When you are the spouse or partner of a person experiencing depression, you may feel stuck between wanting to help and realizing depression is a force larger than your love at times. You may be on edge, hypervigilant, worried, and feel hopeless when you cannot fix it for them.

First things first. If your loved one is in a depressive state lasting longer than two weeks characterized by sleep disturbances, lack of interest in once-enjoyed activities, weight gain or loss, sad feelings, fatigue, irritability, suicidal thoughts, and/or social isolation, you should get professional help immediately. You can start with your family doctor, who may refer you to a mental health professional. Depression is not something to “wait and see” on, and it’s not something just anyone can identify or diagnose. Keep in mind, also, it is common for a depressed person to not want anyone (especially a loved one) to worry, so they will often put on a good front and minimize their true feelings.

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When your spouse or partner is hurting, it is natural to want to solve it for them—to search for actions you can do to remove depression and replace it with happiness. While this is a valiant and tender-hearted gesture, it is also ill-fated. Depression doesn’t simply go away because you’ve loved more. Clinical depression can be a chemical imbalance, a residual effect of past trauma, a situational outcome, or a genetic predisposition, making treatment difficult in the best of circumstances.

So what does it feel like to watch your spouse or partner go through depression? Well, it’s depressing. It creates a situation that may feel out of control, hopeless, and heavy. You may become a watcher—watching what the depressed person says, what they look like, how they acted, and what didn’t happen. You may become a detective trying to identify something that will create change and bring lightness. “If only …” may become your new motto, “Why don’t you try …” your new daily suggestion.

As a partner and (at least to some extent) caretaker, you will need to keep yourself healthy. That may mean seeking your own individual therapy, seeing friends, doing activities you enjoy, exercising, eating healthy, and setting clear emotional boundaries about what you can change and what you must accept.

You may become consumed with fighting this depression and then, without realizing it and without meaning to, you may get angry—angry your loved one isn’t getting better, angry your life stinks, angry you can’t change this. You know it isn’t your loved one’s fault and they didn’t ask for depression, but you may get impatient anyway, wanting change to happen more quickly than they may be able to move. You may experience a grieving of sorts—for the loss of the life with your loved one that you once knew.

As a partner and (at least to some extent) caretaker, you will need to keep yourself healthy. That may mean seeking your own individual therapy, seeing friends, doing activities you enjoy, exercising, eating healthy, and setting clear emotional boundaries about what you can change and what you must accept.

It is not unloving to learn to maintain a distance from the depression; it may, in fact, be the only thing that keeps you healthy and available. Observing your loved one suffering while you live fully can be difficult to comprehend. You will no doubt ask yourself if you should be laughing, eating out, or seeing a movie. However, who will take care of you if you don’t? Finding lighter, more upbeat activities can create space that allows for some happy times for you. This space can fuel you when times are heavy and tough. As with all things, “this too shall pass” can be a mantra to absorb and hold true.

In time and with treatment, your spouse or partner can be happy again, and you can feel less worried and vigilant.

I love to talk. I can sit and watch one of those movies where nothing seems to happen except a bunch of people sitting around a room chatting. I can still be riveted because I love hearing ideas. I like words.

But talk therapy doesn’t always mean a lot of talking. Sometimes it gets quiet in therapy, and that’s okay.

In fact, it can be good.

If you think I’m “talking” out of both sides of my mouth here, it’s probably because I’ve written on this site about how talking about anything, even if it’s not something you think is related to your issue, can bring you to new realizations. It can open a door to your psyche. It can make connections about why you do things that you might not have figured out without the winding, goal-less, meandering free chat.

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Yet, in some cases those words could obscure what’s really going on. They may get in the way of some important feelings. In fact, talking can be the very defense we use to avoid having certain feelings.

The Ultimate Therapy Cliché

“How are you feeling?”

It’s a pretty clichéd therapy line. So much so that when I was a young therapist I told myself I’d never say it. I didn’t want to be compared to the long line of bad TV and movie therapists; I’d have something much more insightful to offer.

Ha.

I soon realized that it’s a cliché because people often don’t know what they’re feeling.

Sometimes the question is actually fairly stressful, and for good reason. Some people spend so much time thinking and talking that they never really connect with what they are feeling. If they are asked, “How are you feeling?” the most honest answer they may be able to give is, “I don’t know.”

And that’s fine. “I don’t know” is always a fine answer. At least as a starting point. It can be a relief to say it. Correct: you don’t know. That’s why you’re here.

And then … silence. And then you sit with that unnamed feeling.

Finding the Feeling in the Silence

If you’re a storyteller, then these are important, rich, and scary moments. It can be exasperating because you often really, really want to know. And I’d love to tell you—but I don’t know how you feel, either. My tool is I’m very aware of how I’m feeling when I’m with you. And that can be helpful to share.

Therapy is not a “conversation.” It’s not a normal situation. It’s a petri dish, an experiment, a place to look at the way we interact on a meta level.

But in general, we need the silence so you can check in with yourself and see where that feeling is. Maybe it’s in your body—many physical sensations are signs of a feeling we’re having before we’re aware of it.

Heck, the “anger management” field is practically built on the idea that if we can sense that first sensation indicating we are angry (tight stomach, hot face, clenching fists), we may be able to prevent ourselves from being taken over by an uncontrolled feeling expression.

For my part, often if I have a headache, it’s a signal I’ve been feeling sad and I need to allow that feeling in. Sometimes the headache needs to pound to let me know I need to stop thinking, stop analyzing, stop talking—and just feel.

Why Silence in Therapy Is Different

Therapy is not a “conversation.” It’s not a normal situation. It’s a petri dish, an experiment, a place to look at the way we interact on a meta level. It’s often pushing against what generally makes sense as to how we go about our lives. This is why it takes time to build trust with your therapist. It’s so when you sit in silence, you can trust that you and your therapist are both still working. You’re both allowing a process to unfold and occur and not know where it’s going.

The silence gives you time to connect with your therapist—and then tell them—what you’re feeling. Something like:

• “When we’re not talking, I get upset because I feel you’re not helping me anymore.”
• “If you don’t talk, I feel like you’re abandoning me. It makes me feel very alone.”
• “You’re getting paid for nothing! You must love it when we don’t talk. What am I to you, just a cash cow?”
• “I don’t know what to say. I’m stuck.”

