aging manThis evening my local newspaper contained this sad headline: “Maryland couple found dead at home.” A husband and wife, both aged 72, died in an apparent murder-suicide. The wife reportedly had a stroke a few years ago, and the husband’s health had recently deteriorated as well, according to the story. The article quoted friends of the family who said that while the husband was devoted to his wife, he had become overwhelmed by the demands of caregiving combined with his own health problems.

No matter the circumstances, this is a tragic story. While reading it, I couldn’t help but think about the difficulty faced by so many caregivers with whom I have worked. Each one expressed absolute determination to care for his or her spouse without assistance, believing that no one else could do it as well. The loyalty, patience, and nurturing care demonstrated by these individuals are admirable, perhaps even saintly. But nobody, even the most patient person on earth, is immune from the effects of putting someone else’s needs above one’s own day after day, week after week, month after month.

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According to WebMD, caregiver burnout is defined as “a state of physical and emotional exhaustion” resulting from the one-sided nature of caring for someone who is chronically ill. The person who is sick does not intend to burden his or her caregiver, but the nature of being unable to care for oneself creates that one-sided dynamic. The spouse who is caring for the ill person may be happy to take on the responsibility of feeding, bathing, and taking his or her loved one to appointments, knowing that were the situation reversed, the other person would gladly oblige. Even so, constant caregiving for a chronically ill spouse can disrupt one’s life in multiple ways. Many caregivers are reluctant to reach out for help, which puts them at risk of burnout.

Help is out there! Caregivers do not have to feel alone.

According to HelpGuide.org, here are some of the signs and symptoms of caregiver stress leading to burnout:

If you feel that you may have some of these symptoms, please don’t wait to ask for help!

Fortunately, if a caregiver begins to experience some of these symptoms, it is not too late to make changes. The following self-care tips, from CareGiver.org, can reduce caregiver stress and lessen the risk for burnout:

Your local department of aging/disabilities can guide you to the resources available in your community. It’s important for your chronically ill loved one that you are taking care of yourself while taking care of him or her. You can also find help here. The National Center on Caregiving has numerous outstanding resources to help you.

To find a therapist for help with caregiver issues/stress, click here.

Teacher and woman doing arts and craftsI recently had the honor and privilege of attending a workshop with renowned art therapists Cathy Malchiodi and Kate Webb in San Diego, CA, entitled Trauma-Informed Art Therapy and Positive Psychology. To say I was inspired, confirmed, validated, and energized by the experience is truly an understatement.

As a licensed clinical social worker, I often have drawn from the expressive arts as a means of helping my clients work through grief, loss, and trauma in psychotherapy. Art making, whether via collage, painting, drawing, sculpting, dancing, making music, and drama, has the potential to help individuals heal through very traumatic circumstances. The workshop focused on the evidence-based use of art making interventions and the intersection with neurobiology and somatic experiencing to help clients work through trying life challenges.

In my 20+ years of psychotherapy practice, I have called upon art intervention with the following populations: child witnesses of domestic violence, abuse survivors, hospice patients and their families, preschool children who witnessed L.A. riots, bereavement support groups, students struggling in academic settings, children of incarcerated parents, and mothers experiencing perinatal depression.

Art allowed clients to transcend their emotional pain, create a narrative through image of their trauma/loss, and subsequently “master” the trauma, thereby releasing the painful memory from its grip in the brain. Art continues to be transformative in my practice with clients and also in my own personal life.

[fat_widget_trauma_ptsd_right]As Malchiodi and Webb stated in their conference, we as humans all experience traumas across the lifespan. These incidents can be as “minor” as a traffic jam to as life-changing as the death of a family member. All traumas, no matter how seemingly big or small, are encoded in the brain’s amygdala where they are registered as potential alarm bells. The hippocampus then takes on the role of organizing these traumatic images, but struggles to encode them in such a way that makes sense to the cognitive (higher thinking/verbal) areas of the brain.

Art making taps into the lower-level (somatic/limbic) areas of the brain and also allows the client to release trauma in a somatic (physically manifested/preverbal) manner. Some individuals are rendered speechless in moments of trauma. As researchers have indicated, Broca’s Area in the brain has the potential to shut down verbalization of trauma, as an individual is in a hyper-alert state of fight or flight.

Art making accesses the somatic elements of the brain, enabling a client to express emotion which at times cannot be verbalized initially. Art making creates containment, safety, encouragement, validation, and an opportunity to narrate the traumatic experience in such a way that the trauma is then organized in the brain so that the individual’s somatic experiencing of the trauma is reduced.

Relaxation exercises coupled with art making bring about great relief for many clients. Playing music that matches a resting heartbeat has been proven to induce a state of calmness in many trauma survivors. Some clients are compelled to also engage in other forms of expression, such as drum playing and dancing. Discharging the trauma physically (exercise, music making, etc.) and through the use of creativity in art allows the client to move through the experience with a sense of self-compassion, mastery of the trauma, and a restored sense of trust in one’s surroundings.

To summarize the workshop I attended in a small article would not lend justice to all the incredible learning experienced. Suffice it to say my education of expressive arts is ongoing, and continues to be a driving force in the work I am honored to provide along the people who come to see me for therapy. Truly, belief that the client has the power of self-determination and the awareness and knowledge within to interpret their own art making is essential in nonjudgmentally supporting the client.

Ongoing training in the cutting edge juxtaposition of art and science in expressive arts and neurobiology is incredibly exciting and groundbreaking. Mindfulness and positive psychology also weave their way into the expressive arts as a form of healing which empowers clients to transcend trauma and loss and evolve to a place of healing and wellness.

