Tag: grief

The Desperate Pain of Miscarriage, and What You Can Do About It.

The Desperate Pain of Miscarriage

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This is a topic that has been near to my heart for the past 6 years. I felt nudged to be transparent and write about this experience as I’m walking through the devastation of miscarriage this week. In her Daring Way curriculum, Dr. Brene Brown defines vulnerability as risk, emotional exposure, and uncertainty.  I work with most clients around vulnerabiity and what it looks like, so I’ve decided to be vulnerable around this experience. I specialize in miscarriage, fetal loss, infertility, and cancer in my therapy practice, yet I find all of my own words of soothing going out the window now that it’s me. I’ve put together the six most profound facets of pain below, and what you CAN say or do to help someone through intense pain.

Our story has been full of pain, apprehension and joy. Our first pregnancy ended in miscarriage and D&C, and that experience is what prompted me to quit nursing school and apply for the master’s program in marriage and family therapy (which I completed in June 2012). It was intensely painful and disheartening, even though I had great support all around me. We did have a successful pregnancy (through in vitro fertilization) and had Nora who is 4 ½. Anna, who is 2 ½, was a spontaneous pregnancy. Both pregnancies were hard on me with nausea and Anna dislocated my sacrum, but they are definitely little miracles. As we found out were spontaneously pregnant again in May of this year, I hit an emotional rollercoaster of fear, apprehension of a tough pregnancy, and planning for the life adjustment of going from two little ones to three. We had an ultrasound last week that showed the flutter of the heartbeat but showed the baby as smaller than it should be. This week, at nine weeks, there was no longer a heartbeat. I had a D&C and we are all grieving and healing at this point.

I’ve tried to distill the thoughts and feelings into six forms of pain that I’ve experienced in this second miscarriage:

1.  Crushing

As I lay on the ultrasound table, oblivious to the idea that this may not actually come to fruition, my heart felt crushed when she said there was no heartbeat. My face got hot, the tears were immediate, and my heart felt as though someone put it in a vice and squeezed. The walls were closing in, and I looked at my husband’s face and could see his broken heart. All death is painful, please hear that. I had feared miscarriage, but after we saw the flicker of a beating heart, we were disarmed and excited. I’d told my four- year-old, so we’re navigating how to explain this news. Her first words after the news was, “but I’d already named my new baby sister and wanted to play with her!” She is sad, yet resilient, as she doesn’t understand exactly what is happening.

I cried as they started my IV, I cried when they discussed the procedure, and I cried as they transferred me to an operating table. The anesthesiologist was kind and gentle and said “let’s just go ahead and get the sedation started,” as the nurse wiped my tears and he put the mask on my face.

2. Confusing

Immediately, and for the next few days, these thoughts were relentless: “but, we had a heartbeat last week! This wasn’t supposed to happen! We were NOT prepared for this!” (and as we know, you can’t really prepare for a loss such as this). Although I counsel people on miscarriage and tell them they did not cause this, my automatic thoughts were, “I’ve screwed up. I did this somehow. I didn’t want it enough or I didn’t protect it enough.” For me, this pregnancy was confusing from the beginning. The pregnancy was a surprise, and while I felt conflicted about it, I was excited for a third child. I struggled the most with the idea of being pregnant again as I’d had rough pregnancies, but I had already envisioned my life moving forward with a third baby in the picture. I’d become pretty excited about it, and was thankful for the blessing of the surprise pregnancy! It took me a few weeks to get there, but I had arrived in the land of excitement. I was there quietly, because it still felt vulnerable to express these emotions to others. Once I saw the heart flutter, I felt that connection that says, “ok lady. You can do this. You’ve created another life!”

Glennon Doyle Melton says that pain is traveling professor, and right now that confuses me because I don’t know what I’m supposed to be learning. I trust that some insight will come, and I know this will help me a better therapist in some way, but that part is confusing as well.

3. Private

As I write about this, I’ve had a few days of distance from the shock and a little distance from the procedure. I felt this the first time around as well… the need for privacy. This may be simply because I’m an introvert, but I wanted to hide and not talk about it! I didn’t want to make the calls I needed to make and tell the important people. I didn’t want to tell the story, I didn’t want to cry with anyone, I didn’t want anyone to ask me questions. So, I didn’t. In a moment of self-compassion, I decided to put together a text, which I began with apologizing for giving the news in a text, and sent the news and details to family and close friends. That was the best thing I did for myself in the moment, as I needed to be alone with my husband and kids, and be free to weep, grieve, and process.

