NOW ASSESSING ADULTS FOR SUMMER 2018 DBT SERIES!

I am excited to announce I will begin the next DBT Mindfulness & Skills Group for Adults the first week in June! It is now February, and I am now open to assessing potential clients for this group. All potential members must meet with me at least two times, first for an assessment to determine that the DBT group is a good fit for your treatment needs and second to determine specific treatment goals. 

The group will meet on Wednesday evenings from 7-8:45pm.

After a successful first DBT series for adults that just ended last week, I have increased the sessions from 18 to 20 for all Adult DBT series going forward. 

Adult participants receive:

  • A group of no more than 6 participants
  • Weekly mindfulness practice in group
  • Relatable, personable, and yes FUN skills training with Katherine Zwick
  • Weekly homework and in-group homework review
  • Phone skills coaching Monday through Friday*
  • Weekly group emails to assist with accountability and support for using skills
  • HIPAA-compliant video-in capability for participants who are traveling or are sick and cannot be there in-person
  • Weekly rewards for effective skills use
  • Graduation ceremony to reflect on skills learned and goals for the future

*Within parameters set forth during the orientation

Emotional Sobriety group starting up!

I'm pleased to announce that I will be starting the Emotional Sobriety recovery process group in the next month or two. This group will meet on Monday evenings from 7-8:30pm. It is a group that will be primarily focused on recovery from codependency. This group is a mixed gender group and is appropriate for those 17 and older. Please feel free to contact me at katherine@katherinezwick.com or 831-324-8054 if you are interested in setting up an assessment with me to see if this group might be a good fit for you. 

DBT Mindfulness, Skills and Process Groups!

Discovering that there is likely a need for a group like this in Santa Cruz, I am pleased to announce that I will be offering two 18-session Dialectical Behavior Therapy (DBT) outpatient groups - one for teens and one for adults!

Here are the details:

DBT Mindfullness & Skills Group & DBT Graduates Process Group

The DBT Mindfulness & Skills Group is an 18-session outpatient group will teach the groundbreaking and evidence-based skills and philosophy of DBT. I am trained in adherent DBT and have spent many years teaching these fundamental and life-changing skills to clients of all ages. This group is appropriate for those struggling with impulsive and/or destructive behaviors such as self-harm, reactive suicidality or hostility, polysubstance use (mixing substances), substance abuse, and eating disorders. This group is also appropriate for those who find themselves reacting in ineffective ways in their closest relationships. Some examples of reacting ineffectively may be: a pattern of "taking things too personally," acting out against loved ones from a place of fear, rage, envy, or jealousy and either losing close relationships or cutting them off abruptly. The 18-session series for Adults begins the final week of August and runs until the end of January, with scheduled breaks for Thanksgiving and the winter holidays. The 18-session series for teens will begin likely in October or November and will also take scheduled breaks for Thanksgiving and the winter holidays. 

Those who graduate from the group are invited to participate in a DBT Graduates Process Group (also separated into teens and adult groups), which will run until the end of May. The Graduates Process Group allows participants to deepen their skills and mindfulness work in a less structured group and continue to receive vital support for their ongoing recovery. 

Contact me to set up an assessment to see if this group might be a good fit for you and to find out the start date of the next series. 

For those interested in my DBT groups who can make a commitment to the group, I am open to discussing sliding scale rates for those with Medi-Cal/Medicare on a case-by-case basis. 

Click HERE for more information about these groups.

New Outpatient Groups for Santa Cruz!

As Santa Cruz's only Certified Group Psychotherapist, I'm very excited to announce my outpatient group offerings have expanded. Here are the groups available to Santa Cruz and surrounding areas!

Emotional Sobriety

Emotional Sobriety is a group appropriate for anyone at any stage of their recovery from trauma, codependency, eating disorders, or other addictions who seeks emotional balance and interdependence in their work, love, and friend relationships. This is a mixed gender group.

Women in Recovery

Women in Recovery is open to cisgender, trans, and non-binary women looking to enter into or deepen their recovery from trauma,codependency, eating disorders, or other addictions. This group focuses on internal family systems, external family systems, and the power of ritual, ceremony, and honesty in relationship with other women. This group meets on Thursday evenings from 7-8:30pm. 

