How Can I Help?: Supporting Those Facing Infertility

At a neighborhood function not too long ago, Rachael complimented Abigail on her cute children. Abigail quickly responded with, “It’s about time that you jump on the bandwagon and have some cute kids yourself!” What might have seemed like a harmless comment to Abigail cut Rachael right to the core. What Abigail did not know was that Rachael and her husband had been trying to get pregnant for years and were struggling with infertility.

It is estimated that 15 million Americans (one in six couples) have infertility issues. If it is not you going through it, it is your sibling, your friend, your coworker, or your neighbor.  Like many physical health conditions that have mental health implications, infertility often goes unnoticed by well-intentioned friends, family, and co-workers. If you are trusted to be let in on the tender topic of someone’s infertility, there are certain things you can do to help those struggling with this difficult trial.

  1. Learn more about infertility. Understand the causes, the language, the options, the process. This will not only help you understand the infertility journey, but it will mean so much to the people struggling that you took the time to understand their situation.
  2. Take comfort in knowing that it is not necessary for you to give advice. In fact, it is not your place to give advice. It is unlikely that you will suggest a route that has not already been thought of and some options might not be realistic, as you may not be aware of your friend’s personal, medical, or financial situation or history, nor their personal beliefs or values. Though it is natural to want to jump in and help problem-solve, infertility is an extremely personal issue; the decisions that need to be made and obstacles that need to be managed are deeply personal.
  3. Avoid trigger phrases. Though you mean well, there are certain responses that are rarely comforting and tend to minimize the very real fears and challenges your loved one is trying to share with you. A few of these include: “Where there’s a will there’s a way”; “Don’t worry; your time will come”; “It will happen when the timing is right”; “Just relax, it’ll happen when you’re less stressed”; “What’s meant to be will be”; “At least you can get pregnant.”
  4. LISTEN. While you may want to offer solutions or words of comfort, oftentimes, the best thing that those struggling with infertility need is a listening ear. They need someone to talk to and someone to be there for them. Instead of chiming in with possible solutions to their dilemma, let them guide the conversation and then be supportive of their plans, whatever they may be. Just listening will mean so much to the person trusting you with this deeply personal issue!
  5. Help where you can. Instead of working overtime to “fix” situations that are beyond anyone’s control, focus on making smaller decisions and stressors more manageable. Attend appointments. Watch kids (if there are older children involved). Be an exercise buddy (sometimes, those undergoing treatment need to lose weight in order for treatment to be more effective). Help around the house. Supply meals. Pick up groceries. Suggest a fun activity, like a comedic movie or a paint class or a number of other non-baby related things. These daily hassles tend to feel even bigger in the face of major life challenges like infertility.

Lastly, my advice would be to recognize and validate the uniqueness of their situation. Although many face infertility, no two struggles are alike. What one person finds most difficult can be very different from another’s perspective. For some, it may be the physical discomfort that comes from medications, daily injections, or invasive ultrasounds and procedures. For others, the financial commitment can generate significant stress and even become a barrier to treatment. Many mourn the loss of a “natural” conception. This is why one of the most helpful approaches is to remain open to a loved one’s experience. Sit with them in the lows, celebrate the highs, and just be present when things feel stagnant. Hear them out. Hear their story. Be there for them…whatever that might look like!

You may feel completely overwhelmed and unsure what to do or how to help. You may worry about saying the wrong thing or not saying enough. That is okay. Your loved one trusts you enough to confide in you and surely does not expect you to know exactly what to say or do. Remember that imperfect support is always better than nothing at all. Learn about infertility, avoid trigger phrases, listen, and help where you can. As you do these things, you will be able to support your loved one through the colossal trial that is infertility, and can bring a sense of peace, hope, and happiness back into their lives. If you are struggling with infertility, and believe the support of a therapist would be helpfuI, contact me. Let me be here for you!

Melissa Cluff is a licensed marriage and family therapist based in Lewisville, Texas, personally seeing clients in the North Dallas area.

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When Your Consent is Taken Away

“Our lives begin to end the day we become silent about things that matter.” ~Martin Luther King Jr.

Almost a year and a half ago, Alyssa Milano posted on Twitter: “If you’ve been sexually harassed or assaulted write ‘me too’ as a reply to this tweet.” 24 hours later, there were more than 500,000 responses. 12 months later, the hashtag was estimated to have been tweeted over 18 million times. The #MeToo movement has caught people’s attention worldwide, yet sexual assault continues to be a difficult topic. Although uncomfortable to discuss, it is prevalent and life-altering, and worthy of our attention and dialogue. I write this post in line with April’s Sexual Assault Awareness Month campaign to raise public awareness about sexual violence and to educate communities on how to prevent it.

In my initial research for this blog post, I found some staggering statistics I would like to include:

  • Approximately eight out of 10 sexual assaults are committed by someone known to the victim
  • More than half of female victims of rape reported being raped by an intimate partner and 40.8% by an acquaintance.
  • A forcible rape occurs every 6.2 minutes within the United States.
  • Nearly 1 in 5 women (18.3%) and 1 in 71 men (1.4%) have been raped at some time in their lives
  • Most female victims of completed rape (79.6%) experienced their first rape before the age of 25, and 42.2% before the age of 18.
  • More than 1 in 4 male victims of completed rape (27.8%) experienced their first rape when they were 10 years of age or younger.

Call 800.656.HOPE (4673) to be connected with a trained staff member from a sexual assault service provider in your area.

Let’s discuss the basics of sexual assault. The term “sexual assault” refers to sexual contact or behavior that occurs without explicit consent of the victim. Some examples of sexual assault include attempted rape; fondling or unwanted sexual touching; forcing a victim to perform sexual acts; penetration of the victim’s body; sexual intercourse against a person’s will; forcible sodomy (anal or oral sex against a person’s will); forcible object penetration; marital rape; sexual contact with minors, whether consensual or not; incest; or any unwanted or coerced sexual contact.

