From The Therapist's Chair

What Next? Or, Finding New Purpose In Your Life.

2012-01-15T11:33:00.000-08:00

A constant refrain that I hear from colleagues and clients alike is, "I wish I had more time in the day!" As a species that is experiencing the cutting edge of technology designed to make our lives easier, we continue to find more and more to do in less and less time. It seems that, as technology reduces the time it takes to accomplish a task, we find more tasks to take on. Which can lead us to apexes of efficiency--punctuated by bouts of exhaustion, frustration, leading to deeper moments that call up the big question: What's it all about? Is this--the frenzy, the efficiency, the ticking off of "to do" lists--is this what it's all about? Why am I here?

I have had the privilege of working with people of all ages, across the lifespan. And, my clients have shown me that past the age of 18 or so, "the big question" above comes into play at many of life's transition moments: For teenagers leaving home for work, the military or college; for young adults getting married, having their first child, moving or choosing more defined career paths; for those who lose jobs or relationships either unexpectedly or after a clear period of dissatisfaction; for those faced with their first physical limitations of normal aging; for those facing serious illness; for those who face retirement and the conclusion of their professional "usefulness;" and, in the ending phases of life those who, examining a life of accomplishments, failures, compromises, regrets and losses find themselves asking: What was it all about?

The people who seem to weather the question the best are those who, at various stages of their lives, find a way to "repurpose" themselves. They find a way to adjust, replace or augment a value system that no longer serves them. And, in the process, they also, unconsciously or not, redefine the meaning of "satisfaction" in their lives.

The young couple who starts a family may initially find the transition from couple to family limiting and difficult, until they recognize and elevate the importance--and joy-- of raising a child.

Job loss--often a devastating blow to the ego at first--can be an invitation to re-examine what you really would like to to if there were no limits to your choices? I've worked with several clients who have found themselves in just that position--and have taken the opportunity to find new purpose in their daily work.

Serious illness or loss of a loved one can act as a life signal to pause--or at least slow down. Loss, of either our own functionality or independence--however temporary--can be a cause for pause. Death of a spouse, family member of friend can further underscore our own relative impermanence--and the finite nature of our span on earth. The question often becomes: What legacy will I leave? Did my time here matter?

Another life marker, retirement, can be a time of reinvention or a time of feeling adrift. Many older adults reach their retirement years facing the question: Now what? If your job so thoroughly defines you, if your professional accomplishments are your primary source of life satisfaction, you may find yourself reaching retirement asking the same question.

Fortunately, we are, as a species, remarkable in our ability to reinvent--to repurpose--ourselves. Businessmen become tutors in retirement; accountants become landscape painters; physicians become organic gardeners. Successful retirement years become a time for passion to either augment or replace profession.

And, finally, in our final years, we are often blessedly equipped with the time--and the insight--to conduct a life review: an examination of where we've been and what the journey has meant. And most of the aging adults I've had the privilege to work with have been blessed with another ability: acceptance. Acceptance of accomplishments, failures, even mediocrity--at the end with a minimum amount of energy devoted to regret.

It's then that an amazing transformation can occur--the shift from wondering if one's life was worthy--to acceptance of the life we actually lived, peaks, valleys and the terrain in between.

Until next time, thanks for listening.

Why They're Called "Resolutions," Or How To Bolster Your Resolve.

2012-01-07T10:25:00.000-08:00

We're one week into the new year and, chances are, it's likely you know someone (perhaps yourself) who has committed to improve, overhaul or otherwise change a behavior in the next 52 weeks. Some goals are lofty (lose 50 pounds!); some are more modest (be kinder to co-workers); and some, despite our best efforts, may be unattainable, which leads not only to disappointment, but also builds resistance to change in the future.

In my work, I'm privileged to sit with intelligent, motivated individuals who are working for change--or acceptance--in their lives. Some of the tools we use in our work together may be helpful to those of you who are fortifying your resolve for change in this new year. Here are a few suggestions that may help.

Set attainable goals. Take a look at your goal. Write it down on a piece of paper and read it aloud to yourself. "Run a marathon" may be completely doable if you're healthy enough for vigorous exercise and have some experience with running. If you've never run before, you may want to set a more reasonable goal--say, walk every day, with a goal of one mile by day 60. You may need input from your doctor or a trainer. The point is, attaining your goal will be a real ego booster. If your goal is too ambitious, you may be setting yourself up for failure.

Set measurable goals. To succeed, you need to know how you define "success." If your goal is to lose weight, it will help to quantify your goal: "Lose 5 pounds by March 30th." If you miss your goal you can always reset. But having a target and a timeline can help keep you on track.

Make sure they're your goals, not someone else's. Our friends and loved ones may have wishes for us that will make our lives better, healthier, etc. But the fact is, if you're not invested in your goals for change, you're not likely to be motivated to do the work to change.

Don't set yourself up for failure. "Become an astronaut" sounds, to me, like an exciting goal; but, at my stage in life, it's unlikely to happen because of the training, physical stamina, and skill set needed to journey into space. Don't get me wrong. Don't abandon goals just because they're lofty. But look honestly at your goal and ask: Am I ready to make the commitment? Can I commit the time and resources needed? Are there any intermediate goals (in this instance, say, attending a space camp) that will help me get to my end goal?

Set up a support system. Let others know how they can help you reach your goals. If, for example, you want to stop smoking, you may find it difficult to be around your smoking friends for awhile. It might be helpful, in this example, to let them know that you need a smoke-free environment for the near future, and that you want to spend time with them when they're not lighting up.

If you slip, start again. Miss a day of exercise? Indulge in a piece of Boston cream pie? Move on. Lamenting your slip won't undo it. Try your best to understand how the slip happened and what you can do to avoid future slips. Learn what you can, accept that you're human, and train your eye--again--on the prize. Move on.

Adjust goals if necessary. Finding that you just can't make it to the gym seven days a week? It may be realistic to temporarily adjust your goal so you can find satisfaction in meeting it. If you're continually disappointing yourself, it will likely erode your resolve to continue with the larger goal.

Take small steps. Your bigger goal may logically have several "building blocks" to success. Set incremental goals that move you toward your ultimate goal. This way, you're always moving in the right direction, and enjoying your incremental successes.

Finally, reward yourself for your progress. Positive reinforcement is a great motivator. Take time to monitor your progress and reward it. Did you eat in a healthy way for five days in a row? Take yourself to the movies, write "Good Job!" on a post-it and put it on the refrigerator, share the news with a friend and enjoy a compliment. You'll be motivated to continue.

Whatever you decide to do in the new year, remember: if you set the bar too high, you may be sabotaging your own success. Be realistic. Build goal upon goal. Recognize your slips and move on. Reward your successes.

May your new year be blessed with your own successes, and more.

Until next time, thanks for listening.

Now What? What To Do If You're Feeling Blue, Blah, or Blechh!

2011-12-27T17:30:00.000-08:00

If ever a single day of the year gets a big build-up, it's December 25th. Literally billions of dollars are spent on gifts, advertisements, holiday food and drink, travel--and the list goes on. All culminating with, hopefully, convivial gatherings, reunited families, festive moments with friends, grinning and satisfied children, and a few moments of contemplation on the inherent goodness of our fellow earthlings.

Followed by a giant exhale and the inevitable question: now what?

After the frenzy to make the season bright, special, happy and merry, the aftermath can arrive as a letdown in contrast to the many-week build up. With no more gifts to buy or unwrap, no holiday meals to prepare, no more festive gatherings, no special foods, no cards or calls-- we ask ourselves, now what?

For some, the answer is simply, move on to the new year. Take down the tree and store the lights and ornaments until next year. Get back into the routine of work (or searching for it if you're between jobs), muddle through the mundane, toast the New Year, go on that diet--and get on with it.

For others, the void left by the holiday is harder to shake. It's the absence left by families and friends that go back home. Disappointments in holiday expectations weren't met. Frustration with the economic realities--and bills--of the coming January. And, for some, the shorter days--no longer punctuated by bright holiday lights--can bring on the blues.

What can you do? Well, here are a few ideas that might help.

Count your blessings. Yes, as down as you might feel, you are blessed. Focus on what you have. Make a list of people, circumstances and attributes you are grateful for. Write down one blessing, how ever small, on a note pad each night. At the end a year you'll have 365 notable blessings that are yours.

Reality test your self-talk. I've mentioned self-talk in a previous post. We all have self-talk, mostly without moving our lips. If you're telling yourself things that bring you down, stop and ask yourself: Is that statement really true? How accurate am I being with myself? Can I edit out any drama? And...what can I do to make things better?
If your negative self-talk isn't true, then stop it. If it is, focus on things you can do to bring the situation more into your control. If you can't do anything to change it, entertain the concept, What would it be like to accept things just as they are? And, related to finding the positive...

Surround yourself with positive people. Negative people can drag you down, making the post-holiday blues seem downright bleak. Practice being a positive person yourself, finding ways to say "yes," be cooperative and generally add to the betterment of your days and others'. Pepper your interactions with more "please" and "thank you," and less #*%&!

Start your new year as a volunteer. It doesn't really matter what you volunteer to do, just do something! Studies show that people who volunteer tend to feel significantly better about themselves than people who don't. And your activity in service to others will likely take your mind off the things that bring you down. Bag groceries for the local food bank, read to the blind, tutor the young, sit and visit with shut-ins. They will be grateful for your interest and effort--and you'll benefit far more than they.

Look forward, not back. Plan something special. It doesn't need to be expensive or lavish. Plan to visit with an old friend you've lost touch with. Pack a sandwich and eat in the park or by the beach. Set aside a little money each week--if possible--for a special treat you'd like in the future. Window shop, make your special soup and share it with a friend, plan a "me day" and pamper yourself as you're able. The looking forward to special events can be as satisfying as the events themselves.

And finally, move! Get off the couch, up out of your office chair, out from in front of the TV or computer screen--and move! Check with your doctor first to be sure that even mild exercise won't hurt you--and then just walk. Studies have shown that a brisk 20-minute walk every day can lighten your mood, and your scale! You needn't be an Olympic athlete to be a winner from the benefits of exercise. Weather in the way? Put on your favorite music and dance, march in place, sway--just move.

More on the holiday blues and winter blahs as we move into January.

Until then, Happy New Year, and thanks for listening.

Do You Hear What I Hear? The Quiet Of The Season.

2011-12-23T15:57:00.000-08:00

It may just be my imagination, but along about the 23rd or so, a calm seems to descend upon the frenzy that is Christmas. By now, like it or not, we're only two days away and most of what needs to get done is either done, or isn't going to get done.

Said another way, the rush is dying down and the calm is growing.

It feels like we can take a collective breath, admire what's been accomplished, allow for what has not, and look forward to whatever Christmas traditions that beckon 48 hours from now.

For those who take a break from work, however brief, there's likely a pause from routine, and a chance to reflect on what Christmas (or Hanukkah or Quanza) means to us. Regardless of how we feel as adults, it's almost impossible to ignore the excitement of children, the beauty of the decorations, and the majesty of the music.

The season--for all its commercialism--is a time to pause. It could be my optimism showing through, but people seem to be a little kinder. They let you guide your sleigh--ok, your car--into the lane you need to be in. The clerk at the hardware store smiles. The bagger at the grocery grins and asks if you're "ready" for the holidays.

The season gives us all kinds of permission. Permission to be a little silly. People don goofy Santa hats, glowing Christmas light necklaces and even elf shoes.

Permission to break the ice in a communication stalemate--after all, who could fault you for sending a holiday card or calling to wish season's greetings?

Permission to treat yourself with an occasional cookie, eggnog or other indulgence. Even permission to snag that bargain sweater for a gift, and maybe one for yourself.

Permission to reconnect with your faith--no matter how lapsed it might feel or how long it's been.

And, yes, Virginia, it gives us--in the face of an awful economy, political unrest, unpredictable and destructive weather, war, need, and loved ones far away--permission to renew. To look for the star in the east. And permission to hope.

With that, I bid you joy in your hearts this season.

Until, next time, thanks for listening.

Dance Of The Holiday Invitations, or Send In The Clones.

2011-12-08T14:16:00.000-08:00

With the Thanksgiving holiday dinner behind us, we now shift into the December holiday rush: parties with friends, work receptions, holiday open houses and family dinners. The difficulty becomes: How can I (we) be at two places at once?

With non-family functions, the pressure is somewhat diminished by the fact that, while invitations are, in effect, gifts of time and (often) refreshment, they are NOT command performances. That is, we can often find graceful ways to say "no" that don't devastate the host.

Family, however, can be another matter.

Parents, in particular, can and do have a difficult time sharing sons and daughters with in-laws. Depending on the degree of dysfunction, families can (and do) exert both implicit and explicit pressure on family members to share the joy of the season--with US!

Clients have reported an array of family tactics designed to turn an invitation into an offer you can't refuse.

Often-used , and quite effective is familial guilt: Don't worry about spending the holidays with us. It will break your father's heart, but we'll be fine. After all, there's always next year...assuming we're all here. Does it make you feel bad? Well, it's designed to do just that. Seems ironic in the season of "good will," doesn't it? And yet, in an effort to orchestrate, arrange and otherwise control, some families deck the halls with guilt, not gilt, to get what they want.

The antidote? Honesty. Yes. Simply tell the truth. Mom, we just can't make the trip this year. With two kids and two car seats, all the toys and the difficulty of travel, we just can't do it. Or, I know you're disappointed. So am I. But we want to experience a holiday in our own home this year. And we'd love to see you here,...visit in January...come for your birthday, etc. Once you've invoked the honesty clause, stick to it. You love your relatives? Tell them. But stick to your guns. The only result of caving will be that you end up where you don't really want to be, feeling resentful and not so jolly.

Another is the "logical argument." It makes the most sense that we spend the holidays at your sister's house. She has all that room, and we'll all be so comfortable there. Yes, yes, I know you'll have to fly across the country, but don't you see how this plan is best for everyone? It can seem logical to everyone who must make the least effort, but not so much to those who have to submit to the rigors of holiday travel. Ask yourself, Can we undertake the effort, time and expense of this plan? If the answer is "yes," then succumbing to logic will sit well with you. If, however, circumstances make "the plan" undoable for you, you need to ask for what you need.

The antidote? Tell the truth. Dad, the truth is, we don't want to travel during the holidays. And, for the first time, we'd like the kids to wake up in their own beds on Christmas morning--just like I did when I was a child. We're creating our own traditions here. And we'll share the ones with you that we can. Again, if you end up caving--even to a logical request--you'll likely end up resentful, tense, irritable and more like Scrooge than Santa.

And loved ones sometimes invoke....Passive-aggressive manipulation. This can take the form of silence, overly "cordial" emails and phone calls, or feigned indifference after you have asked for the holiday arrangement you really want--and need. The communication can be overt or subtle, but the intent is the same: to let you know that someone is not pleased with you.

