Monday, September 5, 2016

A Both/And World

Sometimes the world feels very either/or. You're either happy or unhappy. You're successful or not. With this either/or thinking comes the idea that there's a certain path to happiness; you find it or you don't. If you achieve a certain life (certain type of job or income level, find a partner, have kids, own a home, have a dog named buster, etc.) then you will be happy. Is that really true? If our life doesn't go the way we planned or the way others think it should, does that mean we've failed? I think that an either/or perspective might not actually put us on the path to happiness and that another option, called Both-And thinking, might be a better fit for most people. Both-And thinking focuses on dialectical (flexible with multiple possibilities) rather than absolute (either/or) thinking. Which means:
  •  Two conflicting feelings can be present at the same time: You've probably experienced having two conflicting emotions at once at some point in life. For example, you can be happy your teenager got into Harvard while also being sad that they'll be moving away or you're angry that your department at work is being shut down while also feeling relieved you don't have to work in that environment anymore. In these examples, both feelings are valid for what you're experiencing. It also makes sense that you're feeling them at the same time even though we don't always think two opposing feelings can exist at the same time. Having conflicting feelings is a normal part of life.
  • One truth doesn't guarantee a certain outcome: If one thing is true it doesn't mean that a specific outcome will occur. For example, you didn't achieve some of the dreams you had as a young person yet have lived a full life. It may be true that you had dreams that didn't come true but that doesn't guarantee your life will feel worthless. Sometimes what we expect our lives to be can change but that doesn't always lead to us being disappointed. I see parent's struggling with expectations that if they parent a certain way their children will act or grow up a certain way. For example, you teach your kids that honesty is an important value but your son is caught cheating in high school. When your child is young you spend a lot of family time together and feel very close yet when she grows up, moves across the country, and never calls home. There's an unspoken idea that if you're a good parent then your children will turn out to be a good person, have your moral traits, and will take care of you in your old age yet that is not always the case. There will always be outside variables we can't plan for. We can't control every aspect of life or even how we're going to react to events.
With Both-And thinking life has multiple possibilities with various outcomes. It also factors in that life doesn't always go the way we expect. You may have the goal of getting a college degree in 4 years but then your scholarship fund dries up, a parent has major health issues, or you start experiencing a mental illness and get your degree in 6 instead of 4 years. Does that mean you've failed because it may take you longer to get that degree? If your answer is yes, is that yes going to make you a happier, healthier person or drag you down?

We're more complex than either/or thinking; we can have a cascade of feelings all at once, we can think we want one thing yet find we want something else entirely, we can think our life is going to unfold in one way and find happiness in the way it actually happens. You can be proud that you raised your kids well even if they make decisions you disagree with as adults. You may feel sad that you ended a long term relationship while also feeling confident it was the right decision. You may think you're going to go to graduate school to get your Doctorate but find that you're happy with the work you can do with your Masters degree. When we expand our expectations we aren't expecting there to be one road to happiness. Instead we see that there are multiple roads that lead to a wonderful life, some of which may surprise us.
Thoughts by Alissa Kaasa

