A blog about AI tools and how they are not talk therapy.The number of clients who are telling me during sessions that they are relying on “therapy” from an online AI tool in-between sessions is becoming disturbing. I know that AI can make life more simple at times, but AI is NOT a trauma therapist. AI does not know you. AI does not know your trauma, your triumphs, and the growth you have made during the therapeutic process. So, care enough about yourself that you have the therapist you deserve.

Here are 8 key ways in which AI is not therapy:

1. Lack of Emotional Depth and Empathy: While AI tools can generate text that appears empathetic, it does not possess genuine emotions or the ability to truly understand your pain. Therapy relies heavily on the therapist’s capacity for deep empathy and connection for guidance, growth, and healing.

2. Absence of a Therapeutic Relationship: A core component of therapy is the therapeutic relationship, built on trust, rapport, and a safe, consistent connection. Artificial tools cannot form this type of connection that is a fundamental aspect of therapy.

3. Inability to Provide a Mental Health Diagnosis: Therapists are trained to assess complex mental health situations, recognize patterns, and make clinical diagnoses. AI lacks the ability to make these personalized assessments, especially in crisis situations.

4. No Confidentiality or Ethical Obligations: Therapists are bound by strict ethical and legal guidelines regarding confidentiality. AI has no HIPAA, has no protection of your personal mental health data, and does not know if or when you may need a higher level of care.

5. No Understanding of Nonverbal Communication: Therapists observe and interpret nonverbal cues, such as body language and tone of voice, which are crucial for understanding a client’s emotional state. AI models, being text-based systems, cannot see you or grasp your full emotions.

6. Inability to Provide Personalized Treatment: Therapy is tailored to the individual’s unique needs and circumstances. Most tools provide general “advice” gathered from the web, cannot offer the personalized treatment as a human therapist.

7. Lack of Real-World Experience: Therapists draw upon their training and real-world experience to guide clients. AI draws conclusions from data sets, and does not have real world experience.

8. Inability to Handle Crisis Situations: Therapists are trained to handle crisis situations, and to provide proper intervention. AI cannot provide that level of intervention and cannot support you during an emergency.

It’s vital to remember that while AI tools can be helpful resources at times, they should not replace professional mental health care. If you are looking for a therapist, you can reach me by visiting my profile.

A blog about dealing with teenagersPOV:  Your teenager slams the door loudly and you wonder to yourself what could have possibly happened to that cuddly, chubby-cheeked-child that you once bounced on your lap.  The changing dynamics between parents and children can range from moment to moment, from pride to nostalgia to sadness and confusion.  While you anticipated that they would grow away from you at some point, you didn’t think it would feel like this, and you didn’t expect to flounder so much to maintain a connection with them while simply keeping them “on track”.  Undoubtedly, one of the greatest challenges of parenting teens is in finding the “sweet spot” between encouraging them towards autonomous identity development while also maintaining some type of a positive relationship.

Parenting teenagers can feel like an uphill battle of emotions, conflict, and perhaps some behaviors you’ve never seen before.  While you should certainly consult a professional if you notice worrisome behaviors (substance abuse, self-harm/ suicidality, self-isolating, or other high-risk behaviors), here are 5 key tips for communicating with your teen and staying connected as you both navigate this stage of life together.

Tips for Parents Navigating the Teen Years

Set limits with love.

Setting limits allows for a structure within which your teen may grow and develop safely.  Base your limits on developmentally appropriate behavior and present your limits with compassion, even when they are not MET with compassion.  Parents who set and reinforce consistent limits and expectations allow teens to mature by making “safe” mistakes that help them to learn through natural consequences.

Expert tip for parents:  Practicing your own self-care and coping strategies will help you to stay emotionally regulated and prepared to meet your teenager’s pushback with understanding AND firmness.

Learn to validate your child.

