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Long Term Consequences of Workplace Stress

Health problems associated with job-related anxiety account for more deaths each year than Alzheimer's disease or diabetes.

By many accounts, America’s workers are both overworked and overwhelmed: Work days bleed into personal time, and some complain about the inability to control, or even plan for their constantly changing schedules. So it’s no surprise that such circumstances can lead to high stress levels, but the reality of career-related stress might be more costly than most workers realize.

A 2015 working paper from Harvard and Stanford Business Schools takes a look at 10 common job stressors: from lack of health insurance, to long working hours, to job insecurity. Researchers then considered how the mental and physical effects of these forms of stress related to mortality. The paper found that health problems stemming from job stress, like hypertension, cardiovascular disease, and decreased mental health, can lead to fatal conditions that wind up killing about 120,000 people each year—making work-related stressors and the maladies they cause, more deadly than diabetes, Alzheimer’s, or influenza.

High levels of stress are costly in monetary terms, too. Researchers found that stress-related health problems could be responsible for between 5 to 8 percent of annual healthcare costs in the U.S. That amounts to about $180 billion each year in healthcare expenses.

The study found that some stressors proved more problematic than others. Lack of health insurance, for instance, has a particularly grim effect on health. It results in financial stress, causing delayed treatment for potentially serious medical issues—which can certainly contribute to mortality.

But other, seemingly more innocuous stressors can prove problematic too. “Decisions about work hours and shift work have profound health consequences, possibly through their effects on work stress, sleep, and the conflict between work and other roles,” according to the researchers. The paper cites several problematic conditions that can arise from an unusual or erratic schedule: Those who worked long hours self-reported more cases of hypertension, for instance. There have also been correlations between occupational injuries and working longer hours during the preceding week. In fact, a 2005 study noted that those who reported high levels of feeling overworked were 20 percent more likely to say that they had made lots of mistakes on the job, which could be especially problematic for those with physically demanding or dangerous positions. Shift work and long work hours were also associated with worse health generally, and bad health decisions—like smoking.

Work stressors can be hazardous to health in other ways, too. For instance, employees at downsizing firms have been found to get sick at a rate more than two-times as high as workers who feel secure in their jobs. The stress that comes from the combination of low job control and high demands has also been found to contribute to issues like cardiovascular disease. Conflicting priorities between work and home have a negative affect on mental health, and have been linked to some substance-abuse issues, according to the study.

How employees feel about their company's operation turns out to also be important to health. Those who think that their workplace deals with employees unfairly are more prone to reporting poor health. That means, to some extent, that managers and executives may be able to help mitigate stress-related health issues, and that top-down efforts to foster a more collegial and secure working environment may lead to happier and healthier workers. The researchers recommend company-wide events, and mentorship programs to help in tackling high stress levels for employees and the associated health costs for employers. Efforts to retain employees for significant periods of time might help too, since workers tend to feel more secure and form more supportive social networks when there is some level of consistency within the employee pool, according to the research.

“We do not claim that an ideal stress-free workplace is realistically or economically achievable,” write co-authors Joel Goh, Jeffrey Pfeffer, and Stefano A. Zenios. Instead they suggest that a focus on stressors that can reasonably be targeted and reduced might have a beneficial impact for everyone. “Even though it is likely that these stressors cannot be completely eradicated in practice, our analysis suggests that even reducing their prevalence could potentially go a long way in improving health outcomes and cost.”

By Gillian B. White

Not sure why parts of your character hold you back in your work? For Work Stress Counseling Metro NYC, Kearns Group helps individuals study the gap between goals and their achievement. Through a contextual counseling we reveal the stress that gets in the way and design strategies to better reach their achievement. Conveniently located in Greenwich Village near Union Square.


Interventions and Therapies for Substance Abuse

Psychodynamic therapy focuses on unconscious processes as they are manifested in the client's present behavior. The goals of psychodynamic therapy are client self-awareness and understanding of the influence of the past on present behavior. In its brief form, a psychodynamic approach enables the client to examine unresolved conflicts and symptoms that arise from past dysfunctional relationships and manifest themselves in the need and desire to abuse substances.

Several different approaches to brief psychodynamic psychotherapy have evolved from psychoanalytic theory and have been clinically applied to a wide range of psychological disorders. A growing body of research supports the efficacy of these approaches (Crits-Christoph, 1992; Messer and Warren, 1995).

Short-term psychodynamic therapies can contribute to the armamentarium of treatments for substance abuse disorders. Brief psychodynamic therapies probably have the best chance to be effective when they are integrated into a relatively comprehensive substance abuse treatment program that includes drug-focused interventions such as regular urinalysis, drug counseling, and, for opioid-dependents, methadone maintenance pharmacotherapy. Brief psychodynamic therapies are perhaps more helpful after abstinence is well established. They may be more beneficial for clients with no greater than moderate severity of substance abuse. It is also important that the psychodynamic therapist know about the pharmacology of abused drugs, the subculture of substance abuse, and 12-Step programs.

Psychodynamic therapy is the oldest of the modern therapies. As such, it is based in a highly developed and multifaceted theory of human development and interaction. This chapter demonstrates how rich it is for adaptation and further evolution by contemporary therapists for specific purposes. The material presented in this chapter provides a quick glance at the usefulness and the complex nature of this type of therapy.

Background
The theory supporting psychodynamic therapy originated in and is informed by psychoanalytic theory. There are four major schools of psychoanalytic theory, each of which has influenced psychodynamic therapy. The four schools are: Freudian, Ego Psychology, Object Relations, and Self Psychology.

Freudian psychology is based on the theories first formulated by Sigmund Freud in the early part of this century and is sometimes referred to as the drive or structural model. The essence of Freud's theory is that sexual and aggressive energies originating in the id (or unconscious) are modulated by the ego, which is a set of functions that moderates between the id and external reality. Defense mechanisms are constructions of the ego that operate to minimize pain and to maintain psychic equilibrium. The superego, formed during latency (between age 5 and puberty), operates to control id drives through guilt (Messer and Warren, 1995).

Ego Psychology derives from Freudian psychology. Its proponents focus their work on enhancing and maintaining ego function in accordance with the demands of reality. Ego Psychology stresses the individual's capacity for defense, adaptation, and reality testing (Pine, 1990).

Object Relations psychology was first articulated by several British analysts, among them Melanie Klein, W.R.D. Fairbairn, D.W. Winnicott, and Harry Guntrip. According to this theory, human beings are always shaped in relation to the significant others surrounding them. Our struggles and goals in life focus on maintaining relations with others, while at the same time differentiating ourselves from others. The internal representations of self and others acquired in childhood are later played out in adult relations. Individuals repeat old object relationships in an effort to master them and become freed from them (Messer and Warren, 1995).

Self Psychology was founded by Heinz Kohut, M.D., in Chicago during the 1950s. Kohut observed that the self refers to a person's perception of his experience of his self, including the presence or lack of a sense of self-esteem. The self is perceived in relation to the establishment of boundaries and the differentiations of self from others (or the lack of boundaries and differentiations). "The explanatory power of the new psychology of the self is nowhere as evident as with regard to the addictions" (Blaine and Julius, 1977, p. vii). Kohut postulated that persons suffering from substance abuse disorders also suffer from a weakness in the core of their personalities--a defect in the formation of the "self." Substances appear to the user to be capable of curing the central defect in the self.

The ingestion of the drug provides him with the self-esteem which he does not possess. Through the incorporation of the drug, he supplies for himself the feeling of being accepted and thus of being self-confident; or he creates the experience of being merged with the source of power that gives him the feeling of being strong and worthwhile (Blaine and Julius, 1977, pp. vii-viii).

Each of the four schools of psychoanalytic theory presents discrete theories of personality formation, psychopathology formation, and change; techniques by which to conduct therapy; and indications and contraindications for therapy. Psychodynamic therapy is distinguished from psychoanalysis in several particulars, including the fact that psychodynamic therapy need not include all analytic techniques and is not conducted by psychoanalytically trained analysts. Psychodynamic therapy is also conducted over a shorter period of time and with less frequency than psychoanalysis.

Several of the brief forms of psychodynamic therapy are considered less appropriate for use with persons with substance abuse disorders, partly because their altered perceptions make it difficult to achieve insight and problem resolution. However, many psychodynamic therapists work with substance-abusing clients, in conjunction with traditional drug and alcohol treatment programs or as the sole therapist for clients with coexisting disorders, using forms of brief psychodynamic therapy described in more detail below.

Introduction to Brief Psychodynamic Therapy
The healing and change process envisioned in long-term psychodynamic therapy typically requires at least 2 years of sessions. This is because the goal of therapy is often to change an aspect of one's identity or personality or to integrate key developmental learning missed while the client was stuck at an earlier stage of emotional development.

Practitioners of brief psychodynamic therapy believe that some changes can happen through a more rapid process or that an initial short intervention will start an ongoing process of change that does not need the constant involvement of the therapist. A central concept in brief therapy is that there should be one major focus for the therapy rather than the more traditional psychoanalytic practice of allowing the client to associate freely and discuss unconnected issues (Malan, 1976). In brief therapy, the central focus is developed during the initial evaluation process, occurring during the first session or two. This focus must be agreed on by the client and therapist. The central focus singles out the most important issues and thus creates a structure and identifies a goal for the treatment. In brief therapy, the therapist is expected to be fairly active in keeping the session focused on the main issue. Having a clear focus makes it possible to do interpretive work in a relatively short time because the therapist only addresses the circumscribed problem area. When using brief psychodynamic approaches to therapy for the treatment of substance abuse disorders, the central focus will always be the substance abuse in association with the core conflict. Further, the substance abuse and the core conflict will always be conceptualized within an interpersonal framework.

The number of sessions varies from one approach to another, but brief psychodynamic therapy is typically considered to be no more than 25 sessions (Bauer and Kobos, 1987). Crits-Christoph and Barber included models allowing up to 40 sessions in their review of short-term dynamic psychotherapies because of the divergence in the scope of treatment and the types of goals addressed (Crits-Christoph and Barber, 1991). For example, some brief psychodynamic models focus mainly on symptom reduction (Horowitz, 1991), while others target the resolution of the Oedipal conflict (Davanloo, as interpreted by Laikin et al., 1991). The length of therapy is usually related to the ambitiousness of the therapy goals. Most therapists are flexible in terms of the number of sessions they recommend for clinical practice. Often the number of sessions depends on a client's characteristics, goals, and the issues deemed central by the therapist.

Psychodynamic Psychotherapy for Substance Abuse
Supportive-expressive (SE) psychotherapy (Luborsky, 1984) is one brief psychodynamic approach that has been adapted for use with people with substance abuse disorders. It has been modified for use with opiate dependence in conjunction with methadone maintenance treatment (Luborsky et al., 1977) and for cocaine use disorders (Mark and Faude, 1995; Mark and Luborsky, 1992). There have been many studies of the use of SE therapy for substance abuse disorders, resulting in a significant body of empirical data on its effectiveness in treating these problems (see below).

Mark and Faude asserted that although their therapeutic approach was devised specifically for cocaine-dependent clients, these people often have multiple dependencies, and this approach can be used to treat a variety of substance abuse disorders. However, clients should be reasonably stable in terms of their substance abuse before beginning this type of therapy (Mark and Faude, 1995).

Mark and Faude theorized that substances of abuse substitute a "chemical reaction" in place of experiences and that these chemically induced experiences can block the impact of other external events. The person with a substance abuse disorder will therefore have a "tremendously impoverished and impaired capacity to experience," and traditional psychotherapy might have to be augmented with techniques that focus on increasing a client's ability to experience (Mark and Faude, 1995, p. 297).

Effective SE therapy depends on appropriate use of what is termed the core conflictual relationship theme (CCRT), a concept first introduced by Lester Luborsky. According to Luborsky, a CCRT is at the center of a person's problems. The CCRT develops from early childhood experiences, but the client is unaware of it and how it developed. It is assumed that the client will have better control over behavior if he knows more about what he is doing on an unconscious level. This knowledge is acquired by better understanding of childhood experiences (Bohart and Todd, 1988). The CCRT develops out of a core response from others (RO), which represents a person's predominant expectations or experiences of others' internal and external reactions to herself, and a core response of the self (RS), which refers to a more or less coherent combination of somatic experiences, affects, actions, cognitive style, self-esteem, and self-representations.

