Getting to the Root of Addiction: An Integrated Approach

When I started my practice Integrated Treatment Solutions in 2009, I did so out of professional conviction. My experience working in a variety of healthcare and drug and alcohol treatment settings led me to rethink my approach as a behavioral health professional. I could no longer only treat symptoms at the expense of being complete and addressing underlying issues. I realized that I was at a critical choice point and that working within a traditional clinical framework was preventing many clients from getting help – That was not going to work for me. I wanted to collaborate with clients in the exploration of their problems and see what made sense for them in their respective recoveries.

These are some things about addiction and recovery that I have learned along the way and implement in my daily practice as an addictions specialist and behavior therapist…

Understanding addiction and moving into recovery is a process, not an event. Addiction recovery takes willingness, honesty, openness and time. Recovery is not linear. In fact, it can vary person to person.

The decision about one's relationship with substances is personal. Individuals use substances and engage in addictive behaviors for different reasons – Essentially, all behavior is purposeful. As human beings, we are always trying to accomplish something. Each person has his or her perspective and goals concerning their use, lifestyle and level of wellness desired.

As a co-occurring disorders specialist (previously referred to as dual diagnosis – addiction and mental health together) I counsel and treat clients presenting "clinical complexity." Many have been trying to gain clarity about their conditions and make progress for many years having been through many courses of treatment but continue to struggle with relapse or are "white knuckling" it through tough symptoms. Despite previous attempts at recovery and disappointments incurred along the way, they have stepped up again! I applaud their courage and determination.

I also believe that there is hope. Even after several attempts have been made.

It has become apparent to me that there are no failed clients only failed treatment. While addiction, depression, bipolar disorder, etc. tend to be fairly standard in their presentations, each person affected is different within the issue at hand. Each brings unique strengths, vulnerabilities and life experiences which need to be taken into account when planning treatment.

Treatment must be tailored to the individual – always.

People want to get well – not only sober. To feel at home in their bodies and positive about themselves, others and their relationships - To be able to trust themselves – their thinking, abilities and choices.

Many clients who approach treatment with me had been sober before – for long periods of time and yet continued to be in physical and or emotional pain. Many have made attempts at sobriety in traditional drug and alcohol rehabs and attended daily Alcohol Anonymous (AA) or Narcotics Anonymous (NA) meetings – Worked with a sponsor through the 12 Steps of AA or NA.

Symptoms from chronic pain, mood disorder, trauma, attention deficit (ADD) or chronic physical conditions/ diseases involving the autoimmune system, or unresolved post-surgical complications can surface when the person stops using substances - "breakthrough" symptoms can result in powerful triggers fueling drinking and drug use again. Inflexible personality traits or personality disorders can also serve as barriers to effective therapy and treatment. Trying to manage what is not known or understood is confusing and painful for people.

Unfortunately, situations presenting this level of complexity are not uncommon. There are often multiple problems occurring at the same time, playing off one another. The idea that addiction is a singular issue is often a false construct – An incomplete, inaccurate or an ill-founded psychological concept.

Addiction often travels with other issues – It is critical that all of the problem issues are identified, understood and addressed in order to move towards stabilization and recovery. Expecting a person to reduce their drinking or substance use or to completely abstain (depending on risk) is not realistic without a comprehensive and holistic approach offering precise diagnosis and a personalized plan.

No problem is about "one thing and one thing only."

 

Clients need and have the right to know exactly what the issues are and to be educated about them. Identification of the issues and a conversation about them needs to happen even if it means talking about conditions like borderline personality disorder (BPD), narcissistic personality disorder, Asperger's or anything that is tough to accept.

If difficult issues are NOT talked about, they will sabotage treatment and leave clients confused and defeated yet again, resulting in an increased sense of hopelessness and helplessness. When people are not informed they are deprived of the opportunity to move through their own process of "self-diagnosis", which means "Do I agree with this?" and "What does this mean to me?"

Knowledge is power.

 

Engagement and commit to change can only happen when clients are clear about what they are dealing with and have a sense of what to expect moving forward.

Effective treatment starts with a thorough bio- psychosocial assessment to obtain information about the major physical (bio), psychological, and social issues. A holistic approach posits that separate issues are often related. - No stone is left unturned in the interest of getting the "bigger picture" of what is going on.

Assumptions are dangerous.  Illnesses presented as being "treated" such as autoimmune disease, diabetes, depression or conditions that tend to be minimized like, Lyme disease, premenstrual dysphoric disorder (PMDD), or sleep problems can fuel addiction and its ‘problem behavior. Medical treatments often need to be reevaluated to determine if they continue to be effective.

People are not always consistent with or misuse medications. Many do not have a trusted primary care physician. There are oversights and misunderstandings that can happen which have the impact on any health problem.

So, the solution to the problem is only as good as it's' conceptualization. To be inaccurate or incomplete is time, energy and resource draining.

An integrative approach to addictions treatment and its' co-occurring disorders is collaborative, thorough, health and well- being oriented – Not just about "one thing" or symptom oriented.

Treatment for Drug and Alcohol Addiction - Rehabilitation or Habilitation?

Many years ago, when I was working as an Addictions Therapist in an Intensive Outpatient Program someone said something in a group setting that was quite insightful and ingenious as it related to treatment and recovery - “I have been in and out of treatment and have been in treatment in several inpatient and outpatient programs and just now seeing that I don’t know how to live and I am terrified!” This person went on to say that it often assumed that just because people are grown-ups, that they do not always have the skills to live effectively - That somehow the drugs or alcohol curtailed functioning and the goal was to restore it. But, as he said , “When I try to remember how to live, there is not anything to recall. It is not that I am ignorant, but I never learned anything about how to manage myself and my life in a way that worked for me! Addicted people are not in need of rehab but we often need habbing! In a way, addiction fills a gap and it is my way of coping in the world. Sometimes I am aware that I am digging my heels into the ground, because I don’t know how to move forward and I’m scared.”