Wednesday, July 13, 2016

Our Trauma Epidemic

I recently listened to a podcast that featured Dr. Bessel van der Kolk, one of the leading experts on Trauma who founded the Trauma Center in Boston, about the impacts of trauma on the human body (podcast available at I was surprised to learn that he himself grew up with a great deal of trauma. Bessel grew up in the Netherlands during WWII and had an abusive father who would lock him and his siblings in the basement for hours at a time. So not only is he an expert because of studies but he also lives what he teaches. He started the podcast by explaining how trauma effects the brain and the impact of prolonged exposure to fear or isolation. He described the importance of agency or the need to feel like you are in charge of life and can change how you feel. If this isn't present than you can "get stuck" in trauma which leads to people becoming passive and giving up. Initially people can fight against what's going on but if trauma persists or the trauma is never processed then it can eventually lead to feeling like your lack of control will never change. Continual states of fear change the brain so that it gets stuck in the fight or flight mode. You develop a "terrified brain" that has trouble turning the fear off and reacts in a panic instead of being able to logically process situations. Bessel also described Developmental Trauma's impact on children, which is a result of children enduring neglect and abuse from caregivers. It presents itself through a child's inability to connect with others, an inability to manage emotions like anger or anxiety, and an inability to love or care about themselves. These children are often given labels like Oppositional Defiant Disorder, Conduct Disorder, Intermittent Explosive Disorder, or Bipolar Disorder instead of getting help repairing the trauma brain that's developed. Children who experience a great deal of trauma are also more likely to die sooner or develop severe illnesses (like heart disease, autoimmune disease, skeletal problems, etc.). Long term stress on the body is clearly very harmful. "Trauma sits in our body" and that's where the damage can be found.

The interviewer of Bessel read off some of the statistics he'd gathered from Bessels work that focused on the prevalence of trauma in the United States. He read "..1 in 4 woman are violently assaulted by an intimate partner at some point in their lifetime, that half a million kids are on anti-psychotic drugs, that 1 in 5 people are sexually molested, billions in government spending on anti-depressants, anti-psychotics, and anti-anxiety medications for military personnel..." Bessel added to those stats by saying statistics on gun deaths are incredibly high and the number of women killed by their partners has surpassed the number of people killed in military operations since 2001. He stressed the need to acknowledge that trauma exists for thousands of people around the country. If we put on our blinders then the trauma will continue to build up in our society. This led to a discussion about the legacy of trauma; how it's passed from one generation to the next because no one stops the cycle of trauma on a societal level and if individuals don't address it in their personal lives it then effects their children. Not addressing trauma not only effects the person who experienced the trauma but the people around them and can lead to further traumas to all who are involved.

Not only is there a huge amount of individual trauma in society but generational and cultural trauma heavily exist as well. I started thinking about this type of trauma a month ago, after the Orlando nightclub shooting, and have been reminded again of it's presence with the history of violence and distrust between police and African Americans that we're witnessing around the nation. Certain groups of people have experienced a lifetime of fear and trauma that goes back centuries. Gay, lesbian, and transgender individuals have lived with a great deal of traumatic fear since the start of time; fear of people finding out, a fear of not being accepted, fear of not being loved for who they are. That fear turns into reality through traumatic events when people experience physical or verbal abuse because of their sexual orientation.  Either way, the long term trauma can take a toll on a individuals and communities. African Americans and American Indians have lived with a history of injustices and continue to live in fear. The history of slavery and persecution of people along with the current culture of racism continues the legacy of trauma for many people. Trauma has turned into an epidemic in our culture; both on an individual level and a cultural level.

In some ways. people in the United States are more susceptible to experiencing long term effects of trauma. Outside of the fact that a lot of trauma exists in our society, we also struggle with a "mind-body disconnect" which stunts our ability to cope with trauma and causes us to get stuck. In other parts of the world, they've mastered the art of helping the body cope with trauma through things like yoga and meditation which focuses on a mind-body awareness. Having the mind-body connection helps the individual notice what's going on instead of relying on the immediate reaction to guide what they do next. Eventually the body slows down and repairs the reactive mind. They've learned that being in tune with your body can help you be a more balanced person which in turn helps the trauma mind re-learn how to function outside of that "terrified brain" mode. Other cultures are also better at identifying and talking about trauma which is an important part of healing. We often feel that addressing trauma is a sign of weakness or makes us uncomfortable so we avoid listening to other people's experiences. This builds a culture of shame which keeps people silent because they fear other people's reactions to their experience. Trauma becomes a hidden secret and further widens the mind-body gap. Talking about the trauma in a supported environment (like therapy) can get rid of this shame and brings the pain out into the open so healing can begin. Often times this doesn't happen for people and they sit with their pain a lone even though so many people live with the effects of trauma every day. If we want to change the trauma epidemic in our communities can learn from other culture's experiences and start building the mind-body connection while also encouraging discussion and processing of trauma in safe environments. Bessel is very good at explaining the effects of trauma in a way that's easy to understand and talks more about ways of combating trauma in many of his books and articles. I highly recommend listening to the podcast, hearing him lecture in person, or reading some of his material if you're interested in learning more.
Thoughts by Alissa Kaasa

