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Letters From The Practice

October 2026

Now and Not Now

A letter from Dr. Serravalle

The school year has stopped being new, the light leaves a little earlier each evening, and the calendar begins to fill with things that felt comfortably far away in August. Conferences. Holidays. The end of the year. Somewhere this month, most of us look up and realize the future has arrived ahead of schedule.

We tend to treat time as something we simply know, the way we know whether a room is warm. We do not. There is no sense organ for duration. Our feeling of how long something took, or how far off something is, gets assembled from attention, memory, and how much we noticed along the way. That is why a busy, repetitive stretch can feel endless while you are in it and like almost nothing when you look back. It is also why two people in the same house can be living on very different calendars.

For some people the future registers as a low, steady hum. The thing due Friday has a small presence on Tuesday. For others, and for most of us when we are stretched thin, time sorts itself into two bins: now, and not now. Everything in the second bin feels equally distant until, all at once, it is not.

None of this is a character flaw. It is how attention behaves under load. But it changes what helps. When we keep telling ourselves, or our kids, to plan ahead, we are asking a felt sense of time to do work it may not be able to do. More often the better move is to make the future visible. Put it on paper, where it can be seen instead of remembered.

The clocks change on the first morning of November. Before they do, I hope you will take a few minutes this month to look at what is coming, together, while there is still some daylight to do it in.

This month at Center for Balanced Living

By October, a pattern has usually had time to show itself. The student who started the year with good intentions and a new planner is three assignments behind. The adult who promised this would be the organized year is quietly falling behind at work. When the same struggle keeps returning despite real effort, it is worth a closer look. A good evaluation asks whether the systems underneath attention and follow-through are working the way they should. We evaluate children, teens, and adults, and we write reports that a school team or a treating provider can actually use.

For anyone looking for a therapist, two of our clinicians have openings for adults right now: Kirsten Lowe, featured below, and Brianna Patton, who works with anxiety, depression, and trauma from a structured, goal-oriented approach.

For clinicians, on October 16 I am co-leading TGNC Culturally Aware Assessment through the Delaware Psychological Association. The fall courses are moving toward launch. EMDR Basic Training is pending EMDRIA approval, and Nature-Based Clinical Specialist and the twelve-week Foundations of Trauma Therapy are pending CE approval.

And from MUSA, the writing side of the practice, my conversation with Dr. Christina Zampitella is now available on Phoenix Rising with Dr. Z, released in two parts. We talk about grieving someone who lied about significant parts of their life, the same ground The Stories We Told covers at greater length.

Staff spotlight: Kirsten Lowe, LACMH, NCC

Kirsten Lowe came to counseling by way of special education. Before moving fully into mental health work, she worked with children ages five through fourteen with autism and severe intellectual disabilities. She went on to earn her master’s degree in Clinical Mental Health Counseling at Wilmington University.

Kirsten has a gentle way of bringing people back to what they came to therapy for, without judgment or pressure. Clients who tend to avoid, postpone, or lose the thread of their own intentions often find that especially helpful.

She draws from cognitive behavioral therapy, mindfulness, and strengths-based approaches, and she is completing EMDR training as part of her ongoing trauma-informed work. Outside the office, she really enjoys spending time with her family. Kirsten works with adults and is currently accepting new clients. You can reach her at klowe@balancedlivingde.com or through the contact page.

Featured reading: Time Blindness Is Real, and It Is Not About Being Late

This month’s Make It Make Sense essay takes a phrase that began with people who have ADHD and asks what it gets right. The answer is more than clinicians have tended to admit. Time blindness describes a perceptual problem before it describes a behavioral one, and that distinction changes how we should respond. If a child cannot feel that twelve minutes have passed, telling him to hurry is a little like asking someone with poor eyesight to look harder.

The essay walks through why that happens, why a consequence scheduled for Saturday does so little to change Wednesday, and why every planner you have bought is probably still in a drawer. It follows the same difficulty at six, at twelve, and at thirty-six, including the way women who run late are judged more harshly and come to read their own struggle as a moral failing.

The practical half is the part I would most want parents to read. The principle is simple: put time outside the body, where it can be seen rather than estimated. There is a condensed version at the end for readers whose attention is already drifting, which is rather the point. You can read it now.

