As I've mentioned previously, anxiety can present differently in different individuals. In other words, your anxiety may look very different from a friend's anxiety--and yet, you may both be anxious.
Because anxiety can limit behavior or result in behavior that others may find unusual, when talking with your therapist you may be tempted to minimize or omit information about your behaviors or thoughts because you're embarrassed or ashamed. Even if you know and fully understand that your behavior is irrational, you may find yourself continuing that behavior, because your anxiety is so strong.
I encourage you to be candid with your therapist. Good therapists won't judge or chastise you. They'll work from a place of compassion and professionalism.
So, what methods are used to treat anxiety?
There are many effective methods used in the treatment of anxiety. Your therapist may use one or a combination of several of these treatment methods:
Cognitive Behavioral Therapy (or CBT). Just as the name implies, this therapy focuses on thoughts (cognitions) and actions (behaviors). The goal of this work is to help you identify and challenge negative thinking patterns and irrational beliefs that may be fueling your anxiety.
Exposure Therapy. Working with your therapist, this therapy helps you confront your fears in a safe, controlled environment. Through repeated, sometimes graduated exposures, either in real or imagined settings, you will 1.) gradually gain a greater sense of control, 2.) gain experience that negates or disproves your irrational thoughts, and 3.) help you face your fears without being harmed. All of these therapeutic experiences are designed to help diminish anxiety.
Medication. Anxiety medications, known as anxiolytics, are prescribed and monitored by a physician, preferably a psychiatrist. Medication has been found to be most effective with behavioral therapy(CBT).
Complimentary Treatments.
In addition to traditional therapy, several complimentary treatments have been found to be effective in reducing anxiety, including:
Exercise. Called the "natural stress-buster," regular aerobic exercise three times a week for 30 minutes has been shown to provide significant anxiety relief. Best results have been attained with one hour of aerobic exercise daily. Of course, check with your physician before beginning any exercise regimen.
Relaxation Techniques. These include mindfulness exercises, meditation, progressive muscle relaxation, controlled breathing and visualization. These have been found to lower anxiety and increase emotional well-being.
Biofeedback. In biofeedback, sensors attached to your body measure specific biological functions: heart rate, breathing and muscle tension. Watching these measures in real time helps you to be aware of and learn how to control the body's anxiety responses through specific relaxation techniques.
Hypnosis. Some studies suggest this therapy to be useful in combination with CBT.
So, how long does treatment take? Results, as in any therapy, are not instant. Because your anxiety and your symptoms are unique, there are no cookie-cutter treatments. What does help is a cooperative therapeutic relationship with your therapist. Together, you and your therapist can formulate your treatment plan, monitor the results, and make adjustments in your treatment as needed. While there are no guarantees, some research indicates that some successful treatment methods show improvement within 8-10 sessions.
One thing is certain: your therapist's work with you is designed to lower anxiety, not add to it. If you're suffering from anxiety, making that first call to begin therapy can be difficult--but not impossible. So, take five deep, slow breaths and--when you're ready--pick up the phone.
Thanks for listening.
Thursday, July 28, 2011
Wednesday, July 27, 2011
Anxiety: Am I Having A Normal Reaction To Stress...Or Something More?
Anxiety. The very word makes some people, well...anxious. In fact, there are varying degrees of anxiety that we all experience at some points in our lives. "Normal" anxiety is a reaction to everyday stress. Ranging from "concern" about an issue, to "worry," normal anxiety can be beneficial in our daily lives. Anxiety can help us focus on a task at hand or meet deadlines that may be attached to consequences. Under normal circumstances, anxiety disappears when the stressful situation resolves itself (after the presentation is over, the test is finished, the in-laws leave).
My anxiety doesn't feel "normal." Could I have anxiety disorder?
When your anxiety about ordinary things (such as leaving the house or riding an elevator) disrupts the general quality of your life or work, or causes avoidant behavior that limits or diminishes your life experiences, an anxiety disorder may be present. A few things to look for include:
*Are you constantly worried, tense or on edge?
*Does your anxiety interfere with family, work or school responsibilities?
*Are you plagued by fears that you know are irrational but just can't shake?
*Do you believe that something bad will happen if certain things aren't done in a certain way?
*Do you avoid everyday situations or activities because they make you anxious?
*Do you experience sudden, unexpected attacks of heart-pounding panic?
*Do you feel like danger and catastrophe are around every corner?
Keep in mind that anxiety disorders are a group of related conditions that may look very different from person to person. And, just because you're experiencing symptoms listed above doesn't necessarily mean you have an anxiety disorder. If, however, symptoms persist and cause you concern, you may want to consult both your doctor and a mental health professional.
Why should I consult my doctor?
Anxiety can be caused by certain general medical conditions including difficulties with the thyroid, asthma, and hypoglycemia, among others. A physician is trained to diagnose and treat these conditions; treatment may help reduce or eliminate your anxiety if it is caused by a medical condition.
If you feel persistently anxious, a medical check-up may be in order.
Anxiety can also be attributed to reactions to prescription medications, as well as reactions to over-the-counter remedies and supplements. Be sure to tell your physician about all remedies you are taking.
Also, it's important to remember that anxiety can accompany substance abuse. Questions to ask yourself include: What substances am I putting in my body? Am I using any unregulated (street) drugs that are not prescribed by my physician? Am I taking anyone else's prescription medication? Am I taking more (or less) of my prescription medications than stated on the label directions? Am I medicating with alcohol or marijuana--and, how do I feel when these substances "wear off?"
After consulting your doctor, if he/she rules out a medical condition and/or substance abuse, then you may want to see a mental health professional.
Next time: Treatment options for anxiety.
As always, thanks for listening.
My anxiety doesn't feel "normal." Could I have anxiety disorder?
When your anxiety about ordinary things (such as leaving the house or riding an elevator) disrupts the general quality of your life or work, or causes avoidant behavior that limits or diminishes your life experiences, an anxiety disorder may be present. A few things to look for include:
*Are you constantly worried, tense or on edge?
*Does your anxiety interfere with family, work or school responsibilities?
