Thursday, February 13, 2014

8 Signs you Should see a Therapist

I thought the Huffington Post did a great job running through both reasons to seek therapy and common reasons people do not. I think it needs an addendum- How do you know it is time to bring your child or teen to therapy? I think I feel another blog entry coming...In the meantime, I thought I would refer to a previous blog entry, Common Myths that Fuel Therapy Avoidance. It amazes me how much stigma there still is around psychotherapy, especially for men. Ironically, to me, a benefit of good therapy is rejoining the human race. When you trying unsuccessfully to fix your problems on your own, it is easy to feel increasingly ashamed and alone. Successful therapy has the opposite effect!

Tuesday, February 4, 2014

Should I Divorce?

Should I get a divorce? Many people come to therapy in part to try to answer this question. Not knowing how to proceed in your marriage can painful and confusing. Along with providing support and helping clients cope with painful emotions, I try to help my clients process their responses to certain questions. Fully engaging the following questions should engage your heart, head, and an intuitive sense of what feels true about yourself, your spouse, about your marriage:

1) Is everyone in the home safe? If you and/or your children are not safe emotionally, physically or sexually, divorce may be the best option. However, there may be obstacles to leaving your spouse and pursuing a divorce. Support from others, including a therapist and/or other resources, can be critical when there are safety issues.

2) Is your spouse aware of how s/he contributes to the marital problems? If so, has s/he taken responsibility for making any needed changes? Or, instead, does s/he deny the existence of problems or blame you for causing any unhappiness in the relationship? If the answer to the final question is yes, you should think about the future with the assumption that things are unlikely to get better.

3) Are you aware of any ways you contribute to the problems in the marriage? Have you taken steps to make any needed changes? If the answer is yes and the problems remain, you should think about the future with the assumption that things are unlikely to get better. Note: If you have not told your spouse why you are unhappy, your silence may be contributing to your marital problems. If you find it difficult to communicate honestly with your spouse, couples counseling could be useful.

4) Are you able to think about the good and bad parts of the relationship at the same time? Or, instead, do you hate the relationship on some days and love the relationship or simply not mind the problems on other days? Until you can look honestly at BOTH the good and the bad feelings you have toward your spouse at same time, it will be difficult to make a decision with any staying power.

5) What do your friends and family think of your marriage and your spouse? If your close friends and family members are concerned about you, your spouse, and/or the marriage, this usually means there are problems to address. (Note: Your family may be unsupportive of you and your spouse or marriage because of their own biases, beliefs, and/or emotional issues. For example, same-sex couples can face a lack of familial support because their spouse is the same sex.) If you are not sure whether your family and/or friends have legitimate concerns, this may be a good time to seek out therapy and/or additional counsel of some kind.

6) Does anyone else know about your marital problems? Holding everything inside can make it difficult to see your marriage clearly. Talking to a close friend, family member and/or a therapist might be a helpful next step. If you can't confide in anyone you know, finding a therapist might be a crucial next step.

7) Are you having an affair? If so, it is unlikely you can sustain both relationships indefinitely. If you want to keep open the option of staying in your marriage, it is time to stop the affair as soon as possible and address any marital difficulties. If you do not want to end the affair or work to improve your marriage, it might be time to be honest with yourself and your spouse about your desire for a divorce.

8) Is your spouse having an affair? If so, do they appear to genuinely regret their actions? Have they taken steps to end the relationship? Can you imagine reconciling with your spouse? What are you willing to accept? Finding out your spouse is having an affair is extremely painful and many people find it is a process to work through these questions and decide how to proceed.

9) What are your values? If divorce is against your religious/spiritual beliefs or personal values, it is important to take your convictions seriously as you weigh whether or not divorce the the best choice. Making decisions that explicitly conflict with your values tends to cause inner conflict and stress.

10) What makes you want to stay? In a healthy marriage, at least some of the reasons to stay married will have to do with your connection to your spouse. In order words, there are at least moments you feel genuine affection, you admire and respect your spouse, you are a good team, and you want to connect and communicate. In an unhealthy marriage, people stay for other reasons--e.g. you don't want to hurt your spouse, you don't want to lose the financial support and/or pay alimony, you are afraid of your spouse,  you fear consequences in your social circle, and/or you are worried about the impact of your children. If you are staying in your marriage for the second set of reasons, divorce could be the right decision. However, you will need to address your reservations. For example, many people are legitimately concerned about finances and the potential emotional impact of a divorce on their children.

Tuesday, January 21, 2014

Supporting Others Through Tragedy

You may be visiting this blog in hope of finding a therapist for someone you love. Perhaps that person has been through something extremely difficult, such as a loss or traumatic event. I thought this article, The Art of Presence, by David Brooks, in the New York Times had some extremely insightful words about supporting others in the most difficult of circumstances.

Tuesday, January 7, 2014

Life after Abuse

A large part of what I do in psychotherapy with people as a Clinical Psychologist falls under the category of abuse recovery. Abuse is a broad term, encompassing physical, sexual, and emotional abuse. Sometimes, abuse is a one-time event by an abusive acquaintance of stranger. At other times, there is an ongoing abusive relationship with a parent, stepparent, relative, coach, teacher, religious leader, spouse, sibling, close friend or even an adult child.

When a child is abused, especially when the abuse is repeated by someone who has an ongoing relationship with the child, there are often long-term mental health consequences reaching into adulthood. It is hard to know who to trust and how to build a trusting relationship when you were abused and/or not protected from abuse by adults around you as a child. It is hard to know how to tolerate emotional pain when you have years of experiencing sometimes truly intolerable pain in isolation with no relief other than addictive behaviors that distract and numb.

