Anxiety Girl (or Boy)

OK, so I borrowed this from facebook! I think it speaks for itself. If you, your spouse, your child, or your best friends identifies with this cartoon, check out my Coping with Anxiety page on this blog!

Holiday Blues

Many of the people I see in my office feel more distress around the holidays. Some have lost loved one's to death or divorce. The first Christmas or Hanukkah without your mother, husband, or child is often especially painful. When working with these clients, I try to help them prepare for the holidays by setting aside time to grieve, setting realistic expectations for themselves, and choosing activities that are life-giving.

The holidays are also a difficult time to be single, especially as you get into your late 20s and beyond. Most people dream of creating holidays traditions with that special someone and possibly even children. Going home alone to mom and dad, especially if your siblings bring home their partners, can be quite lonely. It is a common time to contact exes, even when you recognize on some level that the relationship ended badly or the other person has moved on.

Some people find the holidays difficult because of painful memories from childhood. If the holidays were often stressful or painful while you were growing up, it can be difficult to be open to the parts of the holidays that offer joy, peace, connections to others, and meaning. I work with these clients on taking practical steps to create the Christmas or Hanukkah they are seeking. Sometimes these clients also need help recognizing ways they contribute to the tension they experience.

Still others find the holidays complicated simply because it means family time. Even when there is a lot of love, there can also be tension, unresolved hurt or anger, and complicated family dynamics. Sometimes, people cannot name what it is that makes their time with family members uncomfortable or challenging. I hear people say things like "I don't know why I am not looking forward to Christmas with my family." Psychotherapy can help people not only name and describe the problems but find ways to make things better.

Challenges facing LGBTQ Christians

Due to my involvement in One Wheaton, I was recently quoted in Time Magazine online about some of the difficulties Christian LGBT people experience.

Raising Gifted Children

A special interest of mine is working with gifted children and adolescents, both as a therapist and as someone who does IQ testing. I practice in a school district in Illinois (District 220) that has a phenomenal program for gifted youth. Gifted, in this context, means having IQ test scores in the 5th percentile.

The label "gifted" can be very controversial. What parent doesn't think s/he has a gifted child? Isn't every child gifted in some way? Doesn't labeling some children as gifted an elitist notion that denies all children equal educational opportunities? These criticisms have at times contributed to a reduction or absence of funding for gifted and talented programs. It also must be noted people are not simply "born gifted." Children from economically disadvantaged communities are subject to a wide range of factors limiting the development of their IQ, sometimes starting in the womb.***

The reason I think it can be helpful to identify some children as gifted is because of their unique needs, not only intellectually but emotionally. These children can get bored in a normal classroom, contributing at times to behaviors that can mimic ADHD, such as daydreaming and restlessness. Emotionally, it is not always a gift for things to come easily. What happens when that child comes across something that is difficult to do? Many gifted children struggle with perfectionism. Another common challenge for these children is finding peers that are interested in the same things, leading sometimes to feelings of isolation and even inferiority.

Paradoxically, no matter your child's IQ, it does not help to focus on the idea that they are smart. In his book How We Decide Jonah Lehrer reviews some fascinating studies supporting the idea that success comes from the willingness to persist and to learn from our mistakes. Interestingly, children who identify as "smart" may fear losing that "smartness" every time they find a task difficult or do not get the "right" answer, leading them to avoid difficult tasks and ultimately learn less. In contrast, it is good to praise your child for effort and for trying again when they face obstacles.

*** In her book Origins, Annie Murphy Paul does an excellent job of reviewing recent studies of the impact of the prenatal environment on a wide range of factors, including IQ.

"When the heart breaks, no it don't break even..."

These lyrics from the popular song "Break Even" by The Script illustrate an unfortunate truth about the end of relationships. In theory, people would like their intimate relationships to end mutually over relatively benign, agreed upon statements such as "We were growing apart" and "We were just two different people." In reality, it's usually a lot messier and the stories often stand in sharp contrast. In my office, people often come for help because they are stuck with either feelings of rejection or feelings of guilt.

