People at funeral consoling each otherBereavement, the grief we feel in response to the death of a loved one, is part of our being in the world. It includes different categories of loss. There is the literal loss of the unique and irreplaceable other person. There is also the apparent loss of the functions that person carried in the relationship (he was the one who always filed our taxes; she was the one who held the family together). Here we can find as well the loss of the one who witnessed us (he was the last person who knew me when I was a teenager).

Less conscious is the—again, apparent—loss of self, of who one was in relationship to the loved one who passed.

Who among us wants to go through bereavement? Yet grief is a healthy response, and a necessary one in order to adjust and go on in a world where people die. At such times, our religious, spiritual, and philosophical beliefs can support us. It can also happen that such structures of belief or hope, which were previously unconscious, come forward spontaneously in response to loss. This can happen in the form of highly subjective, deeply personal experiences.

In the discussion that follows, names have been changed and personally identifying material has been screened out in order to preserve confidentiality.

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After the death of his partner, Jim finds himself waiting for him to come home, to hear the jingle of his keys in the door or to share a piece of news with him. Leah hears her husband call her name from the next room as she’s falling asleep at night. It’s not scary for her, but it brings her grief back when she starts to get up to attend him and remembers that he’s gone. Janet feels her husband sit down on the couch next to her when she’s watching television before going to bed. Annie, out on lunch break, has her eye caught by what appears to be a dear and departed colleague, waiting across the street at a bus stop. Mark sees a close friend twice after the friend’s death: once walking down the street “looking like hell,” the second time some months later, standing outside an Alcoholics Anonymous meeting. John rages at God each afternoon for the loss of his wife, and God—silent, invisible, but palpably present—hears him out.

These phenomena form a broad spectrum, from a subjective feeling to transitory perceptions when in a relaxed or distracted state. It’s important to note that none of these folks met the criteria for psychotic, mood, or substance dependence disorders at the time of their experiences. Bereavement, while not a formal diagnosis, can be a time of disruption, during which material that was previously unconscious comes into awareness. Often, the material serves an adaptive function. One way to support that adaptation is to treat it as symbolic rather than literal. As in dreamwork, we’ll look for what the experiences mean to the one having them rather than debating whether or not they “really” happened. When supported with empathy and respect, the events yield meaning and can be integrated into the person’s worldview, enriching it and making it more resilient.

Leah acted as caregiver for her husband in his final illness. As a result of hearing him speak her name, she reconsiders her situation. The role she filled for the last several years no longer has a purpose. The house where they raised a family and lived together is “too big” for her now. She begins thinking about moving into someplace smaller and closer to her adult daughter, so she can help out with her grandchildren. Annie notes that when she looked again “I saw it wasn’t Greg, not even someone who looked like him, really. But for that moment, I got to see him again. It’s like he paid me a visit.” When asked where Greg “was” when he visited, Annie gives a bittersweet smile and says, “In my thoughts.” Both Leah and Annie assimilate their experiences easily.

As in dreamwork, we’ll look for what the experiences mean to the one having them rather than debating whether or not they “really” happened. When supported with empathy and respect, the events yield meaning and can be integrated into the person’s worldview, enriching it and making it more resilient.

Like Annie, Mark sees a dead friend. Richard died of an accidental overdose, and Mark grieves as much for what seems to him the waste of his friend’s life as for his actual death. His two glimpses seem to be sequential and almost tell a story. In the first, Richard looks to be doing badly. Mark’s associations are that he has continued on the downward spiral he was in at the time of his death. The second glimpse, some months later, is of Richard among a group of others apparently taking a break outside an AA meeting place and looking “better than I remember seeing him for a long time.”

Mark doesn’t subscribe to the idea of life after death. But he was raised as a Roman Catholic in a small New England town. He notices that these experiences seem to refer to the idea of purgatory, a place or state where corrective balance takes place. Or as Mark puts it, with some humor, “It’s like Richard had to go to summer school so he could graduate.” Then he adds, “It makes me feel hopeful. I don’t want to make a religion of this, but it’s like the message is it’s never too late to get your act together.” The psyche provides Mark with images that help express and heal his grief.

Like Mark, John is surprised at his experience. He describes himself as “a scientific humanist, like Carl Sagan.” His wife’s death from cancer was drawn out and marked by suffering, both from the disease progress and from the treatment. John suffered with her. In this second month following her death, he tells me that he “indicts God” on his afternoon walks, giving vent to anger and bitterness that “someone who never hurt anyone suffered so much for no reason.” Angie wasn’t just his wife, she was his primary companion, and her loss makes the world an empty place for John.

The image of God, never previously active, becomes so in this crisis. It functions like a container for what might otherwise be overwhelming feelings, which John is then more safely able to identify and express in the form of his “indictments.” And more than an image: somewhat like Janet feeling her husband sit down next to her, John describes feeling God’s presence as an almost bodily sensation. Whether or not he goes on to live a religious life, in this period this experience provides a supportive and adaptive function.

As we see, some of these experiences are perceptual—auditory, visual, sensate. As a therapist, when someone describes such things, I look for some awareness on his or her part that these experiences are unusual. Also, that what’s experienced is characterized by feelings of grief or loss, or conversely by feelings of relief or hope. If the material is held concretely or literally, I would expect to find some cultural support for that. For instance, Kenny, a practitioner of Santeria, tells me that his recently deceased brother has given him some important information during a shell reading, or divination ceremony. Mary, first-generation Italian American, covers the mirrors with cloth so she won’t see her husband and “get taken by him.” Where I might become concerned is when there’s no such cultural cuing, or when the material is characterized primarily by feelings of guilt or worthlessness.

Alice tells me that she’s very distressed over the loss of her mother two years ago. She can hear the voices of the dead, blaming her not only for her mother’s death but for theirs as well. In order to get some relief from the voices, she accesses alcohol on a daily basis. She becomes distraught as she tells me this, weeping hopelessly. I don’t argue the matter with her, nor do I help her open it up for meaning. I tell her that I believe that she’s hearing the dead and it must be very rough. I ask if she’ll sign a release so we can call her doctor together and see if there’s something that might work better than alcohol.

Not everyone experiences these types of phenomena. For many of us, bereavement can be tracked through dreams. David, unable to be present when his father died, describes a dream a few months later in which his father enters the room David is in. After making eye contact with David (“so I could feel that he was at peace”), the father smiles, closes his eyes, and slowly leans back until David is left looking at the soles of his feet. Barbara dreams of her husband several times in the year following his death due to cancer. The dreams seem to form a sequence, in which she observes that her husband recovers from the symptoms of Alzheimer’s that were increasingly present the last three years of his life. “He looks like his old self now,” she says.