How do you recover from abuse? Abuse recovery has several important components, including:

1) Finding a Safe Environment. When you are in regular contact with people who abuse you, especially when you live with them, abuse recovery is challenging. Leaving an abusive relationship is very difficult for many people with abuse histories because abuse feels "normal" and because it can be risky on multiple levels to limit or end those relationships.

2) Stopping self-destructive behaviors. Self-destructive behaviors such as restrictive or binge eating, self-harm behaviors, suicidal thoughts /actions, and addiction(s) to drugs and/or alcohol are often what brings people with childhood abuse histories to therapy. While books and seminars can be helpful, do not feel ashamed if you haven't been able to stop them on your own. In my practice, I use DBT frequently to help people with these behaviors.

3) Finding Trustworthy People. This is paradoxical for many abuse survivors. On the one hand, learning how to trust and getting the support of trustworthy people is absolutely essential for abuse recovery. On the other hand, most people with significant histories of abuse have a difficult time knowing who to trust and how much to trust them. Psychotherapy can be an excellent place to learn how to develop trusting relationships. However, not all therapists are equally trustworthy nor will all of them be a good fit for you, your personality, and your set of issues. It is important to hold out for a therapist who is competent in abuse recovery and who feels potentially trustworthy to you.

4) Disclosing the Abuse. It is extremely difficult to recover from abuse without speaking of it to anyone. Unfortunately, some people have had the experience of disclosing the abuse and not being believed or, worse, being abused by the person they trusted enough to disclose the abuse. If this is you, it is even more important to work toward telling someone who can validate that you were abused and that it was not okay. If you want therapy but cannot imagine talking about the abuse, know that it's normal to build a relationship with your therapist before disclosing your abuse. Finally, at some point in your therapy, you may find it helpful to talk about the abuse in detail, either by simply talking to your therapist and/or using additional methods such as EMDR, EFT, or Hypnosis.

5) Building a Life after Abuse. What kind of person do you want to be? What do you want your relationships to be like? What matters to you the most? What do you value? Where do you want to go in your future? These are the questions you will start to answer more fully as you build your life after abuse. Before dealing with the abuse, many people find their lives are centered on pain relief and avoidance. Once you do not need to expend energy numbing yourself and avoiding painful situations, you will free up a lot of energy that can be channeled into building a life worth living for you and the people you love.

Sunday, March 3, 2013

Living a Lie

As part of my listing as a Clinical Psychologist in Psychology Today, I receive their bimonthly magazine. I wanted to give a shout out to their article Living a Lie in the February 2013 edition. When I read it, I thought yes, that is exactly what I do. I help people identify the lies they tell themselves and to acknowledge and ultimately accept aspects of reality.

Denial is a form of protection for the mind. We are not ready to let go of our denial until we have at least some resources to face reality. Facing reality can trigger painful and difficult feelings such as loss, anger, hopelessness, anxiety, shame, inadequacy, vulnerability, terror, uncertainty, or resentment. These feelings can be so overwhelming and alarming to the brain that it blocks them or leaks them out indirectly.

In my office, I regularly meet with people who identify as LGBTQ and people with histories of trauma and abuse. People who are LGBTQ may begin their identity formation process by denying that are not straight and not their biological gender (see my Coming out Scale), largely because they are afraid of the implications of that admission for their own self-identity and their relationships to others. People who have experienced repeated trauma and abuse are usually lied to by the abuser(s) and may even adapt by literally forgetting about the presence or the extent of the abuse, at least temporarily. (For more on trauma and dissociation, click here).

Facing reality is a process whereby you gradually expand your understanding of yourself, the people around you, and even your place in the cosmos. Ultimately, this can be freeing and life-giving. In the short-term, it can be difficult and the journey is easier when you are not traveling alone.

Friday, April 27, 2012

Suicide as an Escape

Yesterday, I had the opportunity to speak with local pastors and chaplains at Good Shepherd Hospital in Barrington, IL about suicide prevention. I have worked with many clients who struggle with suicidal thoughts in community mental health centers and now in private practice. Many people have a hard time understanding why someone would even consider taking their own life. In my experience, suicidal thoughts are almost always motivated by the fantasy of escape.

1) Some people believe that suicide will deliver them from pain they are currently experiencing. This pain can be emotional, physical, or even spiritual. When suicidal thoughts come to mind, a person may be trying to escape feelings of being deeply depressed, alone, abandoned, betrayed, or ashamed. Sometimes, the intensity of this pain is heightened by the existence of Major Depressive Disorder or Bipolar Disorder.

2) Some people believe that suicide will help them escape an impossible situation. Common situations I have observed that place people at risk are the following:

  • The person has experience a significant loss, such as the loss of a person to death (esp. suicide), a divorce or break-up, loss of a home, or loss of a job.
  • The person has recently been arrested or publicly exposed for something s/he experiences as humiliating, financially crippling, or career damaging. 
  • The person experiences distress over his/her sexual identity due to personal beliefs, bullying, fears about implications for current spouse and children, or perceived rejection or potential rejection by family members.
If you or someone you know is experiencing suicidal thoughts, you are not alone. If you are struggling personally, it is really important that you reach out to someone, especially a mental health professional. If you are worried about someone, do not be afraid to talk to them about suicide and encourage them to seek help. It is a myth that asking someone about whether they are suicidal makes them suicidal. Most people who are suicidal feel extremely alone and benefit from someone noticing their pain and caring enough to ask.