The following is a list of titles I have found to be inspiring and helpful for psychotherapists wishing to learn more on the path of incorporating expressive arts in their work with clients:

  1. Malchiodi, Cathy. (2002)The Soul’s Pallete: Drawing on Art’s Transformative Powers, Shambhala Publications
  2. Malchiodi, Cathy. (2006)The Art Therapy Sourcebook, McGraw-Hill
  3. Allen, Pat . (1995) Art is a Way of Knowing,Shambala Publications
  4. McNiff, Shaun (2004). Art Heals: How Creativity Cures the Soul, Shambhala Publications
  5. McNiff, Shaun (1992). Art as Medicine: Creating a Therapy of the Imagination, Shambhala Publications

First of all, I want to commend you on the great job you have done reflecting on and understanding your feelings around this issue, and on sharing them with your partner. It sounds like you two are able to communicate openly and honestly with one another even when it is not easy. I would encourage you to continue the conversation; keeping the lines of communication open will help each of you to get your needs met in the relationship.

Speaking of needs, I’m wondering if there is anything that your boyfriend feels is lacking in the relationship. It’s possible that he is perfectly satisfied by the relationship. However, there might be something he would like that he is not getting, or something he would like more of. If this is the case, it means there are things you can both be doing to nourish your relationship. If there is something he is seeking and you look for opportunities to provide that for him, he might not only feel even more loved, but also look for opportunities to make you feel loved by initiating that physical and verbal affection you are seeking. It could become a very positive cycle that allows you to deepen your connection to one another.

I’m also wondering about the other relationships in your life now—family, friends, colleagues, etc. What needs do these relationships fill? I raise the issue because our intimate relationships are so central in our lives that it can be easy to fall into the trap of expecting our partners to fill all of our needs. It is not possible for any one person to satisfy all of another person’s needs. So, if this is the expectation, even the best of relationships will surely miss the mark and leave us feeling disappointed.

Your level of self-awareness and your ability to speak candidly with your partner is so important. It was brave of you to acknowledge and discuss the connection you have made between your sour mood and your partner’s affection. This is definitely something you want to work through before it goes on too long. I doubt you want to have to be in a bad mood every time you want a little affection from your partner. Plus, while it is working now, your partner might grow to feel manipulated by it and ultimately become resentful. This is something you want to nip in the bud!

As I’ve said, the insight and communication here seems really strong, so keep talking to each other and working on this. If it seems like you are getting stuck, consider reaching out to a couples therapist to get some assistance with moving the conversation forward. Best wishes on your journey together.

Respectfully,
Sarah

Person in yellow raincoat with yellow umbrella walks through snowy forest at night

Much of the United States has had a long, harsh, and cold winter. While it seemed like it would never end, some of us are starting to see the light of spring.

Winter can be a perfect representation of the darkness and despair that we feel from time to time. Whether it is grief associated with death, a trauma that we had to endure, or the end of a relationship, we all have had experiences of darkness and despair that feel never-ending.

But when you have lived long enough and seen enough winters, you know that the despair and darkness do not last forever. There comes a time when the pain recedes, is not all-consuming, and you have a desire to live life again.

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The process of re-emerging into life can be challenging. When you have been wearing the cloak of sadness, grief, or depression for so long, it can feel strange to walk through the world without it. You may even experience a cultural shock, in a sense. Coming back into the world can seem different and even strange.

Just as it takes time to deal with a difficult emotion, it takes time to adjust to its leaving you. It is a process of recognizing that the pain is no longer all-consuming. There are steps you can take to help you navigate this re-emergence:

Reconnect

Reach out to your support system. Many people retreat into isolation when they are struggling with depression or grief; it is necessary to reconnect with people and activities you previously enjoyed. Rather than let the shame or embarrassment of being out of touch stop you from reconnecting, speak to it. Call a friend and acknowledge that you were out of touch. Apologize and tell him or her why it’s been so long since you called. Let the person know that his or her friendship is important to you.

Review

As you reconnect with people and activities, you will need to take time to review what you came through. Think about the grief and sadness that you experienced. Consider how you dealt with it. Ask yourself:

Reviewing the depression and grief can be scary; it might feel as if you will fall right back into the despair. But the contrary is true. Reviewing your sadness allows you to see your resiliency and how you survived. It also provides an opportunity to consider options you may try in the future when facing challenges.

Rest

Finally, it is time to rest. People often wonder, “What do I need to rest for? I was just in my bed/house for two months!” Grief and sadness are exhausting. Recuperating from them is a necessary part of the healing process. Allow your body to be active as you re-engage with the world, but also let your emotions rest, as they have been on a roller coaster of sadness, darkness, and re-emergence to light.

Taking the time to process and come out of the darkness is a foundational tool that you can use throughout your lifetime. When life is challenging, as it will be, you will not only survive it but come through in a way that is healing and compassionate toward yourself.

distraught womanThe loss of a child—no matter the age—can be traumatic and can leave family, particularly the parents, reeling in the emotional turmoil that comes with great loss. I have noticed a few commonalities among those parents, one being that the people in their lives do not know how to react or help.

This article is for friends and family members of a parent who has lost a child. The goal is to raise awareness of common mistakes made in trying to provide support and to suggest more effective ways to support parents as they work through their grief.

“It’s time to move on! You have to get on with your life!”

