By Margarita Tartakovsky, M.S.

Dialectical behavior therapy (DBT) is a highly effective type of cognitive-behavioral therapy (CBT), originally created to treat borderline personality disorder. Today, it’s used to treat a variety of conditions, such as bipolar disorder, eating disorders and depression. DBT teaches clients four sets of behavioral skills: mindfulness; distress tolerance; interpersonal effectiveness; and emotion regulation.

But, whether you have a mental illness or not, you can absolutely benefit from learning these skills and incorporating them into your life. Below, psychotherapist Sheri Van Dijk, MSW, RSW, shares three DBT skills that can help you effectively manage your emotions and lead a healthier and happier life. Van Dijk is the author of several books, including Calming the Emotional Storm: Using Dialectical Behavior Therapy Skills to Manage Your Emotions & Balance Your Life and The Dialectical Behavior Therapy Skills Workbook for Bipolar Disorder.

Mindfulness

According to Van Dijk, mindfulness means “living your life more in the present moment, instead of allowing yourself to be hijacked by the past and the future.” By practicing mindfulness, we become aware of our thoughts, feelings, actions and reactions. We’re able to pause, check in, identify our emotions and consciously make healthy decisions.

To practice this skill, Van Dijk suggested going for a walk mindfully. “Feel your body as it walks, and notice how it just knows what it needs to do in order to move each complicated set of muscles to achieve the goal of walking.” Pay attention to the color of the sky, the trees you’re passing and what the houses look like, she said.

If your mind wanders, redirect it to the present moment. You might choose to refocus on your external experience: what’s happening around you. Or you might refocus on your internal experience: your thoughts, emotions and physical sensations. Here the key is to notice what you’re experiencing without getting caught up in it.

For instance, if you’re entangled in your thoughts, this looks like: “Susan is really nice. She’s such a great person. I wish I were more like her. I should ask her if she wants to go for coffee sometime. I’d like to get to know her better.” Instead, observing your thoughts looks like: “There’s a thought that Susan is such a nice person…”

To learn more about mindfulness, Van Dijk’s favorite book is The Mindful Way Through Depression, which, she said, comes with a great CD of mindfulness exercises.

Reality Acceptance

This skill focuses on accepting our daily experiences and working to accept the more painful events that have happened, Van Dijk said. Because fighting reality only heightens our suffering.

For instance, according to Van Dijk, you’re sitting in a work meeting, bored out of your mind. You start thinking about all the other things you could be doing. Instead of telling yourself, “I have so much stuff to do; this is a waste of my time!” you remind yourself: There’s nothing I can do. This is something I have to sit through. It is what it is. Breathe.”

She also shared these additional examples: You need to rush home, but you’re catching every red light. Instead of getting frustrated, you take a deep breath and tell yourself: “It is what it is. I’ll get home when I get there.”

You need to fill up your car, but gas prices have skyrocketed. Again, you breathe deeply, and say to yourself: “There’s nothing I can do about it. I need gas. Getting angry isn’t going to help.”

You have to walk to work because your car is in the shop. It’s not far, but it’s pouring. You take a deep breath and say: “It’s just rain. I’ll bring a towel, and I’ll dry off when I get to work.”

This skill speaks to being less judgmental in general. Van Dijk suggested starting to notice when you judge things as good or bad. Negative judgments tend to boost our emotional pain. So when you’re angry, irritated or frustrated, pay attention to what judgment you’re making, she said. Then focus on replacing that judgment with a fact and any emotions you’re feeling.

Van Dijk shared these examples: Instead of “the weather is awful today,” you say “it’s raining this morning, and I’m irritated because I have to walk to work.” Instead of saying, “you’re an awful friend,” you say: “There have been a few times recently when you’ve canceled plans with me at the last minute to go out with someone else instead. And I feel hurt and angry by this.”

Instead of saying, “My partner is an idiot,” you say: “I’ve been working long hours and when I got home last night my partner asked me what I was making for dinner. I felt really angry about this and disappointed that he’s not making an effort to help out.”

Being less judgmental doesn’t eliminate our pain. But it does help us reduce emotions such as anger. “[A]nd in doing so we’re able to think more clearly and wisely, opening up choices for us [such as] ‘do I want to spend energy being angry at this person?’” It also empowers us to problem solve, and again, make decisions that serve and support us.

For instance, Van Dijk took her laptop to get fixed. After she picked it up, she realized that vital presentations and documents were missing. It turns out that the person didn’t back up her C: drive because he thought she saved everything under “documents.” Understandably, Van Dijk was incredibly upset. But she took a deep breath, and instead of yelling and criticizing him, she asked what they could do.

“It might not get solved. But judging him is only going to amplify my anger, and I just don’t want to spend the energy on that.” She’s also proud of how she handled the situation, which boosted her self-respect. And it didn’t raise her blood pressure or trigger other physical issues.

Again, all of us can benefit from becoming more aware of our thoughts and feelings, accepting what is and being less judgmental of ourselves and others. Undoubtedly, these are skills that lead to a healthier life.

By Courtney Stivers, PhD

If you are in counseling now or consider seeking a therapist in the future, it is important to choose a counselor who is the right fit for you. I am always saddened to hear of an individual or couple giving up on counseling after one bad experience. Therapists are each unique in their specific approaches and you deserve one who is qualified to meet your needs.

Here are a few signs that you may need a new therapist.

Connection is missing.
It is well researched that the therapeutic alliance, or relationship, with the therapist and client is likely the single biggest predictor of success in therapy (Martin, Garske, & Davis, 2000). If you do not feel a connection or trust starting to build between you and your therapist, it might be time to consider a change.
No improvement.
You see a therapist for several months and do not feel that any progress has been made. You might even feel worse after every session. Some issues take longer to solve or learn to manage than others, but if there is no hope for change, you might need a new therapist.
Lack of boundaries.
Your counselor seems to forget that you are a client. They talk to you in depth about their own personal life or problems with no apparent therapeutic purpose. Maybe they seem a bit too interested in the details of your sex life. They want to be buddies outside of the therapy room while you are still a client. It sounds like they have boundary issues.
Distractions.
Your therapist seems to have trouble paying attention. They take calls or text during sessions. They seem to be thinking about something else. Maybe they even fall asleep. Not only is this rude, but you are paying them for a service. This is your time.
Focus is on the therapist.
It is not a good sign if your counselor monopolizes your therapy hour by talking about him- or herself. A certain amount of self-disclosure is probably therapeutic, but the therapist should not do the overwhelming majority of the talking. If you cannot seem to get a word in during your session, you need a new therapist.
Never neutral.
Your therapist clearly always aligns with you or with your spouse on every issue. Yes, there are times when a therapist might agree with one person on a concern, but this should not be a constant taking of sides. The therapist may have a personal issue that is appearing in the therapy office.
Feeling shamed and judged.
Feeling guilt because you are doing something or have done something that conflicts with your belief system might be a very appropriate response to a situation. A therapist can explore this without shaming a client and making him or her feel bad about who they are. A bad therapist might say things like “you are worthless.” If you feel constantly judged by your therapist, you need a new one.
Violating your belief system.
Every therapist has his or her own set of personal values. We cannot “not” have them. As counselors, we are not allowed to push our beliefs on others. This does not mean we cannot explore issues like spirituality, but simply that we cannot force our own values on you.
Not qualified or a specialist.
Some therapists claim to be able to treat a wide variety of issues. Many therapists truly are generalists, but I recommend that you seek a therapist that specializes in your presenting issue. They may have specialty certifications or degrees in that area. I have heard horrible stories about a therapist blaming a spouse for a client’s addiction, and the therapist was simply not trained properly in addiction. This can be very damaging.
Canceling or showing up late.
This happens to all of us from time to time. If they are consistently late or canceling often, it shows that they are not respectful of you or your time. Your counselor expects you to show up for appointments and they owe you the same courtesy.
In the end, you need to trust your gut. If you have a bad feeling about a therapist, find a new one. If you have a bad feeling about 10 therapists, then something might be off with your gut feeling.

