Category Archives: General

8 Ways to Support Others During Tough Times

Life is vulnerable; uncertainty is the only certainty. Pema Chodron has written a great book about this, the places that scare you, that I highly recommend. At one time or another, we will all go through a difficult time, whether we deal with financial hardship, health problems, death of a loved one, catastrophe, crisis, or relational breakdown. In psychology, we have a list of psychosocial stressors that include bereavement, breakups, housing problems or transitions, health problems, financial troubles, loss of work identity, and domestic or other abuse. Often people may experience more than one area of hardship simultaneously.

In those times, we need each other more than ever, but it’s not just enough to be surrounded by people. We, as supporters, need to be educated in the best way to love our friends and family through tough times.

How do we reach out to others? In tough times, circling the wagons and looking out for yourself and your immediate family becomes instinctual for many people. However, more than ever, we actually need each other. Often people don’t know what to do. They may even cause great harm by saying do not cry or just get over it.

1. Silence speaks louder than words misspoken.
Don’t ignore them. Plain and simple. If you don’t know what to say, don’t avoid them. Say something. Ninety nine percent of what you could say is better than saying nothing at all. I tell my clients to speak as close to the truth as possible. Which means sharing process. You could say, I don’t know what to say, but I really love you and I just want you to know that.

2. Don’t make them ask you for help.
Do they need help? Absolutely. Do they want to ask? Absolutely not. There is nothing more humbling than having to admit that you don’t have your life under control, and for all the people pleasers out there, asking people for something as simple as meals or free babysitting is something we’d rather avoid. We’d rather tough it out than beg.
Instead, offer your help, and offer specific ways that you would like to help.

3. Don’t rush them through their pain.
Saying things like “I know exactly how you feel” or telling me a story of your cousin’s boyfriend’s aunt’s struggle and how she made it through. While we may say things with good intentions, it can also serve to minimize their issues and urge them to stifle their pain. Yes, what they are going through has probably been faced before. Yes, people do survive. Yes, things might get better. Yes, to all the things. People need to know that the pain they feel is real and they need to move through it. They need to get a little messy and be a little more honest and feel a little more, because if they move through it too quickly or try to avoid their feelings, they might not heal just the right way.

A doctor doesn’t just give a sling with no cast to someone who has severely broken their arm. The doctor gives a cast. The doctor prescribes time for healing, because they know that if the healing is rushed, the bone may also not heal properly. In the same way, we need to give time for others to move through their pain rather than rush them. Instead, sit with them. Listen. Let them be honest when life is hard. Let them be angry. Let them be whatever they need to be, and resist the urge to fix them, heal them, or placate them. Just be with them.

4. Don’t give unsolicited advice.
Even if you have been in the situation before, support, but don’t preach. This includes all cliche and trite phrases and platitudes. You may have heard them said before, but that doesn’t mean they are helpful. Instead, listen, love, give. Give time, energy, resources… give yourself. Just don’t give advice when they haven’t asked.

5. Don’t give them magic formulas.
If they stand on their head, count to 30, twice and backwards, confess everything they have ever done, change their past mistakes, then this tough situation would no longer be happening to them. There is no magic formula. Life is hard and messy and it doesn’t negate the goodness in this world, but it does assign blame and guilt to the situation, one of the last things that someone who is suffering needs is to be shamed. Instead, let them know you are thinking of them, praying for them, loving them, and cheering them on.

6. Don’t make it about yourself.
Essentially, don’t complain about how your friend’s tough time makes you feel. If you are close, you will be affected, but if they are closer to the problem than you, then they are not the person to whom you should vent. Instead, you should offer them support. Check on them. Love them. Let someone else support you to stay on track.

7. Don’t forget the person.
With all of the above tips, don’t just follow them in a rote fashion. The beauty in each of us is that we are unique individuals with different backgrounds, personalities, experiences, and circumstances. Instead, consider the recipient. Some people want hugs. Some people aren’t touchy-feely. Some people want company. Some people prefer to sit alone. Some people want you to do things without asking, some people want you to run it past them first. Some people want someone to cry with and talk to, some people reserve that trust for a select few. Consider who they are before you act, and support them accordingly.

8. There is no timeline for grief and loss.
People may return to a place where loss feels fresh again. It’s not linear. Let people have whatever time they need. There’s no time limits or quotas.