It is often assumed that adults know how to do things and are skilled enough to be effective in life and that somehow it was lost along the way and needs to be rehabbed to get that knowledge and skills back. This is not always the case. As a Behavior Therapist and Addictions Specialist, I am aware that despite my clients success in other areas of their lives that they are are starting form scratch in some fundamental areas. knowledge and skills are being taught and learned for the first time or in such a way that they as recovering people (can be applied to recoveries from addiction, depression, chronic pain, etc.) can learn and integrate new material in order to apply it to their lives in an effective manner. This, in turn, reduces stress and confusion, while building more productive coping skills and ultimately makes way for eradicating relapse behavior. It may seem too basic, but not any less important. Sometimes the obvious is easily overlooked; we judge what we think we ought to know. However, life requires a lot of teaching and learning – since managing ourselves, relating to others, organizing, and problem-solving are not necessarily skills that are totally inborn. We learn them.

I think of the man who shared his insight about needing habilitation at times and his complete honesty and candor. He was able to get beyond the human ego and self-examine in such an open way. He also made a lasting impression on others and gave permission to be human and to accept imperfection and the need to learn. He also reminded me to be aware of the danger of assumptions and how they can negatively impact the delivery of quality treatment that is appropriately tailored to the individual.

Hence, rehabilitationis a process of rebuilding and taking a foundation and restoring it. Conversely, habilitation is development from the ground up – the putting into place for the first time. Although adults have life experience and points of strength – perhaps successful in business, popular with friends, a strong athlete – they may have significant skill gaps or other issues, medical or otherwise, which they have been subconsciously trying to compensate for or work around. This impacts the ability to manage themselves and their thoughts, emotions and behavior which negatively impact one’s ability to function and be effective in life.

Hence, although there is a strong genetic component, addictive behavior can be utilized as a coping strategy, although not a healthy one. Repeated use of substances can become habituated behavior and ultimately grow into an entrenched and highly destructive disease that when not treated gets worse and become terminal.  Comprehensive and effective treatment matters.

Next week we will talk about what makes for Successful Drug and Alcohol Treatment with focus on assessment and choice of treatment with emphasis on dual diagnosis/ co-occurring disorders.

Building Cooperation – The Importance of Taking Turns

Early on in life our parents, teachers and other family members teach us the importance of “taking turns” – an important lesson because it’s learning the value of patience and courtesy. Knowing how to take turns becomes even more important as we move forward in life as adults, as we build relationships and alliances with others that we need in order to sustain. But adult “reason” can get in the way of this – making some people, events, and things more important or convenient. This can be hurtful.

As adults we are more apt to apply judgment as to why some things are more important than others.  We can slight people without knowing because our reasons seem just, so it is easy to assume they should be accepted by others. When we do this, we block other people from having experiences that they need to feel valuable and “part of.” We also block people from truly being known and appreciated outside of the roles that we tend to put them in.

A couple of types of situations  come to mind.  One is the position of “mother.”  I have many clients in my West Chester and Chestnut Hill, Philadelphia, PA based counseling practice who are mothers. Their lives are busy with raising children and taking care of their families. They are the nurturers and always aiming to make things better for the people they love. Through their commitment to their families they often sacrifice of themselves.  Over the course of years as children grow older and grow up mothers can continue to be viewed as the “givers” and not receive as much.  Mothers may not be asked questions about themselves – How they are doing; what is going on in their lives, opinions, and thoughts, etc.. It is easy to overlook that “mother” is also a woman, friend, sister, professional, essentially a person with needs, wants and dreams of her own.

Imbalances can happen with friends, too.  For instance, in a friendship between two young women one can be the talker, entertainer, and center of attention while the other can be quieter and go with the flow, but seems to be the “supporter’ or audience for the other. Over the course of years this imbalance can take its’ toll.  Perhaps the “go with the flow” friend, realizes that she is no longer amused with her entertaining – high energy friend who seems to dominate conversations and require constant attention.  She decides to move on in search of more equitable companions.
There is a time to turn the table and start giving back – Striking balance. This is important in all types of relationships, including friendships, coworkers, spouses, and siblings.

As much as we might not want to take turns and do what we feel is wanted or suits us, taking turns is necessary to relationships. At times we must let go of what we want for the greater good of relationship and of the other person. People can get stuck in roles within families, couples, friendships, workplaces and communities and not have enough room to be more of who they really are.  Often, when people are stuck in roles they may either clamor or become withdrawn.  Sometimes people do not know what is going on inside of them, but something seems off and there is dissatisfaction and conflict.  Roles prevent people from growing – and, we are designed to grow. One cannot have a relationship with a “role” only with a person.

Stepping back and looking at your most important relationships, what do you see? How are you with taking turns? Is there someone or some people in your life with whom you could have a better relationship?

We invite you to explore your relationship skills. Are they working for you? Is there room for improvement? Do you have a friend or family member who might need a refresher?

Improving Relationships Through the Power of Validation

Human emotions are complex. They are also unique to each and every person. This means that each person experiences emotions differently.  If a group of five people who were sad were asked to describe their experience of sadness, we would more than likely get five different responses. Why?  Because emotions are private experiences.  Emotions are part of a complex tapestry including human temperament, life experiences, relationships, and perceptions. No two people are completely alike.