By DENNIS O’GRADY, PSYD

10 Introductory Questions Therapists Commonly AskTherapy is about the fine art of asking directive questions. So what should you expect from your first appointment with a counselor, social worker or psychologist?

The answer is simple: You should expect easy, brain-expanding questions, questions and more questions. A “change map” (often called “treatment goals”) is then created to guide you in solving the problems that are currently plaguing you.

Here are 10 of the more typical questions a psychotherapist will ask to prime your mental pump for positive change during the counseling process. Following the question is an example of what it might sound like.

What brings you here? “It seems like you know yourself pretty well and have thought a bunch about what you would like to talk about here. People who show up here have courage galore, perhaps even a tad bit of exasperation. If you don’t mind, I’m going to ask you some questions, and take notes about what you say so I can keep it fresh in my memory. Oh, and feel free to interrupt me at any time or steer the conversation to where you need it to go. In your mind, what brings you here today?”
Have you ever seen a counselor before? “You seem pretty comfortable and confident coming in here and talking about the challenges in your life. Have you ever seen a counselor before? If so, how many meetings did you attend and for what issues? Did you achieve the results you sought, and did your results ‘stick?’ What one thing do you remember most that your previous counselor/psychologist/social worker told you? What went right, or what didn’t turn out the way you would have liked it to?”
What is the problem from your viewpoint? “Everyone has a different perspective on what the problem is, and who or what the solution is. The point of counseling is to create positive changes as rapidly as possible without feeling hurried. How do you see the problem or how do you define it? Which difficult people in your life are causing problems for you? How do you get along with people at work? How would you describe your personality? What are three of your biggest life accomplishments? Who or what is most important to you in your life? What is the problem from your viewpoint?”
How does this problem typically make you feel? “We all have problems or challenges that we must face. Are you an optimist or a pessimist? How do you feel when a problem pops up unexpectedly? Although feelings aren’t right or wrong, good or bad, every problem has a way of making us feel one way or another. So, how does this problem typically make you feel? Do you feel sad, mad, hopeless, stuck or what?”
What makes the problem better? “How often do you experience the problem? What do you think causes the problem to worsen? Have you ever not had the problem or noticed that the problem went away altogether? Have you tried certain tools, read books or pursued avenues in the past that have worked well to solve the problem? How does the problem affect your self-esteem or your sense of guilt?”
If you could wave a magic wand, what positive changes would you make happen in your life? “Setting goals creates focus. Do you regularly set positive goals for your work life, love life and fun life? What is your attitude about change? What are your positive change goals? How would you like to improve your life to be more satisfied and happy? If we can find ways to make the problem better, perhaps we can find ways to greatly reduce or even eliminate the problem.”
Overall, how would you describe your mood? “Moods come and go like the weather. Some of us are moodier than others or pick up someone else’s mood like a cold. Still others are pretty thick-skinned about emotional events. In your case, what makes you feel anxious? Is your mood like a roller coaster, or is it pretty steady? What brings you down or makes you feel blue? What’s guaranteed to make you feel up? How do you get yourself out of a bad mood? Do you use drugs, alcohol, sex, money, or other ‘mood soothers’ to make you feel better? What have people close to you told you about your moods?”
What do you expect from the counseling process? “Everyone who comes here expects something different. I believe you are paying me to help you achieve your positive goals as quickly as possible. Some people like to receive homework, some clients like to vent and have me listen, and others want a high level of interaction. How do you think you learn best? Do you think of me as your communications and relationships coach? What do you expect from the counseling process? How many meetings do you think it will take to achieve your goals? How might you undermine achieving your own goals? Do you blame anyone for your problem? Do you use good advice to grow on? How will you know when we are done?”
What would it take to make you feel more content, happier and more satisfied? “On a scale of 0-10, how content are you with your life? What keeps happening repeatedly that frustrates you? What do people keep doing that you dislike, and what do you wish they would change? How do you typically handle irritations, aggravations and frustrations? Do you get mad easily? How does your anger come out? What baggage or resentments do you carry from the past? What wrongs have been done to you that you haven’t forgiven? What changes could someone make that would really make you happy? What has been a major life disappointment? Do you feel mad when you don’t get your way or lose control? Who is pulling your strings, and why?”
Do you consider yourself to have a low, average or high interpersonal IQ? “Would you rate your communication skills as negative, neutral or positive? How well do you get along with your life partner? Do you love your life partner? What positive relationship rules do you follow? How would you describe your relationship with your kids or grandkids? Do you get along with your siblings? How would you best describe your relationship with your parents? What family conflicts have you been embroiled in recently? What relationship have you been in that you judged to be a failure? Who do you call upon when your heart is hurting to mentor you? Have you put time and money into improving your communication skills lately? What is your biggest vulnerability or Achilles heel in relationships?”
Emotional intimacy is created when you know the honest answers to the questions above.

By CAROL GOULD

Getting to the Good PartWhen I was young, my mom would drive me to the airport for my return flight to California after a visit. The trip to the airport was about 20 minutes.

Inevitably we would get into an intensely personal conversation where I would share whatever fears and insecurities I felt. At that time in my life, I was troubled and confused.

My mom would sometimes comment on how we talked more in the 20-minute car ride than we did over my whole visit. I noticed this, too, and I found the conversations in the car to be satisfying but also unsettling. I enjoyed feeling closer to my mom, but was also aware that I felt vulnerable.

The intensity of these conversations was scary. The expression of intense feelings wasn’t commonplace in my family, so the talks in the car were atypical.

As I became more psychologically aware, I realized that what allowed me to feel safe enough to share was the fact that our contact was limited to 20 minutes. We each processed the experience in the safety of our solitude, me on the plane and her in the car.

As a therapist I have had the experience where my client will spend the first 40 minutes relating details about what happened that week. Then, with only ten minutes left in the session, without warning, the client will drop down into a deeper part of herself or talk about difficult feelings.

At the next session the client might comment that “we didn’t get to the good part until it was time for me to go!” Sometimes there’s an implicit or even an explicit plea to help her get to “the good part” sooner in the hour.

The phenomenon of getting to the good part in the last few minutes of therapy is commonplace. Some therapists call this “doorknob therapy,” where clients express important material just as they are walking out the door.

Therapy clients often come to therapy with a conscious agenda of what they want to talk about, but there is always an unconscious agenda as well. The top item on that agenda is the preservation of safety.

Some people find it difficult to feel safe in the presence of another person. In their experience, closeness and intimacy lead to shame, rejection, punishment, or domination. Even the most empathic therapist can feel like a formidable obstacle to a person whose vulnerability has been exploited or disregarded, particularly in their earliest relationships.

The invitation to allow oneself to be known is like a double-edged sword. We long to express our deep, personal thoughts and feelings, but we dread the negative consequences we’re used to experiencing when we do so. The psyche protects itself by only allowing access to material that has already been processed and is therefore safe to be known.

However, as the process of therapy continues and the client repeatedly experiences the therapist as caring, understanding and nonjudgmental, the psyche’s self-protective defenses begin to loosen. Sometimes it may only feel safe to “know” certain memories and their attendant feeling states for short periods of time, like in the last few minutes of the therapy hour.

I have heard “doorknob therapy” spoken of as something that should be avoided, as if it’s not good for clients to leave the therapist’s office in an emotionally raw state, or that it’s an indication of the client’s “resistance” to the therapeutic process. Clients may feel they are wrong to leave important material for the end of the hour and that they should try to access it earlier.

But the value lies in trying to understand what it means in terms of a particular client’s psychic landscape. It can be a barometer of the client’s developing trust in herself and in her therapist. It can be an unconscious way of testing the therapist to see if she can handle the client’s scarier feelings.

Observing and exploring the phenomenon fosters a sense of safety in that there is no need for the client, or the therapist, to “do” anything other than what is already happening.

Once the meaning is better understood, client and therapist may come to some agreement on how to deal with it. Or they may simply anticipate that it will happen again, respecting the client’s need to protect her vulnerability.

