We may have experienced various traumatic experiences in childhood, whether it be abuse, neglect, abandonment, or ongoing misattunements from caregivers that impact our ability to feel safe to attach. Even though the events themselves may be behind us, those internal responses to the traumatic experiences—images, sensations, meanings we create, and emotions—can become “stuck” in the nervous system. They continue to have a “charge.” That charge stays in our system, is stored maladapatively, and is part of our inner world.

At the most unexpected times, this material can push through what we would consider our “normal” day-to-day activities—such as parenting, working, relationship building, and self-care—in the “outside world.” As a result, we may find ourselves in a constant balancing act of pushing back at that charge. Our normal everyday selves, if you will, try to show the world that we are fine on the outside, even though there may be a lot of material that pushes through.

For example, perhaps we are in a discussion with a loved one when, all of the sudden, we interpret that we are being abandoned, even while there is no actual evidence of this. Or perhaps while attempting to set a boundary with a child, we feel feelings of guilt because we don’t feel that we “deserve” to set those boundaries. All of these can be intrusions on day-to-day life, all from past hurts.

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Those feelings and interpretations can actually be the experiences of the past clouding the now, stopping us from truly being in the moment. The nervous system is activated and defending itself from a past injustice. Unfortunately, that charge from the past compels your nervous system to act as if the traumatic experience is still happening.

There can then develop a kind of tug-of-war between who we are on the outside and the charges that remain from the past. If the tug-of-war with the traumatic material becomes too much and we become flooded, we may need to go numb in order to be able to still “do” life on the outside. We may shut down. Even if we do, it doesn’t mean that the material on the inside is gone; it just means that we have had to become more unaware of it in order to function on the outside.

One of the most challenging aspects of complex trauma, whether or not pursuing EMDR therapy, is that we must be able to identify and “own” our feelings and experiences. This allows us to then process traumatic experiences from the perspective of being “here and now” and visiting them versus feeling as if one is flooded and still in those experiences. In EMDR language, we look for one’s ability to maintain dual attention. It expands into making sure we stay within a window of tolerance as we visit those memories.

Often, those starting their healing work find themselves in one of two extremes: flooded by feelings all of the time or feeling completely numb.

For some, this may not seem like such a large step, but for the majority of those who are healing from complex trauma, it is in fact very difficult. Often, those starting their healing work find themselves in one of two extremes: flooded by feelings all of the time or feeling completely numb. The numbness often comes because the material in our inside world becomes unmanageable and we become more fearful of that material. We shut down from the outside world because the inside world is so invasive.

We typically learn to dance this dance of “daily life” vs. “inner stuff” at an early age. In infancy, we learn that our attachment to our caregivers is required; we cannot survive without a caregiver or we will die. Period. We also learn that our attachment relationship is dependent upon us being in tune with our caregiver’s reactions—to know what to do, how to act, and how OK it is (or not OK) to have our emotions be expressed and seen in the outside world.

We also determine whether it is dangerous to really identify, own, and be with the feelings of shame, anger, or sadness, even happiness or calm. We then create certain strategies that seem helpful at the time but show up later as distressing symptoms. As outlined in my previous article on blocking beliefs, it is often those cognitive errors that hold us back from fully realizing and being in tune with our past hurts because it was, at the time, too much to fully realize.

In future articles, I will share more about what it means to fully realize and own what was once unrealized, back when we were experiencing past injustices. Similarly, I will share more regarding what it means to own and process feelings we may have deemed unacceptable in order to survive the past.

If you are a therapist and are interested in expanding your knowledge on this topic, especially as it relates to structural dissociation theory, you are encouraged to read The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization (2006) by Onno van der Hart, Ellert R.S. Nijenhuis, and Kathy Steele.

It’s a commonly held belief that while our parents’ generation failed to pay enough attention to our thoughts and feelings as children, our generation cares too much about our children’s thoughts and feelings. While this is certainly an over-generalization, I believe it reflects an important reality: Parents today have difficulty setting limits and saying “no” to their kids.

This does not mean we should stop listening to our children. Rather, the key to effective limit setting is finding a balance between being firm, on the one hand, and giving our children some control on the other. If we can identify what our children are capable of, hold onto the limits we know to be important, compromise on those we don’t, and include our children in the process when appropriate, the limit setting process can be (if not exactly fun) quite manageable.

To illustrate this point, I would like to start by describing some limit setting dilemmas a few parents with whom I have worked have faced, and a parenting moment of my own (lest anyone think I am suggesting this limit setting stuff is easy). I have changed the names and details for confidentiality purposes.

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Sleepless Sally: Dan and Mary attended a limit setting workshop I gave because their 2-year-old, Sally, was not listening to them. When I asked Dan and Mary about their approach to limit setting, they explained that they never used the word “no” with Sally because it was too negative. Instead, they would try to explain the reason for the limit in a more positive tone. For example, when Sally refused to get ready for bed (a frequent occurrence), they would tell her, “You need your sleep. Aren’t you tired yet? It’s important to get enough sleep.” When I asked them what they would do if Sally started to run into the street by herself, they responded, “Sally, why don’t you stay with Mommy and Daddy?” They knew their approach wasn’t working, but did not know how to fix it.

Trampoline Thomas: Another parent, Karen, who consulted with me about her 5-year-old son, Thomas, explained that Thomas did not respect the limits she tried to set. Karen was particularly upset over a recent visit to a friend’s house. Her friend had a trampoline, which Thomas absolutely loved. Thomas loved it so much, in fact, that he refused to stay at the kitchen table during dinner, instead leaving the table to go on the trampoline. Karen tried to dissuade Thomas from going to the trampoline during dinner, but she couldn’t seem to figure out how to get him to stay. After a few nights of unsuccessfully trying, Karen decided to set a consequence for Thomas: If he got up from the table and went to the trampoline during dinner, he could not play on the trampoline at all the next day. Despite Karen’s warning, at the next dinner Thomas got up and went to the trampoline. The next day, Thomas was not allowed on the trampoline, but that night at dinner, he did the same thing again. When I heard this story, I was surprised; I would have thought a day without the trampoline would have been enough to get Thomas to change his tune. As I inquired more about the consequence and its implementation, however, Karen sheepishly admitted that not only had Thomas been prohibited from using the trampoline, but everyone had been disallowed from using it, lest Thomas be upset about being left out!

Reserved Rachel: While my daughter, Rachel, had always been rather reserved, it wasn’t until she was 9 years old that my husband and I really took in the fact she was not saying hello to anyone in our building (or in public), even if they greeted her first. Pointing out to Rachel that this was rude or that others might not like her did not seem to help, nor did setting consequences or rewards. We were really at a loss.

I recount these stories not to show how lousy these parents and I are at parenting. We aren’t. In fact, we are all loving, caring parents who really just want to figure out how best to support and help our children. Frankly, all parents try things with their kids that don’t work. Rather, I want to use these stories to highlight how complicated limit setting can be and to point out some of the important questions we need to ask ourselves as we go about the job of figuring out how to set limits with our kids. These questions include:

1. Why are limits important?
2. How do I know when limits are appropriate?
3. How do I enforce limits?
4. When and how should I use consequences?
5. When and how should I use incentives?

1. Why Are Limits Important?

Sometimes, amid the battle of limit setting, we feel like giving up and giving in. At these times, it can be helpful to remind ourselves why we need to stick with it. And here’s why:

Limits help children feel safe, physically and emotionally: It may seem like our children hate us when we tell them what (not) to do, but unconsciously (and sometimes even consciously), children often have their fingers crossed that we will take charge. Why? Because they don’t have total control over themselves and this is scary for them! Until they learn self-control, which happens slowly over the years, our children rely on us to provide that structure and control. In fact, it is partly how they learn self-control, by internalizing the structures and limits we provide them. It is how they feel safe.

For example, if a 2-year-old is doing something dangerous (like running out into the street), the parent must act quickly (“No!” is great for dangerous situations). Two-year-olds do not have the impulse control or reasoning skills to assess danger on their own. They need to be taught to be cautious and wary of certain situations.

Limits teach children how to regulate their different needs (hunger, tiredness, transitions, etc.): Children need to learn how to listen to their bodies and respond appropriately. This is not something that comes easily or quickly. By having routines and limits for our children, we are helping to regulate our children in ways they are not yet capable of. We are also modeling for them the importance of listening to one’s body and needs.