Say a little less. Love a little more.
Life is messy, but with love, we can help each other survive even the toughest times.
#SpiralUp

Parenting and homeschooling, during COVID-19

It’s been a frequent question, how to handle the current situation with regard to kids. In Washington DC, the school systems are closed for at least a month, and I’m thinking longer. This is what I’m telling my patients and families:

1. Establish a routine. This needs to include online schoolwork, chores, exercise, scheduled not random downtime with a preferred activity, and very regular bedtimes and morning routines. You do not get to sleep till 11.

2. This is not a snow day. We can’t live on Doritos, ice cream, and junk food. I am asking all kids nine and above, to help plan and prepare a meal at least once a week for the entire family. This can actually be fun. We all need to cook.

3. Developmentally appropriate information needs to be discussed. From social media to television, we hear bits and pieces that can be very scary. No kid needs to be terrified.

4. Get some outdoor time. It’s spring, and it’s beautiful. Just because we can’t interact, touch or hug, doesn’t mean we don’t get to embrace the sun.

5. Find one cool new hobby or interest to explore. You’ve never had time like this to do that.

6. Don’t forget to check on others. Lack of social contact is one thing, but we have neighbors, relatives, elders, who need our support.

6. Last time, probably most importantly, give each other space. We are used to being at school, the office, sports, activities. Now we are stuck with each other. Annoyance happens.
Find some alone time, for each family member.

8 Scientifically-Backed Ways to Beat the Winter Blues

When your mood is falling as fast as the thermometer, these small lifestyle changes may help boost your spirits.If you’re starting to feel like nothing but a very full, very strong pot of coffee will get you out of bed, join the club. Holiday bills are high, temperatures are low, and the days are way too short. Here, scientifically proven ways to lift your spirits and ease the mid-winter doldrums.

Note: Cuddling, sexual intimacy, and touch in general are great for you, ANY time of year.

1. Make your environment brighter.
When your body is craving more daylight, sitting next to an artificial light—also called a light box—for 30 minutes per day can be as effective as antidepressant medication. Opening blinds and curtains, trimming back tree branches, and sitting closer to windows can also help provide an extra dose of sunshine.

2. Eat smarter.
Certain foods, like chocolate, can help to enhance your mood and relieve anxiety. Other foods, like candy and carbohydrates provide temporary feelings of euphoria, but could ultimately increase feelings of anxiety and depression.

3. Simulate dawn.
People with Seasonal Affective Disorder (SAD), a form of depression that usually begins in late fall or early winter and fades as the weather improves, may feel depressed, irritable, lethargic, and have trouble waking up in the morning—especially when it’s still dark out. Studies show that a dawn simulator, a device that causes the lights in your bedroom to gradually brighten over a set period of time, can serve as an antidepressant and make it easier to get out of bed.

4. Exercise.
A 2005 study from Harvard University suggests walking fast for about 35 minutes a day five times a week or 60 minutes a day three times a week improved symptoms of mild to moderate depression. Exercising under bright lights may be even better for seasonal depression: A preliminary study found that exercise under bright light improved general mental health, social functioning, depressive symptoms, and vitality, while exercise in ordinary light improved vitality only. Try these mood boosting workouts.

5. Turn on the tunes.
In a 2013 study, researchers showed that listening to upbeat or cheery music significantly improved participant’s mood in both the short and long term. Make your playlists personal.

6. Plan a vacation.
Longing for sunnier days at the beach? Research shows that the simple act of planning a vacation causes a significant increase in overall happiness.

7. Help others.
Ladling out soup at the local shelter, fostering an animal, or volunteering your time can improve mental health and life satisfaction.

8. Get outside.
Talking yourself into taking a walk when the temperatures plummet isn’t easy, but the benefits are big: Spending time outside (even when it’s chilly!) can improve focus, reduce symptoms of SAD, and lower stress levels.

Some thoughts on depression – Q&A

I was honored to be recently named as a Top Doc. It’s always gratifying to be recognized for good work, and this kudo comes with the bonus of having an active Q&A section on their website, where readers (and potential patients) can anonymously ask questions.  I’ve tried to find time to answer a bunch of these, and thought it might be helpful to share some of those questions, and answers, here.

This first batch all deal with depression.

