How Psychotherapy Can Help

   by Nate Prentice, MSW, LCSW, CAS-PC
Therapist and client (male)If you are reading this, it is probably because someone suggested that you may benefit from talking with someone about things which are bothering you and causing repercussions for you in your home, your work, or your relationships with other people.  It is probably not a comfortable thing to hear, but you want to feel better, so you are considering your options.  Or, perhaps you have tried other things including medication, but feel stuck and are interested in exploring other options to help you, because, after all, you want to feel better.
What are the benefits of psychotherapy vs medicine alone?   Consistently, in study after study, psychotherapy has been shown to be as effective as medication alone with many mental health issues. More importantly, many mental health issues such as anxiety and depression respond even better to a combination of psychotherapy and medication than psychotherapy or medication alone.
Why is this?  Many people do get a sense of relief from taking medication.  However, they may lack the skills to cope with life stressors, especially when nothing else in their life has changed.  So symptoms may persist.  Or, people may use ways of coping that create their own problems, such as substance abuse (self-medicating the symptoms), yelling at family members, workaholism, etc.  Psychotherapy, because it focuses on skill development and problem solving, helps with these issues.

How do you choose a psychotherapist?  There are several kinds of professionals trained to do psychotherapy.  These include psychologists, psychiatrists, clinical social workers, marriage & family therapists, and licensed professional counselors, among others.  The specific degree a person has may be less important than how experienced and skilled they are, and how comfortable you feel with them.  Some other issues to consider may be the therapist’s gender (male or female), age, or cultural background, or their therapeutic techniques and philosophy.

What is a typical psychotherapy session like?  Gone are the days of lying on the couch.  Today most therapy sessions are held face to face.  The first session is usually an evaluation, where you may be asked a number of related and unrelated questions to help the therapist discern what your issues are and what outside influences are impacting on your issues.  During or after that session, a plan for addressing these issues will be created.  Therapy sessions are usually weekly at first, and may reduce to biweekly or monthly as you begin to feel better.

Therapy sessions will then focus on how you are coping with your issues, as well as reasons why you have the issues.  When you are feeling better, and are able to get a lot of support from friends and family or other supports in the community, you and the therapist may talk about ending therapy.

What are the best things to do to prepare for psychotherapy?  First, have concrete and specific goals.  “Feeling better” as a goal is not as good as “Able to reduce crying spells to less than 3x/month”.  When you frame your goals, frame them in terms of what you want to be different in your life, not what you don’t want to experience anymore.  For example, instead of saying, “I don’t want to feel sad daily”, frame it as “I want to be able to list 3 positive things per day that make me feel good”.  The problem with framing them in terms of the absence of negative things is that it doesn’t provide a direction to move towards.  Another thing that is important is to come with an open mind, being honest with yourself and open to new ways of looking at your issues.

Finally, be aware that the therapist may not be as anxious as you are to explore why you have a problem.  When people in therapy are desperate to find the root of a problem, they often end up in “analysis paralysis” because even if they know the root of a problem, it doesn’t solve the problem in and of itself.  In order to solve a problem, one must use good coping skills to put out the fire before poking in the embers.  Cope first, find out why as you look back over your shoulder later.

It is hoped that this introduction to therapy is helpful, and that it answers any questions you may have.  Feel free to contact Psych Choices if you have any questions or concerns, or would like to make an appointment.  Our telephone number is 610-626-8085, ext. 213 for new patients; you may also email us using the contact form below, or directly to the Intake department at Intake@psychchoices.com.

Parenting 101: A Simple Guide to Child Behavior Management

by Emily Kahn-Freedman, LMFT

As a marriage and family therapist, I am often asked for suggestions about how to help children behave better .  All parents struggle at times with how to help their children learn to cooperate, do their chores, stop fighting with their siblings, reduce whining or temper tantrums.  In my years of studying the subject – and practicing on my own children, who thankfully survived to healthy adulthood – I have developed the following list of parenting suggestions.

