Category: mental illness

Developing a Philosophy of Wellness

Your philosophy of wellness shapes your expectations of what you want to get out of your time in therapy. In the first few sessions, I try to get a picture of what my clients are looking for. Most give an answer like this:
“I want things to go back to how they were before”
“I just want to feel normal again”
“I want to feel good and for everything to be okay”

Many people have a philosophy of wellness that looks something like the above examples. They have some idea of a time when things were going well, and they want to have that feeling all the time. There are two problems with this kind of philosophy. First, it’s not realistic to expect that things will be good for you all the time if only you can reach a particular point of wellness. Second, the idea of “good” and “normal” is undefined and nebulous, and it’s hardest to hit a moving target.

To address these problems, we can safely say that we need to develop a philosophy of wellness that accounts for the normal ups and downs of life. Your definition of what it means for you to be and feel well can’t depend on your life circumstances always being positive. And your understanding of wellness should include specific, measurable targets that are well defined and understandable.

With that in mind, what does it mean to be well? What does it look like in terms of how I behave? How does it feel mentally and emotionally? How do I handle negative experiences when I am well? I’ll show you how I answer these questions and how I use them to develop an overarching philosophy of wellness.

To me, being well means that I am okay with just being. When I am unwell, I tend to rush around and have a sense of striving in hopes of working myself into wellness. When I am well, my actions show it by the pace. Instead of a frantic energy, my behavior is characterized by a centeredness that shows even when I am working quickly. When I am well, this centeredness allows me to be more patient with my family, more open to my friends, and more able to respond to events rather than react. My feeling mentally and emotionally is calm and open, and when I am doing very well, I am curious, creative, and energized by new ideas. When I am well, I handle negative experiences thoughtfully without being derailed by anxiety or panic. I am able to process and analyze the situation, asking for help without feeling frantic or shutting down. I am able to deal with catastrophic thoughts without being caught up in them.

My natural tendency is toward anxiety, so my philosophy of wellness is focused on my ability to move away from my unwellness- frantic, striving, rushing, catastrophizing- toward its opposite. For me, that means calm centeredness, openness, curiosity, and creativity. I feel it mostly in my chest. The sense of striving feels tight and hot, and I notice it in my breathing. I also feel it in my mind. The thoughts move from swirling, ruminating, overwhelming, catastrophizing into stepping back, watching the thoughts without being swept up in them, taking time to think clearly.

So while there’s nothing really wrong with saying that you want to feel normal again, or back to your old self, I’d like to challenge you to really dig into those statements. Make them more specific. What is it that you’re feeling right now that you’d like to manage differently? How would you prefer to handle difficult circumstances? What was different about your behaviors, thoughts, and emotions in the past? How do you know when you’re feeling well or unwell based on your physical sensations in your body, your behavior, and your thoughts?

Dementia Caregiving- Loss Before Death

A diagnosis of dementia in a parent can feel like the beginning of the end. Many caregivers describe the day of diagnosis as the day that they truly lost their parent. It’s an isolating feeling, being with your parent while actively missing who they were.

The changes can highlight these losses. Caregivers are often struck by the sheer difference between their memories of their parent and the current reality. It is incredibly painful to watch a kind, loving person turn nasty during their sundowners and become vicious in their verbal attacks. It is differently painful to watch a strong, independent person become hesitant and withdrawn in their confusion.

The change in role can be difficult to navigate as a parent becomes dependent on their children for caregiving and decision making, and the caregiving child becomes tied down by their parent’s increasing dependence often after many years of living apart.

The issue of caregiving can break families apart as siblings either try to pass the buck to avoid the responsibility or each clamor to put their opinions in the ring and get the care decisions to go their way. As a caregiver, you may feel swamped by hearing from others what you “should” be doing from people who are not willing to lift a finger or send money to help.

All the while, you as the caregiver are navigating the day to day realities of providing care to someone with dementia. It’s not just an opinion to you, it’s your life and reality, and it can feel insulting for someone who isn’t in your situation to think they know better than you what you need to do.

At the same time, you are not just a caregiver. You are a person worth time off, breaks from caregiving, and your own separate life from your parent. There is such a pervasive myth that caregivers should be quietly dedicated to solely providing gentle care to a parent who calmly accepts our aid with gratitude. The reality is so different as you know.

Caregiving can last for years, and too many caregivers come to the end of their parent’s life resentful, burned out, lonely, and isolated. If the totality of your life has been given over to caregiving, you may reach the end of your time at a high risk for suicide.

