Welcome to the CounselingWorks, P.A.
Newsletter Archives
Click on the red ball next to any topic below for cutting edge information.

Alcoholism	Insomnia
Depression	New Year's Resolutions
Group Therapy	Post Traumatic Stress Disorder
Holiday Blues	Social Anxiety Disorder
Bipolar Disorder	Focus on Codependence
Couplehood	Coping with Panic Disorder
Stress Busters	Dear Diary
'Tis the Season	Ready or Not...2002
In Search of Self Esteem	Holding onto Hope
Flattening the Button	Focus on Domestic Violence
Choosing Life	Coping with Serious Illness
Giving Thanks	Choosing Simplicity
Overcoming TRAUMA	Puppy Love
Money and Your Relationship	Living with Depression
Today is a Good Day to Die...	I Work, Therefore I Am
Creating the Life You Want To Live	"I'll Get To It Later": Defeating        procrastination
Coping with Difficult People During the       Holidays	How to Cope in a Blended Family During the       Holidays
What Are Your Goals for 2004	Getting Unstuck
Coping with Change	Do You Have Adult Attention Deficit       Disorder?
Managing Your Anger	Coping With Job Loss
Alcoholism and Alcohol Abuse

All articles are copyrighted by the author, Elizabeth Ruegg, LCSW, BCD, CAP, CT, CCFS
and may not be reproduced without permission.

COPING WITH SOCIAL ANXIETY DISORDER
(May 2001)

Maybe it happens to you.

Your palms sweat, your hands shake, your heart hammers in your chest. Your face and neck flush beet red. Your muscles are as tense as if you're being chased by tigers. You are overwhelmed with a sense of doom, certain that something terrible is about to happen. You feel totally out of control.

And what calamity aroused your panic? Perhaps your boss told you to make a presentation at the monthly staff meeting. Perhaps you got lost coming home from the store and found yourself in an unfamiliar neighborhood, not exactly sure how to get home. Perhaps you were invited to a social gathering where you will have to make small talk with strangers. Perhaps your panic was aggravated by something as seemingly small as needing to use a public restroom.

If these symptoms sound familiar, you may have social anxiety disorder (also known as social phobia), the third most common psychiatric disorder in the United States. This disorder is characterized by excessive fear of being judged by others or fear of being humiliated or embarrassed in social situations. The most common fears associated with social phobia include speaking in public; speaking to strangers or meeting new people; and eating, drinking or writing in public. People with social anxiety may also experience difficulty performing other routine tasks, such as ordering food from a restaurant or asking for a raise. In time, the person with severe social anxiety may feel unable to work or socialize with people other than immediate family, and may rarely leave home.

Social anxiety can be generalized, meaning that many or most social interactions are feared, or can be limited to one or a few situations, such as public speaking or performing. Both adults and children with social anxiety disorder often have emotional characteristics including extreme sensitivity to criticism or rejection, poor self esteem, and feelings of inferiority. Also, they frequently demonstrate impaired social skills, such as lack of eye contact or difficulty maintaining a conversation. While some degree of anxiety is normal in situations commonly thought to be stressful (such public speaking), social anxiety disorder is diagnosed if anxious anticipation of the feared event interferes significantly with the person's daily routine, occupational functioning or social life.

Studies show that social anxiety disorder is slightly more common in women than in men. It also appears to run in families. Symptoms usually begin in adolescence and are often most severe in young adulthood. In about one-fifth of cases, the disorder begins in early childhood. Children with social anxiety may evidence crying spells, temper tantrums or clinginess with familiar adults, and may refuse to speak while at school. They may fail to play with others or participate in structured group lessons or activities, resulting in poor school performance and severely impaired peer relationships.

The long-term economic consequences of untreated social anxiety can be devastating. As many as 85% of persons with this disorder experience academic or occupational failure caused by their inability to meet basic social demands. Nearly 50% of respondents in one recent study were unable to complete high school; 70% earned a less-than-average wage, and about 22% were on welfare. When they are able to work, most people with social anxiety have jobs which are well beneath their capabilities because they fear job interviews, working in positions with public contact, or being promoted to positions where they would have to supervise others. Also, they often have difficulty exchanging information with co-workers or supervisors, which can be a deadly disability in this information age. Other negative consequences are equally severe. For instance, persons with social anxiety are less likely to marry or participate in long-term, meaningful romantic relationships than those without the disorder. Those who do marry experience higher than average divorce rates due to inability to communicate effectively with their partners about their fears and feelings. About 16% of persons with social anxiety have alcohol abuse problems, since alcohol creates a false sense of relief from symptoms. About 70% also meet the diagnostic criteria for major depression.

Social anxiety disorder is left undiagnosed and untreated in an estimated 90% of cases, which is a shame since treatment is highly effective in reducing or even eliminating disabling symptoms. Cognitive behavioral therapy, which teaches the client to change his/her anxious thought processes, is the treatment of choice for most clients. Social skills training is often useful in reducing anxiety around social encounters, and medication can also be used to help reduce anxiety around specific feared events.

Do You Have Social Anxiety?

1. Being embarrassed or looking stupid are among my worst fears  True / False

2. Fear of embarrassment causes me to avoid doing things or speaking to people True / False

3. I avoid activities in which I am the center of attention  True / False

4. Upon entering a crowded room, I feel a strong urge to leave immediately   True / False

5. I find that I can't relax unless I am alone  True / False

6. All my favorite activities are things I do by myself  True / False

7. Pets are generally safer to be with than people  True / False

8. I often think up excuses to avoid social engagements True / False

If you have answered TRUE to more than three items on this quiz, you may have social anxiety disorder.
Considering consulting with your physician or therapist to learn more about treatment options which are available to you

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FOCUS ON: ALCOHOLISM
(April 2001)

At 17, Jonathan was already an expert bartender. His father was a renowned surgeon who spent his days and many of his nights at the nearby university hospital. His mother was a drunk who taught him how to mix martinis without bruising the gin and how to hide her empty bottles from the housekeeper. By October of his senior year, Jonathan had already been accepted to the college of his choice. Life was filled with promise.

At 26, Jonathan was known to his friends as the life of the party. He was famous for livening up a room by tap-dancing on tables and performing risque' striptease acts. He could easily put away a 12-pack of beer and a line of mixed drinks during a long night at the bars, but he was almost always able to get up the next day and go to his management-track marketing job without much of a hangover. He didn't have a steady romantic interest, but dates were easy to get, and women enjoyed his generosity and easy sense of humor. Life was good.

At 41, Jonathan was admitted to detox for the third time. He'd lost his job as a marketing director almost a year before and was rapidly burning through his savings. He justified his failure to find another job as the direct result of transportation problems, since he'd lost his license for five years after repeated DUI's. He was six years divorced from a three year marriage, and spent most of his time drinking or sleeping off a drunk. His girlfriend was a hard drinker, and also enjoyed cocaine. She was poorly educated and rough, but she didn't harp on Jonathan's drinking and still had her license, which was convenient for making trips to the liquor store. "Life's a bitch," she frequently remarked, and Jonathan agreed. Life was, indeed, very hard.

At 49, Jonathan was a dying man. Decades of alcohol use had poisoned his liver and severely compromised his immune system. Homeless, penniless and alone, suffering from cirrhosis, hepatic cancer, high blood pressure, and gastritis, which were all directly related to his alcoholism, Jonathan's life - once full of promise - came to a bitter end.

What is alcoholism?
Alcoholism is a chronic, progressive condition caused by the compulsive use of alcohol. The physically and psychologically addicted person cannot abstain from alcohol use even though he understands intellectually that drinking causes him social, spiritual, occupational and physical harm. In early stages of the disease, the alcoholic is usually in denial of his addiction.

Who is likely to become alcohol dependent?
Alcoholism often runs in families; 55-60% of alcoholics identify a first degree relative who also has the disease. The lifetime risk of alcoholism in the general population of the United States is about 15%, and current, active alcoholics are thought to compose about 5% of the total US population. The majority of those who develop alcohol-related disorders do so by their late 30's, although some develop signs and symptoms of full-blown alcoholism by the late teens or early twenties. Senior citizens may be first diagnosed with alcoholism in their sixties or later as they use alcohol to cope with boredom, loss or loneliness.

What are some signs and symptoms of alcoholism?
Common short-term symptoms include tremor, unsteady gait, insomnia, dry mouth, nausea, vomiting and gastritis. Consequences of long-term use include increased risk of infection, certain cancers, stomach ulcers, high blood pressure, memory impairments and even psychotic symptoms. Male alcoholics in the active stages of the disease often experience erectile dysfunction, while women may experience menstrual irregularities. Pregnant alcoholics are at risk for spontaneous abortion.

What treatment is available?
Short-term inpatient admission to a medical hospital or detoxification unit may be necessary for the alcoholic who is at risk for seizure or stroke during alcohol withdrawal. Longer term residential rehabilitation, which is designed to teach the individual how to live without use of alcohol, may last 28 to 90 days, but typically there are long waiting lists for these programs and they are often very expensive. Alcoholics Anonymous, the self-help support group, is the best known and perhaps the most effective of the outpatient options. Individual counseling is often used as an adjunct to participation in AA, where the individual learns to identify feelings such as anger or frustration which may trigger a relapse, and develops strategies to cope with these.

Do You Have a Drinking Problem?
Take this 10-question quiz to evaluate your relationship with alcohol

1. Do friends and relatives think you have a drinking problem?   YES / NO

2. Have you ever attended AA, or been asked to by your family?   YES / NO

3. Have you ever hidden alcohol in your house or office?   YES / NO

4. Have you ever lost friends or partner because of drinking?   YES / NO

5. Have you ever gotten into trouble at work or school because of drinking?    YES / NO

6. Have you ever neglected your obligations, your family, or your work for more than
two days in a row because you were drinking?   YES / NO

7. Have you ever gone to anyone for help about your drinking, or been asked to by your family?   YES / NO

8. Have you ever had severe shaking, hallucinations or "blackouts" while you were drinking,
or as you sobered up?    YES / NO

9. Have you ever been in a medical or mental hospital because of your drinking?   YES / NO

10. Have you ever been arrested for drunk driving?   YES / NO

Even one "yes" response suggests you might have a drinking problem. Please see your family doctor or your counselor for more information about treatments options which are available to help you.

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DIAGNOSIS: DEPRESSION
(March 2001)

Jeannie M. knew something was wrong.

For the past month, she had been positively paralyzed by feelings of sadness and emptiness. Ordinarily an organized, efficient woman with impeccable personal habits, she'd called off from work for nine days in a row for no reason other than she just couldn't face the thought of getting out of bed. "Take a shower, wash my hair, dry my hair, get dressed, get ready for work... it's too much. I can't." She hadn't seen a friend in three weeks, and let the answering machine fill up with messages instead of talking to the people who called. Her pastor had asked three times if he might stop by and visit because he was so concerned about why she had suddenly dropped out of sight. She hadn't done a load of laundry in weeks. She was barely eating, barely sleeping. When she did sleep, she had strange, confusing dreams during which she was being chased by something in the darkness, and every time she ran from it, she fell off a cliff into an enormous void.

And the strange thing was, nothing was wrong. Well, obviously something was wrong. But nothing terrible had happened to precipitate this sudden withdrawal from the usual activities of her life. She'd heard of people who went through severe losses - a spouse dying, loss of an important job, a serious illness - and became upset and withdrawn. But nothing like that had happened to her. She just... didn't care anymore. She felt worthless. Hopeless. What frightened Jeannie most were the thoughts she'd begun to have. "Maybe I should just... maybe it would be better if I wasn't here anymore." She'd begun looking long and thoughtfully at the small .32 revolver she kept in her bedside table.

One afternoon, her pastor rang her doorbell unannounced. He visited with her for a hour and asked if she would be willing to talk to a counselor he knew. She agreed mostly to placate him, but in her heart, she didn't believe anything or anyone could help her. The next day, Jeannie went to her first therapy appointment.

Signs and Symptoms
Major depression is characterized by appetite and sleep disturbance (eating or sleeping too much or too little); poor concentration; difficulty thinking or making decisions; fatigue and decreased energy; lack of interest in previously enjoyed activities; feelings of worthlessness or guilt; irritability or sadness; hopelessness and recurrent thoughts of death or suicide. Other common complaints include tearfulness, anxiety, difficulty in intimate relationships, unsatisfying social relationships, and loss of sexual interest. For diagnosis, at least four of these symptoms must be present most of the day, nearly every day, for at least two consecutive weeks. Major depression can occur in childhood, adolescence, adulthood and old age and affects both males and females, although recent studies indicate that females are about 50% more likely than males to experience a depressive episode. A significant percentage of women with a history of major depression indicate their symptoms worsen several days prior to the start of their monthly menstrual period.

An untreated episode of major depression typically lasts at least six months, after which the symptoms generally resolve and the depressed individual returns to his previous level of functioning. In about 10% of cases, though, severe symptoms may persist for two years or even longer. About 40% of those who have had one episode of major depression recover fully and never have another episode. The remaining 60% will probably have at least one more episode in between periods of normal, healthy functioning.

Treatment Options
Major depression is the most commonly diagnosed mental disorder in the United States, occurring at some point during the lifespan in 20-25% of women and 9-12% of men. The good news is, it's also one of the most readily treatable. The most common treatment options for major depression include medication management and/or psychotherapy. Several studies indicate that Cognitive Behavioral Therapy (a form of psychotherapy) is at least as effective as medication management in the treatment of depressive symptoms, although you should always consult with your therapist and your physician about all treatment options available to you. A less common form of treatment for major depression is Electroconvulsive Therapy (ECT, or "shock treatment"), which may be quite effective in stabilizing the mood of a severely depressed person who has not responded well to psychotherapy or medication management.

Depression Self-Evaluation Inventory

SCORING:
Give yourself one point for each "most of all of the time" answer to questions 1, 3, 6, 7, 8, 10 and 15.
Give yourself one point for each "none of the time" answer to questions 4 , 5, 11, 12, 14, 16, 17, 18 and 20.
Give yourself one point for each "sometimes" answer to questions 1, 3, 6, 7, 8, 12, 14, 15, 16, 19 or 21.
Give yourself five points if you answered "most or all of the time" to question 19.
Give yourself five points if you answered "most or all of the time" to question 21.

If your score is higher than FOUR points, you may be clinically depressed.
Please contact a licensed medical or mental health professional for a more comprehensive depression evaluation

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POST-TRAUMATIC STRESS DISORDER
(It's all about survival)
(February 2001)

"When I was 15 years old, my family and I headed upstate one Saturday to visit my grandmother. One second my kid sister and I were goofing in the back seat, singing along to 'Hotel California' The next second, chaos. I remember a hard swerve, screaming, a smash-crash impact and the chitter of shattering windshield glass. The car went upside down and I hit my head and smelled leaking gasoline. Weirdest thing, though: the radio kept playing. I remember the chorus: ‘such a lovely place, such a lovely place. I couldn't hear anything but the radio playing on and on.

My father and little sister were killed outright. My mother survived, barely. I walked away with nothing more than cuts and bruises. The drunk driver who hit us got off easy too; just a broken arm and a little cut above her eye. I remember the smell of booze coming off her as she sat on the curb, and 'Hotel California' playing over and over in my head.

