Recently, when I put my 6-year-old son to bed, he reminded me of something I can sometimes lose sight of, particularly when I’m anxious or worried. As I kissed him on the forehead, he said, “No fair.”

“What’s no fair?” I asked.

“You kiss me more than I kiss you,” he said.

“Well, and isn’t that good? When I give you a kiss, doesn’t that raise your love meter?”

My son rolled his eyes in the greenish glow of his Teenage Mutant Ninja Turtles night-light.

“Your love meter gets higher from giving love,” he said.

This idea—that love is something we get more of by giving it away—is a radical one, though it’s nothing new. Folks as varied as St. Francis of Assisi, Mahatma Gandhi, and Martin Luther King Jr. have encouraged people to cultivate true wealth and freedom through conscious unconditional loving, for their own and the world’s sake.

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For many of us, though, living from this principle is easier said than done. The experience of feeling vulnerable and threatened triggers our fight-or-flight response, and it becomes hard to remain aware of ourselves and of our options as we relate to others. Usually, we default to our habitual defensive positions—blame, avoidance, projection, rationalization, just to name a few. And yet, being able to tap into our capacity to give love—even when we’re scared—may be an urgent necessity if we want to preserve our sense of agency and balance in the aftermath of one of the most anxiety-provoking transfers of power in American history.

For one thing, our agendas and ulterior motives have a way of creeping into our words and actions, influencing how the love we try to give those around us is experienced. Sometimes, it’s not attuned to what the recipient needs, like the porridge in Goldilocks and the Three Bears. It’s too hot or too cold, too much or too little. Sometimes, the love we offer reaches its recipient contaminated by our concerns and preoccupations, and we feel hurt when it’s shrugged off, minimized, or ignored.

Defenses against receiving love, or giving it, aren’t necessarily good or bad. We learn to defend ourselves against taking in the very things we deeply want for important reasons, including our own psychic survival.

When the tables are turned and we’re on the receiving end, we get to experience firsthand how hard it is to take love in: whether it’s in the form of a goodnight kiss, a hug from our partner, or a stranger’s compliment, opening our hearts requires something from us we’re not always willing to give: trust, surrender, vulnerability, emotional availability, or even self-love. If you feel unworthy of it yourself, how can you accept it from another?

Defenses against receiving love, or giving it, aren’t necessarily good or bad. We learn to defend ourselves against taking in the very things we deeply want for important reasons, including our own psychic survival. Even if we can’t remember having ever truly trusted another human being to love us selflessly, for exactly who we are, we’ve all counted on someone’s appreciation or approval only to experience it withheld or withdrawn. We’ve all opened to another’s concern and felt it suddenly morph into something suspect, a projection or judgment, a form of control. As sensitive beings imprinted with these types of experiences, it’s not unusual to grow up wary about receiving the emotional gifts others offer us, lest they turn out to be Trojan horses or a version of Narcissus using us for a mirror.

As therapists, one of our jobs is helping people understand what gets in the way of taking in the love that’s already in their lives, even when circumstances are difficult. The more people can access and metabolize the love they’ve been disregarding or ignoring, the more it can nourish them and help them love others. In accelerated experiential dynamic psychotherapy (AEDP), the way in which people take in others’ emotional offerings—referred to as our “receptive affective capacity”—becomes rich ground within the therapeutic relationship for exploring, understanding, and expanding this ability well beyond the therapy session.

The relationship between giving and receiving love can seem like a riddle worthy of a sphinx—a human conundrum we begin grappling with early in our lives, as my 6-year-old son reminded me with his take on the true metrics of love. However you frame it, being able to receive love from another seems to be inextricably linked with our own desire and ability to give it. Finding ways to expand our own and others’ capacity to take in and produce love locally, rather than seeking it elsewhere, has the potential to create a more stable and sustainable psychic economy.

Stalking. The word alone inspires fear and anxiety in many people. For those of us who have experienced it, it may conjure painful images we never stop seeing, no matter how hard we try.

Although the term is used far too casually in some parts of our society, stalking, as defined, is serious stuff. A crime in many jurisdictions, it generally involves unwanted or obsessive attention, following, harassing, or monitoring behavior that might cause a reasonable person to experience fear.

One out of every six women is stalked in her lifetime, according to data compiled by the Centers for Disease Control and Prevention. Men are stalked too, of course, but much less frequently (one in 19).

I’ve been stalked three times.

The first time it happened, I was around 21 years old. It was 11 at night, I was walking home from a friend’s house, and I noticed someone was following me in a car. This was in the suburbs, and there was no one else out on the street. At first I thought maybe it was my imagination, so I turned up a one-way street going the wrong direction for the driver, expecting him to continue on his way and not follow me. He followed me anyway, and that’s when I knew I was in trouble. Then he got out of his car and exposed himself.

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I ran to the nearest house with lights on and began ringing the doorbell and knocking. The man drove away. Then I realized no one was home in the house I had chosen as my refuge—or maybe they just didn’t want to answer. I hid, cowering on the stoop, and looked around carefully. Finally, when I thought it was safe, I fled.

When I was in my early 30s I was stalked again. Although I wasn’t threatened physically, I was tormented for several months and was left terrified for a long time.

I lived in an apartment house. My apartment was opposite the service stairs, and sometimes I thought I saw someone hiding in the stairwell near the door to my apartment, watching. This happened repeatedly, but I never actually saw anyone’s face—just a disappearing shadow. I almost didn’t believe there was anyone there; the first time, I wondered if it was my imagination. I told my husband, but he never saw anybody and thought it was nothing to worry about.

Then a man got hold of my phone number somehow and called me repeatedly for months. This was the same guy who hung out in the stairwell, I figured. For me, this was confirmation he was real; this was not my imagination. I almost wasn’t sure if that made things better or worse. The only thing I was sure about was I was petrified.

I was often home alone with my new baby at that time. The man phoned repeatedly and seemed to know my every move. I was afraid to leave the house and afraid to stay home, too. I was scared to answer the phone. I told my husband again, but nothing ever happened when he was home. I felt like he didn’t take my fears seriously, and I was so scared. He suggested maybe it was just a lot of wrong numbers. Was I exaggerating?

I wasn’t sleeping much because I had a new baby, and on top of that, now I was too scared to sleep. Every time I sat down to relax, the phone rang, and there was nothing I could do but endure—I could never let my guard down. I started having nightmares.

Sometimes a man with a disguised voice phoned to say nasty things. Other times, I just heard someone breathing. It went on and on, and finally my husband started to worry, too. Once, he intercepted one of the nasty calls and told the guy off, but the calls went on anyway. This was in the time before phone numbers came up when you were called, before you could block specific numbers. I was being tortured, and it felt like it would last forever with no way out. I began feeling helpless and weak. I got very depressed. How could I protect my baby if I couldn’t defend myself?

