Windows of Opportunity Counseling Services

Relationship Tips by Rich Nicastro

2012-01-03T10:07:00.000-08:00

Taken from: http://www.strengthenyourrelationship.com/
with permission and by Dr. Nicastro who pulled together all the expert advise.

1. Couples need to set up a clear boundary around their relationship—this boundary involves saying “no” to the influences that can undermine your relationship.

2. Healthy marriages/relationships require balance between having shared couple-experiences that will feed the relationship while at the same time nurturing their individual interests and pursuits.

3. Without a clear expression of commitment to the relationship, trust and emotional security will suffer. A strong relationship foundation is built on mutual commitment.

4. Direct, clear communication should always be a top priority.

5. Being attuned to your needs, wants and desires is the first step in getting them met—when you’re unclear about your own needs, how can your spouse/partner ever meet them?

6. Not everything needs to be discussed, analyzed and “processed” between partners. Letting go, giving your partner the benefit of the doubt, and practicing forgiveness will go a long way in creating a fulfilling relationship.

7. Words have the power to build empathic bridges between partners, and words also have the power to hurt and create a wasteland of distance between you. Choose your words wisely.

8. Important issues that are repeatedly ignored, minimized or go underground will resurface with a vengeance. A healthy relationship requires facing uncomfortable issues from time to time.

9. Like a wildfire, emotional wounding and defensiveness can spiral out of control and quickly consume a relationship. Couples need to be mindful of the negative cycles that arise in their relationship.

10. Deliberately creating positive experiences and interactions between the two of you (while facing the uncomfortable issues that need to be addressed) should be an ongoing priority.

11. Emotional intimacy and closeness are built upon both partners being consistent, emotionally available and responsive to one another.

12. Expecting to get all (or even most) of your needs met whenever you want is like expecting the weather to change based upon your whims and preferences. Unrealistic expectations lead to unhappy marriages/relationships.

13. For some, emotional closeness is a prerequisite for sexual intimacy; for others, sexual intimacy leads to emotional intimacy.

14. Passion and fulfilling sex often needs to be talked about, planned and negotiated (a lack of sexual spontaneity isn’t necessarily a sign of marital/relationship problems).

15. What makes you feel loved and emotionally connected may be very different from what makes your partner feel loved and emotionally close. Communicating and understanding these differences can go a long way in improving your relationship.

16. Certain differences between your and your partner’s communication styles and emotional expressiveness need to be accepted. You can’t make an introvert outgoing, and likewise, don’t expect an extrovert to happily sit home every evening.

17. Friendships are built on joint activities and common interests. In addition to being lovers, couples need to learn to be friends.

18. Couples who actively practice gratitude and appreciation feel a deep sense of connection with one another. It’s too easy to simply focus on what bothers you about your mate while ignoring why you fell in love with him/her in the first place.

19. While a relationship obviously takes two committed people, one person can make a difference in improving the overall quality of the relationship.

20. Fulfilling, healthy relationships are co-created, not found. Couples who work together (at keeping their relationship strong) are more likely to stay together.

While it can be easy to feel overwhelmed by the information presented in this article, remember that you can pick one or two items from the above list and began implementing them into your relationship right away. As a marriage/couples counselor, I’ve seen couples make big differences in their relationship with a simple and relatively small change—the goal is to be consistent and persistent with whatever positive change you’re trying to make.

Meditation and Mindfulness: Day 30 and Beyond

2011-12-04T12:08:00.000-08:00

“Nothing can be more important than being able to choose the way we think.”

EKNATH EASWARAN

(1910–1999)

I am glad I switched my mediation mantra to something in English. If you want to get something out of it, I guess it makes sense to reflect on something in your own language. Who knew? Anyhow, what I have found just in the few days I have been focusing on the St. Francis invocation is that when I am out and about in the crowded public and get frustrated with people as I sometimes do, the words to the quote I am mediating on come up and help me put things in perspective and remind me of my renewed chosen purpose.

For example, my greatest challenge these days is right before my once-a-week 8:15 pm yoga class begins. I get there early so I can stretch a bit and then just be at peace. The class is crowded and often there are many new people there. It is the end of the day. I am a bit tired and less patient than usual.

Consequently, I struggle to keep my sense of internal peace. In this late and often overcrowded class, many seem to disregard all the nicely designed posters which state the studio's practice rules: 1) Silence in the Yoga Room (never happens), 2) Turn Off Cell Phones in the Yoga Room (never happens; instead, we get texting, checking email, and phones ringing right up until class begins and sometimes even after it begins), and 3) Please Make Sure Your Bags Are Not in the Yoga Room But in the Locker Rooms (never happens; the back of the room looks like a teenager's messy closet). The teachers periodically remind us of the rules. No one listens. Hence, I (at least in my mind) become a "Yoga Nazi." I grumble. I complain. I sigh. Not a good way to start out the class.

What I found last Thursday night before class is that when internal grumblings and rumblings started up within my mind, rather than letting them go on and on and allowing myself to get frustrated, I was able to acknowledge and notice my emotion, and then my mind immediately brought up a phase from the passage I had been meditating upon earlier in the day: "May I be an instrument of peace. May I not so much seek to be understood as to understand." This permitted me to step back and take a different and more compassionate perspective not only on others in the class but with myself as well. I could then decide how I wanted to think about the situation and respond. It was nice. I felt calmer and more in control. I definitely plan on making meditation a regular part of my life. I can see it bringing more goodness and vitality into my life and relationships. I highly recommend it to all.

For more on self awareness see: 7 Steps to Develop Awareness.

Mindfulness and Meditation: A 30 Day Challenge/ 25-28

2011-11-28T13:34:00.000-08:00

“The secret of meditation is simple: you become what you meditate on. When you use an inspirational passage every day in meditation, you are driving the words deep into your consciousness. Eventually they become an integral part of your personality, which means they will find constant expression in what you do, what you say, and what you think.”
– Eknath Easwaran

"Whatever is true, whatever is right, whatever is bound to be excellent, let your mind dwell on these things."

- The Bible

I am in a place in my life now (I have hit the over-50 mark) where I realize that life is short and I really want my attitude, actions, and reactions to bring about good in the world, both personally and professionally. Over the past 12 years, I have had a mother who died at 62, two friends die at 52, and a more distant relative die at 38. In addition, in the past few years I have seen several women I know undergo breast cancer treatment. As a result, it is important for me to have a purpose-driven life and a life-enhancing existence.

During my week off this past week, two things really scared me and made me think about having a positive impact in our world. The first was watching the Maury show on TV. I never watch daytime TV, but I was home and so I did. What I saw was unreal. Maybe it was fake, I do not know. The style of interaction and the yelling and posturing concerned me deeply. The second was the news item about the woman who pepper-sprayed people at Wal-mart over a game. Just seeing the crowds fighting over the X-Box disturbed me. Wow. What has become of Americans?

I guess I think something needs to change in this country but feel a bit powerless to do anything that would affect our country on a grand scale. So I have decided that rather than feel overwhelmed, I would continue my meditation but change my mantra to my most favorite prayer by St. Francis of Assisi. I think the intentions in this prayer are universal and applicable to those who believe in God and to those who do not. Just doing this prayer of intention has helped me stay focused on the good I can do making me feel more empowered and less discouraged about humankind. I feel really peaceful and more focused as a result.

Below is my (Evelyn's) edited non-religious version:

"May I be an instrument of peace. Where there is hatred, let me sow love; Where there is injury, pardon; Where there is doubt, faith; Where there is despair, hope; where there is darkness, light ; Where there is sadness, joy.

May I not so much seek to be consoled as to console, To be understood as to understand, to be loved as to love another; For it is in giving that we receive; It is in pardoning that we are pardoned; It is in dying to our false self that we give birth to the true self and bring vitality into our world."

Mindfulness and Meditation: A 30-day challenge/ Day 6-25

2011-11-25T11:10:00.000-08:00

“By virtue of being human, each of us has the capacity to choose, to change, to grow.” -- Eknath Easwaran

Well. I have been pretty consistent and the overall experience has been good. I am realizing that it is important to set aside a regular time for this practice or the day goes by and then it is gone and then it is bed time and you realize you forgot to meditate. Whoops! Consequently, I have had to remind myself that this is an experiment not a competition. And as with yoga, I remind myself to be gentle on myself.

What have I learned or experienced? I guess the biggest thing I have noticed as a result of this practice is that I am more aware of my automatic responses or thoughts to things and how easy it is to judge things and get caught up in negativity. As a result, I have been able to catch myself, reassess my response, and correct it before it gets going in the wrong direction. It has been interesting for me to see how easy it is to automatically assign attributions to objective data or interpretations to feeling tones that come up in the body without slowing down and thinking things through.