Sexual assault can happen to anyone of any age, gender, race, and socioeconomic background. It can happen at any time or place. Assailants may be strangers, acquaintances, friends, or family members, and they may use violence, threats, coercion, manipulation, or other forms of pressure or deception to commit sexual assault.

Not all sexual assault is rape, but rape is one of the more well-known forms of sexual assault,. For its Uniform Crime Reports, the FBI defines rape as “penetration, no matter how slight, of the vagina or anus with any body part or object, or oral penetration by a sex organ of another person, without the consent of the victim.” This can be done in one of three ways; the first is called a “blitz” sexual assault, which is when a perpetrator quickly and brutally assaults the victim with no prior contact, often at night in public.  The second is called “contact sexual assault”, and is when a perpetrator tries to gain their victim’s trust by flirting, luring the victim to their car, or otherwise trying to coerce the victim into a situation where the sexual assault will occur. The third type of rape is a home invasion sexual assault–when a stranger breaks into the victim’s home to commit the assault.

Call 800.656.HOPE (4673) to be connected with a trained staff member from a sexual assault service provider in your area.

The distinguishing line between sexual assault and consensual sexual activity is just that: CONSENT. Consent is a voluntary, sober, enthusiastic, informed, mutual, honest and verbal agreement. It is an active agreement that cannot be coerced. Consent is a process which must be asked for every step of the way. Consent is never implied and cannot be assumed, even in a relationship; simply dating a person does not give the right to sexual interactions. Legally, an intoxicated person cannot give consent!

Survivors of sexual assault often blame themselves for somehow behaving in a way that encouraged the perpetrator. When your consent is forcefully taken away, it is not your fault. I cannot possibly stress this enough: The victim is never to blame for the actions of the perpetrator! In my experience as a clinician, guilt is a feeling that each victim experiences during his/her healing process. Because of this, it is essential that victims get the appropriate and necessary treatment from a licensed, experienced therapist. I have treated numerous clients who have experienced sexual assault, and am equipped to help you or your loved one along this difficult yet beautiful path to healing. It is possible, and I am here for you. Please contact me today or click here to schedule a session.

Call 800.656.HOPE (4673) to be connected with a trained staff member from a sexual assault service provider in your area.

Melissa Cluff is a licensed marriage and family therapist based in Lewisville, Texas, personally seeing clients in the North Dallas area.

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Abuse: When Love Hurts

“If you walked away from a toxic, negative, abusive, one-sided, dead-end low vibrational relationship or friendship—you won.”  ~Lalah Delia

Healthy relationships involve respect, trust, and consideration for each other. Relationships where abuse is present, on the other hand, involve mistreatment, disrespect, intense jealousy, controlling behavior, and/or physical violence. I tend to focus more on building healthy relationships in my blog posts, but after attending a recent training, I realized I cannot ignore a topic that so many readers can relate to. While Hollywood is depicting the vast majority of relationships as happy and fulfilling, more than 12 million American women and men experience some type of abuse in their relationship over the course of a year. Relationships where abuse is present, unfortunately, are NOT uncommon. I hope this post is not only informative for my readers that may find themselves in a relationship where any kind of abuse is present, but also motivational for them to speak up.

What types of relationship abuse are there?

Abuse is the misusing or regularly/repeatedly treating someone with cruelty or violence. While that definition is straightforward enough, there are many types of abuse that need to be discussed when defining abuse.

There is physical abuse (any form of violence, such as hitting, punching, pulling hair, and kicking).

There is emotional or psychological abuse (threatening the physical health of the victim or the victim’s loved ones, purposely controlling the victim’s freedom, and/or acting to undermine or isolate the victim, intimidation, gaslighting, putdowns, controlling behavior, and betrayal).

There is sexual abuse (being forced into any sort of sexual activity).

There is verbal abuse (yelling, put-downs, name-calling, making threats, constantly correcting or interrupting a person, and even employing the silent treatment).

There is spiritual abuse (also known as religious abuse; a form of controlling a person under the guise of religion or the misuse of religion for selfish or secular ends).

Basically, abuse is about domination and submission; it is about giving and withholding in the extreme. In a relationship where abuse is present, a form (or multiple forms!) of abuse is (are) employed by one partner to maintain power and control over the other partner in an intimate relationship. The feelings of love, loyalty, and devotion in the relationship make it difficult to recognize reality, break the cycle, and get help.

Who can be in an relationship with abuse?

Anyone can be a victim to a relationship where abuse is present. No matter the race, age, sexual orientation, religion or gender, anyone can be a victim (or perpetrator!). It can happen to people who are married, living together or who are dating. It affects people of all socioeconomic backgrounds and education levels.

What causes abuse in relationships?

In relationships where abuse is present, often the offender has low self-worth, or has a history of abuse in their family-of-origin and thus feels powerless. Because of this, they use behaviors, such as threats, violence, and mind games to gain a sense of power and control over their partner. The following infographic from the National Domestic Violence Hotline outlines and gives specific examples of abuse in relationships. Regardless of where you start reading on the wheel, everything comes back to the center, the true motive for any kind of abuse: power and control.

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What are the signs of relationships with abuse?

