High-Functioning Autism: A Clinician’s Perspective

Formerly referred to by the mental health field as “Asperger’s Syndrome,” High-Functioning Autism is characterized by challenges in an individual’s social and emotional functioning that can affect the quality of their interpersonal relationships. In addition, such individuals may have difficulty communicating with others, exhibit rigid thought patterns, and restrict their interests to certain topics or hobbies. They often misperceive social cues and, as a result, do not know how to comfortably interact in social situations. 

While these behaviors do characterize High-Functioning Autistic individuals, beyond the social awkwardness, they are wonderfully unique, highly misunderstood, and complex. Traditional neuropsychological evaluations do not always capture the nuances of their personality, their strengths, or their potential. It’s a process to fully understand an individual who meets the criteria for High-Functioning Autism.

The following characteristics can make it rewarding to work with these individuals. 

  1. They cannot help being honest about what they think. You always know where you stand. When my goal is to help these clients achieve healthy and joyful relationships, their honesty is refreshing, especially in a metro area where diplomacy can often feel superficial or fake.

  2. They desire friendships and to belong in community. They may lack the social skills to be positively received by others much of the time, but this often leaves them feeling sad and lonely. It is untrue that most individuals prefer not to have relationships. If they expressed this sentiment, it is more likely because of the social discomfort, rejection, or alienation they have experienced. No one would want to continue pursuing something that has such negative and painful results.

  3. They often possess a wealth of knowledge in areas of their interest. While they do not always pause to listen or allow others to interject as they disseminate their knowledge, I can often learn fascinating and valuable information.

  4. They have the capacity for empathy. I have heard it said that individuals on the autism spectrum are incapable of empathy. It is often not true that they lack the capacity all together; rather, it's a muscle they must build. While it can be difficult for them to see the perspectives of others, it’s possible to raise their awareness.

It’s important for clinicians who decide to work with this population to understand these complexities. If there’s anything I can say with certainty from my clinical experience, it’s that working with these individuals is more of an art form than a science. 

Image by Dmitri Posudin from Pixabay

Five Hard Truths Divorced Parents Must Accept

Since I began practicing in 2007, I have worked with many families in which the parents were going through a divorce. I have been subpoenaed to testify in Family Court over two dozen times. While occasionally it’s necessary for me to testify to advocate for the well-being of a child, I am saddened by the frequency of these requests. Psychologists are often subpoenaed to serve parents, but it does not protect the children. Children’s therapists should not routinely testify because it often compromises the child’s therapeutic relationship. If the motive for taking the child to therapy is to engage their provider in court testimony against a former spouse, parents must ask whether they are serving their child’s best interest or their own. 

In this post, I want to address parents going through divorce and encourage them to reach out to mental health professionals who can help them and their children navigate this difficult time. Therefore, I want to give them some tools to support their children and effectively manage their own emotions.

Here are some factors to consider before making your child’s mental health treatment about court testimony and some recommendations that might help as you navigate custody and visitation challenges:

  1. Your child’s mental health challenges are not your ex-spouse’s fault. It certainly is true that divorce is hard on everyone. It is also absolutely true that your child will be affected by the divorce. Your child may be sad, angry, and scared. Children often worry that the divorce was their fault. Or they may develop separation anxiety from their parents when one of the parents moves out of the home. Your child will grieve the loss of the family as it once was, even if there was conflict. In many cases, children need to see a counselor to support their adjustments, and they can also benefit from a support group. However, it is misleading to identify the divorce as the central cause of any mental health problems. Many children would have had mental health challenges anyway. There are many reasons why children become depressed, anxious, or have school related problems. The reality is that there are complex reasons why children struggle emotionally, and divorce is definitely a factor. But neither parent causes the mental health challenges of their children in the context of divorce. Neither parent is solely to blame for the child’s mental health problems. Furthermore, the solution, even in cases where the parents bear some responsibility, is not to remove the parent from the child’s life.

  2. Your parent-child relationship may be negatively affected by attempting to remove the other parent from your child’s life. Parents who engage in ugly court battles, continuously make derogatory statements about their ex’s acts in front of their children, or attempt to alienate the child from the other parent may ultimately do more damage to their own relationship with their child. Sometimes, they initially have success. I have seen many children who have formed negative opinions of a parent. They begin to not want to spend time with that parent. But I’ve also seen many cases where the child later turns against the alienating parent. Or, in the worst case scenario, the child becomes estranged from both parents as an adult. Parents who are considering removing their ex from the child’s life for any reason must consider the risks involved in doing so.

