Posted on December 21st, 2020by RMANY

Ep 43: Normalizing PTS (Without the D) with Joelle Rabow Maletis

Fertility Forward Episode 43:

Many of us will experience some kind of trauma during our lifetime. Sometimes, we escape with no long-term effects but, for millions of people, those experiences linger, causing symptoms like flashbacks, nightmares, and negative thoughts that interfere with everyday life. Today’s guest is a well-known psychotherapist, clinical director, CEO, and published author. Joelle Rabow Maletis utilizes reflective listening and builds rapport with her clients, incorporating CBT and DBT skills, along with talk therapy and solution-focused therapy to provide a structure that allows clients to make changes in their own lives. She focuses on establishing collaborations, promoting self-growth while incorporating mindfulness training to achieve client results. Joelle works with diverse clientele that includes C-suite executives, active and retired military personnel, first responders, and those experiencing trauma and PTSD. Joelle is a member of TED International, having created TED-Ed’s video on post-traumatic stress, and she is a member of TED Women and TED Salon. She has also been featured on ABC’s 60 Minutes: Beyond The Headlines, and has received multiple Outstanding Achievement Awards for Top Female Executive. In this episode, Joelle defines post-traumatic stress and asserts the importance of normalizing it without calling it a disorder, even reframing it as post-traumatic growth. Hear her advice for validating, recognizing, and honoring your trauma, and some of the coping mechanisms she recommends. Find out why acceptance is crucial for growth – as is working through anger and resentment – as well as the importance of finding the right therapist and knowing you’re not alone.

Transcript of Episode 43

Rena: Hi everyone! We are Rena and Dara and welcome to Fertility Forward. We are part of the wellness team at RMA of New York, a fertility clinic affiliated with Mount Sinai Hospital in New York City. Our Fertility Forward podcast brings together advice from medical professionals, mental health specialists, wellness experts, and patients because knowledge is power and you are your own best advocate.
Rena: We are so excited to welcome to Fertility Forward today we speak with Joelle Rabow Maletis. She is a well-known psychotherapist, clinical director and CEO, and she utilizes reflective listening and builds rapport with her clients, incorporating CBT and DBT skills along with talk therapy and solution focused therapy to provide a structure that allows clients to make changes in their own lives. She focuses on establishing collaborations, promoting self-growth while incorporating mindfulness training to achieve client results. She works with diverse clientele that includes C-suite executives, active and retired military personnel, first responders, and those who are experiencing trauma and PTSD. Joelle's appearance highlights include being a member of TED international, having created Ted Ed videos on PTSD, a member of Ted Women and Ted Salon, guest relationship expert on Lasting and Talkspace, guest speaker on Parenting Tips To Go, US Rec and CAMST. She has been featured on ABC’s 60 Minutes: Beyond the Headlines, associate producer of film short, Repressive Faire, received multiple outstanding achievement awards for top female executives, and is also a published author.
Rena: Wow. Quite a bio. I'm so excited and honored that you are taking the time out of your busy schedule to be with us today to talk about something that I think is so important, especially now, you know, in a time of COVID - trauma and PTSD. So thank you so much.
Joelle: Thanks for having me. It's a pleasure.
Rena: So I would let you just sort of start out, you know, I, I work, a lot of my patients, I think this is going to be such an interesting episode because, we work, we both work with trauma and PTSD, but with vastly different clientele. So, you know, my work is with patients going through infertility and yours is such a broad range, you know, C-suite executives, active and retired military personnel, first responders. And so I'd love to start kind of just talk about trauma and PTSD from your perspective. How would you define it? How do you kind of see it in your space? And we can kind of compare and contrast.
Joelle: Yeah, I mean, it's a great, it's a great question. I think there really a difference betweenPost traumatic Stress Disorder, PTSD, and then this idea of post-traumatic stress and really a newer concept or model of post-traumatic growth, right? So what does all of that mean? And post-traumatic stress disorder is, you know, what the mental health clinicians diagnose based on a certain level of criteria, right? And then this idea of post-traumatic stress that is more about, of course it's traumatic. You know, we go through traumatic events all the time and they're stressful. And fertility is, is hugely traumatic and stressful. Having a car accident is stressful. Being a first responder is stressful. And for some people that traumatic experience or those traumatic events can develop into this disordered behavior that, you know, psychology would then say it's PTSD. I'm more interested in this idea of post-traumatic stress as normalizing that. You know, of course these events are stressful. And so we have this post-traumatic stress response. Does the D, you know, in air quotes mean that we're going to develop this disordered behavior, disordered thinking, and then not, you know, I believe not at all. But there's sometimes we do and sometimes we don't, and there's a multitude of criteria of why that happens. And then more importantly post-traumatic growth. Okay. And so the ‘what?’ Not, so what, who cares about it or it's not important. And so what does that mean for us? We've gone through this very traumatic experience. We may have post-traumatic stress disorder from it and the growth part is, so what do we want to do moving forward? How do we conceptualize that? How do we work through it? How do we resolve it? And then how does that make us better equipped in our life today and moving forward?
Rena: I love that you frame it like that with the post-traumatic growth. You know, that's a lot, a lot with how I work with my patients too, is to help frame things and help show them, you know, that this experience and trauma that they've experienced can really lead to growth. And I think a lot of times people hear, you know, post-traumatic stress, PTSD or acute stress disorder or trauma, you know, however you want to classify it and they get really frightened because it sounds so serious. You know, because it is and then they, they sort of are, they don't know, you know, what that means for them. And so I think to frame it and say it as you know, post-traumatic growth, I really, I really love that. And, you know, I'm, I'm sure you see in your patients just how I see in mine really the growth that people can experience from stressful incidents.