How refreshing would it be to say that to someone whose job it is to process it with you? It’s a chance to better understand how you come across in an environment with someone who won’t leave you.

Trust this part of the process.

Trust the silence. It can say so much.

Let me ease the burden of sex for you. I use the word “burden” because I know sex can feel like one sometimes. Sex may not be the most important pillar in your relationship, but how you engage, navigate, and connect around sex is crucial, whether sex is active or dormant.

Life has a way of steamrolling a couple’s sex life. Kids. School. Chores. Career. Family. Health care. Finances. Other obligations.

It’s always someone’s birthday or a holiday. No matter how much you clean, the house always looks dirty. The lawn keeps growing. Your to-do list has no end. Your boss demands more of your time. The kids always need new shoes or have a baseball game.

When you finally sit down at the end of each day, you feel depleted. The only thing you have any energy for is your favorite TV show. However, you save that for the weekend because you have to catch up on work email. Then you go to bed, only to wake up to the same routine, responsibilities, and exhaustion.

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Somewhere in there, you are supposed to make time for your partner—for date nights and for sex. Not humanly possible, right? Your relationship may go on like this for years until fighting and irritability set in, someone has an affair, or someone walks away.

Whether you are the pursuer of sex or the distancer in your relationship, sex can feel untenable. If sex happens but feels dissatisfying, it may be your sex life is comprised more of quickies and obligatory sex than true engagement. If you habitually compare your current sex life to “how much we used to do it,” you may set up future sexual encounters as failures.

Mismatched sexual desire is not uncommon in romantic relationships—research shows that desire discrepancies are one of the most frequent issues couples report in therapy, with one study finding that 80 percent of couples experience mismatched libidos at some point in their relationship. One person frequently pursues sex while the other, the one with lower drive, distances. Ultimately, the pursuer may feel rejected and wonder, “What is wrong with us? With me?”

Recent research shows that 15 percent of men and 34.2 percent of women reported losing interest in sex for three months or more in the previous year, demonstrating that sexual dry spells are a normal part of many relationships.

Here are some tips to help you survive the inevitable sexual dry spells of a marriage or long-term relationship:

1. Talk About the Dry Spell

The dry spell can become a painful elephant in the room. Have a respectful conversation, acknowledge how you both feel about sex, how life or relationship discord has hijacked you and your spark. Note what you miss sexually (whether it’s about yourself or your partner). Talk about what you look forward to when desire returns. Be honest, regardless of whether you’re the pursuer or the distancer. Own your roles without pressuring each other.

Research shows that open communication about topics such as sexual desires, boundaries, and relationship expectations is linked to greater sexual satisfaction and improved relationship quality.

2. Practice Realistic Expectations

If you set the bar at an unachievable height, you are doomed to feel disappointed. Acceptance reflects a mature outlook on sex. This does not mean either one of you does not want sex or is “settling.” It means you practice realistic expectations regarding how you approach your sex life. It means accepting you are not that couple on television (or in porn) who have spontaneous, hot sex every single time.

3. Strive for Quality, Not Quantity

Some partners place heavy emphasis on quantity. Partners may say, “Well, we have sex only once a month” with embarrassment For some couples, this might be where your baseline settles. If so, focus more on making that “once a month” as fulfilling as possible for both of you. If you improve the quality of those times, you may feel more connected, enough so that the space between does not feel as long or lonely.

Studies show that quality counts more than quantity, with younger generations prioritizing emotional connection over physical frequency.

4. Value Emotional Connection as Much as Sexual Connection

Your emotional life and sexual life are intertwined. If sex chronically diminishes, it may be more than life’s hijack. Have more intimate conversations, ask each other about how your relationship feels, share with one another, express gratitude, compliment each other, and treat each other kindly and with respect. Value these qualities as much as you value sex.

Research supports the strong intertwining between sexual and relationship well-being, with longitudinal findings revealing a bidirectional relationship between relational intimacy and sexual satisfaction.

5. Practice Healthy Doses of Humor

Do not take yourself too seriously. Remember, dry spells are inevitable.

Do not take yourself too seriously. Remember, dry spells are inevitable. Before jumping to conclusions or dwelling in rejection, practice humor to ease the tension around sex. When both partners make light, loving jokes about the dry spell, it may alleviate pressure on both sides. At the same time, humor works only when both partners are laughing. Jokes should not be masked digs. Make them playful, considerate, and loving.

6. Acknowledge Your Partner’s Bids Even If You Don’t Act on Them

Couples run into trouble when sexual bids are ignored, dismissed, or even harshly rejected. When your partner is in the mood but you are not, but you are nonetheless flattered, consider expressing appreciation. Try not to act annoyed. Can you appreciate that, after all this time together, your partner still desires you?

7. Expand Your Definition of Sex

Partners typically view sex through the narrow definition of intercourse or penetration where at least one person experiences orgasm. Can you shift how you think of sex? Rather than striving for penetration, focus on sexual connection. With this expanded view, you may have a wider range of sexual options to choose from that do not obligate you to “go all the way” every time.

8. Look for Small Windows of Opportunity

When time and energy fall short, try mini-moments of sexual connection. These can range from acts such as longer, lingering kisses to light foreplay and more. Smaller gestures let your partner know, “I may not be able to follow through right now, but I want to,” “I like touching you,” and “I miss you.” These are mini-moments. You can even declare, “I’m coming in for a mini” so you are both clear on the intention.

A friend of mine once referred to his sex life as “peaks and valleys.” How you approach those peaks and valleys makes all the difference between sustained connection and disgruntled disconnection.

Important Note: The information in this article is for educational purposes only and should not replace professional medical or therapeutic advice. If you are experiencing persistent relationship or sexual difficulties, consider consulting with a qualified therapist or healthcare provider. Research suggests that stress reduction interventions may be a potential way to promote sexual health, ultimately contributing to improved well-being and overall health.

