Posted on October 28th, 2021by RMANY

Ep 78: Post Trauma Growth with Joelle Rabow Maletis

Fertiity Forward Episode 78

Trauma affects people in different ways. Just because something is not traumatic for some else, doesn’t mean it won’t be traumatic for you. Talking to us today about acknowledging trauma, and Post Trauma Growth is psychotherapist Joelle Rabow Maletis. Joelle’s focus in this episode is on learning to shift from being a victim to a warrior, by choosing to take ownership of your trauma and honoring the impact a traumatic event has had on you. By asking, “So what?”, Joelle teaches us to give space to the trauma, but to also move forward. We cover the biochemical reactions that underpin the three fear responses, and how to tackle each one. From great tips on how to ground yourself, to advice for fellow therapists on treating skeptical patients, this episode contains a wealth of information for all aspects of your life. Tune in to find out how to turn trauma into growth, without dismissing the trauma!

Transcript of Episode 78

Rena: Hi everyone. We're 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. We are so excited to welcome back to Fertility Forward today, Joelle Rabow Maletis who is going to talk with us about post-trauma growth, something so, so important to so many of our listeners, probably so many of you don't even know that that's what's going on. So we're really excited to launch into this and inform you about this really important topic.
Joelle: Thanks for having me. I'm excited to be here again and talk with you all. So...
Dara: So let's jump right in for me as a dietician, I have actually not heard of the term post-traumatic or post-trauma growth. What exactly is that term? And when is it really used and why is it so important?
Joelle: Yeah, so post-trauma growth, post-traumatic growth either one is, they're interchangeable. And then, you know, we're hearing more about PTG, which is the acronym, and this is my new favorite topic. I love talking about it. It's the and so what. Not the and so what who cares. But, so what do we do with these traumatic things that we've experienced and how do we grow from it? And so it's more than just resiliency. I think it has to do a lot with the things that happen to us that are traumatic and trauma’s in the eyes of the holder. I think we had talked about this before on our last podcast of, you know, if someone says that it's traumatic for them, right? Then it counts as trauma. It doesn't have to be in a book somewhere. Right? And so how do we take these things that happen to us that are traumatic and turn that into growth opportunities and experiences without really dismissing or negating the trauma?
Rena: I love that so much because it basically means you're taking an experience that happens to you that's really difficult. And how do you rise from it? How do you empower yourself to not be a victim, but to be a warrior from that experience.
Dara: You took the words out of my mouth. I was like victim-hood to survivor-hood. That's what it sounds like.
Joelle: Yeah. And you know, lately this last year, I've really been looking at this idea about survivor and I love these interchangeable words. Right? Right. And, and using this idea of warrior because even survivor tends to take away power, you know, it's, this thing happened to me and I survived it. And there's a little bit of loss of power with that when it's, this thing happened to me and maybe I didn't cause it, maybe I can't control it. I have no ability to shape the outcome and I survived it and warrior, I love because it just means that, you know, I've taken charge of it and that's post traumatic growth. Right. I've taken charge of this thing and yes, it absolutely shapes my narrative, but that doesn't necessarily have to be negative.
Rena: I love that. I love even putting a spin on, right? identifying as a survivor almost gives away a little bit of your power. And I think always the sentences that end in ‘to me’ are very victimizing, right? So I always encourage patients to reframe. When you say something is happening to me, you're giving all your power away to that situation. So how do we take the to me out of that sentence and instead of just, this is happening. And I think even that small change, there's such a difference.
Joelle: Yeah, exactly. Especially when we're talking about infertility and loss, right? These things are happening to me. And in so many ways, you know, I feel like I have no control and maybe even it is a situation where I have very little control. My body is doing what my body's doing. And in some ways I can't control the outcome of that. And so the, to me piece here, right, is the victimizing of it. And then, you know, working through it is I'm surviving this thing, but then it feels like it's still external. It's outside of me. Right? And so the radical acceptance piece of, you know, I am surviving this thing, I'm working through it. So I accept that it is, it doesn't mean I have to forgive or you have to forget, or even have to say that it's okay. Right? It's more about this thing is going on and I need to figure out how I continue tomorrow and then the next day, and then the next day, how am I going to make it through each day? And so that's that growth piece that I want to reframe for people.
Rena: Well, so what kind of other, you know, skills or tools, you know, someone that's feeling like, okay, I'm listening and now I recognize I sort of have this victim mentality. Help me flip a switch. What do you recommend?