Joelle: Yeah, absolutely. And, you know, I think a lot of my passion in this field is really the, the quote D end quote disordered part, right? And really what that means clinically is there's a list of criteria that the DSM, right, tells us, you know, what we, what we can, and can't diagnose based on what patients are reporting. More practically speaking though, the D is, Hey, when this affects your daily life and living, you know, to the point where your functioning is diminished, right? Your, your quality of life is diminished. Your happiness is diminished. And so looking at it from that framework of, you know, of course this, this experience is traumatic. And, and I think about infertility and, and a lot of different ways as far as being traumatic. Can it be disordered? Absolutely. Can it cause us to, you know, create or have experiences that shape our daily life and living and even negatively? Absolutely. And so what do we do with that? Right? How do we grow from the fact that we're going through this experience? We have very little control over the traumatic components of it and knowing that, can we normalize it a little bit and give ourselves that, that grace and support, right? That internal support is saying, of course, this is traumatic. Of course, it's going to shape how I think about things, how I feel about things, how I respond to things in my day-to-day life. And can I use that on the other side of this? You know, can I use that to grow, maybe my resiliency, right? Maybe my ability to cope. Maybe my ability to radically accept that this thing is the way it is. And I didn't cause it, right? I don't control it. And how do I use that to move forward, to feel more grounded without really dismissing or negating that it is traumatic? I hope that makes sense.
Rena: Oh, totally. I think, you know, that sounds very similar to a conversation I have with patients a lot, which is, you know, they go through this traumatic stressful event and they feel like they should be the same person that they were before so that, you know, they're going, they're introducing this stressor into their life and half of them they're having, it's stressing them out, you know, half of them, they're not able to operate at the same capacity that they were before. You know, how come now they're suddenly, you know, maybe more irritable or they find themselves lashing out at people or triggered by certain things? And so I worked with them a lot to help them understand well, because you've introduced the stressor into your life, you know, you aren't the same person that you were before. And sometimes they have them even do an exercise to sort of look at okay, who I was before and who I am now, and then who I want to be. So these three different selves because it think a lot of it is sort of accepting that, you know, you've introduced this into your life and how are you going to pivot? How are you going to flow with it and accept it instead of trying to fight it and acknowledge and validate that it's there. You know, because, you know, I always say in fertility it’s the same stress levels as AIDS, cancer and heart disease. And so you wouldn't expect someone going through cancer treatment to not be stressed out. You would say, Oh my gosh, that's horrible. You know, how can I help? And so to accept that, okay, when you're going through fertility treatment, it’s the same stress level, so you also need to love yourself and look at yourself and say, Oh my gosh, you know, how can I, how can I help? How can I help you tolerate this and add this into your life? You know, again, you're not the same person you were before. But it doesn't mean that you can't emerge stronger, better having, you know, better coping skills, as you said, you know, understanding your resilience.
Joelle: Yeah. You know, I mean, you bring up some great points too. And I think, you know, when I've worked with, with clients, with infertility and, and multiple, you know, pregnancy loss or late term pregnancy loss and the trauma that that brings, it's this, it's such an out of control feeling. You know, I have no control over my genetics. I have no control over what's happening to my body and I feel helpless, right? And sometimes that sense of helplessness is what solidifies the trauma, you know. And then the anger that, that one feels. And that's part of the grief cycle. It's also part of the post-traumatic stress cycle, which is, I'm so angry and I, I don't know who to lash out to. I'm angry at myself. I'm angry at my body. I'm angry at the world. If people are religious, they may be angry at their God, right? That, that this overarching level of shame, guilt, anger, frustration changes, how people interact with each other, right? And then there's the guilt and shame of, Oh, well, I just yelled at somebody and now I feel terrible, you know? And so for me, kind of being able to normalize all of that and say, and just have these conversations. Well, of course you would feel that way, right? Like this is not, this is not weird. It's not abnormal. It's not, it's not even crazy. I think people so often come into my office and they feel crazy. Right? And being able to just work with them and say, you know, this, we'll get through this together. Right. And there's a way to start working with your experience to help you move through it. I don't think that makes it less traumatic and I'm skeptical of people that say, Oh, well, resiliency training and mindfulness and meditation make this less traumatic. I don't believe that that's true. I think what it does is it, it makes the feelings of trauma less intense. Right? I think the trauma is still traumatic. Right? The, the issue is still traumatic. So for me, it's, it's working with people in infertility, is that somatic? My body's betraying me. I feel like my world is betraying me and I'm so angry about it. I can't see straight. Right? And I feel helpless. I feel out of control and I feel helpless and I don't know what to do about that. I don't know how to gain this, this control back where I feel like I have just a little bit more control.
Rena: Yeah. I love what you said about, you know, you can't, we don't want to invalidate someone's trauma, you know, and I, you know, I'm certainly a big believer in mindfulness and meditation and, you know, kind of the positive psychology tenants, but that's on top of also accepting your trauma and validating and honoring those feelings. And I think so many people, you know, they don't, they almost, they don't let themselves honor. And they say, well, you know, it's not a big deal or, you know, well, so many people have it worse than me. And I always say, but that there's always gonna be someone that's going to have something better than you or something worse than you, but this is where you're at and this experience is traumatic for you. So the first step is accepting that and honoring your feelings. This is a trauma for you. This feels like a trauma for you. And then from there, you can go into coping exercises, you know, and kind of the second piece that I think exactly, as you said, the first piece says, we have to accept that this is a trauma for you, you know, whatever that experience was.
