Many people interested in therapy may be hesitant to share private information or stories about themselves with a stranger. They may fear judgment from the therapist, or worse, that the therapist is going to share their details with others. For therapy to be effective, trust must be built between the individual seeking therapy and the therapist.

Is Therapy Confidential?

In almost every instance, therapy is absolutely confidential. You therapist is required to maintain confidentiality about everything said in sessions between the two of you, just like a doctor is required to keep your records private. While there are laws and regulations in place to protect your privacy, confidentiality is also a key part of psychology’s code of ethics. This means your therapist understands from the very beginning that in order for you to feel comfortable sharing openly with them, you need to know your information is safe.

Remember, you can always talk with your therapist if you have questions about the confidentiality agreement between the two of you during your sessions.

What Are the Limits of Confidentiality in Therapy?

For your own safety, there are some exceptions to the rule when it comes to confidentiality in therapy. Generally, these rules have to do with the well-being of the patient or people in the patient’s life.

For example, therapists are required to report if a patient is a threat to themselves or others. This may mean the patient has threatened suicide, is repeatedly harming themselves, or has threatened to harm another person. In this case, a therapist may recommend hospitalization so the patient can be monitored. Once the patient is deemed stable, the therapist may then work with close friends or family members to develop a support plan for the patient in order to maintain that sense of stability.

Additionally, therapists are also required to report cases of ongoing child abuse or neglect. In these cases, a variety of public servants may be brought into the fold, including law enforcement or child protective services. Again, this is a measure created to ensure the safety of a patient and it should not deter you from being open and honest about your situation with your therapist.

Finally, if a minor is seeking therapy and is engaging in risky behavior, their parents or guardian may be informed. Different states have different laws regarding minors in therapy, so it can be a good idea for the parent, therapist, and patient to sit down in an early session and establish ground rules.

HIPAA and Rules of Confidentiality in Therapy

The group of federal laws and regulations protecting the privacy of your health information is known as the Health Insurance Portability and Accountability Act, or HIPAA. They very clearly and thoroughly define when your therapist is allowed to talk about you or your treatment outside of your sessions. These instances may include but are not limited to:

• When you are talking to your family. HIPAA allows your therapist to talk with your family about your mental health treatment in a variety of ways. If you are present and capable of making decisions and want your family to be involved in your treatment, HIPAA allows your therapist to share your information.
• When you are at a mental health care appointment. If you are seeing a mental health care professional for prescription medication, HIPAA allows for some information to be shared with the family you may have present. For example, if there are warning signs your spouse needs to know in regard to your medication, then the provider is allowed to share that with them.
• When you are incapacitated. If you are unable to make decisions for yourself, either because you are unconscious or deemed not of a sound mind, then your therapist may use their own reasonable judgment to share pertinent information with family or friends involved directly in your care. This usually means immediate family members or partners.

What Therapists Have to Say About Confidentiality

Here, several therapists discuss confidentiality of therapy sessions:

(more…)

We’ve all heard the stereotype of the dumb jock, but a new study suggests that high school sports may actually be good for students’ brains. About 55% of high school students are athletes, and between 23% and 40% of all high school students report feelings of stress, depression, or anxiety. Students may be able to reduce these feelings by participating in sports, and the study suggests that high school sports participation may even have long-term mental health benefits.

High School Sports and Mental Health

The study surveyed nearly 850 students attending 10 different Canadian schools. Students completed surveys about sports participation every year for their five years of secondary school. Then, three years after graduation, researchers asked students about symptoms of depression and stress levels. Students were also asked to rate their mental health on a scale of 1 to 5.

Students who had a history of high school sports participation did better on all three measures of mental health than students who did not play sports. They had lower rates of depression, less stress, and perceived their mental health to be better. Researchers aren’t sure why high school sports positively benefited mental health in the students. They speculate, though, that increased social activity, a connection to their schools, and the chance to bond with their peers may all help reduce the risk of mental health challenges. 

Other Benefits of High School Sports

The latest study isn’t the only one to show major mental health benefits for high school athletes. Previous research has shown that high school sports participation can confer the following mental health benefits:[fat_widget_right]

• A reduced risk of teen pregnancy.
• A decreased likelihood of using drugs such as cocaine and marijuana.
• Higher self-esteem, with student athletes about three times as likely as non-athletes to say they feel good about themselves.
• Feeling socially accepted. Athletes have better social skills and are more likely to say their friends care about them.
• Better grades and test scores.

References:

1. Jewett, Rachel; Sabiston, Catherine M.; Brunet, Jennifer; O’Loughlin, Erin K.; Scarapicchia, Tanya; O’Loughlin, Jennifer. (2014, June 11). School Sport Participation During Adolescence and Mental Health in Early Adulthood. Journal of Adolescent Health. DOI: 10.1016/j.jadohealth.2014.04.018
2. National Campaign to Prevent Teen Pregnancy. (2007, July 26). Not Just Another Single Issue: Teen Pregnancy and Athletic Involvement. Retrieved from http://www.education.com/reference/article/Ref_Not_Just_Another/
3. Sports Promote Psychological and Emotional Health. (2013). DatalysCenter. Retrieved from http://datalyscenter.org/wp-content/uploads/2013/06/Sports-Promote-Psychological-Emotional-Health.pdf
4. Study shows high school athletes perform better in school, persist to graduation more than non-athletes. (2014, January 24). Retrieved from http://news.ku.edu/2014/01/15/study-shows-high-school-athletes-performed-better-school-persisted-graduation-more-non

They are frightening, disturbing, inconvenient, and happen when you are supposed to be rejuvenating your body and brain: the nightmares that follow a traumatic experience.