Perhaps because of our determination not to make the same mistakes our parents made with us and/or because of all the research showing us how smart and capable our children are from very young, parents today often assume that our children are able to regulate their needs on their own, much as adults do. However, this is typically not the case. Learning to self-regulate is a process that happens over many years; it is a developmental task that can’t be rushed. At any given moment in time, we need to figure out what our children are capable of and not ask more from them.

For example, understanding the importance of sleep and being able to choose one’s bedtime is something that Sally, at 2, is simply not capable of. She does not have the cognitive capacity to understand the importance of sleep, delay gratification, or regulate her tiredness and activity level.

Limits teach children important social skills (turn taking, being polite): I am a big believer in allowing children to feel whatever it is they feel, no matter how difficult it may be for them or their parents to handle. However, feeling something and acting on it are two very different things. While a 1-year-old may not be capable of distinguishing between the two, a 5-year-old certainly is.

Thomas, for example, is probably capable of sitting at the dinner table for a reasonable amount of time, assuming he is developmentally more or less on track. At some point, trying to understand why Thomas has trouble sitting at the table will be helpful, but understanding is not a substitute for setting the limit.

Rachel, after much discussion, agreed to work on greetings through role-playing with my husband and me. Rachel also suggested she would try to make eye contact and smile and/or wave to people so that they would not think she was rude. We all agreed on a system for carrying this out. Carried out with starts and fits over time, these solutions helped Rachel feel more comfortable interacting with the outside world.

Parents are one of the primary carriers of culture for our children in these early years. It is our responsibility to teach our children how to be in the world in a way that won’t annoy everyone else. Introducing some of the social graces—sitting at the dinner table, taking turns, greetings, thank yous, etc.—and limiting the no-nos—hitting, biting, grabbing, etc.—is an important part of that job.

Limits help children build self-esteem: When children are able to predict and meet our expectations, they feel more competent. As children learn through our limits how to regulate their needs, handle their feelings, and function effectively in the outside word, they become more confident. However, when we expect too much of them, the opposite can happen; kids can become very frustrated and disappointed in themselves. This brings us to our next question …

2. How Do I Know When Limits Are Appropriate?

I would argue that limits are appropriate when they reflect an understanding of what your child is capable of developmentally, reflect an understanding of your child’s unique needs, and take your (the parents’) needs and preferences into consideration.

One of the problems that Dan and Mary faced with Sally was that they didn’t seem confident about how much sleep she needed. Although it can be hard to know how much sleep an individual child needs, there is a range that is commonly accepted (which you can readily find online). After we discussed this range together, Dan and Mary, through trial and error over a few weeks, were able to figure out how much sleep Sally needed. Feeling more confident about how much sleep Sally needed then made it easier for Dan and Mary to enforce her bedtime. Having a consistent bedtime helped Sally get the sleep her body needed and helped her begin to learn how to self-regulate her own tiredness.

Another reason setting limits is important is that it helps you take care of yourself. For example, having a consistent, reasonably timed bedtime for your child usually gives you some much-needed down time—time to relax, catch up with your partner, and recharge a bit before you face another day of parenting. This benefits not only you, but your child as well. A parent who takes care of himself or herself is generally a happier, more patient parent.

Lastly, when deciding which limits to set, try not to sweat the small stuff. If allowing your child to watch an additional 15 minutes of television gives them a sense of agency and you a much-needed break, why not? As long as the 15 minutes doesn’t turn into two hours, being flexible within your structure gives your child the message you are willing to take their wants and needs into consideration, but that when you set a firm limit, there is a reason for it. In my experience, children tend to respect limits more when there is some flexibility on the stuff that is not as important.

3. How Do I Enforce Limits?

When setting limits, I recommend keeping the following in mind:

• Be clear (with yourself and child) about why you are setting this limit.
• Be clear with how you are setting this limit.
• Be firm; don’t turn back!
• Less is more.
• Separate feelings from behaviors.

Before setting a limit, you need to be confident about why you are setting it. Kids of all ages pick up on doubt. If you start to waver, you are going to have a much harder time setting the limit. When explaining a limit, less is definitely more. With Sally, age 2, “It is time for sleep” is about all she can handle. Said with confidence, Sally will understand the importance of this limit, even if she goes to bed kicking and screaming.

With a child like Thomas, age 5, a longer explanation can be offered, preferably ahead of time rather than in the moment, something in the realm of, “During dinner, you need to sit at the table with everyone else.” “You are not allowed on the trampoline during dinner; it is not safe.” “If you leave the table tonight, you will not be able to use the trampoline at all tomorrow,” or some variation thereof. If your child has questions about the limit you’re setting, feel free to explore, but when it starts to feel repetitive and unproductive, I would suggest ending the conversation with something like, “I’m sorry you feel that way, but this is how it is going to be.”

The key to effective consequences is finding ones that are realistic in terms of age-appropriateness and practicality, relevant to the behavior you are limiting, and are something you have the means and wherewithal to follow through on.

With Thomas, it might even be possible to discuss what is going on for him, what he is feeling, and why he doesn’t want to sit at the dinner table. Perhaps there is something specific that is bothering him. More generally, in setting limits with a 5-year-old, it is often a good idea to ask what limits they consider appropriate. Interestingly, children often come up with harsher limits than we do and are more likely to follow limits they have helped set. Of course, if it feels like your child is playing a game of what-can-I-get-away-with, this is not the route to go.

With Rachel, age 9, I believe she was able to follow through on the agreed-upon strategy in part because she helped come up with the alternatives (eye contact, smile, and waving) herself. Children tend to respond better to limits when they feel like they have some control, no matter how small that control is.

Of course, once you’ve set your limit, you need to enforce it. If you are not able to follow through, the limit obviously gets harder to enforce. However, even if you have had difficulty in the past, it is never too late to start to enforce a limit. A quick heads-up to your child about the change may be useful in advance. “I know I have been letting you get up from the dinner table the past few nights, but tonight is going to be different …” Your child may very well test you for a few nights, but if you are firm, you should be able to get back on track relatively quickly.

Checking in with yourself as to why you are having difficulty enforcing the limit is a good place to start. One reason some parents have difficulty enforcing their limits is because of what I call the “empathy trap.” When our children are upset, we feel badly for them and want to empathize with them. It’s important for us to do this, yes, but when their being upset is connected with a misbehavior or refusal to comply with a limit, we need to be able to separate our children’s behavior from their feelings so we can effectively set the necessary limit. I generally recommend a simple statement of empathy followed by a limit. With Sally, it might mean a sympathetic, “Aww, I know it’s hard,” as you carry her off to bed. With Thomas leaving the table, I might say something like, “I know it is hard for you to sit at the table, but dinner is not over yet.” With Rachel it was, “I know how hard it is for you to greet people in our building, but it is important you not appear rude.”

Later, when the limit setting moment has passed, you might talk to your child about their feelings connected with the (mis)behavior, either through direct conversation (as with Thomas or Rachel) or, for younger children such as Sally, through reading a relevant, age-appropriate book (e.g. on bedtime) or through making a simple observation such as, “Sometimes children get angry at their mommy and daddy when they make them go to bed.” We want to validate all of our children’s feelings, but not all of their behaviors.

4. When and How Should I Use Consequences?

Sometimes you can set a limit and not have to give consequences. Phew! For those times when limits alone seem not to be working, however, consequences can be very effective. Of course, setting consequences is not always easy. One of the difficulties parents face in setting consequences is the worry they will have to keep enforcing the consequence over and over again, which can feel too punishing and depriving, or feel like too much work. However, if consequences are chosen wisely, enforcing them just a few times is often enough to deter the continuation of the misbehavior without being overly punitive.

The key to effective consequences is finding ones that are realistic in terms of age-appropriateness and practicality, relevant to the behavior you are limiting, and are something you have the means and wherewithal to follow through on. In the example with Thomas, Karen was able to pick a consequence that was realistic insofar as it was developmentally appropriate and seemingly practical and relevant insofar as it involved the trampoline, but she didn’t seem to have the wherewithal or confidence to follow through. She simply could not tolerate the idea of Thomas being left out.

One consequence that is particularly controversial among parents and parenting experts is the timeout. There are probably as many opinions about timeouts as there are parents and experts, so my opinion should be taken as just that, an opinion. It is my belief that timeouts should primarily be used for when a child is in some way out of control—temper tantrums, disrupting a gathering, biting, hitting, or threatening another, etc. The main point of a timeout should be to help the child feel more in control of their behavior. In this view, timeouts are less about punishment and more about removing the child from a troublesome or volatile situation.