Joelle: Yeah. And there's so much, you know, it's such a complicated issue as trauma is, but I think especially in fertility, right, there's so much, you know, societal pressure, there's so much guilt and shame. There's so many cultural overtones of, of the culture I was brought up in and what my family of origin, what their history is or what my partner, you know, history is and our expectations and this loss of a dream, you know, this is what I'm quote supposed to do. Right? And this is supposed to be quote easy and it's neither of those things and the guilt and shame that comes with that only exacerbates the trauma even more. Right? So I'm having this traumatic experience that I have, you know, I feel guilty and ashamed about it. Most people, I don't even think they share that, right, with, with the outside world. Maybe if they do it's with the few choice people, you know, and it just continues. It's this downward spiral of the worse it gets the worse I feel, the more guilt and shame I feel the worse it gets, right? Then I'm angry. It's, it's such a convoluted, complex problem. And I think when we look at it and we say, Hey, there's this cookie cutter approach to trauma, right? And there's a way that we can use positive psychology and resiliency training and mindfulness to feel better. Sometimes what we're losing is the recognition of the trauma and the experience to be able to say, let's just try and sit with that for a minute. And how do we want that to define us? Do we, do we want to be on the other side of this and look back and say, wow, we went through that. No matter what the outcome is, is that we made it through and it's going to make me a stronger person because dot, dot, dot. Right? I think we're sometimes we're so busy, you know, and from my own experience, right, we're, we're so busy judging ourselves about what we should and shouldn't be doing and how we don't fit in because we're having these issues. But then it, it, it only compounds the fact that we're also, like you said, you're experiencing something that is on par with and equally traumatic as cancer and AIDS, you know?
Rena: Yeah. I think, I mean, so many things of what you just said resonated with me, I guess the first I'll go back and it's how you brought up sort of the loss of this dream. So I don't know if with your work with clients, you also do a lot of sort of bereavement and loss counseling because that's something that comes up a lot with my patients, you know, sort of in addition to the trauma and PTSD work is we talk a lot about loss and the grief process, you know, most people, you know, they growup, they things, you know, whatever their, their dreams for their life, you know, they want to get married, they want to live in a house. They want to have a car. They want to have two kids, a dog, whatever that dream is. And usually that dream does not involve conceiving in a doctor's office where with assisted reproductive technology. So when that's taken away, there's a whole, I mean, then you start, you know, the stages of grief and there's five stages and people start to cycle through them. And so I think part of it too, is recognizing that you're mourning a loss, you're mourning a loss of that dream and that you're cycling through sort of these stages of grief. And that's also part of this work too, is to allow yourself to feel that.
Joelle: Yeah. And you know, it, it comes to mind that it really is this, this newer, you know, the field keeps changing right, of trauma and how we study trauma and what research is saying. And, you know, we're leaning more and more into what we call C PTSD, right, or complex post-traumatic stress disorder. And I think of infertility most often in that light of this complex post-traumatic stress because a lot of people are dealing with grief and loss of a miscarriage, you know, or not getting pregnant, you know, they do IVF and it doesn't, it doesn't take that one time, right? Or that, or those several times, you know? And so it's not just, I've lost this dream of I'm, I'm supposed to get married, buy a house or not. Right? But I'm supposed to get married and have babies. That's what I want. That's my dream. That's, what's expected of me. And not only is it hard for me to get pregnant and I'm having to do that in a doctor's office, most often, I'm also dealing with multiple pregnancy losses, right? Or, or the loss of being able to get pregnant the first try. And I think that that is so interwoven with, with just the trauma of dealing with infertility, right? Because there's that whole grief cycle too. And, and it's, it's hard sometimes to separate out, you know, what I'm supposed to feel when, and when I say supposed to, that's usually what we hear in our head, right? It's that, it's that negative self-talk that we just keep grinding against. So hard to develop the self compassion or the resiliency, or the mindfulness that you're talking about right? Is, is, you know, okay. Now, not only can I not get pregnant, but I also can't be pregnant. So what is that, what does that mean? And in addition to that, I now have however many losses of pregnancies, right, that I thought it was going to be different and that's a loss and it's a loss of a dream. And we're back into this cycle. And to me, it's just, it's riddled with complexities and, you know, how do, how do we, as clinicians help people sift through that and be able to compartmentalize and, and work through what they need to, to, I think not, not have the resiliency to go on, but have the resiliency to keep trying if that's what they want.
Rena: Oh sure. And I think it becomes almost Pavlovian. You know, I, I talk about that a lot with people too, you know, because it becomes so much about this negative reinforcement. If you keep getting negative pregnancy tests or you keep having losses. So in normal life, if people remember back to Pavlov's dogs, you know, if you took a psych101 class and you get electrocuted you, then, you know, most likely you're not going to stick it in again. And I always say, well, like my personality, I'd probably stick it in a second time, like just to make extra sure, then I would stop. You know? So you have those people. But most people, okay. One or two times you get burned out. Okay, stop. But with this, it's like, you keep sticking your finger in the socket and you don't have a choice because if you want to have a child, you, you have to keep pursuing treatment. Obviously there are alternative ways to family though, but let's say someone's, you know, staying on the path of trying to conceive with assisted reproductive technology it's like, you keep sticking your finger in the socket and you keep getting burned, but what's your alternative? And so people get so burnt out and they often come to a place of feeling like, well, why am I doing this? You know, why do I keep sticking my finger in the socket? It doesn't make psychological sense. And so I think it's about, you know, it's really helping people through that too, because it's so difficult.