References:

1. Arenella, K., Girard, A., & Connor, J. (2024). Desire discrepancy in long-term relationships: A qualitative study with diverse couples. Family Process, 63(3), 1201-1216. https://pubmed.ncbi.nlm.nih.gov/38234271/
2. Chen, T., Dai, M., Calabrese, C., & Merrill Jr., K. (2025). Dyadic and longitudinal influences of sexual communication on relationship satisfaction, emotional intimacy, and daily affect among same-sex male couples. Health Communication, 40(7), 1352-1362. https://doi.org/10.1080/10410236.2024.2400813
3. Hims Health Team. (2024). How can I keep sex fresh in my long-term relationship? Good Health by Hims. https://www.hims.com/blog/dryspell-in-relationship
4. Mües, H. M., Markert, C., Feneberg, A. C., & Nater, U. M. (2025). Too stressed for sex? Associations between stress and sex in daily life. Psychoneuroendocrinology, 181, 107583. https://pubmed.ncbi.nlm.nih.gov/40907147/
5. Psychology Today. (2025). When libidos clash: I love you, but I’m not in the mood. Psychology Today. https://www.psychologytoday.com/us/blog/hidden-desires/202503/when-libidos-clash-i-love-you-but-im-not-in-the-mood
6. Smith, K. (2025). Sex, intimacy, and connection: How often do couples have sex in 2025. South Denver Therapy. https://www.southdenvertherapy.com/blog/sex-intimacy-and-connection-2025
7. University of Cincinnati. (2025). Uncovering what matters to young adults: Communicating about sexual health & relationships. Journal of Sex & Marital Therapy. https://www.tandfonline.com/doi/full/10.1080/15546128.2025.2459381

The adoption of a child is an event, fixed in time, with a beginning and an end. However, the impact of adoption is far-reaching and ever-changing—a process that continues throughout the lifespan of the adopted person and those connected.

It’s been my professional experience that many individuals who were adopted share similar symptoms, beliefs, and reactions in the present that stem from the separation trauma of parting from their biological mother at birth. Multiple placements, foster care, or time in an orphanage can exacerbate this trauma.

An infant or child separated from their birth mother will almost certainly experience some level of trauma, as they will perceive this event to be a dangerous situation. The sensations, sights, and sounds with which they were familiar are gone, and the mother is no longer available to soothe the child or help the child self-regulate. Because the only part of the brain fully developed at birth is the brain stem—this controls the sympathetic nervous system, which generates the “fight, flight, or freeze” response—babies are unable to use parasympathetic abilities, such as self-soothing. When this happens before the age of 3, it is encoded as implicit memory—like any event that takes place before the development of language. As noted trauma expert Bessel van der Kolk explains in his book The Body Keeps the Score, “We have learned that trauma is not just an event that took place sometime in the past; it is also the imprint left by that experience on the mind, brain, and body.”

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Eye movement desensitization and reprocessing (EMDR) is an integrative therapy originally developed by Francine Shapiro to alleviate distress associated with traumatic memories. When a traumatic event occurs or something happens that is perceived as traumatic, the associated memories may become stored in the brain and nervous system in a maladaptive way—frozen rather than processed. Current reactions are fueled by negative beliefs stemming from events that occurred in the past. People become stuck. In some cases, trauma that happened years ago continues to feel like it’s happening in the present.

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EMDR therapy targets the unprocessed memory as well as the emotions, beliefs, and body sensations associated with it. Bilateral stimulation (generally eye movements, tapping, or tones) activates the brain’s information processing system, allowing the old memories to be digested or reprocessed and stored in an adaptive way—even if the person doesn’t have an autobiographical account of the memory. For many adoptees, the trauma happened before they developed the language to explain the events, so the memory is primarily somatic in nature and stored in the nervous system.

Many adoptees have issues related to attachment ruptures. An adopted child whose parent is a few minutes late to pick them up from school may dissolve into tears. The internalized belief or negative cognition that child develops may sound something like “It’s not safe to trust” or “People I love leave me.” An adult who was adopted may unknowingly recreate abandonment scenarios in relationships, unconsciously choosing partners who are not truly available and do leave, fulfilling the negative belief “I am not worth it” or “I am not lovable.”

Using bilateral stimulation, EMDR helps integrate the early memories, body sensations, emotions, and negative beliefs the person has. Over a series of sessions, symptoms are reduced, and beliefs associated with the memories or experience are shifted to a more positive and adaptive state.

In both examples, the reaction in the present is disproportionate to the situation. This is useful information that some feeling, experience, or memory from the past is being triggered. A much younger “self” is running the show. The fight, flight, or freeze response gets activated in these situations, and the prefrontal cortex, the part of the brain in charge of executive functioning and decision making, goes offline. The person may feel disregulated, scared, and confused.

So what does a typical EMDR session with an adopted person look like?

After gathering history and establishing rapport, the therapist and person in therapy work together to establish target memories and present triggers that are causing suffering and/or interfering with daily life. The “targets” are the starting points of the session and a point of reference to trace the memory back in time. Using bilateral stimulation, EMDR helps integrate the early memories, body sensations, emotions, and negative beliefs the person has. Over a series of sessions, symptoms are reduced, and beliefs associated with the memories or experience are shifted to a more positive and adaptive state.

Rather than the belief “I’m not lovable,” the person may be able to recognize and have a felt sense of worth despite what happened in the past. In my work with adopted individuals, I combine various EMDR protocols, guided imagery, mindfulness practices, and visualization to create calm states and nurturing figures in the present to help heal the wounds of the past.

EMDR is safe, effective, noninvasive, and powerful. It does not involve medication or hypnosis, and I’ve found it a wonderful adjunct to talk therapy in my work with people who were adopted. If you want or need support on your healing journey, find an EMDR therapist in your area.

Reference:

van der Kolk, B. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. London, UK: Penguin Books.

I hardly dare to write or even think about suicide, a topic difficult enough to discuss when it is not outright painful. Suicide, attempted or completed, has touched the lives of many. You may know someone who has died by suicide or someone who has made an attempt. You may have experienced thoughts of suicide yourself.

There are people who consider the act of suicide to be a sin, an act tantamount to murder, and consider it unforgivable under any circumstances. My personal belief, though, is that some situations, such as long-term physical pain or terminal illness, may make suicide seem like a rational course of action. Of course, emotional pain can be intolerable too. Severe depression, for example, which may feel endless and can be a match for tormenting physical pain, can often play a part in the development of suicidal thoughts.

