Psychotherapy Perspectives

EMDR—TWENTY YEARS LATER

noreply@blogger.com (Garth Mintun) — Thu, 17 Dec 2009 17:19:00 +0000

By Amy Konkle, M.D.
May 2, 2009

(Accepted for Publication in the Spring 2009 Issue of the Indiana Psychiatric Society Newsletter)

This year marks twenty years since the publication of the first study of Eye Movement Desensitization and Reprocessing (EMDR) for the treatment of post traumatic stress disorder. This article attempts an overview description of the current status of EMDR: what it is, what the research says, and theories as to the mechanism of action. In addition I will share some observations and clinical vignettes from my own practice.

EMDR is a psychotherapeutic approach, rather than a technique or a protocol. EMDR’s underlying theory has two hypotheses: (1) much of psychopathology has its origins in experience implicitly or explicitly perceived as traumatic and (2) there is a block in the central nervous system’s innate ability to process, i.e., to adaptively access and integrate aspects of the trauma into a coherent and temporally updated context. Traumatic experience is understood to exist in a wide range, from a parent’s dismissive remark to an embarrassing childhood experience to the DSM Criterion “A” events that anyone would identify as major trauma. While EMDR appears to “jump start” this innate ability for processing which has become blocked, its mechanisms of action are undetermined and discussions remain lively around just exactly what is happening and what are the minimal essential components of EMDR. Although the preponderance of research looks at EMDR treatment of post traumatic stress disorder (PTSD), most EMDR clinicians perceive little difference in the effectiveness of EMDR in treatment of major trauma and in the reprocessing of the day to day traumas that may appear small but nevertheless shape self-perception, perception of the world, and ways of relating to others. When EMDR is used to treat the lifelong smaller events that shape personality, the duration of the treatment is longer than that of type I PTSD.

A typical EMDR session identifies an event experienced as traumatic by the patient and apparently related to the presenting problem. Even a recent event meeting criterion “A” definition may have an antecedent in childhood which affects the way in which the current event is processed. Components of the trauma—sensory phenomena, negative cognitions about self, emotions and somatic re-experiencing—are elicited. A protocol facilitates the activation of these components so that they are accessible for processing and integration. Desirable alternatives are identified, intensities are measured, and a ground-work is laid to follow progress. These traumatic components are activated and paired with some type of alternating bilateral or dual-attention stimulation, e.g., eye movements, auditory tones, tapping, or vibrating electrodes, which are applied in sets lasting about 20-30 seconds

For example, if eye movements are chosen as the type of stimulation, the assessment is completed as described above. The patient then holds in mind the image representing the worst of the trauma (“I see the truck crossing the median and coming straight at me”), the negative belief about self connected to that image (“I’m going to die”), and where the memory is felt in the body (“my chest, my throat, my shoulders. My whole body feels tense.”) The therapist moves two fingers rapidly from side to side approximately 20 to 30 times in front of the patient, who tracks the finger movement with his eyes. At the end of each set of eye movements, feedback is elicited as to change or lack of change in one or more components, essentially “What comes up now?” If processing is not progressing, that is if some change is not occurring, the therapist has a number of options to help get the processing going again, using the least interference possible. Processing continues until the memory is no longer upsetting, the negative self cognition (usually about safety, responsibility, or choice) is changed to a more positive one, and the body is cleared of disturbance. Ideally past, present and future anticipated triggers are processed to resolution. My experience is that successful processing is in general accompanied by lasting changes in the life of the client, such as decrease or elimination of symptoms, loss of diagnosis, or noticeable difference in life choices. Positive spiritual changes, such as a deep sense of peace, are not uncommon.

Approximately twenty randomized controlled trials exist which positively compare EMDR to antidepressant medication, exposure therapy, cognitive behavioral therapies, and other psychotherapies in the treatment of PTSD. Many treatment guidelines, including the American Psychiatric Association, the International Society for Traumatic Stress Studies, and the Department of Defense, have rated EMDR at the highest level of evidence-based effectiveness in the treatment of PTSD. Numerous meta-analyses show no difference in effectiveness between EMDR and CBT treatments for PTSD, although EMDR requires no homework. The findings in a few studies indicate that it may require fewer sessions than CBT. Although some positive research exists for EMDR’s effectiveness with veterans, children, disaster survivors, and adults abused in childhood, and many clinicians report success with these types of clients, more research is needed for these specific populations. In my own practice childhood abuse survivors have expressed deep gratitude for the transformation that EMDR has brought to their lives. Others have described feeling a “lightness” to life previously unknown.

Although EMDR’s efficacy has been established in the treatment of PTSD, research is still in the preliminary stages for its treatment of other disorders. For example, while EMDR has successfully eliminated secondary depressive symptoms in many PTSD studies, no published study has yet investigated EMDR treatment of primary depression. Similarly, research on EMDR treatment of panic disorder (with agoraphobia) has had uncertain results. It has been suggested that anxious patients may need lengthier preparation before targeting distressful experiences. For example, a recent case study with a woman who had suffered for 12 years from panic disorder with agoraphobia, provided 6 preparatory sessions and 15 EMDR sessions, with complete remission of symptoms and maintenance of positive behavioral changes at one-year follow-up. A clinical series of 4 patients with generalized anxiety disorder were provided with 15 EMDR sessions to each participant to treat etiological memories. At follow-up, two patients were still symptomatic, but all had lost the diagnosis.

There is also some indication that EMDR may be helpful for somatic symptoms with traumatic etiology. Several case studies provided preliminary evidence for EMDR treatment of phantom limb pain. In one case series, 5 patients with chronic (1-16 yrs) phantom limb pain, previously treated in both inpatient and outpatient settings, received 3 to 15 sessions of EMDR. Post-EMDR, there was a significant decrease or elimination of phantom limb pain, reduction in depression and PTSD symptoms to sub-clinical levels, and significant reduction or elimination of medications related to the phantom pain. There are also promising studies of EMDR as adjunct treatment for chemical dependency, conduct disorder, and sexual offense.

Current theories as to how EMDR works include the following: (1) synchronization of the two hemispheres, (2) de-conditioning caused by a relaxation response, (3) “jump-start” of a process similar to that of REM sleep, (4) the initiation of an orienting response, (5) the promotion of thalamocortical temporal binding in 40 Hz neural oscillation range which helps to integrate somatosensory, sensory, cognitive and affective material, and (6) the activation of the cerebellum, setting off a sequence of information processing which activates the thalamus and eventually the frontal lobes, increasing dorsolateral and orbitofrontal processing. Neuro-imaging studies pre- and post-EMDR show changes compatible with any successful treatment of PTSD but do not really clarify the mechanism of EMDR. Dismantling studies which have attempted to demonstrate whether or not eye movements are an essential component of the treatment, have significant methodological flaws and so far add little information. Numerous studies have shown that eye movements reduce the emotionality and vividness of distressing memories, produce physiological relaxation, and enhance episodic memory recall. While research has yet to investigate the effects of the other forms of bilateral or dual-attention stimuli (auditory tones, tapping, etc.) most clinicians report the various stimulation modalities to be equally effective, although they may prefer one over another.

In my own clinical experience with EMDR over the past 12 years, I find it to be a highly effective treatment approach. As with any treatment, EMDR is not appropriate for everyone. However, I have used it with good results in a wide range of patients, including veterans, rape victims with and without significant childhood trauma, accident victims, those witnessing the traumatic death of a loved one, patients with medical traumas such as awaking during surgery, men with anger-management problems stemming from their own childhood abuse, women with childhood physical, sexual and emotional abuse, selected patients with borderline personality disorder and still others with dissociative disorder.

Most (approximately 75 to 90%) of single-episode adult traumas in an otherwise relatively healthy person can be adequately resolved in one to three 90-minute sessions. The greater the number of traumas and the younger the person at the time the traumas occurred, the greater the care required in the stabilization and preparation phases of treatment, and the greater the care required not to “flood” the person with their traumas, resulting in destabilization and re-traumatization. “Fractionation” of the trauma, i.e., processing one aspect of the trauma at a time, may be required. Treatment in those with complex trauma histories, heavy reliance on dissociative defenses, and involvement of the structure of personality formation remains a lengthy process. However, for a number of such patients, therapy can be shortened significantly with the judicious use of EMDR in the hands of a skilled therapist. For many with fewer traumas even if they are severe, and with basically good ego strength, EMDR can produce results which are rapid and dramatic, unlike anything I have seen with other modalities. Results tend to be long-lasting, and positive effect may actually increase with time.

Amy Konkle, M.D.
May 2, 2009

Emotionally Wired and Addicted to the Computer

noreply@blogger.com (Garth Mintun) — Thu, 05 Nov 2009 03:13:00 +0000

by Garth Mintun, LCSW, ACSW, CSW-G

There has been an awareness of a sharp increase in addictive behaviors to computers, as well as Blackberries, iPhones, etc., in our psychotherapy practice in Indianapolis. Many young adults, older adults and children are wired in and don’t know how to quit. Because of this, some people are jeopardizing their relationships, losing their friends, losing their jobs, and/or flunking out of school. There is an increase in sedentary lifestyle, and the sacrifice includes physical health as well as emotional wellbeing.

We have see couples coming in for marital and relationship counseling because of the significant time a partner is spending (upwards of 17-20 hours per day) playing on the internet. The internet games and interactions (role play games) have begun to replace the real life relationships. Partners and family members are feeling ignored, sacrificed, and replaced. The wired person is so into his/her virtual role that sometimes they struggle to distinguish the line between their real world self and the roles they play (which may include changing one’s age, gender switches, animals or fantasy creatures, etc.) on their internet virtual world. Family members complain that an addicted person spends more time with their fantasy relationships than connected to life with the people in their household. In the absence of contact, some partners have resorted to join them in their virtual world as a means of having a relationship.

It is not uncommon for relationships to be broken and couples to separate over the loss of communication, contact, and engagement from the one who is plugged into the computer.

Internet games are not the only way people are wired to their computers. With the convenience of palm computers and/or laptops, work has now become a 24/7 phenomena. Families now have to compete with work and online entertainment in order to have any engaging interaction with their loved one. This behavior condones and promotes work addiction. The Blackberry and iPhone light up for each email, enticing and compelling a response to work when at home, on vacations, or in other spare time. The poor economy exacerbates this when employees are stretched thin and there are plenty of competent unemployed folks who are ready to replace them.

With easy access to technology, Twitter, Facebook, instant messaging, text messaging, ebay, social networking, gambling, and dating sites, one can become compulsive and ultimately addictive, much like drugs and alcohol. An individual may have a full blown addiction and might need an inpatient hospital treatment due to the decline of one’s health and family relationships. In these cases, an individual may be literally in danger of harming themselves due to their compulsion with the computer.

Like food addiction, we cannot give up computers or the internet. We need to be wired to live in this modern world; technology is not the problem. However, like food, we need to moderate our use or we become a slave to it. We can overdo anything, even healthy foods, and/or technological applications. It becomes a compulsion or an addiction when we cannot stop it and/or when we have knowledge of its destructive influence in our life and our family.