Nightmares are quite common among people who have experienced a traumatic event. The aftereffects of a nightmare often follow them into the next day, which can affect their emotional well-being and ability to function. Nightmares can be quite scary and negatively impact the amount of restful sleep a person is getting. They can feel like one is re-experiencing the traumatic event, and the thought of going to sleep can become anxiety-provoking. The less sleep a person gets, the more difficult it is for the brain to process a traumatic event and file it away correctly. Sometimes the symptoms that are present due to trauma are the very barriers that get in the way of a person’s ability to heal.

The Function of Dreams

According to Hartmann (1996), one theory regarding the function of dreaming is that it allows the brain to make connections more efficiently and effectively than the conscious mind. In other words, it is the time when the brain reviews information that has been observed and then sorts and organizes it in a way that makes sense.

[fat_widget_trauma_ptsd_right]

Hartmann (1998) also states that dreaming is a way for the brain to work through trauma, and the dreams are often based on the main emotion the person experienced during the trauma or experiences when they recall the trauma. This is important to the healing process but, as discussed above, can be problematic when the person’s nightmares interfere with their sleep and their ability to function day-to-day. According to Leskin et al. (2002), people who had a diagnosis of posttraumatic stress had a significantly higher rate of sleep problems. They state that 96% of participants in their study who were diagnosed with PTSD experienced nightmares and 100% experienced insomnia.

So what can a person do to work through unwanted trauma nightmares?

1. Keep track of your dreams and nightmares and discuss them with your therapist. Dreams can contain information that is significant in therapy work. I often encourage people in therapy to write down the basic themes of their dreams and nightmares so we can investigate their significance to the trauma treatment work we are doing. I often find that the information gathered from dreams is directly related to the themes that are increasing or continuing the disturbance related to trauma (for example, a sense of helplessness).
2. Develop coping and self-soothing skills. Practice self-soothing and anxiety-reduction techniques before sleep and/or if you wake up from a nightmare. Continue self-soothing throughout the day as needed to deal with the aftereffects of a nightmare. Some of the tools people in therapy have found most useful include guided meditations, body scans, progressive muscle relaxation, and mindfulness exercises. Another tool that many find particularly useful is called “container.” Essentially, the person experiencing the disturbance creates a container (real or imagined) wherein they can keep the things that bother them most (thoughts about the event, flashbacks, or even the nightmares or other disturbing material) until a time when he or she able to sort through the material with his or her therapist. When the disturbing material comes up, the person can allow whatever it is to go into container until therapy, where we can decide what should be addressed. Some containers that are common are safes, boxes, vaults, and jars. The container should have a lid or door of some type. A person can imagine this container in the form of a picture in the mind and imagine the disturbing material going into the container. Alternately, the person can have a physical container and write down the disturbing material on a piece of paper and then place it in the container.
3. Don’t stay in bed if you can’t sleep. Often, when awakened from a nightmare, going back to sleep may be difficult. Also, the act of initially going to sleep may be anxiety-provoking for fear that the nightmares or other symptoms the person may be experiencing will return. If you are not able to go to sleep in a reasonable amount of time, get up and do something self-soothing. It may take time before sleep comes, but it is better to engage in self-soothing exercises than to get yourself worked up and more anxious because sleep won’t come.
4. Make changes to your sleep environment to avoid associating anxiety with the place you sleep. When a person has repeated nightmares, the sleep environment may become a trigger for anxiety and other trauma symptoms. Making changes to the sleep environment, such as moving furniture around, getting new bedding, or changing the decor, may be helpful in starting with a clean slate when it comes to sleep.
5. Remind yourself that your brain is trying to heal. Healing is not always a comfortable process and it takes time. As uncomfortable as nightmares are, your brain is giving you the information it needs you to work through. Nightmares can bring to light issues that you may have been unaware of during your awake time. Work with a therapist so you do not feel alone in this process. A therapist can normalize what you are going through and can help you to process your symptoms in a way that may make them less overwhelming.

References:

1. Hartmann, E. (1996). Outline for a theory on the nature and functions of dreaming. Dreaming, 6(2), pp 147-170.
2. Hartmann, E. (1998). Nightmare after trauma as a paradigm for all dreams: A new approach to the nature and functions of dreaming. Psychiatry: Interpersonal and Biological Processes, 61(3), pp223-238.
3. Leskin, G.A., Woodward, S.H., Young, H.E., and Sheikh, J.I. (2002). Effects of comorbid diagnoses on sleep disturbance in PTSD. Journal of Psychiatric Research, 36(6), pp 449-452.

“Go into your grief, for there your soul will grow.” —Carl Jung

Grieving is a powerful and personal journey. It is an inevitable part of living. Eventually we all grieve something or someone. If you’ve lost a child or parent, or a friend, lover, or spouse, you know that grief has the power to transform.

We usually live within the illusion that we are in control. That is, we live a certain way until something happens to shatter our perception. The resulting dissolution—or you might say dis-illusion—that follows is actually the beginning of a remarkable process of being healed. It marks the first stage in the grief journey.

