what's good for the goose {my first foray into therapy}

sitting outside the new independent coffee shop that opened in the neighborhood this summer

as a physician assistant with an undergraduate minor in psychology, I've always been fascinated by the connection between the mind and the body. that interest serves me well in my chosen specialty of primary care/internal medicine, as mental health comes to bear so frequently on physical, or somatic, complaints like fatigue, upset stomach, and dizziness. in any given day, I'll typically have one or two appointments that are scheduled specifically so someone can address their anxiety or depression, and it often comes up as a subject of conversation during routine physicals. I have probably recommended therapy to my patients literally thousands of times, whether it's to deal with an isolated situational stress or grief, or more pervasive issues like OCD, chronic insomnia, bipolar disorder, depression, or borderline personality disorder. when we're discussing starting antidepressant or anti-anxiety medication, I always explain that the medication can help your brain chemistry function better, but therapy helps your thoughts and habits change to serve you better. "think of it like physical therapy for your brain," I say to the people who are skeptical. "even if you go just a few times, you may learn something helpful that improves your quality of life."

finally, at the beginning of the summer, I took my own advice. we had just completed the busiest season of my life to date. on Sunday mornings, Nick left for his job at the seminary three hours away. on Mondays and Tuesdays, I was home with the two youngest (including Victoria who was waking up generally 2-3 times per night), and shuttling the two oldest to their after school activities. Nick would get home late on Tuesday night and help out with activities the rest of the week in addition to freelancing at other parishes and playing for weddings a few weekends per month. I worked Wednesday through Friday. Saturday was generally spent on basketball and/or soccer games, cheer performances, musical practice, etc. and then we did it all again! 

after much discussion and prayer, we decided it wasn't sustainable for Nick to keep working out of town like this when the kids are young. it's been bittersweet as he truly enjoyed his work at the seminary and found it intellectually, musically, and professionally rewarding. but when he first took that job, we only had two kids, and the fact that he would be home all summer and during holiday breaks made it worth it. now four years later, we have two more kids and the older girls are much more involved in afternoon and evening activities than before, so it made sense to pivot. 

we are so fortunate that he was able to start a fulltime position locally here in June, and after making it through the insanely busy month of May, I was looking forward to hanging up my solo parenting hat. I pictured being able to exercise more consistently and spend more time together as a family, having more emotional energy to engage in deep conversations with the older girls, and being able to keep the house in much better order (not perfect -- but better!). 

and then, he was home. school ended, we had no extracurricular activities except gymnastics one night per week, I switched my work schedule to Monday/Wednesday/Friday which I vastly prefer, and Nick started keeping the babies at home on Mondays so I only needed to do the daycare run twice a week. and I just crashed. Nick kept asking me if everything was okay and I kept pretending that all was fine (why?!). "Yep!" I would say, and then proceed to sit on the couch and stare at the wall for twenty minutes. I didn't want to do anything or talk to anyone or think about anything. I wasn't particularly sad; if I lived by myself, I would have been perfectly content to come home from work and go right to bed without interacting with anybody. as it was, I came home, threw some frozen dinner in the oven, answered Nick and the girls if they were directly addressing me, and otherwise just went on autopilot mode until bedtime. I specifically remember avoiding eye contact (at least up until the point that it would be awkwardly obvious). I didn't read, or blog, or post on social media. it was like living as a ghost.

finally, after about a week of this, I finally told Nick that I wasn't doing so well. bless him, he was like, "I KNOW... what can I do to help?" he offered to stay home with the kids so I could go out with my friends, which was sweet but the last thing I wanted to do -- I didn't even want to talk to anyone! so he did as much as he could to keep the kids occupied and just let me have some space to vegetate.