In the USA, computer addiction is not acknowledged as an addiction or illness. Other countries, such as China, Taiwan and South Korea, take computer addiction as a serious mental health problem. Internet addiction is becoming more recognized in this country. For example, there is a residential program in a suburb of Seattle, Washington (Fall City) which treats individuals addicted to the internet. Hilary Cash, Executive Director for RESTART Center for Internet Addiction, states that three of the following symptoms suggest abuse and five or more suggest addiction:

Increasing amounts of time on the internet
Failed attempts to control behavior
Heightened euphoria while on Internet
Craving more time on Internet; restless when not there
Neglecting family and friends
Lying to others about use
Internet interfering with jobs and school
Feeling guilty or ashamed of behavior
Changes in sleep patterns
Weight changes, backaches, headaches, carpal tunnel
Withdrawal from other activities.

Psychotherapy /counseling help people and families recognize and heal from the fall out caused by “wired in” behaviors. Self awareness, recognition of the patterns, and the use of human supports to help break the compulsive pattern are necessary components of individual psychotherapy. There are also many kinds of support groups ranging from 12-step programs to Smart Recovery programs designed to help regain balance in a person’s life. If the person is in the early stages of neglecting self and the family, often an intervention in therapy to recognize the destructive nature of the compulsion and limit the amount of time on the computer per day can help. Repair of the broken relationships is also needed in the early stages of therapy, which requires finding alternate ways of coping with stress.

The computer and the internet are wonderful in moderation. We all need balance in our lives, and we can achieve that balance if we ask for help from our families and mental health counselor/psychotherapist. We all need other people, and in our “real time” relationships we can experience love and belonging.

When Symptom Relief Happens, Counseling has Only Just Begun!!

noreply@blogger.com (Garth Mintun) — Thu, 17 Sep 2009 13:21:00 +0000

By Garth Mintun, LCSW, ACSW,CSW-G

You and/or your spouse have been engaged in counseling for a few sessions. It is your first time in psychotherapy and you have expressed yourself, you have been heard, you begin to have a fresh look at yourself and your life… and you are starting to feel hopeful; things can be great. Your anxiety is decreased, your relationship with your spouse has improved, and/or your child is remarkably better. Perhaps you are experiencing work to be less stressful now. Maybe you have some relief from depression. You are not in the midst of a crisis anymore, so you think about quitting the counseling. After all counseling is expensive and you feel better now, so why not quit?

This belief is often attached to the notion that it is time to quit because you feel better. Weeks or months go by, however, and the problems not only come back, but seem to get worse. What happened? Was therapy not effective?

As a new client (especially as a new client who is in psychotherapy for the first time), it is important to understand the following:

1. When you start counseling, often you feel better quickly because you feel symptom relief.
2. Symptom relief is good because it often means that there is awareness of old patterns of problems and therapy begins to solve the surface problems.
3. Symptom relief does not heal the underlying deeper problem/patterns; that process takes a longer time.
4. If you quit too soon when you experience the first symptom relief, you will not undo the fundamental patterns, therefore new symptoms or old symptoms often return more forcefully. This is because you have not yet changed the deeper systemic nature of the problem.
5. It is best to stay long enough to work on the deeper pattern, so you will substantially decrease the likelihood that the old problem will reemerge in other aspects of your life. It may take a little longer, but in the long run it saves money and creates a higher degree of success.

When the initial symptom relief occurs, it probably means that you have just started therapy and feel good about your work, but your work is not yet done. Now the real work starts, which often involves grappling with the underlying issues, such as old fears and traumas. At first this next step may create a little angst; you might feel a bit uncomfortable accepting that is part of the healing. Yes, the painful process starts after the initial symptom relief. Therapy helps you uncover fears, sadness, grief, and trauma that you may have previously ignored. Furthermore, therapy helps you make the connections between patterns and problems, so that you can get to the root or source of the problem and explore new behaviors and beliefs. This has the potential to enrich your experiences.

So, roll up you sleeves, take a deep breath, and know that you are in a safe and supportive environment which will help you address the issues that keep you stuck in old familiar and destructive patterns. You can now begin to make lasting changes that will create a healthier sense of yourself and help your relationships to thrive and be more resilient.

Keep up the good work, because you are not in crisis mode! Continued counseling pertaining to underlying patterns will enable you to avoid continued years of emotional pain. This may be hard work in the short term, but it will be beneficial for many years to come.

Luxury of Anxiety

noreply@blogger.com (Garth Mintun) — Tue, 12 May 2009 18:37:00 +0000

In my thirty plus years of working with people in Indianapolis Indiana, struggles with anxiety have come up most often in therapy sessions. Most people that I see are anxious about a variety of issues. They may ask themselves the following questions for the future:

Will I have enough money?
Is my partner right for me?
Will he/she leave me?
What will I do if ________ dies?
Will I ever be peaceful?
When will somebody love me?
Will I ever find happiness?
Will I lose my job?
How will I sabotage this?
What is the matter with me?
What is wrong with me?

Or a person may have anxiety about the past:

Why was I so stupid?
Why did I do that to myself?
Why did I make so many mistakes?
Didn’t I take in consideration of the consequences?
How I was blind sighted and didn’t see it coming?

Anxiety is a luxury in the sense that we really don’t need it. It does not help us survive. If a tiger charged at us we would either flee if we could or, if backed into a corner, we would fight for our life. If a tiger is not present, however, we could worry about what might happen if a tiger were to come into our space. Perhaps we may even believe that our anxiety about a tiger may help us prepare for survival if a tiger were to approach us one day.

Most people who come to see me don’t worry about tigers, but they do have their symbolic tigers that create anxiety. In the present economy, a person may worry about money. One may read about job losses and imagine losing their job. They could even take it to the imagined worse case scenario and think about homelessness. Anxiety often is the worse case scenario and, as we brace for the worst, our adrenaline is pumped, our heart beats faster, and we become mentally involved in our fantasy of anxiety. Our body is equipped for this sudden burst of energy when there is danger, but not all the time when we experience constant anxiety. Consequently, we may become physically tired and sometimes unwittingly cause the worse case scenario to happen because we are not in tune to the present.

The luxury of anxiety keeps us from enjoying the present. Generally, in the moment, we are actually quite safe. Anxiety often causes people to be less safe, however, particularly if something in our reality needs to be responded to. For example, if you are anxious about your relationship while driving in the car, you may fail to see that red light in front of you and could expose yourself to danger. If you are overly pre-occupied with the luxury of anxiety, you may not see your significant other person’s non verbal signs that they are unhappy. For example, you may not see or hear the verbal and physical cues around you and become “blind sighted” when your partner tells you that they are leaving. When we receive the consequences of not paying attention, we may self-loath, which is again the luxury of anxiety bordering on depression. If we continue on the treadmill of the luxury of anxiety, we continue to not see the world around us, with the consequences of a loss of intimacy, job or self-respect.

Some of us may take this anxiety and obsess and create rituals to keep our anxiety at a low level, which may include compulsive acts of counting or creating patterns to feel safe. This continues to debilitate us and make us more vulnerable, and we may not even notice the proverbial tiger in the room.

The key is to lessen anxiety and gently return to the reality of the present:
Some ways to reduce anxiety are the following:

Stay in the present moment (you are doing just fine sitting in that chair)
Breathe with your belly not with your shoulders or chest (deep breathing)
Remember that anxiety usually does not help you
Remember that life has infinite possibilities and your anxiety has just a few
Anxiety is just one or two of thousands of thoughts that you attach to in one hour
Engage in physical exercise to have an outlet for your anxiety
Nurture yourself and love yourself just the way you are
Focus on how you are safe this present moment
Ask if your negative anxiety thought is 100% true (Byron Katie)
Think of anxiety as apart from you and try not to engage or make it personal
Develop a meditative process to practice letting anxiety go

If anxiety is overwhelming, compulsive, and restricting your life, you may need some help to lessen anxiety by going to psychotherapy. If you believe that you cannot cope with your anxiety, talk therapy and/or medication is essential. A therapist can help you get to the root of the problem, as well as offer you some useful techniques.

Anxiety cheats us out of the safety of the present. Anxious thoughts are always about the future or the past; they are never about the present. Anxiety limits us from viewing all of the options available to us. Anxiety is a luxury we simply cannot afford.

Couples Fighting Text Message Wars

noreply@blogger.com (Garth Mintun) — Sat, 14 Feb 2009 16:55:00 +0000

by Garth Mintun, LCSW, ACSW, CSW-G

Imagine you're sitting at home, your significant other is out and suddenly you receive a text message on your mobile phone. You read, “I am breaking up with you, I don’t love you anymore”. You then reply, “What…..what did I do to deserve this” . Hours later both are still texting on the cell phone with short cryptic angry, hurt messages with all thumbs. This has become a common ineffective avenue of fighting. These are unskillful methods of conflict resolution!

Does this sound like science fiction? In our private practice in Indianapolis, text messaging has become the norm for communication with traditional and non-traditional couples. It is happening with all ages from age 15 to age 55. Why are couples not talking directly to each other?! What happened to old fashioned verbal face to face discussions?
Text messaging is a very effective mechanism to send short few word messages like, “I am running late”,” pick up the kids at 5pm” “give me a call when your done”,etc... How did we go from practical short communication of easy to respond to questions and comments to expecting to have emotional intimacy via text messaging?

In our experience, text messaging stalking/warring is becoming widespread. One person is angry/hurt with the other, and texting is used to stonewall and/or attack the significant other. A barrage of “ why are you ignoring me”, verbal attacks, or worse still, “ are you with him/her, you expletive deletion #!!#!#!#”. Then the re-dial button with the text copied is hit, 50 times per hour and this starts the cyber stalking process. This sometimes escalates to physical violence when both parties meet.

As a psychotherapist I ask clients to stop fighting with text messaging. What I am told is that they “cannot stop”. Simple questions without intonations can sound like an innocent question/comments, however there is no insurance that the other will interpret the message as it was intended. It could sound like a demand or accusation to check up on a person like “WHAT ARE YOU DOING”, which could be interpreted as yelling. If the two people are not getting along, that simple question could be interpreted in many different ways and too often it is the worse case scenario that rules the mind. Assumptions and misinterpretations are common place without the benefit of verbal and nonverbal cues, in the absence of both of those the only data comes from cryptic text.

Text message is the worse way for couples to communicate emotional intimacy or to problem solve. E-mail is bad enough but at least you can be verbose. Text messaging is short and laborious, and often an impulsive expressions on a little phone screen where much of the message is left to the imagination and interpretation and the reaction is based on the FANTACY of what is meant.

Clients say to me, “it is much harder to talk face to face, we argue too much”. Lets examine that response. When two parties argue face to face, they see each other’s body language, intonations and can better know how their words are affecting the other. The couple can ask each other for clarification in real human time in front of each other. The tone of the words and remarks are more clearly communicated, thus preventing the imagination of the other to determine the tone in text messaging. Each person takes personal responsibility for what they say because they are saying it in actual real time with their words, body language and voices. There is less left to the imagination, hence less misunderstanding and misinterpretation which often escalates conflict and fallout.