I contacted the police. The phone company put a tap on my phone, but the person never stayed on long enough to make an ID. A police officer advised me to buy a whistle, and when the person phoned the officer told me to answer the call with a piercing blast of the whistle. That was okay with me. I wanted to blow this guy’s eardrums out! I wanted to cause him as much pain as he was causing me. I wanted revenge. But most of all, I just wanted him to leave me and my baby alone.

Even if you’ve never been physically hurt, the emotional disturbance of knowing someone is out there watching, listening to, or otherwise intending to scare or intimidate you is dreadful, especially if you think you’re trapped and can’t do anything.

The whistle worked. He stopped calling. I wondered who he was, of course, and eventually I found out the person stalking me was my neighbor, somebody I used to smile at and say, “Have a nice day!” to when we bumped into each other in the elevator. He lived two doors away from me.

That all ended a long time ago, but I still always check to make sure that the door to the service stairwell in front of my apartment is securely closed.

Just recently, someone stalked me on the message app on my phone. I’ve blocked that person—one benefit of technology, though there are downsides, too, that allow for cyberstalking.

Some of the people I see in therapy have also been stalked and badly frightened, like I was. One young woman got extra locks put on her door after she broke up with her boyfriend. He called her repeatedly, as often as 20 times a day, and lurked on the street near where she lived. She gave his contact information to her sister and to a friend and instructed them to go to the police if something happened to her—and made sure her ex knew it.

Even if you’ve never been physically hurt, the emotional disturbance of knowing someone is out there watching, listening to, or otherwise intending to scare or intimidate you is dreadful, especially if you think you’re trapped and can’t do anything. Except for a situation like the first one, where I believed I was in immediate physical danger, authorities advise people not to try stopping stalking behavior by themselves, as that could provoke the person to get more aggressive and violent.

They have a point. I’m scared just thinking about the idea. But while I hope this article doesn’t provoke anybody, I won’t be scared into silence. People who stalk tend to try to bully their targets into silence so they can continue their harmful and potentially criminal actions.

What to Do If You Are Stalked

If you believe you are being stalked, the U.S. Department of Justice advises you to trust your instincts and take the behavior seriously.

• Your first duty is to protect yourself. If you’re in immediate danger, call the police. Do what you need to do to find safety while you await help: run away, make a lot of noise, or otherwise try to let others know what is going on.
• Keep a record of what is happening and when, especially if the situation is ongoing. Save any evidence you have—emails, messages, physical items.
• If you feel comfortable doing so, connect with an advocacy organization that can support you and walk you through your options. One such outlet is the National Domestic Violence Hotline: 1-800-799-SAFE.
• Experiencing stalking can be quite traumatic, and it can be particularly helpful to seek the support of a mental health professional who works with trauma and domestic violence cases. Some of us know what you’re going through, at least to some extent. Regardless, expect us to do everything we can to help you get what you need so you can feel safe again and heal.

References:

1. National intimate partner and sexual violence survey: 2010 summary report. (2010). Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/violenceprevention/pdf/nisvs_executive_summary-a.pdf
2. Stalking. (2016, January 6). The United States Department of Justice. Retrieved from https://www.justice.gov/ovw/stalking

Narcissism is difficult to diagnose and treat. As with all personality issues, the narcissistic traits a person possesses exist on a continuum. Not all people with narcissism are the same, and treatment approaches vary from individual to individual. This article is written as a basic guide for treating a person who either self-identifies as narcissistic, or one you identify as having narcissism.

Please note the steps below may need to be repeated over and over again, and not necessarily in order.

Step 1: Understand Narcissism

The therapist must be well versed on what it means to be in a narcissistic relationship. It is one thing to read about narcissism, another altogether to be in a close relationship with someone with narcissistic qualities. Many therapists have no idea how intoxicating, exciting, and heart-wrenching life with a narcissistic person can be.

Understand that the three main traits of narcissism are sense of entitlement, lack of insight, and lack of empathy.

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Step 2: Build the Therapeutic Alliance

The therapist must require two things from the therapeutic relationship with a person who has narcissistic tendencies: respect and collaboration. Respect for and collaboration with others is challenging—some might say impossible—for people with narcissism. They will be learning how to practice these interpersonal skills in real time, in vivo, in their relationship with the therapist.

Step 3: Identify the Defenses

The narcissistic person’s defenses come in the form of personality modes or personas (think multiple personalities, but different). The therapist must endeavor to help the person identify some of the protective personality modes they use throughout life. Here are some common examples:

• The critic
• The judge
• The detached persona
• The addict
• The womanizer
• The entitled one
• The victim
• The abuser
• The manipulator
• The rage-aholic
• The superior one
• The bored one

Note: This list is not exhaustive. Therapists should work collaboratively with each person to identify their unique defenses.

All of the above-listed personas are protective personalities that people with narcissism use for emotional protection. The two feelings people with narcissism tend to avoid at all costs are neediness and vulnerability.

Step 4: Identify the Underlying Triggers

The underlying schemas are what cause the need for the protective personas. Think of schemas as triggers or buttons that are pushed when someone causes what is known as a “narcissistic wound.” Here are some common triggers experienced by people identified with narcissism:

• Feelings of emotional abandonment
• Feelings of inner defectiveness
• Feelings of lack of control or security
• Sense of emotional deprivation
• Fear of ridicule or shame

Through both role modeling and psychoeducation, you can teach a person with narcissism about the need for re-parenting the early attachment wounds they have experienced.

It is difficult to identify these underlying triggers because you are working with someone who may have low insight and who may be emotionally “split off” or “blocked” from feeling these vulnerable and devastating emotions. You will likely encounter a protective mode before you will identify the underlying “root” of the problem. Understand that the primary emotional experience the person with narcissism is avoiding is a sense of shame. Rather than experience this sense of shame, the person “flips” into a protective mode.

It is important to help the person with narcissism to manage these underlying feelings of shame by teaching self-compassion and offering healthy self-soothing strategies. Also, as you remain in the relationship with the person, being present with them as they dare to “go there,” they will hopefully learn how to experience and process through relational “demons.”

Step 5: Develop an Inner Healthy Adult/Parent

The job of therapy is to help the person with narcissism learn to re-parent their inner hurt child. The inner child is responding to early attachment trauma or some other type of lack of emotional attunement as a child. Without going into a complete analysis of the causes of narcissism, suffice it to say a developmental component exists.

Developmentally, as a child, the person with narcissism was not properly emotionally regulated in the inter-relationship with the parent(s). This may have caused the child to develop “split off” protective personas as defenses to protect their inner sense of shame.

Teaching the person with narcissism to re-parent their inner hurt child, through the process of imagery, is effective and powerful for initiating healthy change in the person’s inner world.

Step 6: Heal the Inner Child

Even before a person with narcissism learns to re-parent themselves, you, as the therapist, can begin the process by trying to meet their inner hurt child and begin bonding with them. You can be a healthy role model, offering a “corrective emotional experience” for the person. Perhaps you are the only person who has ever been able to reach their inner child in a way that represents safety.