Reflecting upon this experience, I think, if we slow things down, we have better control of how we think, feel, respond, and what we create in our universe. We have a deeper and more profound ability to choose to do good rather than harm. According to Rick Hansen in Buddha's Brain: The Practical Neuroscience of Happiness, Love, and Wisdom, this is the beginning of virtue.

“The secret of meditation is simple: you become what you meditate on. When you use an inspirational passage every day in meditation, you are driving the words deep into your consciousness. Eventually they become an integral part of your personality, which means they will find constant expression in what you do, what you say, and what you think.”
– Eknath Easwaran
(1910–1999)

Mindfulness and Meditation: A 30-day challenge/ Day 2-5.

2011-11-04T17:27:00.000-07:00

After having such a nice response to my first attempts at mediation, I thought it would be a breeze. Well, not so much as day 2-5 have been filled with avoidance. I found myself doing everything under the sun but meditating. I really had to force myself to do it daily. Just like anything else new, I am learning, meditation takes practice and discipline. It is a skill, which needs to be developed. Remember learning to write the alphabet in kindergarten or first grade or practicing riding a bike? Those things did not come easily at first and sometimes we avoided the practice. As kids, we did not think of these things as cultivating a skill but really, that is what we were doing. It was work but we did not know it. "Meditation is the cultivation of skillful qualities of mind, particularly mindfulness, effort, and concentration. Mindfulness is the presence of mind or attentiveness to the present without drifting away from the experience." --From The Beginner's Guide to Insight Meditation by Arinna Weismann and Jean Smith, 2010.

Mindfulness and Meditation: A 30-day challenge

2011-11-01T12:54:00.000-07:00

I have been doing a bit of reading on mindfulness and mediation lately. My husband has studied, practiced, and taught it for years. He takes his information from many sources and traditions and primarily teaches it to the church. For years, I always looked at him as super discipline and thought, "Oh. It is not in my nature to meditate." Now, however, I have decided I am up to the challenge of trying to meditate. I just finished a 30-day Birkam yoga challenge. I made 26 out of 30 days, which is good for me! If I can do that, I can meditate 20 minutes a day for 30 days. I am going to write about my experience. I recommend mediation and mindfulness to my clients and have only dabbled in it a bit. I think it is about time I take this very good for you practice seriously for myself because mindfulness changes the brain.

I am going to practice something very simple called passage meditation recommended to me by my husband and can be practice regardless of one's faith tradition. It is mantra based. I am using it because I like the idea of saying a word or passage that has meaning. It is a little like TM, which has been researched and found effective. As well, I have used this style in the past when I was trying to meditate. It is recommended in the book "Anticancer, A New Way of Life" by David, Servan-Schreiber, MD, Ph.D. He recommends the Buddhist mantra, "Om mani padme hum", which means the jewel in the lotus of the heart. I like this one because of the way it sounds and feels to me. I can sing it as well and hear the overtones in my head. I will probably use this one although there are plenty to chose from. The web site "Timeless Wisdom for Daily Living" has a good list of them.

Day One:

Day one is today but I actually kind of started the day before yesterday. I think I am already experiencing some benefit. I found two things happening to me. The first was I did not become stressed out over the complete breakdown of my iphone calendar. As a therapist, my calendar is my life. I called Apple and they made things worse. It took time and energy I did not have to reconstruct my life. Oddly, I was not stressed out but felt peaceful during the process. The second thing that I have been feeling is more energy and greater focus. This inspired me to try to do this 30-day challenge and write about it. Try it with me. See what happens. Comment here or on my facebook page: Windows of Opportunity Counseling Services. I think this will be fun!

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Invest in Your Relationships; Invest in Your Happiness

2011-10-31T23:39:00.000-07:00

I was thinking about this today. I tweeted about hugging your loved ones. It only takes a second and has great emotional benefits. It is a small and simple investment. However, real long term investment does take some time. It takes thinking about what those in your life need, want, feel, think, etc. You get it. It involves investing your time and energy. It involves face-to-face time not only electronic time with others you care about. My advise, "Do not skimp on your relationships. Do what it takes to nurture them." Even though it feels like the world is going a little crazy right now and people have lost their jobs and homes and retirement, we still have each other. No body can take that away from us! Susan Johnson talks about investing in your marriage and why it is so important.

Attachment Styles and Relationships

2011-10-24T12:22:00.000-07:00

You may have heard about attachment theory and attachment styles. You may not have. However, they are something we talk a lot about in psychology today as attachment theory has become very integrated in our understanding of relationships and family dynamics. Understanding attachment helps us understand what motivates humans, helps them feel safe, and allows them to grow and succeed.

Literature and research describe several types of styles in relationships. These styles or categories were initially inferred from observational research on children. Later adults were interviewed as well to find out that people develop or have certain attachment or relationship mindsets they bring into relationships. These attachment mindsets have certain thoughts, behaviors, and feelings connected to them and they affect the way one relates in very close intimate relationships. The way we talk about these styles may make them seem rigid and unalterable. But personally, I like to think of these categories as somewhat flexibly. What I mean by this is one can change his or her style depending upon different internal and external variables and experiences in relationships. Read More

Dealing with Affairs and Infidelity

2011-07-03T17:31:00.000-07:00

Probably the most painful thing one can experience in a marriage or committed relationship, after death or divorce, is discovering your partner is having an affair. Upon discovery, one's mind starts spinning and one's body goes into high alert. Warning bells go off and panic and anxiety take over. Reality has changed and what once was a safe and secure relationship is unstable and dangerous. Questions like, "Who am I? Who is my partner? What has our life together really been about?" crash down on the mind like a spring waterfall full of furry.

This entire experience is traumatic, often causing PTSD-like symptoms in the betrayed person. Obsessive thinking and obsessive behaviors like cell phone checking take over. Loss of sleep and appetite are not uncommon. Emotions may become mercurial, flipping from grief and sadness to rage and disgust. Self-blame can creep in. This is all normal because this is a crisis.

As with any crisis, it is important to get emotional support and help as soon as possible. Help can come through trusted friends and family. However, people often opt to talk to their clergy or a therapist because the shame they feel is so great. They want the confidentiality these professional relationships bring. Couple therapy is recommended as a means to manage the complex terrain of emotions and movement toward healing the partnership.

Healing is possible but it will take hard work from both parties. This is a time to fight for your marriage or relationship. The first step that has to take place is to stop the affair. In a calm peaceful and clear manner, the straying partner is confronted with the affair and firm boundaries are set by the offended partner as to what he or she will accept in their life together. The unfaithful will have to be remorseful and honest with as much detail as the offended partner needs. Trust has to be rebuilt and can take months and even years. The affair has to be discussed and full accountability is recommended. The couple will have to re-establish their bond with each other by spending time with each other nurturing the relationship. This is sometimes hard with the complex lives we live but it must be done. Finally, the injured spouse will have to work through the process of forgiveness.

Coping with Job and Career Loss: Coming Together as a Family

2011-06-19T11:54:00.000-07:00

It seems like the economy is getting better. However in California the unemployment rate still hovers around 12%, I think. That means a lot of people, at least in California, are still suffering and under a ton of stress. This is really hard on not only individuals but couple and families.

The individual may suffer from loss of self-esteem, depression, and even hopelessness. The key for the individual is to keep on going. That means do whatever it takes. Action toward a goal is good for people. Do temp work, dog sit, work on household projects or do volunteer work. Whatever it takes. Accomplishing a goal gives one a sense of purpose and meaning.

A couple may start to fight or feel disconnected. They can easily start to blame each other and isolate rather than come together. So rather than problem solving and working toward a solution, they stay and feel stuck as if the are in mud or quick sand. The key here is not to blame each other or anyone else, regardless. Make the problem something outside of the individual or the couple. Ask, "What is the problem and how can we work together to solve it? Do we need to make any hard decisions together to get by?" By doing this couples can work together more effectively. They can regain their sense of being a team.

Children are affected as well. They need a sense of safety. They want to know that everything will be all right and that mom and dad are taking charge. It is important to let them in on the process but not to overwhelm them with too much detail. Kids naturally want to help and even fix the problem. Let them know mom and dad are working on solving the probably and that regardless of the situation if they stick together as a family they can and will get through anything.

Healthy Marriage

2011-06-15T20:15:00.000-07:00

The essential element of a healthy relationship is emotional responsiveness. Sue Johnson speaks about helping distressed couples create that emotional responsiveness. Are you there for me? Do I matter to you? When you can answer yes to these questions, you will feel secure in your relationship. When you answer no, you may be heading towards distress. Couples therapy helps people recreate that feeling of "you are mine, I am yours , we are together and a team."

