99 - Dr. Jelena Kecmanovic-Using Acceptance and Commitment Therapy to Heal Grief and Loss.mp3 - powered by Happy Scribe

Ruthless Compassion is a podcast about people who've turned their emotional shit into fertilizer for success. It's about seeing our darkest moments and opportunities for growth and transformation.

Dr. Jelena Kecmanovic, Aka Dr. K, is a clinical psychologist, the founding director of the Arlington/DC Behavior Therapy Institute and an adjunct professor at Georgetown University. She is a cognitive behavioral therapy expert with over 25 years of experience as a therapist, teacher, mentor, researcher, author and presenter. Dr. K a frequent contributor to The Washington Post, and her work also has appeared in the Chicago Tribune, Business Insider and Salon, among others. She also writes a Psychology Today blog from Science to Practice and has been quoted and interviewed widely, from The New York Times to NPR.

Welcome Jelena Kecmanovic to the Ruthless Compassion Podcast.

Thank you so much for having me.

Well, it's really a pleasure to have you. We always like to start by having the guests say a little bit about who they are and what they do. So why don't you go ahead with that?

Thank you. So I'm a clinical psychologist and I have a group private practice that I'm founder of in the Washington, DC area. There are 15 of us psychologists working there, and we work with basically kids from ten years old to adults in their 70s or even 80s. So the whole range of human experience. And we work with people who are struggling with depression, with anxiety, with OCD, with grief, with PTSD, those kinds of problems. And as you can imagine in the last two years now, coming up in two years, I would say that we have been more inundated in the last two years with clients and patients than in my 20 years of practicing.

So it's been really difficult times. I also teach part time as an adjunct professor at Georgetown University. In my past life, I was a full time professor, and I switched then and decided I'm going to go into practice because I felt that it's a more immediate impact on the humanity and doing that than doing research behind the walls of academia. But I still do teach part time. And then I write quite a bit for General public for Washington Post and other publications. So thank you so much for having me on the show.

Well, I'm glad you could find some time with your schedule and all the things that you do. Wow. Well, the first thing that I wanted to talk to you about is that you practice a lot of cognitive behavioral therapy, correct. Yes. So obviously you're working with helping people change the way they think about things, their attitude, the way they approach things. So how has these crazy times, how do they fit together?

Very good question. So, yes, we practice under the umbrella. I would say the Cognitive Behavioral therapy, or CBT, is almost an umbrella term of many different therapies that kind of fall under that umbrella. And all of us are under that umbrella and different practitioners within a practice more closely aligned with, I would say, maybe a subtype of CBT. So my subtype. That's kind of my core in how I understand human functioning and how I approach treatment is something called Acceptance and Commitment therapy, or act, which is a subtype of CBT.

And I feel that act has been particularly well suited for the crazy times that we've been going through, because in act, we talk a lot about what needs to be accepted and what we can change and sort of, broadly speaking, we talk about recognizing what's going on in the world and reality and not living in denial very much recognizing what are the needs of the reality that reality is putting on us and then recognizing that we're going to have different emotional reactions to what we're facing day to day life.

So during the last two years, people were feeling more negative emotions, the sadness, depression, all kinds of grief, anger, a lot of anger, a lot of irritability, a lot of languishing. And so we don't really have direct impact on how we feel. And I sometimes will say pirate and jest when I work with clients, if we could just snap our finger and tell ourselves, don't feel sad, don't feel down, don't feel depressed, then I wouldn't have my job, right? So we don't have direct impact on the emotions.

We have some impact in how we think about emotions and what's happening to us, and that's where we get in and do our work. And we have most impact on our behaviors, our actions. So act really focuses on clarifying what your values are in life, what your values are in different domains of life. So there's a lot of clarification of values. I ask you, are you living according to your values? Are you behaving? Are you acting day to day, hour upon hour based on those values?