Regardless of why you give your child timeouts, however, it is important you do so in an effective way. Ideally, your child would be able to be in their own room or crib until they have calmed down or for however long you have designated the timeout. Depending on the situation, you might choose to be right outside the door to let the child know you are there (without a lot of discussion or engagement), but this does not mean being in the room with your child. Sometimes parents have their child sit on a chair quietly for a few minutes. This is fine as long as the child experiences it to be calming in some way or, if you are using it as a punishment, somewhat negative. The goal with timeouts, like other consequences, is to motivate the child to not do the behavior again and/or to help the child regroup and calm down.

5. When and How Do I Use Incentives?

Sometimes there are behaviors that don’t seem consequence-worthy but need limits, such as getting ready in the morning, getting ready for bed, cleaning your room, etc. In his wonderful book on limit setting, 1-2-3 Magic, Dr. Thomas Phelan calls these behaviors “start behaviors.” These are behaviors you want your child to do (rather than not do) that generally require more participation from your child than “stop” behaviors.

One of the techniques Dr. Phelan recommends for incentivizing these behaviors is “positive reinforcement” (or as some of us prefer to call them, “bribes”). Stickers, treats, etc., are great for these behaviors and help get you and your child out of battle mode. Just be sure to pick a reward that is age-appropriate (a 2-year-old simply cannot wait a whole week for a reward) and is sustainable over the medium- to long term—e.g. a few graham crackers versus a lollipop every day.

Again, as much as possible, involve your child. Even a 2-year-old can decide choose between graham crackers or Goldfish for a reward; the child will feel more in control and is more likely to comply with your limits. Some parents lament the idea of having to bribe their child indefinitely, but it is my experience that (for most behaviors) once the behavior becomes routine, the reward is less important and eventually can be discontinued or modified if you so choose.

Conclusion

Limit setting is not for the fainthearted (neither is having children!), and a lot of figuring out what works is through trial and error and being open to considering other approaches. If you maintain an open attitude to learning about your child’s capabilities and needs and set realistic, age-appropriate limits that allow for some input from your child when warranted, you will most likely find the job of limit setting gets easier and easier as time goes by (well, at least until your child turns 13—EEK!).

In my articles on anger management, I frequently talk about how anger gets disguised as another emotion. Conversely, I also emphasize the reverse: other emotions left unnoticed and unacknowledged can turn into anger. In this article, I offer no disguises, no cover-ups. Witness instead a direct creator and perpetrator of anger.

I expect things. So do you, and so does everyone else. These expectations encompass virtually everything we conceive. We expect things about our bodies and minds, other people (along with their bodies and minds), our jobs, our pets, the sun and moon. If I sound a bit hyperbolic, it’s because I mean to emphasize this: the vast majority of the thoughts we have throughout any given day are comprised of expectations. And with these expectations—every single one of them—we create frustration, irritation, and anger.

An expectation, put in the simplest of terms, is a thought about the way we want something to be. Expectations can range from the obvious form of “I really want to get that job” to more subtle expressions that hardly go noticed, like heavy sighing or rolling one’s eyes. Regardless of what form an expectation takes, it ushers in personalized judgment about the way we think the world should be.

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Expectations trap us when we cannot see past them. When we lead with them and then meet up with something very different from our particular desire, anger is typically the result. At its core, anger expresses dissatisfaction with reality. All the different words for anger apply here: irritation, frustration, annoyance, being “miffed,” etc. The intensity of our anger is often directly correlated to the level of attachment we have to our expectations of reality.

It might seem as if I’ve made expectations out to be truly heinous. Usually at this point, a person I’m working with in therapy might say something like, “Well, then, I suppose I should have no expectations at all? Just have no standards?” On the contrary! Standards dictate our commitment, connection, and drive for excellence. What I shop here isn’t an end to expectations, but a renegotiation with them.

Expectations in and of themselves are actually harmless. They can be viewed from the perspective of expressing personal tastes and preferences. Expectations get the better of us only when they become rigid barriers keeping us from flexibly working with what life hands us.

Expectations in and of themselves are actually harmless. They can be viewed from the perspective of expressing personal tastes and preferences. Expectations get the better of us only when they become rigid barriers keeping us from flexibly working with what life hands us. Toward a more functional use of expectations, I offer the use of what I call basic requirements.

Basic requirements express the base-level necessities that must be met for us to continue cultivating a relationship with another person, a job, a lifestyle, etc. Whereas expectations get used as billy clubs to bash over the head of a reality that doesn’t meet our desires, basic requirements take a more open stance. They state that certain things will need to be in place in order for the relationship to continue—for example, respect and trust in a committed romantic relationship. If for some reason the basic requirement isn’t met, both parties may move on.

The reason expectations so often create anger is we stubbornly keep insisting that the thing in question be different, be what we want. Basic requirements free us from this trap. Instead of staying locked in a constant struggle to get an experience from someone or something that just can’t supply it, we take our basic requirements elsewhere. We relieve ourselves of the need to be constantly angry, because we no longer resist the truth that X can’t give us Y.

Notice that attachment is the real culprit here. Basic requirements express how we want the world to be. Attachment keeps us locked in struggle. Freeing ourselves from chronic anger becomes easier and easier when we let ourselves move on from no-win situations.

At the beginning of therapy, many people are curious about what they need to do to make therapy work for them. They know that they will have to work in therapy to make it effective, but they often don’t know what that entails. Unfortunately, the unknowns of therapy cause some to feel that they’re just wandering and not making progress, or it causes them to leave therapy before they get to experience all the wonderful benefits. On a different end of the spectrum, these circumstances can also cause a person to stay in therapy too long and still not reap the rewards of good psychotherapy.

Getting the most out of therapy requires an alternation of spontaneity and focused reflection. It’s important to let your feelings and thoughts flow freely, but it’s also important to slow down, step back, and reflect on what those thoughts and feelings tell you. There are many ways and many areas of your own self-exploration in which you can practice this. While the content of your therapy sessions will be unique, I’d like to offer some additional guidance I’ve picked up from people who seem to get a great deal out of their therapy sessions:

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• Bring all of the different parts of your personality into your session. There may be a frightened and vulnerable child who needs to come in and cry, a micromanager who wants to tell the therapist what to do, a demon filled with hate, or an angel too sensitive for the real world. We all have many different parts to our personalities; some we’d like to hide, and some that are the only parts we’d like to show. Notice what you’d like to leave at the door and instead bring it in, either by showing it to your therapist or by telling him or her about it. Then, reflect on why you feel you’ve needed to deny this part, and what it may have to offer you if it could be included mindfully.
• Bring all of your emotions into your sessions. Your tears, your anger, your fear, your shame, and your delight—bring them all. Notice which ones you try to avoid, and welcome them all in as much as possible. Be willing to step back, contain them, and be curious about them without letting your emotions get out of control. In therapy, we exercise the capacity to have an emotion without it having us.
• Try to keep the focus on yourself. It certainly feels good to be able to blow off steam about what others have done wrong. A little venting can go a long way, and your therapist’s empathy, at this point, is indispensable. Eventually, though, you’ll need to step back and ask how you can think about the situation differently and how you can respond to it differently. When you focus within, you’ll find a lot of resources to make the changes you want and be much more empowered to make them.
• Forge an authentic connection with your therapist. Research tells us that the connection between a Please don’t feel you have use all of these suggestions, or that these are rigid rules that you must follow. It may take time to develop the ability to use these, and that’s OK.therapist and a person in therapy is profoundly important for change. But, as with all relationships, a good therapeutic relationship is made rather than simply found. To accomplish this, be direct with your therapist.No therapist is perfect. What is your therapist doing that works and doesn’t work? Is he or she leaving things out that you had hoped would be part of your work together? Do you find him or her cold? Intrusive? Not challenging enough? Too challenging? Do you worry that you like the therapist too much or that you depend on him or her too much? Say so.This sort of direct communication not only helps your therapist help you, it also helps you get comfortable with parts of yourself that you usually hide. A core principle of therapy is that it’s the relationship that heals. But you can’t just show up; you need to open up, too.

