Author: Amy Ratkovich

  • What Does It Mean to Truly Relax? | Somatic Self-Care

    How to relax and truly unwind, illustrated by a peaceful black cat resting with eyes closed

    National Relaxation Day is, this coming weekend, August 15th, which seems like a good excuse to ask a deceptively simple question:

    Do you actually know how to relax?

    Have you ever gone for a massage and been so tense that the massage therapist asks, “Why are you so tense?” Maybe you didn’t even realize you were that tense until they asked you. The funny thing about tension is that when you’ve been carrying it around long enough, it doesn’t necessarily feel like tension anymore.

    It just feels normal.

    Most of us know what we mean when we say we’re going to do something relaxing. We watch television. Scroll through our phones. Play a game. Read. Shop. Have a drink. Go on vacation. Many of these have one thing in common: a focus on the external world.

    Some of those things may genuinely help us relax, as sometimes looking away from a stressor for a little while can help. But it doesn’t necessarily help when you have to face that stressor again. Perhaps true relaxation that builds resilience requires something opposite from these external pursuits.

    Are You Relaxing—or Distracting Yourself?

    There is a difference between getting relief from stress and actually entering a more relaxed state. The distinction has become increasingly interesting to me in my work as a therapist. I’ve watched people begin to recognize that some of the things they reach for when they’re stressed can actually leave them more stimulated. A screen can temporarily take your mind off whatever is bothering you while simultaneously giving your brain an entirely new stream of information to process, at times having the opposite effect from what you intended.

    You may no longer be thinking about the thing that stressed you out, and that temporary relief can feel good. But do you ever stop to ask, “What’s happening in my body right now?” What’s happening in your jaw, your neck, your shoulders? Do you notice the effects of your breathing patterns? Does your mind feel more full or less full? Louder or quieter? Is there more “space” inside you? Or do you simply want the next thing?

    This isn’t an argument that television, phones, games, or other distractions are bad. Sometimes distraction is useful, especially if you feel like a raw nerve. The problem tends to arise when that is the only strategy you have to relax because at some point, your inner cup will become too full and the steam will come out one way or another. Sometimes we need to go deeper and take a different approach in order to truly relax.

    “You Need to Relax”

    Have you ever noticed how irritating it can be when someone tells you to relax? Perhaps that’s about more than simply not liking being told what to do. Some part of us may intuitively understand: Just saying it doesn’t make it happen.

    “Relax.” “Calm down.” “Don’t worry.” “Go to sleep.”

    These are instructions directed toward states that aren’t particularly responsive to commands. Perhaps the instruction is coming from the wrong person and being directed toward the wrong part of you—your mind rather than your body, the part that needs to relax.

    Someone else telling your thinking mind to relax rarely has the effect they want it to have anyway. These instructions may work better when they come from ourselves, to ourselves.

    Despite this, the irritation you experience when someone tells you to relax may also be telling you that they’re right. So perhaps the self-caring thing to do is not reject the message simply because it irritated you, but to find a quiet corner for a time-out so your body can discover how.

    Relaxation Is a State, Not an Activity

    So perhaps relaxation isn’t best defined by what you’re doing. Instead, perhaps it’s about noticing what is happening inside you and learning how to use your breath as a kind of pressure-release valve.

    Your autonomic nervous system is continually helping your body respond to changing demands. Stress and perceived threat can mobilize us for action, while parasympathetic processes support settling, restoration and recovery. Robert Sapolsky explores the consequences of prolonged human stress beautifully in Why Zebras Don’t Get Ulcers. Unlike a zebra responding to an immediate predator, human beings can generate and sustain stress responses through memory, anticipation, relationships, work, uncertainty and thoughts about things that haven’t even happened yet.

    Our bodies participate in all of it, and that brings us back to that massage table. You may not consciously be thinking, I’m under threat, but your jaw might have something to say about that—along with your neck, your shoulders and the pace of your breathing.

    What Happens When You Stop Running From Tension?

    Our natural response to discomfort is often to get away from it. Something uncomfortable arises internally and our attention moves somewhere else. Sometimes that’s exactly what we need in the immediate moment to get through something.

    A problem can arise when we don’t return later to be with that charge.

    If distraction becomes our primary means of regulating ourselves, we don’t get much opportunity to discover a way to provide not just temporary relaxation, but relief from stress in a deeper, somatic way. This is where my understanding of how to relax intersects with somatic work. Instead of immediately asking, why am I tense?

    I often begin somewhere much simpler:

    What am I experiencing in my body right now? Maybe there is pressure or tightness in your shoulders or neck. Perhaps you feel hot, heavy, restless, notice a clenched jaw or become aware of shallow breathing. These can all be subtle signs of stress.

    You don’t have to understand the sensation yet. You don’t even have to change it.

    First, you have to notice it.

    The Way Out May Not Always Be Away

    One of the ideas that influenced the way I work with internal experience comes from meditation practices described in The Mind Illuminated: learning to distinguish an unpleasant sensation from our reaction to that sensation.

    That distinction—and the fact that we have a capacity for self-reflection and self-influence—often gets lost under stress and pressure. Later, however, comes the rumination. What would it be like to stay out of the story and just “be with” that unpleasant sensation? What would it be like to stop running from the signal and turn toward it, remaining present with it without judgment? That doesn’t mean overwhelming ourselves or forcing ourselves to endure something intolerable. It means becoming curious about what is happening and discovering whether we can stay in contact with ourselves for another breath, and then another, just right here, right now.

    This is one reason I use breath and body awareness in therapy—and to manage my own stress.

    Learning to Relax by Attending to Yourself

    Years ago, while studying holistic health at San Francisco State University, I was introduced to practices including autogenic training, visualization and other approaches to mind-body awareness. Over time, those ideas became integrated with my training and work as a therapist.

    One of the things I teach people is remarkably simple: Attend to yourself.

    Not analyze yourself. Not fix yourself.

    Attend.

    The breath gives us somewhere to begin. We can slow down and notice what’s happening in the body while using the breath as an anchor for attention. Breathing is one of the few body processes that happens automatically and can also be consciously influenced. Thus, it can become a bridge to our internal world—physically, but also mentally, emotionally and perhaps even spiritually. Something interesting can happen as we become more capable of tolerating sensation: we may become more capable of tolerating what emerges alongside it.

    Can You Tolerate Not Knowing?

    Internal sensations can be strange. They don’t always arrive with explanations. A tight chest doesn’t come with a little label explaining precisely why it’s there. That means body awareness also asks us to develop another capacity: Can I experience something without immediately knowing what it means?

    That tolerance for the unknown can become a doorway. The body gives us a sensation. Attention allows us to remain with it by gently bringing our attention back to the breath, without judgment, when we notice we’ve wandered off.

    Gradually, something that had been outside our awareness may become available to us. This is where somatic work begins to meet psychodynamic work. Instead of immediately explaining away our experience, we become curious about what may be underneath it.

    Relaxation and the Process of Becoming

    This also connects with psychologist Carl Rogers’ idea of becoming increasingly open to experience.

    Being open to experience requires some capacity to tolerate the experience you’re opening yourself to. Somatic work can provide a bridge that helps us tolerate our inner experiences when we have experienced trauma, have reasons to be anxious, or perhaps our wiring is simply more sensitive than most, as can sometimes be the case for highly sensitive or neurodivergent people.

    If your internal world feels overwhelming, frightening or foreign, shutting it out makes sense. So does distraction. Being defensive sometimes makes sense too.

    These ways of being have been doing something for you.

    The goal isn’t simply to rip those protections away. The work is to develop enough capacity that they aren’t always necessary anymore.

    As we become better able to experience sensations, feelings, perceptions and thoughts without immediately becoming overwhelmed by them, we create more room for what Rogers described as the ongoing process of becoming.

    There is more of ourselves available to us. And perhaps that’s one reason genuine relaxation can feel so spacious. We’re using less energy fighting ourselves.

    Even if you’ve got it all going on in life and you only found yourself here because you were hoping for some late-summer tips on how to relax, I would still recommend experimenting with this process.

    It might just take you to the next level.

    How to relax through body awareness and breath, moving from physical tension toward greater openness and capacity for internal experience.
    Even as little as three minutes a day, truly focusing on your breath can help change your inner world from chaos to calm.

    Try It for Yourself

    If this type of practice is available to you, please consult your doctor first if you have heart problems or other medical concerns that could make breath practices unsafe for you.

    Sit back and allow your body to sink into the chair beneath you. If it’s comfortable, let your head rest back so you don’t have to work quite so hard to hold yourself up.

    Close your eyes, or simply lower your gaze if you prefer, allowing your attention to move away from the outside world and toward your internal sensations.

    Take a slow breath in through your nose. Then breathe out through your mouth, allowing the exhalation to become slightly slower and longer than the inhalation.

    Begin noticing your body. Start with your feet and slowly work your attention upward toward your knees, hips and torso. Don’t change anything yet. Just notice.

    Continue breathing.

    Now bring your attention to your jaw, your neck and your shoulders.

    Where are you holding yourself?

    Allow your attention to settle on the area that feels tightest or most uncomfortable. Take another slow breath in.

    Now use your imagination. Imagine—as if it really could—that the relaxation carried by your breath travels directly toward that place.

    As you exhale, imagine some of the tension leaving with your breath. Or perhaps imagine the tension draining downward through your body and out through the bottoms of your feet.

    Breathe in and notice. Breathe out and release.

    If it feels comfortable, pause briefly at the top of the inhalation and notice the tiny movements in your body—the expansion across your back, the movement of your shoulders, the subtle shifting of muscles.

    Your mind will wander. That’s just what minds do.

    When you notice it, return to your breath. Try not to judge yourself. You may become more aware of tension before you become less tense.

    Stay curious.

    If the experience remains manageable, see what happens when you don’t immediately move away from it. Take another breath and another exhalation. Notice the micro-movements and notice what changes.

    There is nothing you have to accomplish.

    This is an exploration, not an evaluation.

    And if the experience becomes uncomfortable, stay curious about what you’re noticing without forcing yourself beyond what feels manageable. When you’re ready, open your eyes, move your body in whatever way feels comfortable or naturally desirable, and bring your attention back to the room around you.

    This lays some of the groundwork for what therapists can help you do in therapy. Relaxation isn’t necessarily the deep work itself. It can help prepare us for the deep work.

    When we’re already overwhelmed by stress, anxiety or uncomfortable sensations in the body, we may not have much capacity left to explore what lies underneath them. Learning how to relax, attend to the body and remain present with internal sensations can help us build that capacity.

    Over time, we may become more able to stay present when something uncomfortable, unfamiliar or not-yet-known begins to emerge. Rather than immediately needing to escape, explain or shut it down, there is a little more room to be curious.

    That increased tolerance gives us a stronger foundation from which to explore the deeper layers of our experience—the feelings, memories, conflicts, associations and patterns that may be more difficult to approach when our system is already overwhelmed.

    This is where I see somatic work laying the groundwork for deeper psychodynamic and relational work. The breath doesn’t uncover the unconscious for us. It can help us develop the internal steadiness and strength needed to explore what we might find there.

    Often, even a simple practice like this can help us reset. But repeated practice can also build something more sustainable: our capacity to stay present with ourselves.

    If you’re struggling to reset on your own, know you have stress coming up, or you’re trying to take yourself to the next level in business or life, I can help.

    The Goal Isn’t to Need a Therapist Forever

    That being said, there is an important difference between doing an exercise from a page and doing this kind of work with another person who is skilled at helping you become aware of yourself.

    Subtle tension and holding patterns in the head, neck and shoulders can point toward how much stress we might be carrying; for others, the body may hold tension somewhere else. When I guide someone through an experience like this in therapy, I’m not simply reading instructions.

    I’m attending to those subtle cues too—watching, noticing and adjusting the prompts I might give based on the shifts I’m seeing. It becomes a personally guided experience.

