Understanding Grief

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Understanding Grief

June 22, 2024 | Jacob Moore, Ph.D. | 10 min. read

My name is Dr. Jacob Moore, and I am a licensed Psychology Associate.

I joined the practice as an extern in 2021, and I primarily work with adolescents and adults experiencing anxiety and/or trauma. I approach therapy with a trauma-informed, culturally-focused lens in an attempt to understand people as their complete and holistic selves. Additionally, I tend to adopt a collaborative and values-based approach to therapy; one that places an emphasis on a person’s lived experience and desire for change. Therapy is a true joy of mine, as are playing/listening to music, Dungeons and Dragons, and playing video games with my wife. At my core, I like to consider myself an ally, advocate, and a perpetual learner.

Mindful Lyrics Exploring Hip Hop's Therapeutic Effects | OMHG Blog

Death, and by extension loss, is one of the most taboo topics in US-based culture.

Despite anxiety being influenced by a fear of death, we do so many things to avoid discussing, thinking about, or referencing our own mortality. Although loss is often talked about in the context of death, it occurs much more frequently than we realize.

Essentially, wee experience loss when something, or someone, very dear to us is taken or removed from our lives.

And, although we do all we can to avoid its presence, loss is a regular and expected experience of our human condition. Whether it is the loss of a job, a home, our health, our family/friends, or even pets, loss is an assumption of living. That’s the trouble with loss; despite our best efforts we all likely have, and likely will, experience grief.

I know, right? Heavy stuff.

Because loss is to be expected, it is important to acknowledge and identify grief and its many faces. The popularized belief follows a five-stage model of grief. I’m sure you’ve heard this all before, right? Denial, Anger, Bargaining, Depression, and Acceptance. That’s the process! Everyone goes through these stages, one at a time, and then grief is gone. Problem solved! Well, it’s a little more complicated than that.

Understanding Grief OMHG Blog

First of all, we no longer use those five stages of grieving because grief cannot really be placed in a neat package.

Grief looks and acts differently across our individual experiences and even within people across experiences of grief. No two people will experience grief the same way, even within the same household. Therefore, we can expect people with different religious affiliations, nationalities, or any variation of identity to experience grief differently as well.

Second, we have come to understand grief as an interconnected process of phases, and choices.

Rather than stages, grief is a cycle of feelings, choices, and meaning making that individuals both move through, and control. So, while we all have naturally occurring feelings about our loss, we can also actively engage in this difficult process.

Uncomplicated grief, or grief “as usual” sees the person slowly but surely heal and grow.

Through appropriate acknowledgement of their feelings, support, encouragement, and a boatload of bravery, they would start to return to the things they love. No longer avoiding the contexts or situations that remind them of their loss, they can make meaning from the loss, and understand themselves just a bit better than before.

On the other hand, complicated grief, or “dysfunctional grief” sees a disruption in one or more of these processes.

We may withdraw from social engagement all together, may avoid applying for a new job, or putting ourselves back out into the world for fear of being hurt or experiencing loss again. Our conversations may center around the loss, months or even years later, and we cannot be consoled. We may focus on what went wrong, what could have changed, or even on how to get revenge on those that are perceived to have instigated the loss.

We can break down complicated grief into a (maybe not so) fun little acronym, DERAILERS:

  • Difficulty letting go of doubts that you did enough.
  • Embracing ideas about grief that make you want to change or control it.
  • Ruminating about ways that the death was unfair or wrong.
  • Anger and bitterness you can’t resolve or let go of.
  • If only” thoughts about imagined alternative scenarios.
  • Lack of faith in the possibility of a promising future.
  • Excessive efforts to avoid grief and/or reminders of the loss.
  • Resistance to letting others help, feeling hurt and alone.
  • Survivor guilt; it feels wrong or uncomfortable to be happy or satisfied.