  3. You can’t dictate how your ex raises the children. You may be a good parent: you have figured out how to discipline, how to support their education, how to love them well, and how to shape them into wonderful human beings. Part of the reason that you divorced may be due to differences in parenting preferences. But now that you are divorced, you have even less power over how they will be parented by your ex partner. Coparenting — continuing to work together to effectively parent even after the marriage has ended — has mixed success. Most of the families with whom I have worked have not had much success with it. This is largely due to the level of conflict between the couple. It can be successfully executed with two cooperating parents whose first priority is their children. But even in the best coparenting scenarios, you cannot control what the other parent does. When the children are in the care of one parent, that person can decide how much screen time they get, what they eat, what they do, and when they go to bed. This may not be congruent with your choices.

    My advice is to focus on your own parenting. Give them good meals when they are with you, limit screen time as advised, help them develop healthy sleep routines, and teach them good self-care. As they grow older, they will develop the healthy habits that you taught them. Obviously, there are circumstances that warrant concern. Suspicion of abuse or other maltreatment should be investigated. However, in the majority of cases that I’ve seen, while one parent makes better choices, the other parent can still be capable of having custody.  When negotiating shared custody following a divorce, both parents have to pick their battles carefully: the more time spent in court, the less time parents spend with their children.

  4. Your ex will likely never agree with you. This one may seem like common sense, but I have worked with enough divorced parents that I think it’s worth saying anyway. The question all divorced parents must ask continuously is “who is my top priority?” You may be extremely angry with your ex, and you may be very well justified. The reality is that even a family court judge can’t make your ex agree with you. If revenge is what you are seeking, or simply “I told you so,” is it worth risking your relationship with your children? Do you respond to your anger by fighting in court? Or, is it a wiser choice to get your own therapy, so you can work through your anger.

  5. Your child’s therapist is not your advocate. The child is not only the client of record, but also the priority of their therapist. It is important for the therapist to guide both parents in better understanding their child’s problems and needs. But it is not appropriate for the therapist to see only the viewpoint of one parent or to begin advocating for the removal of custody from one of the parents. It is not the therapist’s role to focus on either parent, but instead to treat the child’s mental health challenges. The exception would be in cases of known abuse, but even then, it’s not the therapist’s decision. Therapists are mandated to report suspicion of abuse to child protective services, but their focus then returns to providing supportive care and interventions to the child in the family. There have been times when it was necessary for me to give testimony that was not favorable toward a parent. On these occasions, there were grave concerns regarding the children’s well-being and safety.

If your divorce and custody situation needs professional consultation to determine who is more fit to have custody, a custody evaluation is a better choice than using the child’s therapist as your witness. There are psychologists who conduct comprehensive custody evaluations for parents in contentious custody battles. This is the route to take if you believe your ex is abusing your child or putting them in direct danger. However, in most cases, children’s mental health outcomes are far more positive when parents work together and seek a holistic approach to address their child’s emotional and psychological functioning.


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MILLENNIALS: are they the therapy generation?

A recent article in The Wall Street Journal, “Millennials Are the Therapy Generation” by Peggy Drexler, discusses millennials’ increased interest in therapy and new therapeutic strategies for engaging their generation. While I agree that millennials are open minded about therapy, what are their expectations? They often enter therapy prepared to be open about the challenges they are having, but are they open to feedback? I think it is necessary to explore what they perceive therapy to be, as well as what good therapy looks like. We need to engage millennials in therapy in ways that they can receive, but what people want from therapy is not always aligned with the best approach to personal growth and self-improvement. In this article, I want to encourage millennials interested in mental health treatment to adopt realistic expectations, so they can get the most out of their therapy. 

If you are a millennial seeking treatment, you must ask yourself, “am I up for the journey?” Many millennials perceive therapy as helpful, and they come in with high hopes about its efficacy. Their expectations of how quickly therapy is going to cure them, though, can be unrealistic. They typically want advice and practical solutions early in treatment. The desire for solutions is genuinely good, but the process of finding the best solutions for them is a harder and longer journey. Getting them to stay past a handful of sessions can be a challenge. Some of them stick it out. Some of them work through the difficult emotions and dig deeper into the underlying reasons for their stress. 

