The Power of Each Other: Blog - The Power of Each Other: Coaching, Creativity, and Counseling

When people are just mean: How to overcome the hurt and anger

8/25/2017

For the past two years, I've been working in nursing homes, offering counseling to seniors dealing with adjustment issues, depression, anxiety and a host of other mental health concerns. During that time, I've learned that there are people who are polite, and people who are just flat-out mean. I recently had the pleasure of trying to interview a gentleman who could not get over the idea that I was fat, and was very obnoxious about it. Factually, he is right - I am fat. I'm not upset about that - it's the judgment and cruelty in deciding that I am less of a human being because of it that was hurtful.

We'll call him "Mr. Jones" for simplicity. When I went into Mr. Jones' room to introduce myself, he immediately said, "Well, you've put on weight, haven't you?" Not hello, not "how are you," - just an immediate comment on my body. I ignored it and introduced myself and told him I was here to talk with him. He, however, could not get past my appearance. I went to sit down, and he said, "You can't sit on the furniture. You'll break it." I let him know, gently and politely, that I had been sitting on the furniture for over two years without a problem, and that I had a job to do. He said, "you're too fat." At that point, even my patience was shot. I said, "Mr. Jones, I am here as a professional and your comments are out of line. My body is not under discussion. I'll come back again on Friday, and maybe we can try this again."

Robin Williams, Suicide and Depression - Resources Updated

8/12/2014

I thought for a while about whether or not I wanted to write about this, because there are so many armchair psychologists who are ready to explain and point fingers in regard to Robin Williams' suicide. Today, however, after hearing some of my clients' reactions and after hearing some of the things said in the media about it, I feel that I have something to say that might be helpful.

Mr. Williams' struggles with depression and addiction are well-known, and it's very easy to point fingers and say, "that was what did it." I've heard variations on that theme all day, most of them said with the attitude that nothing could help it. One radio host even went as far as to say, "He was beyond help. He was too far gone."

I nearly had to pull my car off the road after hearing that, because I was so angry. I work all day with people who struggle with those feelings and with the pain and hopelessness that goes along with them. To hear a DJ blithely blame the victim was nearly too much for me. NO ONE IS "BEYOND HELP;" AND NO ONE IS "TOO FAR GONE." I can't emphasize that enough.

Depression - Dealing with and Taming the Beast Within

7/14/2014

I think I mentioned this story in another post, but I'll tell it here again because I really like the analogy. This was written by a teenage girl who had been dealing with chronic depression. She wrote that it starts with having a bad day. Everyone has bad days, though, right? You don't think about it too much, and go on living your life. Ok, so you have a few more bad days mixed in here and there, but again - everyone has bad days, so it's nothing to really worry about...Then you realize that you're having more bad days than not, but you don't want to think about it because it might jinx you and bring on more bad days - everyone knows that if you let it get to you, then it gets worse, right? So...finally you realize that the bad days are winning - you feel awful, life doesn't seem to have a whole lot of purpose and the future looks bleak. You realize that the beast has caught up with you again, and that you're depressed.

Depression feels like a heavy weight, a wet blanket, and day upon day of lousy weather all rolled into one. AND, it's more than that. To use the example of an antidepressant commercial, depression hurts in a lot of ways - physically, emotionally, mentally, and interpersonally. You feel rotten, it's hard to think clearly and/or move, life sucks and nobody around you seems to understand or care, or care enough. You feel like things will never change or get better. It's bleak.

I'm not going to lie and say there's an easy way out - there isn't. Honestly, what I've found works the best is a combination of medication and psychotherapy, and I'll tell you why. From what I've seen, it's like fixing a house with a cracked foundation. Having the foundation cracked doesn't mean that the house is broken or useless - far from it. It means that some repair work needs to be done, and that the house can be and is worthy of saving.

So...to begin the repairs, you first have to shore up the house, right? Using medications is like shoring up the foundation - it helps get the biological, chemical piece working again so you can get at the root cause and work on that. That's where psychotherapy comes in. Even if there is no deep, dark past to examine, therapy can help you figure out what triggers depression for you, how to recognize it and the warning signs, how to cope when it hits, and how to let other people know how to help you. Therapy also gives you a chance to really let loose and talk about what it's like to feel and deal with depression - with someone who's not going to judge you, tell you to "pull yourself out of it," or try to fix your problems for you. It will give you someone to talk to, who's got some training in how to deal with it, and can help you develop and practice skills for dealing with it.

Now, that said, I realize that for some people depression is more biochemical than anything else - therapy can help you too, though - in the ways I mentioned above. If you do happen to have things in your past that are affecting your mood, therapy will almost certainly help you with that - but you don't have to have had trauma, abuse, or other painful past experiences in order to benefit from therapy.

Ok, before I start sounding too much like an informercial...what can you do on your own? As trite as it sounds, I usually recommend that people start at the beginning. Accept the reality that you're dealing with depression. For some people, that alone is a huge step - there is still stigma out there about "mental illness" and many people don't understand what depression is, or how it affects you. So, accept reality and then realize you have a choice in how you're going to deal with it. (Yeah, I'm taking a page from my DBT training - radical acceptance again!)

Dealing with depression takes a LOT of energy. Depression is a condition that saps your strength - emotionally and physically. It feels sometimes like you're trying to slog through thick, sticky mud and is every bit as exhausting. You can choose, though, whether you're going to stay in it or not, and there are consequences either way.

Choosing to try to move out of it means choosing that you're going to move, even if it's just a little bit. It's a form of opposite action. It may mean something as simple as getting up and taking a shower, or making yourself go outside for a few minutes.I tell the people I work with that I don't underestimate how much of an accomplishment getting out of bed is. It might be the only major movement someone has made in days or weeks. Moving may mean more - calling a friend, a doctor, or someone you trust and asking for help (and believe me, I know that's HUGE.) Either way - if you're going to choose to deal with it, it means YOU have to do something. And, as I always say (and mean), seeking help really is a sign of strength, and not a weakness in any way, shape, or form. Moving - and then moving consistently are important parts of this process.

If you choose not to deal with it, then you have to be willing to take those consequences - it may mean that someone else has to make decisions for you, if you're not able to do so. It may mean giving up some control so that someone can get help for you...it may even mean hospitalization for some.