To counter such behaviors you might try...name that elephant. Calmly and with as much affection as you can muster, you might say, Mom, I know that you want us to spend the holidays at your house, but, as I said before, we will be staying with Ted's family this year. I know you're disappointed. We'll be talking with you all during the holidays, and sending you photos, etc....

As much as gathering, greeting and giving can create fond holiday memories, keep in mind that that holiday traditions are meant to serve us--not the other way around. What was fun and easy when you were single and 20 or 30 may not be fun--or even reasonable--now. Lives, and circumstances, change.

In the true spirit of the holiday, give what you can in terms of gifts, talents and time. And also remember to give yourself the gift of autonomy: the right of self-government or self-determination. Despite the fact that you have friends and relatives who want you to behave in a certain way this holiday season, remember that you also have a wonderful and timeless gift that is uniquely yours: a voice.

Until next time, thanks for listening.

What Child Is This? Or, Navigating The Holidays As A Grownup.

2011-11-13T11:05:00.000-08:00

If I've heard it once, I've heard it a thousand times: "Christmas? Oh, it's really for the children."

Oh really?

I've also been told: "Oh, let's not exchange gifts this year. It's really about the children."

Is that so?

In my experience, the holiday season can bring out the very best--and worst--of us. And, let's face it: we all enjoy being thought of, remembered if you will, with a token, a keepsake--a gift. Gift giving sends a message: I thought of you. I made an effort to give you something I thought you might like. You are special.

If you think this isn't true, try not giving gifts to those with whom you have traditionally shared an exchange. Unless the change is entirely mutual, timed at exactly the same moment, and completely owned by all, it's likely to result in some hurt feelings.

After all, we're human. And, after years of completely unscientific data-gathering which includes friends, family--and reports from clients--it turns out that the majority of folks don't care so much what you spend on them. It's the gift--no matter how little it cost of how home-spun.

In this, a struggling economy, it think it's fair to say that most everyone realizes that funds are tight for alot of people who never--ever--thought they would find themselves without jobs or with reduced means. Which means that many people who were lavish in the past may not be able to repeat the generosity of Christmases past.

So, what can you do to gracefully recognize the shift? First of all, with family, talk with your adult relatives. Acknowledge their, or your own, economic reality and adjust family traditions to this new reality. This means considering more than just the amount spent on gifts.

"You mean you're not having your holiday open house? But why?"

Or, "Why can't you come east for the holidays? We always meet at mom's?"

These questions, and others like them, asked unwittingly, can bring reactions ranging from acute embarrassment to stares as icy as an east-coast December.

Mindfulness is one answer. It's an internal process that reminds us that circumstances change. Others'--and our own--situations may be different this year than last. Mindfulness, however is more than increased awareness. It's a boost in thoughtfulness.

Mindfulness can mean increased directness: "We won't be able to entertain this year the way we used to." Or, "It's been a difficult year for us financially. We hope you can understand we can't exchange gifts...fly out to see you...donate to your charity...etc."

Mindfulness can also mean increased tact and awareness. When others express discomfort with maintaining holiday traditions, it just might be that they can't afford them this year. Despite outward appearances, unbeknownst to us, friends and family may have experienced the economic downturn in a way that limits their ability to spend or participate.

Children, by definition, have limited ability to delay gratification and accept what they cannot have. Young children sometimes resort to tantrums. As adults, we have the capacity--if we choose to exercise it--to temper our disappointment with acceptance--and hope for better days. As adults, we also possess the ability to experience the holidays as a time to connect--and sometimes re-connect--with those we care about.

As adults, we are equipped with tools and talents that can nurture the holiday joy, and reduce the stressors. Read others' social cues. Listen between the lines. Adjust expectations. Make it ok for others--and yourselves--to share the joy in ways that they can comfortably afford--and enjoy.

Only then does the true meaning of the season shine through. Only then do we give--and receive-- the true gift of the season.

Until next time, thanks for listening.

The Most Wonderful Time...Or, How To Navigate The "Holiday Corridor."

2011-11-10T13:56:00.000-08:00

Well, it's here. The "most wonderful time of the year," according to Andy Williams.

I call it the "holiday corridor," that rush of days that starts sometime after the last Halloween pumpkins have been tossed, and kicks into full gear along about the week before Thanksgiving. And, while it does have many wonderful connotations, from the perspective of the therapist's chair, it's also a time when my clients--and friends and family, for that matter--report rising levels of stress.

In the next few posts, I'll be talking about recurring issues that many of us are faced with during the holiday season: expectations we have, realistic and unrealistic; holiday stress, from without and within; what happens when the family gets together; ghosts of Christmases past: our roles with parents; and, the inevitable "shrinking day:" when 24 hours seems to go by in a blink.

There's also what I call "general holiday fatigue." I can remember when the holiday (specifically, Christmas) season was officially launched on the Friday after Thanksgiving. I have blurry memories of bundling up and riding in my mother's Ford to the Sears parking lot, waiting for Santa to arrive via helicopter. It was late November, cold (often snowy on the east coast), and Christmas arrived in a scant 30 days or less.

Now, our exposure to everything "holiday" (the politically correct moniker now) can start as early as mid-October. Yes, on any given evening of TV watching, Halloween ad "boos" are now interspersed with holiday ad "ho! ho! ho!s" At worst, it confuses children. At best, it's an annoying reminder to adults.

But back to Christmas fatigue. In my former advertising career, a statistic we bandied about with clients was the fact that, on average, human beings were bombarded with about 300 "messages" a day from different sources. At that time, those sources did not include Internet/mobile pop up ads or emails. It's likely that the number of messages is somewhat higher today--and rising. By my unscientific estimate, by the time we have weathered the holiday corridor, if we are exposed to even, say a conservative 100 messages a day, we will have endured a mind-numbing 6,000 messages--most with a holiday theme.

Add to this the holiday shopping, cards, meals, travel--is it any wonder we experience holiday fatigue?

Don't get me wrong. I love the holidays--in my case, Christmas. I also am a big believer in self-care, which is why, over the next few posts, I'll be talking about the challenges of the season, and ways we can minimize humbug and maximize joy.

Until then, thanks for listening.

Don't "Should" All Over Yourself, Or Knowing When To Let Yourself Off The Hook.

2011-10-16T16:11:00.000-07:00

I work with a wonderfully wise and equally unassuming older client who I'll call, "Charlotte," who is approaching 95. She, like others in the senior therapy group I hold each Friday, deals with the usual difficulties of aging: physical decline, illness, problematic relationships with adult children and the work of "life review"--a look back at accomplishments, disappointments, highs and lows.

One Friday morning, as the group was hitting its 10 a.m. stride, an introspective group member I'll call "Colleen" shared a story about her relationship with her sister and a rift that occurred between them when they were young. Now, almost 60 years later, she voiced disappointment in her own actions many years ago: "I should have done something sooner. I should have helped her. Things would have been different."

The group, rapt with attention as the story concluded, exhaled a collective sigh. It was a sad recollection. We all mused silently for a moment.

The silence was broken by Charlotte: "Well, that may be true. Or... things might have not been any different at all." And, after a pause for dramatic effect, "Don't "should" all over yourself. Let--it--go."

The group skipped a beat, looked at her quizzically, realized what she had said--and what she had NOT said--and broke into laughter. Charlotte smiled a wry smile and chuckled a bit herself.

Colleen asked, "How did you come across that. I mean, how did you find you could...do that? You know, stop the "shoulds?"

"Do you mean, who gave me permission to stop beating myself up?" replied Charlotte. "I did. Myself. Just me."

Now, I don't know many "secrets" of happiness, well-being or contentment but, for my money, Charlotte is on to something.

How often are we critical of ourselves? How many times do we lament things we cannot change, could not change and will not change?

Think about it. The job not taken. The apology not issued. The unkind words that spewed out in the heat of an argument. The relationship we could have repaired, but didn't know how at the moment. Missed opportunities for a better outcome. We all have lived through them, and will likely live through more, God willing.

A few years ago, while in consult with "Bennett," a wiser, more seasoned therapist, I mentioned one of my own missed opportunities, my own "mistakes," and my remorse over my actions. He looked at me intently, and asked, quite seriously, "So. How long are your going to have to beat yourself up over this? A week or two? A month? How long will be enough?"

"What do you mean how long? I don't know...I never thought about it like that."

"It's an interesting question, isn't it?" he replied. "I introduces the idea that we actually have control over our own lamentation. Over our own self-punishment. You might want to give it some thought. After all, life's too short."

Armed with that simple but profound idea, I began to actually think about a time frame in which to forgive myself--to free myself from my "should." Now, I personally subscribe to the idea that we can stop beating ourselves up. That we can let go. That we can actually take whatever learning we gained from unpleasant, unproductive and unflattering behaviors--and move forward. Leaving the guilt behind, investing that "guilting" energy into the life ahead.

Are you "shoulding" all over yourself? Ask yourself: 1. Is this behavior making my life any better? 2. How could I do things differently or better next time? And, 3. How much longer do I need to beat myself up over this?

I truly believe that my wise friend Charlotte and my sage/mentor Bennett are on to something. Try it. It might take some practice. But, sometimes, the worthwhile things take time to perfect.

Once you catch on to the art of letting go, you just might feel better.

Until next time, thanks for listening.

Looking Inward: Why We're Wary Of What Lies Within.

2011-09-18T12:54:00.000-07:00

‎"We have been to the moon, we have charted the depths of the ocean and the heart of the atom, but we have a fear of looking inward to ourselves because we sense that is where all the contradictions flow together." Terence McKenna, Author, Philosopher

Perhaps the most difficult task of therapy is the journey inward.

Over the past year I've worked with a young woman, Thea (no real names are used here), who has had, over the years, difficulty with co-workers, tradespeople, and most significantly, with her domestic partner of 12 years.

As we began our work, Thea sat across from me, exasperated with the conduct of the rest of the world. Can you believe the way they treat me....? Thea was frustrated, often angry. Her coworkers failed to see the value of her suggestions for their performance; in fact, they had begun to avoid her in the break room. But, this is all constructive criticism! They should thank me for my insights. With a neutral and curious tone I asked, "Did they ask for your input?" No! They simply don't see what I see. They don't like it when I point out their obvious shortcomings."

Similar frustrations surfaced around the performance of young man who cleaned her house. Thea: I suggested he might clean his other houses in the way I want my house cleaned--and he told me they seemed satisfied with his way. His way is inferior! He is so ungrateful!

The most distressing rift was the one with her partner, Jerry, a software engineer who spent long hours at the office, and was "tired" most of the time at home. Thea: He's tired all the time. I spent an afternoon on the computer researching fatigue and its causes, even printed out an exercise and nutrition regimen guaranteed to improve energy levels. And has he started it? He said "thank you" and the printout is still sitting on the kitchen counter. No matter how I try to help him improve himself, nothing seems to happen. How can he let this happen to me?

A few months into our work together, Thea arrived for her session looking exhausted. Her eyes were red and swollen. She had been up all night, crying. Thea: I try and I try...it seems like no one can see it my way! I want to help, but I'm just ready...to give up. No one appreciates my insights. It's as if...I don't matter. Thea sobbed. When the sobbing subsided, she asked, What is wrong...with me?

And so our real work began. It wasn't so much what was wrong or for that matter, right, with Thea. It was the fact that Thea was willing to look inward.

As much as we would like to change others in our lives, therapy can only affect the person or persons sitting in the room. As much as Thea wanted others to recognize her insights and suggestions, she was the person that they all had in common. She had been getting feedback from them for some time now, and she was not able to take it in.

Only when she began to consider, Is it possible that I am contributing to my own distress in the world? were we able to help her see herself as others saw her. It was only then that Thea and I could begin to explore the messages and values she got as a child--from her parents and others--and how she incorporated those messages into her world view.

Over time, Thea has begun to view the world from other points of view. While it is still frustrating for her that others cannot see things as clearly as she does, she has stopped offering advice--however constructive. And we have been tracking the reactions of those around her.

Looking inward can be scary. But it can also be entertaining and enlightening. It's where we can finally begin to see ourselves as--perhaps--others might see us. It gives us a new perspective from which to navigate our relationships.

Not as lone mariners, but as privileged members of a larger crew.

Until next time, thanks for listening.

On A Personal Note: "The Help," Memories of Pattie And Why You Can't Talk Trash About My Family.

2011-09-13T13:55:00.000-07:00

I just finished reading The Help, and I have to say, I'm left feeling a handful of emotions. If you haven't read the book, read it. The film version, while somewhat (necessarily) abbreviated, is also a gem. Go see it.

Living in California, it's not often that I run into anyone who shares my southern roots, much less even a passing understanding of what it was like to grow up in the south of the 1960s. So I felt a wave of familiarity--a dull ache of nostalgia--as the book swept me back to a different time.

There are similarities between the book and my upbringing. And differences, too. But the flavor--the summer heat, the humidity, the southern drawl, the way of describing things--was so accurately recreated on the pages of The Help. It was a time long passed. A time that predated political correctness. The south of my childhood has seen many positive changes since that time. What follows is a memory of what was, as it was.

My family employed a wonderful, powerful black woman by the name of Pattie. Unlike the fictional Phelans, our family was not wealthy, plantation-dwelling or steeped in the deep traditions of Mississippi. We lived in a comfortable, upper middle-class neighborhood in Virginia, where the men worked and most of the women stayed home to raise their families--often with the help of a "colored girl," a decidedly racist term that was likely used more out of ignorance and habit than malice.

To the best of my knowledge, Pattie came to work for my mother when I was two or three. She came five days a week, doing the housecleaning and laundry. My early memories of Pattie were the scents of Niagara Spray Starch and Lucky Strike unfiltereds. I can picture her at the ironing board, Lucky dangling from her lips, humming over a the collar of one of my father's white shirts, delivering a perfect shot of spray starch to the collar. And then, the hiss of the iron as it glided over the cotton, leaving behind its perfect wake of flattened fabric.

Pattie arrived on the 7:55 morning bus. My mom picked her up at the bus stop and Pattie was at work by 8:00 sharp. In the summers, Pattie arrived with bags of fresh produce, usually half-runner beans and white corn, my father's favorites. Sometimes there were beets and squash and heirloom tomatoes. As a child, I never questioned how Pattie got the produce--it just came with her.

What I learned, years later, was that Pattie, in order to get to the morning farmer's market, got up an hour early, took the 6:20 bus, shopped, then changed buses twice to get to our house as usual. I also learned that Mom never asked for this kindness, and always offered to pay Pattie for the vegetables. It was their "dance." Mom would offer, Pattie would say, Put yo money away, Miss Frances, and turn and walk out of the room. Mom would follow, repeat the offer, get the same answer. Then, when she was certain Pattie wasn't looking, Mom would stick a carefully folded five- or ten-dollar bill in Pattie's purse.

Pattie knew it was there. Mom knew it was there. It was how they worked it out.