1.  What you pay attention to, you get more of.   We all need and deserve attention.   Try to “catch your child being good,” and rather than using the peaceful time to check off something else on your to-do list, spend a moment paying attention to your child.   By the same token, most parents can simply ignore a lot of negative behavior.  Children (and adults) tend to repeat behaviors that are rewarded with attention.  If negative attention is all they get, sometimes children will repeat negative behavior just to get whatever attention they can.
Positive attention includes:

  • words of love
  • questions, comments “looks like you’re having fun with your toy”
  • affection
  • joining in play, if child wants you to
  • occasional rewards such as special treats, special parent-child time, cash, small prizes

2.  For every negative statement (correction, constructive criticism, consequence) be sure you use at least 5 positive statements. (This works well with spouses too.)

family problems

3.  VALIDATE emotions. “I know you really, really want to stay up and play your game. I bet you’d like to stay up all night long! I used to want to do that when I was your age. Maybe this weekend you can stay up later.   But tomorrow is a school day and I’m turning off the computer in two minutes.”

4.  Increase motivation by offering simple rewards:   “Do you think you can find a way to put away all your toys before the timer rings? If you beat the timer, you get an extra story at bedtime!”

5.  Never use punishment that hurts or shames a child. Avoid thinking of consequences as “punishment” at all but as a natural result of behavior: “No throwing balls in the house. If I find you you throwing your ball in the house again, I will need to take your ball and keep it for you until I see that you can be more respectful of our rules.”

6.  If you concentrate on building positive experiences with your child, by expressing love and engaging in having fun together, your child will naturally want to please you. In the same way, if most of your time with your child is spent criticizing or correcting, your child will feel hurt and resentful. He or she may be unconsciously looking for ways to retaliate… or may unconsciously realize that negative attention is better than no attention at all.

7.  Avoid responding when you are angry. If a child’s behavior angers you, take a time out – for yourself. Leave the room if possible, or if the child is too young for that, sit and close your eyes and breathe deeply for a couple of minutes before responding.

8.  If possible, don’t decide on consequences right away. You may decide that consequences aren’t necessary, that a verbal reprimand is sufficient. Try to wait until you have time to think it over and discuss with the other parent, if any.

9.  For repeated problem behaviors, have a problem-solving session with your child and develop a behavior contract with rewards for improved behavior and specific consequences for breaking the rule.

Some Helpful Parenting Books:

How to Talk so Kids Will Listen and Listen so Kids Will Talk by Adele Faber and Elaine Mazlish

Giving the Love that Heals by Harville Hendrix and Helen Hunt

Parenting With Love and Logic by Foster Cline and Jim Fay

 

For further help with your children’s behavior, you may want to contact Psych Choices of the Delaware Valley at 610-626-8085, or email us at Intake@psychchoices.com.   Several of our therapists specialize in working with children and families.

 

The Science of Happiness: A Free Online Class

by Connie Opfell, LCSW
I’d like to invite you to join me and over 100,000 others in taking the first MOOC (Massive Open Online Course) in Positive Psychology. It’s an 8-week course called The Science of Happiness, and is being offered free by the Berkeley Greater Good Science Center. It started on Tuesday, September 9 (but it’s not too late to join), and it includes a combination of lectures, readings, and “happiness practices.” An interesting aspect of the class is its discussion board — imagine a course with students from all over the world and with lots of different perspectives commenting on each topic!
If you’d like to learn more or register for the class, click this link:

Some Truths About Suicide

depression and sorrowby Nathaniel Prentice, LCSW, CAS-PC

September is National Suicide Prevention Month.  As a way of honoring the importance of suicide prevention, I’m writing today to bring it out into conversation.

        Suicide is one of those extremely difficult conversations topics.  There is a lot of stigma about suicide, as well as a lot of myths.  According to the American Foundation for Suicide Prevention, http://www.afsp.org, these are some of the myths associated with suicide:

Myth: Suicide can’t be prevented. If someone is set on taking their own life, there is nothing that can be done to stop them.

Fact: Suicide is preventable. The vast majority of people contemplating suicide don’t really want to die. They are seeking an end to intense mental and/or physical pain. Most have a mental illness. Interventions can save lives.

Myth: People who take their own life are selfish, cowards, weak or are just looking for “attention.”

Fact: More than 90% of people who take their own life have at least one and often more than one treatable mental illness such as depression, anxiety, bipolar disorder, schizophrenia and/or alcohol and substance abuse. With better recognition and treatment many suicides can be prevented.

Myth: Asking someone if they are thinking about suicide will put the idea in their head and cause them to act on it.