In the weeks afterward, I was sort of numb, like in shock. And then strange things began to happen. The smell of alcohol on someone's breath made me run to the bathroom, vomiting. I was angry and snappy, even with good friends. Every night, I'd awaken in heart-pounding panic from the same dream: goofing with my sister in the back seat, the swerve and screaming and 'Hotel California' and the greasy gasoline smell and the chitter of broken glass. I couldn't listen to the radio, afraid I'd hear that song. And once, months later, I walked past a spray of pebbly green windshield glass on the road and wham! - I was inside the nightmare, trapped again in that upside down car, and when I came back to myself I was crouched on the sidewalk, wailing, surrounded by strangers who must have thought I was absolutely psycho.

I thought so too, and started going to therapy. The therapist says I have PTSD, like some combat vets used to get when they spent too long in the war. I'm nineteen now, and putting my life back together piece by piece, but I still have the nightmares and can't hear that song or smell gasoline or booze on someone's breath without getting sick to my stomach. I spend a lot of time wondering why I survived."

Post Traumatic Stress Disorder (PTSD) is a mental health condition that can develop following a terrifying life experience. Events which may trigger PTSD include military combat (as far back as World War I, it was known as "shell shock" or "battle fatigue"); violent personal assault (sexual or physical attack, torture); being kidnapped or taken hostage; severe automobile, train or airplane crashes; and man-made or natural disasters, such as bombings or earthquakes. PTSD is thought to affect an estimated 5.2 million Americans at any given time. Women are more likely than men to develop symptoms of PTSD, and even children as young as 18 months who have been victims of horrifying life events have shown symptoms of this disorder. PTSD often leads to – or is complicated by – other mental health problems including clinical depression, panic disorder, and substance abuse.

PTSD is diagnosed when an individual has been exposed to a traumatic event which involved actual or threatened death or serious injury to self or others, and his response to this event was intense fear, helplessness or horror. Often, the person with PTSD experiences persistent, frightening thoughts and memories of the ordeal which traumatized him. He may have vivid nightmares in which the ordeal is re-created, feel emotionally detached from others, and startle easily. He may lose interest in previously enjoyed activities, be easily irritated, and even behave aggressively when feeling threatened or overwhelmed. Commonly, he will take active steps to avoid thoughts, feelings or conversations associated with the trauma, and will try to avoid activities, places or people that remind him of the event. He may also have incomplete memories of events surrounding the traumatic incident. The person who develops PTSD may have trouble experiencing and expressing emotions, and may develop a fatalistic outlook (for instance, not expecting to have a meaningful career or normal lifespan). He may also have dissociative flashbacks – hallucinations which can come in the form of images, sounds, smells or feelings – during which he may briefly lose touch with reality and believe that the traumatic event is re-occurring. In severe cases, the person with PTSD may have trouble working, socializing or even leaving home.

Not all persons who survive life-threatening trauma will develop PTSD. The severity and duration of the traumatic event appear to be important factors affecting the likelihood of developing this disorder. That is to say, the worse the trauma, the more likely it is that symptoms of PTSD will occur. For instance, in one recent study, as many as 58% of survivors of a severe natural disaster evidenced symptoms of PTSD within three months of the event. Researchers also suggest that some factors may protect individuals from developing PTSD, including an active social support network and absence of family history of any predisposing condition such as a mood or anxiety disorder.

Forgive yourself.
If you survived a life-threatening traumatic event – especially if others died there – you may feel guilty that you are still alive. Maybe you have even wished you died, too. You end up feeling guilty for having survived and then feeling guilty for wishing you hadn't. Forgive yourself for all these confused and confusing feelings. Forgiving yourself is the first step to healing.

Start psychotherapy.
Find a licensed counselor who has experience treating PTSD. Be truthful with your therapist; what you don't tell can hurt you.

Consider medication.
Your therapist may want to refer you to a psychiatrist (a medical doctor specializing in mental disorders) to see if medication would help you cope better with PTSD symptoms and related problems such as depression and panic.

Get a medical check-up.
PTSD often manifests itself with somatic (physical) symptoms, including respiratory distress, irritable bowel syndrome, insomnia and chronic headaches. However, you should confirm with your doctor that there is no underlying medical cause for these symptoms.

Just say no!
You may justify your decision to use drugs/alcohol because it helps to numb your feelings, to forget, to make you sleep, to help you cope. The bottom line is simple: in order to survive PTSD, your drug/alcohol use has to stop. It may make you feel better in the short term, but all you're doing is re-traumatizing yourself, by keeping yourself stuck in patterns of behavior which will kill you in the end.

Find support.
Quite frequently, survivors with PTSD become loners who struggle with the most basic trust issues. You are more afraid than anything of people or events which can hurt you (again), or trigger your PTSD symptoms. As afraid as you are, you must reach out if you are to heal. Check out AA, NA and the Internet newsgroup alt.support.trauma.ptsd for help from those who've been there.

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MANAGING INSOMNIA
(January 2001)

Commonly seen in individuals who have been diagnosed with major depression, anxiety disorder, and adjustment disorder, insomnia is a frustrating – and exhausting – problem, with side effects including irritability, poor concentration, reduced energy, and deterioration of mood and motivation. Given that adults require an average of 8 hours of sleep in any 24-hour period for optimal physiological and psychological functioning, you may have clinically significant insomnia if you have had impaired sleep (less than 6 hours nightly) for at least one month. If you are among the sleep deprived, know that you are in good company; more than half the adults in North America have had at least one episode of disturbed sleep lasting a month or more. And you will be relieved to know that there are a number of steps you can take to improve both the quantity and quality of your sleep. Following the steps and suggestions below should help you get back on track.

First, see your doctor.
If you have experienced a sleep deficit for more than two consecutive weeks, schedule an appointment with your primary care physician. Insomnia - though most commonly the result of tension or depression - can be a symptom of any one of a host of physical disorders, and these need to be ruled out as the cause of your problem.

Develop a regular sleep-wake cycle.
In this age of 24-hour convenience, more and more of us are required to work during non-conventional hours. Some people can adjust to a night-shift life fairly easily. Others simply cannot make the change. If your company requires you to work during non-traditional hours and you can't obtain adequate sleep during the day, seriously consider making a career change. Your health should always be a higher priority than your job.

Get some exercise.
As little as 30 minutes of strenuous exercise during the day will give your body the activity and oxygen it needs to help you relax more and sleep better. However, you should not exercise within one hour of bedtime.

Avoid daytime napping.
The more sleep you get during the day, the less you'll want at night. Naps feel great, but they undermine your ability to get sustained, healthy sleep at night-time.

Avoid caffeine, alcohol and tobacco.
Caffeine and tobacco are stimulants to the nervous system, and studies have shown that alcohol disrupts healthy sleep and prevents deep rest.

Wake up at the same time every day.
Yes, even on weekends. Developing a predictable sleep-wake pattern is one of the most important things you can do to ensure good quality sleep.

Drink warm milk before bed.
Studies show that foods with a high concentration of the amino acid L-tryptophan, including milk, eggs, cottage cheese, chicken, turkey and cashews, have naturally sedating qualities.

Drink herb tea.
If you don't like warm milk or are avoiding dairy products, make yourself a cup of hot chamomile, anise or fennel tea shortly before you're ready to turn in for the night. All contain natural ingredients which will help you sleep. Most health food stores also sell special blends of herb tea designed for their ability to relax and soothe you.

Sleep in a well-ventilated room.
You'll rest better if your room is cool (60-65 degrees is a perfect ambient temperature) and there is active airflow from an overhead fan.

If you can't sleep after 45 minutes, get up.
You'll only frustrate yourself by tossing and turning in bed, and the more aggravated you are, the less likely it is that you'll be relaxed enough to sleep.

Don't read or watch TV in bed.
You should associate your bed with nothing but sleep and sex. Also, reading and television stimulate your thoughts, and an over-stimulated mind is probably what's keeping you awake in the first place. Develop a quiet mind before bedtime by practicing progressive relaxation, deep breathing and visualization. Your therapist can instruct you in these easy techniques which help calm your mind and body and prepare you for satisfying, restful sleep.

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New Year's Resolutions:
How Coping Skills can Change Your Life
(January 2001)

Go on, admit it. At some time or another, you've made a new year's resolution.

Maybe you wanted to quit a bad habit, to start a new, healthier pattern of living. You decided that January first was the perfect target date, and awoke on that morning as motivated as you'd ever been to go to the gym, or quit smoking, or never eat three fudge brownies at one sitting again. For a day or two (maybe, if you were very committed, for as long as a week or two) you lived up to your own expectations. And then… Well, and then real life got in the way. The stresses and demands of your daily responsibilities took their toll on your time and patience and nerves. Bit by bit, you went back to the unhealthy habits you'd pledged to forsake forever.

The bad news is that fewer than 5% of resolutions made in January produce lasting life change. The good news is that life changing resolutions do have a fighting chance of coming to pass if you understand that the "bad habits" you're trying to break are simply coping strategies gone awry. Improving your ability to cope with change, stress, anger, unhappiness and loneliness will inevitably ease your dependence on negative patterns of behavior.

Some of the most "popular" negative coping strategies include all-or-nothing thinking (not allowing for the shades of gray which are a like-it-or-not fact of life); denial (lying to yourself, minimizing or ignoring problems); bad habits (such as use of tobacco, marijuana, alcohol or other non-prescribed drugs to relieve tension); excessive worry (obsessing endlessly about things that cannot be changed, imagining the worst in every situation); and indulging in obviously poor choices (such as impulse buying, poor eating and exercise habits, angry outbursts and rigid thinking). Recognize yourself? Well, of course you do. Most everyone has one or more favorites on the "negative coping skills" hit parade. If you want to, though, you can resolve to substitute those negative skills for more healthful and beneficial options. See the list below for some positive coping skills which you might choose.

• Organize!
  Avoid procrastination by managing issues as they arise. Develop a system for overseeing your mail, your checkbook, your appointments, your work life and your other responsibilities. Having a well-ordered work and personal life will go a long way toward helping you feel less overwhelmed.
• Responsible self-care.
  You would not neglect a child in your care by failing to feed her at regular intervals or allowing her to "get by" with inadequate rest, exercise or relaxation. Extend the same level of conscientious caregiving to yourself. Find time to play!
• Keep busy with meaningful work.
  Even if you are unemployed, retired or disabled. Entropy (steady deterioration of a system) encourages itself. It also leads to social isolation and unhealthy self-preoccupation. If you have too much time on your hands, contact your local United Way office and volunteer for duty at a local hospital, hospice, homeless shelter, animal shelter, or school. This cannot help but focus your attention outward, where it needs to be.
• Relabel.
  Force yourself to change perspective, to take the long view, to find the good in a bad situation. After a while, it becomes a habit you won't want to be without.
• Re-identify change.
  Which is nothing less than the opportunity to learn and grow.
• Lighten up!
  Whatever happens, you will have choices and opportunities.
• Have faith.
  Find purpose and meaning in your life. Ask forgiveness. Give thanks. Do it every day, and watch what happens.

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FOCUS ON GROUP THERAPY
(December 2000)

Group psychotherapy is a form of counseling in which six to twelve people meet regularly together under the guidance of one or more professionally trained psychotherapists to talk about and resolve their problems. It is designed to help people improve their interpersonal relationships and relieve feelings of isolation, depression and anxiety. Group therapy has been a widely used treatment option for more than 50 years, and is an effective means of helping people solve their problems. In fact, studies show that group may be more effective than individual counseling in helping people with specific difficulties such as substance addiction, coping with physical illness and dealing with loss and grief.

How does group work?
Groups are formed by a psychotherapist who selects individuals likely to be helped by the group experience and who are capable of being "therapeutic helpers" to others. A typical group session lasts 90 minutes, during which members discuss the problems which brought them into therapy. Under the direction of the leader, other group members express their thoughts and reactions as honestly and freely as possible, offering constructive feedback and support. In this way, group members improve their ability to relate to others and learn new ways of coping. Those prone to depression, isolation or social anxiety begin to realize that they are not alone, and feel encouraged when they see that others have similar fears and feelings.

How is group therapy different from a self-help support group?
Group therapy helps people cope with their problems and provides for individual change and growth under the guidance of a professional counselor. Self help groups are designed to provide emotional support but are not geared toward change. Also, they are not professionally led.

If I am in a group, do I also need individual therapy?
Group therapy is used as the main treatment approach for some people and is an adjunct to individual counseling for others. Often, people find it very useful to work simultaneously in group and individual counseling. If this is your situation, you may see two different therapists. This should not hinder your treatment at all, as long as you give the therapists permission to communicate with each other periodically about your progress.

Will there be people like me in my group?
While some people in group will have similar circumstances, it's unlikely that all group members will have exactly the same problems unless the group is organized around a specific issue such as "surviving divorce," or "resolving depression." There may also be a demographic mix in the group, with males, females and various age ranges represented. Some groups are limited to specific populations such as lesbian/gay, older adults, adolescents, etc., as a means of helping the group members bond more quickly than might happen with a mixed group.

What does group therapy cost?
Typically, group sessions are charged at about half the rate of individual therapy. However, it is often possible to find low-cost groups through your community mental health center or alternative medicine clinic. Local clergy are also a good source for referrals to psychotherapists who run low-cost groups.

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BEATING THE HOLIDAY BLUES
(November, 2000)

Maybe you know the feeling.

While others are busily enjoying the parties and family gatherings of the season, you are lonely, anxious and stressed. Maybe you live far from loved ones, or you have a troubled relationship with your parents and siblings. The emphasis on gift-giving at this time of year may be an unhappy reminder of your financial difficulties. Perhaps house guests are stretching the limits of your patience and generosity. You're jumping through hoops, feeling irritable and sad, experiencing tension headaches or sleeping problems. Maybe you're eating or drinking too much to help get you through until the holiday hubbub dies down.

You should know that there is a difference between "holiday blues" and clinical depression. The blues usually aren't too bad, don't last very long, and go away on their own without treatment. Clinical depression, on the other hand, is experienced by feelings of emptiness or hopelessness over a period of weeks or even months. The depressed person usually loses interest in previously enjoyed activities and withdraws from friends, family and work. She has a lot of trouble coping with the demands of daily life, and may even think about suicide as a way out of her pain. Are you clinically depressed or just experiencing the blues? Only you and your healthcare provider can figure that out for sure. In the meantime, here are some common sense strategies for coping with Holiday Blues.

Minimize Stress. Plan ahead, so you're not taking care of everything at the last minute. Procrastination is never a great idea, but is particularly damaging at this time of year.

Avoid too much alcohol. It may temporarily make you feel like the life of the party, but there's no question about it: alcohol is a depressant, and will only aggravate your holiday blues.

Try something new. Take a few hours off and visit a place you've never been before. Recharging your batteries is a must if you want to banish the blues.

Make peace. What better time of year to let go of an old grudge? Open the door to better communication (yes, even if it was all his fault ). You'll feel better for having made the first move.

Take a hike! If not a hike, how about a nice long walk with a friend? Physical activity will help get you out of the gloomies.

Do something for someone else. There's nothing like a little volunteer work at your local shelter to help you remember the many blessings in your life.