Stages of Grief

In 1969, Elisabeth Kübler-Ross, a Swiss American psychiatrist, introduced the “five stages of grief.” Her work with people who had terminal cancer led her to define the five distinct phases a dying person goes through while coming to terms with their fate:

• Denial: Disbelief, shock, and numbness after hearing the “bad” news.
• Anger: When the numbness lifts, anger may be easier to feel than the intense pain associated with what is being lost. This free-flowing anger can be directed inward toward the self or outward toward doctors, nurses, friends, family, spiritual advisors, and/or God.
• Bargaining: For some, bargaining can be a reaction to the vulnerability that occurs when feeling the sorrow of loss. It can be an attempt to feel more in control of a situation where control just isn’t possible. It is characterized by an attempt to seek the impossible; to find a way out.
• Depression: The full impact of the unmasked impending loss of life finally hits, and feelings of sorrow, sadness, and depression follow.
• Acceptance: Coming to terms with what is happening and finding a way forward.

[fat_widget_grief_right]

While many have applied these stages to the process of grieving the death of another person, it was not Kübler-Ross’ intention that they be used this way when she created the model. There are other models that are more specific to grieving the loss of a loved one that are used by grief counselors and therapists. While the stages described by these models differ somewhat, like Kübler-Ross’ model they all chronicle a journey-type process that leads to acceptance and the eventual ability to once again move forward.

Acknowledging Brokenness; Being Present

When the shock of sudden loss subsides, the numbness that initially accompanies that shock wears off as well. A pain-filled state ensues when the harsh reality of loss is realized. This early phase of grief is about brokenness. When we experience a loss, the bond that once attached us to the other—whether the other is a person, place, or thing—is severed. When the bond that ties is severed, we feel as though we have been broken. It is a painful and searing state; a state that can’t be rushed.

What a grieving person in this stage needs most is to feel that those they are closest to can accept the pain they are experiencing. Unfortunately, many people are uncomfortable with their thoughts and ideas about endings and death. The feelings that arise with grief are just too much for them. Their attempts, aimed at getting a grieving person to feel better and leave the sorrow behind, only serve to prolong the grief process.

A kind touch and a shared quiet moment that honors the feelings of a grief-stricken friend can be the best offering of condolence. A willingness to simply be present, to witness and accept the raw emotions of grief, is the first step in a transformative and healing process for both the bereaved and those who surround them.

Support Groups

The feelings that come with grief are powerful. Grieving takes time, and often the family and friends of a grief-stricken person are ready to move on long before the grieving one can or wants to. Support groups are a viable option for those who find themselves alone in their grief. Being able to share the experience with others on the same path may be a relief. Since the grieving process is different for everyone, a support group can accommodate these differences. Some studies suggest that men and women grieve differently, with women needing to speak about and share their intense feelings with others while men often deal with their own intense emotions by taking action. In a support group setting, all experiences can be heard, shared, and validated.

Widows and widowers in the gay community often have difficulty finding the support needed while experiencing the grief of bereavement. Even finding a support group can be difficult. Blogger Dan Cano writes poignantly about his experience after finally finding a support group where he could speak freely and be understood:

“I started my lesbian and gay bereavement group a few weeks ago, and every Thursday night we gather to tell our stories. We share of our history with our partners, lovers, husbands and wives. We share the trauma of losing the most central person in our lives. We tell of our difficult goodbyes, and of the daily anguish that we must now endure. We talk about being left behind, of feeling lost, of struggling with a new identity. We talk of people’s well intended, but missing the mark, words. We cry, we laugh, we listen.”

What We Learn from Grief

When we sit in stillness and accept the waves of grief that wash over, eventually there will come a time when the urge to move will stir. It will be quiet, unassuming, and almost imperceptible. From intense feelings over what has been lost there will arise a feeling of gratitude for what is remaining. When experiencing the loss of a loved one, an inevitable gratitude for life and living unfolds. The gift of grief is ultimately a strengthening of the ability to truly appreciate and value the process of being alive.

References:

1. Greenspan, Miriam. Healing Though the Dark Emotions: The Wisdom of Grief, Fear & Despair. Shambhala Publications Inc. Boston, Massachusetts, 2003.
2. Hanson, Rick, Ph.D. (2007). Grief Recovery: Implication of Neuroscience and Contemplative Wisdom. Retrieved from: http://www.wisebrain.org/KaraSlides.pdf on 21/06/2014.
3. Cano, Daniel (2009). Gay Grief. Retrieved from http://daninrealtime.blogspot.ca/2009/11/gay-grief.html on 22/06/2014.

Here are a couple of questions for you. What happens inside you when you when you read or listen to the daily litany of abuse of power, suffering, injustice, murder, war, and destruction of the earth? What do you do when someone close to you has been hurt by unethical actions?

Asking around, these are the things I’ve heard.

“I just get numb because I don’t think I could bear the amount of pain I would feel.”

“Well, I get mad at the news companies because they just seem to look for the bad stuff and don’t give us a balance. There’s good stuff happening too, but I guess that doesn’t sell.”

“I find I can’t see violent movies anymore even if they are Academy Award winners. Hurts too much.”

“I glaze over so I can subdue my feelings.”

“I feel so upset and helpless that it turns to hopelessness. When it’s hopeless, I disempower myself because there’s nothing useful I can do anyway, so why bother?”

“When something gets to me, I can’t sleep at night.”

“I feel disappointed in people. We know better than what we do.”

