Is Anxiety a Problem?

Posted on June 26, 2023 by Lisa Kothari

Is anxiety a problem for you? For me?

Of course, I was reading the New York Times and came across this article about anxiety and it prompted me to think about the feeling of being anxious — which can lead into full-blown anxiety. Anxiety is common — actually I don’t know anyone personally who doesn’t have some level of worry, care and concern over their lives, the state of the world, other people, situations, and more.

If you were to actually sit down and ask somebody, directly, are you anxious about anything in your life or life in general I can’t imagine anyone saying, “no, not at all.” Worry, anxiousness, concern are all basic human emotions and ways of feeling that make us exactly that — human. I think it is how we interact with these feeling states that defines if anxiety is a problem for ourselves or not.

What do you do with the anxious parts of your self? Are you able to listen to what this part of you is saying and put it into perspective, or take a clue that you need to regulate your body and mind to calm both, or take an action that will alleviate your worries and concerns? If so, anxiety is not a problem, but rather something to be mindful of as one part of your feeling state.

Now, if you are having trouble recognizing you are anxious or becoming paralyzed in your life due to feeling anxiety (worry, concern) then it is an emotion that is going to limit your life and how you are living. This is when it is a problem. I would tend to agree with the article referenced above. However, it points to Cognitive Behavioral Therapy (CBT) as the best modality for treatment of anxiety and its symptoms.

CBT seeks to change the way you think about situations so you can alleviate your worry and anxiousness over whatever is causing you anxiety. It is a type of therapy that is often brief and comes with homework to build up skills for reacting differently. It certainly has its place in the canon of treating anxiety, but it is also a type of therapy that insurance companies love — 8-10 sessions and you are cured. Their pocketbooks not needing to pay for anything more.

However, I think of paralyzing anxiety as a symptom of something deeper going on internally within a person. How did you see your caretakers interact with their worries and concerns, were you insecure as a child when your caretakers left you, did you have space to worry and voice your concerns — were these feelings welcomes as a child? Looking at these deeper questions and family of origin patterns can help us take a look at what is driving our anxiety on the surface. Often anxiety that is felt about external things reflects an internalized anxious state that has never been able to be explored — and wants to be heard.

Working with a therapist to uncover these patterns can not only help short-term alleviation of anxiety, but can also shift an internal state where paralyzing insecurity, out of control feelings, and worried states rule the person.

So, there are plenty of options for treatment, but please know if you are worried about someone or something — if you are anxious — to a large degree this is expected as part of being human.

Don’t forget the breath — 4 deep breaths in through the nose and then out through the mouth – can do wonders for any worry.

What’s Your Time Worth?

Posted on March 6, 2023 by Lisa Kothari

What’s your time worth? Have you ever sat down and thought about time as one of — if not the most important – resource we have each and every moment of our lives?

When one is young, especially if you are healthy, time can feel never ending — and sometimes it can almost feel torturous. Remember your childhood days when an afternoon felt like a lifetime — the chorus of “I’m bored” being spouted loud and clear.

Then we get a little older and life begins to take off — and time becomes more precious. Now there are deadlines — some of our choosing and many not of our choosing. Even during this time, though, we often feel like we are “doing, doing, doing” but nothing has yet begun in our lives. Time is something that moves and does not move.

Then we get a little older and life is moving — flowing like a rapid river on a summer’s day. We have made the decisions that carry us into the fullness of our lives — marriages are sealed, children born, careers built, homes bought, hobbies and adventures pursued. During this time, we are so caught up in the doing there is barely any time to think about what our time is worth. We are on the treadmill of life.

The apex!

And then we get a little older, and children go off to school and start their own time journey. Houses are sold as the maintenance and upkeep are too much for too few people, retirement beckons, resources dwindle, enrichment activities become important, and health deteriorates. This, to me, feels like the time when most people feel that their time is worth more than anything else they’ve got.

Funny thing, time was tracking with us each one of the days before we reached this stage, even if we weren’t paying attention.

It seems to me that time is our most precious resource. And although it is hard to pay attention with intention to time and how we are moving through our hours that make up the days that make up the months that make up the years, I want to encourage you to do so. You are running a marathon, not a sprint in life (hopefully!)