While we may not agree that the 10pm curfew that we enforced was “unfair,” we can certainly understand and validate a teen’s desire to be out with their friends.  According to the DBT Skills Manual for Adolescents, “Validation communicates to another person that his or her feelings, thoughts, and actions make sense and are understandable to you in a particular situation” (Rathus & Miller, 2015, p. 171).   Not only does the skill of validation help others to feel more understood and less alone, it can help to de-escalate conflict. And what could be more important than that when we are talking about maintaining an emotional connection with our teenagers?

Remember that validation does not equal agreement, and that we can validate feelings and experiences of others while still upholding limits.

Give your teen the gift of space.

According to the infamous research of Erik Erikson, a well-known psychologist, there are eight stages of development that we all must navigate as we seek connection and purpose throughout our lifetimes (Crain, 2011, pp. 283-297).  During the phase of adolescence, the specific task one must navigate is building a sense of identity and finding “one’s place in the larger social order” (Crain, 2011, p. 291).  Teenagers must be working towards identity development and making strong connections with peers to be prepared to navigate the impending tasks of adulthood effectively.

While most of us understand this idea, it can FEEL HARD to experience your teenager wanting more space, challenging your opinions, and only wanting to be around friends.  However, we must keep in mind that these are indications of healthy development and must try not take it personally.  Giving your teen time alone to explore individual interests and reflect allows them space to build a strong sense of self.  Similarly, giving your teen the ability to prioritize friends allows them opportunity to nurture friendships, build a peer support network, strengthen social skills, and learn to nurture healthy relationships.

*If your child seems unusually withdrawn and isolated or is very invested in peers who are exhibiting unhealthy behaviors, these would be red-flags and indicate a need for further exploration and possibly professional help.

Seek opportunity for positive connection.

Do what they like.  Plan special activities together.  Write them notes.  Make yourself available.  Validate them.  Be playful.  While they are going to turn you down sometimes or even dismiss the effort with attitude, don’t take it personally, give them some space, and try again another time.  Tell them you love them and that you are available when they feel like it.

Couples therapist Dr. John Gottman coined the term “Magic Ratio” to describe the idea that healthy relationships generally exhibit at least 5 positive interactions to every 1 negative interaction (Benson, 2017).  While Gottman’s work was primarily focused on couples therapy, the same ratio can be applied to building strong relationships with our children.  During a developmental phase that is marked by a natural increase in parent-child conflict, keep a lose goal to have more positive interactions than negative interactions and remember that YOU are in control of YOUR behavior.  When conflict or emotionality rises, parents can strive to show-up in these moments with validation, empathy, and compassion.  Thus, an interaction that may once have ended in yelling is transformed into a moment of gentle connection and acceptance.

Parents can also increase positive interactions by choosing their battles wisely. Choose to address teen behaviors that are straying from what is developmentally normal, as opposed to picking apart all mistakes or preferences.  For example, a parent might choose to have a firm discussion with their teen around repeated substance use but choose NOT to dig their heels in around a teenager keeping their room spotless.

Be prepared to seek repair.

There is no perfect way to parent.  We will make mistakes.  Our teens will make mistakes.  Disagreement and conflict are not only inevitable, but a healthy part of all relationships.  Be prepared to use these imperfect moments as opportunities for connection.  Making a relational repair is when we acknowledge a mistake in our behavior as it relates to another, and we take responsibility and apologize for it.  Not only does this give us a shot at making things right again with our teen, but it allows a space for a potential positive interaction (remember that 5:1 ratio) and it offers an opportunity to model skillful behavior.  Especially at an age where lectures go in one ear and out the other, modeling skillful behavior for our children can be the most powerful teacher.

Seeking a repair after a rift in the relationship shows our children that we love them, and that we are willing to acknowledge our mistakes.  It demonstrates the ability to emotionally regulate and take responsibility, which are both qualities of partners in healthy relationships (a behavior we want our teens to both LEARN and EXPECT from others).

References

Crain, W.  (2011).  Theories of development; Concepts and applications (6th ed.).  Prentice Hall.

Rathus, J.H. & Miller, A.L. (2015).  Dbt skills manual for adolescents.  The Guildford Press.

