Avoidance of Pain

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Avoidance of Pain

January 24, 2024 | Katie Lawliss, Psy.D. | 5 min. read

As human beings, our survival instincts lead us to avoid pain. While it makes sense to avoid pain in the sense that touching fire would hurt and burn us, we have begun to apply avoiding pain too broadly.

“Pain is inevitable. Suffering is optional.” — Haruki Murakami

Avoidance of Pain OMHG Blog

There is a big difference between pain and suffering.

When we apply the idea that we should avoid pain too broadly, it has led us to avoiding sadness, anger, disappointment, vulnerability, and more. To avoid pain, oftentimes means to not engage with what is meaningful.

To love, oftentimes means to be sad, angry, disappointed, anxious, and unsure. No matter how secure a relationship is, there will be times when your partner disappoints you, you may be mad at them, or feel sadness when something goes differently than planned. If you were to not open yourself up to the inevitable pain, you would not be vulnerable enough to have a deep close relationship with anyone.

Without acceptance of the fact that pain is inevitable, people tend to be very risk averse.

Wanting to avoid pain may mean that you do not open your own business, buy a house, move across the country, build a family, or even call an old friend. All things in life come with the possibility of pain but we often trick ourselves into believing that if we can control our life enough, we can avoid pain.

In Acceptance and Commitment Therapy, there is a distinction between “clean pain” and “dirty pain”. Clean pain is the pain itself, the discomfort, the emotion that feels uncomfortable. Dirty pain is the feelings about the clean pain, which is where suffering lies.

Have you ever beaten yourself up for feeling disappointed or anxious? Maybe you are nervous to bring up something a friend said that hurt your feelings, and you say to yourself “It is stupid that I am even upset about this” or “Why am I always nervous to be assertive, I am so mad at myself for being anxious about this”. That is dirty pain, your feelings about the initial feeling.

There is freedom in allowing yourself to experience pain and to do so without following it up with judgment about your reaction to pain.

Consider all that you have done in life to avoid pain, what have you missed out on due to this? Consider the times you have experienced pain, how did you react to the fact that you had a reaction to pain, that you experienced pain in the first place? What might your life look like if you opened yourself up to the inevitability of pain and did not judge yourself? Has it been effective to judge your reaction to pain? Has it been effective to avoid or work to get rid of feelings and experiences that are uncomfortable? Has this led to a more meaningful life?

Notice how the world has sold us that the idea that avoiding pain is not only a worthwhile goal, but an attainable one. Going forward, notice what messages you receive from the world about pain and look at it in a new lens given the questions I asked above. I think you may notice the importance of not only knowing that pain is inevitable but allowing yourself to experience it. You are more resilient and capable than you think and living with the knowledge that pain is inevitable will open you up to new experiences and add to your purpose.

If you find yourself struggling with this shift, talk to a therapist about it, explore the concept with your friends or family, do more research on how to live a meaningful life and cope with discomfort.

Our therapists at Orchard Mental Health Group are happy to help you navigate through life’s pain and be more accepting of yourself in the process.

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Understanding Microaggressions as a White Person

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Understanding Microaggressions as a White Person

January 22, 2024 | Katie Lawliss, Psy.D. | 7 min. read

The term racial microaggression is defined as “brief, everyday exchanges that send denigrating messages to people of color because they belong to a racial minority group” (Sue et al, 2007).

Unfortunately, people of color experience microaggressions in their everyday lives. White people commit microaggressions, even without knowing.

My hope is that by gaining a better understanding of what microaggressions really are, white people can do better to ensure they are not causing harm from their biases

Understanding Microaggressions as a White Person OMHG Blog

Monnica T. Williams named sixteen categories of racial microaggressions.