If we were to take the premise that time is the #1 thing in our lives, how would you go about making today be valuable and worthwhile with how you spend your time. And I don’t think the answer is to make every second produce — but seeking the balance seems to be of real importance. And then to review each night how you actually spent your most important resource.

Time waits for no one and will be here long after you and I are gone. Take the time you have and make it count — try to see the marathon you are running before the end is in sight. Life is to be lived forward with intention. Time is one of the best places to house your intentions for the life you are creating,

Word Games

Posted on February 13, 2023 by Lisa Kothari

Word games — do you play them? It used to be games like Scrabble and the NYT Crossword Puzzle — but now there are many more options. It seems like the game Wordle has made us all a fan of word games. Well, that one is quick, even if not always easy, and provides quick satisfaction of being competent in knowing your 5-letter words.

I was never big into word games, but I can see how they keep one’s mind sharp, provide an interesting distraction to calm one’s mind, and can be entertaining during an otherwise boring day. People have taken to sharing their results on social media as well. People comment on how hard or easy it was for them as well — without giving away the answer. (This all has to do with Wordle, of course.)

Recently, I have heard some people say they are using word games as a distraction away from their problems to the point that they cannot focus on what they really “should be focusing on” — often something that is a difficult change process. They see the word game as taking them away from the issues they have at hand, rather than helping. Of course, word games offer a calming and interesting distraction and can often be grounding during a time of personal upheaval.

It is not a bad thing to use word games as an object that takes one away from the worries/changes/anxiety and more at hand. I often see it as a part of one’s change process. Distracting one’s self from always holding the worry in mind feels important. It allows unconscious parts of ourselves to step in and be with the issues at hand. Our mind is turned off from the worry and directed elsewhere which allows for more space to open up and work things out.

I notice how hard people are on themselves for taking pleasure — often for long periods of time — in something like word games. Relax. Word games may not only serve as a puzzle for you to solve, but also a place for other parts of yourself to work out your own puzzle you may be in. Distractions can be very helpful in this way.

There are many distractions out there. If you are choosing a word puzzle, chances are your mind is sharp, you seek to feel competent in an everyday puzzle, and (often unknown to self) are trusting that other parts of your self are working out your own personal puzzle.

Even I Wordle — every now and again.

Write It Down

Posted on April 15, 2022 by Lisa Kothari

Write it down? What’s that?

How often have you seen someone lately with a notebook and pen in hand? My guess is not very often. Now, think back and ask yourself how many people have you seen on a screen lately? I bet the numbers are explosive right now in your mind. They may be reading or typing, but the screen is the gateway to just about anything these days.

I am from an era, however, where people wrote things down — and I mean wrote everything down as lugging out a typewriter to type anything out other than something formal wasn’t about to happen. We wrote out to do lists, recipes, essays, budgets, reminders, letters, notes, and whatever else you can think of — if we were wanting to record something for any reason we were grabbing a pen and paper.

I went back to graduate school in my mid-40s and during the very first class I definitely noticed a change. As class began, everyone was pulling out their laptops as I pulled out my fresh notebook and pen. It didn’t take me too long to gather who was the dinosaur in the room — me! However, that never bothered me, and I gladly opened up my tools to begin to record my notes.

At that point, the Professor looked out into the sea of students in the large class and addressed everyone, “I see you all have your laptops out ready to go, but there is hard core research that says people best learn by writing down notes — something about pen to paper contact makes absorbing information easier.”

Of course, the Professor was probably ten years older than me, so I thought perhaps she just hasn’t gotten with the times and is using “research” as an excuse to not feel so old given how it used to be. However, more and more there has been research out that says exactly this — humans remember more when we write it down.

I know for me this is true. Once I have my to do list written, I sort of know in my head what is on there more so than when I type it on a screen. I have an electronic calendar and I have a paper calendar. Oh how I love my written calendar and writing it all down. Partly this is my era and partly it is because I remember it all better when I write it down.

I was struck recently when a person in her mid 20s was discussing crafting a budget and related she was writing it all out and that this helped her more than any budget app as she could see for herself the ecosystem of her money and remember the amounts and the categories much more easily. Even someone much younger than myself finds putting pen to paper better.