It is vitally important that as a caregiver you stay connected to your community whether that means staying employed, keeping up with your needs, maintaining your hobbies, and nurturing your relationships. You are important in so many ways, not only for what you are doing for your parent, but in terms of your own intrinsic worth.

Dementia derails the entire family, but mostly the caregiving person. You are essentially losing your parent as you see the person they were giving way to the progression of the disease. You are at risk of losing yourself as well, as you are asked to do more and more for your parent. Family disagreement over the care process fuels the sense that things are breaking apart.

Caregiver support is so necessary. As a caregiver, it is important that you prioritize yourself through the process. Therapy is one possibility for support, and there are also so many groups available for you to get to meet with peers going through the same thing.

Narratives of Failure

The stories you tell yourself about how and why you fail are important. You can reshape your meta-narratives to tell a story of fullness instead of blaming, brokenness, and victimhood.

Your meta-narrative is the way you think about life, the story you tell yourself to interpret what’s going on in the world and how it connects back to your own life.

In general, if your meta-narrative is positive, you will be happy and go through life focused on good things and covering over or explaining away the bad things. Similarly, if your meta-narrative is negative, your focus will be on the bad things instead of the good things.

Your meta-narrative can also be passive or active. When you think about your life, do things seem to just happen to you or are you in control of crafting your path through obstacles?

This is best seen in terms of the narrative you tell yourself when you fail.

When you fail an important test, lose a bid on a contract, have your hours cut, get passed over for a promotion, or get rejected romantically, what is the story you tell yourself about how and why this happened?

Let’s look at some of the most common failure narratives people use.

Blaming. Many times, you can comfort yourself through failure by justifying it as another person’s fault. You failed the test because the professor wrote the questions poorly or didn’t teach well enough. You weren’t chosen for the special team or project because the boss hates you or because another, less deserving coworker did something to suck up to the boss to get chosen. The problem with a Blaming failure narrative is it takes all the responsibility off of you. If it’s not your fault, you don’t have to look at the ways you may have contributed to the outcome.

Broken. Instead of passing all the fault to others around you, a Broken narrative assumes the fault is an intrinsic part of your character. You had your hours cut because you’re the worst employee and it was only a matter of time before your boss found out. You were turned down for a date because nobody could ever love you. Again, the problem with the Broken narrative is it takes responsibility away from your actions and puts it on your character, or who you are as a person.

Victim. This narrative feels chaotic since your life is completely out of your control. Things just started happening to you one day and since then it’s one thing after another. Nothing seems to go right at home or at work. Like the others, this narrative also takes the responsibility away from your actions but instead of putting it on yourself or others, it’s just that Life or the Universe or God has it out for you.

Do you see the common thread? All these bad narratives deny personal responsibility. A healthy narrative looks at all aspects of a situation. You, your thoughts, and your actions have a part to play in your failure. Regardless of what others do or don’t do, the contributions of your character and personal history, or your external circumstances, a healthy narrative centers around what you do in response.

Life will always happen, and your meta-narratives about life and your part in shaping it will affect the way you respond to events. Do you notice Blaming, Broken, or Victim stories when you think about your life, particularly your failures? If these have become your habitual responses to failure, therapy can help you untangle your unhelpful meta-narratives and create new ones that support you in thriving through life.

What is ACT?

Curious about ACT? Check out this overview to see if it’s right for you.

ACT stands for Acceptance and Commitment Therapy. ACT is a kind of cognitive therapy that works to help you live your desired life by identifying your values and aligning what you do to make sure your values come out in how you live.

ACT is best explained through a metaphor. One of my favorites is the metaphor of the backseat drivers. Imagine you’re driving a car toward the life you want to live. But fear, anxiety, sadness, grief, and all their friends are piled in your back seat talking over you and pointing you down different roads.

You can pull over, stop the car, and work on trying to get the backseat drivers out of your car. But it takes a lot of effort to get rid of them, and while you’re doing that you’re not moving forward in your life. And when you get back on the road, those backseat drivers will eventually find their way into your car again.

ACT believes that the most effective way to get to your desired life is to keep driving. Focusing on the backseat drivers only leads to a crash. And stopping to get them out of your car is a lot of effort for not much payoff. It might be difficult to learn how to tune them out, but the important part is that you keep going where you want to go, not derailing your dreams because of anxiety, not taking a different path because your low self-esteem says you don’t deserve to get what you want.

