Taking risks in therapy

   

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We all have something that we don’t like to talk about. While therapy is an appropriate setting to explore these issues, we sometimes hold back on certain things — even in that context — out of fear. “Will I sound crazy?” “Will I be believed?” “What will my therapist think of me?” “What are the consequences of saying this?” “Will my therapist think less of me?“ These questions and more prevent us from being completely open in our treatment. 

But if you never take risks, you won’t progress when it comes to those issues. In fact, they may become worse as feelings of shame, embarrassment, guilt, hostility and unworthiness fester inside of you. The fact that you won’t talk about the topic becomes an issue in and of itself. 

The first obstacle you need to pass is trusting your therapist. You can read more about that here. In short, developing a strong therapeutic alliance in a safe relationship allow you to be more open. Keep in mind the ways in which your therapist has been trustworthy in the past. If you remind yourself of these things, opening up might not seem quite as impossible.

Still, even with trust, it can be hard to explore certain topics. I spent a lot of time trying to figure out how to talk about a series of events that happened a few years ago. I had been seeing the same therapist I’m seeing now at the time these things happened and my irrational fear was that I’d remember things wrong and become discredited. But I have yet to find a way around those fears. So what could I do?

It got to a point where my only options seemed to be to keep quiet and never heal or to take a risk and see what happened. After years of deliberation, I decided to just go for it and see what would happen. For me, that meant telling the story regardless of my fears. So I did. 

I was not prepared for how well that went. At first, I addressed my concerns about how he might remember things differently than I did. I asked my therapist to not go back and read his notes from the time in question and he agreed to follow my request. This removed a lot of pressure. 

It’s going to take a while to get through everything. And that’s okay. Breaking the larger story into smaller segments allows me to do a little each week. This way I get insight into each part, which helps me understand the larger context at play. While the content is very difficult and, at times, triggering, I’m feeling better about myself and am more realistic about my role in those events.

Jumping in is not always the solution, but I’m pretty sure that at this point in the post, you have a specific issue or situation in mind. Test the waters. See what happens. Be honest about your concerns. You can discuss them before you get to the actual content. But when you’re ready, opening up despite fear can be extremely healing. I know it has been for me.

What risks have you taken in therapy? How did it work out? Tell us about it in the comments.

Rule of Thumb: Getting Involved

In some ways college students are more connected than ever. Social media has provided multiple methods of staying in touch with friends and sharing information and content. Gaming has also provided a venue of being connected with others and having fun at the same time.

But in other ways many students are not connected at all, and they struggle with "face-time" that is real and not just virtual. Many living environments are both heavily wired and private; if one chooses one may isolate for huge chunks of time and "communicate" widely, yet not actually interact with anyone at all. This is a recipe for diminishing mental health.

So here is a rule of thumb to protect against that deterioration: at least twice a week, get involved in something that takes you out of your living environment, puts you in physical contact with others, and has nothing to do with class, work, or partying. This simple strategy incorporates crucial skill sets which, once learned, will benefit you for a lifetime. The skills also promote good mental health and are also related to retention and academic success.

So what kinds of things can you do? Most students had interests and hobbies in middle and high school, but they may have drifted from them in the excitement of starting college. Consider returning to them, or perhaps be more adventurous and take up new ones. Psychologists believe that learning new skills every five years or so is actually protective of brain health, so it will be good for you on that score as well. On most campuses there are dozens if not hundreds of student organizations, covering topics such as sport, politics or advocacy, environmental awareness, outdoor recreation, art, and so on. If you can't find one that suits you, start your own. You can also see some ideas on this list. There is really no excuse not to try something.

On the other hand, there is no need to get over-involved, as this can lead to meaningless activity and burnout. Trying new activities also does not have to lead to long-term commitment. Simply try some and if they don't feel like a good fit, move on and try another. Frankly, what you pick does not matter. What matters is that you pick something in the first place, and that you expand your skills and relationships. This is part of the recipe for feeling satisfied and in good emotional health, and generally your grades will improve too. That's hard to beat!

