Does Couples Therapy Work?

When couples hit a rough patch in their relationship, they sometimes seek counseling. But does couples therapy work? Unfortunately, some research suggests that couples therapy can sometimes make problems worse.

Why is this? For one, dredging up problems every week can be disheartening to the couple. Also, frequent arguing can lead to more arguing. Researchers used to believe that arguing and getting angry relieve tension. In fact, chronic anger can lead to more emotional and even physical problems.

Does this mean that couples therapy is never helpful? No. It can be useful — but let me add some caveats. Studies show that the most helpful type of couples therapy has a problem solving focus. So rather than the partners just venting old or new hurts, they learn new skills, such as effective communication. This solution-focused type of therapy can lead to more harmony at home.

In my experience, there are other factors that suggest a more positive (or negative) outcome. I’ve listed some of them below:

1. If the partners just want to blame the other or try to change them, therapy is generally unproductive. We can’t change someone else. Each member of the couple should commit to changing patterns within themselves that contribute to problems.

2. The partners need to learn to fight fairly. Lobbing insults at each other; name calling or cursing; threatening divorce; and any physical abuse (including pushing, shoving, or throwing objects) should be strictly off-limits.

3. It’s important for each partner to have self control over use of alcohol or drugs. If one or both people have a substance abuse problem, then therapy is generally of very limited help.

4. There needs to be some level of good will between the couple. If couples are extremely alienated, it can be very hard for them to remember why they got together in the first place. If one party has been wronged (for instance, the other having an affair or being abusive), the aggrieved person needs to be willing to move on from that betrayal. Sometimes this is just not possible, though, because the wound is too deep, and trust is broken. If this is the case, therapy will unlikely change this.

5. The couple should allow the therapist to help them; they should be open to new approaches to problems. Again, if they just want to fight and prove that the other partner is wrong, then therapy will likely go nowhere.

I hope that some of these suggestions will be helpful if you decide to pursue couples therapy. I would also suggest bringing to the therapy realistic expectations. We can’t change another person; we can only change ourselves. There are no perfect relationships or perfect people.

And, according to research, therapy is most helpful when it is solution focused. You might want to find a therapist who can help you learn new relationship skills, such as improved communication techniques, rather than one who will just let you argue.

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Using Insurance for Therapy

I try to offer full disclosure to clients about administrative matters. In that spirit, I would like to share the pros and cons about using insurance to pay for counseling/therapy. Even if you don’t see me, this information would apply to any therapist who accepts insurance.

There are pros and cons to everything in life, and this applies to using insurance to help pay for therapy. If you use private pay (paying out of pocket), you would have to pay all of the the costs of therapy. However, by paying out of pocket, you would be granted much more confidentiality than using insurance.

It is important to realize that when you use insurance to help pay for therapy, you waive your rights to confidentiality with the insurance company. The insurance company becomes a sort of “stakeholder” in the therapy process. A lot of consumers of therapy don’t realize this. Unfortunately, once a client discovers this, it can greatly concern them and even lead them to leave therapy prematurely and upset. (Part of the reason for my writing this blog is to hopefully reduce the potential for this happening.)

At the very minimum, insurance companies require that therapists provide a psychiatric diagnosis and dates of service in order to pay for a claim. Some insurance companies also “case manage.” What that means is that they will call the provider and require a case review by phone. The case manager will ask detailed questions about the therapy, for instance, the client’s presenting problems, issues discussed, goals, and any other question that the case manager deems necessary.

The insurance company, via the case manager, then decides whether the therapist can continue seeing the client through insurance. There are two insurance companies that heavily case manage (Magellan/Blue Shield and Optum/United Health Care.) However, any insurance company can decide to case manage at any time.

In addition, insurance companies are increasingly auditing therapist records. This means that therapists are required to make a copy of the case record, including progress notes, and send this to the insurance company. Therapists are required by law to keep progress notes of the sessions. Such notes would describe details of the session, for instance, topics discussed or any risk factors. Please note that insurance companies are, by law. required to keep these records confidential.

The main reason that this is happening more and more is requirements of the Affordable Care Act, specifically what is called the Health and Human Services (HHS) risk adjustment audit. The HHS mandate requires that the insurance companies conduct audits on a regular basis and provide information to the federal government about the potential risks of the insurance members.

As I understand it, the members are picked randomly. I have had to participate in two separate audits from two different insurance companies the last few months. Insurance companies are supposed to inform a member after an HHS-mandated audit has taken place. In addition to the HHS mandate, insurance companies can audit case files for other reasons, e.g. to pay a claim.

My suggestion to consumers of therapy is to consider the positives and negatives of using insurance versus private pay. Some people are more concerned about confidentiality than others. If you do use insurance, I advise you to go into it with your eyes open. One of the worst therapy situations is when the insurance company makes itself known, either through a case review or an audit, and the client has a strong, negative reaction that could lead to a damaged therapy relationship.

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Showing Up to Win

A number of years ago, I heard a psychologist say something that has stuck with me since. He was giving a talk about how to live a happier and more successful life. The psychologist talked about being in a casino in Las Vegas and seeing a sign there, which read, “You must be present to win.” 

He said that this was an excellent life lesson: that in order to receive the rewards of this life, one has to be present.

What the psychologist said reminds me of an old adage. It is, “Showing up is half of life.” I think that this is true as well. The idea of just “showing up” may sound deceptively simple. But just being present in situations can greatly help ourselves, as well as our relationships with others. Let me give you an example.

Suppose there is a woman, “Elizabeth,” who tends to avoid commitment. When she is invited to gatherings, she’ll say a tentative yes, but then often not show up. Or when she has a date, Elizabeth will call and cancel at the last minute.

Let’s imagine, too, that Elizabeth has a tendency to be late to work. She does complete her projects — but often at the last minute and after her colleagues have to remind her. What impression is Elizabeth making on others in her life?

 Probably people are perceiving Elizabeth as not very reliable. In time, they may not invite her to their parties. She may not garner the most praise at work or be given the best assignments.

Elizabeth may end up feeling discouraged in her life, as though she is stuck and not getting where she wants to go. With a limited social support system, she may feel lonely and depressed.

Now there may be many reasons why Elizabeth is not keeping her various commitments. Maybe she is struggling with depression or anxiety. Perhaps she grew up in a divorced family, where her parents didn’t keep their promises. Elizabeth never learned how to be conscientious and responsible. Maybe Elizabeth practices poor self-care, and doesn’t eat well, get enough sleep, or moderate her drinking.

But whatever the reasons, Elizabeth’s life is not going along as she wants it. If she is motivated to change these patterns of behavior, she will need to understand why she is acting in such a half-hearted and undependable manner.

Then the challenge for Elizabeth would be to put these insights into action. In other words, she will need to show up. She will need to “be present to win.” This would mean meeting her commitments: if she says that she will come to a social gathering, then, aside from an emergency, she should show up. Elizabeth would also need to be prompt to work and to meetings. She’d need to communicate more enthusiasm for the work and be a co-worker whom others can trust.

Can you relate at all to Elizabeth’s story? If you are feeling frustrated in your life, like Elizabeth, think about whether you are keeping your commitments. Are you showing up and being present in your life? If not, maybe this is leading to some of the problems that are making you feel discouraged or frustrated. The good news is that half of life is showing up! If you can do this, you are well on your way to a more satisfying life.

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Playing Detective

As a therapist, at times I try to play detective. And I encourage clients to do the same, in order to figure out why they are struggling.

So, for instance, if you are having trouble with irritability, play detective by sleuthing out why you may be experiencing this. Could it be hormonal? Are you stressed at work? Are you getting enough sleep? Sometimes the reason may be something workable, and, if you make changes soon, you’ll feel better.

This is the same if you have children. If your child is crankier lately, play detective. Notice whether anything has changed in your child’s life. Is his/her best friend moving away? Is he/she having difficulty with anything at school? Could it be food-related, for instance, too many sweets?

There’s a concept that doctors use, and it’s called Occam’s Razor. What is means is that the most obvious reason for a problem is often the right one. If a patient complains to a physician about severe headaches whenever he/she is at work, but not on the weekends, then there may be something wrong at the job: perhaps stress from the job, dealing with a difficult coworker, or maybe a computer set-up that is straining the person’s neck and shoulders.

Occum’s Razor isn’t always accurate, though. There is that rare patient who presents at an emergency room with a severe headache, which turns out to be a tumor. But this is unlikely, and careful screening should determine the true cause.

Careful assessment is also important for emotional and psychological issues. If a client sees me for anxiety, for instance, I will try to work with the client to figure out why he/she has the symptoms. Is the person feeling unsettled about his/her life? Has the anxiety started out of the blue or been triggered by some type of precipitant? Could it be related to a lifestyle issue, for instance, lack of sleep, too much caffeine, or too much screen time on the phone or computer?

Together, by playing detective, hopefully my client and I can figure out what is going on. And, also hopefully, we can work together towards a treatment that will improve the symptoms and his/her quality of life.

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Think Positively??

We live in a generally upbeat culture, especially those of us who live in California. The general attitude tends to be that being positive and optimistic is better. But is that true? Certainly, mental health professionals and lay people alike will assert that this is the case. But, surprisingly, a number of studies have refuted this belief system, that optimism is better.

For instance, there was a famous study done a number of years ago of women with breast cancer who were in support groups, where they practiced positive thinking. Purportedly, the optimistic women lived longer or even beat back the cancer. But years later, researchers reviewed the study and found many statistical errors. It turns out that thinking positively did not help the women with breast cancer live longer.

In fact, there was an earlier study done of women suffering from breast cancer. This study showed the opposite: that women who became angry and emotional about the cancer lived longer.

Aside from the research around illness, other studies have pointed out the downside of optimism. In one study, when both pessimists and optimists observed a video of a crime about to happen, the pessimists saw the warning signs, while the optimists missed them. The researchers surmised that optimists tend to miss things that pessimists see, and could be poorer witnesses in a court of law.

Another downside of optimism: optimists, while living life in a cheerier manner, can also become more devastated when something bad happens. While pessimists may try to prepare for every possible worse case scenario, optimists can be caught off-guard and blindsided when something tragic happens.

Though the research does not prove the theory that optimism is better, still society tries to cajole the pessimist to think positively. There is even a type of counseling called Positive Psychology, that teaches pessimists to be more upbeat. And yet there have been unforeseen consequences of Positive Psychology.