Whether or not someone chooses to go on the journey in therapy depends on many factors. Among the most important, especially for this generation, is the individual’s willingness to explore their decisions, mistakes, and failures. For a generation whose parents largely provided positive feedback and praise, this can be difficult to undertake. Many of them have never had to question themselves because their parents stepped in and solved some of their problems. So, now, they may be looking for their therapist to help them do the same. But it isn’t that simple. We must understand our choices and take responsibility for them before we can grow in our insight of how to make different ones. Acknowledging that sometimes we will do our best and still make a decision that we regret is part of the growth process. Thus, therapy involves growing out of avoidance and into personal responsibility. 

This kind of journey can be hard for many people, not only millennials. But many millennials find it intolerable and not worth doing. They want therapy that’s quick, effective, and that reinforces their ideal self. Good therapy, insightful therapy teaches people to accept their choices, learn from them, and incorporate them into their development of identity. This kind of growth can be uncomfortable. You have to sit with it. That means you come back to therapy once a week, and it’s not always something you gleefully anticipate. You will leave some sessions feeling worse than when you started. You have painful questions to ponder sometimes. But as you progress through the journey, you notice changes in yourself and an understanding of yourself that you have gained through the process.

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Mental Health Awareness: Moving Beyond Stigma to Increase Hope and Resilience

May is National Mental Health Awareness Month. During this month, mental health advocates post online to reduce the stigma that mental illness still carries in our society. I’ve seen lots of posts on social media discussing the need to treat mental illness with the same importance and seriousness as physical illness. For instance, would you tell a person with cancer that they are difficult to deal with, as many people say to loved ones who struggle with chronic depression? Other posts include quotes from prolific writers about their own mental illness, describing in detail the dark depths of depression or the emotional roller coaster of bipolar disorder. Both types of raising awareness deliver the message that mental illness is serious, painful, and deserving of recognition. 

While these articles are doing important work, they overwhelmingly give the impression that mental illness is untreatable, incurable, and something to just be accepted. But what is the next step after recognizing the reality of mental illness? As a mental health professional, my preference is to inject positive energy into the conversation by bringing a message of hope, healing, and resilience. 

Below are six important practices for bringing this perspective into mental health treatment.  For my colleagues, these are practical suggestions that you can incorporate into your work. Individuals receiving or considering mental health services can also benefit from being aware of these options and perspectives.

  1. Redefining Mental Illness As a Treatable Condition Rather Than a Central Part of Their Identify: Would we tell a cancer patient they will be struggling with cancer for the rest of their life without trying to bring the cancer into remission? Would we identify a friend who has cancer as our “cancer friend”? These questions may seem absurd, but I’ve heard persons diagnosed with mental illness identified as “the depressed guy.” I’ve also heard, even from qualified mental health professionals, that certain clients will “always be depressed,” or “will continue to be debilitated by their mental health.” It is true that many people struggle with chronic mood disorders, severe anxiety, or complex trauma in which healing is an ongoing process. However, as professionals, we must send a message that speaks with hopeful optimism regarding treatment. Of course, we must be sensitive to those who struggle with chronic mental health challenges that are resistant to strategies that many people find helpful. That said, as a psychologist, I feel responsible for instilling my clients with hope and encouraging them to believe that, with a team of professionals and supportive resources, they can achieve a more positive outcome.

  2. Building a Supportive Treatment Team: When someone struggles with chronic emotional and psychological challenges, a single practitioner is not enough to provide the level of treatment and support needed. Often a team includes a psychiatrist to prescribe medication, an individual therapist with whom the person meets once or twice a week, therapy groups, and various other resources. These may includes a nutritionist (as we learn more about the connection between gastrointestinal health and mental health); a life coach to assist in managing daily living; or an occupational therapist if the person experiences sensory challenges (sensitivities to sound, textures, or other environmental stimuli). Clients will likely not be aware that they need or can access these services, which is why processionals have an obligation to educate their clients after a thorough clinical intake. 

  3. Assessing Social Support: Outside of professional support and a complete treatment team, we must asses each client’s pool of family, friends, or other people in their lives who can provide comfort, encouragement, and compassion. This may involve meeting with family members or others close to them to provide education about how to be supportive. This reduces the burden of the client having to relay this information. It also ensures that fiends and relatives are helpful, rather than providing well-intentioned but unhelpful advice to those who are hurting. 

  4. Giving Clients Tools and Strategies: Insight oriented therapy can be extremely helpful, especially for those who have long suffered and are connecting the underlying sources of their pain to their present circumstances. However, even when talk therapy is useful, clients can always benefit from learning coping skills and specific strategies to employ when they are experiencing negative thinking or painful emotions outside of therapy sessions. Tools such as mindfulness meditation apps for calming techniques are examples of practical steps that clients can take to relieve the intensity of their symptoms. Taking some time in therapy to practice such strategies is useful because clients then feel more confident in using them on their own. 