Recovering Together

Recovering Together is a group designed for those in recovery from trauma, codependency, eating disorders, or other addictions who may experience themselves as the scapegoat, outcast, or "identified patient" in their families, communities, places of work, or spiritual groups. This role can lead to isolation and deep feelings of guilt, shame and even terror being a part of any group. This group invites healing and collaboration, which is possible, together. This is a mixed gender group.

Professionals in Recovery

Professionals in Recovery is open to therapists, lawyers, doctors, psychiatrists and other professionals, as well as those in graduate school, who wish to connect with other professionals in recovery as they seek to understand the impact of recovery on their work lives and move forward with confidence, together. This is a mixed gender group.

If you are interested in joining a group with me, please contact me HERE and we can set up an assessment to see if this is a good fit. 

Coming Soon! Parallel Process Group Consultation for Clinicians!

I will soon be offering  a consultation group for clinicians - interns as well as fully licensed - designed to enhance clinical skills in group, individual, and family therapy by utilizing a parallel process model of group supervision. This specialized training technique will help you build self-awareness, interpersonal and group-level awareness and acumen, as well as reveal the connectedness between you, your clients, and each other. Contact me at katherine@katherinezwick.com to open the conversation!

Katherine in the News!

Katherine was interviewed by Psychology Today's "The Reslience Regiment" online blog! Click here to read the lengthy interview about her work at The Lotus Collaborative! 

"Humility, authenticity, and collaboration are among the keys to helping a young person struggling with an eating disorder, says Katherine M. Zwick, MA, LPCC, executive clinical director of The Lotus Collaborative."

-Psychology Today, March 13, 2017

Women in Recovery Group - Starting April 1!

Here is my flier with details about my new Women in Recovery group, starting April 1!

Starting April 1, 2017, this group will be available to women of all ages who are interested in courageous self-knowledge, Self leadership, and interpersonal and spiritual growth. If you are a woman in recovery from codependency, substance abuse, eating disorders, gambling addiction, sex addiction, or other forms of addictive processes and are interested in deepening your recovery in a group rather than in isolation, then this group may be a good fit for you. We will focus on internal messages about ourselves and others that get us stuck, learning the language of compassionate inner dialogues, and radical emotional and behavioral transformation that is truly possible, together. This group is open to cisgender women, trans women and non-binary-identifying women. The group can accommodate 8 members.

Please email me at katherine@katherinezwick.com if you are interested in setting up an assessment for this group.

The group will meet for approximately 42 sessions per year. The cost of the group is $50 per group.

 

Only 4 Options When In Distress? Still Better Than Only The Destructive 1.*

Dialectical Behavior Therapy teaches me that we all have four options when we are in distress. Four may sound like too few, but many times, we may think we only have ONE option when in distress - and that option may be ineffective, harmful, or destructive to self and relationships. Our thoughts or emotions may sometimes make it seem like we MUST do ONE SPECIFIC THING URGENTLY (drink, use another substance, impulsively shop, gamble, restrict food intake, binge, purge, etc.) in order to escape an undesirable emotional or psychological experience. So, really, four options is A LOT when you think or feel that you have only ONE.

The "four options when in distress" are not only informative but taken together, it is also a skill - the four options skill. When you are in distress, try going through these four options over and over and over again until your distress subsides to a tolerable level or completely!

1.            Problem-Solve. This is for, you guessed it, problems that can be solved. For example, I feel anxious because I don’t know how to get to Palo Alto. I look up on Google Maps the directions, now I know, my anxiety goes away. Not all distress can be solved, however. An example would be grieving the loss of a loved one - there is not a “solution” to that problem. Additionally, it can be legitimately difficult to think when feeling very distressed, so sometimes we find that we cannot problem-solve when in heightened distress.

