How can just talking possibly help?

In my office, you won't just be talking!  

You will be an active participant in setting goals and in learning to be your own therapist.  I enjoy listening to my clients, but I will also help you learn new skills that you'll be able to use for the rest of your life.  Depending on what you are dealing with, I may give you some worksheets or some exercises to try at home.  We'll figure out what works for you, and then you will practice those new skills.  

Some sample tools you might learn are: relaxation; assertive communication; analyzing your emotions and thoughts; thought stopping (for those persistent cyclical thoughts).  You'll learn about your diagnosis (if applicable) and you'll learn about what psychological science applies.  

It's important that you feel heard and supported throughout your therapy experience, but if I only listen to you and don't teach you any new skills, you run the risk of having to come right back to therapy the next time you encounter a challenge in life.  There's nothing wrong with coming back to therapy, but I would love to see you learn to coach yourself through the difficult patches.  If you decide to come back to see me later, you might learn a different set of skills, or you might want to bring your spouse to work together.  

And don't forget how important words are.  Leaving out even a single word can totally change the meaning of a sentence.  Think about the question, "Are you wearing that tonight?"  Now add a word: "Are you really wearing that tonight?"  It changes the tone of the conversation.  In the same way, changing the way you talk or think about something in your life can change your whole day.  You might go from thinking, "I can't do anything right," to "I made a mistake and I'll do it right next time." 

You can change the way that you're feeling using words, so talking about your feelings is pretty important.  But that's not all you'll be doing if you decide to work with me!  

Erin Kramer

Lying to your spouse: when and how to do it

Spoiler alert: Never.  

If you want to preserve your marriage, you must respect your spouse and trust that s/he wants a truthful answer to anything s/he asks.  The truth can be hurtful, but it is impossible for your marriage to grow and thrive in the midst of a lie.  You will live in fear that your spouse will discover the truth, and your spouse will be working under a false assumption, so any work you do to improve or even maintain the marriage will be done on a marriage that doesn't actually exist.  Later, you will have to try to convince your spouse that, even though there was a lie between you, all that other stuff that you said (I love you, we're happy together, you're the only one for me) was true.  

When you have to tell your spouse that you lied, you make him/her feel foolish, because you have been operating with a full set of facts and he/she has not had all the facts.  Your spouse has been fooled by you into believing something that you knew wasn't true, and this makes him/her feel gullible.  

Once the truth comes out (and yes, it will), the amount of trust lost in the relationship is proportional to the amount of time the secret has been kept.  As hard as it is to come clean now, it will be much harder later!  

There will never be "the right time" to tell someone something they don't want to hear.  It's best to avoid late at night, but other than that, the best time to tell your spouse the truth is right now. 

This should be distinguished from saying something hurtful to your spouse in order to cause pain, and then using the excuse that "it's just the truth."  An example of this would be the classic "does this dress make me look fat?"  You could say, "it's not your most flattering look", or "I really love the way you look in that other one."  You do not need to say, "Yes, that dress makes you look terrible."  You must not lie, but you don't need to say the first thing that comes into your head, either.  If your spouse continues to ask for a direct answer, you may have to answer yes, but there are ways to cushion the truth in compliments.  "I don't know if that's your color/style.  Maybe we could go shopping this weekend for something you'd love. You deserve something new!"  

The Gottman Institute research has found that for every one negative interaction between a couple, the couple must have five positive interactions in order to maintain a happy relationship.  5:1 seems like a pretty high ratio, particularly when a couple is going through a rough patch.  A positive interaction can be a simple compliment and a "thank you" response.  So if you are having to give your spouse a piece of bad news, keep this research in mind.  

 

Lisitsa, E. (2017, March 13). The Positive Perspective: More on the 5:1 Ratio. Retrieved September 22, 2017, from https://www.gottman.com/blog/the-positive-perspective-more-on-the-51-ratio/

IMG_20170601_084848.jpg

How can a counselor help if s/he hasn't been through the same thing I'm dealing with?

Sometimes I am asked how I can help a client if I haven't experienced the same thing.  This comes up because I'm 32, and so I haven't yet experienced all of what life holds.  I've never been through a divorce, I don't have any children, and I haven't been diagnosed with a terminal illness.  It can be easy to conclude that a counselor can't help you if s/he hasn't experienced the same things you have, perhaps citing the idea of walking a mile in someone else's shoes.  

This makes a lot of sense on the face of it.  Everyone seeking emotional health services wants to be heard and understood.  However, most of life's unique experiences elicit, more or less, the same set of emotions.  A divorce is a unique experience, but it elicits grief, anger, and other emotions with which your counselor is already familiar.  Parenting is a unique skill, but it relies on a solid sense of self and on learning to love well and wisely.  Medical issues are again unique, but they often are accompanied by helplessness, fear, anger, and sorrow; these emotions are not unique.  