Joelle: That’s such a great question, because I think it's holistic, right? It's mind, body, spirit. And so, you know, it's nutrition, it's sleep, it's exercise, it's mental health care, right? It's physical, you know, and medical care. It's all of these things that I think from a totality perspective, right, is what helps. And so, you know, right now there are so many things out there about grounding exercises. The, this 5, 4, 3, 2, 1. I know we had talked about it on the show. So, you know, now it's all over Instagram and tick tok and it's great because it's a super easy technique that people can use to help calm themselves, right? Calm their emotional side and their physical side. So some of it comes with being able to get out of the panic of, like you said, this is happening to me and it's making me feel very anxious. Right? And worried, panicked, all right - how can I take this and calm my mind down, calm my body down and just be with it, be present with it. So grounding exercises are great. There's all sorts of ones out there. There's everything from YouTube stuff that people can Google and find their Spotify playlist. So you can find a bunch of free stuff out there.
Dara: I find it it's, I'm happy you mentioned grounding cause that's something that I had only heard about it in the last couple of years when I started my own meditation practice and the idea of, you know, putting your feet to the earth, you know, whether it's the grass or the sand, it's a little harder in New York. And I wish there was, I wish they had something, I guess not synthetic grass. I wish they had something that can actually help people ground here. I guess you can go to the west side highway.
Rena: But I think it's also so many people come up with excuses, right? Like, like I can't do that because whatever this or that. And I only say, but it's really that's, what's within you. So the real trick for being present is to tune out all of this, right? Like I'm sitting here recording this podcast. My dog is scrambling around at my feet, whatever, but I'm being present in this moment. And so for grounding, it is working to tune that other stuff out and accept where you are and find it there.
Joelle: Yeah. And grounding can be anything from go outside for 30 seconds and just take a breath of fresh air. Right? You know, if your allergies are bothering you, I know New York has beautiful seasons. California does not. So, you know, but getting out and just smelling the flowers or looking at the trees and naming things that you see. Right? And, you know, I see, you know, beautiful leaves that are turning, right? And I see clouds in the sky and so I can feel that air, the cool air on my skin. So even that is being present and all of that is grounding. And then using the breath work of taking really big, deep belly breaths. And we know that three to five is the magic number and it seems so easy. And yet we don't do it, right? Cause we spend our life, you know, at our desk or whatever we're doing hunched over. Our shoulders are, you know, up in our ears and we're completely tense. And so sometimes just rolling your shoulders back, you know, relaxing your head a little bit and taking three big, deep breaths can be grounding. And that's all it takes.
Dara: It doesn't take a lot of time. I think that's what is quite overwhelming. I think a lot of people think that they need to commit so much time to something, but just like anything, it's a practice.
Joelle: Yeah.
Rena: Well, what do you say to the patient, you know, and I get this all the time. You know, I know obviously that the three of us believe in all of this stuff?We practice it on our own, but what do you get to the patient that's like this isn't working for me. I tried journaling. I tried breathing. I've tried this, like this sucks. It's not working. Give me something else. What do we say to a patient like that?
Joelle: I think I am that patient. I always joke and say, I'm the worst patient ever. They're like, Joelle read this thing. No. Hey, write, no. So I get it because I, that, that is me. A lot of the time, it, we don't want to look at what's painful. Right? So we do everything we possibly can to avoid what's painful. So sometimes it's, can you do this one thing, just this one thing for the next, you know, whatever it is, people typically see me weekly, right? So I say, Hey, can you try this one thing for seven days until I see you again? You know? And if it helps, cool keep doing it, if it makes it worse, don't do it, right? And if you don't like it, we'll find something else. So sometimes it's so overwhelming to say, Hey, I want you to start a meditation practice or I want you to try this grounding or, Hey, I want you to make this one change in your diet. People tend to, you know, have these huge responses because change is scary. You know, if I can predict the outcome, even if it's a negative one, I'm way more comfortable. Right? But if I have to deal with the unknown, that's terrifying because I don't know, actually know what's on the other side of that and so I don't want to do it. So I think making things that are small, changes, like I said, I want you to go outside, take three big deep breaths and come back in. And can you do that twice in the seven days between when I'm going to see you next? So I think sometimes it doesn't work because it's too big. And so if we break it down, then it's easy.