So, if you are having difficulty remembering tasks, events on the calendar, tracking your money and/or any other number of tasks, write it down instead. Try it at the very least.

Oh! And everyone always appreciates a handwritten letter! You could even begin there!

Peekaboo Moments

Posted on September 20, 2021 by Lisa Kothari

Do you remember peekaboo moments with your parents? It’s probably one of the earliest games parents play with children. First, it is super easy. Second, it’s a game that can be played anywhere. Third, it delights both parent and child. Mother and/or father cover their eyes and baby doesn’t know where her caretaker went. Although the person is right there, without eye contact, baby feels lost. That’s why the peek lasts just a second or two and then Mom or Dad says “Boo” and they are back with their child and the child knows their beloved parent has returned.

We think of this as a baby’s game. Simple to play and understand — except it is actually anything but simple. Peekaboo gets played again and again throughout our lives. Depending on how mother and father played the game with us – the literal and metaphorical game – tells us much about how we will handle our own peekaboo moments in our adult lives.

If we have a secure connection to our parents we learn that when mom and dad go away not only will they be back, but they will also meet our needs. From there, we have the opportunity to develop security within self to meet others and explore our world. If we are not secure that mom and dad will still be there when they go into the peek it can be scary to see the parent return with the “boo.” Further, it can be difficult as we grow up to keep this connection to our primary caretakers and have trust that our needs will be met by them. Often we have not had time or space to figure out ourselves and our own worlds when we don’t have this secure foundation of connection.

Fast forward to being an adult and peekaboo moments unfold left and right — we just don’t see them from this frame. Often this most often can be seen with our love interests. First, when we meet someone whom we are romantically interested in, some part of ourselves is on the line in ways that may not be when we are forming friendships, although these moments can play out in friendships too or any relationship in fact.

What happens? We meet and then the person disappears. You may have exchanged phone numbers, you may already be communicating, you may have even had coffee or another date or two. However, when the connection time is over, the peek comes in, i.e. the person takes their leave. Now, how we handle this moment says much about our connection to ourselves and how we experienced those original peekaboo moments with our first caretakers.

What do I mean? Well, check in with yourself. Does it make you nervous to be in their absence? Do you find yourself calling them in an anxious state to see (for yourself) if they are still there and still interested in you — if they pick up the phone and you hear their voice — is there an immediate end to your anxious state? Of course that is the “boo” moment – that special moment when the person reappears. What happens? If anxiety is not alleviated, do you find yourself angry or agitated. My guess is by tuning into how you deal with the peekaboo game with your adult relationships will reveal insight into how you experienced this with your earliest connections.

This is a place to drop defenses and become curious.

Ideally, when we meet someone it is completely exciting. We often fall down the Alice in Wonderland rabbit hole into something amazing. However, part of the amazement is being able to tolerate the peekaboo moments – when the person is there and then is not. After all, we are getting to know someone and they are getting to know us. It takes time — and more than a few seconds like we experienced in that early game in our lives.

Framing this type of anxiety into a game of peekaboo where we have a chance to not only experience how we feel when the peek and the boo take place, but also observe what this may say about our earliest time in our lives and how we were received by our primary caretakers.

Peekaboo! I’ll be right back!

A Pandemic Ending

Posted on March 23, 2021 by Lisa Kothari

A pandemic ending. Can it even be possible?

Only a year ago, the entire world was going into lockdown. True lockdown days where the government actually counted cars on the road to see if we were doing a good job in WA State of staying home. Except for a trip to the grocery store every now and again, you were meant to stay inside.

Although life became strange, the lockdown provided many with a reprieve from having to be social. Many who feel pressure to live up to others’ expectations no longer need worry about it. Family occasions came and went and there was no need to make uneasy excuses as to why you didn’t want to attend.

The pandemic of course. It allowed for many to have breathing room to slow down, not care so much, and be true to themselves.

A pandemic ending? Now what?

All of a sudden, with everyone soon vaccinated, people are going to be out and about wanting to gather socially. All of a sudden the pressure to keep up, discuss post-pandemic plans, and be with others is on. Even before it actually is over, everyone is chomping at the bit to make plans. It’s no longer a long breath moment of silence and hunkering down. Now it is all about the other and getting out into life.