Through both role modeling and psychoeducation, you can teach a person with narcissism about the need for re-parenting the early attachment wounds they have experienced. They may deny they have any such hurts, but explain to them that their behavior “tells on them.” Do not argue with the person; rather, simply state and instruct what is happening.

Step 7: Develop a Recovery Plan

Not only is it essential to heal the inner world of the person with narcissism, it is also important to identify all of the person’s “bottom-line behaviors” and begin a “program of recovery.” In essence, treat the narcissistic symptoms as part of an addiction of sorts that needs to be put in remission.

Here is a list of some possible items to go on the abstinent (“no-fly zone”) list of the person with narcissism:

• Entitlement
• Blame
• Womanizing
• Substance abuse
• Yelling
• Silent treatments
• Dramatic exits
• Passive-aggressive behaviors
• Manipulation
• Defensiveness

Help the person identify their own “go-to” strategies for self-protection.

Conclusion

As you can see, helping a person with narcissism to heal is a challenging endeavor. While you are working within this relationship, make sure you take care of yourself. I will end by offering these final words of advice for self-care:

• Require and model respect.
• Consult often; debrief after each session.
• Exercise and take care of your physical health.
• Do not personalize the behaviors of people with narcissism.
• If you feel defensive, back off, take a deep breath, change something.
• Do not have a power struggle with the person you’re trying to help.

Remember: While it takes hard work to help a person with narcissistic qualities, there is little to be gained from working harder than they do.

People who are unhappy in their marriages may turn to mental health professionals for help, unaware therapy could in fact make things worse. I’m not talking about bad couples therapy, although therapists who lack training in effective couples therapy certainly can do more harm than good. What I’m referring to is bad individual therapy when the focus of treatment is an unhappy relationship.

There are some good reasons people in an unhappy relationship might seek individual therapy. Sometimes a partner may be unwilling to come to couples therapy, leaving individual therapy as the best available option. Some people may feel too frightened or unsafe to speak openly in front of a partner. By beginning with individual therapy, they may develop more self-confidence and feel better prepared for couples therapy. And for some people who are uncertain about whether to continue working on their relationship, individual therapy can provide a safe, private place to talk through their feelings and concerns.

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However, while some therapists help unhappy partners gain a new perspective that can help both themselves and their relationship, others—especially therapists with no training in couples or family therapy—may further undermine shaky marriages. Many unhappy partners are influenced, either inadvertently or purposely, toward ending a marriage that could be improved with effective couples therapy.

How do you know if your therapist may be harming your marriage? Here are five warning signs:

1. Your therapist allows you to focus almost exclusively on your partner’s flaws, with little attempt to help you understand your role in your unhappy relationship. Regardless of your partner’s shortcomings, every relationship is the result of a pattern created by two people reacting to one another. When the focus of therapy is only on what your partner does, you may feel increasingly hopeless about the relationship and powerless to change it. If you do decide to end your marriage, you will also have lost an important opportunity to learn from this experience and avoid repeating ineffective patterns in the future.
2. Your therapist labels, diagnoses, or criticizes your partner without ever meeting them. Any well-trained couples therapist knows each partner has a unique perspective, and a full understanding of a relationship requires knowledge of both partners’ experiences and perspectives. Even objectively indefensible behavior such as name-calling, shaming, and threatening can usually be addressed much more effectively by understanding and addressing the underlying feelings and dynamics than by labeling the person who has behaved this way.
3. Your therapist does not help you understand your partner’s “bad” behavior in context. There is a world of difference between a partner who purposely uses name-calling, shaming, and threatening to manipulate or control, and a partner who erupts in anger and then feels ashamed or remorseful for losing control. Sometimes the partner on the receiving end may have a difficult time distinguishing between these two very different patterns—another reason therapists should avoid judging or labeling people, especially those they haven’t met.
4. Your therapist clearly prioritizes your individual needs over the marriage and family. While no one should tolerate a relationship in which their own needs are ignored or dismissed, neither should they expect to have a healthy marriage and family if they don’t also attend to the needs of others. An individual therapist who focuses only on the feelings and needs of the person in the room may implicitly discourage the kind of compromise and interdependence that characterize healthy families.
5. Your therapist encourages you to end your relationship for any reason, other than to protect your physical safety, without an adequate trial of couples therapy. Many serious relationship problems can be addressed with the help of a well-trained couples therapist. Therapists who do not recognize this possibility do a disservice to couples and families who may never get the help available to them. It can even be helpful for you and your partner to discuss such “deal-breakers” as a serious, active addiction or an ongoing affair with the help of a skilled therapist before making a final decision to end a relationship.

How to Avoid These Pitfalls in Individual Therapy

If you are unhappy in your relationship and are seeking individual therapy, either because your partner is unwilling to come with you or you are not ready to talk with your partner, there are several steps you can take to minimize the chances of further damage to your relationship:

Many unhappy partners are influenced, either inadvertently or purposely, toward ending a marriage that could be improved with effective couples therapy.

1. Choose an individual therapist who is also trained in an effective model of couples therapy, such as emotionally focused therapy. Most trained couples therapists also practice individual therapy, and they can use their understanding of couples dynamics to help you gain a clearer perspective on your marriage. If you have been unable to get your partner to come with you to therapy, a therapist who understands couples dynamics may also have suggestions for new ways to approach your partner without putting them on the defensive.
2. Ask your therapist directly for help in understanding your partner’s perspective. Your therapist may feel a primary responsibility to be supportive of your feelings and needs, and thus may be reluctant to bring up your partner’s experience. By directly asking for this input, you give your therapist permission to help you understand your relationship from a broader perspective, including how you may unknowingly trigger unwanted reactions in your partner.
3. Focus your individual therapy on your personal growth rather than on your partner’s shortcomings. Focusing on changes you want to make for yourself is the most constructive way to use your time in individual therapy. As it turns out, it is also often the most helpful thing one partner can do to improve a relationship. And if the relationship ends, your increased self-knowledge will help you move forward in healthier ways.

There are, of course, many other signs of questionable therapy, as well as indicators you’ve found a good therapist. If you decide to reach out to a therapist, be sure to ask plenty of questions based on what you’ve read to help you determine which side of the spectrum they fall on.

Trauma bonds occur in very toxic relationships, and tend to be strengthened by inconsistent positive reinforcement—or at least the hope of something better to come. Trauma bonds occur in extreme situations such as abusive relationships, hostage situations, and incestuous relationships, but also in any ongoing attached relationship in which there is a great deal of pain interspersed with times of calm (or maybe just less pain). I liken it to a heroin addiction—the trauma bond relationship promises much, gives fleeting feelings of utopia, and then it sucks away your very soul.

If you or someone you know has been in an abusive relationship, you have witnessed the strength of this type of relationship. Maybe you or someone you know is trying to get out, but seems incapable of leaving.