The treatment modalities used at Sweetwater Counseling are designed to work in different ways for different problems.  Your clinician will work with you on formulating goals for your treatment that are specific to you and your situation.  The methods we use have been tested on people dealing with a wide variety of problems, so even though I haven't experienced Post-traumatic Stress, I have researched the treatments that work best for it.  My colleague and I are always learning more so that we can help you with things we have faced ourselves, and things we haven't faced yet.  

Of course, there are specializations that might be appropriate to seek.  For example, since I have never parented, I refer clients who have parenting questions to my colleague who specializes in early childhood development and is a parent.  Drug and alcohol addiction is a field in which I am only minimally trained, and I refer those clients to a specialist.  To find out if Sweetwater's services are right for you, give us a call.  

You may also want to seek a therapist who has a similar demographic to you if you are specifically interested in working on issues related to your background.  For example, some women prefer to see a female clinician to deal with issues related to gender socialization or sexual assault.  Some people prefer a clinician who shares their racial background if they want to talk about issues of racism or discrimination.  Your therapist wants you to feel comfortable, so s/he can help you find a referral if you feel, after the initial appointment, that you are not a good fit.  

The above is for informational purposes only.  Please consult your therapist for advice.  

Help! My friend is depressed!

It can be so scary to hear your friend say s/he is experiencing depression or anxiety.  It's hard to know how to help while still respecting his/her privacy.  You may not know if suicidal thoughts are an issue.  Since most people will face some form of emotional illness at some point in life, you undoubtedly know people who are struggling right now.  One of the worst parts of mental illness is the way that it isolates its victims from help - a depressed person feels that s/he doesn't deserve or shouldn't need help; an anxious person is too afraid to leave to house to get the help s/he needs.  

How can you help a friend in trouble?  While not an exhaustive list, this will give you a few ideas.  

  • If your friend expresses that s/he wants to commit suicide, get immediate help.  You can go to an emergency room or call a crisis hotline.  In the US, call 1-800-273-8255 (TALK).  If your friend refuses to get help immediately, you can call the police and ask them to perform a wellness check.  They will go to the person's home and check on him/her and may take him/her to get additional help at the emergency room or at an inpatient mental health facility.  
  • Encourage your friend to get help.  You are not responsible for your friend's behavior, and s/he may refuse to seek counseling.  In this case, do not try to be your her/his therapist.  Listen to what s/he has to say, but feel free to continue to encourage your friend to see a qualified professional.  
  • Do not try to "cheer her up" by reminding her that things will look better tomorrow, or that she has always been such a happy person, or that she is wrong about her feelings. In doing so, you make her feel like it's wrong for her to feel the way she does.  You can, however, try to cheer him/her up by taking him/her out to do something fun or stay in and have fun.  
  • If you believe in a higher power, use spirituality to help.  Pray for/with your friend.  
  • Don't shy away from this topic with him/her.  It can be intimidating, but all you need to ask is, "how are you feeling?"  
  • Keep your friend close.  S/he may want to avoid social opportunities, but it's important that you keep inviting him/her to events and that you keep after him/her to join you.  S/he may not be the soul of joy right now, but s/he needs to get out.  
  • Keep an eye on your own mood.  Caretakers often forget that they can easily slide into depression themselves.  If you are spending significant time helping a friend or family member, you may need to see a counselor yourself for a few sessions to help you deal with this stress.  Sweetwater Counseling has experience with caretaker stress.  Call or email to talk about this..  
The above is for informational purposes only.  Consult your mental health professional for help.

How can I find trustworthy friends?

Most of us have had a range of friend experiences.  There's the loyal best friend, who's available at any time to laugh or cry with you.  The occasional acquaintance, who you see in the same social circle but don't know very well.  There's the high school friend who remembers your embarrassing moments as well as your triumphs.  And then most of us have had an experience with the bad friend.  

This could be an experience of betrayal, or one of simply being used up.  It could be as simple as having betrayed a secret, or maybe as complex as turning other friends against you.  These experiences can be extremely painful and can ruin relationships.  

So how do we tell which friends are worth trusting?  Is there a way to know before you work on a relationship?

Sort of.  Naturally, there's no foolproof formula for this.  However, there are certainly some warning signs for those people who are truly toxic.  