In a study, pessimists, who tended towards mild depression, were given an intensive program of thinking more positively. After the program was over, the participants were evaluated. It turns out that the pessimists were even more depressed after completing the program! This shows that their pessimistic attitude served a purpose in their lives (perhaps a form of self-protection) and, without it, they felt worse.

The point I am making is not that it is better to be a pessimist — or that it’s better to be an optimist. I think that that key is to know your own temperament, work with it as best as you can, and accept yourself as you are. If you do this, you will probably feel a lot happier!

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The New Cognitive Science of Happiness

As a psychotherapist, I am interested in observing social trends. A few that come to mind are yoga, mindfulness meditation, and the new cognitive science of happiness.

While yoga classes were rare a few decades ago, now there are studios practically every few blocks. Many people swear by yoga, and say that it helps to calm their minds while improving their overall fitness. And yet there are also people who don’t care for the practice. Some people have even hurt themselves doing some of the poses.

As another example, now mindfulness meditation is taught everywhere from work sites to elementary schools. Multitudes swear by it, that it has helped their concentration and mood. On the other hand, many people find it too agitating to sit and meditate. Some studies even link meditation to increased anxiety and depression.

Lately, I am noticing numerous books and articles on the cognitive science of happiness. The books teach new skills for improving happiness. Again, there appears to be mixed reactions. While many people feel encouraged that they may feel happier, others feel pressure that they should feel differently than they do.

I see pros and cons with the myriad of books on happiness. On the one hand, if the principles help some people try new techniques to improve their moods, then that’s good. But I am concerned about it for a few reasons.

One is that most studies show that while people can change habits, and then feel happier, there is a set point for happiness. Some people are just more upbeat than others, and being more upbeat is not necessarily better. Since there is a set point, the changes people make may be temporary. If they start feeling less happy, they could feel like a failure.

This brings me to another concern about the new science of happiness. What I have observed is people feeling inadequate for not being happier. It seems more helpful for people to realize that happiness (like all emotions, such as anger) comes and goes. But the more we chase after it, the more it often can elude us.

Finally, I’m concerned about whether it is helpful personally and as a society for everyone to walk around happy and untroubled. If someone mistreats us or someone else, it is normal and healthy to have a strong, negative reaction.

In my opinion, the new cognitive science of happiness has advantages, but also distinct disadvantages. As a therapist, I encourage my clients to think for themselves and not necessarily follow all the societal trends.

What I have found is that people are generally happier when they live their lives according to their true nature. If, for instance, a person loves living in the country, he or she will probably unhappy living in a city. If a graduate student really wants to study music, he/she will likely be unhappy devoting five plus years to biology.

If we surround ourselves with people who are good to us, we’ll be happier. If we have a lot of toxic people in our lives, we are going to be stressed. It is possible to be happier. But I don’t know if trying to talk ourselves into it will build lasting changes. I think it’s more effective to learn to trust our intuition and make tangible changes to our lives.

As a therapist, I try to help clients to be discerning and learn to tune into their inner wisdom. If yoga, mindfulness meditation, and/or the science of happiness make them feel better, then that’s good. But if not, then they may be heading down the wrong path.

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The Gift of Intuition

Criminology, Gavin De Becker, wrote a fascinating book a number of years ago, called, The Gift of Fear.  He discovered in his research that almost every time a person is about to be victimized, he or she has a sense of foreboding and danger.

Unfortunately, much of the time people ignore their intuition.  They talk themselves out of it, sometimes with disastrous consequences.

De Becker makes the important point that humans are the only animals who don’t listen to our intuition.  Animals, of course, will not minimize their fear instinct.  If they feel a threat, they will react in a fight/flight/or freeze reaction.

However, as human beings, we want to be nice, and therefore, nonjudgmental.  However, there is a difference between being judgmental and being discerning.

For instance, if you walk down the street and see another person, and immediately make a judgment based on the other person’s appearance, that may be judgmental. However, if you get the sense that the person is acting in a suspicious manner, then that is something to pay attention to.

But it’s not just danger on the street that should grab around attention.   We may have an intuition that the job we’re applying for isn’t the right one.  Or we may sense that a prospective friend isn’t very trustworthy.  But again, we may talk ourselves out of our gut reaction.

We can see how children are often in tune with their inborn reactions.  For instance, they may experience Uncle Henry as creepy or Aunt Jane as mean.  But parents will sometimes admonish the child, and make them spend time with people with whom they are uncomfortable.  Consequently, when children grow up, they may lose their natural intuition, something that is a gift to us, and which has helped us survive.

One of the ways I enjoy working with clients is to help them reconnect with their intuition.   I assist them to discern what is a true danger versus what is preconceived judgments.  Clients often find that once they are fully equipped with the gift of intuition, it is easier to navigate the world, without feeling as confused and vulnerable.

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Maintaining Healthy Boundaries

These days we live in almost boundary-less world, so it’s hard to maintain personal boundaries. Before the Internet, when we left work, there was almost no way for coworkers to locate us. Now, our bosses and colleagues can find us through instant messaging or text or email. Facebook lets us know the regular whereabouts of our close friends, and Linked In announces to the world where we work. People can upload all kinds of personal information on videos via Youtube.

While this boundary-less world can enhance our lives, there are some possible drawbacks. As the expression goes, we can learn “too much information” about others, as well as offer too much information in return. We’ve all heard stories about people being turned down for jobs after prospective employers see too much wild behavior displayed on public Facebook accounts.

Some people have boundaries that are too permeable and loose. At the other extreme, there are those whose boundaries are overly strict and rigid. The latter group may have trouble being close to others, which can lead to loneliness and isolation.

And yet, appropriate boundaries are necessary for satisfying and healthy relationships. It is one way that we feel safe with people. Boundaries help us know where the other person ends and where we begin. While good boundaries make us feel protected and comfortable, lack of boundaries can make us feel vulnerable and powerless.

So what are some characteristics of healthy boundaries? Here are a few:

–Not over sharing information or under sharing.

–Being able to set limits with people who reveal too much personal information, and make us feel uncomfortable. Setting limits can range from saying something to the person to limiting our contact with him/her.

–Being able to intuit when we sense someone violating our personal boundaries.

–Keeping confidential information truly private.

–Having friends who will also keep our confidential information private.

–Not trusting others, even close friends or family, and keeping our world too private.

You may want to observe the state of your own boundaries. Are they too weak? Are they overly rigid? Do you feel comfortable setting limits when you need to? And are you willing to share parts of yourself with loved ones?

If you want to make some changes, perhaps start with someone with whom you feel comfortable, such as a trusted friend or family member. Perhaps you can tell the person that you are working on setting better boundaries, and enlist his or her help. With more awareness, you can begin to have more appropriate boundaries with the people (and the social media) in your life.

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Saying No in Therapy

When an acquaintance, “Gretchen,” heard that I was a psychotherapist, she told me about a bad experience she had in therapy. Gretchen had seen a therapist, “Kathy,” because of problems she was having with her teenage son. When Kathy took a detailed history of Gretchen’s life, Gretchen disclosed that she had been sexually abused as a child. Gretchen said that she had seen a therapist many years ago about the abuse and that she had basically resolved this.

Kathy disagreed, and told Gretchen that her difficulties with her son were due to “unresolved issues around the abuse.” When Gretchen balked, Kathy said that Gretchen was in denial and that this denial was affecting her parenting. Feeling discouraged and frustrated, Gretchen terminated therapy with Kathy.

Gretchen’s story is not unusual. First, it is not uncommon for therapists to believe that trauma is behind most problems today. Kathy’s refusal to allow Gretchen to say no to talking about the trauma is, unfortunately, not uncommon either.

While it can be true that trauma can affect our current problems, this isn’t always the case. Just because someone had a difficult childhood, this doesn’t always mean that stress at work, relationships, etc. are directly related to the trauma.

in addition, it’s important for therapists to not scare clients by implying that they are somehow scarred for life because of difficult experiences. People like Gretchen shouldn’t feel as though they are always going to struggle because of trauma. Also, there’s research that indicates that many survivors of trauma are more resilient from what they have gone through. (This is called Post Traumatic Growth; I wrote a blog about this, see below.)

My strong belief is that clients should not be forced or guilt-tripped into talking about something that they don’t want to talk about. In fact, there’s a serious risk of inadvertently re-traumatizing the client. With trauma, the control has been taken away from them. They shouldn’t feel controlled or forced in therapy.

There may be times, though, when a therapist has to encourage a client to talk about something that he/she doesn’t want to; however, these are rare and extreme circumstances. For instance, if a client mentions suicidal thoughts, but refuses to discuss them, a therapist must pursue this topic.

As a therapist, I feel sad when I hear stories like Gretchen’s. In my view, therapy should empower a client, rather than discourage. My model of treatment is collaborative; my clients are welcome to talk about what they would like to — as well as to say no.

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Ethics in Psychotherapy

See if you can determine whether the behaviors below are ethical or not:

1. A therapist invites a client to an open house at the therapist’s new house.

2. A therapist reads and responds to emails during therapy sessions.

3. Having a home office, the therapist introduces the client to the therapist’s spouse.

4. During a major blizzard, the therapist, driving home from the office, sees the therapist’s last client stranded and offers the client a ride to the client’s home.

5. The therapist, meeting the client’s psychiatrist at a party, exchanges some information about treatment.

6. When a client reveals suicidal thoughts and plans, the therapist calls 911 and gives the authorities the client’s name, address, and phone number.

7. When a client expresses sexual interest in the therapist, they terminate their therapeutic relationship and begin a sexual one.

Over the years, I have heard of a number of ethical violations in psychotherapy. While most therapists do not engage in violations, unfortunately, some do. Such behavior gives the whole profession of psychotherapy a bad name. But worse than this, it harms people. It can deter a client from ever seeking help again. It can cause emotional upset, even trauma.

Clients are often not aware that the actions violate professional ethics. And then there are times when clients are uncomfortable with the behavior but not sure what to do.

Let’s go through the scenarios:

1. Inviting the client to an open house: This is what we call a “dual relationship,” which is unethical. Therapists should not socialize with their clients, for instance, attending parties, going to lunch, etc. There may be some exceptions, for instance, in small towns where a therapist may bump into clients at the food stores, a party, etc. But even in those situations, the therapist must maintain boundaries. It is also considered unethical for a therapist to develop a dual relationship after therapy ends.

2. The therapist reading and writing emails: As a non-attorney, I don’t know if this behavior rises to the level of an ethical violation. But at the very least, it is rude, since the therapist needs to focus on the client, and not email, take phone calls, text, etc.