4. Overwhelming and Intrusive

This is a normal part of grief, I know. The metaphor I use with my clients goes like this: Grief begins as days and weeks of tsunamis. Regardless of your preparation and the things that anchor you, a grief tsunami will brutally suck you out to sea and out of your safety zone. You will spend time paddling like crazy to get back to shore, back to your people, back to your animals, back to your security. Soon, and unpredictably, it will happen again, over and over. Fortunately the waves lessen in ferocity and your paddling skills improve, and eventually you find yourself doused by the water but being forced from your safe zone. The best way to deal with the tsunami is to know it will happen, allow it to happen, and figure out your paddling strategies, as you have no control over how incredible and intense the grief tsunami will be.  We are surrounded by things, pictures, people and places that trigger our memories and grief and our brains process information much faster than we are cognitively aware of. You may find yourself being crushed by the metaphorical tsunami and not realize it, until you realize you were in a place where you once had a special moment with your mom, or you saw someone wearing a shirt like the one your husband used to love. For me it is any news of death as I realize that death has occurred in my body, and pulling the maternity clothes out of my closet. The day of the bad news, I received a package in the mail of some maternity jeans I had bought, and the tsunami arrived. We survive the tsunamis by letting them happen, not shutting the emotion off, and trusting that we will get back to shore.

5.  Discouraging

All grief is special and looks different.  Just like cancer or other major illnesses, miscarriage is especially discouraging and disheartening because you begin to not trust what your body can do or not do. You wonder if you’re capable of a successful pregnancy, and question if you even want to go through this again. I recall this vividly with my first, and although I have had two perfect children in between, I am discouraged about any future pregnancies. I’m discouraged in my ability to carry a pregnancy, in the emotional and physical pain associated with fetal death, and in my own stamina.

6. Connective and Loving Pain

The connection began as soon as I showed him the pregnancy tests, and as I was in a bit of a panic! I was terrified of this process, whether miscarriage or successful pregnancy, as the two babies I have were incredibly hard to carry. He took the news with ease and gentle excitement, and said, “I can’t wait to pamper the crap out of you. We can do this.” His exuberance disarmed my fear day after day. As I spent most evenings hunched over the toilet with sickness, he offered me a stool, a Zofran, a mint to help the nausea. He poured me 7-up. He cared for the kids when I couldn’t move because I felt so nauseated.

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And later, as we sat in the ultrasound room together this week, and later in a private room waiting for a doctor, we cried. He reached to me and held me, and he offered no consoling words as he knew there weren’t any. He just reached across the hurt and held me close. The acknowledgement and realization that our relationship has grown to this place of hurting together and just letting sad take over for a while is incredibly connecting. While seeing the hurt in his eyes was awful, it was also strangely comforting to not be alone in this. He got up at 5am and loaded up the kids with no complaint as we went in for the D&C, he held my hand and wiped my tears as they talked to me about anesthesia, what to anticipate, and started the IV. I watched him love on the girls and support Nora as she questioned why we aren’t having a baby now and what that means. He has been waking me up every four hours for the pain medicine to help me feel as little physical pain as possible.

We have talked a little about this, about the surprise and how we were just not expecting this, but most of all the love has done the talking. I am completely humbled and deeply comforted by his capacity to be the leader and to love me through these devastating times. I know I am fortunate, I know many don’t get the support they need in pain or grief. “Love is not a victory march… it’s a cold and broken hallelujah.” (Leonard Cohen).

Aside from Dave, I have some supportive family and friends. I received a beautiful bouquet of flowers from a bestie, a Startbucks gift card from a sister, and multiple texts of love and support.

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Anyone can play this role for you, it doesn’t have to be a partner. It can be a friend, a mom, a brother, a mentor. This is often one of those places where loved ones want to offer support and don’t know what to say or do.

Here is a short list of what HAS been helpful for anyone walking through this with a loved one:

  1. I’m so sorry you’re experiencing this. Is there any way I can be helpful?
  2. I’m sure this is overwhelming and confusing, and I can’t even imagine. What are you feeling right now?
  3. Can I feed your family? I’d love to bring pizza or cook for you.
  4. It’s okay to feel sad, confused, and just generally not okay. You will be okay again, someday, and I’m available to talk in the meantime.
  5. From Dave: I’ll love you through this.

Go out, love on someone. Sit with them in their grief and understand that pain is important. It is profound, pervasive, uncontrollable, and is not something to be rushed.

–Caylen

From The Therapist’s Chair: HOW TO BE AN AMAZING LISTENER!