And if there are gaps in how you would want to show up in the world, who you want to be in the world, what do you want to stand for in the world? Those are values and how you actually act. Then we look at those gaps and we're looking at what stands in a way and what usually stands in the way of these unwanted negative thoughts and feelings. And then we basically work on both accepting the feelings, recognizing, acknowledging, naming, expressing productively. So as we say, name to tame feelings.

And so lot of emotional regulations. But the foundation is really recognizing having emotional intelligence and accepting those feelings so that you are not a hostage to those feelings that you can actually recognize them, allow them, accept them and end up behaving according to your values. As for thoughts, we work on mindsets that get in the way that gets people really stuck in certain unhelpful ways of thinking. And we try to kind of loosen them up a little bit and see if they are more productive ways of thinking.

And also in some situations, if our mind is so stuck on something, the best way we can do is just observe it and not get caught up in it. Just observe it like leaves on the street or clouds in the sky and so not get kind of completely caught up in our mind but be able to stand back a little bit and observe what's going on. So that again, we have this freedom day to day to act according to evaluates. And I think in the last year, this has come very handy because a lot of distressed people were feeling it was not result necessarily of their dysfunctional thinking or maladaptive thinking or unproductive thinking or unhelpful thinking.

It was a result of a lot of really difficult situations. People were facing a lot of stress, a lot of uncertainty, a lot of losses of all kinds. And so bringing people back to who you want to be in the world, even in this really messed up difficult world. And what you can do even a little bit, just a little bit each day to show up the way you want to show up. That really I felt gave people comfort.

I can imagine as you were talking, I was thinking about how I was speaking to another guest a few weeks ago and Dr. Robert Barrett, and he was talking about how the rates of depression in young adults is close to 25% since the pandemic. And that's astronomical. The suicide rates are going through the roof and drug use is going through the roof. And these poor, vulnerable young people are really suffering. And I just feel like everything that we can bring to help is so needed these days, right?

Yeah. Absolutely. I have found surveys that are starting to emerge support. My observation is that the young have suffered the most children, adolescents and young adults. Absolutely. Everybody has been affected. And there are some other vulnerable groups poor with young children where porn children basically didn't go to school for almost three semesters. And then in people of color and there were other vulnerable groups. But generally speaking, it's basically kids from middle school up to I still call them kids young adults to late 20s. And we see a lot of young adults, a lot of teens and they have suffered the most.

And I can tell you that this semester now, where they've been back in school, they've been back in College is bringing new kinds of challenges because they're kind of entering the social world after having been at home, basically in isolated for so long and the flood is still going on. Basically, it's been really hard because I think the mental trajectories have been so interrupted and they've been forced to basically be stuck with parents at home and not exercise that adult like behavior in the world, what teenagers and printers and teenagers and young adults really need and what they thrive on the wings have been cut off, basically.

And they're struggling mightily. I mean, social anxiety is rampant. Depression is rampant. Gentlemen, anxiety is rampant. It's been really hard for them.

Yeah. We can't just assume that. Okay. You're back in school. Everything is fine now. They're still grieving the losses of all that time alone. They're still reeling from all the stresses, and they're out of practice, right. Their social skills have decreased because they haven't been able to practice them. And like you said, they've been relating to parents, not to peers. So there's a lot of struggles in this reentry period.

Yeah, very much so. And when you think, then let's say you think of a teen who maybe already struggles socially, maybe they're a little introverted. Maybe they had some social anxiety, but it wasn't terrible. I would say that after these three semesters and I'll be in back at school, their social anxiety has now increased dramatically. And now that's a major problem, right? Because in anxiety work, what we say, it's an old Yungi and Maxim what you resist persists, not pushing yourself to face the situations that make you a little bit anxious and kind of running away from the situations that make you fearful as well as from your anxious feelings and thoughts temporarily makes it feel better, right.

Okay. I don't have to face what I'm fearing. I don't have to face my anxious feelings and physical sensations and thoughts by distracting myself. Losing myself on social media with the games or whatever temporarily feels better. But in the long run, it's like Boomerang. In the long run, it makes you more anxious. So next time, when you have to enter a social situation, you're going to be more anxious. And anxiety has now again gone through the roof.

