Show me your elephant

Unresolved trauma is like an elephant. A big, clunky, loud creature that moves into your house and won’t go away. Every elephant is different, but the thing about elephants is that their presence, try as you might, is really hard to ignore. Elephants need a lot of time, care, and attention. You might have never planned to be an elephant owner; that was not part of your vision for your life—yet here you are: the reluctant owner of an elephant.

There are many reasons to avoid being around an elephant. Elephants are inconvenient, loud, and huge. Understandably, you may try to ignore the elephant, or tell yourself you don’t have time to deal with an elephant. Perhaps the elephant will give up and go away on its own. The more you avoid your elephant the needier it becomes—at some point it becomes so belligerent that you can no longer ignore it.

You might be excused for fearing an elephant if the only time you interact with it is when it’s misbehaving. It’s not the elephant’s fault that it’s a big animal (an average African elephant can weigh 7 tons). It’s not the elephant’s fault that it needs a lot of food (Did you know an average adult elephant can eat 300lbs of food in a day?). All the elephant knows is that it’s here and it has needs.

Elephants are pack animals. They are kind, intelligent, compassionate, and communal. Traumatized parts of our selves can hold beauty and wisdom. Traumatized parts need compassion and community to heal and be able to share their innate wisdom.

We all have our own elephants and even though some of our elephants are bigger or more belligerent than others, all our elephants deserve to be cared for. The goal behind good trauma treatment should not be to exile our elephants but rather to learn how to befriend them and care for them.

Activity suggestion:

Take some time to create your own elephant. This can be a drawing, a coloring book page, a collage or some other visual representation. Decide on your elephant’s color, size, and name. Add any features or accessories you think are important for your elephant to have. Carry a picture of your elephant with you as a gentle reminder to attend to yourself for as long as you need to.

As always, if you would like some support learning how to best care for your elephant, don’t hesitate to reach out.

When should you consider psychiatric medication?

I have found over the years that although I am not a psychiatrist, a significant part of my conversations with clients in therapy revolves around medications. Common concerns range from worries about addiction and side-effects to worries about losing parts of self because of the medication. I am not a doctor and recommend that you consult with a medical provider about any specific medication concerns, but I hope that this post can provide you with some pointers about how and when to have conversations with your medical provider and set realistic expectations about medications and medication management.

If you haven’t had a physical exam in over a year and are experiencing low energy, insomnia, hypersomnia, sudden changes in appetite, and/or digestive issues it’s a good idea to schedule a physical exam first to rule out physical health issues that could be contributing to mental health symptoms such as thyroid issues, anemia, and premenstrual dysphoric disorder.

Signs you may want to consider psychiatric medication:

1. If you are consistently working on trying to implement behavioral changes and failing due to emotional overwhelm.

2. You’ve implemented behavioral changes, but mood symptoms are continuing to significantly impact daily functioning.

3. Your symptoms are so severe you are unable to attend to daily tasks, you are experiencing manic symptoms, psychosis, and/or suicidal thoughts.

Topics to address with your psychiatrist/medication provider:

• Side effects of medications being prescribed and any previous experience with psychiatric medication.

• Expected benefits and timeline to see changes with medication. The most common medications prescribed tend to be anti-depressants, usually the SSRI kind (Selective Serotonin Reuptake Inhibitor), which take about a month to build up enough in your system for you to see changes. It’s important to have an accurate idea about the impact of medications so that you can accurately gauge whether the medication is working.

• Process for increasing or decreasing dosages and how to communicate concerns with your psychiatrist.

• Any other substances you might be using. This includes other prescription medications, marijuana, alcohol, caffeine, or any other drugs. Effectiveness and risks associated with psychiatric medications will be impacted based on whatever else you’re taking.

• Discuss any blood testing or other medical testing that might be needed with heavier duty medications. This usually applies to heavy duty mood stabilizers or anti-psychotics.

• Discuss any effects medications may have on appetite and sleep, particularly if you are taking stimulants or medications that might induce nausea for the first few days/weeks of taking them.

• Always consult with your provider before discontinuing medication or adjusting dosage.

What medications can do:

• Medications can help reduce the barrier to accessing behavioral changes needed to make lasting improvements in your life and ease long-term symptom management.

• Medications can reduce severity of mood symptoms biologically in order to allow you to make better cognitive decisions about your health.

• Medications can reduce frequency and intensity of very severe symptoms such as psychosis, mania, and panic attacks.

• Medications can help improve quality of sleep which will improve symptoms of depression, anxiety, PTSD, and ADHD.

What medications cannot do:

• Medications cannot address the quality of your interpersonal relationships.

• Medications cannot instantly make you feel happy all the time.

• Medications may not eliminate all mental health symptoms forever.

• Medications may not work the same way at the same dose forever.

• Medications impact different people in different ways, so what works for a friend or loved one may not work for you.

• Medications alone will not be enough if you are not also working to implement lifestyle changes.

Depending on your needs you may need medication for a short while to address a temporary situation or you may need a low or even high dose of medication depending on symptom severity, lifestyle changes, and chronic nature of your mental health condition. The reality is that there is no way to know for certain, but if you work closely with a trusted provider that you feel comfortable having open conversations with you can drastically improve your outcomes.

I want you to know that needing medication does not make you crazy, weak, incapable, or unreliable. Taking medications appropriately and with active support means that you are taking a necessary step to take care of and improve your health. Psychiatric medication is meant to be a supportive part of your journey. Unfortunately the stigma associated with it often prevents people from seeking necessary care which does a disservice to everyone. Remember that your journey will be unique to you and don’t hesitate to reach out for support if you want to learn more about how therapy can help!

Unpacking Emotions

You are likely familiar with the terms “processing” or “unpacking” emotions if you’ve ever been to therapy, or possibly browsed inspirational posts on Instagram. These are terms we use and hear fairly often, but rarely do we get to really dive into what they mean.

Emotions are made up of different “parts” that come together to create a larger experience. For example: when we experience anger, the neurochemistry in our brains creates physical sensations such as muscle tension, increased blood flow, and changes in body temperature. We also experience thoughts related to the situation we are angry about; we might find ourselves ruminating about whatever caused us to get angry in the first place. We may also exhibit external behaviors such as pacing, yelling, etc.

When we “unpack” these emotions we need to look at each of the components to better understand the whole. In addition to examining the emotion in the moment, it can also be helpful to look at patterns. For example, when have you seen this emotion show up in other parts of your life. What did you learn about this emotion growing up in your family of origin? How have you handled this emotion in the past? What other emotions does this emotion bring up for you? (i.e. how do you feel about the fact that you feel angry). This requires us to cultivate what’s called an “observer mindset.”

Here’s a quick mindfulness practice to help you get started:

• Begin by finding a comfortable place to sit or lie down. Take a few deep inhales through your nose and out through your mouth. You want to feel your belly moving.

• Notice your body. Locate a space in your body that feels grounded, neutral, or calm. If this is hard to do, you might just focus on the cool air as you breathe in and the warm air as you breathe out.

• Now come back to the feeling you are trying to unpack. Notice where in your body you feel that. It might be in your chest, your throat, your shoulders or somewhere else.

• When you can connect with that physical sensation allow yourself to vacillate back and forth between the space that feels grounded and the space where you feel the emotion. The key here is to not try to change the emotion or physical sensation but just allow yourself to observe and describe what you notice happening.

• Stay here as long as you like. I recommend about 5-10 minutes. Once you’re done take some time to reflect on what you observed. Notice the thoughts, memories, and physical sensations that showed up.

As always, if you’re struggling and would like additional support please don’t hesitate to reach out!