This takes effort. The first part of ACT is based in mindfulness. You need to know how to tell the difference between your unhelpful backseat driver thoughts and your core self and its desires.

Once you can separate your unhelpful thoughts, you’ll learn skills to simply observe your thoughts as they come up rather than reacting to them. Observing in the present moment is a key skill.

Then we’ll start looking at your values. Everyone has different values, but because they’re such a core part of who we are, it can be hard to recognize them and put them into words.

Finally, your values will turn into committed action. You’re probably already living out your values in some areas of your life, but we’ll look at where you need help reshaping your life. We’ll identify specific action steps for you to take to transform your life to align with your values so every day feels purposeful and meaningful.

ACT helps anyone who feels like their thoughts and emotions are out of control backseat drivers who are derailing you from living the life you want. It works well for both individuals and couples. ACT has special workbooks for anxiety, depression, couples’ issues, and even chronic pain. But like most cognitive therapies, it can be helpful even if you don’t identify with any of those categories.

If you’re interested in ACT or in learning more, text, call, or email me for a free consultation.

Couples Counseling for One

Couple’s therapy can still be effective even if your partner doesn’t want to work with you to change the relationship. Individual therapy with a couple’s focus is possible and effective.

You may know there’s a problem in your relationship, but your partner isn’t willing to go to therapy with you. Does this sound familiar? If it does, there is hope.

Most people think of couple’s therapy as sessions with all partners in the session where they learn and practice skills to improve the relationship. While this may be an ideal for couples to transform their relationships, it’s certainly not uncommon for only one person in the relationship to want to go to therapy and put in the work for change.

Being an individual doing couple’s work can feel awkward or strange. You’ll learn communication skills that your partner isn’t learning along with you. When you go to practice your new skills, they may respond in a way you didn’t want. It can feel devitalizing and demoralizing.

But even if both of you attend couple’s sessions, these scenarios may still happen. Skills you both learn and practice with the therapist may be difficult to bring into your home. This is a normal part of growth and change.

It only takes one person to change a system. As an individual, your work in therapy can transform your relationship even without your partner participating with you. It may take more work on your part, but it is not only possible, it is effective!

I use the Gottman method with couples, and it is also a valuable resource for individuals to learn to change their relationships. If you are feeling disconnected from your partner, wanting better communication, or looking to revitalize your relationship, you can!

Reach out today to start the process of building a solid foundation for your relationship to grow and flourish.

Therapeutic Journaling

Keeping a journal can be very beneficial for your mental health, but not all journaling gives you the benefits you’re looking for. If you want to make the most out of your writing time, try these tips to make sure your journal is a therapeutic part of your day.

Know your focus. Journaling for therapy benefits is different from simply keeping a daily diary. Dedicated therapy journals should focus on the issue you’re dealing with. If you’re trying to be more outgoing to improve your dating life, your therapy journal should focus on your thoughts, feelings, and dreams about dating as well as reminiscing about past dates, family attitudes about dating, and your ideal dating life.

Keep it secure. One of the major drawbacks of traditional journaling is that your intimate details are open to the world. Whether you lock it up, hide it away, or use a private online journal, it’s important to keep things secure. Journaling for therapy is most beneficial if you can be completely honest and get everything out, but you won’t want to do this if you’re worried about someone else getting access. Find a secure place to keep your journal so you can get the most by being the most honest.

Stay in the habit. Just like traditional therapy is most effective when you go weekly, therapeutic journaling is most beneficial when you practice often. Regular journaling is the key to noticing trends in your thoughts and emotions. This is most important if you’re using journaling to help track depression or anxiety. The more you can observe yourself and your processes that might be fueling your negative emotions, the easier it will be to learn how to interrupt those processes and overcome the cycle.

Check in with how you feel. For the most part, therapeutic journaling is highly beneficial. But if you notice yourself feeling more angry, tense, or sad after you spend time writing, you might be using your journal time wrong. If your journal is just a repeat of the negative thoughts, feelings, and experiences you had in your day, it might easily make you feel worse by the end. This is a sign you need to change up your focus. Instead of writing down why everything is the worst, use your journal space constructively to challenge your negative thoughts and reframe them to something more positive and helpful.

 

Was this helpful? Look out for future series on journaling tips just for anxiety, depression, parenting, and relationships!