This phenomenon, the healing of the deceased in dreams, can generate different meanings. For Ron, his father wanted to come back and show him that he was all right. Bridget experienced this as a promise that our sufferings and their impact on us are reversible, and that there’s mercy operating in the universe. One additional meaning we might consider is that the healing of the image of the loved one corresponds to the healing and adjustment of the dreamer to the fact of loss.

We derive our personal meanings from the common experiences of loss. I expect you to come home because there are corners of the psyche where news of your death hasn’t reached yet. I hear your voice because I’m shocked by the sudden silence. I see you because I’m looking for you, and my eye assembles your lovely face out of whatever the environment provides—a stranger waiting for a bus, or someone smoking outside of a meeting place.

Although we know one another, much of our knowing is activity in our brains. The familiar face is conveyed by light that enters the eye and causes impulses to travel along the optic nerves and stimulate processing in the visual cortex, whose patterns of response are rendered semi-stable in the temporal lobe. Likewise, the voice. And likewise, too, our feeling responses and memories of shared events. The image we form corresponds to the other person, is alive, but is “made” of our own processes. When someone dies, it seems to be essential to successful adaptation to acknowledge and adjust to that fact. And after that adjustment, many of us find that in some very real ways, the image of the other person continues to live in us.

In psychotherapy, the first time a person tells me she dreamed of me, or that when facing conflict he imagined what I would tell him, I smile and say, “Now you have my image, and it belongs to you.” Later on, when working through closure and termination, we return to this idea. Bereavement is about ending. It’s also about ending’s opposite, which is continuation.

Figure walking alone in dark forestThese days, it seems like depression is all over the news. It usually gets publicity when a high-profile tragedy occurs. You don’t hear people talking about how great they feel now that their depression is being effectively treated. A lot of inaccuracies and half-truths get thrown around, and it can be tough to dig through them and find the facts.

Here are 10 particularly troubling myths and misconceptions about depression. I’d love to hear what you would add to the list!

1. It’s Something You Should Be Ashamed Of

The shame people often experience with depression (or any other mental health issue) is real, but this doesn’t mean embarrassment is warranted. In the United States and its territories, as many as 9% of the population currently meets the criteria for depression. Hundreds of celebrities, athletes, and political figures are known to have struggled with depression. You have nothing to be embarrassed or ashamed about. Depression doesn’t mean you’re lazy or pouting or ungrateful.

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2. If You Have Depression, You Will Always Feel Depressed

Depression comes in all shapes and sizes. For many people, their depression changes throughout their lives. Medication, life events, hormonal changes such as pregnancy or menopause, illness, or stresses can change depression. Some people find that psychotherapy relieves their symptoms, others seek out medication or homeopathies, and some make behavioral changes, such as exercise.

3. Depression Is Always Hereditary

Studies have shown that between 40% and 50% of depression is rooted in genetics. So if your parent or sibling has depression, it’s not a guarantee that you will develop it. There are also things you can do that might minimize your risk of developing depression. These include maintaining a strong support network, staying active, having a healthy diet, and learning positive coping skills such as meditation and deep breathing.

4. If Something Horrible Didn’t Happen, You Should Not Be Depressed

This is simply not true. Many people have a trigger in their lives, a trauma they can pinpoint as a starting point for their depression, such as the loss of a loved one or the loss of a job. Sometimes a passing challenge, such as failing a test or moving, can bring on a major depressive episode. Or the depression can appear with no known trigger at all.

5. Depression Is Simply a Feeling

Depression is not having “the blues” or feeling sad. The DSM-5 (a handbook used by mental health professionals to determine what constitutes a diagnosable issue) includes a list of symptoms. People who are clinically depressed have a cluster of these symptoms, such as thoughts of suicide or death, insomnia or hypersomnia, significant weight loss, and depressed mood most of the day nearly every day.

6. Medication Is a Sure Cure for Depression

Unfortunately, there is no magic pill that can obliterate depression. Depression is a complicated beast that can be incredibly hard to treat. Medication can be helpful at managing depression for some people. Others find that medication doesn’t help or, due to side effects, can even make things worse. It can take trying several different medications or combinations of treatments until you feel better.

7. Therapy Is a Sure Cure for Depression

Psychotherapy certainly can help people who struggle with depression. It’s been shown to decrease many symptoms and help people manage their moods. Like medication, though, therapy is not a cure in and of itself. Many people respond to therapy, but some don’t. A combination of therapy and medication tends to yield the best results, and many people incorporate both in their healing.

People with depression aren’t always depressed. Like everyone else, they have their good days and bad days.

8. If You’re Depressed, You Can’t Be Happy

People with depression aren’t always depressed. Like everyone else, they have their good days and bad days. When their depression is being effectively treated, the good days outnumber the bad. You cannot look at people’s Facebook pages with pictures of them laughing and enjoying life and conclude they’re not depressed. Many people are good at hiding their feelings and present to the world a persona that is much different from what they are experiencing.

9. Depression Shouldn’t Be Talked About

Millions of people throughout the world will experience depression sometime in their lives. You’re far from alone, and it doesn’t have to be something you keep secret. I’ve worked with people in therapy who, upon sharing their experience with friends and family, expressed surprise at how many of them also have struggled with depression.

10. If You Have Depression, You Will Never Have a Fulfilled, Productive Life

Depression is not a life sentence to misery. Depression is a treatable condition, and people who are diagnosed with it can go on to have wonderful, happy lives. The key is getting the correct treatment. If something you try isn’t working, keep searching. Find a psychiatrist or doctor who will patiently work with you to find the best medication, if you go that route. Find a skilled therapist who specializes in depression and whom you trust and feel a connection with.

Depression does not have to hold you hostage. The more people are honest about their struggles, the more accepting and understanding society will be—and the better off we all will be.

References:

  1. Centers for Disease Control and Prevention. (2010). Current Depression Among Adults – United States, 2006 and 2008. MMWR 2010, Vol. 59 No. 38.
  2. Levinston, Douglas F., & Nichols, Walter E. (2015). Major Depression and Genetics. Stanford School of Medicine, Genetics of Brain Function. Retrieved from http://depressiongenetics.stanford.edu/mddandgenes.html

Girl Inside CarDuring healthy development, children learn that the people around them are mostly safe and trustworthy. Even when they do not get what they want, they eventually learn to self-soothe in many ways as they grow. They may try persuasion or defiance to get what they want or avoid what they do not want, but ultimately they learn that being respectful and cooperative maintains stability. Because the average child’s brain is not easily triggered to extremes, they typically find ways to self-soothe, delay gratification, and self-regulate their emotions.