• Be very curious about why you are the way you are, and don’t judge yourself for what you find out. We’ve all adopted strategies for getting along in life; some help and some hinder. What are your strategies? Why have you developed them, and what do you get out of them? Some people, for instance, realize that they amplify their anxiety in order to get help from others because that’s the only way they were heard when they were young. Once you identify your strategy, don’t judge it. Have compassion for yourself. Self-acceptance is indispensable for therapeutic progress.
• Take responsibility for your behavior, but not for things that are out of your control. There is a huge price to pay for imagining that you can control things you can’t. Depression and anxiety are two mental health conditions that often arise from this dilemma. On the other hand, if you spend your therapy sessions blaming other people for how you live now, your progress will be slow to nonexistent.
• Use your sessions to identify themes and patterns in your life. Therapy is most effective when we connect the dots between events and understand how our personalities and our responses affect our well-being. Search for a deeper understanding of how you operate in different circumstances and it will serve you once you stop attending sessions and navigate the world on your own. Your therapist will help you recognize themes and patterns that underlie the events you discuss in session, but you don’t need to wait for your therapist to do this.
• Continue your work outside of session. Once you’ve made progress in some of these areas, it’s time to take the show on the road and apply what you’ve learned in therapy to your world. This can take the form of specific assignments you want to take on, such as going to the admissions counselor at a community college to find out what you need to do to start a degree. Or it can take the form of more general intentions about how you want to behave going forward, such as an intention to not avoid situations that make you anxious. Also, meditation, exercise, support groups, community, and creative work can all help you to actualize the change you’ve been discussing in your sessions.
• Use your challenges—even the small ones—as opportunities for growth. Once you know what your triggers are, welcome these situations as opportunities to respond differently. This is an attitude that often develops without conscious effort in therapy as we bring in the most challenging situations from our lives each week. But if you can begin to do this in a more conscious way, your difficulties will be less painful, and you are more likely to grow as a result of them.

Use of even a few of these points can help you not only overcome symptoms, but it can also help you develop a fuller, more satisfying life. Please don’t feel you have use all of these suggestions, or that these are rigid rules that you must follow. It may take time to develop the ability to use these, and that’s OK. It is the exercise of them that makes therapy so potentially powerful. Many people have entered therapy to fix a specific problem and leave treatment with a more balanced personality and more fulfilling approach to life. If you are using these suggestions, rest assured that your work in therapy will bear fruit.

I’m always curious as to what others have done to make their therapy effective. Please leave a comment and let me and other readers know how you get the most out of your therapy.

Many little girls grow up dreaming of being in a fairy tale relationship, being swept off their feet by the perfect gentleman and living happily ever after. As boys get older, they, too, can develop idealistic thoughts about becoming someone’s knight in shining armor. Although Cinderella and Prince Charming’s enduring love story may be the stuff of fantasy, trying to create perfection in a real-life relationship can backfire.

Key Insight: Nathanael Schlect, Licensed Associate Counselor “Fairy tale fantasies often serve a protective function. When love feels uncertain, imagining perfection can temporarily soothe anxiety, even if it ultimately increases pressure on the relationship.”

Modern social media platforms have amplified these fairy tale expectations, with couples constantly exposed to curated “relationship goals” content that can create unrealistic standards for their own partnerships. Research shows that women who endorse fairy-tale ideas about romance and marriage tend to have less relationship satisfaction and a more negative sense of psychological well-being.

When we fall in love, we want to be on our best behavior, look our best, and show our partner how much they mean to us. This is perfectly normal. As love develops and grows, it is also normal to expect love to change and evolve into a maturity and grace that allows for some imperfections to begin to show through.

Over time, all relationships weather ups and downs and highs and lows. Nobody’s perfect, and no partners are perfect together all the time. But in the quest for the “perfect” relationship, sometimes we expect more from our partner than is reasonable. This can mean nobody’s happy.

Recent research published in Frontiers in Psychology describes perfectionism as a “destructive factor” in relationships, with studies showing that high perfectionistic standards for a partner exacerbate stress, burnout and conflict.

Perspective is important in relationships. In that spirit, you might want to check your expectations if you expect your partner to:

Find a Therapist for Relationships

• Read your mind—because if they love you, they should “just know,” right? Wrong. Mental health professionals emphasize that even the strongest emotional bonds cannot replace honest communication and active listening.
• Hang out and get along with all of your friends.
• Meet your every emotional need, desire, and want.
• Never slip up, say the wrong thing, or make the wrong move.
• Never get angry or upset.
• Love you as intensely as you love them.
• Look a certain way 100% of the time.

When we allow for the idea that relationships are perfectly imperfect, we leave room for ourselves and our partners to be authentic and real.

When we are obsessed with the idea of a perfect relationship, we tend to work very hard to maintain what we think is “right” and “correct” without objective balance. We want to present to the world how solid and strong our love is by metaphorically riding off into the sunset. However, the idea of never having challenges and struggles is unrealistic and disingenuous. If the pattern of portraying perfection in your relationship becomes obsessive and intrusive, it may be time to seek help from a therapist.

Obsessive thoughts may be grounded in our own fear. We all fear abandonment and hurt, but some of us have a stronger inclination to create a sense of security. Mental health research shows that fear of abandonment can drive maladaptive behaviors and create chronic feelings of emptiness that further complicate relationships.

To begin loosening the grip on the compulsion to be “perfect” in relationships, try the following strategies:

• Acknowledge that the quest to be perfect is exhausting. Meta-analysis research indicates that perfectionism has a small-to-moderate negative effect on marital outcomes, prompting couple therapists to address it as a destructive factor in intimate relationships.
• Be mindful about when the obsession for perfection comes up in your relationship.
• Ask yourself: What’s the worst that can happen if it isn’t perfect?
• Ask yourself: What kind of love do I want?
• Examine why perfection in a relationship appeals to you. Learn from your findings.
• Allow your partner space to make mistakes. Acknowledge that they are normal.
• Understand that the things you want most are almost always rendered less achievable by your perfectionistic tendencies.

The obsessional quality of perfection is that it is relentless! There is not much room in a fairy tale-like relationship for arguments, hurt feelings, forgotten promises, and repair—the trials all meaningful relationships go through (and typically emerge stronger for) at one point or another. When we allow for the idea that relationships are perfectly imperfect, we leave room for ourselves and our partners to be authentic and real. There may not be a perfect relationship, but a healthy one, in which two people can love, learn, and grow together, might be as good as it gets.

Key Insight: Nathanael Schlect, Licensed Associate Counselor “Healthy relationships are not conflict-free. They are repair-capable. The presence of disagreement is not a failure of love, but an opportunity for growth.”

If you’re struggling with obsessive thoughts about relationship perfection or experiencing significant distress about your romantic relationships, consider speaking with a mental health professional who can provide personalized guidance and support.

References:

1. Baldwin-White, A., & Gower, K. (2023). Influence of social media on how college students perceive healthy relationships and consent. Journal of American College Health, 71(4), 1301–1309.
2. Hadian Hamedani, S., Majzoobi, M. R., & Forstmeier, S. (2024). The relationship between perfectionism and marital outcomes: a systematic review and meta-analysis. Frontiers in Psychology. https://doi.org/10.3389/fpsyg.2024.1466806
3. Kakembo, A. A. (2024). The impact of social media on modern relationships. Kampala International University.
4. National Institute of Mental Health. (2024). Borderline personality disorder. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK430883/
5. Travers, M. (2025, April 7). 2 ‘unrealistic expectations’ that can destroy a marriage. Therapy Tips. https://therapytips.org/articles/2-unrealistic-expectations-that-can-destroy-a-marriage
6. Troutman, M. (2025, August 23). From fairy tale love to social media: External factors affecting relationships. Medium. https://medium.com/@ClassyWriting/from-fairy-tale-love-to-social-media-external-factors-affecting-relationships-63741bdc4d1a
7. Weber, J. P. (2015, May 5). 5 reasons fairy-tale romances almost always go wrong. Psychology Today. https://www.psychologytoday.com/intl/blog/having-sex-wanting-intimacy/201505/5-reasons-fairy-tale-romances-almost-always-go-wrong

As human beings, we have all had to deal with our share of suffering. The causes of our suffering may change, but the experience remains the same. For some, their struggle may be with depression, anxiety, or having experienced abuse or trauma, whereas others may have to deal with a serious illness, chronic pain, an addiction, or the death of a loved one. In all cases, we may ask ourselves why we have been given this cross to bear and whether the pain will ever go away.

In most cases, we tend to make our suffering worse by our ongoing negative thoughts and ruminations about the situation. We create worst-case scenarios in our minds or believe that our agony will never subside. In so doing, we perpetuate and amplify our suffering, remaining attached to our pain rather than looking for the life lessons or gifts that may be present within the experience.