  1. Not a true citizen: reinforcing notions that non-white people are not American
  2. Racial categorization and sameness: The push to categorize people into a “one size fits all” racial box that neglects the complexity of identity
  3. Assumptions about intelligence, competence, or status: assumptions based on someone’s racial and ethnic background that is based in stereotypes
  4. False color-blindness/invalidation racial or ethnic identity: the idea that an individual’s racial ethnic identity should not be acknowledged or recognized leading to invalidation
  5. Criminality or dangerousness: the stereotype that people of color are more likely to commit crimes or cause bodily harm to others
  6. Denial of individual racism: attempting to make a case that they are not racially biased
  7. Myth of meritocracy/race is irrelevant for success: denying that white privilege has impacted their success and contributes success to only their personal efforts
  8. Reverse racism hostility: hostility related to feelings that people of color are given unfair advantages due to their race and therefore white people are being treated unjustly
  9. Pathologizing minority culture or experience: criticism of cultural differences
  10. Second class citizen/ignored: a lack of respect, consideration, and care for people of color
  11. Tokenism: using a person of color to promote the illusion of inclusivity, rather than the qualities or talents of the individual
  12. Attempting to connect using stereotypes: using stereotyped ethnic speech or behavior to be understood and accepted
  13. Exoticism or eroticization: interacting with people of color according to sexualized stereotypes or categorizing their characteristics as exotic in some way
  14. Avoidance and distancing: measures taken to prevent physical contact or closeness
  15. Environmental exclusion: a lack of representation in decorations, literature, media, and more
  16. Environmental attacks: when decorations or depictions are knowingly affronting or insulting to a person’s culture, heritage, or history.

As a white person, we may notice certain categories of microaggressions more than others and overall, we are less likely to notice microaggressions at all. However, according to research conducted by Monnica T. Williams, microaggressions are stressful, anxiety producing, and traumatizing.

Here are some examples of microaggressions that may seem less obvious:

“I would have never guessed you were valedictorian”— this disbelief comes from the racially charged stereotype that Black people are not seen as intelligent. This falls under the microaggression category of assumptions about intelligence, competence, or status.

“All lives matter” — This is invalidating a person’s race being part of their identity to be considered and celebrated, and is an invalidation of the unique struggles that come with being a minority. This falls under the false color-blindness/invalidation racial or ethnic identity category of microaggressions.

“You speak so well, you sound white”— This demonstrates the racially charged idea that whiteness is preferred. Statements like this are examples of pathologizing minority culture and appearance.

“People are racist towards white people. White people are the ones being targeted and canceled now” — This is an example of reverse racism hostility. It neglects the historical and current privileges white people have and the current and historical oppression of people of color.

“I believe that the most qualified person should get the job”— This is the myth of meritocracy and downplays the disadvantages that people of color experience due their race. Therefore insinuating that people of color just need to work harder to get where they want to be.

I encourage you to think about what microaggressions you may be committing without realizing, as well as identifying the microaggressions that you observe from the people around you. Notice what it is like to gain an understanding of the ways stereotypes and white supremacy have infiltrated what you say to others, even unintentionally. This may feel anxiety provoking at first, or you may feel avoidant of engaging with this at all. Notice what thoughts you have when you consider how you can be more mindful of the words you say and educate others on how their words may be harmful. I encourage you to move through the discomfort and make a choice that can help you grow and help those around you feel safer. We can all do better and we need to start by trying.

References:

Williams, M. T. (2020). Managing microaggressions: Addressing everyday racism in therapeutic spaces. Oxford University Press.

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What is Acceptance and Commitment Therapy?

Home » Blog » What is Acceptance and Commitment Therapy?

What is Acceptance and Commitment Therapy?

December 20, 2023 | Katie Lawliss, Psy.D | 15 min. read

What is Acceptance and Commitment Therapy (ACT) OMHG Blog

Acceptance and Commitment Therapy, called ACT (said like the word “act” rather than A-C-T) is a type of therapy that was created by Steven C. Hayes.

It is deemed the “cousin” of Cognitive Behavioral Therapy (CBT) because it has some similar underpinnings to CBT in that it incorporates both cognitive and behavioral aspects, but looks at behavior and cognitions through a different lens. ACT also finds inspiration through Buddhist teachings.

The therapeutic goal of ACT is psychological flexibility, which means you are capable of staying present to the present moment and all it encompasses, including painful or unpleasant experiences, and adapting to the moment in a way that allows you to live a meaningful life. This philosophy means that we are not able to control what thoughts and sensations we have; rather unpleasant thoughts and sensations will always be present.