In my counseling and therapy practice in Chestnut Hill, Philadelphia and West Chester, Pennsylvania my clients tell me about their feelings and emotions and how they were responded to by the people in their lives. Since I work with issue involving, addiction, codependency, depression, chronic pain, etc., learning self- care and self- advocacy is of primary focus.  In order to build these important skills one needs to learn how validate themselves. This is harder than one might imagine, especially if the person has been exposed or is living in an invalidating environment.

So, what is validation?  Validation is to recognize and accept another person’s thoughts and feelings, regardless of whether or not you feel that they should be experiencing them. Validation helps us to develop a sense of self-worth. People who are validated feel reassured that they will be accepted and loved regardless of their feelings, while those who are not validated are more vulnerable to emotional and behavioral problems and relational difficulties.

We can validate another person by paying attention and reflecting back what we heard them share with us, asking questions, and identifying with them. This helps all of us feel “part of” and less alone. We can easily overlook the fact that ignoring others or neglecting to acknowledge them is indeed invalidation.  This is why childhood neglect is considered abuse.

Here are a few everyday ways of validating one another. These can be built into how we communicate over the course of time and help improve relationships.

• Listen with empathy and genuine concern, being careful to stay in the moment. Display interest and engagement through verbally and non-verbally: Nod and maintain eye contact, and use verbal replies such as “Yes" and "I understand."
• Be responsive by reflecting back what the other person has shared. For example, “It sounds like you were very hurt that your friend didn't call you back." Check for accuracy by asking "Is that right?"
• Observe and articulate the individual’s unspoken feelings and emotions, based on what he or she says as well as nonverbal cues. Ask if your observations are accurate. For example, “So you are frustrated when your friend does not communicate directly with you about plans - That when she doesn't call by a certain time that it means that she cannot follow through.  You cannot accept that way of interacting.  Is that correct?”
• Communicate that you are aware of the "bigger picture" of the person's feeling or emotion.  Acknowledge that his or her current emotions are understandable within the context of his or her past experiences and/or present circumstances. For example, “Considering that you grew up in an alcoholic home with little stability, it is understandable that you would feel anxiety when cancels plans with you and  things are uncertain.”

We can validate one another quite readily if we pay attention and seek out opportunities to do so. Validation strengthens relationships, communities and reduces conflict.

What is your experience with validation?

The Importance of Receiving Graciously

Not long ago, I was privy to a conversation between two women who met up with one another at a professional event in Philadelphia, PA.  It was apparent that they had not seen one another for a long time as they hugged and expressed excitement about running into each other.  One woman commented to the other on how healthy and happy she looked, saying “You look really great! And that dress is lovely.” The other woman replied, “Actually, I gained so much weight…and, this dress?  It was a bargain at TJ Maxx…$10.00.  Can you believe that?” The woman who gave the compliment stepped back and was quiet. There was an awkward pause between them. Where does one go after that?

Most of us were taught to say “Thank you” when receiving a compliment. However, debunking a compliment or acknowledgement can come about quite naturally – Out of habit. One might feel uncomfortable with the attention, not want to appear selfish  or feel self-conscious when noticed and in turn think it is okay to  not take the compliment.  It can, however, present a problem for the “giver” of the compliment. Rejecting the compliment actually discounts the observations and intentions of the giver.  It says, “You are wrong. I don’t want your compliment. I am not open to you.  I don’t like myself.” It is a block to connection and relating. Rejecting an acknowledgement such as a compliment or act of kindness can be experienced as very invalidating by the other person.

So many acts of kindness are rejected in this manner – Whether it is an invitation to lunch, holding the door for someone, not allowing a birthday gift to be given…There are so many examples both large and small of heart centered generosity gone awry.

Deep down inside, each one of us wants to receive. I hear what people want everyday in my counseling practice in Chestnut Hill and West Chester, PA. That is just human nature. “Give and take” is built into our primal template of survival skills. We give in order to belong and to build cooperative relationships with others as well as to plant the seeds for being able to take later when we need to. Without the dynamic of give-and-take, civilizations would crumble and cease to exist. Give and take is a necessity. Giving and receiving has a deeper meaning and is more intentional rather than transactional. Receiving is about connecting.

Receiving is different than “taking” in that it involves being aware of the giver, what is being given, as well as the intentions of the giver. It requires being able to receive and truly say “Thank you” and take in the emotions that come along with generosity, such as gratitude, happiness and, at times, awkwardness. Receiving with accountability builds true relationships – allowing for vulnerability and intimacy.

Many of the worlds religions emphasize  “One must receive for the sake of giving.” If no one chooses to receive or cannot receive graciously, then no one can give nor can be acknowledged or known. It diminishes the possibility of the wholehearted connection which we claim to want the most.

How are your receiving skills?

Improving Relationships through Listening

Have you ever been talking with someone and, before you can even finish your sentence, they interrupt to share their own thought or finish yours? Or perhaps you are in the middle of making an important point and their attention is pulled away as they check their ringing cell phone, send an email, or reply to a text message. We’ve all watched someone we are talking to nod and even mutter “uh huh” – knowing they didn’t really hear a word we just said.

People notice and can feel when others are not paying attention. These are conversations that leave people feeling unheard and unimportant, and they happen to all of us. In fact, most of us are guilty on a regular basis of listening to others in this same way. Listening with all of our attention is a discipline that needs to be practiced. It is also a skill that pays big dividends in both personal relationships and business endeavors. After all, every part of life is about relating.

In short, how does one develop or hone the skill of listening? Here are a few points to bare in mind in becoming a more skilled listener:

• Giving the other person your undivided attention. This may included putting your cell phone away, closing your laptop, stepping away from the crowd, turning off the television, music etc. and tuning in to the person with eye contact.  Removing barriers to being present helps with focus.