    Sometimes when a person approaches an internal sensation, the tension increases, and I might notice that before they do. When you’re with someone you trust, the body may be able to surrender more easily to your own mind’s directions within that collaborative experience.

    Another person can also sometimes help us remain in this self-noticing state of curiosity and compassion longer than we might on our own.

    This truly isn’t easy if things have been building up in there for a while.

    I cannot take the journey for you. But I can lend some courage while you brave the unknown—that dark void within—and I can hold up a light while you explore it.

    Then, over time, something else should happen.

    These practices build upon themselves. The more you practice attending to yourself, the more familiar the process can become.

    You become increasingly able to do it for yourself.

    That matters enormously to me.

    My hope isn’t that someone becomes increasingly dependent upon me to regulate, understand or reassure them. I want the opposite. I want my clients to leave with the capacity to attend to themselves in a sustainable way.

    Eventually, I hope to make myself increasingly obsolete in your life as these experiences build upon one another.

    Not because you will never struggle again, but because when struggle comes, there is a stronger relationship waiting for you.

    That’s your relationship with yourself.

    So, Are You Actually Relaxing?

    This National Relaxation Day, try taking the walk. Close your computer for a while and turn off as much outside noise as you reasonably can.

    And just BE.

    Close your eyes. If discomfort begins to arise, notice whether you can ride that wave for a little while and breathe.

    And if that doesn’t work fully in this moment, get a massage and try again. Read a book instead of spending the evening in the quiet stress of your screens. Or simply enjoy a distraction for what it is: a distraction.

    Then, when you finally decide to experiment with truly relaxing, try one more thing. Before reaching for whatever comes next, notice your jaw, your neck and shoulders, your breathing, your thoughts and whether there is a sense of urgency inside you.

    Then ask:

    Do I feel different now?

    Can I try to move and speak from this more spacious, light, soft and quiet state that came from this experiment?

    And if that massage therapist ever asks you again, “Why are you so tense?” maybe you don’t need to know why just yet.

    Perhaps you can see the tension for what it is: a cue to pause.

    Take a few slow breaths in through the nose and out through the mouth, allowing the exhalation to become longer and slower than the inhalation.

    Bring your attention toward the tension with compassion and kindness.

    Learning how to relax through self-care and therapy with Amy Ratkovich, LMFT, and Ziggy, a cat.
    Seriously, close your computer with me, and get into yourself.

    Repeat.

    Happy National Relaxation Day!

    Please share this far and wide. I have a feeling this experiment is worth repeating over and over again.

    Warmly,

    Amy Ratkovich LMFT 124308

    Books & References

    Some book links below are affiliate links. If you purchase through one of these links, I may receive a small commission at no additional cost to you.

    • Sapolsky, Robert M. — Why Zebras Don’t Get Ulcers Sapolsky’s work provides much of the stress-physiology backdrop for this article: human beings can maintain physiological stress responses not only in response to immediate events, but through anticipation, memory, social experience and chronic psychological stress.
    • Benson, Herbert, with Miriam Z. Klipper — The Relaxation Response Benson’s work helped establish the idea of a physiological “relaxation response” as a counterpart to stress-related activation. His research grew partly from studying physical manifestations of stress in cardiology patients and became foundational to the development of mind-body medicine.
    • Yates, John (Culadasa), with Matthew Immergut and Jeremy Graves — The Mind Illuminated This meditation manual influenced my thinking about attention to internal experience, particularly the practice of observing bodily sensation and learning to distinguish the sensation itself from our reactions to it.
    • van der Kolk, Bessel — The Body Keeps the Score This book helped popularize an embodied understanding of trauma and the importance of recognizing that psychological experience is also experienced through the body.
    • Rogers, Carl R. — On Becoming a Person Rogers’ ideas about openness to experience and the ongoing “process of becoming” inform the relational side of this article. I am particularly interested in what becomes possible when we develop greater capacity to remain present with our own experience rather than automatically defending against it.

    Research & Further Reading

    • Fincham, G. W., Strauss, C., Montero-Marin, J., et al. (2023). “Effect of breathwork on stress and mental health: A meta-analysis of randomised-controlled trials.” Scientific Reports, 13, 432. Across 12 randomized controlled trials involving 785 adults, breathwork was associated with a statistically significant small-to-moderate reduction in self-reported stress compared with controls. The authors also found reductions in anxiety and depressive symptoms, while cautioning that much of the research had a moderate risk of bias and that stronger studies are still needed. Read the study
    • Fincham, G. W., Strauss, C., & Cavanagh, K. (2023). “Effect of coherent breathing on mental health and wellbeing: a randomised placebo-controlled trial.” Scientific Reports, 13, 22141. This randomized trial compared approximately 5.5 breaths per minute with a matched attention control over four weeks. It’s particularly relevant to the article because it tests deliberate slow breathing rather than treating “relaxation” as a vague concept. Read the study
    • Price, C. J., & Hooven, C. (2018). “Interoceptive Awareness Skills for Emotion Regulation: Theory and Approach of Mindful Awareness in Body-Oriented Therapy.” Frontiers in Psychology, 9, 798. This one is very close to your formulation. The authors describe interoceptive awareness as learning to identify, access and appraise internal bodily signals and propose that these capacities can improve physical and emotional awareness and emotion regulation. They specifically discuss the difficulty some people with stress or trauma can have attending to internal bodily experience and the value of scaffolding that capacity. Read the study
    • Treves, I. N., et al. (2025). “A meta-analysis of the effects of mindfulness meditation training on self-reported interoception.” Scientific Reports. Across 29 randomized controlled trials with 2,191 participants, mindfulness interventions produced small-to-moderate improvements in self-reported interoception, with improvements related to reductions in psychological distress. This supports the part of your article concerned with deliberately developing the ability to notice and remain in contact with internal bodily experience. Read the study
    • National Center for PTSD, U.S. Department of Veterans Affairs — “Coping with Traumatic Stress Reactions.” The VA recommends breathing exercises, muscle relaxation and meditation while also noting an important complication: focusing inward can initially increase distress for some people, particularly when attention lands on disturbing bodily sensations. Their recommendation to practice in manageable amounts fits nicely with the safety language in your exercise. Read the VA guidance

  • How to Choose a Therapist: Why Goodness of Fit Matters More Than You Think

    Starting therapy is a big decision.

    Whether you’re seeking support for anxiety, ADHD, trauma, relationship challenges, grief, or simply feeling stuck, choosing a therapist can feel overwhelming.

    A quick online search can leave you with hundreds of profiles. Everyone seems compassionate. Everyone seems experienced. Everyone lists specialties, treatment approaches, certifications, and years of experience.

    So, how do you choose the right therapist?

    Many people assume they need to find the best therapist for anxiety, ADHD, trauma, or whatever concern brought them to therapy.

    Experience certainly matters. Training and specialized knowledge matter too.

    But I think there is a better question:

    Who is the best fit for me?

    Key Takeaways

    • Research shows that the therapeutic alliance is one of the strongest and most reliable predictors of successful therapy.
    • The “best” therapist is often the person who can adapt to your needs and build a meaningful relationship with you.
    • A free consultation helps you notice how it feels to speak with a therapist, not just gather information about their credentials.
    • Your intuition offers useful information, but trust develops through experience: trust, but verify.
    • You retain your autonomy at every stage, from sending the first email to deciding whether to continue therapy.

    Choosing a Therapist Starts With Understanding Your Needs

    You do not need to know exactly what is wrong or have a perfectly defined goal before beginning therapy.

    You may simply know that something feels difficult.

    Perhaps anxiety keeps you constantly anticipating what might go wrong. ADHD may leave you feeling overwhelmed, scattered, or unable to follow through on your intentions. Past experiences may continue to affect your relationships, or you may feel disconnected from a part of yourself that you want to understand.

    Those are all valid reasons to seek support.

    Before researching therapists, consider what you hope the experience might offer you:

    • Do you want practical tools, deeper self-understanding, or both?
    • Are you looking for structure or room to explore?
    • Do you want a therapist who is active and direct, or someone who gives you more space?
    • Are you seeking symptom relief, personal growth, or a combination of the two?

    You do not need definitive answers. Therapy can help you discover the questions that matter.

    What Research Says About the Therapeutic Alliance

    Research consistently shows that one of the strongest predictors of successful therapy is not a particular technique. It is the quality of the collaborative relationship between therapist and client, commonly called the therapeutic alliance.

    One major meta-analysis reviewed 295 independent studies involving more than 30,000 clients. The researchers found that stronger therapeutic alliances were consistently associated with better outcomes across different treatment approaches, client populations, countries, and even internet-based therapy (Flückiger et al., 2018).

    Later research found that the alliance remained meaningfully connected to treatment outcomes even after researchers accounted for client characteristics and other treatment processes (Flückiger et al., 2020).

    In other words, the relationship does not matter only because therapy is already going well.

    The relationship appears to be one of the reasons therapy works.

    Researchers generally describe the therapeutic alliance as having three essential parts:

    1. Agreement on goals: You and your therapist understand what you hope to accomplish.
    2. Agreement on the work: You both understand and support the methods you will use.
    3. A trusting emotional bond: You gradually develop enough safety, honesty, and trust to explore difficult experiences together.

    Notice that two of those three elements involve collaboration.

    Therapy is not simply something a therapist does to you. It is something the two of you build together.

    As psychologist Carl Rogers famously emphasized:

    “It is the relationship which heals.”

    How Good Therapists Cultivate Goodness of Fit

    Carl Rogers laid much of the foundation for what we now understand about the therapeutic relationship. His emphasis on empathy, genuineness—or congruence—and unconditional positive regard profoundly influenced modern psychotherapy.

    Later researchers, particularly Edward Bordin, expanded these ideas into the contemporary model of the therapeutic alliance.

    But goodness of fit is not simply something that either exists or does not.

    A good therapist actively works to cultivate it.

    That means continually asking:

    • Am I understanding this particular person?
    • Are we working toward goals that genuinely matter to them?
    • Does my approach fit their needs, personality, and way of processing?
    • Do they need more structure or more space?
    • Am I moving too quickly or too slowly?
    • Have I misunderstood something?
    • Is there something happening between us that we need to discuss?

    A good therapist does not need to share your personal beliefs or experience life exactly as you do.

    They need the capacity—and willingness—to understand how you experience your world.

    They should try to understand how you came to believe what you believe, how you experience your emotions and relationships, and what your fears, values, and hopes mean to you.

    Many people enter therapy because they struggle to accept parts of themselves. One of the therapist’s roles is to create the conditions in which that acceptance can begin to grow.

    How to Research a Therapist Before Your First Appointment

    A therapist’s website can tell you a great deal about their education, specialties, experience, and approach.

    As you read profiles, consider more than the list of diagnoses they treat.

    You may also find it helpful to explore a therapist’s professional blog, podcast appearances, videos, or social media.

    More therapists now allow potential clients to see something of their professional personality before the first appointment. The goal is not to uncover every detail of the therapist’s personal life. It is to get a sense of how they think, communicate, and speak about the people they serve.

    Do they seem compassionate?

    Thoughtful?

    Curious?

    Respectful?

    Able to hold complexity without immediately reducing it to a slogan or diagnosis?

    Those impressions cannot guarantee a good fit, but they can help you decide whether to take the next step.

    A Website Says a Lot. A Conversation Says More.

    This is one reason I—and many other therapists—offer a free, no-obligation 15-minute consultation.

    We know that goodness of fit matters.

    You should not have to pay simply to discover whether the relationship feels promising.

    A short call will not tell you everything, but it can help answer a much more important question than where the therapist went to school:

    How does it feel to talk with this person?

    What to Notice During an Initial Consultation

    “Questions to ask during a therapy consultation” is almost a trick question.

    Of course, practical questions matter. You may want to ask about:

    “Does this person seem to have the capacity to meet me where I am?”

    That capacity is not about having the perfect answer.

    It is about creating a space where you do not feel pressured to perform, hide, defend yourself, or become someone different in order to be understood.