What are some ways we can choose to heal from our afflictions and discover the gifts they may have to offer? The following are a few methods to adopt in order to begin to examine our suffering from a different perspective:

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1. Develop a Different Relationship with Your Emotions

Most people shy away from uncomfortable feelings, preferring to deny or repress them rather than exploring their purpose. If you become more curious about what you are feeling, you can begin to relate to your emotions in a different way and discover what they may be trying to communicate to you.

Although suffering is an integral part of the human condition, we can learn to look for the gifts and life lessons that are present within the experience rather than remaining engulfed in our pain.

For example, we tend to become anxious when we try to conform to others’ expectations rather than remaining true to ourselves. Making an effort to become more authentic can help to alleviate the anxiety in this case.

When we are feeling depressed, on the other hand, our emotions may be asking us to make more time to really listen to what is going on inside of ourselves. These feelings present us with an opportunity to turn inward, examine our lives, and determine any areas where we may have gotten off track and need to make changes.

For individuals who are struggling with the residual effects of trauma, their emotions may be an indicator that they need some help coming to terms with their painful experience. In this case, reaching out to a therapist or support group may be what is most called for to help in the healing process.

The gifts that are available in all of these cases would be in discovering new ways to listen in to what our emotions are trying to tell us and to develop a healthier relationship with them.

2. Forgive and Let Go

Often, we remain attached to our suffering because of our inability to forgive others and/or ourselves. Our inner anger and resentment can lead us to try to punish others in various ways, but we end up punishing and hurting ourselves more than we can ever hurt anyone else. We may rail against the unfairness of the situation, the universe, or even God. In doing so, however, we tend to remain in the role of victim rather than taking responsibility for our lives and attempting to gain understanding. We can never be truly happy as long as we are holding on to grudges against others.

The gift that can be found in this situation is in learning to forgive others and ourselves for any wrongdoings and bringing more understanding and compassion to the situation.

3. Learn to Surrender Control

We tend to want to maintain a sense of control over our lives and can feel helpless, anxious, or heartbroken when something unexpected occurs that disrupts our sense of comfort or peace. Learning to become more accepting of the fact we ultimately are not in control of our lives, and surrendering to the experience of the moment, can help us to find more serenity, despite the struggles or pain we may be going through.

When someone close to us dies, for example, we can grieve the loss and the hole that is left in our lives, but also be thankful for the gift of the time we were granted with the person and the joy that he or she brought to our lives. Meditation and mindfulness are both helpful tools to learn to accept the things we cannot change and to remain grounded in the present moment rather than ruminating on the past or fantasizing about the future.

Although suffering is an integral part of the human condition, we can learn to look for the gifts and life lessons that are present within the experience rather than remaining engulfed in our pain. For individuals dealing with severe emotional or traumatic issues, the help of a professional may be required in order to help them on their healing journey.

Often, we find that the most painful experiences of our lives are those which teach us the most. Living our lives from this perspective can help us to remain more open and present on our ongoing journey of inner growth and discovery.

For those of us in the United States, baseball season is well under way, with the major league season at its midpoint. I love baseball season—warm sunshine, the smell of freshly cut grass, kids smiling and dancing in the stadium bleachers. Hot dogs always seem to taste best at a baseball game, don’t they?

As an avid fan of America’s pastime, it should come as no surprise that I contend that you can learn important life skills and lessons from the game of baseball. Baseball involves competition, strategy, and teamwork, all useful life skills, and teaches those who play it to win and lose with grace.

A batter gets three strikes before he is “out,” or four balls before he “walks.” In life, we are given multiple opportunities to accomplish our goals, if only we keep our “eye on the ball” and are motivated enough to keep trying. In baseball, there are multiple ways to get on base, just as in life there is usually more than one way to accomplish a goal. In both cases, it takes patience, focus, and intent. Often in life, things don’t “just happen.” Motivation and intention serve as catalysts in helping us achieve our goals.

What fuels motivation and intention with regard to accomplishing a goal? A sense of meaning or having a stake in the outcome. Meaning, or making meaning, drives us.

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In baseball, there are nine defensive positions, with each having defined duties and responsibilities. The nine people manning these positions work together each inning toward a shared objective of three outs. The ability to work as a team involves understanding and embracing your unique talents and skills, and applying those talents and skills when and how needed for the benefit of the group or common objective.

Positions can change in any given context. Unless you live by yourself on a deserted island, there are various teams you are a part of in your everyday life. Probably the most important team you are a part of is your family. Inherent in family life are our roles (or “positions”), and those roles dictate our responsibilities in and to our family.

Unless you live by yourself on a deserted island, there are various teams you are a part of in your everyday life. Probably the most important team you are a part of is your family.

As we grow older, our responsibilities change. As children, we are taken care of by our parent(s); as parents age, children often find themselves in a responsibility shift wherein they are taking care of their parents.

Baseball games are full of strategy, from who will play where to the batting order to whether to swing away or bunt to when to pull the pitcher. Strategies are also employed in everyday life in order for a family team or work team to succeed or run smoothly. Such strategies play out in myriad simple or complex ways, from who will pick up the kids to how to meet a team project deadline. Discovering and appreciating our talents and how we can best “play our position” or contribute to our family/work life is an important life skill. Working together is key for any kind of team or unit to succeed—families included.

Finally, in baseball, no matter how well everyone plays, one team wins and one loses. Just as succeeding is a part of life, so is failing. One of the most important lessons baseball (or any sport) can teach us is how to win or lose—how to succeed or fail without letting either outcome define you. Because neither one should.

Life is full of wins and losses. Getting into college, a job promotion, and finding true love are happy life experiences that might generally be considered wins. But meaningful relationships sometimes end, people lose jobs, and there will be illnesses and deaths of loved ones. Just as in a championship baseball game, losing is often harder than celebrating a win. Just as a team that loses a hard-fought game will regroup and come out and play another game, those who experience painful losses can regroup and wake up to a new day. The loss is still there, and nothing will change that, but something generally can be learned from the experience of loss.

Baseball teams learn from losing all the time. Often, losses in life can teach us our most valuable lessons and give us our greatest strengths.

So next time you are taking in a baseball game, think of the correlations between the game and life … and enjoy every inning of both!

Why is it that, in today’s society, parents have so much difficulty getting their kids to transition into adulthood? How is it that many parents find that their kids are seemingly incapable of becoming independent adults?

The simplest answer seems to be that our views and values on family life have changed. I believe much of this has to do with the way family life is depicted in the media: we do so much for our kids that it prevents them from doing for themselves and, as a result, prevents them from learning how to be independent. Many parents find themselves frustrated about the fact they have adult children still living at home, with a burgeoning sense of entitlement, because they supposedly can’t make it on their own.

If we go back 40 years or so, we see a time when kids typically learned the natural and logical consequences of the choices they made. If they did not do their homework, their grades reflected that. Kids performed chores without the expectation of an allowance. Kids were uncomfortable enough with their parents’ rules that they often looked forward to moving out once they were old enough so they could make their own rules and choices. Childhood and adolescence was a training ground to provide the opportunity for kids to learn the skills they needed to one day function as independent adults.

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Fast forward to the present. Technology has exploded. So has the experience of and demand for instant gratification. There is less reason and opportunity for kids to experience the discomfort that often comes with the necessity to problem-solve or use their imaginations. And as parents, we have evolved to the point where many of us don’t want to see our kids be uncomfortable at all. It seems that every parent’s goal is to see his or her kids “happy.” While that’s not unreasonable as an ultimate hope, we have taken the idea of removing discomfort from our kids’ lives to the extreme.

As parents, we have evolved to the point where many of us don’t want to see our kids be uncomfortable at all.

We have confused the ideas of caring for our kids and caretaking. Caretaking is anything we do for our kids that they can do for themselves. Caretaking stunts our children’s growth because they are deprived of the chance to learn the skills needed to entertain themselves, solve problems, resolve conflict with peers, and to take responsibility for themselves and be accountable. Life skills that should be learned in childhood and adolescence are often postponed until kids are in their twenties and thirties, and sometimes, learning the life skills needed to function as independent adults are delayed indefinitely.

While caretaking typically comes from a spirit of caring, love, and the desire to see our kids to be happy and healthy, it can become unhealthy and a cycle can develop that looks a lot like this: kids find themselves dealing with stress and/or struggling, so they immediately go to their parents. Problem solved. Except not—not really. As the cycle continues, kids learn to look outside themselves for ways to cope. Over time, the cycle carries into adulthood.