Fact: When you fear someone you know is in crisis or depressed, asking them if they are thinking about suicide can actually help. By giving a person an opportunity to open up and share their troubles you can help alleviate their pain and find solutions.

Myth: Teenagers and college students are the most at risk for suicide.

Fact: The suicide rate for this age group is below the national average. Suicide risk increases with age. Currently, the age group with the highest suicide rate in the U.S. is middle-aged men and women between the ages of 45 and 64. The suicide rate is still highest among white men over the age of 65.

Myth: Barriers on bridges, safe firearm storage and other actions to reduce access to lethal methods of suicide don’t work. People will just find another way.

Fact: Limiting access to lethal methods of suicide is one of the best strategies for suicide prevention. Many suicides can be impulsive and triggered by an immediate crisis. Separating someone in crisis from a lethal method (e.g., a firearm) can give them something they desperately need: time.  If they balk, remind them that it is temporary.  This provides time to change their mind, time to resolve the crisis, time for someone to intervene.

Myth: Someone making suicidal threats won’t really do it, they are just looking for attention.

Fact: Those who talk about suicide or express thoughts about wanting to die, are at risk for suicide and need your attention. Most people who die by suicide give some indication or warning. Take all threats of suicide seriously. Even if you think they are just “crying for help”—a cry for help, is a cry for help—so help.

Myth: Talk therapy and/or medications don’t work.

Fact: Treatment can work. One of the best ways to prevent suicide is by getting treatment for mental illnesses such as depression, bipolar illness and/or substance abuse and learning ways to solve problems. Finding the best treatment can take some time, and the right treatment can greatly reduce risk of suicide. In fact, it can bring you back your life.

There are some warning signs of suicidal thinking.  Here are some listed from the Suicide Prevention Lifeline organization, http://www.suicidepreventionlifeline.org/, which sponsors a suicide hotline at 1-800-273-TALK, which is available 24-7-365.

  • Talking about wanting to die or to kill themselves.
  • Looking for a way to kill themselves, such as searching online or buying a gun
  • Talking about feeling hopeless or having no reason to live.
  • Talking about feeling trapped or in unbearable pain.
  • Talking about being a burden to others.
  • Increasing the use of alcohol or drugs.
  • Acting anxious or agitated; behaving recklessly.
  • Sleeping too little or too much.
  • Withdrawing or isolating themselves.
  • Showing rage or talking about seeking revenge.
  • Displaying extreme mood swings.

Of course, having some of these does not necessarily mean that someone is fully suicidal or an imminent danger to themselves.  However, it is important to remember to just simply ask and be direct about your concerns to check in with them.  Oftentimes they are anxiously waiting for someone to simply ask.

While helping someone who is suicidal can be scary, it is less scary if you know something about what to do about it.  Http://www.suicidepreventionlifeline.org/ suggests the following for tips for how to help someone who is contemplating suicide.  I added a couple as well.

  • Be direct. Talk openly and matter-of-factly about suicide.
  • Be willing to listen. Allow expressions of feelings. Accept the feelings.
  • Be non-judgmental. Don’t debate whether suicide is right or wrong, or whether feelings are good or bad. Don’t lecture on the value of life.
  • Get involved. Become available. Show interest and support.
  • Don’t dare him or her to do it.
  • Don’t act shocked. This will put distance between you.
  • Don’t be sworn to secrecy. Seek support.
  • Offer hope that alternatives are available but do not offer glib reassurance.
  • Take action. Remove means, such as guns or stockpiled pills.
  • Get help from persons or agencies specializing in crisis intervention and suicide prevention.  Calling the hotline above or getting your friend to the nearest emergency room/calling 911 in an emergency is a simple way to get the help.
  • Usually, people who are suicidal don’t actually want to kill themselves.  They want a troublesome situation to change instead.  Explore that with them and help them get help so that they can change their situation without ending a life.

At Psych Choices of the Delaware Valley, mental health professionals are available to discuss these feelings and help people get the proper treatment.  If you are having suicidal thoughts or feelings, please feel free to ask us about next steps.  Please remember that if it’s urgent you can call the suicide hotline, 1-800-273-TALK.

Your life is important.  To us.  To me.

Many of us remember celebrities and/or people in our lives who have died of this.  Respect them by being more open and prepared to help others, and, if needed, taking care of yourself to prevent tragedy for others.

