gnarly marriage of entitlement to codependence.  

We are all in this world trying to heal the wounds of our childhoods.  The good and bad news is: if you struggle, you are not special.  We all share this story of personal growth and joy and pain.

Equity versus Equality, or why “Black Lives Matter” instead of “All Lives Matter”

Photo by Jumana Dakkur on Pexels.com

by Tanya Ruckstuhl LICSW

In our fantasy world, everyone has access to education, employment, healthcare, housing and support services like therapy.  In this fantasy world, we have achieved equality.

In the real world, the messy, imperfect one we all live in right now, access to all the best offerings of society are based on economics. The more money you have, the easier it is to go to college, to hire a tutor if you are struggling, hence get good grades which then sets you up for a higher paying job. The more money you have, the easier it is to live in a neighborhood with fully stocked grocery stores which makes it easier to eat healthy and be physically fit and live longer.  The more money you have, the easier it is to live in neighborhoods with quality public schools for the best possible education and socialization of your children. The easier it is to maintain stable housing. The easier it is to afford legal counsel and avoid incarceration or exploitation. The more money you have, the more likely you will have medical insurance that both provides you with medical care and prevents bankruptcy in the event of a medical crisis. The more money you have, the easier it is to pay for therapy when you feel stressed, depressed, or anxious. This helps you think about things in a way that decreases your discomfort and results in better overall health and productivity.

And it’s not just your money, it’s the money of your parents and their parents and their parents that sets you up for success: Many of us live in homes we couldn’t have placed the down payment on without parental assistance. Many of our children receive music lessons because of intergenerational money.

Meanwhile people of color have consistently been economically subjugated.  From slavery to chain gangs to sharecropping they were denied the ability to accrue wealth from work. From the segregation of schools which denied access to education, discrimination in hiring practices which solidified poverty, the redlining practices that eliminated access to better neighborhoods, to the refusal of banks to make loans to people of color.

The past four hundred years have involved extensive series of political and Supreme Court decisions that have echoed and reinforced discrimination and economic subjugation.

The reason why the Black Lives Matter movement is so important is not only due to the deaths of unarmed Black men at the hands of police officers. It’s because the whole underlying economic structure of our country has been completely unfair to people of color. African Americans have labored without the just economic benefits of that labor for four hundred years. In a capitalist democracy such as ours, there is a direct line between personal safety, resilience and well being and access to money.

Black Lives Matter because for four hundred years, they haven’t been treated that way. I don’t know how to fix this systemic problem. I don’t even know the right questions to ask. But I do know it’s my moral responsibility to learn more about the Black experience and to better recognize the systemic barriers to equality.

Inhabiting Solitude

Photo by icon0.com from Pexels

By Tanya Ruckstuhl LICSW

“All I want to do is eat chocolate cake and sleep.”

“I accidentally tried to hug my neighbor whose brother just died, and she shrank back like I was a cobra.”

“Some guy told me to stop petting his cat.”

These are weird times.

My therapist friends and I have all been messaging each other about the transition to telehealth in response to the pandemic.  We miss the immediacy and vibrancy of in-person sessions. Between audio glitches and freezing screens, we miss the ease that being in the same room as our clients provided. Like all of us, we are doing our best, figuring it out as we go along.

None of us know how long this situation will last. We don’t know how bad it will get. We don’t know if all of our loved ones will survive. We don’t know if the supply chain will be interrupted. We don’t know the long-term effect on the economy.

Humans like to quantify. We want to know what to expect and how to prepare. To feel safe, we want know what’s coming and how to endure or enjoy it.

And that is precisely what we don’t get to know right now. In the absence of certainty, many of us default to following the news as closely as we can. In this new landscape of invisible enemies, virologists and epidemiologists are the leaders. Doctors and nurses the front-line soldiers.

We must take this pandemic seriously enough to radically change our behavior for the foreseeable future. No more get togethers. No more movie theatres, or restaurants or nights out on the town. No more school. Every surface that someone touched is a possible transmission spot.

On the other hand, we still need to walk the dog, cook meals, vacuum, fold laundry. Focusing on small, doable tasks brings a sense of normalcy, of continuity to our lives.  We need to balance taking appropriate personal responsibility for protecting others along with continuing to have a full life that includes love, learning, exercise, joy, mindfulness, flavor, progress, and creativity.

As we drill down deep in to our time at home, with family if we are lucky enough to have them in the same household (and you’re right, it doesn’t always feel like luck) I wish for you an opening into realms you haven’t visited since childhood. I wish for you thinking time, staring into space time, imagining time. Dream time is slow and mysterious and a rich source of creative inspiration.

On the other end of this situation, we can emerge rested and connected to our deepest selves, ready to engage with one another from a place of deep gratitude.