Joelle: Yeah, absolutely. And, you know, we call it right, compassion fatigue. And so usually we, we put that toward, you know, medical personnel. We're seeing that with COVID and, and first-line responders. Right. We see it in therapy where the therapist is, is fatigued from that level of having to be compassionate all the time, you know? But I think it, a lot of it is this idea of compassion fatigue and moral injury, which is, you know, this is not what's supposed to be happening and I'm not, I'm not capable. I'm not competent. I'm not able. That's the moral injury part. Right? And the compassion fatigue of here we go again, right. Like, like I don't want to do it. I have to do it. I want to do it. I don't know if I want to do it. And that bouncing back and forth between, you know, between all of those different holes and feelings. Right? Only to just go back to the doctor's office the next day, the next week. Right? And do it all over again, it's that alone is fatiguing. Right? And it's this, I'm, I'm willingly putting myself in a situation that I know I'm going to continually be traumatized. And that's the cost of potentially having the family that I want. Right? So then how do you reconcile that too, you know, I knowingly am doing this to myself. Right. And that doesn't, I don't think that takes away from the traumatic experience. I think it only accelerates it.
Rena: Exactly. What would you, so if you had a patient, you know, I'm just so curious, because I guess, you know, I feel like our backgrounds are so different, you know, come in with, with that sort of overarching issue, what sort of coping mechanisms or counseling, like, how would you sort of advise, and I'm just so curious if it would be similar to what I do, or can we sort of open the world to a whole new kind of, you know, information on this from your end?
Joelle: Yeah. Thanks for asking. I think, you know, how we work clinically is, is the magic between, you know, clinicians doing the work to be able to help the most amount of people. Right? Forgive the trite answer in the beginning, right? The first part of it is, well, it depends on the client, but beyond that, you know, I, it depends on the level of crisis. So am I doing crisis management first to have people work on their level of anxiety to calm down a little bit, right? Or work on their levels of anger to calm down a little bit. So their treatment hopefully will be more successful for them or their experience of treatment. You know, we'll be more, more successful that really to answer your question for me, it's a lot of the ‘and so what’ question, which is what we call solution-focused therapy, and it's not, so what, who cares? It's not important. It's okay. Can we accept that this is happening? And if we can accept it, it doesn't mean we have to like it. And it doesn't mean we have to understand and it doesn't mean we have to forgive it. It really is this concept of dialectical behavior or DBT of radical acceptance. I accept it is what it is. I didn't cause it, I didn't create it. I can't control it. You know, am I willing to accept that the situation is happening to me? That for me, that's the first part. And then if I can accept that, the second part of that equation is okay and so what, so what does that mean? Right? And sometimes I find with, with clients who have had multiple losses, who are deciding not to do infertility treatment or clients who have had, you know, who are going through infertility treatment, right, end up getting to this place of, I can, I can, I can get to a place where I can accept that my body is the way that it is that this is my experience, that it is traumatic. And the ‘and so what’ is, I'm willing to try it another day. I'm willing to make the choice to say, even though I accept this, and even though it's traumatic, I want to keep doing it. And I think that the idea of choice takes away the helplessness and for me, the helplessness and not having any control over the outcome is part of what makes that, that what we call vicarious trauma or this, this trauma that is that we're experiencing sometimes even second hand, right? This idea of helplessness, I have no control. Sometimes that's the piece that helps move us through the trauma. You know, I think we get stuck in the helplessness and that solidifies the trauma. And so I always start there. I start with, can we accept that, that it is what it is because it is, and I'm not asking anybody to forgive or let go, or, or any of these, you know, kind of pop psychology things we see a lot of times. What I'm asking is can you sit with for a minute, the extent of your reality? And if you're willing to accept that, can you choose to do something different? And sometimes the choice is yeah. What I can choose to do different is I can give up and not try anymore. Or I can go back to the doctors, you know, tomorrow or next week or whenever my next appointment is and try again. And I think sometimes that is, is the magic of getting through to the growth part. Right? Doesn't mean it's less traumatic. So for me, it's really about, about that piece and then the skills, you know, and like you said, the mindfulness, the, the resiliency training, the breath work I think comes in, in addition to all of that. It's not a linear model. If that makes sense. It's not, you know, one line, A plus B equals C you know, it's more of having a starting point and then we sort of radiate out with a bunch of different ideas. And so I visualize it as, as a bicycle wheel, there's all these different spokes in a bicycle wheel. Right. And, and, and it works if some of them are bent and there's one that's broken, or two, the bike works just fine. It may not be aesthetically fantastic, but there's nothing wrong with it. You know, when a lot of those spokes are bent and there, and a lot of them are broken, the bike stops working well, you know, you may be able to ride it, but it doesn't work well. And so I try and work with people on what are all of the areas of their life and what they're experiencing and where can they regain control. And some of them knowing that within fertility and post traumatic stress, post traumatic stress disorder, that they may not have control in those areas. So are they, are they willing, are they willing to accept the lack of control to keep moving forward? I know it's a long answer, but...
