Advice: Dismissed, Unheeded and Pooh-Pooh-ed

There are things that most therapists say, wish they could say, or have given up saying, that no one ever listens to anyway.

You probably won’t listen either:
But what the hell – I’ll give it another shot:

Please get your thyroid checked, your blood sugar, make sure you aren’t anemic. Get a blood test and a physical. If you are an older man, check your testosterone levels. (I see your eyes glazing over already) Let us make sure before we spend hours and hours and you make a significant financial investment in psychotherapy that we aren’t trying to talk your glands or your pancreas into functioning more consistently.

Your symptoms don’t just live in your mind. Your mind is housed in your body. You have to treat your most pernicious anxious/depressive symptoms in your body too.

And, sure, yes, I am also talking about exercise (recent, flawed studies aside) If you’ve had your exam and your physical health permits: Get some air, some sunshine. Or get rained on. Go to a gym. Find some exercise that you find pleasurable, and do it whenever you can find time and push yourself out the door. Work up a sweat. Salsa dance. Rock climb. Or just walk. Especially when you don’t feel like it. Just around the block a few times, or to the corner and back. Spend a little time in the company of your own body – pay attention to it. We just feel and function better when we treat our bodies with self-respect.

If exercise offers no gain at all – or your energy and motivation is too too low to even consider it – then we need to intervene with your body in some other way: Medical intervention and medication may be a possibility for those who feel committed to the medical model. There are other routes as well: Acupuncture, yoga, a nutritional consult. Therapeutic massage, qi-gong, tai chi, Some believe that a ‘cleanse’ can reboot their bodies response. Some consult an herbalist. Eat aruvedically if that is your thing.

Whatever.

Any gesture that will get you respectfully engaged with your body’s needs again.

The futility of directiveness, I suppose, is why I allied with psychoanalytic, existential, and depth psychology models – as I’ve surrendered to the notion that there is no such thing as effective, directive advice, and that our cognition is rarely changed with out understanding our deeper fears, inheritances, habits, survival mechanisms and resistances.

But I’ll admit, sometimes I still try to slip it in, sandwiched in between moments of exploration and mirroring, amplification, and empathy.

Sometimes I am just itching to tell you what to do.

Especially when you are asking me to.

Actually, its when you ask me to that you seem to listen least of all.

Medication:
I would prefer, if you are considering taking, or feel that you will benefit from psychiatric medication that it be prescribed by a board certified psychiatrist, and please please please, if you won’t or can’t use someone that I refer you to, please find someone who will collaborate, or at least return my call. Please ask them at the first consultation.

Say words like these:
“Will you feel comfortable collaborating as part of a treatment team with my psychotherapist? How do you prefer to be contacted? I would like to be sure to sign a consent for the two of you to communicate before I leave today. Are there times when you might want to know what is happening in my therapy, or would want feedback, or have questions for my therapist?”

I would prefer that you see someone who truly believes in the construct of the lowest therapeutic dose as an guiding ethical value. I would prefer that you consider it as a last resort rather than a simple quick fix. No matter what medication you may utilize for whatever emotional symptoms trouble you, please bear in mind that medication will not change anything enough in and of, or all by itself. In the very best case scenario, it is a single, potentially effective tool to apply to a multi-pronged problem. Tools can be necessary and make things easier. And tools can be dangerous and injurious.

And you will still need to talk things through, look at your choices, heed your intuition, change your life-style, confront changes that you would rather avoid.

Continuing on:

If you are single:
That is fine. Single is not pathology. Life as a single person can be an excellent and healthy choice, and far far preferable to life in a toxic destructive relationship. You are not less than because you are not in a relationship. You are not more unhappy than many many people who have partners. You may have different kinds of unhappiness then they do. Committed partnerships do not inherently make people happier. There are miserable people single, and partnered. There are joyful single folk, and joyful married folk.

No one ever listens to this at all.

If you are dating:
You can have no idea if someone is “perfect for you” after three dates, or a couple of hook ups. Truly. You, and everyone who loves you will be spared a great deal of agony if you can tolerate that fact that we human beings can be extremely attracted to someone who we don’t know at all, probably exactly because we don’t really know them at all.

Enjoy the pheromones. Try to guard your attachments until trust is earned.

