I’m aware that my blog title is an oxymoron: therapists are not supposed to give advice. We are trained to talk to clients about their thoughts, feelings and  behaviors in such a way that our sessions lead them to finding the answers to what we call their “presenting problems” within themselves. This process takes time, of course. So, if there are no “quick fixes”, especially not for long-standing issues, then why bother giving therapy advice? 

Well, after practicing psychotherapy for almost 20 years, I have learned that some client issues seem universal. For this reason,  as well as for the sake of normalizing our experiences, and adding perspective and understanding to these recurring themes, I decided to create a blog to address some of these common concerns.

DROP YOUR EGO ~ reach out for help when you need it

Don’t confuse not reaching out for help with not needing it. Sometimes, when I tell people what I do for a living, they are quick to respond that they have never worked with a therapist in their lives, and they say it loud and proud. 

So, let me get this straight: because you have not sought out the help, you think that you don’t need it? Along the same vein, if someone with a thick, hairy unibrow says that they have never had their brows waxed, is that supposed to mean that their brows are living up to their full potential? Or does it simply mean that the unibrower has no clue that there possibly could be a brow issue? Or maybe it means that they have a clue, but have not yet come around to seeing an esthetician? Either way their statement means absolutely nothing. There is zero correlation between stating that you have not obtained help in a certain area of your life and not actually needing it

I have an acquaintance, let’s call her Emma, who has reminded me on numerous occasions that she has not seen a therapist and probably never will. The irony is that, of all the people I know in my private circle, she stands out as someone who would not only benefit from therapy, but also from psychotropic medications. Emma is dealing with multiple diagnoses that have sadly been left untreated for a long time, at the expense of not only herself, but everyone in her family and friend group. Yes, refusing support and instead “marching on” impacts everyone, not just the person who is either ignoring or minimizing their issues.

Be suspicious of people who claim that they are “dealing with” severe challenges, such as addictions for example, “on their own” since it is unlikely that their approach will be effective. People with addictions, whether alcohol addiction, or an addiction to any of the other substances out there, need a larger support system and a higher level of care than most. Weekly individual therapy is typically not going to cut it. Instead, they will need an intensive outpatient program (IOP), a partial hospitalization program (PHP) or an inpatient program depending on the severity of the addiction and comorbidity. It is common that people with addictions have a dual diagnosis, meaning an alcohol or a drug problem as well as mental health problems. If we fail to treat both the alcohol or drug problem and the mental disorders, we also fail to set the addict up for success. That makes sense, right?

So, how come that some people don’t seem to realize that they need to change in order to promote a healthier lifestyle, or worse, survive? And how come that other people, even though they have the awareness, are either unwilling or incapable of implementing the necessary steps for change?

To help you better understand why some people have a hard time being successful at making changes, I suggest you take a look at the “Stages of Change”, which is also referred to as “The Transtheoretical Model”. TTM was developed in the late 1970s by two psychologists, James Prochaska and Carlo DiClemente, when they were doing a study to help people quit smoking.

The first stage is the “pre-contemplation” stage. In this stage the person in need of change is in complete denial and does not admit that their life choices create problems in the first place (such as Emma). 

The second stage is the “contemplation” stage. In this stage the person has started to consider that there may be problem behaviors, but feels ambivalent because the costs of making a change seem to outweigh the benefits. 

The third stage is the “preparation stage”. In this stage, the person may start gathering information about what it would take to make a change and maybe even implement a few small changes. Some people never make it past either the first stage, the second stage or the third stage.

The fourth stage is the “action” stage. In this stage the person actively works on accomplishing their goal.

The fifth stage is the “maintenance” stage. In this stage the person has reached their goal and is now doing their best to keep stability and not fall back into old habits in order to avoid “relapse”. Relapse is actually quite common and therefore to be expected. The best approach after a relapse is to get back on the horse and prepare for change again as soon as possible. The good news is that, this time around, since you already conquered the first two stages and acquired several new coping skills before you relapsed, you can now immediately move to the preparation stage and start using your old and new skills again (the ones that were effective anyways). 

