By: Nicole Ball, LMSW Mental Health Therapist and Owner of Mental Wellness Counseling: A Traverse City Counseling Practice
Things are tough right now. Many of us are struggling to see the brighter side of things. When we do, it might come in waves; one day we are productive and feeling optimistic about the future, and the next we are crying and fearful about how long the health crisis will last. But practicing gratitude is a proven method that can help not only manage our immediate emotions, but also have lasting positive effects on the lens we see the world through.
Bring grateful is expressing emotion of appreciation and recognition. This can be done in many ways. It can be saying “thank you” to others, identifying what you are thankful for, or recognizing the efforts of others that you might otherwise take for granted. It could also be identifying those things within ourselves that others might see, but we often don’t view as a valuable part of ourselves.
By intentionally and regularly being grateful you are reinforcing the hormones connected to happiness. You are training your brain to be happier and to automatically recognize those things that you have to be grateful for. This will make us happier because it disconnects us from negative emotions.
There is much research that shows that purposely practicing gratitude increases physical health. This is seen in lowers negative hormones like Adrenaline, Cortisol, Norepinephrine, as well as less inflammation, betters sleep and better eating habits.
When the lens we see the world through is tinted with feelings of gratitude and thankfulness it also strengths our relationships, helps us feel more satisfied with our roles or jobs and makes burnout less likely.
So, in the midst so much uncertainty, how can we do this?
Start a daily gratitude list. This is a great way to intentionally identify those things we are thankful for. Start every morning with a quick list of 5-10 things you are grateful for. It starts your day with a lens of happiness and hope. And when the day gets tough you can go back to your lists and review. By practicing this daily you will start to see the lasting effects in how you view the world around you, how you treat others and how you react emotionally to stress.
Send messages of thanks and support. Words have power. Send a message to someone thanking them for their relationship, their service, their skills or their support. Tell someone how much you appreciate them and value their role in your life or in your community. Spreading gratitude to others has immediate positive effects.
In a time when we might feel little control over our surroundings, this is another way that we can turn the focus to what we do have control over. We can control the lens we view an unpredictable world through and be grateful for the many things in our lives that keep us sustained and bring us joy.
Our New Normal: Originally published in the Traverse City Record Eagle
Nicole Ball, LMSW
Life has changed
Life has changed. For everyone. In so many ways.
Many of us are now working from home. Maybe trying to
balance parenting while working; and we are struggling. Many of us have lost
our jobs or our businesses; and we are struggling. Many of us are lonely; and
we are struggling.
Many of us are scared. Scared because we have children or
parents who are at risk, or because we are at risk. Many of us are scared
because we are working on the front lines in the medical field and this is not
what we sign up for, but we are going to keep showing up. Many of us are
essential workers and we are exposed to the public every day.
Most of us are anxious about when this will end.
Some would say that our new normal is uncertainty, struggle,
survival and fear.
But I say our new normal is of strength, resilience, love and patience. We are learning, in our new normal, that we have a much deeper capacity for all these things. And guess what? Each of them is stronger than fear!
So, what can we do? How, in all the uncertainty, do we re-frame our perspective from fear to the strength and resiliency that is already there?
Re-frame and Re-focus
First, focus on what we have control over. It feels like we
have very little control right now, but we can control our actions. For example, we can keep in touch with your
friends and family by checking in and making efforts to connect. We can ensure
that we are taking care of our bodies by getting outside, going for walks or
enjoying fresh air. We can control what we can do with our time, to be
productive and clean out that closet we have been meaning to get to. Or even
the choice to do nothing and just binge watching our favorite TV shows. We can control what we do for our communities
and those in need. We can control what we do for our mind by making space for meditation,
prayer, quiet moments or breathwork. We can control how we nurture our
creativity by doing activities we enjoy. And we can ignore the pressure that
seems to be coming from every angle to be overly productive.
Next, we can limit media exposure. Yes, we should be informed,
and it is important to be up to date on the latest information regarding our
safety. Although spending too much to time on social media, researching or reading
the news can cause increased anxiety and feed the fear. Allow the space and time for this but do so in
a way that limits the duration and frequency and offers time to decompress
We can also do things that keep us, those around us and our
communities safe. We can practice social distancing, stay home if we are sick, wash
our hands and follow other CDC recommendations. We cannot control others that
are not following rules related to social distancing or sheltering at home. We
cannot control how much toilet paper or bread others are buying. We cannot
control others who may not be taking safety measures as seriously as we are. But
we can control how we keep ourselves safe, how we react to others and how we
treat one another.
There is no roadmap for how to live this new normal. But we can create the roadmap. We can re-frame our focus to what we are already doing. We are being strong, being resilient, showing love and support to those around us and our communities. This is our new normal. So, take time to see the strength in yourself, acknowledge it, show gratitude for it and then pass it on.
For many of us, winter brings what is sometimes called
the “winter blues” or “cabin fever”.
Most of us in Northern Michigan are familiar with these feelings. Lack
of sunlight and being cooped up in our homes for months can cause low energy, frustration
and the longing for warm summer weather. The promise of spring keeps us going
but certainly not without some discomfort as we wait oh so patiently for
But for many people winter can cause suffering in the form
of depression known as Seasonal Affective Disorder. Seasonal Affective Disorder
(SAD) is a form of Major Depression that occurs in a seasonal pattern, often with
onset of depressive episodes that begin in fall or winter and usually subside
in the spring.
Symptoms of SAD may include feelings of deep sadness
and depression, having low energy or feeling sluggish, becoming easily
agitated, loss of interest in activities that you may have once looked forward
to, trouble sleeping or concentrating, changes in weight or appetite, having
frequent thoughts of hopelessness or thoughts of self-harm.
When symptoms are minimal there are steps that can be
taken to combat these feelings.
