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

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.

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?

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....

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.

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.

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?"

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."

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.

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.

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

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

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

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...."

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...."

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

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

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.