Q: I'm 15-years-old and we just moved to a new city. My parents are divorced and I live with my father. I want to tell him that I don't want to live with him anymore, but I'm afraid he might talk a lot of crap to me. What should i do? I also think I'm depressed.
A: Family matters like this can be very tricky, as you are keenly aware. If you are truly afraid of talking to your father about this alone, are there any other adults --family members, friends-- who can help you talk to your father? If so, talk to them first. Perhaps even your mother can intervene on your behalf, depending on the temperature of their relationship.
I'm also concerned that you might be depressed. Have you ever sought help for this? Can you talk to either of your parents about this? At 15 years old, you are allowed to seek treatment on your own, without any parental consent, in certain circumstances in California. Otherwise, one or both of your parents, depending on custody, would have to give consent for you to be treated.
In any event, I urge you to seek treatment right away. You can contact me or any private practitioner of your choice. You can also contact the Department of Mental Health's local community mental health center.
If you are feeling suicidal or like hurting yourself in any way, call the suicide hotline at 1-800-784-2433. You can call them 24 hours a day, 7 days a week.
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Wednesday, September 16, 2009
Tuesday, July 28, 2009
What, Me Worry?
Q: I am a worry wart and always have been. But now I feel completely stressed out. Are there any books you'd recommend to help me deal with this?
Scott V.
A: Scott, the good news is that there really is NOTHING to worry about. Worrying about anything has never changed the outcome, ever. What it does is paralyze us from taking action and, ultimately, wasting our real life away because we're trapped in our heads. And maybe that's what your worrying is enabling you to do, to avoid parts of the reality around you, but that's an issue you could deal with in a therapeutic context. But for now, here are two titles I'd recommend.
Feeling Good, The New Mood Therapy by David Burns, MD. A great intro to cognitive-behavioral therapy for all our distorted thinking.
Wherever You Go, There You Are by Jon Kabat-Zinn, PhD, a wonderful and comforting guide to living in the present moment.
Be well,
Michael
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Scott V.
A: Scott, the good news is that there really is NOTHING to worry about. Worrying about anything has never changed the outcome, ever. What it does is paralyze us from taking action and, ultimately, wasting our real life away because we're trapped in our heads. And maybe that's what your worrying is enabling you to do, to avoid parts of the reality around you, but that's an issue you could deal with in a therapeutic context. But for now, here are two titles I'd recommend.
Feeling Good, The New Mood Therapy by David Burns, MD. A great intro to cognitive-behavioral therapy for all our distorted thinking.
Wherever You Go, There You Are by Jon Kabat-Zinn, PhD, a wonderful and comforting guide to living in the present moment.
Be well,
Michael
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Sunday, July 26, 2009
You Can't Go Home Again
Q: I moved out of my parents' house last year. It's been okay, but everything is so expensive I don't know if I want to continue like this. I can pay my bills, but that's it. If I moved back home I could save about $800 a month. Problem is I really don't get along with my parents or my sister. I'm torn about what to do.
Saver not a spender
A: I think you answered your own question when you said that none of you get along in your family. I know you feel the general sense of anxiety about finances, but it sounds like you have the means to live on your own. What price tag can you put on your sanity?
There's something to be said for being on your own. I don't know how old you are, but moving back home can be a reversion to childhood. This can mean you're treated like a child again, and it can also mean that unconsciously you want to retreat to the safety of childhood, no matter how uncomfortable it was. I know that for some the end result of moving back can be an unexpected crushing blow to their sense of self-esteem. I would advise you to carefully weigh the options. You could give the old tried and true method of listing all the pros and cons of each. But most importantly, the decision has to come from your feelings. After all, they will be your constant companion no matter what you do.
Be Well
Michael
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Saver not a spender
A: I think you answered your own question when you said that none of you get along in your family. I know you feel the general sense of anxiety about finances, but it sounds like you have the means to live on your own. What price tag can you put on your sanity?
