[LISA LEWIS] The Am I Ok? Podcast is part of the Practice of the Practice network, a network of podcasts seeking to help you market and grow your business and yourself. To hear other podcasts like Faith Fringes, the Holistic Counseling Podcast, and Beta Male Revolution, go to the website, www.practiceofthepractice.com/network. Welcome to the Am I Ok? Podcast, where you will discover that being highly sensitive is something to embrace and it’s actually a gift you bring to the world. We will learn together how to take ownership of your high sensitivity, so you can make positive changes in your life, in the lives of others, and it’s totally okay to feel this way. I’m your host, Lisa Lewis. I’m so glad you’re here for the journey. . Welcome to today’s episode of the Am I Ok? Podcast. I’m your host, Lisa Lewis. Thank you so much for tuning in. I would like to remind my listeners that I offer a free eight-week email course titled Highly Sensitive People. My email course provides weekly tools that help you feel more whole in a world isn’t exactly made for us and I show you how your sensitivity can be seen as a unique gift and how many others are just like you. To find out more about my email course. Please go to my website, amiokpodcast.com. My guest is Dr. Jennifer Levin. Jennifer specializes in working with adolescent, teens and adults experiencing traumatic grief and sudden loss. In 2000, Jennifer received her doctorate from the UCLA School of Public Health and in 2014, she earned her Masters in Clinical Psychology from Pepperdine University. She is a recognized fellow in Thanatology, the study of death dying and bereavement from the Association of Death Education and Counseling. Professionally Jennifer has served as the executive director of Hospice of Pasadena and taught at several California universities. Jennifer provides continuing education, trainings, consultation, and mobile grief services to schools and community based organizations experiencing bereavement and loss. Jennifer is a licensed marriage and family therapist with a private practice in Pasadena, California, where she works with her clients, living with chronic and terminal illness, bereavement, traumatic death, and post traumatic growth. In 2018, she launched her online program From Grief To Growth and her signature course, Growing After Traumatic Loss, an online self-help course for individuals living with a sudden unexpected loss. Finally in 2020, Jennifer started a not for profit organization, the San Gabriel Valley Grief Resource and Training Center, which provides affordable grief therapy and it’s one of the few training sites for master level students to complete licensure hours and grief training in California. Thank you for coming on the show, Jennifer. [DR. JENNIFER LEVIN] Thank you. [LISA] It’s so glad to have you here. I just love this topic. I’m actually trained in bereavement counseling, so I actually offer it, I’m a consultant for a crisis management firm and do many grief groups myself for employee systems programs for companies around the country. [DR. JENNIFER] Oh, that’s wonderful. [LISA] Thank you. So I like to ask all my guests who come on the show, if you consider yourself a highly sensitive person or not and would you mind sharing a little story about that? [DR. JENNIFER] Sure. Yes, I do, and I had an opportunity actually to go to a conference that was designed for highly sensitive therapists, which was very exciting. And Dr. Elaine Aron who wrote the book and did the original work, did I quote her last name correctly? [LISA] Yes, you did. I know work well. [DR. JENNIFER] She came and spoke to us and it was such a great opportunity to meet other therapists who were highly sensitive and talk about our needs as therapists being highly sensitive and how we interact with our clients and how we take home or how our work impacts us. And I think this is actually a really great topic, traumatic loss and highly sensitive people because the interaction between the two is actually pretty important. So it was a great conference. It taught me a lot about myself and a lot about how I can work with my clients differently as well. [LISA] That must have been a great conference. Wow. I haven’t attended any of her conferences yet, but I hope to do so in the future. Before we jump into more of grief and highly sensitive persons, I’m just so curious, how has it been for the last 18 months with COVID around grief and loss. Has your work, has it just like three folded with the amount of people coming to see you? [DR. JENNIFER] Unfortunately, yes, it’s been a tough 18 months. One of the things with grief, a lot of times I will recommend to my clients spending more time with people, getting out into the world, trying new things, and a lot of the recommendations have not been possible. So I should say it’s increase the number of people who need grief support and really want grief counseling. And it’s really changed the way people grieve and the things that they can do while grieving. So it’s been a really tough time for individuals who are experiencing losses. So not only have there been an increase in people who are grieving from different things such as COVID, but also there’s been, we call living losses as well, or non-death related losses that they’ve had to face as well. [LISA] And how has it been for like if we call it cumulative grief, like multiple griefs or, I mean, losses over a shorter period of time? [DR. JENNIFER] Cumulative grief, so just one loss after another, without the ability to process one grief experience before the next one happens. We’ve definitely seen a surge of that. Then I’ve been using the term grief overload where there’s just so much grief. You just shut down and you can’t do anything new. So definitely that’s been something that