5 techniques for the moment you are overwhelmed

We all have those moments where we are hit with something overwhelming. Whether it be an argument, a panic attack or a piece of bad news, our gut reactions aren’t always the most helpful. That’s why it’s important to have coping strategies for those first few moments. Try one of these techniques the next time you need to stay calm while dealing with a big emotion.

1. Use breathing techniques

There’s a breathing trick I have been using lately to help calm down and refocus. First, you close your eyes. Feel everything that’s inside you and pick a word that best describes your emotions. Now, forget about that while you breathe in for four counts, hold for four counts and breathe out for eight counts, thinking only of your breath (or, if you’re like me, the counting). Do this three times, then check inside again and label your emotion. You should be seeing at least some improvement. Keep doing this as many times as you feel necessary.

  

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2. Accept the situation

There are things we simply cannot change. They happen and we have to deal with them. Instead of thinking thoughts like, “This can’t be happening!” or “That’s completely wrong!”, try just accepting it. Your outrage is not going to change the situation. Accepting is not the same as agreeing. Accepting means facing reality for what it is instead of delving into your own pathology. By trying to make something different than what it is, you are wasting your time and mental resources. Make the decision to accept whatever happened and then see how you can have a helpful reaction.

3. Take a break

There are some situations that have to be dealt with immediately, but often you don’t actually have to respond at once. When you are overwhelmed, step aside from the incident until you can gather yourself. You can tell the others involved that you need a moment, but you can also take a timeout without letting on why. Just go to the bathroom or say that you need to check that you turned off the stove. Anything is helpful. Another trick for smaller breaks is to have a drink with you. When you need a moment, just take a sip. It’s amazing how big of a difference a few seconds can make.

4. Ask for help

If someone else is in a position to be helpful, just ask. If it’s difficult for you, it’s often difficult for someone else, too. They’ll understand and do what they can. You can call a sister and vent, go out on the town with a friend or simply ask your therapist to hand you a tissue. Feeling alone in a situation can make it so much worse, so showing yourself that you are loved and cared for can be very calming.

5. Express yourself

Sometimes, feelings demand action. Some of the options that occur to us are healthy; some are not. Pause to make sure your action is appropriate before you act. Punching a wall might sound therapeutic, but you can hurt yourself and/or the wall.  You could hit a pillow a few times instead. If appropriate, you could also respectfully state out loud what you are feeling and experiencing. If you don’t have the option of expressing yourself in the moment, make a mental note of how you will do it later. This could be journaling, exercising or talking to your therapist, for instance. Knowing that you have an outlet later can help you better focus in the moment.

What do you do in the moments you are overwhelmed? Give your own tips in the comments.

Mental health myths: Intelligence

Sometimes, I take the opportunity to discuss mental health myths and the truths behind them. There is so much misinformation out there and we all need to do our part to help others see the truth about mental illness. This time, I’m talking about intelligence.

Myth: People with mental illnesses are less intelligent.

Fact: Mental illnesses, learning disorders and intellectual disabilities are not the same thing.

   

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While psychologists diagnose mental illnesses, learning disabilities and intellectual disabilities, they are not the same thing. What we commonly refer to as “mental illness” generally means the emotional disorders, with symptoms such as depression, anxiety, psychosis and so on. These are what I talk about most of the time on this blog. They don’t, however, have anything to do with how intelligent you are.

Learning disorders are when you have a problem with your cognition that leaves you on unequal footing with your peers when it comes to your capacity to learn. These include, for instance, dyslexia, math disability and, depending on who you ask, ADHD. These are caused by the way your brain processes information. But they still aren’t a measure of how intelligent you are, just the way you learn and what you struggle with.

Intellectual disabilities are about intelligence. While the actual diagnostic criteria are a little more complicated, they are generally considered to be associated with an IQ of 70 or lower. Since the average IQ is 100 (more or less), this puts someone with an intellectual disability at a serious disadvantage. For comparison, above average intelligence is generally considered 110 and higher. That means that the difference between average and gifted is smaller than that of average and intellectually disabled. An intellectual disability therefore means that you have very real struggles in your day-to-day functioning. 

So how do they all relate? 

• Mental illness is not correlated with IQ.

