BEING PRESENT: The one New Year’s resolution you should make

Happy New Year! The year 2020 is now in full swing. New Year’s resolutions have begun to surface all over social media. I must admit there are some good ones: get in better shape, declutter, eat healthier. The quest to have a healthier, more prosperous year and to improve the quality of one’s life is certainly admirable.

The problem with New Year’s resolutions is that they can often be difficult to achieve; either because there isn’t a plan to implement them, or because the person doesn’t think carefully through the tools and resources needed to be successful. But there is one New Year’s resolution we can all make that does not require significant planning, financial resources, or other means that can be hard to obtain or sustain. This resolution will undoubtedly improve our mental health and well-being; improve our relationships, and perhaps even improve aspects of our physical health. This year, resolve to be present.

What does it mean to be present? It means that you focus your energy on what’s in front of you. This may sound simple, but it requires a shift in thought process and emotions that takes effort. 

To check how often you are focusing on the present, reflect on your typical daily activity. How much time do you spend thinking about the future? Do you experience anxiety about a list of things that you have yet to complete? Now, think about how much time you spend in the moment. Do you take time each day to be grateful for aspects of your life that are going well, for things you have, or for the people in your life? Do you notice things around you, such as natural beauty or a new coffee shop or restaurant that has opened recently? These are examples of being present: getting outside of your head and into your life to notice, enjoy, and attend to what’s happening right now. It’s a shift from outcome oriented living to process oriented living.

You can practice being present by making small changes to your daily life. Sit down and have a meal with your family, and leave your phone in another room. This allows you to focus on conversation and hear how other people’s day went. Then, you can answer emails or texts. Look at your to do list, and instead of feeling overwhelmed by the number of items on it, start at the top of the list and conquer the first task. While completing this task, focus on doing your best and making the most of it, rather than continuing to think about what you have to do next or by the end of the day. After a long day of work or school, set aside time to spend with your family, your significant other, your friends, or even some alone time. You can make a conscious decision to put a time limit on being busy to have some relaxing space. These are examples of being present.

Surprisingly, learning to be present can actually help us achieve other goals. Changing the pace of our lives and shifting our focus from the outcome to the process increases our commitment to all that we do. We become more intentional in our actions, and our motivation is more genuine. We can make decisions more thoughtfully because we are more aware of what we want, how we think, and the impact that our actions have on us and others. 

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HAVE AN ANXIOUS AND A MELANCHOLY NEW YEAR: Feel All Your Feelings This Holiday Season

We had just returned from visiting my parents for Thanksgiving. I looked forward to relaxing and watching Elf — one of my favorite holiday films. I felt peaceful and happy, as I planned decorating and other festivities. Then, the commercial began. A family looking through holiday video clips came upon a memory of their grandma, who apparently had passed away since last year. Cue the music from the movie Up, and my tear ducts started freely flowing. I couldn’t stop for ten minutes. The commercial stirred in me memories of Christmases past with loved ones no longer with us. It also stirred grief in anticipation of future Christmases without my parents. This was not the relaxing experience I had anticipated.

Although the commercial triggered emotions that were inconvenient for what I had planned, I recovered and the evening resumed. In fact, I felt a comforting release after the tears. But left to my own devices, I would have chosen to avoid uncomfortable feelings. We all engage in emotional avoidance sometimes, because we want everything to feel ok. We make black-and-white statements about how situations should feel. Relaxation shouldn’t be interrupted with negative feelings, we say. The holidays are supposed to be happy. It is the most wonderful time of the year, we hear everywhere during the holiday season.

The reality is that, most of the time, we experience mixed feelings. Circumstances can and do evoke several different emotions at once. We may feel happy on our wedding day, but a tinge of sadness that some family aren’t in attendance. It’s the same on holidays. We may feel joyful in celebrating the season with loved ones as we look forward to our favorite traditions. But we also feel heartbroken as we grieve those who are no longer with us.

