The Missing Boundaries of Modern Parenting

In preparing to write this blog, I had to mentally prepare myself to share what may be an unpopular viewpoint about modern parenting. Additionally, I needed to prepare myself for the blow back about the fact that I am not a parent. (I did not choose to be childless, but that’s a topic more appropriate for a different blog post.) Regardless, I earned a PhD in clinical psychology with a specialization in children and adolescents. I’ve worked with children professionally for over 20 years, and I’ve seen hundreds of positive outcomes based on my training. 

The purpose of this blog is to discuss how parents sometimes emphasize a connection with their child that resembles friendship rather than taking on a disciplinary parental role. Setting more boundaries as a parent will help you raise children who are emotionally stable, well-adjusted, and have a good character.

I have a great deal of empathy for those who are parents today. There are new challenges with every generation that haven’t needed to be addressed previously, and there are a lot of aspects of modern life to juggle. Below are some factors that both research and clinical practice consistently indicate are positively related to raising mentally strong and healthy children.

1. Trust is essential. From the moment they are born, parents should invest in earning and maintaining their child’s trust. Children must believe their caregiver has their best interest at heart, will consistently be available to them, and genuinely love them. No one can be with their child all the time: they just need to know that you are there for them when they need help, comfort, or compassion. You can demonstrate this through physical affection, emotional expressions of affection, and consistent efforts to be present, especially when they need you the most. Children form close attachments to their primary caregivers in the earlier stage of life.

2. Unconditional love must be expressed. Children need to know their parents always love them, even when their behavior must be addressed. If you tell them that you love them regularly, and show them affection, they will most likely know that you love them. When you get upset with them or need to correct them, they will not immediately react by thinking that you don’t love them anymore.

3. Be consistent. There are a few behaviors that lead to greater confusion among children than when their parents behave inconsistently toward them. Implement the same forms of discipline and consequences each time they misbehave. Communicate with them, as is age-appropriate, about what consequences will result from their behavior and why you are taking certain actions.

4. Establish and maintain good boundaries around their behavior. The preceding recommendations are all the foundation of this one. If your child trusts you, if they know that you love them unconditionally, and if you are consistent, then giving them boundaries around their behavior will not create confusion or mistrust in their relationship with you. In my practice, I meet parents that seem afraid to discipline their children, but discipline doesn’t have to be harsh to be effective. One of the most important things you can do as a parent is to teach them that the world is not only about meeting their needs. While they are certainly deserving of love and affection, there are times when you will have to say no. There are times when you need to speak to them in a serious and firm voice because their behavior is inappropriate or their emotions are uncontrolled. They need to grow up understanding which settings are appropriate for certain behaviors and which settings require more refined behaviors. This doesn’t mean they don’t get to be themselves or that they serve to please other people all of the time. But none of us, as adults, will be accepted if we insist on our own way, are constantly demanding, or do not consider the perspectives of other people.

The style of parenting discussed in the above suggestions is known as authoritative parenting.The term “authoritative” may mislead parents to think the focus is on being a harsh disciplinarian. Rather, authoritative parenting combines a loving and affectionate attachment style with boundary setting. Boundaries teach your children that their behavior determines their outcomes. For example, they can earn privileges, such as using the iPad, or experience the consequence of not earning iPad use for that day. If they have a bad day, they get a new start the next day. Teaching your children how their behavior interacts with the world around them will teach them to be aware of themselves and of others.

Even more importantly, it teaches them to tolerate negative emotions and builds resilience. If you can’t stand to see your child upset and you do everything in your power to calm them down, you aren’t involving them in the process. You are sending an albeit unintentional message that they don’t have control and that you have to constantly help them make things right. While it may be difficult to hear them cry or complain, it’s a fair trade off to know that sometime in the future, they will be able to tolerate their own tears and know that eventually they will be OK. They can have their emotions, but their behavior matters not only for their own consequences but for those around them. This is a great gift you can give them.

Here are a couple of resources to give parents guidance on providing loving discipline and boundaries:

No Drama Discipline by Daniel Siegel
Parenting with Love and Logic: Teaching Children Responsibility by Foster Cline

Photo by Jessica Rockowitz on Unsplash

How to know if you are ready for therapy

May is Mental Health Awareness Month, and there will be dozens of blog posts, articles, and social media promotions encouraging people to seek help if they are feeling anxious, depressed, or in any other sort of emotional distress. Much of the publicity around mental health awareness will strongly encourage people to seek support, and it will attempt to give therapy a good impression. The press will also aim to reduce the stigma surrounding therapy and normalize the experience, so that people will be more willing to seek the level of care they need. While these are noble intentions, I think it’s even more important to talk about whether you’re ready to start therapy, and how to move forward if you are.

Many people start therapy because they think they should or someone has told them it’s a good idea. But if you aren’t honest about where you are in terms of your willingness and motivation to change, therapy may not be as useful. Thinking through the stages of change — a behavioral psychology model for how we implement and maintain changes in our lives — can help you assess whether or not you’re ready to take this step. 

