Celebrating Thanksgiving During a Pandemic

Thanksgiving is my favorite holiday. My family loves to cook, and we all prepare special dishes for the holiday. In addition to my culinary responsibilities. I am the annoying aunt that reminds all my nieces to tell us what they are grateful for. Before dinner I take our annual family photo and after dinner, we take the dogs for a long walk prior to returning home for dessert.

This year we are trying to figure out how early to eat so we can sit outside without being too cold. We are using paper plates to avoid having lots of people in the kitchen. The family has decided to divide into two pods because my cousin’s college-age children have been more social than the adults. There are several members with compromised immune systems so we may have to skip the photograph and spread out when we walk the dogs.

Each person in the family is chiming in with ideas about how to keep safe during this time, the main point is that we all want to be together; we have been together every year since I moved to California in 1990 and we don’t want to be apart.

My clients are struggling with these same decisions and my job is to help them explore their emotions and make the choice that best suits them. I’m not a scientist, doctor or an expert on COVID-19, but I am a psychotherapist, and I can help them express the feelings that arise as we enter into our ninth month of this pandemic. I’m sad that this Thanksgiving will be different, but I am grateful for my family and the opportunity to be together this year. I wish you and your family a safe and happy Thanksgiving.

Photo by Nancy Hann on Unsplash

Navigating 12-Step Referrals

I specialize in trauma and addictions and often recommend 12-Step meetings to my clients. These meetings offer free support for people trying to recover from alcoholism and many other process addictions. There are also programs like Al-Anon, Coda and SLAA that help clients examine their self-destructive patterns in relationships. I keep a variety of 12-Step literature on hand for clients who may not be ready for meetings but are open to learning about them. Often, I plant the seed of a suggestion that they may be ready to receive in the future.

Many of my clients are hesitant to attend 12-Step meetings. Below are some helpful facts in case you are faced with similar resistance.

1. It’s not for me because it’s a religious program. This is the most common response and many of my clients have experienced religious trauma which may make it impossible for them to consider 12-Step meetings. I explain that Alcoholics Anonymous (AA) which was the first 12-Step Program, was highly influenced by The Oxford group in the 1930s, a Christian movement popular in the United States and Europe in the early 20th century. Members of the Oxford Group practiced a formula of self-improvement by performing self-inventory, admitting wrongs, making amends, using prayer and meditation, and carrying the message to others.  AA is not a religious program and there is no requirement that members believe in God. AA encourages members to search for a god (higher power) of their own understanding and suggests using the AA group itself as a higher power if that feels more comfortable.

2. I don’t consider myself an alcoholic and I am not sure I want to stop drinking. AA’s third tradition states that the only requirement for membership is a desire to stop drinking. I suggest that my clients attend meetings with an open mind and try not to drink right before the meeting. This is just a suggestion because people are welcome at meetings whether they are drinking or not.

3. I heard that you must have a sponsor to be in AA.  I explain that sponsors are suggested but not required. Most of my clients find it hard to trust other people, based on their childhood. I explain that a sponsor is not required in the beginning and I’ll offer to support them in their recovery until they find the right person; this often provides fruitful clinical material for us and eventually they do find someone. If someone is already attending meetings, I’ll encourage them to find a temporary sponsor and give themselves time to get to know the person before committing to sponsorship.

4. I’ve tried meetings and there are no good meetings in Los Angeles.  There are over 350 meetings a day in Los Angeles. I encourage people to try five or six different meetings before deciding whether the program is for them. I offer to go through the online meeting directory and help them find a meeting.  

If your client is not interested in going to the meetings, join with their resistance. In Dr. Larry Heller’s NARM model, we view working with a client’s resistance as a way to foster agency; the resistance is not viewed as something negative.  We are not telling the client what to do, we are helping them explore the way their own choices may reflect their childhood survival styles. I’m interested in helping my clients explore the psychobiological implications of holding onto to these early fixed thoughts and behaviors.
As a therapist specializing in addiction, I know that 12-Step is not the only way.  Many of my clients prefer group therapy, but this is often not enough for clients who are in early recovery.  There’s also SMART Recovery which has been around since 1994, this offers a more cognitive based approach and there is no spiritual component.

