Category: Thinking

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

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CBT: Dealing with Stinkin' Thinkin' and The Shoulds

7/14/2014

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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

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CBT: What is "Stinkin' Thinkin'"?

7/14/2014

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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.

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

What Makes You Happy?

7/13/2014

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Here's a story: One day the Master announced that a young monk had reached an advanced state of enlightenment. The news caused some stir and some of the monks went to see their younger brother. "We heard that you are enlightened. Is it true?" they asked. "It is true," he said. They asked him, "And how do you feel?" And the younger monk replied, "As miserable as ever."

What I've found through working with and being around a lot of people is that often we don't know what makes us happy. We seek it in many places, some of them harmful when carried out to excess: drinking, substance use, gambling, spending money. We also seek it in relationships, where we yearn to be with someone who "completes" us (cue Jerry Maguire, "You complete me.") We seek it in doing things, being busy, being "successful" or as perfect as we can be - at many, many things. How often, though, do we look inside and really ask ourselves, "What makes me happy?" If you do it, the answers may surprise you.

There's a whole branch of psychology that is dedicated to understanding happiness - it's relatively new and goes under the heading "Positive psychology." Two of the leading people in this field are David Myers and Martin Seligman - both of whom wondered why psychology focused so much on the negatives. Research in this area has found that (to quote Madame de la Fayette) "if one thinks that one is happy, that is enough to be happy."

Now I know this sounds like a "pat answer platitude" that oversimplifies things. And to some extent, it is - but there is also wisdom in this saying. As I've discussed before, how we think about and perceive ourselves and the world around us affects how we feel. This is definitely true for negative emotional states like depression and anxiety, but it's also true for positive emotional states. It's not a fixed, easy answer, but rather a factor in what makes us happy.

So what are happy people like? Well, David Myers wrote in his book, The Pursuit of Happiness (1992) that the "best predictor of future well-being is past well-being" (p. 106). Does that mean if you've had a miserable, abusive, or depressed past you can't be happy? Heck no. Does it mean that it's one factor in a whole group that affect happiness - yes, and only that. Myers wrote that happy people in general tend to like themselves, feel like they can choose or have power over their destinies, are hope-filled and outgoing. Ok...this is great as far as it goes - what if you don't like yourself, feel helpless or that your life is out of control, feel like there's no hope and that you're an incurable introvert? Well, honestly - you're probably not happy.

I'll tell you that for a very long time, my self-esteem was in the toilet. I felt like I didn't have control, that the future was hopeless, that I was ugly and stupid, and that I was always going to be that way. Obviously, something changed. I won't like and say that everything is sunshiny goodness and happy-happy-joy-joy every day - that's just not realistic for anyone. Overall, though - things did change AND I still struggle with feeling the way I used to sometimes.

The thing is, changing these factors means working on change in yourself. There are certainly things in life we can't control, and we have to learn how to accept and deal with them. Changing ourselves doesn't mean putting on a mask and pretending that everything is hunky-dory fine, either, though. (I have to admit that there are days when it's pretty tempting, though.) What it means is that we learn to look at the world through a different set of lenses (not always rose-colored, either). Ok - you don't like yourself - what do other people like about you? Feel like you can't do anything right? Make yourself write a list of things you have done right. If you feel like everything is out of your control and you're helpless - examine and list everything you CAN control. For example - you can control your reactions to the world around you. Certainly others' actions, words, and ways of being affect us - BUT we choose how we react to those things.

The idea here is that we "act as if." It's a pretty well-known CBT and DBT trick - even if you're not feeling happy, act as if you are. You're not "putting on a mask" because when I say "act as if" I mean completely, fully, and totally immerse yourself in this acting. "Putting on a mask" implies just looking as if you're happy - I'm suggesting not just looking as if, but acting as if and even trying to think and feel as if. It's hard work - I won't lie, but if you try it for a little while you may be surprised at the results.

When people come to see me professionally, they (and/or others) are usually focused on what's wrong. As in, "What's wrong with me/him/her?" One of my favorite questions, when we have a certain amount of trust built is, "What's right with you?" It's a powerful question, and we almost never ask it. It's worth thinking about: What's right with you? Right here, right now. Really - what is right with YOU?

One other thing that I see a lot of people doing is looking for something outside of themselves to fill the emptiness and sadness inside. Things, substances, relationships - none of those can make you happy long-term if you're not accepting and growing inside. Again - they certainly affect how we feel, but if we're looking for things to make us happy long-term, nothing outside will ever completely work. It has to come from inside at its core. While "Jerry Maguire" and other movies may promote the idea of the relationship that fills us, in the end we have to be complete in ourselves before we can truly create a "complete" in a relationship. Asking someone else to fulfill us and fill us up is asking too much of anyone - they can't read our minds, predict what we want when we want it, or somehow just know exactly what we need - we have to communicate and reciprocate for a relationship to work, and that means we have to have to have a strong sense of self from which to work from. (And yes, that's hard experience talking as well as training!)