2.            Change Your Interpretation. If you tried problem-solving and you are still in distress, try changing your interpretation. What this means is: be curious about alternative interpretations of your situation that you are currently finding distressing. Often, we become a bit (or more than a bit) myopic when in distress, seeing things “only one way” and we become convinced that this is the truth because that’s how it feels. However, if we can be curious about alternative interpretations of the situation, we may find that our distress lessens or dissipates. An example is: I see a parent not minding their children on a public bus and the children are being loud and running all over and being disruptive. My first thought is “What a bad parent! How annoying!” and I find myself getting agitated and internally angry. What if I thought to myself, “He could be having a really hard day and might be trying to hold it together right now while these kids are rambunctious” ? That would actually alter my original thought and the feeling that went with it - my agitation might subside, and I might feel compassion towards the man and his children. I don’t have data yet to support either of my thoughts - but being open to alternative interpretations of a situation (rather than going with my initial and distressing assumption) helps alleviate my distress, and that’s effective for me!

3.            Radical Acceptance. So, say I tried changing my interpretation and I’m still in distress. Then it is time to try to radically accept my situation. What this means is: what do I need to radically accept that I cannot change in order to turn my attention to what I *CAN* change? Radical acceptance is NOT the same thing as condoning a situation. I can not LIKE a situation and even disagree with it while also Radically Accepting it. Radical Acceptance is about acknowledging that in this moment, there is something I cannot alter - and trying to alter it or wishing it were altered is making me more and more distressed or is causing more and more suffering. What is the thing I cannot in this moment alter? Ok - let’s accept that that’s just the way it is - I’ll set that thing aside for one moment. Then I’ll ask myself - what about this situation CAN I CHANGE? Once I shift my thinking and attention in this way - I’m now working at problem-solving! Radical acceptance can help me calm down emotionally just enough that I start to be able to think and then problem-solve. Note: sometimes the main thing I cannot change in the moment is my FEELING. My anger, anxiety, shame, sadness, etc. And trying to change THE FEELING is not working and may be making things worse. So if I can compassionately accept that I have this feeling and right now I cannot seem to CHANGE it - the question then becomes, how do I skillfully take care of myself as I have this feeling? And guess what? That’s bringing me into problem-solving!

4.            Do Nothing Different and Stay Just as Miserable. Well, say I tried Radical Acceptance, and I’m still in distress, and now I’m just fed up with being in distress, and I still cannot think. There’s always this option, Option 4. This is here not because I am encouraging you to choose this Option (I'm not) but to let you know that you have a choice in how you react to your distress (a) and (b) no one can take this particular option away from you. Some people - myself included - can feel very threatened by the idea that we can *never* use an ineffective or maladaptive coping strategy ever again. I acknowledge that it is always your right to go with this option if you really want to. And, I am pointing out to you that it’s only one option among four, and you have a choice in which option you move forward with.

This option doesn’t mean DO NOTHING. It actually means: do what you always do (something ineffective) to deal with distress. Do nothing different. And (very important) stay just as miserable - that means, stay in that vicious cycle whereby you solve your distress with something maladaptive, which may actually result in more distress of some kind.

For example: say I am feeling really anxious because I got my credit card statement in the mail, and I am realizing I cannot afford to pay it off as I’d hoped I would. I am anxious and in distress about this, telling myself I am a failure and a terrible person and that everyone will think poorly of me, and I’m catastrophizing about my financial future. I feel ashamed, anxious, and guilty. My body feels jittery and on-edge, and I cannot sit still. Say I choose this Option (number 4) and choose to restrict my food intake for the rest of the day, because I know that will bring me quick temporary relief from my physical and emotional sensations and thoughts and will offer a sense of relief, an illusion of control and power, and a distracting place to put my attention. And say I do get some relief in that moment from those things. But then I feel a lot of shame for engaging in that behavior, particularly as I’m trying to learn new skills. And that shame becomes really consuming, and I feel sort of ill and trapped in my home and a different kind of jittery. I grab my keys and wallet and drive downtown to go window shopping and end up buying $500 worth of new clothes, which I put on my credit card, racking up more debt. See how this works? In this example, I’m using restricting to deal with anxiety that was in reaction to a credit card bill; I’m using compulsive shopping to deal with shame that was in reaction to restricting (creating more debt!). So. Then how would I feel after the temporary high of compulsive shopping? Probably guilty, ashamed, and anxious again. And how do I deal with that, when I'm not aware that I have other skills and options to use? Probably by using maladaptive behaviors again. Vicious. Cycle. 