Refocusing your diet and exercise routine can help
reduce symptoms. In the winter months we tend to be more laxed in our approach
to exercise and food. Refocusing how you are fueling your body may help to
reducing low energy and sluggishness. As well, exercising releases “feel-good”
endorphins that can boost your mood and attitude.
Scheduling time to get outside or planning events to
look forward can also help. Fresh air can increase energy levels, while increasing
concentration and brain functioning. Planning family events or time out with
friends can provide distraction from the cold weather, while giving you much
needed social interaction that can be lacking when the snow is keeps us stuck at
But when these techniques are not working and you find
continued feelings of hopeless, have ongoing feelings of depression, are
withdrawing yourself socially, experiencing problems at work, if you are
abusing substances or are having thoughts of suicide, then it may be time to
seek professional help. Talk to your doctor about your options such as
medication or light therapy, see a mental health profession to talk through
your feelings and address your mental health needs, and if immediate help is
needed go to your local emergency room or call the National Suicide Prevention
Hotline at 1-800-273-8255.
The holiday season is considered ‘the most wonderful time of
the year’. But for those who have lost loved ones, it can be the most difficult
time of the year. The approaching holidays can feel discouraging and often come
with a complicated mix of sadness, sorrow, anger and pain as we miss the ones
we have lost.
Grief during this time of year can also lend itself to
feeling as if we must experience the holidays in a ‘normal’ way. Others often
have expectations for us that can feel unmanageable and impossible to meet.
Anticipating traditions that once brought delight can feel scary or painful.
What can we do if we are experiencing grief during the
Find a way to honor those that cannot be with you. A special
ornament, a favorite dish at the dinner table, set aside time to share memories
together, sing or play a special song, donate to a charity in their name, light
a candle, volunteer your time in the community in their honor or create new
Help those who might also be grieving or need extra help
during the holidays. Helping others and giving back can bring joy. It can be a
new way to honor those lost and help someone who may be feeling the same difficulty
during the season. Adopt a family to purchase gifts for, donate to an
organization, volunteer your time, visit a nursing home, give to a local shelter
or reconnect with those you have lost touch with.
Don’t feel guilty if it all feels like too much. It’s okay
to not send out holiday cards if it is too difficult. It’s okay to say no to
another holiday event. It is okay to not want to participate in everything.
Allow yourself the space to be alone, make time for yourself, practice
self-care and honor your own feelings. As well, don’t feel guilty if you are happy during the holidays. Feeling
joy does not lessen how much you miss the person you have lost.
Ask for help. Identify the supportive people in your life
that can offer a listening ear or a shoulder to cry on. Don’t be afraid to ask
someone to bring a dish, or two, or three when putting together a holiday
spread feels like too much. Seek out those that would be willing to help you
decorate when it all feels a bit daunting. Ask a friend to go shopping with
you, meet for coffee or visit your loved one’s memorial with you. Oftentimes
those around you want to help but just don’t know how. If you reach out, they
often find great joy in being there for you.
Acknowledge that the holiday season will be different. When
we enter the holidays expecting to feel the same amount of happiness we always have,
we will experience even deeper sadness when feelings of grief come. Give yourself
the permission to experience grief rather than feeling as if you must be happy
to make the holiday ‘normal’. It is okay to feel the pain of your loss. The
more we try to be strong and protect ourselves from the pain, the more it seems
to grow. Allow yourself to feel the pain. Your pain is the result of love, and
love should be honored and acknowledged.
The Mental Wellness Counseling “Meet the Counselors” series offers a deeper look into each counselor’s background, experiences, motivations, values, and philosophies. In this series, I put counselors on the couch to learn why and how they do what they do.
Q: What experiences have you had that make you feel capable of being a counselor?
A: Before my counseling work, I worked at a homeless shelter with women and children. My main job was to make sure everybody was where they needed to be, had what they needed, and resolve guest conflicts. I had a big spread of opportunity to interact with a lot of people with different religious views, cultural backgrounds, and ethnicities. Also, there’s addiction in my family history. My brother dealt with addiction, so I’m able to relate with people on that aspect.
Q: Why are you passionate about working with children?
A: There’s a special place in my heart for kids. They have this wonder about them. They give you a taste of the simpler things in life and remind you of things that don’t matter as much, or things that do.
Q: What is play therapy?
A: Play is a great way for children to express what they’re going through. There’s toys in a room; it’s a free space to let the child create and express what they’re feeling and thinking without words. During the session, the counselor tracks what the child is doing, picking out their actions and emotions.
Q: What is the most important characteristic for a counselor?
A: You have to be a good teacher. An ideal teacher listens, gives information and direction, but also gives the chance to seek solutions. At the homeless shelter and as a teacher’s assistant in a daycare, I tried to help people resolve their problems. Sometimes people really beat themselves up, so I try to convey an atmosphere of “I believe in you, you can do this. You’re not a failure in life; you’re an amazing person.”
Q: What are the challenges or most difficult aspects of your work?
A: Everyone has experienced some trauma in their life to varying degrees. When I’m dealing with trauma, it’s very difficult to keep that separate from my own life, to not take the burden home with me. As a counselor, it’s important to find your own internal validation—feeling good about yourself—not based on your clients’ success or failure.
Q: What is the most satisfying, rewarding thing about what you do?
A: When a client has a lightbulb moment. When you bring up things that you notice in sessions and they’re like, “you’re right, I didn’t notice that.” That’s so powerful, because we don’t always see in ourselves the progress we’re making. When someone else can point it out and when they start to recognize it on their own, it’s so great. They’re noticing, thinking inwardly, and seeing the good in themselves.
Q: Future plans?
A: I’m starting to build up my practice in Traverse City since I’m new to Mental Wellness and Traverse City. I hope to become a registered play therapist and still do private practice counseling. I would also like to train in EMDR to utilize it in trauma counseling.
Click here to learn more about Jessica or to schedule an appointment.