But we can change our relationship to thoughts, emotions, and sensations in a way that enables us to move through the discomfort and towards what is meaningful to us.

This differs from CBT in that CBT aims at replacing dysfunctional constructs with more flexible and adaptive cognitions by restructuring. ACT does not focus on replacing, but rather bearing witness to and acknowledging, which in itself leads to positive psychological change.

ACT is based on six core processes that lead to the therapeutic goal of psychological flexibility. The six core processes are:

  • Acceptance
  • Present Focus
  • Cognitive Defusion
  • Values (see my past blog on values here.)
  • Committed action
  • Self as Context

The name, Acceptance and Commitment Therapy names itself after two of the six core concepts of ACT, acceptance and commitment. The word “acceptance” sometimes brings both confusion to what ACT really is because it is not simply accepting everything and anything.

Acceptance in ACT does not mean accepting someone’s abusive behavior, or accepting your circumstances in life and not doing anything about it.

Those who use ACT as a theoretical approach to therapy often refer to acceptance as willingness instead because it better encapsulates what acceptance means. It boils down to, are you willing to experience discomfort in order to live a meaningful life? To be psychologically flexible, you need to be open to life experiences.

The second process in the name ACT, is committed actions. Committed actions is one of the main behavioral components of ACT.

Committed action means actually engaging in behaviors that are in line with your values. It is important to know your values but to live meaningfully means to do things that are towards your values, another one of the core processes of ACT. Your values are what is most important to you in life. The blog that is linked above explains values in more detail but the basic idea is “What do I hope someone will say about me and how I lived my life by the time I turn 80?”. That question leads us to understand what our values are and what we want to live our life doing. Through knowing our values, we can then identify actions that help us live in line with what matters most to us, which is committed action.

Present focus is the process that is more well known in ACT, because present focus is mindfulness.

Mindfulness means to be present in the moment without judgment. To be psychologically flexible, we need to be able to be psychologically, consciously, present and engaging in the moment. This can be hard to do because people are prone to avoiding discomfort as it is unpleasant, but it is essential to making change in life.

Another core process of ACT is Cognitive Defusion.

Fusion, as we know it outside of ACT, means the process or result of joining two or more things into a single entity. ACT focuses on how we fuse with our thoughts and the impacts this has on us. We all have an inner dialogue in our minds and when we are cognitively fused, it means we are taking our thoughts as truth, which causes us to get caught up in our thoughts or give them more meaning than they are worth. This means that if I have the thought that people will not like this blog post, I take that as the truth and therefore feel upset and stressed by it.

Cognitive Defusion means that we can acknowledge that our thoughts are simply thoughts, not always true, and do not need to hold the meaning we give them.

We can instead step back,notice and watch our thinking, and recognize thoughts as simply thoughts. This gives us more flexibility and freedom.

Finally, Self-as-Context is one of the core processes.

This process can be a little difficult to explain at first but Self-as-Context is the identification that we are not defined by our thoughts, emotions, and sensations. The opposite of this, is Self-as-Content, which means that our sense of self is fused with what we are experiencing. If it is raining outside, the sky does not change what it is. If it is 75 degrees and sunny, the sky does not change who it is, because the sky is the sky regardless of the weather. The weather does not change what the sky is. The weather may change around it and the conditions may differ day to day, hour to hour, but the sky remains the sky throughout. Self-as-context is the recognition that we are the sky, not the weather. As you go through life, your thoughts, emotions, and even roles may change, but the core “you” does not. That stability of a sense of self is an important part of psychological flexibility.

There are pros and cons to every type of approach to therapy.

However, I find ACT is a valuable theoretical approach that is both validating of life’s experiences and enables positive growth and change for clients. If you are interested in seeing a therapist who incorporates ACT into their work, reach out to our front desk to see who may be a good fit for your needs.

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The Role of Inflammation in Depression

The Role of Inflammation in Depression

Research suggests a correlation between inflammation in the body and depression. It implies that mental health may be linked to physical health. Inflammation is the body’s response to an injury or infection, which fosters healing.

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Models of Disability

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The Three Models of Disability

November 17, 2024 | Katie Lawliss, Psy.D. | 7 min. read

The term disability is defined by the ADA as a person who has a physical or mental impairment that substantially limits one or more major life activities.