  • Look for a person who has other friends.  If he/she has no other friends, there is probably a reason.  This isn't to say that you can't befriend him/her; some people are just shy.  But if the person has no other social life, then you will be the person he/she leans on for everything.  Consider the idea that this person may have alienated his/her other friends.  Even if s/he is very close with family, s/he should have friends, too.  
  • Watch out for a string of unstable or broken relationships in the person's past.  Everyone has a few broken relationships, but your potential friends should not have very many.  It's rare that one needs to truly cut another person out of one's life.  A pattern of short-lived volatile friendships or romantic relationships is not a good sign.  
  • How do you feel after you've been with this person?  Are you energized and happy, or do you feel drained or angry?  Overall, you should feel good about spending time with a potential friend.  You should feel that you have gotten some of your social needs met.  Introvert or extrovert, everyone has some social needs, and your time with a friend should make you feel confident and cared for.  Of course, sometimes you will spend time listening to a friend who is going through a rough time, and this may cause you to feel sadness along with your friend.  
  • Are you compromising your own needs or boundaries for your friend?  Is your friend regularly calling in the middle of the night, or doing something you've asked him/her not to do?  Do you find that you get sucked into doing favors for this person when you don't want to?  A good friend will respect you and your feelings.  S/he won't ask for something that you can't give, or that would take you away from other friends and family.  
  • Is your friend jealous?  Is s/he angry when you spend time with other friends or with your spouse?  A good friend will want you to grow and to have a healthy social and family life.  
  • How much of the time is about you?  50% of time spent with your friend should be spent talking about things that you want to talk about, or doing activities you like.  If you're always doing what the other person wants to do, you can try asking your friend to alternate who talks or who decides on an activity.  A good friend will understand and will be happy to go 50/50 on this.  
Your cat doesn't count as a friend because technically you belong to him/her and therefore it's not an equal relationship

Your cat doesn't count as a friend because technically you belong to him/her and therefore it's not an equal relationship

Which kind of psychology professional do I need?

The field of psychology is broad and encompasses many different kinds of professionals with many different degrees.  This post will help you think about your needs and whether Sweetwater Counseling is the right choice for you.  These guidelines apply for Pennsylvania.  

  • Psychiatrist: This person has a medical degree and can prescribe medications.  S/he will get an idea of your symptoms and will work with you to try to find a medication-based solution.  S/he will usually also recommend that you work with a therapist or counselor weekly in order to find behavioral and environmental solutions.  You will probably see your psychiatrist about once a month until you find out what prescriptions work for you.  Your psychiatrist may also do some talk therapy with you, but this is rarer.  S/he may recommend some medical testing to find possible causes of your symptoms.  
  • Psychologist: This person has either a doctoral degree in a psychological field (can be anything from Christian Counseling to a Ph.D. in psychology) or was grandfathered in under a previous licensing system and has a Master's Degree in a psychological field.  S/he will use counseling techniques to help you talk about your symptoms and to guide you toward finding solutions.  
  • Counselor: This person has a Master's Degree in a psychological field.  This can be a social work degree, counseling ministries degree, or clinical psychology degree.  S/he will help you to meet your goals using non-pharmaceutical methods.  These can range from traditional talk therapy to solution-focused or art therapy and many things in between.  Can work with families, couples, and individuals.  
  • Marriage and Family Therapist: This person has a Master's Degree in a psychological field, and will use similar techniques to a counselor.  Can work with families, couples, and individuals.  
  • Coach: This field is not as strictly regulated in the state of Pennsylvania.  A coach tends to work for a specified time period to achieve personal and professional goals, and focuses on those goals rather than emotions.  

 

It is very important that you check the kind of degree that your clinician has.  Many people have degrees in social services and counseling fields, but they are not all able to provide the same level of care, and their focus may be different from yours.  It's not enough to determine what level of degree it is, you need to find out what the degree is in.  

  • Clinical Psychology: This course of study encompasses a whole-person paradigm of psychological health.  A degree in this area means that the holder has studied biological, cultural, environmental, and family bases for health and illness.  S/he has studied child and adolescent development, personality psychology, social psychology, family and marital therapy, and counseling skills.  S/he is able to review and understand current scientific research.  S/he will be familiar with many different methods of dealing with anything from life transitions to depression and anxiety.  Depending on the bestowing institution, a faith focus may be included.  Sweetwater Counseling clinicians all have Clinical Psychology degrees.  
  • Counseling: This course of study deals more with counseling skills.  This person will be familiar with several methods of counseling directed at different kinds of illness or life transition.  S/he will often have an empathic focus.  This degree is similar to one in Christian Counseling.  
  • Counseling Ministries/Pastoral Counseling: This degree focuses on a religious framework of counseling.  This person has worked on the integration of counseling skills with relgion, and has studied the field of psychology primarily from a religious perspective rather than a biological one.  These degrees often focus more on using Biblical wisdom as a method to counsel.  
  • Biblical Counseling: This degree is not a psychology degree, but a religious one.  A Biblical counselor will help you apply the wisdom of the Bible to your daily struggles, and can help with spiritual direction.  
  • Social Work: This degree focuses on the cultural and social aspects of problems in living.  This person can often help with family issues and is a good choice for someone who is looking for help navigating possible services available.  S/he is very knowledgable about charitable organizations and govermental services that might be a fit for your needs, and can help you interface with these organizations.  S/he has studied cultural variables that might cause your trouble.  
My plush neuron, Oliver (named for Oliver Sachs)

My plush neuron, Oliver (named for Oliver Sachs)

Your first steps toward preventative care (and a use of the phrase "fixin' to")

The first thing to address when thinking about a healthy mind has to be the biological brain-as-blob-of-meat issue.  Wait, don't skip this one!

