Friday, May 3, 2013

Let It Out

When I first started working in private practice, I was informed by someone that a bunch of websites listed me as a psychiatrist in Los Angeles (my awesome hubby has since fixed that error, thank goodness).  I found that a bit ironic, given that my least favorite rotation in all of med school was psychiatry.  And yet, it turns out that I deal with mental health issues almost every day both at work and (no shock) at home.

Today I jokingly mentioned to a couple of patients, who were both apologizing for breaking down in tears during their appointments, that I don't feel like I'm doing my job right if I don't make at least one person cry every day.  Obviously, crying is not exactly my goal.  But I guess part of me knows that I'm providing a therapeutic environment when patients feel comfortable crying in front of me and telling me how they really feel.  I can honestly say that it is a rare day that I don't see any tears or talk about sensitive, painful issues with someone. When I picked my specialty, I never realized how much of this my job would involve, and yet, unlike my psych rotation, which never really clicked for me, this feels a bit like my niche, and as much as I sort of dread appointments that are likely to involve tears because I know that they will be draining, I always feel a closer connection to those women.

Dealing with depression and anxiety and other big emotions can be intimidating, but I think the biggest hurdle for a lot of people is facing the person crying in front of them.  The tendency is the shove a bunch of Kleenex at her and hope she'll perk up.  The crying is uncomfortable to watch, especially when there is just silence cut by sobs.  All we want is for her to stop crying so that our discomfort will end, but, as you might imagine, just telling her to stop will only alienate her and teach her that her emotions are not OK and that you don't care.  On the other hand, if you can suck it up and sit through the crying and help her express what's wrong, you might be able to start to understand what the problem is, but it is not an easy thing to do.

The big news here is that it's the same with our kids.  We all hate when our children are upset and crying and throwing tantrums.  Most of us try to hush the offending child, telling him that he's fine or ordering him to stop crying or trying to distract him, but even if that diffuses the situation, which it often does not, it doesn't fix anything.  Worse, it just teaches him that his parents don't really care what's going on with him and that his feelings are unimportant.

Being mindful of our discomfort and feelings of insecurity when people are expressing big emotions can help us respond more empathetically.  If we can join in our children's tantrums in a more empathetic way, we teach them to process their feelings rather than just shutting them out.  They learn mindfulness, which is a key to being able to respond in a positive way to stress, rather than a way that emphasizes stuffing the pain away.  Imagine what it would be like if, instead of saying, "Oh, you're OK.  Get over it," you said, "I can see you're upset.  Tell me what's wrong."  Granted, what is wrong might be something that seems trivial to us, but asking your child to put the problem into words will start helping him learn to identify his emotions so that he can have some control over them.  Your toddler's tantrums probably won't stop overnight, but when he starts understanding better where his feelings are coming from and he starts to feel that his parents are really engaged with him, tantrums will become increasingly less frequent and more productive.

But the change has to start with you.  You've gotta let the tears roll down.  When you see tears, hold out the tissue box to offer help, but don't try to stop them.  Then, when the sobbing subsides, offer a caring ear.  It will connect you in ways you never imagined.

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