Not everyone is ready to start therapy, even when they are feeling depressed, anxious, or unhappy with their lives. If we are not yet ready to make changes, we are in the precontemplative stage of change. To move from here, a person has to decide for themselves that they want to go to therapy and why. If this describes where you are now, at the end of the blog I offer some questions you can think through to help you move forward. 

Once we start asking questions, asking others for their perspective, and reflecting on our current situation and whether we want to change it, we enter the contemplative stage of change. It may not be time to find a therapist or schedule an appointment, but it’s an appropriate time to start thinking about your goals. If you want to feel better, think about what that looks like. Perhaps you have childhood trauma that you want to process, so it may be helpful to think about specific events around which you seek healing. The more specific you can get with your goals, the less stressful and confusing it will be to find a therapist suited to help you accomplish them. 

The preparation stage involves doing some research on therapists in your area: who takes insurance, whose rate is within your price range, and most importantly, who is trained professionally to help you reach your goals. For instance, if you want to change your negative thoughts and feelings, cognitive behavior therapy might be a good fit. If you’re seeking healing from trauma, you want to find a clinician who has specialized training in trauma informed approaches to therapy. Doing research beforehand may save you time later because you’re more likely to find a good fit on your first try. 

The action stage of therapy involves making an appointment, having an initial consultation, and describing your goals to the therapist. Be prepared to schedule a few intakes with therapists to find a good fit in terms of training, personality, and comfort level. As you move into this stage, it’s important to have reasonable expectations for what you can accomplish in therapy and how much time changes will take. It may take more than one session to feel comfortable with a new therapist. And it can be hard to tell whether those feelings are about your relationship with the therapist or your own discomfort with starting therapy. It’s also important to keep in mind that initial sessions will be focused on gathering background information, rather than starting an intervention.  This is yet another reason to make sure that you are ready to begin making changes, and that you find someone who is a good fit for what you want to accomplish.

I was asked recently how to move from the precontemplative stage and begin to prepare to start therapy. Consider the following questions to help you decide whether you’re ready to move forward: 

1. Is therapy scary to you? Are you scared of making changes? If you’re feeling bad, what are you worried will happen if you take action to feel better?

   Sometimes, people worry that they will lose a part of themselves if they go to therapy. Psychotherapy is not intended to erase who you are; it’s intended to make you the best version of yourself.

2. Do you dislike talking about yourself? 

   Some people tell me they feel selfish for spending the better part of an hour each week talking about themselves and their lives. This is especially true for persons who are struggling with low self-esteem. If you think that you will feel selfish or dislike talking about yourself, you may consider finding a therapist who incorporates strategies other than just talk therapy into the process.

3. Are you afraid you can’t change, or that others will judge you for not changing quickly enough?

   This is a common question, and it can feel intimidating to think that you would start therapy and others around you would want to see tangible evidence of change quickly. You should go to therapy because you feel ready to make changes, to gain insight, or to learn about yourself and your relationships with others. If you choose to start therapy because someone else is urging you to do so, you won’t find therapy as valuable or useful. 

If you’re feeling anxious about starting therapy, you are not alone. Not everyone finds therapy exhilarating and life-changing right away. Some people never experience it that way. But you can have a positive experience that results in self-improvement, relief from acute symptoms of emotional distress, and the opportunity to grow.  

 
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Overcoming Shame Increases Resilience

There are a few emotions that, if experienced frequently, can prevent us from making positive changes. Even if our intentions are good, these emotions can hold us back. While I want to stay away from labeling any emotions as “bad,“ I want to have an honest dialogue about how one emotion in particular can hinder our progress and keep us feeling stuck. Overtime, it affects our ability to become more resilient.

We all have experienced shame. Perhaps we were having a bad day and yelled at someone that we love. Or we were feeling stressed, so we indulged in comfort food, then immediately felt ashamed of our lack of self-control. These are human experiences, and we can’t deny what our brain feels. However, a pervasive pattern of shame can begin to wear on our sense of perseverance. Some of us have our sense of shame reinforced by the way that our family or a significant other respond to our behavior, choices, and mistakes. 

After a while, we may not even realize that our shame is holding us back. We may feel such a high level of responsibility that letting go of shame feels wrong. Many of us worry that if we stop being hard on ourselves and carrying around the burdens of things we have said and done, we will do them again. An even more painful belief is that we don’t deserve to let go of our shame. These kinds of negative messages create a perpetuating cycle that can prevent us from reaching out for support, and ultimately, we lose motivation to change or lose hope that change is even possible.

Despite the debilitating ways in which shame can affect our mental health and resilience, it is possible to break the shame cycle. Here are some suggestions on how to get started.

Remember your humanity

Many people grow up in households that focus on mistakes and the choices that lead up to them. We learn early that this is how to respond to our mistakes and failures, and it sets the pattern moving forward. Recognizing that no one is capable of perfectly sailing through life without some stumbling blocks helps us put our behavior into perspective. We can remain humble while acknowledging that we err. Our mistakes and choices become part of who we are, but they do not have to define us. 