Viral Fears

By Tanya Ruckstuhl LICSW

Here in Seattle we have the unfortunate claim of being the epicenter of the US outbreak of the Novel Corona virus. Diagnostic criteria are still being refined, and confirmed cases increase daily. Most public gatherings have been cancelled, some schools have closed, and travel is being put on hold. This flu seems to be most dangerous for our elderly and immunocompromised, so it is unlike the influenza epidemic of 1918 which was especially lethal for young adults and children. It does however seem quite contagious.

For the majority of us, even if we get it and must quarantine ourselves, the most likely negative consequence is loss of income/education and a certain degree of cabin fever. These are inconvenient but luxurious concerns compared to death.

A good citizen is one who cares for the group as a whole. Even though we may be below age seventy and free of underlying health issues, we are each responsible for doing our part to care for the tribe that is the public. It is likely that a good number of us will need to quarantine to slow the progress of this virus.

Here are some measures that can be taken to reduce transmission:

1. Wash all of your clothes each time you wear them. It appears that the virus can live on fabric for up to a week. The dryer is a germ-killing machine.
2. Clean “high touch” areas such as door knobs, light switches, faucets and handles daily. At work don’t open doors or turn on/off faucets with your bare hands.
3. Wipe your phone screen and computer keyboard daily.
4. Wash your hands like an OCD person: hot water, twenty seconds of lathering, plus a paper towel equals clean.
5. At home, switch out your kitchen and bathroom hand-towels every day. Or switch to paper towels for the duration.
6. Try not to touch your face. This is hard! With every itch, I’m going through tissues like a fiend.

In preparation for your mental health needs, under self-quarantine:

• Put together a list of projects for yourself and your kids in the categories of household, yard and bedroom tasks as well as creative/intellectual projects so you can still experience purpose and progress in your life.  
• Pull out those books you’ve been meaning to read.
• While you’re still healthy and mobile, get the ingredients to tackle cooking something new and challenging. An hour of prep is nothing for someone with two weeks of 24 hours to fill.
• Maintain a normal sleep/wake schedule. Late nights watching Netflix plus isolation are a recipe for depression.

No matter what happens:

1. The amygdala and limbic systems are the portions of the brain responsible for recognizing potential danger. The news is a constant amygdala stimulation event. The prefrontal cortex can calm the hindbrain down with conscious and soothing self-talk. Use your prefrontal cortex.

We will get through this.

New Year New You

By Tanya Ruckstuhl LICSW

I’m trying to do this thing that I’m really lousy at. It stimulates all of my defenses: fatigue, defeat, distraction, avoidance. I’m trying to create a new web site, and to do it myself because that’s a thing now…normal non-tech people can write articles and use a template to create their very own website.

Thirteen years ago, I hired my best friend’s husband and he did a great job putting my website together.  But every time I raised my fees or wanted to add info about a group or list my latest presentation, I had to go through him. Then he went and got a full-time job (so rude!) on top of being a part time musician (selfish!) so I didn’t want to ask him to find the one free hour in his week to work for me.

I like thinking and writing. Unfortunately thinking and writing are abstract and real-world change requires decisiveness on the material plane. Paint colors aside (I’m really good at choosing paint colors) I fairly suck at the million-and-one decisions required to do complex projects. My partner recently built me the sweetest little writing studio in the world. In addition to building it, he also took on the design so that I didn’t have to decide layout or siding material or the slope of the roof. Those kinds of choices overwhelm me. And so it is with designing my own website. As I look over my articles from thirteen years ago, I realize my thinking has changed so I need to update them. I need to choose a new domain name. I need to decide if this picture should be centered on this zone, while losing this other zone. On and on the decisions roll.

I’ve decided that this year my theme will be boldness. I will be trying new things, scary things, things that help me grow and become more competent and to feel more alive. I will take risks and adventure forward because here I am in the middle of my life and I want to expand my possibilities, rather than retract into stale routine.

My hope for you, dear reader is that for this new, untouched year of your one precious life, you make a commitment to pick one under-developed area to grow and nurture. You’re not the same as me so your area of construction will probably be different. Maybe you’ve got boldness on tap and could use more empathy.  Maybe you work constantly and could slow down. Maybe you check your phone obsessively and could commit to putting it away when you are with others. Whatever you chose, I wish you success and joy in the pursuit.  Meanwhile, I’ll be working on my new website.

The Diva and the Doormat

by Tanya Ruckstuhl LICSW

We find balance between the extremes Two common extremes have to do with how we relate to other people. On the one side, you have your divas. These are the folks who require an outsized amount of time and consideration to engage with the larger world. They are always running late. They need to curl their hair, paint their nails, and have the temperature just so. There was a rock band in the 80’s that shall remain nameless (only because I can’t remember) that had written into their performance contract that the stage be kept at a perfect 70 degrees for all their outdoor venues. They traveled with a thermometer.  They refused to play if the temperate was off by two degrees. These guys were major divas. Ironically, divas put themselves under massive pressure to look good and perform perfectly under all circumstances, and because no one can look good or perform perfectly in all circumstances, they try to control the circumstances which means controlling everyone around them. Family members, employees, neighbors and community members are all reduced to delivery tools in the diva’s insatiable quest for comfort.