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THE UPS AND DOWNS OF BIPOLAR DISORDER
(June, 2001)

People who know you best describe you as mercurial, quickly changeable, even volatile. You have a lot of trouble maintaining basic emotional stability. You have episodes of deep depression which can last for weeks, during which you want to see no one and do nothing but sleep. After the depression fades, you have episodes of super-activity and unlimited energy when you are likely to begin a million projects all in the same afternoon. During these episodes, you may sleep only an hour or two a night for weeks on end. You may impulsively spend money - a lot of it - buying things you don't really want or need. You may abuse drugs in an effort to maintain a better emotional balance. You may have been diagnosed with depression, anxiety, or impulse-control disorder. In fact, you may be bipolar.

Bipolar Disorder (which used to be known as manic-depression) is primarily characterized by unstable mood and episodes of depression and/or mania. Mania is often understood as a euphoric or "high" state, but it can also be dysphoric, resulting in agitation, anxiety, rage or feelings of self-destruction. The person with bipolar disorder may also have mixed mood, during which he experiences symptoms of mania and depression at the same time. Persons with bipolar disorder may also have transitory psychotic symptoms, such as delusions (false ideas), paranoid thoughts or hallucinations.

There is no blood test or brain wave exam which can definitively prove the presence of bipolar disorder. There is no cure either, but like other chronic diseases such as diabetes, bipolar disorder is an illness which can be well-managed with medication and psychotherapy. Usually, both are necessary for the bipolar individual to maintain good functioning. Medications used for the treatment of bipolar disorder include mood stabilizers, such as Lithium and Depakote; and antidepressants, such as Prozac or Paxil. Sometimes anti-psychotics are also prescribed if the individual has symptoms such as hallucinations or grandiose delusions. Psychotherapy is useful in providing the individual with insight into his illness, so he is less likely to resist or fail to comply with treatment. Therapy also provides the client with skills to detect early signs of an impending episode, and to improve the interpersonal and family relationships which are affected by the illness.

The Mood Disorder Questionnaire

Has there ever been a period of time when you were not your usual self and…

1. You felt so good and so hyper that other people thought you were not your normal self?

2. You were so irritable that you shouted at people or started fights or arguments?

3. You felt much more self confident than usual?

4. You got much less sleep than usual – 2 or 3 hours a night for more than a week – and found you didn't really miss it?

5. You were much more talkative and spoke much faster than usual?

6. Thoughts raced through your head and you couldn't slow your mind down?

7. You were so easily distracted by things around you that you had trouble concentrating or staying on track?

8. You were much more social and outgoing than usual: for example, you telephoned friends in the middle of the night?

9. You were much more interested in sex than usual?

10. You did things that other people thought were excessive, foolish or risky?

If you answered "yes" to six or more of these questions, you should get a full evaluation
for bipolar disorder from your mental health and medical practitioners.

Tips for Coping with Bipolar Disorder

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COUPLEHOOD: BLUEPRINT FOR A HEALTHY RELATIONSHIP
(July, 2001)

We search for it, we strive for it, we struggle toward it, we curse our inability to keep it. We feel ourselves doomed to fail in its pursuit. We dread its alternative. When we are alone, we dream of the perfect partnership in which we will feel safely held. When we are badly coupled, we feel smothered and cramped, cornered and criticized. Is there no hope for reasonable balance? Is that wildest of dreams, the healthy relationship, simply myth?

Well, no, of course not. Many people have maintained healthy, happy relationships for years… even decades. What's their secret? Like an architect, study the plans below and you will learn that with work, practice and patience, anyone willing to be flexible can build a healthy, happy, long-lasting relationship.

A healthy relationship allows you both to grow and change. You know those pretty paperweights, wildflowers preserved for eternity in blocks of glass or Lucite? Relationships aren't like that. You cannot freeze time and keep your wildflower lover exactly the same as s/he was when you first met and fell in love. Life means growth, and growth means change, and there is no way around that fundamental truth. Your partner will not stay the same over time, and neither will you. Instead of resisting that fact, learn to embrace it. Growth is good! Change is life! A relationship which cannot allow for the individuals within it to grow and change is a relationship which will inevitably fail.

Get to know your partner, down to the smallest details. The truth is, every relationship eventually hits bad weather, and intimate familiarity with your partner's strengths, weaknesses, preferences and most secret fears is absolutely essential if your relationship is to ride through the storms. For example, let's say you're totally excited about the possibility of starting your own business. It's going to take most of your savings, and you're going to have to give up the steady job you've had for the past ten years, but you're absolutely certain you can make a go of your dream. Your partner, on the other hand, grew up dirt poor, feeling inadequate and less-than, and has spent his entire adult life determined never to be poor again. To him, security is all-important, and means money in the bank and a steady job with a reliable paycheck. It's important for you to know about your partner's fear of poverty and to understand his need for security, so that when he balks at the idea of your business venture, you're clear that his hesitation isn't related to his doubts about you as much as his old demon fears of poverty and inadequacy. This will help you avoid taking personally his lack of enthusiasm for your project. Understanding your partner's feelings – and having confident assurance that he understands yours – will go a long way toward keeping your relationship strong through the worst of stormy weather.

Do not expect your partner to read your mind. We say out loud or to ourselves, "if you really loved me you'd already know what I need." This totally unreasonable expectation leads to disappointment, resentment and the dissolution of some otherwise solid relationships. Exactly how is your partner supposed to know what you need if you're not willing to tell her? Unless she moonlights on the Psychic Hotline, give yourself and your lover a break and talk about whatever is on your mind. Clear, straightforward communication is absolutely essential to any well-functioning relationship. Seething and stewing, on the other hand, will lead to nowhere but emotional and physical separation.

Turn toward each other, instead of away. Every human being needs affection, attention and support. We can't help it; we're just wired that way. Pay attention to your partner's desire for these fundamental requirements, and offer them freely and frequently. Often, we neglect our partners out of distraction. There's always so much going on; so many responsibilities; so many completing demands for our attention. Unfortunately, lots of otherwise strong and vital relationships wither and die from benign neglect, the unnecessary casualties of lives which are too busy. If this is your situation, consider adjusting your priorities. Spend more time with your partner, rather than spending more money on her. Fact is, it really doesn't matter how busy you are or how poorly your schedules mesh; you absolutely must take time for and with each other if your relationship is to thrive. On the other hand...

Find a balance between shared and separate interests. Sometimes, couples tell me very proudly that they do absolutely everything together. That must be the sign of a committed couple in a healthy relationship, right? Wrong!! You must each pursue activities and interests separate from the other in order to bring life and energy back into the relationship. I've seen couples who work together, play together, socialize together, eat together, sleep together… and within six months they're bored to death and ready to move on. Sometimes, couples do this because they've been in relationships in the past where they did not spend enough time with their mate and the relationship expired from neglect. As a result, they over-react and determine to do absolutely everything with their partner. This over-involvement kills a relationship as surely and swiftly as under-involvement can. In relationships, as in most things… moderation is the key.

Accept disappointment. When you're in love, you become fuzzy-headed, dim-witted, three-quarters deaf and mostly blind. You see near-perfection in your beloved. You do not see the quirks, the foibles, the annoying traits, the irksome habits. At least, not until the heady intoxication of falling in love wears off a bit, when you may become annoyed at your partner for not being the perfect soul you imagined him to be. Turns out he's a messy mortal just like you! When this happens, accept the reality of your partner's imperfection. Remember, he never claimed to be ideal; the ideal is what you hopefully imagined. Practice loving unconditionally, even when you see him in a more realistic light. No, he's not perfect. You know what? Neither are you.

When do you need professional help? You will likely benefit from couples or individual counseling if you have not succeeded in accepting differences between your partner and yourself, or if you find yourself repeatedly leaving relationships – or being left – because you cannot tolerate closeness or distance within the relationship. Counseling is an absolute must if you are abused in a relationship, or if you are abusive. Abuse can be verbal/emotional (put-downs, insults, threats, isolating you from friends and family), physical (shoving, hitting, pinching), or sexual (forcing you to have sex or putting you in sexual situations where you are uncomfortable). If this is happening to you, you should get help immediately.

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"IF YOU'RE NOT OKAY, THEN I'M NOT OKAY!": FOCUS ON CODEPENDENCE
(August, 2001)

I'm nobody. Who are you?
Are you nobody, too?
                                -Emily Dickinson

What it is
Codependence is defined as "the tendency to repeatedly place the needs and wants of others first, to the absolute exclusion of one's own needs and wants." The self-esteem of the codependent individual is typically contingent upon earning approval from others.

Why it Happens
The roots of codependence are frequently found in an unhealthy childhood unbringing. Early research focused on adult children of alcoholics, who demonstrated enabling behaviors such as covering up a parent's alcohol use, lying to outsiders and suppressing personal feelings in an effort to keep the peace or maintain the status quo within the family system. Codependent behaviors also occur in children of families where there is no substance abuse but the parenting style is controlling, rigid or autocratic. In these families, independent thought is discouraged, and positive feelings about the self are conditional upon emotional approval from the parent. When these enabling or excessively dependent/compliant children grow up, the behavioral patterns learned in childhood disrupt their ability to form and maintain healthy emotional ties. These dysfunctional patterns most commonly result in unsatisfying and unproductive social relationships, and can severely impair the codependent's quest for emotional independence.

Common Symptoms
If you are codependent, you are so busy taking responsibility for the feelings of others that you barely have time to meet you own basic needs… yet you respond with exhaustion and resentment to the impossible burdens you create for yourself. You have very low self-esteem, yet do not trust others with important tasks for fear that they will not perform up to your expectations. In fact, because your expectations are impossibly high – for yourself and everyone else – people frequently disappoint you. Ironically, you believe yourself to be flawed, less-than, and inadequate. You are sensitive to criticism or disapproval, are intensely insecure, and require frequent reassurance that you are valued. Unfortunately, you rarely get that reassurance, because you have a lot of trouble asking for what you need, and desperately try to avoid appearing vulnerable to others. You feel incomplete if you are not in a romantic relationship, and try to work frantically to avoid being single. If you are partnered, you may feel lonely even when you are with your significant other, because you have such difficulty getting close to or trusting others. You may compromise your values in order to be accepted by or win approval from your partner. You encourage your partner to be dependent upon you, which makes you feel needed, secure, and safe.

Are You Codependent?

If you have more than five "yes" responses, codependent behaviors may be interfering with your life

Getting Help

• Work with a therapist to learn the skills necessary to meet your own emotional needs and take responsible care of yourself without overly depending upon or controlling others.
• Consider attending Codependent's Anonymous. A meeting is held in Pasco county at St. Michael's church on Route 52 each Thursday evening at 7 PM.
• Read Codependent No More: How to Stop Controlling Others and Start Caring for Yourself by M. Beattie.

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COPING WITH PANIC DISORDER
(September 2001)

"For me, a panic attack is almost a violent experience. I feel like I'm going insane. It makes me feel like I'm losing control in a very extreme way. My heart pounds really hard, and things seem unreal."

A panic attack is a short period during which an individual experiences intense apprehension, fearfulness, or terror, often associated with feelings of impending doom. Symptoms of panic attack often include shortness of breath, heart palpitations, chest pain, dizziness, nausea, sweating, chills or hot flashes, and fears of "going crazy" or losing control. Panic attacks have a sudden onset, and typically build to a peak in ten minutes or less.

A person may be diagnosed with Panic Disorder when s/he experiences recurrent, unexpected panic attacks followed by at least one month of persistent concern that s/he will experience another, or if s/he changes daily routines and behaviors to avoid experiencing another. Panic Disorder affects about 2-3% of the population, and is thought to be about twice as common in women as in men. Symptoms can first occur at any age, but are most frequently experienced between adolescence and the mid-thirties.

If you have Panic Disorder, your life has probably become very difficult. You may have difficulty working outside the home due to your avoidance of driving or going out alone. You may be willing to leave home, but only in the company of trusted friends or family members. Perhaps you are so fearful of having a panic attack while away from home that you avoid going out at all. This condition, known as agoraphobia, develops in about one-third of people with Panic Disorder.

How can Panic Disorder be treated? How long does treatment last? Most studies indicate that cognitive-behavioral psychotherapy and medication management are effective in successfully treating as many as 90% of people with anxiety disorders, with "significant improvement" typically noted in the first 6-8 weeks of treatment. Cognitive-behavioral therapy teaches the individual to reframe her thoughts in relation to the panic attacks, and to gain control of the symptoms rather than being victimized by them. It is common in this type of therapy for the counselor to teach techniques such as breathing exercises and guided meditation in order to help the individual reduce the frequency and intensity of the panic attacks. Medications may also be effective in helping the individual manage her symptoms. Two types of medications which are known to be useful in the treatment of Panic Disorder are benzodiazepines (such as Xanax) and selective serotonin re-uptake inhibitors (such as Prozac or Paxil).

I think I might have Panic Disorder. What should I do? First, see your doctor to rule out any medical conditions which might be causing your symptoms, and to see if you are a candidate for medication management. Then, find a reputable therapist who is experienced in treating anxiety. You may need to attend two or more sessions each week in the first few weeks of treatment, while you and the counselor stabilize your condition by eliminating the worst of the panic symptoms. Expect the therapist to ask you to keep track of the frequency and severity of your symptoms so you can gauge your progress in treatment. You will likely experience at least some relief from your symptoms within the first few weeks of treatment, and should be feeling and doing markedly better within the first month.

When I'm having a panic attack, what can I do to help myself? Try the time-tested techniques below to take control of your symptoms:

Calm Yourself with Positive Self-Talk:

"I am safe. I am not dying." "These feelings are unpleasant, but not harmful." "I can handle this. Nothing terrible will happen." "There is nothing that can hurt me here."

Belly Breathing:

In through your nose, out through your mouth. SLOWLY, to the count of eight.

Distract Yourself:

Splash cold water on your face or take a cool shower. Count backward from 100 by threes. Recite the names of all the states and their capitols. Stroke your favorite dog or cat. Focus on the flame of a candle while breathing deeply and slowly.

Seek Support:

Ask for (and accept) reassurance from your loved ones. Call friends. Call your counselor.

Focus on what works:

Keep a journal to remind yourself what helped you get through your panic attack. Strategies that worked before will work again.

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STRESS BUSTERS
(HOW TO COPE, EVEN WHEN YOU THINK YOU CAN'T)
(October 2001)

Maybe you race around with a constant knot in your stomach, or your jaw aches because you grit your teeth without even being aware of it. Maybe you're short-tempered with those you love and downright hostile to strangers. You're scattered and overwhelmed, irritable and impatient, restless and preoccupied. You feel like you're juggling so many obligations that you don't have enough time to be effective anywhere. More than anything, you just want all those competing demands to stop.

Welcome to the stress-filled 21st century.

The fact is, stress can be both a positive and a negative force in our lives. On the positive side, stress provides us with the ability to adjust and respond to a continually changing environment. Back in the caveman days, stress is what dumped enough adrenaline into the systems of our ancestors that they were able to run away from wild animals. In this millennium, stress is what enables us to meet deadlines, accept the demands of a job promotion or tend to the needs of a new baby. Positive stress enables us to function optimally. Negative stress, on the other hand, can lead to health problems such as high blood pressure, ulcers, heart disease, or stroke, as well as depression, anxiety, lack of life satisfaction, and a host of other emotional disorders.