clients are experiencing and I’ve kind of worked with clients in ways on how to separate your losses. So for a while it just seems like all the losses clump together and you’re grieving so much, you don’t even know what you’re grieving. And it’s a well known fact that when somebody dies it often brings up previous deaths, even if it was 10 years ago and you thought that you had already had an opportunity to grieve a loss. And now there’s been so many people who experience one loss on top of another, and they don’t even have that time in between the 10 years. So it’s been really important to help people separate the different losses that they’re experiencing so that they’re not all just come together. [LISA] How would it show up in somebody that’s had multiple losses? How would that affect their wellbeing? Would they just be more sad, lethargic? [DR. JENNIFER] Well, unfortunately, and that’s where I kind of use the term grief overload, it gets into, for many people functional status where it’s just so much that we start to see things like depression, or we start to see just an increase in anxiety or people are taking time off from work because it’s just reached a level that it’s just too much and they’re having difficulty completing some of their daily tasks or for those people who aren’t able to take any time off or they just have all of the family caregiving then they’re really struggling with their mental health. I don’t think we’ve really seen or we understand yet the full impact of COVID-19 on mental health. There’s been a lot of articles written especially about the impact it’s going to have on teenagers and young adults and the isolation on older adults. And I just don’t think we have a full understanding of the impact on social health, mental health, and even physical health. I think that’s still going to become more clearer as time goes on. [LISA] When do you think it will start showing up or when we’ll start seeing the effects from it? [DR. JENNIFER] Well, we’re definitely seeing the effects now. That’s for sure, but I don’t know when we’re going to see the full extent. I know a lot of my colleagues and I’d be certainly curious about your experience, the mental health system being overwhelmed. A lot of colleagues are full or those waiting lists, or I hear from clients, no, one’s calling me back or there’s a long wait time to get in to see everybody, see anyone and just showing the increase need for mental health services where that perhaps wasn’t the case prior to the pandemic or people weren’t using mental health services like they are right now. So I think that’s one indication that there’s been an increased need for services just by the number of individuals. And it could just be with my colleagues, my small network of people. But like I said, I’m curious if you’re having that issue as all as well but I think we’re going to be seeing it for a while. Yes, go ahead. [LISA] A professional group I belong to, the organizer of that group did a poll and wanted to know if a therapist in the organization, if they have space for new clients or they’re all full. And it came to just small organization that it was people that therapists that were taking, that have insurance space and provider networks were full and had a waiting list. And the therapists that were out-of-network, does cash pain has spaces available, if that makes a difference or not. [DR. JENNIFER] Ok. It’s good to know. [LISA] So can you explain what is traumatic grief? [DR. JENNIFER] So traumatic grief is basically, that’s the focus of my work and my practice and there are several ways to explain it, but the clients that I tend to see are those who have experienced a sudden and an unexpected loss. And this is somebody who wakes up on Tuesday morning, gets a phone call and their world has come completely changed. These are losses that usually occur from a medical crisis or a lot of people who have an unexpected cardiac event, this can include a suicide, an accident, a homicide, just something that we weren’t expecting. There are some real unique aspects of a traumatic loss. Unfortunately, they tend to be untimely. They may have been preventable. As I mentioned, they’re sudden and unexpected and there can be some suffering involved, which can be really hard. Another thing about a traumatic loss that’s different from something that we might call, and I’m not a fan of the word normal, but something that we might call a normal or an expected loss is that it shatters, especially in something that was so sudden. It shatters what we call the assumptions of our normal world. We have all these assumptions of what we think is normal in our sense of control. We think that we’re going to go to work and school and be safe for the day. We think that we’re going to get into the car and drive to our destination and we get there. We have an assumption that we’re going to cross the street and get to the other side, that our kids are going to be safe when we go to school, and when traumatic loss occurs, all of the sudden our assumptions, our expectations that we live by are all of a sudden shattered. We realize how vulnerable we really are. I mean, in reality, we’re always vulnerable, but we can’t live that way. We can’t live thinking, oh my gosh, something could happen at any time. So we live thinking that we’re going to be okay, but when something like this happens, all of a sudden we realize how little control we have and our assumptions of the world being a very safe place are shattered. So, and these days unfortunately this happens more so than others, if you just look at the news these days. But when we see or experience a traumatic loss, we often feel overwhelmed. Our emotions become very unregulated. We can have difficulty functioning and the actual symptoms of trauma