Most people with substance abuse disorders have particularly negative expectations of others' attitudes toward them (that is, the RO), although it remains unclear which came first--this response or the substance abuse disorder. Either way, the two become mutually reinforcing. Following are examples of statements that reflect the core RO of a person with a substance abuse disorder:

"Everybody hates me."
"I am just being used."
"People laugh at me."
"No one understands how I feel."
"Everybody wants me to be something I'm not."
"They're just waiting for me to make a fool of myself."
For many people with substance abuse disorders, alcohol or drug use is a way of self-medicating against feelings of low self-worth and low self-esteem that reflect the client's RS. A negative RO reinforces a negative RS and can lead to the deceptive and manipulative behavior that is sometimes observed in this population. The client's RS is based on the individual's somatic experiences, actions, and perceived needs. Following are examples of statements that could reflect a client's core RS:

"I'm so stupid and gullible."
"I can't do anything right."
"If I didn't use drugs, I would lose my mind."
"I can't help myself."
"I'm not a very nice or honest person."

A third component of CCRT is a person's wish; it reflects what the client yearns for, wishes for, or desires. The client's "wish" is largely based on individual personality style. Those with substance abuse disorders often have a wish to continue using the substance without having to endure the consequences. Put another way, they would like to be accepted (or loved or appreciated) as they are, without having to give up the pleasure they get from their use (Levenson et al., 1997). Many people who have substance abuse disorders have much invested in denying that they really have a problem, in portraying themselves as helpless victims, and in disclaiming their role in the behavior that has brought them into treatment.

Once therapy has been initiated, the therapist and client can work together to put the client's goals into the CCRT framework and explore the meaning, function, and consequence of her substance abuse, looking in particular at how the RO and RS have contributed to the problem. The CCRT framework also can be used to identify potential obstacles in the recovery process as the therapist and client explore the client's anticipated responses from others and from herself and discuss how these perceptions will change when she stops abusing substances.

The CCRT concept also can help clients deal with relapse, which is regarded by virtually all experts in the field as an integral and natural part of recovery. Relapse offers the client and the SE therapist the opportunity to examine how the RO and RS can serve as triggers and to devise strategies to avoid these triggers in the future. Finally, SE therapy is conducive to client participation in a self-help group such as Alcoholics Anonymous, or it can be used as a mechanism to examine a client's unwillingness to participate in these groups.

Stella and Christopher: A Case Study
The case study in this section came from the NIDA Collaborative Cocaine Study (Mark and Faude, 1997; adapted with permission). SE is the therapeutic approach used.

While dependent and impulsive, Stella, a 28-year-old cocaine-dependent woman, would be seen under many circumstances as warm and open. She appears to be the kind of person who wears her heart on her sleeve, but it is a big heart nonetheless, capable of caring for others with loyalty and compassion. In addition, she has a tenacity of spirit; despite a horrific personal history she completed her training as a medical technician and has worked in that capacity for much of the last 4 years. Her therapist, Christopher, is a well-trained psychodynamically oriented therapist. He is an intelligent, serious, and measured person, whose well-meaning nature comes through under most circumstances despite his natural reserve.

Stella has a history of polysubstance abuse, including the abuse of prescription drugs, both anxiolytics and opioids. She worked as a medical technician until she injured her back 3 months ago. At the beginning of treatment, she told Christopher that she was going to request medication from her physician for her back pain. After her eighth session, with her reluctant agreement, Christopher informed the physician that she was in treatment for cocaine dependence. Christopher asked the physician to find a medication other than diazepam (Valium) for Stella's back pain.

Stella began the 19th session complaining that ever since the physician found out she was a drug user, he has treated her differently. "He thinks I'm a scumbag drug addict," she said. Christopher acted uncharacteristically: he offered some advice. He suggested that Stella consider telling her physician how she feels about his treatment. The intervention strikingly altered the mood and productivity of the session. After a brief expression of sympathy for her position, he focused on her extreme distress over the physician's treatment. He attempted to explain the intensity of her reaction in terms of projection: that she responded so strongly because of her negative view of herself.

Matters got worse as the session continued. Stella related a second negative incident when she described her treatment by the physician in a group therapy session. The group therapist responded, "Well, you manipulate doctors!" Stella had been furious.

Christopher encouraged her to say more. Stella became frustrated at Christopher's lack of understanding and explained that again, she felt she was being treated like a "scumbag," this time by the group therapist. Christopher suggested that Stella might tell both the physician and the group therapist how she felt. The tension in the session disappeared, and Stella remarked that she has always had trouble sticking up for herself.

In supervision, Christopher realized immediately that he was indirectly letting Stella know that he understood and agreed with her.

Diagnostically speaking, Stella has a borderline personality disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition [DSM-IV] (American Psychiatric Association, 1994). When she was between 6 and 8 years old, Stella's maternal grandfather sexually abused her. Her parents divorced when she was 10, and she lived with her mother, who was often drunk and physically abusive. Stella said she was closer to her father, whom she described as gentle. He appeared to others as weak and ineffectual.

At age 15, Stella ran off with a boyfriend who was also her pimp. After 2 weeks she returned home, was unable to leave her mother, and was diagnosed as having agoraphobia, for which she took chlordiazepoxide (Librium). Two years later she ran away with another man, a particularly sadistic pimp. For 5 years she was too terrified to leave him. It was during this period that she started using cocaine.

The cocaine both "disclaims action" and affirms her "badness." Her cocaine use enabled her to avoid examining why she stayed with her boyfriend and simultaneously affirmed her badness. So, she deserves her fate. She would use the cocaine to clear her painful feelings and feel "strong and independent," then "feel like a big baby for having to use the drugs." She thought of herself as a "big baby," for returning to her mother at age 15 and for being unable to leave her current boyfriend. Her reactions to cocaine are typical; a brief surge or a "high," followed by a crash. However, these typical reactions also fit her core theme: she wants to be loved and cared for but believes she will be thwarted and exploited by others because of this wish. Her response then is to use drugs, which makes her feel strong and independent for a brief time and also makes her see herself as deserving of being thwarted and exploited, which has happened repeatedly in interpersonal contexts in her life.

Stella's drug use became a part of the therapy in two ways. In the first session, Stella told Christopher that she had taken chlordiazepoxide for several days before their appointment, to relieve her anxiety. She pointed out that it had been prescribed by a doctor. Presumably, Christopher would have known the results of her drug screen, which was part of the program. She thus confessed before being confronted by drug screen results. Her claim that the prescription was legitimate facilitated her denial that she has anything to be concerned about.

Second, Stella announced her intention to ask her physician for diazepam, a commonly abused medication. By contacting her physician, Christopher replayed a common scenario in her life: she signals that someone should take control or care for her, then resents it when they do, feeling that she is being treated like a "scumbag drug addict." She can create the largely illusory sense of being cared for when someone treats her as a helpless incompetent. Was this how Christopher was treating her when he called her physician?

When Christopher suggested that she tell the physician and the group therapist how she felt about the way they had treated her, his words may have given advice, but his communication actually conveyed agreement with Stella's position that she had been unfairly treated.

Stella experienced Christopher's agreement and support through his intervention. However, what could have made this a more powerful therapeutic interaction would have been either for Christopher to directly acknowledge his misgivings about having taken charge and contacted the physician or to explore how Stella came to hear his initial obliqueness as giving her what she wanted--his care and support.

Research on the Efficacy of Supportive-Expressive Therapy
It is only since the 1980s that psychosocial components of the treatment of substance abuse disorders have become the subject of scientific investigation. Most research on the efficacy of psychotherapy for the treatment of substance abuse disorders has concluded that it can be an effective treatment modality (Woody et al., 1994). Comparisons among specific models of therapy have become the focus of much interest.

As mentioned above, SE psychotherapy has been modified for use with methadone-maintained opiate dependents and for cocaine dependents. In SE therapy, the client is helped to identify and talk about core relationship patterns and how they relate to substance abuse. One study compared SE therapy and cognitive-behavioral therapy with standard drug counseling for opiate dependents in a methadone maintenance program. Clients were offered once-weekly therapy for 6 months. Adding professional psychotherapies (either SE or cognitive-behavioral) to drug counseling benefited clients with higher levels of psychopathology more than using drug counseling alone. However, drug counseling alone was helpful for clients with lower levels of psychopathology (Woody et al., 1983). Another study involving three methadone programs was also positive regarding the efficacy of SE therapy (Woody et al., 1995). In this study, clients receiving SE therapy required less methadone than those who received only standard substance abuse counseling, and after 6 months of treatment these clients maintained their gains or showed continuing improvement. Gains tended to dissipate in those who received drug counseling only (Woody et al., 1995).

One study compared SE psychotherapy with structural family therapy for the treatment of cocaine dependence (Kang et al., 1991; Kleinman et al., 1990). Both types of therapy were offered once a week. The researchers found that once-weekly therapy, of either type, was not associated with significant progress. Dropout rates were high, and overall abstinence in both groups did not appear to differ from that expected from spontaneous remission. The main conclusions were that the lack of treatment effects may have resulted because these treatments did not offer enough frequency and intensity of contact to be effective for cocaine-dependent people in the initial stages of recovery. This study had at least two flaws, however. One was that the therapists were not well-trained in SE therapy; therefore, it is questionable whether or not the treatment they provided was actually SE therapy. The other was that the therapy was provided in a municipal office building where courts and social services were administered, thus this setting lacked many features of traditional substance abuse treatment settings.

More recently, a large multisite study of 487 persons receiving treatment compared SE therapy with cognitive therapy and drug counseling for cocaine dependence (Crits-Christoph et al., 1997). Each of the three conditions included, in addition to the individual treatment, a substance abuse counseling group. A fourth condition received group counseling without additional individual therapy. This study was a theoretical descendant of the methadone studies mentioned earlier. It was hypothesized that SE and cognitive therapy might be more effective than individual drug counseling for clients with higher levels of psychiatric severity. The results showed that each type of treatment was associated with significantly reduced cocaine use. However, for this population of outpatient cocaine-dependent clients, drug counseling was more successful at reducing substance use than SE or cognitive therapy (Crits-Christoph et al., 1999). One implication of this finding is that drug-focused interventions are perhaps the optimal approach for providing treatment for substance abuse disorders (Strean, 1994).

What this means for practitioners of psychodynamically oriented treatments is that in addition to providing the more dynamic interventions, it is important to also incorporate direct, drug-focused interventions. This can be accomplished by one therapist combining both models or, in a comprehensive treatment program for substance users, one therapist providing dynamic therapy and an alcohol and drug counselor providing direct, drug-focused counseling. It can be argued that this is why SE therapy was so helpful in the methadone studies. In those studies, psychodynamic therapy was well integrated into a comprehensive methadone maintenance program. In other words, in addition to the dynamic therapy, clients received substance abuse disorder counseling along with methadone (Woody et al, 1998).

One study conducted a small, controlled trial comparing SE therapy to a brief (one-session) intervention for marijuana dependence. The SE approach was adapted for use in treatment of cannabis dependence (Grenyer et al., 1995) and was offered once a week for 16 weeks. Results showed that both interventions were helpful but SE therapy produced significantly larger reductions in cannabis use, depression, and anxiety, and increases in psychological health (Grenyer et al., 1996). The authors concluded that SE therapy could be an effective treatment for cannabis dependence.

Clients Most Suitable for Psychodynamic Therapy
Brief psychodynamic therapy is more appropriate for some types of clients with substance abuse disorders than others. For some, psychodynamic therapy is best undertaken when they are well along in recovery and receptive to a higher level of self-knowledge.

Although there is some disagreement in the details, this type of brief therapy is generally thought more suitable for the following types of clients:

Those who have coexisting psychopathology with their substance abuse disorder
Those who do not need or who have completed inpatient hospitalization or detoxification
Those whose recovery is stable
Those who do not have organic brain damage or other limitations due to their mental capacity

Psychodynamic Concepts Useful in Substance Abuse Treatment
Psychodynamic theories endeavor to provide coherent explanations for intrapsychic and interpersonal workings. Because of the importance of this approach in the development of modern therapy, the techniques that stem from these theories are inevitably used in any type of psychotherapy, whether or not it is identified as "psychodynamic." For example, people who have worked with those who have substance abuse disorders are familiar with "denial," even if they are not aware that this process is one of the psychodynamic defense mechanisms. Counselors whose clients have an immediate and strong negative reaction to them often benefit from an understanding of the concept of "transference." It also is helpful for an alcohol and drug counselor who is left feeling hopeless and confused after a session to understand how "countertransference" could be at work. Therefore, counselors who treat clients with substance abuse disorders can benefit from understanding the basic concepts of general psychodynamic theory discussed in this section, even if they do not use a strictly psychodynamic intervention.