There's something to be said for being on your own. I don't know how old you are, but moving back home can be a reversion to childhood. This can mean you're treated like a child again, and it can also mean that unconsciously you want to retreat to the safety of childhood, no matter how uncomfortable it was. I know that for some the end result of moving back can be an unexpected crushing blow to their sense of self-esteem. I would advise you to carefully weigh the options. You could give the old tried and true method of listing all the pros and cons of each. But most importantly, the decision has to come from your feelings. After all, they will be your constant companion no matter what you do.
Be Well
Michael
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Monday, July 20, 2009
Memories Lead Nowhere
Q: I've been in therapy every week for the last two years. Recently I've started remembering things that happened when I was very young (2 or 3 years old). I thought this would help me get to the root of the problems I have, but instead it seems I'm getting worse. I feel stuck in a rut. I really have two questions. One, how do I go further in remembering traumas that happened, even as an infant? Second, is it normal to be getting worse instead of better?
Losing my patience
A: Great question. Recovered memory may be imaginary, not reality. If you're seriously trying to recollect events prior to five, it's probably not going to happen. Your brain is still developing in childhood. At two or three, you don't have any verbal memories. If you do, there might be an accurate snippet, but it's primarily projection.
Some folks say that therapy has made them worse, and that is often true. I can offer at least a hundred reasons for this, but here are two:
1.Generally, people get worse before they get better in therapy. If they stop prematurely, they can walk away in worse shape.
2. But more likely, when clients or therapists begin digging into the past too soon, the hunt for memories becomes a subclinical, or even clinical, obsession. Depth therapy does more harm than good if someone is given to obsessions.
Here's the reality: Your past is useful only as part of the story you tell about your life. Go to therapy every week with a therapist who uses an interpersonal approach to the therapeutic dialogue. You'll see your past come to life in the present through your relationship with the therapist. Only then can you have the "corrective emotional experience." Otherwise you're stuck saying, "I will not change until (my parents, my brother, my dog, whoever) treats me differently when I was three."
Be well.
Michael
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Losing my patience
A: Great question. Recovered memory may be imaginary, not reality. If you're seriously trying to recollect events prior to five, it's probably not going to happen. Your brain is still developing in childhood. At two or three, you don't have any verbal memories. If you do, there might be an accurate snippet, but it's primarily projection.
Some folks say that therapy has made them worse, and that is often true. I can offer at least a hundred reasons for this, but here are two:
1.Generally, people get worse before they get better in therapy. If they stop prematurely, they can walk away in worse shape.
2. But more likely, when clients or therapists begin digging into the past too soon, the hunt for memories becomes a subclinical, or even clinical, obsession. Depth therapy does more harm than good if someone is given to obsessions.
Here's the reality: Your past is useful only as part of the story you tell about your life. Go to therapy every week with a therapist who uses an interpersonal approach to the therapeutic dialogue. You'll see your past come to life in the present through your relationship with the therapist. Only then can you have the "corrective emotional experience." Otherwise you're stuck saying, "I will not change until (my parents, my brother, my dog, whoever) treats me differently when I was three."
Be well.
Michael
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Friday, July 17, 2009
This Love is Dangerous
Q: Eleven years and counting I have been in an abusive relationship. My SO was diagnosed with Borderline Personality Disorder with antisocial traits. I have looked this up on your site, but feel things have progressed to Narcisistic Borderline Personality Disorder. Now, is there any hope or any use of me continuing on with trying to get my SO to seek medical and therapy intervention when he won't even acknowledge that he has a bonafide psychiatric condition? Or should I just try and escape before he kills me? It's that close. Right now he is rapid cycling all over the place. He cannot even function in activities of daily living or even remember the simplest task that needs to be done for the day. I am at a loss here. I have tried to talk with the M.D. and psychologist but neither is aware of his condition. There has been no intervention on either of their respective sides. This man is not medicated and is a danger to himself.