occur, and they often compete with the symptoms of grief. So both trauma and grief interact, and the event itself on how the person died may for a while overshadow the life story of how an individual lived. So let’s say for example, and unfortunately I get so many stories about this, of somebody finding their loved one in a difficult situation, or someone who took their life or overdosed or even if they died from natural causes, like a heart condition, coming home and finding your loved one deceased in the living room floor. The trauma that, that individual experiences such as flashbacks or rumination where you play the same scene in your head over and over and over and nightmares and hypervigilance, which is like always being in the fight or flight, a stage where you’re always on alert, waiting for the other shoe to drop. When you’ve experiencing traumatic grief or a sudden loss, you’re walking around feeling so much different because you’re first. And again, this is not always, but for many people they’re struck with this trauma on top of grief as compared to somebody who might have died from old age or someone who died from cancer, and they were expecting the death to occur. And I mean, don’t get me wrong too. When we lose a loved one, it’s traumatic for all of us, because we’ve lost somebody that we really, really care about, but when it’s unexpected and it happens in a violent way, and it happens when perhaps our loved one suffers, it’s a very, very different experience. So that’s what I mean by a traumatic loss and experiencing traumatic grief. You might also hear words like complicated grief, which doesn’t always have a trauma involved, but those are some of what’s referred to as a traumatic grief. [LISA] What are some of the methods used to treat traumatic grief? [DR. JENNIFER] Well, so when I see clients, I’ve had clients call me the day something’s happened and I’ve had clients come in to see me three to five years later. So it really, really depends on when I start working with an individual, but the first thing is, and again, in grief I believe strongly, and I think most people do, that grief has no timeline. And as a matter of fact, if you put a timeline on grief, it absolutely backfires on you. So the methods we use to treat traumatic grief are going to depend on how acute the symptoms are. The first thing that we’re going to do is we’re going to stabilize and treat the trauma symptoms. They’re going to be more likely to be acute if the trauma has happened recently. And things that we do here is we make sure like for example, routine and structure are actually one of the most important things that you can do right after a trauma has happened. You want to make sure that there’s a sense of normalcy. Now, I’m not saying like, go back to things like it never happened, but I’m talking about getting up at the same time, going to bed at the same, eating three meals a day, walking or getting some exercise, making sure you’re getting some fresh air, making sure you’re getting out of the house, making sure you’re interacting with people, just being on some sort of routine and that you’re not sitting there all day. So then your body actually starts to trust you again, because your world has just been shattered upside down. One of my clients called it like a bomb went off in your life. So you want to establish some sense of during these initial stages or days so that you can begin to function again. For some people they do like to go back to work part-time or they do like to send the kids to school. And actually, I do think it’s a good idea for kids to go to school or be with their friends so that they can see that things are okay. Now you also want to stabilize emotions during this time, not process them, but stabilize them, grounding exercises, breathing exercises, affirmations, distress tolerance skills from GBT can be really, really helpful. And we don’t know how long this is going to take. It depends on the severity of the trauma, but people are usually numb. They’re in disbelief and they’re just not able to process anything else. So you build resources during this time, you rebuild safety during this time, you process any of the trauma symptoms that need to be treated at this time before you actually go into getting into the depth of treating the trauma. So that’s the next thing that you do, and you would go into some of the treatment processes for working with trauma. Again, everyone is going to be completely different on how or what type of trauma symptoms that they are displaying. And there’s a lot of different ways to approach trauma work itself, and again, that’s going to depend on what’s going on. Some of the stuff that’s specific to working with traumatic grief are things like retelling the narrative of the person who died and how they died, something that’s called invoking an alliance with the person who died after the death has occurred, make meaning of the flashbacks, developing something which we call trauma dialogues, engaging in tasks of mourning. Some of the grief work that actually takes place. I personally use a lot of what we call cognitive behavioral therapy and there’s trauma focused cognitive behavioral therapy. For those of you who don’t know, cognitive behavioral therapy focuses on how our thoughts, our beliefs and our attitudes could impact our feelings and our behavior. And the goal of what we call CBT is to provide you with those tools and skills that the person experiencing the traumatic grief needs to challenge their thinking, their emotions and those behaviors that are interfering with functioning or quality of life. So CBT can be really helpful with trauma out at grief because it targets any thoughts that aren’t healthy or any new behaviors that you’ve started to develop as a result of traumatic