Along with Pattie's pay each week (I don't have any idea what Pattie was paid), Mom set out a bag containing a carton of Lucky Unfiltereds, a small bag of Brach's butterscotch candies, two ribeye steaks, greens, a 48 oz. bottle of Schlitz beer, and whatever seasonal produce that was at market. It was "Pattie's bag" and Mom make it clear we children were not to touch it. Mom would set it by Pattie's satchel next to the front door just as she prepared to take Pattie home for the day. Sometimes I would ride with them to Pattie's house. In those more racially divided days it was in an area called "colored town," as white--and black--people called the area adjacent to Williamson Road.

In later years, when Pattie was coming only three times, then twice, then once a week--I would drive her home myself.

Pattie sat in the front seat with Mom. She sat in the front seat with me. I never remember her talking about her personal life, civil rights, segregation, Martin Luther King or any reference to racial segregation. I know she had opinions. And I know that, after she retired and Mom called or visited her, Pattie shared personal feelings with Mom--and Mom with her. They remained friends until Pattie's death in early 1975.

Kathryn Stockett, author of The Help, explains, in an afterword to the book, about being a southerner in an environment that doesn't understand southerners. I, too, left the south as an adult to work in larger cities in other parts of the country. Here in California I occasionally come across someone who has recently seen a film about the south, changed planes in the Atlanta, Hartsfield airport, or spent a brief time in one of the southern states. After one such brief southern encounter, one particular acquaintance whom I see from time to time, let fly some unflattering comments about how "all southerners are so slow," winking at our dinner companions as if to underscore the unspoken translation: All southerners are so stupid.

Without so much as a hesitation between bites of bean salad from a Berkeley organic grocery I caught her gaze and steelily replied, Careful. You're talking about me, my mom and dad and the rest of my family and by the way just how much time have you spent in the south? Have you ever lived there? Know anyone--personally? And--just, by the way--what if I generalized that way about you and your family. How do you think it would feel?

So, there you have it. To paraphrase Ms. Stockett (and with apologies): With all its faults (and there were and are many) the south is like my family. I'm allowed to complain about her all I want, but God help the person who raises an ill word about her around me, unless she is their family, too.

I'll get off my soapbox now. Thanks for listening.

On A Personal Note: Glimpses Of Childhood, The Birth Of Self-Esteem And The End Of Summer.

2011-08-24T17:06:00.000-07:00

When I was a child, the beginning of summer was just that: a beginning. It was a time of what seemed to be endless possibilities. The countdown to the end of school usually started some time in the middle of May and built to a feverish crescendo that climaxed on or about June 5th, when the last textbooks were stacked in the multipurpose room and we were released into the warm June heat of the Virginia summer.

Early on as a child, I found, to my profound disappointment, that I was a failure on any number of sports courts and fields. Despite endless hours of practice with my naturally athletic cousins, I failed to find either proficiency or personal satisfaction on the baseball diamond, basketball court, or football field--three of the staple neighborhood sports at which boys that age usually excelled.

You can imagine my surprise--and delight--when, at the age of six, I discovered that I could swim! Not only stay afloat, but, with training and determination, I could traverse the length of the pool with enough velocity to compete with--and sometimes beat--my opponents.

It's no wonder that I looked forward to summer so much. I grudgingly suffered through three of the four seasons: football, basketball and baseball. But when the fourth season arrived--swimming--it was my time to shine. Relatively.

For a child who was routinely picked last--or nearly last--for most sports teams, I reveled in my 4th, 3rd, 2nd and the occasional 1st place ribbons I earned each Monday night from June through August. My parents, to their credit, never provided me with either excuses or rationalizations about my wins--or my losses. When I ended a swimming event--all splash and fury--only to find out I had finished an honorable "4th" I wasn't consoled with "You had a bad lane," or "You were swimming with the sun in your eyes," or worse, "The lane judge disqualified you because he doesn't like our team." (And believe it or not, I actually heard parents feeding their kids those lines when I was a swimmer, as well as years later when I was the coach of the team).

In fact, I wasn't really consoled at all. Instead, when I began my own rationalizations, my mom (usually) or dad (sometimes) would hand me a dry towel, look me in the eye and ask calmly: Did you do your best? As difficult as it was to admit that my "best" had only netted me 4th or 5th place, I would soberly reply, Yes. To which my parent(s) would reply, Then you did your best. And, today, in this race, others swam a little better then you did. Next week there will be another race.

Forty-odd years later, I can remember these moments as if they had happened yesterday. I came to look at these as our "no-excuses" moments. Just a realization that my best sometimes wouldn't be as good as somebody else's. And, more importantly, that my best was just fine. Now I suspect there may be some parents out there who will be horrified at my next statement, but here goes: Not only was my best "just fine," 4th, 5th--god forbid last--place was just fine, too. Because I gave it my all.

And, wet and shivering at pool's edge in the early evening chill of a June evening--my self-esteem was born.

Don't get me wrong. Satisfaction with my best didn't mean settling for 4th, 5th or last. It meant pushing myself to whatever personal best I was capable of. And, the summer I turned 14, for a few glorious weeks between our regional meet and state finals, I held the state record for the 50-meter backstroke. There were no parades, no newspaper articles, no celebrations of any kind that I remember. Just the self-satisfaction that, for a handful of days, not only had I finally beaten our city's golden-boy swimmer, Richard Hughes (his real name--sorry Richard) but I had--for just a moment--set the bar for that event. My best, for that brief time, was the best.

I'm not sure what caused that sweet memory from so long ago to surface now. Perhaps it's the fact that it's August and, my sense memory still lingers--August means that summer is winding down. School will be starting soon (in those days we squeezed every drop out of summer, starting school after Labor Day). Perhaps, it's because I see clients often struggle with the competitive nature of jobs--and life--in the Bay Area. Maybe, it's just the fact that, sometimes, the events of the world remind me that this is a time that feels...complicated. And the memories of affirmation--and brief victory--feel simpler, purer, more true.

Now, I'm the first to admit that my memory can be selective, embellished, and optimistic. But, in this instance, the memory of my experience--and the values imparted to me--is pretty much true to the time.

In the Virginia summer of my childhood, this would be the time of summer heat, humid nights, fans blowing cool breezes, lighting bugs at dusk and the winding down of lazy days.

Years later, I still feel late August is a time of anticipation. Of a new beginning. Of a new season. Of things unseen and unknown. And, because of my parents' refusal to rearrange reality to suit my life disappointments, I feel blessedly prepared to meet the unknown. Head-on.

Next week there will be another race.

Thanks, Mom and Dad.

And thanks for listening.

Gaining Perspective And Getting Out Of Your Head or, The Rx For Depression: Volunteer.

2011-08-23T16:00:00.000-07:00

Because I'm not a physician, I can't, of course, prescribe medication. However, I have found, in both a personal and professional realm, that a powerful tool in treating depression is participating in volunteer activity. It can be as simple as serving at a soup kitchen, reading to the elderly, assisting teachers in the school setting, distributing magazines and flowers at a hospital...and the list goes on.

The difficulty when you're depressed, however, can be inertia.

Making that first phone call can be monumental hurdle. And, yet, clients (and friends) report that once the call is made and they overcame their first discomfort with a new challenge, they felt something they had not felt in some time: they were needed. They mattered. They had a contribution to make.

I've related in a previous blog my path to becoming a therapist. Looking back, I'm not certain I was clinically depressed, but I was feeling despondent about my career in advertising. I didn't have a someone special in my life. And I was outside of the US, geographically far away from people I loved. Consequently, I was working hard to "figure out" my life. I was spending alot of time in my head, sometimes spinning in details of my life journey to date: my choices, my talents and shortcomings, my relationships and my loneliness. A friend (who probably was tiring of my constant self-examination) suggested volunteering. Her rationale was sound: You have the time, you're good with people, and the worst that can happen is that they can fire you. So you wouldn't be any worse off than you are now, right?

The first step in that journey was becoming a volunteer at the palliative care ward in a local hospital. The training was great and the experience even greater.

If I had to boil the benefit down to one word it would be: perspective.

When we're trapped in our own heads with our own thoughts, the perspective is short, narrow and limited. When we can interact with others on a personal basis, forgetting for a moment our world and its limitations, we're free to develop an amazing quality: empathy.

The folks at Merriam-Webster define empathy as the action of understanding, being aware of, being sensitive to, and vicariously experiencing the feelings, thoughts, and experience of another... When you think about it, it makes perfect sense. It would seem almost impossible to be able to "understand, " "be aware," and "vicariously experience" another's world if we're trapped in our own world view.

Interestingly, the same folks at Merriam-Webster have the following to say about "depression:" ...a disorder marked especially by sadness, inactivity, difficulty in thinking and concentration,...feelings of dejection and hopelessness.... My clients often use words like "stuck" and "spinning in my own stuff."

When a task, service or responsibility becomes about anything but you, your perspective is forced to change--just for a time. But change it must. That's when you "leave your head" and concentrate on the needs of others. It can be a freeing change of scenery.

I remember, several years ago, when my father's best friend, Ron, retired from a lucrative career that was a major part of his life for more than 40 years. After retiring, he became grumpy, withdrawn and generally difficult to be around. His wife, in an effort to simply get him out of the house, insisted he volunteer--anywhere. Reluctantly, Ron volunteered at a local after-school program teaching six-year-olds to read.

It makes for an interesting image. Picture a six-foot-four, 200 pound bear of a man sitting in a tiny little chair, at a tiny little table, holding a tiny little book in front of...yes, a tiny little six-year-old. As the kids learned to read, Ron began to have purpose again. He began to engage others, to laugh, to talk with pride about "his kids," the ones he was teaching to read. His sense of humor returned. He not only became a favorite of the kids, but his long-time friends were glad to have the old Ron back.

Was Ron depressed? I couldn't say. But, when he went from being in charge of a company to having no business influence, he certainly seemed to have lost purpose. It took a six-year-old to bring that back. He went from being "stuck" in his own head to being relevant. And needed.

Will volunteering cure your depression? "Cure" is asking alot. But could it help? My personal and professional experiences say that it certainly won't hurt. And, if things are looking particularly bleak, how can you argue with a change of scenery?

Until later, thanks for listening.

It's All About You--Part II: Keeping Healthy Boundaries.

2011-08-17T10:06:00.000-07:00

Last time, I shared my thoughts on the therapist's self-disclosure in session, and why I feel the focus should always remain on you--the client. In this post, we'll look at the nature of the professional client-therapist relationship, and a few ways to maintain healthy boundaries.

Our relationship is professional. Personal details can blur the lines.
I genuinely care about my clients and their well-being. I'm honored that they choose to share personal and intimate details about their lives. I hope my clients can feel my compassion for their difficulties and my satisfaction in their therapeutic accomplishments. However, despite the caring nature of the relationship, it is first, foremost and always a professional one.

For example, I can feel great satisfaction for a client who has worked to improve interpersonal skills in order to secure a job, and in session, I will congratulate this client for his success. However, I choose not to send cards, make congratulatory calls, and won't--under any circumstances-- go out to dinner to celebrate.

My relationship with you as a client will never be a social one. We meet in a professional setting, and maintain professional boundaries. Because of confidentiality, if we happen to pass each other on the street, I will not acknowledge you unless you have given me explicit permission to do so in advance. If you think about it, if you're with other people and I say, "Hello," the natural question can arise: So, how do you know each other? Ethically, I cannot tell anyone that you are my client, and this conversation puts you in the potentially awkward position of having to disclose that you are in therapy. It may seem cold, but it's an ethical boundary that has served my clients well.

So, what do I disclose to my clients in session?
Again, for me, the acid test is, what is in the best interest of my client? For example, I have worked with many clients over the years who have lost one or both of their aged parents. At times, I have felt it appropriate to share--briefly--about the loss of my parents in order to to show empathy for my client's grieving process. Again, it's not about getting my clients to take care of my grief--it's about showing empathy for theirs.

I don't have an "approved list" of self-disclosures. It usually happens in the moment, is brief, pointed, and designed to benefit the client in the moment. If I'm not sure it's in your best interest to share, I pass.

Does this mean if your therapist discloses more or less than I do that it's "wrong?" By no means. As I said at the beginning, therapist disclosure in therapy is a very individual thing. However, if you feel that your therapist is spending more time talking than listening, and you don't feel like the hour is yours, you might want to address it.

Years ago, before I'd ever been in a therapy session, a friend was describing her therapy to me: I go once a week. My therapist is totally focused on what I have to say, never makes it about herself, and doesn't make me feel bad when I admit my mistakes. She's genuinely interested in what I choose to talk about, but gets me back on track when I ramble. It's the one hour a week where I feel like what I have to say really matters. I feel heard.

Feeling heard. In therapy, it can only really happen when one person does most of the talking--you.

Thanks for listening. (I feel heard.)

It's All About You...Or, My Thoughts On Self-Disclosure In Your Therapy--Part I

2011-08-16T16:10:00.000-07:00

Individual therapy is a unique relationship between two people. One is encouraged to come in and share any and all details of his/her personal life in an effort to gain self-insight, make decisions around personal growth and change, and process deep and personal feelings and experiences from the past and present. The other person--the therapist--sits and listens, usually addressing only what the client brings into the room in a professionally concerned manner.

I've been asked more than once, How come I tell you everything and you never say anything about yourself?

Self-disclosure by therapists is...well, very individual. Most therapists are trained, in general terms, to disclose personal information only as it serves the best interest of the client, i.e., you. The term "best interest" is open to interpretation by each therapist, which means that one therapist may be vastly more self-disclosing than another.

I tend to err on the side of "less is more." And the reason is simple: this is your therapy, your session, your journey, your time, your money--the only thing about me that should enter the room is an experience, an anecdote or a personal detail that will specifically be beneficial to you.

Why "How are you?" is a thoughtful, but loaded question.
My clients often settle into a session with a polite, "How are you?" to which I always smile and answer, "Fine. Where would you like to begin today?" Clients who know me well, know that I won't say more. The reason? Everyone occasionally has a bad day, even your therapist. However, it's not your job to soothe, cajole or otherwise take care of my needs. I'll be ok. And, for some clients, it can be less difficult to divert the conversation to me and my problems, than to talk about their own difficulty. And this can put a roadblock in the way of the real reason you're here.

My experiences are not the important experiences in the room.
Yours are. How I might react, my history in a similar situation, my personal experience in a similar setting are largely irrelevant, as it's your reaction, your history, your personal experiences that matter. Because we're all unique human beings with different histories and backgrounds, it would be presumptuous--and unprofessional--of me to begin to think that you would react to a given situation or pain the same as I would. The important information about your distress is about you.

My feelings are not the important feelings in the room.
Again, yours are. If you ask me in session, How would that make you feel?, I'm likely to gently ask you how it made you feel. Your thoughts, feelings and behaviors are some of the variables that we'll work with in session to help you achieve the changes you're looking for. My feelings about your experiences--aside from my desire to be non-judgemental and compassionate--are simply irrelevant. My goal is to help you by making it safe to look inward.