When therapist and client can be curious together when important material comes to light at the end of a session, there’s a lot to be gained in terms of trust, understanding, and tolerance of intense feelings. It’s important for clients to be able to progress at their own pace, because while risk-taking is an important aspect of therapy it can only occur in an environment where the client feels safe enough to take a risk.

Sometimes we can only experience “the good part” for short, infrequent periods of time. The therapeutic pair — client and therapist — both trust that the good part is always there, waiting to be discovered and processed, and there’s plenty of time to get there.

When we were born, we weren’t handed a manual to help us manage life. Most of us didn’t have a perfect childhood, and we may have launched our lives without the necessary tools to take good care of ourselves and sustain healthy relationships. Having a great psychotherapist or counselor can ease our load by helping us understand ourselves better and learn how to navigate our lives in a powerful, authentic way. But how do you find that great therapist you can trust to guide you well on this amazing and tumultuous journey?

Choosing the right therapist takes time and a few conversations, and it’s partially an intuitive process. Remember, psychotherapy is a relationship, too. Here are a few tips to help you find that great therapist:

1. Word of mouth. Do you have friends and acquaintances who talk about therapy? Who do you see that’s really transforming and changing? Find out who helped them, and set up an introduction with that therapist.
2. Look at their website. You’ll get a feel for their language and style. What do they say about themselves, and how do you feel as you’re reading it? Do they seem compassionate, clear and straight forward? Look for specific approaches to your problems or issues.
3. Be clear about what you need. In your first session, share openly and honestly about your concerns. Let them know what you’re issues and challenges are, and what you want and expect to get out of therapy.
4. Ask them about their training. Do they have more than one kind? Do they have different tools and skills so they can customize to fit your needs? Can they approach your issues from different angles to provide more depth? Listen to their responses and pay attention to how you feel as they are speaking.
5. What personal work have they done? A good therapist is continually committed to their own personal growth. Ask them what they’ve done and how they’ve benefited from this work. You want a therapist who’s walked some of the territory ahead of you.
6. Ask them how they work. If you’re pretty clear about where you need help, you want to know how the therapist plans to proceed. Ask them how they work or ask them to show you in the first session.
7. Ask them how they can help you. Once you’ve given them a brief summary of what you’re looking for, ask them how they would help. Do you feel they’re paying close attention to what you’re feeling and thinking? How tuned in, empathetic and insightful do they seem in the first session?
8. Don’t be afraid to shop around. You want to find someone who really feels like a good fit for you, and that might not be the first person you meet. Even if you like them, interview a few more to make sure you’re making the right choice. With a little time and care, you’ll meet the very best therapist for you!

How did you choose your therapist? Did you find a great one right away, or have you “kissed a few frogs?” Please leave a comment; it makes a difference for all of us!

by Alyssa Siegel

The “extrovert” versus the “introvert” partner

One person gets their energy from high levels of stimulation; the other requires solitude to feel grounded. Introverts are not necessarily shy or anti-social, but they often prefer one-on-one or small group settings because they fell more in control. Extroverts tend to respond more quickly, hitting the send button or blurting out their thoughts before filtering them. Introverts need more time to process and come back to a conversation while an extrovert may want to talk it out. Neither approach is better, and the differences can be complementary. But, when a conflict arises, it is often each partner’s characteristic style of handling it, rather than the details of the issue itself that actually creates the problem.

My suggestion: It’s important for the extrovert to understand that how they communicate rather than what they say may be overwhelming to their introvert partner. Pushing a conversation with explanations or conclusions can result in a lock down in which the introvert feels like a deer caught in headlights, causing further withdrawal inward. The introvert, on the other hand, must understand that his or her partner has the best intentions, and the urgency to engage reflects a desire for intimacy and connection or anxiety about leaving conflict unresolved.

It can help if the couple establishes a general “rule” to take some time and space apart in moments of conflict with an agreed upon time to return to the conversation; an hour, maybe the next day, depending on the amount of time it takes for the introvert to regroup so that they aren’t flooded and the extrovert to cool down, both waiting respectively to feel centered again. Most of us can’t think clearly, express ourselves rationally or come to reasonable conclusions when we are least emotionally aroused. Otherwise, we risk saying things that may be hurtful rather than helpful, or we may throw up our hands just to end the conflict without it actually being resolved.

The “rational” versus the “expressive” partner

I work with a lot of activists, teachers and social workers who have partners that may not come from the same tradition or training. While this partner approaches conflict with compassion and reason based on their experiences, the other may have been raised in a home in which everyone yelled at each other. Swearing and insults flew freely and fights blew big but were quickly passed over, everyone going on with their day as usual. For them an eruption of anger is normal and even preferable to bottling it. Once they have had a chance to vent, they don’t understand why things can’t then just move on. When those words land on the person that has worked hard to use reason and ownership of their part in the conflict in their lives to avoid shaming and blaming, anger and insults mean a lot. They feel shocked and sometimes deeply wounded. On the other hand, to the non-trained partner, “I” and “feeling” statements from the “rational” partner come off as condescending and manipulative.

My suggestion: Decide on certain language that is off-limits such as “fuck you,” or “bitch,” or “I want a divorce,” etc, but also understand that these words are the result of extreme frustration, like a tea pot letting off steam at the boiling point. They are not necessarily meant to personally injure. It’s no worse to always overreact passionately in the face of conflict than it is to always react reasonably without any genuine expression of emotion. Build the boundaries by setting limits, and if you’re the rational partner, examine your style of “arguing” for its possible rigidities or hidden hostilities. A more genuine expression of feelings may be experienced as less false or aggressive and lead to a more meaningful conversation.

The “avoidant” versus “aggressive” partner

Though a subtly different dynamic than the “rational versus expressive” one, the “avoidant versus aggressive” interaction is no less painful. Most observers would blame a verbally aggressive partner for a couple troubles because of his loud and in your face style, but a passive partner who seems to turn the other cheek may secretly blame the other, refusing to take ownership of the couple’s difficulties. While the passive partner may feel bullied or abused, the aggressive partner may feel like he or she has been quietly undermined, dismissed or abandoned. The more the passive person shuts down or pulls away, the more the aggressive person leans forward and pushes in, demanding resolution or retribution because he or she feels like their partner doesn’t care.

My obvious suggestion: The aggressive partner should try backing off in order to give the passive partner room to step forward and work towards becoming more assertive in their communication. This behavior needs to be positively reinforced by empathic listening. Of course this is easier said than done because in the middle of a conflict, each partner must stop to reflect on their personal contribution to creating the difficulties.

A stop word can help. Choose a word that either partner can invoke to prevent a conflict from escalating or to call a time out to reflect and gather your words. Use the break to think about how you might be maintaining the conflict. Make a leap, stop acting defensive, and consider that what your partner is saying about you might be true. When both of you are ready, apologize for your behavior. “I’m sorry if I was ……..” Then each should talk about ways to change how you’re interacting. This dynamic generosity – the generosity of love, of support, of spirit – is especially important. One person needs to be willing to start approaching the other with generosity and the other will most likely follow suit, softening and reciprocating in this new way of being present with one another.

The “laid-back” versus the “organized” partner

Opposites attracted in this relationship, at least at first. One person was drawn to the other’s spontaneous and relaxed attitude while the other felt attracted by possibilities of greater certainty, order, and focus. Yet, over time, as the differences proved greater than imagined, each partner became increasingly frustrated. The free spirit now sees their partner as inflexible and rigid; the organizer sees the free spirit as irresponsible and flakey. The desire to change each other grows and they become locked in an unending argument over whose way of doing things should prevail.

My recommendation: Use a stop word to end the argument. Reflect on those qualities about your partner that originally attracted you. It was those qualities that are lacking in yourself and an unconscious desire to attain them that created a feeling of chemistry in the first place. Each person can do something to move closer towards the other’s style of interacting by assuming the behavior they first admired in the other. The organized partner can remind himself that just because he feels a sense of urgency, it doesn’t mean that all matters are urgent. Meditation and practicing letting go can help. For the laid back partner, practicing focus, single-mindedness, planning activities, may satisfy a secret desire for order and security and finally change the dynamic in the relationship.

