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“The depression symptoms are just so bad again,” my patient (fictional) sighed as she settled in on my couch after a six month absence. “I’m having the guilt feelings, sadness, no energy, trouble sleeping, and I’m gaining weight because of stress eating. I know you scheduled me to come in once a month for a while after we finished the Plan of Care, but I thought I was cured and didn’t need to. Can we get me back on track?”

As I listened sympathetically to her complaints, I couldn’t help but think how her pain could’ve been avoided with a simple monthly check-in session. Issues such as depression, anxiety, panic attacks, relationship changes, and poor self-esteem don’t develop overnight, and don’t permanently go away that quickly either. But once change has been achieved in counseling, the progress can be maintained with follow up care. Left without this support, issues can return-and often do.

Think about it for a moment. There is no other doctor or dentist that we see once in our lives, and never again, yet we think one round of therapy can permanently keep us mentally healthy? Problems and challenges arise throughout life, just like illnesses and cavities do, to use the medical support mentioned above as an example. Having the skilled insight and support of a therapist to manage these challenges can be the difference between a prolonged struggle or a successful and quick resolution.

I encourage you to use me as a resource throughout your life, much as you do your other healthcare providers. Why struggle alone? I am here for you through your darkest times or just times that the stress feels overwhelming. Let’s maintain the progress and keep you on track!

You Won’t Change, So I Must Be Doing Something Wrong:

A Quick Look at Codependency

Codependency is excessive emotional or psychological reliance on a partner, typically a partner who requires support due to an illness or addiction.

Being in relationship with an alcoholic, addict, or otherwise out of control person often causes behavior traits to emerge that cause great misery for the “helper.” I often see this person in my office, who comes in wanting to know how to change their loved one. Unfortunately, we cannot change another adult, and efforts to do so usually make the addict resist control by going deeper into their addiction.

The Mistaken Beliefs of Codependents:

“If I AM: good enough/nice enough/skinny enough/vigilant enough/accommodating enough/loud enough/upset enough…

“If I say it enough times in enough different ways…

“If I give enough money/withhold enough money, give sex/withhold sex, pout, criticize, get you out of bed in the mornings, do all the irrational things you demand…

THEN YOU WILL BECOME THE PERSON I WANT YOU TO BE.

You will do what I think you need to do to fix your life, our relationship.

You won’t drink/cheat/use drugs/yell/hit/get mad at me.

You will appreciate me.

If I do all of the above and you STILL DON’T become the person I want you to be, then I FEEL LIKE A FAILURE. I FEEL GUILTY.

I keep doing these things because I believe it will make you/others/God pleased with me. You/others/God will admire me for my sacrifice. This is what makes me worthy.

I know exactly what YOU think, feel, and need, and why. I can analyze you endlessly.

I have no idea what I think, feel, or need, or why. And I am uncomfortable when my counselor asks me to be still, listen to myself, journal, dig deeper, try new things that might make me happy, set a boundary with you.

I would much rather figure out what’s wrong with YOU than look at ME.

“Why is getting along with my mother so hard?” said my client, sighing deeply as she wiped away tears in session. “I feel anxious all of the time, I’m depressed, and I can’t even hear her sigh of disapproval on the phone without wanting to run and hide. What am I doing wrong?”

The tendency to feel like everything is your fault, and that YOU are in fact the one “doing something wrong”, is typical of the child of a narcissistic parent. Karyl McBride, PhD* also notes the following symptoms:

1. feeling “not good enough”
2. valued by your parent for what you DO, not who you are
3. feeling unlovable
4. constantly trying to win your parent’s approval
5. your parent emphasizes how your behavior LOOKS, or makes them look, over how you FEEL
6. your parent is jealous of you
7. your parent doesn’t support your healthy expressions of self, especially when it conflicts with their own needs or threatens them
8. In your family, it’s always about pleasing that one parent
9. your parent can’t empathize with you
10. your parent is critical and judgmental

There is typically a family “scapegoat,” a person on whom the family blames the problems. “If only Jane wouldn’t cross Mother…if only she would call her more often…THEN Mother wouldn’t get so upset.”

The truth of the matter is, a parent who is narcissistic is always going to be looking for ways that the “scapegoat” lets them down. This parent’s attitude is not, “what have you done for me,” but instead “what have you done for me TODAY?” It truly is never enough to get the “scapegoated” child off the hook.

Freedom comes when, with the guidance and encouragement of your therapist, you begin to gently challenge these things in the family and express your own needs.

*Will I Ever Be Good Enough? Healing the Daughters of Narcissistic Mothers

“I just can’t do ANYTHING right,” my client sighed as she settled further into the couch. ‘I should just accept that I am fat, depressed and a failure at relationships. Nothing will help me.”