Dara: You made a great point. Joelle, I think like anything, sometimes it can be so overwhelming and may not be a realistic. I think for most people to start a meditation practice and, you know, expect someone to do it 20 minutes, twice a day, but making it, you know, something a little bit more approachable and achievable. And I think also having the person take ownership of what that is. So giving them the tools of these are some ideas perhaps to work towards. Which one to use seems the most realistic, given your environment and your situation?
Joelle: Right. And it could be as simple as you know, I love the sound of waves. And so it could be as simple as there's a lot of free apps out there - put waves on 30 minutes when you climb into bed and just think about being on the beach, right? So it could be something as simple as that to help just calm the nervous system down. It could be, you know, make yourself a cup of hot tea with a little bit of honey and that sometimes so changing the way that people and patients are approaching things when they're so in their head, getting them into their body helps start to recalibrate that fight flight freeze system. And if they're in their body, they're constantly, you know, they're so anxious, they're shaking or they tell you their heart races or they're sweaty, or they get nauseous. It's hard to keep food down. It's hard to eat. They overeat. Any of those kinds of physical symptoms, getting them in their head. Okay. Let's count backwards from 10, just from 10. Right? I want you to take a big deep breath and count 10, nine, take a breath. Eight. So sometimes even something as simple as that can help them be a little bit more approachable when you're right, things aren't working, everything is not working. Totally get it. Right. It's not working. So what can work? Right? What do you love? I love sunflowers. Great. Can we get sunflowers? Can you commit to buying yourself a sunflower once a week? Right? So I know it sounds trivial, but sometimes we have to start at the very beginning with people and then get the buy in that way.
Rena: Let's talk a little more about fight flight freeze also so that people can understand a little bit about what they might be feeling when that arises.
Joelle: Yeah. So the fight flight freeze is so some people lean into that, right? They have that fight mentality to get very angry or defensive. And so what we know about that is the body floods anytime you have the fight flight freeze response with over 30 different and 30 sounds like a big number, but 30 different stress hormones. We know the keys are adrenaline norepinepherine and even for women, it can be estrogen. And so the body floods with all of these hormones, and then we have a biochemical response. So for some people it's anger and so really asking, are you angry? Are you sad? Are you angry? Are you scared? Are you angry? Are you hungry? Are you angry? Because most people can't tell you that. They have an overwhelming response. They move into anger. It becomes their defense mechanism, right? The flight part is other people will run and they have this biochemical response to, I just need to get away. I need to shut down. I need to flee the situation. I don't want to engage. And so we hear people who say, I, you know, I'm really, non-confrontational, you know, anger makes me scared, tend to have that kind of fleeing or flight response. It's the same biochemistry. So that's, what's interesting about it. And then the third one is this idea of freeze where people - it's the deer in the headlights kind of, and what we call a dissociative response. People tend to freeze in their tracks. They can't speak. Some people will say, I feel like I'm watching myself. Like I'm in a movie. I'm having this out of body experience. And so what's hard to know is how somebody's going to respond that way. Because it's our biochemistry and we're pre-programmed to have a response. Typically people respond strongly in one of those three, but again, the chemistry is the same. So it's an interesting thing. And so when we talk about trauma and we're talking about people who are saying, I'm trying everything, right? Especially with, with patients who are coming in and they're so frustrated, they have a lot of body betrayal. My body's betraying me. I have no control over this. They're usually in some kind of what we say, hypo aroused state, where they're triggered. And so they're having these kinds of reactions. And so helping them kind of recalibrate. And that's where that grounding comes into play becomes important.
Rena: Well I think that’s a great segue also into the vicarious trauma.
Joelle: Yeah. Vicarious trauma, secondary trauma people might've heard about it in that sense is something that is happening. It may not be happening to me, but I'm observing it. So we see it with partners, with, you know, again with infertility, we see it with partners a lot where it's not my body, it's my partner's body. And so I'm living this experience, right? It's not necessarily happening to me, but it's happening in my world. And so it's the secondary trauma, you know, we see a lot with nurses have a lot of vicarious trauma. They're witnessing horrible things all the time and they have no control over it. The pandemic is another one, this global pandemic where we're inundated with the news every day. And so there's a lot of trauma out there
Dara: I never would have thought about that - secondary trauma - but it makes sense. And how do you work with people with regards to that it's using similar techniques in terms of grounding in terms of freezing?
