Elephant holds umbrella over dog with trunkTime and again, people share with me the difficulties they have in asking for help. When I hear this, I’m grateful they found their way to my office, because their first phone call to me was an example of having done so.

We all have moments in our lives when we require the assistance of others. We don’t ever know all there is to know or have the skills to do everything proficiently or successfully. We certainly don’t expect that of others, either. So it makes sense we would have occasion to ask someone for help at some point.

The biggest reason many seem to have for staying stuck rather than reaching out is fear. People fear they will be rejected or told “no,” fear being seen as “less than” or weak, or fear being “found out.”

Being told “no” does not have to be awful. We do not have to weave a story and personalize the rejection (make it about us). It may be that the person we chose to ask didn’t have the appropriate resources to help us at that time. It’s best to accept the “no” as the answer to our request, not a negation of ourselves. A “no” tells us not to waste any more time and energy asking this particular person, and guides us closer to someone who will say “yes.”

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Some equate being vulnerable with being weak, but asking for help takes self-awareness and courage. It’s important to know where our strengths lie and where they don’t. Sometimes the most efficient way to proceed is to focus our efforts where they have the most impact, and implore others to fill in the gaps according to their skill sets, leading to teamwork and collaboration. To be vulnerable is to provide the opportunity to connect and pool resources, thereby resulting in further strength.

The fear of being “found out” is akin to the fear of being exposed as a fraud (impostor syndrome). It can coincide with all-or-nothing thinking or perfectionism—believing that if we don’t know it all, we know next to nothing. In most roles in which we function, whether it be parent, employee, or partner, we are not expected to know it all. There are always opportunities for us to learn and grow. It doesn’t serve us to pretend we have every answer. However, it benefits us and others to know where to go for assistance when we need it, and then to avail ourselves of those resources.

What can you gain by asking for help?

It’s also worthwhile to think about whether you’re willing to help others when asked. If you tend to say “yes” and are maybe even happy to be asked, then perhaps you can better see the value in asking for support from someone else.

Asking for help doesn’t devalue you in any way. It can enable you to advance, connect you meaningfully with others, bolster your productivity and ability to do things with greater ease, and better prepare you for your next challenge.

Mannequins posed to appear as if they are having a chat over a fenceThe relationship a person has with a therapist is unique. Some people question why they should seek professional guidance when they can talk to their loved ones for free, while others who are already in therapy wonder about the unspoken etiquette, ethics, and rules of this special relationship. It is critical for those in or seeking therapy to understand the dynamics and boundaries of the therapeutic relationship. The distinction could mean the difference between a deeply healing experience and wasted time and money or, worse, retraumatization and new relational wounding for the person seeking help.

Dynamics That Bring About Healing, Change, and Growth

Unlike relationships with friends or family, the therapeutic relationship is a professional one that happens to be based on deeply personal material. Much like other health or medical professionals, therapists are bound by codes and ethics that not only lay out rules about confidentiality, but also ensure the relationship maintains the emotional safety and best interests of the person seeking help. This is different from the relationship with family and friends in that therapists have nothing to gain personally from the relationship. Any advice, questions, and even opinions expressed by a therapist are based solely on the best interests of the person in therapy. In return, people in therapy owe therapists only a sincere willingness to work toward their goals, basic relational courtesy, and previously agreed-upon fees. Although loved ones typically have your best interests at heart, they also often have their own biases based upon family traditions, cultural understandings, personal history, and the effects various outcomes may have on their lives.

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Additionally, while those closest to you may know you better than a professional therapist (at least at the beginning of a therapeutic relationship), this can be a drawback when it comes to getting clear or unbiased feedback. Those who have known you over a period of time may have preconceived notions of who you are, what you should do, or how you should behave.

In contrast, therapists endeavor to see people in therapy as clearly and objectively as possible, allowing for growth, change, and healing to occur in a way that best serves a person’s needs and well-being. Specifically, therapists are trained to maintain a nonjudgmental stance with unconditional positive regard for the basic humanity of the people who seek their services. Through skill, expertise, and their own self-awareness, therapists hone their ability to support and guide people so they may achieve their highest potential. Through the therapeutic relationship, people in therapy can experience a nurturing presence that helps them feel they are being seen, heard, and responded to appropriately.

Why Boundaries Within a Therapeutic Relationship Matter

In order for the therapeutic relationship to work, it is important the therapist maintain an unprejudiced stance by setting orderly boundaries. In the absence of such boundaries, it may be challenging for the therapist to maintain neutrality and for the well-being of the person in therapy to remain the priority over the duration of the therapy. Additionally, without clear boundaries it can be harder for people in therapy to feel safe, build trust, and focus on their needs.

Boundaries are based as much on judgment as they are on guidelines set forth by various professional codes of ethics. As such, it is less helpful to describe specific dos or don’ts here, as those can be found elsewhere. What should be understood here is the intent and effect of boundaries. Yet, anytime a person in therapy feels uncomfortable about boundaries, whether they consider them too strict or too lax for their needs, they should address their concerns with their therapist. In turn, therapists should respond to conversations about the therapeutic relationship in an open and non-defensive manner so the person in therapy feels their concerns or questions have been heard, answered, and addressed fully and respectfully.

When Boundaries Are Violated or Cause Relational Disconnect

Through the therapeutic relationship, people in therapy can experience a nurturing presence that helps them feel they are being seen, heard, and responded to appropriately.

While therapists are bound by codes of ethics, and must carry state licenses and malpractice insurance, some therapists may exhibit behavior that disregards best practices and violates boundaries to the point it can be harmful to the therapeutic relationship or to the emotional well-being of the person in therapy. If you have experienced therapy in which you felt misunderstood, upset, or used in any way, it is important that you tell your therapist. It may be a simple misunderstanding or feelings that are being projected onto the therapeutic relationship, providing a tremendous opportunity for a breakthrough conversation that leads to growth and healing.

However, if you do not get a genuine and satisfactory response from your therapist or your feelings continue over a period of time, you may choose to find a therapist who better meets your needs. Ultimately, the therapeutic relationship should be nurturing, fulfilling, healing, and reparative for you, the person in therapy, within the context of professional boundaries and mutual respect.

A Professional Relationship That Comes from the Heart

Finally, I want to make a note about the therapeutic relationship from the therapist’s perspective. Although it is a professional relationship and there are clear boundaries and parameters, the connection and desire to help is no less heartfelt or genuine than in any other relationship that exists outside the office.

Appropriate boundaries allow therapists to do good work in a safe manner, but they should not be a barrier to meaningful relational connection within the therapeutic setting. Ultimately, finding a skilled therapist with whom you feel safe and connected can provide the foundation for a powerful and life-enhancing therapeutic experience.

Man walks out of empty room with whitewashed wallsThink of the stories you tell about the endings in your life. Line these stories one against the other. What do they tell you about your relationship with endings in general? For many of us, goodbyes have a bad rap, associated with some of our worst memories. At best, we consider them gratifying conclusions to periods of prolonged misery. At worst, we construct them as traumatic punchlines to stories where we felt powerless and victimized, perhaps by the person who left us or by a harsh world which has taken a loved one. Conversely, as we see ourselves through the eyes of those we have left, we can experience complicated spirals of guilt, as unresolved today as the day we decided to depart. Whether voluntary or forced, the impressions left upon us are fraught with misgivings.

When therapy is successful, we are faced with the prospect of a new kind of ending. By the time it has come to say goodbye, a genuine mutual attachment between two presumed strangers has taken place. This kind of relationship, rare as it is in this world, certainly seems worth keeping. At the same time, it remains a professional relationship designed to conclude naturally as treatment goals are achieved. As therapy concludes, both therapists and the people they serve struggle with some of the same feelings prompted by other losses. We are faced, perhaps for the first time, with an opportunity to construct a mutual and intentional ending to a caring relationship.

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Carrying out an honest and healthy farewell reverberates on many levels. Within the safe field of therapy, there is a full spectrum of meaning we might put to the experience of saying goodbye. I offer the following brief scenarios of therapeutic closure with the expectation that we can see in each some basic elements of the human condition and of our own wish to find peace with the act of parting.

Saying Goodbye in an Incomplete World

Timothy’s goals in therapy had grown less specific over time. As he gained footing with the initial bouts of social anxiety that prompted his first visit to my office, he chose new goals for himself every few months. Overall, it had become a year of great personal growth for Tim. Moving into our second year of weekly sessions, he and I spent less time examining particular life challenges and more time exploring previously unexpressed aspects of his personality. “Expanding self-awareness” was a very appropriate goal for our time together yet brought with it a sense of endless expanse. A few months later, we agreed our work had plateaued. It was coming time to say goodbye.

