Explore What's Next

Explore What's Next Blog Among Top 100 Blogs for Depression!

When the Nursing Schools blog informed me that the Explore What's Next Blog was on their top 100 list for blogs on depression, I was thrilled... And then I wanted to know what number? Yes, I am petty like that.

I don't know that it matters, the person who runs the site doesn't say. Are they rated or are the blogs listed randomly? EWN is number 76 which is wonderful! I mean, #76 in the world! Not bad! EWN is in good company, with the likes of Beyond Blue and the Happiness Project. I look forward to checking out many of EWN's fellow listees that I am not yet familiar with.

Nursingschools.net is a website that helps people interested in a nursing career to navigate all the possible career paths in nursing and how to get there. Their mission is to inform future nurses of many health related topics and they do it well. Here's what they say about depression:

"About 9.5% of Americans each year suffer from a mood disorder of some type, and 18.1% must face down some type of clinical anxiety. Depression in its myriad twisted forms is the leading cause of disability between the ages of 15 and 44, sometimes co-existing with bipolar disorder, anxiety disorders, obsessive-compulsive disorder, borderline personality disorder, schizophrenia, eating disorders, substance abuse, self-mutilation, suicidal thoughts or actions and many other serious conditions. Unfortunately, society's entirely unfair stigmatization of the mentally and emotionally unbalanced leads sufferers to feel even more isolated — even leading some to dangerously avoid seeking treatment altogether. However, more and more people are bravely emerging from the wrongfully-imposed shadows to open up to the world about the challenges they must conquer on a daily basis. Nobody suffers alone, no matter how marginalizing the general public forces upon them."

Click here for the entire list!

Overwhelmed? Stop & Take Your Mood Temperature

When we get overwhelmed we tend to see things in black and white. Depressed, sad, angry, anxious, take your pick of mood, when the going gets tough, it can feel like a heavy wet blanket of yuck. We feel helpless to do anything about it, it is too consuming, a blinding fog, and feeling hopeless isn't too far behind.

Instead of giving into the dark feeling, stop and take a closer look. Take your mood temperature.

Using a 0-10 scale, assign the extremes first because they are easiest. Think of an old-fashioned thermometer: 0 is totally relaxed, happy, content, free of strife, however you want to describe bliss, that's 0. The temperature rises as the stress level and the negative mood rises so 10 is the extreme version of whatever your particular bugaboo is: panic, out of control rage or depression so oppressive you are thinking self-destructive thoughts.

Five might be having moderate stress to deal with but feeling like you have it in control, in balance. Now describe the numbers in between 0-5 and 5-10. Under 5 you may experience increasing stress but still maintain a sense of control. On my scale for anxiety, even up to 6, I feel like I still have enough of a grip that I can easily apply coping techniques to get the temp down.

Seven and above is when the negative mood may be getting out of control and intervention is called for, like taking a mental time-out, conscientiously addressing negative thoughts with more reasonable thoughts, calling a friend for support, or your therapist, if your temperature is rapidly heading for higher numbers.

The idea behind the mood thermometer, developed originally by child psychologists to help children learn how to describe what they were feeling, is to become more sensitive to the nuances of mood. In other words, we can be more effective in dealing with our mood if we can see the different degrees of color in between the black and white. If I only see 10, I am overwhelmed. Also, it is easier to do things to keep from boiling over if you catch the bad mood before it gets too hot. If I stop and note that my mood is more like an eight, or a 7, I can do something about that. Improving my mood suddenly seems attainable.

10 Challenges for Parents With Chronic Illness

In the Parents Magazine article, "Mommy Isn't Feeling Well Today," Sarah Mahoney interviews many experts: professionals, parents who have chronic illness and sometimes, as in my case, people who are both. The article is impressive in how it covers many of the challenges parents face every day rearing their kids while their health is seriously compromised.

Below I summarize the article's most salient points and add my comments:

1)  "Handling chronic illness is about learning to live in balance," said Rosalind Doran, Psy.D. 

Many of us learn the hard way that if we don't pay attention to what and how much we do in all spheres of our lives we can quickly over-do. The result is the same as when the tires on our car are out of balance. We're in for a very bumpy ride.

2) "You can't dwell on questions like. 'Why is this happening to me?' or 'What if it gets worse?' It's important to focus on feeling well and to maintain a positive outlook."

Yes, this is more easily said then done but this is an important point and one I've made before. If you have a chronic illness, and I do, there is a danger that we will over-identify with being a sick person. We are not our illness and it really does matter that we make the effort to see the cup half full.