*Are you plagued by fears that you know are irrational but just can't shake?
*Do you believe that something bad will happen if certain things aren't done in a certain way?
*Do you avoid everyday situations or activities because they make you anxious?
*Do you experience sudden, unexpected attacks of heart-pounding panic?
*Do you feel like danger and catastrophe are around every corner?
Keep in mind that anxiety disorders are a group of related conditions that may look very different from person to person. And, just because you're experiencing symptoms listed above doesn't necessarily mean you have an anxiety disorder. If, however, symptoms persist and cause you concern, you may want to consult both your doctor and a mental health professional.
Why should I consult my doctor?
Anxiety can be caused by certain general medical conditions including difficulties with the thyroid, asthma, and hypoglycemia, among others. A physician is trained to diagnose and treat these conditions; treatment may help reduce or eliminate your anxiety if it is caused by a medical condition.
If you feel persistently anxious, a medical check-up may be in order.
Anxiety can also be attributed to reactions to prescription medications, as well as reactions to over-the-counter remedies and supplements. Be sure to tell your physician about all remedies you are taking.
Also, it's important to remember that anxiety can accompany substance abuse. Questions to ask yourself include: What substances am I putting in my body? Am I using any unregulated (street) drugs that are not prescribed by my physician? Am I taking anyone else's prescription medication? Am I taking more (or less) of my prescription medications than stated on the label directions? Am I medicating with alcohol or marijuana--and, how do I feel when these substances "wear off?"
After consulting your doctor, if he/she rules out a medical condition and/or substance abuse, then you may want to see a mental health professional.
Next time: Treatment options for anxiety.
As always, thanks for listening.
Thursday, July 21, 2011
The Zen of Listening For Understanding or, "When Walking, Walk. When Eating, Eat."
When I Google "effective listening," over 5 million results pop up. Clearly, listening is on the minds of alot of us these days. Currently, there are over 35 research studies that indicate that listening is a top skill needed for success in business. I might add, it's a skill that enhances a great many relationships, too.
It's estimated that 70% of our time communicating is dedicated to listening. And yet, some studies show that we may be listening at only a 25% comprehension rate. That can be a discomforting statistic, considering that 85 % of what we learn is through listening.
When it comes to working with couples, "good listener" is on the wish list of most every couple. We want our significant other to hear us. And, yet, unless we're listening to understand, chances are we're not going to be effective listeners; and it's unlikely our partner will feel heard.
How Do You Listen?
Have you ever met that rare human being who seems to hang on your every word? We leave a conversation with them feeling like we were the only person in the room when we spoke with them. We feel heard, listened to, valued and...well, important. And we usually look forward to speaking with them again.
It's likely that these gifted folks are listening to understand. They have a genuine interest in knowing and understanding what we have to say. They don't have an agenda. They simply listen. If they ask questions, it's usually just to have us clarify a point.
Here are a few ways we all listen at times. While these may serve us in some venues, they rarely are effective when trying to improve communication with our loved ones.
Listening to teach. When we listen to teach, it's likely that our minds are on our response while the speaker is talking. We're taking in some of what we're hearing, but formulating our rebuttal at the same time. We often can't wait for the speaker to finish so we can set him or her straight. But, when we do interrupt, the message we're sending is I really don't value what you're saying--what I have to say is more worthwhile. And, preparing your answer while the other person is talking keeps you from hearing everything the speaker is saying.
Listening to compete. Sometimes we treat a conversation as a way to score points. However, while we're formulating our strategy to "win" the conversation, we lose our ability to hear the other person completely, which can keep us from fully understanding and seeing things from a different point of view.
Listening to impress. When we listen to impress, we impair our listening by planning our next dazzling comment or brilliant challenge--instead of paying attention to the speaker. In essence, what we're planning to say becomes more important than what's being said. And most of the time, the speaker will feel our inattention.
Listening to correct. When we listen this way we are, essentially, waiting to be provoked. We're on guard for inflammatory words, phrases and topics that can send us to our self-righteous place that requires defending. It's no wonder that the speaker feels "pounced" upon, because we've been waiting for just that opportunity.
And finally....
Listening to blame. Blame differs from correction because the goal isn't just to find fault--it's to shift responsibility back to the listener. This is listening to deflect. We become "Teflon," allowing nothing to stick to ourselves. And we're so hypervigilent in our defense of self that listening becomes a secondary task.
Because we listen at about 125-150 words per minute but think at 1,000-3,000 words per minute, we have excess capacity to think about what others are saying while they speak. The best listeners use this capacity to gain clearer understanding of the speaker, not to strategize ways to teach, compete, impress, correct or blame.
When we listen with any ulterior motive, we're using that spare capacity to prepare our next move in the conversation. And listening suffers.
The Zen part? An old Zen proverb says, "When walking, walk, When eating, eat."
When listening, listen. It's one of the greatest gifts you can give your colleagues, friends and loved ones. Sometimes, it's all they need.
As always, thank you for listening.
It's estimated that 70% of our time communicating is dedicated to listening. And yet, some studies show that we may be listening at only a 25% comprehension rate. That can be a discomforting statistic, considering that 85 % of what we learn is through listening.
When it comes to working with couples, "good listener" is on the wish list of most every couple. We want our significant other to hear us. And, yet, unless we're listening to understand, chances are we're not going to be effective listeners; and it's unlikely our partner will feel heard.
How Do You Listen?
Have you ever met that rare human being who seems to hang on your every word? We leave a conversation with them feeling like we were the only person in the room when we spoke with them. We feel heard, listened to, valued and...well, important. And we usually look forward to speaking with them again.
It's likely that these gifted folks are listening to understand. They have a genuine interest in knowing and understanding what we have to say. They don't have an agenda. They simply listen. If they ask questions, it's usually just to have us clarify a point.
Here are a few ways we all listen at times. While these may serve us in some venues, they rarely are effective when trying to improve communication with our loved ones.