“I just don’t read the paper or listen to the news anymore. I don’t want to support this kind of newscasting.”

“I try to offset the bad news with looking at the bright side. I think I do this too quickly in an effort to avoid feeling bad.”

[fat_widget_right]

Do any or many of these responses feel familiar to you? Anything you want to add?

Of course, how we deal with human suffering is one of the universal core life questions that each of us must find an answer to. This question has two dimensions—how will you BE with suffering and what will you DO about it? This article speaks to the kinds of inner doing that can help you be with terrible and disturbing things.

Recently, I was singing in a chanting group. One of our songs was a lament. We were to let go in wailing sounds for some minutes, and then we sang the words of the lament. Stefan Waligur, the leader, reminded us that wailing and keening are an historic and current form of individual and group response to suffering, grief, and injustice. Wailing is often, though not always, the work of women on behalf of the whole community or the whole family. Wailing walls. Wailing in the streets. Wailing over the bodies of the dead. For many people and many cultures, this is the appropriate way to respond to terrible things.

For me, the lamenting sounds felt good and relieving. I was surprised because I tend toward stoically managing my feelings. Lamenting as a chant made it more acceptable for me. It felt good to let my whole body move and sound with the expression of deep grief. Stefan suggested we should make a place for group laments in response to a school shooting, flood, or insurrection.

Public or private lamenting, full of sound and movement, is a good antidote to the responses of fury, numbness, and hopelessness that have become our normal reactions.

My friend Robert said he noticed he regularly shut down about, as he called it, “news of the terrible.” He now has a practice of covering his eyes with his hands and taking a moment to let his grief travel through his body and soul after hearing something distressing. He says it helps him stay alive and real. When you numb yourself about bad stuff, you numb yourself about good stuff, too. Numbing is not selective.

Public or private lamenting, full of sound and movement, is a good antidote to the responses of fury, numbness, and hopelessness that have become our normal reactions.

A study comparing meditation masters and ordinary people in terms of how they respond to disturbing images found that the people in both groups responded to the disturbing images with an equal level of pain and upset. The only difference was that the meditation masters were more resilient and returned to their normal state of equanimity much sooner. Their emotions were quick spikes, whereas the non-meditators stayed in their distress for a significantly longer time. I think regular lamenting could have the same effect of increasing resilience.

My friend Charna suggests a Buddhist practice of consciously breathing in suffering and breathing out love. “We live in a field of energy,” she says. “When I focus on the suffering-and-love exchange, I feel like I am keeping my own system healthy and contributing to the health of the energy field.”

The TV series Nova has a program about the earth atmosphere that showed equipment measuring a remarkably constant global electronic signature of 8 megahertz. This is kept regular by the spikes of lightning that are constantly spread through the atmosphere, steadying the electrical charge. Globally, there are some 8,640,000 lightning flashes worldwide every day! It seems even nature keeps in balance by quick energy spikes.

The process of consciously lamenting could be an often-missing link to maintaining personal balance and resilience. It could help us stay emotionally open and respond to news of the terrible with grief and lamenting instead of rage, numbing, and hopelessness.

Please try making a place for lamenting in your life, and let me know in the comments section what you find out.

Twisted lips, contorted mouth; you know the look of someone who is biting the inside of their cheeks when they are stressed. Why do people do that? Most of us understand it as a bad habit similar to nail biting because on the surface, it would seem like a benign repetitive behavior. However, under further consideration, the behavior may be a byproduct of an obsessive and compulsive reaction to stress and anxiety.

The medical term for the behavior is chronic cheek bite keratosis, which is a body-focused repetitive behavior (BFRB) comparable to hair pulling, nail biting, and frequent blinking. It is categorized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) under obsessive-compulsive and related disorders, and is complementary with anxiety-related types of problems. Body-focused repetitive behaviors, such as cheek biting, most often begin in late childhood and can last throughout adulthood.

Since we often cannot escape the stress of daily life and the resultant anxiety associated with it, behaviors such as this manifest as a subconscious solution to ease emotional overload. While not an ideal choice, it does serve a purpose to those who use it as a coping method. Other times, it is common for boredom and inactivity to trigger the behavior. Cheek biting is self-injurious yet compulsive in nature since it feels almost normal and necessary in the mind of the biter. The compulsive nature is what makes it difficult to stop.

[fat_widget_right]

Since this behavior usually happens mindlessly, damage to the mouth tissue can occur. It is not uncommon for the biter to bite too deep and injure the mouth. Often, cheek biters have a favorite area to bite and repetitively break the skin in the same place inside the mouth. What’s worse is that when the cheek skin has been chewed and is raw, the skin feels broken and jagged, creating an additional compulsion to smooth out the affected area by biting again. This endless cycle can create physical complications only a dentist or oral surgeon can see.

Biting the soft skin inside the cheek over and over again can lead to oral trauma such as mouth sores and ulcers, but is reversible with avoidance of cheek biting, according to the Oral Cancer Foundation.

Whether it is an anxiety-related problem, an obsessive-compulsive issue, or just a bad habit, it is clear that the behavior is not ideal and potentially harmful. However, stopping the biting is a challenge because the biter is not immediately aware of when it is happening and why it is being used as an answer to stress and anxiety. The first line of defense is to lower the affected person’s stress level and provide alternative and healthy anxiety solutions. Stress and anxiety can be lowered multiple ways, most effectively by exercising regularly and eating healthy. After that, removing stressful situations and triggers should be evaluated. Additionally, treatment including mindfulness training and meditation is almost always useful. Learning to be aware and present in each moment allows the person to be in control of behaviors. While easier said than done, mindfulness and meditation are empirically proven to improve mental health.