This statement, and others like it, is the first common mistake well-meaning loved ones make. The intent is to help the parent to get back to life and to find meaning again. Watching someone we love go through grief and extreme suffering can be very uncomfortable. We have an innate need to want to help the people we love through life, and if one of our loved ones seems stuck, we have the urge to do everything we can to get them unstuck. However, this message unintentionally invalidates the parent, who may start to question whether there is something wrong with them for grieving for the child.

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Grief looks different in every person. Some people may need to take a leave of absence from work. They may need to lay on the couch all day and allow themselves to ride the roller coaster that is grief, which usually consists of bouts of crying, depression, anger, numbness, confusion, and inward questioning as to how the person could have prevented the loss, followed by perhaps more anger, depression, and numbness. The parent may feel distant from loved ones, which often makes loved ones concerned and anxious and can lead to statements similar to the one above.

There is no time limit on how long it takes a person to grieve the loss of a child. In fact, it is important to acknowledge that huge losses will make an impact on a person’s life forever. This does not mean there is no life after loss. It just means that it will look different.

Giving the person as much time as they need to grieve, and allowing them to grieve in their own way, is very important. Doing so creates safety for the parent and assurance they can do what is needed to do to work through emotions with support and understanding. Saying something like, “It’s OK that you are feeling the way you are … you have experienced a major loss and I want you to know that I am here to listen … take as long as you need,” is a much better way to communicate to the person that you want to help him or her through the grieving process.

“Why are you having those thoughts? They are completely irrational, and of course you couldn’t have done anything to prevent this!”

When someone becomes a parent, they are forever changed. It is like a switch goes off in the brain. All of a sudden, priorities shift, and keeping one’s child safe and happy is a top priority. So when someone experiences a loss of a child, it is natural to start questioning inwardly and wondering what they could have done to keep the child safe.

Even in situations where it is blatantly obvious there was nothing the parent could have done, there is still that wondering. In my experience, parents are cognitively aware of the fact they could not have done anything to prevent the loss, but emotionally they still feel that they failed. Loved ones often want to jump in and challenge these thoughts in an effort to reassure the parent that this is not true. This may be necessary at some point, but how you do this is extremely important.

When you fail to validate the parent’s feelings by failing to simply listen without trying to fix it, a barrier for communication may be created. Part of healing and moving forward through grief is being able to share what the parent is thinking, no matter how extreme those thoughts may sound. Failing to validate feelings can hinder the healing process.

Instead of jumping right to trying to correct a belief that you feel is irrational, validate that having such thoughts is completely normal for a parent who has lost a child. Listen to the person and practice reflective listening skills (example: “I hear you saying that you feel responsible for this”). Make validating statements such as, “I hear you saying you are hurting. I know this is very painful for you, which is completely understandable.” This can help the person realize that you are trying to understand where they are coming from.

Sometimes even irrational beliefs need to be validated. Sometimes more intensive work has to take place. If the latter is true, it is important to help the person to get to a therapist who can help.

“Everything happens for a reason. They’re in a better place.”

This may be part of your spiritual belief system or even the parent’s belief system, but this statement often backfires. Trying to provide an explanation for the loss of a child can lead to the parent feeling as though their anger (or other intense emotion connected with the loss) is invalid. It is important that the parent is allowed to process the loss and can identify meaning, if any, in their own time.

If the parent wants to have a conversation about meaning and the loss, by all means, have that conversation! But let the person decide if that is a conversation they want and are ready to have. Be aware that people feel a lot of things with such a significant loss, and all feelings and thoughts that come up are valid.

Remember, you shouldn’t try to “fix” the pain that accompanies grieving. Something along these lines is a good place to start: “I can’t imagine what you are going through. This must be so difficult. I am here for you and would like to offer my support during this difficult time. I can offer you a listening ear without judgment or advice.”

A support network is an important part of the healing process after the loss of a child. Knowing how you can be there for the parent can make a huge difference in how that person grieves and begins to work toward healing. Seeking assistance from a professional to help guide you through supporting your loved one can be extremely helpful and can help address the discomfort that often accompanies seeing someone you love suffer.

dr Arden photo from websiteLast week was officially Brain Awareness Week. Yes, the brain—the organ that basically governs all of our body processes—is officially honored for one week in March every year by The Dana Foundation, a New York City-based organization dedicated to advancing brain research and public education.

This only adds to the timeliness of GoodTherapy.org’s recent chat with one of our upcoming continuing education presenters, Dr. John B. Arden. Arden is the director of Kaiser Permanente’s mental health training programs in Northern California and author of a number of books on neuroscience, psychotherapy, mindfulness, and how they work together in our everyday lives. His latest title, The Brain Bible: How to Stay Vital, Productive, and Happy for a Lifetime, offers a scientifically backed examination of simple steps we can all take to nurture optimum cognitive functioning and maintain overall brain health.

Dr. Arden will be presenting on “Neuropsychology: A Brain-Based Therapy” in a GoodTherapy.org web conference in May 2014.

GoodTherapy.org (GT): Can you explain to me what you mean by “brain-based therapy” and where the idea for it originated?

[fat_widget_right]Dr. John B. Arden: Everybody thinks they have the best type of therapy. So my job has been to sift through a lot of theory and try to get to the science, so that my training programs can operate at the cutting edge of what’s going on… and integrate all these seemingly disconnected theories and scientific domains into one robust vision of providing humanized services for people who want to see us [therapists].

The words “brain-based” need not be thought of at all as another one of these clubs; … but rather, okay, … since we all have a brain, every one of these psychotherapies and theories ought to relate in some way to the brain .… In the long run, brain-based therapy is the common denominator vision of the future, and it’s not just my idea.

