Category Archives: counseling

Well…something’s crazy (but it’s probably not us)

Yesterday I attended the Florida Adlerian Society’s annual conference; it runs for three days but I was only able to commit to one. It was a great day: wonderful speakers, challenging information, and, of course, the warm and friendly Adlerians in attendance.

Adler is one of the great founders of psychotherapy, but often is relegated to a corner with a few remarks about birth order and maybe credit for starting the child guidance movement. He’s much more than that, and if you’re curious, visit www.alfredadler.org.

An interesting point made during yesterday’s talks was the evolution of bereavement in psychiatry over the past few decades.   The Diagnostic and Statistical Manual of Mental Disorders is the American Psychiatric Association’s published list of descriptions of various patterns of symptoms. The intention, back in the early 1980s and DSM-III, was to provide a structure for shared dialogue and research for the identified hypothesized mental disorders. No one was pretending these were all clearly identifiable and diagnosable, discrete brain diseases. In the DSM-III days, bereavement, as a category, covered up to a two year long period. If a grieving person was still sad more often than not, still struggling with aspects of grief and getting back to a (new) normal life, mental health professionals figured, depending on the relationship, two years was a reasonable time frame. Of course, some losses never heal – but people somehow figure out how to go on, just the same. The point is, no sensible person thought it was pathological to still have some regular bouts of tearfulness a year or more after your most beloved person died.

In 1994, the next edition of the DSM came along, DSM-IV. It gave people two months – not two years – to get over it and move on. If not – if the person was still crying, or numb, or having appetite and/or sleep disturbances, or otherwise met the minimum criteria for depression…well, that meant that bereavement was over and the person was now diagnosable with a major mental disorder – depression – which was now sometimes described as a permanent brain disease.

In 2013, the DSM-5 was published (note that the change from Roman numerals to integers was done by the APA – it’s not a typo on my part). The DSM-5 got rid of the bereavement issue entirely: now you get two weeks of being sad more days than not, plus the other possible symptoms, and you’re mentally ill with depression (according to the APA). There is no exception for bereavement, although it ought to be noted on the chart. One rationale provided, about which I’ve written in the past, is that this way people can get their health insurer to cover their grief counseling. Whether this makes it worthwhile to pathologize normal grief, I leave each reader to consider.

Are you mentally ill if you have trouble eating or sleeping, or burst into tears almost daily, two weeks after someone you dearly love passes away? I don’t know anyone who thinks so, but the manual that has become the healthcare provider’s and insurer’s standard frames it so.

 

Dr. Lori Puterbaugh

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

Cognitive Behavioral Therapy: So Much More than Positive Thinking

It’s more than just positive thinking

A smart, thoughtful person mentioned the other day, in conversation, that Cognitive Behavioral Therapy (CBT) seems to be just “the power of positive thinking.” That’s probably what it sounds like when it gets boiled down to a sound bite…but in reality, it’s so much more. There are many excellent resources out there, so I won’t attempt to tackle the whole topic here. A brief example, though, on the difference between CBT and simple positive thinking, might help.

In CBT, we are indeed looking for patterns of negative thinking. These are identified, and then we dig down to the underlying thoughts. From there, the challenging and reforming of particular thoughts begins. Then comes the hard work of rehearsing those new thoughts.

Consider, for example, an adult who is very anxious about grades in college. This student is up late studying, preoccupied with grades, and anxious to the point of headaches and nausea before tests. The student feels terrible, of course. The top layer of thinking probably includes themes such as, “I have to do well,” or, “This is too important to fail.” The level of distress the client feels, though, seems out of proportion; the client is sick and nauseated over A- or B+ grades. Digging deeper, the client turns out to have buried beliefs such as, “Perfect or failure – no in-between,” or, “Hero or zero,” or, “No one loves a loser.” Thus, the A- feels like a failure and even a threat to love and security. Those aren’t conscious thoughts: no reasonable grownup thinks, “Oh, no one can love me because I got an A-!” It’s more of a personal belief, often acquired early in life, which became the background to many experiences.

You can see that trying to be “positive” about the top layer thoughts might seem silly: “Oh, it’s fine to fail,” or, “It’s OK for me to not do well.” The client cannot buy into that. However, a deeply held belief – that one is either perfect or a complete and utter failure – merits serious attention, and probably underlies many difficulties for this client. Thus CBT starts it work – which is much more complex than presented here – by seeking the foundational troubling beliefs that are leading to the negative thinking.