3)  The first hurdle is revising expectations of family life. "Of course, you can still be a loving parent, but some adjustments will have to be made. Your family will not look the way you imagined it would. That's a loss, and it hurts a lot."

In order to move on, down a new path, we need to let go of what may have happened if we had gone down another. If we hold on to, "What would my life have been like if I wasn't sick?" we deny ourselves the opportunity to create a real and satisfying present.

4)  A chronic illness may change your plans about having more children.

That may mean imagining a life with fewer kids, considering adoption or even remaining childless. I had to accept the very real possibility that I would not be able to have kids. As anyone who has been through such an agonizing reality, there is a mourning process, a grieving that takes place. For many women there is also a feeling of guilt (could I have done something to avoid this?) that must be let go.

Horses Help Heal Our Wounded Warriors

Thanks to Mac, my friend on Facebook, I learned about this wonderful program that uses Equine Assisted Therapy to help veterans with PTSD.

Suze Maze, a licensed clinical social worker, offers this program for soldiers stationed at Fort Gordon, Georgia in the Warriors in Transition Program. 

"I've always wanted to come back and work with the military...Equine Rescue of Aiken [South Carolina] is a perfect match. We have horses who need healing and we have soldiers and people who need healing."

She goes on to describe the special power horses have...

"...they all have their own style of therapy that they like to work with. One horse likes to work with people who have Attention Deficit Disorder, another works with those who have mental challenges; [the horses] migrate toward them. I worked with civilians in Kentucky. We have a conscious mind, things that we're aware of, and we have [the] sub-conscious and unconscious. The horses seem to be able to get at that innate sub-conscious...things the person being treated may not recognize. It makes people think outside the box to come up with their own solutions."

Suze Maze has what it takes to be a qualified equine therapist. On her Facebook profile page, she says, "After a forced retirement from riding racehorses for 20+ years, then pursuit of a professional career as a licensed clinical social worker, I am now able to combine them both with Equine Assisted Psychotherapy."

Anyone wanting to learn more about this particular program could contact Suze directly at Operation Open Arms. You can get more information about other Equine Assisted Therapy programs at the Equine Assisted Growth and Learning Association website (EAGALA). They have programs around the world.

Five Signs You Probably Need a Vacation!

By Dr. Aletta

The number of people who don't take their hard-earned vacation time is appalling. A survey of American workers reports that more than half don't use their vacation or personal leave time. More than half! Why do people do that to themselves?

Sadly I can think of several reasons why people don't take vacation:

1. Fear of losing their job if they don't appear to be 100% committed. This could be imagined or real depending on the employer's attitude.
2. Our OCD society still sees time off as slacking. Same goes for sleep.
3. If you are self-employed you have no paid vacation time and time is literally money. 
4. An inflated sense of our importance at work. Everything will fall apart if we are not there!
5. We have no idea what we would do with ourselves in the absence of work.

I can think of only one reason to take a vacation: Taking a vacation is the healthy thing to do! It's healthy for your mind, body and relationships. Vacation provides a needed balance. It's like hitting the reset button. Taking a vacation, vacating your mind of work, will improve your on-the-job performance! Otherwise, you risk serious burnout.

I'm a bit guilty of losing track of my time off. I love my job, so I can easily go on and on until a few tell-tale signs it's time to take a break begin to pop up.

1. Irritability. When I went to get a hair cut yesterday, and discovered the appointment was for another day, I could feel the steam coming out of my ears. Something that usually would roll off my back became a huge inconvenience as if they had rescheduled open heart surgery, for crying out loud!
2. Memory loss. I find myself forgetting stuff. When my kids begin to say, more than once, "Mom, I told you about that already," I begin to think there's a clone of myself, like in that movie, Multiplicity, running around engaged with my family while I zone out. Not good.
3. Apathy. The weeds are taking over the flower beds. Dishes pile up. Patient charts are open and lacking notes from a week ago. My dog needs walking and my legs need shaving. When I really don't care once in a while, that's OK. When days and weeks go by and life's little maintenance chores go ignored? Someone needs a vacation.
4. Fatigue. It doesn't matter how much sleep or exercise I get. I'm pooped and want to nap, a lot!
5. Anhedonia. I love that word. It's a fancy way of saying that the old stuff that used to make me happy, doesn't make me as happy anymore. Anhedonia is a major sign that something is off in our lives and can lead to burnout and depression if we don't pay attention to it.

My work usually makes me happy. Before it doesn't bring me contentment anymore, I bit the bullet and scheduled some time off. Chronically not taking your vacation from work is a kind of insanity. Now that I have time off to look forward to, I feel relieved and wonder, why did I resist in the first place?