Acknowledge mistakes, choices, and failures to those you trust

Often holding our regrets, flaws, poor choices, and mistakes inside our own mind feels miserable and in time becomes overwhelming. Talking about them with people who are safe and who encourage us, not only brings a sense of relief, but it can also help us achieve a broader perspective. Getting feedback from others who can show us love and support affirms for us that we are a whole person, not merely the product of our flaws.

Empathizing with the flaws and brokenness of others

The capacity to understand the failures of others, and the ability to sit with them through their struggles, can develop our ego strength. We can achieve personal growth by walking alongside of others through their struggles, which allows us to understand that we are all broken in different ways and that our own flaws and mistakes are not drastically different from those of others. We may feel differently, and make different choices, but we share the common struggle to do the best we can under difficult circumstances.

Identify your strengths and positive qualities

Typically, I ask new clients during the intake to identify a few of their strengths, talents, or positive qualities. The clients who are dealing with a lot of shame have difficulty coming up with even a couple. The embedded shame causes them to believe that they aren’t worthy of identifying positive qualities. I encourage you to make an effort to identify positive qualities about yourself, even if you think they aren’t worth mentioning. They could range from being a talented musician to making your bed every day. It’s OK to start small if it feels uncomfortable to acknowledge skills or talents. If you really believe that you don’t have any positive qualities, ask a friend or family member that you trust to identify some of them for you. It may feel awkward to hear someone say positive things about you, or embarrassing. Sit with those feelings, and know that they are temporary. It’s the first step in moving past the barrier that shame has created. 

Breaking the cycle of shame is a process, but once you are free from it, you will recognize that you have value, with your flaws and your strengths, and that you can live a meaningful life as a balanced person.     

Originally posted on psychologytoday.com 4/14

Image:              Photo by @felipepelaquim on Unsplash 

From where I’m sitting: reflecting on the pressures of being a mental health professional

I decided to become a psychologist when I was a freshman in college. I chose psychology as my undergraduate major, initially, as a non-traditional course of study before applying to law school. After the first semester, however, I was hooked. The subject matter was fascinating, and helping others work through challenging mental health conditions seemed like a good fit for my personality: I like to problem solve, I am intuitive, and I’m not afraid of a challenge. I dove into research projects, I wrote an honors thesis, and I applied to graduate school. Becoming a clinical psychologist involved an academic obstacle course of demanding classes, comprehensive exams, a dissertation, extensive clinical training, a one year internship, and a one year post doctoral fellowship. Passing a comprehensive national exam and meeting state licensure requirements rounded off the journey, and I was finally a psychologist.

I’ve never second-guessed my decision to become a psychologist. I have heard many people say they wish they had done something differently with their career, and I feel very fortunate to be satisfied and dedicated to my choice. I love seeing the healing process unfold as people discover how to face their past or develop skills to become mentally healthier and live more meaningful lives.

There are some challenges, however, about being a mental health professional. They might be different than what most people imagine, and it seems like a good time to mention them, after an extremely stressful year. The difficulties of being a mental health professional certainly did not start with the pandemic, but they have been exacerbated by it. There are a few truths about those of us working in mental health that everyone should know.

Sometimes, we have personal stressors or hard circumstances. 

Mental health professionals typically don’t disclose much about our personal lives. Sometimes it’s necessary, if we have a family emergency, to reveal a bit of information. But we are not encouraged to share because our role is to help our clients navigate their problems, rather than burdening them with ours. I generally agree with this philosophy, but I think it’s worth mentioning that because we are also human and carry our own share of personal stressors, not every day of helping others is our best day. Sometimes, we have personal matters weighing heavily on our minds. It doesn’t take away our desire to listen or to be helpful. My mother died suddenly last April, and I had to contend with the grief while providing care to others during a scary time in our world. Having the opportunity to care for others was actually good for me because it gave me breaks from the persistent grief. Still, I struggled under the pressure to be fully present with my clients. 

We make mistakes.

This is a hard statement to make, not only because I tend to be a perfectionist, but also because as a mental health professional, we feel pressure to always be right. People are paying us for services and they expect us to always have the right answers. Of course, it’s more complicated than that because our answers depend on the information we are given at the time. Some client matters are more complex than others, and they take longer to resolve. Giving us permission to change our minds, and giving us the benefit of the doubt may help us to serve clients better.       

We can’t always be available to our clients. 

I can’t speak for other mental health professionals, but I often feel pressure, from myself, to be constantly available when clients have a question or need to talk. Generally, this pressure doesn’t come from the clients, but rather from a combination of my anxiety about making sure I am serving them well, coupled with some societal expectations about mental health professionals. Technology has definitely increased this pressure, given that we can constantly check our email and text messages. I have developed good boundaries around not checking email after work, defining what a client emergency entails and the steps in responding to it, and helping clients understand the importance of boundaries. But I still occasionally hear my own voice reminding me to respond promptly. 