I have a guess to why text messaging is so popular in these times. For many couples texting is used as a means of courting and is felt to be romantic, interpreted as a means of flirting, showing interest, and signaling to each other that they are being thought of, touching base. The problem is that when people use text messaging to communicate emotional intimacy and/or to avoid emotional intimacy, the consequence too often results in unresolved hurt feelings and anger. Text messaging is too often used to avoid the face to face communication of difficult topics.

I ask my clients not to text unless it is purely logistics, like, “I’m not able to pick up the kids on time, can you? or running 10 minutes late” . I encourage them not to communicate their pain, or try to resolve problems via text messaging. I also indicate that if an innocent communication begins to become conflictual via texting, that they table that dialogue until they can sit together and discuss or have a telephone conversation.

Some people are emotionally addicted to text messaging and I ask them to ban text messaging completely unless it is used for work. This is difficult for many clients because they feel at a loss without the constant contact with the other person and actually feel emotional pain of withdrawal and feel rejected. I ask them to talk about their feelings with the other person face to face, and if that is too difficult they can both come in and talk with me in the office.

If you find yourself dependent on emotional text messaging, make an effort to stop. This medium does not work effectively and can be guaranteed to cause you emotional distance with your partner. If you cannot stop texting, get professional help, you probably have difficulty in expressing yourself with the other person and this points to emotional intimacy difficulties. You and your partner have a better chance at achieving a meaningful conversation if you make a phone call or wait to see each other in person. If you continue to have problems, you may want to contact a professional relationship counselor/psychotherapist for help in improving the communication with your partner.

Remember direct one to one contact with your loved one is what attracted you in the first place. Don’t sell your relationship short by text message wars.

Don’t Wait to Save Your Relationship

noreply@blogger.com (Garth Mintun) — Thu, 13 Nov 2008 19:50:00 +0000

by Garth Mintun, LCSW, ACSW

In my Indianapolis Indiana private practice, often people come in when they are at the breaking point in a long troubled marriage and about to separate or feel hopeless about a long standing “loveless marriage” for many years. In other words, the relationship or marriage is in an emergency or dying state and only intensive crisis work can save the relationship. Often one partner does not have the patience to wait, the desire for change or the hope of repair to invest in the intensive relationship work that psychotherapy or couple work requires.

When couples come in with emergency status, there often are so many long standing negative patterns that it is challenging, even with professional therapy, to salvage the relationship.

The optimal time for a couple to seek counseling is when the problems are relatively young, the couple is not disenchanted with each other, and contempt and or detachment have not taken over the relationship. This early intervention increases the chances of working out their relationship satisfactory.

The best time to begin couple counseling is when there are small troubles with the relationship. Let me list the possible signs that signal need for help:
1. He/she does not listen to me
2. He/she is holding back their feelings
3. He/she roll their eyes
4. She/he is physically present but not emotionally with me
5. I miss the romance that I once had with him/her
6. We never seem to resolve our verbal fights
7. We don’t seem to ever make time together
8. I imagine how my life would be simpler if I was single
9. I lost my best friend
10. She/he does not seem happy
11. I am not as happy as I used to be in my relationship
12. She/he is never home
13. She/he says hurtful things and doesn’t seem to care about my feelings
14. She/he never validates me or gives me appreciation I want
15. We don’t have sex very often and it is not as good as it used to be
16. I constantly find myself jealous of others
17. He/she is constantly jealous of me for nothing
18. I love him/her but I am not in love
19. We constantly verbally fight about little things that don’t matter
20. Every time we fight, he/she throws the kitchen sink at me

These signs can be alerts that harmful relationship patterns are forming, and seeking help when these behaviors and responses are few increases the success of the relationship.
All twenty signs are symptomatic of larger relationship stressors and if not addressed will mushroom and beget many smaller problems until there are significant relationship breakdowns and serious symptoms. These symptoms can come in the form of emotional and physical affairs, separation and sometimes domestic violence.
With one or just a few of these problems taken care of early when they first arise by seeing a professional psychotherapist, often at this stage the relationship is strengthened resulting in more intimacy and satisfaction. However untreated, these problems spiral out of control and couples go into crisis mode, often beyond the point of recovery.

If some of these problems are present in your relationship, don’t hesitate to get help from a professional. If you catch these problems earlier, you will go to counseling for a shorter time, will be less expensive in time and money and emotional harm, and you will probably develop a more loving and satisfying relationship.

Controlling Anxiety about the Economy

noreply@blogger.com (Garth Mintun) — Thu, 25 Sep 2008 17:41:00 +0000

by Garth Mintun, LCSW, ACSW, CSW-G

Many people come to my Indianapolis Indiana private psychotherapy practice alarmed with “stress”, “anxiety attacks” and “panic attacks”. The common themes of concern are often external events like relationships, the economy, hardships of the family and financial issues. Often people judge themselves based on their past decisions and worry about how they will handle future events. Stress, anxiety, anxiety attacks and panic attacks can be traced on a continuum of fear, with the severity of stress on the one side and panic attacks being the most severe. Full flung panic attack consists of a simulation of the person losing control and being “blind sighted” into abject fear.

Many of us have fear about the economy. We read the papers and internet bloggers about where the economy may go in the future. We hear the pundits on TV warning us about the “Great Depression”. Perhaps we go to survivalist web site and hear their dire predictions of the end of the world as we know it. Our imaginations can be crueler than the reality of the present situation. We scare ourselves with our imagination and that can be augmented by the joining of other people’s imaginations. Unfortunately we also torture ourselves by the worst case scenario over and over , sometimes on a daily basis.

My suggestion: Be here in the present now! Look at the situation right now. Are you breathing? Do you have food on the table and a roof over your head today? If the answer to those questions is yes, reality is kinder than our imagination.

When you think of the worst case scenario, are you dismissing the infinite scenarios of the universe? Perhaps with an economic recession we will have to tighten our budgets. For example, we may have to take a job that pays less for awhile, which is not the worst case scenario of being homeless. Are you homeless now? Maybe your are looking for another job and sent out 10 resumes over the internet. Perhaps a reframe is that money is tight, but I have a roof over my head right now, I have food today and I sent out ten resumes towards a potential new job.

Even if the worst case scenario happened, the reality of it would be kinder than our imagination. People lived through the Great Depression and people lived through the double digit inflation times of the 70’s with a gas shortage. When we have a real and present danger in life, we act and don’t have to think about it. If we are in danger we are either in fight or flight. If a bear comes after us, we either protect ourselves from the bear or we run. and we don’t imagine what to do, we just do it. When we imagine a bear attacking us, we still go through the fight or flight survival mode in our minds, even if the bear is not really attacking us. We tend to go in survival mode, have heart palpitations, adrenalin is released and we go into “bear survival mode”. Often anxiety and stress takes place when there is no bear in the room, no homelessness, no starvation, we just worry about those possibilities by creating the “bear survival mode”. After doing this over and over again, we become exhausted and tired. Either we cannot fall asleep or sleep too much. The stress of our imagined future fears or anxiety may cause us to overindulge in food, alcohol, chemical substance, shopping, gambling or a host of other compulsive activities to numb us from feeling the pain of “bear survival mode” If we keep this going then we can make ourselves physically weaker from the stress and then we have new problems to worry about. All this is un-necessary if we stay with the reality of the present.

Please understand I am not encouraging you to be passive. Instead, focus on what can be done, become pro-active and plan for the future without scaring yourself about the future. Look at job options, the second part time job to earn more money, and manage problems with your health and your prized relationships. Be interested and curious about your process of “catastrophizing” and exaggerating the future, allow yourself to catch yourself in those dire thoughts and fantasies, and notice that in the present those events and circumstances are not present in your life at this moment, and remind yourself the future is still unknown. Name your projections into the future so that you begin to distinguish the present from future fears, and remember your own history of overcoming adversity, take stock of the wisdom of your life experience.

In summary, when you are emotionally triggered to go to the worst case scenario , go back to the present reality and ask yourself what is going on that minute. Are you breathing, do you have a roof over your head tonight , do you have food ? Ask if the less adverse scenarios are equally true or more true the worst case scenario. Finally be kind to yourself because the only thing any of us have is the present reality and all the other dire thoughts are negative places. Be kind and be present!

Coping with the stress of our U.S. economy

noreply@blogger.com (Garth Mintun) — Sat, 02 Aug 2008 04:49:00 +0000

By Garth Mintun, LCSW, ACSW, CSW-G

What a stressful time for US citizens! The price of gas and food is rising, our equity in our house is going down and our citizens are over their heads in debt from un-regulated credit card interest and bank charges. The people making most of the money are 1% of the wealthiest among us and the rest of us make the same or less money. To top that off, many of our jobs are in jeopardy because of the economy slowing and borrowing restrictions from banking to employers.

So, what can we do to keep our stress from getting the best of us? First we take a deep breath and realize that economies swing.. I encourage you not to read the “survivor web sites” that describe worst case scenarios and raise our fear and tension. The key to times like these is to feel that we can exercise some control over our lives in the present and keep focused on the moment instead of doomsday scenarios of the future economy.

What are the facts? Most Economists predict a recession until around the end of 2009 and possibly 2010. The energy crisis indicates gasoline will probably be staying high or rising higher until the world demand is lessoned. There is pending legislation and the Federal Reserve is supporting reining in the banks with their gouging interest rates on credit cards and outrageous bank fees. Those are some of the facts as we know today that impact our lives. In my view, everything else is speculation.

So what is a person to do…….? Take control of what we can do right now.! With gas prices for cars, what alternatives do we have for transportation, car pooling, riding bike, mass transit, or bus? How about our jobs? Do you have a plan if your company lays off or goes under?

How about growing some of your own food? . Even if you do not have a yard, most cities and areas have places you can garden for free or minimal cost. Or another option is food cooperatives.

How about joining some community action at the local and national level to pool resources together, coop farming, green life style or pooling together for transportation? I cannot stress the importance of feeling you are taking action to increase your sense of power over your destiny. Organizing a system for bartering a wide range of service would be another alternative. Cooperative groups organizing babysitting, food purchasing in bulk are just a few ways to beat the recessive economy. This kind of action tends to strengthen the community and inherently increase a sense of support, fostering self sufficiency and providing a pooling of resources. Self help community groups provide economic partnerships and decreases isolation in the community.

How about therapy and/or psychotherapy to help with relationship stresses which are magnified by the economy? Many therapists take insurance or have a sliding scale for those with no insurance.. There are Employee Assistance Programs with psychotherapy sessions paid in full by the company. Psychotherapists or “talk therapists” can help you sort out those stress factors that you can do something about and identify the stress factors that create problems with families and marriages. Counseling can also help your with anxiety with your children and the economy, job issues and general stress about the state of the world. How about group therapy counseling as a less expensive form of therapy then individual therapy.