How can you successfully manage stress in your own life? The answer lies in a three-fold approach which requires nothing less than that you change your thinking, change your behavior, and change your lifestyle. The payoff for all this change? A healthier, happier, less-stressed you.

• Have you ever been told that you're your own worst enemy? Many of us are harder on ourselves than anyone else could ever be. It's worth it for you to look long and hard in the mirror and figure out why you're doing that to yourself. Why not give yourself a break? You don't expect anyone else to be perfect. It doesn't make sense for you to have higher expectations for yourself than you have for others.
• Recognize what you can change (and what you can't). There's absolutely no use fretting and fussing over events which might never happen, or those over which you have absolutely no control. When you find yourself worrying about something which is realistic and changeable, take the energy that you're spending in worry and put it to better use: make a plan of action to resolve the problem. For example, if your child's day care is closing, rather than obsessing that you'll never find as good a place, start making calls to other care providers to find out what they have to offer.
• Prioritize your obligations. You're discouraged because you have twenty things to do and not nearly enough time to get them done. What's the answer? Prioritize. Choose the tasks which absolutely must be done today, and get those out of the way first, then turn to the tasks which are less critical. It's a good idea to maintain a written "to do" list. You'll feel more organized and less out of control if you don't have to keep everything in your head. Plus, it's satisfying to be able to cross things off as you accomplish them!
• Study the future. The more you can anticipate stresses and demands, the more you can plan for them. Learn as much as you can about upcoming events in your work and personal life. This will help you manage your obligations actively, instead of reactively.

• Practice responsible self-assertion. If someone pushes in front of you in line at the store, say, "excuse me, but there are several people ahead of you on this line." This is a more effective and satisfying solution than shrugging and ignoring it (internalizing your anger, where it can hurt you) or shooting the person squinty-eyed death-stares and shouting insults at them.
• Get organized. The more time you have to spend searching for lost or misplaced items, the less time you have to spend in peaceful relaxation or productive work. Disorganization in your work and personal life is enormously stressful. Do yourself a favor and develop a system for paying your bills, tracking your appointments, and identifying your work deadlines. The payoff is a life which is – and feels – well-managed and under control.

• Get adequate sleep. Most adults require at least eight hours of continuous sleep each night, but only about one-third of the US population actually gets that much. Are you skimping on sleep because you have too many other things to do? If so, you're setting yourself up for a fall. Chronic sleep deprivation results in depression, irritability, poor concentration, social withdrawal, reduced creativity, lack of attention to detail, blurred vision, and decreased physical coordination, just to name a few. Bottom line: you simply cannot be effective in your life if you are chronically sleep-deprived. Do yourself and everyone else a favor and hit the sack at a decent hour. You'll feel better, you'll function better, and – because you'll be less cranky – people will like you better, too!
• Exercise at least 30 minutes a day. You can garden, go for a walk or bike ride, or play Frisbee with your dog. Exercise is good for the body and soul, and is key to managing the stress in your life. And speaking of dogs…

Practice pet therapy. Studies show that interaction with our four-footed friends measurably reduces stress in those who have had open heart surgery. Fortunately, you don't need to suffer a medical catastrophe to reap the benefits of pet therapy. Cuddle, groom and stroke your favorite non-human pal at least fifteen minutes each day. It's sure to be good for both of you.

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DEAR DIARY:
WRITING YOUR WAY TO BETTER MENTAL HEALTH
(November 2001)

Are you struggling with feelings of anxiety, depression, and anger in the aftermath of the terrorist attacks on New York and Washington? If so, you're not alone. Symptoms such as insomnia, poor concentration and fearfulness are definitely on the rise as we try to cope and carry on while living in an uncertain world.

One of the best ways of working out these fears and feelings is to write about them in a journal. Journaling as a therapeutic tool has many advantages; it's an inexpensive, private and effective means of helping you sort out and ventilate what's on your mind.

You should also know that there are lots of different ways to journal. For example, a woman I know spoke with me recently about how frightened she has been since the September 11 attack. "It's all I can think about," she told me. "I worry that I'll never feel safe again." I encouraged her to write a journal about her fears, but she resisted. "I'm not a writer," she said. "I've never been good at putting my thoughts on paper."

I suggested that, instead of writing a traditional journal filled with sentences and paragraphs, she might start a simple "lists" journal. I gave her some suggestions to get started.

• List places where you feel secure and peaceful.
• List people who comfort you.
• List what makes you feel strong.
• List what you're afraid of.
• List practical things you can do to help yourself feel less afraid.
• List beliefs that give you strength and hope.

This woman, previously so convinced that she was "not a writer," and so couldn't benefit from journaling, was gratified to discover that writing a lists journal really helped! "Sitting down and thinking up things to say in a regular journal is too unstructured for me," she said. "Just the thought of it is overwhelming. But making lists is different. When I thought about places where I feel secure and peaceful, I listed my garden, and the beach, and my sister's house. When I thought about people who comfort me, I listed my sister, my baby niece and my best friend. Then I realized that I haven't gone to the beach in God knows how long, I've only visited my sister and my friend once or twice in the past two months, and I've neglected my garden terribly since the terrorist attack. I suddenly realized that I know what makes me feel centered and secure, and I haven't been allowing myself access to those things!"

It's exactly that kind of "a-ha!" moment which makes a therapist smile.

"I listed things that make me afraid," she continued. "It was a long list, and it kind of depressed me. But then I moved on to making a list about things I could do to help myself feel less afraid. And it turns out that I had a long list of those things, too. I decided to join my neighborhood watch association, and I made an appointment to give blood. Those are things I've been meaning to do for a long time now, but I've never gotten around to them. I figured out that I can sit around and be worried, or I can do things to help myself and other people be safer and healthier. I can't save the world," she finished. "But I'd rather do something than nothing."

This woman, a journaling skeptic, discovered that a simple lists journal could lead her away from immobilized anxiety and toward action and better health. She did it, and you can too, even without benefit of a therapist-coach. Numerous books are available in your local library about journal styles and techniques. Lists journaling is only one style among many; you're sure to find one which suits you. You might also want to attend a journaling workshop, such as the one I'm offering later this month.

You can work through and resolve feelings of anxiety, depression, and anger. Journaling helps. Why not give it a try?

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‘TIS THE SEASON…
(December 2001)

           A. To be jolly
           B. To be overwhelmed and/or depressed
           C. To cope with stressful family demands
           D. All of the above

If you're like most people, the tumultuous weeks between Thanksgiving and New Year's Day are a mixture of enjoyment and distress. You may visit with members of your extended family whom you don't often get a chance to see (which can be a good thing or not, depending on your family ties), and you may be under greater financial pressure due to the commercialization of the holiday season. The stores are busier, the lines are longer, the traffic is worse, and everywhere the pace of life is quicker. If all this leaves you feeling stressed, irritable or emotionally empty, you need to know you're not alone.

The fact is, the holidays are supposed to be a time of happiness, optimism for the coming year, and fellowship with friends and loved ones. Unfortunately, these expectations can trigger many unresolved issues, including a focus on past losses, disappointments, and a sense of increased isolation and loneliness. This phenomenon is commonly described as "the holiday blues." People with the blues tend to either focus on how bad they're feeling or to try and avoid the bad feelings. Unfortunately, neither strategy is effective; staying overly focused on negative feelings will not help you get through them, and avoidance behaviors such as social isolation and abuse of alcohol or other drugs can easily make your other problems even worse than they were before.

If you have the blues, try following these strategies to reinvent the season:

Rethink how you approach the holidays. Are you overwhelmed financially or feeling spiritually empty because of the emphasis on material gift-giving at this time of year? Consider an alternative plan, such as giving your loved ones an IOU for the gift of your time. Does your mother/sister/spouse really need another marble cheese board or bottle of perfume? Write a letter to her instead, telling her what you love about her and thanking her for being in your life.

Plan ahead. If you know you're likely to be overwhelmed by social obligations during holiday time, try to avoid accepting more invitations than you can comfortably manage. If you and your partner both need to visit with family at this time of year, consider spending Christmas eve with your family and Christmas day with your partner's family, rather than trying to visit both places on both days. You'll save yourself some stress, and will better be able to enjoy the spirit of the season.

Practice gratitude. No matter how hard your life is, rest assured you can easily find someone who has it even worse. If you're feeling blue during the holiday season, find a charitable organization whose mission you support and volunteer your time there. You might consider offering your services to a battered women's shelter, a homeless shelter, a hospital or hospice, or some other organization.

Make amends. This is a very good time of year to reach out to people who have hurt you, or who you've hurt. Ask for forgiveness. Accept an apology. Move into the new year by dissolving old resentments and bitterness. Live out the children's hymn:

Let there be peace on earth, and let it begin with me.
I wish you and yours a peaceful and joyful new year.

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Ready or Not...2002
(January 2002)

By now, you're sick to death of hearing it. "Where did the year go?" and "I can't believe it's time for the holidays again," and "this year went by so fast." Ready or not, the new year is upon us.

The end of each year is a natural time to take stock, to evaluate your life, to figure out where you want to go from here. Did you accomplish what you set out to do at the beginning of this year? What were your goals? Can you even remember what were your resolutions at the beginning of 2001?

Michael Gerber, author of a number of business and self-improvement books, writes, "the difference between great people and everyone else is that great people create their lives actively, while everyone else is created by their lives, passively waiting to see where life takes them. The difference between the two is the difference between living fully and just existing." Which kind of person are you? Are you charting your own course, or being led wherever the current takes you? If you're actively steering your life, you wake up each morning invigorated, challenged by activities which stretch your skills, spark your imagination, allow you opportunities to use creative energy, and put you in the path of other people who are motivated, as are you, to live as fully as possible.

If you are being passively drawn along in life's current, on the other hand, you may feel stuck in a life which brings you little satisfaction, autonomy, or pleasure. You may feel trapped in an unhappy relationship or in an unsatisfying job. Perhaps you see few alternatives for yourself other than life as it is. You may be afraid to risk making a change.

When I lived in New York, I had a great job as a therapist at an amazing school for mentally ill children. The work was gratifying, and I stayed for almost ten years. It was hard to imagine leaving that comfortable, stable life for something new, because I was not fond of change. I could have stayed there my entire career, as many others did. And yet… and yet...

I knew I could do more. I knew I could be more. I braced myself for monumental change and moved to Florida. I didn't know what to expect, except that I would have to use all my skills and resources to build an entirely new life.

Almost five years later, now, I am still surprised at – and proud of -myself for the thunderbolt of courage it took to leave everything I knew for the pleasures and pains of something different. It was a risk, absolutely, but how glad I am that I dared to try!

What risks will you dare to take in this new year? What changes can you make in your work life and your personal life so that you feel energized, vitalized, and passionately engaged in life's process, instead of going wherever circumstances happen to take you?

Ready or not, welcome to 2002. May you find abundant opportunities in the next twelve months for growth, creativity, and change! 
~ ER

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In Search of Self Esteem
(February 2002)

So here it is again, the month of St. Valentine's, when all the lovers in the world woo one another and those who are without partners (or who are unhappily coupled) do their best to willfully ignore the whole scene.

You shouldn't disregard the spirit of St. Valentine's day though, especially if you are not in a relationship. What is the day about, after all, if not celebrating love? And who better to love than yourself?

We forget this, you know, in our mad-dash haste to partnership. We focus so fully on loving and giving to our partners that we forget a fundamental truth: you can't give it unless you've got it; you can't fully love another unless you love yourself first.

For most of us, this is not an easy task.

During my initial session with every new client, I ask, "what are your weaknesses?" and I typically hear a long laundry list of self-hate. "I'm impatient. I'm jealous. I procrastinate. I'm too quick to anger. I don't trust. I don't forgive. I'm lazy. I'm stubborn…" and on and on. Then I ask, "what do you love about yourself? What are your strengths?" There is usually a long and painful silence. Then, "well… hmmm… I guess… I'm generous?" or "...I'm punctual?" Sometimes, the silence is broken only with, "I don't really have any strengths. There's nothing I love about myself."

Is it any wonder that we struggle so with loving others?

Sometimes, people resist acknowledging their strengths because they've been raised to believe that having unconditional positive regard for oneself is wrong; is aggrandizing, will lead to vanity. Not true! It is at least as important to know and cherish your strengths as it is to honestly acknowledge your weaknesses; being appreciatively aware of one's strengths and capabilities is the primary ingredient of healthy self-esteem.

If you struggle with finding value in yourself, and have low self-esteem as a result, consider trying these techniques for making peace with the person in the mirror:

Write a letter of recommendation for yourself. Identify your outstanding qualities; what makes you a good worker, friend and human being. Don't be modest; this is the time to trumpet your strengths with grace and style, even if no one else but you ever reads that letter.

Ask your friends and loved ones what makes you special. It may be hard to hear these compliments, especially if you struggle with low self-esteem, but it's important that you listen to what they have to say. Resist the temptation to brush those compliments aside as invalid or – even worse – insincere. Trust these important people in your life. They value you for some very good reasons. Find out what those reasons are.

Every day, remind yourself of your strengths. Read that letter of recommendation you wrote out loud, every day, until you believe and have internalized those positive truths about yourself. You might also want to invest in and read a book of daily affirmations.

The ability to love others is a great gift. Share it. But don't skimp on loving yourself.

Until next month ~ ER

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Holding onto Hope
(March 2002)

Hope, and hopelessness, persist despite the facts.

~ Mason Cooley

Every few months I'm asked to present a lecture or workshop to other therapists in the community on the subject of suicide risk assessment, which is one of my practice specialties. At every talk, I ask the participants if they can name the single most reliable predictor of suicidal behavior. Some guess depression, or substance abuse, or chronic illness. Those are good guesses, but wrong. The single most reliable predictor of suicidal behavior, I tell them, is hopelessness. The person who is depressed, or addicted to substances, or who is battling a major medical illness is certainly at higher suicidal risk than the person who is not facing those challenges, but it is the person without hope who is at highest risk of suicidal behavior.

At some point during the lecture, I usually relate the story of one particular young woman who came to the psychiatric emergency room where I work part-time. It was the night shift, very late, when she came to the door surrounded by four family members. They were worried about her, they said, because she had been very depressed, and couldn't sleep, and they were afraid she would kill herself unless she was admitted to the hospital.

The young woman cried hard throughout the interview. She was horribly depressed, she admitted. The main reason? "Nobody loves me," she said. I confess I was puzzled at first, when she told me that. No fewer than four people brought her to the hospital that night; by all appearances she had a far more substantial support system than most. The young woman, though, perceived herself to be unloved. She had a great support system (you have to wonder: do you have four people in your life who'd rouse themselves out of bed to accompany you to the emergency room in the middle of the night?) but she didn't know it. She couldn't feel it or be safely held by it, because her perceptions had been distorted by hopelessness which had quite completely overwhelmed her.

Hope, you see, is an absolutely essential ingredient for good physical and mental health. Any physician will tell you that the patient who believes she will recover from her illness stands a much better chance of recovery that the patient who believes that the illness will prevail. This is true in counseling, also: the client who is struggling but who has hope – and is willing to strive after that hope – is infinitely easier to treat that the client who believes that nothing will ever change.

