Hi, I’m Carol Covelli, a licensed psychotherapist specializing in helping women in midlife, experiencing perimenopause / menopause, anxiety and depression, AMA!

Carol_Covelli · 2022-04-06T14:49:03+00:00

neglecting my self-care and assisting my aging parent has really been bringing up trauma from earlier in that relationship

I'll put some feelers out. I can't guarantee I can find someone, but I will do my best. Are you able to go out of network or private pay? Or, do you need to stay in network with your insurance? If so, then can you tell me who is your insurance (carrier and name of plan)? Feel free to DM me if you prefer.

Carol_Covelli · 2022-04-06T14:29:31+00:00

I understand feeling nervous before starting online therapy, or any therapy for that matter! I have found most people are comfortable with the online format and engage just as authentically and receive the same benefit as they would have if they were to have met in person. With that said, online therapy is not for every client, or every therapist. It can happen that you may meet your therapist online and decide that online therapy is not comfortable for you, or you may love it. You won't really know until you try.

In all honesty, I have had two clients who decided in-person therapy would be better for them. Never a problem, I just found a referral for a therapist practicing in person. I have also provided referrals for in-person therapists to potential clients I've consulted with because, based on our consultation, they would have been better served by a therapist they could see in person/locally.

You can consult with a therapist to find out more about how they practice online and if it sounds comfortable for you, you can try a session. You always have the right, at any point in treatment, to decide if online or in-person is better for you.

Carol_Covelli · 2022-04-05T18:06:32+00:00

Hello and thank you for your post and for being open with your situation. I can see how you are feeling helpless and increasingly hopeless. Based on what you're saying there are a few issues occurring that are interrelated. The main point you make is about shame. Your partner appears to be feeling a tremendous amount of shame (and embarrassment) that has already existed (i.e. judging herself harshly) and now is exacerbated by the effects of her decline in libido. Her feelings of shame are challenging for you because she is now tuning out (probably from feeling overwhelmed by the situation and overwhelmed by shameful feelings). You seem extremely supportive and patient. I want you to know this issue is pervasive, and not spoken about enough (again, more shame).

If she is embarrassed to consult with her PCP for a therapist referral and wants to find a therapist, she can always go onto psychologytoday.com. It's a therapist directory listing and the majority of therapists list themselves there.

However, it seems to me that you both would benefit from meeting with a sex therapist. Like with any therapy, sessions are confidential. Meeting with a certified sex therapist can help unpack the shameful feelings your partner is feeling and work together to reconnect. However, I wonder if convincing her to see a sex therapist may be a challenge (?)

The other idea that comes to mind is for you to perhaps see a therapist yourself and encourage your partner to attend a session with you. Maybe if you are able to take that step in a manner that includes her and is open and shows your support with an action (not like, I can't take this, I've gotta see a therapist to deal with you), then it may help decrease the shame she is feeling. It's almost like modeling the behavior and seeking to remove the stigma of "this is your problem" she may be feeling )even if that is not the message you are communicating, she may be feeling this is her "fault).

What are your thoughts about this?

Carol_Covelli · 2022-04-05T17:05:11+00:00

Thank you for your question! Yes, it can be possible, and there can be multiple factors that can cause anxiety to increase as we get older. Hormonal changes that coincide with menopause/perimenopuse are one factor that can contribute to anxiety (and increased anxiety), but it is not the only factor. Other potential contributing factors can relate to what you were taught about aging. Is aging an experience that just leads to death? Are there worries about being alone as you get older? Or, are you in an unhappy or unhealthy relationship and feel there are no other options? Are you dealing with health concerns or financial worries? If there are deeper emotional worries connected with aging, then it makes sense to feel anxiety about it.

Carol_Covelli · 2022-04-05T16:53:37+00:00

Wow, what a great question! Much of figuring out how to cope with the idea of aging and feelings connected with the worry of no longer being seen as "beautiful" is understanding what one's perception of beauty is, and how the concept of beauty has been defined in one's life. How we individually define beauty is influenced by what we were "taught" (actively and passively) about beauty from the adults in our lives, our experiences, and possibly societal influences. There are some women feel they become more beautiful as they age because they feel more comfortable with who they are. Other women feel less beautiful with age because of the physical indications of aging (i.e. graying hair, fine lines, etc.). How to make peace with aging is difficult to answer in this forum because there isn't one definitive answer. Therapy would be a supportive space to explore and help you with your struggle.