And the second prescription for dating singles is like unto it:

Just because you have a somewhat icky feeling after the third week of seeing someone doesn’t in and of itself mean that you should dump them. That icky feeling may very well be a signal that this is a relationship that has the capacity for intimacy. Intimacy is scary, and dangerous. It could hurt you. But, it is what most people are seeking when they look for love. When intimacy begins to emerge – it can scare the shit out of you. Wait a few more weeks before bolting. Get more experiential data. Maybe it is a signal that something is wrong or not working between the two of you.

Or maybe its a signal that you could change each others lives.

In someways, being consistently ignored in my more advice-y moments has been relieving from the inflated illusion that I may have substantial power in my clients lives.

Its proven to me that none of of us take in anything that we do not want to, or are not ready to hear.

And none of us can take any action, or change our thinking until we are ready.

But, lets keep going shall we?

For parents of young children:
I know it is expensive, I know its a hassle. I know you are so exhausted you are done for by nine o’clock. But for god-sakes you need to get away from that baby sometimes. If you are in a couple, you need a date night. Single parents also need nights out with other grown ups: Ideally once a week but for many that is a tall order- but at least twice a month – once a month? Your child truly, ultimately doesn’t want to eat you alive, but they will if you let them.

For the chronically overworked:
You need to leave work at a reasonable time at least once a week. If it were up to me it would be more. I know there are deadlines, and this is a big ambitious city. But you need to have some sacrosanct activity – in addition to therapy – that you leave work for and show up to regularly. A book club. A painting class. Any of the activities that I already mentioned that you don’t remember because you were just yes-ing me and not really paying attention. You need to leave work sometimes. Your employer, may, in fact be happy to eat you alive, but if you let them, you will be even more miserable.

My words wash out into a wave of white-noise: just as any adult in Charlie-Brown’s universe: Wah-wah-wahwahwah-wah.

For those who complain about boredom and isolation:
Volunteer somewhere, or get connected to a community organization. We feel better when we are connected to a community of others who share similar goals and values.

A church, a temple a mosque, a political campaign, a charitable organization, and animal shelter. Habitat for Humanity, an urban garden. Its easier to feel connected to people when we are working side by side. Its easier to chat and get to see something about another’s character when you are pulling up weeds, or serving soup, or doing something meaningful together.

There is a vague and anxious guilt that accumulates when we stockpile all of our personal energy for ourselves – and don’t generate something for others. Do something that makes you feel clean and aligned with your own values and proud of yourself.

Certainly by now I have lost you.

But shall I continue to proffer and assemble my beautiful bouquet of all things ignored?

If you are “stuck”:
Keep a pen and pad by your bed and write down whatever you can remember about your dreams. I know, I know, you don’t dream, you never remember your dreams, your dreams are “just weird”, about nothing, are just little bits here and there, mostly about your job. Please. Pretty please? Just indulge me?

When you complain of feeling stuck, and spend hours and hours polling your friends and family and neighbors, and me about “what you should do” to get out of your circumstance – the problem is that you haven’t forged a sufficient, or patient relationship with your own intuition.

You don’t know what you are hungry for and you are asking other people what you want to eat for dinner. The answer will only come from the outside in that your internal hunger will recognize it or reject it.

You can eliminate the middle-men and learn to listen to yourself directly. Your dreams, your unconscious, your psyche is chewing on all of this stuff day and night. When you sleep – you produce little mind-movies about the dilemmas that are most central to you. When you have failed to solve the problem with your consciousness, why not try letting your unconscious have a crack at it? What do you have to lose?

Turn off the morning talk radio ( you only have about 30 seconds to a minute to remember your dream upon waking) set your alarm 7 minutes earlier and hit snooze. Use the 7 minute interim to think about where you just were, and write it down. Even a few key words may help. It might be boring at first. Detritus from the day – nothing exciting – but these are symbols produced by you – and if you keep paying attention – we will certainly find some content to riff on, some grist for the mill, that may lead us right where you need to go.

A drip, drip drip at a time, water built the Grand Canyon, and its part of my work to chip, chip chip away at people’s resistances to the activities of daily living that will at least make our work in the room flow more smoothly, and best put you in more contact with yourself, your core needs and a sense of well being.

But, certainly, you can feel free to ignore me about this too.
Its fine.
I’m resigned. I’m used to it.