I always tell my patients who are avoidant that their avoidance is making everything much worse because by avoiding, they never get to deal with the issue. So they never build confidence and they never build skills.

Absolutely.

So then they go back into the situation with less confidence and less skills. And of course, they're going to be that much more stressed.

Exactly. Right. The type of therapy, which is again subtype of CBT acceptance commitment therapy talks about avoidance as almost a key culprit for a lot of our psychological ailments, because again, that's exactly what you're saying is avoiding external stuff that makes us feel uncomfortable as well as internal stuff that makes us feel uncomfortable just makes it worse in the long run.

So these poor kids, like my heart breaks for them. Another thing that comes to mind when you talk about this is grief. You mentioned grief before, and I know that you do a lot of work with prolonged grief and persistent grief. And I just was wondering, how has grief been coming up in your practice these days?

So we are coming upon 760,000 deaths of coverage in America in the United States. And that's staggering. I mean, that's a staggering number of debts concentrated over a relatively short period of time. So that comes together with all the other losses, not just losses of life, but losses of health, of vitality, all the losses of joyful, lifetime events like weddings and graduations and Proms and all kinds of other miles, going to College, all kinds of other milestones travel that people have planned and so forth, so forth.

It's been almost like tragic and interesting to watch what's been happening. How do people all at once deal with such accumulating losses? People are dealing with it. My patients, my clients are dealing with it, and therapists are dealing with it, right? It's a very unusual situation in that way that we're all really in the same turbulence. It's been said we own the same boat. I don't actually believe we are on the same boat, depending on our own resources and social supports and psychological resilience and so forth.

We might be in a different boat, but we are all in the storm. Grief has been showing up even more than usual. And again, the hardest grief, of course, is over the lost lives. But again, it's definitely broader term. I see grief as dealing with losses in life, whatever that might be. So grief has been more complicated. Let's put it that way, just grieve over lost life has been more complicated over the last two years by another slow factors. And those are the people were not able to be with their loved ones during their last months days of life.

They sometimes wouldn't even see them when they died. Bureaus were done away from everybody. So all these cultural, societal, religious rituals and riots which have developed over millennia that help people grieve that help people process these emotions and accept laws and get reconnected with the loved ones that are still alive. All these rituals have developed for a reason because they facilitate processing of the grief. They were thwarted. They were very often not happening at all. So there were no wakes, there were no shivers. There were no burial to the Cemetery where people come.

There were no celebrations of life. Everybody was grieving in isolation. And that has been additional layer of making it hard for people. So absolutely. I've seen not just more grief, but more complicated grief where these different stages people go through have been really derailed, I would say. And people get stuck. People get stuck in this preoccupation with the thoughts and memories of their loved ones. And they have, like, daily hourly yearning for the disease. And it's very hard for them to accept that this actually happened.

So when you can accept that you can't process your emotions, then you're left with also being confused who you are now, who you are now in this world without the person who is gone. And if you're in that stuck place, then you avoid all kinds of reminders of loss and so your life starts to shrink because this reminds me of my disease husband, and this does. And this does. So stopped going out. I stopped living life, which makes you, of course, feel even worse. And then you're going to feel really excruciating emotional pain.

Sometimes it comes to the point where people are so much in pain that they become numb and they have extreme difficulty engaging with other people, living people with engaging in life, finding meaning in life. We always call the complicated grief, but it's newly named Prolonged Grief Disorder. It's actually going to be included in the newest version of the DSM. So I've absolutely seen more of that. And I think it's because of all these factors.

Yeah. And I think there's another layer, too, which is guilt, right. I think there's a lot of guilt going around these days about the kinds of choices people have made and the guilt of, if only I could have convinced them to make different kinds of choices around their health. I think there's also layers of guilt involved, and that, of course, makes the grief much more sticky as well.

