Category: DBT

Struggling with a "New Normal"

7/25/2022

Let's be honest - No one wants a "new normal." I was working with the idea of "new normal" long before the pandemic hit, but since the beginning of the COVID pandemic, the idea of adjusting to a "new normal" has become more universal. Since I moved to Boise, I've been working with neurological injuries and conditions, and one important aspect of coming to terms with these conditions is adjusting to changes brought on by illness or injury. These injuries and conditions turn peoples' lives inside out and upside down, and adjusting to the changes is an ongoing process. No matter what caused the injury or condition, the adjustment process seems to have some stages in common, similar to a grief process. We are seeing a similar process in people who have survived COVID and societally in our cultural reaction to the pandemic.

Photo by Kindel Media: https://www.pexels.com/photo/woman-in-white-v-neck-t-shirt-smiling-7298391/

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

8/25/2017

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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."

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What's the Difference Between Counseling and Coaching?

7/18/2014

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Unfortunately, there is a lot of confusion about coaching and what it is, especially in regard to how it's different from counseling or therapy. One common - and wrong - distinction I hear a lot is that counselors work with people who are struggling with problems or mental illness, and coaches work with people are healthy. I need to say this clearly - this is NOT true! Even trained mental health professionals buy into this false distinction. Another thing I hear a lot is that coaches set measurable goals and counselors' goals are less well-defined. Again, simply not true. There are many, many other misconceptions, and I hope to clear up these and a few others in this post.

Let's talk about the first misconception. It's half true - coaches do work with people who are not experiencing emotional difficulties or mental illness. They are not trained to do so, and are not licensed or supervised in doing so. However, the other half - that counselors don't work with those who are healthy - is simply not true. The reality is that counselor's and psychologist's training makes them very qualified and trained to do coaching. Dr. Michael Bader, a licensed psychologist, points out that:

The biggest difference between coaching and therapy, in my view, is that the theory that guides my work as a therapist can explain how coaching does or does not work, while theories that guide coaches can't do the same about therapy. (http://www.psychologytoday.com/blog/what-is-he-thinking/200904/the-difference-between-coaching-and-therapy-is-greatly-overstated)

Another, similar distinction is that therapists and counselors work with the past, and coaches work with the future. Again, this simplistic division simply isn't true. Let me give you an example. In the therapy I do, Dialectical Behavior Therapy (DBT), we focus specifically on how to manage situations that are likely to happen in the future. While I do sometimes explore the past in terms of how it affects my client's current level of functioning when it's relevant, the work I do specifically involves working toward making a better future. Cogntive behavioral therapy in general has this orientation. It''s simply untrue that counselors don't focus on the future.

The second misconception - that coaches set measurable, time-limited goals and therapists don't - again, simply is not true. Therapy works best if client and therapist work together to set exactly these kind of goals. That's how we measure progress. Many therapists I know will assess their client's sense of whether or not they are achieving their goals every session or every few sessions. Tied into this misconception is the idea that therapy is long-term and coaching is not. Again - many good systems of therapy (solution-focused therapy for example) work best with a time-limited model.

Many coaches like to point to specialized training they have worked on. As a psychologist, I very much appreciate the effort these coaches have made to educate themselves and work in an ethical manner. Professionals like these are a credit to their profession. However, coaching as a whole has not licensure, certification or even educational requirements. There is no professionally agreed upon code of ethics. Because of this lack of centralized standards and ethical principles, engaging a coach is a risk.

Please don't get me wrong - there are many, many wonderful, trained and ethical coaches out there. There are also some great training programs out there. The International Coaching Federation has made an effort to create a code of ethics and implement standardized training. I think this is a wonderful start. However: The ICF has no authority to implement these standards to the field as a whole. There are no licensing requirements. I hope that will change in the future, and believe that it will. Until then, however, there is a wide range of traininig programs ranging from in-depth programs requiring supervision to simple online classes with no practice component. At this point in time, they can all claim to be "coach training programs" with equal legal standing.

The fact of the matter is that counselors and psychologists are highly trained. They have engaged in in-depth coursework, practicum and internship experiences during which they get real-life experience, and supervision. They are licensed, and regulated by licensing boards and codes of ethics. Because of these safeguards, there is more consistency and safety for you, the consumer.