• Stay focused.  We are conditioned to drift.  There are often many things competing for our attention. Focus is a skill to be built – It is not automatically “there.” When talking with another person be mindful of the thoughts and inner and outer distractions that can negatively impact connecting.  When distracted gently pull your attention back to the person talking – Even if you need to do it over and over again.

• Being aware of the impact of judgment. Defending one’s self  from what is not wanted to be heard or felt or blocks our ability to listen and attend to the relationship. This includes blaming the other person or situation when uncomfortable or distressed- projecting unwanted feeling onto others. Part of this is the experience of how we believe others see us.  When self perception is distorted a person can become distracted and emotionally deregulated.  Working with human judgment and learning to appraise ourselves and others accurately allows for more connection and compatibility.

• Maintain open body language. Body language is non verbal and actually that more significant part of communication than what is verbal. Non- verbal being roughly 55-65% of communication. Remember words and actions need to line up – This is often considered “Walking the talk.” Alignment of verbal and non-verbal communication fosters connection and trust with others. Make sure you are open and receptive – No crossed arms, furrowed brow, abrupt movement, eye rolling – darting or similar behaviors.

When we become skilled listeners, we provide people around us with a gift that they have rarely been given in their lifetime. For when we truly listen we take others in, learn about them, and acknowledge that they exist. When we listen we also learn more and allow ourselves to truly know others and to challenge our assumptions. Listening facilitates change.

Do you tend to hear people or really listen?

Quote: “Since in order to speak, one must first listen, learn to speak by listening.”  

 ~Rumi

Improving Relationships: Skills that Work

As a licensed therapist, coach and addictions specialist I counsel and treat clients with some pretty serious conditions, including, alcoholism, sexual compulsivity, road rage, bi polar disorder, and personality disorders, such as borderline personality disorder and narcissism. Much of the time these issues (and others) may be occurring at the same time and make for immense complexity.

However,  over the many years of practice, I continue to find it curious that despite the crisis, physical and emotional challenges and other problems at hand, that the conversation always comes back to relationships, communication and the development of connection and intimacy. Even in the face of chronic pain, depression and job loss the underlying concern is  often “I don’t think my spouse loves me” or “I am afraid of being left behind” or something similar.

The number one reason why people seek counseling is related to their relationships. Whether it’s due to an intimate couples’ problem, social isolation, family or work related conflict; relational concerns always take precedence – even over finances. It doesn’t matter what the presenting concern seems to be – addiction, eating disorder, pain, depression, etc. – at the end of the day the conversation comes back to connection, love, and belonging. These are not lofty needs or desires, but are necessary for our health, well-being, and survival. But, in today’s world of technology, pressed schedules, increased consumerism, family difficulties and economic pressures, the simple things that have served as the foundation for human health and happiness have been strained and minimized. It’s no wonder chronic disease is on the rise with 25% of American facing such challenges.

Many years ago an author by the name of Robert Fulghum wrote a book All I Really Need to Know I Learned in Kindergarten http://www.peace.ca/kindergarten.htm. In his own simple and elegant manner the author provided practical guidelines for successful living and loving through looking back on what is taught to children in kindergarten, as they learn to take care of themselves and socialize with one another – The importance of respect. Sounds simple, right? However, sometimes the simplest of things are not so easy. What happens when those basics either get lost or are not learned? These relational deficits leave a large gap in one’s ability to relate and have needs met, leading to immense dissatisfaction and suffering – For everyone.

This next grouping of blog postings is focused on getting back to the basics of relating effectively with others; highlighting the importance of our ability to listen, understand, and to develop collaboration and cooperation in order to construct safe, balanced relationship dynamics that are healthy and satisfying.

As you read the blog, you may wish to ask yourself how you rate in these areas and or how others around you rate. Through increasing your skills it becomes easier to discern what healthy relating looks like and how it feels verses poor relational fit.  You will also learn how to build a healthy and satisfying network of supportive relationships in your life in order to feel more balanced, connected and competent.

We hope you find this information useful and encourage you to forward the blog onto a family member or a friend.

Strategies to Increase Energy and Stabilize Mood

Keeping a pulse on our stress level is always a wise idea. Many of us don’t really know our baseline stress level; therefore we don’t really know where we are and what is manageable for us so we keep doing more. For example, all of a sudden we can find ourselves triggered into anger by an erratic driver on the road and wonder how we went flew off the handle. This is what often happens when stress piles up. We become reactive and, at times, out of control. We can decline quickly.

Many stresses cannot be avoided altogether, but we can support our bodies in being more resilient, as well as reorganize some of our routines to minimize mood and energy problems. To help our bodies, it is important to:

-          Get adequate sleep each night. During seasonal change, more sleep is often needed to sustain the shift. Adding an extra half an hour can be of benefit to you.

-          Decrease sugar and carbohydrate intake. When mood declines you may notice increased food cravings, especially for sweets and carbs as the body is looking for that spike in energy. Focus on eating a balanced diet, including fruits and vegetables.

-          Move your body. Make sure that you are getting some physical exercise daily; a walk, time at the gym, working outside.

-          Take your supplements, including probiotic, Vitamins B, C, D, and fish oil.

-          Attend meditation, yoga, or tai chi classes – especially if you are anxiety-prone or get overwhelmed easily.

 

Creative thinking is important in learning to help you and may lead to stress-reducing methods, such as delegating work or deleting less important items from your to-do lists. Then you can look for ways to improve your coping ability, such as learning a new, useful skill or spending more time unwinding each day.

