Sometimes you don’t know which mountain you are training for

My dad, a fit, active, and adventuresome man, announced that for his sixtieth birthday he wanted to hike Mt. Kilimanjaro and he wanted his kids to do it with him.  So, the August I was 36 years old, we flew to Tanzania and started our six-day journey to the highest peak on the continent of Africa at 19,341 feet, led by our charismatic guide, Dismas.  Much to our dismay, Dismas insisted that we shuffle up the mountain, frequently shouting to us, “pole, pole,” or Swahili for “slowly, slowly.”  All six of us made it to the summit by simply putting one foot in front of the other, slowly, slowly, and I embraced a life lesson that would prove to be invaluable as I soon faced a challenge that was even harder than summiting Mt. Kilimanjaro.

“Pole, pole,” or Swahili for “slowly, slowly.”

Six months later, I was diagnosed with Multiple Sclerosis.  I lost most strength and sensation on my left side, and I went from feeling strong and capable to weak and helpless; I had summited the highest mountain on the continent of Africa and now I couldn’t even get up a single flight of stairs!  It was difficult to reconcile these conflicting self-concepts.  Further, I was frightened about my future.  Would I be able to do the things I loved again? How would this affect my children, who were then eight and ten? Did other people, including my husband, see me differently than before?  This period in my life was fraught with loss.  I literally lost my ability to do things.  I had a hard time cutting my food or opening the tab of a drink can, and I certainly wasn’t able to do the physical activities I loved, like hiking or riding my bike.  But of more significance, I lost my sense of self.  I wasn’t sure who I was anymore.

Chronic illness diminishes self, it disrupts one’s personal narrative, it distorts power, control and intimacy, and it narrows one’s domains.  Together, these impacts lead to an overall loss of self, or a change in who we think we are and how we are experienced by others.  Further, a person who has a firm sense of who they are is more likely to fully experience loss of self.  More specifically, loss related to chronic illness describes “the loss of a person as they once were (Weingarten, 2013, p. 86).”

This explanation of loss related to chronic illness resonates with me because it describes the loss I experienced.  I was diminished because I could no longer do certain things, and I felt less capable and more dependent.  MS disrupted my personal narrative as a strong, physically active person; the stark contrast of having just summited Kilimanjaro definitely made this all the more significant.  My sense of power and control was hugely disrupted; up to that point I believed I could control my life by simply willing it to be a certain way.  Intimacy was a problem for me as I had difficulty talking about my feelings; if I couldn’t be physically strong at least I could appear to be mentally strong, and I wanted to protect my family from more worry about me.  My domains had been narrowed; I wasn’t participating in many of my normal activities, like walking with a group of women, and I didn’t want to go to social events because I didn’t want people feeling sorry for me.  Simply put, I was no longer the person I once was.

Chronic illness can lead to stress and anxiety with long term psychological and physical impact, called post-traumatic stress.

Interestingly, loss, defined as “negative events and their sequalae” is identified as the opposite of growth, or “positive transformation,” and growth is a buffer against post-traumatic stress.  Further, loss and growth can occur simultaneously in the face of chronic illness, though they are independent of one another (Gloub, Gamarel, & Rendina, 2014).

I definitely experienced both loss and growth simultaneously.  I felt great loss surrounding my new physical limitations while at the same time experiencing growth related to my ability to cope and adapt.  I began to value myself as mentally strong versus physically strong.  This helped me regain a sense of power and control and develop a new self-concept, and eventually to see my new self-concept in a positive light.  And, as I felt more positive about myself, despite not being the same person I once was, I began to experience my physical symptoms differently.  This is not unusual; the less self-loss a person experiences, the fewer physical symptoms they report (Gloub et al., 2014). The post-traumatic growth I experienced served as a buffer for me and decreased further loss of self.

I read an opinion piece from NBC news about John McCain’s death that is relevant to thinking about trauma and loss and chronic illness; the author (Baig, 2018) takes issue with people using what he calls martial language to describe how people manage illness.  He says, “McCain did not lose his battle with cancer – because cancer is not war.”  He believes statements like these suggest that death from illness is a personal failure.  I absolutely agree.  In reality, there is little to no correlation between what Baig calls a “fighting spirit” to recovering from cancer and other chronic illnesses; sometimes in life you are just dealt a bad hand.