So, let's get at the issue of how this works. Coaching is focused on helping you identify and make movement toward reaching your goals. So is therapy. Coaches are trained (ideally, but not necessarily) in helping you set and achieve these goals, through specific techniques including targeted and open questions, activities, and developing insight. Counselors and psychologists can do this too. The truth of the matter is that a trained and licensed counselor can do anything and everything that a coach can do. Coaches, however, are not able to do everything a counselor or psychologist can do. Coach trainer Barbara Silva said:

As a coach trainer this is an issue I discuss quite a bit with my students. The biggest difference as I see it is that a therapist may address both coaching and therapeutic issues whereas the coach must remain within the coaching realm, staying away from clinical issues. From the client's point of view, it's more about their perspective on the kind of assistance they need.

The two professions work well together and the key is to collaborate, so that the client gets the best support possible. I've noticed a growing number of therapists in my classes who are interested in learning new coaching techniques. Some are pursuing the Board Certified Coach credential via the Center for Credentialing and Education and the National Board of Certified Counselors. I see a great future for both disciplines." (http://www.psychologytoday.com/blog/what-is-he-thinking/200904/the-difference-between-coaching-and-therapy-is-greatly-overstated/comments)

The last misconception I want to address is one that I have to admit bugs me because it strikes at the heart of my work. I read a lot that coaching is a wellness model, while therapy is a treatment. Reality: Many, many therapists (myself included) adopt a wellness model. Focusing only on the negative and on how to fix what is wrong does not help over the long term. Focusing on wellness, and healing, and health is an important aspect of therapy.

So, the bottom line is that really is not much of a difference except training. (I know that there may be coaches that take issue with this, but the evidence is pretty clear.) Therapists and psychologists can do anything and everything a coach can do, because they are trained, they work with wellness as well as problems, and they use many of the same techniques, methods, and models.

If you are interested in working with a coach, check out the International Coaching Federation for their training and ethical guidelines: http://www.coachfederation.org. They are an excellent resource, and can refer you to well-trained and ethical coaches. If you are interested in working with a psychologist or counselor, ask them if they do coaching - many do!

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]

© 2014 Dr. Laura Burlingame-Lee, Ph.D.

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Depression - Dealing with and Taming the Beast Within

7/14/2014

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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]

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You Are Not Your Mood

7/14/2014

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Emotions are weird. They have a way of changing so fast we hardly know what hit us, and they can change our outlook on a situation, person or perception nearly as quickly. It helps to remember that as much as our emotions affect us, they do not define us. We are more than our emotions.

A few months ago, I struggled with this. I was feeling down - I was being impatient and it seemed like nothing was going right. Now, if you've been reading these blogs, you know as well as I do, that this is not the case. Red Flag #1 - feeling down about things does NOT mean that the feeling is reality. Ok, good enough - and I was still feeling lousy.

So, I thought...if I were the client, what would I be doing in therapy? (Yeah, I know... I'm a therapy geek.) Most likely, I'd be looking at the situation and testing out whether my emotions were really reflecting reality, or whether they were masking reality. How do you do this?

Marsha Linehan has a really cool tool that she uses in DBT called "chain analysis." You start with the event, behavior or situation that was the problem. In my case, I looked back to when I started feeling down, and the even had nothing to do with what seemed to be the situation. I was feeling lonely on the afternoon before, because I couldn't reach my family members to talk. That spiraled into feeling somewhat depressed. Specifically, I remember thinking, "I guess no one wants to talk to me. I might as well not exist." Red Flag #2: I was getting caught up in "Stinkin' Thinking."

In doing a chain analysis, you identify the event/situation that started the problem, describe the event, including what you were feeling and/or thinking at the time or what you did as a result of what you felt, and then describe how intensely you behaved, thought, or felt. In my case, the loneliness, sense of failure and depression were pretty strong. I ended up thinking, "I"m never going to be able to do this. I might as well just quit." Red Flag #3 - Stinkin' Thinking again. The idea here is that you want to describe all this in as much detail as you possibly can. Here's a good litmus test: Could someone recreate *exactly* what you went through? If so, then you've done it.