  5. Goal-Setting and Assessing Progress: Helping clients set goals early in their treatment can affect whether they view therapy as being effective. If we notice that clients do not improve, or if they report that they are dissatisfied with their progress, we must reassess their treatment goals. This requires that we give clients the space to tell us they are dissatisfied. Establish their right to do this when they begin therapy. 

  6. Educating Clients About Mind-Body Interactions: A top priority in the treatment of mental health problems should be educating ourselves and our clients about all of the factors contributing to their condition. We must be responsible for staying current in new scientific findings. We must share this knowledge with our clients and provide them with information they can read on their own. While it is true that some mental health problems have genetic links, it is also true that environmental factors play a significant role in the outcome. Now more than ever, we know that our brain chemistry can be altered through our behavior and our interpersonal relationships. Sharing this information with clients can result in them finding more help in treatment, as well as increase their willingness to stay in therapy long enough for it to be more effective.

As mental health professionals, we must ask ourselves, do we have hope for our clients? Do we believe that their mental health can improve and their lives can change for the better? If so, then including some of the above suggestions into your work may enrich the quality of your relationships with clients and instill the hope and resilience necessary for them to remain in treatment and make positive gains. That is what mental health awareness means to me – instilling hope in our clients and in the public. Living with mental health challenges does not have to mean a miserable existence.

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ADHD: It’s Not Just About Attention Deficit

Among one of the most commonly diagnosed disorders in children, ADHD has been a subject of controversy over the years, especially as it relates to the recommended prescribed stimulant medications. 7% of the population of the United States meets diagnostic criteria for attention deficit hyper activity disorder (ADHD), according to the Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (DSM-V). The disorder has two specific subtypes: Predominately Inattentive Type and Combined Inattentive and Hyperactive/Impulsive Type. The criteria for both subtypes are based on the person’s behavior patterns over time. Given that ADHD affects the lives of millions of Americans, it is an important topic to consider during National Mental Health Awareness month. 

Mainstream culture has criticized the disorder’s diagnosis and treatment, stating there are many reasons why children have difficulty focusing, and that all children are hyperactive and misbehave at times. But ADHD is a far more complex disorder that affects many other aspects of life, including social relationships, emotion regulation and mood, increased risk for addiction and other thrill-seeking behaviors, conduct problems, and difficulty forming healthy lifestyle habits. Most people outside of the mental health profession do not recognize the comprehensive toll that ADHD can take on an individual’s functioning and quality-of-life. 

The purpose of this article is to discuss two of the major factors associated with ADHD which, unlike academic functioning, have not received as much attention: social-relational functioning and emotion regulation. Recognizing these components can empower those suffering from ADHD as well as their friends and loved ones. With therapy, individuals with ADHD can manage these symptoms and improve their capacity for interpersonal relationships.

Social Relationships: If you have ADHD, or know someone who does, you may have noticed the difficulty in navigating interpersonal relationships. Many individuals exhibit difficultly engaging in conversation: struggling with active listening or frequently interrupting others to interject their own thoughts. This is because the brain’s pre-frontal cortex struggles with self-control. They may also worry that they’re going to forget what they are about to say because of their trouble paying attention. Thus, frequently interrupting others, or being preoccupied with their own thoughts while others are talking, are common factors that may interfere with their ability to have quality conversations. This may transfer to interpersonal relationships, where they may forget a lot of information their loved ones tell them, and they may become frustrated by their forgetfulness. More serious challenges with social relationships may stem from the person acting impulsively and having trouble filtering their thoughts — so they hurt other people’s feelings — or struggling to make decisions in the relationship. These issues are well-documented by clients and through research studies. Cognitive-behavior therapy supports clients by teaching how to mindfully approach conversations rather than focus on their thoughts while interacting with others.

Emotion Regulation and Mood:  One of the least known facts about living with ADHD is its impact on one’s ability to self-regulate intense emotions. Individuals with ADHD feel their emotions more deeply and for longer periods of time. In addition, they have difficulty regaining self-control after experiencing strong emotions. This is true for both children and adults living with ADHD. They may also experience triggers for intense emotions more often than individuals who do not have ADHD. This remains an important area for research and developments in treatment. Low frustration tolerance, another well-documented symptom of ADHD, has been studied, and it can be treated with both medication and effective coping strategies. Other intense emotional experiences, however, have only recently received attention from researchers. Meanwhile, therapists can teach clients coping strategies such as mindfulness techniques and cognitive restructuring (modifying negative thoughts that provoke intense feelings).