As I noted – this is a cursory glance at one aspect of CBT. It is a well-researched method of treating anxiety, OCD, depression, and other difficulties. If it seems as if it might be helpful for you, please see appropriate professional guidance.

Dr. Lori Puterbaugh

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

Letting Children be Children

Is having a healthy, happy childhood a good thing? Is it important to have that foundation in order to be a productive, healthy and happy adult? All of us would agree that, “Well, duh. Of course.” Well, of course…yet, around the world, it seems that the short-lived glorification of childhood as a separate, sacred stage of life (in many ways a 20th century movement) is crumbling away.

In some European nations, 14 year olds have attained the age of consent to sexual activity with adults. Here in the US, they aren’t expected to remember their homework and thus teachers must dutifully post assignments on a school website so parents can check. For the record: 14 year olds can remember homework. Try breaking a promise about a privilege and see how good their memory actually is. The same child, however, is not capable of informed consent. They are not equipped to really understand long-term consequences due to brain development.

In the Netherlands, a 12 year old who is seriously ill – and consider that here, an awful lot of parents don’t expect 12 year old children to do chores or remember their own shin guards for soccer – can petition a judge to be euthanized due to illness. Their parents get to choose whether to grant permission up until age 16. That means that a 17 year old can petition to be medically killed. The same child might not be able to follow through on a college admission essay, or otherwise exhibit normal responsibility, but somehow their request to die ought to be treated as a perfectly normal legal procedure.

In our own country, about 9% of children have been diagnosed with ADHD and are being treated with medications, most often powerful stimulant medications – a rate that dwarfs much of Europe’s less-than-1% rate for medicating children.

Psychologically and physically, children aren’t miniature adults, as was so often the view in the past, due to the physically challenging, dangerous life most humans lived over much of history. They need love, secure boundaries, and guidance in learning to make good choices as they mature. Where these needs are unmet, adult dysfunction, emotional distress and physical illnesses are apt to follow.

They definitely don’t need to make life-or-death decisions, or be exploited by bad adults, or otherwise be treated with an expectation that they are fully rational, insightful grownups.

 

Dr. Lori Puterbaugh

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

 

Review: The Collapse of Parenting: How We Hurt Our Kids When We Treat Them Like Grownups, by Leonard Sax, M.D., Ph.D.

A friend recommended this book and this past weekend I read a large portion of it. It’s aimed at parents and others who are directly involved in raising children, and cites some pretty striking research about the negative outcomes of giving children more freedom and flexibility than they can handle. Children being given the control over their lives that ought to be reserved for responsible adults are far more likely to develop anxiety, depression and obesity; they have less attachment to their families and adults in general, and are more likely to turn to peers for advice. Their peers, of course, are not apt to know any more than them about making wise choices about life.

It’s a conundrum for some: after all, kids have to learn how to make choices, but they can’t handle the full variety of options that many parents want to give them. Learning how to present a narrow, fair range of choices is, apparently, a challenge for parents who are desperate to be liked. This craving for their children’s approval underlies a lot of dysfunctional, but seemingly well-intended, parenting. I described a parent’s style as a “democracy” (the children are school age) and the parent took it as a compliment…as if being democratic with children, where no one is really in charge and knows best, was a good plan.

Do kids need choices? Absolutely. Do they need – or can they even handle – the full range of options that an adult might handle? Absolutely not.

For parents, teachers, grandparents and others who work with children, this book is a friendly, accessible but thoroughly footnoted guide.

Dr. Lori Puterbaugh

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

…and still more decisions!

Decisions, decisions!

Our nephew and his wife are considering relocating. Given their jobs, they are employable just about anywhere – so the choices are as vast as these United States. They’ve created a spreadsheet to rate the places they are considering on a variety of factors: climate, culture, length of commute, ease of accessing travel to family back home…we’re looking forward to seeing how they narrow their choices as they visit cities and rate them across variables.

It’s a useful way of making difficult choices where there isn’t an obvious “right” or “wrong” choice to make. Take the job that makes less money but is more satisfying and allows for more flexibility, or take the higher-paying job that provides better long-term financial security? Take a second job or scale back on expenses? Move far from family or stay close? The problem, of course, is even ranking how important the factors are, really, in the first place.