3. Introducing one’s spouse in a home office: It appears to me that this behavior violates the client’s confidentiality. Home offices are tricky and open the possibility of these violations. If you see a therapist in a home office, you may want to have a conversation about how your confidentiality will be preserved.

4. A therapist giving a ride in a blizzard: In an emergency situation, it is likely ethical for the therapist to step out of the role to help the client. Obviously, giving rides should not be done on a regular basis.

5. The therapist exchanging information with the psychiatrist: Unless a client has signed a release of information, the therapist should not disclose information about a client’s treatment. (There are some exceptions, for instance, the therapist’s receiving a court order.) However, even if the client signs a release, a party is not an appropriate setting to discuss information about clients.

6. A suicidal client: If a therapist assesses that a client may be imminently suicidal, the therapist is required to break confidentiality in order to ensure the client’s safety. This is true in other emergency circumstances, such as, serious homicidal thoughts towards a particular person and child abuse.

7. A sexual relationship between client and therapist: Sex between clients and therapists is never allowed, even when therapy has terminated. It is considered an egregious ethical violation, one that may cause the client great harm. A sexual relationship between client and therapist is considered unethical even if the client initiates the sexual contact and even after therapy ends.

I hope that this blog has given you some idea of what is considered ethical and unethical in psychotherapy. While therapists are not perfect and may make mistakes at times, this is not the same thing as an ethical violation.

If you feel uncomfortable with what is going on in therapy, don’t talk yourself out of your feelings and concerns. You may want to talk with a trusted friend about what is going on. You can also consult with the psychotherapist’s licensing board. If you feel that your therapist is acting unethically, consider talking with the therapist and/or ending the therapy.

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The Challenge of Everyday Life

A friend of mine, Kim, was struggling to deal with her 8-year-old daughter’s sadness. Kim was a single parent raising “Becky” on her own. Becky would cry every night about not having a dad. Kim, a psychodynamically-oriented therapist, tried her best to soothe Becky. Kim would tell her, “I know that it’s really hard. You’re very sad. You wish you had a dad.” Unfortunately, Becky continued to be inconsolable.

When Kim discussed the situation with me, I suggested a different approach. I said that she should tell Becky, “I know that it is hard for you. But we are doing fine! We have a roof over our heads and enough food to eat. I have a good job, and you are going to a great school. We’re doing well!” After reassuring Becky a few times, her evening crying spells stopped.

Although Kim was trying to be supportive, she was inadvertently sending the message that their family situation was bad, hopeless, and deficient. What Kim needed to do was to help Becky feel more secure.

I was thinking of Becky and Kim after I glanced at a new book called, “The Trauma of Everyday Life, ” by psychiatrist, Mark Epstein. I have not read the book so I can’t speak to its quality. However, I am concerned about the message that the title sends. While life can be very challenging indeed, calling it “traumatic,” sounds as though every day is potentially scarring. Similarly, Kim was unintentionally communicating to Becky that their situation was traumatic.

A difference exists between true trauma and challenges. Calling almost everything “traumatic,” confuses the line between them. Also, telling ourselves that a situation is “traumatic,” creates a mental imprint that is hard to change.

In addition, challenges can build character, empathy, resilience. Even after trauma, there is the potential for recovery and building courage and strength. (See blog I wrote on “Post-Traumatic Growth.”)

Traditionally trained therapists, such as Kim, may at times send a similar-type message to clients that their situation is sad. While it can be helpful to tell a client once or twice, “That sounds hard,” continually reinforcing this may make the person get stuck in sadness, as was Becky.

What is needed is hope. This is what I aim for as a therapist, to convey hope regardless of life’s circumstances. No matter what a person has dealt with in his/her life, there is always hope and the potential for growth and meaning.

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Can You Change Your Personality?

I once heard a talk by psychotherapist, “Sylvia,” who told a story about a conversation she had decades ago with her first therapist. During one of the first sessions, Sylvia told her therapist that she was excited about changing her personality because she was tired of being neurotic, anxious, and controlling. Her therapist listened to her patiently, and then said, “Sorry, Sylvia, we all get one personality this time around.”

That conversation really struck me. How often many of us wish we could change parts of our personality! Perhaps we’d like to be calmer and more relaxed, or maybe more animated and sociable. We may envy people who seem so different than us, and who appear happier.

And yet there is a lot of truth to what Sylvia was told. We all have some fundamental traits that make us who we are: our temperament, likes and dislikes, and personality quirks. While personality is partly shaped by childhood and our environment, brain chemistry also plays a pivotal role. For instance, identical twins separated at birth and then reunited decades later are strikingly similar, even when raised in completely different environments.

What I discern from all of this is that we need to accept basic, inborn personality traits, while trying to change dysfunctional behavior. The pressure to change our personality can lead to even more unhappiness. This is particularly so because our culture promotes the unrealistic idea of constant happiness and the false idea that we can become someone else. The culture also unfairly values some traits (optimism, cheerfulness, extraversion) over others (sensitivity, introversion, creativity).

Even though it may be very hard to change personality and temperament, it IS very possible to change our behavior and habits. This is one of the reasons I enjoy working in my particular therapeutic style, which tends to be practical and strength-based. Behaviors and thought patterns can be changed, with guidance and practice. And by acting and thinking differently, people can become happier and less anxious.

While it may be difficult to change from an introvert into an extravert, it is possible to alleviate social anxiety and become more socially engaged and comfortable. While a pessimist may not necessarily become an optimist, it is possible to stop unfairly judging yourself, and to start accepting yourself for who you are. And it is possible to get some control over the habits that trouble you, rather than let them control you.

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What Therapy Style Would Work for You?

Many years ago, I saw a therapist, whom I’ll call “Denise.” She was a decent enough therapist; however, when I think back about my two years seeing her, one incident stands out. One day I rushed into her office, having braved a particularly nasty rainstorm to get there, as well as some road work on College Avenue. Feeling stressed, I spent a minute or so complaining about the weather and also the traffic. I still remember her reaction: she looked at me silently. And I recall my reaction as well: I felt bad.

Her silence made me feel foolish, like I was silly to be complaining. It also made me feel alone and very lonely sitting there with her. Even though I continued seeing Denise, because she was a competent-enough therapist, unfortunately all I remember from our time together was this incident.

I don’t think that Denise intended to make me feel bad. However, her therapy style lent itself to doing this, at least for me. Denise had a more traditional approach and so did not feel comfortable making some small talk.

I bring this experience up because I think it’s important to be aware that each therapist has a different style, based both on theoretical approaches and also his/her personality. When looking for a psychotherapist, many potential clients look at factors such as the therapist’s years of experience, his/her location, fees, etc. While these are important, so is something more ambiguous such as his/her style.

As a therapist, I would never do what Denise did; I wouldn’t leave a client hanging out there all alone if he/she is making a little small talk.

I view it differently than someone like Denise: I see a little conversation, should a client want to make it, as his or her way of connecting with me. It also may be a way that he/she is transitioning into the therapy experience.

I do my best to try to make my clients feel safe and comfortable, and if a little small talk and maybe a little laughter will help facilitate that, then I am fine with that. I think it also creates a more human-to-human connection, which I strive for. It’s not unusual for me to make some small talk myself!

When you are seeking a therapist, I would suggest evaluating what type of therapy style would work for you. You may be more comfortable with someone very serious, like Denise, who sticks to the therapy format at all times. However, you, like me, may perceive that as withholding and unwelcoming. Everyone is different. For therapy to be successful, style is often a key feature.

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The Pros and Cons of Empathy

Jenna is a very empathic person. However, sometimes she can be too empathic. For instance, Jenna will put up with bad behavior from friends, which stresses her out. When Jenna’s friend, Sasha, flakes out on dates, Jenna tries hard to understand, empathizing with Sasha’s busy work schedule and financial stress. Meanwhile, because Jenna isn’t setting limits with Sasha, her friend continues to stand her up.

Empathy is a good thing — in appropriate dosages. An analogy would be taking vitamins: you want to take the right ones in the right amount. However, too much Vitamin A, for instance, can throw your system out of whack.

Empathy, in the right amount, can enhance relationships. It can make you a deeper and more intuitive person. However, there is a fine line between being empathic and being an enabler.

If Jenna makes excuses for Sasha’s bad behavior, Jenna is enabling the behavior. By being an enabler, she reinforces the behavior and encourages it to continue.

At the same time, too little empathy isn’t a good thing either. It’s a delicate balancing act, and no one performs it exactly right. But the key is to be aware of your own tendencies and your reactions.

If Jenna starts becoming resentful towards Sasha for her flakiness, this is a red flag that Jenna is being hurt by the relationship. In this case, Jenna shouldn’t talk herself out of her feelings by trying to put herself in Sasha’s shoes. Even if Sasha is stressed out, this doesn’t give her the right to be irresponsible and disrespectful of Sasha’s time.

Ask yourself whether you veer towards being too empathic. Can you relate to Jenna? Or do you have a tendency to not be empathic enough? Keeping an eye on empathy can lead to a more balanced and satisfactory relationship with other people.

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“Own Your Own Life”

A number of years ago, I read a book that was life-changing. The book was by Gary Emery, and it was called, “Own Your Own Life.” In retrospect, the advice in the book wasn’t particularly jaw-dropping. I just needed to be in an open and ready place to hear the advice. The author’s basic premise is to, well, own your life! He says that to be a responsible, high functioning, mature adult, this means doing what needs to be done. This doesn’t mean to ignore your feelings, but to not let them get in your way. If your mother was mean, if your father was abusive, be angry at them, if that’s how you are feeling. But don’t let that interfere with doing your chores, finding a decent partner, and being a contented person.

At the time I was reading the book, I had a strong aversion to washing the dishes. I’m not sure why. I don’t recall any traumatic event around dish washing. But I detested this chore.

I would, of course, put it off until there were so many dishes that the task was particularly onerous. Or I would do the dishes and feel resentful and tense. But then I read the book, and suddenly I started doing the dishes!

I’m not saying that I enjoyed it. I still don’t. But I consider it just a task like any other. I don’t despise brushing my teeth, for instance, though I don’t enjoy it. Now dish washing is to me like tooth brushing. I do it because I do it, and I don’t have strong feelings one way or another about it.

I’m not sure that you need to read this particular book in order to get the lesson, though there’s nothing wrong with picking up a copy, if you’d like to. What you might want to do is to be aware of something that you are putting off. Perhaps you want to start with a task that you dislike, rather than something that may be truly threatening to do, for instance, doing your taxes.

