When the Landscape of Loss Lingers

Within the period of three months, I lost three loved ones. Two of them died three days apart. Although I knew the end was eminent as I processed each situation, my knowledge and anticipation did not soothe me - it only served to bring me closer to the inevitability of my own mortality.

Some say that God will never burden us with more that we can endure - those words seem like idle chatter - it was all too much to bear. I braced myself for the predictability and shock of my pain and sought to manage its effects. There has been no single road that has brought me solace. Each day I meander within trying to find a place of peace or respite from it all.

I'm supposed to know this stuff. As a psychotherapist, I teach people how to grieve. It's different, however, when you are the patient rather than the teacher. You become as everyone else, relying on your instincts, courage, hope and faith to guide you through the darkness. What good is it to recite Elizabeth Kubler Ross’ stages of grief when you are the griever? Talking about loss is not the same as experiencing it.

Each of us, in our own way is frail and vulnerable. As psychotherapist Sheldon B. Kopp used to say, "No one is any weaker or stronger than anyone else." Each of us has a story, some of it wondrous and much of it challenging. Our narrative is about learning, and our losses teach us about the meaning and value of life - to cherish every single moment. Grieving our losses gives us an opportunity to take stock and review our life direction. We hopefully assess what really counts and focus our attention on that which lasts - the content of our character and the quality of our most precious relationships. That is all we have.

Unfortunately, as we age, our losses mount. We grieve the loss of youth, physical prowess, time, missed opportunities and fading friendships. Each must grieve in his own way. I have learned that there is no such thing as closure - some wounds never heal.

I have told others that we don't need to stay stuck in our pain. All of us can find ways to manage our grief so that even if it lingers, it doesn't overwhelm us. Like others, I must remember to:

• Seek the emotional support of friends and family.
• Acknowledge and embrace my pain rather than minimize its significance.
• Refocus attention on activities that bring pleasure.
• Learn this self-nurture. Treat myself the way I would a dear friend.
• Keep the positive memories of loved ones alive.
• Try not to fight my way out of depression. It will lift.
• Live in the present and re-evaluate life priorities.
• Rely on faith to provide me with hope.
• Realize that being vulnerable makes me more human and is a connecting asset.
• Learn to leave the self-pity behind. Accept the fact that I am a grown-up who experiences life as unfair. There are no sufficient reasons why certain things have happened to me.

As a grieving patient, I have a better understanding of what it takes to wind oneself down a path of profound loss - no words are adequate to describe the experience. Contrary to what others think, I do not believe that what I have encountered will make me stronger. I only hope that my experience with lingering loss will make my vision clearer as I look through the eyes of those who have suffered and continue to seek my help.


James P. Krehbiel, Ed.S, LPC, is an author, freelance writer, and nationally certified cognitive-behavioral therapist practicing in Scottsdale, Arizona. James is the featured Shrink Rap columnist for TheImproper.com, an upscale arts, entertainment and lifestyle web magazine. He has contracted with New Horizon Press to publish his latest work entitled, Troubled Childhood, Triumphant Life. This book is about the impact of “unavailable” parenting on adults and the people they become. His book will be available March 1, 2010 but now can be pre-ordered through Amazon.com. James can be reached at KrehbielCounseling.com.

Eradicating Depression Through Schema-Focused Therapy

Samantha moved to a large sprawling city to join her boyfriend. They carried on a long-distance relationship prior to her decision to move in with him. Unfortunately, the relationship did not last long, and she felt stuck in a city without a plan to move forward in a positive direction – she sank into a deep depression.

This young lady had parents who were extremely passive and detached. Having lived in a rural town, her options for activity were limited. Her parents never encouraged involvement in outside interests. She lacked confidence and was timid around age-mates. Having moved numerous times during childhood, it affected her ability to build trust and closeness. She felt alone in managing her problems.