Maybe deciding on a job isn’t the right example for you. Perhaps you have to decide on whether to downsize or stay put, or which school to attend. Whenever there are multiple factors to compare, weighing the factors in importance to you can help narrow the choice. Writing it all down – in a chart, or listing – can help, because then it’s in front of you, not rattling around in your head, where it keeps butting into whatever else you’re trying to manage in life.

Then, too, sometimes making decisions is complicated by stress and fatigue. If you’ve ever felt overwhelmed and too hungry to pick something to eat, you’ve been in this state. Likewise, trying to figure out what task to handle first, when everything seems overwhelming. Just doing something – even if you change your mind and revert to a different task – is better than paralysis.

Some people are able to make decisions quickly and easily; for others, the fear of making the wrong decision impacts even minor choices where “wrong” would be, at best, a minor disappointment. If you’re the kind of person who gets stuck in decision making, experiment with some other ways to organize the choices: a spreadsheet or simple paper and pencil chart or list, or focus on what is most important to you as a factor, or, for minor issues, take action and see if that is the better option or if starting in the wrong direction helped you discern, quickly, the right path to take.

Of course, if anxiety is interfering with basic decision-making, please consult a professional.

 

 

 

Dr. Lori Puterbaugh

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

Decisions, decisions!

Choices are good, right? Until they’re bad.

Too many choices becomes overwhelming. We can see the results of seemingly endless choices and information when we, or someone we know, gets lost in hours/days/weeks-long process of sorting through online reviews and information in the attempt to make a decision that might have been made over a dinner conversation twenty years ago. Grownups have problems with this, and yet so many parents inflict too many choices on their children.

It’s important for children to learn to make choices and endure the consequences in small, safe, age-appropriate doses. It’s also important for children to feel like the grownups are running the show. Offering opportunities to make choices – within defined parameters – and then sticking with those choices, are great learning experiences for children.

Consider asking a five-year-old:

“Would you like applesauce or yogurt for a snack?” versus, “What would you like for snack?”

What are the odds the child isn’t going to go for fruit or low-fat dairy and will instead choose something the parent wasn’t planning to provide? With so many modern parents afraid of upsetting their children and overly eager to have their children’s approval, children are left without anyone big and safe to place limits around their world. Temper tantrums, anxiety, and entitlement are often the results.

Children benefit from parameters and calm grownups being in charge. A calm, in-charge grownup can offer safe, appropriate opportunities to learn decision-making skills and learn to live with the consequences.

Dr. Lori Puterbaugh

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

Getting over getting stuck…when change is hard

Sitting on the fence?

Making a change can be hard. The reasons change can be so difficult vary, from person to person, and from situation to situation.

Sometimes people mistake passing discomfort for unbearable distress, and thus the degree of suffering that change seems to require just doesn’t seem worth the payoff. Nicotine addiction and its withdrawal is a common example of this, but there are many.

Sometimes, people’s pride gets in the way. If I’ve been doing some behavior for years, and now I change – am I admitting that I was mistaken in the past? That I was wrong? So people hesitate to make changes they want to make because, deep down, they don’t want to be seen as “hypocritical,” as if maturing and thus having a different (better!?) perspective were a sign of weakness instead of strength.

Sometimes, it’s hard to imagine the benefits. Let’s take the example of a sedentary person. Their doctor, family, and the world all seem in collusion: they need to get moving and get fit. If a person has not been fit in a long time, they may be rationalizing how they feel as “normal.” They have forgotten what it feels like to have an abundance of energy, to not feel wearied by routine chores, and to sleep well. Because they cannot really imagine these benefits, they do not seem to outweigh the here-and-now comfort of a cozy bed on a cold morning.

There are other reasons that positive changes can be so hard to make.   Identifying your particular type of hurdle helps you strategize to overcome it, because making change isn’t a one-size-fits-all process.

Dr. Lori Puterbaugh

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

Thoughts on Lent…

It’s Ash Wednesday, the beginning of the Christian 40-day period of spiritual boot camp. For a few weeks, the normal, daily practices of various forms of prayer, fasting/self-denial and almsgiving are supposed to be kicked up a notch. The point of such actions, as Thomas Merton wrote, is not to become a “spiritual athlete” but to push aside trivial things and focus on Who, and what, ultimately matters.