Through a variety of reasons, folks with complicated grief remain stuck in loss. In this case, we would likely recommend therapy services to help grieve in a more adaptive way that allows for joy in a life beyond their loss.

Ultimately, we can expect grievers to grieve in their own way. The process takes time, and lots of bravery, but loss does eventually heal.

 

We’re here if you need to talk.

Orchard Mental Health Group is a large Maryland-based private practice with offices in Rockville, MD and Frederick, MD, providing affordable, accessible, research-informed counseling, assessment, and medication management services to children, adolescents, and adults.

Our counselors and therapists provide compassionate support to individuals coping with grief and loss. We understand that grief is a deeply personal journey, and there’s no “right” way to navigate it. We offer a safe space to explore your emotions, process the complexities of loss, and develop strategies for healing at your own pace. Whether you’re facing the loss of a loved one, a significant life change, or unresolved grief from the past, we’re here to walk alongside you, helping you find resilience and meaning as you move forward.

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Intuitive Eating: Changing Your Relationship With Food and Body Image

Home » Blog » Intuitive Eating: Changing Your Relationship With Food and Body Image

Intuitive Eating: Changing Your Relationship With Food and Body Image

June 15, 2023 | Katie Lawliss, Psy.D. | 10 min. read

What is intuitive eating? Dr. Tracy Tylka describes it as the unconditional permission to eat when hungry and to eat what foods are desired, eating for physical rather than emotional reasons, and reliance on internal hunger cues and satiety cues to determine when and how much to eat.

Intuitive eating has many benefits including higher self-esteem, well-being, optimism, body appreciation and acceptance, as well as psychological hardiness, life satisfaction, and many more.

Oftentimes, when someone first learns of Intuitive Eating and hears “eat what you want, when you want” their gut reaction is worry about weight gain and poor health. Embracing intuitive eating will require you to challenge these thoughts and beliefs, or at least acknowledge their existence and be willing to experience discomfort while trying something new.

Changing Your Relationship With Food and Body Image Through Intuitive Eating OMHG Blog

In the United States, we are surrounded by diet culture everywhere we look.

Can you remember the first time you noticed the societal pressure to eat and look a certain way? Maybe it was hearing a parent step on a scale and judge the number they saw, perhaps it was a comment about needing to work out to “earn” a slice of pizza later that evening, or maybe it was government programs aimed at “fighting obesity”. We are constantly getting messages that all have the same underlined and bolded idea, “fat is bad, thin is good.” This message is so ingrained in our culture that our health system practices outdated science which reinforces fatphobia, the negative beliefs and ideas we have about fat people and fat bodies.

BMI (body mass index) was never intended to be used in healthcare.

BMI was constructed by Adolph Quetelet in the 1830’s intending to find the “perfect human.” It was based on French and Scottish men, but then adopted by healthcare professionals as the “best” tool to assess health not for its accuracy, but for its ease of use in medicine and research. The BMI does not consider health behaviors or body composition. Therefore, it does not give an accurate picture of health. In your intuitive eating journey, you will learn to challenge these beliefs, which in turn is better for your health.

The principles of intuitive eating include honoring hunger, discovering the satisfaction factor, respecting fullness, making peace with food and gentle nutrition, challenging the Food Police, coping with your feelings with kindness, respecting your body, and joyful movement.

It may seem simple but two crucial principles of intuitive eating include honoring your hunger and respecting fullness. Unfortunately, most messages we have heard related to hunger and fullness include things like “don’t eat past 7 PM”, “drink a glass of water to feel more full so you do not eat more”, etc. This “advice” has made us less in touch with our biological feelings of hunger and fullness. Because of this, we need to relearn what hunger and fullness truly feel like. These feel differently for everyone and there are different levels of being hungry and full. The scale below shows the Hunger and Fullness Scale (image from Lauren Cadillac):

Intuitive Eating | Hunger and Fullness Scale Lauren Cadillac

The goal of intuitive eating is to eat when you are in the hungry sweet spot, before getting to the too hungry end of the spectrum, and to finish eating when you are in the sweet spot of fullness, rather than the too full end of the spectrum when you feel ill.