The Therapeutic Alliance
The alliance that develops between therapist and client is a very important factor in successful therapeutic outcomes (Luborsky, 1985). This is true regardless of the modality of therapy. The psychodynamic model has always viewed the therapist-client relationship as central and the vehicle through which change occurs. Of all the brief psychotherapies, psychodynamic approaches place the most emphasis on the therapeutic relationship and provide the most explicit and comprehensive explanations of how to use this relationship effectively. Luborsky and colleagues are among those who have documented the profound effect that the therapist-client relationship has on the success of treatment, however brief (Luborsky et al., 1985).

The psychodynamic model offers a systematic explanation of how the therapeutic relationship works and guidelines for how to use it for positive change and growth. In all psychodynamic therapies, the first goal is to establish a "therapeutic alliance" between therapist and client. In most cases, the development of a therapeutic alliance is partially a process of the passage of time. The more severe the client's disorder, the more time it will take. The capabilities of the therapist to be honest and empathic and of the client to be trusting are also factors. A therapeutic alliance requires intimate self-disclosure on the part of the client and an empathic and appropriate response on the part of the therapist. However, in brief psychodynamic therapy this alliance must be established as soon as possible, and therapists conducting this sort of therapy must be able to establish a trusting relationship with their clients in a short time.

One study of the therapeutic alliance and its relationship to alcoholism treatment found that for alcoholic outpatients, ratings of the therapeutic alliance by the patient or therapist were significant predictors of treatment participation and of drinking behavior during treatment and at 12-month followup, though the amount of variance explained was small (Connors et al., 1997). Among cocaine-dependent patients, another study found that patients' ratings of the therapeutic alliance predicted the level of current drug use at 1 month but not at 6 months (Barber et al., 1999). The alliance at 1 month, however, predicted improvement in depressive symptoms at 6 months. These findings suggest that the therapeutic alliance exerts a moderate but significant influence on outcome in the treatment of substance abuse disorders. The specific outcomes measured vary from study to study but include length of participation in treatment, reduction in drug use, and reduction in depressive symptoms.

Developmental Level
Psychodynamic theory emphasizes that the client's level of functioning should determine the nature of any intervention. In Freudian psychoanalytic theory, substance abuse is considered a symptom associated with the oral or most primitive stage of development and represents an attempt to establish a need-gratifying symbiotic state (Leeds and Morgenstern, 1996). Analytic theorists within the Object Relations school hold that substances stand in for the functions usually attributed to the primary maternal (or care-giving) object. As a result, the substance abuser relates to the substance based on the disturbed pattern of relating that he experienced with the maternal object (Krystal, 1977). This would be considered a variant of borderline psychopathology, which is viewed as a fairly severe disturbance of ego functioning and object relations. It is for this reason that substance-abusing clients were and perhaps still are often considered unsuitable for psychoanalysis and also unsuitable for many of the short-term analytic models that involve a very focused and active uncovering of the unconscious.

Contemporary analytic theorists who concern themselves with substance abuse disorders typically do not focus on the idea that addiction is linked to a developmentally primitive level of ego functioning, although they may endorse it. One reason is that this idea leads to a rather pessimistic belief regarding the outcome of analytic treatments for substance abuse disorders. Another reason is that it does not contribute helpful information to the therapeutic approach, and it can impede the development of an empathic and respectful therapeutic alliance. Furthermore, there is increasing empirical evidence for the idea that severe substance abuse is largely driven by biobehavioral forces and that individual psychological factors are of lesser importance (Babor, 1991). Although analytic theories have tended to ignore this (Leeds and Morgenstern, 1996), it has become increasingly a part of the knowledge base in understanding substance abuse disorders.

Insight
Another critical underlying concept of psychodynamic theory--and one that can be of great benefit to all therapists--is the concept of insight. Psychodynamic approaches regard insight as a particular kind of self-realization or self-knowledge, especially regarding the connections of experiences and conflicts in the past with present perceptions and behavior and the recognition of feelings or motivations that have been repressed. Insight can come through a sudden flash of understanding or from gradual acquisition of self-knowledge. So, for example, a client who feels depressed and angry and subsequently drinks comes to realize that his feelings toward his father are stimulated by an emotionally abusive supervisor at work. This type of realization gives the client new options.

These options include learning to separate his reactions to the supervisor from his feelings about his father, working through his feelings about his father (of which he may not have been previously aware), actively choosing alternative behaviors to drinking when he feels bad (e.g., attending a 12-Step meeting), and accepting greater responsibility for his feelings and behaviors.

A broader definition of insight, also promoted by brief psychodynamic therapies, is simply any realization about oneself, one's inner workings, or one's behavior. For example, a client who says, "the only emotion I really feel is anger," has opened the door to understanding the effect others have on her, and vice versa. She can then begin to develop alternative behaviors to those that previously followed automatically from her anger (such as drinking), as well as to understand why her emotional repertoire is so limited.

Insight involves both thoughts and feelings. A purely intellectual exercise will not lead to behavior change. True insight involves a powerful emotional experience as well as a cognitive component and leads to a greater acceptance of responsibility for feelings and behavior. In treating substance abuse disorders, it is important to recognize that insight alone is often not sufficient to create change. Substances of abuse are powerful behavioral reinforcers and the therapist needs to help the client counter the strong compulsive desire for them. Thus, in addition to insight, it could be helpful to offer psychoeducation and make behavioral interventions, which might include encouraging attendance and participation in self-help programs and requiring regular testing by urinalysis and/or Breathalyzer™. Many therapists who conduct substance abuse treatment from a psychodynamic perspective are comfortable combining insight-oriented therapy with concrete, behavioral interventions.

Defense Mechanisms And Resistance
In psychoanalytic theory, defense mechanisms bolster the individual's ego or self. Under the pressure of the excessive anxiety produced by an individual's experience of his environment, the ego is forced to relieve the anxiety by defending itself. The measures it takes to do this are referred to as "defense mechanisms." All defense mechanisms have two characteristics in common: they deny, distort, or falsify reality, and they operate unconsciously. Some defense mechanisms are adaptive and support the mature functioning of the individual, while others are maladaptive and hinder the individual's growth. Generally the defenses hamper the process of exploration in therapy, and for this reason they are often confronted in the more expressive models of analytic therapy. However, in more supportive types of therapy, adaptive defenses are supported, and even the maladaptive defenses may not be confronted until the therapist has enabled the client to replace them with a more constructive means of coping.

In the treatment of substance abuse disorders, defenses are seen as a means of resisting change--changes that inevitably involve eliminating or at least reducing drug use. Mark and colleagues noted that two defenses frequently seen in those with substance abuse disorders are denial and grandiosity (Mark and Luborsky, 1992). Particularly with this group of clients, handling defenses can degenerate into an adversarial interaction, laden with accusations; for example, when a therapist admonishes the client by saying, "You are in denial" (Mark and Luborsky, 1992). They recommend avoiding ineffective adversarial interactions around the client's use of defenses by using the following strategies:

Working with the client's perceptions of reality rather than arguing
Asking questions
Sidestepping rather than confronting defenses
Demonstrating the denial defense while interacting with the client to show her how it works
Defense Mechanisms. Denial. Pretending that a threatening situation does not exist because the situation is too distressing to cope with. A child comes home, and no one is there. He says to himself, "They are here. I'll find them soon." (more...)

Effective use of the therapeutic relationship depends on an understanding of transference. Transference is the process of transferring prominent characteristics of unresolved conflicted relationships with significant others onto the therapist. For example, a client whose relationship with his father is deeply conflicted may find himself reacting to the therapist as if he were the client's father. The opening session in psychodynamic therapy usually involves the assessment of transference so that it may be incorporated into the treatment strategy. Strean found that, "all patients--regardless of the setting in which they are being treated, of the therapeutic modality, or the therapist's skills and years of experience--will respond to interventions in terms of the transference" (Strean, 1994, p. 110).

An initial goal of brief psychodynamic therapy is to foster transference by building the therapeutic relationship. Only then can the therapist help the client begin to understand her reasons for abusing substances and to consider alternative, more positive behavior. A longer term goal--necessitated by the brevity of the process--is to increase the client's motivation and participation in other modalities of treatment for substance abuse disorders.

Etiology
Four contemporary analytic theorists have offered valuable psychodynamic perspectives on the etiology of substance abuse disorders.

Wurmser, a traditional drive theorist, suggests that those with substance abuse disorders suffer from overly harsh and destructive superegos that threaten to overwhelm the person with rage and fear. Abusing substances is an attempt to flee from such dangerous affects. These affects are the result of conflict between the ego and superego, brought about by the harshness of the superego. Given this understanding, Wurmser's main focus is the analysis of the superego. He believes that a moralistic stance toward the substance-abusing behavior is counterproductive and that substance abusers' problems consist of too much, rather than too little, superego. Wurmser recommends that the therapist provide a strong emotional presence and a warm, accepting, flexible attitude.

Khantzian theorizes that deficits, rather than conflicts, underlie the problems of those with substance abuse disorders. That is, weakness or inadequacies in the ego or self are at the root of the problem. Khantzian and colleagues developed Modified Dynamic Group Therapy (MDGT) to address these issues in a group therapy format, and this approach has some empirical support. Khantzian put forth the self-medication hypothesis, which essentially states that substance abusers will use substances in an attempt to medicate specific distressing psychiatric symptoms (Khantzian, 1985). It follows, then, that substance-dependent persons will express a strong preference for a particular drug of choice to medicate their particular set of symptoms. For example, those dependent on opioids are thought to be medicating intense anger and aggression that their egos are unable to contain. Cocaine-dependent people are believed to be seeking relief from intense depression or emotional lability (as in bipolar disorders) or attention deficit disorder. This continues to be a popular theory although most researchers and therapists now would say that this can offer only partial answers to the questions of how abusers develop drug preferences and what the meaning is of such preferences. It is important to consider the social and physical environmental context of substance abuse as well. That is, whatever drugs are most readily available in a person's community and what his peers and associates are using also have a strong influence on a user's drug preference.

Krystal offers two possible theories of the etiology of substance abuse disorders. One is based on an object-relations conceptualization. In this theory, the substance abuser experiences the substance as the primary maternal object.

The substance abuser relates to the substance in the same maladaptive relationship patterns that she experienced developmentally with the mother. The second theory focuses on the substance abuser's disturbed affective functions, known as alexithymia. It is thought that individuals with alexithymia do not recognize the cognitive aspects of feeling states. Instead, they experience an uncomfortable, global state of tension in response to all affective stimuli. Thus they seek to relieve this discomfort with substances.

McDougall views substance abuse as a psychosomatic disorder. It is a way of dealing with distress that involves externalizing and making physical what is essentially a psychological disturbance. Substance abuse then is the habitual use of an externalizing defense against painful or dangerous affects. McDougall suggests that these painful affects are the response to deep uncertainty about one's right to exist, one's right to a separate identity, and one's right to have control over one's body limits and behavior. The abuse of drugs is part of a "false self" that the individual creates to ward off these painful feelings.

Some critics have argued that a major limitation of those psychoanalytic theories is that they do not make allowances for the biological bases of substance abuse disorders (Babor, 1991). However, contemporary psychoanalytic theorists acknowledge that biology plays a role in behaviors related to substance abuse. But the unanswered question remains whether biological or psychological factors come first: Why does a person start using substances? Analytic concepts are useful here, in that they can be said to facilitate the resolution of problems that contribute to emotional distress and to help explore the connection among interpersonal patterns, emotions, and substance abuse.