The worst enemy is fear in times of trouble with our economy. The isolation is what hurts us as a nation and hinders effecting the most positive in these times. In the 1970’s the entire decade was recession, gas crisis and double digit inflation and unemployment. Many individuals and families made it by creatively developing cooperatives and altering lifestyle. We can do the same today, and perhaps discover that even in times of adversity, there can be positives in our lives. In summary, take action on the areas which you can do something about, join groups to change laws and try not becoming alarmist about your worries over the future and we don’t know. Again, stick with the reality of the situation right now.

Talk Therapy changes the Brain and helps with Depression and Bipolar

noreply@blogger.com (Garth Mintun) — Tue, 27 May 2008 01:13:00 +0000

by Garth Mintun, LCSW, ACSW

This week I watched the PBS special “Depression: Out of the Shadows.” Dr. Dennis Charney, the Medical Director and Dean of the medical school at Mount Sinai, presented on a panel of experts with Jean Pauley. He stated that depression “on average is 35% genetic and 65% environmental.” (This is for the average person; people with histories of depression or who are bipolar will have higher percentages of the genetic factors). He stated that medication and talk therapy access different parts the brain, thus the change these treatments produce take place in different areas of the brain. Research indicates that people who undergo both psychotherapy or talk therapy and anti-depressant or bipolar medications show more progress in lessoning their depression or bipolar symptoms than they would if they simply engaged in one method of treatment. For more information, please go to the PBS web site to see the video clip or read the transcript of the discussion with Dr. Charney, the panel of experts, and Jean Pauley at: http://www.pbs.org/search/search_results.html?q=dr+dennis+charney&btnG.x=8&btnG.y=10

This report is very good news. It is excellent in its ability to help people understand bipolar and depression and it also attempts to deal with the stigma of mental illness. I suggest that psychotherapists recommend this PBS series to their clients suffering from depression. Often in my practice in Indianapolis, I find that clients on medication for depression or bipolar show improvement when participating in talk therapy/counseling. These clients tend to experience a decrease in their levels of anxiety and lessoned feelings of the inertia when they come in to psychotherapy on medication. Consequently, people are able to deal with difficult core interpersonal issues with less anxiety and vulnerability than they would if they were not on anti-depressant and or bipolar medication.

The other piece of good news is that “talk therapy “actually changes the brain as well, producing biological effects. This program shows how people who have been suffering from long-term depression can perhaps see how their “talk therapy” actually changes the way they think in profound ways and compliments the medication therapy approach.

Often people go to their family practice physicians just for medication, rather than also attending talk therapy. After reviewing the research, people suffering from depression and bipolar may want to receive more comprehensive help by adding psychotherapy to their treatment. Again, the PBS show “Out of the Shadows” is an excellent vehicle for consumers to understand depression and bipolar and learn about ways that they might go about receiving help.

Electronic spying: Impact on couples in the Modern Information Age

noreply@blogger.com (Garth Mintun) — Fri, 02 May 2008 13:46:00 +0000

By Garth Mintun, LCSW, ACSW

In this modern information age with the Internet, mobile phones and GPS systems, we can share or obtain information at a breathtaking speed. The playing field between the small entrepreneur and the corporation is more equal then ever before, as information is much more widely available and accessible at all levels.

For relationships, this comes as a mixed blessing. While this technology certainly has its advantages, it also provides ample opportunity for crossed boundaries and a lack of privacy. For example, one’s wife, husband, partner or significant other can rather easily spy if they think their partner is not being truthful. Your partner might do this by checking your emails, text messages and phone numbers on your mobile phone, your history on the internet, and transportation monitoring via the GPS locator system.

In the years of being a practicing professional working with relationships and families, it is becoming much more common for me to hear about “evidence collected” via information technology. My sense is that, in adult relationships in the modern age, there is a growing dynamic involving the lack of direct communication about emotional needs and desires. Often, couples state that they quite simply “don’t have time” for this level of communication, given the combination of most people working over 40 hours per week, responsibilities of children, and the pressures of the economic recession.

This “busyness” impacts couples by increasing the possibility that their needs will not get met. The hectic schedule and lack of quality time together tends to reduce communication to purely the essential, and prevents the repair of past emotional wounds. Often the result of this involves one partner blaming the other excessively and the other partner passively resisting the blame by either “stonewalling” or “shutting down”. Couples play the roles of “chase and run.” This can play out when one person is the pursuer in the relationship and the other “runs” by shutting down and not responding (the silent treatment). Couples may reverse roles week by week or day by day. However the pattern created prevents the relationship from growing and old emotional wounds are not healed as the problems intensify.

When emotional wounds are not healed in the relationship, trust breaks down and partners can become fearful that the other is meeting their needs elsewhere. That is when the cell phone monitoring begins to take place and the history of the internet sites comes into play, as one of the partners “collects evidence”. In this modern information age, the information is easy to collect and privacy is invaded. Often then the partner confronts the other with the allegations of betrayal and both partners feel like the victim. The partner that “collects the evidence” feels betrayed because of the traces they had found of their partner’s intimate communication with another individual and the other person feels violated because of the “spying”.

When confronted with marital crisis, couples will sometimes turn for help to a psychotherapist at the point when the “evidence is collected”. The couple begins to work to overcome trust issues, anger, and sadness. The couple also begins to address the breakdown from a chronic period of time when the couple did not significantly repair their emotional disconnect. The relationship can be repaired at this stage if the couple chooses to prioritize time and attention with one another. This step involves setting time aside for weekly therapy and arranging “dates” or time together during the week to “wipe the slate clean.” This provides the couple with a basis to engage in the process of rediscovering why the couple originally came together in the first place.

In summary: if you find yourself “collecting evidence” on your partner, or if you find you are beginning to shut down, then it is time to receive professional help for your relationship. A psychotherapist can be very helpful by assisting you with making time for your relationship. Secondly, once the couple feels the relationship is a priority again, they can work on the emotional barriers that have been keeping them from intimate connection. Thirdly, as the trust builds, the need for electronic tracking will become obsolete. Psychotherapy can help both partners remember the initial “sparks” in their relationship and he provide guidance as both individuals to work together to rekindle those sparks.

Men Following Traditional Gender Roles Often Won't Accept Help or Counseling

noreply@blogger.com (Garth Mintun) — Thu, 28 Feb 2008 03:09:00 +0000

by Garth Mintun, LCSW, ACSW

You are not alone among men who feel they cannot receive help. You cannot help it; you have been socialized to not receive help and are a part of learned gender roles that have existed in our North American society for over 300 years. Here are some facts regarding men.

1. Men, like the western lone hero solve all their problems and other peoples problems by themselves.
2. Showing emotions is a weakness to avoid at all cost.
3. Being close or emotionally vulnerable to another man could be perceived as “gay” and that makes me withdraw emotionally and want to appear invincible.
4. Suicide is the leading cause of death for white males between the ages of 15 to 24 and the rates increase dramatically as men age.
5. Men commit suicide up to 8 times more then women and twice the amount of women are diagnosed for depression. 50% fewer men are in counseling then women.
6. Men die in this country 7 years on average before women die.
7. 90% of the homicide/suicide offenders are men
8. Men bond through drinking together or sports activities, fact or Myth? ( myth-relationship is at a superficial level)
9. Men often rely on one woman usually to meet all emotional needs.
10. Boys are nine times more likely to suffer from hyperactivity then girls

Along with these facts are certain “ codes of masculinity ( Pollack and Levant) which requires men to be aggressive, dominant, achievement oriented, competitive, rigidly self –sufficient, adventure seeking , willing to take risks, emotionally restricted and constituted to avoid all things feminine” Quotes from “New Psychotherapy for Men, by William S Pollack and Ronald F. Levant

How Men can take Action

Your personal crisis is your opportunity to change. Take advantage of this experience, i.e., failed relationship (s), career burnout, events that lead to depression, anxiety, and isolation and reach out for help. Please don’t try to be a super hero from Hollywood and ask for help from your support system or receive professional help.

First educate yourself on how the myths of gender are unrealistic in real life and often consists the opposite for us. Never being vulnerable means emotionally “breaking “sooner or later and becoming more vulnerable. Paradoxically, becoming more vulnerable and giving your restricted feelings a voice may make you stronger.

Secondly, go into a consulting or counseling relationship to work on emotional crisis, depression, situational crisis to “stop the emotional bleeding”, help repair some of the relationship (s) and learn how you catch yourself personally in the Male Myth or gender role bias. A therapist/consultant who is aware of male issues and has done his own work on himself is a must with this kind of work.

Thirdly, after one to one counseling, go to a men’s therapy or support group and learn how to interact with other men who want to become more authentic and break out of the gender role box. The combination of education, one on one counseling and therapy/support group is the best combination promoting authenticity with inner peace in the world.

Do you need Help with Depression?

noreply@blogger.com (Garth Mintun) — Mon, 18 Feb 2008 04:08:00 +0000

Garth Mintun, LCSW, ACSW

How do you know if have “clinical depression”? The best way to find out is to talk to a mental health professional. A few “red flags” may help you decide to seek help.

1. Do you feel tired or have low energy all the time?

2. Do you either get too much sleep or not enough sleep?

3. Do you either eat very little or too much?

4. Do your friends tell you that you have changed and “are not yourself”

5. Do you feel isolated and alone?

6. Have you lost your support group, i.e., friends, family, relatives, work buddies, partners, spouse, boy/friend or girlfriend?

7. Do you feel sad and not know why?

8. Do you sometimes day dream of what the world would be like without you?

9. Do you notice it is difficult to focus at work and home and your productive nature has suffered?

10. Do you notice that you rarely smile, laugh or joke?

11. Do you sometimes become angry at the slightest provocation beyond the scope of the event?

12. Do you feel at a loss but don’t know what to do about it?

13. Do you find your concentration at work and at home is decreased, as though you feel you have an intermittent memory problem?

Saying yes to three or more of the above would indicate that you need to talk with a mental health professional and if you answer yes to eight, this is a strong indicator that therapy or counseling could be generally helpful.

You might also consider the strength and nature of your support system, and ask yourself if it is adequate and responsive to your needs.
Isolating and withdrawing from your normal activities can be a strong indicator of depression.
Both depression that is related to an event in your life and clinical depression tend to present with similar symptoms and both can benefit from mental health services

Research is consistent in finding that depression has best treatment results when the client receives a combination of medication and talk therapy services. Recent research indicates that when the side effects of medication are accounted for, talk therapy does at least as well as medication and perhaps better (see webMd.com for more details). Also indicated in the research is that talk therapy is mandated when the symptoms of clinical depression are severe (see depression-guide.com for more details).

Often a mental health professional and/or a psychotherapist can help you find a therapeutic group as well as individual counseling to help address the symptoms and causes of depression. When nurturing and caring people are seemingly absent in your life professional help in the form of individual therapy and group therapy can be very beneficial. The therapist and /or group can become the support you need until you find a natural support structure.

Often clinical depression has ramifications for a marriage, relationship and/or if one has children. Sometimes there are secondary effects on families and couples in which the other person becomes angry, sad or feels like they lost their “old friend, they once knew”. Whatever is the case for a person suffering from depression it is imperative to receive help quickly because depression has the potential to escalate to suicide or death wish ideation? With extreme severe depression, with suicide and death ideation, hospitalization inpatient/outpatient intensive such as partial hospitalization or ILP may be necessary. Insurance generally covers treatment for this service as well as out patient therapy.

