Listening, Learning, and Healing: Kelsee Costanza on Mental Health, Identity, and Healing Practices

In this conversation, Kelsee Costanza shares her path to the mental health field, highlighting how her personal experiences and a passion for reducing stigma have shaped her approach to therapy. She emphasizes the importance of cultural awareness, emotional regulation, and somatic practices in helping clients feel heard, understood, and supported in their healing journey.

Q: “What drew you to this field, and how does your perspective change as you learn?”

There are two major steps to me being drawn into the mental health field. The first being that as a teenager I became very fascinated by neuroscience. How our brain works and why we are the way that we are. I read a lot of neuroscience books around that time so that got me really heavily invested on the science side. 

The second step is that in college I started working at the local crisis center, answering calls for the national crisis hotline. I really just fell in love with that. Through this work, I became much more aware of disparities in the field, especially for people in crisis situations getting adequate mental health treatment. From witnessing those things, came out a passion for reducing the stigma around mental health and accessing services. 

My perspective has changed as I've learned as well. My perspective just continues to move more and more outward, beyond the individual.

For example, being educated in school on nature versus nurture. I was familiar with that concept as being binary. Then, I understood how impactful nurture was, but I saw a pretty narrow view of that. I saw nurture as the context of your immediate family. There are so many other things to categorize under nurture such as extended family, intergenerational experiences, and the various systems that we exist within.

With that comes a lot of unlearning and attending to my own biases and privileges so that I can understand what I'm bringing into the room.

There are many ways in which I'm not going to fully understand somebody else's experiences, especially across different identities and cultures. It's important for me to be aware of that.

Q: “How do you create a listening space for folks, especially those who are coming into therapy for the first time or from cultural perspectives where being heard or listened to might not be emphasized?”

I try to just take things slowly when I know that somebody is coming in for the first time, or is holding views about what therapy is or isn't. In the beginning, I’m focusing heavily on developing a strong therapeutic relationship and creating safety. 

I acknowledge that starting therapy is hard, whether you're coming in for the first time or starting over for the hundredth time. It's hard to be vulnerable with somebody who is effectively a stranger.

I also try to understand where somebody is coming from - what is their frame for therapy, for mental health, what are they comfortable with, what are they not comfortable with.

I will regularly check in with people about how it's going. How was today for you? Is there anything that I could be doing differently? Asking questions like that.

As part of intake sessions I ask questions like, Have you been in therapy before? What was that like? What are your expectations? What's your understanding of therapy? Do other people in your life know that you're in therapy? Why or why not? I will also explore if there are any stigmas being held around mental health. For example, what are the cultural narratives on mental health and therapy, and what has that been like for you?

Q: “How do you explore your own identity?”

In my own therapy, that’s where the most dedicated time goes toward exploring my identity. The other primary way is reading. I've always turned to books in my life. If there's something I'm wanting to learn about myself I will seek out a book or somebody else's perspective or their own experiences.

Q: “What part of your identity are you exploring right now?”

My identity as a parent and what it's meant to enter that space with a lot of baggage in terms of society's expectations, cultural norms, or what motherhood is supposed to look like. I personally have really struggled with feeling like I don't fit into any of these expectations.

The past year has been trying to figure out how to come to a more personalized understanding. Standing up for what parenthood means for me, and that my experience just is my experience, it doesn't have to fit anybody else's mold.

Q: “What do you think society doesn't prepare us for in terms of emotional regulation and insight?”

There are a few different influences here. One I would say is various cultural views, whether that's the U.S. at large or the different subcultures that exist within our country. Generally, there are some stigmas that go along with that.

For example, there is a pretty strong narrative that “negative feelings” are “bad” and this can create a lot of discomfort, avoidance, or pushing away these feelings. From that you get a lot of toxic positivity, or a push to “just be grateful” This avoidance or stuffing down contributes to dysregulation.

Ideally we want to find ways to hold the tension of being grateful or happy while also experiencing grief, anxiety, depression etc..

I think the U.S. also has a DIY mentality to  figure it out yourself. It's a very individualistic society. We don't often think of turning to other people for support in a more collectivist way. That affects people seeking help for their emotions, or even being able to acknowledge what's going on internally.

I would say another thing that doesn't prepare us in terms of emotion regulation or insight are family norms and generational patterns.

Emotion regulation requires self-awareness and tools. If a framework for “how to regulate” isn’t being modeled for or taught to us as kids, it's going to make it hard for us to achieve regulation.

Q: “What do you mean by somatic practices?”

Somatic practices are body-based exercises that help get at what you're feeling emotionally and help to release those physiological sensations to achieve a state of calm or regulation. We tend to hold a lot of emotions in our body. It’s helpful to pay attention to those sensations so that we can better understand what it is we're feeling emotionally. Sometimes it's easier for people to be aware of the sensations in their body, and it’s like an entry into what they're feeling emotionally.

Q: “So listening to body cues to give you information into your feelings. Do you have an example of what that might look like in a session?”

Typically we would establish an understanding of the thing(s) in your life that you view as comforting, calming, a strength, a source of support. Then paying attention to what's showing up in your body as you think about that support so we could come back to it when things get distressing.

So then, if there are more distressing sensations or emotions that are coming up, we might do what’s called pendulation.

That's a practice of where you go back and forth between focusing on that thing that gave you strength and those sensations in your body; and then going back to the distressing sensations, focusing on where that's being held in your body. The goal of that exercise is to get the distressing sensations/emotions to lessen, and it offers a way to tolerate the discomfort in a very contained way.