And as long as she chooses to continue talking to, and about, herself that way, she WILL be overweight, depressed and alone, and most importantly, unable to change, regardless of her therapist’s skills. For the fact is that every cell in our body responds to what we think and say about ourselves.

Although most of us are familiar with the “love our neighbors as ourselves” directive, we miss the meaning of the last part. Most of us wouldn’t dream of calling our neighbor names or criticizing them point-blank to their faces, yet we look in the mirror and do it to ourselves every day. We feel compassion for our friend’s struggles with food, relationships or other issues, yet we are merciless and impatient with our own. Self love is a vital key to health, and self condemnation the thing that most often keeps us from our goals. For instance, if you are having trouble ending an unhealthy relationship, AND you “beat yourself up” for your “weakness,” we now have THREE issues to overcome—the relationship, the self loathing, AND the damage done to your self image by the insult! Self love, forgiveness for our mistakes, and patience with our failures leads to the strength and discipline necessary to move forward into a healthy, balanced life.

To become your own encourager and best friend requires a deep examination of who taught you to be self-critical in the first place. Where did the “I’m not OK” message come from? It is most often from one of two sources—either what was said about you by your parent, or what a parent said about themselves in front of you. If you heard negativity modeled in your growing up years, the pattern was set for you to live that way as well. Children really do learn what they live. But like any learned behavior, this thinking pattern can be changed; sometimes by yourself, and sometimes with the help of a counselor if the pattern is persistent or severe.

To remain vital and healthy in your thinking throughout your lifetime, practice catching yourself when you are saying or thinking self-critical things. Immediately visualize a big red STOP sign to interrupt the pattern. Replace the self-criticism with a positive, encouraging thought, such as “I’m proud of myself for trying to change.”

 If you focus on what you DON”T like about yourself, you will get more of it, but focusing on the successes in your life will lead to more success. Congratulate yourself on victories, whether it’s a ten minute walk when you really just wanted to watch television, or keeping your temper in traffic.

All of us respond to love and encouragement, including when we give it to ourselves. Give yourself the gift of acceptance!

1. Protect the children. Children have a deep psychological need to think well of BOTH parents. Avoid letting them hear you put down or say bad things about the other parent, regardless of how justified you feel in saying these things.

2. Depend on the experts. Well- meaning friends and family will give you legal and psychological advice; that’s not a good source. Thank them for their concern and move on.

3. Avoid other drastic life changes. Make your life as stable as possible right now. Try to keep sleeping and eating on a schedule. See your doctor and/or counselor immediately if these are disrupted for more than a week or so-depression and anxiety may take hold if basic needs are ignored.                                    

4. Take a Divorce Parenting class as soon as possible. When I taught this class, the comment I heard most often was, “why didn’t someone tell me to take this sooner?” You will find help and support there. Ask your attorney for more information.                   

5.  Maintain professionalism at work. It is natural for your focus to be disrupted, but strictly limit the amount of time you spend on email or conversation about your divorce.

6. Lay it down sometimes. Take a break and play with your kids. Go see a funny movie. Let your mind rest. If the worries persist, promise yourself you will go back to worrying about the issues later that day, then return to the fun.

7.  Limit contact with your ex-spouse. You are not obligated to endure any conversations that your attorney does not require of you. Make your contact brief and limited only to necessary details of custody issues.

8. Observe your breathing. Under stress, our breathing often becomes shallow. This leads our muscles to tense up and puts the whole body on constant alert. Put a sticker or an object around your workplace and use it as a reminder to breathe deeply.

9.  Stand up for yourself.  It’s time to say “I need, I feel” or “no, I can’t do that.” Maybe this is new behavior for you.  A counselor who has been specifically trained in divorce (not marital) counseling can teach you how to detach and communicate in a civil manner that protects the dignity and rights of both parties.

10. Finally, remember: this WILL pass. You are currently experiencing one of the hardest life experiences there is. Keep your focus firmly on the hope of a peaceful outcome and take care of yourself in the meantime.

Child counseling can be extremely successful if you support your child throughout the counseling process. Family counseling also works wonders if everyone bands together and supports each other through the changes that are being made. Follow these tips to support your child and family in therapy:

1. Be there to listen and offer caring support, without judgment, to your child during the time in child therapy

2. Meet with the child’s counselor to make sure personalities are a match for you and your child.

3. Be open and talk frequently with your child. Make sure discussions are age appropriate; early school aged children need brief, simple discussions or explanations, upper elementary age children may ask more detailed questions and may need help figuring out reality from fiction.