thinking or the traumatic event. We also do a lot of psycho-education, relaxation strategies. I talked to you about people experience hyper vigilance being really stressed out, being alert all the time. So we do a lot of work on relaxation strategies, gradual exposure. I’ve worked with clients going to sites of the accident or going to cemeteries, just kind of confronting areas that bring up a lot of feelings and emotion related to where the loss actually occurred. Then a huge part of treatment has to do with mindfulness based skills and being present in the moment and working with the feelings that arise. This can include meditation, journaling, yoga, expressive arts, guided imagery, visual relaxation. So I could go on and on about the different treatment strategies, but just wanted to give you an overview of some of the things that we do to work through the traumatic grief, depending on the stage or the place that a person is in their loss. [LISA] One of the common symptoms that I hear when people are going through traumatic grief is they either can’t fall asleep at night or they fall asleep and wake up in the middle of the night and cannot go back to sleep and their mind just clicks on and can’t stop. [DR. JENNIFER] Yes, and that’s a lot when the flashbacks and the rumination occur. Great apps for that are Headspace. The app calms. A lot of my clients use those. They have bedtime stories, they have music, they have guided meditation just to help for those exact times. I do a lot of work with sleep hygiene and really working through but those are really vulnerable time for people who are grieving. [LISA] How might a highly sensitive person experience traumatic grief? [DR. JENNIFER] Such a great question. And I’m sure you can see that some of the traits that a highly sensitive person experiences can be really similar to what a person living with trauma grief experiences. People who live with trauma grief are often really, really raw and very sensitive to the world. They get overwhelmed being around people. They get overwhelmed in crowded places. They get very drained very, very easily. They can often only do one or two things at a time. I recommend support groups so often, and they’re like, I can’t hear the pain of others. I just can’t take it on. They have that hypervigilance and they startle easily. They get very sensitive to lights and sounds. So they take on a lot of common traits, but for different reasons. So the traits are the same, or some of them are same and overlap, but they stem from trauma and grief and not from being highly sensitive in general. And it’s very interesting to hear my clients say, oh my gosh, I didn’t realize how insensitive I was to people beforehand. I didn’t realize that when people were grieving that I wasn’t a good friend. I didn’t realize that I didn’t say the right things or I wasn’t there for people. Or they’ll say, I see the world so much differently now because of what I’ve experienced. And they call these silver linings. Personally as a highly sensitive person, I find so many of these traits, a gift, and I struggle with some of them. So I think that many of these traits that a highly sensitive person has, and then who goes on to experience a traumatic loss are further exasperated. And the grieving experience is going to perhaps be even more difficult and the trauma may even be more challenging. So the hyper vigilance, the overwhelm, the exhaustion that somebody might be able to work through in a shorter time may take even longer for someone who’s highly sensitive. I’m very, very quick to tell people, this is not a race, it’s not a competition and there’s no room for judgment. I see people compare themselves, especially in groups, well, how come so and so is making more progress? I had a friend who went through something similar like this, and no matter how hard I try and stop all of those comparisons, they still happen. But grief is probably one of the most unique experiences in the world with the most commonalities. Someone’s grieving experience is going to depend, are you highly sensitive? What’s your grief history and experience? What’s your cultural background? What your age? What’s your relationship to the person who died? How did they? How long ago did they die? All of these different things are going to impact the grieving experience and once you put in any type of comparison, you’ve shot yourself in the foot. So I just don’t believe there’s any time or place for that. [LISA] What I’ve noticed with comparisons is that when people see other people progressing and they feel like they’re not, then they kind of withdraw and they put up a wall and they stop sharing and that’s hard to watch and also hard to be in that. [DR. JENNIFER] Yes, you’re right. That wall goes up very, very quickly because they feel like their experiences are all a sudden invalid or what they’re going through. [LISA] Yes, and like, they, I hear it as there must be something wrong with me because I’m not progressing. [DR. JENNIFER] Yes. [LISA] And there is nothing wrong with anyone. What is post traumatic growth? [DR. JENNIFER] Great question. One of the people always ask me, how do you do this work? How do you hear all of these stories? How do you sit with so much pain? The reason is, or my ability comes from the concept or the ability to witness, I should say, post-traumatic growth. Post-traumatic growth is the ability to grow and transform and evolve after experiencing the trauma. Now it’s something that I almost have to keep hidden because when a new client comes to see me, I can’t say, oh, wait till the ways you’re going to grow through this experience. Because they literally run out the door screaming like, “You’re nuts, you’re crazy. I can’t even get out of bed. I don’t want to live in this world