For those who “do not know what they want:”
You will likely need some space in your life for some kind of conscious, waking contemplative activity. Learn to mediate, or write in a journal, or draw or create something. You need to spend some time listening to your inner world. Even if its boring or hard. You need to grab your fishing pole, cast the line, and wait for a nibble. Day dream. Paint. Garden. Hike. Buy some charcoals and one of those squishy erasers.

I know its embarrassing. Its not about creating a masterpiece, its about exercising your creative imaginal capacities so that your creative self is more engaged with the process of figuring out how to live a fulfilling live. Something quiet, and a little bit alone. 5 minutes! Thats all I’m asking! Fine, then just 3 minutes doodling and fantasizing and exercising your imagination?

Your imaginal world is going to give you far better advice than I can if you will just spend a couple of minutes listening. How will you be able to surprise yourself if you fill up every moment with email and texting eating and fretting, and TV and live-streaming, and errands, and work?

But I still I sit in my chair, week after week, year after year, trying to restrain myself but, of course, I crack, and indulge in re-re-re-reciting the most basic life prescriptions.

My words blow back to me like spit in the wind…

But random reinforcement is the most enticing: Every once in a while, one pushes through the icky feeling and finds the love of her life. Another, who had become hardened and frozen and cynical discovers his yearning for meaningful engagement with the world by listening to his dreams. Someone treats their thyroid and finds they have more energy for life. Two or three date nights reanimate an unhappy couples dormant sex life. A regular mediation practice slowly relieves life-long anxiety.

Just enough to keep me hooked.

I try not to. I know its dangers.
It almost never leads to anything good.

Except for when someone actually listens.

A quick note about this post: WG at Therapy Tales illustrated a silly, lovely distillation of this essay – Be sure to see the previous post for the charming result!

copyright © 2012
All rights reserved Martha Crawford

A Tale of Unmatched Socks and Miracle Chili

Essential Care, Handling and Training of Oneself
Part 3 of 3

A couple of years ago, a good friend of mine invited our family over for lunch. She was serving “Miracle Chili.” The miracle, she said, was that for the first time in her life, she had discovered how to cook something that she liked to eat and wanted to share with others.

I understood exactly.

I remembered a hazy afternoon in my early 20’s, laying on an unmade bed, wearing the sweatpants I’d put on the night before to save time, surrounded by piles of clothes, books strewn about, an empty fridge, and a notice of overdraft on my checking account. I dreamed of a magical day in the far distant future: a day when all of my socks would be matched and tucked neatly in a drawer. When I would know how to balance my bank account and have invented some schema for paying bills on time. I would know how to shop and plan a menu and cook something I might actually like to eat.

If I’d had more energy or imagination that day, my fantasy might have become even more complete: I might have a regular exercise routine, a physical practice that I approached with structure and commitment. I would discover some spiritual path, a meditation practice and a values-based community that would feel authentic to me, not strained, randomly chosen or forced. Some part of every day would be silent. I would learn what my body needed to be able to get to sleep at a reasonable time, stay asleep through the long night, and wake up feeling ready to face the world. I would have time to read books of my own choosing, spend enough time in nature, and explore museums to feed my hunger for beauty. I would remember to take my vitamins and get my haircut when I needed it. I would find a doctor – a general practitioner, a gynecologist, a dentist, and an acupuncturist that I trusted and would keep appointments regularly.

The process of self-care and healthy self-parenting never ends; it moves and doubles back, re-formulates as we age, change careers, and enter into new stages of life.

In my mid 20’s, I realized for the first time that I needed to begin some kind of regular exercise practice, when I first dated a guy who ran regularly.

I bought a cheap jogging trampoline – with legs that I could screw off and store under my bed. I would run/bounce, singing along to loud music with all the lights off. Obviously, I could only engage in my chosen “sport” when my roommates were out of the apartment. As a long-term exercise plan, it had some limitations.

I signed up at the public pool, swam laps at designated shifts. Frozen hair in the winter with no blow dryer outlets in the changing room ended that. I joined and quickly quit a gym- skeeved by all the indoor sweating, the damp leather seats, and the disturbing Orwellian image of people watching the Nature Channel while running on treadmills.