But what if you aren’t ready? What if you want to stay in lock down a little bit longer or even a lot longer. What to do? Perhaps all of us found a space that felt new and different that we don’t quite want to give up as the pandemic ends. Perhaps you love cooking more or family game nights have become a tradition or working on your creative projects deserve your time. These all feel like easier things to keep as a part of your life even as life resumes to normalcy.

How about drawing boundaries with friends and family? Now that everyone is going to be able to actually see their dear ones without a pandemic looming over us, what if you don’t feel like rushing out to be with everyone? How to handle? Being honest with one’s self seems to be the start. On your own, what did you learn about yourself as far as the others you share time with? Perhaps this is the time to put in motion how to be with others and be true to yourself. Perhaps that is not seeing people, perhaps it is not spending as much time, perhaps it is saying no, perhaps it is saying yes. Having courage to interact with others out of new knowledge garnered while in lockdown feels important as the pandemic ending is about to unfold.

If you are grieving the end of the pandemic, it is perfectly normal. For over a year, we have found a new way to live life that was quite different than life before. Taking some time to think about the losses that you will endure as life resumes also feels important at this time. As we went into lockdown, I don’t think anyone saw that this was going to go on for over a year. We lived into it as it unfolded.

As we have more notice of the pandemic ending, grieving what is over and lost, preparing how you want to engage with the other, and determining what parts of your lockdown life you want to keep are all ways to prepare for coming out of lockdown and engaging in normal life over the next few months.

Money and Spreadsheets

Posted on August 24, 2020 by Lisa Kothari

Times are tough – as they always are when it’s the topic of money. As such, financial experts and advisors tell people to create a budget and stick to it. Indeed, I hear a lot of people are tracking their money these days. One of the best ways people do this is by creating a spreadsheet. If you set it up right, the spreadsheet will show you all the money you have going in, going out, seeking to save, and more.

All there, in one neat place, your whole financial life can be seen and tracked. Sounds like a great idea on one hand, and, like most everything, it can also have a downside too.

Whenever I hear someone saying they are setting this up, it always sounds like a New Year’s Resolution – something to help break a bad pattern or to gain more control or to start a new leaf with money. It always seems to begin from the premise of improving one’s money circumstances. Something has gotten the person to feel that a spreadsheet will provide the solution needed to money ails.

On the surface, a spreadsheet tracking money can absolutely be something that is good and helpful in a person’s life. However, it is rarely the answer to stopping negative ways of interacting with money that reflects how we feel about ourselves. Instead, a spreadsheet can often act like a highlighter as to all that we do wrong, which can then lead into feeling bad about ourselves.

I would suggest asking yourself what is motivating you to track your money in such a concrete way? Is it to actually track your money or is it to highlight a part of yourself that you feel bad about already and this spreadsheet will serve as a tangible reminder of this “bad” part of you?

By asking yourself this question you can get a sense if tracking your money via spreadsheet is a healthy thing for you to undertake or is it just another tool to keep you tied to bad thoughts about yourself and others.

Be honest – as this may be the costliest decision of them all.

Doomscrolling

Posted on August 10, 2020 by Lisa Kothari

Doomscrolling. What a clever word for something many people are doing today.

Most of us were attached to our phones before the pandemic and political craziness of 2020 had taken hold. Yet, now something different is happening when we reach for our phones. It’s like the Temple of Doom.

We turn it on, head to our favorite social media sites, and go down the doom tunnel. A horrific article about the politics of the day to the ever-widening death toll from the pandemic to the economic havoc and mayhem — and that’s just the start. Another critical part of the doom scroll is reading all of the comments. I often think the comments grab us into doom more than the news itself.

All of a sudden, we are reading, scrolling, getting amped up, becoming anxious and depressed all at once — and it just keeps going. Compulsively we continue the doomscroll barely able to take a breath away from all we are reading. Someone told me he finally stops when there is no new doom to read. Seven hours in he takes leave of his phone!

This article in the Washington Post lays out what doomscrolling is and how to reign it in so you aren’t relying on the doom all day long. Some ideas in the article include changing your screen color to gray, spending limited amounts of time on-line in these ways, finding places on the Internet that offer the exact opposite of doom – like cute pictures of animals.