How sustaining is your capacity for hope? In a crisis situation, can you find the gifts? Do you see the blessings? Training yourself to seek out the good in even the most desperate situations will help you hold onto hope. Answer the questions on the next page to see whether your sense of hope is stronger than your hopelessness (the more "true" answers, the greater your level of hopelessness). If you discover that hopelessness has a stronghold in your life, get help. It is not too late. Hopelessness can be transformed into hope, if you're willing. Are you willing?

I encourage you to remember and appreciate the wisdom of St. Clement: "If you do not hope, you will not find out what is beyond your hopes." Until next time ~ ER

1. I think in the future I can be no happier than I am now.
          True            False

2. I might as well give up because I can't make things better for myself.
          True           False

3. When things are going badly, I believe they'll stay that way forever.
          True           False

4. I don't have good luck and there's no reason to think I ever will.
          True           False

5. Things just don't work out the way I want them to.
          True           False

6. I have more bad times than good times.
          True           False

7. I never get what I want, so it's pointless to want anything.
          True           False

8. Tomorrow seems unclear and confusing to me.
          True           False

9. All I can see ahead of me are bad things, not good things.
          True           False

10. I don't think I will get what I really want in life.
          True           False

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Flattening the Button
(April 2002)

Remember how they taught you, how much of it was fear?

Refuse to hand it down. The legacy stops here.

~ Melissa Etheridge

A couple of months ago, I attended a four day intensive workshop on Traumatic Incident Reduction (TIR), an exciting, short-term treatment method for healing trauma. The course was taught by Gerald French, who quite literally wrote the book on the subject, and was an experience by turns both exhausting and exhilarating. TIR is "a procedure intended to render benign the consequences of past traumatic events,… capable of resolving a host of painful and unwanted feelings and emotions that have not surrendered to other interventions," (Traumatic Incident Reduction, French & Harris, 1999). If it can be said that we all have "buttons," those issues or memories which provoke in us strong and often unpleasant reactions, TIR is a technique designed to "flatten the button," so that the issue or memory no longer holds a potent emotional charge. TIR shares some similarity with better known therapeutic interventions such as repetitive exposure and flooding, in which the client is confronted with the feared experience until she gains mastery of her anxiety and dread. The TIR method is different from those, however, in that the therapist has very little role in examining or interpreting the client's fears, but instead follows a script designed to guide the client through the traumatic experience over and over again until an end point is reached, where the client achieves emotional resolution – even peace – with the traumatic event.

Let's be clear: running a traumatic incident using the TIR method can be emotionally grueling. It's definitely not for everyone; it doesn't work well with small children or those who aren't in good contact with reality. TIR doesn't fit well into the 60-minute therapy hour, either, since typical sessions last between 90 minutes and three hours. For clients intact enough and motivated enough to tolerate the procedure, though, it appears to hold great promise as a means of resolving – once and for all – traumatic experiences which cause great suffering after the fact.

Are you a good candidate for TIR? Ask your counselor to fully explain the process to you. You can even have a "practice" TIR session using a non-traumatic event so you can see for yourself what the procedure is all about. After that, you'll be able to make an informed decision about whether it's right for you.

Until next time ~ ER

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Focus on: Domestic Violence
(May 2002)

Until next time ~ ER

This is a screening measure designed to help you determine whether you might be involved in an abusive relationship. Even one "regularly" response suggests you may be in a relationship which is emotionally, physically and/or sexually abusive.

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Choosing Life
(June 2002)

• Major Depression, which is the most common form of mental illness in the US, and also one of the most readily treatable;
• Unresolved trauma, which can cause intrusive memories and generate unhealthy coping strategies;
• Alcohol and Drug Use, which is frequently implicated in impulsive behaviors of all types, including suicidal behavior;
• Maladaptive Beliefs about Achievement and Control, which can result in feelings of anger, inadequacy or failure; and
• Dysfunctional Attitudes about Love and Relationships, which can encourage you to become socially and emotionally isolated from others.

Until next time ~ ER

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Coping with Serious Illness
(July 2002)

Here are five great strategies for coping with serious illness:

Educate yourself. Nothing is quite so wearing as fear of the unknown. Accurate understanding of your illness will also help you develop a plan for treatment as you learn about the various options available to you. Investigate what support groups exist in your area for people who have been diagnosed with your illness, and attend at least one meeting; it can be very comforting to spend time with others who've traveled down the same road. You might also want to consider attending a therapy group, such as the one now forming at Counseling Works.

Give yourself top-notch self-care. Are you a regular at your favorite fast food outlet or pizza joint? This is a good time for you to pay better attention to your nutritional needs. Also, if you've been accustomed to "getting by" on fewer than eight hours of sleep each night, plan on spending a little more quality time with your pillow. A worn-down, tired-out body is not in optimal condition to deal with medical challenges.

Be flexible. It may be necessary for you to cut down on your work hours, or even to stop working entirely. You may also find that you need more time to do things that used to be effortless for you. Try to look upon these needs as changes, rather than failures. The gentler you can be with yourself, the better.

Accept support and help from others. Are you tempted to avoid contact with others and to refuse offers of help and support? Resist that temptation. This is a very good time for you to accept both practical assistance and emotional support from those people who are important to you.

Practice gratitude. There are always — yes, always — things for which you can be grateful. Start a gratitude journal, and add at least five gratitudes to your list each day. This activity is all but guaranteed to improve your outlook… and your ability to cope.

I bid you peace and strength on your journey toward healing. ~ ER 

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Giving Thanks
(November 2002)

"I'm telling you, I dread it. We do Thanksgiving the same way every year, and every year is another disaster." My client looked both aggravated and sad as she reported her family's pattern of high tension, high stress, low satisfaction holiday get-togethers. "We have to-do lists, shopping lists, invitation lists. We plan everything down to who's ironing the napkins, and by the time we finally sit at the Thanksgiving table, we're so angry and exhausted that Henry's the only one who enjoys the meal." Henry, it turns out, is the family beagle.

Sad to say, my client's unhappiness about stressful family holidays is a common complaint at this time of year. So what can be done to make things different? How can you organize and arrange your holiday plan so that family gatherings are pleasant and peaceful, rather than tension-filled and overwhelming?

Make attendance optional. Clients sometimes tell me that they'd rather be anywhere else than at their family's holiday table, but they attend out of a sense of obligation—and fear of relentless guilt-inducing comments from their parents and other family members if they don't show up. Think this one through. Do you really want someone at the family meal who doesn't want to be there? When planning the big family dinner, tell each and every family member that attendance is completely optional. Avoid "guilting" those who choose not to attend. This should apply to adolescent family members also. The only people sitting at the table should be those who really want to be there.

Delegate. It doesn't make sense for one or two people to carry the responsibility for planning and cooking an enormous, multi-course dinner. Make every person who attends responsible for some portion of the meal. The wonderful cooks in the family can be responsible for the turkey and other hot courses, while those less capable in the kitchen can be asked to bring wine, sparkling cider, desserts, breads, etc. Everyone—family members and invited guests—should contribute in some way to the meal. This will give family members a sense of ownership and provide invited guests with a sense of belonging.

Simplify. Why do you need five main courses, nine side dishes and seven desserts, anyway? Scale back that menu. Nobody wants that many leftovers, and you don't need the stress of all the extra preparation, cooking, and cleaning up, either. And while we're on the topic of simplicity, consider toning down the formality of the table. Tip: If you find yourself embroiled in family battles over napkins and tablecloths for the big day, that's a sure sign that you need to simplify your plans. Martha Stewart probably won't be making a surprise appearance at your dinner, so relax. Who are you trying to impress? The honest answer to that question may give you something valuable to think about.

Avoid controversial topics. It never makes sense to talk about politics, religion, gun control, global thermonuclear war or any other hot-button issue unless you're prepared for some spirited—and sometimes heated—debate. Now mind you, there's nothing wrong with a good debate… but if you're looking for calm good humor at the table, consider steering the conversation to more neutral waters.

Discuss gratitude. Even if your family does not traditionally say grace before meals, consider discussing gratitude. Give each person at the table an opportunity to talk about things for which they have been grateful in the past year, and things they look forward to or hope for in the new year.

I wish you and yours a peaceful, blessed Thanksgiving.

Until next time—ER

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Choosing Simplicity
How to stay recharged during the holidays when everyone else is running on empty
(December 2002)

Every year about this time in my practice, I begin to see the same thing: overstressed, overwhelmed, and overworked people doing their best to cope with the demands of the holiday season. This year, I couldn't help but notice that the stores put up their Christmas displays the day after Halloween. Most of us agree that this is much too soon, but retailers hungry for our dollars start applying the pressure as early as possible, encouraging us to scurry around in an eight-week frenzy of shop-shop-shop and spend-spend-spend.

It really misses the whole point of Christmas, don't you think?

Over the years, I've learned that if you keep the focus where it belongs (on reasonable limits, good will toward others, and time with loved ones) you'll keep your sanity during the season when everyone around you is losing theirs. Here are my favorite strategies for enjoying a peaceful, meaningful holiday season.

Decide to do less. I sometimes have to break the bad news to a client that she's not God's other perfect child. This is true of you, too. You can't do it all, not even close. So why stress yourself by expecting the impossible?

Prioritize. Write a list of everything you want to do this season, then rank those things in order of importance. Cross off the two lowest-ranked items on the list. Repeat this until you have a manageable list of things to do. This strategy will help you figure out what's really important to you, and should steer your decision-making about how to spend your precious time this holiday season.

Limit your spending. Have you ever noticed how young children get overwhelmed by too many presents on Christmas morning? They rip into package after package without stopping to see what they've just opened! This feeds into the mindless-consumer mentality which so many of us dislike about the holidays. Follow the example of the Amish and provide each child with three special gifts to open on Christmas morning. And while you're at it… rather than buying gifts for every adult in your family, consider drawing names out of a basket, so that each adult family member buys for (and receives a gift from) just one other person. It's also a good idea to budget the amount to spend on each gift and stick to it. If you plan ahead, you're likely to find some good deals: the best times to buy ahead are from Christmas to late February, and during June and July.

Schedule time for yourself. Do something at least once a week for at least an hour which helps you feel refreshed, centered and peaceful (hint: it's a good idea to do this year-round, but it's especially important around the holidays!).

Don't force yourself to be jolly. Memories both good and bad tend to surface at this time of year, and you may experience some sad or negative feelings as a result. These transitory "holiday blues" are experienced by many people and are perfectly normal.

Exercise. You'll reduce your holiday stress level if you exercise at least 30 minutes a day. Considering walking around your neighborhood with your loved ones to check out the Christmas lights!

Practice gratitude. This is a great time of year to count your blessings and to brighten someone else's life. Consider adopting a needy individual or family by becoming an "angel." Many local charities maintain lists of people in need to whom you can anonymously donate gifts, clothing and toys for the holidays.

Make amends. Think back on the past year. Is there anyone you've injured to whom you haven't made amends? This is the right time to correct that omission.

I wish you and yours a peaceful, blessed holiday season. ~ ER

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Overcoming TRAUMA
(January 2003)

It can happen in a hundred thousand ways.

Maybe it was an auto accident, a bus rollover, a plane crash, a train derailment. Maybe you were the sole victim of a hit-and-run, or one of many wounded in a mass casualty disaster. Maybe it was a building fire, a bombing, a flood, a sniper, a rapist, a drunk driver, a lightening strike, a violent parent or a crazed ex-lover.

Maybe it was war. Maybe in your head you're still trapped in some faraway jungle or desert or on some mountain or island where what-happened-there haunts your dreams and poisons your days and makes you desperate for the ability to forget it, get past it, get over it, to move on, already.

You've tried letting it go, God knows you've tried. You've tried anesthetizing yourself with compulsive behaviors of all kinds: alcohol or drugs or overeating or starving or gambling or intentional self-injury. Maybe you've pushed yourself beyond all limits, staying impossibly busy so you never have time to think, much less to remember or to feel.

It doesn't go away, though. What happened never goes away. The deeper you try to bury it, the more it comes at you, disguised in flashbacks, nightmares, jumpiness, irritability, fearfulness, poor concentration. When people tell you to move on with your life, you're tempted to scream: "don't you think I would if I could?" As if they think you want to be stuck there, in all the pain and confusion of the bad thing that happened. You get so sick of hearing that it happened a long time ago and it's time to stop living in the past, as if you could just snap your fingers and make it all disappear. And wouldn't it be nice if it was as easy as all that?

Well, recovery from posttraumatic stress isn't easy. You can't just snap your fingers and make it all go away, and you can't simply have a stern talking-to with yourself and expect your symptoms to disappear. You can't change whatever traumatic event(s) happened to you, but you can make the decision to get treatment which will allow you to take control of your symptoms. The good news is that the mental health specialty of Clinical Traumatology is growing fast, and with it are emerging some enormously promising treatment methods to help you heal.

Do you have Posttraumatic Stress Disorder? PTSD can be diagnosed when:

You experienced or witnessed an event which involved actual or threatened death or serious injury; and

Your response to that event involved intense fear, helplessness or horror; and

You have symptoms of intrusion (repetitive, distressing recollections or dreams of the event; nightmares; flashbacks in which you act or feel as if the event was recurring), avoidance (efforts to avoid thoughts, feelings, memories, conversations, activities, places or people which remind you of the event; feelings of detachment from others; sense of a foreshortened future) and arousal (sleep disturbances, heart palpitations, anger outbursts, poor concentration, exaggerated startle responses); and

Your symptoms cause you significant distress or impairment in functioning; and

Your symptoms last more than one month.

Two heralded methods for resolution of the symptoms associated with PTSD are Traumatic Incident Reduction (TIR) and Eye Movement Desensitization and Reprocessing (EMDR). Both are effective, time-limited, client-directed interventions, and neither involves the use of hypnosis or medication. Ask your therapist which trauma recovery method might be right for you, and consider giving it a try. What do you have to lose, after all, except some painful, disturbing symptoms which impair your quality of life?

Until next time ~ ER

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Puppy Love
-OR-
Everything I ever needed to know about love, I learned from my dogs
(February 2003)

Valentine's Day, more than any other holiday, is made for lovers. Is there anything better than an intimate relationship in which you feel respected, valued, and safely held? The puzzle is how relationships which once were good can transform so disastrously into vehicles for causing pain. I see it time and time again in my practice: couples who seek counseling in a desperate effort to regain the unity and comfortable familiarity which they once enjoyed. Human relationships, don't you know, can be so complicated.

I have to tell you: it's not that way in the canine world.

Regular readers of this newsletter know that I share my life with three much beloved dogs: Sylvie, a ten-year-old golden retriever; Sam, a nine-year-old German shepherd; and Molly, a four-month-old golden retriever. Bringing Molly into the fold about two months ago reminded me of the fundamentals of puppy-raising; the things you do (and don't do) with a new dog to help develop a strong, loving bond between you which will last a lifetime. Then it occurred to me that these covenants are not species-specific. In fact, they're nothing less than the bare-bones, bottom-line, won't-make-it-without-'em requirements for all relationships—human, canine and otherwise—in which we hope to love well and to be loved well in return.

I will love you unconditionally, even when you piddle on the carpet or otherwise behave inappropriately. Perfection is for machines, not living creations. I trust that you'll do your best as often as possible. You can count on me to do the same.