These issues raise the importance of combining therapy and medication as part of a comprehensive treatment plan. It is in therapy that individuals develop coping strategies, such as mindfulness and social skills training. Learning how to live successfully with ADHD is just as important as medically managing the symptoms with stimulants. Clients and professionals need to work together to improve education about all the ways ADHD affects functioning. Understanding that ADHD is not only about attention and hyperactivity may improve people’s willingness to accept the diagnosis and conceive of a more comprehensive plan of action.

If you, your child, or someone that you know has been diagnosed, or it has been suggested, consider the impact that it can have on their social and emotional functioning, as well as their performance at school or at work. Raising awareness of how ones interpersonal and emotional life can be impacted will hopefully motivate people to seek treatment for themselves or their children. While many intelligent persons who are self-motivated can get through school without actively treating ADHD, it is much harder to successfully regulate emotions or navigate social relationships effectively without identifying the problems and taking a solution-focused approach to addressing the challenges. Understanding how something affects us and being open about finding solutions can bring great freedom, reduce shame, and build self-confidence. 

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UNDERSTANDING SUICIDE PART TWO: The link to depression and the search for hope

According to the American Foundation for Suicide Prevention, 90% of suicides committed in the United States occur in persons with a diagnosed psychiatric condition. Over 50% of people who die by suicide are diagnosed with major depressive disorder. In any given year, 25 million Americans are suffering from depression. These statistics are striking, and they indicate a need for us to better understand how depression can lead to suicidal thoughts and actions. Based on the numbers, most Americans will have a friend or family member who is at risk at some point in their lives. The purpose of this blog post is to discuss the role of depression and suicide; how we may prevent some suicides by better understanding depression; and how to give hope to those with chronic depression who experience suicidal ideation before they attempt suicide.

While it is true that 25 million Americans meet diagnostic criteria for major depression, many of them never have suicidal thoughts. If suicide becomes an option, many of them change their minds or never seriously think about acting on their thoughts. How can we manage depression so that people don’t lose hope and decide there are no other options? What factors contribute to the decision that suicide is the best option? What factors may contribute to the loss of hope? Below are some points to consider to increase our understanding of the link between depression and suicide.

  1. Early Detection and Treatment Can Make a Difference: our goal should be to educate depressed people about their symptoms and the influence of biological and environmental factors such as genetics and stress. Helping people understand that having depression isn’t their fault decreases their shame and possibly allows them to retain some hope of improvement. The longer that someone has suffered from depression without treatment, the less likely they are to actively engage in treatment and believe that it will help.

  2. Social Support Can Make a Difference: educating spouses, parents, siblings, significant others, and anyone else close to the person could help in a couple of ways. First, the more family members and friends understand about depression, the less likely they are to blame the person, shame them, or lose their patience. The second reason to educate loved ones is to make them aware of their own need for emotional support. It is common to suffer from feelings of shame and blame when you live with or are often around someone who is chronically depressed.               

  3. Treating Substance Abuse When It Occurs with Depression: statistics show that when alcohol addiction is factored in, the rate of suicide in depressed persons increases from 50% to 75%. This significant increase warrants specific attention to treatment for alcohol dependence. The best treatment facilities understand the role of dual diagnosis and focus on treating both conditions since the depression may have been present prior to the substance abuse. 

  4. Focus on the Role of Hope: many people become suicidal when they believe all other options have been exhausted. People become suicidal when they believe they are a burden to others, and they have nothing to offer. In retrospect, the friends and relatives of those who have committed suicide recognized the possibility but did not know the gravity of the person's hopelessness. When people begin to withdraw from their life, we can begin to assess their level of hope. Missing work or quitting their job, spending most of their time alone, or giving away their possessions are more obvious signs. More subtle signs may be that the person avoids conversations with close friends and family, ends treatment with their therapist or psychiatrist, or loses interest in things they used to do regularly and enjoy. Noticing differences in the person’s affect (no smiles or laughter) and seeing them less at family gatherings or social events can be signs that are often overlooked. While family members and friends may realize the person is depressed, they may dismiss behaviors that signal the situation is getting worse. 