Samantha came to therapy looking for a way to lift her debilitating depression. She felt sad, grief-stricken, hopeless, unmotivated and unwilling to seek out new friendships. She was troubled by a set of underlying schemas (assumptions) that clouded her worldview and activated depression. These schemas crystallized in response to unmet needs derived during childhood. The schemas were activated anytime that Samantha encountered problems associated with negative beliefs. The schemas that activated depression were:

• "I'm all alone in my problems."

• "I'm not good enough."

• "I don't trust that others will be there for me."

• "Life looks bleak. I feel hopeless."

These core schemas around the theme of depression were activated when my patient encountered the following life situations:

• Trying to establish friendships

• Pursuing intimate relationships

• Facing new problems

• Attempting to change directions in her life

• Trying to get motivated professionally

• Envisioning a positive future

Samantha worked diligently in therapy to alleviate her depression through untwisting her negative thinking. We gently challenged her core schemas by looking for evidence to the contrary. She gained hope in eradicating her depression as we refuted faulty schema-based thinking. She eventually began to respond more rationally and adaptively:

• "I can manage this friendship-making business."

• "I'm not ready for an intimate relationship now, but when I am, I’ll feel confident and will be more selective."

• "I can cope with and manage new problems."

• "I am certain that I can re-create my life."

• "If a chunk things down into smaller pieces, I can set goals and get motivated."

• "The future holds new opportunities."

Samantha "connected the dots" by understanding the relationship between her core depressive schemas and current behaviors. As a result, she was able to modify her current thinking to make it more hopeful and less depressing.


James P. Krehbiel, Ed.S., LPC is an author, freelance writer and nationally certified cognitive-behavioral therapist practicing in Scottsdale, Arizona. James is the featured Shrink Rap columnist for TheImproper.com, an upscale arts, entertainment and lifestyle web magazine. He has contracted with New Horizon Press to publish his latest work entitled, Troubled Childhood, Triumphant Life. This book is about the impact of “unavailable” parenting on adults and the people they become. James can be reached at www.krehbielcounseling.com.

Her Mother and Malia

It is highly unusual for my daughter to ask me for advice. Until recently, I can only remember a few occasions when she sought my wisdom regarding the profundities of life. Maybe denying the need for help from parents is mapped in our genetic code. I never asked for much assistance from my own.

However, recently Amy came of age. At 36, she finally decided it was time to lean on dear old Dad. On this rare occasion, during a recent phone call, a bombshell was hurled. Amy retorted, "Dad, what can I do to rein Malia in a bit? My feisty four year old daughter is wearing me out!"

As a psychotherapist, with plenty of parenting expertise, I'm sure that Amy was waiting for my most profound response. However, my spontaneous reaction took both of us off-guard. Impulsively, I replied with, "I don't know Amy - I sure as hell didn't know how to cope with you - maybe it's payback time."

We both had a good laugh as we processed the parallels between Amy and her precocious, pesky daughter. Here are a few of the significant similarities:

• They both are a strong-willed handful.
• They became non-stop talkers before they were developmentally capable of walking.
• They both love to carry the show with intensity - camera, anyone?
• They are both too smart for their own good. Going to school comes disgustingly easy, but is filled with the challenges of unmet academic needs.
• They both are similarly assertive, bordering on aggressive; please look out when they're unhappy!
• They both appear affectionate, but seem to be overly-sensitive to other’s feelings.
• They are extremely independent people. They know what they want and you don't dare hinder their progress!

One area of temperamental variance is worth noting. It is a fascinating distinction and the area where I believe my daughter is being punished for her past. Malia insists on wearing pink clothes and accessories at all times. Malia has a pink handbag, beret’s and beads to match her feminine looking clothes. This fashion statement, required by Malia, is a foreign concept to my daughter. At first, Amy tried to encourage Malia to wear different colors, but to no avail. Malia resisted wearing anything but pink.

Amy wonders where she went wrong. She was the queen of the Gothic look, wearing black as her only color scheme throughout school as a theater buff. However, when Amy came home from the first semester of college, a miracle occurred. I found a pastel colored sweater lying on her bed. “What are you doing with this pretty sweater?” I replied. Amy laughed and said it was a new day in her life.