Start with something like dish washing — or laundry or cleaning the toilet. If you’re like most people, there’s probably something you’re putting off doing.

And simply say to yourself: “Own Your Own Life.” Don’t do so in a mean or harsh manner. Imagine the voice of a supportive, yet direct and clear, coach. The coach wants the best for you. And see if it works for you too.

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Which Type of Therapist Should You See?

People will occasionally ask me the differences among the type of professionals who are licensed to do psychotherapy in the state of California (that is, MD/Psychiatrists, Psychologists, Licensed Clinical Social Workers (LCSWs), and Marriage and Family Therapists(MFTs)). It’s a difficult question to answer. The reason is that there tend to be few differences among the various professionals, aside from psychiatrists.

Although psychiatrists have a reputation for doing intensive psychotherapy, this is generally no longer the case. In this area of the country, psychiatrists mostly do medication management, and not as much therapy. (Of course, I’m speaking in generalities here.)

But when it comes to the other three disciplines, that is, psychologists, MFTs, and LCSWs, this is where the differences start to blur. In general, most of these professionals do individual and couples therapy, with some seeing children and families (which I do). How a psychotherapist works depends less on his/her degree and license, and more about training and areas of interest.

Let me give you more of a sense about why degree and license don’t matter as much as other factors. While psychologists are specially trained in graduate school to do psychological testing and assessments, most psychologists don’t actually do psych testing, but only psychotherapy.

MFTs are specifically trained in grad school to do marriage, family, and child therapy. However, only a minority of MFTs work with families, and an even smaller minority work with children. Most MFTs work with individuals and couples, exclusively.

Clinical social workers are specially trained in psychosocial issues that may affect clients’ well-being. LCSWs have had specialized coursework in grad school in system issues (for instance, family, community, work, etc), and not just intrapsychic issues. However, most psychotherapists, of any discipline, will keep in mind the impact of systems on their clients’ psychological health.

So in the end, you may want to choose a therapist not so much on their license or degree, but on other factors: for instance, their years of experience and expertise, and, something important, though nebulous, called “fit.” You could do extensive research and find a therapist who is exactly right for you — at least on paper. But then you could meet the person and find that your personalities do not mesh.

My suggestion is to do some research, but then connect with the therapist and get a sense of the person. Trust your instincts. If something feels off, then keep looking around.

There is no perfect therapist, of course, and everyone has his/her strengths and weaknesses. However, the therapist should come across as professional, trustworthy, and knowledgeable, and as a nice person with whom to work. With those factors in place, you may then be able to start opening up and sharing, thereby beginning the process of meeting your treatment goals.

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Preventing Re-Trauma

Amy* had a fairly happy childhood until she was victimized as a teenager. Her brother’s friend sexually assaulted her after her brother left briefly for an errand. Soon thereafter, Amy told her mother, who called the police. Her brother’s friend was arrested and pled guilty. With the support of her family, Amy moved on mentally and started college the next fall.

In a college class, she was asked to write an essay on how she coped with a difficult life experience. Amy decided to write about the attack. After reading the essay, her teacher took her aside. The teacher urged her to seek counseling immediately, even though Amy told her that she was doing fine.

Starting to doubt herself, Amy went to her college counseling center. There she saw a therapist who told her that she must devote a period of time in therapy to processing the assault. Amy was unnerved when the therapist told her that she might have lifelong problems should she not seek therapy.

Amy spent several months talking in depth with the therapist about the assault. When Amy began having nightmares, her therapist reassured her that this was natural; that she should expect to feel worse before she healed. Amy began having disturbing and intrusive thoughts about the trauma. Again, her therapist told her that this was normal.

After a number of months of increasing anxiety and depression, her therapist recommended that she see a psychiatrist. The psychiatrist put her on an anti-depressant and also a sleep aid. Amy not only was continually distressed by thoughts of the attack; now she was dealing with side effects from the medications.

Sadly, Amy’s story is not unique. Most insight-oriented therapists will tell their clients that they must relive a trauma through intensive psychotherapy or else be saddled with a lifetime of issues.

But there are a number of problems with this belief system, as I describe below:

1. First of all, it’s not true! There are many other effective ways of managing trauma that don’t have the same risk of re-traumatization.

2. Having a therapist push a client to talk about trauma if she/he doesn’t want to can be traumatic! Amy’s sexual assault involved force. A therapist must be extremely sensitive to not making the client feel forced again.

3. An effective therapist starts where the client is. If Amy wanted to focus on trauma during our sessions, I would be open to this. However, if Amy told me that she didn’t want to talk about it, I wouldn’t pressure her or scare her into talking.

4. It’s important for a therapist to realize that there is much more to a person than his/her victimization. While it may be appropriate and helpful at times to process a trauma, there are many other topics to explore.

If you are shopping around for therapists, you may want to ask them about their philosophy about trauma. If they state that all trauma must be intensively explored at length for many months, if not years, in order to be healed, my recommendation is to be wary. There are a lot of people who have ended up like Amy, and had to seek therapy in order to recover from therapy!

*Please note that “clients” are composites, not real clients.

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Integrative Therapy

I consider myself an integrative therapist. Let me explain a bit what I mean. For one, I don’t immediate assume that all problems are psychological. If I did so, I might miss other, more subtle, reasons for a client’s distress.

Let me offer an example. I saw a client* once, George, who was having difficulty with mood and temper. Although we explored his childhood as well as current stresses, I did not stop my exploration there. I asked him about lifestyle issues: for instance, his sleep patterns, diet, medications, medical issues, etc.

As it turned out, George had recently started a vegan diet when he noticed the first symptoms of depression and irritability. Because of our discussion, George was able to fine tune his diet to ensure that he getting the proper nutrition. I also suggested that George see his doctor for a full medical check-up to make sure that something biological wasn’t adding to his stress, e.g. blood sugar problems or hormonal imbalance. We also focused on some life stresses that were distressing George, including problems at home.

And then there are times when emotional issues can be causing or worsening physical symptoms. I recall seeing a teenager* once because of ongoing stomach problems. Once he disclosed some problems in the family and was able to get support, his stomach issues resolved.

I view each of my clients as unique beings, with his/her own particular make-up. And after 25 years of experience as a therapist, I have also learned that there are a multitude of factors that may influence a person’s mood and state of mind, and not all of them are psychological.

*Please note: “clients” are composites, not real clients.

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Playing By the Rules

Melissa is the type of person who plays by the rules. She gets to work on time and rarely takes longer than her allotted one-hour lunch. Melissa has chosen friends who are similar to herself in this way. Melissa is comfortable with herself; she likes playing by the rules because it makes her feel safe in the world. There is a problem though: she chooses men to date who are the opposite of her.

For instance, Melissa’s last boyfriend amassed a lot of credit card debt. Another boyfriend drank too much, and a third one cancelled dates with her at the last minute. While Melissa finds all of this behavior unacceptable, the problem is that nice guys who also play by the rules bore her.

While opposites may attract, Melissa’s choosing men who were her polar opposite in this regard was leading to unhappiness. At times opposites may do well together. For instance, a gregarious partner may offer an introvert more opportunities socially.

However, when it comes to playing by the rules versus questioning authority, another saying works better: Birds of a feather flock together. Melissa would do better sacrificing some excitement through dating people more like her.

The idea of rules versus no rules applies not just to love relationships, but to friendships and work environments. Another woman I know, Karen, tends to play by the rules, like Melissa. However, she chooses friends who live a bit more on the edge.

This works in some ways: Karen enjoys living vicariously through hearing their stories of wild Saturday nights. However, if Karen joins a friend at a wild party, she may find herself in uncomfortable situations.

Another example would be work environments. If you play by the rules, but your boss doesn’t, this could lead to your being asked to do things you find unacceptable. And if you tend to bend the rules, but your boss is a stickler for them, you may find yourself continually in trouble.

Do you tend to be a rules person, preferring to keep to the rules rather than doing your own thing? Or do you tend to bend the rules?

If you are having difficulties in friendship, dating, or work, consider whether you may be mismatched with others. Ultimately, you’d be happier working and playing with people who are similar to you in this way.

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Living Well with a Hidden Disability

A friend of mine, Janie, lived with severe pain for many years. Finally, she was wheelchair bound for several more years until doctors performed surgery that alleviated her pain. Surprisingly, Janie told me that life was much easier for her when she was in a wheelchair than when she was walking around, but in pain. The main reason is that people treated her differently in both situations.

When Janie was in a wheelchair, her friends and even strangers on the street were solicitous and caring. People of every age would hold the door open for her and even offer her their place in line.

However, when Janie was in terrible pain but looked able-bodied, she received an indifferent, sometimes even hostile, response. She recalled being in a long line once and asking the cashier if he could provide a chair, since she was in a lot of pain. The cashier just scoffed at her and told her to wait her turn. Janie left the store in tears.

Chronic pain is an example of a hidden disability, that is, a physical or emotional condition that causes disability but is invisible. Other examples of hidden disabilities include autoimmune disorders, chronic fatigue syndrome, fibromyalgia, and migraines, along with mental health issues, such as depression, bipolar disorder, panic disorder, or OCD.

In l999, I published a book on the subject, called, Living Well with a Hidden Disability. In it, I described the challenges of living with a health problem that causes disabling and restricting symptoms though the world doesn’t see them.

I talked about situations like what Janie experienced, when you are suffering and yet people deny your pain. Another frustrating situation can be when friends offer easy solutions, e.g. “try yoga” “go to my acupuncturist.” At other times, loved ones may imply that your suffering is all in your head, and if you just smiled more, meditated more, or thought more positively, all would be well.

When friends and family say these often hurtful things, most of the time they have good intentions. They feel powerless and anxious that you are suffering so. They want to fix you. And yet, their remarks may make you feel even more lonely and misunderstood.

If you are struggling with a hidden disability, know that there are millions of others out there who also look fine but have physical and/or emotional disabilities. It can be helpful to join with like minded others in support groups, either in person or online.

Remember to validate your own experience, and don’t let others make you feel ashamed of being ill. Having a health problem is difficult enough without allowing the world to make you feel discouraged or inadequate.

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Do You Get In Your Own Way?

Jacob is desperate to finally finish his PhD dissertation, which is a year overdo. But he can’t resist playing the latest video game or heading off to a party with his friends.

Traci wants nothing more than to be married and start a family. Yet, she chooses to date guys like Charlie, who are aloof and commitment phobic.