Next, you describe what led up to the feeling, thoughts, or behavior. In my case, not being able to talk to someone was the situation. This "precipitating event" (also called a "prompting event") is usually what we point to when we say that "such and such" caused the problem.

From here, you do a detailed description of all the things that affected the situation - Linehan calls them "vulnerability factors." In my case, I was tired from not sleeping well, I still had an annoying cough from a cold and didn't feel well, I was stressed by all the details stemming from running a new business as well as being worried about several emotionally intense client situations. I was overwhelmed, tired and not feeling good. I was also feeling emotionally exhausted by family situations and childcare issues.

Ok, here's where chain analysis gets tedious - you describle in minute, excruciatingly clear detail the chain of events - starting with the all the way at the beginning with precipitating event(s) and going all the way to the consequences. Ok - here goes: I called my mother and got her answering machine. I then called each of my sisters in turn and had the same result. I started feeling like I didn't matter. I called my husband, who was out at the park with our kids, and he didn't pick up. I started feeling depressed, and went to work on my task list for this week concerning my business and the paperwork I had to complete. Looking at the things I had to do, I felt overwhelmed and incompetent, and felt more depressed. I remember thinking, "Why bother?" and which led to a deeper negative mood. The consequences were that I was not present when my husband did come home and wanted to talk. Right then, I just wanted to be left alone to marinate in my own misery.

At that point, I recognized what was going on, and took steps to counteract the mood. The last step in the process is to describe in detail a prevention strategy and what you are going to do to repair negative consequences that resulted from your behavior or mood. In my case, my prevention strategy was stay mindful of my moods and to write. Writing in my journal, for me, is a safe place to vent and analyze what's going on. When I write, I feel better and so that's a good strategy for me to use. I can also go for a walk, and/or do something artistic. I could take a bubble bath, or have a hot cup of tea. Those are all things that help me - developing a list of what helps you will help you have something to turn to when you get feeling low. Nurturing and caring for yourself really IS important and necessary.

Luckily, the interpersonal consequences here were small. I went upstairs and apologized to my husband, and explained what was going on. I also told him that I needed some extra time to myself to write and sort out the depressed feelings.

If you're interested in more information on doing a chain analysis, you can go to a great website called DBT Self Help (www.dbtselfhelp.com) to get an idea of what this might look like in therapy or in practice. This website has an incredible array of tools, worksheets, handouts and articles.

Hope this helps - DBT helps with a lot of things - I highly recommend looking into it. Even if you don't go for it, learning about these coping tools and other tools available to you can help you get through these tough situations.

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]

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Loneliness: When the World Seems to Go On Without You

7/14/2014

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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]

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It's the Little Things...

7/14/2014

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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]

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CBT: An Introduction to Cognitive Behavioral Therapy

7/14/2014

Ok...I'll be the first to admit that I"m not perfect when it comes to having wonderful, positive, affirming thoughts about myself. One of the reasons I went into counseling psychology as a graduate student was because I wanted to learn everything I could about it, so that I could help myself. I have a LONG history of working on self-esteem issues, negative thinking patterns, and dealing with unnecessary guilt. The reasons don't matter at this point (to me anyway) but dealing with these issues does. I'm imagining that a lot of you are dealing with this too, so I'm going to share some tricks from the therapists' bag.

The cool thing is that you can find a lot of these and more help at your local bookstore. So, a lot of these "tricks" (everyday people-ese for techniques) come from a branch of therapy called "Cognitive Behavioral Therapy" or CBT. CBT has a long history, most of which I'll avoid here except to throw out a couple of names when appropriate. The bottom line with CBT is that therapists with this orientation (and trust me, there are many) ascribe to the idea that our thoughts affect our behavior, and that if we work to change the way we're thinking, then our behavior will be easier to change and we'll feel better. The nice thing about CBT is that a lot of research has been done on it, and most of the research is very positive - it's something that generally works, if done long enough and well enough.

