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Sandra was 34, had just left a bad relationship of stuckness and sadness.  Her friends had left.  Her parents were never in her corner.  We tried for one year for her to leave.  It was hardest to leave the cat.  Now alone, she had wandered into an office romance - that once-in-a-lifetime connection she had longed for. Her new partner had just done the impossible: he met another woman and fell in love.  How could the universe have delivered this unfair affair? How was the world so cruel in its choices.  Well for one thing, magical thinking does not make your future; you do.  What could I tell her?  So lost in the content of her isolation, I failed to see that she needed a hand, not a lecture. I simply said, don't you deserve to have a family and a future of your own?  Her psychic said to stick it out.  Good things come to those who wait.  (I don't mind psychics; only that they charge more than I do!).  They are in the business of hope, just as I am. The girl started sobbing and hyperventilating.  She ended the session. Oh boy did I blow it, I thought, as always.  The insecurity that continued throughout my life was there for the default reaction.  My fault.  My fault!  Then I overcharged her by mistake.  No worries, she said.  My full schedule made it a burden to think that this was part of the therapeutic process.  I consult an ACT (Acceptance and Commitment Therapy) professional.  She said, focus on how her fear of loneliness and lack of connection gets in the way of her getting what she really wants.  There were charts and graphs involved in what I already knew - I had struck a nerve. Nervous about our next session I simply said: I'm sorry.  And she forgave me.  She understood that I only wanted to protect her, but couldn't.  I get attached too. Attachment at the core of our capabilities. A beautiful girl, only stymied by her inability to go on Hinge yet again.  But those dating apps are treacherous.  Guys still want what they want.  You would think they'd have evolved by now.  Yet the men of the world are anxious, aggressive and angry, sometimes armed (and alcoholic).  The four A's I call them.  I used to like men.  They flirted in the workplace, rubbed my shoulders passing by, now all microaggressions (#metoo).  They didn't deserve me.  But it was fun.  Then I ran into a boss who wanted more, and wouldn't stop.  Losing a good chunk of my 20's with him, the married boss, I desperately wanted to spare my client the same wasteful box in the attachment matrix.  But her journey is not mine.  I am happily married 30 years now, with two beyond beautiful children without whom I couldn't imagine life.  I live in my client's fantasy; of wanting things to work out/even out/be fair despite being treated badly. But her boss and mine, all those years ago, would prevent our own happiness for theirs.  Is that love?  No, my friends, it's transference and magical thinking.  I am projecting my experience on to her regressed teen girl dreams of a white picket fence, two kids and yes, a cat.  But no life is without pain and suffering.  And nothing shows up until it teaches us what we need to learn (Pema Chodron).  So what is it that we both need to learn?  That we are enough, we are worthy of love and commitment and so much more.  I didn't get everything I wanted.  Does anyone?  My fancy friends seem to have second homes and vacations and security that they inherited or married or figured out.  But it's not about fancy.  Life is struggle for all of us - it comes at a price.  The price is sorrow, and then rising from the ashes.  Like a phoenix, we carry on. For my parents' legacy, I march forward toward older age and wisdom.  Nothing is going to get fixed with a diagram or a grid. More like grit.  So I tell Sandra patiently, stay with the feelings.  They will soon pass away into dust.