Rena: No, I love that analogy of the wheel and the spokes. I love that. I'm definitely gonna use that and give you full credit because, you know, as you said, I think sometimes people they'll come to me and you know, it's, it's just so much to unpack. And so they'll say, like, I just, I need exercises, you know, help me with my anxiety. And it's like, the place to start, as you said, is not by giving you sort of these band-aid exercises of breath work or visualizations or whatever. Like certainly you can have them and put them in your toolbox, but I think the real work starts with acceptance, you know? And I think that that concept is so liberating when people just accept where they're at, and I always tell clients, you know, I meet you where you're at. So like, hi, nice to meet you. This is where you are today. And so I think that that sort of more macro concept is the real work. And then the other step, you know, comes along as you do it, that's helpful, you know? Okay. So put these tools in your back pocket, if you're feeling out of control or you're feeling triggered, okay. Pull out this, you know, anxiety exercise, so you can kind of, you know, self soothe, but I think, right, the big thing is to, you know, accept, like, you know, look at all of us today. Okay. We're in the middle of a global pandemic. So we have to accept that. This is our reality. So once we accept that, it's a lot easier to then vibe with it. And how do we now sort of melt our lives into what we were given today? You know, we can't, this is our situation. So the sooner we can accept it and go with the flow, the more we can at least have some semblance of normalcy and hopefully joy and happiness with where we're at. You know, but I think if you're not able to do that, it's a lot more difficult then your world becomes a lot darker and more negative.
Joelle: Totally. And, you know, I always joke with people just because that's my, my, you know, my style is, is to be a little sarcastic and have some humor. Right? Which is, you know, it sounds so easy, right? Oh, just do this thing. I'll just accept this. It is what it is, because it is, you're fine. You didn't control it. You'll figure it out. Right. And I don't mean, I don't mean that at all. You know, it, isn't, it's a simple concept, but in no way, is it easy, right? It's not, it's not easy to work on it and it's not easy to accept. Right. And I, I think that, um, I really do believe that that people need to do a couple of things. One is they need, they need to interview the therapist they're going to work with right. To make sure it's the right fit and that they feel comfortable. And I think, you know, and I think the misconception within fertility is that it fits into the single case traumas. The example I would give would be a car accident, which is extremely traumatic - if anybody's ever even been in a fender bender - it can be extremely traumatic. Right. That's not the same thing. And so finding, you know, finding a therapist that, that they connect with, that they interview, they make sure that, that they feel good about it. And that the therapist understands the complexity of what they're working with, you know, and what I mean, what they're working with is what the client is working with, not with the therapist is working with. Right? And I really believe that I think that, that a lot of times what I've seen and, and typically clients come to me where they've, they've tried other therapists, or they've had a lot of therapy before, and they're coming to an expert, you know, they're at that stage and their, their, um, either frustration or recovery. And,you know, there are times where I'm, let's just tell him, just tell me how, you know, how you're experiencing this because the concepts seem so simple. Right? And they seem so easy, just use radical acceptance and it'll work. And I'll tell you experience. That's not the case at all. It took me years to finally understand what that actually meant in, in relation to my own trauma and my own loss. And then saying, okay, well, you know, I'm mad at the world, right. I'm mad that this this happened. And I don't know how to accept that, you know, and I don't know if I want to accept it. Right? Cause if I accepted, it means that then I have to let go of the experience. And so sometimes just holding that space, which is, you don't have to let go of anything. Right? The acceptance piece is, is getting through the guilt and shame component of it. Right. It's not diminishing what you're experiencing in my opinion.
Rena: Yeah, exactly. And I think, you know, again, I think as we sort of talked about through this episode, it's multi faceted and I think, you know, grief comes into play and, um, you know, cycling through denial, anger, depression, and, I'm forgetting...bargaining. Youknow, I think that's part of it too, is, you know, saying like, I didn't want to be here, you know, this isn't part of my plan. So to accept it is that, you know, also making it a reality, you know, and sort of taking away this sort of, you know, maybe fantasy or hope that I am holding onto that this isn't actually my real life because when you accept it, you know, that's also acknowledging it. But I think, you know, once you do it can be extremely liberating. But as you said, it doesn't mean that you then have to also let go of anger and resentment. You know, I think those are things to work through because I think that they don't serve you. But I think it's also a mistake to think that just because you accept something also means that you then let everything go. You can accept then you can also work through, you know, anger and resentment and all that stuff that's also holding you down. And I think as you sort of work on all the different spokes on the bike wheel, as you said, you know, it leads to feeling a lot freer and a lot more comfortable with who you are and where you're at, you know, wherever life has taken you.
Joelle: Yeah. And for me, kind of, that's how I couch it as, as this idea of helplessness versus starting to feel like you're in control, which is the more I can move into understanding my reality and working through all of these stages of grief, the anger, the guilt, the shame, the more I feel like I have a little bit more control and sometimes where that shows up is my behavior with other people, right. I'm not so angry with, with people because I'm just so angry. Right? I, I start to say, okay, I can use the skills that I'm learning in therapy though, you know, use, you know, effective communication, boundary setting, right? Mindfulness breath work. I can start really attaching to those skills and implementing them because I'm working on, on what's behind, right, which is the other things that we, you know, that we've outlined. You know, it's just as it's, I think infertility is one of the things, you know, when I was preparing you to just, just to think about this podcast and, and my own experience, and then also my client's experience and, and thinking about this, and it was, I kept coming to the conclusion that it's one of the most under researched, right. And, and, and misunderstood fields when we come to the psychology side of it and how to work with clients, you know, um, we go to school and we're trained to deal with somebody who's had, you know, God forbid a horrible thing happened to them, right, or a sexual assault or a car accident or, or these single episode experiences. There's not a lot of training in how to work with this. And it's, and I think that that's difficult because I think clients feel so misunderstood, you know, patient patients come in and, and then it's, I don't know how to talk to my friends. I don't know how to talk to my family. I don't know how to set up boundaries. And, you know, I love some of the things that you've brought in, um, from previous podcasts about having that one line cocktail answer on how do you set boundaries when you're dealing with this? Because I think that what leaks out is the trauma, you know, people show up and they interact with family, friends, with medical staff, with the outside world and, and the trauma is leaking through, right? The PTSD part is, is leaking through. And so being able to contextualize that and say, okay, this is my, my reality is, and it's okay for me not to share that reality. And I can find a way to do that, that I don't feel ashamed about my behavior. You know, I can find the one answer that says, Hey, you know, this year we're traveling as a horrible experience because of COVID right? But this year we're working on our careers. Right? And, and, and not get into the guilt and shame. So for me, when you ask about like, how do you work with it? I tend to, to have these dual tracks, one is doing the very deep process work some of the session and then flipping and doing some of the session with the practicality of Implementing skills. Right. Okay. We've done enough process work for today. How about we talk about, okay, what do we do next? Right. How do we implement this? Um, I do, I, because I do feel like infertility is so misunderstood and it's misunderstood by clinicians too, which gets back to, you know, find somebody good, you know?