As previously mentioned, relationships with abuse are not limited to physical violence. Here are some warning signs to be aware of for any type of relationship where abuse is present:

  1. Trying to control where you go/who you see/what you say.
  2. Demanding to know where you are every minute.
  3. Accusing you of being unfaithful or of flirting.
  4. Isolating you from family and friends, often by behaving rudely to them.
  5. Constantly comparing you unfavourably to others.
  6. Deliberately breaking things you value.
  7. Threatening to use violence against you, your family, friends or pets.
  8. Harming you physically.
  9. Forcing you into unwanted sexual encounters.
  10. Punishing you by withholding affection.
  11. Insulting, demeaning, criticizing, or shaming you with put-downs.
  12. Controlling every penny spent.
  13. Preventing you from making your own decisions.
  14. Refusing to trust you and acting jealous or possessive.
  15. Telling you that you are a bad parent; threatening to harm or take away your children.
  16. Intimidating you with guns, knives or other weapons.
  17. Pressuring you to use drugs or alcohol.
  18. Making everything your fault (gaslighting)
  19. Controlling your appearance: your clothes, how much/little makeup you wear, etc.
  20. Using sarcasm and unpleasant tone of voice.
  21. Saying things like “I love you but…” or, “If you don’t _____, I will_____.”

It is common for someone who is being abused to believe that the abuse he/she is experiencing is his/her own fault and that the abuse is somehow deserved. This is a form of abuse itself and could not be farther from the truth! If you walk away with nothing else from this article, I hope that you know that you are never to blame for the abuse!

Being a victim of any type of abuse in a relationship is traumatizing. It can cause anxiety, lowered levels of self-esteem, diminished self-worth, distrust or difficulty connecting with others, and–in severe cases–post-traumatic stress disorder (PTSD). Getting out of and moving on from a relationship where abuse is present will require a steady support system of family, friends, and often a support group. In many cases, the victim needs drugs an advocate–someone to give them a voice in order to break free from the toxic relationship.  That is where I come in; I am an experienced, licensed therapist who has seen multiple couples and individuals work through relationships with abuse. I can help. If you are concerned that you may be a victim of a relationship where abuse is present, please do not hesitate to contact me with questions or to schedule a session. My door is always open and I am here to help.

Melissa Cluff is a licensed marriage and family therapist based in Lewisville, Texas, personally seeing clients in the North Dallas area.

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I Don’t Have Trauma…or Do I?

I Don’t Have Trauma...or Do I - Cluff Counseling - North TX Couples TherapistMost people associate trauma with terribly difficult and disturbing events like war or a natural disaster. Because of this, you may think you have never experienced something traumatic. However, any distressing event that falls beyond your normal scope of human experience can be considered traumatic! Odds are high that you HAVE experienced trauma. How have you dealt with it?

I was recently talking with a friend who told me she had never been through anything traumatic in her life. Although I knew she was referring to the fact that she had not experienced a death of a loved one, abuse, an accident, or something of like nature, I silently disagreed with her. While those experiences are incredibly traumatic for any individual who faces them, trauma is not limited to life-changing events like those. Trauma can happen every day in the normal course of your day without you realizing what you are up against. In this post, I will focus on the two different types of trauma and how we are all affected by trauma’s expansive reach.

Let’s start by defining trauma. What is it really? At its Greek core, trauma means to wound or to pierce. A search for this word will yield a definition much like this: “A disordered psychic or behavioral state resulting from severe mental or emotional stress or physical injury; an emotional upset, an agent, force or mechanism that causes high distress.” Basically, trauma is intense emotional distress resulting from stressful life experiences. Oftentimes when describing trauma, it is divided into two major categories: Big “T” and little “t” traumas.

Big “T” trauma

Big “T” trauma, or complex traumas, are events that involve physical harm and/or a threat to life or physical safety. Big “T” trauma is trauma in its most severe form, and can often result in Post-Traumatic Stress Disorder (PTSD). Examples of big “T” trauma include being in a combat/war zone, a natural disaster, a terrorist attack, immigration, rape, sexual assault, abuse, death, sickness, moving, financial stress, a car/plane accident, etc. These are extraordinary and significant events that leave us feeling powerless, helpless, and as if we have little or no control in our environment. This element of helplessness is a key difference between of big ‘T’ traumas and little ‘t’ traumas–feelings of helplessness being much greater in big ‘T’ traumas. These events can forever alter a person’s life, and may influence our ability to make/maintain relationships, and function later in life. One big ‘T’ trauma can be enough to cause severe distress and interfere with our daily functioning–which is intensified the longer treatment is avoided.

Little “t” trauma

Little “t” traumas are life events that are more common experiences that, although upsetting to an individual, are less severe or dramatic than big “T” traumas. A few examples of little “t” traumas include being teased in elementary school, always being picked last for a team, divorce, death of a beloved pet, losing a job, or losing friends by moving from school to school during childhood.  It is not necessarily the event that determines whether something is traumatic to someone, but the individual’s experience of the event. If an individual experiences an event as life-altering or upsetting in such a way that it changes the way they think about themselves or others,  it is likely a little “t” trauma.

The term little “t” trauma does not imply, however, that the emotional impact of such an event is insignificant compared to big “T” traumas. The emotional wounds can be as lasting and severe as big “T” trauma wounds!

Trauma’s reach

Everyone has endured some sort of trauma in their lifetime. Both big “T” and little “t” traumas have a strong influence on our view of the world and shape how we cope in life. For example, the little “t” traumas of being teased by peers and being picked last for the team can leave us feeling inadequate or insecure amongst our peers. Big “T” traumas may leave us orphaned, severely dissociated, or less physically capable than we may have previously been. The four core signs of trauma include the following:

      • Hyperarousal: These symptoms can be difficult to manage and can vary from person to person. In general, hyperarousal includes having a difficult time falling or staying asleep, feeling irritable or having outbursts of anger, having difficulty concentrating, hypervigilance (constantly being on guard), and being jumpy or easily startled
      • Dissociation of body and mind: This includes feeling disconnected from oneself, problems handling intense emotions, sudden/unexpected shifts in mood, depression or anxiety problems, derealization (feeling as though the world is distorted or not real), memory problems, concentration problems, and significant memory lapses.
      • Constriction of body and perceptions: Which may include the skewed notion that the individual was responsible for causing the trauma.
      • Feelings of helplessness: The inability to act or think for oneself, or to act effectively.