When someone we love dies by suicide, whatever the reason behind their choice, we are likely to feel unspeakable grief. We may feel angry or hurt; we may perhaps experience guilt. Along with these emotions, we might feel a desire for answers and explanations. We want to know why this happened, how it could have happened.

When A Loved One Dies By Suicide

People who complete suicide sometimes leave notes or discuss their plans with loved ones. Other people might say nothing. Even when we have some knowledge or understanding of a person’s reasons, suicide leaves us ungrounded. We need something to hold onto.

I myself know people who have died by suicide. My father’s cousin, who was fatally ill, asked to be removed from his respirator so he could die on his own terms. Another of my cousins who was incurably ill and in pain did something similar. They both said goodbye to close family members before passing on.

One lovely young man I knew who was battling addiction also chose to end his life. He was extraordinarily kind, funny and smart—a feeling soul. Before he died, he took his mother on a trip to the northwestern United States, a place they had both wanted to visit. I don’t know if they discussed his plans, but I do believe this was his way to say goodbye and tell her he loved her. I do feel he was, in some way, looking to be close to her and compensate, in a way, for his death. [fat_widget_left]

Some months after this young man’s death, I read a Facebook post from an older woman, a message that was unusually warm.  Her wishes to her friends and her thoughts about life were so lovely—it took time and rereading to realize it had been a goodbye to those of us reading, a suicide note—that, in fact, she had already passed on by the time I read the post. Many of us wrote back, remembering her gifts and her compassion, expressing their love. I was not the only person who couldn’t believe she was dead.

A colleague with an incurable disease planned her suicide very carefully. She wanted to make sure she would succeed. She wanted to protect her husband and children. She wanted to live as long and as well as she could, and then she wanted to die.

Again, I hesitate to write about suicide. My intention is not to inflict pain, to challenge anyone’s beliefs, or to cause difficult feelings. I only want to help those left behind, the survivors, survive, but I’m not sure if I can.

The people I’ve written about just now had deep relationships with others. They took care of the people around them, both in their lives and in their deaths. Each of these people understood what they were doing and knew their choice would have an impact on the people close to them.

They said goodbye, either directly or metaphorically, to make sure those who survived them knew they were loved. And though their absence left a painful, unreal space, a hole, they are all still alive inside of me. There are always reminders that they are gone, as there should be. They were here, but now they are physically not, though they live in memories and as part of our emotions.

Some might consider love and suicide to be antithetical. But I believe death and love are both so big that they encompass their meanings and their opposites, their synonyms and their antonyms.

To me, the most touching death of all was that of the young man who traveled with his mother before he died. The enormity of his love, and of all that he left behind, is almost more than I can bear. I find his death so poignant because he was young—not yet thirty—and because he and his mother embodied the primal pair of mother and child. Birth and love. Ultimate connection, followed by the ultimate disconnection. But not. (The iconic image of the Pieta—the Virgin Mary holding the body of the dead Christ in her lap, appears before my eyes as I write this.)

When your life has been touched by suicide, working through the complicated feelings that develop can be a challenging process. The support of a qualified therapist or counselor can often be of benefit. If you are having thoughts of suicide, we urge you to reach out. The 988 Suicide & Crisis Lifeline (988) is available at any time, day or night. Additional crisis information and resources are available here.

If you would like to read further on this topic, I suggest Linda Phillips’ book A Beautiful Here: Emerging from the Overwhelming Darkness of My Son’s Suicide. [amazon_affiliate]

Although trauma-informed therapy is gaining in popularity, one crucial component is often missing from the conversation—the importance of healing from a perceived lack of relational safety that often accompanies posttraumatic stress (PTSD).

If you have experienced a life-altering traumatic situation, you may understand all too well the more commonly discussed symptoms of PTSD:

• Re-experiencing symptoms such as flashbacks and nightmares
• Avoiding people or situations that trigger memories of the event, which may include dissociation/numbing as well as external avoidance behaviors
• Negative feelings and beliefs, or a lack of perceived safety or okay-ness
• Hyperarousal such as insomnia, startling easily, or a persistent “fight-or-flight” feeling of tension in the body

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While you may experience some or all of these symptoms as a trauma survivor, they paint only a part of the picture. Taken together, these symptoms often have an unfortunate effect of causing a person experiencing PTSD to distrust themselves and the world around them; to isolate by numbing or avoiding discussing their thoughts or experiences with others; and to feel unsafe in their body due to the hyperarousal symptoms. Healing from PTSD requires connection to friends, family, and community, support from others who have experienced similar symptoms, and a strong therapeutic connection with a therapist who understands how to help heal trauma symptoms. These relationships help restore both a belief and a felt sense that the world can be safe. Yet, paradoxically, PTSD causes those very connections to feel dangerous and threatening rather than potentially healing.

The first step to healing from trauma is recognizing the ways in which symptoms may cause you to want to isolate from others, whether loved ones or support groups or a therapist. This recognition is important, as it will be necessary when pacifying any fear, anxiety, or panicked feelings you may experience while interacting with others. These feelings are natural and understandable in the context of understanding trauma can cause a lack of trust in the world and in others. This can be even truer if the trauma was a result of harm caused by others rather than a natural disaster or events not directly related to a human cause.

Once you have noticed and recognized these isolating behaviors as being an effect of having experienced a traumatic event, you have the choice to deliberately make decisions and take actions that could lead to connection and trust.

While post-trauma survival instincts may cause you to feel most comfortable trusting only yourself, to isolate from others, or to turn to coping behaviors such as drinking or working long hours, these behaviors may prevent you from reestablishing connection and trust in the world and yourself—vital for healing from the effects of trauma and living a satisfying life. The effects of isolation can be even greater if you are living with the symptoms of PTSD caused by traumatic occurrences in childhood, in which case you may never have had the chance to build or experience deep, loving relationships or trust in the world around you.