I remember when I was first diagnosed with MS, people told me I would be all right because I had such a positive attitude.  I would think, “Well, I have always had a positive attitude and it didn’t prevent me from getting MS in the first place.”  Then I would wonder if people would think it was my fault if I didn’t do well, and it made it even more difficult for me to talk honestly about how I was feeling.

As a therapist, I think it especially important to choose language carefully so that in no way do we imply that it is our client’s responsibility to “beat” an illness.

While I understand the value of a good metaphor, this is one I will avoid so to never mistakenly engage in what can feel a lot like victim blaming.

As some of my friends predicted, I have done all right, but not just because I willed it to be so.  Rather, I had lots of social support and access to high quality health care.  I started injecting interferon immediately – a drug that costs my insurance company about $80,000 per year – as well as taking good care of my body.  I began seeing a therapist.  I started physical therapy.  I started going to the climbing gym because it seemed like a good way to regain strength on both sides of my body.  And, I am sure that my positive attitude helped me cope with my disease even if it didn’t cure it.

I wish I could have known then what I know now.  I have regained most of my strength and many days I don’t have any MS symptoms at all, and I live an active and healthy life.  I feel more resilient and competent and well-rounded, and I know I am physically and mentally tough.  I also know how much I drew from my experience hiking Kilimanjaro.

I learned that just like I was able to summit Mt. Kilimanjaro by going slowly, slowly I would also learn to adapt to MS, by simply putting one foot in front of the other.  I had no idea that when I training to climb Mt. Kilimanjaro, I was also training for a different mountain altogether.



Baig, J.  (29 August 2018).  Opinion:  John McCain did not “lose” his battle with glioblastoma – because cancer is not a war.  NBC News. Retrieved from

Golub, S. A., Gamarel, K. E., & Rendina, H. J. (2014).  Loss and growth: Identity processes with distinct and complementary impacts on well-being among those living with chronic illness.  Psychology, Health & Medicine.  19 (5) 572-579.

Weingarten, K.  (2013).  The “cruel” radiance of what is”:  Helping couples live with chronic illness.  Family Process. 52 (1) 83-101.




Impacts of Chronic Illness

The impacts of chronic illness can have a negative effect on individuals due to the accompanying stress and anxiety. When this stress and anxiety is enduring and prevents a person from returning to their baseline functioning, it is called post-traumatic stress.

Post-traumatic stress has serious implications for people with chronic illnesses.


  • More bothersome symptoms
  • Increased depression
  • Increased utilization of medical care


  • Embitterment, including bitterness, defeat, anger, hostility
  • Demoralization including hopelessness, helplessness, isolation


  • Isolation
  • Alienation
  • Stigma

With therapy, people with chronic illness are more likely to experience post-traumatic growth, which is the process of positive transformation after a trauma.


Post traumatic growth has been shown to improve people’s mental health, their overall health status, and how they experience their symptoms.


Many people report positive self-growth as a result of adapting to chronic illness. Therapists can help their clients with chronic illness achieve post-traumatic growth many ways, depending on the time and progression of the illness:

At time of diagnosis:

  • Encouraging social support
  • Offering understanding that is free of guilt or blaming
  • Providing psychoeducation
  • Providing a sense of safety
  • Bringing awareness to potential impacts on biological, social, and psychological aspects of life

In transitional periods of life:

  • Encouraging social support
  • Providing psychological support


  • Providing continued psychoeducation
  • Encouraging continued social support
  • Providing continued psychological support
  • Increasing cultural and social awareness
  • Respecting the individual’s self-management

I am especially interested in working with clients and their families who are affected by chronic illness.  My first career was as a nurse and I have personal experience with chronic illness. Reach out if I can support you, your partner, or your family as you deal with chronic illness.





Trauma and Rumination

The shooting at the King Soopers in South Boulder last week was, at the least, a distressing and deeply disturbing experience. By definition, it was traumatic, in one way or another, to practically every member of our community. Someone I know who regularly shops at the King Soopers commented “I can’t get it out of my head.”  She described vigilantly reading every news story, compulsively checking for new tweets that might provide updated information, and repeatedly talking about the details of the shooting with her partner. She even described lying awake at night, while she imagined walking down each of the aisles of the store and trying to picture the horror that unfolded in them.  