4. Don’t pressure the child to talk to you about what happened in the child counseling session, your child may tell you in his/her own time in his/her own way.

5. Keep the lines of communication open with the child’s counselor and the child. Showing your child that you trust the child’s counselor helps build trust.

6. Try not to rush change. Remember trust is built over time; it’s not any different in child and family counseling. Allow time for your child to learn to trust his/her counselor. If you become intimidated by the child-counselor relationship, bring it up to the counselor (there’s nothing to be embarrassed about).

7. Patience is extremely important throughout the child and family counseling process. Children often don’t know how to express their emotions and fears like an adult would, therefore may have some temporary behavior changes throughout the process.

8. Be a good role model, show the child you are willing to take care of yourself and if you need counseling, seek it.

9. Make time to discuss your child’s worries, fears, and even accomplishments. Be sure to turn off any distractions (phones, TV, video games, etc.) so your child knows how important the time with your child is to you.

10. Most importantly, enjoy favorite activities with your child alone and with the entire family.

If you have any questions, throughout the process, speak up. Your child and family counselor is there to help!

“In the depth of winter, I finally realized that deep within me there lay an invincible summer.” A. Camus

Let’s face it, life throws us curves sometimes. We all experience the ups and downs that lead some of us to seek a counselor’s help: relationship issues, money problems, job struggles, grief and loss. Add any of those stressors to our current economy and it becomes even more challenging to stay positive and thankful! And yet, an optimistic focus is an essential quality for mental health and happiness. What do we do?

The Practice of Optimism

The alarming thing about tough times is that negativity feeds on itself. As we “talk fear” to others, we contribute to THEIR anxiety. They then spread that talk to more people, keeping us all in a state of uneasiness. Negativity is truly contagious, a “mental virus” spread by thoughtless conversation, news stories, and emails. Before you know it, a whole nation is panicking, which helps cause the very hard times we fear.

What we Focus On, Grows…

An ‘attitude of gratitude’ simply means that we make a conscious choice to put our attention on what we like about our lives. One easy exercise is to list the three best things that happened to us today, and then note why they happened. The “why” is usually because we chose to make an effort to improve our lives, whether it’s the good feelings we get from working out, or the pleasure of calling a friend. This helps us see that we are not victims and we are not powerless. There is always one small thing we can do to improve our present circumstance and ease our anxiety. Some ideas:

• Lay the problem down. Take a break from trying to solve the situation. Put aside the divorce papers and take a walk. Leave the resume writing behind and watch a funny movie. Let your mind rest.
• Limit the time spent dwelling on and talking about the problem. Just as not talking about it at all makes it worse by suppressing it into the body, so talking about your problem obsessively can keep you panicked. Your discussions should be brief and you should only confide in a positive, non-advising friend, family member, and your counselor.
• Give yourself healthy treats. A nap, a novel, or signing up for a class can be a little lift to help you get through a hard time.
• Examine the problem on paper. Write down how you feel for a few minutes to release the problem. Things look different on paper than in your head!
• Let yourself grieve. Grief is a natural and necessary process when facing a loss, whether you have lost a job, a person, a lifestyle, or a marriage. Crying is important for release of cortisol, a damaging hormone that builds in the body during stress.
• Avoid negative people. There will always be those who are determined to “spread the virus” of negativity. Some people get a sense of importance from repeating bad news and the media depends on bad news for ratings! Be wise about who gets your attention.

There is always something hopeful to say, something to be grateful for. Fix your attention on what you appreciate, and more good things will come along!

PLEASE NOTE: this list is NOT intended to diagnose or treat you. See a licensed mental health provider or medical professional for proper diagnosis and treatment.

Most people get “the blues” sometimes that last a day or two. However, Major Depressive Disorder is a SERIOUS and often FATAL illness that occurs in approximately 6.7 percent of US adults. Medications can be helpful, but come with side effects that many people cannot tolerate. Medications will NOT cure the mistaken belief system causing the depression.

 Without talk therapy to both uncover the root cause of the depression and learn ways to manage it, depression can persist despite medication. Cognitive Behavioral Therapy, or CBT, can help you uncover the beliefs you carry about life without even knowing it. These beliefs often contribute to depression below your level of awareness. Once uncovered, I can help you face and refute the irrational thoughts and replace them with healthy, logical thoughts.

If you are experiencing any of these symptoms on a frequent or daily basis, please contact me for a full professional evaluation:

1. sadness

2. pessimism

3. feeling like a failure

4. loss of pleasure

5. guilty feelings

6. punishment feelings

7. self-dislike

8. self-criticalness

9. suicidal thoughts or a sense of, It would be better if I  weren’t here*

10. crying, or unable to cry anymore

11. feeling agitated

12. no interest

13. hard to decide things

14. feeling worthless

15. no energy

16. sleep issues

17. irritable

18. appetite changes, up or down

19. can't concentrate

20. fatigue

21. no sexual interest

(Adapted from the Beck Depression Inventory)

Taking that step to call me for an appointment is hard, but can be the best decision you ever make.