Benson, K.  (2017, October 4).  The magic relationship ratio, according to science.  The

Gottman Institute online.  https://www.gottman.com/blog/the-magic-relationship-ratio-according-science/

A blog about Supporting someone through grief

Those of you who know me personally are aware that my son Nikolai passed away in November. Our family has been navigating this unimaginable loss, and while everyone’s grief is unique, I wanted to share a few tips for those who may want to support someone going through it. One thing that has been instrumental in helping us cope is the overwhelming love and support from our community. If you’re wondering how to be there for a friend or family member, below are a few things that have truly made a difference.

Tips That Have Helped Me

Offer Practical Help: Please don’t ask me what I need, especially in the early months of grief. Often, I don’t even know what I need. Offering practical support can be a game-changer. Our community set up a meal train, if you don’t know what this is, look it up, because it saved our family tremendously! Friends brought over groceries; some asked what we needed, while others simply brought staples. Offering to help with things like carpooling kids can also be incredibly helpful. Sometimes small gestures make a big difference, and every act of kindness is so appreciated.

When in Doubt Reach Out: There are times when I need solitude to process my feelings, but that doesn’t mean I want to be forgotten. I don’t want to be left alone entirely, I truly don’t. If you’re unsure how to show support, a simple text is more than enough. If I’m not in a place to respond, please don’t take it personally. We could go for a walk or just sit and talk. Even if I don’t take you up on it right away, knowing you’re there means the world.

Avoid Clichés: Phrases like “They’re in a better place” or “Time heals all wounds” can unintentionally minimize the pain. Acknowledging my grief without trying to fix it allows me to feel seen and understood.

Celebrate the Memories: Say his name. Tell me any memories you have. I want to know that he is still remembered. Celebrating their life rather than focusing only on their absence can be a great comfort.

Avoid Comparisons: Please don’t compare your pain to mine, and please don’t say you understand—because, truthfully, you can’t. Everyone’s grief is deeply personal, and while your intentions may be kind, comparisons can unintentionally diminish what I’m experiencing.

Listen Without Judgment: There are days when I need to talk, vent, or even express emotions I can’t fully understand. Having someone who listens without offering solutions or judgments is invaluable. Just letting me feel heard is incredibly healing.
To those who have been walking with me through this journey, thank you. Your support means the world. If you’re supporting someone through grief, know that even the smallest gesture can have a lasting impact.

The role of ethics in therapy., a blog.When you seek support in therapy, you’re also opening yourself up and entrusting someone with your most personal thoughts and emotions. Therapy should be a safe, confidential, and professional space where you can heal and grow — that’s why ethics in therapy are so critical. Ethical therapists uphold high standards to protect client well-being, maintain trust, and ensure the best possible care.

But how can you be sure a therapist follows these principles? Not all therapists adhere to the same ethical guidelines, and without proper vetting, finding a truly qualified professional can feel like a wild goose chase. That’s where GoodTherapy comes in. Every therapist in our directory meets strict ethical and professional standards, so you can confidently connect with a therapist who prioritizes your well-being.

Why Ethical Standards in Therapy Matter

Ethics are the foundation of quality mental health care. Without strong ethical guidelines, clients could face breaches of trust, poor treatment, or harmful mental outcomes. Ethical therapists follow professional codes of conduct that prioritize:

Without these ethical safeguards, therapy can lose its effectiveness or worsen the mental health of the client. That’s why it’s so important to choose a therapist who follows these principles.

How GoodTherapy Helps You Find an Ethical, Qualified Therapist

While many therapists uphold ethical standards, it’s not always easy to verify their credentials, training, or commitment to ethical care. That’s why GoodTherapy is committed to taking the guesswork out of finding a professional you can trust.

Every therapist in our directory is thoroughly vetted to ensure they:

With so many therapy directories available today, it’s imperative to choose a platform that prioritizes ethical standards. At GoodTherapy, we make it easy for you to find a therapist who is not only experienced but also committed to ethical care of the highest quality.