When symptoms of trauma continue for more than three months, it is considered PTSD or Posttraumatic Stress Disorder. Fortunately, all symptoms are not permanent if addressed properly–which means that healing for both little “t” traumas as well as big “T” traumas are completely treatable. Receiving treatment can truly reshape the way we view both the world and ourselves!

Trauma is treatable

Treatment for trauma consists of specialized counseling techniques and practices that will help you cope and deal with trauma and its effects on your life. I use EMDR (Eye Movement Desensitization and Reprocessing) , as well as Pia Mellody’s inner child framework to treat trauma. Because trauma contributes to negative thinking, negative behaviors, and difficult emotions, counseling for trauma can help you change your thinking and behaviors, which will, in turn, impact your mood. Counseling with me is a safe place where you can explore some very difficult issues that are hindering you from the life you want to live or the person you wish to be. If you think you may struggle with trauma, please reach out to me! Untreated trauma can lead to serious life consequences, the longer it is left untreated.

As always, the take away that I want you to remember (and cling to) is that treatment is available. Healing is possible! No matter where you have been, I can help you get relief from your trauma symptoms. Remember that everyone responds to traumatic situations differently; you may be experiencing only a few of the aforementioned symptoms, or you may be experiencing many. The severity, frequency, and duration of symptoms vary depending on the individual and his/her specific trauma event. What may affect one person may not affect another person in the same way. Counseling can help you explore your trauma and find the healing you may still need. Please feel free to contact me with any questions you may have.  I look forward to working with you!

Melissa Cluff is a licensed marriage and family therapist based in Lewisville, Texas, personally seeing clients in the North Dallas area.

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When Addiction Raises Your Child

When Addiction Raises Your Child - Cluff Counseling - Lewisville TherapistAccording to The US Department of Health and Human Services, more than 8.3 million children currently live in a household where at least one parent is addicted to alcohol or drugs. Do those children notice their parents’ addiction? How does it affect them?

Addiction comes in all sizes and severities. There are addictions to substances like alcohol, tobacco, prescription drugs and illegal drugs (heroin, cocaine, methamphetamine, PCP/angel dust, hallucinogens, etc); there are impulse control disorders like kleptomania, pyromania, and gambling; and then there are behavioral addictions to food, sex, pornography, video games, smartphones, working, exercising, spirituality, cutting, shopping, etc. Because addictive behaviors are often done in isolation, the impacts of the behaviors, to loved ones, are often thought to be minimal.

Due to the many faces of addiction, its impacts can vary greatly. For example, a mother may physically leave her home to frequent bars, clubs, hotels, casinos; as a result, her children may suffer from neglect or abuse by her or others. Other addictions can take place at home and do not require a physical absence–like the father who abuses substances or gets involved in pornography/sex addiction from home. In such cases, his children may inadvertently experience psychological or emotional absence that can cause relational issues later in life. Depending on the age(s) of the child(ren), they may miss out on/not learn important things like how to brush their teeth or take care of their personal hygiene, table manners, stress management, problem solving, communication, how to make/keep friends, conflict resolution, etc. One woman, a new mom, recently told me she is not familiar with any nursery songs to sing to her daughter because she was never sung to herself.

This same woman shared with me the consequences she experienced of having a mother who was addicted to prescription pain medications. She said, “It was terrifying. Every day I dreaded coming home from school because I was afraid my mom would be passed out or dead on the bathroom floor. I was young–maybe third or fourth grade?–but I knew something was seriously wrong. I felt powerless. In order to feel like I had some semblance of control over my life, I formed OCD behaviors; I started pulling out all my eyelashes and even patches of hair off the top of my head. I even resorted to bullying a nice girl in my neighborhood! Eventually, the girl’s mother told my mom and I was put in therapy.” My heart goes out to this woman, as well as the other adult children of addicts whose stories I hear.

The real-life example above illustrates how children–even when they do not fully understand their parent’s addiction–feel its effects, and behaviorally act out their confusion and pain. They may wind up bullying, self-harming, or practicing OCD behaviors (obsessive-compulsive disorders) like cutting, eating disorders, etc. Many of these children go on to distrust authority figures, have commitment issues, and may wind up facing addiction themselves. Although these behaviors are often maladaptive, they are simply the way the child copes and tries to take care of him/herself. It is important that teachers, mentors and other adult family members recognize these as such, instead of punishing the child, and help them learn adaptive ways of coping (watch for a future blog post on specific ways you can help!).

If you are battling addiction, please remember–there is help! Just recently, I posted about the possibility of relying on a support animal through addiction and/or trauma. Not long before that I went into detail on support groups and group therapy which is accessible nationwide. And last summer, I posted about the benefits of therapy in general. The truth is, help is out there. In fact, it is readily available if you make (and follow through with) your decision to get help. So please, I urge you to contact me or schedule a session–not just for your own sake, but also for your family’s.

Melissa Cluff is a licensed marriage and family therapist based in Lewisville, Texas, personally seeing clients in the North Dallas area.

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Emotional Support Animals At a Glance

Emotional Support Animals - Cluff Counseling - Lewisville TherapistEmotional Support Animals (ESA) are no ordinary pets! They serve to stabilize and/or maintain the emotional or mental health of their owner and their role is vital! I am a proponent for emotional support animals when they can truly fill an individual’s needs. Read on to learn more!

It is estimated that 68% of U.S. households (or 85 million families) own a pet. There are some instances, however, where the animal is more than just a “pet.” In these cases, the individuals rely heavily on their animal for mental and/or emotional support. Their animals are called Emotional Support Animals, and they play an important role in the very livelihood and stability of their owner(s). This post will be all about Emotional Support Animals and hopefully will answer your basic questions about Emotional Support Animals.

