Therapy at the End of Life

Therapy at Life's End

Placing your trust in a therapist during the transition into one’s end-of-life is profoundly vulnerable, and very brave. Some people reach the end of life when they are in their older age, and others become ill before they are ready to face their own death. This blog is a discussion of using therapy to receive support in facing an early death, specifically when diagnosed with cancer. As a therapist, I’ve had the privilege of supporting someone through this process, and I will always be grateful in being trusted to help support them.

Receiving a diagnosis of cancer can trigger so many things. In discovering this diagnosis, it’s normal to feel afraid, as it expedites your own contemplation of the end of your life. People often feel terrified, numb, hopeful, devastated, and they find themselves facing so many unknowns. Being sick introduces the possibility of death. Many people with a late stage or potentially terminal cancer diagnosis experience extreme grief, humility, gratitude, love, and a profound shift in perspective.

The loneliness of being very ill and of approaching death often compels individuals to conceal their anxieties and grief from their family, especially before all have accepted that there is no longer a chance to recover. Sharing hope becomes a delicate balance, given the reluctance to uplift loved ones only to potentially disappoint them. As a therapist to someone in this position, I’ve realized that therapy can function to provide a neutral space for someone to process their own hope, loss of hope, exhaustion, fear, and mitigate their reactions to their loved ones as they deeper understand their own illness and their timeline for the end of their life.

One of the hardest parts of being sick is navigating the uncertainty of one's remaining time to live. Similar to the stages of grief experienced after a loss, those facing the end of their life undergo denial, bargaining, anger, grief, and acceptance. Some people may be in denial about the reality that they are dying up until the end. Others may feel angry that this is happening to them. Some people are lucky enough to process their own grief of their upcoming transition into afterlife, and they may reach acceptance before they pass. However, time constraints may hinder the completion of this emotional journey before the final transition.

The pressures accompanying this transition are overwhelming. People find themselves organizing their affairs, preparing themselves, work, and loved ones for the inevitable goodbyes. This process often plunges individuals into extreme emotional pain, arguably one of the most challenging aspects of the human experience. Families, unprepared to bid farewell, grapple with stages of grief, including bargaining (which generally shows up in hoping that their loved one can still receive treatment) to profound anger at the impending loss.

As the body weakens, simple tasks become difficult, and the vulnerability of seeking assistance becomes a major pressure for someone who is ill. It’s very hard to ask for help, and as one becomes more and more sick, they lose their autonomy and ability to function. It can be embarrassing to ask others for simple things that you’ve been able to do your entire life. The loss of agency begins to creep in and its devastating. Maintaining a facade of cheerfulness becomes impossible to somebody who is in that much physical pain. Approaching the end triggers an alternate state of mind, maybe mimicking a younger state, sometimes resembling a more psychedelic experience. Reality undergoes a profound transformation, often accompanied by the acceptance of pain medication and cannabis to help with pain and appetites.

Approaching death requires a spiritual critical point of reflection. Afterlife remains an enigma. We know many things, but with no one can predict what happens in the moments before and after death, we still don’t know what that experience is like, and where we “go”. While some perceive death as final, others, like the Buddhists, term it "Continuation," believing that we continue on after we pass. Society's drive for certainty clashes with the inherent unknowns of life's conclusion, urging individuals to confront their fears and grapple with the uncertainties of the afterlife. A part of approaching your own passing is preparing yourself with your own spiritual belief of what will happen to you.

My experience as a therapist in this context shifted the conventional boundaries of the “standard” therapist-client relationship . I was transparent in a way that I’ve never needed to be. I found myself openly discussing my life, sharing my emotions, and cried alongside my client as we grieved their transition. This work touched me deeply and evoked a profound appreciation for my own life's simple moments. I was gifted many lessons of why life is worth living as I was allowed into processing with my client around what they were saying goodbye to. With this perspective, I was able to evaluate what relationships were meaningful, and prompting farewells to relationships that no longer served a purpose. I got to re-evaluate how I wanted to live my life and spend my time. In processing death, trivial concerns lost their significance, emphasizing the importance of every second.

As the transition from life to afterlife unfolded, my role as a therapist changed, and I stepped in to help facilitate the process of leaving this world. My role became more active as I engaged with family, nurses, and hospice to offer support and help the transition feel comfortable. At the end, I grieved. And I still remember them, because people we care about never truly depart from our lives.

A reflection on Social and Mental Health Recovery after a Pandemic: Recovering from the Loneliness Epidemic

The Beginning

In May three years ago, the lockdown had just been extended for a third time in the bay area.  The lead up to the first lockdown had been murky.  There were talks and fears of Coronavirus,  and of the growing crisis in China in November and December of 2019. Although the threat of a pandemic was possible,  it was too eerie to consider as a reality yet.  There have been so many false alarms for pandemics over the years,  and none of them had come to fruition of a global crisis.  But this time, the news was relentless, and the reality of a pandemic grew closer. 

There were people who would dismiss the reality, and there were people who were convinced that the pandemic would happen. One thing was consistent: everyone was aware of the potential risk in the months leading up to the initial lockdown. 

I remember driving passed the Grand Princess Cruise ship, docked in Oakland, in early March, aware that there were 21 cases of Covid on that ship, that was the point when the reality of the pandemic started to enter my life. I knew that it was coming, and I knew that it would be big.  Several tech companies had already given their employees permission to work from home. And as a therapist, I was questioning at what point it would be safer and more ethical for me to move my practice to fully remote. I made the decision over the weekend, with the news of Coronavirus in the US flooding onto my devices. I went to three grocery stores that weekend, many of which had empty shelves already, buying a month’s worth of supplies. Two days later, the Bay Area officially instated the first shelter in place, a two week lockdown, which ended up being extended for multiple months.

The early days could be classified by shock, trauma, the unknown, classified by a mix of fear and excitement. I remember many reaching out to colleagues, friends, family, making sure everyone was okay. In the beginning, tolerating a lockdown to keep everyone safe seemed doable to many, especially with the time cap of a two week shelter in place order. Everyone landed in different situations. Some people were in secure relationships with secure jobs, others didn’t know what they would do without being able to work. People lived with roommates, with partners, with family, or alone.  Whatever situation one was, you were stuck there. For the period of shutdown, everything stood still.