Levenson and colleagues offer such a theory (Levenson et al., 1997). They describe a biopsychosocial conceptualization of substance abuse disorders that can, in part, be addressed by brief psychodynamic therapy. In this model, substance abuse disorders are particularly difficult to treat because, unlike other psychological disorders, there is a "primary urge" to abuse substances--an urge that can take precedence over every other aspect of life. Furthermore, the symptom (substance abuse) is often considered pleasurable by the client, in contrast to the symptoms of other psychological disorders (such as anxiety or depression). Thus, "[psychodynamic] therapy should be considered as part of an overall treatment plan that includes some kind of drug counseling and possibly other interventions as well, such as medications and family therapy" (Levenson et al., 1997, p. 125).

Integrating Psychodynamic Concepts Into Substance Abuse Treatment
Many of the concepts and principles used in psychodynamic therapy with clients who have substance abuse disorders are similar to those used with clients who have other psychiatric disorders. However, most therapists agree that people with substance abuse disorders comprise a special population--one that often requires more structure and a combined treatment approach if treatment is to be successful. To effectively treat these clients, it is important to combine skill in the provision of the model of therapy with knowledge of the general factors in the treatment of substance abuse disorders. These include knowledge of the pharmacology and the intoxication and withdrawal effects of drugs, familiarity with the subculture of substance abuse and with substance-dependent lifestyles, and knowledge of self-help programs. It also helps to feel comfortable working with substance abusers and for one's therapeutic style to express acceptance of and empathy for the client. In modifying SE psychotherapy for use with clients with substance abuse disorders, Luborsky and colleagues identified certain emphases that are particularly important (Luborsky et al., 1977, 1989). These emphases, listed below, are relevant for applying other types of psychotherapy to substance-dependent clients as well.

Much of the therapist's time and energy are required to introduce and engage the client in treatment.
The treatment goals must be formulated early and kept in sight.
The therapist must pay careful attention to developing a good therapeutic alliance and supporting the client.
The therapist must stay abreast of the client's compliance with the overall treatment program (if the client is involved in a comprehensive treatment program). This includes such things as the client's attendance at all facets of the program, submission to regular urinalysis, and use of any drugs.

If the client is receiving substitution therapy, such as methadone maintenance, attention should be given to the time of the client's daily dose and when, in relation to the dosing, the client feels therapy is best conducted.

Therapists whose orientations are not psychodynamic may still find these techniques and approaches useful. Therapists whose approaches are psychodynamic will be more successful if they also have a knowledge of the general factors in the treatment of substance abuse disorders and conduct psychotherapy in a way that complements the full range of services that clients with substance abuse disorders receive in a relatively comprehensive program.

Treatment Improvement Protocol (TIP) Series, No. 34.
Center for Substance Abuse Treatment.
Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 1999. Contents from SAMHSA

Besma (Bess) Benali, Clinical Social Work/Therapist, MSW, RSW, Counselling Ottawa. I am trained in Cognitive Behavioural Therapy (CBT), Brief Psychodynamic Therapy, ACT, and mindfulness. Clients come to me because they are struggling and feel like they are trapped in a darkness that no matter what they have tried (and many have tried therapy before) they can't pull themselves out. I help my clients understand themselves in ways no one has ever taught them before allowing them to see positive changes.


Why is Failure Important

Is it Worse to Fail at Something or Never Attempt it in the First Place?

Most people have heard the old saying, 'if at first you don't succeed, try again.' But, is trying something new, only to fail, really worth it? How does it affect us when we avoid doing something we know we could fail at? What happens when we do try it, and we just don't get it right?
It might seem like there isn't a clear-cut answer to this question, but that's probably because many people don't want to hear the answer. The truth is, it's much worse to never attempt something in the first place than to fail.

So many success stories have come out of monumental failures. Notable figures like Walt Disney, Steve Jobs, and Michael Jordan have all shared stories about their own failures, and how many times they had to 'lose' at something before landing on a great idea or finding a solution that really worked. Think about it this way: Michael Jordan was cut from his high school basketball team. If he chose not to move forward after that failure, the game of basketball wouldn't be the same.
The idea of failing at something can be scary, especially when it has to do with your career, relationships, or even your reputation. But, you'll never know success without trying something. You'll probably never know significant success without failing.

Failure is important, as those notable figures might agree, because it allows you to learn and grow. Getting something right the first time feels good in the moment, but there's a good chance there is room for improvement. Failures allow your ideas to get bigger and better. Learning from your mistakes again and again tends to mean the final outcome will be above and beyond what it could have been if you got it right the first time.

Never attempting something in the first place might make you feel safe at first. Again, it can be scary to think about failing. But, think about how much scarier it is to spend your life wondering 'what if?'

Not trying something at all due to a fear of failing can cause more turmoil in the long run. You'll always wonder what may have happened if you didn't fail. Those thoughts can actually end up making you feel worse about yourself than if the idea didn't work out.

Face Your Fear of Failing

The best thing you can do is face your fears head on when it comes to failing. The things you're probably afraid of 'messing up' are usually the things you're most passionate about; certain ideas, relationships you really care about, etc. That's why it can seem so scary to fail in the first place.
But, failure is a part of life. It's how we react and move on from our failures that makes all the difference in the world. Never attempting something in the first place will leave you stagnant and discontent, especially if you're passionate about something. Accept failure, learn from it, and embrace it in order to become an even bigger success!

Mollie Busino, LCSW, Director of Mindful Power, Counseling Hoboken. Mollie has had extensive training in Cognitive Behavioral Therapy, Rational Emotive Therapy, and Mindfulness. Her work focuses on Anxiety, Depression, Anger Management, Career Changes, OCD, Relationship, Dating Challenges, Insomnia, & Postpartum Depression and Anxiety.


Social Anxiety and Adolescents

Navigating more complex peer relationships, academic demands and identity issues can be daunting. Managing the multitude of changes that occur during adolescence can lead to anxiety as concerns about the future and conflicts about independence emerge. Fortunately, psychotherapy can help teenagers cope more effectively with difficult emotions and increase self-confidence. The Cognitive Behavioral Therapy and Mindfulness techniques I use are evidenced based and highly effective for anxiety and depression issues.

The following are areas I treat for anxiety.

Anxiety Issues
Chronic Worry: Do you worry excessively about the future, academics, or relationships?
Anxiety and worry is normal for everyone to experience throughout their lifetime. However, many adolescents may have chronic anxiety about every day events. This is often referred to as generalized anxiety disorder. The adolescent with chronic worry may find that after one anxiety issue subsides, another issue shortly emerges. This anxiety may be connected to upcoming events such as tests, athletic performance, peer relationships or concerns about the past. Worries about personal health or the health of others may also be concerns adults may find themselves preoccupied with. The anxiety and worry adolescents experience is often based on beliefs that the worst-case scenario is going to occur. Self-talk statements such as “I am going to fail” and “I will be rejected” are examples of the thoughts that can lead to chronic worry.

Other symptoms of chronic worry and generalized anxiety may be irritability, poor concentration, difficulty sleeping, restlessness or psychomotor agitation (ex: leg shaking, pacing). Often anxiety can impact performance in school and relationships.

How I can help with chronic worry?
I help adolescents develop skills to minimize catastrophic thinking. Rather than jumping to the worst-case scenario my clients learn skills to think in a more balanced and rational fashion. I also utilize mindfulness skills to help adolescents learn how to detach from anxiety thoughts pertaining to worry. I teach relaxation skills to help reduce irritability or psychomotor agitation that adolescents may experience when anxious. Through exploration adolescents will understand social factors that may have made them more prone to anxiety, and how their anxiety impacts social and personal relationships.

Social Anxiety
Do you feel extremely anxious when interacting with others in social situations?
During adolescence concerns about what other’s think and increased self-consciousness is typically normative. When adolescents experience excessive anxiety in social situations they may have a social anxiety disorder. Common thoughts adolescents may have in social situations leading to anxiety, may range from beliefs that they are awkward, unlikable, or boring. They also may fear that their anxiety will be noticed by others. Adolescents with social anxiety may avoid events and school activities all together. Conversely, they may go to social events and be reserved and minimize contact with others. Social anxiety may emerge from underlying self-esteem issues. The adolescent who does not feel positive about himself may feel that others will experience them in a negative fashion. Social anxiety can impact academic performance, classroom participation, concentration and peer relationships.

How I can help with Social Anxiety?
I utilize CBT skills to help adolescents perceive social situations more realistically. Specifically regarding their perceptions and assumptions about how they are perceived. I utilize mindfulness skills to improve social competence and attention skills that can be implemented when interacting with others. This increases confidence and social aptitude. I also use exposure techniques to help clients confront anxiety and become more habituated to anxiety provoking situations. Through exploratory therapy underlying self-esteem issues that may contribute to anxiety are identified. This insight can support self-esteem and self-efficacy.

Obsessive Thoughts
Do you or someone you care about have unpleasant and unwanted thoughts that create intense anxiety and make you feel bad about yourself?
Many teens have unpleasant thoughts that stick in their head like a broken record. These thoughts are unwanted and can be very disturbing. They may be related to sexual issues or aggressive impulses. These thoughts may be extremely dissonant with one’s morals and sense of self. The person suffering with obsessive thoughts may question why these thoughts are occurring and think they are a bad person. It is important to note that this is not the case and that the following unpleasant symptoms typically reflect an obsessive compulsive disorder which can be treated.

How I can help with Obsessive Thoughts
Mindfulness and acceptance skills can be extremely helpful in letting go of obsessive thoughts. My clients learn how to detach from intrusive thoughts and let go of them which helps minimize distress. By learning how to flow with thoughts, rumination (repetitive thoughts) is greatly minimized. Exposure techniques and providing clients with psycho-education about the neurological underpinnings of OCD is also extremely helpful in mitigating symptoms. With skills, knowledge and a compassionate environment, OCD symptoms can be managed and reduced.

Panic Attacks
Do you or someone you care for have intense episodes of anxiety where you feel like you are dizzy, have a racing heart and think you are going crazy?
Panic Attacks can be extremely unpleasant and can co-exist with many other anxiety issues. Signs of panic attacks include racing heart, feeling faint or dizzy, tingling in hands, chest pain, difficulty breathing, and sweating. People who have panic attacks may feel as though they are losing control, going crazy or even dying. Panic attacks are often perpetuated because once they are experienced there is great fear about having another one. This fear about having anxiety actually can elicit panic attacks. Additionally, people who have panic attacks often avoid places where they fear it will happen again. This can greatly impair one’s ability to function. Additionally, avoidance of anxiety provoking situations prevents learning and perpetuates the problem. Fortunately, panic attacks are not life threatening and dissipate in time.

How I can Help with Panic Attacks
I teach my clients relaxation techniques that they can implement while having panic attacks to return to their baseline functioning. Providing knowledge regarding why panic attacks occur and the physiological explanations of the symptoms can reduce the fear of having panic attacks and improve the capacity to manage them. Mindfulness techniques and acceptance are also extremely useful in coping with anticipatory anxiety regarding panic attacks and in reducing the intensity of panic attacks. Exposure techniques can also help people become habituated to panic attacks and reduce emotional reactivity and anxiety. Facing and surviving the fears of panic attacks is the best way of learning to live with them.

Test Anxiety & Performance
Do you or someone you care for have poor study habits, poor concentration and anxiety when studying or while taking exams? Do you find you forget material during tests that you recall after?

How I can Help
Depression, anxiety, or learning issues such as Attention Deficit Disorder can contribute to poor test preparation and lead to test anxiety. I work with students on altering negative thought patterns that contribute to procrastination and impact motivation. I teach students mindfulness skills to mitigate anxiety, depression and enhance concentration both when students are studying and taking a test. I also work with students on mnemonic devices to increase memory retention, which helps students feel more confident and less anxious regarding their performance. Planning and time management skills are taught to help students manage feelings of being overwhelmed by assignments.

Carolyn Ehrlich LCSW, CGP, Counseling Tribeca, specializes in Relationship Counseling NYC. In Couples Therapy Tribeca I help increase your self awareness and help you gain more insight into your inner life. We'll work together so you can get more out of every day and meet any challenge life throws at you.


Counseling in Tribeca New York City

Loneliness. Anyone can feel lonely. It doesn’t matter if you’re in a relationship or not, a social butterfly or someone who isn’t into crowds. To understand what’s making you feel alone, we’ll focus on your inner and outer experiences and work together to find useful things you can do to feel more connected to the world.