Therapist Ethics Matter — So Does Where You Search 

The right therapist can have a profound impact on your mental health journey. By choosing a therapist who upholds ethical guidelines, you’re ensuring a safe, professional, and effective therapeutic experience.

Don’t leave your mental health to chance. Start your search with GoodTherapy today and find a therapist you can trust.

Betrayal - A 3 Step PlanDiscovering a betrayal in your relationship can be devastating. Whether it’s an infidelity, a hidden truth, or another breach of trust, the emotional impact is profound. At this moment, you may feel overwhelmed by hurt and uncertainty. However, if both partners are committed to healing, trust can be rebuilt. Here’s a three-step approach to restoring connection and security in your relationship. 

Step 1: Prioritizing Rebuilding Over Resentment 

Before any real healing can begin, there must be a stronger desire to rebuild trust than to hold onto anger or resentment. This may seem obvious, but without consciously choosing this mindset, progress is impossible. Ask yourself: Do I want to be right, or do I want to be happy? True reconciliation requires a willingness to focus on moving forward rather than staying stuck in the pain of the past. 

Step 2: Taking Ownership of Your Part 

Trust is a two-way street, and healing begins when at least one partner is willing to take full responsibility for their role in the relationship dynamic. Even if your partner refuses to acknowledge their mistakes, you can still make progress by examining your own contributions—without self-blame, but with honesty and self-awareness. A powerful principle in personal growth states: “Be the first to take full responsibility.” This doesn’t mean excusing the betrayal but rather creating space for genuine transformation. 

Step 3: Leading with Vulnerability 

The final key to restoring trust is the courage to let go of defenses and embrace vulnerability. When one partner approaches the situation with openness—without the need to justify, attack, or defend—it naturally softens the other person’s stance. Even if their initial reaction is frustration or continued hurt, consistently showing up with sincerity and care will ultimately shift the dynamic. Over time, they will recognize the depth of your commitment and respond in kind. 

The Ultimate Path to Trust Restoration 

At its core, rebuilding trust requires caring more about the relationship’s success than about proving a point. This doesn’t mean sacrificing your boundaries or needs—it means choosing connection over conflict. While this approach demands courage, the rewards are profound: when one partner leads with accountability and openness, the other often follows. 

Healing takes time, but every small step in this direction strengthens the foundation of your relationship. If you commit to this path, you may find that not only is trust restored, but the bond between you grows even deeper than before. 

OCD is often misunderstood in popular culture. It is commonly simplified and portrayed in media as obsession with cleanliness or order i.e. handwashing or arranging objects on a specific way, but there is a much more nuanced spectrum that OCD can manifest itself.

What is OCD?

Technically speaking, OCD is characterized by recurrent and persistent unwanted thoughts, images, or bodily sensations that provoke significant anxiety or high distress. As a response to this distress, the individual engages in repetitive acts, otherwise known as compulsions. These repetitive acts function to reduce the distress caused by the obsessions.

What are obsessions? Obsessions can range from intrusive repetitive thoughts, images, and bodily sensations to external stimuli, such as colors, words, or sounds. What makes an otherwise neutral stimulus become an obsession is its persistent nature and the level of distress that it generates in the OCD sufferer.

What are compulsions? Compulsions follow the obsessions. In other words, they are any acts that the OCD sufferer engages in to reduce, neutralize, or get rid of the anxiety triggered by the obsessions. Compulsions are categorized into physical and mental:

Physical compulsions are observable behaviors, such as washing hands, tapping, cleaning, checking if doors are locked, arranging items, and seeking reassurance from others.

Mental compulsions are internal and cannot be seen by others. Mental compulsions include replaying events and conversations, praying, repeating mantras over and over, counting, and rumination.

What makes an otherwise neutral mental activity become a compulsion is how excessively the sufferer engages with it and how hard it is for them to stop themselves from doing it. While compulsions can offer momentary relief from anxiety, they ultimately reinforce the OCD cycle and leave the sufferer feeling exhausted and stuck.