Give yourself the gift of feeling everything this season. Rather than working hard to avoid negative feelings and expending a great deal of energy doing so, consider accepting all of the emotions that surface. Rather than setting high expectations for how extraordinary everything should be and how much joy it should bring, wait to see how you feel. Acknowledge the joy and the pain of this holiday season. Reflect on and be grateful for all of your experiences. The memories that trigger tears can then be cherished, instead of avoided. The anxiety that you accept and power through will bring you relief and build resilience.

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HOW THERAPY FOR CHILDREN WORKS BEST: IMPORTANT THINGS TO CONSIDER

I hear similar stories from parents. Their child is having stomachaches unexplained by a medical condition. Maybe the child is having difficulty at school either academically or behaviorally. Their child’s pediatrician or teacher has recommended therapy. But, many parents tell me, therapy doesn’t sound like something that would be appropriate for a child. The decision to take your child or teen to therapy is fraught with questions and concerns. What will they talk about? How will we know when they are making progress? What does therapy look like for a child or teenager?

These are all valid questions. Knowing some of the answers before you choose a therapist and get started with the process can make a big difference as to whether or not therapy will be helpful. The fact is that therapy for children and teens can be very effective in addressing emotional problems, school problems, and problems at home. It is also true that the earlier children receive therapy and other mental health support, the better their outcome. Early intervention can make all the difference in how children grow and develop emotionally if they start having problems at a young age.

But the reality is that many parents take their kids to therapy and feel like it goes nowhere: it just lasted a long time, and they had no clear evidence of positive results. Thus, the purpose of this blog is to educate parents about child therapy. Below are some guidelines about how to look for a therapist, how to get the most out of your child’s therapy, and what to expect in terms of the outcome. 

1. Determining Qualities of a Good Therapist: A therapist who specializes in children and adolescents is the best fit. Even though more generalized practices can work, a therapist who has training and expertise in child development, attachment, and parenting will provide more knowledge and insight specific to the child’s needs. This may seem like common sense, but many people may not be aware that there are therapists who actually specialize in working with children and families. These therapists will also know the best therapeutic approaches to take with a younger person. Talk therapy alone, with a lot of questions, generally does not yield a productive therapy session with a child.

2. Attending an Initial Consultation: Once you have chosen a therapist, I recommend setting up an initial consultation without your child. This allows you to meet the therapist, ask questions, and determine if you think you would trust this person with your child’s therapy. Choosing a therapist is different from choosing a pediatrician or another health professional. Your child is about to develop an ongoing relationship with this person for an extended period of time.

3. Telling Your Child About Therapy: Meet the therapist, then tell your child that you have made an appointment. Do not tell your child the therapist is a “friend.” Your child then wonders why they’ve never heard of this person or met them before. The therapist is also not a teacher. They see teachers all day at school. Be honest. The child likely knows they are struggling with anxiety, fear, sadness, grief, or nightmares. Let them know that you love them so much that you want to take them to a specialist who knows how to help them with these challenges. This will facilitate a smoother introduction with less fear. If they think they are going to see someone who can help them, they will be motivated to go and find out what therapy is all about.

4. Learning About Child Therapy: As your child attends therapy, you can also learn about child therapy. Schedule some time on your own with your child’s therapist if there is not time during the session to talk. Therapists handle their relationships with parents differently. Many of us prefer to have separate time with the parents, so that we can focus on answering their questions without the child nearby anxiously waiting. Use this time to ask the therapist about the goals in therapy, and work with them to come up with a plan of action. For instance, if your child is struggling with anxiety, the therapist is likely teaching your child coping skills to manage anxiety. Thus, you want to learn those skills as well, so that you can apply them with your child at home. Many therapists will also recommend books, apps, or other resources for parents, so they can help children outside of the sessions. An ongoing dialogue with the therapist is always best, so that you feel comfortable with the work that is getting done in therapy.

5. Collaborating with Other Professionals: It’s important for the therapist to talk to other professionals involved in the child’s care: the therapist gets a broader view of the child’s functioning in other settings. This may include a pediatrician, teachers, speech therapists, or occupational therapists. Parents should facilitate these professional interactions.