• You can have a learning disorder without having an intellectual disability.

• Intellectual disabilities and learning disorders can influence each other, but one is not a measure of the other.

Think of the whole “crazy genius” archetype, if nothing else. There have been enough people with extraordinary intelligence and a mental illness for that idea to even exist. Anecdotally, some of the smartest people I’ve met have struggled with some form of mental illness or even a learning disorder. People considered intelligent are just as likely to have a mental illness as those who are less intelligent. 

Intelligence is also not measured perfectly by IQ testing. Artistic aptitude, for instance, is not measured on standardized tests. Neither are your ability to build something with your hands or your social intelligence. The truth is, intelligence comes in many forms. And here another archetype comes into place: the idiot savant. There are people who struggle with overall intelligence, but are geniuses in a specific area. These individuals can have just as much to offer as anyone else, just in a very specific way.

Whether someone has a mental illness, a learning disorder, an intellectual disability or none of these at all, everyone deserves respect. Don’t treat others as if you assume they are “stupid.” Differences in intelligence are a part of human existence, just like race, sexuality, religion, physical illnesses and so on. And remember that emotional disorders have nothing to do with intelligence. They happen to the best of us.

What has your experience been with mental illness and intelligence? Share your stories in the comments.

100 ways to improve your mental health

We’ve reached a milestone today – this is my 100th post! To celebrate, I decided to make a list of 100 things. The most helpful idea that came to mind was ways to improve mental health, so here it is. I have broken the list down into categories so that you can find the ones that are the most relevant for what you are working on. (Another milestone: Happy birthday, A. You’re my favorite.)

  

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Emotionally

1. Honor your emotions for what they are and accept them fully.

2. Do something that makes you happy every day.

3. Remember that feelings are temporary; they will always change.

4. Express your emotions creatively.

5. Ask for help when you feel overwhelmed.

6. Know when to back out of a situation.

7. Stop your thinking and ask yourself what you are actually feeling and why.

8. Use a feelings chart to identify what you are experiencing.

9. Surround yourself with little things that make you happy – flowers, art, scented candles, etc.

10. Find positive and uplifting entertainment.

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Mentally

11. Stay in the present.

12. Deal with stress as it comes up.

13. Eliminate bad habits. 

14. Set realistic goals and work towards them.

15. Stop using negative words to describe yourself.

16. Reward yourself for doing difficult things.

17. Take a break when you need it.

18. Find new ways to do things.

19. Stop and consider other perspectives on what you’re experiencing.

20. Use good common sense.

                                                                                              Physically

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21. Exercise regularly.

22. Take time to relax.

23. Eat three meals a day.

24. Take your medication as prescribed.

25. Stay at a healthy weight. 

26. Get enough sleep.

27. See a doctor when you need to.

28. Choose healthy food.

29. Stay away from harmful substances.

30. Love your body as best you can.

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Socially

31. Rely on your support system.

32. Spend time with other people regularly.

33. Be a helpful friend.

34. Respect the needs of others and expect that they do the same.

35. Engage in volunteer work.

36. Eliminate negative influences in your life.

37. Set and keep healthy boundaries.

38. Make time for yourself.

39. Be clear in your communication.

40. Be considerate.

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Intellectually

41. Be educated about your disorder(s).

42. Learn something new every day.

43. Study things you genuinely find interesting.

44. Study something you know absolutely nothing about.

45. Do mind exercises like sudoku, crossword puzzles and word games.

46. Talk to other people about what they do.

47. Take an evening or community course.

48. Think up funny jokes and witty responses.

49. Take notes when you are learning about something. Refer to them later.

50. Do calculations in your head instead of using your phone.

Spiritually

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51. Practice mindfulness

52. Meditate and/or pray.

53. Eliminate unhealthy beliefs.

54. Rely on a higher power.

55. Learn about the beliefs of others.

56. Journal about your spiritual experiences.

57. Share your spiritual experiences with open-minded loved ones.

58. Forgive.

59. Find or decide on your life’s purpose and live it.

60. Stay true to what you believe.

                                                             Environmentally

                                                             61. Surround yourself with beautiful things.

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62. Hang up motivational posters.