What exactly is an Emotional Support Animal (ESA)?

An emotional support animal (ESA) is a companion animal that a medical professional has determined provides benefit for an individual with a disability or mental illness. The goal is for the ESA to help with or improve at least one characteristic of the disability.

Who can have an ESA?

In order to be prescribed an Emotional Support Animal, the person must have a) A verifiable disability, and b) A note from a physician or other medical professional (stating that the person has that disability and that the emotional support animal provides a benefit for the individual with the disability). ESA are typically used when the owner struggles with depression, mental health issues, autism, aspergers, psychotic disorders, or is a veteran/military individual dealing with PTSD.

When applying for housing with an ESA, the U.S. Department of Housing and Urban Development (HUD) asks two questions:

  1. Does the person seeking to use and live with the animal have a disability — i.e., a physical or mental impairment that substantially limits one or more major life activities?
  2. Does the person making the request have a disability-related need for an assistance animal? In other words, does the animal work, provide assistance, perform tasks or services for the benefit of a person with a disability, or provide emotional support that alleviates one or more of the identified symptoms or effects of a person’s existing disability?

Answering “no” to either of these questions means that a housing provider is not obligated to make a reasonable accommodation according to HUD. This may mean that the person does not meet the definition of disability or that the assistance animal does not help with symptoms of the disability. If the answer is “yes” to both, then HUD states the FHA requires an exception to a ‘no pets’ rule.

How does an animal become an ESA?

An animal does not need specific training to become an emotional support animal. There are several websites online where you can go to register your animal. Some organizations will send you a card, a bib for the animal, and/or packets of information (depending on how much you pay). Many of these organizations are not monitored by the government, however, so I recommend choosing one carefully so as to not get scammed.

Are Emotional Support Animals ONLY dogs?

While dogs are the most common type of assistance animal, other animals can also be used for this purpose. Sometimes cats or other animals may be used by people with a range of physical, psychiatric, or intellectual disabilities. There was a case in 2012 where a guinea pig was used as an ESA, and another in 2015 where a miniature horse was filed as an ESA. All that matters is that the animal needs to alleviate the burdens that come from physical, emotional or mental illness. Obviously, any animal that poses a direct threat to the health and safety of others would be questionable (a wild or exotic animal that poses a greater risk of attack or disease to other residents could be denied based on this reason). The key indicator is whether or not the animal alleviates some part of the disability or mental illness.

Is there a difference between an Emotional Support Animal and a Service Dog?

Emotional Support Animals are animals that provide therapeutic benefits to their owner through affection and companionship, where a Service Dog is specially trained to perform a task to help someone with a disability. For example, a blind individual will likely have a seeing eye dog–a Service Dog with training and a very specific function. Other examples include pulling a wheelchair or responding to seizures. Emotional Support Animals, however, do not need specialized training to handle a task. Further, Emotional Support Animals come in different breeds and animal types and are not just limited to dogs, while Service Animals are either dogs or horses.

Can I have more than one ESA?

Although I have not seen any cases dealing with the issue of multiple emotional support animals, the basic requirements for this reasonable accommodation would be the same. If a person were to claim the need for multiple emotional support animals, he/she would need documentation supporting this need from his or her physician or medical professional. The practitioner would need to provide documentation that each support animal alleviated some symptom of the disability.

WARNING

Unfortunately, people sometimes take advantage of the Emotional Support Animal system… using their “ESA” to get out of paying pet deposits, getting into certain housing where animals typically are not allowed, or even trying to fly for free with them. In an article, from The New Yorker, the author takes a turtle, a snake, a turkey, an alpaca, and a pig (separately!) all over New York and was allowed access to all things “non-pet” because she claimed (and showed fake letters from her “therapist”–an online reference who sent a letter over after she paid $140 to be evaluated) that these were here Emotional Support Animals. I want to be clear–while there are benefits of having an Emotional Support Animal, those should not be the driving force behind having an ESA. The intended use for these animals is to alleviate discomfort and provide meaningful companionship to those who truly need it. I do not condone cheating the system, but I fully support the idea behind and purpose of having an Emotional Support Animal.

It is possible that you or someone you care about could find an Emotional Support Animal extremely helpful in dealing with mental illness or disability. I urge you to contact me with questions or schedule an appointment today and we can discuss whether or not an ESA could meet your needs. I have seen Emotional Support Animals do great work and provide much needed comfort and stability to those grasping at straws for relief. Animals are smart and intuitive, and having an ESA can add much needed comfort and stability in the lives of those who so desperately need it.

Melissa Cluff is a licensed marriage and family therapist based in Lewisville, Texas, personally seeing clients in the North Dallas area.

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SPLIT: A Deeper Look into Multiple Personalities

Britney Spears, Nicki Minaj, Marilyn Monroe, Lady Gaga, and Mel Gibson are a few famous individuals who have shared that they face Dissociative Identity Disorder–more commonly known as multiple personality disorder.  The average number of alternate personalities a person with DID has is between eight and 13, but there have been cases reported of more than 100 personalities within one individual. Read on to learn more about the cause and treatments for this mental illness.

Dissociative identity disorder (DID), often called multiple personality disorder (MPD), has fascinated people for over a century. In 2017, this disorder caught a bit of the limelight with the release of M. Night Shyamalan’s hit movie, “Split,” where the murderous villain has 24 personalities manifesting themselves throughout the abduction of three teenage girls. Although this movie was entertaining for some, 1% of the population who truly face this horror, may not have been as amused.