Wednesday, June 22, 2016

From Rigid to Flexible

When we run into changes in life, whether that be an unexpected loss, an unplanned-for change, or an unpleasant day where everything seems to go wrong, having the ability to be flexible can help us be less miserable. If we think that life needs to go a certain way it's going to be very jarring when life doesn't do what we want. And that will happen because this is life we're talking about. It's often unpredictable, and at some point it will involve at least one really big unexpected surprise that knocks us on our faces. Sometimes in an effort to avoid the unavoidable, we tell ourselves that control is where we can find stability and peace. That we can, in fact, create a life that won't require flexibility. When we do this, we become more rigid and changes become harder because control and rigidity don't stop life from throwing us curve balls. We can never control every aspect of life. We might for a while, but something's bound to snatch that control away leaving you feeling panicky and vulnerable. Increasing flexibility through mindfulness can help difficult times or days feel a little more manageable.

The more rigid we are the more likely it is that we'll try to struggle with change. Picture a game of tug-of-war with a person on one end and the change on the other. While the person is desperately pulling, the change stands like a brick wall, unmoved by any force the person uses. Changes will happen and they will win every time if we view it as winning or losing. We can feel that we must find a way to fight the change, reverse it back, or ignore it until it goes away. Let's continue to imagine change as a brick wall: it's an unexpected obstacle in your path. You can either try kicking the wall to get it to move or decide to follow a different road than you had planned to take. If we choose the panic and fight method, odds are good we'll feel worse about our predicament and feel more lost or hopeless (and possibly end up with a broken foot). If we see it as something that's an annoyance but is passable we can get past it and on our way sooner. If we change our thinking so that we expect changes to happen, it'll be easier to not see the change as a threatening brick wall but as a detour that leads down a slightly different path. Mindfulness can be a way of helping us slow down and adjust our perspective.

I know, mindfulness seems like a buzz word right now but it's actually a fantastic tool. Through mindfulness we find ways to observe what's going on around us and within us. When we stop and notice how we're reacting and what we're feeling we can make a choice about our next step. When we rely on a rigid plan or way of being we run the risk of challenging changes to a never ending game of tug-a-war. We can learn how to stop struggling with difficult situations or unpleasant feelings and we learn to tolerate the unexpected. Notice I'm not saying that the unpleasantness will simply disappear. We may still have to live in that situation or with that thought or feeling. It's not a cure for feeling bad. It gives us a way to feel less out of control because we're not trying to control what we can never control.

Think of a Chinese Finger Trap.You know, the multicolored bamboo cylinder that fits nicely on your pointer fingers but closes around your fingers once you try to pull them apart. If you're like me, when you feel the trap closing around your fingers, you decide brute force will save you and start wildly trying to pull your fingers out. This only makes the trap tighter. If you calm down enough to assess your options, you might realize that gently pushing in instead of frantically fighting gives you the release you’re looking for. So, when you feel yourself starting to react to a change, take a moment to and ask if you're stuck in a finger trap. If so try a few things:

  • Take a few deep breaths.
  • Pay attention to how you're reacting in your body and how the deep breaths affect that reaction.
  • Take a minute to think about why you're upset or trying to fight the change.
  • Remind yourself that you can be flexible and other paths are available.
  • Think of the different options and choose a different path.
  • Let it go. You can do this by mentally saying you're letting it go or by doing something, like physically writing down what's changed and throwing it away. Sometimes physical acts can help with letting something go.
  • Move forward on your new path.
  • Repeat the steps if you feel you're sliding back into the finger trap feeling.