Last week, as I was laying on my yoga mat in the beginning of a Friday evening yoga class, my instructor gracefully stated that “one is the union of the mind, body and consciousness.” As a mental health professional, this truly resonated with me and I thought about it as I practiced that night. Overall health requires so more than drinking green smoothies, practicing yoga or running a 5k.
Now don’t get me wrong, while those are all healthy things that I also engage in, being in good health is so much more. Mental health is an essential and vital piece to one’s overall health. May is national Mental Health month and here are five ways that you can promote your own individual mental health each week.
Mental Health Tip #1 | Creativity and Play
Coloring books are not just for kids anymore – they’re for everyone and actually can be quite helpful in reducing stress. Coloring also can provide a space for creativity. Recent studies have shown that coloring can offer the same mental health benefits as meditation. Coloring in between the lines requires concentration and focus, which relaxes the mind and can be therapeutic. Grab a cup of your favorite herbal tea, coloring book and Crayola crayons for a low-stress activity that will give bring you relaxation and allow your subconscious to drift away.
Mental Health Tip #2 | Grow Mindfulness
Let’s all hop on the Social Media-less Monday train y’all. We live in a culture of busyness, where filling up your schedule is looked at as being successful. Slowing down, disengaging from technology and social media can allow your mind to de-stress. Mindfulness has shown to be effective in reducing anxiety, feelings of depression, chronic pain and increase the ability to cope with negative feelings. Try eating your lunch mindfully, away from your work desk without any distractions, and focus on each individual bite. Take ten minutes at the end of each day and journal any thoughts that come to you without judgment or criticism. Go for a hike with your dog or go for a walk in the woods without your iPhone – be fully present in that moment – think only about who you are with and what you are doing in that moment.
Mental Health Tip #3 | Self-compassion and Gratitude
By focusing on what you have or what you did well, instead of what you do not have or what how you feel like you failed, you can start to live a life rich with purpose and meaning. Start each day by writing or sharing three things in your life that you are grateful for. Let go of any judgmental or critical thoughts, and allow kind and compassionate thoughts to drift in and replace them. Eat a nutritious and delicious meal that feeds your body, mind and soul. Work each day to maintain a sense of humanity by being kind to yourself.
Mental Health Tip #4 | Community and Connection
People need people. Surround yourself with people that love you, support your goals, dreams and nourish your soul. Give back to the community and volunteer as a mentor or local food pantry. Each lunch with a co-worker that you don’t know that well, or call an old friend that you haven’t talked to in a while. If someone is toxic in your life, let them go. The toxicity can spread in other areas of your life beyond your relationships. When you engage in relationships that are meaningful, it gives you a sense of purpose, community and connection to the larger picture.
Mental Health Tip #5 | Mindset
Mindset is everything. Working towards a growth mindset, the term coined by Carol Dweck, can increase motivation, self-esteem and productivity. It can also enhance the quality of relationships that you have in your life. A positive mindset can affect the thoughts that you have about yourself, capabilities and abilities for the better. As Theodore Roosevelt would say, “believe in yourself and you’re halfway there!”
Being in good health isn’t just about eating well and working out, mental health is just as important, if not more! Focus on ways you can promote your mental health, not about intervention when things build up or go wrong. Promote your mental health by engaging in the activities, thoughts and experiences above that benefit your overall health.
Tarah K. Elhardan is a Licensed Professional Counselor (LPC) and Nationally Certified Counselor (NCC) and joined Traverse City counseling practice, Mental Wellness Counseling in 2013. Tarah wants to reassure individuals and families struggling with difficult life events that they do not have to face their issues alone. Tarah is a native of Traverse City who has a passion for helping others find happiness and peace within themselves. She works from a cognitive-behavioral therapy approach where she helps clients find how their thoughts and behaviors connect.
She focuses on food intolerance such as gluten-free living, lactose intolerance, and other eating issues. Through her own personal experiences and research with she has found a passion for nutrition and its connection with mental health. Tarah takes a holistic approach to counseling, considering the mind and body as a whole. She feels that one needs to have a healthy mind to live a happy and fulfilling life.
Once will change your day and more will change your life.
According to the Anxiety and Depression Association of American states that “anxiety disorders are the most common mental illness in the U.S., affecting 40 million adults in the United States and older, or 18% of the population.”
It is also not uncommon for individuals with anxiety to also suffer from depression, the reverse is also true.Since, anxiety and depression are so intimately linked, this actually can be a good thing. When one of the presenting issues is addressed, and symptom intensity can be reduced, managed and positively managed, the symptoms of co-occurring diagnosis more likely than not will lessen as well.
What does anxiety look like?
Anxiety can appear at the surface to be something that will never go away, and it won’t, but what if anxiety could be a positive in life. Anxiety is a reaction in our body for a reason, it communicates to us that something is not right. That attention is needed, much like when our stomach growls, our body communicating “Hey, it is time for dinner!”
If an individual is diagnosed with an anxiety disorder, most likely, anxiety has gotten the best of that person, causing a disruption in life that is no longer acceptable, and therefore has sought out treatment with a professional counselor. Even, if someone has anxiety and is not in treatment, they can also effectively manage anxiety and stress.
How to cope with anxiety
One of the most effective ways to reduce, manage and mindfully cope with stress and anxiety is through mindful breathing and meditation. Meditation has been around, well for a really long time. Spanning the test of time for its effectiveness, it may be one of the most beneficial practices a person can introduce into their daily or weekly life.
The basic Principles of Meditation are the following:
Meditation uses the breath in such a way that it allows for the mind, and therefore the body to ground, to relax and activate the parasympathetic nervous system (aka the relaxation response), reducing the production of cortisol and other stress encouraging hormones. Focusing on a mantra, a word, a sound, your breath, your body, the list is endless, begins to draw your mental focus away from those anxious feelings and into our practice.