*IF YOU ARE FEELING SUICIDAL, CALL THE SUICIDE HOTLINE AT 1-800-273-8255 OR 911 IMMEDIATELY!

Even if your hands are shaking

And your faith is broken

Even if your eyes are closing

Say it with your heart wide open

Say what you need to say.

 (John Mayer)

“Finding your voice” is a wonderful benefit of therapy, as you learn here that you have both a RIGHT to ask for what you want and the WAY to state your needs respectfully.

Some basic tips when you are “saying what you need to say:”

1. Use “I Need” instead of “you should.”

 It is not OK for you to tell other people how to live their lives. “Saying what you need to say” is NOT a license to judge, criticize or otherwise counsel others!

 It IS OK to require them to treat you with respect, but you must first ask respectfully. This means not yelling your message at them. Not using sarcasm or anger. It means speaking up firmly and courteously about what you will or will not tolerate.

2. Speak honestly, clearly and directly—don’t hint, manipulate or guilt-trip others.

We get in trouble when we expect others to “just know” or read our minds. This is a common pitfall when dealing with the opposite sex. Women, most guys don’t get all the hints and signals that your girlfriends do. It’s not a sign of any lack of love. “Say what you need to say” without playing games.

3.  After you say what you need to say, take responsibility for what comes next.

You have choices here. Maybe you’ll get what you’ve asked for, maybe you won’t. The next step is to decide what is required in order for you to stay in the relationship or on the job. Do you need to require marital counseling? Do you need a different job where you are respected? Do you need a time apart? Do you need to hire help to get things accomplished which are being neglected?
 

Then, do what you need to do.

Say what you need to say.

And let me know if I can help in that process.

It contributes to illness. It’s the major factor in back pain. In fact, it makes ANY pain worse. And it’s not always caused by bad things-it can be related to celebrations, new jobs, holidays, new babies, and many other things we would never wish away.

Yes, I’m talking about stress, or as defined by Webster’s, “a strain or pressure on the body or mind.” It’s almost always presented as a reason people finally get professional help for life issues, and I diagnose and treat it daily.

The body and mind perceive any change as potential danger, and they react with heightened awareness, muscle tension, and increased cortisol production (cortisol is that nasty hormone that can increase blood pressure and blood sugar, and suppress immune response). It is essential to our overall health to learn to reduce stress responses in our body and mind. The following are some ways to do so:

Breathing

Under constant stress, our breathing becomes shallow and strained. A simple exercise is to sit back in your chair for a minute or two, close your eyes, and just focus on your breath. Breathe in deeply through your nose to the count of four, using the ticking of a clock if you have one. Hold your breath for four counts, and then SLOWLY let the air out for six beats. This deliberate focus and attention will both calm and distract your mind temporarily.

Guided Imagery

This is an article all by itself, but basically guided imagery involves taking time to mentally “visit” your favorite relaxing memory-be it the beach, the woods, whatever brings a smile to your face- and mentally placing yourself there using all five senses. This also works with visualizing a beloved child’s face or your pet. A few minutes of visualization a day can actually increase immune response and is simple to do.

Tense/Relax (Progressive Muscle Relaxation)

Starting at the top of your head, tense and relax the muscles of your face, neck, hands, shoulders, etc, all the way to your toes. Hold the tension to a count of four, and then let it go, moving on to the next muscle group. This puts a focus on muscles that may have been tight without your awareness.

Journaling

The benefit of scribbling down thoughts and feelings is well researched. You don’t need to watch spelling, grammar or anything else, as no one will see it. You don’t even have to “keep” a journal-just the act of writing in it

self is beneficial, even if you shred it immediately after! Try completing these sentences to start:

It really bugged me today when….

If I could wave a magic wand I would change…

Then just keep writing without thought or censure.

Doing Nothing

A totally foreign concept to our goal oriented society, isn’t it? But sitting completely still in silence for a few minutes a day is a wonderful way to de-stress. As we let the mind daydream, rest and wander, we often find new solutions to our stressors. This concept is summarized by the beautiful quote: “Sitting quietly, doing nothing, spring comes, and the grass grows by itself” (Zen saying).

If these simple measures don’t ease your stress symptoms, the next step is to seek help from a licensed therapist who can help you resolve underlying issues contributing to the problem. Best of all, these simple steps to de-stress can’t hurt!