Will my depression go on its own?
Hello, it really depends on how long you’ve been depressed, and what the other circumstances are that may be occurring. If you’ve had recurrent episodes- Therapy, possible medication consultation, and a self care regimen are absolutely essential to address it. The good news is that there are proven strategies that do work to help with distress and symptoms.

Can social workers suffer from depression?
Yes absolutely. Mental health workers have some of the highest burn out and that includes rates of depression, substance abuse, and anxiety. Self-care is crucial. It used to be done that social workers and psychologists were required to be in therapy as part of their training, and although that cannot be mandated by programs, I believe it’s a good thing to be in treatment at various stages of our own professional and personal lives.

Will my depression go on its own?
Hello, it really depends on how long you’ve been depressed, and what the other circumstances are that may be occurring. If you’ve had recurrent episodes- Therapy, possible medication consultation, and a self care regimen are absolutely essential to address it. The good news is that there are proven strategies that do work to help with distress and symptoms.

Can a divorce drive people toward depression?
In psychology there is a list of daily stressors or daily hassles. Going through a divorce or separation is one of the top stressors. Unfortunately, divorce is usually also combined with financial stress, location changes, shifting of social groups, family related issues, and at times issues related to children. It’s essential to make sure that you fit in time for self-care, and do some consults with a therapist to come up with a plan for coping and support.

There are many more questions on the site, on a variety of topics including stress management, OCD, anxiety and more. I’ll share more of those here, sometime in the near future.

Anxiety Toolkit

1.  Mindfulness Exercise
Start by taking a few deep breaths … breathing in through your nose … and then out through your mouth … in through your nose … and then out through your mouth. Then, while you continue to do so, gradually try to make yourself aware of:

  • 5 Things You Can See:  For example, the table in front of you, the nice painting on the wall, the fridge magnet that your daughter made, the clear blue sky outside, and the leafy green tree across the road.
  • 4 Things You Can Feel:  Once you’ve gotten in touch with five things you can see, then – while you continue breathing in through your nose, and out through your mouth – try to bring awareness to four things you can feel. For example, the chair that’s holding up your weight, your dress against your legs, the soft carpet beneath your feet, or a loose strand of hair brushing against your face.
  • 3 Things You Can Hear:  Next, bring awareness to three things you can hear. For example, the ticking of a clock, a bird chirping outside, or the sound of your children playing in their bedroom.
  • 2 Things You Can Smell:  Then, try to get in touch with two things you can smell. If you try but don’t find yourself able to smell anything, then try to summon up your two favorite smells. For example, the scent of freshly cut grass, or the aroma of a steaming mug of hot chocolate.
  • 1 Emotion You Can Feel:  Lastly, be mindful of one emotion you can feel.

Put all together, this 5-4-3-2-1 grounding exercise is really helpful for when you’re trapped in the “depression fog” and sinking deeper and deeper. It does this by getting you out of your head and in touch with your surroundings – thereby creating some separation between you and your racing thoughts and thus calming you down. Not only that, but it can be used as a preventative exercise too, for the purpose of helping you relax a little bit before something difficult – such as a job interview you’re really nervous about, or meeting someone who’s capable of triggering your depression or anxiety.

2.  Grounding Exercise with Picture Frames
If you find yourself somewhere, where you cannot do a full mindfulness exercise, this is a strategy that works almost anywhere. Find a picture on the wall, or any rectangular framed objects, such as a mirror. In school, and office, classroom, or home, you will usually be able to find something. Walk over to the framed picture. Look at the framed object, and note  the four corners.  While breathing in through your nose slowly, and out through your mouth slowly, mentally count the four corners of the picture. Keep repeating until you find yourself feeling calmer.

3.  Give yourself a timeout
When you’re trapped in the “depression fog”, it’s extremely helpful if you can calm yourself down and put a stop to your racing thoughts. As an alternative to a grounding exercise, another effective way of achieving this is through relaxing self-care practices – for example, by going for a walk, getting lost in your favorite video game, playing with your dog, taking a hot bubble bath, listening to your favorite playlist, reading a good book, watching your favorite series on Netflix, or doing anything else that mellows you out.