One thing I want to make crystal clear here is that I don't think that being hospitalized is shameful. In fact, I believe that it's helpful, and that getting well and being able to function is the goal - and I realize that there are many of you who disagree with me, and I respect your right to do so. After all - I'm not walking in your shoes. However, if you're not able to or are unwilling to make decisions for your care - or if you're self-harming or threatening to self-harm, hospitalization is a possible outcome for your safety and well-being.

The point of all this is that I'm assuming you don't want to deal with feeling depressed. You can't control what's coded in your genes, but you can choose how you're going to deal with it. And I'm not saying that positive thinking, affirmations, etc. are going to magically pull you out of it. These may help, but depression is a lot more complicated than just negative thinking. You can choose to shore up your foundation with meds, or you can choose not to. You can choose to use therapy, or not. You can choose a combination of the two - the point is, you have a choice.

When you're in the throes of a major depression, it may not feel like you have any choices, or that no matter what you do it's not going to work. This is where you have to use your active trust - your emotions are not necessarily giving you the best information, and you may have to let your head overrule your heart on this one. Get help if you need it, and help yourself. Depression is nothing to be ashamed of, any more than kidney disease or diabetes is. It's a treatable condition, and there is hope.

Does getting help mean it's going away for good? For some people, maybe...for others it means that the beast is pushed away again for a while, but will keep following you. For you...well, learning about your triggers, symptoms, etc will help you. Learning this stuff also helps you feel more in control and stronger - nice side effect, huh? One great program, developed by a lady who both does therapy and has bipolar disorder is called the "WRAP program."

WRAP (Wellness Recovery Action Plan) is a system that helps you recognize your triggers and symptoms, and put into place a plan to help yourself feel better. If that plan doesn't work, WRAP also helps you develop a plan that tells who you want involved in your care, how you want to be treated, and who can make decisions for you. It's a great system, and Mary Ellen Copeland (the creator) has some great articles on her website: www.mentalhealthrecovery.com. The purpose of WRAP? "Getting well and staying well." Copeland is also the author of several wonderful self-help books/workbooks for coping with depression and manic-depression - her work is widely respected and used. (I highly recommend her books both to clients and non-clients.)

So, bottom line is that even if it feels like there is nothing you can do or that nothing you do works or has an effect, there ARE things that will help. Talking to a therapist (heck, talking to someone you trust, period!), working with medications, using some great self-help resources, and your own strength all help. (And yes, you ARE strong - it takes a lot of energy to deal with this!) Cognitive behavioral therapy is one route that seems to help a lot of people - Copeland's books actually use a lot of CBT-style work. DBT skills help too - trying them won't hurt, and you have a lot to possibly gain.

Just remember - you're not alone, even if it may feel that way. There are many, many people who are dealing with and have dealt with depression. I have tremendous respect and admiration for those of you dealing with this, whatever the root cause may be. It takes a lot of energy and strength, and pulling yourself out takes even more. You're not alone - really.

As Always:

Please Note: The content on this blog is intended for informational purposes only. This is not therapy, and if you wish to work in therapy, please contact your local mental health agency or your physician for a referral.

If you are in crisis or danger, or are thinking about hurting yourself, please call 911 for immediate help. Please, again, realize that seeking out help really IS a sign of strength and not a sign of weakness. You don’t have to be alone in facing these things – there are people who care and who will help. Email me at: [email protected]

Loneliness: When the World Seems to Go On Without You

7/14/2014

Loneliness is something we've all probably experienced at one time or another, and quite frankly it sucks. In my experience, feeling lonely is one of the most intensely uncomfortable, depressing, and isolating feelings that exists. When you're feeling lonely, it seems that the world is going on around you, and that you're invisible or worse, that no one cares.

I mark a difference between loneliness and solitude. Solitude is when YOU want be be alone - it's a very different thing from wanting to be around others but not being able to. There are many reasons for loneliness, among them shyness or social anxiety, or depression and/or thinking that no one wants to be around you (Remember the "stinkin' thinking"? This is an example).

Feeling lost in the crowed or different from everyone around you is a factor. Loneliness can come up in different situations - when you're single among couples, childless among families, ill or emotionally traumatized around people who seem healthier than you, a member of a minority group surrounded by the majority...there are any number of situations which may trigger loneliness.

There are no easy answers for changing loneliness - this is one of those situations where, if I did have a magic wand, it would be useless. (And trust me, I wish I did have one.) The basic reason there are no easy answers is because the causes are so varied. Cognitive Behavioral Therapy (CBT) helps with some causes like social anxiety, depressive thinking, or dealing with "Shoulds" or "Stinkin' Thinking". Ok...well, that's fine and dandy. I change my thinking and I just feel better, like that?

Uh, well...not really. I wish it was that simple. CBT will help you work with your thought patterns AND with the behaviors that get in your way. This is where the "homework" stuff comes in again. If you want to counter loneliness stemming out of anxiety or depression...guess what? You have to interact with people. Typical homework assignments in this realm might be something like, "Talk to five people about a current news topic" or "Compliment 3 people sincerely." The idea here is to get you out and getting experiences that contradict your fears.

And also - loneliness is a feeling. I know...some of you are saying, "Well, DUH!" Here's the thing though - you can use your skills to deal with feelings that are overwhelming. Call it "riding the wave," DBT, Coping, Self-Care, Self-Soothing - whatever. The idea is you use the skills you've got and have learned to help yourself feel better. "Emotion Regulation" and "Distress Tolerance" have these names for a reason!

Ok, so CBT and DBT help. What if you're stuck in a situation where you really DO "stick out like a sore thumb"? Those are a little harder, to be honest. Your differences will likely be harder to hide, and it may feel as if the situation around you is moving on and leaving you behind, or worse, ignored. I can't tell you what to do in these situations, but I can share what's helped me.

First of all... if I seem to be in a completely different, alien, strange, unsual environment or group, I look around and see if there's someone else who seems something like me. By this I mean, "Is there one other person here who looks uncomfortable - for whatever reason - like I do?" If so, then I gather up my assertiveness and interpersonal effectiveness skills and introduce myself. I'll ask an open question like, "What do you think of all this?" and then LISTEN. Nine times out of ten, this helps.