Cognitive therapy or skills-based counseling can be helpful in learning how to control the mind and work through thoughts that fuel depression and drain energy. But, working with the mind and body together is necessary in improving or resolving mood issues. After all, the mind and body dwell in the same organism.

To maintain a healthy mind and body, it’s important to engage in the effort to review and assess yourself – and, if need be, consult a professional to help.

Quote:

The higher your energy level, the more efficient your body. The more efficient your body, the better you feel and the more you will use your talent to produce outstanding results.

~ Tony Robbins

Depression During Life Transitions: Is it Normal?

Life is all about cycles - Seasons change, weather moves in patterns, the economy fluctuates, trends ... change...transition...all of which are happening constantly.

Recently, I was talking with a woman who had moved into a lovely home.  It was the home of her dreams.  She had been very excited about the move and creating this wonderful space. However, about a month or so after the move she found herself feeling depressed and lethargic.  She was very concerned and considered anti-depressant medication.

Change brings forth many emotions, sensations and shifts - ups and downs. Generally we don't associate depression with "good things" but in truth each one of us responds to change in our own unique way.

Plants were my first teachers about change. Have you ever moved a plant from one spot to another? What happens? They tend to wilt and look like they might die. Just when you think it is a lost cause the plant perks up! Go figure...

We do a little of this too. Our moods and energy are always in flux and subject to change. This can make most people nervous - Who really feels comfortable when feeling, a bit depressed or down?
However, is what is being felt a symptom of depression or a human experience?

There is a difference between a clinical condition and a response to a life event. We tend to label unwanted feelings and experiences as being related to sickness, but just like the plant or the woman who moved, that might not be the case. It just might be because change takes energy and lots of it - more than we might think.  Also, anytime something is gained something is lost. Loss is part of every change - Even the changes that we want or goals we have worked towards. Grieving is a natural response to loss. Depression is part of grieving.

Preparation for change is key in setting ourselves up for success.  Being able to move through change and transition safely and successfully without putting ourselves at risk or sabotaging our success. Each one of us may be sensitive to specific triggers/ stressors, events or circumstances - The conditions that may challenge our sense of mental, emotional and physical balance.

Mood and energy cycles often parallel with the environmental conditions occurring within and around us. If you are a person who is sensitive to change and or has mood, addiction or chronic health problems it is important to pay extra attention to change, especially when it involves your personal space, work or people in your life. Self knowledge is key.

The ability to understand our own cycles is needed in order to help ourselves in the best ways possible.

In order to feel well and to be effective, we need to adapt to changing conditions. This means that we need to identify, understand and prepare for them according to our individual needs.

 

This is why it is critical that we create the conditions we need to be well and successful. We can control that part.

 

This helps us in becoming skilled in managing change.  Being adaptive and able to work with change is needed to be able to grow, increase our skills and capacities and to reach our personal and professional goals.  As we move through life and experience its' joys, our victories, defeats and losses we will have many intensive and personal feelings many of which are part of the process of becoming a whole person. Growth can be stressful and uncomfortable, but necessary if we are to become more skilled in living life.

Approaching ourselves with kindness, inquiry and flexibility allows us to create the conditions we need to move forward through the changes in our lives. This means not judging every uncomfortable feeling and or event that does not go as planned as something wrong or a sign of failure. Instead setting things up so that we have what we need - support, healthy lifestyle habits and a mindset of willingness and openness.

Through this process we become more resilient- meaning stress hardy. Then we truly become more healthy, adaptive and bounce back from set backs and stressors even using them as leverage to move forward.  We are then truly able to move forward with confidence and in a manner by which we can be our best selves.

What is Problematic about Mood Problems? Dysthymia, Bipolar Disorder, and Major Depression

When we think of mood problems, we often think of low energy, negative thinking, sadness, and tendency to isolate. However, mood problems are not just “mental” or “emotional.” According to a September 2013 report from the World Health Organization the amount of damage untreated mood disorders causes takes a greater toll on health than chronic angina, arthritis, asthma, or diabetes. A growing body of research also indicates that mood disorders trigger certain diseases: chronic pain, acid reflux, heart disease, diabetes, cancer, osteoporosis, and other problems. Mood disorders wreak havoc on the entire body by throwing the stress response out of whack. Mood issues are not just about being “down” or feeling unmotivated; they can, indeed, be very physical and need to be taken seriously.

People who are seeking counseling are often looking for relief from mood problems. They are trying to regain or boost their mental, emotional, and physical energy. For the person suffering the energy loss, it can feel that the mood shifted all of a sudden or gradually became worse until they could take no more and sought help. However, it generally becomes more clear that there had been stress building over the course of time, whether that be from physical illness, major change, loss, or unresolved difficulties from the past. We can often identify that the mood issue had been operating in cycles; however, they easily go unnoticed. For instance, a person may experience depression after getting a new job or home. Even though it may be needed or wanted change, it is still change and change takes energy to accommodate, hence the dip in mood.

Over the next month or so, as we start to move from summer into autumn we may be more aware of fatigue as sunlight decreases and we prepare for the solitude of winter. Our bodies are rallying to accommodate this major change. We are part of nature - we go through our own cycles in response to nature.

The changes in our lives are felt deep within the organism (body) in which we live. It is important to pay extra attention when preparing for and or moving towards change. This is something that I notice as a  behavior therapist working with clients with mood problems is that preparation for change is often lacking -- The fallout of lack of preparation can make for unanticipated immense suffering. The overwhelm and dysregulation of emotions can result in regression back into self defeating and self harmful behaviors making for negative impact to self esteem.

Structure and self care are necessary staples.  Eating healthily, getting a good nights sleep, movement, fresh air, recreation.  Moving forward one breathe at a time of course is most important! Creating the conditions to be safe, healthy and stable is key in living and even thriving with a mood disorder.