The Internet and Emotional Health: Online Resources for Everyone

How many ways has the “digital age” changed our emotional lives?internet

Judging by the lives of my clients as well as those of my family and friends, a lot.

People seem to live huge parts of their lives via text message now.  They will ask someone out by sending a text; they carry on huge arguments by text, and eventually they even break up by text.  Unfortunately, text messaging isn’t very good at expressing emotions and many misunderstandings do occur.

Thanks to the Internet, marriage proposals have become a huge industry.  It can cost $2000 or more to stage a marriage proposal that will go viral on Youtube, complete with flash-mob dancing chorus – and to some, that seems to be the only kind of proposal worth saying “yes” to!

Babies continue to be born the (more or less) old-fashioned way, but marriage continues to have its ups and downs with the help of the Internet.  Most of us probably know at lease one person who found their high school sweetheart on Facebook and ended up leaving their spouse for their first love.  We may discover that our spouse is cheating by looking up phone records online, or perhaps we find an incriminating text or photograph on their phone.  (Lipstick on the collar is so last century!)

The porn industry is now perhaps the first “sex educator” for many young people, with often unfortunate results: boys may expect their girlfriends to behave like porn stars, not to mention expecting their own bodies to live up to those of the men in porn videos.  Both men and women may think they are sexually inadequate compared to what they view so readily on the Internet.  And “porn addiction” has become epidemic with the ready accessibility of online porn.

On the other hand, some excellent sources of help exist online.  People may stop drinking with the help of Alcoholics Anonymous online, quit smoking pot with Marijuana Anonymous online, or lose weight with a free online support group (www.sparkpeople.com/).  There are countless sources of free online information on mental health topics, from suicide prevention (for example see www.suicidepreventionlifeline.org/) to anxiety  and panic self-help (for instance, www.anxieties.com).  Online support groups exist for those struggling with bipolar disorder (see the DBSAlliance online)  or schizophrenia (see Schizophrenia.com), as well as many other problems.  A great online resource  and support group for all kinds of mental health problems is the website PsychCentral.com.

And sex education online doesn’t have to be on pornograph sites, which are misleading at best.  For sex education appropriate to teens, see instead Scarleteen, or for adults, try PleasureMechanics.com.

The Internet has changed our world, for better and for worse.  We might as well accept it – our children or grandchildren may learn to use a screen before they can turn the pages of a book – if books still exist!   If you haven’t yet seen this video of a baby trying to “swipe” a magazine as though it were an Ipad, please enjoy this  short clip, A Magazine is an Ipod that Does Not Work.

The Challenge: How an Exercise Program Changed Me

by Chris S., a Psych Choices client

Doing Pull-upsExactly 51 days ago I decided that I would begin to work out again after about 2 months of barely exercising at all.  During those 2 months I felt a lack of motivation and a lack of a good reason to exercise.  After watching a motivating YouTube video from an exercise/lifestyle guru named Elliot Hulse, I decided I would get up and start again.  Specifically, I would exercise my core, starting the next day.  This decision turned out to be very important.

I received a Facebook message from my friend the next day letting me know he started something called The 30 Day Ab Challenge the day before and asked if I was interested in doing it with him.  The 30 Day Ab Challenge, from the website 30dayfitnesschallenges.com, was a bit of a sensation as millions of people were doing it (and probably still are).  Each day of the challenge details a set of ab workouts you’ll have to do that increase in quantity as the days pass.  Coincidentally (or perhaps not, depending on your view on this sort of thing), my friend also hadn’t worked out in about 2 months until he chose to start again the day before.  When he asked if I wanted to join him, I was hesitant, since I’d never been one to commit to any kind of exercise regimen, but I agreed.  Looking back, I doubt I would’ve said “yes” had I not made the decision the night before to start working out again.

I was unusually determined to do this challenge and really took it to heart.  I sat down on my bed and wrote out all the reasons I wanted to commit myself to doing it and what I was looking to gain in the end.  Some of the things I wanted to gain were: A sense of pride; character, knowing I continued to do something even when it got tough; a sense of accomplishment; satisfaction, knowing I put my potential to use (something I scarcely had done); and overall betterment from working my body.

