Adjusting to Change / Life Transitions

One of the most difficult realities of life is that change is the only constant. Seasons change, people come and go, all that lives dies. We often spend so much of our lives trying to achieve our goals, arrange our lives in the manner we desire, and hang onto pleasant situations and avoid unpleasant ones. Sometimes, what is good lasts and what is hard ends quickly; at other times, the reverse is true. One thing to remember is that change often a stressor, and if you have experienced major changes in your life – such a losing a job or relationship, moving, or entering a new phase of life like retirement or “the empty nest” – stress is a near certainty, and quite normal. Therapy can help you make changes in yourself to adjust to changes outside yourself. It can also help you get in touch with what is enduring, such as your values, strengths, close social support system, and spiritual faith.

• DSM Criteria for Adjustment Disorder
• Top Stressful Changes in Life
• The "Serenity Prayer" for Adjusting to Change
• Adjusting to Losing Career as Identity - Case Example
• Adjusting to Life after Death of Parent - Case Example

DSM Criteria for Adjustment Disorder

1.  Behavioral or emotional symptoms must develop in response to an identifiable event(s) and occur within three months of the onset of that event(s) / stressor(s).

2.  These behaviors or symptoms must be clinically significant as evidenced by at least one of the following:

• After exposure to the event(s) / stressor(s), the behavioral or emotional symptoms seem in excess of what would be normally expected.

• Significant social, functioning, or occupational impairment.

3.  The disturbance does not meet the criteria for another specific Axis I disorder or is not part of a preexisting Axis I or Axis II disorder.

4.  The behavioral or emotional symptoms do not represent Bereavement.

5.  Once the event(s) / stressor(s)  has terminated, the symptoms do not last more than an additional six months.

6.  Acute:  Last less than six months.

7.  Chronic:  Last for six months or longer. By definition the disturbance can not last longer then six months. Only use the chronic specifier if the disturbance is in response to a chronic event(s) / stressor(s).

Specifiers and Subtypes:

With Anxiety

With Depressed Mood

With Disturbance of Conduct

With Mixed Anxiety and Depressed Mood

With Mixed Disturbance of Emotions and Conduct

Unspecified

Top Stressful Changes in Life

Research by psychologists over many years has produced the following list of stressful events. Do any apply to you? Add up their values and give yourself a score. If your score is over 40, therapy is probably a good idea to consider, and if it is over 60, therapy is highly recommended.

STRESSFULNESS LIFE EVENT

100 Death of spouse

73 Divorce

65 Marital separation

63 Jail term

63 Death of close family member (except spouse)

53 Major personal injury or illness

50 Marriage

47 Being fired from work

45 Marital reconciliation

45 Retirement

44 Change in health of family member (not self)

40 Pregnancy

39 Sex difficulties

39 Gain of new family member

39 Business readjustment

38 Change in financial state

37 Death of close friend

36 Change to different occupation

35 Change in number of arguments with spouse

31 Mortgage over $40,000

30 Foreclosure of mortgage or loan

29 Change in responsibilities at work

29 Son or daughter leaving home

29 Trouble with in-laws

28 Outstanding personal achievement

26 Spouse begins or stops work

26 Begin or end school

25 Change in living conditions

24 Change in personal habits (self or family)

23 Trouble with boss

20 Change in work hours or conditions

20 Change in residence

20 Change in schools

19 Change in recreation

19 Change in church activities

18 Change in social activities

17 Mortgage or loan less than $40,000

16 Change in sleeping habits

15 Change in number of family get-togethers

13 Change in eating habits

13 Vacation

12 Christmas

11 Minor violations of the law

The "Serenity Prayer" for Adjusting to Change

Many people are aware of the “serenity prayer” from the 12 step tradition: “Grant me the serenity to accept what I cannot change, the courage to change what I can, and the wisdom to know the difference.” One thing we cannot change, is change. In Buddhism, the most popular religion in China and Japan, a core teaching is “impermanence”. There is so much that is out of our control. Change can happen anytime; in fact, it is always occurring. Life stages change; we move from child to adult to elder. Our finances change, for better or worse (and both can be stressful). Relationships change. People change. Beliefs and goals change.

Adjusting to Losing Career as Identity - Case Example

Trudy, 57, enters therapy because she has become suddenly depressed and anxious after many years of feeling healthy and adaptive. Upon exploration, the therapist discovers she has been pressured to retire early by her employers, with an excellent pension and severance pay. Her husband wants her to take the offer, but Trudy feels terrified of having “nothing to do all day” and feels threatened in terms of her identity, insisting “my job is who I am.” The therapist works with Trudy to first enable her to determine whether she is ready for retirement yet (she isn’t) and then to face the reality that retirement is just around the corner, and to discover what activities she can explore to keep meaning and joy in her life. By examining her skills and values, Trudy is able to identify both leisure and volunteer activities and begin to make peace with her impending change of life stage. She also explores her fear of death and being alone and is able to begin working through those feelings.

Adjusting to Life after Death of Parent - Case Example

Dave, 22, is anxious about finding a job and defining himself after graduating college. The transition is made more difficult by the loss of his father, who died of cancer. Talking about his feelings is hard for Dave, but doing so begins immediately to help him feel better. The therapist helps him identify his life goals, spiritual beliefs, and support system, and also normalizes his feelings of fear, about which Dave initially felt rather ashamed. Dave feels her is not ready to commit to a life-time career yet, and the therapist also validates Dave’s desire to first explore life’s many possibilities before “settling down”.

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