Well, there is hope. Here is some advice on how to break a trauma bond:

1. Make a commitment to live in reality

If you find yourself wanting to fantasize about what could be or what you hope will be, stop. Remind yourself that you have made a commitment to live in truth. Even if you don’t choose to leave the relationship immediately, in the meantime you can at least remind yourself that you will stop fantasizing about what is not happening.

Reach out to one of our therapists in Houston, TX, or find a city closer to you.

2. Live in real time.

That means stop holding on to what “could” or “will” happen tomorrow. Notice what is happening in the moment. Notice how trapped you feel. Notice how unloved you feel and how you have compromised your self-respect. self-worth and self-esteem for this relationship. Pay attention to your emotions. Stop hoping and waiting, and start noticing in real time what is happening and how it is affecting you and your well-being.

3. Live one decision at a time and one day at a time.

Sometimes people scare themselves with all-or-nothing thinking. Don’t tell yourself things like, “I have to never talk to the toxic person again or else”; this is akin to trying to lose weight by telling yourself you can never eat chocolate again. While it is true that your relationship is an unhealthy one, you don’t need to make every encounter a do-or-die situation. Don’t scare yourself.

4. Make decisions that only support your self-care and sense of self.

That is, do not make any decision that hurts you. This goes for emotional “relapses” as well. If you find yourself feeling weak, don’t mentally berate yourself, but rather talk to yourself in compassionate, understanding, and reflective ways. Rather talk to yourself in compassionate, understanding, and reflective ways. Remind yourself that you are a work in process and it is a part of the healing process. You will have highs and lows and that is okay. Do not make the uncaring decision to mentally beat yourself up. In every encounter you have with the object of your obsession, stop and think about each choice you make. Make choices that are only in your best interest.

5. Start feeling your emotions.

Whenever you are away from the abusive person in your life and feel tempted to reach out to them for reassurance, stop. Consider writing your feelings down instead. Write whatever comes to you. For example, “I feel ____. I miss ____. I wish I could be with ____ right now, but I am going to sit and write my feelings down instead. I am going to teach myself how to feel my way through the obsession, rather than turning to ____.” This may help you to build inner strength. Learn to simply be with your emotions. You don’t need to run from them, hide from them, avoid them, or make them go away. Once you fully feel them, they may begin to subside. Remember: the only way out is through.

6. Learn to grieve.

Letting go of a toxic and unhealthy relationship and breaking a traumatic bond may be one of the hardest things you ever have to do. You cannot do it without honoring the reality you are losing something very valuable to you.

7. Understand the “hook.” Identify what, exactly, you are losing.

It may be a fantasy, a dream, an illusion. Perhaps your partner had convinced you into believing they were going to fulfill some deep, unmet need. Once you can identify what this need (or hook) is, you can get down to the business of grieving. Grieving means (figuratively) holding your hands open and letting it go. You say goodbye to the notion the need you have may never be met. At minimum, it will not be met by this relationship.

8. Write a list of bottom-line behaviors for yourself.

Possible examples: “(1) I will not sleep with someone who calls me names. (2) I will not argue with someone who has been drinking. (3) I will take care of my own finances. (4) I will not have conversations with anyone when I feel desperate (or defensive, or obsessive, etc.).” Whatever your areas of concern, determine what you need to do to change and make those your bottom-line behaviors.

9. Build your life.

Little by little, start dreaming about your future for yourself (and your children, if you have them); in other words, make dreams that don’t involve your traumatic partner. Maybe you want to go to school, start a hobby, go to church, or join a club. Start making life-affirming choices for yourself that take you away from the toxic interactions that have been destroying your peace of mind.

10. Build healthy connections.

The only way to really free yourself from unhealthy connections is to start investing in healthy ones. Develop other close, connected, and bonded relationships that are not centered on drama. Make these your “go-to” people. It is extremely difficult to heal without a support system. Notice the people in your life who show you loving concern, and care and hang around with them as often as you can. Reach out for professional help as needed.

If infidelity has happened to you (emotional, physical, or both), you don’t have to go running to an attorney right away. Of course, separation or divorce is always an option, both now and in the future.

If you are like many people who have been betrayed, you may be in a state of shock and disbelief and feel as if your entire world has been turned upside down. Perhaps you have always told yourself you would never stay with someone who had an affair, that you don’t deserve to be treated this way and you shouldn’t have to put up with it. Perhaps you have always believed you would end your marriage in a heartbeat, simply out of self-respect.

And now the topic seems to be everywhere—on television, on the radio, or just among others who talk about “kicking a cheater to the curb.” If you have disclosed the infidelity to friends or family, it is not uncommon for well-meaning loved ones to advise leaving right away, or perhaps to offer a spare bedroom or the name of an excellent lawyer.

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But you also don’t instantly stop loving this person, and the word “cheater” does not encompass the complexity or entirety of who your partner is.

As a couples therapist, I am often asked for my advice in these situations about whether to leave. My answer is always the same: “This is a highly personal decision that is not mine to make.” That said, I do recommend that people give themselves permission to slow down and gather information in order to make a grounded and thoughtful decision.

We know from Dr. John Gottman’s research that someone who has been betrayed by their primary romantic partner very often experiences symptoms consistent with posttraumatic stress (PTSD). We also know it is unwise to make major life decisions when in the midst of a crisis and not thinking clearly. Among other things, these PTSD symptoms may include intrusive thoughts of text or email exchanges, disturbing visual images of sexual acts, mood swings, irritability, and an inability to experience positive emotions.

These symptoms can make it nearly impossible to continue to function. Betrayed partners often find themselves doubting what is real and what is not, especially when there has been denial and defensiveness from the person who did the betraying. There can be a loss of trust in their partner, and even in their own perceptions, feeling as if they have failed in their ability to judge the character of their spouse.

As with any trauma, safety and self-care need to be the priorities. Step one is to normalize your full range of emotions and pain. It is normal to want to leave, and it is normal to feel a whole range of reactions including anger, anxiety, depression, suspiciousness, and general overwhelm. It is also normal to want to stay to work things out.

Although recovering from an affair can be very difficult work, there are many times couples find themselves in closer, more intimate partnerships as a result of healing together. Mental health professionals witness this on an ongoing basis. Perhaps neighbors, members of your community, or family have overcome this ordeal and are now happier together, unbeknownst to you.

It is important to recognize you are not alone. Although 90% of Americans say adultery is morally wrong, many families have secrets behind closed doors. One study found that approximately 23% of men and 19% of women in heterosexual marriages have had sexual affairs. These statistics are consistent with many other studies, although it is difficult to gather data about affairs because of the inherent secrecy and stigma of the issue. It may be more prevalent than studies show.

As unbearable as this pain is, and as difficult as it may be to see a way to get past it, a common mistake is a belief you have to “get out quick.” It is rarely this simple. You might still be in love, have children, or be living a life together that is integrally intertwined. Whatever your situation, there is often a confusing mix of strong emotions and feelings of ambivalence.

As you are weighing your options, you might only be looking at two extremes: (1) separation or (2) trying to forgive and move on. We have learned from relationship researchers that these extreme options are too difficult for most people in the immediate aftermath of such a traumatic event.