When Truddi Chase was just two years old, she moved out to the country with her mother and stepfather. At this time, she was sexually abused by her stepfather, and the trauma ultimately led to a DID diagnosis. For years, Chase was able to suppress her memories by holding them in alternate personalities that rarely came to the surface. Each of her 92 personalities held different memories, served different roles, and played different parts in protecting her from the past. One personality named Black Catherine held most of her rage. Another personality, Rabbit, held the pain. Chase wrote a book about her life, When Rabbit Howls, and, later, a movie was produced about her entitled, “The Voices Within: The Lives of Truddi Chase.”

The American Psychiatric Association defines Dissociative Identity Disorder as a disconnection between a person’s thoughts, memories, feelings, actions or sense of who he/she is. To some degree, this is a normal process that everyone has experienced. Examples of common dissociation are daydreaming, highway hypnosis or “getting lost” in a book or movie, all of which involve “losing touch” with awareness of one’s immediate surroundings. The difference between those more daily acts of dissociation and Dissociative Identity Disorder, however, is that DID is nearly always caused by a traumatic experience–such as an accident, disaster or crime victimization. Dissociation helps a person tolerate more than what he/she normally could. A person may mentally escape from the fear, pain and horror–which may make it difficult later to remember/recount the details of the experience.

Although there is so much we do not know about DID, we do know some things about DID:

  • Dissociation is present in all races, but is more common in American children.
  • Females experience more childhood abuse than males at a ratio of 10:1 and thus more females suffer from DID.
  • However, more males who have been abused may experience pathological dissociation.
  • Dissociative identity disorder is typically caused by trauma occurring at less than nine years of age.
  • Early age of abuse onset predicts a greater degree of dissociation.

DID is nearly always the aftermath of some form of trauma. Multiple personalities are unconsciously created in order to shield and protect the individual from reliving and remembering the traumatic experience. Sometimes these personalities can lay dormant as life stabilizes, but may manifest themselves during stressful periods of life. There is no medical attention formulated specific to DID; the recommended methods of treatment include the following three steps: 1) stabilization, 2) trauma-work and 3) integration. Dissociative patients who are not appropriately treated or who attempt to treat themselves tend to get worse and DID then becomes one of the most difficult to treat psychiatric conditions. Alternate personalities do not integrate spontaneously; treatment is necessary. Untreated DID tends to leave the sufferer vulnerable to to further trauma.

As with nearly all mental illness, there is a stigma associated with multiple personalities. We need to remember that this is a natural coping mechanism for those who have experienced intense trauma. The way I see it, those people who have DID are courageously fighting to survive and overcome past trauma. This means that functional, high performing, otherwise healthy individuals can experience DID depending on their childhood history. Mary Higgins Clark wrote a book called, All Around the Town where Laurie, the protagonist, is kidnapped at a very young age. She develops DID to face the sexual and emotional abuse she endures. After her release two years later, and the ensuing stabilization of her life, her multiple personalities subside for a time, only to reemerge after being triggered by her parents’ tragic deaths, causing her to confront the horrors of her past in order to heal. This book was incredibly interesting; I likely dissociated into Laurie’s world as I allowed myself to be fascinated by the manifestation of her mental illness!

My hope for those with DID and any other mental illness, is that they can find healing and hope. I never judge my clients facing these difficult challenges. It is important to remember that SPLIT was incredibly dramatized, and that the individuals with DID are just seeking to cope with life. It is likewise important to keep in mind that we all dissociate to some degree as the stresses of life close in on us! As previously stated, the best methods of treatment for Dissociative Identity Disorder is therapy, eye movement desensitization and reprocessing (also known as EMDR–of which I am trained in), and medications to treat depression or related symptoms. As with all mental illnesses, DID is not a life sentence.  Address the trauma that originally led to intense dissociation is the first step.  I am passionate about helping you find hope and healing. Please contact me today or click here to schedule a session.

Melissa Cluff is a licensed marriage and family therapist based in Lewisville, Texas, personally seeing clients in the North Dallas area.

Resources:

Life After Trauma

A traumatic experience can leave a person feeling broken, angry, hateful, useless, and/or depressed. With time and the appropriate therapy, survivors of trauma can go on to feel strength, forgiveness, empathy, purpose and happiness. Recovery is possible, and lessons learned in the furnace of affliction can go on to be a great strength in a survivor’s life.

Last summer, I wrote a post about being a secondary survivor: those who are the family or loved ones of someone who suffers a traumatic experience. I wrote about how difficult it can be for secondary survivors to watch their loved one struggle and deal with the aftermath of the trauma. I wrote about ways that secondary survivors can help their loved ones as he/she works to overcome their trauma, and offered specific suggestions for things to say to those who have experienced trauma. This post is dedicated to the survivor; although you may feel bruised and broken from the storm you have endured, as you look ahead, you can find your rainbow.

Let’s first define trauma. Trauma is broadly defined as something that produces psychological injury or pain. A traumatic experience can include (but is not limited to) divorce, rape, kidnapping, abuse (physical or emotional), natural disasters, fires, accidents, illness, bereavement, war, etc. Common reactions to trauma include anxiety, trouble sleeping, nightmares, flashbacks, OCD, PTSD (post-traumatic stress disorder), strained relationships, and unpredictable behaviors. In short, the aftermath of a traumatic experience can affect a person’s very being–including his/her daily walk and talk.