Optimism: Maximizing Strengths – Protecting Health

Well, thoughts make for well behaviors. It is hard to be sick or to feel "unwell"  in mind that is balanced and positive. Optimism is well thinking and increases positive mood, moral, persistence while increasing creativity and the ability to solve-problems. It is very needed, especially in our complex world.

Optimism can get a bad rap. Perhaps, some of us have known people who possessed blind optimism – looking at the bright side of things at any cost – All the while discounting another’s personal pain. This can feel immensely invalidating. This type of blind optimism is often another person’s defense against what they deem negative and unacceptable – What they cannot tolerate. It can be wounding to another, however. I hear this often in my counseling practice in West Chester and Chestnut Hill, Philadelphia, PA. I work with people who suffer mood problems, anxiety, or have challenging personality traits and  teach them skills to become more flexible and resourceful. However, it can be hard for some people to accept being more optimistic and open because others have made light of their pain and tried to reframe issues and problems in an unhelpful way. Taking an optimistic view can feel like giving in or making the other people “right.” This can become quite a dilemma – a real set up.

The Fear of Disappointment
Each one of us has unique talents and strengths. However, we often focus on our less developed parts of ourselves rather than maximizing our strengths. Perhaps this comes from fear of lack in that if we have all the bases covered we can be prevent anything “bad” from happening. Of course, this is a form of self-protection often manifesting as perfectionism. Much like a performance review whereby accomplishments are acknowledged, but, then there is that one “opportunity for growth” which stands of like a demerit igniting alarm bells. What happens to the accomplishments? Yes, they get lost and the perceived negative gains complete focus.

What gets in the way of being more optimistic? Perhaps, it is not fear of trying or failing, as much as it is a disappointment. Disappointment can feel heavy and be a letdown. In fact, perhaps it is not as much the fear of things not turning out as planned as it is the difficulty accepting the feeling of disappointment. Time after time disappointment can erode at mood and outlook. It can weave into the fabric of a person’s personality. This is what makes change so hard – Although not impossible! Just to be optimistic of course. It takes time a dedication to increasing optimism. Pessimistic thoughts need to be identified and replaced by more optimistic ones, based in reality. This means that optimistic thoughts must have depth, purpose and value – Not be repetitive “fake it til you make it” talk.

Just like we talked about in last week’s blog on pessimism – We develop a lens based on our world view. Through that lens, we filter information in support of that view.

Choosing a Lens: Positive or Negative
Here’s a snapshot of the difference between optimism and pessimism –
Suppose you are scheduled to meet a colleague for lunch to talk about an important piece of business. You are waiting, and she is late and not answering her cell phone. By the time, 20 minutes pass you notice some pessimistic thoughts:

- “She is not interested and blew me off.”
- “I was duped.”
- “This was not a priority and she forgot.”

There is a choice here, on how to think about this situation. You may tell yourself instead:

- “Something must have come up or is in the way of her getting here and in the car and can’t answer the phone.”
- “I am sure there is a good reason for her not being here or being here yet. I am sure she will be apologetic.”
- “She is human and maybe she genuinely forgot.”

The optimistic thoughts leave more room for moving forward with the relationship. They are less personal and upsetting. They are more kind to both parties, while preserving self-esteem and possibilities. They keep people’s character and integrity intact. Optimistic thoughts also put less pressure on our bodies and less strain on our central nervous system.

Not to mention many times it is more important to be kind rather than right – Open rather than “decided” and forgiving rather than just. It gives us all more room to “be.”

Are You an Optimist or Pessimist?

Each one of us wants to be happy. The meaning of happiness and its ingredients are often unclear – Happiness can be thought of as something “out there," something to be earned, strived for and acquired, but not readily available - Happiness can be viewed as intended for “some people” but not for others.
Happiness can be perceived as a special prize to be achieved by means a some sort of special formula supported by age old secrets. –  The movie “The Secret”  presents that our thoughts are connected to what happens in our lives - That we are creating our outcomes. As one of my clients says, “Its’ a bit woo woo, but there is something to it.” Alternatively, maybe it is not so woo woo! Maybe our thinking does shape our lives and the quality of our experience – After all aren’t we the narrators of our story?

Our thinking is powerful – Thinking prompts emotion – Emotion ignites behavior. These elements develop events which support the development of narratives upon which we build our lives.

This simple story supports how thinking shapes reality - A few years ago I was facilitating a group on communication and teamwork with a group of professionals. When introducing some potential solutions to communication difficulties, one participant stepped forward. This person felt strongly about her dedication to being a “realist.” The strengths-based approach of validating others and making requests in a direct and transparent manner did not resonate with her. Her feedback went something like this, “There is a lot that goes on in my unit – people are out for themselves. It is a passive-aggressive environment. People are back stabbers!”

That is a pretty hefty statement – A lot to carry. I asked about the actual data supporting her statements. Moreover, most importantly how these assumptions may impact attitude, motivation, behavior and mood? After talking through it, the group broke it down. Curious that while there were some behavior challenges in the workplace (as usual), that there were also ongoing assumptions of people as harmful and not well intended impacting how situations were being viewed and responded to. The fear- based narrative served as a lens by which the environment was viewed. The “realistic” stance created more of what was disliked and feared the most.

The option of being effective -- Interfacing with the environment in a direct, helpful, accepting manner felt too “Pollyanna” -  as a form of giving in to something that was harmful and threatening.
We arrived at an understanding that what we refer to as “realism” is often our own attachment to our own views based in our own fears and unprocessed past experiences. Stepping back and looking at the detail of situations can break this down and disempower negative judgments which fuel pessimism.