A: Get away from this man before he kills or injures you! Of all the psychiatric diagnoses, personality disorders are nearly impossible to treat. There is no medication or therapeutic intervention that can save your significant other from himself. The fact that he refuses to acknowledge having a problem in his personality style precludes any hope of therapeutic intervention. Having antisocial personality traits almost guarantees failure. No matter what he may tell you, or how he may try to manipulate you to stay, get out! Please contact me if you need referrals to resources.
Be well and stay safe,
Michael
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A: Get away from this man before he kills or injures you! Of all the psychiatric diagnoses, personality disorders are nearly impossible to treat. There is no medication or therapeutic intervention that can save your significant other from himself. The fact that he refuses to acknowledge having a problem in his personality style precludes any hope of therapeutic intervention. Having antisocial personality traits almost guarantees failure. No matter what he may tell you, or how he may try to manipulate you to stay, get out! Please contact me if you need referrals to resources.
Be well and stay safe,
Michael
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Friday, July 10, 2009
Overspending OCD?
Q: Is overspending a form of OCD?
A: In and of itself, no. Then again, I don't want to give an absolute answer without knowing all the facts of your situation. Overspending can certainly be a component of some OCD-like behaviors. For instance, many folks who hoard will chronically overspend on seemingly useless items.* Someone with a contamination obsession could be overspending on clothes if they will wear them only once.
Overspending as it is traditionally regarded would not qualify as OCD. It may be compulsive, but not in the manner that repetitive checking and washing are. One could be addicted to shopping as they would be to a drug. Likewise, overspending is often a hallmark of a manic episode in bipolar disorder. I hope this helps.
Be well,
Michael
*I refer to hoarding as OCD-like because I regard hoarding as a separate condition that just looks like OCD. However, it is officially considered OCD.
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A: In and of itself, no. Then again, I don't want to give an absolute answer without knowing all the facts of your situation. Overspending can certainly be a component of some OCD-like behaviors. For instance, many folks who hoard will chronically overspend on seemingly useless items.* Someone with a contamination obsession could be overspending on clothes if they will wear them only once.
Overspending as it is traditionally regarded would not qualify as OCD. It may be compulsive, but not in the manner that repetitive checking and washing are. One could be addicted to shopping as they would be to a drug. Likewise, overspending is often a hallmark of a manic episode in bipolar disorder. I hope this helps.
Be well,
Michael
*I refer to hoarding as OCD-like because I regard hoarding as a separate condition that just looks like OCD. However, it is officially considered OCD.
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Thursday, July 9, 2009
High Anxiety
Q: I am 21 years old and have recently began experiencing high anxiety and panic. This has never happened to me before and it started out small and is getting worse. I think it's all in my head, and when I think about or talk about panic, it makes it worse. When I am at work I get nervous and scared for no reason and driving makes me very nervous depending on how far I commute. I don't know what to do. I need some suggestions and tips that I can do myself to relax because I have no insurance and cannot afford private therapy. I would deeply appreciate any advice. Thank you.Freaking Out
A: Dear Freaking Out,First, take heart because you're in swell company with millions of other Americans who suffer panic attacks. I commend you for taking positive steps now to address your symptoms.
You are right to say that it's all in your head. Panic disorder is a game that your mind plays with you, and you have to outsmart it. The fact is that panic attacks live off your fear of them. That's why just thinking about them can send you into one. Let's look briefly at the components of panic.
Anxiety is an evolutionary development that helped our hunting-and-gathering ancestors survive. When you go into panic mode, also known as fight-or-flight mode, a number of physiological changes take place. Blood rushes from your head to your extremities, resulting in dizzyness, light-headedness, and/or feeling "unreal" or "otherworldly." Your breathing becomes shallow, resulting in a sense of "breathlessness." These are helping you to fight or flee a life-threatening situation. Many people become sweaty; the moisture makes us slippery and difficult for a predator to grasp. The thing to remember here is that anxiety was designed to save us, not hurt us.
