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“It just never works to be in contact with my mother,” said my client as she started our session, wiping away tears. “I don’t want to cut her out of my life completely, but I can’t keep going back to be sniped at again and again.”

This client and I had already strategized ways to talk to mother assertively, addressing the hurtful comments, to no avail. Her mother flatly refused to admit fault or change her behavior.

Our next step was to set strong boundaries of self- protection in specific ways. Here’s a list of ways to do just that. If you have a difficult person in YOUR family, ask yourself:

• Do I want to limit phone calls? Yes/no
  
• If yes, how many per week/month/year? _________per _________________________
• Do I want to limit time of day I answer the phone?  Yes/no
• If so, what are my limits? __________________________________________________
• Do I want to limit the amount of time we talk? Yes/no
• If so, what’s the limit? _____________________________________________________
• Do I want to limit time we spend face to face?  Yes/no
• If so, what’s that going to look like? __________________________________________
• Do I want to remove myself when they are inebriated or otherwise inappropriate? Yes/no
• Do I want to acknowledge birthdays and holidays?  Yes/no
• If so, how?       Card          phone call               visit with others present                 visit alone
• Other ways to protect myself: ______________________________________________________________________________

Let’s discuss your answers in our next session. Together we CAN find ways to protect YOU.

Always begin with a visit to your doctor or health care provider to ensure that there is not an underlying medical cause to your symptoms. Don’t self-diagnose.

Panic attack symptoms include:

• Shortness of breath
• Tightness in the chest
• Rapid heartbeat
• Inability to relax
  • NOTE: since these can be symptoms of other medical emergencies, DON’T self-diagnose. Seek emergency medical care if this is the first time you’ve experienced this

What Can I Do To Cope?

• RATE the panic on a scale of 1 to 10, 1 meaning not bad at all, up to 10 meaning, call an ambulance! Anything we can MEASURE we can start to control.
• ACCEPT, don’t fight. Fighting increases the bodily symptoms.
• ASK yourself: what’s the worst that could happen here? How would I handle it?
• BREATHE normally and naturally. Pay attention to your breath.
• FOCUS on an object in the room. See it, describe it to yourself. This helps orient you in the present moment reality.
• TIME the attack (measuring again). Note how little time it actually lasts.
• NOTICE if the attacks are happening in a certain location or at a certain time (“cued” attacks.) When it passes, get out a piece of paper and write about that place or time. BE A SCIENTIST about your panic—objective, measuring, curious.
• TAKE your writings to your counselor to further explore the causes of the panic.
• REMEMBER that overcoming panic is not a matter of willpower. It is a malfunction of brain chemistry which can be helped by cognitive-behavioral therapy and/or medication. Medication takes away the SYMPTOM but not the CAUSE. Therapy helps get to the root of the problem.

Remember that a panic attack won’t hurt your physically. Although it’s very uncomfortable, your body will continue to breathe and function through it. Relaxing even a small amount and observing what’s happening will give you a much-needed distance and perspective.

1. Push for quick involvement: comes on very strong, pressures for an exclusive commitment almost immediately

2. Jealousy: Excessively possessive: calls constantly, visits unexpectedly; prevents you from going to work because “you might meet someone:” checks your mileage

3. Controlling: Interrogates you intensely, especially if you’re late, about whom you talked to and where you were. Keeps all the money; insists you ask permission to go anywhere or do anything.

4. Unrealistic expectations: Expects you to be the perfect woman and meet his every need.

5. Isolation: Tries to cut you off from family and friends; accuses your supporters of “causing trouble;” deprives you of a phone or car.

6. Blames others: for his problems and mistakes: The boss, you—it’s always someone else’s’ fault.

7. Makes everyone else responsible for his feelings: says, you make me angry” instead of “I AM angry,” or, “you’re hurting me by not doing what I tell you.

8. Hypersensitivity: Easily insulted, claiming his feelings are hurt when he is really mad; rants about things that are just part of life.

9. Cruel to animals or children: kills or punishes animals brutally; expects children to do things that are beyond their ability, i.e. whips a two year old for wetting a diaper; teases children until they cry. SIXTY FIVE PERCENT OF ABUSERS WHO HIT THEIR PARTNER WILL ALSO HIT CHILDREN.

10. “Playful” use of force during sex: enjoys throwing you down, holding you down against your will; says he finds the idea of rape exciting.

11. Verbal abuse: constant criticism, says cruel or hurtful things; degrades, curses you, calls you ugly names. This may also involve sleep deprivation, waking you with relentless verbal abuse.