GT: Your most recent book, The Brain Bible, discusses “how to stay vital, productive, and happy for a lifetime.” What is the brain’s role in nurturing vitality, productivity, and happiness?

Dr. Arden: We know now that if you want to be healthier—not pick up the latest virus that’s floating around, not suffer from dementia later in life, not suffer from anxiety and depression—and in general, be happier, there are a number of characteristics that have been identified by many scientists over the past 30 or 40 years.

What I try to do in The Brain Bible is take the most important five that have consistently come up as a focus of inquiry and have a robust body of scientific literature backing them as the healthy behaviors for living with greater pleasure, less depression, less anxiety, and less chance of getting dementia later in life. …

And these five factors are incorporated in the mnemonic SEEDS; if you’re planting SEEDS now, and you cultivate them throughout your lifetime, chances are you’re going to feel a whole lot better about yourself and about everybody around you; people are going to want to be around you, you’re going to be ill less often, and you’re going to get dementia symptoms much later than other people.

GT: So, what are these SEEDS factors?

Dr. Arden:

GT: What are some of the brain degrading habits we should all be avoiding?

Dr. Arden: All the SEEDS factors, if not adhered to, are brain degrading. But what else? Substances … Alcohol on a regular basis—and I’m not talking about alcoholism, just regular drinking—is not brain healthy. And another real common one is medical marijuana, which is really out there right now [being touted] as this panacea, but it is not brain healthy. … Do I think it’s the worst thing in the world if you smoke a joint? No. But if you do that on a regular basis, just like if you drink alcohol on a regular basis, not so good for your brain.

Reference:

BrainFacts.org. What is neuroscience? Retrieved from http://www.brainfacts.org/about-neuroscience/what-is-neuroscience/

zen stones signifying balance and harmony“That’s so Zen,” people say, meaning peaceful, accepting, and soothing. But what is Zen, exactly? You might picture a room filled with fluffy pillows decorated in blues and grays, lavender incense, and synthesizer sound waves punctuated by gongs. I’d probably like hanging out on those pillows, but Zen is much more than relaxation. It’s a way of life emphasizing the value of meditation and intuition, and realizing one’s true nature—the purpose of Zen.

We complain about stress, about losing ourselves in the hectic din of constant activity, always on the go, busy, and in touch. We even sleep with our phones kept handy on the nightstand, so we can be available 24/7. That is too much stress, but stress is not only a bad guy, it’s a good guy, too, often supporting growth.

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Think of how stress helps in the gym. Muscles get bigger with resistance training—which is a form of stress (on the muscles). “No strain, no gain” and “use it or lose it” are popular refrains, but we have to find the optimal amount of strain that promotes growth. We need to work those biceps with the proper weight. Too much will tear our muscles, and too little will leave us with spaghetti arms. This is where a trainer in the gym, or a meditation teacher, a spiritual leader, or a psychotherapist, can come in handy, making sure that the stress you’re experiencing is optimal, be it physical, cognitive, spiritual, or emotional. We need to balance stress and relaxation.

Zen practitioners develop a sense of balance, as well as simplicity, order, and harmony. Right diet, regular exercise, enough sleep, right livelihood, and mindfulness activities such as meditation, yoga, prayer, and other techniques help us recover from too much stress. When we quiet the mind and the body, we have a better chance of finding the true self. That’s the goal of Zen—finding the deep self, who you really are, a key to a more rewarding life, and why psychotherapists often include meditation techniques as part of their treatment plan, although it is not a replacement for psychotherapy.

Zen is a peaceful way of life which avoids killing or harming another living thing, shuns stealing, promotes sexual responsibility, and practices truthful speech that does not hurt anyone. Drinking and drugging, anything that diminishes consciousness, is to be avoided. The Shakyamuni Buddha simplified what a Zen life looks like when he said that Zen means “to do no evil, to cultivate the good, and to purify one’s mind.” These are down-to-earth principles which help us live the good life, without too much stress.

A central aspect of Zen is meditation. Often it’s wise to start a meditation practice by resolving to meditate every day, at the same time if possible, and for a period of perhaps five minutes, so when your meditation time is over you want more and you’re ready to start again the next day. You can use a timer, if you wish; just choose a sound that you like. There are some really good apps for that! You can gradually lengthen the time spent meditating.

Meditation practice is simply sitting quietly while maintaining good posture and focusing on one thing, often the breath. Watching the outbreath is emphasized because the outbreath is a relaxing breath by its nature. We breathe out, let go, and then wait through the pause and on to the next breath, a bead in the necklace of your life’s breaths.

While you meditate and focus on the breath, you try not to get caught in the endless thoughts, stories, and fantasies that our brains are constantly spinning. Each time you catch sight of your thoughts, you simply say “thinking without judgment,” and then you return your attention to the breath. The “without judgment” part? I say it twice; it’s that important. NO JUDGMENT. Meditation is not a self-improvement program. It is a getting-to-know-and-accept-yourself program, after which you can get to know and accept other people, too.

People often get angry with themselves when they catch themselves thinking instead of meditating. They might feel like failures, but it’s exactly the opposite. Catching yourself thinking is the sweet spot. You didn’t do something bad, but just the reverse—you noticed, you woke up and were aware; this is the essence of meditation, the gentle road to mindfulness which leads inside to your true nature. Mindfulness is an extended awareness, throughout the day, noticing, not simply reacting.

Meditation reduces stress by increasing positive feelings and decreasing anxiety. As you get to know yourself better and learn to treat yourself and others with greater kindness, your ability to navigate your emotional reactions with more skillfulness also leads to a greater ability to get along with yourself and with others. Self-acceptance, again, is key.