Err...what about the 10th time? When the person just kind of looks at me as if I'm an alien from another planet, or as if I've just spilled spinach juice and red wine down the front of my shirt? Well..I politely say, "It was nice to meet you," and then move on to something else. At that point (and this may seem silly), I look for someone who has one thing in common with the way I look, or one thing about them that is intriguing to me - maybe it's wearing the same color, or a similar hairstyle, or style of outfit...maybe it's that the person is wearing some outrageously bright colors that I adore, or has eyes that seem to smile. SOMETHING I notice and can comment on.

Y'all are going to think that I'm a pain in the tushie with how I do things, but again, I go up and introduce myself, and say, "Those shoes are so cute! Would you mind telling me where you got them? I love those colors." Or I might say, "You know, I don't know many people here...and honestly, you look like someone I might be able to chat with. I'm Laura. What's your name?"

Here's the thing - fundamentally I am a VERY shy person. (You'd never guess it watching me now, but I swear - it's true.) It took me years of practice and yes, therapy to get over it. During this process I learned, though, that most people are generally nice. I also learned that if I say something completely stupid, or fumble for words, saying, "I feel a little awkward - I'm worried I look like a fool" and then laughing, most of the time people will laugh with me. Do they laught AT me? I'm sure some people do. I know for a fact when I was younger, people did.

And the sad fact is that there are some people who are judgmental and mean. Appearance seems to be a particularly favored target, and it sucks. People have judged me on my appearance, both when I was thin and now that I'm fat. And you know what? I survived. No matter what other people think of me, my sense of who I am is intact. It took YEARS to get here, and I'm not going to say that other people's perceptions don't matter - they certainly do. What matters the most, though, is what YOU do and what YOU think of yourself. I decided that I would try to like myself, no matter what anyone else thought. I don't know about everyone, but for me it was a choice and a conscious decision. And it took hard work.

When you have the sense that you are not just OK, but that you are a worthwhile, interesting, and caring person, loneliness has a harder time getting in. I won't lie - it sure does get in on occasion. But - I have a stronger sense that I can do something important, that I matter, and that I have gifts and talents to share. That goes a long way in pushing loneliness out the door. Even if no one listens, or no one seems to care, I know I matter.

So, when I start feeling lonely...well, I do something to kick it on it's butt out the door. I'll go talk to someone, engage myself in something I enjoy, write, read, take a nap, go sit outside, pet my cat... you get the idea.

And you know what? You don't have to be lonely - I'll talk with you. Seriously. Send me an email message, and I'll get in touch. I know how hard it is to feel lonely, and I want you to know that you're not alone. Really.

As Always:

Please Note: The content on this blog is intended for informational purposes only. This is not therapy, and if you wish to work in therapy, please contact your local mental health agency or your physician for a referral.

If you are in crisis or danger, please call 911 for immediate help. Please, again, realize that seeking out help really IS a sign of strength and not a sign of weakness. You don’t have to be alone in facing these things – there are people who care and who will help. Email me at: [email protected]

It's the Little Things...

7/14/2014

Have you ever noticed how something small can be a "tipping point" that changes your day from "good" to "bad" in an instant? It can be a critical comment from someone at work, or a family member saying or doing something that makes you pause and think, "Wow...that was out of line." It can be something impersonal, like getting flipped off or cut off in traffic because someone else is in a hurry and not driving carefully...there are any number of things that can really mess up our day, and leave us feeling drained, irritated and/or angry, and feeling like everything's going downhill.

Frankly, it sucks. We've all been there, and know what it's like. I'm not going to lie and say I never get stuck in it. It's easy to let things add up and take over, and may feel like we're riding a wild, out-of-control, roller coaster. So, what do you do? Well...as usual, there are some answers and tips from the therapeutic couch that may help. These aren't necessarily the only things you can do, or "THE ULTIMATE COSMIC ANSWER" - rather, they're things you can try to help YOU feel better. Unfortunately, there's no magic wand to change the world around you, and we can't make your husband/kid/boss/coworker/"idiot on the road" change. That's just beyond our control. (In therapy I sometimes take a kid's pretend magic want, whap it on the table or chair and say, "See? It's broken - it doesn't work! NOW what do we do?")

Well...now what do we do? The first thing, in my experience, is to try and separate yourself from what's going on. You can't make your boss be nice, or make that person on the road or in the grocery store be polite and reasonable. You can't make your family members stop making comments about your appearance. However, you can set up some good boundaries and realize that you don't have to allow them to get you upset. I'll fully admit, though - some situations are easier to do this with than are others.

Easier said than done, isn't it? Trust me, I know - from tons of personal experience myself. And yet, it's important to know what's your stuff and what's their stuff. (Remember the definition of a boundary? It's where you end and I begin.) Eastern faith traditions call this compassionate detachment - you can look at what's going on and realize (or even say to yourself) that "this is what's going on for him or her. If I have something to apologize for, I can do it. But their anger or their irritation is NOT me."

It sounds a little weird, I'll admit. And it does take practice to become a habit. But if you think about it, it's incredibly freeing to realize that you're not responsible for someone else's anger, or even their feelings in general. Now, don't get me wrong - certainly what we say or do affects the way other people feel - this isn't a "get out of jail free" card to say or do whatever you want. In fact, our actions can be the tipping point for someone else - so it pays to watch what you say and do as well.

Anyway - realizing that you are separate from someone else's emotional reaction can help you deal with what's going on in a more rational "wise mind" kind of way. (If you don't know what "wise mind" is, see the post for DBT Skills, Part 1 )

So, knowing what's you and what isn't you helps. Another trick from the DBT bag is to try "opposite action" - this is where you do the exact opposite of what you want to do (part of the DBT Emotion Regulation skills). I know...it sounds hard, and it is. When you want to spit back a sarcastic response, you instead say something nice. "Thanks for your input. I hope you have a great day from here on." It might be the last thing in the world that you want to do - and it does help. You'll have to trust me on this one - but think of it this way - if nothing else, it confuses the heck out of the other person!

Another thing to do is just take a quick breathing break - practice distress tolerance skills (another DBT post: Distress Tolerance Skills) or relaxation and stress reduction skills: breathing, distracting yourself, self-soothing (a coffee or tea break can work wonders), a little bit of exercise (say a walk at lunch), or anything that helps you feel better (and doesn't harm anyone - including the person who ticked you off to start with ;p ). All these things can help. Finally - all the CBT stuff I talked about earlier will also help.