Today, we aren't in the literal jungle anymore, but our physiology hasn't caught up. Hence, many people get a small flash of dizzyness or shallow breathing and interpret that they are having a heart attack. Others feel a rush of adrenaline and feel "out of this world," and interpret those sensations as "going out of my mind." They fear they might lose control and run around wildly killing strangers. Others may first have a disturbing "cognitive intrusion" or thought and begin to feel the physiological sensations. In any event,all of these misinterpretations only increase the anxiety and, voila, you have yourself in a panic attack.
The most successful treatment I have used in my practice is symptom induction. In this technique, the client will try to bring on their most disturbing physiological (not psychological) symptoms 3-5 times per day, or when they are starting to have a panic attack. The idea here is not to scare yourself, but rather to try to make your heart pound for about 10 seconds, make yourself feel dizzy for a bit, and so forth. This is a desensitization technique that has worked miracles for many.
This technique is part of cognitive-behavioral therapy treatment for panic disorder. Other essential elements are cognitive restructuring to help you reinterpret events and sensations more realistically.
Another bit of insight: A large majority of my clients with panic disorder exhibit a lack of assertiveness in their interpersonal relationships. I had noted this anecdotally for some time, but now there is research supporting this.
Finally, I would encourage you to visit this wonderful web site from the Centre for Clinical Interventions and the Department of Health in Western Australia, Panic Stations. This is a goldmine. It is a free set of 12 self-help modules for panic attacks, and it's free!
Be well,
Michael
Read more!
A: Dear Freaking Out,First, take heart because you're in swell company with millions of other Americans who suffer panic attacks. I commend you for taking positive steps now to address your symptoms.
You are right to say that it's all in your head. Panic disorder is a game that your mind plays with you, and you have to outsmart it. The fact is that panic attacks live off your fear of them. That's why just thinking about them can send you into one. Let's look briefly at the components of panic.
Anxiety is an evolutionary development that helped our hunting-and-gathering ancestors survive. When you go into panic mode, also known as fight-or-flight mode, a number of physiological changes take place. Blood rushes from your head to your extremities, resulting in dizzyness, light-headedness, and/or feeling "unreal" or "otherworldly." Your breathing becomes shallow, resulting in a sense of "breathlessness." These are helping you to fight or flee a life-threatening situation. Many people become sweaty; the moisture makes us slippery and difficult for a predator to grasp. The thing to remember here is that anxiety was designed to save us, not hurt us.
Today, we aren't in the literal jungle anymore, but our physiology hasn't caught up. Hence, many people get a small flash of dizzyness or shallow breathing and interpret that they are having a heart attack. Others feel a rush of adrenaline and feel "out of this world," and interpret those sensations as "going out of my mind." They fear they might lose control and run around wildly killing strangers. Others may first have a disturbing "cognitive intrusion" or thought and begin to feel the physiological sensations. In any event,all of these misinterpretations only increase the anxiety and, voila, you have yourself in a panic attack.
The most successful treatment I have used in my practice is symptom induction. In this technique, the client will try to bring on their most disturbing physiological (not psychological) symptoms 3-5 times per day, or when they are starting to have a panic attack. The idea here is not to scare yourself, but rather to try to make your heart pound for about 10 seconds, make yourself feel dizzy for a bit, and so forth. This is a desensitization technique that has worked miracles for many.
This technique is part of cognitive-behavioral therapy treatment for panic disorder. Other essential elements are cognitive restructuring to help you reinterpret events and sensations more realistically.
Another bit of insight: A large majority of my clients with panic disorder exhibit a lack of assertiveness in their interpersonal relationships. I had noted this anecdotally for some time, but now there is research supporting this.
Finally, I would encourage you to visit this wonderful web site from the Centre for Clinical Interventions and the Department of Health in Western Australia, Panic Stations. This is a goldmine. It is a free set of 12 self-help modules for panic attacks, and it's free!
Be well,
Michael
Read more!
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