A few more ideas – actually purchase a real newspaper and read it. So old fashioned I know. Here though you can enjoy all of the news of the day without reading the comments of doom. Further, it provides space for your own good thinking about the article. Also, you are deciding what you will read in depth, skim, and skip altogether. Online reading is much more difficult to discern which is which for you on any given article as you may not be so interested, but you do want to hear what others think about it. Taking a more solo path can keep the doom at bay.

Also, choose your time of day for a good doomscroll. One where you are awake, active, and alert and not seeking rest and relaxation. Align yourself with the most energy you have to take it in and then leave plenty of time afterwards to let it all go. At night, keep your phone outside of your bedroom. Do not mindlessly reach for it, but keep in mind and value your sleep and rest over the doomscroll. Don’t worry all of the doom will be there waiting for you tomorrow.

We are wired to latch on to the bad and then worry to the nth degree about it all. We also our communal beings — we are drawn to know what someone else is thinking and then perhaps try that stance on and see if we feel the same way or not. However, this muddies the waters of knowing our own minds and trusting how we are thinking for ourselves. Reading without adopting how others are thinking about something is creating space for your own independent thinking. More important than ever these days.

Finally, doomscrolling is a time suck. It sucks you right down into the temple of doom and doesn’t let you go to actually live your life. There is less time for you. Sometimes I read the comments on news and its just on and on fighting and fighting and I think to myself do people really have so much time to fill arguing with strangers? Everyone is always saying how busy they are — is this what people are busy with? Or is doomscrolling a way to escape life that feels miserable? Sometimes I feel like attracts like. We feel our personal lives are doomed and so we seek out external doomscrolling to match this internal feeling.

Take a break and take stock. Life is lived in reality. Put the phone down, pick up a real paper, after a little bit of time, put the paper down, and go out and embrace your life. May it be full of Joy Living — hopefully steps — even miles — away form the doom.

Mental Health Crisis in America

Posted on May 11, 2020 by Lisa Kothari

I read an interesting article the other day in the Washington Post regarding how the current COVID-19 pandemic is pushing America to the brink of a mental health crisis. I cannot even believe it has taken a severe public health crisis like this one for the media to begin to pick up on how difficult it is for Americans to find and receive quality mental health care today.

Sitting from the vantage point of a therapist, I know this to be true for many reasons. While most articles, like the one in the Post above, focus on access to mental health care, there is something else one has to first realize. Access to mental health care starts with clinicians who are in training to work in the field and serve people in need of mental health services.

It is an unfortunate truth and one not often discussed in the media that to do the work of a therapist, or, as the traditional license is called, a Licensed Mental Health Counselor, is a costly and time-consuming journey. One cannot clinically practice one-on-one therapy with individuals without holding a Master’s Degree in counseling, social work, or marriage and family work. This type of degree takes 3-5 years to complete with significant amounts of debt taken on to complete the degree, upwards and over $100,000.

Along this journey, graduate students in training are called to do an internship with a significant number of clinical hours and supervision time spent in order to earn one’s degree. Although a person may have at least 2-3 years of training experience in school, one’s internship is unpaid. People must find paid jobs as they juggle their internship demands.

This is where it strikes me that the mental health system is failing at its core. Community Mental Health Agencies that serve the poor and mentally unwell, a segment of the population that would have very little access to mental health services, are staffed with interns from graduate schools who are seeing these people for free. The core of the mental health services offered to thousands of Americans is valued at an intern level who earn nothing.

From there, graduate students leave school and are permitted their first license. Where I live it is an Associate’s license, which means you have the ability to see patients, but you must be supervised for a set amount of hours as you work toward full licensure, which is additional hours. Often Associate Mental Health Counselors use this period of time to take clinician positions in mental health agencies. Now they are no longer serving for free, but for $17 to $23 per hour. The average case load for a new Clinician is upwards to 100 clients. Then add in the math of $100,000 of student loan debt.