Clients need support more than ever during these times and 12-Step meetings are happening online. Here are the links to Alcoholics Anonymous meetings in Los Angeles lacoaa.org and Al-Anon alanonla.org. I’m interested in supporting you as you navigate these tricky conversations, feel free to reach out to me via email
(therapy@mariagray.net) if you need help.

Buckets of Money

Most people are uncomfortable talking about money and I’m committed to helping my clients understand the psychology of money and the impact it has on our lives. I’ve read many books about money and I’m fascinated by the way our attitudes about money and worth influence our countertransference and the fee setting process. One of my favorite money books is Bari Tessler’s- The Art of Money. Tessler is a somatically trained financial therapist who teaches a yearlong online money course which I took several years ago. One of the many valuable practices I learned was to divide my money into separate “buckets”. These buckets help me organized my finances and avoid “surprises” at tax time.

My first bucket is a business savings accounts labelled “quarterlies”, I transfer money to this account every week so that when the end of the quarter comes, I have enough money to pay my taxes. My second business savings account is labelled Gray’s Bank which I use for my rainy-day fund to cover me during slower times and to save money for training and other “big ticket” expenses.

I use the same system to manage my personal finances, and the structure is based on my personal values and interests. I value fitness and I invest in yoga and Pilates classes (currently online) which I purchase in packs of 20. I’ve created an account called “Pilates and Property Tax” for my property taxes, yoga and Pilates, and an “Adventures” account that I use to save for vacations. In the past I’d charge my vacations on a credit card which resulted in having to pay off a large debt when I returned home. Now I have the money ready and I can pay for my vacations immediately without any pressure.  I have a main savings account where I’ve saved six months of living expenses. Most financial professionals recommend saving at least a year of expenses, so I’m working on building up that account. 

Maybe this sounds like too many accounts to you, perhaps you’d prefer just one or two. I’ve found that paying myself first and planning for emergencies, vacations, fitness expenses and taxes has created more ease in my financial life. It helps me manage the ebbs and flows of income that come with being self-employed.  What buckets might you use if you were organizing your money this way?

Rest: Why You Get More Done When You Work Less

I’m currently reading a book entitled “Rest: Why You Get More Done When You Work Less” by Alex Soojung-Kim Pang, which explores our relationship to rest and work. Pang is the author of four books and the founder of Strategy and Rest, a consultancy devoted to helping companies and individuals harness the power of rest to shorten our workdays, while staying focused and productive.

Pang believes that you can work better if you learn how to rest better, he challenges our culture’s “respect” for overwork, citing William James’s 1899 essay “Gospel of Relaxation” in which he argued that Americans had become accustomed to overwork and lived with an “inner panting and expectancy” bringing a spirit of “breathlessness and tension’ to work. James could have been describing my years working in the corporate world, prior to following my calling and changing careers.

I enjoy being a psychotherapist and have found that I am at my best when my days are shorter and include a long midday break. I see clients Monday through Thursday and use Fridays for administrative work, yoga/walks and Brainspotting consultation. In the early days of my practice, I was more interested in creating a sustainable business than focusing on work/life balance, so I worked on Saturdays and late into the evening; this was hard for me but it helped me grow my practice. Now that my practice is established, I can see clients during the hours that work better for me. I have more energy in the mornings, so I schedule more sessions early in the day, followed by a ninety-minute lunch break and two clients in the afternoon.

Pang states “If you want rest, you have to take it. You have to resist the lure of busyness, make time for rest, take it seriously, and protect it from a world that is intent on stealing it.”

I wrote this post shortly after returning home from five glorious days in Santa Barbara, the place where I go to hike, bike, eat delicious food and rest. Prior to the pandemic I scheduled time off every three months and this vacation was my first in six months. When I decided to plan a trip, I spoke to my primary care physician and she advised me about how to stay healthy during the trip. My five days felt blissful, with no access to email or voicemail and most of my time spent out in nature.