Either due to traumatic experiences—including abuse or extreme neglect—or developmental anomalies, some kids have intense fight, flight, or freeze responses and little ability to self-soothe. Chronic volatility in family relationships can also set this pattern into motion. Developmental neurobiologist Daniel Siegel (2003) wrote, “The mind develops as the brain responds to ongoing experience.” Problem behavior is a manifestation of well-worn neural and cognitive pathways that translate into reflexive emotional, cognitive, and behavior patterns.

We must learn to detour kids’ domino-effect reactions, which so frequently emanate from underlying fear or shame. Matthew Selekman (1993) wrote that change arises “out of the breaking of patterns, both of thought and action, the interruption of repeating sequences.” Many adults perpetuate volatile cycles of emotion, thought, and behavior unintentionally by interacting with children in ways that trigger further volatility.

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Navigating out of these ruts requires self-control, empathy, and creativity. Explosive and withdrawn behaviors are typically adaptive responses, arising out of needs to be liked, valued, and respected, needs to have some sense of predictability and control, needs to heighten or lessen sensory stimulation, or all of the above. When behaviors are confronted through criticism or control, a defensive neurophysiological response perpetuates the vicious cycle through an emotional display on the outside of feelings being felt on the inside.

Development is a train choo-choo-ing along. When the Polar Express slid out of control on a lake of ice, it took courage, creativity, and collaboration to aim it back onto its tracks. It is important to maintain firm guidance alongside unconditional acceptance, as well as to discern that fine line between what is vital and what is negotiable. Consequently, the need to become defensive and act out may diminish over time if the child finds that it is not needed anymore to be heard or to feel loved.

I describe therapeutic connection in the acronym ATM, in which “A” stands for accommodation, “T” for tracking, and “M” for mirroring. We maximize opportunities for connection when we accommodate our use of words to those used by another, track and intentionally relate with the stories they tell, and mirror body language to the extent that it sends the message, “There is no need for defense. I’m here with you, and I care about you. I’m trying the best I can to know you.” This is part of the way we invest into the relationship account, and when the time comes for withdrawal, those who have done so won’t go for broke.

It is important to maintain firm guidance alongside unconditional acceptance, as well as to discern that fine line between what is vital and what is negotiable.

Children who are withdrawn often need greater affirmation of their strengths and efforts. Mark Twain once wrote, “I can live for two months on a good compliment.” When someone approves of some part of who we are, it is as if that part of us becomes illumined. The need for approval can be compulsive, but just about anything can be. The truth is that we benefit from that sort of love in our lives. We grow better in the light.

Discipline should aim to teach and to train a child. We must not fail to teach facts and skills, for they are pixels in the resolution of a bigger picture. Yet, insight also has its limitations. I believe that there are few better ways to teach or train a child than to immerse him or her in the best experiences that life has to offer: fun, silliness, art, creativity, exercise, work, rest, food, adventure, and relationship—not necessarily in that order. I call these the parenting disciplines. Shared moments equal shared lives.

Children who are explosive may engage easily in power struggles. Before getting hooked in, learn the patterns and try to better anticipate them. Proactively communicate about expectations, limits, and consequences so that they are clear, measurable, and enforceable. When a power struggle is beginning, verbalize guidance authoritatively, then stop talking, and maybe even walk away. Become a broken record, if need be, in reinforcing limits. Play good cop/bad cop, and let established rules and limits do the dirty work.

If you accidentally get stuck in a power struggle, catch yourself, confess it, and end it: “Ah, you hooked me, and I just realized it.” It’s OK to change your mind. It’s also OK to be honest about your own internal ambivalence about a decision, yet to be firm in it. We need not hide these tricks up our sleeves.

Also, be sure that you understand the difference between perpetual tugs-of-war and constructive complaints or requests from your child. Be open to negotiating or changing your mind when there is opportunity to be flexible. Diplomacy and adaptability are fundamental life skills for all of us, skills that are gained via modeling and experience, and we would do well to pass them along to our children.

More than anything, it is important to remain calm and cool-headed when facing difficult behavior. The best strategy is to “seek first to understand and then to be understood.” When people are angry, resistant, and anxious, feeling that someone is attempting to hear and understand them can be calming and helpful.

Many children carry with them legitimate anger, fear, sadness, and shame related to predispositions, situations, and experiences largely out of their control. They need someone to love them in spite of ways they reflexively aggress or distance as they negotiate through ambivalent inclinations. At the end of the day, every child wants to be heard, which is just another way of saying understood, and loved, which is just another way of saying known.

There is a child in your life secretly hoping you will hear and love him or her today. Will you?

References:

  1. Selekman, M. (1993). Pathways to change: Brief therapy solutions with difficult adolescents. New York: The Guilford Press.
  2. Hartzell, M., & Siegel, D. (2003). Parenting from the inside out. New York, NY: Tarcher/Penguin.

A man and woman embracing and laughingThe Myers-Briggs Type Indicator (MBTI) is a personality type classification questionnaire based on Carl Jung’s theory of psychological types. For the past several decades, it has been the most frequently referenced resource on the subject of personality.

I have used a short-form version of the MBTI with most people I’ve worked with in the therapy room since 2000, including more than 500 couples. Many of those couples were seeking answers to a common question: “Are our personality types compatible?”

Before we delve into whether the MBTI is a predictor of compatibility, though, it is important to understand what it is designed to measure.

In the early 1900s, Jung, a Swiss psychiatrist, concluded that natural differences in psychological types exist. He believed these differences were present at birth, identifiable at an early age, and did not change much across time. Jung further believed that an individual’s type orientation is determined by the degree to which he or she is, naturally and normally:

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The MBTI was designed to help identify an individual’s natural response orientation on each of these four dichotomies. It also identifies characteristics and traits known to be common for each of the sixteen types that can be derived from different combinations of response orientations on these dichotomies.

The MBTI assigns a letter, highlighted in bold above, for the response orientation at opposite poles of each dichotomy. (N is used for iNtuition because I was used for Introversion.) A four-letter code is then used to identify each of the sixteen possible psychological (personality) types. For example, because I score toward the Introversion, iNtuition, Feeling, and Perceiving poles, the four-letter code that applies to my personality type is INFP.