Once you have noticed and recognized these isolating behaviors as being an effect of having experienced a traumatic event, you have the choice to deliberately make decisions and take actions that could lead to connection and trust. This may feel frightening or difficult, and you may find yourself having thoughts about other people being unsafe, untrustworthy, or not worth the effort. It is important to take small steps that may be counterintuitive to what your survival-based instincts are telling you, and then stop to reassess to see if your perceptions were true or not.

Two of the best places to experience safety and healing within a relationship are in therapy with a safe and understanding therapist, and in therapeutic or support group settings with others who understand your experiences.

• Individual psychotherapy: You will have the chance to experience a relationship that is safe, nurturing, and healing. You can expect an experienced trauma therapist to work with you in a way that helps you recover without experiencing additional pain or retraumatization as a result of the therapy. In addition, a therapist can serve as a witness to stories you need to tell and emotions you want to share, and can help guide you through the process of owning your experience or making meaning of why bad things happen.
• Group therapy and support groups: Groups can help you meet peers who may have experienced similar situations or symptoms, which can give you a chance to both talk to and hear from others who share similar struggles and triumphs. This can help you feel less alone in your experiences. In a group setting, you may learn valuable problem-solving ideas and skills. Support groups are often run for and by people who have similar experiences, while group therapy run by one or more mental health professional may involve directed therapeutic and relational interventions.

If you are living with symptoms of PTSD, it is possible to recover and feel better. With courage, patience, and the help of experienced professionals and caring peers, you can rediscover the strength within to live a satisfying and meaningful life.

Does your therapist agree with you all the time? Do they shower you with compliments and praise? Do they smile and nod a lot? Do they always let you lead the session? Have you noticed you invariably leave sessions in a good mood? These could be signs you have a supportive, caring, and empathetic helper—or they may be signs your therapist is too nice.

Therapists undergo years of training and are expected to be competent in counseling skills, including skill in confrontation and challenge. However, therapists are also people. Which means they, too, can struggle with disagreeing, being direct, and challenging others, including those with whom they work. Unfortunately, this can be to the detriment of people in therapy.

Consider the potential consequences of therapy with a too-nice therapist. If your therapist always agrees with and never challenges you, there is a good chance they’re not being objective. Objectivity is often a reason individuals seek counseling in the first place. Does “I want to talk to someone who doesn’t know me and won’t just tell me what they think I want to hear” sound familiar?

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If your therapist is subjective, you could be missing out on valuable alternative perspectives. It could be refreshing to hear your therapist state, “Here is another way to consider what happened …” before you make a major decision or change. Or, depending on your personality, you might respond well to a therapist being as forward as stating, “I have to challenge what you just said. I think something completely different is happening.” In subjective or too-nice therapy, such challenges are less likely to occur.

A basic counseling approach many therapists follow is to let the individual lead the session. This is meant to make sure time is spent purposefully meeting the individual’s needs and to respect the expertise they hold regarding their own lived experiences. This is all fine and good, but have you ever gone into session and thought, “I have no idea what to talk about today”? This could lead to what feels like a wasted session (and maybe even wasted money). There are times it might be helpful for your therapist to be directive and actively lead the session.

Additionally, therapist directiveness can produce quicker results with some clinical issues. Take, for example, social anxiety. Getting practical steps for building social confidence, being provided with strategies for managing physical symptoms of anxiety, and practicing newly acquired skills in session demands a high level of involvement and direction from your therapist. A therapist can certainly ask you what you think you can do to improve your social skills, but it’s probably nice to also hear, “Here are some steps we will take to help you build relationships.”

If you find yourself in a relationship in which you feel as if your therapist is being too nice (or too directive, too nondirective, too laid back, too confrontational, or any other too …), a good first step is to communicate how you feel. Let your therapist know you wish for more direction or challenge.

There is no one-size-fits-all model when it comes to therapy. This is evident in the fact there are hundreds of different therapy approaches, with no one approach found to be superior to all others (American Psychological Association, 2013). What is important is your therapist is a good fit for you and vice versa. When the therapeutic relationship includes a strong bond, cultural understanding, and individualized treatment, therapeutic change is more likely to occur (Laska, Gurman, and Wampold, 2014).

If you find yourself in a relationship in which you feel as if your therapist is being too nice (or too directive, too nondirective, too laid back, too confrontational, or any other too …), a good first step is to communicate how you feel. Let your therapist know you wish for more direction or challenge. Express your desire to learn more about their views or perspectives on the issues brought up.

Maybe your therapist is intentionally being too nice. It may be a means to elicit a certain emotion from you or to move you to confront unsatisfying relationships. However, therapy tends to not work well if it is a mystery. If you feel confused or uncertain, ask your therapist to explain more about their approach and how they see therapy working. Such a conversation could give you the insight you need to tackle your presenting concerns.

After having an honest conversation about your needs, should you find your therapist’s style is still not a good fit for you, don’t give up on therapy; instead, find a new therapist. Wanting a therapist who may be a better fit for what you need is not a personal attack against your therapist. Therapists recognize they won’t be the best match for everyone who seeks their services. Additionally, having worked with you, your therapist might have suggestions for another therapist they feel will better suit your needs.

So if your relationship with your therapist is too nice, remember it is never too late to make a change in how you and your therapist work together—and it is never too late to change your therapist, either.

References:

1. American Psychological Association (APA). (2013). Recognition of psychotherapy effectiveness. Psychotherapy, 50, 102–109.
2. Laska, K. M., Gurman, A. S., & Wampold, B. E. (2014). Expanding the lens of evidence-based practice in psychotherapy: A common factors perspective. Psychotherapy, 51(4), 467–48.1

Somatic psychotherapists often use the informal metaphor of a “container” in describing a person’s state of overwhelm or resilience.

It’s a simple concept: If Janelle is experiencing a lot of stress, and/or her system isn’t very resilient, then one can say her container is overflowing, or close to it. On the other hand, if she successfully deals with her feelings and the external situations that cause them, she would create more “room” in her figurative container and she wouldn’t be so vulnerable to becoming stressed out. She could also work with a therapist in order to develop affect tolerance and self-regulation. She would then be making her container larger and less brittle, increasing her resilience across many life situations.