Person #1 feels rejected, abandoned, and sometimes betrayed. Sometimes, Person #1 starts therapy with some denial about whether the relationship is truly over. Attempts may be made to win back the affections of Person #2. When the reality that the relationship is over sinks in, Person #1 is stuck with intense feelings of sadness, loss, and devastation. S/he commonly feels rejected or even abandoned.  Sometimes, the pain is so significant that s/he cannot see a future where there is hope. Is there something wrong with me? Person #1 wonders. Will anyone ever truly love me and stay around?

Person #2, in contrast, usually feels a combination of guilt, shame, and relief.  Person #2 often feels like a "bad" person for wanting ending the relationship in light of the pain of Person #1. Sometimes the shame and guilt leads Person #1 to make decisions that are appealing in the short-run but ultimately prolong the pain, such as attempting to comfort Person #1 about the divorce or break-up. Person #2 may also deal with the guilt and shame by minimizing the pain of Person #1 or by trying to prove to themselves and others that they were justified to end the relationship. Ultimately, Person #2 wonders: Will I ever be able to love someone without hurting them?

Whether you are Person #1 or Person #2, your pain is legitimate and psychotherapy can be a good option. Identifying the problems that led to the end of the relationship can help you avoid repeating the same mistakes in the future. Also, grieving in a healthy way will allow you ultimately to open your heart to future happiness.

Tips for Parents of Teens who Self-Injure

I commonly see teens and adults who engage in self-injurious behavior, including cutting, burning, and a range of other behaviors. Parents of teens who engage in these behaviors understandably have a number of strong feelings, including shock, anxiety, frustration, sadness, and guilt. Most want to know what they can do to help. Here are a few dos and don'ts:

                                                                  Don'ts

1. Don't assume the problem will simply go away, even if your teen assures you s/he won't engage in the behavior anymore. Your teen needs professional help.
2. Don't try to control their behavior. Keeping an eye on them constantly, taking away self-injury instruments, and harsh consequences are unlikely to reduce the behavior and could instead trigger a stress reaction that makes the behavior more likely.
3. Don't communicate to your teen that s/he is "crazy" for engaging in the behavior. It may be difficult for you to understand, but people engage in this behavior for a reason.
4. Don't accuse your teen of trying to make you feel guilty. You may feel guilty, but it is unlikely that you teen started engaged in self-injurious behavior for that purpose.

                                                                       Do's

1. Do get professional help. Depending on the severity of the problem, your teen could benefit from some combination of outpatient therapy, medication, and an inpatient or outpatient hospitalization program.
2. Do try to stay as calm as possible when talking to your teen.
3. Do ask helpful questions such as: "How does self-injury help you feel better?" and "Is there anything stressing you out right now that I can help you with?"
4. Do communicate that you are there if and when your teen wants to talk. If they are not ready to talk when you initiate the conversation, let them know you will check in again later.

For more information about self-injury and how you can help, the Cornell University Family Life Center has created an excellent website.

Borderline Personality Disorder (BPD)

I regularly work with people with Borderline Personality Disorder using DBT (Dialectical Behavior Therapy). These clients seek psychotherapy for a wide range of reasons, including tumultuous relationships, anxiety, depression, PTSD, histories of abuse, addictions, self-harm (e.g. cutting, burning), and suicidal thoughts/attempts. These clients frequently face the dilemma of knowing they are in psychological pain but finding it difficult to trust mental health treatment providers. If you have been diagnosed with BPD, you are not alone. I cannot promise I am the right therapist for you. But I urge you to be intentional about selecting the right therapist. Make sure to ask any potential therapist about their qualifications specifically for working with BPD clients; ideally someone with training in DBT.

Sometimes, clients come to me because someone they love has BPD. Perhaps a parent has BPD or they are in an intimate relationship with someone with BPD. This can be a confusing and sometimes difficult experience.  If this is you, you are not alone. There are indeed unique challenges of relating to someone with BPD. The book Stop Walking on Eggshells by Mason and Kreger does a good job of describing what it is like for people who are close to someone who has BPD. They have also written a workbook that includes practical ways of relating to someone you love with this disorder.