The “committed” versus “one foot out the door” partner

It is very hard to make much progress in couples therapy when one person’s sense of commitment has changed. A partner may be at their wit’s end after years of frustration or unhappiness, one signature away from a lease on a new apartment. But until he or she feels ready, they have become resigned to live in the relationship, finding evidence for their unhappiness in each failed interaction with their partner. For them “the grass may be greener on the other side.” He or she has made their decision and nothing can change it. The other partner is, however, committed to making the relationship work and willing to make comprises or even sacrifices in order for it to continue.

My advice: Consider this. It’s incredibly easy to see a partner as the source of your unhappiness, and maybe sometimes they are. But just as often, they are the scapegoat for it. No one else’s life is as entwined, and it may feel as if the other is accountable for things that may actually grow from your own unresolved conflicts and unmet needs. Each partner can do a personal inventory of qualities about themselves that may have contributed to the impasse in the relationship. In other words, instead of blaming a partner, consider how your own behavior makes matters worse.

The committed partner might be served by also considering what it is they are holding on to. Are they sacrificing at all costs? Are they in love with the fantasy of what a partner or relationship “could be” rather than what they really are? Acting like the relationship has to continue as a matter of personal survival may not always serve its betterment. Sometimes a more neutral stance allows what is best to happen slowly become apparent. Don’t be so sure of anything. Despite what you think, your survival doesn’t depend on the relationship. Take an inventory of what’s valuable about yourself. If there isn’t going to be reciprocity, leave open the option that the relationship probably isn’t going to work.

Until a decision is made, stop blaming. Again, find a generosity of spirit within yourself – praise, support, and seek to make the partner’s life easier even when your feelings are hurt and resentment has been longstanding. If one partner changes his or her behavior, then chances are the other will pick up on it and do the same. Even if the relationship is ultimately not viable, you can part on more peaceful terms and enjoy kinder times as you come to your decision.

We all have it in us to be better partners. Every relationship can be improved. Relationships are never perfect and maintenance always necessary. With an attitude of generosity versus self-centeredness, self-responsibility versus blaming, open-mindedness versus defensiveness, intractable patterns can be broken and new, more satisfying ones formed.

There are many reasons to prefer being single. The lack of responsibility for another, the freedom in time and in choices. There are also many reasons to prefer being in relationship, such as the feeling of security that comes with knowing someone has your back, and the opportunity to grow and create memories with a partner who supports and respects you. Whatever you chose, honor yourself by asking yourself why it is that you seek out or avoid certain people or kinds of relationships, especially if it seems to be a pattern. Think about the ways in which you can be your best self, both alone or with a partner, and make sure that you are responsible for making that happen and don’t depend on anyone else to do it for you. If you want a relationship, seek out partners that inspire you, not only those that simply need you. Choose instead of waiting to be chosen.

By Jennine Estes, MFT 47653 .
If you recognize any of these excuses, here’s why you should go to counseling anyway.
Going to counseling can be a scary concept, so if you’re avoiding it — you’re not alone. You might wonder if counseling will work, what it means about your relationship that you want a mediator, and if the financial investment is really worth it. People put off finding counseling for plenty of reasons, but the truth is that you don’t have to be ashamed about wanting help, and putting it off can likely make your situation worse. Here are some of the main reasons people avoid counseling.

10. The Financial Aspect: Yes, coming to counseling will cost money. Think of counseling as an investment in your life, whether it’s individual counseling or couples counseling. It’s OK to put yourself first and spend money getting back on track — it’s worth it in the long run.

9. Horror Stories: Sometimes you might a story from a friend or other loved one about counseling gone bad. Maybe your friend left counseling feeling that it didn’t work, or your sister says she had a therapist who wouldn’t really listen to her. It can be hard to be motivated to go to counseling yourself when you’ve heard a bad story. Counseling is different for each person, and it’s important not to let someone else’s bad experience steer you clear of counseling.

8. Bad Previous Experience: Maybe you haven’t hear horror stories from others, but you yourself have gone to counseling before and didn’t think it helped you. Remember that each counselor is different, and many use entirely different styles and theories. Instead of writing off all counseling, look for a counselor who uses a different approach than your previous counselor.

7. It’s Only for “Crazy” People: No, counseling isn’t just for crazy people, or couples who are totally dysfunctional. Counseling can address so many issues, and is really just a safe space to talk freely about what you’re going through and get help moving forward. It can benefit almost anyone who needs to figure out the reason behind bad feelings or troubled communication.

6. Privacy Concerns: If you’re a private or reserved person, it seems intimidating to open up in front of a complete stranger, it’s true. You might also have reservations about repeating personal conversations. However, a good counselor will make you feel comfortable, and over time you can actually feel quite safe about being honest in counseling. And, of course, any thing you say in counseling is completely confidential and won’t be repeated.

5. Other Peoples’ Opinions: Even if you don’t announce that you’re going to counseling, at some point your friends and family may find out you are going to counseling, and it’s easy to be anxious about what they’ll think. In reality, counseling is about your personal development, and you might be surprised that people who love you are totally supportive about you wanting to improve yourself. Even if other people judge you in a negative way, the benefits of counseling outweigh listening to a negative opinion about it.

4. Asking For Help is Hard: If you pride yourself on being self-sufficient, stepping into a counselor’s office might feel like you’re letting yourself down. You might think you can handle your problems on your own, and asking for help means you’re weak. On the contrary — counseling helps you build a stronger self-esteem and learn new tools for handling whatever life throws at you. You’re not weak for reaching out!

3. It’s Overwhelming: The thought of tackling a big problem is overwhelming, so you might procrastinate going to counseling or avoid it altogether. This won’t make your problems disappear, however, and things might get a whole lot worse. Your counselor will help you tackle issues piece by piece, and give you realistic goals so you won’t be overwhelmed.

2. Drudging Up the Past is Scary: Bringing up past hurt isn’t fun, and the thought of going as far back as childhood might be a deal breaker for people considering counseling. Yes, you will probably have to bring up some past issues in counseling. But keep in mind that these issues will be there whether you enter counseling or not — at least when you go to counseling you can start to work through them. Pretending that past hurt doesn’t matter anymore won’t make it go away.

1. Small Problems Don’t Require Counseling: Many people think your problems must be HUGE before you go to counseling. So, they put off seeking help because it seems silly to go to counseling over what they conceive to be a minor issue. The thing is, small problems can snowball into big ones. It often makes sense to get counseling if you have a problem that is haunting you or your relationship, no matter how minor, so you can prevent it from getting bigger.

By David Palmiter
The large majority of adults and kids who might benefit from psychotherapy do not receive it. For example 14-22% of U.S. children meet criteria for a diagnosable psychological disorder, but only about 20% of these kids get effective care. And, even when kids get effective care they usually suffer for years before getting it. Similar statistics are available for adults. This is beneath us as a culture and often yields dramatically painful and unnecessary outcomes (e.g., suicide is the third leading cause of death among people aged 15-24, depression has a higher mortality rate than cardiac disease, etc.). This post reviews some of the common myths I’ve found that serve as barriers to understanding and healing.

If I enter therapy I might become too dependent on the therapist. Therapy will never end.

The goal of psychotherapy is to foster healthy independence, not unhealthy dependence. So, the aim of evidence-based psychotherapy is to reach measurable treatment goals as fast as possible. Indeed, the chief job of the competent therapist is to make her services obsolete. While some problems require longer treatment, many do not.

Counseling costs too much money.

Most health insurance polices cover the lion’s portion of psychotherapy. Clients end up being out of pocket only for the part not covered by the insurance company. In addition, the costs are considered a medical expense and may be deductible from taxes. Studies also suggest that trips to a counselor can dramatically reduce trips to the medical doctor, sick days and an assortment of other expensive problems (e.g., divorce, addiction, etc.). Plus, think what it would be like to be rid of any significant psychological pains that inflict you or a loved one. What would that be worth? Finally, there are options for low fee services all across the country; for example, if your local university has a graduate program in the mental health professions they may have a low fee training clinic (the average fee in the clinic I direct is $10/visit), community mental health centers exist across the country, etc.