A third option is to make the decision together with your partner. A couples therapist or other professional trained in affair recovery can help the two of you process what happened, provide education, and give you a safe space to explore your options. You don’t have to know what you want before asking for help. Much of what we do is to guide couples in the decision-making process. You might benefit from learning what the journey would look like and hearing more about where your partner is emotionally. Your feelings might change as a result.

Although recovering from an affair can be very difficult work, there are many times couples find themselves in closer, more intimate partnerships as a result of healing together. Mental health professionals witness this on an ongoing basis. Perhaps neighbors, members of your community, or family have overcome this ordeal and are now happier together, unbeknownst to you.

There are, of course, other times couples decide to peacefully dissolve their union. This can be done respectfully and thoughtfully, especially if they wait until after the initial shock of the trauma. Energy can be placed into co-parenting—if there are children—or amicably separating property, thus reducing the risk of harm for all parties.

Ultimately, this decision lies with you and your partner. If you take your time to find clarity and make an informed and grounded decision, you may be more likely to feel the sense of peace you desperately seek.

References:

1. Gottman, J. M., & Gottman, J. S. (2016). Healing a Relationship from an Affair-Research Training Manual. The Gottman Institute.
2. Gottman, J., & Silver, N. (2012). What Makes Love Last? How to Build Trust and Avoid Betrayal. New York, NY: Simon & Schuster, Inc.
3. Mark, K.P., Janssen, E., & Milhausen, R.R. (2011, October). Infidelity in heterosexual couples: demographic, interpersonal, and personality-related predictors of extradyadic sex. Archives of Sexual Behavior. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/21667234

When a person is in need of an organ transplant, a process referred to in medical circles as a “transplant work-up” begins. This process is lengthy, as it is necessary to make sure the person is medically and psychologically fit for organ transplantation. Often, a social worker who works with transplant cases will conduct the psychological evaluation to identify any mental health issues the person may have that warrant consideration, as well as take stock of the emotional support network currently in place.

Typically, the emotional support network consists of family, friends, and the person’s transplant team. The transplant team includes doctors, nurses, and social workers. During the transplant work-up process, at the time of the transplant, and immediately after transplantation, the person has access to potentially dozens of people who can provide emotional support. The emotional support provided is almost ’round-the-clock if the person is hospitalized while waiting for transplantation. If the person is stable enough to remain at home while waiting for transplantation, they are in and out of doctor’s appointments so frequently that they, too, have consistent access to emotional supports as part of ongoing care.

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What happens after organ transplantation? In the year following the procedure, the person continues frequent visits to doctors’ offices and the hospital for invasive check-ups to control for rejection and illness, as the person is immuno-suppressed. These frequent visits allow for continued access to professional emotional supports. However, as the person begins to improve physically, the appointments steadily decrease and may decline to as little as once per year. With this decline in physical check-ups, the person gradually loses ready access to professional forms of  emotional support. The transplant social worker is constantly working with new patients, and the cycle continues.

Organ transplant recipients may not have identifiable mental health issues pre-transplant, but lifestyle changes, medications, and immuno-suppression—necessary for the organ transplant to be successful—can take a toll mentally. Transplant patients can experience depression, anxiety, grief, survivor’s guilt, and other concerns. Sometimes, life becomes much more difficult after transplant due to unforeseen complications, job loss/change, loss of insurance, and a shift in caregiver roles. Sometimes, people are not able to do the work they once did. Transplant recipients may not be accustomed to a daily medication routine.

How do we balance the “gift of life” that organ donation represents with the emotional toll a transplant can have on an individual?

Post-transplant, people may become hypercritical of their own thoughts, feelings, and behaviors, especially if those thoughts, feelings, and behaviors do not align with the “gift of life” ideology commonly associated with transplantation. How do we balance the “gift of life” that organ donation represents with the emotional toll a transplant can have on an individual?

Person-centered therapy can help transplant recipients by giving them more control, with appropriate guidance. Transplant recipients have not had control over their illness or their treatment. Person-centered therapy can help by allowing the transplant recipient to process their experience and develop a more cohesive sense of self.

The genuineness, unconditional positive regard, and empathic relationship that is the nature of person-centered therapy can allow for deep healing among transplant recipients. Each transplant recipient has a unique experience to share. Some have been sick for years, some caught a fast-acting virus while on vacation abroad. Some are young, some are not. Person-centered therapy encourages the individual to choose the topics discussed in session, navigate and find solutions to their concerns, and decide how often to meet and when to stop therapy. For many, it’s the first step toward regaining a sense of agency in their lives.

For better or for worse, the holiday season is associated with the giving and receiving of gifts. Gifts are exchanged between those we are close with, including family members and friends. Gifts are exchanged between acquaintances, such as coworkers or local service providers (think mail carrier or hairdresser). Gifts may also be given or received among those with which we have no relationship, or anonymously (adopting a family, donating time or money to a charity).

With so many gifts being passed around in so many contexts, it’s an opportune time to talk about some of the potential issues one must be mindful of when considering gifting within the therapeutic relationship—be it during the holiday season or any other time of year.

It may seem only natural to exchange gifts in therapy. After all, in therapy, a close bond may be established, great care and concern are typically expressed, and when the rapport is strong, there may be a genuine like between the parties. The giving of gifts may also be thought of as a means to show appreciation or honor a special stage in therapy.

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But not so fast. Although gifts may seem appropriate between a person in therapy and their therapist, receiving and giving gifts can be a source of stress for the therapeutic relationship. It can hurt therapeutic progress, and it can have serious consequences. Professional ethics codes typically caution therapists from giving or receiving gifts within a therapy relationship. For example, the American Counseling Association Code of Ethics (2014) advises counselors to consider the therapeutic relationship, monetary value of gifts, and the motivation for accepting or declining gifts from people they serve, and the American Psychological Association Code of Ethics (2010) requires that psychologists avoid personal and financial situations that could create a conflict of interest.

Such standards are meant to protect people in therapy from exploitative or manipulative therapy tactics and relationships. These standards are also meant to protect therapists. For example, if a therapist was presented with a gift of value, they may feel pressured to give preferential treatment or refrain from challenging the gift giver. Exchanging gifts may also suggest or invite a change in the nature of the therapeutic relationship—from a professional relationship to a relationship that is too casual, too friendly, or potentially provocative.

Where some mental health professionals might draw a hard line on gifting in either direction, others may see a sliver of gray area. While there are possible pitfalls and ethical complications to consider, there are also ways in which gifts might legitimately be argued to be potentially helpful and culturally appropriate. For example, if a child draws their therapist a picture, it may be hurtful to the child if the therapist rejects the drawing. Another example: After visiting their homeland, an individual brings their therapist a small gift of tea from their country. It might be unnecessarily complicated to explain why accepting the gift is a bad idea, particularly if giving gifts is a meaningful part of that person’s culture and rejecting it would be counterproductive to therapy goals.