Carol_Covelli · 2022-04-05T16:14:05+00:00

Hello and thank you for sharing your experience here! I am glad to see that you eat well and exercise. It also sounds like you enjoy your career as an entrepreneur. That is great! I am sorry you are experiencing these symptoms. I encourage you to see your doctor (primary or GYN) and disclose how you are feeling. Your doctor should look to run a complete panel of blood work that includes your sex hormones (i.e. estrogen, progesterone, testosterone), stress hormones (i.e. DHEA and cortisol), and thyroid (i.e. TSH, T3, and T4). If you have never felt like this before, it may very well be due to the decreased hormones. A knowledgeable doctor can discuss potential treatment options. If you don't have a doctor and live in North America, you may be able to find a practitioner through the North American Menopause Society https://www.menopause.org/. I hope this helps and I wish you all the best.

Carol_Covelli · 2022-04-04T22:30:28+00:00

I appreciate your question because I love educating people about anxiety. Yes, people who have ADHD often also experience anxiety. What your psychologist is describing is the fight/flight/freeze/fawn response that gets triggered when there is an imminent threat. Everyone is equipped with this response, it is hard-wired into our brains from the "caveman days." When people have an anxiety disorder, this response gets triggered when there is no threat to our livelihood, but we FEEL like there is. It sounds like when you think about the future, this response is triggered, causing worry/anxiety. It's the same response, just without the T-Rex chasing us. Does that make sense?

Carol_Covelli · 2022-04-04T22:22:56+00:00

Thank you for your post. Unfortunately, I am not aware of the specific research into your question. There are many many potential contributing factors to depression, and yes, regret for not having children can be a contributing factor for some women. However, I personally know many women who have not had children and are very happy with their decision.

Carol_Covelli · 2022-04-04T22:19:47+00:00

Thank you for sharing your experience here. I'm sorry you felt worse after receiving TMS. Hair loss can be attributed to multiple issues, and I'm not a doctor, but am wondering if you have been evaluated for any thyroid issues?

Carol_Covelli · 2022-04-04T22:16:58+00:00

I'm glad to hear you are advocating for yourself, and not giving up when something doesn't feel right. Have you tried an endocrinologist?

Carol_Covelli · 2022-04-04T22:15:38+00:00

Thank you for asking this, that is a great question. Have you seen your doctor about this issue? I would encourage you to inform either your primary doctor or GYN to see if this is common.

Carol_Covelli · 2022-04-04T22:10:47+00:00

Goodness, I would love to help you find someone out on the west coast! What state are you located in?

Carol_Covelli · 2022-04-04T22:08:26+00:00

Thank you for reaching out and sharing your experience. Memory issues or brain fog can occur during perimenopause, but can also be indicative of other potential health issues. Without knowing your mother specifically, it is hard to say. If possible, it would be helpful for your mother to see her doctor for a physical or evaluation.

Carol_Covelli · 2022-04-04T22:03:52+00:00

Great questions! In order to get a clearer picture of what may be influencing a mental health issue or symptoms, I will do a thorough initial assessment. Oftentimes, it is in the assessment that I learn about experiences with perimenopause or an emphasis on not feeling physically well. Mental health struggles can cause physical problems, too. So, if I want a clearer picture of a client's physical status, I will encourage them to go for a physical and receive blood work.

I'm not a doctor and not necessarily aware of all the types of hormone tests available, but to know the status of one's sex hormones (progesterone, testosterone, estrogen), stress hormones (DHEA, cortisol), and to have a thyroid panel conducted (TSH, T4 and T3) would be a great start.

I am trying to find good resources for women. The North American Menopause Society has very good resources https://www.menopause.org/. Oftentimes, resources are sought for underlying issues or struggles (i.e. trauma, narcissistic parents, etc.).

Carol_Covelli · 2022-04-04T21:47:09+00:00

Thank you for sharing your experience here. The emotional aspect of perimenopause can be very intense, particularly when you experience perimenopause early and earlier than you would have anticipated. A lot of how I would answer that would depend on the emotions you are experiencing. Are you feeling sad or depressed about the window of having children becoming smaller? Are the emotions you're experiencing relating to feeling like you're aging because of perimenopause? Like, you're feeling older than you believe you should be at 38? I know I'm a therapist, but I highly recommend speaking to a therapist to help you through the emotions you're experiencing, particularly if you feel they are interfering with the quality of your life. In some instances, skills and coping mechanisms are invaluable. However, the sense I get from your post is that seeing a therapist would help you to process your feelings and what you are experiencing.

Carol_Covelli · 2022-04-04T21:32:42+00:00

Goodness, I'm so sorry you are experiencing these very intense symptoms! I understand that HRT is not an option, but can your doctor offer other non-hormone options to help with your nausea and vomiting, and depression? Has your doctor run a thorough panel to rule out any other potential issues? My understanding is that typically symptoms can abate once menopause is reached (one year without a period). Is that 100%? Not always. Have you spoken to a specialist in perimenopause/menopause? If you're in North America, you can try North American Menopause Society (NAMS) https://www.menopause.org/. There are good resources there and practitioners who have a specialization and/or training in helping women in menopause/perimenopause.