Often, body-focused repetitive behaviors such as cheek biting respond well to talk therapy that includes techniques drawn from cognitive behavioral therapy and its subcategories dialectical behavior therapy, habit reversal therapy, and acceptance and commitment therapy. Although no one approach works for everyone, an eclectic sampling may work well. These therapies are based on the idea that obsessions and compulsions, like body-focused repetitive behaviors, help people experience stress, anxiety, and emotions without reacting negatively to them in the form of a behavior. The goal is to experience life without needing a compulsive outlet, like cheek biting, to handle what comes.

Robert’s palms were sweating and his heart was pounding. His big presentation was scheduled in less than an hour and he was starting to panic. What if he forgot his lines? What if he made a complete fool out of himself? His job was on the line and his anxiety was building.

Jenny was also apprehensive. She’d been trying to muster the courage to ask her boss for a raise for several weeks now, but every time she thought about doing so, she became too nervous to say anything.

We have all experienced anxiety at one time or another, although some people tend to struggle with nervousness more than others. Some of the common symptoms of anxiety are feelings of fear or panic, repetitive thoughts about the situation, difficulties sleeping, muscle tension, increased heart rate, shortness of breath, restlessness, nausea, and cold or sweaty palms and feet.

Part of our discomfort stems from our fear of being criticized, ridiculed, or rejected. We all have a basic need for love, acceptance, and validation, and tend to avoid situations that will jeopardize our relationships with others in any way. This is especially true if we have grown up in dysfunctional families, where these primary needs were not met and we were taught instead to behave in certain ways to please others and discount our own needs and emotions.

[fat_widget_anxiety_right]

We also frequently tend to play over and over in our minds the worst-case scenario, which only leads us to feel even more anxious about the situation. Rather than visualizing the outcome that we are hoping for, we make ourselves sick with our inner horror stories.

So how do we go about coping with anxiety in a healthier way? The following are some helpful techniques to begin to get our fears under control:

1. Take 10 deep breaths, focusing on the sensation of expansion in your chest and abdomen that occurs while inhaling and the release while exhaling.
2. Take some time the day before a stressful event to become physically active. Working out or going for a long walk are ways to decrease your stress levels. Doing so will also help you get a better night’s sleep.
3. Before bedtime, journal about your feelings of anxiety and the obsessive thoughts you have been having. Putting your emotions down on paper can often get them off your chest and prevent you from ruminating about them throughout the night.
4. Whenever you start to imagine the worst-case scenario, try to picture what you would like to happen instead. For example, if you are worried about an upcoming speech that you have to give, imagine remembering your words with ease and receiving a standing ovation afterward.
5. Lower your stress levels by doing relaxation techniques and/or listening to calming music. Help your physical body to relax by lying down or getting into a comfortable position, then progressively focus on contracting each of your muscles then releasing them. Start with your toes and feet and slowly work your way up to your face and scalp.
6. Try to gain some perspective about your fears by thinking about other times in your life that you may have dealt with a similarly difficult or stressful situation. How did you cope at that time? What are some of the strengths that you used then and can call on again?
7. If you are feeling anxious about talking to your boss (or another authority figure) about a specific problem, consider trying to role-play the conversation with a friend or therapist first. Practicing what you will say can help you feel more comfortable when the time comes to actually have that conversation.
8. Use mindfulness to tune into the emotions that you are feeling and allow yourself to feel them fully. Much of the time, we avoid the direct experience of our emotions, especially those that are uncomfortable, such as fear and anxiety. This tends to intensify the uncomfortable feelings rather than diminish them. To experience them, try to tune into the actual physical location in your body where the tension or fear is stored. Do you feel a knot in the pit of your stomach? Are your neck and shoulders tensed up? Allow yourself to fully experience the physical sensations and you will often find that they shift as you accept and honor them.

If you have tried some or all of these techniques and are still experiencing a considerable amount of anxiety, you may want to consider working with an empathic therapist. Although a certain amount of anxiety is a normal part of life, when stress becomes overwhelming and starts to interfere with our ability to function on a day-by-day basis, help is likely needed. Working with a compassionate therapist can assist you with facing some of your fears in a safe setting and bring you back in touch with your innate sense of peace and joy.

Mass shootings are quickly becoming a new norm; over 900 people have died in mass shootings in the U.S. since 2006. And while many people agree that the mental health system needs work, some “solutions” could undermine the rights of people with mental health issues. U.S. Representative Tim Murphy, a psychologist, proposed a bill in 2013 called the Helping Families in Mental Health Crisis Act. In response to several recent shootings, Murphy has begun advocating for the benefits of his bill, but a provision in the legislation could force some people with mental health concerns to take psychotropic medication.

About the Bill

The legislation is more than 100 pages, and offers numerous proposals for addressing mental health issues. One proposal is the use of a treatment protocol called assisted outpatient treatment (AOT). This treatment approach, already legal under some circumstances in 45 states, permits courts to order a person with a history of “medication noncompliance” to take psychiatric medications. Murphy’s legislation would greatly expand the power of courts to force medication on people with mental health issues.