This requires practicing mindfulness within your body. By honoring your hunger and fullness, you are taking care of your body by giving it the energy it needs. The other principles like making peace with food, challenging the “food police”, and coping with emotions with kindness all help with honoring hunger and fullness. This is because there are a lot of reasons why we may not be in touch with our hunger/fullness cues and many reasons why we may not listen to these cues when we are aware of them.

Below are some ways that can help you be aware of your cues:

  1. You can pay attention to what foods are appealing to you and notice if you “allow” yourself to eat these foods or not. “Allowing” yourself means that you eat without guilt, shame, restriction on the amount you are eating and without a plan to “exercise it off” later.
  2. Give yourself permission to eat what is appealing to you. Notice if it is as satisfying as you imagined and begin to be mindful of what satisfies you while permitting yourself to eat those things.
  3. Be present while eating and notice how you talk to yourself during your meal. Step away from distractions and notice each bite and the thoughts that you have while you eat. This can give you a clearer picture of what Food Police thoughts you need to challenge and the areas that you can attend to with self-compassion.

Intuitive eating is a very different way of eating than you are likely used to!

It’s a journey. The benefits are well worth it and it can be uncomfortable along the way. It is important to remember there is no version of perfect in your pursuit of eating intuitively and to practice self-compassion as you try to unlearn messages you have received your whole life.

You can dive more into the practice of intuitive eating by reading Intuitive Eating: A Revolutionary Anti-Diet Approach by Evelyn Tribole and Elyse Resch, following social media accounts like @feelgooddietitian (Lauren Cadillac) on Instagram, or finding a therapist who has an understanding of intuitive eating and can help guide you through the principles and process the experience in therapy sessions.

References:

School of Public Health. Addressing weight stigma and fatphobia in public health | School of Public Health | University of Illinois Chicago. (n.d.).

Tribole, E., & Resch, E. (2020). Intuitive eating: A revolutionary anti-diet approach. St. Martin’s Essentials.

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What is a Psychological Evaluation?

Home » Blog » What is a Psychological Evaluation?

What is a Psychological Evaluation?

June 6, 2023 | Vanessa Buonopane, Psy.D. | 7 min. read

Hello and welcome to our blog! My name is Dr. Vanessa Buonopane and I am a clinical assessment psychologist at Orchard Mental Health Group.

I am part of the testing team at OMHG, where I primarily assess individuals of all ages for various neuropsychological concerns, including Attention-Deficit/Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), anxiety, and depression. I am also certified to provide gender-affirming care, as well as conduct evaluations prior to major surgeries and procedures.

If you are a parent or an adult wondering if you have some sort of neurodivergence, a psychological evaluation might be able to help you find answers.

An assessment psychologist conducts a series of “tests” to understand an individual’s cognitive and emotional functioning. In some cases, an assessment psychologist can assess academic skills and motor functioning too. While brain imaging (e.g., MRIs and CT scans) can show the structure of the brain, the tests in a psychological evaluation show the function of the brain. These tests can help us determine diagnoses and can aid in treatment planning.

Often, parents begin to notice their child is experiencing difficulties in school at the end of a grading period and want to be proactive about helping their child get back on track. They might notice that their child is having difficulties learning or paying attention in class. Sometimes, parents have seen emotional and behavioral issues persist for years and just had no idea about the clinical utility of a psychological evaluation. In other cases, many adults have experienced significant executive functioning challenges during the pandemic or even since childhood, and they want to understand what the underlying cause could be.

Boy with ADHD | What is ADHD?

Before I start any evaluation, I explain to my patients that “testing is not the same as the types of tests you might take in school where you have to study.