63. Spend time in nature.

64. Keep your home clean.

65. Use sticky notes to post affirmations where you’ll see them frequently.

66. Support any environmental causes you believe in.

67. Use your resources well.

68. Take basic safety precautions.

69. Repair broken things so they don’t continue to frustrate you.

70. Stay organized.

Occupationally

71. Do things you love.

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72. Know your limits when it comes to work.

73. Develop schedules and routines.

74. Simplify your work.

75. Get support from colleagues when necessary.

76. Keep good boundaries between your personal and professional lives.

77. Compliment coworkers on a job well done.

78. If you are unhappy in your job, look for a new one.

79. Multitask less.

80. Take a day off when you need to.

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Self-care

81. Journal regularly. 

82. Go for a walk.

83. Make your favorite meal.

84. Use grounding techniques.

85. Have a list of coping skills.

86. Be patient.

87. Keep a gratitude journal.

88. Go easy on yourself.

89. Respect yourself.

Other

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91. Stand up for yourself.

92. Believe you can get better.

93. Keep a beginner’s mindset.

94. Learn from every experience.

95. Keep some money in savings.

96. Have alternatives for self-destructive behaviors.

97. Be prepared for change.

98. Have a safety plan.

99. Stay progress-oriented.

100. Make a list of personal reasons to recover.

Do you have any tips to add? Please do so in the comments!

My top 10 posts

The next post I make will be number 100 and I have a special post coming up for that. Here at number 99, I figured I’d look back at my top 10 most popular posts. They cover a variety of topics and exercises to do at home.

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10. Lapse, relapse and recovery

“Part of recovery is relapse. It's almost expected. At some point, after things have gotten better, they'll probably get worse again. The truth is, though, that your attitude towards relapses will have a big impact on how you handle them and whether you can use them to grow.”

9. 7 signs you need a new therapist

“Not every therapist is a good match for every client. This means that sometimes, finding someone else is the best thing to do to progress in your recovery. There are, of course, reasons to stay with the one you have. By working through your differences, you develop a stronger bond and learn how to manage relationships outside the therapy room. But if any of the following points are a problem, then it might be time to find someone new.”

8. 10 journal prompts to improve relationships

“Journaling is a very powerful way to explore yourself and come to a better understanding of who you are. I thought we’d look at some other ideas to write about. This time, we’ll take a look at questions that can help you improve your relationships.”

7. Learning to trust your therapist

“It’s hard to make progress in therapy if you don’t trust your therapist. Trust is essential to the therapeutic relationship, which in turn is essential to recovery. But for many people, it’s by no means easy to open up to a complete stranger and talk about the most personal parts of their lives. This is where trust building comes in.”

6. 10 signs of mental illness you should never ignore

“There are a lot of symptoms of mental illness, more than anyone can list off the top of their heads. But some are more severe than others. Here are a few of the ones where you should immediately seek advice from a mental health professional.“

5. You don’t need to justify your mental illness

“You might have certain beliefs that invalidate your mental illness. They might be reasons why you shouldn’t be mentally ill or why your illness is not that serious. You may even feel guilty for seeking treatment. One of the biggest causes for these thoughts is comparison to others.”

4. 15 Best Picture winners about mental illness

“The entertainment industry has a tremendous power in shaping the public view of mental health topics. With Silver Linings Playbook, a romantic comedy featuring a protagonist with bipolar disorder, up for eight awards at tonight's Academy Awards, attention is currently being focused on the challenges faced by those affected by mental health conditions.”

3. 3 art therapy exercises to do at home

“Art therapy is a form of treatment that allows for expression beyond words. It gives you a chance to look at your problems in a different way and learn more about yourself. Today I thought I'd share three different exercises you can do at home. I've included examples of my own work.”

2. 20 questions to ask a potential therapist

“First sessions with therapists can be kind of like first dates or job interviews. You want to find someone who is a good fit for you, so you ask a lot of questions. Figuring out what to ask, however, might not be the easiest thing to do while you’re in the moment. Pick whichever of the following questions are the most important to you and bring a list to your fist session. It’s better to know sooner rather than later if your therapist is the right person for you to be working with.”