The more pronounced your response process is toward one pole on a dichotomy, the more likely traits and characteristics associated with that pole will fit for you. However, many people find that some do not fit at all. For this reason, while the MBTI may provide insight into the nature of one’s personality, it cannot be described as unfailingly accurate.

The terms used for the dichotomy opposites on the MBTI have specific meanings that are sometimes misunderstood. For example, extroverts may view introverts as quiet, shy, withdrawn, possibly depressed or antisocial, withholding, self-centered, or uninvolved. Introverts may view extroverts as talkative, sociable, friendly, noisy, needy, intrusive, or either unable or unwilling to listen. Such assumptions are often inaccurate, of course.

Extroverts tend to be more energized when interacting with others, while introverts draw energy from more introspective, reflective processes. Each type has its strengths.

Let’s take a closer look at the other three dichotomies.

Sensing-oriented people naturally process information based on what is literally happening within the context of past experience, while intuition-oriented people naturally process information from a possible meanings plane—from consideration of alternative possibilities for what is literally happening.

Thinking-oriented people have feelings, and feeling-oriented folks can think. It’s just that thinking-oriented people naturally assess what is happening from a logical assessment of cause and effect, expressing their conclusions in an objective manner. Feeling-oriented people naturally add an additional consideration for how others might feel in making decisions and expressing them.

Individuals with a judging orientation naturally plan future events in advance, while perceiving-oriented people naturally respond more as events play out.

Implications for Relationships

The stronger an individual’s natural response orientation toward one pole of a dichotomy, the greater the likelihood he or she will have difficulty experientially comprehending the natural response process of someone who responds from that dichotomy’s opposite pole. This has particular relevance when addressing the issue of relationship compatibility.

Understanding the nature of personality differences, and acceptance of those differences, is key to lasting harmony.

Contemporary models for understanding individual differences in human behavior are built on an assumption of choice—a belief that human beings can alter their response patterns if they want to. Consequently, when a couple is dealing with a difference of opinion in an area where natural differences are at play, each may believe the other could understand his or her perspective if he or she really wanted to, when that may not be so. The assumption of choice in comprehension can lead to debilitating and perhaps relationship-threatening debates over who is right and who is wrong.

MBTI-based information has been instrumental in my work in helping couples and families resolve their differences. This experience has provided a solid base of empirical evidence to support Jung’s belief that differences are natural and normal and not subject to an option to alter. Understanding the nature of personality differences, and acceptance of those differences, is key to lasting harmony.

With regard to MBTI type orientations and their implications for relationships, I have observed the following:

In cases where couples were unable to resolve differences, at least one of the following factors has usually been present:

A Note of Caution

While the characteristics and traits associated with individual differences in MBTI-based types tend to be accurate, the MBTI is broad in nature, addressing response dynamics known to be common among individuals with each type profile. A comprehensive understanding of oneself, separate from others, is far too complex to be captured by a measure with such a design.

United States Supreme Court
United States Supreme Court

In 2008, Teresa Sheehan, a woman with a long history of mental health issues, was shot multiple times by two San Francisco police officers. The incident occurred after a social worker called police to the group home where Sheehan lived. Sheehan was experiencing mental health difficulties, and allegedly threatened group home members. When police arrived and entered the home without a warrant, they claim she threatened them with a knife.

Sheehan sued the city, claiming that her status as a person with mental health issues should have been considered when police evaluated how to deal with her. The Americans With Disabilities Act, a federal law, requires that people with disabilities—including mental health disabilities—not face discrimination. It also mandates that employers and schools give “reasonable accommodations” to those with such disabilities.

The Supreme Court’s opinion has been widely cited as determining that the ADA does not apply to Sheehan’s case. In fact, the Court opted not to rule on the issue, citing the fact that the City changed its arguments halfway through the proceedings. This change means that lower courts were not fully able to address the ADA issue, making it inappropriate for the Supreme Court to do so. Justice Scalia wrote in his opinion, “We were thus deprived of the opportunity to consider, and settle, a controverted question of law that has divided the Circuits, and were invited instead to decide an ADA question that has relevance only if we assume the Ninth Circuit correctly resolved the antecedent, unargued question on which we granted certiorari.” Thus the law on whether the ADA applies in police shootings remains unclear for now.

Oregon Outlaws Gay Conversion Therapy, Joining Two Other States

Conversion therapy, which attempts to change a person’s sexual orientation or gender identity, is increasingly the subject of controversy. It’s also been roundly condemned by most major mental health organizations. Now, Oregon has joined California, New Jersey, and Washington, D.C. in outlawing conversion therapy for minors. While adults can still seek conversion therapy, it’s often minors who are subjected to it, frequently against their will. Many other states are considering similar legislation. [fat_widget_right]

Ted Lieu Introduces First Federal Ban on Gay Conversion Therapy

Congressman Ted Lieu (D-Los Angeles) played a key role in California’s ban on conversion therapy three years ago. Now, as a member of the U.S. House of Representatives, he hopes to replicate these results. Arguing that conversion therapy is a kind of fraud, he introduced the Therapeutic Fraud Prevention Act this week. If the bill passes, it will ban conversion therapy at the federal level.

The Army’s New Plan to Help Soldiers with PTSD

Veterans and active-duty soldiers continue to struggle with posttraumatic stress (PTSD), anxiety, depression, and other effects of war. An overhaul of the military mental health system endeavors to reverse this trend. As part of this overhaul, the Army wants to make mental health care more accessible by putting mental health specialists within walking distance of soldiers’ barracks. The idea here is that soldiers will be more likely to seek care when it’s convenient and accessible.

Texting at the Playground: New Study Shows How Much Time Parents Spend Buried in Their Smartphones

Though a new University of Washington study suggests 44% of parents think smartphones have no place at the playground, the temptation of the phone can be tough to resist. To assess whether smartphones are a playground distraction, researchers observed caregivers at several playgrounds, collecting a total of 33 hours of data. It turns out that many parents spend little time on their phones when watching their children at playgrounds. They found that two-thirds of participants spent less than five minutes on their phones. Forty-one percent didn’t use their phones at all.