Here's the problem though - a lot of people think that since it seems to be based in common sense, it should be easy and quick. Creating change using CBT isn't a "quick fix" - in fact it takes a lot of commitment and practice to get to where you want to be. If you're really looking for change, though, it's likely that you're feeling lousy to start with and will do what it takes to feel better. And CBT generally helps.

The basics of CBT are grounded in the idea that what we think and how we think about and interpret the world around us affects how we behave. Cognitions are the things that go through our minds: thoughts, interpretations, judgments, hopes, dreams, expectations, reasonings, rationalizations, plants, motivations, doubts, images - pretty much anything that goes on in your conscious mind is a "cognition." (I use conscious mind deliberately here because CBT therapists generally don't work with the subconscious or unconscious mind - that's a more psychoanalytic approach.)

Here are a couple of examples of how these work:, "Geez, that driver is such an IDIOT! He cut me off! He saw me, and he cut me off anyway!" is a cognition that can be taken apart for analysis: the observation: "he cut me off,:, the interpretation: "he cut me off deliberately," the assumption:"he saw me," and the judgment:"what an idiot!" And another: "I can't do anything right. No one wants to be around me anymore because I'm such a failure. I absolutely nose-dived that interview, and I know I came across as stupid. I should have had a job 6 months ago, and I keep screwing it up. No wonder I can't find something." And here's the analysis: The observation: "I don't have a job," the interpretation: "I'm stupid," "I keep screwing up," the assumptions: ""no one wants to be around me," "I can't do anything right," the judgments: "I'm a failure," "I come across as stupid," and "I should have had a job 6 months ago." And this is just one way to take it apart!

On to the "nuts and bolts" - what do you do in CBT? Well, when you're working with a therapist, generally we're pretty empathetic people. We're not out to tell you, "Geez, get your act together...honestly!" Frankly, if most therapists were judgmental, mean people we wouldn't have much worth, now would we? Generally, therapists will sympathize with you and check in with you to see if they're understanding you - a process we call "reflection." It works like this:

Client: I've been feeling really depressed lately. I just look at where my life is and I think I"m just a huge failure. I feel like the worst person in the world.
Therapist: I'm hearing a couple of things here...first is that you've been pretty down lately, is that right?
Client: Yeah, pretty much. I still don't have a job and I just can't seem to get out of this hole.
Therapist: So it seems like you've been pretty hard on yourself...I heard you say that you felt like the worst person in the world. That's pretty harsh. (therapist's interpretation of client's statements)

So, you can see that a therapist - of any orientation - is likely to be sympathetic. From there, where you go with your therapist depends a lot on their orientation, or what style of therapy they do. A CBT therapist will focus on the way you're thinking and how it affects you. The therapist will gently challenge you on negative thinking (or "stinking thinking" as we sometimes call it), and encourage you to think of other interpretations that aren't so negative in nature. Using our earlier example, this is how a CBT therapist might continue:

Therapist: I wonder where that idea that you're the worst person in the world came from? (exploration)
Client: Well, I can't seem to do anything right. Nothing seems to work out the way I want it to. I can't get a job, I can't do things right with my husband. Even my kids are mad at me.
Therapist: Wow...that's a lot of stress. (empathizing) You know, though...somehow I think there are people who are probably a lot closer to being "the worst person in the world" than you are...you know...maybe guys like Hitler? Somehow, I'm guessing that you're a little higher up than he is on that scale. What do you think? (gentle challenge, with a little humor)
Client: <laughing a little> Yeah, you're probably right on that one. I still feel pretty lousy about myself though.
Therapist: I know you've really had a tough time with the job stuff and what's going on at home. Is it possible that maybe it's not all because of you, though? What else could be going on? (reframing)
Client: Well...I guess the economy is probably making it harder to find jobs now. I still feel like I should have gotten something by now.
Therapist: <making time out signal> whoah...hang on there...time-out. Do you remember how we talked about "shoulds"? How they're like guilt-trips inside your head? I just heard you "shoulding" on yourself... (gentle confrontation)
Client: yeah...I guess I am pretty hard on myself.
Therapist: What would it be like to ease up a little? What would change? (challenge and exploration)