Rena: Totally. Yeah. I mean, I love that you say that, of course, you know, I think the same and one of my macro goals is really to help change the stigma surrounding infertility. You know, I think 20, 30 years ago, cancer was still, you know, the C word, you know, in quotes about it. You know, it, wasn't talked about and now we all understand cancer, you know, there's cancer months. There's, you know, we can get it, you know, and I think infertility is where sort of, you know, cancer was at, you know, 20, 30 years ago, there's shame, there's stigma, you know, it's whispered about. And because of that, you know, people, you know, suffer in silence and experiences, guilt and shame. And, you know, one of my goals with patients usually is how to kind of navigate this with dignity and grace. So how did they get through this and not kind of blow up their friendships or relationships because they're so mad at how people respond to this and how do I kind of teach them the tools to set people up for success, because there is just such a lack of understanding. So, you know, I love of course, you know, connecting with you and meeting you and learning about your work as someone who also, you know, understands it and works with clients in a similar way to help them, you know, navigate this and,you know, give them these skills, which I always remind them, like, look, these are great life skills, you know, what we're working on in therapy and they're, you know, they're going to just make you a better person for everyone in your life. And so, you know, that's, you know, certainly a positive for going through this is maybe you wouldn't have taken the opportunity to do this work on yourself and,you know, be better both, you know, if you do end up becoming a parent, you know, you'd be a better parent and be a better partner if that's in your life. You know, all the hats that you kind of wear. So, but I think as you said, too, it certainly is about finding a clinician that you connect with and vibe with and it should go both ways. I think people feel sometimes sort of shy to talk about it. If they feel that, that connection is weird. And, you know, I always tell people you know, you need to bring that up. You know, it's really important. This is a personal thing and you know, some people you connect with some you don't, but it's really important to bring that up. It's your therapist is doing something that you find weird. You know, the best thing to do is talk about it. And either you can get through it and say, Oh, maybe it was a big miscommunication. Or maybe you say like, look, I just, this just, isn't like such a great personality match. And let me find someone else who is, but, you know, I think definitely build out your supports, reach out for help and really find someone who can help you navigate that. You know, it takes a village for sure.
Joelle: Yeah. I, I, you know, like, like you said, you know, it's really about, you know, moving, like you said, moving, moving through this with, with dignity and grace, and I think that's the post-traumatic growth, right? That's exactly it in a nutshell, you know, and, and that, that trauma is not a, this is not a death sentence. This doesn't mean that you're, you know, that your, your life is over and that you're quote broken or, you know, that, that you'll, that you'll never function, you know, the way he used to be. And, and the truth is is that, yeah, you won't, you know, somebody's not going to be the way they used to be. Um, they may be a completely better version of themselves, right? And then in a year from now, they could be a completely better version of themselves and that idea of growth and, you know, and working through the trauma part, I think is so difficult because we want to say this D part, this disordered part means that, you know, one is broken and there's a lot of moral injury that comes with infertility. And being able to work through that part of, I feel broken. I feel crazy. I feel broken. I feel out of control. I'm angry at the world, right. I'm angry at everybody I come into contact with because they don't get it. I'm angry because it seems like their life is so much easier. Right? You know, whatever, whatever it is that that's coming up in this moment and normalizing that like, well, of course, of course you would feel that way. You know, that, that makes perfect sense to me. That that's not only not abnormal, but it's also not crazy. So let's talk about that. Let's talk about these things and then how can we, how can we look at it? You know, what, what do you need to start working through the fact that, that this is a part of who you are? This isn't, this, isn't a death set trauma, and I'm talking about trauma specifically, right. Or PTSD, you know. There's a lot of misconceptions with PTSD about what that actually means, because you know, this day and age, you know, we see that, that the, you know, gen Z and, and even younger use clinical terms, you know, hyperbolically right. They're like, Oh, I'm so depressed. Oh, I have PTSD. Oh, I'm, I'm suicidal. Oh, she's bipolar. You know, we tend to normalize very clinical terms that have meaning, you know, and so, you know, somebody saying, you know, I have PTSD and for me, I just hold that.,You know, I don't, I don't necessarily have to diagnose it and it doesn't have to be traumatic for me. I do have to be able to sit with that for the person and say, okay, tell me what that means for you. Tell me all the things that trigger you. Tell me about the things that scare you. Tell me about the nightmares and tell me about, and some people have those things and other people don't and trying to not put this on a scale. Well, then your trauma is little T trauma and non-important which is not the case, you know, it's, you don't have to have the, you know, diagnostic criteria to suffer with post-traumatic stress or post-traumatic stress disorder. And it also doesn't mean that, that you forever have this, you know, again, air quote, mental illness, you know, thing, that's going to hang over your head for the rest of your life.