Groundbreaking Study on Shifting Attitudes Toward Gays Used Fake Data

Late last year, a study was published in Science claiming that a 20-minute conversation might be sufficient to undermine homophobia. Now, the authors of the paper have retracted it, admitting that they faked their data. The research was so convincing that it fooled even statisticians. It took two graduate students intending to extend the study to uncover the problem. The news comes on the heels of a study in which researchers were only able to duplicate 39% of recently published psychology studies.

Bullied as a Kid, Obese as a Grown-up?

According to a study of more than 7,000 adults, there may be yet another consequence of bullying: obesity. Researchers gathered data about participants’ childhood experiences, including whether they were bullied. By the age of 45, more than 25% of women who were bullied were obese, compared to just 19% of women who weren’t bullied. Men were also more likely to become obese if they had been bullied, and both men and women who were bullied were more likely to have high blood inflammation, a risk factor for heart disease, diabetes, and similar health problems.

Bruce JennerBruce Jenner, former Olympic athlete and reality star, has made recent headlines. After months (or longer) of tabloid and entertainment news speculation, Jenner publicly came out in an April 2015 interview with ABC News‘ Diane Sawyer, identifying as transgender. No doubt the episode sparked public interest and a great deal of conversation. In fact, in the days immediately following the Jenner interview, Answers to Your Questions About Transgender People, Gender Identity, and Gender Expression was the most-viewed link on the American Psychological Association (APA) website. Considering the high number of hits, assumptions could be made that the general public is seeking more information on transgender identities and transitioning.

To better understand what transgender means, it is important to make the distinction between sexual orientation and gender identity, which are frequently and erroneously used interchangeably. Sexual orientation is our romantic, physical, emotional, and relational attraction to another, and includes labels such as gay, lesbian, bisexual, and heterosexual. Gender identity, on the other hand, refers to our internal sense of being male, female, or another gender identity.

Someone who identifies as transgender experiences a lack of conformity between their sense of gender and the societal standards of their assigned birth sex. Cisgender is the term used to describe someone whose sense of gender conforms to the societal standards associated with their assigned birth sex. What does “assigned birth sex” mean? In most cases, a doctor “assigns” our sex based on our visible anatomy appearing to be that of a boy or girl. Without undergoing extensive and expensive genetic, chromosomal, and hormonal testing, most people do not know what their true biological sex is.

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Although Jenner is all over the news, transgender identities are not a new phenomenon. It is probably not a stretch to say that transgender individuals have always existed. Many accounts, such as those documented in the book Transgender Emergence (Lev, 2004), detail transgender individuals throughout historical and modern times and across a diversity of cultures.

If transgender identities have always been around, one could question why transgender individuals are often treated like second-class citizens. Well, in looking at history, before Western colonization, in some cultures, those with transgender identities enjoyed inclusion and reverence within their communities. For example, in Native American culture, individuals identifying as “two-spirit,” who are thought to encompass both male and female qualities, were once well revered within their culture. However, after Western colonization, social value and reverence were stripped from transgender identities.

And if you are still wondering why transgender individuals do not have full respect in society although transgender identities have existed for thousands of years, recognize that other groups, such as women and ethnic minorities, have been around for a long time too, but continue to endure less than equal treatment.

There is no one right way to come into our gender identity. Some transgender individuals comment on always feeling that their gender identity and assigned sex were incongruent. For others, it could be later in life that one recognizes their sense of gender identity. Safety is another reason that forces some individuals to transition later in life.

Jenner is 65 years old, a parent, and until recently was married to a woman. Some might wonder why it took Jenner so long to come out. There are several explanations for this. There is no one right way to come into our gender identity. Some transgender individuals comment on always feeling that their gender identity and assigned sex were incongruent. For others, it could be later in life that one recognizes their sense of gender identity. Safety is another reason that forces some individuals to transition later in life.

In general, the U.S. is more accepting of diverse identities today than at any other time in its history, yet transgender individuals encounter high rates of verbal, psychological, and physical victimization and violence. Now consider the atmosphere and attitude toward transgender individuals 20, 30, or 40 years ago; for many older adults, the threats to their physical and emotional safety were true barriers to transitioning at younger ages. Also, consider the financial costs. Would there have been endorsement deals and commercial shoots if Jenner came out in 1976?

Accessibility to information also impacts coming out. Today, there is greater transgender awareness and there are more transgender individuals in the media. Today’s youth have more access to information regarding gender identity and transitioning than their predecessors. Furthermore, transitioning can be an expensive endeavor that may not have been an affordable option when older transgender individuals were younger. All transgender-identifying individuals do not desire to pursue a physical transition. For those who do, depending on the transgender individual’s desire for transitioning, hormonal therapy, surgeries, and other costly procedures may have prevented them from making any physical transitions until later in life. Finally, in regard to parenting and marital status, gender identity has little to do with someone’s desire to parent or marry, making it very reasonable that someone may transition or come out as transgender after marrying and childrearing.

Jenner’s children were asked how they felt about their father’s transgender identity. Like other families in which a parent transitions, they acknowledged undergoing a transitional process themselves. The family has to adjust to appearance and gender expression changes, adopt new pronouns, and may have considerations regarding marital status. The families of transgender individuals are not immune from experiences of prejudice and discrimination that were previously unknown to them. Family members can be asked invasive questions, feel alienated by those who are not supportive of their family member’s transition, or experience the financial byproduct of discrimination. For example, many states do not include gender identity in housing and employment nondiscrimination policies. So if a parent is fired for being transgender, their child may no longer be able to afford to attend college.

Initial stages of a family’s transition may be challenging and confusing, but later stages in family transition may include acceptance of their loved one’s identity and providing a supportive and safe environment that is respectful to all gender identities. A safe environment allows space to grieve perceived loss and welcome mental wellness and gender affirmation. Fortunately, there are a growing number of resources to help families who have loved ones who are transitioning and to support the family’s transition.

Reference:

Lev, A. I. (2004). Transgender Emergence: Therapeutic Guidelines for Working with Gender-Variant People and Their Families. Binghamton, NY: Haworth Press.

medicationsTwenty percent of Americans take at least one psychiatric drug. According to Peter C. Gøtzsche, professor at the Nordic Cochrane Center in Denmark, these drugs may be more harmful than beneficial. BMJ published Gøtzsche’s claims that it’s possible to eliminate psychiatric drugs without serious negative consequences, but not all experts agree. Responding to Gøtzsche’s claims, Allan Young, a professor of mood issues at King’s College London, argued that psychiatric medications offer benefits similar to medications for other conditions.