This is an example of doing nothing different and staying just as miserable. Even if I’m not yet in touch with the emotional, physical, and financial misery, I can look at this situation and think - yeah, this is creating a lot of suffering for myself. And I can ask myself - do I really want to keep doing that? NO. SO. If I’m using the 4 Options as a skill, I can get to this Option and think - ok, do I want to do nothing different and stay just as miserable? My hope is that the answer can be NO. If it is NO, then I go back to number 1 and try again. Can I problem-solve? Not yet? Can I change my interpretation? Still in distress? What do I need to radically accept? And so on.

Trying new behaviors when you are in distress is UNFAMILIAR.  Even trying new OPTIONS when in distress is unfamiliar. That is not the same thing, though, as it being “hard.” Hard is actually a judgment word that often implies “impossible” or just impossible enough to not attempt. “That’s too hard” often means “Too hard to attempt.” When we think and talk in that way, we tend to be less likely to be willing to do the new “hard” thing! The language we use has a direct impact on our mental health and how we think! “Unfamiliar” reminds me that it’s new and not a habit yet - AND I can continue to practice to help it become more familiar, a habit. That is why it takes consistent practice to start thinking and behaving in new and different ways.

The Four Options help you start to engage in that practice - it is a practice and it takes PRACTICE. I practice DBT; I don't PERFECT DBT. If you notice you are starting on Option 4, be willing to shift into Option 1, then 2, then 3 and see what can happen. If you momentarily take Option 4 off the table and circle through Options 1, 2, and 3 for awhile, you may find that your distress goes down and allows you to take care of yourself in a new non-Option-4 way. It may be unfamiliar now; and, with consistent practice, it will become familiar and rewarding - and hopefully relieving!

 

*Adapted from Marsha Linehan's DBT Skills Training Handouts and Worksheets (2014) and supervision from Dr. Ellen Astrachan-Fletcher Years 2012-2015

Prince, Addiction, Pain and Our Issues

As we now have concrete data that Prince died of an overdose on Fentanyl (an opioid pain medication), I am posting here a microblog post from May 11 that I had written in response to what I was seeing on my Facebook News Feed and in popular media regarding Prince and addiction.

I don't have a dog in the fight about whether or not Prince was addicted to pain medication. I didn't know the man personally, I wasn't his therapist, his confidante, or his doctor. I am grateful for the immense joy and connection he brought so many through his art - one of the people who raised me was gaga over Prince and the color purple, and his albums were threaded throughout my early childhood like so many sunrises.

What I'm surprised by and in pain about, however, is seeing this article posted over and over and over again claiming "Prince did not die from pain pills, he died from chronic pain," as a backlash against the hint of the possibility that he may have been addicted to his pain medication and this addiction may have contributed to his death. Since when do we need to feign to know and to discern the difference between addiction and opioid use for chronic pain - from a distance and with no actual data about this person's or that person's life? And, perhaps more to the point, why is it necessary to say he was unequivocally *not* an addict? Again, I don't know if he was "an addict" or not - but I do know that the need to claim he certainly wasn't one seems more to me like stigma against people with addictions than a defense of Prince's character or the realities he lived with.

Berry writes, "And yet, despite the evidence that Prince was being given Percocet for documented pain, the media narrative has shifted to a story in which Prince died of an overdose. An overdose is a self-inflicted wound. It’s a moral judgment. That’s how we react to it. 'He was such a talented actor. Why overdose?' Or, 'She had such a powerful voice. But she was a demon for drugs.' That story allows us to distance ourselves, to see it as the fault of a weak personality, an 'addictive' personality. It’s part of the mythos we create around talented folks. The idea that the truly gifted are also the ones in the worse psychological pain, and their psychological 'weaknesses' make them ripe for drug addiction."