Joelle: Yeah. So the treatment's the same, I think. And so really helping people identify and be able to define, right? Like I said, this is traumatic and I'm watching this thing unfold and I don't have any control over it. And so that's a huge component of this. And then how do we gain that control back? Right? Because that helplessness really sets in. You know, this thing is happening. I can't control it. I can't shape the outcomes. So the skill work is similar, right? That we would use, you know, cause again, trauma is, trauma is trauma. We can put it into all these different categories, but the body's going to react the same and the mind's going to react the same and the spirit reacts the same. So we use similar techniques and it's all skills-based stuff and therapy is also great.
Rena: Well, I think that's an important point. You know, something I often talk about with patients is about how their partner's experiencing this. Right? And it's no, you know, it's not their body that's going through it, but they're still experiencing a trauma and a loss. And I think that's something that's really important to explain to people how difficult it is to watch someone you love going through something so difficult and not be able to help or feel as though you're helping. And then we work on ways to help.
Joelle: Right. You know, so I'm sure, you know, when you work with a lot of reflective listening and communication skills and being able to learn how to dialogue between partners and be able to validate somebody's experience without being dismissive. And so it's difficult. And especially, I think when we talk about loss and we, again, we feel like we have no control over it, right? How do we hold that space for ourselves? And so much of it is loss, disappointment, anger, grief, that moral injury piece of, I don't understand. It doesn't make sense why this is happening to me. And then the partner sitting with that of, I don't know how to help this person. I don't know how to hold this space for this person because it's happening to me, too. And that feels dismissive sometimes, right? When I say this is happening to me, too. And the other person is saying, but it's not your body. Right? And so learning how to have these conversations where it's equally validating for both people. And so that they're on the same page and they're communicating with each other instead of against each other.
Dara: Yeah. And also, I mean, I can't believe I never thought of this before, but also the trauma for the nurses or for people working in that space. It's not something that I ever really kind of considered, but it is something that I'm sure a lot of us have had a tough time. And I think it's great that you brought that up.
Joelle: Yeah. I think especially for people in medical care and first responders are similar where you're trained to deal with this. Therapists are trained to deal with trauma. Right? And yet a person can only hear so much. Right? You can only observe so much before we start taking it on, you know? And so, you know, that comes in fatigue, burnout, feeling jaded, feeling like, oh, okay, it's this story again or it's this experience again. Or, you know, like, yeah, yeah, yeah. I've heard it all. Like, you know, as mental health professionals, as medical care professionals, we get into these mindsets where we've been doing this and doing this and doing this and we're exposed to so much, right? That's that vicarious trauma that we end up feeling jaded and disconnected or numb from it, you know? And so, having a mindfulness practice using the same skills, being grounded and having someone to talk to, even if it's just the other medical care staff, right? Having somebody to just have a conversation about this really sucks. You know, this is not, it was a hard day to day and I feel sorry for, you know, patient X and we don't usually have those conversations, you know, in our line of work and being able to have that support, to be able to say this was just a really awful day. And I just, I need some support around that.
Dara: For sure. That's an important discussion. I think that medical facilities should definitely have with their staff.
Rena: Absolutely. And what about traumatic loss? What's the difference between vicarious trauma and traumatic loss?
Joelle: Yeah. So vicarious traumas, typically anything that's observed it's secondary. So again, if it's something that I may be a part of, but it's not necessarily happening to me specifically. And you know, this idea of traumatic loss is something that happens, sometimes it's without any prior warning or knowledge, right? There's trauma around it. And so I think it's splitting hairs with the distinction, but traumatic loss, really, when I think about miscarriage and fertility and just the volume of losses for people, it's usually not a loss, it's multiple losses and you know, there's one after the other, after the other. And after awhile, the trauma of, oh my gosh, this is going to happen again, right? Starts to take over. And so it's not just the loss. Right now it's everything surrounding that. You know, now I have to tell my friends and family, now I have to, you know, there's so many things that go with it. You know, my partner's going to be disappointed. I have to hold a space for that. And so we start taking all of this stuff on and we pile that on, in addition to what we're already experiencing.
Rena: What are some tips for someone going through that to help them work through that?