Fear.  That was a theme of the early days.  What could this virus do? How contagious was it? Was the virus fatal?  These are questions in which no one yet had the answer.  Everyone responds differently to fear, everyone has a different natural fear response. Some people dismiss fear, and for some people, maybe they were inclined to dismiss covid. There were risk takers early on, people who were not afraid of getting or spreading covid. Some people froze, locked down in an extreme way, didn’t even think of leaving the house, not for a walk, not to take out the trash. Many people started wiping their groceries down with bleach, cleaning their houses incessantly.  Fear impacts people differently.  The unknown can elicit a universe of fear. In those early days, we begin to fear other humans, fear getting covid from being outside at all. Without knowledge, there weren’t limits to fears.

The Lockdown that never ends

The number of deaths continued to grow. We were given more information, for example, it’s an airborne illness. Most people who get it don’t end up in the hospital, but the fatality rate is much higher than the flu, and there is no cure. It’s extremely contagious.  There aren’t enough N95 masks. Nurses are dying, hospitals are flooding.  Almost all news is pandemic related news. Social media and Apps are getting better, people are using Zoom to connect. Most social contact is coming from a device. People are processing what they have lost, the sadness of death, the fear that it could be them. Some people haven’t worked in months.  Government assistance kicks in for some people and not for others.  The other side of this is that things are pretty cozy and unchanging at home.  People are eating all home cooked meals, maybe some people are developing substance use disorders, others are making bread. People live in their pajamas. Habits are forming. There are no transitions: to and from work, to therapy, to a workout class.  Time is melting together.  Nothing seems to be changing. We are forgetting how to talk to strangers, how to make new friends, how to smile at people, how to have small talk. Social anxiety and “stranger danger” are increasing.  Focus and the ability to get work done are decreasing.  Parents are the most tired they’ve ever been, kids are losing years of education and socialization. Domestic violence is reaching an all time high in many homes. Poverty is affecting the families that can’t earn money.

This is where I’d like to name that many different humans, across many different cities, had completely different pandemics.  And this is a spot where relatives and friends started disagreeing and fighting with each other at times.  Politics split the pandemic into different realities, different safety levels.  In the Bay Area specifically, we had one of the most extreme lockdowns.  This is partially because we could, because many people did have the privilege of being remote indefinitely.  And when the Bay did reopen, it was a different place, because so many people had left, and so many businesses could not afford to survive.

I would like to talk about the emotional arc of the pandemic, to some extent.  Here is what I saw.  Fear was one of the only feelings that people could feel early on.  And if fear was too much to feel, people would dissociate instead, shut things out.  Tara Brach, a well known psychologist and Buddhist teacher,  would say that we’ve forgotten who we are in the trance of fear.  Within a fear response,  play, joy,  and light-heartedness shuts down.  Grief came next.  Grief of what we lost, grief of the world as we knew it, grief that it would never be the same.  People stopped being able to watch hard things, read the news at times,  and grieve.  Breakups felt harder.  Sadness was intolerable; so many feelings were.  What I noticed is that people stopped being able to grow as humans, on a higher level.  Obsessive thinking and OCD behaviors became worst.  Here we were, with the most free time we have maybe had in our entire lives, and all of our aspirations to learn instruments, to write books, to start companies could not, in many cases, be actuated.  Health care workers, therapists, and teachers have never been more busy, and at a certain point, begin to burn out.

With everyone going through the same trauma at the same time, there wasn’t much space to help other people,  because we were all suffering.  There were very little emotional resources to go around. No one was really “ok”. There was no light at the end of the tunnel. With each new day of lockdown and isolation, weeks on end of no social contact in some cases, we were in an exponentially growing mental health crisis. All the therapists I know were completely full the entire pandemic. If you already had a therapist, you were probably holding on tight to that therapist.  If you didn’t, you were probably fighting hard to find one. With lockdown, vacations stopped happening for therapists and for many people. With that went our reason to take a break from our work. With the insecurity around the economy long term, many people who had jobs and healthcare were terrified to lose those things. 

Trump, George Floyd,  Differing opinions,  “False News”

Navigating Political Dynamics in the Pandemic

We entered the pandemic during a time when our country was severely divided politically. The novel and severe challenges of the pandemic were intensified by the leadership of President Donald Trump, who seemed to dismiss and minimize the risk of Covid. The political landscape became a focal point, with divergent opinions on the severity of the virus and the efficacy of public health measures contributing to a deeply divided narrative. The dynamics surrounding Trump's approach added a layer of complexity to the pandemic, showcasing the intricate relationship between political decisions and public health outcomes with maximum risk of the outcomes failing. The laws became a state by state decision, which led the people of the united states to be living in completely different pandemics, ranging from completely shut down job markets and local economies to cities that did not seem to be experiencing a pandemic at all. And even worst, in a time of crisis where a society could come together, ours begin to split apart at the seems, leading to political and social unrest, an insurrection, and violence against our government that we haven’t witnessed in our modern society.

George Floyd Tragedy and Societal Unrest

In the midst of the pandemic's chaos, and with many peoples undivided attention on social media, we witnessed on camera the heart breaking and completely unjust death of George Floyd in May. Watching a black man be murdered for no reason by the police ignited a long due rage and awakening around racsicm in the US, sparking a wave of protests and reigniting conversations about systemic racism and police brutality. The intersection of a global health crisis and the fight for social justice highlighted the interconnected challenges facing society. Differing perspectives emerged, both on the streets and in online spaces, reflecting a broader societal awakening to deeply rooted issues. The events surrounding George Floyd's death became a pivotal moment, propelling the ongoing struggle for racial equality and social justice into the forefront of public consciousness.