The Argument Against Psychiatric Drugs

Gøtzsche, the author of Deadly Medicines and Organised Crime: How Big Pharma Has Corrupted Healthcare, has long argued that psychiatric medicines are potentially dangerous. Unlike some others in the anti-psychiatry crowd, his arguments aren’t rooted in the belief that mental health issues aren’t real. Instead, he points to evidence suggesting that psychiatric drugs kill more than half a million people over the age of 65 each year. Gøtzsche also believes that deaths related to psychiatric medications are under-reported. He estimates that there are at least 15 times more suicides than reported by the Food and Drug Administration among those taking antidepressants. He says the FDA includes only suicides that occur 24 hours after stopping the drug in its data, creating the illusion that antidepressants are safer than they are.

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Even if psychiatric drugs are more dangerous than previously thought, don’t they help people? Gøtzsche says no. Poorly designed experiments, he says, make psychiatric medications appear more effective than they are. Most randomized controlled trials include people already taking another psychiatric drug, potentially confusing the results. A number of drugs, including Prozac and other popular antidepressants, don’t do much better than a placebo, especially after a couple of days.

Gøtzsche believes it would be possible to completely end the use of psychiatric drugs without any serious negative effects, though he cautions that many people may need help to manage withdrawal from their medications.

How Psychiatric Drugs Can Be Beneficial

In his response to Gøtzsche, Young argues that psychiatric medications can save lives. He points to his co-author, psychiatric patient John Crace, who says that antidepressants have kept him happy for years. According to Young, more than a fifth of all disabilities result from mental health issues, so psychiatric medications can have significant benefits for public health, the economy, and families.

Young acknowledges that many studies are imperfect, but says it’s impossible to discount the lived experiences of millions of people who have been helped by psychiatric drugs.

References:

  1. Doctors debate long-term use of psychiatric drugs. (2015, May 14). Retrieved from https://www.onmedica.com/newsarticle.aspx?id=a6d8253b-d243-4c74-8ddc-f59456cc46b4
  2. Donnelly, L. (2015, May 12). Throw away the antidepressants, urges leading scientist. Retrieved from http://www.telegraph.co.uk/news/nhs/11600868/Throw-away-the-antidepressants-urges-leading-scientist.html
  3. Friedman, R. A. (2013, August 19). A dry pipeline for psychiatric drugs. Retrieved from http://www.nytimes.com/2013/08/20/health/a-dry-pipeline-for-psychiatric-drugs.html

GoodTherapy | What Makes Some People More Resilient to Trauma Than Others?Why do some people suffer after a traumatic event while others do not?

This is an important question in the world of trauma psychology, one that is being extensively researched. We know, both anecdotally and empirically, that, given exposure to a critical incident, some people will be negatively affected by it, while others will move on and be essentially fine. For example, several young people of similar age and background can be deployed on the ground in the same unit in Iraq or Afghanistan, be exposed to roughly similar experiences, and some will return stateside, move ahead with happy and fulfilling lives and be fine, while others will experience some level of disruption associated with their service.

Why is that?

The answer to this appears to be largely the same as the answer to so many other quandaries in the field of psychology: the unique combination of genetic constitution and set of life experiences for any given individual. It’s the old “nature vs. nurture” question, and, as is typically the case, the answer seems to be “yes, both influence outcome significantly.”

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As with so many things, it seems clear that we inherit a genetic constitution that may leave us more or less at risk of developing lasting problems after trauma exposure. Recent studies indicate that, with similar levels of trauma exposure, individuals who have close family members who have struggled with trauma-related problems are more likely than those without such a connection to struggle after trauma. This link seems fairly strong.

However, one generally does not experience trauma-related problems without … trauma. Life experiences do not occur in a vacuum, and trauma-related concerns are certainly no exception. Sometimes when we talk about trauma, we talk about a “dose-response relationship,” which simply means that a person’s response to trauma is directly related to the amount of exposure he or she has. Because of the differing “doses,” a person who experiences a single-incident trauma of brief duration (a car accident, for example) is at less risk of lasting problems than a person who experiences chronic exposure to ongoing traumatizing events for a lengthy period of time (such as child abuse or neglect).

Life experiences do not occur in a vacuum, and trauma-related concerns are certainly no exception.

This is not to say that people who experience a single car accident do not develop significant problems; they can and, unfortunately, sometimes do. However, the likelihood of ongoing struggles increases as the amount and severity of exposure to trauma increases. So, a person’s history of trauma and learned coping skills combines with his or her genetic constitution to create that person’s level of risk and resilience.

Sometimes when we talk about trauma-related struggles, we talk about trying to find ways that we might “inoculate” people against developing serious negative outcomes after a traumatic event. Of course, there is no shot or medicine that will achieve this; what we mean when we say this is that we hope to create a set of life experiences that will reduce a person’s vulnerability to troubles by increasing his or her resilience level. Essentially, we want to start to establish—prior to trauma exposures—habits and ways of being and relating to the world that seem to be associated with better outcomes after trauma exposures. For example, habits of thought are important in structuring how we perceive the world. A tendency to blame extensively or to personalize others’ behaviors may reduce resilience, so, with an eye toward increasing resilience, we may try to shift habits of thought in a different direction.

Of course, unlike “inoculation” in the true sense of the world, none of these will provide any real immunity. At present, there is no such thing—bad things happen to good people unexpectedly, and sometimes, in spite of everything, that person will encounter struggles associated with that. But we know that some habits can and do increase the chances that, upon exposure, the individual will be able to incorporate the experience and continue living life without major disruption.

Our knowledge about this grows every day, and we continue to work toward a more complete understanding of how to assist survivors of trauma. Both before and after traumatic incidents, there are interventions that we have identified that we know can meaningfully reduce suffering; this being so, it seems worth the effort to continue pursuing them as best we can, in spite of the imperfect state of our knowledge.

Sleeping FamilyIs it OK to allow a child to sleep with his or her parents? This is a hot-button and controversial topic. Some believe there is nothing wrong with parents sharing a bed with their child as long as the parents set aside time for their own intimacy. Others believe that parents who share a bed with their child are setting themselves and the child up for future frustration and failure when it comes time to transition the child to his or her own bed. When the child knows that the parents want him or her to transition but can’t make it happen, he or she may experience guilt and believe he or she is disappointing the parents. Even parents who have difficulty transitioning a child into his or her own bed sometimes have separation issues.