By my 30’s, as I began my clinical practice, it became clear to me that I needed a daily physical practice more than ever to feel well – and that my own right exercise needed to happen outside. I needed air, weather, horizon, wind, ground, and distance. I began hiking the trails outside of the city on weekends, and taking 10-12 mile urban walks during the week. I skipped subways and scheduled appointments so that I had opportunities to walk as my primary transportation. I bought an ergonomic backpack and all the weather gear I needed.

As my schedule intensified and I had less time, I bought books and looked at videos on speed walking. I did my pointy-elbowed-hip-swinging-goofy laps, 3 miles religiously around and around Washington Square Park. I grew less embarrassed, and prouder of myself, when I began to pass the slower runners.

A move to a new apartment put me near a softer running path – and I began running 2 or so miles several days a week. When we became parents, I realized that since there was no more reliable silence in my home, I needed my exercise to double up with my meditation practice. I began studying tai chi and bagua individually once a week with a martial arts master. For the past 7 years, I’ve had my own regular practice – running, meditation, and martial arts practice 4 or 5 days a week, outside, in the park near our home. And with the proper gear, neither snow nor rain nor heat will delay this courier from my appointed rounds.

Learning to cook, finding the right health care providers, establishing a meditative practice, finding a spiritual community, creating systems for housekeeping, devising my own rituals for good sleep hygiene, all involved lengthy processes of building up mastery, growing pride in myself, uncovering knowledge about what was realistic and sustainable for me, and gathering data about what actually felt good, right, interesting and pleasurable.

Don’t even think about getting it right the first time. Forget about finding and “settling” on one routine or system. Your needs will shift; your time, your energy, your location, your commute, your finances, and your priorities will change over time. And so will your bill-paying routing, your workout, your diet, your shopping list, and your bedtime.

As all things, these are fluid practices – you are unlikely to find a routine that “fits” all of your life stages, local logistics, and physical changes as you grow and mature. In Winnicottian terms: “holding” and what it takes to feel held becomes increasingly complex and changes throughout life and development. An infant is easier to hold and care for than a toddler; and providing a sufficient holding environment for a teenager is a far more complex process than mere diapering and bottle warming. Holding our adult selves well – creating a rhythm of life and activity that makes our adult needs feel contained, soothed, regarded and respected is a veritable Rubik’s Cube: needs coming into conflict with each other, switching and flipping back, working through, to find the right time and space for them all.

And then doing it over again when growth or change messes it all up.

Miracle Chili actually takes years and years to cook. Years of first learning what you are hungry for, what you like, what you digest well, what tastes good together, and what really feeds you.

And I vividly remember the day when I opened my dresser drawer and realized that somehow – after years of struggling to pay attention, many starts and stops, relearning, reworking, and regrouping – that all my socks were matched and rolled neatly in my sock drawer.

The Lazy Illusion

What if you aren’t lazy?

What if you aren’t too busy, too disorganized, a mess, a procrastinator, a scatter-brain?

What if you already have enough “will-power”?

What if those beliefs were taken off the table?

What if none of those constructs are at all useful for changing your lifestyle, creating a daily exercise routine, feeding yourself well, structuring quiet time, meditating, getting to sleep, tending to your finances, looking for that new job, or for facing down any important, self-regarding task you have been avoiding?

Berating yourself, scolding yourself is rarely useful, and usually just makes things worse, more painful, more shameful.

What if there is a very good reason that this specific task is hard, frightening, anxiety-provoking, unfamiliar, or uncomfortable for you?

Self-neglect often just feels usual, normal. The ignoring feels like a part of us. It’s how we have always done it or not done it. Sometimes we pretend that our avoidance is a proactive choice and express contempt toward others who have mastered self-care tasks that feel beyond us.

We even construct pseudo-identities on top of it:

“I don’t cook”

“I’m a spender, not a saver”

“I’m not an exercise person”

And that way we won’t even notice the void when we step in it.

But – what if that is all an illusion?

What if the truth is more complicated, and much messier? What if you’ve been avoiding the dreaded task, failing to establish the healthy habit because it is associated with something painful, scary, confusing, vulnerable, overwhelming, sorrowful, or is something you simply can’t learn how to do on your own? What if it requires your compassion, attention, kindness or understanding to make it possible to change your ways?