My tests are not ones you can study for and, unfortunately, I cannot tell you the answers to any of the questions. The only rule I have is that you try your best. This evaluation is not invasive and I am not hooking you up to any machines. I will simply ask you a ton of questions and have you complete a variety of tasks to understand how your brain works. From there, I can determine if there are any diagnoses that you might meet and what to do moving forward.” I allow each person to ask any questions before, during, and after the evaluation.

When you go to the doctor to have blood drawn, you might get your results back within a few days. Unfortunately, a psychological evaluation simply cannot be completed in the same timeframe.

There is a lot of thinking (and often research) that goes into each case, meaning it could take between two to three weeks to complete a psychological evaluation report. Many times, individuals request a psychological evaluation expecting to receive school or work accommodations following the evaluation; however, an assessment psychologist can only recommend accommodations and do not have any authority in the school or work setting. If you or your child needs accommodations to perform successfully, it is the assessment psychologist’s job to provide the evidence for those needs based on the individual’s performance. In any case, the results can provide answers and relief for many individuals, and the individual will typically be given recommendations to follow-up on to address their concerns.

Do you suspect that you or your child may have a type of neurodivergence? 

Orchard Mental Health Group is a large Maryland-based private practice with offices in Rockville, MD and Frederick, MD, providing affordable, accessible, research-informed counseling, assessment, and medication management services to children, adolescents, and adults.

Our assessment team provides comprehensive psychological evaluations to help individuals gain clarity and understanding about their mental health and cognitive functioning. Our skilled clinicians use evidence-based tools and techniques to assess a wide range of concerns, including ADHD, learning differences, mood disorders, and more. Each evaluation is tailored to the individual’s unique needs, offering detailed insights and actionable recommendations for treatment, accommodations, or support. Whether you’re seeking answers for yourself, a loved one, or a child, our compassionate team is here to guide you through the process with professionalism and care.

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True Relaxation

Home » Blog » True Relaxation

True Relaxation

May 26, 2023 | Katie Lawliss, Psy.D. | 12 min. read

When we think of what we do to relax, we tend to think of activities such as TV, baking, exercising, and more. While those are all identified by the general public as relaxation, oftentimes when mental health professionals refer to relaxation, we are discussing nervous system regulation.

True Relaxation - Fight or Flight

The mind-body connection is real.

When our mind is stressed, our body is stressed and the opposite is also true, when our body is giving off stress signals, our mind begins to feel stressed as well. Furthermore, by engaging in nervous system relaxation, we can help our mind and body feel more relaxed. This can be a great wellness “hack” because if you are not able to get your mind to calm down, you can work to get your body to relax which will in turn help your mind to relax.

Let’s dive into a brief overview of human anatomy to better understand why nervous relaxation is so important.

Relaxing, as in nervous system relaxation, is finding ways to tap into the parasympathetic nervous system. Our body has a complex system of nerves and cells that work together to send messages throughout the body. The nervous system can be broken down into two sides: the central nervous system and the peripheral nervous system. Within the peripheral nervous system, there is the autonomic nervous system, which regulates involuntary body processes like heart rate, blood pressure, respiration, and digestion. The autonomic nervous system contains three parts, the sympathetic, parasympathetic, and enteric nervous systems. You may know the sympathetic nervous system as the “fight or flight response.” The opposite of fight or flight is relaxation and restoration, which is the parasympathetic nervous system.

Being able to truly relax has many benefits including restorative sleep, decreased inflammation, as well as better memory, auditory processing, learning, sensory processing, and more.

A large amount of people spend more time in fight or flight mode in their day-to-day life than not. When you are driving in traffic and notice you are clenching your jaw, or you end the day with neck pain because your shoulders were tense all day, or maybe you found yourself overthinking all day, you are engaging your sympathetic nervous system.