And so you see, that the therapist here is working with the client's pattern of thinking negatively about herself. We use gentle challenges, reframing things ("what else could cause this"), turning negative thoughts into positive thoughts, and give clients "homework" - thing to practice and use between sessions. It's actually a pretty cool system. If you've read my posts on DBT (Dialectical Behavior Therapy), you'll recognize some of this. DBT is a specific form of CBT. Another cool thing is that you can find CBT-based self-help in a LOT of places. New Harbinger, a publisher of self-help materials, has a lot of self-help workbooks that have a CBT orientation for dealing with all kinds of issues: depression, anxiety, stress and relaxation, obsessive-complusive disorder (OCD, and I would recommend working with a therapist if you're dealing with this), PTSD, anger, and grief and sorrow. And I'm sure this is only a partial list!

The point is, CBT techniques are relatively easy to teach and learn - the tough part is putting it together, practicing them in real-life and actually continuing to use and practice them. This kind of therapy can help you learn a lot of things: coping skills, relationship skills, and all the nuts and bolts stuff we talked about: reframing, thought changing, challenging negative or all-or-nothing thinking, and a whole host of other things Next up: "Stinkin' Thinking" - how to work with negative thought patterns and some more tricks from the therapists' bag.

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] to ask questions or get information.

Assertiveness: An Introduction

7/13/2014

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"Oh, you want me to organize the next women's group? Well, I've got a lot on my plate, but if you really want me to, I guess I could do that..."

"Ok, I'll get this report done by the end of the day..." (followed by getting caught up in other tasks, conversations, etc.)..."I'm so sorry, things just got out of hand. I'll just try again tomorrow; I might be able to get to it then."

"I'm so tired. But if you need this right away, I guess I can get it done."

Do any of these situations sound familiar? One of the workshops I offer teaches assertiveness skills. I'll admit something to you here: Being assertive is something I still work on, and probably will be working on for a while. So let's start at basics: What is assertiveness?

Assertiveness is first of all a way of communicating. It's worth discussing what assertiveness is not as part of this definition: it's not aggressive, disrespectful, or mean - it's not looking for a fight. Assertiveness is also not passive or passive aggressive - it's not doing things behind someone's back even if you think you're right, it's not giving in or letting someone run roughshod all over you. It's not a tactic for getting your own, way, either. In both of these methods, you have trouble saying "no" or maintaining and respecting boundaries (your own, or someone else's). I've talked about saying no and boundaries in other posts, so I won't spend a whole lot of time on these, other than to say that assertiveness is more than these two important factors. These are also skills that are used in DBT, in the Interpersonal Effectiveness module.

Ok, so what IS assertiveness then? As I mentioned, it's a style of communication. Here's a quote from a workbook I use (and draw upon heavily):

...it recognizes that you are in charge of your behavior and that you decide what you will and will not do. Similarly, the assertive style involves recognizing that other people are in charge of their own behavior and does not attempt to take that control from them. When we behave assertively, we are able to acknowledge our own thoughts and wishes honestly, without the expectation that others will automatically give in to us. We express respect for the feelings and opinions of others without necessarily adopting their opinions or doing what they expect or demand" (Paterson, 2000, p. 19).

The bottom line is that being assertive means being respectful of ourselves and of others. It means being aware of what we want and need, and working to meet those needs in honest, open, and respectful ways, and respecting other people as they try to do the same. Learning to say and hear "no" and developing, maintaining and respecting healthy boundaries are techniques used in assertiveness - they are part of it, but not the whole. Here's some examples of an assertive statements:

"I can't join this committee now. I'm on two other committees and I need to have some 'down time' to take care of myself."

"I just bought this book yesterday, and I noticed today that there is a page missing. I'd like a replacement, please."

"Excuse me, I'm next in line."

So, what gets in the way of being assertive? Lots of things. Again, drawing heavily from Paterson's book, our own fears, the reactions of others to us being assertive, power differences in relationships (e.g., employer/employee, doctor/patient, parent/child, man/woman - I'll address the gender thing in a bit), stress (this is hard work!), our own beliefs about what being assertive means. Stress reactions can be calmed with stress reduction and relaxation techniques. I don't want to minimize the importance of these, but they are a different set of skills and can be covered in a different post.