Baby Steps

One of my favorite movies of all time is What About Bob? Thankfully, I have not had any clients like Bob and I haven't come near to losing it like Dr. Leo!  But a useful, albeit overly exaggerated, idea in the film is baby steps. Clients usually come to me because they want to change something, whether it is their way of relating to others, an addiction, or simply the way they feel.

In the area of personal growth, it is all too easy to set yourself up for failure by being overly ambitious. I  use the example of someone who is completely out of shape creating a work-out plan that entails starting with 2 hours a day of exercise. Depending on your fitness goals, it might indeed be desirable to spend 2 hours in the gym. However, if this is your first step, it is very likely that: 1) you will never start this fitness plan or 2) you will actually attempt the fitness plan for 1 or 2 days and quit exercising altogether due to the physical discomfort.

Similarly, you are not likely to simply "stop worrying" or "stop criticizing yourself" overnight just because you realize it is a problem and make a decision to do so. All of us have varying psychological vulnerabilities, just as we have physical vulnerabilities, due to a combination of genetics and our past experiences. How then does change happen? In DBT language, the dialectically opposed poles of acceptance and change are part of the process. So, you have to try to accept yourself and your vulnerabilities, make realistic goals that take your strengths and vulnerabilities into account, and put sustained effort toward your goals over a period of time. In other words, baby steps.

Common Myths that Fuel Therapy Avoidance

Some people avoid seeking psychotherapy because of myths or half-truths they believe. Here are a few common myths that keep people from seeking help:

Myth #1: Only really "crazy" people seek psychotherapy.

Fact: It is true that people with serious mental illnesses like Major Depressive Disorder or Bipolar Disorder need therapy. However, more people seek therapy for the sadness, worry, and/or agitation triggered by common stressors.

Myth #2: I should be able to solve my problems on my own.

Fact: This myth is especially favored by men, but some women also feel like seeking therapy means admitting defeat. The fact is, most people come to a point sooner or later when their toolbox could use some new tools. There is no shame in this.

Myth #3: My problems are not that important because other people have much worse problems.

Fact: If your problems are important to you, they are important period. You are as valuable as anyone else. 

Myth #4: It's not me that needs psychotherapy, it's my brother/ spouse/ mother/ child.

Fact: Even if your loved one does need help, you too may need therapy if you find yourself consumed by worry, sadness or irritation because of the person in question.

Myth #5: My problem will go away on its own. 

Fact: This may be true. Some problems do resolve naturally in time. Others fester until they are properly addressed.  


Myth #6: My problem is too embarrassing to tell anyone about.
Fact: While you may be embarrassed to talk about your problem, it is unlikely your therapist will be uncomfortable. Part of a therapist's job is to help people feel comfortable talking about difficult, personal issues. 

Do I Need Therapy?

Deciding whether or not to start psychotherapy can be tricky. Some questions to ask yourself right off the bat are: 1) What is likely to happen if I do not seek help?
2) What's the worst thing that could happen if I do seek help?

Let me give you a few common reasons why people come in to my office:

• Some people are in a strained relationship with a spouse, a parent, a child, or a friend. 
• Some people experience sadness, anxiety, or anger that does not go away.
• Some people are grieving the loss of a loved one due to death or divorce. 
• Some parents seek counseling for a teen who is moody, explosive, withdrawn, or even suicidal.
• Some young mothers experience sadness or fear that interferes with their ability to fully take joy in their little one. 
• Some people need help with a previously diagnosed mental illness such as Bipolar Disorder, Major Depressive Disorder, or an Anxiety Disorder. 
• Some people are addicted to alcohol or drugs.
• Some people struggle with how to relate to a loved one who has an addiction, a serious mental illness, or a significant physical condition. 
• Some adults & teens are distressed about the fact they may be lesbian, gay, bisexual, or transgender. Others have positively identified as LGBTQ and are trying to cope with the potential or actual negative responses of family members and friends. 

I offer you this list because maybe you will recognize yourself. People seek psychotherapy for many, many reasons. Life may get better without the help of psychotherapy. But why not invite a professional  to coach you on how to lighten the burden you are carrying? 

Talking to your Tween about about Teen Suicide

I wanted to share this article that I wrote with a colleague with mine, Rayanne Coy, who is a parenting coach. In the Barrington area where I practice, the community has had to confront the problem of teen suicide several times over the past several years.