When we are stressed, our bodies tend to have more muscle tension, our blood goes towards the center of our bodies leaving our fingers and toes colder, we sweat more, our heart rate gets faster, and our breathing gets more shallow. Each person tends to experience stress differently, but we all have the same basic body responses to stress. By engaging in true relaxation, via nervous system regulation, you are allowing yourself to engage your parasympathetic nervous system (i.e., relaxation and restoration), which benefits you in so many ways.

There are a few different ways we can tap into our parasympathetic nervous system. Practicing present focus without judgment, otherwise known as mindfulness, is a great way to regulate your nervous system.

Mindfulness can look like many different things. It can mean something more formal like listening to a guided body scan meditation that leads you to breathe more slowly and deeply while releasing muscle tension. It can also be more informal like sitting outside and noticing the feeling of the temperature of the air on your skin, the smell of the leaves, the sounds around you, and the taste of your tea in the morning. Both of these experiences can help you tap into your relaxation and restoration mode because they are slowing you down. By slowing down and taking ourselves out of the hustle and bustle of everyday life, we can better notice the ways our body and mind are experiencing stress and tailor our relaxation to them.

When learning to truly relax, there are a few “entry points”.

Two of the easier ways to tap into your parasympathetic nervous system are through breathing and muscle tension. There are a few ways you can modify your breathing to get out of fight or flight mode. The first is through slowing your breathing. You can use an online breath pacer to help you, like this one.

Online Breath Pacer Inhale - True Relaxation
Online Breath Pacer Exhale - True Relaxation

It is a great tool that allows you to change the timing of the visual pacer to fit your needs. You want to practice breathing slower and deeper, but not so slow that it makes you feel more tense. With trial and error, you can find the right pace for you.

Another way to adjust your breathing, to tap into the parasympathetic nervous system, is by breathing through your diaphragm rather than your upper chest.

To practice diaphragmatic breathing, lay on your back while wearing loose clothing and place a book on your stomach (not too heavy!). Focus on what parts of your body are moving when you breathe naturally, is the book moving upwards as you inhale and down as you exhale? If not, see if you can focus on trying to move the book, rather than your chest with each breath. It may feel uncomfortable at first, but it is something that takes practice to feel natural. You are not expected to breathe this way all day but practicing it, periodically, throughout the day and in times of stress will help your body relax, which in turn helps your mind relax.

Additionally, you can tap into your parasympathetic nervous system by releasing muscle tension.

You can do this through something called a body scan or progressive muscle relaxation. To use these techniques, you can use apps like InsightTimer or videos on youtube to hear guided practices that will teach you how to release your muscle tension and become more aware of it.

These are both skills that take time to learn and feel natural. Just like you would not expect yourself to feel natural on your first day learning to ice skate, you will not feel like a professional at these types of relaxation techniques at first either. If you find yourself struggling to relax in these ways on your own but think it could be beneficial, mention it to your therapist if you have one. If not, you can also find a biofeedback provider who can use electronic tools to help you gain better awareness of your body’s response to stress which helps these relaxation techniques become even more effective.

You can find a provider near you through https://www.bcia.org/consumers-find-a-practitioner or you can contact our front desk to try heart rate variability biofeedback at Orchard Mental Health Group.

So continue to enjoy your hobbies and try and incorporate some true relaxation into your days, the benefits are well worth it!

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Practicing Self-Compassion

Home » Blog » Practicing Self-Compassion

Practicing Self-Compassion

May 16, 2023 | Katie Lawliss, Psy.D. | 10 min. read

Hello! Welcome to our blog. My name is Dr. Katie Lawliss and I am a clinical psychologist at Orchard Mental Health.

I specialize in working with folks with chronic illness and chronic pain, as well as focusing on women’s health. Additionally, I enjoy working with all types of people with different concerns because I value creating strong therapeutic relationships that enable people to grow and gain insight into themselves. I deeply care about helping people have the best quality of life they can have and I hope this blog serves as one more way to help people achieve contentment. I am looking forward to sharing ideas that will help you attend to your health and wellness.