These may not completely turn around your day, but they can help you feel better. The key point is to remember that you don't have to let someone else's bad mood or bad day ruin yours. So...have a great day, and remember that someone out here is rooting for you!

Please Note: The content on this blog is intended for informational purposes only. This is not therapy, and if you wish to work in therapy, please contact your local mental health agency or your physician for a referral.

If you are in crisis or danger, please call 911 for immediate help. Please, again, realize that seeking out help really IS a sign of strength and not a sign of weakness. You don’t have to be alone in facing these things – there are people who care and who will help. Email me at: [email protected]

Tough Times, Resiliency, and The Power of Each Other

7/14/2014

I've been thinking lately about how things are going here in our world, and I know that life doesn't always fall into these neat little packages, situations, diagnoses - whatever way you can think of to make life seem "simple." Right now, life is tough - financially and societally. Pensions and 401-Ks, the ones that still exist anyway, are pretty much looted and worth (at best) half of what they were. The job market reeks. These are tough times. The world we were raised in, or the world in which our parents were raised- where job loyalty meant employer loyalty, a handshake could really seal a deal, and where anothers' word meant something - just doesn't exist anymore. Life, and the world around us has changed.

And yet I'm finding that even with the hardships and overall socially negative mood, there is hope. We are, overall, a resilient people. We endure, we work, and we survive. We have hope that things won't always be this way - that's what keeps us going sometimes. I see people helping each other in parking lots, or stopping to talk to a little child. I see smiles and sharing at the parks I take my kids to. And I see things that money could never buy, like cerulean blue skies and fields bursting with the color of wildflowersa or the smile of a child and the music in the wind.

Resiliency, in my field, essentially means the ability to bounce back and thrive. I, like all of us, face situations that feel overwhelming. For many years, I was passive and simply gave up and let things happen. Not anymore - I'm going to not just bounce back, but I will thrive. I'll admit I'm scared at times. I'm scared of failing, of financial ruin, of not being good enough - things we ALL feel at one time or another. AND, I'm not going to just bounce back, I'm going to thrive. I am NOT going to let these things stop me.

Resiliency is as much stubborness and determination as anything else - we decide that we are NOT going to let the "tough times" win. I have an "art journal" that I've kept for the last few years - many pages say, "I AM going to get through this," "I am smart enough and prepared enough to do this," or "I'm NOT going to give up." It's not very artistic, but it IS a creative expression of my will and my resiliency. Remaining hopeful in the face of unrelenting discouragement is hard, but not as hard as surviving some of the situations that my friends, clients, and co-workers face. I try to remain hopeful not just for myself, but for them as well.

These are tough times - and honestly, I use every trick in my therapist's bag of tricks to get through sometimes. That's also why I'm sharing them with you - even if they don't cure all the problems, they can help you cope or feel better and have hope in the face of everything that's hard, tough, and discouraging. I go back and read some of my favorite self-help/inspirational books - stuff by Sark, Jennifer Louden and books like "Feel the Fear - and Do It Anyway" by Susan Jeffers. Another favorite is "Broken Open" by Elizabeth Lesser. I talk with other people who have been through what I'm facing - it helps to know it CAN be done, and HAS been done. It might be tougher right, and there might be more obstacles - but it's still possible.

We are a resilient people. And we don't have to go it alone. We can be there for each other - and it doesn't have to be therapy. It can be a smile, or a "good job" or an encouragement like, "I know you can do this." It can be a compliment, or an understanding - we don't HAVE to get mad when the checkout line at the store takes forever. We can tell the cashier, "it looks like you've had a long day. I hope it gets better." The power of each other is us, folks...we can choose to help each other, or not. I can tell you, though - it's a lot easier to hide than it is to stick our necks out, AND it's a lot easier to be resilient when we're there for each other.

We don't have to go it alone - that's a powerful statement. We are NOT alone, and we won't BE alone. There are people who care, and there are people who want to help. Sometimes reaching out and asking is the scariest and hardest thing - we're risking rejection and hurt when we do. And...we don't have to go it alone. Seriously - say it: "I don't have to go it alone. I am NOT alone." It's a powerful, inspiring, comforting thought. And if you're feeling alone - write me. I know what it's like and I'll write back. You - yes, YOU - are not alone. Really.

That's what the power of each other is all about.

Please Note: The content on this blog is intended for informational purposes only. This is not therapy, and if you wish to work in therapy, please contact your local mental health agency or your physician for a referral.

If you are in crisis or danger, please call 911 for immediate help. Please, again, realize that seeking out help really IS a sign of strength and not a sign of weakness. You don’t have to be alone in facing these things – there are people who care and who will help. Email me at: [email protected]

CBT: Dealing with Stinkin' Thinkin' and The Shoulds

7/14/2014

Ok - in the last post, we ended on kind of a "down" note (reminds me of "The Empire Strikes Back - who wanted it to end with Han Solo getting iced and Luke losing his hand? C'MON!) Anyway - back to CBT...

In this post, we're going to talk about what to DO with these shoulds, absolutes, and other negative thought patterns that get in our way. CBT is, as I've mentioned, a very flexible orientation, and there are many systems of therapy that are based in CBT concepts (like DBT, for example.) So, instead of going into a whole lot of specific techniques based in one system, I'm going to touch on some general techniques that you'll find a lot of CBT therapists using. I've mentioned a few of them in the first post, but I'll review those here again.

One thing I mentioned in the first CBT post bears repeating again: this is NOT a "quick fix" solution to problems. These techniques, and change itself require commitment to practicing the techniques and to changing the way you think and interpret things. This takes time, and does not happen overnight. CBT has been accused also of being a feel-good way of saying that if you think happy you'll be happy. While this criticism has some merit, it's just not that simple. CBT does assert that if you change the way you think, you'll likely feel somewhat better, but does not promise results (like any therapy) and is way more complex than the simple "if you think better you'll feel better" platitude.