Once, you’ve dropped those or reduced those stressful feelings, letting go into that space still silence. If a thought or two or three pops up, simply observe it, and let it float by. And repeat for whatever duration of time you deem best for you. The mind and body are connected, arguably they are the one in the same. If the body is stressed, the mind follows. If the mind is stressed, the body follows. Meditation allows for anyone to relax the mind, relax the body, relax the body, relax the mind, therefore reducing symptoms of anxiety.
Quick Note: We also use technology to teach this at Mental Wellness Counseling. We have Muse, the brain-sensing headbands that we use in counseling.
The benefits of a meditation practice are many and backed by science.
Reduced hypertension (blood pressure)
Lowers risk of heart attack and stroke
Decreases stress, anxiety and depression
Decreases panic attacks
Reduces sensitivity to pain
Increases awareness and focus
Improved quality of sleep
Increased brain growth
Increases circulation of oxygen in the blood stream
Increases lung capacity
The practice of meditation does not have to be scary, nor for the elite or the so-called enlightened. Meditation is for everyone; for the young ones, teens, students, moms & dads, grandmas & grandpas, the CEO’s and Yogis. It is especially for anyone desiring an improved quality of life or at the least to take the edge off.
After starting a meditation practice one might even start to notice bizarre and fascinating things occurring such as:
You get more done
You feel more rested, alert and maybe consuming less coffee
The little things don’t get under your skin as much as they used to
You start noticing magic in your daily life
You feel more fulfilled by conversations and connections rather than material things
Self-defeating behaviors (SDBs) are behaviors used to protect oneself against perceived dangerous stimulus from the outside world. These behaviors are often not regarded as self-defeating initially, but rather survival mechanisms. An example could include a young child who is outgoing, but is continually regarded as irrelevant. This contrast could bring SDBs such as negativism or alienation to protect him/her against classmates’ attack.
SDBs tend to live far beyond the initial encounters and become staples of current and future personality traits. The Boothroyds further state that defeating behaviors interfere with the true internal self. Through continual use they can damage physical health, social and interpersonal connections, mental, emotional, and spiritual growth, vocational and educational connections, and financial stability (p 5).
The Boothroyds list of common self-defeating behaviors include:
substance abuse – used as a form of escapism
inferiority – constantly comparing oneself with others
excessive worry – can cause possible health issue due to created stress
alienation of others – can lead to loss of possible life-giving and changing contact
defensiveness – not willing to listen to others makes one shallow in understanding different points of view
negativism – it is hard for others to enjoy a relationship if it is never positive in nature
procrastination, disorganization, and indecision – these could all be unhealthy traits for the implementation of a career choice
The Continuing Pattern of Self-Defeating Behavior
In Going Home, the Boothroyds describe continuing SDB as a circular pattern of behavior. Each step the individual partakes in further strengthens the SDB response imbedded in the unconscious.
The steps are as follows:
Situation (Flashpoint): Something strikes a chord and the SDB is initiated; cues bring out the SDB response.
Conclusion (what the behavior is supposed to prevent): Experience now shows that the SDB is the safest and the smartest thing to do for that particular situation and it is repeated.
Fears (If I don’t use the behavior then….): Individuals wants to avoid being in a frightening situation without the SDBs that have protected them for so long.
Choice (to throw the self-defeat switch again): This stage happens so fast one does not realize they have made a decision to use old SDB; it is an unconscious reaction.
Techniques (tools to implement the choice): Techniques are any kind of thought and action that help promote and deliver the SDB.
Results (consequences of the choice): Using SBDs over time greatly affects one’s emotional and physical well-being. The result stage can be an important avenue of change when one realizes what was lost and is finally willing to do something.
Minimizing (denial of results): A person using SBDs denies that the behavior is bad.
Disowning (dump the responsibility): This stage allows the individual to release the responsibility to anyone or anything other than themselves for their behavior. The individual paints him- or herself as the victim of circumstances.
How to Eliminate Self-Defeating Behavior
The Broothroyds share that “it’s time to rediscover and thereby recover home that place within us that’s not in form, not in time and not in space. It’s just here – waiting and beckoning” (p 41).
How to go about rediscovering oneself is laid out in the following 12-step program:
Step 1 – Identify your self-defeating behavior: One should pick a strong, often-used SDB and focus attention on one at a time. The SDB chosen may affect other SDBs and you may kill two birds with one stone.
Step 2 – Isolate the flashpoint situation: What creates the stimulus to use the SDB? What particular events or situation arouse your need to use the SDB? It is important to connect arousal points so as to be know when to be aware of your responses to situations.
Step 3- Identify your favorite techniques: Techniques are used to carry out the SDB. This is the stage that gives you the ability to catch yourself before implementing an old SDB. The Boothroyds use examples of internal techniques, such an individual dwelling on past hurts or anticipating negative results, and external techniques, such as failing to meet obligations and manipulating others.
Step 4 – Do a thorough damage assessment: This is a critical stage in which an individual assesses and connects the dots, so to speak, with SDBs and the effects they have on many aspects of one’s life.
Step 5 – Identify your minimizing strategies: In this step, it is time to confront your past minimizing behavior after using SDBs. It takes courage for the individual to realize what is truthful about their behavior and its effect on the quality of one’s life.
Step 6 – Identify your disowning targets: Now it is time for the individual to face their personal responsibility for past behaviors.
Step 7 – Identify a replacement behavior: People need this step to fill the void in a positive manner that will replace the old SDB.
Step 8 – Identify replacement techniques: This step encourages the individual to realize that to be able to sustain behavioral changes will not be easy, and that it will be a continual work in progress.
Step 9 – Seize the moment of choice: In this step, it is critical that the individual empower the moment of choices. Take advantage of the changes of behavior one has been working on and don’t be afraid to implement them into a process of action.
Step 10 – Identify life-generating results: This step revisits step 4 but instead of listing a self-defeating behavior and its effects, the prescription of this step is to list all positive consequences of the life-generating behavior. Listing positive outcomes will hopefully be a positive reinforcement toward the implemented behavioral changes that are underway.