Putting it all together

OCD is a highly distressing condition that manifests in recurrent obsessions that lead to compulsive acts or rituals. Compulsions can be physical (checking stove) or mental (replaying events over and over in your head). Compulsions function to momentarily reduce the anxiety triggered by the obsessions (unwanted stimuli) but do not teach the sufferer how to effectively cope with anxiety and ultimately recover from OCD.

Recovery Journey

Fortunately, recovery from OCD is possible, and the journey starts by identifying the idiosyncratic way OCD shows up for you:

The answers to these questions can provide important data on how to work with your OCD.

If you believe you or someone you care about might be struggling with OCD, please know that you are not alone, and that recovery is possible with proper treatment.

Post-Traumatic Stress Disorder (PTSD) is a well-known mental health condition that arises from experiencing or witnessing a traumatic event. Post-Traumatic Stress Disorder (PTSD) is a well-known mental health condition that arises from experiencing or witnessing a traumatic event. However, a lesser-known but equally significant condition, Complex PTSD (C-PTSD), occurs when an individual endures prolonged or repeated trauma, particularly in interpersonal contexts. Understanding the distinction between PTSD and C-PTSD, recognizing symptoms, and exploring treatment options is essential for individuals seeking healing and support. Often times CPTSD is mis diagnosed, as symptoms like anxiety and depression come with it.

What is Complex PTSD?

Complex PTSD is a psychological disorder that develops in response to chronic trauma over an extended period. This type of trauma often occurs in situations where escape is difficult or impossible, such as childhood abuse, domestic violence, emotional neglect, or prolonged bullying. Unlike PTSD, which can result from a single traumatic event, C-PTSD stems from sustained traumas, particularly when inflicted by caregivers or authority figures. These traumas can be less noticeable, like microaggressions, but over time they wear down a persons ability to function.

How is C-PTSD Different from PTSD?

While PTSD and C-PTSD share similarities, they differ in key ways:

Symptoms of C-PTSD

The symptoms of C-PTSD can be grouped into several categories:

  1. Emotional and Psychological Symptoms:
  1. Cognitive and Behavioral Symptoms:
  1. Interpersonal Symptoms:
  1. Physical Symptoms:

Treatment Approaches for C-PTSD

Healing from C-PTSD is a complex process, but with the right therapeutic support, individuals can learn to manage symptoms, develop resilience, and improve their quality of life. Some of the most effective treatments include:

  1. Therapy:
  1. Medication:
  1. Somatic and Body-Based Therapies:
  1. Lifestyle and Self-Care Practices:

The Path to Healing

Recovery from C-PTSD is not linear, but with the right support, individuals can regain a sense of safety, self-worth, and emotional balance. Seeking professional help, building healthy relationships, and practicing self-compassion are critical steps toward healing.

If you or someone you know is struggling with C-PTSD, reach out. It is important to find a practitioner who understands CPTSD and can facilitate an effective treatment plan. CPTSD is not a life sentence, you can take the first step toward reclaiming a life free from trauma’s grip.

Social media has undoubtedly changed the way we connect, communicate, and engage with the world. Social media has undoubtedly changed the way we connect, communicate, and engage with the world. It has transformed from a tool for sharing vacation photos to an all-encompassing platform where we manage relationships, create content, and connect with others. However, as much as social media has become an essential part of our daily lives, it has also brought new mental health challenges. These issues primarily stem from two factors: social media’s addictive nature and its ability to fuel social division (DeAndrea et al., 2012; Pantic, 2014). 

A New Era of Connection: From MySpace to Today

Social media began with the goal of bringing people together. Early platforms like MySpace allowed users to curate pages with wallpapers, music, and a top eight friends list. This enabled public expressions of our personalities, likes, dislikes, and connections. Fast forward to today, social media has become an even greater force in our lives. Whether sharing a reel or posting updates, its core functions—connection, self-expression, and relationship building—remain unchanged. With nearly everyone using these platforms, their massive reach is undeniable. However, this influence has led to rising mental health concerns, primarily due to social media’s addictive nature and its role in creating social division (DeAndrea et al., 2012; Pantic, 2014). 