Although it may not feel like it immediately after the event, there is life after trauma. In fact, a difficult event can often lead to growth! We see this modeled in nature–majestic rainbows appear after torrential rainfall; butterflies emerge from their cocoon only after the caterpillar disappears as if dead in the cocoon; and even after the coldest of winters, flora and fauna reemerge or blossom for springtime. There are positive outcomes to come out of the wake of trauma; allow me to enumerate a few:

  • Recognizing strength. One of my friends experienced a horrible car accident where not only was she physically injured, but her friend’s life was lost. My friend’s rehabilitation took time, but she summoned the strength to face each day, took the time for both physical and emotional therapy, and is flourishing today. Trauma can teach us about our strength–how much we can endure and withstand giving in. Not only that, but once that strength is found, it is difficult to refrain from applying said strength to other situations. Survivors of traumatic situations tend to use their enhanced resilience to bounce back from opposition better than their pre-trauma selves.
  • Extending forgiveness. It takes incredible courage to be able to forgive the person who rapes you, abuses you, or crashes into you. But holding on to anger, hate, and frustration cankers the soul; when we let go of being wronged, we release bitterness and resentment that is poison to us. It is liberating to forgive, and often the forgiver receives more benefits than the person who is forgiven!
  • Feeling empathy. Experiencing trauma firsthand connects us to so many others who have faced hardship. Until we experience trauma, it can be difficult to really understand what other people are going through, what they are thinking, or what they really need to heal. The connection and compassion a trauma survivor gains provides a further source of strength, as well as, the ability to strengthen, connect with, and comfort others.
  • Finding purpose. Many survivors find that living through a traumatic experience awakens a passion or a deep purpose within them. Elizabeth Smart–who was kidnapped at age 14 and survived nine months in captivity–has used her horrifying experiences to become advocate and published author, traveling around the world bringing awareness to others. Sometimes, the darkest moments of our lives can inspire us to serve others.
  • Enjoying life. One of my clients has survived two deployments to Afghanistan. Although he faces understandable bouts of PTSD, he has found such vigor for living, and gratitude for life. To be alive in a functioning body is an amazing thing. Sometimes traumatic experiences help us enjoy aspects of life we had previously taken for granted.

Trauma is hard, scary, overwhelming. Surviving trauma, however, can teach you things you never knew about yourself, can help you comfort those similarly struggling, can awaken purpose and gratitude for living, and so much more. You may walk away from your trauma a better, changed person. As Viktor Frankl said, “When we are no longer able to change a situation, we are challenged to change ourselves.” Often, those changes can result in positive growth.  If you can wade through the storm your trauma puts you in, you will be able to look around after the storm passes to see how far you’ve come, see the beauty in your struggle, and see all the more clearly where you are going. You may even see that hopeful spectrum of light Issac Newton classified as a rainbow.

It takes time and work–sometimes both physical and emotional–to get to the other side of trauma. I am a qualified and experienced advocate; I can help you work through the effects of trauma. Please contact me today or schedule your first session and let me guide you as you write your story of life after trauma.

Melissa Cluff is a licensed marriage and family therapist based in Lewisville, Texas, personally seeing clients in the North Dallas area.

Resources:

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When the One You Love Most Hurts You

Partner Trauma - Cluff Counseling - Dallas TherapistWhat happens when the person you would normally turn to is the one who betrayed your trust? You understandably feel deeply hurt, a great level of sudden distrust, and the desire to increase distance between you and this significant other. Partner trauma is real and it requires help in order to heal–both individually and in your relationship. If you or someone you know is experiencing partner trauma, help is available.

What exactly is partner trauma? Let’s begin by defining trauma. Trauma is the unique and personal experience of an event, a series of events or a set of enduring conditions that has the effect of overwhelming the person’s ability to integrate and regulate his or her experience at the levels of sensorimotor (body), cognition (thoughts), and emotion (feelings). In order for me to adequately explain the specifics of partner trauma, we need to take a step back and evaluate connection and our need for healthy, stable relationships.

At our core, we are all wired to connect with others; we begin as babies where we are entirely reliant on our caregivers. As we grow and gain independence, we look to others for comfort, guidance, support, and love. The children in Romanian orphanages, who are not given the opportunity to form meaningful relationships with caregivers and are deemed “unable to thrive” by healthcare professionals, are examples of how the lack of connection with others affects us greatly–physically, mentally, and physiologically.

We never outgrow our need for connection; adults need connection as much as small children do. As stated in my previous blog about connection, humans are wired for attachment! Answer the following questions about a significant relationship in your life:

  1. Will you be there for me when I need you the most?
  2. Can I count on you?
  3. Do I matter to you?
  4. Am I a priority in your life?
  5. Will you value me and accept me even with my imperfections?
  6. Will you stay close to me?

Answering yes to any of the above questions signals healthy attachment; whereas responding “no” to one or several could be indicative of relational trauma. When the person you once relied on, cared for, confided in, trusted and/or loved, no longer fills that role in your life, due to their actions, you are experiencing partner trauma.

Partner trauma (commonly known as relational trauma) has many faces; your partner could be an addict, involved in an affair, or ignored your needs at a time you needed him or her the most, such as a miscarriage, or loss of a job, etc. The common denominator, though, is that the stressor causes a traumatic attachment injury for one of the partners. The person you have leaned on for connection, comfort and support is the one you feel abandoned by. These feelings disrupt your relationship and your entire life. The person you have been the most vulnerable with may suddenly feel dangerous and unsafe. Relational trauma overwhelms the coping strategies you have in place and if not attended to, can appear to define you and how you see the world.

It is important to note that in the majority of cases, the person bringing the hurt into your life is not doing so intentionally; he or she is not trying to cause you emotional harm, although their actions have directly negatively impacted you. The deeper your relationship is with the one who hurts you, the more traumatic the experience and lack of trust will be. How you find out about the betrayal, how long it has been taking place without your knowledge, and your trauma history also factor into the symptoms you may experience. The following are some of the most common symptoms of trauma: fear, anxiety, outbursts of anger or rage, hypervigilance (excessive alertness or watchfulness), irritability, worrying/ruminating, intrusive thoughts of the trauma, tendency to isolate, difficulty concentrating or remembering, feelings of panic or being out of control, increased need to control daily experiences, difficulty trusting, feelings of betrayal, feelings of self-blame or responsibility, numbness, feelings of helplessness, minimizing the experience, feeling detached, concern of over-burdening others, under- or overeating, shame, shock, diminished interest in everyday activities, withdrawal, and preoccupation with body image.