The ease and companionship afforded by our extended time together gave Tim a broad view of himself. He had grown to expect the unexpected to surface. Thus, as the time of our departure arrived, there was no sense he had reached any set destination. Unlike graduating from school, he had no final test to measure mastery of a predesigned curriculum. Instead, similar to how it is to end relationships outside the office door, our ending point was inconclusive. “I feel like there is so much left uncovered, so many parts of me that have barely broken through,” he told me. “That hurts a little. Still, it just feels right to put this chapter of my life behind me. I’m grateful for it.”

Leaving therapy, for Tim, called upon a newfound experience of self-acceptance. We said our goodbyes with a bittersweet appreciation for what had transpired—both purposefully and unexpectedly—between us. As we shook hands at the door for the last time, we shared a final moment of accord: “This was enough.”

Saying Goodbye in a Solitary World

Julie felt trapped in her relationships and looked to therapy for help in setting better boundaries. “I am sick of being so afraid to make my own decisions when they inconvenience those who care about me,” she said. We spent three months together as she focused on establishing more independence as a daughter, wife, and mother. Julie was practical about her goals and diligent in applying new coping skills when confronted with others’ unease. I played what seemed a supplementary role in her personal transformation as I encouraged her latent sense of power, praised her intelligence, and offered assurance to the legitimacy of her quest. Over the course of these 12 sessions, she achieved a more outspoken and balanced role with her family members and felt “almost ready” to terminate therapy.

I was propelled into my career by a high regard for building deep connections. It wasn’t clear to me during my training as a therapist that I would become a master at relinquishing them as well.

“Maybe I should plan on seeing you monthly,” she said. “You’ve become a bit of a father figure to me and I just don’t want to give this up.” This statement, shared at our “final” session, was uncharacteristic for Julie. She seemed surprised, though not embarrassed, by her tears as she spoke. I felt touched by the depth of her affection but also recognized that her tears were not about her and me. There was the ghost of another father in the room with us, one whom she had never had the chance to show those tears. “He left me way before I was ready to let him go. I’m still so afraid to be on my own.”

Julie and I settled on a four-week extension of therapy to look a little deeper at the fears associated with the early loss of her father. It was a volatile and vulnerable set of sessions. In one, Julie gave herself brief permission to rage and sob over being abandoned in a lonely world; a side of herself so rarely expressed but situated at the center of her long-held habits of dependency. Then, just as quickly as they surfaced, the intense feelings subsided. The following week, we took another try at having a final session. Julie’s voice was steady and her hands lay still at her side as she thanked me for our work together. Our goodbye was that of two grown-up adults—solitary, intact, prepared.

Saying Goodbye in an Impermanent World

Death and dying had become a preoccupation for Matthew. He had good reasons to fear death—as do we all—but for Matthew these fears tended to permeate his every waking hour. His apartment had begun to reflect his inner state (“Why bother washing dishes if I might die tomorrow?”), making it a difficult place for casual entertaining or dating. In therapy, he sought the space to expound on the bleak thoughts he knew his friends would find too morose.

With time, as we formed our own retreat for his darker visions (both real and imagined), Matthew learned to compartmentalize his fears and address them more fully with me. As our sessions focused on giving air to his compulsive morbid thoughts, the rest of his life opened up. He took more interest in others and incidentally began to adopt more of their interests as his own. His apartment began to express more of a genuine investment in life.

Anticipating his eventual departure from treatment, Matthew grew nervous. He had no intention of painting the end of therapy as a point of progress or new possibility. Endings, for him, would always carry an air of intense calamity. Ending his relationship to me meant also ending his relationship to the history of thoughts expressed between us. “Without you as my witness, it’s like all those parts of me will be taken from me as well,” he said. I immediately understood the truth of his words.

When we end relationships, we are forced to say goodbye to parts of ourselves as well. Terminating therapy brought a conclusion not only to Matthew’s past dysfunction, but also to the kindness, integrity, and intelligence we showed each other along the way. We decided to treat this closure much like a funeral. We took turns honoring the sadness entailed in letting go of this significant yet transitory connection. Our bonds with others on this planet are always tinged with melancholy for their brevity. Each goodbye is a small death to those grand pieces of ourselves that we can only find in one another.

I was propelled into my career by a high regard for building deep connections. It wasn’t clear to me during my training as a therapist that I would become a master at relinquishing them as well. Of course, the door to those connections never fully closes. Most people are invited to return as the need arises or to schedule additional sessions to revisit their long-term goals. But the act of ending therapy is always a crucial piece of the process and a strong reflection on the nature of the person seeking help. Financial limits, scheduling conflicts, and abrupt changes at home usually provide the pragmatic reasons for sudden terminations. These are genuine, but they often also mask an underlying distrust that a meaningful ending is possible in a fragmented and fragile world.

I’ve learned to hold out that an intentional goodbye is the most instructive. A true companion deserves nothing less.

Note: To protect privacy, names in the preceding article have been changed and the dialogues described are a composite.

Yellow flower grows in crack on sidewalkPart of GoodTherapy’s mission and vision is encouraging people everywhere to learn more about mental health issues and treatment. We believe this is helpful in changing stigmatizing language and beliefs about mental health issues, in developing mental health care policies, and in promoting a system in which better, more compassionate outcomes are the norm.

Mental Health Awareness Month, established in 1949 and recognized each May, is a great opportunity for us to talk about stigma, share statistics, and demystify psychotherapy and other healthy treatment options. It’s also a chance to celebrate the important work mental health professionals are doing every day. This Mental Health Awareness Month, we reached out to our members and asked them to share, in their own words, what motivated or influenced them to work in mental health care. They responded:

 

jessica wade therapistJessica Wade, LPCC

As long as I can remember, I have been a student of people. I remember asking questions about why some people did well in life and others seemed struggle. While I think this is a question researchers are still studying, I did notice patterns in the lives surrounding mine. I noticed that people who believed they could overcome their problems seemed to fare better than those who believed their problems were too big. I watched people who believed they could overcome problems truly rise to the occasion and overcome serious addiction, rise out of poverty, choose healthy relationships, and find mental and behavioral stability. As a therapist, my goal has been to enrich and fortify people’s self-knowledge that they can overcome difficulty. They have the potential for personal greatness within them, and I help them rally their resources to create the lives they desire. I firmly believe that they can create the kind of lives and relationships they desire, only when they firmly believe they can. I have made it my mission to help my people see their own potential and believe in the power of themselves to make it happen. I see greatness come alive in the small steps my clients take each day.

 

benjamin meyer therapistBenjamin Meyer, LCSW

As I think about the tears that dripped down the face of one of the mothers who had lost her son in the 1970s in the clandestine and infamous German colony known as Colonia Dignidad, located in Southern Chile, I distinctly remember the words of one of my college advisers: “And to think, Benjamin, that after all these years, she still remembers it as if it was yesterday.” My interest in becoming a mental health professional stems from my experiences working with individuals and families who had been violently persecuted under Chile’s Pinochet dictatorship and during the Salvadoran Civil War.

[fat_widget_right]I witnessed the ongoing impact of having lost a loved one, having experienced torture or knowing someone who was, and being forcibly uprooted from one’s community. I felt limited in my ability to help the persecuted and their family members to process the complex feelings associated with political violence. My motivation for becoming a therapist stemmed from my desire to do more. Therefore, I pursued a master’s in social work and began to work with children and families, many of whom have faced forced immigration, domestic violence, racism, and school-related concerns. I make a difference every day.

 

davida price therapistDavida D. Price, MS, EdS

For them; that’s why I did it, at first. I wanted them to understand that they didn’t ruin me. That I had become full—exceptionally strong, self-empowered, capable—despite them. I completed my undergraduate degree in psychology, seeking to understand them and myself. I wanted to understand how I had become an adolescent poetess, drinker, smoker, partying, feeling-all-the-time-not-wanting-to-feel-at-all type of person. I learned during that time in my life that I was none of those things, but rather an empty, love-desperate child pretending to be an adult who was complete. Then, I entered graduate school. Now older, rubbed raw from military experience and weary from rumination and “self-help,” I wanted it for me this time. Not them. The program I entered was strategically designed to cultivate integrity, strength, and wholeness.  The student-therapist I became developed a strong self-concept, a secure locus of control, and (most important of all) faith. That faith led me to where I am today. Today, I want to serve others. Motivate others. Help other people on their journey from emotional poverty to wholeness, security, and their truest self.