Some people see the terms “co-sleeping” and “bed sharing” as synonymous. They’re not. Co-sleeping is the act of a child sleeping in the same room as the parents, perhaps in a sleeper that attaches to the bed, while bed sharing is sleeping on the same surface.

In many cultures, children have shared a bed with their parents going back centuries. However, co-sleeping and bed sharing have a negative rap in the Unites States.

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As with most things, there are pros and cons. For nursing mothers, bed sharing is often easier and can be done safely. Often, though, there is concern around bed sharing with infants due to the possibility of suffocation.

Some parents struggle with the idea of having an infant sleep apart from them in a separate bed and room. Some believe bed sharing provides the best opportunity for secure attachment. Others disagree.

For parents, the decision to co-sleep or bed-share with a child is a personal one.

There is concern among some that bed sharing does not provide an opportunity for infants to learn how to self-soothe, that it encourages over-reliance on parents when the infant is upset. Another concern is that infants may not learn to fall asleep on their own.

For parents, the decision to co-sleep or bed-share with a child is a personal one. Parents must decide what works best for their family’s needs and structure. Having said that, parents should not have a child sleep with them in order to get their own emotional needs met, or as a solution to an infant’s inability to go to sleep.

Transitioning the Child to His or Her Own Bed

Close connection between parents and their child is crucial to the child’s healthy emotional development. Such a connection helps to facilitate the transition from the family bed to the child’s own. Some suggestions for parents to transition their child back to his or her bed while staying close emotionally include:

When parents help their child feel safe in his or her own bed, at his or her pace, while listening to any feelings expressed along the way, they will typically see the child shed any lingering concerns and successfully transition.

blurred image of spinning circus rideSometimes, anxiety feels a lot like riding too fast on a spinning carousel at an amusement park. It takes hold of a particular thought or fear and spins on it nonstop. It’s frustrating and exhausting, and it can feel out of our control.

The temptation in that situation is to do one of two things to feel better: (1) distract ourselves from the thoughts or (2) indulge them. Distraction maneuvers include watching television, calling a friend, taking a pill, or checking Facebook. Indulging behaviors might look like making endless lists and notes about anxious thoughts, researching whatever the issue is for hours, or calling people to talk through the same problems over and over.

The tough truth is that we can’t run from what’s bothering us, and we can’t necessarily “solve” it, either. If our minds are telling us to be very worried about a work meeting tomorrow, the answer is not to spend hours thinking about that meeting. This gives us the illusion of control—“If I can imagine every possible issue that could arise during the meeting, I’ll be able to handle whatever happens”—while keeping us tired out and high-strung. Trying to solve an irrational fear through rational thought is, as it sounds, impossible.

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Instead, we have to do something that feels pretty counterintuitive: To keep anxiety at bay, we should sit with it. This means choosing actions that address the anxiety itself rather than dealing with the subject we think we’re anxious about. “Sitting with the feelings” sounds a lot harder; who wants to lean into feeling scared and worried? But we’ve already tried distraction and indulgence, so we know those are temporary fixes without any long-term gain. Once the fear about the work meeting is soothed, another problem will be waiting to frighten us, and we’ll have to start working feverishly again to calm that thought.

There are many ways to attack anxiety more productively. The tools below are described in their simplest form. If you see one that appeals to you, a professional, a book, or even a website could help you flesh them out and practice them. Other ideas can be tried here and now, on your own.

To keep anxiety at bay, we should sit with it. This means choosing actions that address the anxiety itself rather than dealing with the subject we think we’re anxious about.

1. Words

When your mind is spinning, there’s a story that you’ve created. First, try to figure out the words the anxiety is using to scare you. Perhaps they’re “don’t bother asking that girl on a date, she’ll never say yes.” Or “if you drive on the freeway, you will be in danger.” Write down this message in the clearest words possible, then see if there’s any deeper message underneath it. If you’re afraid to ask someone out, could there be a fear underneath that such as “no one ever likes me”? Does anxiety about driving also include the larger worry that “the world is unsafe”? When we uncover the core message, we can sometimes see that it’s exaggerated and devastating. It’s a huge generalization.

Next, try to find a replacement thought that is more balanced, more realistic. It doesn’t have to be something magical like “everyone always loves me!” or “no one ever gets into car accidents!” These will be difficult to focus on because they’re hard to trust. A more reasoned statement might be “I can handle rejection” or “some women have wanted to date me in the past.” When you come up with a thought that feels more positive and easy to believe in, consciously stop yourself whenever the anxious thought arises, push it away, and replace it with the new thought. Over and over, practice the new words to create a new thought process.

2. Images

If you’re drawn more to pictures than to words, visualizations are a wonderful and powerful way to calm your spinning mind. Try to discern how your anxiety looks to you. Maybe it’s a field of pulsating red, or a spiky ball. Close your eyes and take a deep breath. Imagine holding your anxiety in your hands. Feel its texture, its weight, its temperature. Then imagine chilling this anxiety with a breeze of fresh, cool air. See it shrinking in your hand. It becomes as small as a medicine ball, then a kickball, then a handball. Soon, it’s as tiny as a ball bearing. Continue to hold and shrink the anxiety whenever it occurs.

Another way to calm anxiety with images is through creative visualization. There are many such resources available online as audio, video, or written scripts. These stories walk you through a calming experience, simultaneously helping your body relax and moving your mind away from the distressing thoughts and into a more peaceful, controlled state. Practicing these mini-meditations trains your mind to focus less on outside subjects, which we have little control over, and more on our inner selves, which we have complete control over (although this often doesn’t feel true). One lovely visualization can be found here.

3. Physical Feelings

Finally, relaxation and anxiety management can be found by changing how your body is functioning. Sometimes, anxiety starts in the body instead of as a thought. The sympathetic nervous system gets triggered, we feel a thumping heartbeat, quicker breathing, and twitchy muscles, and then the mind looks for something to blame it on. What am I so upset about? Suddenly we’re searching for a cause and choosing targets that may or may not be relevant or significant. It must be my relationship. And then we’re off on the cycle of repetitive thoughts that feel unmanageable.

Anxious thoughts and an anxious response in our bodies are almost always linked, and they need to be dealt with on both levels. First, taking deep breaths and slowing our body movements can help bring some oxygen and blood flow back to the brain, making it easier to think logically. Experts suggest breathing in to a count of four and out to a count of five, both through the nose. The slower out-breath mimics breathing patterns while we sleep, and can help trick the brain into thinking we’re relaxed before we actually are.