  5. Seek Treatment for Depression That Is Evidence-Based: it is very important that people suffering from chronic depression seek treatment that includes scientifically validated approaches. Talk therapy is not enough in these situations. The therapy sessions should be frequent, sometimes two or more times a week; include specific goals; include spouses or other loved ones as appropriate in some of the work; and should teach coping skills. People are more likely to regain hope if they see a clear vision forward of how they can experience relief from their symptoms. If a psychiatrist is part of the treatment plan, persons experiencing chronic depression should see their psychiatrist on a regular basis to determine whether the medication regimen is appropriate or sufficient to address the severity of the person’s symptoms. Patients who see their care providers more frequently and have clear goals are more likely to believe their providers care about their well-being. This can also be a factor in restoring hope during a dark period in their life. 

Preventing suicide in persons with chronic depression is a difficult process. There is no treatment or no treatment provider that can prevent every suicide from happening. But if we know the risks and the benefits of good treatment, we can restore hope to many who are contemplating suicide as their only option.

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In June 2018 two celebrities committed suicide in the same week. First, I was shocked and sad and to learn that Kate Spade, fashion designer and business woman, had taken her life. A few days later, chef and host of the show “parts unknown” Anthony Bourdain committed suicide. Both celebrities inspired others through their vocations and seemed to live enviable lives. However, as a result of their suicides, we learned that they both had struggled with depression for years.

When a celebrity, or someone in our own lives, commits suicide, we struggle to understand their decision. Some people, who may not understand mental illness or who have been personally affected by a suicide, think that suicide is a selfish act: Surely, the person must not be thinking of how others will suffer as a consequence of their choice. Surely, they must realize that their problems are temporary and that if they only seek help, things will get better.

That is likely true, to some extent. 

However, when someone is deeply depressed for long periods of time, their focus turns more inward. This doesn’t mean that people choose to focus only on themselves. It means that they are not confident that they have purpose or meaning, that they are worthy of being loved and supported by others, and that they deserve the support of others or even the help of professionals. Thus, by the time they contemplate suicide, they believe there is no other choice. They believe that others cannot help them because they are incapable of being helped. 

To better understand the mind of someone contemplating suicide, let’s explore the word “self.” When I Google the word, hundreds of terms appear, including self-love, self-compassion, self-esteem, self-confidence, self-worth, self-sufficiency, self-reliance. Our culture is obsessed with the concept of self. The word perpetuates a sense of autonomy, confidence, greatness, or the lack of these qualities and the importance of acquiring them. Thousands of media articles discuss how important it is to be ourselves, love ourselves, be kind to ourselves, forgive ourselves. The self-help section of bookstores is full of information telling us that we can become great and that we don’t need anyone else. We can become whatever we want, do it ourselves, and have it all without relying on others. 

Now, imagine a depressed person who has tried to believe these things. They have tried to believe they can do it themselves, and they have failed. They are not self-sufficient. They do not love themselves. They do not have self-compassion. Their definition of “self” has only negative implications.

The irony is that we can’t do it ourselves. Despite the cheerleading self-help books and articles, neuroscience supports that our brains are wired to be relational. We need others, and it’s OK to ask for help. It’s also acceptable to allow ourselves to be helped because it doesn’t mean that we are a failure. It doesn’t mean that we cannot achieve success, or become self-sufficient, or that we lack identity. Receiving support and help from others, even professional help, builds resilience. The best thing that we can do for those struggling with chronic depression is to take them outside of their selves. To help them understand that they don’t have to suffer in isolation. 

In closing, let’s help those at risk for suicide understand that they don’t have to figure it all out to feel better. Let’s help them develop a healthy sense of self that allows them to include others. They can experience relief from symptoms, bounce back from struggles, and experience love and support.  

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POLITICS IN PSYCHOTHERAPY: A Commentary on the Role of Therapists in Politically Turbulent Times

The holidays are over. The new year has arrived. It is a January following a mid term election, and many seats in Congress and the senate will change hands. Not to mention many local and state Government positions will receive new leaders during this inaugural month. Whether our chosen candidate won their election or not, we live in a contentious political climate in our country. The strength of friendships has often been tested due to political differences, and relationships in which partners have different political perspectives have experienced greater tension and conflict. This is especially true here in the nation's capital, where political ideology plays an important role in forming not only our values, but also our identity.

Late last year, Peggy Drexler published an article in The Wall Street Journal titled “Therapy Is No Longer a Politics-Free Zone” which discussed whether therapist and clients should exchange political view points, and whether or not that poses important dilemmas around the personal boundaries of the therapist. Drexler suggests that, if the client initiates the conversation, then it might be valuable for the therapist to share their politics because that validates the client’s concerns. Although sharing with someone you disagree with might be divisive in the therapist-client relationship, on the other hand, it could help the client navigate that experience in life.

