By Mike McMahan, LPC
 
Kudos to Selena Gomez for being so open about facing her mental health struggles. Every person who takes this step knocks one more brick out of the stigmatizing wall that surrounds mental and behavioral health. In this article from Vogue, she recalls feeling "depressed" and "anxious" as well as experiencing "panic attacks."
 
There’s quite a bit to explore in her remarks from the Vogue piece. She discusses the struggles she had with touring, something that many of us can probably understand and NOT understand simultaneously. On one hand, so many people dream of being a rich and successful performer. On the other, no matter our life situation, face challenges and problems. From reading years of rock star memoirs and biographies, it seems these problems may be magnified when the pressures of fame are rolled into the mix with their mix of temptations. Clients frequently struggle with this dilemma: “I have a problem, but it’s not as bad as children that are starving.” This may or may not be true, but we can only deal with the things in our own life and from our own perspective.
 
Gomez talks about efforts to slow her life down and create boundaries between herself and the world of fame, as well as seeing a therapist five days a week. “DBT has completely changed my life. I wish more people would talk about therapy. We girls, we’re taught to be almost too resilient, to be strong and sexy and cool and laid-back, the girl who’s down. We also need to feel allowed to fall apart.”
 
DBT is an acronym for Dialectical Behavioral Therapy. I spoke with therapist Karen Nowacek, LPC, who works with clients at San Antonio’s Eating Recovery Center and is a DBT practitioner and advocate to get her thoughts on Selena Gomez’s words, though she has obviously not worked with Gomez personally.
 
“It sounds like Selena Gomez is living into one of the basic assumptions of DBT—the assumption that everyone is doing the best they can and in the next moment can make changes to do better,” Nowacek said. “When you start from that premise, it really helps to us to build empathy for those that have invalidated and hurt us in the past.”
 
Many psychotherapists use Cognitive Behavioral Therapy. If you’ve been to therapy, odds are good that this is the approach your therapist used (though it’s not the one I use personally, which I’ve talked about previously). 
 
“DBT is an emotion regulation therapy,” Nowacek explained. “It offers real life skills (such as minding the consequences and checking the facts) to help regulate our strong emotions that can make life difficult to handle. Most of the maladaptive coping we do is just our struggling to feel better.”
 
“DBT is a mindfulness based therapy—teaching us a practice which helps to focus on present moment awareness while noticing our thoughts, emotions and physical sensations,” she added. “It is in the non-judgmental noticing that we can let go of those thoughts, emotions and feelings that are so difficult. This therapy has been truly life changing for many.”
 
Unfortunately, this approach is not as widely practiced, so it can be challenging to find a clinician with this orientation. However, they are out there and websites like Psychology Today make it easier than ever to find a therapist and discover their approach before calling.
 
If you are experiencing any of the symptoms that Selena Gomez discussed, please talk a mental health professional in your area.
 
 
Mike McMahan, LPC, is a psychotherapist based in San Antonio, Tx.
 
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By Mike McMahan, LPC
 
Anyone who has been following the story of Metallica for years knows the band has had its share of ups and downs. From the highs of their rise from the thrash metal underground in the 80s to the release of Metallica (a.k.a. The Black Album), which remains one of the top-selling albums of all time, to the lows of James Hetfield’s struggle with alcoholism that almost tore the band apart in the early 00s. That struggle is documented in the film Some Kind Of Monster, which, if you read this blog and you haven’t seen it… stop reading and go watch. Much of the film is focused on group therapy the band undertook to keep the Metallica ship afloat. The band caught a lot of flak for it, but I found it extraordinarily brave that they were willing to open up to the world about the fact that they are regular people with real problems. There was an undeniable element of Spinal Tap at parts, but the film is a real achievement.
 
Point being, Metallica knows therapy. Recently, vocalist/guitarist Hetfield gave an interview and said: “There are times when I'm happy; there are times when I'm not as happy. I think I'm a human most of the time. Music is therapy for me. I get to write lyrics, I get to get crazy thoughts out of my head and onto paper, and other people read them and say, 'Wow! I understand that.' So it makes me feel okay.”
 