This includes people who have a record of such an impairment, even if they do not currently have a disability. It also includes individuals who do not have a disability but are regarded as having a disability (1). This definition is intended for use in the legal world. However, the ADA definition of disability is what most people think of when they hear the word disability. After exploring the models of disability, there may be a better way to define disability.

Models of Disability OMHG Blog

A model of disability means a way of conceptualizing disabilities.

While there are many models of disability, there are three main models of disability that are used today. These include the Medical Model, Functional Model, and Social Model. 

First, the Medical Model of disability describes disability as a consequence of a health condition, disease, or caused by trauma that disrupts a person’s wellbeing.

In other words, the Medical Model views disability as a defect within an individual that needs to be cured or fixed in order to have a high quality of life. The medical model considers the concept of an average person and determines that deviations from the “average person” indicate a need for correction. This model therefore assumes that disability is inherently negative. 

Second, the Functional Model of disability also conceptualizes disability as an impairment or deficit and focuses on the functional limitations.

The view is that a disability itself limits the person’s functioning or ability to perform functional activities. The functional and medical models have some in common, mainly that the disability is viewed as something to fix about the person rather than look at systematic, cultural, and situational influences that impact functional limitations. The functional model focuses less on the underlying condition and instead focuses on restoring functional capacity. 

Finally, the third primary model of disability is the Social Model. The Social Model focuses on the barriers that disabled people face rather than the condition leading to impairment.

This model states that the person’s activities are limited by the environmental conditions rather than the underlying condition itself. In this case disability is defined as “the loss of limitation of opportunities to take part in the normal life of the community on an equal level with others due to physical and social barriers” (Barnes, 1991). The Social Model depathologizes disability by focusing on systematic and environmental concerns that lead to prejudice and discrimination, which truly causes disability.

Is it important for people to consider which model of disability they see the world from, and it could be a perspective that integrates aspects of the various models of disability.

Historically, psychology has mainly aligned itself with the Medical Model of disability, with some theoretical approaches leaning more towards the Functional Model. However, more recently as the field becomes more aware of its biases and prejudice, mental health practitioners are gaining a better understanding of the Social Model of disability which is important to the therapeutic relationship and therapy as a whole. 

If you are a person with a disability, consider how these models have affected your wellbeing and which you align with.

This can be an important topic to discuss with a therapist to gain a better understanding of how you view yourself and the world around you. I hope this language allows you to gain insight into your life and disability. If you are not someone with a disability, consider how your understanding of disability affects how you interact with the world and people with disabilities. While you may be currently able bodied, that may change over time and gaining insight into your beliefs about disability can be instrumental in your wellbeing going forward in life. 

  1. https://adata.org/faq/what-definition-disability-under-ada

  2. Evans, N. J., Broido, E. M., Brown, K. R., & Wilke, A. K. (2017). Disability in higher education: A social justice approach. Jossey-Bass, a Wiley Brand. 

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Will My Therapist Send Me to the Hospital?

Home » Blog » Will My Therapist Send Me to the Hospital?

Will My Therapist Send Me to the Hospital?

November 14, 2023 | Katie Lawliss, Psy.D. | 10 min. read

Trigger warning: discusses self-harm and suicidality.

First, please know that hospitalization is not done lightly. No therapist enjoys sending their clients to the emergency room. This blog will cover some of the reasons why a therapist may make the call to send their clients to the hospital.

Will my Therapist send me to the Hospital OMH Blog

When beginning therapy, a therapist should go over informed consent.

This typically includes practice policies and limits to confidentiality. During this conversation, your therapist will explain that one of the limits of confidentiality is if the client is in imminent danger to themselves or to someone else. This means that your therapist is legally allowed to not keep confidentiality if you are a danger to yourself or to someone else. With that in mind, what does it mean to be in imminent danger to yourself?

The topic of self harm and suicidality comes up frequently in therapy.

In fact, researchers have stated that almost a third of young people attending youth-orientated mental health services and participating in longitudinal research report some degree of suicidal ideation (Scott, Hermens, Naismeth et al., 2012). This study included 494 people between the ages of 12-30. It is not uncommon for adolescents and adults to have thoughts about killing themselves. It is common for those with suicidal thoughts to not engage with therapy so the actual number of people experiencing suicidal ideation is higher than 32%. 