Help! I have obessive thoughts about my therapist! Or– What is transference?

Recently, I received an email from a reader asking for some help. He knew his cognitive behavioral treatment (CBT) which had gone well for several years, hit a snag. He felt his hidden obsessive thoughts about his therapist were getting in the way of the treatment's progress. He asked me if there were any CBT techniques to help him get past this road block. He said,  "...this obsession really is quite disturbing to me. I feel that it is not fair [to] the therapist who is not seeing me make any progress. Any advice would be more than appreciated."

Here, edited a bit, is my response...

What you describe is not uncommon in many forms of psychotherapy, so please do not think poorly of yourself for it. We call it transference.

Transference in psychotherapy is defined as an unconscious process where the attitudes, feelings, and desires of our early significant relationships get transferred onto the therapist.

As your relationship with your therapist deepens, the situation triggers familiar feelings related to previous connections with others, like to your parents, for example. You begin to experience the therapist, in the present, in much the same way you had experienced a significant person from your past. Sigmund Freud, the great grand-daddy of all therapists, was the first to observe this process.

You do not say what form the obsessive thoughts you have about your therapist take, but regardless of whether they are positive or negative, sexual or parental, taking a look at these thoughts can be an important part of your therapeutic process. In other words, instead of giving you some specific CBT exercises to 'get rid of them' I would strongly (and gently) suggest you talk with your therapist about them directly.

I know... this is very hard; I hope I am not asking too much. From what you write you have a reasonably good working relationship with your therapist. You have worked together for years, only now you are both feeling 'stuck'. It could very well be these transference feelings are blocking your progress, as you suggest. As therapists we are trained to help our clients process transference thoughts and feelings in a way that is helpful to you, for your emotional growth.

Since you ask for a CBT technique I will share one that I often use for clients who are faced with doing something they dread. It's called 'Biking up the Hill'.

5 Reasons to Get a Marriage Check Up – Couples Counseling

1. Your spouse/partner/boyfriend is perfect...except for this one thing he does when he's eating soup which makes you insane!

2. You are facing a transition. A move, career change, retirement, and other such life events can mess up your relationship's balance.

3. You are in love and looking forward to your life together.  A couples counselor will help you set up good relationship habits before bad ones have a chance to creep in.

4. There is a problem outside the relationship that is causing stress. It's not the relationship, it's – a bad boss, an ex-spouse, step-kids, demanding in-laws, caring for a chronically ill loved one – you name it.

5. There is tension in the air but you are thinking, "It's not that bad yet."

By working with couples before they are unhappy, the checkup identifies potentially “corrosive” behaviors and helps couples make small changes in communication style before their problems spiral out of control.

So says a recent New York Times article, Seeking to Pre-empt Marital Strife. And I say Amen to that!

I'm a couples counselor and I love this work when the relationship is basically sound but has gone off track for some reason. The challenge is monumental when the troubles have gone on unchecked for months, even years, and the couple have finally agreed to see a counselor, clearly as a last resort. Please don't wait until you are just this side of breaking up before you seek help.

“Couples won’t go to marital therapy with just the one thing that they are struggling with,” Dr. Córdova said. “So they end up struggling in places where the fix might be simple, it’s just that they themselves are blind to it.”

Couples who come in before it gets 'too bad' don't need a ton of therapy. It is still true that an ounce of prevention is way worth a pound of cure! 

Contact me for your marriage/relationship check up today!

From the Archives: 7 Ways to Give An Apology & 4 Ways to Accept One

When I was seven years old, preparing for my First Communion, I had to go to Confession first. Back in the day, that was a scary prospect, involving a dark booth, hell’s fire and spilling your guts to a shadow behind a screen. What does a seven-year-old self have to confess?

I knew exactly, because I was a convicted thief. I stole a fancy little brush from Joyce Weber, my friend from down the street. I coveted that pink and blue plastic brush and I took it! When she discovered my sin, Mom marched me over to Joyce’s house to hand the brush back and apologize, face to face. It was agonizing. What more penance could there possibly be?

As a dear friend said, "Apologizing sucks." Apologizing is uncomfortable, at least if you are doing it right, but it is the pain of cleansing a deep wound so that it can heal properly. Here are a few suggestions on how to make a good apology:

Seven ways to apologize:

1. Avoid defensiveness. "I don't have anything to apologize for!" Really? Think about it.
2. Be humble. You may even consider groveling if your transgression was extreme, like an affair. In that case, expect to grovel for a long time, but not forever.
3. Make it from the heart. When my son was three years old he banged his little sister on the head with Buzz Lightyear. My mother witnessed his apology. With my coaxing, he mumbled an "I'm sorry," to his sister. “That’s not a sincere apology,” my mother said.  “He should mean it!”  Well, he was three. “Form first,” I said. “We’ll work on sincerity later.”  By the time he was five or so I figured he should be able to understand the concept of meaning it. Unfortunately, there are many adults out there who don't.
   