I will not embarrass you in front of others. If you've done something which really upsets me, I promise to talk to you about it in private. Big, showy displays of dominance in front of other people aren't good for the health of any relationship.

I will be trustworthy. I understand that trust is a fragile thing; slow to grow, and easy to lose. I promise always to be mindful of behaving in ways which encourage your trust in me.

I will remember the value of play. We grown-up humans can be so serious, but it's good for us to roll around in the grass from time to time and kick our legs up in the air and make grunty noises.

I will celebrate with you as you learn new things, like asking to go out for a walk in the middle of the night instead of piddling on the carpet.

I will not blame you for things which aren't your fault, even if it means I have to walk you in the middle of the night because your bladder is the size of a thimble and you just can't wait until morning.

I will try to understand your point of view, even when it's really hard for me to figure out what is so incredibly irresistible to you about my slipper.

I will never shame you. Shame is not good for puppies, people, or any other living thing.

I will be patient, even after I've told you for the thousandth time not to chew the power cord to the TV.

I will support your friendships with others, and do my best to avoid jealousy when you play with people other than me.

I will nuzzle your cheek to mine every single day, and whisper in your ear that I'm glad you're in my life. No one ever gets tired of hearing how precious and valued they are.

I will humbly give thanks every day that your path crossed with mine, and celebrate that the Great Spirit (Father God, Yahweh, Ra, Universal Creator, or however you understand Him) saw fit to let us walk together for a little while on the journey.

Until next time ~ ER

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MONEY AND YOUR RELATIONSHIP
(March 2003)

It's a sad-but-true fact of twenty-first century life: financial stressors and disagreements are the number one reason why American couples separate or divorce.

Mostly, this has to do with poorly aligned financial behaviors and goals. Maybe you save faithfully, and only really feel safe if you have some thousands in an emergency fund, while your partner just has to have the latest (and most expensive) electronic gadget that comes along and couldn't care less about saving anything. These conflicting priorities and behaviors could potentially cause some serious trouble in your relationship.

If you want to see how you and your partner are doing around this important issue, consider sitting down with this short true-false quiz to rate the financial health of your romantic partnership.

FINANCIAL ATTITUDES INVENTORY

T F My partner and I talk about money and financial issues regularly - at least once a week.
T F We have decided cooperatively who handles our bills (or who will handle them after we marry or live together).
T F I feel my partner manages his/her own money well.
T F I would feel comfortable if my partner made a purchase of $300 without talking to me first.
T F I feel that my partner knows about and supports my retirement dreams.
T F I know exactly how much debt, savings and investments my partner is bringing into our relationship.
T F Between us, we have more than five credit cards.
T F I know exactly how much money my partner makes.
T F I feel my partner avoids sitting down and talking about money matters with me.
T F My partner and I have the same financial dreams.
T F I feel that my partner treats his/her money as if it's his/her own, rather than ours.
T F I never talked about money matters with my parents.
T F I know how my partner would feel if I wanted to quit my job and not work for a year.
T F We have enough savings that I would feel comfortable living off one salary if I lost my job or my partner lost his/her job.
T F When we talk about money, my partner interrupts me or dismisses my point of view.
T F I feel my partner is a cheapskate.
T F We have a very clear financial budget and long-term plan.
T F We've talked to a financial planner.

SCORING: Give yourself one point if you answered true to questions 1,2,3,4,5,6,8,10,13,14,17 and 18. Give yourself one point if you answered false to questions 7,9,11,12 and 15.

0-6 points
Red Flag! Make sure your partner takes this quiz, and compare scores. If there is a significant difference in your scores, or if you both had low scores, consider working with a therapist and a financial planner to resolve your financial incompatibility issues.

7-12 points
You and your partner have a few things to work out, but for the most part appear to understand where the other is coming from. Maybe you won't see eye to eye about everything, but you've probably got enough financial compatibility to work things out on your own without the need for professional intervention.

13+ points
You and your partner have a lot in common, both financially and otherwise. Keep up the great communication and the responsible financial planning.

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LIVING WITH DEPRESSION
(April 2003)

For me, depression is best depicted as some dense, primeval forest of your very worst nightmares. There are trees blocking out the warmth and the light; branches reaching out to scratch you as you walk; roots sneaking upward out of the ground to trip you, make you fall.

There's no sunlight. Everything - everything seems dark, colorless, and drab, as if you're viewing the world through a black-and-white lens. Your peripheral vision disappears, too, leading you to see fewer and fewer choices, options and alternatives. All you can perceive is this pathless wood around you. You have no idea how you got there, and no idea how to bushwhack your way out. And something else, too. You feel totally alone. When you call out for help, the sound of your voice gets as trapped in that dense foliage as you are yourself.

Maybe you've never been lost in there, but if you have, you know exactly what I mean. Your whole life feels overtaken by symptoms like appetite and sleep disturbance (eating or sleeping too much or too little); poor concentration; difficulty thinking or making decisions; fatigue and decreased energy; lack of interest in previously enjoyed activities; feelings of worthlessness or guilt; irritability or sadness; hopelessness and recurrent thoughts of death or suicide. Other symptoms of major depression include tearfulness, anxiety, difficulty in intimate relationships, unsatisfying social relationships, and loss of sexual interest. For diagnosis, at least four of these symptoms must be present most of the day, nearly every day, for at least two consecutive weeks.

When you're depressed, you've got little energy, little motivation, and little hope. It may be all you can do to drag yourself out of bed every morning, and some days, you may not even be able to do that. So how do you live with that? How do you live through that? When the simple act of breathing feels like an effort, how do you pick yourself up and walk out of the woods? Well, one small step at a time, of course. Here's how.

Eat smart. People who are depressed almost always have appetite disturbance. For some, that means a very diminished appetite; nothing looks, smells, or tastes good, so they don't eat enough to feed the machine. For others, overeating, or even bingeing, is a symptom. Find a way to avoid both of these. As much as possible, try to eat fresh foods, with a strong emphasis on bread, cereal, rice, pasta, vegetables, and fruit. Schedule yourself for three simple meals each day at specific times, and then stick to that plan. Eating by the clock, rather than by your stomach, is a good strategy for ensuring that your over-or-undereating patterns won't get out of control. When you're preparing meals, make extra portions that you can refrigerate or freeze to eat later, when you may not have the energy to make a meal from scratch.

Exercise. I know, I know. You barely have the energy to breathe, and you're still supposed to exercise? Consider this: depressed people who exercise have been found to recover from depression more quickly than those who don't. And it doesn't take much: just ten minutes of walking each day will help elevate your mood. The key here is to find something you like to do, then do it regularly (Note: if you've been inactive for a while, get a physical exam and discuss any exercise limitations you might have with your doctor). Swimming, yoga, gardening, and tai chi are examples of some great low-impact activities which will improve your mood and overall level of function.

Sleep enough, but not too much. As with appetite, sleep disturbances (insomnia or hypersomnia) are common in people with depression. Be cautious with prescribed or over-the-counter sleep medications; most are recommended for short-term use only, and some are habit-forming. Set a standard bedtime and rising time, and try not to deviate from these. If you absolutely can't sleep, get out of bed and do something relaxing (take a warm bath or a read a few chapters from your favorite book) rather than tossing and turning. Try to avoid daytime napping, which will disrupt your nighttime sleep pattern.

Get enough light. Open your curtains or blinds, and minimize your use of sunglasses when you're outside. Some people find that use of special light boxes are useful, but here in Florida, you should be able to obtain enough light from the sun to make use of a light box unnecessary. Caution: some medications cause light-sensitivity, so check with your doctor before exposing yourself to more light than usual.

Have fun. Depressed people often describe themselves as "fun-impaired." Because even previously enjoyed activities seem dull and uninteresting (a condition known as "anhedonia"), people who are depressed often have little in their lives which may spark pleasure. Here's a tip: don't wait until you get motivated to have some fun. Recall what used to give you pleasure - crafts, or writing, or canoeing, or whatever - and schedule yourself for that activity at least once a week. It doesn't much matter if you don't feel like doing it. Do it anyway. Do it even if it doesn't seem as much fun as it used to be. Go through the motions; the motives (and motivation) will follow.

Get treatment. Studies show that major depression is best treated with a combination of psychotherapy and medication. If you have some or all of the symptoms of depression, schedule an appointment with your doctor to discuss some of the treatment options which are available. If you've never taken antidepressants before, fear not: most medications in this category are both effective and very well tolerated.

I wish you safe travel as you find the path out of that dark forest which is depression. You can get out of there. Pick up your feet, watch where you're going, and take small, steady steps in the direction of your own recovery.- ER

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"TODAY IS A GOOD DAY TO DIE: 
WHAT TO DO WHEN A LOVED ONE IS SUICIDAL"
(May 2003)

Few things are more frightening.

Your loved one confides that it's too hard to go on, that death would be a welcome relief from the emotional pain which s/he carries. What should you do? What can you say? How do you manage your own anxiety while trying to keep safe someone who isn't committed to life anymore?

First, here's some education. It's unfortunate but true that suicidal thoughts are an equal-opportunity misery. Children and adolescents, adults and the elderly may all be susceptible to that nagging inner voice which questions what the struggle is all about; which advises that it would be easier and less painful just to quit the fight. And while it's impossible to predict with certainty who will follow through with the impulse to self-harm, there are certain risk factors which place some individuals at higher suicidal risk than others. These include:

History of major depression, bipolar disorder, schizophrenia or borderline personality disorder; history of substance abuse or addiction; preoccupation with death and dying; loss of interest in previously enjoyed activities; prior suicidal attempts or gestures; hopelessness about the possibility of change (this is the single most reliable predictor of suicidal behavior); recent serious losses or serious medical illness; chronic pain; and feelings of powerlessness, worthlessness, shame and guilt. Suicidal people often feel they are a burden to others and perceive that their death would lighten the load of their loved ones.

Here's what you can do to help when a loved one is in suicidal crisis.

Take the talk seriously. It's a myth that people who talk about suicide don't do it.

"Have you been feeling unhappy lately?" If yes...

"Do you feel hopeless about the future?" Hopelessness is highly associated with suicidal thoughts and behaviors. If yes...

"Do you think about death?" Thoughts of death are symptomatic of major depression but do not necessarily predict suicidal behavior. If yes...

"Do you ever get the urge to kill yourself?" If yes...

"Do you have any plan to kill yourself?" If yes...

"What is your plan?" The more specific and viable the plan, the greater the risk of suicidal behavior.

Be willing to listen non-judgmentally. Let her know you're glad she's talking to you. Allow and encourage open ventilation of feelings. Don't engage in a debate about whether suicide is right or wrong. Also, don't act shocked or angry. This will merely shut down her desire to share her feelings with you.

Don't get involved in negative contracts (promises to keep secret what you've been told). Understand that the vast majority of suicidal persons are ambivalent about the wish to die, and most do talk about their suicidal feelings before actually taking any steps to harm themselves. Assume your loved one is trusting you with that information because, on some level, he wants help.

Be involved. If your loved one is seeing a doctor or therapist, don't hesitate to contact that person if you become concerned about your loved one's suicidal potential. If he is not imminently suicidal and the doctor/therapist doesn't have a release of information to talk to you, she may not be able to discuss his case with you. But nothing prevents her from accepting information from you and listening to your concerns about your loved one's safety.

If the risk of suicidal behavior is emergent, don't leave your loved one alone. Arrange for an immediate short-term hospitalization until the acute risk of suicidal behavior has passed.

Until next time ~ ER

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I WORK, THEREFORE I AM
(June 2003)

It seems so benign at first, the behavior of that highly motivated person who arrives to work early and leaves late, who powers through complicated assignments with a shrug, who is the go-to person of a dozen others. Society smiles on you. You're a success! The boss loves you and colleagues admire you. It seems that you rack up achievements and accomplishments as effortlessly as breathing. You make good money because you're always hip-deep in several projects at a time, and you stay continuously on the lookout for the next interesting challenge.

No problem here, right? Well, maybe not. Maybe.

Not every hard worker is a workaholic. There is a critical difference between the person who works efficiently and effectively, and the one who is compulsively addicted to work, who craves a perpetual adrenaline rush like a junkie craves heroin and therefore lives his life as if he's being chased by tigers. In a word, that difference is anxiety.

The non-compulsive individual, who works hard and enjoys a sense of achievement after a job well done, is satisfied with himself. He strives for excellence, but not perfection. The workaholic, on the other hand, is driven by anxious distress. He is a no-holds-barred perfectionist who derives little satisfaction from his achievements. He works harder to feel better. He pushes himself relentlessly and is unable to relax well. Leisure activities, to him, feel like a waste of time. He thinks about work almost constantly. He worries about the future, too, because the career he has built seems like an unstable house of cards, ready to collapse the moment his attention shifts away.

Unlike many other types of compulsive behavior, workaholism isn't recognized by the psychiatric community as a bona fide mental health disorder. And that's a sad omission, too, since it can be just as damaging as any other addiction. Look at these facts:

Adult Americans work an average 160 hours more each year than we did in 1969;

Worker's Compensation claims related to stress disorders tripled from 1980 to 1990;

More fatal heart attacks occur on Monday mornings than any other time.

Can't decide if you've crossed the line into compulsive workaholism? Ask your family. One of the best diagnostic questions for any addict is "do your loved ones think you have a problem?" Also, you can take the quiz on the opposite page to see how you score. And, if you're ready to acknowledge that your work habits may be out of control, here are some things you can do:

Get Help. There is an established Workaholics Anonymous meeting in St. Petersburg each Wednesday night at the Northwest Presbyterian Church at 6330 54th Avenue North. You can also check out the WA website at www.workaholics-anonymous.org for reading lists and directions to a yahoo chat room for workaholics in recovery. Also, consider getting therapy to help manage your anxiety and reduce your need for perfectionism and control.

If you have a faith system, use it! Workaholics have trouble delegating. But if you believe in an all-powerful and benevolent God (whether you call Him Father or Great Spirit or Ra or Buddha or anything else), consider asking for help and willingness to overcome your compulsive behavior.

Schedule time off. Grown-ups need playtime too (yes, even you). Make a contract with yourself that you will not work more than a specified number of hours a week, and then stick to that commitment. Find leisure activities which you enjoy, and then participate in them regularly, being mindful not to make your play into another competitive work project.

Practice substitution. If you plan on adding a new project or responsibility to your schedule, eliminate another project which demands equivalent time and attention.

Seek support from trusted others. Ask them to help you monitor yourself as you strive to conquer your addiction to work. An attitude of honesty, open-mindedness and humility will serve you well in this endeavor and all of life.

I bid you peace, strength and courage as you move toward better balance and better emotional health.

Until next time ~ ER

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"Creating the Life You Want To Live"
(August 2003)

Last month, I had another birthday. "The big three-nine," one birthday card trumpeted. "One step closer to over the hill."

Artistic expression
Community/public service/volunteerism
Culture/theatre/dance/drama
Education/learning
Employment/professional/career
Development of talents
Family
Financial
Hobbies
Intimate relationship with significant other
Personal growth
Physical health/exercise
Recreation/relaxation
Social/friends
Social justice
Spiritual
Travel/cultural exposure

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"I'll Get To It Later": Defeating Procrastination
(October 2003)

Maybe you recall it from your student days, that adrenaline rush of pulling an all-nighter to finish the paper you'd been avoiding all semester. Maybe it's been years since you've dodged a deadline, or maybe that tendency toward avoidance still dogs you.

