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“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!

You Won’t Change, So I Must Be Doing Something Wrong:

A Quick Look at Codependency

Codependency is excessive emotional or psychological reliance on a partner, typically a partner who requires support due to an illness or addiction.

Being in relationship with an alcoholic, addict, or otherwise out of control person often causes behavior traits to emerge that cause great misery for the “helper.” I often see this person in my office, who comes in wanting to know how to change their loved one. Unfortunately, we cannot change another adult, and efforts to do so usually make the addict resist control by going deeper into their addiction.

The Mistaken Beliefs of Codependents:

“If I AM: good enough/nice enough/skinny enough/vigilant enough/accommodating enough/loud enough/upset enough…

“If I say it enough times in enough different ways…

“If I give enough money/withhold enough money, give sex/withhold sex, pout, criticize, get you out of bed in the mornings, do all the irrational things you demand…

THEN YOU WILL BECOME THE PERSON I WANT YOU TO BE.

You will do what I think you need to do to fix your life, our relationship.

You won’t drink/cheat/use drugs/yell/hit/get mad at me.

You will appreciate me.

If I do all of the above and you STILL DON’T become the person I want you to be, then I FEEL LIKE A FAILURE. I FEEL GUILTY.

I keep doing these things because I believe it will make you/others/God pleased with me. You/others/God will admire me for my sacrifice. This is what makes me worthy.

I know exactly what YOU think, feel, and need, and why. I can analyze you endlessly.

I have no idea what I think, feel, or need, or why. And I am uncomfortable when my counselor asks me to be still, listen to myself, journal, dig deeper, try new things that might make me happy, set a boundary with you.

I would much rather figure out what’s wrong with YOU than look at ME.

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.

“Why is getting along with my mother so hard?” said my client, sighing deeply as she wiped away tears in session. “I feel anxious all of the time, I’m depressed, and I can’t even hear her sigh of disapproval on the phone without wanting to run and hide. What am I doing wrong?”

The tendency to feel like everything is your fault, and that YOU are in fact the one “doing something wrong”, is typical of the child of a narcissistic parent. Karyl McBride, PhD* also notes the following symptoms:

1. feeling “not good enough”
2. valued by your parent for what you DO, not who you are
3. feeling unlovable
4. constantly trying to win your parent’s approval
5. your parent emphasizes how your behavior LOOKS, or makes them look, over how you FEEL
6. your parent is jealous of you
7. your parent doesn’t support your healthy expressions of self, especially when it conflicts with their own needs or threatens them
8. In your family, it’s always about pleasing that one parent
9. your parent can’t empathize with you
10. your parent is critical and judgmental

There is typically a family “scapegoat,” a person on whom the family blames the problems. “If only Jane wouldn’t cross Mother…if only she would call her more often…THEN Mother wouldn’t get so upset.”

The truth of the matter is, a parent who is narcissistic is always going to be looking for ways that the “scapegoat” lets them down. This parent’s attitude is not, “what have you done for me,” but instead “what have you done for me TODAY?” It truly is never enough to get the “scapegoated” child off the hook.

Freedom comes when, with the guidance and encouragement of your therapist, you begin to gently challenge these things in the family and express your own needs.

*Will I Ever Be Good Enough? Healing the Daughters of Narcissistic Mothers

“I just can’t do ANYTHING right,” my client sighed as she settled further into the couch. ‘I should just accept that I am fat, depressed and a failure at relationships. Nothing will help me.”

And as long as she chooses to continue talking to, and about, herself that way, she WILL be overweight, depressed and alone, and most importantly, unable to change, regardless of her therapist’s skills. For the fact is that every cell in our body responds to what we think and say about ourselves.

Although most of us are familiar with the “love our neighbors as ourselves” directive, we miss the meaning of the last part. Most of us wouldn’t dream of calling our neighbor names or criticizing them point-blank to their faces, yet we look in the mirror and do it to ourselves every day. We feel compassion for our friend’s struggles with food, relationships or other issues, yet we are merciless and impatient with our own. Self love is a vital key to health, and self condemnation the thing that most often keeps us from our goals. For instance, if you are having trouble ending an unhealthy relationship, AND you “beat yourself up” for your “weakness,” we now have THREE issues to overcome—the relationship, the self loathing, AND the damage done to your self image by the insult! Self love, forgiveness for our mistakes, and patience with our failures leads to the strength and discipline necessary to move forward into a healthy, balanced life.

To become your own encourager and best friend requires a deep examination of who taught you to be self-critical in the first place. Where did the “I’m not OK” message come from? It is most often from one of two sources—either what was said about you by your parent, or what a parent said about themselves in front of you. If you heard negativity modeled in your growing up years, the pattern was set for you to live that way as well. Children really do learn what they live. But like any learned behavior, this thinking pattern can be changed; sometimes by yourself, and sometimes with the help of a counselor if the pattern is persistent or severe.