Any licensed mental health professional should be keenly aware of potential ethical entanglements involved in gifting, and it is up to the therapist to determine whether gifting a person in therapy may risk or promote therapeutic growth. Where there is doubt, caution is always the wisest path.

It might also be argued that there are benefits of therapists providing some people, in some circumstances, with certain types of small, symbolic, therapeutic gifts. Such therapeutic gifts might be intended to represent growth and provide ongoing motivation. At the completion of therapy, a small memento may go a long way in maintaining positive change, or serve as a reminder to reach out for help in the future. Additionally, some individuals may have difficulty affording the therapeutic tools, such as journals or books, that are sometimes recommended or assigned as therapy “homework.” In these cases, within reason, a therapist might decide that gifting the individual with a homework tool is justified and appropriate.

Of course, some therapists might reasonably feel uncomfortable providing even therapeutic tools, no matter the circumstances. It’s a position few could fault them for. When therapists do choose to provide people in or completing therapy with these types of small gifts, they must consider the potential ethical issues. Therapists should never give gifts that impede the therapy relationship or promote a harmful or unsafe environment, and must be mindful of issues associated with power and control.

Below are some examples of free or low-value gifts and tools that therapists, in an informal survey, reported having given to people they worked with in the therapy room. The reasons the gifts were deemed to be therapeutically beneficial are also summarized. The general theme was this: in each case, the gift complemented the therapeutic relationship and the journey of the person in therapy.

1. Cards. At the end of therapy, some therapists may provide a card highlighting therapy progress and reminding people of the changes they have made. During a termination session, sharing with a person the changes their therapist sees in them may be considered a special and caring way to end the relationship.
2. Stones. Some therapists may keep small stones in their office. Stones may be representative of strength, resilience, hardiness, or other qualities. Stones that have flaws may be seen as beautifully imperfect. Allowing people to choose a stone may serve as a symbolic reminder of the person’s strength and imperfect beauty.
3. Mandalas. These spiritual or ritual symbols in traditional Indian culture represent wholeness and one’s relationship with the universe. The therapeutic benefits of coloring mandalas may include expanding creativity, building spiritual connection, and enhancing relaxation.
4. Journals. Therapists may request that people maintain a journal while in therapy. Journaling can help to organize thoughts, decrease anxiety, and serve as a means for tracking change. Some therapists may provide a simple journal or use time in therapy to create a journal.
5. Books. Self-help books can be used separate from therapy or in conjunction with what is being explored in therapy. Therapists may provide a person with a book that is already in their office, one they believe the person would benefit from. Or, as routine practice, therapists may supply books associated with the specific form of therapy being used.
6. Metaphors, quotes, or poems. Metaphors or inspirational quotes and poems can be symbolic of the unique qualities or strengths people possess.
7. Candles. Candles can inspire relaxation, meditation, and focus. Use of a candle can help people reproduce a space of awareness and insightfulness outside of therapy.
8. Music or meditation. Playing a song in session or giving a person a meditation recording may be a special way to acknowledge and maintain clinical progress.

Ultimately, the decision whether to give or accept a gift rests with the individuals involved. Some therapists might not want any part of gifting, while others might leave room for unusual considerations. Under no circumstances should a gift be expected or rewarded. Any licensed mental health professional should be keenly aware of potential ethical entanglements involved in gifting, and it is up to the therapist to determine whether gifting a person in therapy may risk or promote therapeutic growth. Where there is doubt, caution is always the wisest path.

References:

1. American Counseling Association. (2014). Code of ethics. Washington, DC: Author.
2. American Psychological Association. (2010). Ethical principles of psychologists and code of c Washington, DC: Author.

People pleasing is a way to reduce anxiety and eliminate stress. Some please to assure good feelings that come with positive responses like being approved of, admired, praised, or respected. Others please because of strong needs to avoid bad feelings that occur when, for example, others criticize, complain, or become angry. But there are some people who are not typical people pleasers. Instead, they live with intense anxiety that if they don’t behave in ways that elicit strong approval and avoid disapproval from others, the consequences will destroy their sense of well-being and safety. These are what I will refer to, for the purposes of this article, as terrified people pleasers.

Relationships and Terrified People Pleasers

Terrified people pleasers view the world as an impending source of danger. They tend to see relationships much like earthquakes and hurricanes: at any time, often with little warning, attachment to others can wreak great destruction in their lives. Vigilance and compliance become guidelines for safety.

Samantha walked into my office, and before I could ask, “What brings you here?” I found myself in the presence of an avalanche of feelings from someone who seemed to be a very angry, upset, frightened woman.

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“This is it. I can’t take it anymore,” she said. “All my friends are never available and selfish. I’m 63 years old, and I’m going to die alone. I’ve been seeing Marty on and off for 10 years, and he’s like everyone else: self-involved, stubborn, unloving or loving depending on his mood. I tell you, it’s enough! I’m so good to everyone, and they get what they want. I’m afraid to do things and be on my own, and I have to rely on people who always have time for each other but not for me. I’m tired of being angry and depressed and giving everyone what they want. I don’t know what’s wrong with me. I can’t seem to enjoy anything. No one likes me, and I hate everyone.”

It would take many months for me to understand the narrative of Samantha’s life. In our early sessions, Samantha described her anger and unhappiness with her friends who didn’t appreciate how she was always there for them and never reciprocated. She described taking them to dinner, helping them move into apartments, visiting when they were sick: “I did all the things a good friend does. Do you think I really wanted to be so helpful and attentive? No, I didn’t. But I felt that I had to be the perfect friend or they would all drop me. I sort of feel dropped anyway. No one ever offers to help me with anything.”

Samantha repeats this pattern of behavior with Marty: “I always work hard to figure out what he wants, and I work very hard to provide it even when I want to say ‘no.’ Then I resent him, but I’m scared he’ll leave me if I ask for anything. So for the last 10 years, our relationship has been crazy in and out. We date, we’re lovers, we’re friends, we stop seeing each other for a while, and then it starts all over again. Mostly, I freak out if either one of us gets angry. I always worry he’s going to be critical or distant, and I‘m never sure if I want him to stay or leave, but I get panic attacks if I think he wants to leave.”

When we explored this experience that felt so one-sided, it became apparent Samantha never asked friends for help or indicated any wish to be celebrated: “I don’t know, I guess it never feels okay to ask for anything. I’m afraid they’ll say no, and I’ll feel hurt and angry. I think I really have the feeling that they don’t want to please me like I don’t really want to please them. But I have no choice. I have to do it or I’ll be hurt and alone.”

Family Origins and Terrified People Pleasing

As her story unfolded, I could visualize the frightened little girl who had been designated by her father to be responsible for her mother. Although never medically diagnosed, I believe Samantha’s mother was probably bipolar. She describes a mother of unpredictable extremes: the mother who danced around the kitchen was funny, silly, all hugs, and the mother who stayed in bed, was silent or angry, and made several suicide attempts. Her father, a rarely present man who worked too much, praised Samantha for taking good care of her mother and would tell her, “You’re my good girl doing your job for us to make sure mommy is okay.”