When I see Malia, I see the wonderful reflections of my daughter. I see the smile, the passion, the precociousness, and the personal need to be understood. They are versions of the same person. Being out-of-state, I don't see Amy or Malia that often, but when I do, I'm so grateful that my granddaughter has not forgotten who I am. She's a slice of my daughter and a good one indeed!


James P. Krehbiel, Ed.S., LPC is an author, freelance writer and nationally certified cognitive-behavioral therapist practicing in Scottsdale, Arizona. James is the featured Shrink Rap columnist for TheImproper.com, an upscale arts, entertainment and lifestyle web magazine. He has contracted with New Horizon Press to publish his latest work entitled, The Search for Adulthood: Saying Goodbye to the Magical Illusions of Childhood. This book is about the impact of “unavailable” parenting on adults and the people they become. James can be reached at www.krehbielcounseling.com.

The Search for Adulthood: Grieving the Past and Embracing the Present

Learning to process and accept our past is a necessary step in one’s search for adulthood. Instead, people often choose neurotic suffering as a way of coping with painful memories. Neurotic suffering consists of coping mechanisms that put a salve over our wounds. Rather than confront one's painful past, adults will convert their grief into physical symptoms, and mask their losses through over-activity, intellectualization, avoidance, self-blame and projected anger.

Neurotic sufferers ignore the stop signs, transcending their grief as if it weren't there. They pretend that everything is running smoothly, ignoring what their bodies, mind and feelings are trying to tell them. They diminish the truth in the pursuit of coping, choosing to ignore their emotional distress.

Holding Ourselves Together

Anxious sufferers hold themselves together like a ball of yarn. They fear that if one strand were pulled from the ball, they would slowly unravel into a mound of scattered threads. However, protecting oneself from the realities of the past eventually creates insurmountable fatigue. One's sympathetic nervous system reacts to the stress of trying to ignore the reality of stored and unprocessed psychic pain.

We must move through our grief and loss in order to get to the other side. There is no substitute. We cannot short-circuit the grief process without paying a price consisting of unnecessary suffering. Grieving our pain allows us to legitimately navigate our loss, finding closure over past perplexing problems.

Mourning and releasing our losses takes time. There is no way to short-circuit the process. There are strategies that we can employ to facilitate moving through the grief process. Here are a few ideas:

• Share one's painful narratives with friends.
• Seek the emotional support of family.
• Journal one’s thoughts and feelings.
• Write a letter (not to be delivered), focusing on the impact of a significant other as you grieve the loss. Explore difficult emotions and thoughts.
• Give up the illusion that people (particularly our parents), will change into the people we have always wanted them to become.
• Face our mortality by grieving the aging process and its affect on us.

Learning to Get Our Power Back

Once we face our grief, our past will no longer have power over us. We are freed from being straddled with false guilt, remorse, regrets, and the inability to connect on an emotional level with others. Grieving is like peeling an onion. There are layers, and it takes patience and persistence to navigate through our turmoil.

If one holds tightly to metaphors of pain, refusing to acknowledge its presence and impact, the lack of resolution creates the conditions to foster self-defeating thinking and behavior in the present. Often, individuals who have thwarted the grief process, continue to play out interpretations and narratives of behavior similar to scripts present during childhood. Individuals may have failed to squarely face their painful past - as interpreted through the eyes of a childhood burdened by emotionally unavailable parents. They may never have come to terms with the pain generated by those who failed to love them unconditionally.

Saying Goodbye to the Magical Illusions

People, who experience the pain of a turbulent childhood, often cling to the illusion that someday their parents will magically morph into the loving parents they longed for. Rather than swallow the "bitter pill" of how our parents dealt with us, we continue to hold out hope that someday, somehow, they will change. By holding out false hope, we minimize the significance of promises un-kept, thus cutting ourselves off from the part of us that needs individuating.