If you spend your time focusing on me, you're not focusing on yourself.
Many therapists, including myself, have spent time in therapy looking at our own issues and difficulties in life. That said, most therapists can empathize with the fact that, as a client, it's sometimes easier to talk about something other than yourself. However, it's in your best interest--there's that phrase again--to keep the conversation focused on your experiences, feelings and movement forward toward your therapeutic goals.

Next time: It's All About You, Part II: More about the professional nature of the client-therapist relationship and keeping healthy boundaries.

Thanks for listening.

From The Therapist's Deck Chair: Why Pets Make Good Therapists.

2011-08-13T10:45:00.000-07:00

The weekends take me and my partner north of the city to a place overlooking the Alexander Valley. It's a beautiful morning, one of those Saturday mornings where I can hear the sound of dogs, sheep, horses, goats and roosters from the valley below. Oddly enough, the roosters greet every hour and random minute--not just the dawn--with gusto and abandon.

Close by it would feel like a noisy intrusion. Somehow, in the near distance, it's reassuring that we're not alone on the planet.

Aside from this personal observation (as well as a long and mostly satisfying relationship with George and Gracie, our cats), there is scientific data to support the therapeutic benefits of having pets. Studies have found that human-animal relationships can positively affect mood and health, instill healthy lifestyle changes, and play an important role in healthy aging.

Improved mood and health. Recent studies have shown:
*Pet owners survive heart attacks longer than non-pet owners
*If you have a pet, you're less likely to suffer from depression
*Pet owners tend to have lower blood pressure in stressful situations
*Pet play can increase dopamine levels in the blood, which can help you feel calmer and more relaxed
* Pet owners have lower blood indicators of heart disease (lower cholesterol and triglyceride levels).

We can attribute many of the health benefits of pet ownership to the power of touch. Stroking or holding an animal can actually provide a calming effect in times of stress. Interaction with our pets is a way we can express--and receive--affection. Some of our furry friends require physical activity, which can motivate us to move with them. And some forms of vigorous exercise are known mood elevators.

Pets and healthy lifestyle changes. As I mentioned above, pets can help motivate us to exercise. Dog-walking and house play with your cat are two simple ways to get off the couch.

Caring for your pet can also help you feel less isolated and more needed. When you focus on your pet, you are taking your mind off of your troubles and providing nurture for another living thing. The companionship of a pet can reduce anxiety and stress while providing company and comfort. For those who feel life lacks purpose, many pet care regimens provide structure and purpose on a daily basis.

And, if you've ever visited a dog park you know that walking your dog is a great way to socialize with other animal lovers.

Pets and healthy aging. As we grow older, we often become less connected to others. We retire, our children move away, health concerns make us less mobile, and, inevitably, we begin to lose friends and family members to death.

In older age, making new friends can be difficult. As mentioned above, a dog can be a great new friend for you, and can also provide a pathway to new friends.

Dogs and other pets also encourage movement, playfulness, exercise and even laughter (just add one kitten to one roll of toilet paper and you'll see what I mean).

And, in a life that may feel less and less meaningful at times, the responsibility of a pet and its care can not only provide renewed sense of purpose, but also increased morale and optimism.

Like many joys, pets require commitment and responsibility.  Before you decide to add a pet to your life, consider the following:

* While a pet can be playful, it's not a plaything.  All pets require daily care and attention. Feeding, walking, litter box care--they all take time and when you neglect these tasks you're neglecting a living being.

* While pets keep on giving, they also keep on costing. Money. Pet maintenance--food, licenses, spaying and neutering, vet care, boarding fees--can amount to significant sums of money. Be sure you're willing and able to make this commitment before taking on the responsibility of a pet.

* Adorable pets can do deplorable damage.  Despite all your best efforts at training your pets, occasionally they can shred, tear, soil and otherwise damage your furniture, rugs, walls, clothing and virtually anything you leave unattended. You need to consider: pets are not humans and don't understand why we value the items we value. They will encroach on our territory and our things.

* Some pets carry health risks. The most common health problem associated with pets is allergies. The time to find out about pet allergies is before you take on pet ownership, not after. And for some older adults, it will be important to match your stamina, mobility and stability to the right pet.

After all that, you may be wincing and saying to yourself, Well, why bother? Any pet owner can tell you why. And, I began all this with the notion that pets make good therapists. If for no other reason, pets, like a good therapist, listen to us without judgement. Yes, while some pet owners won't admit it, most of us talk to our pets. We ask them how they feel, if they like their food, and confide in them about our day.

The therapeutic part? They listen without reservation. They don't judge or offer advice we may not want. They don't take sides or provide rationales that make our reasoning seem lame. They simply listen. They entertain us. They provide good company.

And wait for the next scratch behind the ears.

Until next time, thanks for listening.

"It's None Of Your Business." And 9 Other Reasons People Say "No" To Therapy.

2011-08-11T07:48:00.000-07:00

Suppose someone proposed the following to you: 1.) Call a complete stranger on the phone; 2.) Make an appointment to see that stranger to tell her about a distressing or shameful part of your life; 3.) Show up and actually tell that person things about yourself and your personal life that you've never told anyone else on the planet--while the stranger says virtually nothing about herself; 4.) Write the stranger a check.

Is it any wonder that therapy could be feared or misunderstood?

Of course, anyone who has been to a compassionate and competent therapist is likely to give a fuller, more balanced account of therapy. In fact, about 8 out of 10 people would report that therapy actually helped them feel significantly better.

So, why do people say no to counseling--at least at first? Here are the "Top Ten:"

1. It's a sign of weakness. Sometimes we're taught that accepting help--of any kind--is an indicator that we can't solve our own problems. But, if we take that analogy to its extreme, that same person would have to believe that it's a sign of weakness to have your appendix removed, your broken leg set in a cast, or your high blood pressure diagnosed. In fact, it takes a very strong person to recognize a difficult situation and take steps to get help.

2. Only crazy people go to therapy. It's far from "crazy" to have the insight and the intelligence to be able to recognize a difficulty that is causing you distress--and to ask for the help that you need. A popular definition of "insanity" is repeating the same behavior over and over and expecting different results. People who take the brave step to enter treatment are ones who are, very likely, tired of the same results and who wish to try a different way.

3. I can't afford it. It's for rich people. It's true that therapy can be expensive. However, most health care plans provide for some mental health care benefits. And, more and more, therapists are offering a sliding scale for clients who cannot afford full fees. In the end, it comes down to the value you place on relieving your distress--and your belief in feeling better.

4. If I tell someone about my horrible experience, everyone will know. Far from it, licensed therapists are ethically bound to hold confidential your therapeutic conversations. In fact, your therapist cannot even acknowledge that you're in treatment without written permission from you. There are a few instances that involve your safety and the safety of others that require your therapist to break confidentiality. Please see my previous post to learn more.

5. I don't want to betray my family. A good therapist will be sensitive to strong familial or cultural beliefs that discourage you from "airing the family laundry" with someone outside of the family circle. Working with your therapist, you can determine how much, and a what point you're ready to talk about family and relationships you have with them.

6. I wouldn't even know where to start. That's ok. However, the one person in the world who is an expert on you is...you. With your therapist's help, you can learn to talk about how you feel about yourself, your relationships, the way you act and the way you think. As you move forward, you can determine how you would like things to be different for you at the end of your therapy.

7. It's nobody's business but mine. No matter how private a person you are, your life, your actions and your choices can have a big effect on others. And others' reactions to your life choices can have a profound--and sometimes negative--impact on you. And so the cycle goes. Recognizing our connectedness in the world can be a first step in actually helping ourselves feel better.

8. Just talking couldn't possibly help. Actually, imagine talking with someone who will never judge you, never disapprove of your choices, never shame you for your past, and who will listen intently with genuine concern and compassion for your pain. This is what the therapeutic relationship is all about. And it may be unlike any other relationship you've had in the past. It can provide you with a safe room to talk about painful things. And, over time, it can allow you to try out different ways of looking at things that have previously felt too "stuck" or shameful to examine.

9. Dwelling on problems will just make them worse. Sometimes, when you first begin to talk about concerns and worries that you've been reluctant to look at before, it can be painful. However, over time, talking freely, in a safe environment can help lessen the pain and provide clarity for future change and choices. Remember, you're not alone in the room.

10. Therapists only want to get you on medication. A competent therapist is going to work to provide you with the best possible care within his or her scope of practice. Unless your therapist is a physician (psychiatrist), he or she cannot prescribe medication for you. It's true that some therapists may refer you to a psychiatrist for an evaluation for medication which may be helpful in relieving your distress. However, it's important to remember, it's only a referral. You decide whether you want to include medication in your treatment. It's only one part of many conversations you will have with your therapist.

As with any relationship, you and your therapist start out as strangers. But, unlike most other relationships you may have, your therapist, through education, training and a genuine desire to help, puts your well-being and best interest at the forefront of your time together. Without judgement. Without pressure. Without an agenda. For once, it's truly all about you. Which can be a very good reason to say "yes" to therapy.

As always, thanks for listening.

Confidentially Speaking: What Your Therapist Can--And Cannot--Share.

2011-08-09T16:23:00.000-07:00

In principle, the therapy room is "Las Vegas:" What happens here stays here. Well, almost.

If you're in therapy with a licensed therapist in the state of California, your therapist has (or should have) already told you that there are a few instances where he or she must break confidentiality in order to address an issue of safety. These instances are:

1. If you tell me that you're going to harm yourself. On occasion, you may have heard many people say in a moment of frustration, "I could just kill myself." Often, this is just taken as a figure of speech, and passed over with no real concern.

However, in the therapeutic setting, even if I really don't think you're serious, I'll discuss the comment with you to understand if you're serious, somewhat serious, unsure or not serious at all about harming yourself. I take any comment about harm to self or others very seriously, until I'm sure there is no reason for concern.

The standard for reporting a client's self-harm is "reasonable suspicion," that is, if, after talking with you directly about your suicidal thoughts and/or plans, your therapist has a reasonable belief that you are going to hurt yourself, your therapist is obligated to call someone to help keep you safe. Before breaking confidentiality, your therapist may attempt to have you agree to a no-harm contract. If this is not successful, or if your therapist believes that you are not sincere in making the contract, he or she may call in the police, paramedics or other emergency response team trained to assess for suicidalitiy.

If these professionals feel you are an imminent danger to yourself, they may initiate a "51/50" which allows you to be taken to a safe place for observation and treatment. The length of the hold will depend on the assessment of the mental health professionals involved.

2. If you tell me you're going to harm someone else. Again, a frustrated person may blurt out in anger, "She's such a jerk. I could just kill her sometimes!" Again, I take the words seriously, and will assess to see if there is any reason to be concerned. Like the scenario for self-harm above, if I have a reasonable belief that you are an imminent danger to another person, I have an obligation to notify that person (if at all possible) and to notify the police.

3. If you tell me that a child (under the age of 18) is being physically or emotionally abused. This child doesn't necessarily have to be in your family. I have an obligation to try to identify the child and make a report to Child Protective Services (CPS), or any similar agency in your community. Physical abuse includes certain forms of hitting, using excessive force in any way and/or sexual abuse. Emotional abuse involves repetitive and degrading behavior, often verbal, designed to intimidate and demean the child. Again, I don't have to have "proof" that there is abuse, just reasonable suspicion. It will be up to CPS to determine if an investigation is warranted. If so, they will usually make a visit to the home or school to gather more information, clarify facts, discuss the situation with the child's family or legal guardians and take any corrective action needed to keep the child safe from physical or emotional harm.

4. If you tell me an elder (aged 65 or older) is being physically, emotionally or financially abused.
Again, this person doesn't necessarily need to be related to you. The criteria for physical and emotional abuse are virtually the same as for children. Financial abuse has to do with unwanted interference with the financial dealings of an elder, theft from assets, cash or accounts, or negligence in the management of an elder's financial matters. As with all instances listed here, I don't need proof. This will be up to a team of investigators from Adult Protective Services, or a similar agency in your community. Like the other scenarios listed above, I'm required to report a reasonable suspicion of these kinds of abuse with elders.

5. If a judge orders me to release your client records. While it has never happened in my practice, on a rare occasion, a judge will compel a therapist to release confidential psychotherapy records. It can sometimes happen when couples who are divorcing or contesting child custody ask their attorneys to subpoena family psychotherapy records.

I am only authorized to release your records (or any requested information about your treatment) if 1.) you provide me with a written, signed release stating that I may do so, or 2.) a judge overrules my attorney's objections to release your records and orders me to provide them to the court.

Currently, these are the specific instances I'm required to report to authorities, and all are directly related to human physical, emotional, or financial safety.

What about domestic violence? Currently, there is no mandate to report incidents of domestic violence between adults. While I may work with you to help you decide how to stay safe or access resources so you can ensure the safety of yourself and your children, I cannot, by law, break confidentiality in this instance.

I've been fortunate. I have never been compelled to release client information. On rare occasions, my clients themselves have asked for very specific information about their treatment to be released. I will only release this information if I've had the opportunity to discuss this with my client so that we both can adequately understand the ramifications of release of such information.

A good therapist will freely discuss with you the limits of confidentiality in therapy. If you're not sure, ask. Neither you nor your therapist should leave disclosure up to a roll of the dice.

Until next time, thanks for listening.

Sitting With Discomfort Or, Accepting What Is.

2011-08-02T14:05:00.000-07:00

Discomfort, frustration, disappointment--none are strangers to most of us. And, none are classified as "disorders." However, if you suffer from an anxiety disorder or clinical depression, the ability to "sit" with your discomfort--to temporarily accept what cannot be changed--can be an extremely helpful coping mechanism.

Developmentally, tolerance of discomfort is usually mastered gradually, starting in later childhood and spanning into adulthood. However, it's a skill or talent, which suggests that we may all have varying degrees of ability in this area. And, given our financial circumstances, physical health, mental health, life stressors--even our diet and drug/alcohol intake--our ability to tolerate mental discomfort can vary widely in different life stages.

I don't like this, I don't want this. But I can't change this. Now what do I do?
According to the Cleveland Clinic's web page on "Emotional Well-being," there are several ways to help cope with things, events--even people--that are causing us distress.

Lowering your expectations. Can you think of a time when you really were expecting too much of the situation? The person? The environment? Or, perhaps, yourself? Adjusting expectations can be a helpful first step in sitting in the here and now.

Asking others to help or assist you. Sometimes relief is just a question away. Trying to do everything on our own can cause us to feel isolated and overwhelmed. Learning to ask for help can lessen the discomfort.

Taking responsibility for the situation. Said another way: "Own your stuff." This can be difficult, especially if we're used to trying to share the blame. You may not be able to change a situation, but if you can own it, you may be able to accept responsibility until a solution comes along.