This is where Berry veers in a direction of othering addiction and addicts that does nothing to actually defend Prince's character (a) while (b) serving to collude with the constant stigma against addiction that addicts face. In fact, she unfortunately plays right into our fears by saying, essentially, how dare you call him *an addict.*

I do have a dog in *that* fight. That desire to not have a certain word or label - addict - put upon a treasured person, as if that word were or needed to be this horrific brand singed into the skin. Surely, the label certainly can carry that off - addicts have to fight that stigma off their backs most places they turn, except typically when in the presence of other addicts, recovering addicts, or people who 'get it' about addiction. But when a New York Times article suggests a beloved person may have had an addiction (and I remain agnostic about the truth of that suggestion) - must we leap to the other extreme and claim that surely he did *not?*

What's most frustrating about seeing this article posted over and over again is that the article has real nuance and depth to it - the author deftly outlines her skepticism in the face of media claiming to know any true thing about Prince's real life and struggles, and she contextualizes these possible misconceptions as embedded in racist views of Black men and Black people in general as well as contextualizes the alarmingly misunderstood experience of chronic pain, which is in itself also stigmatized - by 'regular people' as well as by medical professionals. This is beautifully and heartbreakingly undertaken and written about.

But what is troubling is that this author also doesn't know what was truly Prince's experience. His internal one. And she does not illuminate the fact that actually people who are prescribed opioids for chronic pain *do* become addicted to these medications and *can* accidentally die from overdose on these medications. This is a shadowy, horrifying underbelly of the difficulty with treating chronic pain -- people who may otherwise not have become addicted to anything become chemically addicted to a substance that is assisting them in reducing debilitating physical pain. What is troubling to me is the presumption that Prince's - or anyone's - chronic pain could not also have been accompanied by addiction to his pain medication. Is "addict" still such a leper of a word? To Berry, it seems to be. Why not dismantle the stigma around that word rather than proclaim, "Do not call him that!?"

When I first read the New York Times article, I didn't think any less of Prince. My opinion of him was untarnished. I didn't shake my head and think bad thoughts or think "Well, now the truth is out" or "Tsk tsk." I did not cluck my tongue at the dead. I did not wag my finger or suck my teeth.

I will say, I didn't think any of those bad thoughts about Amy Winehouse either. Or Michael Jackson. Or Phillip Seymour Hoffman. Or my mother. Or her father. Or his father. Or myself.

Maybe this lack of horror, othering and shaming is because I come from a tribe of addicts myself. A legion. A score. Generations so far back, I lose count. My first addiction was food. That one started before I could talk. I found recovery for this, and I am blessed. Now I work on my work addiction, an addiction that is lovingly supported by our culture and incredibly difficult to put down. I never saw that one coming, but like I said. We are legion in my lineage. We are adult children of alcoholics and addicts. And most of us have had one addict-like struggle or another if not a full-blown chemical addiction or eating disorder (genetically proven to be related now) or have been the loved one to the addict.

This is not something I need to "come out" about, because I wear this on my life openly. I don't write much about it, but if you ask or we happen to be talking about addiction, I'm unreserved about my status. I call myself an addict, because it's like a surname to me, and to be in relation to that surname keeps me honest. I call myself recovering, because that keeps me honest, too. I call myself a recovering codependent, because that's the family cigil.

And, I have almost no shame about this - where I come from, who made me, who made them, and who made them. I say "almost," because I do live in this world, and I do have to contend with its influence on my psyche. I have worked hard to have this little shame in a world that jumps at the chance to make sure a revered and beloved person should never be called an addict. We should never jump to that conclusion. We would never want to demean someone's good name with that notion. I have learned to be grateful - for my former eating disorder, for my (diminishing!) codependency, for the dark places I have been and have felt, for the addiction running through my family tree like water from the roots. For better or worse, it has led me to being a therapist, to being available to take the hands of others who are buried in their shame and say, "You don't have to keep carrying that. Let me help you put that down."

I don't think Lorraine Berry meant it this way - to put that word "addict" in our mouths as such a dirty, shameful thing. I didn't take the New York Times article as about shaming Prince for potentially struggling with an addiction, either. But watching so many people repost this article by Berry and point out how terrible a thing it is to call someone an addict when perhaps he/she just has chronic pain, I had to start scratching my head, getting a funny tickle in my throat, a sort of annoyed feeling, like how did the word addict suddenly become the target?