Her father and her brother, older by three years, were emotionally detached from Samantha and her mother. Samantha recalled, “I was 12. It was the second time my mother tried to kill herself. I found her in bed with an empty bottle of pills, hardly breathing. I called 911 and my father. I don’t know where my brother was. My father told me to go in the ambulance with my mother and stay with her. He told me what a good girl I was. I don’t remember if he came to the hospital. He must have come to take me home. I just remember feeling so alone. I also felt so good that I made my father happy. There wasn’t much I could do to get that feeling.”

Much like the experience with her parents, her compliance resulted only in the transient feeling of being loved. From day to day and perhaps minute to minute, Samantha could not depend on her parents for reliable and consistent loving feelings. How could she trust anyone to love her or want to be with her?

I learned that Samantha craved the feeling of being the good girl and feeling that her mother and father loved her: “There wasn’t much I could do that would make me feel my father loved me. It looked like he loved my brother, who he did things with and joked with. He didn’t talk with me much except when he would ask about mom and how she was doing. I could get wonderful, loving feelings from my mother. I knew just what to do. I’d come home early to be with her after school. I never brought friends home. I thought she’d be mad that I wasn’t totally there for her, but I also didn’t want them to see how she was. I knew something was wrong, but I couldn’t put it into words. What was so scary for me was I’d never know which mother I would encounter on any day. She could be funny and hug and love me, or depressed and silent and absent. I’d feel so abandoned and then helpless to figure out how to make her happy and get her back so she could love me.”

One day, Samantha came to her session looking agitated. She told me: “I need to tell you about something. This is the memory I can’t get out of my head. It’s excruciating.” She burst into sobs: “I was terrified every day that she would kill herself. She did. In my senior year, I was talking about going to the local college, and I felt she was upset with me. I don’t know if that’s true, but I was afraid I was abandoning her. I thought maybe she and my father would be mad that I might not still be able to watch over her. In February of my senior year, I came home on a cold, snowy day. She wasn’t in the kitchen, and I felt that scary feeling I always got when she was in the bedroom when I got home. I went upstairs to her room and I knew as soon as I opened the door. I can’t say any more.”

Samantha learned very early that her behavior could lead to terrifying consequences: In order to feel safe, it was required that she make her parents happy. The dread of making them unhappy created panic and terror. Her detached father gave her the feelings of being valued, loved, and connected only if she played her ascribed role of caring for her mother’s emotional life and keeping her alive. Her mother’s erratic and unpredictable emotional life made it difficult for Samantha to feel she had any ability to know, predictably, how to please her mother.

Samantha had no space to develop an identity other than “the daughter who pleases her parents.” Separation and individuation were not an option, as it was too dangerous to think about her own wishes, needs, and desires.

Ambivalent Anxious Attachment

Samantha’s inability to make satisfying attachments to the people in her life mirrored her early attachments in her family. Perhaps the best categorization of Samantha’s attachment style is “ambivalent anxious attachment.” In this kind of attachment, the connection is characterized by mistrust and worry, but the need for the attachment is nevertheless intense. This pattern of attachment repeats itself in Samantha’s friendships and in her relationship with Marty. Even when wanting to say “no” to their wishes, desires, and perspectives, she always agreed. Much like the experience with her parents, her compliance resulted only in the transient feeling of being loved. From day to day and perhaps minute to minute, Samantha could not depend on her parents for reliable and consistent loving feelings. How could she trust anyone to love her or want to be with her?

Samantha has begun to understand how she repeats her early attachment style. She is learning to use thinking to override the terror and panic which emerge when she starts to feel that Marty is angry with her or a best friend doesn’t return texts or invite her to social events. This awareness is helping to diminish the degree of anxiety that occurs when she feels she’s being abandoned. She also is starting to see that her anger is evoked when she is suspicious about what people think of her and want from her.

Samantha is struggling. But she is committed to working at making changes in her patterns of attachment. As she alters her expectations and reactions to the people in her life, I expect they will respond to her in new ways. She has become increasingly able, in the moment, to consider that her assessments of her relationships based on historical responses are likely to need revision. As we continue to work, I believe she will continue to strengthen the power of her thinking so she can override acting on her feelings. Significantly, Samantha is developing a positive sense of self which can consider that she is making progress. She is.

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

We all experience love in one form or another. We all experience hurt and pain. It’s part of the human condition.

Likewise, people can be insensitive sometimes. They say or do things either intentionally or unintentionally that hurt others. At times, a careless action or critical remark can really hurt us, especially if we attach too much importance or meaning to it. The more closely connected we are to the person, the deeper the pain.

An infraction that is relatively minor or insignificant to one person may be devastatingly painful to another. For some, resentments are difficult to release. The tighter the hold, the harder it may be to let go.

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When ruminated about over a period of time, a resentment can transform into a grudge. If these negative feelings are left unresolved within ourselves, they can lead to unhappiness, bitterness, and permanent unforgiveness. Research has shown that prolonged anger can have devastating effects on our health and longevity.

Although we may feel justified in our anger, what can we do to stop feeling the pain and upset feelings that the hurt has caused? Not every infraction requires forgiveness. However, if the hurt is personal, profoundly deep, and seems unjust, the following ideas may help you begin to release your anger and bring back a sense of peace and joy.

1. Decide to Forgive Yourself

Remind yourself that you are doing the best you can at any given moment. Try not to replay the “what-ifs.” Validate your feelings by acknowledging your anger and pain. Anger is a helpful emotion that signals to us that something is wrong and needs to be corrected.

When you are ready, make a conscious choice to release the anger and hurt and let go of the past. Be kind to yourself and set yourself free from hurt. Being able to forgive solves many problems.

2. Decide to Forgive Others

Everyone is imperfect and flawed. Everyone makes mistakes every day. Everyone is doing the best they can given their personal life history and the impact that history has had on them.

Make a conscious decision to let go of offensive words and behavior. Decide to not let what others do or say have power over you. Stand firm in your truth.

3. Redirect Your Thoughts

What we believe may become true for us. Thoughts are powerful, either positive or negative. Dwelling on past hurts only serves to reinjure ourselves.

Challenge your negative thoughts and reframe them in a positive and more balanced way. Bitterness can cloud your vision and alter your perspective. Be truthful to yourself and allow yourself to be aware of how you may have hurt others in similar ways.

4. Change Your Perspective

Allow yourself to see things from a more positive perspective. Try being able to see the person or situation in a new light. Look for things that the person is doing right rather than emphasizing their flaws.

5. Live in the Present

Realize that the past is in the past. You only have the present moment to live in. Focus on what is going well right now, and try not to allow negative thoughts about the past to creep into your consciousness.