However, oftentimes clients worry about what they can share with their therapist without alarming them to the point of being admitted to an inpatient hospital (or as the younger generation calls it, “grippy sock vacation” named after the type of socks you are given to wear in the hospital that are anti-slip). 

There are varying levels of self harm and suicidality that your therapist is assessing in these conversations to determine the level of risk you are to yourself.

A therapist may ask their client questions like “how often are you thinking about hurting yourself?”, “have you thought about how you would do it?”, “what are the reasons you have not hurt yourself?”, “do you have access to medication/firearms/etc.?” 

A therapist wants to understand how much time their client is spending thinking about hurting themself, if they have a plan, if they have access to means of harming themselves, and if they have intent on acting on their plan. If the answers to those questions cause a therapist significant alarm and feel like the only way to keep their client safe is to have the client go to the hospital, then that is when a therapist will make the call to do so. 

However, when there is cause for alarm but not imminent danger there are efforts to keep clients safe before enacting a plan to go to the hospital.

Examples of these types of plans include: phoning a friend/family member, who a client and their therapist explain the situation to so they can be of closer support; it could mean more frequent check ins with a therapist; it might be developing a safety plan; or referring the client to intensive outpatient treatment (multiple hours and multiple days a week of treatment) or partial hospitalization (spending days but not nights in a program at the hospital). The same line of questioning and assessment is indicated when a therapist believes a person is in imminent danger to someone else.

If a client tells a therapist that they have plans to seriously injure or kill someone else, the therapist will break confidentiality.

Appropriate measures will be taken to keep both their client and the other person safe. In some states, therapists also have a duty to warn. This means that beyond helping their client be safe, they need to protect the other person in danger. This may include notifying police, warning the intended victim, and/or taking other reasonable steps to protect the threatened individual. 

The other circumstance that may lead a therapist to send a client to the hospital falls under the same principals; however, the imminent danger to themselves or someone else is not related to suicidality or intent to harm someone else.

In the case that a client has seriously impaired judgment that could lead to harm to themselves or someone else a therapist may deem that going to the hospital is necessary. This could be due to mania, psychosis, or something else related to mental health. In this case, harm to self could look like being so impaired that the person can not see the danger of running into a busy street, inability to care for oneself, or worsening symptoms that require immediate stabilization. Danger to others may look like a client having the inability to accurately assess a situation that could seriously harm another person, hallucinations encouraging violence that the person believes due to psychosis, or physically injuring someone due to a break in reality, just to name a few. 

Therapists do not want to send you to the hospital; however, if going to the emergency room is going to keep you safe then they need to make that call.

Ideally, your therapist discusses the need to go to the emergency room and you agree to go with a trusted loved one. Unfortunately, if you do not agree to this arrangement, the therapist does have the ability to petition for emergency evaluation due to the present danger of hurting yourself or others. If this happens, you would be escorted to the emergency room by law enforcement. This is a last resort option and only used when it is imperative to your health and life. 

The goal of hospitalization is safety and stabilization. Being in the emergency room will keep a client safe during a crisis in a way that the therapist cannot outside of the hospital. The hospital is also able to administer and adjust medication quickly which will help with stabilization of symptoms. As therapists, we know the hospital is daunting and uncomfortable. We wish the inpatient mental health system had a better set up and was more useful therapeutically. However, its main use is keeping clients safe when nothing else will.

If you are concerned about your therapist sending you to the hospital, have a conversation about it.

Tell them your concerns and ask for a review about the limits to confidentiality. Your therapist cares about you and is looking out for your best interest, and this includes having open conversations about suicidality, self harm, thoughts about hurting others, and symptoms like mania and psychosis. Most conversations about these topics will not lead to hospitalization and they are important conversations to have with your therapist so they can best help you. 

Reference

Scott, E.M., Hermens, D.F., Naismith, S.L. et al. Thoughts of death or suicidal ideation are common in young people aged 12 to 30 years presenting for mental health care. BMC Psychiatry 12, 234 (2012). 

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