PHOTO CREDIT: Jennie Carr My phone rings three times a day with the same message: my teenage (daughter) needs someone to talk to.  I try to be my usual calm self.  I ask certain intake questions.  I say there may be a wait list.  For the first time in my social work career there is a demand that no one saw coming.  For the first time we can perhaps get more business, more money, help more people, be important even.  It's quite seductive in a field where starting salaries can be no higher than 35,000$ per year at the height of your powers.  We are used to having no pensions, no respect, shoved aside by doctors and nurses, even psychologists.  We are those people who deal with things like broken homes, getting medicaid, working out a bus route.  I once had three interviews and then no callback for a job that was 3 decades below my level.  If you work in a clinic, you get bean counters checking your every move while real people suffer with real problems, waiting, waiting for help.  In many cases, whether it's the inner city or the suburbs they wait. Now comes covid.  For a while I rode that wave by booking more and more appointments. It became very alluring to be wanted, needed and in demand.  But it soon became much too much.  We therapists talk a good game about self-care but we rarely practice it so well.  We have to practice what we preach.  So now how to get off the roller coaster. Cutting back and taking higher paying clients is one way, creating even more demand. But once you're in the insurance racket everything changes.  You are forced to accept drastically lower rates and compelled to do endless paperwork.  Most in my area have opted out of all that.  What does that do to the people who have really emergent needs? My colleagues are saying some very very simple things.  It comes down to access and money.  None of this is new.  Medicaid and Medicare do not typically include other types of licensed mental health professionals.  In addition the regular insurance company's jobs are to limit care.  It's that plain.  When the incentive is the bottom line, and not care, everyone suffers.  Healthcare becomes a privilege, not a right.  Therefore it's the neediest who get the least help.  I work with solidly middle class families, those working for their benefits and wanting to use them.  According to another therapist, Jennifer Rowe, LCSW, "prior authorizations, lack of reimbursement, constant resubmissions to obtain payment for service..." created a barrier. Yet most of my peers are "out of network" because they themselves can't live on the fees that the network pays us. We in private practice have no benefits.  This is why our rates may seem high.  Rates for therapy around the NY area range anywhere from $60 to $350 per session.  If you happen to need a prescription along with that, psychiatric evals can start as high as $850 for the initial evaluation. Access and money. Now every teenage girl needs someone to talk to.  That's great news!  They were locked up for 18 months of their incredibly stressful lives, at the exact moment their brains were seeking comfort from their friends and their bodies were going through monumental changes.  The isolation, languishing and depression would be putting it mildly.  These kids were flattened.  Lifeless, listless, empty, you name it.  I'm surprised there wasn't a new diagnosis called childhood burnout.  My colleague, Gayle Skovron, LCSW of Nyack, NY said, "We ignored and stigmatized mental health for too long. This is the fall out of torn families, lack of community and greed."  Another Clinic Director, Max Benezra, EdM, MA, LMHC, from Sound Shore Counseling in NY reported, "We experienced such an increase in referrals during the pandemic, especially with teens, that we hired more therapists and still did not have enough therapists to meet the demand. Additionally, the tiresome nature of insurance reimbursement, particularly when telehealth was first being instituted during the pandemic, made it all the more difficult to provide our patients with the support they sorely needed." Lastly, and this is an extremely overlooked dilemma, according to NY therapist Jessica Hazard, LCSW, "Some difficulties I have been experiencing in my private practice is that parents can clearly see their children are suffering but want them to "snap out of it" and "behave like they used to." It is hard for them to see their kids having a tough time and so they want the healing and behavior change to happen rapidly. Having to tolerate that it will take time is proving difficult for them. I have a patient who has historically been a very good student that is currently failing two classes. They have never even come close to failing something so the parents are demeaning her and putting tons of pressure to perform as she once did. Some of the work is with the parents realizing the pressure is adding to their struggles and making it more difficult to do the things they once did. And it also feels challenging to me as a clinician because if parents are not liking the "results" they can get rid of me prematurely even if both the teen and I feel we are doing good work together. The rest is history.  No policy changes were made besides a brief covering of copays and of course telehealth.  Bold for the short term but what if you still had a high deductible and your teen girl was putting gashes in her arm out of boredom?  I was contacted by the parent of triplets -- they all needed therapy.  There was a time this would have been a perfect gig for me.  I said no.  The mother was desperate.  I said I would help her.  But I can no more help them than help myself.  I let my hair go grey.  My wise therapist told me, "having more patients does not make you a better therapist." "The report cited significant increases in self-reports of depression and anxiety along with more emergency room visits for mental health issues. In the United States, emergency room visits for suicide attempts rose 51 percent for adolescent girls in early 2021 as compared to the same period in 2019. The figure rose 4 percent for boys." --https://www.nytimes.com/2021/12/07/science/pandemic-adolescents-depression-anxiety.html Where is the policy change here among all the statements?  We wait.