 

Pessimism is a manifestation of self-blame; taking people and events personally. It is a form of self- protection.

Once again – fear is at the baseline of many of our emotions. Fear can be healthy, but also sneaky and misguided in its ways. It can creep in and create a sense of certainty – Certainty, however, is yet another emotion parading as truth.

Next week we’ll talk about Optimism.

Summertime Blues?

For anyone who was around last weekend over July 4th you may have noticed that there wasn’t a soul on the roads – no one around. It was immensely quiet. Perhaps many folks ventured to the shore points or to visit family. Regardless, it was desolate in the Philadelphia area. There was a palpable “hush” that was much like the stillness that settles in later in the night on Christmas Eve.

A friend of mine who is also a healthcare professional routinely comments about how we are communal beings and tend to share a common biorhythm – That we are “plugged into each other."

We were talking about how eerily quiet it was on the holiday weekend - That people did not seem to migrate to the fireworks until the last minute and that even the local ice cream stand was vacant of patrons until late into the evening.

Why would this be the case? Well, we as living beings are very much affected by our environment. Over the course of the last year, we have endured constant pressure from extreme weather. The winter was relentless with one-snow storm after another with intense cold and ice. The rain storms have been no better. When we anticipate storms, we have come to expect to be left without power for days and or to anticipate damages. This is hard to endure as a steady diet. Perhaps, there is a collective feeling of “burnout” in the atmosphere. Maybe we haven't recuperated.

We had been desperate for warm weather and the ease of summer, but perhaps the heat and humidity of late has introduced yet another extreme to rally against and accommodate. Extremes zap us of our energy. The intensity of extreme conditions can create distress in our bodies and minds – more than what we would imagine. For instance, over the winter you may have noticed yourself getting more tired, cranky, low energy and impatient as the snow storms continued - Due to being tapped of energy and resilience being worn down. Heat and humidity can be equally as damaging to energy and vitality.

For those who suffer mood problems and chronic illness, such as depression, pain syndromes, ADD, etc., you may find yourself more irritable and cycling or dipping mood-wise unexpectedly despite the sunshine and longer days. Heat can also fuel aggression. Be on the lookout for subtle and not so subtle changes in your thinking, emotions and behavior.

Do make sure to keep hydrated, drinking plenty of water. Eat healthily and veer away from quick unhealthy meals because you may not feel like cooking. Maintain exercise – perhaps swim or take a late night walk after the sun goes down. Overall, maintain structure and routine.

Moreover, of course, remember that this too shall pass. Most importantly, bear in mind that the conditions around us are impacting us on a deeper level.

How to Create a Bit of Vacation Every Day - Mindfulness

Ahhh…Summertime.  There’s nothing like those long summer days, starting with glorious sunny mornings, hot lazy afternoons, and extended time outside through light-filled evenings.  If we slow down and notice, we respond internally to the nuances of the season.  Perhaps we notice an increased sense of well-being or less stress, even if dealing with tough issues involving clinical or mental health.  But, summer is short and can fly by - It is July 4th weekend already!  It is important to be mindful of where we are time-wise and to be aware of taking advantage of what the season has to offer.  Sometimes, we Americans are not too good at enjoyment with our work orientation and busy schedules.  In fact, it is noted that we are the second most overworked country in the world!

So, instead of waiting to unwind and relax on vacation, why not learn to have a bit of vacation every day?  Yes, you heard me – vacation every day!  That means integrating relaxation and enjoyment into each day – being in the moment and noticing the beauty around us, releasing stress, being more present to others and more available for pleasurable activities.  This can indeed be done – that is, with a bit of a shift of mindset as well as willingness to experiment with new ways of living – learning to recreate, being more experiential, and taking loving care of ourselves through soothing our senses.  These skills help us make for a well-rounded lifestyle and increased quality of life.

Recreation vs. Recuperation

Americans take much less time off for vacation and pleasure.  This is probably no surprise for any of us as we know that it can be tough to take the time to get away.  But there is a price to be paid for not taking time off or overworking.  For instance, have you ever had the experience of overworking over a long period of time and then take time off, only to get sick?  By the time vacation came around, it was too late.  You may have planned to recreate but your body needed to recuperate.  When we overwork and live disconnected from ourselves, we tend to operate on empty and there is no energy for fun, recreation, and leisure.  We can even forget who we really are!  Time off then becomes more about recuperating from exhaustion, irritability, and poor lifestyle habits – sort of like a short-term rehab!  This is totally different from recreation which is about movement, play, interacting, laughing, and creating.

Recreating is actually needed and is productive – much like play is not only about fun for children, but is necessary in order to complete brain development.  Recreating and its associated healthy activities help us grow and become more expansive and whole, both neurologically as well as emotionally.  Perhaps that is what is meant by the old saying “All work and no play makes Jack a dull boy.”

Watching vs. Experiencing

One evening last summer I was standing on the deck at the beach on the Cape anticipating the sunset.  It was a beautiful evening, clear and warm with a gentle breeze blowing through the dunes.  Some other people started to gather as well.  The sun started to make its descent.  Some of the people were talking and seemed to be more engaged in the topics at hand.  However, this is what they missed – As the sun slowly set, there were wondrous hues of orange, pink, lavender, gold, and shades of blue streaming across the evening sky.  The sun grew deeper in color from orange to fire red.  The ocean seemed to grow louder as its waves hit the shore.  The wind picked up a bit and the temperature dropped.  Then the sun dropped under the horizon and the night sky emerged.  Day literally turned into night.  Amazing!