Jacob and Traci are people with good intentions. They want to stabilize their lives. They want to move on and meet their life goals. And yet something — themselves! — keeps getting in the way.

Can you relate to someone like Jacob or Traci? Do you also cause yourself to stumble at times, and to get off course from your dreams? Are you intent on checking your Facebook less, getting more sleep, and being more productive at work, but something always gets in the way?

If so, you’re not alone. Most people get in their own way at times, particularly when their priorities clash. For Jacob it’s a collision course between his long-term goals and immediate gratification. One of his major life goals is to finish his dissertation and begin working in the tech industry and making real money. And yet, immediate gratification sets in: that is, having fun and distracting himself from the hard work of writing.

For Traci, she’s torn between her biological clock and her attraction to the bad boys. For her, it’s not just immediate gratification but habit and fear. She has some real anxieties about being close to someone in a “normal” relationship. Traci may have to explore her fears about being vulnerable and mainstream before she can find the right relationship.

If you also get in your own way, try to figure out why this is the case. Is it because you can be impulsive like Jacob, and desire pleasure and immediate gratification? Do you have fears, like Traci, and therefore are choosing the safer and more familiar route?

Is there some other reason that is keeping you from doing what you know you should do? Once you discover your hidden motivation, you can move towards changing old habits and beginning new, healthier ones.

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The Three Rs of Communication

Most of the arguments between people have less to do with malice, and more about problems with communication. I call it the “Three Rs” of communication: Reactive, Reflective, and Responsive. When we have fights with others, it’s oftentimes because we (and/or the other person) became more reactive than reflective or responsive. And in our fast-paced world, reactivity is more prevalent than ever before.

As an example of how the Three Rs work, let’s take as an example a nasty blowout between two brothers, Jacob and Gabe. Jacob IM’ed his brother because he had to cancel their dinner because of a hard deadline at work. Gabe, a student struggling to finish his thesis, was looking forward to seeing his brother in order to unwind and have some fun.

When Gabe received Jacob’s email about cancelling, he was quick to react. Gabe was already having a bad day as his advisor was on his back to finish his thesis. Gabe wrote back, “Why am I not surprised? Since you took this job, you’ve been totally undependable.”

Of course, this angered Jacob, who already was stressed out about this big project at work. Offended, Jacob wrote back, “And you’re being a total jerk about this.” That led to another angry email exchange, by the time their IM’ing was over, they were both hurt and angry.

This argument could have been avoided if each of them had taken the time to Reflect, then Respond, rather than React emotionally. For instance, when Gabe heard his brother was canceling, suppose Gabe took some time to cool off rather than immediately write Jacob back. Perhaps Gabe went out for a run to let off steam, and then had a bite to eat. When he felt better, Gabe could have empathized with Jacob’s situation, rather than take his brother’s canceling as a personal insult.

Gabe could have instead wrote back, “Hey bro, that’s a serious bummer. I was really hoping we’d kick back and have some good food.”

Jacob could have taken this as guilt-tripping and thus overreacted. Instead, imagine that he didn’t write back right away and instead reflected on the stress in Gabe’s life. Then he could email, “Sorry, bro, my bad. I shouldn’t have made plans this week since my boss is on my back to get this project done by Friday. But the weekend should be free and clear, so how about breakfast on Saturday?”

It’s important for all of us to evaluate our communication style. Do we tend to be reactive — that is, take things personally, perhaps misread the situation, and react with frustration too quickly?

There may be times when reactivity is appropriate; however, you want to pick your battles. Otherwise you’ll find yourself locking horns with everyone you know.

To become less reactive, take a time-out before you answer an email or a voice mail, if possible. Reflect on the other person’s point of view, and try to see things from his or her shoes. Then come up with a response that won’t escalate the situation even further.

If a response can wait, give it at least an hour, and perhaps even a day if this is possible. By then, you’ll be more clear headed and able to talk to the person in a way that you won’t later regret.

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Post Traumatic Growth

There’s an interesting new field of study called, “Post Traumatic Growth.” Researchers are trying to find out why traumatic experiences can sometimes lead to growth, rather than suffering. For decades, therapists have assumed that trauma always leads to misery, sometimes even producing irrevocable damage. And yet, researchers are discovering that in some situations, a difficult situation can lead to growth.

Whether we experience growth or suffering may sometimes be due to the particulars of the situation. I like to use this example with clients: suppose that you have a friend whose arm is badly burned in a fire. Would that be awful for him? Most of us would quickly say, “Yes.”

But what about if he ran into a burning building and saved a child? And he received such public accolades that he was awarded a medal from the Mayor, and was even able to get a better job from new contacts? In this situation, he may not have suffered trauma, but instead growth.

In addition, we might grow if we’ve been able to carve out some personal meaning from the event. For instance, the woman who started Mothers Against Drunk Driving experienced the death of a loved one at the hands of a drunk driver. From her sorrow, she helped engineer a whole movement that has helped prevent many more deaths.

I find the concept of Post Traumatic Growth to be helpful, with one caveat. If a person has indeed been traumatized by a terrible experience, it would be unfair to assume he/she should have grown, rather than suffered. One problem I see with the idea of PTG is that a person could feel guilty for not “growing” from the experience.

The reality is that some experiences in life will lead to growth, and others to suffering. Trying to force ourselves to be appreciative can only saddle us with guilt and shame, along with the original trauma. However, we should not always assume that something difficult will produce lifelong trauma. And sometimes by changing our thinking about the experience, and trying to find meaning in it, we may be able to alleviate some of the trauma.

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Kids and Counseling

I worked for a number of years as a child therapist, mostly providing one-on-one therapy. I came away from the experience believing that there are distinct advantages and disadvantages of individual therapy with kids. Here are some advantages, in my mind:

– If children will not disclose what’s troubling them to parents, individual therapy may offer the child a neutral place to share.

–For children who are traumatized by, for instance, abuse or death of a loved one, therapy can allow them to gain mastery over the event by symbolically acting it out.

–If parents are unavailable for help, for example due to a painful divorce or a parent’s serious depression, counseling may offer the child the attention and validation he/she needs.

While there are pros to individual child therapy, there are some cons as well:

–Child therapy can present some ethical dilemmas in terms of confidentiality. With some exceptions, a minor doesn’t have a legal right to confidentiality. And yet disclosing information to the parents can make the child feel betrayed.

–Working individually with the child doesn’t help the parents to deal effectively with challenges the child is presenting. If a child is anxious, for instance, individual therapy wouldn’t teach the parent how to help the child.

–On that same note, the parents are the most important people in the child’s life. In my view, they are in the best position to help the child on a regular basis, particularly since the therapist only sees the child for 50 minutes once a week.

–One of the goals of counseling should be helping to facilitate healthy attachment between the child and his/her parents. By my working alone with the child, this would not encourage this attachment; in fact, it may make the child attached and dependent on the therapist, which could be counterproductive.

The model in which I prefer to work is one of parent and child coaching. I view myself as the family’s consultant or coach, rather than the expert. The parents are the experts on the child since they have known the child since the he/she was born! Although I have professional knowledge and experience to offer, the parents are generally in the best position to guide and steer the child.

For instance, if a child is suffering from anxiety or depression, I would enlist the parents’ help as his/her coach. Through meeting with the parents alone, I would teach them how to help the child manage his/her symptoms. I may then want to meet with the parents and the child together to demonstrate some strategies and exercises.

There are times when I might meet alone with a child, for instance, with a teen who prefers to sort out some issues without his/her parents’ presence. However, even in those cases, I would try my best to keep the parents apprised about the child’s progress.

If you are seeking help for your child, my suggestion would be to ask the prospective therapist about his/her model of treatment. If it is important for you to be involved, make sure that the therapist is on the same page, since many therapists prefer to work just with the child, with parental involvement at a minimum.

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Being Quiet

There’s a recently released book that has proven to be an overnight sensation. The book is called, “Quiet,” and it’s a nonfiction work about the challenges of being an introvert in an extroverted world. Perusing the book has made me realize that not just introverts, but extroverts as well, can struggle from being in situations where they are out of place. This is because introverts need time alone to refuel, while extroverts must be around people to restore their energy.

And yet life often positions us in situations that don’t work for us because we are an introvert or an extrovert. A friend of mine, Sam, for instance, chose a profession that ultimately caused him a great deal of discomfort.

An introvert, Sam decided to become a psychologist, a career where he was dealing with people all of the time. When he returned home at the end of the day, Sam felt depleted and stressed out. Upon realizing that there was a mismatch between his temperament and his job choice, Sam found a position in a mental health job where he was doing more policy and research (solitary work) than direct service.

We may struggle not just in jobs, but in our personal lives, if we are an introvert in an extrovert-like setting (and vise versa). For instance, if you married an introvert, and you are craving more people contact, you may feel frustrated. Or if you prefer to have the house to yourself, and your partner keeps inviting over friends, you may feel tense and stressed.

The first step in recovering your equilibrium is deciding whether you lean more towards the introvert or the extrovert side. Then you’ll want to find ways to de-stress and recover from the day.

For an extrovert, this may mean meeting a bunch of friends for Happy Hour. For an introvert, it may be going home and unwinding with a good book. And if you live with someone in a “mixed marriage or partnership” (that is, an introvert with an extrovert), you’ll want to begin a negotiating process where you each can have the type of time you need to de-stress from the day.

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Raising Sane Children in an Insane World

It’s never been harder to raise children than these days. Not only do you have the media desensitizing children with obscene amounts of violence, but the computer exposes children to hard-core pornography and other disturbing images. And computers and Smart Phones create a virtual world that parents are not privy to.

And yet, even with the challenges, it is quite possible to raise happy and healthy young people. To do so, however, means finding innovative ways to guide and coach your children. Here are some suggestions:

1. Guard your children’s media and Internet exposure as much as you can. Studies are showing that many children as young as l0 are viewing hard-core porn online. Put parental controls on your children’s computer and consider keeping the computer out in the open, such in the family room.

And be careful about social messaging sites, such as Facebook, which are causing addiction in many youth. Some parents are not allowing their child to join Facebook unless one of the parents is a “friend.” This is a good way to keep an eye on what your child, and his/her friends, are posting. (One savvy parent knows which parties will be unsupervised and serving alcohol because she is her child’s Facebook friend.)

2. Maintain as many family rituals as possible, such as dinners around the same time each day. Studies have found that small things like family meals have big payoffs in helping the child to feel stable.

3. Be mindful of your own television watching and cell phone use, since the child often will often model him/herself after you. The same advice applies for alcohol use.