12. Rigid gender roles: expects you to serve, obey and remain at home.

13. Sudden mood swings: switches from sweetly loving to explosive in a matter of minutes.

14. Past battering: admits hitting women in the past, but says they made him do it or the situation was to blame.

15. Threats of violence: makes statements like “I’ll break your neck” or “I’ll kill you,” then dismisses it with “everybody talks that way, you’re too sensitive” or “I didn’t mean it.”

IF IT HAS COME THIS FAR, GET HELP OR GET OUT.

From the Project for Victims of Family Violence, Lafayette, ARK

If you’ve never talked to a counselor, social worker, or psychologist—and you should ONLY put your life in the hands of a licensed professional– it may seem like a mysterious process. What actually happens in there? Why can’t I just talk to my buddy instead?

Let’s take those questions one at a time.

Should I go to therapy?

If you think you might need to, that’s a good indicator that you should give it a try. There’s no commitment made in the first session; it’s a time to tell your story, get some feedback and a sense of your therapist’s personality, ask questions about how they work, then go home and make your decision.

There’s a saying that those who don’t study history are condemned to repeat it. Therapy is a place to recount your history and hear about new ideas: new ways to think about your life, new responses to replace your old ones that aren’t working. I am extensively educated to help you with that.

What actually happens in there?

There will be paperwork, of course, including a written explanation of the privacy laws that govern licensed therapists. For example, you can tell me anything and keep it private, with these exceptions:

If you use insurance, your company has the right to your chart.

If you say you’re going to hurt yourself or someone else, I have to contact authorities.

If you say a child or elder has been or is being abused, I have to report this information as well.

I will take a history of the important events in your life, hear about your current challenges, and possibly have you fill out some tests to get a better diagnosis of your problem. In future sessions, I will give you a Plan of Care that outlines our work together.

Why can’t I just talk to my buddy instead?

Friends are not unbiased, trained, objective, or equipped to help challenge and change your thinking. Talking to a friend without professional feedback just keeps the problem going in circles. We are governed by strict codes so that we can’t be your friend, business associate, or anything else that would complicate your care.

If you would like to explore therapy with me, I welcome your questions! Call today for an appointment.

“What is it?”

Although the specific diagnosis is complicated, these symptoms may indicate signs of Seasonal Affective Disorder: craving for carbohydrates, excessive sleeping, lack of energy, weight gain, and all of the symptoms of depression that go along with it: excessive guilt, irritability and others.

“Who’s at risk?”

People who live at higher latitudes have a higher risk, as do people already diagnosed with Bipolar II disorder. Younger people are more at risk than older ones. Regardless of these factors, anyone can suffer with symptoms of Seasonal Affective Disorder. ONLY A LICENSED HEALTH PROFESSIONAL can make this diagnosis!

“What makes it worse?”

Having the short days of winter upon us right after the overspending, overeating, and family time of the holidays can contribute to the exhaustion we feel. Less daytime light to feed our vitamin D needs is also a factor, as is less stimulation of the glands that provide serotonin production. Making New Years’ Resolutions can make you feel ineffective and hopeless if you are depressed; postpone until spring.

“What makes it better?”

Getting outside, even 20 minutes a day, without sunglasses. This exposes you to unfiltered light.

Leaving lights on inside the house, and drapes open to outside light.

Light boxes (available online) specifically designed for Seasonal Affective Disorder.

Therapy to offer support and new ways of viewing your world, and to prevent worsening of depression.

Exercise, exercise, exercise: again, 20 minutes a day helps. Exercise can be a ‘magic bullet’ for depression and anxiety relief! If it’s bad weather, walk at a mall or a gym.

“How can a therapist help me?”

A therapist can hold you accountable for putting these helps into place in your life, as well as help you examine how you think when depressed and challenge that faulty thinking. There’s no need to go at life alone, and untreated depression is indeed dangerous. There IS help!

When the Holidays Aren’t So Merry—Making it Through the Season

“What’s wrong with me?” my patient (fictional) asked, shredding the tissue in her hands as she wept on my couch. “Shouldn’t this be a happy time of year? Why can’t I feel Christmassy and jolly?”

And she is not alone. When you think of all of the people who are grieving and/or going through their first holiday season after divorce, widowhood, or the loss of a loved one, you realize that the memories can make the holidays more painful than happy at this time of year. Add to that the additional stress the season brings in the form of activities, shopping, and school events—well, you can see the problem. It’s like adding that last too-much drop of water to an already overflowing bucket.