Relationship Tip

I wanted to pass on a tip which I have found helpful in my practice. The next time you have a problem to discuss with someone, ask yourself the following question: how would I bring up my concern if I genuinely believed I would receive a positive response?  It can help to visualize the other person listening carefully and responding with warmth. How emotionally present and receptive would you be in this scenario? What would your tone of voice be like? What words would you use? How relaxed would your facial muscles be? What would your posture be like? How much eye contact would you choose? How would you bring up the topic in the first place?

When we don't expect to be heard, we can speak in a way that makes it hard for someone else to give us that positive response we desire. Here are some things people commonly do when they expect an antagonistic response: talk loudly, use aggressive body language, tense up physically, speak overly apologetically, avoid eye contact, hurl insults, shut down emotionally, avoid the conflict altogether, make threats, refuse to listen, or try to prove to the other person that they are wrong. In other words, we fall into a "fight or flight" way of communicating (see my blog entry on Trust.)

The tip does not always work--e.g. if you are speaking to someone who is emotionally detached from you or who genuinely believe your concerns are not legitimate. But, in many cases, it is one step toward not only defusing conflict but deepening the intimacy level of a relationship.

A Plea for Couples - Seek Help Early!

One of the greatest challenges for any couples therapist is helping a couple rebuild trust when at least one person has years of resentment piled up. In these situations, even when the person in the "dog house" is finally ready to make changes, it can be too late. A relationship problem is like a weed in your garden. When it is an inch tall, it is easy to pluck. When it becomes a 4-5 foot tall plant with thistles with a root system just as deep, it is much more challenging. To make this practical: if your alcoholic spouse is finally in recovery after 20 years, how do you move forward? How do you forgive them for the impact the drinking has had on you and your children? How can you possibly trust that things will be different? How can you even picture your relationship without the addiction?

This is why I am sending out this plea--if problems in your relationship are just beginning and you cannot seem to resolve them as a couple, do not pass go, do not collect $200, apply the $200 you already have toward your couples therapy fund! If you are considering making a long-term commitment but have any significant reservations it is better to face those things now before becoming more deeply invested in building your life together. If you feel your partner is spineless with the in-laws, come in before you come to despise both your spouse and the in-laws. If you and your partner have nasty, explosive arguments, it is better to seek help before you have years to nurse grudges over insults hurled in the heat of the moment. If you feel emotionally neglected or intruded upon with some regularity, realize that these issues often do not get resolved without intervention. Even if you decide to move on, these issues can reappear in subsequent relationships, so getting therapy for yourself can be worthwhile even if your partner refuses to come to counseling.

This is not to say that all is lost if you have been stuck in the same pattern for years. It is difficult to soften your heart toward someone who you believe has failed you significantly and/or repeatedly over the years. But that softening is where hope lies. Being open to your partner's efforts to change, even if those changes are small and gradual, helps to cultivate the soil where your relationship can grow. 

Trust

Relationships cannot exist without trust. The absence of trust can keep people isolated from each other, or in a combative pattern of relating to each other. All of us have a built in "fight-or-flight" response to danger. If a tiger is racing toward me, I will flee to safety, if possible, or fight for my life if there is no alternative. In The Gift of Fear, Gavin de Becker writes about the value of this response pattern in protecting us from physical violence. However, physical violence is not needed to activate this system. When day-to-day relationships start to sour, the other person may feel like that tiger. When this happens, your instincts may tell you to fight (i.e. verbally attack the other person, defend yourself) or to flee (i.e. emotionally withdraw or physically leave the relationship). Sometimes these responses are entirely appropriate. At other times, our fears serve to shape  reality as we unwittingly help to create a corrosive dynamic in a valued relationship.

To add a layer of complexity, our judgment is not perfect. I must ask myself--am I truly under attack or do I just expect to be attacked because of my (or our) past? These kind of questions are sometimes difficult to answer on one's own. Part of my job as a Clinical Psychologist is to help people sort through when trust is appropriate, how much trust is warranted, and when "fleeing" might be the best choice. People with a history of trust violations due to emotional, physical, and/or sexual abuse find these questions especially challenging.