There have been many scientific investigations into the benefits of mindfulness. An early one was the relaxation response developed by Dr. Herbert Benson, who founded the Mind-Body Institute, affiliated with Harvard University. He reports that meditation produces healthful changes in metabolism, heart rate, respiration, blood pressure, and brain chemistry. The National Institutes of Health concur. Other findings reveal that long-term meditators have increased grey matter in their brains, and an increase in alpha-wave activity.

Meditation can be an important part of your daily life. With patience, you will reap great benefits of consciousness and emotional development. Following basic Zen principles of compassion and nonviolence, and establishing a regular meditation practice, makes for a satisfying life with less stress—and provides the tools to handle stress when you need to. A Zen mind-set can go a long way toward teaching us to deal with stress. You don’t have to make a huge change to gain its benefits.

Recommended reading:

Depressed manWhile most Americans will experience some level of depression in their lives, some will experience an intense and serious depression that requires the help of friends, family, and often a mental health professional.

The severity of a depressive state will fluctuate based on a variety of factors, including the availability of a support system, treatment options such as a therapist or psychiatrist, emotional coping skills, and a history of successfully navigating previous mental health episodes. However, when depression worsens, suicidal ideations (or thoughts) may develop, and are therefore often seen together. The focus of this article is to help identify common signs and symptoms of suicidal thoughts related to severe depression and how to recognize when to seek help.

Common depressive symptoms include a loss of interest in previously enjoyed activities, low energy, changes in sleep and appetite, concentration and focus problems, and changes in libido. When depression worsens, often people will experience hopelessness, a desire to isolate and withdraw, and may begin to have thoughts about how to make the pain (depression) stop. These are symptoms most commonly associated with the onset of suicidal ideations. This is where outside help is needed. The vulnerability experienced with hopelessness and a desire to make the pain stop sometimes leads to irrational actions and decisions. Once this hopelessness manifests as a desire to “go to sleep,” “make the pain go away,” or identifying ways to die and how to obtain the means (guns, pills, etc.), the suicide risk is dramatically heightened.

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Other factors must be considered when determining how soon help should be acquired during a worsening depression. First, if a firearm is in a person’s possession or at least accessible to the person, help should be sought as soon as the depression is apparent. The firearm should be secured by a third party or by law enforcement. Next, any use of recreational drugs or alcohol limits a person’s insight and judgment, making them more impulsive and less likely to consider available resources. If a person is likely to use drugs, help needs to be called before a person becomes intoxicated and possibly makes a dangerous mistake. A previous history of suicide attempts increases a person’s suicide risk; thus, help should be attained immediately if a suicide survivor begins to experience suicidal thoughts.

Risk Factors

Numerous risk factors need to be evaluated to determine suicide risk level. Below is a listing of the more serious factors warranting immediate intervention. If any of the following become present in a person’s thoughts or behavior, help should be sought immediately (note this is not a comprehensive list but rather an overview of the more common risk factors):

Treatment Options

Depression and thoughts of suicide are serious, but they are also highly treatable. The sooner a person elicits help from friends, family, or a compassionate mental health professional, the sooner they may be able to gain healthier perspectives and insight into ways they can work to handle their current state. Help may be able to instill hope and help a person begin the process of returning to a happier and stable state.

It is important to know some available resources for those experiencing suicidal ideation. First, call 911 immediately if a person is expressing they may no longer be able to remain safe on their own. Second, if safety permits, a person can be taken by friends or family to any hospital emergency department, where the person will receive a comprehensive evaluation and possible placement inside a mental health facility. Third, many therapists have after-hours support available, but this should be used only if there is not an imminent threat to personal safety. Fourth, the 988 Suicide & Crisis Lifeline (24 hours, seven days a week) can be reached at 988, where a trained person will listen and help a person decide the best route for help. And lastly, many communities have local-based suicide-prevention crisis lines and clinics. Check with your local mental health department to see what resources are available.

Developing a safety plan before depression worsens is a key element in the treatment of those at risk for suicide. Having support systems early and risky behavior identified (e.g., thinking of ways to die, acquiring means to harm self, etc.) can be a life-saver. It is best to have a plan of prevention and response in place before a crisis; trying to develop a safety plan amid an active crisis is often unsuccessful. A mental health professional can help you develop an excellent care and safety plan in your very first session.

Valentine Day appleThe world can be a cold and cruel place, and as such, every display of warmth and goodness makes a difference. Performing random acts of kindness for those around you—such as opening doors, offering to help carry groceries, giving free hugs, or buying a cup of hot coffee for a stranger—can trigger a ripple effect, reverberating outward into the masses and spreading the good vibes like wildfire.

However, if you’re feeling lonely and unloved, showing kindness to others is often a stretch; in fact, it can be nearly impossible to do so with any amount of sincerity.

“We have all heard the adage that ‘you can’t love anyone else if you don’t love yourself first,’ and this is 100% true,” says Marla B. Cohen, PsyD. “When we are not practicing self-love, we may begin to see ourselves as unlovable and unworthy of the love and kindnesses shown by others.  This can lead to a sense of distrust with other people and a tendency to devalue others and reject some of the kindness and care coming our way.”

An important component of this practice, Cohen adds, is acknowledging that imperfections and mistakes are a part of being human. “When we are judgmental and critical of ourselves, and when we saddle ourselves with unrealistic expectations and unending obligations, we become dependent on others around us to help, heal, or save us.  As this is an impossible task, we inevitably become resentful of others, because no amount of love, concern, or assistance from another will feel adequate if we are in a constant state of self-criticism and self-imposed pressure.”