It may seem like you've already heard about how it's important to keep your body healthy.  And it is.  But not just for the nebulous goal of "health and long life".  It's impossible for your brain to function at its peak if your body is poorly maintained.  You can actually contract mental illness just by failing to take care of your body (Moy 2009).  And not just dementia or anorexia nervosa. 

If you're concerned about maintaining your mental health, or if you've struggled with depression or anxiety and you worried that you might relapse, you can't afford to dismiss your physical health.  I'll talk more about what that exactly means.  Yes, I actually talk to myself to help me write.  Shut up, it works. 

This makes sense, if you think about it.  Your brain is an organ, so just like your heart or lungs, it's affected by obesity, high cholesterol, thyroid problems, vitamin and mineral deficiency, and myriad other conditions.  The brain is powered by nutrients in the blood, which come from everything you consume, like food, beverage, drugs, air particles, and chemicals.  If you don't take care of the brain's needs for nutrients and oxygen, it can't possibly serve you properly.  It would be like giving a race horse nothing but corn husks and dirt and then wondering why he doesn't keep up with his peers.  Your brain only gets what you decide to give it.  You have to actively choose to give it the best you can, and your brain will serve you well for years to come. 

I'm fixing to (my mom is from Oklahoma, where that phrase is common) give you some ideas on this in later posts.  The main one I want to emphasize for now is regular check-ups with your doctor.  And while I'm at it, nothing on this blog should be considered as medical advice, because I'm not a doctor and I don't want to get sued.  And I don't have anything worth suing over, except my wonderful family. 

But you should go see your actual doctor.  He/she can do all kinds of helpful things, like checking your blood pressure and BMI, monitoring your prescriptions, answering questions about any symptoms you have (you want to get that rash looked at), and telling you about other tests you should have regularly, like mammograms, prostate screening, and PAP tests.  Although these things don't seem directly linked to your mental health, they absolutely are.  That fatigue you're feeling could be a blood chemistry problem, and the anxiety might be caused by excessive caffeine or sugar.  You could get the mental health symptoms taken care of as easily as a single doctor visit.  So call your PCP (primary care physician, not angel dust.  More about drug use later)! 

Moy, M. L. et al. Multivariate models of determinants of health-related quality of life in severe chronic obstructive pulmonary disease. The Journal of Rehabilitation Research and Development, Vol. 46, 2009, pp. 643-54

IMG_20170914_142543_660.jpg

What's with the Latin?

Sometimes, when my colleagues and I are in a particularly expansive and idealistic frame of mind, usually aided by some Malbec and a dangerous feeling of daring to stay awake far later than bedtime, we fantasize about a world in which psychological health is broached in the same was as physical health.

Sort of like this - income disparities aside, many of my readers take basic daily actions to care for their bodies and those of their family members. You might make sure to really really try to get eight hours of sleep, or at least insist that your teenager does. You scrub your body free of bacteria and you keep your hands and face especially clean to prevent infection. You brush your teeth, so that when you're older, you still have teeth to brush. You probably give some thought to the nutrition of your breakfast food, at least when you're buying it in the store (you know, when you thought about buying the packet of plain oatmeal and somehow ended up home with Frosted Flakes®).

So by the time you get to starting your day, you've performed several actions that are designed to provide health and long life. Don't forget about your annual doctor visit, your trips to the eye doctor, dentist, GYN, and any specialists you see. These are all just for you – you're also probably taking care of your family's health as well! Those of we with pets even take them to the vet every year.

Now ask yourself this: what was the last thing you did for your brain's health? Did you throw one of those fish oil supplements at it, work half the newspaper crossword two weeks ago and then hope for the best? If so, you're a little bit ahead of the curve.
See, psychological health plays more like emergency care for most people. You're arguing constantly with your teenage daughter, and just about the time you think you will lose your sanity if she slams that door one more time...

you find a therapist in your insurance network, see him/her for ten sessions until the crisis passes, and then you head back to your normal life.

What if it didn't need to be this way? Can you imagine, like my wine-soaked peers, how we might do life differently if we kept tabs, even passively, on our brain health? Even better, are there some simple things that could actually help prevent those crisis situations, so that instead of needing to see a counselor right the hell now, we could be aware of a problem building and defuse it?

I'm so glad you asked.

Insanity Wolf!

Insanity Wolf!