These techniques represent just the beginning of ways to address anxiety directly, without trying to run from it. The good news is, once you find a way (or two or three) of gaining control of your spinning thoughts, there can be a powerful sense of mastery and relief. The carousel does not have to rule your mind and body. Rather than pretending it doesn’t exist, you can slow the ride, dismount from the horse, and get a good night’s sleep.

Cropped shot of a couple in a coffee shop, focus on hands and cups of coffee on tableA 28-year-old woman sits across the room from me. Recently diagnosed with bipolar, she is slowly but surely accepting her diagnosis. With a perplexed look, she asks, “But what, exactly, am I supposed to tell guys when we go out? And when should I tell them? And do I even need to tell them at all?”

If you have a chronic illness and are in the dating world, these questions may sound familiar. Whether you have an “invisible” condition (think arthritis, HIV, diabetes) or a chronic mental health diagnosis (think bipolar, obsessive compulsion, major depression), it can be difficult to know when or how to disclose sensitive information about yourself to romantic prospects.

The realm of online dating has brought about fast and efficient ways to meet new people. Online dating can take away some anxiety and stress when meeting others, and it can open up a world of possibility. Online profiles generally allow users to disclose as much or as little as they want. Similarly, users can often make checklists of must-haves and deal-breakers. So you may put it out there that you don’t want to date someone who smokes, but do you want to tell the dating world about your battle with fibromyalgia?

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People who have been rejected by friends and family because of their diagnosis may feel even more anxiety when it comes to sharing it with a date or potential date. It’s a quandary, no doubt! So how do you decide when to tell a prospect about your diagnosis?

Perhaps these guidelines can help you navigate the world of dating with a chronic illness:

  1. Inform yourself about your condition and find acceptance. First and foremost, educate yourself about your diagnosis and empower yourself in your treatment. Once you have accepted your condition (at least on most days!), your confidence and self-love will shine through to others. If you need help with this step, find a therapist who can help you move through the stages of grief when it comes to chronic illness.
  2. Know what you want and what you need in a partner. You are not looking for a caregiver here. You want a partner who will physically help you when needed, one who will be supportive and understanding, and one who is empathetic to your condition. Don’t settle for someone who can “put up with” you. Look for someone who will accept and love you for who you are. Remember the 80/20 rule of relationships: you get 80% of what you really want. Maybe your new date doesn’t like hiking or going to the movies, but the 80% of things you do have in common is really great.
  3. Share your information thoughtfully. In other words, don’t dump out your purse or pockets on your first date. Think about the important facts of your diagnosis and be able to share them in a succinct way. If your new date has questions, answer them accordingly. If not, that’s OK, too—some people need time to process or may not, in fact, have any questions. Allow the other person time to digest the information, and be open to answering questions if he or she wants to talk more about it later.

In my experience, the vast majority of people who follow these guidelines when disclosing their chronic illness are welcomed with open arms. It’s a rare occasion when a new person is turned off by this kind of disclosure, but if it happens, then he or she simply isn’t the right person for you.

Think you want to share your chronic illness with others on dating websites? There are dating sites, such as PositiveSingles.com, NoLongerLonely.com, and Prescription4Love.com, that cater to people with chronic medical and mental health conditions. The idea behind these sites is that you will be in good company and can more openly talk about your experiences with others who understand.

AdobeStock 489280039“I’ve been fine for years. Now I have nightmares every night and can barely function at work. What’s going on?”

“I thought I was over it. I even went to therapy as a kid! Why is it all coming back again?”

“I feel like I’m falling apart, but the abuse was years ago. Does this mean I’m getting worse?”

One of the first things survivors of sexual abuse ask me when they come into my therapy office is, “Why now? Why are these feelings and memories coming back now?” Often, the underlying question is, “I was fine before, but now I’m struggling. Am I going crazy?”

If you’re having this experience—being suddenly overwhelmed by a past trauma—let me reassure you the same way I reassure the people I work with in my office. No, you’re not going crazy! As difficult as it may be to believe, a sudden reemergence of old feelings is often a sign that you’re ready to heal on a deeper level.

Recovery from Trauma Happens in Stages

Healing from a trauma such as sexual assault or abuse happens in stages. In the first few days after an assault, we tend to shut down because the emotions feel so overwhelming that we can deal with them only in small doses. For ongoing sexual abuse or molestation, this shutdown state may last for the entire time the abuse occurs. Eventually, in the days, weeks, and months after an assault occurred or the abuse ends, we usually find ways to “put the past behind us,” to regulate our emotions and to build a stable life. We may still experience some triggers or have some nightmares, and we don’t typically forget about what happened, but over the years we start to feel “normal.”

Then, sometimes, all those feelings come roaring back. What’s going on?

When the fear, the anger, the sadness, the helplessness, the heartache—all the emotions that were perhaps too painful, too complicated, or just “too” in the immediate aftermath of the trauma—suddenly reemerge, your new task is to sit with those emotions and let them have their say.

In my experience as a therapist, what’s happening is that some deep, inner part of you finally feels safe and stable enough to address the leftover emotional fallout that’s been patiently waiting for years. Your job right after the trauma and in the years since the trauma occurred has been to find stability. You developed successful coping mechanisms that let you function in the world without falling apart. Those are invaluable skills that are going to get you through the next part of your recovery.

You Are Strong Enough to Feel Vulnerable Now

When the fear, the anger, the sadness, the helplessness, the heartache—all the emotions that were perhaps too painful, too complicated, or just “too” in the immediate aftermath of the trauma—suddenly reemerge, your new task is to sit with those emotions and let them have their say. They’ve been patiently waiting for you to develop the strength to cope with them successfully, and if they’ve shown up for you now, after all this time, they think you’re finally ready. You are strong enough to feel vulnerable for a while.

So what do you do? How do you cope without getting overwhelmed?

If you need additional support or resources, a therapist specializing in trauma recovery can help. If you need immediate help regarding sexual assault or abuse and you’re in the United States, you can call the 24-hour National Sexual Assault Hotline at 1-800-656-HOPE (4673) for support, resources, and referrals.

Related Reading: 

Important Notice

GoodTherapy is not intended to be a substitute for professional advice, diagnosis, medical treatment, or therapy. Always seek the advice of your physician or qualified mental health provider with any questions you may have regarding any mental health symptom or medical condition. Never disregard professional psychological or medical advice nor delay in seeking professional advice or treatment because of something you have read on GoodTherapy.