So how can we break this cycle? The solution is to help kids foster internal coping skills, develop confidence, self-esteem, and self-efficacy, and allow them to experience discomfort in order to learn that they have the survival skills they need and can be successful at facing challenges and obstacles.

Some Dos and Don’ts for Helping Kids Transition into Adulthood

• Be aware of supports and resources that allow kids launching into adulthood to level the playing field in order to successfully accomplish tasks at hand. Kids need to learn how to advocate for themselves. Part of this process requires that kids learn what works for them and what doesn’t.
• Support adolescents in finding and using tools for organization. Such tools are crucial when working on big projects and juggling the many facets of adulthood.
• Teach kids how to talk with adults who are leaders. Learning how to communicate with those in authority positions is a life skill that will help kids understand how to negotiate effectively and get their needs met as they transition into adulthood.
• Instead of rescuing kids, parents need to teach them how to learn effective techniques for managing tasks at home, work, or school. Kids need to learn how to help themselves by taking responsibility for implementing techniques that will help them be successful.
• Instead of criticizing when kids make mistakes, parents need to focus on the emerging adult, focus on what he or she does well, and to talk to him or her about those things. It is helpful for parents to trust that kids will eventually get to where they need to be, even if it takes some kids longer to get there.
• One of the most difficult things for parents about watching kids transition into adulthood is the fact they make choices parents often don’t agree with. Still, kids launching into adulthood have not only the right but the responsibility to make their own choices. Parents need to trust that kids will transition into adulthood and create their own lives.

All of this is not to say parents should give up; it is to say, rather, that parents need to allow kids to have control over their lives as they enter adulthood. While parents need to avoid always rescuing kids when they mess up, kids launching into adulthood need to know that their parents have their back. Be sure to show plenty of compassion and empathy, while at the same time holding kids transitioning into adulthood accountable.

Most of the people who come to my office are contemplating a life change or trying to feel better about one that happened recently. They feel stressed and unsure about decisions they have to make, such as a parenting issue or what to do after graduation. Or they are unhappy about a decision that has been made for them (divorce, layoff, medical issue).

Many times, there is some room to move within this uncomfortable spot. A person can try to improve a relationship, job marketability, or health. But what are we to do when a life situation involves working with the unchangeable? How does solution-focused therapy help people live and thrive when something about their situation is completely outside their control?

Have you been stuck with a situation that feels unbearable? This might include:

• Unhappiness at work with a coworker or supervisor
• Fertility issues
• The death of someone close to you
• Bankruptcy
• The end of a relationship
• Frustration over a someone’s decisions (your child, spouse, friend, etc.)

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Feeling powerless and at a dead end is how some people I work with describe themselves in these situations. They can take some small steps in some of these cases, but for the most part these people feel like they have no control.

I find it to be NOT useful in these moments to remind people of all they have. Someone who is mourning the end of a relationship is unlikely to appreciate his or her health, and someone whose financial woes have overtaken daily life is usually unable to be glad that at least he or she has a job. A couple struggling to conceive a child may not feel fortunate that “at least” they have this or that. Gratitude is a powerful, necessary element of life which unfortunately does not initially help those who are feeling regret, guilt, and sadness.

Gratitude is a powerful, necessary element of life which unfortunately does not initially help those who are feeling regret, guilt, and sadness.

When we must live with the unchangeable, I find it most useful to find outlets for the feelings that result from our position of powerlessness or suffering. There are plenty of tactics that we can use with cognitive therapy to help someone compartmentalize thoughts about his or her situation so that the person can function throughout the day. But what about those unstructured times, such as in the shower, driving, or late at night when the house is quiet, when the feelings creep in and feel hard to withstand?

Acknowledge your feelings, but give them a place to go. Even if you write the same thing down every night for a month in a cognitive thought chart, it is important to allow your expression to have an outlet. This could also look like a journal, a walk where you allow your thoughts to fill the time, a yoga or exercise practice, or creative expression such as painting, gardening, or baking.

Accept that, for now, these feelings and thoughts about your unchangeable situation are going to be with you for a while, but they do not have to paralyze you or sink you like an anchor. For example, people who struggle with grief come to think of that heavy feeling as one that can accompany them for a few hours but does not have to keep them from going about their days. In time, this becomes easier as you welcome the feelings that come and then go in waves. When they arise, they can go with you throughout your day. You can familiarize yourself with what they feel like and be extra compassionate with yourself. You will see that your feelings are nothing more than emotional states that come and go throughout your life. You can endure them. You were built with resilience to manage them.

Make some meaning out of your daily routine that gives you power over your situation. You may not be able to swap out your boss, move the calendar forward faster, or undo something you regret, but you have control over how you think and feel about these things today. Take charge of what you can. Have a brainstorming session about what could be part of your day that you think will help you feel good. Start with little things—guaranteed things that you know bring you happiness. Start your morning in the most positive way possible, employing these ideas as much as you can. Hang your expression of art or wear a token of strength or memory to remind yourself that you are honoring the unchangeable but not controlled by it.

How a Therapist Can Help

Seek therapy to put this situation to rest. It might sound elusive, but many people find that achieving peace with their situation is a process that is helped by the presence of a skilled professional. A therapist can help you understand why you might be stuck on a certain part of your story, or help you gain clarity to the meaning of holding on to the feelings you have.

At the very least, it is a great relief to have another person on your team during a time you feel powerless. We all need someone who believes in our ability to endure the unchangeable, and who can abide with our journey.

There is a paradox when it comes to bipolar mood episodes in terms of the treatment versus the prevention of episodes. On the one hand, the treatment of mood episodes can be rigorous, prolonged, and unsatisfying for people with bipolar and those around them. However, there are things people with bipolar can do to empower themselves in managing and, in some cases, staving off mood episodes.

Here is a focused outline on three self-guided components for living with bipolar: sleep, self-care, and support.

1. Train Yourself to Sleep

Your body responds to natural circadian rhythms. Based on a 24-hour cycle, a person’s physical and mental processes (e.g., mood) are affected by the changes of light and darkness. Setting the same wake and sleep schedule can dramatically improve your mood. Try to go to bed around the same time each night (even weekends) and get up around the same time in the morning. To do this, utilize these sleep hygiene tips.

Establish a routine to wind down in the evening. Pay attention to what time it is, so there is room to slowly navigate the dental routine, preparing for tomorrow’s workday, and the contact lens storage process. Avoid projects and other mentally taxing activities. Instead, read a novel, take a shower, or do some light stretching in the evening. Using alcohol, nicotine, or other drugs can disrupt nighttime habits, which consequently leads to increased stress and less capacity to manage it. Finish eating at least two to three hours before you go to bed, and abstain from caffeinated beverages in the evening. It takes approximately six hours for caffeine to leave the body, so a reasonable rule would be switching to decaf by 4 or 5 p.m.

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When you are ready to hit the sack, use your bed for two things: sleep and sex. This means not binging on Netflix or writing a dissertation from the confines of the bed. Train the body to know that when you are getting into and lying in bed, it is time to fall asleep. You do not want to be alert in front of a screen or stimulated by a task you are doing while in bed. Consistent, alert activity in bed teaches us to be awake; when we do want to go to bed, the brain is confused as to whether dreamland is approaching or to perk up for Breaking Bad.

Similarly, do not submit to long periods of insomnia (no more than 10 or 15 minutes at a time). Although seemingly counterintuitive, this goes back to the idea of training the body. After 10 to 15 minutes of not being able to fall asleep, do not continue counting sheep; go to another room and get a glass of water, read a brief article or part of a book, and wait until you are a little sleepy before returning to bed. This reminds the body that the bed is for sleeping. Life can get in the way, but aim for seven to eight hours of sleep per night.

2. Practice Regular Self-Care

Recent research shows that exercise is at least as effective for relieving depression as antidepressant medication. It also comes with a lot of less intrusive side effects (i.e., feeling relaxed, improved sleep and energy levels). Exercise regularly and make sure to finish a few hours before bedtime. Our bodies did not evolve to sit in office chairs for 12 hours per day, so getting your heart rate up or simply going for a long walk is a great stress release.

The more one understands about contributing factors to bipolar episodes, the more empowered he or she is to take preventative actions. You can develop a lifestyle management routine around your specific needs for mental health.

In addition, the mind, which regulates the flow of energy in our bodies, needs time to regenerate without stimulation. Develop a mindfulness practice or other type of spiritual process that you really value as necessary for mental well-being.

