The Power of Each Other: Blog - The Power of Each Other: Wellness and Well-Being

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.

When Is It Time To End Therapy?

8/6/2014

In my work, one of the hardest things I face is letting a client know that it’s time move on. There are many reasons for ending therapy, and I’m going to explain some of them so you can see how complex the decision can be. I’ll start with a couple of reasons why clients end therapy.

What's the Difference Between Counseling and Coaching?

7/18/2014

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: thepowerofeachother@outlook.com

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

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: thepowerofeachother@outlook.com

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: thepowerofeachother@outlook.com

CBT: What is "Stinkin' Thinkin'"?

7/14/2014

Now that you've gotten a pretty good idea of what CBT is and how it might work, let's take a more in-depth look at understanding how negative thinking and interpretations of the things around you affect you. Let's start with the kinds of negative thought patterns that are related to feeling rotten (I know - great way to start, huh?) Albert Ellis and Aaron Beck are two guys in our field that are pretty much the founding fathers of CBT. They both start with types of negative thinking or information processing - Ellis calls these "irrational beliefs" and Beck calls them "errors in information processing." (Ellis, by the way is the dude who came up with the phrases "stinkin' thinking," "catastrophizing," and "don't 'should' on yourself". The man is blunt, but he does know how to turn a phrase!) The gist of these is that we get caught up in unrealistic and unhelpful ways of thinking, interpreting and perceiving ourselves and the world around us.

Ellis has 11 "irrational beliefs" that he describes:

It is essential that a person be loved or approved of by virtually everyone in the community
A person must be perfectly competent, adequate, and achieving to be considered worthwhile
Some people are bad, wicked, or villainous and therefore should be blamed and punished
It is a terrible catastrophe when things are not as a person wants them to be
Unhappiness is cause by outside circumstances, and a person has no control over it
Dangerous or fearsome things are cause for great concern, and their possibility must be continually dwelt upon
It is easier to avoid certain difficulties and self-responsibilities than to face them
A person should be dependent on others and should have someone stronger on whom to rely
Past experiences and events are the determinants of present behavior; the influence of the past cannot be eradicated
A person should be quite upset over other people's problems and disturbances
There is always a right or perfect solution to every problem, and it must be found or the results will be catastrophic.

These are pretty harsh statements, don't you think? While some may be true in part, having these roiling around in your mind as absolutes can really make it hard for you to see things as they are. Beck's list is somewhat similar (but shorter!):

Arbitrary Inference: Coming to a certain conclusion without any evidence or in the face of evidence to the contrary. (Example: "I'm an idiot.")
Selective Abstraction: Pulling out one little bit of a situation and ignoring other meaning ful pieces, followed by labeling or interpreting the whole thing based on that one little bit. (Example: I got a "C" on my exam. I'll never get into grad school. I'm going to flunk out, I just know it.")
Overgeneralization: Making a general rule out of what really should be an isolated incident - then using it over a whole range of situations. (Example: The driver of that car was an idiot - he cut me off! Ah, he's from California...the people there don't know how to drive. I'm sure he's a hippie, too.)
Magnification: blowing something out of proportion (Example: You ruined this whole trip by not sharing a room with me. This whole thing is just a mess now.) Minimization: the opposite of magnification - making things that significant seem insignificant or nonexistant. (Example: An abusive spouse, who after hitting someone says, "It was just a tap. It wasn't anything.")
Personalization: Thinking it's all about you, even when there's no reason to think so. (Example: "Oh it just figures it would rain. It's MY prom day, and of course, there's bad weather.")
Absolute and/or dichotomous thinking (Also called "black & white" and "either/or" thinking): Not seeing the "gray area" or middle ground, and categorizing people, "I'm the worst mother in the world" or "Nobody will ever like me" or "I'm a failure.")

Another type that is common here - and probably falls across a lot of these categories is the "should." Ellis had a phrase that I love: "Don't 'should' on yourself," and I have to tell you that as true as it is, it's also hard to break the habit of shoulding. And, quite frankly, not all shoulds are harmful - some of them are the glue holding our society together: we should follow the law, we should not harm other people, we should respect other people's boundaries, etc. However, there are a LOT of shoulds that can and (pardon the pun) should be examined - do they help us or not? Even becoming aware of all the shoulds is a tough process - a lot of them are so ingrained in how are and who we are that we don't even think of them as "shoulds" anymore. Things like, "I should not complain, even when ________ hits me," or "I should not air my family's dirty laundry" (even when doing so would stop abuse). "I should be over it by now" "I should be a better ________" " I should do _______ better/more often/less"...you get the idea.

Beck thinks that, with people who are depressed (and my guess is that this this true for people in a lot of situations), there is a cognitive triad that is essentially a cycle that is on a downward spiral. The first part of the triad is seeing the self as being fundamentally flawed or defective. The second piece is that the person interprets things as being negative, even when they're not or if there is evidence that they aren't. Life here is always getting in the way and is never good, so the everday aspects of living feel overwhelming and impossible. The final piece of the triad is that the future is probably going to be bad, and the person expects failure to happen.

I don't know about you all...but I see myself in a lot of this. "Stinkin' thinking" and "shoulding" are easy patterns to slip into, easy to make a habit out of. It's especially true when there are others who get let off the hook and gain from us doing this - they tend to reinforce us thinking this way. There are ways out, though - and as I said earlier, it takes commitment and practice. On that pleasant note...on to the next bit, which will be a lot more upbeat.

So, next up: Dealing with Stinkin' Thinkin & the Shoulds (sounds like the name of a band, doesn't it? "Stinkin' Thinkin' & the Shoulds")

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: thepowerofeachother@outlook.com.

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: thepowerofeachother@outlook.com to ask questions or get information.

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

7/13/2014

"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: thepowerofeachother@outlook.com. You may also call me at (970) 776-6043 for information.

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: thepowerofeachother@outlook.com.

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: thepowerofeachother@outlook.com.

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.