Media Narratives: Divergent Opinions and the Challenge of "False News"

The information landscape during the pandemic witnessed a surge in divergent opinions and the proliferation of misinformation. The term "fake news" gained prominence as conflicting narratives about the virus, its origins, and potential treatments inundated public discourse. Having a leader who believed in, and focused on disparaging the news created information mayhem in our country. Disparate views on public health measures, mask-wearing, and the gravity of the virus fueled impassioned debates, often amplified within echo chambers on social media platforms. The infodemic, characterized by the rapid dissemination of both accurate and inaccurate information, underscored the critical need for media literacy and discernment in navigating the intricate information landscape during times of crisis.

People are your enemy: Judgement

With so much fear came extreme judgement, and judgement on differing opinions.  Everyone had an opinion. Many people had different opinions. People fought, friendships ended over these differing opinions.  Some people were very cautious and stopped hanging out with those who weren’t. Some people were less worried and didn’t think that they needed to wear a mask in certain spaces.  The concept of consent was tested often, paranoia rolled out with how honest others were being with their safety practices. Many felt like they were in an open relationship with everyone in their life,  having to discuss their other relationships and the risk factors involved.   

The rollout of vaccinations and of Getting Covid

With the successful vaccine trials and the near future of being vaccinated, many saw a glimpse of hope in sight for how we had all been living, and for the impending fear of death.  Hope on the Horizon: Initial Vaccine Rollout

The initial phases of the vaccine rollout marked a pivotal moment of hope in the battle against the pandemic. Frontline workers and high-risk populations took center stage, receiving the first doses as a testament to the prioritization of those most vulnerable to the virus. The sight of healthcare professionals and essential workers receiving their vaccinations became a symbol of progress, signaling the beginning of the end of a long and arduous journey. Yet, there was also fear about the vaccine. Was it safe? what were the long term affects? could the vaccine cause damage to us?

Expanding Access: Broadening Vaccine Eligibility

As the initial phases progressed, a concerted effort was made to expand vaccine access to a wider population. Eligibility criteria broadened to encompass various age groups, underlying health conditions, and essential worker categories. Mass vaccination sites, community clinics, and mobile units played a crucial role in ensuring widespread accessibility. This phase marked a shift towards reaching the general population, instilling a sense of collective responsibility and a shared commitment to achieving widespread immunity. Within this phase, it seemed that people were competing to get vaccinated, and those who managed to get vaccinated first felt guilty that they were taking away the chances from someone more vulnerable.

Vaccine Hesitancy and Education

Despite the positive momentum, challenges emerged in the form of vaccine hesitancy. The dissemination of accurate information and education about vaccine safety and efficacy became paramount. Health authorities, community leaders, and influencers engaged in outreach efforts to address concerns, dispel myths, and encourage widespread vaccination. This phase highlighted the importance of transparent communication and community engagement in fostering public confidence and promoting the greater good.

Recovery

Rebuilding Connections

As the vaccination rollout progressed and the grip of the pandemic begins to loosen, there arose a collective yearning to rebuild connections that were strained or severed during the tumultuous period. The resilience of human relationships was tested, and the process of reconnecting demanded patience and understanding. The shared experience of navigating through unprecedented challenges may serve as a foundation for empathy, fostering a renewed appreciation for the importance of community and human connection. Some people raced towards connection, others continued to live in the pandemic life that they had build for themselves, not yet ready to leave their cacoon.

Addressing Emotional Aftermath

The emotional aftermath of the pandemic has been nuanced and varied, reflecting the diverse ways individuals coped with fear, grief, and isolation. We Mental health professionals have foun ourselves at the forefront, guiding individuals through the process of introspection, healing, and rediscovery. One thing that became worst was social anxiety. Regularly interacting with strangers and acquaintances felt difficult and tiring, people had to evaluate if they wanted to make new friends after such a traumatic world event. Embracing vulnerability become paramount as individuals confronted the lingering effects of the prolonged uncertainty. The journey to emotional recovery involves acknowledging the impact, processing complex emotions, and crafting strategies to navigate a post-pandemic world with resilience and self-compassion.

Rediscovering Resilience

In the wake of a global loneliness epidemic, the process of recovery has extended beyond restoring the status quo. Our priorities have been defined and rewritten. We’ve had a lot of time to reflect.  The lessons learned during the pandemic, though challenging, provide an opportunity for personal and societal growth. Resilience becomes a beacon guiding individuals towards a future marked by adaptability, compassion, and a deeper understanding of the interconnectedness of humanity.

The Biggest Existential Crisis of Our Time

We lost everything about our way of life, and we were forced to evaluate what was important to us, as we were unsure that the world would ever return to how things were before. As we tentatively step into the "new normal," the lessons learned during the pandemic are being negotiated with work life balance. The recalibration of social norms, the reshaping of work environments, and the ongoing impact on mental health underscore the need for a mindful and intentional approach to the post-pandemic era. As things become busy again, we remember how we did things back then and we choose to do things differently, knowing that a pandemic is possible again. The journey of recovery invites individuals and communities to actively participate in shaping a future that prioritizes well-being, connection, and a collective commitment to fostering a more resilient and compassionate society.

The Patriarchy Isn't Working Anymore

A client of mine recently posed the wise question, “what is the feminine word for the concept of Misogyny?” I have her explicit permission to share this. We couldn’t think of the feminine version of misogyny. Can you? The definition of misogyny is being strongly prejudiced against women. If I think about misogyny and how it feels, I would say that misogyny includes elements of belittling, objectification, and trying to have power over women. The only comparable word that we could come up with for the feminine concept that may be on the other side of the gender spectrum for misogyny was the word “feminism,” which is actually defined as the advocacy of women’s rights on the basis of equality of sexes. Misogyny seems to become enlarged as women’s rights become more equal. Misogynistic backlash seems to become stronger in ways as the patriarchy, the rule of men, shifts toward a more equal model between all sexes. This blog post is a reflection on patriarchy as it relates to current systems of capitalism, race, and gender, and how this system affects mental health.