Post Pandemic Teens: My landscaper said, after this the kids are "spiritually bankrupt."  He's right you know. There are a lot of kids and adults who are scared to leave the house.  I'm not one of those. But it's weird.  Let's face it.  An entire generation has lost a year of their lives.  What have we gained or gleaned as a result?  My teen group explained it in terms of Macbeth which they are reading in 10th grade. A.  Lady Macbeth Speaks Out - she is mad and rightly so.  No partnership with a powerful figure can save her from her own guilt and malevolence.  She is damned if she does and damned if she doesn't.  Lady Macbeth is an out of control teen who stuffs everything from the people who love her most and locks it inside.  The result is a mental breakdown worth remembering.  To love and lose is one thing; to survive without guilt and other uncomfortable feelings is another.  Lady Macbeth kids need a place to vent and learn some critical life lessons.  The problem is the kids today won't take the chance to make a mistake.  The stakes are too high.  Live a little, I say.  It's good to make a few mistakes now and then.  How else can you know what you want or who you are?  Get out of your room! B. Macbeth as Self-Harmer - he is guilty guilty guilty but hey who cares?  If the adults all around him can get away with murder, why can't he?  Because it doesn't suit him to rage at himself.  Lashing out and turning on oneself leads to hurtful action and reaction (aka Trump). Macbeth must settle down and understand his limitations as a leader without losing himself in petty peer pressure.  He must agree to take his anger to the appropriate place - where he can be heard and understood.  Teens are saying they're too insecure to go out.  But now is the time to gain experience so in later years they can be more confident, not less.  Carpe Diem! C. The Three Witches - misogyny and hatred for women runs throughout the story and Lady Macbeth doesn't disappoint with her cunning manipulations of her husband, but the three witches know the future in ways we cannot.  Pay attention to the voices of ambition vs. corruption, tyranny and greed.  In your twenties it is your task to learn your identity not shatter it. Take the time to reach out to those who can help and support and hear your voice.  Let it take shape so you can do good deeds not lock yourself into your own revolving door of self-loathing.  Do this in a deliberate way by trying yes instead of I can't. D. Banquo's Ghost - rather than unchecked ambition like Lady Macbeth, try for humility in the face of grief, danger and trauma.  We have been through a lot this year - don't rush what you want.  It is not selfish to take time for yourself, choose wisely, settle down and consider your path.  As Banquo so studiously declares, That, trusted home,      Might yet enkindle you unto the crown,      Besides the thane of Cawdor. But ‘tis strange.      And oftentimes, to win us to our harm,      The instruments of darkness tell us truths,      Win us with honest trifles, to betray’s      In deepest consequence. What we have gained is gratitude, appreciation and contemplation; not the cycle of violence and despair.  Travel, see friends, call for an informal interview/internship, work, volunteer, be a voice for the unheard, be yourself, try belly dancing, free yourself from the bonds of isolation.  The time is now.

Really it's so bad. Teens are in trouble. The teens in my group are laughing and screaming, alone in their rooms or wandering in cars or sitting on zoom-homework or staring or crying at the screen, growing anxious and avoidant and not sleeping. I am just holding it and holding it, ready to burst myself. There's a hypnosis to it. My voice is rhythmic like a yoga teacher. I am projecting calm if not coma. I give them hope, patience, laughter. I let them cry. I am not afraid of tears. I am medicated and vaccinated and caffeinated. Yes it's true, when my thyroid went offline I got to take a drug that also helps w anxiety. Jackpot! The kids are not alright but we soldier on. No wonder they want to change gender/friend group/hair/family/school - what else is there to ponder these days? I keep them strong, I ask what they need because only they ultimately know. One said, "I need a friend." Then in the group I asked, would anyone be willing to be her friend? They volunteered one by one. We all cried. Life is just a game and we let slip away says Seals and Croft. Be patient with yourself. The process works. The girl said, ok I'll talk to my mom even though I am so very angry. Little tiny hints of Spring take form. Daylight Savings brings a new Vernal Day. You smell it on the wind. I am scared to go forward and scared not to. A lot of people have told me about time. Time is playing a trick on us all more like Russian roulette. Be ready.