On the other end of the spectrum, you have the doormats. They apologize preemptively. They don’t ask for what they want. They back down immediately when challenged. They practically invite domination. These folks accept mistreatment because they have disconnected from their own self-protective anger in order to protect their connection with others. They don’t believe themselves to be worth sticking up for.  Doormats are the parents who beg their near-adult children to clean up after themselves. The women who stay with mean or unreliable men. The men who stay with cruel and demeaning women. Doormats behave in passive aggressive ways because they still get mad about mistreatment, and they still punish mistreatment, but they don’t have the relational power or the emotional skill to have direct conversations about their needs.

Many people flip between diva and doormat behavior, depending on their perception of the importance of the other person. If you want to see a bunch of doormats, watch the behavior of people around a famous person. They ogle, they fawn, they do everything except act like they might have their own important ideas. If you want to see a diva, watch modern hip-hop videos. They show off money, (doormat) girls, weapons, all the symbols of social importance and dominance.

If you want to be as emotionally healthy as possible, avoid these extremes. Also avoid people who exhibit these extremes.

Good Stuff

Tanya Ruckstuhl LICSW

Photo by Pixabay on Pexels.com

Lately I’ve been chewing on the balance between care of self and service to others.  I believe we all exist in a web of connection. Consider the underground fungus: it transmits nutrients to tree roots, which keeps the trees alive and in return protects the fungus from drying out.  If the fungus gives away too much of its nutrients it dies, and if it gives away too little, it struggles to live.

As humans, we hold this tension of self versus other constantly: Do we check in on our elderly neighbor or take those few extra minutes to savor some time alone?

Too much service to others creates depletion, resentment and fatigue.  Co-dependents are not happy people. They give and give, and exhaust themselves and wind up indignant and angry that their needs are never someone else’s top priority.

On the other hand, folks who only care for themselves, who spend their time and energy in sole pursuit of their own betterment suffer from isolation and meaninglessness. Without sustained and reciprocal connection to others, our existence lacks purpose.

I want to live in the intersection, to promote and protect my own well-being without apology while actively supporting the well-being of others. There’s a way to do this, but it takes a spirit of experimentation and willingness to make mistakes and plenty of time to get it right and then have the balance go and shift on you so that what worked at one point no longer works. No matter, its what we’re here for. Share your good stuff. Just make sure you keep some of it for yourself.

Relationship Repair

By Tanya Ruckstuhl LICSW

I once called a client a “walking vagina.”  For real. This was years ago.  I’d like to think I’m more delicate with my Sword of Sarcasm these days; but the truth is I’m not always able to tell the difference between useful humor which cuts through defenses and damaging humor which just hurts feelings.

I know I’m a weirdo and my humor can be fully wrong. I rely on the quality of the relationship, the trust my clients feel towards me that they can come back and tell me if something I say lands in a way that hurts rather than helps or clarifies. This requires trust and courage on the part of my client and humility and non-defensiveness on my part. And it’s helluva good practice for IRL—because people (including this therapist) are imperfect and language is an abstract, approximate tool for building reality.

The backstory of my inappropriate comment was this: my young adult client was being texted in the middle of the night by a guy who was only interested in no-strings-attached sex, while she had a huge crush and yearned for a relationship with this same fellow. This happened enough times that she knew what was going on, but still found it irresistible when he booty-called her. I was trying to engage her self-protective anger to increase her ability to resist him. So, I told her he was treating her like a vagina delivery service. This worked! She stopped responding to him. Yay! But I also hurt her feelings. Boo!

When I hear about how many supposedly terrible therapists there are out there, I wonder what the hell is wrong with my profession?! Then I wonder: what if there are just these unfortunate moments when the therapist is trying to say something useful in a unique, therefore noticeable way but they get it wrong?  And if the client feels hurt but they don’t go back and have a conversation, then the comment becomes this toxic thing that erodes trust. And that doesn’t even include the (abundant!) times when the therapist is trying to summarize what is happening and they just don’t get it.

In real life, like in therapy, we are constantly trying to understand one another, communicate needs, make meaning, provide care, and feel received. If you have conflict in your life or in your therapy, try this: call upon your courage and talk to that person.  It might not work. They might lack humility or willingness to hear your perspective. They might deny responsibility for hurting you, and when that happens it really sucks. And it might work: you might feel better understood or better understand where they were coming from. But no matter how they respond, you will be operating from a place of courage and willingness to process your pain, rather than withdraw from connection.