Absolutely. There's guilt. There's shame, there's regret. And you'll hear it again more often than usual, because none of us knew what we were doing, right. We were just making what we thought the best decisions were in the moment, and nobody knows what would have happened if we made decision a differently or decision B differently and so forth. And yet people look back over their decisions, and they almost have this fantasy that things would have turned out better if only they did this differently, if only they did that differently.

Guilt and shame and regret very insidious and hard emotions because they lead people to withdraw even more when guilt becomes internalized. We call a shame. And it's not just that I've done something bad, but now I'm a bad person. And usually the sort of posture of that is to hide away from the world, withdraw, put cover over your head and not deal with anything basically. And as you can imagine, that makes grief worse. One of the kind of relatively simple interventions. Well, not simple, but relatively concrete interventions that I really like doing with my clients who are stuck in this place of regret and shame is writing a letter to a deceased and expressing really everything you would want to express.

Of course, it's exercise one sent letter, but it really can help sometimes and even sometimes in sessions. I do what's called empty chair technique, right where you imagine the deceased sitting on the chair across from you and you try to very vividly get into that sense of embodiment. They are there you are there. And what would you want to say? What is that sense of unfinished business? What do you want to maybe we want to apologize or something, and it's interesting how much emotion comes up in those situations.

And people do usually start to feel better.

Yeah. I'm very moved when you say it. I can imagine I have a patient who lost a sibling and they were almost like twins. They weren't twins, but they felt like they were so, so close. And I think I'm going to do that empty chair. I remember that from Gestalt.

Yes.

I'm going to do that empty chair with her, I think, because I think it would be helpful for her. She's having some difficulty. Her sister died just at the beginning of Covet, and she's been alone in her grief, too. So I think it will be helpful to share that with her. It's a hard time for everyone. As you said, there's so many losses and so little support.

Yes, absolutely. And you mentioned yes, there is a Gestal technique act, by the way, borrowed pretty heavily, I would say, from Gestal technique. So we use that a lot. The support here and I live in Canada as well is increasing. That's the good news, right? It is increasing. I mean, we are now in this difficult situation because it's a limbo situation. It's still pandemic, but it is different. Most importantly, you have some control over how you're living in this pandemic right now because you can get vaccinated and you can encourage others around you to do the same.

And, of course, that's not 100% protection, but it really does allow you to have some control over your life. And in the States that just recently approved vaccinations for ages five to eleven. And I have just watched Sign of Relief, a huge sign of relief for parents who have been waiting since January since the vaccines were approved for adults, just that they felt they couldn't really start living life or even going on a basic vacation. I have actually family I work with and they're the big travelers.

That's what they do. And they haven't gone anywhere for almost two years. And their youngest son just got vaccinated, and it was just a collective sign of relief and joy and happiness. And now we're going to go. So it is getting better. It is getting better. And people are definitely socializing more among friends. But also a lot of things are opening up, like theaters have been really curious about holiday parties. Just in last couple of days, I've gotten so many holiday party invitations and I'm thinking, oh, wow.

For the first time in again, two years, we actually meeting in person for holiday party. So it is definitely moving along. And it is still very hard because people are still left with having to make a lot of decisions in the uncertain time. There are still people who are immunocompromised who are vulnerable if they have those in their midst or in nursing homes. And my work, one of our associates, psychologists. She is immunocompromised, and she basically continued to work via telehealth. She does only teleherapy. We have accommodated that, of course.

And I really don't know if and when she will be able to come back and see people in person. The rest of us do kind of hybrid. We see some clients in person, some clients via telehealth. So it's almost kind of an equal way of being right. For a lot of us, the normality has returned to a great extent. But some of the folks like her, it hasn't at all. Right. And so you have this discrepancy now. And that's hard, because imagine how it is for people like her watching the society come back to some version of normal.