Listening to teach. When we listen to teach, it's likely that our minds are on our response while the speaker is talking. We're taking in some of what we're hearing, but formulating our rebuttal at the same time. We often can't wait for the speaker to finish so we can set him or her straight. But, when we do interrupt, the message we're sending is I really don't value what you're saying--what I have to say is more worthwhile. And, preparing your answer while the other person is talking keeps you from hearing everything the speaker is saying.
Listening to compete. Sometimes we treat a conversation as a way to score points. However, while we're formulating our strategy to "win" the conversation, we lose our ability to hear the other person completely, which can keep us from fully understanding and seeing things from a different point of view.
Listening to impress. When we listen to impress, we impair our listening by planning our next dazzling comment or brilliant challenge--instead of paying attention to the speaker. In essence, what we're planning to say becomes more important than what's being said. And most of the time, the speaker will feel our inattention.
Listening to correct. When we listen this way we are, essentially, waiting to be provoked. We're on guard for inflammatory words, phrases and topics that can send us to our self-righteous place that requires defending. It's no wonder that the speaker feels "pounced" upon, because we've been waiting for just that opportunity.
And finally....
Listening to blame. Blame differs from correction because the goal isn't just to find fault--it's to shift responsibility back to the listener. This is listening to deflect. We become "Teflon," allowing nothing to stick to ourselves. And we're so hypervigilent in our defense of self that listening becomes a secondary task.
Because we listen at about 125-150 words per minute but think at 1,000-3,000 words per minute, we have excess capacity to think about what others are saying while they speak. The best listeners use this capacity to gain clearer understanding of the speaker, not to strategize ways to teach, compete, impress, correct or blame.
When we listen with any ulterior motive, we're using that spare capacity to prepare our next move in the conversation. And listening suffers.
The Zen part? An old Zen proverb says, "When walking, walk, When eating, eat."
When listening, listen. It's one of the greatest gifts you can give your colleagues, friends and loved ones. Sometimes, it's all they need.
As always, thank you for listening.
Monday, July 18, 2011
How Do I Know It's Time To Get Help or, Is This Normal Or...Something Else?
Often, after we've worked together awhile, my clients will confide, "You know, I almost didn't come in that first time. I was second-guessing myself asking, Why can't you just suck it up and handle this on your own?" When I ask what tipped the balance in favor of therapy, the answers, in retrospect, range from "I was out of control," to "It was too scary to do this on my own," to "I'd tried everything and nothing was working."
Virtually everyone referred to the one commonality that separates the everyday from the debilitating: severe, prolonged distress. In almost every case, clients reported that the distress had become too much, for too long, affecting one or more important areas of their lives: relationships, work, health, finances, and legal difficulty. What becomes evident over time is that intense and prolonged distress cannot only cause somatic (in the body) difficulties, but also significant impairment in carrying out the activities of daily living.
So, the symptoms. How do I know this just isn't a rough patch, like everybody goes through from time to time?
Most people don't seek therapy at the first sign of that "rough patch." In fact, I believe that, as a species, most human a beings are remarkably resilient. We tend to endure hardship and bounce back, often many times in a lifetime.
When you begin to feel like you're not bouncing back and decide to seek clinical help, your clinician (psychiatrist, psychologist, licensed marriage and family therapist, social worker, etc.) is likely to rely on a 900-page publication called the Diagnostic And Statistical Manual of Mental Disorders (DSM-IV) to guide his/her assessment and diagnosis of your condition. Published by the American Psychiatric Association with contributions from some 1,000 mental health professionals, this manual categorizes, defines and provides specific guidelines for diagnosis.
While everyone is unique and not everyone experiences mental distress in precisely the same ways, there are two criteria which, in general, surface in the diagnoses, which help clinicians discern what's going on with their clients: intensity and duration of distress.
Intensity or depth of distress refers to "How bad is it?" For example, if you're concerned about depression, your therapist will likely start out asking you questions about your daily routine. Are you able to get out of bed in the morning? Can you make it to work, or are you missing lots of days? Are you sleeping? How much or how little? Are you isolating from people you love? What's the degree of isolation? (Remember from above: relationships, work, health, finances, and legal difficulty?)
For anxiety, a similar discussion might go along the lines of: How does your anxiety show up in your body (what does it feel like)? How is it affecting your relationships? Does it limit your enjoyment of your life (have you stopped doing things your might otherwise enjoy) ? Is it affecting your work or your ability to go to work? Has your anxiety led you to do things that have gotten you into legal or financial trouble?
Duration simply means "How long has this been going on?" Many of life's disappointments, difficulties and setbacks resolve themselves in a reasonable amount of time. But, when your distress has been interfering with your life, work, relationships or daily functioning for longer than the norm (as outlined in the DSM-IV, referenced above), you may benefit from therapeutic intervention.
A few things to pay attention to when considering whether to seek therapy.
Pay attention to how you feel. If you're not "yourself" for an extended period of time or if you have intrusive thoughts that are disturbing to you, you may need to talk with someone. If you're having persistent thoughts of hurting yourself or someone else, I would recommend talking with a professional right away. Most communities have crisis or suicide hotlines that can provide immediate help, often round the clock. Remember, you won't be shamed--just helped.
Pay attention to your routine. Are you sleeping more or less than usual? Has your appetite changed? How about school or work attendance? Are you engaging in unusually risky behaviors or behaviors that are a bit bizarre for you?
Pay attention to your relationships. Are your relationships at home or work deteriorating or becoming progressively more difficult, with no end in sight?
Pay attention to your body. Are you experiencing new, chronic pains or aches? Stomach or digestive difficulties? First thing, consult your physician to rule out any organic difficulties. If he/she finds nothing organically wrong, your next step might be to consult about your mental health.
Pay attention to your moods. Do your moods swing from euphoric to profoundly sad? Are you more angry now, more often and with more intense behaviors? Are you more sad, worried, easily frustrated, disinterested, confused than usual?
And finally, pay attention to feedback from those you usually trust. Have friends or loved ones expressed concern about your behaviors, moods, or thoughts? Are you hearing the same concerns from several sources?
Despite our resiliency, intelligence, and support from others, sometimes it doesn't feel like "toughing it out" is productive or even possible. If your distress has become so intense that it's affecting many areas of your life, and it's been going on longer than you're used to, you may want to talk with someone. Someone trained to help you determine if this distress you're going through is "normal"--or something else.