The search for adulthood involves recognizing the power of our painful past, creating and releasing it, and learning to rationally respond with fresh interpretations in the present. The search for adulthood involves finding integrity, authenticity and adventure. By appropriately grieving roadblocks from our painful past, we are able to move forward and become adaptive, functioning adults in the present.


James P. Krehbiel, Ed.S., LPC is an author, freelance writer and nationally certified cognitive-behavioral therapist practicing in Scottsdale, Arizona. James is the featured Shrink Rap columnist for TheImproper.com, an upscale arts, entertainment and lifestyle web magazine. He has contracted with New Horizon Press to publish his latest work entitled, The Search for Adulthood: Saying Goodbye to the Magical Illusions of Childhood. This book is about the impact of “unavailable” parenting on adults and the people they become. James can be reached at www.krehbielcounseling.com.

The Hazzard of Dichotomous Thinking within the Therapeutic Community

In cognitive therapy, cognitive distortions represent the lenses out of which we view the world and filter our version of reality. In light of recent developments among some therapists, dichotomous (either/or) thinking has emerged as a professional hazard. I recently attended a national mental health conference. I was intrigued as presenters and colleagues alike made comments that presented a distorted perspective regarding some significant behavioral health issues.

As M. Scott Peck eloquently articulated in his work, The Different Drum, it is important that as thinkers we look at problems multi-dimensionally. We must not get trapped by any one side of an argument, but stay open to multiple sides of an issue; by doing so, we show integrity. Staying open to the truth wherever we find it allows us to be more grounded, rational and informed.

Within the last several years, many clinicians within the counseling profession have started to under-cut the role of prescription psychotropic medications as a facet of treatment. Some of the arguments from these naysayers of medication management are:

• There is no evidence that serotonin or norepinephrine levels affect mood.
• A quality therapist’s treatment is sufficient to free us from the dependency to psychotropic medications.
• Primary care physicians and psychiatrists have a propensity to push medication, thus justifying the need for their professions.
• Touting the use of antidepressants and other mood-stabilizers is primarily a marketing ploy.

Lately, high profile cognitive-behavioral therapists have been down-playing the efficacy of antidepressants and other mood-elevating medications by stating that CBT is sufficient to "cure" any problem without a crutch, thus “ditch the Zoloft.” Although many research studies support the synergistic effect of cognitive therapy and antidepressants, CBT therapists are dismissing such findings as misguided.

Existential therapists are also following suit. Since they believe that all suffering is legitimate, using medications to stabilize mood remains unnecessary. In fact, existentialists believe that taking antidepressant medication thwarts the grieving process, thus delaying the natural progression of growth. According to their viewpoint, we must not pathologize the human experience.

I believe that a more pragmatic, balanced and useful position is to acknowledge the legitimacy of psychotropic medications in curbing anxiety, depression and other disorders of mood. We should accept these medications because for many sufferers they work. Antidepressants serve as an aid, an emotional "floor" while patients undergo therapeutic treatment to derive more long-lasting benefits in coping with emotional distress. Furthermore, it is essential that those suffering from bipolar disorder take mood-stabilizing medication to treat their symptoms. There is no other viable option for treatment.

Why is it that many therapists now embrace a philosophy which discounts the use of psychotropic medications? It is true that people generally do what’s in their best interest, and many therapists hold a position which dismisses the legitimate use of medication for several reasons:
• It enhances their belief that their therapeutic orientation is unique and sets them apart from the competition.
• It increases their ability to generate income. Therapists postulate that marketing an approach that will fix you without the use of medication (prescribed by a PCP or psychiatrist), is more enticing and potentially lucrative.
• Therapists, who disown the use of psychotropic medications prescribed by physicians, are driven by their feelings of exclusivity about their approach, coupled with the desire to market themselves. The practicalities of what is in the best interest of the patient are ignored. Marketing takes precedence over pragmatism and utility.