She wondered why was she doing this? Shouldn’t she be trying to avoid thinking about this awful and upsetting event?  Yet, she described these thoughts as intrusive and out of her control, no matter what she did to distract herself from them. The clinical term for this is rumination. 

Actually, what my friend is describing is perfectly normal. In fact, it is the first step to healing from a traumatic event. According to trauma experts, revisiting the trauma and rumination are part of the cognitive process through which new insights emerge that lead to meaning making and posttraumatic growth. Meaning making is comprehending an event and acknowledging its significance.  Post-traumatic growth is new ways of viewing ourselves and the world after a traumatic event (Werdel & Wicks, 2012).  

In other words, we let our minds think about a traumatic event in an effort to understand what happened, and this helps us regain a sense of control over the event. Maybe we imagine what we would do differently during a traumatic event or why it could not happen again. We tell ourselves stories to explain how such a thing happened, and we try to fill in any gaps with actual or imagined information, so the story makes sense to us. We also consider why the traumatic event matters to us. We might think “I feel sad because I know what it’s like to lose a loved one.”  Then we begin to develop new assumptions, such as “I need to take these precautions to stay safe” or “I am braver than I realized.”  Talking to a therapist can help you work through this process. 


It’s not about the Zoo!

Showing up, is a way to show affection to our kids. I was talking to a friend over coffee this morning about how challenging it is to organize family get-togethers now that the kids are grown and out of the house. We miss the days when the kids were younger and our lives were structured around their activities – a Saturday bike race, an after-school climbing practice, or maybe a Sunday evening Scout meeting.  We just showed up at the right time, at the right place, with the right gear … and we were good.  There was no debate about what to do, when to do it, or whether or not we wanted to do; it was decided for us, and either we showed up or not.  And, by just “showing up” we showed our kids they were loved. 

Recently, her grown son told her – a little sheepishly – he wanted to visit the zoo. He said he hadn’t been to the zoo in years and it sounded like fun. So, she and her son agreed to go to the zoo that weekend. Later, she asked her husband if he wanted to join. He declined. In fact, he could not imagine why a grown adult would want to wander around the crowded, noisy zoo in the blistering sun if they didn’t have to! 

She got what her husband was saying – the zoo did sound hot, crowded, tiring, and even a little stressful. And, we all have our preferences for where and how we spend our precious weekends. For him, the zoo was not it. But she couldn’t help feeling hurt and disappointed, and she wondered why.

Well, because it isn’t about the zoo at all!  Rather, it is about showing up.  Even if it was the last place in the world they wanted to be, their son could count on his parents being on the sideline of his soccer game in cold, drizzling rain, or in the audience of the world’s longest spelling bee in the sweltering school auditorium. Just “showing up” was a way they showed him he was loved.

The circumstances may have changed, but it’s still just as important to “show up” for your family members. Sometimes this is as simple as putting down your phone and really listening to what someone is telling you and other times it’s agreeing to do something that is not your first (or second, or third) choice, like going to the zoo! It may be harder these days to figure out what “showing up” looks like in the absence of recitals, practices, or performances, but being deliberate to spend time with your family members is an important way to show them they are loved. 

Let’s talk about ways you can “show up” in your relationships!



The Therapeutic Alliance and Couples Therapy

The therapeutic alliance can be a tricky thing to navigate when working with couples!

The challenge lies in balancing the needs of one person against the needs of another person while tending to the health of their relationship. The therapeutic alliance consists of the therapist-client bond, agreement about therapeutic goals, and agreement about the tasks of therapy (Wampold, 2015).  

The therapeutic alliance is at the heart of therapy.  It is through the therapeutic relationship that healing takes place, and the therapeutic alliance fosters the belief and trust in the efficacy of therapy. This requires the therapist to continuously monitor the therapeutic alliance by directly asking clients about their experience, watching for nonverbal cues, and balancing their focus between both partners. Even more importantly, the couple’s therapist recognizes the couple rather than the individuals as the client.  This is important because it identifies the relationship as the source of dissatisfaction rather than the individuals.  As your couple’s therapist, I promise to do all of the above.  