4. Remember that your main job is to be your child’s parent, not necessarily his/her friend. Children of every age need parental boundaries, which make them feel safe. Even if he/she may fight with you about it, in the long run, your child will be grateful that you kept him/her from harm’s way.

5. Have confidence in your child that he/she will be alright. Overly worrying and fretting (aka “helicopter parents”) can erode a child’s confidence. It can go a long way to say to a child, “I know you’re struggling in math, but I believe in you. You’ll get it eventually; just try to be patient with yourself.”

6. Fathers (or grandfathers, uncles, or male family friend) have a particularly important role to play with their daughters, in that a father’s attention can make a girl feel special and loved. Dads will want to build up your daughter’s self-esteem by telling her that she’s pretty and interesting and smart. Although mother’s opinion is important, girls can assume that their moms think they’re terrific. Also, attention from dad (e.g. special activities such as walking the dog together) can reduce the daughter’s neediness for male attention when she becomes a teenager.

7. When raising boys, make sure to encourage physical activity and other channels for their energy, such as scouting. Many boys spend too much time immersed in video games. Make sure that they engage in physical play, as well as technology.

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Are You What You Eat?

As a psychotherapist, I consider myself “holistic,” in that I consider the whole person before me. I am interested in my client’s lifestyle and their environment, and not just their emotional make-up and history. Part of my interest is that in many cases, a client’s physical state will have a lot to do with their moods. If a person has chronic pain, he/she may feel depressed, irritable, and/or anxious. In fact, there are many physical causes of emotional issues, including diabetes, hypoglycemia (low blood sugar), heart problems, environmental contaminants, such as mold or mercury, and medication side-effects.

The same can be said for one’s diet. What we eat can help to shore up our resources and increase our well-being. But the wrong diet for us can cause or exacerbate emotional and physical symptoms.

I could cite numerous examples of clients whose emotional symptoms improved or even vanished when they made some simple changes to their diet. For instance, I recall a couple I saw who often had a big argument right before dinner time. When I suggested that they each eat some healthy snack (that included protein) before they returned home from work, the fights ceased.

Here’s another example: I saw an 8-year-old child with her grandma once with the presenting problem being the child’s temper tantrums.* The child had a horrendous background with her biological mom, and she moved in with her grandmother when she was five.

Most therapists would have assumed that her temper had to do with her anger at being abandoned. Then the child would have been scheduled for once weekly play therapy for months if not years. While I wasn’t averse to seeing her one-on-one, first I wanted to make sure that the problems were just psychological.

I asked the grandmother when the girl tended to have tantrums, and she said they were after school. I then asked the grandmother to bring a snack for the child to eat in the car when driving home from school. I also suggested that the grandma serve dinner a bit earlier, at 5:30 rather than 6.

We scheduled another appointment for two weeks. But the grandmother called me a couple of days before the scheduled time and said that she was canceling because the child hadn’t had another tantrum since the new eating regimen began.

If you’d like to find out whether food is playing a role in your symptoms, you can try this simple test. For at least one week, eat three meals a day, each with high quality protein. Reduce your carbs (which convert to sugar in the body). Eliminate or greatly reduce sugar, caffeine, and alcohol. Take a multiple vitamin every day. And make sure to eat an afternoon snack, again one with protein, for instance, nuts or lunch meats. And then see if you feel better.

If you notice an improvement in your symptoms, you may have discovered one of the causes of your psychological distress. In that case, relief from emotional distress may be as close as your nearest Safeway or the Berkeley Bowl!

*Please note that all references to clients are composites, not real people, with no identifying names or information.

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Don’t Believe Everything You Feel

I wrote a blog (see below) about the bumper sticker, “Don’t Believe Everything You Think.” The same can be said about our feelings Our feelings can lead us towards illumination. But they can also lead us astray.

For instance, we all have known people like Janie, who is in love with Justin even though he’s Mr. Wrong. Though Justin takes his bad moods out on her, even though he goes out drinking and gambling with the boys, Janie insists that she’s in love with Justin. And in her mind, her emotional connection to Justin means that they should be together.

It’s not just women like Janie who can get thrown off track by her emotions. At times, we all let our emotions take over.

If, for example, you take a job that you know you’ll hate because of fear of not getting another, or if you marry a person you don’t love because you’re lonely, your emotions are not acting as your friends. If you become enraged at your landlord for raising the rent and he/she then retaliates by kicking you out, your feelings may have blinded you to the potential consequences.

How do we know when our feelings are leading us in the right direction versus making a mess of our lives? It’s not always easy to tell. There’s a difference between intuition and feelings, though. Intuition is an innate, sixth sense about something or someone. Feelings can sometimes just be a physiological, maybe a hormonal, reaction.

Intuition can center a person and make him/her feel more grounded. Emotions can sweep us up in the impulses of the moment.

Before you make a major decision in your life, try to discern whether you are acting upon intuition or simply an emotional reaction. Otherwise you might find yourself like Janie: stuck in a situation which has disaster written all over it.

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Don’t Believe Everything You Think

There’s a popular bumper sticker around Berkeley that reads, Don’t Believe Everything You Think. There’s a lot of truth in this clever statement. When a thought appears, we have a tendency to pay close attention. We may think that every thought is important.

And that’s true at times, but deep insights are infrequent. While we may occasionally have an important “aha” moment about our lives, many of our thoughts are not productive at all. In fact, they may be downright destructive. Some thoughts may lead to discouragement, even depression.

As a therapist, I pay close attention to how the client’s thinking and talking are making him/her feel. If it appears that my client’s thoughts are starting to agitate him/her, I’ll ask, “Do you think that it is helpful to go down the path you’re going?”

Most of the time the person will say an empathic, “No!” I will then try to find a more productive avenue for them than simply analyzing the issue.

I do my best to distinguish between what may be a useful exploration on the client’s part, even if he or she may feel a bit uncomfortable, versus the person going into a shame state. In other words, I try to differentiate between true insight, one that leads to growth and relief, versus allowing their inner bully to beat them up.

One of the crafts of therapy, I think, is differentiating between productive thinking and overthinking. While some therapists feel that no amount of thinking or analysis is too much, I disagree. Not only can overanalyzing be distressing, but it can lead to paralysis. We can inadvertently empower our inner critic, who keeps us hostage to negative thinking and to the past.

Therapy should help to free you from the past, not make you a hostage to it. It should help you to start letting go of old patterns that you’ve outgrown. And one of the first places to start is noticing your thoughts, that is, learning which ones you should believe and which ones you should trash.

An analogy I often use is spam on the computer. Those unproductive, even self-destructive, thoughts are a lot like spam. If you double click, you know what happens: you can get a virus and a lot more spam.

Just like with real spam in your email folder, do the same with thoughts that are useless, even destructive. Don’t double click on them! Instead, send them off to the trash!

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Values Clarification

Monica and Anna were close friends until they started living together. But once they rented an apartment together, they were barely speaking to each other. They argued about almost everything: the cleanliness of the apartment, how they spent money together, and even how much time they spent together or alone. But the problem wasn’t so much that Monica was right and Anna was wrong (or vise versa), but that their values collided.

Many problems between people come down to a values clash. And if people clarify their values prior to living or working together, most issues could be avoided.

For Monica, socializing was a high value. She expected that Anna and she would have friends over almost every day of the week. Anna, in contrast, wanted some peace and quiet after working all day.

For Anna, having a neat and tidy place was a high value. Monica would much prefer to chat with her friends online rather than clean the bathroom. Monica also expected that the two of them would hang out in the living room and talk and watch TV. Anna was preparing for the LSATs, and she wanted time in her room to study.

While Monica and Anna may have been compatible as friends, they were not well-matched as roommates. The problems could have been avoided — and their friendship saved — if they talked prior to moving in about their priorities and values. Once they realized they were mismatched, they could have negotiated some middle ground or decided to live with others.

There are many other relationships that can run into problems because of value differences. For instance, prior to engaging in a business endeavor, it’s wise to talk together about your priorities and values.

Perhaps most importantly of all, if you are considering marriage, clarifying your priorities is of utmost importance. Too many divorces happen because people were propelled by chemistry and not by shared visions of the future.

Pre-marital counseling can be helpful in order to compare your priorities in a variety of areas. For instance, if your partner wants to live near his/her family in suburban Orange County, and you love San Francisco, this is a big difference that should be negotiated prior to marriage. Of course, if you want children, and he/she don’t doesn’t, don’t wait until you’ve exchanged rings and wedding vows.

Even if there are clashes in priorities and values, that doesn’t mean the relationship must end. It’s impossible to find someone exactly like you — and you may not want this! Some issues can be worked out through negotiation and compromise. Others, however, may signal a need to slow down and think twice before proceeding. And, although it can be very disappointing to realize that you and your future mate (or roommate, or business partner) have too many differences to merge lives, it is better than finding this out once you’ve made the big commitment.

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The Happiness Trap

A few months ago, I was having lunch with two other therapist friends, “Diane,” and “Marcy.” Diane shared that she didn’t feel as happy as she felt she should. She said that even though she likes her job, her partner, and living in the Bay Area, she wasn’t always happy. In Diane’s mind, everyone looked happier than her; consequently, she felt like she was doing something wrong.

Marcy, a psychoanalytic therapist, wondered whether Diane had some deep-seeded issue that was getting in the way of her happiness. Marcy suggested that Diane see her therapist more often. “Perhaps there’s some area you haven’t explored yet about your childhood.”

My advice to Diane was different. I said to her, “It sounds like you are pressuring yourself to feel happy all of the time. Maybe that’s the real problem — your unrealistic expectations. No one is always happy. I bet you’d be happier if you didn’t strive to be so happy!”

Like Diane, many of us make ourselves miserable by pressuring ourselves to feel a certain way. If we are sad, we talk ourselves out of our feelings. If we’re angry, we cajole ourselves to chill out. We may do to ourselves what a parent or teacher did to us when we were children — that is, make us feel ashamed of our feelings.

Feelings are fluid; they transform into something else when we leave them alone. But when we become distressed about having a particular feeling, this emotion may hang around a lot longer.

Happiness and unhappiness both come and go. It’s the same with other feelings: fear, anger, boredom, disappointment. The problems come when we demand to feel joyful all of the time. Like Diane, we may criticize ourselves for not being happier.

It’s been called “The Happiness Trap:” that is, when we pressure ourselves to be so happy, that we, like Diane, make ourselves unhappy. The good news is that there are ways to escape the happiness trap.