4.  Journaling
When you feel yourself suffocated by negative thoughts, worry, fear, or any other difficult emotions associated with “depression fog”, then another way of dealing with them is to try to “release” them. This is not only extremely cathartic – and therefore likely to calm you down – but also, when you have a healthy way to release your pent-up emotions, you’re also able to distance yourself from them, which makes it much easier for you to be able to gain clarity over those thoughts and be able to work through them.

A great way to do this is by journaling. Start with a pen and a blank piece of paper, take a few deep breaths, and then, just write what you feel (you could type your thoughts up on a computer as well, but using a pen and paper is generally recommended since it doesn’t come with distractions like Facebook and your email). Like I said, the process of writing down your thoughts is likely to relax you a little bit, and by “getting them out there” instead of keeping them trapped inside your head, you’ll find it easier to sort them out and gain some control over them.

Write down your thoughts without editing. It’s been shown to be very cathartic.

5.  Talk to an emotion buddy or coach
Just like journalling, talking to someone who you feel comfortable with and trust can also be really cathartic when you’re experiencing “depression fog”. Not only that, but someone you’re close with can also give you a new perspective on the thoughts or the situation that you’re struggling with. This can be particularly helpful, because when you’re in the midst of “depression fog”, your perspective is often negatively distorted, so talking with someone can often result in you seeing things in a more positive or less catastrophic light.  Find one or two trusted people you can talk to in times of trouble.

What is Executive Functioning?

Executive Functioning has become a catchphrase in psychology, parenting, and, increasingly, education.  Executive functioning is mediated by the frontal lobe. You can think of it as the conductor of the orchestra. Or the chef of a bustling kitchen. You can have very talented musicians, but the orchestra doesn’t do so well without the guidance and direction of the conductor. Similarly, even in the most delicious or skilled restaurant settings, the head chef is required to pull together all of the stations, to make and serve the perfect meal.

We use executive function when we perform such activities as planning, organizing, prioritizing, self-monitoring, strategizing, and paying attention to and remembering details. People with executive function problems have difficulty with planning, organizing, processing information, and managing time and space. They also show weakness with “working memory” (keeping information in your mind while working).

Why is executive function important?
In school, at home or in the workplace, we’re called on all day, every day, to self-regulate behavior. Normally, features of executive function are seen in our ability to:

  • make plans
  • keep track of time
  • keep track of more than one thing at once
  • meaningfully include past knowledge in discussions
  • engage in group dynamics/interactions
  • evaluate and analyze ideas
  • reflect on our work
  • change our minds and make corrections while thinking, reading and writing
  • finish work on time
  • ask for help
  • wait to speak until we’re called on
  • seek more information when we need it.

These skills allow us to finish our work on time, understand if we are doing it right, ask for help when needed, manage our time, and seek more information.

Problems with executive function may be manifested when a person:

  • has difficulty planning a project
  • Frequently procrastinates
  • has trouble comprehending how much time a project will take to complete
  • struggles to tell a story (verbally or in writing); has trouble communicating details in an organized, sequential manner
  • has difficulty with the mental strategies involved in memorization and retrieving information from memory
  • has trouble initiating activities or tasks, or generating ideas independently
  • has difficulty retaining information while doing something with it; e.g., remembering a phone number while dialing.

How do we identify problems with executive function?
There is no single test or even battery of tests that identifies all of the different features of executive function. Educators, psychologists, speech-language pathologists and others have used measures including the Wisconsin Card Sorting Test (Berg, 1948), the Category Test (Reitan, 1979), the Trail Making Test (Reitan, 1979), and the Progressive Figures and Color Form Tests (Reitan & Wolfson, 1985) to name a few.

Careful observation and interviewing are invaluable in identifying, and better understanding, weaknesses in this area. It’s often helpful to receive information from another person who observes the behaviors, such as a parent, coach, spouse, or teacher.

Strategies to improve executive function.
There are many effective strategies one can use in when faced with the challenge of problems with executive function.