The Addictive Nature of Social Media: A Feedback Loop

One of the most significant ways social media affects our mental health is through its addictive qualities. Just like a substance addiction, social media can trigger a dopamine feedback loop that encourages compulsive use (Pantic, 2014). Dopamine, often referred to as the “feel-good” neurotransmitter, is released when we experience pleasure or anticipate a reward. Social media platforms are designed to trigger dopamine production by providing users with content that engages them (Pantic, 2014). When we receive likes, comments, or new notifications, our brains get a burst of dopamine, creating a sense of satisfaction. This mechanism drives us to keep scrolling, seeking more rewards, and in turn, we can become addicted to the constant stream of content. Social media algorithms are tailored to show us content we are likely to engage with, which keeps us hooked (Przybylski & Weinstein, 2017). This content is often designed to trigger an emotional response—be it humor, surprise, anger, or awe. The more time we spend on these platforms, the more content we are exposed to, and the more our brains crave that next dopamine hit. This cycle of “doom scrolling” can quickly become a habit, just like any other addictive behavior, and it’s one that’s hard to break. This endless cycle of content consumption is also driven by businesses that use these platforms to market their products. Companies have learned that engaging content keeps users on the platform longer, so they invest in creating compelling, attention-grabbing content to sell their products. Similarly, individuals looking to build an online following, such as influencers, also create engaging content to attract likes and shares. The result is a constant feed of captivating posts, videos, and advertisements that activate our brain’s reward system, reinforcing the habit of staying glued to our screens (Pantic, 2014; Przybylski & Weinstein, 2017). 

Social Media and Social Division: The Dangers of Echo Chambers

While social media can connect us with others, it also has a dark side—it can fuel social division. One of the core features of social media is the ability to share perspectives, opinions, and ideas. But as perspectives clash, they create tension and division. The diversity of opinions on platforms like Twitter or Instagram, where anyone can voice their thoughts, often leads to polarized debates (Pantic, 2014). This is especially true when celebrities, politicians, or public figures share their views—there is always a counterargument or group of people who disagree. On social media, these disagreements don’t remain contained between two individuals. Instead, they have the potential to go viral. The comment section of a post can quickly turn into a battleground of conflicting opinions, with each side trying to convince the other of their truth. This division is exacerbated by the algorithmic design of social media, which reinforces the exposure to ideas that align with our pre-existing beliefs (Przybylski & Weinstein, 2017). When we engage with certain types of content, the platform learns what interests us and continues to show us similar content, creating an echo chamber. This reinforces our biases and makes us less likely to see diverse perspectives. As tribal creatures, we tend to gravitate toward groups that share our values and beliefs. These virtual tribes then reinforce our perspectives, making it even more difficult to have a balanced, civil discussion. This can lead to a breakdown in empathy and understanding, turning social media into a platform for ideological wars rather than meaningful dialogue (Pantic, 2014). 

How to Combat the Negative Effects of Social Media

So, what can we do to prevent these mental health issues caused by social media’s addictive and divisive nature? The first step is awareness. Understanding how these platforms work and how they affect our brains is essential for making conscious decisions about our usage (Pantic, 2014). 

  1. Set Boundaries and Limit Screen Time: One of the most effective ways to curb the addictive nature of social media is to set strict boundaries. This can include using built-in tools on your phone or apps that track and limit your screen time. For example, Instagram and Facebook allow you to set daily time limits, which can help you be more mindful of how much time you’re spending on these platforms. 
  1. Curate Your Feed: To combat social division, it’s important to diversify your feed. Follow accounts with different perspectives, and engage with content that challenges your viewpoints. This can help you develop a more balanced and open-minded approach to the information you consume. 
  1. Take Social Media Breaks: Regularly stepping away from social media can help reset your brain’s reward system and reduce the feelings of anxiety or comparison that often accompany overuse. Consider taking a digital detox for a weekend or a week to help reset your relationship with social media. 
  1. Be Mindful of Your Mental Health: Pay attention to how you feel after using social media. If you notice unsettling feelings, take a break and check in with your mental health. It may be helpful to practice mindfulness or engage in self-care activities to manage emotions. 