[fat_widget_right]Silencing the critical voices within can be a challenge, but it’s one worth taking on—and small acts of kindness toward ourselves can be incredibly transformative. “Self-kindness helps stop the constant flow of negative self-talk, criticism, judgment, and relentless pursuit of perfection that most of us have come to see as normal.

When we treat ourselves with kindness, compassion, and understanding, we feel worthy, nurtured, and secure.  When we provide ourselves with an unconditional environment of safety and security, we free ourselves up to take more risks in service of our potential.”

Simply put, the more gentle and forgiving we are with ourselves, the more likely it is that these positive vibrations will overflow into our interactions with those around us. “When we accept our own imperfections and limitations, we are much more able to have empathy for others’ shortcomings.  This helps us be more accepting and loving in all of our relationships,” says Cohen.

So if you’re feeling the need for a little therapeutic love boost, treat yourself to one—or all—of the following random acts of self-kindness:

Young Woman Bathing at Health Spa

1. Take a hot bath.

Soaking in a hot tub, preferably with Epsom salt and aromatherapy oils, can do wonders for sore muscles and a worn-out spirit. Light a candle and turn on some relaxing music to add to the experience.

 

 

 

Little girl with dog walks on the road

2. Go for a walk.

Ideally, this will be in a favorite park or neighborhood. But it could be as simple as a walk around the block. Moving your legs, breathing the outside air, and taking in the sights and sounds will naturally increase blood flow and endorphins, thereby warming your body and bettering your mood.

 

 

woman shopping in garden nursery

3. Buy a special treat.

What makes you smile? Candles, jewelry, a good book, a trinket from an antique or thrift store, a bar of chocolate, flowers, a latte from a local coffee shop—there are so many small purchases that can make a big difference in how you feel, if only for a few moments. Cohen adds that it’s a good idea to keep the purchase around $20 or less to avoid buyer’s remorse. Whatever you choose, allow yourself to savor the indulgence.

 

 

Woman Receiving a Facial Massage

4. Schedule a massage.

Touch is a powerful form of pain relief and endorphin release. Giving yourself permission to make an appointment with a massage therapist sends the message that you are worthy of tenderness, care, and relaxation. Your body, mind, and spirit will thank you.

 

 

man in meditation outside

5. Meditate.

Setting aside the time to simply be—for a few minutes or a few hours—tells your inner taskmaster to simmer down and be still. Using candles, soft music, dim lights, and comfy cushions during meditation will help to set the mood, and slow, rhythmic breathing will guide you into a relaxed state. You can incorporate a mantra or simply allow your mind to become empty, letting go of one nagging thought at a time until all that remains is the sound of your heart beating and breath going in and out.

 

young woman reading card

6. Pick a card, any card.

Have you ever had a bad day and come home to find a card from a loved one in the mail? Knowing that someone is thinking good things about you can be an uplifting and powerful heart warmer, so imagine making that gesture of kindness for yourself. “I love to encourage my clients to go to a card store and buy themselves a loving card,” says Cohen. “It’s wonderful to write a note inside, honoring and appreciating yourself, and offering yourself encouragement.”

 

Wall covered in colourful post-it notes.

7. Decorate your personal space with positive messages and mantras.

Cohen encourages her clients to surround themselves with physical reminders of positive, encouraging messages. “In my office, I have painted rocks and notecards bearing messages such as ‘I matter,’ ‘I am worthy,’ ‘I will take time for me,’ and ‘I am enough,’” she says. “Keeping these kinds of messages around where you can see them regularly can really help the practice of self-care and kindness.”

 

 

Man Watching Movie in Empty Theater

8. Take yourself on a date.

The idea of going to a restaurant or a movie sans friends or a romantic partner may seem a bit daunting. But all it takes is one time to realize that the experience can actually be quite enjoyable. What restaurant do you typically only go to for special occasions? What type of food do you love to eat but never feel like making at home—or don’t know how? Is there a movie or a live show you’ve been wanting to see? Make a reservation, buy the tickets, and go solo. Bring a book to read if you can’t handle the thought of eating alone and without conversation. Your self will be immensely grateful for the gesture.

 

As a final thought, Cohen says, “I encourage people to consider all of the ways they show love and kindness to others, and then urge them to treat themselves with the same attention, consideration, nurturance, forgiveness, and respect.”

woman with abdominal acheHave you ever experienced pain during sex? If so, you are not alone. According to a Huffington Post report from a National Survey of Sexual Health and Behavior study, 30% of all women ages 18 to 50 experienced painful sexual intercourse during their last sexual encounter.

What Causes Painful Sex?

Painful sex can be attributed to variety of possible reasons. Some women experience pain after giving natural birth due to scar tissue that forms after tearing or cutting of the vaginal walls.

Other women develop a condition of vaginal muscle atrophy or atrophic vaginitis According to Medical News Today, up to 75% of women will experience this problem after menopause. The conditions involves vaginal dryness, irritation, painful sex, and changes to the appearance of the vagina.

If you are experiencing painful sex, there are many other potential causes of pain that can be assessed with proper treatment. Ideally, the best treatment option is a combination of medical treatment, physical therapy, and sex therapy.

Medical Treatment

[fat_widget_sex_right]Initially, it is helpful to get assessed by your primary care physician, gynecologist, or urologist. One challenge women face when seeking medical treatment is working with a doctor who is not familiar with the available options for painful sex.