Many cultures have followed/ still follow a patriarchy model. Specifically in the United States, I think that the patriarchy refers to men in power, who are mostly white men. When examining patriarchy, it's essential to acknowledge its ties to capitalism. When I think about capitalism, I think about colonialism, the roots of which were white men and women colonizing the global majority of people who are brown. The legacy of colonialism includes mass murder, ownership, profit, and the destruction of well-functioning societies for the profit of less well-functioning ones. Fast forward to capitalism, another power-involved game about survival and ownership, depending on what part of the capitalistic system you are buying into, and who you are choosing to help make rich in some cases. Production, ownership, and desires have far surpassed what many of us need on a base level, often at the blind expense of our physical environment. Capitalism and the people who want to profit the most may cause the end of our species, because there are no limits to how much damage we will cause to the environment for the sake of money. Capitalism is not a well-functioning village; it has disrupted the sense of community and connection.

Let’s talk about power. Money is one way that people wield power. Until recently, men were the only ones who could make money within many societies. Weilding power is the act of leveraging something that someone else needs to get what you want, to act how you want, to feel in control. For women, power and value have been placed on thinness, beauty, and fertility. When I think about racism, I think about white people wielding the power and privilege and profit of being white to continue to have the money, to act the way that they want, to treat people of color below them, or to avoid people of color thus not having to “think about race”. Capitalism and the patriarchy have rewarded the white person who performs to “the way,” which is geared towards being wealthy and having connections high up. The standard of perfection in school and in job performance has long been associated with success. In Hollywood, success is defined by perfect beauty and behavior in the public eye.

In examining the role of patriarchy, it's necessary to evaluate into its manifestation within our past institutional structures, one being the church. Historically religious institutions been imbued with patriarchal values, often reinforcing traditional gender roles and perpetuating power imbalances. The hierarchical structure of many religious institutions tends to place men in authoritative positions, limiting the role of women to subordinate or supporting positions.

The concept of original sin, often rooted in religious doctrines, has been used to justify the subjugation of women, casting them as the temptresses responsible for the fall of humanity. This narrative reinforces harmful stereotypes and contributes to the unequal treatment of women within religious communities. The exclusion of women from leadership roles, including priesthood or clergy positions, further solidifies the patriarchal nature of many religious organizations. The stigma associated with challenging these interpretations over the centuries has often silenced dissent and reinforces the power dynamics inherent in patriarchal structures. Marriage has been used to control female virginity and imply ownership within relationships.

Now I will share my personal take: the patriarchy isn’t working for anyone. The same racist white people who abused people of color raised their own children. And those children did not suffer the way that people of color suffered by their hand, but they didn’t get away unscathed. I see the damage of the patriarchy in everyone. I see the cycle of abuse being passed from father and mother to sons and daughters. Almost everyone that I see as a therapist is ready to fire the patriarchy; it’s not working for anyone anymore.

How do we all use our humanity to drive our society? How do we respect each other, share, and be kind? In a society where we all need each other, we have more motive to behave and get along. But it’s within human nature to wield power, to murder, to fight over land and ownership and resources, to want to be “up one” from each other.

The generation of white people that raised my parents were promised certain things. They were promised good jobs and houses and cars if they worked hard enough and behaved. The men of that generation were expected to make the money and be respected by their wives and children, and the women were expected to run the household and raise the children. The village never existed for them. Some men felt pressure and frustration, and were in some cases angry for their responsibility as the provider, and took their anger out on their families. Women and children were dependent and bore the brunt of the anger. Men fell ill, drank too much, acted out. Women tolerated cheating and abuse. And by extension, so did their children.

Now let’s think about the generation that they raised. Some people followed this model, or an amended version of it. Some women fought tooth and nail to make anything near equal to what men could make. People rebelled. Some men stopped wanting to work, some women were the sole financial laborers (and in some cases at-home laborers as well) of the family. The men of that generation still benefited from their privilege, even when they weren’t buying into the role of making money, by believing that they could act however they wanted without repercussions. Many of them were never (and will never be) held accountable. The children of my generation were also abused by their power trips in many cases.

Now let’s look at the millennials and then Gen Z, who were raised mainly by the boomers and Gen X. These generations have begin rebelling against relational ownership culture and rape culture, are shifting in ways to instead employ non-monogamy and polyamory, consent, and callout culture. We’ve all suffered and we’re all fed up. What we watched our parents do feels egregious. We don’t understand and we don’t want to. We live in a world where the old white men still prioritize boosting up the young white men, but we are all challenging it, even (some of) the young men who are being boosted up. The boomers are ranting and raving as they enter their 70s and 80s; their power and privilege are slipping away from them in every tantrum motion. And what we are left with is a need to heal, to de-program, to unwind from a society that is still capitalistic, that is still sick, that we can’t live comfortably in but can’t live at all without.

Gender has been a binary concept on a mainstream level. The binary is beginning to fall apart. We are all becoming welcome to share elements of gender neutrality or of embodying all genders. The concept and roles of the genders are becoming looser and fluid within the millennials and within Gen Z. I would say that many of us are confused about gender roles at this point; the old “rules” aren’t applying as easily to the new generation. With marriage being a religious and financial construct, the newer generations are in some ways less sure whether or not marriage is necessary at all. With the looming insecurity of our environment collapsing at an alarming rate, many are unsure whether it is wise to have children at all.

Roe v. wade was overturned in the United States last year. Femicide is being committed in massive swaths in Mexico. One in four women are still reporting being raped, and those numbers don’t include those who haven’t reported. Men and Male identified humans are also sexually assaulted, and many don’t report it at all, and don’t seek treatment. The patriarchy is still fighting hard to exist. As the world becomes more modern and things begin to shift, there seems to be a backlash. I would like to proclaim that the patriarchy is no longer working for any of us. We have a lot of healing to do on a societal level. Many of us are working through fear conditioning in relationships from abusive past relationships with parents, and they are often reacting to and propagating the abuse from their parents. People must confront how they’ve internalized and propagated this abuse, within themselves and within others. We must hold that internalized relationship accountable to heal it, and one way to start is with how we treat ourselves and the people around us.

Bianca Aarons LMFT is a licensed psychotherapist in San Francisco. Bianca’s specialties include attachment, trauma, C-PTSD, sexual abuse, post traumatic stress, relationship issues, depression issues, couples work and work with teenagers. Learn more about Bianca at www.biancaaarons.com, email her at BiancaAaronsMFT@gmail.com, or call her at (415) 553-5346 to ask any questions or to set up a consultation session.