Final Thoughts

Social media is a powerful tool that can help us connect with others and express ourselves. However, its addictive nature and tendency to fuel division can have significant consequences for our mental health (Pantic, 2014; Przybylski & Weinstein, 2017). By setting boundaries, diversifying our feeds, and practicing empathy, we can use social media in a way that promotes well-being rather than detracts from it. 

References 

DeAndrea, D. C., et al. (2012). Reputation, relationships, and social networks: A study of the relationships between social media and well-being. Journal of Social and Personal Relationships, 29(3), 456–475. 

Pantic, I. (2014). Online social networking and mental health. Cyberpsychology, Behavior, and Social Networking, 17(10), 652–657. 

Przybylski, A. K., & Weinstein, N. (2017). Can you connect with me now? How the presence of mobile communication technology influences face-to-face conversation quality. Journal of Social and Personal Relationships, 34(1), 39–56. 

A blog about the different types of loss and how to cope.Ambiguous vs. Unambiguous Loss

When I looked into my loved one’s eyes during one of her first manic episodes, I did not recognize the eyes staring back at me.  Equally heartbreakingly, I felt that she did not recognize me. And so it began: a cycle of highs and extreme lows, agitation and depression, characteristic of bipolar disorder. While bipolar disorder affects each person differently, in her case, the depression has often lasted longer than the manic state, sometimes lasting years. During these polarized periods, one of the hardest parts was the feeling that “she” was lost to me – she whose counsel I trusted and valued so much, and she to whom I could be my most honest and vulnerable self. The person who replaced her in these periods was either highly agitated and manic, or depressed and despondent – unable to provide the type of support or nurturance I might be craving.  In those periods, though she was still there in her body, I could not expect much from her – it was all she could do to keep her own spirit alive or stable and had little to give anyone else. And though I understood this on an intellectual level, it was hard to escape the mixed feelings of sadness, helplessness, disappointment, and frustration.

It wasn’t until years later that I was finally able to put a name to this feeling: ambiguous loss, a term coined by the social scientist Dr. Pauline Boss in the 1970s. Ambiguous loss refers to losses that do not have the type of clarity and finality that an unambiguous loss like death has. Ambiguous loss lacks closure and results in grief that is unresolved and confusing.  According to Boss, there are two main types of ambiguous loss. The first is physical absence with psychological presence. This may include a missing person due to abduction, war, or natural disaster. The second type is physical presence with psychological absence. This may include losing someone to Alzheimer’s disease, dementia, addiction, or severe mental illness. Something like divorce can also result in ambiguous loss, where the family unit that once was is no longer.

Frozen grief: “leaving without goodbye” and “goodbye without leaving”

A loss of any kind can be hard, but Boss contends that ambiguous loss can be particularly challenging because of its lack of closure and resolution. For example, in the case of a missing person, those left behind may feel like they must make the excruciating choice of either living in a state of perpetual uncertainty but holding onto hope, or deciding to inject some resolution by mourning and attempting to move on. Everyone will respond differently to such ambiguous loss and everyone must find a way to cope in a way that makes sense for them. Regardless, the overarching uncertainty of the situation often leads to prolonged grief and feelings of anxiety and helplessness.  Boss calls this “frozen grief” and highlights the pain behind “leaving without goodbye” (as in the case of missing persons) and “goodbye without leaving” (as in the case of losing someone to a condition like dementia).

How to cope: revising expectations and adjusting to a new reality

So how can we cope with ambiguous loss? Boss recommends naming the ambiguous loss and labeling the situation as such as a first step in acknowledging and validating the experience and the associated host of feelings.  She also encourages people to find ways to live with the uncertainty and the changes brought on by the loss by revising your own expectations to reflect the new reality (as opposed to being in denial).  For example, the wife of a formerly active husband who has been diagnosed with Alzeheimer’s disease may now have to revise her expectations that they will continue to live the active lifestyle they had grown accustomed to, filled with outdoor activities and travels.  She may have to learn to revise her expectations that though they may be able to enjoy some quiet moments together she would have to fulfill her needs for the outdoors and social engagement in a new way – by perhaps dedicating a day in the week where she can take part in such activities while her husband is in the care of someone else.