Coming tomorrow, October 4: “Everyone Is Stressed. Not Everyone Has a Stress Disorder.” Most of us carry stress most of the time, and that part is ordinary. A stress disorder is defined by something else, which is what has happened to your ability to manage it. The essay describes the two directions that breakdown tends to take. In one, everything is overwhelming and nothing settles. In the other, stress has been constant for so long that it stops registering, and the person sincerely reports feeling fine. It also takes on the most common reason people rule themselves out of PTSD: they cannot name one catastrophic event, when the diagnosis allows for a series of them. This piece opens a longer run of writing on trauma this fall.

Later in the month, on October 22, an essay on rejection sensitivity and the emotional side of ADHD that the diagnostic criteria left out.

Featured resource: a Sunday preview

Ten minutes, once a week, out loud. On Sunday evening, sit down with whoever lives in your house and walk through the coming week, day by day. Not the whole calendar, just its shape. Monday is an ordinary day. Tuesday has the dentist after school. The project is due Thursday, so Wednesday night is for finishing it. Friday is early pickup.

Then write it on paper and put it where everyone will see it, on the refrigerator or by the door. That second step matters as much as the first. A schedule that lives in a phone exists only when someone remembers to open it. A schedule on the wall is present all week without anyone having to go looking.

Transitions go better when they are anticipated, and anticipation depends on the future feeling real. Saying the week aloud and leaving it in view gives everyone, adults included, a little more of the hum that lets Tuesday know about Friday. For children who struggle with transitions, it turns surprises into things they already heard about. For adults, it is often the only moment all week when the whole picture is visible at once.

Most of us can’t hold the dentist on Tuesday, and yet nobody has ever forgotten October 3rd. Put the dentist on the refrigerator.

Community spotlight: a first cohort

In September, CFBL Institute taught its first live intensive, Foundations of Trauma Therapy, to a small pilot cohort of clinicians over two days. If you were not there, a few short clips from those two days are now on our Instagram, which is the closest thing to sitting in. It was free because it was a pilot, and the arrangement was honest on both sides. We brought the material, and the participants told us what landed and what did not.

That second half is the part I value most. Training is how clinical knowledge moves from one clinician to the next, and it moves best when the people in the room are willing to push back. What they told us will shape the twelve-week courses that follow. To everyone who gave two full days to learning alongside us, and then told us the truth about it, thank you.

Upcoming events

This month

• TGNC Culturally Aware Assessment, Delaware Psychological Association, co-led by Dr. Niki Serravalle. Friday, October 16.

Professional education through CFBL Institute

• EMDR Basic Training, twelve weeks. Pending EMDRIA approval, launching fall 2026. Interest-list members are invited to register first. Interest list
• Nature-Based Clinical Specialist, twelve weeks. CE approval pending, launching fall 2026. Interest list
• Foundations of Trauma Therapy, twelve-week course. CE approval pending, launching fall 2026. Interest list
• Assessment-Informed Trauma Treatment. Live online, 9:00 AM to 4:00 PM. Dates to be announced. Waitlist
• Applied Clinical Reasoning Intensive. Live online, 9:00 AM to 1:00 PM. Dates to be announced. Waitlist

Also this month

• Kirsten Lowe and Brianna Patton are accepting new adult clients.
• Psychological evaluations for children, teens, and adults are scheduling now.
• Phoenix Rising with Dr. Z, both parts of the conversation, available wherever you listen to podcasts.

A closing reflection

October has a way of making people feel behind. The things that felt far off all summer start arriving, and it is easy to read that as proof that you planned badly or tried too little.

Usually it is neither. It is what happens when the future was never quite visible to begin with. What helps is a clearer view: the week on the refrigerator, the clock you can actually see, the person who helps you keep the goal in sight.

You do not have to feel the future to prepare for it. You only have to put it somewhere you can see.

Stay connected

• Read this month’s essays, and pass the time blindness piece to the parent who keeps buying planners.
• If a pattern at school or at work keeps returning despite real effort, reach out about an evaluation.
• If you have been waiting for the right therapist, Kirsten and Brianna both have openings.
• Listen to both parts of the conversation on Phoenix Rising with Dr. Z.

Everything is at balancedlivingde.com. Thank you for reading, and for being part of this community.

With warmth,
Dr. Niki Serravalle
Center for Balanced Living