    Sometimes a healing moment occurs because someone listens without rushing to give advice.

    At other times, a thoughtful reflection helps you recognize a pattern you had not noticed before.

    A responsive therapist adapts to what you need rather than forcing every client into the same way of working.

    That is part of what separates licensed psychotherapy from less regulated forms of support. Therapists receive extensive training in ethics, clinical assessment, relational processes, and the creation of a therapeutic holding environment.

    Our ethical responsibilities—including beneficence, non-maleficence, respect for autonomy, justice, fidelity, and integrity—help guide how we create that environment.

    The therapist’s personal values should not overshadow your autonomy, your values, or your goals.

    Goodness of Fit Goes Both Ways

    The initial consultation is not simply about whether you believe the therapist is a good fit for you.

    It also gives the therapist an opportunity to consider whether they have the competence, emotional capacity, experience, and availability to support you responsibly.

    For me, that first conversation is not a sales call.

    It is an opportunity to begin understanding what you need and to consider whether I can create the kind of therapeutic relationship that will support your growth.

    If I do not believe I am the right fit, the ethical response is not to convince you otherwise. It is to help you clarify what kind of support might serve you better.

    Goodness of fit is not something that simply happens. Therapist and client begin building it together from the first conversation.

    Trust Your Instincts—and Verify Them One Step at a Time

    One of the things I hope therapy offers people is the opportunity to trust themselves a little more.

    That does not happen all at once.

    It happens one decision at a time.

    Maybe today all you are ready to do is send an email.

    That is enough.

    Some time may pass before you think, “Maybe tomorrow I’ll schedule a free consultation.”

    That is enough too.

    Perhaps you have the consultation and decide the therapist is not the right fit.

    That is okay.

    You may schedule a first appointment, complete the intake paperwork, and decide after a session or two that someone else might be a better match.

    That is okay too.

    At every step, the choice remains yours.

    I really want you to know that.

    As therapists, one of our ethical responsibilities is to respect your autonomy. That means recognizing that you are the expert on your own life.

    My role is not to convince you to work with me. My role is to create conditions in which you can make thoughtful, informed decisions about what feels right for you.

    Trust is not expected during the first phone call, nor is it earned in a single session.

    Like every meaningful relationship, it develops gradually—even when your intuition tells you, “I think this is a good fit.”

    That may sound like a paradox, but therapy is full of them.

    You can have a strong first impression while still allowing that impression to unfold over time. You can trust what you notice and remain open to learning more.

    That is what I mean by trust, but verify.

    Your intuition gives you a place to begin. Your experience helps you decide whether that first impression continues to hold true.

    Together, therapist and client develop a relationship in which vulnerability becomes safer—not because either person always knows what the other is thinking or feeling, but because they discover they do not have to know everything to remain connected.

    Each session builds upon the one before it.

    Eventually, many people feel ready to explore places they have protected for a long time: the quiet ache in their heart, the relentless circus in their mind, or the parts of themselves they have never felt safe enough to share.

    That kind of work cannot be rushed.

    It often becomes especially difficult when we feel desperate for immediate answers.

    I understand that feeling.

    Real growth usually unfolds one conversation at a time, one choice at a time, and one moment of honesty at a time.

    As self-acceptance gradually replaces self-judgment, and commitment to growth becomes stronger than fear of change, caring for yourself may begin to feel less like another obligation and more like something you genuinely want to do.

    Frequently Asked Questions About Choosing a Therapist

    How do I know whether a therapist is a good fit?

    Pay attention to whether you feel heard, respected, and increasingly able to speak honestly. A good fit does not mean every session feels easy or that the therapist always agrees with you. It means that challenges occur within a relationship characterized by trust, collaboration, curiosity, and respect.

    How many sessions should I try before deciding?

    There is no universal number. Some people sense a connection quickly, while others need several sessions before trust begins to form. If you feel uncertain, discuss it directly with the therapist. Their response to your concern may offer valuable information about the relationship.

    Is it okay to change therapists?

    Yes. You retain the right to pause, end, or change therapy at any time. A responsible therapist should respect that choice and, when appropriate, help you identify another source of support.

    Amy Ratkovich LMFT 124308 and 2018-124

    Does a therapist need to share my personal beliefs?

    Not necessarily. A therapist does not need to share your worldview to understand and respect it. What matters is their ability to keep your experiences, values, goals, and autonomy at the center of the work.

    Should I choose a therapist based only on their specialty?

    Specialized training can be important, especially when you need support for a specific or complex concern. However, credentials and specialties alone do not guarantee a strong therapeutic alliance. Clinical competence and relational fit both matter.

    Final Thoughts

    Finding the right therapist does not require you to solve everything before you begin.

    Whether you are carrying an ache in your heart or a circus in your mind, you only need to decide whether you are ready to take the next small step.

    The rest, if it feels right, can unfold from there.

    I would be honored to begin that conversation with you. If you are curious whether we might be a good fit, I invite you to schedule a free 15-minute consultation.

    Together, we can explore whether I am the right therapist for you—or clarify what kind of support might serve you best.

    References

    Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy, 55(4), 316–340. https://doi.org/10.1037/pst0000172 Cited by: 2764

    Flückiger, C., Del Re, A. C., Wlodasch, D., Horvath, A. O., Solomonov, N., & Wampold, B. E. (2020). Assessing the alliance–outcome association adjusted for patient characteristics and treatment processes: A meta-analytic summary of direct comparisons. Journal of Counseling Psychology, 67(6), 706–711. https://doi.org/10.1037/cou0000424 Cited by: 208

    Horvath, A. O., Del Re, A. C., Flückiger, C., & Symonds, D. (2011). Alliance in individual psychotherapy. In J. C. Norcross (Ed.), Psychotherapy relationships that work (pp. 25–69). Oxford University Press. https://doi.org/10.1093/acprof:oso/9780199737208.003.0002 Cited by: 4058

  • What Do Psychodynamic, Relational, and Somatic Therapy Really Mean?

    What Do Psychodynamic, Relational, and Somatic Therapy Really Mean?

    Cutting Through the Therapy Jargon to the Work of Healing

    Dear Near and Dear Readers,

    Most people have heard words like psychodynamic, relational, and somatic and have no idea what they mean. These words mean so much more in the context of therapy than even this blog can convey. More importantly, many people do not know why these approaches belong together or why so many people benefit from working with a therapist who allows all three to inform their work.

    I have spent years studying different theories, modalities, interventions, and techniques. Like many therapists, I have attended trainings, read books, sat through workshops, and accumulated a small mountain of continuing education credits. Yet the longer I do this work, the more I find myself returning to something surprisingly simple:

    We Heal by Becoming More Aware of Ourselves

    We become more aware of ourselves through relationship, and we learn to trust that awareness by experiencing it in both mind and body. Psychodynamic, relational, and somatic approaches fit together naturally by looking closely at a different part of the same process. Our history or “stories,” our relationships to “other” and the messages of our sensory experiences of the body. We heal because by becoming more aware of how all three of these play out, we become more able to influence our own living experiences and create lives that feel worth living.  It is only in relationship with another person that we can become more aware of ourselves in relationship and that beings often by sensing everything in our physical bodies.  For some of us, this can be a journey that isn’t pleasant. Hence a good therapeutic relationship is highly recommended.

    “The curious paradox is that when I accept myself just as I am, then I can change.” — Carl Rogers

    Be Curious

    Relationships Make or Break Us

    Relationships shape us from the very beginning of life. “Live we learn, we learn, we love we learn, we choice we learn…” and often these lesson matter more in relationship to others. Much of what we know about ourselves was learned in relationship with other people for better or for worse. It makes sense, then, that a human to human relationship would be a basic requirement for healing. This is one reason I believe healing requires a human-to-human relationship, especially when the hurt come from other people but often even a tragedy in our lives a benevolent other can help us learn to live again. Therapist I believe strive to embody this benevolence along with boundaries, non judgmental, and promoting well being and growth. Not because therapists possess some secret knowledge that lets them be this way, but because these are the conditions in which we can finally see, in the presence of another, what has become invisible to us.

    A good therapeutic relationship helps cultivate empathy for ourselves and others. It creates enough safety that we can begin looking honestly at parts of ourselves that we may have spent years avoiding, explaining, defending, or hiding. Carl Rogers captured this beautifully when he wrote: “The curious paradox is that when I accept myself just as I am, then I can change.” Change often begins with understanding rather than judgment.

    History Lives in the Present

    Psychodynamic therapy is often misunderstood as endlessly talking about childhood. In reality, psychodynamic thinking is about understanding how the past continues to influence the present with the understanding that sometimes we get in our own way to see it, after all, you wouldn’t need to “get therapy” if you could…

    Many of the beliefs, expectations, fears, and assumptions that shape our lives were learned long before we were consciously aware of learning them and sometimes continue to be unconscious. History is more than just you’re a story, our histories can often live in the body and live in habits. Sometimes it can influence our expectations of others unbeknownst to us. It can live in the assumptions we carry into our relationships.

    Sometimes our past influences us in obvious ways. More often, it influences us quietly. We find ourselves replaying familiar patterns without understanding why. We keep ending up in similar relationships or we react more strongly in situations that seems warranted.  This seems to go on and on in different ways. As psychodynamic writer Stephen Grosz observed: “We repeat what we do not repair.”

    Sometimes we when we can’t see the forest for the trees, when our defenses don’t let us see, well we end up with “symptoms.”

    Slow Down

    Symptoms as Guideposts

    I tend to think symptoms are trying to tell us something rather than some list that some one made up in the DSM, though I do appreciate the time and efforts and even the symptoms listed there in a great deal, there is insight there.  More importantly, your inner experiences and how you see your “symptoms,” are the guideposts I can help you look for and understand.  Call me old-fashioned, but I rarely view symptoms as random defects. Instead, I often see them as signals and as an attempts to get our attention. Symptoms are often guideposts pointing toward something that needs understanding.

    When we become curious about them instead of simply fighting them, they often begin revealing the story underneath.We start asking questions such as:

    • Where did this come from?
    • What purpose did it once serve?
    • Why does it still feel necessary now?

    Understanding does not automatically create change but understanding often creates the possibility of change.

    The Body Carries History

    One of the most fascinating things about therapy is how often people understand something intellectually long before they feel it emotionally. This is where somatic work becomes important. The body caries all that emotional history that we were talking about that the relationship, the exploration of those stories and how you feel in this moment in side your own body to figure out together in relationship what is not in your awareness.

    When it comes to symptoms I see them as a protective layer that pops up, like an emotional immune system response. For millions of years mammals have relied on an ancient danger-and-safety detection system and this works closely with our emotions to protect us from all kind of threats be they real or imagined!

    When the autonomic nervous system functions well, it helps us respond to real danger.

    When it becomes overwhelmed or dysregulated because we are struggling with things outside our awareness, or in it but looping, we may find ourselves living as though old dangers are still present.  We eventually stop trusting ourselves and our own perceptions of what is happening around us leading to more and more stress and leaning onto old responses rather than adapting to what IS in the moment the alarm sounds.

    Can you see how this might cause some “problems?”

    The Power of “Both/And”

    One of the most important things therapy has taught me is that human beings are more complicated than simple formulas allow. We are shaped by our past, yet capable of change. We are influenced by our history, yet not condemned to repeat it. We can be wounded and resilient at the same time.

    The goal of therapy is not perfection. It is becoming more capable of empathy, authenticity, and self-understanding.

    I believe Socrates once said, “The unexamined life is not worth living.” Perhaps those words are less a judgment and more an invitation. Maybe the task is not to decide whether life is worthy, but to examine it closely enough to discover the worth that has always been there.

    Therapy, at its heart, is an act of examination—not to criticize ourselves, but to understand ourselves more fully.

    Amy Ratkovich LMFT 124308, 2018-124

    Are You Ready to Go Deeper?

    How long healing takes depends on you, me, and us.

