About Therapy

Treatment for Depression

Depression is a widely varied disorder with different symptoms, depending on the form it takes.  The definition is "depressed mood most of the day, for more days than not, as indicated by either subjective report (e.g. feels sad, empty, hopeless), or observation by others.  (e.g. appears tearful)."  Depending on the type of depression, additional symptoms include fatigue, weight gain or loss, sleep disturbance (sleeping too much or too little), lack of interest in normal activities, and anhedonia (inability to enjoy formerly pleasurable activities).


Depression can have many different causes.  Obviously, bereavement and grief can segue into depression.  Other stressors, such as loss of a relationship or divorce,  poor finances, feelings of failure in career or school, and traumas can lead to depression.


But, surprisingly, depression can also come out of the blue, when nothing is wrong.  This sort of depression can run in families and can be difficult to treat because it comes and goes.   This type of depression is sometimes, but not always, severe enough to include suicidal ideation and inability to function in normal life. 


Treatments for depression vary widely depending on the cause and severity.  Severely depressed people, those who suffer from suicidal ideation or who cannot function in life, sometimes require medication.  I do not prescribe medication and prefer to try to address the problems with talk therapy.  


Depression usually involves a negative view of oneself, one's life, and one's future.  It is like a black cloud descending on one's consciousness and causing this negativity. Hopelessness and helplessness are common.  Relationships become stressful and difficult.  Energy is very hard to come by, and sometimes even getting out of bed in the morning can be difficult.   


Band-aid therapy for depression involves exercise, starting with very easy exercise, increasing social contacts little by little, "mastery activities",  which are activities that are a little bit challenging , but not so challenging as to feel impossible, and "pleasure activities," which are activities that are fun or that used to be fun. 


Psychotherapy helps each client look at the unique factors predisposing him/her to depression, whether it be childhood trauma, excessive stress, or poor life coping skills.  Then, after examining and looking at these predisposing factors, the client and therapist start examining together the best ways to change the negative, and usually, self -destructive patterns  leading to unhappiness.  Often the client has to look closely at his/her negative thinking about him or herself, examining whether it is based in reality or whether the client is being way too hard on him or herself.  Often, depresssed people have extraordinarily high and perfectionistic standards for themselves, standards  which are unattainable. Likewise, some people are tormented by the need to please others, to the detriment of their own needs, forging destructive relationships which result in abuse and self-hate.  


Therapy has been shown to be very effective in helping depressed individuals start to change their negative views of self and future.  It is a very effective treatment for depression for most people.


Treatment for Anxiety

 

Anxiety can be a very debilitating illness. It has different forms that may be problematic, such as Generalized Anxiety Disorder, Agoraphobia, Post-Traumatic stress Disorder and other phobias. Although psychotherapy is the best way to treat anxiety, there are several things you can do to help yourself. However, do not think that these ideas will cure your anxiety. These are band-aid techniques that will help but not get rid of your anxiety.


First is to exercise regularly. Specifically aerobic exercise can be very helpful in working then relaxing your tense muscles. Research has shown exercise to be very helpful for many emotional disorders, but particularly for anxiety.


Second is to try to relax or meditate every day. You can purchase different relaxation or meditation tapes at a local bookstore or online. But you can also try to do it yourself. To relax, get yourself in a comfortable chair or in bed, lie down and close your eyes. Try visualizing yourself in someplace very relaxing to you.  Maybe on a warm, sunny beach or sitting in a hot springs with a waterfall nearby. When you imagine yourself in this place, imagine everything about it: the sights, the smells, the sounds, the feelings. If your mind wanders to other worries, etc., just calmly bring it back to your safe, relaxing place. Let go of other worries for 20 minutes or so.


To try to meditate.  Get yourself in a comfortable position and close your eyes. Concentrate on one syllable, such as the universal mantra, "om". Say this syllable to yourself in your mind over and over. You will find your mind wandering after awhile. Just gently bring yourself back to your mantra and, again, say it in your mind over and over. Again, your mind will wander. Just bring it back gently. Do this for 15-20 minutes a day. It is bound to help reduce your anxiety.


Another possibility is to listen to calming, soothing music, rather than to very loud and excitable music. Some classical music can bring you to a relaxed and quiet state of mind that it promotes more of a sense of calmness. Especially before bed, try to get yourself in a more sleepy state of mind by listening to calming music.


One last idea is to take a daily warm bath or long shower. The warm water on your skin can help you feel more at ease and safer in your skin.


Marital and Couples Therapy

 

Unless one member of a couple suffers from one of the “seven deadly sins” (alcoholism, substance abuse, physical abuse, emotional abuse, spendaholism, illegal activity, infidelity), most couples’ issues are related to communication problems. We are not taught in our society to listen. We are raised to believe we should stand up for ourselves and not let someone push us around. This works well in a career situation, but does not work so well in a relationship. Relationships must involve give and take on both sides or the giver ends up giving up.