Thanks for listening.
Tuesday, July 12, 2011
Getting The Most Out Of Group Therapy
The power of group therapy can be remarkable. I've seen group dynamics bring out the best in people; they offer others support, guidance, compassion, and most of all, acceptance.
For some, group work provides feedback they can't get anywhere else. Often, what friends won't tell you, family won't tell you--group will, in a respectful and caring way.
Group work can help to alleviate shame around issues that you may think are only yours. Misery may love company, but a healthy group--and a good therapist--won't allow the group to become mired in misery and self-pity. One of the greatest values of sharing difficulties with others is knowing that you're not alone. Another huge benefit is drawing on the strengths and experiences of others to find help--and hope.
Because successful group work depends on group members being vulnerable to others in the group, it's important that the room be a safe and respectful place. Members must be able to suspend judgment in the room, and behave in a way that honors the pain and difficulty others may be going through.
This means giving others space. Knowing when to talk and when to be still. Listening--really listening--to others talk about themselves and providing feedback to you. Done in a caring, non-blaming way, feedback from others who have been where you've been, can be powerful--and sometimes cathartic.
Of course, group work isn't for everyone. As I mentioned previously, some clients are not in a place where they can take in others' stories and experiences. This is why most therapists require an intake interview prior to admitting you to a group. It helps you and the therapist determine if you, the group, and group work itself will be a good fit.
For those who join my groups, I provide a tip sheet on getting the most out of the group experience. I want to acknowledge the words and wisdom of other therapists that appear mingled with mine below. I believe that these guidelines underscore some of the behaviors that make for a successful group experience; and hopefully sets expectations for participants. I've provide these guidelines here:
Guidelines For Getting the Most Out of Group
1. Be on time. It shows respect for the group and minimizes the disruption caused by coming in late.
2. Be as honest and open as you can be with yourself and others.
3. Focus on expressing feelings as opposed to judgments.
4. Practice listening to understand, rather than to agree or disagree.
5. Try listening and reflecting when someone gives you feedback, rather than automatically jumping in to defend yourself.
6. If you feel the need to confront someone, be respectful but direct rather than commenting an aside to someone else or under your breath.
7. Use “I statements” which express and own your point of view rather than assuming everyone shares your experience or opinion.
8. Avoid generalizations and intellectualizations. These kinds of statements are usually more isolating than inviting.
9. Speak directly to, make eye contact with the person you’re addressing. This will help make connections with others in group.
10. Feel free to remain silent. Much can be learned in silence as well as through speaking.
11. Take responsibility for yourself in group. If you’re feeling uncomfortable, frustrated, bored or dissatisfied, tell us how you’re feeling and suggest a different direction.
12. Take risks. Fear is a sign that you’ve reached the limit of your self-concept. If you allow yourself to go beyond that it can be a freeing experience. Trust the group to support you in this.
13. Don’t smoke, eat or chew gum during the group. These activities tend to distract and diffuse intensity of the group experience.
14. Avoid cross-talk. It’s almost impossible to understand more than one person at a time. Please honor the person talking with your attention.
15. Power off all cell phones. The group needs your attention for only the short time we’re together each week. Phone calls/text messages are interruptive and disrespectful of the group.
In conjunction with or separately from individual therapy, group work can be transformative. Yes, it can be scary to sit in a room with strangers and talk about your innermost feelings. But, the good news is, they won't be strangers for long. As you form bonds within the group, begin to feel comfortable, safe and emotionally held by the group, the fear can ease, then disappear altogether. Leaving you open to the strength and support of others who truly do understand. Or who at least try.
Thanks for listening.
For some, group work provides feedback they can't get anywhere else. Often, what friends won't tell you, family won't tell you--group will, in a respectful and caring way.
Group work can help to alleviate shame around issues that you may think are only yours. Misery may love company, but a healthy group--and a good therapist--won't allow the group to become mired in misery and self-pity. One of the greatest values of sharing difficulties with others is knowing that you're not alone. Another huge benefit is drawing on the strengths and experiences of others to find help--and hope.
Because successful group work depends on group members being vulnerable to others in the group, it's important that the room be a safe and respectful place. Members must be able to suspend judgment in the room, and behave in a way that honors the pain and difficulty others may be going through.
This means giving others space. Knowing when to talk and when to be still. Listening--really listening--to others talk about themselves and providing feedback to you. Done in a caring, non-blaming way, feedback from others who have been where you've been, can be powerful--and sometimes cathartic.
Of course, group work isn't for everyone. As I mentioned previously, some clients are not in a place where they can take in others' stories and experiences. This is why most therapists require an intake interview prior to admitting you to a group. It helps you and the therapist determine if you, the group, and group work itself will be a good fit.
For those who join my groups, I provide a tip sheet on getting the most out of the group experience. I want to acknowledge the words and wisdom of other therapists that appear mingled with mine below. I believe that these guidelines underscore some of the behaviors that make for a successful group experience; and hopefully sets expectations for participants. I've provide these guidelines here:
Guidelines For Getting the Most Out of Group
1. Be on time. It shows respect for the group and minimizes the disruption caused by coming in late.
2. Be as honest and open as you can be with yourself and others.
3. Focus on expressing feelings as opposed to judgments.
4. Practice listening to understand, rather than to agree or disagree.
5. Try listening and reflecting when someone gives you feedback, rather than automatically jumping in to defend yourself.
6. If you feel the need to confront someone, be respectful but direct rather than commenting an aside to someone else or under your breath.
7. Use “I statements” which express and own your point of view rather than assuming everyone shares your experience or opinion.
8. Avoid generalizations and intellectualizations. These kinds of statements are usually more isolating than inviting.
9. Speak directly to, make eye contact with the person you’re addressing. This will help make connections with others in group.
10. Feel free to remain silent. Much can be learned in silence as well as through speaking.
11. Take responsibility for yourself in group. If you’re feeling uncomfortable, frustrated, bored or dissatisfied, tell us how you’re feeling and suggest a different direction.