They're moving along. But I'm stuck right. And that happens, of course, with the elderly and with the people who are vulnerable and so forth. So it'll be interesting what happens. Another thing that I've noticed is this workplace situation where it's really unclear how the future of work is going to look like. And a lot of workplaces, at least around here, have not required people to come back in person. If they have required them, they might have asked one or two days, but overall, I would say more than not, they haven't required them.

They still remain teleworking. And while that's incredibly helpful for many people, especially people 30s and up who have families obviously not commuting or people who were commuting a lot before not commuting, being there with their families, really huge support for families, for women, working women and mothers. Especially what I've seen, though. Kind of a flip side. There's always a flip side, right for young adults, like kids, as I called them in their 20s, who this is maybe their first job, second job out of College. And the workplaces used to be the places where you socialize, where you find friends.

Sometimes I would say they're almost extension of College, especially some of the big companies, like consulting companies, for example, where we practice several big consulting companies. I've always watched them come out of College, and a lot of them are about the same age and that's their life work is their life because that's where they meet friends and where socializing happens. So if that's not returning in person, I am really worried about that generation. What happens with them? Because again, we said just a couple of minutes ago that they are suffering the most psychologically and a lot of them have been feeling so left out and isolated to say, look, when are we going to be back in person so I can meet people.

So there's no right answer, right?

Yes. That's that old curse you live in interesting times.

Yes.

Well, I want to flip the question a little bit on it and ask you as a therapist, how do you take care of yourself in the middle of all this craziness?

Thank you for asking. I am an avid hiker, so I can tell you that I think hiking has saved my life over the last two years. To be completely honest, I live actually in the District in Washington, DC, and not many people would probably associate D. C. With hiking. But in the middle of DC, there is absolutely gorgeous piece of nature. They call it Rock Creek Park, but it's really not a manicured park at all. It's really just federal government. Thank God for that kept this piece of land and it's hilly.

It's full of trees. It's pretty big. It runs kind of up and down North, south in Washington, DC. So I mean, almost every other day I would be there. And even if it's a short, I live very close to it. And if it's a short hike, I would do that. And then every weekend we would go a little bit further and hike and then pandemic summers. We actually headed west to Colorado and Utah, and I would work with Telehealth. That was very helpful that I could do that.

And for, like a month, escape the swampy heat of summer in DC and then go to the Rockies and hike there. There were, of course, other things that I did to take care of myself. But I can tell you that's bringing me into nature and all that one feels when in nature and being part of realizing that we are also part of the nature and we're constantly changing and the mindful awareness that comes as a result of that has been absolutely saving Grace.

It's funny. I've been doing something similar. I'm not what I thought I would consider a hiker, but I'm a Walker, and I started walking about a year and a half ago, and yeah, it's been very positive and experienced. I try to go for an hour most days, maybe five days a week. Sometimes I can only get a half an hour, but I find that, yeah. Being outside in the fresh air, looking at the trees, watching the seasons change, smelling things, looking at the flowers, watching the birds, simple little things like that are so life affirming and so healing.

Absolutely. Yes. To all what you said. It's just stepping out of our daily routine and getting out of our mind right into the nature is incredibly healing. Yes. You live in Toronto, right?

Yes.

It's a beautiful town to walk in.

It really is. And I just walk around my neighborhood and I take a couple of different routes. So I switch out my routes and I just love it. It's really been a godsend.

It is a beautiful town. I hopefully we'll visit it next month. I have my aunt actually lives there, so I'm looking forward to visiting.

Very nice. Well, I have another question for you as well. We were talking about being therapist, but I was very curious. What got you interested in this profession, in being somebody who does therapy for others?

That two answers to that question. So in my interest, just generally in mental health and people who are suffering goes back way back. I am originally from executive. And from Sarajevo, that's where I was born and raised. And my father was a psychiatrist. And so growing up with the father who all the bookshelves were lined with the Freud and Erickson and all the other Giants in our field. You couldn't escape it. So I got interested by reading some of the books early on and by my dad talking about his patients.