Rena: Totally. And I think too, you know, people bring in all sorts of things to this process. You know, if we're talking, you know, that fertility specifically, you know, they bring in their own individual pathology, you know, then you, if you want to go kind of add to that, you bring in where they're at in their relationships and their outside supports. And so, you know, there's so much that goes into this.And you know, I think that this process can, it can break you or it can make you, and, you know, I always say, you know, I struggled for almost two years. In the first year, totally broke me. You know, I wasn't, I, you know, after a year I realized that I was trying to create a life and I really wasn't living with him anymore. And that, for me was kind of the turning points. And, you know, then sort of my period of self-growth began, et cetera, et cetera which is sort of another story. But I think, you know, again, that this process really does. It can be really hard to see when you're in it. It can be really hard to see that there's a light at the end of the tunnel. You know, I certainly couldn't see it for a very long time and it relates to, you know, my daughter who really was the catalyst for me doing serious work on myself and learning to love myself which could be a whole episode in itself.
Joelle: This day, you know, kids, kids, you know, can make us go to therapy or, or do our own work. And now mine are the age where I finally just said, well, maybe I won't pay for college. I'll just pay for therapy when you're 30 and you'll be okay.
Rena: I just think, you know, for anyone struggling, it's just so important to, to know, you know, you're not alone. There is no shame in this. You know, it doesn't make you a weak person. It doesn't mean that you're not going to be a wonderful parent or, you know, whatever the path takes you, but this is hard and so reaching out for help is so important. You know, that's certainly the hardest part, but really there's, there's no shame in that. You know, this process is so difficult and then, you know, you add in of course now the complexity of, you know, going through it, you know, with a global pandemic and I mean, man, I'm sure you Joelle to, like the past seven months has been really a wild time to be a mental health professional, just because it's part of the added element of that and navigating that.
Joelle: Right. You know, and I mean, I, and I can, you know, I always appreciate, you know, the, the self-disclosure and people sharing their own experiences because we're human, right? And, and I don't know, I don't know everything, you know, I've done a lot of therapy. I've been in a lot of therapy. I've been doing this for a long time but, I'm just human, you know, and, and I can tell you, you know, from my own experience, after having a very difficult loss, you know, felt that I don't think I'm ever going to attach, right, during, during then that next pregnancy of, I, I don't know if I can do it now. Right? So here was this thing that I wanted for so long. And then all of a sudden now I'm in a position where I don't know what to do, and I don't know if I can do it. And what happens if I fail at this and what happens, right? There's the level of complexity and trauma and, and pressure I think we have as women. And it is not less than, right, pressure that men have or partners have. It's just different. It's just different pressure. You know, what if my body failed, what if my body fails again, what if I'm not gonna, you know, be able, you know, what if I lose this baby late again? You know, what if like all of that anxiety and terror just absolutely terrified. And, and, and for me, the best thing that happened was finding a therapist that one understood trauma and, and all of the trauma and baggage that I brought into that situation, but also understood skills and was able to say, Hey, I want you to, you know, for the next seven days, I'm going to see you next week, right? For the next seven days I just want you to try this thing. And if it works, keep doing it. If it doesn't work, don't do it right. If you hate it, don't do it. And there was no pressure to have to perform in therapy. Righ? It was really more about, let's just find a few things that work for you and if it works, cool, and if it doesn't, you're not hurting my feelings. We'll try something else because there's so many different things that we can try to help you learn how to manage your anxiety about this. And for me personally that, that was the turning point of alright, the skills were able for help to help we're able, you know, for me to sit with it. Right? And, and that was long before it became a therapist, you know, and, and for a while, that's all I wanted to do. I didn't want to talk about the trauma. And, and that was okay. And my therapist was okay allowing me to just show up that way of, I don't want to talk about this thing. I just want to feel better. And, and that, and so I tend to find that, that that's been my best mentor and, and I've, I've sort of adopted her approach, which is fine. Then let's not talk about it. Let's just work on the things that may help you feel better. I know eventually when people trust me enough, they'll talk about this stuff. Right? And so it's okay for, like you said, you know, you just meet them where they're at that day and it's perfectly okay for patients, you know, anybody out there listening. Right? It's perfectly okay to walk in and just say, I don't want to talk about this thing today, today. I want to do this
Rena: I want to establish a rapport with you and get to know you before I, you know, trust you with this, you know? Totally. Yeah. Thank you so much for sharing your personal case too. I'm sure that, you know, resonated with so many people and just really helped people know that they're not alone with, you know, similar feelings that they may be experiencing.