    Therapy is ultimately a relationship, and relationships work best when there is a good fit.

    This is one reason I enjoy consultation calls you can reach me at 510 269 4808 and I typically get back to people within 24 hours.

    They allow us to determine whether we can do meaningful work together.

    If what you’ve read here resonates with you, please reach out.

    And if I am not the right therapist for your needs, I am happy to connect you with one of the many therapists I have come to trust—people who are thoughtful, ethical, respectful of autonomy, and deeply committed to understanding the people they serve. We are all here to help.

    References

    Kishimi, I., & Koga, F. (2018). The courage to be disliked: How to free yourself, change your life, and achieve real happiness. Atria Books.

    Levine, P. A. (2010). In an unspoken voice: How the body releases trauma and restores goodness. North Atlantic Books.

    Porges, S. W. (2011). The polyvagal theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation. W. W. Norton & Company.

    Rogers, C. R. (1961). On becoming a person: A therapist’s view of psychotherapy. Houghton Mifflin.

    Rogers, C. R. (1980). A way of being. Houghton Mifflin.

    Rosenberg, M. B. (2015). Nonviolent communication: A language of life (3rd ed.). PuddleDancer Press.

    Siegel, D. J. (1999). The developing mind: Toward a neurobiology of interpersonal experience. Guilford Press.

    Siegel, D. J. (2010). Mindsight: The new science of personal transformation. Bantam Books.

    van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.

    Wallin, D. J. (2007). Attachment in psychotherapy. Guilford Press.

    Affiliate Disclosure: I may earn a commission from purchases made through the links above, at no extra cost to you. I only recommend resources that I have personally used and trust.

  • You are Not Your Diagnosis: Finding Hope Today

    You are Not Your Diagnosis: Finding Hope Today

    Dear Near and Dear Readers,

    Mental Health Awareness Month has helped bring important conversations into the open. More people today feel comfortable discussing anxiety, depression, ADHD, trauma, and emotional struggles than perhaps ever before.

    In many ways, this is progress.

    Slow Down

    When we have language for what is happening for us, an explanation can reduce shame.
    A diagnosis can often provide relief and a map for what is going on inside. It can truly help people feel seen, understood, and less alone.

    The concern here is that things have begun to blur:

    A diagnosis is meant to describe patterns of experience. It is not meant to become the totality of a person’s identity. And yet increasingly, many people no longer say:
    “I struggle with anxiety.” They said “I am an anxious person.”  Instead of saying they have symptoms that align or look like ADHD, they said “I am neurodivergent.”

    At first, this may seem harmless or even empowering and don’t get me wrong, I think it can be to some extent very helpful.  The difference is I am interested in naming an experience in order to bring validation and clarity. However, there can also be a subtle psychological shift that occurs when a clinical description moves from something a person experiences to something a person fundamentally believes themselves to be.

    This distinction matters more than many realize.

    The Diagnostic and Statistical Manual of Mental Disorders (DSM) was designed as a clinical tool. Its purpose is to help clinicians, that’s right, professionals, to identify clusters of symptoms, guide treatment planning, facilitate communication between providers, and support research.

    The Problem with “I Am”

    It was never intended to function as a blueprint for identity, or short hand so you can tell someone who you are.  The bigger danger, is they may have a different definition of the label than you do.

    In my practice, I integrate NVC (Nonviolent Communication). Marshall Rosenberg, the founder of NVC, would call this “life-alienating language.” Telling yourself you are something rather than experiencing something is superficial; it doesn’t get to the heart of what is really happening. It not only alienates you from others but also yourself.

    Furthermore, using these labels as shorthand allows others to misinterpret you based on their own definitions. “You keep using that word. I do not think it means what you think it means.” Inconceivable? Not really. We assume it’s just shorthand, but we must ask: what is the actual cost to our internal world when we continue to speak this way about ourselves and others?

    A diagnosis  describes tendencies, struggles, patterns, symptoms or vulnerabilities. Fact is, human beings are far more dynamic than diagnostic categories because people change, adapt, people mature and people heal.  This means how they see themselves will change.  That original label may no longer apply.

    No DSM label, or any label really can fully capture a person’s history, capacity for creativity and relationships, how defenses show up, how strengths develop and the layers of controdictions, unconscious motivations and values layered into the complex human being.

    Bottom line, the map is not the terrain.

    Be Curious

    It’s Human to Label

    Psychologically speaking, labels can provide something deeply human:
    coherence. Human beings naturally seek explanation and meaning. When someone has spent years feeling different, overwhelmed, emotionally reactive, scattered, ashamed, or misunderstood, finally receiving language for those experiences can feel profoundly relieving. Sometimes a diagnosis answers questions people have carried for decades:
    “Why do relationships feel harder for me?”
    “Why do I react this way?”
    “Why have I always struggled with this?”

    That relief matters and the problem is not diagnosis  but the use of it as an explanation or short hand to explain who you are and what you need and why.  This can slowly hardens into self limiting beliefs.

    When a diagnosis becomes fused with identity, the psyche can begin unconsciously organizing around it. This can happen in subtle ways including interpreting every behavior through the label (both yourself and anyone you’ve told you are X label), reducing complexity into symptom language that can lead to interpersonal conflict when one person thinks one thing and other some thing different about the same label. People for years have feared that being label comes with others expecting limitation in them instead of possibility.  Finally, we run the risk of forming relationships around shared pathology rather than shared humanity. Over time, curiosity about the self can narrow.

    Instead of asking:
    “What happened to me?”
    “What do I need?”
    “What patterns developed around stress, attachment, or survival?”
    “What strengths exist alongside these struggles?”

    The internal dialogue can become:
    “Well… that’s just my ADHD.”
    “That’s my anxiety.”
    “That’s my trauma.”

    In some cases, labels that initially reduced shame can unintentionally begin reinforcing hopelessness, rigidity, or over-identification. The problem begins when explanation slowly hardens into limitation. As Nancy McWilliams reminds us “The goal is not to eliminate defenses, but to have more flexible ones.” Psychological health is not the absence of coping mechanisms or vulnerability. It is the capacity to respond to life with greater flexibility, awareness, and choice rather than becoming rigidly organized around fear, shame, or identity labels.

    You Are A Whole Person

    From a psychodynamic perspective, symptoms do not emerge in a vacuum.

    They often develop in relationship to stress, attachment experiences, environments, defenses, nervous system adaptation, loss or overwhelm.  Sometimes it is an attempt to or to survive emotionally difficult situations Symptoms are not random character flaws but most often are meaningful adaptations. Trauma researcher Bessel van der Kolk writes, “Being able to feel safe with other people is probably the single most important aspect of mental health.” Many symptoms we reduce to diagnostic language are deeply relational at their core. The nervous system adapts to environments, relationships, stress, and perceived safety over time.  Creating deeply held beliefs about the world.

    For example, hypervigilance may once have protected someone in an unpredictable environment but later on leads to someone isolating themselves or having social anxiety.

    Emotional withdrawal may once have reduced overwhelm but over time teaches the person they have to stay small, not express a controversial opinion in order to stay safe and accepted.

    Perfectionism may have developed around fears of criticism or rejection as a result of repeated negative feedback from others who had no patience or were putting on them their own fears and self criticisms they refuse to examine for themselves.

    The good news is that when we slow down, become curious and seek first to uderstandi before judging themselves or others and shift to exploring these patterns with compassion can help reduce shame without collapsing the entire self into a diagnosis. This honors the reality that you are a person with a mind, body, history, nervous system, relationships, defenses, strengths, and an unfolding story.

    Modern culture increasingly encourages people to speak about themselves through diagnostic language and labels in general. Social media in particular often rewards identity-based mental health content because it creates belonging and instant, but shallow recognition. Again, the desire for belonging is deeply human but we can’t truly belong with anyone or any group without first deeply knowing ourselves from the inside out.

    Thus let’s focus again on the fact that there is a difference between “this describes part of my experience” and “this is who I am.” One invites understanding first of self then of others.
    The other risks confinement, and shallow confusing explanation of behaviors. Healing requires flexibility, curiosity, and the ability to imagine oneself beyond current patterns and usually the current labels naturally change. This process of change and healing becomes harder when the label itself becomes psychologically central.

    The Both And

    True mental health awareness is not about pretending diagnoses do not exist. I reference the DSM all the time to find a map of what MIGHT be happening for my clients. I have to keep in mind that people are larger than the language used to describe their struggles. A diagnosis may help explain your experience and does often help to guide treatment and reduce shame but needs to be held lightly.

    Thus, you are not your diagnosis. If you have a diagnosis remember, you are a human being experiencing patterns that deserve understanding, compassion, and support, but it doesn’t have to be “who you are” fundamentally.  People are always more complex—and more capable of growth—than any manual could ever fully describe.  So next time you think about introducing yourself as a label remember, once that label is received the listener is the one who gets to define it, not you. 

    Your story is larger than any label; if you’re ready to explore the unique terrain of your own mind with curiosity and compassion, I invite you to book a call with me to begin our work together.”

    Amy Ratkovich LMFT 124308

    References & Further Reading

    Corrigan, P. W., & Watson, A. C. (2002). The paradox of self-stigma and mental illness. Clinical Psychology: Science and Practice, 9(1), 35–53

    Doidge, N. (2007). The brain that changes itself: Stories of personal triumph from the frontiers of brain science. Viking.

    McWilliams, N. (2011). Psychoanalytic diagnosis: Understanding personality structure in the clinical process (2nd ed.). Guilford Press.

    Rosenberg, M. B. (2015). Nonviolent communication: A language of life (3rd ed.). PuddleDancer Press.

    van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.

    Yanos, P. T., Roe, D., & Lysaker, P. H. (2010). The impact of illness identity on recovery from severe mental illness. American Journal of Psychiatric Rehabilitation, 13(2), 73–93.

    Many of the books referenced here have deeply shaped my professional lens and continue to inform my work as a therapist.

    Some links may be affiliate links, meaning I may receive a small commission at no additional cost to you.

  • Transforming Relationships: Understanding ADHD Through Executive Functioning and Nervous System Regulation

    Transforming Relationships: Understanding ADHD Through Executive Functioning and Nervous System Regulation

    Dear Near and Dear Readers,

    Intimate relationships often bring out the best and the most challenging parts of ourselves. When ADHD is part of the picture, misunderstandings and frustrations can grow quickly. Many couples find themselves caught in cycles of blame and hurt, not realizing that the root of their struggles often lies in how ADHD affects executive functioning and nervous system regulation. Recognizing these underlying factors can shift relationships from conflict zones to places of compassion and creativity.

    In this post, we explore how ADHD impacts the brain’s ability to manage attention, emotions, and impulses, especially in close partnerships. We will also discuss practical ways to support nervous system regulation and executive functioning to foster healthier, more understanding connections.

    How ADHD Affects Executive Functioning in Relationships

    Executive functioning refers to the brain’s management system. It helps us plan, focus, remember instructions, and juggle multiple tasks. When ADHD is present, this system faces unique challenges that can affect how partners interact.

    Common executive functioning difficulties in ADHD include:

    • Sustaining attention amid distractions

    It can be hard to stay focused on conversations or shared tasks, especially when external stimuli or internal thoughts compete for attention.

    • Holding information in working memory

    Forgetting details or losing track of plans is common, which may look like not caring or being unreliable.

    • Regulating emotions without becoming overwhelmed

    Emotional responses can feel intense and sudden, making it difficult to stay calm during disagreements.

    • Shifting perspectives or tasks flexibly

    Moving from one topic or activity to another can be challenging, leading to frustration or rigidity.

    • Pausing before reacting impulsively

    Impulsive reactions may cause misunderstandings or hurt feelings.

    These challenges often get misinterpreted as personal failings or lack of commitment. For example, a partner might say, “You never listen,” when the real issue is difficulty sustaining attention. Understanding this helps replace blame with empathy.