Engaging in problem solving. Sometimes, it's difficult to look for solutions when we're feeling down or hopeless. But, breaking the "there's no way out" self-talk can provide an alternative--even in theory--to what may seem to be a dire situation.

Maintaining emotionally supportive relationships. Sometimes, it can be extremely helpful just to talk with someone--someone who knows you, listens to you and can give you what you want in a listener. Sometimes we want someone to listen and provide feedback. Other times, we simply want someone who will let us vent. Maintaining supportive relationships can give us these outlets.

Maintaining emotional composure or, alternatively, expressing distressing emotions. I've never been a big fan of "holding it in," but there can be therapeutic benefit in not letting our emotions get the best of us. What does this mean? It can be as simple as resisting strong emotional urges: to cry, stomp, throw things, yell--or worse. Constantly yielding to every emotional urge can lead to feelings of being out of control. Expressing distressing emotions through discussion, journaling--even art therapy--can provide a socially acceptable outlet for our emotions that doesn't add to our distress.

Challenging previously held beliefs that are no longer adaptive. Self-talk can be central to coping with discomfort. By listening to our internally-held beliefs and challenging their usefulness in our lives, we have the opportunity to literally change our "internal" minds, and release ourselves from beliefs that no longer serve us.

Distancing yourself from the source of distress. Sometimes "acceptance" takes the form of distance. If a person or situation is causing emotional discomfort, putting distance between yourself and the source doesn't necessarily solve the problem, but it can make it easier to tolerate.

Viewing the problem through a religious or spiritual perspective. Using the "filter of faith" can be helpful in relinquishing a problem. "Giving it up to God, " or "surrendering a problem to the universe" can provide both relief and freedom from a discomforting situation that is beyond your control.

Regardless of which techniques you use, experts agree that coping is a process rather than an event. You may find yourself using one or more coping mechanisms or alternating between them.

If you're reading this and finding that you're quietly resisting help at every turn, you may want to ask yourself: What's in the way of my accepting an alternate way of dealing with my distress? Why don't I want to try to lessen my discomfort?

Unless you live a charmed life devoid of stress or disappointments, you'll likely find that sitting with discomfort is a part of everyday life. If nothing else, take a few deep breaths and take mental stock of your blessings. Gratitude can be a wonderful healer, too. But that's a subject for another posting.

Until then, thanks for listening.

Treatment For Anxiety: First, Take Five Deep Breaths And Pick Up The Phone.

2011-07-28T11:57:00.000-07:00

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.

Anxiety: Am I Having A Normal Reaction To Stress...Or Something More?

2011-07-27T10:35:00.000-07:00

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.

The Zen of Listening For Understanding or, "When Walking, Walk. When Eating, Eat."

2011-07-21T09:20:00.000-07:00

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.

How Do I Know It's Time To Get Help or, Is This Normal Or...Something Else?

2011-07-18T22:53:00.000-07:00

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.

Getting The Most Out Of Group Therapy

2011-07-12T07:30:00.000-07:00

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.

Group Therapy: Strength In Numbers, or "I'm Not The Only One Who Feels This Way!"

2011-07-09T10:51:00.000-07:00

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:

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.

It's Your Time, Your Money, Your Life--Your Therapy. Who Do You Choose?

2011-07-07T07:54:00.000-07:00

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.

Counselor, Therapist, Psychologist, Psychiatrist? How many does it take to...?

2011-07-06T07:18:00.000-07:00

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.

.

From The Therapist's Deck Chair, or The Mental Health Benefits of Watermelon.

2011-07-04T10:54:00.000-07:00

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.

The Depression Quiz, or Is It All In Your Head?

2011-06-30T08:40:00.000-07:00

What do Buzz Aldrin, Winston Churchill, Agatha Christie, Rodney Dangerfield, Charles Dickens, Eminem, Terry Bradshaw, Dick Cavett, Courtney Cox, Nelly Furtado, Janet Jackson, Beyonce, John Lennon, Abraham Lincoln, Isaac Newton, Marie Osmond, Edgar Allan Poe, Sergei Rachmaninoff, Anne Rice, John D. Rockefeller, Brook Shields, Mark Twain, Kurt Vonnegut, Mike Wallace and Walt Whitman have in common?

Sorry for the long list, but the famous people listed above are only a few of a long, long list of notables who have suffered from depression.

Yes, a man who walked on the moon, legendary recording artists, sports greats, noted authors, gifted composers, presidents, moguls, celebrated actors--all have experienced bouts of serious depression.

And yet, despite revelations from public figures, the stigma and misunderstanding about depression persists. Just how informed are you about depression? Can you separate fact from fiction? Try your hand at the quiz below.

TRUE OR FALSE:

1. Depression only happens to people who are weak emotionally disturbed.

2. Depression isn't really a medical condition at all--it's all in your head.

3. Depression is like getting the blues--a normal part of life. Stuff happens.

4. Teens don't suffer from real depression--they're just naturally moody.

5. Symptoms of depression can last for months, even years.

6. Thinking positively will make your depression go away.

7. You're not certain to "inherit" depression even if it runs in your family.

8. Depression can cause emotional and physical pain.

9. Developing depression requires a specific negative event.

10. Taking anti-depressants will change your personality.

The answers are below:

1. False. Depression is an equal-opportunity disorder that affect millions of strong, decisive, functioning and otherwise healthy individuals every year.

2. False. Depression is a medical condition that affects not only mood and thoughts but also your body. Those suffering from depression have been found to have higher levels of stress hormones as well as decreased levels of activity in some areas of the brain.

3. False. Depression is to "the blues" as pneumonia is to a cold. Unlike feeling blue, depression is pervasive, deep, long-lasting and can lead to far greater and more damaging outcomes including suicide.

4. False. Depression can affect people of any age, socioeconomic group or ethnicity. And depression isn't the same as "moodiness."

5. True. This is one of the characteristics that separates true depression from the occasional few days of feeling sad or down.

6. False. You cannot "think" your way out of depression any more than you can any other illness. Depression is a condition caused by a variety of factors which are thought to include changes in brain chemistry and structure due to environmental and even biological influences.

7. True. Just because family members have suffered from depression, it's not a given that you will. While you may inherit a tendency toward depression, and genetics can play a factor, it takes a combination of factors to develop depression.

8. True. Depression can be accompanied by changes in body chemistry which not only affect mood but also how you feel physically.

9. False. While there are precipitating events that can trigger a depressive episode, depressive symptoms can arise suddenly, even when your life seems to be going well.

10. False. Anti-depressants are designed to work with the body chemistry related to the symptoms of your depression, not the neurochemistry related to personality. Many people who take anti-depressants report feeling more like themselves, with relief from depressive symptoms.

So, how did you do? More and more, people are demystifying mental illness by shedding light on the facts, and talking about their own experiences of depression, anxiety, phobias and more.

And the prevailing views on depression are becoming less shame-based, and more tempered by understanding and compassion.

All in your head? Hardly. If you've been feeling deeply sad and hopeless for more than two weeks, with little hope in sight, and have difficutly just getting through everyday activities, you may benefit from time with your physician, therapist, lay counselor, even your minister or rabbi. There is help for how you feel.

And the good news is, feeling hopeless doesn't have to last forever. Just ask Buzz Aldrin, Janet Jackson, Eminem, Beyonce, Mike Wallace, Marie Osmond, Anne Rice...well, you get the picture.

Thanks for listening.

No Quick Fix or, Therapy: It's Not For Sissies.

2011-06-28T23:20:00.000-07:00

I have a confession: I love to look at other therapist's websites. Not only does it help me understand how other therapists view our profession, it gives me a clue as to how others approach the therapeutic process.

In my site-surfing, I often notice words like "journey," "discovery," "insight," and "collaboration." When I took a look at my own site (www.therapistsf.com) one word keeps jumping out at me: work.

I fully believe that, of all the things therapy is, it's primarily a commitment to do work. Yes, it can provide insight, self-revelation, healing, change, coping skills, hope, direction and repair. But not unless you're willing to do the...wait for it...work.

I had a client several years ago who came to me in true despair. In our first session, she flooded--spoke rapidly and non-stop--about her history, her deep hurt and her need to be understood. We were off to the races. It seemed to be a good start, with a clear direction for the work. She seemed as though she would be a good candidate for therapy. However, I should have seen the warning signs when, in our second session, she strode into my office, kicked off her shoes, plopped down on the couch, propped up her feet, put her hands behind her head and said, not-half jokingly: Ok. I've told you everything. Fix me. How do I get better?

There is a place for reclining in therapy but I'm not a Freudian or even a neo-Freudian, so the work done in my office is done sitting up, facing one another. After inviting my client to sit up, I also invited her into the therapeutic conversation. Her refrain, for this session and most of the remainder of our work together was, in essence, "I feel so bad. Fix me. Make it better. That's your job."

After assuring her that I am not in the business of "fixing" my clients, and inviting her time and again to participate in her own therapy, I eventually terminated our work together, referring her to a colleague who I thought might be a good fit. Postlogue: my client never went to see my colleague. I can only guess that she just didn't want to do the work--or wasn't ready to do it at that time.

Therapy is not like a spa-treatment. It isn't done to you. Therapy, at its most effective, is more like a collaborative safari. You and I work to set goals, coming to an understanding (over time) of where you'd like to arrive at the end of our work together. My role, if I'm doing my work well, is to provide not only guidance in the process, but also safety. If I do my job as I'm supposed to, I can help to make the therapeutic conversation a safe one.

Not only do I not judge you, I'll try help you be less judgmental, less critical, less hard on yourself. When the room is safe, when the internal focus shifts from finding blame to finding understanding, it's more likely that clients can actually look at issues that, while painful, can be examined with an eye toward change.

Easy? Not all the time. Again, it's my role (among others) to monitor the room, to watch the intensity of the work, and to make sure you have time to "decompress" from the deep work, so you can feel composed and safe to go back out into the world when your clinical hour is up.

So, does therapy have to be chore? I hope not. Challenging? Certainly. Difficult and emotional at times? Yes, often. But the very word--work--suggests accomplishment. And that can make the challenge, the difficulty and the time spent not only worthwhile, but life-changing.

And when's the last time you got that from a mudpack and loofah scrub?

Thanks for listening.

What Causes Depression? or, Why Can't I Just Feel Better?

2011-06-27T20:40:00.000-07:00

Two children are bullied by the same aggressive child on the same playground. One, frustrated and hurt, seeks support from teachers and family, eventually moving on from the traumatic experience. The other also seeks support from teachers and family, but eventually sinks into a chronic depression. At first, he's identified as an "angry child," or "loner," " a "sensitive boy," or just the child who doesn't fit in. It takes an observant parent, interested teacher or, perhaps, a competent therapist to put two and two together--this kid is depressed.

Given our increasing understanding of depression in children, it may not be surprising to know that, according to a Harvard University study, almost one in four children are clinically depressed. What may actually surprise you (it surely surprised me) is a study published by Psychiatric Services (2002), which reported that the fastest growing market for antidepressants is--yes this is true--preschoolers. Medication, and its place in depression treatment, is food for a future post. In the meantime...

So why does one child move through this trauma, and another, through no fault of his own, carry forward a dark feeling of hopelessness and despair?

The scientific community has a variety of explanations ranging from trauma (emotional and/or physical), genetics, neurochemisty, brain structure--even learned behaviors and beliefs. Lifelong or chronic depression is thought to originate from childhood trauma including yelling or threats of abuse, sexual abuse, neglect, persistent and severe criticism, unclear or inappropriate expectations, separation from one's mother, exposure to violence (real or vicarious), poverty, racism and more.

Short-term depression is often attributed to loss or extreme trauma, physical or emotional or both. Severe and persistent stress is also associated with depressive states.

Some studies suggest that depression is genetic in nature, but posit that the genetic tendency must be "triggered" by some stressful or traumatic event.

Neurochemical imbalance and structural problems in the brain are also cited as causes of depression. Serotonin levels have long been the target of most anti-depressants; recently, the presence of the stress hormone, cortisol, has been tied to the incidence of depression.

Finally, the things we learn--as children and as adults--can shape our reactions to the world as well as our ability to make functional decisions, causing not only stress but also situational or longer-term depression.

Regardless of the cause, depression is not simply a deep sadness. It's a more complicated, pervasive and difficult-to-shake disorder. It's not a weakness or an inability to "take life's lumps." It hurts. It can be overwhelming. And, while there's no definitive understanding of why it affects some people and not others, there are trends of understanding who it does affect. The research continues.

In the meantime, if you know someone--perhaps yourself--who seems perpetually sad, or feels hopeless more often than not, I invite you to exercise compassion. No one who has ever felt true depression would ever wish it on anyone.

The good news is, that, with treatment, much headway can be made in lessening depressive symptoms and restoring those afflicted to happier, productive lives.

Feeling better--it can happen.

Coming soon--Myths About Depression: What It Is And Isn't.

Until then, thanks for listening.

On A Personal Note....

2011-06-26T15:34:00.000-07:00

Just 10 days ago, I wrote about my affinity for working with seniors and the gifts they bring to the work I do. I would be remiss if I didn't explain that my genuine affection and admiration for seniors extends to my personal life as well. Two days ago, I lost a good friend, Florence, who died after a brief decline at the age of 91 (she would have claimed "92" as her birthday is only a handful of weeks away). I don't think she'd mind my using her real name. I can hear her now, a a twinkle in her clear blue eyes: "After all, it's me you're talking about, isn't it?"

To know Florence was to know optimism, wit, humor, and a tenacity for living.

She worked as an architect at a major university, and was actively involved in campus projects until her last years; in fact, at her death, she still maintained an office on campus.

I knew Florence in only a personal capacity--which was rich and fulfilling on its own. Over the years, I met many of her colleagues who not only held her in awe for her professional longevity but also for her work ethic, high standards and what can only be described as the ability to connect with you.

In conversation with Florence, you were met with her steady gaze and an intent expression that said I'm listening, I want to hear every word. When she spoke, it was meaningful, interesting, full of recollections of time passed. She was blessed with an elephantine memory; and she was also blessed with the restraint of someone who knew just how much of a story would be of interest. I never knew Florence to be repetitive or boring. And even if she had been, her charm would have eased away any ill feelings over it.

Florence's ever-ready answer for any suggestion of adventure, travel, engagement, performance, discovery or renewal was: Yes! Her enthused, "Wouldn't that be fun!" welcomed most social engagements with gusto. I never knew her to say no--to any discovery to come.

She travelled extensively in her later years, often to Austria or Italy, and on a regular basis to her home territories of New York City and the Pennsylvania farm country. If you ever needed a review of the current Broadway theatre offerings, Florence could fill you in. Likewise with the current symphony performances and latest best-selling authors. She maintained her membership with the Metropolitan Museum, and delighted in treating her guests to lunch at the patron's dining room there. The view of Central Park was magnificent from our table, and she seemed equally excited to see it as her guests.