12. Take risks. Fear is a sign that you’ve reached the limit of your self-concept. If you allow yourself to go beyond that it can be a freeing experience. Trust the group to support you in this.
13. Don’t smoke, eat or chew gum during the group. These activities tend to distract and diffuse intensity of the group experience.
14. Avoid cross-talk. It’s almost impossible to understand more than one person at a time. Please honor the person talking with your attention.
15. Power off all cell phones. The group needs your attention for only the short time we’re together each week. Phone calls/text messages are interruptive and disrespectful of the group.
In conjunction with or separately from individual therapy, group work can be transformative. Yes, it can be scary to sit in a room with strangers and talk about your innermost feelings. But, the good news is, they won't be strangers for long. As you form bonds within the group, begin to feel comfortable, safe and emotionally held by the group, the fear can ease, then disappear altogether. Leaving you open to the strength and support of others who truly do understand. Or who at least try.
Thanks for listening.
Saturday, July 9, 2011
Group Therapy: Strength In Numbers, or "I'm Not The Only One Who Feels This Way!"
Group therapy can be a powerful therapeutic modality that offers group members the benefits of empathy, understanding and healing that comes from group feedback and support. It it for everyone? Probably not. Some personalities and treatment of some disorders are better suited to individual therapy. For the client, it takes patience to sit and truly listen to difficulties that others are experiencing. However, when you become comfortable with listening and sharing, you may find that I'm not the only one who has experienced this! I'm not the only one who feels this way!"
There is power in being supported by others who genuinely understand your distress. Is group work for you? Read on.
A few ways group and individual therapy differ.
1. Obviously, in group therapy, you share the floor with others. In groups that I lead, I structure them to provide each participant with time to "check in," that is, to share recent developments, challenges and accomplishments related to their therapeutic goals. Then, typically, we open the floor to individual members who have issues or challenges (preferably related to the group's work together) they wish to share and gain feedback on.
2. In many groups, there can also be an educational component provided by the therapist. For example, in groups on drug and alcohol addiction, I often provide the group with information on how people change, how various drugs affect the body, as well as group exercises to help participants understand the effects of addiction on their own emotions, values and relationships.
3. Sometimes there is homework where, individually, you are invited to examine some of your personal beliefs, behaviors and values; then, back in group, you're invited to share what you're comfortable sharing with the group. In my groups, and in most groups I know of, no one is forced to share anything. Keep in mind, sharing is an invitation, not a command.
4. Group therapy sessions usually cost less than individual sessions. This can be a consideration when deciding on the treatment that you want. Typically, group session charges can be half of the cost of individual work or more. Your therapist will discuss cost with you prior to your enrollment in group.
5. Group therapy sessions are typically longer than individual sessions. While my individual sessions are 50 minutes, my group sessions usually last between 90 minutes and two hours, depending on the group.
Making a commitment to your group experience.
In groups that I hold, in order to ensure that the group setting is a safe and comfortable place for group members and, to ensure group continuity, all members are asked to make these commitments to the group:
There is power in being supported by others who genuinely understand your distress. Is group work for you? Read on.
A few ways group and individual therapy differ.
1. Obviously, in group therapy, you share the floor with others. In groups that I lead, I structure them to provide each participant with time to "check in," that is, to share recent developments, challenges and accomplishments related to their therapeutic goals. Then, typically, we open the floor to individual members who have issues or challenges (preferably related to the group's work together) they wish to share and gain feedback on.
2. In many groups, there can also be an educational component provided by the therapist. For example, in groups on drug and alcohol addiction, I often provide the group with information on how people change, how various drugs affect the body, as well as group exercises to help participants understand the effects of addiction on their own emotions, values and relationships.
3. Sometimes there is homework where, individually, you are invited to examine some of your personal beliefs, behaviors and values; then, back in group, you're invited to share what you're comfortable sharing with the group. In my groups, and in most groups I know of, no one is forced to share anything. Keep in mind, sharing is an invitation, not a command.
4. Group therapy sessions usually cost less than individual sessions. This can be a consideration when deciding on the treatment that you want. Typically, group session charges can be half of the cost of individual work or more. Your therapist will discuss cost with you prior to your enrollment in group.
5. Group therapy sessions are typically longer than individual sessions. While my individual sessions are 50 minutes, my group sessions usually last between 90 minutes and two hours, depending on the group.
Making a commitment to your group experience.
In groups that I hold, in order to ensure that the group setting is a safe and comfortable place for group members and, to ensure group continuity, all members are asked to make these commitments to the group:
- Commitment. All group members are asked to agree to attend for a minimum time period ranging from several weeks to several months. Because the group benefits from each other’s input and support, you agree to make this commitment a high priority. You agree to arrive on time for each group, as latecomers can be interruptive to a group in progress.
- Confidentiality. You agree to keep confidential the identities of other members in the group. I also ask you to agree NOT to have discussions about group content with other members of the group or anyone else outside of the group setting.
- Dual relationships. Because dual relationships can create experiences outside of the group that can be problematic for the rest of the group, I ask that you agree not to socialize with, date, or have sexual relations with any other group member while active in the group.
- Payment. I ask members of every group honor the payment schedule that we agree on in advance. Because your commitment to the group ensures you a seat each week that cannot be given to someone else, I ask that you agree there will be no refunds for missed groups.
- Goals. Because it is important to know what you want from your group experience, I ask that you agree to establish some goals, giving some thought to what you want from the group and how you would like things to be different for you when group therapy ends.
How is group therapy sounding so far? For many, it can be a life-changing experience or, at least, one which helps your clarify your own thoughts, values and goals by entertaining differing perspectives.
Next time: Guidelines for getting the most out of your group experience.
Until then, thanks for listening.
Thursday, July 7, 2011
It's Your Time, Your Money, Your Life--Your Therapy. Who Do You Choose?
So, you've come to an important decision: you'd like some help with the distress in your life, and you want to choose the right person to help you. You've heard of counselors, therapists, psychologists and psychiatrists? Who's right for you?
Only you can answer that question. It can be a complicated decision, based on many factors. But, depending on your difficulty and the help you're looking for, you may find it helpful to consider the following.