    Nervous System Regulation and Its Role in ADHD Relationships

    The nervous system controls how we respond to stress and emotional demands. For people with ADHD, the nervous system often operates in a heightened state of alertness or dysregulation. This means:

    • The body may react strongly to small stressors.
    • It can be hard to find a steady rhythm or calm state.
    • Emotional demands in relationships can feel overwhelming.

    When nervous system regulation is off balance, partners might experience:

    • Increased irritability or anxiety.
    • Difficulty calming down after conflicts.
    • Challenges in maintaining emotional connection.

    Supporting nervous system regulation involves creating safe, predictable environments and using grounding techniques. One example is the Echo Anchor practice, which helps individuals find a steady point of focus amid mental chaos. This practice encourages tuning into bodily sensations or a simple repeated action to anchor attention and calm the nervous system.

    Using a smooth stone as a grounding tool to support nervous system regulation in ADHD

    Using a smooth stone as a grounding tool to support nervous system regulation in ADHD

    Practical Strategies to Improve Executive Functioning in Partnerships

    Couples can take concrete steps to ease the impact of executive functioning challenges:

    • Use clear, simple communication

    Break down requests into small, manageable steps. Instead of “Remember to clean the house,” say “Please vacuum the living room today.”

    • Create external reminders

    Use calendars, alarms, or shared apps to track plans and deadlines.

    • Build routines and rituals

    Predictable patterns reduce the mental load of planning and help regulate the nervous system.

    • Practice patience and pause

    When emotions run high, take a break before responding to avoid impulsive reactions.

    • Celebrate strengths

    Recognize creativity, enthusiasm, and problem-solving skills that ADHD can bring to the relationship.

    Emotional Compassion Through Understanding

    When partners understand that ADHD-related behaviors stem from brain function and nervous system regulation, they can approach conflicts with more compassion. This understanding helps:

    • Reduce feelings of blame and resentment.
    • Encourage supportive problem-solving.
    • Strengthen emotional bonds by validating each other’s experiences.

    For example, instead of saying “You don’t care about my feelings,” a partner might say, “I see that it’s hard for you to stay focused when I’m upset. How can we work together to make this easier?”

    Supporting Yourself and Your Partner

    Both partners can benefit from self-care and mutual support:

    • Mindfulness and grounding exercises help regulate the nervous system.
    • Therapy or coaching focused on ADHD can improve executive functioning skills.
    • Open conversations about needs and challenges build trust.
    • Setting realistic expectations prevents frustration.

    Relationships involving ADHD require patience and understanding, but they also offer opportunities for growth and creativity. By focusing on executive functioning and nervous system regulation, couples can transform their connection into a source of strength and compassion.

    Take the next step by exploring grounding practices like the Echo Anchor or setting up simple routines together. Small changes can lead to big improvements in how you relate and support each other.

    Please reach out today, you need not figure it out alone. You can book through my website or call me at (510) 269-4808.

  • Honoring Women’s History Month The Dignity of Defense: Anna Freud and the Modern Woman

    Honoring Women’s History Month The Dignity of Defense: Anna Freud and the Modern Woman

    The Dignity of Defense:

    Anna Freud and the Modern Woman

    Women’s History Month is a time to honor the pioneers who reshaped our understanding of the human mind. Few shifted that understanding more profoundly than Dr. Anna Freud. She will no longer be overshadowed by her father. It is time for Anna—not just “Freud”—to take the spotlight as an equal where she belongs.

    Sigmund Freud opened the door to the unconscious. Anna stepped through it and asked a different question:

    What will the ego do—or be willing to do—to survive?

    In her 1936 landmark, The Ego and the Mechanisms of Defense, Dr. Anna Freud systematically mapped the mind’s protective strategies: repression, projection, denial, and identification with the aggressor. She reframed these not as flaws or pathology, but as adaptive responses to anxiety and threat. In today’s language, we might call her trauma-informed. She de-pathologized natural human survival long before the phrase existed.

    The Ego Develops in Relationship

    Dr. Anna Freud understood that the ego grows through connection. In stable, attuned environments, the ego becomes flexible. It learns to tolerate ambiguity and builds trust. However, in environments marked by chronic stress, emotional volatility, or rupture, the ego tightens around protection. Curiosity is replaced by vigilance.

    What once ensured your survival in a difficult past can eventually narrow your experience in the present, creating chaos in your current life. This is not weakness; it is adaptation. The real question is: Are my defenses conscious or unconscious? Am I being flexible to reality, or repeating patterns born from past pain?

    War-Time Stress in a Peacetime Body

    During World War II, Anna Freud directed the Hampstead War Nurseries, caring for children separated from families during bombing raids. She discovered that it wasn’t just danger that destabilized children, but the separation from caregivers.

    This insight is vital for the modern woman. When early life involves chronic stress, the nervous system adapts. The “window of tolerance” narrows, and emotional cues carry heightened meaning:

    • A shift in tone.
    • A delayed text.
    • A distracted glance.

    If you grew up with unpredictable caregivers, that vigilance lingers. The impact can resemble war-time conditioning. When we are unable to reason through stress, the emotional mind becomes our only source of information.

    When Mentalizing Collapses

    In the late 1990s, the Anna Freud Centre (founded by Anna herself) became the birthplace of Mentalization-Based Treatment (MBT). Developed by Peter Fonagy and Anthony Bateman, MBT builds directly on Anna’s foundations.

    Under relational stress, our capacity to “mentalize”—to reflect on our own thoughts and others’ intentions—weakens. We regress into three “pre-mentalizing” modes:

    1. Psychic Equivalence Mode: Treating feelings as literal reality. If you feel rejected, you are rejected. No alternatives exist.
    2. Teleological Mode: Focusing only on concrete actions. “If they loved me, they would have done X.” You demand physical proof of safety.
    3. Pretend Mode: Retreating into detached intellectualizing. You talk about feelings, but remain disconnected from the actual emotion.

    Why This Matters for Women and ADHD

    Historically, women’s emotional pain was dismissed as “hysteria.” Anna Freud was disruptive because she believed women’s suffering was meaningful.

    Today, many high-functioning women carry relational strain quietly. You appear competent and resilient, while internally managing the anxiety and hypervigilance that often accompany ADHD. Research increasingly shows that MBT is a valuable tool for managing ADHD, specifically addressing the socio-emotional and self-regulatory deficits that medication often misses.

    When safety narrows, perspective narrows. Relationships become arenas of misinterpretation rather than connection. This leads to more hurt and less clarity—a predictable response of a stressed nervous system.

    The Gift of Good Therapy

    It’s no one’s fault; these wounds took root long ago. The good news is that it is never too late to unwind them.

    The work involves feeling these patterns in the body—often learning to tolerate an intensity that terrifies—recognizing when a pattern is activated, and deciding if that activation still serves you. From there, we work on learning to choose action consciously in the midst of that intensity. Though life will continue to have its ups and downs, together we will help you get off that roller coaster and onto a ride that is more tolerable and sustainable.

    This is the heart of what I do at Near and Dear Therapy. AI can’t do this for you. Only another person—a compassionate human guide—can help you stay present through the pain to interrupt the cycle.

    If you’re ready to move from protection to genuine connection, reach out to me. I am happy to spare 15 minutes to understand you and help you take the next steps toward emotional freedoms beyond your current reach.

    References & Further Reading

    Primary Sources by Anna Freud

    • Freud, A. (1936/1966).The Ego and the Mechanisms of Defense (Rev. ed.). New York: International Universities Press. (Original German work published 1936).
      • The seminal work outlining defense mechanisms as adaptive ego strategies rather than mere pathology.
    • Freud, A. (1965). Normality and Pathology in Childhood: Assessments of Development. New York: International Universities Press.
    • Freud, A., & Burlingham, D. (1942). Young Children in War-Time. London: Allen & Unwin.
    • Freud, A., & Burlingham, D. (1944).Infants Without Families. London: Allen & Unwin.
      • Key observations from the Hampstead War Nurseries on how separation from caregivers impacts child development.

    On Anna Freud’s Life and Legacy

    • Young-Bruehl, E. (2008). Anna Freud: A Biography (2nd ed.). New Haven, CT: Yale University Press.
    • Anna Freud National Centre for Children and Families. (n.d.). Our History. https://www.annafreud.org/about/our-history/

    The Bridge to Modern Practice (MBT)

    • Bateman, A., & Fonagy, P. (2004). Psychotherapy for Borderline Personality Disorder: Mentalization-Based Treatment. Oxford: Oxford University Press.
    • Bateman, A., & Fonagy, P. (2016).Mentalization-Based Treatment for Personality Disorders: A Practical Guide. Oxford: Oxford University Press.
      • The foundational manuals for MBT, integrating ego psychology with attachment theory.

    Peer-Reviewed Research: MBT and ADHD

    • Badoud, D., Rüfenacht, E., Debbané, M., & Perroud, N. (2018). Mentalization-based treatment for adults with attention-deficit/hyperactivity disorder: a pilot study. Research in Psychotherapy: Psychopathology, Process and Outcome, 21(3), 149-154.
    • Halfon, S., et al. (2024). The Efficacy of Mentalization-Based Treatment for Children With Internalizing and Externalizing Problems: A Randomized Controlled Trial. Journal of the American Academy of Child & Adolescent Psychiatry, 64(3).
    • Perroud, N., Badoud, D., Weibel, S., et al. (2017). Mentalization in adults with attention deficit hyperactivity disorder: Comparison with controls and patients with borderline personality disorder. Psychiatry Research, 256, 334-341.
    • Quarterly of Experimental and Cognitive Psychology. (2024). The Effectiveness of Mentalization-Based Therapy on Problem-Solving Skills and Self-Regulation in Children with Attention-Deficit/Hyperactivity Disorder. 1(2), 211-225.
  • How ADHD Shapes Romance: Struggles, Strengths, and Staying Connected

    How ADHD Shapes Romance: Struggles, Strengths, and Staying Connected

    Dear Near and Dear Readers,

    I wanted to share something that’s been close to my heart lately—a reflection on how ADHD shows up in our most intimate connections, and why understanding it through the lens of nervous system regulation and executive functioning can transform relationships from sources of pain to spaces of deeper compassion and creativity.

    First and Foremost!

    I’d like to start by naming something essential: self-regulation is the foundation of connection. Not willpower. Not effort. Not how much you care.

    For many people with ADHD, regulation is about learning how to find an embodied rhythm—a reliable point of orientation—when the mind pulls in a thousand directions at once. When that rhythm is missing, attention slips, emotions escalate, and misunderstandings multiply.

    This matters profoundly in romantic relationships, where vulnerability is high, expectations are unspoken, and the nervous system is constantly being asked to stay open, present, and responsive under stress.

    Executive Functioning: The Missing Translation in Romance

    So often, when ADHD enters a partnership, struggles get framed in moral or emotional language: “You don’t listen,” “You don’t care,” “You never follow through.” But beneath those painful accusations are usually executive functioning challenges—the executives in the brain’s boardroom helps us:

    • Sustain attention amid distractions
    • Hold information in working memory long enough to respond thoughtfully•
    • Regulate emotions without flooding
    • Shift perspectives or tasks flexibly
    • Pause before reacting impulsively
    • Manage stress without shutting down.

    In romance, these systems are tested constantly: during vulnerable conversations, shared planning, conflict, or simply the daily rhythm of closeness.

    Studies show that elevated ADHD symptoms, particularly inattention and hyperactivity-impulsivity, predict lower relationship quality in adults, often mediated by emotion dysregulation and conflict patterns (Bruner et al., 2015; see also qualitative insights in Matheson et al., 2025). Adults with ADHD frequently describe how these executive hurdles lead to relational instability—uneven sharing of responsibilities, heightened daily stress, and a sense of being overwhelmed by demands neurotypical partners might handle more automatically (Matheson et al., 2025; Sedgwick-Müller et al., 2023). It’s easy to see how this pattern can contribute to low self-esteem and, in some cases, avoidance of romance or close romantic connections, as the intensified emotions from basic arousal and attraction feel overwhelming or risky amid fears of rejection or failure.