 

gena golden therapistGena Golden MSW, LCSW, CHt

As a child, my outlook was filled with pessimism and negativity mainly as a means to protect myself from hurt and disappointment. I convinced myself that if I had low expectations about outcomes, I would be shielded when the other shoe dropped. My mother, a case worker at a Philadelphia psychiatric hospital, would always refer to a concept called mind over matter. She would try to convince me that what we believe to conceive, we can achieve. Clinging to my “Negative Nancy” outlook on life, I couldn’t understand my mother’s notion about the mind having power over my experience. However, it all changed one day when I had the most horrific headache I ever experienced in my young life. I was so miserable and debilitated by this strange pain in my head that I declared at 9 years old that I would never have another headache again. That day, I put my mother’s teachings into action and declared and imagined every day that I was free of headaches. I maintained a 35-year headache-free life all due to how I changed my thinking, words, and actions as a tool to manifest my desired outcomes for my life. I decided as a young girl that I wanted to support others through challenges in their life by helping them to heal through the use of their own inner power. As a counselor and hypnotherapist, I help people relax their bodies and minds through the use of hypnosis. Together, we explore positive ways to recondition limited thinking patterns, belief systems, and behaviors to uncover the results desired for their lives, business, and relationships. I am passionate about people I treat and their transformation from self-sabotage, unhealthy beliefs, self-doubt, and pessimism, to a space of clarity, self-esteem, confidence, and optimism with our work together. I find joy in helping others live a more fulfilled life.

 

therapist meri levyMeri Levy, LMFT

I imagined growing up to be a therapist when I was a teenager, because my mother worked as a psychotherapy office manager and the therapists seemed like interesting people. But when I got to college, the psychology department was all about lab rats and psychological experiments, and I really had no interest in that. I discovered I was good at economics and ended up getting a master’s degree and working as an economist in state government for over a decade. Then, after having my second child, I suffered from postpartum depression and anxiety. It took months of suffering to get a diagnosis and the proper treatment. After I recovered, I was fired up about supporting other moms in getting help. After several years of running support groups, I decided the best way I could help was to become a therapist and specialize in the treatment of new moms. It’s been so satisfying to be able to help light the way for those suffering through a traumatic journey that I have personally experienced.

 

marni amsellem therapistMarni Amsellem, PhD

Mental Health Awareness Month is a meaningful time to reflect on why I wanted to become a psychologist and how that still rings true today. As someone who has devoted my career to the promotion of mental health, I am grateful for the opportunities I have been granted through my work. As a therapist, I have been allowed access into the inner worlds of others. I have been entrusted with thoughts and feelings that are often not shared with others in their daily lives. It is a giant responsibility and something that I thoroughly enjoy.

I became a therapist so that I could help others understand themselves better so they learn how to help themselves feel better. I help others recognize insights and make connections in their own world that lead to a shift in their understanding of themselves. My goal is to help teach skills that bring meaningful and positive change into the lives of others. The changes that happen in therapy will both lead to immediate relief and, ideally, to sustained improvement and growth over time. Having the opportunity to have an influential role in this process is exactly why I provide therapy.

 

tammi young therapistTammi Young, LMFT-S

I became a therapist because of the sexual abuse and domestic violence that I experienced as a child. I could not understand why I could not get over the anger and other overwhelming feelings I had until I went into counseling. The feeling of being understood and validated was so healing that it didn’t matter to me anymore if my family didn’t understand me because I knew that God understood me as well as my therapist. I became a therapist to walk that “scary road” with people and to let them know that I do understand! Understanding is what I received, and understanding is what I want to give back!

 

Reference:

Mental health month. (2016). Retrieved from http://www.mentalhealthamerica.net/may

Silhouette of upset woman in open doorwayThe therapeutic relationship can be a very powerful relationship. In fact, power in this relationship is vital, and something ethical therapists should think carefully about. Ideally, the therapist uses the position of authority inherent to the role to empower people in therapy and encourage them toward wellness and autonomy. Unfortunately, this does not always happen. In some cases, therapists have been known to abuse the imbalance of power in the therapeutic relationship. This can of course be harmful to the people they are entrusted to help, who may not know exactly what is happening or what to do about it.

As a person in therapy, trusting your own experience and communicating about it are both essential to the outcome of therapy. If you have fears or doubts about something that happened or how you are being treated, in most cases you should speak with your therapist about these concerns. In turn, any such concerns should be taken seriously and addressed immediately by the therapist.

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Some ways therapists may go astray in the therapeutic relationship include behaviors related to boundaries, to fostering dependence, to their duty of care to you, and to acting in hostile ways. A number of specific things would be red flags. While I will discuss some of them, please know this list is by no means exhaustive, nor can it possibly be. It is important to trust your instincts about how you are being treated.

Boundaries are extremely important in the therapeutic relationship, and many are outlined in the ethical codes mental health practitioners are bound by. It is incumbent upon your therapist to maintain appropriate and professional boundaries; this is one of the ways the therapist fosters trust in the relationship and in the therapeutic process. Maintaining boundaries means your therapist should neither cross boundaries nor allow you to cross them as part of the relationship. The therapeutic relationship should empower you and enrich your life.

Examples of boundaries being crossed include:

Fostering Dependence

Therapists are ethically obligated to support people in therapy in living full, independent lives to the extent this is possible for them. In some (hopefully few!) cases, therapists have intentionally fostered dependence. As a therapist, my goal is always, as I say, to “work myself out of a job,” because this means the person in therapy has achieved the goals established at the outset and moved into a better space.

Some clues that your therapist may be fostering dependence in the relationship include:

For what it’s worth, some of the signs above are hallmarks of emotional abuse. You don’t deserve such abuse from anyone, let alone your therapist.

Deviations from Duty of Care

Therapists have a specific duty of care to you. This includes a legal and ethical duty to work actively toward your welfare and to be responsive to your needs.

Therapists have a specific duty of care to you. This includes a legal and ethical duty to work actively toward your welfare and to be responsive to your needs.

Some specific deviations from a therapist’s duty of care to you might include:

Hostile or Abusive Behaviors

Therapists may sometimes need to confront problematic behaviors or hold reasonable expectations regarding behavior of the person in therapy. However, this boundary should never take the shape of openly hostile or abusive behaviors.

Some indications your therapist is engaging in hostile behavior include:

The scenarios above provide a broad overview of some behaviors that may be indicators of a problematic or abusive therapeutic relationship. In some of these cases, it is conceivable that there might be reasonable clinical justification for certain behaviors. However, if you feel uncomfortable about your therapeutic relationship, you should address that discomfort—it is real, valid, and deserves attention.

If You Have Concerns Regarding Therapy or Your Therapist

If you have concerns about the safety or appropriateness of your therapy relationship, in most cases the best first step is to bring these to the attention of your therapist. In many cases, there may have been a miscommunication of some sort and your therapist will be grateful to you for bringing this to their attention so it can be addressed. (Good therapists want to help you feel better!)

If this does not seem possible or reasonable in your circumstances, you are always free to seek a second opinion from another therapist. Although it’s rarely advisable to have multiple concurrent therapists, one session to consult with a different therapist about how your therapy is going and explore the possibility of changing to a therapist who may be a better fit for you is always a reasonable step.

If you have serious concerns about how you have been treated in therapy, you can contact the licensing board for the type of professional you are working with in your state and ask what your options are. A simple web search should help you find this body. For example, searching for “counselor board state of Indiana” should help you navigate to the relevant authority that can help you with your specific questions or concerns.

Two wooden chairs in a waiting room with a clock hanging on the wall above themDefinitions convey meaning, but in the mental health field they have also historically wrought serious consequences, often while reflecting progress, procrastination, and prejudice.

As words, concepts, and public perceptions evolve along with modern psychology, clarifying certain words can help reduce suffering, encourage treatment, and eliminate the stigma often associated with mental health conditions. However, terms that are outdated, inaccurate, or just ill-conceived can be spread by institutions, media, and fear while halting needed progress.

In recent decades, greater attention has been paid to accurately shaping definitions of conditions, symptoms, and diagnoses. The afflicted—as they were once widely called and viewed—are now more appropriately seen as individuals exhibiting symptoms of a condition.

Words such as “affliction” and “sufferers” can each connote a literal meaning that projects negativity or suggests a threat. Such unsound terms have, in part, been responsible for much of the stigma that still affects the conversation surrounding mental health.

Language, when used by health care professionals, can carry even more weight in shaping public perception and policy. When outdated terminology is implemented professionally or at the public policy level, false meanings may become institutionalized, potentially extending their lifespan by decades.

What’s in a Word?

A 2010 study from the Centers for Disease Control and Prevention (CDC) examined the historical use of the term “wellness” over “illness” in the mental health field, noting each carries a clear but opposing distinction—even when used interchangeably.

One suggests positive energy, enthusiasm, and life itself, while the other reflects the presence of a disease. The CDC report posits, “the major focus of (mental) health reform should be to promote wellness and well-being.”