Overall, 15 years of experience in private practice has allowed me to cope effectively with most of the pressures clinicians may feel.  However, I think it’s important to be reminded that we aren’t made of steel, we aren’t always right, and we aren’t always available. Remembering that we, too, are human, in addition to our knowledge and training, will increase the emotional connection and empathy in between mental health professionals and our clients.

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The New “Virtual” Reality of Therapy: Is it the future of psychotherapy?

Almost one year ago, mental health practices throughout the United States faced a difficult reality. They would have to transition their practice to a telehealth platform or close down. Most mental health professionals, myself included, had not widely practiced telehealth before. Occasionally, I would have clients out of town on business who would want to do a video session, or college students who would want to do check-in’s. But it was certainly not the norm, and it wasn’t something that most of us planned on doing regularly. So, when governors began announcing widespread, 14 day quarantines to “flatten the curve“ as the coronavirus began to infect more people, we had to think on our feet and respond quickly so the continuity of our patients' care would not be disrupted. 

Clinicians like myself, who work with younger children and teens as well as adults, scrambled to find creative ways to engage clients over the virtual platform for the first time. Some clients connected with it right away, willingly cooperating and adjusting quickly. Others were reluctant, but gave it a chance with some coaching from me. I had to adjust my own expectations of what it would entail, and modified my home environment accordingly to have proper boundaries and to successfully focus on the screen. This is not to say there weren’t any distractions. Sometimes my cat visited unexpectedly, demanding attention, or a child client wandered away from the screen to get a toy they wanted to show me. Overall, though, it was a surprisingly successful endeavor which most people assimilated to easily.

We are now approaching the first year anniversary of this experiment in psychotherapy. Our practice receives daily calls from new clients who insist on being seen in person. We also continue to receive a number of calls requesting that therapy be conducted virtually for the foreseeable future. As a clinician, I believe that I bear some responsibility for setting a good example. When it became clear that COVID-19 was going to be a pandemic and there were major safety risks with meeting in person, it was my responsibility to take the lead when clients were resistant to trying virtual therapy. But now, as we have the opportunity to get vaccinated, we know more about how the illness is spread, and we are capable of taking extensive precautions to keep people safe, it’s also my responsibility to lead those for whom it is most appropriate back into a more traditional clinical setting. At the moment, we are allowing clients to choose which format they prefer. My associates and I have gotten vaccinated, and we continue to take extensive precautions to keep everyone safe for those who choose to come in person.

But let’s be honest, there are definite perks to working virtually. It can be tempting to remain at home, for convenience, or to continue to reap the benefits of virtual therapy: clients generally don’t run late; I’ve had fewer cancellations; and I’m more more physically comfortable. I can start dinner and let it cook while I am in a video session. So if there are reasons that I am hesitant to return to in-person therapy, I must ask myself what they are and how I should deal with them.

It seems clear that there are some clients who should be seen in person so long as it is safe to do so. In particular, clients with severe social anxiety who may avoid in person contact, persons struggling with agoraphobia (fear of going out into public places), or clients who struggle with nonverbal, social interactions that makes therapy less productive. Continuing to see these clients virtually may hinder their progress because it doesn’t give them exposure to the source of their anxieties or opportunities to practice in-person social interactions.  

I’m certainly not suggesting that this is an all or nothing situation. The ability to conduct virtual therapy has indeed broadened the access to mental health, and there are certain individuals who should be able to continue to use the platform. Some of my clients with chronic physical illnesses and disabilities come to mind, for whom attending regular visits in the office can become an obstacle to the continuity of their care. Individuals who live in rural areas, children and teens whose parents are juggling work and cannot commute to bring them consistently are other examples for whom the prospect of ongoing virtual work is worth considering. It also provides continuity to clients such as college students who have gone back to campus.

My message to clinicians and clients alike is that we must be thoughtful about this decision. We cannot allow modern conveniences to take precedence over the client’s best interest, nor can we allow virtual therapy to enable patterns that will hinder clients from making progress in areas for which they are seeking our therapeutic support. Clinicians may have to become more assertive in guiding clients back to the therapy office by educating them about the risks of continuing virtual therapy. An honest discussion should be held with each client to determine what is best for them and for your therapeutic relationship. This could be a positive experience for therapists and their clients because the clients will know that you genuinely care about their progress, and therapists can explore their own potential anxieties about going back into the office. No matter what is decided, the conversation is a win-win for both parties.                   

As we move out of the pandemic, we will have to consider whether teletherapy should be a standard fixture of mental health care or if it should be a solution we turn to only in contexts where in-person therapy is not a valid option.    

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THE REALITY OF ADULT ADHD

You’re sitting in front of your computer, browsing the Internet, and engaging with your favorite social media platform. You have a pile of work to do, but no motivation. You decide to go for a walk to clear your head, get a cup of coffee, and come back to your computer. You realize that two hours have passed, and little work has gotten accomplished. We all have days like this. We can’t focus. We feel exhausted even in the beginning of the day. We can’t do our work, but we can spend unlimited time on Facebook or Instagram. If this sounds like a typical day to you, however, there might be a bigger problem than just a tough day at work.