Ok - on to the nuts and bolts again. When you're involved in doing CBT or going through one of the many CBT-based workbooks you can find in the self-help section, you will see that there are many commonalities. First, you are likely to be asked to either talk about what the problem is (to help the therapist understand your interpretations and perceptions as well as your thought patterns) and/or fill out some paper-pen type questionnaires (called "inventories" in the clinical field.). These inventories will ask about a variety of symptoms (to help therapist or you get a handle on what's going on.) For example, if you come in thinking or feeling depressed, you might be given something called the "BDI" (Beck Depression Inventory - guess who developed that? ) This questionnaire asks you to rate the severity of common depressive symptoms that you might be experiencing. There are other inventories and symptom checklists that are useful as well. Well and good, so when do we get to the CBT stuff?

A-ha...remember the "B" part of CBT? That stands for "behavior" - in order to work well here, your therapist (or you, if you're working in a workbook) needs to know what you're experiencing and doing, as well as what you're thinking. There really is a reason behind the stuff we do - promise! How we act often reflects the way we're thinking - we interpret things, we feel an emotion related to the interpretation, and we act based on the interpretation and the emotion. Ok...so you've filled out the inventories, done all the paper work, described the situations and what you've been feeling - now what? That's where the "behavior" part - what we do - comes in. A lot of the "homework" and activities in CBT is, quite frankly, behavioral.

Here's where the workbooks and being in therapy differ some. The workbooks will go straight into the things that we typically call "homework," where a therapist will explore the situations more in-depth, provide support, and help you see and work with the stuff that brought you in. This is why I really recommend therapy (ok - I'm biased, too - I admit it). The workbooks can be really valuable resources; I use them myself as part of the work I do with clients sometimes. I've recommended them to clients, and I use them in session, when appropriate - they make my job easier because I don't have to reinvent the wheel here in terms of homework. BUT, they don't provide you with that ongoing sense of support and empathy that you get with a well-trained therapist. It's a choice you make, though.

When you're working with a therapist, the therapist will help you identify the thought patterns that are getting in the way for you - are you thinking in absolutist terms? Are you overwhelmed by "shoulds"? What about feeling like everyone should like you - or that you should do everything to make people like you? You get the idea...the therapist will spend time talking with you and helping you identify where your thinking and/or interpreting get in the way of you feeling better. The workbooks may have you answer a lot of fill-in-the-blank questions or do a lot of sentence completions, but the goals are the same: helping you identify the types of negative thinking or interpreting that are not helping you.

Typical homework assignments include keeping a record of your thoughts and how those thoughts affected your emotions and behavior, or keeping track of how many times you catch yourself sliding into one kind of thought pattern. There are also behavioral challenges or assignments to help you practice a new way of interacting with and intepreting the world around you. I once kept track for a week of all my "shoulds" - I filled an entire 70-page mini-notebook! It's really eye-opening when you realize how often we engage in these ways of thinking, and how much they affect our moods and behavior - which is, of course, the point of the exercise!

Next, what may happen is that you may be asked to work on contradicting or "softening" these patterns. For example, if you're overly harsh with yourself, you might be asked to come up with thoughts or phrases or sentences to tell yourself that are loving, accepting and/or nonjudgmental. If you're stuck in a pattern where you're overgeneralizing things or magnifying/minimizing, you might be asked to come up more realistic interpretations. Many times, some of this work is done in the therapy room with the therapist helping you, because for many people in therapy these thought patterns have become habits. It may have happened out of ongoing abuse or neglect - these patterns are likely part of what helped you survive, or it may be something that's resulted from some situational things going on like, "I've been out of work for a year, and I'm worried I may not have enought money left to meet my or my family's basic needs" or "I can't seem to get myself to feel better even though it's been two years since my great-aunt Clara passed away".

Situations have a LOT of power - we tend to interpret our stuff in terms of the situation ("I was speeding because I needed to get home to a sick child") but we tend not to give others the same benefit of the doubt ("They were speeding...what jerks. I bet they cut everyone off and run red lights too"). As a side note: If you've taken introductory psychology, you'll probably recognize a few concepts here: self-serving bias, fundamental attribution error, actor-observer effect...

So, your therapist may use some gentle challenges, some reflecting, some humor (when appropriate), summations, "check-ins" (making sure they understand what you're telling them), etc. In therapy, you may also use some of the "workbook techniques" - they're very useful as homework.

With both the workbooks and in therapy, you'll also examine what triggers the thoughts, the emotions, and the behaviors - you may find that a certain style of thinking or way of interpreting things is behind the way you feel or behave. Or it may be something in your environment - a certain authority figure that reminds you of someone in your past who'd been critical, or a certain place, smell, sound that triggers memories and experiences from a a traumatic event - it's hard (or even impossible) to think clearly and well when you're re-experiencing something traumatic. (Here's where working with a therapist is really helpful - the therapist can help with the PTSD symptoms as well as the cognitive stuff.) From there, you can work to change, heal and hopefully start to feel better.

One thing I want to say about triggers: If you're dealing with PTSD or things that trigger severe emotional distress, please see a therapist. The therapist can provide a safety net where you can work on and process these triggers, and can again provide support for you while you're working on these. Any time you're dealing with severe or chronic emotional distress, it's best to see a professional who can do more than anything you'd find in a workbook or web site. A therapist can also help you go more in-depth and safely explore the event(s) or trauma behind the triggers. Workbooks and web-sites can provide tremendous support and information, and they don't take the place of a really good therapist. I don't want to diss support groupgs and websites - they are incredible and filled with fantastic people who have been through, treated or supported people through some pretty traumatic stuff. However, if you're in the throes of serious distress, adding a good therapist to that mix will only help you.

Ok - back to nuts and bolts: Another area you'll want to concentrate on, again with both the self-help stuff and in therapy, is what to do to help you maintain any changes you make and/or improve on them. Changing things in your lifestyle may help (for example, if you're dealing with depression, building in some exercise into your routine will likely help you feel better), as would continuing to use some of the tools you've used in therapy (like the mood log, or examining realistic vs unrealistic thinking). These aspects of therapy or self-help can help you manage situations in the moment and help you realistically process and think about them afterward.