How To Heal Your Broken Heart

noreply@blogger.com (Garth Mintun) — Sun, 23 Dec 2007 03:32:00 +0000

By Margy Davis-Mintun, LCSW, ACSW

Please answer the following questions (true or false) to rate your coping after a break up. ( answers at the end of the article)

1. T F I had high expectations of my significant other and the person did not live up to my ideals.

2. T F I felt blindsighted by him/her leaving me.

3. T F I felt that I was in love until we became married, and then he/she was not the same person.

4. T F I feel the pain of being rejected by not only her/him and am re-living every rejection in my life.

5. T F I keep asking myself , what if……. and I seem to obsess about being dumped.

6. T F I will never allow myself to be hurt again and refuse to have another relationship.

7. T F I can’t stand to be alone and will quickly establish a new intimate relationship.

8. T F I don’t want to talk to anybody about this break up and I can handle it all myself.

9. T F Sometimes professional counseling and group work can help me map a strategy to heal my emotional wounds after this breakup.

10. T F I am basically a good person and will use this break-up to reflect on how I can make changes in my next relationship.

In relationships there is always the matter of coping with disappointment and loss. This begins in the early phase of relationship in which you meet someone and feel this instant connection. In the early phase of relationship we are enchanted with the illusion of who we believe we have met. We begin by having a relationship with our idealized version of our partner. Slowly over time we begin to replace the mental construction we’ve developed of who they are with the facts as they slowly build in the context of time together. This process of the early phase of relationship is very important as we slowly deconstruct our fantasy of our partner so that we can build a more authentic relationship with the person they are. Often relationships that move very fast can bypass this process and the relationship continues to be based on “fill in the blanks” that we have created, rather than based on who we actually are. The fact is that no one is a perfect match and each of us will have to come to terms with aspects of the other that are not to our liking.

Have you ever met someone, and you think you know who they are and then, as you get to know them, “they are not who I thought they were”. This is a common phenomenon in many relationships, including friendships. Taking time to get to know who you are dating and “falling in love with” allows you to more fully grasp the nuances and discover the gifts and the not so wonderful parts of who they are.

In short term relationships/marriages, often the discovery of your partner’s actual identity will create much conflict and ultimately terminate the relationship. This occurs because who they are is not really who you thought and as you begin to loose interest and hope, you disengage from the relationship.

The other important aspect of getting to know someone has to do with the bottom line of what compromises each of you is willing to make against your ideal version of who you want as a partner. Common interests, values, belief systems, and the ability to accept who they are become critical factors in relationships. Often there is a false belief that if you continue in the relationship you can change them so that you can tolerate the parts you don’t like. It can be very disillusioning when a partner either doesn’t change and/or you find yourself increasingly less tolerant of them. These are common factors that bring stress and frustration to relationships that end in breakups or divorce.

The focus of this discussion will be on the recovery process of a “broken heart” and hopefully help deter the “lonely heart” experience. One of the least emphasized aspects of relationships is the repair of oneself after a difficult and heart rendering end of relationship. It is common for individuals to experience a sense of failure, self criticism, rage, isolation, self righteousness and depression, just to name a few reactions to loss.
Grief is a time to allow oneself to begin to let go and mend from sorrow and loss. Within grief, the emotions are in an active state of change. Despair about being alone is a strong pull that can keep you in a very unhealthy state of trying to hold on and digging yourself deeper into depression. Sometimes there can be a belief that what you feel at the time a relationship ends will last forever. We tend to project this desperate feeling of loss into our entire future and overwhelm ourselves with a sense of urgency to fix everything right now. This can be seen in relationships that are “on again off again” as avoidance of the ending and the fear of never finding someone again. These endings can be very destructive to the couple as the only string that holds then together is the fear of ending and not the desire for the other.

So the first step in the break up is to allow yourself some time to sort out the decision to let go of the relationship, and/or the impact of the decision made by another to end the relationship. This allows you to review the factors that brought you to this point, and let yourself experience the feelings that emerge without taking action, just being in the moment of loss. This is not a time for action, rather a time for reflection. It may be that fear and anger flood you emotionally, which is a natural reaction to loss. The feeling of rejection and the angst of rejecting are also common powerful emotional responses to ending a relationship. These feelings of guilt, rage, and/or rejection can often cloud the process of allowing yourself to experience grief.

The healing process is not rapid, and often triggers other past losses and sorrow. As these feelings blend, the emotional response often intensifies and coping becomes more difficult.

For healing, it is important to reach out to loved ones, utilize your support systems, engage in physical activity, write in a personal journal and begin to understand what your part was in the breakdown of the relationship/marriage. We often come from hurt/anger and want to blame others; it’s easy to find fault in our partner. Another common response is to accept full blame and feel self loathing.

Healing and change come from being able to understand and discover our contribution to the relationship ending. This understanding enables us to grow and to make changes in behaviors that are destructive to our relationships. This allows us to feel empowered instead of hopeless about the future. If it’s all their fault, we are absolutely powerless and helpless. If we can claim our part, however, we have something to take hold of to become stronger and more capable in future relationships.

Support groups and therapeutic groups that address grief associated with the loss of a relationship create a structured environment for learning together how to cope with loss. This offers an opportunity to get feedback and to hear observations from others. We can learn from others’ experiences and minimize isolation within a positive environment which promotes growth and change.

Sometimes individual counseling in conjunction with group work provides added help as you cope with loss. This is particularly useful to address past triggers that often are surfaced in times of grief and loss.

Sometimes individuals want to give up on any possibility for future healthy relationships. Many close down emotionally, fearing they cannot ever succeed in relationships. Other times individuals will throw themselves into random relationships to avoid the pain of being alone and try to turn off the feelings of grief. Both of these methods of coping have little success in creating growth or change for positive future outcomes.

Choosing to be reflective, going slow with any new relationship with a long courtship phase, and joining either a therapeutic therapy group for “broken hearts” or a support group is important. Try to remember to “go slow” and do not succumb to extreme thinking of giving up on relationships or quickly moving into another intimate relationship. In mapping out your strategy, you may want to seek professional psychotherapy or counseling. (See other articles in Psychotherapy Perspective blog for assistance with seeking professional help)

****Answers to emotional I Q on relationships

1. true
2. true
3. true
4. true
5. true
6. true
7. true
8. false
9. true
10. true

If you answered one question true (or 8. false) you have awareness of your “broken heart” and, with reflection and help, can emotionally heal yourself.

Parenting Teenagers and Discipline in the Modern Age

noreply@blogger.com (Garth Mintun) — Fri, 02 Nov 2007 16:55:00 +0000

We know it is difficult being a parent in this present age, but it is also difficult to be a teenager today as well. Never before has “good judgment” been so crucial to survival. As part of the boomer population, I don’t remember that my bad judgments would have the range of severe consequences. Sexually transmitted disease such as HIV, potent drugs and pills and pornography are every day risks for teens. My mistakes back when I was a teenager did not often have the consequences of permanent injury or death. With sexually transmitted disease and HIV, permanent injury and death are real possibilities in this present day world for teens. Never before in our history have children had to make so many risky choices by themselves.

At the same time, I never had the internet growing up. While the internet can give me wonderful relevant information, it also allows predators into my home through the computer. How wonderful and awful at the same time is this technology! It’s wonderful because we can broaden our whole world and allow ourselves to be exposed to diverse ideas and cultures that were not imaginable over 10 years ago. It’s awful because of the diversity of violence, hate and sex available to teens in graphic form, i.e. hate groups, pornography, etc.

In my private Indianapolis-based counseling practice, parents often ask, “What do we teach our kids that can compete with what the media and their friends tell them?” Of course there are no “right answers” and I struggle with the same questions. With teens especially, I believe the media, culture and their friends have more influence in direct communication than parents do. However that does not mean that parents do not have influence; I believe parents do, and they have to change their tactics of parenting when their children are teens because the previous ways of communication no longer work effectively.

Parents are the most obvious role models of how to be a man and a woman, mom and dad, and wife and husband. The most important aspect to me is that values be communicated more by the action of a parent rather than through the spoken word. The role of the parent and the discipline of the child are demonstrated by the action rather than words. Words are secondary, and I believe questions are better than statements when confronting your teen on a subject that requires critical thinking.

Show your teen how you think. Your values, respect and interest in your child may go further than telling them how to be or how to act. Being observant of your own communication style with your spouse, the teen, and others may have more influence on them than anything you tell directly tell your teenager. Asking questions in a non-judgmental way to help them understand that the consequences of their behavior may go further than “laying down the law”. The act of helping your child think things through and develop critical thinking is a lifetime gift.

For example, your teen says that some of the other kids he/she admires are drinking or taking drugs. Harping on your fears, the illegality, and consequences of the actions will not teach her/him to think for her/himself. On the contrary, your words will probably fall on deaf ears or may cut off communication with your teen on this subject. However, if you ask him/her to think with questions such as:

 What does drinking do for your friend __________?
 What does drinking do for you, how does it help you or hurt you?
 What are the consequences if you are caught by the police/lose control/drive?
 What if you don’t do what your friends do (drinking)? How would they react? How would you feel?

Of course, if your child is in ever-present danger, you supply the safety net and avert the danger of high risk. At the same time, let the teenager think the problem through, including all of the consequences. If you can teach a child how to think, this will serve him/her forever. Combined with being a good role model and learning how to think critically, your teen will be well equipped to make decisions both in childhood and as an adult.

The biggest problem with authoritarian parental discipline is that it does not provide space for the child to learn from natural consequences. Often authoritarian discipline prevents the child from learning through mistakes. As a result, later as a teenager he/she may rebel, making it more difficult to keep him/her safe. If, for example, Johnny drinks and drives, then natural consequences are losing his car privileges for a while until he can demonstrate that he/she will be responsible. He/she may also give you ideas for natural consequences for drinking. Natural consequences, providing the teen with a way to “redeem” him/herself with trust, is a wonderful way parents can teach teens to be mature. With natural consequences, dialogue is needed to problem-solve and to determine what actions should be taken to remedy the act. A spirited dialogue with the parents and teen through open communication shows the child that, although he/she does not have final say, he/she at the very least plays an important part in the act of considering the consequences. Parents want to be sure that they allow their teens the opportunity to gain their trust back without impossible consequences.

When using natural consequences as a part of parental discipline, it is advisable to use “I messages”. The parent is questioning the behavior, but not questioning the character of the child. This is very important. The behavior of drinking is unwise and immature at a school function, but the child’s character is not devalued. When talking to the child about inappropriate drinking, the parent may say, “Son, I am disappointed in your behavior of drinking at the school dance and would like to know what you think the legal consequences would be if the school officials found out.” In addition, a parent might say, “I wonder what you believe the natural consequences for drinking at school should be?”. The focus of the parent should stay on the behavior of the child and not the character of the child.