Here are some methods to try:

  • Take step-by-step approaches to work; rely on visual organizational aids.
  • Use tools like time organizers, reminders, computers or watches with alarms.
  • Prepare visual schedules and review them several times a day.
  • Ask for written directions with oral instructions whenever possible.
  • Plan and structure transition times and shifts in activities.
  • Create checklists and “to do” lists, estimating how long tasks will take.
  • Break long assignments into chunks and assign time frames for completing each chunk.
  • Use visual calendars to keep track of long term assignments, due dates, chores, and activities.
  • Use management software such as the Franklin Day Planner, Palm Pilot, or Lotus Organizer.
  • Organize work space.
  • Minimize clutter.
  • Consider having separate work areas with complete sets of supplies for different activities.
  • Schedule a weekly time to clean and organize the work space, including your desk, work bag or backpack.
  • Make a checklist for getting through tasks and assignments. For example, a student’s checklist could include such items as: get out pencil and paper; put name on paper; put due date on paper; read directions; etc.
  • Meet with a teacher or supervisor on a regular basis to review work; troubleshoot problems.
  • Doing chores at home has been shown to improve executive function for young people. Sequential tasks facilitate frontal lobe development. For example, learning to do laundry includes sorting clothing by fabric or color, learning how to put the correct amount of clothing into the washer, putting in laundry detergent and softener, learning stuff how to pick the correct settings, taking clothing out in a timely fashion after it’s completed, putting clothes in the dryer, the correct setting for the dryer, removing clothing, folding, putting items away.

Nine Tips for Dealing Calmly with Criticism

We can have a very hard time being criticized, corrected, or accused – even of the smallest mistakes. One client succinctly said: “it feels like an attack on my character, my very person”. Here are some of the strategies to use to accept criticism.

  1. Listen to what a critic is saying. Really listen, try to understand that point of view, don’t just nod while you formulate your retorts.
  2. Don’t be defensive. This is the toughest step for me. With my writing, for example, I always have to take a deep breath and remind myself, “I welcome criticism. This person is helping me. I want to hear how to improve my book/article/post.”
  3. Act the way you want to feel. It’s really uncannily effective; acting friendly and eager to learn makes me feel friendlier and more eager to learn.
  4. Don’t fire back by criticizing your critic. Your comments will just sound defensive, and you’ll escalate the exchange. This urge is very difficult to resist, because the impulse to justify and attack is strong when you feel criticized, but it isn’t helpful, and it certainly isn’t effective.
  5. Delay your reaction. Count to ten, take a deep breath, sleep on it, wait until the next day to send that email…any kind of delay is good. I find it’s much easier to apply this rule when I’m responding in writing. I’ve trained myself to think long and hard before hitting “send” or “enter.”
  6. Explain honestly the reason for your actions. Sometimes it’s tempting to re-characterize your actual feelings, actions, and motives. Usually, though, that just complicates things more. It becomes impossible to have an honest exchange.
  7. Admit your mistakes.
  8. Explain what you’ve learned. If you can show a critic that you’ve learned something, you prove that you’ve understood the criticism and tried to act on it. That, itself, usually mollifies critics.
  9. Re-frame the issue entirely to embrace criticism. Fact is, trying new things and aiming high opens you to criticism. You wanted to grow, and accepting criticism can be part of the process.

A Year of Growth

Just 14 months ago, my vision of a company providing multi-tiered mental health services for the widest range of people in the DMV came to life.

Since that time, we have opened two offices, with a third location on the way next year, served the community through psycho-education and consultation for teens in Fairfax County public schools; taught meditation to youngsters in middle school and high school; provided services to the restaurant and bar industry through mental health screening and seminars/outreach; aired a West Coast podcast on minority mental health; used social media to write blogs and post articles of interest for timely topics in psychology; been a contributor to local news sources for psychology; led mental health discussions at faith based and secular groups; given talks at local professional organizations such as the Maryland Psychological Association; partnered as a consultant for some of the most innovative private schools in the area; and established working relationships with other mental wellness professionals, including coaches, trainers, physicians, educators, attorneys, hospitals, advocates, activists, artists, writers; and so much more. 
Grateful.

Most important, I have had the great pleasure of working with a huge range of clients for testing, psychotherapy, and consultation, greatly individualized.

There is so much more to learn and do.
Mental health is for all. Stay tuned.

Q & A with Dr. Hoorie Siddique

Occasionally I’m asked to do Q&As by people interested in psychology as a field and/or the practice I’ve developed with Embolden Psychology. What follows are the questions and answers from a brief interview I did recently with an actor who was researching a role.

1.) What fascinates you about psychology?

So many things, but what comes to mind are two important but different levels.