without my loved one, and you’re talking to me about growing.” Post-traumatic growth has been, but the term was actually coined I believe in the eighties by two researchers Richard and Lawrence in North Carolina. And according to these researchers, when we experience a trauma, and I wish I could show you a chart here, but I can’t and if you imagine that we’re living our life at baseline and we have a nice flat line and all of a sudden we experience a trauma and man, do we dip and we just go down it takes a really long time and a lot of hard work to restore ourself back to baseline. But when we experience post traumatic growth, we don’t just get back to baseline. We go higher. We experience growth that puts us at a higher level than baseline and we exceed. According to these researchers, we are most likely going to experience post-traumatic growth in five areas. So after a trauma, we are going to likely experience growth in our ability to develop deeper relationships in our opportunity, excuse me, in our opportunities to try new things. We’re going to have increase in our strength, a greater appreciation for life and spiritual or spiritual enhancement. Now, first of all, not everybody experiences posttraumatic growth. It’s not a given. And we don’t really experience all five of these things; maybe one or two. So obviously the goal is to figure out what therapists can do to enhance the likelihood that an individual will experience post-traumatic growth and to incorporate into their therapeutic process, things to facilitate post-traumatic growth. But I will tell you, most of my clients probably work with me about a year, a year and a half, and the ability to see somebody who comes in on day one and tell me I’m broken, I’m and I don’t want to live in this world without my loved one. When they leave treatment to say, I still hurt, this is not going to go away because I miss them but I see that I now able to do A, B and C, and I now see that I have all of this in front of me. I still have so much love to give and there are opportunities I never realized are possible. That is so fulfilling and I feel so much, I don’t want to say pride, but I feel like I was able to make a contribution in giving somebody their life back and to be a part of that is an amazing opportunity. [LISA] Yes, I can just imagine. That’s wow. That’s really powerful and just sounds so hopeful, especially if a person starts the beginning and how awful they feel inside and out, and then to see like that light at the end the tunnel. Maybe they don’t see it and I’m assuming as the therapist are holding that space for them. [DR. JENNIFER] Absolutely. And no one leaves and says the pain’s gone, because it’s never gone. It’s never gone, but there are ways to go around it and still honor and acknowledge that relationship and keep it with you. [LISA] Wow. Well, I just imagine, must be a delight to work with you as a client and as a professional too. [DR. JENNIFER] Thank you. [LISA] You’re welcome. So I have, this will be second to the last question. What is important you want listeners to know or take from our time together today? [DR. JENNIFER] That living with grief from a sudden and traumatic loss is different and that it’s not the same as grief from unexpected loss. And there are specific tools and treatment modalities available to help you to process and to work through that. And that there’s definitely hope. [LISA] And my last question, where can listeners get in touch with you? [DR. JENNIFER] Oh, great question. So I have two ways. I have a private practice, Therapy Heals in Pasadena and I have myself and a few other clinicians, all who I have trained providing individual therapy. I have a couple support groups. But I have actually developed an online course for individuals nationwide to be able to work through these issues and process them on their own. It’s full of 25 videos and worksheets, growing exercises and a lot of writing prompts and things like that so that you can do some of this work on your own. That’s at my website, fromgrieftogrowth.com. The course is called Growing After a Traumatic Loss. [LISA] Well, thank you so much for coming on the show today and providing our listeners, whether they they’ve gone through grief or they’re going through it right now, that there are ways to get help and I hope just by listening to this, that you are taking away some many great tools and there is light at the end of the tunnel. Thank you just for just being on the show, especially at this time with what’s happening in our society, with all the losses with COVID. [DR. JENNIFER] Well, thank you so much for having me. It’s been an absolute pleasure. [LISA] Thank you, my listeners for tuning into a day. Remember to subscribe, rate, and review wherever you get your podcast. To find out more about highly sensitive persons, please visit my website at amiokpodcast.com and subscribe to my free eight-week email course to help you navigate your own sensitivities and show you that it’s okay not to take on everyone on else’s issues. This is Lisa Lewis reminding each and every one of you that you are okay. Until next time, take care. [LISA] Thank you for listening today at Am I Ok? Podcast. If you are loving the show, please rate, review and subscribe to it on your favorite podcast platform. Also, if you’d like to learn how to manage situations as a highly sensitive person, discover your unique gift as a highly sensitive person, and learn how to be comfortable in your own skin, I offer a free eight-week email course called Highly Sensitive People. Just go to amiokpodcast.com to sign up. In addition, I love hearing from my listeners, drop me an email to let me know what is on your mind. You can reach me at lisa@amiokpodcast.com. 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