Another danger involving dichotomous thinking relates to mind-body therapies. Holistic thinking has taken root in the mental health profession. Many therapists integrate alternative therapies that claim to remedy behavioral and emotional conditions. Some of the treatments are evidence-based, but many cannot be supported empirically. Case in point is reflexology and therapeutic touch, which claim to explore and heal energy systems. The therapeutic community needs to do a better job of ferreting out modalities that have functionality versus those which are of questionable utility. Once again, in the process of propagating the mind-body connection, we may error on the side of discounting physical medicine, including psychotropic medications.

As a therapist, one must carefully weigh all sides of an issue before making value judgments. Therapists must be honest and informed when making statements about psychotropic medications and the mind-body connection. At a recent mental health conference that I attended, a participant claimed that she was dismayed by the over-use of stimulants for students experiencing ADD. However, it is clear that ADD has been under-diagnosed, not over-diagnosed, and those who receive treatment with stimulant medication in concert with therapy do significantly better than those prior to treatment or without treatment.

It is imperative that therapists represent their profession appropriately. This means that we take a carefully crafted approach to treatment based upon sound research and a sense of balanced thinking and integrity. Being blinded by any one perspective only polarizes the profession. Theory and practice must come together in a way that provides our patients with the best chance of making improvement. Part of the answer is to offer our clients a multipronged approach with the best quality evidence-based theory, medication management (if needed), and alternative adjunctive treatment modalities that have a history of demonstrated effectiveness.

The Identity of Imperfection

When Alex was a kid, he recalls his father chastising him for not washing the car properly. Alex volunteered his services as a five-year-old child, but his dad showed little appreciation. On the contrary, when he "missed a spot," his father would berate him by calling him stupid. He was a sensitive child who wanted to please his father, but ended up feeling devalued.

Over time, Alex associated his less than perfect performance with his personal identity. If what he did was less than acceptable, then by all means he must be defective. His father never encouraged or coached him on a better way to wash the car, so he was left to feel inadequate about any task he attempted.

Alex evolved into a self-critical, angry youngster. In Little League, he excelled as a player. He was known for his outstanding skills and performance. Nevertheless, he berated himself, other players and the umpires during his occasional unsuccessful at-bats during games. He recalls running feverishly towards first base, being called out, and throwing his helmet, stomping his feet and raging at the officials. Although he was conflicted and confused about his poor sportsmanship, he wasn't capable of stopping his inappropriate behavior. His parents never got involved, intervened and discussed the "why" of his self- defeating thinking and behavior nor tried to correct it.

In adulthood, Alex was able to trace his painful memories of personal performance-related criticism and anger through the filter of his son’s experience. His son, Damon, was a very talented basketball player. Alex was perplexed because he never recalled Damon losing his "court presence" during a game. His son was grounded, focused and in control. These qualities actually helped enhance the level of his game. Alex was thrilled that the legacy of persistent perfectionism never created a problem for his child.

As he sat in the stands and watched one of his son’s tournament games, Alex recalls reflecting on what parenting skills he had implemented with Damon that were different from the way in which he was raised:

• Like Alex, his son was very sensitive. Alex made sure that he never harshly scolded him.
• His form of discipline was facilitated through coaching, instruction and encouragement.
• He always let Damon know that he was proud of him.
• He believed that mistake-making was a necessary part of child-development.
• He challenged his son to excel without motivating through intimidation.
• He remained involved with Damon and attended his activities at school and in the community.
• Alex's limits were firm, but reasonable with logical consequences for positive and negative behaviors.
• He always differentiated Damon's behavior from his personal worth.

Alex gave his son what he found difficult to provide for himself - support, soothing, comfort and affirmation. Ironically, he learned through role-modeling his son’s behavior how to begin parenting himself. The process of learning to self-nurture involved facing his past, grieving and releasing its emotional impact while creating fresh interpretations of his thinking and behavior.