First,  studying human behavior is something we all do. From trying to figure out our friends and family to people watching, it’s all about psychology. In my belief, we have an inherent need to understand others that’s part of our wiring. The field of clinical psychology takes it to a level of science and research, combined with empathy and treatment/healing.  My doctoral program emphasized what is called the scientist practitioner model. This basically refers to having an understanding of social science, psychological, and medical research and how to use this knowledge in ways that are helpful to your clients.

Second, in clinical psychology practice, you actively strive to meet another in their experience, with empathy, acceptance, and a genuine desire to understand all that has brought them to this place and time. This has been described as a “corrective emotional experience” for clients, Meaning an acceptance and openness to the uniqueness of that individual that may not necessarily be present in other meaningful relationships with family, friends, and partners.

2.) What do you love about your job?

I love seeing people find satisfaction and joy in their lives. I also love, on a personal level, how much I learn just from talking to hundreds of people every year.  I’ve had the privilege of hearing thousands of stories of courage, pain, and triumph. Although psychologists go through many years of education and training, the education we receive from being with our clients is the highest echelon.

Another wonderful thing about psychology is the broad range of work and learning it makes possible. Psychologists were the original consultants for the advertising industry, as seen in Mad Men. Psychologist are professors, researchers, therapists, consultants, and scientists, just to name a few roles. For example, I received advanced training in neuropsychology, mindfulness-based therapy, and psychodynamic psychotherapy after I completed my formal doctoral program. The field of psychology is dynamic and growing.

3.) Rewards? Challenges?

The rewards are having a job where you can genuinely help alleviate suffering, do something different every day, work with multiple colleagues (I believe in a team approach), and continue to grow and learn as a person. For example, we have to to keep up with continuing medical education credits, so staying on top of advances in our field is extremely important and required. Education never stops.

The challenges parallel the rewards. On a daily basis, we hear some of the most painful things, and sit with people who are suffering. Self-care is paramount to prevent burnout. Most mental health health professionals have participated in personal counseling/therapy, which is highly recommended, and in my belief crucial, to help us understand our own concerns that might affect our work. Having a strong social support network, healthy routines, and personal activities to destress are essential. I have an incredible network of colleagues and close friends who are so helpful in this regard. For me, being outdoors, being with my dogs, and spending quiet time (reading, writing, meditation) are tools that help me replenish.

Lastly, I have to add that I believe that psychology has a social justice and advocacy component that is relatively new to the field, at least “officially”.  Not until 2017, did the American Psychological Association add to their ethical guidelines that examining systems of oppression and environment are factors that we must actively address as psychologists.

On Grief and Grieving

Loss is a universal experience. Grieving takes many forms.

Many people truly want to help a friend or family member who is experiencing a severe loss. Words often fail us at times like these, leaving us stammering for the right thing to say. Some people are so afraid to say or do the wrong thing, they choose to do nothing at all. Doing nothing at all is certainly an option, but it’s not often a good one.  While there is no one perfect way to respond or to support someone you care about, here are some good ground rules.

Grief belongs to the griever.
Grief is personal.  You have a supporting role, not the central role, in your friend’s grief. This may seem like a strange thing to say. So many of the suggestions, advice and “help” given to the griever tells them they should be doing this differently, or feeling differently than they do. Grief is a very personal experience, and belongs entirely to the person experiencing it. You may believe you would do things differently if it had happened to you. We hope you do not get the chance to find out. This grief belongs to your friend: follow their lead.

There is no timeline.  And grief is not linear.
Everybody has their own time frame for grief. There are no rules and there is no need for them.  Some people describe waves of pain. Some people don’t think about it until there is a reminder. Often, there are anniversary reactions on important dates that elicit memories.  As a therapist I have found that many people have a deep fear of forgetting.  When they want to speak about their loss or their relationship with a loved one, give them the space to do so.

There is culture, and there is personal culture
From wanting to be quietly alone, to craving the presence of loved ones. Wanting to talk. And not.  Crying, or not.  Wanting to talk about spirituality and loss is also personal.  There is no formula.

Stay present and state the truth.
It’s tempting to make statements about the past or the future when your friend’s present life holds so much pain. You cannot know what the future will be, for yourself or your friend — it may or may not be better “later.” That your friend’s life was good in the past is not a fair trade for the pain of now. Stay present with your friend, even when the present is full of pain.