Florence seemed, to me, to squeeze every drop out of every day. She paced herself as needed, but seemed, until only the past several months, to be on a mission to live every day fully.

This past May, on Mother's Day, she invited a handful of guests to join her at home. I had been out of touch for several weeks, but knew that she had been in a skilled nursing facility for physical therapy. What I didn't know was that she had not returned home to live by Mother's Day: "I sprung myself for the day!" she chuckled, hosting a catered lunch in her own dining room. It was typical Florence. She was determined. She usually got what she wanted.

In the face of age, Florence was the definition of grace. A realist without being morbid, Florence simply seized each day as she was able, and invited her friends along for the ride. She lived in a lovely, generous and dignified way. She will be missed beyond what words can express.

Depression: When You've Got More Than The Blues.

2011-06-22T12:25:00.000-07:00

Depressive disorders are thought to affect about 9% of the adult U.S. population each year, or more than 18 million Americans over the age of 18. Some studies claim that even if you yourself don't develop a major depressive disorder, you'll be affected by someone else's depressive symptoms during your lifetime.

I'd like to take some time here and in subsequent blogs to take a look at depression and to shed some light on what it is and isn't, conventional treatments, and some common misconceptions about depressive disorders.

Most of us feel "down" or "blue" every so often. It can be a normal reaction to a sad or disappointing event, loss, or even a physical condition. But, when these down feelings deepen into feelings of profound and persistent sadness, worthlessness and hopelessness, you may be suffering from a depressive disorder.

A "low-grade" feeling of persistent sadness almost daily that lasts for more than two years can be a condition known as dysthymia. It can cause mild to moderate distress that can interrupt or hinder the enjoyment of daily activities.

A severely depressed mood that lasts for more than two weeks is called a major depressive episode. More severe than dysthymia, major depressive episodes are usually characterized by depressed mood, inability to take pleasure in formerly pleasurable activities, loss of energy, isolation from friends and family--and more.

There many diagnoses for depressive disorders but most require evidence of distress which interrupts daily activities or normal enjoyment of life. Depression can also be characterized by atypical changes in appetite, weight or sleeping patterns (too much or too little).

While depression has a number of causes, if you suspect you're depressed, it may be a good idea to see your physician, as there can be any number of organic conditions that contribute to or cause depressive symptoms.

Depression can also "somatize" or express symptoms in the body, commonly including generalized body aches. According to one study, 80% of people who see a doctor are depressed. Additional studies increasingly link depression to illness, including osteoporosis, heart disease, eye disease, back pain and diabetes, among others.

The good news is, despite conflicting opinions on treatment of depression, many studies conclude that talk therapy, in coordination with antidepressant drug therapy can be effective in treating depression. One of the first steps to treatment, however, is overcoming some of the stigma people feel about depression. In a 2004 study by the National Mental Health Association, 54% of people feel that depression is a personal weakness; in a previous survey, the same organization reported that 41% of depressed women are too embarrassed to seek help.

Recognizing that depression is an illness, not a weakness, can help many shift away from feelings of shame and inadequacy to a more realistic view that embraces treatment. And, if you're having a hard time seeing depression as an illness, then consider this: depression causes more absenteeism each year in the U.S. than any other physical disorder, costing employers more than $51 billion--yes, billion--each year in sick pay and lost productivity.

And that's enough to make anyone feel a little blue.

Coming soon: Causes Of Depression.

Until then, thanks for listening.

Defense Mechanisms: How They Serve Us, How They Don't, Or Mother Nature: Great Protector, Lousy Therapist.

2011-06-21T07:04:00.000-07:00

Defense mechanisms--we all use them, sometimes daily (often unconsciously), to protect ourselves from unpleasant thoughts and emotions. Trouble is, these built-in ways of organizing and viewing our reality sometimes do not serve our true needs. As often as not, they only help us but a band-aid on the underlying difficulty. Recognizing how our defense mechanisms are at work can help us begin to see how we handle our emotions and unresolved tension; further, we can then examine if these really work for us and how we'd like to do things differently.

Here are five common defense mechanisms. Recognize anyone here?

1. Rationalization. Chances are you're familiar with this one. It's defined as, "Creating false but plausible excuses to justify unacceptable behavior." An example might be cheating on one's taxes, with the rationalization that, "The government is too big and powerful and has billions--they can spare it."

Why it doesn't serve us: if we truly believe that we're exempt from the rules of society or from basic ethics, we're more likely to behave in ways that will eventually get us in trouble--great or small.

2. Identification. People often use identification to bolster their self-esteem by forming an imaginary or real alliance with a person or group. It's a way to feel better about ourselves by association: by joining a sports team, social group, club, fraternity or clique which we feel will elevate our perceived worth in the world.

Why it doesn't serve us: while identification does allow us to feel better at times, it can also take the place of genuine self-examination and change.

3. Displacement. Ever come home from a bad day at work and take it out on your spouse? Then you've used displacement, which is defined as "Diverting emotional feelings (usually anger) from their original source to a substitute target."

Why it doesn't serve us: Actually, some forms of displacement can provide healthy outlets for anger, for example, taking frustration out on a punching bag or screaming into a pillow to release anger. However, when the recipient of your displacement is a physical object (punching a hole in a wall) or a person (verbal or physical abuse), you have crossed a boundary between acceptable and unacceptable behaviors that could damage your possessions--and your relationships.

4. Regression. Regression is defined as "A reversion to immature patterns of behavior." A reaction to frustration or disappointment, regression can take the form of an old-fashioned tantrum that would more likely be appropriate to a cranky two-year-old. While it's often evident in teens, adults also exhibit their share of regressive behaviors.

Why it doesn't serve us: Like displacement, regression allows for release of emotions, but results in behaviors that put us in a very unfavorable light. Instead of evoking empathy or understanding, regression tends to put distance between us and others.

And, finally,

5. Repression. Repression involves keeping distressing thoughts and feelings buried in the unconscious. Repression of painful memories has stirred much controversy, especially when these memories surface in the form of devastating accusations of others such as molestation or other forms of abuse. Court battles have been fought over the validity of such memories, resulting in decisions which deem the memories to have varying degrees of validity from completely untrue to completely accurate.

Why it doesn't serve us: Pushing down feelings, emotions and painful memories can result in a buildup of anger and resentment. When the offending events are completely repressed, the accuracy with which they can be recalled is both unpredictable and often unreliable.

The laundry list of defense mechanisms is much longer than we can devote attention to here. Suffice it to say, mother nature has provided us with many ways to order our reality in order to feel better about it, from making seemingly valid excuses to completely erasing offending experiences from consciousness. Ultimately, they tend to do little help us examine the real issues in our lives that can cause us not only distress, but also a distortion of our actions and our place in the world.

While, as a species, we are blessed with remarkable mechanisms for adaptation both physically and psychically, defense mechanisms, more often that not, leave us just that: defended.

More on defense mechanisms later. Thanks for listening.

Coping Strategies: Deciding To Get Better or "How's That Workin' For You?"

2011-06-20T14:02:00.000-07:00

In my previous blog I spoke of goals for therapy. Many clients discover (or just are reminded) that their therapy cannot effect change in anyone but themselves. Because the people and some situations that create distress in our lives are generally beyond our control, many goals for therapy center around developing coping strategies. Developed with your therapist, these are strategies for finding different behaviors that serve you and reduce your distress.

Depending on your goals and the way you work with your therapist, these strategies can include:

1. Changing patterns of behavior. By taking responsibility for our own actions, we can empower ourselves to eliminate behaviors that bring us, intentionally or unintentionally, harm or distress.

2. Changing our "self-talk." Almost all of us have some sort of running thought dialogue with ourselves: things we tell ourselves about the way the world works; judgments we make about ourselves and others; assumptions and expectations that we have (some realistic, other not). Changing self-talk can be an effective way to reduce distress.

3. Changing our narrative. Some clients view their lives as an on-going narrative or "story." It's often comprised of what others have taught or told us about ourselves, as well as contributions we've made to our own story. If your narrative has become a story that makes your feel frustrated or "bad" about yourself, re-examining the story (and amending it) can be helpful in alleviating these feelings.

4. Challenging our belief systems. Just as taking another look at our life story can be powerful, re-examining our current belief systems can be empowering, too. Sometimes we're operating under antiquated belief systems that we were taught in the past; because people change, at times our belief systems no longer serve us. Challenging our beliefs (and the limitations and distress they bring to our lives) can help us re-define what is really important to us.

Of course, there are many other ways to navigate your therapeutic journey. These are only a start. The key thing they have in common, is that they start with you: your actions, your thoughts, your story, your beliefs. Sometimes, this intense focus on yourself can cause you to feel uneasy, shameful, or frustrated. With a good therapist, you'll find that this focus suspends blame and shame, and emphasizes change for the purpose of feeling better.

As Dr. Phil is famous for asking his patients, "So, how's that workin' for you?" If you look at your own behaviors and decisions and the answer is, "Not so well," then at least you've started the process: you know what doesn't work, and can focus on alternative strategies the might work better.

Next time: Defense Mechanisms: How They Serve Us, How They Don't.

Thanks for listening.

Setting Goals For Your Therapy or How To Get To "Better."

2011-06-19T22:26:00.000-07:00

In earlier blogs, I've offered ideas about how to choose a therapist and what you might expect in your first session. Later, I'll offer thoughts on how therapy comes to an end. What's left? The in-between: the work.

If you're like alot of people, you're likely to come to therapy in fair amount of distress. Some distress shows up emotionally: anger, fear, sadness, frustration, shame, doubt, anxiety, confusion, just to name a few. Other times, distress is accompanied by physical symptoms: insomnia, weight loss, weight gain, loss of appetite, stomach pains, as well as assorted body aches. Distress can also show up as a challenge for relationships: rocky romantic relationships; difficulty with bosses, employees or coworkers; rifts with family or friends. Distress can even come from isolation from relationships, which causes distance, and can gradually erode your contact with the world outside your space.

No matter how your distress manifests itself, most people come to therapy with a common goal: to feel better.

It's likely that, early on, your therapist will help you to develop your goals for therapy. It gives your therapist a specific direction for your work together and helps you both have a clearer understanding of how therapy is progressing. Setting goals can help you answer the question: how will I know when I'm getting better?

Goal-setting can be a challenge. Understandably, my clients often walk into their first session in a great deal of emotional pain. They may not be able to name "goals" for therapy. As soon as it feels productive I like to introduce the idea of goal-setting with the question: At the end of our work together, how would you like things to be different?

Together, we take a look at every goal you might have. Then, over the course of a session or two, we begin to prioritize goals. Which one or two are the most important for us to start with? Which goals are truly achievable in the therapy office? Are your goals about changing yourself from within, or are they focused on changing others in your life? If you're out to change people who are not even in the room, who may not even feel there is a problem--may not want therapy or any changes in their lives--chances are the results of your therapy will be disappointing, if not fruitless.

Your therapy is about you. Your distress, your symptoms, and how you cope. The only productive goals are ones that focus on the changes you wish to see in yourself.

Goals should be realistic, observable and, as much as possible, measurable. For example: if you're feeling depressed and are isolating yourself from friends and family, one goal might be to eventually reconnect with the very people who might provide you support. One way to measure this goal would be to log the number of outside contacts you make with these people each week, with increased contact as the goal over time. Weekly discussions with your therapist might include examination of what worked and what was in the way each week of the contact you want to have.

As I've stressed in previous blogs, everyone is unique. You'll work at your own pace; no two clients experience the same velocity or depth of progress. While there are, alas, no guarantees, many clients, over time, report feeling better. Goals can help you and your therapist focus on where you want to go in your journey together. Along the way, you and your therapist will hopefully discover what works for you and, together, you will start seeing the results: feeling better.

Better is better. I wish this for you in your therapeutic journey.

Thanks for listening.

The Gift Of Working With Seniors.

2011-06-16T20:17:00.000-07:00

Eight years ago when I was in training to become a therapist, I was privileged to begin working with a group of men and women whose average age was about 80. From the beginning, it was a good fit. I have always had an affinity for older adults. I was the child of older parents (40 and 47 when I was born), and, hence, an extended family of older aunts, uncles and grandparents.

According to Wikipedia, as of today, there are approximately 311,563,000 people in the US. Approximately 12% of this population are over the age of 65; approximately 45% are men; 57% are women. And, as this population ages, women will outnumber men in larger percentages, as they tend to outlive their male counterparts.

While the AARP was eager to have me join their fold when I turned 50, for the purpose of this discussion, I'll use the term "senior" to refer to older adults who are age 65 and above. NOTE: I struggle to find a term that appropriately honors this group; the term "golden years" makes them laugh; "elders" has a more dignified ring to it, but implies a family structure and respect that, unfortunately, sometimes does not exist. "Senior" seems to evoke the least ire in the older adults I work with.

While no two individuals have the same history or experiences, I've noticed that many of the seniors I work with have similar issues that tend to surface on a regular basis. So, at the risk of generalizing, I'll share a few observations from my work with seniors about the lifestage challenges they are facing:

1. Physical decline. Thanks to advances in medicine and health care, many seniors are living longer and coping better with the physical (and mental) tolls of the aging process. However, many eventually face a variety of age-related or inherited conditions which include, in my experience with seniors, osteoporosis, arthritis, certain cancers, high blood pressure, dementia and decline in vision, hearing and mobility.

2. Loss of independence. Almost proportionally related to physical decline is loss of the ability to perform tasks of daily living (laundry, cooking, cleaning, grocery shopping, paying bills and especially driving) as well a decline in safety while living alone.

3. Fear of falling. Certain medical conditions, age-related declines in strength and coordination, as well as side-effects of certain medications all can contribute to the risk of falling. Often, falls go unreported for fear that well-intentioned friends or family members may pressure seniors to move out of their homes to a places where their safety can be ensured--or at least monitored.

4. Difficulty with adult children. Seniors I work with often report that their adult children either a.) fail to see or refuse to acknowledge the fact that the aging parent simply can't do the things he or she used to and needs help; or, b.) fail to hear and respect their aging parent's wishes regarding how they would like to navigate their old age. Somewhere between showing little concern or overwhelming interference is the adult child who engages their adult parent as just that: an adult. And this is where most seniors find the respect and support they need.

5. Invisibility. Some of my senior clients report, that, over time, they seem to fade from view (or concern) of family and friends. As seniors lose their spouses and become single again, coupled friends call less frequently, issue fewer invitations. Seniors report being ignored, sometimes blatantly disrespected by "young people." And, because some seniors tend to move and respond more slowly, others often express frustration or stop including seniors in their plans altogether.

6. Pain. Aside from the emotional pain of isolation, many seniors experience varying levels of chronic pain. Again, it's often not communicated to others, as seniors often tend to just "live with it."

