Therapy for Anxiety, Depression, Relationship Conflicts, Grief, and Cultural or Political Stress
"Have patience with everything that remains unsolved in your heart and try to love the questions themselves like locked rooms and like books...live in the questions now."
-Rainer Maria Rilke
While feelings of anxiety are normal, fear and related symptoms-- if intense and persistent enough-- can become distressing and disruptive, e.g. in social anxiety, generalized anxiety, post-traumatic stress, phobias, obsessive-compulsive tendencies, and panic. Cognitive therapy techniques address worries and beliefs that are causing pain or getting in your way; I sometimes provide written exercises to practice recognizing automatic thought distortions, e.g. all or nothing thinking or fortune-telling. This can become a tool, along with behavioral strategies like deep breathing, to manage heightened anxiety and stress. I may recommend mindfulness meditation exercises to help change a habitual problem and further develop your "witnessing self." I work with survivors of assault, mental/emotional abuse, harassment, and accidental injury. To heal trauma, I facilitate clients' acceptance of feelings, the reality of the trauma that occurred, and their own exploration of ways to move forward with increased clarity and hope.
Procrastination, inattention, shame, perfectionism, and mistrust are often associated with anxiety problems. Sometimes habitual problems begin as healthy coping attempts, in order to handle fear and vulnerability, but at some point stop serving an individual. Therapy supports mindful, proactive decision-making and, over time, can lead to improved confidence in contacting reality with more balance. I may also recommend a medication evaluation with a psychiatrist for a possible combined treatment for anxiety or depression.
The persistence and pervasiveness of feeling down should help determine when common explanations for it, such as character or "weakness," are insufficient. Therapy does not eliminate natural feelings of sadness and sorrow. It alleviates the sense of being paralyzed by feeling sad or down (often described as a dark cloud). Depression is partly genetic and partly associated with stressful life events and social/societal factors. Even when circumstances explain a lot, interpersonal therapy (IPT) helps treat depression by facilitating acceptance of feelings as well as behavioral changes in a particular problem area. IPT helps a client explore ways to modify communication and enhance social support and satisfaction. Cognitive-behavioral strategies also work well to interrupt self-reproach and guide clients toward improved mood.
When a down or low mood lasts for years, perhaps as far back as a client can remember, it may not register that life can be any different. In addition, stigma relating to depression is still present in society; however, depression is not anyone's fault. Realizing that chronic depression is treatable encourages a client towards, and throughout, talk therapy. Symptoms like difficulty concentrating and feeling down on oneself can improve, especially with emotion tolerance skills and understanding significant life transitions or past experiences. It's never too late to receive help to experience relief and vitality. I treat depression that is low-grade, intermittent, chronic, or acute. I also work with bipolar disorder, which has been stabilized through medication.
With attunement to details of communication patterns, interpersonal therapy hones in on ways for a client to increasingly meet attachment needs and reduce conflict or social withdrawal. New communication options may be role-played. When a therapist "walks with you" in this interpersonal terrain, it can be easier to breathe, observe, and manage strong feelings while remaining connected in significant relationships. Support is provided to acknowledge expectations, assess whether they are realistic, make requests or assert limits; whatever is needed becomes clearer and confidence grows, as a client takes more charge in a relationship. Different ways to use discernment in choosing and pacing friendships and new romantic relationships can also be addressed. Authentic communication with, and trust in, the therapist often transfers to sharing more with others and in relationship with yourself. Aspects of the true self may be developed more fully over time.
Relationship issues I work with:
Conflicts with a spouse, boyfriend/girlfriend; dating challenges; conflicts at work (coworker, boss) or with a friend
Decisions and choices on a path to parenthood: Assisted reproductive technology; adjustment to a new family structure
Family of origin: Difficulty managing conflict or distance in relationship with a parent or sibling
Parent-Child: Handling limit-setting, anger, conversations about difficult topics; helping build emotional resilience
Self: Conflictual childhood experiences, self-neglect; compassionate self-inquiry, a groundedness of being
Grief is a universal experience after someone close has died; the experience unfolds in unique ways and often involves waves of intense sadness. Therapy offers a space to process strong or conflicting feelings and to talk about the course of the relationship with your loved one, including the death itself and the days that followed. If you feel stuck or depressed, you may be struggling with common grief stumbling blocks, such as guilt or disbelief. Conflicts with a family member since the death, or social withdrawal, can compound feelings of loss. In interpersonal therapy focused on grief, I facilitate emotional expression and help clients consider ways to enhance social support. Over time, the meaning of the loss becomes clearer through conversation about the person who died-- naming specific, positive memories and treasured qualities as well as negative experiences or qualities. Ways to carry the valued aspects of this relationship into the present, in new forms, are considered.
If the death of a loved one was sudden or involved the effects of a devastating illness, grief can have elements of reaction to a trauma. In what's called a complicated grief (CG), the pain of the loss is pervasive nearly every day, for longer than expected, marked by unrelenting sadness, emotional numbing or helpless feelings. CG is often accompanied by avoidance of certain reminders of the loved one and recurring, troubling thoughts, eg. missed opportunities to help, a sense that the death just happened. In treatment of CG, a cognitive-behavioral technique called exposure helps clients to recognize where the grieving may have stalled and to move through painful perceptions. I serve as a guide in this process, responding to the unique aspects of your loss, and alternately, your present aspirations, in order to hep restore balance and forge new paths.
Cultural or Political Stress
Are you experiencing stress related to the political climate? Do you have a sense of being between two or more different identities or cultures? I am sensitive to and well-informed about the impact of societal factors like belonging and marginalization on mental health. I work with clients who are struggling with discrimination or abuse, due to religious, ethnic, gender, sexual or racial identity. Therapy supports self-expression, problem-solving, and personal growth. Acknowledging your own mental health needs is an important step toward stress relief and empowerment.
After the last presidential election, political grief was named and discussed by Kathy Shear, MD, an expert in complicated grief. There are repeated triggers for this grief, hence complicating it: the constitution or law is disregarded, new xenophobic and racist policies, hate crimes, climate crisis, etc. While many have been shocked, it can be difficult to recognize the internal experience of mourning. Coping may include numbness and avoidance, fear or dread regarding the future of the planet, or new community activism (frequently a combination). Concerns about mistakes, family reckonings, feelings of overwhelm and the multigenerational effects of trauma arise. My practice addresses the impact of these stressors on health, job situations and relationship satisfaction. Therapy can help to clarify needs and options, e.g. effective communication, social support or resources, and improve adaptation.
Cultural adjustment issues I work with:
Racism, LGBTQIA discrimination, prejudice, privilege, ableism, sexism: Questions about identity, experience of differences or navigating conflict in the context of dominant power blocs' shaping of consciousness
Immigration: Coping with this administration's enforcements, living apart from family, or past trauma
Work and financial stress: Expectations, self-esteem, insecurity, new demands
Activist burnout: Examine emotional toll, communication strategies, self-care, balance
Clinical psychologist Dr. Nina Miller provides psychotherapy on the Upper East Side of Manhattan, 10128, near 10028, 10021, and 10025.