Why Forced Medication Is a Problem

Forced treatment is controversial even when violence and severe mental health issues are factors, but forcing someone to take medication simply because of a history of medication noncompliance is even more troubling to many mental health professionals. The Substance Abuse and Mental Health Services Administration and the Protection and Advocacy for Individuals with Mental Illness Program, two government administrations dedicated to mental health care, both oppose forced treatment.

The trouble with forced treatment doesn’t end there, though. Sometimes those with psychiatric issues stop taking medication for good reason. Particularly among people with severe symptoms, medication can cause serious—and sometimes even life-threatening—side effects.

[fat_widget_right]

Not all medications work for all people, which means a person forced to take medication could be forced to undergo serious side effects even though the medication doesn’t improve mental health symptoms. Therapy can be just as effective as medication, and therapy can actually be more effective than medication at treating some mental health issues. By forcing people with mental health issues to take medication, courts privilege one treatment over another.

Perhaps most importantly, forced treatment undermines the autonomy of people with mental health conditions. Courts have repeatedly ruled that simply having a mental health condition does not remove a person’s fundamental rights. Forced treatment, however, destroys the hallowed concept of informed consent. It could also deter people who need help from seeking it.

Is It Legal?

Whether or not Murphy’s bill is legal is an issue for legal scholars. However, legislation can’t generally be ruled illegal until someone brings a lawsuit alleging that a law is unconstitutional. This means that, if Murphy’s bill becomes law, the issue could ultimately be heard by the Supreme Court. Even if the Court rules that the legislation is unconstitutional, it could affect thousands of people before being struck down.

References:

1. Assisted outpatient treatment laws. (n.d.). Retrieved from http://www.treatmentadvocacycenter.org/solution/assisted-outpatient-treatment-laws
2. Grossman, D. (2014, June 4). Scary new congressional bill would force medication on some mentally ill people. Retrieved from http://www.alternet.org/personal-health/scary-new-congressional-bill-would-force-medication-some-mentally-ill-people
3. Mass shootings toll exceeds 900 in past seven years. (2013, December 02). Retrieved from http://www.usatoday.com/story/news/nation/2013/02/21/mass-shootings-domestic-violence-nra/1937041/
4. Nordal, K. C. (2010, November). Where has all the psychotherapy gone? Retrieved from https://www.apa.org/monitor/2010/11/perspectives.aspx

How do you stay married? One way is to be sensitive to each other’s needs and to compromise every now and then. That means taking turns getting one’s way, or finding a third way that suits you both.

I bought tickets to a concert months ago; I bought them because I’m the one who wanted to go, and my husband acquiesced because he is a good sport, better than I am. But when the time came to go (actually, the night before), I saw he wasn’t feeling that great and the concert promised to be a brawl anyway so I suggested we stay home. He agreed immediately because he thought I was tired, he said, even though we must have both known he felt lousy too and never really wanted to go in the first place. He told me he was skipping the concert for my sake. He’s done this before, where he indicates he’s doing something for me but it’s really for him. Occasionally I point that out, but this time I didn’t. And he was right; I was tired. This spring has been a rough time in many ways for us both, and I’m not talking about the weather.

I had bought the tickets looking forward to us having a good time together, but now I didn’t think it would be fun with him punky and me tired, although I felt disappointed. I knew someone who would probably like to go to the concert, so I gave her the tickets and got to be generous twice with one gesture. It all added up: two tickets minus two people who didn’t want to go plus two other people who did want to go equals four happy campers. My math may not be that good, but you get the idea.

[fat_widget_right]

Relationships are not logical like math. The numbers don’t always add up; they are about the space between people, the back-and-forth flow, feeling the whole being of the other. That takes time, determination, an open heart, and a sensitive touch.

Oh, and by the way, on the day of the concert I was very busy and tired and glad to have an early evening. When work was over, my husband and I met at a local restaurant, had a lovely dinner together, and went home feeling happy and connected. We had found the third way, a low-key evening that pleased us both.

Eighteen qualities that help make a marriage last:

1. Trust. Our marriage space is sacred and private.
2. Restraint. We resist temptation and remain true to each other.
3. Intimacy. We are open with each other.
4. Priorities. We both put our marriage first.
5. Difference. We respect each other’s differences, and know that difference lends interest.
6. Sameness. We share basic values, some interests, and tastes.
7. Communication. We speak up and communicate our needs, likes, dislikes, agreements, and disagreements.
8. Fairness. We play fair.
9. Respect. We demonstrate it.
10. Emotion. We get mad at each other sometimes; we are human.
11. Reconnection. We get un-mad. If it takes a day or so, we live with it and work on letting the anger go.
12. Humor. Having a sense of humor helps.
13. Gratitude. We are so glad to be together, and we say so.
14. Truthfulness. If we have to say something that might be hard for one of us to hear, we tell the truth, and we try to say it gently and clearly so that the other person can hear it.
15. Sensitivity. We know where the buttons are and are careful not to push them.
16. Persistence. Staying married takes time, determination, and hard work.
17. Forgiveness. For your partner and for yourself, too.
18. Teamwork. We help each other grow.

I’m sure there are many other qualities that you can think of that help a marriage stay healthy and alive, and I’d love to hear from you. What things do you and your partner consider important? How long have you been together? We first met in 1980 and have been together ever since.