Although relational trauma is not as visible as physical trauma–like being a victim of rape, bullying, or domestic violence–it leaves scars that take a great deal of time to heal. Relational trauma causes a ripple effect in all aspects of your life and influences how you see and treat people, yourself included. It is important to resolve relational trauma and work through it (both with your partner and also on an individual-basis) alongside a trained, experienced therapist. I have counseled many couples through varying degrees of relational betrayal and, while it is never easy, I can attest that couples that come out on the other side have some of the strongest marriages that I have seen. Everyone makes mistakes and we all need second chances. Healing is possible. Please contact me today to schedule your first appointment.

Melissa Cluff is a licensed marriage and family therapist based in Lewisville, Texas, personally seeing clients in the North Dallas area.

Resources:

What You Need to Know About Trauma

Cluff Counseling - Childhood TraumaMary J. Blige was only five years old when she was sexually abused. The trauma of that experience has followed her all of her life. She blamed herself for the molestation, felt great shame, believed she had no worth, and eventually struggled with alcoholism before finding hope and healing for her childhood trauma.

A quick look in the dictionary will render a simple definition of trauma: a deeply distressing or disturbing experience. The American Psychological Association describes trauma as an emotional response to a terrible event like an accident, rape or natural disaster. There are two types of trauma: big “T” trauma and little “t” trauma. An example of big “T” trauma would be rape or war; this type of trauma threatens one’s very life and safety, and often result in post-traumatic stress disorder (PTSD). Examples of little “t” trauma would be being teased in elementary school, always being picked last for a team, divorce, death of a beloved pet, losing a job, or losing friends by moving during childhood. Although little “t” traumas are more common, they can be just as life-altering as big “T” traumas. The majority of my clients have experienced some degree of trauma and need assistance to overcome the accompanied shock, denial, unpredictable emotions, flashbacks, post-traumatic stress disorder (PTSD), strained relationships and even physical symptoms like headaches or nausea. Although these feelings are normal responses to trauma, they can be quite unsettling and can make it hard to function. To heal from the effects of trauma, it is important to seek help with a properly trained, licensed counselor. The ramifications of not seeking and receiving adequate care can be far-reaching.

Mary J. Blige is not the only celebrity who has spoken publicly about their childhood trauma. A short, non-comprehensive list of familiar faces who have faced trauma include Eminem, Missy Elliott, Nicki Minaj, Charlize Theron, Christina Aguilera, 50 Cent, Ashley Judd, Queen Latifah, Jim Carrey, Drew Barrymore, Angelina Jolie, Shania Twain, and even Oprah. It is possible that your neighbor experienced trauma early on in life, or your spouse, or even you yourself! According to the Mental Health Connection, 60% of adults report experiencing abuse or other difficult family circumstances during childhood and a whopping 60% of youth, age 17 and younger, have been exposed to crime, violence and abuse either directly or indirectly. Although some think children and adolescents are too young to remember or be affected by trauma early on in their lives, the above facts provide evidence that people DO remember and are affected by events early in their lives.

Every child responds to trauma differently. Some will have no ill effects, while others may suffer immediate and acute effects. Still others may not show signs of stress until some time after the event. According to the Mental Health Connection, those who experience childhood trauma are…

  • 15 times more likely to attempt suicide
  • 4 times more likely to become an alcoholic
  • 4 times more likely to develop a sexually transmitted disease
  • 4 times more likely to inject drugs
  • 3 times more likely to develop depression
  • 3 times more likely to have serious job problems
  • 2.5 times more likely to smoke
  • 2 times more likely to have a serious financial problem

As if those figures are not frightening enough, early trauma affects brain development. Earlier this year, a study was published which measured the impact to the brain after trauma. Researchers scanned the brains of 59 youth, ages 9-17, and found statistically significant evidence that traumatic stress leads to premature aging of the brain.

So how can we address it? How can we help our children–or ourselves–properly process, deal with, and move through the effects of trauma? Come and see me. Getting help from a certified, licensed therapist is an essential step of recovery. Other ways to start healing from trauma is by talking–and even writing–about it. This can bring clarity, raise immunity, and improve life functioning. Play therapy is also an option (for children); this is a method of therapy where the child can draw, paint, and use any type of play as a means of encouraging expression/communication of their feelings. For teenagers and adults, EMDR and Cognitive Behavioral Therapy are commonly used to successfully treat trauma.

Clinicians and philosophers have tried countless ways of treating trauma and anxiety in order to find, as the philosopher Seneca called it, tranquillitas, or peace of mind. It takes time and work, but it is possible. My heart aches hearing about the trauma my clients have experienced, but I feel so satisfied as I witness them find freedom from the emotional bonds that accompanied their trauma. If you or someone you love is carrying this heavy burden, please contact me today.

(If you are a parent, you may be struggling with how to talk with your children about a traumatic experience in their lives. This article is for you.)

Resources:
American Psychological Association, “Trauma”
Cluff Counseling: “Are You are Secondary Survivor?”
Cluff Counseling:  “Choosing the Right Therapist for You”
Cluff Counseling: “What is Trauma?”
Education Development Center: “Promote Prevent”
Mental Health Connection, “Recognize Trauma”
Molecular Psychiatry, “Preventing intrusive memories after trauma via a brief intervention involving Tetris computer game play in the emergency department: a proof-of-concept randomized controlled trial”
Psychology Today: “What Childhood Trauma Does to Brain Development”
Psychology Today: “What is Trauma?”
VH1: “These Celebrities’ Horrific Childhood Stories Will Make You Hug Your Parents Tightly”