Step 11 – Maximize and enjoy the results: One should be able to take credit for his or her behavior. This does not mean becoming cocky about what one has accomplished, but rather giving oneself credit for the new pathway one is traveling in generating a new lifestyle.
Step 12 – Own your new behavior: Finally, one should be able to enjoy the fruits of his or her labor. Realizing the importance of this accomplishment will hopefully give one confidence to tackle other aspects of life that may also be leading to SDBs.
SDBs are powerful avenues that people take to live their lives. Many times, one does not realize how strong the emotions are in wanting to not be hurt. The goal is to become what Abraham Maslow describes as a “fully functioning individual” versus an individual striving to survive and cope in the scary world that we envision is around us.
“Self-acceptance comes from meeting life’s challenges vigorously. Don’t numb yourself to your trials and difficulties, nor build mental walls to exclude pain from your life. You will find peace not by trying to escape your problems, but by confronting them courageously. You will find peace not in denial, but in victory.” Donald Walters
“Every habit he’s ever had is still there in his body, lying dormant like flowers in the desert. Given the right conditions, all his old addictions would burst into full and luxuriant bloom.” Margaret Atwood
When discussing an addiction or dependency, most standard beliefs center around the continued repeatability of use of a substance and/or behavior, in which the user loses site of the ramifications of his/her actions. The user can become so attached to substances or an action (pornography, gambling) that the instant gratification of the moment far overrides the consequences.
It is like having a little voice on your shoulder telling you everything will be fine–go ahead–just one more. Someone who is fighting an addiction or dependency is fighting both urges from the outside world and a battle with voices inside of themselves.
Negative Reinforcement: I am Worthless Because You Say I Am
Many of my clients have suggested their addictive behaviors began with the need to escape or numb from the world around them. They understood the consequences of their addictive behaviors, but the pain—through either anxiety or depression—was so intense they could not seek any other alternative.
To someone overwhelmed in the moment, long-term recovery seems as difficult and tedious as climbing a mountain. On the other hand, their addictive behaviors can be instantly satisfying.
All of the judgment and opinions from friends and loved ones in fact become reinforcement to continue. To a certain extent, it is socially acceptable to use alcohol, gamble, or shop when emotionally stressed, as long as you don’t cross certain social norms. When a user does violate those norms, the reaction of others reinforces the feelings of weakness, worthlessness, and being out of control. So, he thinks, I might as well keep using.
As Robin Williams once stated in Weapons of Self-Destruction: “As an alcoholic, you will violate your standards quicker than you can lower them.”
When talking about any kind of addiction, it is important to recognize that its cause is not simply a search for pleasure, and that addiction has nothing to do with one’s morality or strength of character. Experts debate whether addiction is a “disease” or a true mental illness, whether drug dependence and addiction mean the same thing, and many other aspects of addiction.
Pleasure Principle: This is Your Brain on Drugs
The brain registers all pleasures in the same way, whether they originate with a psychoactive drug, a monetary reward, a sexual encounter, or a satisfying meal. In the brain, pleasure has a distinct signature: the release of the neurotransmitter dopamine in the nucleus accumbens, a cluster of nerve cells lying underneath the cerebral cortex. Dopamine release in the nucleus accumbens is so consistently tied with pleasure that neuroscientists refer to the region as the brain’s pleasure center.
All drugs of abuse, from nicotine to heroin, cause a particularly powerful surge of dopamine in the nucleus accumbens. The likelihood that the use of a drug or participation in a rewarding activity will lead to addiction is directly linked to the speed with which it promotes dopamine release, the intensity of that release, and the reliability of that release.
Even taking the same drug through different methods of administration can influence how likely it is to lead to addiction. Smoking a drug or injecting it intravenously, as opposed to swallowing it as a pill, for example, generally produces a faster, stronger dopamine signal and is more likely to lead to drug misuse.
Is it a wonder that a depressed individual would seek out this pleasure—any form of relief from the darkness that surrounds their soul?
Diagnostic Criteria for Addiction
Based on the criteria by the American Psychiatric Association (DSM-IV) and World Health Organization (ICD-10) an addiction must meet at least three of the following criteria:
Do you use more alcohol or drugs over time?
Have you experienced physical or emotional withdrawal when you have stopped using?Have you experienced anxiety, irritability, shakes, sweats, nausea, or vomiting? Emotional withdrawal is just as significant as physical withdrawal.
Limited control. Do you sometimes drink or use drugs more than you would like? Do you sometimes drink to get drunk? Does one drink lead to more drinks sometimes? Do you ever regret how much you used the day before?
Negative consequences. Have you continued to use even though there have been negative consequences to your mood, self-esteem, health, job, or family?
Neglected or postponed activities. Have you ever put off or reduced social, recreational, work, or household activities because of your use?
Significant time or energy spent. Have you spent a significant amount of time obtaining, using, concealing, planning, or recovering from your use? Have you spent a lot of time thinking about using? Have you ever concealed or minimized your use? Have you ever thought of schemes to avoid getting caught?
Desire to cut down. Have you sometimes thought about cutting down or controlling your use? Have you ever made unsuccessful attempts to cut down or control your use?
Many people with addiction issues who I have spoken to shared how they had a high tolerance, and could drink more than peers when in their early stages of drinking. At the time, one who could chug the beer and down the shots and still be able to stand was regarded in high esteem. Many clients have told me, though, as life went on, having a high tolerance for booze became a curse as it became a thirst that could not be quenched.
Relapse and Recovery
Symptoms of addiction include tolerance (development of resistance to the effects of alcohol or other drugs over time) and withdrawal, a painful or unpleasant physical response when the substance is withheld.
Many people who are addicted deny it. They often emphasize that they enjoy drinking or taking other drugs.