The other stuff leads up to the stress component, so let's focus on those things. Our own fears and beliefs about assertiveness get in the way for several reasons. First, we may worry that we'll offend someone, or that they'll be angry at us. And the reality is, that may be true. Let's go back to our working definition of what assertiveness is, though - they are responsible for their emotions, reactions, and behavior. Your job is to take care of yourself, in a way that's respectful - and that means respectful of yourself as much as anything. Dealing with someone else's anger is tough, I'll admit. (When you're in a relationship where abuse is possible, it can be downright dangerous, and this is where you want to have support - people you trust and that can help, a place to go if you need it, and a safety plan. This post isn't meant to address abuse situations.) Anger comes up a lot when you're changing your style of interacting - if you've always been passive before, seeing you change may be a shock to the people who are used to having their own way. And you know what? They'll adjust. Your fear, though, can get in the way.

So what do you do? Well, imagine you're a coach - what would you tell your client or athlete? First of all, ask yourself what you're afraid of? What is the worst that can happen? Are your fears realistic? If so, how can you help yourself, respect yourself and still be assertive? (Tough question, I know!) Second, try it out. See what happens - you may be surprised. Maybe you can find a less stressful or lower intensity situation in which to practice. Success is the best reinforcer here; if you succeed and have a good experience you'll be more likely to do it again. As the title of one book says, "Feel the fear and do it anyway." Here's the thing - if our fears get in the way, we tend to act out of our fears rather than acting out of the need to respect and meet our needs. The result is, we don't get our needs met.

Your other beliefs about assertiveness can get in the way as well. Do you belief that being assertive is unladylike or bitchy? Do you believe that it's selfish, or that other people's needs come first? These are all things that women who are assertive face in this society, by the way - there's that gender thing. Do you think it's impolite to disagree or say "no"? Many of us were raised to disrespect our own needs and focus on others. Being assertive after all this training otherwise is hard. Examine these, and look at how these beliefs affect your behavior. Then try an experiment - just try, once, to contradict one of these and be assertive anyway. See what happens.

Ok - now what about how everyone else reacts? Well, we've already noticed that other people may react by being angry, offended, or puzzled by your new assertiveness. This is where your boundaries become important. Don't back down, but don't get aggressive either. It's important to keep and maintain those boundaries.

Here's a good rubric for being assertive:

Decide whether to be assertive
Decide what to say
Decide what to do
Assess the results:

Ok, believe it or not, this is just a little part of the workshop. (It's a long post, I know).

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]

References:
Paterson, R.J. (2000). The Assertiveness Workbook. Oakland, CA: New Harbinger.

Stephen Ministry Leader's Training Manual. (2000). T-6, Assertiveness: Relating Gently and Firmly. St. Louis, MO: Stephen Ministries.

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Dealing with "No": How to Say It, How to Take It

7/13/2014

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"No" is one of the first words we learn to speak, and it's loaded with a lot of emotional baggage. When we first learn to say "no" as a toddler, we have likely heard it enough times that we know what it means, and it's a first expression of our individuality and independence. We learn that "no" means stop doing something, it means we can't have what what we want, and it means annoyance, disappointment and sometimes, hurt. However, we also learn to say "no."

As we get older, though, saying "no" gets harder. We learn pretty quickly that saying "no" to Mama and Daddy doesn't work too well. Saying "no" to teachers doesn't work at ALL well. We hear "no" more often too. Women especially learn that saying "no" is harder because we're expected to be nurturing, kind, caring - all those things that fly in the face of an honest and sometimes appropriate "no."

Dealing with "no" and setting/maintaining healthy boundaries is a big part of CBT, DBT, and Assertiveness Training Skills - with good reason. Many of us don't learn what good boundaries are and have little to no idea of how to set and maintain our own, or how to deal with others' boundaries.

Saying and receiving an appropriate "no" is a boundary issue and something that we have to learn to deal with everyday in a multitude of situations. For example, I recently learned that I did not get a job I for which I'd hoped to hired. This was a clear "no." Whether it was appropriate or not (my opinion certainly differs from the hiring committee!) isn't the issue here - the issue is how I deal with hearing "no." I won't lie and say I wasn't disappointed, but I'm also not getting into a death-spiral-funk about it either. My boundaries and sense of self are intact enough that I don't take this as a reflection on me as a person.