There is almost nothing bad about listening to and enjoying music. It’s one of the most harmless vices in life, as long as you don’t blow out your ears. And these days, with Spotify, it doesn’t even sink your wallet. But music listening is not therapy, though it is therapeutic. What’s the difference? Well, psychotherapy is a very specific process, even though how the therapist chooses to apply the theory is more of an art. But if you’re going to therapy, you shouldn’t just feel better. You should be able to cope with life’s challenges more effectively in the future, even when not in therapy. A good therapist will help you set goals and change your way of thinking to help you get there. Are there times when you might not be aware of what the therapist is doing? Quite possibly. Though there is an ethical component to being a therapist, you can’t break everything you’re doing with the client down. It takes away the magic, so to speak. The client comes to change his or her life, and the therapist wants to make them aware of how. But there is still an element of subtle manipulation.
 
So is it possible that music can be therapy and therapeutic? Maybe! There are music therapists who help people learn to communicate better by using exercises based around listening to music. I’ve seen them work with children, asking them to choose a “hello” song to describe their feelings, to write songs that capture their emotions. But this can work for adults, too. Something I like to do with clients is ask people to consider why they like a certain song. “I like the way it makes me feel,” is often the answer. Is it the lyrics? The melody? The people or situation you were in the first time you heard it? This is a way of reflecting on the past and possibly identifying things you enjoyed or (even better) strengths you may have forgotten that you can apply to the present.
 
What’s your favorite song ever? Where were you when you first heard it? If your past self could come to your present self via the song as a time machine, what would your past self say was the most important thing you learned from the era when you first heard the song? What traits of your personality are important to keep in mind and will make you more the person you want to be right here and now?
 
 
Mike McMahan, LPC is a therapist based in San Antonio, Tx.
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By Mike McMahan, LPC

Evan Rachel Wood has been in the news quite a bit lately, due to her lead role on the fascinating new HBO series Westworld. The series deals with robots in a futuristic amusement park who endure all matter of violence in an Old West setting. The robots’ memories are then wiped and they repeat the experiences over and over. However, as the show opens, they have become sentient and begin to remember what has occurred in their pasts. The show itself provides plenty of food for thought on how we deal with trauma as well as providing a commentary on how the entertainment industry (and HBO, specifically) uses violence (especially sexual violence against women) as a plot device.

Wood gave a recent interview with Rolling Stone in which she dropped some serious knowledge bombs about bisexuality and psychiatric struggles; talked about her years ago relationship with aging shock rocker Marilyn Manson who is 17 (!) years her senior; and hinted at a history of sexual violence in her own life. While the matter is oblique in the actual interview, she clarified in a powerful statement on Twitter that she had, in fact, been raped twice. “I will not be ashamed ... I don't believe we live in a time where people can stay silent any longer. I certainly can't. Not given the world we live in with its blatant bigotry and sexism.”

Kudos to Wood for being brave enough to speak out on this matter. While certainly no one should be required to acknowledge such a matter publicly, each time someone does (especially someone who is famous), it chips away with the stigma associated with being sexually assaulted. There are many recent cases in the news in which young men have received light sentences or in which the judge has implied that the victim is somehow to blame: this reflects our so-called “rape culture.” The strength of someone like Wood may show that women (or men) who have been assaulted do not have to accept some sort of blame or suffer in silence for fear of persecution.

What impressed me the most about Wood, however, was not her bravery in speaking out but, instead, her acknowledgement that her role in the show was therapeutic for her. “Good God. I left so much in that first season and never looked back,” is a great attitude to have. When I have worked with sexual assault survivors, I talk about their path to recovery as a journey. Though I obviously wouldn’t wish trauma on anyone, people may come out on the other side of their recovery from the experience much stronger. In this case, Wood, who is magnificent in the show, is able to use past trauma to inform her performance and inhabit the character in a way that many other actresses would not have been able to. Given that one of the primary themes of the show is how we move on from trauma, it could be that the role itself will be key in her realizing new opportunities in her life. To be clear, I am not suggesting that survivors “get over it.” What I am suggesting is that one’s status as a survivor may allow mastery of new skills and that these survival skills may be applied successfully in other areas of one’s life.