It’s also tempting to make generalized statements about the situation in an attempt to soothe your friend. You cannot know that your friend’s loved one “finished their work here,” or that they are in a “better place.” These future-based, omniscient, generalized platitudes aren’t helpful. Stick with the truth:  this hurts. I love you. I’m here.

Do not try to fix the unfixable.
Your friend’s loss cannot be fixed or repaired or solved. The pain itself cannot be made better.  Do not say anything that tries to fix the unfixable, and you will do just fine. It is an unfathomable relief to have a friend who does not try to take the pain away.

Be willing to witness searing, unbearable pain. 
To do so, while also practicing  the above is very, very hard.

This is not about you.
Being with someone in pain is not easy. You will have things come up — stresses, questions, anger, fear, guilt. Your feelings will likely be hurt. You may feel ignored and unappreciated. Your friend cannot show up for their part of the relationship very well. Please don’t take it personally, and please don’t take it out on them. Please find your own people to lean on at this time — it’s important that you be supported while you support your friend. When in doubt, refer to #1.

Do not impose your personal spirituality or religious beliefs on another.
I believe in prayer and spirituality.  My beliefs are highly personal. Telling somebody that you will be reunited in a better place and how a loved one is in a better place may not be helpful. Let them guide you.

Anticipate, don’t ask.
Do not say “Call me if you need anything,” because your friend will not call. Not because they do not need, but because identifying a need, figuring out who might fill that need, and then making a phone call to ask is light years beyond their energy levels, capacity or interest. Instead, make concrete offers: “I will be there at 4 p.m. on Thursday to bring your recycling to the curb,” or “I will stop by each morning on my way to work and give the dog a quick walk.” Be reliable.

Do the recurring things.
The actual, heavy, real work of grieving is not something you can do (see #1), but you can lessen the burden of “normal” life requirements for your friend. Are there recurring tasks or chores that you might do? Things like walking the dog, refilling prescriptions, shoveling snow and bringing in the mail are all good choices. Support your friend in small, ordinary ways — these things are tangible evidence of love.

Please try not to do anything that is irreversible — like doing laundry or cleaning up the house — unless you check with your friend first. That empty soda bottle beside the couch may look like trash, but may have been left there by their husband just the other day. The dirty laundry may be the last thing that smells like her.  I have a strand of hair from a loved one from years ago, carefully wrapped.   Do you see where I’m going here? Tiny little things become precious. Ask first.

Tackle projects together.
Depending on the circumstance, there may be difficult tasks that need tending — things like casket shopping, mortuary visits, the packing and sorting of rooms or houses. Offer your assistance and follow through with your offers. Follow your friend’s lead in these tasks. Your presence alongside them is powerful and important; words are often unnecessary. Remember to bear witness and be present.

Run interference.
To the new griever, the influx of people who want to show their support can be seriously overwhelming. What is an intensely personal and private time can begin to feel like living in a fish bowl. There might be ways you can shield and shelter your friend by setting yourself up as the designated point person — the one who relays information to the outside world, or organizes well-wishers. Gatekeepers are really helpful.

Respect privacy and boundaries.
In the event of loss, and faced with our own mortality, one of the first questions we ask is: what happened?  We have a need to search for and find meaning. Again, this is not about us. What someone chooses to tell us, or others, is up to them.

Educate and advocate.
You may find that other friends, family members and casual acquaintances ask for information about your friend. You can, in this capacity, be a great educator, albeit subtly. You can normalize grief with responses like, “She has better moments and worse moments and will for quite some time. An intense loss changes every detail of your life.” If someone asks you about your friend a little further down the road, you might say things like, “Grief never really stops. It is something you carry with you in different ways.”

Love.
Above all, show your love. Show up. Say something. Do something. Be willing to stand beside the gaping hole that has opened in your friend’s life, without flinching or turning away. Be willing to not have any answers. Listen. Be there. Be present. Be a friend. Be love. Love is the thing that lasts.

Sources and resources:
https://www.refugeingrief.com/blog/
https://suicidepreventionlifeline.org

Embolden Psychology
Embolden

Embolden offers the ADOS-2, the gold standard assessment for kids on the spectrum.

Combined with psychoeducational testing, it helps provide comprehensive information and recommendations to help children and teens six and up.

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