People recovering from addiction can experience a lack of control and return to their substance use at some point in their recovery process. This faltering, common among people with most chronic disorders, is called relapse. To ordinary people, relapse is one of the most perplexing aspects of addiction. Millions of Americans who want to stop using addictive substances suffer tremendously, and relapses can be quite discouraging.
To appreciate the grips of addiction, imagine a person that “wants to stop doing something and they cannot, despite catastrophic consequences,” says Dr. Nora Volkow, director of the National Institute on Drug Abuse. “We’re not speaking of little consequences. These are catastrophic. And yet they cannot control their behavior.”
Many in the addiction recovery field suggest that it takes more than just “not using” to fully recover. Recovery needs to come from the heart and the way one perceives him- or herself.
The following are important points your clients in recovery should know:
Check into your values; what’s important to you. What are the things that mean more to you than remaining addicted.
Develop and practice the skills you need to manage your life without relying on your addiction
Learn how to control addictive urges through mind management techniques
Find and appreciate the rewards that come from a “sober” (non-addicted) lifestyle
Build and appreciate personal relationships and turn to positive communities for support and companionship
Find your purpose and plan a future that leads to accomplishing your life goals
Mature into a new, non-addicted you — a person who simply and naturally rejects addiction in all forms
“I am spinning the silk threads of my story, weaving the fabric of my world…I spun out of control. Eating was hard. Breathing was hard. Living was hardest. I wanted to swallow the bitter seeds of forgetfulness…Somehow, I dragged myself out of the dark and asked for help. I spin and weave and knit my words and visions until a life starts to take shape. There is no magic cure, no making it all go away forever. There are only small steps upward; an easier day, an unexpected laugh, a mirror that doesn’t matter anymore. I am thawing.” Laurie Halse Anderson, Wintergirls
“You can get the monkey off your back, but the circus never leaves town.” Anne Lamott.
In the modern recovery world “rehab” can mean many things. To treat addictions a person can choose long-term (usually 90 days) and shorter-term (30 days to 2 weeks) in-house programs. Each type of program has its own specific strengths and weaknesses.
The benefit of an inpatient program is that an individual is isolated away from their substance of choice and is thus given an opportunity to begin to think clearly. Isolation away from behavioral triggers allows them to focus solely on their recovery without distractions from the outside world.
Over time, family members and close friends may be invited to participate in visiting days or family therapy sessions. This helps to build the support system that is so crucial to those in recovery once they leave the rehab facility.
In outpatient, the individual has freedom of movement and is able to handle day-to-day activities of life outside of a facility. Depending on possible involvement of court system, there could be required drug testing in place.
An outpatient program gives an individual the opportunity to gather facts and converse with fellow members of the group to learn coping skills to avoid the decisions of the past. Outpatient care is best for those with short-lived dependence and is not recommended for those with serious or long-term addictions or those with dual diagnosis conditions.
What Happens in Rehab
Once an individual passes through the initial detox from drugs or alcohol, they will move on to the rehabilitation portion of the recovery process. The rehab portion of recovery is where the patients get to evaluate the underlying reasons behind their addictions, addressing those issues so they can effectively move on with their lives without going back to drugs, alcohol, or other addictive behavior.
In individual behavioral therapy, the patient will identify when they began using the substance and why they started abusing it. The patient will receive strategies on how they can direct their time to focus on getting involved in new hobbies or interests. Time management skills will allow them to better use their time so they have less opportunity to think about relapse.
Patients learn to identify triggers, and how to deal with these triggering situations when they come up. If patients have a plan for various tempting situations, they are more likely to put their plan into action and avoid relapse. This type of cognitive behavioral therapy also addresses thoughts that patients have in relation to substance abuse, or life in general. It helps to reform their thinking patterns and make behavioral changes toward a healthy, sober life.
The addiction rehabilitation process usually includes group therapy. These group sessions allow the recovering addict to interact with others who are in the same situation. It is often helpful for recovering addicts to know that they are not alone in their struggles. Likewise, it can be beneficial for addicts to share their own stories of addiction and recovery, as others find solace in them. This sense of community support is integral to the recovery process.
Most addiction rehabilitation facilities offer family therapy as part of their program. Addiction is far-reaching, affecting many more people than just the individual with the addiction. Family members are often those who are most deeply affected by their loved one’s addiction, and they are an important component of the recovery process for that person.
Initially, patients may be restricted from contacting loved ones, but later in the recovery process, family members are often welcomed to participate in family therapy sessions. During these sessions, family members can discuss pain caused by their loved one’s addiction and their desire to see that person live a healthy life. Family therapy can help to resolve issues so the family can serve as a pillar of support once their loved one leaves the rehabilitation facility.
There is no one-size-fits-all solution to treatment.
Different treatments work for different people.
Patients must commit enough time to treatment in order to effectively overcome their addictions.
Everyone should have easy access to treatment when they need it.
Addiction affects the way the brain works.
Effective treatment should address all areas of the addict’s life, not just the abuse or addiction.
Medicinal treatment is often necessary and should be used in conjunction with therapy.
Treatment plans should continually be tailored to meet the individual’s needs and circumstances.
Mental disorders are often linked to drug addiction and should be addressed in treatment.
A setting that provides recovery in a holistic manner and provides services that treat the underlying reasoning behind the need to escape or numb is critical to helping those we serve to find long-term recovery.
The best services include the following components:
Individual and Family Therapy
Individual Treatment Plan Creation
The service must be helpful in creating long- and short-term goals in the recovery process:
Establishing an individual relapse prevention plan
Daily reflections and meditations
Learning how to encourage longer-term dependent free living
Creation of a spiritual-based premise of a higher power
To meet the goals prescribed above a service covers areas such as:
Past and current medical history
Employment and educational background
Basic needs being met currently
Substance abuse history
Legal issues (current and past)
Family/social genogram of dependent history
Psychiatric diagnoses (current and past)
Personal insights and supports each client has
What Exactly is “Recovery”?