While more general words like “wellness” are broad and used with considerable flexibility, the greater issue definition-wise is with more specific terms that directly depict false or misleading information. Through ambiguity and assumptions, a thick glossary of malleable terms persists.

[fat_widget_right]A study last year in the journal Frontiers in Psychology examined the issue and aimed to “promote clear thinking and clear writing among students and teachers of psychological science by curbing terminological misinformation and confusion.” The study’s authors offered a provisional list of 50 commonly used terms that they recommended should only be used sparingly or completely avoided.

The spotlighted terms were a mixture of inaccurate, misleading, and often misused definitions. These included:

Closure

Described by the authors as “hopelessly vague,” closure is challenged in its popular meaning as a “purported experience of emotional resolution” following a trauma. The authors point to a lack of specificity and research to support the idea that it will be clear when trauma victims reach a desired end to their emotional state.

Personality Type

Categorizing personalities into neat little boxes—such as introvert or extrovert—is still common, even among many medical professionals. This continues despite little significant evidence for the accuracy or completeness of such labels, which often overlook the nuanced degree of various personality traits.

Scientific Proof

It is often premature to suggest certainty while forgetting that science is provisional and always evolving. The concept of scientific confirmation can convey a clarity that clashes with the self-correcting nature of the field. As the authors suggest, no theory should be viewed as strictly proven, as all theories may end up being overturned by additional evidence.

Chemical Imbalance

Despite slim scientific credentials, the notion that mental health conditions such as depression are sparked by a chemical imbalance of neurotransmitters in the brain has become an assumed truth. This is largely unsupported, and some treatment methods contradict any available evidence suggesting there even is an optimal level of neurotransmitters in the brain.

Brainwashing

The idea that long-term perceptions and behavior can be altered through conditioning is not science fiction. Real and positive benefits from changing perceptions and attitudes are possible, but the idea of scrubbing the mind—either voluntarily or involuntarily—suggests erasing emotion rather than treating symptoms. According to the report, the techniques generally used in “brainwashing” are similar to those used in typical persuasion.

Autism Epidemic

The media likely bears much responsibility for the idea that a sudden rash of autism has been seen in recent years despite little corroborating evidence. What did increase were the actual diagnoses as both parents and professionals became more aware and informed about the condition. The most recent version of the Diagnostic and Statistical Manual (DSM) also lowered the diagnostic threshold for the condition, which likely resulted in increased diagnoses.

When outdated terminology is implemented professionally or at the public policy level, false meanings may become institutionalized, potentially extending their lifespan by decades.Genetically Determined

While genes can certainly influence psychology, the idea that they flatly determine psychological capacities is inaccurate. The concept may even deter treatment in individuals who might see a condition as irreversible. Believing something is genetically determined usually does not leave enough room for undetermined environmental influences.

Hard-wired

Similar to “genetically determined,” the idea that an individual might be innately predisposed to a given psychological framework (based on gender, for instance) is challenged by research. Studies have shown growth in data on neural plasticity, meaning only few things are completely inflexible in behavior expression. Most capacities, such as language and emotions, can be modified by the environment.

Underlying Biological Dysfunction

Another innate concept is the suggestion that certain psychological conditions or variables are biologically prepackaged. This approach often ignores other factors or even additional conditions at play beyond simple biology.

Multiple Personality Disorder

Though it was relabeled as dissociative identity disorder (DID) in the DSM in 1994, the perception that multiple personalities develop within a single individual is still widely held in many academic sources. Continued use of the misnomer perpetuates a view that falsely depicts people experiencing DID, while promoting stigma associated with DID and other mental health conditions as well.

The Evolution of the DSM

The industry’s touchstone for many years has been the DSM, from the American Psychiatric Association. The fifth edition was released in 2013, and like previous updates, it caused controversy and confusion upon its arrival. Dropped from the manual that year was the classification of dyslexia as a learning disorder, while Asperger’s syndrome was folded into the autism spectrum diagnosis.

The beauty of psychology as a science is its ability to change to more accurately define itself. The challenge is conveying such concepts in an open and honest exchange—ever aware of the consequential power mere words can wield.

References:

  1. Lilienfeld, S. (2015, August 3). Fifty psychological and psychiatric terms to avoid. Retrieved from http://journal.frontiersin.org/article/10.3389/fpsyg.2015.01100/full
  2. Manderscheid, R. W. (2010, January 9). Evolving definitions of mental illness and wellness. Retrieved from http://www.cdc.gov/pcd/issues/2010/jan/09_0124.htm
  3. (2012, January 20). Word of drastic changes to DSM-V autism definitions reaching the mainstream press. Retrieved from http://www.pediastaff.com/blog/word-of-drastic-changes-to-dsm-v-autism-definitions-reaching-the-mainstream-press-6671

Double exposure with woman sitting on floor and city in the backgroundRecently, I’ve found myself somewhat annoyed at the Pinterest mental health community. I know some may consider it taboo to disagree with other mental health professionals or, worse, to challenge the beliefs of people who live with mental health conditions, but I feel strongly that many in my profession do a great disservice to the people we serve and our culture by perpetuating the belief mental health issues are mostly biological and always require treatment. What irks me even more is that in a well-intentioned effort to reduce stigma, we may suggest there is relatively little individual choice or personal power in creating an emotionally healthful life for oneself.

I saw a pin on Pinterest recently that read, “Depression is an Illness, not a Choice,” and it made me angry. While a temporary state of depression can sometimes be caused by biological or hormonal factors, such as in the case of premenstrual dysphoria, most forms of depression are not caused by biological factors but rather by social factors, learned thinking styles, and ineffective behavioral choices. The desire to reduce mental health stigma is well-intentioned, but our efforts can be misguided at times, and we have gone overboard.

Here’s why.

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First, feelings of depression and anxiety, among other unpleasant experiences, are a normal part of the human condition. Most of us, at one time or another, have avoided doing something because it made us nervous. Are we all disordered? Do we all need medication? By discounting the fact ups, downs, and difficult emotions can be part of normal human growth and development experiences, we fail to give people the knowledge, support, and tools they need to move past those difficult periods. We label these feelings “disorders,” which can affect how people view themselves and can become a permanent part of their identity and self-concept.

Second, the medical model of labeling feelings as “illnesses” limits recovery options. In American culture, we have been conditioned to believe illnesses require medication. So that’s how we treat them. In other cultures, even some medical illnesses do not necessarily dictate the use of medication. There is an Ayurvedic saying about illness: “When diet is wrong, medicine is of no use. When diet is right, medicine is of no need.” Although diet isn’t the only factor at play, this ancient wisdom underscores the importance of a healthy lifestyle in avoiding illness.

I believe this notion extends to mental health as well. A healthy emotional lifestyle includes learning how to communicate in relationships to increase closeness and social support; it means learning how to believe in your abilities, conquer your fears, and try new things; and it means practicing mind-calming techniques, such as meditation and yoga, and having the courage to heal old wounds while learning how to create your own happiness.

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I recently interviewed Dr. Barry Duncan, author of What’s Right With You: Debunking Dysfunction and Changing Your Life. He struck a chord with me when he said, “As crazy as it sounds, problems, like depression, also provide possibilities for living our lives differently, for reaching new conclusions. Depression is obviously painful, and it brings attention to the fact we are not happy with some aspect of our lives. The depression, therefore, can be a life-transformation vehicle.”

I agree wholeheartedly. I have experienced severe depression myself—several episodes, in fact. I have felt suicidal on occasion. Yet, those difficult times helped me. They helped me learn about myself, to seek out support and build relationships, and to have more empathy for others who go through similar challenges. Suffering can be a tool for growth, and personal growth, in turn, can lead to more happiness and inner peace.

As Dr. Duncan puts it, “Depression represents a profound crisis—it calls into question our very identity and how we are conducting our lives. It is at once a crisis point, a real danger and an opportunity for incredible change.”

By perpetuating the belief depression is an illness, we encourage people to take medication—that in many cases may not help them and can, in some cases, make them worse—without looking at the entire picture of why an individual is depressed and what is truly the best form of help for that person’s unique set of circumstances.

Third, by perpetuating the belief depression is an illness, we encourage people to take medication—that in many cases may not help them and can, in some cases, make them worse (Sparks, J., Duncan, B., Cohen, D., & Antonuccio, D., 2010; Valentstein, E., 1998)—without looking at the entire picture of why an individual is depressed and what is truly the best form of help for that person’s unique set of circumstances. My view is that in a limited number of cases, medication can be beneficial in the short term but only in combination with psychotherapy. Without therapy, the underlying cause of the depression goes unresolved and the person does not acquire the tools to prevent further episodes.