To remain vital and healthy in your thinking throughout your lifetime, practice catching yourself when you are saying or thinking self-critical things. Immediately visualize a big red STOP sign to interrupt the pattern. Replace the self-criticism with a positive, encouraging thought, such as “I’m proud of myself for trying to change.”

 If you focus on what you DON”T like about yourself, you will get more of it, but focusing on the successes in your life will lead to more success. Congratulate yourself on victories, whether it’s a ten minute walk when you really just wanted to watch television, or keeping your temper in traffic.

All of us respond to love and encouragement, including when we give it to ourselves. Give yourself the gift of acceptance!

1. Protect the children. Children have a deep psychological need to think well of BOTH parents. Avoid letting them hear you put down or say bad things about the other parent, regardless of how justified you feel in saying these things.

2. Depend on the experts. Well- meaning friends and family will give you legal and psychological advice; that’s not a good source. Thank them for their concern and move on.

3. Avoid other drastic life changes. Make your life as stable as possible right now. Try to keep sleeping and eating on a schedule. See your doctor and/or counselor immediately if these are disrupted for more than a week or so-depression and anxiety may take hold if basic needs are ignored.                                    

4. Take a Divorce Parenting class as soon as possible. When I taught this class, the comment I heard most often was, “why didn’t someone tell me to take this sooner?” You will find help and support there. Ask your attorney for more information.                   

5.  Maintain professionalism at work. It is natural for your focus to be disrupted, but strictly limit the amount of time you spend on email or conversation about your divorce.

6. Lay it down sometimes. Take a break and play with your kids. Go see a funny movie. Let your mind rest. If the worries persist, promise yourself you will go back to worrying about the issues later that day, then return to the fun.

7.  Limit contact with your ex-spouse. You are not obligated to endure any conversations that your attorney does not require of you. Make your contact brief and limited only to necessary details of custody issues.

8. Observe your breathing. Under stress, our breathing often becomes shallow. This leads our muscles to tense up and puts the whole body on constant alert. Put a sticker or an object around your workplace and use it as a reminder to breathe deeply.

9.  Stand up for yourself.  It’s time to say “I need, I feel” or “no, I can’t do that.” Maybe this is new behavior for you.  A counselor who has been specifically trained in divorce (not marital) counseling can teach you how to detach and communicate in a civil manner that protects the dignity and rights of both parties.

10. Finally, remember: this WILL pass. You are currently experiencing one of the hardest life experiences there is. Keep your focus firmly on the hope of a peaceful outcome and take care of yourself in the meantime.

Even if your hands are shaking

And your faith is broken

Even if your eyes are closing

Say it with your heart wide open

Say what you need to say.

 (John Mayer)

“Finding your voice” is a wonderful benefit of therapy, as you learn here that you have both a RIGHT to ask for what you want and the WAY to state your needs respectfully.

Some basic tips when you are “saying what you need to say:”

1. Use “I Need” instead of “you should.”

 It is not OK for you to tell other people how to live their lives. “Saying what you need to say” is NOT a license to judge, criticize or otherwise counsel others!

 It IS OK to require them to treat you with respect, but you must first ask respectfully. This means not yelling your message at them. Not using sarcasm or anger. It means speaking up firmly and courteously about what you will or will not tolerate.

2. Speak honestly, clearly and directly—don’t hint, manipulate or guilt-trip others.

We get in trouble when we expect others to “just know” or read our minds. This is a common pitfall when dealing with the opposite sex. Women, most guys don’t get all the hints and signals that your girlfriends do. It’s not a sign of any lack of love. “Say what you need to say” without playing games

       3.  After you say what you need to say, take responsibility for what comes next.

You have choices here. Maybe you’ll get what you’ve asked for, maybe you won’t. The next step is to decide what is required in order for you to stay in the relationship or on the job. Do you need to require marital counseling? Do you need a different job where you are respected? Do you need a time apart? Do you need to hire help to get things accomplished which are being neglected?
 

Then, do what you need to do.

Say what you need to say.

And let me know if I can help in that process.

It contributes to illness. It’s the major factor in back pain. In fact, it makes ANY pain worse. And it’s not always caused by bad things-it can be related to celebrations, new jobs, holidays, new babies, and many other things we would never wish away.

Yes, I’m talking about stress, or as defined by Webster’s, “a strain or pressure on the body or mind.” It’s almost always presented as a reason people finally get professional help for life issues, and I diagnose and treat it daily.