– Be aware of the pressure you may put on yourself to be happy most of the time. Emotions are like waves in the ocean or clouds in the sky that are ever changing and shifting.

– Be mindful of comparing yourself unfavorably to others. Part of the reason that Diane was so unhappy was that she was thinking everyone else was happier. Then she felt that she was doing something wrong.

But everyone is unhappy some of the time — even if he or she hides it with a smile. Know that if you’re in a funk, you are not alone. Have compassion for yourself. And most of the time, the unhappiness will go away — particularly if you don’t give it a lot of attention.

(Of course, If you feel out of control of your emotions (for instance, depressed to the point of despair or angry all the time), seek professional help.)

–Finally, remember that there is a difference between happiness and pleasure, though our culture tends to mix up the two. Pleasure generally comes from an outside force. For instance, if you buy a new IPAD, you’ll probably feel a lot of pleasure.

However, if your IPAD crashes, or if you misplace it, you’ll likely feel the opposite of pleasure! When we are pleasure seeking, we rarely feel content. To quote an old Joni Mitchell song, “Pleasure moves on too early, and trouble leaves too slow.”

By not over-focusing on happiness and by developing more realistic expectations about emotions, you will be on your way to escaping the Happiness Trap.

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“Medical Masquerades”

An acquaintance of mine, Susan, was going through a traumatic divorce.  But her son, Jacob, seemed to be suffering even worse than Susan. A once sociable teenager with a lot of friends and straight A grades, Jacob’s mood plummeted.  He isolated himself, stayed alone in his room, and spent most of his time on the computer.

Worried, Susan brought Jacob to a series of psychotherapists and doctors.  They all assumed Jacob was depressed because of the divorce.  They also pointed out that teenagers may go through changes of personality and behavior patterns.

One day, Jacob complained of a headache so severe that Susan took him to the Emergency Room.  When Susan also mentioned Jacob’s depressed state, the savvy doctor ordered a brain scan.   It turned out that Jacob’s symptoms were not psychological.  He had a brain tumor.

Luckily, Jacob’s tumor was operable, and he is fine today.  He was extremely fortunate to have found an Emergency Room doctor who took his symptoms seriously.

This is not always the case.  Many people suffer from what are called, “Medical Masquerades; ”  that is, medical problems that disguise themselves as psychological ones.

While Jacob’s situation was dramatic, I have seen numerous clients who have had less serious medical issues that caused or worsened their psychological issues.   Some of the most common Medical Masquerades are the following:

Thyroid problems.   Thyroid disorders have become epidemic, and this is likely due to the widespread use of industrial chemicals.   Thyroid problems are common in women, particularly in middle age.  Some endocrinologists believe that half of all people with thyroid problems are undiagnosed. Symptoms of thyroid disorders may include the following:  fatigue, mood swings, depression, irritability, low libido, anxiety, easy weight gain or loss, hair thinning, dry skin.

Many doctors, as well as psychotherapists, are quick to assume that the above symptoms indicate depression or even manic depression (bipolar disorder).  Since anti-depressants, such as Paxil and Lexopro, are easily available, these are often suggested.

While doctors may run a thyroid test, called the TSH, the test is not l00% accurate.  Further, some endocrinologists believe that the current test range should be narrower than the current one, and that too many people with thyroid problems are not being diagnosed.

Blood sugar problems.  Low blood sugar (hypoglycemia)  and erratic blood sugar can also cause psychological symptoms,  such as depression, anxiety, and irritability,  as well as medical symptoms, like headaches, fatigue, and dizziness.   While doctors can order a blood test for diabetes, they generally will not test for hypoglycemia, because the test is time-consuming and expensive.

However, you can see for yourself whether low blood sugar problems are contributing to your distress. For a week or two, change your diet by eliminating sugar, reducing carbs, increasing protein, and eating more often.  Remember to eat three meals a day, and a couple of snacks.  If your symptoms are getting better, you’re on to something!

For women over 40, mood swings, depression, panic attacks, or irritability can be due to the normal changes of peri-menopause.  Peri-menopause is a 5 to l0 period of time prior to your period stopping (which is called menopause).  For some women, peri-menopause can begin in their 30’s or even, rarely, in their 20′s.

Other medical problems that can masquerade as psychological ones include:  MVP (mitral valve prolapse, a benign heart condition that can panic attacks);  environmental contaminants, such as mold; mercury poisoning, generally from too much fish; seizure disorders;  diabetes; overuse of caffeine or legal or illegal drugs; or food allergies, such as gluten intolerance.

In my years of doing therapy, I have seen innumerable people who were misdiagnosed as having an emotional problem when their main problem was medical.  The trouble is that most medical and mental health professionals are quick to assume that symptoms are psychological.   

Therefore, it’s important to be proactive, and to learn as much as they can about your symptoms.  Don’t assume that because the doctor says you are fine, that there is no physical basis for your psychological stress!

The good news is that in some cases, simple changes to lifestyle may alleviate emotional symptoms.  As a therapist, I’m committed to helping clients explore all the possibilities that will lead to improved psychological and medical health.

(Please note:  check with your health care professional before exploring any new medical or nutritional treatment.)

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Can Therapy Harm?

Leslie,* age 30, came to therapy to deal with a bully boss. Her new manager was making her life miserable, and she needed some coping skills. Leslie chose Dr. M because she was within walking distance and because she was impressed by Dr. M’s Ivy League PhD. In the first session, Dr. M did a detailed history of Leslie, and then told her that her problem wasn’t her boss, but her unresolved issues with her mother.

Although Leslie protested that she had already dealt with her alcoholic, abusive mother before in therapy, Dr. M insisted that the issues were much deeper than work stress. Reluctantly, Leslie agreed to focus on her relationship with her mother.

After several months, Leslie’s problems with her boss worsened, and she could barely sleep or eat. Dr. M told her that she wasn’t working hard enough on her issues, and asked her to increase her appointments to twice weekly. Exhausted and desperate, Leslie said yes.

A number of weeks went by, and Leslie’s friends began becoming concerned about her. She was a shell of her former self, lacking her usual confidence and positive attitude. They were particularly distressed to see that Leslie now needed to call her therapist around every little issue. Finally a friend bravely told Leslie that the therapy was making her worse, and that she needed to go in a different direction with Dr. M or find a new therapist.

Leslie’s story, while extreme, is not uncommon. I have seen many “Leslies” in my career. Psychotherapy, like all professions, can be of great help to people. But it can also cause harm.

The same can be true with physical therapists, or chiropractors, or physicians. Their techniques can transform lives. But they can also make problems worse.

How can consumers of therapy avoid some of the pitfalls? How can you not end up in Leslie’s shoes?

First, let’s look at some of the red flags for Leslie’s treatment with Dr. M. First off, Leslie chose Dr. M based on logistics and Ivy League credentials. While it may be helpful to find a therapist close by, perhaps this shouldn’t be the number one factor. Also, the therapist’s experience, ethics, and personal style are generally more important than where they went to school and whether they are a doctor or a master’s level therapist.

Next, Leslie came to therapy with a definite goal — to get help with an abusive boss. But Dr. M ignored her request, and came up with her own agenda.

Now there may be times when the therapist will point out that other issues exist along with your presenting problem. There was nothing wrong with Dr. M suggesting that Leslie’s problems with her boss may be related to her abusive mother. Exploring this issue briefly may have been useful. However, Dr. M should not have dismissed entirely the reason why Leslie was coming for help.

When Leslie got worse rather than better, Dr. M didn’t consider that the therapy may be causing problems. Instead, she asked Leslie to come more often. While there may be times when it is appropriate to come twice weekly (for instance, during an emergency), the risk is that it can build too much dependence on the therapist, and put the client in a child-like, regressed state. Good therapy should foster independence, confidence, and resilience.

So how can you find the right therapist and not end up in Leslie’s situation? Here are some tips:

1. Trust your instincts, and don’t talk yourself out of your concerns. No therapist is perfect! However, if you feel uncomfortable around the person, then take this seriously. And don’t disregard inappropriate behavior (for instance, taking phone calls during sessions; poor boundaries in a home office, such as introducing you to spouse or kids; the therapist inviting you to a social event, etc.)

2. If something doesn’t feel right during the therapy, speak to your therapist. A good therapist will be open and interested in your concerns. If the therapist gets overly defensive, accusatory, blames you, or ignores your concern, this is a definite red flag that you may not be in a safe place.

3. Don’t let the therapist talk you into doing anything that makes you uncomfortable: e.g. going twice weekly to therapy if you don’t want to and you aren’t in crisis; remaining in therapy even when you have said you feel ready to stop, etc.

4. Be careful about overly focusing on the past. While it may be useful to connect the dots of your past and your present, too much talking about old disappointments and traumas can put you in a depressed and anxious state. Simply put, talking over and over about a bad experience will leave you feeling bad!

5. Notice if therapy is making you feel better or worse. Most traditional therapists will tell you that you may have to get worse before you feel better. I don’t agree.

There’s a kernel of truth because sometimes a particular session may not leave you feeling better. However, in my opinion, the therapy in general should be leading in a positive direction: towards increased optimism, hope, coping skills, and confidence.

6. Be careful if you are feeling more regressed. Leslie ended up in a dependent, regressed state. She couldn’t make a decision without consulting a therapist! Therapy should make you feel more independent, not dependent. Yes, you may become attached to your therapist, and there’s nothing wrong with this. However, at the same time, you should be stronger in your “adult” side and becoming a more capable person.

*Please note that all references to clients are composites, with no identifying names or information.

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Do You Self-Sabotage?

You are your own best friend. Or are you? There are times when we look out for ourselves, when we may protect ourselves from harm. But at other instances we may inadvertently sabotage ourselves, whether in relationships, work, with our kids. . .anywhere for that matter.

Take the example of Becky, who complains that she can’t get ahead at work. Even though Becky has been employed at her company for 8 years, others have been promoted with less tenure.

What is Becky doing to limit her promotional opportunities? For one, she tells her co-workers, even her boss, too much personal information, such as partying heartily on the weekend. At times, Becky dresses a bit inappropriately for a professional workplace, for instance, in transparent shirts or very low cut blouses. Becky also hasn’t taken advantage of the classes offered at her workplace to cultivate new skills.

Becky is getting in her own way. Are you doing the same? If so, you may feel frustrated and stymied. The good news is that there is much you can do to create change. It may be useful to take a good look at your behavior, as humbling and difficult as that might seem.