    How These Challenges Show Up in Relationships

    Here are some of the patterns I witness most often in my work:

    Attention and Presence

    Zoning out mid-conversation, missing subtle cues, or appearing distracted even when trying hard to stay present. The DSM calls it “often seeming not to listen when spoken to directly,” but in love, it lands as disinterest or neglect. Partners with ADHD share how this creates feelings of being unheard or unimportant, frequently misinterpreted as emotional withdrawal rather than a genuine capacity limitation (Matheson et al., 2024).

    Working Memory and Remembering What Matters

    Holding onto plans, preferences, dates, or emotional details that say “I see you” can be a struggle in ADHD. When working memory slips, partners can feel unseen or undervalued, even when the intention to care is strong. These lapses often lead to uneven “mental load,” where one partner ends up carrying more reminders and planning, breeding quiet resentment over time (Sedgwick-Müller et al., 2023; Matheson et al., 2024).

    Emotional Regulation

    Faster, more intense emotional responses and slower return to baseline. In conflict, this can look like flooding—words tumbling out before reflection—or difficulty letting go. Emotion dysregulation is a key mediator of relational strain in ADHD, with reduced use of adaptive strategies contributing to dissatisfaction (Davenport, 2020; broader patterns in recent reviews).

    Stress and Overload

    Many thrive until relational stress ramps up—intimacy deepens, expectations clash, vulnerability peaks—then executive access narrows sharply, turning small issues into escalations. Partners often describe exhaustion from constant scaffolding or emotional support (Matheson et al., 2024).

    Rejection Sensitivity

    This one amplifies everything. A missed text, delayed response, or distracted glance can trigger intense pain, often called Rejection Sensitive Dysphoria (RSD). It leads to preemptive withdrawal, defensiveness, or over-correction to protect the bond. Qualitative explorations reveal how rejection sensitivity drives avoidance of closeness, contributing to loneliness and relational strain in ADHD (Sandland, 2025).

    Why Labels Help—and Where They Can Hurt

    Clinical terms offer relief: they reduce shame by naming what’s happening biologically rather than morally. Yet when “that’s just my ADHD” becomes a conversation-ender, it can block curiosity and growth. I see diagnoses as maps—helpful for orientation, but intimacy lives in the ongoing, moment-to-moment exploration of how two unique nervous systems meet. When partners learn accurate information about ADHD traits, blame often softens, and collaborative strategies emerge, strengthening connection (Sedgwick-Müller et al., 2023).

    The Compassionate Reframe

    Through this lens, so many struggles aren’t about lack of love, effort, or intention. They’re about mismatched rhythms, overloaded systems, and missing shared language for the neurobiology at play. In relationships, executive functioning is less about “doing things right” and more about noticing—especially in moments of tension—whether we are still present and choosing, or reacting from a place that feels out of control.

    The Heart of My Work

    Supporting women in reframing challenges, building practical tools, and developing a deeper understanding of their own nervous systems isn’t just my work—it’s a path I walk with intention and care.

    Learning to regulate and trust internal signals, and to recognize others as separate and whole—and as trustworthy—is an essential foundation for intimacy, repair, and lasting connection. This kind of capacity doesn’t develop through insight alone or through words on a page—it develops in relationship. It is through felt, lived connection that real transformation occurs (and yes, even over the internet).

    Together, we cultivate mindfulness, regulation, stress resilience, and somatic awareness. I support women in learning to slow down, be curious, and seek what is alive within themselves—moment to moment—and within their relationships, so they can connect more authentically with the people they love.

    If any of this resonates—if you’re navigating ADHD in your own relationships, or supporting a partner who is—I’d be honored to walk alongside you.

    Please reach out by calling me at (510) 269-4808 or through my contact form.

    Therapy isn’t about “fixing” anyone; it’s about creating space to

    feel seen, regulated, and truly connected.

    Warmly,

    Amy Ratkovich LMFT 124308

    Psychotherapist Specializing in ADHD, Women & Relationships

    P.S. If this resonates, you’re welcome to follow along.

     

     

    References

    For further reading—many are open-access:

    Bruner, M. R., et al. (2015). Attention-deficit/hyperactivity disorder symptom levels and romantic relationship quality in college students. Journal of American College Health.

    This study empirically links higher ADHD symptom levels (especially inattention and hyperactivity-impulsivity) in college students to poorer romantic relationship quality, mediated by mechanisms like conflict and dysregulation—offering quantitative support for the claim that ADHD symptoms predict lower relationship satisfaction.

    Davenport, T. (2020). ADHD traits, emotion dysregulation, and romantic relationship satisfaction in college students [Honors thesis]. University of North Carolina Greensboro.

    This honors thesis examining ADHD traits, emotion dysregulation, and romantic satisfaction in college students demonstrates that increased emotion dysregulation is associated with lower relationship satisfaction—providing targeted evidence for the role of intense, prolonged emotional responses in relational strain.

    Matheson, L., et al. (2024). “I Felt Like a Burden”: An exploration into the experience of romantic relationships for people with ADHD. Journal of Marital and Family Therapy (PMC open access).

    Titled “I Felt Like a Burden,” this qualitative exploration captures how adults with ADHD experience romantic relationships as burdensome due to inattention, forgetfulness, emotional overload, and the need for constant scaffolding—providing vivid, first-hand evidence for the attention, working memory, stress, and partner exhaustion dynamics highlighted.

    Sandland, B. (2025). Neurodivergent experiences of rejection sensitive dysphoria expose the environmental factors too often overlooked. Sage Journals.

    This recent qualitative work centers neurodivergent adults’ lived experiences of Rejection Sensitive Dysphoria (RSD), emphasizing intense emotional pain from perceived rejection, environmental triggers, and resulting relational withdrawal or avoidance—directly substantiating the amplified impact of rejection sensitivity in ADHD relationships.

    Sedgwick-Müller, J. A., et al. (2023). The experiences of adults with ADHD in interpersonal relationships and online communities: A qualitative study. SSM – Qualitative Research in Health (PMC open access).

    This qualitative study directly explores adults’ lived experiences of ADHD in interpersonal relationships, revealing themes like stigma, uneven responsibility sharing, heightened stress, and the value of accurate information to reduce blame—aligning closely with patterns of executive dysfunction and relational instability described in the post.

  • Dry January, ADHD and the Relationship You’re Trying to Save

    Dry January, ADHD and the Relationship You’re Trying to Save

    Dear Near Dear Readers,

    Dry January is about becoming more aware of yourself by temporarily removing things that might be blocking that clarity—in this case, substances or habits you enjoy but aren’t always sure are just “for fun” versus something you quietly rely on. It’s a month to test the waters: Do I need this to feel okay, or is it filling a gap I haven’t fully named?

    Many people use this time to gently confront the small ways we justify patterns that interfere with relationships, work, or self-trust—even when a deeper part of

    us has always known. Dry January is well known, so if you participated (or even just followed along), you may have noticed something important: when substances quiet down, underlying patterns speak up louder. With fewer cultural expectations and more reflective space, it offers a second, quieter invitation to notice those patterns again.

    For women with ADHD, this matters deeply—especially in relationships.

    ADHD, Dopamine, and the Pull Toward Relief

    ADHD nervous systems are wired differently. Research consistently shows lower baseline dopamine activity in key brain regions involved in executive functioning and reward processing, including the prefrontal cortex and mesolimbic pathways (The mesolimbic pathway, or “reward pathway,” is a dopaminergic neural circuit connecting the ventral tegmental area (VTA) in the midbrain to the nucleus accumbens, amygdala, and hippocampus.)

    It mediates motivation, pleasure, and reinforcement learning for natural rewards (food, sex) and is the primary site of action for addictive drugs, which increase dopamine release, driving drug-seeking behavior and compulsion.  This impacts focus, impulse control, emotional regulation, and motivation, creating a constant drive for intensity, novelty, or quick relief just to feel balanced (Barkley, 2015; Volkow et al., 2009).

    Substances can become an efficient shortcut. Alcohol or cannabis may temporarily boost dopamine, quiet racing thoughts, soften emotional overwhelm, or dull rejection sensitivity. Rejection Sensitive Dysphoria (RSD)—an intense and often overwhelming emotional pain triggered by perceived criticism or rejection—is especially common in ADHD and can make interpersonal moments feel unbearable. Substances offer fast relief from that sting, helping someone feel more relaxed, “fun,” or connected in social or romantic settings.

    In relationships, these shortcuts often appear subtly:

    • Drinking to unwind and feel more present or playful with a partner
    • Using substances to tolerate conflict rather than addressing it directly
    • Numbing loneliness or anxiety instead of voicing needs
    • Escaping discomfort to stay “okay” in the moment

    Over time, this can create distance—not because you don’t care, but because emotional regulation is happening around the relationship instead of within it.

    Why Dry January Can Feel Uncomfortable—and Revealing

    When these supports are removed, ADHD brains often don’t just experience cravings; they face amplified symptoms due to the loss of an external dopamine source. You may notice:

    • Heightened emotional intensity or mood swings
    • Increased irritability, restlessness, or racing thoughts
    • Sharper sensitivity to tone, silence, or perceived rejection (RSD can feel especially raw)
    • Clearer awareness of relational dissatisfaction or unmet needs

    This can feel destabilizing—especially if substances were quietly holding things together. But the discomfort isn’t failure. It’s data. Dry January doesn’t cause relationship problems; it reveals where regulation, communication, and self-trust may need more intentional support.

    Studies on Dry January participants show that even short breaks from alcohol are associated with improved mood, reduced anxiety, better sleep, and increased mental clarity—often within weeks (University of Sussex, 2019). For ADHD nervous systems, this clarity can bring long-standing relational and emotional patterns into sharper focus.

    Reliance Isn’t Always Dramatic—Sometimes It’s About Survival

    Many high-achieving women with ADHD don’t identify their patterns as “addiction” because they function well externally. Yet research consistently shows that individuals with ADHD are at significantly higher risk for substance use disorders—often two to three times higher than the general population—frequently using substances to self-medicate core symptoms such as emotional dysregulation, inattention, hyperactivity, or RSD (Lee et al., 2011; Wilens & Morrison, 2011).

    In women especially, this reliance can look relational and functional rather than chaotic or destructive.

    If something consistently:

    • Manages your emotions for you
    • Keeps you from speaking honestly
    • Helps you tolerate situations that feel off
    • Prevents you from being fully present

    …it’s worth gentle attention. Not with shame—with curiosity.

    A Different Intention for Dry January

    Dry January doesn’t have to mean giving up all comfort or dopamine sources—that’s rarely sustainable for ADHD nervous systems. Instead, it can be an invitation to ask:

    • What happens in my relationships when I’m clearer-headed?
    • Where do I feel closer—and where do I feel more exposed or raw?
    • What emotions surface when I can’t numb them away?
    • What do I actually need that I’ve been outsourcing to substances or habits?

    Clarity isn’t about perfection. It’s about reclaiming choice.

    Moving Forward

    If Dry January is stirring discomfort in your relationship—or illuminating patterns you don’t yet know how to shift—that’s not a signal to push harder or return to numbing. It’s an invitation to get support.

    Therapy that integrates ADHD neuroscience, nervous system regulation, relational dynamics, and somatic awareness can help you understand why these patterns developed and how to build sustainable ways to feel regulated and connected—without outsourcing it.

    My hope is that this season gives you information, not pressure.Insight, not judgment.And a clearer sense of what actually supports the love and life you want to build.

    Reach Out…

    If this is resonating and you’d like a safe space to explore these patterns in your relationship—or simply understand your ADHD brain more deeply—I’m here. As a Marriage and Family Therapist specializing in neurodivergent women, ADHD, emotional regulation, and relational dynamics, I’d be honored to support you.

    Book a free 15-minute consultation —no pressure, just a conversation to see if it feels like a fit.