After a patient has completed a rehabilitation program, they are not finished with recovery. In fact, recovery is a process that an addict must work at for the rest of their life.
Sometimes, the path to lifelong recovery will be easy. Other times, it will be difficult for individuals to withstand the temptation to relapse. Like anything in life, it’s a journey that may feature varying terrain, so constant support is essential.
Prior to leaving an addiction treatment program, a patient will meet with counselors to discuss a plan for aftercare. Many addiction rehab facilities offer follow-up programs to assist the patient as they return to normal life.
These may include weekend stays back at the rehab center when the individual feels a touch-up stay is needed. Or a patient may live in a sober living facility for a while with other recovering addicts before returning home. This offers a supportive transitional time for recovering addicts before being thrown back into “normal” life.
Many patients maintain regular therapy sessions post-rehab, and some submit to scheduled drug testing as a way to keep them accountable to their sobriety. Group therapy is a method for building a support system in your local area. Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) are well-known 12-step groups that many recovering addicts attend on a very regular basis. Both AA and NA have meetings all across the country at easily accessible times.
There are various offsprings of the AA model for a wide range of other addictions, such as Overeaters Anonymous (OA), Emotions Anonymous (EA), Gamblers Anonymous (GA) and Sex Addicts Anonymous (SAA). There are also subsets of NA for specific drugs, like Cocaine Anonymous (CA) and Crystal Meth Anonymous (CMA). Some addicts find the type of support they can get in very specific 12-step groups is more beneficial, whereas other addicts gain the help they need from more general groups.
In the end the most important aspect of any rehab and recovery is that it is not just the mind thinking about recovery but also the heart. One must be willing to sacrifice immediate gratification with at times a long arduous plan that leads to fulfillment in never-ending recovery process.
“Yet it is hard to tread water with someone on our back without drowning.” -Jeffrey Kottler
Jeffrey Kottler throughout his book “On Being a Therapist” sprinkles seeds of wisdom that will not only benefit the inexperienced therapist but the experienced therapist as well.
Kottler states that many in today’s therapeutic community regard therapy as little more than simple accountability and measured outcomes that are all held together in some limited time frame described as brief therapy.
Kottler believes that therapy is more than brief interchanges between a client and a therapist but an opportunity no matter how slight for the therapist to role model a positive influence on the client’s life.
Along with the relationship between client and therapist, Kottler shares in his book other challenges that confront today’s therapists such as:
increased diversification of client base
advances and changes in theory and technique
increased bureaucracy in health care
living in a stressed filled world.
These variables, along with the personal inner struggles professionally and personally that therapists are dealing with, makes the task of being productive in therapy in today’s world a daunting task.
Kottler believes that theories, prescribed rules, regulations and other therapeutic practices have their time and place and are in many ways helpful for the therapist, but he emphasizes that importance must still be placed on the client/therapist relationship.
Learned Along the Way
Another key point Kottler emphasizes is how the client and therapist change each other during therapy.
Kottler warns counselors to be wary of the destructive energy emanating from a patient that it can pollute the spirit of the healer (Kottler, 2003).
Kottler wonders whether Freud’s habit in counseling sessions to remain detached had more to do with preserving his own emotional safety than transference issues.
It is important not to fall into the same emotional trap that the client is experiencing but rather encourage the client to risk take and act more than reflect on their issues.
Key for the therapist is timing when the client is ready for the next step in the process of dealing with painful issues. Kottler felt that an error in judgment by the counselor could result in tragic consequences or at the least regressive backlash.
To Kottler, clients become our greatest teachers, who let us know what is working and what is not, that is, if we are paying close attention (Kottler, 2003).
Another interesting aspect of counseling shared by Kottler is learning to love someone unconditionally, non-possessively, non-sexually, with warmth, empathy and genuineness. He states that this experience can be exhausting.
Patients can test the patience of any therapist and that can affect how the therapist relates to the client.. In doing so, we tend to feel more comfortable working with people who are most like us.
But, Kottler states feeling too comfortable with a client can be dangerous. We tend at this point to limit our therapy to:
what worked well in previous cases
deal with issues that are not personally threatening
limit the challenges that the particular case can teach us.
Real learning and growth comes from learning to be flexible, when we are forced to use new therapy styles and realize, that in some cases, it is not the client’s antisocial or annoying behavior that is the problem but our own listless, lack of caring attitude being expressed to the client that is the center of the problem.
Kottler shares other important suggestions for a therapist in the midst of analyzing a client/therapist relationship:
determine whether the problem is with the client or with you
respect the purpose and function of resistance and client defenses
when feeling trapped, follow the principles of the “reflective practitioner”
do not try to cure the incurable
acknowledge that the client is operating under different rules from what you would prefer
remain as flexible as possible
educate yourself about clients who come from backgrounds that are beyond your experiences or comfort level; and
when all else fails, allow the clients to keep their dysfunctional behavior. Do what you can do no more and no less (Kottler, 2003).
When a therapist experiences a loss of motivation, energy, control and direction, Kottler said, these are conditions that could be as simple as boredom but left untreated, can turn into chronic, incurable and causation for a larger problem named burnout.
Kottler felt the single most common personal consequence of practicing therapy is not who will experience burnout but how long the next episode will last.
Kottler cautions that when a therapist can no longer deal with stress and/or symptoms of burnout he/she is more likely to engage in unethical conduct or to make decisions that will harm the client rather than help (Kottler, 2003).
He reminds the reader (therapists) that it is important to take care of yourself (burnout protector). He suggests the therapist needs to:
adjust expectations to realistic levels
break away as needed
not be afraid to use the concept of talking to oneself as you do to your clients
demonstrate that you take your own growth as seriously as you do that of your clients
The last chapters of “On Being a Therapist” consist of lies we, as therapists tell, alternative therapies we can use and ideas for furthering growth and creativity within. Kottler states that many of the negative personal consequences of being a therapist derive less from the pressures of clients, supervisors and work schedules but from not being true to oneself.