Prayer or meditation is best practiced in the morning after waking up. This establishes an intention for mindfully approaching daily life. Sit in silence while paying attention to your breathing for 20 to 30 minutes (start in smaller increments). Mindfulness group practices and classes are ever more ubiquitous and offer instruction to guide your work. Practicing these techniques within a community can be especially powerful. Contemplative activities are not rooted in gaining or self-improvement, which drive our identification with productivity. It is a commitment to sustaining a healthy lifestyle for the betterment of your relationships with others. Being curious and actively aware of the present will elicit awareness to subtle symptoms while decreasing impulsive behaviors.

A simple tracking sheet for mood and anxiety levels as well as self-care initiatives is a constructive way of monitoring behavioral and mental changes. Use a spreadsheet and leave it next to the bed or, if applicable, next to your daily supplements and/or medication box. Quickly note on a scale from 1 to 10 (1 being depressed and 10 equaling manic symptoms) what your mood was for the previous day. You can do this for anxiety levels as well. Also, note whether you exercised or practiced other self-care (yoga, meditation, etc.) and any significant events (interpersonal issues, medication changes, etc.) that took place. Over time, you will have a noteworthy amount of data to compare the actions you have been taking with changes in your routines, moods, and levels of stress. Utilize the correlations you find and make predictions about what you need to do—or not do—in order to stay on top of emerging problems.

The more one understands about contributing factors to bipolar episodes, the more empowered he or she is to take preventative actions. You can develop a lifestyle management routine around your specific needs for mental health. This includes clues to early warning signs and possible factors you have identified that get you into psychological trouble.

3. Lean on Others for Support

The effects of bipolar rarely occur within a vacuum. When a person tries to manage it alone, it can consume the person. Like any stressor or bothersome life event, the symptoms of bipolar pull on relationships. This becomes a systems issue that requires the support of others. Wright et al. (2009) state that “family members and friends are generally good observers and may be able to recognize the subtle changes in behavior, emotions, and thought processes that signal the onset of mania.”

Having individuals in your life who are aware of your historical battles raises the likelihood that mood changes will be identified before complete manifestation. Talk to people who are close to you when you have medication or drug-use changes, feelings of depression, or energy changes, and allow space for them to discuss your routines or behaviors. Appreciate their information and knowledge while assuming they love and want the best for you. Transparency will alleviate the concerns of others and lessen the burden you feel for managing the prevention of mood episodes.

It is essential to develop close relationships with your health providers so they have a longitudinal vista into your mental health. If you wanted to see how your face aged over time, you could take a selfie on a daily or weekly basis and run the images through a video program. Similarly, regular meetings with a psychotherapist will foster insight, but also enable the psychotherapist to notice subtle changes in your mental health presentation. A psychotherapist typically takes a “snapshot” of you each week—or two—and, akin to a series of selfies, compares and contrasts the “images.” This clinical timeline is examined with you in order to make correlations and inferences about mood episodes as well as behavioral changes. A disciplined regimen of psychotherapy is necessary to understand our habitual processes. You become aware of the holes you continuously fall into despite seeing warning signs.

If you can regulate your sleep, monitor internal changes, and stay physically active—while also training your mind—you and your therapist might not have much to talk about.

References:

1. Archer, A.J. (2013). Pleading Insanity. Bloomington, IN: Archway Publishing.
2. American Psychiatric Association. (2013). Diagnostic & Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
3. Kirsch, I. (2010). The Emperor’s New Drugs: Exploding the Antidepressant Myth. New York: Basic Books.
4. Kirsch, I., Deacon, B.J., Huedo-Medina, T.B., Scoboria, A., Moore, T.J., & Johnson, B.T. (2008). Initial severity and antidepressant benefits: a meta-analysis of data submitted to the food and drug administration. Public Library of Science Medicine 5 (2): 260-268.
5. Miklowitz, D.J. (2014). Bipolar Disorder. In: D.H. Barlow (ed.) Clinical Handbook of Psychological Disorders: A Step-by-Step Treatment Manual. (5th ed.). New York: The Guildford Press. 462-501.
6. Murray-Swank, A., & Dixon, L. (2005). Evidence-Based Practices for Families of Individuals with Severe Mental Illness. In: R.E. Drake, M.R. Merrens, & D.W. Lynde (eds.). Evidence Based Mental Health Practice. A Textbook. New York: W. W. Norton & Co., pp. 425-452.
7. National Institute of General medical sciences: basic discoveries for better health. Circadian Rhythms Fact Sheet. Content reviewed November 2012. Retrieved from: http://www.nigms.nih.gov/Education/Pages/Factsheet_CircadianRhythms.aspx
8. Siegel, D.J. (2010). The Mindful Therapist: A Clinician’s Guide to Mindsight and Neural Integration. New York: WW Norton & Company.
9. Wright, J.H., Turkington, D., Kingdon, D.G. & Basco, M.R. (2009). Ch. 8 Mania. In: Cognitive-Behavior Therapy for Severe Mental Illness. An Illustrated Guide. Washington, D.C.: American Psychiatric Publishing, Inc. pp. 181-209.

The Golden Gate Bridge, which connects San Francisco and Marin County, is a marvel of architecture and engineering. It’s an internationally recognized symbol of American culture and ingenuity. It’s billed as one of the top tourist destinations in the world.

It’s also, sadly, a well-known suicide hotspot where more than 1,600 people have jumped to their deaths since the span opened in 1937.

Suicides from bridges and other high points have long been a concern for communities. Much has been done in the way of suicide prevention by adding barriers designed to make suicide more difficult, posting signage with helpline information, and installing special phones that connect a person directly to crisis help. Such efforts, though, have generated some debate regarding just how helpful they may be. Some wonder, in fact, if it’s possible they do more harm than good.

Let’s take a look at some of suicide prevention methods in use today on bridges around the world to see whether their intended use and results are as solid as the bridges on which they are installed.

Prevention Signs and Phones: Are They Effective?

On some high bridges, you might see a sign with a message that reads something like, “There is hope. Make the call.” For some people, people at the right place at the right time, this message could be a lifesaver. Some have speculated, though, that suicide prevention signs and phones, while clearly well-intentioned, could inadvertently contribute to the problem by planting the idea of suicide. Could they give someone who otherwise was not considering jumping—from that spot, at least—the idea to do so?

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There is no known evidence or research to support this possibility. What little evidence we do have tells an important, more optimistic, story, even if not everyone is buying it. Data collected from several bridges suggests that prevention signs may have an effect on the number of suicides per year—albeit minimal.

Researchers studied data from the Sunshine Skyway Bridge in St. Petersburg, Florida to analyze the period before and after emergency crisis telephones and signage were installed. The results from examining three-year periods before and after signs and phones indicated that the suicide rate dropped from 8.3 per year to 6.3.

In another example, in the mid-2000s, the New York State Bridge Authority (NYSBA) created a comprehensive suicide prevention plan to address this public health issue. Consulting with experts in the field, they concluded that the best possible prevention method was establishing a human connection between someone considering jumping and a mental health professional or law enforcement official. This led to the installation of emergency hotline services on every bridge, an awareness campaign for the public on use of the hotline, and increased emergency training for police dispatchers. The NYSBA declared the program an immediate success, citing that calls from the hotline phones began coming in less than two months after installation. In fact, the first call from a person using the phones resulted in a life saved.

Not everyone is convinced that signs and phones are effective, however. Reacting in 2013 to plans by the city of Pasadena, California to post four signs with a message and hotline number on the Colorado Street Bridge, site of more than 150 suicides over the past century, the then-medical director of the American Foundation for Suicide Prevention expressed doubt that they would have a measurable effect. “It’s a nice first step,” Dr. Paula Clayton told KNX 1070 Newsradio, “but the Golden Gate Bridge does have signs, and yet it hasn’t changed the rate of people dying by jumping from that bridge, so it’s doubtful.”

Dr. Lanny Berman, then-executive director at the American Association of Suicidology, told The Oregonian in 2013 that phones aren’t the answer. “No data shows this method is effective,” Berman told the newspaper. “The only data that exists, both in this country and internationally, regarding prevention of jumping from height, are barriers.”

Physical Barriers: The Gold Standard?

In the city of Bern, Switzerland, a safety net was installed on the Muenster Terrace, another popular spot for suicides. An analysis of the data conducted in 2005 by researchers Reisch and Michel (2005) found that in the years following the installation, no suicides occurred.

Some have speculated that suicide prevention signs and phones, while clearly well-intentioned, could inadvertently contribute to the problem by planting the idea of suicide. Could they give someone who otherwise was not considering jumping—from that spot, at least—the idea to do so?