The container can be filled by our response to events earlier in our lives that we’ve repressed and not dealt with. Researchers and clinicians working with intergenerational trauma believe our containers hold the trauma passed down to us from the experiences of earlier generations. Such experience includes but is not limited to systemic racism and oppression. The field of epigenetics looks at changes in gene expression (which pieces of our DNA strands are being expressed, and which aren’t). These changes are thought to be responses to the environment, either current or historical. On the other hand, our containers can also be filled by present-day, acute stressors that we’re all too aware of. In practice, it’s usually a mix of both, and they can be interrelated.

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Sometimes it isn’t immediately evident how full the container is becoming, because we are experts at hiding this from ourselves and the world. When talking about this with a person in therapy, I’ll often use the metaphor of my coffee cup. It’s a metallic travel mug, and when I hold it up, you can’t immediately tell how full it is. It could be nearly empty, or it could be close to overflowing. (It’s just a visual example. No fair trying to gauge my mood in order to figure out how much coffee is inside me rather than still in the cup!)

If the level inside the cup gets too close to the top, it overflows easily. This overflow would represent having a “meltdown”: panic attack, relapse into addictive behavior, major depressive episode, etc. Sometimes this surprises the person, as they hadn’t been consciously aware of the rising level in their container.

Psychology is the study of human thoughts, feelings, and behaviors. It shares some overlap with sociology, political science, anthropology, etc. However, most clinical psychology focuses on the individual and their cognitive, developmental, marital, or family dynamics. After many years in this field, I would guess that the majority of what’s discussed in therapy rooms does not focus on larger cultural, sociopolitical, large-scale economic, or environmental factors. Or such factors may be acknowledged, but therapeutic interventions usually focus on the micro (person/family) rather than the macro (environment). In that sense, therapy can be a bit myopic at times.

If the level inside the cup gets too close to the top, it overflows easily. This overflow would represent having a “meltdown”: panic attack, relapse into addictive behavior, major depressive episode, etc. Sometimes this surprises the person, as they hadn’t been consciously aware of the rising level in their container.

However, just because we’re repressing something doesn’t mean it’s not affecting us and filling our figurative containers. The emerging fields of ecopsychology and ecotherapy assert that humans have an ecological unconscious. That is, since we are born of earth and our entire existence depends on our fragile biosphere (and the other species we share it with), anything threatening our planet causes stress and anxiety in us. Just about everyone I talk with has tremendous anxiety about the future of our environment, and for good reason. This often invisibly adds to the total “volume” inside our containers; and since people often tend to feel helpless about large-scale events, it may increase their tendency toward immobility and dissociation.

For some people, it might be a useful exercise to write out a list of all the things they can think of that could be impacting their stress levels. However, for many other people, if their container is filling up, then the exercise of looking at everything at once could send them into depression, immobility, or even panic (“Oh, my god, it’s so much worse than I’d thought!”). Somatic therapists are trained to gauge a person’s autonomic stress response on a moment-to-moment basis and intervene as needed, coaching the person in taking on a manageable amount at any one time, and using that experience to grow stronger.

In my opinion, the goal of therapy is to increase a person’s self-regulation, which increases coping, health, joyfulness, and myriad other desirable outcomes. People who are able to self-regulate tend to be more aware of their overall stress levels, including “whole-world issues.” They may be less prone to anxiety, depression, and immobility, so they can engage in effective self-care, including taking action to better their lives and the greater world.

References:

1. Bell, A. (2016). What is self-regulation and why is it so important? Retrieved from https://www.goodtherapy.org/blog/what-is-self-regulation-why-is-it-so-important-0928165
2. Sashin, J.I. (1985, April). Affect tolerance: A model of affect-response using catastrophe theory. Journal of Social and Biological Structures, 8(2): 175-202. Retrieved from http://www.sciencedirect.com/science/article/pii/0140175085900089
3. Shulevitz, J. (2014). The Science of Suffering. New Republic. Retrieved from https://newrepublic.com/article/120144/trauma-genetic-scientists-say-parents-are-passing-ptsd-kids
4. Smith, D.B. (2010). Is There an Ecological Unconscious? New York Times Magazine. Retrieved from http://www.nytimes.com/2010/01/31/magazine/31ecopsych-t.html
5. Weinhold, B. (2006, March). Epigenetics: The Science of Change. Environmental Health Perspectives, 114(3): A160-A167. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1392256/

You may know how common depression is—6.7% of all Americans age 18 or older experience at least one major depressive episode each year, according to statistics compiled by the National Institute of Mental Health. It might even be expected in certain contexts, such as the loss of a job or a loved one. Other times, it creeps in mysteriously. As a therapist, I see many people who struggled for a long time before they finally sought help.

One of the first things I do when meeting for the first time with a person experiencing depression is try to figure out if their blues are an internal or external job. This can take a little time to unravel, as there are many layers that can lead to someone feeling depressed. It’s important when treating depression to try to change what we can control and learn coping skills that can help us with the rest.

So how do you know if your depression is a product of your environment—family, friends, job, housing or financial situation—or if it instead stems from unproductive or self-defeating thoughts, self-esteem or self-control issues, or possible biological reasons that may warrant a medical assessment?

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When It’s an External Job

Perhaps this winter has been a difficult time in your life. The holidays are past, the weather is cold, and the days are short. The nation is apprehensive and divided about a new presidential term. Maybe you are worried about tax season, waiting anxiously on news from college applications, or feeling bad after excess food or drink at the end of the year.

Many people seek therapy after enduring a difficult situation. They have been caring for a sick family member, are going through a breakup, or have failed a class for the second time in a row. They need help for a depression which is mostly a result of a life situation that has happened to them. They feel like a weight has been put on them and can identify what it is.

Right now, many people are feeling the weight of conflict on a global scale. Some are worried about climate change, health care, humanitarian crises, or unemployment. “State of the world” depression, as I call it, is a common woe in 2017.

These cases call for action:

• Tools (to date again, for example, or to reconcile with a partner or roommate)
• Skills (to interview for a different job or take better care of themselves)
• Ideas (for how to ease overwhelm around finals at the end of a semester)
• Information (how to sleep better, study better, or manage time more efficiently)

Taking action on external depression is an important step toward feeling better and more empowered. Fortunately, therapy can help—especially solution-focused therapy, which is practical and tool-oriented.