Depression. It affects the way you think and feel, it can even affect you physically. It can alter the way you think about yourself, your relationships and the people around you and the events you experience every day. We’ll work together to understand what’s going on and help you feel more positive.

Confusion. There are times when making a decision feels impossible. We’re not sure about who we are, how we live, who we love, or whether we’d be better off in a different career. But by spending some time together, we can help you find a sense of clarity and work out what’s really important to you.

I started Mindwork back in 2007 for people who want to get a better understanding of themselves and the world around them. I found InSession in 2017, InSession has been wonderful to work with, guiding my practice into a new area with their expert Marketing and SEO skills. I couldn't be happier with the results.

For Counseling Tribeca NYC, contact Therapist Carolyn Ehrlich with offices near TriBeCa in SoHo, specializing in Counseling TribecaCouples Therapy Tribeca.

Carolyn Ehrlich, LCSW,Relationship Counseling NYC


Ketamine Infusion Therapy, Can this new treatment help you thrive?

Using Ketamine Infusion Therapy To Help With Depression. Can this new treatment help you thrive?

What happens when traditional anti-depressants don’t work for you? Actually, it’s relatively common; as many as 30% of people won’t have success with traditional anti-depressant medications. Perhaps you’re frustrated with having to take a pill each day. Maybe the side effects of nausea, weight gain, or headaches are too much to bear. Or perhaps despite trying many of the traditional medications, you can’t find one that works appropriately. No matter what the reason, if anti-depressants like Zoloft, Prozac or Lexapro don’t work for you, emerging research suggest that there are other alternatives that may help.

More and more doctors have noted the extreme speed and effectiveness of administering Ketamine to ER patients with suicidal tendencies. This drug can quickly stabilize depressed ER patients so they can be treated appropriately. Doctors are now looking into using the drug as an infusion therapy to help depression sufferers long term.

What is Ketamine?:
Ketamine is a dissociative anesthetic that has been used since the 1970s as a reliable, quick acting general anesthetic in the operating room and in small doses, as a pain management drug. The drug is typically used to start and maintain anesthesia and provides pain relief, sedation, and memory loss. The name of this drug may ring a bell as it was often touted as an illicit party drug n the 90s and 2000s due to its hallucinogenic effects. Better regulation has helped to remove this drug from the streets, so its illegal use is much less of an issue today.

Ketamine Infusion Therapy:
Ketamine infusion therapy is a revolutionary treatment using low doses of the drug, ketamine, to quickly treat severe depression. Doses come in the form of IV treatments over the course of a few weeks. These doses are administered at Ketamine clinics by anesthesiologists. Doses take about 45 minutes to deliver with side effects consisting of general confusion, fuzzy vision and lucid daydreaming but clear up quickly once the infusion is over. The beneficial effects of the infusions last anywhere from 3 to 12 weeks after the treatment is over. Despite the high success rate, Ketamine is not yet FDA approved for the treatment of depression, so this procedure is not covered by insurance. The initial infusions can cost around $4,000.

How does it work?:
Unlike traditional anti-depression drugs that target the neurotransmitter serotonin, ketamine acts on a different neurotransmitter called glutamate. It also works on the synaptic level to create more connections in the brain, which allows other anti-depression drugs to work more efficiently. The fact that its effects last longer than 24 hours also helps add to the allure of this treatment. The fact that patients wouldn’t need to take the drug every day is a welcome idea for those used overwhelmed by the frequency of other medications.

What’s next:
Despite being useful in small segments of the population, no large-scale trial has been implemented showing the long-term effects of the drug. Widespread testing, as well as the development of ketamine-like drugs, should help move this treatment forward.

Dr. Jeffrey Ditzell is a Psychiatrist in New York City and specializes in issues involving anxiety depression and adult ADHD. Ketamine Infusion Therapy is one of the many treatments Dr. Ditzell offers to treat a variety of mental health issues.


Same Sex Pairings In The Animal Kingdom

In Discovery Magazine online, scientists report observing same-sex parents entering into enduring relationships to raise communal albatross young.

The observation, by Lindsay Young and her colleagues at the University of Hawaii, shows albatross females entering into monogamous relationships to raise young, even where the nest contains only a single hatchling from either female.

The reason is fairly apparent. On Oahu, females outnumber males, so nearly one-third of these females are able to mate with, but unable to pair with, a member of the opposite sex. It’s sort of like living in New York city, but on a human scale. Of course, the fact that the females mate with males before forming these same-sex households calls into question the use of the word monogamous. Nonetheless, this same-sex altruism directed toward albatross young is rather remarkable in the animal kingdom – or so the tone of the article implies.

But is it? Not really, according to a 2006 study published in World Science via Oslo University, which states that same-sex pairings among animals have been observed in more than 1,500 animal species, and even among insects (an observation first noted by Watson and Crick in early fruit-fly studies). The pairings can either be male or female oriented and act as social buffers. For example, homosexuality may soothe the frayed nerves of immature males who are excluded from mating and solidify relationships among competing females in matriarchal societies (chimpanzees, for example).

Some will argue that taking examples from the animal kingdom is degrading. We are, after all, humans – more advanced and more civilized than the lesser creatures inhabiting the planet alongside us. It’s a valid argument in some respects, since we do have that artificial construct called technology, and that curious ability to reference future time (the only two things that really separate us from “lower” species). Even so, both are simply artifacts of two characteristics that are present, or potentially present, in other mammals (opposable thumbs and imagination), even if not well developed. Language, pain, empathy, grief and even reverence are shared characteristics. As, apparently, is homosexuality, which may be as much a social adaptation as it is a genetic one.

In any case, our society’s intolerance of it appears to be a purely modern, Western development, at least according to Foucault and planophysical theory. Unfortunately, this prevents us from seeing it for what it is; a sociobiological construct designed to create a certain social equilibrium in which stable but expanding populations propagate by specific selection. It’s sort of like seeing a photon as a wave, and then not being able to see it as a particle.

If we could get past this single-minded sort of observational paralysis, we might realize that only advanced societies (ancient China, ancient Greece, etc.) even give rise to homosexuality. Developing societies, or social groups perilously close to survival in terms of resources, have no place for it because it imperils propagation of the species. Thus, homosexuality is a testimony to our advancing civilization (even if our behavior toward it often isn’t).

But enough of sociology. Whether social or genetic in origin, or some as-yet undiscovered combination of the two, we need to come to terms with homosexuality in our society. Social integration, in the form of same-sex partners being granted equal participation in health insurance programs in some corporations, has already begun. Some states, like Massachusetts and California, have legalized same-sex marriages, and NewYork state’s support, while not actually legitimizing these marriages, goes a long way toward making social and state services a lot more accessible to gay couples.

Expect proposed legislation in liberal states to facilitate the process even further, protecting gays from the sort of discrimination most of us find distasteful when directed at racial or religious groups, as the federal government drags its heels on this issue, which is only slightly less divisive than abortion (at least until a new administration is sworn in, or perhaps beyond, depending on who wins the coming presidential election).

Dr. Dimitra Takos is a Newport Beach Psychologist specializing in the treatment of adolescents and adults suffering from depression, anxiety, and trauma-and stressor-related disorders.

 

 


Insurance, Sex and Reproductive Issues

Former Hewlett Packard CEO Carly Fiorina might have blown her chances of being Senator McCain’s Vice Presidential running mate after she told reporters that, as McCain’s campaign advisor, she’s been getting a lot of comments from women who are upset at the unfairness that many health plans cover Viagra but not birth control.

When reporters asked the Republican presidential nominee what he thought about the issue, Senator “Straight Talk” responded, “I certainly do not want to discuss that issue.” McCain was unable to recall that he voted against a 2003 bill that would have required health insurance companies to cover prescription birth control.

Insurance, sex and reproductive issues, power and money, all fall under the domain of Pluto and the sign Scorpio. Health plans that cover drugs for erectile dysfunction (ED) but do not cover prescription birth control, are not only engaging in gender discrimination but also age and economic discrimination. Any form of discrimination in a society boils down to the influential group exerting power and control over another less influential group.

Gender Discrimination: ED medications are for men only; prescription birth control is for women only. Legislators who permit health plans to operate under a double standard are engaging in gender discrimination against women.

Age Discrimination: Most men taking ED medication are older than women taking prescription birth control, so plans covering ED but not birth control are engaging in a form of age discrimination.

Economic Discrimination: Most women still earn less than men. This drug coverage inequality puts a greater financial burden on women who are less able to afford it. The age issue further exacerbates this. A 50 year old woman has either finished her need for prescription birth control or will soon no longer need it once she completes menopause. Yet middle aged and older men are the largest group of ED users – an age group with a higher disposable income level than young women.

Oral contraceptives have many off label uses that have nothing to do with sexuality. Some women taken them to clear up acne, others to alleviate or minimize menstruation and other cycle problems. A woman who chooses to take oral contraceptives for medical reasons is less likely to need to take time off from work as the result of menstrual difficulties. Some health plans will make an exception to cover oral contraceptives for medical reasons, but only if women submit periodic documented proof from their doctor that it is medically necessary.

It makes no financial sense for health plans to cover ED drugs and not prescription birth control. If a man taking his health plan covered ED drug impregnates a woman, insurance will pay a lot more for pregnancy and maternity care than the cost of covering birth control.

Politicians pander to religious and special interest groups that want to exert their power by trying to limit women’s reproductive freedoms. Power is another form of discrimination. Interestingly, these same groups do not seem to have a problem with ED drugs even though (unlike oral contraceptives) their sole existence is for sexual gratification. These male needs are viewed as a God-given right. Unfortunately some people still place less importance on a woman’s pleasure, let alone her right to control her own body.

Legislators need to make health plans end the discrimination now by either covering prescription birth control or dropping coverage of ED drugs. A better way to end discrimination and lower costs would be to make oral contraceptives available over the counter (sold like cigarettes from behind the counter to women 18 and over).

Carolyn Ehrlich LCSW, CGP specializes in Relationship Counseling NYC. I increase your self- awareness and help you gain more insight into your inner-life. We'll work together so you can get more out of every day and meet any challenge life throws at you.


Online Dating for those Other Animals

Finding that elusive, compatible other – the one your mother assured you would show up in due time – is part of human programming, and using an online site to do so can be effective for several reasons. First, individuals are screened before being released on an unsuspecting and emotionally vulnerable population. Second, the anonymity provides greater safety for women than the club scene, where things can go south so quickly it’s hard to know whether it's ever safe to take your eyes off your drink.

Online matching is fairly simple, Provide a profile of your physical attributes and likes and dislikes, and a computer algorithm selects the candidate(s) most likely to please you. From ice cream brands to shoes, and including those nasty little habits, someone out there likes what you like (and hates what you hate).

The rules aren’t that much different at your local zoo (and, no, I’m not referring to that tacky little bar down the street). There, the same sorts of databases that work to connect people also work to match breeding-age lemurs, antelope and capybaras. The difference is, in zoos, only the matchmakers (animal breeders) have Internet connections.

These databases, originally developed on paper and still called studbooks, are increasingly being used by zookeepers, animal handlers and wildlife biologists in captive breeding programs for rare or endangered animals. The particular Discovery.com article I’m citing involves Killarney, an Australian koala female who seems to have the animal form of social anxiety disorder. Not only does she ignore potential mates, but she tends to take a swing at them if they get too intimate.

In the human world, this would be an automatic fail, the female eventually relegated to spinsterhood, cats and causes. In the animal world, zookeepers and animal handlers persist because species extinction is the alternative. Killarney, like her human counterpart, will be allowed to choose a mate more to her liking, but she won’t be allowed not to choose. Not, that is, until she either kills her potential partner (unlikely with a koala, very likely with tigers) or becomes too old to reproduce.

Another case study in captive breeding involves Naomi, the young giraffe at the Miami zoo. Naomi is the result of bringing together two zoo giraffes (the male from the St. Louis zoo) chosen for their health, strength and size. Unlike human liaisons, which can take place based on appearance or shared interests (and sometimes on nothing more than impulse), the matching of animals is a precise science with predetermined objectives.