LISTENING FOR CONNECTION

 

Recently in my private practice, a client and I were preparing for her to “graduate therapy.”  We were discussing her growth, articulating what she has learned, and reflecting on the identity work she had done.  She said, “what has helped me so much is simply the experience of being “heard,” and feeling that what I’m saying really does matter.  I want to be a better listener.  I want to listen like therapists listen, and learn to empathize with accuracy.”  I teach this to my graduate students early in their therapy training: that the solid foundation of a client/therapist relationship begins with simply “holding space” for a client, truly listening, being present, validating, and empathizing. However, clinicians train intensely in those skills for years before they come naturally.

There are different listening situations in which we can find ourselves unsure how to maneuver.  Do we really understand when someone is asking for advice versus when they want to share a story?  Can we tell if they are upset and need for us to fix the situation, or if they’re venting?  Oftentimes, people can not tell the differences, and the listener is only partly to blame.  The speaker doesn’t always know what is motivating them to communicate and this can go downhill quickly.  True conversation and connection is the best way to enrich your relationships.  In his book, “Lost Connections,” Johann Hari suggests that depression and anxiety are both symptoms that stem from the same problem: deep disconnection with those around us.  He suggests we’ve lost the art of having each other’s backs, creating a culture of surface communication and deep loneliness.  We have to appreciate all of what communication entails, because discussing the hard stuff is just as essential as the belly laughs.  Presence in hard conversations is what communicates, “you matter to me.”  A good listener can demonstrate deep caring and appreciation without saying the “right thing,” or anything at all!


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FIVE TIPS FOR LISTENING AND CONNECTION

1. Take a deep breath.

When someone is laying out a disturbing situation, we get anxious! Our heart races, our face gets warm, and we are freaking out and thinking, “I have no idea what to say here.” Most of us want to fix this for our friend, and we are unable to do so. The anxiety grows and then takes over our mouth, and we begin speaking loads of what I like to call WORD VOMIT! “God has a plan! Everything happens for a reason! You have to stay positive! Refuse to hear that kind of news! Drink this tea and take these herbs, I heard they cure cancer!” (hint: not a single one of these statements is helpful to someone in distress).  As Brene Brown says, “rarely does a response make a situation better. What makes it better is connection.”

It is important to understand that word vomit comes from a good place. The listener is trying to take a big story and make it manageable. However, they’re only making it manageable for themselves. The speaking partner isn’t benefitting. So when you find yourself in a conversation like this, relax, take some deep breaths, realize this is about connection and not at all about fixing!

2. Consider NOT speaking.

When you feel overwhelmed and unsure what to say, don’t say anything! If someone is delivering news of a partner’s affair and the devastation left in the wake, I suggest you try to simply check in with, “hey. I’m here with you. Tell me more.” A few years ago I attended training with about 20 other therapists where we learned more about emotions focused therapy. One of our activities was to pair up, choose a traumatic story to tell, and tell the story for ten minutes while our partner sat and listened. The listening therapist was to not say anything. In this exercise, I realized two things: 1. I actually tune out the person speaking when I’m already thinking about what I want to say in response, and 2. it is possible to encourage someone and support them with your eyes, facial expression, and nods. You can encourage someone with just your eyes, and signal to them to keep going!  As I kept quiet, my partner kept talking because I wasn’t stopping to ask questions or expand on something.  Because I didn’t interrupt, she was able to follow her thought process and expand more upon the situation, and finished the story with more insight.

We have our graduate students video themselves in their internships.  They are providing real therapy for about 16 months, beginning only 8 months after they begin their training, and are required to take video of themselves in every session.  We know they’ll to be anxious, we don’t expect that they’ll know what to do or say, and we haven’t taught them much theory yet (which informs what therapists do and say).  We DO expect them to learn how their own anxiety can derail a conversation.  We expect they’ll notice when they’re talking, but have lost their client.  We challenge them to sit in quiet, in their anxiety, and be more silent.  It’s easy to talk freely.  It is very difficult to sit in silence and trust that the pregnant pause will allow deeper connection and trust to be birthed.

When people step into our story by responding or giving feedback, we feel like we have to adjust it (speed it up, make sense of it, explain the back story, etcetera).  But when they sit with us in our story, let us know we’re loved and safe, we can speak freely.  We may continue the story past the usually cut off point, we may talk about the impact of the situation, we may talk about future fears, and even what we need from other people… if someone just lets us talk.