There is a distinct difference between watching as an observer versus experiencing it as a participant.  Watching is passive and non-connective – sort of being there but not fully engaged, or looking from the outside in.  Experiencing is about being completely present with our whole self or whole body – being one with the experience at hand.  In the instance of the sunset the experience was about allowing the colors, sounds, and other qualities to touch us emotionally, physically, and mentally – being authentically moved internally by beauty and wonder – noticing the interconnectedness in nature and all things.  Unless one is paying full attention and is completely focused, the moment-to-moment changes pass right by and the process goes unnoticed.  Thinking is not experiencing.  If anything, thinking takes us away from reality and the moments at hand.

What might we change if we were to tune into others more often and truly listen with our whole bodies?  Or, notice the day when we walk outside for the first time in the morning?  Or, tune into what we ourselves are saying, eating, thinking?  Essentially, what if we were to notice the details as well as the depth of each moment?  Do you tend to watch or experience?

Relaxation Soothing with the Five Senses

Self-soothing is a key part of self-care.  The goal of self-soothing is to comfort you emotionally and physically by doing things that are sensually pleasant and not harmful.  Self-soothing is a mindfulness practice when you are focusing your full attention on the feelings being experienced by your five senses. By being fully present on what you are experiencing in the moment, you will be able to get you outside of your head and away from troubling thoughts, feelings, and impulses.

Here are some ideas on how you can practice self-soothing this summer:

Vision: Plant a colorful flower garden or arrange potted plants on your deck or balcony. Watch the birds in your feeder and notice the different types and colors. Shop at a local farm market for vegetables and take time to notice the look of the fresh vegetables. Notice the colors and shape.

Hearing: Take a few minutes in the morning as you wake up to listen to the birds singing outside. Listen to the sound of the summer rain. Attend an outdoor summer concert and spend the evening listening to some pleasant music.

Smell: When driving through wooded areas put the windows of your car down and smell the sweetness of the honeysuckle. When you are in your garden, literally take time to “smell the roses!” Plant an herbal garden including basil, parsley, mint, and sage. Be sure to pick some to use in cooking and smell the freshness.

Taste:  Take a pause and take in the taste of a fresh summer peach or other fruit of your liking. Tune into the taste. Take time to chew and taste your barbequed meal noticing the many flavors. When drinking an iced tea, slow down and taste it – don’t gulp!

Touch:  When outside put your face up to the sun – close your eyes and feel its warmth on your face. If on the beach, feel the sand between your toes and the feel of the ocean as you walk along the shoreline. Feel the texture of the soil when planting flowers or vegetables.

Try making time every day to pay attention to these summer pleasures.  Take them in and notice your response.  Pay attention to what happens within your body.  It would be interesting to hear about what you learned when you look back and reflect on your summer.

Why Count Sheep? The Importance of Sleep

Do you suffer depression or have unstable mood, problems with your appetite, weight, or chronic pain? If so, how you much sleep do you get per night? - Probably not much or as much as you need.
In fact, it is estimated that approximately 70% of Americans are sleep deprived.

In my counseling practice I work with many clients who are trying to improve their mood and increase their ability to control their behavior with food, alcohol or decrease reactivity when angry or having strong feelings. They are getting just a few hours per night. Five or six hours just doesn’t cut it!

I often hear that people do not have time to sleep or that they cannot sleep – Either way, lack of sleep impacts our ability to function safely and effectively.

How can we expect to feel well and perform through the day if we do not sleep well enough at night?
There are quite a few “sleep deterrents” as I call them, which contribute to ongoing sleep problems.

Some of these include:

- Staying up too late surfing on-line instead of going to bed.
- Completing procrastinated
- Catching up on work email or projects.
- Texting, emailing and social media activity.
- Watching television and “tuning out.”
- Eating too late with no time to digest.
- Anxiety and worry about the next day or “life” in general.

Technology is a big culprit! Without solid boundaries, it steals time and can interfere with self-care. It also creates an illusion of connection between people, and we are social creatures – We tend to get drawn in!

I recommend that my clients to shut off all technology about 1-2 hours before bedtime - including television. Replacing technology with pleasant music, aromatherapy, candles or some other soothing sense based ritual can be helpful - And, of course, to do them repeatedly over time.

It takes time to learn to calm down and wind down.
 
There needs to be time to prepare for sleep – This is called sleep hygiene. These are the habits throughout the day and the time before bedtime that set the foreground for healthy sleep. It is about creating a mind-set of sleep.
 
Being aware of the impact of sugar, caffeine, alcohol on the ability to sleep is of key importance - Cut these out before bedtime. Also, that technology is stimulating and has a bigger effect on the ability to sleep than we might think.

All of these small changes add up to better health as sleep is just as important as food!

Sleep is medicine. It is a restorative process which keeps the human body maintained and “tuned” in order to be able to function safely and effectively. During the night we are going through stages of sleep whereby the body is recalibrating biochemically, which helps the body reset and be ready to interface with the challenges of the next day.

Lack of quality sleep can impact the quality of our lives. In fact, it can create as well as worsen many problems – It can decrease resiliency and make conditions ripe for impulsivity, moodiness, relapse on alcohol, and food cravings. It can also contribute to other problems with blood sugar, heart and more.

When we sleep through the night that important body functions are happening. The body is replenishing and repairing itself. Part of this process involves the natural lowering of the stress hormone cortisol. This helps us be able to be refreshed and recharged and ready to take on the challenges of the next day.

Lowering cortisol is also necessary to be able to have behavioral control over our impulses. It also has an impact on metabolism and weight control. If we do not get adequate sleep, we are more likely to gain weight.

So, if you are not sleeping well – What’s keeping you up at night?