Only crazy people are in therapy.

This is really a bunch of nonsense. Putting aside the meaning of the word “crazy” for a moment, choosing to be in therapy is often a very rational act. It seems much more irrational to avoid therapy, because of silly myths, when therapy might be helpful in important ways. Effective therapy helps people to identify new methods for overcoming emotional pain and solving life’s problems. What is crazy about the pursuit of such learning?

People who spend significant time and resources on therapy are being self indulgent and selfish.

If effective therapy does anything, it increases a person’s freedom to love. Did you ever try to give to others when you have a sharp toothache? The same thing applies with psychological pain. Those who have been healed in counseling are in a position to be able to love others more and better. How can this be considered selfish?

I’ll get better eventually anyway.

According to studies on counseling, effective psychotherapy promotes healing and recovery. It may not be helpful to wait years for change. Even if change does come, the same problem may resurface later if the central issues have not been sufficiently resolved. Psychotherapy provides a way to confront and resolve problems at their source. It also provides tools for dealing with future problems. Moreover, a competent therapist can direct you to the evidence that supports the methods that he or she is prescribing.

Being in therapy is a sign of weakness. Strong, effective people don’t need help solving their problems.

Maybe in a Rambo movie. In the real world more vulnerability is often found in the person who fears acknowledging human limitations and faults and is unwilling to take the steps necessary to overcome them. Counseling is no panacea and not everybody is a candidate for counseling. However, those who can acknowledge the possible need for counseling may be stronger, and more secure in themselves, than those who cannot.

If I take my kid in for an evaluation, he’ll get the idea that there is something seriously wrong with him.

Experienced child therapists both know that parents are concerned about this and have developed procedures that minimize this risk (e.g., making sure to assess for your child’s and family’s strengths). Besides, a child or teen with a legitimate behavioral or emotional problem is much more likely to think that there is something wrong with him/her, and to have that reflected in others’ eyes, if she/he does not get help. Also keep in mind, as is the case in medicine, that behavioral and emotional problems are much more easily understood and resolved sooner rather than later.

If you are wondering if counseling might be of benefit to you or a loved one, why not look into it? A competent therapist will be able to evaluate whether or not counseling is advisable and, if advisable, what it might be able to accomplish and how long it might take to complete. What do you have to loose, really? (If you’d like a referral in your community, click here.)

By Traci Pedersen Associate News Editor
Reviewed by John M. Grohol, Psy.D. on December 19, 2012

Mindfulness Cognitive Therapy Reduces Anxiety in Bipolar PatientsIn patients with bipolar disorder, mindfulness-based cognitive therapy (MBCT) has been shown to significantly reduce anxiety, according to researchers at the University of New South Wales.

MBCT involves traditional cognitive behavioral therapy (CBT) methods, while also incorporating newer psychological strategies, such as mindfulness meditation. The goal is to become aware of and accept all incoming thoughts and feelings, but not to attach or react to them.

The newer therapy, however, seemed to have no effect on symptoms of depression or mania; nor did it reduce episodes, found the researchers during 12 months of follow up.

For the study, the team recruited 95 patients with bipolar disorder, who were at least 18 years old. They were either assigned to MBCT or typical therapy.

Those in the MBCT group received weekly mindfulness meditation practice, cognitive therapy regarding depression, and psychoeducation.

All of the participants were assessed at baseline and follow up using the Montgomery-Åsberg Depression Rating Scale (MADRS), the Young Mania Rating Scale (YMRS), the Depression Anxiety Stress Scales, and the State Trait Anxiety Inventory (STAI). They were also evaluated for mood episode recurrences over the study period.

Overall, 34 participants assigned to the MBCT group finished the program and were assessed at followup.

The findings revealed that there were no significant differences between the two groups regarding improvements in MADRS and YMRS scores over the 12-month study period. There were also no significant differences regarding either time to a first mood episode recurrence or the total number of recurrences over the study period.

However, patients assigned to MBCT had significantly lower anxiety scores on the STAI over the study period.

“These findings suggest that MBCT may offer some assistance in managing anxiety for those with bipolar disorder,” said researcher Tania Perich and team in Acta Psychiatrica Scandinavica.

But they add that “MBCT did not reduce time to recurrence of depressive or hypomanic episodes over a 12-month follow-up period, nor was it associated with a reduction in mood symptom severity scores.”

Cognitive behavioural therapy (CBT) can reduce symptoms of depression in people who fail to respond to drug treatment, says a study in the Lancet.

CBT, a type of psychotherapy, was found to benefit nearly half of the 234 patients who received it combined with normal care from their GP. Up to two-thirds of people with depression do not respond to anti-depressants. Patients should have access to a range of treatments, the charity Mind said.

CBT is a form of talking psychotherapy to help people with depression change the way they think to improve how they feel and alter their behaviour. The study followed 469 patients with treatment-resistant depression picked from GP practices in Bristol, Exeter and Glasgow over 12 months.

One group of patients continued with their usual care from their GP, which could include anti-depressant medication, while the second group was also treated with CBT. After six months, researchers found 46% of those who had received CBT reported at least a 50% reduction in their symptoms.

Continue reading the main story
“The research confirms how these approaches – the psychological and physical – can complement each other. ”
Prof Chris Williams
University of Glasgow

This compared with 22% experiencing the same reduction in the other group. The study concluded CBT was effective in reducing symptoms and improving patients’ quality of life. The improvements had been maintained for a period of 12 months, it added.

Other options

Dr Nicola Wiles, from the Centre for Mental Health, Addiction and Suicide Research at the University of Bristol, said: “While the addition of CBT was effective for patients who had not responded to anti-depressants, not everyone who received CBT got better. These patients had severe and chronic depression so it is unlikely that one treatment would be effective for everyone.”

“We need to invest in other research to find alternative treatments for patients whose symptoms have not responded to treatment with anti-depressants.” Cognitive behavioural therapy is:
a way of talking about how you think about yourself, the world and other people
how what you do affects your thoughts and feelings
CBT can help you to change how you think (cognitive) and what you do (behaviour).

Unlike some other talking treatments, it focuses on the “here and now” instead of the causes of distress or past symptoms. The patients who did benefit from cognitive behavioural therapy spent one hour a week with a clinical psychologist learning skills to help change the way they think.

Chris Williams, professor of psychosocial psychiatry at the University of Glasgow, and part of the research team, said: “The research used a CBT intervention alongside treatment with anti-depressants. It confirms how these approaches – the psychological and physical – can complement each other.

“It was also encouraging because we found the approach worked to good effect across a wide range of people of different ages and living in a variety of settings.”

Paul Farmer, chief executive at the mental health charity Mind, said there was no “one size fits all” treatment for people with mental health problems.

“We welcome this research because it recognises that patients should have the right to a wide range of treatment options based on individual needs,” he said.

“Initiatives such as the Improving Access to Psychological Therapies (IAPT) programme has helped to ensure that more treatment options are available for conditions such as depression, however, we know that there still is a huge difference between what treatment people want and what they actually get.”

Have you benefited from cognitive behavioural therapy? Send your comments and experiences

By ALice Boyes, Ph.D.
Cognitive Behavioral Therapy techniques come in many shapes and sizes, offering a wide variety to choose from to suit your preferences.

You and your therapist can mix and match techniques depending on what you’re most interested in trying and what works for you. You can also try the following Cognitive Behavioral Therapy techniques as self-help.