So, being happy comes as much from us as is it does to us. Which brings me back to my original question - What really, truly, deeply makes you happy? Think about it - and you might just be on your way to finding it.

Until next time...I'll be on the other side of the couch, waiting to hear from you.

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

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Coping With Tough Times, Part 2: Coping Skills

4/28/2014

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

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

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

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

So what are the things that may help?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

If you have any questions or comments, please contact me here or via email: theothersideofthecouch@live.com . I'll be happy to talk to you and listen to your input.

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

Resources:

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

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

Mind Over Mood - Dennis Greenberger & Christine A. Padewsky

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Coping With Tough Times, Part 1: Move

4/28/2014

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Today, I went for a walk. That might not seem like a big deal, but for me it was a change, and I’d like to share its importance with you. I moved, and that IS a big deal. I’ll explain why it’s a big deal in just a bit, so bear with me while I give you some background first.

Like many of you, I struggle in this economy. I try to be financially fair to the people I work with, because I realize that services like mine are expensive, and I want people to be able to get the help and support they need. This has been hard for me, though, because I struggle financially as well. I have been waiting for things to change, which brings me to the purpose of this post and the next few to follow. I’m finding that if I simply sit and wait for things to happen, I feel depressed, anxious and frustrated – and I’m generally not a pleasant person to be around when I’m feeling this way. A lot of us are like this - I know I'm not alone.

So, I decided to change the way I’m looking at my situation and living my life. Here’s where coping with tough times and moving comes in. There are things I can’t control, like the economy, and the fact that many of the things I'd like to do in my business rely on people wanting what I have to offer. There are a multitude of things I can’t control, and if I focus on them, then it’s an easy slide down to feeling lousy.

However, I CAN control myself and how I choose to react to this situation. After talking to people and experiencing unemployment myself, I know that it’s very easy to slip into feeling helpless, hopeless, and paralyzed about the future. There IS something I can do though. I can move. I can move my body, my mind, my feelings and my thoughts.

Ok, I can hear some people groaning, “Oh no…another Little Miss Sunshine who thinks that if I think good thoughts, everything good will happen to me.” So… hang in here with me. I’m NOT going to promise that if you change your thoughts you will automatically attract good things. What I AM telling you is that if you work to change the way you’re thinking, feeling and being now, you may start to feel better. How do I know this? I do it. It's the simple - I practice what I preach.

What I’m suggesting is that you move, somehow – even if it’s just getting out bed to face the day. Moving can be as simple as reframing your thoughts from “I’m never going to get a job” to “Things are tough right now. I’m doing the best I can.” Moving can be, “OK…I’m feeling pretty crummy right now and I have no money. What CAN I do to help myself feel better?” and coming up with ideas. Moving can be noticing the very little, simple things that make life worth living. For me, this is the smiles on my children’s faces and hearing their laughter. It’s feeling the sunshine on my face and noticing the colors and fragrances of the spring flowers. It's enjoying the feel of the wind on my face. For others, it might be the smell of a freshly-brewed cup of coffee, or the feel of your favorite blanket wrapped around you. The point is, moving – no matter how or how much – is a change that may help you start to feel better. And that’s why my walk today was so important – I moved.

I moved my body, and while moving my body, I moved my mind. Moving my mind (thinking) helped me move my feelings. During my walk, I thought about what I have to offer – what are my skills and talents? What am I passionate about? I thought about how to share what I know with others who might be feeling the same thing. And I felt better about myself, in spite of my job situation. I thought about how to market myself, and what I can do to promote my business. In short, moving helped.

SARK has made some worksheets that come from her book “Make Your Creative Dreams Real” involving what she calls “microMOVEments.” These involve taking baby steps toward creating and realizing a dream that you have. Whether you call them baby steps, micromovements, tiny leaps of faith – it’s still movement.

The world isn’t necessarily going to change because you move (but who knows - maybe it will!). However, YOU may start to change because you move. Honestly, this post – and the idea of coping with tough times - came out of my desire to feel better. I am “moving” by writing and sharing my knowledge with you. I can’t change the world, but I can offer my skills and gifts as a way to help me feel better and to hopefully make a difference for others who feel like I’ve been feeling.

I’m going to continue to write on ways to cope in tough times. If you have suggestions on topics you’d like to see, please get in touch with me: thepowerofeachother@outlook.com. I’m always interested in feedback and ideas. For you? Move with hope in your heart and life in your soul!

Please Note: The information on this blog is intended for informational purposes only. This is not therapy, and if you wish to work in therapy, please contact your local mental health agency or your physician for a referral. If you are in crisis or danger, please call 911 for immediate help.

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Depression - Dealing with and Taming the Beast Within

CBT: Dealing with Stinkin' Thinkin' and The Shoulds

CBT: What is "Stinkin' Thinkin'"?

CBT: An Introduction to Cognitive Behavioral Therapy

What Makes You Happy?

Coping With Tough Times, Part 2: Coping Skills

Coping With Tough Times, Part 1: Move

Laura Burlingame-Lee:

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