For Christians, the increased on focus on prayer highlights our need to grow in faith. Fasting and other forms of self-denial teach us to trust God – to have hope, rather than an inflated notion of self-reliance. Almsgiving pushes us to love others without conditions or recognition.

All pretty hard stuff, actually.

What if you’re not Christian, or a Christian from a denomination that isn’t particularly engaged in the Lenten season? What about you? Is it still useful to have some sort of extended period of intensive work on bettering yourself in whatever areas you could use a little boost? No doubt a loved one, or perhaps your coworkers, physician, or dental hygienist have suggestions for your improvement. Odds are, the answer for most of us is, yes – sometimes ramping things up for a set period of time is enough to break a bad habit, start a good habit, and have a target date in mind for a shift in perspective to take hold.

Have a Lent that is a season of growth or, if not Lent – have a personal boot camp.

 

Dr. Lori Puterbaugh

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

Way 31/Day 31: Make it a great year: Ask for feedback…and use it

Some of us remember former NYC Mayor Ed Koch, who would famously ask, “How am I doing?” and get loud feedback from everyday people nearby. That seems useful for someone who is a public servant. For most of us, just randomly asking strangers how we’re doing seems more irrational than reasonable.

We all have people close to us, though, who do have a sense of how we’re doing, and perhaps more than we do. “Jane” thinks she’s doing fine, and managing well, but her husband “Joe” sees that she is frazzled, irritable, and apt to burst into tears of helpless frustration every couple of days. Meanwhile, “Joe” thinks his Ironman training is going fantastically – and doesn’t realize that he is nodding off mid-conversation, grouchy and distracted during what little time he does find for family. The conversation is likely to become pretty unpleasant, very quickly, if they decide to sit down and tell each other what they need to do differently or what seems “wrong with you.”

It’s hard to do, but asking someone for honest feedback – someone whom you can trust to describe what they observe without slamming you or criticizing you – can be a real insight into how we seem to be doing. It’s information, after all, and, if you trust the source, it merits careful reflection – not immediate rejection. If Jane comments, gently, on Joe’s tendency to be exhausted and grouchy, he might tend to imagine he’s hearing a death-knell for his Ironman dream. No, he’s hearing that something about the balance of training, work, and home life is leading to his being so tired that the people who love him miss his (awake, ungrouchy) presence. How can he get some of that back for all of them, including himself? If Joe expresses concern about Jane’s seeming awfully stressed out these days, she is apt to hear still more criticism and feel defensive, when she’s really hearing concern.

Find one, or two, or three, people whose feedback you can trust to be in your best interest and fairly accurate…and at least take it into consideration. Better yet, sincerely try it on and see if it fits, and if so…use it.

Make it a great year!

Dr. Lori Puterbaugh

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

Way 30, Day 30: Make it a great year: Let go of having to have an opinion on everything

A lot of us grew up hearing well-intentioned grownups say things like, “Stand up for yourself! Your opinion is as good as anyone else’s!” This was supposed to build up self-esteem but it can end up creating narcissism or, if not to that level of pathology, a very disagreeable arrogance.

An opinion, after all, is supposed to be based on knowledge. It’s different than a preference, which is more a matter of liking something. So I might have an opinion that one kind of food is healthier (based on facts) but have a tremendous preference for another (based on its taste).

In Toxic Mythology (© 2015), I addressed this for a full chapter. You have no doubt encountered people who have opinions on everything, even if they have no real knowledge on which to base that opinion. An opinion, after all, is supposed to be based on knowledge and expertise. Its value (to others) comes from that knowledge and expertise.   I suspect that a lot of people feel anxious about not having an opinion, as if it means they are foolish, uninformed, or wishy-washy. If it’s something critical to your life, then you probably ought to be doing the homework to develop an informed opinion. If it is something about which you have no interest and no need for interest, why do you care? Is your insecurity about being judged leading you to pass judgment on things and situations about which you have insufficient information?

Punt on having an opinion when you’re lacking information. It’s easier than you might think:

“I don’t know enough about that topic to have an opinion. What are your thoughts?”

“I haven’t looked it into sufficiently to really have a full picture. What sources would you recommend?”

See, that was easy.

Dr. Lori Puterbaugh

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.