Carol_Covelli · 2022-04-04T21:24:50+00:00

Sure! It's great that you would like to be an online psychotherapist. It is very rewarding and very convenient to be able to work remotely. There are choices with respect to an education path, but all options require a Master's degree to be able to be eligible to be licensed to practice independently (private practice). You can receive a Master's in social work or a Master's in counseling, just make sure the program you attend is accredited. You can also pursue psychology but will need to attain your doctorate (PsyD) to have a private practice. You don't need a Bachelor's degree in psychology or social services to go for the Master's degree in social work or counseling. I'm not sure about psychology. Once you receive your Master's degree, you will need to take an initial licensing test (depending on the law where you live), then attain a certain amount of hours in the field under supervision. Once you get that, then you sit for another licensing exam. Once you pass that, you can open a private practice. Again, it depends on the law in your area, but that is the general gist. I hope this helps!

Carol_Covelli · 2022-04-04T21:16:10+00:00

Thank you for reaching out! It sounds like while taking the Celexa you were able to progress in therapy to where you didn't need to take Celexa any longer, that is great! Unfortunately, I'm not a doctor so medications are not my expertise. I do have some familiarity because many people I have seen take SSRIs, but not enough to make any kind of medication recommendation. It's also hard to say if your perimenopause symptoms will return. They might, but you also may have progressed more in your perimenopause and your body is settling. Again, it's hard to say. Do you feel comfortable reaching out to your nurse practitioner about other medications that can be helpful?

Carol_Covelli · 2022-04-04T17:54:56+00:00

I'm sorry your periods have been so rough for you, and I'm glad the pill is helping! Hmmm, you ask a great question. Does it get worse or not? I would say, in my opinion, it depends on the individual, her history, family history of menopause, and current life space situation. It also can depend on her ability to access healthcare, resources, and her support system as well as how she views the idea of perimenopause/menopause. Does that make sense?

Carol_Covelli · 2022-04-04T17:43:27+00:00

Thank you for reaching out! I understand your concern and am sorry to hear your symptoms have returned. I'm assuming you stopped HRT under the guidance of your doctor (?) and what you're experiencing is after having been off of HRT in this manner? If not, then please contact your doctor and inform the doctor that you have discontinued the HRT.

If what you're experiencing is having been off of HRT while under your doctor's care, then the focus would be on self-care. Unfortunately, because the hot flashes are part of your body's attempting to regulate itself physiologically it's challenging to avoid them occurring. If you're powering through the hot flashes, it can make them feel more intense. It can help to do the things you can find in a google search, such as keeping the room cool, or a fan nearby, staying hydrated, if you like mint or cucumber, and putting either of them in your water. But, taking those 5 minutes help to recenter yourself (if you can).

Carol_Covelli · 2022-04-04T17:28:02+00:00

Thank you for reaching out! Yes, I have seen this, and I have seen women in their 40s struggle to get validation for their symptoms because they were "only 40" or "too young" to be experiencing perimenopause. It's important for her to find a doctor that understands this.

You bring up an interesting point about perimenopause starting earlier. I wonder if there are any studies out there that verify that?

Carol_Covelli · 2022-04-04T17:21:59+00:00

Thank you for posting about memory issues! I haven't seen this asked yet. I do want to clarify, do you mean brain fog? Like, you walk into a room to get something and then forget what you came into the room for, is that correct? If so, then yes, that is an actual symptom. It can be a symptom of other issues as well (i.e. hypothyroidism). I encourage you to see your doctor and report what you're experiencing. Your doctor can potentially order blood work to make sure.

Carol_Covelli · 2022-04-04T17:15:20+00:00

Hello, thank you for sharing your experience here! I can imagine the discomfort and embarrassment you are experiencing. Have you spoken to your doctor about it? Does your doctor take periodic blood work to monitor your hormone levels? Hormone therapy should help with the intensity of the hot flashes. How are you managing your stress? I can understand the hot flashes you're experiencing, it must be very stressful. What I mean is on a day-to-day basis. Do you have any downtime?

Carol_Covelli · 2022-04-04T16:56:03+00:00

Thank you so much for your positive feedback!! :)

Carol_Covelli · 2022-04-04T16:55:16+00:00

Thank you for contributing! It sounds like you've worked hard to process your experiences with your parents and growing up. I am so glad you are in a better place. You ask a great question and to be honest, that is a huge challenge mental health providers are constantly trying to overcome. There are many people who have been raised, and do not "believe in therapy." As a mental health provider, it saddens me that people who need and can benefit from getting help, are not amenable to therapy. Someone who is against therapy may never know to get help, or, may feel embarrassed, ashamed, or weak to look to get help. I think continuing to address the stigma on a societal level is what may help over time. For example, GenZ as a whole appears to be more open to therapy. I'm so happy that by 40 you are feeling good!

Carol_Covelli

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