In summary, I believe that we are teaching our young people how to have problem-solving skills and how to think critically, so that they will know how to make good decisions when they are adults. We are teaching them respect for rules as well as respect for others by being respectful in our contact with them. If we prescribe the arbitrary discipline or only punish, the child may not learn critical lessons of life. Open the door with your teenager and create the experience of problem solving, natural consequences, and critical thinking as gifts they can use the rest of their life.

How do I know when I need Professional Psychotherapy or Counseling?

noreply@blogger.com (Garth Mintun) — Mon, 10 Sep 2007 03:04:00 +0000

By Garth Mintun, LCSW

As a psychotherapist in Indianapolis Indiana, often clients ask me “how do I know when I need help or professional psychotherapy?” I usually reply by asking them to ask themselves the following questions:

Do you feel like you have been in a “rut” for a long time and don’t know how to get out of it?

Do you have anxiety or sad thoughts come over you and does this affect any major part of your life, i.e., home, relationship, work, financial and /or legal problems.

Do you find something seems to come over you and makes you behave in a way in which you feel is not you?

Do you feel terribly insecure or have fear of abandonment?

Do you sometimes wish you were not living?

Do you feel contempt for your significant other or does he/she feel contempt for you?

Do you sometimes participate in compulsive behavior too much, i.e., gambling, drinking, drugs, shopping, cleaning or anything compulsive (meaning that you are not sure that you can stop the behavior)?

Do you continue to be in an abusive (emotional and or physical) relationship and feel all alone and powerless?

Do you feel life has passed you by?

Do you have many physical illnesses or are you sick often?

Do you feel you could do something to harm yourself in any way, like sabotaging your job, relationship or yourself in any way?

Do you have nobody you can trust to talk to?

If you answer yes to one of the questions , it may indicate that you could be a good candidate for psychotherapy since all the questions involve deep emotional issues that are difficult to “self help” and change by yourself. If you answer two "yes" then in my professional opinion to receive professonal help soon!

Paradoxically, when people feel good they may need psychotherapy. Little know questions are the following:

Are you excited about life and wish to explore obstacles that get in your way of happiness?

Have you been partaking in a self awareness process for years but feel that you are getting stuck and want professional help to take you to the next level?

Do you get along with your significant other and want to take the relationship to a new wonderful level?

Do you have difficulty with transitions in life and just need a little help in the process of change?

Are most things in life good, but just one little area nags at your for attention and you want to deal with it?

Of course there are no right answers and this is just the opinion of this author. It is my belief if one question fits for you, then psychotherapy or counseling may be helpful. Also it is important to ask your psychotherapist if they have had psychotherapy themselves. It is our belief that psychotherapists need to be alert to their own biases and are more effective when they “walk the walk “of their clients and seek help too.

The Benefit of Groups and What is a Therapeutic Group

noreply@blogger.com (Garth Mintun) — Thu, 09 Aug 2007 00:59:00 +0000

By Margy Davis-Mintun, LCSW

Group work has been around in the United States since the early 1900’s used primarily by Social Workers until the late 1960’s when “encounter groups” made group work popular. There are a variety of groups, most known are groups such as Alcoholics Anonymous and Narcotic Anonymous which are support groups around a common theme. Intensive out patient and inpatient hospital programs have groups that tend to be more psycho educational in nature, where the purpose is to increase cognitive understanding of behaviors and promote change.

The type of group I will be describing is what is called therapeutic groups. These groups are closed, meaning there is a designated group membership meeting for a predetermined length of time. The nature of this group is to create a safe environment in which to experiment with getting and giving feedback and exploring new behaviors and responses in a social context.

Therapeutic groups tend to contain elements that enable a simulation of family and community experiences. In this context, a member can address issues of family of origin and break through past barriers in order to find release from old ways of being which originated in the family. Societal and cultural discourses can also be addressed and promote how members of the group can respond to the community in a different way.

These groups also allow for members to provide support to each other both in the form of understanding and empathy as well as support around gentle confrontation allowing members to experience conflict in a positive manner and to see themselves through the eyes of others.

An important aspect of group therapy comes from the group context allowing the member to receive feedback about how they are seen by others and in what ways they generate being seen as genuinely who they are and/or being seen in the manner they want to portray themselves. Even beyond those two choices, group members may see aspects of each other that are “shadow” (out of our awareness) that an individual may perceive they conceal.

The objective of group therapy is to increase self awareness, increase social comfort, allow exploration of new behaviors, provide support, develop skills, and promote more genuine interactions with others.

The format of group work is open ended, with facilitators providing opportunities for sharing within the group, encouraging risk taking and openly talking with others about one’s experiences. The facilitator also encourages feedback and participation of members in providing support to each other. Reflection by the person “working in group” and by the group members is another added benefit to therapeutic group therapy.

Group therapy is based on the premise of confidentiality, so that what is shared in the group remains private and individuals are honored in this manner. Group therapy also is based on a screening process by facilitators to assure that members are well suited for this therapeutic process and ready for group work. Sometimes there is a theme that defines the nature of the group and other times its open and the members themselves bring forth the themes they are working on.

In group therapy the work occurs both by the individual who in that circumstance is identified as “working” on an issue as well as the participants who are witness to the work and are impacted by similar themes in their own lives. This unique element of group therapy enriches the process for all members. The universality of the human experience is one of the most powerful elements of group therapy.

Groups are generally less expensive than individual psychotherapy and the experiences generated are often multiplied for every person in the group. The dynamics of multiple experiences and reflections often means more feedback and support than what individual psychotherapy provides. Each time a person does therapeutic work, this in turns “sparks” therapeutic work and reflections for everyone in the group.

Couples, Relationships and "Fix"

noreply@blogger.com (Garth Mintun) — Wed, 06 Jun 2007 02:31:00 +0000

By Garth Mintun, LCSW

Work solutions aren’t necessarily transferable to “fix” relationship problems. What you do on the job does not necessarily mean it will work at home. For example, if an engineer, attorney, clerk or technical person tries to fix the relationship with his/her intimate significant other; the results may not be what he/she wants. At our employment we are trained to fix problems and are paid to be “problem solvers”. The problem solving method usually works like this:
*isolate the problem and find what is “not working”
* Rationally figure out what the problem is and try to fix it
* Minimize the bad effects of the problem
* Plan a pro-active solution to the problem

Intimate relationships involve a different process. First it involves emotional and physical “sparks” which in our western culture is called “falling in love”. Then the couple goes through a courtship period of time where they learn how to be with each other and see if they can get along after the “honeymoon “period which is often an infatuation state of mind where both are on their best behavior. The couple often imagines what it like is to live together and try to picture themselves as a “unit”. Both bring their “stories” of the good and bad of their life into the relationship. Some relationships even believe
that their significant other will “fill the other half” and they are more whole when they are together. Both individuals when they come together as a couple bring stories of how they were raised by their parents, how their parents interacted together and how they fit into the family. All these old histories go into the new relationship. And guess what happens when couples bring all this together………………..they change too and are different than they used to be.

So what happens if a couple works with a relationship problem and one of the couple tries to fix “the problem” as if they were at work? Usually one of the couple becomes the “rational one” and is not emotional while the other is “emotional” and is upset about the so called problem with the relationship. Let’s pick a “problem” with couples for example “trust”. One of the individuals has a trust issue with the other. Let’s say there was an emotional affair with another and this brings up discourse in the relationship. The person, who had the “affair”, admits it and then tries to fix the issue. He/she may think that if they say “I won’t do it again, the problem is fixed”. But alas, when he/she tries to “fix” the problem, it moves to another issue, the problem does not stay fixed on one point or theme. The person who has the affair presents a plan for fidelity and wants to move on. However the other person wants to talk about what happened and will bring up many issues of how it affected him/her. So just when the one who had an affair thinks that he/she has a solution to the problem by promising fidelity, the problem shifts. Now the affair becomes a trust, listening and judgment issue. The problems seem to be escalating and the person who had the affair, feels beat up and tries to stop the talking by silence or cutting off from the conversation. This seems to make matters worse and then the other party mentions separating or divorce.

The couple could not “fix “the problem with tools used at work because there were many factors in the relationship that caused the affair to be the symptom of the relationship difficulty. Infidelity was not the only breakdown; there were many cracks in the relationship. Every time the couple tried to fix the problem, more problems came up and it was very exhausting for them.

It is our experience that it is helpful that couples understand that the aftermath of an affair is very difficult and cannot be fixed like problems at work. Feelings and stories of pain need to be honored and shared with the couple over the infidelity. The pain and hurt of what the “other did to them” needs to be transitioned to how the couple can keep destructive forces out of their relationship. We collaborate together on how to keep the “destructive forces” out of their relationship. We often ask couples to externalize the “problems” and encourage them to collaborate against the “problem” utilizing strategies that have assisted them in the past and access alternative stories of how they have been helpful to each other in the past. This enables the couple to develop comprehensive response together warding off the “destructive forces” which try to come in their relationship.

In relationships the problem solving model at work is too static and views problems to be fixed. Relationships are never static and couples continually add to the stories of their relationship through experiencing emotion and logic together. Unlike work, couples are the experts of their life and they have the ability to change their life together as expertly as they want.

Being Open in Psychotherapy

noreply@blogger.com (Garth Mintun) — Wed, 04 Apr 2007 14:13:00 +0000

by Garth Mintun, LCSW, CSW-G

Being open to others and accepting is very important in psychotherapy. Often we (as psychotherapists) talk the talk, but may not “walk the walk”. To walk the walk takes considerable awareness of self and often we have to put aside the conventional knowledge aside to be open and accepting of/toward others.

For example, when you think of a diagnosis do you think the person "holds" the problem inside of them? When I hear a diagnosis I need to “set it aside” to see the person in front of me! It is too bad that medical theory concentrates on the “pathology” and not the wellness of the person. What if we were to diagnosis people on wellness? What if we called people with the terms like “warmly resonating”, “friendly and articulate”, intensely honest, emotionally beautiful, and open to new ideas and holistically abundant? What if people came to therapy for helping a family member, “fit into the family more completely”? Instead of a child having school problems, what if the school came to the psychotherapist and asked how to help change the institution so the child could learn more of what he/she or the parents wanted. What if there was no normal and everybody was special in their own way? What if instead of an “addiction problem”, the issue was that the person “learned compulsivity very quickly” and the help were to assist this “gifted “person attends to other ways of learning compulsivity in ways they want to be.”

In narrative therapy (Michael White, David Epston, http://www.dulwichcentre.com.au/) the use of externalization is used to address “problems” as something outside the person. Narrative therapy uses the persons own words to describe the external “problem” rather than the so called diagnosis in the therapy process. The alternative stories rather then the problem stories are favored in therapy and the client is considered the “expert” while the therapist helps collaborate with the person against the external problem. The problem is addressed and externalized with the therapist and person collaborating with each other against the problem. If a client brings up a traditional diagnosis and names it such, we try to assist the client in externalizing it and finding ways of “keeping the problem at bay”.