This way of managing change requires practice and becomes more effective the more you use it. So practice on small, day to day changes or disappointments. The more easily you can be flexible in daily life the more easily you'll be able to apply it to bigger life changes. Good luck!
Thoughts by Alissa Kaasa

Wednesday, June 8, 2016

"Normal" Grief Would Be Nice

I'm co-facilitating an ambiguous loss group right now so I've been thinking a lot about grief'lately. After the last group it hit me that over the last few weeks everyone had made at least one comment regarding the ways they should be grieving and expressed feelings of frustration, guilt, or failure about not grieving in that way. This idea that there's a particular way to grieve is something I've noticed in other people as well as myself. I've had thoughts that maybe something was wrong because my grief experience was longer or looked differently than others. We have ideas that grief should last a certain amount of time or should manifest itself in different emotions that occur one after the other. There's this picture of what "normal" grief looks like that we grow up believing is the only healthy way to process grief. As I've thought about it I've been realizing how unhealthy that rigidity is, especially with complicated or ambiguous loss. We would all choose to experience this "normal" grief; that's there for a short time, runs its course, and leaves us to go back to an unaltered life. But in my experience that's almost never how it works. The things we think won't bother us are the things that plague us during the day and keep us awake at night. Even when we can prepare for a loss grief can drown our well planned out ways of coping and leave us feeling hopeless. Then there's the surprise losses that come out of no where and knock us down so hard we're dazed and confused about what's up and what's down. All of that on top of it never going away, which no one wants to admit happens. We're also individually complex people. We all come from different backgrounds, grew up learning different ways of coping with life, live by different philosophies, and have different strengths and weaknesses. With all that, there's no way there would be one path to correct or normal grieving.

The dream of "normal" grief slapped me in the face a couple years ago and shook up my understanding of grieving in new ways. About two years ago I started to get sick. At first I thought it was stress but after several weeks suspected it was something more. 6 months later after taking a leave of absence from work, going through numerous tests, feeling miserable most of the time, and watching my strength slowly diminish to the point where I couldn't walk down the block I finally got a diagnosis of Celiac Disease. I knew life wouldn't be the same and that I would most likely experience some grief but thought the relief of feeling better and having answers would be far greater than the grief. Some days that was true. Other days I'd walk past the bread or beer isle at the store and start to sob. I would have never guessed something so ordinary and basic would have such a strong effect on me. I thought it was weird (I mean, it probably looked plenty weird) and it scared me. I thought "What is wrong with me? Who has a melt down when they see a loaf of bread? I know what's wrong and how to fix it so why do I feel this way? It's not a severe like other illnesses, so why can't I move on like a normal person?". As I digested the experience I realized that this was part of my grief journey. It wasn't what I was expecting but it was clearly something I wasn't going to escape. Once I realized that I stopped fighting how I thought it should be and tried to experience things in the context of my grief journey. It was mine and not someone elses grief so of course it would look differently. If I cried because I couldn't eat something then I cried. If I got angry when waitstaff didn't understand my dietary needs I'd be angry and email them later about the need for more awareness. I started to learn how to acknowledge it as grief and sit with the horrible, uncomfortable whirl of emotions because I was no longer trying to compare it to this idea that grief needed to look a certain way. It became a healthy, natural response to the loss I was experiencing. I could be both happy I was going to get better and have feelings of loss around how my life had changed. Two years later the still grief pops up at times (as grief usually does) and I have to remind myself that my grief journey continues. It's a part of my path now and I can both have it while also having a life outside of the grief. Some days that comes more naturally while other days it's a struggle to not go back to judging myself. Depending on your experience this may be the biggest challenge you will ever face or something that just takes some time to master. Again, different for each person and different for each loss a person experiences.