Dr. Duncan makes an excellent point when he talks about how we, in mental health professions, have contributed to perpetuating myths about a biological basis for depression and, in the process, helped pharmaceutical companies create learned helplessness in people. Many people have bought into the notions life should not include struggle and most individuals do not have the strength or creativity to navigate their challenges. We are empathic and do not enjoy seeing the people we serve suffer, so we often suggest medication. The use of antidepressants has consequently skyrocketed over the past two decades, yet two-thirds of Americans still report not being “very happy.” Something isn’t working.

Dr. Duncan surprised me with his next comment, and it gave me pause. He suggested that, perhaps unwittingly, mental health practitioners have bought into the illness model of mental health in part because it sustains our work and income. I had never thought of this before, but it’s a perspective worth examining. I don’t remember ever saying to a person after an intake session: “I think what you are going through is normal. You don’t really need therapy for this.” Hmm …

The Science of Depression

There are many theories about a possible neurological cause of depression, but very little evidence. In spite of advances in research technologies and neuroimaging studies, a biological cause or marker for depression has yet to be found (Duncan, B., 2005).

Further, meta-analytic reviews of medication treatment for depression found the difference between taking medication and a placebo was less than two points on a popular depression scale (Kirsh, I., 2014). One study found that a psychiatrist with a positive therapeutic alliance with his patients was more effective in improving depression symptoms with a placebo than was a psychiatrist with a poor therapeutic alliance administering a real antidepressant drug (Krupnick, J., Sotsky, S. M., Simmens, S., Moyer, J., Elkin, I., Watkins, J., & Pilkonis, P.A., 1996). In other words, relationships may heal more effectively than medication. In its totality, the research shows that except for a small percentage of people with severe depression, medication does not work well to remit most depressions and, in many cases, has adverse effects.

How to Heal Depression

There are many options to consider in treating your depression. Here are a few:

  1. Make life changes. Sometimes medication allows you to tolerate an intolerable situation. For example, if you have to take medication to cope with your stressful life, it may be time to reevaluate how you live life and perhaps make major changes. One person I work with in therapy decided she would stop being angry and verbally abusive, would learn to have healthy boundaries and say no when appropriate, and discontinue living with a husband who is addicted to alcohol and has a girlfriend on the side. Although this was a difficult time for her, she is much happier now and no longer reports depression symptoms.
  2. Give it some time. Some episodes of depression spontaneously remit with time. Improvement without treatment ranges from 20% to 60% for a given episode of depression (Duncan, B. 2005).
  3. Seek psychotherapy. Studies show psychotherapy is more beneficial than medication in the long run. Therapy maintains a positive effect over time, while medication does not. Psychotherapy can help you identify the causes of your depression and develop a more personalized plan for how you can get better. Therapy teaches the skills you need to manage your mood and difficult emotions. Most people report a lasting benefit when they participate in therapy for at least three to six months.

While medication may be the best option in some cases, research tells us psychotherapy is generally a more effective treatment for depression. The effects can last beyond the treatment, and there are few, if any, unwanted side effects. Therefore, in my view, it should be our first line of defense.

References:

  1. Duncan, B. (2005). What’s Right With You: Debunking Dysfunction and Changing Your Life. Deerfield Beach, FL: Health Communications, Inc.
  2. Kirsch, I. (2014). Antidepressants and the Placebo Effect. Zeitschrift Fur Psychologie, 222(3), 128–134. http://doi.org/10.1027/2151-2604/a000176
  3. Krupnick, J. L., Sotsky, S. M., Simmens, S., Moyer, J., Elkin, I., Watkins, J., & Pilkonis, P. A. (1996). The role of the therapeutic alliance in psychotherapy and pharmacotherapy outcome: Findings in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Journal of Consulting and Clinical Psychology, 64(3), 532-539. doi:10.1037/0022-006x.64.3.532
  4. Sparks, J., Duncan, B., Cohen, D., & Antonuccio, D. (2010). Psychiatric drugs and common factors: An evaluation of risks and benefits for clinical practice. In B. Duncan, S. Miller, B. Wampold, & M. Hubble (Eds.), The heart and soul of change: Delivering what works in therapy (199-236). Washington, DC: American Psychological Association.
  5. Valenstein, E. S. Blaming the Brain: The Truth About Drugs and Mental Health. Free Press, 1998.

Side view of woman working at table with coffee and laptopBy nature, humans are emotional creatures. When things are going well, you are likely to experience positive emotions that often lead to increased motivation and productivity. However, in times of hardship or stress, it can be challenging to leave negative feelings at home and keep them from impacting your work.

Whether you work in an office or from home, staying productive in times of personal crisis is no easy task. When a loved one is diagnosed with an illness, a pet passes away, or your partner loses a job, the added stress, grief, or anxiety can be distracting and sometimes even debilitating.

At some point, you may face a time when life stressors come up, and you may not be able to put your professional life on hold. Here are 11 tips to help you stay focused and remain productive in a time of personal crisis.

1. Adjust Your Schedule

In a time of crisis, you may need to adjust your schedule to accommodate personal matters. Time management is key to maintaining your professional life when your personal life requires more attention than usual.

Take a look at your schedule and see how you can adapt it. In medical situations, you may need to attend health appointments in the mornings and work later in the afternoon, or vice versa. Try to plan your day efficiently to maximize the value of the time you are able to put in at work. Consider scheduling your time in blocks with frequent breaks. Taking a break can help you reset and prevent emotional overwhelm.

2. Practice Self-Compassion

Be gentle with yourself. Don’t beat yourself up for not performing as well as you think you should. Remember: you are human. If you’re grieving the loss of a loved one, anxious about a medical diagnosis, or stressed about some other personal matter, allow yourself to recognize your emotions as a normal part of the experience.

Feeling distracted or foggy during stressful times is not uncommon. It may take time to bounce back, so give yourself a break. Honor your feelings and do the best you can under the circumstances. Praise yourself for what you do manage to accomplish rather than feeling frustrated by any difficulties you may be experiencing.

Amy Armstrong, LPC, suggests embracing difficult emotions rather than suppressing them.

“For many of us, it’s tempting to tamp down those unpleasant feelings and hide them. This usually just increases your stress levels,” Armstrong said. “Confide in friends you trust. Get professional or peer support, if you are comfortable with that. Go for a run. Have a good cry. Most importantly: feel what you need to feel and let it out. I’m not advising anyone to freely cry at their desk because that can be problematic in other ways, but it’s important to own your feelings and give yourself an outlet. If you can do it in a fairly controlled way, those emotions are less likely to just pop up in places where they are less helpful to you—like in the middle of a stressful meeting.

3. Share with Discernment

[fat_widget_right]When times are tough, talking about your situation can provide you with support and help you process your emotions. However, it is important to use discernment when sharing personal details.

Depending on your situation, you might be obligated to share some information with your supervisor, but you may want to be more cautious when sharing information with coworkers.

Ask yourself how sharing this information could impact the relationship and your personal situation. Do you work in the type of workplace that is friendly and open with personal concerns? Are you prepared to hear any advice or input your coworkers may have about your situation? How might telling your coworkers impact your performance at work?

In some instances, sharing your situation with your colleagues may make things easier for you. In others, it could become more challenging. Consider the effects and use discernment before you choose to share.

4. Practice Living in the Moment

Meditation and mindfulness practices can help you embrace the moment and find feelings of inner peace and acceptance even during the hardest of times. By practicing being present, you can prevent yourself from ruminating about your problems, dwelling on the past, or worrying about the future. A daily meditation practice can help you to remain mindful and present at work and help you stay focused on the task at hand.

It may also be helpful to reframe your time at work as an escape from what is happening in your personal life. Focusing on another task can provide temporary relief from any turmoil or crisis you may be dealing with at home.

5. Use Your Support System

Sometimes it can be tough to ask for help from others, even when it is needed the most. If you are dealing with a crisis, it can be very difficult to stay productive without a solid support system. Seek out the people in your life who you can count on during times of hardship and reach out to them. Perhaps you need someone to take your child to school, prepare meals, clean the house, or just to listen to you. If you try to maintain everything on your own, you’re more likely to experience emotional overwhelm, which will not only increase your stress, but it can wind up making you less productive in the long run.

6. Prioritize and Delegate

Recognize that your productivity potential will likely be lower during times of crisis. So make the best use of the productivity you have by prioritizing your tasks. Create to-do lists and prioritize the most important tasks first.

“Even though it’s difficult, this is a time to be diligent about saying no to extra commitments to people in your personal and professional life,” Armstrong said. “You’ve gone the extra mile for others when they were having difficulties, and you can do so again, but this isn’t the time.”

Delegating tasks to others can also be helpful. Look to your co-workers for assistance when possible, rather than trying to conquer everything on your own.