In summary, we psychotherapists need to be open to our clients and the expertness they bring to the process. If we were more open to learning from our clients and question our professional assumptions more, perhaps we could be more open to others and ourselves.

A Notion of Change

noreply@blogger.com (Garth Mintun) — Sun, 25 Feb 2007 22:42:00 +0000

By Margy Davis-Mintun, LCSW

Through the years I’ve been intrigued with the idea of change and growth and how that process actually takes place. I recall being at an in-service back in the days when I worked in health care and learning that children don’t grow in small continuous increments, rather they can grow an inch or a quarter of an inch in a 24 hour period of time. That idea seemed strange to me, and challenged my concept of growth as a very slow continuous process.

As I turn to examine change in terms of human behavior, what strikes me in my work, is that the process of awakening to change is rather slow, as we gain new insights, new ideas, new ways of understanding ourselves and our stories. However the actual moment of change seems to be rather radical and instant, when our entire body/mind/spirit transforms and a new reality is embodied!

Have you ever noticed that you have believed or experienced something in life a particular way and then one day, that old way of being/thinking has just vanished and has been replaced with a new perspective?

An example I can use in my life, is that I used to feel/believe that I was responsible for making sure that everything in my life “worked”. I used to think that if I were not on top of all matters, my life would fall apart, and what would follow is that I would somehow lose my sense of purpose and meaning. This is quite ridiculous, of course, but nevertheless this was a fundamental belief that guided many of my choices and most of my interpretations. It seems like I “worked” in my own psychotherapy on this for an extensive period of time. Cognitively and intellectually I realize that of course these ideas were filled with flaws and that my grandiosity was beyond the scope of truth. Still, I held on to these notions and guarded them for “dear life”, they were for me defining, and I wasn’t about to give them up. These beliefs allowed me to think of myself as sacrificing and to hold noble meaning in my life.

Of course to maintain this story, I had to push aside the awareness of my helplessness, of my limitations and of my vulnerability. Some how, life did not feel safe enough to allow for my fraility, at least not for me to openly recognize it.

Yet one day, when I woke up to the diagnosis of cancer, all that I held in my belief system fell apart. I had to face the falsehood of my story, that somehow I in my arrogant and/or childlike way I held the notion of having so much more control than I ever actually had. In a moment I realized that a belief system integral to my self concept was in fact false, not only false because my intellect understood that to be so, but false because my being knew that to be true.
It was at this point that I began to understand in a “felt” sense, that change is not so much a process, but rather a momentary shift in the way we think, a shift that allows for new beliefs to create new embodied experiences in a magnificently irreversible manner. This was the equivalent of the twenty four hour growth spurt of our childhood body
This experience led me to continue to explore the relationship between our beliefs and our experience, particularly related to the shift that allows us to become free to embrace something new in our life view.

When in the process of psychotherapy, we sometimes wonder if things will ever change, the journey can seem long and winding. We are often preoccupied with the “desert” of our problems, beliefs and limitations. Then suddenly we shift and unexpectedly change happens, we see the “oasis” in the desert! Like the child growing an inch overnight, a shift in our world/personal view. To me, this is what a Notion of Change is all about!

More to come…………………………..

Therapeutic Separation for Couples

noreply@blogger.com (Garth Mintun) — Sun, 21 Jan 2007 23:23:00 +0000

By Margy Davis-Mintun, LCSW, ACSW

When a marriage/live in relationship feels broken and the zest of the early years seems lost, before jumping to the solution of divorce, why not consider a less drastic yet jarring experience, a therapeutic separation. This type of separation is designed between clients and therapist to increase the possibility of reinvigorating and rediscovering the essence that has been covered by stress, work, children and life’s distractions.

Good candidates for a therapeutic separation are couples who can remember that in the past they experienced pleasure, joy and companionship with each other, and through the years distance has prevailed and loneliness has become the more frequent companion.

What a therapeutic separation is designed to accomplish is to create enough distance, physically, by living apart to really allow the opportunity to feel the absence of the partner. During this time of living apart the thrust is to repair the marriage, rather than move toward divorce. We know that 70% of second marriages end in divorce, a higher number than first marriages. We also know that many relationships can repair provided a concerted and focused effort is directed toward that end so long as both want the relationship to continue. Furthermore, we know that past feelings of connection can be rediscovered provided the purpose/opportunity is designed for such.

In a therapeutic separation, the couple agrees to the terms of the separation, with the guidance and counsel of the therapist. Both are engaged in ongoing therapy and there may be occasion for individual work as well. In these separations, dating becomes the means of contact with each other, and contact is reduced to a minimal level so that each can gain a glimpse of what it would be like to live without the partner and experience the most positive aspect of being together. There are mutual rules established around the terms of the separation, these include and are not limited to such choices as monogamy, dating others, privacy, finance, how to deal with work, family and friends, and if relevant the care of children. The time frame is 3-6 months, anything longer tends to increase the possibility of moving too far apart to come back together, and anything shorter tends to be too quick to actually fully benefit from the time apart..

This separation discourages problem solving (regarding the couple) outside the therapeutic relationship in order to prevent further harm and repeated failure of repair.
The goal is to rediscover the positive aspects of the relationship, to build safety within the context of the couple and to provide space for the individual as well as the couple. In the therapy process, problem solving differences, communication and negotiation skills are enhanced, so that the couple can practice newly learned skills. Assumptions are reevaluated and beliefs are examined. When there are breakdowns in the relationship outside the therapy session, those are discussed and reviewed in the protective environment of the psychotherapy session. The goal is to recreate the positive underlying theme in the couple so that assumptions, if made allow for the benefit of the doubt rather than falling to negative interpretations.

With the support of therapy, and the commitment of couples to find ways to stay together in a more meaningful and rewarding relationship, therapeutic separations have been successful in preventing divorce and in creating stronger, more loving, and healthier partnerships. The key in deciding to try this as an alternative to divorce, is that both partners in the relationship want to remain together, are willing to work toward this end and commit to the process of creating a more satisfying and stronger connection with each other rather than “jumping” into divorce.

Holiday Myth and What to Expect

noreply@blogger.com (Garth Mintun) — Mon, 18 Dec 2006 23:05:00 +0000

Garth Mintun , LCSW, CSW-G

Do you wonder why when we have the full range of emotions for approximately 11 months of the year, we expect to be happy 100% during the Holiday season the last month of the year? These expectations tend to be carried forward from generation to generation and are transmited in our culture, the myth that we should be able to be completely happy and in the absence of happiness, we may judge ourselves harshly.

In our psychotherapy practice, people come in for consultations during the holiday season often because of past histories of painful experiences during this period of the year and sometimes because they wonder why they are “not happy and what’s wrong with me”. Their notion is that others are happy, and something must be “wrong with me” and can “you fix it”. I address the “myth of 100 % happiness” and work from the awareness of the following facts about holidays:
1. Families gather more than any other time in the year. Families are composed of individuals of whom some are doing well/poorly, feel well and/or feel badly. We hold feelings/opinions toward everybody in our family at different times, i.e., anger, sadness, guilt, joy, and often mixed feelings about individuals.
2. We grieve our tragedies, deaths and losses. We mourn for those of us who cannot come “home” for the holidays”. With grief there arises intense sadness.
3. As the year comes to a close we tend to review the past year, the events that caused both pain and joy, as we look forward to the New Year. This process may generate strong emotions.

We would not expect ourselves to have only one emotion during the first 11 months of the year. I wonder if we can allow ourselves instead to have our many feelings during the holiday season and allow space to feel all those feelings as human beings? Perhaps we could celebrate our human-ness with all of our mixed emotions. Perhaps we could gently attend to our own process with compassion and love, honoring the fullness of our being. In giving ourselves grace we can honor our experience. As we move forward with more openness to our own process, we often find increased tolerance for others as well.

When with family, we often experience sadness, anger and need to take a deep breath and “be in the moment”. We don’t need to verbalize all of our emotions; we can be selective about the emotions we share with family and close friends. Perhaps we can expand our ability to connect with ourselves in a more caring manner.

What if we can expect and allow the wide range of human experience this holiday season and not “should “ourself away. Let the feelings at the present time and let the “Season” be part of the experience and less of expectations. Perhaps I can give myself space to have the whole range of feelings this holiday season and expect this instead of a Merry Little Christmas…….Maybe we can have a Human little Christmas and a Wide range of feelings in the New Year.

Have a Wide range of feelings this Holiday Season!!!

Coping With Anxiety

noreply@blogger.com (Garth Mintun) — Mon, 23 Oct 2006 00:15:00 +0000

By Margy Davis-Mintun LCSW

“Generalized Anxiety is characterized by at least six months of persistent and excessive anxiety and worry” according to the DSM IV manual of mental disorders.

Anxiety is most often manifested when focusing on the past or the future. It’s impossible to feel anxious and present simultaneously. Anxiety is usually experienced through remembering the past and projecting into the future. Since it’s impossible to live in either the past or the future, anxiety takes over.

Often negative experiences of the past are relived in one’s mind, and in this process, the individual actually experiences the emotions as though the experience is occurring in the present. In an effort to avoid the repetition of negative past experiences, one may begin to imagine the situation and project that incident into the future, attempting to prepare for a new and different response. The problem is that the projection is only that, and, despite the best planning, the situation does not usually play out in the manner imagined, our responses tend to be spontaneous, regardless of the amount of planning. This process is often experienced as worry.

A cycle begins in our thought process where we are attempting to avoid negative experiences in the future. Unfortunately in doing so we re experience the suffering and pain of the past with little advantage to future changes. The suffering and pain is actually repeated in our planning process, and we relive that which we are trying to avoid.

The illusion we engage in is the belief that we can actually prepare and prevent pain in the future by creating scenarios in our mind and altering the events that are yet to come.
While anticipating the future and preparing/planning has an important role in life, we can become anxious by the continuous repetitive thoughts that recreate over and over the past events causing more suffering than relief. These thoughts can take on an obsessive quality and re occur as worries.

It’s not uncommon that we criticize our past actions, and curse ourselves for our behaviors/words, and try to make corrections in our mind by thinking about what we could have or should have done differently.

There are a couple of simple alternatives that help alleviate the worry/anxiety. The simplest is to become focused on the present, since it is only possible to live in the moment. This can be done by either paying attention to breathing, or paying attention to our senses. We can only breathe and experience our senses in the present, e.g. hearing, touching, smelling, and seeing. These two options allow us to come out of the past and future and focus on what is actually possible, that which is now.
An easy way to attend to breathing is to pay attention to the breath, noticing inhaling and exhaling our breath. For some it helps to count and slow down breathing so that we are taking oxygen in a rhythmic pattern of slow and deep (belly) breathing. This process of noticing our breath brings us back to NOW and allows disruption from worry. Another option is to take in our senses and look and actually see what surrounds us, pay attention to the sounds in our environment, and notice our body sensations such as the contact between our body and the surface we touch, or feet on the ground, or our hands. Also notice the scent in the surroundings. Since we can only have our senses in the moment, this also brings us out of worry and into the present.