1. 15 journal prompts to increase self-reflection

“Journaling can be a great way of expressing what is going on inside of you. Writing forces you to slow down your thinking and be more mindful of your words, leading you to reach a deeper understanding of what you are going through. This can help you gain insights that let you progress on your journey towards healing.”

What have your favorite posts been? If you tell me in the comments, I can write more like them.

A case for family treatment

We cannot escape family. Their presence or absence will always impact us on some level because family is interconnected in a way that nothing else is. It’s foundational to who we are. A family can be composed in many ways – with blood being only one possible tie – and we will all have different “families” throughout our lifetimes. Sometimes we may be more alone than others, but we all started in a family and that is paramount to the people we become.

There’s an analogy that compares a family to a mobile or a wind chime. There are independent units, but you can’t move one without moving the others. Everything we do impacts our families – and everything they do impacts us. For instance, if a child graduates high school and moves out to go to college, the family has to readjust to the environment without that person. This can mean practical changes, such as redistributing chores, or emotional ones, like when the sibling closest to the one who moved feels left out and has to form new bonds with the remaining family.

  

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There’s a concept in psychology called the “identified patient” (IP). The IP is the family member who has a “problem.” This could be an alcoholic parent, a child failing out of school or someone struggling with physical or mental illness. Everyone else in the family can convince themselves that they are okay because they are not the IP. In this way, all the problems of the entire family get shifted on to one person. 

This isn’t done with bad intentions. Often, the family has benevolent or fond feelings for the IP. A wife will make excuses for her partner’s absences due to a drug problem in order to save face or get him off the hook. A parent gives a child lots of attention because she’s acting out at school. A teenager is happy to have an ill brother because he distracts the parents so she can rebel. This isn’t the family being mean. It’s the family adjusting.

These adjustments that are made for the IP do, however, have consequences. The wife is saving the husband from the repercussions of his drug problem, enabling him to continue to use. The siblings of the “problem child” feel like their parents don’t care about them. The sister gets in trouble because the parents were busy caring for the sick brother. Trying to cover up the problem is just creating more problems, but because they aren’t the IP, the other family members eschew their own troubles in favor of those of the IP.

Remember that mobile? One person “moves” by having a problem and everyone else shifts their problems somewhere else. 

This brings up the question of where the real problem lies. Is the identified patient of concern, or is it the family as a whole? What starts out as an obstacle for one family member can set off a chain reaction wherein everyone becomes involved.

So what happens when the IP gets better? First of all, the family often stands in the way of the IP improving. If her problems are resolved, then theirs become real again. While the family wants what’s best for the IP, they also want to retain the balance they have established. They might even fear becoming the next IP because the family doesn’t know how to function without one. 

This is why family treatment is so important. It allows all the cards to be put on the table, making it easier to notice connections between family members and their various problems. Sometimes, having a mental health professional take a look at your family unit as a whole can help all of the family better understand what is going on and how to make the family healthier. Everyone’s problems get a chance to be addressed, not just the IP. A good therapist will know not to blame the IP for everything.

   

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Family treatment can cause upset, though. It’s a time of change as new habits and coping skills need to be put in place. It will bring out all sorts of things that no one knew were there and things might even feel worse for a while. But having the family unit heal both individually and as a whole is worth it. There is no price for having stronger, healthier bonds and better problem management. 

When each family member learns to see what he contributes to the problem, he can learn valuable information about how he relates to others, which will be useful in any type of relationship. As she examines her real issues and how she displaces them, she can learn to take more responsibility and thereby have more control over her life. None of us exist in isolation and none of us can heal that way.
                                                                                                                   Individual and common concerns are intricately
                                                                                                                   interwoven.

Even if all the family members aren’t struggling, consider getting treatment together anyway. If nothing else, the love and support shown by joining the treatment is irreplaceable. There is work that simply cannot be done in individual therapy. Besides, by learning healthier patterns, you can improve the lives of the generations to come by having and teaching the skills necessary to have a healthy and happy family.

Have you had any experiences with family treatment? Post your experience in the comments.