It is from this vantage point that I see our mental health system failing in America. From the start, when people seek to train to become a mental health clinician, no value is given to the skills that they are learning and employing to help people with their mental health needs. From weighting people down with student loan debt, to not providing any value to the intern seeing clients, and then providing a very low income to the new clinician with a caseload that no one can keep up with — not only are the clinicians burned out, but the system is overwrought with little to no support for people who need tremendous care.

What happens after one has completed her Associate’s license requirements and you are now a fully licensed therapist? Unfortunately, most clinicians leave Community Mental Health and set up their own private practice. Even if the clinician charges a reduced fee, it is often three times the amount one was earning at the mental health agencies. It is unfortunate that the very poor and mentally unwell people in America are left to be churned through by clinicians who are in some training phase of their career burning out without proper care, support, or caseload numbers.

Insurance also plays a roll in the inequity of the Mental Health system in America. Are you in network and, if you are, your patients may benefit, but the Clinician will likely make very little money for their services when all is said and done. If you are out of network, then the Clinician works with the patient to determine the fee. A patient may submit a receipt to their insurance company which may provide them with a portion of the fee they have paid. In this way, the patient has to decide what can they afford given the insurance company will only be reimbursing some of the full fee and that is often after deductibles are met.

All of this to say that when we look at the mental health crisis in America, we need to critically think about how we value our clinicians in training as well as how we value the services provided to the mentally unwell, especially those accessing care through the community mental health agencies. It begins with both parties being valued and supported in terms of money and care.

Until this happens, the system is on crumbling crutches which is going to further lead to the black hole of inadequate care, funding, and a lack of people to serve during crisis such as the one we are in currently.

Dear Therapist: Pandemic Nightmares

Posted on May 8, 2020 by Lisa Kothari

Dear Therapist,

Ever since this pandemic took over our lives I have been unable to sleep well and, when I do find sleep, I also find nightmares. Seriously, they are disturbing! Is there any way to alleviate these terrifying dreams. It’s gotten to the point where I don’t even want to fall asleep as I am scared of where my dreams will go — death, violence, isolation — this type of imagery is rampant for me. How to get good sleep during this time?

Sincerely, A Terrified Dreamer

This is so common. First, the inability to even get to sleep these days. This happens for a lot of reasons, including not maintaining one’s regular sleep regime, too many screens on too close to trying to sleep, worries and uncertainty on one’s mind — all leading to the inability to let go into an unconscious state and sleep. Which is critical to feeling rested and restored, bright and energetic to greet the next day.

Some tips on getting to sleep during this time include:

Maintain your normal sleep time — when you go to bed and when you get up
Turn off your screen well in advance of bedtime
A better activity is actually reading a real book or working on an old fashioned puzzle with a pencil – activities that can ground
If you have many worries on your mind, writing them down before sleep. In this way they become externalized. You are free to pick those worries back up again the very next morning, but writing them down and letting them breathe for the night outside of you may be helpful
Engage in a ritual that will relax you like a salt bath, gentle stretching or a meditation to calm one’s self.
Direct your dreams! (And this will lead into your nightmares) If there is something on your mind that you want to know about or an answer to, write it down on a piece of paper. Also, as you close your eyes, have this question on your mind and repeat it to yourself again and again. Often, this type of exercise is calling to your internal world to respond with an answer that is not conscious.

I mention this last idea of dream direction to help with the nightmares you are experiencing. All of us are carrying anxiety, worry, and, some of us, even terror over what is unfolding in our daily lives. We speak to it in a myriad of ways while we are awake during the day, and we are also speaking to it in our dreams. Deep down in the places we are not aware of, we are holding these worries and frights and they come out to haunt us in our nightmares.

I hear how terrifying they can be and that they are happening on a continual basis to the point that you do not want to even go to sleep. Engaging in steps #4 and #6 that I have noted above may help you set aside consciously the concerns you are feeling terrorized about as well as direct your mind to focus on something more interesting to you.

It will take some work to actively employ these strategies, but it may very well worth it to find not only sleep, but dreams that answer something on your mind, rather than terrorize you with worries. This is not just you — so many around the globe are being terrorized by their pandemic nightmares — you are not alone. I encourage you to take the steps above to help you sleep through this time of uncertainty that plagues us all.

Lisa Kothari Counseling

Tag Archives: Anxiety