3. Do not try to make it safe or simple!

In my office, I teach people how to “sit with” the uncomfortable, scary, and awkward. We affectionately call it the USA. Most of us have not been trained to hear hard things without taking over the discussion with platitudes. When we hear, “I have cancer,” we immediately work to make the person stronger and help them to feel safer, or at least we think we do. We hope we are making it better, but in fact, we are creating distance and likely causing the other person to feel isolated because they don’t feel as motivated as we do. I’ve heard a person with breast cancer discuss her experience in telling her family. “Breast cancer? Oh that’s nothing these days. They’ll cut those things off and you’ll be good as new. You’ll be fine.” This person was appalled because in reality, it is a brutal and lengthy process of chemo, surgery, radiation, and eventually reconstruction. She knew what she was in for, and when a family member minimized to that level, she immediately chose to no longer be honest with this person.

We simplify the complex and painful situations to make ourselves feel better, and don’t even realize how powerful that motivation is.  So many have “fixer” or “helper” deeply embedded in their identity and don’t like to feel helpless, so they move in to “fix.”  There is a devastating effect to this: through good intentions of improving mood or morale, we may be actually insinuating that a complex situation is simple, and the person *just* needs to think differently, make a simple change, see a different doctor, etc.  We must respect that most human problems are actually very complex and that most people have tried to solve them.  Cancer, divorce, job loss, depression….  none of it is simple.  None of it can be fixed with a response.  The most valuable response we can offer is when we learn to NOT try to fix or help, but to respond meaningfully and with genuine care and concern.  

4. Keep the focus of the conversation on THEM!

How many times has the following scenario played out for you in some manner:

Person 1: I rear-ended someone last night, it was terrifying! I’m a mess today and can’t believe I wasn’t paying attention and let that happen.

Person 2: Oh my gosh. I know what you mean. Don’t you remember when I did that in college?   I was driving home from class and was on the phone, and I totally didn’t realize traffic had stopped. I looked up and my heart literally stopped! I hit the car so hard my airbags blew and …. blah blah blah.

You get the idea. If you find yourself telling a story, you’ve taken over the conversation and it’s likely your partner is feeling unheard and uncared for. They are sharing something with you and need for you to lean in to their experience, not educate them or tell them your experience. We often turn into experts when someone shares something with us, and most of the time, this is not what they need! If you hear yourself ME TOO-ing or ONE UP-ing, slow down and come back with a question to focus on your friend’s experience. They don’t want an expert or to hear about your cousin’s neighbor’s wife and her experience with miscarriage. They want for you to hear their experience about miscarriage.

5. Choose your words carefully.

If our conversation partner is about to share some heavy news, they are already watching us and scanning to make sure we are a safe person. They’ve decided we’ve earned the right to hear their story, so they divulge. This is a privilege! It is an honor to be let into someone’s pain. It means that we are a safe and special person to be asked into the grief or intensity of one’s life. The best words are those that are reflective, connective, and/or encourage them to keep talking. Here are some of my go-tos:

  • What is this like for you?
    • With this, you’re not assuming how they feel. You’re asking, and allowing them to express possible ambiguity instead of showering them with our own experience, or our guess at their experience.
  • How do we feel about this?
    • This is one of my favorites! This was once said to me by a friend when I told her I was pregnant. She asked me, “and how do we feel about this?” It was so impactful because she said WE, and I immediately felt like she was in it with me. She also asked instead of assumed, and the truth was that I was really struggling. I was really sick, and having a miserable time, and still trying to wrap my head around it. Her response gave me space to express the frustration and the fears, and she listened.
  • Tell me more.
    • This is vague and open-ended, and one may begin unpacking some serious emotional baggage with this simple question. They may respond with, “about what, specifically?” To which I reply, “whatever is weighing on your heart.” Give them permission to keep talking, unpacking, and expressing.
  • I don’t even know what to say right now, I’m just so glad you told me.
    • This is from RSA short animation that was created around Brene Brown’s TED talk. It discusses sympathy vs. empathy, and this is a line she uses. I love it because it says, “I can handle my anxiety so keep talking because you matter to me.”  If you  haven’t watched it, it’s a must see. You’ll find it here.

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What I hope you can understand is this: the true blessing in friendship is when someone sits with us in our pain and allows us to feel it.  They understand that pain is part of life, and it can not and should not be minimized or distracted from.  Anything that distracts from pain or grief can COMPLICATE it.  You see, the real blessing is when someone gives you space and love from their heart, as opposed to their advice, their stories, or their platitudes.

Go forth and love on each other!