About Anxiety Disorders

Anxiety disorders are common. Learn about the three types of anxiety and the best ways to treat them in this introductory post.

Anxiety

Along with depression, anxiety disorders are the most prevalent of all mental health problems. The majority of people, sometimes estimated as high as 80%, will experience clinically significant anxiety during their lifetimes.

What Causes Anxiety?
There are a number of possible causes for anxiety. The three general categories are environmental, biological, and psychological. A serious anxiety disorder may involve one source or several. Different treatments will be more or less effective depending on the reason for your anxiety. Talking with a therapist about your anxiety can help you identify the reason for your anxiety and how it can be treated.

Environmental anxiety comes up when you are in a stressful situation. Outside stressors from your personal life, work, school, or home can result in clinically significant anxiety. When you deal with the stress, either by managing the situation or increasing your coping skills, the anxiety usually diminishes or goes away. Therapy can help you find ways to manage your environment to reduce stress. A therapist can also help you develop skills to increase your internal resilience to stressful situations that you can’t control and come up with things you can do to manage your feelings of anxiety in those situations.

Biological anxiety is caused by neurochemical imbalances in your brain that result in you feeling anxious even though there is no apparent reason for the feeling. These imbalances can happen for a number of reasons, and they can be treated by re-balancing your neurotransmitters through medication. There are several different kinds of medications that can be effective, and your doctor or psychiatrist can walk you
through your options. You may also benefit from therapy even with medication because when you experience anxiety, you can learn negative thought patterns that may continue even on medication.

Psychological anxiety is the result of your thought patterns. When you focus on anxiety-provoking thoughts, you begin to feel anxious. The feeling of anxiety reinforces the negative thought patterns which results in feeling even more anxiety. This kind of anxiety is treated best with therapy, though you may need medication to help break the cycle of negative thoughts before therapy is effective. Therapy can help you change the way you think to help you feel better.

Any questions about anxiety you want answered by a therapist? Leave a comment below or send a message and we may feature your question in a future post.

Treating Refractory Schizophrenia

Refractory schizophrenia occurs in about 30% of cases. When medication doesn’t work, traditional therapy can still be effective.

I’ve recently had a few new people come in for therapy with diagnoses on the schizophrenia spectrum. Not only that, but they’ve tried a few different medications with no significant reduction of symptoms. Refractory is just a fancy way of saying treatment resistant.

As a therapist, when I hear that my new clients have treatment resistant schizophrenia, my first thought is this- Can therapy help someone who isn’t helped by medications? After all, schizophrenia is a pretty major mental illness.

It’s not like depression or anxiety where the cause could be either biological or psychological, and the origin of the symptoms shapes treatment. Instead, schizophrenia is understood as a primarily biological disorder with clear ties to dysfunction in major brain systems.

With schizophrenia, medication works to relieve symptoms in approximately 70% of cases. That’s a much lower number than I expected. That means 30% of people who experience schizophrenia get little to no help from medications. There’s a lot we don’t know about schizophrenia though, so we could see that number decrease as we learn more about the brain and how it works in mental illness. In fact, I just read an article today about scientists searching for brain cues related to major mental illness. They discovered tons of tiny factors that all play into the etiology and course of major mental illness.

But that’s a bit of a tangent. My goal was to learn if there were any therapy interventions that were designed to work for people with refractory (treatment resistant) schizophrenia spectrum disorders.

I was actually surprised to find that this has been studied by a few different researchers. I found two different treatment protocols based on CBT that were demonstrated to be effective with refractory schizophrenia. They seemed similar, with slight differences. I figured it would be easy to combine these approaches and create a protocol of my own that will hopefully be effective in my three new clients.

I’ll post the full protocol in a separate post. For now, here are the two studies I used to develop this method of treatment for refractory schizophrenia.

 

Cognitive–behavioural therapy for refractory psychotic symptoms of schizophrenia resistant to atypical antipsychotic medication. Lucia R. Valmaggia, Mark Van Der Gaag, Nicholas Tarrier, Marieke Pijnenborg, Cees J. Slooff. The British Journal of Psychiatry Apr 2005, 186 (4) 324-330; DOI: 10.1192/bjp.186.4.324
The omnipotence of voices. A cognitive approach to auditory hallucinations.. P Chadwick, M Birchwood. The British Journal of Psychiatry Feb 1994, 164 (2) 190-201; DOI: 10.1192/bjp.164.2.190