Our society likes to have concrete, well defined steps that lead to getting what you want. How often have you read or heard things like these are the 8 steps to make you happy, if you work hard your life will be good, if you follow these steps you will achieve success? We like things to play out in a predictable and tidy way.  I'm sure there are a few who could say their life has followed that pattern yet most people I've met don't have that luxury.  Life is messy and unpredictable even when we make carefully planned steps. There's also an idea that we can all do and experience the same things in life regardless of who we are or what we've been through. Yet if we look at our siblings we see that, even though we had the same up bringing and similar experiences, we turn out very different from each other. So, shouldn't grief also come with curve balls and differences between people? Or is that the one thing in life that follows a predictable pattern across all people? My experience and work with others points to the opposite. We never know what grief will bring us until we experience it. We can prepare and hope that what we've set in place will be beneficial for us yet we never really know how we're going to respond, how deep the grief will run, and how it will sit with us long term until we're living with it. That to me is the normal part of grief. It's normal to be surprised by what grief looks like in your life and the misery it brings regardless of how big or small the loss may be to others.

That said, there are similar feelings and experiences that can happen in grief that pull us together. For example, we may feel sadness to varying degrees and if you've experienced grief sadness you know what that feels like in your body and mind and how that may differ from sadness in other areas of life. Those similarities can draw us together. We can support each other even though our grief journey's will all look and play out differently. I argue that having a "normal" grief experience doesn't actually exist so why should we try to hold ourselves to something that's not real. What does exist is your unique grief journey, which will look different than other people's journey, and the connection we can find in others who know what grief feels like.
Thoughts by Alissa Kaasa

Monday, June 6, 2016

Ambiguous Loss...That's a Thing?

Since starting our group practice in January we've wanted to find gaps in support in our community so we could better meet people's needs. The most glaring gap has been in grief and loss, especially ambiguous loss. When a loss is ambiguous it's not clearly defined and is often not recognized as a difficult loss by society. The examples of this kind of loss are almost endless (not having a relationship with an adult child, developing a chronic illness, ending an affair, having an abortion, being a caregiver to someone with dementia, experiencing multiple losses at once) yet when you look for support it's almost non-existent. Pauline Boss is one of the first people to identify ambiguous loss as an actual experience. She has many wonderful resources and articles that have been groundbreaking over the last several years (see her website for more information: The four of us have read so much of her work and use it almost daily in our practice so it was shocking to realize that the concept still wasn't widely acknowledged in our community or by other therapists. We saw ambiguous loss in so many of our clients as well as our own lives. It seemed odd that there weren't more resources for people and that so many clients were telling us they had never heard of the term ambiguous loss before. How could that be when it's something most of us experience at some point in our lives? Right now ambiguous loss is a silent ache that sits inside people; never being acknowledged as a legitimate loss experience. People suffer alone without knowing their pain has a name. It's not acceptable.

We want to name the pain, create a community of support, and then, together, find ways to move forward. Our journey down that path has started with the creation of ambiguous loss groups. We currently have one for parents with estranged adult children, one for caregivers, and one for people who develop serious mental illnesses. We hope that's just the start for us. Eventually we would like to have more groups that target very specific areas of loss. I've been making an effort to talk about it more in personal life as well. Sharing my own experience of loss and the struggle ambiguity adds to life has opened up fantastic conversations with friends and family. It's exciting but also surprisingly challenging; trying to bring to light a pain that's so often hidden and ignored. I often expect looks of complete confusion and pity yet have found the opposite response, one of relief and understanding, is more common and makes the momentary discomfort of broaching the subject worth it. If we all start acknowledging ambiguous loss as a genuine, painful loss experience then we'll be able to create a community where there are resources and support to help people live with the pain. Creating this awareness and support is possible but will take more than a few therapists in Minneapolis creating groups and talking about ambiguous loss in their personal lives. Will you join us in trying to create this change?
Thoughts By Alissa Kaasa