Writing it all down proved to be very important.  I got the idea from Brian Tracy, author of Accelerated Learning Techniques.  In his audiobook, he speaks about how in writing our goals down, they become more assimilated into our consciousness than they would otherwise.  Creating a physical copy of what we want to achieve makes it feel more real to us.  I recall how I felt a bit scared as well as determined while writing it all down – scared because I had never done something like this before – I had never taken it upon myself to commit to something for 30 days with no external force pushing me along.  This whole process brought up excitement as well as nervousness as it indeed became more real to me.  I concentrated on every word I wrote and recited them to myself.  I then grabbed a bunch of flash cards and made a timeline.  I drew four segments on each side of every flashcard, signifying four days worth of workouts on each side.  Every day I would write down the workouts as I did them as a sign of progress.

Keeping track of my progress and affirming my goals in this way proved invaluable.  I know I would’ve faced many more problems had I not done that.  So every day I did however many workouts I needed to do, affirming beforehand that even when I didn’t feel like working out, I would anyway.  I’d say this attitude made up about 90% of what carried me through.

I began to realize as I continued that I was gaining even more from the challenge than what I’d initially planned.  The first thing I noticed was that it was a good way to initiate conversation and connect with people.  My everyday life became a little more social because of it, and because engaging in this kind of challenge gave me a bit more confidence, I found it easier to interact with people in general.

The next thing I realized was that I was no longer only doing it for myself.  My friend and I would give each other updates through Facebook as to how we were coming along, which was a great source of motivation.  I found about halfway through the challenge that I felt totally invested in him.  At that point, even though the workouts were getting more and more intense, I simply wasn’t going to stop, because to me that would mean letting him down.  It wasn’t even an option; I was going to finish it.  Additionally, I realized that I was inspiring my mother and sister to start workout out too.  This in turn motivated me even more to continue the challenge.

Physically I felt stronger as I was able to do more workouts more easily.  When it got difficult, I would sometimes look back to the first flash card I filled out and recall the first workout day.  I would feel surprised that I needed to take 3 breaks to get through the first set of sit-ups! Seeing the progress right in front of me felt good, like I was clearly getting somewhere.

I remember during the last 10 days of the challenge how I seemed to randomly feel energized as I took out the trash.  This was abnormal for me, as I’m assuming it would be for most people.  I was literally jogging back and forth to drag the trash cans to the front of the house.  Needless to say, consistent exercise made me feel more energized.  Perhaps what is even more interesting is that I also started to feel more mentally energized and more focused.  As they say, “A body in motion is a mind in motion.”

I got to the point where I would look forward to my workout days, and on my “Rest Days,” which were every other three days, I found myself actually wanting to work out.   I think a big reason for all of this was that I had something to look forward to.

As the challenge drew to an end, I knew I wanted to continue exercising.  I believe it was the yoga master Yogi Bhajan who said that doing something consistently for 40 days will rewire parts of the brain to adapt to the new behavior; 90 days will create a new habit; 120 days will confirm the new habit; and 1000 days will master the habit.  As I continued to work out, my new goal was to do it for 40 days.  Now 51 days in, my current goal is to get to 90 days to create a new habit.

As I’ve taken up this challenge I’ve learned many things and have changed in many ways.  I know now that my fear in the beginning was one that often came up for me, and still does sometimes, but at the time I wanted to challenge myself more than I wanted to run, and so I did it.

I must give much credit to my friend who presented me with the challenge.  Had he not offered it to me, I wouldn’t have done it and probably the majority of good things that have happened to me wouldn’t have, or at least not as quickly as they did.  Thinking back to even before that, I doubt that I would have taken him up on the challenge had I not made the decision the night before to start working out again.  I probably would’ve felt too intimidated and left it up to him had I not already made that conscious choice.  Decisions are powerful.

Feeling motivated is a great thing to feel, but it is secondary, as I’ve learned.  I’ve been seeing more and more that the most important thing to do to create a new positive habit, whatever it may be, is to do it even when you don’t want to.  That is about 90% of the challenge.  You don’t even have to do it 100% correctly; what matters is that you show up.  That is what builds character and that is what will propel you forward into accomplishing your goals.

As a final thought, I feel that goal achievement is great when done for reasons that will aid in our growth, but more importantly is to be able to utilize our potential.  I hope I helped someone by writing this.