Love, Limerence, and the Emotionally Unavailable Partnership

No one ever said that love was easy, although we may have all had the experience that it can be.  I think that everyone can agree that love can be different, and with each new person that we love, we may discover a new version of love, or we may discover that we can love and be loved in a different way.  Some people think that ‘true love’ is very obvious and maybe even immediate, and others take a while to build on and grow into love.  There is no one standard of love, which is the beauty of it, because although we often know when we love someone, different types of love force us to grow and change as humans.

What we do know about love is that our formative love and family experiences can often define what we consider to be love, and what we go into the world looking for. Our young experiences and the things that we know about love from our families can shape our concept of love as we begin to explore at an early age what it may mean to us. And as adults, we may have to stretch our imaginations and try dating people who don’t feel familiar to us or remind us of our young relationships to find different experiences and definitions of how love can be. This is especially true in situations where the love that we received from our family of origin is not the type of love that we need, or that feels healthy to us now.

In this article, I’d like to talk about a type of love that is often very intense and extremely exciting, which can also cause a great deal of pain, and it may even be a version of love that is terrifying and can cause extreme turmoil when it falls apart. I’d like to define this type of love as “limerence”. I don’t think that everyone has had the experience of limerence, though many people can definitely say that they have had this type of love multiple times, even. Limerence is a state of infatuation or obsession with another person that involves an all consuming passion and intrusion of thoughts. I believe that limerence is a type of love that can sometimes be related to childhood trauma, and those who find this experience repeating in adulthood over and over again are working through some version of Complex Post Traumatic Stress Disorder (also known as c-ptsd) from a time in their childhood when they experienced neglect, or from when they’ve felt tenuous love from an emotionally unavailable caregiver. Symptoms of c-ptsd include fantasy, obsession, and longing among many other things. These mechanisms, also present in limerence, were all coping mechanisms to having an emotionally unavailable caregiver. The use of fantasy is usually born to protect one from the feelings of disappointment and the reality of loneliness.  The obsessive thoughts are a form of feeling like one has control over a situation when they do not, and the obsession attempts to block the feeling of hopelessness and helplessness that the person felt (and maybe still feels) in relationships, specifically with someone who is unavailable. And longing is in a similar vein, the feeling of longing implies that we don’t have our needs met, and so we may get stuck in a longing infatuation with the person who is unavailable as a way to meet our own need for them.

Limerence can begin as mutual love and become limerence if one person withdrawals or abandons the other. The withdrawal itself is the trigger of the original wound of being abandoned over and over again by a caregiver, emotionally or literally or both. The love that was once mutual and shared can become unrequited and obsessive,  and the obsession can become limerence,  the addiction to the unavailable partner and trying to get their love or attention again. Here is how limerence can be explained as a symptom of one’s earlier wounds.

In adulthood, when we fall into limerence with someone, we may be repeating this wound of obsessing about the breadcrumbs of love that we may be receiving from someone who is unavailable as a way to undo what happened to us in the past and finally have the unavailable person choose us and become available to us, which is likely something that our parents or caregivers could never give us and never will.  In therapy, we call this type of repeating event a “Repetition Compulsion”, and the compulsive aspect of us attempting to undo this trauma or get our needs met is what causes limerence.

Falling in love with someone who is unavailable means that you are unavailable. This is a tricky concept to understand, so bare with me.  As long as we are attempting to love someone who cannot properly give us love,  we are keeping ourselves unavailable to someone who can, who would like to love you. As long as you are in limerence, you are the unavailable one, because you are committed to someone who is not committed to you, who will likely never be committed to you, and you are keeping yourself from loving someone who can commit to you, who you can be committed to. If you have a habit of choosing unavailable partners who don’t want commitment, it’s possible that you are actually terrified of commitment and it feels safer to you to love someone who is not actually an option to keep yourself safe.  This fear of commitment is ironically also born from being trapped in a primary relationship as a child with someone who could not meet your needs, so in a way,  you are keeping yourself trapped by your continual choice to become attached to unavailable people.

There is a fantasy that the person who abandoned you will come back, and the fantasy is the coping mechanism that you have formed to tolerate the loss.  In my next blog post,  I’ll be writing about how to grieve, work through the c-ptsd symptoms that have kept you unavailable, and how to become present and available to a partner who is also present and available.

“I Can’t Breathe” – How To Not Accept What Is Unacceptable, From a Therapist’s Perspective

George Floyd was murdered on camera, by police officers, on May 25th, 2020. The world is in a pandemic. We have just learned how to respond to a global crisis. And now, hopefully, we will respond to systemic racism and police brutality with the same amount of response and action.

There are a lot of painful things in the world, and mental health can be difficult to maintain in the light of taking everything in, even in the pre pandemic world, which was already a lifetime ago. If we let all of the pain into our hearts and our psyches all of the time, we would drown. Ignoring the pain of the world is a defense mechanism that we have formed to cope with our daily realities, with the news, with death, with the pandemic, with war. Ignoring the pain of racism is a privilege, a privilege only allotted to those who have basic safety in the world because they are not in danger walking down the street, from the police, the people who are meant to protect us. Please stop ignoring this privilege, fear, and pain. Because it’s painful for a reason. And it is imperative to treat the cause of the pain as a crisis.

When one accepts racism and murder as a reality, when one accepts police brutality against Black people as “the way things are”, they are normalizing something that is not normal, thus training themselves to accept a truth that is not true. In psychological terms, this concept fits somewhere in between societal gaslighting and mystification. We could also call this dissociation, it’s a type of splitting off of reality and of emotion.  The concept behind “un- intentional” is that it is unconscious. And in the case of normalized, systemic racism across a country over hundreds of years, it is the collective unconscious, which is the unconscious agreement of how things are within a group of people.  The concept behind “intentional” is that we have agency, we have a choice to make something conscious, to be conscious, to purposely choose our awareness. In the case of America, our violence against Black lives has been intentional in our past and in our present.  And our choice to ignore this or not fight this may have been “un-intentional”(and intentional as well, by many groups of Americans over the years), but now that America is finally trying to pay attention, we must choose to be intentional, and to be conscious.