Behavioral Experiments

In Cognitive Behavioral Therapy, behavioral experiments are designed to test thoughts. Example: You might do a behavioral experiment to test the thought “If I criticize myself after overeating, I’ll overeat less” vs. “If I talk to myself kindly after overeating, I’ll overeat less.”
To do this you would try each approach on different occasions and monitor your subsequent overeating. This would give you objective feedback about whether self-criticism or self-kindness was more effective in reducing future overeating. This type of behavioral experiment might also help counteract a thought like “If I’m kind to myself, it’s like giving myself a free pass to overeat and I’ll lose all self-control.” (CBT Behavioral experiment example)

Thought Records

Like behavioral experiments, thought records are also designed to test the validity of thoughts. For example, a clinical psychology student who gets negative feedback from a supervisor might jump to the conclusion “My supervisor thinks I’m useless.” The student could do a thought record evaluating the evidence for and against that thought. Evidence against the thought might be things like “My supervisor gave me positive feedback yesterday” or “My supervisor is allowing me to run assessments and give feedback to clients. If she thought I was useless, she probably wouldn’t be allowing me to feedback to clients.”

Once you’ve looked at the objective evidence for and against a thought side by side, the idea is to come up with several more balanced thoughts. An example of a balanced thought might be “I made a mistake in doing… Making mistakes is normal. I can learn from this. My supervisor will be impressed to see me learning from my mistakes and incorporating her feedback.”
Thought records tend to help change beliefs on a logical level, whereas behavioral experiments may be more helpful in also changing beliefs on a gut or felt level i.e., what you emotionally feel is true, regardless of the objective evidence. (CBT Thought record example)

Pleasant Activity Scheduling

Pleasant activity scheduling is a surprisingly effective Cognitive Behavioral Therapy technique. It’s particularly helpful for depression.
Try this: write the next seven days down on a piece of paper, starting with today (e.g., Thurs, Fri, Sat…). For each day, schedule one pleasant activity (anything you enjoy that’s not unhealthy) that you wouldn’t normally do. It could be as simple as reading a chapter of a novel or eating your lunch away from your desk without rushing.
An alternative version of this technique is to also schedule an activity a day that gives you a sense of mastery, competence, or accomplishment. Again, choose something small that you wouldn’t usually do. Aim for something that will take you less than ten minutes.
An advanced version of this technique would be to schedule three pleasant activities per day – one for sometime during your morning, one for the afternoon, and one for evening.
Doing activities that produce higher levels of positive emotions in your daily life will help make your thinking less negative, narrow, rigid, and self-focused.

Situation Exposure Hierarchies

Situation exposure hierarchies involve putting things you would normally avoid on a list. For example, a client with an eating disorder might make a list of forbidden foods, with ice cream at the top of the list and full fat yogurt near the bottom. A client with social anxiety might put asking someone on a date at the top of her list and asking a woman for directions near the bottom of her list. For each item on your list, rate how distressed you think you’d be if you did it. Use a scale from 0-10. For example, ice-cream = 10, full fat yogurt = 2. Order your list from highest to lowest. The theme of the list should reflect your problem.

Try to have several items at each distress number so there are no big jumps. The idea is to work your way through the list from lowest to highest. You would likely experiment with each item several times over a period of a few days until the distress you feel about being in that situation is about half of what it was the first time you tried it (e.g., you can eat full fat yogurt with only 1/10 distress instead of 2/10). Then move to the next item up the list.

Imagery Based Exposure

One version of imagery exposure involves bringing to mind a recent memory that provoked strong negative emotions. For example, let’s take the earlier example of a clinical psychology student being given critical feedback by a supervisor. In imagery exposure, the person would bring the situation of being given the feedback to mind and remember it in lots of sensory detail (e.g., the supervisor’s tone of voice, what the room looked like). They would also attempt to accurately label the emotions and thoughts they experienced during the interaction, and what their behavioral urges were (e.g., to run out of the room and cry, or to get angry). In prolonged imagery exposure, the person would keep visualizing the image in detail until their level of distress reduced to about half its initial level (say from 8/10 to 4/10).

Imagery based exposure can help counteract rumination because it helps make intrusive painful memories less likely to trigger rumination. Because of this, it also tends to help reduce avoidance coping. When a person is less distressed by intrusive memories they’re able to choose healthier coping actions.

Summary

This list of Cognitive Behavioral Therapy techniques is far from exhaustive but will give you a good idea of the variety of techniques that are used in Cognitive Behavioral Therapy. If you’re working with a therapist and you’ve been doing your own reading about CBT, you can let your therapist know what techniques you’re excited to try.

By John M. Grohol, PsyD Many of us go to the doctor for a physical checkup from time to time, especially as we get older and things start creaking or breaking down on our bodies. Suddenly they don’t quite work the way they used to, or the way you’ve come to expect.

But few of us think about going to a doctor or therapist for an emotional or mental health checkup. And that’s a shame, because things break down in our minds too.

Ann Carrns, writing over at the New York Times, suggests that the time has perhaps finally come where people start taking their mental health as seriously as their physical health.

Carrns writes:

But taking periodic stock of your emotional well-being can help identify warning signs of common ailments like depression or anxiety. Such illnesses are highly treatable, especially when they are identified in their early stages, before they get so severe that they precipitate some sort of personal — and perhaps financial — crisis.

“Absolutely, people should have a mental health checkup,” said Jeffrey Borenstein, editor in chief of Psychiatric News, published by the American Psychiatric Association. “It’s just as important as having a physical checkup.”

While I agree, in principle, with this idea, I wonder how many professionals are properly trained to offer a mental health wellness “checkup” of this nature. And just as importantly, whether your insurance would pay for such a checkup.

Weirdly, the article points to a website suggesting it’s a place where “you can use a free online screening tool” to see if you have any of the common mental disorders. But I couldn’t find such tools anywhere on the site.

If you’re interested in a free online screening tool for mental disorders, I might humbly suggest our own Sanity Score mental health screening tool, which offers instant results detailing not only major mental health problems, but also other common problems of living. It takes about 10 minutes to take, and at the end it offers you a report you can print out and take into a professional for review.

As for a mental health checkup, I think it’s a good idea, but perhaps one that most people still aren’t going to be comfortable with. Just as some people fear with going to a physician, there’s this common (but false) belief that if I go to a therapist and they dig deep enough, they will always find a problem or something that could be worked on.

And in our emotional health life, I’d probably have to agree with that sentiment, since nobody is perfect. We could all benefit from self improvement, making a mental health checkup somewhat of a subjective, slippery slope (since few clinicians employ objective testing to assess for these concerns).

Read the full article: The Importance of Regular Mental Health Checkups

By Rick Nauert PhD Senior News Editor
A new paper revisits the insights of pioneering psychoanalyst Carl Jung, tying his beliefs on dream symbols to a method of improving care for mental health issues.

Lance Storm, Ph.D., a visiting research fellow with the University of Adelaide’s School of Psychology, believes dream images could provide insights into people’s mental health problems and may help with their treatment.

In the early 1900s, Jung proposed that dream symbols or archetypes were ancient images stemming from humans’ collective unconscious. He believed that dream symbols carried meaning about a individual’s emotional state which could improve understanding of the person and also aid in their treatment.

Storm’s current paper, published online in the International Journal of Jungian Studies supports Jung’s theories and recommends that dream analysis be explored further for potential clinical use.

“Jung was extremely interested in recurring imagery across a wide range of human civilizations, in art, religion, myth and dreams,” Storm said.

“He described the most common archetypal images as the Hero, in pursuit of goals; the Shadow, often classed as negative aspects of personality; the Anima, representing an element of femininity in the male; the Animus, representing masculinity in the female; the Wise Old Man; and the Great Mother.

“There are many hundreds of other images and symbols that arise in dreams, many of which have meanings associated with them – such as the image of a beating heart (meaning ‘charity’), or the ouroboros, which is a snake eating its own tail (‘eternity’).

“There are symbols associated with fear, or virility, a sense of power, the need for salvation, and so on.

“In Jungian theory, these symbols are manifestations of the unconscious mind; they are a glimpse into the brain’s ‘unconscious code’, which we believe can be decrypted,” he said.

Storm believes Jung’s theories have practical significance and could broaden the range of options available to patients undergoing treatment for mental health problems.