Photo Credit: Rosalind Bank Why should a therapist be smart, wise, empathic and CURIOUS?  Because we are dealing with individual lives. Lives that are part of the greater society. Lives that MATTER. Right now the collective is the personal. The political is personal. If we don't get some leadership pronto, we will be in this mess for decades to come. So what does our work mean? It means even if you're exhausted, you follow up, ask the questions, wonder what's going on over in that house. One house has little food. Another has too much. Yesterday I followed up on a hunch with one of the parents of my client. The client had mentioned that things were going poorly at home but didn't go into much detail. When I followed up with the Mom, boy did she give me a mouthfull! It turns out something quite serious was going on with the other step sibling in the home that is impacting everyone. If I hadn't followed up, I would have never known! In another case, a teen was telling me about her new hobby. I asked her to show me her art work and it opened a whole can of insights through her eyes. Teenagers are stuck in the middle of the greatest economic shift we have seen in a Century. The landscape of school, college, jobs, families are forever changed. Sure some kids will weather the storms to come. Some won't. I have a client who has been emotionally abused by her parents her whole life. Right when she was scheduled to "launch," the pandemic hit. She is emotionally, physically and mentally stuck now. Like literally. Can't leave an abusive home. Let that sink in. Other signs that therapy is working: you go deeper, you ask harder questions, you ask them to come up with why things are going well, you ask them to practice it, you wait in the silence, and you help make connections from past to present. You offer perspective and patience. Great phrases that capture this are: What was that like for you? I wonder why you're avoiding the deeper issue here? Do you need time to process this? Why not practice doing things a new way? Is it scary to give up being the victim? I feel upset hearing this, it must be intense for you? Maybe "fixing" it is not the answer; perhaps you can accept it? There is no shame in feeling your feelings. Therapy on zoom/phone is not ideal but it's the best we have right now. Insurance doesn't dictate our therapy. If they don't want to cover it, perhaps you can pay on your own? There is no stigma in asking for help. You do not have to be crazy to go to therapy. You don't have to share your therapy experience with anyone if you don't want to or are not ready. If you feel you are not making progress, why don't we talk about it? I guess what I'm saying is this is new for all of us. So jump in and maybe something important can grow within in spite of our ever-changing, uncertain environment.

We all know that panic is painful.  Uncomfortable.  Hard.  Scary.  All I have to do is get a scam call from the IRS and I'm jammed all day with brutal, miserable anxiety.  I work with young adults on this all the time.  I have it myself.  As soon as each of my girls got their driver's licenses I was a basket case.  Every time i heard a siren, while working from home, I had that sinking feeling in my gut. There are many ways to "make friends" with your anxiety. Our understanding from science is that "fight or flight" or freeze takes over our body's regulatory system to make us primed for urgency.  This is in fact an ancient part of our bodies.  A panic attack is a false alarm.  All the symptoms with no real trigger.  Science tells us that when the stress hormone CORTISOL is released, we react with over reaction, the AMYGDALA forgets to regulate, and we feel out of control, like we might collapse, be embarrased or even lose consciousness.  This will likely NOT HAPPEN! 1. We remind ourselves this is not real. 2. We acknowlege the panic. 3. We talk back to it: I see you but you don't control me; I control you. 4. Distract with creative, calming activities. 5. We argue back - no, this is not real.  It will pas in 10 minutes (usually). 6. We slow down. 7. We are safe, secure and loved. 8. And then we soothe anything IN YOUR BODY that needs rest, relaxation. I have done this myself and it works. Whether by literally tapping or holding yourself, distraction or just time, we can reduce the fear. For young adults and teens this can be especially frightening.  With no school/work/camp etc. it is easy to get submerged in isolation, then by making your world smaller, you lose vital interactions for growth and adulting.  Try now to get a hobby that takes your mind to a peaceful refuge.  Try anything!  I will guide you.  My hobbies are writing, swimming, hiking, and reading.  What are yours?