Susan Johnson on a healthy marriage.

Afraid of my Partner's Anger

2011-05-13T11:00:00.001-07:00

I decided to write this blog entry because when I was looking at my web site statistics one of the google search phases that pointed to my site was, “afraid of my partner’s anger.” I was alarmed and thought, “Oh no. I hope that person is getting the right help for his or her situation.”

It is impossible to know what the situation is just from a search engine phase. Could it be that the person's partner has an untreated mental illness like irritable depression, bipolar mania, OCD, or even PTSD? For different reasons, all of these can sometimes have anger as part of the symptom profile. On the other hand, is the person living with a batterer? Is there chronic illness or job loss stress? I could go on and on about the possibilities.

The bottom line is that no one should have to feel afraid of his or her partner. The person we love should make us feel safe and secure and visa versa. That is usually why most people get together. The person they love makes them feel good. When a situation has gotten to the point of feeling fear of a loved one it is time to take calm, focused, and planned action. Fear is a message from the body that things could be dangerous. It is time to stand up to the anger and to reach out and get help.

Native American Commandments

2011-04-18T14:53:00.001-07:00

I was perusing a web site of a gentleman I went to High School with who is a corporate coach and I came across these Native American Commandments. I thought, "Wow. If we all would live by these what a great world we would have. Our hearts, minds, families, and even world might find greater peace and happiness. Thanks to Scott Schilling for this great list.

1) Remain close to the Great Spirit—
2) Show great respect for your fellow beings—
3) Give assistance and kindness wherever needed—
4) Be truthful and honest at all times—
5) Do what you know to be right—
6) Look after the well being of mind and body—
7) Treat the Earth and all that dwells there on with respect—
8) Take full responsibility for your actions—
9) Dedicate a share of your efforts to the greater good—
10) Work together for the benefit of all mankind—

The Power of Words

2010-07-27T19:26:00.001-07:00

This morning as I was dressing for work I was reminded of the power of words, and how they have energetic impact that can linger for years. The simple act of putting on a pair of earrings reminded me of something unkind someone said to me years ago, bringing up a tinge of self doubt causing me to question something I have always done and believe in deeply. The comment was, "Those earrings are for old ladies. They make you look old." Ouch!

I have always deeply believed that, at least for me, I should dress for myself. Dressing feels like an art and I usually enjoy decorating myself. I generally don't do it for anybody but myself. So why would words from years ago ring in my ears and cause me to question my internal sense of personal fashion and confidence, even for a second? The answer to this is because, in my opinion, words have energy and power to either heal and uplift or be damaging and destructive.

From a book I read called Power vs.Force, by David R. Hawkins, MD, I learned that words can be tested and calibrated at different energetic vibration levels. This all may sound a bit out there but makes sense when you look at examples. Think of the feeling that arises in yourself when you think of the word thrifty. Now think about the word cheap. Can you sense the difference? No? Try saying this out loud, "That person is cheap." Now try this, "That person is thrifty." Feel the difference? I do not know about you but the different words cause me to use completely different intonation when articulating the different sentences. I find this fascinating. Interestingly and according to Hawkins, the reason explanation for this is that thrifty would calibrate on a much higher energetic level than cheap would when tested. Theoretically, the higher the level the more loving the word, sentence, or intent.

So how does this relate to communication, families, or relationships? Are we to walk on eggshells trying to be perfect and only saying the polite thing all the time? I do not think so. However, I do think we need to be aware that what we say may have a lasting impact on another person. I do not know about you but I want to be truthful yet loving and uplifting, regardless. It saddens me to think that my words could cause a lasting negative impact. Therefore, I think that this is the bottom line. We can either uplift or tear down with our words. So what would it hurt to be more attuned and careful, especially with our loved ones?

Just a little food for thought.

Job Loss

2010-07-10T14:04:00.001-07:00

With unemployment continuing to be high, I wanted to put something out there about job loss and career crisis. I feel like many of you out there are in this really difficult and stressful place. Some of you may have out of work for a year or so. What I offer is some general advise. I hope it helps elevate just a little bit of the stress I know many are under.

How to Recover from a Career Crisis

If you have ever experienced any of the following, you have had a career crisis:

• Losing your job

• Being fired

• Burning out

• Not wanting to do your job for one more day

A career crisis can be caused either by someone else (being laid off) or by your own feelings (burning out).

Common Causes of Career Crises

There are many reasons why people experience career crises. Here are a few:

• Corporate downsizing

• Burnout

• Relocating for your spouse’s career

• Being fired

• Making the wrong career move

• Corporate politics

• Not fitting in

Why a Career Crisis Is So Devastating

A career crisis is usually devastating because it can affect your life in so many ways. Here are a few examples:

1. Money: Losing your income with no warning can be financially devastating.

2. Status: If your job gives you status or a professional identity, you may feel devastated without it.

3. Surprise:If the job loss happens without warning, you will probably feel shocked.

4. Self-esteem: You may feel embarrassed by what has happened.

5. Feeling alone: You are likely to lose friends and companions when you no longer work in the same place.

6. Feeling out of synch: Your regular routine may be disrupted.

7. Confusion: If the crisis happens because of burnout or for reasons inside yourself, you may feel confused about what to do next.

8. Effect on others: If people around you depend on your income and need you to be predictable, they may react negatively to your crisis.

Career Crisis: Whom It Hurts the Most

A career crisis and job loss hurts you because it is devastating to your ego. The hurt tends to be greater when one gets a sense of identity and self-esteem from his or her job title, status, and income.

A crisis hurts your family because they must experience the emotional fallout that follows a crisis. Your family may also experience a feeling of lost self-esteem and status, especially if you were fired or laid off.

The Flashback Effect

A major loss like this sometimes can cause you to reach back into the past and reactivate unfinished business from a major loss, or a crisis from an earlier time.

For example, when Sharon was terminated after seven months at her dream job, she became very depressed. While depression is a normal reaction to such a loss, Sharon was reacting to losing her job and the similar feelings she had when she flunked out of a top university 12 years earlier. When she finally saw a therapist after a few weeks of depression following the job loss, she saw that she had never fully resolved her feelings about failing in college.

Here are some other points about recovery:

1. The process of recovering from a career crisis will happen on its own schedule. It cannot be rushed.

2. Every person responds to a career crisis differently. There is no right way to respond or to deal with it.

3. Depending on the circumstances, processing a career crisis can take years.

4. Build and use a support system. People need other people when they are experiencing such a crisis. A group of people who have experienced similar losses is especially helpful.

5. It is a good idea to find support both inside and outside of your family and friends. Even the most supportive family and friends may grow tired of hearing about your situation, or you may find yourself censoring your behavior to avoid alienating them.

How to Help Someone in a Career Crisis

Here are a few ideas for being helpful to people going through career crises:

1. People need support when they are having a career crisis, even though they may seem to push you away.

2. Ask how you can help.

3. Don’t give advice unless asked.

4. Check in regularly with the crisis victim; let him or her know you are there.

5. Remind the crisis victim of what a good person he or she is, even without the identity and status that the job provided.

6. Sometimes a career crisis sends a person into a serious depression for which help is needed. If you sense danger, urge the crisis victim to seek help.

How to Turn a Crisis into a Victory

Here are some suggestions for turning a career crisis into a victory:

1. Give yourself time to heal. If recovery is rushed or interrupted, the crisis victim will not fully heal and a victory is not possible.

2. Remind yourself as often as necessary that your pain will end and you will eventually feel happy again.

3. Avoid jumping into something new on the rebound; let yourself experience all the stages of grief.

4. Accept that many people will not understand the depth of your grief. They will not understand why this is so difficult for you, and they will say stupid things.

5. Use the opportunity to stop and consider other options.

6. Explore what meaning your feelings have for you. If we pay attention to them, our feelings can lead us places we would otherwise never visit.

7. Keep a journal of your experiences. Make it your intention to see what there is to be learned from this experience.

8. A loss such as a career crisis can be viewed as both a door-closer and a door opener. Start thinking about what you are learning and gaining from this experience.

9. Create a ceremony of letting go. Yours will be as unique as your experience.

The Career Crisis Recovery Exercise

Write out your answers to the following questions. This self-help exercise can help you process your feelings about what has happened to you.

1. Describe what happened when your career crisis happened.

2. Describe the job or career. Where did you work? What was it like? Whom did you work with? What do you miss the most? What do you not miss at all?

3. Describe your feelings about the loss of the job or career.

4. What has the impact of this crisis been on your life? What else have you lost because of your career crisis?

5. What barriers stop you from moving on?

6. What are 10 things you can do starting today to continue the recovery process?

Suggested Reading

William Bridges, Job Shift: How To Prosper In A Workplace Without Jobs. Reading, MA: Addison-Wesley, 1994.