One place to start: What are the symptoms of your distress?
Are you having intrusive thoughts that won't go away? Feeling depressed and can't shake hopeless feelings? Wondering if you have Attention Deficit Disorder? Frustrated with your life choices? Feeling angry with a loved one? Struggling with an alcohol addiction?
So you'll want to determine Is this person qualified to help me with my particular difficulty?
There are many ways to choose a person to help, but one way is to consider the scope of practice of the person you're considering. Scope of practice refers to what this person is trained to do and services he or she is deemed capable of providing safely, by either a state licensing board or other certifying body.
If you seek a counselor, be aware there are many types of counselors with varying degrees of training. For example, a peer counselor may be trained to listen and provide practical life advice, but is not trained to assess or provide treatment of mental illness. Career and rehab counselors usually have master's degrees in their specialty. Other counselors such as "life coaches" may have varying degrees of training (from several weeks to several years). Pastoral counselors may offer counseling tempered with a particular religious view. When you interview your counselor, ask: What training have you had? Do you have a specialty? How long have you been practicing? Do you have a license or a certification?
A licensed therapist has received the training and the approval of a state licensing board to treat a variety of mental disorders that can cause moderate to severe distress such as depression, anxiety, chemical dependence, anorexia, bulimia, stress, personality disorders and marital and relationship problems, among many others. A licensed therapist has studied human psychology, lifespan development, individual as well as couple/family counseling techniques, drug addiction and treatment, psychopharmacology, multicultural implications for counseling, theories of psychotherapy--among other studies--over the course of several years. When you interview your therapist, ask: Are you licensed? Do you have a specialty? How do you like to work with your clients? Where did you go to school?
You may choose to see a clinical psychologist. In addition to the talk therapy work that therapists do, clinical psychologists are trained to administer and interpret a variety of diagnostic tests which can clarity diagnoses of mental disorders or addictions. They have extensive training and are licensed.
Finally, you may choose to see a psychiatrist. A licensed medical doctor, a psychiatrist cannot only assess and diagnose your difficulty, she or he can also prescribe medications to help combat the symptoms of depression, anxiety, Attention Deficit Disorder, and a host of other disorders which have been shown to respond to medical treatment. Psychiatrists can provide short- or long-term talk therapy as well, or provide medication management while working in conjunction with your therapist or psychologist to coordinate your care.
What about insurance? Most insurance companies invite licensed therapists (MFTs), psychologists and physicians to serve on their panel of providers, subject to the approval of the insurance company. Some providers of mental health care choose not ally with insurance companies and therefore require you to reimburse them directly. When you contact any mental health care provider, be sure to ask: Do you accept reimbursement from medical insurance plans? If so, which ones? How can I find out if you are on my insurance panel of providers? What are your fees? How are insurance claims submitted?
You can see that you have many choices when it comes to mental health care, and this discussion just scratches the surface. When it comes to sorting out who to choose, ask questions. Decide if you want to utilize your insurance coverage. Consider the scope of practice, experience and training of the person you're considering. Ask friends for recommendations.
And finally, try him or her on for size. If it's not a good fit, you have the right to say goodbye and try someone else. After all, its your time, your money, your therapy--and your life.
Thanks for listening.
Only you can answer that question. It can be a complicated decision, based on many factors. But, depending on your difficulty and the help you're looking for, you may find it helpful to consider the following.
One place to start: What are the symptoms of your distress?
Are you having intrusive thoughts that won't go away? Feeling depressed and can't shake hopeless feelings? Wondering if you have Attention Deficit Disorder? Frustrated with your life choices? Feeling angry with a loved one? Struggling with an alcohol addiction?
So you'll want to determine Is this person qualified to help me with my particular difficulty?
There are many ways to choose a person to help, but one way is to consider the scope of practice of the person you're considering. Scope of practice refers to what this person is trained to do and services he or she is deemed capable of providing safely, by either a state licensing board or other certifying body.
If you seek a counselor, be aware there are many types of counselors with varying degrees of training. For example, a peer counselor may be trained to listen and provide practical life advice, but is not trained to assess or provide treatment of mental illness. Career and rehab counselors usually have master's degrees in their specialty. Other counselors such as "life coaches" may have varying degrees of training (from several weeks to several years). Pastoral counselors may offer counseling tempered with a particular religious view. When you interview your counselor, ask: What training have you had? Do you have a specialty? How long have you been practicing? Do you have a license or a certification?
A licensed therapist has received the training and the approval of a state licensing board to treat a variety of mental disorders that can cause moderate to severe distress such as depression, anxiety, chemical dependence, anorexia, bulimia, stress, personality disorders and marital and relationship problems, among many others. A licensed therapist has studied human psychology, lifespan development, individual as well as couple/family counseling techniques, drug addiction and treatment, psychopharmacology, multicultural implications for counseling, theories of psychotherapy--among other studies--over the course of several years. When you interview your therapist, ask: Are you licensed? Do you have a specialty? How do you like to work with your clients? Where did you go to school?
You may choose to see a clinical psychologist. In addition to the talk therapy work that therapists do, clinical psychologists are trained to administer and interpret a variety of diagnostic tests which can clarity diagnoses of mental disorders or addictions. They have extensive training and are licensed.
Finally, you may choose to see a psychiatrist. A licensed medical doctor, a psychiatrist cannot only assess and diagnose your difficulty, she or he can also prescribe medications to help combat the symptoms of depression, anxiety, Attention Deficit Disorder, and a host of other disorders which have been shown to respond to medical treatment. Psychiatrists can provide short- or long-term talk therapy as well, or provide medication management while working in conjunction with your therapist or psychologist to coordinate your care.
What about insurance? Most insurance companies invite licensed therapists (MFTs), psychologists and physicians to serve on their panel of providers, subject to the approval of the insurance company. Some providers of mental health care choose not ally with insurance companies and therefore require you to reimburse them directly. When you contact any mental health care provider, be sure to ask: Do you accept reimbursement from medical insurance plans? If so, which ones? How can I find out if you are on my insurance panel of providers? What are your fees? How are insurance claims submitted?