6. Waiting Patiently for Progress: No one wants to hear that therapy takes time. However — depending on the seriousness of the issues, the ability of the therapist and the child to establish rapport, and many other factors that are not in our control — it could take a matter of weeks or months before you notice positive change. While following the advice in this blog can make therapy more productive, there is no one answer as to how long therapy takes to work. Defining clear goals early on can make a big difference because the therapist and the parent know what progress will look like.

Deciding to pursue therapy for a child will result in less stress if parents are educated about what therapy for children involves. It can be an enriching, positive experience for children when the expectations are clear and when communication between the therapist and parents is consistent and strong. For more resources regarding child psychotherapy, check out www.drcarlamessenger.com

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GOOD THERAPY IS AN ART AND A SCIENCE

I recently attended a presentation by one of my colleagues called “The Art of Psychotherapy in Integrative Practice.” The presentation, and the conversation afterwards, was thought-provoking because it provided new insight that complements my own clinical background. While my doctoral training emphasized the importance of evidence-based practices, which represent a scientific approach to conducting psychotherapy, I believe that conducting psychotherapy is both an art and a science. That is the approach that I prefer to use, and the one that is most valuable to my clients. This blog is intended to educate potential clients, and anyone else interested in therapy, as to how psychotherapy functions as both an art and a science. Understanding therapy in this way will make it a more valuable and enriching experience.           

THE SCIENCE OF THERAPY: 

While popular culture is still determining whether or not psychology and its practice is technically a science, I would present the case that it is indeed a science if the therapist chooses to utilize its scientific virtues. Research continuously provides evidence in support of cognitive behavior therapy (CBT), dialectical behavior therapy (DBT), cognitive processing therapy for trauma (CPT), and exposure and response prevention (ERP) for phobias and obsessive-compulsive disorder (OCD). When therapists have obtained proper training in any of these techniques, and clients are motivated and cooperative, the research validates their success. Not only does science support their effectiveness, but clients feel relief from their symptoms. This is very encouraging, especially after months or even years of suffering with emotional challenges that can be debilitating. Clients who seek treatment with therapists who utilize these strategies are more likely to return to therapy later if the challenges return. They find hope in their newly acquired emotional stability and higher level of functioning.*

However, as freeing as it feels for clients to experience a reduction in their anxiety, depression, and other emotional symptoms, implementing scientific strategies in therapy alone is not enough to result in long-term, positive mental health outcomes. People want to feel relief from their symptoms, that is true. But the manner in which those strategies are developed, and the relationship and sense of trust necessary for clients to engage in therapy, is even more important.

THE ART OF THERAPY: 

Effective long-term therapy requires more than scientific training and being a good teacher of strategies. Crafting a relationship with a complete stranger where they develop trust in you as their therapist is indeed an art form. Not only do they trust you to give advice and to guide them in the process of healing, but they also trust you with long held fears, embarrassing details, and other secrets. If the therapist asks too many questions, too quickly, it may invoke greater fear and anxiety. If a therapist makes suggestions that are taken, and they backfire, this may compromise trust. Thus, the timing in therapy is one aspect that represents the art of conducting a meaningful session. When adding individual touches like humor into a therapy session, you have to take into account the individual preferences of each client. The therapist must know the client well before engaging in advice-giving, humor, or other personal touches. This is the hardest work for the therapist to achieve.

Finding ways to connect, emotionally, with a range of individuals and maintaining a rapport that prevents sessions from becoming stale and unproductive are factors that you can’t learn by reading a book or even entirely through graduate training. Truthfully, there are therapists much more gifted the art of psychotherapy, and others who are well-versed in the scientific discipline of evidence-based approaches to treatment. I believe that clients are in need of both the scientific and the artistic aspects of psychotherapy. Integrating the art of building a relationship with the use of practical strategies is the approach that my clients deserve. This is the kind of therapy that grows the integrity of the mental health profession and the one that will result in the promotion of long-term mental health and well-being.  

*If you’re interested in learning more about evidence-based therapy, check the Resources section on my website: http://www.drcarlamessenger.com/resources .   

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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. 

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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. 

Photo by Alexis Brown on Unsplash

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.

Photo by Joshua Earle on Unsplash