Practice Self Compassion OMHG Blog
Practice Self Compassion OMHG Blog

Dr. Kristin Neff first defined the term “self-compassion” as it is used today. Self-compassion is just how it sounds, experiencing and directing compassion toward yourself.

Most of us tend to be harshly critical of ourselves in a way that we would not be towards others. Essentially, self-compassion is how people emotionally respond to suffering, how they cognitively understand their situation, and how they pay attention to the suffering (Neff, 2016).

When making a harsh judgment of yourself, a common question a therapist may ask you is “Would you say this about a friend?”

I also find it powerful to ask, “How would you feel if I was the one to say that about you?” Imagine a person walking down the street passing you and saying, “You don’t do anything right and you are useless.” You would probably be shocked that someone would say that to you. However, we don’t feel shocked when we say it to ourselves. 

When negative self-criticism is in our voice in our head, it can sound very believable compared to what it would sound like coming from a stranger’s mouth on the street. So I ask clients (and you) to consider what it would be like to hear a stranger criticize themselves the way you criticize yourself. We have become so used to negative self-talk that we fail to see the harshness of it. While we may be used to this inner critical voice and not notice it often, it greatly impacts our emotional wellbeing. 

Self-compassion is a way to be kind and understanding to yourself.

Self-compassion is different from self-esteem in the sense that self-compassion is a way of relating to yourself rather than an evaluation of yourself. While self-compassion can help self-esteem in the long run, you can practice self-compassion no matter your self-esteem. 

One way to practice self-compassion is by considering what an unconditionally loving and wise friend, imaginary or not, would say to you about your perceived inadequacies and struggles. After considering this, see if you can say those words to yourself. 

For example, this friend might say “I see how much you go through every day and I see the energy you put forth. Even when you lose your temper, I know you are trying. I love you even when you express anger and I notice how you are working to express anger differently. I believe in you and know you will continue to work on this” after you tell them how you yelled at your significant other earlier that day or became impatient with your child before school. Now imagine what it would be like to say this to yourself. 

Some people worry that practicing self-compassion means they will not hold themselves accountable for their actions and wrongdoings.

However, self-compassion and accountability can go hand in hand. True accountability means willingness to do something differently in the future. Practicing self-compassion can lead to more willingness and ability to make actionable changes in the future because harsh, negative self-talk often inhibits our ability to change by taking away energy from the behavior that needs to change and using it on putting ourselves down. When we practice self-compassion, we are allowing ourselves to feel capable of making an ongoing change and reserving the energy for that actionable change, rather than using that energy on self-ridicule. 

For instance, in the example above, perhaps after yelling at your spouse, you typically beat yourself up and think of all the ways you make their life harder. Consider what it would be like if you said, “I see how much you go through every day and I see the energy you put forth. Even when you lose your temper, I know you are trying. I love you even when you express anger and I notice how you are working to express anger differently. I believe in you and know you will continue to work on this.” Would you be more likely to be able to communicate and apologize for yelling? Would you feel more motivated to keep working on how you express your anger and impatience?  I think you would be. Read more about the Impact of Strong Communication in a Marriage

As you practice saying these things to yourself, focus on the feelings of comfort and soothing that arise.

Sometimes, you may experience sadness or longing to hear this from others at the same time. You can practice compassion about that experience as well by saying something like, “I know you wish someone else was giving you this compassion. You inherently deserve this support no matter where it comes from.” As you practice this more and you are mindful of all the experiences you have in life, you will notice many chances to practice self-compassion.

The fact is you deserve to be cared for, encouraged, and supported. Self-compassion is the practice that allows you to do this for yourself. 

If you are interested in learning more about self-compassion, please visit Dr. Kristin Neff’s website

References:

Neff KD (2016) The Self-Compassion Scale is a valid and theoretically coherent measure of self-compassion. Mindfulness 7(1):264—74. 

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