You can see that you have many choices when it comes to mental health care, and this discussion just scratches the surface. When it comes to sorting out who to choose, ask questions. Decide if you want to utilize your insurance coverage. Consider the scope of practice, experience and training of the person you're considering. Ask friends for recommendations.
And finally, try him or her on for size. If it's not a good fit, you have the right to say goodbye and try someone else. After all, its your time, your money, your therapy--and your life.
Thanks for listening.
Wednesday, July 6, 2011
Counselor, Therapist, Psychologist, Psychiatrist? How many does it take to...?
Therapy. The word conjures up a variety of images from Freud to voodoo dolls. But when the laughter dies down and you find yourself in need of help the question becomes Just exactly which professional do I turn to?
For the purposes of this discussion, I'd like to look at four options (of many) which are available for mental health consultation and therapy.
Counselors. The term "counselor" can refer to anyone who offers another help. There are lay counselors, peer counselors, pastoral counselors, career counselors, rehabilitation counselors--and the list goes on. The thing most counselors have in common is specialized training. Lay and peer counselors usually do not require a degree program, but often involve a variety of training, usually specific to the type of of counseling being offered.
Pastoral counseling may be a part of a cleric's training, but usually does not involve diagnosis of mental illness. Often, pastoral counseling is rooted in the fundamentals of the religious denomination of the practicing pastor or priest. They are not usually required to be licensed by the state.
Some career counselors have completed master's degree programs which are devoted to this specialty. They are usually extensively trained in basic counseling skills and theory, with a concentration in their specialty. Some who provide career counseling can do so without a degree program; sometimes this is referred to as "life coaching" or "career development."
Rehabilitation counselors have master's degrees in their specialties, usually followed by a rigorous certification examination. Rehabilitation counselors can work with those with illness, injury, mobility challenges, deafness and other disabilities. Rehab counselors work to empower people with disabilities to make informed choices, build careers and live independently.
Therapists. In the mental health field, therapists are master's degree graduates who have (in most states) completed up to 3,000+ hours of clinical practicum work and passed a rigorous licensing exam administered by the state. In the past, in the state of California, these therapists were designated Marriage Family and Child Counselors. Today, these same professionals are called Marriage and Family Therapists. They work with couples and families dealing with relationship issues; they also work with as individuals struggling with a variety of disorders that are causing difficulty in personal and professional relationships such as anxiety, depression, eating disorders, stress, phobias, personality disorders and more.
Traditionally, therapists practice talk therapy, which is precisely as it sounds.
Psychologists. Clinical Psychologists have usually have doctorates in psychology or philosophy. While they hold doctorate degrees and are addressed as "Doctor," they are not physicians, and cannot dispense medication.
In order to be called a "psychologist" you must be licensed. Clinical psychologists work with those who have life adjustment problems, emotional disorders or mental illness. They also provide diagnostic assessment or "testing services" which can be essential for clarifying diagnoses of a mental disorder or addiction.
Psychologists must complete a specific number of hours of supervised training, usually two to three years, prior to finishing their Ph.D. They must pass licensing examinations; most have produced a doctoral dissertation on original research. In addition to Clinical Psychologists, there are also Educational Psychologists, Neuropsychologists, Forensic Psychologists, Organizational Psychologists as well as other specialities.
Psychiatrists. These individuals are medical school graduates with years of advanced training in their specialty, Psychiatry. They are physicians, licensed to treat patients and prescribe medications. In the past, many psychiatrists had full-time talk-therapy practices and functioned as the prescribing physician as well as admitting physician should a patient need inpatient psychiatric care.
In more recent years, some psychiatrists have shifted their focus to evaluation and medical management of mental illness, providing an extensive psychiatric evaluation at intake, prescription of psychotropic medication as needed, and followup visits on a regular basis.
So, now you know. Who's the best fit for you? Only you can decide what you need and who the best provider will be. The answer will depend on a variety of factors, which we'll take a look at in the next posting.
I hope to shed more light on the subject then.
Thanks for listening.
.
For the purposes of this discussion, I'd like to look at four options (of many) which are available for mental health consultation and therapy.
Counselors. The term "counselor" can refer to anyone who offers another help. There are lay counselors, peer counselors, pastoral counselors, career counselors, rehabilitation counselors--and the list goes on. The thing most counselors have in common is specialized training. Lay and peer counselors usually do not require a degree program, but often involve a variety of training, usually specific to the type of of counseling being offered.
Pastoral counseling may be a part of a cleric's training, but usually does not involve diagnosis of mental illness. Often, pastoral counseling is rooted in the fundamentals of the religious denomination of the practicing pastor or priest. They are not usually required to be licensed by the state.
Some career counselors have completed master's degree programs which are devoted to this specialty. They are usually extensively trained in basic counseling skills and theory, with a concentration in their specialty. Some who provide career counseling can do so without a degree program; sometimes this is referred to as "life coaching" or "career development."
Rehabilitation counselors have master's degrees in their specialties, usually followed by a rigorous certification examination. Rehabilitation counselors can work with those with illness, injury, mobility challenges, deafness and other disabilities. Rehab counselors work to empower people with disabilities to make informed choices, build careers and live independently.
Therapists. In the mental health field, therapists are master's degree graduates who have (in most states) completed up to 3,000+ hours of clinical practicum work and passed a rigorous licensing exam administered by the state. In the past, in the state of California, these therapists were designated Marriage Family and Child Counselors. Today, these same professionals are called Marriage and Family Therapists. They work with couples and families dealing with relationship issues; they also work with as individuals struggling with a variety of disorders that are causing difficulty in personal and professional relationships such as anxiety, depression, eating disorders, stress, phobias, personality disorders and more.
Traditionally, therapists practice talk therapy, which is precisely as it sounds.
Psychologists. Clinical Psychologists have usually have doctorates in psychology or philosophy. While they hold doctorate degrees and are addressed as "Doctor," they are not physicians, and cannot dispense medication.