Go ahead and read that last sentence again: zero suicides after the installation of the safety net. They also found that the overall rate of suicides by jumping from any place in Bern dropped significantly after the net was put up, suggesting that potential jumpers most likely did not move to another high point.

Researchers Bennewith, Nowers, and Gunnell (2007) examined a barrier on the Clifton suspension bridge in Bristol, England and found that it reduced suicides by 50%. They also believe it may correlate to an overall decrease in suicides in the area.

Physical barriers designed to prevent suicide from bridges come in many forms, ranging from high fences topped by barbed wire to sloped walls to safety nets. Their purpose is to make it impossible (or at least very difficult or inconvenient) for a person to leap to his or her death, and there’s abundant evidence showing they work.

In 2008, the 988 Suicide & Crisis Lifeline (a network of crisis centers in 49 states and the folks handling those hotline calls from bridges) stated matter-of-factly, “The use of bridge barriers is the most effective means of bridge suicide prevention. Subsequently, as bridge/transportation authorities or other stakeholders approach the Lifeline with requests for implementing bridge phones, the Lifeline should emphasize the need for barriers as the most effective solution.”

In reaching its conclusion on bridge suicide prevention methods, the Lifeline detailed three studies (including one of the Golden Gate Bridge and another conducted on the Sunshine Skyway Bridge) where the efficacy of suicide prevention signs and phones as the sole method of prevention is put into question, pointing out that suicides have still occurred from these points after signs were installed. Lifeline believes that signage and phones should be used as supplements to physical barriers.

The strongest piece of evidence for physical barriers as a suicide prevention tool, however, emerged in Auckland, New Zealand, where safety barriers were removed from the Grafton Bridge after having been in place for 60 years. After removal of the barriers due to complaints of unsightliness, suicide researcher Annette Beautrais and her colleagues found that suicides from Grafton Bridge increased from three in the four years preceding the removal to 15 in the four years after removal. This prompted the reinstallation and redesign of the barriers, after which zero suicides occurred from the bridge. This was the only known time and place in the world that physical barriers have been installed, removed for a period of time, and then reinstalled, providing the opportunity to study the effect in a way that would have otherwise been highly unethical.

Lessons Learned: The Future of the Golden Gate Bridge

We end now where we began—at the Golden Gate Bridge, where 38 people died of suicide in 2014 alone and where debate regarding the installation of safety barriers has raged for decades. Progress had been stalled by financial cost and questions of effectiveness, but things are changing. Last year, the Highway and Transportation District, the agency that oversees the Golden Gate Bridge, approved a $76 million project that will install safety nets on the bridge—an action, according to the evidence, that will save lives.

Knowing what you know now, what are your opinions on these types of suicide prevention methods? Have you seen backlash against barriers or signs in your community?

Do signs, phones, and barriers simply distract from the larger issue of creating better access to mental health care for people with suicide ideation?

References:

1. Aleaziz, H. (2015, February 3.) 38 Golden Gate Bridge suicides last year, down from 2013 spike. San Francisco Gate. Retrieved from http://www.sfgate.com/bayarea/article/38-Golden-Gate-Bridge-suicides-last-year-after-6059465.php
2. Beautrais, A. L., Gibb, S. J., Fergusson, D. M., Horwood, L. J., Larkin, G. L. (2009). Removing bridge barriers stimulates suicides: An unfortunate natural experiment. Australian and New Zealand Journal of Psychiatry, 43 495-497.
3. Bennewith, O., Nowers, M., Gunnell, D. (2007). Effect of barriers on the Clifton suspension bridge, England, on local patterns of suicide: Implications for prevention. The British Journal of Psychiatry 190(3). 266-267. Doi: 10.1192/bpj.bp.106.027136
4. Cabanatuan, M. (2014, June 28). Golden Gate Bridge board OKs $76 million for suicide barrier. San Francisco Gate. Retrieved from http://www.sfgate.com/bayarea/article/Golden-Gate-Bridge-going-to-get-suicide-nets-5585482.php
5. CBS Los Angeles. (2013, June 21). Signs Along Pasadena Bridge Aimed at Curbing Suicides. Retrieved from http://losangeles.cbslocal.com/2013/06/21/signs-along-pasadena-bridge-aimed-at-curbing-suicides/
6. Draper, J. (2008). Suicide prevention on bridges: The national suicide prevention lifeline position. Retrieved from http://host31.spidergraphics.com/spv/doc/SUICIDE_BRIDGES_Lifeline_Position_Paper_Final_6-16-08.pdf
7. Glatt, K. M. (1987). Helpline: Suicide prevention at a suicide site. Suicide and Life-Threatening Behavior, 17(4), 299.
8. Lester, D. (2005). Suicide by jumping from bridges. Perceptual and Motor Skills, 100(3), 628-628.
9. New York State Bridge Authority. (2007). A comprehensive plan for suicide prevention New York state bridge authority briefing & summary report for consideration by transportation agencies. Retrieved from http://www.nysba.state.ny.us/Documents/NYSBA%20Suicide%20Prevention%20Summary%20Report.pdf
10. Pogash, C. (2014, March 26). Suicides mounting, Golden Gate looks to add a safety net. The New York Times. Retrieved from http://www.nytimes.com/2014/03/27/us/suicides-mounting-golden-gate-looks-to-add-a-safety-net.html?smid=fb-nytimes&WT.z_sma=US_SMG_20140326&bicmp=AD&bicmlukp=WT.mc_id&bicmst=1388552400000&bicmet=1420088400000&_r=1
11. Reisch, T., Michel, K. (2005). Securing a suicide hot spot: Effects of a safety net at the Bern Muenster Terrace. Suicide and Life-Threatening Behavior 35(4). 460-467
12. Stabler, D. (2013, February 2). Vista Bridge: Is it time to stop the dying at Portland’s iconic bridge? The Oregonian. http://www.oregonlive.com/living/index.ssf/2013/02/post_37.html
13. Walsh, B. (2011). Evaluation of the suicide prevention activities at Gap Park: Crisis telephones. Sydney, NSW: Lifeline.

Crows and ravens are a long evolutionary chain away from humans, but some of their behavior closely resembles that of humans. Viral videos of crows that talk and count frequently make the rounds on social media. Until recently, scientists were unsure how basic math skills evolved in crows, but a study published in the Proceedings of the National Academy of Sciences offers insights into why and how crows count.

Counting Crows Have Human-Like Neurons

Researchers have long puzzled over why crows seem able to count. The brain structures that enable humans and other primates to count evolved long after crows and humans shared a common ancestor. This suggests that counting may have independently evolved in crows.

To explore how crows’ brains enable them to count, Helen Ditz and Andreas Nieder, researchers from the University of Tübingen, trained carrion crows to play a numerical matching game. The crows saw between one and five dark dots inside a gray circle on a computer screen. Crows who tapped the same number of dots when it appeared again received a treat. The size of each dot, as well as their placement within the circle, randomly varied. This means that the crows weren’t just measuring shapes; they were counting the number of dots, or at least memorizing what particular quantities of dots looked like.

On average, the crows got the answer right about 75% of the time—a figure that can’t be explained by chance alone. In most cases, the mistakes occurred when the difference between images was only one dot.[fat_widget_left]

The crows wore surgically implanted neuron sensors as they played the game, enabling the team to observe the activity of about 500 neurons. Approximately 100 neurons behaved differently depending on the number of dots the crows saw. Some neurons showed activity only when there were three dots, while others showed activity only with one or five dots, suggesting that the crows’ neurons might behave differently depending on how many dots the crows counted.

Though the part of the primate brain that allows counting works differently, the neurons behave the same. Just as crows’ neurons light up according to the number of items they count, so too do primate neurons. The correlation between neuron activity wasn’t perfect. For example, “four” neurons still responded when there were three or five dots, though not as dramatically as they did when there were four dots.

The researchers say that their results could shed light on the evolution of counting in both humans and crows. Because similar neuronal processes enable both species to count, the common ancestor of crows and humans—who existed more than 300 million years ago—might also have been able to count.

References:

1. Ditz, H. M., & Nieder, A. (2015). Neurons selective to the number of visual items in the corvid songbird endbrain. Proceedings of the National Academy of Sciences. doi:10.1073/pnas.1504245112
2. Johnson, S. K. (2015, June 24). Counting crows’ neurons work just like yours. Retrieved from http://arstechnica.com/science/2015/06/counting-crows-neurons-work-just-like-yours/