Or take the baby meerkats at Auckland Zoo in New Zealand. Though the zoo has had meerkats since 1991, age and natural attrition had reduced their numbers and breeding potential to near extinction level. Only the arrival of meerkat sisters from South Africa saved the day, and the meerkat triplets that resulted have made the population viable again, insuring that these lovable, highly social creatures will continue to exist and charm us with their televised antics.

If online dating for endangered animals seems kind of cold and calculating, remember that captive breeding is driven by both necessity (to preserve species) and economics. As human populations expand, animals run out of space. Equally as relevant, zoos have budgets, just like people do. The cost just to set up a captive breeding program can exceed $15,000. The cost to accomplish breeding runs even higher. Estimates peg the worldwide zoo budget at $500 million in 1990, with captive breeding programs taking about five percent of the budget. Assuming there are about 100 zoos large enough for captive breeding programs, each producing one rare animal per year, the cost of an animal can easily reach $25,000 – a cost matched, somewhat surprisingly, by the price of a modern wedding. But where human alliances can fail, affecting the children, animal breeding has no unwanted offspring.

The studbooks, many still in paper form, are used at more than 200 zoos in the U.S. and elsewhere, and individual handlers, like Laurie Bingaman Lackey in Asheville, North Carolina, consider them a sacred trust. Lackey keeps the giraffe studbook, and tracks the genetic linkages of every one of North America’s giraffe’s within its pages. The entries aren’t about a potential mate’s favorite food, color, film or leisure activity though, but the candidate’s age, sex, weight, and general health or special needs. The animals can’t lie about this, either, the way humans often do. Studbook keepers are scrupulously honest because the future of their charges depends on it.

The only other area in which human and animal “dating” coincide is personality profiling. Studbooks almost always contain an overview of the animal’s temperament, which is a valuable matching tool in the case of aggressive species like tigers, hippos and elephants. Killarney, the hyper-aggressive koala, is clearly an exception to the rule and likely has several pages devoted to her phobias.

As new software makes them Web-compatible, many of these studbooks are going online. This holds the promise of faster and more accurate matches and, as a result, greater breeding success. One thing hasn’t changed however; studbook keepers are assiduous about recording their information, and once an animal is born, or brought into a zoo, and assigned a number, that number never changes, even if the animal is later moved. The number is also retired if an animal dies, much like a Social Security number.

The Columbia Zoo in South Carolina and Walt Disney World in Florida are two of about 20 locations chosen to test this new online matching program, called ZIMS. Disney World, which manages about 27 studbooks in the U.S., is the sole repository of information on the endangered African elephant.

As humans spread across the planet, captive breeding programs in increasingly sophisticated zoos may be the only way to preserve these beautiful, wild, threatened fellow denizens of earth. While no program can save the lovely, shy Vaquita, which has habitat needs man can’t duplicate, it’s nice to know that many other creatures, from bottlenose dolphins to lemurs, will survive to delight our children as they once delighted us.

Christy Weller, Psy.D., Couples Counseling Boulder. I bring a genuine curiosity, a kind appreciation of where you have been, and a non-judgmental stance so that you feel comfortable exploring your story and making sense of it. I tailor my work to each client and I'm trained in both short-term and long-term therapies.


Mindfulness & Stress Reduction

Do you feel stressed? Overworked? Negative? Like you can never get a handle on the tasks that pile up on a daily basis? You’re not alone. Life is busy, and it only continues to become more stressful and overwhelming as our days go by. Despite this fact of life, being stressed out doesn’t have to be the norm. You have the ability to take the steps necessary to reduce stress and anxiety so you can live a more organized and intentional life. Using Mindfulness Based Stress Reduction (MSRB) can help you do just that.

Mindfulness Based Stress Reduction (MSRB) is a program that helps you learn how to calm your mind and body to help you cope with illness, pain, and stress.When learning how to use mindfulness to help reduce stress, it’s important to first understand what mindfulness is and isn’t. Being mindful isn’t “zoning out” or “turning off” but rather the act of being present in the moment. Being mindful is being able to be aware of what’s going on around you without letting your mind wander to your grocery list or the fact that you need to clean the house later. Mindfulness enables you to experience the presence without regretting the past or worrying about the future; actions that contribute to your overall stress level. Most importantly, mindfulness is intentional, active, and isn’t particularly easy to achieve. It’s human nature always to be thinking ahead and planning for your next step. However, the process of mindfulness gives you the ability to be the in the moment. Ultimately, you need to ensure that you’re controlling your mind, and your mind isn’t controlling you. This skill lets you handle stress better so when something is stressful, you’re able to process it quickly and easily.

Being able to practice mindfulness for even a few minutes a day is a great way reduce stress. Not sure how to start? A simple walk outside is a great way to begin. Start by taking note of the environment. Is it warm? Cold? Sunny? How does the air feel? Then, notice the noises around you. Are the birds signing? Can you hear snow hitting the trees? Are kids playing in the park? If intrusive thoughts enter your brain simply acknowledge them and move on. If you’re worried about work, make a mental note about it and then let the thought go. It will still be there when you’re done with your exercise, so it makes no sense being concerned with it now. Starting this practice in a place with a lot to experience (like the outdoors) makes it easier to stay in the moment. As you continue to practice this stress reduction technique, you’ll be surprised at how effective it can be.

A great perk of mindfulness is that its effects are cumulative. The more you work on being mindful, the easier it becomes to overcome stress, anxiety, and negative thoughts as they appear. Do you already have a mindfulness practice? If so, keep at it! If not, now is the perfect time to start. Simply take a few deep breaths and be with your thoughts, if only for a moment.

Counselling Burnaby Vancouver, Via Counselling & Consulting. Burnaby Counsellor Shari Wood, M.Ed., R.C.C. dedicated to helping clients begin their personal therapeutic journey. A Clinical Counsellor, specializing in helping people overcome self-doubt and build healthy relationships.


Boosting Your Self-Esteem – and Keeping It Up!

The way we tend to view ourselves has a huge impact on the way we feel. Beyond that, it can start to take over our lives in such a way that a negative image of ourselves can lead to things like depressive thoughts, poor relationships, and more. It's easy to brush away thoughts of low self-esteem for some people. Unfortunately, it's much harder for others to let those thoughts go, and they can really take a toll you.

The good news? There are so many ways to help rebuild your self-esteem. Of course, these techniques and tips are different for everyone. It all depends on why you might be feeling low about yourself in the first place. Together, we can find ways of boosting your self-esteem so you can begin to see your own value again.

If you've been trying to handle a low self-esteem mindset on your own, understand that you don't have to. Ignoring it can be extremely dangerous and harmful not only to yourself, but to your relationships. Let's take a look at a few ways in which low self-esteem can impact your life negatively.

How Does Low Self-Esteem Affect Your Life?

Unfortunately, many of the ways low self-worth can impact your life are either ignored or not fully recognized. Even if you understand some of the negative effects of a poor image of yourself, you may not be thinking of all the ways you could be damaging your own mindset, as well as your relationships. Below are some of the unexpected ways in which low self-esteem can impact your life:

You avoid social situations: Not everyone is always comfortable in certain social situations. But, if you find yourself avoiding them altogether because of how you feel about yourself, it could lead to damaging relationships. It may also eventually contribute to feelings of loneliness.

Your relationships lack intimacy: When you don't feel good about yourself, it's easy to push people away. Even relationships you've been invested in for years can start to feel distant because you're unwilling to let anyone in.

You are defensive: In order to protect yourself from feeling even worse, you may become overly-defensive toward others. If anyone says anything about you (good or bad), you might be quick to argue with them.

Underlying fear: One of the biggest ways in which low self-esteem impacts your life is bringing fear into it. A constant fear of rejection or not being good enough can really start to take over. When you're so worried about being rejected, you're likely to close yourself off even more. Again, this can damage your relationships, your career, and so much more.

Is it Possible to Rebuild Self-Esteem?

It is absolutely possible to build up your self-esteem. The important thing is getting to the root of what might be causing you to feel so unworthy to begin with. It's not enough to simply give yourself a boost here and there. It can take time and consistent effort to really rebuild your image of yourself from the ground up.

Together, we can use these skills to help you see yourself in a more positive light. It's not about a quick fix or feeling better for a few minutes. It's about a long-term solution that will allow you to sustain a positive image of yourself for life. When you start to feel better about yourself, you'll start to notice the negative effects of self-esteem don't have as much of an impact on your day-to-day life or your relationships.

Anna M. Hickey, Licensed Professional Counselor practices Counseling in Macomb Michigan. Anna's practice, Life Transitions specializes in Counseling and Divorce Mediation.


Interpersonal Psychotherapy (IPT)

It’s not just in your head; sometimes when it rains, it pours. The dog got sick, your son forgot his backpack, you’re running late to work, and you just spilled coffee on your shirt, all before 9 am. These little annoyances can build up and lead to you getting frustrated with the people that you interact with on any given day. A co-worker, your kids, or your significant other all could be in the place you let out your aggression, despite the fact that it shouldn’t be directed toward them. This example may feel like a small part of your daily life, but for some people, these situations lead to demanding interpersonal skills and a frustrating lack of communication. Luckily, a tested therapy called interpersonal psychotherapy understands that life events can affect a person’s mood and that concise and focused treatment can help someone better handle these ups and downs.

What is Interpersonal psychotherapy?
Interpersonal psychotherapy (IPT) is a brief, attachment-focused psychotherapy that centers on resolving interpersonal problems and symptomatic recovery. It’s unique in the sense that it follows a highly structured and time-limited approach and is intended to be completed within 12–16 weeks. It was developed by Gerald Klerman and Myrna Weissman in the 1970s and was created to help treat major depression. It’s since then it has been adapted to help treat other mental disorders such as anxiety, postpartum depression, and bipolar disorder.

Its popularity and overall effectiveness has made it the gold standard of psychosocial treatment. In fact, IPT and Cognitive behavioral therapy (CBT) are the only psychosocial interventions psychiatry residents are mandated to be trained in throughout the United States.

The primary goal of IPT is to help a patient improve their interpersonal and intrapersonal communication skills, develop realistic expectations in communication, and to positively react to their stressors so they can live a more balanced life. The beauty of this therapy is its nuanced nature and ability to understand that a person’s mood is a large factor in how they see and digest the world around them. IPT is based on the principle that relationships and life events impact mood and one’s mood impacts relationships and life events. The acceptance of this idea allows the practitioners of IPT to empathize with a patient and help them understand that little annoyances and stressors can truly lead to stress and overwhelm. By thoughtfully tackling how one sees the world and interprets stressors, a psychologist can help to rewire some of the instant reactions that patient experience. Bubbling anger and immediate annoyance can turn into calm understanding and thoughtful intention. A mind shift like the ones that patients experience when going through IPT allow them to be better communicators and listeners; and ultimately, better friends, partners, coworkers, and parents.

The limited timeframe of this therapy is also helpful for a lot of people as it makes them feel as if they’re completing a course or going through specific training. When someone knows that they’ll be going through a finite therapy, they tend to work more actively towards their end goal as compared to being a more passive observer.

Consider giving this useful therapy a try. A change in your mindset is on the horizon with IPT!

Dr. Takos is a Newport Beach Psychologist specializing in the treatment of adolescents and adults suffering from depression, anxiety, and trauma-and stressor-related disorders.


How is ADHD Officially Diagnosed?

Both children and adults can experience the symptoms and signs of ADHD for years without getting an official diagnosis. Sometimes, people never get the diagnosis they need, and in turn don't get the treatment they need. This isn't only a problem for the person with the disorder. It can also create issues in their personal and professional lives, affecting the people around them.

The best thing you can do if you have children is to learn the symptoms of ADHD early on. Yes, it's fair to say that some children can have trouble with attention or 'sitting still' for long periods of time. But, there is a difference between ADHD behaviors and normal childhood behaviors. If you're an adult who experiences these problems, it's worth it to get an official diagnosis from your doctor.

So, how is ADHD diagnosed professionally?

Symptoms That Go Beyond 'Average'
Attention Deficit Hyperactivity Disorder must be diagnosed by a medical professional. There is a set of criteria mental health specialists use and look for when it comes to ADHD patients, so they are treated with the right kind of care.

One of the biggest factors that allow doctors to give a proper diagnosis is looking at the symptoms themselves. If a person shows behaviors that are not considered normal or appropriate for their age, and these behaviors are consistent in different situations, an official diagnosis may be given. The symptoms must also be present for at least six months.