“Our research suggests that instead of randomly interpreting dream symbols with educated guesswork, archetypal symbols and their related meanings can be objectively validated. This could prove useful in clinical practice,” he says.

“We believe, for example, that dream analysis could help in the treatment of depression.

“This is a rapidly growing area of mental health concern, because depressive people are known to experience prolonged periods of rapid eye movement (REM) sleep, which is directly linked with emotional processing and dreaming.”

Source: University of Adelaide

By Michelle Castillo CBS News) About 1 out of 10 Americans report having depression, according to the Centers for Disease Control and Prevention. While prescription medication is one way to treat the symptoms, the American Psychological Association (APA) is urging people in new videos to consider an alternative form of treatment first, psychotherapy.

“By arming people with information, APA is encouraging those with symptoms of depression or anxiety to ask their primary-care practitioners about psychotherapy as a first course of treatment,” Dr. Katherine Nordal, executive director for professional practice at the American Psychological Association, told CBSNews.com by email. “We want Americans to know that when it comes to treating depression and anxiety, they have choices about treatment, and psychotherapy is one of them.”

The National Institutes of Health calls depression one of the top 10 chronic health problems in the United States, affecting more than 14 million people. The National Healthcare Quality Report reported that mental health problems accounted for 156 million visits to the doctors’ offices, clinics and hospital outpatient departments in 2005.

Throughout this time, the number of people taking antidepressants has risen but the number of people seeking psychotherapy has fallen, the APA says.

Consumer Reports notes that U.S. doctors prescribed $9.9 billion worth of antidepressants in 2009, a 3 percent increase from 2008. And according to the CDC, one-third of Americans taking one antidepressant medication and less than one-half of those taking multiple antidepressants have seen a mental health professional in the past year.

In order to promote psychotherapy as a viable treatment option, the APA has started a campaign to raise awareness. Part of the campaign includes two videos that parody television commercials for antidepressants.

“Our message is in cases of mild to moderate depression, psychotherapy has been shown to be effective and give people some tools on how to deal with their depression,” Luana Bossolo, APA assistant director for public relations, said to CBSNews.com.
Bossolo said that pharmaceutical companies spend $4.2 billion on advertising, and the APA just wants to balance the trend and show people that they may have other options.

“In some cases, medication is appropriate, but what we’re trying to do is arm people with information,” she added.

Nordal added on the APA blog “Your Mind Your Body” that psychotherapy helps people work through their problems, and is a safe and secure way to help deal with depression.

“Psychotherapy provides a safe and effective treatment with enduring effects that can result in improved mood, increased energy, better job performance, more satisfying relationships, and enhanced functioning in other areas of life that are negatively impacted by depression,” she said.

Having a great sense of self-esteem is a critical factor and a necessary component of success and is important in being able to help us handle the daily rigors of modern day life. With a great sense of self-esteem we can make the right choices in different aspects of our lives as well as our careers.

Doubt is one factor which leads to low self-esteem which can affect our abilities to succeed in the long run. If you want to know if you or other people close to you have started exhibiting any signs of low self-esteem you should take a careful look for any of the following symptoms:

■Apprehension of any changes in life or any new experiences.
■Need for perfection in everything and need to appear perfect to everyone they meet.
■Always apologetic about everything they do whether it’s really their fault or not.
■Talking negatively about themselves. People with low self-esteem are always putting themselves down by making unnecessary and negative statements.
■Shows symptoms of addiction. People with low self-esteem tend to get affected by negative addictive behavior and this addiction may be to substances or harmful habits.
■Lack of individuality. People with such behavior show a complete lack of self-belief and often choose to follow others blindly instead of seeking their own paths.
■Unhappiness with their current status. Such people are always unhappy with what they have no matter how perfect their lives are. They fail to appreciate what they have with them and are always looking for more.
■Put down behavior. People with low self-esteem often criticize others frequently in a bid to look better to people and feel better about whom they are.
■People suffering from low self-esteem frequently lack energy to do anything else and find the smallest and simplest of chores inundating.
■Over exaggeration of failures and problems in their lives.
■Constantly feel hopeless and distraught about issues that they shouldn’t.
■Tend to either neglect their appearances a great deal or focus too much on preening themselves constantly.
■Never like to own up when they are wrong.
■Constantly think about past mistakes instead of focusing on the present.
■Always complaining about non existent physical symptoms.
■Find it difficult to resolve simple issues without involving other people.
If you see these signs in yourself or in other people it makes it easier to understand that you suffer from self-esteem. It is then up to you to find ways to help yourself or the other individual get the necessary courage to take care of their lives as well as their feelings.

From beeyourself.com

By Traci PedersenAssociate News Editor
A fear of the dark may trigger some insomnia, according to researchers at Ryerson University. The findings will be presented at Sleep 2012, the annual meeting of the Associated Professional Sleep Societies, in Boston.

In the small study of 93 college-aged men and women, researchers found that more poor sleepers than good sleepers confessed a fear of the dark. “I think the most surprising part of the study is that people told us,” says researcher Colleen Carney, Ph.D., associate professor of psychology at Ryerson University, Toronto. Fear of the dark was confirmed through sleep lab experiments.

Carney and her research team decided to pursue the fear of the dark notion after she heard many people with insomnia, over the years, talk about sleeping with a light or TV on. All participants (average age 22) completed questionnaires regarding their sleep habits. One particular questionnaire is called the Insomnia Severity Index that helps classify people as good or poor sleepers. Participants were then assigned into either the poor-sleeper group or the good-sleeper group—there were 42 poor sleepers and 51 good sleepers.

Interestingly, of the 42 poor sleepers, almost half said they were afraid of the dark. Of the 51 good sleepers, only about one-quarter were afraid of the dark. In the sleep lab, Carney tried to confirm the fear of the dark. Four different times, she exposed both the good and poor sleepers to a burst of white noise. “If you are nervous, you are going to flinch,” said Carney.

Researchers observed participants’ responses, such as blinking speed and other reactions to measure the level of fear. They were measured twice in a simulated bedroom setting that was lit and twice in the same setting while dark. “We measured the blinks, the size, and how fast,” Carney said. ”The poor sleepers tended to blink fast in the dark in response to the unexpected noise.”

The poor sleepers had greater ”startle” responses only in the dark, she found, while the good sleepers tended to get used to the burst of white noise. “That’s what you do when you aren’t afraid,” she said. “The poor sleepers actually became more afraid.”

Carney believes that, for the poor sleepers, a fear of the dark may contribute to increased arousal once the lights are turned off. To lessen insomnia, Carney says those who have a fear of the dark should work directly on the fear, or phobia.

By Margarita Tartakovsky, M.S. In past pieces in the “Therapists Spill” series, clinicians have shared everything from why they love their work to how to lead a meaningful life. This month clinicians reveal the myths and misunderstandings that still persist about going to therapy.

Myth 1: Everyone can benefit from therapy.

Everyone who wants to engage in therapy can benefit. Not surprisingly, people who don’t have a modicum of motivation to change probably won’t. Psychotherapist Jeffrey Sumber, MA, stressed the importance of being ready, willing and open to therapy. Some folks believe that therapy is right for everyone; that “who couldn’t benefit from a little therapy?” While I personally believe that there are a huge number of people that benefit from our services, it is my experience that unless a person is truly open and ready to do their own work, then therapy can actually create a negative experience for the person so that when they might be truly ready to make a change, their experience with therapy was less than enjoyable. …Hostile clients do not serve the client or the therapist. Our job is not to fix people; it is to support people who want to heal by reflecting their own strength back to them. There are clearly some clients who are 99 percent against changing their behaviors or thoughts, but it takes 1 percent, some thread of interest or hope, for the process to be successful.

Myth 2: Therapy is like talking to a friend.

According to Ari Tuckman, PsyD, clinical psychologist and author of Understand Your Brain, Get More Done: The ADHD Executive Functions Workbook, while friends are a vital support, a therapist is uniquely qualified to help you. It’s important to have friends to talk to, but a therapist is trained to understand these matters more deeply and therefore is able to offer more than just good advice. Life gets complicated and it sometimes takes a deeper understanding of human nature in order to move beyond the current situation. Also, because therapy is confidential and the therapist has no vested interest in what you do, it can be easier to talk openly with a therapist and really get down to what is going on.