Joelle: You know, I don't want to harp on therapy. I think therapy though is one thing that does help. You know, I think this is where support, having support. That's not just family and friends. Our family and friends are great, cause they're always going to have our back. They're always going to tell us everything we want to hear. And they're going to say things that are not helpful. I'm so sorry. You know, if I could take your place, I would, I've heard it all. And you know, with what my patients say to me and what they're being told, right? You're only given what you can handle and so on and so forth. And our family and friends are great. That's not helpful. And so finding support with other people that are going through the same thing, where they have that connection, I think is helpful. And then being able to talk about it, journaling, I know you mentioned journaling people, you know, have a love hate with journaling. And so it helps though. And sometimes that's hard for people it's like, oh, take a piece of paper and just write what? So I say, start with a letter, you know, who do you want to write to? And it can be an, I hate you letter because sometimes just the cathartic process of getting it out there. This is not something that we're going to send to anybody. I suggest if you have a shredder, shred it, put it in the fireplace as the winter's coming. Right. But sometimes getting it out and getting some movement around it makes it feel less painful. We want to run from the pain. It hurts so much that we don't want to deal. And it's counterintuitive to say, Hey, lean into it a little bit, just a little bit at a time. Feel it just a little bit more, just a little bit more because it will dissolve that doesn't mean that the loss will be gone. The pain around it will be less with coping. So journaling for this one is a really great technique.
Dara: You made a good point - the idea of feeling it, which I think is a tough one. I think an easy way is to deflect or push things in and down, which often can manifest elsewhere or, you know, or, you know, can build up and, you know, be extra challenging down the road. But I think just the idea, the notion of feeling it, even the yuckiness can be, you know, the starting path to healing.
Joelle: Yeah. And we don't want, I mean, I don't want to, like, that sounds terrible. Right? And especially if I'm grieving and I'm hurting so much so, why would I want to feel it even more? So it's being able to set the timer and just say, okay, do this for two minutes. Right? And then you don't have to think about it anymore today. So sometimes it's really taking that overwhelmed and scaling it back for people and saying, okay, just do this a little teeny tiny bit. Right? And not that it's going to be okay because it's not going to be okay. Right? But what it will do is it'll help you be able to sit with it. Right? It'll help the heart heal a little bit more. Right? I don't think with traumatic loss things become okay. And that's the whole point of post-traumatic growth, right? Is that, it's not that it's okay. It's that the narrative changes, which is I went through this thing or I went through these things and they were horrific. Right? And I survived and I'm okay. Right? But it shaped who I am and I have a different outlook now. Right? And things, this can be a way for me to find meaning and importance in other areas of my life. Right? And so it starts to change the way that we show up in the world, you know? And so a lot of things that help, right? And I'm just looking at my notes, forgive me. But things like safety and choice, right? Having choice. I choose to do this again. Right? Especially women who are going through, you know, pregnancy loss and choosing to go through treatment. Right? Being able to just say that and have that ownership of this was terrible. Right? And I'm choosing to do it again because it's important to me starts to take back some of that power. I could choose not to do it.
Rena: I love that so much that I choose. Definitely something I always do with patients and help them come up with action sentences. I love that you brought that up. I love that point.
Joelle: Yeah. So that's the empowerment piece as medical professionals, right. Being collaborative, right. Dara, you were talking about that, you know, it's like, okay, what can we do? And you have some ownership, so what can you do? Right? What do you want to do? How do you want to work through this? And I'll tell you, some of my clients say, I just want to have a pity party. And I'm like right on, me too. So here's what I do. I give myself 30 minutes. It's like, all right, you know, fine. Don't get out of bed. Feel sorry for yourself, pull the covers over your head, have a pity party, go for it. You got 30 minutes. Get it all out. And by the time I'm five minutes into it I usually I'm like, all right, this is ridiculous. Just get up, get up and go do something. And so sometimes just giving ourselves permission to feel sorry for ourselves is cathartic. We don't allow ourselves to lean into that because we're supposed to be perfect. Right? And perfection is a trauma response. So the more trauma I experience, the more perfect I need to be the next time, because if I'm perfect, it won't happen again. And it's such a misconception. And so part of the growth part is, okay, what if you weren't perfect? What would happen? Right. If you weren't perfect.
Rena: I love that. I know something that Dara and I always say, is it's progress, not perfection.
Joelle: And this idea of being perfectly imperfect. So another thing that helps is giving people mantras. As a retired ballerina and career perfectionist, I give myself permission to make a minimum of three mistakes a day. I make way more than that, but I'm like, all right, if I shoot for three, I can at least manage the anxiety I get from not being perfect all the time. And so things like that where we can help our clients and our patients start to chip away at some of these things that they're holding onto. So tightly, because it feels like that helps with the pain, right. It feels like I can handle it if I just hold onto it tighter. Right? And in reality, that doesn't help.