7. Practice Self-Care

When you are under a large amount of stress, it can be easy to forget about the importance of taking care of yourself. In times of crisis, people tend to be more vulnerable and self-care may be more important than ever. Do your best to take good care of yourself. Remember to eat healthy foods, exercise, and take time to rest.

“Self-care during times of personal crisis is crucial,” Armstrong said. “Don’t skimp on things like sleep, baths, workouts, walks, massages, or just time spent kind of zoning out for 10 minutes. Taking the time to take care of yourself is the best investment you can make during difficult times. It helps you maintain your resilience (and your sense of humor) when you need it the most.”

8. Acknowledge Difficult Days

Remember you are human. You are allowed to feel emotions. Some days will be more difficult than others. There may be days when you don’t have the strength to get out of bed. Even when you’re trying so hard to focus on what’s important, some tasks may slip your mind, and that’s okay.

“Even though it may sound selfish and may seem like everyone says this, if you are going through a personal crisis, you need to make sure that you put yourself first and are honest about what you can and cannot do,” Armstrong said.

Don’t berate yourself for your feelings. Instead, allow yourself to feel the emotions at the surface, knowing that everything passes in time.

9. Choose Positive Coping Skills

Stress often makes it easier to reach for a vice. Whether it’s smoking cigarettes, drinking alcohol, overspending, gambling, or some other addictive habit, everyone has weaknesses. While vices may relieve some stressful feelings immediately, they usually wind up making things worse and increasing stress over time.

Rather than engaging in a bad habit, use positive coping mechanisms to deal with your stress. These might include spending time with loved ones, exercising, eating a healthy and delicious meal, napping, meditating, trying a new hobby, or working on a creative activity.

10. Take Some Time Off

As much as you might want to be productive, sometimes it is necessary to take some time off to heal. If things get too challenging to maintain, use some of your vacation or sick days and take some time away from work.

Though Armstrong advocates for a combination of an improved self-care routine, increased exercise, and therapy, she suggests people do an honest self-assessment on how they’re coping with everything.

When you are under a large amount of stress, it can be easy to forget about the importance of taking care of yourself. In times of crisis, people tend to be more vulnerable and self-care may be more important than ever.“If you are seriously considering taking a leave of absence from work, talk to your doctor and mental health professional as soon as possible regarding appropriate documentation. Also, contact your Human Resources department regarding the Family and Medical Leave Act (FMLA),” Armstrong said. “Do not tell your manager or co-workers about your personal crisis. It may seem tempting, but if you are considering a leave of absence, it is crucial that all of your information remain confidential and that starts with you. Even the Human Resources department should only be provided with the minimum amount of documentation required to substantiate your request for leave, and all of that should come from medical professionals, not you. It’s important to remember this because even though nobody is supposed to press you for details, they often do.”

Armstrong suggests the best time to request a leave of absence is before a personal crisis starts to affect your work performance. Don’t be afraid to ask for what you need from your employer. Oftentimes, people will be willing to work with you to come up with a solution that works for everyone. Many people may feel guilty for missing work, but remember emotional crises can sometimes be as debilitating as physical illnesses, and some time off may be the best way to start the healing process.

11. See a Therapist or Attend a Support Group

Therapists and counselors play an important role in helping people cope with a crisis. Psychotherapy can help individuals assess their situation and create positive coping skills to manage their stress.

Support groups can also be a valuable means of support. They are widely available for those facing many different life challenges, from cancer to divorce to drug addiction. Whatever you’re dealing with, being able to talk with another person who can empathize with your situation can be helpful.

Couple looks at coastline, man stands, woman sits on back of carCouples who come to therapy typically hope for a renewed connection and deeper intimacy. Ideally, both partners are equally ready to be vulnerable and accountable. In the real world, though, one of you might be ready to dive deep into those emotional waters, while the other fears drowning. One of you is prepared to bear all, while the other feels dangerously exposed.

It’s common for partners to differ in their level of interest and openness to the therapy process. Depending on your presenting issues, your background, and any past therapy you’ve had, you and your partner may experience your therapy together very differently.

Maybe one of you has already done a great deal of internal work through individual therapy, spiritual exploration, or even self-help materials. Couples therapy seems like the logical next step because you want to use your personal healing to enrich your relationship. In some ways, the foundation you’ve built for yourself will be a great support to the work you and your partner will do together. Many times, you will enter into therapy with a great deal of patience and compassion to offer your partner as they try to meet you where you are. Perhaps your partner sees you as a model for where they want to be and uses that as motivation when therapy feels difficult or anxiety-provoking.

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At the same time, however, your differing stages of healing can bring about unexpected obstacles. If you’ve spent months or even years developing self-awareness, you’ve become accustomed to the language of emotions and to the discomfort involved in exploring the deeper, lesser known parts of the self. Perhaps you’ve confronted shame, anger, and fear and have successfully come out on the other side. You learned facing your pain reveals a stronger, more resilient sense of self. You know the benefits of the work, and you’re ready to keep going!

Your desire to hit the ground running, however, might set you up for disappointment and resentment. You might feel impatient or frustrated if you use your personal healing as a measuring stick for how your partner’s progress should look. Expecting that your health will engender health in your partner places unreasonable pressure on both of you. Don’t make yourself solely responsible for lifting your partner up; allow them to develop the self-efficacy that comes from doing their own hard work. Feel free to maintain your own progress without feeling tethered to theirs. Act as a witness to your partner’s work and acknowledge their efforts. Remember the courage it took for you to get where you are today, and offer compassion to encourage your partner to keep moving at their own pace.

It’s important to note healing manifests in various ways. Assuming your partner’s journey toward health will resemble yours fails to take into account their personal history and unique way of being in the world. As you witness their journey, practice respect and acceptance for their individualized needs and development.

It’s important to note healing manifests in various ways. Assuming your partner’s journey toward health will resemble yours fails to take into account their personal history and unique way of being in the world. As you witness their journey, practice respect and acceptance for their individualized needs and development. Together, you can decide how to create a joint path to healing your relationship.

When you’re the one who has less experience with self-exploration, you face a different challenge. You might perceive your partner as soaring easily to newer heights of self-actualization, while you feel you are limping along, too far behind to catch up. Don’t judge yourself against your partner’s current experience of health. Your partner has been where you are right now. They have struggled to confront distressing emotions. They have felt discouraged when they couldn’t move forward with a new pattern of thought or behavior. And they have wanted to give up when fear or shame overwhelmed them.

Because self-improvement is an inside-out process, your partner’s growing pains might have been invisible to you. Imagine an iceberg; what we see on the surface of the water is nothing compared to the enormity of what exists underneath. Your partner’s comfort with introspection and emotional expression was hard-earned and the result of long-term, internal trial and error. Accept that you do need time, not necessarily to catch up to your partner, but to determine what the path to healing looks like for you.

If you’d like more time to prepare for the relational work, individual therapy is a great option. Sometimes it’s helpful to engage in both individual and couples therapy at the same time. Your couples therapist might even be able to offer a few individual sessions to acclimate you to the process and allow you to feel more comfortable.

At the end of the day, both of you need to feel you are working toward a common goal. Offer empathy and compassion to each other as you encounter deeper levels of intimacy. Give each other room to be vulnerable and authentic, offering acceptance and validation for uncomfortable thoughts and feelings. No matter how far apart your healing processes seem to be, you can join together in couples therapy to create profound change. Your relationship can become a sanctuary—the place you both go to feel safe, connected, and finally at home.

Woman sitting on beach swing facing the seaFourteen years ago, when I was first trained in EMDR therapy, there was less of an understanding of its benefits, as well as a lot of confusion about what eye movement desensitization and reprocessing actually was. One thing it’s never been is a quick fix. And while I make it a point to educate people about this reality, I have found there is another layer to that common misunderstanding: lack of awareness that the existence of complex trauma, as opposed to single-incident trauma, can make EMDR an even longer-term treatment.

When working with those with single-incident trauma—a survivor of a car accident, for example—the standard eight-phased, three-pronged EMDR protocol has the potential to guide the treatment process in a relatively straightforward manner. Treatment can also be more clear-cut and focused when there are multiple traumas that can be grouped into the same category. Someone who reports being raped at various times in their life would be an example of this. Neurologically, the traumas can travel down a similar “track” when processed.

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However, it is usually the cumulative effect of multiple traumas, of multiple kinds and categories, that brings folks to my office. The majority of those who are engaging in ongoing therapy have symptoms driven by foundational experiences—developmental traumas that impact their worldviews. These experiences affect their ability to feel safe, not only physically but also emotionally. These people are seeking to heal from a history of complex trauma.