When It’s an Internal Job

Have you had a time in your life when you just couldn’t seem to get enough sleep? When the things you always looked forward to didn’t interest you or when you had trouble feeling much of anything at all? People with these depression symptoms might say their lives are “better than most” and may feel guilty for feeling down. They may struggle with feeling ungrateful because, at the same time, they feel like something is “missing.” Life may feel like an endless treadmill of nice-but-nothing-great.

The No. 1 indicator to me of an internally driven depression is when people can’t tell me anything they’re excited about in their future.

The No. 1 indicator to me of an internally driven depression is when people can’t tell me anything they’re excited about in their future. When we lose the ability to look forward to the things that historically keep us satisfied, we’re in trouble. People with internally driven depression may have grown used to being on the sidelines, watching the energy of the world bustle around them. They may find it tiring to make decisions or to engage.

These cases call for structured treatment:

• Evaluation (by a medical doctor to determine there’s no medical cause, such as anemia, thyroid problems, or other issues that may cause fatigue or apathy)
• Cognitive therapy (thought charts and other structured homework done daily to encourage the person to engage less with their “sideline”-causing thoughts)
• A “good habits” checklist (making sure they are getting enough sleep, sunshine, healthy diet, exercise, contact with others, etc.—all the recommended depression treatments to give themselves the best chance of feeling better)
• Journal therapy (structured 5-minute writing sessions that allow a solution-focused therapist to look at the person’s thoughts)

Some things are out of my scope of practice (medical evaluations, for example), but since symptoms of depression overlap with some treatable medical conditions, if there is no identifiable external cause it’s always a good idea to see a doctor, too. Recently someone I work with in therapy felt too tired to socialize or exercise, which was creating problems at work as well as causing him to spiral personally. When he learned he was anemic and started following his doctor’s medical recommendations, his fatigue went away, which started positive momentum toward participating in his usual, satisfying life.

People with internally or externally driven depression can usually expect their symptoms to improve if they use structured, research-based treatment methods such as cognitive therapy. Depression tends to call for a lifestyle tune-up—and you don’t have to go it alone.

Reference:

National Institute of Mental Health. (n.d.). Major Depression Among Adults. Retrieved from https://www.nimh.nih.gov/health/statistics/prevalence/major-depression-among-adults.shtml

Do any of these statements sound like you?

• I find I am drinking more often
• Friends and family are starting to express their concerns about how much I drink
• More and more of the things I do involve alcohol
• Sometimes I drink more than I planned
• Getting a buzz is how I deal with stress, end the day, or have fun

If you identified with more of these statements than you would like to admit, it’s time to change your relationship with alcohol. According to the Dietary Guidelines for Americans, moderate alcohol consumption is having up to one drink per day for women and up to two drinks per day for men. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) recommends up to four alcoholic drinks for men and three for women in any single day, with a maximum of 14 drinks for men and seven for women per week.

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I recommend the Dietary Guidelines’ amounts over NIAAA’s. Many people start to feel an effect after two or three drinks. Then they have a harder time sticking to their limits because their decision-making is getting altered. I also recommend against drinking every day. It can become a habit and the way you deal with difficult emotions.

Most of the people I see in my work have experienced consequences from their drinking but are not physically dependent on it. They have tried those meetings for people who want to quit, but they don’t quite fit in. They know they need to change their relationship with alcohol, but they do not want to totally give it up.

So I did the research. Then I designed the “How Do I Know If I Can Keep Drinking Quiz” to help figure out if moderation is an option.

Answer yes or no to the following:

1. Do I have any mental health, medical, or legal concerns?
2. Can I pick someone who will support my moderation plan?
3. Have I had more than one blackout?
4. Am I willing to monitor how many drinks I have?
5. Have I had withdrawals from drinking?
6. Am I free of illicit drugs?
7. Am I drinking to change how I feel?
8. Will my loved ones support moderation?
9. Do the consequences of drinking outweigh the benefits of abstinence?

Trying to change your drinking can be challenging to do on your own. If you are wondering if you have a problem with alcohol, find a licensed therapist who is trained in both mental health and substance use.

In my experience, answering yes to the even-numbered questions increases the chances of successful moderation. If you answered yes to any of the odd questions, you may not be a candidate for moderate drinking.

Below are some tips on how to try moderation:

• Identify someone who knows what your plan is and be accountable to that person.
• Plan an activity where alcohol is not involved. You may wake up feeling better the next morning.
• Have a response prepared for when people ask why you are changing your drinking patterns.
• Plan ahead what and how many you will have.
• Chose a non-alcoholic drink you enjoy and alternate it with the alcoholic one.
• Try a “mocktail”—a drink without alcohol. You may even save some calories!
• Order a tonic and lime. No one will know if there is any gin or vodka in your beverage.

Trying to change your drinking can be challenging to do on your own. If you are wondering if you have a problem with alcohol, find a licensed therapist who is trained in both mental health and substance use. Make sure the person you choose to work with is familiar with the concept of moderate drinking.

Together with your chosen professional, you can decide what a healthy relationship with alcohol looks like for you. It may mean quitting. But it also may be changing the amount and frequency of your drinking.

References:

1. Hester, R. K., Delaney, H. D., & Campbell, W. (2011). ModerateDrinking.com and Moderation Management: Outcomes of a Randomized Clinical Trial with Non-Dependent Problem Drinkers. Journal of Counseling and Psychology, 4, 215-224.
2. Logan, D. E., & Marlatt, G. A. (2010). Harm reduction therapy: a practice-friendly review of research. Journal of Clinical Psychology, 66, 201–214.
3. National Institute on Alcohol Abuse and Alcoholism. (1992, April). Alcohol Alert: Moderate Drinking. Retrieved from https://pubs.niaaa.nih.gov/publications/aa16.htm
4. U.S. Department of Health and Human Services and U.S. Department of Agriculture. (2015, December). 2015–2020 Dietary Guidelines for Americans, 8th Ed. Retrieved from https://health.gov/dietaryguidelines/2015/guidelines/

Raising a teenager can be one of the most challenging tasks of parenthood. One day you are raising a sweet, respectful child who loves to be with you, and the next, you are tiptoeing around your house hoping not to wake the bear. At some point during adolescence, many parents will classify interactions with their teen as unpredictable, confrontational, and/or dismissive. It is during these years teens and their parents often feel as though they are speaking different languages. And often, both parents and teens suddenly think talking louder, in a more animated way, will somehow get their points across.