Barry Glassner, Career Crash: The New Crisis—and Who Survives. New York: Simon and Schuster, 1994.

Ayala Pines and Elliot Aronson, Career Burnout: Causes and Cures. New York: The Free Press, 1988

Marriage/ Relationships Part Two

2010-06-23T17:29:00.000-07:00

Marriage Part Two

Ways to Keep Your Relationship Tuned Up

Why do some relationships last forever and others fall apart? Here are some ways you can make your partner feel appreciated again and prevent your relationship from becoming a casualty.

1.Treat your partner as you would your boss, best friend, or best customer. Show respect, love, and kindness.

2.Think about what your partner wants and give it to him or her. John Gottman, Ph.D says that receiving influence from one's spouse is a major indicator of marital happiness. Consider your spouse or partner's advise. It shows that you care and the he or she counts.

3.Think of ways you can do the unexpected and be thoughtful. Remember how you acted when you wanted to win your partner over. These acts of thoughtfulness remind your partner that he or she is one your mind. This creates safety and security in the relationship.

4.Express your thoughts carefully. Being married doesn’t give anyone permission to let it all hang out. Be caring and assertive but not aggressive and abusive. Be present and engaged. Being too aggressive can create a pursue/ withdrawal pattern in the relationship that can spiral out-of-control.

5.Spend regular time together alone without the family or the kids. Being together enjoying each other builds positive memories that can keep you positive when the going gets tough.

6.Look for ways to compliment your partner. We all need to know that people see the good and special parts of ourselves.

8.Hug when you say hello and goodbye. It feels good and it makes people feel loved. Rituals like this are so important to establishing and maintaining a secure bond between people.

9.When your partner does something for you, say thank you. When your partner comes home after a day at work, greet her at the door and say hello. Ask how his or her day went. When your partner leaves for work in the morning, say goodbye and “I love you” or “Have a good day.” When your partner faces a challenge at work during the day, ask how it went when you get home or call during the day to see how the he or she is doing. This all says, "I love you, you are on my mind, we are a team."

10.Learn and practice communication skills. Relating successfully to another person requires a set of skills that can be learned.

11.During your evening meal together, avoid the temptation to watch television or read the paper or mail. Look at your partner and have a conversation.

12.If you want to make plans that affect how your partner will be spending time, check with him first and make sure it’s convenient.

13.When you ask your partner a question, make eye contact, and listen to the answer.

14.When you disagree with something your partner says, pay attention to your response. Do you express your opinion without putting him or her down? You can express your opinion assertively rather than aggressively.

15.Pay attention to how much of your side of the conversation is asking questions versus making statements. If you tend to be the dominant one, ask more questions.

16.Ask open-ended questions to encourage your partner to open up and talk. Open-ended questions begin like this:
a. Tell me about...
b. What do you think of...
c. What was it like when...

17.Have you become passive with your partner because that is the easiest way to avoid conflict? Over time, this is not a good idea. You will inevitably begin to build up feelings of resentment because you are stifling your feelings, thoughts, and opinions. If you think you are choosing passive behavior too often, think about discussing it with your partner and asking him to help you be more assertive. Holding things in and withdrawing from a relationship can trigger feelings of insecurity in one's partner. It can trigger the pursue/ withdraw cycle often seen in counselor's offices. Try to stay present and engaged to avoid this.

18.Check your communication with your partner and beware of using “You” messages. These statements begin with you.

For example:

You need to come home by 6:00 tonight.
You should not do that.
You should call me from the office and tell me when you will be home.

Here is what you ought to do.

“You” messages are damaging because they make the other person feel bad or disrespected. It feels like you are talking down to him or her.
If you want to demonstrate to your partner that you respect and esteem him or her, try speaking with “I” messages instead. When you start your statement with “I,” you are taking responsibility for the statement. It is less blaming and less negative than the “you” message.

You can use this formula: Your feelings + Describe the behavior + Effect on you. This is how an “I” message sounds: When I heard that you’d planned a weekend up north, I was confused about why you hadn’t asked me first, so I could be sure to get the time off. It takes some practice and you have to stop and think about what you are going to say, but your marriage deserves to be handled with care.

19.Make a list of your partner’s positive qualities. Share them with him and tell her why you think each is true.

20.Respect each other’s private space. Over time, many couples let this slide.

Marriage Today Part One

2010-05-09T15:23:00.001-07:00

Skills for Making Your Marriage Thrive

Any marriage counselor will tell you that one of the most common problems observed when couples come for help is poor communication skills. People get into trouble in their marriages because they have not developed their ability to listen and communicate.

Barriers to Communication

These are a few of the things that prevent people from communicating effectively:

1. Not knowing how to communicate properly
2. Not taking the time to think through what you want to say
3. Not taking the time to anticipate what your partner might be thinking and feeling
4. Fear of revealing too much of yourself
5. Fear of your partner’s anger
6. Not wanting to hurt your partner’s feelings
7. Not being attuned to your partners deep need for comfort and connection

Empathy, Acceptance, and Attunement is the Key

People marry because they want to spend the rest of their lives with their partner. They have every hope of growing together and creating a relationship that makes them feel emotionally healthy. Three factors that are necessary for this to happen are empathy, acceptance, and attunement on the part of both partners. Empathy is the capacity to put oneself in another’s shoes and understand how they view their reality, how they feel about things. Acceptance is, “I love you warts and all. I will not leave you because you are not perfect. I will be a team with you.” Demonstrating empathy and acceptance is critical to maintaining a strong relationship. Attunement combines empathy and acceptance but goes deeper. It is the intuitive capacity to get and know what the other person is about. It is the calming non-defensive presence of another that creates a sense of security in the relationship. Let’s look next at some communication skills that enable you to start to create a climate of empathy, acceptance, attunement, and understanding.

Active Listening

Active listening is a way of communicating that creates the important climate of empathy, acceptance, and understanding.

It is a two-step response to a statement made by your partner. It includes reflecting back what emotion you detected in the statement, and the reason for the emotion.
This is what active listening sounds like:“Sounds like you’re upset about what happened at work.” “You’re very annoyed by my lateness, aren’t you?”

Why Active Listening Is a Valuable Skill

Active listening is a valuable skill because it demonstrates that you understand what your partner is saying and how he or she is feeling about it. Active listening means restating, in your own words, what the other person has said. It’s a check on whether your understanding is correct. It demonstrates that you are listening and that you are interested and concerned.

Actively listening does not mean agreeing with the other person. The point is to demonstrate to your partner that you intend to hear and understand his or her point of view. This is good for your relationship for several reasons. When someone demonstrates that they want to understand what you are thinking and feeling, it feels good. It creates good feelings about the other person. Restating and checking understanding promotes better communication and fewer misunderstandings.

More Active Listening Examples

Here are some more examples of active listening.“You sound really stumped about how to solve this problem.” “It makes you angry when you find errors on Joey’s homework.” “Sounds like you’re really worried about Wendy." “I get the feeling you’re awfully busy right now.”

More Communication Skills

Without making this blog too long, there are a few more communication skills that I must mention. These include asking open-ended questions, making summary statements to check understanding, and encouraging your partner to open up and elaborate by using neutral questions and phrases. Open-ended questions begin with what, why, how do, or tell me. These questions get the other person to open up and elaborate on the topic. Asking these kinds of questions gets the other person involved by giving him or her a chance to tell what he or she thinks or knows. These questions are designed to encourage your partner to talk. They are useful when the other person is silent or reluctant to elaborate. They are also useful in dealing with negative emotions (such as anger or fear), since they help encourage the other person to vent feelings.

Summary Statements

Summary statements sum up what you hear your partner saying. A summary statement enhances your partner’s self-esteem by showing that you were listening carefully. It also helps you focus on facts, not emotions. It helps your partner clarify his or her own thinking by hearing your summary. Summary statements also help you deal with multiple disagreements so you can deal with them one by one.They help eliminate confusion by focusing on the relevant facts. Summary statements also help you separate the important issues from the trivial.

Neutral Questions and Phrases

Neutral questions and phrases get your partner to open up and elaborate on the topic you are discussing. These questions are more focused than open-ended questions. They help your partner understand what you are interested in hearing more about. They further communication because they help you gain more information.When you ask these kinds of questions, you demonstrate to your partner that you are interested and that you are listening.

Business Skills for Marriages

You might be surprised to hear that the same skills that help people succeed in business can also be used to build a better marriage. Like any business, a marriage is a partnership of people. Many of the skills that make businesses run successfully—planning, organizing, and setting goals—also can be applied to running your marriage successfully. These are some of the skills that will strengthen any marriage. Create an overall vision of what you want your life to be like; consider all life areas. Develop a long-range strategy. Set short-term and long-term goals. Plan the steps that will help you accomplish your goals. Organize projects. Manage projects. Manage people. Evaluate progress and results at regular intervals. Revise goals as needed.