It is important to seek a medical professional who specializes in the area of sex. Doctors who know about this field are more likely to collaborate with other potential resources and offer more specific medications that are designed to help in this area.

Pelvic Floor Physical Therapy

In addition to medical treatment, many women seek the help of a physical therapist who specializes in pelvic floor work. You can find these specialists at the Women’s Health website.

Physical therapists help women in several ways. First, they spend more time assessing the entire area including potential problems with the hips, groin, and urinary tract. Second, they offer specific exercises women can use to strengthen their vaginal muscles both in and out of sessions. Third, they teach internal stretching exercises that help sex become less painful over time.

Sex Therapy

As a final option, sex therapy can be used to help incorporate partners into treatment. Some women have difficulty transitioning exercises from the physical therapy room to the sexual relationship.

In sex therapy, clients are taught how to make exercises a more fun part of their sexual experience. It also helps women transition treatment from a solo endeavor (she is fixing her sexual problem) to a partnership (the couple is developing a better sex life).

Sex therapists can also help women who are burdened by psychological anxiety as a result of painful sex. Women report feelings of anxiety about potential pain that could happen, even when the pain is not present. If you are experiencing pain during sex, please don’t wait to get help.

hand marking checkboxes on checkboxesWhen you go to your doctor for some problem you are having, there is no question that you want an answer to what it is. Not only does it ease your mind because you have clarity, but it also means that there may be treatment for that problem/disease and you will hopefully get better.

It’s not quite so apparent when it comes to our mental health. You may have heard of the Diagnostic and Statistical Manual (DSM), which is like a bible of diagnoses for mental health. Originally compounded by psychiatrists (MDs), it reflected doctors’ beliefs that mental health issues are like diseases, and can be treated once diagnosed.

The most recent version of the DSM, put out in 2013, has been updated to reflect current research and practices. It is used to label mental health issues so that insurance companies know what and how to bill. But for many practitioners it is also a useful way to define a client’s condition. So, is it helpful or not?

On the plus side, there are times when having a label to your experiences gives you peace, as you have a name for it and don’t feel you are “just crazy”. It is also critical in determining medication interventions. If one is diagnosed with attention deficit issues (ADD) or bipolar, for instance, it is likely that the right medication(s) can greatly improve quality of life. Having such a diagnosis—and very clear criteria to make that diagnosis—aids therapists and clients in collaboratively identifying courses of treatment.

[fat_widget_right]Labeling also often helps clients in explaining unexplainable behavior to their significant others. Imagine, for example, that your spouse is constantly late, procrastinates, forgets everything you tell him, and seems to space out a lot. Perhaps you are angry because he doesn’t seem to be trying to improve these problems.

If your partner is diagnosed with ADD, that gives a lens through which you can now understand your husband’s behavior, and it allows you to problem solve together, set realistic expectations for change, and, of course, get appropriate help in the form of therapy and/or medication.

On the down side, labeling can be highly stigmatizing and can even limit treatment options. Certain diagnoses come with all sorts of judgments—even on the part of therapists, who should be aware of these judgments, but aren’t always. Clients can become stuck on their diagnoses, instead of working on the solutions.

Most diagnoses don’t come with a clear and definite treatment, like a medical problem might. For instance, a diagnosis of depression might be treated with medication, cognitive behavioral therapy, hypnosis, mindfulness, or dozens of other options, depending on the client’s needs and the therapist’s skills. So some therapists prefer to look at the constellation of symptoms, and decide how to approach them without needing to put them in a box.

Having a label can be freeing, and can allow you and your therapist to come up with the right plan for you without adhering to strict labels. Another serious concern about labeling is that mistakes are made quite often! It could be the result of an unskilled therapist, or perhaps that clients share only selective information or inadvertently leave things out because they don’t know it’s important to share. Sometimes it takes years to piece together the whole picture and fully understand a person.

Whether you believe in labeling or not, it is always wise to do your own research, get a second opinion, ask lots of questions, and trust your gut!

angry young boy“I hate you!” 4-year-old Carly screams at her mother. Some moms might react by grabbing their daughter and spanking her on the bottom, or screaming, “You are a bad girl!” or telling her, “That’s a bad word, we don’t say things like that,” or starting to cry and admonishing, “You hurt Mommy’s feelings.” There are many ways children learn to think of their angry or hateful feelings as bad even though anger and hate are normal human feelings. Too frequently, families don’t differentiate between expressing these feelings through words and acting on them. When families succeed in outlawing feelings of anger and hate and don’t teach their children appropriate ways of expressing their feelings, they limit the child’s ability to be aware that he or she has these feelings and to use them successfully. These limitations seriously interfere with the ability to become a person who can navigate life and relationships with a full range of feelings and self states.

Several years ago, I received a call from Frank, who made an appointment. In our first session, he was clear that he wasn’t sure he needed therapy, but his wife thought he should see a therapist because he seemed so unhappy with everything. He told me that he thought his wife was probably right, that he wasn’t very happy. “But I don’t think I’m depressed,” he said. “You know, I just do my life. I share responsibility for my 10-year-old son, who I love. I have a job that helps to pay the bills, but I don’t care much about it one way or the other. I’ve been married for 14 years and my relationship is OK, even though my wife keeps complaining that I don’t seem happy. She can be a nag, but that’s fine—I’m used to it. I’m OK.”

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I commiserated with Frank that it seemed his wife had sent him to therapy and that he didn’t really feel that it was something he wanted or needed. He responded, “That’s so true, but I guess I don’t really know what I want or need. My wife always seems to know what I should do more than I do. So I’ll give it a try.”