The nice thing about CBT is that what you do and how you do it really is individualized. It's not about unconscious motives, Oedipus complexes, penis envy or any of that - it's about what YOU can do to help yourself think in a healthy manner, feel better and change your behaviors so that you're interacting with the world in a way that creates a better life for you. It's not a one-size-fits-all orientation either - CBT, through research, is always working to incorporate things that help and are validated by research. That said, sometimes it can seem "manualized" and "remote" - if this is the case, bring up how you're feeling about it in therapy, and process that with your therapist. If you're using a workbook, ask yourself what you're hoping to see in the workbook, and where you're missing what you wanted - then get recommendations for something new, or scale down your expectations and continue to work the program. (And expectations are a whole AREA of cognitions to work on, by the way!).

So...if you have questions about specific techniques, or want to know more about a specific area of cognitions and/or disorder where CBT may be helpful, feel free to comment or send me an email. I'm always happy to help, and answer all the comments and emails I get.

Take care and think well!

Please Note: The content on this blog is intended for informational purposes only. This is not therapy, and if you wish to work in therapy, please contact your local mental health agency or your physician for a referral.

If you are in crisis or danger, please call 911 for immediate help. Please, again, realize that seeking out help really IS a sign of strength and not a sign of weakness. You don’t have to be alone in facing these things – there are people who care and who will help. Email me at: [email protected]

Dealing With Trauma - Coping

4/28/2014

Due to the length of this post, I am dividing it into two sections for readability. If you have any comments or questions, please feel free to contact me: [email protected].

During my training, I developed an analogy I'm going to share with you here. Using medication and therapy together is like working to fix a house with a crack in the foundation. The first thing you have to do before you fix the crack is shore up the house, right? Using medication is like shoring up yourself - it takes care of the biological and chemical aspects of what is going on. One thing I want to emphasize - these medications are not addictive! They help stabilize you and bring you up to feeling normal, NOT feeling "high." From there, you work to fix the crack in the house - this is where the therapy piece comes in. If you try to fix the house by shortcutting either one of these steps, guess what? The foundation is going to stay cracked, get worse, or possibly break again. Using both tools (medication and therapy) will help you heal the foundation and make your house - you - stronger by helping you learn to recognize problems and deal with them in a way that keeps you healthy and whole.

With these things in mind, there are things you can do to help yourself as well. Among those things are some of the techniques I mentioned earlier in the "Coping with tough times" posts. The difference here is that there is a slightly different focus. When you are dealing with recovery from trauma and/or PTSD, anxiety and fear are huge issues that don't simply "go away." When you're working with anxiety, self-soothing to reduce the anxiety, worry and fear that you feel is crucial. So, the same things I mentioned before: listening to relaxing music, meditating, journaling - whatever you find soothing and helpful that does NOT become hurtful - will help some.

The cognitive - or "thought" - piece that's different is that you want to recognize and acknowledge the emotion specifically related to the trauma or experience - "Ok, I'm really anxious and feel like I'm coming apart at the seams. What is behind this anxiety? Am I afraid that <insert whatever traumatized you> will happen again?" If that is the case, asking yourself, "how likely is it that it really will happen again?" may help. In some case, the likelihood might be high - you'll want to work on what you can do to protect and shelter yourself if that's the case, and working with professionals in many fields (police, medical, psychological) may be part of that process. In other cases, the likelihood of the event reoccuring may be low - in that case, reassuring yourself that you're safe, that you're doing everything you can to keep yourself safe may also help. Please - again realize that you don't have to do this alone. The support you'll receive from a good therapist can really help you feel better.

Another area in which you may want to work involves your boundaries. Especially for those of you who were victims of abuse, rape or other traumas where your physical and emotional boundaries were violated, setting and maintaining healthy boundaries is crucially important AND very hard work. For those of you who are in situations where your boundaries are still being violated, setting and maintaining healthy boundaries may threaten the person violating them - for you, I would strongly recommend seeking the support of a professional in working on these issues, creating a safety plan, and having an escape ready if necessary. You will need support and possibly protection, and working with a professional - whether it's a medical doctor, psychologist, therapist, or clergy - will help you get the physical and mental protection and support that you need. Do not hesitate to call 911 if you need help!

Learning to set boundaries takes practice and work. I've done completely separate posts on working on boundary issues, but for now, let's first discuss what boundaries ARE. The basic idea here is that a boundary is something that separates you from everything else. Your skin is a boundary between your insides and the outside world, and protects you from injury. Likewise, psychological boundaries are the ways that you know you are separate from everyone else around you. To quote the title of a popular book on boundaries, they are "where you end, and I begin." ("Boundaries: Where You End and I Begin" Anne Katherine). Another book described boundaries this way: "They define what is me, and what is not me" ("Boundaries" Henry Cloud & John Townsend). When your boundaries are violated, you are being told "it doesn't matter who you are, what you want, or what you need. What I need or want is what counts, and I'm going to take it whether you agree or not or whether you say no or not." For many of us who have experienced trauma, our boundaries have been severely violated and compromised; this leads to a sense of helplessness, fear, anxiety and/or depression. The best thing you can do at this point is first realize that your boundaries have been violated (and that you have a right to even HAVE boundaries), and from there, work on realizing what they are and how to set and maintain them. This, as I know from experience, is hard work.

Working on boundaries though, also helps you work on and deal with trauma. By building boundaries, you are saying that you have the right to be whole, the right to control who and what has access to your body, your thoughts, and your feelings. Dealing with trauma also involves understanding and working with your feelings. Emotions can be very frightening and very threatening sometimes, especially if they are powerful or intense, like anger/rage, depression, or anxiety. It may feel like they are going to engulf you, drown you, and/or never end. This is where envisioning the emotion as a wave can be helpful (see the previous post for more information.) If you feel you can't stand it, that you are going to do something harmful like cut yourself, hurt yourself or someone else - get help - call 911. If you're not to that point - do something that will help yourself - call a friend (or sponsor if you're in a 12-step program), distract yourself if it helps, write it out, something that will help you. The thing is, the emotion WILL pass, and you WILL survive it.

In "dialectical behavior therapy" - one of my areas of expertise - we teach people some skills for "emotional regulation" and "distress tolerance." These skills help people deal with the overwhelming sensations that their emotions are going to engulf them. What I've described for you in the coping skills post are some of those skills. I will write more about DBT in coming posts, as it is a very helpful system for dealing with trauma, emotional storms, and coping in general.