This is an important conversation because the topic of politics is volatile enough that it has the potential to compromise trust in a therapeutic relationship if it is not handled well. To simply ignore the topic of politics in therapy seems unrealistic given how important it is in our culture. Research studies show that people who are committed to therapy are also more likely to be committed to their political beliefs. They are often socially conscious and think deeply about the candidates they choose to support. Thus, to leave the discussion of politics out of therapy not only seems outdated, but ill-advised. 

As a practicing clinical psychologist within 5 miles of the nation’s capital, I have a unique perspective on teaching clients to navigate political conversations they may encounter in different contexts. Below are four steps to support therapists and clients as they approach this discussion. These steps offer suggestions for how to sensitively address the issue with compassion and problem-solving. To me, this is essential to our distinct role as therapists advising others on how to lead healthy, enriching lives.

First Step: Empathize with clients who are anxious about the political climate. Your client comes in after a major election saddened because their candidate lost, anxious about what will become of our country and the important social and political agenda to which they subscribe. You may or may not be anxious about the future along with them. If their views are similar to yours, it’s easy to empathize. If you disagree with them, listen to their perspective and understand their reasons for feeling scared, disappointed, or hopeless. It’s possible to empathize without agreeing if you are empathizing with their underlying anxiety. Most of the time, we are empathizing with situations that we know nothing about from a personal standpoint, but part of being a competent mental health professional is to exert the effort to understand what we cannot personally experience. Clients can tell if we are genuinely empathic or not. They can also tell, most of the time, when we agree with them whether we speak it or not. We must remind ourselves that, in our unique role, we must give to them something they cannot receive from others in their lives. They may have plenty of others with whom to commiserate. We offer them a safe place to be heard and to better understand how they can respond to their feelings: first by owning them. Without receiving empathy in therapy, they may not feel that same ownership. 

Second Step: Keep your focus on your clients. If they are distraught over a candidate’s loss, or overjoyed by their victory, your role is to help the client navigate their relationships amidst the outcome. If they are delighted their candidate will soon take office, but family dynamics at home are difficult with differing viewpoints and contention, rejoicing with them and failing to help them understand those around them would be a disservice. The obvious example here is the election of 2016 when Donald Trump surprisingly became the president. The DC area is largely Democratic by party association, but thousands of people who live here now grew up elsewhere. They may have gone home to families who were happy about the outcome, which caused strife and stress not only for the clients but within those relationships. While you may align more with the client, your job is also to support them in bridging the gap between them and their loved ones to retain peace and compassion in the family system. 

Third Step: Respond, but do not offer unsolicited information about your political affiliation. Remember that the focus is on the client. If they ask you if you are happy about the outcome of an election or which candidates you plan to support in the future, you have a decision to make. The decision may be different depending on the client, the duration of your relationship, and how comfortable you feel in self disclosing with clients. Rather than feeling obligated to share because it is important to the client, consider the potential consequence on your relationship. If the client’s views or party affiliation differ from your own, it could affect rapport. If you agree, it could also turn the therapeutic relationship into one of mutual venting, rather than a productive relationship where you take a leading role in advising the client about how to deal with disappointing outcomes. If you find yourself caught up in your own grief, direct the conversation towards productive responses such as encouraging political and social activism. As a second strategy, educate clients to use active listening skills to better understand views different from their own. A third approach is teaching clients to avoid catastrophic thinking. While surprise outcomes, such as those in 2016, can impact millions of people in significant ways, we all need to be reminded that the political pendulum does swing in both directions. Historical reflection on how things ebb and flow can be a helpful and hopeful perspective to share. Clients who are in therapy because they already think negatively or experience cognitive distortions leading to depression must be reminded that things do change, and they can be an agent of that change if they choose.

Fourth Step: Remember resilience. Your relationship with clients can help them become resilient if you model for them what they may have trouble grasping after disappointment, severe anxiety, or depressed thinking. Walk alongside them in understanding that there is life after an election. This does not mean that you dismiss or minimize their concerns. Quite the contrary, you have a unique opportunity to understand the context in a healthier, more objective manner. Validating them in a gloom and doom perspective not only diminishes your ability to be effective, it may contribute to the greater anxiety and feelings of helplessness. Clients who already experience persistent anxiety and depression on a regular basis need a more balanced perspective, and one that many of us are losing sight of in recent years. Sitting elected officials have a limited term in office. They may weld great power for a period of time, but ultimately, others will assume the role, and things will change. The best thing we can do for our clients is to instill in them a sense of what they can control, and how they can proactively seek the kind of life they want, even if their favored leaders are not elected.