In order to be called a "psychologist" you must be licensed. Clinical psychologists work with those who have life adjustment problems, emotional disorders or mental illness. They also provide diagnostic assessment or "testing services" which can be essential for clarifying diagnoses of a mental disorder or addiction.
Psychologists must complete a specific number of hours of supervised training, usually two to three years, prior to finishing their Ph.D. They must pass licensing examinations; most have produced a doctoral dissertation on original research. In addition to Clinical Psychologists, there are also Educational Psychologists, Neuropsychologists, Forensic Psychologists, Organizational Psychologists as well as other specialities.
Psychiatrists. These individuals are medical school graduates with years of advanced training in their specialty, Psychiatry. They are physicians, licensed to treat patients and prescribe medications. In the past, many psychiatrists had full-time talk-therapy practices and functioned as the prescribing physician as well as admitting physician should a patient need inpatient psychiatric care.
In more recent years, some psychiatrists have shifted their focus to evaluation and medical management of mental illness, providing an extensive psychiatric evaluation at intake, prescription of psychotropic medication as needed, and followup visits on a regular basis.
So, now you know. Who's the best fit for you? Only you can decide what you need and who the best provider will be. The answer will depend on a variety of factors, which we'll take a look at in the next posting.
I hope to shed more light on the subject then.
Thanks for listening.
.
Monday, July 4, 2011
From The Therapist's Deck Chair, or The Mental Health Benefits of Watermelon.
I'm sitting on a deck overlooking lush vineyards. A gentle morning breeze is washing over me. In the distance I hear a dog barking and sheep bleating. A cranky rooster is making himself known. It's just after 9 in the morning.
Clearly I'm not in my office. It's a holiday. A day off. One of life's stress-reducers.
I'm a big fan of time away from work. Studies show that absence of work stress--even for a day--can lower blood pressure, heart rate, and even improve our odds against cardiovascular disease. When we slow down, our bodies slow down.
For "type A" personalities, slowing down can be a challenge, but one that can change lives.
I have a theory about holidays like the Fourth of July. We march in parades. Some people paint their faces red, white and blue. We wave the flag, beat drums, and set off explosions of multicolored grandeur in the air. Tonight, all across America tonight, millions of children (and, ok this adult) will coo in unison: ooooh, ahhhhh! as pyrotechnics light up the sky.
And, for most of us, it's a day away from our normal work. I count this as one of life's blessings, and hold in high regard those who work holidays so the rest of us can run out for that extra head of garlic, have a meal out, grab a box of Band Aids or the can of cat food we forgot the day before.
Oh, yeah, my theory. I'm getting to it. I'm distracted by hawks who are riding the air currents in the valley below. My theory is this: holidays are permission-giving occasions. On holidays, we get permission not only to skip work, but to be a bit childish again. Just observe anyone, of any age, at any picnic eating a juicy slice of watermelon. I rest my case.
We also get permission, on these "special" occasions, to do "special" things: we might spring for a steak instead of hamburger, pull out that "good" bottle of pinot we've been "saving," whip up our special salad, invite over special friends, indulge a little in that dessert we only have on special occasions. You get the point. It's a delicious bit of indulgence that, in moderation, lets us not only enjoy a few of life's treats, but also, in my mind, give us permission to treat ourselves well.
Two quail have just crossed the garden path, looking for worms? Their treats, perhaps? They walk slowly, oblivious to us humans, seemingly content with their leisurely stroll in the morning sun.
We could learn something from the quail. But wait, we're on holiday, so I'll suspend the learning, the "shoulds," the must-dos and the agendas, just for the day.
Enjoy your holiday. Spend time with friends. Ooo and ahhhh at tonight's fireworks. And have an ice-cold slice of watermelon, and let the juices run down your chin. I can almost guarantee the sight will provide you--or at least those around you--with a genuine, child-like grin.
I can almost hear the blood-pressure dropping.
Thanks for listening. Happy Fourth.
Clearly I'm not in my office. It's a holiday. A day off. One of life's stress-reducers.
I'm a big fan of time away from work. Studies show that absence of work stress--even for a day--can lower blood pressure, heart rate, and even improve our odds against cardiovascular disease. When we slow down, our bodies slow down.
For "type A" personalities, slowing down can be a challenge, but one that can change lives.
I have a theory about holidays like the Fourth of July. We march in parades. Some people paint their faces red, white and blue. We wave the flag, beat drums, and set off explosions of multicolored grandeur in the air. Tonight, all across America tonight, millions of children (and, ok this adult) will coo in unison: ooooh, ahhhhh! as pyrotechnics light up the sky.
And, for most of us, it's a day away from our normal work. I count this as one of life's blessings, and hold in high regard those who work holidays so the rest of us can run out for that extra head of garlic, have a meal out, grab a box of Band Aids or the can of cat food we forgot the day before.
Oh, yeah, my theory. I'm getting to it. I'm distracted by hawks who are riding the air currents in the valley below. My theory is this: holidays are permission-giving occasions. On holidays, we get permission not only to skip work, but to be a bit childish again. Just observe anyone, of any age, at any picnic eating a juicy slice of watermelon. I rest my case.
We also get permission, on these "special" occasions, to do "special" things: we might spring for a steak instead of hamburger, pull out that "good" bottle of pinot we've been "saving," whip up our special salad, invite over special friends, indulge a little in that dessert we only have on special occasions. You get the point. It's a delicious bit of indulgence that, in moderation, lets us not only enjoy a few of life's treats, but also, in my mind, give us permission to treat ourselves well.
Two quail have just crossed the garden path, looking for worms? Their treats, perhaps? They walk slowly, oblivious to us humans, seemingly content with their leisurely stroll in the morning sun.
We could learn something from the quail. But wait, we're on holiday, so I'll suspend the learning, the "shoulds," the must-dos and the agendas, just for the day.
Enjoy your holiday. Spend time with friends. Ooo and ahhhh at tonight's fireworks. And have an ice-cold slice of watermelon, and let the juices run down your chin. I can almost guarantee the sight will provide you--or at least those around you--with a genuine, child-like grin.
I can almost hear the blood-pressure dropping.
Thanks for listening. Happy Fourth.
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