    You deserve clarity and compassion.

    Please give me a call at (510) 269-4808

  • Why December Felt Different When You Have ADHD

    Why December Felt Different When You Have ADHD

    How do you feel right now, as December comes to a close?

    If you’re being honest, your answer might include exhaustion, overwhelm, or a quiet sense of relief that it’s finally over.

    If so — you’re not imagining it.

    December asks more of ADHD brains than most people realize. And if you’re here reading this, chances are you felt it. It’s been a long month. This is a longer blog. Go at your own pace.

    Here’s the reassurance up front: If you make it to the end, you’re doing okay.And even if you don’t, you may still walk away with a clearer understanding of why December felt the way it did.

    The point of this article is simple:

    December places unique demands on attention, emotional regulation, and executive functioning — the very systems ADHD brains already work hardest to manage.

    Why December Hits Differently

    In the United States, December is culturally dense with celebration and expectation. Christmas, Hanukkah, Kwanzaa, New Year’s Eve, solstice gatherings, office parties — the month is layered with social scripts about connection, reflection, and fresh starts.

    Even for deep thinkers, being asked to reflect while also celebrating can be a lot.

    Even if you didn’t personally celebrate any of these events, the cultural narrative was hard to escape. The buzz was in the air. There was implicit pressure to show up (at least to the office party), be present, feel festive, and end the year with something meaningful to show for it — preferably alongside a solid plan for the year ahead.

    For many people, this season is simply busy or even energizing — a welcome chance to reconnect with family and friends they don’t usually see.

    But for those with ADHD — especially women whose nervous systems are already working overtime to regulate emotions and navigate social expectations — December often feels less like a celebration and more like a minefield.

    It’s not just that the month is full.

    It’s that December demands consistent performance from internal systems that were already stretched thin.

    When interpersonal dynamic alone feel taxing— reading social cues, managing emotional reactions, staying regulated in group settings — the cost tends to rise even higher during the holidays due to layers of expectations quietly pile on.

    Should that be no big deal? Right?

    The Functioning Tax

    What December Actually Costs

    Emerging research is confirming what many people with ADHD already know from lived experience: ADHD nervous systems are more sensitive to sensory input than non-ADHD nervous systems.

    A large 2025 meta-analysis found that individuals with ADHD experience significantly greater challenges across sensory sensitivity, sensory avoidance, low sensory registration, and sensory seeking (Jurek et al., 2025).

    In plain terms, your brain is already working harder to process the world around you.

    Lights feel brighter. Sounds are harder to filter. Crowds are more draining.

    December intensifies all of this. Holiday lights, crowded stores, loud gatherings, overlapping conversations, and constant stimulation are everywhere during what’s often called the most wonderful time of the year. Unlike a typical workweek or a single social event, December rarely includes true recovery time. There are fewer pauses, fewer days without social obligations built in, and very little space to recharge. Even finding a quiet bathroom to hide out in can feel harder to come by.

    When your brain is busy filtering sensory input, it has less capacity left for everything else. And because increased stimulation is essentially the name of the holiday season game, it makes sense that this creates a clash of needs.

    For neurodivergent people, everyday social interaction already requires extra effort. Adding more social rules — and the emotional weight attached to those rules — places additional strain on an already sensitive autonomic nervous system (fight, flight, or freeze). December adds another layer: more expectations, more emotional demands, and more opportunities for nervous system burnout.

    This is the holiday functioning tax.

    And it compounds quietly, day after day.

    Belonging vs. Loneliness

    The Emotional Paradox

    One of the heaviest experiences many ADHD women face in December is the tension between wanting connection and being overwhelmed by it.

    Holiday gatherings often amplify this paradox. You can be surrounded by people — coworkers, family, familiar faces — and still feel strangely alone.

    This isn’t just anecdotal. A 2024 meta-analysis found that individuals with ADHD experience significantly higher levels of loneliness than their non-ADHD peers (Jong et al., 2024). Importantly, loneliness is not the same as social isolation.

    Loneliness reflects a perceived lack in the quality of connection, not the quantity.

    In plain terms:

    • You can have a full social calendar and still feel disconnected
    • You can be at a party and feel like you’re performing rather than participating
    • You can love the people around you and still need to step away just to regulate

    This is the belonging paradox: the more you want connection, the more overwhelming it can feel when your nervous system is already overloaded.

    December — with its endless invitations, heightened expectations, and subtle pressure for “mandatory fun” — turns that tension up even louder.

    Executive Function Overload

    Why Planning Feels Impossible

    Executive functions are the brain’s management system — the processes that allow us to plan, organize, shift between tasks, manage time, and regulate emotional responses (Diamond, 2013). For individuals with ADHD, these systems function differently. Research has consistently shown that ADHD involves differences in working memory, self-regulation, and planning (Barkley, 1997).

    This isn’t about intelligence or effort.

    In plain terms: your brain’s filing system works differently.

    December dramatically increases executive demands. Coordinating schedules, buying gifts, preparing meals, managing travel, moving between work events and family gatherings — often with very little downtime. For ADHD brains already working hard to manage these tasks on a typical day, December requires sustained high-level executive performance across weeks.

    That’s exhausting and stress makes it worse.

    Stress directly impacts the prefrontal cortex — the brain region responsible for executive functioning and already under strain in ADHD (Arnsten, 2009). Under stress, the prefrontal cortex becomes less efficient, reducing the very abilities needed for planning, organization, and emotional regulation.

    In plain terms: when stress rises — as it does in December — the systems you rely on most become less effective.

    Emotional Regulation

    A Core ADHD Challenge

    Emotional dysregulation is not a secondary feature of ADHD — it’s central to the experience. Research shows that ADHD affects how intensely emotions are felt and how difficult they are to regulate in the moment (Shaw et al., 2014; Mohammadi et al., 2020).

    In plain terms: Your emotions aren’t just “bigger.”Your nervous system processes and regulates them differently.

    December adds specific pressures that make regulation even harder:

    • The pressure to perform joy, even when you’re exhausted
    • Family dynamics, where old roles and expectations resurface
    • Increased social demands, layered on top of sensory and executive overload

    It’s not that you can’t handle emotions.

    It’s that December asks you to regulate emotions under conditions that are uniquely dysregulating for your nervous system.

    This is often why others notice changes — “You’re so different this month” — not because you changed, but because the load did.

    Decision Fatigue

    Why Every Choice Feels So Hard

    Research shows that individuals with ADHD already expend more cognitive energy on everyday decision-making, making them especially vulnerable to decision fatigue (Fisher et al., 2023).

    December multiplies decisions:

    • What gifts to buy
    • Which events to attend
    • What to wear
    • What to bring
    • When to leave
    • What to cook or order

    Each decision drains limited cognitive resources.

    By mid-December, many ADHD brains are running on empty, leading to:

    • Procrastination
    • Impulsivity
    • Analysis paralysis

    This is decision fatigue — and for ADHD brains, it hits faster and harder.

    Which brings us to something many people don’t give themselves permission to do.

    Permission to Participate at 70%

    You didn’t have to show up at 100% to every December obligation.

    Did you allow yourself to:

    • Leave parties early
    • Say no to events
    • Participate on your terms
    • Acknowledge that December was hard?

    You weren’t failing. You were practicing self-compassion if you only had 70 percent to give. That was your best, and that’s all we can do. If you did push yourself to 100% and now feel completely depleted? That’s understandable too. You were doing what you were taught to do.

    Moving forward, you get to choose differently.

    Moving Forward

    ADHD doesn’t disappear in January — but the cultural noise does quiets a little for a little while. If you’re finishing December feeling depleted, know this:

    You didn’t fail December. December asked for something your nervous system couldn’t sustainably give — and you made it through anyways, because here you are.

    That matters.

    If You’d Like Support Moving Forward

    If this resonated with you and you’d like support navigating the patterns you’ve been noticing, you don’t have to do that alone. Therapy has been shown to help people work with patterns that quietly shape their nervous system responses — often long before we’re consciously aware of them.

    The approaches which inform my work integrate somatic awareness, mindfulness, and relational insight can help reduce nervous system reactivity, increase emotional regulation, and improve attention and self-trust over time — especially for adults with ADHD.

    You don’t need to wait until things are falling apart again.

    My hope is that next year you can dance at the parties, leave when you’re tired, and wake up without the emotional hangover — not just in December, but year-round.

    I offer a free 15-minute consultation where we can talk about what you’re experiencing and explore whether therapy might be a good fit to help you dance to the beat of your own drum.

    You’re allowed to move at your own pace and I would be honored to help you find your rhythm.

    References

    Arnsten, A. F. T. (2009). The emerging neurobiology of attention deficit hyperactivity disorder: The key role of the prefrontal association cortex. The Journal of Pediatrics, 154(5), I-S43.

    Barkley, R. A. (1997). Behavioral inhibition, sustained attention, and executive functions: Constructing a unifying theory of ADHD. Psychological Bulletin, 121(1), 65-94.

    Diamond, A. (2013). Executive functions. Annual Review of Psychology, 64, 135-168. https://doi.org/10.1146/annurev-psych-113011-143750

    Durmaz, A., & Türkoğlu, S. (2024). Sensory processing in adolescents with attention deficit hyperactivity disorder and its relationship with executive functions. Research in Developmental Disabilities, 145, 104659.

    Fisher, J. T., Hopp, F. R., & Weber, R. (2023). Cognitive and perceptual load have opposing effects on brain network efficiency and behavioral variability in ADHD. Frontiers in Psychology, 14, 1015102.

    Gmehlin, D., Fuermaier, A. B., Walther, S., Tucha, L., Koerts, J., Lange, K. W., Tucha, O., Weisbrod, M., & Aschenbrenner, S. (2016). Attentional lapses of adults with attention deficit hyperactivity disorder in tasks of sustained attention. Archives of Clinical Neuropsychology, 31(4), 343-357. https://doi.org/10.1093/arclin/acw016

    Jong, L. M., Tan, S. H., Maybery, M., & Steele, M. (2024). Loneliness in young people with ADHD: A meta-analysis. Journal of Attention Disorders, 28(6), 743-755. https://doi.org/10.1177/10870547241229096

    Jurek, L., Baltazar, M., Gulati, S., Novak, L., Jarrick, S., Deserno, M. K., Bennett, D., D’Cruz, A. M., Harrop, C., Sasson, N. J., Bal, V. H., Manohar, H., Hus Bal, V., Robinson, E. B., Wolfers, T., & Jamalabadi, H. (2025). Sensory atypicalities in attention-deficit/hyperactivity disorder: A meta-analysis. Journal of the American Academy of Child & Adolescent Psychiatry, 64(1), 79-91.

    Leonard, M. A., Milich, R., & Lorch, E. P. (2011). The role of pragmatic language use in mediating the relation between hyperactivity and inattention and social skills problems. Journal of Speech, Language, and Hearing Research, 54(2), 567-579.

    Marchetta, N. D. J., Hurks, P. P. M., De Sonneville, L. M. J., Krabbendam, L., & Jolles, J. (2008). Sustained and focused attention deficits in adult ADHD. Journal of Attention Disorders, 11(6), 664-676. https:doi.org/10.1177/1087054707305108

    Mohammadi, M. R., Mostafavi, S. A., Keshavarz, S. A., Eshraghian, M. R., Hosseinzadeh, P., Hosseinzadeh-Attar, M. J., Kooshesh, S. M., Chamari, M., Akhondzadeh, S., & Hosseinzadeh, P. (2020). Emotion dysregulation in adults with attention deficit hyperactivity disorder: A meta-analysis. BMC Psychiatry, 20(1), 120. https://doi.org/10.1186/s12888-020-2442-7

    Shaw, P., Stringaris, A., Nigg, J., & Leibenluft, E. (2014). Emotion dysregulation in attention deficit hyperactivity disorder. American Journal of Psychiatry, 171(3), 276-293.