Dara: Letting go. Rena and I have that discussion a lot about just the simple act of letting go. And I love that you, you know, giving permission to scream, giving permission to, to whine and complain and to do what you need to do and the grace to not be perfect.
Joelle: And then also I think knowing what's retraumatizing, right? And so that's the difference with traumatic loss versus something different is traumatic loss usually has a retraumatizing component. So when we think about miscarriage, right, and multiple miscarriages, that's traumatic loss. And every time that I go through this again, right, it's retraumatizing me all over. So maybe I got through the growth, the traumatic growth piece, and I'm feeling better and I'm encouraged and I'm hopeful and I've done my therapy and I'm doing my grounding and I'm following, you know, Dara’s advice with, right? And then this thing happens again. And so how do I work through that when I can scream and yell and carry on and have a pity party all day long, and it's not going to change. It's not going to change anything. It's not going to make me feel better. So that's this idea of that warrior part. I love the way you said that earlier, Rena, is all right, how do we fight it? How are we willing to take this and move with it? Because letting go, in some ways it has this misconception of, if I let it go, then it means I'm forgetting. And I don't want to forget. And as much as it hurts, you know, patients will say, I don't ever want to forget this. This is important to me. So letting go doesn't mean forgetting. And it doesn't also mean forgiving, right? It means not being tied to it. So it's holding you down in the past all the time. Right?
Dara: Such a good point
Rena: A great point, especially for those that have had a loss, you know, and then feel guilty or disloyal, you know, moving forward. How do I honor, you know, what was while I'm still trying to achieve my dream? I think that can often cause a lot of angst and anxiety for people. So I love that you brought that point up
Joelle: And different people, you know, different people hold this traumatic loss and miscarriage differently. And so a lot of times I'm asking and that's that spirit piece, right? It doesn't necessarily have to be grounded in religion for some people it is, for others, it's not. And so it's finding out for them, you know, how do you need to remember this? What do you need to do to honor this experience and move forward from it? And again, not forgetting, it'll always be a part of you. So how do we help you move through that spiritual part where we talk about moral injury. There's a hole in my soul that's never going to be filled. And so how do I heal from that knowing that I'm always going to have this part of me? Right? And that's when people talk about feeling broken. They'll say, I feel broken. I feel defective. I feel incompetent. Right? Incapable. And so that's the moral injury piece of, I get that. I absolutely get that. And what would happen if you woke up tomorrow and you didn't feel that way, you couldn't change it, couldn't change it, it still exists for you. What would happen tomorrow? If you didn't feel that way, or if you could move forward, what would life look like? So sometimes playing that what if game is helpful. It's solution focused therapy. If I had a magic wand and I couldn't change anything other than your reaction tomorrow, and you woke up and you felt differently, what would you feel like?
Dara: Is that like mind manifesting, like seeing yourself where you want to be?
Joelle: A little bit. Yeah.
Rena: I love that. I think that's super powerful and a great, great tool. I think, you know, I suggest that to patients a lot. And then of course you get the ones that say, well, I can't do it. There's a block. I can't, what does that mean? You know? So what do we say to somebody like that?
Joelle: Yeah. I think when patients are saying that to me, I always will respond with a question and I know always is a big word, but I always respond with a question, which is, are you hurting right now? And I always get, yes. Okay. Right? Where? Can you show them? You know, and a lot of times I have my hand on my chest. Right. And it helps me ground as a clinician because it hurts when people are in that much pain, hurts your heart. That's the empathy piece. And so it's like, this hurts me in my heart. Is this hurting you in your heart? If it hurts me this much, I'm wondering how much it's hurting for you. Right? Are you in pain? Where in your body do you feel it? You know, and a lot of times people say I don't, I feel numb and just feel numb. I'm blocked. I feel numb. I can't think of anything. I'm angry all the time. I just wish I didn't, you know, I didn't have to deal with this. So let's start there. You know, is there anything that you can think of that would make you feel better and you're probably going to get no. So where do we start? Right? And not so much. Oh, well, okay. I guess there's nothing we can do about it, right? It's like, yeah, this block is real. This is not somebody being disgruntled. This is a real thing. So if we could take it away, 10% of it away, you know, how do you think that would feel? Do you think it would be easier to get up tomorrow? No. Okay. Let's talk about what that would look like. So it's really working with that resistance because the resistance is fear. And so sometimes the fear manifests as block and sometimes it manifests as anger. And usually with the clients that I see it's anger. So the more I push on, tell me how you feel about these things. The more angry they get with me. And it's like, all right, well, let's work with that, right? Like, I can handle you being mad at me. That's not a problem. And sometimes just giving them the permission to just get it out, just get it out. You want to scream at me, scream at me. We can't do that without my permission. Right? But in a therapy setting or in a patient setting, sometimes it's just, what do you need right now? And how can I help
Rena: It’s about meeting someone where they’re at.