In some cases, we may have a wish to establish a new pattern that is simply un-familiar – literally: not of the family. If no one in your family of origin ever spoke Greek, it is unrealistic to expect yourself to be able to magically, spontaneously, effortlessly speak Greek in adulthood. If you do decide to learn a new language, it will not be an intuitive process, it will not feel natural; it will be uncomfortable, embarrassing at times, exposing, vulnerable. It will involve investing money, time, and consistent effort. It will require generous, patient teachers, role models, fluent-speakers who model proper, conversational speech for you. There are processes that we can only learn through relationships with others.

Many simply continue to parent themselves as they were parented. If your care-taking through childhood was disorganized, abusive, withholding, or passive, you will likely care for yourself the way you were, or were not, cared for. If bedtime was experienced as a battleground, or abandonment, it’s going to be very hard to learn to transition yourself through the subtle stages that precede sleep. If your needs were ignored, you may not, for example, think to seek medical treatment before a condition becomes unnecessarily severe.

In other instances, we have absorbed our notions of how to meet our needs as adults from watching how our parents treated themselves. Did they self-medicate? Smoke? Overspend? Sink into depressed, passive, depleted, deprived, neglected states themselves? Did they chronically – too generously and masochistically – set their needs aside for others?

It can feel disloyal, like a betrayal, to abandon their model, to treat ourselves better or differently than our parents treated themselves. Sometimes, self-neglect is a cherished, comforting memento from home.

Others of us are on strike: still waiting, holding our breath – well into our own adulthood – for an archetypal Grown Up to arrive at long last and take care of it all for us.

Taking deep responsibility for our own well-being means giving up hope that we will be rescued. To stop waiting for Godot means we may be left alone upon a barren mound of grief and mourning. They haven’t come, they never came, they never will come; we may have lost our opportunity to have our childhood needs met, at the right time, by an all-knowing, all-loving omnipotent caretaker. Facing down self-care may mean first accepting this mournful reality and breathing through all the painful feelings that attend a loss.

Sometimes the shame of not-knowing-already, the fear of needing to be taught, the humiliation of asking, and the vulnerability of beginners’ mind, is enough to make us avoid the things we truly need. We feel a fool – a baby, a first-grader – our savvy and maturity stripped away from us, as we struggle to learn the new thing, search for a teacher, struggle, fail, regroup and try again. We want the first meal we cook to be delicious, and to feel powerful and strong our very first day at the gym.

All of us have our own unique, inherited blind spots and neglect-holes:

One woman regularly bickers with her partner about her own messiness, until realizing that her mother, a housewife with paralyzing depression, rarely initiated and never completed necessary household chores.

Another woman, constantly overdrawing her account, discovers that her red-inked bank statements recreate the powerless feeling of living in her father’s household, the family members shamed and controlled by his money.

A man, disorganized and distracted, constantly loses his keys, his wallet, his necessary personal items, creating many anxious, angry, panicked moments in his day. When he begins to consider that there might be some meaningful reason that he does so, he is flooded with memories of being repeatedly forgotten among his many siblings, regularly left behind, and actually lost – omitted from the head count on family outings.

Another man, in a life-long angry battle with his weight and health, begins an exercise plan. He tolerates the sabotaging noise in his head, the discomfort, the agitation, the boredom, the wish to revert. He listens deeper and discovers he is increasingly anxious as he loses more and more weight and his health improves. He realizes that he holds enormous guilt for enjoying his own body, an experience he could never share with his father – who was disabled, in chronic pain since early adulthood.

For each of us, it will be different.

And the same.

Sometimes the avoidance marks a trauma point, other times a battleground, an emptiness, or a low-grade chronic annoyance.

Sometimes we must open up to healing before we can initiate change.

Sometimes initiating change opens us up to be healed.

By occasionally asking you to focus on such rudimentary aspects of self-care, I may be asking you to speak a language you have never heard before and cannot fathom. Please know that these aren’t merely simple behavioral prescriptions.

Instead, I am asking you to

- look beyond self-judgement and the illusion of laziness,
– consider your accepted default, your original template,
– to explore it,
– mourn it,
– and to treat yourself in a new way.

In any order you choose.

copyright © 2011
All rights reserved Martha Crawford

Practice Practice Practice

Essential Care, Handling, & Training of Oneself.
Part 1 of 3

It seems that no one ever wants to talk about this.
Some sigh, others even roll their eyes.
No juicy catharsis, no shocking revelations await.
Everyone knows, everyone has heard it a million times.
It is as boring as piano practice on a sunny afternoon.