I said aloud to my partner that I was confused why this needed to be an "either/or" discussion. Couldn't Prince have had chronic pain and also have happened to be addicted to his pain medication (as frequently happens for those who take opioids for chronic pain)?
My partner said to me, unassumingly and brilliantly, "But isn't all addiction about managing chronic pain?"

And that about sums it up for me.

Blog entries should not be taken as therapeutic intervention, diagnosis, assessment or advice. 

 

Happy to be Needy

"Needy" - wow, do so many people I know fear ever being seen as "needy." I believe our word choices and the meaning we ascribe to those words have a direct impact on our mental health, and I think we need to differently understand this word. Like now.

"Needy" is a cultural repurposing of the existence of needing other people as a shameful thing. It additionally strikes me as gender-skewed, at least within the dominant culture of which I am a part, a way of shaming predominantly women for speaking up for having needs, for asking for attention, for having a voice. Be smaller, be hidden, do it yourself; be a martyr, be a servant, be independent, be chill.

And if it's used against people of other genders, it is a gendered way of shaming someone and calling them "weak" for having needs.

I don't know about you, but I didn't make the shirt on my back. I didn't construct my car. I didn't get the gas from wherever in the Earth to put into my car. I didn't farm my food, I didn't figure out how to make plastic containers or build my home or fashion my pots. Did you?

My daily existence is dependent on other people showing up for their jobs. And others, total strangers, are dependent on me for the money I spend, predominantly; this is an intricate part of my local and international economy, which is dependent on me and people like me to spend the money we make for the goods we need, so we can all interdependently roll.

We are all needy.

Ignoring my emotional and psychological needs is no less idiotic and irrational than ignoring the fact that I need electricity in my home. If I chose to ignore paying my electric bill because I was telling myself "I shouldn't NEED electricity to survive in my home, because that makes me weak," we would all likely agree that that's a deprivational way to view my needs and the resources available to me (an electric company, electricity).

Similarly, it is deprivational to tell myself I don't need human connection, I don't need to check out the realness and abidingness of my human connections, I don't need love, warmth, tenderness, validation, mirroring, laughter, commiseration, empathy, sympathy, tears, conversation, and to know I'm not alone. It is illogical to tell myself I "shouldn't" need these things, just because they are needs. It is a cultural construction, and a fairly young one, that isolation is the pinnacle of human achievement. Take that to its logical conclusion, and where does that really get us? Alone, barren, depressed - and, literally, a dead species.

Just like electricity is available to me, emotional and pro-social resources are available to me. To you. Everywhere. And we need each other. We are a social species; it is part of how we survive. Go get it. No sorry. 

Blog entries should not be taken as therapeutic intervention, diagnosis, assessment or advice. 

Now Offering A Group Consultation Group!

3/13/16: NOW OFFERING: A new Group Consultation Group for therapists who wish to become more adept at running groups or who would like expert consultation about groups they are currently running.

It takes a group to understand a group and group supervision is, in my opinion, the best place to learn about being a group therapist. 

Learn more about the specialization that is group psychotherapy and take your group work to a new level.

Group consultation will be semi-didactic, semi-experiential (a process group), and will offer the opportunity to consult on groups, as a group.

The group will begin with 1 or more members and will cap at 8 members.

We will meet once a month on Mondays from 9am - 10:30am on the West Side of Santa Cruz.

Contact me at katherinezwickMA@gmail.com if you are interested in joining.

The fee for participation is $75 per month per member.  I ask for a minimum commitment of 6 months.

We will have ample time to talk individually to see if this is a good fit for you.

My group psychotherapy training is extensive as I have been a practicing group therapist for nearly a decade and have ardently pursued this specialization. My theoretical orientation as a group therapist is a mix of group relations/organizational dynamics, family systems, and here-and-now interpersonal; I also bring in psychodrama and Gestalt techniques as may be called for in the spontaneous life of the group. As a consultant to a group consultation group, I will bring in elements of parallel process to assist group members in enhancing their understanding of how to apply the "here and now" to the "then and there."

This will be a lively, vibrant, and dynamic experience that can invigorate your passion for group work as well as equip you with the skills needed to be an effective group psychotherapist!