A woman I used to know, Rachel, did something risky and bold; she came up with a self-rating, and asked everyone she knew to fill it out honestly. Rachel learned some valuable things about her strengths and weaknesses that helped her to excel to a very high level career-wise.

What else can you do to change old patterns of behavior of self-sabotage? Here are some more ideas:

1. Pay attention to the behavior of someone whom you admire. What can you learn from them? What are you doing differently that may be thwarting your progress?

2. If you’re frustrated relationship-wise, for instance, you’re not meeting the right people, evaluate whether your expectations are realistic. Consider expanding your search to different kinds of people than you’ve dated before. For example, if you are thinking marriage, maybe kids, that bad boy/girl may not be the true keeper. Perhaps look beyond excitement to potential partners who evidence loyalty, stability, and low drama.

3. Do you ruminate too much about the past? Continually reviewing past disappointments could unknowingly create new ones. Remember that the past is over. Learn what you can, and then try to let go.

4. Write down a list of your strengths. Most people have a huge list in their minds about their weaknesses! It’s time to keep in mind what you do right in the world, and build on this.

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Uncluttering Your Brain

Many people are talking about hoarders and their bizarre behavior. Reality shows feature the most extreme pack rats.

But there’s another type of clutter that isn’t spoken about as frequently: brain clutter. This is when we pack our brains with way too much material.

I’m not just talking here about information overload, meaning too many views on news web sites, too many text messages. I mean another kind of overload: carrying around too much stuff in the brain, especially the negative kind.

We may remember every negative thing someone has said to us. Perhaps we’re still carrying memories of our mother shaming us, or an old partner (or spouse) rejecting us. We also may be holding on to too many positive memories, for instance, the “perfect” boyfriend or girlfriend whom we dumped, and now every new partner doesn’t measure up.

This type of clutter may flood the brain, making it hard to think clearly and make decisions. We may be holding on so tightly to the past, that we miss opportunities in the present.

It can help to start noticing the mind clutter and asking yourself, like with an old pair of jeans, “Do I really need it?” If you move, you usually get rid of a lot of old stuff. Perhaps it’s time to start doing this with your brain clutter. You’ll feel like you’re carrying a lighter load by doing so.

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Vampires in Your Life?

These days, vampires are quite popular, in films, TV, and books. But vampires may not just be a product of the imagination. You may have some real life vampires in your life depleting you.

While these people don’t want your blood, they may be sucking your life force dry! They are energy drainers, “emotional vampires.”

Emotional vampires can be anyone in your life: your mate, friends, kids, boss, mother, neighbor. It’s not uncommon to have more than one EV in your world.

Sometimes we have to deal with EV’s whether we like it or not. If you have a great job, but your co-worker is an EV, you may just have to find a way to cope. Or if you have a teenager who is an emotional vampire, you can’t simply kick him out.

But there are ways to deal with EV’s so that they don’t take over your life. Also, you may want to start paying attention to whether you inadvertently invite these people in — or don’t notice the tell-tale signs early on.

For instance, if you are a very nice and giving person, then emotional vampires may very well come into your life. They are not exactly going to bother people like themselves. Also, if you feel worry about hurting people’s feelings, you may keep these people around longer than you should. If you’re prone to guilt, then you likely will have some emotional vampires in your life.

How can you tell when someone is an EV? One of the signs is that you feel drained after talking to the person. You may also have a knot in your stomach before you see him or her. Relationships should leave you feeling refreshed, not depleted. If a person is draining you, then they may be an EV.

Should you talk to the person about it? Maybe. If you think that they may be amenable to change, then clueing them in could be helpful.

But be realistic going in to a conversation. There’s a good chance that the person won’t hear you and will get defensive. Or he/she may agree to change, but then not do so.

At that point, you may need to distance yourself from the person, or end all contact. Something that can help you to do so is to remember these things: first, that friendships shouldn’t be this hard. Also keep in mind, that you are not their therapist or their mother, but a friend. Lastly, friendships should nourish your life, not deplete it.

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How to Break Old Patterns

Do you find yourself doing the same things over and over? Are you dating the same type of people or stuck in the same type of dead-end jobs? There’s a whimsical definition of insanity that has been making the rounds for years. And that is, that insanity is doing the same thing over and over and expecting the same results.

This isn’t quite what insanity means. However, it certainly is a repetitive loop that leads to frustration.

A psychoanalytically oriented therapist might tell you that you are getting something from choosing the same partners, taking the same old jobs, or choosing the same type of unsupportive friends. There may be a kernel of truth to this: that you’re still trying to work something out from the past. However, I prefer to take a non-blaming/non-shaming approach.

Most of the time, we do the same thing because we’re on automatic pilot. We’re making choices based on what and who is familiar and comfortable. It’s not because you’re a masochist! It’s because you don’t know how to break the habits.

The type of treatment is twofold: one, to recognize your automatic patterns. You’re going to keep doing them until you become conscious of them. It’s like any other habit: if a person bites her fingernails, that person won’t stop if she doesn’t notice she’s doing it!

Secondly, you’ll want to learn new behaviors to substitute for the old. It’s difficult to change old patterns without learning new ones. For instance, if your parents always fought, this might be a familiar pattern which propels you to choose angry mates. You may need to learn how to choose healthier people in your life.

The good news is that old patterns can be broken. That’s the beauty of the human brain: we can reprogram it and start making smarter and healthier decisions. And then these become automatic pilot!

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The Gift of Intuition

Criminology, Gavin De Becker, wrote a fascinating book a number of years ago, called, The Gift of Fear.  He discovered in his research that almost every time a person is about to be victimized, he or she has a sense of foreboding and danger.

Unfortunately, much of the time people ignore their intuition.  They talk themselves out of it, sometimes with disastrous consequences.

De Becker makes the important point that humans are the only animals who don’t listen to our intuition.  Animals, of course, will not minimize their fear instinct.  If they feel a threat, they will react in a fight/flight/or freeze reaction.

However, as human beings, we want to be nice, and therefore, nonjudgmental.  However, there is a difference between being judgmental and being discerning.

For instance, if you walk down the street and see another person, and immediately make a judgment based on the other person’s appearance, that may be judgmental. However, if you get the sense that the person is acting in a suspicious manner, then that is something to pay attention to.

But it’s not just danger on the street that should grab our attention.   We may have an intuition that the job we’re applying for isn’t the right one.  Or we may sense that a prospective friend or lover isn’t very trustworthy.  But again, we may talk ourselves out of our gut reaction.

We can see how little children are in tune with their inborn reactions.  For instance, they may experience a neighbor as creepy.  But parents will sometimes admonish the child for being “mean.”  Consequently, when children grow up, they may lose their natural intuition, something that is a gift to us, and which has helped us survive.

One of the ways I enjoy working with clients is to help them reconnect with their natural intuition.   I help them to discern what is a true danger versus what is a preconceived judgment.  Clients often find that once they are fully equipped with the gift of intuition, it is easier to navigate the world, without feeling as confused and vulnerable.

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Is It Really Depression?

A few years ago, I met a new friend who had a history of depression.  She had been diagnosed as depressed by scores of professionals since she was a teenager.

But when I got to know her, I didn’t think she was depressed at all.  She had a vibrant spirit, many interests, and a lot of friends.  But she did seem like a nervous type.

One day I decided to tell you that she didn’t seem depressed to me.  I suggested that she may actually be anxious.  I was surprised by her reaction, which was to get angry and defensive.  She insisted that she was not an anxious type of person.

I let the matter rest, and a couple of weeks later, my friend came to me rather sheepishly.  She said that had thought about it, and yes, she was quite anxious.  She noticed how tense she became waiting on lines at stores.  She recalled being a kid and having severe separation anxiety from her mom.

My friend isn’t the only one who is diagnosed as depressed, when the real diagnosis in anxiety.  It’s not uncommon for a person to be diagnosed with something erroneously — even if he or she has carried the label his/her entire life. It’s important to get a correct diagnosis for depression versus anxiety for several different reasons.   One of the main ones is that the medication for depression could make anxiety even worse (especially if it isn’t even anxiety — if it’s hypomania.  See how complicated it gets?)

Back in Freud’s days, the diagnosis of depression was not a common one.  Most clients were diagnosed with nervous disorders.  This changed once effective anti-depressants, such as Prozac, were developed in the l970’s.  Now with effective treatment available, which have fewer side effects than older medications, it may not be a coincidence that most people are diagnosed as depressed!

Of course, a person can be both depressed and anxious.  But it’s important to determine which diagnosis is primary and which one is secondary.  The treatment for an anxiety disorder may differ from that of depression.

There is also bipolar disorder, and its many variants: cyclothymia, Bipolar II. etc. With “soft bipolar disorders,” the person is usually high functioning, unlike Bipolar I, which can involve psychiatric hospitalizations and psychosis. The soft bipolar disorders are actually quite common, and can be misdiagnosed for years. (Actress Catherine Zeta Jones has just gone public with her diagnosis of Bipolar II; she spent years searching for a correct diagnosis.)

So if you have been diagnosed with depression but you are not getting better, it may be because depression is not your primary diagnosis.  The good news is that if you see a mental health professional well versed in differential diagnosis, you may finally get an accurate diagnosis of your problems — and, even more importantly, relief from your symptoms.

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Dealing with a Cyber Addiction

There have been a number of recent news stories lately about Internet addiction disorders. One group of researchers have identified a syndrome, “Facebook Depression,” for people whose frequent personal networking triggers depression and anxiety.

Many people have become dependent on the computer for work and relationship purposes. Consequently, it may feel destabilizing to no longer have access to our virtual world. But while the Internet can be a wonderful tool, the problems develop when the computer is in control of us, and not the other way around.

If you’re concerned about your computer use, you might want to try this simple test. See if you can go for half a day without checking your email, etc. unless absolutely necessary. If you notice yourself becoming agitated, depressed, panicky, and/or irritable, you may have become overly dependent on screen time.

This doesn’t mean that you have to give up Facebook, texting, or computer games. I’m a big believer in moderation, not extreme starvation diets, both with regard to food and also the computer. Striking a balance in your life will foster happiness and productivity.

If you are concerned about your computer use, start with shaving a little bit of time from your Internet surfing or Facebook time. If you check your Facebook five times a day, just cut it down a bit, to four times. If you spend two hours on computer games, set a timer and aim for 1 1/2 hours.

If you think you have a full-blown cyber addiction, you may want to see a professional to help you. There are also some good self-help books that you can buy for guidance and advice.

Posted in Anxiety Disorders, Cyber Addiction, Depression, Uncategorized | Comments closed
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