I hear similar scenarios frequently. People tell me they are struggling with motivation, and they’ve gotten feedback from employers, coworkers, and even spouses that they need to be getting things done. They know they are struggling beyond what most of us occasionally do, but it’s hard for them to believe they have attention deficit disorder. “I was a good student,“ they say. Or, “I have a professional career.“ “If I have ADHD, wouldn’t my parents have known that when I was a kid?“  These are statements commonly made by adults who have ADHD but have not yet been diagnosed. They have been academically and professionally successful, at least enough to graduate and launch a career. They are high functioning, but the struggles begin to catch up with them. This blog discusses why ADHD symptoms might be overlooked, and why adults should consider diagnosis and treatment. 

How can someone have ADHD and go through school without knowing it?

Many children begin to show signs of ADHD prior to the age of seven years. They may be hyper active, impulsive, have trouble following directions, and have trouble staying on task. While this description fits thousands of people who are eventually diagnosed, not everyone displays these challenges earlier in life. In addition, some people have trouble focusing, keeping schoolwork organized, and accomplishing things, but they don’t outwardly appear to be struggling. A sub-group of individuals who would meet criteria for ADHD are smart, resilient, and high functioning. They develop compensatory strategies that allow them to get through life, even though internally it may be incredibly stressful and painful. For instance, some students wait until the last minute to do their work, but they work well under pressure. So they pull an all nighter and receive a good grade on a research paper. Or they have excellent long-term memory capacity, so they don’t need to study for tests. They acquire a great deal of basic knowledge and retain it without having to review it. But as the workload becomes more demanding, or more work is required of them on the job, they begin to struggle. They miss deadlines, they are disorganized, and they procrastinate work that doesn’t interest them or that is more administrative in nature. Thus, they function, but it becomes more difficult to perform over time, and these difficulties begin to affect their quality of life and their relationships.

Why do adults get evaluated for ADHD?

You don’t have to be a student to get an ADHD evaluation. There are reasons to pursue testing for ADHD as an adult. Even if you have no plans to go back to school, knowing and understanding your diagnosis can be extremely helpful as you plan your professional development and other aspects of your life as welL. Clients tell me that it is a huge relief to know that ADHD is behind their challenges with initiating, planning, and executing work and other daily activities. Knowing that there is a specific problem that can be treated feels freeing to them. Identifying the problem alleviates negative thinking such as feeling lazy or stupid, or wondering why they can’t get things done as easily as others. 

In addition to the insight and the freedom that the diagnosis offers, there are effective treatment approaches for adults that will allow them to be much higher functioning and achieve their personal and professional goals. Additionally, ADHD can affect emotion regulation, social interactions, and communication and relationships. Thus, understanding the bigger picture of how it impacts adult life and finding strategies to manage is also valuable. 

What do I do once I know that I have ADHD?

There are several ways to learn about how to manage ADHD as an adult when it hasn’t previously been addressed. Here are some suggestions that clinicians recommend

1. Seek a consultation from a psychiatrist who has expertise in treating adult ADHD. Medication is definitely worth considering, especially if symptoms are intruding in multiple aspects of your life, such as work and personal life. Research does show efficacy for using medication as part of a comprehensive treatment plan.

2. Read about adult ADHD from reliable sources. The list of resources at the end of this blog are a helpful start to better understanding.

3. Find a therapist who practices cognitive behavior therapy. Cognitive Behavior Therapy (CBT) can be extremely helpful in managing symptoms by learning strategies for time management, organization, and planning. Additionally, CBT can teach coping skills to manage intense emotions impulsivity, and other behavioral symptoms.

If my descriptions of adult ADHD resonate with you, I encourage you to pursue evaluation and treatment because it can make a significant difference in your life. 

Resources

Driven to distraction: recognizing and coping with attention deficit disorder by Edward Hollowell, MD

You Mean I’m Not Lazy, Stupid or Crazy? by Kate Kelly

Smart but Stuck: Emotions in Teens and Adults with ADHD by Thomas E. Brown, Ph. D.

Photo by Maxim Ilyahov on Unsplash

Getting Real About Depression

It goes without saying that 2020 has been a year like no other. The pandemic has emerged not only as a threat to physical health, but it has also negatively impacted mental health for millions of people. Depression, suicide risk, and substance abuse have all become more significant problems since the pandemic started. Factors such as unemployment and social isolation contribute to feelings of depression and hopelessness. Perhaps something good that can come from all that has transpired will be greater awareness of mental health challenges and the importance of seeking effective interventions and support for those who suffer.

Depression, however, has always been a chronic struggle for millions of people: long before the stresses of the pandemic, depression has impacted people’s ability to go to school, work, and have healthy relationships. Misunderstandings about depression and inaccurate information about its causes and treatments have also been around for a while. The purpose of this article is to dispel some of the myths about depression by providing information is based on research studying depression and its effective treatment. An additional goal is to increase empathy from those who do not experience depression, so they can better understand the struggles of their loved ones and be available to support them.