He worked in the city at Catherine Hospital, so mostly working with severely mentally ill. Our lives were imbued with this experience. So I was fascinated from the beginning and I had wanted to become psychiatrist back home. Psychology was not developed as a discipline really inexpensive. If you wanted to be in the mental health field, you would become a psychiatrist. So I actually did start medical school back home. And then the war happened from Sarajevo. So unfortunately, had to leave and my country dissolved and ended up in the United States.

And then eventually kind of looking at different landscapes of things in America, decided that PhD in clinical psychology is the way to go because I was really interested in academia as well as in practice. And it seemed that especially if I want to do research, the PhD seemed like the better route. So then fast forward, I was in my last year of my clinical psychology PhD at Temple University in Philadelphia. And really at that time, it was interesting. I had started doing therapy and I enjoyed it and something interesting happening.

I was in my 20s. I felt much more comfortable doing research and even teaching than doing therapy. I think a lot of therapists when they start doing therapy, you kind of feel, oh, my God, what am I doing? There's a lot of impostor syndrome, right? If they only knew that I've only seen three clients in my life, it's a hard job, and especially when you're just starting and you're young. I didn't feel as confident as I did research and academic stuff. I've done that well all my life.

So there was no problem. So I think that partly because I did genuinely like research and teaching, but partly because I didn't feel as assured in the therapy setting. I did actually pursue academia as my initial choice. And then something changed. Slowly, something changed. I became disenchanted with the impact that one makes. But science is really important and producing psychological research is important. And yet there was no immediate impact. And the impact was very prolonged and very ambiguous. And after a couple of years of teaching, I decided I'm going to come back and start seeing a couple of clients just on the side in my private practice.

And I think my stage of life at that point I was in my 30s. I was a mother, actually a single mother at that time. A lot of life experiences and at once sitting in the room just felt right. It felt really right. And it was still intimidating and I can sit in this chair and feel that I'm actually helping people and that's kind of slowly how it happened. Then I ended up flipping basically and doing practical work and clinical work for my main job. And then these other heads that I wear on the side.

It's been a bit of a meandering journey, but those are the best, but very gratifying. And there was one other thing that helped in a way. I did a practicum in New York, the center for Survivors of Torture, which is housed at NYU Medical School in Bellevue Hospital. And it's like a phenomenal center that helps refugees, basically survivors torture. But who've gone through torture abroad. And these were sometimes refugees very recently who come into this country. And I have gone through the war myself and have been lucky to have been able to land by 2ft in the new country here.

But working with that population, I mean, it was so meaningful. It was so purposeful that's another thing that kind of pushed me to wanting to do clinical work.

I'm glad you brought that up, because when you said you're from Sarajevo, it reminded me of a young woman that I was sharing an office with when I was doing my residency in New York City. And she was from Saravo. And she said that before she came to do her residency, they would have to go on water runs. And she said that there were snipers on the rooftops and she would have to every morning go get water because there was no running water. And every morning when she went to get water, there was a chance that she could be shot and killed by the sniper.

And she's just sitting there. We're just colleagues. She's a couple of years behind me, and she's telling me this story and I'm thinking, my goodness, right. What she has gone through. She's telling me this matter of fact because I guess that was her reality for quite a long time. But I thought, wow, how do you take this experience and have that inform your practice, right. Like the kind of trauma that you've been through yourself.

Yes. Law has been written about that. Right. That we do take our life experiences. And maybe the most important way to form some practice is understanding suffering, understanding the pain and suffering. It comes in all shapes and forms. And some of us had it more in that particular flavor. War trauma. But people suffer in all different ways and suffering, as we say, pain and suffering. They're not competition. So I think just being humble and being able to relate to profound human suffering that we all go through.

Interesting. So she was a resident in psychiatry back in Saravo, and then here, I suppose, right. When she came no.

She had done medical school. And then when she came, she started her residency. Psychiatry in the United States.

Yes. Okay. I understood. I thought maybe she did because some people have to repeat the residency. So she did medical school. Yeah. That's funny. It's a small world. Back in Sarah. We might have even been the same year of medical school.