Depression

2010-04-14T21:31:00.000-07:00

Depression: What Is It?

Depression is a serious illness, not a harmless part of life. It is a complex disorder with a variety of causes. It is never caused by just one thing. It may be the result of a mix of factors, including genetic, chemical, physical, and sociological. It is also influenced by behavior patterns learned in the family and by cognitive distortions.

Depression affects millions of people in this country. It is always troubling, and for some people it can be disabling. Depression is more than just sadness or “the blues.” It can have an impact on nearly every aspect of a person’s life. People who suffer from depression may experience despair and worthlessness, and this can have an enormous impact on both personal and professional relationships. In this newsletter, I will describe many of the factors that may cause depression, and I will explore strategies for preventing it.

Depression Affects the Entire Person

When a person suffers from depression, it can affect every part of his or her life, including one’s physical body, one’s behavior, thought processes, mood, ability to relate to others, and general lifestyle.

Symptoms of Depression
People who are diagnosed with clinical depression have a combination of symptoms from the following list:

Feelings of hopelessness, even when there is reason to be hopeful

Fatigue or low energy

Much less interest or pleasure in most regular activities

Low self-esteem

Feeling worthless

Excessive or inappropriate guilt

Lessened ability to think or concentrate

Indecisiveness

Thinking distorted thoughts; having an unrealistic view of life

Weight loss or gain without dieting

Change in appetite

Change in sleeping patterns

Recurrent thoughts of death

Suicidal thoughts

A specific plan for committing suicide

A suicide attempt

Feelings of restlessness or being slowed down

When a person is suffering from depression, these symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning. This means that the person’s family and social relationships, as well as work life, are impaired.

Grief, Sadness, and Depression

Depression may include feelings of sadness, but it is not the same as sadness. Depression lasts much longer than sadness. While depression involves a loss of self-esteem, grief, disappointment and sadness do not. People who are depressed function less productively. People who are sad or disappointed continue to function.

Depression and Socioeconomic Factors

Depression does not seem to be related to ethnicity, education, income, or marital status. It strikes slightly more women than men. Some researchers believe that depression strikes more often in women who have a history of emotional and sexual abuse, economic deprivation, or are dependent on others. There seems to be a genetic link as depression is more common among parents, children, and siblings of people who are diagnosed with depression.

Physical Causes

Many physicians believe that depression results from a chemical imbalance in the brain. They often prescribe antidepressant medication that target specific neurotransmitters. Many people find relief as a result. However, at this point in time there is no reliable test to identify chemical imbalances. It is unknown whether life experiences cause mood changes, which create changes in brain chemistry, or whether it works in reverse. There is some evidence that stress and biological vulnerability work together to create depression.

Depression may be associated with physical events such as other diseases, physical trauma, and hormonal changes. A person who is depressed should always have a physical examination as part of the assessment process to determine the role of physical causes.

Signs That Professional Treatment Is Needed

If you or someone you know is depressed and exhibits any of the following signs, it is extremely important to seek the assistance of a medical or mental health professional.
1.Thinking about death or suicide. This is always dangerous and you should see a professional therapist immediately.

2.When symptoms of depression continue for a long time, you may need professional help. Acute responses to events are normal, but they should not last beyond a reasonable time.

3.Your ability to function is impaired by your depression. Seek help before your life situation deteriorates to a serious level.
4.You have become so isolated that you have no one with whom to check reality. Seek out someone to share your thoughts and feelings with.

5.Depressive symptoms have become severe.

Suggested Reading

David D. Burns, M.D., Feeling Good: The New Mood Therapy. New York, Avon Books, 1980.
The American Psychiatric Association, Diagnostic and Statistical Manual, 4th Edition. Washington, D.C., The American Psychiatric Association, 1994.

Michael Yapko, Ph.D., Breaking the Patterns of Depression. New York, Doubleday, 1997.

Depression

2010-04-14T21:23:00.000-07:00

Depression:What to Do about It.

There are three basic ways to treat depression: psychotherapy, self-help, and medication. Many people respond best to a combination of two or more methods.

1. Psychotherapy: Individual treatment exploring one’s beliefs and ways of thinking and relating, and learning new ways of thinking, relating, and behaving. Family and couples therapy are very helpful, especially if one's relationships are affecting one's mood or one's mood is starting affect one's relationships. Relationships matter and the support of family and friends is essential for recovery. Depression often causes isolation, which tends to feed the depression and make it worse. Relief can come through connecting with others. Couple or family therapy can help with this by promoting connection.

2. Self-help: Exploring one’s beliefs and ways of thinking on one’s own.

3. Medication: Altering one’s brain chemistry by taking antidepressant medication.

A physician may recommend medication when four conditions exist:

1. The patient’s depression is moderate to severe.

2. The patient has suffered at least one previous depressive episodes.

3. There is a family history of depression.

4. The patient asks for medication only and refuses psychotherapy.

There are four types of antidepressant medication available today:

• Tricyclic antidepressants (TCAs)

• Monoamine oxidase inhibitors (MAOIs)

• Selective serotonin reuptake inhibitors (SSRIs)

• Other compounds that work with dopamine, and norepinephrine

The TCAs and MAOIs have been used for decades. The SSRIs (such as Prozac) and structurally unrelated compounds are newer and are being prescribed more and more frequently. They have fewer and less pronounced side effects than the TCAs and MAOIs.

Treatment without Medicine

One of the leading methods for treating depression is cognitive therapy. Cognitive therapists help depressed clients feel better by identifying how faulty ways of thinking are making him or her feel bad. The client analyzes his or her thoughts and beliefs, and learns to substitute more healthy ways of thinking and believing. Many mental health professionals believe that the ideal treatment of clinical depression is medication in conjunction with psychotherapy.

Prevention of Depression

1. Identify your risk factors and be aware of where you are vulnerable. Each of us has unique risk factors, such as things we were taught in our families of origin, values we have learned, and the presence or absence of a family history of depression. Anything that has been learned can be unlearned and replaced with something healthier.

2. Learn to manage stress. You can learn proven techniques for calming and relaxing yourself. Consider taking a stress management class or buying a set of relaxation tapes.

3. Learn problem-solving skills. Many people who develop depression never learned problem-solving skills. They need to develop the ability to see problems from many viewpoints and to look for a variety of solutions.

4. Build your life around things you can control. Learn to recognize what you can control and what you can’t. Avoid spending much effort on situations that won’t pay off for you.

5. Learn self-acceptance. Instead of rejecting the parts of yourself you don’t like, learn to manage them more productively.

6. Become aware of selective perception. Observe how you generate ideas and opinions about people and events. Remember that these are just your views, not necessarily objective facts.

7. Focus on the future, not the past. Depressed people tend to be focused on the past. People who set goals and focus on the future tend to be more positive about life.

8. Develop a sense of purpose. Many depressed people lack a sense of purpose or meaning. This means they have no goals and nothing in the future drawing them forward. To prevent depression, develop your sense of purpose and meaning.

9. Strengthen your emotional boundaries and set limits. Boundaries define your role in a social situation. They determine how you will or won’t behave in a given situation. Having clear, strong boundaries is empowering, while boundary violations make you feel victimized and helpless. Setting limits means having and enforcing rules for the behaviors you expect in a relationship.

10. Build positive and healthy relationships. Think about what you need from others in relationships. Learn to read people and trust your instincts about which people are good for you.

11. Avoid isolation. Talk to others about what’s going on with you. If you keep your thoughts to yourself, you may be unaware that your thoughts are distorted. If you share them with another person, you can become more objective.

Signs That Professional Therapy Is Needed

1. Thinking about death or suicide. This is always dangerous and you should see a professional therapist immediately.

2. When symptoms of depression continue for a long time, you may need professional help. Acute responses to events are normal, but they should not last beyond a reasonable time.

3. Your ability to function is impaired by your depression. Seek help before your life situation deteriorates to a serious level.

4. You have become so isolated that you have no one with whom to test reality. Seek someone out to share your thoughts and feelings with.

5. Depressive symptoms have become severe.

Suggested Reading

David D. Burns, M.D., Feeling Good: The New Mood Therapy. New York, Avon Books, 1980.

Michael Yapko, Ph.D., Breaking the Patterns of Depression. New York, Doubleday, 1997.