Joelle: Yeah. It just, it's just, it's such a complex, it's such a complex thing too. And, and, and, and, you know, having the therapist be able to say, you know, what we, we can do, you have total control of, of the session. We can do whatever you want. We can talk about whatever you want. We can not talk about it. And, and, you know, for me, like the theme of today's talk really has been this idea of helplessness and the ability to regain control in some ways helps us shift to work through the grief process. Right? When I don't feel out of control all the time and everything I do, I can, I can breathe a little bit, you know, and so many people are coming in within fertility where they are, you know, extremely successful, high functioning. They, they've done very well for themselves. Right? And this is the first time where all of a sudden now things are not going the way they want, and they can't wish it to be different. Right? They can't will it to be different. And I think sometimes that solidifies the PTS part or the PTSD part and that's what makes it into this disorder is no matter how hard I try to fix this, nothing I do is working, you know, and it, and it's making that part is making me feel crazy. Again, I'm not, not that they are crazy, or I'm saying that that's an acceptable word. I'm just saying that so much, so many times whether it's infertility, whether it's, you know, I worked at work with active duty, special forces teams which is, I've just have a very unique niche of people that I work with, you know, I'm in the middle of Silicon Valley. So I have all sorts of different people I work with, right? Whether it's content moderators or it's C-suite or military, right? People come in and they're successful, you know, that they, they've done well for themselves, and they are struggling with that part and that just compounds the problem.
Rena: Right. Well, I think it's, you get a lot of people who they're used to, you know, you can dot every I, cross every T and do everything you're supposed to do, and then life doesn't give you that validation, be it, you know, you get the promotion, you get into college, you get into grad school, whatever. And it's, people don't know how to reconcile that, that, you know, because it's like, well, where's my gold star? I've done everything I'm supposed to do and I'm not getting where I want to go and that's really, really difficult for people that are used to doing what they're supposed to do, working hard, and you get results. And this sometimes you work really hard, you do everything you're supposed to do, and you're not getting a tangible return on your investment and that's really hard to wrap your head around.
Joelle: Yeah. And then this, so for me, it was the somatic, right, or the body betrayal. Right? That, that, um, and I found, you know, that, that I find a lot too, which is, I'm so angry with my body I'm so with my body and that somatic betrayal and that sometimes is the work of being able to work through, you know, my, my body is the way that it is and there are some things that I can do that may help me, but there, it's not, it's not a direct line. If I exercise, I eat better, I get better sleep that that is a a hundred percent guarantee that it's going to solve my problem. And again, whether that's infertility or that's war trauma, or, you know, first-line responders with COVID, you know, if I just work through...well it doesn't work that way. It's not the, if I just, you know?
Rena: Exactly, exactly. Well, I feel like I could talk to you all day. We should do a workshop together. Yeah, definitely a part two. I feel like there's so much to talk about, but just for the interest of the podcast we'll wrap this part up for today, but definitely stay tuned because I think there's so much we could do for part two. And how I really like to end the episodes is on a positive note. So to have us each say something we’re grateful for. So I would love to hear your gratitude today.
Joelle: You know, it's, it's so funny. This is one of the questions that I like least, and I'll tell you why, because, because when I'm put on the spot I go, I don't know. And there are so many things I'm grateful for. So I'm just laughing you know, if you could see my..
Rena: It doesn’t have to be existential.
Joelle: Yeah. If you could see my face, you would, you would, you could appreciate it. You know, I'll be honest, there are days where I'm grateful for my, you know treat whether that, you know, pumpkin spice latte, forgive me for the shout-out, but, yeah, sometimes it's just that. But I'm too be, to be honest with you, I'm, I'm grateful for the fact, to get to do this work, but also that, you know, my friends and my family and the people I employ that we've made it through this, this thus far in COVID and people have been for the most part okay. Not great, but okay. And so there's a lot of gratitude that I have and, and just, just being really trying to practice what I preach, you know, accepting every day I am what I am and that's all I can do. And so for that, I'm grateful.
Rena: Well, that was a really good one. I think, give yourself some props that that was great. Pumpkin spice latte and I think they’re both great. I guess I’m piggybacking off of yours, I'll say, yeah. I mean, same for COVID, you know, it's definitely been a very difficult time and I think people are okay, you know, I guess, my dad is just getting over it. So, you know, I'm so grateful. His case was fairly mild and my mom didn't get it and, you know, super grateful for that right there, because you know, that could have been a whole different conversation. So yeah, I mean, just sort of taking it one day at a time grateful for every day and you know, grateful too that, you know, even on days where I just feel like I'm sitting in my house and again for the whatever day in a row, you know, grateful that I'm still doing work, you know, talking with you, putting this out there, you know, I know this will be a really helpful content to people. So, you know, these always give me such a boost of energy. So thank you so much for taking the time to come on and share, and I'm really looking forward to sharing this with everyone in the show notes and everything we'll put info for you about your website and your contact info if anyone wants to contact you also.
Joelle: Oh, absolutely. And I'm always, I'm always happy to just have a conversation with, with people and point them to resources, answer questions, and like, like you, you know, it's, it's the same, you know, I think we have the same goal as far as de-stigmatization, but also just, just getting people out there, getting them connected and, and helping them, you know, feel better about themselves through this process. And so, yeah, by all means, drop me a line I'm on social media. Would love to connect with anybody and just thanks so much for the opportunity. It's been a blast. I can't wait to do more with you.
Rena: Yeah. Well, thank you so much. Stay safe and be well, and it's going to be horrible weather on the East coast this week, so I know you weren't on the West coast, so send us some good weather.
Joelle: Yeah, yeah, exactly. It's, it's, it's a little bit rainy, but Hey, I'm not complaining. It's definitely better than the times I'm in New York. So…
Rena: Yeah, I think it's gonna be a rough week for us, so, well thank you so much and take care, okay?
Joelle: Okay. Talk to you soon.
Rena: All right. Bye.
Dara: Thank you so much for listening today. And always remember, practice gratitude. Give a little love to someone else and yourself. And remember, you are not alone. Find us on Instagram @fertility_forward. And if you're looking for more support, visit us at www.rmany.com and tune in next week for more Fertility Forward.

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