It's important for doctors to be able to see that the symptoms of ADHD are present in a person in different situations. With children, for example, an official diagnosis may only be given if they exhibit the same symptoms in school as they do at home.

How Do I Know If I Should Get Evaluated for ADHD?

If you're an adult who has experienced common ADHD symptoms since childhood, getting a full evaluation may help to give you peace of mind. However, one of the main reasons people go for an evaluation in the first place is because the behaviors from the disorder are disrupting their daily lives in some way.
Some problems to look out for include:

Losing jobs frequently (or quitting)
Poor work performance
Academic underachievement (or history of underachievement in the past)
Forgetting important dates or information
Chronic stress and worry
Relationship issues

As you can see, these are real-life situations that can be caused by this mental disorder. If you regularly experience any of these issues, getting a full evaluation may be necessary in order to start on a treatment plan. Keep in mind that there is no 'one test' for ADHD. It is considered to be a diagnostic evaluation and must be done by a qualified medical professional.
Different practitioners may have slightly different methods for their evaluation techniques. But, most evaluations will combine questions about family history with symptom checklists, behavioral rating scales, and tests of cognitive ability.

Whether you have shown signs of ADHD for years and are ready to determine if you have the disorder, or you're worried your child may already have it, getting a true diagnosis is the best thing you can do. You don't have to live with the signs of this disorder forever, and neither does your child. Help is available once the condition has been fully determined.

Marcy M. Caldwell, Psy.D. is a licensed clinical psychologist who specializes in the treatment and assessment of adult ADHD Psychologist Philadelphia.


Are You in a Co-Dependent Relationship?

Co-dependency is not a standalone mental health problem but a learned behavior.

The term “co-dependent” was originally coined to indicate adults living with someone (usually another adult) who is an addict. The addiction can be to alcohol – and that was how the term was intended – or to drugs, gambling, sex, relationships, work, food, shopping, or any behavior that invites excess. Co-dependency may also involve emotional, physical, and sexual abuse.

Was Your Family Co-dependent?

Co-dependency can be passed down from one generation to the next, but it is not inherited. Rather, it is a set of emotional and behavioral responses learned by being part of a dysfunctional family. Children who grow up in those circumstances often copy the behaviors of other family members, and are “inoculated” to seek out other dysfunctional individuals when they grow up and start to form their own pairings.

Co-dependent relationships are largely one-sided, with the addict creating chaos and misery and the co-dependent partner so needy that he or she will put up with anger, fear, pain, or shame in order to remain in the relationship. A relationship which, however uncomfortable, is at least familiar.

Identifying the Dysfunctional Family

One of the most amazing and disconcerting elements of the dysfunctional family is that they do not “talk”. They do not acknowledge the problem, and as a result all the other normal family behaviors (feeling, needing, and trusting) are absent as well. The dysfunctional family spends an inordinate amount of time suppressing emotions and disregarding needs: only the addict is allowed to be needy, and all the energy focuses on that person. And this is how the co-dependent becomes a “survivor”, albeit inside an almost impenetrable emotional shell.

This is also how the co-dependent half of the pair “enables” the addict’s behavior, whether it is irresponsible, immature, or physically debilitating. This quid pro quo has the addictive partner taking all the help he or she can get, and the co-dependent partner glad to help because it is only through helping that he or she can feel needed and worthwhile.

You may not even realize that you are a co-dependent personality from a dysfunctional family, but there are certain traits which can help you figure it out. If you are:

Unable to set limits on what you will put up with, or unable to change those limits when it is called for

A victim of low self-esteem, even if you come off to others as thinking highly of yourself

Highly susceptible to other people’s opinions, especially when directed at you

Obsessive, to a degree where that “perfect relationship” fantasy keeps you from living in the real world

Denying your thoughts, feelings, and needs in order to take care of someone else

Having difficulty identifying and conveying your feelings, or feeling numb

Accepting the valuation of others over your own feelings of self-worth

How Can I Overcome Co-Dependency? The co-dependent personality begins forming in childhood. There are, however, a number of steps you can take to help the process. The first is facing up to your denial, in every phase of your life, from the workplace where you are known as standoffish, to the rose- (or smoke-) tinted glasses you have worn since childhood, because it was too painful to face your life head on. Once they are gone, you may be surprised to note that you haven’t done so badly for yourself, co-dependent or not.

Your friends, including the ones you may have alienated (perhaps especially those) are good sources of support. Join a support group, most of whose members are already grappling with co-dependency. Take up a hobby, maybe one you have always wanted to try but never had time for, because you were too busy being dealing with other people's needs.

Finally, learn to say “no” – a word you have seldom used. It can save your life. Also prepare for the fact that a new, non-co-dependent you may have outgrown the existing relationship, but that is okay, too.

Remember, you have the rest of your life in front of you.

Couples Counseling Boulder by Therapist Christy Weller, Psy.D. Also specializing in Psychotherapy and Psychological Assessment Services.


How to Get Along With Your Partner

There are a number of other skills that help preserve a marriage, a friendship, and even a co-worker’s loyalty. These include:

Knowing the right time and place for everything, including arguments. For example, don’t bring up the dirty clothes strewn all over the bedroom floor this morning as soon as your significant other comes in the door after a grueling day at work. How would you know it was a grueling day?

Do not argue in the heat of battle. In fact, don’t battle, because you know you will likely say things that can never be forgiven, even if the other person never brings them up again.

Make sure you have the other person’s attention. This can be as simple as eye contact, and as firm as asking that person to sit down and look at you while you explain something.

Frame all complaints and comments using the word “I”. Don’t say “You always leave you dirty clothes on the floor!” Instead say “I work late, and it’s no fun to wake up to a mess in the bedroom.” This simple reversal changes blame to need – the exact location from which to negotiate change.

Don’t sweep relationship issues under the carpet. There will come a time when you reach the breaking point, and every angry, hurtful thing you ever thought spews out of your mouth. If you can’t talk to your life partner about issues, why are you even in a relationship?

Keep the message simple – no more than three items at a time. These can be promises or problems, but it’s always best to keep the message short.

Repetition is key. The more often we hear something, the deeper it penetrates into that grey matter between our ears.

Another way to reinforce any communication is to have the other person repeat the essence of what we have said back to us. This can take the form of a verbal summary or a written one, and neither one has to sound like a kindergartner’s lesson.

Be truthful about your own needs without purposely being hurtful. If the other person is talking, learn to listen without interrupting or getting upset every time he/she says something that you would rather not hear.

If you can master these rules of communication with your husband/wife, life partner, or significant partner, you will be well on the road to an ideal partnership, which includes: being able to talk honestly about each other’s faults; being able to make each other laugh; agreeing to disagree; taking time away from each other without guilt or fear; and always having each other’s backs.

Couples Counseling Boulder by Therapist Christy Weller, Psy.D. Also specializing in Psychotherapy and Psychological Assessment Services.


Relationship Advice – How to Communicate What You Feel

Communication is the key to any successful relationship. But, communicating how we really feel about any given situation can be more difficult than we usually realize. When we aren't given the correct communication tools, or we don't do it properly, it can lead to arguments and frustration on both parties.

Thankfully, communicating what you feel, and doing it effectively, doesn't have to be extremely difficult. Use the following tips for healthier communication overall, and to make sure your partner is really able to understand how you feel when you're trying to tell them something. The clearer your communication, the less chance of conflict.
Choose Words that Don't Attack

When you're feeling a certain way (especially if you're feeling hurt), it's easy to use words that can feel like an attack on your partner, even if that isn't your intention. Saying things like "you" can instantly put your partner in defense mode. If you really want to talk about your feelings without attacking them, start statements with "I" or "we." This simple switch can help to get your point across clearly, and it will give your partner an open opportunity to listen without feeling judged.

Always Be Honest

It's easier said than done sometimes, but being completely honest is extremely important in sharing your feelings. You will feel better about your openness, and though the truth may hurt at times, in the end, it's likely to make your relationship stronger. Don't tip toe around what you're trying to say. Keep the truth as simple and as uncomplicated as possible.

Engage in Face-to-Face Conversations

In a world filled with technology, a lot of our daily communication is done via text, video chatting, email, and everything in between. Those are all fine mediums for casual conversation, but if you really have something on your mind, having a face-to-face conversation is necessary.

It's not possible to fully communicate how you're feeling if you're not looking directly at your partner. They could misconstrue what you're saying, or you won't be able to get your full emotion across in another medium. Plus, if you talk face-to-face, things are less likely to get misinterpreted, and the conversation can be resolved faster.

If you're used to communicating via mediums like text, etc., and you're worried that you won't have the right words to say in a direct conversation, consider writing down your thoughts and feelings ahead of time. Don't create a 'script,' but jotting down how you feel and some important things you want to say can increase your comfort level, and make it easier to share everything you need to with your significant other.
Share Your Feelings and Save Your Conversation Style

These simple tips can make a huge difference in the way you converse within your relationship. Expressing your feelings directly is important for your personal emotional health, and for the health of two people as a couple. When you know how to communicate what you feel properly, you'll likely experience less arguments and less frustration.

Make sure your partner is aware of these tips, as well. Two people who can communicate honestly in a relationship are always on the right track. Even if important disagreements arise (and they will), being able to be open with one another can make even the biggest problems seem manageable together.

Written by Kin Leung, MFT, providing couples therapy Burlingame


4 Ways to Cope With Work Anxiety

Everyone struggles with stress in their job at some point. Some days are just easier than others. But, it's important to realize that a little extra stress here and there is vastly different from 'work anxiety.' It is absolutely possible to feel anxious everyday at your job, for a variety of different reasons. Whether you're dealing with an unhealthy work environment, or you feel stuck in your current situation, it can lead to crippling anxiety that won't only impact your career, but your entire life.

Thankfully, getting the help of a therapist is always an option. They can help you to work through the stressors affecting your work life, and carrying over to the other areas of life. There are also several tips you can use on your own to calm the regular anxieties that might plague you on a daily basis. Use the following ways to cope with work anxiety to get through the day, until you're able to find the help you really need.

Keep Yourself Busy Around Work

Think about your daily routine. Do you get up at the last possible minute and rush out the door to the office? When you get home, do you feel drained and exhausted, so you just end up watching television or falling asleep? Reevaluating your time outside of work can be important, so you can keep yourself busy. If most of your life is just spent working and resting, it's easy to continuously get trapped in your thoughts and stresses.
Find something that you enjoy doing outside of work, and stay busy with it as often as possible. When you have something else to look forward to, it can ease the tension you might feel at your job.

Stay Active

It's been proven that exercise benefits our bodies both physically and mentally. It's a great way to reduce stress, and get yourself into a healthier mindset before going into a tough situation. Try going on a morning jog before work, or join a gym. Better yet, get a few friends involved regularly for a pickup game of basketball, etc. Regular exercise can lessen anxiety symptoms, clear your head, and allow you to feel a sense of tranquility, even in stressful situations.

Take a Break

There will always be more work to do, and if you're overwhelming yourself by not seeing an end to it, it can lead to anxious feelings. Take breaks when needed. You can answer that email after a five minute walk. In fact, utilizing a short break time outdoors is even better. Sometimes, it really does benefit to get some fresh air and experience some greenery. It usually only takes a few minutes to feel refreshed again, and far less anxious.

Figure Out What You Can Control

Oftentimes, people feel anxious on the job because it becomes overwhelming, or they feel like they have lost their grasp on their daily tasks. Instead of letting work overtake you, figure out each day what you control, and how you control it. Set up a system for project management, or figure out different tactics to answer emails, etc. Little things like this add up with time, and can make you feel like you have more power over your regular tasks than ever before.

Work can be a battle for the mind each day, especially if you're prone to stress and anxiety. Use the tips above to give yourself more peace of mind. If you're still feeling the weight of those anxious thoughts on a regular basis, help is out there.

Dr. Jeffrey Ditzel is a Psychiatrist in New York City and specializes in issues involving Anxiety and Depression.


Postpartum Depression

Why do you feel so down after having a baby?

It is "expected" that a new mom will be full of joy and happiness when she has her baby and it can be very upsetting if you feel the opposite. Roughly 40 percent to 80 percent of new moms experience a condition called Baby Blues. This emotional state of worry, tearfulness, worry, fatigue, and self-doubt starts a few days after birth.