Looking for Strength

2009-10-18T11:30:00.000-07:00

As therapists, we are trained to look for and focus upon family dysfunction. Sometimes though we are so caught up trying to find the maladaptive aspects of our clients that we fail to see the adaptive or healthy characteristics they possess. Perhaps, we inherited this from the medical or disease model of treatment. Simply stated, this model encourages us to find the problem and fix it. It does not encourage us to find the good, healthy, or productive aspects of family life. Naturally, we want to make things better. However, perhaps we have been going about it in slightly the wrong way. It is not much easier for families to build on their strengths rather than to try to learn completely new ones. So, what are some family strengths we could build on?

1. Accepting Influence, Repair Attempts, and Turning toward Each Other (See John Gottman’s work).

Being connected to one another and bonding are protective elements to families under stress. If family members know how to listen to each other and to accept influence, know how to turn the volume down when necessary and enact repair attempts, and can come together responsively, they can solve almost any problem. These habits cause families to be united against the struggle, not against each other. Some researchers call this trait cohesion. Strong families who exhibit a good amount of cohesion are like super glue. They stick together under pressure. They do not pull apart.

2.Flexibility.

Flexibility in the family is both a strength and a benefit. Flexibility is the ability to bend or change when necessary. The term, flexible, when referring to families, extends to their ability to change roles, rules, and behaviors when necessary. Families that have this quality are more prepared to change or shift gears when trouble comes or times change. Essentially, flexible families are more adaptable. They do not keep doing the same thing repeatedly hoping to get different results. Change does not scare them; it mobilizes them to think, feel, perceive, and behave or interact in new ways. Combined with cohesion, this is a powerful trait.

3.Resilience.

Resilience is protective in nature. Resilience is the remarkable quality of being able to come out on top when the odds are against coming out on top. Families who are resilient know how to make the best of their circumstances, regardless of how grim. They somehow are able to maintain a realistic but positive attitude. They keep on going and do not give up. They take charge of the situation. Their nature or disposition draws support toward them. If no support is available within the immediate system, they know how to get it outside of the system. They seek support because they know it is important to survival. Even if they rely primarily on their own abilities to overcome, they know and believe in the importance of interconnectedness and community.

Conclusion

Families come to us exhibiting various levels of distress. They usually are in some type of a crisis and not functioning like normal. It is important to remember that it is not they who are the problem but the problem that is the problem. To help remind them of this, therapists should not only look at the immediate functioning and structure of the family but also ask questions about past functioning and successes. At some level, most families have or had at least one of these skills. Building on strengths first helps build confidence and then prepares people for the more difficult task of correcting weaknesses.

Resilience

2009-10-18T11:14:00.000-07:00

I answered another question posted on linked in and thought it worth posting on my blog. The question was, "How does one stay resilient when facing adversity?"

I think some people may have temperaments that are more naturally resilient. These people naturally see the glass half full, regardless. The rest of us have to work a bit at bouncing back from adversity, especially when faced with multiple adversities. It may take a little effort but resiliency can be developed.

First, it is important to acknowledge ones feelings but not to be stuck in them. As a little girl, my mother used to remind me that feelings are not forever, they come and go just like the wind. Every day must be seen as a new day with new possibilities. AA gives great advice when it teaches us to take one day at a time. Tomorrow will bring new things.

Second, it is easy to want to isolate and pull away from others when multiple difficulties arise. This may be okay for a very short period for a time of grieving, reflecting, or regrouping but is not a wise long-term strategy. People need people. Staying connected to encouraging and supportive family and friends is imperative to bouncing back and being resilient.

Third and finally, I suggest always keep on going and take action. Movement is the key. By this, I mean take the next step whatever it may be depending upon the situation. For some, it might mean just getting out of bed. For others, continuing to apply for jobs even though past efforts may not have paid off.

To see my post on family strengths click on title.

Is Happines a Moral or Religious Obligation?

2009-10-03T16:13:00.000-07:00

I tried to answer this on my Linked In account but deleted my answer by mistake and could not reload it. I thought my brief reflection was worth putting out there somewhere in cyberspace. So here it lands. From a mental health perspective, I think is it important not to judge people on their temperament or ability to regulate mood. However, I realize there are ways people can work at improving their disposition. This is what I wrote:

I pretty much agree with Ashley on this. Mood is largely a brain chemistry thing with our level of happiness related to genetics, for the most part. As with anything, happiness is probably multifaceted in origins.

Can we change our mood? With hard work, sometimes we can. There is evidence out there supporting the use of cognitive therapy to treat depression. It works. Behavioral therapy has been shown to decrease anxiety for people who suffer from obsessive-compulsive disorder. Studies also suggest good loving relationships help decrease negative affect.

Having said this, I in no way believe it is we should moralize mood. Regardless of whether one is a "happy camper" or an "unhappy camper,” one can act and be a person with moral integrity. I do not think we need to connect moral character or religious faithfulness with disposition. I know both happy and unhappy people who express a deep faith in God and are consistently morally upright. A happy person is not better than a sad or grumpy person. They are just different.

ADHD

2009-04-03T10:50:00.000-07:00

In response to Connie, who left a comment about being frustrated because she has an ADD/ ADHD child, I wanted to direct her and other parents to a great resource called Children and Adults with Attention Deficit Disorder. The web site is: http://chadd.org/. Click blog title. I know it can be really challenging trying to raise a child who struggles with this disorder. Our society is not structured for those who have these ADD tendencies. As well as looking at this web site, I suggest finding a coach for your child. This can take some of the burden off of the parents.

Attention Deficit Hyperactivity Disorder (ADHD)

2009-04-01T13:24:00.000-07:00

Attention Deficit Hyperactivity Disorder

Definition. Attention Deficit Hyperactivity Disorder (ADHD) begins and is most often diagnosed in childhood. Some people are not diagnosed until adulthood, but, as they look back, they can document symptoms starting before age seven (Hallowell & Ratey, 1994). There are three sub-types of ADHD: primarily hyperactive, primarily inattentive, and a mixed type where one exhibits both hyperactive and inattentive symptoms. Regardless of type, ADHD is considered a cognitive and primary processing deficit disorder. The processing deficits found in those with ADHD are attention and effort, inhibition, arousal modification, and self-regulation. These problems cause symptoms such as impaired higher order reasoning, difficulty developing schemata, impaired metacognitions, and poor effectance motivation (Teeter, 1998). This processing problem leads to the various symptoms seem by parents, teachers, and doctors. Preston and Johnson (2008) note the symptoms for ADHD. They are impulsivity, difficulties with motivation, impaired attention and concentration, easy distraction, restlessness, hyperactivity, and emotional deregulation or impaired emotional control. Those who suffer from ADHD often suffer from learning disabilities and low self-esteem (Preston & Johnson), and they often have social-emotional problems and present with aggressive behavior (Teeter).

Causes. It is generally thought that ADHD is caused by neurochemical problems. It is believed that there is dysregulation of both dopamine (DA) and norepinephrine (NE) in the prefrontal cortex (Preston & Johnson, 2008) and to a lesser degree, serotonin (SE) (Teeter, 1998). These transmitters, DA and NE, work together to control attention, inhibition, and motor planning. Their deficiency is related to the underactivity of the brain region involved with them. This underactivity related to DA and NE is thought to cause the behavioral symptom such as disinhibition, hyperactivity, and irritability. Dysregulation of SE may be the cause of aggression seen in those diagnosed with ADHD. Other nontraditional hypothesis suggest that ADHD may have many different causes such as food allergies, heavy metal toxicity, low protein and high carbohydrate diets, mineral imbalances, essential fatty acid (EFA) and phospholipid deficiencies, amino acid deficiencies, vitamin B and phytonutrient deficiencies, and thyroid disorders (Harding et al., 2003).

Treatment Interventions for Attention Deficit Hyperactivity Disorder

Medication. Medication for all subtypes of ADHD target the hyperactive and inattention symptoms. As well, the associated symptoms such as anxiety, depression, and aggression are addressed with other medications as appropriate. The use of stimulant medication is the first choice for both the hyperactive and the attentive symptoms. These medications work by increasing the level of dopamine at the synapse (Ratey, n.d.). The most common stimulants used are Ritalin, Concerta, Dexedrine, Adderal, and Cylert. All of these except Cylert have abuse potential (Preston & Johnson, 2008). However, Cylert is not often the first line of treatment because of several possible deaths as a result of liver malfunction, which, according to Ratey, is sad. He feels that because Cylert is long-acting, working all day, it has better effects and is generally more stabilizing than shorter acting stimulants such as Ritalin, the shortest acting of all the stimulants. Dexedrine and Adderal are longer acting than Ritalin but not as long-acting as Cylert. Some antidepressants can be used to specifically treat ADHA. They are Wellbrutrin-SR and Strattera (Preston & Johnson) and Norpramin and Tofranil (Teeter, 1998). As well, there are two alpha-adrenergic agonists prescribed for the condition. These are Catapres and Tenex. These other medications are usually used in conjunction with a standard stimulant but can be used alone as well (Preston & Johnson).