Photo by roya ann miller on Unsplash

Is it the Most Wonderful Time of the Year?: Solutions for Surviving the Holidays

It’s the most wonderful time of the year… So the song says. I’ve heard it at least a dozen times since Thanksgiving in shopping malls, the pharmacy, and on the radio while driving around. The holiday decorations, music, and festivities of the season surround us. Yet, for many, the holidays are far from wonderful or happy. Many of us had a difficult year, whether the reason was financial, family oriented, or some other challenge that prevents us from easily transitioning into the joyful spirit of celebration. We may have struggled with chronic illness or disability, unemployment, the loss of a loved one, or another tragedy. Or, perhaps, we just don’t feel like being festive. Whatever the reason we lack holiday spirit, it can feel forced upon us. I hope to bring you good tidings by letting you know that there are ways to get through the holiday season with joy, or at least some peace of mind. 

Don’t force yourself. You don’t have to enjoy the holidays in the same ways that others do. If you don’t feel up to buying personal gifts for everyone, think about what you do feel comfortable doing. Suggest a gift exchange, so you only need to buy a gift for one person from the group or family. If you don’t want to completely remove yourself from the festivities, choose events where you feel most comfortable. Attend parties for shorter periods of time so that you may enjoy yourself briefly and then excuse yourself before it becomes overwhelming. There are times when stretching yourself outside your comfort zone can be healthy and helpful. The holidays are often not these times, as the expectations that you experience or perceive may give you greater stress than is necessary. Let others know that you are struggling, even if you don’t want to go into details. Most people can be very compassionate if you give them the opportunity.

Figure out what you enjoy about the holidays. If nothing strikes you, perhaps you can explore. Do you enjoy the music? Do you enjoy attending religious services? Or do you enjoy quiet evenings at home sipping hot chocolate? There are simple pleasures you can find that do not involve the high energy festivities that our culture emphasizes. You can enjoy the holidays your way.

The expectations that our friends and families have of us during the holidays can feel overwhelming. Think about what you can manage, and talk with family members or loved ones ahead of time. Many people are unable to empathize with pain or grief. However, communicating our thoughts and feelings, regardless of the response, can still be a proactive step in taking good care of ourselves. Attending smaller family events or not staying as long can be an option. Keeping conversations over holiday meals to topics that do not engage in conflict is a good tactic for managing difficult relationships and personality clashes. Loneliness can be a major factor affecting millions of people during the holidays. Many people spend the holidays alone while watching others enjoy themselves with family and friends. If you’re going to be alone this holiday season, think about volunteering at a shelter or some place where other people would welcome your presence. People who volunteer during the holidays report greater satisfaction, not only in the act of giving time to others, but in the companionship and the gratitude they receive. If volunteering is too much for where you are, perhaps you can find others in your neighborhood or community who are not with family and have a small meal together or just gather for hot chocolate and conversation. Our world has become increasingly more isolated in recent years for many reasons, so we must proactively seek friendships and community. Sometimes this is extremely anxiety provoking, but you can start small with one or two people to see where it leads. Ultimately, people who find companionship in even the smallest of circles draw great joy from it and find that it can be a game changer over an otherwise dull and dreary holiday season.

Sometimes before we can enjoy others genuinely, we must appreciate time on our own: developing solitude is an important part of developing community. Take time out of your busy holiday schedule to enjoy moments of peaceful reflection. If you are alone, self reflection can be a great way to set goals for the coming year and to think about what you would like to be different in your life. Reading, meditating, praying, going for walks, and writing in a journal can be great ways to engage in much-needed introspection. I call it taking a break from every day life. This does not mean that you would exclude yourself from activities that you may enjoy or totally isolate. It simply means that you take time to be with your self in a meaningful way to rest, reflect, and think about how your future can unfold.

Gratitude is an important way to both reflect on our blessings and achieve personal growth. Being intentional about showing gratitude can make a huge difference in the way that our brains process the events of our lives. Think back on the previous year. Can you identify events or experiences that you appreciate? Are there people who you would like to thank or who you were glad to have in your life? Numerous studies have shown that demonstrating gratitude lifts our spirits almost instantly. When we recognize that there is good in our lives, despite the pain, struggles, and challenges, our brain develops a new perspective that improves our self awareness and contextualizes our circumstances within a bigger picture.

Regardless of what’s troubling you this season, I hope these strategies allow you to find peace and joy during the coming holidays and to look forward to a new year.

Photo by Annie Spratt on Unsplash