As a therapist, I sometimes experience a sense of “fullness” at the end of the day where I cannot imagine taking in any more information. It feels like my mind needs to be emptied and time away from work creates room in my brain and body; Pang’s book cites research explaining how rest can create space in our brains for creative thinking. Sometimes just a small amount of restful, quiet space is all I need after a busy day. I like to create a clear divide between my sessions and my evenings, sometimes I’ll take a short walk or sit outside on my patio. I notice that on the nights when I don’t have enough quiet time after work, I struggle to stay asleep. Pang explains “While you sleep, your brain is busy consolidating memories, repairing physical damage, and generating dreams. Most of the time you’re not aware of all this work, but it’s been going on your whole life. And your life depends on it.”

Are you allowing yourself enough time to rest?

Are We There Yet? Deciding When to Return to In-Person Sessions

Throughout the pandemic therapists have been engaged in social media debates about when/how to return to in-person sessions with their clients. I’m writing my article after watching a video where the Executive Director of CAMFT, Nabil El-Ghoroury, PhD, CAE weighed in about seeing clients in-person during the quarantine. He suggested we carefully consider the decision and cautioned his readers not to pressure themselves into making a hasty decision. El-Ghoroury stated that he planned to continue to see clients via telemedicine through Labor Day and would revisit his choice at that time. After watching his video, I took some time to reflect on the logistics of in-person sessions; my feelings about it deserve a separate blog post.

I knew I wasn’t ready to return yet, but I wanted to consider my options for the future and writing this post helped me gather my thoughts. The first question was masks. Right now, I wear a mask when I am out in public, except for my early morning runs when very few people are outside and the world seems almost normal. The thought of wearing a mask does not feel conducive to my work as a trauma therapist, where facial expressions help me attune to what’s happening inside of my clients and my face helps regulate their nervous systems. Some of my clients choose not to wear a mask, how would that work?

I’m concerned that my clients’ journey from their cars to my therapy room could be activating. We have seven offices in our suite and approximately twenty other suites in our large, three-story building. As I considered the entrance to the building, keypad, and elevators, I realized that on the way to my office my clients could encounter people who might not be wearing masks or practicing social distancing; I wondered how these encounters might impact their sessions, there would certainly be “grist for the mill.”

Antibacterial wipes would be available at the entrance to the suite. Once they made it to my office, clients could text me to bypass the waiting room and I could meet them in the outer hall. How would we handle it if another person’s client was walking out when I was escorting my client in? There is no way to stagger the schedules of seven clinicians, even if we all started and ended our sessions precisely on time, which is never going to happen.

Once we made it to my office, I imagined my chair being six feet away from my client, which feels way too far. To handle the credit card payment I’d have to roll my chair over to my client, and once they handed me the card I could swipe it, show them the amount on the screen and sign for them. Once I gave the card back, we could have another round of hand sanitizer. I realize I can keep a credit card on file, however, the fees are significantly more expensive, and it eliminates the chance to explore any potential financial transference as the client pays for their session.

I decided to ask my doctor for some recommendations, and she strongly recommended that I wear a mask at all times and require my clients to wear a mask. She advised me to wash my hands frequently and use antibacterial hand disinfectant with 70% alcohol. She told me to avoid touching my face and to wash my hands after touching any door handles.

Writing this article has helped me see that there is no magic business process that will allow me to feel perfectly comfortable returning to in-person sessions. We all have different opinions about this issue, and it can feel adversarial when colleagues communicate their judgment on social media. Writing this article has led me to decide to continue to practice telemedicine (via ZOOM) for now. Although it presents some challenges, I have been able to do important, clinical work during this time. Two weeks ago, I returned to the comfort of my air conditioned, quiet office, away from the many distractions at home and the noise of my neighbor’s bathroom remodel. I’m wearing my mask, washing my hands and using antibacterial wipes on the door handles. My doctor’s suggestions proved to be helpful as I navigated the reentry process, sharing a restroom and elevators with other people.

I will continue to reevaluate my decision as I learn more about the Covid-19 virus. I know there is no perfect solution, but it’s clear to me that I don’t want to do therapy with a mask on and I am not willing to risk my health or the health of my clients in order to see them in person. I’m interested in your ideas about this and would welcome a discussion.