Trauma and Making Meaning

Trauma and making meaning have a very strong correlation.

Trauma disrupts a person’s sense of meaning. There are two types of meaning.  The first is situational meaning, or the meaning a person gives to a specific traumatic event. For example, someone might explain a traumatic event as “an accident.” The second is global meaning, or how a traumatic event fits into a person’s overall view of life. For example, someone might say “I believe everything happens for a reason.” However, after a traumatic event, these two types of meaning may be at odds.  That same person may wonder why an accident happened if they cannot make sense of the reason it happened, especially if they believe the event should have led to greater understanding or an unpredicted better outcome but that is now what they are experiencing. 

After a trauma, there are often discrepancies in one’s belief systems that are resolved either by a person’s ability to incorporate the trauma into their global beliefs or by altering their global beliefs to include the possibility of the trauma (Werdel & Wicks, 2012, p. 62). Therapy helps a person resolve this conflict that a traumatic event might create through in-depth exploration of both their situational meaning and global meaning. 

Contact Christin P Bellian


How are families like mobiles?

I like to use a metaphor popular in Satir theory to prepare families for some discomfort as we move through the therapeutic process.  Virginia Satir compares the strings of a mobile to family rules about what and how family members communicate.  She says, when the strings of a mobile are at the correct lengths, the mobile achieves balance, but if the lengths of the strings change, the mobile is no longer balanced (Satir, 1988).  Similarly, we assume roles and communicate with our family members in ways that maintain family balance.  In other words, we do what we have always done.

I like to tell my clients, “Like the strings of the mobile, if just one family member’s patterns of communication or ways of behaving are different, the family is out of balance.

In therapy, we are going to try different ways of communicating, which might get uncomfortable.”


Solution Focused Theory for Couples …. Easy as Pie!

Solution focused therapy (SFT) is an excellent choice for working with couples.  For one, couples determine what is or is not a problem in their relationship.  I know I would not want another person determining what is a problem in my own relationship, and I certainly would not want to make that determination about someone else’s relationship.

By using different skills or traits, couples can have different experiences.

SFT uses strengths couples already possess to find solutions to their problems.  By using different skills or traits, couples can have different experiences.  I help couples discover their strengths and put them into action.

SFT uses “the exception question” to help couples identify when the problem is not happening and to appreciate what is different about those times. I use this technique to help couples recognize and disrupt their dysfunctional patterns.

SFT sees couples as caught up in problem-saturated versus solution-building narratives. I help couples change the conversation around their relationship which can change how they experience it.

Finally, I like SFT because of its simplicity.  SFT has just three guiding rules:

  1. Do not fix it if it is not broken.
  2. Do more of what works.
  3. Do not do what does not work.

Easy as pie!


What is framing in family therapy?

Framing is retelling the problem in a new way that is useful to the individual and family (Combrinck-Graham, 2014).

Why is framing so important to therapy?  Framing in family therapy helps people consider experiences not just from their own perspective but also from the perspective of other family members.  Framing help clients identify factors they may not have previously considered, which can alter their perceptions of a situation and encourage new or different ways of dealing with a problem.

Framing can help people see change as an opportunity for growth and to encourage people to adapt instead of reacting.

Framing helps people experience an event from a broader context; this is important because how a family is impacted by an event is more about how the individual and family relates and reacts to the event than the event itself.

Talk to Christin P. Bellian


Why is self-esteem so important?

Self-esteem, or self-worth,  is “the ability to value one’s self and to treat one’s self with dignity, love, and reality,” says family theorist Virginia Satir (1988).

Without high self-esteem, people value the thoughts, feelings, and needs of others more than their own, but this denies a person of their own thoughts, feelings, and needs.  People need to know what they think, feel, and need in order to get their yearnings satisfied.

Through therapy, we will explore your thoughts, feelings, and needs, and we will discover your yearnings.

We will work on making the changes in your life that help you satisfy your yearnings. We will find the self-esteem that already resides in you so that you believe you are deserving and worth it. You will treat yourself with dignity, love and reality.

Talk to Christin