Let’s think about the pain. Unlike a breakup or childhood trauma, which is rooted in the past or the recent past and is a concrete event that has happened, the pain that we feel when we consider what has happened to George Floyd, Breonna Taylor, and Ahmaud Arbery is in the present. Systemic racism is happening in our present, on a daily basis. We attempt to understand what is happening and the grief that we feel with each murder, but understanding what is happening and preventing future murders requires us to see this as something bigger, like a wound that does not go away even when the pain from yesterday has passed. What happens emotionally when one feels that they are trapped in a hopeless situation is that they shut down, and collapse into hopelessness. That is how many people may feel in the face of creating change. Instead of facing that pain every time they see a new death of an unarmed Black person on the news, they may shut it out or dissociate it out to cope with their daily life. This is a defense mechanism, and it’s a privilege only allotted to the people in society who can afford it, in this case, people with white privilege who can afford to not think about it because they are not in danger, and they do not fear that their death (or the death of a loved one) will be next.

Stop ignoring your feelings and your pain. It is there because the wound is being continuously opened. We are still all sick, we all have a disease and the pain is the symptom. Murder is the symptom. White privilege is the symptom. Misuse of power, via whiteness of skin and police brutality, is the symptom. We are still all agreeing to these terms of systemic racism on the level of the collective unconscious by choosing to brush off each death, minimize the extreme injustice, the hatred that ignites within us, the disgust that we experience in our gut, when we think about how wrong it is, really.

Are you white? Let’s talk about shame and guilt.  Let me go first. I have privilege that I benefit from: this makes me feel guilty. I don’t know how to be a good ally or how to talk about racism without saying or doing something wrong. This brings up extreme, crippling shame within me. How could I not know? I am a part of the problem. I don’t already know, because I haven’t had to know. Because I haven’t had to learn, from an early age, what it’s like to be treated differently, what it’s like to be in danger, what it’s like to make a system work for me that was made to benefit someone else. I haven’t had to fight, to work extra hard to get the same grade, to be extra good to not get in trouble, to have to be three times more well behaved than everyone else just to not be made bad for not being white. I haven’t had to evaluate, on a daily basis, whether or not people are being racist towards me, in normal interactions at the grocery store or walking down the street.

 When I feel shame I shut down. In shameful situations that are not race related, that’s ok. When it comes to making mistakes around race (and white fragility) that’s the worst because then, I may unintentionally make it about me, and people then feel obligated to take care of me. But ultimately, it’s not about me. And, it’s also not about you right now, if you benefit from white privilege. A goal is to ideally push past the shame and  continue to try to be a better ally and to educate myself in how to do so if I make mistakes around race. That is my responsibility at this point as a white person. Shame and guilt are normal feelings for white people in this dynamic, they must be acknowledged and moved through swiftly so that one can continue to learn and try to stand up for injustice. They must be put aside so that one can instead acknowledge the guilt and rage of the injustices that are happening.

Let’s talk about power dynamics and the history of racism- up until the present time. America has the darkest of histories. White people came to the united states, killed Native Americans, and stole their land. White people kidnapped Africans and forced them into slavery. White Americans actively tortured and lynched Black Americans. Our history is bloody. People with power will always actively resist giving away their power. We are still seeing that today. Most of the senators, judges, and people in congress are White Americans. Most of the millionaires and Billionaires are White Americans. People in power are reticent to dismantle the system because then it will not serve them anymore. This is where white Americans who would like to dismantle white privilege and systemic racism must use their intentionality and awareness. By voting, and actually doing research. By supporting grassroot organizations and candidates. By choosing to support POC businesses and organizations, and choosing to withdraw support from corporate organizations that hold all the power.

So just to recap, systemic racism is a crisis in society that must be treated. Just like, say, coronavirus, it will get much worst if you ignore it, and it takes a lifestyle change, care, consciousness, and intention to heal. Most people will ignore the symptoms of an illness until their lives are threatened. In this case, people of color are having their lives threatened. But everyone is living in the environment that causes coronavirus. And in order to heal this environment, everyone must pay attention to the symptoms, our feelings, our gut. We just changed our entire lives to flatten the curve for the vulnerable during coronavirus. Can we change our lives to protect the vulnerable to police brutality and racism?

If you feel terrible after hearing about a racist event, a racist comment, a racist person, or the way that systemic intergenerational racism affects people, great, you have what we call “normal empathy”.  If you feel stuck and frozen about what to do, you are probably in a freeze response- induced by fear or shame.  Now is the time to change this freeze response to a fight response. Anger is not the enemy, it is an indicator that we need to change something. It is a protective emotion that helps us protect those that we care about. If we ignore our feelings,  we also ignore our care and our desire to make changes.

We are at a critical moment. If you are an American, you have a choice to fight, or not to fight. This week was a turning point. People are choosing (or not choosing) to pay attention. Couples are finding that it may be a deal breaker if their partner doesn’t care about fighting injustice as much of them. Many people are re-evaluating who they would like to be in this civil rights and social justice fight with, and who they’d like to leave behind. We are in an important historical moment. Who will you be in this moment?