Below, I list some common misconceptions about depression and explain the realities of the condition: 

1. Depression is a state of mind: We all have bad days, bad moods, and find ourselves in stressful circumstances. But this is not depression. Depression is a persistent set of symptoms that affect a person’s ability to sleep, eat, concentrate, handle stress, regulate their emotions, and interact in healthy relationships. People experience episodes of depression that last up to two weeks, and they may have chronic episodes lasting six months or longer that may meet criteria for major depressive disorder. Thus, depression involves much more than just feeling down or having a bad day.

2. Smiling will make it better: some people say, “smile and the world smiles with you.” Perhaps it is true that seeing someone smile can spread a temporary moment of cheer. For those with depression, however, it’s important to remember that it’s more complicated. Simple behaviors such as smiling do not result in happiness or remove the complexity of problems that the person is experiencing. It is true, though, that expressing gratitude for things one has to be grateful for can be helpful as part of a larger picture. Gratitude helps us focus on the present, which is one strategy that mental health professionals use in mindfulness and cognitive behavior therapy. That said, leave it to professionals to help depressed persons change their focus. Depressed individuals feel very misunderstood when those who do not share their experience give this kind of advice.

3. Depressed people are selfish: those who have family members or friends who struggle with depression can certainly feel left out and ignored. It can often be hard to be with them because they focus on how they are feeling, and it feels selfish. While it is true that persons with depression focus quite a bit on their internal thoughts and feelings, this isn’t intentional. It’s not selfishness in the way that we typically think. In contrast, they feel insecure, they lack self-confidence, and they often feel like they have nothing of significance to contribute.

4. They could talk themselves out of feeling depressed if they tried: depression isn’t only about emotions. Thought processes become challenged as well, including difficulty focusing and making even the smallest of decisions. Their brains often repeat negative thought patterns, making it difficult for people with depression to change what they are thinking. It is possible to change the thought patterns over time, with the right kind of professional help. But it’s not as simple as making the decision to feel better. This is especially true when the depression goes untreated for an extended period of time. The longer that negative thought patterns continue to cycle, the harder it is for people to change them.

The experience of depression is different for everyone who struggles with it. The research is clear that millions of people have been effectively treated with a combination of medication and therapy, and sometimes with psychotherapy alone. Social support is also critical, and those without friends and family to provide emotional support can have a bigger battle to fight. Some people struggle with depression throughout their lives, and stress can definitely trigger depression in those who are at risk. Some individuals do not experience relief from depression from traditional treatment approaches; therefore, it’s important to remember that because someone has sought treatment doesn’t mean that their depression can be cured. Rather than giving advice without knowing their complete circumstances, it’s best to just ask those you know who struggle with depression how you can best support them. If they aren’t sure, then reassure them that you will be there for them as best you can. Letting them know that you care about them and that you don’t pretend to know their struggles can be more helpful than trying to solve their problems. Empathy and active listening are the best ways to support those who are struggling with any mental health challenge.  

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MASTERING SELF-CONTROL IN A CHAOTIC WORLD

The day started with sunshine, a bright blue sky, and a chill in the air. The perfect autumn day. I was excited to select a sweater, which was appropriate for the crispness of the fall season. Pumpkins and chrysanthemums lined our sidewalk, and I was looking forward to a fire pit and s’more‘s with friends that weekend. Then, my husband came home from work feeling poorly. Within hours, my strong, healthy husband was curled up shaking and in terrible pain. Three trips to the emergency room later, we began to understand his symptoms, and things started to calm down. 

This drama happened in the midst of a pandemic, during a contentious election season, during the same year in which my mother died suddenly. It was hard not to lose control of my emotions. I was furious about everything and with everyone. When was my family going to get a break from the suffering? Combined with all of society‘s problems, I wasn’t sure if it was possible to stay strong, to keep calm and carry on. I alternated between experiencing fits of anger and episodes of frantically crying in sadness and fear. However, I knew that I could not continue on this path; that it was not good for my physical and mental health. I managed to compose myself long enough to take a step back and engage rational thought again. I have learned over time there are things that I can do to regain my self-control when I feel emotionally overwhelmed. These strategies are drawn from my professional training, but even professionals struggle at times to implement them amidst tremendous personal stress. 

1. BREATHE: I know it seems simple and cliché. Many people have told me to “take a deep breath.“ I didn’t believe that this would be helpful until I actually started to do it. Deep, slow breathing when we are upset is like clicking the “restart“ option on our computer when we can’t figure out how to correct its problems. When the brain is overloaded, it needs to be reset; to clear its cache before it can think clearly.