As she grows into the new reality, she can hopefully find moments of joy and hope in this new phase of her life.  This may take time and grieving of what once was – and that is absolutely to be expected.  The key will be to learn to not only accept the uncertainty but also be able to take empowered action so that her focus shifts away from the uncertain aspects in her life (for example the progression of the disease) to aspects that are within her control (for example how she chooses to take care of herself or the support system she creates for herself).  The support system she builds may include support groups of people going through similar experiences, friends, family, and/or a therapist, who can help her work through the range of emotions she is likely to experience.  In my practice, I work with grief – ambiguous and unambiguous – as it impacts not only individuals but also in couples and families.

Any loss, ambiguous or unambiguous, can be traumatic. As the preeminent trauma researcher and psychologist Peter Levine has said: trauma is not what happens to us but what happens inside of us in the absence of an empathetic witness – and a support system can serve as that empathetic witness.

Member submitted article about therapy.

What does it mean to be a therapist?

What happens when someone discloses about killing someone in therapy? Has that happened to you yet? Talk about getting out of my comfort zone! As therapists, we hold a sacred career; we are holders of deep dark secrets and keepers of some of the most untold stories in the world. We carry the power to love people through some of the hardest times of their lives and help them through some horrendous shame and pain. 

I truly believe people are good at the core of themselves, but the world really knows how to be cruel to mankind. There is so much pain, fear and hurt in this world caused by other broken and unhealed people and as therapists we get the privilege to be there to help those that are wounded and broken to open up and get free of some of that bondage. I genuinely love my job, even though sometimes it can be heavy and difficult to hold the pain of others at times. 

The Transformative Power of Therapy

Over the years of practicing as a therapist, I have learned that people are not their behaviors and at the core, they are good. I’ve also learned that people are separate from their behaviors and if I can just get clients to see that, then half the battle is over. As children, we embody a beautiful innocence, purity, and joy that is truly contagious. So, believing that depression, anxiety, or fear defines us, or that our past behaviors determine our identity, is not aligned with who we are truly meant to be. I approach therapy this way and always strive to never judge my clients and instead help them to disassociate from the negative behaviors that they hate about themselves so that we can both as a team judge the behaviors and then decide if they are serving them or not. Some behaviors that others may judge as dysfunctional are actually serving a purpose of survival in that person’s life, or at least they use to when they were a child, or perhaps when they were in a bad relationship. However, in most cases, as adults those bad behaviors that we picked up as children to self-protect are now no longer needed and are just being used in our lives to self-sabotage, not realizing that we are all grown up now and have the ability to change those behaviors because we are no longer powerless like we were when we were children. 

Can people be evil?

It’s important to remember that when we see people’s actions that seem reprehensible or unforgivable; to take a step back and ponder why and wonder if those actions are coming from some deep unprocessed pain, unmet need, or trauma. Choosing to see from this perspective of compassion and love doesn’t mean we justify bad behavior, but instead; we can understand it and empathize with how one could use actions that could seem horrendous to an outsider. While killing someone is never right; knowing the deep dark secrets and pain that lead to that point can create a lens to embrace understanding as to why someone could get to that point. Can people be evil? Yes, some people can choose to live in pain and never look for healing and it can lead down to a dark path at time, so understand that I know there is another perspective to what I’m writing about. 

Healing is our responsibility.

In a world with so much evil it can become easy to let ourselves fall into cynicism, criticalness and despair. However, by allowing our love and compassion to come into the parts of a person that’s hidden and living in shame, we empower that person to decide to embrace a higher reality of who they truly are. We can create an environment that allows a person to fight for a greater identity and value system and let go of the old identity that holds those behaviors that are no longer serving them. 

Important Notice

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