When I ask if you…

…have a regular routine to pay attention to your body’s need for gross motor activity?

…are able to keep your home clean?

…have some quiet time for contemplation built into your week?

…get to bed early enough and sleep through eight hours?

…know how to choose and cook food that you enjoy and that meets your personal digestive and nutritional needs?

…have a clear sense of your income and expenses?

…see your medical/alternative care providers regularly?

…spend sufficient time in daylight?

…overuse, abuse, or addictively depend on toxic substances – even the “regular” ones?

…participate in meaningful recreational, social, educational, or community building activities?

You may think my inquiry is annoying and overwhelming and off the point. You may think that the behaviors I’m asking about are not really necessary and that you can get along just fine without them – because the real problem is your job, your boss, your roommate, your girlfriend, your kids, your schedule, the city you live in.

You may think that it is shockingly obvious and that, of course, you read the magazines, and the Health section in the Times, and we all know what we “should” be doing to “take care” of ourselves – but that doesn’t mean that you have the time, the structure, the wherewithal, the money, the discipline, or the motivation to do it.

I know that you believe that you should be able to feel better even while you suspect that you are living in a state of active neglect/abuse of yourself. I know that you think if I would just join you and focus on the “real problem” that you will be able to face these “other things” when you feel better, or when you win the lotto, or when you retire.

This is the real problem.

Any animal who is deprived of sleep, and/or fed inadequate nutrition, sitting in its own waste, ingesting poisons, prohibited from gross motor discharge, cut off from meaningful interaction with others of its species, experiencing unrelenting stress with no respite – all of its natural drives thwarted – is going to feel like shit. We would expect it to suffer. We anonymously call animal control on the neighbors, or feel impelled to donate money to animal rescue associations after seeing animals in such states of neglect and abuse.

It astounds me how often people prefer to first consider anti-depressant and anti-anxiety medication for clearly mild symptoms before they will consider walking to work, turning off the crappy late night TV to get to sleep earlier, cooking at home, or reducing their “normal” alcohol consumption.

There is ample and sound research that such self-care: the endorphins generated by exercise, the impact of mindfulness meditation on anxiety and pain levels etc., etc., all have substantial and measurable effects toward helping us “feel better” in the here and now. I’m not going to even bother to cite the studies.

And although coming to therapy is a significant and important step, therapy is unlikely to offer much sustainable solace if it is the only hour or two out of your week that you actually tend to yourself.

True, facing down these lifestyle changes won’t cure your bad marriage, a crazy abusive boss, your controlling father, your financial anxieties, or loneliness. It’s not going to take away all of the discomfort or pain.

But nonetheless: these activities of healthy daily living are also profoundly important symbolic gestures:

They are the daily rituals of self-regard. Actions which demonstrate that you value and will be loyal to your own core needs regardless of your mood or whim. Proof to your psyche that you will not be distracted, that you will faithfully show up for yourself. A message to the back of your brain that you will be steadfast and brave and true, that you can be trusted and reliable – and that you won’t let yourself down. These are gestures which create a symbolic experience of the devoted, attentive, reassuring internal parent who will care for you no matter what. It means committing to (at least) beginning to behave in a loving way toward yourself, even if you don’t always feel it.

As old Freud himself stated: “The ego is first and foremost a body ego.” Our first and most primal experiences of ourselves and our loved ones are through our bodies. Our essential sense of self is formed through how our bodies’ needs have been cared for – or not. Our sensory embodied experience is how we first know what it means to feel loved, valued, soothed, fed, and tended to.

Part of the function of therapy is to initiate you into the mysteries of becoming your own Healer, your own best Caretaker.

Yet, these first stages of initiation are so obvious, such a part of our common knowledge, that we often think we can forgo them altogether.
You can’t.
It will thwart your progress.

I’m not asking you to do it all at once.

I expect it to take time – there are likely years ahead of trial and error, dead-ends, stall-outs and do-over’s. You can feel lost, overwhelmed, and you can fail and quit, and regroup.

But we have to begin to listen to the nagging, pressing voice of our most basic needs – even if it feels as obvious, repetitive, and annoying as a good-enough mother reminding a child to eat their vegetables, clean their room, and practice the piano.

copyright © 2011
All rights reserved Martha Crawford

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