2. TAKE A STEP BACK FROM YOUR THOUGHTS: When I am angry, sad, fearful, or experiencing a mixture of these emotions, it’s easy for the negative spiral to begin. I think to myself “nothing is ever easy“ or “ why do so many bad things happen to me and my family?” It’s certainly understandable that I would think these things when multiple stressful and scary events take place within a short period of time. But I have learned that rather than judging the thoughts, it’s more helpful if I observe them. After all, they are merely thoughts. They do not predict the future. They are often untrue. When we are in the midst of a crisis, they seem like they are true. So, I make these observations. I call them distorted thoughts. In reality, bad things do not always happen to my family. Everyone’s family goes through trials. Stressful times are temporary. Thus, we don’t need to respond to our negative and catastrophic thoughts. We sit with them, having the understanding that they, too, shall pass.

3. CHOOSE THE COMPANY WHO CAN BEST SUPPORT YOU: when I am feeling intense emotions, I need to be around people who are calm, uplifting, and “realistically“ positive. I become equally triggered by those who go down a negative road and by those who offer superficial reassurance. People who empathetically listen without judgment, offering advice, or too much commiserating are the best choice of companionship during hard times. It’s important to be heard and supported; however, people who dwell in the negative and easily go to a negative place may not be the best people to have around during a crisis.

4. FIND HUMOR WHEN POSSIBLE: there are some situations in life that are not funny. While we don’t want to make light of hard times, there may be certain aspects of our circumstances that need levity. We don’t have to make jokes at the expense of another’s pain to find appropriate laughter and a break from the intensity. Perhaps it’s in the form of a funny TV show, a funny quote that we remember, or laughing about good times with friends. Sometimes, humor gives our brain a much needed break from mulling over our problems. After this break, we can often think more clearly and have a fresh perspective.

5. STAY AWAY FROM SHAME: When we are experiencing big feelings and losing control, we often blame ourselves later. We feel guilty for having a meltdown. We may tell ourselves that we are weak because we lost control. Most people lose control of their feelings once in a while. Replaying our emotional reactions does not erase them or change anything. Shame is a very powerful emotion that can undermine our self compassion and lower our self-esteem. When you notice that you are feeling ashamed of losing control over your emotions, remember that you are human. There are times when you will reach the bandwidth of what you can handle. You can proactively plan how to recognize when you are approaching your limits and possibly prevent future meltdowns. Learn from the experience and move forward.

A lot of people are going through a hard time during this tough year, and I can definitely relate to feeling like I could lose at any minute some days. But how you respond to these feelings will affect your ability to bounce back from being overwhelmed and move forward with the things you need to do. Practicing the strategies above will equip and empower you to persevere even when you feel like your emotions are out of control.

OVERCOMING LONELINESS DURING AN ERA OF SOCIAL ISOLATION

Even before the COVID-19 pandemic swept the nation and millions of people were ordered to stay at home as much as possible, many were suffering from loneliness and social isolation. At least in the United States, loneliness had already become its own epidemic. If you google “scholarly articles on loneliness and social isolation,” dozens of articles written within the past five years immediately surface. An article published in the APA monitor in 2018 outlines some of the health risks associated with chronic social isolation and loneliness, including a risk of harm to physical and mental health that is twice as high as obesity. Studies have shown that individuals who struggle with loneliness over an extended period of time are more likely to suffer from depression, develop medical conditions, and die younger than their peers. According to recent studies, loneliness has become a concerning public health issue. 

While a great deal of attention has been given to the negative outcomes associated with loneliness, not many solutions have been proposed. The purpose of this post is to have a candid conversation around how those who are suffering can seek support to fight their battle with loneliness and social isolation. But there is also a call to action for the rest of the community. We must all work together to fight this battle, and to support those who are struggling and to help them overcome it and build resilience.

Is loneliness the battle you’re fighting? First, we must distinguish between “loneliness“ and being alone. Not everyone who spends a lot of time by themselves considers themselves to be lonely. Loneliness is an emotion people experience when they are longing for connection with others, both physically and emotionally. We can live alone and be content, we can live alone and feel incredibly lonely, or we can live amongst others in the same household and feel lonely and isolated. We know from the research that people living in close proximity to each other can be just as lonely as those who live in rural areas. In fact, we know it can feel even lonelier to be surrounded by people but to not feel connected.

Is loneliness a problem we can solve? The increase of loneliness in the United States in the past decade is a result of societal changes that make it more difficult to make social connections. People who report feeling lonely regularly say that it’s harder to make friends and takes more energy to meet new people. 

A lot more people live by themselves, and it has become more common to move far away from traditional support networks like families and childhood friends. We spend more time on electronic devices for work and recreation, but interacting over social media and the internet does not create the same sense of connection. Thus, solutions to fight loneliness must involve ways for people to more easily connect.  

Identifying loneliness as a major public health concern and a condition that leads to physical and mental health problems is the first step to finding solutions. But it’s more complicated than just getting people together, though, that is of course important. Here are some steps that individuals can take to fight their battle with loneliness:

1. Get involved in your community. Volunteer in areas that interest you. Nowadays, volunteering does not have to be a huge time commitment, but it can make one feel purposeful, and it often leads to feeling connected to those who are also volunteering and those you are helping.