For people who define themselves as socially awkward, the perceived risk of being seen in endlessly negative ways—inadequate, ugly, boring, stupid, anxious, depressed, empty, arrogant, fat, pathetic, etc.—is always present. When I think about people in therapy who see themselves as socially awkward, I find little correlation between how I experience each individual as a social person and how they think of themselves. Every one of them seems to have characteristics that I enjoy and admire, and they are often (but not always) in occupations of respectable social status. However, for the “socially awkward” person who supposedly “knows” how little they have to offer to the world, the facts of their occupational status or character are irrelevant.

What I have come to recognize about many people in therapy who feel severely socially awkward is that they share the belief that when they were growing up they missed out on learning the rules of social discourse. As a consequence, they are intensely anxious about how they will be responded to if they are socially off the mark. For example, Robert, an attorney, worries about phone calls and what to do after you say hello. Paula, an information technology manager, panics about being in a social situation and not knowing how to approach someone. Tanya, a college graduate, unemployed for the past year, keeps asking “what are the rules, how long do you talk with someone at a party and how do you get yourself out of a conversation?” Everyone worries about silence and eye contact.

While many of us might experience similar social concerns, a “socially awkward” person believes that their anxiety and inability to navigate these situations will be blatantly evident, and they expect to be responded to with rejection and disgust. Even when there are no evident responses that confirm their fears, such people continue to experience bad feelings about how they behaved and consequently justify their continued self-attacks and self-hate.

[fat_widget_right]

Parental Expectations

A major source of the feelings of social inadequacy and the consequent self-hate that people often express is related to parental expectations. Both Tanya and Robert had parents with very high expectations. Robert talked about his parents pushing him to work harder at all the extracurricular activities they insisted he engage in: “They thought I was a virtuoso and kept pushing me to do more with the violin. My mother kept telling me what a wonderful writer I was and that I should try and get published. But she also insisted on critiquing any creative writing I tried.”

Tanya described how her parents pushed her to succeed in high school so she could get into an Ivy League school: “They would compare me to their best friends’ son and list all his achievements. On the surface, they seemed to be saying they thought I had what it took to be superior. But I never felt I could really be good enough, no matter how well I did. I upset them when I didn’t apply to Harvard, but I couldn’t bear the thought of disappointing them by not getting in.”

Paula also was negatively affected by her parents’ expectations. They wanted her to “be good.” The worst thing she could do was make anyone outside the family think any negative thoughts about her. This would shame and humiliate her parents and result in physical or verbal abuse. The most Paula could hope for from her parents was to avoid anger and criticism. She recalled: “My mother would scream and berate me if I didn’t smile the right way at a neighbor. I remember, when I was about 9, she dragged me from the Thanksgiving table at my aunt’s house because I didn’t say ‘please’ when I asked for the turkey. I was a very scared kid and never knew when I was going to get hit or criticized. I never knew what the right thing to do was. I still don’t know.”

The Importance of the Audience

Robert and Tanya needed to be high achievers so the parents could feel pleasure and ego satisfaction about their parenting. By pushing achievement on their children, the message, consciously and unconsciously, was that you must do more, be better, and shine or you will hurt and disappoint me. For all three people in therapy, the ultimate authority on how they were doing as children was the social audience their parents looked to and empowered. Most importantly, the incredible power of the “audience out there” cast the final judgment on how the parents were doing.

Without audience approval, the parents felt inadequate and humiliated and put the responsibility for these bad feelings onto their child. The parents held the child responsible for their own feelings of inadequacy, which were then attributed (projected) to the child who was designated as inadequate. The child not only felt the shame of insufficiency, but experienced the badness of having socially hurt, disappointed, and shamed the parents. It is no surprise, then, that for the humiliated, “inadequate” child, the social world would feel like a constant source of scrutiny with the mission of detecting and identifying the guilty party.

Developing Feelings of Social Adequacy

These three individuals have great certainty and strong emotional attachments to their belief that they are socially inadequate people. While they typically begin therapy with some hope that they can do something to improve their experiences, feelings of hopelessness often outweigh the hope. The journey to feeling more socially able begins with people becoming aware of the ways in which their social awkwardness has been shaped and confirmed by their early and continuing life experiences. While this provides a rational understanding of how their feelings of social inadequacy developed, it does not alter the strong emotions that arise when they find themselves in social situations.

I often hear about their intense anxiety in social situations and how they become panicked. With intense agitation, they scan faces of others to detect the expected negative reactions. If I wonder how it would be if I helped them to strategize for a social situation, the response is usually negative: “It won’t work; I’m too anxious; it’s useless.” I believe this is an expression not only of hopelessness but of the self-hate that the person feels. If I can help the person reflect about this and put his self-hate into words, it can help break through the paralysis and allow the person to agree to try and practice some new behaviors before a social situation.

Even when a person may bravely go to the party and try out a strategy, it is unusual for the person to feel that he or she has had success. As Robert told me: “It was horrible. I saw a woman standing alone near the bar and I went over to her and introduced myself and asked her name and how she came to be at the party (like we planned). I couldn’t make eye contact very well, but I tried. She did answer my questions, but then this other girl came over and started talking to the first girl and I panicked. I couldn’t say anything and left.”

The example above illustrates how, even with a strategy, it is difficult to succeed with the plan. What is even more difficult is to change the negative feelings about one’s self that influence our social behaviors. With considerable work, repeated experiences of small successes can lead to incremental but steady changes in behavior and self-perceptions.