Frank and I began our work, and since Frank didn’t have any specific complaints, I thought it would be useful for him to tell me his life story.

Frank described his childhood as “the usual—no real problems.” In one session, he recalled, “My mother taught me to be thoughtful about people. She was anxious and always worried about what other people thought. It was most important that I treat her with utmost respect. I always did what she said; I was very aware of not wanting her to feel embarrassed by my behavior.” In another session, he spoke of his mother: “She could get very hurt if I disobeyed or said no in any way. I remember when I was 6 or 7, I wanted so badly to go to my friend’s house to play with these action figures he just got. She wouldn’t let me go because my father was away on business and she didn’t want to be alone. I think I said something like, ‘Please, it’s not fair. It’s only for a few hours.’ She got very upset with me and started crying, ‘How could you be so mean to me and hurt me like this? How dare you say I’m not fair?’ I felt terrible. I couldn’t stand to see her hurt.”

Frank’s father, a successful litigator, was always involved in his work. Frank understood that his job was to be there for his mother and keep her emotionally comfortable. Any attempt to protest or “do his own thing” would be met with the mother’s hurt and Frank’s remorse. He learned early how to be a “good son.” When I asked Frank if he ever felt angry with his mother, he looked startled. “Why would I be angry at her?” he said. “I was the bad one. I hurt her. Besides, I could never feel angry with her. She never said so, but it wasn’t allowed. I think it would have destroyed her.”

Frank’s demeanor in our sessions was usually slouched over, talking quietly, mostly in a matter-of-fact way. When he spoke about high school, he perked up and began to describe doing well academically and feeling good about it. But then those feelings disappeared as he explained, “In my junior year I was thinking about going away to college and started to talk to my parents about it. My mother said I would be better off going to college at home and my dad agreed. I remember him saying that he appreciated my being at home with his being away for business so much and that it would be good for me to live at home and save the family some money.” Frank looked sad and said, “You know, maybe I did get kind of depressed then. I know I didn’t have a choice. It seemed that was just the way things were, not something to have feelings about. I never applied to schools away from home. I lived at home all through college but got my own apartment when I graduated. My parents found one for me in the neighborhood where they lived.”

I asked Frank, “What do you mean when you say you had no choice?” He looked perplexed and seemed to have trouble responding. “I don’t know. It wasn’t something that I would have thought about once they said no. They said no and that was that. I suppose I never gave it a second thought.”

“What do you imagine would have happened if you did give it a second thought?” I asked.

“It’s not conceivable,” he said.

“Just try to let yourself imagine and see what you think of.”

“I don’t know …”

“It’s OK not to know. But I really would like you to try.”

“Well, let’s see. I feel like crying. … Maybe I would have cried.”

“What do you imagine you would have cried about?”

“Hmm. I would have been sad that I couldn’t go away to college.”

“Why do you think you would have been sad?”

“I don’t know. Maybe I would have liked to go away and was unhappy that I couldn’t.”

“I remember you told me about wanting to go with your friend when you were 6 or so and you told your mother that it wasn’t fair that you couldn’t. Do you think this could have been a similar feeling?”

Frank began to cry softly, “Oh yes, yes, that’s it. I couldn’t go with my friend, I couldn’t go away to college, and I couldn’t do a lot of things. It wasn’t fair.” Frank put his head in his hands, and his crying got louder.

“It’s very sad. You learned not to protest and to accept the life your parents prescribed for you,” I said.

After this session, Frank and I began to look at this pattern of accepting what was put in front of him, choosing what was pleasing for others and opting for paths that were least likely to create conflict or stir up feelings of anger.

We are currently talking about Frank’s relationship with his wife and son. He is more curious about his wife’s description that he’s “always unhappy” and is considering what he could be unhappy about. He recognizes that feelings have been accumulating about his life that he has never been free to feel or express. This worries Frank. “What if I know what I want or think or feel? What happens if I start to get angry at the people I love? Oh, my god! What if I even hate them?” These are frightening thoughts, and we are working on Frank becoming more comfortable bringing more of himself into his relationships. Frank had an “a-ha!” moment when it occurred to him that maybe his son doesn’t listen to him because he can’t say no to him. Frank told me with great surprise, “I’ve been afraid to get angry with him, so I just say yes, and I haven’t been tuned into myself. You know, I can see now—I do feel angry!”

Frank is scared but also excited about the possibilities of developing his voice and getting comfortable with his feelings. We have much more talking to do, and we will take it slowly. Frank will be anxious as he grows and develops and tests his new thoughts and feelings in the world. But each success in voicing his authentic self will make his next attempt to be the person he is becoming feel a little less frightening. With continued work, Frank can get comfortable enough with himself in the world.

Frank’s story is not unique. Many children grow up in families where they learn, consciously and/or unconsciously, that feelings of anger and hate are bad. They may be unaware that they are fighting within themselves not to feel these feelings. As they mature, they are handicapped. They can’t know themselves or be themselves or use these feelings to help make choices. For example, they won’t be clear that they are being treated badly, or that it’s OK to compete to get what they want, or, like Frank, that it’s necessary to say “no” to help a child learn to accept “no” and limits.

Children who grow up believing that anger and hate are bad usually believe that if they have these feelings they will DO something bad or act in a hateful or rageful manner. But feelings do not have to be acted upon, or can be acted upon in appropriate and nondestructive ways. If we don’t have a full range of feelings available to us, we are at risk of not knowing what we want and who we are—and of having limited lives and relationships.

Editor’s note: Names in the preceding narrative were changed to protect privacy.

Important Notice

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.