2. Get outdoors. Going for walks in your neighborhood, visiting a local garden or natural habitat, or exercising outside can also increase connection to the community, even if you aren’t always talking to others around you. 

3. Seek professional support, especially if you were struggling with severe anxiety, depression, or other mental health conditions that may affect your willingness to be proactive in fighting loneliness. Often, people say that a cycle develops, where they are lonely, but they are also anxious about reaching out to others or getting involved in the community. If anxiety or depression results in avoidance, it will be hard to take steps to find connection. During COVID-19, there are more opportunities than ever to find affordable support groups, therapists, and other resources to help reduce anxiety and improve self-confidence.

What can the community do to fight loneliness? Those who are struggling with loneliness should not have to fight this battle by themselves. Communities have the responsibility of supporting others who are struggling and making it easier for people to connect. Say hello to your neighbors when you see them outside. You never know who needs a positive word of encouragement. Call friends and family members who live alone, or who you know may be struggling with feelings of loneliness. Sometimes a text, phone call, or FaceTime can brighten someone’s day just because they know someone cares enough to stay in touch. It doesn’t take a grand gesture to make someone feel supported. 

Fighting the epidemic of loneliness is going to require more than recognizing that it exists. Whether you are lonely, know someone who is, or cannot relate to either, we all must take part in finding solutions.    

Photo by Priscilla Du Preez on Unsplash

A LOOK AT TELEHEALTH: Therapists Must Keep it Real

Over the past three months, we have all made adjustments to every aspect of our lives, especially the work environment. Mental health professionals are no exception. Since March 13th, I have been working from home and using video platforms to connect with my clients. I’ve gotten used to it, and I am making the best of the situation. But I have concerns about continuing to do so, and I think they are important to discuss. If teletherapy is going to become more common, we need a reality check regarding the risks so that we can engage in it without compromising the safety and trust of the client-therapist relationship. This requires explicit dialogue between the client and therapist about how the teletherapy sessions will take place. Here are some questions therapist and client can discuss to make sure that teletherapy is as private and productive as possible. 

1. How private is the client’s teletherapy environment? Therapists must not assume that because the client is alone in a room or a closet that they can talk freely. Clients should not have increased anxiety that what they are sharing will be overheard by members of their household. Having an intentional discussion about this issue could affect how therapy sessions will be conducted. Perhaps there are certain topics that can’t be addressed over telehealth. Or perhaps the client needs to think about words or phrases that can be used to communicate during session as a sort of “code“ for discussing sensitive topics. Therapists can ask clients to take the lead in opening up the discussions, so they don’t accidentally ask questions that clients wish not to discuss over virtual therapy. There are ways to minimize the risks of violating privacy, but they must be addressed in advance.

2. Are there distractions on either side of the call that need to be minimized? Unlike an office, where distraction can be more easily problem solved by altering the environment, home life is a much different scenario. Many therapists who work from home have spouses, children, or pets that may unexpectedly appear. While, in the abstract, watching videos of babies interrupting meetings can be cute, this may not be the case during a difficult or emotional conversation that a client is having with their therapist. For mental health professionals, doing our utmost to ensure that the client’s 50 minute session is protected is extremely important. Perhaps it means we go to our office to do telehealth. If we don’t have that option, it may mean that we schedule clients when children are sleeping or when there is someone else to watch them. It may mean that pets are confined to a room during working hours with food and water. It’s unfair for a therapist to expect their clients to focus if they are not also motivated to do so. Clients also need to think carefully about scheduling. If possible, sessions should be at a time when there are likely to be fewer interruptions and when the client has the energy to participate fully in the session. In addition, although it can be tempting, do not multi-task or pause your camera. To the best of your ability, give these 50 minutes the same attention you would if you were in the therapist’s office. The therapist and the client should acknowledge these potential pitfalls of teletherapy and have an intentional conversation about how they can work to make the most out of sessions.  

3. How do we stay professional? Even if you’ve maximized privacy and minimized distractions, the fact that you’re in your personal space changes the nature of the sessions. While having a window into those personal paces might be intriguing, noticing each other’s environment doesn’t need to become part of the therapy session. Instead you should be continuing to focus on the client’s therapeutic goals. Therapists can let the client take the lead and refrain from mentioning details that the client doesn’t address first. Clients in turn should avoid commenting on their therapist’s space. Together you can set explicit goals at the beginning of each session to help you stay focused. You might even consider setting up a Zoom background. 

We now have the option to do therapy remotely, thanks to modern technology. But just because we can, doesn’t mean that we should. Conducting teletherapy is very helpful in keeping therapy consistent during a crisis. But it is certainly not a model that I would advocate maintaining instead of meeting in person, when that is possible and safe. When we must do it, however, being cautious and thoughtful about how it is conducted is essential. Maintaining a standard of privacy and sensitivity can make the difference between preserving or alienating the therapeutic relationship.

Photo by Oliur on Unsplash