Trauma is also isolating - we may feel that we're all alone in this, or that we'll be punished or embarrassed if we talk - a common phrase I've heard is "we don't air our dirty laundry to others." The thing is, the "dirty laundry" that is being aired is often the very stuff that is traumatizing. Opening up - say, in the context of a trusted relationship or a support group, can be the most healthy thing you can do - you'll find out you're not alone, and that other people have experienced similar things. You may feel like you don't belong, or that you're alone, or that you're somehow "damaged" - being with other people who have experienced similar things or with someone you trust can help you see that you're not damaged and not alone.

The final thing I want to say at this point, is have a safe space. Someplace where you CAN relax - at least a little - and feel safe just being and healing. This might be your bedroom, a special spot in nature, going to your place of worship, or even just creating a safe spot in your mind, wherever you happen to be. While you're in this safe space, breathe slowly and deeply. This is part of learning to soothe yourself, and is part of healing. If you experience triggers related to your trauma, get help if you need it - take care of yourself! If you don't need immediate help, do what it takes to get through it.

Please Note: The content on this blog is intended for informational purposes only. This is not therapy, and if you wish to work in therapy, please contact your local mental health agency or your physician for a referral.

If you are in crisis or danger, please call 911 for immediate help. Please, again, realize that seeking out help really IS a sign of strength and not a sign of weakness. You don't have to be alone in facing these things - there are people who care and who will help.

Dealing With Trauma - What is PTSD?

4/28/2014

Due to the length of this post, I am dividing it into two sections for readability. If you have any comments or questions, please feel free to contact me: [email protected].

I've had several people over the past few days contact me and tell me about trauma-related incidents. First of all, for those of you who did contact me, thank you for trusting me. I respect you for your strength, and want you to know that your trust in me and your confidentiality is and will be honored.

That said, it seems that the posts around coping may have opened a door for talking about how to deal with trauma and PTSD. For those of you who don't know much about PTSD (Post-Traumatic Stress Disorder) beyond what you've heard about veterans, let me fill you in. PTSD is a reaction to dealing with extreme or long-standing traumatic stress. The classic example we most hear about is that of soldiers experiencing PTSD as a reaction to the horrific things they witness in combat and/or military activities. I'm NOT going to minimize those experiences at all - from what we've heard in the news, PTSD is - if anything - on the rise especially in current military personnel and veterans of the recent actions in Iraq and Afghanistan.

However, PTSD is also found in many people who experience other traumatic injuries and insults - both physical and psychological. Rape victims and victims of physical abuse may experience PTSD, people who are victims of emotional and psychological abuse also experience PTSD. The abuse or insult does not have to be an ongoing issue, either - people who have experienced a single episode of a traumatic event can also experience PTSD. Those involved in car or other vehicle accidents, victims of crimes, those who have had a family member hurt, those who have been victims of robberies or break-ins..the list of possibilities for who can experience this is nearly endless. Another thing to keep in mind is that what is traumatic and triggers PTSD in one person may or may not trigger it in someone else - we are all unique people with our own strengths and weaknesses and areas of resilience and vulnerability.

So, what is PTSD? Generally speaking, to receive a diagnosis of PTSD, one must have "experienced, witnessed, or was confronted with" something that risked death or severe injury, or a threat to the someone's physical or psychological wholeness. The other major piece of this is that the person's response involved "intense fear, helplessness, or horror" (I'm quoting from our clinician's book of diagnosis information, the DSM-IV-TR). These are the two most basic things that have to be met. Beyond that, the trauma is re-experienced in a multitude of ways such as flashbacks, nightmares, not being able to get it out of your mind, or reacting disproportionately to things that remind the person of the trauma. In PTSD, the victim will also go out of her/his way to avoid things that remind them of the trauma, or may seem numbed or non-responsive to things that would normally cause a reaction. Finally, the person will experience other emotional and/or physical difficulties such as depression, difficulty concentrating or controlling their emotions, not being able to fall asleep, or startling at even little things. For true PTSD, these symptoms last longer than a month (in the cases of symptoms being less than a month, we call it "Acute Stress Disorder," but except for the duration of symptoms, they are generally the same thing.)

So, if you've been dealing with something in your life that has triggered these symptoms, what do you do? The first thing I would recommend, honestly, is working with a good psychologist or therapist. As I've mentioned before (and firmly believe from experience as well as training), seeing a therapist and/or getting help really IS a sign of strength and of hope, NOT a sign of weakness. We have such an unfortunate stigma in our society - you are NOT "crazy" if you seek out help. If anything, you're showing how sane you are. These traumatic things that happen sap our strength, and test our abilities to function and live life - we have a right to be free of and heal from the traumatic things that happened, and a right to recover and live fully.

Seeing your doctor about medications might help as well - I and many other people view using medication for anxiety, depression and other disorders as being the same as using medication to treat diabetes or heart disease. The main difference is that you're working with brain chemicals that you can't see. Otherwise, there is a medical aspect to these conditions and working on that as well as the psychological is important.

Please Note: The content on this blog is intended for informational purposes only. This is not therapy, and if you wish to work in therapy, please contact your local mental health agency or your physician for a referral.

If you are in crisis or danger, please call 911 for immediate help. Please, again, realize that seeking out help really IS a sign of strength and not a sign of weakness. You don't have to be alone in facing these things - there are people who care and who will help.

Coping With Tough Times, Part 2: Coping Skills

4/28/2014

Ok, so what do you DO if things are still tough? "Tough Times" can be found in relationships, financial troubles, work situations, family issues - a whole range of things. What's "tough" for you, may not be tough for someone else, and what's tough for them might not be for you. So, given that these things are different for different people, what are some things that pretty much everyone can use? First of all:

If you have been feeling down for two weeks pretty much every day and for most of the day, if you have thoughts of hurting yourself and/or others, or if you're having trouble functioning, please see your doctor right away - you may be dealing with clinical depression. If you are feeling that you might hurt yourself or someone else, please call 911. Please also realize that seeking help really is a sign of strength and belief in yourself and not a sign of weakness.