Of course, the aging process, particularly as one passes 80, provides many more challenges than the ones I've listed above. So, why do I refer to working with seniors as a "gift?" In my experience, seniors bring so much into their group work, so many valuable and inspiring offerings--among them:

1. Wisdom. With experience and age comes a depth of exposure and understanding that most 20-year-olds cannot and do not have. I doubt that 40- or even 60-year-olds have the mileage and the patina of experience that accumulates by one's 80s.

2. Generosity of spirit. My senior clients demonstrate an extraordinary empathy for one another--and even for those who misunderstand them. What may have caused ill will at 40 ceases to be important at 80. When I asked my seniors what advice they would give to a 30-year-old, one seasoned client replied without hesitation: Don't sweat the small stuff!

3. Perspective. With age, comes development of what I refer to as "the long view." Relationships have had time to mature, deepen or fail; children have grown up, moved out and made their own ways it the world, complete with their own successes and disappointments; careers have been concluded, accomplishments and failures duly logged, fortunes made and lost. With the long view comes an appreciation for what really matters: family, personal connections with friends, health and physical ability to enjoy the day. The rest, in perspective, ceases to matter so much.

And for some,

4. Serenity. One sage senior summed it up this way: Don't "should" all over yourself. "I should have done this, said that, been more this way, less that way...." The seniors I work with--some, not all--have traded in that self-talk for something more positive, along the lines of, "I did the best I could. I can only move ahead. I can't beat myself up for the past. I will learn from my mistakes and try to take that learning forward."

Amen.

Thanks for listening.

How I Got Started.

2011-06-15T23:37:00.000-07:00

The experience that most influenced my decision to change careers at age 46 (from advertising creative director to psychotherapist) was my volunteer work in the Palliative Care Unit at St. Paul's Hospital in Vancouver, British Columbia, Canada. The ward was, originally, one of the first AIDS hospices in North America, a model for many other facilities. As AIDS research yielded drug therapies that slowed the devastation and afforded longer lifespans, the hospice ward at St. Paul's began to see more and more elderly men and women afflicted with more age-related terminal illnesses along with an inevitable number cancers which, at the time, were more often fatal than than they are today.

At the time I began my volunteer work I was already entering the "restless" stage of my 25-plus years in advertising and marketing. An unsettling voice inside was saying There must be more to a life's work. Not sure what I was looking for, but intrigued by a friend's suggestion of hospice work, I entered a rigorous volunteer training program; six weeks later, one or two evenings week, I was sitting at the bedsides of mostly older adults confronted with the final stages of illnesses that would eventually bring their lives to an end. As volunteers, we were fortunate to have been trained by professionals who gave us tools--and boundaries--with which to be actually useful to our patients. I remain grateful to Sharon, our volunteer coordinator, who was patient with all of us, and a particular inspiration to me.

My volunteer role was almost exclusively errand-driven: fetching tea and coffee for my patients and their visitors. Writing letters for those who felt the need to express words of closure, or to reconnect with an old friend. Even running to the nearby drug store for writing supplies, stamps or some forbidden chocolate (not to worry--all treats were approved by the floor nurse).

Some of these patients were simply on the ward to give their full-time caregivers a week or two of respite--which meant that, during the course of a year, I might see them leave and return to our ward several times. Others came in periodically for pain management, then, a fancy term for finding the right combinations and dosages of meds that would alleviate pain without completely dulling contact with one's waking world.

As the months went by and I became more accustomed to the routine and rhythm of the ward, it became more clear to me that another group found their way to the 8th floor: those who were in the final stages of their battle. Sometimes there was a stream of visitors for those who were starting what the floor nurses informed me was "active dying." There were final goodbyes and tears shared with family members.

But, sometimes, few people, if anyone came. If a patient was lonely, or sometimes just scared, I would stop by and ask if they would like a visit. If they felt up to it, and said yes, I would often just sit with them, sometimes holding their hands. Often, they said very little, if anything at all.

Other times, however, they would interrupt the quiet hum of the ward with an intimate, personal monologue. It was often a series of reminisces about simpler times, old loves, life dreams and disappointments, shining moments, regrets--personal, intimate, a life-review of sorts, shared with me, the person completely unqualified at the time to do anything but listen, smile and nod. This was the first time I was struck by the human need to be heard. To know that someone is listening. To feel that what you are saying, what you've done--that your life--matters.

And, most of the time, a smile and nod were acknowledgment enough. But I was left wanting to do more. Despite the fact that we, as volunteers, were carefully trained not to try to solve problems, or offer advice, I often wished I could do more to ease their distress. But at that time, our job, as volunteers, was to make the time we spent with patients completely about them. So my need to help (beyond my capacity) was subordinated to their need to make the final leg of their life journey in whatever way helped them most.

In the ensuing years, I've become qualified to offer more than smiles and nods. But my path to becoming a therapist started in the company of those older adults who honored me with their stories and most intimate thoughts. While I enjoy my work with clients across the lifespan, I continue to enjoy and be honored to work with older adults. More tomorrow about the gift of working with seniors.

Thanks for listening.

Tell Me A Little About Yourself: Your First Therapy Session Part II

2011-06-14T23:01:00.000-07:00

Once you've given me consent to treat you, the floor is yours. I usually start with, "Where would you like to start?" For some, the floodgates are unleashed; if you've been carrying something extremely painful--all by yourself--and haven't found the words or the opportunity to tell a close friend or spouse, there may be alot that comes spilling out. For others, there can be issues with self-esteem or a deep underlying shame that makes it too difficult to utter the words that express the core issue; and so, there is a gradual "warm-up"where you, the client, regularly take the temperature (and assess the safety) of the room to determine how much you can tell this person you met only minutes ago.

In either case (flooding or reserve--or a multitude of variations in between), eventually, most clients find it safe enough to talk about the issue that brings them to therapy and the distress it is bringing to their lives. From there, your therapist will be looking for ways--therapeutic interventions--to help.

If not in that first session, then soon after, I'll gather a bit more information about you that will help me understand more about you. The questions may seem a bit mundane, possibly intrusive to some, but let me share the rationale behind them. It's not idle curiosity--I need to understand the person on the couch (you) as much as possible to do the best possible work with you.

Aside from your name, I need to know your date of birth, just in case you want me to file insurance for you--most companies require it. Also if your physical appearance isn't in sync with your biological age (you appear significantly younger or older than you are), then I need to have an idea of the time span you've spent on earth to understand what world events you've experienced: WWII? Kennedy's assassination? The summer of love? 9/11? World events can shape our world view, and it helps to understand yours.

I also ask for your address. Again, most standard insurance forms ask for this. I rarely send communication through the mail to your home (and only with your express permission) but if I need to do so, your address will come in handy.

I ask for an emergency contact person and a way to reach him or her. In case you should become ill in session and need medical attention, it helps to know who you would like to be informed, either to assist you or to provide them with information--because they care.

I ask who referred you. I always appreciate referrals; and, while I cannot thank your friend for referring you (confidentiality!) it's nice to know they feel good enough about our work together to send a friend to my see me. Also, I have a website and use selective advertising from time to time in order to publicize my practice. It's helpful to know where people find me.

Your marital status may or may not be germane to our immediate conversation, but it tells me about your history of loss (divorced? widowed? separated?), and who may or may not be in your life to support you when things are difficult.

I ask the reason that brings you to therapy, and more specifically what made you decide to come for treatment now? I find that people carry different levels of distress for differing periods of time. If there has been a recent event or life change that made therapy a viable option for help, it helps me to know this.

I ask about previous therapy. If you've been in therapy before, I would like to know what worked for you in past therapeutic sessions, as well as what didn't. If you're new to therapy, I can be alert to your concerns about how the process works; as well, I can take more time to explain our work if it seems like this will be beneficial.

Don't be surprised--or offended--but I ask every client about alcohol and/or recreational drug use. I've worked for many years with drug offenders in the legal system who are mandated for treatment, and I've found that the connection between numbing out and psychological distress is often strong. I don't judge anyone's use: the quantity, the reasons you use or any of the distress you may report associated with your use. But it helps me to know more about how you may or may not use substances as a coping mechanism. I will also ask that you not come to session under the influence. It's almost always a poor use of your time in session if you're not completely present.

Finally, I'll ask a little about your medical history, as well as any prescribed meds you're currently taking. While I'm not a physician and cannot dispense medical advice, I may refer you to your physician to rule out any organic (physical) causes of the distress you describe.

Seems like alot to ask, and yet it takes very little time. For some clients, it provides warm-up conversation that's easier to tackle than the deeper, more weighty stuff. Most importantly, the answers come from the person with the most accurate information and expert understanding of you: you.

In future blogs we'll explore more of how the therapeutic process unfolds. For now, I believe our time is up. Thanks for listening.

You Have The Right To Remain Silent (But Didn't You Come To Talk?): Your First Therapy Session: Part I

2011-06-13T22:35:00.000-07:00

In my last post, I mentioned a few ideas on how you might go about choosing a therapist. Once you've chosen one...then what? More than once, after our first session together, my clients who were first-timers to therapy have commented "That wasn't what I thought it would be." Thankfully, most felt it was easier, less threatening, not as emotionally difficult as the session they had conjured up in their heads. Again, the mental picture of therapy is fraught with stereotypes that, in many cases, is inaccurate at best. Think: classic New Yorker cartoon: The therapist, almost always male, looks eerily like Freud, with beard, round glasses and notepad poised. The client is almost always in semi-repose on a couch or divan, gazing at the ceiling, and saying (in true New Yorker style) something not only ironic, but chuckle-inducing.

What these cartoons are parodying is called psychoanalysis, pioneered by Freud and built upon, modified and changed as the therapy profession grew, creating a variety of theoretical orientations that are still in use today (my first therapy experience--see my previous blog--was at the hands of a decidedly psychoanalytical therapist, with strong overtones of what has been referred to as the "silent analyst." While he was well-trained and completely competent, we weren't a good fit).

I tend to practice using a blend of cognitive behavioral and reality therapy. But, before I drown you in jargon (more on theories in a later blog), by way of contrast to the psychoanalytical model, I'd like to provide you with a view of how I practice. Remember: no two therapists work exactly alike, so this is just my comment on what you might experience in a first session with me. Equally competent--even more competent and esteemed--therapists may work differently and with wonderful results. This is just one point of view.

My sessions almost always start at the top of the hour. Before you arrive, we will have spoken on the phone and I will always invite you then to share what issues or difficulties bring you to therapy at this time. Because it's really all about invitations, you're free to reveal what you want, when you want, as you feel comfortable.

I recognize that, in many cases, by the time you've made the decision to meet with a therapist, you're ready to talk. But, prior to talking, and only in our initial session together, I do ask you to read a brief statement about how things work, called "Office Policy & Consent To Treat." This usually takes about 5 minutes or so at the most; and while it delays our session briefly, it's important. Because it's designed to inform and protect you. Read on.

I ask every new client to read and sign my "Office Policy and Consent to Treat." It informs you of the things I'm ethically required to disclose about how therapy will be conducted: what it will cost, the limits of my availability (I'm not available for 24-hour crisis counseling), and the limits of confidentiality (e.g., if you tell me you're going to hurt yourself or others, I am obliged to assess the seriousness of your intent and take steps to keep you or others safe, if necessary--more on this future blogs). Also included in this form is also a crisis hot line number you can use in case things get too overwhelming between sessions, how I handle insurance, cancellations, phone calls, and termination of treatment. This constitutes "informed consent," which is a fancy way of saying that you have been told how things are going to work and you consent to these terms. I ask that you sign and date the form, and I give you a copy to refer to as you would like.

I've heard that some therapists aren't as formal about all this as I. I prefer a policy of "no surprises." And I want you to feel comfortable with the process. If everything is written down, there tend to be very few, if any, unpleasant surprises later.

Speaking of later, I'll continue this tomorrow: What I'll ask you in the first 15 minutes of therapy--and why.

Until then, thanks for listening.

Finding The Therapist Who's A Good Fit For You or... 21 Million Americans Can't Be Wrong

2011-06-11T14:10:00.000-07:00

According to a 2007 survey reported in the American Journal of Psychiatry, approximately 3% of Americans said they had at least one psychotherapy session in the past year. That number remained steady between 1998 and 2007 according to the same survey.

At last count (July 2010), our country had roughly 310,300,000 inhabitants, give or take a few thousand or so. That translates to approximately 21,721,000 Americans who sought out therapy in 2007. For the remaining 288,579,000 of you who might be interested in how to go about finding a therapist who is a good fit for you, I can offer my observations--from both the therapist's chair, and the couch.

My first therapy session--ever--was as a client. It was over 20 years ago, prior to becoming trained as a therapist. I knew little about how therapy worked, but I had just experienced a difficult break-up and decided it might be good to "talk to someone about it." As I recall, I arrived on time, and entered a nicely appointed office. My therapist had come highly recommended. I thought He must be good, right? so I didn't really ask him anything prior to arriving for my first session. After a few introductory remarks, he smiled, nodded knowingly and said, "How can I help you?"

Over the course of the next 12 weeks I talked. And talked. And talked some more. My therapist, by contrast, never said a word. Aside from his cordial one-word "Hello," at the top of our hour, he settled back in his chair, looked and me and smiled, which was my cue to begin. Occasionally, he looked up from his note pad (he took extensive notes) and peered over his half-rimmed glasses with the slightest hint of interest--I thought: He's gonna say something now. He's ready to tell me what's wrong with me. He'll tell me what he wants to know. He'll help me fix this.

But he never did. Not once. By the end of 12 weeks I was impatient. No, I was more than that--I was angry. This wasn't what I thought therapy would be like. In my naivete, I had expected this warm and consoling conversation with a sage and experienced pro who would make me feel a whole lot better. Instead, I got a mute Yoda-like creature who offered no wise words, no quick fixes. Instead of feeling better, I felt worse--and angry on top of it all.

So, in session number 13, I shared my frustrations with him about the therapy, his silence--everything. He simply nodded and smiled. And then he said, "I was waiting for you to tell me this. I was waiting for you to talk yourself out." Dumbfounded, I think I muttered something like, "Oh," and left, deciding that there must be another way to do this that worked better for me. I never went back.

Years later, I found myself in therapy once again, after my father had died. I needed help with the grieving process. This time, I found a therapist who was a wonderful fit. He listened, and then gave feedback. He told me about the grieving process and how it worked. I didn't feel like my situation was so unusual any more. I didn't feel as alone. I wanted feedback and ideas that would help. He gave me this and more. Over the course of our work together, I felt better. I was able to process my grief and handle it as it washed over me from time to time. I will always be grateful for his wisdom and help.

I mentioned in my last post about how clients who actively shop for and participate in their therapy tend to have better outcomes. To that end, before you decide on a therapist, I encourage you to get an idea of the type of therapist and the kind of experience that will work best for you. A few tips:

1. Talk to some friends who are in therapy. Ask what they like about their therapists. If your friends aren't in therapy, then ask prospective therapists if they have any clients with whom you can talk. Ask for references.