Myth 3: Therapy isn’t working unless you’re in pain.

Therapy often gets painted as a painful and miserable process. But this picture glosses over the fact that therapy equips clients with effective coping skills to live a more fulfilling life – and can be very rewarding. As Tuckman said: Although therapy can address some pretty painful subjects, it doesn’t need to be all about pain and suffering. Therapy is often more about understanding yourself and others differently and learning how to cope with the sorts of things that most people deal with at one point or another: relationship dissatisfaction, loss, anger, uncertainty over the future, transitioning from one situation to another, etc. Even though most people go through these experiences, therapy can help you navigate them more smoothly and set yourself up for success on the other side of it.

Myth 4: Therapy entails blaming your parents.

“Therapy has come light years from the old days of talking about potty training,” Tuckman said. But while therapists don’t fixate on a client’s parents or their past, tracing their history helps provide a clearer picture of their experiences and current concerns.
According to Joyce Marter, LCPC, psychotherapist and owner of Urban Balance, LLC, a multi-site counseling practice in the greater Chicago area:

Many people come into therapy and say they want to address a current life issue or stressor but do not want to talk about their histories because they don’t want to wallow in the past. I explain that the first phase of therapy is information gathering, where the therapist asks questions about the client’s past in a process of getting to know and understand him or her.

My belief is that our past experiences often shape and mold us into who we are. We all unconsciously repeat familiar patterns until we make them conscious and work through them. You certainly don’t need to spend years in psychoanalysis to make progress in therapy, but providing even a brief psychosocial history is an important part of even short-term, solution-focused therapy. I explain to clients that it is not about blaming their parents or staying stuck in the past, rather it is about honoring their emotional experiences and increasing awareness of how these previous life circumstances are impacting them currently with regard to their presenting issue for seeking therapy. Addressing and resolving issues from the past can be the key to moving forward in the future.

Myth 5: Therapy entails brainwashing.

Amy Pershing, LMSW, a psychotherapist and director of the Pershing Turner Centers, actually heard this myth at a party. Some people believe that therapists push their ideas and agendas on their clients. However, a good clinician helps you re-discover or regain your voice, not lose it. She explained:… There is a time in therapy, especially at the beginning, when the therapist, from only their own philosophical lens, helps a client understand the workings of their mind (and, at least in eating disorders treatment, their body), educates on the allegedly normative path of human development, and identifies the patterns clients may have developed to survive traumas of all kinds.

Every therapist does this from their own unique brand of wisdom, developing tools and strategies they believe in both professionally and personally. So is therapy about making people be “in line” with how the therapist sees things? …Good therapy, to my way of thinking, always starts with creating a container. It is about building trust and safety, born from acceptance and “unconditional positive regard.”

These are commodities many clients [do] not have in abundance. The purpose of this container is not to convert, but to create space for clients to risk finding their authentic Self. To do that, sometimes clients need to use parts of someone safe to help build a bridge back to that Self. They can try on things I suggest with the goal [of] listening for their true response (“Did this work for me?”), not practicing a lesson and ultimately passing some test.

…If clients say something because they think I want to hear it, we are not done with the work. If they say something because it is true for them, we have accomplished our mission. …For those who have not participated in psychotherapy for fear they might lose their voice, I would invite them to challenge a prospective therapist with this very question. Their answer should in fact convince you that you will come away from the work not closer to being like them, but closer to being like you.

Myth 6: Therapists typically agree with their clients, since their job is to make them feel better.

A therapist’s job isn’t to placate clients. Rather, it’s to challenge them and help them grow. According to Marter: Of course, having a strong therapeutic rapport or positive working relationship is the key to success in therapy. However, this doesn’t mean that your therapist is just going to accept your point of view as verbatim and affirm everything you say and do.

As therapists, we are trained to recognize that there are always other sides of the story. We notice patterns and trends, clients’ behaviors, experiences and relationships. We can usually tell when there is missing information or things don’t seem to add up and will challenge clients to explore these blind spots and support them in that process of increasing insight and consciousness. While a therapist will most often empathize with a client’s emotional response to a situation, we also encourage clients to challenge their thinking, their belief systems, or look at things from other perspectives to help them learn, grow and move forward in their lives.

Myth 7: A therapist never takes sides.

Sometimes taking sides is necessary because it leads to progress. According to Terri Orbuch, Ph.D, a psychotherapist and author of Finding Love Again: Six Simple Steps to a New and Happy Relationship:

At times, a therapist might have to take a side, either to keep a couple moving along, to challenge a client, or because of a particular issue at hand. For example, let’s say a couple comes in for marital counseling. One of the partners refuses to change, and refuses to discuss any issue or even listen to the other partner. The partner that is refusing to discuss is very angry about being at the therapist’s office. At that time, a therapist might say to the angry partner: “Why are you here if you don’t want to discuss anything?” or “Do you think this lack of involvement is helping your marriage?” To me, this is siding with one partner [in order] to engage one partner or move the couple along. The therapist is taking a side to challenge the other partner.

Myth 8: If you don’t start feeling better right away, therapy isn’t working.

Many people think that therapy takes one or two sessions, said John Duffy, Ph.D, a clinical psychologist and author of the book The Available Parent: Radical Optimism for Raising Teens and Tweens.

“That’s about how long it takes to get the story down and establish a little sense of trust,” he said. “Then, therapy can begin.” Think of getting better as less like getting a shot at the doctor’s office and more like organizing a messy closet. According to Marter: I tell my clients that starting therapy is a little bit like cleaning out a messy closet. If you finally decide it is time to organize a closet that you’ve crammed with stuff over the years, you first need to start by pulling everything out. After all your stuff is spread around the room, it is normal to feel pretty overwhelmed and worry that you have made things worse or think it may have been better to just leave it alone.

The beginning of therapy can be overwhelming in a similar way, as you share old memories and experiences with your therapist, some of which may have been very difficult. It is common to feel a bit worse before you feel better, but if you stick with the process you can let go of some old stuff, rework some things and have your “closet” functioning better than ever. I always encourage clients to discuss their feelings about therapy directly with me so we can address any uncomfortable feelings and work through them together. The therapeutic journey of healing and growth doesn’t always feel good during the process but the feeling of having resolved difficult issues will make it all worthwhile in the end.

Myth 9: Change takes place during therapy.

Change actually takes place before and after the therapy session, Duffy said. “There are a-ha’s and revelations [in the session], to be sure, but for change to really happen and last, the majority of the work happens between sessions.” The goal of therapy is to apply these changes to your life, which, of course, is the hard part.

Myth 10: Seeing a therapist means you’re weak, damaged or really crazy.

There’s nothing weak or crazy about working on specific problems or trying to overcome intrusive symptoms. Therapy gives you the opportunity “to utilize all the tools at your disposal to maximize your satisfaction and effectiveness in life,” Duffy said. Sounds like a smart strategy, doesn’t it?

Myth 11: Once you start seeing a therapist, it’s best not to change therapists.

According to Orbuch, “If you are dissatisfied with the progress you’re making or you’re not comfortable with a therapist, you owe it to yourself to change who you’re seeing and find someone who is better suited to you.” How do you find a clinician you’re comfortable with?

Consider why you’re going to see a therapist in the first place, and research the best types of treatment approaches for those concerns, Duffy said. For instance, if anxiety is impairing your life, after doing some research, you’ll learn that cognitive behavioral therapy (CBT) is the most effective treatment. So you’d look for therapists who specialize in CBT. Also, consider if you’d prefer to work with a male or female therapist, Orbuch said. She suggested contacting two therapists and asking them questions before making an appointment. Ask about the therapist’s credentials, training and treatment approach (psychoanalytic? CBT?), she said. Then figure out if you’re comfortable with their responses, tone of voice, and anything else that’s important to you, she said.