And that is the trouble with hearing "no." Often, we take it as meaning that we are not good enough or right enough when we hear it. Like children, "no" may mean not getting what we want and we equate it with "no, you're not worthy of/good enough for __________ (fill in the blank)." It may feel like a personal attack, or that the person saying "no" doesn't love us enough, want us enough, or care about us enough. Hearing "no," though, really doesn't mean that it's a reflection on who we are - it simply means that the person saying "no" simply can't or won't meet our need at that time. The reason doesn't matter, what matters is how we deal with "no."

Honestly, there are a lot of ways we can do this. We can do the emotional equivalent of having a temper tantrum and yell, insult, or fight with the person saying "no." (You see this all the time in comments sections under articles or stories on the net.) We can turn the cold shoulder and freeze the person out. We can try and try to change their mind, even when it's a clear "no." However, all of these methods are boundary violations - we are violating the boundaries of the person who said "no."

So how DO you deal with it? First, recognize that it's not a reflection of your value as a person or your value to the person saying "no." That's a hard pill to swallow, I know - many of us learn through life experience that our value to others depends on pleasing them, and we alternate between trying to do that and rebelling against that internalized message. The idea here is "no" simply means "no" and that it doesn't mean we're bad people or that the other person doesn't care about us.

Next, ask yourself how you would want the other person to act if you had to say "no" to them. (I know - I can hear a lot of you saying, "but I wouldn't say "no" to them!" Just go with me on this, ok? :) ) Would you want them to scream, cry, threaten you, insult you, try to change your mind? Somehow, I don't think so. This is where the "golden rule" really has value - treat them the way you'd want to be treated.

Also, if you have to vent - if you think the "no" was unfair, was mean, etc - vent in your journal or to someone else. Venting is not a bad thing; you just want to use it appropriately. Venting at the person saying "no" isn't going to help and may in fact damage your relationship with the person beyond repair. So think about how you want to react to them, and where you REALLY want to vent - and then do it in a way that is safe and respectful. Respecting the other person's boundaries is something we all have to learn to do.

So, what if you need to say "no"? Well, again the golden rule applies: we don't want to be mean, sarcastic, threatening or insulting. The goal here is to first respect our own boundaries and then be respectful of the other person's. Assertiveness training and skills come in handy here, but generally a kind but firm "no" is all it takes. You don't have to explain it (you can if you want), and you don't have to change your mind, even if the other person doesn't respect your boundaries. You can use what is called the "broken record" technique if you need to. "I'm really busy that day and can't drive you to the picnic." "I'm really busy that day and can't drive you to the picnic," etc.

If the other person is not respectful of your "no," you have the right to remove yourself from the situation or to be firm and clear about your "no." You don't have to be angry or threating in your tone of voice (although you may feel justifiably irritated and annoyed!). Women especially have a hard time saying "no" appropriately because we've been socialized to be the nurturers and caregivers. Saying "no" contradicts the "take care of everyone else before you take care of yourself" mantra that is the undercurrent around traditional women's roles. Saying "no" is an important skill.

So here's an idea for you: Keep track of how many times someone says "no" to you and to how you react. Also, keep track of how many times you wanted to say "no" and didn't, and how you felt about yourself and the other person. Finally, keep track of how you did say "no" to others, and how you felt. It's an interesting exercise and very eye-opening. Even simply paying attention to the pattern can help you see and work on appropriate boundaries. And that, my friends, is a very good thing.

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]. You may also call me at (970) 776-6043 for information.

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<<Previous

Struggling with a "New Normal"

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

What's the Difference Between Counseling and Coaching?

Depression - Dealing with and Taming the Beast Within

You Are Not Your Mood

Loneliness: When the World Seems to Go On Without You

It's the Little Things...

CBT: An Introduction to Cognitive Behavioral Therapy

Assertiveness: An Introduction

Dealing with "No": How to Say It, How to Take It

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