It's entirely possible.

Yeah.

It's very funny how small the world it can be. But I always remember that story. When did I do my residency from 96 to 2000? I always remember that story. So I was in third year when she was in first year, and I was in fourth year when she was in second year. So when I was in my fourth year and she was in her second year just starting the psychotherapy practice. And we shared an office and she would tell me her stories about life in Saraba, and I was just like my jaw was on the floor.

This is just a young woman, just like me. Her experiences are so different. It really gave me a perspective about how different the world could be when people very much like me.

Yes.

So, wow. This has been such an incredible conversation, and I'm so glad we got to talk a little bit about your own experiences, because I think that being a therapist like you said, it's such a hard job and we have to bring so much to it. And we really need to know ourselves and do our own inner work to do a good job. Right?

Absolutely. Yes. That's something that I would say, unfortunately, has been lost in the CBT cognitive behavioral therapy training circles. The idea that wants to be a good therapist really needs to have gone or concurrently is going to their own therapy. And I see it coming back, especially in X circles, like really believing that we have to be aware of our own stuff. We have to be aware of our own avoidances to be able to do a good job. And I'm a huge proponent of it. Huge proponent.

Yes. You have to be. If you have any conscious awareness, you have to know that if you've got your own avoidance, you can't help somebody else.

Exactly. Yeah.

We are on unresolved issues. Right. Then you're going to be putting up a wall when the person brings up something similar, right.

If they push our buttons, we won't be able to tolerate it. Exactly.

It's really been fun talking with you. What are your current projects that people listening might be interested in knowing about?

Well, my biggest current project is I'm writing a proposal for a nonfiction book. So something that it's been in the works for way too much longer than I care to admit. But life gets busy, as we say. So between running the practice and seeing still my own clients and teaching and writing for a popular press, there's not much time left, and we all again go through different stages of life. And now I'm an empty Nester. My kid has gone to College, and so at once, a little bit more time has freed up.

So I'm working on a non fiction book. The idea is kind of personalized selfhelp. I find that there's been so much written about self help and how to increase psychological resiliency and so forth. And I think sometimes the finer distinctions about what type of person you are, what kinds of struggles you're dealing with. Depending on that, some typical self help strategies might be helpful, some might be hurtful, actually, and some are good to have, but not necessary, and some are really necessary. There's an interesting example, for example, if you're prone to anxiety and you're a really anxious person, then being conscious that a lot of things can turn into rituals and really increase your anxiety.

For example, if you may be a little afraid of flying and you buy a magazine in airport shop and wear certain shirts and so forth, you start to think, oh, my God. The flight went really well. There was no turbulence. Oh, you consciously unconsciously associated with what you did before, and next time you do the same, and next time you do the same, and sooner than you want to admit you have this we call it safety behavior ritual that has now developed that, unfortunately, is increasing your anxiety, which we talk about, right.

What your resistance is. And so the rituals can very quickly become very harmful for people who struggle with anxiety. I mean, in the end, you can develop several CD, right. Whereas Interestingly, there's this whole other flip side of it that for people who are not anxious, who are not prone to anxiety, kind of tiny rituals can be really helpful to us to lower just momentary anxiety before something that a presentation or having to perform at the high level in certain contexts. For example, there's a beautiful story of astronauts, both American Russian astronauts, having all these little rituals that they do before they go into the capsule because I don't know the previous astronauts did that.

And some are very silly rituals. And everything went well. And so now they all do it, and they all kind of collectively do it and they have laugh at it. But it's like, no, why not do it? But these people, as you can imagine, these are probably one of the most fearless people in the world who astronauts. So for them doing that, it doesn't lead to bad things. On contrary. Right. That's a little thing, a little kind of crutch that helps you just get on that capsule and go up.