Complex trauma is identified by Judith Herman and other leaders in the field of traumatology as “the existence of a complex form of posttraumatic disorder in survivors of prolonged, repeated trauma” (Herman, 1992). An example of a history of complex trauma would be a woman who was adopted at birth, experienced sexual abuse by her brother, experienced ongoing physical abuse by her mother, and perhaps had a series of abusive relationships throughout her teenage and early adult years. She has an extensive history of interpersonal traumas at various ages and developmental stages, and spanning multiple categories.

The majority of those who are engaging in ongoing therapy have symptoms driven by foundational experiences, developmental traumas that impact their worldviews. These experiences affect their ability to feel safe, not only physically but also emotionally. These people are seeking to heal from a history of complex trauma.

As part of our healing journeys, we must pay attention to traumas of both omission and commission; both matter and can impact a person’s mental health. Neglect and abandonment, among others, are traumas of omission. Sexual abuse, physical abuse, and violence are clearly acts of commission. Perhaps a person experienced ongoing parental misattunements, significant attachment losses, a parent’s hospitalization or depression, or witnessed a mother grieving the loss of a sibling. These and myriad other experiences are examples of traumas that, at the time, impacted the person’s sense of emotional and physical safety and, more often than not, included caregivers. If they happened in childhood, they may greatly impact the person’s perceptions of the world today. All of this adds up to complex trauma.

Many leaders in the field of trauma treatment believe the newest diagnostic criteria for posttraumatic stress (PTSD), as outlined in the DSM-5, are not comprehensive enough. Although an improvement over the DSM-IV, the latest guide for mental health practitioners does not account for the full clinical picture when it comes to developmental trauma.

The term “complex trauma” didn’t even make it into the DSM-IV; instead, “DES NOS” (disorders of extreme stress not otherwise specified) was often used in clinical application. In the DSM-5, some of the symptoms of DES NOS, such as re-experiencing, avoidance, negative cognitions and mood, and arousal, were included in the PTSD criteria.

Which brings us back around to EMDR therapy. Yes, it is possible to heal from a history of complex trauma. Doing so just takes a conscious, methodical, and phased approach to treatment. If you are considering EMDR and have a history of complex trauma, I highly recommend ensuring that your therapist has experience in working with both. Make sure, also, that your therapist talks to you about extensive preparation and stabilization; these aspects will be a necessary part of your healing journey.

Reference:

Herman, J. (1992). Trauma and Recovery. New York: HarperCollins.

Young woman listens to therapistDo you know what type of therapist you are seeing or are about to see? Not all therapists are the same—they have different perspectives and training. Therapists need to know what motivates their work, what they hope to accomplish professionally, and how they want to serve people in therapy. Many therapists struggle with questions such as, “What’s my niche?” or, “How, exactly, should I help this person?” Most of us come into the field wanting to help and make a difference in people’s lives; orienting ourselves professionally can help us achieve this goal.

As a person in therapy, you may expect your therapist to know exactly what they’re doing, but this is not always the case. Some degree of uncertainty and self-doubt is common and natural among therapists. However, it can become problematic when they fall back on outdated training, integrate interventions that are incompatible, or serve populations with which they have no expertise or knowledge. This can confuse both the person in therapy and the professional.

I have struggled with lack of direction in my own practice, and I have learned to view my work as a therapist from a different, more realistic angle. After working in the field and developing my professional identity, I came to understand there are four important components that describe the style of every therapist. People seeking therapy might benefit from learning about these and being prepared to ask questions when searching for a therapist.

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1. The Therapeutic Philosophy/Approach

It can be helpful for therapists to understand how their worldviews inform their therapy. As a result of their training and experience, they may automatically and unconsciously perceive people in therapy and their work with them in a specific way. As they begin to notice what makes them feel more competent in their work, therapists can become confident about the interventions they use and can identify a clear pattern in their clinical practice.

For instance, therapists who find they are interested in understanding people’s thinking patterns and processes, and adopt a deliberate intervention to redirect these, are usually approaching their work from a cognitive or cognitive behavioral angle. This may not make a lot of sense for people in therapy; however, it is the therapist’s responsibility to be informed and aware of therapeutic philosophy, or at least aspire to this level of professional self-awareness.

You may sometimes hear therapists referring to themselves as “eclectic.” This is common in the field of psychotherapy, and it means they integrate multiple therapeutic approaches, or perhaps use specific techniques borrowed from different models. Although this can be a valid lens from which to conduct therapy, it can also create confusion, diminish the efficacy of evidence-based practices, and distort the objectives of therapy. There are eclectic therapists who truly believe their best work comes from borrowing from different approaches, and then there are “eclectic” therapists who fail to take the time to develop expertise in any one approach.

It is not always easy to distinguish between these two types of eclectic therapists, but it’s important for a person seeking therapy to know the difference. Many therapeutic approaches or models are similar, but they are different enough that therapists may want to be deliberate and specific about their worldview.

2. The Delivery

You may notice therapists often identify with a delivery that matches the model they use. A therapist whose therapeutic philosophy is cognitive behavioral will frequently describe their delivery with people in therapy as “directive.” Specific therapeutic models suggest therapists who use their model should always have a particular way of conducting their sessions.

One of the most common complaints from people in therapy is that therapists act like robots—they aren’t being themselves, or they don’t connect. I believe this is a result of forcing an unnatural delivery in therapy sessions.

I think this is unrealistic. The delivery is about the way therapists communicate with someone in therapy, how they translate the information, and how they choose to convey their messages. A therapist who identifies with a cognitive behavioral philosophy, who tries to exhibit a “directive” delivery as the cognitive behavioral model suggests, but whose personality and natural presentation are more soothing or indirect, is simply not being truthful.

One of the most common complaints from people in therapy is that therapists act like robots—they aren’t being themselves, or they don’t connect. I believe this is a result of forcing an unnatural delivery in therapy sessions. The delivery should match the therapist’s personality, not necessarily the therapeutic approach or philosophy. People pick up on these things.

As most therapists know, one of the most important factors in therapy is the relationship between the therapist and the person in therapy. How can there be a genuine relationship if the therapist is trying to be someone else? I suggest therapists simply be themselves. This is likely to be the easiest part of their clinical work. Therapists can adopt a variety of delivery styles: directive, soothing, indirect, challenging, curious, humorous, reflective, supportive, intellectual, or a combination of these. I don’t think it should be about trying to match the model, but about who the therapist truly is.

3. Skill Level

To have a big influence on another person’s life, therapists should make sure their skills are strong, sharp, and up to the challenge. When I say skills, I am not referring to experience or age of the therapist. Skill level involves the preparation, commitment, and willingness to become a better therapist. A therapist should never assume they know it all, or that they should know it all. This can be a terrible trap and one that can make people in therapy feel like they are wasting their time.

Most licensed therapists are required to participate in continuing education as required by the agency or organization that regulates their credentials. Some therapists may attend any training just to get the hours they need to renew their license, while others may research and attend training that specifically target their personal needs and contributes to their professional development.

For example, if you have a therapist who specializes in treating young girls experiencing an eating disorder who attends a training on substance abuse in middle-aged men, you may want to ask why. Your therapist may have a perfectly sound reason for this, but sometimes the reason is license renewal. An important exception to this is when therapists are curious about new modalities, or when they truly don’t know yet what their niche will be. Most therapists are quite comfortable sharing their recent training and education with people seeking therapy. This is not part of the mandatory disclosure statement, but I think it should be.

4. Awareness of Readiness to Help

Is your therapist ready to help you attain your goals? Sadly, some are not, even if they really want to help. Readiness to help can include preparation, skill level, delivery style, and even therapeutic philosophy—but it’s more than that. Therapists need to be self-aware regarding how helpful they can be within the therapeutic context. Does your therapist have the tools to navigate vicarious trauma? Have they lost their passion for therapy? Are they burned out?

Naturally, this work is difficult. Therapists are exposed to painful stories every day, all day long. This can take a toll on a therapist’s ability to perform on the job in the long run. Burnout can influence a therapist’s self-perceptions about their ability to help. When this happens, your therapist may not be ready to help, or they may be completely unaware of this and continue to do clinical work. (They also have bills to pay.)

The good news is there is hope. Therapists are used to hearing about something called “self-care,” which is necessary to maintain a healthy balance between personal and professional lives. When therapists neglect this area of their work (yes, self-care should be part of the work), they may be unaware or even in denial about the effects of their work on their emotional well-being. This in turn can affect the quality of the service they provide.

Burnout is a real thing in this field. Many therapists who work in community mental health, residential services, in-home therapy, or hospitals run the risk of becoming burned out. It is important to recognize the signs and take immediate action. You want your therapist to love what they do for a job. If they don’t, take your business elsewhere.