I've had a few episodes like this in my adult life before that always lifted just as suddenly as they came. each time I'd think about maybe pursuing therapy, and each time, before I could even make the arrangements to see a therapist, I'd be back to my normal bubbly self and just keep going full steam ahead from there. this time, I was especially conscious of the older girls picking up on my ennui. there is a family history of depression and anxiety as well, and while my symptoms have never been persistent or pervasive enough to warrant starting on medication, I realized that chances are good I will deal with these episodes periodically in the future. so I figured it would be helpful to reach out to a therapist not only to help support my own mental health during these times, but also to come up with a plan for how I can be authentic and emotionally present for my family. 

of course, a significant barrier to starting therapy is finding a therapist -- I knew that it can take months to get in to see a clinician and some aren't accepting new patients at all. but I did a quick perusal of recommendations on one of my local Catholic Facebook groups and landed on the Pittsburgh Pastoral Institute. I filled out their intake form online and had an email back from them just two days later offering several different options for a virtual intake appointment the next week! the intake therapist was so kind and encouraging as I explained my reason for pursuing therapy. I was impressed by the extensive review of my medical and family history as well. then she said she had a therapist in mind for me and that I would hear back in a few weeks with more information. by the end of that same week, my therapist called and we chatted for about 15 minutes to make sure we had a good rapport before embarking on therapy. she is warm, funny, down-to-earth, and older than me (I just could not handle a 24-year-old giving me life advice). 

true to form, I was feeling back to normal by the time we had our first official session. she and I both agree that that episode was a very normal "letdown" as my mind and body finally relaxed after the adrenaline rush of the previous school year. essentially, my subconscious knew it was safe to crash since Nick was home to hold everything together (sorry, babe!). we've had five virtual sessions so far and it is absolutely one of the best things I have ever done for myself. she has helped me recognize that I need to build more rest and downtime into my day-to-day routine, and that it is okay and good to ask for help when I need it -- or even when I just want it (!). I have felt badly about the fact that I withdraw when feeling negative emotions, and she has helped me realize that that characteristic is part of what helps me maintain clear thoughts and a sense of calm during a medical crisis AND that there are ways I can take care of myself as well as I take care of the people around me. for example, she's coached me through a 30-second breathing exercise to re-center myself after seeing a challenging patient, and introduced me to Dr. Kristin Neff's work on self-compassion. her website features several free guided meditations built around three principles of self-compassion: 1) naming that you are experiencing something difficult; 2) recognizing that anyone else experiencing this difficult thing would be suffering too; and 3) practicing kindness to oneself. 

at the end of each therapy session, my mind feels so much clearer. even without consciously thinking about it, I find myself more present and engaged with my surroundings, noticing what my body is feeling, whether it's tension in my neck or a pleasant breeze on my arm. if I have a few minutes to spare, I've made it a point to go sit outside on the back deck to read a book or simply watch the birds, when before I would scroll social media for that time because it wasn't "worth it" to spend that small amount of time on something that actually refreshes me. 

and now we are embarking on another school year with a rhythm that looks wonderfully different. the girls currently have no extracurriculars for the fall (they're both on a waitlist for their respective gymnastics classes, and had no interest in the fall sports offered through the school). I have been mostly able to complete the scheduled workouts for the Couch to 10K program I'm using to prepare for the Great Race at the end of the month. I've finally had the mental energy (and the time!) to do more consistent deep cleaning around the house, although you'd have to see each room immediately after it's been cleaned to believe it -- two toddler tornadoes make short work of any clean space. it still feels like there aren't enough hours in the day, but I feel good about how most of those hours are being spent.  

so now, whenever I extol the benefits of therapy to my patients, I do so with added gusto. unfortunately, access and cost can still be barriers to mental health care, but for an introvert like me, it has been a huge blessing to have someone who is paid to listen to me talk and unload all of my woes, and is trained to help me work through them, without the expectation of me then listening to all of her problems and taking on that emotional load in return. every session we have feels like an opportunity to shake off things that have been weighing me down so I can swim more freely. as we learn more about how chronic stress leads to inflammation in the body, I'm even more motivated to optimize my mental health. next year I'll be forty (!), and it's somewhat surprising but ultimately exciting to realize that I still have a lot to learn about myself and how to make the most of this beautiful life God has given me.

turns out, trails are a big part of keeping me sane!