Resources for Allyship and futher education:

An Antiracist Starter Pack:   https://parade.com/1046031/breabaker/anti-racist-tv-movies-documentaries-ted-talks-books/?fbclid=IwAR3sGgZGymDMnl8qvJGYZcihVaqYgAP0lNEIjXmTCaAg_1qN7blSgVYmWNg

Antiracism Resources for White People: https://docs.google.com/document/u/1/d/1BRlF2_zhNe86SGgHa6-VlBO-QgirITwCTugSfKie5Fs/mobilebasic?fbclid=IwAR3SVmtbdTi1nZaT6E_qmipBR6S0_hnj6PJN3g_74AvYlCOnzsigqGw3378

Assuming the Intentions of Others, and Other Relationship Hacks

Something that many of us may do unconsciously in relationships is to automatically assume the intentions of others. These assumptions are often very subtle, and usually they are based on our attachment styles and our experiences of how people are in the world. How does this effect you? Let me give you an example.  Your friend cancels plans with you, again.  Maybe you are in the habit of cancelling plans as well. If this is the case, then it is unlikely that you will assume that your friend meant anything by it, aside from just having something come up. Now imagine that you have had many friends flake on you recently, or you have had a bad experience with people cancelling on you recently. You may assume negatively that this friend is a bad friend, or that they don’t want to be friends with you. In this example, one can see how easily attachment styles and past experiences can play into assumptions. Let me explain. People with more insecure attachment styles may be generally insecure in relationships, and they may choose to attach to people who are also more insecurely attached. Their experiences up until now may have supported or confirmed that their assumptions are correct.  This is called a self-fulfilled prophecy. It’s not that they are wrong, it’s that they collect information and evidence to support their beliefs; and they unconsciously miss or pass by the other evidence, that may support the other options around people’s intentions being good. They may also not notice they times that people show up for them, have good intentions toward them, and support them.  

By this point in the article, you are probably aware that assuming intentions also probably plays a big part in your relationships at work and in your romantic relationships. If you are a person who may be a little jaded, who has been burnt, or who has had hard experiences in relationships, then you are probably someone who may assume the worst, or at least you may tend to lean toward skeptical. And you may notice that assuming less than ideal outcomes in your relationships may be getting you in trouble. For example, your anniversary is coming up, and your partner hasn’t mentioned it. You may just assume that they are planning a surprise for you, or that they two of you will figure it out together. But, if you are sensitive about the relationship, you may assume that they’ve forgotten, or that they don’t care. This assumption may keep you from talking to your partner. And if your partner discovers that you have assumed the worst of them, then they might feel hurt by you, and offended that you would assume that.

Why do we make assumptions?  We make assumptions in the absence of being able to ask another, our assumption may be protecting us from being too vulnerable, or from getting hurt.  If you are a person that is often making assumptions alone, this may be preventing you from sharing your feelings with the other, asking the other what they are going through, or understanding them better.  You may be trying to manage your disappointment in relationships by predicting peoples’ intentions; maybe that way, you feel less let down by managing your expectations of people.

The difficult work of assuming the best: a relationship hack. Although assumptions are often automatic, the honest truth is that they take work. If you are someone who is assuming that people are trying to hurt you, that people aren’t good, or that people can’t be trusted, then the reality is that you are probably working hard to maintain that position. So here is a hack.  Why not work just as hard to assume the best intentions of the people around you? Does this feel threatening, to lose the jaded defense? Well, let me clarify. Assuming good intentions and choosing to continue to trust someone who may not be trustworthy are two separate things. Also, assuming better intentions of people doesn’t mean that you aren’t allowed to have your feelings about something or be angry at someone. It just means that even if you are hurt, you are assuming that what someone did to hurt you could have been un-intentional, or a way that someone is protecting themselves. Here is my theory. Getting into the habit of assuming the best of others will ultimately help you, and make you a much happier human. Even if you don’t want to, say, make plans with that person who keeps on cancelling, you can still assume the best intentions of them, and then choose to invest your energy into someone else. It takes a low-level amount of work to assume the best, but you will notice that doing so will change how people view you, how safe people feel with you, and general relationship maintenance, if we are referring to your romantic and work relationships. Yes, some people have bad intentions. And you don’t need to be involved with those people. You can both generally assume that people are trying their hardest in life and also make choices around whom you would like to be close to.

Bianca Aarons LMFT is a licensed psychotherapist in San Francisco . Bianca’s specialties include attachment, trauma, sexual abuse, post traumatic stress, relationship issues, depression issues, couples work and work with teenagers. Learn more about Bianca at www.biancaaarons.com, email her at BiancaAaronsMFT@gmail.com, or call her at (415) 553-5346 to ask any questions or to set up a consultation session.

Take Responsibility: It Will Change Your Life.

Do you feel like your life is out of your control? Do the same bad things seem to be happening to you over and over again? Do you feel powerless to what happens to you in relationships, with jobs, and with friends?  If so, then I am sorry to hear it, and I think that there may be a solution for you.  

The world can be a difficult and unpredictable place.  Bad things happen to people all the time. Unfortunately,  when someone has experienced a traumatic event that is out of their control, one might feel powerless and like other people are responsible for how they feel. And to some extent,  they aren’t wrong. Other people make choices that impact us. There is no doubt about that. Someone may choose a fate for you, one that you would have never chosen for yourself.  And this is where things get tricky, because if you are a victim of a crime or an assault, alcoholic or narcissistic parents, or relationships with controlling people, you may have forgotten that you too, have agency, and you too, can continue to make decisions that can affect the outcomes of not the past, but of the present and forward.

Let me tell you about taking personally responsibility and how it will change you life. Lets first talk about what it means to take responsibility.  Taking responsibility is owning that you may be acting in a way that is propagating your current situation. For example, if you are in a bad relationship with someone who is selfish. Maybe you made a mistake and didn’t know what the warning signs were. That’s ok. There is no need to blame or shame yourself. But you also don’t need to continue to suffer.  A way to take responsibility is to own that, although maybe you made a mistake, you are choosing now to stay in this relationship, and it is therefor your responsibility to choose to stay or to decide to leave.  

Please do not mistake someone telling you to take responsibility for victim blaming.  If something terrible has happened to you, such as a sexual assault, a car accident, or an attack, that’s not your fault. You cannot take responsibility for the actions of another who has harmed you.  You cannot change the past, and you cannot stop bad things from happening. You can, however,  take responsibility for yourself as much as possible. Going to therapy to explore your beliefs in the world, your tendencies in relationships, and what responsibility you are taking to heal, be accountable to others, and choose to surround yourself with supportive people can be helpful.  

And this is how it will change your life:  once you take responsibility for yourself and for your actions, you might find that you feel empowered, because when you believe that you have agency and you can change your situation,  you may realize that you are making choices for yourself, as opposed to the world around you making choices for you.