I am going to list some steps that represent what happens in the therapy process that can help in altering self-defeating behaviors and feelings of self-hate and social inadequacy. To undertake these steps, with or without the help of a therapist, requires commitment to tolerate frustration and painful unwanted, and intolerable feelings. There must be a willingness to fail and try again repeatedly.

Steps to Changing Feelings of Social Inadequacy

1. Gain knowledge through self-reflection to hypothesize how your “social awkwardness” has been shaped and confirmed by your life experiences.
2. Self-talk to remind yourself of (1) positive qualities, (2) feelings that seem intolerable, and especially (3) your resilience, i.e., ability to withstand those intolerable feelings. (After all, you are still standing and functioning, and have had many encounters with those feelings, and you’re still here.)
3. Develop strategies to help manage behavior in social situations, e.g., what to say when approaching a stranger at a party or subjects to talk about on a date. (Google your questions if you can’t come up with your own strategies.)
4. Try out behaviors and be prepared to fail.
5. Learn to see failed attempts as success. This means overriding old patterns of self-attack and bad feelings and allowing yourself to feel courageous for trying.
6. Try out behaviors again and be prepared to fail again.
7. Keep trying to feel successful for trying.
8. Repeat steps 1 through 7 as long as necessary until you begin to feel more positively about yourself and more able to tolerate your unwanted feelings.
9. Come up with a new thought which reflects positive feelings about yourself.
10. Come up with a new thought about yourself as someone who is feeling a little more socially adequate.
11. Allow yourself to consider that you can change and be aware of your anxiety about change.
12. Keep repeating steps 1 through 11.
13. Never stop working on developing positive feelings about yourself.
14. Never stop working on your ability to tolerate unwanted feelings, change your behavior, and feel positive about yourself.

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

Therapy can be a wonderful tool to help people live happy, fulfilling lives. Therapy addresses a wide range of mental health issues such as depression, anxiety, and grief, but therapy can also be used for purposes other than immediate mental health concerns. For example, if you are struggling with the stress of a new career, a therapist can help you develop strategies for managing the stress to get the most out of your new job. Read the answers below from therapists who explain what therapy can accomplish:

(more…)

Hoarding is a serious mental health condition that can expose people who do it to dangerous living conditions, the derision of family and friends, and social isolation. About 5% of the world’s population hoards, but only about 15% of people who hoard recognize that their behavior is irrational. If you’re concerned about someone you love who hoards, you can’t force your loved one to get better. You can, however, provide a supportive environment that encourages your loved one to seek help and makes recovery possible.

Don’t Take Their Possessions

If your loved one’s house is covered in old magazines or unused clothes, it can be tempting to “cure” him or her by taking the items he or she hoards. This won’t remedy the underlying problem, though, and it can destroy your relationship with your loved one. Moreover, people who hoard can experience serious emotional distress when their possessions are taken, so your good intentions may actually harm a person you love.

Don’t Enable the Behavior

While you can’t stop someone who hoards from hoarding, you can avoid enabling the behavior. If your friend hoards antiques, don’t invite her to go antiquing. If your mother is a compulsive collector, don’t add to her collection at every birthday and holiday. Don’t offer to store hoarded items for a loved one, and if you live with someone who has been hoarding, don’t allow their possessions to overtake your home.

[fat_widget_right]

Educate Yourself

To the outside observer, hoarding just doesn’t make sense. If you want to help a loved one, learn as much as you can about this condition by reading websites, consulting mental health professionals, or even attending a support group for people who want to love and help people who hoard. Once you understand the fear, loneliness, and anxiety associated with hoarding, you may be better able to offer empathy and support.

Recognize Small Victories

Particularly among people who hoard who have had the habit for years, it can take months or years to get rid of hoarded possessions and for progress with the issue to become visible. If your loved one doesn’t feel like small victories matter, he or she will have little incentive to keep trying. Help your loved one celebrate small victories by praising them for throwing away a few items or refraining from buying new ones.

Help Them Sort Their Belongings

Some people who hoard accumulate so much stuff that it fills an entire house. Even after your loved one stops hoarding, he or she may have an entire home filled with hoarded items. Volunteer to help your loved one sort through his or her items and clean out the home. Some companies specialize in helping those who have hoarding issues clean up, so if you and your loved one are daunted by a packed home, consider contacting an organization that can help.

Don’t Clean Up for Them

Although helping your loved one sort his or her possessions can be helpful, doing it for him or her is not. Likewise, you can’t expect that the person in your life who is hoarding will make progress if you force him or her into treatment. These individuals need to make independent decisions, and this might mean waiting to intervene until the person you love is ready for help.

Help Your Loved One Find Treatment

Taking the first step toward treatment can be daunting, and it’s not always easy to find a qualified therapist. Don’t force your loved one into treatment, but consider researching treatment providers so you can offer information when your loved one is ready. GoodTherapy.org can help you find a therapist who specializes in hoarding.

References:

1. Hoarding and OCD, stats, characteristics, causes, treatment and resources. (n.d.). Retrieved from http://www.namimass.org/hoarding-and-ocd-stats-characteristics-causes-treatment-and-resources
2. Hoarding: The basics. (n.d.). Retrieved from http://www.adaa.org/understanding-anxiety/obsessive-compulsive-disorder-ocd/hoarding-basics
3. How to help the hoarder in your life: Some suggestions. (n.d.). Retrieved from http://www.ocfoundation.org/eo_families_of_hoarders.aspx