Alternative Intervention. Nutritional supplements and fresh air can be used to address ADHD. Several are used together to address the dopamine and norepinephrine imbalances that are believed to be caused by several factors such as allergies, toxins, insufficient diet, and vitamin deficiency. One study prescribed tyrosine, B vitamins, cooper, iron, vitamin C, phospholipids, and EFA to 10 patients and Ritalin to 10 other patients. The research found that the nutritional prescription to be as efficacious as Ritalin in calming the symptoms of the patient (Harding, 2003). Another study found that if children spent more time out-of-doors in green and grassy areas, they exhibited fewer ADHD symptoms (Lawson, 2008).

Psychotherapy. The primary treatment modality for this disorder is supportive and psychoeducational. Both the sufferer and their families need understanding, compassion, and a way to manage this illness. Hallowell and Ratey (1994), suggest that this be accomplished by not only explaining the diagnosis to the parents and teachers but to the child sufferer, too. Once the diagnosis is thoroughly explained and the sufferer is also educated as to his or her active part of the treatment plan, learning to use structure becomes the focus. Structure means learning to use tools like lists, reminders, notepads, appointment books, filing systems, schedules, bulletin boards, an alarm clock, etc. Essentially, structure sets up external systems that are reliable because internal systems of the ADHD suffer are not. The therapist’s job is to help the sufferer and the families set up and utilize a structured environment.

References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author.

Hallowell, E. M. & Ratey, J. J. (1994). Driven to distraction: Recognizing and coping with Attention Deficit Disorder from childhood through adulthood. New York: Simon & Schuster.

Harding, K. L., Judah, R. D., & Gant, C. E. (2003). Outcome-based comparison of Ritalin versus food-supplement treated children with AD/HD. Alternative Medicine Review 8(3): 319-326. Retrieved on March 21, 2009 from Alternative Mental Health.com under ADD article “ADD: Nutrients Perform as well as Drugs.”

Lawson, W. 2004). ADHD’s outdoor cure. Psychology Today Magazine Mar/Apr 2004. Retrieved on March 20, 2009 from http://www.psychologytoday.com/articles/pto-20040406-000015.html via AlternativeMentalHealth .com ADD article titled, “Outdoor Greenery Improves ADHD Symptoms.”

Preston, J. & Johnson, J. (2008). Clinical psycholpharmacology made ridiculously simple (5th ed.). Miami, FL: MedMaster.

Ratey, J. (n.d.). An update on medications used in the treatment of Attention Deficit Disorder. Retrieved on March 20, 2009 from http://www.add.org/articles/updatemed.html

Teeter, P. A. (1998). Interventions for ADHD: Treatment in developmental context. New York: Guilford.

A Look at Psychiatric Medication

2009-01-26T11:31:00.000-08:00

Psychiatric Medication: Is It the Answer?
A paper submitted for a class 25 January 2009

Before reading this, please be advised:

"The following information should not be used in place of sound medical advise from your physician or therapist. It is a summary of information I had to read for a class. I thought the public may find it interesting. Its purpose it not to diagnose, treat, or advise on any medication related issues." thank you.

Contemporary science and research, mostly by pharmaceutical companies, would have us believe that drug therapy is the answer to all of our emotional and psychological problems. Ads for these powerful psychoactive drugs can be found in magazines, online, on the radio, and on television. As well, we have come to demand quick fixes for almost all of our ailments, including psychological ones, and rarely do we question the effects of the medicine we ingest. This combination of scientific promotion and unquestioning demand has caused us to ignore what these psychoactive substances may really be doing to the bodies and minds of those who ingest them. What do these drugs actually do to the brain? Are these substances helpful or harmful? Are there side effects and withdrawal effects? What are the long-term effects of ingesting them? Moreover, are there any alternatives to drug therapies for emotional distress and mental illness.

What Do These Drugs Actually Do to the Brain?

Regardless of the origins, whether genetic, environmental, relational, hormonal, chemical, disease, or abuse- and trauma-induced, the resulting mental illness is thought to affect brain neurochemistry. There are different theories for each category of illness. Depression and bipolar illness are thought to be caused by a disruption in several neurotransmitter systems. The affected chemicals are norepinephrine, serotonin, and dopamine. “These three neurotransmitters function within structures of the brain that regulate emotions, reactions to stress, and the physical drives of sleep, appetite, and sexuality” (All About Depression, 2009, “Causes” Section). The affected structures are the limbic system, the basal ganglia, and the hypothalamus (Kaplan & Sadock, 1996). As with depression, anxiety is also a brain disease. With anxiety, there are three major neurotransmitter systems thought to be associated with anxiety: norepinephine, serotonin, and γ-aminobutyic acid (GABA). Research on schizophrenia finds dysfunction in the limbic system, basal ganglia, and the frontal cortex. One hypothesis states that there is too much dopaminergic activity in these regions (Kaplan & Sadock). Finally, disorders such as attention deficit hyperactivity (ADHD) are understood to be a result of the underfunctioning of the frontal lobes (Kaplan & Sadock).

Based on these ideas and brain chemistry research, medication for mental illness targets the brain and alters its neurochemistry. The goal of each medication is to decease the overt symptoms of the reported disorder influencing the brain and implicated neurotransmitter systems (Janicak, Davis, Preskorn, & Ayd, 1997). Medication targets symptomology and neurochemistry but not necessarily root causes of the altered state of mind (Robertson & Monte, 1997). For example, with ADHD the symptoms are treated with stimulants that target the frontal lobe. The increased stimulation of this area of the brain is thought to help the sufferers of ADHD concentrate, focus, and settle down (Mate, 1999). It does not address diet, exercise, environment, relationship issues, classroom structure, or parenting skills, things that are important in the recovery or management of the disorder (Mate, 1999).

Are These Medications Helpful or Harmful?

Mood disruption, anxiety, psychosis, and other emotional and mental problems all cause those so afflicted and their families a great deal of pain and suffering. Fortunately, we live during a time where there are medications that target the symptoms of these illnesses. People who suffer from depression can take Prozac and within several weeks feel like themselves again. The anxious and panic-ridden can take a little bit of Xanax and within an hour or so be freed from their distress. Those who hear voices, are overly agitated, have extreme or volatile mood swings, or feel persecuted are given Ability, which quiets the mind. If one’s child cannot focus or sit still in school, Ritalin helps solve this problem. On the surface and compared to the past, this seems good and helpful. It was not so long ago those who had mental illness were treated with lobotomies, straightjackets, and institutionalization. However, there is mounting evidence that these powerful psychoactive substances may do more harm than good, may be less efficacious than previously thought, and that they ought to be used cautiously for a limited time only.

Breggin (2009), a Harvard trained psychiatrist, believes that what we consider the medicinal effects of psychiatric medication are really drug induced disabilities. He believes that psychoactive medications are harmful. On his web site, Psychiatric Drug Facts, he states that “Antidepressants cause emotional anesthesia and numbing or sometimes euphoria, providing a fleeting, artificial relief from emotional suffering. Neuroleptic or antipsychotic drugs disrupt frontal lobe function, causing a chemical lobotomy with apathy and indifference, making emotionally distressed people more submissive and less able to feel. Mood stabilizers slow down overall brain function, dampening emotions and vitality. Benzodiazepines suppress overall brain function, sedating the individual, with temporary relief of tension or anxiety at the cost of reduced mental function. Stimulants blunt spontaneity and enforce obsessive behaviors in children, making them less energetic, less social, less creative, and more obedient (Psychiatric Drug Adverse Reactions (Side Effects) and Medication Spellbinding)."

Breggin has reviewed numerous cases, finding that some of these substances, especially the antidepressants, cause extreme and erratic behavioral changes and even violent episodes. Others have looked at the data regarding antidepressants and come to the same conclusion. The Canadian and British regulatory agencies found antidepressants to cause violence, agitation, and increase suicidal ideation and behavior, especially in children. As a result, the Canadians banned all newer anti-depressants but Prozac for usage with children, and the United States requires a black box notice on all newer antidepressants warning patients about possible agitation and suicide ideation in children (Breggin, 2004).

The most frightening thing about Breggins’ and others’ findings is that those who suffer altered behavior because of medicine often do not connect the dots and believe that the medication is causing the disruption or problem (Breggin, 2006). Breggin calls this Intoxication Anosognosis and believes that, as with alcohol or other non-prescription psychoactive substances, those under the influence of psychiatric medication are spellbound and believe that the medication is actually helping them when in fact it may be harming them and their relationships. He extends this spellbinding affect to the practitioner prescribing the medication and to family and friends of the affected. He believes that what is seen as helping or healing is actually damaging and controlling the brain.