Until next time ~ ER

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Coping with Difficult People During the Holidays
(November 2003)

Pssst. Don't turn around and look. Act natural. Keep breathing. You're safe for the moment. But... did you know the holidays are roaring up behind you like a lion on the loose?

Yessiree, here we go again. Seems like just yesterday I was writing last year's newsletter article on keeping the Thanksgiving workload manageable, and now it's time to give another nod to the season by sending along my annual reminder not to make yourself crazy with over-stressing, over-working, over-indulging and otherwise over-doing at this over-the-top time of year.

This time around, let's talk a bit about how to cope with the difficult personality types whom you might only see at annual celebrations like Thanksgiving.

Pushy-Pushy: These folks wants it done their way, and typically want it done their way right now. They find it difficult to cope with group consensus or discussion. They know the right way to get the job done and become frustrated when others want to consider different options.

How to Cope: Provide them with important, specific tasks to accomplish. Giving them total authority over their own responsibilities helps them to feel important and will make them less likely to want to control everybody else.

The Know-it-All. These individuals think they know more than anyone about almost everything, and go on, and on, and on, and on... lecturing endlessly to anyone who might (or might not) be listening about politics, cloud formations or the reproductive system of the dung beetle.

How to Cope: Give them some attention, which is their bottom-line craving. Listen respectfully for as long as you can manage while still appearing interested and polite. Allow them to save face even if you know they don't know what they're talking about. You can try to deflect some of their pontificating by sharing related information with them ("oh, you say pelicans are extremely long-lived? That reminds me of our recent cruise to Alaska. We..."), which might help break the cycle. If all else fails, beat a hasty retreat to the kitchen to help with the washing up.

The Expressionless Unresponsive. These folks are typically outsiders to the family who are unsure how to relate during family rituals or get-togethers. New spouses, rather distant relatives whom you rarely see, and people with rusty social skills often fit into this category. You may find them sitting woodenly on the sofa watching television or hiding out for prolonged periods in the restroom or other out-of-the-way places. Every well-meaning effort to engage them in casual conversation seems to dead-end into an uncomfortable silence. Usually, these individuals are in an agony of anxiety. In their effort to fit in and avoid offense, they try to be as still and inconspicuous as possible so as not to make some unpardonable social gaffe.

How to Cope: Don't give up on them. Sit patiently and be prepared to carry the conversational load until they relax enough to participate. Ask open-ended questions (those which cannot be answered with a simple yes or no) and appear interested in the response. Also, don't be afraid to put them to work. Giving them specific tasks to complete will provide them with a sense of purpose and activity which should help to ease their social discomfort.

The Sniper. Thesniper comes out of nowhere to humiliate or embarrass the target of his attack. Snipers typically have long memories and are excellent grudge-holders. They often hide behind sarcastic humor and are, as a rule, very angry and unhappy people.

How to Cope: Effectively dealing with a sniper requires direct, unflinching confrontation. Immediately address the attack. Ideally, try to get the sniper alone, but if he refuses to move to a more private location, deal with the problem right where it happened, as in, "Uncle Harry, when you say I cook just like my mother and she couldn't boil an egg, I feel that you're criticizing this meal, which is hurtful to me." Often, snipers will roll their eyes at confrontation and will try to pass off their sniping as a joke. You may calmly but firmly say, "that's a 'joke' which hurts my feelings. Please stop." Then, the sniper is likely to either discontinue his attack or convert into an Exploder.

The Exploder. These individuals have learned that throwing showy tantrums is an effective way to become the center of attention. They may storm around the room, yell, or even throw things. Exploders may also be thunderously silent while visibly shaking, clenching their fists and flexing their jaw muscles. Whiny Exploders may cry noisily while complaining that nobody understands or loves them.

How to Cope: Attention encourages the Exploder, so don't feed into this behavior by dignifying it with much notice. If an Exploder stomps out of the room, don't go after him; just let him alone to cool off. If he returns to the group and has regained control of himself, don't punish him by shaming his behavior ("are you over your little tantrum now?"). Instead, let him reintegrate and help him to feel welcome ("Uncle Harry, how about some pumpkin pie?"). Similarly, Whiny Exploders should be ignored until their inappropriate behavior stops. Then welcome them back into the group without any fanfare.

Armed with these tips for coping with even the most challenging personalities who come to your Thanksgiving table, may you find yourself well-equipped for dealing successfully with whatever comes your way! I wish you and yours a peaceful and blessed holiday season.

Until next time ~ ER

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How to Cope in a Blended Family During the Holidays
(November 2003)

Remember the good old days, when you grew up with your biological mom and your biological dad, and the only other kids in the house were your biological sisters and biological brothers, and you all lived together in peace, love and harmony?

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What Are Your Goals for 2004?
(January-February 2004)

Some while ago, I began meeting with a group of colleagues once a month to discuss the issues and challenges that come up for counselors in private practice. As part of this effort, a few of use have begun using a practice development workbook to help us achieve our long-term business goals, and one of the first assignments in that book was to identify ten specific goals we wanted to achieve in the next 90 days. 

I was stumped.

I mean, I have lots of goals for myself in the next five or ten or fifteen years. But goals I expect myself to achieve in the next three months? At first, I found the assignment to be surprisingly difficult. Try as I might, I was only able to think up two or three 90-day goals. Then, over the next few days, I added a couple more. Then it was as if the floodgates opened: I was able to identify lots of things I could do (and wanted to do) in support of my practice. By the time I stopped letting myself add items to the list, I had sixteen goals! I pared the list down to the ten most important things that I thought I could do for CounselingWorks in the next three months. Then, following the instructions in the workbook, I identified the three easiest, and set out to do them in the next 30 days.

Although I don't consider myself to be much of a procrastinator, at least as far as my business is concerned, I realized there were a number of chores I was putting off and opportunities I was not pursuing because I perceived them to be tedious or difficult or time-consuming. But I genuinely believed that each short-term goal on the list would help keep my business on a stable growth track, so I made the commitment to myself that I would knock the three easiest items off that list. One of my easiest was to finally make arrangements to accept credit card payments at the office. Nothing about that task was particularly difficult, but it's something I've been putting off for the past year, because I always found something more important (or, let's face it, more interesting) to do with my time.

Here, then, is my challenge to you. In the beginning of this new year 2004, identify ten things you can do in the next 90 days to help yourself move from where you are to where you want to be in your professional or personal life.

Expect yourself to have a little difficulty with this assignment. We're trained from early on in life to think large and long-term: "I want to be a licensed therapist" or "I want to be a law-enforcement officer" or "I want to be able to retire at 50." But we tend to fall short on the details, the specific little tasks which will help us achieve the big goals.

What ten things can you do now, in the next three months, to work toward the achievement of a long-term goal you really want for yourself?

MY TEN 90-DAY GOALS ARE:

_________________________________________________________

_________________________________________________________

_________________________________________________________

_________________________________________________________

_________________________________________________________

_________________________________________________________

_________________________________________________________

_________________________________________________________

_________________________________________________________

_________________________________________________________

Were you able to come up with ten goals? If you weren't able to think of all ten at one time, don't worry about it... but don't give up on your list, either. Come back to it from time to time in the next few days and you're likely to identify other goals you want to achieve in the next 90 days.

Now here comes the second part of this assignment: rank those ten goals in order of difficulty, from easiest to hardest. Then choose the three easiest items on the list, and make a commitment to yourself to achieve them in the next 30 days.

 MY THREE 30-DAY GOALS ARE:

_________________________________________________________

_________________________________________________________

_________________________________________________________

Next month, choose the next three, and the month after that, tackle the last four items on your list. I invite you to take some action on this today! Really do it for yourself, and enjoy the feeling of accomplishment and momentum you will develop as you move toward the achievement of your dreams. Get fully engaged in living the life you want to live!

I wish you a peaceful and productive 2004. ~ ER

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Getting Unstuck
(March-April 2004)

Problem: "I can't get motivated." Lack of motivation usually results from feeling overwhelmed by a goal before you even get started. You feel like the job's too big, the work's too hard, you just can't see the light at the end of the tunnel. Uncertain how to begin a project which feels impossible, you find irrelevant distractions to occupy your time and never quite manage to get - or stay - on task. This avoidance comes at the expense of your self-esteem, since you probably berate yourself harshly with all sorts of negative messages ("I'm stupid" or "I'm lazy" or "this is all my fault") about your lack of action. 

Solution: Break down that goal into smaller, more manageable pieces. If you become exhausted just thinking about reorganizing your closet (or writing your thesis or losing weight or starting a business or whatever else eludes you), focus on accomplishing one very small, achievable task in support of the goal. If your whole closet is a disaster area, just start by organizing the shoes, and don't look at anything else. 

Make yourself engage in productive activity for
a short time every day - even fifteen minutes
is a good start. You'll be surprised how much
you can get done over a period of several weeks
if you just put a measly fifteen minutes a day
into the effort. 

After a while, you'll probably begin to notice something: the more you work toward the accomplishment of your goal, the more you want to accomplish as you begin to feel some anticipatory pride in the achievement of your task.

Sometimes, people decide to wait until they feel motivated in order to get going with a particular project, when in fact just the opposite strategy is likely to be effective; you typically need to begin a job in order to gain the motivation to take it as far as you can go. There's a simple law of physics at work here: a body at rest tends to stay at rest; a body in motion tends to stay in motion. More than twenty years ago, one of the best therapists I ever had told me, "it's all about momentum, kiddo; just go through the motions, the motives will follow." I didn't believe him at the time (in fact, I'm pretty sure my response was just dripping with hostile adolescent sarcasm), but it turns out he was right. You just need to get started. Just start. Don't worry about how much is left to do or how you'll never get anything accomplished in fifteen minutes a day. That negative self-talk will only serve to keep you stuck exactly where you are right now.

Problem: "I'm afraid, so I'm keeping a secret." Fear is probably the most terrible - and significant -  reason why we avoid doing what we need to do in order to live our best lives. I once knew a woman who noticed a dimple on her breast which hadn't been there before. There was a history of cancer in her family and she was pretty sure what that dimple meant, but she was so afraid of learning she might have cancer that she ignored the warning sign. She didn't tell anyone, just lived alone with her fear. Many months later, when her breast had deteriorated into a giant, open wound, she was in such pain that she couldn't keep her secret any longer, and finally went to the doctor. She had emergency surgery, but by then the cancer had spread to her bones, and she was admitted to Hospice care and died shortly afterward. She was so afraid of dealing with reality that she did nothing. The terrible irony is that she made the thing she feared most - incurable cancer - come true. Avoidance literally killed her.

Solution: Fear breeds in secrecy and silence, and so does avoidance. Your best defense against the terror and loneliness of fear-based avoidance is to talk about it. Tell your life partner, your friend, your therapist, your doctor, your religious leader, your mother, your sister or anyone else whom you trust. Just talking about the thing you most fear seems almost magically to drain power from it. I see this time and time again in the therapy process:

When you make the decision to talk
about something you're deeply afraid of
and have been keeping secret,
the simple act of speaking the truth out loud
to a trusted other defuses the power of the fear
and helps you move from avoidant paralysis
into productive action.

In 1987, Susan Jeffers wrote a phenomenal book called Feel the Fear and Do it Anyway, which has become a well-deserved classic in the self-help genre. If you find that you're allowing fear to keep you stuck in a pattern of avoidance, treat yourself to a copy of this book (available second-hand on Amazon.com for just a couple of dollars), which is brimming with useful strategies for converting fear into action.

Look below for the "Personal Achievement Inventory" tool which is designed to help you stay on track as you move away from avoidance and into productive, goal-oriented activity. Try it for a month, and enjoy the delicious sense of accomplishment you feel as you begin to get "unstuck" from avoidant behavior patterns. You might even want to make a few copies of the form so you can track your progress from month to month. You can do this. Give your own life the gift of time and effort and loving attention, and you'll be amazed what you can achieve. Until next time ~ ER

Personal Achievement Inventory      
Month of ____________________

What were my goals for the last 30 days?
______________________________________________________
______________________________________________________
______________________________________________________

What goals did I achieve in the last 30 days? 
______________________________________________________
______________________________________________________
______________________________________________________

What goals am I avoiding or procrastinating on?
______________________________________________________
______________________________________________________
______________________________________________________

For each goal I am avoiding or procrastinating on, how could I break that job down into smaller,
more manageable pieces?
Goal 1:
______________________________________________________
______________________________________________________
______________________________________________________

Goal 2:
______________________________________________________
______________________________________________________
______________________________________________________

Goal 3:
______________________________________________________
______________________________________________________
______________________________________________________

What positive opportunities (playful, creative, spiritual, occupational, social, relationship, etc.) exist for
me that I am not currently pursuing?
______________________________________________________
______________________________________________________
______________________________________________________

What are my goals for the next 30 days?
______________________________________________________
______________________________________________________
______________________________________________________

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Coping With Change
(May-June 2004)

But how do you keep your balance - and your courage -  when you're thrown hard into one of life's curves? What if your relationship has just ended and you have no idea how to pick up the pieces of your life and move on? What if you've been diagnosed with a serious illness, and can't do the things you always expected yourself to accomplish? What if you or a loved one has been seriously injured or disabled in an accident and, as a result, you need to adjust your dreams and expectations for the future? How do you cope, exactly, when the realities of your life have changed? 

Well, one small step at a time, of course. Here's how.  

Be patient with yourself. Coping with changes - especially really major, life-altering changes - can take a lot of time, and you may feel moody, angry, scared or tearful during the transition phase. It's perfectly normal for you to need some time to grieve your old life and adjust to your new one.

Give yourself top-notch self-care. Are you a regular at your favorite fast-food outlet or pizza joint? This is a good time to pay better attention to your nutritional needs. Also, if you've been accustomed to "getting by" on fewer than 7-8 hours of sleep each night, plan on spending a little more quality time with your pillow. You might also consider treating yourself to a series of appointments with a licensed massage therapist. A worn-down, tired-out body is not in optimal condition to cope during a time of major life adjustment.

>Accept support and help from loved ones. Are you tempted to avoid contact with others and refuse offers of help and support? Resist that temptation. This is a very good time for you to accept both practical assistance and emotional support from those people who are important to you.

Practice gratitude. Regardless of your circumstances, there are always - yes, always - things for which you can be grateful. Start a gratitude journal, and add at least five new things for which you are grateful to your list each day. This activity is all but guaranteed to improve your outlook... and your ability to cope.

Get counseling. Sometimes it can be a relief to talk to someone who listens patiently and can offer both guidance and support as you adjust to your new circumstances. This is especially important if you feel pessimistic about your ability to cope or if you're having suicidal thoughts. If this is your situation, please reach out for help immediately, so you don't get stuck in the quicksand of your own desperation and hopelessness.