I have been (and am) a person in therapy myself, just like many other therapists. I don’t want my therapist, the person who is supposed to help guide me through my journey, to be unaware of where their philosophy and passion lie, to pretend to be someone else, to lack the necessary skills or education to help me overcome my challenges, or to be burned out to the point of not being helpful at all.

I will conclude with sharing the four characteristics that shape my own therapeutic identity. My therapeutic philosophy is narrative therapy, an approach that views the problem external to the person, who is the expert of their own experience, able to retell their stories in their own voice. My delivery includes some traits usually connected to narrative, such as curiosity and respect, but I am also direct, which is often associated with therapeutic models very different from narrative. As for my skill level, well, I’ll let that speak for itself. Lastly, my awareness of my readiness to help is strong because I have made it an important part of my work to practice self-care and to not allow the difficulties of this field diminish the passion that drove me to this work in the first place.

Happy couple taking selfie on road tripEarlier this year, the Powerball jackpot soared to $1.5 billion dollars. Ticket sales went through the roof. People who never played the lottery before were suddenly buying handfuls of tickets. According to psychologists, this is likely rooted in an innate fear of missing out.

FOMO, an acronym for “Fear of Missing Out” has become a popular internet term in the last few years. It was even added to the Oxford English Dictionary in 2013. FOMO is defined as the feeling of anxiety or apprehension over the possibility of not being included in an exciting event happening elsewhere that others are experiencing.

The term may be new, but the feeling itself is not. People tend to wonder if the grass might be greener on the other side. There’s always the question of whether someone out there is living a better life, making more money, or finding more opportunities. In the digital age, when social media and smartphones have the potential to make us more preoccupied with others’ lives than ever before, FOMO can become a serious problem for some people.

Where FOMO Comes From

The term FOMO was originally popularized by entrepreneur Caterina Fake. FOMO is a modern-day form of “keeping up with the Joneses.” Where people were once trying to keep up with a handful of neighbors, they’re now trying to keep up with hundreds, even thousands of social media friends and followers.

Social media has its good points. It can help people stay connected to friends and family around the globe, but it can also create serious feelings of anxiety, inferiority, and depression for some. People look to social media to feel more connected, but in many ways, it can make people feel more disconnected.

[fat_widget_right]It is not clear to researchers whether social media is responsible for creating feelings of FOMO or if it simply makes it easier for people to indulge in those feelings. The latter is more likely, as humans have dealt with emotions such as envy and regret since the beginning of time. Looking at others’ lives on social media for hours each day can exaggerate those emotions.

Research has linked FOMO to feeling disconnected from others and discontent with one’s own life. According to a 2013 study published in Computers in Human Behavior, people with a high degree of FOMO feel less competent, less autonomous, and less connected in their daily lives than the average person. People with strong feelings of FOMO also reported using social media more often, suggesting social media may be a significant contributing factor to their anxiety.

Megan MacCutcheon, LPC, has noticed the negative effects of social media in people who are seeking to improve their self-esteem through therapy.

“In my workshops, participants often begin a conversation around social media and how it affects their self-esteem and the ability to feel satisfied in their own lives,” MacCutcheon said. “They see all these pictures and status updates on Facebook and develop a fear that they are missing out on the happiness, success, perfect families, and exciting experiences that everyone else seems to have.”

For those looking to improve their self-esteem and increase satisfaction in their own lives, here are some tips for overcoming FOMO.

Embrace the JOMO (Joy of Missing Out)

JOMO, or “Joy of Missing Out” is a counter-term created by entrepreneur Anil Dash. While people with FOMO may second-guess their choices and wonder if they could be having more fun elsewhere, people with JOMO embrace the choices they have made and find joy in the present situation.

Millions of amazing events take place in the world at any given moment. It is impossible to be everywhere at once. Rather than worrying about what you may or may not be missing out on, try making the choice that is best for you and owning that decision. Find happiness in what you’re doing, and remind yourself why you made the choice in the first place.

Limit Your Social Media Intake

FOMO might be an age-old problem, but social media can add fuel to the fire. If you find social media is making you feel envious of others’ lives or unsatisfied with your own, try limiting your time on social media websites such as Facebook, Instagram, and Twitter. Many people have become addicted to knowing what is happening in others’ lives. They end up neglecting their own lives, staring into a screen instead of being fully present in the moment.

Try giving yourself a set amount of time to check social media each day. Applications such as StayFocusd, Anti-Social, and Self-Control can block or limit time on social media and other distracting websites. You can also stop notifications from appearing on your phone so you are only engaging with social media when you are actively logged on.

Go to a Digital Detox Camp

FOMO is a modern day form of “keeping up with the Joneses.” Where people were once trying to keep up with a handful of neighbors, they’re now trying to keep up with hundreds and even thousands of social media friends and followers.If limiting time on social media doesn’t seem like enough, sometimes a full hibernation may be helpful. Some people choose to take a few weeks or even months off from social media to spend time with their real-life friends and family and focus on the present moment.

Some may choose to go on a camping or hiking trip to unplug. Others may find it more difficult to put their phones down, so they choose to attend a digital detox camp. Camp Grounded, located in Northern California, is one such digital detox camp. Adult campers willingly give up their phones for a few days, leaving the work jargon at home and participating in activities such as campfires, yoga, meditation, swimming, archery, and stargazing, among others.

Remind Yourself Social Media Is Airbrushed

Remember what is posted on social media is usually not what it seems. Just like the photos of models in magazines are airbrushed, people don’t typically post the whole truth on social media. Instead, people typically only post their best selfies and are more likely to share a photo of an exciting adventure rather than a rant about any difficulty they may be having. Remember, no matter how perfect or interesting a person’s life seems, everyone has bad days.

Be Grateful

Cultivating an attitude of gratitude can help combat anxious and envious feelings. Research has shown simply writing down a few things you’re grateful for each day can help increase your overall life satisfaction. Further positive psychology research links gratitude to greater feelings of happiness and well-being. The next time you’re feeling envious of what someone else has, try redirecting your focus to the positive aspects of your own life. You may start to feel better.

Practice Meditation

Meditation can help you become more mindful of your thoughts and feelings and how they affect your life. Taking a few minutes to meditate each day can help clear your mind and reduce anxiety.

Change Your Thoughts

According to psychologists, FOMO can actually be a form of cognitive distortion. Cognitive distortions are irrational thought patterns—such as believing your friends don’t like you if you weren’t invited to a recent event—that can lead to depression and other mental health conditions. Cognitive behavioral therapy techniques can help people learn to spot cognitive distortions when they occur and transform them into more positive and constructive thoughts.

Unplugging from technology, redirecting your thoughts, and seeking help from a qualified mental health professional are all ways you can stop worrying about what you’re missing out on and start feeling confident in the way you choose to spend your time.

References:

  1. Burkeman, O. (2014, October 17). This column will change your life: The joy of missing out. The Guardian. Retrieved from http://www.theguardian.com/lifeandstyle/2014/oct/17/joy-of-missing-out-oliver-burkeman
  2. Hinds, H. (2016, January 13). Fear of missing out fuels pressure to play Powerball. Retrieved from http://www.fox13news.com/consumer/74215255-story
  3. Huet, E. (2014, June 20). Camp Grounded: Where people pay $525 to have their smartphones taken away from them. Retrieved from http://www.forbes.com/sites/ellenhuet/2014/06/20/camp-grounded-digital-detox/#732df78c688a
  4. Giving thanks can make you happier. (2011). Harvard Health. Retrieved from http://www.health.harvard.edu/healthbeat/giving-thanks-can-make-you-happier
  5. Glei, J. K. (2010). 10 online tools for better attention and focus. Retrieved from http://99u.com/articles/6969/10-online-tools-for-better-attention-focus
  6. Pappas, S. (2013, May 14). Life satisfaction linked with fear of missing out. Huffington Post. Retrieved from http://www.huffingtonpost.com/2013/05/14/fear-of-missing-out-life-dissatisfaction-fomo_n_3275349.html
  7. White, J. (2013, July 8). Research finds links between social media and the ‘fear of missing out.’ The Washington Post. Retrieved from https://www.washingtonpost.com/national/health-science/research-finds-link-between-social-media-and-the-fear-of-missing-out/2013/07/08/b2cc7ddc-e287-11e2-a11e-c2ea876a8f30_story.html
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GoodTherapy is not intended to be a substitute for professional advice, diagnosis, medical treatment, or therapy. Always seek the advice of your physician or qualified mental health provider with any questions you may have regarding any mental health symptom or medical condition. Never disregard professional psychological or medical advice nor delay in seeking professional advice or treatment because of something you have read on GoodTherapy.

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