However, if these feelings get unusually intense and last for more than two weeks, you could be having postpartum depression. One major characteristic of PPD is that daily tasks become so daunting and simple tasks seem almost impossible to accomplish, like nursing the baby or just taking a shower.

As much as 10 percent of new mothers develop PPD. However, the percentage may be higher given that a large number of women do not seek treatment. Sometimes, PPD starts before birth or even weeks after birth.

Other symptoms of postpartum depression

Feeling overwhelmed, sad, empty or hopeless
Crying regularly, more than usual and for no apparent reason
Feeling overly anxious or worrying excessively
Feeling, moody, irritable and restless
Oversleeping or unable to get sleep even when the baby has slept
Having trouble remembering details, concentrating or making simple decisions
Experiencing random bouts of anger
Eating too little or too much
Losing interest in activities that you used to enjoy
Avoiding or withdrawing from friends and family
Thinking of harming the baby or herself
Suffering from physical pain ex. muscles, joints, headaches and stomach issues
Doubting your ability to care for your child

Who is at a higher risk of getting postpartum depression?

Depression during or after a previous pregnancy
A previous bipolar disorder
A previous diagnosis of mental illness
A stressful life event after the birth, or an event during pregnancy ex. job loss, death of a loved one or illness
Having mixed feeling about a pregnancy especially if the pregnancy was not planned.
Lack of emotional support from family members or spouse
Drug abuse and alcohol problems

Any woman can experience postpartum depression regardless of the number of births she has had in the past, ethnicity, and age.

What is the treatment for postpartum depression?

There are some options available for postpartum depression. They include:
Medication - You and your doctor will decide, and most antidepressants are safe for lactating mothers and their children.

Counseling

Cognitive Behavioral Therapy (CBT): This therapy is focused on helping people recognize and change the negative behaviors and thoughts.

If postpartum depression is not treated, it may affect the health of the mother and her ability to connect with her child. The child may also have problems with behavior, eating and sleeping, so don't be afraid to reach out if you think you may be experiencing postpartum depression.

Polly Sykes, Registered Psychotherapist, MEd, RP, is a Toronto Psychotherapist with extensive post-graduate training and experience in the treatment of Trauma, and the use of Emotion-Focused Therapy for both Individuals and Couples. The support of an experienced and highly-skilled Psychotherapist can be a powerful tool to help you face the challenges of life with more hope, more self-acceptance, and stronger relational bonds.


Depression Medication Explained

Depression is not a one-size-fits all mental disorder. There are many types of depression including major depression, persistent depressive disorder, bipolar disorder, seasonal affective disorder, psychotic depression, peripartum (postpartum) depression, premenstrual dysphoric disorder and situational depression. It is impractical to expect then that one treatment plan will be effective across all types of depression. A thorough evaluation by a psychologist or psychiatrist will help pin point the specific type of depression so that a specific treatment plan may be developed.

Patients with mild depression may positively respond to strategies that do not include medication. Lifestyle changes for example, including exercising moderately three times per week, have been proven by research to diminish the symptoms of depression. Other strategies include educating oneself about the disorder and avoiding isolation by spending time with trusted friends and family. Talk therapy may also prove to be effective. While these approaches may provide gradual incremental improvement for milder forms of depression, more severe depression may require prescription medications.

Depression is a complex mental disorder and it is not fully understood. However medical science has identified several underlying causes as follows: sexual or physical abuse, grief, drug or alcohol abuse, genetics and unexpected life events. Thyroid disorders and diseases of the endocrine system (hormones) can also cause depression. Chronic illness, including heart disease, kidney disease and diabetes may also contribute to depression. Recognizing the complexity of depression is not difficult; nor is it difficult to understand that use of antidepressants for the treatment of depression must be carefully supervised by a properly trained medical professional. An understanding by the patient as to how the chemistry of antidepressants work may be helpful.

Our brains are composed of complex communication circuits and chemicals called neurotransmitters. Neurotransmitters allow the chemical transmission of signals from one nerve cell to another nerve cell. You may have heard these chemicals referred to as serotonin, dopamine or norepinephrine. Serotonin is found in the brain, bowl and blood platelets. It is believed by some medical scientists to be our body’s primary “mood regulator” and an imbalance of serotonin may lead to depression. At this time science is unsure if decreased levels of serotonin cause depression or if depression causes a decreased level of serotonin. In either case, the relationship has been established and represents the basis of how antidepressants work.

You may also have heard certain antidepressants referred to as SSRIs, selective serotonin reuptake inhibitors. SSRIs are thought to minimize depression by increasing levels of serotonin. Said another way, they enhance nerve cell function by blocking the reabsorption (reuptake) of serotonin in the brain making more serotonin available. This class of antidepressants targets (selects) serotonin and allows the buildup of serotonin between nerve cells thereby affecting emotion and depression.

Antidepressants such as SSRI’s can take two to four weeks to produce effects. They may also cause side effects which may decrease in time. A licensed psychiatrist or psychologists can explain both benefits and potential side effects. In all cases, close supervision by your treatment provider is necessary, and if you are prescribed medication, do not stop taking the medication without first consulting with your health care provider.

Carolyn Ehrlich LCSW, CGP specializes in Relationship Counseling NYC


Stuttering Disorder in Children

What is stuttering? Most likely we’ve all encountered a person who stutters and perhaps we’ve had stuttering episodes ourselves. Stuttering is actually a speech disorder caused by “disfluencies.” Disfluencies are interruptions in the smooth cadence of speech caused by repetition of a word or syllable. Pauses between words are also disfluencies. We’ve all used the sounds “um” or “uh” from time to time and occasional use of these sounds does not necessarily impede communication. However, when a person uses too many of them, communication problems arise.

Stuttering usually begins in childhood as early as 18 months of age. In some cases the stuttering stops at age five but for other children it does not stop. Frustrated parents are left to understand the nature of stuttering and subsequent therapies to help their child maximize communication. Left untreated, an elementary school student, for example, is likely to be embarrassed by other children who tease or bully the child. Here are some symptoms to look for in the event you believe your child needs intervention:

• Child changes word or sentence structure because they anticipate stuttering
• Child avoids situations where they might be required to speak
• Disfluencies became more frequent
• Child finds speaking difficult and stressful
• Tension in the voice becomes evident

Partial word repetition occurs when the child is having difficulty moving from a consonant to the remainder of a word. An example is “G-G-Go over there.” By the third G, they are able to complete the word “go.” Sound prolongation occurs when the child again, is unable to complete a word. An example is “SSSSo why not?”

Parents can help their stuttering child by not putting pressure on them to speak perfectly all the time. They should allow communication to be fun. Using family meals to share fun conversation provides a natural relaxed setting for the child to develop confidence when speaking. Parent can also help by avoiding interruptions or harsh criticism and dictates such as “don’t talk so fast.” A more relaxed calm family atmosphere at home might also improve stuttering.

A diagnosis of stuttering may be done on a topical level by a parent or caregiver. However, a full professional diagnosis should be made by a certified speech-language pathologist. A series of tests and observations will determine the depth of the disorder and the likelihood that it will continue into adulthood. Treatments are behavioral as the child learns self awareness of their speech habits. Instruction may include breath measurements, slowing speech, lessening tension and using shorter phrases or sentences.

If stuttering continues after speech therapy fails to produce positive results, other causes should be examined. For example, could social phobia or an underlying mental illness cause the stuttering? While there is no research to support these causes in children, research is available for adults and one could infer that the adult stuttering might well have commenced in childhood. In one study (32 adults) 60% of participants had social phobia issues and in another study (64 adults) 66% had mental health disorders. While these studies claim no direct correlation between children and adult, a child that is non responsive to speech therapy might do well to seek the counsel of a certified child psychologist.

Colin B. Denney, Ph.D., is the Director of the Pacific Psychology Services Center in Honolulu, Hawaii, he is a Child Psychologist Honolulu.


The Importance Of Touch: Give A Little Love

UC Berkeley's Greater Science Center has performed enough research and experiments on the effects of touch to have a pretty good handle on what it can mean for people. Their decision, as far as an accurate description: Touch is “the primary language of compassion.”

It might seem simple, and even obvious when we actually think about touch, just how impactful it can really be. It’s one of the most natural actions in all of human nature, from the moment we’re born. A newborn baby needs several basic ingredients to live, yes, but what they really want most of all is to be held, to be touched, and to feel the love and compassion radiating from the simple and delicate touch of their parents, and people who love them. That desperate need for touch and compassion doesn’t just disappear over time. If anything, as we get older, that need continues to grow and develop.

Unfortunately, we live in a society where touch itself has become somewhat of an awkward concept. Technology has done incredible things for our world, but where it has supposedly ‘connected’ us to so many people, it’s actually done us a disservice by disconnecting us from the relationships that really matter most, and the touch that is supposed to go along with those relationships. At the end of a bad day, what’s going to provide you with more comfort? A few hours of playing around on your phone, or a compassionate, real, emotional hug?

There is no substitute for touch, or what it can provide to us emotionally. But, there is also scientific evidence to show that compassion touch actually has a positive effect on our bodies as well. Being able to break this strange limbo that touch has found itself in over the past several years is important to the overall health and wellbeing of our society, but that can be easier said than done.

When we think of loving touch, our minds usually go to the romantic side of it, which is important, but absolutely not the only form of compassionate, loving touch. Siblings, parents and children, friends, and even complete strangers can all benefit from compassionate touch at any time. Research has been shown that the simple feel of holding someone’s hand, and feeling as though they are showing genuine compassion toward you, even if you can’t see their face, can do everything from calm nerves, slow down heart rate, and offer a feeling of peace and happiness.

There is some kind of strange stigma behind touch nowadays, because we’ve been ‘trained’ to desensitize ourselves from it. With so much happening in the world all the time, it’s much easier to talk about it, post our thoughts about it on social media, rant about it, or even try to deal with these heavy concepts on our own, but that can really only work for so long before our society implodes on itself thanks to all the pressure we’re putting on our own minds and bodies.

Touch has become awkward, in a sense. Maybe it’s because you’ve never had a compassionate relationship. Perhaps your parents were loving in a different way, but never showcased the importance of touch, never gave you hugs, etc. Maybe you’ve just drifted away from physical touch because it’s easier to remain in the safety of your own world. We back away from compassionate touch for many reasons, and while there is no concrete ‘evidence’ as to why touch has fallen out of ‘popularity’ in recent years, getting it back in the limelight is certainly important for the future.

A lack of touch can make us feel rejected, unwanted, and unloved. So, adversely, imagine the greatness that comes along with even the simplest of touches from someone we love. Happiness, comfort, peace, and of course - love!

Now more than ever, as our world faces uncertain times, and it seems as though a new tragedy is showing itself every single day, we need the comfort and compassion of touch from people we care about, and from people in general. So, the next time you’re feeling blue, or lonely, or even just ‘off’ somehow, consider trading in a few minutes on your phone for a hug from someone you love. You might be surprised at just how comfortable that hug can make you feel, and you can in turn pass it on to someone else. If we all just start with one hug, it won’t take long before compassion through touch starts to fill the world again, giving us exactly what we need.

Being able to understand the past and these old, pushed away feelings and memories will help you to effect positive change in your life and not repeat what has caused suffering in the past. As a couples therapist in Pasadena I understand the obstacles and challenges that face. Donna Shanahan, LMFT Couples Therapy Pasadena, Licensed Marriage and Family Therapist.


The Beauty of Art In Food

Creativity Explored is a studio and gallery space where adults with developmental disabilities make, exhibit and sell their work. And Wright and Graham were brainstorming broad and poignant subjects to which the wide range of artists Creativity Explores works with would respond — when they landed on food.

The artists of Creativity Explored are sometimes referred to as self-taught artists, non-mainstream artists, or the ever-controversial term, outsider artists. What this means, simply, is that they aren’t trained artists in the traditional sense, though they do work with instructors at the Creativity Explored studio. Their techniques, are often unorthodox, highly personal, and tangibly impassioned. Looking an their artwork can feel like looking straight into their minds, without filters of ego, self-consciousness, or ambition, glimpsing the particular ways that chaos and order, memory and imagination coexist.

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