Joelle: Because the more we push them and say, no, no, you're not blocked. Oh no, it's so easy. Oh, just do this one thing. They're going to be more resistant. And then they feel not only now, do they feel guilty, but now they feel ashamed, right? Or completely invalidated. Like this is a big deal to me. And you don't think it well, whoa, whoa, whoa, hold on for a second. Right? Like that's not what I want my clients to feel
Dara: They want to feel heard. People want to feel heard and validated.
Joelle: Exactly. Yeah. And it isn't fair. Right? Like there's nothing fair about this. I hear that so often. This isn't fair and you're absolutely right. It's not, it's not fair, right? No, it's the and so what not and so who cares? And so what, it's not important. You're right. It is not fair. And so what, so what can we do together to help move forward?
Dara: That's amazing. I wish I met with you when I was going through my fertility struggle. I really, you know, the more and more I learn about therapy, just realize how powerful it can be to get that support, to have the tools and to learn about the tools and be able to move forward and work through traumas, however big or small.
Rena: This was wonderful. I think, thank you so much. I think so many amazing points for our listeners and patients that really will hit home and resonate with people and give some real concrete things to do. Thank you so much for sharing your wisdom with all of us.
Joelle: My pleasure. Thanks for having me
Dara: So, Joelle, you probably know this by now, but we end our sessions with gratitude. So what are you grateful for today?
Joelle: Oh my gosh. You know, I love this question because I always deer in the headlights as my freeze response. I am grateful. I have an amazing family and I'm very blessed with two adult children now, which is interesting with my own struggles so many years ago. And just to be here. I think in this pandemic just to be here and have this conversation and every day, you know, I get up and I'm like, all right, what's it going to be today? Cause it's not easy. Life right now is hard. And so I'm grateful to just be able to be here. So thank you for asking.
Dara: That's beautiful. Rena?
Rena: I’m going to piggyback off that and it kind of circles back to the beginning of our conversation about grounding and just being where we are. I'm also grateful to just be. I was having a conversation with a friend of mine the other day about traveling. And this friend was basically saying that, you know, they were traveling to escape. And I had this moment where I felt really grateful because I used to do that. And I remember I would come home from trips and I would cry because I didn't want to come back to my life. But that has really changed for me in the past few years. And I love traveling, but now I'm also so grateful to come home and be in my life how it is, which is huge. And it really, I was so grateful for that realization the other day.
Dara: I'm grateful for spending time by myself. I think it's, we got a lot of that, of course, during quarantine COVID all that time. But now getting back into the swing of things. So I do cherish those moments when I still get to be by myself and be with my thoughts and also read, I feel like for me, a big part of my healing process is reading and I'm, I've read it before, but I'm reading it again, the four agreements and it's like, oh, it's calling to me. And it's, it's so simple yet so complex. And you know, when you read something and you can really connect to it and it can really help you grow. So I'm grateful for that.
Rena: Oh, I love that. I feel like I always said you could start a book club because you suggest the best books to me.
Dara: This one’s a good one. It's an oldie, but a goodie.
Joelle: It's by far one of my favorites.
Rena: Well, I'll suggest too for our listeners that are tuning into this episode, one that Dara told me about letting go by David Hawkins, one of my favorite books of all time. And I think for this crowd might resonate. And then also the Alchemist. Fantastic! Love, love that. You know, so much it's about being present and achieving your personal legend. I think those are fantastic books for this crowd.
Dara: Totally. Well, thanks again so much for being here. We're so grateful for you to share your knowledge and your wisdom, and we hope to have you back on soon.
Joelle: Thanks. Thanks again. I would love to.
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 at fertility_forward and if you're looking for more support, visit us at and tune in next week for more Fertility Forward.

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