After working with adolescents and their parents for almost a decade, I have found that my initial role as therapist is interpreter. From there, I work to help them learn each other’s languages so they can go back to healthy communication and connection. I have many tools in my toolbox to help parents and teens reconnect, but one of the most profound is validation.

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Validation is the act of acknowledging another person’s thoughts and feelings and communicating to them that those thoughts and feelings make sense and are understandable given the situation. It is important to note validating is not the same as agreeing. Validation is important because it shows you are listening, you understand, and you are approaching the person in a nonjudgmental way.

Now, let us think about validation in terms of interactions with teenagers. When it comes to interacting with their parents, they often feel judged, unheard, and criticized. These perceptions frequently lead to conflict with their parents and/or withdrawal from interactions with them. When parents take time to validate (i.e., listen without judgment), teens often feel more open to having a conversation and more responsive to information being shared by parents.

Validation is disarming and encourages dialogue. In my experience, parents just want to talk with their children. Using validation can open those lines of communication again. Teens like to talk with people whom they feel understand them. The minute they sniff judgment or criticism, they may shut down or lash out. So, leading with validation can encourage connection.

When parents take time to validate (i.e., listen without judgment), teens often feel more open to having a conversation and more responsive to information being shared by parents.

Sounds easy, right? Well, validating a teen can be difficult for parents for many reasons. First, teens can seem somewhat irrational at times, and it can be challenging to find something to validate. Second, after weeks, months, or years of built-up frustrations and disagreements, it can be difficult to want to validate. Third, I have found parents often feel stuck on the idea that by validating they are somehow saying their teen’s behavior is okay and/or they agree with what their teen is saying. However, it is important to remember validation is a form of understanding, not agreeing. By validating, you are not saying your teen is right—you are simply using a tool to help start a dialogue and prevent a potential conflict.

According to Miller, Glinski, Woodberry, Mitchell, and Indik (2002), there are six levels of validation. Jeffrey B. Jackson, PhD, LMFT, adapted these levels and five of the six are shared below.

• Listen: Be attentive and listen in a nonjudgmental way.
• Reflect: Reflect back the thoughts and feelings shared by your teen. This helps them to feel heard. It also prevents miscommunication because they can correct any information they feel you did not hear correctly. It also allows them to hear their own thoughts and feelings out loud and may prompt them to start thinking a bit differently. Example: “I hear you say you are feeling overwhelmed right now because you have a lot of responsibilities.”
• Empathize: Share your best guess about your teen’s unspoken thoughts or feelings. Share how you might feel if you were in their shoes. Example: “If my parents told me they were worried about who I was hanging out with, I might feel angry and judged. Is that how you are feeling?”
• Acknowledge reasons for behavior: Try to reflect an understanding of the reasons for their behaviors. Example: “I can see why you would feel devastated after your friend cut you off. You really valued that friendship and didn’t feel you did anything wrong.”
• Acknowledge courage: Reinforce good judgment and acknowledge personal strength. Example: “It must take a lot of courage for you to try and make the best of this situation and try not to let it get you too upset.”

Think about the last time someone validated you in one of these ways. Didn’t it make you feel good? Didn’t you feel understood? Didn’t it make it feel safe to share more? We all crave validation, teens included. In fact, validation might just be the key to better communication and a happier household.

Reference:

Adapted by Jeffrey B. Jackson, PhD, LMFT from Miller, A.L., Glinski, J., Woodberry, K.A., Mitchell, A.G., & Indik, J. (2002). Family therapy and dialectical behavior therapy with adolescents: Part I: Proposing a clinical synthesis. American Journal of Psychotherapy, 56(4), 568-584.

When people think about attention-deficit hyperactivity (ADHD), social difficulties are not typically among the first things that come to mind. However, many children, teens, and adults with ADHD often find themselves struggling socially in a variety of ways.

People who have ADHD commonly struggle with the following social issues:

• Difficulty taking initiative to make plans
• Not taking steps to maintain contact with friends they don’t otherwise see regularly
• Forgetfulness or canceling plans last-minute (and thus being perceived as “flaky”)
• Being perceived as too talkative (and thus off-putting)
• Trouble following conversations and contributing in a way that enhances them rather than shifts the focus (especially in group situations)
• Difficulty organizing ideas logically and concisely when talking (i.e., taking 5 minutes to tell a story that could be told in 30 seconds)
• Missing social cues

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If you have ADHD and identify with the struggles above, here are some ideas and tools you can use to help improve your social functioning:

1. Strive to make plans with friends while still with them (i.e., after a movie, look at the calendar and schedule plans for the following week). This may make it easier to sustain seeing friends frequently.
2. Schedule calendar events at preset intervals to remind you to call friends who live far away.
3. Don’t commit to plans if unsure you will be free.
4. If you have to cancel plans, give as much notice as possible and explain why. Offer to reschedule right away.
5. Practice explaining things or telling stories concisely on your own. Go through what you want to say initially. Then tell it again and try to cut down the amount of time it takes. Next, try to summarize what you want to convey in a few sentences. The more you practice this, the easier it may become.
6. When telling a story, think about the punchline or end point first. Try working backward.
7. Practice following multiple people talking in a conversation. For example, watch a television show with scenes where multiple people are talking. Watch it first without sound, then watch with only sound. Finally, watch again with sound and picture. This may help improve your ability to use your different senses in observing social interactions. Write out key points each person is saying and draw a diagram or other visual representation, if needed.
8. In social situations, always look at the person speaking; watch their body language and facial expressions. If you’re more of a visual person, imagine a line like a spiderweb being drawn back and forth from person to person as they speak. Then imagine a few keywords being displayed above them. Creating visual representations may help you follow conversations.
9. If you often forget key things discussed, write them down, perhaps in your phone after each social interaction. Then you can refer to them before seeing the person again. For example, if your friend is dating someone or just broke up, make a note about it so you can refer to it for next time.

I hope these suggestions are helpful.