Here are some references that have helped me along:

30DayFitnessChallenges.com

Elliot Hulse’s YouTube Channel

Accelerated Learning Techniques by Brian Tracy (Audiobook)

Miracles Now by Gabrielle Bernstein

The Jillian Michaels Show Podcast

Why People Gain Weight, and What To Do About It

Mature man with big belly struggling to put pants onIt’s well known that obesity is epidemic in this country.  Unfortunately, there doesn’t seem to be much agreement about its causes and cures.

While it might seem obvious that overeating causes overweight, a recent article in the New York Times (Always Hungry? Here’s Why) explains that one reason people overeat is because they are overweight.  Once you have excess fat cells, they start absorbing the calories you eat, leaving your bloodstream low on calories and continuing to crave more.

The authors, David Ludwig and Mark Friedman, explain what happens when fat cells store the extra calories.  The brain notices fewer calories in the bloodstream, so it tells the body to increase intake (so we feel hungry) and to save energy (so our metabolism slows down, burning calories more slowly).

Other causes of weight gain include stress, reduced physical activity (such as sitting at a computer all day), lack of sleep,  many medications including psychiatric and diabetes medicines, and genetic tendencies.

Additionally, being told you are fat (even by well-meaning parents) can actually make you gain weight.  A recent study, published in a medical journal for pediatricians (JAMA Pediatrics, “Weight Labeling and Obesity“), found  that if a child is told she is “too fat” by her family members, she is more likely to be obese by the age of 19 than is a child of similar weight who is not stigmatized by the “fat” label.

It’s pretty hard if not impossible to change these factors, so is there any hope at all for people who want to lose weight? Diet books and articles are everywhere, and many of them see m to contradict one another.  The authors of the New York Times article, Ludwig and  Friedman, who also published their findings in the Journal of the American Medical Association (“Increasing Adiposity: Consequence or Cause of Overeating?“), offer a few guiding principles.

They explain that weight gain is triggered by excess insulin, and that highly refined carbohydrates produce the most insulin.  So, they explain, it’s not true that all calories are equal.  It’s better to avoid certain kinds of calories: specifically, those from refined carbohydrates including sugar, flour, and white potatoes.

Whole grains, and certain starchy vegetables such as boiled sweet potatoes, are a better source of the carbohydrates we all crave and need as part of a balanced diet.  Surprisingly, whole wheat bread and brown rice may not be particularly lower in glycemic index (a measure of how quickly carbs are converted to glucose).  Instead, eat whole grains such as barley, millet, quinoa, wild rice, or cooked whole wheat berries.  Dr. Andrew Weil explains more about glycemic index in this article on his website.

It is likely that fat slows the absorption of the carbohydrates, which prevents a spike of insulin in the blood, leading to less of the glucose being stored in fat molecules.

Furthermore, fructose (from table sugar, honey, maple syrup, agave and high fructose corn syrup, among other sources), is even more toxic than other carbohydrates.  Fructose is metabolized down the same pathways as alcohol. Thus it, like alcohol, can cause fatty liver disease, and eventually cirrhosis of liver and liver failure.   You can hear a lecture by Dr. Robert Lustig on the dangers of sugar here.

Doctors and nutritionists all seem to agree that vegetables are good for you, especially fresh vegetables, and that protein is important, though there is room for disagreement about the value of animal proteins (meat and dairy).

And given a choice between a “low fat” product, which is likely to contain extra sugar to make up for the loss of flavor, and a full fat product with less sugar, choose the latter.  It may be that one more cause of the obesity epidemic is the spread of “low fat” processed foods over the past few decades.  Although no one advocates eating slabs of butter or deep fried foods to lose weight, we all do need some healthy fats in our diet.

It turns out that a higher fat, lower carb diet may help with weight loss.  Ludwig and Friedman point to another study showing that dieters burned about 325 more calories on a low carb diet than did others who followed a low fat diet, even though both diets involved eating the same number of calories per day.   They also cite animal research: a group of rats who were fed a diet of highly refined carbohydrates gained 71 percent more fat than did rats who ate less refined carbs – even though the  rats on the whole-grain diet consumed more calories overall.

In conclusion, what we eat is more important than how many calories we consume.   By adjusting what we eat rather than counting calories, we may be able to achieve more lasting weight loss and better health.