At times, Kottler believes that therapists have to put on a façade of confidence to instill confidence and motivation in the client.
Kottler shares what Milton Erickson was fond of saying that if you can pretend very convincingly, then clients will pretend to make changes in their lives. And when things go well, after a period of time, they will forget they are pretending (Kottler, 2003).
Not only does Kottler share the importance of being honest in one’s therapy, he also relates the idea of the importance of not becoming married to a particular theory. A therapist must be flexible not idealistic toward his/her client. If the therapist does not genuinely believe that the therapeutic tools for our profession can work for the client, then we have no business practicing them on anyone else (Kottler, 2003).
Lastly, Kottler shares that in the process of doing therapy we must regard ourselves as explorers. We teach others to discover uncharted territory, to learn survival skills and apply them in conditions of maximum stress.
We teach people about their limits and their capabilities. We help people take controlled risks, where much danger can be anticipated. But, we must never forget that we change as much as we change each client we see.
A wedding is an important life experience that takes a lot of time and effort to prepare for.
With all of the preparation comes stress that can lead to various consequences. Some partners lose their connection and question their proposal or acceptance of a proposal. Others become overwhelmed with constant decision making. Family, friends, wedding planners, and even partners can become additional sources of stress. Understanding that both partners have different perspectives on the celebration is essential to making sure preparations go smoothly.
Here are some ways to make sure stress does not affect the connection you have with your partner:
Remind each other why you wanted to get married in the first place.
Take the time to tell your partner what you love about them. Couples often overlook this, leading to one partner feeling under-appreciated.
Make mutual decisions.
In the beginning stages of a relationship there are decisions that can be made independently. There are also certain things that do not necessarily need to be shared with the other partner. This will change when the decision is made to enter into a marriage. Making decisions together from the early stages of wedding planning can prepare a couple for challenges that may lie ahead.
Mutually choose the caterer, colors, theme, motif, sponsors, officiating person, entourage, gowns, tuxes, guests, reception hall, and everything else. Men often prefer to have the ladies make decisions while they foot the bill. This strategy can often lead to disagreements where men are disappointed, especially because they paid for the thing they did not like. This source of stress and arguments can be minimized by making decisions together. It will also give partners a better idea of how they cope with decision making and show each individual’s point of view on an issue. Always include partners in decision making, never rush them into making a decision, and encourage participation.
Have a fire/water strategy.
When couples inevitably lose patience and argue, it is easy for them to start attacking each other. In cases such as these, avoid attacks as much as possible. If one partner is steaming, angry, and playing the role of fire, the other partner should not attack them. Instead, they should take time to cool off, avoid flaring up, and calm the angry partner. Simply getting them to a level where they can sensibly talk about the issue will do wonders. Do not avoid the argument, but slightly delay the discussion so both partners can rationally take part in it.
Take time to unwind.
Staying connected during the planning process is not just about making decisions, handling difficult situations, or reminding each other of the your love connection. Both of you should have fun while preparing for the wedding. Take time to withdraw from preparations and chill out. Plan a short vacation, play games, or participate in activities you both love. What matters is that you both enjoy the planning and the down time.
Ultimately, a marriage is a mutual decision between two people to spend the rest of their lives together. A wedding should be planned with a similar approach in mind. A couple should not feel forced to show their relationship off to the world. It is not just a special occasion that you should prepare for, but the first step both of you are taking in order to solidify your bond and take your relationship to the next level.
Your friend or family member asked you to be the best man at their wedding.
Whether you felt unsure or accepted immediately, your reaction is entirely normal. After all, it is a great honor that the groom has chosen you to take part in a very important stage of his life.
Here are some ways to ensure that you will be the best best man you can be at the wedding.
1. Assist in the Planning Process
Many couples choose to hire a wedding planner to take care of the planning process. Be sure you do not take away from the planner’s job, but try to be helpful. There may be some errands that need to be taken care of. Make yourself available to help the groom whenever necessary. This is especially important for fittings. Be sure you and the rest of the groomsmen have fittings done in a timely manner.
2. Plan the Bachelor Party
It is very common for the best man to plan the groom’s bachelor party. Ask the groom whether or not he would like to have one and when he is available. Include the other groomsmen in preparing, paying for, as well as hosting the party and be sure to invite guests that will make the party more enjoyable. Most importantly, try to keep the plans a secret and have a great time!
3. Attend the Wedding Rehearsal and Rehearsal Dinner
Most weddings have rehearsals ahead of time. Make sure you are able to attend because they cannot take place without you! The rehearsal dinner usually includes people who are very close to the family. You may be asked to give a toast, but try to save the actual speech for the day of the wedding.
4. Make Sure the Groom is Ready
It is important for the groom to be physically and emotionally ready for his wedding day. Be there for the groom as he dresses up for the event. He may be nervous about the ceremony for many different reasons. Your role is to keep him relaxed. Do not be discouraging or make offbeat jokes. Encourage him to talk about his stressors and keep him from being anxious. In addition, make sure he has everything he needs for the big day. For example, if the chauffeur does not show up, drive the groom to the ceremony.
5. Be Prepared for the Ceremony
Stay focused and remember what you did during the rehearsal. Depending on the country and place of worship, your place in the procession will vary, however, during the ceremony, you will probably be required to stand beside the groom. Be flexible and coordinate with the maid of honor so things run smoothly. The two of you can help each other sign the marriage certificate and complete other tasks, like ushering, that are needed for the ceremony.
6. Rock the Reception
There will be a program for the reception that includes your toast. This is your chance to shine. If you need help writing it, there are many websites available that can provide formats and examples.
7. Take Care of the Aftermath
Your role does not end after the reception. Help return rented clothing and any other items that require transportation.