    Yovel, I., Shechner, T., & Bar-Haim, Y. (2023). Listen up! ADHD slows spoken-word processing in adverse listening conditions: Evidence from eye movements. Journal of Communication Disorders, 103, 106324. https://doi.org/10.1016/j.jcomdis.2023.106324

  • The Stories We Tell Ourselves: Understanding Rejection Sensitivity in ADHD

    The Stories We Tell Ourselves: Understanding Rejection Sensitivity in ADHD

    For women navigating relationships with heightened emotional sensitivity

    You know that feeling. Your partner’s tone shifts slightly. Their energy changes. Maybe they’re quieter than usual, or there’s a tension in their body language you can’t quite name but definitely feel.

    And instantly, your body responds: What did I do wrong?

    Your heart races. Your mind scrambles through the last hour, the last day, searching for evidence of your mistake. The story writes itself before you even realize you’re telling it: They’re upset with me. I messed up. They’re going to leave.

    If this resonates with you, you’re not alone. And here’s what might surprise you: your sensitivity isn’t the problem.

    The Mistranslation: When Accurate Perception Becomes Painful

    Here’s what’s actually happening in those moments of sudden panic: You ARE perceiving something real. Your sensitivity is accurate. That shift in your partner’s energy? It’s there. You’re not imagining it.

    The challenge isn’t your perception—it’s the automatic story your brain tells you about what it means.

    Psychological research has shown that humans make sense of emotional experiences through story—even when we don’t realize we’re doing it. A 2022 review in the European Journal of Psychotraumatology noted that narrative processing is central to how people understand stress, regulate emotions, and recover from difficult experiences.

    Think about it this way: You pick up a genuine emotional signal from someone you care about. Maybe they’re having an internal moment—stress about work, worry about a family member, physical discomfort, or simply processing their own thoughts. Your perceptive brain registers this shift immediately.

    But here’s where the mistranslation happens. Without pausing to verify, your brain automatically interprets that signal as: This is about me. This is a threat. This means rejection.

    The story becomes “They’re disappointed in me” rather than “They’re experiencing disappointment that may have nothing to do with me.”

    Narrative research consistently finds that the brain automatically creates meaning from emotional cues—often before we’re consciously aware of it. The trauma literature calls this narrative coupling: the linking of a raw emotional signal with a story that explains it. In ADHD, that automatic coupling tends to skew toward self-blame or rejection.

    For women with ADHD, this pattern can feel especially intense and exhausting. The combination of naturally heightened emotional sensitivity paired with challenges in executive functioning creates a perfect storm. You feel everything more intensely, and that pause button that might help you reality-check the story? It’s harder to access.

    Why This Happens: The Developmental Roots

    Most children develop a crucial cognitive ability somewhere between ages 5 and 7: the understanding that other people’s internal emotional states can exist independently of us. In other words, “Mom is upset, but it’s not necessarily about me or caused by me.”

    For many neurodivergent folks, particularly those with ADHD, this differentiation happens at a cognitive level—you can intellectually understand that someone else’s bad mood isn’t always about you—but it doesn’t fully integrate at the emotional and somatic level.

    The difference isn’t the sensitivity itself—it’s in how our brains automatically translate the signals we pick up. In my clinical experience working with neurodivergent clients, I’ve observed what appears to be a pattern: where most people’s brains seem to develop a kind of “emotional firewall” that filters “this is about me” from “this is about them,” neurodivergent brains often process emotional data as relational by default. While research confirms that people with ADHD experience heightened emotional sensitivity and challenges with emotional regulation, this specific mechanism I’m describing is based on my clinical observations and warrants further research.

    The Protective Story

    But here’s the compassionate piece: this didn’t happen in a vacuum.

    If asking for clarification was historically unsafe—maybe you grew up with dismissive caregivers, unpredictable emotional environments, or heard “you’re too sensitive” one too many times—then your younger self learned something important:

    • My perception is real (it is—you ARE picking up accurate signals)
    • But investigating is dangerous (asking led to dismissal, gaslighting, or more rejection)
    • So I must figure it out alone (create a story to make sense of what I’m sensing)
    • The safest story is: “It’s about me, and I need to fix it” (at least then I have some control)

    Your brain wasn’t broken. It was brilliant. That automatic storytelling was a survival adaptation that helped you navigate an emotionally unpredictable world.

    Narrative-based trauma research shows that when people grow up in unpredictable or emotionally dismissive environments, their nervous system learns to create protective meaning-making patterns that prioritize safety over accuracy. That’s why the old story of “It must be about me” feels so instinctive—it once protected you.

    The problem is, that same protective mechanism that once kept you safe now creates suffering where there doesn’t need to be any.

    The Rejection Sensitivity Loop

    This pattern creates what we call rejection sensitivity, but it’s more complex than just “fear of rejection.” Here’s how the loop typically plays out:

    1. Accurate perception of an emotional shift in someone else
    2. Automatic “about me/threat” story (because asking once felt unsafe)
    3. Body responds to the story with anxiety, panic, shame
    4. Behavior changes—you might withdraw, seek excessive reassurance, become defensive, or people-please
    5. This behavior may actually create tension in the relationship
    6. Which confirms the original story: “See, I WAS right to worry”

    And here’s where the dopamine piece becomes crucial. Research shows that with insufficient dopamine in ADHD brains, social approval doesn’t provide the same rewarding feeling it does for neurotypical folks. Your brain becomes desperate to avoid even mild rejections because they feel devastatingly punishing without the dopamine-fueled reward from acceptance or praise.

    This can show up as:

    • Ruminating when you’re alone—feeling rejected even when no one else is around, as if the mere absence of connection equals abandonment
    • Constant mental scanning—preoccupied with potential rejection even when there’s no evidence
    • Social inhibition—afraid of saying something “out of pocket” and facing rejection
    • Valuing others’ opinions more than your own—their approval becomes the source of dopamine you desperately need
    • Self-loathing lens—when self-worth is low, all perceptions get filtered through self-contempt

    The exhausting truth? You’re not just managing relationships. You’re managing an internal narrative system that’s working overtime to protect you from a threat that may not even be there.

    The Way Out: Rewriting Your Story

    Here’s the liberating truth that changes everything: That past moment is not happening right now.

    If you’re reading this, you’re safe. You’re here. And you have a choice about the story you tell yourself.

    The old story kept you safe once. But now? Now you get to choose a new one—one that honors both your incredible perceptiveness AND your right to verify what you’re sensing.

    Understanding the Hidden Face of Depression in Women with ADHD

    For many women with ADHD, depression doesn’t always look like sadness—it shows up as perfectionism. Research shows that perfectionism in ADHD is deeply linked to fear of failure, disappointing others, and vulnerability to anxiety and depression. Women with ADHD often become overly critical of themselves, fearing rejection based on perceived shortcomings, which directly impacts self-esteem.

    When matters of the heart are involved, this perfectionism intensifies. The constant second-guessing—Did I say the right thing? Did I misread that? Am I too much?—becomes a relentless internal critic that erodes self-worth over time. Girls and women with ADHD face societal expectations that drive them to mask symptoms through perfectionistic behaviors, and this self-criticism fuels both anxiety and depression.

    In relationships, this perfectionism isn’t about having impossibly high standards for yourself—it’s about judging yourself more harshly for not meeting them. Each perceived misstep, each moment of uncertainty, becomes evidence in a story of “not good enough.”

    But here’s what research shows: this story can be rewritten. A 2021 study in Japanese Psychological Research found that women who participated in narrative therapy groups focused on re-authoring their stories experienced new understanding of themselves, forward-looking perspectives on life, and measurable reductions in depression. When women learned to separate their perception (accurate) from their interpretation (often distorted by old protective stories), they found freedom from the perfectionism trap.

    The New Story Framework

    Trust your perception. That signal you’re picking up? It’s real. Your sensitivity is a gift, not a flaw. You notice things others miss. That’s valuable.

    Question the automatic meaning. The story your brain instantly adds—”this means rejection, this means I’m not enough, this means danger”—that’s old wiring. It’s not truth. It’s interpretation based on outdated protective programming.

    Give yourself permission to inquire. This is where the real healing happens. Practice asking: “Hey, I noticed a shift in your energy. What’s going on for you?”

    Notice the wording: for you. Not “what did I do?” Not “are you mad at me?” Just genuine curiosity about their internal experience.

    Will this feel scary at first? Probably. The old programming will scream that asking is dangerous. But here’s what you’ll discover: most of the time, their answer has nothing to do with you. They’re stressed about work. They’re worried about their mom. They’re hungry. They’re processing something from earlier.

    And when it IS about something in the relationship? You’ll know. You can address it directly instead of drowning in assumptions.

    Gratitude and Compassion as Tools

    This rewriting process isn’t about forcing positivity or gaslighting yourself into believing “everything is fine.” It’s about bringing both gratitude and compassion to your experience:

    Gratitude for:

    • The sensitivity that kept you safe and makes you deeply perceptive
    • Your capacity to notice the difference between signal (real) and story (interpretation)
    • Your courage to learn a new way of being in relationships

    Compassion for:

    • Your younger self who needed that protective story
    • The learning curve as you practice inquiry instead of assumption
    • The moments when the old pattern still shows up (because it will—that’s normal)

    What You Can and Can’t Control

    Here’s the empowering distinction that changes everything:

    You CAN control:

    • The story you tell yourself about what you perceive
    • Whether you choose to inquire or assume
    • How you respond to your own emotions with kindness
    • The meaning you make of your experiences

    You CAN’T control:

    • Other people’s internal states or moods
    • Whether someone is having a difficult moment
    • The past and what happened there
    • How quickly this new pattern becomes natural

    Right here, right now, you get to choose a story that empowers you instead of one that keeps you small and afraid.

    Ready to Take the Next Step?

    Understanding these patterns is the first step. But actually rewiring them? That takes support, practice, and often guidance from someone who understands the neurodivergent experience.

    If you’re ready to explore rewriting the narratives that no longer serve you, I invite you to join me for a free 15-minute consultation call. Together we can explore whether now is the right time in your life to seek support in rewriting the past in order to create a brighter future.

    You’re not too sensitive. You’re not broken. You’re perceptive, you’re feeling, and you’re ready for a new story—one where your sensitivity becomes your strength.

    References

    Bunford, N., Evans, S. W., & Wymbs, F. (2015). ADHD and emotion dysregulation among children and adolescents. Clinical Child and Family Psychology Review, 18(3), 185-217.

    Karibwende, F., Niyonsenga, J., Nyirinkwaya, S., Hitayezu, I., Sebuhoroo, C., Sebatukura, G. S., Ntete, J. M., & Mutabaruka, J. (2022). A randomized controlled trial evaluating the effectiveness of narrative therapy on resilience of orphaned and abandoned children fostered in SOS children’s village. European Journal of Psychotraumatology, 13(1), 2152111. https://doi.org/10.1080/20008066.2022.2152111

    Koganei, K. (2021). Women’s narrative in a narrative therapy‐based group: A qualitative study. Japanese Psychological Research, 63(4), 326-338. https://doi.org/10.1111/jpr.12326

    Quinn, P. O., & Madhoo, M. (2014). A review of attention-deficit/hyperactivity disorder in women and girls: Uncovering this hidden diagnosis. The Primary Care Companion for CNS Disorders, 16(3). https://doi.org/10.4088/PCC.13r01596

    Shaw, P., Stringaris, A., Nigg, J., & Leibenluft, E. (2014). Emotion dysregulation in attention deficit hyperactivity disorder. American Journal of Psychiatry, 171(3), 276-293. https://doi.org/10.1176/appi.ajp.2013.13070966

    Surman, C. B., Biederman, J., Spencer, T., Miller, C. A., McDermott, K. M., & Faraone, S. V. (2013). Understanding deficient emotional self-regulation in adults with attention deficit hyperactivity disorder: A controlled study. ADHD Attention Deficit and Hyperactivity Disorders, 5(3), 273-281.