What to do? If you are experiencing loss this time of year, your goal is this: to make it through. This is not the time to fill your chore list with handmade gifts (or gifts at all—who’s going to blame you this year?) or high stress dinners. If ever there was a time in your life to put you (and your children, if any) first, this is it. Exercise your “say-no” muscle with a firm and assertive smile and pass on committees, obligations, and entertaining. The people who might judge you—and believe me, there are fewer than you imagine—are simply not worth a second thought.

When the memories and tears come, allow them. What we resist, grows stronger, so don’t fight the feelings that arise. Tears actually expel cortisol, a stress hormone that is damaging to the body and needs to come out in order for you to be healthy.

Ask your friends and family for what you need this year, specifically. Do you need help making decisions on the children’s Christmas list? You probably have at least one friend who would love to help you. Do you need people to just listen to your grief without advising you? Tell them that you really just need an ear, not a response, from them.

These are just a few ideas; you know best what helps you stay strong. Just remember that you WILL make it through. Rest, heal, and wait for better days.

By: Elizabeth Scott, MS

Holiday perfectionism is one of the main causes of holiday stress. We want things to be perfect for our loved ones and for ourselves. They (and we) deserve the best, right? We have the best of intentions. But whether it’s due to the impossible standards of holiday bliss sold to us by various marketing campaigns, to the exaggerated memories of holiday greatness that we’re trying to match (or outdo) from our own childhoods, or simply our regular-life perfectionism carried over and applied to the holidays, holiday perfectionism is all too common.

Signs of Holiday Perfectionism

Perfectionists often think they’re merely high achievers, but there are some key differences. With holiday perfectionism, the differences to look for involve happiness and satisfaction. Holiday high-achieving can mean being busy with holiday activities that will create lasting memories. So can holiday perfectionism. But with holiday high-achieving, if everything doesn’t get done, it’s okay—the focus stays on all of the fun activities that were enjoyed. Not so with holiday perfectionism—for the holiday perfectionist, if everything doesn’t get done (and done perfectly!) it’s a stressful, disappointing experience. Also, holiday high-achievers tend to cut corners here and there in order to get everything done. Holiday perfectionism, however, involves going all-out in every area of holiday activity. Holiday perfectionism involves high demands and little enjoyment.

Examples of Holiday Perfectionism

You might be dealing with holiday perfectionism if:

• Every gift must be hand-made—and you’re not even enjoying the process!
• The holiday card is two pages, single-spaced, and includes every detail of your year—along with a hand-written note for each person on your 100-address list. (And each address is hand-written on the envelope!)
• You spend an entire day on the holiday meal, and can’t enjoy it because you worry that your recipes aren’t elaborate enough.
• You’re procrastinating on major activities because you want to do an amazing job, but don’t have the time to give an activity the attention you feel it deserves. The activity goes undone, and you beat yourself up over it.
• The kids look exhausted and stressed early in December because it’s all just too much!
• You’re doing many, many things to celebrate the holidays, and aren’t enjoying most of them because you feel that your efforts aren’t good enough.

Consequences of Holiday Perfectionism

The main consequence of holiday perfectionism is holiday stress. That stress can be felt by you and everyone around you. Instead of enjoying the holiday season as a time of sharing and celebrating, holiday perfectionism causes people to feel inferior, overwhelmed, and unhappy. And these feelings can be felt by those around them. Basically, holiday perfectionism robs people of the very joy and satisfaction that they’re seeking to achieve in the first place. But it doesn’t need to be that way.

Solutions to Holiday Perfectionism

• Become Aware of Holiday Perfectionism—Now that you know the signs of holiday perfectionism, examine your thinking and behavior patterns a little more closely and notice whether or not you’re a holiday perfectionist. Just being aware can be a significant help.
• Re-Examine Your Thoughts—Practice a little cognitive restructuring by paying attention to what you tell yourself as you take on an attitude of perfectionism, and challenge those thoughts. Are you afraid that the holidays won’t be fun for your family if you don’t make everything perfect in one specific way or another? Think instead about how your mood (overwhelmed or happy) might affect their happiness.
• Practice Imperfection—Purposely challenge yourself to do things somewhat imperfectly. Take shortcuts, do things mostly-well. See how it feels, and practice coping in small increments. This will allow you to feel more in control of your situation without having to make it perfect, and can alleviate some of your holiday perfectionist anxiety.
• Find Support If You Need It—If you find yourself experiencing stress or anxiety due to holiday perfectionism, you might want to talk to a good friend about it. If you’re experiencing stress and anxiety levels that feel unmanageable, you might want to talk to a professional—there’s a lot that can be done to help.