Activity can also alleviate worry, taking a brisk walk or exercising is helpful. A healthy diet and eating meals rather than snacking as a means of coping with worry is also helpful... Generally, activities in which we are mindful of the moment will help distract from worry and keep us focused on that which we have control.

Though these suggestions sound elementary and simple they actually require our presence to our self, becoming alert to drifting back into old patterns of worry. Sensations in our body can signal that anxiety is taking over. This is commonly felt by racing heartbeat, increased sweating, and tension in the chest or body. By becoming aware of these tell tell signs in our body, we can catch our anxiety at the initial stage and begin to move away from worry before full blown anxiety takes place.

If you are inclined toward meditation, art or music, sometimes those are also ways to gain some relief from anxiety. Remember to focus on the present. Easy as this sound it takes practice and mindfulness, and over time, old patterns of worry begin to diminish. You will find that much is possible in the present and nearly nothing is possible when the mind is stuck in reviewing past actions and trying to create remedies in the future, only worry and anxiety persist, causing one to become lost in the illusion that we can control the future.

Mentoring Youth Programs

noreply@blogger.com (Garth Mintun) — Fri, 13 Oct 2006 14:52:00 +0000

Mentoring/Making a Difference
( talk given by Garth Mintun, LCSW, CSW-G at the Sheridan Indiana Kiwanis Club on 10-13-06)
By Garth Mintun, LCSW, CSW-G

I. What is mentoring: Wikopedia definition:
Youth mentoring is the process of matching caring, concerned adults with young people who may be at risk. The adult is usually unrelated and works as a volunteer through a community, school or church based social service program.
A more formal definition of youth mentoring is provided by the website InFed:
"The classic definition of mentoring is of an older experienced guide who is acceptable to the young person and who can help ease the transition to adulthood by a mix of support and challenge. In this sense it is a developmental relationship in which the young person is inducted into the world of adulthood (Hamilton, 1991; Freedman, 1995)."
II.
Benefits of Youth Mentoring
Intuitively we know youth mentoring is good for young people. However, many studies have provided evidence that youth mentoring has many positive outcomes for young people, adults and their communities.
According to the National Mentoring Partnership, youth mentoring helps produce benefits such as:
* young people tend to stay in school
* young people tend to get better grades
*young people improve their self-esteem
* young people are less likely to start using drugs or alcohol
* young people learn to get along better with others

III. Research regarding Mentoring:
A. The results of many research studies on childrresilienceliency indicated numerous factors which may have aided in a child being able to persevere against adverse circumstances. Only one factor was cited in every study that increased a child's ability to cope with life and strive beyond their circumstances. The one factor was these children had one adult who believed in them. IV. What does it take to influence a child to be stronger to life's challenges for the rest of his/her life?
A. One half an hour per week for one year of attention devoted to child's interest
B. Be a positive role model
C. Be counted on to do what you say
D. Good listener, educate with your behavior not by lecturing

V. Setting up a Mentoring Program
A. Ask your target group what they want to do
B. Give them the tools to make the project work and show by doing
C. Help them gain credit and acclaim for what they do
D. Stay in regular contact with the child (ren)

VI. Challenges of setting up a Mentoring Program
A. Making sure the Adult Mentors can make most of the meetings
B. Making the project is child centered instead of adult focused
C. Mentors getting through the testing period of the children.
D. Problems of communication with the Mentors and the Adults of any community system.

YOU are in charge of your Health-Advocating for Your Wellness

noreply@blogger.com (Garth Mintun) — Fri, 15 Sep 2006 02:13:00 +0000

Sometimes we forget that we (the consumer of health care services) are in charge of our wellness. This is indicative of the system because often when we receive medical service whether it is psychiatric or for physical ailments it appears that the "experts" have all the power. That is not true, they are our consultants and we need to navigate our own health care by advocating for our wellness. This is true (we are in charge) whether we are in psychotherapy, counseling, or at our physicians office for a check up. The health care regulations make the consumer in charge of our own health. All of us need to take responsibility for advocating for our wellness by doing the following:

1. Recognize that you are in charge of your health.

2. Act in charge of your wellness

3. You are in charge of your health care plan and the health care rules protect you
a. The rules in health care are made to protect the consumer
b. The problem is that health care providers don't always follow the rules and forget that you run your own health care plan
c. Consumers win most appeals with insurance if you challenge them with their own rules

4. Take charge of your health care plan when in a hospital
a. Stay in the hospital for as long as necessary and until you have a safe discharge plan!
b. Make sure that representatives of all the physicians and hospital have a meeting called a care plan , so you understand what your choices are
c. Don't leave the hospital until your care plan meeting takes place and all your questions are answered
d. Make sure that you have a safe discharge plan to home or wherever you are going.

5. Take charge of your health care plan when you are with your physician
a. Formulate your questions before you see your Doctor.
1. Ask your Doctor what the numbers say or the % of this outcome.
a. Don't ask if you are going to get better, ask what the %Âs
2. Don't ask your Physician to play God; he/she is your consultant!
3. Don't ask your Physician about wellness, he/she doesnÂt knowÂ

6. When you are really sick, don't be a hero, get an advocate
a. Figure out who that should be before you get real sick
b. If you are having surgery, make sure you have a responsible person on site to sign for you at the surgical center and make decisions if you remain unconscious and something goes wrong.
c. Stop procrastinating and start paying into Long term care insurance before you really get sick and it is too late. It is one of the few insurance programs you will use when you are alive.

7. Most illness is life style related; change your life style to enhance wellness

8. Pay attention to what your parents are going through now and make an effort not to repeat it their mistakes when you get to be a senior.
a. Medicaid planning is for everybody whose estate is worth less then 2 million
b. Be wary of your parents "gifting" when they are sick, see your Medicaid planning attorney even if your parents never plan to be on Medicaid. It makes sense.
c. If your parents want a qualitative life style, make sure that they put enough money into "custodial care" or have a generous long term care insurance program for life.

9. Working with health care insurance
a. Study the small print of the booklet well
b. When you call your health care insurance representative make sure you do the following:
1. Get their name and number to respond to later
2. Most of the representatives do not give accurate information, make sure that they log what you ask into the computer and then log how they answer the question. If they won't log on the computer and print it out for you, then talk to their supervisor
3. Ask for their supervisor (ask nicely)
4. Ask for how to appeal their interpretation (you will probably win if you are persistent!
5. Ask them to fax or call when they logged the response on the computer.

Boundaries in Psychotherapy Practice

noreply@blogger.com (Garth Mintun) — Sun, 03 Sep 2006 18:15:00 +0000

(Excerpts from workshop on “Boundaries” at Children’s Bureau presented by Margy Davis Mintun on August 31, 2006)

By Margy Davis-Mintun, LCSW, ACSW

Boundaries in Psychotherapy practice are established to create safe, reliable and useful platforms for the work to take place, and are the most fundamental responsibility of the Psychotherapist in client relationships in order to establish the ground for therapeutic work.

Boundaries define personal space and can be characterized as physical, behavioral, verbal and emotional. Boundaries can be strong and healthy, rigid and inflexible, distant and fused (lacking definition).

Two aspects of boundaries are going to be discussed,
- Boundaries within the Psychotherapist
- Boundaries between client and Psychotherapist

Boundaries with self include the somatic base of experience, the sensations of our body, and the awareness of our own emotional responses, our belief system, and our interpretation of our history. These define our experience with distance and proximity and reflect how we each navigate levels of connection and distance in our own relationships.

In the process of knowing our own boundaries, we become aware of our body sensations in relationship to others. This knowing helps us to gauge the comfortable and uncomfortable.

The distance at which each of us feels comfortable/uncomfortable, often reflects our personal experiences with levels abandonment or control. Our early childhood experience with our primary caregivers, and our notion of safety and danger in relationship, also reflect our history of boundary violations. These factors have shaped the level at which we are comfortable with others, our own boundaries, and the line at which our personal preferences are drawn.

The Psychotherapist who ignores their own needs in the service of the client runs a great risk of becoming vicariously traumatized and/or traumatizing the client. This occurs when we ignore our own experience of distress or boundary discomfort and don’t take action to address our internal or external conflict and it mixes with our perceptions of the needs of the client. Our lack of awareness of our own personal boundaries, and/or self care can lead to resentment and/or unconsciously blaming the client. This can create situations that adversely impact self, the client, and the relationship.

The ability to identify behavioral boundaries begins in childhood in a secure attached relationship where cycles of arousal and relaxation lead to appropriate self regulation. This is as simple as when a child cries and someone picks them up, feeds them, or changes their diapers.

The ability to self regulate emotional states is established as we learn to replicate for ourselves the experience of arousal and relaxation. Learning how to pay attention to internal signals of discomfort and distress in our body sensations and respond to the unmet need by self soothing or taking action.

The ability to have connection to our own personal experience in the context of doing our work allows us to have the means with which to attend to our reactions, so that we can regulate our emotional responses. This means that by attending to the signals from body sensations, emotional responses, and physical comfort, we are addressing our own comfort level and thereby decreasing the possibility of confusing them with client experiences.

Another area of boundaries involves the social context that often informs us of what is acceptable and unacceptable in our social environment. Examples are the secrets we keep, the intimate details we might reveal to specific persons, and the honest ability to say yes or no or to express an opinion. We are influenced by our experience as to what is acceptable, including how much room we have to be honest, authentic, and genuine in our relationships. When we can validate for ourselves what we feel and think, we can more fully sort out our experience. This allows us to be more honest and experience integrity and a sense of connection with others. If we pay attention to the signals in our body and emotions, we can be informed about what is right for us at a specific interaction/time. If we says “yes” and are unaware of the “no” in our body, we may be in contradiction to our true feelings and may be at risk for compassion fatigue. This does not provide healthy modeling for clients.

Boundaries also define the space with our bodies. This space has an intangible but physical energetic quality. Physical boundaries may extend beyond our body varying in size of radius and sometimes may be larger or smaller.

You may notice times when you feel a particular person is too close at a specific time and you feel uncomfortable. Another time, you may experience the person’s proximity differently. Unlike defenses which are rigid, boundaries are flexible and can change depending on the person and or situation.

Another area of boundaries that can arise is around the spiritual beliefs and how these relate to our interactions. For example, if I believe in fate or free will, how does this belief system play out in my decisions and my expectations and interpretations of events, and my relationships? If I believe life is predestined then I may understand my life experiences as part of a greater whole and may have a sense of acceptance about the events and relationships that are in my life. Whereas if I believe in free will, my interpretations about how my life unfolds will have a completely different meaning as will my belief of my ability to influence the events in my life. The awareness of these beliefs will have some effect on how I also interpret the events in the other’s lives.

We as humans tend toward two responses to boundaries with others. Either we tend to hold back and not travel to the edge of our boundary with others by being somewhat cautious and tentative, or we tend to cross over the boundary and notice later down the road in the relationship that the boundary had been passed. In this case we have to back track to a more comfortable place.

What is important in our relationships with clients is that we find a way to be able to either stretch to a more expansive boundary which allows for more full contact with another, or to contract from the spaciousness that creates boundary confusion because we have gone to an unsafe place in our relationship.