2. Think about how you'd like the sessions to go. Are you someone who would appreciate little interruption from your therapist, with only an occasional summary or interjection? Or do you want alot of feedback, with interpretations, psycho-educational information about your diagnosis, as well as homework exercises designed to help you move through your distress? Or would you prefer something in between?

3. Ask prospective therapists how they work. Does their way of working sound like it would be a good fit for you? If they use words or terms that are unfamiliar to you, ask for clarification. Notice how they answer: Are they warm and reassuring? Or reluctant, finding your questions tedious? Chances are, their demeanor in your sessions is likely to be similar to your phone experience.

4. If you don't know, ask. How long are sessions? How long is treatment likely to go? How much does each session cost? Does your therapist accept insurance? How is insurance submitted? Is there convenient parking nearby? Is the office close to public transportation?

5. Try out your therapist. Just because you choose a therapist doesn't mean you're wed forever. However, in fairness, give your therapist and the process a chance. If, after three or four sessions, you have misgivings, have a candid talk with your therapist and see if you can work out your differences. If you feel like you can't, ask if he or she can recommend another therapist (based on your feedback). A good therapist won't take any of this too personally, and should be able to recommend a colleague to help you.

Additionally, there are any number of online sites and therapist directories that can help you find a qualified therapist in your area. Many of my colleagues and I are listed on www.PsychologyToday.com Click on "Find A Therapist" in the tool bar.

Ideally, you'll find a therapist who is a good fit. After all, according the the U.S. Bureau of Labor Statistics, there were 1,138,000 therapists in the U.S. in 2008--and growing. One of them is bound to be just right for you.

Thanks for listening.

Facts vs. Myths About Therapy or "A priest, a rabbi and a therapist walk into a bar...."

2011-06-09T22:58:00.000-07:00

Chances are, you've heard your share of jokes about therapists and therapy. The punch lines range from references to shrunken heads and voodoo to mind-reading and Freudian slips. Truth is, if you've never been in therapy (and sometimes, even if you have), there are likely alot of unanswered questions, vague assumptions and downright spooky misconceptions that may cloud your decision to seek therapy. I'd like to offer a few thoughts (and facts) about therapy that may be useful. Let's start with five--facts or myths?

FACT OR MYTH?:

1. If I'm completely candid with my therapist, he might be very disappointed with some of the poor choices I've made.

This is a myth. While we often are judged at the hands of our family, friends, and colleagues, judgement has no place in your therapy. One of the foundations of an effective therapeutic relationship is suspension of judgement, or "unconditional positive regard" for you, the client. The focus of therapy isn't blame, it's relief from distress.

2. There's no way to know if therapy works or not. It's just a bunch of talk.

Not true. One study by none other than Consumer Reports surveyed hundreds of therapy clients and found that 87% went from feeling"very poor" to "very good," "good," or "at least so-so;" 92% went from feeling "fairly poor" to "very good," "good," or "at least so-so." You might chuckle at a rating of "so-so," but if you ask someone who initially was so depressed he found it impossible to get out of bed in the morning, it's likely he found "so-so" a worthwhile improvement.

3. If I ask about my therapist's credentials and experience she'll feel offended.

Also untrue. A good therapist will be happy to provide you with information about her training, licensure and experience in the field. Further, in the same study referenced above, they found that those clients who were "active shoppers" when choosing a therapist did better in therapy than "passive" clients. Active shoppers not only asked about training and experience but also asked about frequency, duration and cost of treatment, as well as references. They also often interviewed more that one therapist.

4. The single most important factor in successful therapy is the relationship with the therapist.

This is true. While a number of factors contribute to the success of your therapy, your therapeutic relationship--and the safety you feel in the therapy room--tends to be the single most important factor in the success of your therapy.

5. If I just try hard enough, a good therapist can fix me.

This isn't true. Mainly because therapists are not in the business of "fixing" their clients. "Fixing" suggests that your therapist can make a repair and all will be well. Human beings are more complicated than this, and the work you do in therapy is work you do with your therapist; he doesn't do it to you. In fact, studies show that clients who are active in their therapy do better than passive clients. You can be an active participant in your treatment by being as open as possible, asking for an explanation of your diagnosis and any unclear terminology, doing assigned homework (yes, therapy can include homework assignments), not cancelling sessions, and openly discussing any negative feelings that you may have toward your therapist.

How did you score? No matter what you thought about therapy before, I hope you came away with a clearer picture of what therapy can accomplish, how it works and how you can contribute to your own healing. We'll look at more facts and misconceptions in future posts. Because the more you know, the more empowered you can be in your decisions. And that's no joke.

Thanks for listening.

Post Three: Adult Time-Outs or "If you can't say anything nice...."

2011-06-08T21:54:00.000-07:00

In my last post, I included a few elements of better communication that may help couples in difficulty. I mentioned "time-outs" and wanted to circle back and offer a more detailed explanation here.

Anyone who has had the privilege of raising children in the past thirty years is likely to be familiar with the concept of the "time-out." If you were raised with time-outs chances are you dreaded them. Used in their least effective form, as punishment for "bad" behaviors, they were often simply a way to call a halt to chaos and send the opposing parties to opposite corners. More effective, but equally punitive versions of the time-out added the ominous dictum, "And you just think about what you've done!" At worst, they brought a temporary halt to conflict; at their best, children may have actually pondered their offending behaviors. Somewhere along the way, clever children figured out the magic words to get out of jail, which went something like: "Mom, I've thought about my behavior and I realize that it was inappropriate. I want to make better choices in the future." Contrite, eloquent, introspective--this perfect (and often dumbfounding) response has probably cut collective time-out sentences by three of four hundred years--in California alone.

Kidding aside, the concept has merit and it has been adapted for adults, with a few key differences:

1. Adult time-outs are designed to diffuse, not punish. Couples in my office have reported the ability to go "from zero to sixty" in five seconds; that is, their anger can flash quickly to the point that they have reported a "blind rage" or literally, "seeing red." When this happens, most conversations go from meaningful to just plain mean in the same flash. Adult time-outs are designed to give a couple a prearranged plan to stop conversation instantly when either party feels he or she cannot continue without the danger of descending into loud, angry, hurtful drivel.

2. Adult time-outs are prearranged. To work, the rules of adult time-outs are discussed ahead of time in (ideally) a calm, safe environment where both of you acknowledge that you would like to use this tool to diffuse your traditionally volatile interchanges. You both agree that you'd like for your conversations to hurt less. And you'd prefer to say what you really mean instead of being really mean. While you're calm and feeling safe with each other, you set the code word that will start the time-out, and you arrange, in advance, how long your time-outs will last and where you will regroup when the time-out ends.

3. They're used for cooling off, not shutting down. They can be called by either party. And, in the heat of the moment, no justification needs to be offered. A simple "time out" or other code word, that has been agreed to by both of you, is all it takes to halt the conversation and allow for cooling-off.

4. They last for an agreed-upon period of time. Couples I've worked with usually find that a half-hour time-out is effective, but you may find that a longer (or shorter) period works for you. Take a short walk, read, meditate--again, whatever works for you. One simple way to re-start the conversation on a positive note is to honor your partner by honoring your agreement: regroup at the designated place--on time.

5. Effective time-outs mean being out of sight. Many couples find it difficult to have a time-out in the same room. Finding space to be physically away from each other tends to facilitate calming, and lessens the likelihood of you sending damaging non-verbals (scowls, grunts or "the finger") across the room.

6. You get to have a "do-over." Adult time-outs require you to dig down deep and call upon the part of you that really is, well... adult. You've got to genuinely want for things to go differently when you regroup. And you have to genuinely examine how you might attempt to say things in a way that helps, not hurts, the conversation--and your partner.

7. If at first you don't succeed.... If you regroup and conversation #2 isn't working, call another time out. And, if needed, another. And another. One couple I worked with reported calling 6 time-outs in the first try. If you find it's not working, look at items 1-6 above and be honest: are you doing it the way it's designed to work, or are you skipping or changing crucial parts? Keep your eye on the prize: to remove the anger and impulsivity from your talk. It might take a few tries to make it work.

And finally: Remember, not everything works for everybody. Others may offer different ways to make the time-out work better, and if that works better for you, great! But if you follow both the letter and the spirit of the adult time-out, you may find that you're hurling fewer unkind words--and hearing fewer, too. And, when you think about it, who turns a deaf ear to a kind word?

Thanks for listening.

Post 2: Food, Water & Being Heard

2011-06-07T22:52:00.000-07:00

One of the fundamental observations I've made from the therapist's chair is evidence (thoroughly anecdotal, but experienced repeatedly in hundreds of sessions) of the basic human need to be heard.

Whether I'm sitting with individuals, couples or families, a common refrain from the couch is: No one ever listens to me. Which is just another way for clients to say they are feeling unheard. Devalued. Misunderstood. As if what they say is of little consequence, especially to the one person in their life by whom they desperately want to be heard.

The person "not listening" can be pretty much anyone: a boss, boyfriend, girlfriend, spouse, mother, father, or colleague. And, if you or the other person in your relationship feels unheard, not only does communication break down, so does the feeling of safety between the two of you--that comforting feeling that you can trust the other person to be respectful of what you say. The feeling of being not only heard, but understood.

I've found couples (or individuals in difficult relationships with non-spouses) can actually feel more heard and more understood by by introducing a few new elements into their communication:

1. Identify the goal of your communication. If you're out to belittle, annoy, or otherwise push the other person's buttons, there's no need to read any further. If, however, you really would like to be heard and feel valued--and you want to hear and value the other person-- read on.

2. Recognize that, in any conversation, there is a "pitcher" and a "catcher." Sometimes it's helpful to recognize what your role is in the conversation, and to take a good look at how well you pitch: Do you speak in a way that makes it safe for the catcher to hear what you have to say? And, how well do you catch? Do you listen in a way actually allows you to hear and understand what was said?

Pitching and catching are talents that require taking turns. One way to check out how you're doing is to ask your partner to "parrot" or repeat back what you just said. If you're not recognizing what you just "pitched," ask for permission to try again. Restate what you said, keeping in mind how you say it: are you yelling or speaking? Is your tone even and respectful or condescending and snide? And ask yourself, honestly, how would you feel if someone spoke to you this way? How would you feel if someone constantly spoke over you? Catchers, ask yourself honestly, Am I just waiting for him to finish his sentence so I can say something? Or, can I set aside what I want to say long enough to really hear him?

3. Ask for what you want. How many times have you been asked by a loved one, "How was your day?" The question is innocent enough, but can be dangerous territory if your honey can't read your mind. Let's suppose that your boss was a complete idiot that day and you need a listening ear when you get home. ASK for what you want: "It's been a rotten day and what I'd really like from you right now is to listen. Just listen." Do you want feedback or no feedback? Ask. Do you want to state your whole case and then get advice, or would you like feedback as you go along? Asking for what you need from the catcher can ward off alot of frustrating interchanges as well as resentment toward a partner who, otherwise, might have no idea how to give you what you want.

4. Keep in mind that, as the volume goes up, understanding goes down. I don't know many people who like to be yelled at. And yet, time and again, couples in my office try turning up the volume in a desperate effort to be heard, while causing their partners to feel less and less understood. Yelling can kill understanding because it often makes the conversation threatening. If you find the volume going up, take a time out and try again.

5. Slow down. If you find it impossible to do anything else, at least slow down. In the heat of the moment, have you ever said something you wished you could instantly take back? Unfortunately sound travels so fast that calling the words back just isn't possible. Slow down, and think: what is the end result you want from this conversation? If, when the conversation was over, and everything went really, really well, what would you want to hear from the other person? What can you say that will help the conversation turn out well? Should we take a break and try this again later?

OK, you say. That's all well and good on paper, but we end up screaming and going to bed angry.

Be realistic. You didn't get to the yelling part over night, and you won't undo it overnight either. Practice what you can. Take time outs (more about them later). Understand that being heard could actually sound something like this: "I hear what you're saying. You feel frustrated and upset. We disagree about this issue. I'm not sure how to solve this, but I know that I don't want to make it worse, and I want you to know that I'll try to own my part in it."

Nirvana, no. Respectful, yes. Heard? Better than yelling.

More later. Thanks for listening.

First entry: A Start, and What's In It For You

2011-06-06T22:43:00.000-07:00

Each day, thousands, perhaps millions, of people sit with their therapists, sharing intimate details of their lives: feelings of despair over the loss of a loved one; frustration over not feeling heard by the one person they love and want to hear them the most; anger and betrayal over their own aging body that no longer lets them enjoy a vital and independent life; fear over seemingly inescapable and irrational ideas, thoughts or events that threaten their very ability to go about the tasks of daily living--and the list goes on.

I am fortunate--and honored--to sit in the other chair. The therapist's chair.

If you've ever been curious about psychotherapy and what goes on in the room, I'm hoping this blog will lessen the mystery, and perhaps dispel a few common (and threadbare) stereotypes (Think dinner conversation: Guest: "So what do you do?" Me: "I'm a psychotherapist." Guest (nervous mock laughter and a big wink): "Well, ha ha, I better be careful what I tell you or you'll be analyzing me all night, ha ha ha, right?").

I'm not sure why therapy can be threatening or scary for some, but I have a few ideas. And I'll be sharing those in future blogs and, hopefully, dispelling some myths.

I've been fortunate to sit with some brilliant, moving, dedicated, vulnerable, strong, witty, charming, fascinating clients. What they all have in common is this: they have taken a step to get to know themselves better in order to influence the one person on the planet over whom they ultimately have immeasurable influence and control: themselves.

(A caution to self: people who are infinitely smarter about blogging than I have warned me: Keep it short. Don't ramble. So, I'm going to bring this first post to a close.)

What do I hope to accomplish? I'm hoping to share a little of what I've learned from my training, from my wonderful colleagues, and my esteemed clients. I am often humbled by my clients' vulnerability and their courage to venture into territory that enables them to say, "Maybe this is about me."

What you'll never see here: actual client names, or any identifying information that would compromise the confidential nature of the work I do with my clients. It's possible that, after reading future blogs, you'll think to yourself: I know that person! But, trust me, you don't. It's my goal to share my experience of the therapist's chair by using composites of a vast number of client sessions, altering any identifying details, but preserving any learning that I flatter myself to think might be interesting or valuable to others reading this.

Finally, I've long been of the opinion that blogging is, in many ways, an exercise in vanity. So be it. If it isn't of any value to you, if you disagree with me, if you think it's a time-waster, I honor your opinion and encourage you to exercise your right to dismiss this exercise. If, however, along the way, this touches someone, starts an internal dialogue about change, or motivates someone to seek help to lessen their distress, well, then, that will make it all worth it. We'll see. And so the journey begins.