As part of my training and my work with people in various situations in their lives, I learned a lot about coping skills - the fancy name for "learning to deal with it" - whatever "it" is. As you might imagine, this is a pretty important topic for therapists and their clients. And to be honest - I practice what I preach, and use these myself. There are a LOT of good self-help workbooks out there - I'll give a list at the end of this post - and these may help you structure your coping, if that's what you need. So - on to the meat of the post:

Let's start with things that end up being harmful. Basically it boils down to two things: Stuff that gets you in trouble, and stuff that ends up hurting you and/or someone else. Stuff that gets you in trouble includes excessive drinking, using mind-altering substances, excessive spending, sex, gambling, not fulfilling responsibilities like going to work, etc. Stuff that hurts you and/or someone else includes: excessive eating or undereating, exercising too much or not enough, losing your temper and abusing yourself or someone else, physically hurting yourself or someone else, beating yourself or someone else up emotionally, getting caught up in or laying on guilt trips, calling names, insulting yourself or others, and talking or thinking in absolutes (like, "I'll never be able to get out of this hole" or "You always ruin my day"). If you're feeling out of control with these things, please find help for them, if for no other reason than it helps yourself and your loved ones.

So what are the things that may help?

First of all - when you're feeling down or really anxious, realize that emotions are like waves - they build up, peak, and then pass. This idea is not new; Marsha Linehan's "dialectical behavior therapy" uses this concept. To cope with strong emotions that really feel like they're going to knock you down, it can sometimes help to remind yourself that the emotion will not last forever, and that it WILL pass. You are not your emotions - your feelings are reactions to things in your environment. Just as your situations change, so will your feelings. For me, I visualize an ocean wave as it builds, swells, and washes over me. You might like this, or maybe a gust of wind - whatever works. The point is, the feelings WILL pass.

Second, you can help the wave pass by distracting yourself. There are many things you can do - I work in my journal, create art, go for a walk, listen to calming music, surf the internet, etc. What you want to do is find something that will take your mind off the "down" feelings - it doesn't have to last forever, but distracting yourself will pay off, even if you only are able to distract for a few minutes. It's at least a few minutes that you weren't focusing on feeling "down" or anxious, right? There are an infinite number of ways to distract yourself - just use your imagination and see what you can come up with (and yes, this in itself is a distraction!) However, be careful with distractions - don't let them turn into "target behaviors" (the things that get you in trouble or harm you or someone else.)

One thing is important if you're feeling "down" or super-anxious - do something positive for yourself every day, such as exercise, get involved in doing something you enjoy - a hobby or pastime - , enjoy some quiet time to yourself, etc. Treating yourself as you want other people to treat you (a twist on the golden rule) or as you would treat other people is very important - you really are worth the effort and deserve to be treated well.

Third, try reframing your thoughts. This is admittedly sometimes a tough thing to do, especially when things feel hopeless or that a situation will never change or end. Sometimes working on changing your thoughts is a conscious effort; if you keep at it, hopefully the positive thinking will feel more natural. If you're having a tough time doing this, try writing down all the negative things you tell yourself and then contradicting them. Here's an example: With my work life, I admit to feeling like sometimes I'm spinning my wheels and not getting anywhere. I remind myself of what I've done (developed a private practice and found work with an amazing group of women at Beyond the Mirror), what I've achieved (my Ph.D., passed my licensing exam), and where I realistically am at (working on new content, expanding into new areas like life coaching, and applying my passions to my work) Reminding myself of the postives can help contradict the negative feelings.

Many therapists recommend keeping a "mood diary" or "thought record" where you can keep track of the thoughts you have, the feelings associated with them, how you changed your thinking, and what the result of the change was. Again, if this works for you - if you need and/or want to see your progress - by all means do it. It can be very simple - a piece of notebook paper divided into four or five columns (if you want to include the dates), and simply keeping track. It can be more complex, for example setting up an Excel spreadsheet. Keep in mind that first, the very act of doing this at all is a distraction (being busy tends to distract us from our feelings) and second of all, productive because you're working on helping yourself.

Mary Ellen Copeland, a therapist who deals with bipolar disorder, has developed some excellent tools for dealing with stress. She recommends creating a "wellness action plan" that includes 5 distinct parts:

1) Developing a wellness toolbox (similar to the coping skills described above) and keeping track of your moods and activities on a daily basis (the "Daily Maintenance List")

2) Listing the things that trigger feeling rotten and planning on ways to deal with those

3) Listing the "Early Warning Signs" of impending mood changes, and planning on ways to cut off mood changes BEFORE they get too bad

4) What to do when things are breaking down - how to deal with crisis situations: what the signs of this are, who to call/contact in case of an emergency, and how to deal with this when/if it happens

5) Developing a Crisis Plan: How to help other people know when you're in crisis, how other people can help you, and again who to contact

Copeland's web site: http://www.copelandcenter.com has some excellent information and resources related to this program. She also has several workbooks in publication and again, I'll list those here at the end.

There are also the things that we hear everyday from all kinds of experts: eat well and moderately, exercise regularly (this really DOES work to help moods, by the way), limit how much alcohol and other substances you put in your body, get enough rest and/or sleep, and see your physician if you're having problems in any of these areas to rule out physical/medical causes.

Specifically getting involved things that are designed to be relaxing may also help. Again, listening to calming or relaxation music may help. Other tools include meditation, relaxing tense muscles/progressive relaxation (for example, tense and then relax each muscle group in turn, starting at head and working down), using deep breathing from your tummy (diaphramatic breathing) - all of these things (and more) help ease stress and help you cope with feeling in the dumps.

The bottom line is that working to change your thoughts, helping yourself relax, and soothing yourself by doing things that make you feel better help you deal with feeling down. These aren't a be-all and end-all to always feeling down, or a sure-fire "cure" for the blues. They ARE things that may help, though, and are time-tested tools that have been shown to help.

If you have any questions or comments, please contact me here or via email: [email protected] . I'll be happy to talk to you and listen to your input.

Please Note: The information on this blog is intended for informational purposes only. This is not therapy, and if you wish to work in therapy, please contact your local mental health agency or your physician for a referral. If you are in crisis or danger, please call 911 for immediate help. If you wish to contact me, you can call (970) 776-6043 or send email to: [email protected]

Resources:

The Relaxation and Stress Reduction Workbook, 5th ed. - Martha Davis, Elizabeth Robbins Eshelman, & Matthew McKay

The Depression Workbook, 2nd ed. - Mary Ellen Copeland

Mind Over Mood - Dennis Greenberger & Christine A. Padewsky