If you have been assaulted and wish to speak to someone about the experience, consider your local Rape Crisis Center. You can also seek assistance via RAINN.

 
Mike McMahan, LPC is a psychotherapist based in San Antonio, Tx.

By Mike McMahan, LPC

Recently, both CNN’s Brianna Keilar and standup comedian Patton Oswalt have shared deeply personal thoughts on the recent deaths of loved ones; in Keilar’s case it was her mother, while Oswalt lost his wife.

​Brianna Keilar detailed her experience to the network that employs her, CNN. Keilar went viral during coverage of the presidential election after a conversation with Donald Trump’s lawyer. On the heels of this success, she thought that her key challenges this year would be career-related, but instead she faced the passing of her mother. Keilar’s mother died less than 24 hours after being diagnosed with leukemia. She still managed to find a balance between work and life, even though her mother was seemingly her biggest fan, hooked into the primaries like her own “reality show.” The experience provided Keilar with insights into what matters in life and led to a shift in perception towards a greater appreciation in her life. A death can provide these types of lessons, especially for those who choose to embrace the positives of what the tragedy may teach or show them, and look for ways to keep the spirit of their departed loved ones alive.

Oswalt’s piece is similarly personal and has an open-ended aspect, as the cause of his wife’s death is undetermined by the medical examiner at this time. Nonetheless, he too has thrown himself back into his work, which is standup comedy. The idea that comedians are “sad clowns” is not a new one, and the public was reminded of this when Robin Williams committed suicide. In the article, Oswalt admits that he has suffered from depression in the past, but grief is different from depression, though grief can certainly morph into depression after some amount of time. It makes more sense that he could tell jokes after his wife’s death when you consider the “sad clown” aspect of his chosen career, though he could have faced significant barriers that Keilar didn’t have to deal with. After all, while she missed her mom, her job is very serious and if she seemed slightly more serious, well, who would notice in a reporter? But a comedian wants to make people feel better via laughter. How does one do this when you’re hurting inside?

This idea of throwing yourself into work is an obvious commonality in both pieces. When a person suffers a loss, sometimes returning to normal routines can be comforting. Human beings are creatures of habit, and many of us find comfort in daily routines and rituals. On the other hand, many experts suggest that maintaining rituals for family events can be difficult and suggest that a death is an opportunity to establish new traditions. Consider the difficulty of the first Christmas without a beloved family member. If that person was very active in the Holiday traditions, their absence will be felt acutely. Some ideas include holding the gathering or celebration at a different house, or doing an activity that might not have been done before, such as going to a movie as a family. Of course, these things are not one-size-fits all. Some families choose to maintain traditions as a way of honoring the family member who has passed, which is understandable and may be therapeutic in different ways. After all, when someone dies, they will live on in our memories and hearts, and many choose to honor the person in that way. Some also find comfort in asking “what would my family member want me to do?”

In working with clients who have experienced a loss, virtually every single one says “my loved one would want me to go on and live life to the fullest.” Oswalt’s statement that he will “never be 100% again” struck me as extraordinarily sad. I am not remotely questioning how he chooses to feel or process his wife’s death, and he certainly may be right. But given that he has a young daughter to raise, he may not feel that way in the future and I am skeptical that his wife would want this (without knowing her, of course). I believe strongly in the basic goodness or people and choose to believe that they want the best for loved ones, even after their passing. His wife was giving her all to the true crime book she was writing, so she understands passion, commitment and achievement, which is why I believe she would want him to live to the fullest. For his own sake, and that of his daughter, I hope that he gets where he wants to be and finds peace.

Facing a significant loss is one of the most difficult things we face in life. If you are struggling with a passing, please reach out to a mental health professional or a doctor. There are people and resources who can help at these difficult times.


Mike McMahan, LPC is a psychotherapist based in San Antonio, Tx.