So it's just interesting to me how same behaviors can be harmful for somebody and helpful for somebody and for another person. It's like you can take it or leave it. So I'm just kind of really interested in finding these different behaviors, especially that we can really personalize to what people need. So that's what the book is about. It's like we talk about personalized medicine. It's like a personalized psychological self help.

When your book is out. I'd love to interview you about it again, because I love the idea that there's no one size fits all helping process.

Thank you.

Thank you so much for sure. Let's talk when it's out, because I'm very interested to learn all about it. And where can people find you if they're interested in learning about you and your work and your articles that you write?

So the best place is our website of my Institute. So my Institute is Arlington/DC Behavioral Therapy Institute. The web address is just Arlingtonbehaviortherapy. Arlingtonbehaviortherapy. Com. And that's our website where we have media stuff and stuff I write. And then among staff is me and so forth. If that's too long to remember. If one puts just in a browser. Doctor K, psychologist, I come up and my Twitter handle is Dr. K, just Dr. K psychologist, and I'm under my full name on LinkedIn. Those are the only two social media that I do.

That's wonderful. Well, just before we end, I'd love it if you could do a call to action for the listeners, something that they could consider or try moving forward.

Absolutely. So I think that grief, allowing all the negative emotions that have bubbled up more than ever for most people in the last two years is a really way forward. I think that in spite of lot of recognition of negative emotions and mental health problems that we have seen among the celebrities, even and sports stars and so forth, and also the criticism of toxic positivity that we've heard about a lot in the last year. In spite of all of that, I still get a sense that our culture, American culture has having a hard time moving away from this.

Let's fix it. Let's move it on. Let's move on.

Right.

Let's deal with this. What are the quick and dirty strategies we can deal with it and then just move on with life. Right. And in grief, you see, that a lot. I mean, a lot of clients that I talk about, they say first week or so when maybe I've lost my parents or my spouse. My boss was very understanding. Yes, of course. Take as much time as you need. We don't expect you to be present or even to send us anything for a week or so. And then my clients come back and they say, but they really don't mean as much time as you need, because in their mind, it's like a week or in their mind, maybe two weeks at most.

Right. And then the third week, you're supposed to be back at work or working from home, sending emails at 07:00 in the morning and 09:00 in the evening. And that is something beautiful about American culture that we are progress focused, future focused, very hopeful nation. And I appreciate that having come from Balkans, which is all different. And there is this flip side. We almost afraid of allowing feelings and negative emotions to kind of coexist or live aside. And we are afraid to realize that maybe that person won't be themselves completely for next couple of months and they'll be doing work.

But it won't be may be the same, and maybe they won't be able to send emails at 09:00 p.m. Or even if they're able to. It's not healthy for them and the end of the day, it's in the interest of everybody that they heal and maybe work nine to five for a couple of months, maybe half a year, so that after that, they will be back full force and not be stuck again in prolonged Reef or complicated grief and so forth. So I think that we still have ways to go, and I would just urge all of us.

I mean, we are all guilty of this right to slow down and to recognize, not to be afraid of negative feelings. They can again, coexist. They can live alongside hopefulness and joy and awe. Mixed emotions are more frequent than pure emotions, Research says. So that's my call in action. Just open ourselves up to all the rises of emotional experience and not feel like you have to quickly put it in the box and move on.

That's a really good call to action for now and for the future. Thank you so much, Jelena, for coming on the show. You have some very common sense ideas, and I think we need common sense these days. Like you talked about toxic positivity. There's a lot of very strange ideas floating around about psychology and mental health, and it's very refreshing to speak to somebody who has such a depth of knowledge and experience and such profound common sense.

Thank you so much. That's a good compliment. Thank you. I thank my grandmother, who was infinitely commonsensical, my good old balcony grandmother. So thank you.

That was the delightful Dr. Jelena Kecmanovic and I'm Dr. Marcia Serota, if you like this podcast, please review it wherever you're and you can sign up for my free Biweekly Wellness Newsletter at marciaserotamd.com, where you'll also learn about my online courses and my YouTube video series.