Our existence provides us both positive and negative experiences. Life offers us numerous opportunities to be hurt and offended by others. It can be difficult to let go of the past, forgive ourselves, forgive others, and try to experience life differently, but the benefits of forgiveness far outweigh the benefits of unforgiveness. Working toward creating a happier, more peaceful existence through forgiveness is worth the price.

If you’re struggling with forgiveness, contact a licensed therapist for compassionate support and guidance.

Reference:

Smedes, L. B. (1984). Forgive and Forget: Healing the Hurts We Don’t Deserve. New York, NY: Harper Collins.

From the time children are born, they count on their parents to provide a sense of safety as they learn about the complex world around them. When a parent dies, it may create intense emotional upheaval for children old enough to understand what has happened. Often, children do not know what to do with those feelings. Surviving parents, guardians, and other adults have a difficult task in helping such children process their grief and move forward.

Perhaps the most important thing anyone can offer a child who has lost a parent is time. Grief does not happen on a specific timetable, and the process of grieving may look very different from one child to the next.

In addition, adults can encourage children to share their feelings safely and without judgment. It is helpful to refrain from using words such as “should” or “should not” when talking to children about a loss or trauma they experienced. Adults can also facilitate a sense of togetherness or shared struggle to ensure children do not feel alone in their grief, and encourage compassion and support among other kids or people in the child’s life.

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The specific challenges facing children who have lost a parent include:

• Accepting the significance of the loss (it changes them forever)
• Allowing the grief process to unfold on their own terms as they work through painful feelings
• Transitioning into an environment where the parent is no longer physically present
• Maintaining a sense of connection with the lost parent while allowing themselves to live their life

Surviving parents have the unique challenge of providing support for their children as well as processing their own grief. Some parents may feel inclined to grieve in private, believing it is in the children’s best interests to shield them from displays of pain. However, it is appropriate and healthy to allow children to see adults grieving because it signals that is okay to feel the impact of the loss and to openly express their own grief. The objective is to help children understand they are loved, supported, and far from alone in the grieving process.

Often one of the biggest challenges children face when they lose a parent is to accept that they may be experiencing many different feelings. This is normal, and it’s important for children to know that. It can be confusing when they feel emotions such as anger and yet miss their parent at the same time. Children may believe it’s better not to show emotion and that if they don’t, they may be able to forget about the parent they lost or forget the pain they feel. Caring adults need to let children know that when someone they love dies, it’s important to remember them and cherish the positive memories they have.

It’s important to help children understand that the goal is not to “get over” what happened, but to move toward acceptance. They will never get over it; the loss of a parent changes a child from that point on.

It’s important to help children understand that the goal is not to “get over” what happened, but to move toward acceptance. They will never get over it; the loss of a parent changes a child from that point on.

Adults often find it difficult to know what to say to children who have lost a parent. Others may be wary of bringing up difficult feelings in children or reopening emotional wounds. As a result, the topic may be avoided altogether, creating an “elephant in the room” effect and contributing to feelings of isolation.

The primary goals for caring adults in the lives of children who have lost a parent are to encourage them to accept their feelings rather than push them away and to offer support whenever it is needed. Often during the grief process, children will move back and forth through the various stages of grief. Being available to listen whenever they’re ready to talk may be what is most comforting to them.

Ultimately, children need to know that there is no “right way” to get through the grief process. Everyone experiences it differently, and children should be encouraged not to judge themselves if the way they experience their grief is different from the way someone else does.

The purpose of most therapies is to heal, or alleviate, symptoms of a concerning issue or condition. Medical professions create treatment plans that outline the professional’s approach and interventions used to achieve a certain goal. In mental health therapy, this is generally created collaboratively with input from both the person in therapy and the therapist. In some cases, it may be wise to include input from other professionals, such as a primary care physician, psychiatrist, or school counselor, perhaps even parents or caregivers.

When it comes to creating a treatment plan for a physical condition, it is often a bit more straightforward because such conditions tend to be visible or otherwise apparent. For example, the goal of a fractured wrist would be to heal the wrist. The treatment plan would perhaps consist of wearing a cast for several weeks, taking medication as prescribed, and resting.

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I have found that some people have a difficult time setting goals for their counseling treatment plans because healing an emotional condition can be more complex. It can be hard to know where to start. It is even common for people to have difficulty explaining why they are seeking counseling in the first place.

Why Now?

Everyone has struggles in their lives, and everyone has the ability to cope with stress. You would not have made it to this point in life without some helpful strategies and problem-solving for difficult times.

Asking yourself what is happening now for you, or in your life, that is compelling you to seek counseling is an important first step. One common reason may be that your usual coping strategies aren’t working as well as they used to. Perhaps there is a lot of change occurring in your life, and things feel out of your control. You may be noticing an impact on your thinking, feeling, or relationships that you’re not satisfied with. Try to dig deep and describe what is happening that’s making you consider counseling at this specific time.

Get Behaviorally Specific

Contrary to some people’s perceptions, therapists can’t “fix” everything—and what does get resolved happens largely as a result of the work the person in therapy does outside of session, using tools and strategies learned in therapy.

Your therapist will ask you to describe your symptoms. It is helpful to use common language rather than “psychobabble” so both you and your therapist are clear on what you are describing. For example, you may self-describe as having depression, meaning you feel sad most of the time. However, your therapist may interpret this as you having been diagnosed in the past with a condition called major depression, which is used to describe a specific set of symptoms. However, your feeling sad most of the time may be related to a recent breakup, which may be normative and not a symptom of a depressive condition.

Through proper and thorough assessment, your therapist should be able to make an accurate diagnosis to describe your symptoms accurately. Being behaviorally specific also allows you and your therapist to be clear on what you actually want to address and change with the help of counseling.

Let Yourself Dream

Contrary to some people’s perceptions, therapists can’t “fix” everything—and what does get resolved happens largely as a result of the work the person in therapy does outside of session, using tools and strategies learned in therapy. Therapists don’t possess a magic wand.

However, as part of the goal-setting process, imagine a magic wand that could change your life overnight does exist. Allowing yourself to imagine using this wand, and noticing what would be different, can help you and your therapist clarify what areas of your life you’d like to change.

Be Realistic

When setting goals, make sure they are realistic. Setting a goal for feeling happy 100% of the time is unrealistic because we all experience a variety of moods throughout the day. It is reasonable to expect you will have difficult days that may be filled with uncomfortable emotions, as well as happier days. Rewording the idea of being happier into a more realistic goal may mean focusing on how you can create more happiness in your life—perhaps by learning how to manage or cope with difficult emotions, or making some other change.

Be Kind and Patient

Therapy is hard work! It can feel horribly uncomfortable and exhausting to go through the process of examining and talking about the difficult things we experience.

Much in the same way you need to feel fatigue in your muscles to build strength, the same is true for mental health therapy. Be sure to take care of yourself and be kind along the way. If you knew what to do already, you wouldn’t ask for help. And the truth is no therapist has all the answers. Simply showing up, making the effort, and being honest along the way are some of the key ingredients to successful therapy.