4. With candy and flowers. Gifts may be used only to open the door or after the apology has been accepted, as a thank you. Do not expect treats to substitute for sincerity. No, not even a diamond tennis bracelet.
5. Face to face is best, maybe because it's the hardest. A phone call comes in second.  A hand written letter might work. Any form of writing needs to be carefully thought out when the advantage of voice and body language is absent. Email or direct message works for an apology, but only if there is seriously no other way. Be aware that privacy cannot be guaranteed. Texting an apology? You’ve got me there. Maybe for a fourteen year old? I don’t know, it may be a generational thing. I wouldn’t recommend it.
   
6. Stick to the issue at hand. Don’t apologize for all the sins of the past. That can smack of insincerity. If all the sins of the past is the issue, one apology won’t cover it. You probably need a mediator, like a pastor or a therapist.
7. Say you’re sorry once, genuinely said, with all the sincerity you can muster. Then let it go. Like a message in a bottle, send it off, be patient and hope it lands in receptive hands.

Receiving an apology isn't easy either.

Before You Burn Out – CBT for the Therapist: An Interview with Dr. John Ludgate

Do you ever wonder about how your therapist does it? If you are a therapist, do you ever have a day when it takes everything in you not to reach over and slap your patient silly? Or raise a white flag in defeat?

Occasionally people ask me, "How do you listen to peoples' problems all day long without becoming depressed yourself?" The answer is the same for whatever the job is: we need to pay attention to balance. I do my best to balance the hours I dedicate to work, for family time, and for just plain old time off and play.

But to be perfectly honest, there are those days when I find myself severely stressed out. It could be I've over-booked myself too many days in a row, or had a series of challenging sessions or maybe just one person I wonder if I'm really helping.

On those days, before I decide to chuck it all and go work for Mary Kay, I remind myself of what Dr. John Ludgate, of the Cognitive-Behavioral Therapy Center of Western North Carolina, wrote. He says turnabout is fair play and invites the therapist to use the CBT techniques they share with their patients on themselves.

Whether we are new to the profession or seasoned, in private practice or in a not-for-profit setting, sometimes the therapist's thinking could use a tune up to help them feel better about their work. That's why I am happy that Dr. Ludgate agreed to be interviewed on this subject, one he describes as being close to his heart:

EWN: Dr. Ludgate, in looking over the material you gave the attendees of your workshop, "Advancing Your CBT Skills", I was pleasantly surprised to see "Common Negative Thoughts" and "Dysfunctional Beliefs" written specifically for therapists. Reading those pages for the first time I thought, "Wow, other therapists have these thoughts?" It was a revelation. When did you start looking into how therapists could use CBT for themselves?

Dr. Ludgate: Probably about 20 years ago when I realized how my own thoughts were getting in the way of doing effective CBT and also causing distress (anxiety, frustration etc). This was confirmed when I started supervising novice CBT practitioners who had these same issues and also as I realized just how little our training equips us for this part of our job!

EWN: Is there something about therapists that makes them particularly vulnerable to critical self-judgment?

Why Making Mistakes Can Be Good For You

Thank God my parents supported the idea that with mistakes comes opportunity. The messier and more public the gaff the more profound and significant the lesson learned. You can imagine how much grief this philosophy saved me as a kid.

Last week, not just one, but two books came out that focus on what it means to make mistakes, “Being Wrong,” by Kathryn Schulz, and “Wrong,” by David H. Freedman. Dwight Garner, of the New York Times, wrote a review of both in To Err is Human – And How! And Why. Garner clearly liked Ms. Schulz's book better. He says:

“Far from being a sign of intellectual inferiority, the capacity to err is crucial to human cognition...

Thinkers have toyed with theories of error since Plato’s time, many of them generally agreeing with Albert Einstein, who said, “If we knew what we were doing, it wouldn’t be called research, would it?”

'Being Wrong' is optimistic. “Error, even though it sometimes feels like despair, is actually much closer in spirit to hope,” Ms. Schulz writes. “We get things wrong because we have an enduring confidence in our own minds; and we face up to that wrongness in the faith that, having learned something, we will get it right next time.”

With compassion and forgiveness we may allow ourselves to be human, make mistakes and learn from them. Then, as the old song advises you can, "Pick yourself up, dust yourself off and start all over again."