After years of conducting therapy, I have learned that it is often our ego that stands in the way of reaching out for help. We believe that accepting help is showing weakness. So, even though we might be suffering, we continue to move on as if nothing is wrong, and we tell ourselves that by doing so, we are being strong. Nothing could be further from the truth: by pretending that everything is fine, we make matters worse, not better. We are stronger when we acknowledge our individual predispositions, limitations, and vulnerabilities. We are stronger when we accept that, at times, we face personal challenges too big to go it alone. During times like these, it is important that we swallow our pride, and reach out to loved ones and professional experts who can guide us through our self-discovery, positive change and personal growth. 

Remember, when you are ready to do the work, there is an entire support network waiting out there to assist you with your healing. Give people in your community the chance to lend a helping hand. Believe it or not, you are actually doing them a favor too: by granting them the opportunity to help you, they get to enjoy an improved mood. When people help others, the brain chemicals that are being released (oxytocin, serotonin, and dopamine) make them feel good. This phenomenon is called the “Helper’s High” or the “Happiness Trifecta”. As a matter of fact, it is a common prescription I give out to my depressed clients to help them find some relief; I suggest that they do some volunteer work, for example. 

Finally, please don’t worry, if you ever feel guilty because you feel indebted to your helpers, keep in mind that there will be plenty of times when the roles will be reversed. One thing in life is certain: it is not static, and this includes your “helpee” or “helper” status – it continuously changes. Therefore, plenty of opportunities will present themselves for you to take on the helper position and as such keep the helpee-helper roles somewhat balanced. When you need help, ask for it and accept it gracefully. When you don’t need help, pay it forward.

10 Fair Fighting Tips

When you feel yourself becoming emotionally dysregulated during an argument with your partner, here are 10 suggestions:
1. Take a break; practice a calming technique, such as a walk around the block, before you engage.
2. Avoid name-calling and swear words; they are insulting and cause embarrassment, or worse, shame.
3. Avoid the words “always” and “never”; they are examples of all-or-nothing thinking and generalizations, which are two thinking errors.
4. Avoid yelling and interrupting; let your partner finish and use a calm voice when it is your turn to talk.
5. Avoid projecting your negative feelings and thoughts onto your partner; projection is a defense mechanism and is counterproductive – it will lead to escalations, not solutions.
6. Avoid “you” statements; they are offensive and lead to defensiveness. Instead, start with an “I” statement, then add a feeling word, and finally, keep the issue in the here-and-now and specific. For example, “I (I statement) am feeling anxious (feeling word) right now (here-and-now) with you driving 95 miles an hour on the highway” (specific), instead of “You (offensive) always (cognitive distortion) drive like a maniac (name-calling) on the highway.
7. Listen to your partner, and once your partner is done talking, repeat back what you heard them say. For example, “What I heard you say is that you get scared when I drive too fast on the highway”. Paraphrasing is the best way to validate your partner.
8. After validating your partner, show curiosity. For example, “Can you tell me more about your anxiety; what does it feel like?”, or “Do you always feel scared when I drive at this speed”? or “Are there other things that I do that scare you?”, etc.
9. Avoid “moving on” from the issue until you are both okay with letting it go. Usually, the partner, who was most hurt, needs more time to recover, so let them call the shots when it comes to the amount of time it takes to repair the relationship. Don’t shut your partner out by withdrawing and emotionally abandoning them.
10. Whenever you can, schedule heated topics at a time that suits you both, so you have control over when (e.g. after the children are in bed), where (e.g. in the privacy of your own home), and with who (preferably just the two of you) the argument occurs. Remember: your partner is not the enemy; they are your ally and you belong on the same team!

The A-N-S-W-E-R to “How to deal with painful feelings?”

A – Allow the painful feeling (it’s OK; you will survive it)
N – Name the feeling (label it; then ask yourself where in your body it is located)
S – Spend time in stillness to sit with the feeling (let your body experience it; ease
into it until it creates discomfort, but pull back if it creates pain)
W – Wallow in the feeling (give yourself permission to be self-compassionate)
E – End the wallowing in the feeling (give yourself 2 to 20 minutes, then distract
yourself with a pleasure activity; what usually makes you feel a little better?)
R – Release the feeling (let it go for now; it may come back, and that’s OK too)