While Breggin notes the faulty interpretation of behavioral changes induced by medication as being good rather than harmful, others have reviewed studies to find some medications such as antidepressants may not work to relieve depression. A meta-analysis of data submitted to the Food and Drug Administration found antidepressants to be less than efficacious. This study by Kirch, Deacon, Huedo-Medina, Scoboria, Moore, and Johnson (2008) concluded that when treating moderate to severe depression, the newer antidepressant when compared to placebo were no more effective. They found antidepressants to be more helpful than placebo in only the most depressed group. This was due to the decease in placebo effect rather than due to increased efficacy of the medication.

Are There Side Effects, Withdrawal Reactions, or Long-Term Consequences?

Almost all of the psychotropic medications have possible side effects and some have withdrawal syndromes. In general, the newer generation of antidepressants such as Zoloft, Paxil, and Effexor, has fewer side effects than the older generation yet they still can initially cause anxiety, agitation, restlessness, and sleeplessness. This is usually only for a short period of time and a benzodiazepine like Xanax or Ativan can be added temporarily to calm the side effects down. Long-term side effects include inorgasmia, apathy, decreased spontaneity, and weight gain. Inorgasmia, apathy, and decreased spontaneity can be treated by medication adjustment or by adding additional medication to the regimen. Weight is addressed with exercise (Preston & Johnson, 2008). Withdrawal effects of many of the newer antidepressants include nausea, headache, and dizziness, lasting a few days to a few weeks. There are not many studies documenting this, but one only needs to surf the web for a few minutes to find people expressing distress over trying to get off various antidepressants. Because of the difficulties of many trying to get off antidepressants, there is a now a syndrome called antidepressant discontinuation syndrome (Healthy Place.com, 2009).

Initially, the medication used to treat anxiety called benzodiazepine (including drugs like Valium, Xanax, Ativan, and Klonopin) can be overly sedating. However, that effect usually diminishes with time or medication adjustment. When used for a long period, these drugs can become addictive. They also have significant withdrawal complications if not tapered off slowly. Mild to moderate withdrawal reactions include anxiety, restlessness, insomnia, and nightmares. Severe reactions include seizures, high fever, psychosis, and death (Preston, O’Neal, & Talaga, 1994).

Older antipsychotic medications such as Thorazine, which acts as a strong dopamine blocker, have many distressing and immediate as well as long-term side effects such as slowed movements, resting tremor, shuffling gait, and muscle spasms. Because these drugs also block acetylcholine, they cause dry mouth, blurred vision, constipation, sedation, and sexual dysfunction. If one stays on these medications for extremely long periods, he or she may develop an almost irreversible disorder involving involuntary movements called Tardive Dyskinesia (Preston, O’Neal, & Talaga). The newer antipsychotic medications like Abilify, Geodon, Zyprexa, and Risperdal, all have fewer side effects, but most continue to cause weight gain, akathisia (inner restlessness), and sedation. As well, some of these medications have been found to contribute to hyperglycemia, type II diabetes, and elevations of triglycerides and cholesterol (Preston & Johnson, 2008). Some of these drugs may also have the long-term side effect of Tardive Dyskinesia. They have not been around long enough for us to know yet (Preston, O’Neal, & Talaga).

Finally, stimulants, which are used to treat ADHD, can cause anorexia, insomnia, nausea, abdominal pain, headache, thirst, vomiting, lability of mood, irritability, sadness, tachycardia, and blood pressure changes. Long-term usage of stimulants with children may stunt their growth (Green, 1991).

This long list of potential and even frightening side effects, withdrawal syndromes, and long-term negative effects caused by psychotropic medication makes one wonder whether drug therapy should be used at all. These side effects make it easy to reject all pharmaceutical interventions for mental health issues. However, this would be extreme and perhaps dangerous in the case of severe mental illness. Medication does have its usefulness if used cautiously and in a time limited manner. Even if one agrees with Breggin and believes that these drugs cause brain disabilities, it seems that drug induced disabilities may be preferable to some of the severe mental illnesses people suffer from. For example, a person diagnosed with schizophrenia may be plagued by paranoia and withdrawing from life because he or she thinks people are talking about them or that they can read his or her mind. The antipsychotic medications used to treat this may cause the person to be more submission and emotionally blunted, but this may be preferable to being plagued by paranoia or hearing voices that are not there. As well, sufferers of depression who cannot sleep, eat, find pleasure in anything, and feel chronically suicidal may accept some emotional numbing, if these symptoms are numbed as well. Children placed on stimulants may be less creative, but if they are fitting in better and getting better grades, they will have better self-esteem. This may be a trade-off the parents are willing to make.

Alternative Treatments to Drug Therapy

Nobody knows exactly what causes mental illness. The influences are probably many, including genetic predisposition, environmental stressors, and personality. Medication is one of many possible interventions that can help bring a person’s brain chemistry back to normal. It may be the quickest treatment, yet not necessarily the most comprehensive or even safest (Breggin, 1991, Robertson, 1997). It is important to look at other ways brain chemistry can be changed through behavior and activities.

Diet and Exercise. The food we ingest influences our brain. For example, foods with caffeine speed up neurotransmission (Robertson, 1997). Ingesting too much caffeine can cause intoxication, which includes symptoms such as nervousness, restlessness, and insomnia (Chartrand, 2008b). As well, too much caffeine can alter one’s sleep cycle (Preston & Johnson, 2008). It makes sense for an agitated, anxious, or depressed person to consider cutting out all caffeine. Protein–rich foods speed up neurotransmission and boost the levels of dopamine and norepinephrine in the brain, and carbohydrates boost serotonin (Robertson). A diet rich in complex carbohydrates would increase one’s serotonin levels and decrease depression, low energy, and fatigue. A diet including moderate amounts of lean meat and fish or of beans will help a person think more clearly, be more alert, and more assertive. (Robertson). It is imperative for anyone suffering from mental illness to find out which chemicals may be most affected and to learn to eat right for his or her mental health. Food can serve as medicine.

We all know that exercise is good for us. However, it may be more important than ever for those with mental illness to understand, as exercise may be an extremely helpful intervention to overcoming negative symptoms. Not only does food affect the neurotransmitters but so does exercise. “Research has shown that exercise reduces both anxiety and depression. After only 20 minutes of running the brain secretes elevated levels of beta-endorphins, which act like morphinelike compounds that create the “ natural high” that runners frequently talk about (Robertson, 1997, p. 148). Serotonin increasing exercises include walking, riding a bike on a flat surface, stretching, low-impact aerobics, and ballroom dancing. Exercises that boost dopamine and norepinephrine and, temporarily, serotonin are aerobics, dancing, cross-country skiing, jogging, strenuous bicycling, hiking uphill, and swimming. Activities that increase just dopamine and norepinephrine are wrestling, tennis, basketball, and competitive swimming (Robertson).

Therapy and Social Support. Several years ago, this author read an article in the paper that talked about a group of older Italians who ate a high fat diet but did not have any heart problems compared to others who ate the same diet. The only significant factor that could be found is that these men got together to eat their unhealthy food. The conclusion was that it was not what you eat but with whom you eat that decreases your risk factors for heart problem. Something similar can be said for therapy and social support. Good therapy, positive social support, and an encouraging environment all affect a person’s inner world and thus their neurochemistry for the good (Schore, 1997). These essential interventions cannot be overlooked or dismissed because of easy access to psychotropic medication.

Medication may decrease symptoms, but it does not get to the root of the problem. Medication does not address a person’s negative thinking, poor relationship skills, abuse background, bad marriage, or internal conflict about his or her sexual orientation. Medication can help a person feel better, but it does not solve problems that initially may have altered one’s chemistry to start with. Studies have shown that, at least for depression, medication with psychotherapy is more effective in treating depression than medication alone. As well, it has been shown that although psychotherapy may take longer than drug therapy to see results it alone is as effective or more effective than drug therapies alone. This is because therapy provides emotional support, skills training, and behavioral and cognitive education that alter a person’s lifestyle and way of being, which may have been a major contributor to the depression to start with (Robertson, 1997),
Other Brain Chemistry Altering Activities. Finally, just as there are numerous ways to skin a cat, there are many ways to alter brain chemistry. Effective tools for boosting serotonin are reading inspirational literature, praying, meditating, using positive imagery, and listening to classical, folk, or inspiration music. In addition, volunteer work, finding purpose, and serving others not only connect us to others but boost serotonin. Listening to exciting music, watching action-packed movies, and thinking of pleasurable events can enhance dopamine and norepinephrine
(Robertson, 1997).

References

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