Bottom line—holiday perfectionism can ruin the joy of the season for you and your loved ones. You can free yourself from the stress that comes from it, and simply enjoy the holidays.

Following Your Plan of Care

Many times, patients quit their treatment prematurely because the immediate crisis is over. This is equivalent to quitting a two week antibiotic prescription after the second day’s dose; the SYMPTOMS are eased, but what about the root cause? It will surely return later because it hasn’t been thoroughly addressed. Momentum toward recovery will be lost as well.

Depression, anxiety, relationship issues, panic attacks, teen and children’s behavior issues, anger management, divorce recovery—these all take time to change, to heal. You didn’t GET this way in a month or two, and it will take longer than that to heal completely. Often, we’ve carried problems of poor self- esteem, drug or alcohol addiction, and other counseling issues for most of our lives.

Periodic check ins, where we go over your progress and look again at your goals in the Plan of Care, help us understand where we have been together in therapy, what we have accomplished, and what still needs to be addressed. This is also a great time for you to “dream” and set new goals for a better life! When these goals have been met and all issues addressed, you are ready to go on to “maintenance care,” where you come in to see me every few months or so for checkups. These checkup visits can go a long way toward maintaining the growth and rational thinking you worked so hard to achieve in our sessions.

When I give you a Plan of Care, I’ve carefully considered your issues, your hopes and dreams, and your goals, using all of my education and experience to help you toward as happy a life as possible. It can be painful to go deeper at first, but the rewards you can experience can be very gratifying and life changing!

How we see it is how it will be.” (Anonymous)

We most often suffer more from what we FEAR than what actually HAPPENS, so it’s important for you to learn how to evaluate what you are thinking. Things always look less fearful when we face them head on vs. running or distracting ourselves into TV, alcohol, food, or work.

Spend some time in your journal with your anxious thoughts, asking yourself these questions:*

1. What is the situation that I’m stressed or worried about?
2. What am I THINKING or IMAGINING?
3. How much do I believe that thought? A little? A lot? Or give a percentage
4. How does that thought MAKE ME FEEL? (assign a feeling)
5. How STRONG is that feeling? A little? A lot? Or give a percentage
6. What makes me think the thought is true?
7. What makes me think the thought is NOT true or not COMPLETELY true?
8. What’s another way to look at this situation?
9. What’s the worst that could happen?
10. Could I still live through that?
11. What’s the BEST that could happen?
12. What will PROBABLY happen?
13. What WILL happen if I keep telling myself the same thought?
14. What COULD happen if I changed or challenged my thinking?
15. What would I tell my friend _________________ if this happened to him/her?
16. What should I do now?
17. How much do I believe that negative thought now? A little? A lot? Or give a percentage
18. How strong is my negative FEELING now? A little? A lot? Or give a percentage.

Remember: you are not alone! I am here for you to evaluate and explore these fears and help you learn new ways of thinking and seeing your life.

 

*from the work of J.S. Beck

“The depression symptoms are just so bad again,” my patient (fictional) sighed as she settled in on my couch after a six month absence. “I’m having the guilt feelings, sadness, no energy, trouble sleeping, and I’m gaining weight because of stress eating. I know you scheduled me to come in once a month for a while after we finished the Plan of Care, but I thought I was cured and didn’t need to. Can we get me back on track?”

As I listened sympathetically to her complaints, I couldn’t help but think how her pain could’ve been avoided with a simple monthly check-in session. Issues such as depression, anxiety, panic attacks, relationship changes, and poor self-esteem don’t develop overnight, and don’t permanently go away that quickly either. But once change has been achieved in counseling, the progress can be maintained with follow up care. Left without this support, issues can return-and often do.

Think about it for a moment. There is no other doctor or dentist that we see once in our lives, and never again, yet we think one round of therapy can permanently keep us mentally healthy? Problems and challenges arise throughout life, just like illnesses and cavities do, to use the medical support mentioned above as an example. Having the skilled insight and support of a therapist to manage these challenges can be the difference between a prolonged struggle or a successful and quick resolution.

I encourage you to use me as a resource throughout your life, much as you do your other healthcare providers. Why struggle alone? I am here for you through your darkest times or just times that the stress feels overwhelming. Let’s maintain the progress and keep you on track!