Bianca Aarons LMFT is a licensed psychotherapist in San Francisco . Bianca’s specialties include attachment, trauma, sexual abuse, post traumatic stress, relationship issues, depression issues, couples work and work with teenagers. Learn more about Bianca at www.biancaaarons.com, email her at BiancaAaronsMFT@gmail.com, or call her at (415) 553-5346 to ask any questions or to set up a consultation session. 

The Human Condition

   As a mental health professional, and someone who is a curious human being in general, I spend a large amount of time trying to understand the complexities of human emotions and the reasons for the pleasure and pain that humans can experience on a regular basis. The underlying question is this:  are humans always bound to return to “suffering”, regardless of what we do? Is it the human condition to experience loss and sadness, forever, along side happiness and pride and excitement?

    As a therapist I must ask myself this question repeatedly as it is part of my job to help people with their suffering. If there were a “happy” pill to take away sadness, people wouldn’t go to therapy at all.  If there were a pill to take away sadness, would we every really feel happy, though? Would there really be light if there were no darkness?  If the human condition is to swing between emotional well-being and emotional suffering, then would we really know happiness without knowing what pain feels like?

    I don’t try to talk my clients, my friends, or myself out of being unhappy.  Mostly because I have learned that being unhappy is not permanent, and I don’t think that ignoring or burying the pain will really make it go away faster.  I do, however, strive to work with the meaning of the pain.  For example, if someone is consistently depressed over a long period of time, they may think that this means that they will always be depressed, which is not necessarily the case.  But every time that they are depressed thereon after, when they return to sadness, the meaning that they make may be that they are still sad and that they will always be sad.  On the other side of 10 years of steps to becoming a therapist and practicing therapy, I have formed the opinion that the point of therapy might not be to eliminate the sadness, but rather, to learn let people in when you are suffering as to not be alone. I now understand therapy as being the practice of reaching out in the suffering, and learning to be with another in suffering, as to learn to repeat this in your outside life, as to surround yourself with those people in your life who understand and who also don’t want to be alone in suffering. 

  For hundreds of thousands of years before this point in time, it was our purpose to survive on a daily basis.  Our survival needs were forefront to our emotional issues.  Finding food, clean water, safety, warmth, and other basic survival needs kept us from the daily suffering that we now experience in absence of the basic will to survive.  Struggles now have become making enough money, not feeling isolated, finding meaningful relationships, and finding meaning in general for our purposes on a daily basis.  Our survival needs have manifested differently and they are now not what we spend every second of every day thinking about, or fighting for.  So if you are feeling depressed, overwhelmed, hopeless, and like your life is existentially pointless, it might be helpful to think about spending some time in the wilderness, conceptualizing how you would go about finding food if you didn’t have any, how you might build a shelter, how you could keep warm. And if you feel like you are the only one in the world suffering right now, it might be helpful to talk to someone to discover that you could possibly be understood by another person and potentially many others. 

Bianca Aarons LMFT is a licensed psychotherapist in San Francisco . Bianca’s specialties include attachment, trauma, sexual abuse, post traumatic stress, relationship issues, depression issues, couples work and work with teenagers. Learn more about Bianca at www.biancaaarons.com, email her at BiancaAaronsMFT@gmail.com, or call her at (415) 553-5346 to ask any questions or to set up a consultation session.

What It Has Been Like To Be a Sexual Abuse Survivor During The 2016 Presidential Elections

It’s November 9th. The polls are in. Many are shocked and amazed that their worst fears have been realized: Donald Trump is the president of the united stated of America. And many of us wonder, how did it come to be, and what does it mean.

   As a psychotherapist who specializes in Sexual Abuse Trauma,  I would like to look back on this election through the lens of what it has been like for sexual abuse survivors to watch this election and vote in this election.  I would like to bring a voice to sexual violence, for it is traditionally and societally silenced. Why is it silenced, and why is it important that trump won the election despite clearly having views on consent and sexuality that represent Sexual Abuse? I would like to tell you in a clear and consolidated way why it’s such a big deal.

            Many people I know who are survivors of sexual abuse trauma have reported terrible dreams during this election, specifically after the second debate. The dreams include flashbacks of their sexual abuse and their perpetrators. It has become my life work to grapple with this type of trauma, and it has become my professional work to be a therapist for sexual abuse trauma, to run groups for survivors in need, and to be the voice that is repressed and silenced.

Since before the election even started, I have been worried.  One in Three women are sexually assaulted in this country. Surprised? It’s surprising, especially considering that most cases are not pursued legally or even talked about at all.  Hillary Clinton, from the beginning, has represented something to not only women, but to the LBGTQ population, to less privileged populations. She is a woman standing up against patriarchy to become a president.  This gave other women, minorities, and anyone really who has suffered from patriarchal systems a glimpse of  hope. But the threat in this election is much more than just patriarchy- Its Donald Trump himself, and what he represents.  It’s Brock Turner.  It’s the Rich, White, Wealthy men getting a slap on the wrist for “grabbing by the pussy” or raping an unconscious woman. It’s the fact that our country chose a xenophobic racist billionaire as the president instead of a woman. It’s the fact that, when people do stand up to their perpetrators, their perpetrators often times win with a smirk on their face. I know that my words are maybe a simplified version of the complexities of the election, but the themes cannot be denied.

  This Election is personally triggering for sexual abuse survivors, and for Women, LBGTQ Folk, Men, Minorities, Immigrants, and Underprivileged populations alike, because that same message that one got from society when they were originally assaulted has just been reinserted with the Election:  Someone who is unsafe has power over you and you will be out of control. I encourage those to fight for what they believe in and I strive to illuminate the voice and the experience for sexual abuse survivors who wish to be heard and seen right now.

Bianca Aarons LMFT is a licensed psychotherapist in San Francisco through the auspices of the Grateful Heart Holistic Therapy Center. Bianca’s specialties include attachment, trauma, sexual abuse, post traumatic stress, relationship issues, depression issues, couples work and work with teenagers. Learn more about Bianca at www.biancaaarons.com, email her at BiancaAaronsMFT@gmail.com, or call her at (415) 553-5346 to ask any questions or to set up a consultation session.