The body and mind perceive any change as potential danger, and they react with heightened awareness, muscle tension, and increased cortisol production (cortisol is that nasty hormone that can increase blood pressure and blood sugar, and suppress immune response). It is essential to our overall health to learn to reduce stress responses in our body and mind. The following are some ways to do so:

Breathing

Under constant stress, our breathing becomes shallow and strained. A simple exercise is to sit back in your chair for a minute or two, close your eyes, and just focus on your breath. Breathe in deeply through your nose to the count of four, using the ticking of a clock if you have one. Hold your breath for four counts, and then SLOWLY let the air out for six beats. This deliberate focus and attention will both calm and distract your mind temporarily.

Guided Imagery

This is an article all by itself, but basically guided imagery involves taking time to mentally “visit” your favorite relaxing memory-be it the beach, the woods, whatever brings a smile to your face- and mentally placing yourself there using all five senses. This also works with visualizing a beloved child’s face or your pet. A few minutes of visualization a day can actually increase immune response and is simple to do.

Tense/Relax (Progressive Muscle Relaxation)

Starting at the top of your head, tense and relax the muscles of your face, neck, hands, shoulders, etc, all the way to your toes. Hold the tension to a count of four, and then let it go, moving on to the next muscle group. This puts a focus on muscles that may have been tight without your awareness.

Journaling

The benefit of scribbling down thoughts and feelings is well researched. You don’t need to watch spelling, grammar or anything else, as no one will see it. You don’t even have to “keep” a journal-just the act of writing in it self is beneficial, even if you shred it immediately after! Try completing these sentences to start:

It really bugged me today when….

If I could wave a magic wand I would change…

Then just keep writing without thought or censure.

Doing Nothing

A totally foreign concept to our goal oriented society, isn’t it? But sitting completely still in silence for a few minutes a day is a wonderful way to de-stress. As we let the mind daydream, rest and wander, we often find new solutions to our stressors. This concept is summarized by the beautiful quote: “Sitting quietly, doing nothing, spring comes, and the grass grows by itself” (Zen saying).

If these simple measures don’t ease your stress symptoms, the next step is to seek help from a licensed therapist who can help you resolve underlying issues contributing to the problem. Best of all, these simple steps to de-stress can’t hurt!

Depression wreaks havoc on the entire body by throwing the stress response system out of whack. The risk of heart disease, osteoporosis, diabetes and cancer are all raised as normal immune function is disturbed by anxiety, stress and /or depression. Difficult relationships, parenting and work issues all contribute to this situation.

This post contains my  “prescription” for becoming (and staying) healthy. Basically, here’s what we should all be doing for a healthy, happy lifestyle:

• Get a yearly physical exam.  Depression and anxiety can be related to thyroid and other issues
• Exercise: it relieves stress, raises endorphin levels. It’s even better if you get outside in natural light to exercise!
• Journaling: research shows it increases hopefulness,releases stress, and calms the brain.
• Regular Sleep: essential to mood stability and a healthy immune system.
• A good social or family support system increases longevity and raises immune system function
• Professional Therapy: coming for a session BEFORE symptoms are out of hand with regular checkups

Now maybe you are thinking, well, if I could MAKE myself do all of these things, I’d be fine! What you may not realize is that a mental health provider is trained, licensed and qualified to be a resource to help you do these things. A therapist can be your encourager, your supporter, and your guide in prioritizing and planning your best, healthiest life.

Therapy helps uncover the roadblocks to your success that exist outside of your awareness. These roadblocks include childhood messages, both told to you and modeled by your parents, and negative experiences that impact your habits to this day. Together we can gently uncover and examine these self-defeating beliefs without shame or judgment. When “the truth sets you free,” you are then able to move forward and possibly see new levels of well being.

SURVIVAL:

Virtually all counseling clients start at this level. You are in crisis, at a low point, depressed or anxious. My focus here is an immediate and practical prescription for helping you regain hope and basic functioning. This most often includes health issues such as exercise and rest, as well as releasing pain out of the body by relaxation and journaling.

RECOVERY:

At this stage you move on to the relationships around you as a focus for change. You are ready to see how you help create the painful patterns in your own life, and you go out into the world as a scientist, observing your patterns with others. You begin to see how you contribute to your own problems by the thinking habits you’ve formed.

PROGRESS:

Too many clients leave therapy at this stage. The pain is eased—why go deeper? The problem with stopping here is that the fundamental issues and reactions have not been changed yet. It’s like stopping an antibiotic on the second day because you feel better—the basic “infection” has not been eradicated, and will resurface in time.

PLEASURE:

A client who “stays the course” to this stage begins to reap the deeply satisfying rewards of enjoyment and contentment in life. Persistent body aches, migraines, rashes and recurring illnesses often ease or disappear entirely as the client ceases to be at war within and therefore has the energy to heal.

AWARENESS:

Once the bothersome thinking patterns are uncovered and corrected, the client has found peace in their personal boundaries and dealings with others. The “coaching” side of my work now begins. I help the client explore what they want their legacy to be in life, how to live with integrity regardless of circumstance, and dream for the future by exploring goals.