He cut into the "pedestal of perfectionism" and learned to allow himself the freedom to perform less than admirably at times. He practiced selective mistake-making as a way of giving up some control and allowing for a measure of vulnerability. Alex worked on being less self-critical and judgmental of others, and eventually learned to hold the identity of imperfection. He learned to push less, and relax more as his performance, like his son’s, actually improved.



James P. Krehbiel, Ed.S., LPC is an author, freelance writer and nationally certified cognitive-behavioral therapist practicing in Scottsdale, Arizona. James is the featured Shrink Rap columnist for TheImproper.com, an upscale arts, entertainment and lifestyle web magazine. He has contracted with New Horizon Press to publish his latest work entitled, The Search for Adulthood: Saying Goodbye to the Magical Illusions of Childhood. This book is about the impact of “unavailable” parenting on adults and the people they become. James can be reached at www.krehbielcounseling.com.

Make Way for a Different Kind of Thinking

I distinctly recall when Nathan began seeing me for counseling. He was a skinny, sensitive kid with a big heart. At age 13, he struggled in the midst of a tumultuous custody battle that left emotional scars. My job was to prop him up - to give him hope that things would change for the better - and they did.

Nathan came back to see me three years after he had "graduated" from therapy. He brought his new guitar and treated me to few melodies in the privacy of my own office. He was serenading me - it was a gift for being there for him. However, Nathan's visit took on a more important purpose. He came to tell me, in so many words, how he had become a different kind of thinker - the type of young person who inevitably would change the very foundations upon how we view matter and energy and life itself. At age 16, Nathan had graduated from a college preparatory high school and made his way to a prestigious university to study nanotechnology.

As I intently listened, Nathan explained that nanotechnology will allow us to snap together the fundamental building blocks of nature more easily, more cost effectively, and in a way that is permitted through the laws of physics. Nanotechnology has the ability to transform our thinking about science, physical health and disease, emotional well-being, computer programming, and travel to outer space. Not only was Nathan "studying" this complex, molecular thinking, but he was actually conducting research with the world's greatest scientists in this technological field.

Like an H. G. Wells of his time, Nathan passionately projected what the world would look like in the next 15 years due to his work. His words seemed prophetic and powerful, and I sense that I was sitting before one of a new age of young people - the dreamers, the problem-solvers, the visionaries who would create a new way of thinking about thinking. These are not “egg-heads,” but balanced, well-rounded kids who have the capacity to not only reflect on problems but to communicate about how the world will dramatically change due to their influence.

Nathan represents an influx of thinkers among thinkers, who will quietly work behind the scenes to make things happen. These are not our future leaders or managers, but those who empty themselves of all internal clutter or preconceived notions about how the world works. By staying open to the truth, wherever they may find it, new, exciting discoveries will be made that will impact all aspects of the human condition.

Like Nathan, our future thinkers can recognize the qualities and significance of emptiness. They can handle the perplexing nature of uncertainty and ambiguity. They understand that there are multiple dimensions to any problem with conflicting and paradoxical meanings. They are willing to surrender conventional notions about how the world works in order to make room for the new. By cutting a path through the clutter and letting go of a traditional means of thinking, these talented young people will open themselves up to what Robert Schuller referred to as, "possibility thinking."
In the midst of all the incivility and strife that we are faced with, Nathan will make a difference. He has not forgotten what it was like to stand face to face at a young age with problems that were bigger than he was capable of solving. He will use that experience to empower and propel him in a direction to bring peace as he thinks about and humbly solves problems that raise hope and healing for all humanity.



James P. Krehbiel, Ed.S., LPC is an author, freelance writer and nationally certified cognitive-behavioral therapist practicing in Scottsdale, Arizona. James is the featured Shrink Rap columnist for TheImproper.com, an upscale arts, entertainment and lifestyle web magazine. He has contracted with New Horizon Press to publish his latest work entitled, The Search for Adulthood: Saying Goodbye to the Magical Illusions of Childhood. James can be reached at www.krehbielcounseling.com.