Until next time ~ ER

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Do You Have Adult Attention Deficit Disorder?
(May-June 2004)

But what happens when the ADHD/ADD child grows up? Conventional wisdom used to hold that "they grow out of it." In fact, the reality is that for most people, ADHD/ADD is a lifelong challenge, and some adults are recognizing their symptoms and getting treatment for the first time. In addition to attention deficit, many ADHD/ADD adults have low self esteem related to thinking of themselves (or being thought of by others) as unable to get it together, disorganized, bad with details, tardy, not good with authority, impatient, etc. 

For most adults newly identified as ADHD/ADD, therefore, there is great relief and optimism associated with being correctly diagnosed. Relief because so many of the symptoms associated with ADHD/ADD are stigmatizing, and optimism because ADHD/ADD is a condition which is highly treatable with a combination of medication and life skills training. 

If you think you might have Adult ADHD/ADD, take the quiz below and consider talking to your doctor or therapist about your symptoms so you can be more fully assessed. In the meantime, read on for some strategies to help you cope. 

Release the Steam. Vigorous exercise is often a very effective coping strategy for those with ADHD/ADD. Aside from the obvious health benefits, spending out some of your excess energy may help you focus better when it's time to concentrate on detail-oriented work. 

Make Lists. Because thoughts tend to come and go quickly through the ADHD/ADD mind, it's a good idea to get into the habit of jotting down notes or thoughts or items-to-do as they occur to you, before they get forgotten. Consider investing in a PDA and become proficient in writing your notes electronically, so you can avoid having dozens of easy-to-misplace sticky notes scattered around. If you don't want to use an electronic organizer, you might want to keep your lists in a notebook or on a large notepad. One of my friends with Adult ADD has a folder with a legal pad inside which she keeps with her wherever she goes, so she always has a space for important papers or reminders. She has various lists of things to do at home, at her job, and for her personal projects. Experiment with a few systems until you find the one which works best for you, and then stay with the system you've developed. 

Use a Reminder Device. Consider getting a wristwatch or cell phone with an audible or vibrating alarm, so you can set it to go off when you need to leave for a meeting, take dinner out of the oven, or tend to other tasks from which you might get distracted. 

Break Down Large Tasks. If you have Adult ADD, you may tend to procrastinate on multi-step projects which are likely to require concentrated effort over a long period of time. You can make these long-term projects more appealing by breaking them down into smaller, more manageable segments. For example, if you're in a job search, you may want to begin by focusing only on updating your resume. There are lots of other tasks to accomplish before you win that new job, but keep your focus on this one, small, first step. Once you've accomplished that, you can move on to the next task. And, if you find yourself becoming distracted or overwhelmed...

Learn and Practice Relaxation Skills. Strategies such as progressive relaxation, guided imagery, meditation and biofeedback training may be effective in helping you to quiet your mind and focus your thoughts. Ask your therapist to teach you a few of these skills so you can choose the ones which work best for you. 

Consider medication. There are a number of medications available which can help with the most intrusive symptoms of ADHD/ADD. Ask your doctor whether you would be a good candidate for any of these.

Adult ADD Behavioral Checklist

How did you do?
Almost everyone experiences some of these symptoms some of the time.
But if you frequently experience ten or more of the items on this checklist, you should
consider getting evaluated for Adult ADD.

Until next time ~ ER

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Managing Your Anger without Losing Your Cool
(September/October 2004)

One of these days, I'm just going to completely lose it," my forty-something client said. She was coiled up like a spring, breathing fast, and her hands were clenched into fists. "My boss has performance goals which are flat-out impossible to achieve, no matter how many extra hours I spend at the office. My co-workers complain that I have a bad attitude. My spouse complains that we don't get enough time together. My kids complain that I'm cranky all the time. And I feel bad about that, I really do, but most of the time I'm just so stressed out that I want to scream at all of them to go away and leave me alone."

I asked her what she did to manage her anger and she laughed sardonically. "I don't manage it," she said. "I get chest pain, my stomach is in knots. I fantasize about running away: changing my name, leaving everything behind, just disappearing one day and starting over someplace new. I worry that one day I'll just snap.”"

Coming to counseling hadn't been the client's own idea; she was referred by her boss due to her irritability and hostility on the job. Fortunately - and to her surprise - she found that she actually enjoyed her counseling visits. "So what can I do?" she asked. "Is there anything I can do differently, anything I can learn, so I don't walk around so mad all the time?"

The good news for this client (and her boss and her co-workers and her spouse and her kids) is that there are indeed strategies which anyone can learn and use to manage anger more effectively. But certainly, this client isn't alone by responding to stress with irritability, hostility and tension. So what about you? How many of the following stressors leading to anger occur frequently in your own life?

Relationship anxiety

Feeling hurried or rushed

Feeling overworked/job performance anxiety

Feeling depressed and/or fatigued

Feeling abandoned and/or attacked

Feeling out of control

Feeling guilty, ashamed and/or hurt

Coping with significant losses

Experiencing physical pain

Financial worries

Problems with your children

The more life stressors you have, the more likely it is that you feel overwhelmed, and you may find yourself acting out angrily as a result.

Depending on your personality type, you probably use one of the three primary means of coping with and resolving anger, which are: expressing, suppressing, and calming. Let's evaluate them one at a time.

Expressing your anger directly, depending upon how it's done, can be a healthy coping style. Productive expressions of anger include asserting for yourself respectfully and responsibly, without losing verbal or physical control.

Scenario: your neighbor has a new puppy, an unfenced backyard, and a rather lax supervision style, which has resulted in major damage to your prize rose bushes.  An unhealthy expression response, which raises your heart rate, blood pressure and adrenaline levels, might have you snarling epithets at the neighbor and fantasizing revenge against the hapless puppy. A healthier option? Stop, breathe deeply, cool down, and then address the situation directly by pointing out the damage to the neighbor and asking for necessary restitution. Follow up by taking action to protect your rose bushes with a little fence of their own, so the situation doesn't repeat itself a week down the road (because you recognize that, alas, puppies are slow learners but fast runners, and prone to escape even the most responsible human parent from time to time).

Suppressing your anger can be a healthy short-term strategy as long as you are able to appropriately convert or redirect your angry feelings. Suppression which doesn't allow for any conversion or redirection, however, can have damaging physical, emotional and social consequences.

Scenario: your company has downsized, leading to ever-increasing demands on an ever-decreasing labor force. Those of you who are left behind are uncertain about the security of your jobs and resentful of management's escalating expectations. You're already doing the work that three others used to perform, and now your boss hands over yet another time-consuming assignment. An unhealthy suppression response leads you to hold in your anger without converting or redirecting it, resulting in depression (feelings of hopelessness and worthlessness), passive-aggression (finding sneaky ways to get back at those who've wronged you, by procrastination, obstructionism, sarcasm and purposefully inefficient activity), or displacement (you're mad at your boss so you yell at your kid). A healthier option? Spend out your angry energy in physically demanding sports such as racquetball, or invest in a punching bag (to avoid hand injuries, be sure to use gloves). You might also want to practice some practical problem-solving skills: if your job makes you that angry that often, it might be time to consider some new possibilities.

Calming your anger can be a wonderful way of purging negative energy and helping you feel in rock-steady control of yourself, regardless of external stressors. Some popular calming methods include:

Mental Relaxation such as deep breathing, guided visualization or light hypnotic trance-states;

Physical Relaxation such as yoga and progressive relaxation (a technique involving the alternating constriction and loosening of each major muscle group in the body);

Cognitive Restructuring, so that you change the way you think about what's happening. For example, you can learn to adjust your thoughts from "this situation is impossible" to "this is disappointing and difficult, but I have the skills and  the strength to get through it."

Talk to your therapist if you're having trouble managing your anger and want to use these tools to help you cope more productively with the stressors in your life. Remember: it's never too late to learn new skills.

Until next time ~ ER

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Coping When You Lose Your Job
(November/December 2004)

It's news no worker ever wants to hear: your services on the job are no longer needed. Whether the decision is corporate or personal, the impact of job loss can be devastating.

Corporate job loss occurs when your employment is terminated because of business circumstances other than your job performance.  In this situation, your company has downsized, outsourced, re-organized or relocated, or you have been laid off due to the economy. You are dealing with a personal job loss crisis, on the other hand, if you have been fired as a result of office politics, interpersonal conflicts or poor performance. Although personal job loss can be a bigger hit to the ego than corporate job loss, there's really no happy road to involuntary unemployment. For whatever reason it happens, loss of a job can feel like the end of the world.

If you have lost your job, you may be dealing with some immediate and unpleasant consequences, including:

Financial stressors. Most Americans live almost paycheck to paycheck, with heavy debt and little or no savings. If this is your situation and you have lost your job, you may find yourself in danger of bankruptcy or even homelessness.

Loss of Status. Our culture often defines who you are as a person by what you do for a living. Loss of a job, especially one where you enjoyed some professional or financial power, can leave you feeling utterly lost and uncertain how to proceed.

Diminished self-esteem. Especially if your job loss was personal rather than corporate, you may feel embarrassed or inadequate about your status as an unemployed person.

Social isolation. Yoy are likely to lose friends and acquaintances when you no longer work at the same place.

The flashback effect. A major loss such as unexpected unemployment can cause you to reach back into your past and reactivate unfinished business, such as an earlier, similar major loss or crisis. For example, Phil was terminated eight months after landing a high-demand sales job because he didn't meet the performance goals his supervisor had developed for him. He became severely depressed and went to a therapist for help. After a few weeks, he realized that he was reacting both to the loss of his job and to feelings generated when he's flunked out of a top university fifteen years before. He had spent the intervening years with a low-grade but pervasive sense of dread and inadequacy that were amplified into major depression when he lost his job.

So how can you turn a job loss crisis into an opportunity for improvement, change and growth? Here are some suggestions:

Give yourself time. Rushing through your hurt, anger and disappointment, or denying, ignoring or otherwise squashing your feelings will inevitably result in apathy and negativity. Remind yourself that it's okay to feel badly about what's happened.

Accept that others may not fully understand your feelings. Some well-intentioned people might slap you on the back and tell you you're better off without that lousy job and something wonderfully better is right around the corner. Even if it's true, that's a fundamentally disrespectful attitude, because it minimizes your feelings about your current experience.

Explore what meaning your feelings have for you. Perhaps, like Phil, you are greiving not just the current loss, but some earlier, painful experience which this loss echoes.

Keep a journal of your experiences. Make it your intention to learn what there is to learn from this crisis. Use your extra time to be really still and quiet for a while and consider all your options.

Choose new opportunities thoughtfully. Unless your financial situation is dire, try to avoid jumping reactively at the first employment opportunity which presents itself. Be certain that your next job is one you choose with intention, rather than desperation.

Job Loss Recover Exercise

Identify your key strengths, those which would be valuable in any job.

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What do you miss the most about the job you lost?

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What do you miss the least?

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If the job loss was personal rather than corporate, what could you have done differently in order to better secure your job?

What can you do differently next time?

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What do you need most from your support system right now?

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(Tell your support people what's on this list!)

What practical steps can you take today to move on from this loss?

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If you're feeling stuck and unable to move on, what would help to motivate you?

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Do I Have a Problem? Facts About Alcoholism and Alcohol Abuse
(Spring 2005)

Not so long ago, a woman came to my office to talk about her drinking. She wasn't even sure she had a problem, she said, because she didn't have any of the "classic" symptoms of alcoholism.

I asked her what symptoms she meant. "Well, you know," she said, "it's not like I'm a skid-row bum." She explained that she didn't have to drink every morning in order to get going, and she didn't drink every day, and she didn't get the shakes on the days when she didn't drink. She had a good job at a large company and for the most part functioned very well there, although she admitted her performance had been slipping for the past several months. She had a home and a car and some money in the bank. "You hear about people hitting bottom," she said. "But my life isn't like that."

Subsequently she revealed to me that her marriage had ended in the past year, at least in part because she had gotten drunk at a party, flirted with a man she knew casually, and then ended up in a sexual encounter with him. She also acknowledged that she had been physically violent with her husband, striking out at him when she was drunk.

And there were other issues. She ordinarily drank at home, but "a few times" had been out drinking away from home and then had driven her car while under the influence. She hadn't been caught, yet, but understood the seriousness of that behavior.

"I know it sounds pretty bad when I put it all together," she said. "And that's why I'm here. Tell me, bottom line. Do I have a problem?"

For this woman and lots of people, the line between social substance use and substance abuse seems unclear, as does the line between substance abuse and substance dependence. So here are some clarifying definitions:

Alcohol and other drug abuse is usually characterized by:  

Failure to fulfill major work, school, or home responsibilities because of alcohol or other drug use;

Drinking or using in situations that are physically dangerous, such as while driving a car or operating heavy machinery;

Having recurring alcohol or other drug related legal problems, such as being arrested for driving under the influence of alcohol or drugs or for physically hurting someone while drunk or high; and

Continued drinking or using despite having relationship problems that are caused or worsened by the drinking or drug use.

Substance abusers can often (but not always) use the power of personal choice in order to limit or eliminate substance use, because they have typically not developed physical dependence on alcohol or other drugs.

Alcohol and other drug dependence is usually characterized by:

Craving: a strong need, or compulsion, to drink or use;

Loss of control: the inability to limit one's drinking or drug use on any given occasion;

Physical dependence: as evidenced by withdrawal symptoms such as nausea, sweating, shakiness, and anxiety, which occur when alcohol or drug use is stopped after a period of heavy drinking or using; and 

Tolerance: the need to drink greater amounts of alcohol or other drugs in order to get high.

Substance dependent individuals usually can't stop using through personal choice, willpower, or self discipline alone, Unfortunately, overcoming substance dependence has little to do with willpower. Active addicts often find themselves in a grip of an uncontrolled physical need for alcohol or other drugs that overrides their ability to stop drinking or using. The need can be stronger than the need for food or water, stronger than the need to keep the self or loved ones safe, stronger than the need for security or comfort or love or approval or any of the other factors than ordinarily motivate human behavior.

Getting Help

Substance abusing individuals who are ready to change can:

Work with a substance abuse counselor to examine the benefits of stopping an unhealthy pattern of substance abuse; 

Set a drinking or using limit. Some people choose to abstain from alcohol or other drugs. Others prefer to limit the amount they drink or use; 

Examine the situations that trigger unhealthy drinking or using patterns, and develop new ways of handling those situations; and Attend and actively participate in 12 step support meetings.

Substance dependent individuals who are ready to change can: 

Cooperate with a physical examination; 

be completely honest with the health care professional so s/he can screen for any medical complications which have resulted from the substance dependence; 

Get treatment, such as inpatient or outpatient detoxification, inpatient rehabilitation, outpatient day treatment or outpatient substance abuse counseling sessions, as recommended by the physician; 

Follow up with recommendations for medication such as disulfiram (Antabuse) or naltrexone (ReVia), to help prevent a return or relapse to drinking once drinking has stopped; 

Become educated about the nature of substance dependence, including acceptance of the chronic nature of the disease. Even if an alcoholic or addict has been sober for a long time and has regained health, s/he remains susceptible to relapse forever. "Cutting down" on drinking or using doesn't work for the alcoholic/addict; 

total abstinence can be the only goal in order for successful, long-term recovery to occur; 

Attend and actively participate in 12 step support meetings; and Understand that relapses are very common and do not mean that a person has failed at sobriety or cannot recover from addiction. The key to long-term recovery is to never give up trying. 

Until next time — ER  

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