When a couple arrives for therapy, I usually give them a list of things not to do in communicating. For example, no yelling, hitting, calling names, spitting, kicking, etc. Then we work on training in listening skills. This is very difficult. Most people, when arguing, are not listening to their partner as he or she talks, but are preparing their next comment, which they are sure will win the argument for them. It is surprising, when you actually start to listen to your partner, how many good ideas they have.


In addition to listening skills training, I generally try to help people go through a problem-solving approach to each difficulty they encounter. The process goes something like this: 1) define the problem, then stick to that issue, 2) each person states his or her thoughts, feelings and attitudes about the problem in a calm non-threatening way, 3) the couple generates possible solutions to the problem, even seemingly unworkable ones, 4) they decide on a plan to resolve the problem, 5) they implement the plan, 6) they come back to the discussion after a sufficient period of time to make sure the plan is working and the problem is resolved.


Most couples get stuck somewhere around step one or two, then get distracted by other past issues and never get to the step of deciding on a plan. Then they feel that their partner does not want to change the situation causing the problem, which may or may not be the case. But if they never come up with a plan to solve the problem, there is no way they will resolve the problem and it will come up again and again.


Therapy with Teenagers

 

“It was the best of times, it was the worst of times…” This quote from Dickens’ "A Tale of Two Cities,” perhaps best sums up the experience of teenagers in our society today. There are many different reason why parents may seek out psychotherapy for their teenagers, but many of the reasons have to do with the huge changes that occur in teen years, as well as the emotional upheaval that characterizes these very important years.


First, let’s talk about the teens who are on track with their behavior, but their emotions are out of control. These are the kids who are, perhaps, high achievers, but very anxious about their performance, or who get depressed when they are not able to be perfect. Or they might include the athletes who get depressed and anxious when they are injured or their performance goes down. Or they might include the kids who are quiet in school, get along, but are socially lost and have few or no friends. For these kids, who are usually in agreement with the decision to seek therapy, it often involves helping them to be more realistic in their self-expectations, or to build self-esteem and help them to stop blaming themselves when they can’t be perfect, or to teach them some social skills.


However, frequently teens are referred for therapy because of behavioral problems, such as arguing, disobedience, drinking, drugs, skipping school, etc. These problems are more difficult to address because often the teen, him or herself, does not wish to change and only wants the parents off his or her back. It is difficult to motivate those who don’t want to be motivated. These cases are not as easily resolved as the ones mentioned above. However, I do not mean to be discouraging. Many of these teen will respond to therapy positively. Many of them want the reassurance that their parents still love them, even when they have been mean to the parents or when they have been in other kinds of trouble. They will often respond to a new start in relating to their parents.


One teen I was treating surprised me the other day. She was feeling low because she felt her parents did not love her because they let her go be with her friends so often. She felt that if they loved her, they would keep her home with them more of the time. I recommended she talk to her mother about it. How relieved she was to find that her mother just wanted her to have a good, positive social life as a teen, as the mother, herself, had experienced when she was a teenager.


Thus things can be easily misinterpreted even when parents are trying to be kind and permissive with their children. Teens easily jump to the wrong conclusions. A lot is going on in their brains and bodies, a lot of hormonal changes and other stresses. Further, teens now have so many more challenges than we did years ago. The high school and college course work they encounter is more detailed and more difficult. The social situation is fraught with more difficulties in terms of cyber-bullying and temptations for sexual relationships on the internet. Our society has changed to be more permissive of sexuality at an earlier age. Though teens' bodies are developed, their emotions are often not fully developed.


Scientific research shows that teens brains are not fully developed until 24 or 25 years of age. The last area of the brain to develop is the frontal lobe. This is the brain area that has the most to do with impulse control, judgement and emotional control. Thus young adults may have difficulties in self-control until well into their twenties.


If you are experiencing problems with your teen, first start by sitting them down. Rather than lecturing, start by telling them how much you love and care for them. Ask them questions about their life and the challenges they face in school and with friends. Try not to be judgmental, and try not to give advice. But keep asking questions to keep them talking. You’d be surprised at how hard this is to do, but at how well they respond to you listening without judging them.


The TV ads that advise talking to your child as the way to avoid problems are correct. Your child wants you to be interested in his or her life. He or she wants you to show you care. They may not always tell you the truth if there is a long history of feeling vulnerable or attacked. However, this can be a start.


Further try to get them to do something fun with you. It is more important to do something that they like doing rather than something you like doing. Remember this is your precious child, whom you care about and want to spend positive time with. Try to remember the times when they were little and hugged you or otherwise showed you their love for you. By building positive memories of activities together, hopefully you can build a sense in your child that you are a favorable person in their life and that the advice you give them is given with good, loving intentions and not with rejection and criticism.


If these strategies do not work, you may need to refer your child for therapy. Therapy can take place with the teen alone. Teens usually prefer this. Or it can occur with the whole family. The direction a therapist will take will depend on the circumstances in the family or for the teenager.


Please never give up on your teenager. They are precious people whom you love.